Rectal & Prostate Exam

Practice flashcards covering anatomy, history taking, physical examination techniques, and common clinical conditions related to the male genitourinary and anorectal systems.

What should be asked about in the “partner” section of sexual history?

number of partners

gender of partners

What should be asked about in the “practices” section of sexual history?

vaginal, oral, anal sex

What should be asked about in the “protection from STIs” section of sexual history?

condoms, barriers, spermicides, dental dam, etc

patient perception of risk and partner’s risk

What symptoms should be asked about to assess urinary storage issues?

urinary frequency

urinary urgency

nocturia

incontinence

What symptoms should be asked about to assess voiding and obstructions?

hesitancy

weak urinary stream

dribbling

incomplete bladder emptying

decreased urination

What symptoms should be asked about to assess pain and infections?

dysuria

kidney and flank pain

suprapubic pain

What symptoms should be asked about to assess issues outside of storage, obstructions, and infections?

polyuria

hematuria

What symptoms should be asked about to assess male genital lesions or discharge?

penile sores or lesions

penile discharge

genital rash or itching

What symptoms should be asked about to assess scrotal or testicular symptoms?

testicular pain or masses

scrotal pain, redness, or swelling

What symptoms should be asked about to assess groin or hernia symptoms?

inguinal swelling or masses

bulge with coughing, lifting, straining

What symptoms should be asked about to assess male sexual function?

erectile dysfunction

decreased libido

ejaculation concerns

What symptoms should be asked about to assess the rectum and anorectal region?

pain with defecation

rectal tenderness

anal itching

anal lesions

rectal discharge

What symptoms should be asked about to assess bowel and bleeding?

change in bowel habits

blood in stool

What should be associated with distention of the renal capsule?

aching pain in costovertebral angle

pyelonephritis, obstruction, hydronephrosis

What should be associated with ureter distention pain?

severe, spasmodic, colicky pain (+/- radiation to groin, testes, scrotum)

patient restless and uncomfortable

ureteral stone or obstruction

What should be associated with bladder pain?

suprapubic pain, pressure, lower abdominal fullness

urgency or intense desire to urinate

urinary retention, cystitis, bladder dysfunction

What conditions are associated with groin pain?

hernia

spermatic cord and testicular pathology

possible herpes zoster

What conditions are associated with testicular pain?

epididymitis, orchitis, hydrocele

do not miss testicular torsion

Where can pain refer from a ureteral stone?

ipsilateral testicle or scrotum

What is priapism?

medical emergency

painful erection >4h, unrelated to sexual stimulation

What medications are associated with priapism?

trazodone

chlorpromazine

sildenafil

What is pyuria?

WBCs or pus in the urine

suggestive of UTI, stones, prostatitis, or malignancy

What is fecaluria?

fecal material in the urine

highly concerning for a fistula

What symptoms should be asked about when a patient complains of change in urine flow?

frequency

nocturia

urgency and volume

hesitancy and weak stream

incomplete emptying

straining

fluid intake

What is the maximum score on the American Urological Association BPH Symptom Score, and what score is considered mild?

The maximum score is $35$, and a score of $\le 7$ is considered mild.

What patient report is suggestive of stress incontinence?

leakage when coughing, laughing, lifting, or bending

What patient report is suggestive of urge incontinence?

sudden need to go and unable to make it in time

What patient report is suggestive of overflow incontinence?

leakage of small amounts frequently

What is classified as polyuria?

increased total urine volume (>2-3L/day)

What is the normal approximate daily urine output for an adult?

1-2 L/day

Why should prior episodes be asked about with hematuria?

recurrent stones, infection, malignancy, glomerular disease

Why should clots be asked about with hematuria?

nonglomerular bleeding (lower urinary tract)

Why should recent URI and sore throat be asked about with hematuria?

post-infectious glomerulonephritis

IgA nephropathy

What medications should be asked about when assessing hematuria?

anticoagulants or antiplatelets

NSAIDs

cyclophosphamide

rifampin

phenazopyridine

What should be considered if there is purulent yellow or green penile discharge?

gonorrhea or urethritis

What should be considered if there is clear or mucoid penile discharge?

chlamydia or nongonococcal urethritis

What should be considered if there is bloody penile discharge?

trauma, severe urethritis, malignancy

What should be considered if there is dysuria and penile discharge?

urethritis or STI

What is the typical appearance of a psoriasis genital rash?

bright red and well demarcated plaques, possible scaling

located on scrotum, inguinal folds, penis

What is the typical appearance of a contact dermatitis genital rash?

erythematous, itchy, and irritated rash

What is the typical appearance of a fixed drug eruption genital rash?

sudden and well defined red/dusky patches, possible blisters

recurs in same location after medication exposure

What is the typical appearance of a lichen planus genital rash?

violaceous, flat-topped, shiny papules

often involves the glans

What is indicated by sudden scrotal swelling?

torsion, infection, trauma

What is indicated by gradual scrotal swelling?

hydrocele, varicocele, hernia, mass

What is indicated by scrotal swelling that changes size with position change?

hernia or varicocele

What is indicated by scrotal swelling that goes away when lying down or with pressure?

hernia

What is suggested by sudden or situational ED?

psychogenic or relationship factors

What is suggested by gradual ED?

vascular or metabolic cause

What parts of the penis should be inspected on exam?

ventral and dorsal surface

base of penis

foreskin

gland

urethral meatus

What should be looked for in foreskin inspection?

chancres

carcinoma

smegma

phimosis

paraphimosis

What is phimosis?

foreskin of penis unable to be retracted

What should be looked for in inspection of the glans?

ulcers

scars

nodules

inflammation

What should be inspected on the scrotum?

skin lesions, scars, and pubic hair distribution

scrotal contour

erythema, excoriations, or adenopathy

How should the penile shaft be palpated?

use thumb and first 2 fingers

retract foreskin

How should the glans be palpated?

gently compress between index finger above and thumb below (should allow for inspection of urethra)

How should the testis be palpated?

between thumb and first 2 fingers within the scrotum

What should a normal testis feel like?

firm but not hard, descended, symmetric, nontender and without masses

How should the epididymis be palpated?

use thumb and forefinger on posterolateral testis

do not use excess pressure

What should a normal epididymis feel like?

nodular and cord like

not tender

How should the spermatic cord and vas deferens be palpated?

palpate from epididymis to external inguinal rung

What should a normal vas deferens feel like?

slightly stuff and tubular

What is the patient and provider positioning for a hernia exam?

patient standing

provider sitting in front of patient using dominant hand

How should a hernia exam be done?

place finger at inferior portion of scrotum and move redundant scrotal skin up towards external inguinal ring

palpate opening of external inguinal ring

ask patient to turn head and cough, feel for bulge or mass against finger

palpate up to internal inguinal ring and repeat coughing

During a scrotal exam, what does a red glow during transillumination indicate?

A cystic mass or hydrocele

During a scrotal exam, what does a dark shadow or blocked light during transillumination indicate?

A solid mass or hernia

How should a varicocele be assessed for?

palpate spermatic cord and have patient bear down

What patient position is needed for a rectal exam?

patient laying on side with partially flexed hips and knees

What should be inspected on a rectal exam?

sacrococcygeal and perianal areas

What is the normal appearance of adult perianal skin?

more pigmented and coarser than buttock skin

How should a DRE without a prostate be performed?

lubricate finger and place at anal entrance

have patient bear down to help sphincter relax

gently insert finger and rotate clockwise and counterclockwise

have patient squeeze finger with sphincter

How should a DRE with a prostate be performed?

complete normal DRE

locate prostate and sweep finger from side to side

identify lateral lobes and groove of median sulcus

What should a normal prostate feel like?

rubbery and nontender without evidence of fixation to surrounding tissue

What are the steps of a self testicular exam?

stand in front of mirror and check for swelling on skin of scrotum

feel scrotal sac, locate testicle, examine each side separately

stabilize testicle and use finger and thumb of other hand to feel or roll testicle between fingers

find epididymis

repeat on other side

What protrudes in a femoral hernia?

preperitoneal fat, omentum, bowel

What is an incarcerated hernia?

hernia contents cannot be returned to abdominal cavity

What is a strangulated hernia?

blood supply to entrapped contents in compromised

What are the clinical signs of a strangulated hernia that necessitate surgical intervention?

Tenderness, nausea, and vomiting.

What is the pathway for an indirect inguinal hernia?

through deep inguinal ring, travels in inguinal canal

possibly enters scrotum or labia majora

What is the pathway for a direct inguinal hernia?

pushes through weak abdominal wall in Hesselbach triangle

What is the pathway for a femoral hernia?

passes through femoral canal

What are key landmarks for an indirect inguinal hernia?

lateral to inferior epigastric vessels

What are key landmarks for a direct inguinal hernia?

medial to inferior epigastric vessels

What are key landmarks for a femoral hernia?

below inguinal ligament

What is the typical exam location for an indirect inguinal hernia?

above inguinal ligament, may descend into scrotum

What is the typical exam location for a direct inguinal hernia?

above inguinal ligament, usually does not enter scrotum

What is the typical exam location for a femoral hernia?

bulge below inguinal ligament, often medial thigh or upper groin

What patient population is associated with an indirect inguinal hernia?

most common overall

more common in children

What patient population is associated with a direct inguinal hernia?

men older than 40

What patient population is associated with a femoral hernia?

more common in women

What is hypospadias?

opening of urethra develops on underside of the penis instead of at the tip

What is Peyronie’s Disease?

build up of fibrous scar tissue building up in the penis

What is a hydrocele?

painless buildup of fluid in scrotum

What is cryptochordism?

undescended testicle, increased risk of testicular cancer

What does a testicular tumor feel like?

testicle feels heavier than normal

What is the normal adult testes length?

4-5cm

What testes size is seen in Klinefelter?

small and firm testes (2cm or less)

What is acute orchitis?

acutely inflamed, painful, tender, and swollen testicle

seen in mumps and other viral infection

What is a spermatocele and epididymis cyst?

painless, moveable cystic mass above the testis

transilluminate

What is a varicocele?

gravity mediated varicose vein of spermatic cord

How is a varicocele typically described during palpation?

A soft "bag of worms"