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53 Cards in this Set
- Front
- Back
Smegma
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Found in prepuce/foreskin of uncircumcised penis.
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Corpus spongiosum
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Contains the urethra
Forms the bulb of the penis that becomes the glans. |
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Balantitis
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Infection/inflammation around the tip (glans) of the penis
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Hypospadias
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Meatus is displaced
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Scrotum
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A loose, wrinkled pouch divided into two compartments, each containing a testis.
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Testis
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Ovoid, rubbery (3.5-5.5 cm)
Left lies lower than the right Produce spermatozoa and testosterone |
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Epididymis
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Ovoid, rubbery (3.5-5.5 cm)
Left lies lower than the right Produce spermatozoa and testosterone |
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Vas deferens
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Cordlike structure, begins at the tail of the epididymis
Transports sperm from the tail of the epididymis to the urethra. It ascends within the scrotal sac (as the spermatic cord) and passes through the external inguinal ring on its way to the abdomen and pelvis |
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Landmarks in the groin
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Anterior superior iliac spine, the pubic tubercle, and the inguinal ligament.
The inguinal canal, which lies above and parallel to the inguinal ligament, forms a tunnel for the vas deferens. The exterior opening of the tunnel is the external inguinal ring; the internal opening of the canal is the internal inguinal ring. When loops of bowel force their way through weak areas of the inguinal canal, they produce inguinal hernias. Another potential route for a herniating mass is the femoral canal - femoral hernias protrude here. |
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Lymphatics in the groin
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Penis and scrotum drain into the inguinal nodes and may cause inflammation of the nodes.
The testes drain into the abdomen. No inguinal lymphadenopathy if infections is in the testes. |
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What questions should you ask the patient about sexual activity?
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How is your sex life?
Are you satisfied with your sex life Change in level of desire of sexual activity Sexual preference STI risk factors |
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What questions should you ask the patient about sexual function?
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Changes in sexual function/ response
Penile discharge or lesions? Scrotal pain, swelling or lesions Sores or growths on the penis Anal lesions |
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Causes of lack of libido
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Lack of libido may arise form psychogenic causes as in depression, endocrine dysfunction, or medication side effects.
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Causes of erectile dysfunction
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Psychogenic (especially if AM erection is preserved)
Decreased testosterone Decreased blood flow Impaired neural innervation Lack of orgasm with ejaculation is usually psychogenic. |
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Causes of premature ejaculation
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Medications - SSRIs (Paxil, Zoloft)
Surgery Neurologic deficits Lack on androgen Reduced or delayed ejaculation is less common. |
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Prevention of STIs
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US is highest STI’s in industrialized world
19 million new STI each year - ½ in the age group 15-24 years old 19 million currently infected with HIV Presence of any STD raises need for investigation of HIV co-infection. CDC 2006 - recommends HIV screening for all people 13-64 year old (despite risks) |
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Testicular self exam
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15-35 year olds - monthly
Painless lumps, swelling, enlargement, or pain |
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Sexual maturation rating
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See image
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Inspection of the penis
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Prepuce – retract and look for smegma
- Always replace foreskin if you retract it! Glans - look for lesions, ulcers, scars, nodules, signs of inflammation. Pubis and pubic hair for distribution, nits or lice. Note the location of the urethral meatus Inspect for discharge. Compress glans between index finger and thumb. - Mount discharge on a slide for culture. --- Ask patients to “milk” discharge down for sample. |
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Inspection of the scrotum
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Skin – lift the scrotum to view its posterior surface
Scrotal contours – note swelling, lumps, veins |
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Palpation of the penis
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Palpate any abnormal findings from inspection.
Asymptomatic patients do not need to be palpated (except for meatus opening). If foreskin was retracted, replace it to it’s original position. |
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Palpation of the testes
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Size, shape, consistency and tenderness
Palpate: - Each testis and epididymis- between you thumb and first two fingers, locate epididymis - Each spermatic cord- form epididymis to superficial ring |
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Possible abnormalities of the testes
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Epididymitis
Orchitis Torsion Strangulated hernia Testicular cancer Varicocele Hydrocele Cryptorchidism |
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Cryptorchidism
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Testis may be atrophied and lie in the inguinal canal or abdomen or absent testes.
Significant increased risk for testicular cancer is testicle does not descend or removed. |
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Hydrocele
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Non-tender, fluid-filled mass within the tunica vaginalis.
If testicle transilluminates, it is fluid filled and probably not a mass. Examining fingers can get above the mass within the scrotum. |
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Varicocele
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Varicose veins of the spermatic cord
Bag of worms - sometimes seen as a tortuous mass on the surface of the scrotum. Usually on the left. Improves when scrotum is elevated Infertility may be associated due to increased heat production. |
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Testicular torsion
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Surgical emergency!
Twisting of the testicle on its spermatic cord produces acutely painful, tender, swollen organ that is retracted upward in the scrotum. - Scrotal edema and erythema - Most common in adolescents |
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Acute orchitis
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Acutely inflamed, painful, tender, and swollen testicle.
Seen in mumps and other viral infections. Usually unilateral |
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Epididymitis
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Inflamed epididymis that is tender, swollen, and may be difficult to distinguish from testis.
Scrotum and vas deferens may be inflamed. Mainly found in adults. Coexisting UTI, prostatitis, or STD may support. |
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Spermatocele or cyst
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A painless, movable cystic mass just above the testis or epididymis.
Both transilluminate (clinically indistinguishable otherwise). |
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Testicular tumor
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Usually painless nodule
May be within or near surface of testis, or replace the entire organ. Irregular, non-mobile, and does NOT transilluminate |
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Inspection of hernias
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Sit comfortably in front of the patient while he is standing.
Inspect the inguinal region for masses/asymmetry Ask the patient to strain or bear down (valsalva maneuver). |
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Palpation of hernias
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The inguinal area for hernia (right side with right index)
Place the tip of your index finger close to the inferior margin of the scrota sac, then move you finger upward along the inguinal canal invaginating the scrotum. Follow the cord to the inguinal ligament. Find the triangular shaped slit-like opening for the external inguinal ring just above and lateral to the pubic tubercle. Ask the patient to bear down. Search for bulges/masses Palpate obliquely the internal ring Palpate for femoral hernia |
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Indirect inguinal hernia
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Most common type of hernia
Intra-abdominal contents protrude through the abdominal ring lateral to the inferior epigastric vessels. Origin is above the inguinal ligament (internal inguinal ring) Congenital lesion Most Common and in all ages Often into scrotum Comes down inguinal canal and touches the tip of finger. |
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What is the most common type of hernia?
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Indirect inguinal hernia
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How do you determine the type of inguinal hernia?
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Insert finger into inguinal ring.
- Indirect will press on tip of finger - Direct will press on side of finger |
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Direct inguinal hernia
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Direct – protrusion of intra-abdominal contents medial to the inferior epigastric vessels. Origin is above the inguinal ligament, close to the pubic tubercle, near external inguinal ring
Rarely into scrotum Less common Hernia bulges anteriorly and pushes the side of the finger forward |
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Femoral hernia
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Defect is through the femoral canal
Inferior to inguinal ligament Short medial attachment of transverus abdominus onto coopers ligaments that results in an enlarged femoral ring Least common Below inguinal ligament and appears more lateral to inguinal hernia Never into scrotum |
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How do you distinguish a scrotal mass versus a hernia?
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With the patient supine
Palpate superior to the mass Can you enter the inguinal canal? Listen with stethoscope Transilluminate the mass Attempt to reduce the mass Have the patient bear down |
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Anus
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Terminal canal of GI tract
Closed by : - Internal anal sphincter - External anal sphincter Anorectal junction - Aka pectinate line - Dentate line Somatic innervation |
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Health history of anus and rectum
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Change in bowel habits?
Blood in stool? Caliber of stool? Color of stool? Pain with defecation? Itching? Rectal bleeding? Anal warts or fissures? |
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Health history of prostate
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Weak stream with urination?
Hesitancy starting urination? Urinary frequency? Nocturia? Burning with urination? Blood in urine? Feeling of discomfort or heaviness in pelvis or at the base of the penis. Back pain? |
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What is the leading cause of cancer in men?
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Prostate cancer
3rd leading cause of death in men Risk factors - Age >50 - African American >Caucasian - Family history of 1st degree relative |
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Test to evaluate prostate cancer.
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DRE
PSA (not recommended every year) Limitations of tests Lack of sensitivity and specificity Screening recommended at age 50 (age 40 for African American or positive family history Combination of DRE and PSA exam) |
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Positioning ptient for DRE anal exam
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Standing
Have the patient expose his anus Flex at the hips and rest the upper body on the exam table Lying - Lie in the left lateral decubitus position - Flex the patients knees and hips |
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Inserting finger into rectm
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Lubricate your gloved index finger
Notify the patient of what you are going to do - May get the urge to defecate - Have the patient strain down Press against the anal sphincter but wait to insert you finger The sphincter will relax with gentle pressure Do not force the examination |
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Palpation of the prostate
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Insert index finger as far as possible
Rotate clockwise, palpating the right side Rotate counterclockwise to palpate the left Return to center to palpate the prostate Note tenderness, Induration, Irregularities, Nodules, masses (use clock notations or ventral/dorsal terms to describe location) |
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Prostate
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Pt may feel the need to urinate when palpating the prostate
Identify the lateral lobes and the sulcus in the middle Try to palpate the seminal vesicle Note Shape, size, consistency, tenderness, nodules Normal prostate feels rubbery and non-tender |
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Prostate/rectal exam
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Remove finger gently
Wipe the anus or hand the patient tissue to do so Note color of fecal matter on the glove When the exam is complete, look for frank blood on the gloved finger. |
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Guaiac/hemocult card
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Tests for occult blood in stool
Positive test is blue on the test side (-) |
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Phimosis
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Tight prepuce that cannot be retracted over the glans
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Cryptorchidism
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Testis is atrophied and may lie in inguinal canal or abdomen, resulting in unfilled scrotum.
Raises risk for testicular cancer |
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Acute orchitis
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Acutely inflamed, painful, tender and swollen
May be difficult to distinguish from epididymis Scrotum may be reddened Seen in mumps and other viral infections Usually unilateral |