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USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 16-year-old boy is brought to the emergency department for evaluation of testicular pain and scrotal swelling. He had an episode of bilateral facial swelling along the jawline several days ago with associated fevers, headaches, and myalgias. The pain is worsened with movement. He has no dysuria. He is not sexually active. Records demonstrate his parents refused vaccinations throughout childhood. Temperature is 38.2°C (100.7°F), pulse is 98/min, and blood pressure is 122/84 mmHg. Physical examination reveals bilaterally enlarged and tender testicles. Stroking of the inner thigh bilaterally results in elevation of the testes. Which of the following is the most likely etiology of this patient’s clinical condition?  


A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum due to increased venous pressure. It is the most common cause of scrotal enlargement in adult males. Varicoceles are more common on the left side, since the left spermatic vein drains at a right angle first into the left renal vein and then into the inferior vena cava (IVC).

Varicoceles can lead to infertility by raising local temperature, which damages the Sertoli cells of the seminiferous tubules. On scrotal examination, a 'bag of worms' appearance is seen. The lesion does not transilluminate. Doppler ultrasound will show increased blood flow. Varicoceles can be treated with surgery to tie off or remove the affected veins, or with embolization to block the affected veins and seal them shut.


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