S. Reproductivo Hombre Flashcards
An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects?
Gynecomastia
A 30-year-old man comes to the physician for evaluation of lump on his right testicle that he noticed 2 weeks ago while bathing. He has a history of bilateral cryptorchidism treated with orchidopexy at 8 months of age. Physical examination shows a firm, nontender nodule on the right testis that does not transilluminate. His serum alpha-fetoprotein, placental alkaline phosphatase, and beta-human chorionic gonadotropin concentration are all within the reference range. This patient’s testicular tumor is most likely of which of the following types?
Teratoma
Testicular germ cell tumors are divided into two groups: seminomas (most common) and nonseminoma tumors. Nonseminoma tumors include embryonal carcinomas, yolk sac tumors, testicular choriocarcinomas, teratomas, and tumors with mixed germ cell histology. Pure teratomas typically do not cause an elevation in testicular tumor markers (beta-hCG, AFP, PLAP), which is consistent with this patient’s laboratory studies.
A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient’s condition is best classified as which of the following?
Psychogenic ED classically manifests with consistent sexual dysfunction that develops acutely, often during a time of increased psychosocial stress (e.g., this patient’s impending divorce).
The Appendix testis is a vestigial remnant of the Müllerian duct system and one of the four main testicular appendages. There it tends to be torsion. What cells are involved in its formation?
Sertoli cells produce Müllerian inhibitory factor (MIF), which causes the regression of the paramesonephric duct to the appendix testis. In the absence of MIF, the paramesonephric duct develops into female internal structures (i.e., fallopian tubes, uterus, proximal vagina).
This male newborn has epispadias, a condition that manifests with a urethral opening on the dorsal aspect of the penis. Epispadias is often associated with bladder exstrophy , which causes herniation of bladder mucosa through the lower midline abdominal wall, as seen in this patient. Which of the following is the most likely underlying cause of this patient’s findings?
Misdirected growth of the genital tubercle in the posterior (rather than superior) direction during the 5th week of gestation results in epispadias.
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Male Reproductive System: Block 1
6/40
1
An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects?
2
A 30-year-old man comes to the physician for evaluation of lump on his right testicle that he noticed 2 weeks ago while bathing. He has a history of bilateral cryptorchidism treated with orchidopexy at 8 months of age. Physical examination shows a firm, nontender nodule on the right testis that does not transilluminate. His serum alpha-fetoprotein, placental alkaline phosphatase, and beta-human chorionic gonadotropin concentration are all within the reference range. This patient’s testicular tumor is most likely of which of the following types?
3
A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient’s condition is best classified as which of the following?
4
A previously healthy 8-year-old boy is brought to the emergency department by his mother 2 hours after the sudden onset of scrotal pain. Physical examination reveals nontender testes and a tender, 5-mm, bluish nodule at the superior pole of the left testis. The patient undergoes urgent surgical exploration of the scrotum. During the operation, the appendix testis is found to be necrotic. In the process of embryologic development, which of the following is mainly involved in the formation of the appendix testis?
5
A previously healthy 25-year-old man comes to the physician because of a 1-week history of fever and fluid release from painful lumps in the right groin. He had an atraumatic ulceration of the penis about 1 month ago that was not painful and resolved on its own within 1 week. He works at an animal shelter for abandoned pets. He is sexually active with multiple male partners and does not use condoms. His temperature is 38.5°C (101.3°F). Examination of the groin shows numerous, tender nodules with purulent discharge. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal pathogen?
6
A male newborn is born at 37 weeks’ gestation after spontaneous vaginal delivery. The mother had no prenatal care. Physical examination shows a urethral opening on the dorsal aspect of the penis, 4 mm proximal to the glans. There is a 3-cm defect in the midline abdominal wall superior to the pubic symphysis with exposure of moist, erythematous mucosa. Which of the following is the most likely underlying cause of this patient’s findings?
7
A 20-year-old male comes to the physician because of a 1-week-history of a painless ulceration on his penis. The patient is sexually active with multiple partners and does not use barrier protection. Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis and nontender bilateral inguinal adenopathy. Which of the following is most likely to confirm the diagnosis in this patient?
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Question
A 20-year-old male comes to the physician because of a 1-week-history of a painless ulceration on his penis. The patient is sexually active with multiple partners and does not use barrier protection. Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis and nontender bilateral inguinal adenopathy. Which of the following is most likely to confirm the diagnosis in this patient?
Darkfield microscopy is a diagnostic method that allows direct visualization of T. pallidum from the lesion’s serous exudate.
A 33-year-old man comes to the physician with his wife for evaluation of infertility. They have been unable to conceive for 2 years. The man reports normal libido and erectile function. He has smoked one pack of cigarettes daily for 13 years. He does not take any medications. He has a history of right-sided cryptorchidism that was surgically corrected when he was 7 years of age. Physical examination shows no abnormalities. Analysis of his semen shows a low sperm count. Laboratory studies are most likely to show which of the following?
Decreased inhibin B concentration
In this patient with a history of cryptorchidism, Sertoli cell dysfunction would be expected due to temperature-induced damage to the seminiferous tubules, which can result in infertility. Therefore, inhibin B concentration would be decreased and FSH concentration would be increased (due to the loss of the feedback inhibition by inhibin B).
A 52-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The swelling started several weeks ago but is not always present. Physical examination shows an 8-cm, soft, cystic nontender right-sided scrotal mass that transilluminates. The mass does not increase in size on coughing and it is possible to palpate normal tissue above the mass. There are no bowel sounds in the mass, and it does not reduce when the patient is in a supine position. Examination of the testis shows no abnormalities. Which of the following is the most likely cause of the mass?
Since this patient has no signs of ongoing inflammation, no history of recent testicular trauma, and a normal testis on palpation, he most likely has a primary/idiopathic hydrocele, which is caused by an imbalance in the rate of fluid secretion and resorption by the tunica vaginalis.
A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance (straddle injury). His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which of the following parts of the urinary tract is most likely damaged in this patient?
The bulbous urethra lies in close proximity to the pubic symphysis, is relatively immobile, and lacks the protection of the corpora cavernosa.
A 63-year-old man comes to the physician because of a 4-month history of urinary hesitancy and poor urinary stream. Digital rectal examination shows a symmetrically enlarged, nontender prostate. Serum studies show a prostate-specific antigen concentration of 2 ng/mL (N < 4). Pharmacotherapy with finasteride is initiated. Which of the following is the most likely effect of this drug?
Increased prostatic apoptosis is an effect of finasteride and other 5-alpha-reductase inhibitors (e.g., dutasteride), which inhibit the conversion of testosterone to dihydrotestosterone (DHT)
