Male GU exam

Question 1

Prostate gland

Answer 1

5 lobes

anterior, posterior, middle and 2 lateral
Posterior lobe most common for cancer (what you are feeling)

Question 2

types of hernia

Answer 2

indirect: MOST COMMON FOR BOTH SEXES
direct: less common, mostly male
Femoral: leas common, more common in women, below the ligament, never into scrotum

Question 3

Testicular self exam

Answer 3

testicular cancer is a disease of young men

teach self-exam

examin each testicles with both ands, gently roll the testicle b/w the thumbs and fingers

locate the posterior surface of the testicle
f/u with PCP

Question 4

Prostate cancer

Answer 4

most common non-skin cancer

2nd leading COD in men

DRE and PSA ( can get false positives)

Question 5

hypospadia

Answer 5

urethra during development ends up on the ventral side of the penis

**important in newborn exam, it is associated with renal abnormalities

Question 6

Phimosis

Answer 6

cannot retract the foreskin back

very painful, with erection, prone to infection

generally in adolescents

tx= circumcision

Question 7

paraphimosis

Answer 7

foreskin is stuck behind the blanx

very painful

tx= circumcision

Question 8

hydrocele

Answer 8

fluid filled mass w/in the tunica vaginalis

transilluminates with light

Question 9

cryptorchidism

Answer 9

undescendind testisticle

increased risk for cancer, usually atrophied

esp check in 4-5 yo

Question 10

Syphilis

Answer 10

syphilitic Chancre, erosion or ulcer, non tender

enlarged inguinal nodes

test with dark field microscope

• Treponema Pallidum is causative agent
  tests: Non-treponemal tests (RPR, VDRL) common for false positives

confirmatory tests: test directly for T. pallidum

**recommends against routine screening of asymptomatic pt who are not at increased risk

Question 11

secondary syphilis

Answer 11

any unexplained rash on body, hands or feet, think syphilis

Question 12

genital herpes

Answer 12

**cluster of painful small vesicles

Herpes 1 or 2

**can vertically transmit b/w mother and child during birth: NEED TO DO C SECTION

Do a viral culture (open up vesicle), don’t do serology-i.e. dont need to differentiate b/w HSV1 and HSV2

treatment is suppressive not curative

Question 13

Venereal warts

Answer 13

caused by HPV

grow in clusters

difficult to treat: cryosurgery, lasers, etc.

Question 14

DRE positions

Answer 14

Sims: laying in Left lateral decubitus
Modified Lithotomy: bed bound pt. legs spread
Standing and leaning forward

Question 15

high risk sexual behavior

Answer 15

all sexually active persons under 24 yrs 
previous hx of STD
new or multiple partners
inconsistent condom use 
exchange of sex or drugs 
early onset of sexual activity

Question 16

Genital scabies

Answer 16

contagious disease caused by mites
passed thru direct skin contact

nocturnal pruritus ___> intense pruritus

linear or S shaped burrows
dx with slide mount
tx= Permethrin cream (Eliminate, oral steroids, antihistamines)

Question 17

Gonococcal urethritis

Answer 17

Purulent discharge= gonorrhea, gram neg intracellular

3-5 day incubation
abrupt onset
burning pee

Question 18

non-gonococcal urethritis

Answer 18

7-28 day incubation 
gradual onset 
smarting feeling during urination 
mucoid or purulent discharge
polymorphonuclear leukocytes 

**Chlamydia