| Question |
Answer |
| Which veins of the tesitcle are most likely to become varicosed? |
left |
| Which testicle hangs lower? |
left |
| Urinary stream is more like to be involved with? |
benign prostatic hypertrophy |
| What is testicular torsion? |
twisting of the spermatocord which cuts of venous return. Venous engorgement leads to backpressure thru the capillaries which prevents arterial blood delivery. SURGICAL EMERGENCY |
| What are the characteristics of the testicle? |
ovoid and approximately 4x3x2 cm |
| What is cryptorchidism |
absense of one or both testicles in the scrotum due to failure of descent. Associated with a 20-40% increased risk of testicular cancer |
| What is H and P of testicular torsion? |
acute onset, nausea, vomiting, orchalgia, scrotal discoloration and swelling. Absent cremasteric reflex |
| What is cremasteric reflex? |
This reflex is elicited by lightly stroking the superior and medial part of the thigh. The normal response is a contraction of the cremaster muscle that pulls up the scrotum and testis on the side stroked. |
| When do testicles descend? |
by 6 months. By age of 1 it is a problem |
| What is epididymitis? |
inflammation of the epididymis usually associated with bacterial infection. |
| What is H and P of epididymitis? |
gradual onset, Hx of recent urinary tract or sexually transmitted infection. Pyruia or bacteria with fever. Pain is relieved by elevation of the scrotum |
| A mother is concerned because she c an’t find 1 month olds right testicle and his foreskin doesn’t retract. Should she be concerned? |
no |
| A patient eats a diet high in animal fat. That puts him at risk for? |
colon and prostate cancer as well as heart disease |
| A patient presents with sudden onset of suprapubic pain. What is the most likely cause? |
Urinary tract infection |
| What is priapism? |
due ot thrombosis of the corpora cavernosa. Think Sickle Cell and leukemia. |
| What is pyuria? |
pus in urine |
| What is polyuria? |
>2 liters a day |
| A 23 yr old male presents with a painful 3 cm mass below the right inguinal ligament. What test will be most helpful? |
auscultation of the mass |
| What is tensesmus? |
painful, continued ineffective straining at the stool caused by inflammation |
| What are varicoceles? |
testicular veins that are prone to backpressure buildup leading to dilation and varicosities |
| What is a good description of varicoceles? |
bag of worms |
| What may cause scrotal enlargement? |
testicular torsion, varicocele, hydrocele, spermatocele, hernia and tumor |
| What is hydrocele? |
Fluid accumulation in the tunica vaginalis, fluid is confied to the scrotum. It is transilluminate |
| What is spermatocele? |
cystic swelling in the epididymis. Not as large hydrocele |
| What is hypospadias? |
congenital defect where the urethral opening lies too far ventral on the glans, shaft or perineal area |
| What is prepuce? |
retractable covering for the genitals such as the foreskin or clitoral hood |
| What is phimosis? |
inability to retract the foreskin from the glans penis |
| What is balanitis? |
inflammation of the glans only |
| What is balanoposthitis? |
inflamation of glans and prepuce |
| What is clear/white discharge indicate? |
chlamydia |
| What does yellow-green discharge indicate? |
gonococcal |
| What is dysuria? |
painful urination usually associated with UTI |
| What is nocturia |
increased frequency at night (2 or more times) |
| How many lobes in the prostate? |
5 |
| What is the normal texture of the prostate? |
firm, smooth, slightly movable and should be symmetric. |
| How far should the prostate protrude into the rectum? |
<1cm |
| What is benign prostatic hyperplasia? |
enlargement of the prostate throughout life that becomes symptomatic |
| What is pneumaturia? |
air bubbles or gas in the urine stream |
| What is fecaluria? |
fecal material in the urine |
| A twelve year old with right testicular pain presents with his left testicle being lower than his right. What does he most likely have? |
torsion of the right testicle |
| What is most common site of prostate cancer? |
posterior lobe |
| Whathich lobes generally hypertrophy? |
middle and lateral lobes |
| What is PSA? |
Prostate specific antigen which is a protein produced by all prostate cells. It increases greatly with prostate cancer |
| What is a grade 1 enlargement of the prostate? |
1-2 cm (3fingers) |
| What is a grade 2 enlargement of the prostate? |
2-3 cm (4 fingers) |
| What si a grade 3 enlargement of the prostate? |
3-4 cm (>4 fingers wide) |
| What is a grade 4 enlargement of theprostate? |
>4 cm (most anterior pelvic outlet) |
| What are internal hemorrhoids |
varicosities above the ano-rectal junction. Not palpable on rectal exam. No discomfort uless prolapsed, thrombosed, or infected. Bleeding with or without defecation. |
| What are external hemorrhoids? |
varicosities below the anorectal junction. Causes itching and bleeding with defecation. Protrude with straining |
| What are fissures? |
tears in the anal mucosa, usually in the posterior midline. Caused by traumatic passage of large hard stool. Painful with itching and bleeding |
| What are fistulas? |
tract running between the anus and other tissues caused by the drainage of an abscess. The external opening ois often surrounded by granulation tissue and ay have purulent drainage. |
| What is puritus Ani? |
perianal burning and irritation caused by chronic inflammation |
| What do excoriation and pigmentation changes indicate? |
fungal infections or parasites |
| What is an indirect hernia? |
viscera passes thru deep and superficial inguinal rings. May enter the scrotum. Feel against the tip of finger on palpation |
| What is direct hernia? |
passes thru the superficial ring only. Normally does not enter the scrotum. Feel against side of finger on palpation thru hasselbach’s triangle |
| What is a femoral hernia? |
passes thru the fossa ovalis and enters the femoral canal (most common in women) |
| What should be considered with the fetus? |
sexual differentiation of the male external genetialia occurs starting the 8th week of gestation. |
| What should be considered with infant/child? |
a physiologic form of phimosis may be present in an infat. Between 3-6 y/o the forskin becomes separable from the glans |
| What happens in puberty? |
penis and testicles grow; scrotum reddens and becomes more pendulous. Pubic hair becomes curly, dark, dense, and distributed in a diamond shaped pattern. |
| What changes occur in elderly? |
pubic hair thins, scrotum even more pendulous, and ejactulatory volume may incrase |
| Pain occurs with sudden distention of: |
renal pelvis, ureter and bladder |
| What causes renal pelvis pain? |
kidney stones…occurs in the flank |
| What causes ureter pain? |
kidney stones or bladder obstruction. |
| Where does upper ureter pain present? |
flank |
| Where does lower ureter pain present? |
scrotum and lower abdomen |
| What is associated with bladder pain? |
bladder stones and infection |
| Where is bladder pain? |
suprapubic pain |
| What causes testicular pain? |
orchitis, hydrocele, spermatic cord, epididymis, tumor, torsion and referred pain from ureter |
| What is hematuria? |
blood in urine |
| What is the three glass test? |
glass 1 is initiation of urine stream, glass 2 is midstream urine and glass 3 is termination of urine stream |
| What does glass 3 test indication? |
a source above the bladder neck indicating renal and prostate. |
| What causes hematuria? |
infections, stones, cancer, drug-induced, trauma |
| What does hematuria in all glasses suggest? |
a renal, diffuse source or massive bleeding |
| What are risk factors for penile risk factors? |
not circumcised and condyloma accuminatum |
| What is condyloma accuminatum? |
genetal wards |
| What are testicular cancer risk factors? |
cryptochidsm |
| What are prostate risk factors? |
age > 50, African American and high fat diet |
| What are colorectal cancer risk factors? |
age > 40, family Hx of polyp disease, personal Hx of polyp disease or inflammatory bowel disease, personal Hx of breast, ovar, or endometrial cancer, high fat, low fiber diet, and environmental exposures |
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