Male

Question 1

Scrotal contents that should be palpated

Answer 1

Testes
Epididymis
Spermatic cord(Vas Deferens)

Question 2

What age range has the highest incidence of testicular cancer?

Answer 2

15-35 year olds

Question 3

What should the consistency of the testicles be?

Answer 3

Like a hard boiled egg

Question 4

Epididymis

Answer 4

located on top of testicle and posterolateral – feels nodular & cordlike

Question 5

Spermatic cords

Answer 5

Bilateral firm cords that feel like the “inside of a BIC pen”
Palpate from the epididymis to the inguinal ring
Palpate between thumb and index finger

Question 6

Hernia Examination

Answer 6

Invaginate some scrotal skin when inserting index or little finger into inguinal ring
Use “cross-handed” method:Right hand for patients right side & vice versa
Ask patient to, “turn your head and cough” or Valsalva
Feel for sudden pressure at side or tip of finger

Question 7

Prostate exam

Answer 7

Size: about size of a walnut
Shape: “almond” (with 2 lobes)
Consistency: firm, like tip of nose or thenar area of palm

Question 8

Hemoccult/guaiac test

Answer 8

done if blood is found on stool after rectal exam

Question 9

Prostate Specific Antigen(PSA) causes of elevation

Answer 9

Routine rectal exam does not alter PSA

Biopsy or rigorous manipulation of prostate may elevate PSA

Question 10

Testicular Cancer rates

Answer 10

most common cancer in males aged 20-39 yrs

Question 11

ACS testicular exam recommendation

Answer 11

testicular exam by a healthcare provider as part of a routine cancer-related check-up
Seek care if a a lump is found
No recommendation about regular self-testicular exams but recommended by some doctors
Men with risk factors, such as an undescended testicle (cryptorchidism), previous testicular cancer, or family history should consider monthly self-testicular exams (see handout)

Question 12

USPSTF Testicular

Answer 12

recommends against routine screening for testicular cancer in asymptomatic patients (no provider or self-testicular exam)
Based on low prevalence of testicular cancer & unknown accuracy of examination for detection. Even without treatment, current treatments = favorable outcomes

Question 13

Evaluation for hernias

Answer 13

AAFP, AAP, American College of Sports Medicine, & others recommend routine male genitourinary exam, including testicular & hernia examination as part of a sports physical
-USPSTF has no recommendation

Question 14

ACS Prostate recommendations

Answer 14

Men should be given the opportunity to make an informed decision about whether or not to be screened for prostate cancer – includes PSA testing & DRE
Current evidence suggests that annual screening with PSA & DRE detects more prostate cancer but does not lower death rate

Question 15

USPSTF Prostate recom

Answer 15

Recommends against PSA-based screening for prostate cancer

Screening methods such as DRE or transrectal US alone have not been evaluated in controlled studies

Question 16

Abnormality of Penis: Genital Herpes

Answer 16

Caused by Herpes Simplex virus: Usually HSV 2
Begins with painful vesicles that become ulcerated
Often recurrent

Question 17

Abnormality of Penis: Molluscum contagiosum

Answer 17

Umbilicated vesicular-like lesions
Contagious, usually painless
Benign viral condition; self-limited (6-12 mos.)

Question 18

Abnormality of Penis: Primarily Syphilitic Chancre

Answer 18

Small red macule enlarges and develops through a papuar stage, becoming eroded to form a round, painless ulcer. If left untreated heals in 4-8 weeks

Question 19

Abnormality of Penis: Urethritis

Answer 19

Gonococcal: caused by Neisseria gonorrhoeae
often with meatitis (Inflammation of penis opening)
Non-gonococcal: Chlamydia tracho-matis is most common cause. More watery than above

Question 20

Abnormality of Penis: Peyronie’s Disease

Answer 20

• Idiopathic condition resulting in fibrosis in the corpora cavernosa
• Palpable, nontender plaques just beneath skin, usu. along the dorsum of the shaft of the penis
• May result in penile curvature, painful erections; occasionally erectile dysfunction

Question 21

Abnormality of Penis: Carcinoma of Penis

Answer 21

Begins as a firm nodule or ulcer that does not heal
Usually nontender
More common in uncircum-sized males

Question 22

Hernias types

Answer 22

-Inguinal: 2 types
direct and indirect(most common)
-Fermoral

Question 23

Indirect vs direct hernias

Answer 23

Indirect: most common, everyone, hernia in inguinal canal often into scrotum. palpable as impulse down inguinal canal
Direct: less common, men over 40, rarely in scortum, bulges anteriorly, above inguinal ligament

Question 24

Femoral Hernia

Answer 24

Least common
More common in women
Below inguinal ligament, more lateral than inguinal hernia, never into scrotum, may feel like a lymph node

Question 25

Abnormality in scrotum: Varicocele

Answer 25

``` Varicose veins of scrotal vessels Usually on the left Feels like a soft “bag of worms” May slowly collapse if scrotum elevated while patient supine May be assoc. with infertility ```

Question 26

Abnormality in scrotum: Hydrocele

Answer 26

Benign, nontender, fluid-filled mass within the tunica vaginalis Transilluminates - red glow

Question 27

Abnormality in scrotum: Spermatocele

Answer 27

Painless, mobile mass just above the testis Usu. smaller than a hydrocele Contains sperm May transilluminate

Question 28

Abnormality in scrotum: Acute Epididymitis

Answer 28

Infection of the epididymis Local pain & swelling Primarily in adults Often assoc. with UTI or prostate infection

Question 29

Abnormality in scrotum: Acute Orchitis

Answer 29

Inflammation or infection of the testis Testicular swelling & tenderness Similar in appearance to epididymitis Complication of mumps & other viral infections

Question 30

Abnormality in scrotum: Testicular Torsion

Answer 30

``` Due to twisting of the spermatic cord Intense pain Red, swollen, tender scrotum Testis may be pulled upwards Surgical emergency! (obstructed circulation) ```

Question 31

Abnormality in scrotum: Testicular Tumors

Answer 31

Firm, painless testicular nodule Does not transillum-inate As tumor grows it may replace teste and the testicle will feel heavier than normal

Question 32

Abnormality of Anus: Hemorrhoids

Answer 32

Internal and external

Question 33

Prolapsed Internal Hemorrhoids | Thrombosed external Hemorrhoids

Answer 33

Prolapsed Internal Hemorrhoids: protrude from anus | Thrombosed external Hemorrhoids: develops blood clot, painful

Question 34

Abnormality of Anus: Anal Fissure

Answer 34

Anal fissure is a tear in the inside lining of the wall of the anus May be caused by the passage of very hard stools Symptoms – severe pain as stool passes Also, itching, burning, bleeding & wet discharge Diagnosed by history & anoscopy

Question 35

Abnormality of Anus: Perirectal Abscess

Answer 35

swelling & erythema of buttocks

Question 36

Abnormality of Anus: Perianal Condylomata

Answer 36

HPV – human papillomavirus infection | Usually sexually transmitted

Question 37

Abnormality of Prostate: Prostatitis acute and chronic

Answer 37

``` Enlarged, tender prostate gland Much more tender during acute infection, often with fever & chills Examine carefully Avoid spread of infection Treat with antibiotics ```

Question 38

Abnormality of Prostate: Benign Prostatic Hypertrophy (hyperplasia)

Answer 38

BPH more common with increasing age Symmetrical enlargement of gland Slowing of urine stream with difficulty starting stream

Question 39

Abnormality of Prostate: Carcinoma of Prostate

Answer 39

Enlarged, firm nodule or area of hardness Irregular contour, median sulcus obscured Usually a slow-growing tumor Metastasizes locally and to bone