Male Reproductive System — Clinical MCQs

Question 1

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. Which of the following diseases is most likely to be found to precede development of penile neoplasia in these men?

Accepted Answer

Phimosis — 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. ---

Question 2

A 20-year-old man has noted a penile discharge with some pain on urination for the last 2 days. A small amount of whitish exudate can be expressed from the urethral meatus. Culture of the penile discharge reveals Neisseria gonorrheae. If untreated, which of the following complications is he most likely to develop?

Accepted Answer

Epididymitis — When the testis is involved by gonorrhea, it is typically the epididymis. Many male gonorrheal infections are asymptomatic and not followed by significant complications. Urethritis with stricture is a possible complication. ---

Question 3

A 77-year-old man has a routine check-up. The only finding is slight nodularity of his prostate on digital rectal examination. Serum PSA is 6 ng/mL. A prostate biopsy shows prostatic intraepithelial neoplasia (PIN). Which of the following is the best medical care option to offer this man?

Accepted Answer

Monitoring PSA levels — PIN is a potential precursor of prostatic adenocarcinoma, but by itself does not warrant therapy. ---

Question 4

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 shows Trichophyton rubrum organisms. Which of the following lesions is he most likely to develop?

Accepted Answer

Angiokeratoma — The chronic rubbing and scratching from this dermatophyte infection can result in epidermal hyperplasia and chronic inflammation. ---

Question 5

A subset of sexually active 30–45-year-old men are found to have a history of pelvic pain with enlarged, tender prostates on digital rectal examination. However, routine microbiologic cultures from prostatic secretions show no growth. Which of the following infectious agents is most likely to produce this condition?

Accepted Answer

Chlamydia trachomatis — C. trachomatis, the leading cause of non-gonococcal urethritis, is the most frequent form of prostatitis in young adult men. There is typically no history of chronic urinary tract infection. ---

Question 6

A 30-year-old sexually active man has experienced burning pain with urination for the past 5 days. There is a profuse yellowish urethral discharge. He is afebrile and is treated with ceftriaxone. He is most likely to be infected with which of the following organisms?

Accepted Answer

Neisseria gonorrheae — Gonorrhea is a common cause of urethritis in males. Culture of the purulent discharge is possible, but microbial culture of this fastidious organism is challenging, so molecular methods such as a DNA probe or PCR can be used for diagnosis. ---

Question 7

A term male infant is born with 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?

Accepted Answer

Epispadias — Epispadias is a rare congenital anomaly that may be mild or, as in this case, severe with a large open defect that must be repaired. The failure to close the bladder is termed exstrophy. ---

Question 8

A 35-year-old healthy man desires a permanent form of contraception and has a vasectomy performed with no complications. Which of the following is most likely to result from prior vasectomy?

Accepted Answer

Testicular torsion — Also called vasitis nodosa, a sperm granuloma results from a foreign body granulomatous reaction to extravasated sperm at the vasectomy site. The granulomatous reaction is typically not florid. ---

Question 9

A study documents testicular abnormalities in adult males with infertility, some having a patchy pattern of atrophy of testicular tubules. Which of the following infections is most likely to produce these findings?

Accepted Answer

Mumps virus — This is a very common childhood infection (when vaccinations are not done) resulting in orchitis as well as parotitis. The inflammation rarely causes enough damage to produce a significantly reduced sperm count if acquired in childhood. The virus tends to produce more testicular damage when adults are infected. ---

Question 10

A 21-year-old sexually active man is notified that his last sexual contact 3 weeks prior has a positive serologic test for syphilis. Which of the following findings is most likely to be indicative of his acquisition of this infection?

Accepted Answer

Penile chancre — This would be the typical finding for primary syphilis from recent infection by Treponema pallidum. ---

Question 11

A healthy 17-year-old circumcised adolescent has pearly penile papules noted at the edge of the glans penis. There is no erythema or urethral discharge. He is not sexually active. Which of the following is the most likely diagnosis?

Accepted Answer

Normal variation — This is really a normal variation, but some patients may be concerned when they notice that other men do not have them. ---

Question 12

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

Accepted Answer

Anti-androgen therapy — A Gleason 1,2 adenocarcinoma is so low grade that it is unlikely to progress. At least half of men his age probably have a focus of prostatic adenocarcinoma. ---

Question 13

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?

Accepted Answer

Enzyme immunoassay — This is the easiest and most cost-effective method, since C. trachomatis cannot be easily cultured by routine methods. ---

Question 14

A term male infant 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?

Accepted Answer

Hypospadias — This is a congenital anomaly. Infection is a common complication, and partial urethral stricture may lead to urinary tract obstruction. ---

Question 15

A 45-year-old uncircumcised man complains of dysuria for the past week. On physical examination he has erythema and edema of the glans penis, with inability to retract the foreskin. Which of the following infectious agents is most likely to be associated with these findings?

Accepted Answer

Staphylococcus aureus — He has balanitis with paraphimosis, and staphylococcal or streptococcal infections are most likely to be present. ---

Question 16

A pathologic study is performed in men aged 50–100 years with PSA levels above 15 ng/mL who underwent prostatectomy. The sites of adenocarcinomas are mapped within the prostate. In which of the following regions are these adenocarcinomas most likely to arise?

Accepted Answer

Peripheral zone — Most prostatic adenocarcinomas arise in the peripheral zone posteriorly where they can potentially be palpated by digital rectal examination. ---

Question 17

A clinical study is conducted to determine survival following treatment for testicular neoplasms. Treatments included surgery, chemotherapy, and radiation therapy. Which of the following types of testicular neoplasm is most likely to have responded best to radiation therapy?

Accepted Answer

Seminoma — Seminomas are the most radiosensitive of testicular carcinomas. ---

Question 18

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?

Accepted Answer

Hypospadias — Inflammation with scarring may prevent full retraction. There is an increased risk for phimosis and for balanitis in uncircumcised males. ---

Question 19

A 2-year-old boy has enlargement of the left testis. An ultrasound scan shows a 2 cm solid mass within the body of the testis. Serum AFP is 226 ng/mL. Which of the following neoplasms is this child most likely to have?

Accepted Answer

Teratoma — The most common testicular tumor under the age of 3 is a yolk sac tumor (infantile embryonal carcinoma). However, finding any testicular tumor in children is uncommon. The prognosis is good in most cases. ---

Question 20

A 43-year-old uncircumcised 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, with difficulty in retracting the foreskin. Which of the following is the most likely diagnosis?

Accepted Answer

Bowen disease — This is squamous cell carcinoma in situ. If excised at this stage, it is curable. If not treated, it can progress to an invasive carcinoma. ---

Male Reproductive System — Clinical MCQs

Questions, Answers & Explanations