NURS 5432 Men's Health & STDs Module
UTA Actual Exam 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
Section 1: Testicular & Scrotal Disorders (Questions 1–10)
Q1: A 28-year-old male presents to the clinic with sudden onset of severe left scrotal pain that woke him
from sleep 3 hours ago. On exam, the left testicle is high-riding, exquisitely tender, and the cremasteric
reflex is absent. The patient denies trauma. Which of the following is the most appropriate immediate
management?
A. Doppler ultrasound to confirm the diagnosis before any intervention
B. Manual detorsion followed by observation if pain resolves
C. Immediate surgical exploration with detorsion and bilateral orchiopexy [CORRECT]
D. IV antibiotics and warm compresses for presumed epididymitis
Correct Answer: C
Rationale: The best answer is C. This is classic testicular torsion—sudden severe pain, high-riding
testicle, absent cremasteric reflex, and onset during sleep (the "bell clapper" deformity allows torsion
during nocturnal cremasteric contraction). Time is testicle here; you have about 6 hours before
irreversible ischemia sets in. Doppler ultrasound takes too long and isn't needed when the presentation
is this textbook—surgical exploration is the standard of care, and you do bilateral orchiopexy because
the contralateral side has the same anatomic risk. Manual detorsion can be attempted in the ED while
prepping for surgery, but it's not definitive management. Epididymitis doesn't present this acutely or
with absent cremasteric reflex.
Q2: A 42-year-old man with a history of vasectomy 5 years ago presents with a gradual onset of right
scrotal heaviness and a palpable, non-tender mass posterior to the testicle that transilluminates
brightly. The mass is separate from the testicle itself. Which diagnosis best fits this presentation?
A. Testicular torsion
B. Spermatocele
C. Hydrocele [CORRECT]
,D. Varicocele
Correct Answer: C
Rationale: The best answer is C. A hydrocele is a collection of fluid in the tunica vaginalis that presents as
a painless, fluctuant scrotal mass that transilluminates brilliantly—literally lights up like a glow stick
when you shine a penlight through it. The gradual onset, non-tender nature, and history of vasectomy
(which can disrupt lymphatic drainage) all point toward a reactive hydrocele. A spermatocele also
transilluminates but is typically a smaller, cystic mass at the head of the epididymis and doesn't usually
cause this degree of heaviness. Varicoceles feel like a "bag of worms," don't transilluminate, and worsen
with Valsalva. Torsion is acutely painful—this presentation is the opposite.
Q3: During a routine sports physical, a 16-year-old male is found to have a left varicocele that is palpable
without Valsalva and visibly bulging through the scrotal skin. The right side is completely normal. Which
of the following is the most appropriate next step?
A. Reassure and schedule routine follow-up in 6 months
B. Order a scrotal ultrasound with Doppler to assess for testicular atrophy
C. Refer for surgical repair given the grade and age [CORRECT]
D. Prescribe scrotal support and NSAIDs for symptomatic relief
Correct Answer: C
Rationale: The best answer is C. This is a grade III varicocele—visible and palpable without Valsalva—and
in an adolescent, this warrants referral for surgical repair (varicocelectomy). The concern here is
testicular growth impairment; varicoceles can cause progressive testicular atrophy and are the leading
correctable cause of male infertility. In adolescents, a grade II-III varicocele with any evidence of
testicular volume discrepancy (even if not yet apparent) is an indication for repair. The "left-sided only"
presentation is typical because the left gonadal vein drains into the left renal vein at a right angle,
creating higher hydrostatic pressure. You wouldn't just watch this—intervention preserves future
fertility potential.
Q4: A 35-year-old man presents with scrotal pain, dysuria, and a tender, swollen epididymis on the right
side. He reports unprotected sex with a new partner 2 weeks ago. His urinalysis shows pyuria but no
bacteriuria. Which empiric treatment regimen is most appropriate?
A. Ceftriaxone 500 mg IM × 1 plus doxycycline 100 mg PO BID × 7 days [CORRECT]
B. Ciprofloxacin 500 mg PO BID × 10 days
C. Azithromycin 1 g PO × 1 dose
D. Trimethoprim-sulfamethoxazole DS PO BID × 10 days
, Correct Answer: A
Rationale: The best answer is A. In a sexually active man under 35 with acute epididymitis, the most
likely pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae—this is an STI-related
epididymitis until proven otherwise. Current CDC guidelines recommend ceftriaxone 500 mg IM (1 g if
>150 kg) plus doxycycline 100 mg PO BID for 7 days. The pyuria without bacteriuria supports a non-
urinary pathogen. Fluoroquinolones like ciprofloxacin are reserved for men over 35 or those with enteric
organisms (like E. coli from urinary tract sources), not young sexually active men. Azithromycin alone
doesn't cover gonorrhea adequately, and TMP-SMX doesn't cover the typical STI pathogens.
Q5: A newborn male is noted to have an undescended right testicle on routine newborn exam. The
testicle is not palpable in the inguinal canal or scrotum. At what age should orchiopexy be performed if
the testicle has not descended spontaneously?
A. By 3 months of age
B. By 6 months of age
C. By 12 months of age, ideally between 6–12 months [CORRECT]
D. By 24 months of age, as spontaneous descent often occurs later
Correct Answer: C
Rationale: The best answer is C. Cryptorchidism (undescended testicle) is the most common congenital
genitourinary anomaly in boys. Spontaneous descent can occur up to about 6 months of age, but after
that, the window for intervention narrows. Current AUA and pediatric urology guidelines recommend
orchiopexy between 6 and 12 months of age, with the sweet spot being around 9–12 months. The
reason for this timing is two-fold: first, waiting beyond 12 months increases the risk of progressive germ
cell loss and testicular atrophy; second, cryptorchidism carries a significantly increased lifetime risk of
testicular cancer (roughly 3–8 times higher than descended testicles), and early orchiopexy allows for
easier future surveillance. Waiting until 24 months is too late—you've already missed the window for
optimal testicular development.
Q6: A 24-year-old college athlete presents with acute left scrotal pain after a direct blow during a soccer
match. On exam, the scrotum is swollen and ecchymotic, but the testicle itself is non-tender and the
cremasteric reflex is intact. Prehn's sign is positive (pain relief with elevation). Which of the following is
the most likely diagnosis?
A. Testicular torsion
B. Testicular rupture
C. Epididymitis [CORRECT]
D. Hematocele
UTA Actual Exam 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
Section 1: Testicular & Scrotal Disorders (Questions 1–10)
Q1: A 28-year-old male presents to the clinic with sudden onset of severe left scrotal pain that woke him
from sleep 3 hours ago. On exam, the left testicle is high-riding, exquisitely tender, and the cremasteric
reflex is absent. The patient denies trauma. Which of the following is the most appropriate immediate
management?
A. Doppler ultrasound to confirm the diagnosis before any intervention
B. Manual detorsion followed by observation if pain resolves
C. Immediate surgical exploration with detorsion and bilateral orchiopexy [CORRECT]
D. IV antibiotics and warm compresses for presumed epididymitis
Correct Answer: C
Rationale: The best answer is C. This is classic testicular torsion—sudden severe pain, high-riding
testicle, absent cremasteric reflex, and onset during sleep (the "bell clapper" deformity allows torsion
during nocturnal cremasteric contraction). Time is testicle here; you have about 6 hours before
irreversible ischemia sets in. Doppler ultrasound takes too long and isn't needed when the presentation
is this textbook—surgical exploration is the standard of care, and you do bilateral orchiopexy because
the contralateral side has the same anatomic risk. Manual detorsion can be attempted in the ED while
prepping for surgery, but it's not definitive management. Epididymitis doesn't present this acutely or
with absent cremasteric reflex.
Q2: A 42-year-old man with a history of vasectomy 5 years ago presents with a gradual onset of right
scrotal heaviness and a palpable, non-tender mass posterior to the testicle that transilluminates
brightly. The mass is separate from the testicle itself. Which diagnosis best fits this presentation?
A. Testicular torsion
B. Spermatocele
C. Hydrocele [CORRECT]
,D. Varicocele
Correct Answer: C
Rationale: The best answer is C. A hydrocele is a collection of fluid in the tunica vaginalis that presents as
a painless, fluctuant scrotal mass that transilluminates brilliantly—literally lights up like a glow stick
when you shine a penlight through it. The gradual onset, non-tender nature, and history of vasectomy
(which can disrupt lymphatic drainage) all point toward a reactive hydrocele. A spermatocele also
transilluminates but is typically a smaller, cystic mass at the head of the epididymis and doesn't usually
cause this degree of heaviness. Varicoceles feel like a "bag of worms," don't transilluminate, and worsen
with Valsalva. Torsion is acutely painful—this presentation is the opposite.
Q3: During a routine sports physical, a 16-year-old male is found to have a left varicocele that is palpable
without Valsalva and visibly bulging through the scrotal skin. The right side is completely normal. Which
of the following is the most appropriate next step?
A. Reassure and schedule routine follow-up in 6 months
B. Order a scrotal ultrasound with Doppler to assess for testicular atrophy
C. Refer for surgical repair given the grade and age [CORRECT]
D. Prescribe scrotal support and NSAIDs for symptomatic relief
Correct Answer: C
Rationale: The best answer is C. This is a grade III varicocele—visible and palpable without Valsalva—and
in an adolescent, this warrants referral for surgical repair (varicocelectomy). The concern here is
testicular growth impairment; varicoceles can cause progressive testicular atrophy and are the leading
correctable cause of male infertility. In adolescents, a grade II-III varicocele with any evidence of
testicular volume discrepancy (even if not yet apparent) is an indication for repair. The "left-sided only"
presentation is typical because the left gonadal vein drains into the left renal vein at a right angle,
creating higher hydrostatic pressure. You wouldn't just watch this—intervention preserves future
fertility potential.
Q4: A 35-year-old man presents with scrotal pain, dysuria, and a tender, swollen epididymis on the right
side. He reports unprotected sex with a new partner 2 weeks ago. His urinalysis shows pyuria but no
bacteriuria. Which empiric treatment regimen is most appropriate?
A. Ceftriaxone 500 mg IM × 1 plus doxycycline 100 mg PO BID × 7 days [CORRECT]
B. Ciprofloxacin 500 mg PO BID × 10 days
C. Azithromycin 1 g PO × 1 dose
D. Trimethoprim-sulfamethoxazole DS PO BID × 10 days
, Correct Answer: A
Rationale: The best answer is A. In a sexually active man under 35 with acute epididymitis, the most
likely pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae—this is an STI-related
epididymitis until proven otherwise. Current CDC guidelines recommend ceftriaxone 500 mg IM (1 g if
>150 kg) plus doxycycline 100 mg PO BID for 7 days. The pyuria without bacteriuria supports a non-
urinary pathogen. Fluoroquinolones like ciprofloxacin are reserved for men over 35 or those with enteric
organisms (like E. coli from urinary tract sources), not young sexually active men. Azithromycin alone
doesn't cover gonorrhea adequately, and TMP-SMX doesn't cover the typical STI pathogens.
Q5: A newborn male is noted to have an undescended right testicle on routine newborn exam. The
testicle is not palpable in the inguinal canal or scrotum. At what age should orchiopexy be performed if
the testicle has not descended spontaneously?
A. By 3 months of age
B. By 6 months of age
C. By 12 months of age, ideally between 6–12 months [CORRECT]
D. By 24 months of age, as spontaneous descent often occurs later
Correct Answer: C
Rationale: The best answer is C. Cryptorchidism (undescended testicle) is the most common congenital
genitourinary anomaly in boys. Spontaneous descent can occur up to about 6 months of age, but after
that, the window for intervention narrows. Current AUA and pediatric urology guidelines recommend
orchiopexy between 6 and 12 months of age, with the sweet spot being around 9–12 months. The
reason for this timing is two-fold: first, waiting beyond 12 months increases the risk of progressive germ
cell loss and testicular atrophy; second, cryptorchidism carries a significantly increased lifetime risk of
testicular cancer (roughly 3–8 times higher than descended testicles), and early orchiopexy allows for
easier future surveillance. Waiting until 24 months is too late—you've already missed the window for
optimal testicular development.
Q6: A 24-year-old college athlete presents with acute left scrotal pain after a direct blow during a soccer
match. On exam, the scrotum is swollen and ecchymotic, but the testicle itself is non-tender and the
cremasteric reflex is intact. Prehn's sign is positive (pain relief with elevation). Which of the following is
the most likely diagnosis?
A. Testicular torsion
B. Testicular rupture
C. Epididymitis [CORRECT]
D. Hematocele
