The Male GU

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  1. In what age range should practitioner encourage male to perform MONTHLY testicular self examination?
    • 15-35
    • after shower bc testes are descended
  2. Define phimosis and paraphimosis?
    Phimosis --> tight prepuce that cannot be retracted over glands

    Paraphimosis --> tight prepuce once retracted, cannot be returned – edema ensues
  3. How to inspect and palpate the inguinal nodes?
    Ask pt to strain down while inspecting. – bulge that appears with straining suggest hernia
  4. How do you differenciate an hernia from an hydrocele in the scrotum?
    • If scrotum hernia is suspected, ask pt to lie
    • down, if mass comes up to abdomen than it is an hernia. 
    • If not, can you get your hand above the hernia ? If yes = hydrocele
  5. Difference between an incarcerated hernia and a strangulated hernia?
    • Incarcerated hernia = contents cannot be
    • returned to abdomen
    • Strangulated hernia = when blood supply
    • to the entrapped content is compromised ( usually come w/ tenderness, n/v)
  6. How does the prostate feel during the anal exam?
    • Rounded, heart shaped, firm structure
    • about 2.5 cm in length, lobes divided by shallow median sulcus or groove.
    • At exam, prostate measures 2 fingerbreaths or less.
  7. Differences between direct, indirect inguinal and femoral hernia?
    • Direct inguinal hernia
    • - occurs in an area where the abdominal wall is naturally slightly thinner.
    • - rarely will protrude into the scrotum.
    • - tends to occur in the middle-aged and
    • elderly bc their abdominal walls weaker.

    • Indirect inguinal hernia
    • - descending from the abdomen into the scrotum. Sometimes the hernia sac may protrude into the scrotum.
    • - may occur at any age.

    • Femoral hernia
    • - causes a bulge just below the inguinal
    • crease in roughly the mid-thigh area.
    • - Usually occurring in women, femoral
    • hernias are particularly at risk of becoming irreducible and strangulated.
    • - Not all hernias that are irreducible are
    • strangulated, but all hernias that are
    • irreducible need to be evaluated by a health-care provider.
  8. Complication of having an hernia?
    • obstruct the bowel, leading to severe
    • pain, n/v and the inability to have a BM or pass gas.
    • diminish blood flow to the trapped portion of the intestine à strangulation which may lead to the death of the affected bowel
    • tissues.  
    • A strangulated hernia is life-threatening and
    • requires immediate surgery
  9. SS of BPH?
    • Urinary Frequency; Nocturia
    • Urinary Urgency
    • Change in stream, Weak
    • Difficulty starting
    • Post void dribbling
    • Painful urination, ejaculation
  10. SS of prostatitis
    • Blood in the urine
    • Decreased urine stream
    • Frequent urination
    • Incontinence
    • Low-grade fever
    • Pain with urination
    • Urinary hesitancy (delayed start of urination)
  11. Prostate cancer screening guidelines according to ACS?
    Age 50, No Risk factors:  screening not advocated but may be offered

    - Age 45AA men, 1st degree relative with PCA diagnosed before age 65

    Age 40: men with several 1st degree relatives with early Prostate CA diagnosis.

    Age >75:  poor risk/benefit for screening/treatment; not recommended
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The Male GU
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