PHYSICAL EXAMINATION OF THE MALE GENITALIA

Question 1

HPI considerations
Difficulty achieving or maintaining erection.
Ask patients about

Answer 1

-pain with erection,
-pattern of erection with one or more partners,
-alcohol and medication ingestion,
-erections unrelated to sexual stimulation,
-curvature of erect penis.

Question 2

HPI considerations
Difficulty with ejaculation
Pertinent data include:

Answer 2

-painful or premature ejaculation
-color and consistency of fluids,
-medications used on a regular basis.

Question 3

HPI considerations
Discharge or lesions on the penis.
Note the…

Answer 3

-character of lesion (lumps, sores, rashes)
-discharge (color, consistency, odor).
-Record any associated symptoms (e.g., itching or burning),
-exposure to sexually transmitted infections,
-medications used.

Question 4

HPI considerations
Infertility.
Patients reporting problems with conceiving should be assessed for

Answer 4

-lifestyle factors (e.g., hot tub use),
-length of time attempting pregnancy,
-knowledge of fertile period of woman’s reproductive cycle,
-incidence of undescended testes,
-previous diagnostic studies (e.g., semen analysis or sperm antibody titers)
-medications used.

Question 5

HPI considerations
Enlargement in inguinal area.
Questions relevant to:

Answer 5

-enlarged inguinal area address pain associated with lifting,
-change in size or character of mass,
-groin pain,
-use of truss or other treatment,
-medications used.

Question 6

HPI considerations
Testicular pain or mass.
Patients should be assessed for:

Answer 6

-changes in testicular size,
-events surrounding onset (e.g., sporting event),
-any irregular lumps,
-soreness,
-heaviness of testes,
-medications used.

Question 7

Past Medical History considerations
Pertinent data include:

Answer 7

-previous genitourinary tract surgeries (e.g., surgery to correct hypospadias or hernia),
-sexually transmitted infections
-chronic illnesses (e.g., prostatic cancer, arthritis, or neurologic or -vascular impairment).

Question 8

Family History Considerations
Data should be collected on:

Answer 8

-any infertility problems in siblings,
-hernias in family members,
-family history of prostate, testicular, or penile cancer.

Question 9

Personal and Social History
Relevant data include

Answer 9

-employment risks (e.g., exposure to toxins),
-exercise patterns,
-concerns about genitalia,
-testicular self-examination practices,
-concerns about sexual practices,
-reproductive function (number of children, form of contraceptive use),
-use of medications, alcohol, or street drugs that may interfere with sexual response.

Question 10

HPI considerations in older adults
Relevant data include:

Answer 10

-sexual activity patterns
-any changes in sexual response or desire.

Question 11

HPI considerations in Adolescents.
Relevant data include knowledge of:

Answer 11

-reproductive function,
-presence of nocturnal emissions,
-enlargement of genitalia,
-sexual activity patterns,
-use of contraceptives,
-concerns of sexual abuse.

Question 12

HPI considerations for Infants and children

Answer 12

-Information should be gathered on maternal use of sex hormones or birth control pills during pregnancy.
-Circumcised infants should be assessed for any complication from the procedure.
-Pertinent data for uncircumcised infants include hygiene measures and retractability of foreskin.
-Congenital anomalies (e.g., epispadias) and any incidence of scrotal swelling when infant is crying or having bowel movements
should be recorded.
-Notation should also be made of any swelling, discoloration, sores on penis or scrotum, and genital pain.
-Questions should be asked about any concerns with masturbation, sexual exploration, or sexual abuse.

Question 13

Erection of the penis occurs when the two corpora cavernosa become engorged with _______ mL of blood in response to the autonomic nervous system.

Answer 13

20 to 50 mL

Question 14

True/False
Examination
Patient may be lying or standing.

Answer 14

True

Question 15

Examination of the genitalia involves…

Answer 15

-inspection,
-palpation, and
-transillumination of any mass found.

Question 16

Findings associated with disorders: Adults
Pinpoint opening suggests…

Answer 16

meatal stenosis

Question 17

Findings associated with disorders: Adults
a prolonged and often painful penile erection, may suggest a more serious condition.

Answer 17

Priapism

Question 18

Findings associated with disorders: Adults
Beaded or lumpy vas deferens suggests…..

Answer 18

diabetes, tuberculosis, or inflammatory changes.

Question 19

Findings associated with disorders: Adults
The hernia is described as _____ if it lies within the inguinal canal.

Answer 19

indirect

Question 20

_______ is the inability to replace the foreskin to its usual position after it has been retracted behind the glans.

Answer 20

Paraphimosis

Question 21

Findings associated with disorders: Adults
Uncircumcised males may have ______ as a result of nonretractable foreskin.
-this results from infection.
-Penile discharge suggests inflammation or infection

Answer 21

balanoposthitis

Question 22

_______ is a congenital defect in which the urethral meatus is located on the ventral surface of the glans, penile shaft, or the perineal area.

Answer 22

Hypospadias

Question 23

__________ generally occurs 2 weeks after exposure. Most commonly located on the glans. Painless lesion has indurated borders with a clear base.

Answer 23

Syphilitic chancre lesion of primary syphilis

Question 24

_______ is a viral infection that appears as superficial vesicles. Lesions may be located on the glans, penile shaft or base. Painful and associated with inguinal lymphadenopathy

Answer 24

Herpes

Question 25

_______ is a soft, reddish lesion that arises because of infection with a papovavirus. The lesions are commonly present on the prepuce, glans penis. The lesions may undergo malignant degeneration to squamous cell carcinoma.

Answer 25

Condyloma acuminatum

Question 26

_________ is an STI caused by a chlamydial organism. The lesions appear on the genitalia. The initial lesion is a painless erosion at or near the coronal sulcus.

Answer 26

Lymphogranuloma venereum

Question 27

_______ is an STI caused by a poxvirus. The lesions are pearly gray, often umbilicated, smooth, dome shaped, with discrete margins.

Answer 27

Molluscum contagiosum

Question 28

__________ is characterized by a fibrous band in the corpus cavernosum that results in deviation of the penis during erection.

Answer 28

Peyronie disease

Question 29

__________ is cancer of the penis. Generally squamous and tend to occur in uncircumcised men, who practice poor hygiene. Often appears as a painless ulceration.

Answer 29

Penile carcinoma

Question 30

is a nontender, smooth, firm mass that results from fluid accumulation in the tunica vaginalis. The mass will transilluminate.

Answer 30

Hydrocele

Question 31

_________ is a cystic swelling occurring on the epididymis.

Answer 31

Spermatocele

Question 32

___________ is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. Most common on the left side and is painful. Occurs in boys and young men and associated with reduced fertility.

Answer 32

Varicocele

Question 33

_____________ an acute inflammation of the testis, orchitis is uncommon except as a complication of mumps in the adolescent or adult.

Answer 33

Orchitis

Question 34

________ is inflammation of the epididymis is often seen in association with a urinary tract infection. The epididymis is exquisitely tender and overlying scrotum may be marked erythematous.

Answer 34

Epididymitis

Question 35

____________________ is a surgical emergency occurring most commonly in adolescents. It has acute onset and is often accompanied by nausea and vomiting.

Answer 35

Testicular torsion

Question 36

___________________ is a neoplasm arising from the testicle appears as an irregular, nontender mass fixed on the testis. It does not transilluminate and is the most common in males.

Answer 36

Testicular tumor

Question 37

Varying degrees of maturation should be classified according to the _________

Answer 37

Tanner stages.

Question 38

Femoral hernias occur at the______, where the femoral artery exits the abdomen and are more common in __________

Answer 38

-fossa ovalis
-females than males.