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PCM II > Male GU and Prostate Exam > Flashcards

Male GU and Prostate Exam Flashcards

1
Q

The three columns of vascular erectile tissue are:

A
  1. corpus spongiosum
  2. corpora cavernosa x2
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2
Q

Corpus spongiosum contains what?

A

Urethra

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3
Q

Glans

A

the cone shaped end of the penis

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4
Q

Prepuce (foreskin)

A
  1. Covers the glans
  2. is present on uncircumcised males
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5
Q

Urethral meatus

A

A vertical slit-like opening at the tip of the glans

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6
Q

Scrotum

A

pouch that contains the testes

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7
Q

Tunica vaginalis

A

serous membrane covering the testes

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8
Q

Epididymis:

  1. Definition
  2. Function
A
  1. tightly coiled spermatic ducts on the posterior-lateral surface of each testicle
  2. Stores sperm
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9
Q

Vas deferens

  1. Definition
  2. Function
A
  1. cord-like tube
  2. transports sperm from the epididymis to the urethra
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10
Q

Spermatic cord contents (4)

A
  1. vas deferens
  2. blood vessels
  3. nerves
  4. muscle fibers
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11
Q

Prostate gland:

  1. # /name of lobes
  2. Characteristics
A
  1. 5 lobes-Anterior, posterior, middle, lateral x2
  2. heart shaped, consistency of a rubber ball (Clinical Correlate: Posterior lobe most common for cancer)
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12
Q

Indirect Hernia

  1. Location of swelling?
  2. Scrotal Involvement?
  3. Commonality?
  4. Bilateral?
  5. Where is it palpated?
A
  1. above inguinal ligament, enters through deep ring, exits at superficial ring
  2. commonly
  3. most common for both sexes
  4. 1/3
  5. at tip of finger in inguinal canal
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13
Q

Direct Hernia

  1. Location of swelling?
  2. Scrotal Involvement?
  3. Commonality?
  4. Bilateral?
  5. Where is it palpated?
A
  1. above inguinal ligament, directly behind and through superficial ring
  2. rarely into scrotum
  3. less common (usually men, rare in women)
  4. ~1/2
  5. at side of finger in inguinal canal
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14
Q

Femoral Hernia

  1. Location of swelling?
  2. Scrotal Involvement?
  3. Commonality?
  4. Bilateral?
  5. Where is it palpated?
A
  1. below the inguinal ligament
  2. never into scrotum
  3. least common (women > men)
  4. rarely
  5. not felt in inguinal canal; mass below inguinal canal
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15
Q

Male GU Hx-Common Complaints (13)

A
  1. Pain
  2. Dysuria (painful urination)
  3. Changes in urine flow
  4. Red urine (hematuria)
  5. Penile discharge
  6. Penile lesions
  7. Genital rashes
  8. Frequency and urgency with urination
  9. Scrotal enlargement
  10. Groin mass or swelling
  11. Testicular mass
  12. Erectile dysfunction
  13. Infertility
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16
Q

Components of the Physical Exam (5)

A
  1. Penis
  2. Scrotum and its contents
  3. Hernias
  4. Prostate examination
  5. Special techniques
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17
Q

Inspection of the penis: 5 areas and what you’re looking for in each area

A
  1. Skin-lesions and rashes
  2. Hair-distribution, lesions, infections, parasites
  3. Prepuce (foreskin)-if present, retract
  4. Glans-ulcers, scars, rashes, signs in inflammation
  5. Meatus-lesions, inflammation, discharge
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18
Q

Palpation of the penis

  1. Direction
  2. Things to note (4)
A
  1. Glans to base
  2. Note tenderness, nodules, masses, inflammation
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19
Q

Palpate inguinal areas for (4)

A
  1. lymph nodes
  2. masses
  3. hernias
  4. tenderness
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20
Q

Proper technique for evaluating a hernia (3 steps)

A
  1. Finger slides up inguinal canal
  2. Palpate inguinal areas
  3. Ask patient to cough or bear down
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21
Q

Scrotum and Contents

  1. Inspection (2)
  2. Palpation (3)
A
  1. skin, scrotal contours (incl. underneath and perineal areas)
  2. testes (rock-like feel may indicate testicular cancer), epididymis, spermatic cord (smooth, ropy, size of pinky, spermatocele [hard nodule, rock-like feel–>ok])
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22
Q

Positions to examine the Prostate (3)

A
  1. Sim’s position or left lateral decubitus
  2. Modified lithotomy (supine, hips slightly abducted knees flexed, no stirrups)
  3. **Standing position and leaning forward (puts prostate directlly below finger)
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23
Q

Digital Rectal Exam (5 Steps)

A
  1. Inform the patient of what is going to happen
  2. Lubricate your gloved index finger
  3. Place your finger pad on the external sphincter and ask the patient to relax the sphincter muscles
  4. Slowly roll and insert the finger as the sphincter relaxes as far as possible
  5. Palpate posterior lobe of prostate through anterior wall of rectum
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24
Q

Prostate exam: Things to note (4+)

A
  1. size (~walnut)
  2. tenderness
  3. consistency (rubber ball)
  4. nodules (bi-lobed, but feels smooth not lumpy; no hard pebbles/peas)

etc?

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25
Q

Testicular Self-Exam (Special Techniques)

  1. Perform when?
  2. Steps (4)
  3. As a physician you should…
A
  1. during or after bath/shower
  2. (a) Examine each testicle with both hands (b) Gently roll the testicle between the thumbs and fingers (c) Locate the epididymis on the posterior surface of the testicle (d) Follow up with a physician if you find any lumps or tenderness
  3. EDUCATE YOUR PATIENTS!
26
Q

Prostate Cancer

A
  • Most common non skin cancer
  • 2nd leading cause of cancer death in US men (lung is 1st)
27
Q

Prostate Cancer Screening Tests (2)

A
  1. Digital Rectal Exam (DRE)
  2. Prostate Specific Antigen (PSA)-(more sensitive than DRE, can give false positives-prostatic hypertrophy, etc)
28
Q

Hypospadias:

  1. Definition
  2. Important to check when?
  3. Associated with?
A
  1. congential displacement of the urethral meatus on the inferior surface of the penis along the urethral groove
  2. New born exam
  3. Congenital renal abnormalities

**contraindication for circumcision bc use foreskin in surgical repair

**epispadias on superior side of penis

29
Q
A

Hypospadias

30
Q

Hypospadias (4 Types)

A
  1. Glanular
  2. Coronal
  3. Penile Shaft
  4. Perineal
31
Q

Phimosis

  1. Definition
  2. Treatment
  3. Other (2)
A
  1. foreskin cannot be retracted over the penis
  2. circumcision
  3. very painful with an erection; hygeine issues
32
Q
33
Q

Paraphimosis

  1. Definition
  2. Treatment
A
  1. foreskin cannot be retracted back over the glans (to cover it)
  2. circumcision

**opposite of phimosis

34
Q
A

Paraphimosis

35
Q

Hydrocele

  1. Definition
  2. Other
A
  1. fluid filled mass within the tunica vaginalis
  2. transilluminates with a light (otoscope light underneath scrotal sac, light diffuses in fluid and lights up scrotal sac)

**many times will resorb on its own

36
Q
37
Q

Cryptorchidism

  1. Definition
  2. Other (2)
A
  1. undescended testicle
  2. usually atrophied

*pull down and tack to bottom of scrotum to prevent –> increased risk for cancer

38
Q
A

Cryptorchidism

39
Q

Treponema pallidum

A

organism that causes syphilis

40
Q

Syphilitic Chancre-Primary Syphilis

  1. Definition
  2. Associated
A
  1. painless round or oval erosion or ulcer
  2. non-tender enlarged inguinal lymph nodes are common
41
Q
A

Syphilitic Chancre (Primary Syphilis)

42
Q

Secondary Syphilis

A

Any unexplained rash on the body, palms of the hands and soles of the feet

43
Q

1 (2)

Syphilis Lab Tests (2 categories-5 total tests)

A
  1. Non-treponemal tests (common false positives)
    (a) Rapid Plasma Regain
    (b) Venereal Disease Research Lab
  2. Confirmatory Tests
    (a) fluorescent treponemal antibody absorbed
    (b) T. pallidum particle agglutination
    (c) dark field microscopy
44
Q
A

Secondary Syphilis

45
Q
A

Dark field microscopy with spirochetes (confirmed diagnosis of syphilis)

46
Q

Recommendations regarding syphilis

  1. 2 groups strongly recommended for screening
  2. group (non-specific) recommended against routine screening
A
  1. anyone at increased risk for infection; all pregnant women
  2. asymptomatic patients NOT at increased risk of infection
47
Q

High Risk Sexual Behavior (6)

A
  1. All sexually active persons 24 years old and younger
  2. Previous Hx of other STD
  3. New or multiple sexual partners
  4. Inconsistent condom use
  5. Exchanging sex for money or drugs
  6. Early onset of sexual activity
48
Q

Genital Herpes

  1. Definition
  2. Diagnosis
  3. Causitive Organism
A
  1. cluster of small vesicles, burning and painful which progress to ulcers on an erthymic base
  2. viral culture fo the vesicle fluid
  3. Herpes simplex virus 1 and 2
49
Q
A

Genital Herpes

50
Q

Genital Herpes (Clinical considerations) (5)

A
  1. Primary infection
  2. Recurrent infections
  3. Pregnant women
  4. Serological Testing
  5. Treatment
51
Q

Genital Herpes Primary Infection Symptoms (4)

A
  1. painful lesions
  2. lymphadenopathy
  3. fever
  4. malaise
52
Q

Genital Herpes Recurrent Infections (3)

A
  1. localized lesions
  2. less symptoms than primary infection
  3. viral shedding is usually asymptomatic
53
Q

Genital Herpes-Pregnant Women

A

Can transmit virus to infant during birth

indication for C-section

can cause herpatic encephalitis of baby –> death

54
Q

Genital Herpes-Serological testing

A

can differentiate between HSV-1 and HSV-2

55
Q

Genital Herpes-Treatment

A

acute and suppressive therapy

56
Q
A

Venereal Warts

57
Q

Venereal Warts

  1. Alternate name
  2. Causative organism
  3. Treatment
A
  1. Conduloma acuminatum
  2. HPV (human papillomavirus)
  3. Difficult to treat-cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara (imiquimod), surgery
58
Q

Genital Scabies

  1. Causative organism
  2. Transmitted how?
  3. Characterized by (2)
  4. Diagnosis
  5. Treatment
A
  1. Sarcoptes scabiei
  2. Direct skin contact
  3. Nocturnal pruritus progressing to intense pruritus; linear, curved, or “s” shaped burrows
  4. clinical suspicion, slide mount preparation in oil
  5. permethrin cream, Lindane; oral steriods or antihistamines for pruritus
59
Q
A

Genital Scabies

60
Q

Gonorrhea

  1. Incubation period
  2. Onset
  3. Dysuria
  4. Discharge
  5. Gram stain of discharge
  6. AKA
A
  1. 3-5 days
  2. abrupt
  3. burning
  4. purulent
  5. Gram-negative intracellular diplococci
  6. Gonococcal Urethritis
61
Q

Chlamydia

  1. Incubation period
  2. Onset
  3. Dysuria
  4. Discharge
  5. Gram stain of discharge
  6. AKA
A
  1. 7-28 days
  2. gradual
  3. smarting feeling
  4. mucoid or purulent
  5. Polymorphonuclear leukocytes
  6. Nongonoccoal urethritis
62
Q
A

Purulent discharge of gonorrhea

PCM II (4 decks)

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