Male Genitourinary Emergencies Practice Questions

25 multiple-choice questions on Male genitourinary emergencies for paramedic and EMT students, from Chapter 22 (Genitourinary and Renal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A 10-year-old has testicular pain with a tender small lump and a blue dot visible through the skin at the top of the testis. This most suggests:

   1. A. A strangulated groin hernia
   2. B. Fournier gangrene
   3. C. Testicular cancer that has bled
   4. D. Torsion of the appendix testis
   Show answer

   Answer: D. Torsion of the appendix testis

   The 'blue dot sign' is a twisted, infarcted appendix testis, a small remnant that causes pain but does not threaten the testis. Because true torsion can look similar, the child still needs urgent evaluation.

2. A painless, soft scrotal swelling glows when a penlight is held behind it. This most likely is:

   1. A. A fluid-filled hydrocele
   2. B. Testicular torsion
   3. C. A strangulated hernia
   4. D. A ruptured testis from trauma
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   Answer: A. A fluid-filled hydrocele

   A hydrocele is fluid around the testis and transilluminates. Torsion and strangulated hernias are painful, and solid masses or blood do not transmit light.

3. On exam, a testis affected by torsion is often:

   1. A. Low-hanging and soft
   2. B. High-riding and lying sideways
   3. C. Less painful when lifted
   4. D. Normal with a brisk cremasteric reflex
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   Answer: B. High-riding and lying sideways

   The twisted cord pulls the testis upward and may turn it horizontally. The cremasteric reflex is often absent. Lifting the testis does not reliably ease torsion pain, and a brisk cremasteric reflex argues against torsion.

4. Epididymitis differs from torsion in that it usually has:

   1. A. Gradual onset, fever or dysuria
   2. B. Sudden onset during sleep
   3. C. A high-riding, horizontal testis
   4. D. No tenderness at all
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   Answer: A. Gradual onset, fever or dysuria

   Epididymitis is an infection that develops over days, often with urinary symptoms. In young men it is often from an STI.

5. Prehospital management of suspected testicular torsion includes:

   1. A. Applying heat and waiting it out
   2. B. Massage of the testis
   3. C. Delaying for antibiotics
   4. D. Analgesia, rapid transport
   Show answer

   Answer: D. Analgesia, rapid transport

   Give pain medicine per protocol and transport quickly. Manual detorsion is done by physicians, not routinely in the field.

6. Priapism is:

   1. A. Inflammation of the glans and foreskin
   2. B. A twisted testicle
   3. C. A prolonged, painful erection
   4. D. Blood in the semen
   Show answer

   Answer: C. A prolonged, painful erection

   An erection lasting more than 4 hours is a urologic emergency because trapped blood can damage the penis.

7. Which patients are at increased risk for priapism?

   1. A. Those with asthma
   2. B. Those with sickle cell disease
   3. C. Those with chronic migraines
   4. D. Those with recurrent kidney stones
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   Answer: B. Those with sickle cell disease

   Sickle cells block venous outflow. Medications for erectile dysfunction, cocaine, and spinal cord injury are other causes.

8. Paraphimosis is a condition in which:

   1. A. The foreskin cannot be retracted
   2. B. The testis twists on its cord
   3. C. The urethra is blocked by a stone
   4. D. Retracted foreskin cannot return
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   Answer: D. Retracted foreskin cannot return

   A retracted foreskin left behind the glans swells and constricts it. It is an emergency because the glans can lose blood flow.

9. A soft, 'bag of worms' swelling above the left testis that gets bigger when standing is most likely:

   1. A. A varicocele
   2. B. A hydrocele
   3. C. Torsion
   4. D. A scrotal abscess
   Show answer

   Answer: A. A varicocele

   A varicocele is a dilated venous plexus, usually on the left, that enlarges with standing or straining. A new right-sided or non-reducing varicocele may suggest a mass blocking venous drainage.

10. Which medication is a well-known cause of priapism?

    1. A. Ibuprofen
    2. B. Loratadine
    3. C. Trazodone
    4. D. Omeprazole
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    Answer: C. Trazodone

    Trazodone and other drugs that block alpha receptors, along with erectile dysfunction injections, can cause ischemic priapism. NSAIDs, antihistamines like loratadine, and PPIs do not.

11. A 58-year-old diabetic man has fever, severe scrotal pain out of proportion to the skin findings, and a foul odor. You suspect:

    1. A. Fournier gangrene
    2. B. Simple epididymitis
    3. C. Inguinal hernia
    4. D. Testicular torsion
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    Answer: A. Fournier gangrene

    Pain out of proportion, fever, and crepitus suggest necrotizing infection. Septic shock can develop quickly.

12. A man has blood at the urethral opening after a straddle injury. You should:

    1. A. Place a catheter to drain urine
    2. B. Avoid inserting a catheter
    3. C. Massage the area to stop bleeding
    4. D. Apply ice and release
    Show answer

    Answer: B. Avoid inserting a catheter

    Blood at the meatus suggests urethral injury. Catheterization can worsen it.

13. Which finding after pelvic trauma suggests a bladder injury?

    1. A. Pain referred to the left shoulder
    2. B. Bright red rectal bleeding only
    3. C. Suprapubic pain, bloody urine
    4. D. Ringing in both ears after impact
    Show answer

    Answer: C. Suprapubic pain, bloody urine

    Pelvic fractures often injure the bladder or urethra. Hematuria and inability to urinate are common findings.

14. Penile fracture usually occurs:

    1. A. From a fall onto the buttocks
    2. B. With urinary tract infection
    3. C. After prolonged sitting
    4. D. During vigorous intercourse
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    Answer: D. During vigorous intercourse

    Rupture of the erectile tissue causes a popping sound, swelling, and bruising. It needs surgical repair.

15. A man reports a scrotal mass that increases with straining and decreases when lying down. This suggests:

    1. A. Testicular torsion
    2. B. Epididymitis
    3. C. Testicular cancer
    4. D. Inguinal hernia
    Show answer

    Answer: D. Inguinal hernia

    Hernias change size with abdominal pressure. A firm, tender, non-reducible hernia may be incarcerated.

16. A painless, firm lump on the testis in a young man is concerning for:

    1. A. Testicular torsion
    2. B. Epididymitis
    3. C. Testicular cancer
    4. D. Inguinal hernia
    Show answer

    Answer: C. Testicular cancer

    Testicular cancer is most common in men aged 15 to 35. It is usually painless and needs follow-up.

17. The cremasteric reflex is tested by:

    1. A. Stroking the inner thigh
    2. B. Squeezing the testis gently
    3. C. Lifting the scrotum
    4. D. Stroking the lower abdomen
    Show answer

    Answer: A. Stroking the inner thigh

    The testis normally rises when the inner thigh is stroked. Absence suggests torsion. Lifting the scrotum tests for pain relief (Prehn sign), stroking the abdomen tests the abdominal reflex, and squeezing the testis is not a reflex test.

18. Which diabetes drug class carries an FDA warning for Fournier gangrene?

    1. A. Metformin
    2. B. SGLT2 inhibitors
    3. C. Insulin
    4. D. Sulfonylureas such as glipizide
    Show answer

    Answer: B. SGLT2 inhibitors

    In 2018 the FDA warned of rare cases of Fournier gangrene (necrotizing perineal infection) in patients taking SGLT2 inhibitors such as empagliflozin. Ask about these drugs when a diabetic patient has perineal pain.

19. Which patient positioning is appropriate for scrotal pain?

    1. A. Prone with legs straight
    2. B. Trendelenburg
    3. C. Position of comfort
    4. D. Sitting with legs crossed
    Show answer

    Answer: C. Position of comfort

    Allow the patient to choose a comfortable position and support the scrotum if helpful.

20. A man has a metal ring stuck at the base of his penis with increasing swelling. You should:

    1. A. Transport promptly for removal
    2. B. Wait for the swelling to resolve
    3. C. Apply heat to shrink the ring
    4. D. Pull firmly to slide it off
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    Answer: A. Transport promptly for removal

    Constriction devices can cause ischemia and tissue loss as swelling worsens. Hospital teams use cutting tools or specialized techniques. Forceful pulling can cause injury, and heat will increase swelling.

21. A man with spinal cord injury has a prolonged erection. This is most likely due to:

    1. A. Infection of the bladder
    2. B. Excess fluid intake
    3. C. Testicular torsion
    4. D. Loss of nervous control
    Show answer

    Answer: D. Loss of nervous control

    Spinal cord injury can disrupt normal nerve signals and cause priapism.

22. Why should you limit exposure during genital exams?

    1. A. It makes the exam go much faster
    2. B. To protect privacy, dignity
    3. C. It prevents wound infection
    4. D. It reduces the pain level
    Show answer

    Answer: B. To protect privacy, dignity

    Expose only what is needed and keep the patient covered. Explain what you are doing.

23. After a kick to the scrotum, a man has a large, very tender, swollen scrotum. You should:

    1. A. Transport for imaging
    2. B. Reassure him; give ice only
    3. C. Massage to reduce swelling
    4. D. Advise follow-up next week
    Show answer

    Answer: A. Transport for imaging

    Blunt scrotal trauma can rupture the testis, which needs surgery within hours to save it. Ice, support, and pain relief are appropriate, but the patient needs ultrasound evaluation.

24. Which is the best way to describe genital injuries in your report?

    1. A. Your guess about how it happened
    2. B. Judgments about the patient
    3. C. The patient's sexual history in detail
    4. D. Objective description of findings
    Show answer

    Answer: D. Objective description of findings

    Document what you see in clear, objective terms. Avoid opinions.

25. Which treatment is indicated for paraphimosis in the field?

    1. A. Forcing the foreskin over
    2. B. Cutting the foreskin
    3. C. Cold packs and transport
    4. D. Applying a tight dressing
    Show answer

    Answer: C. Cold packs and transport

    Cold packs may reduce swelling. Reduction is usually done in the ED.