Chapter 25 Male Genitourinary System

15. What do you expect to find on examination of a neonate whose medical record indicates he has epispadias? A. A meatus opening on the dorsal side of the glans or shaft B. A markedly edematous scrotum C. An empty scrotum as a result of undescended testicles D. An abnormally large glans penis

A. A meatus opening on the dorsal side of the glans or shaft

9. A soon-to-be new mother of a baby boy asks you for information about circumcision. What information should you share with her? A. Benefits of circumcision include decreased risk of UTIs in infancy and certain STIs in adulthood. B. Circumcision is recommended by the American Academy of Pediatrics (AAP) for all newborn males. C. Circumcision is basically risk free. D. Circumcision enhances adult sexual experience.

A. Benefits of circumcision include decreased risk of UTIs in infancy and certain STIs in adulthood.

25. On examination of a male patient, you note a discharge from the urethra. What is your immediate action? A. Collect a smear and a culture. B. Obtain a clean-catch urine specimen. C. Check the cremasteric reflex. D. Refer to a urologist.

A. Collect a smear and a culture.

20. How should you check for signs of urethritis in a male patient? A. Compress the glans anteroposteriorly between your thumb and forefinger. B. Palpate each spermatic cord between your thumb and forefinger from the epididymis up to the external inguinal ring. C. Press gently with the pads of your first two fingers along the dorsal aspect of the penile shaft from the tip to the base. D. Use the fingertips of one hand to feel for induration at the juncture of the penis and scrotum.

A. Compress the glans anteroposteriorly between your thumb and forefinger.

4. Which acronym should you use as a guide when palpating the femoral area for a bulge? A. NAVEL B. MALE C. BELLY D. PUBIS

A. NAVEL

30. Mr. Peyser is a 38-year-old patient who presents to your office for a yearly physical examination. On exam, you note that the foreskin of the penis is very tight, preventing it from retracting over the glans. What term could be used to describe this finding? A. Phimosis B. Paraphimosis C. Spermatocele D. Epispadias

A. Phimosis

39. If an erection occurs during your examination of a male patient's genitalia, how should you respond? A. Reassure the patient that the erection is simply a physiologic response to touch. B. Turn away and spend a few minutes recording your examination findings so far. C. Excuse yourself and leave the examining room for 3 to 5 minutes. D. Say nothing; just continue with the examination.

A. Reassure the patient that the erection is simply a physiologic response to touch.

22. When examining a 3-year-old, the scrotal sac feels empty. What do you ask the child to do? A. Squat with the knees flexed up. B. Stand on one leg while holding onto the examining table for balance. C. Bend over at the waist while standing. D. Sit up with one leg out straight and one bent at the knee.

A. Squat with the knees flexed up.

40. Mr. Frank, a 32-year-old patient, presents to your office with a complaint of urinary frequency. On examination, you note a painless lesion with a clear base and indurated borders located on the glans penis. With what problem is this clinical finding most consistent? A. Syphilitic chancre B. Tinea crurus C. Genital warts D. Herpes simplex

A. Syphilitic chancre

12. A patient comes to the clinic with symptoms of testicular torsion. On examination, you find the left cremasteric reflex is absent. How do you interpret this finding? A. The left spermatic cord is twisted. B. The right spermatic cord is twisted. C. The involved testis has begun to necrose. D. Testicular torsion is not the problem.

A. The left spermatic cord is twisted.

18. On previewing a patient's medical record, you see that he was diagnosed with a hydrocele 2 years ago. How do you interpret this information? A. The patient had a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. B. The patient had a meatus opening on the dorsal side of the glans or shaft. C. The patient had an acute inflammation of the testes. D. The patient had a red, round, superficial ulcer with a yellowish, serous drainage on the penis.

A. The patient had a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes.

36. On examination of a patient who complains of difficulty urinating, you note that the meatus has a pinpoint, constricted opening. What problem is suggested by these findings? A. Urethral stricture B. Urethritis C. Phimosis D. Genital warts

A. Urethral stricture

34. Mr. Liggett is a 42-year-old patient who presents with a painful left testicle. On examination, you note that, when the patient is standing, there is a soft, irregular mass like a bag of worms above and behind the testis. When the patient lies down, it collapses. With which condition are these signs and symptoms consistent? A. Varicocele B. Priapism C. Hypospadias D. Epididymitis

A. Varicocele

24. Thomas is a 32-month-old boy who is brought in by his mother for a routine health examination. Which question should you ask his mother? A. "Does Thomas wet the bed at night?" B. "Has toilet training started yet?" C. "Does Thomas' penis become erect when he has a full bladder?" D. "Does Thomas prefer the pull-on, pant-style disposable diapers?"

B. "Has toilet training started yet?"

32. In previewing a patient's medical record, you note that the patient was previously diagnosed with a spermatocele. How should you describe this problem? A. A nonaggressive form of testicular cancer B. A retention cyst in the epididymis filled with milky fluid containing sperm C. A congenital malformation associated with infertility D. A painful testicle caused by abnormal dilation and tortuosity of the veins along the spermatic cord.

B. A retention cyst in the epididymis filled with milky fluid containing sperm

23. Mrs. Baker comes to your office with her 2-year-old son. On examination, you note that the child's urinary meatus appears on the upper surface of the penis. Which term could be used in documenting this finding? A. Varicocele B. Epispadias C. Hydrocele D. Hypospadias

B. Epispadias

10. Why is testicular torsion an emergency? A. Life-threatening infection can rapidly ensue. B. Gangrene can develop in a few hours. C. Prolonged inflammation can result in infertility. D. Reflux can result in kidney failure.

B. Gangrene can develop in a few hours.

14. You could best use transillumination to aid in the identification of which condition? A. Scrotal hernia B. Hydrocele C. Testicular tumor D. Varicocele

B. Hydrocele

3. Where do you palpate when checking for inguinal lymphadenopathy? a. Superior to the inguinal ligament and along the upper outer thigh b. Inferior to the inguinal ligament and along the upper inner thigh c. Superior to the inguinal ligament and along the inner middle thigh d. Inferior to the inguinal ligament and along the outer middle thigh

B. Inferior to the inguinal ligament and along the upper inner thigh

35. A patient comes to the clinic because his urine is "bright orange." Which medication should you ask him if he takes? A. Indocin B. Warfarin C. Amitriptyline D. B-complex vitamins

B. Warfarin

13. Why is it suggested that testicular self-examination (TSE) be done while taking a shower? A. Warm water increases blood flow to the testes. B. Warm water relaxes the scrotal sac. C. Warm water acts as a lubricant for palpation. D. Warm water minimizes tenderness when feeling the testes.

B. Warm water relaxes the scrotal sac.

6. Which set of urinalysis findings would you interpret as normal? A. pH 4.3, Specific gravity 1.101, <3 RBCs B. pH 6.2, Specific gravity 1.018, <5 WBCs C. pH 7.6, Specific gravity 1.029, <8 WBCs D. pH 5.8, Specific gravity 1.001, 0 RBCs

B. pH 6.2, Specific gravity 1.018, <5 WBCs

11. For which patient would testicular self-examination (TSE) be most valuable? A. A 34-year-old with human papillomavirus (HPV) infection B. A 17-year-old with a spermatocele C. A 22-year-old with a history of cryptorchidism D. A 27-year-old with recurrent epididymitis

C. A 22-year-old with a history of cryptorchidism

16. At change-of-shift report in the emergency room, you are told that the patient in Room 3 came in with priapism. Which statement describes the patient's problem? A. The urethral meatus opens on the dorsal side of the glans or shaft. B. The foreskin is advanced and fixed too tightly to retract over the glans. C. A prolonged, painful erection of the penis without sexual desire has occurred. A circumscribed collection of serous fluid is present in the tunica vaginalis surrounding the testes

C. A prolonged, painful erection of the penis without sexual desire has occurred.

21. Which questions asked as part of a patient s health history provide information about symptoms of prostatic hyperplasia? (Select all that apply.) A. Do you have any burning on urination? B. Is your urine cloudy? C. Do you dribble at the end of urination? D. Do you have difficulty starting to urinate? E. Do you have a weak stream when urinating?

C. Do you dribble at the end of urination? D. Do you have difficulty starting to urinate? E. Do you have a weak stream when urinating?

37. A 32-year-old male patient comes to the clinic with "some kind of a rash on my private parts that really hurts." On examination, you note clusters of small vesicles with surrounding erythema on the foreskin and glans penis. What is the likely cause of these findings? A. Cystitis B. Urethritis C. Genital herpes D. Peyronie's disease

C. Genital herpes

33. When palpating the male genitalia, where would you locate the epididymis? A. Low on the back of the testicle B. Low on the front of the testicle C. On top of and behind the testicle D. On top of and in front of the testicle

C. On top of and behind the testicle

27. How do you palpate the shaft of the penis for a nodule or induration? A. Palpate with the pads of the first two fingers. B. Palpate with the pads of the first three fingers. C. Palpate between your thumb and first two fingers. D. Palpate between your thumb and index finger.

C. Palpate between your thumb and first two fingers.

29. Mr. Tucker is a 28-year-old patient who presents to your office with a concern that, during an erection, his penis is bent and painful. On examination, you palpate nontender, hard plaques on the lateral surface of the penis. What problem is suggested by these signs and symptoms? A. Paraphimosis B. Phimosis C. Peyronie's disease D. Spermatocele

C. Peyronie's disease

28. On examination of a noncircumcised man, you find that the foreskin is fixed in a retracted position and the glans is swollen. What action should you take? A. Discuss proper penile hygiene. B. Culture the swollen glans. C. Refer him to a urologist. D. Arrange for emergency treatment.

D. Arrange for emergency treatment.

7. During a routine examination of an uncircumsized male child, which guideline should be followed? A. Retract the foreskin as part of examination of the penis if the child is 6 months or older. B. Ask the parent to retract the foreskin when the patient is an infant or toddler. C. Retraction of the foreskin is unnecessary until the first signs of puberty are evident. D. Do not retract the foreskin until the parent says it retracts itself or until the child can do it.

D. Do not retract the foreskin until the parent says it retracts itself or until the child can do it.

5. Shooting pain in the buttock or down the leg is a characteristic of which sexually transmitted infection (STI)? A. Genital warts B. Syphilis C. Chlamydia D. Genital herpes

D. Genital herpes

17. Serum creatinine contributes to assessment of urinary system function by providing information about which factor? A. Ability of the kidney to concentrate urine B. Exchange of sodium and potassium ions C. Reabsorption of protein in the tubules D. Glomerular filtration rate

D. Glomerular filtration rate

26. On examination of a newborn boy, you observe that the urethral meatus opens on the ventral side of the penis. Which term can you use to describe this condition? A. Phimosis B. Urethritis C. Priapism D. Hypospadias

D. Hypospadias

8. Which finding on examination of the scrotum would you identify as abnormal? A. Asymmetry with one side hanging lower than the other B. Presence of small, firm, nontender, yellowish nodules C. Easy sliding of scrotal contents when palpated D. Marked tenderness on palpation

D. Marked tenderness on palpation

31. Mr. Harrison is a 28-year-old patient who presents to your office urgently with a concern of a penile erection that has not subsided. Which term could you use in documenting this problem? A. Paraphimosis B. Phimosis C. Spermatocele D. Priapism

D. Priapism

19. A 59-year-old patient presents with painless hematuria. Which finding in the patient's history would most support the possibility of bladder cancer as the source of the problem? A. Drinks 1 to 2 glasses of wine per day B. Frequent childhood urinary tract infections C. Works at a nuclear power plant D. Smokes half a pack per day for 42 years

D. Smokes half a pack per day for 42 years

38. Which position do you ask a male patient to assume when palpating the right inguinal canal? A. Stand with knees slightly bent. B. Stand with weight equally distributed. C. Stand with weight on right leg. D. Stand with weight on left leg.

D. Stand with weight on left leg.

1. When palpating the inguinal canal for a hernia, which direction do you give the patient? a. "Cough." b. "Bear down." c. "Bend your knees." d. "Hold your breath."

b. "Bear down."

2. A 24-year-old man comes to the clinic with scrotal pain and marked erythema. Which other finding supports your impression of epididymitis as the problem? a. An uneven scrotal size and shape is observed. b. The patient has nausea and vomiting. c. The patient reports an acute onset of severe pain. d. Urinalysis shows elevated white blood cells (WBCs) and bacteria.

d. Urinalysis shows elevated white blood cells (WBCs) and bacteria.