Case Study

Critical Thinking Questions  

1. One of the potential complications of arthroscopy is infection. What signs and symptoms of joint infection would you emphasize in your patient teaching?

2. Why is glucose evaluated in the synovial fluid analysis? 

3. What are special tests used to differentiate type of Tendon tears in the knee ? Explain how they are performed (Always on boards) 

2-Testicular Cancer  

A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. 

Studies and Results 

Routine laboratory studies: Within normal limits (WNL) 

Ultrasound the testicle: Solid mass, right testicle associated with calcifications 

HCG (human chorionic gonadotropin): 550mIU/mL (normal: <5) 

CT scan of the abdomen: Enlarged retroperitoneal lymph nodes 

CT scan of the chest: Multiple pulmonary nodules 

Diagnostic Analysis 

At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes. 

Critical Thinking Questions 

1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer? 

2. What might be the side effects of cytotoxic chemotherapy? 

3. What was the purpose of preserving his sperm before chemotherapy? 

4. Is this young man’s age typical for the development of testicular carcinoma?

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