Male Pelvic exam

Question 1

Why do you need permission before starting a male GU exam?

Answer 1

Patient consent essential for invasive procedures

Question 2

What may a Patient’s attitude be affected by regarding the male GU exam?

Answer 2

1. Cultural or religious beliefs

2. Previous positive or negative experiences

Question 3

Define scrotum

Answer 3

muscular pouch containing testes

Question 4

Define Testis

Answer 4

a network of tightly coiled seminiferous tubules that converge and anastamose into efferent tubules
Encapsulated by tunica albuginea

Question 5

Define epididymis

Answer 5

a structure formed from merged efferent tubules, which attaches along the posterior and upper border of the testis
Described as having head, body & tail

Question 6

Define vas deferens

Answer 6

tube arising from tail of epididymis,

Passes through inguinal canal and joins seminal vesicle duct to form ejaculatory duct, which passes into prostate gland

Question 7

Define spermatic cord

Answer 7

structure formed by vas deferens, testicular arteries, and veins

Question 8

What needs to be assessed when a pt is standing?

Answer 8

check for hernias or varicoceles

Question 9

What structures need to be assessed on the male GU exam?

Answer 9

1. Penis
Foreskin
Glans
Urethral Meatus
2. Scrotum
Testis
Epididymis
Spermatic Cord
3. Inguinal area
Hernias
Lymph nodes
4. Anus
Rectum
Prostate

Question 10

Define varicoceles

Answer 10

1. Varicoceles, or varicosities of the pampiniform plexus that surrounds the spermatic cord, are gravity-dependent. Varicoceles occur in 8% - 15% of normal adult males, and are nearly always left-sided

Question 11

Define hernia

Answer 11

A hernia is a protrusion or projection of an organ or a part of an organ through the wall of the cavity which normally contains it.

Question 12

What is inspected when performing the GU exam?

Answer 12

1. Development of penis and surrounding hair
2. Foreskin (retract if present, replace after exam)
   Glans
3. Urethral meatus
   Note any discharge

Question 13

What may be found upon inspected when performing the GU exam?

Answer 13

1. Sexual maturation, rashes, scabies
2. Ulcers, scars, nodules or inflammation
3. Urethritis

Question 14

What is inspected AND palpated when performing the GU exam?

Answer 14

1. Shaft of the penis
   A. Note any induration or tenderness
2. Visible lesions

Question 15

What may be found upon inspected and palpation when performing the GU exam?

Answer 15

1. Urethral stricture or carcinoma

2. Syphilis or cancer

Question 16

What must be inspected of scrotum when performing the GU exam?

Answer 16

Skin of scrotum

Contours of scrotum

Question 17

What may be found upon inspected of the scrotum when performing the GU exam?

Answer 17

1. Rashes, inflammation
2. Swellings or bulges (hernia or hydrocele)
3. Cryptorchidism (undescended testis)

Question 18

Define transillumination

Answer 18

a technique in which a light source is applied to the side of a scrotal enlargement, is useful in determining the nature of a scrotal mass.

Question 19

What needs to be palpated on the male GU exam?

Answer 19

1. Testis
   A. Note tenderness, Orchitis, torsion, Lumps (cancer)
2. Epididymis
   A. Note tenderness, Swelling or lumps (cysts, tumors, or epididymitis)
3. Spermatic Cord and adjacent area
   A. Note Varicocele (“bag of worms”)

Question 20

Define orchitis

Answer 20

acute inflammatory condition characterized by a swollen, tense and very tender testicle.

Question 21

Define testicular torsion

Answer 21

Testicular torsion most often occurs in boys aged 12-18 years and presents with severe scrotal pain that may radiate to the inguinal region and lower abdomen. The affected testicle is often swollen, tender, and lies higher than the unaffected testicle. Testicular torsion is a twisting of the testis that leads to venous obstruction, edema and arterial obstruction. It is a surgical emergency that requires prompt recognition within the first 10-12 hours so that the testicle can be salvaged.
Epididymitis is the most common cause of acute scrotal swelling. It occurs in young, sexually active men and in older men with associated GU problems. Patients will report recent testicular pain, dysuria, and scrotal swelling. On examination, the epididymis is tender and indurated.

Question 22

What is the most common scrotal mass among adolescent and older adults?

Answer 22

varicocele, which may be seen and felt as a “bag of worms” superior to the testicle.

Question 23

What is inspected and palpated in the inguinal and femoral areas?

Answer 23

1. Inguinal and femoral areas
   A. Instruct patient to cough or to bear down
   B. Palpate
2. External inguinal ring through scrotal skin
   A. Instruct patient to cough or to bear down
3. Lymph nodes

Question 24

What may be found in the inguinal and femoral areas?

Answer 24

1. Sudden swelling in scrotum (hernia or mass)
2. Pain during cough or strain should be evaluated
3. Direct hernia
4. Indirect hernia
5. Enlarged nodes (infective or malignant disorders)

Question 25

What are common positions for the DRE?

Answer 25

Left lateral position | Standing, hips flexed

Question 26

What are the steps in a DRE exam?

Answer 26

1. Lubricate the gloved index finger 2. Warn the patient before inserting finger 3. Gently press on the sphincter’s edge and wait for it to relax, then insert your finger into anal canal 4. Pause and allow patient to adjust to your finger, then continue to insert finger fully 5. Assess sphincter tone by asking the patient to squeeze anal muscles around finger

Question 27

How is the rectum examined?

Answer 27

1. Examine the posterior and lateral walls of the rectum by gently rotating the finger through 180 degrees 2. To palpate the entire circumference of the rectum, you should turn away from patient and hyperpronate your wrist 3. Sweep your finger across the anterior and anterolateral walls of the rectum 4. Note texture and elasticity of the rectal lining

Question 28

What are the possible findings in a rectal exam?

Answer 28

1. Normal rectal mucosa feels uniformly smooth and pliable 2. Polyps--may be attached by a stalk or base 3. Masses or irregularly shaped nodules 4. Areas of unusual hardness 5. Abscesses (perirectal sepsis) may be indicated by extreme tenderness 6. Hemorrhoids (internal and external)

Question 29

How is the prostate examined?

Answer 29

1. Inform the patient that you’re going to examine his prostate gland 2. Sweep your finger over the prostate gland (found anteriorly through rectal wall) 3. Identify the two lobes with a longitudinal groove (median sulcus) between them 4. Note the size, nodularity, consistency and tenderness of the prostate

Question 30

What are the normal prostate findings?

Answer 30

1. About 2.5 cm from side to side 2. Prominent median sulcus 3. Consistency is rubbery and smooth 4. Tenderness not usual, but patients should feel urge to urinate when you palpate

Question 31

What are the BPH findings?

Answer 31

1. Enlargement of gland is symmetrical 2. Marked protrusion into rectal lumen 3. Smooth with no nodularity 4. Median sulcus may be indistinguishable 5. Consistency is rubbery, ‘boggy’ or slightly elastic

Question 32

What are the PE findings for prostate cancer?

Answer 32

1. Asymmetric shape 2. Hard consistency 3. Discrete nodule may be palpable 4. Median sulcus often obscured 5. Note: Hard areas of prostate are not always cancerous but may indicate conditions such as chronic inflammation

Question 33

What are the PE findings in acute prostatitis?

Answer 33

1. Gland is swollen 2. Firm consistency 3. Very tender to touch 4. Examine the gland carefully 5. Pay attention to patient’s verbal and nonverbal cues

Question 34

How is the DRE exam concluded?

Answer 34

1. Inform the patient before withdrawing your finger 2. Note the color of any fecal matter on glove 3. Use fecal material for occult blood testing if this is indicated for CRC screening 4. Offer the patient a tissue 5. Allow the patient to cover up and rise to sitting position before discussing results

Question 35

What pt education needs to occur for a young adult male?

Answer 35

(<35 years) 1. Sexuality, including safe sexual practices 2. Self-care, including the testicular self-exam

Question 36

What pt education needs to occur for an older adult male?

Answer 36

(40+ years) 1. Prostate and colorectal cancer screening 2. Sexual function 3. Lower urinary tracts symptoms that affect quality of life (e.g., incontinence)