Seidel Ch 20 Male GU

Which finding when assessing a 17 year old would be a cause for concern? A. Complaint of heaviness in the scrotum B. Marked scrotal rugae C. Erection during the examination D. Presence of a foreskin

A. Complaint of heaviness in the scrotum Testicular cancer is characterized by a sensation of heaviness in the scrotum.

Mr. Scott is a 22-year-old sexually active man who presents for a yearly physical examination. You are providing him with information on genital self-examination (GSE). What do you tell him is the primary purpose of GSE? A. Early detection of sexually transmitted infections B. Early detection of testicular cancer C. Early identification of signs of infertility D. Early identification of prostate enlargement

A. Early detection of sexually transmitted infections The purpose of GSE is to detect any signs or symptoms that might indicate the presence of an STI.

Mr. Walker is a 28-year-old patient who presents for a routine office visit. On examination, you note reddish lesions on the prepuce, glans, and shaft. Which of the following best describes your clinical findings? A. Genital warts B. Herpes simplex C. Lymphogranuloma D. Syphilitic chancre

A. Genital warts Genital warts caused by HPV may be the same color as the skin, or they may be reddish or hyperpigmented. Lesions are commonly present on the prepuce, glans penis, and penile shaft, but they may be present within the urethra as well.

Which disorder is suggested by the presence of painful superficial vesicles on the penis and perineum? A. Herpes simplex B. Syphilitic chancre C. Molluscum contagiosum D. Lymphogranuloma

A. Herpes simplex Genital herpesis a sexually transmitted disease characterized by superficial vesicles on the glans, penile shaft, or at the base of the penis.

Which assessment is being made when the glans is pressed between the thumb and forefinger and stripped? A. Inspecting for urethral discharge B. Palpating for inguinal hernia C. Observing for phimosis D. Palpating for tender testes

A. Inspecting for urethral discharge Strip the urethra for any discharge by firmly compressing the base of the penis with your thumb and forefinger and moving them toward the glans. The presence of a discharge may indicate an STI.

____________ is an initially painless erosion on or near the coronal sulcus. A. Lymphogranuloma B. Herpes simplex C. Molluscum contagiosum D. Syphilitic chancre

A. Lymphogranuloma Lymphogranuloma venereum is a sexually transmitted infection of the lymphatics whose initial lesion is a painless erosion at or near the coronal sulcus. Syphilitic Chancre is also painless but appears on the glans and can be on the foreskin. Indurated borders with clear base

Mr. Yates, a 47-year-old patient, presents to your office with a concern over a lesion on his penis. On examination, you note dome-shaped, umbilicated, smooth, pearly gray lesions on the penis. Which disorder do you conclude Mr. Yates has? A. Molluscum contagiosum B. Lymphogranuloma C. Herpes simplex D. Syphilitic chancre

A. Molluscum contagiosum Lesions of molluscum contagiosum are pearly gray, often umbilicated, smooth, dome shaped, and with discrete margins.

Mr. Nylan is a 38-year-old patient who presents to your office for a yearly physical examination. On examination, you note that the foreskin of the penis is very tight, preventing it from retracting over the glans. What is this condition called? A. Phimosis B. Paraphimosis C. Spermatocele D. Epispadias

A. Phimosis Occasionally the foreskin is tight and cannot be retracted. This condition is called phimosis and may occur during the first 6 years of life or as a result of recurrent balanitis (inflammation of the glans), or balanoposthitis (inflammation of the glans penis and prepuce).

Mr. Frank is a 32-year-old patient who presents to your office with a complaint of a penile lesion. On examination, you note a painless lesion with a clear base and indurated borders located on the glans penis. What do you conclude this lesion is? A. Syphilitic chancre B. Lymphogranuloma C. Genital warts D. Herpes simplex

A. Syphilitic chancre Syphilitic chancre is a lesion with indurated borders with a clear base.

Which finding may indicate diabetes? A. The vas deferens feels beaded or lumpy. B. The testicle feels hard with a lump. C. Sebaceous cysts are present on the scrotal skin. D. The urethra has a slitlike orifice.

A. The vas deferens feels beaded or lumpy. The vas deferens itself feels smooth and discrete; it should not be beaded or lumpy in its course as you palpate from the testicle to the inguinal ring. The presence of such unexpected findings might indicate diabetes or old inflammatory changes, especially tuberculosis.

Mr. Torres is a 42-year-old patient who presents for a routine examination. On examination, you note abnormal dilation and tortuosity of the veins along the spermatic cord. Which of the following conditions best describes this clinical finding? A. Varicocele B. Priapism C. Hypospadias D. Epididymitis

A. Varicocele Varicocele is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. Varicocele described as a "bag of worms."

Mr. Wolf is a 46-year-old patient who presents for a yearly physical. On examination, you ask the patient to bear down while you palpate the inguinal ring. You feel a soft swelling sensation on the fingertip. The patient complains of pain while straining. These findings are consistent with a(n): A. indirect hernia. B. direct hernia. C. femoral hernia. D. rectal hernia.

A. indirect hernia. An indirect inguinal hernia is indicated by soft swelling in the area of the internal ring and pain on straining; the hernia comes down the canal and touches the fingertip on examination.

Mr. Javed is a 46-year-old patient who presents for a yearly physical examination. To examine for an inguinal hernia you would ask him to: A. stand. B. lie on his back. C. sit on a table with heels together. D. assume a knee-chest position on the examination table.

A. stand. With the patient standing, ask him to bear down as if having a bowel movement. While he is straining, inspect the area of the inguinal canal and the region of the fossa ovalis.

A hernia that lies within the inguinal canal is called: Direct hernia Femoral hernia Indirect hernia Ventral hernia

ANS: A Rationale: A direct hernia is one that protrudes through the inguinal ring located in the region of the Hesselbach triangle.

Expected genitalia changes that occur as men age include: Ejaculatory volume decreases with age Erections develop more quickly Viability of sperm increases The scrotum becomes more pendulous

ANS: D Rationale: Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production.

________ is an inflammation of the glans penis. A. Hydrocele B. Balanitis C. Varicocele D. Epididymitis

B. Balanitis Balanitis is an inflammation of the glans penis; balanoposthitis is an inflammation of the glans penis and prepuce. Phimosis, a condition in which the foreskin is tight and cannot be retracted, can be the result.

Which is an expected characteristic of the scrotum of a full-term newborn boy? A. Fibrous B. Pendulous C. Smooth D. Without rugae

B. Pendulou The scrotum of the premature infant may appear underdeveloped, without rugae, and without testes, whereas the full-term neonate should have a loose, pendulous scrotum with rugae and a midline raphe.

Which fact from a patient history indicates a risk factor for cancer of the penis? A. The patient was circumcised at birth. B. The patient has a history of genital warts. C. The patient had a congenital hydrocele. D. The patient has a history of untreated epispadias.

B. The patient has a history of genital warts. Human papillomavirus (HPV) infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; and anal and oropharyngeal cancer and genital warts in both men and women. Vaccination against HPV before exposure to the virus through sexual activity is recommended for preadolescent and adolescent girls and boys.

Mr. Jones brings his son to you after a softball game. The child complains of a swollen testicle, acute pain, and vomiting. On examination, you note the absence of the cremasteric reflex on the side of acute swelling. What do you suspect is occurring? A. Epididymitis B. Torsion C. An inguinal hernia D. Spermatocele

B. Torsion Twisting of testis on the spermatic cord, called testicular torsion, is a surgical emergency. Signs and symptoms include testicular swelling, scotal pain, and absence of the cremasteric reflex on the affected side. Nausea and vomiting often occur.

While examining the genitalia of a 2-year-old boy, the examiner should be aware that the: A. scrotum is normally edematous. B. foreskin of the uncircumcised penis is not fully retractable until 3 or 4 years of age. C. testicles typically do not descend into the scrotum until 5 years of age. D. supine position is preferred for examination of children this age.

B. foreskin of the uncircumcised penis is not fully retractable until 3 or 4 years of age. Mobility of the foreskin increases with time, and for most boys it is fully retractable by 3 or 4 years of age.

A premature infant's scrotum will likely be: A. bifid. B. smooth. C. loose. D. rugated

B. smooth. The scrotum of the premature infant may appear underdeveloped, without rugae, and without testes, whereas the full-term neonate should have a loose, pendulous scrotum with rugae and a midline raphe.

Mr. Walker is a 24-year-old patient who is being seen for a health promotion visit. You have given Mr. Walker information regarding genital self-examination (GSE). Which statement made by the patient indicates that further teaching is necessary? A. "I should perform this every month on a regular schedule." B. "I should look for discharge or sores on my penis." C. "I should look for a hernia while doing this." D. "A good time to do this is while bathing."

C. "I should look for a hernia while doing this." The purpose of GSE is to detect any signs or symptoms that might indicate the presence of a sexually transmitted infection (STI).

In which situation is transillumination of the scrotum indicated? A. A syphilitic chancre is noted. B. An indirect hernia is palpated. C. A mass is felt within the sac. D. Dilated blood vessels are apparent on the undersurface.

C. A mass is felt within the sac. Examination of the genitalia involves inspection, palpation, and transillumination of any mass found.

Mr. Casey is a 38-year-old patient who presents with a complaint of fever, pain on urination, and left testicular pain. On examination, you note tenderness on palpation of the epididymis and spermatic cord on the left. Which condition do you conclude he has? A. Spermatocele B. Hypospadias C. Epididymitis D. Peyronie disease

C. Epididymitis Symptoms of epididymitis include painful scrotum, urethral discharge, fever, and pyuria.

Mr. Taper is a 50-year-old man who presents to your clinic with a deep ulceration with rolled edges on his penis. What do you suspect is occurring in this patient? A. Epididymitis B. Herpes simplex virus infection C. Penile carcinoma D. Hydrocele

C. Penile carcinoma Almost all cases of penile cancer are squamous cell carcinoma, usually originating in the glans or foreskin. Warty growth, shallow erosion, or a deep ulceration with rolled edges are common signs.

Mr. Tucker is a 28-year-old patient who presents to your office with a concern that during an erection his penis is bent and painful. This clinical finding is characterized by a fibrous band in the corpus cavernosum and is called: A. paraphimosis. B. phimosis. C. Peyronie disease. D. spermatocele.

C. Peyronie disease. Peyronie disease is characterized by a fibrous band in the corpus cavernosum.

Which assessment finding would be expected when examining a 14 year old with Klinefelter syndrome? A. Hirsutism B. Absence of breast tissue C. Small scrotum D. Short stature

C. Small scrotum Klinefelter syndrome is a congenital anomaly associated with XXY chromosomal inheritance, which becomes evident at puberty. It is characterized by hypogonadism, including a small scrotum; diminished pubic, axillary, and facial hair; and enlarged breast tissue.

When examining the penis of an uncircumcised neonate, what is the basis for your conclusion that the foreskin is not too tight? A. The urethral meatus is visible when the foreskin is gently retracted. B. The glans penis is pink and moist when the foreskin is retracted. C. The foreskin pulls back enough to allow a good urinary stream. D. The infant shows no sign of discomfort when the foreskin is retracted.

C. The foreskin pulls back enough to allow a good urinary stream. The foreskin in the uncircumcised infant is commonly tight, but it should retract enough to permit a good urinary stream.

The examiner inspects the scrotum of a 43-year-old man. Which finding requires further evaluation or follow-up? A. The left testicle hangs lower than the right testicle. B. The scrotum is darker than the general skin color. C. The skin on the scrotum is shiny and smooth. D. The scrotum is divided into two sacs by a septum.

C. The skin on the scrotum is shiny and smooth. Scrotal skin is characterized by rugae and may be darker and coarser than skin in other areas. Reddened scrotal skin may also be normal in red-haired individuals. Shiny, smooth scotal skin is abnormal, and therefore further evaluation is required.

An enlarged, painless testicle in an adolescent or adult may indicate: A. epididymitis. B. testicular torsion. C. a tumor. D. an undescended testicle.

C. a tumor. A hard, enlarged, painless testicle may indicate a tumor.

Attempting to retract the foreskin is associated with: A. palpating for tender testes. B. palpating for inguinal hernia. C. checking for phimosis. D. observing for hydrocele.

C. checking for phimosis. Occasionally the foreskin is tight and cannot be retracted. This condition is called phimosis and may occur during the first 6 years of life or as a result of recurrent balanitis (inflammation of the glans) or balanoposthitis (inflammation of the glans penis and prepuce).

______________ is a fluid accumulation in the tunica typically seen in infants. A. Varicocele B. Hypospadias C. Epididymitis D. Hydrocele

D. Hydrocele Fluid accumulates in the scrotum as a result of a defect in the tunica vaginalis; this condition is common in infancy; if the tunica vaginalis is not patent, the hydrocele will generally disappear spontaneously in the first 6 months of life.

Mrs. Baker presents to your office with her 2-year-old son. On examination, you note that the urinary meatus appears at the base of the penis. What is the name of this condition? A. Varicocele B. Epispadias C. Hydrocele D. Hypospadias

D. Hypospadias Hypospadias is a congenital defect in which the urethral meatus is located on the ventral surface of the glans penile shaft, or the base of the penis.

What type of hernia would you most likely see in a 15-year-old boy? A. Femoral hernia B. Umbilical hernia C. Direct inguinal hernia D. Indirect inguinal hernia .

D. Indirect inguinal hernia An indirect inguinal hernia is the most common type of hernia; both genders are affected. Often patients are children, especially young boys

Mr. Garbin is a 42-year-old patient who presents to your office for a yearly physical examination. On examination, you note that the foreskin of the penis is retracted over the glans and is unable to relax into its normal position. Which condition is most consistent with this clinical finding? A. Epispadias B. Spermatocele C. Balanitis D. Paraphimosis

D. Paraphimosis Paraphimosis is almost always an iatrogenically or inadvertently induced condition caused by retracting the prepuce and then inadvertently leaving it in its retracted position. In most cases, the foreskin reduces on its own, but if reduction does not occur, swelling and paraphimosis can occur.

Mr. Grayson is a 28-year-old patient who presents with a painful penile erection of 3 hours' duration. Which condition does Mr. Grayson have? A. Paraphimosis B. Phimosis C. Spermatocele D. Priapism

D. Priapism Rarely, you may see a patient with a prolonged penile erection, called priapism.

When examining the testes, it is important to palpate the vas deferens. How should a normal vas deferens feel? A. Spongy B. Beaded C. Rugated D. Smooth

D. Smooth The vas deferens itself feels smooth and discrete; it should not be beaded or lumpy in its course as you palpate from the testicle to the inguinal ring.

1. Mrs. Jones brings in her newborn infant son for a routine physical examination. On examination, you palpate a testicle in the inguinal canal that cannot, with gentle pushing, be moved into the scrotum. This finding is consistent with: A. a hydrocele. B. ambiguous genitalia. C. a direct inguinal hernia. D. an undescended testicle.

D. an undescended testicle. A testicle that is either palpable in the inguinal canal but cannot be pushed into the scrotum or not palpable at all is considered an undescended testicle.

Dense fibrous scar tissue forms in the tunica albuginea, and results in loss of penile length and pain on erection is called: Balanitis Paraphimosis Peyronie disease Phimosis

Peyronie disease

Moving a finger along the vas deferens is associated with: A. observing for hydrocele. B. observing for phimosis. C. palpating for tender testes. D. palpating for inguinal hernia.

palpating for inguinal hernia. Examine for evidence of a hernia. After asking the patient to relax again, insert your examining finger into the lower part of the scrotum and carry it upward along the vas deferens into the inguinal canal