Chapter 20 (Exam 3) Flashcards by Cody Prentice

The movement of the testes by cremasteric action regulates
A. Ejaculatory flow
B. Sebaceous material production
C. Testicular temperature
D. Urinary flow
E. Prostate gland secretion

C. Testicular temperature

The cremasteric muscle contracts and relaxes the scrotum. This action alters the distance of the testes from the body to cool or warm the testes.

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What structure of the male genitalia travels through the inguinal canal and unites with the seminal vesicle to form the ejaculatory duct?
A. Epididymis
B. Corpus cavernosum
C. Urethra
D. Vas deferens
E. Ureter

D. Vas deferens

The vas deferens begins at the end of the epididymis, travels the spermatic cord, goes through the inguinal canal, and then unites with the seminal vesicle to form the ejaculatory duct.

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Normally, the male urethral orifice is located
A. 2mm ventral to the tip of the glans
B. On the dorsal surface of the glans
C. Cephalad to the dorsal vein
D. Adjacent to the prostate
E. On the ventral surface of the corpus spongiosum

A. 2mm ventral to the tip of the glans

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While examine an 18y/o man you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be 
A. Caused by a lack of testosterone
B. Suggestive of a skin fungus
C. Suggestive of psoriasis
D. Caused by excessive progesterone
E. Within normal limits

E. Within normal limits

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Testicular temperature must be maintained lower than 37C for which of the following to occur?
A. Penile erection
B. Spermatogenesis
C. Testosterone production
D. Ejaculatory duct to function 
E. Sperm to ascend in the vas deferens

B. Spermatogenesis

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In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is usually 
A. Evidence of a fungal infection
B. Collection of sebaceous material 
C. Indicative of penile carcinoma
D. Suggestive of diabetes
E. Evidence of a gonococcal infection

B. Collection of sebaceous material

The glans secretes a sebaceous material, smegma, in uncircumcised males. It looks like a cheesy white material. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. Smegma is not candidiasis nor is it suggestive of diabetes, cancer, or gonorrhea.

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The greatest contribution to the volume of ejaculate comes from the 
A. Prostate
B. Epididymis
C. Seminal vesicles 
D. Corpus cavernosa
E. Testes

A. Prostate

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Inspection of the scrotum should reveal
A. No epidermoid cysts
B. Two tests per sac
C. Smooth scrotal sacs
D. Left scrotal sac lower than the right
E. Lightly pigmented skin

D. Left scrotal sac lower than the right

The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The scrotum is more darkly pigmented, has one testis per sac, and has small epidermoid cysts that give it a lumpy appearance.

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Sexual differentiation in the fetus has occurred by \_\_\_\_\_ weeks gestation. 
A. 8
B. 12
C. 16
D. 20
E. 30

B. 12

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How much blood usually engorges the two corpora cavernosa of the penis when it is erect?
A. 5-15ml
B. 20-50ml
C. 60-80ml
D. 70-90ml
E. Over 100ml

B. 20-50ml

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Expected genitalia changes that occur as men age include
A. Ejaculatory volume decreases with age
B. Erections develop more quickly
C. Viability of sperm increases
D. Scrotum becomes more pendulous
E. Increase in time for mature sperm to develop

D. Scrotum becomes more pendulous

Ejaculatory volume may increase with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age. There is no change in the length of time necessary for mature sperm production.

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Parents of a 6y/o boy should be asked if he has 
A. Erections
B. Nocturnal emissions
C. Rapid detumescence
D. Scrotal swelling
E. More pendulous scrotum

D. Scrotal swelling

Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The question of nocturnal emissions is asked of adolescents; erections and rapid detumescence questions are questions for older men. With the onset of puberty, the scrotum becomes more pendulous.

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Which of the following is a risk factor for testicular cancer?
A. Circumcision
B. Condyloma acuminatum
C. Crytorchidism
D. Poor hygiene 
E. Multiple sexual partners

C. Cryptorchidism

Cryptorchidism (testes that fail to descend by 12 months of age) is a risk factor for testicular cancer.

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Gloves are used for examination of male genitalia to
A. Facilitate grasp of external organs
B. Makes masses easier to detect
C. Prevent spread of unsuspected infection
D. Protect the patient from embarrassment
E. Decrease the incidence of erections

C. Prevent spread of unsuspected infection

Inspection of male genitalia involves manipulation of the glans and scrotum. This potentially involves contact with body secretions and infections; therefore, gloves are required.

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Inspection of the male urethral orifice requires the examiner to
A. Ask the patient to bear down
B. Insert a small urethral speculum
C. Press the glans between thumb and forefinger
D. Transilluminate the penile shaft
E. Apply a lubricant to the meatus

C. Press the glans between thumb and forefinger

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Which penile structure should be visible to inspection during the physical exam?
A. Cowper glands
B. Proximal urethra
C. Epididymis 
D. Corpus cavernosa
E. Dorsal vein

E. Dorsal vein

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You are inspecting the genitalia of an uncircumcised man. The foreskin is tight and cannot be easily retracted. You should
A. Chart the finding as paraphimosis
B. Inquire about previous penile infections
C. Retract the foreskin firmly
D. Transilluminate the glans
E. Chart the finding as balanitis

B. Inquire about previous penile infections

This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum. Balanitis is inflammation of the glans that may occur with phimosis.

Which technique is appropriate to detect an inguinal hernia?
A. Conduct percussion while the patient coughs
B. Have the patient strain as you pinch the testes
C. Inspect rectal area as the patient bears down
D. Conduct the exam only in the supine position
E. Move your finger upward along the vas deferens

E. Move your finger upward along the vas deferensExamination for inguinal hernias is performed with the patient standing. Inspect the groin while the patient performs a Valsalva maneuver. Insert your examination finger into the lower part of
the scrotum and follow upward along the vas deferens to screen for a hernia.

Which type of hernia lies within the inguinal canal?
A. Umbilical 
B. Direct
C. Indirect
D. Femoral 
E. Incisional

C. Indirect

Which of the following conditions is of minor consequence on the adult male genitalia?
A. Viscus felt medial to the external canal
B. Continuous penile erection
C. Lumps in scrotal skin
D. Venous dilation in spermatic cord
E. Adhesions of the foreskin

C. Lumps in scrotal skin

Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits. The other choices require medical or surgical intervention.

Mr. L has an unusually thick scrotum with edema and pitting. He has a history of cardiac problems. The appearance of his scrotum is more likely a(n)
A. Congenital defect that has worsened
B. Indication of general fluid retention
C. Normal consequence of aging
D. Complication to the development of mumps
E. Consequence of prior STDs

B. Indication of general fluid retention

General fluid retention can cause scrotal thickening and pitting edema and is more often seen as a result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the genitalia but rather a condition of these related systems.

A characteristic related to syphilis or diabetic neuropathy is testicular 
A. Dropping with asymmetry 
B. Enlargement
C. Insensitivity to painful stimulation
D. Recession into the abdomen
E. Nodularity

C. Insensitivity to painful stimulation

Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis. Any nodules found on the testes must be evaluated for malignancy and are not characteristic of syphilis or diabetes.

A normal vas deferens should feel 
A. Tender
B. Smooth
C. Rugated
D. Spongy
E. Beaded

B. Smooth

A premature infant's scrotum will be
A. Bifid
B. Loose
C. Rugated
D. Smooth 
E. Enlarged

D. Smooth

A scrotum in a premature infant will appear underdeveloped and smooth without rugae or testes; a full-term infant should have a loose, pendulous scrotum with rugae and a midline raphe.

``` An enlarged painless testicle in an adolescent or adult may indicate A. Epididymitis B. Testicular torsion C. Tumor D. Undescended testicle E. Hypospadias ```

C. Tumor A hard, enlarged, painless testicle can indicate a tumor in an adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months. Hypospadias is a congenital defect of the urethral opening causing the meatus to be located ventral to its normal position.

You palpate a soft, slightly tender mass in the right scrotum of a man. You attempt to reduce the size of the mass, and there is no change in the mass size. Your next assessment maneuver is to A. Use two fingers to attempt to reduce the mass B. Palpate the left scrotum simultaneously C. Lift the right testicle, then compare pain level D. Transilluminate the mass E. Culture the meatus for gonococcal infection

D. Transilluminate the mass A soft mass is either a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a nonreducible mass should be transilluminated to determine whether it contains fluid and is possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is suspected. Urethral cultures are not indicated at this point.

``` The most common cancer in young men age 15-30 is A. Testicular B. Penile C. Pancreatic D. Anal E. Prostate ```

A. Testicular

``` The most emergent cause of testicular pain in a young male is A. Varicocele B. Epididymitis C. Tumor D. Hydrocele E. Testicular torsion ```

E. Testicular torsion Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate.

An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria and fever. Your prioritized assessment should be to A. Obtain urine and DNA probe urethral samples B. Lift the left scrotum to confirm epididymitis C. Establish absent cremasteric reflex D. Transilluminate the left and right scrotum E. Have the patient stand and observe the scrotum for a "bag of worms"

C. Establish absent cremasteric reflex The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a supporting finding to differentiate torsion from epididymitis.

``` When examining a small child, in which position should he be placed to help push the testicles into the scrotum? A. Trendelenburg B. Tailor C. Standing D. Prone E. Supine ```

B. Tailor When the child is old enough to sit cooperatively, ask him to sit in a tailor position with legs crossed for the testicular examination.

``` The most common type of hernia occurring in young males is A. Hiatal B. Incarcerated femoral C. Indirect inguinal D. Umbilical E. Femoral ```

C. Indirect inguinal

``` Difficulty replacing the retracted foreskin of the penis to its normal position is called A. Paraphimosis B. Peyronie disease C. Prepuce D. Priapism E. Phimosis ```

A. Paraphimosis

``` The finding of a painless indurated lesion on the glans penis is most consistent with A. Herpes simplex B. Herpes zoster C. Warts D. Chancre E. Molluscum contagiosum ```

D. Chancre Syphilitic chancre is a painless lesion with an indurated border and a clear base.

``` A finding associated with male genital herpes is A. Disseminated lymphadenopathy B. Pain subsiding with scrotal elevation C. Soft, red papule on the prepuce D. Painful superficial penile vesicles E. Pearly gray dome-shaped lesions ```

D. Painful superficial penile vesicles Genital herpes presents as painful superficial vesicles on an erythemic base.

``` A male whose urethral meatus opens on the ventral surface of his penis has which condition? A. Peyronie disease B. Hydrocele C. Hypospadias D. Normal variation E. Epispadias ```

C. Hypospadias

``` Pearly, gray, smooth, dome-shaped, often umbilicate lesions of the glans penis are probably A. Lymphogranuloma venereum B. Condylomata C. Molluscum contagiosum D. Chancres E. Herpetic lesions ```

C. Molluscum contagiosum

Self-examination of the male genitalia A. Should be restricted to adults with prior crytorchidism B. Should be performed while bathing C. Starts with palpation then inspection D. Should be performed yearly E. Cannot be adequately performed due to poor visualization of the scrotum

B. Should be performed while bathing Monthly self-examination is recommended as a screening test for testicular cancer as well as sexually transmitted infections for all young men starting at 15 years of age. It is encouraged during bathing because the scrotal skin is less thick at this time and because the scrotum hangs looser because of the warmth. Inspection is done first followed by palpation.

``` A 12y/o boy says that his left scrotum has a soft swollen mass. The scrotum is not painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with A. Orchitis B. Hydrocele C. Rectocele D. Scrotal hernia E. Epididymitis ```

B. Hydrocele A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore does transilluminate. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal. Epididymitis is an extremely painful condition.

``` Which condition is a complication of mumps in an adolescent or adult? A. Varicocele B. Epididymitis C. Orchitis D. Paraphimosis E. Cystitis ```

C. Orchitis

A man with peyronie disease will usually complain of A. Painful, inflamed testicles B. Deviation of the penis during erection C. Lack of sexual interest D. Painful lesions of the penis E. Painless ulceration on the penile shaft

B. Deviation of the penis during erection Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection.

A cremasteric reflex should result in A. Scrotum appears to contain a "bag of worms" B. Penile deviation to the left side C. Scrotum to elevate bilaterally D. Immediate erection of the penis E. Testicle and scrotal rise on the stroked side

E. Testicle and scrotal rise on the stroked side