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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 |