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Chapter 25: Alterations of the Male Reproductive System MULTIPLE CHOICE

1. In the 95% of those with delayed puberty, the problem is caused by which condition? a. Disruption in the hypothalamus c. Deficit in estrogen or testosterone b. _{Disruption of the pituitary} d. _{Physiologic hormonal delays}

ANS: D

In 95% of cases, delayed puberty is a physiologic delay; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is happening slowly. This selection is the only option that accurately describes 95% of those with delayed puberty.

PTS: 1 REF: Page 886

2. What is the first sign of puberty in boys?

a. Thickening of the scrotal skin c. Enlargement of the testes b. Growth of pubic hair d. Change in voice

ANS: C

The first sign of puberty in boys is an enlargement of the testes and a thinning of the scrotal skin.

3. Which type of precocious puberty causes the child to develop some secondary sex characteristics of the opposite sex?

a. Mixed c. Isosexual

b. Incomplete d. Homosexual

ANS: A

Mixed precocious puberty (i.e., virilization of a girl or feminization of a boy) causes the child to develop some secondary sex characteristics of the opposite sex. This selection is the only option that accurately identifies the type of precocious puberty described.

4. What term is used to identify a condition in which the foreskin cannot be retracted over the glans penis?

a. Paraphimosis c. Prephimosis

b. Priapism d. Phimosis

ANS: D

Phimosis is the only term used to identify the condition in which the foreskin cannot be retracted back over the glans.

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5. What term is used to identify a fibrotic condition that causes lateral curvature of the penis during erection, which is associated with a local vasculitis-like inflammatory reaction and decreased tissue oxygenation?

a. Phimosis c. Lateral paraphimosis

b. Lateral phimosis d. Peyronie disease

ANS: D

Peyronie disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis, resulting in varying degrees of curvature and sexual dysfunction (see Figure 25-2). Although the exact cause is unknown, a local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification. Peyronie disease is the only term used to identify the pathophysiologic condition described.

PTS: 1 REF: Pages 889-890

6. What term is used to identify an inflammation of the glans penis?

a. _Glanitis c. _Priapism

b. Balanitis d. Hydrocelitis

ANS: B

Balanitis is the only term used to identify an inflammation of the glans penis (see Figure 25-4).

7. Cryptorchidism can be defined as which of the following? a. Normal developmental state of the testes

b. Abnormal state in which the testes are overdeveloped c. Lack of scrotum

d. Testicular maldescent ANS: D

Cryptorchidism is a condition of testicular maldescent, the only option that accurately defines cryptorchidism.

8. What is the most common infectious cause of orchitis and one that usually affects postpubertal boys?

a. Herpes c. Mumps

b. Escherichia coli d. Cytomegalovirus ANS: C

Of the options available, mumps is the most common infectious cause of orchitis and usually affects postpubertal boys.

9. The risk of which cancer is greater if the man has a history of cryptorchidism?

a. Penile c. Prostate

b. Testicular d. Epididymal

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The risk of testicular cancer is 35 to 50 times greater in men with cryptorchidism or in those with a history of cryptorchidism than it is for the general male population. This is not true of the other options.

10. What are the clinical manifestations of testicular cancer?

a. Firm, nontender testicular mass c. Painful fluid-filled testicular mass b. Painful, mobile, firm testicular mass d. Soft, nontender testicular mass

ANS: A

Of the options available, a firm, painless testicular enlargement is commonly identified as the first sign of testicular cancer.

11. How does the epididymis become infected?

a. The pathogenic microorganisms ascend the vasa deferentia from an already infected urethra or bladder.

b. _{The pathogenic microorganisms are attached to sperm that travel through the} genital tract.

c. The pathogenic microorganisms from the tunica vaginalis are transported to the epididymis.

d. The pathogenic microorganisms from the prostate fluid ascend to the epididymis. ANS: A

The pathogenic microorganisms usually reach the epididymis by ascending the vasa deferentia from an already infected urethra or bladder. Of the selections available, this is the only option that accurately describes how the epididymis becomes infected.

12. Symptoms of benign prostatic hyperplasia (BPH) are a result of which pathophysiologic condition?

a. Infection of the prostate c. Ischemia of the urethra b. Obstruction of the urethra d. Compression of the urethra

ANS: D

BPH becomes problematic as prostatic tissue compresses the urethra, where it passes through the prostate. Of the selections available, only this option accurately describes the

pathophysiologic condition behind the symptoms of BPH.

13. Which infection has clinical manifestations that include the sudden onset of malaise, low back pain, and perineal pain with high fever and chills, dysuria, nocturia, and urinary retention?

a. Orchitis c. Epididymitis

b. _Balanitis d. _{Bacterial prostatitis}

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Bacterial prostatitis can exhibit common manifestations that include a sudden onset of malaise, low back and perineal pain, high fever (up to 40° C [104° F]), and chills, as well as dysuria, inability to empty the bladder, nocturia, and urinary retention. Myalgia and arthralgia also may occur. This selection is the only option that exhibits the symptoms described.

14. Priapism has been associated with the abuse of what substance?

a. Marijuana c. Cocaine

b. Alcohol d. Heroin

ANS: C

Of the options available, priapism has been associated with cocaine use.

15. Which age group should be targeted for testicular cancer education and screening? a. 15 to 35 year olds c. 30 to 55 year olds

b. 20 to 45 year olds d. 45 to 70 year olds ANS: A

Overall, testicular cancers are rare, yet they are the most common form of cancer in young men between the ages of 15 and 35 years.

16. What is the reason breast cancer in men has such a poor prognosis? a. Breast cancer is extremely aggressive in men.

b. _{Treatment is usually delayed as a result of late detection.} c. Chemotherapies are not as effective in men.

d. Breast tumors tend to be small and hard to isolate. ANS: B

Breast cancer is relatively uncommon in men, but it has a poor prognosis because men tend to delay seeking treatment until the disease is advanced. This selection is the only option that accurately identifies the reason breast cancer in men has a poor prognosis.

MULTIPLE RESPONSE

17. Which are clinical manifestations of male breast cancer? (Select all that apply.) a. Ulceration present on the breast

b. Retraction of breast tissue c. Nipple discharge

d. Palpable mass midline of the nipple e. Unilateral solid mass

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The malignant male breast lesion is usually a unilateral solid mass located near the nipple. Because the nipple is commonly involved, crusting and nipple discharge are typical clinical manifestations. Other findings include skin retraction, ulceration of the skin over the tumor, and axillary node involvement.

18. Which statements are true regarding urethritis? (Select all that apply.) a. A purulent drainage may be present.

b. A clear mucus-like discharge may be present.

c. Symptoms include urethral tingling and itching or burning on urination. d. A 24-hour urine test is required to diagnose the disorder.

e. Treatment includes appropriate antibiotic therapy. ANS: A, B, C, E

Symptoms of urethritis include urethral tingling and itching or a burning sensation on urination (dysuria), frequency, and urgency. The individual may note a purulent or clear mucus-like discharge from the urethra. Nucleic acid detection amplification tests allow easy detection of Neisseria gonorrhoeae and Chlamydia trachomatis in first-void urine. Treatment consists of appropriate antibiotic therapy for infectious urethritis and an avoidance of future chemical or mechanical irritation.

19. Which statements are true regarding prostate cancer? (Select all that apply.) a. It ranks second to lung cancer as being most common among American men. b. _{A familial history of prostate cancer is a risk factor.}

c. Dietary habits seem to play a role in its development.

d. African-American men have an increased risk for its development.

e. _{Being over 65 years of age increases the risk for developing prostate cancer.} ANS: B, C, D, E

Prostate cancer is the most commonly diagnosed non–skin cancer in American men, and the incidence varies greatly worldwide. Possible causes include a genetic predisposition,

environmental and dietary factors, inflammation, and alterations in levels of hormones (e.g., testosterone, dihydrotestosterone, estradiol) and growth factors. Incidence is greatest among northwestern European and North American men (particularly African Americans) older than 65 years of age.

MATCHING

Match the description with the disorder.

______ A. Painless diverticulum of the epididymis located between the head of the epididymis and the testis

______ B. Collection of fluid in the tunica vaginalis

______ C. Rotation of a testis, which twists blood vessels of the spermatic cord ______ D. Abnormal dilation of the vein within the spermatic cord

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21. Hydrocele 22. Testicular torsion 23. Spermatocele

20. ANS: D PTS: 1 REF: Page 891

MSC: A varicocele is an abnormal dilation of a vein within the spermatic cord and is classically described as a bag of worms

21. ANS: B PTS: 1 REF: Page 892

MSC: A hydrocele is a collection of fluid within the tunica vaginalis

22. ANS: C PTS: 1 REF: Page 894

MSC: Torsion of the testis is rotation of a testis, which twists blood vessels in the spermatic cord.

23. ANS: A PTS: 1 REF: Page 892

MSC: A spermatocele is a painless diverticulum of the epididymis located between the head of the epididymis and the testis.