Module 5 Flashcards
A cheesy whitish material, may accumulate normally under the foreskin
Smegma
On the posterolateral surface of each testis is the softer, comma-shaped organ, consisting of tightly coiled tubules emanating from the testis that become the vas deferent
epididymis
The parietal and visceral layers form a potential space for the abnormal fluid accumulation of a
hydrocele
a firm muscular cord-like structure, transports sperm from the tail of the epididymis along a somewhat circular route to the urethra
VAs Deferens
is normally separated from the testis by a palpable sulcus and provides a reservoir for storage, maturation, and transport of sperm.
the epididymis
During ejaculation, the …, a firm muscular cord-like structure, transports sperm from the tail of the epididymis along a somewhat circular route to the urethra.
vas deferens
protrude at the femoral canal and are more likely to present as emergencies with bowel incarceration or strangulation.
Femoral hernias
-Most common, all ages and sexes. Often in children; may occur in adults.
-Above inguinal ligament, near its midpoint (the internal inguinal ring)
–often in the scrotum
he hernia comes down the inguinal canal and touches the fingertip.
- a bulge near the internal inguinal ring
indirect inguinal hernias
-Less common. Usually in men older than 40 yrs; rare in women.
-Above inguinal ligament, close to the pubic tubercle (near the external inguinal ring).
-The hernia bulges anteriorly and pushes the side of the finger forward
- a bulge near the external inguinal ring
direct inguinal hernias
-Least common. More common in women than in men.
-Below the inguinal ligament; appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes.
-never in the scrotum
-The inguinal canal is empty.
-Most commonly present inferior to the inguinal ligament and medial to the femoral artery
femoral hernias
Examining finger in inguinal canal during coughing or straining
Hernia examination
-Appearance: Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous). -Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5%–10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.
- Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain. -May disappear without treatment.
Genital Warts (Condylomata Acuminata)
-Appearance: Small scattered or grouped vesicles, 1–3 mm in size, on glans or shaft of penis. Appear as erosions if vesicular membrane breaks. Causative organism: Usually Herpes simplex virus 2 (90%), a double-stranded DNA virus. Incubation: 2–7 days after exposure. -Primary episode may be asymptomatic; recurrence usually less painful, of shorter duration. -Associated with fever, malaise, headache, arthralgias; local pain and edema, lymphadenopathy. -Need to distinguish from genital herpes zoster (usually in older patients with dermatomal distribution) and candidiasis.
Genital Herpes Simplex
Appearance: Small red papule that becomes a chancre, a painless erosion up to 2 cm in diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated. Chancre heals within 3–8 wks. Causative organism: Treponema pallidum, a spirochete. Incubation: 9–90 days after exposure. May develop inguinal lymphadenopathy within 7 days; lymph nodes are rubbery, nontender, mobile. 20–30% of patients develop secondary syphilis while chancre still present (suggests coinfection with HIV). Distinguish from: genital herpes simplex; chancroid; granuloma inguinale from Klebsiella granulomatis (rare in the United States; four variants, so difficult to identify).
Primary Syphilis
Appearance: Red papule or pustule initially, then forms a painful deep ulcer with ragged nonindurated margins; contains necrotic exudate, has a friable base. Causative organism: Haemophilus ducreyi, an anaerobic bacillus. Incubation: 3–7 days after exposure. Painful inguinal adenopathy; suppurative buboes in 25% of patients. Need to distinguish from: primary syphilis; genital herpes simplex; lymphogranuloma venereum, granuloma inguinale from Klebsiella granulomatis (both rare in the United States).
Chancroid
A congenital displacement of the urethral meatus to the inferior surface or ventral surface of the penis. The meatus may be subcoronal, midshaft, or at the junction of the penis and scrotum (penoscrotal).
Hypospadias
Pitting edema may make the scrotal skin taut; seen in heart failure, liver failure, or nephrotic syndrome.
scrotal edema
Palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis. The patient complains of curved, painful erections.
Peyronie disease
On the dorsal if the penis, plaques of peyronie disease can sometimes be palpated under the skin on the right or left aspect of the shaft in the corpora cavernosa
A nontender, fluid-filled mass within the tunica vaginalis. It transilluminates, and the examining fingers can palpate above the mass within the scrotum.
Hydrocele
n indurated nodule or ulcer that is usually nontender. Limited almost completely to men who are not circumcised, it may be masked by the prepuce. Any persistent penile sore is suspicious.
carcinoma of the penis
Usually an indirect inguinal hernia that comes through the external inguinal ring, so the examining fingers cannot get above it within the scrotum.
scrotal hernia
The testis is atrophied and lies outside the scrotum in the inguinal canal, abdomen, or near the pubic tubercle; it may also be congenitally absent. There is no palpable testis or epididymis in the unfilled scrotum. Cryptorchidism, even with surgical correction, markedly raises the risk of testicular cancer.24
Cryptorchidism
Failure of one or both testes to descend.
the testis is acutely inflamed, painful, tender, and swollen. It may be difficult to distinguish from the epididymis. The scrotum may be reddened. Seen in mumps and other viral infections; usually unilateral.
Acute Orchitis
In adults, testicular length is usually ≤3.5 cm. Small firm testes usually ≤2 cm suggest Klinefelter syndrome. Small soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use of estrogens, and hypopituitarism; may also follow severe orchitis.
small testis
-Usually appears as a painless nodule. Any nodule within the testis warrants investigation for malignancy.
-As a testicular neoplasm grows and spreads, it may seem to replace the entire organ. The testicle characteristically feels heavier than normal.
tumor of the testis
A painless, movable cystic mass just above the testis suggests a spermatocele or an epididymal cyst. Both transilluminate. The former contains sperm, and the latter does not, but they are clinically indistinguishable.
Spermatocele and Cyst of the Epididymis
An acutely inflamed epididymis is indurated, swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Causes include infection from Neisseria gonorrhoeae, Chlamydia trachomatis (younger adults), Escherichia coli, and Pseudomonas (older adults); trauma; and autoimmune disease. Barring urinary symptoms, urinalysis is often negative.
Acute Epididymitis
The chronic inflammation of tuberculosis produces a firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens.
Tuberculous Epididymitis
… refers to gravity-mediated varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” in the spermatic cord above the testis, and if prominent, appears to distort the contours of the scrotal skin. A varicocele collapses in the supine position, so examination should be both supine and standing. If the … does not collapse when the patient is supine, suspect a left spermatic vein obstruction within the abdomen.
Varicocele of the Spermatic Cord
Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is often retracted upward in the scrotum. The cremasteric reflex is nearly always absent on the affected side in boys or men with testicular torsion, though this can be difficult to assess during acute pain episodes. If the presentation is delayed, the scrotum becomes red and edematous. There is no associated urinary infection. Torsion is most common in neonates and adolescents but can occur at any age. It is a surgical emergency because of obstructed circulation and requires urgent surgical consultation.
Testicular Torsion
risk factors for testicular cancer
A major risk factor for testicular cancer is cryptorchidism (undescended testicle), which confers a 3- to 17-fold increased cancer risk.22 Other risk factors include family history, Klinefelter syndrome, and HIV infection
yellow penile discharge
gonorrhea
white discharge in nongonococcal urethritis
Chlamydia
patient complaining of intense pruritus with evidence of penile or pubic excoriations.
Suspect scabies or peduculosis pubis (lice)
a tight prepuce that cannot be retracted over the glans.
Phimosis
is a tight prepuce that, once retracted, cannot be returned. Edema ensues.
Paraphymosis
inflammation of the glans
Balanitis
inflammation of the glans and prepuce
Balanoposthitis
congenital dorsal displacement
epispadias
A malformation in which the urethra opens on the dorsum of the penis; frequently associated with exstrophy of the bladder.
congenital ventral displacement of the meatus on the penis
Hypospadias
Purulent, cloudy or yellow discharge sometimes signals
gonococcal urethritis
canty white or clear discharge can signal
nongonococcal urethritis
Tender painful scrotal swelling is present in
acute epididymitis, acute orchitis, testicular torsion, and strangulated inguinal hernias.
A bulge suggests
a groin hernia.
Groin hernias in women often do not have a visible bulge.1
-place the tip of your dominant index finger at the anterior inferior margin of the scrotum, staying superficial to the testes, then move your finger and hand upward toward the external inguinal ring, invaginating the redundant scrotal skin beneath the peripubic fat pad next to the base of the penis.
-Follow the spermatic cord upward to the inguinal ligament. Find the triangular slit-like opening of the external inguinal ring just above and lateral to the pubic tubercle. Palpate the external inguinal ring and its floor. Ask the patient to cough. Palpate for a distinct bulge or mass that moves against your stationary finger during the cough.
inguinal hernia examination
(Patient should be standing)
A hernia contents that cannot be returned to the abdominal cavity.
incarcerated hernia
when the blood supply to the entrapped contents is compromised. Suspect strangulation in the presence of tenderness, nausea, and vomiting, and consider surgical intervention.17
A hernia is strangulated