Bates Chapter 13- Male genitalia (complete review) Questions With 100% Correct Answers.

American Cancer Society recomends testicular self-examinations for___________ - ages of 15 and 34, monthly Disseminated gonorrhea may present as? - Rash, tenosynovitis, monoarticular arthritis, even meningitis Erection from venous engorgement of the corpora cavernosa results from two types of stimuli, Which are? - 1- Visual, auditory, or erotic cues that trigger sympathetic outflow from higher brain centers to the T11 through L2 levels of the spinal cord. 2- Tactile stimulation initiates sensory impulses from the genitalia to S2 to S4 reflex arcs and parasympathetic pathways through the pudendal nerve. Frank but tactful questions about sexual practices - patient's sexual orientation, the number of partners in the past month, and any history of past STIs , alcohol and drug use, especially injection drugs How to do palpation of Penis - Palpate any abnormality of the penis, noting any tenderness or induration, shaft of the penis between your thumb and first two fingers, noting any induration. Palpation of the shaft may be omitted in a young, asymptomatic male patient. How to inspect for hernias? - Sitin front of the standing pt and an assistant present, inspect the inguinal regions and genitalia for bulging areas and asymmetry. As you observe, ask the patient to strain and bear down (the Valsalva maneuver) to increase intra-abdominal pressure, making it easier to detect hernias How to Palpate each testis and epididymis - Btw Thumb and first two fingers (feels nodular and cord-like . Note size, shape, consistency, and tenderness; feel for any nodules. Pressure on the testis normally produces a deep visceral pain.If penile discharge is present, what should you ask the pt next? - amount, color, and any fever, chills, rash, or associated symptoms. If you detect a hernia of any type, what does this warrant? - surgical evaluation If you detect a large scrotal mass and upon auscultation of the mass you do not hear bowel sounds, what does this suggest? - hydrocele If you detect a large scrotal mass and upon auscultation of the mass you hear bowel sounds, what does this suggest? - hernia If you detect a large scrotal mass that does not return to the abdomen when the patient is supine but you are able to get your fingers above the mass in the scrotum, what does this suggest? - hydrocele If you suspect hernia and you can you get your fingers above the mass in the scrotum, this indicates - hydrocele Increase Nitric oxide and cyclic GMP levels due to stimulation, resulting in? - local vasodilation. Inspecting the scrotum - skin, scrotal contours, Note dome-shaped white or yellow papules or nodules formed by occluded follicles filled with keratin debris of desquamated follicular epithelium. (there are common, frequently multiple, and benign) Lack of orgasm with ejaculation is usually - psychogenic Listen to the mass with a stethoscope for bowel sounds. If present its---- - not hydrocele. Risk factors for Testicular Carcinoma - cryptorchidismundescended testicle carcinoma in the contralateral testicle mumps orchiti an inguinal hernia; hydrocele in childhood. Sequence of entire evaluation - Penis (inspect, palpate, Milk) Scrotal (testis, spermatocord, vas d) Hernias (Inspect, Palpate external inguinal, then internal inguinal; palpate femoral) Evaluate for possible scrotal hernia Advise pt to do testicular self-examination (TSE) Sequence of Inspection of Penis - Skin, Prepuce (retracted), glans, around the base (ulcers, scars, nodules, or signs of inflammation) Swellings containing blood or tissue that do not transilluminate include what conditions? - normal testes, tumors, most hernias Swellings containing serous fluid that light up with red glow or transilluminate are suggestive of what condition? - hydroceles T/F Premature ejaculation is common, especially in young men than in middle-aged or older men - T T/F Testicular carcinoma is the most common cancer of young men between ages 15 and 34 y/o - T T/F You shouldn't palpate both spermatic cords? - F. always do both and vas deferensTips for Taking the Sexual History - -Explain why you are taking the sexual history. -Note that you realize this information is highly personal, and encourage the patient to be open and direct. -Relate that you gather this history from all your patients. -Affirm that your conversation is confidential. What are causes of lack of libido? - Psychogenic causes such as depression, endocrine dysfunction, or side effects of medications What are conditions that may cause small, soft testes suggesting atrophy? - cirrhosis, myotonic dystrophy, use of estrogens, hypopituitarism; may also follow orchitis What are multiple tortuous veins in the area of the spermatic cord, from the epididymis to the superficial inguinal ring, suggestive of? - varicocele What are pubic or genital excoriations suggestive of? - lice (crabs) or sometimes scabies What are rash, tenosynovitis, monoarticular arthritis, meningitis, but not always with urogenital symptoms suggestive of? - disseminated gonorrhea What are some common causes of erectile dysfunction? - May be from psychogenic causes, especially if early morning erection is preserved; may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, or diabetes What are some common causes of pain in the male genitalia? - testicular torsion, epididymitis, orchitis What are some common causes of reduced or absent ejaculation? - medications, surgery, neurologic deficits or lack of androgen What are some common causes of scrotal swelling? - indirect inguinal hernias, hydroceles, scrotal edema, testicular carcinoma (rarely)What are some infections a/w oral-penile transmission? - gonorrhea, chlamydia, syphilis, herpes What are the peak incidence years for testicular cancer? - 15-34 years old What can cause swelling of the male genitalia? - mumps orchitis, scrotal edema, testicular cancer What can cause ulcers on the penis? - syphilitic chancre, herpes