PDx - Male and Female GU exam

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includes breast exam for female

What condition(s) may cause bulging of the vaginal walls?

cystocele or rectocele

Unduly late menarche may be related to what physical abnormality?

an imperforate hymen

yellowish d/c on endocervical swab suggests ________. What are some common causes?

mucopurulent cervicitis; Chlamydia trachomatis, Neisseria gonorrheae or herpes simplex

Conditions resulting in a raised, friable, or lobed wartlike lesions of the Cx include...

condylomata or Cx CA

Name conditions associated with Chlamydial infection.

urethritis, cervicitis, PID, ectopic preg, infertility, and chronic pelvic pain

What are the risk factors for Chlamydial infection?

younger than 25 yo, multiple sexual partners, h/o STD's

vaginitis with d/c is caused by ....

Candida, Trichomonas vaginalis, BV

What are the risk factors of vaginal CA?

- DES exposure in utero
- HPV infection

Pain on movement of the Cx together with adnexal tenderness suggests what condition?

PID

what condition may result in uterine enlargement?

pregnancy, uterine myomas, malignancy

What physical finding is suggestive of myomas?

nodules on uterine surfaces

A palpable ovary s/p menopause should be a concern for what?

ovarian cyst or CA

Pelvic pain, bloating, increased abdominal size, and UTI Sx are more common in women with _________.

Ovarian CA

Other than myomas or CA, give other possible causes of adnexal masses.

TOA, salpingitis, ovarian tube inflammation 2nd to PID, or ectopic preg

What type of adnexal mass is typically "smooth and compressible"?

cysts

What type of adnexal mass is typically "solid and nodular"?

tumors

Uncomplicated cysts are (tender or nontender) ?

nontender

What are the diagnostic features of POS? (other than exclusion of other endocrine d/o)

- absent or irregular menses
- hyperandrogenism
- confirmation of polycystic ovaries on US

What are two predictors of POS?

Obesity and absence of lactation outside pregnancy or childbirth

PID is most often a result of what?

STI

Sx of "very tender bilateral adnexal masses" is associated with what condition?

acute PID

How is a physiologic vaginal d/c distinguished from vaginitis?

physiologic d/c is clear/white, may contain white lumps of epithelial cells and is NOT malordorous

Identify the type of vaginitis associated with the following Sx: profuse, sometimes malordorous yellowish green/gray d/c pooling in the vaginal fornix. Vestibule and labia minora may appear reddened, while vaginal mucosa may appear reddened with petechiae in the posterior fornix. Associated sx of pruritis, dysuria, and dyspareunia. What type of organism is the pathogen?

Trichomonal vaginitis (Trichomonas vaginalis); protozoan

Identify the type of vaginitis associated with the following Sx: mildly profuse, typically thick, white, curdy d/c without malodor. Vulva and surrounding skin are often inflammed with occasional swelling; vag mucosa often reddened with white tenacious patches of d/c. Assoc sx of intense pruritis, vag soreness, dysuria, and dyspareunia. What type of organism is this pathogen?

Candidal vaginitis (Candida albicans); yeast

Identify the type of vaginitis associated with the following Sx: concentrated or minimal areas of malodorous, homogeneous gray/white, thin d/c coating the vag walls. Vulva and vag mucosa appear otherwise normal. Assoc sx of fishy or musty genital odor. What type of organism is this pathogen?

BV; usually anaerobic bacteria

Lab findings of clue cells, + "whiff test", vag secretions with pH >4.5

BV

Lab findings of branching hyphae seen after KOH prep

candidal vaginitis

Lab findings of trichomonads on wet mount

tricomonal vaginitis

What are the visible signs of breast CA?

- skin dimpling
- abnl contours
- nipple retraction and deviation
- edema of skin (peau d'orange sign)
- Paget's Dz of the nipple (starts with scaly, eczematous lesion that weeps, crusts and/or erodes)

This hernia is the most common, often in children, originating near the midpoint of the inguinal ligament, often entering the scrotum; may be described as touching the fingertip upon exam of the inguinal canal.

Indirect inguinal hernia

This hernia is less common (usually in men > 40 yo, rare in women), originating above inguinal ligament and close to the pubic tubercle, and rarely entering the scrotum; may be described as bulging anteriorly and pushing the side of the finger forward on exam of the inguinal canal.

Direct inguinal hernia

This hernia is least common (more common in women), originating below the inguinal ligament and somewhat lateral, and never enters the scrotum; cannot be detected upon exam of inguinal canal.

Femoral hernia

This penile or scrotal abnormality involves a congenital displacement of the urethral meatus to the inferior surface of the penis.

hypospadias

This penile or scrotal abnormality involves pitting edema, making the scrotal skin taut. What underlying conditions might be indicated by this finding?

scrotal edema; CHF or nephrotic syndrome

This penile or scrotal abnormality involves palpable, nontender plaques found just beneath the skin usually along the dorsum of the penis. Name a typical associated complaint with this condition.

Peyronie's Dz; crooked painful erections

This penile or scrotal abnormality involves a nontender, fluid-filled mass within the tunica vaginalis that transilluminates and can be passed by fingers within the scrotum.

hydrocele

This penile or scrotal abnormality involves an persistent typically nontender, indurated nodule or ulcer that is almost always in uncircumcised men.

carcinoma of the penis

This penile or scrotal abnormality involves a scrotal mass originating from the external inguinal ring and cannot be passed by fingers within the scrotum.

scrotal hernia

This testicular abnormality presents with an atrophied testis or unfilled scrotum resulting in no palpable testis or epididymis. This problem markedly raises the risk for what condition?

cryptorchidism; testicular CA

This testicular abnormality presents with a testicular length < or = 3.5 cm and may follow orchitis. What conditions are causative of small "soft" testes suggesting atrophy? What syndrome would present with small, "firm" testes < 2cm?

small testis; cirrhosis, myotonic dystrophy, use of estrogens, and hypopituitarism; Klinefelter's syndrome

This testicular abnormality presents with acutely inflamed, painful, tender, and swollen testis that may be difficult to distinguish from the epididymis; usually unilateral. What conditions is this usually associated with?

acute orchitis; viral infections (mumps)

This testicular abnormality presents with a painless nodule that grows to eventually replace the entire organ. The testicle feels heavier than normal.

Testicular CA

This abnormality of the epididymis or spermatic cord presents as a painless, movable cystic mass just above the testis that transilluminates.

spermatocele and cyst of the epididymis

This abnormality of the epididymis or spermatic cord presents as a soft "bag of worms" seperate from the testis that slowly collapses when the scrotum is elevated in the supine pt.

Varicocele of the spermatic cord

This abnormality of the epididymis or spermatic cord presents as tenderness and swelling above the testis sometimes accompanied by reddened scrotum and inflamed vas deferens. (chiefly in adults) What coexisting conditions support the Dx?

acute epididymitis; UTI or prostatitis

This abnormality of the epididymis or spermatic cord presents as acute pain, tenderness and swelling to testicle and spermatic cord that appears retracted into the scrotum, which may itself appear red and edematous. Not associated with UTI and most common in adolescents.

Torsion of the spermatic cord

This abnormality of the epididymis or spermatic cord presents as a firm enlargement of the epididymis, sometime tender, with "thickening or beading of the vas deferens".

Tuberculous epididymitis

A normal prostate is rounded, ______ shaped and approximately _______ cm long.

heart; 2.5

Lesions on what portion of the prostate may not be detectable on PEx?

anterior

This abnormality of the prostate presents with fever and UTI Sx including incomplete voiding and sometimes low back pain. The gland feels tender, swollen, "boggy and warm". More than 80% of these conditions are caused by _____________.

acute bacterial prostatitis; gram-neg aerobes

This abnormality of the prostate is present in > 50% of men by age 50 and presents with either irritative Sx of urgencym frequency, or nocturia or obstructive Sx (decreased stream, incomplete emptying, straining) or combinations of both. Exam findings typically include symmetrically enlarged, smooth, and firm gland with possible obliteration of the median sulcus.

BPH

This abnormality of the prostate presents as an area of hardness in the gland such as a nodule that alters the contour of the gland. Characterized by irregular enlargement.

Prostate CA

This abnormality of the anas/surrounding skin/rectum may present with a small tuft of hair surrounded by a halo of erythema above the coccyx or lower sacrum.

pilonidal cyst (and sinus)

This abnormality of the anas/surrounding skin/rectum presents as a tender, swollen, bluish, ovoid, skin covered mass visible at the anal margin that typically causes acute local pain that increases with defecation or sitting.

Thrombosed external hemorrhoids

This abnormality of the anas/surrounding skin/rectum may appear as reddish, moist, protruding masses that may result in bright red bleeding especially after defecation.

Prolapsed internal hemorrhoids

This abnormality of the anas/surrounding skin/rectum presents as a donut or rosette of red tissue that may or may not involve radiating folds.

Prolapse of rectum

This abnormality of the anas/surrounding skin/rectum presents as a painful ovoid ulceration of the anal canal with potential association of a swollen "sentinel" skin tag just inferior.

Anal fissure

This abnormality of the anas/surrounding skin/rectum presents as an inflammatory tract or tube that opens at one end into the anus or rectum and at the other end into a skin surface or another viscus.

Anorectal fistula

This abnormality of the anas/surrounding skin/rectum presents as soft, variable pedunculated or sessile masses within the rectum that may prove difficult to feel upon examination.

Rectal polyps

This abnormality of the anas/surrounding skin/rectum may present as a firm, nodular mass with rolled edge.

Rectal CA

This abnormality of the anas/surrounding skin/rectum may present as a firm hard nodular "shelf" in the anterior rectum.

Rectal shelf

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