when56you56examine56them.56What56should56you56do?56-56CORRECT56ANSWER56-
Ask56how56she56acquired56them.
A5658-year-
old56man56comes56to56your56office56complaining56of56bilateral56back56pain56that56now56a
wakens56him56at56night.56This56has56been56steadily56increasing56for56the56past56256mont
hs.56Which56one56of56the56following56is56the56most56reassuring56in56this56patient56with56b
ack56pain?56-56CORRECT56ANSWER56-Pain56that56is56bilateral
The56Phalen's56test56is56used56to56evaluate:56-56CORRECT56ANSWER56-
inflammation56of56the56median56nerve
Which56of56the56following56would56lead56you56to56suspect56a56hydrocele56versus56other56
causes56of56scrotal56swelling?56-56CORRECT56ANSWER56-
A56positive56transillumination56test
You56are56examining56a56newborn56and56note56that56the56right56testicle56is56not56in56the56
scrotum.56What56should56you56do56next?56-56CORRECT56ANSWER56-
Attempt56to56bring56down56the56testis56from56the56inguinal56canal
A5650-year-
old56truck56driver56comes56to56your56clinic56for56a56work56physical.56He56has56had56no56
upper56respiratory,56cardiac,56pulmonary,56gastrointestinal,56urinary,56or56musculoskelet
al56system56complaints.56His56past56medical56history56is56significant56for56mild56arthritis5
6and56prior56knee5 6 surgery56in56college.56He56is56married56and56just56changed56jobs,56
working56for56a56different56trucking56company.56He56smokes56one56pack56of56cigarettes5
6a56day,56drinks56less56than56six56beers56a56week,56and56denies56using56any56illegal56dr
ugs.56His56mother56has56high56blood56pressure56and56arthritis56and56his56father56died56o
f56lung56cancer56in56his56sixties.56On56examination,56his56blood56pressure56is56130/8056
and56his56pulse56is5680.56His56cardiac,56lung,56and56abdominal56examinations56are56nor
mal.56He56has56no56inguinal56hernia,56but56on56his56digital56rectal56examination56you56p
alpate56a56soft,56smooth,56and56nontender56pedunculated56mass56on56the56posterior56w
all56of56the56rectum.56What56anal,56rectal,56or56prostate56disorder56best56fits56his56prese
ntation?56-56CORRECT56ANSWER56-56Rectal56polyp
A5615-year-
old56high56school56football56player56is56brought56to56your56office56by56his56mother.56He56
is56complaining56of56severe56testicular56pain56since56exactly568:0056this56morning.56He56
denies56any56sexual56activity56and56states56that56he56hurts56so56bad56he56can't56even56u
rinate.56He56is56nauseated56and56is56throwing56up.56He56denies56any56recent56illness56or
56fever.56His56past56medical56history56is56unremarkable.56He56denies56any56tobacco,56al
cohol,56or56drug56use.56His56parents56are56both56in56good56health.56On56examination,56y
ou56see56a56young56teenager56lying56on56the56bed56with56an56emesis56basin.56He56is56v
ery56uncomfortable56and56keeps56shifting56his56position.56His56blood56pressure56is56150/
100,56his56pulse56is56110,56and56his56respirations56are5624.56On56visualization56of56the56p
enis,56he56is56circumcised56and56there56are56no56lesions56and56no56discharge56from56th
e56meatus.
His56scrotal56skin56is56tense56and56red.56Palpation56of56the56left56testicle56causes56se
vere56pain56and56the56patient56begins56to56cry.56His56prostate56examination56is56unre
markable.56His56-56CORRECT56ANSWER56-Torsion56of56the56spermatic56cord
, Which56is56true56of56prostate56cancer?56-56CORRECT56ANSWER56-
Ethnicity56is56a56risk56factor.
Ask56how56she56acquired56them.
A5658-year-
old56man56comes56to56your56office56complaining56of56bilateral56back56pain56that56now56a
wakens56him56at56night.56This56has56been56steadily56increasing56for56the56past56256mont
hs.56Which56one56of56the56following56is56the56most56reassuring56in56this56patient56with56b
ack56pain?56-56CORRECT56ANSWER56-Pain56that56is56bilateral
The56Phalen's56test56is56used56to56evaluate:56-56CORRECT56ANSWER56-
inflammation56of56the56median56nerve
Which56of56the56following56would56lead56you56to56suspect56a56hydrocele56versus56other56
causes56of56scrotal56swelling?56-56CORRECT56ANSWER56-
A56positive56transillumination56test
You56are56examining56a56newborn56and56note56that56the56right56testicle56is56not56in56the56
scrotum.56What56should56you56do56next?56-56CORRECT56ANSWER56-
Attempt56to56bring56down56the56testis56from56the56inguinal56canal
A5650-year-
old56truck56driver56comes56to56your56clinic56for56a56work56physical.56He56has56had56no56
upper56respiratory,56cardiac,56pulmonary,56gastrointestinal,56urinary,56or56musculoskelet
al56system56complaints.56His56past56medical56history56is56significant56for56mild56arthritis5
6and56prior56knee5 6 surgery56in56college.56He56is56married56and56just56changed56jobs,56
working56for56a56different56trucking56company.56He56smokes56one56pack56of56cigarettes5
6a56day,56drinks56less56than56six56beers56a56week,56and56denies56using56any56illegal56dr
ugs.56His56mother56has56high56blood56pressure56and56arthritis56and56his56father56died56o
f56lung56cancer56in56his56sixties.56On56examination,56his56blood56pressure56is56130/8056
and56his56pulse56is5680.56His56cardiac,56lung,56and56abdominal56examinations56are56nor
mal.56He56has56no56inguinal56hernia,56but56on56his56digital56rectal56examination56you56p
alpate56a56soft,56smooth,56and56nontender56pedunculated56mass56on56the56posterior56w
all56of56the56rectum.56What56anal,56rectal,56or56prostate56disorder56best56fits56his56prese
ntation?56-56CORRECT56ANSWER56-56Rectal56polyp
A5615-year-
old56high56school56football56player56is56brought56to56your56office56by56his56mother.56He56
is56complaining56of56severe56testicular56pain56since56exactly568:0056this56morning.56He56
denies56any56sexual56activity56and56states56that56he56hurts56so56bad56he56can't56even56u
rinate.56He56is56nauseated56and56is56throwing56up.56He56denies56any56recent56illness56or
56fever.56His56past56medical56history56is56unremarkable.56He56denies56any56tobacco,56al
cohol,56or56drug56use.56His56parents56are56both56in56good56health.56On56examination,56y
ou56see56a56young56teenager56lying56on56the56bed56with56an56emesis56basin.56He56is56v
ery56uncomfortable56and56keeps56shifting56his56position.56His56blood56pressure56is56150/
100,56his56pulse56is56110,56and56his56respirations56are5624.56On56visualization56of56the56p
enis,56he56is56circumcised56and56there56are56no56lesions56and56no56discharge56from56th
e56meatus.
His56scrotal56skin56is56tense56and56red.56Palpation56of56the56left56testicle56causes56se
vere56pain56and56the56patient56begins56to56cry.56His56prostate56examination56is56unre
markable.56His56-56CORRECT56ANSWER56-Torsion56of56the56spermatic56cord
, Which56is56true56of56prostate56cancer?56-56CORRECT56ANSWER56-
Ethnicity56is56a56risk56factor.
