when54you54examine54them.54What54should54you54do?54-54CORRECT54ANSWER54-
Ask54how54she54acquired54them.
A5458-year-
old54man54comes54to54your54office54complaining54of54bilateral54back54pain54that54now54a
wakens54him54at54night.54This54has54been54steadily54increasing54for54the54past54254mont
hs.54Which54one54of54the54following54is54the54most54reassuring54in54this54patient54with54b
ack54pain?54-54CORRECT54ANSWER54-Pain54that54is54bilateral
The54Phalen's54test54is54used54to54evaluate:54-54CORRECT54ANSWER54-
inflammation54of54the54median54nerve
Which54of54the54following54would54lead54you54to54suspect54a54hydrocele54versus54other54
causes54of54scrotal54swelling?54-54CORRECT54ANSWER54-
A54positive54transillumination54test
You54are54examining54a54newborn54and54note54that54the54right54testicle54is54not54in54the5
4scrotum.54What54should54you54do54next?54-54CORRECT54ANSWER54-
Attempt54to54bring54down54the54testis54from54the54inguinal54canal
A5450-year-
old54truck54driver54comes54to54your54clinic54for54a54work54physical.54He54has54had54no54
upper54respiratory,54cardiac,54pulmonary,54gastrointestinal,54urinary,54or54musculoskelet
al54system54complaints.54His54past54medical54history54is54significant54for54mild54arthritis5
4and54prior54knee5 4 surgery54in54college.54He54is54married54and54just54changed54jobs,54
working54for54a54different54trucking54company.54He54smokes54one54pack54of54cigarettes5
4a54day,54drinks54less54than54six54beers54a54week,54and54denies54using54any54illegal54dr
ugs.54His54mother54has54high54blood54pressure54and54arthritis54and54his54father54died54o
f54lung54cancer54in54his54sixties.54On54examination,54his54blood54pressure54is54130/8054
and54his54pulse54is5480.54His54cardiac,54lung,54and54abdominal54examinations54are54nor
mal.54He54has54no54inguinal54hernia,54but54on54his54digital54rectal54examination54you54p
alpate54a54soft,54smooth,54and54nontender54pedunculated54mass54on54the54posterior54w
all54of54the54rectum.54What54anal,54rectal,54or54prostate54disorder54best54fits54his54prese
ntation?54-54CORRECT54ANSWER54-54Rectal54polyp
A5415-year-
old54high54school54football54player54is54brought54to54your54office54by54his54mother.54He54
is54complaining54of54severe54testicular54pain54since54exactly548:0054this54morning.54He54
denies54any54sexual54activity54and54states54that54he54hurts54so54bad54he54can't54even54u
rinate.54He54is54nauseated54and54is54throwing54up.54He54denies54any54recent54illness54or
54fever.54His54past54medical54history54is54unremarkable.54He54denies54any54tobacco,54al
cohol,54or54drug54use.54His54parents54are54both54in54good54health.54On54examination,54y
ou54see54a54young54teenager54lying54on54the54bed54with54an54emesis54basin.54He54is54v
ery54uncomfortable54and54keeps54shifting54his54position.54His54blood54pressure54is54150/
100,54his54pulse54is54110,54and54his54respirations54are5424.54On54visualization54of54the54p
enis,54he54is54circumcised54and54there54are54no54lesions54and54no54discharge54from54th
e54meatus.
His54scrotal54skin54is54tense54and54red.54Palpation54of54the54left54testicle54causes54se
vere54pain54and54the54patient54begins54to54cry.54His54prostate54examination54is54unre
markable.54His54-54CORRECT54ANSWER54-Torsion54of54the54spermatic54cord
, Which54is54true54of54prostate54cancer?54-54CORRECT54ANSWER54-Ethnicity54is54a54risk54factor.
Ask54how54she54acquired54them.
A5458-year-
old54man54comes54to54your54office54complaining54of54bilateral54back54pain54that54now54a
wakens54him54at54night.54This54has54been54steadily54increasing54for54the54past54254mont
hs.54Which54one54of54the54following54is54the54most54reassuring54in54this54patient54with54b
ack54pain?54-54CORRECT54ANSWER54-Pain54that54is54bilateral
The54Phalen's54test54is54used54to54evaluate:54-54CORRECT54ANSWER54-
inflammation54of54the54median54nerve
Which54of54the54following54would54lead54you54to54suspect54a54hydrocele54versus54other54
causes54of54scrotal54swelling?54-54CORRECT54ANSWER54-
A54positive54transillumination54test
You54are54examining54a54newborn54and54note54that54the54right54testicle54is54not54in54the5
4scrotum.54What54should54you54do54next?54-54CORRECT54ANSWER54-
Attempt54to54bring54down54the54testis54from54the54inguinal54canal
A5450-year-
old54truck54driver54comes54to54your54clinic54for54a54work54physical.54He54has54had54no54
upper54respiratory,54cardiac,54pulmonary,54gastrointestinal,54urinary,54or54musculoskelet
al54system54complaints.54His54past54medical54history54is54significant54for54mild54arthritis5
4and54prior54knee5 4 surgery54in54college.54He54is54married54and54just54changed54jobs,54
working54for54a54different54trucking54company.54He54smokes54one54pack54of54cigarettes5
4a54day,54drinks54less54than54six54beers54a54week,54and54denies54using54any54illegal54dr
ugs.54His54mother54has54high54blood54pressure54and54arthritis54and54his54father54died54o
f54lung54cancer54in54his54sixties.54On54examination,54his54blood54pressure54is54130/8054
and54his54pulse54is5480.54His54cardiac,54lung,54and54abdominal54examinations54are54nor
mal.54He54has54no54inguinal54hernia,54but54on54his54digital54rectal54examination54you54p
alpate54a54soft,54smooth,54and54nontender54pedunculated54mass54on54the54posterior54w
all54of54the54rectum.54What54anal,54rectal,54or54prostate54disorder54best54fits54his54prese
ntation?54-54CORRECT54ANSWER54-54Rectal54polyp
A5415-year-
old54high54school54football54player54is54brought54to54your54office54by54his54mother.54He54
is54complaining54of54severe54testicular54pain54since54exactly548:0054this54morning.54He54
denies54any54sexual54activity54and54states54that54he54hurts54so54bad54he54can't54even54u
rinate.54He54is54nauseated54and54is54throwing54up.54He54denies54any54recent54illness54or
54fever.54His54past54medical54history54is54unremarkable.54He54denies54any54tobacco,54al
cohol,54or54drug54use.54His54parents54are54both54in54good54health.54On54examination,54y
ou54see54a54young54teenager54lying54on54the54bed54with54an54emesis54basin.54He54is54v
ery54uncomfortable54and54keeps54shifting54his54position.54His54blood54pressure54is54150/
100,54his54pulse54is54110,54and54his54respirations54are5424.54On54visualization54of54the54p
enis,54he54is54circumcised54and54there54are54no54lesions54and54no54discharge54from54th
e54meatus.
His54scrotal54skin54is54tense54and54red.54Palpation54of54the54left54testicle54causes54se
vere54pain54and54the54patient54begins54to54cry.54His54prostate54examination54is54unre
markable.54His54-54CORRECT54ANSWER54-Torsion54of54the54spermatic54cord
, Which54is54true54of54prostate54cancer?54-54CORRECT54ANSWER54-Ethnicity54is54a54risk54factor.
