module 19 male genital

Question 1

older adults changes

Answer 1

change in sexual desire or activity
change in sexual response
longer time to achieve full erection 
less forceful ejaculation 
longer interval between erections

Question 2

infants and children

Answer 2

congenital anomalies/incomplete development
sexual ambiguity 
urethral placement 
retractability of foreskin (after 4) 
testicles descended 
masses

Question 3

older adults physical exam

Answer 3

pubic hair finer and less abundant

pendulous scrotum

Question 4

hernia patho

Answer 4

protrusion of the peritoneal-lined sac through some defect in the abdominal wall

Question 5

Inguinal hernia

Answer 5

arise along the course that the testicle traveled as it exited the abd and entered the scrotum during intrauterine life.

Question 6

femoral hernia

Answer 6

occur at the fossa ovalis, where the femoral artery exits the abdomen

Question 7

strangulated hernia

Answer 7

occur when the blood supply to the protruded tissue is compromised

Question 8

hernia subjective

Answer 8

soft swelling or bulge in inguinal area

may have pain on straining (indirect, femoral)

Question 9

hernia objective

Answer 9

indirect: soft swelling in area of internal ring: hernia comes down canal and touches fingertip on exam
direct: bulge in area of hesselbach triangle, easily reduced, hernia bulges anteriorly, pushes against side of finger on exam

Question 10

paraphimosis patho

Answer 10

inability to replace the foreskin to ususual position after it has been retracted behind the glans

Question 11

paraphimosis subjective

Answer 11

retraction of foreskin during exam, cleaning, urethral cath, or cystoscopy
penile pain and swelling
children may report obstructive voiding s/s

Question 12

paraphimosis objective

Answer 12

glans penis congested and enlarged
foreskin edematous
constricting band of tissue directly behind the head of the penis

Question 13

chancre patho

Answer 13

skin lesion associated with primary syphilis

- generally appears 2wks after exposure

Question 14

chancre subjective

Answer 14

painless lesion on penis

hx of sexual contact

Question 15

chancre objective

Answer 15

solitary lesion 
- firm, round, small, commonly located on the glans but can be on foreskin
indurated borders with a clear base
scrapings from the ulcer
-> microscope: spirochetes

Question 16

genital herpes patho

Answer 16

STI caused by HSV

- most transmission of HSV occurs when individuals shed virus in the absence of s/s

Question 17

genital herpes subjective

Answer 17

painful lesion on penis, genital area, perineum
hx of sexual contact
poss. burning or pain with urination

Question 18

genital herpes objective

Answer 18

superficial vesicles on the glans, penile shaft, at the base of the penis, or around the anus
often assoc. with inguinal lymphadenopathy and systemic s/s including fever

Question 19

condyloma acuminata patho

Answer 19

genital warts caused by HPV
- invades basal layer of epidermis, penetrates through skin and causes mucosal microabrasions.
Latent phase: no s/s month to several years

Question 20

condyloma acuminata subjective

Answer 20

soft painless wart like lesions on penis

hx of sexual contact

Question 21

condyloma acuminata objective

Answer 21

single or multiple papular lesions

• pearly, filiform, fungating cauliflower, or plaquelike
• smooth, verucous, or lobulated
• same color as skin, or reddish, or hyperpigmented
• lesions could be present within the urethra as well

Question 22

lymphogranuloma venereum patho

Answer 22

STI of the lympatics

• caused by chlamydia trachomatis
• enters through skin breaks
• > initial lesion at site of entry
• > travels via lymphatics to regional lymph nodes

Question 23

lymphogranuloma venereum subjective

Answer 23

painless lesion on penis
s/s: fever, malaise
hx sexual contact

Question 24

lymphogranuloma venereum objective

Answer 24

initial lesion is painless erosion at or near the coronal sulcus
enlarged regional lymph nodes
- drainage blocked: penile and scrotal edema
draining sinus tract in untreated infection

Question 25

molluscum contagiosum patho

Answer 25

viral infection of the skin and mucous membranes
STI in adults
- poxvirus that infects only the skin

Question 26

molluscum contagiosum subjective

Answer 26

painless lesions on penis

contact with infected person

Question 27

molluscum contagiosum objective

Answer 27

lesions are pearly gray, often umbilicated, smooth, dome-shaped and with discrete margins

Question 28

peyronie disease patho

Answer 28

fibrous band in the corpus cavernosum

• dense, fibrous scar tissue forms in the tunica albuginea
• interferes with expansion of the corpus cavernosum during erection

Question 29

peyronie disease subjective

Answer 29

bending and/or indentation of the erection
loss of penile length
poss. pain with erection
family hx. of conditon
hx of dupuytren contraction (finger joint flexion)

Question 30

peyronie disease objective

Answer 30

one or more palpable hardened area
reduced elastitiy of the flaccid penis
radiography or US show plaque calcification

Question 31

Penile cancer patho

Answer 31

almost all cases are squamous cell carcinoma usually originating in the glans or foreskin

• HPV: 16 and 18
• superficial neoplasms of prepuce or glans penis -> corpora cavernosa and urethra -> metastases to the inguinal lymph nodes

Question 32

penile cancer subjective

Answer 32

painless ulceration that fails to heal
uncircumcised
poor penile hygiene

Question 33

penile cancer objective

Answer 33

lesion, usually on glans
papule or pustule
warty growth, shallow erosion, or deep ulceration with rolled edges
may have phimosis that obscures the lesion