EVMS Male Exam PDF

1. Orient a patient to the male genitourinary and rectal examination. Ask if patient has voided recently Ask if they would like a chaperone present You want to provider a brief overview of the purpose, process and basic procedures of the exam Instruct patient to change into gown and let them know it...

1. Orient a patient to the male genitourinary and rectal examination. Ask if patient has voided recently Ask if they would like a chaperone present You want to provider a brief overview of the purpose, process and basic procedures of the exam Instruct patient to change into gown and let them know it is okay to keep socks on 2. Describe and demonstrate the steps to perform a proper male genitourinary examination including: Inguinal lymph node exam ○ Heel of right foot placed to inside of left knee (making a figure 4) to expose to inguinal crease ○ Inspect crease for enlarged lymph nodes, fungal infections ○ Use dime sized circular light motions down (top to bottom) the medial portion of crease until you get to adductor longus muscle - checking for pain, then work towards knee for 3-4 inches ○ The superficial inguinal lymph nodes should be palpable, soft, mobile and painless ○ Switch to other side External genital exam (including penis, scrotum, and testes) ○ Have the patient stand up (you should also stand at this time), lift one side of their gown, then you sit on the rolling chair ○ Always orient the patient to the next section of the exam and what to expect ○ This exam is best conducted standing (or supine) ○ Tell the patient to let you know if they have any pain, tenderness or discomfort ○ Penis The patient should be standing for the exam Overall inspection of hair distribution, any discharge, skin, warts, rashes Palpation distally to proximally (three fingers on bottom, thumb on top) Minimal contact with frenulum as it is the most sensitive area of the penis Tight grip on head of penis and extend Palpate from underneath, light then deep - on the sides of the penis shaft (do not run fingers up and down shaft of penis for obvious reasons) Then complete top and bottom surfaces (light, deep, lift) Inspect coronal ridge for signs of STDs (near head of penis), the the urethral meatus (using thumbs of open and close) (if patient is uncircumcised, ask them to retract foreskin) ○ Scrotum Have patient lift, cover and hold penis to abdomen to have direct view of scrotum Inspection of skin Palpation of tissue with both hands, stretch away and roll area between fingers and thumbs to feel for lumps or masses Palpate contents of scrotum (above and below) If you find a mass, check to see if it is fluid filled, use a pen light and place directly behind the mass, the light will shine thru a fluid filled mass Isolate each testicle with a scissor motion, palpate light then deep (can be uncomfortable - let patient know) Do not deeply palpate epididymis (it is the pain center for the testicle) Find spermatic cord at base of shaft of penis Hernia exam ○ Patient is standing ○ Push finger into scrotum and then up toward head (toward inguinal ring), tell patient to turn and cough (do this twice), if you keep intestinal or fatty tissue = indirect inguinal hernia ○ A direct inguinal hernia would be hitting the lateral or medial portion of the finger, depending on whether the patient is in a standing or a supine position. 3. Describe and demonstrate the steps to perform a proper rectal and prostate examination. Always use a clean pair of gloves Need lubricant gelly Patient lies on their side with knees to their chest (left lateral decumb) Apply lubricant to gloved finger and use thumb to spread Ask patient to lift buttocks - inspect for hemorrhoids Have the patient exhale and insert finger (tell patient this), pad of finger faces feet, then sweep back and forth to feel prostate (should feel even and walnut sized) Checking rectal wall for polyps, lumps, masses with 360 sweep Check for sphincter tone - ask patient to clamp - then remove finger. Remove glove, drape patient