Gynecology and Urology Quiz

A 52-year-old woman tells her physician that she is concerned about her risk for developing endometrial cancer. Which of the following factors poses the largest risk for developing endometrial cancer?

A 28-year-old married woman who has been trying to become pregnant for the past 1 months presents to the emergency department with sudden and severe abdominal pain. Ultrasonography shows a mass in her left fallopian tube with free fluid in the cul-de-sac. Previous infection by which of the following agents most likely put this patient at a higher risk for developing this complication?

A 2-month-old boy is brought to the pediatrician by his mother for a wellbaby visit for the fi rst time since his birth. On examination, the doctor notes that the patient has cryptorchidism, with both testicles remaining undescended. This patient is at increased risk for developing which of the following conditions

A 69-year-old man presents with urinary frequency, nocturia, dribbling, and difficulty in starting and stopping urination. Rectal examination reveals the prostate to be enlarged, firm, and rubbery.A needle biopsy reveals increased numbers of glandular elements and stromal tissue. The glands are found to have a double layer of epithelial cells. Prominent nuclei or back-lo-back glands are not seen. Which of the following is the most likely diagnosis

A 5-year-old boy has a history of recurrent urinary tract infections. Urine cultures have grown Escherichia coli, Proteus mirabilis, and Enterococcus. Physical examination now shows an abnormal constricted opening of the urethra on the ventral aspect of the penis, 1.5 cm from the tip of the glans penis. There also is a cryptorchid testis on the right and an inguinal hernia on the left. What term best describes the child's penile abnormality?

The patient recently noticed a pale area of discoloration on the labia. Pelvic examination shows the presence of a 0.6-cm flat, white area on the right labia Majora. A biopsy speciment is obtained and on microscopic examination shows dysplastic cells that occupy half the thickness of the squamous epithelium, with minimal underlying chronic inflammation. In situation hybridization shows human papillomavirus type 16 DNA in the epithelial cells. What is the most likely diagnosis

A 42-year-old woman has had menometrorrhagia for the past 2 months. She has no history of prior irregular menstrual bleeding, and she has not yet reached menopause. On physical examination, there are no vaginal or cervical lesions, and the uterus appears normal in size, but there is a right adnexal mass. An abdominal ultrasound scan shows the presence of a 7-cm solid right adnexal mass. Endometrial biopsy shows hyperplastic endometrium, but no cellular atypia. What is the most likely lesion that underlies her menstrual abnormalities?

A 79-year-old, previously healthy woman feels a lump in her right breast. The physician palpates a 2-cm firm mass in the upper outer quadrant. Nontender right axillary lymphadenopathy is present. A lumpectomy with axillary lymph node dissection is performed. Microscopic examination shows that the mass is an infiltrating ductal carcinoma. Two of 10 axillary nodes contain metastases. Flow cytometry on the carcinoma cells shows a small aneuploid peak and high S-phase. Immunohistochemical tests show that the tumor cells are positive for estrogen and progesterone receptor (ER/PR), negative for HER2/neu expression, and positive for cathepsin D expression. What is the most important prognostic factor for this patient?

A 30-year-old woman, gravida 3 para 3, comes to the office with worsening shortness of breath over the past week. She had a recent episode of hemoptysis. The patient has also had ongoing vaginal bleeding after an uncomplicated vaginal delivery of her son 9 weeks ago. She has no bleeding elsewhere, and she has not resumed sexual intercourse. On physical examination, the patient's uterus is enlarged and the adnexa are normal. Laboratory studies show markedly increased β-hCG levels. Chest radiograph shows multiple bilateral lung nodules. Which of the following would most likely be found on endometrial curettage in this patient?

35 year old women, gravida 1, para 0, comes to the office for a routine prenatal checkup at approximately 33 weeks gestation. The patient has started having persistent, throbbing headaches that are not relieved by acetaminophen. She has no nausea, vomiting, or abdominal pain. She eats a well-balanced diet, takes prenatal vitamins, and has normal bowel movements. Medical history is unremarkable and prenatal care has been uneventful. Review of medical records show that her blood pressure was 12/75 mm Hg at 28 weeks gestation. Today, blood pressure is 170/100 mm Hg, and heart rate 95 per minute. Which of the following additional findings is most likely present in this patient

A 35-year-old woman is seen 6 months after giving birth to a normal infant. She suffered severe cervical lacerations during delivery, resulting in hemorrhagic shock. Following blood transfusion and surgical repair, postpartum recovery has so far been uneventful. She now complains of continued amenorrhea and loss of weight and muscle strength. Further investigation might be expected to demonstrate which of the following findings

A 32-year-old woman presents with amenorrhea, galactorrhea, and visual field defects, all of several months’ duration. Magnetic resonance imaging reveals a hypophyseal mass impinging on the optic chiasm. This is most likely a(n

A 23-year-old woman presents with tremor, restlessness, heat intolerance, palpitation, and unexplained weight loss. The thyroid is symmetrically enlarged, the pulse is rapid, the skin is moist and warm, and exophthalmos is apparent. This condition is considered to be

A 23-year-old African-American man who is known to have sickle cell anemia presents to the emergency department with a painful erection. The patient explains that the erection had started 3 hours ago. This condition is referred to as

A 3-year-old boy is brought to the pediatrician because his mother noticed an abnormal mass in his scrotum while changing his diapers. Further workup demonstrates elevated levels of serum α-fetoprotein. Which of the following is the most likely diagnosis

A 45-year-old woman presents with general discomfort and increasing tightness in the skin of her face. She reports intermittent pain in the tips of her fi ngers when exposed to the cold. Physical examination shows “stone facies” and edema of the fi ngers and hands. Serologic tests for antinuclear and anti–Scl-70 antibodies are both positive. Which of the following gastrointestinal manifestations is expected in this patient?

A 40-year-old woman presents with a 2-month history of burning epigastric pain that usually occurs between meals. The pain can be relieved with antacids or food. The patient also reports a recent history of tarry stools. She denies taking aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia (serum hemoglobin = 8.5 g/dL). Gastroscopy reveals a bleeding mucosal defect in the antrum measuring 1.5 cm in diameter. An endoscopic biopsy shows that the lesion lacks mucosal lining cells and is composed of amorphous, cellular debris and numerous neutrophils. Which of the following is the most important factor in the pathogenesis of this patient’s disease

A 47-year-old man suffers from long-standing peptic ulcer disease, which is largely unresponsive to pharmacologic therapy. Endoscopic examination reveals multiple, nonhealed ulcerations of the duodenum and jejunum. Which of the following is the most likely diagnosis

A 35-year-old woman presents with 6-month history of skin rash and fatigue. Physical examination shows pallor and a necrotizing erythematous skin rash of her lower body. Laboratory studies reveal mild anemia and fasting blood glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass in the pancreas. Which of the following is the most likely diagnosis?

A 12-year-old girl has the sudden onset of severe abdominal pain and back pain. On physical examination her abdomen is diffusely tender, but there are no masses. She is afebrile. A CBC shows Hgb 6.5 g/dL, Hct 19.0%, MCV 99 fL, platelet count 149,000/microliter, and WBC count 11,200/microliter. Examination of her peripheral blood smear shows nucleated RBCs and sickled RBCs. Which of the following types of gene mutation is she most likely to have?

A 56-year-old man experiences episodes of severe substernal chest pain every time he performs a task that requires moderate exercise. The episodes have become more frequent and severe over the past year, but they can be relieved by sublingual nitroglycerin. On physical examination, he is afebrile, his pulse is 78/min and regular, and there are no murmurs or gallops. Laboratory studies show creatinine, 1.1 mg/dL; glucose, 130 mg/dL; and total serum cholesterol, 223 mg/ dL. Which of the following cardiac lesions is most likely to be present in this man

A 19-year-old man has had a low-grade fever for 3 weeks. On physical examination, his temperature is 38.3° C, pulse is 104/min, respirations are 28/min, and blood pressure is 95/60 mm Hg. A tender spleen tip is palpable. There are splinter hemorrhages under the fingernails and tender hemorrhagic nodules on the palms and soles. A heart murmur is heard on auscultation. Which of the following infectious agents is most likely to be cultured from this patient's blood

A 9-year-old boy living in Uganda has had increasing pain and swelling on the right side of his face over the past 8 months. On physical examination, there is a large, nontender mass involving the mandible, which deforms the right side of his face. There is no lymphadenopathy and no splenomegaly, and he is afebrile. A biopsy of the mass is performed. Microscopically, the specimen is composed of intermediate-sized lymphocytes with a high mitotic rate. A chromosome analysis shows a 46,XY,t(8;14) karyotype in these cells. The hemoglobin concentration is 13.2 g/dL, platelet count is 272,000/mm3, and WBC count is 5820/mm3. Infection with which of the following is most likely to be causally related to the development of these findings

A 55-year-old man is admitted to the hospital with increasing shortness of breath and dry cough for the past few years. He smokes 1.5 packs of cigarettes and drinks about four bottles of beer a day. He is constantly “gasping for air” and now walks with difficulty because he becomes breathless after only a few steps. Prolonged expiration with wheezing is noted. Physical examination shows a barrel chest, hyperresonance on percussion, and clubbing of the digits. The patient’s face is puffy and red, and he has pitting edema of the legs. A chest X-ray discloses hyperinflation, flattening of the diaphragm, and increased retrosternal air space. Which of the following is the appropriate diagnosis?

A 51-year-old man has noted constant, dull right hip pain for the past 3 months. On physical examination he has diminished range of motion of the right hip. A radiograph reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has irregular borders and there are extensive areas of bony destruction along with some scattered calcifications. The lesion is resected, and grossly the mass has a bluish-white cut surface. Which of the following is the most likely diagnosis

A 14-year-old West African man has a history of multiple episodes of sudden onset of severe abdominal pain and back pain lasting for hours. Each time this happens, his peripheral blood smear demonstrates numerous sickled erythrocytes. A hemoglobin electrophoresis shows 94% Hgb S, 5% Hgb F, and 1% Hgb A2. He now has a painful right hip that is tender to palpation. A radiograph reveals irregular bony destruction of the femoral head. Which of the following infectious agents is most likely responsible for his findings?

A 58-year-old man has the sudden onset of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils and needle-shaped crystals. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. Which of the following laboratory test findings is most characteristic for his underlying disease process

An 80-year-old woman has had no major medical problems, but she has never been physically active for most of her life. One day she falls out of bed and immediately notes a sharp pain in her left hip. She is subsequently unable to ambulate without severe pain. Radiographs show not only a fracture of the left femoral head, but also a compressed fracture of T10. Which of the following conditions is she most likely to have

You suspect Glucose 6-phosphate Dehydrogenase Deficiency, and microscopic analysis of the child's blood showing

A 58-year-old man from Nagasaki, Japan, has noted an increasing number of skin lesions for the past 8 months. On examination, there are scaling red-brown patches on all skin surfaces. He also has generalized lymphadenopathy and hepatosplenomegaly. Laboratory studies show hemoglobin, 9.7 g/dL; hematocrit, 31%; MCV, 89 μm3; platelet count, 177,000/mm3; and WBC count, 18,940/mm3 with differential count of 35 segmented neutrophils, 2 band neutrophils, 58 lymphocytes, and 5 monocytes. His serum calcium is 11.5 mg/dL. Examination of his peripheral blood smear shows multilobated “cloverleaf” cells. Despite aggressive chemotherapy, his condition worsens with development of paresthesias along with erythematous plaques and red-brown nodules on his skin. Which of the following infectious agents most likely caused his illness?

A 72-year-old man who works for a mine in Libby,Montana, has a clinical history of pulmonary function tests that show a decreased FEV1 and FVC, with a normal FEV1/FVC ratio. He dies and an autopsy is performed. The autopsy reveals a tumor in the right pleural cavity, which completely encases the lung. He also has tan-white pleural plaques in the right pleural cavity. Upon histologic examination of the lung, prominent alveolar septal fibrosis with honeycomb change is identified. This patient was most likely exposed to which of the following agents?

While on an international medical rotation, you encounter a pregnant woman in a rural village in India who presents with fever, jaundice, and malaise. The patient unexpectedly expires. This is the second case this month with a similar presentation. Which of the following is the most likely form of hepatitis?

A previously healthy, 24-year-old woman presents with a 1-week history of intermittent fever, lethargy, and yellow skin and sclerae. Physical examination shows jaundice. Laboratory studies reveal decreased serum albumin (2.2 g/dL), extremely high levels of AST and ALT (1,200 and 1,800 U/L, respectively), and elevated alkaline phosphatase (300 U/L). Her ceruloplasmin level is normal. She is admitted to the hospital. Her condition progressively deteriorates, and she develops hepatic encephalopathy and hepatorenal syndrome. Which of the following is the most likely diagnosis?

Bleeding from the nipple in a 45-year-old woman, without a palpable breast mass should suggest

Which one of the following lesions usually presents as a discrete, freely movable nodule in the breast ?

What is the expected thyroid function test in primary hyperthyroidism

What is the most common cardiomyopathy in athletes

A 37-year-old previously healthy male presents with difficulty walking due to severe pain, swelling, redness, and warmth of his right great toe over the last 24 hours after partying all night at a friend’s bachelor party. His hangover has subsided, but his big toe pain continues despite taking Tylenol. What finding is diagnostic

A 55-year-old obese male with history of HTN, diabetes, and lumbago presents with bilateral knee pain that has worsened slowly over the last 2 years. The knee pain is worse in the morning, lasts less than 30 minutes, and improves with activity. What physical exam finding would be present in patients?

Multiple enchondromas are a feature of

A 47-year-old man presents to his primary doctor with 2 weeks of fever, headache, and muscle aches. He also has noted a nonpruritic erythematous rash in the right groin. The rash has been enlarging for the past week, with new areas of clearing resulting in concentric rings of erythema. The patient is a Boy Scout leader and recently returned from a camping trip in Connecticut. Which of the following is the most likely diagnosis

In osteoarthritis

A 24-year-old male presents with history of diarrhea 3 weeks ago and returns to the clinic with redness in the eyes, tearing, painful urination, mouth sores, and right knee pain. What is the diagnosis?

You encountered a 35-year old patient with necrotizing granulomas along the respiratory tract and the lungs. He eventually died of crescentic glomerulonephritis. Which of the following markers would turn out positive in this patient

Which of the following is most likely associated with the Philadelphia chromosome?

A 65 year old female presents with fever, headache and diplopia. On palpation, tenderness is noted along the course of the temporal artery. A biopsy would most likely confirm which of the following diagnosis?

A 70-year-old woman complains of a throbbing unilateral headache and vision problems. She reports weight loss and mandibular pain while eating. The patient also has a history of recurrent bouts of fever accompanied by malaise and muscle aches. Physical examination reveals nodular enlargement of the temporal artery with pain on palpation. A biopsy is obtained (shown in the image). What is the appropriate diagnosis?

An 80-year-old man with long-standing diabetes and systemic hypertension dies of congestive heart failure. The luminal surface of the abdominal aorta is shown in the image. Which of the following pathologic changes would you expect to see on microscopic examination?

Upon autoposy an incidental finding of atherosclerosis was made. Which of the following is true of atherosclerosis?

A 60-year-old man presents with dizziness, nausea, and severe shortness of breath of several months’ duration. Physical examination shows hepatomegaly, ascites, and anasarca. His blood pressure is 200/115 mm Hg. An X-ray fi lm of the chest demonstrates cardiomegaly and mild pulmonary edema. Although different mechanisms may have contributed to the pathogenesis of hypertension in this patient, the common end result for all of them is which of the following?

A 32-year-old female was brought to the cardiologist with fever, night sweats, myalgias. Physical examination shows diminished carotid and absent brachial pulsations. ESR was markedly elevated. Treatment with prednisolone was started. Which of the following vasculitis does she have?

A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals palpable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythrocyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. Which of the following is the most likely diagnosis?

A 45-year-old black man undergoes renal biopsy for evaluation of chronic renal failure. The patient has a 60-pack-year history of smoking. Physical examination reveals a blood pressure of 190/120 mm Hg. A renal biopsy shows thickening of small arteries and arterioles, as well as edematous intimal expansion and fi brinoid necrosis. The Congo red stain is negative. Laboratory studies show hemoglobin is 10.2 g/dL and serum cholesterol is 250 mg/dL. BUN and serum creatinine are 42 and 5.5 mg/dL, respectively. Which of the following is the most likely cause of renal failure in this patient?

An young athlete dies suddenly and unexpectedly. Autopsy reveals massive myocardial hypertrophy with disproportionate thickening of the ventricular septum. What is the most likely pathologic etiology of this condition

A 17-year-old high school student dies suddenly while playing basketball. At autopsy, asymmetric hypertrophy of the interventricular septum is discovered. Histologic sections from this area reveal disorganization of the myofibers, which are thicker than normal and have hyperchromatic nuclei. What is the most likely diagnosis?

A 4-year-old child from China was brought to the pediatrician due to fevers lasting 5 days. Fever is unresponsive to acetaminophen. Physical examination shows the desquamation of the skin on fingers, as well as edema of the hands and feet. The patient has bilateral conjunctival injection, cervical lymphadenopathy, erythema of the tongue. Immediate treatment with Aspirin and intravenous immunoglobulin was started to avoid which of the following complications?

A 17-year-old girl is short in stature for her age. She has not yet shown any changes of puberty. On physical examination her vital signs include T 37°C, RR 18/minute, P 75/minute, and BP 165/85 mm Hg. She has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with diminished pulses and poor capillary filling. She has a webbed neck. A chest radiograph reveals a prominent left heart border, no edema or effusions, and rib notching. Which of the following cardiovascular abnormalities is she most likely to have

A 63-year-old woman has the sudden onset of 'knife-like' pain in the chest radiating to the back. She has been previously healthy except for a history of poorly controlled hypertension. She is transported to the hospital and on arrival she has a heart rate of 90/minute, respirations 20/minute, temperature 36.8°C, and blood pressure 150/100 mm Hg. No murmurs, rubs, or gallops are audible. A chest radiograph reveals a widened mediastinum. Laboratory findings include a total serum creatine kinase of 55 U/L, creatinine 0.9 mg/dL, and glucose 123 mg/dL. Which of the following is the most likely diagnosis?

A 19-year-old woman has had increasing malaise for the past 5 months. On physical examination she has a cardiac murmur characterized by a mid systolic click. An echocardiogram demonstrates mitral insufficiency with upward displacement of one leaflet. There is aortic root dilation to 4 cm. She has a dislocated right ocular crystalline lens. A year later she dies suddenly and unexpectedly. The medical examiner finds a prolapsed mitral valve with elongation, thinning, and rupture of chordae tendineae. A mutation involving which of the following genes is most likely to be present in this patient?

The following are features of right sided heart failure EXCEPT

A 67-year-old man presents to the GP with breathlessness upon exertion, orthopnea and oedema of legs, feet and ankles. Which of the following of heart failure is true

Pulmonary hypertension that results from the reversal of the direction of blood flow through a congenital heart defect that initially had produced a left-to-right shunt is a characteristic feature of which of the following disorders?

A 53-year-old man presents with recurrent chest pain that has gotten progressively worse over the last several weeks. He says that approximately a year ago the pain would occasionally occur when he was mowing his yard but now the pain sometimes occurs while he is sitting in a chair at night reading a book. The pain, which is localized over the sternum, lasts much longer now than it did a few months ago. What type of angina does this individual have at present?

A 56-year-old man experiences episodes of severe substernal chest pain every time he performs a task that requires moderate exercise. The episodes have become more frequent and severe over the past year, but they can be relieved by sublingual nitroglycerin. On physical examination, he is afebrile, his pulse is 78/min and regular, and there are no murmurs or gallops. Laboratory studies show creatinine, 1.1 mg/dL; glucose, 130 mg/dL; and total serum cholesterol, 223 mg/ dL. Which of the following cardiac lesions is most likely to be present in this man?

A 9-year-old girl is diagnosed with acute rheumatic fever. Instead of recovering as expected, her condition worsens, and she dies. Which of the following is the most likely cause of death?

A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented neutrophils, and decreased platelets. The most likely cause of the anemia is

A 7-year-old African-American boy is brought to see his pediatrician. His father says he has noticed that the boy has been complaining of right knee pain for the past week. On physical exam, multiple ecchymoses are noted on both upper and lower extremities. His father claims that the boy has always bruised easily, and he has recently learned how to ride a bicycle. Which of the following elements of the coagulation cascade is most likely to be missing in this child?

A 31-year-old male complains of such difficulty in chewing that he no longer buys gum. He also describes diplopia when reading or watching television for long periods. He has no extremity weakness. He has no other medical problems and takes no medication. He does not use tobacco, alcohol or illicit drugs. This patient's condition is most likely associated with which of the following neoplastic processes

"45 year old woman patient has had menometrorrhagia for the past 1.5 months. She has no history of prior irregular menstrual bleeding, and she has not yet reached menopause. On physical examination, there are no vaginal or cervical lesions, and the uterus appears normal in size, but there is a right adnexal mass. An abdominal ultrasound scan shows the presence of a 6.5-cm solid right adnexal mass. Endometrial biopsy shows hyperplastic endometrium, but no cellular atypia. What is the most likely lesion that underlies her menstrual abnormalities?"

Which of the following anemia profiles is typical of thalassemia?

The most fibrogenic dust in pneumoconiosis is

Which of the following conditions is characterized by findings of giant rugal hypertrophy, thickened gastric mucosa, excessive mucus production, hypoproteinemia and hypochlorydia

A 45-year-old man presents with long-standing heartburn and dyspepsia. An X-ray film of the chest shows a retrocardiac, gas-filled structure. This patient most likely has which of the following conditions?