Phys DIE Flashcards
Pts with what disease are more likely to have UTIs?
DM
Questions to ask about medical history
- UTI
- renal dz
- congenital GU problems
- stones
- new onset of or change in sexual partner
- recent cath or GU procedure
- dialysis
- DM
- immunocompromised
- infertility
- STDs
- circumcised or uncircumcised
Fam hx
- UTIs/surgeries
- kidney stones
- renal cell carcinoma (runs in families)
- PKD
- prostate ca
social Hx
- SMOKING
- hygiene
- toilet habits
- adult diapers
Sexual hx
- risky behavior
- orientation, MSM, instrumentation
- symptomatic sexual partner?
- substance abuse - increases risk behavior
- sexual dysfunction
PE - inspection
- facial edema
- flank scars
- masses on flank/kidney area
- masses/distention of bladder
Proper kidney palpation technique
- both hands
- similar to spleen exam
- can’t palpate a normal kidney
Where do you palpate the kidneys for tenderness?
CVA
how to palpate bladder
- suprapubic area
- tenderness, mass, distention
what does it mean if the pt has an urge to void with gentle pressure of midline suprapubic mass?
distended bladder most likely
Four parts of male genitalia exam
- penis
- scrotum and contents
- prostate gland
- Hernia
3 parts of penis exam
- prepuce (foreskin)
- glands/meatus
- shaft
4 parts of scrotum/contents exam
- testicle
- epididymis
- spermatic cord
- special test: transilluminate scrotal mass
What position should the patient be in for the male genitalia exam?
standing
phimosis vs. paraphimosis
phimosis - difficulty retracting foreskin
paraphimosis - inability to replace prepuce once retracted
how to tell candida/yeast from smegma?
candida/yeast stuck to skin, smegma moves freely
Examination of glans penis
- lesions
- erythema
- swelling
- adhesions
- vesicles
balanitis
- inflammation of glans penis
- more common in uncircumcised men
examination of urethral meatus
- note location
- discharge
- express discharge if needed.
hypospadias
urethral meatus is ventral surface of glans, shaft, or perineal area
examination of shaft
- lesions or deformities
- palpate for irregularities, lesions
- note tenderness or increased warmth
dorsal vs. ventral
- remember anatomical position is erect penis
- dorsal is the “top”
- ventral is the “bottom”
what part of scrotum/testis most often involved in swelling
tunica vaginalis
examination of scrotum
- hold penis to one side
- scrotum should be wrinkled
- Note: scars, edema, sebaceous cysts, lesions, swelling, erythema
What asymmetry is normal/abnormal with scrotum/testes
- normal to hang asymmetric (left usually longer)
- size should not be drastically asymmetric
Examination of scrotal contents
- technique
- use both hands, one to support, one to palpate
- are both testes present?
- if absent, palpate inguinal canal and perineum for undescended
three things to feel for during scrotal inspection
- testicle
- epididymis
- spermatic cord
Examination fo testicle
- should move freely
- body is oblong
- smooth, rubbery, firm
- note nodules, masses, pain, tenderness, warmth, swelling
Scrotal mass transillumination
- dim the lights
- cool light source
- place light on posterior scrotum
- if light does not pass through = solid
- if light does pass through = fluid filled
Epididymal cyst
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- fluid filled sac, serous fluid, benign
- no pain
- yes transilluminate
- separate from testes
- behind testis
Spermatocele
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- cystic swelling in epididymis, milky fluid
- no pain
- yes transilluminate
- separate from testes
- behind testis
Hydrocele
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- serous fluid in tunica vaginalis
- no pain
- yes transilluminate
- surrounding testes
- in front of testis
Epididymitis
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- infection of epididymis
- yes pain
- no transilluminate
- separate from testes
- UTI, fever, catheter, STD
Varicocele
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- dilated veins in pampiniform plexus
- +/- pain
- no transilluminate
- separate from testes
- empties with pt supine, L>R
Hematocele
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- blood in tunica vaginalis
- +/- pain
- no transilluminate (fluid is opaque)
- surrounding testes
- Hx of trauma
Testicular cancer
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- testis is harder than normal
- no pain
- no transilluminate
- is the testes
- PE might be normal, young males common
Testicular torsion
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- testicle twisted on spermatic cord, ischemia
- YES!! pain
- no transilluminate
- n/a
- ipsilateral leg often held in flexion, affected testis is higher
- surgical emergency
Orchitis
- describe
- pain?
- transilluminate?
- testis or separate?
- other
- acute inflammation, often epididymis also
- YES!! pain
- no transilluminate
- testis itself
- mumps or other infection
Torsion
- cause
- age
- onset
- vomiting?
- fever
- dysuria
- associated sx
- cause: twisting of testis on cord
- age: newborn to adolescent
- onset: acute
- vomiting: common
- fever: uncommon
- dysuria: uncommon
- associated sx: scrotal discoloration
Epididymitis
- cause
- age
- onset
- vomiting?
- fever
- dysuria
- associated sx
- cause: infection (UTI/STD)
- age: adolescent to adulthood
- onset: gradual
- vomiting: uncommon
- fever: possible
- dysuria: possible
- associated sx: pyuria, nodular epididymis
Hernia exam technique
- insert examining finger into lower part of scrotum and push it into inguinal canal
- feel for oval external ring
- lrg hernia may feel like a mass
- ask pt to bear down to feel indirect hernia
Indirect hernia
- within the scrotum (usually)
- younger pts
- congenital
- through teh inguinal canal
Direct hernia
- Felt medial to examining finer
- Comes directly through abdominal wall
- Older pts
- Acquired
Three things to look for on perirectal skin
- candidiasis
- condyloma (genital warts)
- skin tag
Prostate exam technique
- insert finger to distal phalanx to allow sphincter to relax
- assess sphincter tone
- WINK
- sweep finger to left and right to cover rectal vault
How should the prostate feel?
- firm, smooth (pencil eraser)
- note masses, nodules, tenderness
- assess size and texture
Prostate grading (enlargement)
I: 1-2 cm
II: 2-3 cm
III: 3-4 cm
IV: >4 cm
enlargement is considered >1 cm
BPH
- describe
- sx
- benign prostatic hyperplasia
- smooth, rubbery, symmetric but enlarged
- sx: obstructive, nocturia
Prostate Cancer
- describe
- sx
- feels like gravel or rock
- hard, irregular, nodular
- sx are obstructive, low back pain if bone mets
Prostatitis
- describe
- acutely tender
- enlarged and boggy
- can be infectious
- don’t milk or massage
- sx: fever, discharge, irritative voiding, suprapubic or perineal pain
Rectum exam during prostate exam
- as remove finger palpate rectal walls for masses, nodules, tenderness
- stool specimen for hem occult test
- opportunistic exam :)
