clinical skills male genitalia, anus, rectum, and prostate

what should be considered for H/O prostate disease?

prostatitis, BPH, prostate cancer

how often should testicular self examinations (TSE) be performed?

monthly 15-35 yo

what is it called when the prepuce cannot be pulled back to expose the glands?

phimosis

what is it called when the prepuce cannot be pulled forwards to cover the glands?

paraphimosis

what is balanitis?

inflammatory condition affecting penis, specifically the glands and sometimes the foreskin

what is the correct terminology for a ventrally displaced urethra?

hypospadias

what is the correct terminology for a dorsally displaced urethra?

epispadias

what should you do if there is a concern for an STI?

milk shaft of penis for discharge and culture

what is the disease where there is a plaque in the tunica albuginea causing a deformity?

peyronie's disease

how do we categorize genital development?

sexual maturity rating or Tanner staging

what is sexual maturity rating or Tanner staging based on?

pubic hair growth, penis, testis development

what are visual findings with gonorrhea?

yellow penile discharge, more likely to spread and infect other parts of the body

what might also be seen in pts with gonorrhea?

urethritis, rectal discharge, itching or bleeding, disseminated sx (rash, arthritis, fever)

what would be seen in male pts with chlamydia?

white penile discharge

what would be seen in male pts with scabies?

pruritis, excoriations

what is the medical term for genital warts?

condyloma acuminata

describe findings with genital warts

raised, cauliflower like lesions, no pain or other sx

describe findings with genital herpes simplex in males?

scattered or grouped vesicles that progress to erosions, with or without pain, may have fever, malaise, arthralgias, and lymphadenopathy

what is visual presentation of primary syphilis?

small red papule that becomes chancre/painless erosion

what are pts with primary syphilis more likely to have?

lymphadenopathy

describe presentation of chancroid

red, painful papule that develops into deep ulcer, painful lymphadenopathy

what is normal for the scrotum?

firm, descended, symmetric, nontender, ovoid, and 3x3-5cm

which testicle lies lower (normal)?

left

what are abnormal findings for scrotum?

swelling, lumps, veins, bulging, masses, asymmetry

what are abnormal findings for inguinal areas?

bulging or asymmetry, erythema, excoriations, lymphadenopathy

how should the epididymis feel when palpated?

nodular and cordlike without tenderness

how should the spermatic cord including the vas deferens feel when palpated?

stiff and tubular

when palpating the spermatic cord including the vas deferens, you should palpate from ___ to ___

epididymis to external inguinal ring

what is the lifetime risk for inguinal hernias in men?

25%

what is the lifetime risk for inguinal hernias in women?

<5%

if you palpate a bulge that moves your finger when feeling the external inguinal ring (after asking pt to cough), what type of hernia is it?

direct inguinal hernia

if you palpate a bulge that moves your finger when feeling the internal inguinal ring (after asking pt to cough), what type of hernia is it?

indirect inguinal hernia

femoral hernias have a higher incidence in what group of pts?

older women

what type of hernias are more likely to be emergent?

femoral hernia

how do you palpate for femoral hernia?

place fingers on anterior thigh and located femoral pulse, move medial towards pubic tubercle, ask pt to cough or strain

what is most important to check with hernias?

reducibility

what is a hernia that cannot be returned to abdominal cavity?

incarcerated hernia

what is a hernia called when the blood supply to the entrapped hernia contents is compromised?

strangulated hernia

what sx are more likely with strangulated hernia?

pain, nausea, vomiting

if a mass goes away when a pt lies down, what is it more likely?

hernia

if you are unable to palpate around and above a scrotal mass, what is it more likely?

hernia (sm)

how will the borders of a scrotal mass be?

clean cut and able to be palpated

what is the congenital abnormality where one or both testes do not descend?

cryptorchidism

who is cryptorchidism most common in?

premature infants

what are findings associated with cryptorchidism?

asymmetrical scrotum and non-palpable testicles or testes

if untreated, what can cryptorchidism increase the risk of?

testicular cancer, fertility issues, testicular torsion, and inguinal hernias

what is it called when fluid collects in the thin sac around the testicle?

hydrocele

can you palpate above and around the mass with hydrocele?

yes

what will happen on transillumination of hydrocele?

will light up

what is enlargement of the veins in the scrotum?

variocele

what does varicocele feel like?

bag of worms

how should you inspect variocele?

when pt is standing

what is testicular torsion?

twisting of the testicle on the spermatic cord

what is the presentation of testicular torsion?

acute pain, scrotal asymmetry/high riding testicle, absent cremasteric reflex

who is testicular torsion most common in?

neonates and adolescents

describe urgency of testicular torsion

acute surgical emergency

where is a testicular self examination best performed?

standing in shower

for females, can perform rectal exam in ___ after vaginal exam

lithotomy

what is normal for perianal skin?

more pigmented and coarser without lesions

for a DRE, how should you advance your fingers?

in direction of umbilicus

for DRE, how should you access sphincter tone?

have pt squeeze external anal sphincter

lack of sphincter tone is concern for what?

neurological problem

what is normal for palpation of prostate gland?

~2.5 cm with palpable lateral lobes with median sulcus, smooth and firm without enlargement, nodules, masses, or tenderness

what should you test fecal matter for?

occult blood

what is the second most diagnosed cancer and second leading cause of cancer death in men?

prostate cancer

what is the median age of dx of prostate cancer?

66yo

when should screening for prostate cancer begin for average risk pt?

50 yo

how often should PSA be done for prostate cancer screening?

annually

what exam findings are consistent with prostate cancer?

nodules or asymmetry on DRE, possible enlargement

what is BPH?

enlargement typically seen with age

what are sx of BPH?

urinary frequency, nocturia, urinary retention, decreased stream, dribbling

what findings are associated with BPH?

enlarge, smooth, nontender prostate

what is prostatitis?

acute infection, typically bacterial

what are sx of prostatitis?

fever, UTI, rectal or peritoneal pain

what are findings of prostatitis?

boggy and tender prostate

what is fistula commonly preceded by?

abcess

when a fistula connects to the rectum, what should be considered?

crohns, rectal TB, cancer, lymphogranuloma venereum

what are skin tags of rectum associated with?

inflammatory diseases

what are rectal fissures?

rocket-shaped ulcers usually <5mm

what are rectal fissures typically associated with?

trauma to anal canal during defecation

what underlying diseases can be associated with rectal fissures?

crohns, anal CA, syphilis, HIV/AIDS, TB

what is perianal itching/discomfort?

perianal pruritus

what can perianal pruritus be caused by?

poor hygiene, fistulas/fissures, pin worms, overcleaning

anal fissures and crohns disease can lead to...

rectal abscesses