PD Male Genitalia

Question 1

History

Answer 1

Urinary symptoms
Changes in sexual function
Penile discharge/lesions
Scrotal pain/swelling/lesions
Part of complete physical exam

STD/HIV prevention
Testicular self exam

Question 2

Exam prep

Answer 2

Always explain what is being done
Patient removes underwear
Patient standing, examiner sitting in front
Wear gloves
Patient occasionally has an erection, try not to get flustered
Document any refusal

Question 3

P1 pubic hair

Answer 3

Preadolescent

No growth of hair in pubic area

Question 4

P2 pubic hair

Answer 4

Slightly pigmented, longer/straight hair (downy like)

Usually at base of penis

Question 5

P3 pubic hair

Answer 5

Dark pigmented, curly pubic hair around base

Question 6

P4 pubic hair

Answer 6

Pubic hair definitely adult in type, but not extent

Question 7

P5 pubic hair

Answer 7

Hair spread to medial surface of thighs

Question 8

P6 pubic hair

Answer 8

Hair spread along line alba (80% of men)

Question 9

Tanner staging genitals

Answer 9

G1 - 5

Question 10

G1 genitals

Answer 10

Testes, scrotum, and penis are same size and shape as child

Question 11

G2 genitals

Answer 11

Enlargement of the scrotum and testes, skin of scrotum becomes redder, thinner, and wrinkled

Question 12

G3 genitals

Answer 12

Enlargement of the penis, esp in length, further enlargement of testes
Descent of scrotum

Question 13

G4 genitals

Answer 13

Continued enlargement of the penis and sculpturing of the glands
Increased pigmentation of scrotum

Question 14

G5 genitals

Answer 14

Adults stage, penis reaching bottom of scrotum

Question 15

Inspection of penis

Answer 15

Circumcised/uncircumcised
Examine glands, skin, foreskin
Retract foreskin

Ulcers
Nodules
Lesions
Discharge
Lice
Rashes

Question 16

Palpation

Answer 16

Tenderness
Induration
Nodules
Discharge - may have to milk
Have culture material ready if STD suspected

Urethral meatus

Question 17

Phimosis
Causes
Tx

Answer 17

Tight prepuce (foreskin) that can’t be retracted over glands

Scarring
Balanitis
Lichen planus

Tx - circumcision

Question 18

Paraphimosis

Answer 18

Tight foreskin becomes trapped behind the head of penis and can’t be retracted, causing edema

Question 19

Balantitis
Complication
Causes

Answer 19

Inflammation of the glans
Phimosis is most common complication

Diabetes
Poor hygiene 
Irritants
Morbid obesity
Infection
Trauma

Question 20

Balanoposthitis

Answer 20

Inflammation of glans and foreskin

Question 21

Balantitis S&S

Answer 21

Erythema of glans/foreskin
Edema of glans/foreskin
Discharge
Ulceration

Question 22

Epispadias

Answer 22

Congenital defect with open in of the urethra on the dorsum of the penis

Question 23

Hypospadias

Answer 23

Congenital defect with opening on the urethra on the ventral side of penis

Question 24

Peyronie’s disease

Answer 24

Hard, contender, subq plaques on dorsal or lateral side of penis
Etiology unknown
Plaques may be single or multiple
Causes painful bending with erection
Most common 45 yo or older

Question 25

Carcinoma of the penis

Answer 25

Most common is squamous cell | More common in uncircumcised men

Question 26

Bowen's disease

Answer 26

Carcinoma in situ of the penis | Doesn't invade dermis

Question 27

Primary syphilis

Answer 27

``` Caused by Treponema palladium ~2 weeks post exposure painless ulcer (chancre) Heals 3-6 weeks even without tx Regional LAD ```

Question 28

Condyloma lata

Answer 28

Secondary syphilis Appear few weeks to 6 months after initial syphilis cancer Multiple moist appearing lesions, flattened, round-oval Can be painful, itchy Contagious

Question 29

Condyloma accuminata

Answer 29

Genital warts | Caused by HPV

Question 30

Gonorrhea cause

Answer 30

Neisseria gonorrhea

Question 31

Chlamydia cause

Answer 31

Chlamydia trachomatis

Question 32

Herpes simplex

Answer 32

Painful vesicles, most commonly on glans or shaft | May coalesce to form ulcer

Question 33

Inspection of scrotum and testes

Answer 33

Symmetry Swelling Masses Rashes

Question 34

Palpation of scrotum and testicles

Answer 34

Masses | Tenderness

Question 35

Hydrocele

Answer 35

Collection of fluid within the tunica vaginalis Most common cause of scrotal swelling Painless, readily transilluminated

Question 36

Causes of hydrocele

Answer 36

Epididymitis Trauma Hernia TUmor

Question 37

Spermatocele

Answer 37

``` Usually painless cystic mass located between head of epididymis and testis Filled with milky fluid containing sperm No scrotal erythema No dysuria No systemic symptoms ```

Question 38

Varicocele

Answer 38

Dilation of veins within the spermatic cord "Bag of worms" Does not transilluminate More common on left side

Question 39

Orchitis

Answer 39

Acute inflammation of the testis | Uncommon except when complication of extension of epididymitis, UTI, or systemic infection

Question 40

Cause and Symptoms of orchitis

Answer 40

Mumps, usually in post pubertal males Fever Swelling (uni or bilateral) Erythema and induration of testes Hydrocele may develop as a result

Question 41

Testicular torsion | S&S

Answer 41

Blood supply to testis becomes twisted leading to ischemia Usually in adolescents (rare after 20) Left side more common ``` Sudden onset of severe pain No fever May have nausea/vomiting Testis on affected side will sit higher in scrotum Spermatic cord feels thicker SURGICAL EMERGENCY ```

Question 42

Testicular cancer

Answer 42

``` Most common ages 15-30 Seminoma most common Rare in blacks, hispanics, asians 1% of all male carcinomas Irregularly shaped, firm, usually non tender mass Most often discovered during palpation ```

Question 43

Risk factors for testicular cancer

Answer 43

Undescended testes | Caucasian

Question 44

Cryptorchidism

Answer 44

Condition in which one or both of testes fail to descend into scrotum Common congenital condition involving testes No testes detected with palpation of scrotum Impaired fertility Risk of testicular cancer up to 50% higher than in men who have descended testes

Question 45

Inguinal hernia

Answer 45

Diffuse swelling amidst the cord structures Inguinal canal region protuberant Usually non tender

Question 46

Detecting inguinal hernia

Answer 46

Have pt bear down or cough while you inspect inguinal area (Increase intraabdominal pressure and may make hernia more prominent) Place right finger along right spermatic cord, inverting scrotal skin, as you trace cord to where it emerges from the external ring of inguinal canal Put fingers of left hand over inguinal canal Note any swollen area Have pt cough or bear down again Repeat on left side, switching hands

Question 47

Incarcerated hernia

Answer 47

Contents of hernia cannot be returned to the abdominal cavity Risk of strangulation

Question 48

Strangulated

Answer 48

Blood supply to the entrapped contents is compromised | Ischemia/infarction

Question 49

Indirect inguinal hernia

Answer 49

Passes through entire inguinal canal (through internal deep ring and external ring) Most common type Due to congenital defect Often enters the scrotum

Question 50

Direct inguinal hernia

Answer 50

Passes through weakness in fascia of abdominal wall (Hesselbach's triangle) Through external ring only Seldon enters the scrotum

Question 51

Femoral hernia

Answer 51

Intestines push through femoral ring and canal, below inguinal ligament Pain can be severe High risk of becoming strangulated