Pace Quiz 1 Part 2

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| By Chachelly
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Pace Quiz 1 Part 2 - Quiz

Questions and Answers
  • 1. 

    A 63-year-old man presents to your office with the following lesion. The biopsy of this large ulcerated area confirmed a squamous cell carcinoma. Where would the cancer cells from this lesion directly metastasize to? 

    • A.

      Superficial inguinal nodes

    • B.

      Deep inguinal nodes

    • C.

      Internal iliac nodes

    • D.

      Lumbar nodes

    • E.

      External iliac nodes

    Correct Answer
    B. Deep inguinal nodes
    Explanation
    The cancer cells from this lesion would directly metastasize to the deep inguinal nodes. This is because the deep inguinal nodes are the primary drainage pathway for lymphatic fluid from the lower extremities, including the area where the lesion is located. Squamous cell carcinoma is known to spread via lymphatic channels, and the deep inguinal nodes are the first lymph nodes along this pathway.

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  • 2. 

    The cell type at the arrow contains what chromosome and chromatid number?

    • A.

      23, 1N

    • B.

      46, 2N

    • C.

      None, it is a Sertoli cell

    • D.

      46, 4N

    • E.

      A & B

    • F.

      B & C

    Correct Answer
    F. B & C
    Explanation
    The cell type at the arrow contains 46 chromosomes and a chromatid number of 2N. This means that the cell is diploid, with two sets of chromosomes, and each chromosome is replicated and consists of two chromatids.

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  • 3. 

    I am a structure in the male reproductive tract.  I am composed of tubuloalveolar glands and I secrete a clear mucous-like secretion that helps to coat the urethra to prepare for ejaculation.  What am I?

    • A.

      Ejaculatory duct

    • B.

      Bulbourethral gland

    • C.

      Seminal vesicle

    • D.

      Prostate gland

    • E.

      Epididymis

    Correct Answer
    B. Bulbourethral gland
    Explanation
    The correct answer is the Bulbourethral gland. This gland is located in the male reproductive tract and is composed of tubuloalveolar glands. It secretes a clear mucous-like secretion that helps to coat the urethra in preparation for ejaculation.

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  • 4. 

    The BCR-ABL gene is involved in causing:

    • A.

      Alzheimer in Down syndrome

    • B.

      The specific sound of the cry in Cri-du-Chat

    • C.

      Cell growth in leukemias

    • D.

      Polydactyly in Patau syndrome

    • E.

      Hyperactivity in XYY syndrome

    Correct Answer
    C. Cell growth in leukemias
    Explanation
    The BCR-ABL gene is involved in causing cell growth in leukemias. This gene is a fusion gene that results from a translocation between chromosomes 9 and 22. The fusion protein produced by this gene has uncontrolled tyrosine kinase activity, which leads to the abnormal growth and division of white blood cells, characteristic of leukemias. This gene is particularly associated with chronic myeloid leukemia (CML), where it plays a crucial role in the pathogenesis of the disease. Inhibitors targeting the BCR-ABL protein, such as imatinib, have revolutionized the treatment of CML.

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  • 5. 

    The following pedigree shows a family segregating for Duchenne Muscular Dystrophy (DMD).  Individual II-1 was found to have a deletion of exons 45-48 of the dystrophin gene.  Individual II-3 is currently pregnant with a boy. She shows an elevated CK but she tested negative for this mutation (exon 45-48).  The risk for the pregnancy III-2 to have DMD is closest to?

    • A.

      0%

    • B.

      10%

    • C.

      50%

    • D.

      75%

    • E.

      100%

    Correct Answer
    A. 0%
  • 6. 

    Although II-3 tested negative for the mutation seen in her brother, the physician is concerned regarding the persistent CK level of II-3.  The pregnancy was tested again and showed a deletion of exon 45-48 considered consistent with being affected with DMD. The most likely explanation is?

    • A.

      Laboratory error in the testing of II-3

    • B.

      Non maternity

    • C.

      Non paternity

    • D.

      Somatic mosaicism of III-2

    • E.

      De Novo mutation in III-2

    Correct Answer
    A. Laboratory error in the testing of II-3
    Explanation
    The most likely explanation is that there was a laboratory error in the testing of II-3. This is supported by the fact that II-3 initially tested negative for the mutation seen in her brother, but the subsequent pregnancy test showed a deletion of exon 45-48 consistent with being affected with DMD. The inconsistency between the two test results suggests a possible error in the laboratory testing process for II-3.

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  • 7. 

    A 33 year old man presents to a clinic complaining of infertility.  He previously fathered a child with another woman, but explains that he and his wife have been having unprotected intercourse for the past 14 months and have been unable to get pregnant.  Multiple semen analyses taken two weeks apart reveal oligospermia (sperm count 40,000 sperm/mL) with normal motility.  Testosterone levels are in the normal range.  Which hormone is most likely reduced in this man? 

    • A.

      Luteinizing hormone

    • B.

      Prolactin

    • C.

      Gonadotropin releasing hormone

    • D.

      Dihydrotestosterone

    • E.

      Follicle stimulating hormone

    • F.

      B & D

    • G.

      D & E

    Correct Answer
    G. D & E
    Explanation
    FSH is the best answer. but...
    Explanation: Testosterone and FSH are the hormones that predominantly regulate spermatogenesis. Intra-testicular levels of testosterone are approximately 100 fold higher than DHT. First, recognize that testosterone (produced in the Leydig cells) binds with the androgen receptor (AR) on the Sertoli cells – and therefore directly regulates Sertoli cell function. Recognize that testosterone is acting DIRECTLY on the AR in the Sertoli cells, and therefore only a small portion of this intra-testicular testosterone is converted to DHT. FSH also binds to the FSH receptor on the Sertoli cell, and the cumulative actions of testosterone and FSH collectively regulate spermatogenesis. Thus, although DHT is produced in the Sertoli cells, it is the actions of testosterone (acting through the AR on the Sertoli cell) that is the primary androgen regulating spermatogenesis.
    I decided to accept DHT as an answer for a few reasons:
    1. Testosterone is converted via 5 alpha reductase (5ARD) to DHT in the Sertoli cells – and this is a highly efficient process – BUT- the majority of testosterone is bound to the AR. However, this DHT then binds to the AR in Sertoli cells or, the DHT is secreted into the tubular fluids. In essence, we do not know the exact role of DHT in the tubular fluids, and the administration of DHT inhibitors DO NOT (in most studies) reduce sperm count – but instead, those DHT inhibitors reduce sperm motility. Thus – in this particular question/answer – because sperm motility was not impaired, DHT would not be a correct answer.
    2. Additionally, the man (in this particular question) may have a deficiency in 5ARD which would reduce intra-testicular production of DHT. Although the exact role of DHT within the tubular fluids is not known (as mentioned above), there are a few reports and some evidence that indicate individuals with 5ARD deficiency present with decreased sperm count, with a higher percentage of abnormal sperm. As you might expect – the lack of DHT also renders the sperm immotile in 5ARD deficient individuals.

    Collectively though, please recognize that testosterone and FSH are the primary endocrine hormones that regulate spermatogenesis.

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  • 8. 

    A 28 year old woman visits the gynecologist complaining of irregular menstrual cycles.  Her cycles over the past year have been occurring every 7-10 weeks.  Menstrual bleeding lasts for 3-5 days and there is no associated pain.  Plasma levels of estradiol and progesterone are in the normal range for the luteal phase of the menstrual cycle.  Urinalysis is negative for chorionic gonadotropin (hCG); pelvic exam is unremarkable.  Which one of the following descriptions best defines this woman’s menstrual periods?

    • A.

      Oligomenorrhea

    • B.

      Dysmenorrhea

    • C.

      Amenorrhea

    • D.

      Polymenorrhea

    • E.

      Menorrhagia

    Correct Answer
    A. Oligomenorrhea
    Explanation
    This woman's menstrual periods can be defined as oligomenorrhea. Oligomenorrhea refers to infrequent menstrual cycles, with intervals longer than 35 days. In this case, the woman's cycles are occurring every 7-10 weeks, which is significantly longer than the normal 28-day cycle. The fact that her plasma levels of estradiol and progesterone are normal for the luteal phase of the menstrual cycle suggests that ovulation is occurring, but at irregular intervals.

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  • 9. 

    During which phase of the menstrual cycle does estrogen concentration increase markedly to stimulate the release of the gonadotropins?

    • A.

      Mid proliferative

    • B.

      Mid secretory

    • C.

      Late secretory

    • D.

      Menses

    • E.

      Late proliferative

    Correct Answer
    E. Late proliferative
    Explanation
    During the late proliferative phase of the menstrual cycle, estrogen concentration increases markedly. This increase in estrogen stimulates the release of the gonadotropins, which are hormones responsible for the development and maturation of the ovarian follicles. This phase occurs after the menses phase, when the uterine lining is shed, and before the mid-secretory phase, when the uterine lining thickens in preparation for potential implantation.

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  • 10. 

    A 62-year-old man complains to his physician that he frequently feels the urge to urinate, but then he has trouble starting the flow and is sometimes troubled by dribbling when he has finished urinating. His prostate gland is found to be significantly enlarged, and following additional tests, benign prostatic hyperplasia is diagnosed. The physician prescribes a drug to help prevent further enlargement of the prostate and possibly to help reduce the size. Which of the following drugs was most likely prescribed?

    • A.

      Testosterone enanthate

    • B.

      Flutamide

    • C.

      Leuprolide

    • D.

      Finasteride

    • E.

      Medroxyprogesterone

    Correct Answer
    D. Finasteride
    Explanation
    Finasteride is the most likely drug prescribed in this case. It is a medication commonly used to treat benign prostatic hyperplasia (BPH), which is characterized by an enlarged prostate gland. Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to prostate enlargement. By reducing DHT levels, finasteride can help prevent further enlargement of the prostate and may even help reduce its size. This drug is frequently prescribed for patients with BPH to alleviate urinary symptoms such as frequent urination, difficulty starting urination, and dribbling after urination.

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  • 11. 

    A 25-year-old woman is conferring with her gynecologist regarding treatment options for debilitating endometriosis.  She wishes to have children in the future and hopes to get her endometriosis under control without further compromising her fertility. They decide to try depot injections of leuprolide for the next 6 months and then re-evaluate the condition.  In addition, the physician prescribes a low dose combined oral contraceptive preparation. What is the most likely reason for adding the low-dose OC?

    • A.

      To prevent pregnancy during exposure to leuprolide

    • B.

      To maintain normal menstrual periods

    • C.

      To maintain body weight

    • D.

      To prevent hypotension

    • E.

      To prevent bone loss

    Correct Answer
    E. To prevent bone loss
    Explanation
    The most likely reason for adding the low-dose oral contraceptive (OC) is to prevent bone loss. Leuprolide, a gonadotropin-releasing hormone (GnRH) agonist, is known to cause estrogen deficiency, which can lead to bone loss and osteoporosis. By prescribing a low-dose OC, the physician can provide exogenous estrogen, which helps maintain bone density and prevent bone loss. This is especially important for the patient who wishes to have children in the future and wants to minimize the impact of endometriosis treatment on her fertility and overall health.

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  • 12. 

    In the accompanying photomicrograph of the ovary, the structures indicated by the pointer produce which of the following hormones?

    • A.

      Androstenedione

    • B.

      Estrogen

    • C.

      LH

    • D.

      Progesterone

    • E.

      HCG

    Correct Answer
    A. Androstenedione
    Explanation
    The structures indicated by the pointer in the photomicrograph of the ovary produce androstenedione.

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  • 13. 

    The structures indicated by the pointer in the accompanying photomicrograph can be derived from which of the following structures? (Choose the one best answer)

    • A.

      Primordial, primary follicles and secondary follicles

    • B.

      Primordial, primary, secondary, Graafian follicles, corpus luteum

    • C.

      Primordial, primary, secondary, and Graafian follicles (*)

    • D.

      Primordial, primary, secondary, Graafian follicles, corpus luteum, and corpus albicans

    • E.

      Primordial, primary, secondary, Graafian follicles, corpus luteum, corpus albicans, and interstitial glands

    Correct Answer
    C. Primordial, primary, secondary, and Graafian follicles (*)
    Explanation
    The structures indicated by the pointer in the photomicrograph can be derived from primordial, primary, secondary, and Graafian follicles.

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  • 14. 

    Which of the following characterizes the changes in the endometrium in the luteal phase of the menstrual cycle?

    • A.

      Ischemia and necrosis of the stratum functionale

    • B.

      Influenced mainly by progesterone

    • C.

      Starting upon arrival of ovulation

    • D.

      Presence of straight tubular glands

    • E.

      Necrosis and sloughing off of the endocervix

    Correct Answer
    B. Influenced mainly by progesterone
    Explanation
    The correct answer is "Influenced mainly by progesterone". During the luteal phase of the menstrual cycle, the endometrium undergoes changes in response to increased progesterone levels. Progesterone stimulates the development of the secretory glands in the endometrium, preparing it for potential implantation of a fertilized egg. If fertilization does not occur, progesterone levels decrease, leading to shedding of the endometrium during menstruation.

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  • 15. 

    A syndrome is known to cause excessive height, reduced IQ, and the cells exhibit 2 Barr bodies. Which karyotype is compatible with the above description?  

    • A.

      45X

    • B.

      47XXX

    • C.

      46XX, del(5p)

    • D.

      47XXY

    • E.

      47XYY

    Correct Answer
    B. 47XXX
    Explanation
    Pay close attention to the TWO barr bodies. while the XXY can give excessive height, there would ABSOLUTELY not be TWO barr bodies.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 19, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Mar 28, 2012
    Quiz Created by
    Chachelly
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