During a school health fair, a nurse teaches testicular self-exam to adolescent boys.
What is the most important teaching point?

Choice A rationale

Performing a testicular self-exam weekly is too frequent and unnecessary. The recommended frequency is monthly. While lying down might be acceptable, performing it after a warm shower is generally preferred due to muscle relaxation. Checking for pain is part of the examination, but the emphasis is on identifying changes rather than just pain.

Choice B rationale

Using fingertips and checking for pain are indeed components of the testicular self-exam; however, these are not the *most important* teaching points. The primary goal is to become familiar with the normal consistency and feel of the testicles to detect any subtle changes, not just to check for pain, which might only be present in symptomatic conditions.

Choice C rationale

This statement is incorrect and misleading. Testicular self-exams are recommended for *all* adolescent boys, regardless of family history of cancer. Early detection through regular self-examination significantly improves prognosis for testicular cancer, which can occur without any prior family history.

Choice D rationale

Performing the exam monthly after a warm shower is the most important teaching point. The warm shower relaxes the scrotal sac, making it easier to palpate the testicles and detect any abnormalities. Monthly performance ensures consistency and allows for early identification of any changes from the baseline normal.

Choice A rationale

Duchenne muscular dystrophy (DMD) is a progressive genetic disorder characterized by muscle degeneration and weakness. Individuals with DMD experience significant muscle weakness, particularly in the lower limbs, leading to an increased risk of falls due to impaired balance and gait instability. Decreased muscle strength directly compromises postural control.

Choice B rationale

Rapid cognitive development is not a typical characteristic of Duchenne muscular dystrophy. While DMD primarily affects skeletal muscles, some individuals may experience cognitive impairments, ranging from mild learning difficulties to more significant intellectual disabilities. The disease is linked to dystrophin deficiency in brain tissue, which can impact neurological function.

Choice C rationale

Increased muscle strength is antithetical to the pathology of Duchenne muscular dystrophy. The hallmark of DMD is progressive muscle weakness caused by the absence or malfunction of dystrophin, a protein vital for maintaining muscle fiber integrity. This leads to chronic muscle damage, inflammation, and eventual replacement of muscle tissue with fat and fibrous tissue.

Choice D rationale

Wheelchair dependence is a common and almost inevitable outcome for individuals with Duchenne muscular dystrophy. Due to the progressive muscle weakness affecting ambulation, most individuals with DMD lose the ability to walk independently between ages 7 and 13, necessitating the use of a wheelchair for mobility as the disease progresses and leg muscles deteriorate.