Ch 19 Male Genitalia

Front 1

 what constitutes the male genitalia?

Back 1

 Penis
 Testicles
 Epididymis
 Behind the testicle
 Scrotum
 Skin surrounding the testicles. Can’t say “normal scrotum”-doesn’t tell you about the testicle.
 Prostate gland
 Seminal vesicles

Front 2

 the penis serves as

Back 2

the final excretory organ of for urine and when erect, as means for introducing semen into the vagina

Front 3

 Anatomy and Physiology: Penis:  consists of

Back 3

 Corpora cavernosa
 Corpus spongiosum

Front 4

 Anatomy and Physiology: Penis: Corpora cavernosa

Back 4

 which form the dorsum and sides

Front 5

 Anatomy and Physiology: Penis: Corpus spongiosum

Back 5

 contains the urethra
 the corpus spongiosum expands at its distal end to form the glans penis

Front 6

 Anatomy and Physiology: Penis:  Urethra/orifice

Back 6

 a slit like opening located approximately 2 mm ventral to the tip of the glans

Front 7

 Anatomy and Physiology: Penis: prepuce

Back 7

 foreskin
 newborn-4 years old-put light traction on prepuce when bathing-smegma can get stuck

Front 8

 Anatomy and Physiology: Penis; Penis function

Back 8

 Excretes urine
 Introduces sperm into vagina

Front 9

 Anatomy and Physiology: Scrotum: Testis

Back 9

 ovoid and measures approximately 4 x 3 x 2 cm
 Testicular functions
 Spermatogenesis
 requires maintenance of temperature lower than 37°C
 Testosterone production

Front 10

 Anatomy and Physiology: Scrotum:  Epididymis

Back 10

 a soft, comma-shaped, structure located on the posterior lateral and upper aspect of the testis.
 It provides for storage, maturation, and transit of sperm

Front 11

 Anatomy and Physiology: Scrotum: Spermatic cord

Back 11

X

Front 12

 Anatomy and Physiology: Scrotum: Muscle Layer

Back 12

 termed the creamastic muscle, that allows the scrotum to relax or contract
 testicular temperature is controlled by altering the distance of the testes from the body through muscular action

Front 13

 Anatomy and Physiology: Infants/Children:  Sexual differentiation

Back 13

 Sexual differentiation by 12 weeks gestation
 any fetal insult during a or nine weeks of gestation may lead to major anomalies of the external genitalia
 minor morphologic abnormalities arise during later stages of gestation

Front 14

Anatomy and Physiology: Infants/Children:  Descent of testes

Back 14

 Descent of testes may occur after birth
 during the third trimester, the testes descend from the retroperitoneal space to the inguinal canal to the scrotum.
 At full-term, one or both testes may still lie within the inguinal canal, with the final descent into the scrotum occurring in the early postnatal period
 descent of the testicles may be arrested at any point, however, or they may follow an abnormal Pap
 Catch undescended testicles early, otherwise can be sterile and nonfunctional + risk factor for testicular cancer

Front 15

Anatomy and Physiology: Infants/Children: separation of prepuce

Back 15

 Complete separation of prepuce at about 3-4 years
 small separations between the glans and the inner preputial epithelium began during the third trimester
 separation of the prepuce from the glans is usually incomplete at birth and often remain so until the age of 3 to 4 years in uncircumcised males

Front 16

 Anatomy and Physiology: Adolescents

Back 16

 Puberty - functional maturation of reproductive organs
 Increased size - penis/testes
 Pubic hair develops

Front 17

 Anatomy and Physiology: Older Adults

Back 17

 Pendulous scrotum
 Increased ejaculate volume
 Decreased sexual activity
 Slower erection
 Orgasm less intense
 Pubic hair finer/balding
 Decrease in sperm viability
 Psych/couple therapy
 Treatment-viagra

Front 18

 Related History: Present Problem:  Difficulty achieving/maintaining erection (Impotence)

Back 18

 Difficulty achieving/maintaining erection (Impotence)
 Pain with erection, prolonged painful erections
 Consider infection
 Character
 constant or intermittent, with one or more sexual partners
 Associated symptoms
 associated with alcohol ingestion or medication
 Medications
 diuretics, sedatives, antihypertensive agents, anxiolytics, estrogens, inhibitors of androgen synthesis, antidepressants, carbamazepine, erectile dysfunction agents

Front 19

 Related History: Present Problem:  Difficulty with ejaculation

Back 19

 Painful/premature
 Emotional issue-social worker/urologist
 Efforts to treat
 Character of ejaculate
 color, consistency, odor, and amount
 White/creamy normal.
 Medications
 Alpha blockers, antidepressants, antipsychotics, clonidine, methyldopa

Front 20

 Related History: Present Problem: Discharge/lesion on penis

Back 20

 Character
 Painful
 Herpes until proven otherwise
 Painless
 Syphilis until proven otherwise
 Discharge
 color, consistency, odor, tendency a stained underwear
 Urethritis
 Associated symptoms
 itching, burning, stinging
 Exposure to STD
 exposure to STD's, multiple partners, infection and partners, failure to use condom, history of prior STDs
 Medications

Front 21

 Related History: Present Problem: Infertility

Back 21

 Lifestyle factors
 lifestyle factors that may increase temperature of scrotum: tight clothing, briefs, hot baths, employment in high temperature environment (e.g., a steel mill) or required prolonged sitting (e.g., truck driving), variceal
 Time attempting pregnancy
 Sexual activity pattern
 Knowledge of female reproductive cycle
 History undescended testes
 Increased change of sterility and testicular cancer
 Diagnostic evaluation to date
 semen analysis
 physical examination
 sperm antibody titers
 Women/female
 Emotional counseling
 Medications
 testosterone, glucocorticoids, hypothalamus releasing hormone

Front 22

 Related History: Present Problem:  Enlargement in inguinal area

Back 22

 Character
 intermittent or constant, Association with straining or lifting, duration, presence of pain
 Tender, transient, after bowel movement
 Change in mass
 change in size or character of mass; ability to reduce the mass; if unable to reduce it, how long since it could be reduced
 Pain in groin
 character (tearing, sudden, searing, or cutting pain), associated activity (lifting heavy objects, coughing, or straining at stool)
 Nausea-if gonads are effected-nausea WILL happen
 Efforts to treat
 use of truss or other treatment
 Medications
 analgesics

Front 23

 Related History: Present Problem: Testicular pain/mass

Back 23

 Change in testicular size
 Onset
 a fence surrounding onset: noted casually while beeping, after trauma, during a sporting event
 Lumps
 Soreness
 Heaviness
 Medications
 analgesics, antibiotics

Front 24

 Related History: Past Medical History:  Surgery of GU tract

Back 24

 undescended testes, hypospadias, FB status, hydrocele, variceal, hernia, prostate; vasectomy

Front 25

 Related History: Past Medical History:  Sexual history

Back 25

 Erection, ejaculation, frequency, pleasure
 sexually-transmitted infections: single or multiple infections, specific organism (gonorrhea, syphilis, herpes, warts, chlamydia), treatment, effectiveness, residual problems

Front 26

 Related History: Past Medical History:  Chronic illness

Back 26

 testicular or prostatic cancer, neurologic or vascular impairment, diabetes mellitus, arthritis, cardiac or respiratory disease
 Effect on libido

Front 27

 Related History: Family History

Back 27

 Infertility in siblings
 genetic
 Hernias

Front 28

Related History: Personal/Social History

Back 28

 Employment risks
 occupational risks of trauma to suprapubic region are genitalia, exposure to radiation or toxins
 Exercise risks
 use of protective device with contact sports or bicycle riding
 Riding bicycles frequently
 Concerns about genitalia
 size, shape, surface characteristics, texture
 Testicular self-exam practices
 Concerns about sexual practices
 sexual partners (single or multiple), sexual lifestyle (heterosexual, homosexual, bisexual)
 Reproductive function
 number of children, form of contraception used, frequency of ejaculation
 Use of alcohol/drugs
 quantity

Front 29

 Related History: Infants/Children

Back 29

 Maternal use of sex hormones
 Birth control pills will NOT kill fetus early in pregnancy
 Circumcision complications
 Too much can cause problems
 Hygiene measures
 Scrotal swelling
 Congenital anomalies
 Masturbation/sexual exploration
 Swelling/sores on penis/scrotum
 Genital pain

Front 30

 Related History: Adolescents

Back 30

 Knowledge of reproduction/sexual function
 Nocturnal emissions
 Pubic hair/organ enlargement
 Sexual activity/barrier protection

Front 31

 Related History: Older Adults

Back 31

 Change in sexual activity
 related to loss of spouse or other sexual partner; no sexual partners; sexually restrictive environment; depression; physical illness resulting in fatigue, weakness, or pain
 Change in sexual response
 longer time required to achieve full erection, less forceful ejection late and, more rapid detumescence, longer interval between directions, prostate surgery

Front 32

Exam & Findings: Inspection/Palpation:  Genital hair distribution

Back 32

 Coarseness
 coarser than scalp hair
 Abundance
 it should be abundantly pubic region and may continue in narrowing midline pattern to the umbilicus
 Hair: diamond shape from umbilicus.

Front 33

Exam & Findings: Inspection/Palpation: penis:  Dorsal vein

Back 33

should be apparent

Front 34

Exam & Findings: Inspection/Palpation: penis: foreskin retraction

Back 34

 retract the foreskin are asked the patient to do so
 it should retract easily and a bit of white, cheesy Snecma may be seen over the glans
 PHIMOSIS-
 occasionally foreskin is tight and cannot be retracted-this condition is called phimosis and may occur during the first six years of life it is usually congenital but may result from reoccurring infection or previous unsuccessful efforts to retract the foreskin that may have caused radial tearing of the preputial ring, resulting in adhesions of the foreskin and so gland
 Balantis
 inflammation of the glans, occurs only in uncircumcised individuals and is often associated with phimosis
 it may be caused by either bacterial or fungal infections and is most commonly seen in men with poorly controlled diabetes mellitus and the candidal infection
 PRIAPISM
 prolonged penile erection
 often painful
 in the majority of cases the conditions idiopathic, a can occur in patients with leukemia or hemoglobinopathies such as sickle cell disease.

Front 35

Exam & Findings: Inspection/Palpation: penis: phimosis

Back 35

occasionally foreskin is tight and cannot be retracted-this condition is called phimosis and may occur during the first six years of life it is usually congenital but may result from reoccurring infection or previous unsuccessful efforts to retract the foreskin that may have caused radial tearing of the preputial ring, resulting in adhesions of the foreskin and so gland

Front 36

Exam & Findings: Inspection/Palpation: penis: balantis

Back 36

inflammation of the glans, occurs only in uncircumcised individuals and is often associated with phimosis
 it may be caused by either bacterial or fungal infections and is most commonly seen in men with poorly controlled diabetes mellitus and the candidal infection

Front 37

Exam & Findings: Inspection/Palpation: penis: priapism

Back 37

prolonged penile erection
 often painful
 in the majority of cases the conditions idiopathic, a can occur in patients with leukemia or hemoglobinopathies such as sickle cell disease.

Front 38

Exam & Findings: Inspection/Palpation: penis:  Texture

Back 38

 the texture of a flaccid penis should be soft and free of nodularity

Front 39

Exam & Findings: Inspection/Palpation: penis: tenderness/induration

Back 39

x

Front 40

Exam & Findings: Inspection/Palpation: penis:  Discharge

Back 40

 strip the urethra for any discharge by firmly compressing the base of the penis with your thumb and forefinger and moving them towards the glans
 the presence of discharge may indicate a sexually-transmitted infection

Front 41

Exam & Findings: Inspection/Palpation: urethral meatus: ORIFACE SIZE/LOCATION

Back 41

the orifice should appear slit like and be located on the ventral surface just millimeters from the tip of the glans
 press the glans between your thumb and forefinger to open the urethral orifice

Front 42

Exam & Findings: Inspection/Palpation: urethral meatus: COLOR/MOISTURE

Back 42

 the opening should be glistening in pink
 bright erythema or discharge indicates inflammatory disease, whereas a pinpoint around opening may result from meatal stenosis

Front 43

Exam & Findings: Inspection/Palpation: scrotum

Back 43

 Color
 it may appear more deeply pigmented in the body skin, and the service may be course
 Texture
 the surface may appear course
 the scrotum usually appears asymmetric because the left testicle has a longer spermatic cord and therefore is often lower
 the thickness of the scrotum definitely varies with temperature in age, and perhaps with emotional state
 lumps in the scrotal skin are commonly caused by sebaceous cysts
 Pitting
 occasionally you may observe unusual thickening of the scrotum caused by edema, often with pitting
 this does not generally imply disease related to genitalia, but is more likely a consequence of general fluid retention associated with cardiac, renal, or hepatic disease
 Cysts

Front 44

 Exam & Findings: Inspection/Palpation: Testes

Back 44

 palpate the testes using the thumb and the first three fingers
 LEFT IS TYPICALLY HIGHER THAN RIGHT
 Tenderness
 should be sensitive to gentle compression but not tender, and they should feel smooth and robbery and free of nodules
 in some diseases (e.g., syphilis and diabetic neuropathy), a testis may be totally insensitive to painful stimuli
 Texture
 they should feel smooth and robbery and free of nodules
 Nodules
 they should feel smooth and robbery and free of nodules

Front 45

Exam & Findings: Inspection/Palpation: Creamastic Reflex

Back 45

 stroke the inner thigh with a blunt instrument such as the handle of a reflex hammer, or for child, with your finger
 possessive form scrotum should rise of stroke side

Front 46

Exam & Findings: Inspection/Palpation: infants

Back 46

 Inspect/palpate
 Congenital anomalies
 Incomplete development
 Sexual ambiguity
 Urethral placement
 Retractability of foreskin
 Descent of testicles
 Masses
 Transilluminate scrotum if mass found

Front 47

 Exam & Findings: Children:  Inspect/palpate

Back 47

 Size
 Lesions
 Malformations
 Discharge
 Descent of testicles
 Masses

Front 48

 Exam & Findings: Adolescents

Back 48

 Allay anxiety
 Protect privacy
 Inspect/palpate
 Expected maturational changes

Front 49

 Common Abnormalities: Hernia: definition

Back 49

 protrusion of the peritoneal lines sac do some defect in the abdominal wall

Front 50

Common Abnormalities: Hernia: Pathophysiology

Back 50

 occur because there is a potential space for protrusion of some abdominal organ, commonly the bowel but occasionally the omentum
 hernias arise along the course that the testicle traveled as it exited the abdomen entered the scrotum during intrauterine life
 femoral hernias occur at the fossa ovalis, where the femoral artery exits the abdomen
 strangulated hernia is a non-reducible hernia in which the blood supply to the protruded tissue is compromised; this condition requires prompt surgical intervention

Front 51

Common Abnormalities: Hernia: Subjective data

Back 51

 soft swelling or bulge in inguinal area
 may have pain or straining (indirect, femoral)

Front 52

Common Abnormalities: Hernia: Objective Data

Back 52

 indirect: soft swelling in area of internal ring; hernia comes down canal and touches fingertip on examination
 large hernia may be present in scrotum
 direct: bulge an area of hesselbach triangle; easily reduce; hernia bulges anteriorly, pushes again side of finger on examination
 femoral: right-sided presentation more common than left; inguinal canal empty on examination

Front 53

Common Abnormalities: Hernia: Direct

Back 53

 Direct less common goes through External ring
 presentation: bulging area of hesselbach triangle; usually painless; easily reduced; hernia bulges anteriorly, pushes against side of finger on examination

Front 54

Common Abnormalities: Hernia: Indirect

Back 54

 Indirect more common goes through internal ring
 presentation: soft swelling in area of internal ring; pain on straining; hernia comes down canal and touches fingertip on examination

Front 55

Common Abnormalities: Hernia: Femoral

Back 55

 least common, goes through femoral ring
 presentation-right-sided presentation more common than left; pain may be severe; inguinal canal empty on examination

Front 56

 Common Abnormalities: Penis: Paraphimosis: Definition

Back 56

 the inability to replace the foreskin to his usual position after it has been retracted behind the glans
 intrapment of the foreskin behind the glans

Front 57

Common Abnormalities: Penis: Paraphimosis: Pathophysiology

Back 57

 almost always a iatrogenically or inadvertently induced condition caused by retraction 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
 when the foreskin becomes trapped behind the corona for a prolonged period, constricting band of tissue forms around the penis and Paris blood and lymphatic flow to the glans penis and the prepuce

Front 58

Common Abnormalities: Penis: Paraphimosis: Subjective Data

Back 58

 retraction of the foreskin during penile examination, cleaning, urethral catheterization, or cystoscopy
 penile pain and swelling
 children airport obstructive voiding symptoms

Front 59

Common Abnormalities: Penis: Paraphimosis: objective data

Back 59

 glans penis is congested an enlarged
 foreskin edematous
 constricting band of tissue directly behind the head of the penis
 if untreated, necrosis and gangrene of the glans penis may be present (discolored, blackened, ulcerated)

Front 60

Common Abnormalities: Penis: HYPOSPADIAS: definition

Back 60

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

Front 61

Common Abnormalities: Penis: HYPOSPADIAS: pathophysiology

Back 61

 congenital defect that is thought to occur embryonic way during urethral development, from 8 to 20 weeks of gestation
 several etiology suggested, including genetic, endocrine, and environmental factors
 presence of hypospadias puts the infant at greater risk for having undescended testicles

Front 62

Common Abnormalities: Penis: HYPOSPADIAS: subjective data

Back 62

 parent may note penile defect

Front 63

Common Abnormalities: Penis: HYPOSPADIAS: Objective data

Back 63

 diagnosis generally made on examination of the newborn infant
 urethral meatus located on the ventral surface of glans penile shaft with the base of the penis
 dorsal fluid of foreskin and glanular groove are evident, but prepuce is incomplete ventrally
 penis may have ventral shortening and curvature, called chordee, with more proximal urethral defects

Front 64

Common Abnormalities: Penis:  Syphilitic chancre: definition

Back 64

 skin lesion associated with primary syphilis

Front 65

Common Abnormalities: Penis:  Syphilitic chancre: pathophyisology

Back 65

 sexually-transmitted infection caused by the bacterium treponema pallidum
 contracted through direct contact with the syphilis sore
 lesion of primary syphilis generally occurs two weeks after exposure

Front 66

Common Abnormalities: Penis:  Syphilitic chancre: subjective data

Back 66

 painless lesion on penis
 history of sexual contact

Front 67

Common Abnormalities: Penis:  Syphilitic chancre: objective data

Back 67

 solitary lesion; firm, round, small, commonly located on the glans but can be located on the foreskin
 lesion has indurated borders with a clear base
 scrapings from the ulcer, when examined microscopically, show spirochetes
 tinker last 3 to 6 weeks and heals without treatment

Front 68

Common Abnormalities: Penis: GENITAL HERPES: definition

Back 68

 genital herpes is a sexually-transmitted infection caused by the herpes simplex virus

Front 69

Common Abnormalities: Penis: GENITAL HERPES: pathophysiology

Back 69

 genital herpes most commonly caused by the HSV-2vvirus
 most transmission of HSV occurs when individual shed virus in the absence of symptoms

Front 70

Common Abnormalities: Penis: GENITAL HERPES: subjective data

Back 70

 painful lesions on penis
 history of sexual contact
 may report burning or pain with urination

Front 71

Common Abnormalities: Penis: GENITAL HERPES: objective data

Back 71

 superficial vesicles on the glans, penile shaft, or the base of the penis
 often associated with inguinal lymphadenopathy and systemic symptoms, including fever
 men who have sex with men may also get blisters in or around the anus

Front 72

Common Abnormalities: Penis: CONDYLOMA ACUMINATA: Defintion

Back 72

 genital warts caused by the human papilloma virus

Front 73

Common Abnormalities: Penis: CONDYLOMA ACUMINATA: Pathophysiology

Back 73

 HPV invades the basal layer of the epidermis; virus penetrates through skin and causes mucosal micro-abrasions
 latent viral phase begins with no signs or symptoms and can last for a month to several years
 following latency, viral DNA, Sites and particles are produced; host cells become infected in develop the characteristics skin lesions
 considered a sexually-transmitted infection

Front 74

Common Abnormalities: Penis: CONDYLOMA ACUMINATA: Subjective Data

Back 74

 soft painless warty like lesions on penis
 history of sexual contact

Front 75

Common Abnormalities: Penis: CONDYLOMA ACUMINATA: Objective Data

Back 75

 single or multiple papular lesions
 may be pearly, filiform, fungating (ulcerating and necrotic) cauliflower, or plaque-like
 can be smooth, verrucous, or lobulated
 may be the same color as the skin, or they may be pretty sure hyper pigmented
 lesions are commonly present on the prepuce, glans penis, and penile shaft, but they may be present within the urethra as well

Front 76

Common Abnormalities: Penis: Molluscum contagiosum: DEFINITION

Back 76

 benign skin infection

Front 77

Common Abnormalities: Penis: Molluscum contagiosum: PATHOPHYSIOLOGY

Back 77

 caused by poxvirus that infects only the skin
 spread by skin to skin contact or by contact with an object that has touched infected skin
 virus enters the skin through small breaks in the skin barrier
 after incubation period, growth appears

Front 78

Common Abnormalities: Penis: Molluscum contagiosum: SUBJECTIVE DATA

Back 78

 painless lesion on penis
 contact with an infected person

Front 79

Common Abnormalities: Penis: Molluscum contagiosum: OBJECTIVE DATA

Back 79

 lesions are pearly gray, often umbilicated, smooth, dome shaped, and with discrete margins
 lesions most common on the glans penis

Front 80

Common Abnormalities: Penis:  Peyronie disease: DEFINTION

Back 80

 characterized by a a fibrous band in the corpus cavernosum, causes deviation during erection

Front 81

Common Abnormalities: Penis:  Peyronie disease: PATHOPHYSIOLOGY

Back 81

 dense, fibrous scar tissue (plaque) forms in the Tunica Albuginea (wall of the corpus cavernosum)
 plaque vocally interferes with expansion of the corpus cavernosum during erection
 etiology unclear; may occur as the result of trauma, inflammation, or inherited disorder
 it is generally unilateral
 the mid top of the penis is the area most commonly involved

Front 82

Common Abnormalities: Penis:  Peyronie disease: SUBJECTIVE DATA

Back 82

 bending and/or indentation of the erection
 loss of penile length
 may have pain with erection
 family history of the condition
 history of the Dupuytren contracture (fourth and fifth fingers of the hand)

Front 83

Common Abnormalities: Penis:  Peyronie disease: OBJECTIVE DATA

Back 83

 one or more palpable hardened areas
 reduce elasticity of the flaccid penis
 radiographs or ultrasounds can show plaque calcification

Front 84

Common Abnormalities: Penis: Penile cancer: Pathophysiology

Back 84

 squamous cell carcinoma usually originating in the glans or foreskin
 may initially form on the corona of the clans and spread superficially across the glance into the prepuce
 etiology of these cancers may be related to chronic exposure to carcinogens contained in smegma that collects within the prepuce
 manually have been circumcised rarely develop penile cancer

Front 85

Common Abnormalities: Penis: Penile cancer: subjective data

Back 85

 painless ulceration that fails to heal
 uncircumcised
 poor penile hygiene

Front 86

Common Abnormalities: Penis: Penile cancer: objective data

Back 86

 lesion, usually on glans may presents as a reddened area
 papule or pustule
 40 growth, shallow erosion, or a deep ulceration with rolled edges
 may have a phimosis that obscures the lesion

Front 87

 Priapism

Back 87

 Persistant usually painful erection. Causes: Pediatric age group = sickle cell anemia, Leukemia, Idiopathic, Other:
 Excessive sexual stimulation, anticoagulants, DM, impotency treatment (injections)

Front 88

 Phimosis

Back 88

 inability to retract

Front 89

 Sexually Transmitted Disease: Urethritis:

Back 89

 Uretheral Inflammation
 Usually Sexually Transmitted
 Penile Swab
 Treat Presumptively
 Reportable
 Treat Partner
 Education

Front 90

Sexually Transmitted Disease: Epididemitis: DEFINITION

Back 90

 inflammation of the epididymis (a major consideration in the differential diagnosis in testicular torsion, surgical emergency)

Front 91

Sexually Transmitted Disease: Epididemitis:PATHOPHYSIOLOGY

Back 91

 often seen in Association with a urinary tract infection
 may also occur as a result of a ST I
 occasionally, chronic epididymitis may occur as a consequence of tuberculosis
 Etiology is Age Dependent
 Young: Chemical epidimitis from reflux disease (PRESEXUAL-PLUMBING)
 16-45: STDs (SEXUAL-STDS)
 Old: E Coli, etc from Benign Prostatic Hypertrophy or strictures (OLDER-CHEMCIAL)
 Caution testicular torsion
 Sudden pain

Front 92

Sexually Transmitted Disease: Epididemitis: SUBJECTIVE DATA

Back 92

 painful scrotum
 urethral discharge
 fever
 pyuria
 recent sexual activity
 Gradual onset of Lower Abdominal and /or Testicular Pain/Tenderness
 Swelling, erythema and tenderness of the testicle
 Typically with fevers, chills, pyuria
 Pain relieved with scrotal elevation

Front 93

Sexually Transmitted Disease: Epididemitis: OBJECTIVE DATA

Back 93

 epididymis feels firm and lumpy; is tender
 vasa differentia may be beaded
 overlying scrotum may be markedly erythematous

Front 94

 Common Abnormalities: Scrotum: Hydrocele: DEFINITION

Back 94

 fluid accumulation in the scrotum

Front 95

Common Abnormalities: Scrotum: Hydrocele: PATHOPHYSIOLOGY

Back 95

 fluid accumulation in the scrotum as a result of the defect in the tunica vaginalis; this condition is common in infancy; if the tunica vaginalis is not patent, the hydrocele will generally appear spontaneously in the first six months of life
 Fluid in Tunica Vaginalis
 Tissue surrounding testicle

Front 96

Common Abnormalities: Scrotum: Hydrocele: SUBJECTIVE DATA

Back 96

 painless enlargement or swelling of the scrotum

Front 97

Common Abnormalities: Scrotum: Hydrocele: OBJECTIVE DATA

Back 97

 nontender, smooth, firm mass superior and anterior to the testes
 transilluminate
 confined to the scrotum and is not enter the inguinal canal, unless it has been present for a long time and is very large and taut
 Hydrocele should be confined to the scrotum, does not enter the inguinal canal. Should transilluminate

Front 98

Common Abnormalities: Scrotum: SPERMATOCELE: DEFINITION

Back 98

 benign cystic accumulation of sperm occurring on the epididymis

Front 99

Common Abnormalities: Scrotum: SPERMATOCELE: PATHOPHYSIOLOGY

Back 99

 etiology and pathophysiology unknown

Front 100

Common Abnormalities: Scrotum: SPERMATOCELE: SUBJECTIVE DATA

Back 100

 asymptomatic; incidental finding on physical examination are self-examination

Front 101

Common Abnormalities: Scrotum: SPERMATOCELE: OBJECTIVE DATA

Back 101

 smooth, spherical, nontender mass at epididymis (superior and posterior to the testis)
 usually smaller than 1 cm

Front 102

Common Abnormalities: Scrotum: VERICOCELE: DEFINITION

Back 102

 abnormal tortuosity in dilation of the veins in the paminiform plexus within the spermatic cord
 Tortuose/Dilated veins in the spermatic cord

Front 103

Common Abnormalities: Scrotum: VERICOCELE: PATHOPHYSIOLOGY

Back 103

 more common in the left testicle than the right because of several anatomic factors, including the angle at which the left testicle vein enters the left renal vein, the lack of effective anti-reflux valves at the juncture of the testicular pain in the renal vein, and the increased renal vein pressure due to his compression between the superior mesenteric artery and the aorta
 usually on the left side. Can cause infertility.

Front 104

Common Abnormalities: Scrotum: VERICOCELE: SUBJECTIVE DATA

Back 104

 usually asymptomatic (and found in course of evaluation for infertility)
 may report scrotal pain or heaviness

Front 105

Common Abnormalities: Scrotum: VERICOCELE: OBJECTIVE DATA

Back 105

 often visible only when patient is standing; is classically described as “bag of worms"

Front 106

Common Abnormalities: Scrotum: ORCHITIS: DEFINITION

Back 106

 acute inflammation of the testes secondary to infection
 Testicular Inflammation
 Trauma/infection

Front 107

Common Abnormalities: Scrotum: ORCHITIS: PATHOPHYSIOLOGY

Back 107

 uncommon except as a complication of moms in the adolescent or adult
 is generally unilateral and results in testicular atrophy and 50% of the cases
 in older adults may result from bacterial migration from the prostatic infection

Front 108

Common Abnormalities: Scrotum: ORCHITIS: SUBJECTIVE

Back 108

 acute onset testicular pain and swelling
 pain ranges from mild discomfort to severe pain
 associated systemic symptoms: fatigue, malaise, myalgia, fever
 mumps orchitis follows the development of parotitis by 4-7 days

Front 109

Common Abnormalities: Scrotum: ORCHITIS: OBJECTIVE

Back 109

 enlarged, tender testes
 erythematous and edematous scrotal skin
 enlarge epididymis associated with epididymo-orchitis

Front 110

Common Abnormalities: Scrotum: TESTICULAR CARCINOMA: Definition

Back 110

 Seminomas and nonseminomas arise from germ cells (sperm producing cells)
 non-germ cell tumors arise from supportive and hormone producing tissue
 most testicular cancers are germ cell cancers
 germ cell tumors tend to occur in young man and is the most common tumor in males 15 to 30 years of age

Front 111

Common Abnormalities: Scrotum: TESTICULAR CARCINOMA: Pathophysiology

Back 111

 presence of painless mass in testicle
 PAINLESS NODULE
 may report scrotal enlargement or swelling
 sensation or heaviness in the scrotum
 dull ache in the lower abdomen back or groin
 sudden collection of fluid in the scrotum

Front 112

Common Abnormalities: Scrotum: TESTICULAR CARCINOMA: subjective data

Back 112

 presence of painless mass in testicle
 may report scrotal enlargement or swelling
 sensation or heaviness in the scrotum
 dull ache in the lower abdomen, back, or groin
 sudden collection of fluid in the scrotum

Front 113

Common Abnormalities: Scrotum: TESTICULAR CARCINOMA: objective data

Back 113

 a regular, non-tender mass fixed on the testis
 does not transilluminate
 may have hydrocele (does transilluminate)
 may have associated inguinal lymphadenopathy

Front 114

Common Abnormalities: Scrotum: TESTICULAR TORSION: DEFINITION

Back 114

 twisting of testes on spermatic cord; testicular torsion is a surgical emergency

Front 115

Common Abnormalities: Scrotum: TESTICULAR TORSION: PATHOPHYSIOLOGY

Back 115

 a congenital anatomic and anomaly (bell Clapper deformity) results in incomplete testicular attachment
 twisting of the spermatic cord cuts off the blood supply to the testicles
 Causes testicular ischemia/infarction
 occurs in newborns to adolescence; most commonly and adolescence

Front 116

Common Abnormalities: Scrotum: TESTICULAR TORSION: SUBJECTIVE DATA

Back 116

 acute onset of scrotal pain, often accompanied by nausea and vomiting
 absence of systemic symptoms such as fever or myalgia
 risk factors: trauma and strenuous physical activity
 Pain can come and go

Front 117

Common Abnormalities: Scrotum: TESTICULAR TORSION: OBJECTIVE DATA

Back 117

 the testicle is exquisitely tender
 scrotal discoloration is often present
 absence of cremastic reflex on side of acute swelling
 Diagnosis is time critical
 6 hours before testicular infarction
 Scrotal Elevation does not relieve pain

Front 118

acute testicular swelling: torsion versus epididymitis: cause

Back 118

torsion: twisting of testes on spermatic cord
epididymitis: bacterial infection (STI or UTI)

Front 119

acute testicular swelling: torsion versus epididymitis:age

Back 119

torsion: newborn to adolescence
epididymitis: adolescents to adulthood

Front 120

acute testicular swelling: torsion versus epididymitis:onset of pain

Back 120

torsion:acute
epididymitis:gradual

Front 121

acute testicular swelling: torsion versus epididymitis:vomiting

Back 121

torsion:common
epididymitis:uncommon

Front 122

acute testicular swelling: torsion versus epididymitis:anorexia

Back 122

torsion:common
epididymitis:uncommon

Front 123

acute testicular swelling: torsion versus epididymitis:fever

Back 123

torsion:uncommon
epididymitis:possible

Front 124

acute testicular swelling: torsion versus epididymitis:dysuria

Back 124

torsion:uncommon
epididymitis:possible

Front 125

acute testicular swelling: torsion versus epididymitis:supporting findings

Back 125

torsion:absence of cremasteric reflex on side of acute swelling, scrotal discoloration
epididymitis:urethral discharge, history of recent sexual activity, fever, pyuria, thickened or nodular epididymis

Front 126

Sexual differentiation in the fetus has occurred by _____ weeks’ gestation

Back 126

12 weeks gestation

Front 127

The most common cancer in young men aged 15 to 30 years is

Back 127

testicular cancer

Front 128

Which type of hernia lies within the inguinal canal

Back 128

indirect hernia

Front 129

How much blood usually engorges the two corpora cavernosa of the penis when it is erect?

Back 129

20 to 50 ML

Front 130

An enlarged, painless testicle in an adolescent or adult may indicate

Back 130

a tumor

Front 131

Parents of a 6-year-old boy should be asked if he has

Back 131

scrotal swelling

Front 132

Penile erection

Back 132

Spermatogenesis

Front 133

Which of the following is a risk factor for testicular cancer

Back 133

Cryptorchidism

Front 134

You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should

Back 134

inquire about previous penile infections

Front 135

The movement of the testes by cremasteric muscular action regulates

Back 135

testicular temperature