inpatient medicine
Terms
undefined, object
copy deck
- shaft of penis
-
corpus spongiosum(w/ urethra)
corpora cavernosa - secretions of glans
- smegma
- loose wrinkled pouch w/ 2 compartments
- scrotum
-
ovoid rubbery structures
left usually lower than right - testes
- serous membrane enclosing a potential cavity
- tunica vaginalis
- cordlike struct begins at tail of epididymis
- vas deferens
- vas with vessels, nerves, and mx fibers
- spermatic cord
- tunnel for vas deferens to pass
- inguinal canal
- triangular slitlike struc lat to pubic tubercle
- external inguinal ring
- potential route for hernia below inguinal lig
- femoral canal
- lack of libido may arise from psychogenic causes such as:
-
depression
endocrine dysfx
medications - erectile dysfx from:
-
*psychogenic causes
*dec testosterone
*dec blood flow in hypogastric arterial sys
*impaired neural innervation - causes of reduced or absent ejaculation in middle -older men
-
meds
surgery
neurologic deficits
lack of androgen - lack of orgasm w/ ejaculation is usually ________
- psychogenic
- t/f premature ejac. is common especially in young men
- true
-
assoc w/ yellow discharge:
clear or white: -
gonococcal
non-gonococcal - infections from oral-penile transmission:
-
gonorrhea,
clamdia,
syphilis,
herpes - most common cancer for men 15-35
- testicular cr.
-
tight prepuce that can't be retracted over glans:
once retracted can't be returned: -
phimosis
paraphimosis -
inflammation of the glans:
same + prepuce: -
balanitis
balanoposthitis - pubic or genital excoriations suggest:
- lice(crabs) or scabies
- congenital, ventral displacement of the meatus on the penis
- hypospadias
- poorly dev. scrotum on one or both sides suggests:
- cryptorchidism (undescended testicle)
-
common scrotal swelling include:
+ tender and pain: -
indirect inguinal hernias
hydroceles
scrotal edema
*acute epididymitis
*acute orchitis
*torsion of spermatic cord
*strangulated inguinal hernia - multiple tortuous veins usually on left side suggest
- varicocele
- cystic structure in spermatic cord suggests; transilluminate
- hydrocele
- t/f structures containing blood or tissue tranilluminate
-
false
tumors or most hernias do NOT - hernias return to abdomen when supine. If not but you can get fingers above mass in scrotum- suspect:
- hydrocele
- bowel sounds may be heard in testes over a ________
- hernia
- a hernia is __________ when its contents can't return to abdominal cav.;_________ when blood supply is compromised + tender, n/v
-
incarcerated
strangulated - risk factors for testicular cr.:
-
*cryptorchidism
*hx of cr in
contralateral testicle
*mumps orchitis
*inguinal hernia
*hydrocele in childhood - most common type of hernia
- indirect(comes down canal)
- ________forms the bulb of the penis, ending in the cone shaped _________ with its expanded base, or _______
-
corpus spongiosum
glans
corona - a firm partly muscular chestnut sized gland in males at the neck of the urethra; produces a viscid secretion that is the fluid part of semen
- prostate
- a rounded eminence on the upper margin of each pubis near the pubic symphysis
- pubic tubercle
- internal opening of the inguinal canal
- internal inguinal ring
- inspect penis skin for:
-
Veneral warts
Genital Herpes
Chancre
Ca of the penis (noncircumcised as child)
Peyronie’s Disease
Hypospadias - hair covered fat pad covering symphysis pubis
- mons pubis
- rounded folds of adipose tissue
- labia majora
- thinner pinkish red folds extending anteriorly to form prepuce and clitoris
- labia minora
-
boat shaped fossa
posterior portion _________ hidden in virgins by ________ -
vestibule
introitus
hymen -
tissue b/t introitus and anus
opens into vestibule b/t clitoris and vagina: -
perineum
urethral meatus -
glands post. on either side of urethral meatus
glands on either side vagina: -
paraurethral (Skene's) glands
bartholin's glands -
tube b/t urethra and rectum
upper portion terminates in: -
vagina
fornix -
flattened fibromx struc. shaped like a pear:
2 parts joined by: -
uterus
body(corpus) and cervix joined by isthmus -
convex upper portion of uterus body:
lower portion: -
fundus
cervix -
vaginal surface of cervix
opening of endocervical canal: -
ectocervix
external os -
boundary b/t epithelium in cervix:
columnar epi encircling the os: -
squamocolumnar junction
ectropion - fanlike tip of uterrus toward ovary:
- fallopian tube
- ovaries, tubes, and supporting tissues
- adnexa
-
production of ova
secrete hormones - functions of ovaries
- tanner scale for females depends on:
-
1. growth of pubic hair
2. development of breasts -
ovarian fxn diminishes at:
menstral pds cease b/t: -
40's
45-52 - postmenopausal bleeding raises question of:
- endometrial cancer
- secondary amenorrhea causes:
-
low body weight from:
1. malnutrition and anorexia
2. stress
3. chronic illness
4. hypothalmic-pituitary- ovarian dysfxn -
failure to initiate periods
cessation after they estab. -
primary amenorrhea
secondary amenorrhea -
pain with menstruation:
abnormally frequent periods:
inc. amount or duration flow: -
dysmenorrhea
menorrhagia
metrorrhagia - postcoital bleeding suggests______ or in an older woman _________
-
cervical dz.(polyps, cancer)
atrophic vaginitis -
tenderness
tingling
increased breast size - common early symptoms of pregnancy
- amenorrhea followed by heavy bleeding suggests:
-
*threatened abortion
*dysfunctional uterine bleeding related to lack of ovulation - most common vulvovaginal symptoms:
- vaginal discharge, local itching
-
discomfort during sex:
involuntary spasm of mx surrouding vagina making sex painful or impossible: -
dyspareunia
vaginismus - at 18 or at onset of sexual activity
- start screening for cervical cr
- methods of birth control:
-
natural
barrier
implantable
pharmacologic
surgery -
mood shifts
changes in self-concept
hot flashes
accel bone loss
inc LDL-C
dysuria
dyspareunia - changes of menopause
- types of specula for pap smear:
-
Pedersen
Graves - best for parous women with vaginal prolapse
- graves specula
- prolapse of the urethral mucosa found almost exclusively in the post menopausal woman
- urethral caruncle
-
small, firm, round nodules in labia; yellowish color:
Firm, painless ulcer: -
epidermoid cyst
syphilitic chancre - yellow discharge suggests mucopurulent cervicitis caused by:
-
chlamydia trachomatis
neisseria gonorrhoeae
herpes simplex - uterine enlargement suggests:
- pregnancy or tumors
- nodules of the uterine surface suggest
- myomas
- _____years after menopause, the ovaries atrophy and are no longer palpable
- 3-5 years
-
most common hernia in female groin:
_____ ranks next in frequency: -
indirect inguinal hernia
femoral hernia - urethritis may arise from infection with:
- clamydia trachomatis or neisserria gonorrhoeae
- rapidly growing excrescences that are moist and malodorous. result from infx by hpv
-
vereal wart
(condyloma acuminatum) - cluster of small vesicles, followed by shallow, painful, noninfurated ulcers on red bases
- genital herpes
- oval or round,dark red, painless erosion or ulcer w/ indurated base; when secondarily infx may be pain
- syphilitic chancre
- urethral meatus to inf surface of penis.
- hypospadias
- palpable nontender hard plaques just beneath skin along dorsum of penis; crooked painful erections
- peyronie's dz
- infurated nodule or ulcer that is usually nontender. almost all are not circumcised in childhood
- cr. of the penis
- comes through inguinal ring, so fingers can't get above it in scrotum
- scrotal hernia
- scrotal edema my accompany generalized edema of:
-
CHF
nephrotic syndrome - testis acutely inflamed, painful, tender, and swollen; diff to dist. from the epididymis; seen in mumps and other viral infx; usually unilat.
- acute orchitis
-
small firm testes in:
small soft testes seen in: -
klinefelter's syndrome
cirrhosis, mytonic dystrophy, use of estrogens, hypopituitarism; may follow orchitis - acute epididymitis dx is supported:
- UTI or prostatitis
- painless movable mass above testis suggests; both transilluminate
- spermatocele or epididymal cyst
- firm enlargement of epididymis with beading of vas deferens
- TB epididymitis
- small firm round cystic nodules in the labia
- epidermoid cyst
- warty lesions on the labia w/in vestibule suggest:
-
condylomata acuminata
(due to hpv) - shallow small painful ulers on red bases suggest
- genital herpes
- slightly raised, flat, round or oval papules coveed by gray exudate suggest:
- condylomata lata (these are contagious)
- ulcerated or raised vulvar lesion in elderly woman may indicate:
- vulvar cr.
-
buldge of ant vaginal wall and bladder
+ urethra: -
cystocele
cystourethrocele - herniation of the rectum into post wall of vagina
- rectocele
- small, red, benign tumor visible at post part of urethral meatus chiefly in postmenopausal women with no symptoms
- urethral caruncle
- forms swollen red ring around the urethral meatus before menarche or after menopause
- prolapse of urethral mucosa
-
2 epi that cover cervix:
these meet at: -
squamous and columnar
squamocolumnar junction - columnar epi changes to squamous epi:
- metaplasia
- retention cysts:
- nabothian cysts
-
: childhood nipples may be slightly elev in fem
: scant, straight, pubic hair
Boys: testes enlarge, scrotal texture
Girls: slight elev of breast
: pubic hair more, curly
boys: penis inc length, testes enlarge
: boys: p -
tanner stage
1
2
3
4
5 - infrequent or very light menstruation
- oligomenorrhea
-
__________: fairly common, probably congential
abnormality located in the midline superficial to the coccyx or the lower sacrum
look for opening of sinus tract
may exhibit a small tuft of hair and be surrounded by a halo of erythema - pilonidal cyst
-
dilated veins that orginate below the pectinate line and are covered with skin
seldom produce symptoms unless thrombosis occurs - acute local pain increasing with defecation & sitting - external hemorrhoids (thrombosed)
-
enlargements of normal vascular cushions located above the pectinate line
usually not palpable
may cause bright red bleeding during defecation - internal hemmorrhoids (prolapsed)
-
on straining for a bowel movement, the rectal muscosa, with or without its muscular wall, may prolapse through the anus
appears as a doughnut or rosette of red tissue - prolapse of the rectum
-
a very painful oval ulceration of the anal canal
most commoly in the midline posteriorly
its long axis lies longitudinally
may be a swollen "sentinel" skin tag below it
the sphincter is spastic making the exam painful - may - anal fissure
- an inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus
- anorectal fistula
-
variable in size and number
can develop on a stalk (pedunculated) or lie on the muscosal surface (sessile)
soft and may be difficult or impossible to feel
proctoscopy & biopsy are needed to determine if benign or malignant - polyps of the rectum
- asymptomatic _________ of the rectum makes routine rectal exams important for adults
- carcinoma
-
peritoneal mets may develop in the area of the peritonial refection anterior to the rectum
a firm to hard nodular _________ may be palpable with the tip of the finger - rectal shelf
-
the prostate is about _____ cm long
on DRE the median sulcus and be felt
_________ lesions are not detectable by physical examination -
2.5
anterior -
an acute, febrile condition caused by bacterial infection
the gland is very tender, swollen, firm & warm - acute prostatitis
- _____________ doesnt produce consistent findings and must be evaluated by other methods
- chronic prostatitis
-
the prostate feels symmetrically enlarged, smooth, and firm though slightly elastic
seems to protrude more into the rectal lumen
median sulcus may by obliterated
finding a normal size gland by palpation doesn't rule it out - BPH
-
it is suggested by an area of hardness in the prostate
a distinct hard nodule that alters the contour of the gland may or may not be palpable
fells irregular & may extend beyond the gland - cancer of the prostate
- anal canal held closed by voluntary________and involuntary________
-
external anal sphincter
internal anal sphincter(extension of muscular coat of rectal wall) - anorectal jxn denotes boudary b/t somatic and visceral nerve supplies
- pectinate or dentate line
- 3 lobes surround urethra
- prostate gland
- shaped like rabbit ears above prostate and aren't normally palpable
- seminal vescicles
- felt through ant wall of rectum in females
- cervix
- 3 inward foldings in rectal wall
- valves of houston
-
black stools
red blood in stools -
melena
hematochezia - change in bowel pattern, expecially thin pencil like caliber may warn of
- cancer
- blood in stool from:
-
polyps
cancer
GI bleeding
local hemorrhoids
mucus in villous adenoma -
proctitis with:
Bleeding in anorectal infx w/: -
anorectal pain
pruritus
tenesmus
discharge
gonorrhea
chlamydia
lymphogranuloma venereum -
ulcerations in:
chancre in: -
herpes simplex
primary syphilis - itching in younger pts from:
- pinworms
-
genital warts from:
condylomata lata
anal fissures in: -
hpv
in secondary syphilis
proctitis, crohn's dz - discomfort or heaviness in prostate area or assoc w/ malaise,fever,or chills suggests:
- prostatitis
- leading cancer dx in men in U.S. and 2nd cause of death in North American men
- prostate cr.
-
highest incidence of prostate cr.:
lowest: -
african american men
asian and native american - AVG. AGE OF DX AND DEATH FROM PROSTATE CR
- 70
- SCREENING TESTS FOR PROSTATE CR
-
DRE
PSA - INCOMPLETE EMPTYING OF BLADDER, URINARY FREQ OR URGENCY, WEAK STREAM, STRAIN TO INITIATE FLOW, HEMATURIA, NOCTURIA, PAIN IN PELVIS
- SYMPTOMS OF PROSTATE D/O
- SCREENING TESTS FOR COLORECTAL CANCER
-
DRE
FOBT
SIGMOIDOSCOPY(every 3-5 yrs over 50) - hemorrhoids, venereal warts, herpes, syphilitic chancre, carcinoma
- anal and perianal lesions
-
anal sphincter tightens in:
laxity in: -
inflammation,scarring
neurologic dz - induration may be due to:
- inflammation, scarring, or malignancy