Male Reproductive System — Clinical MCQs – 35 MCQs | Kenya MBChB

35 Year 3: Male Reproductive and Urinary System Pathology exam questions on Male Reproductive System — Clinical MCQs for medical students. Includes MCQs, answer

This MCQ set contains 35 questions on Male Reproductive System — Clinical MCQs in the Year 3: Male Reproductive and Urinary System Pathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: A 25-year-old man and his wife undergo an infertility workup. His wife's reproductive function is normal. On physical examination he has descended testes that appear decreased in size. A sperm count shows aspermia. A testicular biopsy is performed and on microscopic examination only Sertoli cells ar

  1. A. Increased FSH
  2. B. Increased HCG
  3. C. Increased alpha-fetoprotein
  4. D. Decreased testosterone

Correct answer: A – Increased FSH

Such a 'Sertoli cell only' syndrome is a cause for male infertility and may be idiopathic. A similar pattern would be present in a cryptorchid testis.

Q2: A 30-year-old man has had a feeling of heaviness in his left testis for the past 6 months. Physical examination reveals enlargement of the left testis, while the right testis appears normal. There is a palpable left inguinal lymph node. An ultrasound reveals a 4 cm solid mass within the body of the

  1. A. Choriocarcinoma
  2. B. Embryonal carcinoma
  3. C. Seminoma
  4. D. Yolk sac tumor

Correct answer: C – Seminoma

The most common pure form of testicular cancer is seminoma, a type of germ cell tumor which is radiosensitive. The tumor markers are not markedly elevated. This form of testicular carcinoma has the best prognosis overall, when not mixed with other elements.

Q3: A 35-year-old man goes to his physician for a routine examination. On physical examination there is a left inguinal mass. The right testis is palpated in the scrotum and is of normal size, but a left testis cannot be palpated in the scrotum. An ultrasound scan shows that there is a 2 cm solid inguin

  1. A. Put the mass into the scrotum surgically
  2. B. Remove the mass along with the opposite testis
  3. C. Remove the mass
  4. D. Put the patient on testosterone therapy

Correct answer: C – Remove the mass

A cryptorchid testis that is not treated in early childhood no longer functions in spermatogenesis and presents a risk for subsequent development of seminoma. The earlier in life that an orchiopexy is performed, generally under the age of 5, the more likely the testis will function properly. The risk of carcinoma in the descended testis is unlikely to be increased, so it can be left to function.

Q4: A 70-year-old healthy man has a routine check-up. On physical examination there is a firm nodule palpable in the prostate via digital rectal examination. A MRI scan confirms the presence and location of a posterior 0.4 cm nodule. Prostate biopsies are performed and on microscopic examination show sm

  1. A. Adenocarcinoma
  2. B. Nodular hyperplasia
  3. C. Chronic prostatitis
  4. D. Urothelial carcinoma

Correct answer: A – Adenocarcinoma

Such a nodule at that age strongly suggests carcinoma. Most carcinomas of the prostate arise in the posterior portion of the gland where they can be palpated on digital rectal examination. Microscopically, prostatic adenocarcinomas have irregular glands without intervening stroma. Large nucleoli are a characteristic microscopic feature.

Q5: An epidemiologic study is performed to determine potential risk factors for development of penile squamous intraepithelial neoplasia. It is observed that persons who develop this disease are elderly men. Which of the following diseases is most likely to be found to precede development of penile neop

  1. A. Phimosis
  2. B. Herpes simplex virus infection
  3. C. Lichen simplex chronicus
  4. D. Balanitis xerotica obliterans

Correct answer: A – Phimosis

The chronic irritation from accumulation of secretions and smegma under the prepuce is the likely risk. Circumcision reduces the risk for development of penile carcinoma, and can reduce transmission of infections as well.

Q6: A 32-year-old man reports increasing size and number of lesions in his genital region. On examination there are multiple 0.2 to 1 cm raised, smooth to rough-surfaced to verrucous pale pink plaques on the penis, scrotum, and perineum. No ulceration is observed. Which of the following organisms is mos

  1. A. Chlamydia trachomatis
  2. B. Human papillomavirus
  3. C. Klebsiella granulomatis
  4. D. Treponema pallidum

Correct answer: B – Human papillomavirus

HPV produces genital warts and cancers, but not typically ulcers.

Q7: A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife's reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However,

  1. A. Hydrocele
  2. B. Testicular torsion
  3. C. Spermatocele
  4. D. Varicocele

Correct answer: D – Varicocele

The increased warmth from the vascularity reduces sperm production. Spermatogenesis needs to occur at a temperature below that of the body as a whole, which explains why testes are in the scrotum.

Q8: A 72-year-old man gets up several times during a football match to urinate, even though he has had only one beer. This is a problem that has plagued him for 4 years. On physical examination he has a diffusely enlarged prostate. His serum PSA is 6 ng/mL. Which of the following pathologic findings is

  1. A. Adenocarcinoma
  2. B. Acute inflammation
  3. C. Multiple infarctions
  4. D. Nodular hyperplasia

Correct answer: D – Nodular hyperplasia

Benign prostatic hyperplasia (BPH) is a common finding in older men. The lateral lobes are typically involved (in contrast to carcinomas which are most often found in the posterior lobe), and the increasing prostatic urethral obstruction leads to the classic symptoms of frequency and hesitancy with urination. The PSA can be mildly elevated with hyperplasia, but the level tends not to increase sign

Q9: A 19-year-old university student notes the sudden onset of severe discomfort in his scrotum late one evening. No position is comfortable. He is brought to the emergency room. His left testis is slightly enlarged and exquisitely tender. A doppler ultrasound scan shows decreased blood flow in the left

  1. A. Choriocarcinoma
  2. B. Torsion
  3. C. Lithiasis
  4. D. Varicocele

Correct answer: B – Torsion

Testicular torsion often has a sudden onset and must be treated immediately, as lack of blood flow can lead to hemorrhagic infarction. An ultrasound can be used to help identify this condition, demonstrating lack of blood flow.

Q10: A 20-year-old man has noted a penile discharge with some pain on urination for the last 2 days. A small amount of whitish exudate can be expressed from the urethral meatus. Culture of the penile discharge reveals Neisseria gonorrheae. If untreated, which of the following complications is he most lik

  1. A. Aortitis
  2. B. Balanitis
  3. C. Epididymitis
  4. D. Orchitis

Correct answer: C – Epididymitis

When the testis is involved by gonorrhea, it is typically the epididymis. Many male gonorrheal infections are asymptomatic and not followed by significant complications. Urethritis with stricture is a possible complication.

Q11: A 31-year-old man has had a feeling of heaviness in his scrotum for over 6 months. An ultrasound reveals a solid 5 cm mass in the body of the right testis. Laboratory studies show serum AFP of 81 ng/mL and HCG of 15 IU/L. On gross examination the testicular mass is soft and reddish brown. Microscopi

  1. A. Teratoma
  2. B. Embryonal carcinoma
  3. C. Mumps orchitis
  4. D. Leydig cell tumor

Correct answer: B – Embryonal carcinoma

The embryonal carcinoma is likely to have an elevated AFP. Many malignant testicular neoplasms produce some detectable HCG, but this does not mean that choriocarcinoma is present.

Q12: A 77-year-old man has a routine check-up. The only finding is slight nodularity of his prostate on digital rectal examination. Serum PSA is 6 ng/mL. A prostate biopsy shows prostatic intraepithelial neoplasia (PIN). Which of the following is the best medical care option to offer this man?

  1. A. Radical prostatectomy
  2. B. Multiagent chemotherapy
  3. C. Transurethral prostate resection
  4. D. Monitoring PSA levels

Correct answer: D – Monitoring PSA levels

PIN is a potential precursor of prostatic adenocarcinoma, but by itself does not warrant therapy.

Q13: A 27-year-old man has complained of continuing 'jock itch' for the past year. On physical examination there are small whitish scaling patches on the skin of his perineum. A scraping shows Trichophyton rubrum organisms. Which of the following lesions is he most likely to develop?

  1. A. Condyloma acuminatum
  2. B. Chancre
  3. C. Bowen disease
  4. D. Angiokeratoma

Correct answer: D – Angiokeratoma

The chronic rubbing and scratching from this dermatophyte infection can result in epidermal hyperplasia and chronic inflammation.

Q14: A subset of sexually active 30–45-year-old men are found to have a history of pelvic pain with enlarged, tender prostates on digital rectal examination. However, routine microbiologic cultures from prostatic secretions show no growth. Which of the following infectious agents is most likely to produc

  1. A. Human papillomavirus
  2. B. Herpes simplex virus
  3. C. Chlamydia trachomatis
  4. D. Human immunodeficiency virus

Correct answer: C – Chlamydia trachomatis

C. trachomatis, the leading cause of non-gonococcal urethritis, is the most frequent form of prostatitis in young adult men. There is typically no history of chronic urinary tract infection.

Q15: A 30-year-old sexually active man has experienced burning pain with urination for the past 5 days. There is a profuse yellowish urethral discharge. He is afebrile and is treated with ceftriaxone. He is most likely to be infected with which of the following organisms?

  1. A. Herpes simplex virus
  2. B. Treponema pallidum
  3. C. Neisseria gonorrheae
  4. D. Mumps virus

Correct answer: C – Neisseria gonorrheae

Gonorrhea is a common cause of urethritis in males. Culture of the purulent discharge is possible, but microbial culture of this fastidious organism is challenging, so molecular methods such as a DNA probe or PCR can be used for diagnosis.

Q16: A term male infant is born with incomplete development of the dorsal aspect of the penile urethra, with the defect extending to the bladder, which is open onto the lower abdominal wall. Which of the following is the most likely diagnosis?

  1. A. Hypospadias
  2. B. Bowen disease
  3. C. Balanoposthitis
  4. D. Epispadias

Correct answer: D – Epispadias

Epispadias is a rare congenital anomaly that may be mild or, as in this case, severe with a large open defect that must be repaired. The failure to close the bladder is termed exstrophy.

Q17: A 35-year-old healthy man desires a permanent form of contraception and has a vasectomy performed with no complications. Which of the following is most likely to result from prior vasectomy?

  1. A. Varicocele
  2. B. Orchitis
  3. C. Hydrocele
  4. D. Testicular torsion

Correct answer: D – Testicular torsion

Also called vasitis nodosa, a sperm granuloma results from a foreign body granulomatous reaction to extravasated sperm at the vasectomy site. The granulomatous reaction is typically not florid.

Q18: A study documents testicular abnormalities in adult males with infertility, some having a patchy pattern of atrophy of testicular tubules. Which of the following infections is most likely to produce these findings?

  1. A. Mumps virus
  2. B. Chlamydia trachomatis
  3. C. Neisseria gonorrheae
  4. D. Human papillomavirus

Correct answer: A – Mumps virus

This is a very common childhood infection (when vaccinations are not done) resulting in orchitis as well as parotitis. The inflammation rarely causes enough damage to produce a significantly reduced sperm count if acquired in childhood. The virus tends to produce more testicular damage when adults are infected.

Q19: A 21-year-old sexually active man is notified that his last sexual contact 3 weeks prior has a positive serologic test for syphilis. Which of the following findings is most likely to be indicative of his acquisition of this infection?

  1. A. Positive VDRL in the CSF
  2. B. Testicular gumma on biopsy
  3. C. Mucocutaneous rash
  4. D. Penile chancre

Correct answer: D – Penile chancre

This would be the typical finding for primary syphilis from recent infection by Treponema pallidum.

Q20: A 40-year-old man has noted gradual enlargement of his scrotum, more on the right side, for the past 2 years. There is no pain. The right side is enlarged to three times the size of the left testis. This mass transilluminates. Ultrasound reveals a 5 cm thin-walled cystic fluid-filled area. Which of

  1. A. Seminoma
  2. B. Torsion
  3. C. Hydrocele
  4. D. Varicocele

Correct answer: C – Hydrocele

A hydrocele is a fluid-filled sac that gradually enlarges. It represents fluid collection between the parietal and visceral layers of the tunica vaginalis. If congenital, it is the result of failure of the processus vaginalis to obliterate.

Q21: A healthy 17-year-old circumcised adolescent has pearly penile papules noted at the edge of the glans penis. There is no erythema or urethral discharge. He is not sexually active. Which of the following is the most likely diagnosis?

  1. A. Bowen disease
  2. B. Human papillomavirus infection
  3. C. Normal variation
  4. D. Balanitis with Staphylococcus aureus

Correct answer: C – Normal variation

This is really a normal variation, but some patients may be concerned when they notice that other men do not have them.

Q22: A 55-year-old man has experienced pain with urination for the past week. His prostate is slightly enlarged and mildly tender. Temperature is 37.5°C. WBC count is 12,910/microliter. Urine culture grows 100,000/mL E. coli. Serum PSA is 7 ng/mL. He improves with antibiotics but the condition recurs 5 t

  1. A. Chronic bacterial prostatitis
  2. B. Prostatic adenocarcinoma
  3. C. Nodular prostatic hyperplasia
  4. D. Urothelial carcinoma

Correct answer: A – Chronic bacterial prostatitis

Chronic bacterial prostatitis should be considered in men who have a history of recurrent bacteriuria. A chronically infected prostate can serve as the source of pathogens for recurrent UTIs. E. coli is a typical organism associated with urinary tract infection. The PSA can be slightly elevated with prostatic inflammation.

Q23: A 95-year-old man has had difficulty with urination for the past 15 years. His prostate is diffusely enlarged. A transurethral resection shows glandular hyperplasia and a focus of grade 1,2 adenocarcinoma. Which of the following is the next most appropriate treatment plan?

  1. A. Chemotherapy
  2. B. Alpha blocker therapy
  3. C. Radiotherapy
  4. D. Anti-androgen therapy

Correct answer: D – Anti-androgen therapy

A Gleason 1,2 adenocarcinoma is so low grade that it is unlikely to progress. At least half of men his age probably have a focus of prostatic adenocarcinoma.

Q24: A group of subjects is found to have Chlamydia trachomatis infection. Which of the following laboratory methods is most likely to be useful in diagnosis of C. trachomatis?

  1. A. Darkfield microscopic examination of exudate or secretions
  2. B. Cytologic smear
  3. C. Tissue biopsy
  4. D. Enzyme immunoassay

Correct answer: D – Enzyme immunoassay

This is the easiest and most cost-effective method, since C. trachomatis cannot be easily cultured by routine methods.

Q25: A term male infant has an abnormal opening of the urethra onto the ventral surface of the penis for a distance of 0.3 cm. Which of the following is the most likely diagnosis?

  1. A. Hypospadias
  2. B. Exstrophy
  3. C. Phimosis
  4. D. Epispadias

Correct answer: A – Hypospadias

This is a congenital anomaly. Infection is a common complication, and partial urethral stricture may lead to urinary tract obstruction.

View on OmpathStudy