Bates' Guide to Physical Examination and History Taking: Male Genitalia Flashcards

3 cylindrical columns of erectile tissue

make up the dorsal side of the penis

make up the ventral side of the penis; expands into a cone of erectile tissue glans

joins shaft at corona

goes through the corpus spongiosum and forms meatus

slit at the glans tip

hood or flap of skin over glans

loose sac continuation of abdominal wall

controls the size of the scrotum in response to temperature to keep 37 degrees or lower

produce sperm; solid oval shape 4-5cm long 3cm wide; suspend vertically by the spermatic cord; covered by double layer membrane separating from the scrotal wall; layers lubricated to allow testis to slide and prevent injury

the lower of the two testes

coiled duct system that provides for storage maturation and transit of sperm ; sits atop the testis; comma shaped, curved over the top and posterior surface of the testis

a duct which with other vessels forms the spermatic cord

ascends posterior border of testis; runs through tunnels of inguinal canal into abdomen; unites with seminal vesicle to form ejaculatory duct at level with prostate

arterial dilation with concurrent venous constriction of emissary veins; sympathetic inhibition and parasympathetic activation; release of pro-erectogenic neurotransmitters

parasympathetic neurotransmitter during erection

sympathetic neurotransmitter during erection

reduced intracellular calcium increased cGMP and increased cAMP

fills with 20-40x blood flow during erection and pressure averages 100mmHg

fills during erection with less blood and 1/3 the pressure of the other

muscles that increase pressure in all three chambers; the muscles force more blood into chamber increasing pressure to several hundred mmHg

contract to prevent retrograde seminal flow and urinary output

semen pH

urine pH

occurs during and after ejaculation; transient increased pressure of smooth muscle contraction against occluded venous system; emissary veins expand and allow sinusoids to drain with a fast drop in pressure; norepinephrine released as sympathetic impulse takes over; calcium channels close, smooth muscle relaxes

expand during and after ejaculation and allow sinusoids to drain with a fast drop in pressure

released as sympathetic impulse takes over

inhibits erection by degrading cGMP

result in smooth muscle relaxation increasing cGMP and decreased intracellular calcium

male genitalia health history cues

age of concern for chlamydia

age of concern for testicular torsion

age of concern for varicocele

age of concern for testicular cancer

age of concern for NG urethritis

age of concern for hydrocele

age of concern for testicular lymphoma

age of concern for erectile dysfunction

age of concern for bacteriuria

past medical history concerns males

family history concerns males

social history concerns males

medication concerns males

inability to retract foreskin

unable to return foreskin to original position

ventral location of meatus

dorsal location of meatus

congenital condition; downward deflection occurring on its own or with hypospadias; noticeable most from the side; a contraindication to circumcision in newborn-instead can be done at surgical correction

fibrous scar tissue on penis causes curvature and pain with erection in adult

genital warts caused by HPV

flat warts second stage of syphilis

what to consider when nodule, tenderness, swelling on inspection/palpation

dilated veins in spermatic cord; bag of worms texture; with patient standing what to consider when thickened cord, soft swollen tortuous on inspection/palpation

bulge extending into scrotum

firm non tender mass that does not transilluminate

painful swollen testes

serous fluid around testes, transilluminated with red glow

cystic mass in epididymis, transilluminates separate from testis

undescended testis (risk of cancer and infertility)

excruciating one sided testicular pain, sudden swelling, testicle elevation, nausea and vomiting, sometimes abdominal pain, fever, and previous history of testicular pain; mostly in 12-18 year olds, many under 30, can be any age including newborns; urologic emergency that must be treated within 4-6 hours to spare the testicle

seen with torsion of the appendix testis; mullein duct remnant superior aspect of the testicle; often treated with analgesics, cooling, and decreased activity

common in newborns, but usually goes away within the first year; testicle drops into scrotum, a sac from abdominal cavity travels along with testicle; fluid flows to the scrotum to surround the testicle, sac usually closes and fluid is absorbed

when sac closes and fluid remains the scrotal sac can be compressed fluid will not flow back into the abdomen; often found in newborns and fluid will usually be absorbed with time

scrotal sac is compressed and fluid slowly goes back up into the abdomen or hydrocele changes size; usually appears after activity indicating the sac or processes vaginalis is still open and requires intervention

inspect inguinal region for bulge with standing, palpate canal on each side; start finger low on scrotal half, palpate up length of cord to external ring triangular slit like opening; if finger fits advance gently and have patient bear down or cough; normally no bulge or change, palpating mass bumps finger

male genitalia documentation

3.5 x 3 cm gland below bladder encircling urethra; consists of 5 lobes; surrounds urethra at bladder neck; produces most ejaculatory fluid; secretions are thin, milky, and alkaline- the transport medium protecting sperm and preventing UTI; contains fibrolysin which liquefies semen and aids sperm motility; common site of age related issues

health history cues for rectal, anal, prostate

risk factors of rectum anal and prostate

age to begin prostate screening

age to begin screening if high risk: African American, 1 st degree relative diagnosed <65

age to begin screening if multiple first degree relatives affected at early ages

test frequency if PSA <2.5

test frequency if PSA >2.5

percentage of men and women that will be diagnosed with anal cancer at some point in their lifetime

overall five year survival rate of anal cancer

rubbery or boggy on palpation

stony hard on palpation

fluctuant softness

prostate exam normal findings

prostate protrusion 1-2cm

prostate protrusion 2-3cm

prostate protrusion 3-4cm

prostate protrusion >4cm