Male GU

Question 1

The shaft of the penis is formed by 3 columns of vascular erectile tissue, what are the three layers?

Answer 1

Corpus spongiosum, containing the urethra and forms the bulb of the penis
Two corpora cavernosa

Question 2

The urethra opens into the vertical, slit like structure called

Answer 2

urethral meatus

Question 3

What testes typically lies lower?

Answer 3

The left testis

Question 4

What is the tunical vaginalis?

Answer 4

serous membrane covering the testis, except posteriorly

Question 5

The epididymis is a reservoir for

Answer 5

storage, maturation, and transport of sperm

Question 6

What is the vas deferens?

Answer 6

A cordlike structure, beginning at the tail of the epididymis

Question 7

What are the groin landmarks?

Answer 7

Anterior superior iliac spine
Pubic tubercle
Inguinal ligament

Question 8

What lobes of the prostate are palpable?

Answer 8

Only the lateral lobes and median sulcus, can not feel the anterior or central areas of the prostate

Question 9

When should you ask about sexual history in men?

Answer 9

New patient comprehensive visit; annual check
Patients with chronic illness/medications
Major life cycle events (puberty)
Major surgical procedures

Question 10

At what time during the medical visit do you ask about sexual history?

Answer 10

When it makes the most sense to do so

Question 11

When speaking to patients about sexual history should you use medical words for body parts?

Answer 11

Yes, avoid slang

Question 12

What are the 5 P’s of sexual history?

Answer 12

Partners
Practices
Protection from STI’s
Past history of STI’s
Prevention of pregnancy

Question 13

What are the specific ROS questions for men?

Answer 13

Are you able to get an erection?
Are you able to maintain an erection?
Are your erections firm enough for intercourse?
Do you wake up with an erection?
Any problems with ejaculations?
Discharge from penes, sores, or ulcers?
Testicular pain?
Infertility, use of contraception?
Protection against STI?

Question 14

According to the AAP a chaperone should be present for all pediatric GU exams, if the patient or parent/guardian refuses what is the appropriate response?

Answer 14

The patient or parent should be give alternatives, including seeking care elsewhere as a chaperone needs to be present

Question 15

Is it common for a man to get an erection during the exam?

Answer 15

No, it is not common but can happen. If it does, stay professional and consider saying it is normal for it to happen while continuing to be professional.

Question 16

What is smegma?

Answer 16

White, cheesy material that can accumulate under the foreskin (normal)

Question 17

What is the process for palpating the testis?

Answer 17

Palpate each one handed, between the thumb and first 2 fingers

Question 18

What are common sites for hernias?

Answer 18

Umbilical
Groin- Inguinal
Femoral (more common in females)

Question 19

What does it mean when a hernia is reducible?

Answer 19

Organ (bowel) can be pushed back into the correct location

Question 20

What does it mean when a hernia is incarcerated?

Answer 20

Organ or part of the organ is trapped and can’t be pushed back (irreducible)

Question 21

What does it mean when a hernia is strangulated?

Answer 21

Loss of blood supply to the trapped part of the organ

Question 22

Where do direct inguinal hernias occur?

Answer 22

Begin above inguinal ligament near pubic tubercle and external inguinal ring (within Hesselback’s triangle), often due to weakness in floor of the inguinal canal

Question 23

Where do indirect inguinal hernias occur?

Answer 23

Begin above inguinal ligament near its midpoint (internal inguinal ring) that travels through the inguinal canal and into the scrotum

Question 24

Is the patient typically standing or laying down during the examination for hernias?

Answer 24

Standing

Question 25

If you suspect a scrotal mass, ask the patient to lay down and if it is hernia what should happen?

Answer 25

The mass should disappear, if the mass remains listen to mass with stethoscope for bowel sounds (if heard then it is hernia)

Question 26

When transilluminated and a red glow is observed is it hernia?

Answer 26

Probably not

Question 27

What is the normal documentation for the genital physical exam?

Answer 27

Circumcised male. No penile discharge or lesions. No scrotal swelling. Testes descended bilaterally, smooth, and without masses. Epididymis non-tender. No inguinal or femoral hernias.

Question 28

What is the normal documentation for the rectal physical exam?

Answer 28

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Prostate smooth, non-tender and without enlargement or nodules. Median sulcus palpable. Stool brown, negative for occult blood.