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A 34-Year-Old Man Comes to the Office Due to a Persistent

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A 34-year-old man comes to the office due to a persistent, painful erection for 12 hours without sexual stimulation.  He has had no trauma to the perineal region.  Over the past few months, the patient has also had fatigue.  He has no prior medical conditions and takes no medications.  Family history is significant for stroke in his father and hypothyroidism in his mother.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.8 C (98.2 F) , blood pressure is 120/78 mm Hg, and pulse is 100/min.  There is no lymphadenopathy.  Cardiopulmonary examination is normal.  The liver and spleen are palpable.  The penis is erect, is tender, and has venous engorgement.  The remainder of the examination shows no abnormalities.  The patient is given appropriate treatment, with reduction of symptoms.  Which of the following is the most appropriate diagnostic test to identify the cause of this patient's symptoms?


Definitions:

Substances

Materials or items with distinct physical or chemical properties.

Cytoplasm

The gel-like substance within a cell, excluding the nucleus, that contains organelles and is the site of numerous metabolic reactions.

Nucleus

A central and most important part of an object, movement, or group, forming the basis for its activity and growth, or in a biological context, the membrane-bound organelle found in eukaryotic cells that contains most of the cell's genetic material.

Nuclear Membrane

The double-layered membrane that encloses the nucleus of a eukaryotic cell, controlling the flow of substances in and out of the nucleus.

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