Module 5 Flashcards
(94 cards)
1
Q
5α-DHT
A
that triggers pubertal growth of the male genitalia
2
Q
FSH regulates(male)
A
sperm production by the germ cells
3
Q
2 types of stimuli that trigger erection
A
Visual, auditory, and erotic cues trigger sympathetic outflow from higher brain centers to the T11 through L2 levels of the spinal cord.
Tactile stimulation initiates sensory impulses from the genitalia to the S2 to S4 reflex arcs and the parasympathetic pathways through the pudendal nerve.
4
Q
yellow penile discharge seen in
A
gonnorhea
5
Q
white penile discharge seen in
A
nongonococcal urethritis from Chlamydia
6
Q
intense pruritius in groin
A
suspect scabies or pubic lice
7
Q
Smegma
A
, a cheesy, whitish material, may accumulate normally under the foreskin
8
Q
Phimosis
A
is a tight prepuce that cannot be retracted over the glans
9
Q
Paraphimosis
A
is a tight prepuce that, once retracted, cannot be returned. Edema ensues.
10
Q
Balanitis
A
is inflammation of the glans;
11
Q
balanoposthitis
A
is inflammation of the glans and prepuce
12
Q
cryptorchidism
A
(an undescended testicle).
13
Q
testicular cancer
A
painless nodule
peak incidence between 15-34 in white males
14
Q
A bulge near the external inguinal ring suggests a
A
direct inguinal hernia
15
Q
A bulge near the internal inguinal ring suggests an .
A
indirect inguinal hernia
16
Q
incarcerated hernia
A
A hernia is incarcerated when its contents cannot be returned to the abdominal cavity.
17
Q
strangulated hernia
A
A hernia is strangulated when the blood supply to the entrapped contents is compromised. Suspect strangulation in the presence of tenderness, nausea, and vomiting, and consider surgical intervention
18
Q
Genital Warts (Condylomata Acuminata)
A
Appearance: Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous).
Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5%–10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.
Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain.
May disappear without treatment.
19
Q
Primary Syphilis
A
Appearance: Small red papule that becomes a chancre, a painless erosion up to 2 cm in diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated. Chancre heals within 3–8 wks.
Causative organism: Treponema pallidum, a spirochete. Incubation: 9–90 days after exposure.
May develop inguinal lymphadenopathy within 7 days; lymph nodes are rubbery, nontender, mobile.
20–30% of patients develop secondary syphilis while chancre still present (suggests coinfection with HIV).
Distinguish from: genital herpes simplex; chancroid; granuloma inguinale from Klebsiella granulomatis (rare in the United States; four variants, so difficult to identify).
20
Q
Genital Herpes Simplex
A
Appearance: Small scattered or grouped vesicles, 1–3 mm in size, on glans or shaft of penis. Appear as erosions if vesicular membrane breaks.
Causative organism: Usually Herpes simplex virus 2 (90%), a double-stranded DNA virus. Incubation: 2–7 days after exposure.
Primary episode may be asymptomatic; recurrence usually less painful, of shorter duration.
Associated with fever, malaise, headache, arthralgias; local pain and edema, lymphadenopathy.
Need to distinguish from genital herpes zoster (usually in older patients with dermatomal distribution) and candidiasis.
21
Q
Chancroid
A
Appearance: Red papule or pustule initially, then forms a painful deep ulcer with ragged nonindurated margins; contains necrotic exudate, has a friable base.
Causative organism: Haemophilus ducreyi, an anaerobic bacillus. Incubation: 3–7 days after exposure.
Painful inguinal adenopathy; suppurative buboes in 25% of patients.
Need to distinguish from: primary syphilis; genital herpes simplex; lymphogranuloma venereum, granuloma inguinale from Klebsiella granulomatis (both rare in the United States).
22
Q
Hypospadias
A
A congenital displacement of the urethral meatus to the inferior surface of the penis. The meatus may be subcoronal, midshaft, or at the junction of the penis and scrotum (penoscro
23
Q
Peyronie Disease
A
Palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis. The patient complains of curved, painful erections.
24
Q
Carcinoma of the Penis
A
An indurated nodule or ulcer that is usually nontender. Limited almost completely to men who are not circumcised, it may be masked by the prepuce. Any persistent penile sore is suspicious.
25
Scrotal Edema
Pitting edema may make the scrotal skin taut; seen in heart failure, liver failure, or nephrotic syndrome.
26
Hydrocele
A nontender, fluid-filled mass within the tunica vaginalis. It transilluminates, and the examining fingers can palpate above the mass within the scrotum.
27
Cryptorchidism
The testis is atrophied and lies outside the scrotum in the inguinal canal, abdomen, or near the pubic tubercle; it may also be congenitally absent. There is no palpable testis or epididymis in the unfilled scrotum. Cryptorchidism, even with surgical correction, markedly raises the risk of testicular cancer.
28
Small Testis
In adults, testicular length is usually ≤3.5 cm. Small firm testes usually ≤2 cm suggest Klinefelter syndrome. Small soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use of estrogens, and hypopituitarism; may also follow severe orchitis.
29
Acute Orchitis
The testis is acutely inflamed, painful, tender, and swollen. It may be difficult to distinguish from the epididymis. The scrotum may be reddened. Seen in mumps and other viral infections; usually unilateral.
30
Acute Epididymitis
An acutely inflamed epididymis is indurated, swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Causes include infection from Neisseria gonorrhoeae, Chlamydia trachomatis (younger adults), Escherichia coli, and Pseudomonas (older adults); trauma; and autoimmune disease. Barring urinary symptoms, urinalysis is often negative.
31
Tuberculous Epididymitis
The chronic inflammation of tuberculosis produces a firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens.
32
Varicocele of the Spermatic Cord
Varicocele refers to gravity-mediated varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” in the spermatic cord above the testis, and if prominent, appears to distort the contours of the scrotal skin. A varicocele collapses in the supine position, so examination should be both supine and standing. If the varicocele does not collapse when the patient is supine, suspect a left spermatic vein obstruction within the abdomen.
33
Testicular Torsion
Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is often retracted upward in the scrotum. The cremasteric reflex is nearly always absent on the affected side in boys or men with testicular torsion, though this can be difficult to assess during acute pain episodes. If the presentation is delayed, the scrotum becomes red and edematous. There is no associated urinary infection. Torsion is most common in neonates and adolescents but can occur at any age. It is a surgical emergency because of obstructed circulation and requires urgent surgical consultation.
34
Indirect Inguinal Hernia characteristics
Most common, all ages and sexes. Often in children; may occur in adults.
Above inguinal ligament, near its midpoint (the internal inguinal ring).
Often into the scrotum.
The hernia comes down the inguinal canal and touches the fingertip.
35
Direct inguinal hernia characteristics
Less common. Usually in men older than 40 yrs; rare in women.
Above inguinal ligament, close to the pubic tubercle (near the external inguinal ring)
Rarely into the scrotum.
The hernia bulges anteriorly and pushes the side of the finger forward.
36
Femoral hernia characteristics
Least common. More common in women than in men.
Below the inguinal ligament; appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes.
Never into the scrotum.
The inguinal canal is empty.
37
vulva composed of
he mons pubis, a hair-covered fat pad overlying the symphysis pubis; the labia majora, rounded folds of adipose tissue forming the outer lips of the vagina; the labia minora, the thinner pinkish-red folds or inner lips that extend anteriorly to form the prepuce; and the clitoris. It also includes the vestibule, the boat-shaped fossa between the labia minora that surrounds the opening of the urethra, the urethral meatus anteriorly and the vaginal opening, the introitus, posteriorly.
38
the external os of the cervix
At its center is a round, oval, or slit-like depression in cervix,, which marks the opening into the endocervical canal
39
the area at risk for later dysplasia, which is sampled by the Papanicolaou, or Pap, smear.
The squamocolumnar junction in the transformation zone is
40
adnexa,
Latin for “appendages,” refers to the ovaries, fallopian tubes, and their supporting tissues
41
The ovaries have two primary functions:
the production of oocytes and the secretion of hormones, including estrogen, progesterone, and testosterone.
42
Menarche
—onset of menses
43
Dysmenorrhea
—pain with menses, often with bearing down, aching, or cramping sensation in the lower abdomen or pelvis
44
Premenstrual syndrome (PMS)—
a cluster of emotional, behavioral, and physical symptoms occurring 5 d before menses for three consecutive cycles
Criteria for diagnosis are symptoms and signs in the 5 days prior to menses for at least three consecutive cycles, cessation of symptoms and signs within 4 days after onset of menses, and interference with daily activities.
45
Menopause—
absence of menses for 12 consecutive months, usually occurring between ages 48 and 55 yrs
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Postmenopausal bleeding
—bleeding occurring 6 mo or more after cessation of menses
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menstrual cycle
The interval between periods ranges roughly from 24 to 32 days; menstrual flow lasts from 3 to 7 days.
48
Primary dysmenorrhea results from
increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
49
Causes of secondary dysmenorrhea include
endometriosis, adenomyosis (endometriosis in the muscular layers of the uterus), pelvic inflammatory disease (PID), and endometrial polyps.
50
metrorrhagia
bleeding or spotting in between your menstruation
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Menopause
typically occurs between ages 48 and 55 years, peaking at a median age of 51 years. It is defined as cessation of menses for 12 months, progressing through several stages of erratic cyclical bleeding.
52
premature ovarian failure
Some women may have stopped menstruating before the age of 40 years. This “early menopause” (
53
mittelschmerz
, which is typically a mild unilateral pain lasting for a few hours to a few days arising at midcycle from ovulation, ruptured ovarian cyst, or tubo-ovarian abscess
54
Endometriosis
, from retrograde menstrual flow and extension of the uterine lining outside the uterus,
55
fibroids
, which are tumors in the uterine wall or submucosal or subserosal surfaces arising from the smooth muscle cells of the myometrium
56
An enlarged clitoris is seen
in masculinizing endocrine disorders.
57
A yellowish discharge on the endocervical swab commonly represents
mucopurulent cervicitis from Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex
58
For best results from cervical collection
the patient should not be menstruating. She should avoid intercourse and use of douches, tampons, contraceptive foams or creams, and vaginal suppositories for 48 hours before the examination
59
HPV Vaccine Recommendations.
The ACIP recommends routine vaccination for females and males beginning at age 11 or 12 years, though vaccinations can be first given at age 9.27 For persons being vaccinated before age 15, the recommendation is two doses of HPV vaccine within 6 to 12 months. For persons first being vaccinated at ages 15 through 26 and immunocompromised persons ages 9 through 26, the recommendation is for three doses of HPV vaccine (0, 1 to 2, and 6 months).
60
Age at which to begin screening
pap smear
21 yrs
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Screening method and interval- pap
Ages 21–65 yrs: cytology every 3 yrs OR
Ages 21–29 yrs: cytology every 3 yrs
Ages 30–65 yrs: cytology plus HPV testing (for high-risk or oncogenic HPV types) every 5 yrs; HPV testing alone (age 25 or 30)
62
Age at which to end screening
pap smear
Age >65 yrs, assuming three consecutive negative results on cytology or two consecutive negative results on cytology plus HPV testing within 10 yrs before cessation of screening, with the most recent test performed within 5 yrs
63
Epidermoid Cyst
A small firm round cystic nodule in the labia suggests an epidermoid cyst. These are yellowish in color. Look for the dark punctum marking the blocked opening of the gland.
64
Syphilitic Chancre
This firm painless ulcer from primary syphilis forms ∼21 d after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals regardless of treatment in 3–6 wks.
65
Genital Herpes
Shallow small painful ulcers on red bases are suspicious for infection from genital herpes simplex virus 1 or 2. Ulcers may take 2–4 wks to heal. Recurrent outbreaks of localized vesicles, then ulcers are common.
66
Secondary Syphilis (Condyloma Latum)
Large raised, round or oval, flat-topped gray or white lesions point to condylomata lata. These are contagious and, along with rash and mucous membrane sores in the mouth, vagina, or anus, are manifestations of secondary syphilis.
67
Cystocele
A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall, together with the bladder above it. It results from weakened anterior supporting tissues.
68
Urethral Caruncle
A urethral caruncle is a small red benign tumor visible at the posterior urethral meatus. It occurs chiefly in postmenopausal women and usually causes no symptoms. Occasionally, a carcinoma of the urethra is mistaken for a caruncle. To check, palpate the urethra through the vagina for thickening, nodularity, or tenderness, and palpate for inguinal lymphadenopathy.
69
Bartholin Gland Infection
Causes of a Bartholin gland infection include trauma, gonococci, anaerobes like bacteroides and peptostreptococci, and C. trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small.
70
Cystourethrocele
When the entire anterior vaginal wall, together with the bladder and urethra, produces the bulge, a cystourethrocele is present. A groove sometimes defines the border between the urethrocele and cystocele, but is not always present.
71
Prolapse of the Urethral Mucosa
Prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. It usually occurs before menarche or after menopause. Identify the urethral meatus at the center of the swelling to make this diagnosis.
72
Rectocele
A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.
73
Mucopurulent Cervicitis
Mucopurulent cervicitis produces purulent yellow drainage from the cervical os, usually from C. trachomatis, N. gonorrhoeae, or herpes infection. These infections are sexually transmitted and may occur without symptoms or signs.
74
Carcinoma of the Cervix
Carcinoma of the cervix begins in an area of metaplasia. In its earliest stages, it cannot be distinguished from a normal cervix. In later stages, an extensive, irregular, cauliflower-like growth may develop. Early frequent intercourse, multiple partners, smoking, and infection with human papillomavirus increase the risk for cervical cancer.
75
Fetal Exposure to Diethylstilbestrol (DES)
Daughters of women who took DES during pregnancy are at greatly increased risk for several abnormalities, including (1) columnar epithelium that covers most or all of the cervix, (2) vaginal adenosis (i.e., extension of this epithelium to the vaginal wall), and (3) a circular collar or ridge of tissue, of varying shapes, between the cervix and vagina. Much less common is an otherwise rare carcinoma of the upper vagina.
76
Pelvic Inflammatory Disease
PID is due to “spontaneous ascension of microbes from the cervix or vagina to the endometrium, fallopian tubes, and adjacent structures.”22 85% of cases involve STIs or bacterial vaginosis affecting the fallopian tubes (salpingitis) or the tubes and ovaries (salpingo-oophoritis), primarily N. gonorrhoeae and C. trachomatis. Hallmarks of acute disease are adnexal, cervical, and uterine compression tenderness. The diagnosis is imprecise, however—only 75% have confirmed pathogens on tubal laparoscopy. If not treated, a tubo-ovarian abscess may ensue; 18% of treated patients report infertility after 3 yrs. Infection of the fallopian tubes and ovaries may also follow childbirth or gynecologic surgery.
77
Ectopic Pregnancy, Including Rupture
Ectopic pregnancy results from implantation of the fertilized ovum outside the endometrial cavity, primarily in the fallopian tube (90% of cases).12,13 Ectopic pregnancy occurs in 1%–2% of pregnancies worldwide and remains an important cause of maternal morbidity and mortality. Clinical presentation ranges from subacute, in ∼80%–90% of cases, to shock from rupture and intraperitoneal hemorrhage (10%–30% of cases). Abdominal pain, adnexal tenderness, and abnormal uterine bleeding are the most common clinical features. In more than half of ectopic pregnancies, there is a palpable adnexal mass that is typically large, fixed, and ill-defined, at times with adherent omentum or small or large bowel. In milder cases, there may be a prior history of amenorrhea or other symptoms of a pregnancy.
Risk factors include tubal damage from PID, prior ectopic pregnancy, prior tubal surgery, age older than 35 yrs, presence of an IUD, subfertility (has altered tubal integrity), and assisted reproductive techniques.
78
prostate increases how much during puberty
5x
79
he main questions for prostate health involve
urinary habits.
80
Change in stool caliber, especially pencil-thin stools, may warn of
colon cancer
81
Anorectal pain, tenesmus, or discharge and/or bleeding suggest .
proctitis
82
A tender fluctuant mass with overlying redness and induration is suggestive of
a perirectal/perianal abscess
83
primary prostate cancer screening test
The prostate-specific antigen (PSA) blood test is the
84
A pilonidal cyst
is a fairly common, probably congenital, abnormality located in the midline natal cleft. Look for the opening of a sinus tract, sometimes with a small tuft of hair surrounded by a halo of erythema. Pilonidal cysts are generally asymptomatic, except for slight drainage, but abscess formation and secondary sinus tracts may occur.
85
External hemorrhoids
are dilated hemorrhoidal veins that originate below the pectinate line that are covered with skin. They seldom produce symptoms unless thrombosis occurs. Thrombosis causes acute local pain that increases with defecation and sitting. A tender, swollen, bluish, ovoid mass is visible at the anal margin.
86
Internal hemorrhoids
are enlargements of the normal vascular cushions located above the pectinate line, usually not palpable. Internal hemorrhoids may cause bright-red bleeding, especially during defecation. They may also prolapse through the anal canal and appear as reddish, moist, protruding masses, typically located in one or more of the positions illustrated.
87
An anal fissure
is a very painful tear/ulceration of the anoderm, found most commonly in the midline posteriorly, less commonly in the midline anteriorly. Its long axis lies longitudinally. There may be a swollen “sentinel” skin tag just below it. Gentle separation of the anal margins may reveal the lower edge of the fissure. The sphincter is spastic; the examination is painful. An examination under anesthesia may be necessary to fully characterize the lesion.
88
An anorectal fistula
is an abnormal connective tract that originates from anal glands to an external opening on the skin (as shown here). Fistulas are the result of previous anorectal abscess/infections. Look for the fistulous opening or openings anywhere in the skin around the anus.
89
normal prostate
As palpated through the anterior rectal wall, the normal prostate is a rounded, heart-shaped structure approximately 2.5 cm long. The median sulcus can be palpated between the two lateral lobes. Only the posterior surface of the prostate is palpable. Anterior and central lesions, including those that obstruct the urethra, are not detectable by physical examination as they are not in contact with the rectal wall.
90
Acute bacterial prostatitis
presents with fever and urinary tract symptoms such as frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain. The gland feels tender, swollen, “boggy,” and warm. Examine it gently as it can be extremely tender and painful for the patient. More than 80% of infections are caused by gram-negative aerobes such as Escherichia coli and Enterococcus and Proteus spp. In men younger than age 35 yrs, consider sexual transmission of Neisseria gonorrhea and Chlamydia trachomatis.
91
Chronic bacterial prostatitis
is associated with recurrent urinary tract infections, usually from the same organism. Men may be asymptomatic or have symptoms of dysuria or mild pelvic pain. The prostate gland may feel normal, without tenderness or swelling. Cultures of prostatic fluid usually show infection with E. coli.
92
BPH
BPH is a nonmalignant enlargement of the prostate gland that increases with age, present in more than 50% of men by age 50 yrs. Symptoms arise both from smooth-muscle contraction in the prostate and bladder neck and from compression of the urethra by hypertrophied prostate tissue. They may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both, and are seen in more than one-third of men by age 65 yrs. The affected gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen. Because of the limited nature of the digital rectal examination, the severity of symptoms may not correlate with the examination findings.
93
Prostate cancer
is suggested by an area of hardness in the gland, such as a distinct hard nodule or firmness. As the cancer enlarges, it feels irregular and may extend beyond the confines of the gland. The median sulcus may be obscured. Hard areas in the prostate are not always malignant. They may also result from prostatic stones, chronic inflammation, and other condit
94
Hydrocolpos
Distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction
