Male GU Exam - Stasio Flashcards
For the quiz know the types of hernias, congenital abnormalities and the infectious agents that cause STIs
Dr. Stasio
Tunica vaginalis
Serous membrane covering the testes.
Epididymis
Tightly coiled spermatic ducts on the posterior-lateral surface of each testicle. Storage of sperm.
Vas deferens
Cordlike tube, transports sperm from the epididymis to the urethra.
Spermatic cord
Contains the vas deferens, blood vessels, nerves and muscle fibers.
Prostate Gland
Size: approx. 3.0 cm x 3.5 cm Divided into five lobes: Anterior lobe Posterior lobe Middle lobe 2 Lateral lobes ***Posterior lobe most common for cancer.
Indirect hernia
Most common for both sexes. Herniates above the inguinal ligament, into the deep inguinal ring. Often can protrude into the scrotum (in males). MOST COMMON
Direct hernia
Less common, usually seen in males, rare in women. Above/medial to the inguinal ligament…rarely protrudes into the scrotum.
Femoral hernia
Least common type. More common in women than men. Below the inguinal ligament. Never into the scrotum.
Common GU complaints:
Pain Dysuria (painful urination) Changes in urine flow Red/bloody urine (hematuria) Penile discharge Penile lesions Genital rashes Frequency and urgency with urination Scrotal enlargement Groin mass or swelling Testicular mass Erectile dysfunction Infertility
GU exam: Inspection details
Skin – lesions or rashes. Hair – distribution. Lesions, infections, parasites. Prepuce or foreskin – if present, need to retract. Glans – ulcers, scars, rashes or signs of inflammation. Meatus – lesions or inflammation, discharge. Gently compress the glans to express any discharge from the urethral meatus. Also can “milk” or “strip” the penis. Can put the sample on a glass slide or send for culture.
STD lab tests
Chlamydia - WBC Gonorrhea - WBC with Gm(-) intracellular diplococcic
Trichomonas - WBC with moving organisms
GEN Probe - Chlamydia & GC (all of these are infections that “live” within the urethral meatus of the penis)
GU exam: Palpation
Palpate from the glans to the base. *Especially if there are any penile lesions. Note any tenderness, nodules, masses, inflammation. Palpate the inguinal areas for lymph nodes, masses, hernias or tenderness.
GU exam: Scrotum and contents
Inspection of the skin and scrotal contours. Palpation of the testes and epididymis (don’t want to feel a “hard pebble or rock”…sign of testis CA). Go down to palpate the spermatic cord.
Hernias
Proper technique for evaluating a hernia. Finger slides up the inguinal canal. Also palpate the inguinal areas. Ask the patient to cough or bear down.
Review types of hernias
What are the three different rectal exam positions?
Sim’s position (left lateral decubitius)
Modified lithotomy (table acts as stirrups)
Standing position and leaning forward (preferred for males)
Review of prostate examination
Palpation or Digital Rectal Examination (DRE):
Inform the patient of what is going to happen.
Lubricate your gloved index finger.
Place your finger pad on the external sphincter and ask the patient to relax the sphincter muscles.
Slowly roll and insert the finger as the sphincter relaxes as far as possible.
Prostate gland palpation
Prostate Gland – bi-lobed, heart shaped, consistency of a rubber ball. The inferior aspect of the posterior lobe is best palpated on DRE.
Note size, tenderness, consistency, nodules, etc.
Testicular Self-Examination
Best performed during or after a bath
or shower.
Examine each testicle with both hands.
Gently roll the testicle between the
thumbs and fingers.
Locate the epididymis on the posterior
surface of the testicle.
Follow up with a physician if you find any
lumps or tenderness.
Educate your patients.
What is important to do with patients having testicular concerns or with young male patients?
Educating them on how to do testicular self-examination
U.S. Preventive Task Force (USPTF)
Grade Definitions and Practice Suggestions
Review table
Prostate Cancer details
•Most common non-skin cancer.
•2nd leading cause of cancer death in men in the U.S.
•Screening tests:
–Digital rectal exam (DRE).
–PSA – more sensitive than DRE.
•PSA screening can detect some cases of prostate cancer. False Positives.
What is a PSA test?
Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter(ng/mL) of blood.
Testicular CA rating/recommendation?
Rating : D recommendation
Recommends against routine screening for testicular cancer.
Testicular CA screening (“won’t be tested on this”)
•Clinical considerations:
–Low incidence of testicular cancer and favorable outcomes make it unlikely that clinical testicular screening would provide health benefits.
–Most testicular cancers are discovered by patients or their partners, there is no evidence teaching young men how to examine themselves improves health outcomes.
Clinicians should be aware of testicular cancer as a possible diagnosis when young men present with suggestive signs and symptoms
(Dr. Stasio disagrees with this!)
Hypospadias
Congenital displacement of the urethral meatus on the inferior surface of the penis along the urethral groove.
Important in a new born exam. Associated with congenital renal abnormalities.
Phimosis
Where the foreskin cannot be retracted over the penis.
Very painful with an erection.
Hygiene issues.
Treatment = circumcision.
Paraphimosis
Foreskin cannot be retracted back over the glans (opposite of phimosis).
Treatment = circumcision.
Hydrocele
Fluid filled mass within the tunica vaginalis.
Transilluminates with a light.
Usually will resorb on its own.
What is cryptorchidism? What are you at an increased risk for if you have this condition?
An undescended testicle…usually atrophied. **Increased risk for cancer. **
*Causative organism of primary syphilis?
Treponema pallidum
Primary Syphilis details
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA - ABS is positive or Dark Field Microscopy (confirmatory test).
Secondary Syphilis
Any unexplained rash on the body, palms of the hands and soles of the feet.
“Think Syphilis”
Clinical considerations of Syphilis
–Primary and secondary syphilis reported in the U.S. = 2.4 cases/100,000.
–Congenital syphilis = 11.1 cases/100,000 live births.
–Laboratory tests:
•Non-treponemal tests (common false positives)
–RPR (Rapid Plasma Regain)
–VDRL (Venereal Disease Research Lab)
•Confirmatory tests
–FTA-ABS (fluorescent treponemal antibody absorbed)
–TP-PA (T. pallidum particle agglutination)
–Dark field microscopy
Dark field microscopy with spirochetes image
Chancre of primary syphilis image
Syphilis screening rating
•Rating: A recommendation
Strongly recommends screening patients at increased risk for syphilis infection.
•Rating: A recommendation
Strongly recommends screening all pregnant women for syphilis infection.
•Rating: D recommendation
Recommends against routine screening of asymptomatic patients who are not at increased risk.
High Risk Sexual Behavior
•Assessment of risk:
–All sexually active persons 24 years old and younger.
–Previous history of other STD.
–New or multiple sexual partners.
–Inconsistent condom use.
–Exchanging sex for money or drugs.
–Early onset of sexual activity.
Genital Herpes
**Painful **cluster of small vesicles, can be burning in quality.
Progress to ulcers on a erthymic base.
Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 – causative organism
Herpes Clinical Considerations
- Primary infection – painful lesions, lymphadenopathy, fever, malaise.
- Recurrent infections – localized lesions and less symptoms.
- Viral shedding is usually asymptomatic.
** -Pregnant women can vertically transmit HSV to the infant during birth (absolute indication for C-section).**
- Serological testing can differentiate between HSV-1 and HSV-2.
- Viral culture of vesicle fluid can confirm active infection (best to confirm).
- Treatment – acute and suppressive therapy.
Herpes screening rating
Rating: D recommendation
Strongly recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic adolescents and adults.
There is no evidence that screening asymptomatic adults with serological tests for HSV antibody improves the health outcomes or symptoms or reduces the transmission of the disease.
Venereal Warts
**(Condyloma acuminatum) - caused by HPV (human papillomavirus. ** Grow in clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.
Genital Scabies
Genital Scabies:
- Contagious disease caused by a mite (Sarcoptes scabiei)
- Direct skin contact.
- Nocturnal pruritus is very characteristic progressing to intense pruritus (itchiness).
- Linear, curved or s-shaped burrows.
- Diagnosis: clinical suspicion, slide mount preparation.
- Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
Gonococcal vs Nongonococcal Urethritis
Gram-negative intracellular diplococci?
Gonorrhea
NGU?
Non-gonococcal urethritis (chlamydia)
Differences between Gonococcal and Nongonococcal Urethritis?
