Male Physical Exam Flashcards
Examination of the penis
Inspect for gross deformities
Inspect the pubic hair and distribution Of hair
Inspect dorsal and lateral surfaces
Ask the patient to lift their penis, don’t do it yourself
Ask the patient to retract the foreskin and inspect glans penis and urethral meatus
Palpation
- use a finger and thumbs press along the entire penile shaft
Peyronie’s disease
A fibroproliferative disorder that affects the tunica albuginea of the penis which causes abnormal curvature
Pathogenesis = repeated micro trauma during sexual intercourse or athletic activity which follows abnormal wound healing
Clincial feature s
- pain along he shaft on palpation
- penile nodules felt on palpation
- erectile dysfunction due to abnormal curvature
Treatment = oral pentoxifylline is first line
- can also use intralesional collagenase injections as 2nd line
Examination of the scrotum
Inspect anterior, posterior, lateral and posterior surfaces of the scrotum
- make sure to let the patient lift the penis and dont just do it yourself
Next palpate all surfaces and note for any masses, tenderness and nodules or asymmetry
Then palpate the epididymis and note anything and then move up to each spermatic cord from the testicle to the external inguinal ring and note tenderness
** if a mass is present = use transillumination to help evaluate for hydrocele
Examination for hernias
Indirect vs direct
- indirect = goes through entire inguinal canal and into the scrotum
- direct = goes through the abdominal wall and into the inguinal canal
Make sure to have patient stand and you sit on a stool
Use index finger and carry a scrotal skin and follow up along each spermatic cord to the external inguinal ring and then ask them to bear down and note any masses or bulges
Rectal and prostate examination
Position the patient in either
Leaning forward on elbows over a exam table or in lateral decubitus position
Use gloves and lubricant
- place on index fingertip and inform patient it will be cold and slightly uncomfortable
- shouldnt be painful though
Separate the gluteal muscles and inspect for fissures and hemorrhoids
When going in = note anal tone
- palpate the anterior surface of the rectum and at the end = prostate will push up on the finger
- if the prostate is enlarged = you will bump into it before end
- also feel for any masses, firmness or tenderness.
If stool sample needed = while on guaiac card
Step out of room and let patient get back to normal