Male GU/Rectal Exam

Question 1

The Rule of Four
Genital Exam
Inspection
Palpation
Palpation
Palpation

Answer 1

Inspection and initial observation of the pubic area
of the penis
of scrotal contents
for hernia

Question 2

The Rule of Four
Rectal Exam
Inspection
Palpation
Palpation
Palpation

Answer 2

Inspection of the interglutenal cleft
of the rectal wall
of the prostate
of sphincter control and symmetry

Question 3

Patient positioning for Genital Exam

Optional positions?

Answer 3

Standing and leaning back against the exam table, legs spread shoulder width apart

Supine patient. Lithotomy position

Question 4

Position for clinician?

Answer 4

on stool directly in front of the patient with the patient’s genital area fully exposed

Question 5

Palpate the shaft of the penis in what direction?

Answer 5

proximally to distally

Question 6

Look for evidence of what during palpation of the penis?

Answer 6

lumps or fibrous “knots” within the shaft

Question 7

It is good to know what about the patient’s erection?

Answer 7

its shape

Question 8

During palpation of the penis the clinician should do what to the ureathra?

Answer 8

compress or “strip” it towards the urethral opening

Question 9

Spread the urethra open for inspection looking for evidence of what?

Answer 9

redness or unusual color
suspicious discharge (obtain a sterile sample for culture)

Question 10

Be during what in the uncircumcised patient?

Answer 10

foreskin retraction

Question 11

Possible findings during penis palpation?

Answer 11

Peyronie’s disease
phimosis
paraphimosis
balanitis
urethritis
epispadias
hypospadias

Question 12

Urethritis is what?

Answer 12

A sexually transmitted disease with urethral discharge, dysuria, hesitancy, urgency, pyuria

Question 13

Bacterial agents that can cause urethritis?

Viral?

Answer 13

gonorrhea
chlamydia
HSV1&2

Question 14

Two-Hand Method for Scrotal Palpation
The first hand does what?

Answer 14

lifts the scrotum, separates one testicle and stabilizes it by holding the spermatic cord between thumb and forefinger for palpation of the spermatic cord

Question 15

Two-Hand Method for Scrotal Palpation
Second hand does what?

Answer 15

palpates the testicle with the first three fingers (pill rolling) over the entire surface of the testicle.

Question 16

Two-Hand Method for Scrotal Palpation
Which hand supports the right testicle?

Answer 16

Left hand

Question 17

Two-Hand Method for Scrotal Palpation
Which hand supports the left testicle?

Answer 17

Right hand

Question 18

Possible findings during Scrotal Palpation?

Answer 18

Hydrocele
spermatocele
variocele
testicular carcinoma
epididymitis

Question 19

What is the most common cancer of young men between 15 and 34?
Which cell does it originate from 95% of the time?

Answer 19

Testicular cancer
predominantly of germ cell origin

Question 20

Palpation for Hernia
Invaginate loose scrotal skin to where?

Answer 20

external inguinal ring

Question 21

Palpation for Hernia
Patient should do what?

Answer 21

cough or “bear down” to increase abdominal pressure
Verify hernia

Question 22

Palpation for Hernia
Right forefinger to patient’s?

Answer 22

Right

Question 23

Palpation for Hernia
Left forefinger to patient’s?

Answer 23

Left

Question 24

End of genital exam occurs with what?

Answer 24

brief inspection of rectal area for all patients

Question 25

Patient position for rectal exam?

Answer 25

bent forward over the exam table supported on the elbows, legs spread shoulder width apart

Question 26

Clinician position for rectal exam?

Answer 26

on stool or standing slightly to one side.

Question 27

How to examine the rectal area?

Answer 27

fully spread the buttocks with thumbs, inspecting the area from the sacrum to the perineum including a careful inspection of the anal verge

Question 28

Possible findings of inspection of the rectal area include?

Answer 28

Pilonidal disease
anal fissures
perianal warts
prolapsed rectal mucosa
perirectal abscess
hemorrhoids

Question 29

Palpation of the lower rectal wall
1st step: Alert the patient to what?

Answer 29

cool sensation as you place lubricated pad of finger on the anus. Pause to allow sphincter to relax.

Question 30

Palpation of the lower rectal wall
2nd step: gently flex fingertip where?

Answer 30

through the sphincters advancing entire finger into the rectum

Question 31

Palpation of the lower rectal wall
3rd step: complete a full sweep of where?

Answer 31

anterior, posterior and lateral sweep of the lower rectal wall

Question 32

Palpation of the lower rectal wall
While palpating clinician is sensing for what?

Answer 32

any masses, polyps or unusual surfaces related to rectal carcinoma

Question 33

Palpation of the lower rectal wall
Possible findings include?

Answer 33

polyps
masses
hemorrhoids

Question 34

Palpation of the prostate
Alert the patient to the pressure of?

Answer 34

Pressure and urination

Question 35

Palpation of the prostate
Assure the patient that urination sensation is from what?

Answer 35

placing pressure on the bladder during prostate palpation

Question 36

Palpation of the prostate
Press firmly where?

Answer 36

downward toward the umbilicus feeling for the two lobes of the prostate. Apply firm pressure

Question 37

Palpation of the prostate
Five questions to be addressed during palpation

Answer 37

Are there two lobes and the sulcus?
Are the lobes equal in size and texture?
Are the lobes free of any nodularity?
Is the prostate a normal size?
Is there discomfort-pain?

Question 38

Palpation of the prostate
Vigourous palpation of the prostate may cause what?

Answer 38

prostatic fluid to be expressed from the penis.
It’s infrequent but normal, reassure the patient

Question 39

Palpation of the prostate
Possible findings include?

Answer 39

BPH
Prostatic Carcinoma
prostatitis

Question 40

Palpation of Anal Sphincters
Before removing your finger from the anus ask the patient to do what?

Answer 40

tighten or squeeze your forefinger with the anal sphincters

Question 41

Palpation of Anal Sphincters
The patient tightening the anal sphincters is a quick test for?

Answer 41

tone
sensitivity
coordination of contraction and symmetry

Question 42

Palpation of Anal Sphincters
Withdraw forefinger and any residual stool on glove can be used for what?

Answer 42

testing for occult blood using the chemical guaiac procedure