3. Exam - Male GU Exam

Venereal warts How does it present? Causative organism? How to Dx?

"Condyloma acuminatum" - Warts that grow in clusters - Caused by HPV (human papillomavirus) Usually Dx'd by inspection

What test to order for urethritis? Two most common causes?

GEN probe Gonorrhea = N. gonorrhea (gram neg intracellular diplococci) Chlamydia = Chlamydia trachomatis (non staining)

On which side of the testicle is the epididymis? What's its function? What plexus of veins go to the testes?

Posterior lateral surface - Sperm storage/maturation Pampiniform plexus

What is the most common non-skin cancer? and 2nd leading cancer death in men in the US?

Prostate cancer

What do it call it when the foreskin can't be pulled distally over the end of the penis? Tx?

Paraphimosis tx: circumcise "Para" the foreskin is stuck AROUND the base of the glans

What do it call it when the foreskin can't be pulled down shaft?

Phimosis

Any unexplained rash on body, palms of hands, or soles of feet, think ____________

Secondary Syphilis

Which lymph nodes drain the testes? Drain the shaft of the penis?

Testes ---- lumbar LN's Shaft ---- Superficial Inguinal LN's

What kind of cancer is a "young man's disease"?

Testicular cancer

What is a Gen Probe?

Way to check for chlamydia or gonorrhea. Put culture stick in penis a inch then culture it.

Is prostate cancer common (among cancers) ?

Yes! 2nd most common cancer (for males) behind skin cancer - Especially for older males

Absence of vas deferns on one side is indicative of ___________

A missing kidney (mesonephric duct failure)

Phimosis Tx?

Foreskin cannot be retracted - It's stuck at the end - Opposite of paraphimosis Tx = circumcision

Paraphimosis Tx?

Foreskin is stuck behind the gland Tx = circumcision

If you have purulent discharge from the penis, what are the two major things it could be? How to distinguish?

"Urethritis" Gonorrhea - Gram-negative, Intracellular, Diplococci - 3-5 day incubation - Burning urine Chlamydia (non-gonococcal urethritis) - Not gram staining - 7-28 day incubation

Types of hernias Which is most common? Where does each happen?

*Indirect* inguinal hernia - *Most common for both sexes* - Lateral to inferior epigastric - Above inguinal lig *Direct* inguinal hernia - Very rare in women - Medial to inferior epigastric - Not into scrotum *Femoral* hernia - *Least common overall* - But, *more common in females*, though - Below inguinal lig

RPR What does it test for? Is it a screening or a confirmation test? What can give false positives?

*Screening* test for syphilis False positives due to - Pregnancy - Lupus - Measles - Chickenpox

Condyloma acuminatum What is it? Caused by what?

*Venereal warts* - Caused by HPV - Grow in clusters - Very hard to Tx

What counts as high risk sexual behavior? (6)

- All sexually active people < 24 y/o - Previous Hx of STD - New/multiple sexual partners - Inconsistent condom use - Exchanging sex for money/drugs - Early onset of sexual activity

Common GU Sx's

- Pain - Dysuria (painful urination) - Changes in urine flow (common for prostate) - Red urine (hematuria) - Penile discharge - Penile lesions - Genital rashes - Frequency and urgency with urination - Scrotal enlargement - Groin mass - Testicular mass - Erectile dysfunction - Infertility

Components of the male GU exam (5)

- Penis - Scrotum - Hernias - Prostate (DRE) - Special techniques (self-examination + transillumination)

What can give false positive PSA results? What does this test?

- Prostatic hypertrophy - Acute prostatitis Measures prostate specific Ag in serum - This is produced by prostate

What to inspect on the penis?

- Skin (lesions, rashes) - Hair (distribution, infection) - Prepuce (foreskin, need to retract) - Glans (lesions, inflammation) - Meatus (lesions, discharge)

All the rest should just be review if you want to do it.

...

1. How many lobes to the prostate gland? 2. Which one is easiest to feel and why is that clinically a good thing?

1. 5, Ant/Middle/Post/R/L 2. Posterior is easiest to feel with DRE This is good b/c this is the *most likely for cancer*

Which aspect of the inside of the rectum will you feel the prostate?

Anterior

What other pathology is associated with hypospadis?

Associated with congenital renal abnormalities

What are the two main types of bacterial urethritis? Most common causative organism of each? Can you have viral urethritis? Causative virus?

Bacterial - Gonococcal (Neisseria gonorrhoeae) = Gonorrhea - Non-gonococcal (Chlamydia trachomatis) = Chlamydia/The Clap Viral - HSV - Cytomegalovirus

How to do a testicular self-exam?

Best done during or after bath/shower - Examine each testicle with both hands - Roll testicle between fingers - Locate epididymis on POST surface - Looking for lumps/tenderness

Between what layers are you likely to find the fluid of a hydrocele?

Between layers of tunica vaginalis

Genital herpes How does it present? Due to what organism?

Cluster of small vesicles on penis - Painful ! - Progress to ulcers on erythmic base - Giant cells Herpes simplex virus 1 or 2

Genital scabies How does it present? Causative organism? How to Dx?

Contagious disease - Due to skin contact - Usually an itchy penis rash - Nocturnal pruritis progressing to intense pruritis (itching) - Caused by a mite (sarcoptes scabiei) Dx - Scraping and slide mount

Genital scabies Caused by what agent? How to transmit it?

Contagious disease caused by a mite - Sarcoptes scabiei - Due to direct skin contact, itching like crazy - Scrape the lesions and put on oil mount

Types of erectile tissue in the penis? Function of each?

Corpus spongiosum (one, contains urethra) Corpus cavernosa (two, fill with blood for erection)

Which type of hernia is more common in women?

Femoral hernia - BUT the LEAST COMMON overall hernia type - A woman is more likely to have an indirect inguinal hernia

Hydrocele What layers is it between? How to test for it?

Fluid filled mass - Between tunica vaginalis + testicle - Test with transillumination

How to get a sample of discharge from meatus?

Gently compress glans to express discharge from urethral meatus. Also can "milk" or "strip" the penis

What do you call the cone at the end of the penis? What do you call the foreskin?

Glans Prepuce

Genital warts are commonly caused by __________

HPV Human Papillomavirus

Which type of hernia is most common in men? In women?

Indirect inguinal hernia = Most common for both sexes

Pruritis (define)

Itching

Example of normal GU exam on SOAP note

Inspection - Circumcised - Glans without lesions - Urethral meatus w/o discharge - Scrotum no lesions - Normal hair distribution w/o lesions Palpation - Non-tender penis, no lesions/masses - Testicles smooth w/o tenderness or masses - Epididymis palpated, not enlarged - Spermatic cord not enlarged, no varicoceles, Vas deferns palpated - Inguinal lymph nodes not palpable Special - NEG hydrocele - NEG hernia B/L Prostate/Rectal - No hemorrhoids, no lesions - Sphincter tone good - Prostate not enlarged, smooth, non-tender - Rectal vault smooth, no masses

Gram negative, intracellular, diplococci

Neisseria gonorrhoeae Gonorrhea

What tests are there for syphilis (screening and confirmation) ?

Screening - RPR (Rapid plasma reagin) - VDRL (Veneral disease research laboratory test) Confirmation - FTA-ABS (blood test for syphilis Ab's) - TP-PA (T. pallidum particle agglutination) - Dark field microscopy (looking for treponema pallidum)

Common positions for prostate exam?

Sim's (good for girls) Standing and bending over (good for boys) Modified lithotomy (not recommended by Stash)

How to palpate for hernias?

Slide finger up inguinal canal - Ask them to cough, and feel for abdominal contents - Take a bunch of scrotal skin with you

What is the name for a hard little "pebble" like nodule in the spermatic cord?

Spermatocele, usually benign

Primary syphilis Sx's? Causative organism? How to Dx?

Syphilis - Gives painless chancre (ulcer) on shaft - Lymphadenopathy - Organism: *Treponema pallidum* (spirochaete) Dx - Screening = RPR + VDRL - Confirmation = FTA-ABS or Dark field microscopy or TP-PA

What do you call it when the the urethra opening is on the top of the shaft? When it's on the bottom of the shaft? What is important about the foreskin if your patient has this problem? What do you call the opening?

Top = Epispadis Bottom = Hypospadis *DO NOT circumcise!* Skin can be used to help fix it. Opening = "meatus"

True/False Pregnant women can transmit herpes to their babies

True! Herpes simplex virus

Cryptorchidism The problem? Tx?

Undescended testicle - Important to do in kids - Risk for testicular cancer Tx - Orhiopexy (pull it down and suture it to the bottom of the sack)

You feel a "bag of worms" when feeling a spermatic cord. What is it likely? Is it bad?

Varicocele NOT pathological, but if it's on the *left side* it could be concerning for cancer.

"Bag of worms" What are you feeling? Is it bad?

Varicocele - Enlarged and tortuous panpiniform plexus - Benign

What is the pubic hair pattern for male? Female? What if it changes?

male- triangle up to belly button Female- triangle pointing down Change in hair pattern could mean there is a change in hormones. (ex. lady has hair triangularly to bellybutton)