Ask44how44she44acquired44them.
A4458-year-
old44man44comes44to44your44office44complaining44of44bilateral44back44pain44that44now44a
wakens44him44at44night.44This44has44been44steadily44increasing44for44the44past44244mont
hs.44Which44one44of44the44following44is44the44most44reassuring44in44this44patient44with44b
ack44pain?44-44CORRECT44ANSWER44-Pain44that44is44bilateral
The44Phalen's44test44is44used44to44evaluate:44-44CORRECT44ANSWER44-
inflammation44of44the44median44nerve
Which44of44the44following44would44lead44you44to44suspect44a44hydrocele44versus44other44
causes44of44scrotal44swelling?44-44CORRECT44ANSWER44-
A44positive44transillumination44test
You44are44examining44a44newborn44and44note44that44the44right44testicle44is44not44in44the44
scrotum.44What44should44you44do44next?44-44CORRECT44ANSWER44-
Attempt44to44bring44down44the44testis44from44the44inguinal44canal
A4450-year-
old44truck44driver44comes44to44your44clinic44for44a44work44physical.44He44has44had44no44
upper44respiratory,44cardiac,44pulmonary,44gastrointestinal,44urinary,44or44musculoskelet
al44system44complaints.44His44past44medical44history44is44significant44for44mild44arthritis4
4and44prior44knee4 4 surgery44in44college.44He44is44married44and44just44changed44jobs,44
working44for44a44different44trucking44company.44He44smokes44one44pack44of44cigarettes4
4a44day,44drinks44less44than44six44beers44a44week,44and44denies44using44any44illegal44dr
ugs.44His44mother44has44high44blood44pressure44and44arthritis44and44his44father44died44o
f44lung44cancer44in44his44sixties.44On44examination,44his44blood44pressure44is44130/8044
and44his44pulse44is4480.44His44cardiac,44lung,44and44abdominal44examinations44are44nor
mal.44He44has44no44inguinal44hernia,44but44on44his44digital44rectal44examination44you44p
alpate44a44soft,44smooth,44and44nontender44pedunculated44mass44on44the44posterior44w
all44of44the44rectum.44What44anal,44rectal,44or44prostate44disorder44best44fits44his44prese
ntation?44-44CORRECT44ANSWER44-44Rectal44polyp
A4415-year-
old44high44school44football44player44is44brought44to44your44office44by44his44mother.44He44
is44complaining44of44severe44testicular44pain44since44exactly448:0044this44morning.44He44
denies44any44sexual44activity44and44states44that44he44hurts44so44bad44he44can't44even44u
rinate.44He44is44nauseated44and44is44throwing44up.44He44denies44any44recent44illness44or
44fever.44His44past44medical44history44is44unremarkable.44He44denies44any44tobacco,44al
cohol,44or44drug44use.44His44parents44are44both44in44good44health.44On44examination,44y
ou44see44a44young44teenager44lying44on44the44bed44with44an44emesis44basin.44He44is44v
ery44uncomfortable44and44keeps44shifting44his44position.44His44blood44pressure44is44150/
100,44his44pulse44is44110,44and44his44respirations44are4424.44On44visualization44of44the44p
enis,44he44is44circumcised44and44there44are44no44lesions44and44no44discharge44from44th
e44meatus.
His44scrotal44skin44is44tense44and44red.44Palpation44of44the44left44testicle44causes44se
vere44pain44and44the44patient44begins44to44cry.44His44prostate44examination44is44unre
markable.44His44-44CORRECT44ANSWER44-Torsion44of44the44spermatic44cord
, Which44is44true44of44prostate44cancer?44-44CORRECT44ANSWER44-
Ethnicity44is44a44risk44factor.