Anatomy and Physiology, Genital and Rectal Exam, Testicular Disorders
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| Meatus | urethral opening
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| Molluscum contagiosum on the penis | not quite normal. Common viral infection, no dire consequences, but is a STI in many cases
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| Hunk of skin on the end of the penis that can be retracted is known as the | prepuce. Fxn: Protection for the glans, sensory. In circumcision, the prepuce is removed
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| Age of Prepuce Separation/Retraction | not until 4-10 years of age
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| Physiological phimosis | Prepuce pouting when it is pulled back in young is good.
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| Phimosis | Abnormal. tightness of the prepuce (foreskin) of the penis that prevents the retraction of the foreskin over the glans. The condition is usually congenital but it may be the result of an infection.
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| Paraphimosis | a medical condition where the foreskin becomes trapped behind the glans penis, and cannot be pulled back to its normal flaccid position covering the glans penis. Can get a swollen in erection. Painful, should self-resolve, but if it persists, emergency
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| Balanitis-balonoposthitis | Defined as the inflammation of the foreskin and glans in uncircumcised males, balanoposthitis occurs over a wide age range; E.coli, not usually candida, usually not recurrent, not an indication for circumcision. Want to splash clean it, not pick or poke
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| Does Circumcision prevent HIV infection? | Despite the positive results of a number of observational studies, not yet sufficient grounds to conclude that male circumcision, as a preventive strategy for HIV infection, does more good than harm.
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| Circumcision and UTIs | boys who were circumcised were less likely to need hospital admission for their UTI
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| Circumcision and sexuality | Circumcision may make male more sensitive and have greater ease of reaching orgasm. However, another study shows that the glans in the circ. penis is less sensitive to fine touch
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| Circumcision yes or no? Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; However | data are not sufficient to recommend routine neonatal circumcision
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| The urethra is surrounded intimately by which structure? | Corpus Spongiosum
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| Superior to the corpus spongiosum is are the | Corpus Cavernosa
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| Peyronie's Disease is a connective tissue disorder affecting the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1-4% of men. | The fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal upward curvature of the penis. Repaired Surgically
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| Physiology of Erection: Starts as either a | reflexogenic sensation or psychogenic (if this happens during an exam, just say it is a spinal cord rxn)
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| Which nerves make up the reflex arch involved in an erection | parasympathetic nerves. Most upper spinal cord injuries maintain reflexogenic erection. Not so for lower injuries. Reflexogenic alone incomplete.
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| Cavernous nerve | Parasympathetic and somatic
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| Viagra MOA | Inhibits vasodilation/relaxation
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| Bulbospongiosus muscle | in males and females; in males assists erection
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| ____ is where urine and semen come together | Prostate; ureters from the kidney and vas def off of prostate. Meeting of streams
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| ____ are glands that produce alkaline to neutralize urine so sperm do not die | Cowper's glands (bulbourethral gland); inferior to Prostate
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| Prostate Abnormalities | BPH, Prostatitis, Prostate Cancer
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| Epidemiology of BPH | Present in more than 90% of men over age 80. No risk factors other than having testosterone
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| SX of BPH | <1/2 of men have sx; slow or delayed stream, weak stream, dribbleing post urination, straining to urinate, urgency incontinence, incomplete emptying, nocturia, urinary retention
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| Prostatitis on exam | Tender and boggy to exam, big and soft.
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| Massage results in prostatitis | No significant difference shown
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| Prostate Cancer on Exam | Knobby,hard; send to urologist
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| Femoral Hernia | Loop of bowel comes out where femoral vein and artery exit
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| Direct Hernias | Direct inguinal hernias occur when abdominal contents herniate through a weak point in the fascia of the abdominal wall and into the inguinal canal.
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| Indirect Hernias | Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring; this is ultimately caused by failure of embryonic closure of the processus vaginalis.
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| What are the dangers with Cryptorchidism? | Needs to be fixed b/c it is too warm up in the body for viable sperm. Risk of cancer increases also
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| Cremasteric Reflex | L1L2; lost in testicular torsion. Reflex: stroke thigh, testicle goes up
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| Testicular Function | Spermatogenosis, testosterone production
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| Spermatogenesis | Spermatozoa-->Spermatids-->Secondary Spermatocytes-->Primary Spermatocyte-->Germinal Cell
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| Which cell in the testicle is referred to as the "mother cell" | Sertoli cells.
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| What substances do Sertoli Cells secrete? | anti-Mullerian hormone, inhibin, activins, androgen binding protein, neurotrophic factor, ERM transcription factor, transferrin
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| Which cells produce testosterone? | Leydig cells
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| Actions of Testosterone include: Inhibition of LH release, facilitates spermatogenesis, development of male genitalia and accessory sex glands, secondary sex characteristics, plus | increase calcium retention and synthesis of bone matrix, stimulates closure of epiphyseal plates, protein anabolic--increases nitrogen retention and metabolic rate. Not good for younger athletes b/c stunts growth
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| Tanner staging (1-5) measures | physical development based on external primary and secondary development
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| If you find a lump or mass in the scrotum... | turn a pen light on it/transillumination (mass won't light up, but you can see borders; hyproceles do light up)
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| Painful Scrotal Masses | Incarcerated hernia, testicular torsion, epididymitis/orchitis, appendix testis torsion
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| Painless scrotal masses | Hydrocele, spermatocele, varicocele, tumors
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| Phren's sign | Scrotal elevation relieves pain in epididymitis, but not in testicular torsion
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| Blue dot on testes may be | torsion of the appendix testes
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| Spermatocele | Sac of sperm in the epididymis, doesn't have to be fixed
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| Where does the spermatic vein branch from? | Left renal vein (left side more common).
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| Where does the testicular artery branch from? | abdominal aorta
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| Seminal Pathway | Seminiferous tubule, epididymis, vas deferens, seminal vesicles, prostate, Cowper's glands, urethra, penis
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| For whom are genital screening exams appropriate? | USPSTF: recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males. American Cancer Society: recommends occasional exams for testicular cancer
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| What to look for in the anus | fissures (may see a sentinel tag), external hemorrhoids, abscesses
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| Types of anal abscesses | Supralevator, Intersphincteric, Ischioanal, Perianal, Perirectal (deeper than perianal)
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| Pilonidal Sinus | cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris.
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| DRE evaulates | prostate and checks for internal hemorrhoids
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| Internal Hemorrhoids | painLESS, tend to bleed
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| External Hemorrhoids | PaniFUL, don't bleed as much unless it's actually a fissure
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| Varicocele | Dilated veins of the spermatic cord; usually on the left
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| Epidermoid Cysts seen on the Scrotal Skin | Collections of fat
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| Smegma is | a cheesy, whitish material; secretions of the glans. They may collect at the prepuce/foreskin
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| Where is the urethra located? | ventrally on the shaft
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| Function of the epididymis | they are spermatic ducts that provide a reservoir for storage, maturation, and transport of sperm from testis to the vas deferens
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| What is the pathway of the vas deferens? | It is a cordlike structure that begins at the tail of teh epidymis, ascends within the scrotal sac, and passes through the external ring on its way to the abdomen and pelvis. Behind the bladder, it is joined by seminal vsicle duct and enters the urethra
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| Passageway of sperm | from the testes and the epididymis through the vas deferens into the urethra
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| Tactile stimulation nitiates sensory impulses from the genitalia to __ reflex arcs and parasympathetic pathways through the pudendal nerve | s2-s4
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| When you find an inflammatory or possibly malignant lesion on the penile or scrotal surfaces, assess the | inguinal nodes (where they drain) very carefully for enlargement or tenderness
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| hernia that lies below the inguinal ligament and medial to the femoral vein | femoral hernia
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| Balanitis | Inflammation of the glans
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| Suspect ____ in a scrotal hernia in the presence of tenderness, nausea, and vomiting | Strangulation: blood supply to the entrapped contents is compromised. (incarceration is different, it means that it cannot be reduced to the abdominal cavity)
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| Risk factors for Testicular cancer | cryptorchidism, hx of carcinoma in the contralateral testicle, mumps orchitis, an inguinal hernia, or a hydrocele in childhood
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| Scrotal hernia | usually an indirect inguinal hernia. It comes through the external inguinal ring, so the examining fingers cannot get above it within the scrotum
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| Acute Orchitis | Testis is acutely inflamed, painful, tender, and swollen. May be difficult to distinguish from teh epididymis. The scrotum may be reddened. Seen in mumps and other viral infxn. Usually unilateral
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| ACute Epididymitis | tender and swollen. Scrotum may be reddened and the vas deferens inflamed. Occurs chiefly in adults. Coexisting UTI or prostatitis supports the dx
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| Beading of the vas deferens may be caused by | chronic inflammation (ex: with tuberculosis)
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| Torsion of the Spermatic Cord | acutely painful, tender, swollen organ that is RETRACTED upward in the scrotum. The scrotum becomes red and edematous. No associated UTI. Most common in adolescents. Surgical emergency b/c of obstructed circulation
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| This type of hernia originates above the inguinal ligament near its midpoint (the internal inguinal ring) | indirect
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| pectinate or dentate line | anorectal junction which denotes the boundary between somatic and visceral nerve supplies. Not palpable, but readily visible on proctoscopic examination
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| Which parts of the prostate are felt on the DRE | lateral and posterior surfaces
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| DRE and PSA in prostate cancer | Evidence that screening improves health outcomes of prostate cancer remain inconclusive
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| Sexual Maturity Rating evaluates | pubic hair, penis, testes and scrotum
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