Male GU- PD III Final Exam Graded A+

Corpus spongiosum - ANS What tissue contains the urethra and extends up to form the glans? Corpus cavernosa - ANS What tissue is "circumcised" or "uncircumcised?" Another name for foreskin; and what is secreted by it? - ANS Prepuce- secretes smegma Which side of the testes lies lower and what is its function? - ANS Left; Produces spermatazoa and testosterone What two structures ascend together as the spermatic cord and where do they pass through? - ANS Scrotal sac & Vas deferens; passes through external inguinal ring on way to abdomen and pelvis What combines with the vas deferens and creates fluid that sperm can live in? - ANS Seminal vesicle; these secretions include protein, enzymes, fructose, mucus, vitamin C, flavins, phosphorylcholine and prostaglandins What constituent of seminal fluid provides nutrient energy for spermatozoa when stored in semen in the laboratory? - ANS Fructose What forms a tunnel for the vas deferens and is a common location for hernias? - ANS Inguinal canal What are three basic landmarks of the male anatomy? - ANS ASIS Pubic tubercle Inguinal ligament What are the MC sites for males and females, respectively? - ANS Inguinal ligament are MC in males; Femoral hernias are MC in females What structure lies against the anterior rectal wall and is rubbery in nature? - ANS The prostate gland *Rounded, heart-shaped; normally 2.5 cm long The inguinal canal forms a tunnel for what structure? - ANS The vas deferens *Common spot for hernia in men What are the only palpable parts of the prostate? - ANS The lateral lobes & median sulcus The lymphatics from the penile and scrotal surfaces drain into... - ANS The inguinal LNs The lymphatics from the testes drain into... - ANS The abdomen (where enlarged LNs are clinically undetectable) The Tanner stages assess.. - ANS The size of penis and testes, how much pubic hair they have, and what age correlates with what stage. Development is complete and they reach a sexual maturity rating of 5 between age ____. - ANS 14.5-18 How should a pt with a potential STD be positioned for exam? - ANS Laid down How should someone be examined for hernias? - ANS Standing up! What are common lesions on the scrotum? - ANS Epidermoid cysts, which are occluded follicles filled w/ keratine debris What should be done when examining the foreskin (prepuce)? - ANS Always retract and check for smegma What should be done before putting finger into the anus? - ANS *Lubrication *Have pt bear down (hemorrhoids expand when pt bears down) **ONLY insert 1 finger, not 2 - Two ways to perform the rectal/prostate exam... - ANS 1) Bending over 2) Laying on side w/ spread buttcheeks (more difficult w/ obese patients) What type of hernia occurs when a palpable mass can be felt through the EXTERNAL INGUINAL RING (more medial)? - ANS A direct inguinal hernia What type of hernia occurs when the spermatic cord passes through the internal inguinal ring? - ANS Indirect inguinal hernia What should be done for a hernia check? - ANS Follow the spermatic cord up to the inguinal ligament into the external inguinal ring, and have the pt bear down What should be done if a hernia check is ambiguous? - ANS *Have them lie back and the hernia will disappear *Listen for bowel sounds *Transillumination What occurs in a femoral hernia and who are they MC in? - ANS A portion of the bowel descends through the femoral canal beneath the inguinal ligament; Very common in females and very rare in men What are 6 of the MC abnormalities of the penis? - ANS Carcinoma of the penis Peyronie's Disease Phimosis Paraphimosis Priapism Balanoposthitis What are characteristics of carcinoma of the penis? - ANS Typically NON-TENDER *Almost always NON-CIRCUMCIZED *Indurated nodule or ulcer, usually non-tender- suspect if there is a persistent penile sore What disease causes palpable, nontender HARD PLAQUES on the DORSUM of the penis- causes excruciatingly PAINFUL,CROOKED erection? - ANS Peyronie's disease *Usually occurs in those 50 What is the name of the condition where the foreskin cannot be retracted over the glans? - ANS Phimosis, which is NOT a medical emergency What is the name for the MEDICAL EMERGENCY where the foreskin has been left retracted behind the glans, resulting in painful engorgement and edema of the glans? If not tended to, this may result in glandular ischemia - ANS Paraphimosis (Pair of bulges) Priapism is defined as a PAINFUL pathologic erection that lasts longer than ____? - ANS 4 hours *Caused by loss of penile blood flow regulation or obstruction of venus flow What is the tx for priapism? What group can this not be done in? - ANS *May need to evacuate blood through a needle placed in the glans *Intracorporeal phenylephrine 250-500 mcg/3-5 minutes until detumescence (return to flaccid state) What is the condition involving inflammation of the glans, and when the foreskin is pulled back there is a malodorous, excoriated area of skin? What is the tx? - ANS Balanoposthitis (MC in uncircumcised men) *Tx= cleansing with soap, adequately dring, and antifungal powder What is usually used for older males with balanoposthitis? What about younger males? - ANS Older- antifungal powder (Nysatin) Younger- antistaph (Keflex) Congenital displacement of the urethral meatus to the VENTRAL surface - ANS Hypospadias Congenital displacement of the urethra meatus on the DORSAL side of the penis - ANS Epispadias What is a non-tender fluid-filled mass within the tunica vaginalis called? *"feels like an extra testicle" - ANS Hydrocele **Edematous around perimeter of scrotal sac What is a non-tender mass ABOVE the testis? - ANS Spermatocele- these generally don't occur before puberty **edematous at the TOP of scrotal sac, up by epidermis What is a varicose vein of the spermatic cord called? What does it feel like upon examination? - ANS Varicocele, feels like a "bag of worms" **Left side Right and improves when the scrotum is ELEVATED in supine pt Which two scrotal abnormalities can be lit up on transillumination? - ANS Hydrocele and spermatocele A true urologic emergency resulting from twisting of the spermatic cord; ACUTEly PAINFUL, swollen and retracted- What test should be done to make sure there's good blood flow? - ANS Testicular torsion **Check US to check bloodflow *Blood dot sign and lack of cremasteric reflex What is it called when the epididymis is inflamed & tender upon palpation (localized ONLY to epididymis) - ANS Epididymis Males that have an extra X chromosome have what, and what are the defining characteristics? - ANS Klinefelter's *Normal before puberty- thereafter, long legs and arms, female escutcheon, gynecomastia, and small testes; Infertile, sometimes mental retardation and learning disabilities- higher risk of breast cancer and diabetes Scrotal edema can occur secondary to what conditions, causing the scrotal skin to become taut? - ANS CHF & Nephrotic syndrome What is the name for the issue when one or both testes are absent? - ANS Cryptorchism *Decreased fertility, but most men are fine with one *Markedly raise the risk for testicular cancer The name when testis are swollen and painful (usually unilateral); often seen in MUMPS - ANS Orchitis **Sometimes hard to differentiate from epidiymitis Testes are typically ____, so ___ is considered small testis and are often caused by what? - ANS 4.5 cm 3.5 cm= small