A 25-year-old man has been unable to father children. He and his wife undergo an infertility workup. His wife's reproductive function is normal. On physical examination he has descended testes that appear normal in size. A testicular biopsy is performed and on microscopic examination only Sertoli cells are present in the seminiferous tubules. Which of the following laboratory test findings is he most likely to have?
A Decreased sperm count
B Elevated serum human chorionic gonadotrophin
C Decreased serum luteinizing hormone
D Increased serum testosterone
E Decreased plasma muellerian inhibiting substance
F Increased serum alpha-fetoprotein
NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU
A 30-year-old man has had a feeling of heaviness in his left testis for the past 6 months. Physical examination reveals enlargement of the left testis, while the right testis appears normal. There is a palpable left inguinal lymph node. An ultrasound reveals a 4 cm solid mass within the body of the left testis. Laboratory findings included a serum beta-HCG of 5 IU/L and alpha-fetoprotein of 2 ng/mL. The left testis is removed and with gross examination on sectioning reveals a firm, lobulated light tan mass without hemorrhage or necrosis. He receives radiation therapy. Which of the following neoplasms is he most likely to have?
B Embryonal carcinoma
D Yolk sac tumor
E Leydig cell tumor
A 35-year-old man goes to his physician for a routine examination. On physical examination there is a left inguinal mass. The right testis is palpated in the scrotum and is of normal size, but a left testis cannot be palpated in the scrotum. An ultrasound scan shows that there is an inguinal mass. Which of the following approaches is most appropriate to deal with this patient's testicular abnormality?
A Put it into the scrotum surgically
B Remove it along with the opposite testis
C Remove it
D Put the patient on testosterone therapy
E Perform a chromosome analysis
A 70-year-old healthy man goes to his physician for a routine check-up. On physical examination there is a firm nodule palpable in the prostate via digital rectal examination. Prostate biopsies are performed and on microscopic examination show small, crowded glands containing cells with prominent nucleoli within the nuclei. Which of the following is the most likely diagnosis?
A Adenocarcinoma of the prostate
B Benign prostatic hyperplasia
C Chronic prostatitis
D Metastatic urothelial carcinoma
E Recent infarction of prostate
An epidemiologic study is performed to determine potential risk factors for development of penile squamous intraepithelial neoplasia. It is observed that persons who develop this disease are elderly men. The medical histories of these men are reviewed. Which of the following diseases is most likely to be found to precede development of penile neoplasia in these men?
B Herpes simplex virus infection
C Lichen simplex chronicus
D Balanitis xerotica obliterans
A clinical study is performed with male subjects diagnosed with sexually transmitted diseases. The clinical and laboratory findings in their medical records are analyzed. It is observed that in some cases there is ulceration of the male external genitalia while in others no ulceration is observed on physical examination. Which of the following organisms is most likely to result in non-ulcerated lesions?
A Chlamydia trachomatis
B Human papillomavirus
C Calymmatobacterium granulomatis
D Treponema pallidum
E Hemophilus ducreyi
F Herpes simplex virus
A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife's reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a "bag of worms". Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have?
B Testicular torsion
A 72-year-old man gets up several times during a football match to go to the restroom to urinate, even though he has had only one beer. This is a problem that has plagued him for several years. When he visits his physician for a checkup, on physical examination he has an enlarged, nodular prostate palpated on digital rectal examination. Laboratory studies show his serum prostate specific antigen is 5 ng/mL. Which of the following pathologic findings is most likely to be present on prostate biopsy in this man?
B Acute inflammation
C Multiple infarctions
D Nodular hyperplasia
E Granulomatous inflammation
A 19-year-old university student notes the sudden onset of severe discomfort in his scrotum late one evening. No position is comfortable for him to sit or lie down. Aspirin and a can of beer have no effect. He has a friend drive him to the emergency room. On physical examination his vital signs include temperature 37 C, respirations 22/minute, pulse 80/minute, and blood pressure 100/65 mm Hg. His left testis is slightly enlarged and exquisitely tender. There is no inguinal adenopathy. A doppler ultrasound scan shows decreased blood flow in the left testis. Which of the following conditions is he most likely to have?
C Ureteral lithiasis
D Spermatic cord torsion
A 20-year-old man has noted a penile discharge with some pain on urination for the last 2 days. On physical examination there is a small amount of whitish exudate that can be expressed from the urethral meatus. Laboratory studies with culture of the penile discharge reveal Neisseria gonorrheae. If untreated, which of the following complications is he most likely to develop as a consequence of his disease?
A 31-year-old man has had a feeling of heaviness in his scrotum for over 6 months. The examining physician notes an enlarged right testis. An ultrasound reveals a solid 5 cm mass in the body of the right testis. Laboratory studies show a serum alpha-fetoprotein (AFP) of 81 ng/mL and human chorionic gonadotrophin (HCG) of 15 IU/L. A right orchiectomy is performed, and on gross examination the testicular mass is soft and reddish brown. Microscopic examination shows cords and sheets of primitive cells with large nuclei. Which of the following is the most likely diagnosis?
C Mumps orchitis
D Leydig cell tumor
E Squamous cell carcinoma
A 77-year-old man has a routine check-up by his physician. The only physical examination finding is slight nodularity of his prostate on digital rectal examination. Laboratory studies show a serum prostate specific antigen of 6 ng/mL. A prostate biopsy is performed and on microscopic examination shows prostatic intraepithelial neoplasia (PIN). Which of the following is the best medical care option to offer this man?
A Radical prostatectomy
B Multiagent chemotherapy
C Transurethral prostate resection
D Monitoring of PSA levels
a 27-year-old man has complained of continuing "jock itch" for the past year. On physical examination there are small whitish scaling patches on the skin of his perineum. A scraping from the lesion shows Trichophyton rubrum organisms. Which of the following lesions is he most likely to develop?
A Condyloma acuminatum
C Bowen's disease
E Lichen simplex chronicus
A clinical study is performed with subjects who are sexually active 30- to 45-year-old men. A subset of these subjects are found to have a history of pelvic pain with enlarged, tender prostates on digital rectal examination. However, routine microbiologic cultures from prostatic secretions in this subset of men show no growth. Which of the following infectious agents is most likely to produce the condition seen in this subset of subjects?
A Human papillomavirus
B Herpes simplex virus
C Human immunodeficiency virus
D Chlamydia trachomatis
E Candida albicans
A 30-year-old sexually active man has experienced a burning pain with urination for the past 5 days. On physical examination there is a scant pale yellowish urethral discharge. He is afebrile. He is most likely to be infected with which of the following organisms?
A Herpes simplex virus
B Treponema pallidum
C Chlamydia trachomatis
D Mumps virus
A 22-year-old G2 P1 woman gives birth following an uncomplicated pregnancy to a term male infant weighing 2850 gm. On physical examination he has incomplete development of the dorsal aspect of the penile urethra, with the defect extending to the bladder, which is open on the lower abdominal wall. Which of the following is the most likely diagnosis?
B Bowen disease
A 35-year-old healthy man desires a permanent form of contraception. He has a vasectomy performed. He is advised of the potential complications of this procedure. Which of the following is most likely to result from prior vasectomy?
D Testicular torsion
E Sperm granuloma
An autopsy study is conducted to document testicular abnormalities in adult male patients who had an accidental manner of death. In some of these cases, the patients had grossly normal testes but microscopic examination showing a patchy pattern of atrophy of testicular tubules. Review of their medical histories showed that they were fertile. Which of the following infections is most likely to produce the findings seen in these men?
B Chlamydia trachomatis
C Neisseria gonorrheae
E Herpes simplex virus
A 21-year-old sexually active man is notified by the health department that his last sexual contact 3 weeks prior has a positive serologic test for syphilis. He goes to see his physician that day. Which of the following findings in this man is most likely to be indicative of his acquisition of this infection?
A Positive VDRL in the CSF
B Testicular gumma on biopsy
C Mucocutaneous rash
D Penile chancre
E Genital condyloma lata
A 40-year-old man has noted gradual enlargement of his scrotum, more on the right side, for the past 2 years. There is no associated pain, but the size is becoming uncomfortable. Physical examination reveals that the right side of the scrotum is enlarged to three times the size of the testis palpable on the left. This mass transilluminates. There is no tenderness on palpation. There is no inguinal lymphadenopathy. An ultrasound reveals a 5 cm thin-walled cystic fluid-filled area in the region of the right testis. Which of the following is the most likely diagnosis?
E Syphilitic orchitis
A healthy 17-year-old adolescent has a routine check of his health status. On physical examination pearly penile papules are noted at the edge of the glans penis. He is noted to be circumcised. There is no erythema or urethral discharge. He is not sexually active. Which of the following is the most likely diagnosis?
A Bowen disease
B Human papillomavirus infection
C Normal variation
D Balanitis with Staphylococcus aureus
A 55-year-old man has experienced pain with urination for the past week. On physical examination his prostate is slightly enlarged and mildly tender to palpation on digital rectal examination. His temperature is 37.5 C. Laboratory studies show is WBC count is 12,910/microliter. Urine culture grows >100,000/mL Escherichia coli. His serum prostate specific antigen is 7 ng/mL. He receives antibiotic therapy and improves. This condition recurs 5 times in the next 6 months. Which of the following diseases is he most likely to have?
A Nodular prostatic hyperplasia
B Prostatic adenocarcinoma
C Chronic bacterial prostatitis
D Urothelial carcinoma of urethra
A clinical study is performed using subjects diagnosed with testicular neoplasia. The laboratory findings of these subjects are reviewed. A subset of these subjects is found to have had an elevated serum alpha-fetoprotein. Which of the following types of testicular neoplasm is this subset of men most likely to have had?
C Leydig cell tumor
A clinical study is performed to determine the optimal means for diagnosis of sexually transmitted diseases (STDs). The clinical and laboratory findings in subjects diagnosed with STDs are reviewed. A group of subjects is found to have Chlamydia trachomatis infection. Which of the following laboratory methods is most likely to be useful in diagnosis of C. trachomatis in these subjects?
A Darkfield microscopic examination of exudate or secretions
B Cytologic smear
C Tissue biopsy
D Enzyme immunoassay
E Microbiologic culture
A 30-year-old G3 P2 woman gives birth at term following an uncomplicated pregnancy to a male infant. On physical examination he has an abnormal opening of the urethra onto the ventral surface of the penis for a distance of 0.3 cm. Which of the following is the most likely diagnosis?
A 45-year-old man complains of dysuria for the past week. On physical examination he is uncircumcised and has erythema and edema of the glans penis, with inability to retract the foreskin over the glans penis. Which of the following infectious agents is most likely to be associated with these findings?
B Staphylococcus aureus
C Herpes simplex virus
E Sarcoptes scabiei
A pathologic study is performed in male subjects ranging from 50 to 100 years of age who had serum prostate specific antigen levels above 15 ng/mL and who underwent prostatectomy following biopsies in which there was adenocarcinoma on microscopic examination. The resected prostates were examined pathologically and the sites of the adenocarcinomas mapped within the prostate. In which of the following regions of the prostate are these adenocarcinomas most likely to arise?
A Anterior fibromuscular stroma
B Central zone
C Peripheral zone
D Periurethral zone
E Transitional zone
A 21-year-old man notes the presence of a lesion on his penis for the past week. On physical examination there is a solitary 0.7 cm diameter circumscribed area of ulceration on the dorsal aspect of his penis just proximal to the glans. This ulcer has a firm erythematous base containing minimal grey exudate. Which of the following is the most cost effective method for laboratory diagnosis of this man's lesion?
A Darkfield microscopy
A clinical study is conducted to determine the survival following treatment for testicular neoplasms utilizing subjects recorded into a hospital tumor registry. Treatments included surgery, chemotherapy, and radiation therapy. The patient records are reviewed to determine the pathologic diagnosis and the 5 year survivals for these patients. Which of the following types of testicular neoplasm is most likely to have responded best to radiation therapy?
E Yolk sac carcinoma
A 35-year-old man has a routine check of his health status. On physical examination the prepuce cannot be fully retracted from the glans of his penis. No other abnormalities are noted. Which of the following is the most likely diagnosis?
A double blind study is conducted involving men who have been symptomatic from urinary frequency and hesitancy for 5 or more years. One group men receive a pharmacologic agent designed to reduce the synthesis of dihydrotestosterone in prostatic stromal cells. Another group receives a placebo. The group receiving the drug has a statistically significant decrease in symptoms. Which of the following enzymes is this pharmacologic agent most likely to block?
A 2-year-old boy is brought to the physician because his mother has observed that his scrotum is no longer symmetrical (she is a geometry teacher). On physical examination the child has enlargement of the left testis. An ultrasound scan shows a 2 cm solid mass within the body of the testis. Laboratory studies show a serum alpha-fetoprotein of 226 ng/mL. Which of the following neoplasms is this child most likely to have?
A Leydig cell tumor
E Yolk sac tumor
A 43-year-old man has noted a lesion on his penis for the past year. On physical examination there is a 0.9 cm diameter rough, tan, firm, slightly raised area at the right lateral base of the glans. He is uncircumcised, and there is difficulty in retracting the foreskin. Which of the following is the most likely diagnosis?
B Balanitis xerotica obliterans
C Bowen disease
D Hard chancre
A 32-year-old has noted bilateral breast enlargement over the past 7 months. On physical examination there is bilateral gynecomastia without tenderness or masses. His external genitalia appear normal. An ultrasound scan reveals a 1 cm solid mass within the body of the right testis. Laboratory studies show a serum testosterone of 550 ng/dL and estradiol of 36 pg/mL. His serum alpha-fetoprotein is 9 ng/mL and HCG non-detectable. Which of the following neoplasms is this man most likely to have?
E Yolk sac tumor
FIRST QUESTION - - INDEX OF QUESTIONS - - EXAM MENU