The Male GU
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In what age range should practitioner encourage male to perform MONTHLY testicular self examination?
- after shower bc testes are descended
Define phimosis and paraphimosis?
Phimosis --> tight prepuce that cannot be retracted over glands
Paraphimosis --> tight prepuce once retracted, cannot be returned – edema ensues
How to inspect and palpate the inguinal nodes?
Ask pt to strain down while inspecting. – bulge that appears with straining suggest hernia
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
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)
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.
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.
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
- A strangulated hernia is life-threatening and
- requires immediate surgery
SS of BPH?
- Urinary Frequency; Nocturia
- Urinary Urgency
- Change in stream, Weak
- Difficulty starting
- Post void dribbling
- Painful urination, ejaculation
SS of prostatitis
- Blood in the urine
- Decreased urine stream
- Frequent urination
- Low-grade fever
- Pain with urination
- Urinary hesitancy (delayed start of urination)
Prostate cancer screening guidelines according to ACS?
- Age 50, No Risk factors: screening not advocated but may be offered
- Age 45: AA 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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