Wk 9: Male health PE (incl. in 9%)

Question 1

What should you know abt male health PEs?

Answer 1

1) The anorectal and prostate examinations are usually the least popular segments of the physical examination
2) A skillfully performed examination should not be painful
3) Successful examination requires a calm demeanor, explanation to the patient of what he or she may feel, gentleness, and slow movement of your finger

Question 2

In asymptomatic ____________, it is appropriate to defer the rectal exam

Answer 2

adolescents

Question 3

One of several patient positions may be used for examination, what are they?

Answer 3

-The patient may stand, leaning forward with upper body resting across the examining table and hips flexed
-The patient may lie on left side with his buttocks close to the edge of the exam table near you; flex the patient’s hips and knees, especially the top leg

Question 4

What should you inspect the sacrococcygeal and perianal areas for?

Answer 4

-Lumps, ulcers, inflammation, rashes, or excoriations
-Palpate any abnormal areas, noting lumps or tenderness

Question 5

Occasionally, severe tenderness prevents entry and internal examination, give examples of causes of this

Answer 5

Anal fissure, external hemorrhoids

Question 6

What should you do if you can’t insert your finger due to tenderness?

Answer 6

1) Instead, place your fingers on both sides of the anus, gently spread the orifice, and ask the patient to bear down
2) Look for a lesion, such as an anal fissure/hemorrhoid that might explain the tenderness

Question 7

Describe how to examine the anus and rectum with a gloved finger. Incl. what you should assess for and note.

Answer 7

1) Lubricate a gloved index finger
2) Explain what you are going to do
3) Inspect the anus, noting any lesions
4) Ask the patient to strain/bear down
5) Place finger pad over the anus and gently insert your fingertip into the anal canal; proceed with insertion upon relaxation of the sphincter
-Assess for sphincter tone of the anus, tenderness, induration, irregularities, or nodules
6) Note the color of any fecal matter on the glove, and test it for occult blood
7) Prostate: examine posterior surface

Question 8

What should you examine when you’re palpating the posterior surface of the prostate gland?

Answer 8

1) Identify lateral lobes and median sulcus
-Is it enlarged? Boggy? Masses or nodules?
-Normal prostate is rubbery and nontender
2) If possible, extend your finger above the prostate to the region of the seminal vesicles and the peritoneal cavity; note any nodules or tenderness

Question 9

Define boggy. What is a boggy prostate a sign of?

Answer 9

Usually soft, spongy; a sign of infection or inflammation

Question 10

slide 59
During palpation, describe what you may feel with each pathology:
1) Rectal cancer
2) Prostate cancer
3) Peritoneal metastases
4) Acute bacterial

Answer 10

1) Firm, nodular, rolled edge of ulcerated cancer

Question 11

1) What condition may occur at the opening of sinus tract in midline natal cleft, sometimes with a small tuft of hair and halo of erythema, and may have slight drainage?
2) What can complicate this condition?

Answer 11

1) Pilonidal Cyst and Sinus
2) Abscess or secondary sinus tract formation

Question 12

1) A “very painful tear/ulceration of the anoderm, most commonly in the midline posteriorly (less commonly midline anteriorly)” describes what condition?
2) What may be just below this ulceration?
3) Gentle separation of anal margins may reveal what?

Answer 12

1) Anal Fissure
2) A swollen “sentinel” skin tag
2) Lower edge of the fissure; sphincter is spastic and exam is painful

Question 13

1) What action exacerbates rectal prolapse?
2) What is an anorectal fistula?
3) What do anorectal fistulas result from?

Answer 13

1) Straining.
2) Abnormal connective tract originating from anal glands to an external opening on the skin
3) A previous anorectal abscess/infection

Question 14

1) What are thrombosed hemorrhoids? Where do they originate and what are the symptoms?
2) What are prolapsed hemorrhoids? Where are they and what are the symptoms?

Answer 14

1) External Hemorrhoids; dilated veins originated below pectinate line, covered with skin.
-Thrombosis causes acute localized pain, worse with defecation and sitting.
-Tender, swollen, bluish, ovoid mass at anal margin.
2) Internal Hemorrhoids; enlargements of normal vascular cushions located above pectinate line, usually not palpable.
-May cause bright-red bleeding during defecation.
-May prolapse through anal canal; reddish, moist, protruding masses, classically located in the positions illustrated.

Question 15

A 65-year-old male presents to clinic for a routine examination. The following is the documentation of his prostate examination. Which would be of concern?
“Nodular, heart-shaped, 2.5 cm long, w median sulcus palpable”

Answer 15

“Nodular” (The normal prostate is smooth and rubbery, without nodules)

Question 16

Describe female rectal exams

Answer 16

1) The rectum is usually examined after the female genitalia, while the woman is in the lithotomy position
-This position is also ideal for conducting the bimanual examination and is suitable for testing the integrity of the rectovaginal wall
-May also help to palpate a cancer high in the rectum
2) If only the rectum requires inspection, the side-lying position affords a much better view to the perianal and sacrococcygeal areas
3) Use the same techniques for examination that are used for men