Chapter 19: Male Genitalia

What causes paraphimosis? Leaving the foreskin in a retracted position gonorrhea leaving the foreskin over the glans penis hernia

Leaving the foreskin in a retracted position REF 477

Under what condition is translumination included in assessment of the male genitalia? When a mass is found in the scrotum When a chancre is observed on the penis When the foreskin cannot be retracted because of phimosis When areas of plaque are present on the outer surface of the penis

When a mass is found in the scrotum Translumination is used to obtain additional information if a mass is found in the scrotum. A penlight is used to shine light through the scrotum, identifying whether the mass is fluid or solid. A chancre is the sore of syphilis, a sexually transmitted disease with serious complications if untreated. Phimosis is observable, and translumination is not needed. Areas of plaque on the penis are observed with inspection and are caused by Peyronie disease.

Sexual differentiation in the fetus has occurred by _____ weeks' gestation.

ANS: 12 By 12 weeks' gestation, sexual differentiation has occurred in the fetus. REF: p. 468

A painless indurated lesion on the glans penis is most consistent with a _________.

ANS: chancre A syphilitic chancre is a painless lesion with an indurated border and a clear base. REF: p. 478

The most common cancer in young men aged 15 to 30 years is: a. testicular. b. penile. c. prostate. d. anal.

ANS: A Because testicular tumors are the most common cancer occurring in young adults, self-examination is encouraged REF: p. 470

Which genital virus infection is known to have a latent phase followed by the production of viral DNA capsids and particles? a. Condyloma acuminatum b. Molluscum contagiosum c. Herpetic lesions d. Lymphogranuloma venereum

ANS: A Condyloma acuminatum (genital warts) are soft, reddish lesions commonly present on the prepuce, glans penis, and shaft. These lesions can undergo latency, followed by viral DNA capsids and particles, which are produced in the host cells. REF: p. 479

While examining an 18-year-old man, you note that his penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be: a. within normal limits. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone.

ANS: A Darker pigmentation on the penis and testicles, as compared with other body skin, is a normal finding and is not suggestive of a skin fungus, psoriasis, or excessive progesterone. REF: p. 466

A cremasteric reflex should result in: a. testicular and scrotal rise on the stroked side. b. penile deviation to the left side. c. bilateral elevation of the scrotum. d. immediate erection of the penis.

ANS: A On stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should rise on the stroked side. REF: p. 474

Difficulty replacing the retracted foreskin of the penis to its normal position is called: a. paraphimosis. b. Peyronie disease. c. phimosis. d. priapism.

ANS: A Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans. REF: p. 478

The most emergent cause of testicular pain in a young male is: a. testicular torsion. b. epididymitis. c. tumor. d. hydrocele.

ANS: A Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate REF: p. 476

Which penile structure should be visible to inspection during the physical examination? a. Dorsal vein b. Proximal urethral c. Epididymis d. Corpus cavernosa

ANS: A The dorsal vein of the penis should be evident. The others are internal structures and should not be visible. REF: p. 471

The greatest contribution to the volume of ejaculate comes from the: a. prostate. b. epididymis. c. seminal vesicles. d. corpus cavernosa.

ANS: A The major volume of ejaculatory fluid comes from the prostate gland.

Normally, the male urethral orifice is located: a. 2 mm ventral to the tip of the glans. b. on the dorsal surface of the glans. c. cephalad to the dorsal vein. d. adjacent to the prostate.

ANS: A The urethral orifice is located approximately 2 mm ventral to the tip of the glans. REF: p. 466

A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not painful on palpation. The left inguinal canal is without masses. The mass transilluminates with a penlight. This collection of symptoms is consistent with: a. orchitis. b. a hydrocele. c. a rectocele. d. a scrotal hernia.

ANS: B A hydrocele is a soft scrotal mass that occurs as a result of fluid accumulation and therefore transilluminates. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal. REF: p. 481

Mr. L has an unusually thick scrotum, with edema and pitting. He has a history of cardiac problems. The appearance of his scrotum is most likely a(n): a. congenital defect that has worsened. b. indication of general fluid retention. c. normal consequence of aging. d. complication of the development of mumps.

ANS: B General fluid retention can cause scrotal thickening, and pitting edema and is usually seen as a result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the genitalia, but rather a condition of these related systems. REF: p. 472

In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance. This is usually: a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes.

ANS: B In the uncircumcised male, smegma is formed by the secretion of sebaceous material by the glans and the desquamation of epithelial cells from the prepuce. It appears as a cheesy white substance on the glans and in the fornix of the foreskin. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. It is not usually evidence of a fungal infection, penile carcinoma, or diabetes. REF: p. 466

Self-examination of the male genitalia: a. should be restricted to adults with a prior cryptorchidism. b. should be performed while bathing. c. starts with palpation and then inspection. d. should be performed yearly.

ANS: B Monthly self-examination is recommended as a screening test for testicular cancer and for sexually transmitted infections for all males starting at 15 years of age. It is encouraged during bathing because the scrotal skin is thinner at this time and because the scrotum hangs looser because of the warmth. Inspection is first, followed by palpation. REF: p. 470

How much blood usually engorges the two corpora cavernosa of the penis when it is erect? a. 5 to 15 mL b. 20 to 50 mL c. 55 to 60 mL d. More than 100 mL

ANS: B Penile erection occurs when 20 to 50 mL of blood is contained in the corpora cavernosa. REF: p. 468

The male with Peyronie disease will usually complain of: a. painful, inflamed testicles. b. deviation of the penis during erection. c. lack of sexual interest. d. painful lesions of the penis.

ANS: B Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection. REF: p. 480

Testicular temperature must be maintained lower than 37° C for which of the following to occur? a. Penile erection b. Spermatogenesis c. Testosterone production d. Rugae to form

ANS: B The production of sperm is dependent on the maintenance of testicular temperature below the normal body temperature of 37° C (98.6° F). REF: p. 466

On palpation, a normal vas deferens should feel: a. beaded. b. smooth. c. ridged. d. spongy.

ANS: B The vas deferens should feel smooth and discrete as it is palpated from the testicle to the inguinal ring. A beaded or lumpy vas deferens might indicate diabetes or the presence of old inflammatory changes. REF: p. 473

You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should: a. chart the finding as paraphimosis. b. inquire about previous penile infections. c. retract the foreskin firmly. d. transilluminate the glans.

ANS: B This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. You should not chart this finding as paraphimosis. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. REF: p. 471

When examining a small child, in which position should he be placed to help push the testicles into the scrotum? a. Supine b. Tailor c. Standing d. Prone

ANS: B When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination. Placing a small child in the other positions will not help. REF: p. 475

An enlarged painless testicle in an adolescent or adult male may indicate: a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle.

ANS: C A hard, enlarged, painless testicle can indicate a tumor in the adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. REF: p. 475

Which of the following is a risk factor for testicular cancer? a. Circumcision b. Condyloma acuminatum c. Cryptorchidism d. Poor hygiene

ANS: C Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer. REF: p. 470

A characteristic related to syphilis or diabetic neuropathy is testicular: a. dropping, with asymmetry. b. enlargement. c. insensitivity to painful stimulation. d. recession into the abdomen.

ANS: C Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. REF: p. 473

Which of the following hernias occurs more often in females and has the lowest incidence of occurrence? a. Indirect b. direct c. femoral d. ventral

ANS: C Femoral hernias are the least common type of hernia and occurs more often in females. Most common type of hernia is an indirect inguinal hernia. REF: p. 476

Which type of hernia lies within the inguinal canal? a. Umbilical b. Direct c. Indirect d. Femoral

ANS: C Hernias found within the inguinal canal are called indirect hernias. REF: p. 473

Inspection of the male urethral orifice requires the examiner to: a. ask the patient to bear down. b. insert a small urethral speculum. c. press the glans between the thumb and forefinger. d. transilluminate the penile shaft.

ANS: C Inspection of the urethral orifice is accomplished by pressing the glans between the examiner's thumb and forefinger. This maneuver opens the slitlike orifice for further inspection. REF: p. 472

Which one of the following conditions is of minor consequence in an adult male? a. Adhesions of the foreskin b. Continuous penile erection c. Lumps in the scrotal skin d. Venous dilation in the spermatic cord

ANS: C Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. REF: p. 472

Which condition is a complication of mumps in the adolescent or adult? a. Cystitis b. Epididymitis c. Orchitis d. Paraphimosis

ANS: C Orchitis is uncommon unless seen as a complication of mumps in the adolescent or adult. REF: p. 482

Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably: a. herpetic lesions. b. condylomata. c. molluscum contagiosum. d. chancres.

ANS: C Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum. REF: p. 480

Mr. Johnson is a 43-year-old patient who presents for a routine physical examination. On examination, you note that the urethral meatus opens on the ventral surface of his penis. You determine that he has which condition? a. Epispadias b. Hydrocele c. Hypospadias d. Normal variation

ANS: C The congenital defect in which the urethral meatus is located on the ventral surface of the glans is called hypospadias. REF: p. 484

The movement of the testes by muscular action regulates: a. ejaculatory flow. b. sebaceous production. c. testicular temperature. d. urinary flow.

ANS: C The cremasteric muscle contracts and relaxes the scrotum. This action alters the distance of the testes from the body to cool or warm the testes. REF: p. 466

The most common type of hernia occurring in young males is: a. hiatal. b. incarcerated femoral. c. indirect inguinal. d. umbilical.

ANS: C The most common type of hernia in children and young males is an indirect inguinal hernia. REF: p. 476

Which of the following is the most accurate approximation of normal adult testicular size (in centimeters)? a. 5 × 2 × 3 b. 2 × 3 × 3 c. 4 × 3 × 2 d. 5 × 7 × 7

ANS: C The normal dimensions of the adult male testes are 4 × 3 × 2 cm. REF: p. 468

An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your priority action should be to: a. obtain urine and DNA probe urethral samples. b. lift the left scrotum to confirm epididymitis. c. establish absent cremasteric reflex. d. transilluminate the left and right scrotum.

ANS: C The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a supporting finding to differentiate torsion from epididymitis. REF: p. 482

You palpate a soft, slightly tender mass in the right scrotum of an adult male. You attempt to reduce the size of the mass, and there is no change in the mass size. Your next assessment maneuver is to: a. use two fingers to attempt to reduce the mass. b. palpate the left scrotum simultaneously. c. lift the right testicle and then compare pain level. d. transilluminate the mass.

ANS: D A soft mass is a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a nonreducible mass should be transilluminated to determine whether it contains fluid and is possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is suspected. REF: p. 475

Expected genitalia changes that occur as men age include that: a. the ejaculatory volume decreases with age. b. erections develop more quickly. c. the viability of sperm increases. d. the scrotum becomes more pendulous.

ANS: D Ejaculatory volume increases with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. REF: p. 468

A finding associated with recurrent male genital herpes is: a. disseminated lymphadenopathy. b. pain subsiding with scrotal elevation. c. soft, red papules on the prepuce. d. superficial penile vesicles.

ANS: D Genital herpes presents as painful superficial vesicles on an erythematous base. REF: p. 478

Which technique is appropriate for detecting an inguinal hernia? a. Conduct percussion while the patient coughs. b. Have the patient strain as you pinch the testes. c. Inspect rectal areas as the patient bears down. d. Move your finger upward along the vas deferens.

ANS: D Inspect the groin while the patient performs a Valsalva maneuver. Insert your examination finger into the lower part of the scrotum and follow upward along the vas deferens to screen for a hernia. REF: p. 473

Parents of a 6-year-old boy should be asked if he has: a. erections. b. nocturnal emissions. c. rapid detumescence. d. scrotal swelling.

ANS: D Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The questions about erections and rapid detumescence are for the older male. The question about nocturnal emissions is asked of adolescents. REF: p. 469

Inspection of the scrotum should reveal: a. lightly pigmented skin. b. two testes per sac. c. smooth scrotal sacs. d. the left scrotal sac lower than the right.

ANS: D The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The skin of the scrotum is more darkly pigmented. The scrotum has one testis per sac. The scrotum has small epidermoid cysts that give it a lumpy appearance. REF: p. 472

A premature infant's scrotum will appear: a. bifid. b. loose. c. ridged. d. smooth.

ANS: D The premature male scrotum will appear underdeveloped, smooth, without rugae, and without testes; the full-term infant should have a loose, pendulous scrotum, with rugae and a midline raphe. REF: p. 474

Which structure of the male genitalia travels through the inguinal canal and unites with the seminal vesicle to form the ejaculatory duct? a. Epididymis b. Prostate gland c. Testicles d. Vas deferens

ANS: D The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct. REF: p. 468

Which assessment finding from the male genitalia examination requires further investigation? The epididymides are palpable but not tender. Left side hangs lower than the right side of the scrotum. An area of hardness is palpated on the surface of one testicle. An opening is palpated in the external inguinal ring on the left side

An area of hardness is palpated on the surface of one testicle Palpating an area of hardness on the testicle calls for further study because this may represent early testicular cancer. Testicles are normally smooth and rubbery and without nodules or hard areas. Palpable epididymides within the scrotum, the left side of the scrotum slightly lower than the right, and a palpable external inguinal ring are all normal findings.

The nurse performs an assessment of the genitalia of an uncircumcised man. What action is necessary for the examination? Ask the patient to bear down to release the foreskin. Cleanse all the smegma that is present under the foreskin. Open the urinary meatus with a cotton-tipped applicator. Ask the patient to retract the foreskin before examining the penis

Ask the patient to retract the foreskin before examining the penis. The nurse requests the patient to retract the foreskin so the glans penis and urinary meatus can be examined. A client is asked to bear down to increase intraabdominal pressure when assessing for the presence of inguinal hernias. Smegma is sebaceous material and skin cells present under the foreskin of an uncircumcised male. It is washed off as part of hygiene by the patient but not scrubbed off entirely. The urinary meatus is opened by applying pressure to the glans.

What health benefits has research shown for males who are circumcised? (Select all that apply.) Decreased risk of prostate cancer. Decreased incidence of penile cancer Prevention of urinary tract infections. Less risk of acquiring HIV infections. Decreased transmission of some sexually transmitted infections

Decreased incidence of penile cancer Prevention of urinary tract infections. Less risk of acquiring HIV infections. Decreased transmission of some sexually transmitted infections A report from the American Pediatric Association (2012) stated benefits associated with circumcision include prevention of cancer of the penis, urinary tract infections, acquiring HIV, and transmission of some sexually transmitted diseases. Circumcision is not associated with a decreased risk for prostate cancer.

A female nurse is performing an annual physical assessment of a male patient. Which is the best approach to discuss assessment of the genitalia? Explain the procedure and proceed in a professional manner. Use common slang terms to explain the procedure and proceed. Ask the patient if he cares if the nurse quickly checks the genitalia. Explain risks of untreated sexually transmitted diseases and proceed

Explain the procedure and proceed in a professional manner. The best way to approach assessment of the genitalia is to explain the procedure in a matter-of-fact way and proceed in a professional manner. Using slang terms, asking permission to perform a quick examination, or assuming that the patient may be at risk for sexually transmitted diseases is not respectful of the patient as an individual.

What term is used to describe a loop of bowel that cannot be reduced? Femoral hernia Incarcerated hernia Strangulated hernia Indirect inguinal hernia

Incarcerated hernia An incarcerated hernia is a loop of bowel that cannot be reduced or returned to its normal position within the abdominal cavity by gravity or gentle pressure. Femoral and indirect inguinal hernias refer to the anatomic area where the hernia occurs. A strangulated hernia is one with the blood supply cut off and will become necrotic without surgical intervention.

Which assessment finding is associated with a left testicular torsion? (Select all that apply.) Nausea and vomiting Scrotal discoloration Severe left testicular pain Purulent discharge from the penis Absence of the cremasteric reflex on the left side

Nausea and vomiting Scrotal discoloration Severe left testicular pain Absence of the cremasteric reflex on the left side With testicular torsion, the spermatic cord turns on itself, and blood supply to the testicle is obliterated. This causes severe pain in the affected testicle, often accompanied by nausea and vomiting, scrotal discoloration, and absence of the cremasteric reflex on the affected side. To elicit the cremasteric reflex, the inner thigh is stroked; the normal response is elevation of the testicle and scrotum on that side. Purulent discharge from the penis is associated with an infectious process.

The nurse teaches a young adult male genital self-examination for men. What is the purpose of this instruction? Lower the risk for developing penile cancer. Develop awareness of the risk of testicular torsion. Lower his risk of contracting a sexually transmitted disease. Observe for signs of a sexually transmitted disease if he had exposure.

Observe for signs of a sexually transmitted disease if he had exposure. Teaching young male patients about genital self-examination includes observation for signs of sexually transmitted diseases, including skin lesions and discharge. Men at risk can seek treatment if they are aware that they have signs of commonly sexually transmitted diseases. This teaching does not increase awareness of testicular torsion or lower the risk of penile cancer or contracting sexually transmitted diseases.

A nurse reviews the health history with a male patient previously diagnosed with condyloma acuminata. What does the nurse expect to observe during the examination? Ulceration of the penis Soft wartlike lesions on the penis Lymphedema of the penis and scrotum Plaques on the surface of the penis

Soft wartlike lesions on the penis Condyloma acuminata is a sexually transmitted disease that causes wartlike lesions in the genital area. Ulceration occurs with penile cancer. Lymphedema of the genitals occurs with blockage caused by lymphogranuloma venereum. Peyronie disease causes areas of plaque to form on the penis.

In which of the following would you not find a cremasteric reflex? Testicular torsion Epididymitis ochitis testicular cancer

Testicular torsion REF 482

Infertility is associated with which condition? Phimosis Hydrocele Varicocele Inguinal hernia

Varicocele A varicocele, a mass of varicose (dilated and tortuous) veins within the spermatic cord, is a common cause of infertility. The infertility is caused by decreased sperm viability related to increased venous pressure and testicular temperature. Phimosis, hydrocele (accumulated fluid within the scrotum), and an inguinal hernia are not associated with infertility.

Which of the following is described as a "bag of worms"? varicocele spermatocele hydrocele

varicocele REF 481