Ch. 19: : Male Genital Tract Quiz

Which of the following choices is NOT used as a tumor marker for testicular cancer? A. CA 19-9 B. Lactate dehydrogenase (LD) C. α-Fetoprotein (AFP) D. Human chorionic gonadotropin (hCG)

A. CA 19-9 [More than 90% of testicular cancers arise from germ cell tumors. These tumors produce substances, which include choices B, C, and D, that can be used as tumor markers. All of these markers are most useful to evaluate the patient for complete removal of the tumor and detect cancer recurrence, as well as monitor the effects of treatment to eliminate the testicular cancer.]

Which of the following statements is incorrect about the collection of semen for male infertility evaluation? A. The ideal specimen for sperm count and volume assessment is one which is collected within 10 hours after a previous ejaculation. B. Seminal fluid characteristics should be measured 15 to 30 minutes after ejaculation with the samples stored during that time at 37°C or at room temperature to permit liquefaction of the semen. C. Semen analysis should be performed early in the evaluation of the infertile couple. D. Semen may contain agents that cause hepatitis or HIV in need to be handled as potentially infectious.

A. The ideal specimen for sperm count and volume assessment is one which is collected within 10 hours after a previous ejaculation. [The semen sample should be collected 2 to 5 days after sexual abstinence. When this fact is not taken into consideration, the semen presented for evaluation is usually of a lower volume and a decreased sperm count.]

Which of the following statements about prostate cancer is NOT true? A. Prostate cancer incidence increases with age. B. Most cases of prostate cancer are slowly progressive and do not cause major morbidity or lead to death. C. Laboratory testing is available to differentiate the rapidly progressive and fatal forms of prostate cancer from those that do not rapidly progress and do not cause death. D. The test for serum prostate-specific antigen concentration has had a significant impact on increased detection of this cancer.

C. Laboratory testing is available to differentiate the rapidly progressive and fatal forms of prostate cancer from those that do not rapidly progress and do not cause death [Currently, there are no laboratory tests to differentiate rapidly progressive prostate cancer that leads to death from the indolent forms. A man who has been diagnosed with prostate cancer, therefore, is unable to know whether prostatectomy will be lifesaving or relatively unnecessary. This is a major dilemma at the current time because of the complications of impotence and incontinence, which may arise from prostatectomy.]

In young men with a low testosterone, a subsequent test to be performed is the test for luteinizing hormone (LH). When the value for LH in a patient with low testosterone is extremely low, which of the following is likely to be dysfunctional? A. Testes B. Adrenal gland C. Pituitary gland D. Thyroid gland

C. Pituitary gland [When a man with low testosterone levels is also found to have a very low level of luteinizing hormone, it is likely that the pituitary or the hypothalamus is not functioning correctly. The follicle-stimulating hormone (FSH) follows the LH. Therefore, there is no additional information provided by the results of the test for FSH.]

Which of the following statements about testosterone measurements is NOT true? A. Free testosterone, which is not bound to proteins, contributes significantly more of the biological effects of testosterone than protein-bound testosterone. B. Testing for testosterone should be avoided in hospitalized individuals because testosterone levels can decrease in persons who are acutely ill. C. Testosterone secretion has a circadian rhythm with higher levels in the evening and lower concentrations in the morning and afternoon. D. Complete gonadal failure in men is rare, whereas partial androgen deficiency is common.

C. Testosterone secretion has a circadian rhythm with higher levels in the evening and lower concentrations in the morning and afternoon. [Testosterone secretion does have a circadian rhythm, but the higher levels are present in the morning and the lower concentrations are found in the afternoon and evening. The reference ranges for the expected values of testosterone are generally based on morning samples. Therefore, collection of a blood sample for testosterone measurement in the afternoon or evening is problematic because the value obtained is being compared to a reference range generated by the results from samples collected in the morning when the testosterone is highest.]

Which of the following is NOT a parameter that is measured as part of the routine semen analysis procedure? A. Ejaculate volume B. Sperm count and morphology C. Sperm motility D. Assessment for antisperm antibodies

D. Assessment for antisperm antibodies [Antisperm antibodies may indicate an immunologic basis for infertility. However, this is a highly specialized test and not part of a routine semen analysis.]

Which of the following is the least likely cause for male infertility after 1 year of unprotected intercourse among the choices below? A. Absence of spermatozoa in the semen B. Blockage of a duct within the male genital tract C. Absence of the vas deferens D. Decreased androgen production in the adrenal glands

D. Decreased androgen production in the adrenal glands [All the other choices are well-known causes of male infertility. Nonobstructive azoospermia may occur as a result of the absence of germ cells in the testes or failure of spermatogenesis. Obstructive azoospermia may follow from a vasectomy reversal because it may persist after reversal of a vasectomy. Obstructive azoospermia can also result from a sexually transmitted infection. The absence of the vas deferens may be a congenital defect in men carrying one of the many alleles for cystic fibrosis, even if the cystic fibrosis is not clinically apparent.]

Which one of the following statements about the clinical utility of prostate-specific antigen (PSA) is controversial? A. It is useful to determine success of treatment. B. It is useful as an indicator of the extent of disease, particularly bone metastases. C. It is useful for monitoring recurrence of prostate cancer. D. It is useful as a screening test for prostate cancer in men older than 50 year

D. It is useful as a screening test for prostate cancer in men older than 50 year [The use of the PSA level as a screening test for prostate cancer is highly controversial. PSA levels correlate with the size of the prostate, and, therefore, a larger gland results in a higher PSA value even if there is no prostate cancer. Men with benign prostatic hyperplasia (BPH) can also show elevations in serum PSA.]

Which of the following statements about male gonadal dysfunction is NOT true? A. Partial androgen deficiency is common in men with advancing age. B. Not all men develop low levels of testosterone, while gonadal failure in women is inevitable. C. The reference range for testosterone in men is based on the values found in healthy young men. D. Routine use of testosterone for hormone replacement, especially in men over the age of 65, is widely accepted.

D. Routine use of testosterone for hormone replacement, especially in men over the age of 65, is widely accepted. [Tx of deficiency of androgens in young men with primary gonadal failure is clearly beneficial. However, it is a much more controversial issue for middle aged and older men. Androgen supplementation increases the likelihood of both benign prostatic hyperplasia and prostate cancer, may lead to a decreased sperm count, and causes undesirable changes in blood lipids that increase the risk of myocardial infarction and stroke.]