male GU physical exam

Question 1

how to begin the exam

Answer 1

pt may be either supine or standing
check for hernias or varicoceles when pt is standing
explain the procedure
use models or diagrams
chaperone in exam room often advisable
always wear gloves

Question 2

penis inspection and palpation

Answer 2

Inspect: development of penis and surrounding hair, foreskin (retract if present AND replace), glans, urethral meatus
-possible findings include: sexual maturation, rashes, scabies, phimosis, ulcers, scars, nodules, inflamm, urethritis
inspect/palpate: shaft of the penis (for nodules or tenderness), fibrous areas (crooked erection), visible lesions
-possible findings include: urethral stricture or carcinoma, Peyronie’s disease (contracture of skin), syphilis or cancer

Question 3

Scrotum inspection and palpation

Answer 3

inspect: skin of scrotum, contours of scrotum
- possible findings: rashes, inflamm, swelling, bulges, crytochordism
transilluminate: light source is applied to the side of a scrotal enlargement to determine the nature of a scrotal mass
palpate: testis, epididymis, spermatic cord and adj area
- possible findings: orchitis, torsion, lump, swelling, varicocele

Question 4

inguinal area

Answer 4

inspect: inguinal and femoral area (have pt cough or bear down)
palpate: ext inguinal ring through scrotal skin, lymph nodes
- possible findings: sudden swelling in scrotum, pain during cough, direct hernia, indirect hernia, enlarged nodes

Question 5

hernias

Answer 5

weakening of the underlying structures, ligaments, muscles, fascia, that allow abd contents to protrude through
3 types: direct (in ligament itself); indirect, and femoral (occurs in empty space of NAVEL) *classified by their relationship to Hasselbeck’s triangle

Question 6

prostate

Answer 6

inspect: sacro-coccygeal for pilonidal cysts, peri-anal area for HPV, fissures, hemorrhoids, rash, have pt bear down for rectal prolapse

rectal exam: apply lubricant to your finger, warn pt, have pt bear down as you insert your finger, try to reach above prostate to palpate over the seminal vesicles if possible and palpate the walls of the rectum

prostate exam: identify both lobes of the prostate and the median sulcus, note the size, shape, and consistency, identify any nodules or tenderness, normal = rubbery and non-tender

after the exam: withdraw your finger and assess any fecal material remaining and put it on hemoccult, offer pt a tissue to clean themselves, perform FOBT