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GU Screening > Male GU > Flashcards

Male GU Flashcards

1
Q

What is in the ROS for male GU?

A

Urine first: Frequency of urination, urgency, hesitancy, retention
burning, pain with urination, polyuria, nocturia, hematuria, renal stones, reduced caliber of stream

Think Anatomy * Hernias, testicular pain or masses
penile discharge or lesions, STI’s and Tx’s, exposure to HIV, are you taking any precautions against HIV and STI’s?

Sexual interest, orientation, function -satisfaction/problems. What are your methods of contraception, ask about abuse

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2
Q

Why are men so difficult to communicate with?

A
  • males hesitate to speak
  • don’t feel comfortable
  • anxiety is high and unexpressed
  • they feel embarrassment
  • Gender and age may affect interactions.
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3
Q

What constitutes professional demeanour?

A
  • competence helps with patient trust confidence- or lack of it- can decrease or increase anxiety
  • Acknowledge- patient’s bodily responses
  • Always make patient comfortable
  • Ask permission before proceeding
  • Be respectful always,
  • make the pt feel at ease with bodily responses “its a normal process”
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4
Q

PMhx Screening, what are age appropriate questions?

A
  • Date of last prostate exam
  • Date of last PSA and result if known
  • Date of last testicular exam
  • Gardasil? Zostavax?
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5
Q

When obtaining a sexual history what can you ask?

A

Age of first coitus, number of sexual partners, how is your satisfaction? and problems? heamtospermia. Abuse, contraceptive/protection, privacy

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6
Q

When you ask questions make sure they are:

A

open ended.

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7
Q

Why is anxiety high an unexpressed in males about GU concerns?

A
  • They have anticipation of pain/discomfort
  • Lack knowledge about proc
  • previous bad experience with GU exam
  • “urban legends” from friends
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8
Q

Why are males reluctant to seek preventitive healthcare or acknowledge need of assistance?

A
  • access to health information is often limited: only look at media sources, internet, physician/clinician information available, go based off what family tell them.
  • health beahaviors often neglected
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9
Q

How can your build the relationship with your male patient?

A
  • ask open ended questions
  • Maintain non-judgmental, respectful attitude
  • Display tact, sensitivity, and humor when appropriate.
  • explain what you are doing as you are doing it
  • ask permission before proceeding
  • pt consent is essential for invasive proc
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10
Q

What is the patients attitude affected by?

A
  • cultural or religious beliefs
  • previous positive or negative experiences
  • what their friends tell them
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11
Q

What constitutes being sensitive towards your patient?

A
  • Give the pt privacy to dress and undress
  • Use drape to limit exposure
  • Allow patient to cover up after exam
  • Offer a tissue for cleaning.
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12
Q

Know anatomy for exam

A

Im not going to list it cause girl you know it :p

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13
Q

During a focused exam your are noting?

A
  • any external abnormalities
  • screening opportunity for testicular ca
  • detection of hernias, swelling, or masses.

Relate findings and discuss them immediately with your patient

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14
Q

Before beginning the GU exam you should?

A
  • explain the proc to the pt (diagrams or address pts concerns)
  • Chaperone always
  • Always wear gloves
  • Perform exam with proper lighting
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15
Q

How should you position the patient?

A

Have pt lay in front of you and YOU raise his gown to umbiliquis

  • note buldges or scars (herniation)
  • look for obvious penile/scrotal abnormalities
  • note any skin abnormalities on the penis, scrotum, or surrounding areas
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16
Q

How should you inspect the penis?

A
  • first retract the foreskin (note circumcised or uncircumsized)
  • Inspect glans (not inflamation, ulcers, nodules, or poor hygiene)
  • return the foreskin to its natural position
  • note location of urethral meatus (not discharge)
  • palpate the shaft
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17
Q

Inspecting the scrotum you examine what ?

A

The skin of the scrotum, contour, swelling or buldges, testicles, epididymus

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18
Q

How do you perform testicular palpation?

A

-Gently palpate the tissue of the testes between thumb and forefinger—-> each side should feel the same.
-Palpate from the epididymus to superficial inguinal ring
- If a testicle is missing, ask the pt why
surgically or cogenitally -> document why
- make not of an swelling, erythema, pain, nodules

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19
Q

Cremastor reflex

A

-elicitated by light stroke of the superior medial (inner) thigh activates sensory nerve L1, L2
Nml finding - rise and fall of scrotum

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20
Q

What diagnosis is associated with testicular ca?

A

cryptoorchidism

21
Q

What diagnosis is transilluminate?

A

The celes: hydrocele & spermatocele

22
Q

Varicocele are tender ? T or F

A

False, the diagnosis that are tender are epididymitis, torsion, anteverted epididymitus.

23
Q

The femoral canal lies _____ in relation to the inguinal ligament

A

below the inguinal ligament

24
Q

What are the three surrounding structures of the hasselback triangle

A
  • inferior epigastric (lateral)
  • rectus abdominus (medial)
  • inguinal ligament (inferior)
25
Q

What is the difference between indirect and direct inguinal hernias?

A

Indirect —> through canal can lead to necrosis of intestines
direct—> breaches posterior inguinal wall, passes medial to inferior epigastic vessels.

26
Q

How do you examine a hernia

A
  • use your right hand for the right side. Left for the left.
  • start low enough in the scrotom so your finger can reach far as the internal canal.
  • follow the spermatic cord upward to above the inguinal ligament and find the triangular slit like opening.
  • if you detect a diffuse swelling amidst the cord structure or note protuberance within the inguinal canal the pt has a hernia
27
Q

Have the pt bear down and cough

A
  • this manuever increases the abdominal pressure forcing the intestines/peritoneal fluid through any defect which may exist.
  • for femoral hernia place fingers at anterior thigh in the region of the femoral canal and ask the pt to bear down or cough.
28
Q

Incarcerated hernia are always tender? T or F

A

False can be both.

29
Q

Strangulated hernias are

A

tender, show sign of tenderness or not, but require urgent intervension.

30
Q

Common positions for the DRE include?

A

Modified lithotomy, left lateral position, standing flexed at hips

31
Q

Before starting the DRE

A
  • ask the pt if he feels stable and comfortable before proceeding
  • make sure lighting is sufficient
32
Q

To perform the DRE

A
  • glove both hands and spread buttocks apart
  • Inspect the sacrococcygeal and perianal areas (fissures, skin tags, hemorrhoids, bleeding, abscess draining)
  • palpate throughout the rectum and the prostate, noting masses or tenderness.
  • ask the pt about localized pain
  • place lubricant and inform pt you are going inside
  • talk through this part
  • place index finger against the anus ask pt to bear down as if trying to have BM.
33
Q

Palpate rectum

A

upwards, posteriorally, and laterally to feel for any rectal masses.

  • orient fingers so that it is towards the umbilicus.
  • In this position, your finger should be resting on the prostate
  • collect stool put on guiac card for occult blood
34
Q

What are possible rectal exam findings?

A

Nml rectal mucosa - feels uniformly smooth and pliable.
polyps may be attached by a stalk or base
masses or irregularly shaped nodules
areas of ununsual hardness
abscesses may be indicated by extreme tenderness
external hemorrhoids

35
Q

Prostate glands increase how many folds between puberty and age 20

A
  1. Consistency of the prostate gland is rubbery and smooth. Urge to urinate is nml
36
Q

By the 5th decade the prostate enlarges? T or F

A

true.

37
Q

Tabi ______

A

loves you <3

38
Q

A normal prostate consists of

A
  • about 2.5 cm from side to side
  • prominent median sulcus
  • consistency is rubbery and smooth
  • tenderness not usual but patient should feel urge to urinate when you palpate it.
39
Q

How would you examine the prostate?

A
  • Inform the pt first
  • Use the same techniques as DRE (perform prostate exam while doing DRE actually)
  • Sweep your finger over the prostate (found in anterior rectal wall)
  • Identify the two lobes with a longitudinal groove (median sulcus between them )
  • Note: size, nodularity, consistency, tenderness
40
Q

The best position the patient should be in during prostate exam is ?

A

Most easily performed when pt is in decubital or lithotomy position.

41
Q

What is abnormal findings in a prostate exam?

A

Boggy prostate- indicated inflammation

42
Q

Abscence of a prostate can indicate

A

Ca or radiation therapy

43
Q

What must you also not in the presence of an enlarged prostate?

A

Urinary bladder

44
Q

If a patient has suprapubic abdominal pain, a distended abdomen, or both must

A

examine the prostate.

45
Q

Concluding the prostate/rectal exam

A
  • inform pt you are withdrawing finger
  • note the color of any fecal matter on glove
  • use fecal matter for guiac
  • offer pt tissues for wiping
  • always remove gloves outside the sight of your patiet
  • allow pt to dress privately
46
Q

Patient education

A
  • when should the pt follow up?
  • Are you sending pt to specialist?
  • Are there screening exams needed?
  • When will the next physical exam be?
47
Q

Patient education in young males < 40

A
  • sexuality, including safe sex practices

- self-care including testicular exam

48
Q

patient education in older males > 40

A
  • Prostate and colorectal ca screening
  • sexual function, libido, arousal, ED
  • lower urinary tract symptoms that affect quality of life : incontinence, BPH

GU Screening (2 decks)

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