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Male Lecture

Advanced Physical Assessment

QuestionAnswer
Prostate cancer screening no recommended screening- not much to do about it
Inquire about tingling, penile sores or growths, vesicles, which could be due to herpes
Priapism Persistent erection unrelated to sexual stimulation-sickle cell anemia, leukemia, MS, diabetes, spinal cord injury-ED meds, anxiolytics and recreational drugs, trazodone
Phimosis is a tight prepuce that cannot be retracted over the glans. Paraphimosis
Balanitis is inflammation of the glans;
Balanoposthitis is inflammation of the glans and prepuce
The urethral meatus:Inspect its location; hypospadius is a congenital ventral displacement of the meatus on the penis- Compress the glans gently and look for any urethral discharge- also there is epispadius- on the upper/dorsal area
Test ulcers/chanchroid vs primary chancer syphilis painful vs painless
Common scrotal swellings include *inguinal hernia, hydroceles, scrotal edema, and testicular carcinoma
Epidermoid cysts Dome-shaped white or yellow papules or nodules formed by occluded follicles filled with keratin debris of desquamated follicular epithelium, common, frequently multiple and benign
Any painless nodule on the testis raises the possibility of testicular cancer
Tender painful scrotal swelling is present in acute epididymitis, acute orchitis, torsion of the spermatic cord, or a strangulated inguinal hernia
To check for a varicocele vasalva- bag of worms-pt standing, palpate spermatic cord 2 cm above the testis- do valsalva; temporary increase in diameter of spermatic cord indicates filling of abnormally dilated spermatic veins draining tetis
Hydrocele It transilluminates with red glow if it has water- Scrotal masses containing blood or tissue e.g. testis, tumors, most hernias, do NOT transilluminate
Direct inguinal hernia suggested by a bulge near the external inguinal ring
Indirect inguinal hernia suggested by a bulge near the internal inguinal ring- goes into the scrotum
To evaluate hernia ask the pt to lie down after feeling the hernia, if it goes back then it is herni, if not, place fingers above the mass, suspect hydocele, transilluminates, and you can put your fingers above the swelling
Gently try to return the hernia to the abdomen:A hernia is incarcerated when its contents cannot be returned
A hernia is strangulated when the blood supply to the entrapped and content is compromised- s/s: tenderness, N/V- consider referral to a surgeon
Ambiguous Genitalia newborn genitalia not clearly male or female, infertility in relatives, deficiency of male hormones in fetus, genetic abnormalities, Urethral opening anywhere above, or below the penis; appears female, Small scrotum, resembles labia, Undescended testicles
Klinefelter Syndrome XXY chromosomal inheritance, physical , language, social development, Hypogonadism, small scrotum, depends on how many XXY cells, testosterone level, age, time of dx, ↓ pubic, axillary, facial hair, Enlarged breast tissue, Tall, short trunk, infertile
primary syphilis vs chancroid painless (Treponema pallidum, a spirochete) vs the chancroid is painful (Haemophilus ducreyi; an anaerobic bacillus)
hypospadias A congenital displacement of the urethral meatus to the inferior surface of the penis- ventral- on the bottom
Peyronie Disease palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis- complains of crooked, painful erections
Scrotal Hernia Usually an indirect inguinal hernia that comes through the external inguinal ring, so the examining fingers cannot get above it within the scrotum
Scrotal Edema Pitting edema may make the scrotal skin taut; seen in heart failure or nephrotic syndrome
Cryptorchidism atrophied testies- predisposed to CA- and lies outside the scrotum in the inguinal canal, abdomen, or near the pubic; it may also be congenitally absent
Acute Orchitis testes acutely inflamed, painful, tender, and swollen, unilateral, difficult to distinguish from the epididymis, reddened, Seen in mumps
Spermatocele and Cyst of the Epididymis A painless movable cystic mass just above the testis suggests a spermatocele or an epidermal cyst; both transilluminate, one sperm, and the latter does not, but they are clinically indistinguishable
Acute Epididymitis indurated, swollen, tender, difficult to distinguish from the testis, reddened, vas deferens inflamed, possible Neisseria gonorrhea, Chlamydia trachomatis (younger adults), E.coli, and Pseudomonas (older adults); trauma, and autoimmune disease
Varicocele of the Spermatic Cord common, can cause infertility- varicose veins of the spermatic cord, found on the left feels like a soft “bag of worms” in the spermatic cord above the testis, prominent,distort the contours of the scrotal skin.
Torsion of the Spermatic Cord emergency- Torsion, or twisting of spermatic cord =painful, tender, swollen organ retracted upward in the scrotum- cremasteric reflex is absent on the affected side in torsion-the scrotum becomes red and edematous
Test- indirect hernia goes into the scrotum
Test- direct hernia Usually in men older than 40 yrs; rare in women- originates above the inguinal ligament close to the pubic tubercle (near the external inguinal ring)-bulges anteriorly and pushes the side of the examining finger forward- rarely in scrotum
Test Femoral hernia more in women- Least common-below the inguinal ligament; appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes- inguinal canal empty- don’t feel
Acute Bacterial Prostatitis fever, urinary tract symptoms- frequency, urgency, dysuria, incomplete voiding, low back pain- gland feels tender, swollen, boggy, warm, examine gently-caused by gram-negative aerobes such as E.coli,& Proteus- in <35, consider STI gonorrhea/chlamydia
Chronic Bacterial Prostatitis recurrent UTIs, usually from the same organism, dysuria or mild pelvic pain, infection with E.coli
BPH smooth ms contraction- they may be irritative (frequency, urgency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both, and are seen in more than one third of men by age 65 yrs.
Test question- prostate CA A DISTINCT HARD NODULE that alters the contour of the gland may or may not be palpable
Which hernia goes into the scrotum? Inguinal- cannot put fingers above it
Paraphimosis The inability to replace the foreskin to its usual position after it has been retracted behind the glans- will form a ring around it- can necroes
Condyloma Acuminata Genital warts caused by HPV PAINLESS
Molluscum Contagiosum painless- pearly gray- infectious- in adults, sti but in kids- infx- Viral infection of the skin and mucous membranes-
lymphogranuloma Venereum STI of lymphatics- enlarged lymph nodes- caused by chlamydia
Peyronie Disease curved penis- Characterized by a fibrous band in the corpus cavernosum
Penile CA ulcer that does not heal
Created by: arsho453