A 7-month-old boy is brought to the physician for a well-child examination. He was born at 36 weeks' gestation and has been healthy since. He is at the 60th percentile for length and weight. Vital signs are within normal limits. The abdomen is soft and nontender. The external genitalia appear normal. Examination shows a single palpable testicle in the right hemiscrotum. The scrotum is nontender and not enlarged. There is a palpable mass in the left inguinal canal. Which of the following is the most appropriate next best step in management?
AOrchidopexy
BGonadotropin therapy
CExploration under anesthesia
DReassurance
ESerum testosterone level
A 6-month-old boy is brought to the physician because of a right-sided scrotal swelling for the past 2 months. The swelling is intermittent and appears usually after the patient has been taken outdoors in a baby carrier, and disappears the next morning. The patient was born at term without complications and has been healthy. Examination shows a 3-cm, soft, nontender, and fluctuant right scrotal mass that is reducible and does not extend into the inguinal area. A light held behind the scrotum shines through. There are no bowel sounds in the mass. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the management of this patient?
AReassurance and follow-up
BPercutaneous drainage
CLigation of the patent processus vaginalis
DBilateral orchidopexy
ESurgical excision of the mass
At postpartum physical examination, a newborn is found to have male external genitalia. Scrotal examination shows a single palpable testicle in the right hemiscrotum. Ultrasound of the abdomen and pelvis shows an undescended left testis, seminal vesicles, uterus, and fallopian tubes. Chromosomal analysis shows a 46, XY karyotype. Which of the following sets of changes is most likely to be found in this newborn? Legend: Normal = normal levels, ↑ = increased levels, ↓ = decreased levels SRY-gene activity | Müllerian inhibitory factor (MIF) | Testosterone | Dihydrotestosterone (DHT)
ANormal normal normal ↓
B↓ ↓ ↓ ↓
CNormal ↓ normal normal
D↓ ↓ normal normal
ENormal normal ↑ ↑
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