Wk 9: Male health + misc (9% of final)

Question 1

Anatomical structures and their pathologies:
1) What is a pathology of the urethral meatus?
2) What is a pathology of the urethra?
3) What is a pathology of the glans?
4) What is a pathology of the corona/ prepuse?

Answer 1

1) Hypospadias
2) Cystitis
3) Balanitis
4) Paraphimosis

Question 2

1) What is the significance of the corpus cavernosum?
2) What structure do vasectomies involve?
3) What pathology can occur at the epididymis/testicle?
4) What very common pathology can occur involving the Tunica Vaginalis?

Answer 2

1) Erection
2) Vas deferens
3) Epididymitis/orchitis
4) Testicular torsion

Question 3

1) Hydroceles and varicoceles both involve what structure?
2) BPH can occur where?

Answer 3

1) Scrotum
2) Prostate

Question 4

1) Define paraphimosis
2) Is it an emergency? Why or why not?

Answer 4

1) Retracted fοreѕkiո in an uncircumcised mаlе that cannot be returned to normal position
2) Emergency; can cause ischemia to the glans/penis

Question 5

List the 3 basic landmarks of the groin

Answer 5

Anterior superior iliac spine (ASIS), the pubic tubercle, and the inguinal ligament

Question 6

1) What forms a tunnel for the vas deferens and lies above and parallel to the inguinal ligament?
2) What is the exterior opening of this tunnel called?
3) What about the interior opening?

Answer 6

1) The inguinal canal
2) External inguinal ring
3) Internal inguinal ring

Question 7

When loops of bowel force their way through weak areas of the inguinal canal, what type of groin hernia is this?

Answer 7

Inguinal

Question 8

1) What type of hernias arise at internal inguinal ring?
2) What type of hernias arise more medially through floor of inguinal canal (Hesselbach’s triangle)?

Answer 8

1) Indirect inguinal
2) Direct inguinal

Question 9

When an organ protrudes through femoral canal, it’s a ___________ hernia

Answer 9

femoral

Question 10

What are the boundaries of Hesselbach’s Triangle medially, laterally, and inferiorly?

Answer 10

1) Medially: Rectus abdominis m.
2) Laterally: Inferior epigastric vessels
3) Inferiorly: Inguinal ligament

Question 11

What 7 symptoms of infection questions should you ask when it comes to male health? [during health history]

Answer 11

1) Is there any discharge from the penis, dripping, or staining of underwear? If so, how much and what is its color and consistency?
2) Any associated fevers, chills, or rash?
3) Any sores or growths on the penis?
4) Any pain or swelling in the scrotum?
5) Any lymphadenopathy?
6) Any history of risk factors for STI? (promiscuity, homosexuality, illicit drug use)
7) Any irritative (dysuria or frequency) or obstructive (initiating flow/ceasing flow) urinary tract symptoms?

Question 12

Divide urinary tract symptoms into 2 categories

Answer 12

1) Voiding (obstructive) symptoms: urinary hesitancy, diminished stream, straining, incomplete emptying, interruption of the urinary stream, and dribbling
2) Filling (irritative) symptoms: urgency, frequency, and nocturia

Question 13

What should Health Promotion and Counseling involve regarding male health? (3 things)

Answer 13

1) Prevention of STIs, HIV, pregnancy
2) Testicular self-examination
3) Prostate exam & PSA

Question 14

1) What is the most common malignancy in adult males 15-35 years old?
2) Is it curable? Explain.
3) How does it often present as?

Answer 14

1) Testicular cancer
2) Highly curable if detected early; do not delay evaluation
3) Painless testicular mass

Question 15

1) In any male with a solid, firm mass within the testis, __________________ must be the considered diagnosis until proven otherwise
2) How could it be proven otherwise?

Answer 15

1) testicular cancer
2) Scrotal ultrasound followed by other diagnostic work-up as necessary

Question 16

How should you perform a male GU exam? (technique/ bedside manner) (4 things)

Answer 16

1) It may be reassuring to explain each step of the examination, so the patient knows what to expect
2) Male patients may have erections during the examination; if this happens, this is a normal response
3) A good genital examination may be done with the patient either standing or supine
4) When checking for hernias, the patient should stand, and the examiner should sit on a chair or stool

Question 17

Male GU exam:
1) What should you check about the skin?
2) What should you check abt the prepuce? (after u ask the pt to retract if present)
3) What should you check abt the glans? What should you compress and why?

Answer 17

1) Check the skin around the base of the penis for excoriations or inflammation
2) Smegma, a cheesy, whitish material, may accumulate normally under the foreskin
3) Ulcers, nodules, or signs of inflammation
-Note the location of the urethral meatus
-Compress the glans gently between your index finger above and thumb below to open the urethral meatus and allow inspection for discharge (normally there is none)

Question 18

1) What should you palpate abt the penis?
2) If the patient has reported a discharge that you are unable to see, what should you do? Why?

Answer 18

1) The shaft of the penis, noting any induration/ deformity, any abnormality, tenderness, or induration
2) 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.

Question 19

What two features of the scrotum should you inspect? What should you look for?

Answer 19

1) Skin; lift the scrotum to view its posterior surface
2) Scrotal contours; note swelling, lumps, veins

Question 20

1) What should you palpate on each testis and epididymis?
2) What is the epididymis?
3) What should you note abt each spermatic cord?

Answer 20

1) Size, shape, consistency, and tenderness; feel for any nodules
2) A soft, nodular, cordlike structure at the back of the testicle
3) Nodules or swelling

Question 21

1) In what positions should you inspect hernias? What should you note?
2) What hernias should you palpate for?

Answer 21

1) Sit comfortably in front of the standing patient; Ask the patient to strain and bear down, making it easier to detect any hernias
-Note any areas of bulging or asymmetry
2) Inguinal and femoral hernias

Question 22

1) Who are indirect inguinal hernias most common in?
2) What abt direct hernias?
3) What abt femoral hernias?
Of these, which hernia is most common?

Answer 22

1) All ages, both sexes. Often in children, may be in adults. Most common.
2) Usually in men >40 and rare in women. Less common.
3) Least common. More common in women.
-Indirect inguinal most common

Question 23

What is the point of origin of:
1) Indirect inguinal hernias?
2) Direct inguinal hernias?
3) Femoral hernias?
-Of these, which can be hard to differentiate from lymph nodes?

Answer 23

1) Above inguinal ligament near midpoint (internal inguinal ring)
2) Above inguinal ligament close to pubic tubercle (near external inguinal ring)
3) Below inguinal ligament, more lateral than an inguinal hernia.
-Femoral hernias can be hard to differentiate from lymph nodes

Question 24

How do
1) Indirect inguinal hernias
2) Direct inguinal hernias
3) Femoral hernias
relate to the scrotum, and to examining w. a finger in the inguinal canal?

Answer 24

1) Often into scrotum; the hernia comes down inguinal canal & touches the fingertip.
2) Rarely in the scrotum; hernia bulges anteriorly and pushes the side of the finger forward.
3) Never in the scrotum; inguinal canal is empty
slide 29

Question 25

When evaluating a large scrotal mass for scrotal hernia, what position should you have the pt in? How do you know if it’s a hernia?

Answer 25

Ask the patient to lie down. If the mass disappears, it is a hernia.

Question 26

1) What should you do if a scrotal mass remains while the pt is laying down?
2) Transillumination is primarily used to dx what?

Answer 26

1) -Listen to the mass with a stethoscope. If bowel sounds are heard, it is a hernia.
-Shine a strong light from behind the scrotum through the mass (transillumination). If a red glow is observed, it is probably not a hernia.
2) Hydrocele

Question 27

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 >40
D) Indirect inguinal hernias originate above the inguinal ligament near its midpoint
E) All of the above

Answer 27

All of the above

Question 28

1) The gastrointestinal tract terminates in a short segment called the ____________.
2) Normally, this segment is held in a closed position by what two muscles?

Answer 28

1) anal canal
2) Voluntary external anal sphincter and involuntary internal anal sphincter

Question 29

1) The angle of the anal canal lies on a line roughly between what 2 structures?
2) The anal canal is liberally supplied by what?

Answer 29

1) Anus and umbilicus
2) Somatic sensory nerves

Question 30

1) What demarcates the anal canal from the rectum?
2) What is the boundary between somatic (anal canal) and visceral (rectum) nerve supplies?

Answer 30

1) A serrated line
2) The anorectal junction (often called the pectinate or dentate line)

Question 31

1) In the male, the prostate gland lies against what?
2) What does a normal prostate gland feel and look like? important
3) True or false: You can only palpate part of the prostate (right and left lateral lobes) on DRE.

Answer 31

1) The anterior rectal wall
2) Rounded, heart-shaped, 2.5 cm long, smooth, rubbery, non-tender, not fixed to surrounding tissues
3) True

Question 32

What are 6 common or concerning Sx of the male anus, rectum, and prostate?

Answer 32

1) Change in bowel habits
2) Blood in the stool (hematochezia & melena)
3) Pain with defecation; rectal bleeding or tenderness
4) Anal warts or fissures
5) Weak stream of urine
6) Burning upon urination (dysuria)

Question 33

Questions concerning symptoms related to the anorectal area may be classified into what two categories?

Answer 33

1) Lower gastrointestinal (GI)
2) Lower genitourinary (GU)

Question 34

List 5 health concerns about the lower GI

Answer 34

1) Is there any change in the pattern of bowel function?
2) Any change in the size or caliber of the stool?
-colon cancer causes smaller mass
3) Any diarrhea or constipation?
4) What color is the stool? (black, brown, acholic)
-acholic stool = no color/ bile, kinda clayish pale = liver/ gallbladder issue.
5) Any obvious blood or mucus in the stool?
-colon cancer, polyps, hemorrhoids

Question 35

1) Change in stool caliber, especially pencil-thin stools, may warn of ________ cancer
2) Blood in the stool may be from one of what 5 things?

Answer 35

1) colon
2) Polyps, hemorrhoids, GI bleeding, or carcinoma

Question 36

1) Mucus in stool may accompany what 4 conditions?
2) Define acholic stool and what causes it

Answer 36

1) Villous adenoma, intestinal infections, IBD, or IBS
2) Clay colored; lack bile pigment which normally gives yellow-brown color due to hepatobiliary disease

Question 37

List 6 additional concerns about the lower GI

Answer 37

1) Any pain on defecation?
2) Any itching?
3) Any extreme tenderness in the anus or rectum?
4) Any purulent discharge or bleeding?
5) Any history of anal warts, ulcerations, or fissures?
6) Any involvement in anal intercourse?

Question 38

Anorectal pain, tenesmus [feeling of needing to defecate even though you cannot], or discharge and/or bleeding suggest what?

Answer 38

Proctitis

Question 39

Anal fissures are seen in what 2 conditions?

Answer 39

Proctitis and Crohn disease

Question 40

List potential causes of proctitis (don’t need to be detailed)

Answer 40

1) IBD
2) Sexually transmitted infections (STIs)
-such as gonorrhea, chlamydia, lymphogranuloma venereum, herpes simplex, or chancres of primary syphilis
3) Trauma from receptive anal intercourse; bacterial infections
4) Radiation therapy.

Question 41

List 7 lower GU concerns for men

Answer 41

1) Is there any difficulty starting or holding back the urine stream?
2) Is the urine flow weak? Intermittent (starts/stops during urination)?
3) Is there frequent urination, especially at night (nocturia)?
4) Is there any pain or burning upon urination (dysuria) or ejaculation?
5) Any blood in the urine (hematuria) or semen?
6) Any pain or stiffness in the lower back, hips, or upper thighs?
7) Any discomfort or heaviness in the perineum and low back?

Question 42

Sudden onset pain in the perineum and low back can be associated with what symptoms?

Answer 42

1) Malaise, fever, chills
2) Irritative urinary tract sxs (frequency, urgency, dysuria)

Question 43

Changes in ability to start or hold back the urine stream, changes in urine flow, or changes in frequency in urinatino (esp nocturia), all may suggest what?

Answer 43

Benign prostatic hyperplasia (BPH), especially in men older than 70 years.

Question 44

Advanced ____________ cancer can cause urinary symptoms and back pain.

Answer 44

prostate

Question 45

Blood in the urine can be caused by what?

Answer 45

1) BPH
2) Urolithiasis (stones)
3) UTIs
4) Prostate, bladder, or kidney cancer.

Question 46

Sudden onset irritative urinary tract sxs [frequency, urgency, dysuria] w. perineal + low back pain & associated malaise, fever, chills suggests what condition?

Answer 46

Acute prostatitis

Question 47

What men’s health Health Promotion and Counseling should be done? (3 things)

Answer 47

1) Discuss prostate cancer screening
2) Screen for colorectal cancer and premalignant polyps/lesions (USPSTF)
3) Provide counseling about sexually transmitted infections (STIs)

Question 48

1) Prostate cancer is the leading cancer diagnosed in men in the United States, and the ________ leading cause of death
2) What are the primary risk factors? What else may be a risk factor?
3) Are screening recommendations universal?

Answer 48

1) third
2) Advanced age, ethnicity (black), and family history
-intake of dietary fat
3) Screening recommendations vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial

Question 49

1) Why should you engage in shared decision making regarding prostate cancer screenings?
2) For average risk males, initiate discussion of screening at age ___ years (as early as age ____ for higher risk)

Answer 49

1) Screening may offer a small potential benefit, but there are risks of harm (false positives, etc.)
2) 50; 40

Question 50

1) What prostate cancer screening method is recommended? How often and in what age group?
2) Frequency of ________ testing and age to initiate and stop screening varies depending on the source

Answer 50

1) Prostate-specific Antigen (PSA) testing every 1-2 years up to age 69-75
2) PSA

Question 51

1) What type of GI cancer and polyps should you screen for in both males and females?
2) At what age should screening start for all adults of avg risk? (in both sexes)
3) What age group is there selective screening?
4) How often are colonoscopies done?

Answer 51

1) Colorectal cancer and premalignant polyps/lesions (USPSTF)
2) 45
3)76-85 years
4) Every 10 years (other testing options exist if pt is not amenable to colonoscopy)

Question 52

When you provide counseling about sexually transmitted infections (STIs), what else should you suggest?

Answer 52

Partners to be tested