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Hnp > Penis/Testes Exam > Flashcards

Penis/Testes Exam Flashcards

1
Q

The shaft of the penis is formed by three columns of vascular erectile tissue which are:

A

The corpus spongiosum, (containing the urethra)

and the two corpora cavernosa

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2
Q

The corpus spongiosum forms the _______ of the penis, ending in the cone-shaped glans with its expanded base, or ________

A

bulb; corona

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3
Q

In uncircumcised men, the glans is covered by a loose, hood-like fold of skin called the _______, or foreskin, where ________, or secretions of the glans, may collect

A

prepuce; smegma

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4
Q

The urethra opens into the vertical, slit-like ___________________

A

urethral meatus

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5
Q

The _________ are ovoid, somewhat rubbery

structures approximately 4.5 cm long

A

testes

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6
Q

Which testes lies lower than the other?

A

left is usually slightly lower than the right

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7
Q

What does the testes produce?

A

spermatazoa and testosterone

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8
Q

The ________ is a loose, wrinkled pouch divided into two compartments, each containing a testis

A

scrotum

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9
Q

Covering the testis, except posteriorly, is the serous membrane of the _________________

A

tunica vaginalis

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10
Q

On the posterolateral surface of each testis is the softer comma-shaped __________;

A

epididymis

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11
Q

What does the epididymis do?

A

the epididymis provides a reservoir for storage, maturation, and transport of sperm

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12
Q

The _____________, a cordlike structure, begins at the tail of the epididymis

A

vas deferens

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13
Q

The vas deferens ascends within the scrotal sac (as the _______________) and passes through the external inguinal ring on its way to the abdomen and pelvis

A

spermatic cord

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14
Q

Behind the bladder, the spermatic cord is joined by the duct from the ___________ and enters the urethra within the ______________

A

seminal vesicle; prostate gland

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15
Q

The basic landmarks of the groin are the ______________________, the ______________, and the __________________

A

ASIS, pubic tubercle, and the inguinal ligament

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16
Q

The _______________, which lies above and parallel to the inguinal ligament, forms a tunnel for the vas deferens

A

inguinal canal

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17
Q

The exterior opening of the tunnel is the ___________________; the internal opening of the canal is the ______________________

A

external inguinal ring; internal inguinal ring

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18
Q

What is an indirect inguinal hernia?

A

develop at the INTERNAL inguinal ring, where the spermatic cord exits the abdomen

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19
Q

What is a direct inguinal hernia?

A

they arise more medially from weakness in the floor of the inguinal canal and are associated with straining and heavy lifting, it is found at the EXTERNAL inguinal ring

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20
Q

When checking for hernias, the patient should ______ and the examiner should ________ on a chair or stool

A

stand; sit

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21
Q

When the patient retracts the prepuce, you may see a cheesy, white material called what?

A

smegma

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22
Q

Compress the _____ gently between your index finger above and thumb below to open the _______________ and allow inspection for discharge (normally there is none)

A

glans; urethral meatus

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23
Q

If the patient has reported a discharge that you are unable to see, what should you do?

A

ask him to milk the shaft of the penis from its base to the glans. This maneuver may bring some discharge to the urethral meatus for appropriate examination

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24
Q

What is the soft, nodular, cordlike structure at the back of the testicle?

A

epididymis

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25
Q

What can the patient do to make it easier to detect hernias?

A

stand, strain and bear down

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26
Q

When evaluating a possible scrotal hernia, If a large scrotal mass is found, ask the patient to lie down. If the mass disappears, it is a ________

A

hernia

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27
Q

If a scrotal mass remains when they lay down, what can you do to check if it is a hernia?

A

Listen to the mass with a stethoscope. If bowel sounds are heard, it is a hernia.

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28
Q

What can you do to a scrotal mass to see if it is a hernia?

A

Shine a strong light from behind the scrotum through the mass (transillumination). If a red
glow is observed, it is probably not a hernia

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29
Q

How do you access for hernias?

A

Use right hand to press into inguinal canal on right and vise versa with left hand and left side. Ask patient to bear down to see if a hernia touches your finger.

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30
Q

What is the normal write-up for a male GU exam?

A

Circumcised male. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally, smooth, without masses. Epididymis non-tender. No inguinal or femoral hernias.

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31
Q

Which of the following statements about hernias is true?

A.) Indirect inguinal hernias are the most common form of hernia
B.) Femoral hernias are the least common form and are more common in women
C.) Direct inguinal hernias are more common in men over age 40
D.) Indirect inguinal hernias originate above the inguinal ligament near its midpoint
F.) All of the above

A

ALL OF THE ABOVE!

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32
Q

A 21-year-old male presents complaining of a “nodule” on the back of his left testicle found during testicular self-examination. On examination, you find both testicles to be of normal size, shape, and consistency. On the back of the left testicle in the area of the “nodule,” you find a soft, nodular, tubelike structure with no areas of abnormal tenderness. Your most likely diagnosis is:

Acute epididymitis
Cyst of the epididymis
Normal epididymis
Carcinoma of the epididymis

A

Normal epididymis. The epididymis is located on the superior, posterior surface of each testicle. It feels nodular, soft, and cordlike and should not be confused with an abnormal lump.

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33
Q

single or multiple papules or plaques of variable shapes; may be round, acuminate (or pointed), or thin and slender. May be raised, flat, or cauliflowerlike (verrucous).

A

genital warts (condylomata acuminata)

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34
Q

What is the causative organism for condylomata?

A

HPV, usually from subtypes 6 and 11

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35
Q

How common is the carcinogenic form of condylomata?

A

rare, approx. 5-10% of all anogenital warts, incubation is weeks to months, infected contact also may have no visible warts

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36
Q

Where can condylomata show?

A

penis, scrotum, groin, thighs, anus, usually it is asymptomatic, occasionally cause itching and pain- may disappear without treatment

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37
Q

Small scattered or grouped vesicles, 1-3 mm in size, on glans or shaft of penis. Appear as erosions if vesicular membrane breaks.

A

genital herpes simplex

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38
Q

What type of herpes simplex usually occurs?

A

herpes simplex virus 2 (90%), a double stranded DNA virus. 2-7 days incubation

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39
Q

What are the associated symptoms of herpes besides the vesicles?

A

primary episode may be asymptomatic; recurrence usually less painful and of shorter duration. Associated with fever, malaise, headache, arthralgias, local pain and edema, lymphadenopathy

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40
Q

What do you need to distinguish herpes from?

A

genital herpes zoster (usually older people with dermatome distribution), candidiasis

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41
Q

Small, red papule that becomes a chancre, painless erosion up to 2 cm in diameter, base of chancre is clean, smooth, red and glistening. Borders are raised and indurated. It heals within 3-8 weeks.

A

syphillis

42
Q

What is the causative organism for syphillis?

A

treponema pallidum, a spriochete, incubation is 9-90 days after exposure

43
Q

What are the associated symptoms of syphillis?

A

may develop inguinal lymphadenopathy within 7 days, lymph nodes are rubbery, non-tender and mobile

44
Q

What percentage of people get secondary syphillis?

A

20-30% of patients will get it with chancre still present, which suggests coinfection with HIV

45
Q

What do you need to distinguish syphillis from?

A

genital herpes simplex, chancroid, granuloma inguinale from klebsiella (rare in the United States)

46
Q

Red papule or pustule initially, then forms a painful deep ulceration with ragged nonindurated margins; contains necrotic exudate, has a friable base.

A

chancroid

47
Q

What is the causative organism for chancriod?

A

haemophilus ducreyi, an anaerobic bacillus, incubation: 3-7 days after exposure

48
Q

What are the associated symptoms of chancroid?

A

painful, inguinal adenopathy, suppurative buboes in 25% of patients

49
Q

What do you need to distinguish chancroid from?

A

primary syphilis, genital herpes, lymphomogranuloma venereum, granuloma inguinale from klebsiella granulomatis (both rare in the United States)

50
Q

A congenital displacement of the urethral meatus to the inferior surface of the penis. A groove extends from the actual urethral meatus to its normal location on the tip of the glans.

A

hypospadias

51
Q

pitting edema may make the scrotal skin taut; seen in heart failure of nephrotic syndrome

A

scrotal edema

52
Q

Palpable, non-tender, hard plaques are found just beneath the skin, usually along the dorsum of the penis. The patient complains of crooked, painful erections

A

peyrnonie’s disease

53
Q

A nontender, fluid filled mass within the tunica vaginalis, it transilluminates, and the examining fingers can get above the mass within the scrotum

A

hyrdrocele

54
Q

An 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.

A

carcinoma of the penis

55
Q

Usually an indirect inguinal hernia, that comes from the external inguinal ring, so the examining fingers cannot get above it within the scrotum

A

scrotal hernia

56
Q

The testes is atrophied and may lie in the inguinal canal or the abdomen, resulting in an unfilled scrotum. There is no palpable left testis or epididymis. This condition raises the risk for testicular cancer.

A

cryptochidism

57
Q

In adults, testicular length is usually < or equal to ________ cm.

A

3.5 cm

58
Q

In what conditions may you see small, firm testes?

A

small, firm testes in klinefelter’s syndrome, usually less than or equal to 2 cm

59
Q

In what conditions do you see small, soft testes?

A

soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use of estrogens, and hypopituiatarism, may also follow orchitis

60
Q

Acutely inflamed testes, painful, tender and swollen. It may be difficult to distinguish from the epididymis. The scrotum may be reddened, and it is usually unilateral.

A

acute orchitis

61
Q

What kind of infections do you see acute orchitis in?

A

Mumps and other viral infections

62
Q

is a tumor of the testes painful or painless?

A

painless

63
Q

What are the characteristics of a late tumor in the testes?

A

as the tumor grows, it may seem to replace the entire organ, the testicle feels heavier than normal.

64
Q

A painless, movable, cystic mass just above the testis suggests a…….

A

spermatocele or epididymal cyst

65
Q

What test can you do to ensure something is a cystic mass (spermatocele or epididymal cyst)?

A

transillumination

66
Q

What is the difference between a spermatocele and an epididymal cyst?

A

a spermatocele has sperm, and an epididymal cyst does not, they are clinically indistinguishable though

67
Q

varicose veins of the spermatic cord

A

varicocele

68
Q

Where do you see a varicocele usually?

A

on the left

69
Q

What is the buzz word or buzz term for a varicocele?

A

It feels like a soft “bag of worms” separate from the testis, and slowly collapses when the scrotum is elevated in the supine patient.

70
Q

What may be associated with a varicocele?

A

infertility

71
Q

How does acute epididymitis present?

A

Tender, swollen epididymis that may be difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. It occurs chiefly in adults.

72
Q

What STD infection most commonly occurs along with acute epididymitis?

A

chlamydia

73
Q

What goes along with acute epididymitis that helps with the diagnosis?

A

coexisting urinary tract infection or prostatitis

74
Q

How does torsion of the spermatic cord present?

A

acutely painful, tender, and swollen organ that is retracted upward in the scrotum. Scrotum is red and edematous. No associated urinary infection.

75
Q

How do you treat a spermatic cord torsion?

A

Most common in adolescents, it is a surgical emergency because of obstructed circulation.

76
Q

Who most commonly gets indirect hernias?

A

All ages, both sexes. Often in children, may be adults.

77
Q

What is the point of origin for an indirect hernia?

A

Above the inguinal ligament, near its midpoint (the internal inguinal ring)

78
Q

What does an indirect hernia often course into?

A

often into the scrotum

79
Q

When the examining finger goes into the inguinal canal during straining.. the INDIRECT hernia…

A

comes down the inguinal canal and touches the fingertip

80
Q

How common is a direct hernia? Who is it most common in?

A

Less common, usually seen in men above 40. It is rare in women.

81
Q

What is the point of origin for a direct hernia?

A

Above the inguinal ligament, close to the pubic tubercle (near the external inguinal ring).

82
Q

What is this course for a direct hernia?

A

Rarely into the scrotum

83
Q

The examining finger in the inguinal canal during straining.. the DIRECT hernia

A

bulges anteriorly and pushes the side of the finger forward

84
Q

How common is a femoral hernia? In who is it most common?

A

It is the least common of all hernias. It is most common in females.

85
Q

How does a femoral hernia present?

A

Below the inguinal ligament, appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes. It never goes into the scrotum. The inguinal canal is empty.

86
Q

Non-distended testes increases your risk for what?

A

Testicular cancer

87
Q

Symptoms and treatment for herpes?

A

Painful, burning, fever, malaise, headache, treat them with antivirals- valtrex and adenovir cream

88
Q

How do you treat syphillis? If left untreated what can it lead to?

A

Penicillin, untreated can lead to secondary and tertiary syphillis. It can also lead to blindness.

89
Q

How do you treat chancroid?

A

Antibiotics

90
Q

What could be the cause of a hydrocele?

A

Ascites, fluid backs up in the scrotum

91
Q

How do you treat Peyronie’s disease?

A

CCB’s, PO or injected into penis

92
Q

Bilateral small testes could be from what?

A

Mumps

93
Q

Inguinal lymphadenopathy and painful testes

A

Acute epididymitis

94
Q

Hydrocele, non tender or tender?

A

Non tender

95
Q

When is the phren’s sign positive or negative?

A

Positive with testicular torsion, negative with epididymitis

96
Q

How do you treat a hydrocele?

A

Self limiting, do not drain

97
Q

Who are hydroceles often seen in?

A

Newborns

98
Q

What is paraphmosis?

A

Retracted foreskin gets stuck

99
Q

What is phimosis?

A

Foreskin doesn’t completely cover glans

100
Q

What is a true undescended testicle?

A

Never had documentation of a descended testicle, born without testicle in the scrotum

101
Q

Testicular ascend as well as cryptochidism have increased risks for what?

A

Testicular cancer

102
Q

What can cause an anal rectal fistula?

A

Giving birth and perirectal abscess

Hnp (9 decks)

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