Deck 22: The Male Genital Organs, the Penis, and the Scrotum

Question 1

A 55-year-old man was admitted to the hospital with a large hard, fixed, intraabdominal mass. On examination of the abdomen, the mass was situated on the transpyloric plane and appeared to be attached to the posterior abdominal wall. The inguinal lymph nodes were normal.

-The symptoms and signs displayed by this patient can be explained by the following statements except which?

A) Radiologic examination of the stomach showed nothing abnormal.
B) The right testicle was enlarged and was much harder than normal.
C) A diagnosis of malignant disease of the right testis was made.
D) The malignant tumor had metastasized to the lumbar lymph nodes lying on the transpyloric plane on the posterior abdominal wall, which is the normal lymphatic drainage of the testis.
E) In malignant disease of the testis the superficial inguinal lymph nodes only become involved if the tumor spreads to involve the scrotal skin.
F) The normal testis is tethered to the skin of the scrotum.

Answer 1

The normal testis is tethered to the skin of the scrotum.

Question 2

While bathing her 5-month-old boy, a mother noticed that his penis tended to curve downward. She decided to seek advice from a pediatrician.

-The pediatrician examined the child and made the following possible correct observations and statements except which?

A) The penis had a definite downward curvature (chordee).
B) Both testes were in the scrotum.
C) The external urethral meatus opened halfway along the undersurface of the penis.
D) The fusion of the genital folds on the ventral or undersurface of the shaft of the penis was incomplete so that the urethra opened on the ventral surface.
E) The condition is a rare congenital anomaly.

Answer 2

The condition is a rare congenital anomaly.

Question 3

The pediatrician made the following possible correct statements to the mother regarding the diagnosis and treatment except which?

A) The child had hypospadias associated with chordee.
B) The proximal portion of the penile urethra had developed normally but was incomplete.
C) The bud of cells (ectodermal) on the tip of the glans penis had failed to grow into the substance of the glans and join with the cells (entodermal cells) of the penile urethra.
D) The treatment is the surgical correction of the chordee, which is followed by the plastic reconstruction of the penile urethra.
E) In view of the delicate tissues involved, the treatment should be delayed until the child is at least 10 years old.

Answer 3

In view of the delicate tissues involved, the treatment should be delayed until the child is at least 10 years old.

Question 4

A65-year-old man with a history of prostatic disease was found on radiographic examination of his skeleton to have extensive carcinomatous metastases in his skull and lumbar vertebrae. His PAS levels in his blood were very much higher than normal. Using your knowledge of anatomy, can you suggest a possible route taken by the cancer cells as they migrated from the prostate to (1) the lumbar vertebrae and (2) the skull?

Question 5

An 88-year-old man had a history of prostatic disease. His latest symptoms included difficulty in starting to micturate, a poor urinary stream, and difficulty in stopping the flow of urine. Which lobe or lobes of the prostate are related to the sphincter vesicae? The enlargement of which lobe is likely to interfere with the sphincter's function?

Question 6

A 6-year-old boy was examined by a pediatrician and found to have no testicle present in the right side of his scrotum. On careful palpation, a deep, firm ovoid structure could be felt above the medial part of the inguinal ligament. What is the diagnosis? Is surgical treatment necessary?

Question 7

An 18-year-old boy, at a medical examination for admission to the army, was found to have no testis in the left side of the scrotum. Nothing abnormal could be palpated in the inguinal canal, but a small, firm ovoid structure could be felt in front of the upper part of the left thigh. What is the diagnosis? Is surgical treatment required?

Question 8

A 25-year-old man developed a swelling above the medial end of the right inguinal ligament. It was associated with a dull, aching pain, bit it did not expand on coughing. On palpation, the swelling appeared to fluctuate, and on grasping the right testis through the scrotal wall and gently pulling it inferiorly, the swelling moved medially along the inguinal canal. What was the swelling? Why did it move with the testis?

Question 9

A patient suffering from tuberculosis of the left epididymis was found to have an ulcer on the posterior surface of the scrotum. Which group of lymph nodes would you examine for local spread of the disease?

Question 10

A resident was asked to examine the vas deferens of a patient. Where would you examine the vas deferens and what does a normal vas feel like?

Question 11

In a patient with a history of venereal disease, a large, fluctuant swelling developed in front of the left testis. From your knowledge of anatomy, and given that there is fluid present in the scrotum, where in the scrotum is the fluid likely to collect?

Question 12

A 50-year-old man was found on examination to have a small cystic swelling above his right testis. What anatomic structure is likely to be involved? Can you explain the presence of this structure embryologically?

Question 13

A 25 -year-old man was found, during a physical examination, to have an abnormal scrotum. On feeling the scrotum with the palm of the hand, it felt like a bag of worms. This situation was caused by an enlargement of the pampiniform plexus on the left side. The physician examined the scrotum and then the left kidney. Can you explain why he should examine the left kidney?