Physical Examination
Part 2
Xue Huiping
Male reproductive anatomy
This illustration represents an average normal adult human penis. The head of the
penis (glans) has a covering, called the foreskin (prepuce). This covering folds in
on itself, forming a double layer. The foreskin is not a `flap' of skin on the end of
the penis, and it is not `useless' or `redundant' skin.
There is some natural variation in the length of the foreskin, which often covers a
bit more or less of the glans than illustrated.
In an average circumcised adult man, the area of skin that is missing because of
penile reduction surgery would, when erect and unfolded, measure approximately
three by five inches, or a little smaller than a postcard. That is about half the total
skin of the penis.
Structures of the penis
 The outer foreskin layer is a continuation of the skin of the shaft of the
penis.
 The inner foreskin layer is not properly `skin', but mucocutaneous
tissue of a unique type found nowhere else on the body.
 The frenar band is the interface (join) between the outer and inner
foreskin layers. When the penis is not erect, it tightens to narrow the
foreskin opening. During erection, the frenar band forms a ridge that
goes all the way around, about halfway down the shaft.
 The reddish or purplish glans or glans penis (head of the penis) is
smooth, shiny, moist and extremely sensitive.
 The frenulum, or frenum, is a connecting membrane on the underside
of the penis, similar to that beneath the tongue.
Here is a normal testis
and adjacent structures.
Identify the body of
the testis, epididymis,
and spermatic cord.
Note the presence of
two vestigial structures,
the appendix testis and
the appendix
epididymis.
On the left is a normal testis. On the right is a testis that has
undergone atrophy. Bilateral atrophy may occur with a variety of
conditions including chronic alcoholism, hypopituitarism,
atherosclerosis, chemotherapy or radiation, and severe prolonged
illness. A cryptorchid testis will also be atrophic. Inflammation may
lead to atrophy. Mumps, the most common cause for orchitis, usually
has a patchy pattern of involvement that does not lead to sterility.
Here is a large hydrocele of the testis. Such hydroceles are
fairly common. Clear fluid accumulates in a sac of tunica
vaginalis lined by a serosa with a variety of inflammatory
and neoplastic conditions. A hydrocele must be
distinguished from a true testicular mass, and
transillumination may help, because the hydrocele will
transilluminate but a testicular mass will be opaque.
完全型具有正常女性体征，有正常女性外
阴且发育良好（但阴毛稀少或缺如），阴
道发育良好，深度正常。青春期后乳房可
发育。不完全型外阴有不同程度的畸形，
阴蒂增大，阴道短浅或呈尿生殖窦。睾丸
多位于腹股沟内。
Epididymis附睾
The epididymides (plural for epididymis
附睾) are narrow, elongated storage
vessels for newly generated spermatozoa.
They are located within the scrotum阴囊,
adjoining each testicle睾丸. Spermatozoa
精子remain in the cord-like
epididymides附睾 until ejaculation, at
which time they eject them into the vas
deferens输精管.
Cryptorchidism隐睾病
Cryptorchidism is defined as failure
of the testis to descend from its
intra-abdominal location into the
scrotum.
Epididymis 附睾
A long, narrow, convoluted tube, part
of the spermatic duct system, that
lies on the posterior aspect of each
testicle, connecting it to the vas
deferens.
Elephantiasis象皮肿 of the scrotum
scrotal hernia
an inguinal hernia腹股沟疝
which has descended into the
scrotum.
The Prostate Gland 前列腺
The prostate is a walnut-sized gland
that forms part of the male
reproductive system. The gland is
made of two lobes, or regions,
enclosed by an outer layer of tissue.
As the diagrams show, the prostate is
located in front of the rectum and
just below the bladder, where urine is
stored. The prostate also surrounds
the urethra尿道, the canal through
which urine passes out of the body.
Normal urine flow
Seminal Vesicle
produces a mucoid secretion that's
released into the semen精液
Female reproductive anatomy
External Genitalia
External organs include the
sensitive and erotic sex organs:
mons pubis, labia唇 and clitoris阴
蒂 (also known collectively as the
vulva外阴), and the breasts.
The Mons Pubis
The mons pubis (sometimes
called the mons veneris after
Venus, the Roman goddess of
love) is the region of fatty tissue
above the pubic bone. At puberty,
the mons pubis enlarges and
becomes covered by pubic hair.
The Labia
Often referred to as "lips," the labia are
the fold of tissue surrounding the vaginal
and urethral openings, protecting the
sensitive orifices from damage. The outer,
fleshy hair-covered folds form the labia
majora and the inner hairless folds form
the labia minora. The labia are rich with
nerve endings and generally respond well
to stimulation.
The Clitoris 阴蒂
The female glans (the male glans is the penis),
the clitoris is extremely sensitive and engorges
with blood during sexual arousal. Protected by
the clitoral hood, the clitoris is above the
urethral opening and below the clitoral shaft,
which has two arms (called crura) that stretch
backwards into the woman's body, under the
skin on either side above the vaginal opening.
Nerves controlling clitoral muscle
contractions travel alongside the walls of the
vagina阴道, the bladder and urethra, passing
along the sensations produced in any part of
Internal Structures
Internal organs include the
uterus子宫, Fallopian tubes输卵管
and ovaries卵巢, which contain
the female’s sex cells: the ova, or
eggs.
The Ovaries
The ovaries are paired structures,
approximately the size of a walnut, that
are anchored to the body cavity and to
the uterus by strong cord-like structures
known as ligaments. The ovaries contain
the ova and produce the female sex
hormones estrogen and progesterone孕
酮.
The Fallopian Tubes
The Fallopian tubes, also called the uterine tubes or
oviducts, extend from the uterus up around the
ovaries. The Fallopian tubes display muscular
contractions that help draw the ovum into the uterus.
The upper portion of the tubes is where fertilization
of an ovum by a sperm commonly occurs; if the
zygote does not move down into the uterus, an
ectopic pregnancy occurs, which can be fatal to the
mother and must be terminated. The Fallopian tubes
are surgically altered when a woman undergoes the
sterilization procedure known as a tubal ligation.
The Uterus
The uterus (or womb) is a pear-shaped multilayered organ located at the base of the pelvic
cavity. The opening of the uterus, known as
the cervix子宫颈, contains a narrow opening
that serves as a passageway for menstrual flow
or for a fetus to exit the vagina. The innermost
layer of the uterus is the endometrium, which
is partially shed with each the menstrual flow.
The uterus can be host to a number of sexual
health problems, including endometriosis子
宫内膜异位, cervical cancer and uterine
cancer.
The Vagina
The vagina is a three to four-inch
long, thin-walled mucous-lined tube.
In addition to providing an exit for
menstrual blood or a fetus, the
vagina is the reception site for the
penis during intercourse.
Anus and Rectum Exam
♣ Patient position and preparation
Left lateral decubitus position
Assistant or patient spreads glutei
♠ Findings on Inspection
Anal Fissures 肛裂
Anal fistula 瘘
Perianal肛周的 dermatitis
Anal mass
External Hemorrhoid 外痔
Condyloma 湿疣
♣ Rectal examination
Digital Rectal Exam
Anoscopy 肛门镜检查术
WHAT IS AN ANAL FISSURE?
An anal fissure is a small tear or cut
in the skin lining the anus which can
cause pain and/or bleeding.
A thin slit-like tear in the anal tissue, an anal
fissure is likely to cause itching, pain, and
bleeding during a bowel movement.
The typical symptoms of an anal
fissure are extreme pain during
defecation and red blood
streaking the stool. Patients may
try to avoid defecation because of
the pain.
How is it diagnosed?
The diagnosis of an anal fissure is
made by examination of the anus
and anal canal. The tear usually is
easy to see, although occasionally a
small viewing instrument, called an
anoscope, may be used in the
evaluation.
What Are Hemorrhoids 痔?
The term hemorrhoids refers to a condition in
which the veins around the anus or lower
rectum are swollen and inflamed.
Hemorrhoids may result from straining to
move stool. Other contributing factors include
pregnancy, aging, chronic constipation or
diarrhea, and anal intercourse.
Hemorrhoids are either inside the anus
(internal) or under the skin around the anus
(external).
What Are the Symptoms of
Hemorrhoids?
Although many people have hemorrhoids,
not all experience symptoms. The most
common symptom of internal
hemorrhoids is bright red blood covering
the stool, on toilet paper, or in the toilet
bowl. However, an internal hemorrhoid
may protrude through the anus outside
the body, becoming irritated and painful.
This is known as a protruding
hemorrhoid.
Internal hemorrhoids occur higher up in the
anal canal, out of sight. Bleeding is the most
common symptom of internal hemorrhoids, and
often the only one in mild cases.
Sometimes, internal hemorrhoids will come
through the anal opening when straining to move
your bowels. This is called a prolapsed脱垂
internal hemorrhoid; it is often difficult to ease
back into the rectum, and is usually quite painful.
Symptoms of external
hemorrhoids may include painful
swelling or a hard lump around
the anus that results when a
blood clot forms. This condition
is known as a thrombosed
external hemorrhoid.
In addition, excessive straining,
rubbing, or cleaning around the
anus may cause irritation with
bleeding and/or itching, which
may produce a vicious cycle of
symptoms. Draining mucus may
also cause itching.
External hemorrhoids are visible-occurring out
side the anus. They are basically skin-covered
veins that have ballooned and appear blue.
Usually they appear without any symptoms.
When inflamed, however, they become red and
tender.
When a blood clot forms inside an external
hemorrhoid, it often causes Severe pain. This
thrombosed external hemorrhoid can be felt as a
firm, tender mass in the anal area, about the size
of a pea.
Extremities and Articulus
Koilonychia反甲
Fingernail Nail Abnormality
Signs
Concave凹的 or Spoon shaped nails
Associated Conditions
♥ Anemia
♥ Thyroid甲状腺 dysfunction
♥ Trauma
♥ Impaired peripheral circulation
♥ Familial 家族性的
♥ Normal finding in infants
Koilonychia may be caused by or
feature of (sorted by category)
♪ Autosomal dominant conditions
Steatocystoma皮脂腺囊瘤multiplex
♪ Nutritional conditions
Iron deficiency
The nails are flattened and have concavities. This
condition may be associated with iron deficiency.
acropachy 杵状指
"Clubbing" of the fingers with
thickening of skin at the base of the
nails, often with an increase in the
curvature of the nails.
Acromegaly 肢端肥大症
Acromegaly is the Greek word for
"extremities" and "enlargement." When
the pituitary gland produces excess
growth hormones, this results in
excessive growth -- called acromegaly.
The excessive growth occurs first in the
hands and feet, as soft tissue begins to
swell. Acromegaly affects mostly middleaged adults. Untreated, the disease can
lead to severe illness and death.
Acromegaly - Hands - Normal
female hand for comparison
genu valgum 膝外翻, a deformity in
which the knees are abnormally close
together and the space between the
ankles踝关节 is increased; known
also as knock knee.
genu varum膝内翻, a deformity in
which the knees are abnormally
separated and the lower extremities
are bowed inwardly; the deformity
may be in the thigh or leg, or both.
Known also as bowleg.
(A), Genu varum; (B), genu valgum.
genua [ plural of genu ]
Genu valgum
Genu varum
Standing
radiograph in a
child with
hypophosphatae
m-ic rickets
demonstrating
genu varum.
Flatfoot
Definition
Foot medial longitudinal arch
depression or loss
Associated conditions
Heel足跟 eversion外翻 (valgus)
Forefoot前足 abduction外展
Muscular atrophy
Muscular atrophy is the decrease in
size and wasting of muscle tissue.
Muscles that lose their nerve supply
can atrophy and simply waste away.
Skeletal spine
The spine is divided into several
sections. The cervical vertebrae make
up the neck. The thoracic vertebrae
comprise the chest section and have
ribs attached. The lumbar vertebrae are
the remaining vertebrae below the last
thoracic bone and the top of the
sacrum骶骨. The sacral vertebrae骶椎
are caged within the bones of the
pelvis骨盆, and the coccyx尾骨
represents the terminal vertebrae or
vestigial残迹的 tail.
Kyphosis 脊柱后凸
Kyphosis is a curving of the spine
that causes a bowing of the back,
such that the apex of the angle
points backwards leading to a
hunchback驼背 or slouching
posture.
Kyphosis is a spinal deformity that
can result from trauma,
developmental problems, or
degenerative disease. Kyphosis can
occur at any age, although it is rare
at birth.
Adolescent kyphosis, also known as
Scheuermann's disease, results from
the wedging together of several
consecutive vertebrae (bones of the
spine). The cause of Scheuermann's
disease is unknown.
In adults, kyphosis can be a result of
osteoporotic compression fractures
(fractures caused by osteoporosis),
degenerative disease (such as
arthritis), or spondylolisthesis脊椎前
移(slipping of one vertebra forward
on another).
Symptoms
Mild back pain
Fatigue
Tenderness and stiffness in the spine
Round back appearance
Difficulty breathing (in severe cases)
Signs and tests
Physical examination by a health care provider
confirms the abnormal curvature of the spine. The
doctor will also look for any neurologic changes
(weakness, paralysis, or changes in sensation) below
the level of the curve.
A spine X-ray will be done to document the severity
of the curve and allow serial measurements to be
performed.
Occasionally, pulmonary function tests may be used
to assess whether the kyphosis is affecting breathing.
If there is any question of a tumor, infection, or
neurologic symptoms, then an MRI may be ordered.
Lordosis 脊柱前凸
Lordosis is excessive
curvature in the lumbar
portion of the spine, which
gives a swayback 背部过份
凹陷appearance.
The spine has three types of curves:
Kyphotic, which typically refers to
the outward curve of the thoracic
spine (at the level of the ribs)
Lordotic, which refers to the inward
curve of the lumbar spine (just above
the buttocks)
Scoliotic, which is a sideways
curvature of the spine and which is
always abnormal
What is scoliosis?
Scoliosis is an abnormal curve of the spine (backbone).
With scoliosis, the spine isn't straight. Instead, the spine
is crooked and curves to the side. If the spine is very
crooked, the ribs or hips may stick out more on one
side than the other side. Also, one shoulder may be
lower than the other. 脊柱侧凸
Inside the Knee
The knee is designed for its own protection.
It's completely surrounded by a joint
capsule that's flexible enough to allow
movement but strong enough to hold the
joint together. The capsule is lined with
synovial滑液的;滑膜的tissue, which secretes
synovial fluid to lubricate the joint. Wearresistant cartilage软骨 covering the ends of
the thighbone股骨(femur) and shinbone胫
骨 (tibia) helps reduce friction during
movement.
Pads of cartilage (menisci) act as
cushions between the two bones and help
distribute body weight in the joint. Fluidfilled sacs (bursas囊) provide cushioning
as skin or tendons move across bone.
Ligaments along the sides and the back
of the knee reinforce the joint capsule,
adding stability. The kneecap (patella髌
骨) protects the front of the joint.
Thanks!