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NBME p2ck_form7 Answers

step2ck_form7/Block 1/Question#2 (11.3 difficulty score)
A 27-year-old man comes to the physician with ...
Bilateral varicocelesπŸ”,πŸ“Ί

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submitted by russnels(12),

I'm not sure what they were going for on this question. Is it that bilateral varicoceles are the only answer correlated with decreased sperm count? Maybe testicular atrophy? Doesn't mention anything about the testes, so not sure what to think.

zjb80291  My best guesss: Sperm/semen need to be at a lower temperature than body temp (why testicles hang away from body). Varicoceles contain warm blood that would more likely cause infertility. +  
ad54me  Varicocele is classically "bag of worms" feeling which they alluded to in the question "ill-defined soft masses palpated bilaterally, high in scrotum" +  

submitted by keyseph(44),

"Bilateral varicoceles" is the only answer choice that is associated with male infertility and fits the description of bilateral masses palpated high in the scrotum. Scrotal varicosities increase the temperature around the testes, leading to impaired spermatogenesis.

Hydroceles are not associated with male infertility and typically involve swelling of the lower scrotum

submitted by seagull(1573),

bilateral; i would have thought a congenital defect like hydroceles but fml

submitted by step_prep5(74),
  • Key idea: Varicoceles are a major cause of male-dependent infertility because the increased pooling of blood in the pampiniform plexus near the testes leads to increased temperature, which leads to impaired Sertoli cell function (Note: Leydig cells will still be functioning well so testosterone levels will be normal)
  • Key idea: In NBME-style infertility questions, if one of the partners has had a previous child then the problem likely involves the other individual