TERM 2-MY NOTES HEALTH ASSESSMENT CH.24 "Male Genitourinary System" Flashcards Preview

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Flashcards in TERM 2-MY NOTES HEALTH ASSESSMENT CH.24 "Male Genitourinary System" Deck (367):
1

Male Genitourinary System

,

2

STRUCTURE AND FUNCTION

,

3

THE MALE GENITALIA

,

4

The male genital structures include the penis and scrotum externally and the testis, epididymis, and vas deferens internally.
A)true
B)false

A

5

The ________ include the penis and scrotum externally and the testis, epididymis, and vas deferens internally.

The male genital structures include the penis and scrotum externally and the testis, epididymis, and vas deferens internally.

6

Glandular structures accessory to the male genital organs (the prostate, seminal vesicles, and bulbourethral glands).
A)true
B)false

A

7

The penis is composed of three cylindric columns of erectile tissue: the two corpora cavernosa on the dorsal side and the corpus spongiosum ventrally
A)true
B)false

A

8

The ________ is composed of three cylindric columns of erectile tissue: the two corpora cavernosa on the dorsal side and the corpus spongiosum ventrally

The penis is composed of three cylindric columns of erectile tissue: the two corpora cavernosa on the dorsal side and the corpus spongiosum ventrally

9

The scrotum is a loose protective sac, which is a continuation of the abdominal wall. After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles.
A)true
B)false

A

10

The __________ is a loose protective sac, which is a continuation of the abdominal wall. After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles.

The scrotum is a loose protective sac, which is a continuation of the abdominal wall. After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles.

11

The scrotal wall consists of thin skin lying in folds, or rugae, and the underlying cremaster muscle.
A)true
B)false

A

12

The ________ consists of thin skin lying in folds, or rugae, and the underlying cremaster muscle

The scrotal wall consists of thin skin lying in folds, or rugae, and the underlying cremaster muscle

13

The inguinal area, or groin, is the juncture of the lower abdominal wall and the thigh. Its diagonal borders are the anterior superior iliac spine and the symphysis pubis.
A)true
B)false

A

14

The __________, or groin, is the juncture of the lower abdominal wall and the thigh. Its diagonal borders are the anterior superior iliac spine and the symphysis pubis.

The inguinal area, or groin, is the juncture of the lower abdominal wall and the thigh. Its diagonal borders are the anterior superior iliac spine and the symphysis pubis.

15

DEVELOPMENTAL COMPETENCE
Infants

,

16

Prenatally, the testes develop in the abdominal cavity near the kidneys.
A)infants
B)adults

A

17

During the later months of gestation, the testes migrate, pushing the abdominal wall in front of them and dragging the vas deferens, the blood vessels, and nerves behind.
A)infants
B)Adults

A

18

The testes descend along the inguinal canal into the scrotum before birth.
A)infants
B)adults

A

19

At birth, each testis measures 1.5 to 2 cm long and 1 cm wide. Only a slight increase in size occurs during the prepubertal years.
A)infants
B)adults

A

20

DEVELOPMENTAL COMPETENCE
Adolescents

A

21

Puberty begins sometime between the ages of 9 Yrs and 13 Yrs years. The first sign is enlargement of the testes. Next, pubic hair appears, and then penis size increases. The stages of development are documented in Tanner's sexual maturity ratings .
A)true
B)false

A

22

The complete change in development from a preadolescent to an adult of testies takes around 3 years, although the normal range is 2 to 5 years.
A)true
B)false

A

23

The median age of attaining stage 2 for pubic hair development was 12 years.
A)true
B)false

A

24

African American boys showed pubic hair growth about 9 months earlier than white boys and over 1 year earlier than Mexican American boys.
A)true
B)false

A

25

Toward the end of puberty, or Tanner stage 5, African-American boys were 1 year younger than white or Mexican-American boys in completing genital development.
A)true
B)false

A

26

Although these racial/ethnic differences could not be explained, the study suggested racial differences in the interactions between insulin, glucose, and androgens and racial/ ethnic differences in diet, lifestyle, and exposure to environmental factors.
A)true
B)false

A

27

DEVELOPMENTAL COMPETENCE
Adults and Aging Adults

,

28

The male does not experience a definite end to fertility as the female does. Around age 40 years, the production of sperm begins to decrease, although it continues into the 80s and 90s.
A)true
B)false

Aging adult true

29

After age 55 to 60 years, testosterone production declines very gradually so that resulting physical changes are not evident until later in life.
A)true
B)false

A

30

In the aging male, the amount of pubic hair decreases and the remaining hair turns gray. Penis size decreases. Due to decreased tone of the dartos muscle, the scrotal contents hang lower, the rugae decrease, and the scrotum looks pendulous.
A)true
B)false

A

31

pendulous is termed hanging down loosely
A)true
B)false

A

32

The testes decrease in size and are less firm to palpation. Increased connective tissue is present in the tubules, so these become thickened and produce less sperm.
A)aging adult
B)infant

A

33

In general, declining testosterone production leaves the older male with a slower and less intense sexual response, and an erection takes longer to develop and is less full or firm.
A)aging adult
B)infant

A

34

Ejaculation is shorter and less forceful, and the volume of seminal fluid is less than when the man was younger.
A)aging adult
B)infant

A

35

After ejaculation, rapid detumescence (return to the flaccid state) occurs, especially after 60 years of age. This occurs in a few seconds as compared with minutes or hours in the younger male.
A)aging adult
B)infant

A

36

The refractory state (when the male is physiologically unable to ejaculate) lasts longer, from 12 to 24 hours as compared with 2 minutes in the younger male.
A)aging adult
B)infants

A

37

Sexual Expression in Later Life. Chronologic age by itself should not mean a halt in sexual activity. The justmentioned physical changes need not interfere with the libido and pleasure from sexual intercourse.
A)aging adult
B)infant

A

38

The older male is capable of sexual function as long as he is in reasonably good health and has an interested, willing partner. Even chronic illness does not mean a complete end to sexual desire or activity.
A)true
B)false

A

39

The danger is in the male misinterpreting normal age changes as a sexual failure. Once this idea occurs, it may demoralize the man and place undue emphasis on performance rather than on pleasure.
A)aging adult
B)infants

A

40

In the absence of disease, a withdrawal from sexual activity may be due to loss of spouse; depression; preoccupation with work; marital or family conflict; side effects of medications such as antihypertensives, psychotropics, antidepressants, antispasmodics, sedatives, tranquilizers or narcotics, and estrogens; heavy use of alcohol; lack of privacy (living with adult children or in a nursing horne); economic or emotional stress; poor nutrition; or fatigue.
A)aging adult
B)infants

A

41

CULTURE AND GENETICS

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42

During pregnancy or the immediate neonatal period, parents will ask you about whether to circumcise the male infant.
A)true
B)false

A

43

There are religious and cultural indications for circumcision; other indications include preventing phimosis and inflammation of the glans penis and foreskin, decreasing the incidence of cancer of the penis, and decreasing the incidence of urinary tract infections in infancy.
A)true
B)false

A

44

Circumcision reduces HIV acquisition in men by 53% to 60%,as shown in three randomized trials and numerous observational studies in sub-Saharan Africa and it reduces HIV transmission to uninfected women sexual partners.
A)true
B)false

A

45

circumcision significantly reduced the incidence of herpes simplex virus type 2 (HSV-2) and the prevalence of human papillornavirus (HPV).
A)true
B)false

A

46

The mechanism may be that the presence of the foreskin increases susceptibility to small abrasions, allowing more contact time between pathogens and the mucosa of the partner.The risk for other STIs (Trichomonas vaginalis, bacterial vaginosis) is reduced in women with circumcised partners as well.
A)true
B)false

A

47

Routine neonatal circumcision rates have dropped from a high of 80% after World War II to about 65% of newborns in 1999, in part because the American Academy of Pediatrics does not endorse the procedure. Because of this, Medicaid does not cover routine neonatal circumcision costs in 16 states. This is disadvantageous especially to African American and Hispanic male infants who are over represented in poorer groups whose only medical coverage is Medicaid.
A)true
B)false

A

48

Circumcision carries a very small but possible risk for complications. Most are minor and treatable: pain, bleeding, swelling, or inadequate skin removal. Serious complications are rare and include excess bleeding, wound infection, and urinary retention.
A)true
B)false

A

49

Neonates certainly are capable of perceiving pain; therefore parents need to be apprised of pain-relief measures for the circumcision procedure. These include dorsal penile nerve block and a lidocaine-prilocaine cream (EMLA).
A)true
B)false

A after circumsicion

50

Kidney Disease. Chronic kidney disease (CKD) is determined by blood tests, urinalysis, and imaging studies that show decreased kidney function or kidney damage lasting 3 months or longer.
A)true
B)false

A

51

This can lead progressively and irreversibly to end-stage renal disease (ESRD), when the person survives only by kidney transplant or dialysis.
A)true
B)false

A

52

CKD is a global health problem. It has two main causes, hypertension and diabetes, which comprise 70% or more of patients who progress to ESRD and are having dialysis.
A)true
B)false

A

53

In the United States, the majority of patients with CKD are white;
A)true
B)false

A

54

When compared with whites, the per million prevalence rates are 47% higher for Hispanics, 230% higher for American Indian/Alaskan Natives, and 420% higher for African Americans.
A)true
B)false

A

55

One factor of CKD may be long-term underutilization of antihypertensive medications, the renin-angiotensin-aldosterone system (RAAS) inhibitors, by African Americans.
A)true
B)false

A

56

In the United States, 22% of whites are uninsured or receiving publicfunded health care, compared with 55% of Hispanics and 45% of African Americans.
A)true
B)false

A

57

SUBJECTIVE DATA

,

58

1. Frequency, urgency, and nocturia
2. Dysuria
3. Hesitancy and straining
4. Urine color lump
5. Past genitourinary history
6. Penis-pain, lesion, discharge
7. Scrotum, self-care behaviors,
8. Sexual activity and contraceptive use
9. Sexually transmitted infection (STI) contact
A)subjective data
B)objective data

A

59

Frequency, urgency, and nocturia. Urinating more often than usual?
A)assessing Frequency. Average adult voids 5-6 x/day, varying with fluid intake, individual habits
B)Polyuria-excessive quantity.
C)Oliguria-diminished quantity,

D

60

Polyuria-excessive quantity of urine
A)true
B)false

A

61

Oliguria-diminished quantity,

A

62

Feel as if you cannot wait to urinate?
A)Urgency
B)false

A

63

Awaken during the night because you need to urinate? How often? Is this a recent change?
A)Nocturia occurs together with frequency and urgency in urinary tract disorders. Other origins: cardiovascular, habitual, diuretic medication
B)dysuria

A

64

Nocturia occurs together with frequency and urgency in urinary tract disorders. Other origins: cardiovascular, habitual, diuretic medication
A)true
B)false

A

65

Dysuria. Any pain or burning with urinating?
A)Dysuria. Burning is common with acute cystitis, prostatitis, urethritis.
B)false

A

66

Dysuria. Burning is common with acute cystitis, prostatitis, urethritis.
A)true
B)false

A

67

Hesitancy and straining. Any trouble starting the urine stream?
A)Hesitancy
B)noctouria

A

68

Need to strain to start or maintain stream?
A)straining
B)dysuria

A

69

Any change in force of stream: narrowing, becoming weaker?
A)Loss of force and decreased caliber.
B)false

A

70

Dribbling, such that you must stand closer to the toilet?
A)Terminal dribbling.
B)false

A

71

Afterward, do you still feel you need to urinate?
A)assessing for Sense of residual urine.
B)false

A

72

Ever had any urinary tract infections?
A)Recurrent episodes of acute cystitis. These symptoms suggest progressive prostatic obstruction.
B)false

A

73

Recurrent episodes of acute cystitis. suggest progressive prostatic obstruction.
A)true
B)false

A

74

Urine color. Is the usual urine clear or discolored, cloudy, foul-smelling, bloody.
A)Cloudy in urinary tract infection.
B)Hematuria-a danger sign that warrants further workup.
C)both a and b

C

75

Cloudy urine means urinary tract infection.
A)true
B)false

A

76

Past genitourinary history. Any difficulty controlling your urine?
A)assessing Urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder. It contracts, causing urgent need to void.
B)false

A

77

Urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder. It contracts, causing urgent need to void
A)true
B)false

A

78

Accidentally urinate when you sneeze, laugh, cough, or bear down?
A)assessing Stress incontinence-involuntary urine loss with physical strain, sneezing, or coughing due to weakness of pelvis floor.
B)false

A

79

Stress incontinence-involuntary urine loss with physical strain, sneezing, or coughing due to weakness of pelvis floor.
A)true
B)false

A

80

Any history of kidney disease, kidney stones, flank pain, urinary tract infections, prostate trouble?
A)true
B)false

A

81

Penis. Any problem with penis-pain, lesions? ·Any discharge? How much? Has that increased or decreased since start? • The color? Any odor? Discharge associated with pain or with urination?
A)assessing because Urethral discharge occurs with infection
B)false

A

82

Scrotum, self-care behaviors. Any problem with the scrotum or testicles?
A)Concern about any self-discovered mass (spermatocele, hydrocele, varicocele, rarely testicular cancer) alerts you to careful exploration during examination.
B)false

A

83

Concern about any self-discovered mass (spermatocele, hydrocele, varicocele, rarely testicular cancer) alerts you to careful exploration during examination.
A)true
B)false

A

84

Any lump or swelling on testes? Any change in size of the scrotum? Any history of undescended testicle as infant?
A)assessing patient
B)false

A

85

Noted any bulge or swelling in the scrotum? For how long? Ever been told you have a hernia? Any dragging, heavy feeling in scrotum?
A)assessing for Possible hernia.
B)false

A

86

Sexual activity and contraceptive use. Are you in a relationship involving sexual intercourse now?
A)assessing
B)false

A

87

Arc aspects of sex satisfactory to you and your partner? Are you satisfied with the way you and your partner communicate about sex? Occasionally a man notices a change in ability to have an erection when aroused. Have you noticed any changes?
A)assessing
B)false

A

88

Questions about sexual activity should be routine in review of body systems for these reasons:
• Communicates that you accept individual's sexual activity and believe it is important.

• Your comfort with discussion prompts person's interest and possibly relief that topic has been introduced.

Establishes a database for comparisons with any future sexual activities.

Provides opportunity to screen sexual problems.

Your questions should be objective and matter-of-fact
A)true
B)false

A

89

Do you and your partner use a contraceptive? Which method? Is this satisfactory? Any questions about this method?
A)assessing
B)false

A

90

How many sexual partners have you had in the past 6 months?
A)assessing
B)false

A

91

What is your sexual preference-relationship with a woman, a man, both?
A)Gay and bisexual men need to feel acceptance to discuss their health concerns. Men who have sex with men (MSM) are at increased risk for STI; psychological distress.
B)false

A

92

. Men who have sex with men (MSM) are at increased risk for STI; psychological distress.
A)true
B)false

A

93

STI contact. Any sexual contact with a partner having an STI, such as gonorrhea, herpes, AIDS, chlamydia, venereal warts, syphilis? • When was this contact? Did you get the disease? • How was it treated? Any complications? • Do you use condoms to help prevent STis? Any questions or concerns about any of these diseases?
A)assessing
B)false

A

94

Additional History for Infants and Children

,

95

Does your child have any problem urinating? Urine stream look straight? • Any pain with urinating, crying, or holding the genitals? • Any urinary tract infection?
A)true
B)false

A

96

(If child older than 2 to 2 1/2 years.) Has toilet training started? How is it progressing?
A)true
B)false

A

97

• (If child 5 years or older.) Wet the bed at night? Is this a problem for child or for you (parents)? What have you done? How does the child feel about it?
A)Nocturnal enuresis-involuntarily passing urine at night after age 5 to 6 years.
B)false

A

98

__________-involuntarily passing urine at night after age 5 to 6 years.

Nocturnal enuresis-involuntarily passing urine at night after age 5 to 6 years.

99

Any problem with child's penis or scrotum: sores, swelling, discoloration? • Told if his testes are descended or undescended? • Ever had a hernia or hydrocele? • Swelling in his scrotum during crying or coughing?
A)assessing
B)false

A

100

Ask directly to preschooler or young school-age child.) Has anyone ever touched your penis or in between your legs and you did not want them to? Sometimes that happens to children and it's not okay. They should remember that they have not been bad. They should try to tell a big person about it. Can you tell me three different big people you trust who you could talk to?
A)assessing
B)false

A

101

Screen for sexual abuse. For prevention, teach the child that it is not okay for someone to look at or touch his private parts while telling him it is a secret. Naming three trusted adults will include someone outside the family-important, since most molestation is by a parent.
A)true
B)false

A

102

Additional History for Preadolescents and Adolescents

,

103

Use the following questions regarding sexual growth and development and sexual behavior. First:

,

104

Ask questions that seem appropriate for boy's age but be aware that norms vary widely. When you are in doubt, it is better to ask too many questions than to omit something. Children obtain information, often misinformation, from the media, Internet, and peers at surprisingly early ages. You may be sure your information will be more thoughtful and accurate.
A)assessing
B)false

A

105

Ask direct, matter-of-fact questions. Avoid sounding judgmental. Start with a permission statement. "Often boys your age experience .... " This conveys that it is normal and all right to think or feel a certain way.
A)assessing
B)false

A

106

Try the ubiquity approach. "When did you ... ?" rather than "Do you ... ?"This ... ... method is less threatening because it implies that the topic is normal and unexceptional.
A)assessing
B) false

A

107

Do not be concerned if a boy will not discuss sexuality with you or respond to offers for information. He may not wish to let on that he needs or wants more information. You do well to "open the door." The adolescent may come back at a future time.
A)assessing
B)false

A

108

CONTD.... Preschoolers and Adolescents

,

109

Around age 12 to 13 years, but sometimes earlier, boys start to change and grow around the penis and scrotum. What changes have you noticed? Have you ever seen charts and pictures of normal growth patterns for boys?
A)true
B)false

A

110

Who can you talk to about your body changes and about sex information? How do these talks go? Do you think you get enough information? What about sex education classes at school? How about your parents? Is there a favorite teacher, nurse, doctor, minister, or counselor to whom you can talk?
A)assessing
B)false

A

111

Boys around age 12 to 13 years (SMR3) have a normal experience of fluid coming out of the penis at night, called nocturnal emissions, or "wet dreams." Have you had this?
A)An occasional boy confuses this with a sign of STI or feels guilty.
B)false

A

112

nocturnal emissions, or "wet dreams."
A)true
B)false

A

113

Teenage boys have other normal experiences and wonder if they are the only ones who ever had them, like having an erection at embarrassing times, having sexual fantasies, or masturbating. Also, a boy might have a thought about touching another boy's genitals and wonder if this means he might be homosexual. Would you like to talk about any of these things?
A)A boy may feel guilty about experiencing these things if not informed that they are normal.
B)false

A

114

Often boys your age have questions about sexual activity. What questions do you have? How about things like birth control or STis such as gonorrhea or herpes? Any questions about these?
A)Assess level of knowledge. Many boys will not admit they need more knowledge
B)false

A

115

Are you dating? Someone steady? Have you had intercourse? Are you using birth control? What kind?
A)Avoid the term "having sex." It is ambiguous, and teens can take it to mean anything from foreplay to intercourse. Use behavior-specific words.
B)false

A

116

What kind of birth control did you use the last time you had intercourse?
A)This particular question often reveals that the teen is not using any method of birth control.
B)false

A

117

Has a nurse or doctor ever taught you how to examine your own testicles to make sure they are healthy?
A)Assess knowledge of testicular self-examination
B)false

A

118

Has anyone ever touched your genitals and you did not want them to? Another boy, or an adult, even a relative? Sometimes that happens to teenagers. They should remember it is not their fault. They should tell another adult about it.
A) assessing
B)false

A

119

Additional History for the Aging Adult

,

120

Any difficulty urinating? Any hesitancy and straining? A weakened force of stream? Any dribbling? Or any incomplete emptying?
A)Early symptoms of enlarging prostate may be tolerated or ignored. Later symptoms are more dramatic: hematuria, urinary tract infection.
B)false

A

121

Early symptoms of enlarging prostate may be tolerated or ignored. Later symptoms are more dramatic: hematuria, urinary tract infection.
A)true
B)false

A

122

Do you ever leak water/urine when you don't want to? Do you use pads/ tissue to catch urine in your underwear?
A)Incontinence is any involuntary leaking of urine.
B)false

A

123

Do you need to get up at night to urinate? What medications are you taking? What fluids do you drink in the evening?
A)Nocturia may be due to diuretic medication, habit, or fluid ingestion 3 hours before bedtime; especially coffee and alcohol have a diuretic effect.
B)Also, fluid retention from mild heart failure or varicose veins produces nocturia because recumbency at night mobilizes fluid.
C)both a and b

C

124

Nocturia may be due to diuretic medication, habit, or fluid ingestion 3 hours before bedtime; especially coffee and alcohol have a diuretic effect.
A)true
B)false

A

125

fluid retention from mild heart failure or varicose veins produces nocturia because recumbency at night mobilizes fluid.
A)true
B)false

A

126

. Is it all right to ask you about your sexual function? This is something I ask all the men. For example, it is normal for an erection to develop slowly at this age. This is not a sign of impotence, but a man might wonder if it is. Select all that apply?
A)Excluding physical illness, an older man is fully capable of sexual function. But some assume normal changes mean that they are "old men" and withdraw from sexual activity. B)The older person is not reluctant to discuss sexual activity, and most welcome the opportunity.
C)Depressants to sexual desire and function include antihypertensives, sedatives, tranquilizers, estrogens, and alcohol.
D)Alcohol decreases the sexual response even more dramatically in the older person.

A B C D

127

Any change in your ability to have an erection? • Wanting to have an erection is normal, and it is treatable with medication.
A)assessing
B)false

A

128

OBJECTIVE DATA

,

129

PREPARATION

,

130

Alternatively, the male may be supine for the first part of the examination and stand to check for a hernia.
A)true
B) false

A

131

It is normal for a male to feel apprehensive about having his genitalia examined, especially by a female examiner.
A) true
B) false

A

132

Younger adolescents usually have more anxiety than older adolescents.about examination of genital
A)true
B) false

A

133

But any male may have difficulty dissociating a necessary, matter-of-fact step in the physical examination from the feeling this is an invasion of his privacy.
A)true
B)false

A

134

His concerns are similar to those experienced by the female during the examination of the genitalia: modesty, fear of pain, cold hands, negative judgment, or memory of previously uncomfortable examinations.
A)true
B)false

A

135

In addition, he may fear comparison with others or fear having an erection during the examination and that this would be misinterpreted by the examiner.
A)true
B)false

A

136

Your demeanor should be confident and relaxed, unhurried yet businesslike.
A)true
B)false

A

137

Use a firm, deliberate touch, not a soft, stroking one. If an erection does occur, do not stop the examination or leave the room. This only focuses more attention on the erection and increases embarrassment. Reassure the male that this is only a normal physiologic response to touch, just as when the pupil constricts in response to bright light. Proceed with the rest of the examination.
A)true
B)false

A

138

EQUIPMENT NEEDED

,

139

EQUIPMENT NEEDED
Gloves: wear gloves during every male genitalia examination
Occasionally: glass slide for urethral specimen
Materials for cytology Flashlight
A)true
B)false

A

140

INSPECT AND PALPATE THE PENIS

,

141

The skin normally looks wrinkled, hairless, and without lesions. The dorsal vein may be apparent.
A)normal finding for penis
B)abnormal finding

A

142

Inflammation. Lesions: nodules, solitary ulcer (chancre), grouped vesicles or superficial ulcers, wartlike papules
A)abnormal findings of penis
B)normal finding of penis.

A

143

The glans looks smooth and without lesions. Ask the uncircumcised male to retract the foreskin, or you retract it. It should move easily. Some cheesy smegma may have collected under the foreskin. After inspection, slide the foreskin back to the original position
A)normal finding
B)abnormal finding

A

144

Inflammation. Lesions on glans or corona. Of the penis is an abnormal finding
A)true
B)false

A

145

Phimosis-narrowed opening of prepuce so cannot retract the foreskin.
A)true
B)false

A

146

________-narrowed opening of prepuce so cannot retract the foreskin.

Phimosis-narrowed opening of prepuce so cannot retract the foreskin.

147

Paraphimosis-painful constriction of glans by retracted foreskin.
A)true
B)false

A

148

___________-painful constriction of glans by retracted foreskin

Paraphimosis-painful constriction of glans by retracted foreskin

149

The urethral meatus is positioned just about centrally.
A)normal finding of the penis
B)abnormal finding of the penis

A

150

Hypospadias-ventral location of meatus. On the penis
A)true
B)false

A

151

________-ventral location of meatus. On the penis

Hypospadias-ventral location of meatus. On the penis

152

Epispadias-dorsal location of meatus .on the penis
A)true
B)false

A

153

__________-dorsal location of meatus .on the penis

Epispadias-dorsal location of meatus .on the penis

154

At the base of the penis, pubic hair distribution is consistent with age. Hair is without pest inhabitants.
A)normal finding
B)abnormal finding

A

155

Pubic lice or nits can be seen with the unaided eye. Excoriated skin usually accompanies.
A)true,abnormal
B)false

A

156

Compress the glans anteroposteriorly between your thumb and forefinger. The meatus edge should appear pink, smooth, and without discharge.
A)true for normal finding
B)false

A

157

Stricture-narrowed opening. Edges that are red, everted, edematous, along with purulent discharge, suggest urethritis and is a
A)abnormal finding
B)normal finding

A

158

If you note urethral discharge, collect a smear for microscopic examination and a culture. If no discharge shows but the person gives a history of it, ask him to milk the shaft of the penis. This should produce a drop of discharge.
A)assessing
B)false

A

159

Palpate the shaft of the penis between your thumb and first two fingers. Normally, the penis feels smooth, semifirm, and nontender.
A)normal finding
B)abnormal findings

A

160

Nodule or induration(harden). Tenderness. Of the shaft of the penis means
A)abnormal finding
B)normal finding

A

161

INSPECT AND PALPATE THE SCROTUM

,

162

Inspect the scrotum as the male holds the penis out of the way. Alternatively, you hold the penis out of the way with the back of your hand.
A)true
B)false

A

163

Scrotal size varies with ambient room temperature. Asymmetry is normal, with the left scrotal half usually lower than the right.
A)true
B)false

A

164

Scrotal swelling (edema) may be taut and pitting. This occurs with heart failure, renal failure, or local inflammation. Lesions.
A)true
B)false

A

165

Spread rugae out between your fingers. Lift the sac to inspect the posterior surface. Normally, no scrotal lesions are present, except for the commonly found sebaceous cysts. These are yellowish, 1-cm nodules and are firm, nontender, and often multiple.
A)true, on the scrotal
B)false

A

166

Palpate gently each scrotal half between your thumb and first two fingers. The scrotal contents should slide easily. Testes normally feel oval, firm and rubbery, smooth, and equal bilaterally and are freely movable and slightly tender to moderate pressure.
A)true
B)false

A

167

. Each epididymis normally feels discrete,
softer than the testis, smooth, and nontender.
A)true
B)false

A

168

Absent testis-may be a temporary migration or true cryptorchidism
A)abnormal finding
B)false

A

169

Atrophied testes-small and soft. Fixed testes. Nodules on testes or epididymides. Marked tenderness. Are all abnormal findings
A)true
B)false

A

170

An indurated, swollen, and tender epididymis indicates epididymitis.
A)true
B)false

A

171

Palpate each spermatic cord between your thumb and forefinger, along its length from the epididymis up to the external inguinal ring. You should feel a smooth, nontender cord.
A)true
B)false

A

172

A Thickened cord. Soft, swollen, and tortuous cord-see the discussion of varicocele. of a spermatic cord is an abnormal finding
A)true
B)false

A

173

Normally, no other scrotal contents are present. If you do find a mass, note:
-Any tenderness?
-Is the mass distal or proximal to testis?
• Can you place your fingers over it?
• Does it reduce when the person lies down?
• Can you auscultate bowel sounds over it?

True

174

Abnormalities in the scrotum are hernia, tumor, orchitis, epididymitis, hydrocele, spermatocele, varicocele.
A)true
B)false

A

175

Transillumination. Perform this maneuver only if you note a swelling or mass. Darken the room. Shine a strong flashlight from behind the scrotal contents. Normal scrotal contents do not transilluminate.
A)normal finding of the scrotum
B)false

A

176

Serous fluid does transilluminate and shows as a red glow (e.g., hydrocele or spermatocele).
A)abnormal finding of the scrotum
B)false

A

177

Solid tissue and blood do not transilluminate (e.g., hernia, epididymitis, or tumor)
A)true, abnormal findings
B)false

A

178

INSPECT AND PALPATE FOR HERNIA

,

179

Inspect the inguinal region for a bulge as the person stands and as he strains down. Normally, none is present.
A)true
B)false

A

180

Bulge at external inguinal ring or at femoral canal. (A hernia may be present but easily reduced and may appear only intermittently with an increase in intraabdominal pressure.)
A)abnormal finding
B)normal finding

A

181

Palpate the inguinal canal. For the right side, ask the male to shift his weight onto the left (unexamined) leg. Place your right index finger low on the right scrotal half. Palpate up the length of the spermatic cord, invaginating the scrotal skin as you go, to the external inguinal rings.
A)true
B)false

A

182

It feels like a triangular slitlike opening, and it may or may not admit your finger. If it will admit your finger, gently insert it into the canal and ask the person to "bear down."* Normally, you feel no change. Repeat the procedure on the left side.
A)checking the inguinal canal
B)false

A

183

Palpable herniating mass bumps your fingertip or pushes against the side of your finger during an palpation of the inguinal canal is an abnormal finding
A)true
B)false

A

184

Avoid the old direction, "turn your head and cough." For one thing, a brief cough does not give the steady, increased intra-abdominal pressure you need. For another, the person is likely to cough right in your face.
A)true
B)false

A

185

PALPATE INGUINAL LYMPH NODES

,

186

Palpate the horizontal chain along the groin inferior to the inguinal ligament and the vertical chain along the upper inner thigh. For the inguinal lymph nodes
A)true
B)false

A

187

It is normal to palpate an isolated inguinal lymph node on occasion; it then feels small (

A

188

Abnormal finding of inguinal lymph nodes would be Enlarged, hard, matted, fixed nodes
A)true
B)false

A

189

SELF-CARE- TESTICULAR SELF-EXAMINATION (TSE)

,

190

Encourage self-care by teaching every male (from 13 to 14 years old through adulthood) how to examine his own testicles. The overall incidence of testicular cancer is rare, accounting for about 8000 new cases annually. It is rare before age 15 years, peaks during ages 20 to 39 years, and then declines
20 and is associated with a history of cryptorchidism.
A)true
B)false

A

191

Testicular cancer is associated with a history of cryptorchidism.
A)true
B)false

A

192

When detected early and treated before metastasis, the cure rate is almost 100%. Therefore include the teaching but adjust your message to emphasize familiarity with the young man's own body, rather than only cancer detection, as the goal.
A)true
B)false

A

193

Early detection is enhanced if the male is familiar with his normal consistency. Points to include during health teaching are:
T = timing, once a month
S = shower, warm water relaxes scrotal sac
E = examine, check for changes, report changes immediately

True

194

A good time to examine the testicles is during the shower or bath, when your hauds are warm and soapy the scrotum is warm. Cold hands stimulate a muscle (cremasteric) reflex, retracting the scrotal conteuts.
A)true
B)false

A

195

ASSESS URINARY FUNCTION

,

196

A urinalysis shows a color of pale yellow to amber due to the presence of urochrome pigments.
A)true
B)false

A

197

Normal urine is clear and slightly acidic with a pH range of 4.5 to 8.0. Specific gravity measures the concentration of urine, from very dilute at 1.003 to concentrated at 1.030.
A)true
B)false

A

198

There is little or no protein, no glucose, and fewer than 5 red blood cells (RBCs) or white blood cells (WBCs) per highpowered field.
A)true
B)false

A

199

Cloudiness in urine suggests presence of WBCs, bacteria, casts.
A)true
B)false

A

200

Certain drugs or foods can change urine color.
A)true
B)false

A

201

Proteinuria indicates glomerular disease in the nephron.
A)true
B)false

A

202

Glycosuria suggests hyperglycemia occurring with diabetes.
A)true
B)false

A

203

Increased WBCs occur with urinary tract infection (UTI);
A)true
B)false

A

204

increased RBCs occur with UTI, glomerulonephritis, renal calculi, trauma, and cancer.
A)true
B)false

A

205

Serum analysis of kidney function is measured with creatinine, an endproduct of muscle metabolism. Normal levels range from 0.7 to 1.5 mg/dL and are fairly constant from day to day.
A)true
B)false

A

206

Blood urea nitrogen (BUN) measures urea, an end-product of protein metabolism. lt measures 10 to 20 mg/dL and rises with a decrease in fluid volume or an increase in protein intake.
A)true
B)false

A

207

Creatinine measures glomerular filtration rate (GFR). When the GFR decreases by half, the serum creatinine level doubles, indicating decreased kidney function.
A)true
B)false

A

208

The BUN rises with decreased kidney function but is less specific.
A)true
B)false

A

209

DEVELOPMENTAL COMPETENCE
Infants and Children

,

210

For an infant or toddler, perform this procedure right after the abdominal examination. Reassure child and parents of normal findings.
A)true
B)false

W

211

In a preschool-age to young school-age child (3 to 8 years of age), leave underpants on until just before the examination. Reassure child and parents of normal findings.
A)true
B)false

A

212

In an older school-age child or adolescent, offer an extra drape, as with the adult. Reassure child and parents of normal findings.
A)true
B)false

A

213

Inspect the penis and scrotum. Penis size is usually small in infants (2 to 3 cm) and in young boys until puberty.
A)true
B)false

A

214

In the obese boy, the penis looks even smaller because of folds of skin covering the base.
A)true
B)false

A

215

Rarely, a very small penis may be an enlarged clitoris in a genetically female infant.
A)abnormal finding
B)false

A

216

Redness, swelling, lesions. Discharge. Are abnormal findings in an infant
A)true
B)false

A

217

In the circumcised infant, the glans looks smooth with the meatus centered at the tip.
A)true
B)false

a

218

While the child wears diapers, the meatus may become ulcerated from ammonia irritation. This is more common in circumcised infants.
A)true
B)false

A

219

Hypospadias, epispadias, and Stricture-narrowed opening. Are all abnormal findings of an infant
A)true
B)false

A

220

Occasionally, ulceration may produce a stricture, shown by a pinpoint meatus and a narrow stream. This increases the risk for urine obstruction.
A)abnormal finding for a circumsized infant
B)false

A

221

If possible, observe the newborn's first voiding to assess strength and direction of stream.
A)true
B)false

A

222

Poor stream is significant, because it may indicate a stricture or neurogenic bladder.
A)abnormal finding of an infant
B)normal finding

A

223

If uncircumcised, the foreskin is normally tight during the first 3 months and should not be retracted because of the risk for tearing the membrane attaching the foreskin to the shaft. This leads to scarring and, possibly, to adhesions later in life.
A)true
B)false

A

224

Uncircumcised infants wait until three months before pulling back because this can lead to adhesion later in life and scarring of the shaft
A)true
B)false

A

225

In infants older than 3 months, retract the foreskin gently to check the glans and meatus. It should return to its original position easily.
A)true
B)false

A

226

Phimosis-unable to retract the foreskin.
A)true, abnormal finding
B)false

A

227

Paraphimosis-the foreskin cannot be slipped forward once it is retracted
A)true, abnormal finding
B)false

A

228

Abnormal finding of an infant that is uncricumsized is Dirt and smegma collecting under foreskin.
A)true
B)false

A

229

The scrotum looks pink in white infants and dark brown in dark-skinned infants.
A)true, normal finding
B)false

A

230

Rugae are well formed in the full-term infant. Size varies with ambient temperature, but overall, the infant's scrotum looks large in relation to the penis. No bulges, either constant or intermittent, are present.
A)true, normal finding
B)false

Q

231

Palpate the scrotum and testes. The cremasteric reflex is strong in the infant, pulling the testes up into the inguinal canal and abdomen from exposure to cold, touch, exercise, or emotion.
A)true, normal finding
B)false

A

232

Take care not to elicit the cremasteric reflex:
(1) keep your hands warm and palpate from the external inguinal ring down, and
(2) block the inguinal canals with the thumb and forefinger of your other hand to prevent the testes from retracting
A)true
B)false

A

233

Cryptorchidism: undescended testes (those that have never descended). Undescended testes are common in premature infants. They occur in 3% to 4% of term infants, although most have descended by 3 months of age. Age at which child should be referred differs among physicians
A)true
B)false

A

234

_____________: undescended testes (those that have never descended). Undescended testes are common in premature infants. They occur in 3% to 4% of term infants, although most have descended by 3 months of age. Age at which child should be referred differs among physicians.

Cryptorchidism

235

If the child testies have not descended yet by 6 months the child might. Have _____

Cryptorchidism

236

Normally, the testes are descended and are equal in size bilaterally ( 1.5 to 2 cm until puberty). It is important to document that you have palpated the testes. Once palpated, they are considered descended, even if they have retracted momentarily at the next visit.
A)true
B)false

A

237

If the scrotal halves feel empty, search for the testes along the inguinal canal and try to milk them down. Ask the toddler or child to squat with the knees flexed up; this pressure may force the testes down. Or, have the young child sit cross-legged to relax the reflex .
A)true
B)false

A

238

Migratory testes (physiologic cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. Note that the affected side has a normally developed scrotum (with true cryptorchidism, the scrotum is atrophic) and that the testis can be milked down. These testes descend at puberty and are normal.
A)true
B)false

A

239

______________ (physiologic cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. Note that the affected side has a normally developed scrotum (with true cryptorchidism, the scrotum is atrophic) and that the testis can be milked down. These testes descend at puberty and are normal.

Migratory testes

240

Palpate the epididymis and spermatic cord as described in the adult section. A common scrotal finding in the boy younger than 2 years is a hydrocele, or fluid in the scrotum. It appears as a large scrotum and transilluminates as a faint pink glow. It usually disappears spontaneously.
A)true
B)false

A

241

common scrotal finding in the boy younger than 2 years is a hydrocele.
A)true
B)false

A

242

A hydrocele is a cystic collection of serous fluid in the tunica vaginalis, surrounding the testis.
A)true
B)false

A

243

A _________ is a cystic collection of serous fluid in the tunica vaginalis, surrounding the testis.

hydrocele

244

Inspect the inguinal area for a bulge. If you do not see a bulge but the parent gives a positive history of one, try to elicit it by increasing intra-abdominal pressure. Ask the boy to hold his breath and strain down, or have him blow up a balloon.
A)true
B)false

A

245

If a hernia is suspected, palpate the inguinal area. Use your little finger to reach the external inguinal ring.
A)true
B)false

A

246

DEVELOPMENTAL COMPETENCE
The Adolescent

,

247

The adolescent shows a wide variation in normal development of the genitals. Using the SMR charts, note:
(1) enlargement of the testes and scrotum;
(2) pubic hair growth;
(3) darkening of scrotal color;
(4) roughening of scrotal skin;
(5) increase in penis length and width; and
(6) axillary hair growth.
Be familiar with the normal sequence of growth.

True

248

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

249

In the older male, you may note thinner, graying pubic hair and the decreased size of the penis.
A)true
B)false

A

250

The size of the testes may be decreased and may feel less firm.
A)aging adult
B)infant

A

251

The scrotal sac is pendulous with less rugae. The scrotal skin may become excoriated if the man continually sits on it.
A)aging adult
B)infant

A

252

PROMOTING A HEALTHY LIFESTYLE: SCREENING FOR PROSTATE CANCER Understanding Prostate Changes

,

253

Two groups that are increased risk for prostate cancer are African-American men and men whose first-degree relatives have had prostate cancer.
A)true
B)false

A

254

PSA is a substance made by the normal prostate gland. When prostate cancer develops, the PSA level increases.
A)true
B)false

A

255

DRE involves a gloved, lubricated finger being inserted into the rectum. The prostate gland is located just in front of the rectum, making it possible to palpate the surface of the gland manually for bumps or hard areas that may be a developing cancer.
A)true
B)false

A

256

ABNORMAL FINDINGS .. -- -- - -------------------------------

,

257

Urine Color and Discolorations

,

258

Cloudy urine indicates Urinary tract infection and Kidney stones
A)true
B)false

A

259

Blue urine indicates Medication side effect: amitriptyline, lndocin and Foods: asparagus and Dye after prostate surgery.
A)true
B)false

A

260

Dark gray urine indicates that Urine contains melanin, melanuria
A)true
B)false

A

261

Tea urine indicates Liver disease, especially with pale stools, jaundice, Myoglobinuria and Some medications or food dyes and Blood in urine.
A)true
B)false

A

262

Pink urine indicates With menses , Some foods: beets, berries, food dyes • Some laxatives , Kidney stones • Urinary tract infection
A)true
B)false

A

263

Red urine indicates Blood in urine • Nephritis, cystitis • Cancer • Following prostate surgery
A)true
B)false

A

264

Orange urine indicates Medication side effect: rifampin for meningitis, Pyridium, warfarin (Coumadin) • Some foods, food dyes, laxatives • Dehydration • Jaundice (bilirubinemia).
A)true
B)false

A

265

Amber urine indicates Gold or concentrated with dehydration • Some laxatives • Food or supplements with B-complex vitamins
A)true
B)false

A

266

Urinary Problems

,

267

Infection of urethra causes painful burning urination or pruritus. Meatus edges are reddened, everted, and swollen with purulent discharge. Urine is cloudy with discharge and mucus shreds. Cause determined by culture: (1) gonococcal urethritis has thick, profuse, yellow or gray-brown discharge; (2) nonspecific urethritis (NSU) may have similar discharge but often has scanty, mucoid discharge. Of these, about 50% are caused by chlamydia infection. This is important to differentiate because antibiotic treatment is different.
A)Urethritis (Urethral Discharge and Dysuria)
B)Renal Calculi (not illustrated)

A

268

Renal stones (crystals of calcium oxalate or uric acid) form in kidney tubules; then migrate and become urgent when pass into ureter, become lodged, and obstruct urine flow. Cause abrupt severe flank pain with radiation to the groin or abdomen, nausea and vomiting, restlessness, gross or microscopic hematuria.
A)Renal Calculi (not illustrated)
B)urethritis

A

269

Abrupt inability to pass urine with bladder distention and lower abdominal pain. Much more common in men due to bladder outlet obstruction, such as benign prostatic hyperplasia (BPH). Must catheterize to relieve acute discomfort; then manage underlying problem.
A)urethritis
B)Acute Urinary Retention

B

270

Pinpoint, constricted opening at meatus or inside along urethra. Occurs congenitally or secondary to urethral injury. Gradual decrease in force and caliber of urine stream is most common symptom. Shaft feels indurated along ventral aspect at the site of the stricture.
A)Urethral Stricture
B)renal calculi

A

271

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

,

272

Male Genital Lesions

,

273

A fungal infection in the crural fold, not extending to scrotum, occurring in postpubertal males ("jock itch") after sweating or wearing layers of occlusive clothing. It forms a red-brown half-moon shape with well-defined borders.
A)Tinea Cruris
B)Genital Herpes-HSV-2 Infection

A

274

Infection Clusters of small vesicles with surrounding erythema, which are often painful, erupt on the glans or foreskin. These rupture to form superficial ulcers. A sexually transmitted infection (STI), the initial infection lasts 7 to I 0 days. The virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms .
A)Genital Herpes-HSV-2
B)Genital Warts

A

275

Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower-like patch. Color may be gray, pale yellow, or pink in white males, and black or translucent grayblack in Black males. They occur on shaft of penis, behind corona, or around the anus where they may grow into large, grapelike clusters.
A)Genital Warts
B)herpes

A

276

These are caused by the human papillomavirus (HPV) and are one of the most common STis. The HPV infection is correlated with early onset of sexual activity, infrequent use of contraception, and multiple sexual partners.
A)genital warts
B)herpes

A

277

Begins within 2 to 4 weeks of infection, as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. Palpation reveals a nontender indurated base that can be lifted like a button between the thumb and the finger. Lymph nodes enlarge early but are nontender. This is an STI easily treated with penicillin G, but untreated leads to cardiac and neurologic problems, blindness. Almost eradicated in the United States in 1957; epidemics recur cyclically every 7 to 10 years.
A)Syphilitic Chancre
B)Carcinoma

A

278

Begins as red, raised, warty growth or as an ulcer, with watery discharge. As it grows, may necrose and slough. Usually painless. Almost always on glans or inner lip of foreskin and following chronic inflammation. Enlarged lymph nodes are common.
A)Carcinoma
B)herpes

A

279

Abnormalities of the Penis

,

280

Nonretractable foreskin forming a pointy tip with a tiny orifice. Foreskin is advanced and so tight it is impossible to retract over glans. May be congenital or acquired from adhesions secondary to infection. Poor hygiene leads to retained dirt and smegma, which increases risk for inflammation, calculus formation, obstructive uropathy.
A)phimosis
B)Paraphimosis

A

281

Foreskin is retracted and fixed. Once retracted behind glans, a tight or inflamed foreskin cannot return to its original position. Constriction impedes circulation, so glans swells. A medical emergency; the constricting band prevents venous and lymphatic return from the glans and compromises arterial circulation.
A)Paraphimosis
B)Hypospadias

A

282

Urethral meatus opens on the ventral (under) side of glans, shaft, or at the penoscrotal junction. A groove extends from the meatus to the normal location at the tip. This is a congenital defect that is important to recognize at birth. The newborn should not be circumcised because surgical correction may use foreskin tissue to extend urethral length
A)Hypospadias
B)Epispadias

A

283

Meatus opens on the dorsal (upper) side of glans or shaft above a broad, spadelike penis. Rare; less common than hypospadias but more disabling because of associated urinary incontinence and separation of pubic bones.
A)Epispadias
B)Priapism

A

284

Prolonged painful erection of penis without sexual stimulation and unrelieved by intercourse or masturbation, most common in men in 30s and 40s. A rare condition but when lasting 4 hours or longer can cause ischemia of penis, fibrosis of tissue, erectile dysfunction. Can occur as a side effect of some medications and street drugs and with sickle-cell trait or disease; leukemia in which increased numbers of white blood cells produce engorgement; malignancy; or local trauma or spinal cord injuries with autonomic nervous system dysfunction.
A)Priapism
B)Peyronie Disease

A

285

Hard, nontender, subcutaneous plaques palpated on dorsal or lateral surface of penis. May be single or multiple and asymmetric. They are associated with painful bending of the penis during erection. Plaques are fibrosis of covering of corpora cavernosa. Usually occurs after 45 years. Its cause is trauma to the erect penis (e.g., unexpected change in angle during intercourse). More common in men with diabetes, gout, and Dupuytren contracture of the palm.
A)Peyronie Disease
B)urethritis

A

286

Abnormalities in the Scrotum

,

287

S: Empty scrotal half
0 : Inspection-in true maldescent,
atrophic scrotum on affected side
Palpation- no testis
A: Absent testis .
A)Absent Testis, Cryptorchidism
B)Small Testis

A

288

S: (None)
0: Palpation-small and soft (rarely may
be firm)
A: Small testis
A)small testies
B)testicular torsion

A

289

S: Excruciating pain in testicle of sudden
onset, often during sleep or following
trauma. May also have lower abdominal
pain, nausea and vomiting, no fever
0: Inspection-red, swollen scrotum, one
testis (usually left) higher owing to
rotation and shortening
Palpation-cord feels thick, swollen,
tender; epididymis may be anterior;
cremasteric reflex is absent on side of
torsion
A)testicular torsion
B)epididymislitis

A

290

S: Severe pain of sudden onset in
scrotum, somewhat relieved by
elevation (a positive Prehn sign); also
rapid swelling, fever
0: Inspection-enlarged scrotum;
reddened
Palpation-exquisitely tender; epididymis
enlarged, indurated; may be hard to
distinguish from testis. Overlying scrotal
skin may be thick and edematous
Laboratory-white blood cells and
bacteria in urine
A: Tender swelling of epididymis
A)Epididymitis
B)urethritis

A

291

S: Dull pain; constant pulling or dragging
feeling; or may be asymptomatic
0 : Inspection-usually no sign. May
show bluish color through light scrotal
skin
Palpation-when standing, feel soft,
irregular mass posterior to and above
testis; collapses when supine, refills
when upright. Feels distinctive, like a
"bag of worms"
The testis on the side of the varicocele
may be smaller owing to impaired
circulation
A: Soft mass on spermatic cord
A)Varicocele
B)herpes

A

292

Acute infection of epididymis commonly caused by prostatitis, after prostatectomy because of trauma of urethral instrumentation, or due to chlamydia, gonorrhea, or other bacterial infection. Often difficult to distinguish between epididymitis and testicular torsion.
A)epididmylitis
B)herpes

A

293

A ________ is dilated, tortuous varicose veins in the spermatic cord due to incompetent valves within the vein, which permit reflux of blood. Most often on left side, perhaps because left spermatic vein is longer and inserts at a right angle into left renal vein. Common in young males. Screen at early adolescence; early treatment important to prevent potential infertility when an adult.
A)varicocele
B)Spermatocele

A

294

S: Painless, usually found on examination
0 : Inspection-does transilluminate
higher in the scrotum than a hydrocele,
and the sperm may fluoresce
Palpation-round, freely movable mass
lying above and behind testis. If large,
feels I ike a third testis
A: Free cystic mass on epididymis
A)Spermatocele
B)varioatocele

A

295

Retention cyst in epididymis. Cause unclear but may be obstruction of tubules. Filled with thin, milky fluid that contains sperm. Most spermatoceles are small (

A

296

S: Painless, found on examination
0 : Palpation- firm nodule or harder
than normal section of testicle
A: Solitary nodule
A)Early Testicular Tumor
B)false

A

297

Most testicular tumors occur between the ages of 18 and 35. Practically all are malignant. Occur in whites; relatively rare in Blacks, Mexican Americans, and Asians. Must biopsy to confirm. Most important risk factor is undescended testis, even those surgically corrected. Early detection important in prognosis, but practice of testicular selfexamination is currently low.
A)Early Testicular Tumor
B)diffuse tumor

A

298

S: Enlarging testis (most common
symptom). When enlarges, has feel of
increased weight
0 : Inspection- enlarged, does not
transilluminate
Palpation-enlarged, smooth, ovoid, firm
Important-firm palpation does not
cause usual sickening discomfort as
with normal testis
A: Nontender swelling of testis
A)diffuse tumor
B)herpes

A

299

Diffuse tumor maintains shape of testis.
A)true
B)false

A

300

S: Painless swelling, although person may
complain of weight and bulk in
scrotum
0: Inspection-enlarged, mass does
transilluminate with a pink or red glow
(in contrast to a hernia)
Palpation-nontender mass, able to get
fingers above mass (in contrast to
scrotal hernia)
A: Nontender swelling of testis
A)Hydrocele
B)false

A

301

Cystic. Circumscribed collection of serous fluid in tunica vaginalis, surrounding testis. May occur following epididymitis, trauma, hernia, tumor of testis, or spontaneously in the newborn.
A)Hydrocele
B)false

A

302

S: Swelling, may have pain with straining
0: Inspection-enlarged, may reduce
when supine, does not transilluminate
Palpation-soft, mushy mass; palpating
fingers cannot get above mass. Mass is
distinct from testicle that is normal
A: Non tender swelling of scrotum
A)Scrotal Hernia
B)false

A

303

S: Swelling, may have pain with straining
0: Inspection-enlarged, may reduce
when supine, does not transilluminate
Palpation-soft, mushy mass; palpating
fingers cannot get above mass. Mass is
distinct from testicle that is normal
A: Non tender swelling of scrotum
A)Scrotal Hernia
B)false

A

304

Scrotal hernia usually due to indirect inguinal hernia
A)true
B)false

A

305

S: Acute or moderate pain of sudden
onset, swollen testis, feeling of weight,
fever
0: Inspection-enlarged, edematous,
reddened; does not transilluminate
Palpation-swollen, congested, tense, and
tender; hard to distinguish testis from
epididymis
A: Tender swelling of testis
A)Orchitis
B)false

A

306

Acute inflammation of testis. Most common cause is mumps; can occur with any infectious disease. May have associated hydrocele that does transilluminate.
A)Orchitis
B)false

A

307

S: Tenderness
0: Inspection-enlarged, may be
reddened (with local irritation)
Palpation- taut with pitting Probably
unable to feel scrotal contents
A: Scrotal edema
A)scrotal edema
B)false

A

308

Accompanies marked edema in lower half of body (e.g., congestive heart failure, renal failure, and portal vein obstruction). Occurs with local inflammation: epididymitis, torsion of spermatic cord. Also, obstruction of inguinal lymphatics produces lymphedema of scrotum.
A)scrotal edema
B)false

A

309

Inguinal and Femoral Hernias

,

310

Sac herniates through internal inguinal ring; can remain in canal or pass into scrotum

Pain with straining; soft swelling that increases with increased intra-abdominal pressure; may decrease when lying down

Congenital or acquired
A)Indirect Inguinal
B)direct Inguinal

A

311

Directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum

Usually painless; round swelling close to the pubis in area of internal inguinal ring; easily reduced when supine

Acquired weakness; brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites

A)Direct Inguinal
B) indirect

A

312

Through femoral ring and canal, below inguinal ligament, more often on right side

Pain may be severe; may become strangulated

Acquired; due to increased abdominal pressure, muscle weakness, or frequent stooping

A)femoral
B) inguinal

A

313

Reducible-contents will return to abdominal cavity by lying down or gentle pressure.
A)true
B)false

A

314

Incarcerated-herniated bowel cannot be returned to abdominal cavity.
A)true
B)false

A

315

Strangulated-blood supply to hernia is shut off. Accompanied by nausea, vomiting, and tenderness.
A)true
B)false

A

316

Summary Checklist: Male Genitalia Examination

,

317

1. Inspect and palpate the penis.
2. Inspect and palpate the scrotum.
3. If a mass exists, transilluminate it.
4. Palpate for an inguinal hernia.
5. Palpate the inguinal lymph nodes.

,

318

EXTRA INFORMATION

,

319

A nurse is assessing the risk factors of the male reproductive system in a patient. Of the following questions, which are pertinent in assessing the risk factors? Select all that apply.

Select all that apply:
A
Is there a history of penile cancer in your family?
B
Is there a family history of genital warts?
C
Is there infertility in siblings?
D
Is there a family history of testicular torsion?
E
Do you have any current or chronic illnesses such as diabetes, hypertension, neurologic impairment, respiratory problems (asthma, COPD, chronic bronchitis), or cardiovascular disease?
F
Is there a history of hernia in your family?

A C E F

320

An uncircumcised man has just come to the recovery room following a 4-hour back surgery. Before surgery, he received 2 g of Ancef IV; a urinary catheter was placed. During the assessment, the recovery nurse discovers that the patient has developed paraphimosis. What might have happened to the patient to cause this?

Choose one of the following
A
The patient is having a reaction to the Ancef
B
The catheter was too taut for too long and has damaged the urethra
C
The patient is having an anatomical reaction to being face down on a pillow for 4 hours
D
The foreskin was not pulled back over the head of the penis after catheter placement

D

321

The two functions of the penis are (1) serving as the final excretory organ of urination and (2) it becoming firm or erect with sexual excitement to allow penetration for intercourse.

Choose one of the following
A
True
B
False

A

322

A young homosexual patient who is currently HIV negative tells the nurse that he is worried about contracting the virus someday. What teaching would be appropriate for this patient?

Choose one of the following
A
Conversion therapy to heterosexuality
B
New AIDS treatments in case he contracts HIV
C
Safe-sex practices and proper use of condoms
D
Antiviral drugs used to fight AIDS

C

323

One Healthy People goal is the reduction of the rate of death from prostate cancer. Which of the following could help patients achieve this goal? Select all that apply.

Select all that apply:
A
Prostate surface antigen testing
B
Yearly colonoscopy starting at age 50
C
Digital rectal examinations
D
Practicing safe sex through the use of condoms
E
Regular prostate screenings

A C E

324

A nurse is assessing the genitalia of a male patient. The nurse finds that the patient has a piercing in his penis. Why is it important to investigate details of the piercing?

Choose one of the following
A
To help the patient better care for the piercing
B
Because the nurse may also want to get a piercing there
C
To assess for health risks relating to how it was performed
D
To call the authorities, because these piercings are illegal in most states

C

325

Prostate enlargement is common in older men. The nurse should be aware of what signs and symptoms when interviewing an older male patient? Select all that apply.

Select all that apply:
A
Chronic kidney infection
B
Increased caliber of urine stream
C
Erection that will not subside
D
Dribbling
E
Straining to urinate
F
Sensation of residual urine

D E F

326

The exact cause of BPH is unknown, but the condition is believed to be associated with what?

Choose one of the following
A
Environmental factors
B
Lifestyle
C
Age-related hormonal changes
D
Diet

C

327

Ejaculation occurs with the emission of semen from which of the following? Select all that apply.

Select all that apply:
A
Epididymides
B
Corpus spongiosum
C
Seminal vesicles
D
Vas deferens
E
Prostate
F
Corona

A C. D E

328

It is best to perform the testicular self-examination (TSE) after a cool shower or bath. The cool water tightens the scrotum and makes screening easier.

Choose one of the following
A
True
B
False

B

329

A 16-year-old boy comes to the ED with severe left testicular pain and vomiting. Elevation of his left testicle does not lessen the pain. What could these symptoms indicate for this patient?

Choose one of the following
A
Hydrocele
B
Testicular cancer
C
Left testicular torsion
D
Epididymitis

C

330

The patient is a 34-year-old man who was shot in the lower abdomen, suffered bladder trauma, and now has a urinary catheter. With these risk factors, what would be an appropriate nursing diagnosis for this patient?

Choose one of the following
A
Risk for urinary retention
B
Ineffective sexuality pattern
C
Risk for urge incontinence
D
Risk for infection

D

331

A 69-year-old retired farmer comes to the ED bleeding from the rectum. He has a history of atrial fibrillation and has had two small strokes. He is currently taking blood pressure medication and anticoagulation therapy at home. Why might this patient need to be hospitalized?

Choose one of the following
A
The patient has had a stroke in the past
B
The patient is 69 years old
C
All rectal bleeding requires immediate hospitalization
D
The patient is on anticoagulation medication

D

332

The nurse establishes an open and trusting relationship with a patient by maintaining a nonjudgmental attitude.

Choose one of the following
A
True
B
False

A

333

A new mother brings her newborn to the clinic. She states that the baby has been having black tarry stools. Which of the following could be the cause?

Choose one of the following
A
Viral infection
B
Vitamin K deficiency
C
Rectal bleeding
D
Meningitis

B

334

Newborns with dark tarry stools or vomiting blood may have a vitamin K deficiency.
A)true
B)false

A

335

Infants presenting with rectal bleeding could have necrotizing enterocolitis
A)true
B)false

A

336

A new mother calls the clinic because she is concerned about her infant son who is having a stool after each feeding. The nurse explains that this is a common occurrence because of what reflex?

Choose one of the following
A
Gastrocolic
B
Rectocolic
C
Ileocolic
D
Anocolic

A

337

What part of the penis fills with blood when the penis becomes erect?

Choose one of the following
A
Corpus spongiosum
B
Urethral meatus
C
Corona
D
Corpora cavernosa

D

338

By what week of gestation has sexual differentiation occurred?

Choose one of the following
A
8
B
20
C
16
D
12

D

339

Soft, pointed, fleshy papules that occur on the genitalia caused by the human papilloma virus (HPV) are known as: genital warts
A)true
B)false

A

340

Syphilitic chancres are small, solitary, silvery papules that erode to a red, round or oval, superficial ulcer with a yellowish serous discharge.
A)true
B)false

A

341

A varicocele is a dilated, tortuous varicose vein in the spermatic cord.
A)true
B)falsse

A

342

the ejaculatory duct is the passage formed by thhe joining of the vas deferens and thhe seminal vesicle
A)true
B)false

A

343

the penis is composed of two corpora carvenosa and one corpus spongiosum
A)true
B)false

A

344

a retention cyst in the epididymis filled with milky fluid containg sperm is called
A)a spermatoccele
B)varicolel

A

345

peyronie disease is a result of hard,non-tender, subcutaneous plaques on the penis that cause a painful bending of the penis during erection
A)true
B)false

A

346

over the glands, the skin folds in and back on itself forming a hood or flap called the foreskin or prepue
A)true
B)false

A

347

testicular torsion requires an emergency surgery ASAP.
A)true
B)false

A

348

The cremaster muscle controls the size of the scrotum by responding to the temperature around the scrotal area. This action keeps the testes at 3° C below the abdominal temperature, which is the ideal temperature for producing sperm.
A)true
B)false

A

349

Undescended testes have histologic changes by age 6, and the result is decreased spermatogenesis and infertility.
A)true
B)false

A

350

The examiner is going to inspect and palpate for a hernia. During this examination, the man is instructed to:
a. hold his breath during palpation.
b. cough after the examiner has gently
inserted the examinatio n finger into the
rectum.
c. bear down when the examiner's finger is
at the inguinal canal.
d. relax in a supine position while the
examination finger is inserted into the canal.

C

351

2. During examination of the scrotum, a normal finding would be:
a. The left testicle is firmer to palpation than the right.
b. The left testicle is larger than the right.
c. The left testicle hangs lower than the right. d. The left testicle is more tender to
palpation than the right.

C

352

H.T. has come to the clinic for a follow-up visit. Six months ago, he was started on a new medication. The class of medication is most likely to cause impotence as a side effect; therefore medication classes explored by the nurse are:
a. antipyretics.
b. bronchodilators.
c. corticosteroids.
d. antihypertensives.

D

353

4. Prostatic hypertrophy occurs frequently in older men. The symptoms that may indicate this problem are:
a. polyuria and urgency.
b. dysuria and oLiguria.
c. straining, loss of force, and sense of
residual urine.
d. foul-smelling urine and dysuria.

C

354

A 64-year-old man has come for a health examination. A normal age-related change in the scrotum would be:
a. testicular atrophy.
b. testicular hypertrophy.
c. pendulous scrotum.
d. increase in scrotal rugae.

C

355

6. During palpation of the testes, the normal finding would be:
a. firm to hard, and rough.
b. nodular.
c. 2 to 3em long by 2em wide and firm.
d. firm, rubbery, and smooth.

D

356

7. A 20-year-old man has indicated that he does not perform testicular self-examination. One of the facts that should be shared with him is that testicular cancer, though rare, does occur in men ages:
a. younger than 15 years.
b. 15 to 34 years.
c. 35 to 55 years.
d. 55 years and older.

B

357

8. During the examination of a full-term newborn male, a finding requiring investigation would be:
a. absent testes.
b. meatus centered at the tip of the penis.
c. wrinkled scrotum.
d. penis 2 to 3 em in length.

A

358

9. During transillumination of a scrotum, you note a nontender mass that transilluminates with a red glow. This finding is suggestive of:
a. scrotal hernia.
b. scrotal edema.
c. orchitis.
d. hydrocele.

D

359

10. How sensitive to pressure are normal testes?
a. somewhat
b. not at all
c. left is more sensitive than right
d. only when inflammation is present

A

360

11. The congenital displacement of the urethral meatus to the inferior surface of the penis is:
a. hypospadias.
b. epispadias.
c. hypoesthesia.
d. hypophysis.

A

361

12. An adhesion of the prepuce to the head of the penis, making it impossible to retract, is:
a. paraphimosis.
b. phimosis.
c. smegma.
d. dyschezia.

B

362

13. The first physical sign associated with puberty in boys is:
a. height spurt.
b. penis lengthening.
c. sperm production.
d. pubic hair development.
e. testes enlargement.

E

363

15. In the aging male, when does infertility occur?
a. At age 60, with the sudden decline in sperm production.
b. At approximately age 55 to 60, when testosterone levels are lower.
c. When the male is not longer able to achieve an erection.
d. There is no specific age; men may be fertile into their 80s and 90s.

D

364

16. A patient has soft, moist, fleshy, painless papules around the anus. The examiner suspects this condition is:
a. HSV-2.
b. HPV.
c. gonorrhea.
d. Peyronie disease.

B

365

Chancre is a red, round, superficial ulcer with a yellowish serous discharge that is a sign of syphilis
A)true
B)false

A

366

Condylomata acuminata is a soft, pointed, neshy papules that occur on the genitalia and are caused by the human papillomavirus (HPV)
A)true
B)false

A

367

Vas deferens is a duct carrying sperm from the epididymis through the abdomen and then into the urethra
A)true
B)false

A