Male Genitourinary Exam Flashcards
What is the shaft of the penis made of
3 columns of vascular erectile issue (2 corpus cavernosum and spongiosum)
Corpus spongiosum contains ______ and forms _______
the urethra, the bulb
The shaft is composed of ______
2 corpus cavernosum
Foreskin aka _______
prepuce
Scrotum is divided into two pouches and each contain
a testis
The testes are _______cm long
4.5cm
Which testicle lies lower
Left usually lower than the right
The function of the testes are to
make sperm and testosterone
Serous membrane covering the testis, except posteriorly
Tunical vaginalis
Epididymis is located on the ___________ surface
posteriolateral
What is within the epididymis
storage, maturation, transport of sperm
The epididymis can be confused for
a mass
Cordlike structure, beginning at the tail of the epididymis
Vas deferens
Epididymitis can be confused for
testicular torsion
The vas deferens is part of the
spermatic cord
Where does the vas deferens pass through
external inguinal ring
What does the seminal vesicle produce and where does it enter
seminal fluid, prostate gland
Anterior superior iliac spine (ASIS)
pubic tubercle
inguinal ligament
landmarks of the groin
Inguinal canal lies
above and parallel to the intgional ligament
The inguinal canal forms a tunnel for the
vas deferens
Exterior opening of inguinal canal
external intgional ring
Internal opening of inguinal canal
Internal inguinal ring
Where does the GI canal terminate
rectum and anus/anal canal
What two muscles hold the anal canal in position
the voluntary external anal sphincter and involuntary internal anal sphincter
Where does the angle of the anal canal lies roughly
between the anus and umbilicus
What nerves supply the anal canal
somatic sensory nerves
What demarcates the anal canal from the rectum
serrated line
Boundary between somatic and visceral nerve supplies
anorectal junction
The rectum serves as
storage for stool
The prostate is located
against the anterior rectal wall
What is the shape of the prostate
Rounded, heart shaped, size of a walnut (like a peach)
Anatomical lobes of the prostate
anterior, median, right lateral, left lateral
What are the only palpable lobes of the prostate
lateral lobes (right and left) and median sulcus
Zones of the prostate
Central- around ejaculatory ducts
Transitional- surrounds the urethra
Peripheral- located posteriorly
When do you do a sexual history
new patient comprehensive
annual check
patients with chronic illness/medications
major life cycle events
major surgical procedures
When do you ask men about their sexual history
social history during relationships
5Ps of sexual history
Partners: number of partners
Practices: risk assessment
Protection from STI
Past history of STI
Prevention of pregnancy
Are you able to get an erection, maintain an erection, erections firm enough for intercourse, morning wood, problems with ejaculation
discharge from penis, sores, ulcers
testicular pain, testicular masses, pain in the scrotum
use of contraception, infertility
protection against STI
Specific ROS of questions for men
Pediatric male genital exam
always be with a guardian or chaperone
Adolescent or young adult male genital exam
palpation of anorectal or genital areas a chaperone is recommended
Male GU exam is usually saved for
last
best to have the patient standing and the examiner
sitting
Proper clothing attire for male GU exam
gown on and remove underwear
What happens if a dude gets a boner during the exam
stay professional and unflustered, “it is normal for that to happen” and continue the exam in a professional way
Inspect the skin, ventral and dorsal surfaces
inspect the foreskin
inspect the glans
inspect the urethral meatus
palpate for any induration (not usually done in asymptomatic patient)
examination of the penis
Smegma
white, cheesy material that can accumulate under foreskin (normal)
How do you inspect for discharge
compress the urethral meatus slightly to look for discharge
How do you palpate the testis
one handed: between thumb and first 2 fingers
Two handed: cradle the testicle at both poles in the thumb and fingertips of both hands
What are you assessing for with testicle exam
size, shape, consistency, presence of nodules, tenderness
What should testicles feel like
firm but not hard, non-tender and no masses
What does the epididymis feel like with palpation
feels like a cord and is a bit nodular
What does the vas deferens feel like with palpation
firmer and wire-like compared to the rest of the spermatic cord
Where do you palpate the epididymis and the spermatic cord
posteriorly
protrusion, bulge or projection or an organ or a part of an organ through the body wall that normally contains it
hernia
what are common sites for hernias
umbilical
groin
inguinal (more common in males) direct or indirect
femoral (more common in females)
Reproducible hernia
organ (bowel) can be pushed back into the correct location
incarcerated hernia
organ or part of the organ is trapped and can’t be pushed back (irreducible)
strangulated hernia
loss of blood supply to the trapped part of the organ
What hernia are women more likely to get
femoral hernia
Femoral hernia
least common, come through the femoral ring and start below the inguinal ligament and never travel to the scrotum
How do femoral hernias present
40% present as emergencies with incarceration or strangulation
Hesselbach’s triange
Rectus abdominis
Inferior epigastric artery and vein
Inguinal canal
Inguinal hernias are located
above the inguinal ligament and extend below it
Direct inguinal hernia
less common, usually in men >40
begin above inguinal ligament near public tubercle and external inguinal ring (within Hesselbach’s triangle)
Often due to a weakness in floor of the inguinal canal
OUTSIDE PUSHING ON CANAL
Indirect inguinal hernia
most common, occurs in all ages and both genders
begin above inguinal ligament near its midpoint (internal inguinal ring) and travel through the inguinal canal and into the scrotum
GOES INTO SCROTUM
What does turning head and cough do
increase abdominal pressure
Examine for a hernia the patient should be
standing
Where are you palpating for a hernia
external inguinal ring
If a scrotal mass disappears after a patient lies down
it is a hernia
If a scrotal mass remains after a patient lies down you need to
listen to it for bowel sounds
transilluminate it, if a red glow, likely not a hernia
When do you do a rectal and prostate exam
colon cancer screening, evaluating GU symptoms, possible GI bleeding
50 with discussion
What are the 2 positions for rectal exam
patient standing; lean forward and rest on exam table with hip flexed
Patient lying on the side with knees and hips flexed
How do you do a rectal exam
separate the cheeks of the buttocks, inspect peri-anal area, digital rectal exam (wait for sphincter to relax- assess for tone, tenderness, irregularity and nodules)
)The rectal exam will be _______ but not ________
uncomfortable, painful
During the digital rectal exam you should insert your finger
as far as possible, rotate clockwise and counterclockwise
stool moves, masses do not
USPSTF Recommendation for prostate cancer screening
Men aged 55-69 years C
Men over 70 D
If a hemorrhoid is below the dentate line It will tend to be
painful
