[08.24] PE of the Male Reproductive System V2.pdf

70-90%

History and physical examination alone can diagnose approximately what percentage of patients?

60-80%

History alone accounts for what percentage of diagnoses?

10-20%

Physical examination adds what percentage to the diagnosis rate?

Inspection and Palpation

Which two primary physical examination techniques are used for the male reproductive system?

Percussion

Which physical examination technique is difficult and usually not used for the testes?

Auscultation

Which technique is rarely used but may be applied to hernia-containing bowels?

Stone, Tumor, and Infection

What are the three primary categories for differentials given in the source?

Bacterial, Viral, Tuberculosis, and Fungal

What are the four types of infection mentioned as differentials?

Back pain

A patient with pyelonephritis may present with what common symptom that requires differentiating from stones or cancer?

Standing, Supine, Lateral decubitus, Bend forward, and Lithotomy

List the five general positions for examination.

Left-lateral decubitus

What position involves the patient lying on his left side with legs flexed toward the abdomen?

Modified lithotomy

In which position does the patient lie on his back with knees flexed, hips flexed, and abducted?

Standing-up position

Which rectal exam position involves leaning over the examining table on the elbows with heels apart and toes in?

Kneeling

Which position is a variant of the exaggerated knee-chest position for rectal exams?

Lubricating jelly

What must be used specifically for a rectal exam to ensure patient comfort?

Prepuce

In an uncircumcised penis, what structure covers the glans penis?

Exposed

In a circumcised penis, what is the status of the glans penis?

Dorsal Slit

Which circumcision method involves a surgical incision along the top of the foreskin that exposes the glans without removing tissue?

Medical missions

Dorsal slit is the preferred method for what setting due to its speed?

Island flap procedure

What is the name of the schematic procedure shown for penile reconstruction?

Urethral meatus

What structure must be inspected to ensure it is at the tip of the glans before performing a circumcision?

Hypospadias or epispadias

Circumcision should be deferred if the patient has which two congenital conditions?

Utilized for reconstruction

Why is the prepuce kept in cases of hypospadias instead of being removed?

Apply local anesthesia and stretch the opening

What should be done if a patient has a small urethral opening preventing foreskin retraction before circumcision?

Syphilis, herpes, or HPV

Name three types of skin lesions or STIs to look for during penile inspection.

Blister

Genital herpes typically begins as what type of lesion before it ruptures?

Cauliflower

Penile warts from HPV typically have what physical appearance?

Phimosis

What is the term for the inability to retract the foreskin?

Children

Phimosis is particularly common among which population?

Urinary tract infection (UTI)

Pee pooling in the prepuce due to phimosis can lead to what condition in children?

Paraphimosis

What is the term for the inability to return the foreskin over the glans?

Medical emergency

How should paraphimosis be treated if it persists for several hours or shows lack of blood flow?

Penile necrosis or gangrene

Untreated paraphimosis can lead to which two severe consequences involving tissue death?

Glans

What is the most distal, conical part of the penis?

Corpus spongiosum

The glans is formed by the distal expansion of which structure?

Corpora cavernosa

Which part of the penis hardens during an erection?

Manual reduction

What is the first-line non-surgical management for paraphimosis?

Thumbs on the glans, fingers behind the prepuce

How are the hands placed during manual reduction of paraphimosis?

Pinch or squeeze the glans

Before pushing the glans during manual reduction, what must you do to drain it?

Corpora spongiosum

Drainage of the congested glans occurs through which structure during manual reduction?

Gauze

What can be used to help push the glans during manual reduction if hands are difficult to use?

Dorsal slit

If manual reduction of paraphimosis fails, what surgical intervention is performed?

Gonorrhea and chlamydia

Urethral discharge is a sign of which two common infections?

Gonorrhea

Which infection is considered the most common cause of urethral discharge?

Peyronie’s disease

What disease is characterized by plaques over the corpora cavernosum causing an acute angle or curvature?

Caucasians

Peyronie’s disease is noted as being specifically common among which group?

Penile fracture

A tunica albuginea break during sex or rigorous masturbation results in what?

Presence of hematoma

What physical finding distinguishes a penile fracture from Peyronie's disease?

Hydrocele

Which scrotal swelling is typically checked through transillumination with a flashlight?

Testicular torsion

What scrotal condition involves twisting and is considered a surgical emergency?

Fournier’s gangrene

What is the life-threatening necrotizing infection of the scrotum that presents with sloughing skin?

Bad odor

What is a characteristic clinical feature of Fournier’s gangrene besides skin sloughing?

80%

Historically, what was the mortality rate for Fournier’s gangrene?

25-30%

What is the current estimated mortality rate for Fournier’s gangrene due to medical evolution?

Schistosomiasis or filariasis

Which two conditions can block lymphatics causing lymphedema and giant scrotal elephantiasis?

Varicocele

What condition involves dilated blood vessels or spermatic veins in the scrotum?

Subclinical

Which varicocele grade is non-palpable and identified only through ultrasound imaging?

Grade 1

Which varicocele grade is palpable only when the patient performs the Valsalva maneuver?

Grade 2

Which varicocele grade is palpable without the need for a Valsalva maneuver?

Grade 3

Which varicocele grade features visible veins and is described as a bag of worms?

Asking the patient to cough or strain

How is the Valsalva maneuver performed during a hernia exam?

Umbilical, Inguinal, and Femoral

What three areas are inspected for abdominal and inguinal hernias?

Morning

By history, when is urethral discharge most commonly noticed by the patient on their underwear?

Squeeze or compress the meatus

Because discharge is not always apparent, what action may the examiner need to take?

Stone in the urethra

What rare finding should be checked for by palpating the course of the urethra?

Separately

Should testicles be palpated together or separately?

Front

Is the testis located at the front or the back of the structures within the scrotal sac?

Back

Where is the epididymis located relative to the testis?

Above

Where is the vas deferens located relative to both the testis and epididymis?

Malignancy or cancer

Intra-testicular tumors are most likely to be what?

Benign

Extra-testicular tumors are usually what?

Tuberculosis

An extra-testicular mass that feels beaded behind the scrotum may indicate what?

Smooth, firm, and oval

What is the normal size, shape, and consistency of a testis?

Orchitis

A painful testis that is normal in size or only slightly enlarged may indicate what?

Testicular torsion

A mass that is painful and significantly swollen may indicate what?

Cryptorchidism

What is the medical term for an undescended testicle?

Torsion

Undescended testes are specifically at risk for what emergency condition?

Hernia

Undescended testes are commonly associated with which other condition?

Epididymitis

Inflammation of the epididymis is commonly caused by infections or what other specific chronic disease?

Soft and non-tender

What is the normal feel of the epididymis?

Spermatocele or epididymal cyst

Name two benign extra-testicular cystic masses.

Varicocele

What is the most common cause of swelling in the spermatic cord?

Severe pain, infertility, and large varicoceles

What are the three main indications for a varicocelectomy?

Sperm function, morphology, numbers, and movement

A varicocele can damage which four aspects of sperm quality?

Fragment DNA and increase oxidative stress

What are two molecular-level consequences of a varicocele on sperm integrity?

External ring

Hernias typically protrude through which specific part of the inguinal canal?

Finger

What is used to palpate the external inguinal ring while the patient coughs?

Inferior epigastric vessel

What is the anatomical reference used to distinguish direct from indirect hernias?

Lateral

Is an indirect inguinal hernia lateral or medial to the inferior epigastric vessels?

Medial

Is a direct inguinal hernia lateral or medial to the inferior epigastric vessels?

Indirect

Which type of hernia passes through the inguinal canal and emerges from the external ring?

Direct

Which type of hernia only pushes the segment and does not pass through the canal?

Admit the tip of the finger

How much should a normal external inguinal ring allow upon examination?

Transillumination test, Cremasteric reflex, and Prehn’s sign

List the three additional specialized examinations of the scrotum.

Penlight

What tool is used to perform the transillumination test?

Hydrocele

Clear fluid transmission during transillumination confirms what diagnosis?

Tumor or hernia

A solid mass that does not exhibit transillumination may be what?

Bladder or ovaries

Name two structures that could be in a female inguinal hernia besides bowel or omentum.

Stroke the inner thigh

How is the cremasteric reflex elicited during a neurological exam?

Testicle retracts upward

What is the normal response of a positive cremasteric reflex?