Examination Of The Male Genitourinary System

Front 1

How many new cases of testicular cancer are made each year?

Back 1

6,000 (approx. 1% of all cancers in men)

Front 2

The peak incidence of testicular cancer occurs between what ages?

Back 2

20 and 35, with a small peak occurring in early childhood

Front 3

What age is testicular cancer considered uncommon? and at what age is it so rare that tumors of the testes almost always turn out to be malignant lymphoma?

Back 3

40
50

Front 4

What are 4 risk factors for testicular cancer?

Back 4

1. Caucasian race
2. cryptorchidism or undescended testes. Abdominal testes increase risk more than inguinal testes. The descended testis is still at increased risk if the other testis is undescended.
3. a history of mumps orchitis
4. a history of inguinal hernia in childhood

Front 5

Which increase the risk more for testicular cancer: abdominal testes or inguinal testes?

Back 5

abdominal

Front 6

What does early detection of testicular cancer lead to?

Back 6

to treatment that is often curative

Front 7

What are some symptoms a pt may have with testicular cancer?

Back 7

most pts present with a lump in the scrotum, scrotal hardness, scrotal heaviness, scrotal pain or swelling

Front 8

In the US, what is the most common malignancy in men?

Back 8

prostate cancer (approx. 20% of all cancers in men)
and follows only lung and colon cancer as being the most common cause of cancer deaths in men older than 55 years of age (10% of all cancer deaths in men)

Front 9

How many new cases of prostrate cancer are diagnosed each year in the U.S?

Back 9

320,000 new cases

Front 10

In a pt. with Prostate Cancer, what is believed to play a role in pathogenesis?

Back 10

environmental factors

Front 11

Which cancer is disease more common in Caucasians? how about African- Americans?

Back 11

Caucasians= testicular cancer
African-Americans- prostate cancer

Front 12

What are some common symptoms of prostate cancer?

Many of the same symptoms occur in men with what?

Back 12

burning or pain on urination, decreased urinary stream, increased urinary frequency, hematuria and back or pelvic pain

many of the same symptoms occur in men with benign prostatic hyperplasia

Front 13

Why is the rectal exam an extremely important component of the adult male physical?

Back 13

Bcuz some cases of prostate cancer, even advanced one, may be completely asymptomatic

Front 14

Is it mandatory that women examiners need to have a male chaperone present?

Back 14

yes

if a male is not available, two women is better than just one, however it may substantially increase the level of emotional discomfort for the pt. so permission from the pt needs to be given

Front 15

Is it mandatory that male examiners need to have a chaperone?

Back 15

some suggest they do

having a male or female chaperone accompany a male examiner has the potential to increase pt discomfort and result in the pt refusing to undergo examination

Front 16

What does examination of the penis begin with?

Back 16

inspection

Front 17

What is the color of the skin of the penis like in comparison to the rest of the body?

Back 17

it is often darker than the skin over the rest of the body

Front 18

What must the dr. do in non-circumcised males?

Back 18

the prepuce (foreskin) of the penis must be retracted in order to visualize the glans

Front 19

What is it called when their is an inability to retract the foreskin?

Back 19

phimosis

Front 20

Once the foreskin is retracted, an inability to replace the foreskin over the glans is termed what?

Back 20

paraphimosis

Front 21

What is inflammation of the glans of the penis called?

Back 21

balanitis

Front 22

Balanitis is often secondary to _________ and the build up of _____ (sloughed epithelial cells and mucus)

Back 22

phimosis

smegma

Front 23

What should the external meatus and terminal urethra be observed for?

Back 23

congenital defects or urethral discharge suggestive of sexually transmitted disease

Front 24

What are the glans and shaft of the penis inspected and palpated for?

Back 24

signs of skin breakdown, ulceration, growths or induration

Front 25

What is the term given to the situation where the urethral meatus opens on the ventral surface of the glans or the shaft. It may be an external marker for other internal urinary malformations/

Back 25

hypospadias

Front 26

What is the term given to the situation where the urethral meatus opens dorsally on the glans or shaft of penis?

Back 26

epispadias

Front 27

What 4 things does the scrotum contain?

Back 27

testis
epididymis
spermatic cord
a layer of muscle

Front 28

What separates the two scrotal sacs?

Back 28

a septal fold

Front 29

What is the major role of the scrotum?

Back 29

temperature regulation of the testis, keeping the gland about 2 degrees C lower than core temperature

Front 30

What is the spermatic cord composed of?

Back 30

the vas deferens and testicular arteries and veins

Front 31

What does the spermatic cord leave the scrotum through?

Back 31

the inguinal canal

Front 32

Which scrotal sac hangs lower than the other? and why?

Back 32

left, bcuz the spermatic cord is longer

Front 33

What muscle determines the size of the scrotum?

Back 33

the tone of the dartos muscle

Front 34

In what type of environment does the scrotum contract in?

Back 34

cold environments

Front 35

In what type of environment is the scrotum more pendulous in?

Back 35

warm environments

Front 36

Scrotal edema occurs because of what 5 things?

Back 36

lymphatic obstruction
congestive heart failure
nephrotic syndrome
portal vein obstruction
torsion of the spermatic cord

Front 37

What are common and need to be differentiated from each other?

Back 37

scrotal masses

Front 38

What are 4 exam techniques commonly used to differentiate one scrotal mass from another?

Back 38

inspection
palpation
auscultation
transillumination

Front 39

What should all scrotal masses be palpated for?

Back 39

size, shape, and consistency

Front 40

When may an indirect inguinal hernia present as a scrotal mass?

Back 40

when the hernia descends through the inguinal canal coming to lie in front of the spermatic cord and testis

Front 41

Do indirect inguinal hernias transilluminate?

Back 41

NO

Front 42

In a pt with indirect inguinal hernia, what may be heard in the scrotal sac during auscultation of the scrotum?

Back 42

peristaltic sounds

Front 43

What is the accumulation of serous fluid in the cavity of the tunica vaginalis secondary to infection or trauma.

Back 43

a hydrocele of the tunica vaginalis

Front 44

In a pt with hydrocele of the tunica vaginalis, what does fluid accumulation result in?

Back 44

a mass that lies anterior to the testis and epididymis

Front 45

In a pt with hydrocele of the tunica vaginalis, what is the mass caused by?

Back 45

a hydrocele transilluminates

Front 46

Where does a hydrocele of the spermatic cord usually lie?

Back 46

lies high in the scrotum

Front 47

Can a hydrocele of the spermatic cord transilluminate?

Back 47

Yes...this makes it difficult to differentiate from a hydrocele of the tunica vaginalis

Front 48

What is a cystic collection of fluid in the epididymis that contains sperm?

Back 48

spermatocele

Front 49

What is the size of spermatoceles?

Back 49

usually pea sized but can be as large as 8-10 cm

Front 50

What does the mass produced by a spermatocele follow the course of?

Back 50

follows the course of epididymis posterior and superior to the testis

Front 51

Can spermatoceles transilluminate?

Back 51

yes they may

Front 52

Are spermatoceles tender?

Back 52

usually non tender

Front 53

Varicocele is the term given to what?

Back 53

it is the term given to varicosities of the pampiniform venous plexus running along the spermatic cord

Front 54

Are varicoceles most visible when a pt is sitting or standing?

Back 54

standing

Front 55

What does a varicocele produce?

Back 55

a soft, irregular, scrotal mass superior to the testis that has the feel of "a bag of worms"

Front 56

Do varicoceles transilluminate? Why or why not?

Back 56

NO, because they are simply a conglomerate of tortuous dilated veins

Front 57

On which side do varicoceles usually occur and why?

Back 57

on the left side bcuz venous pressure in the left spermatic vein (which empties into the left renal vein) is normally higher than pressure in the right spermatic vein (which empties into the inferior vena cava.

Front 58

What do varicoceles occurring exclusively on the right side require?

Back 58

additional evaluation to rule out the possibility of inferior vena cava obstruction as a cause

Front 59

Varicoceles found exclusively on the left side can develop as a result of what?

Back 59

compression of the left renal vein by renal carcinoma

Front 60

What three things can varicocele cause?

Back 60

infertility
heaviness in the scrotum
pain

Front 61

Varicoceles may cause infertility. What is this due to?

Back 61

increased temperature of the testicle as a result of retrograde blood flow into testicular veins

Front 62

What is orchitis?

Back 62

an acute inflammation of the testis that presents as tender swelling of the scrotal contents

Front 63

What is the most common cause for orchitis?

Back 63

bacterial infection originating in the urinary tract

Front 64

What is the most common cause for orchitis induced hypogonadism?

Back 64

viral orchitis (mumps)

Front 65

In what type of inflammation may the scrotum be characterized as red and hot?

Back 65

orchitis

Front 66

In orchitis, does the scrotal sac transilluminate?

Back 66

no

Front 67

What systemic symptoms may a pt with orchitis have?

Back 67

fever
chills
myalgias

Front 68

What is epididymitis?

Back 68

a tender swelling of the epididymis usually due to a venereal disease

Front 69

What are the symptoms of a pt. with epididymitis?

Back 69

swelling and tenderness tend to localize along the course of the epididymis (superior and posterior to the testicle)

Front 70

swelling and tenderness localized along the course of the epididymis (superior and posterior to the testicle) is a sign of what?

Back 70

epididymitis

Front 71

Like orchitis, apididymitis is often accompanied by what type of systems?

Back 71

systemic symptoms

Front 72

Does the scrotal sac transilluminate in a pt with epididymitis?

Back 72

NO

Front 73

What does testicular torsion result form?

Back 73

rotation of the spermatic cord and blood vessels along the vertical axis

Front 74

What develops rapidly in testicular torsion?

Back 74

severe pain and scrotal swelling

Front 75

Does the scrotum transilluminate during testicular torsion?

Back 75

no

Front 76

When do most cases of torsion happen?

Back 76

around the time of puberty

Front 77

Why is Torsion an urologic emergency?

Back 77

bcuz testicular infarction will result if the torsion is not corrected

Front 78

What does testicular cancer presents typically as?

Back 78

a painless testicular nodule adherent to the surface of the testis. multiple nodules may exist

Front 79

Does the scrotal sac transilluminate in a pt with testicular cancer? why/why not?

Back 79

No, bcuz the cancer is solid

Front 80

What does the normal testis measure?

Back 80

3.5 to 5cm in length and 2.5 cm in width

Front 81

When is testicular atrophy present?

Back 81

when the testes are small than the normal measure of 3.5 to 5 cm in length and 2.5 cm width

Front 82

What 3 things can atrophy result from?

Back 82

infection (mumps)
normal aging
deficiencies in the hypothalamic-pituitary hormone axis

Front 83

What does an indirect inguinal hernia result from?

Back 83

Weakness in the internal inguinal ring that allows a piece of bowel to slide down along spermatic cord. The hernia may exit the external ring and enter the scrotal sac or manifest as a bulge over the midpoint of the inguinal ligament

Front 84

In an indirect inguinal hernia, the hernia may exit the external ring and do what?

Back 84

may exit the external ring and enter the scrotal sac or manifest as a bulge over the midpoint of the inguinal ligament

Front 85

What must the examiner do to detect an indirect inguinal hernia?

Back 85

must palpate the length of the inguinal canal by invaginating the scrotal sac with the index finger inserted into the external inguinal ring

the pt is asked to cough or strain while the examiner checks for an impulse at the end of the fingertip

Front 86

What does a direct inguinal hernia result from?

Back 86

weakness in the posterior wall of the inguinal canal almost directly behind the external ring

Front 87

In a pt with a direct inguinal hernia, where is a bulge produced?

Back 87

a bulge is produced through the floor of the inguinal canal close to the pubic tubercle and medial to that of an indirect inguinal hernia.

Scrotal involvement is rare.

Front 88

Femoral hernias occur most commonly in who: females or males?

Back 88

females

Front 89

What do femoral hernias produce?

Back 89

a bulge distal to the inguinal ligament and adjacent to the femoral vessels

Front 90

What does the normal prostate measure?

Back 90

4x3x2 cm

Front 91

What does the normal prostate weigh?

Back 91

approx. 20 gms in the young adult

Front 92

In the prostate, the posterior surface of the gland is in close contact with what?

Back 92

the anterior rectal wall

Front 93

In the prostate, the posterior surface of the gland is accessible to digital palpation on______?

Back 93

rectal exam

Front 94

Digital exam of the rectum typically explores how far into the rectum?

Back 94

8-10cm

Front 95

On exam, the prostrate is convex and divided into two halves by what?

Back 95

a shallow medium sulcus

Front 96

What does the normal prostrate have the consistency of?

Back 96

tightly extended thenar eminence

Front 97

How are prostrate sizes graded?

Back 97

by estimating the amount of protrusion of the gland into the rectum

one system for estimating size is depicted blow:
grade 1 enlargement= 1-2 cm of protrusion into the rectum
grade 2= 2-3cm
grade 3= 3-4cm
grade 4= 4cm or more

Front 98

The normal prostrate gland protrudes no more than how far into the rectum?

Back 98

1 cm

Front 99

Who does benign prostatic hyperplasia (BPH) affect?

Back 99

a condition that affects nearly all elderly men

Front 100

When does benign prostatic hyperplasia typically begin?

Back 100

after age 45

Front 101

What is the mean age for symptoms to occur in a pt with benign prostatic hyperplasia?

Back 101

65 in Caucasians
60 in African Americans

Front 102

In a pt. with benign prostatic hyperplasia, as the prostate enlarges, urethral obstruction occurs resulting in what symptoms?

Back 102

decreased urinary system
difficulty starting and stopping the urine
terminal dribbling
frequency of urination including nocturia

Front 103

What does increased alpha-adrenergic receptor density in prostate tissue contribute to?

Back 103

bladder outlet obstruction by increasing smooth muscle tone within the prostate itself

Front 104

What are the two necessary features for benign prostatic hyperplasia to occur?

Back 104

aging
presence of dihydrotestosterone that is normally produced within the prostate from testicular testosterone

Front 105

Where is dihydrotestosterone normally produced?

Back 105

within the prostate from testicular testosterone

Front 106

What characteristics of the prostate does hyperplasia produce?

Back 106

smooth, firm, elastic, or rubbery enlargement of the prostate

nodularity may be present

urethral obstruction can occur in the absence of an enlarged gland on digital rectal palpation

Front 107

Rubbery enlargement of the prostate can be a cause of what?

Back 107

hyperplasia

Front 108

Cancer of the prostate can occur without what?

Back 108

without prostatic enlargement

Front 109

What are the characteristics (consistency) or cancer of the prostate?

Back 109

nodular, irregular, and stone-hard in consistency

Front 110

Can cancer of the prostate occur in the absence of palpable nodularity?

Back 110

yes

Front 111

Because some cancers are undetectable on exam, yearly measurement of what?___ has become a valuable adjunct to physical exam for the early detection of prostate cancer.

Back 111

prostatic specific antigen

Front 112

Where does cancer of the prostate most often develop?

Back 112

in the lateral lobes of the gland which are very accessible to digital rectal exam

Front 113

Can pts with cancer of the prostate be asymptomatic?

Back 113

yes and many are

Front 114

Pts with cancer of the prostate who are NOT asymptomatic, may have obstructive symptoms similar to those that develop in BPH. Some present with__________ or ___________ as a result of bone metastasis.

Back 114

skeletal pain or pathologic fractures