Male Exam

Question 1

What are the scrotal contents to palpate?

Answer 1

Testes, epididymis and spermatic cord (vas deferens)

Question 2

When is the highest incidence of testicular cancer?

Answer 2

15-35 yrs old

Question 3

Where do you palpate the epididymis?

Answer 3

Located superiorly and posterolaterally on testicle

Question 4

How do you palpate the spermatic cord?

Answer 4

Palpate from the epididymis to the inguinal ring using thumb and index finger

Question 5

How would you know there is hernia in the inguinal canal?

Answer 5

When turn head and cough, feel sudden pressure at side or tip of finger

Question 6

What do your check for when examining the perianal area?

Answer 6

Hemorrhoids, fissures, skin tags, other lesions

Question 7

What do you feel when palpating prostate?

Answer 7

Size of a walnut but feels like an almond with 2 lobes, firm like tip of nose or thenar area of palm

Question 8

What test do you do after removing your finger?

Answer 8

Hemoccult/guaiac test

Question 9

Condyloma acuminata

Answer 9

Sexually transmitted (HPV)
Usually multiple, grow together and spread to perineum and anal area
Variable sized soft papule and plaques in anogenital regions

Question 10

2 types of HSV

Answer 10

Type 1: lips, area around mouth

Type 2: genital infections

Question 11

What is genital herpes?

Answer 11

Begins with painful vesicles on an erythematous case, vesicles can ulcerate
Incurable with recurrent outbreaks

Question 12

What causes syphilitic chancre?

Answer 12

Due to spirochete treponema pallidum

Question 13

What is syphilitic chancre?

Answer 13

Primary (acute) phase begins as a painless papule that erodes into a painless ulcer
May become secondarily infected
Usually self-limiting 4-8 wks

Question 14

What is urethritis?

Answer 14

Infection of inflammation of the urethra

Male complains of dysuria and discharge (may have inflamed meatus)

Question 15

2 types of urethritis

Answer 15

Gonococcal (by neisseria gonorrhoeae)

Non-gonococcal (by chlamydia trachomatis and others-usually more clear, less purulent discharge)

Question 16

Peyronie’s disease

Answer 16

Idipathic condition resulting in fibrosis in the tunica albuginea
Firm plaques in penile shaft are palpable
May develop penile curvature, painful erection and occasional ED

Question 17

What is a carcinoma of the penis?

Answer 17

Begins as form nodule or ulcer that doesn’t heal and is usually non tender

Question 18

When in carcinoma of the penis most common?

Answer 18

Avg age is 50

More common in uncircumsized males

Question 19

Indirect inguinal hernia

Answer 19

Above inguinal ligament, near the internal inguinal ring
Often extends into scrotum
Palpable as impulse down inguinal canal

Question 20

When is a direct inguinal hernia seen?

Answer 20

Usually in men over 40

Question 21

Direct inguinal hernia

Answer 21

Above the inguinal ligament, rarely into the scrotum

Bulges anteriorly through the abdominal wall

Question 22

When is a femoral hernia most common?

Answer 22

In women

Question 23

Femoral hernia

Answer 23

Below inguinal ligament and more lateral than an inguinal hernia
May mimic lymph node
Never into scrotum!!

Question 24

Common description of varicocele

Answer 24

Soft bag of worms

Question 25

Varicocele

Answer 25

Varicose veins of scrotal vessel that develops slowly May slowly collapse if scrotum elevated while pt supine Associated with infertility

Question 26

Hydrocele

Answer 26

Soft, non-tender hemi-scrotal swelling that transilluminates because full of fluid Size of swelling may wax and wane (check for concurrent indirect hernia or testicular masses)

Question 27

Spermatocele/epididymal cyst

Answer 27

Painless, mobile mass just above the testis | Smaller than hydrocele usually and may transilluminate

Question 28

Acute epididymitis

Answer 28

Infection of epididymis via vas deferens Fever and chills Acute and unilateral, dull to severe scrotal pain radiating to ipsilateral flank Hemi-scrotal swelling and tenderness which may progress to erythematous, fluctuant mass

Question 29

What sign is seen in acute epididymitis?

Answer 29

Prehn's sign (elevation of scrotum providing relief)

Question 30

What often occurs after epididymitis?

Answer 30

Acute orchitis (also complication of mumps)

Question 31

Acute orchitis

Answer 31

Inflammation of infection of the testis Testicular swelling and tenderness Similar appearance to epididymitis

Question 32

What is a pt complaint of testicular pain until proven otherwise?

Answer 32

Testicular torsion

Question 33

Testicular torsion

Answer 33

ACUTE onset of scrotal pain, unilateral with hemi scrotal swelling Often hrs after vigorous activity/ minor trauma TTP without relief from elevation Absent cremasteric reflex

Question 34

When is testicular torsion most common?

Answer 34

Neonates and adolescents

Question 35

What deformity is seen with testicular torsion?

Answer 35

Bell-clapper

Question 36

Testicular tumors

Answer 36

Painless, solid testicular swelling or nodule Inguinal LAD or para-aortic LAD May have abdominal pain or pulmonary symptoms of neurologic deficits

Question 37

Internal hemorrhoids

Answer 37

Enlargements of normal vascular cushions above pectinate line Can cause bright red bleeding with defecation Can prolapse and appear as red, moist mass

Question 38

External hemorrhoids

Answer 38

Dilated veins covered with skin Tender, swollen, bluish mass at anal margin Asympomatic unless thrombosed

Question 39

Anal fissure

Answer 39

``` Tear in inside lining of wall of anus Caused by stretching of anal mucosa Severe pain with passage of stool and scant bleeding Pain causes spasm that worsens fissure Diagnose with history and anoscopy ```

Question 40

Anorectal abscess

Answer 40

Originates from an infected anal crypt gland Severe pain in anal or rectal area Fever and malaise common Perianal erythema and palpable, fluctuant mass Purulent rectal drainage if abscess begins to drain spontaneously

Question 41

What can an anorectal abscess lead to?

Answer 41

Anorectal fistula

Question 42

Rectal polyps

Answer 42

Protuberance into lumen above surrounding colonic mucosa May be pedunculated (stalk) or sessile (at base) Soft, difficult to feel with finger Biopsy to rule out malignancy

Question 43

Rectal carcinoma

Answer 43

Firm, nodular rolled edge Often have blood per rectum Not usually diagnosed with physical exam

Question 44

Acute prostatitis

Answer 44

Enlarged, tender prostate gland UTI symptoms, often with fever and chills Perineal or abd pain Examine gently!

Question 45

How do you treat acute prostatitis?

Answer 45

Antibiotics

Question 46

How does chronic prostatitis present?

Answer 46

With recurrent UTIs Prostate exam may be normal Treat with abx for longer

Question 47

When is benign prostatic hypertrophy more common?

Answer 47

With increasing age

Question 48

What is benign prostatic hypertrophy?

Answer 48

Symmetrical enlargement of the gland | Slowing of urine stream with difficulty starting stream

Question 49

Carcinoma of the prostate

Answer 49

Enlarged, firm nodule or area of hardness Irregular contour and median sulcus is obscured Usually slow-growing tumor Metastasizes locally and to bone May have difficulty voiding