when57you57examine57them.57What57should57you57do?57-57CORRECT57ANSWER57-
Ask57how57she57acquired57them.
A5758-year-
old57man57comes57to57your57office57complaining57of57bilateral57back57pain57that57now57a
wakens57him57at57night.57This57has57been57steadily57increasing57for57the57past57257mont
hs.57Which57one57of57the57following57is57the57most57reassuring57in57this57patient57with57b
ack57pain?57-57CORRECT57ANSWER57-Pain57that57is57bilateral
The57Phalen's57test57is57used57to57evaluate:57-57CORRECT57ANSWER57-
inflammation57of57the57median57nerve
Which57of57the57following57would57lead57you57to57suspect57a57hydrocele57versus57other57
causes57of57scrotal57swelling?57-57CORRECT57ANSWER57-
A57positive57transillumination57test
You57are57examining57a57newborn57and57note57that57the57right57testicle57is57not57in57the57
scrotum.57What57should57you57do57next?57-57CORRECT57ANSWER57-
Attempt57to57bring57down57the57testis57from57the57inguinal57canal
A5750-year-
old57truck57driver57comes57to57your57clinic57for57a57work57physical.57He57has57had57no57
upper57respiratory,57cardiac,57pulmonary,57gastrointestinal,57urinary,57or57musculoskelet
al57system57complaints.57His57past57medical57history57is57significant57for57mild57arthritis5
7and57prior57knee5 7 surgery57in57college.57He57is57married57and57just57changed57jobs,57
working57for57a57different57trucking57company.57He57smokes57one57pack57of57cigarettes5
7a57day,57drinks57less57than57six57beers57a57week,57and57denies57using57any57illegal57dr
ugs.57His57mother57has57high57blood57pressure57and57arthritis57and57his57father57died57o
f57lung57cancer57in57his57sixties.57On57examination,57his57blood57pressure57is57130/8057
and57his57pulse57is5780.57His57cardiac,57lung,57and57abdominal57examinations57are57nor
mal.57He57has57no57inguinal57hernia,57but57on57his57digital57rectal57examination57you57p
alpate57a57soft,57smooth,57and57nontender57pedunculated57mass57on57the57posterior57w
all57of57the57rectum.57What57anal,57rectal,57or57prostate57disorder57best57fits57his57prese
ntation?57-57CORRECT57ANSWER57-57Rectal57polyp
A5715-year-
old57high57school57football57player57is57brought57to57your57office57by57his57mother.57He57
is57complaining57of57severe57testicular57pain57since57exactly578:0057this57morning.57He57
denies57any57sexual57activity57and57states57that57he57hurts57so57bad57he57can't57even57u
rinate.57He57is57nauseated57and57is57throwing57up.57He57denies57any57recent57illness57or
57fever.57His57past57medical57history57is57unremarkable.57He57denies57any57tobacco,57al
cohol,57or57drug57use.57His57parents57are57both57in57good57health.57On57examination,57y
ou57see57a57young57teenager57lying57on57the57bed57with57an57emesis57basin.57He57is57v
ery57uncomfortable57and57keeps57shifting57his57position.57His57blood57pressure57is57150/
100,57his57pulse57is57110,57and57his57respirations57are5724.57On57visualization57of57the57p
enis,57he57is57circumcised57and57there57are57no57lesions57and57no57discharge57from57th
e57meatus.
His57scrotal57skin57is57tense57and57red.57Palpation57of57the57left57testicle57causes57se
vere57pain57and57the57patient57begins57to57cry.57His57prostate57examination57is57unre
markable.57His57-57CORRECT57ANSWER57-Torsion57of57the57spermatic57cord
, Which57is57true57of57prostate57cancer?57-57CORRECT57ANSWER57-
Ethnicity57is57a57risk57factor.
Ask57how57she57acquired57them.
A5758-year-
old57man57comes57to57your57office57complaining57of57bilateral57back57pain57that57now57a
wakens57him57at57night.57This57has57been57steadily57increasing57for57the57past57257mont
hs.57Which57one57of57the57following57is57the57most57reassuring57in57this57patient57with57b
ack57pain?57-57CORRECT57ANSWER57-Pain57that57is57bilateral
The57Phalen's57test57is57used57to57evaluate:57-57CORRECT57ANSWER57-
inflammation57of57the57median57nerve
Which57of57the57following57would57lead57you57to57suspect57a57hydrocele57versus57other57
causes57of57scrotal57swelling?57-57CORRECT57ANSWER57-
A57positive57transillumination57test
You57are57examining57a57newborn57and57note57that57the57right57testicle57is57not57in57the57
scrotum.57What57should57you57do57next?57-57CORRECT57ANSWER57-
Attempt57to57bring57down57the57testis57from57the57inguinal57canal
A5750-year-
old57truck57driver57comes57to57your57clinic57for57a57work57physical.57He57has57had57no57
upper57respiratory,57cardiac,57pulmonary,57gastrointestinal,57urinary,57or57musculoskelet
al57system57complaints.57His57past57medical57history57is57significant57for57mild57arthritis5
7and57prior57knee5 7 surgery57in57college.57He57is57married57and57just57changed57jobs,57
working57for57a57different57trucking57company.57He57smokes57one57pack57of57cigarettes5
7a57day,57drinks57less57than57six57beers57a57week,57and57denies57using57any57illegal57dr
ugs.57His57mother57has57high57blood57pressure57and57arthritis57and57his57father57died57o
f57lung57cancer57in57his57sixties.57On57examination,57his57blood57pressure57is57130/8057
and57his57pulse57is5780.57His57cardiac,57lung,57and57abdominal57examinations57are57nor
mal.57He57has57no57inguinal57hernia,57but57on57his57digital57rectal57examination57you57p
alpate57a57soft,57smooth,57and57nontender57pedunculated57mass57on57the57posterior57w
all57of57the57rectum.57What57anal,57rectal,57or57prostate57disorder57best57fits57his57prese
ntation?57-57CORRECT57ANSWER57-57Rectal57polyp
A5715-year-
old57high57school57football57player57is57brought57to57your57office57by57his57mother.57He57
is57complaining57of57severe57testicular57pain57since57exactly578:0057this57morning.57He57
denies57any57sexual57activity57and57states57that57he57hurts57so57bad57he57can't57even57u
rinate.57He57is57nauseated57and57is57throwing57up.57He57denies57any57recent57illness57or
57fever.57His57past57medical57history57is57unremarkable.57He57denies57any57tobacco,57al
cohol,57or57drug57use.57His57parents57are57both57in57good57health.57On57examination,57y
ou57see57a57young57teenager57lying57on57the57bed57with57an57emesis57basin.57He57is57v
ery57uncomfortable57and57keeps57shifting57his57position.57His57blood57pressure57is57150/
100,57his57pulse57is57110,57and57his57respirations57are5724.57On57visualization57of57the57p
enis,57he57is57circumcised57and57there57are57no57lesions57and57no57discharge57from57th
e57meatus.
His57scrotal57skin57is57tense57and57red.57Palpation57of57the57left57testicle57causes57se
vere57pain57and57the57patient57begins57to57cry.57His57prostate57examination57is57unre
markable.57His57-57CORRECT57ANSWER57-Torsion57of57the57spermatic57cord
, Which57is57true57of57prostate57cancer?57-57CORRECT57ANSWER57-
Ethnicity57is57a57risk57factor.
