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
b. Growth of pubic hair

c. Enlargement of the testes

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.
PTS: 1

REF: Page 886

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

characteristics of the opposite sex?

a. Mixed
b. Incomplete

c. Isosexual
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.
PTS: 1

REF: Page 887

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

glans penis?
a. Paraphimosis
b. Priapism

c. Prephimosis
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.
PTS: 1

REF: Page 888

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 254).
PTS: 1

REF: Page 890

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.
PTS: 1

REF: Page 892

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

boys?
a. Herpes
b. Escherichia coli

c. Mumps
d. Cytomegalovirus

ANS: C

Of the options available, mumps is the most common infectious cause of orchitis and usually
affects postpubertal boys.
PTS: 1

REF: Pages 894-895

9. The risk of which cancer is greater if the man has a history of cryptorchidism?
a. Penile
c. Prostate
b. Testicular
d. Epididymal
ANS: B

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.
PTS: 1

REF: Pages 893-894

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.
PTS: 1

REF: Pages 895-896

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.
PTS: 1

REF: Page 897

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

condition?
a. Infection of the prostate
b. Obstruction of the urethra

c. Ischemia 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.
PTS: 1

REF: Pages 897-899

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?
c. Epididymitis
d. Bacterial prostatitis

a. Orchitis
b. Balanitis
ANS: D

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.
PTS: 1

REF: Pages 899-900

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.
PTS: 1

REF: Page 890

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.
PTS: 1

REF: Page 895

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.
PTS: 1

REF: Page 914

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
ANS: A, B, C, E

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.
PTS: 1

REF: Page 914

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.
PTS: 1

REF: Page 888

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 nonskin 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.
PTS: 1

REF: Pages 900-910

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
20. Varicocele

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.