MCQ Book Questions

Q60662. A 25-year-old woman presents with a 6-month history of increasing facial hair, deepened voice, and amenorrhea.

Q60663. A 33-year-old woman presents after 3 weeks of a painful genital lesion. Physical examination reveals a tender, ery- thematous, submucosal lesion of the labium minor (shown in the image). Which of the following is the most likely diag- nosis?

Q60664. A 22-year-old woman presents to the emergency room with an 8-hour history of high fever, vomiting, diarrhea, and night sweats. Her temperature on admission is 38.7°C (103°F), blood pressure 100/60 mm Hg, and respirations 24 per min- ute. She has a diffuse desquamative erythematous rash. Upon pelvic examination, the patient is found to be menstruating, and a tampon is in place. A purulent exudate is found within the vagina, which is cultured and grows Staphylococcus aureus. The hemoglobin is 12 g/dL, and the platelet count is 40,000/μL. Which of the following represents the most com- mon life-threatening complication of this patient’s systemic disorder?

Q60665. A 30-year-old woman suffers traumatic injury to her breast while playing soccer. Physical examination reveals a 3-cm area of ecchymosis on the left breast. Two weeks later, the patient palpates a fi rm lump beneath the area where the bruise had been located. Which of the following is the most likely patho- logic diagnosis?

Q60666. A 50-year-old woman presents with a mass in her left breast that she fi rst detected 6 months earlier. A fi rm 4-cm mass is palpated on breast examination. Excisional biopsy reveals malignant cuboidal cells that form gland-like structures and solid nests, surrounded by dense collagenous stroma. Which of the following terms best describes the adaptive response of this patient’s normal breast tissue to the tumor?

Q60667. A 54-year-old woman complains of bloody discharge from her left nipple. Physical examination reveals a 0.5-cm nod- ule in the subareolar breast tissue, which is surgically excised. Histologic examination (shown in the image) reveals cuboidal and myoepithelial cell–lined vascular connective tissue cores, which project into the lumen of a major lactiferous duct. Which of the following is the appropriate diagnosis?

Q60668. A 60-year-old man presents with painless, bilateral enlarge- ment of both breasts. The patient has a history of nodular prostatic hyperplasia and is taking medication for hypercho- lesterolemia. Physical examination reveals no discrete breast masses or axillary lymph node enlargement. Which of the fol- lowing is the most likely underlying cause of breast enlarge- ment in this patient?

Q60669. A 30-year-old woman presents with nipple discharge of 3 weeks in duration. Physical examination reveals a white dis- charge from both nipples. The patient has not menstruated for the past 4 months, and she is not pregnant. The breasts are fi rm and nontender. A cytologic smear of the discharge shows no evidence of acute or chronic infl ammatory cells. Which of the following is the most likely cause of galactorrhea in this patient?

Q60670. A woman consults her physician because of painful swelling of her breasts. Physical examination reveals nodularity of both breasts. Mammography shows irregular areas of increased density in the lower, outer quadrants of both breasts. A breast biopsy reveals increased fi brous stoma, cystic dilation of the terminal ducts, and varying degrees of apocrine metaplasia. This patient’s condition is most commonly seen in which of the following groups?

Q60671. A 22-year-old woman presents with a painless nodule in the lower outer aspect of her right breast that she has had for 2 months. The nodule appears to be freely movable, sharply demarcated from the surrounding parenchyma, and fi rm. A mammogram demonstrates a circumscribed, homogeneous density. A biopsy of the breast mass is shown in the image. Which of the following best estimates the risk of subsequent invasive breast cancer developing in this patient?

Q60672. A 35-year-old nulliparous woman complains that her breasts are swollen and nodular upon palpation. A mammogram discloses foci of calcifi cation in both breasts. A breast biopsy reveals cystic duct dilation and ductal epithelial hyperplasia without atypia (shown in the image). What is the appropriate diagnosis?

Q60673. A 24-year-old woman delivers a 3.5-kg baby and begins breastfeeding her infant. The patient presents 2 weeks later with a fever of 38°C (101°F). Physical examination shows no abnormal vaginal discharge or evidence of pelvic pain but does reveal redness on the lower side of the left breast. The patient stops nursing the infant temporarily, but the symptoms per- sist, and the entire breast becomes swollen and painful. What is the most likely diagnosis?

Q60674. Upon self-examination, a 53-year-old woman discovers a lump in her left breast. Physical examination reveals a palpa- ble lump about 1 cm in diameter in the outer quadrant of the left breast. No palpable lymph nodes are found in the axilla. Mammography reveals an ill-defi ned, stellate density measur- ing 1 cm in the left breast. Fine-needle aspiration of the mass discloses malignant epithelial cells. A partial mastectomy is performed and shows invasive ductal adenocarcinoma. Which of the following is the most important prognostic factor for this patient?

Q60675. A mammogram of a 52-year-old woman demonstrates calcifi - cations in her left breast. No axillary lymph node enlargement is detected on physical examination. An excisional biopsy is shown in the image. If this patient foregoes further treatment, which of the following best estimates her risk of developing invasive carcinoma in this breast over the next 20 years?

Q60676. A 54-year-old woman presents with a mass in her right breast that she fi rst palpated 5 days before. A breast biopsy reveals malignant cells, and a mastectomy is performed. Immuno- histochemical staining is performed for HER2/neu (shown in the image). Which of the following genetic mechanisms best accounts for the intensity of staining in this specimen?

Q60677. A 20-year-old woman asks for your advice regarding her risk of developing breast cancer. Her mother, maternal aunt, and maternal grandmother all developed breast cancer. She would like to know if she has a genetic predisposition. Laboratory tests for mutations in which of the following genes would be most likely to answer your patient’s question?

Q60678. A 58-year-old woman presents with an irregular nodularity that has developed in her right breast over the past 3 months. Mammography demonstrates irregular densities in both breasts. A needle biopsy of one breast lesion is shown. An excisional biopsy of the contralateral breast shows similar his- tology. Which of the following is the most likely pathologic diagnosis?

Q60679. A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. On physical examination, a purulent exudate is observed to drain from an open fi ssure. Culture of this exudate will most likely grow which of the following microorganisms?

Q60680. A 45-year-old woman discovers a solitary, freely movable mass in her right breast on self-examination, which is confi rmed on physical examination. Mammography demonstrates focal calcifi cation, with a linear confi guration in the region of the breast mass. A breast biopsy (shown in the image) reveals large, pleomorphic epithelial cells confi ned to dilated ducts, with central zones of necrosis. What is the appropriate patho- logic diagnosis?

Q60681. A 45-year-old woman presents with an oozing, reddish patch on her left nipple (patient shown in the image). The patient has a history of skin rashes and food allergies and believes this condition is due to an allergic reaction to her bra. Cyto- logic examination of fl uid oozing from the skin lesion reveals neoplastic cells. Excisional biopsy shows large clear malignant cells in the epidermis of the areola. Which of the following is the most likely diagnosis?