GU exam Flashcards
(17 cards)
1
Q
Why do we perform GU/DRE?
A
- colorectal cancer screening
- part of comprehensive physical exam - sacrococcygeal and perianal areas, anus, rectum, scrotum, and prostate
- other rectal pathology
- allows for palpation of only posterior surface of prostate gland but stil widely used when there is a urinary complaint
- rectal mucosa exam: allows clinician to palpate - polpys or abnormally firm, irregular or raised areas that may indicate presence of carcinoma
2
Q
Is DRE by itself adequate screening method for CRC?
A
- no
- also common practice for some clinicians to use stool sample obtained during DRE for FOBT
3
Q
Common positions for the DRE?
A
- modified lithotomy (pt on back, knees flexed)
- sim’s position (for bedridden pts) - left lateral
- standing, hips flexed w/ upper body on table
- have to carefully assess pt’s strength and mobility b/f positioning him
4
Q
Inspection part of GU exam?
A
- inspect penis, including foreskin, uretheral meatus (for d/c)
- inspect scrotum noting any visible rashes or underdevelopment
5
Q
Palpation part of GU exam?
A
- palpate each testis and epididymis b/t your finger and 1st 2 fingers
- palpate each spermatic cord, including vas deferens
6
Q
What should be done if there is any swelling found in scrotum other than in the testicles?
A
- should be eval by transillumination - swellings that contain serous fluid, such as hydrocecele, will transilluminate
7
Q
Inspecting for hernias?
A
- inspection: inspect inguinal and femoral areas carefully for bulges - while observing - ask pt to strain down
- palpation: using R hand on pt’s right side invaginate loose scrotal skin with index finger
- follow spermatic cord upward to above the inguinal ligament and find triangular slitlike opening of external inguinal ring
- ask pt to bear down or cough
- stand on L side using R hand for assessing other side
8
Q
Steps of performing the DRE?
A
- make sure lighting is good
- glove both hads and spread buttocks apart
- inspect sacrococcygeal and perianal areas
- palpate any abnormal areas, noting lumps or tenderness
- ask pt about localized feelings or tenderness or pain
- lubricate gloved index finger
- warn pt b/f inserting finger - gently press on sphincter’s edge and wait for it to relax and then insert finger into anal canal
- pause and allow pt to adjust to your finger, then continue to isnert finger fully
- assess sphincter tone by asking pt to squeeze anal muscles around finger
9
Q
Examination inside the rectum?
A
- examine posterior and lateral walls of rectum by gently rotating finger through 180 degrees
- to palpate entire circumference of rectum - you should turn away from pt and hyperpronate wrist
- sweep your finger across anterior and anterolateral walls of rectum
- note texture and elasticity of rectal lining
10
Q
What are possible findings on rectal exam?
A
- normal rectal mucosa feels uniformly smooth and pliable
- polyps - may be attached by a stalk or base
- masses or irregularly shaped nodules
- areas of unusual hardness
- abscesses (perirectal) may be indicated by extreme tenderness
- hemorrhoids (internal and external)
11
Q
How do you examine the prostate?
A
- inform pt that you are going to examine his prostate gland
- sweep your finger over prostate gland (found anteriorly through rectal wall)
- ID 2 lobes w/ longitudinal groove (median sulcus) b/t them
- note size, nodularity, consistency and tenderness of prostate
12
Q
Characteristics of a normal prostate?
A
- about 2.5 cm from side to side
- prominent median sulcus
- consistency is rubbery and smooth
- tenderness isn’t usual and pts should feel urge to urinate when you palpate
13
Q
Characteristics of BPH?
A
- enlargement of gland is symmetrical
- marked protrusion into rectal lumen
- smooth w/ no nodularity
- median sulcus may be indistinguishable
- consistency is rubbery or slightly elastic
14
Q
Characteristics of prostate cancer?
A
- asymmetric shape
- hard consistency
- discrete nodule may be palpable
- median sulcus often observed
15
Q
Characteristics of acute prostatitis?
A
- gland is swollen and boggy
- firm consistency (have pt f/u - worry about cancer)
- very tender to touch
- examine gland carefully
- pay attention to pt’s verbal and nonverbal cues
16
Q
What should you do if DRE yields suspicious results?
A
- explain findings to pt
- negotiate f/u plan for pt:
colonoscopy
PSA and possible bx - address pt concerns
17
Q
Use of DRE and PSA as screening tools?
A
- 2 principle screening tests for prostate cancer
- each has distinct limitations that warrant careful review w/ pt
- DRE reaches only posterior and lateral surfaces of prostate
- PSA can be elevated for benign conditions
- providers need to counsel all men undergoing screening about utility of testing and benefits and harms of early detection and tx
