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Advanced Physical Assessment

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Prostate cancer screening   no recommended screening- not much to do about it  
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Inquire about tingling, penile sores or growths, vesicles, which could be due to   herpes  
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Priapism   Persistent erection unrelated to sexual stimulation-sickle cell anemia, leukemia, MS, diabetes, spinal cord injury-ED meds, anxiolytics and recreational drugs, trazodone  
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Phimosis   is a tight prepuce that cannot be retracted over the glans. Paraphimosis  
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Balanitis   is inflammation of the glans;  
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Balanoposthitis   is inflammation of the glans and prepuce  
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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  
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Test ulcers/chanchroid vs primary chancer syphilis   painful vs painless  
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Common scrotal swellings include   *inguinal hernia, hydroceles, scrotal edema, and testicular carcinoma  
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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  
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Any painless nodule on the testis raises the possibility of   testicular cancer  
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Tender painful scrotal swelling   is present in acute epididymitis, acute orchitis, torsion of the spermatic cord, or a strangulated inguinal hernia  
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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  
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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  
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Direct inguinal hernia   suggested by a bulge near the external inguinal ring  
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Indirect inguinal hernia   suggested by a bulge near the internal inguinal ring- goes into the scrotum  
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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  
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Gently try to return the hernia to the abdomen:A hernia is incarcerated when   its contents cannot be returned  
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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  
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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  
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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  
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primary syphilis vs chancroid   painless (Treponema pallidum, a spirochete) vs the chancroid is painful (Haemophilus ducreyi; an anaerobic bacillus)  
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hypospadias   A congenital displacement of the urethral meatus to the inferior surface of the penis- ventral- on the bottom  
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Peyronie Disease   palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis- complains of crooked, painful erections  
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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  
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Scrotal Edema   Pitting edema may make the scrotal skin taut; seen in heart failure or nephrotic syndrome  
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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  
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Acute Orchitis   testes acutely inflamed, painful, tender, and swollen, unilateral, difficult to distinguish from the epididymis, reddened, Seen in mumps  
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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  
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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  
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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.  
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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  
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Test- indirect hernia   goes into the scrotum  
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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  
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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  
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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  
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Chronic Bacterial Prostatitis   recurrent UTIs, usually from the same organism, dysuria or mild pelvic pain, infection with E.coli  
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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.  
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Test question- prostate CA   A DISTINCT HARD NODULE that alters the contour of the gland may or may not be palpable  
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Which hernia goes into the scrotum?   Inguinal- cannot put fingers above it  
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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  
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Condyloma Acuminata   Genital warts caused by HPV PAINLESS  
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Molluscum Contagiosum   painless- pearly gray- infectious- in adults, sti but in kids- infx- Viral infection of the skin and mucous membranes-  
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lymphogranuloma Venereum   STI of lymphatics- enlarged lymph nodes- caused by chlamydia  
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Peyronie Disease   curved penis- Characterized by a fibrous band in the corpus cavernosum  
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Penile CA   ulcer that does not heal  
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