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  #1  
Old 10-06-2012
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Arrow Billy Step 1 Questions #11 and #12

NUMBER 11

A 25-year-old man has occasionally felt pain in the scrotum for the past 3 months. On physical examination, the right
testis is more tender than the left, but does not appear to be appreciably enlarged. An ultrasound scan shows a 1.5-cm
mass. A right orchiectomy is performed, and gross examination shows the mass to be hemorrhagic and soft. A
retroperitoneal lymph node dissection is done. In sections of the lymph nodes, a neoplasm is seen with grossly extensive
necrosis and hemorrhage. Microscopic examination shows that areas of viable tumor are composed of cuboidal cells
intermingled with large eosinophilic syncytial cells containing multiple dark, pleomorphic nuclei. Immunohistochemical
staining of the tumor is most likely to show which of the following antigenic components in the syncytial cells?


□ (A) Human chorionic gonadotropin
□ (B) α-Fetoprotein
□ (C) Vimentin
□ (D) CD20
□ (E) Testosterone
□ (F) Carcinoembryonic antigen
□ (G) CA-125



NUMBER 12

A 35-year-old man and his 33-year-old wife are childless. They have tried to conceive a child for 12 years, and now they
undergo an infertility work-up. On physical examination, neither spouse has any remarkable findings. Laboratory studies
show that the man has a sperm count in the low-normal range. On microscopic examination of the seminal fluid, the sperm
have a normal morphologic appearance. A testicular biopsy is done. The biopsy specimen shows patchy atrophy of
seminiferous tubules, but the remaining tubules show active spermatogenesis. Which of the following disorders is the most
likely cause of these findings?


□ (A) Mumps virus infection
□ (B) Cryptorchidism
□ (C) Hydrocele
□ (D) Klinefelter syndrome
□ (E) Prior chemotherapy
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  #2  
Old 10-06-2012
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First answer is B ... And second ??? Guessing A....
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  #3  
Old 10-06-2012
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Thinking A, and A. Not so sure, though.
'Syncitial cells' could mean the syncitium in syncitiotrophoblastic cells --> HCG?
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  #4  
Old 10-06-2012
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Lol.. I did not take a look at the first option for the first Q.. If hcG is present then it should be the answer I think .. ( the answers in the first option are a bit scary to choose though .. !!)
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  #5  
Old 10-06-2012
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Keep guesing
i will tell the answer later
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  #6  
Old 10-06-2012
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1> A.
And
2> B.
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Old 10-06-2012
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Quote:
Originally Posted by billy View Post
NUMBER 11

A 25-year-old man has occasionally felt pain in the scrotum for the past 3 months. On physical examination, the right
testis is more tender than the left, but does not appear to be appreciably enlarged. An ultrasound scan shows a 1.5-cm
mass. A right orchiectomy is performed, and gross examination shows the mass to be hemorrhagic and soft. A
retroperitoneal lymph node dissection is done. In sections of the lymph nodes, a neoplasm is seen with grossly extensive
necrosis and hemorrhage. Microscopic examination shows that areas of viable tumor are composed of cuboidal cells
intermingled with large eosinophilic syncytial cells containing multiple dark, pleomorphic nuclei. Immunohistochemical
staining of the tumor is most likely to show which of the following antigenic components in the syncytial cells?


□ (A) Human chorionic gonadotropin
□ (B) α-Fetoprotein
□ (C) Vimentin
□ (D) CD20
□ (E) Testosterone
□ (F) Carcinoembryonic antigen
□ (G) CA-125



NUMBER 12

A 35-year-old man and his 33-year-old wife are childless. They have tried to conceive a child for 12 years, and now they
undergo an infertility work-up. On physical examination, neither spouse has any remarkable findings. Laboratory studies
show that the man has a sperm count in the low-normal range. On microscopic examination of the seminal fluid, the sperm
have a normal morphologic appearance. A testicular biopsy is done. The biopsy specimen shows patchy atrophy of
seminiferous tubules, but the remaining tubules show active spermatogenesis. Which of the following disorders is the most
likely cause of these findings?


□ (A) Mumps virus infection
□ (B) Cryptorchidism
□ (C) Hydrocele
□ (D) Klinefelter syndrome
□ (E) Prior chemotherapy
My answer is double A ,
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  #8  
Old 10-06-2012
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Quote:
Originally Posted by billy View Post
NUMBER 11

A 25-year-old man has occasionally felt pain in the scrotum for the past 3 months. On physical examination, the right
testis is more tender than the left, but does not appear to be appreciably enlarged. An ultrasound scan shows a 1.5-cm
mass. A right orchiectomy is performed, and gross examination shows the mass to be hemorrhagic and soft. A
retroperitoneal lymph node dissection is done. In sections of the lymph nodes, a neoplasm is seen with grossly extensive
necrosis and hemorrhage. Microscopic examination shows that areas of viable tumor are composed of cuboidal cells
intermingled with large eosinophilic syncytial cells containing multiple dark, pleomorphic nuclei. Immunohistochemical
staining of the tumor is most likely to show which of the following antigenic components in the syncytial cells?


□ (A) Human chorionic gonadotropin
□ (B) α-Fetoprotein
□ (C) Vimentin
□ (D) CD20
□ (E) Testosterone
□ (F) Carcinoembryonic antigen
□ (G) CA-125



NUMBER 12

A 35-year-old man and his 33-year-old wife are childless. They have tried to conceive a child for 12 years, and now they
undergo an infertility work-up. On physical examination, neither spouse has any remarkable findings. Laboratory studies
show that the man has a sperm count in the low-normal range. On microscopic examination of the seminal fluid, the sperm
have a normal morphologic appearance. A testicular biopsy is done. The biopsy specimen shows patchy atrophy of
seminiferous tubules, but the remaining tubules show active spermatogenesis. Which of the following disorders is the most
likely cause of these findings?


□ (A) Mumps virus infection
□ (B) Cryptorchidism
□ (C) Hydrocele
□ (D) Klinefelter syndrome
□ (E) Prior chemotherapy
1. Choriocarcinoma- increase in hCG
So A. hCG

2. Not sure
Random guess would be cryptorchidism at childhood.


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  #9  
Old 10-06-2012
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Default my answer :)

11) a
12) a
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  #10  
Old 10-06-2012
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I'll go with Double (A)
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  #11  
Old 10-06-2012
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Correct Answer Yes double A is correct

11 This patient has a choriocarcinoma, the most aggressive testicular carcinoma. It often metastasizes widely. The
primitive syncytial cells mimic the syncytiotrophoblast of placental tissue and stain for human chorionic gonadotropin. α-
Fetoprotein is a marker that is more likely to be found in mixed tumors with a yolk sac component. Vimentin is more likely to
be seen in sarcomas, which are rare in the testicular region. CD20 is a lymphoid marker for B cells. Testosterone is found
in Leydig cells. Carcinoembryonic antigen (CEA) is found in a variety of epithelial neoplasms, particularly
adenocarcinomas. CA-125 is best known as a marker for ovarian epithelial malignant tumors.


12 Mumps is a common childhood infection that can produce parotitis. Adults who have this infection more often
develop orchitis. The orchitis is usually not severe, and its involvement of the testis is patchy; infertility is not a common
outcome. Cryptorchidism results from failure of the testis to descend into the scrotum normally; the abnormally positioned
testis becomes atrophic throughout. A hydrocele is a fluid collection outside the body of the testis that does not interfere
with spermatogenesis. Klinefelter syndrome and estrogen therapy can cause tubular atrophy, although it is generalized in
both cases. Patchy loss of seminiferous tubules indicates a local inflammatory process. Many chemotherapeutic agents
are particularly harmful to rapidly and continuously proliferating testicular germ cells, but the effect would not be patchy
within the testicular parenchyma. Patients who wish to father children may want to store sperm in a sperm bank before
undergoing chemotherapy
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The above post was thanked by:
beka-CTS (10-06-2012), dockhi (10-07-2012), dr.rick (03-28-2013), MANIAKOS (10-10-2012), MiSeRy (10-07-2012), rupesh (10-07-2012), venky2600 (10-06-2012)
  #12  
Old 10-07-2012
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1 a is my ans
2 e is my ans
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  #13  
Old 10-07-2012
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1 a is my ans
2 e is my ans
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