Male reproductive organs — MCQs

10 questions

A 32-year-old man presents to his primary care physician complaining of pain accompanied by a feeling of heaviness in his scrotum. He is otherwise healthy except for a broken arm he obtained while skiing several years ago. Physical exam reveals an enlarged “bag of worms” upon palpation of the painful scrotal region. Shining a light over this area shows that the scrotum does not transilluminate. Which of the following statements is true about the most likely cause of this patient's symptoms?

A 57-year-old male is found to have an elevated prostate specific antigen (PSA) level on screening labwork. PSA may be elevated in prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Which of the following best describes the physiologic function of PSA?

A 68-year-old man presents to his primary care physician complaining of a bulge in his scrotum that has enlarged over the past several months. He is found to have a right-sided inguinal hernia and undergoes elective hernia repair. At his first follow-up visit, he complains of a tingling sensation on his scrotum. Which of the following nerve roots communicates with the injured tissues?

A 39-year-old man presents with painless swelling of the right testis and a sensation of heaviness. The physical examination revealed an intra-testicular solid mass that could not be felt separately from the testis. After a thorough evaluation, he was diagnosed with testicular seminoma. Which of the following group of lymph nodes are most likely involved?

A newborn infant with karyotype 46, XY has male internal and external reproductive structures. The lack of a uterus in this infant can be attributed to the actions of which of the following cell types?

After a year of trying to conceive, a young couple in their early twenties decided to try in vitro fertilization. During preliminary testing of fertility, it was found that the male partner had dysfunctional sperm. Past medical history revealed that he had frequent sinus and lung infections throughout his life. The physician noted an abnormal exam finding on palpation of the right fifth intercostal space at the midclavicular line. What would be the most likely diagnosis responsible for this patient's infertility?

A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for?

A 65-year-old man presents to the emergency department with abdominal pain and a pulsatile abdominal mass. Further examination of the mass shows that it is an abdominal aortic aneurysm. A computed tomography scan with contrast reveals an incidental finding of a horseshoe kidney, and the surgeon is informed of this finding prior to operating on the aneurysm. Which of the following may complicate the surgical approach in this patient?

An 11-year-old girl is brought in to her pediatrician by her parents due to developmental concerns. The patient developed normally throughout childhood, but she has not yet menstruated and has noticed that her voice is getting deeper. The patient has no other health issues. On exam, her temperature is 98.6°F (37.0°C), blood pressure is 110/68 mmHg, pulse is 74/min, and respirations are 12/min. The patient is noted to have Tanner stage I breasts and Tanner stage II pubic hair. On pelvic exam, the patient is noted to have a blind vagina with slight clitoromegaly as well as two palpable testes. Through laboratory workup, the patient is found to have 5-alpha-reductase deficiency. Which of the following anatomic structures are correctly matched homologues between male and female genitalia?

Q10

A 47-year-old woman comes to the physician because of involuntary leakage of urine for the past 4 months, which she has experienced when bicycling to work and when laughing. She has not had any dysuria or urinary urgency. She has 4 children that were all delivered vaginally. She is otherwise healthy and takes no medications. The muscles most likely affected by this patient's condition receive efferent innervation from which of the following structures?

Male reproductive organs US Medical PG Practice Questions and MCQs

Question 1: A 32-year-old man presents to his primary care physician complaining of pain accompanied by a feeling of heaviness in his scrotum. He is otherwise healthy except for a broken arm he obtained while skiing several years ago. Physical exam reveals an enlarged “bag of worms” upon palpation of the painful scrotal region. Shining a light over this area shows that the scrotum does not transilluminate. Which of the following statements is true about the most likely cause of this patient's symptoms?

A. Equally common on both sides
B. More common on left due to drainage into renal vein (Correct Answer)
C. More common on right due to drainage into renal vein
D. More common on right due to drainage into inferior vena cava
E. More common on left due to drainage into inferior vena cava

Explanation: ***More common on left due to drainage into renal vein*** - The patient's symptoms of scrotal pain, "bag of worms" on palpation, and lack of transillumination are classic for a **left-sided varicocele**. - The longer course and perpendicular drainage of the **left testicular vein** into the left renal vein create higher pressure, making varicocele formation more common on the left. *Equally common on both sides* - Varicoceles are distinctly asymmetrical, with a well-established higher incidence on the left side due to anatomical differences. - Bilateral varicoceles can occur but are less common than isolated left-sided ones and do not support an "equally common" distribution. *More common on right due to drainage into renal vein* - The right testicular vein typically drains directly into the **inferior vena cava (IVC)**, not the renal vein, which is a lower pressure system compared to the left. - Therefore, anatomical factors do not favor varicocele formation on the right side due to drainage into the renal vein. *More common on right due to drainage into inferior vena cava* - While the right testicular vein drains into the IVC, this direct drainage path is associated with good venous return and a lower risk of varicocele. - A right-sided varicocele is less common and, if present, should prompt investigation for retroperitoneal mass obstructing the IVC or right testicular vein. *More common on left due to drainage into inferior vena cava* - The left testicular vein typically drains into the **left renal vein**, not directly into the inferior vena cava. - This anatomical description is incorrect and does not explain the higher incidence of left-sided varicoceles.

Question 2: A 57-year-old male is found to have an elevated prostate specific antigen (PSA) level on screening labwork. PSA may be elevated in prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Which of the following best describes the physiologic function of PSA?

A. Regulation of transcription factors and phosphorylation of proteins
B. Maintains corpus luteum
C. Response to peritoneal irritation
D. Sperm production
E. Liquefaction of semen (Correct Answer)

Explanation: ***Liquefaction of semen*** - Prostate-specific antigen (PSA) is a **serine protease** produced by the epithelial cells of the prostate gland. - Its primary physiological role is to **liquefy the seminal coagulum** formed after ejaculation, allowing sperm to become motile and navigate the female reproductive tract. *Regulation of transcription factors and phosphorylation of proteins* - This function is characteristic of **kinases** and **phosphatases**, which are involved in intracellular signaling pathways. - While essential for cellular function, it does not describe the specific role of PSA. *Maintains corpus luteum* - The maintenance of the corpus luteum is primarily the role of **luteinizing hormone (LH)** and, in pregnancy, **human chorionic gonadotropin (hCG)**. - These hormones are involved in the female reproductive cycle, unrelated to PSA. *Response to peritoneal irritation* - Peritoneal irritation triggers an inflammatory response involving various immune cells and mediators, but not specifically PSA. - PSA itself is not directly involved in the systemic or local response to peritoneal inflammation. *Sperm production* - **Sperm production (spermatogenesis)** occurs in the seminiferous tubules of the testes under the influence of hormones like FSH and testosterone. - While semen is the vehicle for sperm, PSA's role is in the post-ejaculatory processing of semen, not in the initial production of sperm.

Question 3: A 68-year-old man presents to his primary care physician complaining of a bulge in his scrotum that has enlarged over the past several months. He is found to have a right-sided inguinal hernia and undergoes elective hernia repair. At his first follow-up visit, he complains of a tingling sensation on his scrotum. Which of the following nerve roots communicates with the injured tissues?

A. S1-S3
B. L1-L2 (Correct Answer)
C. S2-S4
D. L4-L5
E. L2-L3

Explanation: ***L1-L2*** - The **ilioinguinal nerve** and **genitofemoral nerve**, which are commonly injured during inguinal hernia repair, arise from the **L1 and L2 spinal nerves**. - These nerves provide sensory innervation to the **scrotum**, **inguinal region**, and **medial thigh**, explaining the patient's tingling sensation. *S1-S3* - These nerve roots typically contribute to the **sciatic nerve** and innervate the posterior thigh, leg, and foot, and are not directly involved in scrotal sensation relevant to an inguinal hernia repair. - They also contribute to the **pudendal nerve**, which primarily supplies the perineum and external genitalia, but injury to this nerve is less common in routine inguinal hernia repair. *S2-S4* - These nerve roots primarily form the **pudendal nerve**, which innervates the **perineum** and external genitalia (including some scrotal sensation), but injury to these specific nerves is not a typical complication of routine inguinal hernia repair. - They also contribute to the **pelvic splanchnic nerves**, controlling bladder and bowel function, which are unrelated to the described sensory deficit. *L4-L5* - These nerve roots primarily contribute to nerves supplying the **lower limb**, such as the **femoral nerve** and **sciatic nerve**, and do not directly innervate the scrotum. - Injury to these roots would typically result in motor or sensory deficits of the **thigh and leg**, not isolated scrotal tingling. *L2-L3* - While L2 contributes to nerves supplying the inguinal region and scrotum (genitofemoral nerve), the **ilioinguinal nerve** originates from L1. - The **lateral femoral cutaneous nerve**, which originates from L2-L3, innervates the **lateral thigh**, and its injury would cause tingling there, not in the scrotum.

Question 4: A 39-year-old man presents with painless swelling of the right testis and a sensation of heaviness. The physical examination revealed an intra-testicular solid mass that could not be felt separately from the testis. After a thorough evaluation, he was diagnosed with testicular seminoma. Which of the following group of lymph nodes are most likely involved?

A. Superficial inguinal lymph nodes (lateral group)
B. Deep inguinal lymph nodes
C. Superficial inguinal lymph nodes (medial group)
D. Para-rectal lymph nodes
E. Para-aortic lymph nodes (Correct Answer)

Explanation: ***Para-aortic lymph nodes*** - The **testes** develop in the abdomen and descend into the scrotum, retaining their original lymphatic drainage. Therefore, **testicular cancer** typically metastasizes to the **para-aortic** (or retroperitoneal) lymph nodes, which are located near the renal veins at the level of L1-L2. - This is the primary lymphatic drainage pathway for the testes. *Superficial inguinal lymph nodes (lateral group)* - These lymph nodes primarily drain the skin of the **scrotum**, perineum, and lower limbs, but not the **testes** themselves. - Involvement would suggest spread to the scrotal skin or compromised lymphatic flow due to prior scrotal surgery or infection, which is not indicated here. *Deep inguinal lymph nodes* - **Deep inguinal lymph nodes** drain structures deeper in the leg and gluteal region, as well as receiving efferent vessels from the superficial inguinal nodes. - They are not the primary drainage site for the **testes**. *Superficial inguinal lymph nodes (medial group)* - Similar to the lateral group, the **medial superficial inguinal lymph nodes** primarily drain the external genitalia (excluding the testes), perineum, and lower abdominal wall. - They are not the direct drainage route for **testicular cancer**. *Para-rectal lymph nodes* - **Para-rectal lymph nodes** are located near the rectum and are involved in the drainage of the rectum and lower sigmoid colon. - They have no direct connection to the lymphatic drainage of the **testes**.

Question 5: A newborn infant with karyotype 46, XY has male internal and external reproductive structures. The lack of a uterus in this infant can be attributed to the actions of which of the following cell types?

A. Granulosa
B. Theca
C. Leydig
D. Reticularis
E. Sertoli (Correct Answer)

Explanation: ***Sertoli*** - **Sertoli cells** in the fetal testis produce **Anti-Müllerian Hormone (AMH)**, which is crucial for the regression of the **Müllerian ducts**. - The **Müllerian ducts** (also called paramesonephric ducts) would otherwise develop into the uterus, fallopian tubes, and upper vagina in the female fetus. In a male fetus, AMH from Sertoli cells causes these structures to degenerate, leading to the absence of a uterus. *Granulosa* - **Granulosa cells** are found in the ovarian follicles of females and are involved in **estrogen synthesis** and support of oocyte development. - They do not play a role in Müllerian duct regression; in fact, the absence of AMH in female fetuses allows the Müllerian ducts to develop. *Theca* - **Theca cells** are also found in the ovarian follicles and are responsible for producing **androgens** (which are then converted to estrogen by granulosa cells). - Like granulosa cells, theca cells are involved in ovarian function and estrogen production, not in the regression of Müllerian ducts. *Leydig* - **Leydig cells** are located in the interstitium of the testes and are responsible for producing **androgens** (primarily testosterone) in response to luteinizing hormone (LH). - Testosterone from Leydig cells promotes the development of the **Wolffian ducts** (which form male internal reproductive structures like the epididymis, vas deferens, and seminal vesicles), but it does not directly cause the regression of the Müllerian ducts. *Reticularis* - The **zona reticularis** is the innermost layer of the adrenal cortex and produces **adrenal androgens**. - While adrenal androgens play a role in puberty and certain endocrine conditions, they are not involved in the differentiation of fetal reproductive tracts or the regression of Müllerian ducts.

Question 6: After a year of trying to conceive, a young couple in their early twenties decided to try in vitro fertilization. During preliminary testing of fertility, it was found that the male partner had dysfunctional sperm. Past medical history revealed that he had frequent sinus and lung infections throughout his life. The physician noted an abnormal exam finding on palpation of the right fifth intercostal space at the midclavicular line. What would be the most likely diagnosis responsible for this patient's infertility?

A. Chédiak-Higashi syndrome
B. Kartagener syndrome (Correct Answer)
C. Adenosine deaminase deficiency
D. Williams syndrome
E. Cystic fibrosis

Explanation: ***Kartagener syndrome*** - This syndrome is a subgroup of **primary ciliary dyskinesia** characterized by the triad of **situs inversus**, **chronic sinusitis**, and **bronchiectasis**. The abnormal exam finding on palpation of the right fifth intercostal space at the midclavicular line suggests the apex beat is on the right side, indicating **dextrocardia** (situs inversus) which supports this diagnosis. - The **dysfunctional sperm** and **frequent respiratory infections** are also classic features, resulting from immotile cilia in the respiratory tract and immotile flagella in sperm. *Chédiak-Higashi syndrome* - This is a rare autosomal recessive disorder characterized by **immunodeficiency**, **partial oculocutaneous albinism**, and **peripheral neuropathy**. - While patients suffer from recurrent infections due to impaired phagolysosome formation, it does not typically cause situs inversus or male infertility due to dysfunctional sperm. *Adenosine deaminase deficiency* - This is a severe form of **severe combined immunodeficiency (SCID)**, leading to a profound deficiency of T and B lymphocytes. - Patients typically present with **recurrent opportunistic infections** and failure to thrive early in life, but it does not cause situs inversus or issues with sperm motility. *Williams syndrome* - This is a genetic condition characterized by specific **facial features** (e.g., "elfin" facies), **cardiovascular problems** (especially supravalvular aortic stenosis), unique **cognitive profiles**, and **overly friendly personalities**. - It does not involve recurrent respiratory infections, situs inversus, or male infertility. *Cystic fibrosis* - This genetic disorder primarily affects the **lungs**, **pancreas**, liver, and intestines, causing the production of thick, sticky mucus. - While it causes **recurrent lung infections** and **male infertility** (due to congenital bilateral absence of the vas deferens, not immotile sperm), it does not cause situs inversus.

Question 7: A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for?

A. Prostatitis
B. Prostate abscess
C. Benign prostatic hyperplasia
D. Prostate cancer (Correct Answer)
E. Normal physical exam

Explanation: ***Prostate cancer*** - A **firm**, **nodular**, and non-tender prostate on digital rectal examination is highly suspicious for prostate cancer, particularly in a 51-year-old male. - The patient's presentation with **syncope** could indirectly be related to a paraneoplastic syndrome in advanced prostate cancer, although this is less common. *Prostatitis* - Prostatitis typically presents with **perineal pain**, **dysuria**, and **fever**, none of which are noted in this patient. - The prostate would usually be **tender** and boggy, not firm and nodular. *Prostate abscess* - A prostate abscess is characterized by **severe pain**, **fever**, **chills**, and urinary symptoms, which are absent in this case. - The prostate would be exquisitely **tender** and potentially fluctuant on examination. *Benign prostatic hyperplasia* - While BPH can cause urinary symptoms, it typically results in a **smooth**, enlarged, and rubbery prostate, not a firm and nodular one. - It is not associated with syncope or the specific prostate findings described. *Normal physical exam* - A **firm** and **nodular** prostate on rectal exam is an abnormal finding that warrants further investigation, especially given the patient's age. - While other findings may be normal, the prostate exam is highly concerning for pathology.

Question 8: A 65-year-old man presents to the emergency department with abdominal pain and a pulsatile abdominal mass. Further examination of the mass shows that it is an abdominal aortic aneurysm. A computed tomography scan with contrast reveals an incidental finding of a horseshoe kidney, and the surgeon is informed of this finding prior to operating on the aneurysm. Which of the following may complicate the surgical approach in this patient?

A. Anomalous origins of multiple renal arteries (Correct Answer)
B. Low glomerular filtration rate due to unilateral renal agenesis
C. Proximity of the fused kidney to the celiac artery
D. Abnormal relationship between the kidney and the superior mesenteric artery
E. There are no additional complications

Explanation: ***Anomalous origins of multiple renal arteries*** - A horseshoe kidney often receives its blood supply from **multiple renal arteries** arising anomalously from the aorta, iliac arteries, or inferior mesenteric artery. - These aberrant vessels can cross the surgical field and complicate **abdominal aortic aneurysm repair**, increasing the risk of injury and hemorrhage. *Low glomerular filtration rate due to unilateral renal agenesis* - This patient has a **horseshoe kidney**, which involves fused kidneys, not renal agenesis (absence of a kidney). - While chronic kidney disease can be associated with horseshoe kidneys, **unilateral agenesis** is a distinct condition and not described in this scenario. *Proximity of the fused kidney to the celiac artery* - The fused portion of a horseshoe kidney (the **isthmus**) typically lies anterior to the great vessels at the L3-L5 vertebral level, below the origin of the celiac artery. - Therefore, its proximity to the **celiac artery** is generally not the primary surgical concern during abdominal aortic aneurysm repair. *Abnormal relationship between the kidney and the superior mesenteric artery* - The superior mesenteric artery typically originates from the aorta above the level of the horseshoe kidney's isthmus. - While other anomalies can exist, an **abnormal relationship** between the kidney and the superior mesenteric artery is not a classic or primary complication of horseshoe kidney during AAA repair. *There are no additional complications* - The presence of a horseshoe kidney significantly increases the complexity of **abdominal aortic aneurysm** surgery. - The potential for **vascular anomalies** and altered anatomical relationships makes this statement incorrect, as there are definite additional surgical considerations.

Question 9: An 11-year-old girl is brought in to her pediatrician by her parents due to developmental concerns. The patient developed normally throughout childhood, but she has not yet menstruated and has noticed that her voice is getting deeper. The patient has no other health issues. On exam, her temperature is 98.6°F (37.0°C), blood pressure is 110/68 mmHg, pulse is 74/min, and respirations are 12/min. The patient is noted to have Tanner stage I breasts and Tanner stage II pubic hair. On pelvic exam, the patient is noted to have a blind vagina with slight clitoromegaly as well as two palpable testes. Through laboratory workup, the patient is found to have 5-alpha-reductase deficiency. Which of the following anatomic structures are correctly matched homologues between male and female genitalia?

A. Corpus spongiosum and the clitoral crura
B. Scrotum and the labia majora (Correct Answer)
C. Corpus spongiosum and the greater vestibular glands
D. Corpus cavernosum of the penis and the vestibular bulbs
E. Bulbourethral glands and the urethral/paraurethral glands

Explanation: ***Scrotum and the labia majora*** - Both the **scrotum** in males and the **labia majora** in females develop from the **labioscrotal folds**. - These structures serve to protect the underlying reproductive organs and are homologous due to their shared embryonic origin. *Corpus spongiosum and the clitoral crura* - The **corpus spongiosum** in males forms the glans penis and surrounds the urethra, while the **clitoral crura** are part of the corpus cavernosum homologues. - The clitoral crura are homologous to the penile crura (part of the corpus cavernosum), not the corpus spongiosum. *Corpus spongiosum and the greater vestibular glands* - The **corpus spongiosum** is erectile tissue, while the **greater vestibular glands** (Bartholin's glands) are secretory glands. - Greater vestibular glands are homologous to the **bulbourethral glands (Cowper's glands)** in males, which are also secretory. *Corpus cavernosum of the penis and the vestibular bulbs* - The **corpus cavernosum of the penis** is erectile tissue that forms the shaft of the penis and is homologous to the **corpus cavernosum of the clitoris (clitoral crura and body)**. - The **vestibular bulbs** are masses of erectile tissue surrounding the vaginal opening, which are homologous to the **corpus spongiosum** in males, specifically the bulb of the penis. *Bulbourethral glands and the urethral/paraurethral glands* - The **bulbourethral glands** (Cowper's glands) are exocrine glands that secrete pre-ejaculate and are homologous to the **greater vestibular glands (Bartholin's glands)** in females. - The **urethral/paraurethral glands (Skene's glands)** in females are homologous to the **prostate gland** in males.

Question 10: A 47-year-old woman comes to the physician because of involuntary leakage of urine for the past 4 months, which she has experienced when bicycling to work and when laughing. She has not had any dysuria or urinary urgency. She has 4 children that were all delivered vaginally. She is otherwise healthy and takes no medications. The muscles most likely affected by this patient's condition receive efferent innervation from which of the following structures?

A. S3–S4 nerve roots (Correct Answer)
B. Obturator nerve
C. Superior hypogastric plexus
D. Superior gluteal nerve
E. S1-S2 nerve roots

Explanation: ***S3–S4 nerve roots*** - The patient's symptoms of **involuntary urine leakage** during physical activity (**stress incontinence**) and a history of multiple vaginal deliveries strongly suggest **pelvic floor muscle weakness**. - The **levator ani muscles**, which are crucial for maintaining urinary continence, receive their primary innervation from the **pudendal nerve**, which originates from the **S2-S4 spinal nerves** (though contributions from S3-S4 are often highlighted for pelvic floor efferent innervation). *Obturator nerve* - The **obturator nerve** primarily innervates the **adductor muscles of the thigh** (e.g., adductor longus, magnus, brevis, gracilis), as well as the obturator externus muscle. - It does not significantly contribute to the innervation of the **pelvic floor muscles** responsible for urinary continence. *Superior hypogastric plexus* - The **superior hypogastric plexus** is part of the **autonomic nervous system** and primarily carries **sympathetic innervation** to the pelvic organs. - While it plays a role in bladder function (e.g., bladder relaxation and internal urethral sphincter contraction), it does not provide **somatic efferent innervation** to the skeletal muscles of the pelvic floor. *Superior gluteal nerve* - The **superior gluteal nerve** innervates the **gluteus medius**, **gluteus minimus**, and **tensor fasciae latae muscles**. - These muscles are involved in **hip abduction** and **medial rotation** and are not directly involved in maintaining urinary continence through the pelvic floor. *S1-S2 nerve roots* - While the **S1-S2 nerve roots** contribute to the innervation of various lower limb muscles and sensory pathways, their primary efferent contributions related to pelvic floor continence are not as direct as S3-S4. - The **pudendal nerve**, critical for pelvic floor muscle function, originates predominantly from **S2-S4**, with S3-S4 being particularly important for the motor components.

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