A 30-year-old man presents with a left-sided, painless testicular lump. He has a history of orchidopexy for an undescended testicle.
On examination, there is a firm lump lying in the body of the left testicle. His body mass index is 27. There are a few left-sided inguinal lymph nodes palpable. You suspect testicular cancer.
Which of the following findings on history and examination makes this provisional diagnosis more likely?
A 63-year-old man reported experiencing trouble initiating and ending urination. He had no prior history of urinary issues. The physician used a gloved index finger to examine the patient’s prostate gland, most likely by palpating it through the wall of which of the following structures?
A 40-year-old man presents with blood in his ejaculate. He reports no lower urinary tract symptoms and no abdominal pain and is generally healthy. He has been in a long-term monogamous relationship and denies any history of trauma. Examination of his scrotum and penis is unremarkable, and his prostate is normal and non-tender upon digital rectal examination. Urinalysis results are within normal limits, and there is no family history of cancer.
What is the most appropriate next step, in addition to obtaining a urine sample for microscopy, culture, and sensitivities?
A 68-year-old man tells his general practitioner that, for the past two months, he has been passing urine more often than usual and getting up at night to urinate. Given the man’s age, you suspect he might have symptoms related to an enlarged prostate.
Which of the following should be done first to confirm the first impression?
A 30-year-old woman presents to the Emergency Department with acute abdominal pain which started about six hours ago. She claims the pain is in the lower abdomen and has been worsening gradually. She has not been able to pass urine since before the pain started.
Upon examination, vital signs are stable and suprapubic tenderness is present. There is no rebound tenderness, and the examining doctor does not find any signs of peritonitis. In addition, the doctor finds a large solid abdominal mass in the right lower quadrant. The patient said this mass had been there for a few years and has made it difficult to get pregnant. The patient also claims that she has heavy periods. She is due to have an operation for it in two months. A serum pregnancy test is negative.
Which of the following is the most likely diagnosis requiring immediate treatment and admission?
A 30-year-old woman with a history of Crohn’s disease comes in for evaluation due to left flank pain indicative of renal colic. During the physical examination, a significant midline abdominal scar is observed, which is consistent with a previous small bowel resection. An abdominal X-ray without contrast shows several kidney stones.
What kind of kidney stones are most likely present in this scenario?
A 22-year-old man discovered a painless enlargement of his left testicle during his shower. He is sexually active, but he reports no recent sexual encounters. What would be the most suitable serological test to assist in diagnosing his condition?
A 55-year-old man has been experiencing pain with urination for the past week. His temperature is 37.5 °C. On digital rectal examination, his prostate is slightly enlarged and mildly tender to palpation. Laboratory studies show his white blood cell count to be 13 000 mL. Urine culture grows > 100 000 Escherichia coli organisms. His serum prostate-specific antigen (PSA) is 6 ng/ml (normal < 5ng/ml). He receives antibiotic therapy and his clinical condition initially improves. However, his symptoms recur six times over the next 12 months.
What is the most likely diagnosis for this patient?
A 42-year-old man presents to his General Practitioner with a 6-month history of erectile dysfunction. He also reports that he has noticed galactorrhoea and is experiencing headaches, usually upon waking in the morning. He has no significant past medical history. His blood test results are as follows:
Investigation(s) Result Normal range
Haemoglobin (Hb) 142 g/l 130–180 g/l
White cell count (WCC) 5.0 × 109/l 3.5–11 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.3 mmol/l
Thyroid-stimulating hormone (TSH) 3.8 mU/l 0.27-4.2 mU/l
Prolactin 5234 mU/l 86-324 mU/l
Which of the following further investigations should be requested?
A 70-year-old man with a history of hypertension presents to his general practitioner after discovering a mass in his scrotum. He reported feeling a heavy, dragging sensation in his scrotum for approximately 2 weeks before noticing the mass during self-examination. Upon examination, the patient had a palpable, non-tender mass on the right side of the scrotum, seemingly associated with the right testicle. Ultrasound of the scrotum revealed dilation of the right pampiniform plexus.
What is the most probable cause of this patient’s condition?