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Physical Diagnosis > PD Male Genitalia > Flashcards

PD Male Genitalia Flashcards

1
Q

History

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

STD/HIV prevention
Testicular self exam

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2
Q

Exam prep

A

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

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3
Q

P1 pubic hair

A

Preadolescent

No growth of hair in pubic area

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4
Q

P2 pubic hair

A

Slightly pigmented, longer/straight hair (downy like)

Usually at base of penis

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5
Q

P3 pubic hair

A

Dark pigmented, curly pubic hair around base

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6
Q

P4 pubic hair

A

Pubic hair definitely adult in type, but not extent

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7
Q

P5 pubic hair

A

Hair spread to medial surface of thighs

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8
Q

P6 pubic hair

A

Hair spread along line alba (80% of men)

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9
Q

Tanner staging genitals

A

G1 - 5

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10
Q

G1 genitals

A

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

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11
Q

G2 genitals

A

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

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12
Q

G3 genitals

A

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

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13
Q

G4 genitals

A

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

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14
Q

G5 genitals

A

Adults stage, penis reaching bottom of scrotum

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15
Q

Inspection of penis

A

Circumcised/uncircumcised
Examine glands, skin, foreskin
Retract foreskin

Ulcers
Nodules
Lesions
Discharge
Lice
Rashes
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16
Q

Palpation

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

Urethral meatus

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17
Q

Phimosis
Causes
Tx

A

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

Scarring
Balanitis
Lichen planus

Tx - circumcision

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18
Q

Paraphimosis

A

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

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19
Q

Balantitis
Complication
Causes

A

Inflammation of the glans
Phimosis is most common complication

Diabetes
Poor hygiene 
Irritants
Morbid obesity
Infection
Trauma
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20
Q

Balanoposthitis

A

Inflammation of glans and foreskin

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21
Q

Balantitis S&S

A

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

22
Q

Epispadias

A

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

23
Q

Hypospadias

A

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

24
Q

Peyronie’s disease

A 
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
25
Q

Carcinoma of the penis

A

Most common is squamous cell

More common in uncircumcised men

26
Q

Bowen’s disease

A

Carcinoma in situ of the penis

Doesn’t invade dermis

27
Q

Primary syphilis

A 
Caused by Treponema palladium
~2 weeks post exposure
painless ulcer (chancre)
Heals 3-6 weeks even without tx
Regional LAD
28
Q

Condyloma lata

A

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

29
Q

Condyloma accuminata

A

Genital warts

Caused by HPV

30
Q

Gonorrhea cause

A

Neisseria gonorrhea

31
Q

Chlamydia cause

A

Chlamydia trachomatis

32
Q

Herpes simplex

A

Painful vesicles, most commonly on glans or shaft

May coalesce to form ulcer

33
Q

Inspection of scrotum and testes

A

Symmetry
Swelling
Masses
Rashes

34
Q

Palpation of scrotum and testicles

A

Masses

Tenderness

35
Q

Hydrocele

A

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

36
Q

Causes of hydrocele

A

Epididymitis
Trauma
Hernia
TUmor

37
Q

Spermatocele

A 
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
38
Q

Varicocele

A

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

39
Q

Orchitis

A

Acute inflammation of the testis

Uncommon except when complication of extension of epididymitis, UTI, or systemic infection

40
Q

Cause and Symptoms of orchitis

A

Mumps, usually in post pubertal males

Fever
Swelling (uni or bilateral)
Erythema and induration of testes
Hydrocele may develop as a result

41
Q

Testicular torsion

S&S

A

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
42
Q

Testicular cancer

A 
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
43
Q

Risk factors for testicular cancer

A

Undescended testes

Caucasian

44
Q

Cryptorchidism

A

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

45
Q

Inguinal hernia

A

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

46
Q

Detecting inguinal hernia

A

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

47
Q

Incarcerated hernia

A

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

48
Q

Strangulated

A

Blood supply to the entrapped contents is compromised

Ischemia/infarction

49
Q

Indirect inguinal hernia

A

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

50
Q

Direct inguinal hernia

A

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

51
Q

Femoral hernia

A

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

Physical Diagnosis (10 decks)

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