Questions from the Case Files Flashcards
1
Q
A 40-year-old female says she feels tired all the time. On exam, you note that she is tachycardic and pale. You order a CBC, which shows the following: Hgb 10 g/dL (12-16), MCV 75 (80-100). Her reticulocyte count is not increased. Which of the following is most likely?
She has iron-deficiency anemia
She has megaloblastic anemia, probably due to folate deficiency
She has megaloblastic anemia, probably due to B12 deficiency
She has a hemolytic anemia
A
She has iron-deficiency anemia
2
Q
What causes the anemia in sickle cell disease?
An inability of the red cell to reduce organic peroxides.
An abnormal hemoglobin which polymerizes and irreversibly injures the red cell.
Insufficient Hgb A and excess unpaired β, γ, and δ chains.
Insufficient Hgb A and excess unpaired α chains.
Consumption of red cells by splenic macrophages.
A
An abnormal hemoglobin which polymerizes and irreversibly injures the red cell.
3
Q
Which of the following red cell indices tells you how big your patient’s red cells are? RBC Hgb MCV RDW MCHC
A
MCV
4
Q
A 60-year-old male has a hemoglobin of 9 g/dL. He also has the following lab results: MCV normal; LDH increased; haptoglobin decreased. Which of the following is most likely? Iron-deficiency anemia Megaloblastic anemia Hemolytic anemia Sickle cell anemia There is no sign of anemia
A
Hemolytic anemia
5
Q
Which of the following is used therapeutically in Megaloblastic anemia? Methylcobalamin Folate polyglutamate Hydroxocobalamin Methyltetrahydrofolate
A
Hydroxocobalamin
6
Q
Which of the following is associated with pernicious anemia?
Ileal resection
Thyroid antibodies in serum
System lupus erytheomatosus
Malabsorption of B12 intrinsic factor complex
A
Thyroid antibodies in serum
7
Q
Which one of these statements is TRUE concerning the reduction of folate? It needs vitamin B12 It is inhibited by sulphonamide It is inhibited by methotrexate It occurs during thymidylate synthesis
A
It is inhibited by methotrexate
8
Q
Which of one of the following does NOT cause folate deficiency Antiepileptic drugs Veganism Gluten sensitivity Inflammation Pregnancy
A
Veganism
9
Q
Causes of microcytic RBCs include which one of the following? Alcohol Renal disease Alpha-Thalassemia Increased reticulocyte count
A
Alpha-Thalassemia
10
Q
Which of the following are not one of the four main risk factors for a “heart attack?” Hypertension Hyperlipidemia Hypercholesterolemia Age Male sex
A
Hypercholesterolemia
11
Q
Cardiac enzyme readings are preferred at what time interval for a patient with a possible Myocardial Infarction taking place? With in 1 hour With in 2 hours With in 45 minutes Within 15 minutes With in 10 minutes
A
Within 15 minutes
12
Q
The patient in Case 30 was suffering from which ailment? GERD Esophageal Spasm Pericarditis Coronary Atherosclerotic Heart Disease Mediastinitis
A
Coronary Atherosclerotic Heart Disease
13
Q
Which irregularity in ECG/EKG can signify an MI? Normal Heart Rhythm Sinus Bradycardia An ST segment elevation A missing “QRS” complex A missing “ST” segment
A
An ST segment elevation
14
Q
Superimposed vasospasm on atherosclerotic arteries is the reason for episodes of angina without any direct relation to exercise. The name of this type of angina is? Variant/prinzmetal angina Angina pectoris Unstable angina Congestive Heart Failure Extertional Angina
A
Variant/prinzmetal angina
15
Q
Which of the following are not risk factors for heart disease
Hyperlipidemia Hypertension Male sex Dating Age
A
Dating
16
Q
Which one of the following is correct about Coronary Artherosclerosis
Age, physical activity, gender, and obesity are all risk factors of Coronary Artherosclerosis
Coronary Artherosclerosis is caused by too elevated blood calcium levels
Coronary Artherosclerosis is more common in women
Cancer causes Coronary Artherosclerosis
None of the above
A
Age, physical activity, gender, and obesity are all risk factors of Coronary Artherosclerosis
17
Q
Which part of the ECG corresponds to Ventricular Depolarization ONLY
PR Interval QRS Interval QT Interval TU Interval None of the above
A
QRS Interval
18
Q
. Which of the following is false
Smoking does not cause heart disease
Obesity can cause heart disease
Family history plays a role is weather an individual will get heart disease
Heart disease is the leading cause of death
Hypertension can lead to heart disease
A
Smoking does not cause heart disease
19
Q
- Prinzmetal angina (atypical angina) is characterized clinically by chest pain that occurs at rest rather than with exercise. Which of the following is the most likely cause of this type of angina?
A) Atherosclerosis of a coronary artery B) Dissection of a coronary artery C) Embolism of a coronary artery D) Thrombosis of a coronary artery E) Vasospasm of a coronary artery
A
E) Vasospasm of a coronary artery
20
Q
. A previously healthy 70-year-old man presents to the emergency department with lower abdominal pain, fever, and an elevated WBC count. Which of the following is the most likely etiology of this patient’s condition?
Embolic arterial occlusion of the superior mesenteric artery leading to bowel infarction
Idiopathic transmural inflammation of the distal colon
Increased intraluminal pressure leading to perforation of a bowel outpouching
Malignant cells invading one of the vessels supplying the colon
Twisting of the sigmoid colon about its mesenteric base
A
Increased intraluminal pressure leading to perforation of a bowel outpouching
21
Q
A 60-year-old man presents with hematemesis, melena, guaiac-positive stools, and signs of circulatory collapse. He has a 20-year history of burning mid-epigastric pain and tenderness relieved by food, milk, or antacids. Also, he has been taking high doses of NSAIDs to relieve the pain of long-standing arthritis. Esophagogastroduodenoscopy reveals a peptic ulcer in the upper duodenum. Which of the following is an important association of duodenal peptic ulcer disease?
Barrett esophagus and columnar intestinal metaplasia of esophageal squamous epithelium
Evolution into carcinoma as a likely sequela
H. pylori infection
Hiatal hernia and incompetent lower esophageal sphincter
Pernicious anemia and achlorhydria
A
H. pylori infection
22
Q
An elderly woman with chronic constipation dies of a stroke and comes to autopsy. The figure illustrates a portion of her colon. The lesions shown in the figure:
Can be complicated by inflammation, perforation, and peritonitis.
Are most likely related to a high-fiber diet.
Most frequently occur high on the right side of the colon.
Occur most often in teenagers.
A
Can be complicated by inflammation, perforation, and peritonitis.
23
Q
A 32-year-old woman presents to the physician with alternating bouts of diarrhea and constipation. She also has chronic abdominal pain relieved by frequent bowel movements. Her symptoms are exacerbated by stress. The patient denies fever or weight loss. She has a negative hemoccult test. Colonoscopy and endoscopy reveal no abnormalities. The most probable diagnosis in this patient is commonly associated with which of the following?
Leukocytosis
Normal biopsy
Primary sclerosing cholangitis
Strictures in the small bowel
Villous flattening in the small intestine
A
Normal biopsy
24
Q
Which form of E. coli can lead to hemolytic uremic syndrome H:17 E423:H7 O157:H7 H7:QRT None of the above
A
O157:H7
25
What pathogen is associated with osteomylitis in sickle cell disease?
```
Klebsiella
Clostridium perfringens
Cholera species
Vibrio species
Salmonella
```
Salmonella
26
Which pathogens are responsible for food poisoning due to exotoxins?
S aureus and Bacillus cereus
C. difficile and Cryptosporidium
Astrovirus and Norovirus
Cholera species and Vibrio species
Giardia species and Cryptosporidium species
S aureus and Bacillus cereus
27
```
What pathogen is associated with rice water stools?
S. aureus
Vibrio cholerae
Klebsiella
Clostridium perfringens
Giardia species
```
Vibrio cholerae
28
```
What pathogen may be responsible for diarrhea that develops after antibiotic use?
S. aureus
Vibrio cholerae
Klebsiella
Clostridium perfringens
Clostridium difficile
```
Clostridium difficile
29
The most common mechanism by which K. pneumoniae attains its antibiotic resistance is by plasmid acquisition. Which of the following best describes the direct transfer of a plasmid between two bacteria?
Competence
Conjugation
Recombination
Transduction
Conjugation
30
A specimen of thick, bloody sputum from a hospitalized 80-year-old patient with diabetes mellitus and difficulty in breathing is sent for laboratory analyses. The tests yield heavy growth of a lactose positive, non-motile, gram negative rod with a large capsule. Which of the following bacteria is most likely to be the cause of the pulmonary problems?
```
Enterobacter aerogenes
Escherichia coli
Klebsiella pneumoniae
Pseudomonas aeruginosa
Yersinia pseudotuberculosis
```
Klebsiella pneumoniae
31
```
A 65-year-old diabetic man presents to the emergency room with a severe productive cough producing thick bloody sputum resembling a “currant-jelly” like appearance. Culture using MacConkey agar reveals pink colonies, with large mucoid colonies on routine laboratory media. Which of the following organisms is most likely responsible for this patient’s pneumonia?
Enterobacter cloacae
Escherichia coli
Klebsiella pneumoniae
Pseudomonas aeruginosa
Serratia marcescens
```
Klebsiella pneumoniae
32
The O antigens that are used to help characterize members of the Enterobacteriaceae family are found on which of the following?
```
Capsules
Endotoxins
Exotoxins
Fimbriae
Flagella
```
Endotoxins
33
```
A 28-year-old Caucasian women with a 30 pack-year history of smoking presents with diarrhea and right, lower quadrant colicky pain. You note tender, red nodules on her shins. Radiograph imaging after barium study is shown in Figure A. What is the most likely diagnosis?
Ulcerative colitis
Irritable bowel syndrome
Appendicitis
Hirschprung disease
Crohn’s disease
```
Crohn's disease
34
A 44 year old woman is being operated on for acute appendicitis. After inguinal incision, a gangrenous, ruptured, retrocecal appendix is encountered. The cecum adjacent to the appendix is edematous and livid. A pus collection behind the ascending colon, spreading to the lower pole of the right kidney, is drained (100 mL of pus). Median laparotomy and extensive lavage are done. Antibiotics active against anaerobes are added to the regimen. Which of the following is the most appropriate course of action?
A. Simple appendectomy
B. Appendectomy with ileostomy
C. Appendectomy with cecostomy
D. Resection of the cecum together with the appendix
E. Right hemicolectomy with ileotransverse anastomosis
E. Right hemicolectomy with ileotransverse anastomosis
35
67-year-old male presents to the emergency room with left lower quadrant pain that he has been experiencing for five days. He says the pain is constant and sharp in nature. Currently he says the pain is 6 on a scale of 1 to 10. There are no identifiable alleviating or aggravating factors. He denies nausea and vomiting and has not noticed any blood in his stools. He did take his temperature at home and has had a fever as high as 101°F. The patient has never had these symptoms before. On physical examination, there is tenderness in the left lower quadrant. Bowel sounds are present. There is no guarding or rebound tenderness appreciated. A rectal exam is performed and is negative for blood. He undergoes complete blood count (CBC) and basic metabolic panel (BMP) blood tests that reveal elevated white blood cell count. Based on what this patient likely has, which of the following is the most appropriate diagnostic test and management for this patient?
A. Perform a colonoscopy and initiate ciprofloxacin and metronidazole
B. Check lactic acid blood level and refer patient to a surgeon
C. Check CT scan of the abdomen with IV contrast and refer patient to a surgeon
D. Check CT scan of the abdomen and initiate ciprofloxacin and metronidazole
E. Perform a colonoscopy and refer patient to a surgeon
D. Check CT scan of the abdomen and initiate ciprofloxacin and metronidazole
36
A 27-year-old man has had intermittent cramping abdominal pain and low volume diarrhea for several weeks. On physical examination, he is afebrile; there is mild lower abdominal tenderness but no nausea, and bowel sounds are present. A stool sample is positive for occult blood. The symptoms subside within 1 week. Six months later the abdominal pain recurs with perianal pain. On physical examination, there is now a perirectal fistula. Colonoscopy shows many areas of mucosal edema and ulceration and some areas that appear normal. Microscopic examination of a biopsy specimen from an ulcerated area shows a patchy acute and inflammatory infiltrate, crypt abscesses, several noncaseating granulomas. Which of the following underlying disease processes best explain these findings?
```
A. Crohn disease
B. Diverticulitis
C. Shigellosis
D. Ulcerative colitis
E. Sarcoidosis
```
A. Crohn disease
37
A female patient is rushed to the emergency department due to severe pain in the right lower quadrant of the abdomen. The pain started about 7 hours before the consult. On physical examination, the patient demonstrates rebound tenderness at the McBurney’s point. A series of diagnostic tests are ordered to verify a diagnosis of acute appendicitis. Which of the following laboratory findings is least likely noted by the physician?
A. White blood cell count greater than 10,500 clls/mm
B. C-reactive protein greater than 1mg/dl
C. Appendix is not observed or noted by ultrasonography
D. Increased levels of urinary 5-hydroxyindoleacetic acid
B. C-reactive protein greater than 1mg/dl
38
A 25-year-old man presents to a rheumatologist with complaints of joint pain involving the large joints of the legs. On questioning, the patient indicates that exacerbations in the joint pain are frequently accompanied by diarrhea. Which of the following is the most likely diagnosis?
```
(A) Amebic colitis
(B) Chronic appendicitis
(C) Diverticulosis
(D) Pseudomembranous colitis
(E) Ulcerative colitis
```
(E) Ulcerative colitis
39
```
A 75-year-old man presents to his physician with complaints of nocturia, urinary urgency, and a feeling that he could not completely empty his bladder. A digital rectal exam reveals a firm, enlarged prostate. A bone scan is ordered and shows positivity in multiple vertebral bodies. Elevation of which of the following substances would be most strongly associated with the development of bone lesions?
(A) Prostatic acid phosphatase
(B) Prostate-specific antigen
(C) Serum alkaline phosphatase
(D) Tartrate-resistant acid phosphatase
(E) Urinary hydroxyproline
```
(C) Serum alkaline phosphatase
40
A 12-year-old girl has a temperature of 102.5 F and a sore throat. Two days later, she develops a diffuse erythematous rash and is taken to her pediatrician. On physical examination, there is circumoral pallor, and an erythematous rash with areas of desquamation is noted. The myocardial damage that can follow this infection is produced in a manner similar to the damage associated with which of the following disorders?
```
(A) Atopic allergy
(B) Contact dermatitis
(C) Graft-vs-host disease
(D) Graves disease
(E) Idiopathic thrombocytopenic purpura
```
(E) Idiopathic thrombocytopenic purpura
41
A 74-year-old woman presents with 3 weeks of left lower quadrant abdominal pain, changes in bowel habits, and intermittent fever. Her temperature is 38°C (101°F), respirations are 19 per minute, and blood pressure is 130/80 mm Hg. Physical examination shows left lower quadrant tenderness. A CBC reveals neutrophilia. An abdominal-pelvic ultrasound examination is normal. Which of the following is the most likely diagnosis?
```
(A) Appendicitis
(B) Diverticulitis
(C) Ovarian carcinoma
(D) Renal colic
(E) Uterine leiomyom
```
(B) Diverticulitis
42
```
A 24-year-old man is brought to the emergency room with symptoms of acute intestinal obstruction. His temperature is 38°C (101°F), respirations are 25 per minute, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal quadrant. At laparoscopy, there are numerous small bowel strictures and a fistula extending into a loop of small bowel. Which of the following is the most likely diagnosis?
(A) Adenocarcinoma
(B) Carcinoid tumor
(C) Crohn disease
(D) Pseudomembranous colitis
(E) Ulcerative colitis
```
(C) Crohn disease
43
A 16-year-old girl with short stature, rounded face, and shortening of the fourth and fifth metacarpals and metatarsals has hypocalcemia and hyperphosphatemia. She has multiple calcifications involving the basal ganglia, vasculature, and other sites. PTH varies from normal to increased, and administration of PTH does not result in phosphaturia. These findings are characteristic of which of the following?
```
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Tertiary hyperparathyroidism
D) Hypoparathyroidism
E) Pseudohypoparathyroidism
```
E) Pseudohypoparathyroidism
44
A 41-year-old woman has hypocalcemia, hyperphosphatemia, and decreased urinary phosphate excretion. Injection of parathyroid hormone (PTH) causes an increase in urinary cyclic adenosine monophosphate (cAMP). The most likely diagnosis is
```
primary hyperparathyroidism
Vitamin D intoxication
vitamin D deficiency
Hypoparathyroidism after thyroid surgery
Pseudohypoparathyroidism
```
Hypoparathyroidism after thyroid surgery
45
A 24 year old female patient comes into the clinic complaining of recurrent blood in her urine. She also mentions that she has always had problems with hearing and vision, but attributed her hearing loss to having parents who loved listening to loud music in the house as a child. You note in her history that her grandfather has CKD, and suspect that her illness is a result of a mutation in the COL4A5 gene. What type of testing is most appropriate in this scenario?
a) Voiding cystourethrography (VCUG)
b) Microscopic urinalysis & immunostaining
c) urinalysis for XPN cultures
d) renal biopsy
e) ultrasonography with contrast, then uteroscopy
Answer is B
46
A 36 year old Asian man with a history of asthma present with a complaint of red urine. He describes 5 days of nasal congestion and dry cough. He notes no sore throat, fever, chills, myalgias, arthralgia or flank pain. He has no family history of renal disease. A urine study indicates 1+ protein, an no bacteria, leukocyte esterase or nitrates. Thirty to 50 erythrocytes are observed, but no leukocytes are present. His serum creatinine level is normal. Which one of the following is the mostly likely diagnosis?
```
IgA nephronpathy
Nephrolithiasis
Transitional cell carcinoma of the bladder
Wegener’s granulomatosis
Postinfectious glomerulonephritis
```
A
47
A 27 year old Chines male present with gross hematuria. The patient has a long history or recurrent hematuria, made worse by pharyngitis. He denies arthralgia, fever, chills or skin rash. There is no family history of kidney disease or hematuria. His temperature is 37C (98.6) and his blood pressure is 120/70 mm Hg. His throat and lungs are clear, his abdomen is soft and non-tender. Theres is no edema, rash, or arthritis. His blood urea nitrogen is 10 mg/dL and his creatinine is .8 mg/dL. A urine specimen show 15 - 20 dimorphic red blood cells/ hpf, there is +2 protein and 1 RBC cast. Which of the following is the most likely diagnosis?
```
Alport syndrome
Goodpasture syndrome
IgA nephropathy
Nil Disease
Wegner granulomatosis
```
C
48
A 33-year-old female presents with recent onset of painful urination, fever, and right flank pain. Urinary sediment analysis is positive for the presence of white blood cell casts and Gram-negative bacteria. She has not recently started any new medications. What is the most likely diagnosis in this patient?
```
Pelvic Inflammatory Disease
Acute Interstitial Nephritis
Pyelonephritis
Cystitis
Appendicitis
```
C
49
71-year-old male complains of urinary hesitancy and nocturia of increasing frequency over the past several months. Digital rectal exam was positive for a slightly enlarged prostate but did not detect any additional abnormalities of the prostate or rectum. The patient’s serum PSA was measured to be 6 ng/mL. What is the most likely diagnosis?
```
Benign prostatic hyperplasia
Carinoma of the bladder
Prostate cancer
Obstructive uropathy
Prostatic abscess
```
Benign prostatic hyperplasia
50
A 22-year-old sexually active, otherwise healthy female presents to her primary care physician complaining of several days of dysuria, frequency, urgency, and suprapubic pain. She denies fever, flank pain, vaginal itching, or vaginal bleeding/discharge. Which organism is most likely responsible for this patient's symptoms?
```
Staphylococcus saprophyticus
Chlamydia trachomatis
Proteus mirabilis
Klebsiella pneumoniae
Escherichia coli
```
E
51
10-year-old boy is brought to his pediatrician for evaluation of bloody urine. A urine sample is positive for hemoglobin and RBC casts. The boy’s maternal grandfather suffered from deafness and died of renal failure. The boy also has a 25-year-old male maternal cousin who uses a hearing aid and requires dialysis for end-stage renal disease. The physician suspects the patient has Alport Syndrome, but must perform which of the following confirmatory tests?
a) Audiologic assessment
b) CT scan of the head
c) kidney biopsy
d) upper GI endoscopy
e) skin biopsy
C
52
Which of the following is the most common site of urinary stone impaction?
a) Renal calix
b) Ureteropelvic junction
c) Near the pelvic brim, where the ureter arches over the iliac vessels
d) Posterior pelvis, where the ureter is crossed anteriorly by pelvic blood vessels and the broad ligament
e) Ureterovesical junction
C
53
```
What/who are the reservoir of Corynebacterium diphtheriae?
Cattle
Birds
Humans
Dogs
Rats
```
C
54
A 12-year-old male whose family recently emigrated from eastern Europe presents to the emergency room with a fever of 103.5 degrees F, a swollen neck, difficulty breathing, and grayish-white membranes in the oral pharynx. Cultures were taken from the pharynx and the bacteria were found to be Gram-positive rods with metachromatic granules. The toxin produced by this bacterium has which of the following mechanism of action?
```
Pertussis toxin inhibits Gai via ADP ribosylation
Overactivates guanylate cyclase
Inactivates the 60S ribosomal subunit
Inactivates elongation factor 2
Cleaves SNARE proteins
```
D
55
. A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's initial infection?
```
Increased CD4+ T cell count
Secretory IgA against viral proteins
Increased IgM preventing bacterial invasion
Circulating IgG against AB exotoxin
Improved IgE release from mast cells
```
E
56
How is exotoxin of Corynebacterium diphtheriae tested?
```
Elek test
Gram staining
Blood Agar
Oxidase test
Litmus Test
```
A
57
8. A 3-year-old male is brought to the ER with a sore throat and fever. Examination of the pharynx reveals a dark, inflammatory exudate. Cysteine-tellurite agar culture produces black, iridescent colonies. Microscopic features of the causal organism most likely include which of the following?
```
Serpentine growth patterns
Metachromic granules
Lancet-shape
Long, branching filaments
Kidney-bean shaped rod
```
B
58
You see a 6-year-old boy in clinic who presents with several days of fever and a sore throat. On physical exam he is febrile to 38.5 C, with all other vital signs within normal limits. His physical exam is notable for a bright red tongue, grey-white tonsilar exudates, a blanching erythematous "sandpaper-like" rash on his trunk, and circumoral pallor. Upon further review of his medical history you note that he has an allergy to penicillin, described as an itchy, red rash on the trunk and arms by the patient's mother. What would be the most appropriate treatment of choice for his condition?
```
Penicillin after desensitization
Ceftriaxone
Trimethoprim-Sulfamethoxazole
Cephalexin
Ciprofloxacin
```
Cephalexin
59
```
What type of vaccine is the diptheria vaccine?
Attenuated bacteria
Inactivated toxin (toxoid)
Killed whole bacterial cells
Recombinant
Acellular
```
B
60
A young child has low-grade fever and malaise and is unwilling to eat. On physical examination, enlarged cervical lymph nodes and a grey membrane covering the tonsils and throat are found. A throat specimen shows gram-positive rods shaped like clubs that grew in “Chinese letter” forms. Which of the following statements concerning the illness is correct?
The gene for toxin that is present in this disease is carried in a bacteriophage
This illness could have been prevented by vaccination with a killed suspension of an organism
The causative organism expresses its toxin only in high-iron environments
An adequate dose of penicillin will lead to the child’s complete recovery
The causative organism’s most common reservoir is the saliva of domesticated pets
A
61
```
What is the most important virulence factor of Corynebacterium diphtheriae?
Pili
Flagella
LPS
Diphtherotoxin
M protein
```
D
62
```
Where are the target cells of diphtheria toxin located?
The throat
The skin
The skeletal muscles
The lungs
The heart and nervous system
```
The heart and nervous system
63
```
Pseudomyxoma peritonei is a complication that is most commonly associated with which histologic subtype of ovarian tumor?
Brenner
Clear cell
Endometrioid
Mucinous
Serous
```
Mucinous
64
A 25-year-old woman is noted to have a solid and cystic right ovarian mass measuring 10 cm in diameter by ultrasound. The mass is resected surgically and after examining histologic sections the diagnosis of benign teratoma (dermoid cyst) is made. Which of the listed microscopic descriptions is characteristic of this tumor?
A tumor mass composed of a uniform proliferation of blood vessels and fibroblasts
A tumor mass composed of islands of transitional-like epithelial cells
A tumor mass composed of malignant cytotrophoblast and syncytiotrophoblasts
A tumor mass composed of multiple cysts lined by ciliated columnar epithelial cells
A tumor mass composed of structures derived from all three germ lines
A tumor mass composed of structures derived from all three germ lines
65
```
A 4-year-old girl is noted to have breast enlargement and vaginal bleeding. On physical examination, she is noted to have a 9-cm pelvic mass. Which of the following is the most likely etiology?
Cystic teratoma
Dysgerminoma
Endodermal sinus tumor
Granulosa cell tumor
Mucinous tumor
```
Granulosa cell tumor
66
```
What are the most common nonphysiologic tumors found in females under the age of 30?
Benign cystic teratomas
Granulosa-theca cell tumors
Krukenberg tumors
Pancreatic cancer
```
Benign cystic teratomas
67
```
Sertoli-Leydig cell tumors in women are a type of sex cord-stromal cell tumor found in the ovaries. These cells are functional and typically secrete what?
Estrogen
Androgens
Cortisol
Norepinephrine
```
B
