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Flashcards in Male GU Exam Deck (36)
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Risk factors for erectile dysfunction

DM, HTN, hyperlipidemia, obesity, testoterone deficiency, prostate cancer treatment, anxiety

Medications: antidepressants (SSRIs, SNRIs), tobacco

Age 40-79


Diagnostic testing for ED may include BP, BMI, waist circumference, genital exam, assessment of secondary sex characteristics, A1c or fasting BG, lipid panel, TSH level, etc. as well as international index of erectile function (IIEF-5).

What are some management strategies for ED?

Tobacco cessation, regular exercise, weight loss, improved control of DM/HTN/Hyperlipidemia/etc.

First line med = Oral PDE-5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil)

Second line med = alprostadil and vacuum devices


Gradual onset of unilateral posterior scrotal pain <6 weeks along with dysuria, urinary frequency, fever, hematuria, abd pain, etc. may indicate _____



Risk factors for epididymitis

Hx of UTI or STI, anatomic abnormalities (bladder outlet obstruction), prostate or urinary tract surgeries or instrumentation, prolonged sitting, cycling, or trauma

[reflux of urine into ejaculatory ducts is considered most common cause of epididymitis in kids <14; N.gonorrheae and C.trachomatis are most common etiologies in sexually active males 14-35]


PE findings associated with epididymitis including diagnostic signs and reflex findings

Swollen and tender epididymis with testis in anatomic position

Elevating scrotum may alleviate pain (Prehn sign)

Intact cremasteric reflex


Treatment recommendations for epididymitis in the following pt groups:

-Sexually active males age 14-35

-Men who practice insertive anal intercourse

-Sexually active males age 14-35 = single IM dose of ceftriaxone with 10 days of oral doxycycline

-Men who practice insertive anal intercourse = ceftriaxone with 10 days of oral levofloxacin or ofloxacin


Aspects of penis and testes exam

Penis — inspect for lesions, palpate for plaques or induration

Testes — inspect, palpate for masses, equal volume, tenderness, cryptorchidism. All masses should be transluminated (light will not go through solid mass, hydrocele will glow soft red). Chronic lesions can cause testicular atrophy. Check cremaster reflex on both sides.


Aspects of epididymis, spermatic cord, and vas deferens exam

Palpation to evaluate induration and to localize pain to the testicle or adjacent structures. Epididymis is posterior to testicle. Valsalva while standing evaluates dilated testicular veins in the spermatic cord forming a varicocele above and behind the testis


Aspects of inguinal canal exam

Canals explored for hernias or cord tenderness. Funiculitis, inflammation of cord structures, may cause inguinal or scrotal pain, but testis is normal. Evaluate for cord lipomas or hydroceles also


A bellclapper deformity is indicative of _____ _____

Testicular torsion


Presentation of testicular torsion including exam findings

Presents in young to middle aged men with sudden, severe, unilateral scrotal pain often associated with nausea/vomiting

Exam reveals a tender, firm affected testis that may appear retracted upward as a result of the twisted spermatic cord. Cremaster reflex is typically ABSENT in testicular torsion


Presentation of urethritis in men and primary pathogens involved

Urethral discharge, penile itching or tingling, and dysuria

Primary pathogens are C.trachomatis and N.gonorrhea


Physical exam considerations in a male presenting with urethral symptoms

Examine for inguinal LAD, ulcers, or urethral discharge. Palpation of the scrotum for evidence of epididymitis or orchitis is advised. DRE of prostate may be cosnidered especially in older pts or if rectal pain is reported

The urethra should be gently “milked” by serial palpation down shaft of penis toward the urethra; any discharge should be tested/cultured


Diagnoses of ______ may include presence of urethral discharge, positive leukocyte esterase test in first-void urine, or at least 10 WBCs per hpf in first-void urine sediment



In what pt populations is routine syphilis screening strongly recommended by USPSTF?

Persons at increased risk

Pregnant women


In what pt populations is routine GC/Chlamydia screening recommended by USPSTF?

Sexually active women age 24 and younger, and in older women who are at increased risk for infection


Polymicrobial cellulitis with genital, groin, or perineal involvement, characterized by signs or symptoms of infection followed by suppuration and necrosis of overlying skin. Not sexually transmitted but associated with/secondary to epididymitis

Fournier’s gangrene


Presentation of prostatitis

Acute onset of irritative (dysuria, urinary frequency, urinary urgency) or obstructive (hesitancy, incomplete voiding, straining to urinate, weak stream) voiding symptoms

Pts may report suprapubic, rectal, or perineal pain

Painful ejaculation, hematospermia, and painful defecation may also be present in addition to systemic symptoms such as fever, chills, nausea, emesis, and malaise


Presentation of cystitis in males

Acute onset of irritative urinary symptoms or other signs/symptoms including cloudy or strong smelling urine, hematuria, feeling of pressure in lower abdomen, pelvic discomfort


Most common causes of genital ulcers in the US

1. HSV 1 and 2
2. Syphilis
3. Chancroid

[other causes include granuloma inguinale, lymphogranuloma venareum (C.trachomatis types L1, L2, L3)]


What tests should be considered in pts who present with genital ulcers?

Serologic tests for syphilis (VDRL or RPR) and darkfield microscopy OR direct fluorescent antibody testing for treponema pallidum

Culture or PCR for HSV

Culture of H.ducreyi in settings with high prevalence of chancroid


Etiology of the following genital ulcer:

Usually multiple vesicular lesions that rupture and become painful, shallow ulcers. Constitutional symptoms, LAD in first time infections



Etiology of the following genital ulcer:

Single painless well-demarcated ulcer with a clean base and indurated border. Mild or minimally tender inguinal LAD.

Syphilis (primary chancre)


Etiology of the following genital ulcer:

Nonindurated, painful with serpiginous border and friable base; covered with a necrotic, often purulent exudate. Tender, suppurative, unilateral inguinal LAD or adenitis


[H.ducreyi — gram-negative slender rod or coccobacillus in “school of fish” pattern]


Etiology of the following genital ulcer:

Small, shallow, painless, genital or rectal papule or ulcer; no induration. Unilateral, tender inguinal or femoral LAD “Groove sign”


[RARE and primarily occurs in men who have sex with men]


Fungal infection that affects genital skin, inner thighs, and buttocks, causing an itchy, red, often ring-shaped rash in warm, moist areas of your body

Tinea cruris


Most common of all STIs



Any sexually active person is at risk for getting HPV. However, genital warts are more common in what pt populations?

Age <30
Weakened immune system
Hx of child abuse
Children of a mother who had virus during childbirth


Birth defect in which opening of urethra is on underside of penis instead of the tip



Development of fibrous scar tissue inside penis that causes curved, painful erections; may develop suddenly or more gradually, typically due to trauma

Peyronie’s disease