Male reproductive system — Past Paper OmpathStudy

Male reproductive system — Questions and Answers Complete review bank: 35 questions recovered from all 21 source pages. 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 Answer: A. Such a 'Sertoli cell only' syndrome is a cause for male infertility and may be idiopathic. A similar pattern would be present in a cryptorchid testis. 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 Answer: C. The most common pure form of testicular cancer is seminoma, a type of germ cell tumor which is radiosensitive. The tumor markers are not markedly elevated. This form of testicular carcinoma has the best prognosis overall, when not mixed with other elements. 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 2 cm 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 D. Put the patient on testosterone therapy E. Put the patient on chemotherapy Answer: C. A cryptorchid testis that is not treated in early childhood no longer functions in spermatogenesis and presents a risk for subsequent development of seminoma. The earlier in life that an orchiopexy is performed, generally under the age of 5, the more likely the testis will function properly. If the opposite testis were also cryptorchid, it would be at increased risk for development of carcinoma. However, the risk of carcinoma in the descended testis is unlikely to be increased, so it can be left to function. The patient may opt for orchiopexy of the cryptorchid testis, but it can be explained that fertility and hormone production can be provided by the descended testis. If the patient wanted two 'balls' in the scrotum, a prosthesis could be placed. 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. A magnetic resonance imaging scan confirms the presence and location of a posterior 0.4 cm nodule. 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 Answer: A. Such a nodule at that age strongly suggests carcinoma. Most carcinomas of the prostate arise in the posterior portion of the gland where they can be palpated on digital rectal examination. Microscopically, prostatic adenocarcinomas have irregular glands without intervening stroma. Large nucleoli are a characteristic microscopic feature. 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 Answer: A. The chronic irritation from accumulation of secretions and smegma under the prepuce is the likely risk. Circumcision reduces the risk for development of penile carcinoma, and can reduce transmission of infections as well. 6. A 32-year-old man reports increasing size and number of lesions in his genital region. On examination there are multiple 0.