Exam V: Pelvic & Junk Flashcards Preview

Introduction to Clinical Medicine > Exam V: Pelvic & Junk > Flashcards

Flashcards in Exam V: Pelvic & Junk Deck (55)
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1

Office Environment

ALWAYS have another person in the room while examining genital area or the female breasts.
Explain what you are going to be doing, before you do each step/maneuver
Insure patient comfort, and modesty

2

Patient Comfort and Modesty

Use gowns AND sterile drapes over pt legs
Allow patient to wear socks, shirt- as long as access can be facilitated etc.
Foot of exam table does not face the door
Door is clearly marked to avoid interruption
Another person in the room all the time, taking notes or somehow attentive

3

Male Anatomy: Penis, Root, Glans, Foreskin, Corona, and Frenulum

Penis - formed of three cylindrical masses of erectile tissue - enclosed in separate fibrous coverings - held together by a covering of skin

Root at base of penis, divides into crura which are attached to the pelvic bones

Glans is at the tip of the penis and is the most sensitive part for most men - covered by prepuce or foreskin which may be removed by a surgical procedure called circumcision

Corona (crown) - ridge between glans and foreskin

Frenulum - connects glans to shaft on underside of penis

Smegma - secretion that can accumulate under foreskin of penis and must wash/clean thoroughly to prevent infections

4

Male Anatomy: Shaft

Contains spongy tissue which fills with blood when a man is aroused, leads to erection (there is no bone in the penis)
Cavernous bodies (corpus cavernosum) - on top - 2 of them
Spongy body (corpus spongiosum) underneath - 1 only - urethra runs through it

5

Malformations of the Penis

Abnormal location of urethral orifice along penile shaft

Hypospadias: urethra on ventral aspect; most common

Epispadias: urethra on dorsal aspect

If these issues are present = congenital issues which mean problems downstream like pelvic organ abnormalities, inguinal hernias, undescended testes

Clinical Consequences: constriction of orifice, urinary tract obstruction leading to infection, impaired reproductive function

6

Kegel Exercises

benefit sexual functioning and pleasure – note that the musculature around the penis is comparable to the pelvic floor muscles in the female

strengthening the muscles with Kegel exercises may produce benefits for men in that are similar to those produced by Kegels in women

Prevents pelvic floor prolapse
Contraction muscles that hold the urine

7

Seminiferous Tubules and Interstitial Cells

Seminiferous tubules are the site of sperm production
sperm maturation occurs in the epididymus (about 20 feet long) on the back of each testicle

Interstitial cells are located between the seminiferous tubules and are the major producer of androgens in men

8

Epipdidymitis vs. Testicular Torsion

BOTH are EMERGENCIES

Testicular torsion: pain is sudden and severe; abnormal axis; acute; early puberty; UA is negative; cremasteric reflex is negative; tx is surgical exploration

Epididymitis: gradual onset of pain of testis or epididymis; the testicle may be warm and/or red and swollen; axis of testicle is normal; insidious onset of symptoms; adolescents; UA can be + or -; cremasteric reflex is positive; tx is antibiotics

9

Seminal Vesicles

Seminal vesicles - two pouch-like structures between the bladder and the rectum - function not completely understood – they secrete an alkaline fluid rich in fructose - sperm become motile here and can propel themselves (got to this point via cilia in ducts) - contribute about 70% of seminal fluid 

10

Prostate

Doughnut shaped gland just below the bladder - thin alkaline secretions counteract acidity in male urethra and in the vagina – contributes about 30% of seminal fluid

11

Cowper's Glands

Or bulbourethral glands
Pea-sized - lie just below prostate - connect to urethra by a duct - secrete a slippery substance when a man is sexually aroused - alkaline - helps lubricate flow of seminal fluid through urethra
can contain active sperm and cause pregnancy without ejaculation occurring

12

Semen

(or seminal fluid)
one teaspoon of fluid – one ejaculation contains 200-500 million sperm which - provide only 1% of volume - rest from seminal vesicles (70%), prostate (30%) and Cowper's gland (<2%)
semen of a healthy man is not harmful if swallowed – but semen can transmit HIV from an HIV-positive man

13

Ejaculation

Two stages = emission and expulsion

Emission phase - prostate, seminal vesicles and upper part of vas deferens (ampulla) contract - moves secretions into ejaculatory duct and prostatic urethra
internal (bladder exit) and external (below prostate) urethral sphincters close - urethral bulb balloons - leads to sensation of ejaculatory inevitability

Expulsion phase - strong rhythmic contractions of the penis expel semen – urethra contracts - external sphincter relaxes allowing semen to be expelled - internal sphincter continues to contract preventing urine from being expelled

14

Circumcision Sutures

Interrupted sutures in case one comes out
If continuous, if it is damaged, the whole suture is at risk

15

Phimosis

Extremely tight foreskin
Prepuce cannot be easily retracted over glans
May be congenital, but usually associated with balanoposthitis (STD) and scarring
Paraphimosis: trapped glans causing urethral constriction

16

Penis Enlargement Procedure

Detach crura to give 2-3 inches and then inject fat behind glans
The erection will be pointing straight instead of angled dorsally so urination and ejaculation flow is different
Must wear a pole attached to the penis to prevent crura from reattaching

Gelking: some men go for the stretch method of enlargement- get ulcers if too much weight stretched the skin

17

Inflammatory Lesions of the Penis: STDs

Balanitis (balanoposthitis): inflammation of the glans plus prepuce associated with poor hygiene in uncircumcised men (smegma); distal penis is red, swollen, tender, and with or without purulent discharge

18

Inflammatory Lesions of the Penis: Fungal

Candidiasis
Especially in diabetics
Erosive, painful, pruritic, simple yeast
Can involve entire external male genitalia
Baby powder and air helps prevent yeast growth – they like warm, dark, and moist areas

19

Neoplasms of the Penis: Squamous Cell Carcinoma

Epidemiology: uncommon aka less than 1% of cancer in males, but mostly in uncircumcised men between 40-70 years old

Pathogenesis: poor hygiene, smegma, smoking, HPV (16 and 18)
CIS first then progression to invasive squamous cell carcinoma

20

3 Parts to Pelvic Exam

1. Observation and the speculum exam

2. Bimanual exam

3. Recto-Vaginal Exam (includes DRE)

21

History, Inspection, and Palpate

Pubic hair-triangle pattern
Lymph nodes
Orifices

Palpate:
Urethral meatus-incontinence
Labia
Skene’s, then Bartholin’s glands
Perineum

22

Speculum Exam

Performed prior to the bi-manual exam so as not to disturb the tissues/samples
Performed without lubricant jelly
Always inserted with the speculum blades warmed with warm water and closed
Inserted at a 45 degree angle posteriorly

23

Visual Observation of Cervix

Position—is it anteverted, deviated, etc
The position of the cervix gives clues to the position of uterus
Color—should be flesh-colored, but ranges from pink to dark brown (blue or pale??); certain colors indicate pregnancy
Surface characteristics—cysts, erythema
Discharge
Size and shape of os- indication of reproductive history

24

Nulliparous Cervix

No baby has passed through
Small and round

25

Multiparous Cervix

At least one or more children have passed through
Bigger and not round, more linear

26

Everted Cervix

The endothelium of canal will move out
True cervical tissues and inner cervical tissues

27

Nabothian Cysts

aka: retention cysts
Pimple like things on the cervix

28

The Papanicolaou Exam (“Pap”)

A minimum of two samples will be taken:
Cervical cells
Vaginal secretion
Other tests may be done to screen for STDs

The “Pap smear” evaluates the condition of the cervical cells (taken with cervical brush or spatula)
SCREENS FOR CERVICAL CANCER- very accurate and decreased cancer rates

Assessing “transitional zone” of the cervix

29

Three Most Common STDs in Women

HPV, Herpes, Chlamydia, (Now 10’s of millions of existing cases)
In women, often no visible symptoms

30

Bacterial Vaginosis

aka: Vulvovaginitis
General description for anything that causes symptomatic discharge (an irritant)

May be due to bacteria, viruses, fungi, or protozoans

Patient may talk to you about: vaginal or vulvar itching, burning, or change in color, texture or odor of discharge