Question 1

A 25-year-old man and his wife undergo an infertility workup. His wife's reproductive function is normal. On physical examination he has descended testes that appear decreased in size. A sperm count shows aspermia. 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 Increased FSH

B Increased HCG

C Increased alpha-fetoprotein

D Decreased testosterone

E Decreased muellerian inhibiting substance

F Decreased luteinizing hormone

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Question 2

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 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?

A Choriocarcinoma

B Embryonal carcinoma

C Seminoma

D Yolk sac tumor

E Leydig cell tumor

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Question 3

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 a solid inguinal mass. Which of the following approaches is most appropriate to deal with this patient's testicular abnormality?

A Put the mass into the scrotum surgically

B Remove the mass along with the opposite testis

C Remove the mass and biopsy the right testis

D Put the patient on testosterone therapy

E Put the patient on chemotherapy

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Question 4

A 70-year-old healthy man has 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

B Nodular hyperplasia

C Chronic prostatitis

D Urothelial carcinoma

E Recent infarction

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Question 5

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?

A Phimosis

B Herpes simplex virus infection

C Lichen simplex chronicus

D Balanitis xerotica obliterans

E Epispadias

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Question 6

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 Klebsiella granulomatis

D Treponema pallidum

E Hemophilus ducreyi

F Herpes simplex virus

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Question 7

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?

A Hydrocele

B Testicular torsion

C Spermatocele

D Varicocele

E Seminoma

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Question 8

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 4 years. When he visits his physician for a checkup, on physical examination he has a diffusely enlarged prostate palpated on digital rectal examination. Laboratory studies show his serum prostate specific antigen is 6 ng/mL. Which of the following pathologic findings is most likely to be present in this man?

A Adenocarcinoma

B Acute inflammation

C Multiple infarctions

D Nodular hyperplasia

E Granulomas

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Question 9

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 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?

A Choriocarcinoma

B Varicocele

C Lithiasis

D Torsion

E Hydrocele

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Question 10

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 Aortitis

B Balanitis

C Epididymitis

D Orchitis

E Sacroiliitis

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Question 11

A 31-year-old man has had a feeling of heaviness in his scrotum for over 6 months. On exam he has 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?

A Teratoma

B Embryonal carcinoma

C Mumps orchitis

D Leydig cell tumor

E Squamous cell carcinoma

F Choriocarcinoma

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Question 12

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 PSA levels

E Nothing

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Question 13

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

B Chancre

C Bowen disease

D Angiokeratoma

E Lichen simplex chronicus

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Question 14

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

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Question 15

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

E Hemophilus ducreyi

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Question 16

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 onto the lower abdominal wall. Which of the following is the most likely diagnosis?

A Hypospadias

B Bowen disease

C Balanoposthitis

D Epispadias

E Paraphimosis

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Question 17

A 35-year-old healthy man desires a permanent form of contraception. He has a vasectomy performed with no complicatios of the surgery. He is advised of the potential future complications of this procedure. Which of the following is most likely to result from prior vasectomy?

A Varicocele

B Orchitis

C Hydrocele

D Testicular torsion

E Sperm granuloma

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Question 18

A study is conducted to document testicular abnormalities in adult male patients with no major medical problems who had biopsies performed for infertility workups. In some of these cases, the patients have normal sized testes but microscopic examination showing a patchy pattern of atrophy of testicular tubules. Which of the following infections is most likely to produce the findings seen in these men?

A Human papillomavirus

B Chlamydia trachomatis

C Neisseria gonorrheae

D Mumps virus

E Herpes simplex virus

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Question 19

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

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Question 20

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?

A Seminoma

B Torsion

C Hydrocele

D Varicocele

E Orchitis

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Question 21

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

E Phimosis

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Question 22

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

E Prostodynia

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Question 23

A 95-year-old man has had difficulty with urination for the past 15 years. On examination his prostate is diffusely enlarged. A transurethral resection is performed. On microscopic examination there is glandular hyperplasia and a focus of grade 1,2 adenocarcinoma. Which of the following is the next most appropriate treatment plan for this man?

A Chemotherapy

B Alpha blocker therapy

C Radiotherapy

D Anti-androgen therapy

E No further therapy

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Question 24

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

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Questions 25

A 33-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 Hypospadias

B Exstrophy

C Phimosis

D Epispadias

E Cryptorchidism

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Question 26

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?

A Human papillomavirus

B Staphylococcus aureus

C Herpes simplex virus

D Treponema pallidum

E Sarcoptes scabiei

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Question 27

A pathologic study is performed in men 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

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Question 28

A 22-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

B Cytologic smear

C Tissue biopsy

D Enzyme immunoassay

E Microbiologic culture

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Question 29

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?

A Choriocarcinoma

B Embryonal carcinoma

C Seminoma

D Teratoma

E Yolk sac tumor

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Question 30

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 Balanoposthitis

B Epispadias

C Exstrophy

D Hypospadias

E Phimosis

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Question 31

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 5-alpha-reductase

B Aromatase

C 17-alpha-hydroxylase

D Desmolase

E 11-beta-hydroxylase

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Question 32

A 2-year-old boy is brought to the physician because his mother (a geometry teacher) has observed that his scrotum is no longer symmetrical. 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

B Neuroblastoma

C Rhabdomyosarcoma

D Teratoma

E Yolk sac tumor

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Question 33

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?

A Angiokeratoma

B Balanitis xerotica obliterans

C Bowen disease

D Hard chancre

E Lichen simplex chronicus

F Paraphimosis

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Question 34

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?

A Choriocarcinoma

B Embryonal carcinoma

C Leydig cell tumor

D Seminoma

E Yolk sac tumor

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