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Flashcards in week 1- male Deck (79)
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1

• What are hx Q’s for male genitalia cc?

o Penile Lesions (sores or growths): ask sexual hx
o Scrotal pain, swelling or lesion
o sexual function and response
o change in libido, quality of erections, timing/situational problems
o Prostate: discomfort in perianal, rectal or suprapubic areas
o Obstructive urinary sxs: hesitancy, forked stream, dribbling, straining

2

• What are the 3 parts of a male genitalia exam?

o External (inspect and palpate)
o Inguinal hernia exam
o Recta/prostate exam

3

• How do you perform an external male genitalia exam?

o Inspect: Low abd for femoral inguinal hernias; Hair distribution; Scrotum: contours, lesions; Prepuce (pt retracts foreskin); Glans penis, meatus, shaft (lesions, discharge, induration)
o Palpate: Inguinal LN (tender, swelling); Penis: start at base and move forward, d/c, induration; Glans penis (visualize meatus for redness, d/c); Scrotum: Testes for masses, Epididymis (pain, mass), Spermatic Cord (swelling)

4

• How is an inguinal hernia exam performed? Special test for scrotal mass?

o Pt stands; Use right hand for pt right side
o Invaginate loose scrotum with index finder
o Follow spermatic cord up to external inguinal ring
o Note any bulges with straining or cough
o Special: Transillumination to differentiate fluid vs. solid structures

5

• How is the rectal/prostate exam performed?

o Pt stands or LLD
o Inspect: Sacralcoccygeal area (pilonidal dimple); Perianal area: skin tags
o Palpate: Note sphincter tone; circumferentially for masses, swellings
o prostate: size (usu 4 cm wide), tender, consistency, mobility
o Normal: size of walnut, firm, central sulcus
o Prostatitis: boggy and tender
o BPH: enlarged, rubbery, nontender
o Carcinoma: hard nodules or areas

6

• What labs are done for male genitalia cc?

o serum hormones (T, LH, SHBG, prolactin)
o Sperm analysis (count, motility, % abn)
o Prostate specific antigen (PSA): total, free (see below)
o Urine culture and sensitivity
o UA, w Expressed Prostatic Secretion (EPS) for prostate infx (ejaculate culture more accurate)

7

• What imaging or procedures is done for male genitalia cc?

o Pelvic CT for staging
o Scrotal US to assess mass
o Transrectal US (TRUS), w needle bx for prostate
o Rigiscan for nighttime tumescence (erectile function)
o Uroflowmetry for obstruction (eg BPH)

8

• What are common presenting sxs for male genitalia cc?

o Erectile dysfxn
o Hematospermia
o Urethra d/c
o Scrotal pain

9

• What is a red flag for erectile dysfxn? Scrotal pain?

o ED: prolonged erection >4hrs (priapism); crucial to determine if organic cause!
o SP: acute onset, N/V, abd pain (r/o testicular torsion)

10

• What is hematospermia? Red flags?

o =blood in semen
o Mb from epididymis, seminal vesicle, prostate, bulbourethral glands; mb idiopathic
o Common after prostate bx. Also, BPH, urethritis, epididymitis, prostatitis, bleeding disorder, STI
o RF: sxs >1mo, palpable mass, hematuria, obstructive sx

11

• What could cause male urethra d/c? red flags?

o mb STI (gonococcal or non-gonococcal) or E coli
o Note: GU or NGU treated empirically
o RF: pelvic pain, fever, chills, urinary retention

12

• What are the penile conditions?

o Epispadias
o Hypospadias
o Balanitis, Posthitis and Balanoposthitis
o Phimosis
o Paraphimosis
o Peyronie’s Dz
o Cutaneous Penile Lesions

13

• What is epispadias? Hypospadias?

o E: congenital malformation of urethral meatus: upper (dorsal) side of penis; make sure urine flow is adequate - refer to urologist
o H: lower (ventral) side of the penis
o Both: mb repaired by urethroplasty → scarring/stricture → reflux

14

• What are Balanitis, Posthitis and Balanoposthitis? Variant?

o Balanitis: inflam of glans penis
o Posthitis: inflam foreskin
o Balanoposthitis: inflam of both
o Infx (candida, GC, Chlamydia, scabies, etc) or Non-infx (contact dermatitis, psoriasis, etc)
o Usu w poor hygiene, diabetics
o May predispose to meatal stricture, phimosis, paraphimosis, CA
o Variant: Balanitis xerotica obliterans (BXO)= lichen sclerosis of penis; indurated, white area on glans penis, from chronic inflam

15

• What is phimosis? 2 types? Risks factors? Paraphimosis?

o Foreskin can’t retract away from glans penis
o Physiologic: In boys, 50% of normal retractability by age 10 (or 15) Do not force retraction! St → circumcision
o Pathologic: Pain, constriction, meatus blockage dt adhesion
o Risk: Frequent diaper rash; poor hygiene; use of condom catheter, DM, aging w reduced sexual activity
o Para: Foreskin stuck in retracted position → inflamed → ↓ blood flow to glans may → gangrene, necrosis

16

• What is Peyronie’s Dz? PE?

o Scarring of tunica albuginea in corpora cavernosa → plaques →painful erection and dorsal curvature
o d/o of wound healing → over-expression of TGF-β1
o usu Caucasians. Up to 10% of men with ED have PD.
o Significant psychological affects!
o PE: palpable plaque on dorsal surface of penis

17

• What are the types of cutaneous penile lesions?

o Genital herpes: primary or recurrent infx; common ulcerative STI; usu dt HSV-2 (10-30% HSV-1)
o Genital warts (Condylomata Accuminata)
o Syphilitic Chancre
o Chancroid:
o Carcinoma in situ/Erythroplasia of Queyrat
o SCC of Penis
o Pearly Penile Papules
o Contact dermatitis: eczematous rash (red, pruritic) mb dt latex/other allergy

18

• What is a primary genital herpes infx?

o Usu occurs 4-7 after exposure to virus; Outbreak is more painful, prolonged and widespread than recurrent form
o Clusters of vesicles erupt and form superficial ulcers, erythematous base (on prepuce, glans, penile shaft, anus, rectum, thighs)
o Ssx: urinary hesitancy, dysuria, constipation, sacral neuralgia, flu-like discomfort, fever. Scarring may follow healing
o The virus sheds for about 3 weeks

19

• What is recurrent genital herpes infx? Dx?

o 80% HSV-2 and 50% HSV-1 have recurrent outbreaks, less severe
o Virus only sheds ~ 3 d
o On average, ~ 4 recurrences a year
o Men have 20% more recurrences than women
o Dx: PE lesions, Tzanck test, viral culture

20

• What are genial warts (Condylomata Accuminata)?

o common STI, dt HPV (> 100 types)
o ~90% dt 6 and 11, considered "low risk" cancer–causing potential.
o 16 and 18 highly associated w cervical and penile CA
o Usu ages 17–33
o highly contagious: 60% risk of infx w exposure

21

• what is pathophysiology of genital warts? Risk factors?

o Path: Viral particles penetrate skin and mucosal surfaces through microscopic abrasions in genital area, during sexual activity. Latency mb mos-yrs
o Risk: assoc w OCPs dt ↑ sexual contact w/o condoms, multiple sex partners, and early onset sexual activity

22

• What do genital wart lesions look like?

o Painless, mb bothersome dt location, size, or itching
o Size: variable < 1mm to several cm2 (if grouped)
o Soft consistency, raised, irregular surface
o Loc: mb > 1 area. urethra, penis, scrotum, rectal area
o HPV infx mb dormant or undetectable, lesions mb hidden by hair or in inner aspect of uncircumcised foreskin

23

• What is Syphilitic Chancre?

o contagious primary infection of Treponema pallidum
o solitary, painless (or slightly tender) ulcer
o non-exudative, indurated edge
o regional nontender LA
o Serologic testing

24

• What is Chancroid?

o infx of Haemophilus ducreyi
o painful, shallow non-indurated ulcers, irregular edges and red borders
o gray or yellow purulent exudate
o regional tender LA, may abscess (form buboes)
o PCR testing

25

• What is Carcinoma in situ/Erythroplasia of Queyrat?

o premalignant lesion: intraepithelial neoplasia
o well circumscribed area of reddish, velvety pigmentation usu on glans or at corona
o usu in intact (uncircumcised)

26

• what is SCC of penis? Dx?

o Mc uncircumcised, poor local hygiene habits
o HPV 16 and 18 play a role
o Fungating/exophytic or ulcerative/infiltrative types
o Non-painful “sore that does not heal”
o Dx by bx

27

• What are Pearly Penile Papules?

o soft papular angiofibromas around corona
o hair-like projections
o benign

28

• what are the erectile d/os?

o Impotency/Erectile Dysfunction (ED)
o Priapism

29

• What is ED?

o Very common, ↑ incidence w age
o =inability to attain or sustain erection satisfactory to perform sexual activity and ejaculation

30

• What is etio/risk factors for ED?

o Drugs: anti-depressants (SSRIs), NSAIDs, substance abuse, esp narcotics
o Neurogenic dos: spinal cord and brain injuries, nerve dos like stroke, PD, AD, MS
o Cavernosal dos (Peyronie’s dz)
o Psychogenic causes: performance anxiety, stress, mental health dos: depression, schizo, panic do, anxiety, personality do
o Surgery (radiation tx, surgery of colon, prostate, bladder or rectum may damage nerves and blood vessels involved in erection
o Aging: incidence ↑ linearly 40-70.
o Kidney failure
o Diabetes (affects both vascular and nervous systems)
o Smoking: → arterial narrowing
o Alcoholism
o Saddle injury: long bike rides