Lecture Final Review

Question 1

New parents of an otherwise healthy baby boy are concerned when they notice a tiny opening on the dorsal aspect of their child’s penis. Urine is seen to dribble from this opening and their obstetrician indicates that a corrective surgery is necessary.
What is the most appropriate term given to this condition?

Answer 1

Epispadiasis

Question 2

A 32-year-old sexually active female has been experiencing lower abdominopelvic pain for a few months. She is spotting and has not had a period in about two months’ time. Her gynecologist performs an ultrasound and multiple fluid filled lucencies within the uterus are discovered. They measure approximately 1cm in diameter. She is told that they will need to go in surgically to remove the excess tissue.
What is most likely the diagnosis in this case?

Answer 2

Hydatidiform mole

Question 3

A 15-year-old female embarrassingly admits to her mother that she is developing a lump near her armpit. Worried, she makes an appointment for her daughter to see a pediatrician. After palpation of the axillary region on the left-hand side, the doctor suggests a fine needle aspiration. Results demonstrate a normal pattern of glands resembling the terminal duct lobular unit.
What is the most likely diagnosis?

Answer 3

Polymastia

Question 4

Of the following choices, which conditions were discussed in this last unit of study which would present with “keratin pearls”? Choose all that apply

• Cervical carcinoma
• Renal cell carcinoma
• Bladder carcinoma
• Ovarian carcinoma
• Seminoma
• Prostatic carcinoma
• Mucinous carcinoma of the breast
• Sarcoma botryoids
• Verrucous carcinoma of the penis
• Scrotal carcinoma

Answer 4

• Cervical carcinoma
• Bladder carcinoma (squamous cell)
• Sarcoma botryoids (vulvar cancer in young females)
• Verrucous carcinoma of the penis
• Scrotal carcinoma

Question 5

A pathology resident is given a tissue sample harvested from the genitourinary system from a surgical patient. A report is due within the hour that characterizes the potential insult to the tissue.
What is the most likely mechanism of injury in the slide provided?

Answer 5

End-stage immune complex glomerulonephritis

Question 6

A 24-year-old male is preparing for his first bodybuilding competition. He has unfortunately decided to get some “help” in the form of exogenous hormones. In his last cycle, he was regularly injecting himself with 400mg of testosterone cypionate. Over the past few days, he started to notice a puffiness in and around his pectoral region, especially around the nipple. He visits his doctor who then performs a biopsy of the affected tissue. It is determined that he has excess duct development.
What condition does this individual have?

Answer 6

Gynecomastia

Question 7

Normal development of ovarian follicles is noted as well as ovulation on the 14th day of the wife’s cycle. Ejaculate analysis reveals a decreased sperm count along with a high percentage of immotile spermatozoa. His medical history is slightly more complex as he did suffer from a meningioma earlier on in life which was successfully treated with radiation.
What best explains this couples infertility difficulties?

Answer 7

Testicular infertility

Question 8

Who is most likely to have an increased risk of breast carcinoma?

• Two children, BMI of 18.2, onset of menstruation at age 15
• BMI of 20, onset of menopause at 45, normal BRCA 1/BRCA to gene loci
• Nulliparous, BMI of 24.4, onset of menopause at 55
• BMI of 26.5, 10 pack-year smoker, two children, onset of menstruation at 15

Answer 8

• Nulliparous, BMI of 24.4, onset of menopause at 55

Question 9

New parents are elated with the birth of their healthy baby girl. The mother’s pregnancy was unremarkable with a flawless, yet prolonged period of labor and delivery. Approximately 2 months after delivery, the mother begins to present with uncharacteristic vaginal bleeding. In addition, she also begins to demonstrate marked dyspnea and starts to cough up a little bit of blood. Blood work reveals that she still might be pregnant which is extremely confusing to her and her husband.
What best explains this turn of events?

Answer 9

Theca lutein cyst

Question 10

During his yearly physical, a 71-year-old male admits to his doctor that he has been feeling “tired all the time”. In addition to complaining about general aches and pains, most of them of the back-pain variety, he states that his wife keeps on stating that he looks “pale”. Confirmation of anemia is made through blood work. It is also determined that he has hematuria.
What is most likely?

Answer 10

Invasive pattern of glands (prostate cancer)

Question 11

A routine mammogram on a 54-year-old female shows a positive result. Areas of spiculated calcifications are seen to obscure a questionable area of density and result in a fine needle aspiration being performed. Ducts in lobules are seen within the same field of view. Intact ducts are visualized with well-defined borders and intact basement membranes. Lobular walls are visualized having hyperchromatic nuclei with some cells occupying the inside of the lobule itself without any evidence of lobular cells situated in connective tissue stroma.
Based on these findings, what is most likely the diagnosis?

Answer 11

Lobular carcinoma in situ

Question 12

After a single instance of unprotected sex, eruption of painful vesicles is observed on the labia majora of a 24-year-old female.
What is the most likely causative agent?

Answer 12

HSV-2

Question 13

A 50-year-old male is experiencing some uncomfortable symptoms. After a two-day bout of dysuria, his condition worsened to now experiencing deep boring pain which radiates to his back, perineal region, and abdomen. This is accompanied with fever and chills.
Which is most consistent with the patient’s presentation?

• Infiltration of plasma cells within glandular architecture of the prostate
• Hyperplastic prostatic acini would be evident on biopsy
• Patient would respond well with antibiotic therapy
• Patient would likely have a moderate Gleason score

Answer 13

Patient would respond well with antibiotic therapy

Question 14

During a PHY6405 final exam, a student is shown a series of four CT scans. In this series of CT scans, the student is asked to select the scan that represents a congenital variant with the assumption of normal renal function.
This is that exam, and you are that student.

Answer 14

Question 15

Patient presents to their primary physician after hearing a “pop” in their ankle following a minor injury. The fracture is confirmed. The doctor notes however, there is a general decrease in bone density and orders some blood work as well as urinalysis. Urinalysis demonstrates marked proteinuria. Blood work demonstrates elevated numbers of odd-looking lymphocytes.
What is most likely?

Answer 15

Multiple myeloma

Question 16

In the elderly, patients are in rapidly declining health. Lifelong hypertension has led to complications associated with left ventricular hypertrophy. 24 hours after measuring rapidly rising serum creatinine as well as dramatic drop in urine output, the patient passes away.
What is the most appropriate term given to the cause of effects on the kidney?

Answer 16

Pre-renal cause of failure

Question 17

Mary is starting to become a bit dismayed as her workout routine is just not working out. She continues to gain weight and is now feeling a bit depressed despite eating right and getting in as much activity as possible. She is also starting to contend with changes that are occurring in her body. It has been three months since her last period. She is noticing some unwanted facial hair on her upper lip that she is seriously considering making an appointment for laser removal
What is consistent with her presentation?

Answer 17

Multiple small subcapsular cysts should be evident in both ovaries (PCOS)

Question 18

Inability to engage in pain-free intercourse has prompted a 25-year-old female to visit her gynecologist. She states that not only is intercourse painful, but she also has heavier than normal menstrual flow as well as painful menses. An internal ultrasound is performed, and small distinct lesions are found within the wall of the myometrium, two of which are biopsied during the procedure. Both lesions demonstrate the presence of a glandular architecture within the myometrium which substantiates the diagnosis of ___

Answer 18

adenomyosis

Question 19

Which condition is characterized by proteinuria, hypoalbuminemia, and edema?

Answer 19

Focal segmental glomerulosclerosis

Question 20

Recurrent UTI in a 27-year-old male prompts his physician to take a coronal CT scan. A round tissue mass is visualized medially to psoas major muscle. A normal capsule is seen. The condition is thought to be a failure of normal embryological development.
What is most likely?

Answer 20

Renal ectopia

Question 21

A 37-year-old female has been complaining of dysmenorrhea for years. She currently has one son but has been trying to get pregnant to have a second to no avail. Recently, she has be developing abdominal pain in a cyclical manner which peaks about one week before her period and then subsides significantly after her period. Exploratory laparoscopy surgery is performed, and multiple dark densities are noted on both ovaries as well as the fundus of the uterus and posteriorly on the parietal peritoneum. Biopsies of these densities reveal a dark amorphous material that resembles blood.
What is the most likely explanation?

Answer 21

Lesion are atrophic endometrial tissues that have grown and then sloughed off

Question 22

A patient presents with difficulty urinating for approximately two days duration. They are mildly febrile. When asked about a specific pain location, they have difficulty localizing pain to one specific point.
What would unequivocally mark this condition as being an upper urinary infection?

Answer 22

Leukocytic casts

Question 23

Bob is a 44-year-old Caucasian male who is having his yearly physical exam. He is 5’6” tall and weighs 244lbs. His blood pressure is 132/92. Bloodwork demonstrates mild hyperlipidemia. However, urinalysis demonstrates marked proteinuria, yet no hematuria.
Assuming that glomerular crescents are absent and there is no elevation of ANCAs, what would most likely be presenting in this patient?

Answer 23

Elevated blood glucose

Question 24

While changing diapers on their two month old son, it is noticed that there is conspicuous swelling of their scrotum. Worried, the parents take their child to the pediatrician who performs a quick transillumination study as well as ultrasound. It is determined that this swelling is not a solid mass, but likely only composed of fluid.
This pertains to which particular disease?

Answer 24

Patent processus vaginalis

Question 25

An elderly patient is admitted to the hospital in declining health. Bloodwork demonstrates decreased GFR. Their blood pressure is 158/96. During his hospital stay, he frequently gets up to urinate which includes 2-3 times each evening as well. CT scans of the abdomen demonstrate a normal size and shape of the bladder. Thickening is noted bilaterally in both ureters all the way to the renal pelvis and calyces. Renal cortices are thinned.
What other findings would you suspect in the affected tissues?

Answer 25

Collection of red blood cells, fibrin, and platelets within kidney tubules

Question 26

Bilateral ovarian masses are found on a 50-year-old female presenting with abdominopelvic pain. Biopsies of these masses present with glandular architecture.
Of the following statements, which is most consistent with this presentation?

• Metastasis from endometrial tissue
• Result of chronic polycystic ovarian syndrome
• Metastasis from infiltrating ductal carcinoma of the breast
• Most likely originated from a gastric carcinoma

Answer 26

Most likely originated from a gastric carcinoma

Question 27

Oliguria, salt and water retention, and elevated blood urea nitrogen is characteristic of which condition?

Answer 27

Wegener’s granulomatosis

Question 28

A new born is referred to surgery as a result of the condition demonstrated in the picture. A ventral fissure is observed in the abdominal wall.
What is the diagnosis?

Answer 28

Exstrophy

Question 29

Breast-feeding has become extremely difficult for this new 25-year-old mom. Several slender cracks have developed in the skin in and around the nipple as a result of near constant breast-feeding.
What is the appropriate name given to this condition?

Answer 29

Mastitis

Question 30

A 26-year-old female complains of pelvic pain that localizes to the right inguinal region. An ultrasound is ordered, along with blood work. She states that she is sexually active, but has not used any contraception. Bood work demonstrates a mildly elevated white blood cell count, and normal HCG values. Ultrasound demonstrates a 2.5mm hypoechoic lesion approximately 4cm lateral to the uterus, and a 1.5cm medial to the ovary.
Based on this alone, what is the likely finding?

Answer 30

Pyosalpinx

Question 31

Scarring of the renal cortex is visualized in a 74-year-old rheumatoid arthritis patient who is showing signs of decreased renal function. Their condition has been managed over the past 30 years with a variety of medications such as etercept (used to lower TNF) as well as Tylenol to minimize pain on “bad days”.
What would you expect to see in this patient’s kidney tissue?

Answer 31

Medullary damage along with necrosis in renal papilla

Question 32

Palpation of a painful nodule within the scrotal sac in a 30-year-old male prompted him to visit his primary care physician. A mass is detected and aspiration is performed in the area of complaint. A milky fluid is removed.
What most closely aligns with the patient’s presentation?

Answer 32

Dilated efferent ductules of the rete testis (spermatocele)

Question 33

A 34-year-old male develops both pulmonary and genitourinary symptoms. He has been developing a progressively worsening cough and during his last coughing fit, produced a small amount of blood. Worried, he visits his family physician who runs a blood panel as well as urinalysis. Microhematuria is observed.
What else would you expect in this patient?

Answer 33

Anti-glomerular basement membrane antibody production

Question 34

Abnormal spotting prompts a 21-year-old female to visit her gynecologist. A physical exam is performed using a spectrum to visualize the vaginal canal and cervix. Two small lesions are noted, the first approximately 2mm in diameter at the 2 o’clock position on the cervix, and the other, a larger 3mm diameter lesion at the 7 o’clock position on the cervix. The epithelia in these regions are crimson in appearance with their centers showing induration. A swab is performed and plasma cells are discovered.
What is consistent with this finding?
(Lesion is likely…)

Answer 34

Lesion is likely a chronic manifestation of a viral infection

Question 35

A 38-year-old female makes an appointment to see her gastroenterologist due to a relapsing remitting pattern of pain in her abdomen. After not being able to determine the cause of her illness, her doctor orders an endoscopy as well as colonoscopy. There are no mucosal changes evident in these procedures. Over the next few months, her condition worsens and an exploratory laparoscopy surgery is performed. Three distinct masses of spongy tissue are seen to be wrapping around the jejunum, distal ileum, and on the inferior aspect of the colon. Biopsy of these lesions reveal a rich vascular supply in the presence of well-defined glandular tissue as well as some connective tissue stroma.
What is the most likely explanation for this person’s condition?

Answer 35

Endometriosis

Question 36

Susan is mortified when she suddenly is presented with difficulty urinating followed by significant amounts of blood in her urine. Her doctor orders an imaging series which includes a cystoscopy, abdominal CT, and IVP. Normally, this amount of imaging would be overkill, however she is a colleague and works at the pathology laboratory that processes these biopsy samples. Her daily routine is quite boring in that she fixes tissues samples to slides and applies several types of different stains such as congo red, sudan red, and mordant brown, all molecules in the azo dye family.
What would you anticipate for the findings of the diagnostic imaging based on the case?

Answer 36

Invasive transitional cells in mucosa of bladder

Question 37

What started off as a joke results in a horrific turn of events. A married couple is attempting to conceive and have a plethora of home pregnancy tests. The husband himself asks what the results of his urine dipstick test would be if he provided the urine sample. Much to his confusion, when he used his own urine, the test came out positive.
What is the most likely explanation?

Answer 37

He is presenting with non-seminoma

Question 38

A 4-year-old girl is admitted to the hospital for a condition that has caused her to have a white blood cell count of 96,000 WBCs/mm3. During her physical exam, it is noted that she is edematous, especially in the face and around the eyes.
Based on this information, which of the following aligns with her condition?

• Patient should also present with hematuria
• Loss of change repulsion leads to proteinuria
• Crescentic membranes should be visible in a tissue biopsy
• Patient most likely co-presents with asthma

Answer 38

Loss of change repulsion leads to proteinuria

Question 39

Of the following choices, which is most likely to cause serous edema within the scrotum that is relatively acellular?

• Cirrhosis of the liver
• Dilation of pampiniform plexus of veins
• Widening of efferent ducts of the testes
• Mumps orchitis

Answer 39

Cirrhosis of the liver

Question 40

A 35-year-old female has a characteristic butterfly rash on the face.
Of the following, which is consistent with her condition?

• Risk of pathologic fracture, increased frequency of UTIs, and proteinuria
• Loss of basophilic nuclei in kidney tubular cells and recurrent urinary calculi
• Dysuria, retropubic pain, and infiltration of plasma cells in the bladder wall
• Elevated serum creatinine and blood urea nitrogen, co-presenting with hematuria

Answer 40

Elevated serum creatinine and blood urea nitrogen, co-presenting with hematuria

Question 41

A 45-year-old female has noticed an area around her areola has become progressively erythematous. Thinking that it was a case of eczema, she has been applying a moisturizing cream, however her condition has not improved. Four weeks later, she notices that a discharge was emanating from her nipple and a tiny sore has opened up approximately one half of a centimeter superior and lateral to her nipple. Frightened, she makes an appointment to see her doctor immediately. A sample of this tissue reveals cells that resemble odd glands.
What is most likely to be diagnosed?

Answer 41

Paget’s disease of the breast

Question 42

A 30-year-old male finally decides to see his doctor when he realizes that he might be wrong in his self-diagnosis of a fungal infection. The tip of his penis has changed to a ruby-red color and has not gotten better with topical application of ketoconazole, a common topical antifungal agent. His physician takes a skin scrape biopsy. Results demonstrate a disordered pattern of growth of the layers of the squamous epithelium along with numerous mitotic figures and hyperchromatic nuclei.
Based on this information, what is the most likely diagnosis?

Answer 42

Erythroplasia of Queyrat

Question 43

A 30-year-old female is perplexed when she receives a diagnosis of hypertension during her last physical exam. She is extremely active, does not drink nor smoke, and does not possess a family history of hyperlipidemia, hypertension, or heart disease. The only health related issue that she must contend with is staying away from wheat products as she was diagnosed with celiac disease two years prior. Admittedly, this has been difficult for her as she is of European descent and not consuming bread during a family meal is considered sacrilegious, and so she often cheats.
Based on this information, what explains the diagnosis of hypertension?

Answer 43

IgA nephropathy

Question 44

A 31-year-old sexually active male becomes concerned with the appearance of a small painless ulceration on the lateral side of his glans penis. He also notices that his inguinal crease has become tender and swollen to the touch with palpable mass protruding from the area.
What is the most likely diagnosis?

Answer 44

Lymphogranuloma venereum

Question 45

Dysuria as well as the production of a purulent discharge from the urethra prompts a 25-year-old male to visit a sexual health clinic. A urethral swab of this discharge reveals that he is infected with gonorrhea. During his patient history, he also notes that his pain extends to his scrotal sac.
Of the following choices, which is not likely his case? Choose all that apply

• Epididymitis
• Orchitis
• Torsion
• Carcinoma of the skin
• Inguinal hernia

Answer 45

Not likely:

• Torsion
• Carcinoma of the skin
• Inguinal hernia

Question 46

Bob thought he had an abnormal mole on his anterior thorax, along his costal margin. During a dermatology appointment, he asked the doctor to take a look. The doctor said that he had an extra nipple.
What is the appropriate term for this?

Answer 46

Polythelia

Question 47

Parents agree to an autopsy after delivering a child who died shortly after birth. It is determined that the baby had complete agenesis of the kidney.
Based on this information, what other finding would you expect?

Answer 47

Pulmonary hypoplasia

Question 48

Which term refers to a congenital variant of the kidney which presents as a single midline organ?

Answer 48

Horseshoe