Path Exam 4 Webpath

Front 1

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?

Back 1

Decreased sperm count

Front 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 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?

Back 2

Seminoma

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

Back 3

Remove it

Front 4

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?

Back 4

Adenocarcinoma of the prostate

Front 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?

Back 5

Phimosis

Front 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?

Back 6

Human papillomavirus

Front 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?

Back 7

Varicocele

Front 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 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?

Back 8

Nodular hyperplasia

Front 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 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?

Back 9

Spermatic cord torsion

Front 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?

Back 10

Epididymitis

Front 11

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?

Back 11

Embryonal carcinoma

Front 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?

Back 12

Monitoring of PSA levels

Front 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?

Back 13

Lichen simplex chronicus

Front 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?

Back 14

Chlamydia trachomatis

Front 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?

Back 15

Chlamydia trachomatis This is the most common non-gonococcal urethritis in males.

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

Back 16

Epispadias

Front 17

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?

Back 17

Sperm granuloma

Front 18

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?

Back 18

Mumps virus

Front 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?

Back 19

Penile chancre

Front 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?

Back 20

Hydrocele

Front 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?

Back 21

Normal variation

Front 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?

Back 22

Chronic bacterial prostatitis

Front 23

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?

Back 23

Embryonal carcinoma

Front 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?

Back 24

Enzyme immunoassay

Front 25

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?

Back 25

Hypospadias

Front 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?

Back 26

Staphylococcus aureus

Front 27

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?

Back 27

Peripheral zone

Front 28

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?

Back 28

Darkfield microscopy

Front 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?

Back 29

Seminoma

Front 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?

Back 30

Phimosis

Front 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?

Back 31

5-alpha-reductase

Front 32

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?

Back 32

Yolk sac tumor

Front 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?

Back 33

Bowen disease

Front 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?

Back 34

Leydig cell tumor