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Male GU

Clinical Medicine II

What is the shaft of the penis composed of corpus spongiosum and two corpus cavernosa (dorsal)
Contains urethra and forms the bulb and glans corpus spongiosum
Two erectile tissue corpus cavernosa
Fxns of testes produce spermatozoa and testeosterone
How long are the testes usually ~4.5cm with left a little longer
What covers the testes a memberane of the tunica vaginalis
Where is the epididymis located posteriolateral surface of each testes
Fxn of epididymis sperm is housed to mature and eventually transported into the vas deferens
Where doe the vas deferens go from epididymis, ascends in the spermatic cord thru the external inguinal ring, joins the urethra in prostate gland
Where does the vas deferens and urethra meet prostate gland
What are the genitals and testicles drained by G: inguinal lymph nodes, testes: drain into the abdomen
What is the tunica vaginalis surrounds the epidydmis and testes and extension from the peritoneum
What is a hydrocele communication of the tunica vaginalis to the abdomen (fluid filled sac in the scrotum (anterior))
What causes a testicular torsion spontaneously d/t a cough, sneeze, or injury
Two types of testicular torsion intravaginal and extravaginal
Spermatic cord twists within the tunica vaginalis intravaginal testicular torsion
Testis, spermatic cord, and tunig ttwist together extravaginal TT
Tx for TT medical emergency, decompress and restore blood supply
4 causes of ED endocrine, vascular, nevous, psychogenic, and medication side-effects
Nerves controlling erectile tissue S2 and S4 parasympathetic pathways thru the pudendal n.
What pathways need to be intact for an erection to occur alpha-adrenergic and cholinergic pathways
3 types of pshycogenic ED depression, anxiety, self image
2 meds that can cause ED beta blockers, anticholinergics, SSRIs???
Causes of biological ED inadequate testosterone, ↓ hypogastric a. flow, impaired neural innervation, back injury?
Secondary causes of ED many vascular, smoking nervous, DM
What are the medical causes of premature ejaculation none, common in young men, usually psychogenic
Causes of ↓ or absent ejaculate medications, surgery, neuro deficit, lack of androgens
Causes of ejaculate not to come out anymore prostate, testosterone def, ↓ abd musculature
Yellow penile discharge gonococal
Clear or white penile discharge – non-gonococcal
Painful, clear vesicles on an erythematous base herpes
Painless ulceration chancre of syphilis
STDs we should be screening for syphilis, HPV, Hep B, genital herpes
Who are at an ↑ risk of STDs men w/ men partners, past/present IV drug users, past/present HIV infx, bisexual, injection drugs, hx of blood transfusions b/w ’78 and ‘85
Which age range should men especially perform a testicular self-exam 15-35
Reasons to consult a physician after self teste exam painless lump, swelling, enlargement, pain/discomfort in testicle or scrotum, heaviness feeling or fluid collection, dull ache in lower groin, abd or groin
Teste failed to desend cryptorchidism
Surgical restoration of an undescended testicle into the scrotum orchipexy
Dx of testicular cancer good physical exam, ultrasound,
Do we biopsy for testicular cancer no, not usually
Removal of testes orchiectomy
When do we check for varicoceles and hernias when the pt is standing,
Cannot retract the foreskin ver the glans phimosis
Cannot pull the foreskin back over the glans paraphimosis
Crooked penis peyronie’s??
Reason for transillumination r/o hydrocele or suspicious mass
“bag of worms” caricocele
Hernia in the scrotum (or through external inguinal ring) indirect hernia
Direct hernia thru the abdominal wall
Weakening in the underlying structures, ligaments, muscles, fascia of the abd wall hernias
Complications of a hernia incarceration or strangulation
A hernia that can’t be reduced incarceratied can lead to strangulation
3 types of hernias direct, indirect, femoral (in relation to hasselbeck’s triangle)
What do we do to an indirect hernia listen to it with our steahtoscope
Where is the prostate just inferior to the urinary bladder
How many lobes does the prostate have 3, two which are palpable w/ DRE
How big is the prostate 2.5cm, heart-shaped, with a palpable median sulcus b/wlobes
Define the following: decreased calibler lower GI mass
Blood polyps, CA, hemorrhoids, fissue
Pain hemorrhoids, fissures, herpes, proctitis
Discharge urethritis, chlamydia, chancre in primary syphilis
Warts HPV
Fissures proctitis, Crohn’s
Review Ch. 11 causes of diarrhea and constipation fjdosajfewoao;v
Causes of urethral obstruction BPH and CA
Discomfort of heaviness in the prostate or at the base of the penis associated w/ malaise, fever, chills prostatitis (tender on exam)
Most commonly diagnosed male malignancy 2 to lung cancer prostate cancer
Median age of prostate CA dx 72
Which ethnic group has the highest incidence of prostate cancer African americans
Lowest incidence Asian and NAs
Risk for men w/ 1st degree relative doubled
Screening of prostate cancer DRE, PSA
What can transiently elevate PSA ejaculation, prostate biopsy, urinary retention, DRE
What can elevate PSA in general inflammatory response, RE, BPH, prostatitis
When should we start PC screening DRE and PSA annually >50
Start for AA’s and fhx 40yo
When should we do annual screening b/w 40-50 urinary retention, frequency and urgency, weak stream, difficullity initiating, hematuria, nocturia
2nd leading COD in U/S colo-rectal cancer
Screening for CRC DRE, FOBT, flex-sig, colonoscopy, virtural??
What has a high false + results FOBT
+ of colonoscopy can biopsy and remove polyps especially >10mm
See bates pg 560
What are we inspection for prior to DRE sacro-coccygeal area for pilonidal cysts, peri-anal area for HPV, fissures, hemorrhoids, rash,
What do we ask our pt to do prior to insertion bear down
Steps to prostate exam lube, warm patent, bear down as u insert, reach above prostate, turn and palpate rectum walls
Identification of prostate both lobes, median sulcus, note size, shape, consistency, identify nodules/tenderness
Normal feel to prostate rubbery and non-tender/nodular
+ FOBT blue
Created by: becker15
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