USMLE题库Genitourinary1-10

Genitourinary题库Q1A28-year-oldwomanisbroughttotheERwithsevereabdominalpainintherightlowerquadrantandvaginalbleeding.Herlastmenstrualperiodwas7weeksago.Shehasapastmedicalhistorysignificantforpelvicinflammatorydisease,hypothyroidism,andappendectomy.Herbloodpressureis80/40mmHgandherpulseis130beatsperminute.Sheispaleandherextremitiesarecoldandclammy.Endometrialcurettageinthispatientwouldmostlikelyreveal:A.StraightshortendometrialglandsandcompactstromaB.DecidualizedendometriumC.DecidualizedendometriumwithchorionicvilliD.EndometrialinflammatoryinfiltrationE.Atypicalendometrialcells,disorganizedglands,andmultiplemitosesA1:Correctanswer:BEctopicpregnancyoccurswhenafertilizedovumimplantsoutsideoftheuterus.Themostcommonsiteistheampullaofthefallopiantube.Themainriskfactorforectopicpregnancyisahistoryofpelvicinflammatorydisease(PID).Withtime,ectopicpregnancycompromisesthebloodsupplytothesurroundingtissuesandcanleadtoorganrupture.Apatientwitharupturedectopicpregnancymightpresentwithabdominalpain,vaginalbleedingandsignsofhemorrhagicshock(lowbloodpressure,tachycardia,coldclammyextremities,andoliguria).Ahistoryofamenorrheaisimportantformakingthediagnosis.Vaginalexaminationmayrevealaslightlyenlargedsoftuterus.Althoughthereisnoembryopresentinsidetheuterinecavity,thehormonalchangesthatoccurduringanectopicpregnancyareidenticaltothosethatoccurduringanormalpregnancy.Thus,auterinebiopsyorcurettagewouldrevealpregnancy-relatedendometrialchanges(suchasdecidualizationofstroma)withoutembryonictissueorchorionicvilli.(ChoiceA)Straightshortendometrialglandsandcompactstromaarefoundintheearlyproliferativephaseofthemenstrualcycle.Thismicroscopicappearancewouldbeobserved4-7daysaftertheonsetofmenses.(ChoiceC)Decidualizedendometrium,chorionicvilliandembryonictissuewouldbefoundwithanintrauterinepregnancy.Aninterruptedintrauterinepregnancycancausevaginalbleedingandabdominalpain,butwouldbeunlikelytocausesymptomsofhemorrhagicshock.(ChoiceD)Aninflammatoryendometrialinfiltratewouldsuggestendometritis.(ChoiceE)Thefindingofatypicalendometrialcellsthatformglandswouldsuggestendometrialadenocarcinoma,amalignancythatoccursinpostmenopausalwomenandmanifestswithvaginalbleeding.Q2A56-year-oldCaucasianfemalewithaone-weekhistoryofdysuriaandflankpaindevelopschills,highfever,andconfusion.Herbloodpressureis80/40mmHgandherheartrateis120/min.Herextremitiesarewarmandherbreathisrapidandshallow.Whichofthefollowingsubstancesismostlikelyresponsibleforthepatient’scurrentsymptoms?A.LeukotrieneB4B.IL-3C.IL-4D.IL-10E.INF-YF.TNF-aA2Correctanswer:EWhenobservedinthesettingofinfection,thetetradofhypotension,tachycardia,tachypnea,andmarkedlyelevatedordecreasedbodytemperaturearesuggestiveofsepticshock.Earlysepsisischaracterizedbyincreasedcardiacoutput,peripheralvasodilation,andwarmextremities(asseeninthispatient).Whensepsisprogresses,thestrokevolumedecreases,cardiacoutputdecreases,anddistalhypoperfusionbecomesevident.Inadvancedsepticshock,coolandclammyextremities,delayedcapillaryrefill,alteredmentalstatus,anddecreasedurineoutputareobserved.Themostimportantmediatorofsepsisistumornecrosisfactoralpha(TNF-a),anacutephasecytokineproducedbyactivatedmacrophages.OthercytokinesresponsibleforinducingthesystemicinflammatoryresponseincludeIL-1andIL-6.(ChoiceA)LeukotrieneB4isametaboliteofarachidonicacid.Itsmainfunctionistostimulateneutrophilmigrationtothesiteofinflammation.(ChoiceB)IL-3isacytokineproducedbyactivatedTcells.Itstimulatesthegrowthanddifferentiationofstemcellsinthebonemarrow.(ChoiceC)IL-4isacytokineproducedbyTh2T-helpercells.ItstimulatesthegrowthofBcellsandincreasesthenumberofTh2T-helpercellsatthesiteofinflammation.(ChoiceD)IL-10isananti-inflammatorycytokineproducedbymacrophagesandTh2T-helpercells.IL-10limitstheproductionofpro-inflammatorycytokines(eg,gammainterferon,IL-2,IL-3,TNF-a).(ChoiceE)Gammainterferon(INF-y)isproducedbyactivatedTcellsandservestorecruitleukocytesandactivatephagocytosis.Q3Asexuallyactive22-year-oldfemalepresentstotheERwithbloodyvaginaldischargeandcrampyabdominalpain.Sheisfoundtohaveapositivepregnancytest.Followingtheinitialevaluation,adilationandcurettageprocedureisperformed.Edematousvilliareevacuatedfromtheuterus.Cytologicevaluationofthetissuerevealsa69XXXkaryotype.Whatisthemostlikelydiagnosis?A.CompletemoleB.PartialmoleC.ChoriocarcinomaD.MissedabortionE.AbruptioplacentaeF.TubalpregnancyA3Correctanswer:BThispatienthasapartialhydatidiformmole,aconditionthatmanifestswithvaginalbleedingandcrampyabdominalpain.Partialhydatidiformmolestypicallyhaveatriploidkaryotype.Evacuateduterinecontentscontainfetaltissues,edematousvilliwithproliferatedtrophoblasticlining,andsomenormal-appearingvilli.(ChoiceA)Acompletemolemaypresentwithvaginalbleeding.Oftentimestheuterusisenlargedoutofproportiontothegestationalage.Theremaybepre-eclampsia?hyperthyroidismandtheca-luteincystsaswell.Cellsoftheevacuatedtissuehavea46XX(orrarely46XY)karyotype.(ChoiceC)Choriocarcinomacandevelopaftermolarpregnancy,abortionornormalpregnancy.Itpresentswithvaginalbleedingandsymptomsofmetastaticdisease(eg.cou