Genitourinary Exam

Question 1

Anatomy of male prostate, rectal, and GU systems

Answer 1

(see picture)

Question 2

Physiology of erection

Answer 2

begins with the corpora cavernous becoming engorged with blood due to increased arterial dilation and decreased venous outflow, controlled by autonomic nervous system, stimulated by release of nitric oxide in area

Question 3

Physiology of orgasm

Answer 3

ejaculation of secretions from vas deferent, epididymides, prostate, and seminal vesicles, resolution by vasoconstriction in corpora cavernosa

Question 4

Equipment and supplies necessary to perform the male GU, prostate, and rectal exams
(including transillumination of the scrotum)

Answer 4

Gloves - examine penis, glans, urethral meatus, penile shaft, scrotum, any hernias, testes, prostate, digital rectal exam
Penlight - Transillumination of scrotum (determine if mass is fluid or tissue filled
GUI card - FOB
Emesis basin - contain defecation
Lube

Question 5

Purpose of FOB testing as rectal exam

Answer 5

To test for blood in the stool that cannot be seen with naked eye. Can be a sign of gastrointestinal bleeding

Question 6

Sequence and exam techniques used in assessing male GU health - Inspection

Answer 6

I: Much of inspection during palpation, lesions, chancres, pubic hair patterns, circumcised/not, position, meatus position/stenosis, symmetry of scrotum, rashes, redness, separate hair to look at skin.

Question 7

Tanner stages for genital and pubic hair development in the male adolescent

Answer 7

Stage 1: Testes, scrotum, and penis are same size/shape as young child; no pubic hair growth
Stage 2: Enlargement of scrotum and testes, skin becomes redder, thinner, and wrinkled, no penile enlargement; slightly longer, straight, pigmented hair at base of penis, sometimes on scrotum, texture is still downy
Stage 3: Enlargement of penis, especially in length, further enlargement of testes and scrotal descent occurs; dark pigmented, curly pubic hair at base of penis
Stage 4: Continued enlargement of penis and sculpturing of glans, increased pigmentation of scrotum; atult type pubic hair but only to inguinal folds; “Not quite adult”
Stage 5: Penis reaches to nearly bottom of scrotum; hair spreads to medial surface of thighs buts not upward; Adult distribution
Stage 6: (Seidel/Mosby only says) Hair spreads to lenea alba (at midline from umbilicus down); occurs in 80% of men

Question 8

Exam variations in assessing a circumcised vs. noncircumcised patient

Answer 8

Circumcised: glans should appear erythematous and dry, no smegma
Uncircumcised: retract foreskin (should be easy), normal to see smegma (white cheesy sebaceous matter that collects between glans penis and foreskin), note ease of retractability, complete exam of glans and urethral meatus, always reduce foreskin back to normal.

Question 9

Techniques used to minimize patient anxiety associated with a genital exam

Answer 9

Chaperone (esp. opp. sex), answer questions ahead of time, thorough communication before exam starts, position (explain before), equipment (assemble ahead of time to minimize time and confusion ), while doing exam instruct patient on how they can do the self-exam

Question 10

Steps and techniques utilized in genital and testicular self exam, and recommended associated patient education

Answer 10

Educate and demonstrate the self exam procedure, give them chance to perform a GSE with your guidance.
Steps 1 - 5
Recommended to do this while taking a bath. The warmth will make the skin less thick and easier to access for abnormalities.

Question 11

Paraphimosis

Answer 11

foreskin becomes trapped behind the glans penis

Question 12

Hypospadias

Answer 12

urethral opening is on underside of the penis

Question 13

Chancre

Answer 13

painless ulceration formed during primary stage of syphilis

Question 14

Condyloma

Answer 14

presence of warts caused by HPV

Question 15

Peyronie disease

Answer 15

connective tissue disorder; chronic inflammation and scar tissue formation in the tunica albuginea

Question 16

Hydrocele

Answer 16

collection of fluid in scrotum

Question 17

Spermatocele

Answer 17

benign, sperm-filled cyst at the head of the epididymis

Question 18

Varicocele

Answer 18

enlargement of the veins within the scrotum

Question 19

Epididymitis

Answer 19

inflammation of infection of the epididymis; generally caused by chlamydia, gonorrhea, or E.Coli

Question 20

Testicular tumor

Answer 20

cancer that develops in the testicles

Question 21

Epispadias

Answer 21

urethral deformity; can open of top, side, or be open along length of penis

Question 22

Indirect inguinal hernia

Answer 22

through internal ring; most common type of hernia, patients often young males; pain on straining; touches fingertip on exam

Question 23

Direct inguinal hernia

Answer 23

doesn’t go through internal inguinal ring; through external right; hernia bulges anteriorly, pushes against side of finger

Question 24

Femoral hernia

Answer 24

bulging of intestines though the femoral ring

Question 25

Cryptorchidism

Answer 25

undescended testicle

Question 26

Palpation of GU exam

Answer 26

P: glans: tenderness, nodules, lesions, palpate top to bottom/side to side/ strip the urethra looking for any abnormal discharge or blood at urethral meatus. Open meatus to inspect for discharge, lesions
scrotum: cremasteric reflex - tongue blade stroked on inside of thigh, testicle on that side should rise voluntarily (tests T12, L1, L2 nerves)
Testis: Gentle, one at a time, ask pt to hold penis out of way, roll testicle around in fingers, smooth, not overly tender, note contours during palpation, find spermatocord (check for hernia)

Question 27

GU exam for children/adolescent

Answer 27

Lesions, malformations, discharge, masses, hernias

*For adolescents, allay anxiety, protect privacy, inspect/palpate, tanner stage

Question 28

Infant GU exam

Answer 28

Mostly looking for congenital abnormalities, urethral placement, retractability of foreskin, descent of testicles (1-2 months), masses (transilluminate)

Question 29

Transillumination of scrotum

Answer 29

to test for hydrocele, light should shine through, if clear fluid inside

Question 30

Hernia check

Answer 30

Follow spermatocord up to pelvis, toothpick feeling is the vas deferent, find the external inguinal ring, place tip of finger here and have patent cough/ bear down. If bulge felt on tip of finger = indirect hernia, if bulge felt on side of finger = direct hernia

Question 31

Step 1 GS exam

Answer 31

Patient should hold penis in hand, Inspect head of penis for lesions or masses (if not circumcised, pull back foreskin)
Palpate head of penis feeling for bumps, sores, warts or blisters.

Question 32

Step 2 GS exam

Answer 32

Inspect urethral meatus, squeeze to see if there is any discharge.

Question 33

Step 3 GS exam

Answer 33

Patient should examine entire shaft. Evaluate for any lesions, asores or masses.
Use a mirror to visualize the underside.

Question 34

Step 4 GS exam

Answer 34

Patient should then examine the base of the penis by moving pubic hair out of the way.

Question 35

Step 5 GS exam

Answer 35

Scrotum evaluation

Patient should hold each testicle gently while inspecting and palpating using lighter then firmer pressure.