PD Male Genitalia Flashcards Preview

Physical Diagnosis > PD Male Genitalia > Flashcards

Flashcards in PD Male Genitalia Deck (51):
1

History

Urinary symptoms
Changes in sexual function
Penile discharge/lesions
Scrotal pain/swelling/lesions
Part of complete physical exam

STD/HIV prevention
Testicular self exam

2

Exam prep

Always explain what is being done
Patient removes underwear
Patient standing, examiner sitting in front
Wear gloves
Patient occasionally has an erection, try not to get flustered
Document any refusal

3

P1 pubic hair

Preadolescent
No growth of hair in pubic area

4

P2 pubic hair

Slightly pigmented, longer/straight hair (downy like)
Usually at base of penis

5

P3 pubic hair

Dark pigmented, curly pubic hair around base

6

P4 pubic hair

Pubic hair definitely adult in type, but not extent

7

P5 pubic hair

Hair spread to medial surface of thighs

8

P6 pubic hair

Hair spread along line alba (80% of men)

9

Tanner staging genitals

G1 - 5

10

G1 genitals

Testes, scrotum, and penis are same size and shape as child

11

G2 genitals

Enlargement of the scrotum and testes, skin of scrotum becomes redder, thinner, and wrinkled

12

G3 genitals

Enlargement of the penis, esp in length, further enlargement of testes
Descent of scrotum

13

G4 genitals

Continued enlargement of the penis and sculpturing of the glands
Increased pigmentation of scrotum

14

G5 genitals

Adults stage, penis reaching bottom of scrotum

15

Inspection of penis

Circumcised/uncircumcised
Examine glands, skin, foreskin
Retract foreskin

Ulcers
Nodules
Lesions
Discharge
Lice
Rashes

16

Palpation

Tenderness
Induration
Nodules
Discharge - may have to milk
Have culture material ready if STD suspected

Urethral meatus

17

Phimosis
Causes
Tx

Tight prepuce (foreskin) that can't be retracted over glands

Scarring
Balanitis
Lichen planus

Tx - circumcision

18

Paraphimosis

Tight foreskin becomes trapped behind the head of penis and can't be retracted, causing edema

19

Balantitis
Complication
Causes

Inflammation of the glans
Phimosis is most common complication

Diabetes
Poor hygiene
Irritants
Morbid obesity
Infection
Trauma

20

Balanoposthitis

Inflammation of glans and foreskin

21

Balantitis S&S

Erythema of glans/foreskin
Edema of glans/foreskin
Discharge
Ulceration

22

Epispadias

Congenital defect with open in of the urethra on the dorsum of the penis

23

Hypospadias

Congenital defect with opening on the urethra on the ventral side of penis

24

Peyronie's disease

Hard, contender, subq plaques on dorsal or lateral side of penis
Etiology unknown
Plaques may be single or multiple
Causes painful bending with erection
Most common 45 yo or older

25

Carcinoma of the penis

Most common is squamous cell
More common in uncircumcised men

26

Bowen's disease

Carcinoma in situ of the penis
Doesn't invade dermis

27

Primary syphilis

Caused by Treponema palladium
~2 weeks post exposure
painless ulcer (chancre)
Heals 3-6 weeks even without tx
Regional LAD

28

Condyloma lata

Secondary syphilis
Appear few weeks to 6 months after initial syphilis cancer
Multiple moist appearing lesions, flattened, round-oval
Can be painful, itchy
Contagious

29

Condyloma accuminata

Genital warts
Caused by HPV

30

Gonorrhea cause

Neisseria gonorrhea

31

Chlamydia cause

Chlamydia trachomatis

32

Herpes simplex

Painful vesicles, most commonly on glans or shaft
May coalesce to form ulcer

33

Inspection of scrotum and testes

Symmetry
Swelling
Masses
Rashes

34

Palpation of scrotum and testicles

Masses
Tenderness

35

Hydrocele

Collection of fluid within the tunica vaginalis
Most common cause of scrotal swelling
Painless, readily transilluminated

36

Causes of hydrocele

Epididymitis
Trauma
Hernia
TUmor

37

Spermatocele

Usually painless cystic mass located between head of epididymis and testis
Filled with milky fluid containing sperm
No scrotal erythema
No dysuria
No systemic symptoms

38

Varicocele

Dilation of veins within the spermatic cord
"Bag of worms"
Does not transilluminate
More common on left side

39

Orchitis

Acute inflammation of the testis
Uncommon except when complication of extension of epididymitis, UTI, or systemic infection

40

Cause and Symptoms of orchitis

Mumps, usually in post pubertal males

Fever
Swelling (uni or bilateral)
Erythema and induration of testes
Hydrocele may develop as a result

41

Testicular torsion
S&S

Blood supply to testis becomes twisted leading to ischemia
Usually in adolescents (rare after 20)
Left side more common

Sudden onset of severe pain
No fever
May have nausea/vomiting
Testis on affected side will sit higher in scrotum
Spermatic cord feels thicker
SURGICAL EMERGENCY

42

Testicular cancer

Most common ages 15-30
Seminoma most common
Rare in blacks, hispanics, asians
1% of all male carcinomas
Irregularly shaped, firm, usually non tender mass
Most often discovered during palpation

43

Risk factors for testicular cancer

Undescended testes
Caucasian

44

Cryptorchidism

Condition in which one or both of testes fail to descend into scrotum
Common congenital condition involving testes
No testes detected with palpation of scrotum
Impaired fertility
Risk of testicular cancer up to 50% higher than in men who have descended testes

45

Inguinal hernia

Diffuse swelling amidst the cord structures
Inguinal canal region protuberant
Usually non tender

46

Detecting inguinal hernia

Have pt bear down or cough while you inspect inguinal area
(Increase intraabdominal pressure and may make hernia more prominent)
Place right finger along right spermatic cord, inverting scrotal skin, as you trace cord to where it emerges from the external ring of inguinal canal
Put fingers of left hand over inguinal canal
Note any swollen area
Have pt cough or bear down again
Repeat on left side, switching hands

47

Incarcerated hernia

Contents of hernia cannot be returned to the abdominal cavity
Risk of strangulation

48

Strangulated

Blood supply to the entrapped contents is compromised
Ischemia/infarction

49

Indirect inguinal hernia

Passes through entire inguinal canal (through internal deep ring and external ring)
Most common type
Due to congenital defect
Often enters the scrotum

50

Direct inguinal hernia

Passes through weakness in fascia of abdominal wall (Hesselbach's triangle)
Through external ring only
Seldon enters the scrotum

51

Femoral hernia

Intestines push through femoral ring and canal, below inguinal ligament
Pain can be severe
High risk of becoming strangulated