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Advanced Physical Dx > Male Pelvic exam > Flashcards

Male Pelvic exam Flashcards

1
Q

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

A

Patient consent essential for invasive procedures

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2
Q

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

A
  1. Cultural or religious beliefs

2. Previous positive or negative experiences

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3
Q

Define scrotum

A

muscular pouch containing testes

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4
Q

Define Testis

A

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

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5
Q

Define epididymis

A

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

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6
Q

Define vas deferens

A

tube arising from tail of epididymis,

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

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7
Q

Define spermatic cord

A

structure formed by vas deferens, testicular arteries, and veins

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8
Q

What needs to be assessed when a pt is standing?

A

check for hernias or varicoceles

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9
Q

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

A 
1. Penis
Foreskin
Glans
Urethral Meatus
2. Scrotum
Testis
Epididymis
Spermatic Cord
3. Inguinal area
Hernias
Lymph nodes
4. Anus
Rectum
Prostate
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10
Q

Define varicoceles

A
  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
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11
Q

Define hernia

A

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.

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12
Q

What is inspected when performing the GU exam?

A
  1. Development of penis and surrounding hair
  2. Foreskin (retract if present, replace after exam)
    Glans
  3. Urethral meatus
    Note any discharge
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13
Q

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

A
  1. Sexual maturation, rashes, scabies
  2. Ulcers, scars, nodules or inflammation
  3. Urethritis
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14
Q

What is inspected AND palpated when performing the GU exam?

A
  1. Shaft of the penis
    A. Note any induration or tenderness
  2. Visible lesions
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15
Q

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

A
  1. Urethral stricture or carcinoma

2. Syphilis or cancer

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16
Q

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

A

Skin of scrotum

Contours of scrotum

17
Q

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

A
  1. Rashes, inflammation
  2. Swellings or bulges (hernia or hydrocele)
  3. Cryptorchidism (undescended testis)
18
Q

Define transillumination

A

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.

19
Q

What needs to be palpated on the male GU exam?

A
  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”)
20
Q

Define orchitis

A

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

21
Q

Define testicular torsion

A

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.

22
Q

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

A

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

23
Q

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

A
  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
24
Q

What may be found in the inguinal and femoral areas?

A
  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)
25
Q

What are common positions for the DRE?

A

Left lateral position

Standing, hips flexed

26
Q

What are the steps in a DRE exam?

A
  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
27
Q

How is the rectum examined?

A
  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
28
Q

What are the possible findings in a rectal exam?

A
  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)
29
Q

How is the prostate examined?

A
  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
30
Q

What are the normal prostate findings?

A
  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
31
Q

What are the BPH findings?

A
  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
32
Q

What are the PE findings for prostate cancer?

A
  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
33
Q

What are the PE findings in acute prostatitis?

A
  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
34
Q

How is the DRE exam concluded?

A
  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
35
Q

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

A

(<35 years)

  1. Sexuality, including safe sexual practices
  2. Self-care, including the testicular self-exam
36
Q

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

A

(40+ years)

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

Advanced Physical Dx (9 decks)

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