1.
Which of the following is the most important prognostic factor in breast cancer?
Correct Answer
A. LympH node involvement
Explanation
As reported in the MDC on Feb 6, 2009. 11min 40s
2.
A 12 year old boy suddenly doubles over in pain while watching TV, complaining of pain in his scrotum. Which of the following most accurately describes the situation?
Correct Answer
C. He has torsion of the testis, which requires prompt surgery
Explanation
Torsion of the testis primarily affects adolescent boys and is the result of an anatomic abnormality that allows for increased mobility of the testes. This is an emergency requiring treatment within 6 hours to preserve the testis. No other choice provides a reasonable explanation for the sudden onset of pain.
3.
In females, where would you most likely find the highest concentrations of aromatase, which catalyzes the production of estradiol?
Correct Answer
B. Granulosa cells
Explanation
In the female, theca cells produce testosterone which moves into the granulosa cells to be converted into 17-beta-estradiol by aromatase.
4.
A young couple comes to you asking about the benefits of tracking the woman's body temperature to predict fertile days. Which of the following statements is most accurate?
Correct Answer
D. Body temperature follows a similar pattern to progesterone (baseline during the follicular pHase and highest levels in the luteal pHase)
Explanation
Body temperature is lowest in the follicular phase and begins to rise roughly at the time of ovulation. It peaks during the luteal phase, similar to progesterone. In fact, progesterone is thought to act on the hypothalamus to cause this change. Costanzo has a nice image of these changes.
5.
During a normal menstrual cycle at the peak of LH, which of the following would you least expect?
Correct Answer
E. Decrease in cervical mucus
Explanation
The increase LH is the cause of ovulation. There is a concomitant increase in FSH. Meanwhile, estrogen is decreasing and progesterone is just starting to increase. If you were unsure, the process of elimination should have left you with E as the only possible answer. What typically happens is an increase in cervical mucus which is more receptive to sperm, allowing for increased fertility. Some family planning methods rely on observation of the cervical mucus.
6.
The loss of the endometrium is caused predominantly by decreases in which two hormones?
Correct Answer
G. C & D
Explanation
LH and FSH are not true since their levels peak 14 days before the onset of menses and are virtually at baseline levels 10-12 days before menses. Estradiol and progesterone, on the other hand, do not reach low levels until menses begins.
7.
Ductal carcinoma in situ is most likely to be detected as which of the following?
Correct Answer
D. Incidental finding on biopsy
Explanation
Check Robbins 7th pg 1123 and 1124 DCIS is the most associated with calcifications.
8.
You detect numerous calcifications on a routine mammography on a 40 year old woman. Which of the following is not on the differential?
Correct Answer
E. Actually, all of the above are reasonable causes of calcification
Explanation
Robbins 7th 1124 Many things can cause calcifications: secretory material, necrotic debris, and hyalinized stroma. Of course, cancer, such as invasive carcinoma, is high on the list. Routine mammograms typically begin at age 40.
9.
A baby boy is delivered by caesarian section at 32 weeks because of oligohydraminos. Which of the following features are you least likely to find in the baby?
Correct Answer
D. Birth weight of 2500 grams
Explanation
The most common cause of oligohydraminos is an amniotic leak, although it often occurs from renal agenesis, obstructed ureters, cystic kidneys, etc. Oligohydraminos results in features from the baby being squeezed by the uterus: flattened face, low set ears, and club feet. Without sufficient amniotic fluid, the lungs do not develop properly. Hypoplasia and deficient surfactant production (made of phospholipids) will result. Answer D is correct because we would not expect a "normal" birth weight of 2500 grams (or about 5.5 pounds) at 32 weeks, even in the absence of oligohydraminos. Another good question would be "what is the most likely cause of death after a baby is delivered after an extended period of oligohydraminos"? The baby would die from IRDS.
10.
An autopsy is performed on a 4 month old baby that was found dead in his crib sleeping on his stomach. The baby was previously healthy, although he was born 3 week premature. Autopsy findings include periadrenal brown fat, hepatic hematopoiesis, congested lungs without edema, and petichiae on the parietal pleura. What was the cause of death?
Correct Answer
B. SIDS (Sudden Infant Death Syndrom)
Explanation
All of the findings listed in the question are common in SIDS. SIDS affects children within the first six months of life. It is associated with many factors, perhaps most importantly sleeping in the prone position. Other risk factors include second hand smoke, recent upper respiratory tract infection, prematurity, and low socioeconomic standing. Although many factors play a role, Robbins suggests that the fundamental abnormality is in the arcuate nucleus, which normally arouses the body if stressed during sleep (7th ed pg 497).
11.
Which of the following is least likely to produce precocious puberty?
Correct Answer
D. Teratoma
Explanation
Only teratomas are not associated with excessive hormone production. Teratomas are common germ cell tumors of the ovary that are usually benign.
12.
Which of the following plays the largest role in maintaining the blood-testis barrier?
Correct Answer
C. Sertoli cell
Explanation
The occluding junctions between Sertoli cells play a crucial role in maintaining the barrier. Spermatogonia lie on the basal compartment below the blood-testis barrier. As divisions occur, cells move past the basal compartment and move into the adluminal compartment. (Junqueira et al. Basic Histology, 11th Ed pgs 426, 427)
13.
Which of the following is not true regarding breast density in mammography?
Correct Answer
B. Lactating women tend to have lower density breast tissue
Explanation
When lactating the breast is filled with fluid, which appears dense (white) in mammography. Fat appears black. Younger women and lactating women tend to have the densest breasts.
14.
Which of the following is not true about the BI-RADS (Breast Imaging Reporting and Data System)
Correct Answer
E. Actually, all of the above are true
Explanation
The BI-RADS is a "quality assurance guide" that covers all of the features listed in the question. Source: frequently asked questions about BI-RADS on the American College of Radiology website
15.
Primary spermatocytes are derived from:
Correct Answer
A. Spermatogonia
Explanation
The primary spermatocytes come from type B spermatogonia, and are undergoing the first meiotic division.
16.
Where it is thinnest, the barrier between maternal blood and fetal blood consists of all except:
Correct Answer
D. Hofbauer cells
Explanation
Synctiotrophoblasts provide the immunologic protection for the fetus by shrouding the villus in a placenta. The Hofbauer cell is essentially a macrophage in the villus.
17.
Where is the male reproductive tract will you most likely find true cilia?
Correct Answer
C. Efferent duct
Explanation
Only the efferent duct expresses cilia. They are identified by their star-like shape. The epididymis and ductus deferens do exhibit stereocilia, but these are microvilli, not true cilia. The epididymis and ductus deferens moves sperm via peristalsis. Therefore, we expect to see more smooth muscle lining these structures than the efferent duct.
18.
What structure in the male reproductive tract provides secretions that allow sperm to be motile?
Correct Answer
D. Epididymis
Explanation
The epididymis provides the secretions that allow for the sperm to be motile. The epididymis is made of pseudostratified columnar epithelium with microvilli.
19.
Which of the following women has the greatest chance of developing breast cancer?
Correct Answer
A. 75 year old woman in good health
Explanation
The 75 year old woman has a 17 fold increased risk of developing cancer since she is over 70. The other three present with mild risk factors (~1.5x chance). These risks are age of menarche less than 12, post-menopausal estrogen, and BMI greater than 31.
20.
Which of the following contains a secondary oocyte? (there may be more than one answer)
Correct Answer
E. Graafian follicle
Explanation
Seems like a good test question. Source: Dr. Nichols lecture on Histo of the Female slide 4. Although, after looking at slide 9 in his lecture it looks like D could also be correct.