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EC Physical Examination > Male Genitalia > Flashcards

Male Genitalia Flashcards

1
Q

What forms the dorsum and sides of the penis?

A

corpora cavernosa

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2
Q

Which part of the penis contains the urethra?

A

corpus spongiosum

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3
Q

The corpus spongiosum expands at its distal end to form the _____ ___.

A

glans penis

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4
Q

The urethral orifice is a slitlike opening located ____mm ____ to the tip of the glans.

A

2; ventral

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5
Q

Unless circumcised, what covers the glans?

A

the prepuce

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6
Q

In an uncircumcised penis, what is formed by the secretion of sebaceous material by the gland and the desquamation of epithelial cells from the prepuce

A

smegma

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7
Q

What is the appearance of smegma?

A

cheesy white lateral on the glans in the fornix of the foreskin

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8
Q

What is contained in each pendulous sac?

A

a testis
epididymis
spermatic cord
cremasteric muscle

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9
Q

What is the muscle that allows the scrotum to relax or contract?

A

cremasteric muscle

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10
Q

What temperature is required for spermatogenesis?

A

lower than 37 degrees C

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11
Q

What is responsible for the production of spermatozoa and testosterone?

A

testicles

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12
Q

What is the size of the adult testis?

A

ovoid

4x3x2 cm

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13
Q

What is a soft, comma-shaped structure located on the posterolateral and upper aspect of the testis?

A

epididymis

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14
Q

What is the function of the epididymis? (3)

A

storage
maturation
transit of sperm

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15
Q

The vas deferens begins at the ____ ____, ascends the ____ ___, travels through the ____ ___ and unites with the ____ ____ to form the _____ _____.

A 
tail of the epidydimis
spermatic cord
inguinal canal
seminal vesicle
ejaculatory duct
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16
Q

What produces the major volume of the ejaculatory fluid which contains fibrinolysin?

A

prostate gland

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17
Q

What is the role of fibrinolysin?

A

an enzyme that liquefies the coagulated semen, a process that may be important for satisfactory sperm motility

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18
Q

Where so the seminal vesicles extend?

A

from the prostate onto the posterior surface of the bladder

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19
Q

What causes erection of the penis?

A

the two corpora cavernous become engorged with 20-50mL of blood

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20
Q

What causes the increased blood supply in erection?

A

arterial dilation and decreased venous outflow

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21
Q

the 2 processes of erection are under the control of what?

A

the autonomic nervous system and occur because of the local synthesis of nitric oxide

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22
Q

Ejaculation during orgasm consists of the emission of secretions from what?

A

vas deferens
epididymides
prostate
seminal vesicles

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23
Q

What happens after orgasm that causes subsidence of the erection?

A

constriction of the vessels supplying blood to the corpora cavernosa

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24
Q

How is pubic hair affected in older adults?

A

it becomes finer and less abundant, possibly pubic alopecia

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25
Q

How is the scrotum affected with aging?

A

more pendulous

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26
Q

How is an erection and orgasm affected in older adults?

A

erection may develop slowly and orgasm may be less intense

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27
Q

When is the HPV vaccination recommended through the age of 26?

A

men who have sex with men

compromised immune systems

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28
Q

What are common causes of change in frequency of sexual activity or desire?

A 
loss of spouse or partner
no partner
restrictive environment
depression
physical illness resulting in fatigue, weakness or pain
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29
Q

What are the common causes of change in sexual response in older adults?

A 
longer or inability to achieve full erection
less forceful ejaculation
rapid detumescence
longer interval between erections
prostate surgery
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30
Q

What are the risk factors of penile cancer?

A

infection with HPV
lack of circumcision with failure to maintain hygiene
phimosis
age
smoking
HIV infection
UV light treatment of psoriasis if genitalia exposed

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31
Q

What are the risk factors of testicular cancer?

A 
undescended testicles (risk elevated for both)
personal history (opposite testes)
family history
HIV infection
20-34 years
Whites (5x blacks)
androgen suppression (transgender women)
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32
Q

What is the biologic male escutcheon pattern?

A

hair abundant in the pubic region and may continue in a narrowing midline pattern to the umbilicus

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33
Q

What is it called when the foreskin is tight and cannot be retracted?

A

phimosis

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34
Q

What are causes of phimosis?

A

occur during the first 6 years of life as a result of recurrent balanitis or balanoposthitis
poorly controlled DM (MC)
previous unsuccessful efforts to retract the foreskin that have caused radial tearing of the preputial ring, resulting in adhesions

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35
Q

What is balanitis

A

inflammation of the glans penis

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36
Q

What is balanoposthitis?

A

inflammation of the glans penis and prepuce

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37
Q

What does bright erythema or discharge indicate of the urethral meatus?

A

inflammatory disease

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38
Q

What does a pinpoint or ROUND opening indicate of the urethral meatus?

A

meatal stenosis

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39
Q

If there is discharge with striping the urethra what might that indicate?

A

STI

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40
Q

What is prolonged penile erection called?

A

priapism

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41
Q

What are the causes of priapism?

A

Majority are idiopathic
leukemia
hemoglobinopathies such as sickle cell
medications for impotence

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42
Q

What might indicate an inflammatory process in the scrotum?

A

reddened scrotal skin in someone who is not red headed

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43
Q

What makes the scrotum asymmetric?

A

the left testicle has a longer spermatic cord and therefore is lower

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44
Q

What causes variation in the thickness of the scrotum?

A

temperature and age

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45
Q

What are small lumps on the scrotum that may enlarge and discharge oily material?

A

sebaceous cysts or epidermoid cysts

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46
Q

What is the consequence of general fluid retention associated with cardiac, renal or hepatic disease?

A

unusual thickening of the scrotum caused by edema, often with pitting

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47
Q

When examining for a hernia, what area should be inspected when the pt is bearing down?

A

area of the inguinal canal and the region of the fossa ovalis

48
Q

After having the ft relax where should you insert your examining finger for a hernia?

A

into the lower part of the scrotum and carry it upward along the vas deferens into the inguinal canal

49
Q

If bowel sounds are present with a hernia what does that indicate?

A

uncomplicated reducible hernias

50
Q

If an inguinal hernia is present what will you feel when using finger to feel the oval external ring?

A

As the patient coughs, you will feel the sudden presence of a bulge against the finger

51
Q

What is an indirect inguinal hernia?

A

it lies within the inguinal canal or it may come through the external canal and pass into the scrotum

52
Q

An indirect hernia on one side strongly suggests…

A

possibility of bilateral herniation, so examine both sides

53
Q

Where is a DIRECT inguinal hernia felt?

A

felt medial to the external canal

54
Q

When might testis be totally insensitive to painful stimuli?

A

diseases such as syphilis and diabetic neuropathy

55
Q

Irregularities in texture and size of the testes may indicate what?

A

infection, a cyst or a tumor

56
Q

Unexpected findings of the vas deferens might indicate what?

A

diabetes or old inflammatory changes, especially TB

57
Q

What is a protrusion of a peritoneal lined sec through some defect in the abdominal wall?

A

hernia

58
Q

What type of hernia arise along the course that the testicle traveled as it exited the abdomen and entered the scrotum during intrauterine life

A

inguinal hernia

59
Q

What type of hernias occur at the fossa ovalis, where the femoral artery exits the abdomen?

A

femoral hernia

60
Q

What type of hernia occur when the blood supply to the protruded tissue is compromised?

A

strangulated hernias

61
Q

What type of hernias may have pain on straining?

A

indirect or femoral

62
Q

What type of hernia has soft swelling in area of internal ring; hernia comes down and touched fingertip on examination?

A

indirect inguinal

63
Q

What type of hernia is bulge in the area of Hesselbach triangle; easily reduced; bulges anteriorly and pushes against side of finger on exam?

A

direct inguinal

64
Q

What type of hernia had inguinal canal empty on examination?

A

femoral

65
Q

What type of hernia is non reducible; this condition requires prompt surgical intervention?

A

strangulated hernia

66
Q

What is the most common type of hernia; both genders are affected, often children and young males

A

indirect inguinal

67
Q

What type of hernia occurs more often in males and those older than 40 years of age?

A

direct inguinal

68
Q

What is the least common type of hernia that occurs more often in females?

A

femoral hernia

69
Q

What type of hernia has a right sided presentation that is more common than left; pain may be severe?

A

femoral hernia

70
Q

What is almost always an iatrogenically or inadvertently induced condition caused by retracting the prepuce and then inadvertently leaving it in its retracted position?

A

paraphimosis

71
Q

What is it called when the foreskin becomes trapped behind the corona for a prolonged period, a constricting band forms around the penis and impairs blood and lymphatic flow to the glans penis and prepuce?

A

paraphimosis

72
Q

What can happen if paraphimosis is left untreated?

A

necrosis and gangrene of the glans penis may be present (discolored, blackened, ulcerated)

73
Q

What is a skin lesion associated with primary syphilis (bacterium Treponema palladium)?

A

chancre

74
Q

How is chancre contracted?

A

through direct contact with a syphilis sore

75
Q

When do lesions of primary syphilis occur?

A

2 weeks after exposure

76
Q

What is a painless solitary lesion that is firm, round and small commonly located on the gland but can be located on the foreskin. It has indurated borders with a clear base?

A

chancre

77
Q

When scrapings are taken from a chancre, what is seen when examined microscopically?

A

spirochetes

78
Q

What is the most common cause of genital herpes?

A

HSV-2 virus

79
Q

When does most transmission of HSV occur?

A

in the absence of symptoms

80
Q

What are painful lesion of the penis, genital area, perineum and may report burning or pain with urination?

A

genital herpes

81
Q

What are superficial vesicles on the glans, penile shaft, at the base of the penis or around the anus?

A

genital herpes

82
Q

What is often associated with genital herpes?

A

inguinal lymphadenopathy and system symptoms such as fever

83
Q

What is it called when HPV invades the basal layer of the epidermis; virus penetrates through skin and causes mucosal micro abrasions?

A

condyloma acuminata

84
Q

When do condyloma acuminatas develop (HPV)?

A

after months to years of latency, viral DNA capsids and particles are produced. host cells become infected and develop skin lesions

85
Q

What are soft painless wartlike lesions on penis, single or multiple papular lesions?

A

condyloma acuminata

86
Q

What lesions can be pearly, filiform, fungating, cauliflower, or plaque like?

A

condyloma acuminata

87
Q

What lesions can be smooth, verrucous, or lobulated and may be the same color as the skin or reddish or hyper pigmented?

A

condyloma acuminata

88
Q

What is a sexually transmitted infection of the lymphatics caused by Chlamydia trachomatis?

A

Lymphogranuloma Venereum

89
Q

What organism enters the skin through breaks and abrasions or crosses the epithelial cells of the mucous membrane, to travel via lymphatics to LN where it replicates within macrophages?

A

Lymphogranuloma Venereum caused by Chlamydia

90
Q

What presents as an initial lesion that is a painless erosion at or near the coronal sulcus?

A

Lymphogranuloma Venereum caused by Chlamydia

91
Q

What can be the result of Lymphogranuloma Venereum caused by Chlamydia if untreated?

A

if lymphatic drainage blocked penile and scrotal lymphoma may ensue
draining sinus tract

92
Q

What is a viral infection of the skin and mucous membranes that is caused by poxvirus that infects only the skin? (considered STI in adults)

A

molluscum contagiosum

93
Q

How is molluscum contagiosum spread?

A

skin to skin contact or by contact with an object that has touched infected skin. virus enters the skin through small breast in skin barrier

94
Q

What presents as pearly gray, often umbilicate, smooth dome-shaped with discrete margins on the penis?

A

molluscum contagiosum

95
Q

Where are molluscum contagiosum lesions most common?

A

glans penis

96
Q

What is penile cancer associated with?

A

HPV 16 &18

97
Q

Who rarely develops penile cancer?

A

pts who have been circumcised

98
Q

How do penile cancer lesions start?

A

as superficial neoplasms of the prepuce or glans penis and then progress to invade the corpora cavernous and urethra with subsequent development of mets to inguinal LN

99
Q

What is a benign cystic accumulation of sperm occurring on the epididymis?

A

spermatocele

100
Q

What is the presentation of a spermatocele?

A

asymptomatic, non tender mass at epididymis usually smaller than 1 cm

101
Q

What is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord?

A

varicocele

102
Q

Why is a varicocele more common in the left testicle?

A

the angle at which the left testicular veins enters the left renal vein,
the lack of effective anti reflux valves at the juncture of the testicular vein and renal vein, and
the increased renal vein pressure due to its compression between the superior mesenteric artery and the aorta.

103
Q

Why is a varicocele associated with reduced fertility?

A

from increased venous pressure and elevated testicular temperature

104
Q

What is commonly called “a bag of worms”?

A

varicocele

105
Q

What are the gradings of a varicocele?

A

small: palpated only during Valsalva maneuver
moderate: easily palpated without valsava
large: causing visible bulging of the scrotum

106
Q

What is acute inflammation of the testis secondary to infection?

A

orchitis

107
Q

What is acute onset of testicular pain (mild to severe) and swelling, associated with fatigue, malaise, myalgia and fever

A

orchitis

108
Q

What can develop in older adults as a result of bacterial migration from a prostatic infection?

A

orchitis

109
Q

Mumps orchitis follows the development of ________.

A

parotitis by 4-7 days

110
Q

What is a major consideration in the differential of epidymitis?

A

testicular torsion

111
Q

What is often seen with a UTI infection or STI and can be chronic as a complication of TB?

A

epididymitis

112
Q

What is a painful scrotum, urethral discharge, fever, and pyuria

A

epididymitis

113
Q

What type of testicular cancer arises from seminomas and nonseminomas?

A

germ cell

114
Q

What do non-germ cell tumors arise from?

A

supportive and hormone producing tissue

115
Q

What is the MC type of testicular cancer?

A

germ cell cancers

116
Q

What is the most common age of germ cell tumors?

A

15-30 years old

EC Physical Examination (9 decks)

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