Male GU Exam (stasio-8) Flashcards by Marina Mesiha

three columns of vascular erectile tissue

corpus spongiosum

copora cavernosa X2

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glans

cone shaped end of penis

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prepuse/foreskin

present on uncircumcised males

covers glans

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urethral meatus

vertical slit opening at top of glans

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scrotum

pouch containing testes

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tunica vaginalis

serous membrane covering testes

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epididymis

tightly coiled spermatic ducts on posterolateral surgace of each testicle
stores sperm

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vas deferens

cordlike tube

transports sperm to urethra

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spermatic cord

contains vas def, blood vessels, nerves and muscle fibers

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prostate gland

3 cm X 3.5 cm
5 lobes:
ant, post, middle, lat X2

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prostate lobe most common for cancer?

posterior lobe

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indirect hernia

most common
above ing lig
into scrotum

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direct hernia

less common
usually in men
above ing lig
rarely into scrotum

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femoral hernia

least common
usually in women
below ing lig
never into scrotum

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common GU complaints

pain
dysuria
changes in urine flow
hematuria
penile discharge
penile lesions
genital rashes
frequency and urgency with urination
scrotal enlargement
groin mass/swelling
testicular mass
ED
infertility

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components of male GU exam

penis
scrotum + contents
hernias
prostate exam
special techniques

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inspection of penis

skin for lesions, rashes
hair dist, lesions, infxns, parasites
prepuce/foreskin-if here
glans for ulcers, scars, rashes, ifm
meatus for lesions, ifm, d/c

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STDs

chlamydia-WBC
gonorrhea-WBC w/ gm (-) intracellular diplococcic
trichomonas-WBC with moving organisms

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GEN probe

checks for chlamydia and GC

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palpation of penis

from base to glans
note tenderness, nodules, masses, ifm
palpate inguinal areas for LN, masses, hernias, tenderness

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inspection and palpation of scrotum

skin and scrotal contours

testes and epididymis, spermatic cord

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hernia check

finger up inguinal cancal
also, palpate inguinal areas
ask pt to cough or bear down

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positions to examine prostate (3)

sim’s or L lateral decubitus
modified lithotomy
standing and leaning forward

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prostate gland

bi-lobed
heart shaped
feels like rubber ball
inferior aspect of posterior lobe best palpated on DRE
note size, tenderness, consistency, nodules

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what is best palpated on DRE?

inferior aspect of posterior lobe of prostate

testicular self exam

``` performed post-shower/bath examine each with 2 hands roll between thumbs and fingers locate epid on post side f/u w/ dr if lumps/tender ```

prostate cancer

msot common non-skin CA 2nd leading cause of death in men screen with: DRE and PSA (PSA can have false (+))

what USPTF does NOT recommend screening for

prostate cancer | testicular cancer

hypospadias

congenital urethral meatus displaced on inferior surface of penis along urethral groove important in newborn exam to check for renal abnml as well

phimosis

foreskin can't be retracted over penis painful erections hygiene issues tx w/ circumcision

paraphimosis

foreskin can't be retracted over glans | tx w/ circumcision

hydrocele

fluid filled mass in tunica vaginalis | TRANSILLUMINATES

cryptorchidism

undescended testes atropied increaes risk for cancer

which dz state increases risk for cancer?

cryptorchidism

cause of syphilis

treponema pallidum

primary syphilis

painless erosion/ulcer | non-tender enlarged LN common

what tests are positive in primary syphilis?

RPR-many false (+) VDRL-many false (+) FTA-ABS Dark field microscopy-confirmatory

secondary syphilis

unexplained rash on body. palms and soles

RPR

rapid plasma regain | common false pos

VDRL

venereal disease research lab | common false pos

FTA-ABS

fluorescent treponemal Ab absorbed | confirms

TP-PA

T. pallidum particle agglutination | confirms

dark field microscopy

confirmatory test

USPTF rates syphilis how?

strongly recommends screening pts at increased risk and all pregnant women for syph NO screening for pts not at risk and without sx

how dr assesses risk for syph

``` all sexually active ppl under 24 yrs old previos hx of STDS new/many partners inconsistent condom use sex for money/drugs early sex activity ```

genital herpes

cluster of small vesicles burn, painful, become ulcers with erythemic base pregnant women can pass to baby

cause of genital herpes

herpes simplex virus 1 and 2 | serological testing differentiates b/w the two

how to dx genital herpes

viral culture of fluid in vesicle

primary genital herpes

painful lesions, lymphadenopathy, fever, malaise

recurrent genital herpes

localized lesions, fewer sx, viral shedding asymptomatic

tx for genital herpes

acute and suppressive therapy

USPTF screening for genital herpes?

recommends against screening for HSV in those without sx

venereal warts

grow in clusters | hard to treat

cause of venereal warts

caused by HPV

tx for venereal warts

``` cryosurgery laser surgery electrosurgery podophyllin aldara (imiquimod) surgery ```

genital scabies

linear, curved, s-shaped burrows nocturnal pruritus to intense pruritus spread by direct contact

cause of genital scabies

mite=sarcoptes scabiei

dx genital scabies

clinical suspicion | slide mount prep

tx of genital scabies

permethrin cream (elimite) lindane oral steroids antihistamines for pruritus

gonococcal urethritis

``` purulent d/c gram (-) intracellular diplococci WBC (neutrophils) abrupt onset burning dysuria 3-5 d incubation ```

nongonococcal urethritis

``` chlamydia 7-28 d incubation gradual onset "smarting feeling" dysuria mucoid d/c PMN leukocytes ```