General diagnosis - Rectal and urogenital exam

Question 1

Bacterial vaginosis

Answer 1

gynecologist referral

• fishy smelling watery discharge after sex or menstruation
• inflammatory condition of the vagina (associated w/: gardnerell species overgrowth)
• vagianl pH > 4.5, numerous clue cells, + amine test confirms Dx

Question 2

Cancer of the penis

Answer 2

urologist referral

• non-healing ulcer or mass on the glans penis or foreskin with inguinal node spread
• neoplastic condition of the penis; associated w/ chronic HPV infection
• biopsy confirms Dx

Question 3

Cancer of the vulva

Answer 3

gynecologist referral (biopsy confirm Dx)

• non-healing ulcer or mass in the vulva with spread to involve the inguinal nodes
• neoplastic condition of the vulva; associated w/: chronic HPV infection

Question 4

candidiasis

Answer 4

gynecologist referral for treatment

• sever vulvar and vaginal itching with thick cottage cheese discharge
• infection of the vulva/vagina d/t candida albicans overgrowth; after use of broad-spectrum antibiotics and in diabetics
• labs: discharge have buds and branching hyphae (characteristic of candida albicans)

Question 5

cervical cancer

Answer 5

gynecologist referral (PAP smear and follow up biopsy)

• post-coital (after sex), bleeding and non-healing erosion of cervix
• neoplasia of the cervix; MC associate w/ chronic HPV infection

Question 6

chancroid

Answer 6

medical practitioner referral

• painful yellow genital ulcers, swollen tender inguinal lymph nodes
• seually transmitted disease cause by Hemophilus ducreyi
• tissue culture to confirm Dx

Question 7

endometriosis

Answer 7

Co-manage with gynecologist

• severe dysmenorrhea, painful nodules in the adnexa, retroverted uterus and infertility
• deposition of endometrial tissue outside uterine cavity; commonly in broad ll., on the ovary and in the pelvis
• laproscopic biopsy of chocolate cysts in the pelvis confirm Dx

Question 8

epididymo-orchitis

Answer 8

hospital referral

• tender swollen testis and epididymis, prehn’s sign (elevation of scrotum relive pain) may be present
• acute inflammation of the testes and epididymis; associated with gonorrhea and chlamydia

Question 9

granuloma inguinale

Answer 9

medical practitioner referral

• painless beef-red ulcers in genital region
• STD d/t calymmatobaacterium (klebsiella) granulamatis

Question 10

herpes genitalis

Answer 10

Co-manage with medical practitioner

• painful recurrent multiple vesicles and shallow ulcers in the genital region
• STD d/t herpes simplex type 2 infection

Question 11

lymphogranuloma venereum

Answer 11

medical practitioner referral for antibiotics

• fleeting rash, followed by swollen painful draining inguinal lymph nodes (buboes), and rectal strictures
• uncommon STD d/t chlamydia tachomatis types L1-3
• sin of groove may be present in inguinal region

Question 12

pelvic inflammatory disease

Answer 12

hospital referral

• fever, lower abdominal pain, cervical motion tenderness, mucopurulent cervical discharge
• inflammatory disease of uterus, fallopian tubes and surrounding pelvic connective tissue; d/t gnorrhea or chlamidia

Question 13

prostatic cancer

Answer 13

urologist referral

• often asymptomatic
• symptomatic (cancer spread): hematuria, hard irregular prostate, LBP, fatigue, weight loss
• slow-growing malignancy of the prostate gland
• Labs: elevated PSA, alakaline phosphatase, hypercalcemia occurs with metastases

Question 14

ovarian cancer

Answer 14

gynecologist referral

• bloating, abdominal disconfrt adn ascites; 1 ovary enlarged
• malignancy of ovary (MC after 50yo)
• US confirm presence of mass

Question 15

syphilis

Answer 15

Medical practitioner referral

• painless hard nodule or genital ulcer
• STD d/t treponema pallidum
• • VDRL, FTA-abs needed to confirm Dx

Question 16

Testicular cancer

Answer 16

urologist referral

• dull ache in scrotum with an enlarged irregular testis and gynecomastia
• US confirms ECHOdensity of mass, biopsy confirms Dx

Question 17

Trombosed external hemorrhoid

Answer 17

proctologist referral (if, conservative care with sitz baths and preparation H are not helpful)

• vary tender blue swollen nodule at he anal orifice arising below the pectinate line
• painful thrombosed tributary of the inferior rectal vein; associated with constipation

Question 18

Torsion of the testis

Answer 18

urgent referral to confirm and do surgery

• sudden onset of testicular/scrotal pain, refered to the periumbilical region, n/v, prehn’s sign is negative, affected testis will be higher than the other
• uncommon twisting of the testis d/t long mesorchium

Question 19

Trichomonas

Answer 19

gynecologist referral

• vulvar itching, malodorus frothy yellow-green vaginal discharge female (asymptomatic in males)
• STD d/t protozoan called trichomonas vaginalis
• Lab: motile flagellates in discharge

Question 20

Uterine leiomyoma (fibroids)

Answer 20

gynecologist referral

• polymenorrhagia (frequent periods w/ prolonged bleeding), irregularly enlarged uterus, anemia
• benign smooth mm tumors of the uterus (related to estrogen stimulation)
• may be: microcytic hypochromic anemia d/t prolonged bleeding

Question 21

Varicocele

Answer 21

urologist referral

• dragging sensation in scrotum, bag of worms’ sensation on palpation
• vericose veins in pampiniform plexus of veins (MC on left)
• doppler US confirms Dx

Question 22

bag of worms’ sensation on scrotum

Answer 22

varicocele

Question 23

buboes in groin (draining lymph nodes)

Answer 23

lymphogranuloma venereum

Question 24

cheesy white curds in the vagina

Answer 24

candidiasis

Question 25

craggy hard irregular nodule in prostate

Answer 25

prostatic cancer

Question 26

erosion on the cervix

Answer 26

cervical cancer

Question 27

irregular painless testicular enlargement

Answer 27

testicular cancer

Question 28

irregular uterine enlargement

Answer 28

uterine fibroids

Question 29

froth malodorous vaginal discharge

Answer 29

trichomaonas

Question 30

multiple painful shallow genital ulcers

Answer 30

herpes genitalis

Question 31

non-healing vulvar ulcer

Answer 31

carcinoma of the vulva

Question 32

non-healing penile ulcer

Answer 32

carcinoma of the penis

Question 33

painful bluish mass protruding from the anal orifice

Answer 33

thrombosed external hemorrhoid

Question 34

painful nodules in the adnexa

Answer 34

endometrosis

Question 35

painless fleshy mass protruding form anal orifice

Answer 35

internal hemorrhoid

Question 36

painful soft yellow genital ulcer

Answer 36

chancroid

Question 37

painless soft red genital ulcer

Answer 37

granuloma inguinale

Question 38

painless firm genital ulcer

Answer 38

syphilis

Question 39

pelvic mass in a postmenopausal woman

Answer 39

ovarian cancer

Question 40

regular uterine enlargement

Answer 40

pregnancy

Question 41

sign of the groove (swollen inguinal nodes with groove)

Answer 41

lymphogranuloma venerum

Question 42

smooth round prostate with median sulcus

Answer 42

normal prostate

Question 43

strawberry cervix

Answer 43

trichomonas

Question 44

swollen tender testis and epididymis

Answer 44

epididymo-orchitis

Question 45

tender boggy prostate

Answer 45

prostatitsis

Question 46

tenderness on motion of the cervix

Answer 46

pelvic inflammatory disease

Question 47

transilluminable mass in the scrotum

Answer 47

hydrocele

Question 48

watery fishy vaginal discharge

Answer 48

bacterial vaginosis