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Review of Clinical Signs Review Questions

Gynecomastia

Bernard M. Karnath, MD

Choose the single best answer to each question.

1.  A 30-year-old man presents with a 3-month history of worsening headaches and a 2-month history of bilateral gynecomastia. Physical examination includes a visual field test that reveals bilateral temporal hemianopsia. Which of the following laboratory tests (serum levels) would be most helpful in evaluation?

  1. Alpha-fetoprotein (AFP)
  2. Beta subunit of human chorionic gonadotropin (ß-hCG)
  3. Prolactin
  4. Testosterone
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2. A 25-year-old man presents with a 3-month history of bilateral gynecomastia. He reports normal puberty with onset at age 13 years. Physical examination reveals a unilateral testicular swelling on the left side. Laboratory testing reveals normal levels of AFP but markedly elevated ß-hCG levels. What is the most likely diagnosis?

  1. Kallmann syndrome
  2. Klinefelter’s syndrome
  3. Leydig cell tumor
  4. Nonseminomatous germ cell tumor
  5. Seminoma
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3. A 50-year-old man with congestive heart failure diagnosed 5 years ago presents with bilateral gynecomastia that has been present for the past 6 months. His medications include amlodipine, spironolactone, digoxin, and enalapril. Which of the medications he is taking has estrogen-like activity?

  1. Amlodipine
  2. Digoxin
  3. Enalapril
  4. Spironolactone
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4. A 30-year-old man presents for an infertility evaluation. He has been married for 5 years, and he and his wife have been unable to conceive during this time. His past medical history reveals delayed onset of puberty at age 18 years. Physical examination reveals bilateral gynecomastia and small testes. Laboratory examination reveals azoospermia. Which of the following laboratory tests is most likely to reveal his diagnosis?

  1. Karyotype
  2. Serum ß-hCG
  3. Serum prolactin levels
  4. Testicular ultrasound
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