MCQ Book Questions

Q60582. A 12-year-old girl complains of headaches and blurred vision. She has a history of high blood pressure, but is not currently taking medication. Her blood pressure is 160/95 mm Hg and pulse is 95 per minute. Funduscopic examination reveals small retinal microaneurysms and cotton-like zones of retinal edema and necrosis. She is hospitalized for further evaluation. Renal arteriography shows segmental stenoses forming multi- ple ridges that project into the lumen. What is the most likely cause of secondary hypertension in this young patient?

Q60583. A 75-year-old homeless man is brought to the emergency room in a coma. Upon admission to the hospital, the BUN is 74 mg/ dL, and the creatinine is 6.5 mg/dL. He dies thereafter, and an autopsy reveals abnormal kidneys (shown in the image). The pathogenesis of this disease is most likely related to which of the following?

Q60584. A 55-year-old man dies of chronic renal failure. Examination of his kidneys at autopsy reveals a “staghorn” calculus. Which of the following best describes the pathogenesis of this renal stone?

Q60585. A 64-year-old man presents with a 4-day history of dysuria and hematuria. He has a history of repeated bouts of acute cystitis. Urine cultures are positive for E. coli. Ultrasound examina- tion reveals an echogenic object in a bladder diverticulum. Which of the following conditions most likely contributed to the formation of a bladder diverticulum in this patient?

Q60586. A 20-year-old pregnant woman (gravida II, para I) complains of lower pelvic discomfort, fever, and pain during urination for the past 2 days. She also reports seeing blood in her urine. Which of the following is the most likely cause of hematuria in this patient?

Q60587. In the patient described in Question 4, which of the following would be the most likely etiologic agent?

Q60588. A baby girl has an open defect of the lower abdominal wall (patient shown in the image). Which of the following best describes the pathogenesis of this congenital birth defect?

Q60589. The abdominal wall defect in the patient described in Ques- tion 1 is repaired surgically. Despite this corrective surgery, the child is at increased risk for developing which of the following neoplasms?

Q60590. A 62-year-old man presents with a 1-month history of inter- mittent painless hematuria. Cystoscopy reveals multiple, red, velvety fl at patches in the bladder mucosa. A biopsy is shown in the image. Which of the following is the appropriate diagnosis?

Q60591. A 68-year-old man presents with a 4-week history of painless hematuria. Cytoscopy reveals a large exophytic tumor near the neck of the bladder. The cystectomy specimen is shown in the image. In addition to cigarette smoking, which of the following is the most signifi cant risk factor for the development of this patient’s malignant neoplasm?

Q60592. A 9-month-old boy is brought to the physician by his mother, who noticed that her son had developed scrotal swelling. Physical examination reveals a scrotal mass. The lesion can be transilluminated and is composed of clear serous fl uid. What is the appropriate diagnosis?

Q60593. A 67-year-old man complains of frequency of urination, pain on urination, and pelvic discomfort. The patient had a transurethral resection of the prostate 3 months ago, which required an indwelling catheter (both before and after sur- gery). Urine cultures are negative. Cytoscopy reveals multiple areas of hemorrhage on the bladder wall. Biopsy shows fi bro- sis of the lamina propria and a predominance of lymphocytes (shown in the image). Which of the following is the most likely cause of urinary symptoms in this patient?

Q60594. A 28-year-old man presents with multiple, raised lesions on the shaft of his penis. Physical examination shows condyloma acuminata. Biopsy of the lesion is shown in the image. This benign lesion is caused by infection with which of the following pathogens?

Q60595. A 20-year-old man presents with dysuria, urgency, and ure- thral discharge. Physical examination shows suppurative urethritis, with redness and swelling at the urethral meatus. Which of the following is the most likely etiology of urethritis in this patient?

Q60596. A 27-year-old man presents with acute and chronic infl am- mation of his glans penis. Which of the following is the most likely complication of chronic balanitis in this patient?

Q60597. A 65-year-old man presents with multiple lesions on his penis that he has had for 2 months. Physical examination reveals shiny, soft, erythematous plaques on the glans and foreskin. Biopsy of lesional skin shows neoplastic epithelial cells, con- nected by intercellular bridges, with invasion into the dermis. Which of the following is the appropriate histologic diagnosis for this patient’s penile neoplasm?

Q60598. A 50-year-old man presents with painless hematuria. A CT scan of the abdomen reveals a mass in the left ureter, which almost completely obliterates the lumen and has resulted in mild hydronephrosis. The surgical specimen is shown in the image. Which of the following is the most likely histologic diagnosis for this malignant neoplasm?

Q60599. A 4-year-old girl is brought to the physician by her parents who report seeing blood in the child’s urine. A CT scan reveals a neoplasm of the urinary bladder. Which of the following is the most likely diagnosis?

Q60600. A 55-year-old woman presents with a 2-week history of pain and bleeding near the urethral meatus. Urine cultures are negative. Biopsy of the affected tissue shows chronic infl am- mation, granulation tissue, and epithelial hyperplasia. Which of the following is the most likely diagnosis?

Q60601. A 40-year-old Egyptian fi sherman presents with painless hematuria. The patient’s past medical history is signifi cant for chronic schistosomiasis, which is endemic in his country of origin. Urinalysis shows malignant cells and cystoscopy reveals a mass in the wall of the urinary bladder. Which of the following is the most likely diagnosis?