Unit4: Ch 43- Disorders of the Male Reproductive System (Porth's 5th Ed) Flashcards
A newborn male has been diagnosed with hypospadias following his postpartum
assessment by a pediatrician. Which of the following diagnostics and treatment options
is the physician most likely to rule out first?
A) Chromosomal studies
B) Circumcision
C) Surgical repair
D) Testosterone supplementation
Ans: B
Feedback:
Because the foreskin is often used in surgical repair of hypospadias, circumcision is
normally contraindicated. Chromosomal studies are frequently warranted, and surgery is
the standard treatment for the repair of the urethra. Testosterone supplementation is
often necessary.
A 41-year-old male has presented to his family physician stating that for the last 2 years
his erection “is as crooked as a dog’s hind leg and hurts too.” He has subsequently been
diagnosed with Peyronie disease. Which of the following statements by his physician is
most appropriate?
A) “Even though it’s obviously distressing, you should know that this will likely
resolve on its own with time.”
B) “I’ll refer you to a urologist who will likely want to perform a circumcision.”
C) “This might need surgery, but it could possibly disappear over time without
needing treatment.”
D) “There are things you can do to minimize this, such as getting more exercise,
stopping smoking, and maintaining a healthy diet.”
Ans: C
Feedback:
While spontaneous resolution is possible, surgery is sometimes necessary for the
treatment of Peyronie disease. Circumcision would not be an effective treatment, and
lifestyle factors are not noted to contribute to the etiology or resolution.
A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The client has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The client has a 40-pack-year smoking history and uses nebulized
bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and an adrenergic–blocking medication. During the nurse’s assessment, the man states that he has been unable to maintain his erection in recent months. Which of the following
aspects of the man’s health problems and treatments would the nurse identify as contributing to his erectile difficulty (ED)? Select all that apply. His
A) antihypertensive medications.
B) use of bronchodilators.
C) hypertension.
D) diuretic use.
E) smoking history.
F) age.
Ans: A, C, E, F
Feedback:
Hypertension, antihypertensive medications, age, and smoking are all implicated in the
etiology of ED. Ischemic heart disease and bronchodilators are less likely to directly
contribute to the condition.
A 54-year-old diabetic has come to the urology clinic complaining of erectile
dysfunction. His history includes obesity, coronary artery disease that required CABG 3
years ago, hypertension, and gout. The nurse practitioner is reviewing his record in
order to prescribe medication. The practitioner is considering prescribing sildenafil
(Viagra). Which of the following home medications is contraindicated if taken
concurrently with sildenafil?
A) Diltiazem (Cardizem), a calcium channel blocker
B) Cordarone (amiodarone), an antiarrhythmic
C) Imdur (isosorbide mononitrate), a vasodilator
D) Lasix (furosemide), a diuretic
Ans: C
Feedback:
Sildenafil (Viagra) is a selective inhibitor of phosphodiesterase type 5 (PDE-5), the
enzyme that inactivates cGMP. This acts by facilitating corporeal smooth muscle
relaxation in response to sexual stimulation. The concomitant use of PDE-5 inhibitors
and nitrates (Imdur) is absolutely contraindicated because of the risk of profound
hypotension. The other medications listed are not nitrates and do not have this adverse
reaction.
Two nursing students are debating the merits and demerits of infant circumcision.
Which of the following statements is most accurate?
A) “Circumcised men tend to have a lower incidence of penile cancer.”
B) “Getting circumcised basically rules out the possibility of getting Peyronie disease
later in life.”
C) “Circumcision reduces pressure on the deep dorsal vein and the dorsal artery,
making erection easier later in life.”
D) “The odds of getting infant priapism fall with circumcision.”
Ans: A
Feedback:
A correlation between circumcision and lower incidence of penile cancer has been
noted. Circumcision is unlikely to affect the development of Peyronie disease or
priapism, and is not noted to influence the ease of attaining or maintaining erection.
A care aide at a long-term care facility has left a note for the care director stating that an
82-year-old resident has a grossly distended scrotum and a likely inguinal hernia. On
examination, the resident has been diagnosed instead with hydrocele. What will the care
team most likely tell the resident and his family about his diagnosis?
A) “We’ll get you to the hospital quickly, because if this isn’t treated, it can result in a
blockage in the blood flow to your testes.”
B) “This isn’t a result of your intestine entering your scrotum, but an accumulation of
fluid within your testes.”
C) “This can sometimes result from the lower level of sex hormones that comes with
age, so you will likely benefit from a testosterone supplement.”
D) “While distressing to look at, this condition usually doesn’t have any significant
consequences and won’t need treatment.”
Ans: D
Feedback:
Hydrocele in adult males is normally considered benign condition that does not warrant
treatment unless mobility is affected. Fluid accumulates in the space between the tunica
vaginalis and tunica albuginea, not within the testes themselves, and hormone therapy is
not indicated.
A 14-year-old boy has been brought to the emergency department by his mother in
excruciating pain that is radiating from his scrotum to his inguinal area. The boy’s heart
rate is 122 beats/minute, and he has vomited twice before arrival at the hospital.
Examination reveals that his scrotum is reddened and slightly swollen, and the testes are
firm to touch and tender, with extensive cremaster muscle contraction noted. What is the
boy’s most likely diagnosis?
A) Epididymitis
B) Hydrocele
C) Testicular torsion
D) Varicocele
Ans: C
Feedback:
The combination of the boy’s age, signs, and symptoms is indicative of testicular
torsion. Epididymitis normally lacks cremaster muscle involvement, and hydrocele is
marked by massive distention of the scrotum. Varicocele is often asymptomatic or
marked by heaviness in the scrotum.
A medical student is assessing a 22-year-old male who has come to the emergency
department because of pain and swelling in his scrotum over the past 36 hours. The
attending physician has told the student that she suspects epididymitis. Which of the
medical student’s following questions is most likely to be useful in the differential
diagnosis of epididymitis?
A) “Do you know if your vaccinations for mumps are up to date?”
B) “Have you had unprotected sex in the past?”
C) “Do you have a sensation of heaviness in the left side of your scrotum?”
D) “Has it been painful when you get an erection lately?”
Ans: B
Feedback:
Sexually transmitted infections are a common contributing factor to epididymitis.
Mumps are more often a precursor to orchitis, and heaviness on the left side is
associated with varicocele. Pain with an erection is not a noted symptom of
epididymitis.
A 20-year-old male has been diagnosed with testicular cancer and is seeking
information about his diagnosis from a number of Web sites. Which of the following
statements that he has read is most plausible?
A) “Testicular cancer is a leading cause of death among males who should be in the
prime of their life.”
B) “Men with cryptorchidism––the term for an undescended testicle––are known to
have a higher risk of developing testicular cancer.”
C) “For most men with testicular cancer, bloody urine is their first sign that
something is wrong.”
D) “Recent developments in the treatment of testicular cancer mean that few men
now need to have a testicle removed
Ans: B
Feedback:
Cryptorchidism is an identified risk factor for the development of testicular cancer. The
diagnosis is no longer a leading cause of death. Hematuria is not a common symptom,
and orchiectomy is still the standard treatment modality.
A 34-year-old male has been diagnosed with testicular cancer after he visited his family
physician with a complaint of an enlarged, painful testicle. Biopsy has indicated that his
tumor is malignant, and his oncologist believes that the tumor arose in the seminiferous
epithelium and is producing a uniform population of cells. What is the client’s most
likely specific diagnosis?
A) Seminoma
B) Choriocarcinoma
C) Germ cell tumor
D) Nonseminoma
Ans: A
Feedback:
Seminomas are the subtype of germ cell tumors that are most common in the fourth
decade and are thought to originate with the seminiferous epithelium and produce a
uniform cell population. Nonseminomas tend to produce a variety of cell types, and
choriocarcinoma is rare variant of nonseminoma testicular cancer that originates in the
placental tissue.
While teaching a health class to junior and senior male high school students, the school
nurse educates them regarding the first sign of testicular cancer, which would include
A) one testicle being lower than the other in the scrotal sac.
B) enlargement of the testicle.
C) back pain.
D) coughing bloody sputum.
Ans: B
Feedback:
Often the first sign of testicular cancer is a slight enlargement of the testicle that may be
accompanied by some degree of discomfort. Back pain and hemoptysis are last signs
leading to a metastatic lesion. It is normal for the testicle to hang lower than the other.
Which of the following teaching points by an oncologist is most appropriate for a
33-year-old male who will begin treatment shortly for his testicular cancer?
A) “Thanks to new treatment advances, there’s a very good chance that I won’t have
to remove a testicle.”
B) “If steroid treatment fails, then we can consider surgery and/or chemotherapy.”
C) “You should know that there might be adverse effects on your sexual function
after treatment is finished.”
D) “The advantage of performing an orchiectomy over other treatments is that it rules
out recurrence.”
Ans: C
Feedback:
Orchiectomy is the standard treatment for testicular cancer. Steroidal treatments are not
used, and sexual function is commonly affected. Recurrence is possible even after
orchiectomy.
A nurse practitioner has a 30-year-old male patient presenting with fever and chills,
urinary frequency and urgency, and pain with urination. A urine sample displays cloudy
and foul-smelling urine. During digital rectal exam of the prostate, the nurse notes a
thick white discharge. A likely diagnosis would be
A) urinary tract infection requiring a prescription of sulfur drugs.
B) acute bacterial prostatitis requiring antimicrobial therapy.
C) testicular cancer requiring appointment with an urologist.
D) inflammation of the epididymis requiring scrotal elevation
Ans: B
Feedback:
Manifestations of acute bacterial prostatitis include fever and chills, malaise, frequent
and urgent urination, and dysuria. The urine may be cloudy and malodorous because of
urinary tract infection. Rectal examination reveals a swollen, tender prostate. During
exam, prostatic massage produces a thick discharge with WBCs that grow a large
numbers of pathogens on culture.
Following a long history of intermittent back pain and urinary urgency, a 50-year-old
client has been diagnosed with chronic bacterial prostatitis. Which of the following
factors is most likely to influence his health care provider’s choice of treatment?
A) The diagnosis is thought to have an autoimmune etiology with limited response to
steroid treatments.
B) Antibacterial drugs penetrate poorly into the chronically inflamed prostate.
C) Urethral catheterization provides symptom relief and contributes to resolution of
the underlying infection.
D) There are no proven treatments for chronic prostatitis that address the infectious
process
Ans: B
Feedback:
The fact that antibacterial drugs penetrate poorly into the chronically inflamed prostate
makes treatment difficult. Inflammatory prostatitis, not chronic prostatitis, is believed to
be an autoimmune problem. Urethral catheterization does not provide resolution of the
underlying infection, though treatment modalities do exist.
When explaining to a patient why his prostate is enlarging, the nurse will mention that which of the following hormones may contribute to the prostatic hyperplasia? Select all that apply. A) Glucocorticoids B) Testosterone C) Dihydrotestosterone D) Estrogens E) Progesterone
Ans: B, C, D
Feedback:
Both androgens (testosterone and dihydrotestosterone) and estrogens appear to
contribute to the development of BPH. Testosterone is the most important factor for
prostatic growth. DHT, the biologically active metabolite of testosterone, is thought to
be the ultimate mediator of prostatic hyperplasia, with estrogen serving to sensitize the
prostatic tissue to the growth-producing effects of DHT. Glucocorticoids do not play a
role in making the prostate gland enlarge.
