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Male GU
Clinical Medicine II
| Question | Answer |
|---|---|
| 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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