Podcast
Questions and Answers
In the context of a male genital examination, what is the most critical initial step in managing a patient who expresses apprehension or anxiety regarding the procedure?
In the context of a male genital examination, what is the most critical initial step in managing a patient who expresses apprehension or anxiety regarding the procedure?
- Administer a mild sedative to alleviate the patient's anxiety and ensure cooperation.
- Thoroughly explain each step of the examination, addressing potential concerns and reassuring the patient about the procedure's purpose and normalcy. (correct)
- Request the immediate presence of a senior physician to handle the apprehensive patient.
- Immediately proceed with the examination while providing minimal explanation to expedite the process.
What is the most appropriate course of action when a patient undergoing a male genital examination develops an erection?
What is the most appropriate course of action when a patient undergoing a male genital examination develops an erection?
- Acknowledge the physiological response as normal and proceed with the examination in a calm, professional manner. (correct)
- Administer an anti-androgenic medication to resolve the erection and continue the examination.
- Immediately halt the examination and reschedule for a later date.
- Document the occurrence as a sign of potential underlying sexual dysfunction.
In what manner should a clinician proceed if a patient explicitly refuses to undergo a male genital examination?
In what manner should a clinician proceed if a patient explicitly refuses to undergo a male genital examination?
- Proceed with the examination regardless, as the clinician's judgment supersedes patient refusal in a medical setting.
- Employ therapeutic techniques, exploring their reasons for refusal to overcome their reluctance.
- Document the refusal and proceed with alternative diagnostic methods or referrals if deemed necessary. (correct)
- Immediately transfer the patient's care to another physician to avoid confrontation.
Which modification to the standard male genital examination protocol is most appropriate to maximize patient comfort when performing the examination in the supine position?
Which modification to the standard male genital examination protocol is most appropriate to maximize patient comfort when performing the examination in the supine position?
What is the clinical significance of the Sexual Maturity Rating (Tanner Stages) in the context of a male genital examination, particularly in adolescent patients undergoing evaluation?
What is the clinical significance of the Sexual Maturity Rating (Tanner Stages) in the context of a male genital examination, particularly in adolescent patients undergoing evaluation?
During the inspection of the penis, which specific maneuver is most effective for accurately assessing the urethral meatus for potential abnormalities or the presence of discharge?
During the inspection of the penis, which specific maneuver is most effective for accurately assessing the urethral meatus for potential abnormalities or the presence of discharge?
Which technique is most appropriate for eliciting a urethral discharge in a patient reporting such, particularly when no spontaneous discharge is observed during initial inspection?
Which technique is most appropriate for eliciting a urethral discharge in a patient reporting such, particularly when no spontaneous discharge is observed during initial inspection?
What diagnostic information can be derived from the characteristics (e.g., color, consistency) of a urethral discharge obtained during a male genital examination, and how should these findings guide subsequent clinical management?
What diagnostic information can be derived from the characteristics (e.g., color, consistency) of a urethral discharge obtained during a male genital examination, and how should these findings guide subsequent clinical management?
During palpation of the penile shaft, what is the most critical technique for identifying subtle induration or plaques indicative of conditions such as Peyronie's disease or urethral strictures?
During palpation of the penile shaft, what is the most critical technique for identifying subtle induration or plaques indicative of conditions such as Peyronie's disease or urethral strictures?
Following retraction of the foreskin during a penile examination, what is the immediate next step a clinician should take to ensure patient safety and prevent potential complications?
Following retraction of the foreskin during a penile examination, what is the immediate next step a clinician should take to ensure patient safety and prevent potential complications?
During inspection of the scrotum, what technique is employed to thoroughly assess the posterior surface and identify potential lesions or abnormalities?
During inspection of the scrotum, what technique is employed to thoroughly assess the posterior surface and identify potential lesions or abnormalities?
What are the key differentiating features of scrotal lesions suggestive of sexually transmitted infections (STIs) versus benign dermatological conditions, and how do these distinctions influence diagnostic and therapeutic approaches?
What are the key differentiating features of scrotal lesions suggestive of sexually transmitted infections (STIs) versus benign dermatological conditions, and how do these distinctions influence diagnostic and therapeutic approaches?
How does cryptorchidism typically manifest during scrotal inspection, and what potential long-term complications are associated with this condition if left unaddressed?
How does cryptorchidism typically manifest during scrotal inspection, and what potential long-term complications are associated with this condition if left unaddressed?
What are the subtle yet critical distinctions between the palpation techniques used to differentiate between a testicular tumor, epididymitis, and testicular torsion in a patient presenting with acute scrotal pain and swelling?
What are the subtle yet critical distinctions between the palpation techniques used to differentiate between a testicular tumor, epididymitis, and testicular torsion in a patient presenting with acute scrotal pain and swelling?
Why is the palpation of the epididymis performed without applying excessive pressure, and what key characteristics differentiate the normal nodular and cord-like texture of the epididymis from an abnormal mass or lesion?
Why is the palpation of the epididymis performed without applying excessive pressure, and what key characteristics differentiate the normal nodular and cord-like texture of the epididymis from an abnormal mass or lesion?
During examination of the spermatic cord, what are the key distinguishing features between a normal vas deferens, a chronically infected vas deferens, and a hydrocele of the cord upon palpation?
During examination of the spermatic cord, what are the key distinguishing features between a normal vas deferens, a chronically infected vas deferens, and a hydrocele of the cord upon palpation?
What are the recommended patient positioning techniques for optimizing the detection of groin hernias during physical examination, and how do these positions influence the sensitivity and specificity of the examination?
What are the recommended patient positioning techniques for optimizing the detection of groin hernias during physical examination, and how do these positions influence the sensitivity and specificity of the examination?
What are the key differentiating features between indirect, direct, and femoral hernias upon physical examination, focusing on their anatomical location, relationship to the inguinal canal, and typical patient demographics?
What are the key differentiating features between indirect, direct, and femoral hernias upon physical examination, focusing on their anatomical location, relationship to the inguinal canal, and typical patient demographics?
In differentiating between a direct and indirect inguinal hernia, what specific palpation technique is employed to determine the hernia's relationship to the deep inguinal ring?
In differentiating between a direct and indirect inguinal hernia, what specific palpation technique is employed to determine the hernia's relationship to the deep inguinal ring?
What are the implications of identifying a femoral hernia during a male genital examination, considering its anatomical location and the patient's gender, and how does this finding influence subsequent diagnostic and management strategies?
What are the implications of identifying a femoral hernia during a male genital examination, considering its anatomical location and the patient's gender, and how does this finding influence subsequent diagnostic and management strategies?
What is the pathophysiological rationale for the recommendation to review a younger patient's sexual maturity rating (Tanner stage) during a male genital examination, and which specific clinical findings correlate with specific Tanner stages?
What is the pathophysiological rationale for the recommendation to review a younger patient's sexual maturity rating (Tanner stage) during a male genital examination, and which specific clinical findings correlate with specific Tanner stages?
In the context of penile examination, how would one clinically differentiate between phimosis and paraphimosis, considering their respective definitions and potential complications?
In the context of penile examination, how would one clinically differentiate between phimosis and paraphimosis, considering their respective definitions and potential complications?
What is the clinical significance of identifying smegma during a penile examination, and what patient education should be provided regarding its management?
What is the clinical significance of identifying smegma during a penile examination, and what patient education should be provided regarding its management?
How do hypospadias and epispadias present differently during a penile examination, and what are the potential implications of these congenital anomalies?
How do hypospadias and epispadias present differently during a penile examination, and what are the potential implications of these congenital anomalies?
In the context of evaluating scrotal contours, what key differences exist between the physical examination findings of a hydrocele, varicocele, and testicular torsion?
In the context of evaluating scrotal contours, what key differences exist between the physical examination findings of a hydrocele, varicocele, and testicular torsion?
What is the clinical relevance of properly palpating the spermatic cord during a male genital examination, and what are the clinical signs of its pathology?
What is the clinical relevance of properly palpating the spermatic cord during a male genital examination, and what are the clinical signs of its pathology?
During examination for groin hernias, what specific instructions should be given to the patient to optimize the evaluation, and what physical findings would suggest the presence of each type of hernia?
During examination for groin hernias, what specific instructions should be given to the patient to optimize the evaluation, and what physical findings would suggest the presence of each type of hernia?
What is the typical management approach of an inguinal hernia?
What is the typical management approach of an inguinal hernia?
How can a clinician differentiate a hydrocele/varicocele from an inguinal hernia on physical examination?
How can a clinician differentiate a hydrocele/varicocele from an inguinal hernia on physical examination?
What is the primary differential diagnosis for a patient with acute scrotal pain and swelling, and what clinical findings would lead you to suspect each condition?
What is the primary differential diagnosis for a patient with acute scrotal pain and swelling, and what clinical findings would lead you to suspect each condition?
What is the clinical significance of inguinal lymphadenopathy in the context of a male genital examination, and how does its presence or absence influence your differential diagnosis?
What is the clinical significance of inguinal lymphadenopathy in the context of a male genital examination, and how does its presence or absence influence your differential diagnosis?
During a male genital examination, what specific steps should be taken to ensure appropriate infection control and prevent the transmission of infectious agents?
During a male genital examination, what specific steps should be taken to ensure appropriate infection control and prevent the transmission of infectious agents?
When examining the scrotum, what clinical signs and symptoms should an examiner look for that might be associated with a fungal infection?
When examining the scrotum, what clinical signs and symptoms should an examiner look for that might be associated with a fungal infection?
What is the appropriate way to palpate the testes to ensure accurate findings?
What is the appropriate way to palpate the testes to ensure accurate findings?
What does the term 'milking' refer to in the context of a male genital exam?
What does the term 'milking' refer to in the context of a male genital exam?
What specific aspects should be noted when documenting lesions on the scrotum?
What specific aspects should be noted when documenting lesions on the scrotum?
During a male genital examination, a patient expresses concerns about potential discomfort. What preemptive strategy would most effectively mitigate this anxiety, optimizing patient cooperation and diagnostic accuracy?
During a male genital examination, a patient expresses concerns about potential discomfort. What preemptive strategy would most effectively mitigate this anxiety, optimizing patient cooperation and diagnostic accuracy?
In the event a patient undergoing a male genital examination experiences an involuntary erection, what is the most judicious clinical response that respects patient dignity while enabling the continuation of the necessary diagnostic procedures?
In the event a patient undergoing a male genital examination experiences an involuntary erection, what is the most judicious clinical response that respects patient dignity while enabling the continuation of the necessary diagnostic procedures?
A patient vehemently refuses to undergo a male genital examination despite a clear clinical indication for such an assessment. What is the most ethically and clinically sound approach a practitioner should adopt?
A patient vehemently refuses to undergo a male genital examination despite a clear clinical indication for such an assessment. What is the most ethically and clinically sound approach a practitioner should adopt?
In performing a male genital examination on a patient in the supine position, what specific modification to the standard protocol maximizes exposure while ensuring the patient's sense of modesty and comfort are rigorously maintained?
In performing a male genital examination on a patient in the supine position, what specific modification to the standard protocol maximizes exposure while ensuring the patient's sense of modesty and comfort are rigorously maintained?
In pediatric male genital examinations, how does an awareness of Tanner staging pragmatically inform and refine the clinical evaluation, optimizing diagnostic accuracy and therapeutic decision-making?
In pediatric male genital examinations, how does an awareness of Tanner staging pragmatically inform and refine the clinical evaluation, optimizing diagnostic accuracy and therapeutic decision-making?
During the penile inspection, what specific procedural modification most effectively optimizes visualization of the urethral meatus, facilitating accurate assessment for subtle morphological anomalies or occult discharge?
During the penile inspection, what specific procedural modification most effectively optimizes visualization of the urethral meatus, facilitating accurate assessment for subtle morphological anomalies or occult discharge?
When a patient reports urethral discharge, but none is evident upon initial examination, what highly sensitive provocative maneuver should be employed to maximize the likelihood of eliciting a sample for diagnostic evaluation?
When a patient reports urethral discharge, but none is evident upon initial examination, what highly sensitive provocative maneuver should be employed to maximize the likelihood of eliciting a sample for diagnostic evaluation?
How should the macroscopic characteristics of a urethral discharge (color, consistency, and volume) be interpreted to guide immediate diagnostic stratification and refine the differential diagnosis of infectious urethritis?
How should the macroscopic characteristics of a urethral discharge (color, consistency, and volume) be interpreted to guide immediate diagnostic stratification and refine the differential diagnosis of infectious urethritis?
During palpation of the penile shaft, what precise bimanual technique, incorporating both dynamic and static assessment, maximizes the sensitivity for detecting subtle induration indicative of early-stage Peyronie's disease or urethral strictures?
During palpation of the penile shaft, what precise bimanual technique, incorporating both dynamic and static assessment, maximizes the sensitivity for detecting subtle induration indicative of early-stage Peyronie's disease or urethral strictures?
Immediately following foreskin retraction during a penile examination, what specific prophylactic measure should be implemented to mitigate the risk of iatrogenic paraphimosis and ensure patient safety?
Immediately following foreskin retraction during a penile examination, what specific prophylactic measure should be implemented to mitigate the risk of iatrogenic paraphimosis and ensure patient safety?
What specific bimanual technique, optimizing tactile sensitivity and patient comfort, should a clinician employ to meticulously assess the posterior scrotal surface during physical examination?
What specific bimanual technique, optimizing tactile sensitivity and patient comfort, should a clinician employ to meticulously assess the posterior scrotal surface during physical examination?
What are the critical differentiating features between scrotal lesions indicative of sexually transmitted infections (STIs) versus benign dermatological conditions, and how do these distinctions mandate divergent diagnostic and therapeutic algorithms in clinical practice?
What are the critical differentiating features between scrotal lesions indicative of sexually transmitted infections (STIs) versus benign dermatological conditions, and how do these distinctions mandate divergent diagnostic and therapeutic algorithms in clinical practice?
How does cryptorchidism characteristically manifest during scrotal inspection, and what are the critical pathophysiological sequelae of delayed intervention that dictate the urgency of clinical management?
How does cryptorchidism characteristically manifest during scrotal inspection, and what are the critical pathophysiological sequelae of delayed intervention that dictate the urgency of clinical management?
In a patient presenting with acute scrotal pain and swelling, what are the most critical distinguishing features elicited via palpation that allow for differentiation between testicular torsion, epididymitis, and testicular tumor, and how do these distinctions direct acute management strategies?
In a patient presenting with acute scrotal pain and swelling, what are the most critical distinguishing features elicited via palpation that allow for differentiation between testicular torsion, epididymitis, and testicular tumor, and how do these distinctions direct acute management strategies?
What is the physiological rationale for palpating the epididymis without applying excessive pressure, and what fundamental tactile qualities differentiate a normal epididymis from an abnormal mass, guiding refined diagnostic decision-making?
What is the physiological rationale for palpating the epididymis without applying excessive pressure, and what fundamental tactile qualities differentiate a normal epididymis from an abnormal mass, guiding refined diagnostic decision-making?
When examining the spermatic cord, what specific criteria, incorporating both anatomical and textural assessment, differentiate a normal vas deferens from a chronically infected vas deferens, and how does this differentiation guide therapeutic strategies?
When examining the spermatic cord, what specific criteria, incorporating both anatomical and textural assessment, differentiate a normal vas deferens from a chronically infected vas deferens, and how does this differentiation guide therapeutic strategies?
What specific postural adjustments and dynamic maneuvers should be employed during a male genital examination to optimize the detection of occult groin hernias, maximizing diagnostic sensitivity and specificity?
What specific postural adjustments and dynamic maneuvers should be employed during a male genital examination to optimize the detection of occult groin hernias, maximizing diagnostic sensitivity and specificity?
What are the key clinical differentiators among indirect, direct, and femoral hernias upon physical examination, with emphasis on anatomical location, relationship to the inguinal canal, and differential patient demographics?
What are the key clinical differentiators among indirect, direct, and femoral hernias upon physical examination, with emphasis on anatomical location, relationship to the inguinal canal, and differential patient demographics?
In distinguishing between direct and indirect inguinal hernias via physical examination, what nuanced palpation technique precisely determines the hernia's relationship to the deep inguinal ring during Valsalva maneuver, maximizing diagnostic accuracy?
In distinguishing between direct and indirect inguinal hernias via physical examination, what nuanced palpation technique precisely determines the hernia's relationship to the deep inguinal ring during Valsalva maneuver, maximizing diagnostic accuracy?
What are the specific implications of identifying a femoral hernia during a male genital examination, given its unique anatomical location and propensity for complications, and how does this impact subsequent diagnostic and therapeutic decision-making?
What are the specific implications of identifying a femoral hernia during a male genital examination, given its unique anatomical location and propensity for complications, and how does this impact subsequent diagnostic and therapeutic decision-making?
What is the underlying pathophysiological rationale for routinely assessing a younger patient's sexual maturity rating (Tanner stage) during a male genital examination, and what specific clinical observations are directly correlated with defined Tanner stages?
What is the underlying pathophysiological rationale for routinely assessing a younger patient's sexual maturity rating (Tanner stage) during a male genital examination, and what specific clinical observations are directly correlated with defined Tanner stages?
How should a clinician definitively distinguish between phimosis and paraphimosis during a penile examination, given their respective definitions and potential sequelae, to appropriately guide acute management strategies?
How should a clinician definitively distinguish between phimosis and paraphimosis during a penile examination, given their respective definitions and potential sequelae, to appropriately guide acute management strategies?
What is the clinically relevant significance of identifying smegma during a penile examination, and what patient education should be implemented regarding its proper management to promote optimal genital health?
What is the clinically relevant significance of identifying smegma during a penile examination, and what patient education should be implemented regarding its proper management to promote optimal genital health?
How do hypospadias and epispadias characteristically present during a penile examination, and what associated genitourinary anomalies should be actively investigated given their pathophysiological connections?
How do hypospadias and epispadias characteristically present during a penile examination, and what associated genitourinary anomalies should be actively investigated given their pathophysiological connections?
When evaluating scrotal contours, what key distinctions exist between the physical examination findings associated with hydrocele, varicocele, and testicular torsion, particularly with respect to transillumination, palpation, and response to positional changes?
When evaluating scrotal contours, what key distinctions exist between the physical examination findings associated with hydrocele, varicocele, and testicular torsion, particularly with respect to transillumination, palpation, and response to positional changes?
What is the critical clinical relevance of meticulously palpating the spermatic cord during a male genital examination, and what nuanced physical signs are indicative of its specific pathologies, such as varicocele, hydrocele, or torsion?
What is the critical clinical relevance of meticulously palpating the spermatic cord during a male genital examination, and what nuanced physical signs are indicative of its specific pathologies, such as varicocele, hydrocele, or torsion?
When examining for groin hernias, what precise instructions should be provided to the patient to optimize examination sensitivity, and what specific physical findings suggest the presence and type (direct vs. indirect vs. femoral) of hernia?
When examining for groin hernias, what precise instructions should be provided to the patient to optimize examination sensitivity, and what specific physical findings suggest the presence and type (direct vs. indirect vs. femoral) of hernia?
If a patient is found to have an inguinal hernia, what course of treatment is indicated?
If a patient is found to have an inguinal hernia, what course of treatment is indicated?
How can a clinician definitively differentiate between a hydrocele/varicocele and an inguinal hernia on physical examination, particularly when faced with equivocal findings on initial assessment?
How can a clinician definitively differentiate between a hydrocele/varicocele and an inguinal hernia on physical examination, particularly when faced with equivocal findings on initial assessment?
A 25-year-old male presents with a painless scrotal mass that transilluminates brightly. Palpation reveals a smooth, firm, non-tender mass anterior to the testis. Assuming no other abnormalities, which of the following diagnostic modalities would provide the LEAST additional information?
A 25-year-old male presents with a painless scrotal mass that transilluminates brightly. Palpation reveals a smooth, firm, non-tender mass anterior to the testis. Assuming no other abnormalities, which of the following diagnostic modalities would provide the LEAST additional information?
A 68-year-old male presents with symptoms suggestive of benign prostatic hyperplasia (BPH). Digital rectal examination reveals a smooth, rubbery, and symmetrically enlarged prostate. Serum prostate-specific antigen (PSA) is within the normal age-adjusted range. Which of the following interventions carries the highest risk of causing retrograde ejaculation?
A 68-year-old male presents with symptoms suggestive of benign prostatic hyperplasia (BPH). Digital rectal examination reveals a smooth, rubbery, and symmetrically enlarged prostate. Serum prostate-specific antigen (PSA) is within the normal age-adjusted range. Which of the following interventions carries the highest risk of causing retrograde ejaculation?
A 17-year-old male presents with a chief complaint of a 'bag of worms' sensation in his left scrotum, noticeable primarily when standing. Physical examination reveals a palpable mass that decompresses when the patient is supine. Valsalva maneuver exacerbates the distension. Further investigation using which of the following imaging modalities would yield the LEAST clinically significant information?
A 17-year-old male presents with a chief complaint of a 'bag of worms' sensation in his left scrotum, noticeable primarily when standing. Physical examination reveals a palpable mass that decompresses when the patient is supine. Valsalva maneuver exacerbates the distension. Further investigation using which of the following imaging modalities would yield the LEAST clinically significant information?
A 32-year-old male presents with a several-week history of penile deviation during erection, accompanied by palpable plaque formation along the dorsal penile shaft. He denies any history of trauma. What cellular or molecular process is most directly implicated in the pathogenesis of this patient's condition?
A 32-year-old male presents with a several-week history of penile deviation during erection, accompanied by palpable plaque formation along the dorsal penile shaft. He denies any history of trauma. What cellular or molecular process is most directly implicated in the pathogenesis of this patient's condition?
A 22-year-old male presents with a painful, purulent urethral discharge. Gram stain reveals gram-negative diplococci. Which mechanism of action would be LEAST effective against the causative organism in this scenario, considering increasing rates of antibiotic resistance?
A 22-year-old male presents with a painful, purulent urethral discharge. Gram stain reveals gram-negative diplococci. Which mechanism of action would be LEAST effective against the causative organism in this scenario, considering increasing rates of antibiotic resistance?
A 10-year-old male presents with a congenital anomaly in which the urethral meatus is located on the ventral surface of the penile shaft near the penoscrotal junction. Surgical correction is planned. What is the MOST critical long-term complication that must be considered and addressed during the surgical planning and execution to ensure optimal functional and cosmetic outcomes?
A 10-year-old male presents with a congenital anomaly in which the urethral meatus is located on the ventral surface of the penile shaft near the penoscrotal junction. Surgical correction is planned. What is the MOST critical long-term complication that must be considered and addressed during the surgical planning and execution to ensure optimal functional and cosmetic outcomes?
A 55-year-old uncircumcised male presents with a painless ulceration on the glans penis that has been present for several months and is progressively enlarging. Biopsy reveals squamous cell carcinoma. Which etiological factor is most strongly implicated in the development of this patient's condition, independent of HPV infection?
A 55-year-old uncircumcised male presents with a painless ulceration on the glans penis that has been present for several months and is progressively enlarging. Biopsy reveals squamous cell carcinoma. Which etiological factor is most strongly implicated in the development of this patient's condition, independent of HPV infection?
A 28-year-old male presents with multiple soft, reddish, cauliflower-like lesions on the penile shaft. Histopathological examination reveals koilocytic cells. Which of the following molecular mechanisms is MOST directly responsible for the oncogenic potential associated with the causative agent?
A 28-year-old male presents with multiple soft, reddish, cauliflower-like lesions on the penile shaft. Histopathological examination reveals koilocytic cells. Which of the following molecular mechanisms is MOST directly responsible for the oncogenic potential associated with the causative agent?
A 45-year-old male presents with a history of recurrent, intensely pruritic lesions in the groin area. Microscopic examination of skin scrapings reveals the presence of hyphae. Which of the following virulence factors produced by the causative organism is MOST directly responsible for the patient's intense pruritus?
A 45-year-old male presents with a history of recurrent, intensely pruritic lesions in the groin area. Microscopic examination of skin scrapings reveals the presence of hyphae. Which of the following virulence factors produced by the causative organism is MOST directly responsible for the patient's intense pruritus?
A 62-year-old male presents with urinary frequency, urgency, nocturia, and dribbling. Digital rectal exam reveals a symmetrically enlarged, smooth, and rubbery prostate. A post-void residual urine volume is significantly elevated. Which of the following pharmacological approaches is MOST likely to provide rapid symptomatic relief?
A 62-year-old male presents with urinary frequency, urgency, nocturia, and dribbling. Digital rectal exam reveals a symmetrically enlarged, smooth, and rubbery prostate. A post-void residual urine volume is significantly elevated. Which of the following pharmacological approaches is MOST likely to provide rapid symptomatic relief?
A 24-year-old male presents with a firm, non-tender testicular mass discovered during self-examination. The mass does not transilluminate. Serum tumor markers reveal elevated alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). Which of the following immunohistochemical markers would be MOST useful in differentiating between seminoma and non-seminomatous germ cell tumors?
A 24-year-old male presents with a firm, non-tender testicular mass discovered during self-examination. The mass does not transilluminate. Serum tumor markers reveal elevated alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). Which of the following immunohistochemical markers would be MOST useful in differentiating between seminoma and non-seminomatous germ cell tumors?
A newborn male is noted to have a foreskin that cannot be retracted. The parents are concerned. Which of the following statements regarding this condition is MOST accurate and should be used to counsel the parents?
A newborn male is noted to have a foreskin that cannot be retracted. The parents are concerned. Which of the following statements regarding this condition is MOST accurate and should be used to counsel the parents?
A 30-year-old male presents with a history of recurrent painful erections lasting longer than four hours. He denies any illicit drug use but reports using sildenafil occasionally. Which of the following underlying conditions should be MOST aggressively investigated as a potential cause of his priapism?
A 30-year-old male presents with a history of recurrent painful erections lasting longer than four hours. He denies any illicit drug use but reports using sildenafil occasionally. Which of the following underlying conditions should be MOST aggressively investigated as a potential cause of his priapism?
A 26-year-old male presents with a painless erosion near the coronal sulcus and significant inguinal lymphadenopathy. History reveals recent travel to Southeast Asia. Which of the following diagnostic tests is MOST specific for confirming the suspected diagnosis?
A 26-year-old male presents with a painless erosion near the coronal sulcus and significant inguinal lymphadenopathy. History reveals recent travel to Southeast Asia. Which of the following diagnostic tests is MOST specific for confirming the suspected diagnosis?
During an infertility evaluation, a 35-year-old male is found to have a left varicocele. Semen analysis reveals oligoasthenoteratozoospermia (OAT). Which of the following mechanisms is MOST likely contributing to the sperm abnormalities?
During an infertility evaluation, a 35-year-old male is found to have a left varicocele. Semen analysis reveals oligoasthenoteratozoospermia (OAT). Which of the following mechanisms is MOST likely contributing to the sperm abnormalities?
A 6-year-old male is noted to have bilateral undescended testes during a routine physical exam. What long-term complication is MOST directly associated with this condition if left untreated?
A 6-year-old male is noted to have bilateral undescended testes during a routine physical exam. What long-term complication is MOST directly associated with this condition if left untreated?
A 50-year-old male presents with a bulge in his groin that appears with straining and disappears when lying down. On examination, the bulge is located medial to the inferior epigastric vessels. This finding is MOST consistent with which type of hernia?
A 50-year-old male presents with a bulge in his groin that appears with straining and disappears when lying down. On examination, the bulge is located medial to the inferior epigastric vessels. This finding is MOST consistent with which type of hernia?
A 70-year-old male presents with non-tender, blue-tinged masses at the anal verge accompanied by severe pain exacerbated by defecation. Which of the following is the MOST appropriate initial intervention?
A 70-year-old male presents with non-tender, blue-tinged masses at the anal verge accompanied by severe pain exacerbated by defecation. Which of the following is the MOST appropriate initial intervention?
A 16-year-old male presents for evaluation of delayed puberty. Physical examination reveals small testes, gynecomastia, and a female distribution of pubic hair. Chromosomal analysis is MOST likely to reveal which of the following karyotypes?
A 16-year-old male presents for evaluation of delayed puberty. Physical examination reveals small testes, gynecomastia, and a female distribution of pubic hair. Chromosomal analysis is MOST likely to reveal which of the following karyotypes?
A 65-year-old male undergoing a routine physical exam is found to have a firm, irregular nodule on his prostate during digital rectal exam. The remainder of the exam is unremarkable. Serum PSA is elevated. Transrectal ultrasound-guided biopsy is performed. Which histopathological finding is MOST indicative of a poor prognosis?
A 65-year-old male undergoing a routine physical exam is found to have a firm, irregular nodule on his prostate during digital rectal exam. The remainder of the exam is unremarkable. Serum PSA is elevated. Transrectal ultrasound-guided biopsy is performed. Which histopathological finding is MOST indicative of a poor prognosis?
A 30-year-old male presents with intense itching in the pubic area that worsens at night. Examination reveals small, crab-shaped insects attached to the pubic hair shafts. Which of the following interventions is MOST effective in preventing recurrence after treatment?
A 30-year-old male presents with intense itching in the pubic area that worsens at night. Examination reveals small, crab-shaped insects attached to the pubic hair shafts. Which of the following interventions is MOST effective in preventing recurrence after treatment?
A 40-year-old male presents with a history of infertility. Physical examination reveals that he has a hydrocele. Which of the following underlying mechanisms is MOST directly responsible for male infertility in the setting of a hydrocele?
A 40-year-old male presents with a history of infertility. Physical examination reveals that he has a hydrocele. Which of the following underlying mechanisms is MOST directly responsible for male infertility in the setting of a hydrocele?
A 21-year-old male presents with acute onset of severe left testicular pain and nausea. Physical examination reveals a high-riding testis with a negative cremasteric reflex. Which of the following is MOST critical for preventing irreversible testicular damage?
A 21-year-old male presents with acute onset of severe left testicular pain and nausea. Physical examination reveals a high-riding testis with a negative cremasteric reflex. Which of the following is MOST critical for preventing irreversible testicular damage?
A patient is diagnosed with penile cancer after presenting with a non-healing ulcer. Which factor is LEAST likely to be associated with an increased risk of developing cancer?
A patient is diagnosed with penile cancer after presenting with a non-healing ulcer. Which factor is LEAST likely to be associated with an increased risk of developing cancer?
A 30 year old male presents with a chronically infected vas deferens. Palpation in the region will reveal what?
A 30 year old male presents with a chronically infected vas deferens. Palpation in the region will reveal what?
A 32 year old male presents with painful vesicles that erupt and scab over. What underlying process causes this?
A 32 year old male presents with painful vesicles that erupt and scab over. What underlying process causes this?
During a male genital exam on an adolescent, the scrotum is redder and thinner. There also appears to be some enlargement of the testies. What stage of development is this?
During a male genital exam on an adolescent, the scrotum is redder and thinner. There also appears to be some enlargement of the testies. What stage of development is this?
What findings would suggest a spermatocele instead of other masses?
What findings would suggest a spermatocele instead of other masses?
What is the underlying cause of the congenital defect of hypospadias?
What is the underlying cause of the congenital defect of hypospadias?
A 70 year old patient presents with decreased stream and incomplete bladder voiding. Which of the following physical findings is found?
A 70 year old patient presents with decreased stream and incomplete bladder voiding. Which of the following physical findings is found?
A physician notes the pubic hair has spread to the medial surface of a patient's thighs. What pubic hair stage of development does this indicate?
A physician notes the pubic hair has spread to the medial surface of a patient's thighs. What pubic hair stage of development does this indicate?
Lice can be transferred except for which of the following ways?
Lice can be transferred except for which of the following ways?
Which of the following is a rare and long term effect of mumps?
Which of the following is a rare and long term effect of mumps?
What feature is a major concern for condyloma acuminatum?
What feature is a major concern for condyloma acuminatum?
What is true of Herpes Simplex Virus?
What is true of Herpes Simplex Virus?
Which of the following is a major sign of syphilis?
Which of the following is a major sign of syphilis?
Which is a feature of paraphimosis?
Which is a feature of paraphimosis?
What is true about a hydrocele?
What is true about a hydrocele?
Flashcards
How to reassure a patient during a male genital exam?
How to reassure a patient during a male genital exam?
Explaining the examination process and each step to reassure the patient, and requesting an assistant if needed.
What to do if a patient refuses a genital examination?
What to do if a patient refuses a genital examination?
Explore the patient's reasoning for refusal to understand their concerns and address them.
How to drape a patient for a male genital examination?
How to drape a patient for a male genital examination?
The gown covers the chest and abdomen and a drape is placed at the midthigh to expose only the areas being examined.
Patient position during male genital examination?
Patient position during male genital examination?
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What to inspect on the penis?
What to inspect on the penis?
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Phimosis
Phimosis
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Paraphimosis
Paraphimosis
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Balanitis
Balanitis
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Balanoposthitis
Balanoposthitis
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Hypospadias
Hypospadias
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Epispadias
Epispadias
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Purulent, cloudy or yellow discharge
Purulent, cloudy or yellow discharge
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Scanty white or clear penile discharge
Scanty white or clear penile discharge
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Peyronie disease
Peyronie disease
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Scrotal Inspection
Scrotal Inspection
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Epidermoid cysts
Epidermoid cysts
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Normal Testes
Normal Testes
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Tender/painful scrotal swelling
Tender/painful scrotal swelling
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Painless nodule on testis
Painless nodule on testis
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Normal Epididymis
Normal Epididymis
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Normal Vas Deferens
Normal Vas Deferens
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Hydrocele of the cord
Hydrocele of the cord
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Lifetime Risk Groin Hernia
Lifetime Risk Groin Hernia
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Approach to male genital exam
Approach to male genital exam
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Genital Skin Inspection
Genital Skin Inspection
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Urethral Meatus Inspection
Urethral Meatus Inspection
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Penile Shaft Palpation
Penile Shaft Palpation
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Scrotum: Inspect For?
Scrotum: Inspect For?
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Palpation of testis involves?
Palpation of testis involves?
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Evaluating Groin Hernias
Evaluating Groin Hernias
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Epidermoid Cysts Appearance
Epidermoid Cysts Appearance
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Steps to Examine Penis
Steps to Examine Penis
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Urethral Meatus Maneuver
Urethral Meatus Maneuver
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Scrotum: Inspect Skin
Scrotum: Inspect Skin
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Poor Scrotum Development
Poor Scrotum Development
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Chronically Infected Vas Deferens
Chronically Infected Vas Deferens
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Spermatic Cord Cyst
Spermatic Cord Cyst
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Indirect Inguinal Hernia
Indirect Inguinal Hernia
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Direct Inguinal Hernia
Direct Inguinal Hernia
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Femoral Hernia
Femoral Hernia
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Hydrocele Exam Finding
Hydrocele Exam Finding
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Testicular Torsion Presentation
Testicular Torsion Presentation
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Varicocele
Varicocele
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Genital Herpes
Genital Herpes
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Primary Syphilis
Primary Syphilis
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Genital Warts
Genital Warts
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Gonorrhea
Gonorrhea
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Penile Carcinoma
Penile Carcinoma
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Newborn Male Genitalia
Newborn Male Genitalia
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Undescended Testes Incidence
Undescended Testes Incidence
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Cremasteric Reflex
Cremasteric Reflex
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Retractile Testes
Retractile Testes
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Undescended Testis
Undescended Testis
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Phimosis: Definition
Phimosis: Definition
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Paraphimosis: Definition
Paraphimosis: Definition
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Balanitis: Definition
Balanitis: Definition
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Priapism: Definition
Priapism: Definition
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Syphilitic Chancre: Characteristics
Syphilitic Chancre: Characteristics
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Genital Herpes: Characteristics
Genital Herpes: Characteristics
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Condyloma Acuminatum (Genital Warts): Description
Condyloma Acuminatum (Genital Warts): Description
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Lymphogranuloma Venereum: Characteristics
Lymphogranuloma Venereum: Characteristics
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Gonorrhea: Clinical Presentation
Gonorrhea: Clinical Presentation
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Pubic Lice: Characteristics
Pubic Lice: Characteristics
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Tinea Cruris ('Jock Itch'): Definition
Tinea Cruris ('Jock Itch'): Definition
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Penile Carcinoma: Clinical Presentation
Penile Carcinoma: Clinical Presentation
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Hypospadias: Definition
Hypospadias: Definition
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Peyronie Disease: Characteristics
Peyronie Disease: Characteristics
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Hydrocele: Characteristics
Hydrocele: Characteristics
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Spermatocele: Characteristics
Spermatocele: Characteristics
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Epididymitis: Clinical Presentation
Epididymitis: Clinical Presentation
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Orchitis: Clinical Presentation
Orchitis: Clinical Presentation
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Testicular Tumor: Characteristics
Testicular Tumor: Characteristics
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Varicocele: Definition
Varicocele: Definition
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Indirect Inguinal Hernia: Definition
Indirect Inguinal Hernia: Definition
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Direct Inguinal Hernia: Definition
Direct Inguinal Hernia: Definition
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Femoral Hernia: Definition
Femoral Hernia: Definition
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Klinefelter Syndrome: Characteristics
Klinefelter Syndrome: Characteristics
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External Hemorrhoids: Clinical Presentation
External Hemorrhoids: Clinical Presentation
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Benign Prostatic Hypertrophy (BPH): Clinical Presentation
Benign Prostatic Hypertrophy (BPH): Clinical Presentation
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Prostatic Carcinoma: Clinical Presentation
Prostatic Carcinoma: Clinical Presentation
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Study Notes
Circumcised and Uncircumcised Considerations
- Phimosis is a condition where the foreskin is too tight and cannot be retracted, commonly occurring in the first 6 years of life and can be congenital or from recurrent infections. Imagine a young boy presenting with difficulty urinating due to his foreskin being too tight.
- Paraphimosis is the inability to return the foreskin to its normal position after retraction, potentially leading to edema of the glans due to impaired circulation. Picture a man who has retracted his foreskin, but it becomes stuck, causing swelling and pain.
- Balanitis is the inflammation of the glans, exclusively affecting uncircumcised individuals, often linked to phimosis, and can be caused by bacteria or fungi.
Clinical Cases
Priapism
- Priapism is a prolonged, often painful penile erection with causes including idiopathic, medications, or underlying diseases. Consider a patient who presents to the emergency department with a persistent erection that isn't related to sexual stimulation.
Sexually Transmitted Diseases (STDs)
- Herpes presents as painful, superficial vesicles due to a viral infection. Contrastingly, a syphilitic chancre generally occurs 2 weeks post-exposure and presents as a painless ulcer with indurated borders and a clear base.
- Imagine a patient who notices small, scattered, or grouped vesicles on the glans or shaft of the penis with fever, malaise, headache, arthralgias, localized pain, edema, and lymphadenopathy. This could indicate an active viral infection.
- Condyloma acuminatum (genital warts) appears as soft, reddish lesions caused by human papillomavirus (HPV) that may undergo malignant degeneration to squamous cell carcinoma. Envision a person noticing small, flesh-colored growths on their genitals that are later identified as HPV-related warts.
- Lymphogranuloma venereum, caused by a chlamydial organism, initially presents as a painless erosion at or near the coronal sulcus, followed by lymph node involvement.
- Gonorrhea, an STD caused by Neisseria gonorrhoeae (a Gram-negative diplococcus), presents as purulent discharge from the anterior urethra with dysuria, appearing 2 to 7 days after exposure.
Other Infections and Infestations
- Lice infestation involves crab-shaped insects, potentially asymptomatic but can cause itching that worsens at night, transmitted through direct contact or shared items.
- Tinea cruris, or "jock itch", is a dermatophyte fungal infection of the groin caused by Trichophyton, Epidermophyton, or Microsporum species.
Penile Conditions
- Penile carcinoma often affects uncircumcised men with poor hygiene, manifesting as a painless, non-healing ulceration.
Congenital and Acquired Conditions
- Hypospadias is a congenital defect where the urethral meatus is located on the ventral surface of the glans, penile shaft, or perineal area.
- Peyronie's disease, of unknown cause, involves a fibrous band in the corpus cavernosum, generally unilateral, leading to penile deviation during erection. Suppose a man notices his penis curves significantly when erect, potentially indicating Peyronie's disease.
- Sebaceous (epidermoid) cysts may discharge oily material.
Scrotal Masses
- Hydrocele is a nontender, smooth, firm mass due to fluid accumulation, commonly found in infants and will transilluminate.
- Spermatocele presents as a cystic swelling on the epididymis, smaller than a hydrocele, but also transilluminates.
- Epididymitis often occurs with a urinary tract infection, causing a tender epididymis and potentially erythematous scrotum where scrotal elevation may relieve pain; chronic cases can result from tuberculosis.
- Orchitis is an acute inflammation of the testes, uncommon except as a mumps complication in adolescents or adults, generally unilateral, and may cause testicular atrophy in 50% of cases.
- Testicular tumors present as irregular, nontender masses that do not transilluminate, may be associated with inguinal lymphadenopathy, are most common in males aged 15 to 30, and are usually malignant.
- Varicocele involves abnormal tortuosity and dilation of the pampiniform plexus veins within the spermatic cord, most common on the left side, may cause pain, affects boys and young men, may impair fertility due to increased venous pressure and testicular temperature, and feels like a "bag of worms." Envision a young man complaining of a dull ache in his scrotum, with examination revealing a mass that feels like a bag of worms.
Groin Hernias
- Indirect inguinal hernias are the most common type, affecting both sexes, occurring through the internal inguinal ring, may remain in the canal or pass into the scrotum, and can be bilateral.
- Direct inguinal hernias are less common, more frequent in males over 40, rarely enter the scrotum.
- Femoral hernias are the least common, more often found in females, rare in children, more common on the right side, and may cause severe pain.
Klinefelter Syndrome
- Klinefelter syndrome is a congenital anomaly (XXY) causing hypogonadism, small scrotum, female distribution of pubic hair, and sometimes gynecomastia.
Stages of Pubic Hair Development
- Stage 1: No growth.
- Stage 2: Slightly pigmented, longer hair, usually at the base of the penis, sometimes on the scrotum.
- Stage 3: Dark, definitely pigmented, curly hair around the base of the penis.
- Stage 4: Definitely adult in type, but not in extent, not beyond the inguinal fold.
- Stage 5: Spread to the medial surface of thighs, but not upward.
- Stage 6: Hair spreads along the linea alba (occurs in 80% of men).
Stages of Penis and Testes/Scrotum
- Stage 1: Testis, scrotum, and penis are the same size and shape as in the young child.
- Stage 2: Enlargement of the scrotum and testis. The skin of the scrotum becomes redder, thinner, and wrinkled; penis is scarcely larger.
- Stage 3: Enlargement of the penis, especially in length; further enlargement of testis; descent of scrotum.
- Stage 4: Continued enlargement of the penis and sculpturing of the glans; increased pigmentation of the scrotum.
- Stage 5: Adult stage; penis reaching nearly to the bottom of the scrotum.
Anorectal Conditions
- External hemorrhoids are varicose veins originating below the anorectal line, covered by anal skin, causing itching and bleeding with defecation; thrombosed hemorrhoids appear as blue, shiny masses at the anus.
Prostate Conditions
- Benign prostatic hypertrophy (BPH) is common in men over 50, causing decreased force and caliber of stream, dribbling, incomplete bladder emptying, frequency, urgency, nocturia, and dysuria; on rectal exam, the prostate feels smooth, rubbery, symmetric, and enlarged.
- Prostatic carcinoma is rare before 50; early carcinoma is asymptomatic; on rectal exam, a hard, irregular nodule may be palpable, the prostate feels asymmetric, and the median sulcus is obliterated as the carcinoma enlarges.
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