Physical Assessment Unit 3- Male GU, Rectosigmoid Area, and Prostate

what history questions do you ask before PE?

sexual orientation, relationship status, sexual response (function), anal or oral (associated symptoms for those areas)

what ROS questions do you ask before PE?

penile discharge or lesions, scrotal swelling or pain and STIs, risk of HIV

corpus spongiosum

identify this structure

corpora cavernosa

identify this structure

glans penis

identify this structure

foreskin

identify this structure

what is the mechanism of creating testosterone in the testes?

GRH, LH + Leydig cells, testosterone

what is the mechanism of triggering puberty?

testosterone, 5a reductase, 5a dihydrotestosterone, triggers pubertal growth

what hormone regulates sperm production?

FSH

In order to trigger pubertal growth in men, testosterone is converted by what?

5a reductase

scrotum

identify this structure

describe the divided pouch of the scrotum

each contains a testicle covered by tunica vaginalis (except posterior aspect)

epididymis

identify this structure

this structure is a tightly coiled spermatic duct on the posterolateral surface of the scrotum and serves as a route for sperm to the vas deferens

epididymis

vas deferens

identify this structure

Where is GRH produced?

Hypothalamus

This is the name of the pouch of serous membrane covering the testes.

Tunica vaginalis

The tunica vaginalis covers the entirely aspect of the testicle, except for which paart?

Posterior aspect

what makes up the spermatic cord?

vas deferens, seminal vesicle, ejaculatory duct, seminal fluid

how do sympathetic and parasympathetic signals reach the male genitalia?

pudendal nerve

Does increased nitrous oxide and cGMP cause local vasoconstriction or vasodilation?

Vasodilation

In regards to the lymphatics, the scrotal and penile areas drain into which set of lymph nodes?

Inguinal lymph nodes

if there is a lesion present in the scrotum or penis, this is concerning for what in regards to lymphatics?

inflammation or possible malignancy

In regards to the lymphatics, the testicular lymphatics drain into what?

Abdomen

Can we clinically assess the inguinal lymph nodes?

Yes

Can we clinically assess the abdomen lymph nodes?

No

ASIS

identify this structure

inguinal ligament

identify this structure

internal inguinal ring

identify this structure

external inguinal ring

identify this structure

spermatic cord

identify this structure

pubic tubercle

identify this structure

femoral canal

identify this structure

when inspecting the penis, what are we looking for?

skin abnormalities and smegma

This is the term for sebaceous secretions under the foreskin.

rashes, cysts, masses, Smegma

when palpating the penis, what are we looking for?

lumps, veins, tenderness

Is skin cancer on the scrotum common?

No

what are we noting when palpating the epididymis?

size, shape, consistency, nodules, tenderness

This is the term for pain located superior to the pubic tubercle.

Suprapubic pain

This is the term for pain in the CVA region.

Flank pain

This is the term for dribbling after the completion of urination.

Dribbling

This is the term for the need to urinate more often than usual.

Frequency

This is the term for difficulty starting or maintaining a urine stream.

Hesitancy

This is the term for sudden, compelling urge to urinate.

Urgency

This is the term for a spurt-like leakage of urine during moments of physical activity, such as coughing, sneezing, laughing, jumping, or exercise and with walking, changing position from sitting to standing, or with sexual activity.

Stress incontinence

This is the term for a strong, sudden need to urinate due to bladder spasms or contractions.

Urge incontinence

This is the term for blood-tinged or bloody semen.

Hemospermia

This is the term for secretions seeping from penis which may indicate infection.

Penile discharge

This is the term for inability to achieve or maintain an erection with decreased sex drive.

Impotence

This is the term for inability or diminished ability to produce offspring.

Infertility

This is the term for inability to achieve or maintain an erection without decreased sex drive.

Erectile dysfunction

This is the term for absence of urine.

Anuria

This is the term for reduced amount of urine production.

Oliguria

This is the term for excessive production and discharge of urine.

Polyuria

This is the term for excessive urination during the night.

Nocturia

This is the term for pain with urination.

Dysuria

This is the term for bloody urine.

Hematuria

This is the term for excretion of urine containing free gas.

Pneumaturia

what most often causes nocturia?

enlarged prostate compressing the urethra, so bladder never fully empties

what most often causes pneumaturia?

fistula/diverticulitis

This is the term for atrophied testis that may be located in the inguinal canal or abdomen.

Cryptochidism

Is the scrotum filled with cryptochidism?

no

Cryptochidism increases a man's risk for what?

Testicular cancer

is cryptochidism congenital or acquired?

congenital

which side of the penis is the ventral surface?

the side you see when it is erect

This is the term for displacement of the urethral meatus to the ventral surface of the penis.

Hypospadias

This is the term for the displacement of the urethral meatus to the dorsal surface of the penis.

Epispadias

is hypospadias congenital or acquired?

congenital

is epispadias congenital or acquired?

congenital

Which is more common? Hypospadias or epispadias?

Hypospadias

femoral hernia

identify this structure

direct inguinal hernia

identify this structure

what kind of hernia is most common, all ages and sexes. often in children?

indirect

what hernia has an origin of above inguinal ligament, near midpoint, internal inguinal ring?

indirect

what hernia often goes into the scrotum, comes down inguinal canal, touches examining finger?

indirect

what hernia is less common, usually in men older than 40, rare in women?

direct

what hernia has its origin above the inguinal ligament, close to pubic tubercle, near external inguinal ring?

direct

what hernia rarely goes into the scrotum, and normally bulges anteriorly and pushes the side of the examining finger foreward?

direct

what is the least common hernia, more common in women than men?

femoral

what hernia originates below the inguinal ligament, appears more lateral, can be hard to differentiate from lymph nodes?

femoral

what hernia does not travel into the scrotum, and the inguinal canal is empty?

femoral

This is a small, red papule on the penis that has painless erosion.

Syphilitic chancre

how to examine and test for hernias?

tip of index finger at anterior inferior margin of scrotum, superficial to testes, move finger upward toward external inguinal ring, follow spermatic cord upward to inguinal ligament, find opening of external inguinal ring, ask patient to cough

bulge near external inguinal ring suggests what kind of hernia?

direct

bulge near internal inguinal ring suggests what kind of hernia?

indirect

this condition due to STI exposure is a small red papule with chancre (painless erosion)

syphilitic chancre

Do syphilitic chancres usually heal on their own? time frame?

Yes, 3-8 weeks

If secondary syphilis develops while a syphilitic chancre is present, what does this suggest?

Co-infection with HIV

Treponema pallidum will cause what disease?

Syphilis

how long after exposure to treponema pallidum does syphilitic chancre occur?

9-90 days

About 7 days after exposure to treponema pallidum, what will you notice?

Inguinal lymphadenopathy

lymph nodes of the inguinal region are mobile, non-tender, and rubbery. condition?

inguinal lymphadenopathy

This condition caused by STI exposure is small, scattered, or grouped vesicles 1-3mm in size on the glans or shaft. They will appear as erosion if the vesicles break.

Genital herpes

Genital herpes is more often caused by what strain of the virus?

HSV2 (2 double stranded DNA virus)

The vesicles from genital herpes usually appear how many days after exposure?

2-7 days

What are associated symptoms of primary episode of genital herpes? Are subsequent episodes of herpes usually more or less painful? longer or shorter?

asymptomatic. less painful/shorter

This is single/multiple papules/plaques that may be raised or cauliflower like (verrucous)

Condyloma acuminatum

Condyloma acuminatum is caused by what?

HPV subtypes 6,11

Condyloma acuminatum occurs how often after exposure to HPV?

Weeks to months

what are associated symptoms of condyloma acuminatum?

itching, pain