A 31-Year-Old Man Comes to the Physician Because of Right

question 619

Multiple Choice

A 31-year-old man comes to the physician because of right testicular swelling for the past one week.  He recalls trauma to the perineum and testes when he fell from a bike one month ago.  He is otherwise healthy and has no other complaints.  His past medical history is unremarkable.  He admits to several unprotected sexual encounters in the past.  He smokes marijuana occasionally but does not smoke tobacco.  He denies any intravenous drug use.
On physical examination, a non-tender right testicular mass is palpated.  Scrotal ultrasound shows a well-defined 2 x 1.5 cm hypoechoic lesion without cystic components in the right testis.  His HIV test is negative.  Serum alpha-fetoprotein and β-hCG levels are normal.  CT scan of the abdomen and pelvis do not reveal any lymphadenopathy.
Which of the following is the best next step in managing this patient?

• A)Fine needle aspiration
• B)Incisional biopsy
• C)Radical inguinal orchiectomy
• D)Repeat ultrasound in 4-6 weeks
• E)Trial of antibiotic therapy

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Definitions:

Polyploidy

The condition of having more than two complete sets of chromosomes, common in plants and some animal species, leading to variation and sometimes increased size or vigor.

Plants

Plants are multicellular, predominantly photosynthetic eukaryotes of the kingdom Plantae, characterized by their ability to produce their own food through photosynthesis and their unique cell structures.

Fungi

A kingdom of heterotrophic organisms that includes yeasts, molds, and mushrooms, characterized by their chitin cell walls and absorptive nutrition.

Primates

An order of mammals that includes humans, apes, monkeys, and related species, characterized by large brains, forward-facing eyes, and opposable thumbs.