Male GU Exam Flashcards
Inspection of the penis
- Hair pattern
- Circumcision status
- Foreskin-retractable and reducible
- Glans- note lesions or inflammation
- Urethal meatus- not the position and look for discharge
Medical indication for circumcision
Congenital phymosis- opening of the foreskin is very narrowed, can’t be retracted
Most reasons for circumcision
Parent preference
Balanitis
Inflammation of the glans, usually due to yeast
Hypospadius
Urethral opening on the underside of the penis.
Can occur anywhere along the shaft of the penis
Epispadius
urethra ends in an opening on the upper aspect (the dorsum) of the penis
What presents with purulent discharge
Gonorrhea
How to confirm for syphilis
Look for spirochettes
Dark field microscopy
Serology RPR
VRDL
Palpation of the penis
- Tenderness
- Induration (swelling and inflammation)
- nodularity
- Fibrous tissue
- Strip the urethra if the pt has had a discharge
Peyronie’s disease
Fibrous plaque that forms on the tunica albicans (buck’s fascia) on corpus cavernosum
- Associated with people on beta blockers
- Also get Duprytin’s contracture
- Can be debilitating, will cause the penis to bend- will make intercourse impossible
- Does not affect voiding
Inspection of the scrotum
- Inspect for rashes or ulceration
- Visible masses or asymmetry- may indicate scrotal mass or atrophy of a testicle
- Rugal pattern and median raphe
Palpation of scrotal contents
- Presence of 2 testicles
- Testicular size-shape, consistency
- Presence of extra-testicular masses
- Epididymis-size and tenderness
- vas deferens-swelling and tenderness
Testicular masses
Carcinoma
Hydrocele
Testicular tenderness
Orchitis
Torsion
Epididymitis
Tumor Hernia
Extratesticular masses
hernia
varicocele
epididymal cyst
What masses will transilluminate with light?
Hydrocele
Epididymal cyst
What should you look for if there is an absent vas deferens?
Need to do a b/l renal ultrasound
Could show an ipsilateral missing kidney
If you hear bowel sounds in the scrotum that indicates?
Hernia
What side is a varicocele most common?
Left
Hydrocele presentation
Non tender, mass contained within the scrotum
- Can be transilluminated
- May be present at birth or in the pediatric population
Inguinal hernia presentation
Nontender, mass that extends into the inguinal canal. Entire loop of bowel in there
- Usually u/l
- May or may not be able to transilluminate
Inspect the inguinal canal and femoral triangle for bulging
- Have pt perform a valsalva maneuver
- Unless the hernia is quite large, it is unlikely that you will detect it on inspection
Epididymitis presentation
- Exquisitely tender
- May have a history or dysuria
GRADUAL onset - Does not transilluinate
- Difficult to destinguish from orchitis
Testicular torsion presentation
- ABRUPT onset
- Usually early to mid teens, very severe pain
- Affect testicle is usually elevated in scrotum
Rapid diagnosis is essential –> testis will undergo necrosis within a few hours
varicocele presentation
Feels like a bag of worms on palpation
- Painless
- Very gradual onset
- Does not transilluminate
- May be b/l
Testicular cancer presentation
Painless, gradual onset
- Testicle may feel very hard and enlarged
- Does not transilluminate
Indirect inguinal hernia
Most common
- Hernia sac exits through the internal inguinal ring
- May pass with the cord toward and sometimes into the scrotum
Direct inguinal hernia
The hernia sac exits through a tear in the floor of the canal (transversalis fascia)
- Generally caused by straining
Femoral hernia
Hernia sac exits inferior to the inguinal ligament and into the femoral triangle
- More common in women than men but not the most common hernia in women
Inspection of the perianal area
- Fissures
- Fistulae
- External hemorrhoids
- Prolapsed internal hemorrhoids
- STDs
- Rectal prolapse
- Skin tags
External hemorrhoid
Sensory innervated- thrombosis causes pain
- May account for rectal bleeding
Internal hemorrhoid
No sensory nerve endings so they are painless
- Bleed more often than external and may bleed more profusely
Skin tags
Overgrowth of anal epithelium
- Very common, painless
Pale color differentiates them from hemorrhoids
Anal fissure
Tear in the anal mucosa
- Very painful
Common in people who are chronically constipated and strain moving bowels
Anarectal fistula
An abnormal tract between the rectum and perianal region
- Almost always caused by an abscess such as those found in Crohn’s disease
Cauliflower appearance
HPV
Appearance of HSV
Vesicles that ulcerate
- Usually causes pruritis and pain
Appearance of secondary syphilis
PAINLESS, usually asymptomatic
- Usually overgrowth of tissue in a chancrous shape
Appearance of anal cancer
- Squamous cell
- Generally painless until the surface becomes ulcerated
- Usually presents with bleeding so it is often ignored in people with hemmorrhoids
Rectal prolapse
Weakening of the floor of the pelvis usually secondary to multiple childbirths or age
- Rectum can prolapse through the anus
Size of prostate
4 cm in diameter and protrudes 1 cm into the rectum
