A 72-year-old man presents to your office with reports of a hard lump slowly enlarging...

A slowly enlarging, hard inguinal “lump” in an older adult is concerning for inguinal lymphadenopathy or an inguinal hernia , and MCCQE objectives emphasize targeted examination of the regional drainage areas to identify a primary source. Inguinal lymph nodes receive lymphatic drainage from the external genitalia and scrotal skin , perineum, and lower abdominal wall and lower extremity. Therefore, careful genital examination —including the testicles/scrotum—can reveal common underlying causes such as skin malignancy of the scrotum , penile/scrotal lesions, chronic infection, or other local pathology that would explain a hard inguinal node.

Digital rectal examination assesses the prostate and rectum, whose lymphatic drainage is primarily to pelvic nodes rather than superficial inguinal nodes, making it less likely to identify the cause here. Palpation of liver or spleen looks for systemic malignancy/hematologic disease but is less likely to reveal the cause of a unilateral inguinal mass. Sexual history may suggest STI-related nodes, but these are typically tender and acute; a focused physical exam is more likely to reveal the etiology.