Practice questions answers Male reproductive system I
Practice questions answers
Male reproductive system I
© Jun Wang, MD, PhD
1. E. Screening test
for syphilis
has been recommended for all sexually active patients with genital ulcers,
especially painless hard ulcers. These screening tests including rapid plasma reagin
and venereal disease research laboratory (VDRL). Fluorescent treponemal
antibody absorption and treponema pallidum hemagglutination assay are confirmation
tests, performed after the screening tests are positive. Culture and gram stain
for ulcer debris may growth various bacteria, but not treponema pallidum, the
microorganism causing syphilis.
Human papilloma virus is associated with condyloma
and many penile
squamous neoplasia, but not syphilis.
2. B. See discussion
in question 1.
3. E. Treponema
pallidum causes syphilis.
Chlamydia trachomatis is the most common sexually transmitted infection, and is
associated with various conditions, including lymphogranuloma
venereum and pelvic
inflammatory disease. Human herpes virus causes herpes.
Human papilloma virus is associated with condyloma
and many penile
squamous neoplasia. Klebsiella granulomatis causes granuloma
inguinale.
4. C. Syphilitic
chancre is characterized by diffuse plasma cell infiltrate and spirochetes
identified by silver stain. Atypical squamous cells with malignant appearance is
seen in squamous dysplasia, including penile
squamous neoplasia and cervical
intraepithelial neoplasia. Diffuse neutrophilic infiltration is seen in
many acute inflammations, including herpes.
Granulomatous changes may be seen in granuloma
inguinale. Irregular nests and cords of markedly atypical squamous cells is
characteristic for squamous
cell carcinoma, regardless of the location.
5. A. Non-syphilitic
ulcer of genital area with positive culture of Gram-negative rod in chains is
most compatible with chancroid.
Condyloma
has papillary growth and koilocytic
changes. Granuloma
inguinale is caused by Klebsiella granulomatis and characterized by painless
nodule and ulcer with Donovan
bodies (large intracytoplasmic encapsulated bipolar bodies). Herpes
has multinucleated cells with margining of chromatin and nuclear molding. Lymphogranuloma
venereum is caused by chlamydia trachomatis, and characterized by painless papule or ulcer at inoculation site
appears and rapidly disappears; followed later by enlarged
inguinal lymph nodes with suppurative
granulomatous changes, with focal necrosis (stellate abscesses).
6. A. Chancroid
is caused by Gram-negative rod haemophilus ducreyi. Human herpes virus causes herpes.
Human papilloma virus is associated with condyloma
and many penile
squamous neoplasia. Klebsiella granulomatis causes granuloma
inguinale. Treponema pallidum causes syphilis.
7. C. Clusters of
small painful ulcer with multinucleated cells containing molding nuclei and margining
chromatin are most likely herpes.
Chancroid
has painful non-syphilitic ulcer of genital area with positive culture of
Gram-negative rod in chains. Granuloma
inguinale is caused by Klebsiella granulomatis and characterized by painless
nodule and ulcer with Donovan
bodies (large intracytoplasmic encapsulated bipolar bodies). Lymphogranuloma
venereum is caused by chlamydia trachomatis, and characterized by painless papule or ulcer at inoculation site
appears and rapidly disappears; followed later by enlarged
inguinal lymph nodes with suppurative
granulomatous changes, with focal necrosis (stellate abscesses). Syphilitic
chancre is characterized by diffuse plasma cell infiltrate and spirochetes
identified by silver stain.
8. B. See discussion
of question 6.
9. B. See discussion
of question 7.
10. D. See
discussion of question 6.
11. C. See
discussion of question 7.
12. A. See
discussion of question 7.
13. B. Papillary
growth with koilocytic
changes is characteristic for condyloma.
Bowen’s
disease is squamous cell carcinoma in situ. It has full thickness squamous
dysplasia. Molluscum
contagiosum is caused by molluscum contagiosum virus, and is characterized
by pruritic red skin nodules. Microscopically it has invagination of epidermis
containing eosinophilic viral inclusion. Phimosis
is characterized by foreskin fibrosis and non specific inflammation. Squamous
cell carcinoma has irregular nests and cords of markedly atypical cells
with squamous differentiation, such as intercellular
bridges and squamous pearls.
14. C. See
discussion of questions 6 and 13.
15. B. Bowen’s
disease is squamous cell carcinoma in situ. It has full thickness squamous
dysplasia. Balanoposthitis
is a nonspecific inflammation of glans and foreskin. Chancroid
has painful non-syphilitic ulcer of genital area with positive culture of
Gram-negative rod in chains. Condyloma
has papillary growth and koilocytic
changes. Syphilitic
chancre is characterized by diffuse plasma cell infiltrate and spirochetes
identified by silver stain.
16. C. See
discussion of question 6. Candida is the most common cause of balanoposthitis.
17. E. Irregular
nests and cords of markedly atypical squamous cells is characteristic for squamous
cell carcinoma, regardless of the location. Bowen’s
disease is squamous cell carcinoma in situ. It has full thickness squamous
dysplasia but no invasion. Condyloma
has papillary growth and koilocytic
changes, but not markedly atypia nor invasion. Granuloma
inguinale is caused by Klebsiella granulomatis and characterized by painless nodule and ulcer with Donovan
bodies. Syphilitic
chancre is characterized by diffuse plasma cell infiltrate and spirochetes
identified by silver stain.
18. B. HPV
associated carcinogenesis involves degradation
of p53 and inactivation of Rb1. It usually has overexpression of p16. Over
expression of Her2 and PTEN can be seen in certain malignancies, including breast
cancer and endometroid adenocarcinoma of endometrium
and ovary,
but not squamous cell carcinoma.
19. D. Squamous
dysplasia involving mid third of the epithelium is PeIN
II. This is the same grading system used in cervical
intraepithelial neoplasia. Bowen’s
disease is squamous cell carcinoma in situ, or equivalent to PeIN III. Condyloma
has papillary growth and koilocytic
changes, but usually the dysplasia, if present, is limited to lower
third, or equivalent to PeIN I. Squamous
cell carcinoma has irregular nests and cords of markedly atypical cells
with squamous differentiation, such as intercellular
bridges and squamous pearls.
20. Bowenoid
papulosis is a full thick dysplasia but the severity is less than Bowen’s
disease. It is more common in young population, while the later is seen in
older population. Condyloma
has papillary growth and koilocytic
changes, but usually the dysplasia, if present, is limited to lower
third. Squamous
cell carcinoma has irregular nests and cords of markedly atypical cells
with squamous differentiation, such as intercellular
bridges and squamous pearls. Verrucous
carcinoma is an extremely well differentiated squamous
cell carcinoma with pushing border of invasion. It is usually NOT
associated with HPV.
21. E. See
discussion of question 20.
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