Practice questions Male reproductive system I

Practice questions I

Male reproductive system

© Jun Wang, MD, PhD

1. Use this case for next four questions. A 28-year-old man presents with a hard painless ulcer at his glans for 2 weeks. He is sexually active with multiple sexual partners. He is HIV negative and past medical history is unremarkable. Physical examination reveals a 1.5 cm discrete, nontender superficial ulcer at the base of his glans. His routine laboratory tests are within normal range. What is the proper test like to lead to diagnosis?

A. Culture of ulcer debris

B. Fluorescent treponemal antibody absorption

C. Gram stain for ulcer debris

D. PCR for human papilloma virus

E. Rapid plasma reagin

2. A 28-year-old man presents with a hard painless ulcer at his glans for 2 weeks. He is sexually active with with multiple sexual partners. He is HIV negative and past medical history is unremarkable. Physical examination reveals a 1.5 cm discrete, nontender superficial ulcer at the base of his glans s. His routine laboratory tests are within normal range.

Rapid plasma reagin test is positive. What is the proper test like to lead to diagnosis?

A. Culture of ulcer debris

B. Fluorescent treponemal antibody absorption

C. Gram stain for ulcer debris

D. PCR for human papilloma virus

E. Rapid plasma reagin

3. A 28-year-old man presents with a hard painless ulcer at his glans for 2 weeks. He is sexually active with with multiple sexual partners. He is HIV negative and past medical history is unremarkable. Physical examination reveals a 1.5 cm discrete, nontender superficial ulcer at the base of his glans s. His routine laboratory tests are within normal range. Rapid plasma reagin test and fluorescent treponemal tests are positive. What is associated with his penile ulcer?

A. Chlamydia trachomatis

B. Human herpes virus

C. Human papilloma virus

D. Klebsiella granulomatis

E. Treponema pallidum

4. A 28-year-old man presents with a hard painless ulcer at his glans for 2 weeks. He is sexually active with with multiple sexual partners. He is HIV negative and past medical history is unremarkable. Physical examination reveals a 1.5 cm discrete, nontender superficial ulcer at the base of his glans s. His routine laboratory tests are within normal range. Rapid plasma reagin test and fluorescent treponemal tests are positive. What is most likely the histologic features of his penile ulcer?

A. Atypical squamous with enlarged hyperchromic irregular nuclei and perinuclear halo

B. Diffuse neutrophilic infiltration

C. Diffuse plasma cell infiltratioin

D. Granulomatous changes

E. Irregular nests and cords of markedly atypical squamous cells in stroma

5. Use this case for next two questions. A 31-year-old man presents with a painful penile ulcer for 1 week. He is sexually active with multiple partners and solicited prostitute during his recent trip to southeast Asia. He is HIV negative and his past medical history is unremarkable. Physical examination reveals a 0.5 cm irregular ulcer at ventral side of his penis. A few slightly enlarged lymph nodes are noted at the left inguinal area. His routine laboratory tests are within normal range. Rapid plasma reagin test is negative. Culture of the ulcer debris reveals growth of Gram negative rods in chains. What is the diagnosis?

A. Chancroid

B. Condyloma

C. Granuloma inguinale

D. Herpes

E. Lymphogranuloma venereum

6. A 31-year-old man presents with a painful penile ulcer for 1 week. He is sexually active with multiple partners and solicited prostitute during his recent trip to southeast Asia. He is HIV negative and his past medical history is unremarkable. Physical examination reveals a 0.5 cm irregular ulcer at ventral side of his penis. A few slightly enlarged lymph nodes are noted at the left inguinal area. His routine laboratory tests are within normal range. Rapid plasma reagin test is negative. Culture of the ulcer debris reveals growth of Gram negative rods in chains. What is the cause of his condition?

A. Haemophilus ducreyi

B. Human herpes virus

C. Human papilloma virus

D. Klebsiella granulomatis

E. Treponema pallidum

7. Use this case for next two questions. A 21-year-old man presents with painful penile ulcer for a week. He is sexually active with multiple partners. His past medical history is unremarkable and he is HIV negative. Physical examination reveals clusters of small crusted ulcers. A few slightly enlarged non-tender inguinal lymph nodes are noted bilaterally. Smear of the ulcers reveal multinucleated cells with darker peripheral stain and ground glass appearance at the center of the nuclei. Diffuse neutrophilic infiltration is seen in the background. What is the diagnosis?

A. Chancroid

B. Granuloma inguinale

C. Herpes

D. Lymphogranuloma venereum

E. Syphilitic chancre

8. A 21-year-old man presents with painful penile ulcer for a week. He is sexually active with multiple partners. His past medical history is unremarkable and he is HIV negative. Physical examination reveals clusters of small crusted ulcers. A few slightly enlarged non-tender inguinal lymph nodes are noted bilaterally. Smear of the ulcers reveal multinucleated cells with darker peripheral stain and ground glass appearance at the center of the nuclei. Diffuse neutrophilic infiltration is seen in the background. What is associated with these findings?

A. Haemophilus ducreyi

B. Human herpes virus

C. Human papilloma virus

D. Klebsiella granulomatis

E. Treponema pallidum

9. Use this case for next two questions. A 45-year-old sexually active man presents with painless ulcers at his genital area. His past medical history is unremarkable, and he is HIV negative. He has solicited prostitutes during a trip abroad 2 months ago. Physical examination reveals multiple red non tender round ulcers on his penile shaft and scrotum. No lymphadenopathy is noted. Rapid plasma reagin test is negative. Biopsy of the ulcers reveal diffuse neutrophilic and plasma cell infiltrate. Large mononuclear cells with intracellular encapsulated bipolar bodies are noted. No significant atypia is seen. What is the most likely diagnosis?

A. Chancroid

B. Granuloma inguinale

C. Herpes

D. Lymphogranuloma venereum

E. Syphilitic chancre

10. A 45-year-old sexually active man presents with painless ulcers at his genital area. His past medical history is unremarkable, and he is HIV negative. He has solicited prostitutes during a trip abroad 2 months ago. Physical examination reveals multiple red non tender round ulcers on his penile shaft and scrotum. No lymphadenopathy is noted. Rapid plasma reagin test is negative. Biopsy of the ulcers reveal diffuse neutrophilic and plasma cell infiltrate. Large mononuclear cells with intracellular encapsulated bipolar bodies are noted. No significant atypia is seen.

What is associated with these findings?

A. Haemophilus ducreyi

B. Human herpes virus

C. Human papilloma virus

D. Klebsiella granulomatis

E. Treponema pallidum

11. Use this case for next two questions. A 49-year-old man presents with painless penile ulcer with enlarged bilateral inguinal lymph nodes for 2 days. The ulcer started as a nodule a week ago, and gradually enlarged and ulcerated. He is HIV positive for 10 years and is currently receiving highly active antiretroviral therapy. He is sexually active with multiple partners. He has follicular lymphoma three years ago that was treated with chemotherapy. Physical examination reveals a 1.5 cm ulcer at foreskin with inflammation in surrounding tissues. Bilateral inguinal lymphadenopathy is noted. His routine laboratory test results are within normal range. Rapid plasma reagin test is negative. Biopsy of the inguinal lymph nodes reveals diffuse necrosis, acute inflammation and granulomatous changes. Flow cytometry studies reveal no evidence of monoclonal lymphocytic proliferation. What is the most likely diagnosis?

A. Chancroid

B. Granuloma inguinale

C. Lymphogranuloma venereum

D. Recurrent follicular lymphoma

E. Syphilitic chancre

12. A 49-year-old man presents with painless penile ulcer with enlarged bilateral inguinal lymph nodes for 2 days. The ulcer started as a nodule a week ago, and gradually enlarged and ulcerated. He is HIV positive for 10 years and is currently receiving highly active antiretroviral therapy. He is sexually active with multiple partners. He has follicular lymphoma three years ago that was treated with chemotherapy. Physical examination reveals a 1.5 cm ulcer at foreskin with inflammation in surrounding tissues. Bilateral inguinal lymphadenopathy is noted. His routine laboratory test results are within normal range. Rapid plasma reagin test is negative. Biopsy of the inguinal lymph nodes reveals diffuse necrosis, acute inflammation and granulomatous changes. Flow cytometry studies reveal no evidence of monoclonal lymphocytic proliferation. What is associated with these findings?

A. Chlamydia trachomatis

B. Haemophilus ducreyi

C. Human herpes virus

D. Klebsiella granulomatis

E. Treponema pallidum

13. Use this case for next two questions. A 29-year-old man presents with a few small growth on his foreskin for 3 months. His past medical history is unremarkable. He is sexually active with multiple partner. Physical examination reveals a few small polypoid growth with cauliflower like surface, up to 0.3 cm in greatest dimension, on his foreskin. No other abnormalities are noted. Biopsy reveal finger like growth containing a fibrovascular core, covered by squamous epithelium. Some squamous cells have slightly enlarged hyperchromic irregular nuclei and perinuclear clear spaces. All squamous cells beyond basal layer have abundant cytoplasm. What is the diagnosis?

A. Bowen’s disease

B. Condyloma

C. Molluscum contagiosum

D. Phimosis

E. Squamous cell carcinoma

14. A 29-year-old man presents with a few small growth on his foreskin for 3 months. His past medical history is unremarkable. He is sexually active with multiple partner. Physical examination reveals a few small polypoid growth with cauliflower like surface, up to 0.3 cm in greatest dimension, on his foreskin. No other abnormalities are noted. Biopsy reveal finger like growth containing a fibrovascular core, covered by squamous epithelium. Some squamous cells have slightly enlarged hyperchromic irregular nuclei and perinuclear clear spaces. All squamous cells beyond basal layer have abundant cytoplasm. What is associated with these findings?

A. Haemophilus ducreyi

B. Human herpes virus

C. Human papilloma virus

D. Molluscum contagiosum virus

E. Treponema pallidum

15. Use this case for next two questions. A 69-year-old man presents with an irregular erymethematous lesion at his foreskin for 3 months. The lesion does not cause any symptoms. He tried over counter antifungal creams and no changes are seen. His past medical history is unremarkable. Physical examination reveals a 0.7 cm slightly raised plaques with scales at the dorsal side of his foreskin. Biopsy of the lesion reveal squamous epithelium composed of cells with enlarged hyperchromic irregular nuclei, less than normal cytoplasm, with variable sizes of nuclei. These changes are seen in full thickness of the epithelium, with mitosis are seen in upper layers. There is no evidence of invasion. What is the diagnosis?

A. Balanoposthitis

B. Bowen’s disease

C. Chancroid

D. Condyloma

E. Syphilitic chancre

16. A 69-year-old man presents with an irregular erymethematous lesion at his foreskin for 3 months. The lesion does not cause any symptoms. He tried over counter antifungal creams and no changes are seen. His past medical history is unremarkable. Physical examination reveals a 0.7 cm slightly raised plaques with scales at the dorsal side of his foreskin. Biopsy of the lesion reveal squamous epithelium composed of cells with enlarged hyperchromic irregular nuclei, less than normal cytoplasm, with variable sizes of nuclei. These changes are seen in full thickness of the epithelium, with mitosis are seen in upper layers. There is no evidence of invasion. What is likely associated with these findings?

A. Candida

B. Human herpes virus

C. Human papilloma virus

D. Klebsiella granulomatis

E. Treponema pallidum

17. Use this case for next two questions. A 51-year-old man presents with a painful ulcer at his glans for 6 months. His past medical history is unremarkable. Physical examination reveals a 2.5 cm firm ulcerated mass at the dorsal side of his glans. A few enlarged lymph nodes are noted at his left inguinal area. Biopsy of the ulcer reveals irregular cords and nests of markedly atypical cells within fibrous stroma. These cells have abundant cytoplasm and pleomorphic nuclei. Intercellular bridges and squamous pearls are seen. Diffuse neutrophilic and lymphoplasmacytic infiltrate is seen in the background. What is the diagnosis?

A. Bowen’s disease

B. Condyloma

C. Granuloma inguinale

D. Syphilitic chancre

E. Squamous cell carcinoma

18. A 51-year-old man presents with a painful ulcer at his glans for 6 months. His past medical history is unremarkable. Physical examination reveals a 2.5 cm firm ulcerated mass at the dorsal side of his glans. A few enlarged lymph nodes are noted at his left inguinal area. Biopsy of the ulcer reveals irregular cords and nests of markedly atypical cells within fibrous stroma. These cells have abundant cytoplasm and pleomorphic nuclei. Intercellular bridges and squamous pearls are seen. Diffuse neutrophilic and lymphoplasmacytic infiltrate is seen in the background. Abnormalities of what intracellular signaling factor is likely associated with these findings?

A. Degradation of p16

B. Degradation of p53

C. Over expression of Rb

D. Over expression of Her2

E. Over expression of PTEN

19. A 27-year-old man presents with a slowly growing lesion at his foreskin. His past medical history is unremarkable. He is sexually active with multiple partners. Physical examination reveals a 0.5 cm pink polypoid growth with cauliflower like growth. No other abnormalities are seen. Laboratory tests are within normal range. Rapid plasma reagin test is negative. Biopsy of the lesion reveal finger like projects with fibrovascular core and squamous covering. Majority of the squamous cells in basal and mid layer have enlarged hyperchromic nuclei and reduced cytoplasm, while the cells in upper third have abundant cytoplasm. No invasion is seen. Immunohistochemistry studies reveal diffuse reactivity to p16. What is the diagnosis?

A. Bowen’s disease

B. Bowenoid papulosis

C. Condyloma

D. Penile intraepithelial neoplasia II

E. Squamous cell carcinoma

20. A 29-year-old man presents with pruritic lesion at his glans for 3 months. His past medical history is unremarkable. He is sexually active with multiple partners. Physical examination reveals a 1.5 cm slightly erythematous papule at the ventral side of his glans. No other abnormality is seen. Biopsy reveal squamous mucosa with thickened epithelium. The squamous cells have moderately enlarged hyperchromic nuclei with moderate amount of cytoplasm involving full thickness of epithelium. Maturation is seen. There is no evidence of invasion. What is most likely the diagnosis?

A. Bowen’s disease

B. Bowenoid papulosis

C. Condyloma

D. Squamous cell carcinoma

E. Verrucous carcinoma

21. A 55-year-old man presents with a slowly growing painless mass at his glans for 4 months. He has a history phimosis. Physical examination reveals a 2.5 cm firm warty mass at the left side of his glans. No other abnormality is seen. Biopsy of the lesion reveals thickened squamous epithelium with mild cytological atypia. The growth has pushing border of invasion. Immunohistochemistry studies reveal negative p16 reactivity. What is the diagnosis?

A. Bowen’s disease

B. Bowenoid papulosis

C. Condyloma

D. Squamous cell carcinoma, not otherwise specified

E. Verrucous carcinoma

Answers

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