Assessing the Genitalia and Rectum

A 21-year-old college student reports to your clinic with external bumps on her genital area. The bumps are painless and feel rough. The patient is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. The patient reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She had one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
Post a description of the health history you would need to collect from the patient in the case study. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

References that may be used:
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 16, “Breasts and Axillae” (pp. 455–481)

This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.
Chapter 18, “Female Genitalia” (pp. 535–599)

In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.
Chapter 19, “Male Genitalia” (pp. 600–625)
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.
Chapter 20, “Anus, Rectum, and Prostate” (pp. 626–647)

This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.
Seller, R., & Symons, A. (2012). Differential diagnosis of common complaints (6th ed.). Philadelphia, PA: Elsevier Saunders.
Chapter 5, “Breast Lumps” (pp. 58–66)

This chapter focuses on the most common breast complaints and how they can be used to help identify the cause of the problem. Emphasis is placed on mammography and its recommended uses.
Chapter 20, “Menstrual Irregularities” (pp. 224–244)
The focus of this chapter is menstrual irregularities, including symptoms and most common causes. The chapter includes several tables that list potential diagnoses, as well as drugs that can affect the menstrual cycle.
Chapter 21, “Menstrual Pain”

This chapter provides criteria for diagnosing different causes of menstrual pain. It includes potential symptoms, precipitating and aggravating factors, and possible physical findings.
Chapter 32, “Urethral Discharge and Dysuria” (pp. 371–381)

In this chapter, the focus is identifying the causes of urethral discharge. The authors examine the common symptoms and distinguish between infections and sexually transmitted diseases.
Chapter 33, “Vaginal Discharge and Itching” (pp. 382–391)

The topic of this chapter is vaginal discharge, and the information provided describes common symptoms, physical findings, and the resultant diagnoses.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Mosby, Elsevier.
Chapter 4, “Amenorrhea” (pp. 46–60)

Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.
Chapter 5, “Breast Lumps and Nipple Discharge”

This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.
Chapter 6, “Breast Pain”

Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.
Chapter 24, “Penile Discharge” (pp. 296–302)

The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.
Chapter 33, “Vaginal Bleeding” (pp. 396–410)

In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.
Chapter 34, “Vaginal Discharge and Itching” (pp. 411–422)

This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)

Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.
Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)

In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.
Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)

The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.
Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.
Steggall, M., & Cox, C. (2009). A step-by-step guide to performing a complete digital rectal examination. Gastrointestinal Nursing, 7(2), 28–32.
Retrieved from the Walden Library databases.

The authors of this article describe the process of conducting a digital rectal examination. The article also highlights areas of knowledge that gastrointestinal nurses may enhance.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

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