Practice Exam Review/Guiding Qs

Question 1

a woman is infertile because of an absence of ova. where might primordial ova have failed to differentiate?

Answer 1

hindgut endoderm

Question 2

where in male is junction of urethra derived from UG sinus and surface ectoderm?

Answer 2

penile urethra and navicular fossa in the glans

Question 3

“intermittent” UPJ obstruction likely caused by ….

Answer 3

a crossing vessel

Question 4

when should orchiplexy for undescended testes at birth be performed?

Answer 4

6 months old

Question 5

what do aromatase inhibitors do?

Answer 5

inhibition of aromatase → ↓ conversion of androstenedione to estrone, ↓ conversion of testosterone to estradiol → ↓ tumor growth

can induce ovulation
associated with vaginal dryness

Question 6

what is the lymphatic drainage of lesion in anal canal below pectinate line?

Answer 6

superficial inguinal lymph nodes

Question 7

A 32-year-old male has infertility of one year duration. His semen testing reveals mild oligospermia (low sperm concentration). His serum hormone testing is normal except for two low morning testosterone values of 210 ng/dL and 230 ng/dL respectively (normal > 300 ng/dL). He wishes to optimize his semen parameters in order to facilitate chances for conception by natural means. The next step is treament with:

Answer 7

oral clomiphene citrate

Question 8

51 year-old woman presents with a single painful lesion on her vulva. She noticed it a few days ago. You order some labs, and she has a positive nontreponemal test. The test that will likely be positive is

Answer 8

Gram stain

Question 9

A 17-year-old who presents with primary amenorrhea is diagnosed with Turner’s Syndrome (45X). Which of the following serum hormone level is MOST common in this patient?

Answer 9

High FSH, low estrogen

Question 10

A 17-year-old girl presents for evaluation of primary amenorrhea. She reports beginning breast development around age 10 years. On exam she has Tanner 3 breast development, scant Tanner 2 pubic hair, no axillary hair, and no palpable gonads. You recommend an evaluation including karyotype, ultrasound and endocrine testing and diagnose a specific condition. What results fit with this history and exam?

Answer 10

46,XY karyotype; bilateral abdominal testicles and no uterus; high testosterone

Question 11

Which of the following is potentially beneficial for the management of patients with intermediate to high risk metastatic kidney cancer?

Answer 11

use of a PD-1 and CTLA-4 inhibitor

Question 12

what type of penile cancer will 9-valent HPV vaccine NOT prevent

Answer 12

It will not prevent penile cancers associated with balanitis xerotica obliterans.

Question 13

A 32-year-old woman presents to her gynecologist with abdominal pain. Imaging and laboratory findings are significant for a right ovarian mass and an elevated serum alpha fetoprotein (AFP). The patient undergoes surgical resection of the mass, and you identify the following histologic finding within the tumor. What is the most likely diagnosis?

Answer 13

Yolk sac tumor

Question 14

A 25-year-old stopped her oral contraception nine months prior given that she would like to conceive. She has been haivng regular intercourse but has not had a menstrual cycle since stopping her contraception. What evaluation should be performed initially?

Answer 14

Ovarian reserve testing

Question 15

A patient presents with a 1cm renal pelvis stone faintly visible on KUB. The patient was treated with ESWL. Intravenous contract was necessary to help define the stone under fluoroscopy for ESWL. After stone analysis, the patient is started on oral potassium citrate. The patient developed a new stone one year later, as noted on his yearly KUB. The new stone is most likely:

Answer 15

Calcium phospate

they alkalize the urine w/ potassium citrate, making him more susceptible to calcium phosphate stones that precipitate at a higher pH.

Question 16

Varicoceles arise because of venous stasis and incompetence of the valves within the involved pampiniform plexus. They occur most often on the left side due to the longer length of the left gonadal vein; perpendicular entry of the left gonadal vein into the left renal vein; and because of extrinsic compression of the left renal vein by which of the following visceral arteries?

Answer 16

Superior mesenteric

Question 17

The highest risk for puncture of the urethra in the male via the insertion of a catheter is in which of the following locations?

Answer 17

At the junction of the membranous and bulbous urethra

Question 18

A 54 year old woman with multiple sclerosis. After a recent flare of her disease, she has new bladder symptoms. She feels the sudden, severe urge to urinate, but she is unable to void when she sits on the toilet. She has been taught to self-catheterize in order to empty her bladder because her urethral sphincter will not relax, even when her bladder is full and her detrusor muscle contracts. Where in her central nervous system did she sustain damage during her recent MS flare?

Answer 18

The high thoracic spinal cord

Question 19

A chromophobe renal cell carcinoma is correctly linked with which of the following features?

Answer 19

Derivation from intercalated cells in the distal nephron

Question 20

Routine prenatal labs demonstrate the presence of anti-D antibodies in maternal blood. Which risk factor best accounts for the presence of these antibodies?

Answer 20

Rh-negative patient who suffered a placental abruption in her prior pregnancy and did not receive Rh immune globulin.

Question 21

Which of the following is the best management option for this patient who is exhibiting rising post-orchiectomy tumor markers despite normal imaging studies?

Answer 21

Start platinum-based chemotherapy

Question 22

A 25-year-old man was kicked in the scrotum and presents to the emergency room the next day with significant right hemi-scrotal pain. Examination shows a tender right testis with a palpable defect. He has a normal left testis on exam. The next step is:

Answer 22

Scrotal exploration

Question 23

A 42 year-old woman undergoes a total abdominal hysterectomy through a pfannensteil incision. On POD #1 she notes inability to walk. On exam, she has a patellar reflex. The nerve roots of the nerve injured at the time of surgery are

Answer 23

L2, L3, L4

Question 24

A man fractures his ischiopubic ramus in a car accident, and the attached crus is lacerated along with the artery contained within it. Which of the following would have its blood supply greatly diminished as a result?

Answer 24

Corpus cavernosum

Question 25

A 65-year-old woman undergoes hysterectomy for a a large endometrial tumor. On histologic exam, the tumor demonstrates both markedly atypical epithelium and markedly atypical stroma, as pictured below:

Answer 25

Carcinosarcoma

Question 26

is immunosuppression a risk factor for cervical cancer?

Answer 26

yes

Question 27

Colle’s fascia lining the scrotum is continuous with which of the following?

Answer 27

Scarpa’s fascia

Question 28

The rate of acquisition or spread of an STI (Ro) is equal to (β) x (c) x (D). What is (β), (c) and (D) and explain how each impacts the rate of spread of an STI.

Answer 28

Ro=case reproduction ratio

β=efficiency of transmission(will be different for each pathogen)

c=rate of change of sexual partners (sexual concurrency & sexual networks are important, not just total number)

D=duration of infectiousness (Ro increases for STIs w/ a long duration of infection like HIV)

Question 29

how do we use gravidity and parity?

Answer 29

Technically the G is the number of times a woman has been pregnant, P is the outcomes of those pregnancies. The P is further divided into TPAL (term, preterm, abortus, and live). With a twin pregnancy, the G always counts as one, but the L counts as 2. Example- A woman who has had 1 term twin pregnancy, G1P1002.

Question 30

Which of the following should be administered first in a CaP patient with symptomatic bone metastases?
A. Antiandrogen
B. LHRH agonist
C. Radiation therapy
D. Chemotherapy

Answer 30

A. antiandrogen

Question 31

How would you manage a septic patient with

Hydronephrosis and an obstructing stone in the proximal ureter?

Answer 31

Ureteral stent or percutaneous nephrostomy tube.

Question 32

What is the classification of hypercalciuria?

Answer 32

Absorptive (from GI tract), Renal Leak, and Primary Hyperparathyroidism

Question 33

what is a useful clinical landmark for anesthetizing the pudendal nerve?

Answer 33

ischial spine

Question 34

when monozygotic twins split before 2d what is the chorion/amnion situation?

Answer 34

di/di

Question 35

when monozygotic twins split between 2-8d what is the chorion/amnion situation?

Answer 35

monochorionic diamniotic

Question 36

when monozygotic twins split after 8d what is the chorion/amnion situation?

Answer 36

mono/mono

Question 37

what effects does progesterone have during pregnancy? (different symptoms that pregnant people might experience)

Answer 37

smooth muscle relaxation leading to GERD, constipation

decreased gallbladder motility leading to gallstone

Question 38

what hormone causes nausea/vomiting in pregnancy?

Answer 38

b hCG

Question 39

Imaging the pelvis of a woman revealed cystic structures in the broad ligament of the uterus. These are most likely to be remnants of what structure?

Answer 39

mesonephric duct

Question 40

what endometrial tumor has markedly atypical epithelium and markedly atypical stroma?

Answer 40

carcinosarcoma

Question 41

52 year-old woman undergoes a hysterectomy as part of a prolapse procedure. You note this cystic structure stemming from the fallopian tube. (hydatid cyst of morgangi) What is the embryologic source of this?

Answer 41

either Wolffian duct or Mullerian duct

Question 42

A woman experienced pain during sexual intercourse due to lack of lubrication from what turned out to be an infected greater vestibular gland. Where was the infection located?

Answer 42

Superficial perineal pouch