Male GU Exam

Question 1

Inspection of the penis

Answer 1

• Hair pattern
• Circumcision status
• Foreskin-retractable and reducible
• Glans- note lesions or inflammation
• Urethal meatus- not the position and look for discharge

Question 2

Medical indication for circumcision

Answer 2

Congenital phymosis- opening of the foreskin is very narrowed, can’t be retracted

Question 3

Most reasons for circumcision

Answer 3

Parent preference

Question 4

Balanitis

Answer 4

Inflammation of the glans, usually due to yeast

Question 5

Hypospadius

Answer 5

Urethral opening on the underside of the penis.

Can occur anywhere along the shaft of the penis

Question 6

Epispadius

Answer 6

urethra ends in an opening on the upper aspect (the dorsum) of the penis

Question 7

What presents with purulent discharge

Answer 7

Gonorrhea

Question 8

How to confirm for syphilis

Answer 8

Look for spirochettes
Dark field microscopy
Serology RPR
VRDL

Question 9

Palpation of the penis

Answer 9

• Tenderness
• Induration (swelling and inflammation)
• nodularity
• Fibrous tissue
• Strip the urethra if the pt has had a discharge

Question 10

Peyronie’s disease

Answer 10

Fibrous plaque that forms on the tunica albicans (buck’s fascia) on corpus cavernosum

• Associated with people on beta blockers
• Also get Duprytin’s contracture
• Can be debilitating, will cause the penis to bend- will make intercourse impossible
• Does not affect voiding

Question 11

Inspection of the scrotum

Answer 11

• Inspect for rashes or ulceration
• Visible masses or asymmetry- may indicate scrotal mass or atrophy of a testicle
• Rugal pattern and median raphe

Question 12

Palpation of scrotal contents

Answer 12

• Presence of 2 testicles
• Testicular size-shape, consistency
• Presence of extra-testicular masses
• Epididymis-size and tenderness
• vas deferens-swelling and tenderness

Question 13

Testicular masses

Answer 13

Carcinoma

Hydrocele

Question 14

Testicular tenderness

Answer 14

Orchitis
Torsion
Epididymitis
Tumor Hernia

Question 15

Extratesticular masses

Answer 15

hernia
varicocele
epididymal cyst

Question 16

What masses will transilluminate with light?

Answer 16

Hydrocele

Epididymal cyst

Question 17

What should you look for if there is an absent vas deferens?

Answer 17

Need to do a b/l renal ultrasound

Could show an ipsilateral missing kidney

Question 18

If you hear bowel sounds in the scrotum that indicates?

Answer 18

Hernia

Question 19

What side is a varicocele most common?

Answer 19

Left

Question 20

Hydrocele presentation

Answer 20

Non tender, mass contained within the scrotum

• Can be transilluminated
• May be present at birth or in the pediatric population

Question 21

Inguinal hernia presentation

Answer 21

Nontender, mass that extends into the inguinal canal. Entire loop of bowel in there

• Usually u/l
• May or may not be able to transilluminate

Inspect the inguinal canal and femoral triangle for bulging

• Have pt perform a valsalva maneuver
• Unless the hernia is quite large, it is unlikely that you will detect it on inspection

Question 22

Epididymitis presentation

Answer 22

• Exquisitely tender
• May have a history or dysuria
  GRADUAL onset
• Does not transilluinate
• Difficult to destinguish from orchitis

Question 23

Testicular torsion presentation

Answer 23

• ABRUPT onset
• Usually early to mid teens, very severe pain
• Affect testicle is usually elevated in scrotum
  Rapid diagnosis is essential –> testis will undergo necrosis within a few hours

Question 24

varicocele presentation

Answer 24

Feels like a bag of worms on palpation

• Painless
• Very gradual onset
• Does not transilluminate
• May be b/l

Question 25

Testicular cancer presentation

Answer 25

Painless, gradual onset - Testicle may feel very hard and enlarged - Does not transilluminate

Question 26

Indirect inguinal hernia

Answer 26

Most common - Hernia sac exits through the internal inguinal ring - May pass with the cord toward and sometimes into the scrotum

Question 27

Direct inguinal hernia

Answer 27

The hernia sac exits through a tear in the floor of the canal (transversalis fascia) - Generally caused by straining

Question 28

Femoral hernia

Answer 28

Hernia sac exits inferior to the inguinal ligament and into the femoral triangle - More common in women than men but not the most common hernia in women

Question 29

Inspection of the perianal area

Answer 29

- Fissures - Fistulae - External hemorrhoids - Prolapsed internal hemorrhoids - STDs - Rectal prolapse - Skin tags

Question 30

External hemorrhoid

Answer 30

Sensory innervated- thrombosis causes pain | - May account for rectal bleeding

Question 31

Internal hemorrhoid

Answer 31

No sensory nerve endings so they are painless | - Bleed more often than external and may bleed more profusely

Question 32

Skin tags

Answer 32

Overgrowth of anal epithelium - Very common, painless Pale color differentiates them from hemorrhoids

Question 33

Anal fissure

Answer 33

Tear in the anal mucosa - Very painful Common in people who are chronically constipated and strain moving bowels

Question 34

Anarectal fistula

Answer 34

An abnormal tract between the rectum and perianal region | - Almost always caused by an abscess such as those found in Crohn's disease

Question 35

Cauliflower appearance

Answer 35

HPV

Question 36

Appearance of HSV

Answer 36

Vesicles that ulcerate | - Usually causes pruritis and pain

Question 37

Appearance of secondary syphilis

Answer 37

PAINLESS, usually asymptomatic | - Usually overgrowth of tissue in a chancrous shape

Question 38

Appearance of anal cancer

Answer 38

- Squamous cell - Generally painless until the surface becomes ulcerated - Usually presents with bleeding so it is often ignored in people with hemmorrhoids

Question 39

Rectal prolapse

Answer 39

Weakening of the floor of the pelvis usually secondary to multiple childbirths or age - Rectum can prolapse through the anus

Question 40

Size of prostate

Answer 40

4 cm in diameter and protrudes 1 cm into the rectum