Block 1 - Pd2: Breast, Genital, Prostate And Rectal Exams

Front 1

What are the 4 zones of the prostate?

Back 1

Transition zone, central zone, peripheral zone, and anterior fibromuscular stroma

Front 2

Which part of the prostate accounts for only 5-10% of prostate, yet is the location for the majority of BPH and 20% of prostatic adenocarcinoma?

Back 2

Transition zone

Front 3

Which part of the prostate is 25% of the bulk, originating at the ejaculatory ducts? 1-5% of adenocarcinomas originate here.

Back 3

Central zone

Front 4

Which part accounts for 70% of the prostate, 70% of adenocarcinomas, and 90% of all prostatitis?

Back 4

Peripheral zone

Front 5

Which part of the prostate is rarely invaded by adenocarcinoma but can experience BPH?

Back 5

Fibromuscular Stroma

Front 6

What area is inflamed in prostatitis and what can cause it?

Back 6

Inflammation of the peripheral zone of the prostate due to infection, trauma, or stasis

Front 7

T/F

Prostatitis is palpable on a rectal exam, with pain and bogginess.

Back 7

True!

Front 8

What does prostatitis frequently show on end catch urinalysis (VB-3)?

Back 8

Frequently shows bacteriuria on end catch urinalysis (VB-3)

Front 9

What are a couple of things that prostatitis can lead to?

Back 9

Can cause urethral discharge or obstruction of the lower urinary tract

Front 10

T/F

It is relatively easy to culture for prostatitis.

Back 10

False!
Difficult to culture, prostatic massage (EPS = expressed prostatic secretion)

Front 11

Prostatitis causes increased levels of what in the blood?

Back 11

PSA (prostate-specific antigen)

Front 12

What disorder frequently becomes chronic, especially in conjunction with BPH?

Back 12

Prostatitis

Front 13

T/F

BPH (chronic enlargement of the prostate gland) is not a normal finding in males.

Back 13

False!

Occurs to some degree in all males

Front 14

What do studies suggest occurs with the prostate between the ages of 30 and 50?

Back 14

Studies suggest that the prostate doubles in size between the ages of 30 and 50

Front 15

Is there a link between BPH and prostate cancer?

Back 15

There is no causative link between BPH and prostate cancer, although more difficult to diagnose.

Front 16

What causes BPH?

Back 16

Many causes including hormonal control

Front 17

What can BPH cause?

Back 17

Urinary obstruction and chronic UTI

Front 18

What does treatment of BPH aim to accomplish?
When is surgery needed?

Back 18

Treatment aimed at prevention and reversal of hypertrophy.

Surgery for recalcitrant (difficult to manage, not responsive to treatment) cases.

Front 19

During what age range is prostatic carcinoma most common?

Back 19

Age 50-90

Front 20

Prostatic carcinoma can spread to what via the lymphatics?

Back 20

Bone

Front 21

What can prostatic carcinoma cause?

Back 21

Can cause acute urinary obstruction, with first symptom as urosepsis

Front 22

How often is prostatic carcinoma palpable on rectal exam?

Back 22

50% of cases

Front 23

Describe the etiology of prostatic carcinoma.

Back 23

Etiology is multifactorial, hormonally controlled

Front 24

What is the treatment for prostatic carcinoma?

Back 24

Treatment includes hormone manipulation, surgery, chemotherapy, and radiation

Front 25

How should the patient be positioned for a rectal exam?

Back 25

Lateral decubitus or bent forward with arms on table

Front 26

How should you maneuver your finger in a rectal exam?

Back 26

Insert finger pointing toward the umbilicus anteriorly and rotate your examining finger around 360 degrees for full palpation

Front 27

If you are doing a rectal exam and feel a mass on the prostate, is it better for the mass to be tender or nontender?

Back 27

Tender

Front 28

What does the anorectal junction separate (besides anus and rectum)?

Back 28

Boundary of skin and rectal mucosa. It also marks the change between somatic and visceral nerve supplies

Front 29

T/F

A prostate biopsy is a benign procedure.

Back 29

False!

If you don't know exactly where the mass is, they'll stick 5 or 6 shots into the prostate.

Front 30

What is the most common cause of urethritis?

Back 30

Chlamydia Trachomatis
(although there are many others)

Front 31

What disorder is associated with dysuria with discharge and a negative urinalysis?

Back 31

Urethritis

Front 32

How is urethritis usually spread?

Back 32

Usually sexually transmitted, although many etiologies

Front 33

How can you diagnose urethritis?

Back 33

Culture urethral tip

Front 34

If you have multiple urethritis infections, what can it cause?

Back 34

Urethral strictures

Front 35

What is another name for venereal warts?

Back 35

Chondyloma Accuminata

Front 36

What is the physical description of venereal warts?

Back 36

Can be single or multiple warts, that are raised, flat, or verrucous (cauliflower); asymptomatic, and nontender to palpation

Front 37

a) HPV is a causative agent for what?

b) HPV is highly associated with what?

Back 37

a) Venereal warts

b) Cervical cancer

Front 38

What is the incubation period for venereal warts?

Back 38

Weeks to months

Front 39

T/F

Venereal warts may disappear spontaneously.

Back 39

True!

Front 40

What is the physical description of genital herpes?

Back 40

Small red grouped or scattered vesicles that are tender to palpation. Primary episode usually painful, recurrence less so

Front 41

What is the causative organism for genital herpes?

Back 41

HSV II (herpes simplex virus)

Front 42

What is the incubation period for genital herpes?

Back 42

2-7 days

Front 43

What prodromal symptoms may genital herpes cause?

Back 43

Fever, malaise (feeling uneasy), cephalgia (headache), arthralgia (joint pain) and lymphadenopathy

Front 44

What is the name for congenital displacement of the urethra to the inferior surface of the penis?

Back 44

Hypospadius

It usually requires surgical correction

Front 45

What is the physical description of carcinoma of the prepuce or glans of the penis?
Who is it most common in?

Back 45

Indurated (hardened?) nodule or ulcer that is nontender.

Nearly all limited to uncircumcised men

Front 46

Most common neoplasm of testicular cancer occurs in what age range?

Back 46

men aged 15-35

Front 47

What are some relatively accurate tumor markers of testicular cancer?

Back 47

AFP and bHCG

Front 48

Where can testicular carcinoma spread via the lymphatics?

Back 48

lymphatic spread to chest and brain

Front 49

T/F

The mortality rate for testicular cancer is 50%

Back 49

False!

Over 50% mortality in 1970 to < 5% in 2000

Front 50

What are some risk factors for testicular cancer?

Back 50

Risk factors include exposure to high estrogen levels in utero, radiation, cryptorchidism, history of testicular carcinoma, and infertility

Front 51

How is testicular cancer diagnosed?

Back 51

ultrasound and biopsy

Front 52

How is testicular cancer treated?

Back 52

Multimodal treatment including orchiectomy

Front 53

What is the most common type of scrotal hernia?

How can you determine if that's what it is?

Back 53

Usually indirect inguinal

You won't be able to palpate above it, and you may use stethoscope to assess bowel sounds

Front 54

What is cryptorchidism?

Why must it be removed?

Back 54

Atrophied testicle, nonpalpable in scrotum or will not stay ‘down’. It may lie in the inguinal canal or abdomen resulting in empty scrotum.

Because it markedly raises the risk for testicular cancer

Front 55

What is the physical description of acute orchitis?

Back 55

Inflamed, tender swollen testicle. It can be difficult to distinguish from epididymitis. It is usually unilateral.

Front 56

Acute orchitis is usually (bacterial/viral).

Back 56

Viral

Front 57

What is the physical description of acute epididymitis?

Back 57

Tender to palpation superior to testicle, and it may be difficult to differentiate from testis (orchitis)

Front 58

Acute epididymitis may also occur with what other problems?

Back 58

UTI or prostatitis

Front 59

What is the name for a painless mobile cystic mass superior to the testicle that contains sperm?

Back 59

Spermatocele

It may be an epididymal cyst filled with fluid

Front 60

Which male disorders/problems transilluminate?

Back 60

Spermatocele and hydrocele

Front 61

Which male problem feels like a soft ‘bag of worms’ on palpation.

How else can it be described physically?

Back 61

Varicocele

Feels nontender (usually) and collapses when scrotum is raised.

Front 62

Why can varicoceles be associated with infertility?

Back 62

Because the blood may make the testes too warm to produce sperm.

Front 63

Which side are varicoceles usually found?

Back 63

Left

Front 64

A hydrocele is a (tender/nontender) fluid filled mass.

Back 64

Nontender

Front 65

Where is a hydrocele located in the scrotum?

Back 65

Tunica Vaginalis

No mass above the testicle

Front 66

What is the physical description of a testicular tumor?

Back 66

Usually painless nodule on the testicle, indurated and smooth

Front 67

When in life are testicular tumors most common?

Back 67

Generally presents in 3rd or 4th decade of life

Front 68

T/F

All suspicious lumps in the scrotum are investigated, regardless of age.

Back 68

True!

Front 69

T/F

Advanced testicular tumors may replace the entire testicle.

Back 69

True!

Front 70

What is the physical description of testicular torsion?

Back 70

Acutely painful, tender, swollen testicle of sudden onset. The testicle may retract upward in the scrotum, and the scrotum becomes erythematous and edematous.

Front 71

Testicular torsion is most common in what age group?

Back 71

Adolescents

Front 72

T/F

Testicular torsion is usually associated with trauma or infection.

Back 72

False!

Usually NOT associated with trauma or infection

Front 73

Which male disorder/problem is a surgical emergency?

Back 73

Testicular torsion

Front 74

Why are UTI's less common in males?

Back 74

Because of the increased length of the urethra and isolated entrance

Front 75

a) 85% of UTI's are caused by what?

b) They are also frequently seen when?

c) They are rarely caused by what?

Back 75

a) E. Coli invasion from the rectum

b) After intercourse due to trauma of the bladder trigone, urethral meatus.

c) Rarely from hematogenous or lymphatic spread

Front 76

What happens in up to 50% of UTI cases?

This especially happens when?

Back 76

Infection ascends into ureters and causes pyelonephritis.

Especially in concomitant decreased peristaltic activity i.e. pregnancy, bacterial endotoxins

Front 77

T/F

Recurrent pyelonephritis in females, and ANY case in males must be investigated.

Back 77

True!

Front 78

How do you perform a speculum exam?

Back 78

First, place 2 fingers on the posterior aspect of the introitus to relax pelvic musculature and facilitate insertion of speculum.
Then, insert the speculum at an angle, and upon insertion, rotate it vertically.
Open speculum only after it is fully inserted.
The speculum may be pivoted slightly for better inspection.
Remove the speculum without closing it.

So, do not open speculum until it is inside, and then do not close it until it is outside.

Front 79

What are the types of epithelium on the cervix?

Back 79

Columnar in the middle and squamous around the outside

Front 80

In a bimanual exam of a female, what structures can be palpated?

Back 80

Cervix, uterus (fundus) and adenexa (uterine tubes and ovaries)

Front 81

How does cranberry juice prevent UTI's?

Back 81

It helps prevent bacterial adhesion in the bladder

Front 82

How can you tell by looking at the cervix if the woman is nulliparous?

Back 82

The os will be small and round if nulliparous. If not, it will look more like an incision.

Front 83

What problems do rectoceles and cystoceles cause?

Back 83

Rectocele: problems with defecation
Cystocele: trouble urinating and stress incontinence (coughing)

Front 84

Why might the body of the uterus be palpable through the rectum?

Back 84

If there is marked retroversion of the uterus (cervix faces forward)

Front 85

How far along a woman is in pregnancy can be estimated by palpating for the fundus of the uterus (in normal, single baby pregnancies).
If the fundus is at the umbilicus, about how far along is she?

Back 85

20-22 weeks

Front 86

When might the fundus of the uterus be palpated through the rectum?

Back 86

When the uterus is retroflexed. (angled back)

Front 87

What is the term for onset of menses?

Back 87

Menarche

Front 88

What is the term for when menses stop?

Back 88

Menopause

Front 89

T/F

Menarche age is the same across all countries.

Back 89

False!

For some reason, menarche varies depending on which country you're in (U.S. average 12)

Front 90

What is the most common cause of amenorrhea?

Back 90

Pregnancy

Front 91

What is the term for painful menses?

Back 91

Dysmenorrhea
(cramps are only a type of dysmenorrhea)

Front 92

What is the term for lots of bleeding?

Back 92

Menorrhagia

Front 93

What is the term for frequent bleeding (implies dysfunctional uterine bleeding)?

Back 93

Metrorrhagia

Front 94

What is the term for frequent periods (less than 21 days) that are regular and consistent?

Back 94

Polymenorrhea

Front 95

Describe key characteristics of viticulture in Bordeaux.

Back 95

mostly high density planting w/machine harvesting. Handpicking for fine sweet wines (noble rot)
regular spraying required

Front 96

What is the term for less bleeding?

Back 96

Hypomenorrhea

Front 97

What is the term for bleeding after intercourse?

Back 97

Post coital bleeding

Front 98

What is the most common cancer in females aged 15-40?

Back 98

Cervical cancer

Front 99

What is a good serum tumor marker for cervical cancer?

Back 99

There is no good serum tumor marker

Front 100

What types of symptoms are associated with cervical cancer?

Back 100

It's essentially asymptomatic

Front 101

How is cervical cancer diagnosed?

Back 101

It's easily discoverable on a PAP smear.
Then biopsy on colposcopy

Front 102

How is cervical cancer treated?

Back 102

Surgery (multiple procedures) is curative if caught before spread

Front 103

How is ovarian cancer diagnosed

Back 103

It's difficult to diagnose, because there is no screening test or reliable tumor marker. Ca-125 can be used as marker, but it's not sensitive or specific.
It cannot be felt on PAP smear accurately, and is usually found late, or incidentally.

It CAN be seen on ultrasound or CAT scan.

Front 104

How is ovarian cancer treated?

Back 104

Treatment includes surgery, chemo, and radiation

Front 105

What is the prognosis for ovarian cancer?

Back 105

Up to 80% mortality 5 year survival rate

Front 106

What is the strongest risk factor for ovarian cancer?

Back 106

Family history of breast or ovarian cancer and BRCA1 and/or BRCA2 mutations.

It tends to run in families, but this is not reliable.

Front 107

How is pregnancy history recorded?

Back 107

Using Gravida-Para notation:

G = gravida, or total number of pregnancies

P = para, or pregnancy outcomes
F = full term
P = premature
A = abortions (includes miscarriages)
L = Living child

example: G2 P1102

Front 108

T/F

Nipples may be present anywhere along the milk line.

Back 108

True!

The milk line extends from the axilla down to the very upper inner thighs.