Male Genitaia

Question 1

What are the erectile tissue of the penis?

Answer 1

1. Corpus spongiosum
   *contains the urethra
   *extends from the bulb of the penis to the cone shaped glans with its expanded base or corona
2. 2 Corpora cavernosa

Question 2

What is the function of the penis

Answer 2

1. Excretes urine
2. Introduces sperm into vagina

Question 3

In uncircumcised men what is the glans covered by?

Answer 3

1. Loose, hood-like skin fold called prepuce or foreskin
2. Smegma or secretions of the glans may collect

Question 4

Where does the urethra open?

Answer 4

1. Into a vertical slit-like urethral meatus

Question 5

What are the testes and what are they covered by

Answer 5

1. They are paired ovoid glands consisting primarily of seminiferous tubules and interstitial tissue
   *covered by a fibrous outer coating tunica albuginea

Question 6

What are the normal size of the testes

Answer 6

Pre-puberty
*1.5 to 2 cm
Post-puberty
*4 to 5 cm

Question 7

What is the scrotum

Answer 7

A loose wrinkled punch of skin and underlying the tunica darts

Question 8

What does the scrotum contain

Answer 8

Its divided into two compartments each contains a testicle

Question 9

What covers the testis posteriorly

Answer 9

Tunica vaginalis
*derived from the peritoneum of the abdomen

Question 10

What can lead to an indirect inguinal hernia

Answer 10

If the peritoneal lining remains and open channel to the scrotum

Question 11

What leads to a hydrocele

Answer 11

1. The parietal and visceral layers form a potential space for the abnormal fluid accumulation

Question 12

What is the purpose of the vas deferens

Answer 12

1. Transports sperm from the tail of the epidermis along to the urethra
   *will ascend from the scortal sac (as the spermatic cord) into the pelvic cavity through the inguinal canal via the external inguinal ring

Question 13

What helps form the ejaculatory duct

Answer 13

1. Vas deferens and seminal vesicle

Question 14

What contributes to seminal fluid

Answer 14

1. Secretions from the vas deferens, seminal vesicles and prostate

Question 15

Which testis hangs lower?

Answer 15

1. Left
   *will produce spermatozoa and testosterone

Question 16

What is the purpose of the epididymis

Answer 16

1. On the posterolateral surface of each testis
   *provides a reservoir for storage, maturation and transport of sperm

Question 17

Where are femoral hernias located

Answer 17

1. Inside the femoral canal
   *presents as emergencies with bowl incarceration or strangulation

Question 18

Where are indirect inguinal hernias located

Answer 18

1. Develop at the internal inguinal ring (into the abdominal canal)
   *where the spermatic cord exits the abdomen

Question 19

Where are direct hernias located

Answer 19

1. Arise more medially due to weakness in the flor of the inguinal canal
   *associated with straining and heavy lifting

Question 20

When does sexual differentiation happen by?

Answer 20

12 weeks
*decent of tests may occur after birth
*undescended happens bc of cancer

Question 21

When does complete separation of the prepuce happen?

Answer 21

1. 3 to 4 years

Question 22

What are the basic landmarks of the groin

Answer 22

1. ASIS
2. Iliac spine
3. Pubic tubercle
4. Inguinal ligament

Question 23

Where does the inguinal canal lie?

Answer 23

1. Lies above and parallel to the inguinal ligament
   *forms a tunnel for the vas deferens

Question 24

What where does the external inguinal canal open into?

Answer 24

1. The scrotum

Question 25

What produces inguinal hernias

Answer 25

1. When loops of bowel force their way through weak areas of the inguinal canal

Question 26

What question will help determine desire, arousal, orgasm and ejaculation

Answer 26

Desire *have you maintained interest in sex Arousal *can you achieve and maintain an erection Orgasm and ejaculation *about how long does intercourse last

Question 27

What can be associated with difficulty achieving and maintaining an erection

Answer 27

1. Pain 2. Character 3. Associated symptoms 4. Medications

Question 28

What can be associated with difficulty with ejaculation

Answer 28

1. Painful and premature 2. Efforts tok treat 3. Character of ejaculate 4. Medications

Question 29

What to document if there is an enlargement in the inguinal area

Answer 29

1. Character 2. Change in mass 3. Pain in groin 4. Efforts to treat 5. Medications

Question 30

What to include in the PMH

Answer 30

1. Surgery of genitourinary tract 2. Sexual history 3. Chronic illness

Question 31

Are testicular self-examinations recommended?

Answer 31

1. No *recommend to be aware of testicles

Question 32

If there is swelling or sore on the penis or scrotum on children what does that indicate

Answer 32

1. Cleanliness issue or sexual abuse

Question 33

What does the USPTF think about testicular self examinations

Answer 33

D

Question 34

When checking for hernias how should the patients be situated

Answer 34

1. Stand *examiner should sit on a chair or stool

Question 35

How to test the cremasteric reflex

Answer 35

Stroke the inner thigh *then the testicle will pull back

Question 36

What are indirect inguinal hernias

Answer 36

1. Extend into scrotum through the internal ring *due to patent processes vaginalis - will stay open and creates a weak spot *lateral to the inferior epigastric

Question 37

Where do indirect inguinal hernias travel into?

Answer 37

1. Into the scrotum through the internal ring

Question 38

What is the most common hernias in males and females

Answer 38

Indirect inguinal hernias *have patient turn head and cough

Question 39

What are direct inguinal hernias

Answer 39

1. Viewed as acquired hernia due to weakness of muscle wall “no sac” *medial to inferior Epigastric vessels *mostly fat and less bowl (less risk of incarceration (getting stuck on in the inguinal ring) *associated with older, overweight males

Question 40

What are femoral hernias

Answer 40

Acquired no sac 1. In triangle of inguinal ligament, femoral vein, and underside of pubic bone *more common in females (still not more common than indirect) *strangulation is common

Question 41

If you are unable, to see the discharge that the patients reports due to an uncircumcised penis what should you do?

Answer 41

1. Ask the patient to retract his foreskin

Question 42

What does the epididymis feel like?

Answer 42

1. Soft nodular, cordlike structure at the back of the testicle

Question 43

If there is a hernia while the patient is standing what should you do?

Answer 43

1. Have them lie down to see if the hernia goes away *if it disappears it is almost always a hernia

Question 44

What happens if the mass remains prominent when the patient lies down?

Answer 44

1. Listen to the mass with a stethoscope, if bowel sounds are heard it is almost always a hernia 2. Shine a light from behind the scrotum through the mass *if a red glow is observed is is probably not a hernia

Question 45

What is paraphimosis

Answer 45

Foreskin is retracted and wont move

Question 46

What is hypospadias

Answer 46

Urethral meatus is below

Question 47

What is molluscum contagiosum

Answer 47

1. Waxy dome with a central umbilication (common in kids)

Question 48

What does a varicocele feel like?

Answer 48

Bag of worms

Question 49

How to treat testicular torsion

Answer 49

Try to turn the testicle externally

Question 50

What is Klinefelter syndrome

Answer 50

Small testicles in adult, hypospadius, small penis, and undescended testicles may be present in infant\ *male patients have more female like characteristics

Question 51

What steps to a male genitalia exam are done with the patient lying or standing?

Answer 51

1. Inspect the pubic hair characteristics and distribution 2. Retract the foreskin if the patient is uncircumcised