NMS Q&A Family Medicine

120 NMS Q&A Family Medicine(D) Sulfamethoxazole/trimethoprim given twicedaily for 7 days(E) Elective general surgery for repair of hernialdefect8 An 80-year-old gentleman complains of testicularpain that had its onset 3 days ago and has built sinceto prevent sleep the night before this visit. On examinationthe testicle seems on palpation to be irregularin shape and quite tender. The scrotal contents aredifficult to differentiate. The patient’s temperature is100.8 F. The urinalysis demonstrates 20 to 30 whiteblood cells/high-power field. Which of the followingis the most likely diagnosis?(A) Epididymitis(B) Testicular trauma(C) Torsion of the testicle(D) Orchitis(E) Testicular cancer9 A 34-year-old factory worker whose daily activityinvolves heavy lifting seeks advice for a growing groinmass. He first noted the swelling about 2 monthsago after lifting a 75-lb (34-kg) packet of steel rods,and now it has become apparent to him during dressingand undressing. You examine him and find ascrotal mass that transilluminates well. You diagnosean inguinal hernia. Which of the following additionalfindings renders this clinical situation anemergency?(A) Inability to reduce the hernia(B) Finding a direct rather than an indirect inguinalhernia(C) Associated testicular pain(D) Tenderness of the hernial sac(E) History of urinary tract infection10 A 25-year-old man develops an inflammatory arthritisin his left knee that has been present for 1 week.Upon questioning, he avers that he has had bloodydiarrhea that nevertheless had abated by the time ofonset of his knee pain, and he complains of blurredvision in the right eye. He denies any history oftrauma and any previous history of joint pain orswelling, and there is no family history of connectivetissue disease. On examination he exhibits some rednessof the right eye and the pupil is smaller than thatof the left eye. Which of the following is the mostlikely etiology for this problem?(A) Rheumatoid arthritis(B) Osteoarthritis(C) Reflux sympathetic dystrophy(D) Reactive arthritis(E) Systemic lupus erythematosus11 You examine a 35-year-old man who presents with apainless enlarged testicle noticed by him over the past3 months. On examination, the testicle is irregular inshape and does not transilluminate. Alpha-fetoproteinand human chorionic gonadotropin levels are withinnormal limits (i.e., barely perceptible), as is the lacticdehydrogenase level. You also note developing gynecomastia.You diagnose a testicular tumor. Which ofthe following types is it most likely to be?(A) Seminoma(B) Embryonal cell carcinoma(C) Teratocarcinoma(D) Choriocarcinoma(E) Leydig cell carcinoma12 A 25-year-old man and his 22-year-old wife are seekingconsultation to find out why they have beenunable to achieve fertility in the marriage after tryingfor pregnancy for more than 3 years. The wife’s pelvicexamination showed normal anatomy. The couplehas confirmed and timed her ovulations by a temperaturegraph over the past year and attemptedimpregnation during the period surrounding ovulation,with no success. You initiate an evaluation toinvestigate the problem. Which of the following is themost logical first step?(A) Hysterosalpingogram on the wife(B) Computed tomography scan of the brain toinvestigate for pituitary adenoma(C) Pelvic ultrasound to rule out polycystic ovarysyndrome in the wife(D) Sperm count on the husband(E) 24-hour urine collection for 5-OH ketosteroids13 Which of the following is the most common cause ofmale infertility?(A) Malnutrition(B) History of undescended testicle(C) Varicocele(D) Adrenal hyperplasia(E) Klinefelter syndrome14 A 55-year-old male patient complains of graduallyincreasing prostatism over the past 6 months. Thishas taken the form of increasing difficulty in initiatingthe urinary stream (hesitancy), decreasing size ofthe stream, and increasing nocturia. There have beentimes when his symptoms were worse than others.Each of the following statements are correct regardingthese developments except for which one?(A) One cause may be prostatic cancer.(B) The differential diagnosis includes benignprostatic hyperplasia.