Part 1: Renal System and Male reproductive System

1. The activation of angiotensin does which of the following:

a. Vasoconstriction b. Increase the resorption of sodium and water c. Increase blood volume d. Decrease blood volume

2. A 56 year old male presents to the clinic with the following complaints: increased urgency and frequency of urination, fever, malaise. Urinalysis reveals cloudy urine with white blood cells and bacteria present. Which of the following is a likely diagnosis?

a. Benign prostatic hypertrophy b. Chlamydia c. acute bacterial prostatitis d. Prostate cancer

3. A 32-year-old man comes to his physician complaining of frequency, dysuria, and urgency for several days, as well as pain in the perineal region. The digital rectal examination is extremely painful. He most likely has

A. A primary chancre of syphilis in his genital organs B. A bladder infection C. Pyelonephritis D. Kidney stones
E. Acute prostatitis

4. One of the kidneys of an 18-month-old girl is removed because she has had repeated urinary tract infections. The kidney is smaller than normal and contains many cysts. Microscopic examination shows poorly developed and disorganized glomeruli, and tubules and islands of cartilage in the cortex. The renal pelvis, calyces, and proximal ureter are dilated. The other kidney appears entirely normal. This condition is called

A. Potter’s syndrome B. Infantile polycystic kidney disease C. Horseshoe kidney D. Renal agenesis
E. Renal dysplasia

5. Which of the following patients is not at increased risk for developing a urinary tract infection?

A. A 73-year-old, demented man with an indwelling urinary catheter
B. A 25-year-old, recently married woman
C. A 2-year-old boy with ureteral reflux
D. An 82-year-old man with severe prostatic hypertrophy
E. A 70-year-old man with prostatic carcinoma

6. A 56-year-old man has a hard, irregular lump in the posterior lobe of his prostate. Which of the following signs or symptoms would most likely be present?

A. Elevated prostate specific antigen B. Hematuria C. Casts in the urine
D. Urinary frequency E. Dysuria

7. A 69-year-old man presents to the clinician complaining of unilateral flank pain and hematuria for several weeks. He does not have a fever. The physician can palpate a mass in the patient’s right flank. The best way to diagnose this patient’s condition is:

A. Cystoscopy B. Intravenous pyelogram C. Cytologic examination of urine
D. CT scan E. Digital rectal exam

8. The most common causes of dialysis-dependence in the United States are

A. Urinary tract infection and pyelonephritis B. Membranous and mesangial nephropathy due to systemic lupus erythematosus
C. Hypertension and diabetes D. Congenital conditions such as polyceptic kidney disease
E. Various types of renal cell carcinomas

9. All of the following are treatments for urolithiasis except:

I. Large volumes of water II. Lithotripsy III. Pain medications IV. Ultrasound

a. I and II b. II and III c. I and III d. I, II, and III e. All of the above

10 Functions of the nephron include all of the following except

A. Reabsorption of urea nitrogen B. Fluid homeostasis C. Maintaining electrolyte balance
D. Regulation of blood pressure E. Maintaining blood pH

Part 2: Female Reproductive System

1. A 24-year-old female presents to the clinic with complaints of headache, a rash on her palms, soles, and mucus membranes. Which of the following is a likely diagnosis?

A. secondary syphilis B. Chlamydia C. Gonorrhea D. Pelvic inflammatory disease

2. A 22-year-old female presents to the clinic with complaints of vaginal itching and pain, and thick cottage cheese like discharge. Which of the following is a likely diagnosis?

A. Trichomoniasis B. Candidiasis C. Herpes simplex virus D. Human papillomavirus

3. Meigs syndrome is the occurrence of ascites and right-sided hydrothorax associated with which of the following:

A. Teratoma B. Leiomyoma C. Fibrothecoma D. Leukoplakia

4. A 71-year-old woman who has never been pregnant and always had normal Pap tests notices spotty vaginal bleeding. Work-up is performed and a biopsy reveals cancer. Which is she most likely to have?

A. Stage I endometrial carcinoma B. Stage IV cervical carcinoma C. Stage I ovarian cancer
D. Stage III endometrial carcinoma E. Stage I vulvar carcinoma

5. A 36-year-old woman, following an evaluation for infertility, is told that her fallopian tubes have excessive scar tissue, thus not allowing the ovum to travel to the uterus at the time of ovulation. This is most likely due to remote:

A. Ovarian cyst B. Herpes infection C. Gonorrhea D. Trichomoniasis E. Syphilis

6. A 56-year-old, otherwise perfectly healthy woman comes to the doctor complaining of vulvar itching. Which of the following is the most likely cause?

A. Trichomoniasis B. Lichen simplex chronicus C. Squamous cell carcinoma
D. Herpes simplex virus E. Candidiasis

7. A 26-year-old woman who is otherwise healthy and has normal menstrual cycles complains of diffuse pelvic pain that is worse during menstruation. She also has recently developed pain with defecation and sexual intercourse. An ultrasound reveals a large cyst on one of her ovaries. This cyst is likely

A. A malignant serous carcinoma B. Pseudomyxoma peritonei C. A teratoma
D. An endometrioma E. A benign fibroma

8. A 36-year-old woman, following an evaluation for infertility, is told that her fallopian tubes have excessive scar tissue, thus not allowing the ovum to travel to the uterus at the time of ovulation. This is most likely due to remote:

A. Ovarian cyst B. Herpes infection C. Gonorrhea D. Trichomoniasis E. Syphilis

9. A 45-year-old woman is being evaluated for dysfunctional uterine bleeding. Pelvic examination reveals a large, lumpy uterus. According to the patient’s medical record, a large, lumpy uterus was noted at her last pelvic examination five years earlier. The most likely diagnosis is:

A. Uterine carcinoma B. Leiomyomata C. Cervical carcinoma D. Pregnancy
E. Polycystic ovary disease

10. An obese, 28-year-old with hirsutism, irregular menstrual cycles, and a history of gonorrhea infection is being evaluated for infertility. Which of the following conditions is least likely to be contributing to her infertility?

A. Pelvic inflammatory disease B. Endometriosis C. Obesity D. Leiomyomata
E. Polycystic ovary disease

Part 3: Breast

1. Which of the following are risk factors for the development of breast cancer?

I. Exogenous estrogen therapy II. Early menarche III. Late menopause IV. Not breast-feeding
V. Obesity

A. I, III, and V B. II, III, and IV C. II, III, and V D. I, II, and III E. All of the above

2. A 36-year-old woman who had her last baby six years ago develops milky secretions from both her nipples. She is not pregnant and has no other health problems. Which of the following is the most likely diagnosis?

A. Pituitary tumor B. Fibroadenoma C. Intraductal papilloma D. Breast cancer E. Duct ectasia

3. A 30-year-old woman is breast-feeding her newborn infant. One of her breasts becomes red, swollen and very tender, and she develops fever. Which of the following statements is most correct?

A. She has developed inflammatory breast cancer.
B. She should be treated with antibiotics.
C. She should discontinue breast feeding, and the changes will go away on their own.
D. She should consult a lactation specialist to help the baby latch on to the nipple better.
E. The condition will likely recur if she continues to breast feed.

4. A 45-year-old woman has a breast biopsy of a 2 cm in diameter lump. The pathologist makes a diagnosis of fibrocystic disease. The microscopic finding that predicts later development of cancer is

A. Ductal hyperplasia B. Large cysts C. Excessive adipose tissue D. Larger than normal lobules E. Lactational change.

5. A 27-year-old woman whose grandmother, mother, and older sister have all died of breast or ovarian carcinoma is contemplating starting a family. She should be advised that

A. she should have had bilateral mastectomy and oophorectomy at puberty to prevent the development of cancer in these tissues.
B. she should not have children because increased estrogen levels during pregnancy and lactation will stimulate the growth of cancer.
C. she should adopt, so that she doesn’t transmit her bad genes to the next generation.
D. testing for genes known to impart a greater risk for breast cancer is available, and knowing for sure that she is a carrier of the gene will help her with decision-making.
E. she does not need to start screening for breast cancer earlier than the general population because screening modalities are not effective in detecting breast cancer in young women.

6. Which of the following statements about breast cancer in men is correct?

A. The lifetime risk is the same as for women
B. It is usually lobular carcinoma
C. It can occur in familial cancer syndromes
D. It usually occurs at the same age as testicular cancer
E. It is more common than melanoma skin cancer

Part 4: Skin

1. A child presents to the clinic with chief complaint of flaccid bullae on her face that have ruptured and formed a crust. The mother reports there are several children at the daycare with similar lesions. Which of the following is a likely diagnosis?

a. Candidiasis b. Tinea c. Treponema pallidum d. Impetigo

2. A life-threatening skin infection caused by a severe drug reaction is:

a. Candidiasis b. Treponema pallidum c. Toxic epidermal necrolysis d. Eruptive xanthoma

3. A patient presents at the clinic with large, raised, papillated, dry lesion on the plantar surface of the left foot. He says he has been watching it grow for a while and it has been painful from time to time. This growth is cause by

a. S. aureus b. P. acnes c. Human papillomavirus d. all of these

4. A patient reports to the clinic complaining of patchy, red, raised edematous areas that itch. The patient does not currently have any, but states it happens periodically, and they last for about a day before fading. The clinician diagnoses the patient with urticaria. Which of the following is responsible for these lesions?

a. Histamine release b. Malassezia furfur yeast exposure c. Long exposure to sunlight d. Emotional stress

5. A 19 year old woman is seen by a dermatologist for red crusty lesions on her neck wrists and the backs of her knees. Other members of her family have a similar affliction. Which of these is most likely the correct diagnosis?

a. impetigo b. acne c. contact dermatitis d. eczema

6. A 35 year old man is treated by UV light for a chronic skin rash characterized by patches of thickened skin with silver scales on the knees and elbows. Which condition is mostly his problem?

a. urticarial b. seborrheic keratosis c. psoriasis d. atopic dermatitis

7. Mrs. Collins was born with a rare condition called xeroderma pigmentosum. Which of these activates should she avoid?

a. using a tanning bed b. swimming in an indoor pool c. swimming in salt water d. playing basketball

8. Uncle Fred returns from the dermatologist with news that he has skin cancer but he can’t remember what type. You examine the lesion to find it is a papule with an ulcer in the center. What type of skin cancer does Uncle Fred heave?

a. melanoma b. basal cell carcinoma c. squamous cell carcinoma d. nevus

9. During your shift at the rural health clinic a young boy is brought in by his mother. The child has a red, scaly rash formed into rings in his hair. What is the most probably diagnosis?

a. Tinea cruris b. Tinea pedis c. Tinea capitis d. Tinea barbae

10. Mr. Akers is a 68 year old male in good health. He comes to the clinic complaining of severe pain, burning sensation, and numbness but itchy rash. The rash is located at his waist and is in a belt-like shape on the right side. The rash is beginning to scab. Looking at his medical history you note that he had chicken pox as a child as well as measles, rubella and mumps. What is the most probable diagnosis?

a. dermatitis b. shingles c. acne d. epidermal necrosysis

Part 5: Bones and Joints

1. Concerned parents bring their infant to the clinic saying the child has been crying inconsolably for hours. Physical exam reveals the infant cries harder when palpating the clavicular region, and note the infant has blue tinged sclera. X-ray reveals a broken clavicle. The parents can offer no explanation. Which of the following is a likely diagnosis?

A. Marfan Syndrome B. Osteogenesis imperfecta C. Child abuse D. Achodroplasia

2. A patient presents to the emergency department with complaint of sudden chest pain and shortness of breath. Physical exam reveals a tall, thin male with pectus excavatum (a sunken sternum). Which of the following is a likely diagnosis?

a. Spontaneous pneumothorax in a patient with Marfan syndrome
b. Spontaneous pneumothorax in a patient with achondroplasia
c. Spontaneous pneumothorax in a patient with osteogenesis imperfecta
d. Spontaneous pneumothorax in a patient with torticollis

3. A 48-year-old male presents to the clinic with complaints of joint stiffness. X-rays reveals new bone formation with lipping. Which of the following is a likely diagnosis?

a. Osteomalacia b. Rheumatoid arthritis c. Degenerative arthritis d. Gout

4. Baby Jonie is born with one foot turned equino, varus, metatarsus adductus and cavus deformity. She has

a. dysplasia of the hip b. clubfoot c. torticollis d. achondroplasia

5. Her twin brother Joseph is born with a genetic mutation of the FGRF 3. He has

a. dysplasia of the hip b. clubfoot c. torticollis d. achondroplasia

6. Andrew is 10 years old and loves to climb trees. Andrew fell while climbing his favorite magnolia tree and broke his ulna. The x-ray reveals that the injured ulna is broken into 4 small pieces. What type of fracture is this?

a. incomplete b. complete c. comminuted d. compression

7. Four days later Andrew’s great grandmother, Memaw, tripped over her kitty, Precious, fell, and broke the neck of her right femur. Given her age, which of the following probably contributed to Memaw’s fracture?

a. osteomyelitis b. osteoporosis c. osteomalacia d. septic arthritis

8. Michelle is taking a conducting class at ETBU. Her professor suggests that she video herself while conducting. Michelle notices that she is awkwardly bent at the hips and shoulders. Which problem of the spine is the most likely cause of her posture?

a. kyphosis b. compression fracture of vertebra c. herniated intervertebral disc d. scoliosis

9. Rheumatoid factor is an antibody directed against

a. the pannus b. immunoglobulin G c. the synovium d. joint cartilage

Part 6: Muscles and Nerves

1. A difference between Duchenne Dystrophy and myotonic dystrophy is:

A. Duchenne dystrophy is an autosomal dominant disease, while myotonic dystrophy is sex-linked
B. Myotonic dystrophy is an autosomal dominant disease, while Duchenne dystrophy is sex-linked
C. Duchenne is characterized by progressive weakness
D. Myotonic dystrophy features the replacement of muscle by adipose and fibrous tissue

2. In which disease are antibodies against the acetylcholine receptor found in serum?

A. Guillain-Barre B. Werdnig-Hoffman C. Myasthenia gravis D. Rhabdomyosarcoma

3. A patient presents to the emergency department with new onset paralysis in the peripheral limbs. The patient reports they recovered from a viral illness the previous week. Which of the following is a likely diagnosis?

A. Guillain-Barre B. Werdnig-Hoffman C. Myasthenia gravis D. Rhabdomyosarcoma

4. A patient presents to the clinic with complaint of weakness, pain, and tenderness. Laboratory exam reveals elevated creatine kinase levels, and a muscle biopsy reveals lymphocytic infiltration of muscle fibers. Which of the following diagnoses is likely?

A. Guillain-Barre B. Polymyositis C. Amyotrophic Lateral Sclerosis D. Myasthenia Gravis

5. A patient presents to the emergency department with new onset paralysis in the peripheral limbs. The patient reports they recovered from a viral illness the previous week. Which of the following is a likely diagnosis?

a. Guillain-Barre b. Werdnig-Hoffman c. Myasthenia gravis d. Rhabdomyosarcoma

6. A patient presents to the clinic with complaint of weakness, pain, and tenderness. Laboratory exam reveals elevated creatine kinase levels, and a muscle biopsy reveals lymphocytic infiltration of muscle fibers. Which of the following diagnoses is likely?

a. Guillain-Barre b. Polymyositis c. Amyotrophic Lateral Sclerosis d. Myasthenia Gravis

7. Your nephew Justin has been diagnosed with pseudohypertrophic muscular dystrophy. Which type of muscular dystrophy is he most likely to have?

a. Duchenne b. myotonic c. congenital d. neurogenic

8. Justin has a twin sister, Caroline. Is she likely to succumb to the same condition as Justin?

a. yes b. no c. maybe d. depends on what she eats

9. Lexi strained her gastrocnemius muscle while chasing Jeremy around the student center. What type of injury is this?

a. joint injury b. pulled muscle c. pulled ligament d. broken bone

10. Fernando comes into the clinic complaining of muscle weakness in his shoulders, soreness, and pain since chopping a cord of wood. Blood serum studies show normal CBC with normal distribution of WBC. Serum creatine kinase is elevated but all other blood chemistries are normal. You decided to do an electromyographic study . The results are “asynchronous spontaneous activity” in the right shoulder. Which is most likely the source of his discomfort?

a. myopathic damage b. neurogenic damage c. myotonia d. none of these.