Male Genitalia and Prostate Sherpath

The testicle of a newborn is typically _______________________________ cm in diameter.

1 cm

Testicles are about _______________ in diameter in the newborn.

1 cm (0.39 inches)

Things the nurse should do before a prostate exam

1. explain the procedure step by step and note why its important. 2. warn the patient that he may feel the urge to urinate, this is normal 3. position patient in left lateral position with hips and knees flexed OR standing with hips flexed at 90 degrees while upper body is supported by table OR knees to chest

When performing the rectal examination, what 4 thing should be assessed

1. prostate 2. anal ring 3. sphincter 4. rectal wall

By ______________ years of age, the glans and prepuce completely separate in uncircumcised males.

3 to 4

The prostate of a healthy patient should have a diameter of ______________ cm.

4 cm

In healthy adults, the prostate should be about________________, with only about ______________________________of protrusion into the rectum.

4 cm (1.57 inches) 1 cm (0.39 inches)

Palpate infant genitalia for:

Ability to retract the foreskin enough to see urethra Urethral placement Abnormalities, including bleeding and lesions Force of urinary stream Size, shape, and symmetry Presence of testicles Presence of masses

Abnormal findings for inspection of male pubic hair

Absent, patchy hair Pubic lice

Which findings related to the foreskin of an infant would the examiner consider normal? Red in color Inflamed Nodular Adherence to the prepuce of the glans

Adherence to the prepuce of the glans

Which response is expected on a light touch of the anal opening of an infant? Anal contraction Anal discharge Anal dilation Anal erythema

Anal contraction

How can the examiner determine if a bulge in the groin is a hernia? Select all that apply. Auscultate the chest Inspect the abdomen Ask the patient to bear down Ask the patient to take a deep breath Push contents back into the inguinal canal

Ask the patient to bear down Push contents back into the inguinal canal

Which findings would be considered abnormal when palpating the prostate through the rectal wall? Select all that apply. Firm surface Bogginess Nodularity Palpable seminal vesicles Symmetric lateral lobes

Bogginess Nodularity Palpable seminal vesicles

Which findings would be considered normal when the examiner gently retracts the foreskin of the penis of an uncircumcised patient? Select all that apply. Penile discharge Bright red urethral orifice Cheesy sebaceous matter Slitlike urethral meatus Visible dorsal vein on the penis

Cheesy sebaceous matter Slitlike urethral meatus Visible dorsal vein on the penis

Which findings are considered normal when assessing the anus and the surrounding skin? Select all that apply. Fissures Skin tags Coarse texture Hemorrhoids Dark pigmentation

Coarse texture Dark pigmentation

On examination of the urethral meatus, which elements would be assessed? Select all that apply. Color Discharge Location Texture Orifice size

Color Discharge Location Orifice sizze

Which elements of genital hair should be assessed on inspection? Select all that apply. Color Coarseness Distribution Abundance

Color Distribution Abundance The coarseness of the genital hair should be assessed on palpation, not inspection.

Which elements of the scrotum should the examiner assess on inspection? Select all that apply. Color Abundance Texture Presence of cysts Presents of edema

Color Presence of cysts Presents of edema

After inspecting the penis, observe the scrotum and ventral surface for

Color Asymmetry Lesions Presence of a hernia Swelling (edema) Masses, lumps, cysts

Inspect male genitalia hair characteristics, noting :

Color Distribution Abundance Skin redness, flakiness Presence of parasites

Palpate the testes, epididymis, and vas deferens for the following

Consistency Size Texture Unusual thickening Tenderness Bleeding Masses Lumps Nodules Ability to retract foreskin (in uncircumcised patient)

Which elements of the prostate gland should be assessed on palpation? Select all that apply. Contour Hair texture Tenderness Movability Consistency

Contour Tenderness Movability Consistency

Palpate the prostate for:

Contour Size Consistency Movability Tenderness Protrusion into the rectum Symmetry of lobes Presence of median sulcus Nodules

Which findings would the examiner note as normal on assessment of the scrotum? Select all that apply. Pitting Coarse texture Sebaceous cysts Asymmetrical shape Skin darker in color than body

Course texture Asymmetrical shape Skin darker in color than body

In a circumcised patient how should the glans penis appear? Select all that apply. Dry White Hairy Inflamed Erythematous

Dry Erythematous

Abnormal findings of inspection of the scrotum

Erythema Lumps (may be sebaceous or epidermoid cysts) Unusual thickening of scrotal skin Pitting edema

Which findings are normal when assessing the prostate gland? Select all that apply. Firm Smooth Tender Slightly movable Nodular

Firm Smooth Slightly movable

Which features should be inspected when assessing the anus? Select all that apply. Fistulae Fissures Skin tags Moisture Skin lesions Hemorrhoids

Fistulae Fissures Skin tags Skin lesions Hemorrhoids

In which area do femoral hernias occur? Scrotum Inguinal canal Penis shaft Fossa ovalis

Fossa ovalis Rationale: Femoral hernias occur at the fossa ovalis, where the femoral artery exits in the abdomen.

Abnormal findings found upon palpation of the inguinal canal

Hernia felt in the inguinal canal or scrotum Palpable lymph nodes Redness, increased vascularity Tenderness Viscus against examining finger on cough Swelling of internal ring Palpable bulge in Hesselbach triangle

The penile shaft should be palpated for which elements? Select all that apply. Color Induration Tenderness Hair distribution Presence of lice

Induration Tenderness

A hernia is described as indirect if swelling is identified in which area? Scrotum Shaft Inguinal canal Hesselbach triangle

Inguinal canal

Where would the examiner insert a gloved finger when checking for a hernia? Inguinal canal Rectum Prostate Glans penis

Inguinal canal Rationale: The examiner should insert a gloved finger into the scrotum and carry it up into the inguinal canal to check for a hernia

When evaluating a patient for hernias, which areas should be inspected? Select all that apply. Inguinal canal Penile shaft Fossa ovalis Glans penis Prostate

Inguinal canal Fossa ovalis

How should the patient be positioned for a prostate and rectal examination? Select all that apply. Supine Knees-to-chest Lying on the stomach Left lateral with hips and knees flexed Standing with hips flexed 90 degrees

Knees-to-chest Left lateral with hips and knees flexed Standing with hips flexed 90 degrees

Abnormal findings upon inspection AND palation of Anus, Anal Sphincter, Anal Ring

Lesions, polyps or warts Hemorrhoids Fissures, fistulas Rectal prolapse Discomfort Extremely tight sphincter Extremely lax sphincter Tenderness Nodules Irregularity

What are expected findings when assessing the scrotum of a healthy newborn? Select all that apply. Loose Hairy Pendulous Midline raphe Enlarged

Loose Pendulous Midline raphe

Abnormal findings upon inspection AND palation of Sacrococcygeal and Perianal Areas

Lumps Rashes Inflammation Excoriation Tenderness Tufts of hair Pilonidal dimpling

Expected findings of the urethral opening upon palpation

No discharge with stripping Slitlike

Which findings would be considered abnormal when palpating the testes? Select all that apply. Nodules Smooth Rubbery Tenderness Sensitive to compression

Nodules Tenderness

Abnormal findings upon inspection AND palation of Rectal Walls

Nodules Masses Polyps Tenderness Irregularities Hemorrhoids

Abnormal findings upon palpation of the Prostate

Nodules Masses Polyps Tenderness Irregularity Rubberiness Bogginess Fluctuating softness Palpable median sulcus Palpable seminal vesicles Protrusion into the rectum >1 cm (0.39 inches) Discharge at urethral meatus with palpation

Expected findings of the Inguinal canal upon palpation

Oval external ring palpable Non palpable inguinal lymph nodes

Which element of the rectum can be identified more readily through bidigital palpation? Fistulae Prostate Rectal prolapse Perianal abscess

Perianal abscess

Abnormal findings of inspection of the urethral meatus

Pinpoint or round opening Not located on the ventral surface near the tip (example: along the shaft, on dorsal surface) Erythema Discharge

Which findings are considered abnormal when palpating the rectal walls? Select all that apply. Smoothness Polyps Evenness Nodules Hemorrhoids

Polyps Nodules Hemorrhoids

What is the correct order of the steps for introducing a finger into the rectum. Position patient with hips flexed Wait for the external sphincter to relax Slip finger into the anal canal Press pad of finger against the anal opening

Position patient with hips flexed Press pad of finger against the anal opening Wait for the external sphincter to relax Slip finger into the anal canal

Which aspect of the prostate gland can be palpated? Posterior wall Anterior wall Lateral wall Floor

Posterior wall

Which findings would be considered abnormal when palpating the shaft of the penis? Select all that apply. Priapism Induration Nodularity Tenderness Soft to touch

Priapism Induration Nodularity Tenderness

Identify the structures to palpate during the rectal examination. Select all that apply. Prostate Anal ring Sphincter Rectal wall Urethral meatus

Prostate Anal ring Sphincter Rectal wall

Which element of the foreskin should be assessed in a newborn infant? Size Color Shape Retractability

Retractability

Which structure should the examiner palpate to detect the testicles in an infant? Scrotum Glans penis Fossa ovalis Inguinal canal

Scrotum

Which age-specific abnormalities should the examiner inspect for when assessing the genitalia of a male infant? Select all that apply. Lesions Sexual ambiguity Displaced urethra Incomplete development

Sexual ambiguity Displaced urethra Incomplete development Rationale: The examiner should inspect the genitalia of a male infant for sexual ambiguity. An enlarged clitoris (clitoromegaly) may be mistaken for a small penis and should be distinguished. The examiner should inspect the genitalia of a male infant for urethral placement, which should be ventral to the tip of the glans. The examiner should inspect the genitalia of a male infant for incomplete development, which may suggest conditions of abnormal testicular development (e.g., Klinefelter syndrome).

Which elements of the infant scrotum should the examiner assess? Select all that apply. Size Shape Moisture Symmetry Testicles

Size Shape Symmetry Testicles

Which findings would be considered normal when palpating the anal ring? Nodules Smooth texture Erythematous Uneven pressure around examining finger

Smooth texture

Which findings would the examiner note as normal on palpation of the flaccid penis? Soft Tender Nodularity Discharge

Soft

Expected findings of the penis upon palpation

Soft when flaccid Free of nodules Nontender Foreskin easily retracted Cheesy sebaceous matter in uncircumcised patients Visible dorsal vein

Which findings regarding pubic hair distribution would be noted as normal? An ample amount of hair on the penile shaft An ample amount of hair on the scrotum Scant hair on the glans penis Some hair growth around the anal orifice

Some hair growth around the anal orifice

Which findings are expected regarding the urinary stream of a healthy newborn? Select all that apply. Strong Offset Dribbling Good caliber Spray

Strong Good caliber

Which findings are abnormal when palpating the inguinal area? Select all that apply. Tender Swelling Oval external ring Viscus on examining finger Absence of palpable lymph nodes

Tender Swelling Viscus on examining finger

Which elements should be noted on palpation when assessing the sacrococcygeal and perianal areas? Tenderness Mobility Contour Tufts of hair

Tenderness Rationale: The examiner should inspect, not palpate, the sacrococcygeal and perianal areas for tufts of hair.

Which findings are considered abnormal when palpating the inguinal canal for a hernia? Select all that apply. Tenderness Oval external ring Viscus on cough Bulge in inguinal area Swelling of internal ring

Tenderness Viscus on cough Bulge in inguinal area Swelling of internal ring

Abnormal findings found upon palpation of the penis

Tenderness Induration Nodules Priapism (prolonged erection)

Expected findings of the Cremasteric Reflex upon palpation

Testicles and scrotum rise on side that is stroked

*Which elements of the penis should be assessed on palpation? Select all that apply. Color Texture Spermatic cord Tenderness Foreskin retraction

Texture Spermatic Cord Tenderness Foreskin retraction

Expected findings of the scrotum and testes upon palpation

Thickness will vary based on age and environmental temperature No lumps Two testes present Sensitive to gentle compression Nontender Smooth, rubbery

Abnormal findings of inspection of the penis

Tight foreskin (phimosis) Lesions Discharge

At which location should the urethral meatus be in relation to the glans penis? Tip Base Lateral side Offset from the head of penis

Tip

When assessing the sphincter, which elements should be evaluated? Tone Color Hair Moisture

Tone Rationale: When assessing the sphincter, the examiner should evaluate the external sphincter tone. A lax sphincter could indicate a neurologic deficit, whereas an extremely tight sphincter may be the result of scarring.

Which elements should be palpated when assessing the anal ring? Select all that apply. Tone Texture Nodules Color Irregularities

Tone Texture Nodules Irregularities

How can the examiner determine if a scrotal mass, found on palpation, is fluid filled or solid? Peirce with syringe Palpate harder Squeeze the mass Transillumination

Transillumination

Which findings would the examiner consider normal when palpating the sacrococcygeal and perianal areas? Masses Nodularity Polyps Uninterrupted

Uninterrupted

Abnormal findings found upon palpation of the scrotum and testes.

Unusual thickening of the scrotum Cryptorchidism (missing testicle) Tenderness Nodules Insensitivity to painful stimuli Irregular texture Irregular size (<1 cm or >5 cm; 0.39 inches or >1.97 inches) Gross asymmetry

Which elements of the penis should the examiner assess when inspecting the genitalia of a male infant? Select all that apply. Urethra Prostate Foreskin Presence of lesions Urinary stream

Urethra Foreskin Urinary stream **Presence of lesions (The presence of lesions should be assessed and noted as an expected finding.) ***The question right before this said lesions ARE NOT an age appropriate finding of a male infant. So i think this question is wrong but the answers are above

Expected findings of the vas deferens upon palpation

Vasculature should not be palpable Smooth Discrete No beading or lumps

raphe

a crease, ridge, or seam of the halves of various symmetric parts, which appears as a narrow dark streak on the inferior surface of the penis.

prepuce

a fold of skin that forms a retractable cover, such as the foreskin of the penis or the fold around the clitoris.

smegma

a secretion of sebaceous glands, especially the foul-smelling secretion sometimes found under the foreskin of the penis and at the base of the labia minora near the glans clitoris.

cremasteric reflex

a superficial neural reflex elicited by stroking the skin of the upper inner thigh in a male. This action normally results in a brisk retraction of the testis on the side of the stimulus.

If bowel sounds are heard in the inguinal area, it could indicate the presence of ______________________ .

an uncomplicated hernia

Valsalva maneuver

bear down as if having a bowel movement

Because an indirect hernia on one side strongly suggests the possibility of___________________ , be sure to examine _________________________ thoroughly.

bilateral herniation both sides

If the viscus is felt medial to the external canal, it probably represents a __________ inguinal hernia. The hernia is described as _____________ if it lies within the inguinal canal. It may also come through the external canal and even pass into the scrotum.

direct indirect

Three types of (male inguinal) hernias

direct inguinal, indirect inguinal, and femoral hernias.

If a mass is palpated in the scrotal area, determine if it is ___________ , _______________ , or _________________ .

gaseous, fluid filled, or solid

A mass in the scrotum that does not transilluminate but reduces when pushed back into the inguinal canal is most likely a ________________.

hernia

protrusion of the bowel through the abdominal muscle wall

hernia

The two most common sites for male hernia formation are the__________________ and ________________ .

inguinal canal and the fossa ovalis

Cryptorchidism

missing testicle

Expected findings of the epididymus upon palpation

mooth Discrete Larger cephalad cephalad toward the head, away from the end or tail. Nontender

Priapism

prolonged erection

Palpation of the prostate may cause _____________________________ .

secretions to leave the urethral orifice. *Note the color and consistency of any discharge as well as the presence of any foul odor.

To observe for male hernia formation, have the patient __________ and perform the ________________ maneuver.

stand Valsalva maneuver

Lobes of the prostate should be _______________ and __________________ should not be palpable. The __________________________should be palpable.

symmetrical seminal vesicles median sulcus

The prostate is located at the base of___________________________________________________. The posterior prostate sits close to the______________________________.

the bladder surrounding the urethra anterior rectal wall

The scrotum may be asymmetrical because _____________________________________________.

the left testicle has a longer spermatic cord and may hang slightly lower

transillumination

the passage of light through body tissues for the purpose of examining a structure interposed between the observer and the light source.

Phimosis

tight foreskin

cephalad

toward the head, away from the end or tail.