A 30-Year-Old Man Comes to the Emergency Department Due to Scrotal

question 147

Multiple Choice

A 30-year-old man comes to the emergency department due to scrotal pain.  The patient initially felt a sharp pain along his right groin yesterday morning after lifting weights.  He tried resting and taking a warm bath, which initially improved his symptoms, but as the day progressed, the pain returned and was accompanied by nausea.  The patient took a few doses of ibuprofen, but it did not help.  The pain progressively worsened overnight; when the patient woke up this morning, he had difficulty walking and has vomited twice.  Medical history includes an umbilical hernia that was surgically repaired at age 2.  The patient takes no daily medications.  Temperature is 37.7 C (99.9 F) , blood pressure is 142/90 mm Hg, pulse is 110/min, and respirations are 20/min.  Physical examination shows marked swelling, induration, and erythema of the right hemiscrotum.  Ultrasound reveals that the right testicle is twice as large as the left.  The right testicle is heterogeneous in echotexture and has a small hydrocele.  Which of the following is the most likely cause of this patient's presentation?

• A)Bowel protrusion through weakened fascia
• B)Dilation of the pampiniform plexus
• C)Malignant neoplasm of the testis
• D)Persistent patent processus vaginalis
• E)Twisting of the spermatic cord

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Definitions:

Homozygotes

Individuals having two identical alleles for a specific gene, resulting in the expression of that genetic trait.

Negative Frequency-Dependent Selection

Negative frequency-dependent selection occurs when rare genotypes have a fitness advantage simply because they are rare, helping to maintain genetic diversity within populations.

Pleiotropy

The genetic phenomenon where a single gene influences multiple phenotypic traits, demonstrating the complex nature of gene action.

Foraging Strategy

The behavioral patterns and techniques employed by animals, including humans, to find and gather food.