Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 26: Alterations of the Male Reproductive SystemMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. In the 95% of boys with delayed puberty, the problem is caused by which condition?a. Disruption in the hypothalamusb. Disruption of the pituitaryc. Deficit in estrogen or testosteroned. Physiologic hormonal delaysANS: DIn 95% of cases, delayed puberty is a physiologic delay; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is happening slowly. Hypothalamic and pituitary problems and hormone deficits account for the other 5% of cases.PTS: 1 DIF: Cognitive Level: Remembering 2. What is the first sign of puberty in boys?a. Thickening of the scrotal skinb. Growth of pubic hairc. Enlargement of the testesd. Change in voiceANS: CThe first sign of puberty in boys is an enlargement of the testes and a thinning of the scrotal skin. Growth of pubic hair and voice changes come later.PTS: 1 DIF: Cognitive Level: Remembering 3. A student reads in a chart that a child has been diagnosed with mixed precocious puberty and asks for an explanation. What explanation by the healthcare professional is most accurate?a. When a child develops some secondary sex characteristics of the opposite sexb. When a child does not develop any identifiable external sex organsc. When early puberty occurs due to multiple, integrated causative effectsd. When early puberty has signs of physical and hormonal abnormalitiesANS: AMixed precocious puberty (i.e., virilization of a girl or feminization of a boy) causes the child to develop some secondary sex characteristics of the opposite sex. It is not the lack of identifiable external sex organs, the effect of many causative factors mixed together, or a combination of physical and hormonal abnormalities specifically. The latter statement is accurate to a point but is too vague to be the best answer.PTS: 1 DIF: Cognitive Level: Understanding 4. A healthcare professional sees a patient in the clinic who reports that his foreskin cannot be retracted back over the glans penis. What term does the professional use to document this condition?a. Paraphimosisb. Priapismc. Prephimosisd. PhimosisANS: DPhimosis is the term used to identify the condition in which the foreskin cannot be retracted back over the glans. Paraphimosis is the opposite condition where the foreskin is retracted and cannot be pulled back over the glans. Prephimosis is not a term used in the text. The healthcare professional would document this patient’s condition as phimosis.PTS: 1 DIF: Cognitive Level: Remembering 5. A student in the medical clinic is reviewing a patient’s medical record and sees the diagnosis of Peyronie’s disease and asks the healthcare professional for an explanation of this disorder. What statement by the professional is most accurate?a. When the man’s foreskin is retracted and cannot go back over the glansb. When the man’s foreskin cannot be retracted over the glans penisc. A very painful condition of prolonged erection seen in some diseasesd. A fibrotic condition that leads to curvature of the penis and sexual dysfunctionANS: DPeyronie’s disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis, resulting in varying degrees of curvature and sexual dysfunction. Although the exact cause is unknown, a local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification. A retracted foreskin that will not reduce back over the glans is known as phimosis. Paraphimosis is the opposite condition where the foreskin is retracted and cannot be pulled back over the glans. Priapism is the term for the painful, prolonged erection.PTS: 1 DIF: Cognitive Level: UnderstandingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A man has balanitis. What action by the healthcare professional is most appropriate?a. Educate the man on the side effects of chemotherapy.b. Perform a finger stick for a blood glucose reading.c. Administer pain medication before retracting the foreskin.d. Prepare the man for a needle aspiration of the corpus.ANS: BBalanitis is an inflammation of the glans penis that is usually associated with poor hygiene and most often in men with poorly controlled diabetes mellitus. The health care professional should test the man’s blood glucose. Chemotherapy is not used to treat this condition. There is no difficulty retracting the foreskin so pain medication is not needed. Needle aspiration is one treatment for priapism.PTS: 1 DIF: Cognitive Level: Understanding 7. A 7-year-old child has cryptorchidism. What action by the healthcare professional is most appropriate?a. Educate the child and parents on orchiectomy.b. Instruct the parents to give the child all the antibiotics.c. Describe skin precautions used during radiation therapy.d. Describe the correct administration of GnRH.ANS: DCryptorchidism is a condition of testicular maldescent. Treatment often begins with administration of GnRH or human chorionic gonadotropin (hCG), hormones that may initiate descent. If medical treatment does not work the child may need to have the testis moved surgically (orchiopexy). In children over 10 years of age and adults, the testis is removed in an orchiectomy. Neither Antibiotics nor radiation therapy is needed.PTS: 1 DIF: Cognitive Level: Applying 8. What is the most common infectious cause of orchitis in postpubertal boys?a. Herpesb. Escherichia colic. Mumpsd. CytomegalovirusANS: COf the options available, mumps is the most common infectious cause of orchitis and usually affects postpubertal boys.PTS: 1 DIF: Cognitive Level: Remembering 9. The risk of which cancer is greater if the man has a history of cryptorchidism?a. Penileb. Testicularc. Prostated. EpididymalANS: BThe risk of testicular cancer is 35 to 50 times greater in men with cryptorchidism or in those with a history of cryptorchidism than it is for the general male population. Cryptorchidism does not increase the risk of penile, prostate, or epididymal cancer.PTS: 1 DIF: Cognitive Level: Remembering 10. What are the clinical manifestations of testicular cancer?a. Firm, nontender testicular massb. Painful, mobile, firm testicular massc. Painful fluid-filled testicular massd. Soft, nontender testicular massANS: AA firm, painless
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