PA II: Male GU Physical Exam

what organ eliminates nitrogenous waste, regulates fluid, electrolytes, acid-base and mineral balance

kidneys

what transports urine to bladder

ureters

what collects urine

bladder

what produces seminal fluid, produces muscular contraction to assist with ejaculation and regulates urine flow

prostate

what carries urine from bladder and transports semen

urethra

shaft of penis is formed by 3 columns of _______ tissue

vascular

what can expand to accomodate large volumes of fluid

scrotum

what are common causes of epididymitis

chlamydia/GC, heavy repetitive lifting

what transports sperm to the urethra

vas defrens

what is contained within the spermatic cord

vas defrens, blood vessels/veins, nerves and muscle fibers

what should you do when bacterial prostatitis is suspected?

"milk" the prostate to ensure infectious prostate pathogen is released in urine stream

what are some lower urinary tract symptoms

- inc in urinary frequency

- pain with urination

- sensation there is more to void after peeing

- NVD

- recent travel and woodland water exposure

- nocturia/incontinence

what do you suspect if there is active bleeding when the penis is in the downward position

urethral shearing injury - requires qualified surgeon

what do you suspect if there has been a change in testicular size or height (especially if scrotum was not supported)

torsion

what etiology do you think if there is a painful lump on scrotum? painless?

inflammatory; malignant

what must you complete before beginning infertility workup for men?

STI, LUTS, and trauma HPI to rule out other issues

painful or difficulty urinating

dysuria

visible blood in the urine stream

hematuria

cloudy urine that contains high levels of WBCs

pyuria

what are some meds can induce LUTS

- diuretics

- antihistamine/anticholinergic (diphenhydramine, TCAs)

- alpha-adrenergic (pseudophedrine)

- alpha-antagonist (prazosin, doxazosin)

- opioids

- benzos

congenital displacement of the urethra to inferior/ventral peni

hypospadias

congenital displacement of the urethra to the dorsal penis

epispadias

what illicit drug is a powerful vasoconstrictor and can induce erectile dysfunction

cocaine

what illicit drug can induce urinary retention and induce ED

methamphetamine

what can EOTH use cause

ED

polyuria

what are 2 key features when doing a male GU PE

offer chaperone to be present

done with patient standing

what should be included in the examination of the kidneys during male GU exam

- attempt to palpate lover pole of kidneys

- auscultate renal arteries for bruits

- percuss right and left lower back at CVA for any tenderness

bladder can normally hold ________ ml of urine and is not normally palpable

400-500

what lymph. nodes should be examined in male GU exam

inguinal lymph nodes

what are you inspecting the genital skin for

- erythema

- xerosis

- pubic lice

- ulcerations

- hair distribution

- tinea cruris

- inverse psoriasis

- etc....

what intensifies the itch for yeast/fungal infections

heat or warm showers

inability of the foreskin to naturally retract to normal position

phimosis

profuse yellow drainage from the urethra may indicate ....

gonorrhea

scanty white discharge form urethra may indicate .....

chlamydia

clear discharge from urethra may indicate ....

trichomonas

any injury to the tunica albuginea may result in scar tissue forming in cells which forms a plaque

- characterized by curvature in penile shaft that is preceded by painful erections

peyronies dz

HSV-2 is traditionally associated with _____

genital dz

when are benign small-dome shaped skin colored papules around the sulcus or the corona of the glans penis

pearly penile papules

what bacteria is syphilis caused by

treponema pallidum

what are anogenital warts (condyloma acuminatum) most commonly associated with

HPV 6 and 11

a painless ulceration that fails to heal on the glans may indicate....

malignant lesion

when should you comment that both tests are descended on pt chart?

EVERY well check especially @ 2,4,6,12 months

what will transillumination of the scrotum help diagnose

hydrocele & spermatocele

inflammation of the testicle

orchitis

what is highly associated with orchitis

mumps

what will the scrotal skin look like in orchitis

erythematous & edematous

what s/s will you see in epididymitis

- painful scrotum

- urethral discharge

- pyuria

- epididymis is tender, firm and lumpy on palpation

- scrotum may be erythematous

what s/s do you see in testicular torsion

- acute onset of scrotal pain

- NV

- absence of cremasteric reflex on affected side

what reflex:

stroke inner thigh --> testicle and scrotum on that side should rise

cremasteric reflex

what s/s do you see with varicocele

- often asymptomatic

- heaviness of scrotum

- described as bag of worms

how are varicoceles graded?

small - palpated only during valsalva

moderate - easily palpated w/out valsalva

large - visible bulging

where does fluid accumulate with hydroceles of the scrotum

tunica vaginalis

what s/s do you see with hydrocele

- painless swelling of scrotum

- on-tender firm and smooth mass superior and anterior to testes

- confined to scrotum

what s/s with testicular cancer/malignancy?

- painless mass

- enlarged scrotum

- heaviness

- dull ache in lower back, abd or groin

- sudden collection of fluid in scrotum

- fixed mass on testes that does not transilluminate

what should you have the patient do on hernia exam

stand, turn head and bear down or cough

_____ hernia comes down into the scrotum

indirect inguinal

_____ hernia is palpable in the pubic area

direct inguinal

a normal prostate measures _____cm from side to side and protrudes _____cm into the rectum

3.5; 1

prostate must be examined in all males who report _____

LUTS

what are you feeling for during a prostate exam

size

shape (normal is heart shaped)

symmetry

consistency (normal is rubbery)

nodules

tenderness

what would be felt on prostate exam with cancer

asymmetric

hardness

distinct nodule

obliteration of the median groove

induration of a lobe

palpable seminal vesicles

what would be felt on acute bacterial protatitis

tender

swollen

boggy

warm

nodular

suprapubic tenderness

what would you feel in benign prostatic hypertrophy

symmetrically enlarged

rubbery

non-tender

loss of median furrow