Chapter 20: Male Genitalia

Question 1

While examining an 18-year-old man, you note that his penis and testicles are more darkly
pigmented than the body skin. You should consider this finding to be
a. within normal limits.
b. suggestive of a skin fungus.
c. suggestive of psoriasis.
d. caused by excessive progesterone.

Answer 1

ANS: A
Darker pigmentation on the penis and testicles, as compared with other body skin, is a normal
finding and is not suggestive of a skin fungus, psoriasis, or excessive progesterone.

Question 2

In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance.
This is usually
a. evidence of a fungal infection.
b. a collection of sebaceous material.
c. indicative of penile carcinoma.
d. suggestive of diabetes.

Answer 2

ANS: B
In the uncircumcised male, smegma is formed by the secretion of sebaceous material by the
glans and the desquamation of epithelial cells from the prepuce. It appears as a cheesy white
substance on the glans and in the fornix of the foreskin. Smegma lubricates the cavity between
the foreskin of the penis and the glans, allowing smooth movement between them during
intercourse. It is not usually evidence of a fungal infection, penile carcinoma, or diabetes.

Question 3

Inspection of the scrotum should reveal
a. lightly pigmented skin.
b. two testes per sac.
c. smooth scrotal sacs.
d. the left scrotal sac lower than the right.

Answer 3

ANS: D
The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The
skin of the scrotum is more darkly pigmented. The scrotum has one testis per sac. The
scrotum has small epidermoid cysts that give it a lumpy appearance

Question 4

Expected genitalia changes that occur as men age include that
a. the ejaculatory volume decreases with age.
b. erections develop more quickly.
c. the viability of sperm increases.
d. the scrotum becomes more pendulous.

Answer 4

ANS: D
Ejaculatory volume increases with age, erections develop more slowly, sperm viability
decreases, and the scrotum becomes more pendulous with age.

Question 5

Inspection of the male urethral orifice requires the examiner to
a. ask the patient to bear down.
b. insert a small urethral speculum.
c. press the glans between the thumb and forefinger.
d. transilluminate the penile shaft.

Answer 5

ANS: C
Inspection of the urethral orifice is accomplished by pressing the glans between the
examiner’s thumb and forefinger. This maneuver opens the slitlike orifice for further
inspection.

Question 6

You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and
cannot be easily retracted. You should
a. chart the finding as paraphimosis.
b. inquire about previous penile infections.
c. retract the foreskin firmly.
d. transilluminate the glans

Answer 6

ANS: B
This condition is phimosis and is usually congenital, or it may be related to recurrent
infections or poorly controlled diabetes. You should not chart this finding as paraphimosis.
Retracting the foreskin forcibly would lead to further adhesion formation and worsening
phimosis. Transillumination is indicated for masses of the scrotum.

Question 7

Which type of hernia lies within the inguinal canal?
a. Umbilical
b. Direct
c. Indirect
d. Femoral

Answer 7

ANS: C
Hernias found within the inguinal canal are called indirect hernias.

Question 8

Which condition is of minor consequence in an adult male?
a. Adhesions of the foreskin
b. Continuous penile erection
c. Lumps in the scrotal skin
d. Venous dilation in the spermatic cord

Answer 8

ANS: C
Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal
limits.

Question 9

Mr. L has an unusually thick scrotum, with edema and pitting. He has a history of cardiac
problems. The appearance of his scrotum is most likely a(n)
a. congenital defect that has worsened.
b. indication of general fluid retention.
c. normal consequence of aging.
d. complication of the development of mumps.

Answer 9

ANS: B
General fluid retention can cause scrotal thickening and pitting edema, and is usually seen as a
result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the
genitalia, but rather a condition of these related systems.

Question 10

A characteristic related to syphilis or diabetic neuropathy is testicular
a. dropping, with asymmetry.
b. enlargement.
c. insensitivity to painful stimulation.
d. recession into the abdomen.

Answer 10

ANS: C
Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions.
Asymmetry is a normal finding; enlargement and recession are not related to diabetes or
syphilis.

Question 11

On palpation, a normal vas deferens should feel
a. beaded.
b. smooth.
c. ridged.
d. spongy.

Answer 11

ANS: B
The vas deferens should feel smooth and discrete as it is palpated from the testicle to the
inguinal ring. A beaded or lumpy vas deferens might indicate diabetes or the presence of old
inflammatory changes.

Question 12

A premature infant’s scrotum will appear
a. bifid.
b. loose.
c. ridged.
d. smooth.

Answer 12

ANS: D
The premature male scrotum will appear underdeveloped, smooth, without rugae, and without
testes; the full-term infant should have a loose, pendulous scrotum, with rugae and a midline
raphe.

Question 13

An enlarged painless testicle in an adolescent or adult male may indicate
a. epididymitis.
b. testicular torsion.
c. a tumor.
d. an undescended testicle.

Answer 13

ANS: C
A hard, enlarged, painless testicle can indicate a tumor in the adolescent or adult male.
Epididymitis and torsion are painful; an undescended testicle is common in infants and is
usually resolved by 12 months.

Question 14

You palpate a soft, slightly tender mass in the right scrotum of an adult male. You attempt to
reduce the size of the mass, and there is no change in the mass size. Your next assessment
maneuver is to
a. use two fingers to attempt to reduce the mass.
b. palpate the left scrotum simultaneously.
c. lift the right testicle and then compare pain level.
d. transilluminate the mass.

Answer 14

ANS: D
A soft mass is a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a
nonreducible mass should be transilluminated to determine whether it contains fluid and is
possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is
suspected.

Question 15

The most common cancer in young men ages 15 to 30 years is
a. testicular.
b. penile.
c. prostate.
d. anal.

Answer 15

ANS: A
Because testicular tumors are the most common cancer occurring in young adults,
self-examination is encouraged.

Question 16

The most emergent cause of testicular pain in a young male is
a. testicular torsion.
b. epididymitis.
c. tumor.
d. hydrocele.

Answer 16

ANS: A
Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the
onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in
a much lower salvage rate.

Question 17

An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your priority action should be to
a. obtain urine and DNA probe urethral samples.
b. lift the left scrotum to confirm epididymitis.
c. establish absent cremasteric reflex.
d. transilluminate the left and right scrotum.

Answer 17

ANS: C
The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a
supporting finding to differentiate torsion from epididymitis.

Question 18

The most common type of hernia occurring in young males is
a. hiatal.
b. incarcerated femoral.
c. indirect inguinal.
d. umbilical.

Answer 18

ANS: C
The most common type of hernia in children and young males is an indirect inguinal hernia.

Question 19

Difficulty replacing the retracted foreskin of the penis to its normal position is called
a. paraphimosis.
b. Peyronie disease.
c. phimosis.
d. priapism.

Answer 19

ANS: A
Paraphimosis refers to the inability to replace the foreskin to its original position after it has
been retracted behind the glans.

Question 20

Which genital virus infection is known to have a latent phase followed by the production of
viral DNA capsids and particles?
a. Condyloma acuminatum
b. Molluscum contagiosum
c. Herpetic lesions
d. Lymphogranuloma venereum

Answer 20

ANS: A
Condyloma acuminatum (genital warts) are soft, reddish lesions commonly present on the
prepuce, glans penis, and shaft. These lesions can undergo latency, followed by viral DNA
capsids and particles, which are produced in the host cells.

Question 21

Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably
a. herpetic lesions.
b. condylomata.
c. molluscum contagiosum.
d. chancres.

Answer 21

ANS: C
Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative
of molluscum contagiosum.

Question 22

A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not
painful on palpation. The left inguinal canal is without masses. The mass transilluminates with
a penlight. This collection of symptoms is consistent with
a. orchitis.
b. a hydrocele.
c. a rectocele.
d. a scrotal hernia.

Answer 22

ANS: B
A hydrocele is a soft scrotal mass that occurs as a result of fluid accumulation and therefore
transilluminates. Orchitis results in a swollen, tender testis. A rectocele does not result in
scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal.

Question 23

Which condition is a complication of mumps in the adolescent or adult?
a. Cystitis
b. Epididymitis
c. Orchitis
d. Paraphimosis

Answer 23

ANS: C
Orchitis is uncommon unless seen as a complication of mumps in the adolescent or adult.

Question 24

Parents of a 6-year-old boy should be asked if he has
a. erections.
b. nocturnal emissions.
c. rapid detumescence.
d. scrotal swelling.

Answer 24

ANS: D
Scrotal swelling, especially with crying or with bowel movements, signals the presence of a
hernia. The questions about erections and rapid detumescence are for the older male. The
question about nocturnal emissions is asked of adolescents.

Question 25

The male with Peyronie disease will usually complain of
a. painful, inflamed testicles.
b. deviation of the penis during erection.
c. lack of sexual interest.
d. painful lesions of the penis.

Answer 25

ANS: B
Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in
unilateral deviation of the penis during erection.

Question 26

A cremasteric reflex should result in
a. testicular and scrotal rise on the stroked side.
b. penile deviation to the left side.
c. bilateral elevation of the scrotum.
d. immediate erection of the penis

Answer 26

ANS: A
On stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should
rise on the stroked side.