A 21-year-old man presents with acute onset of severe unilateral scrotal pain, swelling, and nausea. On exam, the affected testis is elevated and tender, with an absent cremasteric reflex. Which pathophysiologic process best explains his presentation?

• Chronic venous congestion causing dilation of pampiniform plexus veins and increased scrotal temperature

• Rotation of the spermatic cord leading to arterial occlusion, venous congestion, and ischemic injury to testicular tissue

• Fluid accumulation between the layers of the tunica vaginalis compressing the testis and epididymis

• Autoimmune destruction of seminiferous tubules causing acute inflammation and swelling

A 32-year-old woman reports pelvic pain that worsens during menses and improves afterward. Laparoscopy reveals endometrial glands and stroma on the ovaries. Which pathophysiologic mechanism is most consistent with her condition?

• Benign neoplastic proliferation of myometrial smooth muscle in the uterine wall

• Ectopic implantation of functional endometrial tissue that undergoes cyclic bleeding, inflammation, and scar formation

• Bacterial infection ascending from the lower genital tract into the peritoneal cavity

• Hormone-induced overgrowth of endometrial glands leading to irregular bleeding and anemia

A 27-year-old woman presents with amenorrhea, hirsutism, acne, and obesity. Labs reveal elevated LH, low-normal FSH, and hyperinsulinemia. Which integrated pathophysiologic mechanism explains these findings?

• Deficient estrogen production from premature ovarian failure leading to hyperandrogenism

• Chronic elevation of FSH stimulating excessive follicular development and androgen release

• LH/FSH imbalance and insulin resistance causing increased ovarian androgen production and anovulation

• Low progesterone production from luteal phase deficiency causing menstrual irregularity

A 45-year-old woman reports progressively heavy, prolonged menstrual bleeding and pelvic fullness. Pelvic exam reveals an irregularly enlarged, firm uterus. Which pathophysiologic process is most likely responsible?

• Endometrial hyperplasia due to unopposed estrogen stimulation of the endometrium

• Benign smooth muscle proliferation in the myometrium forming multiple leiomyomas that distort the uterine contour

• Chronic endometritis causing diffuse thickening of the endometrial lining

• Polycystic ovary syndrome causing cystic enlargement of the ovaries and uterine congestion

A 50-year-old man presents with a painless, firm, non-mobile nodule in one testis. Which explanation best describes the pathophysiology of the most likely diagnosis?

• Congenital abnormality in testicular descent leading to chronic torsion and ischemia

• Bacterial infection causing granulomatous orchitis and fibrosis

• Malignant proliferation of germ cells forming a tumor that can metastasize via lymphatic and hematogenous routes

• Benign proliferation of Sertoli cells within the seminiferous tubules producing a palpable mass

A 23-year-old woman presents with vaginal itching, burning, and a thick, white, clumpy discharge. Which pathophysiologic explanation best accounts for her symptoms?

• Overgrowth of anaerobic bacteria producing amines that increase vaginal pH

• Overgrowth of Candida albicans in the vaginal canal due to altered normal flora and impaired immune defense

• Ascending infection by Chlamydia trachomatis causing cervicitis and mucopurulent discharge

• Protozoal infection causing cytolysis of vaginal epithelial cells and frothy discharge

A 29-year-old man presents with burning urination and purulent urethral discharge after unprotected sex. Gram stain of the discharge reveals intracellular gram-negative diplococci. Which process explains the pathophysiology of the likely pathogen?

• Spore-forming bacteria invading epithelial cells and producing endotoxin

• Bacterial pili and outer membrane proteins enabling mucosal adhesion and evasion of immune clearance in the urethra

• Protozoan flagella facilitating motility through the mucosal surface

• Lipopolysaccharide-induced inflammatory destruction of the lamina propria without direct invasion

A 34-year-old woman has multiple tender nodules in her breasts that enlarge and become painful before menstruation, then regress. Which best describes the pathophysiologic process?

• Fibroadenoma formation from proliferation of stromal cells and ducts

• Inflammatory mastitis from bacterial entry via cracked nipples

• Hormone-driven proliferation of glandular and stromal tissue with cyst formation, influenced by estrogen and progesterone fluctuations

• Malignant transformation of ductal epithelial cells with invasion of surrounding tissue

A 25-year-old woman has green, frothy vaginal discharge with a strong odor. Pelvic exam shows a strawberry cervix. Which pathophysiologic explanation fits best?

• Overgrowth of normal lactobacilli lowering vaginal pH excessively

• Protozoan infection causing direct epithelial cell damage, inflammation, and punctate cervical hemorrhages

• Overgrowth of Gardnerella vaginalis producing biofilm on vaginal epithelium

• Yeast infection causing pseudohyphae invasion into superficial mucosa

A 42-year-old woman presents with a painless, firm breast mass and skin dimpling. Which pathophysiologic process is most likely occurring?

• Benign stromal proliferation compressing ducts and overlying skin

• Hormonal overstimulation causing ductal hyperplasia without invasion

• Malignant ductal epithelial cell growth causing desmoplastic response and retraction of Cooper’s ligaments

• Inflammatory infiltration of adipose tissue causing localized swelling