male genitalia, anus, rectum, prostate, and GU disorders

HPV causing cancer

16, 18

peyronie’s disease

contracture of penis d/t plaque

important surgical hx for men

GU tract surgery, prostatectomy, TURP, phalloplasty, penile implants, etc

prostate cancer RF

age >50, African Americans, BRCA1, lynch syndrome

anal cancer RF

HPV, multiple partners, anal intercourse, cigarettes, HIV, women

penile cancer RF

HPV, phimosis, poor hygiene, age, smoking, HIV, UV light tx

testicular cancer RF

cryptorchidism, fhx, HIV, age 20-34, white men, androgen suppression

cryptorchidism

undescended testes

requirement for genital exam

chaperone

urethral meatus

orifice at end of urethra on glans

pripism

prolonged penile erection, compartment syndrome

priapism tx

phenylephrine/epinephrine injection

hernia exam steps

ask pt to stand and bear down, inspect, insert finger into scrotum and follow vas deferens, feel external inguinal ring

indirect inguinal hernia

bowel herniates within inguinal canal and can pass into scrotum

direct inguinal hernia

bowel herniates but stays medial to canal

femoral hernia

bowel herniates into femoral canal

indirect hernia age

young

indirect hernia shape

pyriform/oval

indirect hernia descent

oblique and downward

indirect hernia descent to scrotum

complete/to bottom of scrotum

indirect hernia location

lateral to inferior epigastric artery

direct hernia age

elderly

direct hernia shape

globular/round

direct hernia descent

directly forward

direct hernia descent to scrotum

rarely complete

direct hernia location

medial to inferior epigastric artery

balanitis

phimosis

indirect inguinal hernia

direct inguinal hernia

femoral hernia

indirect inguinal hernia

cystitis

infection of bladder from urethra

cystitis MCC

e.coli

cystitis RF

BPH, prostate issues if male, females

cystitis CP

dysuria, surapubic pain, febrile, urinary urgency/frequency, hematuria

cystitis diagnostics

UA - +WBC, blood, nitrates

urine culture gold standard

testes exam

palpate with thumb and 2 fingers, should be smooth, rubbery, and free of nodules

spermatic cord exam

compare at neck of scrotum by compressing each cord

vas deferens exam

should be smooth and discrete, no lumps

epidiymis exam

on posterolateral testis, smooth, discrete

cremasteric reflex

stroke inner thigh, scrotum and testes should rise on that side

rectum location

superior to anus, 12cm long

rectal exam

press pad of finger against anal opening, slip fingertip into anal canal as external sphincter relaxes

CVA tenderness exam

put palm on flank and hit back of your hand with ulnar surface of fist

prostate exam

palpate posterior surface of prostate through anterior rectal wall, should be chestnut sized and no nodules/tenderness

pyelonephritis

UTI ascending into kidneys and causes infection in renal parenchyma

pyelonephritis MCC

e. coli

pyelonephritis CP

N/V, fever, tachy, back/flank pain, hematuria, CVA tenderness

pyelonephritis tx

ceftriaxone, cipro/levo, aztrenonam

epidiymitis

painful enlargement of epidiymis

MCC epididymitis

chlamydia and gonorrhea if <35, e.coli if >35

epidiymitis CP

fever, urethritis, gradual onset unilateral scrotal pain, radiation to lower abd, urinary frequency, prehn’s sign, prostate tenderness

prehn’s sign

lift scrotum to see if pain is present

orchitis

swelling/inflammation of testes

MCC orchitis

mumps, STDs

orchitis CP

tender swollen groin with abrupt onset pain, painful intercourse/BM, fever, dysuria, hematospermia, penile discharge, negative cremasteric reflex

urethritis

inflammation of urethritis

MCC urethritis

gonorrhea and herpes, also chlamydia

urethritis CP

fever, burning during urination, malaise, discharge

green/yellow penile discharge

gonorrhea

whitish penile discharge

chlamydia

painful vesicles on penis

herpes

urethritis dx

NAAT for STD

chancre

chancre

painless genital ulcer often caused by syphilis

HPV causing genital warts

6, 11

herpes

condyloma acuminata/genital warts

MCC prostatitis

gonorrhea, chlamydia if <35, e.coli or PsA if >40

prostatitis CP

fever, chills, back pain, perianal pain, UTI sx, urinary retention

prostatitis PE

warm and exquisitely tender prostate, boggy if chronic

nephrolithiasis

formation of stones in kidneys

nephrolithiasis CP

severe colicky flank or back pain with radiation to groin, hematuria, N/V, dysuria

nephrolithiasis RF

age, white, males, vit C/calcium, high protein diet, dehydration, smoking

nephrolithiasis PE

notable CVA tenderness

nephrolithaisis dx

CT no cx, CBC, BMP, UA/culture

nephrolithiasis tx

alpha blockers, pain control, uro consult

hydrocele

collection of fluid between tunicas in testes

hydrocele CP

painless testicular swelling, pain if large

hydrocele PE

transillumination

varicocele

engorgement of internal spermatic veins

varicocele CP

dull/dragging discomfort, scrotal heaviness

varicocele PE

“bag of worms” on exam, + prehn’s sign, palpable with valsalva

hydrocele

varicocele

R sided varicocele

think malignancy - renal tumor/carcinoma

testicular torsion

twisting of testis and spermatic cord

testicular torsion CP

acute pain, swelling of scrotum, N/V, abd pain

testicular torsion PE

negative ipsilateral cremasteric reflex, negative prehn’s sign, bell clapper deformity, angell’s sign, deming’s sign

bell clapper deformity

testicles hang in scrotum and swing freely

angell’s sign

testicles lay horizontally

deming’s sign

affected testis is higher d/t twisting

blue dot sign

testicular appendage torsion

blue dot sign

BPH CP

urinary frequency, urgency, nocturia, incontinence, straining to void, urinary intermittency, hesitancy, terminal dribbling

BPH PE

DRE can be normal or enlarged, firm, rubbery prostate

BPH dx

PSA

prostate CA RF

african american, fhx prostate cancer, toxin exposure (diesel fuel, pesticides, agent orange, aresenic, cadmium)

prostate CA CP

urinary frequency, urgency, retention, possible bone/back pain