Male GU

Question 1

Description of BPH on DRE

Answer 1

Enlarged but smooth prostate

Question 2

S/sx of BPH

Answer 2

Oliguria/anuria, nocturia, frequency, weak stream

Question 3

Prostate cancer on DRE

Answer 3

Asymmetric, firm and nodular

Question 4

S/sx of prostate cancer

Answer 4

Asymptomatic unless severe progression, then you can see voiding symptoms

Question 5

Prostatitis on DRE

Answer 5

“Boggy” (aka soft) prostate, painful for pt to perform exam

Question 6

S/sx of prostatitis

Answer 6

Presents similarly to a UTI – dysuria, frequency, +//- urethral discharge, perineal pain like “sitting on a golf ball”

Question 7

Presentation of the different types of incontinence?

Answer 7

Stress – micturition after stress inducing event/event that increase intraabdominal P (laughing, coughing, etc.), leakage during valsalva

Urge – sudden urge to urinate

Overflow – urine retention then subsequently leads to urge to urinate

Question 8

Direct inguinal hernia

Answer 8

Passes directly through Hesselbach’s triangle, medial to the inferior epigastric artery, and into the abdominal wall

If palpable, typically feel bulge on the SIDE of your finger

More associated with stress/straining

Question 9

Indirect inguinal hernia

Answer 9

Passes through the inguinal canal and travels into the scrotum, lateral to the inferior epigastric artery

If palpable, typically feel bulge on TIP of your finger

More congenital association

Question 10

Scrotal hernia

Answer 10

Scrotal mass that can return to the abdomen while pt lays down!

Question 11

Hypospadis vs epispadias

Answer 11

Hypospadias – urethral opening on ventral surface (more common)
Epispadias – urethral opening on dorsal surface
Both – present with atypical stream

Question 12

Balanitis presentation

Answer 12

Distal penile pain
Pruritus
Rash on glans penis

Question 13

Phimosis versus paraphimosis

Answer 13

Phimosis - unable to retract foreskin distally
Paraphimosis - unable to reposition foreskin after initial distal retraction

Question 14

Male GU red flag physical exam findings

Answer 14

Saddle anesthesia
Acute loss of bowel/bladder control
Painless hematuria
Testicular mass, especially if painful

SEND THESE PATIENTS TO THE ER!

Question 15

Which disease process is Prehn’s sign and cremasteric reflex negative in?

Answer 15

Testicular torsion –> surgical emergency

Question 16

True or false: testicular cancer is always painless

Answer 16

F – some pts report a heaviness/achiness

Question 17

What is the most important thing to r/o if a pt is presenting with sudden onset testicular pain?

Answer 17

Testicular torsion – r/o with a doppler US of the scrotum

Question 18

Difference in discharge between gonococcal and non-gonococcal urethritis?

Answer 18

Gonococcal - yellow discharge
Non-gonococcal - clear/white discharge

Question 19

Symptoms of chlamydia assuming pt is not asx

Answer 19

Discharge, dysuria

Question 20

Presentation of genital warts

Answer 20

Painless papules or plaques, raised or flat, throughout the genital area

Question 21

HSV presentation

Answer 21

Painful blisters/vesicles on penis

Question 22

Chancroid presentation

Answer 22

Deep, non-indurated, PAINFUL ulcer

Question 23

Syphilis presentation

Answer 23

Single PAINLESS ulcer that typically self resolves

Neurologic sx if t remains untreated after initial development of ulcer

Question 24

Description of a typical epididymis on physical exam

Answer 24

Cordlike, nodular and in posterior aspect of scrotum