Physical Assessment Final

Male anatomy

• testes: make sperm & testosterone

• Epipidymis: stores & matures sperm

• Vas deferens: transports sperm

• Prostate: produces fluid for semen

• Urethra: carries urine out of the body

• Scrotum: holds the testes

Where do you check for a hernia?

• inguinal area (groin)

• Femoral area (below inguinal ligament)

• ask pt to cough or bear down

Tanner stages

• sexual maturity

• 1: no puberty

• 2: puberty begins

• 3: continued development

• 4: almost mature

• 5: fully mature

• first sign of puberty in males is testicular enlargement

• first sign of puberty in females is breast budding

Male GU Abnormalities

• Phimosis: foreskin cannot retract

• Paraphimosis: foreskin trapped behind glans (swelling, emergency)

• Hypospadias: urethral opening underneath penis

• Epispadias: urethral opening on top

• Cryptochidism: undescended testicle (missing from scrotum)

• Hydrocele: fluid around testicle (swelling)

• Orchitis: inflammation of testicle (pain & swelling)

• Epididymitis: inflammation of epididymis (testicular pain and tenderness)

• Varicocele: enlarged scrotal veins

• Tinea cruris: fungal groin infection

• Testicular torsion: twisted spermatic cord, cuts off blood supply to testicle (severe sudden pain, emergency)

• Priapism: prolonged erection (emergency if greater than 4 hours)

BPH vs Prostate Cancer

• BPH

  • benign enlargement, enlarged prostate, weak urine streak, urine retention, nocturia (urinating at night), hesistency & dribbling

• Prostate Cancer

  • malignant growth, hard or irregular nodule, may have no early symtpms, may cause urinary symptoms later

    • clue: hard irregular prostate nodule

Other conditions

• CKD (chronic kidney disease)

  • long term kidney damage or reduced function

  • possible findings: edema, hypertension, fatigue, increased creatinine

• Bladder cancer:

  • classic clue: painless blood in urine (hematuria)

• STIs

  • Herpes: painful blisters or ulcers

  • syphillis: classically a painless chancre

  • HPV: genital warts may occur

  • Gonorrhea: thick yellow, white or green discharge

  • Chlamydia: buring during urinating, cloudy/watery discharge

• TSE: testicular self examination

  • check for new lumps, swelling or changes in the testes

Anus, Rectum & Prostate

• order:

  • colon → rectum → anal canal → anus

  • the prostate is located in front of the rectum, below the bladder

• Digital rectal examination (DRE)

  • assess for masses, tenderness, abnormal tissue, prostate enlargement

  • findings:

    • smooth, enlarged prostate = BPH

    • tender prostate = prostatitis

    • hard irregalar nodule = possible prostate cancer

Rectal abnormalities

• Hemorrhoids: swollen veins, may cause bright red blood

• Anal fissure: tear causing pain during bowel movements

• Fistula: abnormal tunnel with possible drainage

• Rectal prolapse: rectal tissue protrudes through anus

• Colorectal cancer: change in bowel habits, blood in stool & weight loss

Bright red blood vs Melena

• Bright red blood: often associated with lower GI bleeding

• Melena: black, tarry stool associated with upper GI bleeding

• Occult blood: blood that cannot be seen with the naked eye

• remember: severe upper GI bleeding can sometimes cause red blood in the stool

Colorectal cancer

• possible symp:

  • change in bowel habits

  • blood in stool

  • unexplained weight loss

  • iron deficiency anemia

  • average risk screen starts at age 45

Female GU system

• Menarche: first menstrual period

• LMP: first day of last menstrual period

• Menorrhagia: heavy or prolonged menstrual bleeding

• Dysmenorrhea: painful periods

• Amenorrhea: absence of menstruation

• Menopause: 12 months without a menstrual period, when not caused by another condition

• Nulliparous: has not delievered a pregnancy or beyond the relavent gestational threshold

• Parous: has delievered a pregnancy at or beyond that threshold

Pregnancy history terms

• Gravida: number of pregnancies

• Para: number of pregnancies reaching the relevant gestational threshold

• Primigravida: pregnant for the 1st time

• Multigravida: pregnant 2 or more times

• Primipara: has delivered 1 pregnancy at or beyond the relevant threshold

• Multipara: has delivered 2 or more pregnancies at or beyond the relevant threshold

twins count as 1 pregnancy

Cervical findings

• these signs may suggest pregancy but not confirm it

• Chadwicks sign: bluish cervix/ vagina

• Goodell’s sign: soft cervix

• Hegar’s sign: soft uterine isthmus

• Nabothian cyst: benign mucous filled cysts on the cervix

Urge incontinence

• stress incontinence: urine leaked with coughing, sneezing, lauging or exercise

  • caused by a weakend pelvic floor or urethral closure mechanisms

• urge incontinence: sudden, strong urge to urinate followed by leakage

  • associated with overactive bladder

Cervical cancer

• associated with persistent high risk HPV infection

• HPV vaccination help prevent HPV related cancers

• screening detects precancerous changes

Sexual health history

ask about

• partner & practices

• contraception

• STI history & exposure

• pregancy possibility

• menstural hx

• pain, discharge

General sequence

• start from the head then travel through system

• normal order: inspect, palpate, percuss, auscultatin

• for abdomen: inspect, listen, palpate then percuss

How to approach different ages

• infant: keep warm, involve caregiver, assess while calm

• toddler: simple words & distraction

• preschooler: explain simply & use play

• school-aged child: explain what your doing & allow questions

• adolescent: privacy, independence

infant assessment

fontanels: assess for abnormal bulging or depression

moro relfex: startle response

rooting reflex: turn towards stimulation near mouth

sucking relfex: should suck involuntary when finger is placed on lip

grasp reflex: grabs objects that is placed in palm

ortolani maneuver: hip dysplagia/hip stability

meconium: first stool, passed within 24-48 hr after birth

Presumptive, Probable & Positive Signs of Pregnancy

• presumptive: symptoms felt by pregnant person (nausea, fatigue, missed period)

• Probable: finding suggesting pregancy, but not definite (+ preg test, hegars signs, chadwicks etc)

• Positive: findings confirming a fetus ( heart tones, ultrasound, fetal movement)