NEW
Font size
WorksheetsPractice Questions for Exam #3
Total questions: 20
Worksheet time: 10mins
A 58-year-old man presents with hematuria and a dull ache in the flank. CT reveals a solid mass in the kidney that has invaded the renal vein. Considering its most common cellular origin, which histologic feature would be expected?
Sheets of transitional epithelial cells with papillary projections
Polygonal epithelial cells with clear cytoplasm due to lipid and glycogen content
Small blue cells with scant cytoplasm forming rosettes
Abundant eosinophilic cytoplasm with perinuclear clearing and keratin pearls
A 46-year-old woman develops jaundice, pruritus, and dark urine over several weeks. Labs show elevated conjugated bilirubin and alkaline phosphatase. Ultrasound reveals dilated intrahepatic bile ducts but no gallstones. Which mechanism best explains her presentation?
Autoimmune destruction of extrahepatic bile ducts
Fibrotic narrowing of intrahepatic bile canaliculi due to autoimmune cholangitis
Sudden spasm of the sphincter of Oddi following opioid use
Microvascular ischemia of hepatocytes leading to bilirubin leakage
A newborn male is noted to have bilateral undescended testes. Which long-term complication is most likely if the condition is not corrected?
Hypogonadotropic hypogonadism due to pituitary suppression
Increased risk of malignant transformation of germ cells
Loss of Sertoli cell function causing testosterone deficiency
Autoimmune orchitis due to blood-testis barrier breakdown
A 33-year-old man has painless jaundice and pale stools. Imaging shows a mass at the head of the pancreas compressing the adjacent duct. Which component of bilirubin metabolism is most directly impaired?
Uptake of unconjugated bilirubin into hepatocytes
Conjugation of bilirubin in the smooth ER
Delivery of conjugated bilirubin to the small intestine
Conversion of bilirubin to urobilinogen by gut flora
A 27-year-old woman reports chronic pelvic pain, dysmenorrhea, and infertility. Laparoscopy reveals dark, powder-burn lesions on the uterosacral ligaments. Which is the most likely direct effect of these lesions on her fertility?
Inhibition of hypothalamic GnRH release causing anovulation
Formation of pelvic adhesions that distort tubo-ovarian anatomy and block gamete transport
Destruction of endometrial glands reducing estrogen production
Disruption of cervical mucus production reducing sperm motility
A 70-year-old man presents with progressive difficulty initiating urination and incomplete bladder emptying. Ultrasound shows bilateral hydronephrosis. Which histopathologic change in the kidneys is most likely?
Expansion of the interstitium with lymphocytic infiltration
Cortical and medullary thinning due to sustained increased intratubular pressure
Proliferation of glomerular endothelial cells with immune deposits
Hyperplasia of collecting duct intercalated cells
A 62-year-old woman has chronic gastritis with intestinal metaplasia. Which cellular change has occurred in the gastric mucosa?
Replacement of gastric columnar cells by squamous epithelium
Hypertrophy of mucosal glands with increased mucus production
Transformation of gastric columnar epithelium into intestinal-type columnar cells with goblet cells
Replacement of columnar epithelium by fibroblasts and collagen
A 49-year-old man presents with frothy urine. Labs show hypoalbuminemia, hyperlipidemia, and proteinuria exceeding 3.5 g/day. Which alteration of the glomerular barrier is most likely responsible?
Widening of glomerular basement membrane lamina densa
Immune complex deposition in the mesangium
Effacement and fusion of podocyte foot processes reducing size-selective filtration
Proliferation of endothelial cells narrowing capillary lumens
A 40-year-old woman develops clay-colored stools and right upper quadrant pain. Imaging shows stones in the cystic duct and gallbladder distention without common bile duct obstruction. Which bile flow change is most likely?
Complete absence of bile secretion by hepatocytes
Increased bile salt reabsorption from the ileum
Obstruction of bile exit from the gallbladder into the common bile duct
Regurgitation of bile into the pancreatic duct
A 28-year-old man has recurrent flank pain and hematuria. Imaging reveals bilateral, variably sized renal cysts and numerous liver cysts. Which underlying defect is most likely?
Mutation in collagen IV affecting the glomerular basement membrane
Mutation in PKD1 gene affecting polycystin-1 protein in tubular epithelial cells
Failure of mesonephric duct development during embryogenesis
Defective ureteric bud branching during kidney formation
A 50-year-old man with chronic hepatitis develops portal hypertension. Which vascular change in the liver contributes most to the increased portal pressure?
Proliferation of sinusoidal endothelial cells
Enlargement of the central veins
Fibrous septa bridging portal tracts and central veins, distorting vascular architecture
Loss of Kupffer cells from the sinusoidal lining
A 39-year-old woman reports persistent watery diarrhea and flushing. Colonoscopy is normal, but CT shows a mass in the ileum. Which diagnostic finding would most likely confirm the systemic cause of her symptoms?
Increased serum gastrin level
Positive stool occult blood
Elevated urinary 5-hydroxyindoleacetic acid level
Increased fecal calprotectin concentration
A patient with celiac disease has persistent anemia despite iron supplementation. Which portion of the intestine is most likely still damaged?
Jejunum near the ligament of Treitz
Proximal duodenum with loss of villi and crypt hyperplasia
Terminal ileum with Peyer’s patch hyperplasia
Colon with mucosal ulcerations
A 61-year-old man presents with increasing abdominal girth and ankle edema. Labs show hypoalbuminemia and proteinuria. Which hemodynamic change is most directly responsible for the edema?
Increased lymphatic flow in peripheral tissues
Increased capillary hydrostatic pressure in the venules
Decreased plasma oncotic pressure due to albumin loss
Increased interstitial oncotic pressure from protein leakage
A 35-year-old man develops severe epigastric pain radiating to the back after a large meal. Labs show elevated serum amylase and lipase. Which mechanism best explains his enzyme elevation?
Direct injury to duodenal mucosa with brush border loss
Increased bile salt production from the liver
Leakage of digestive enzymes from inflamed acinar cells into the circulation
Pancreatic duct hyperplasia increasing enzyme secretion
A patient develops hypoalbuminemia and fat-soluble vitamin deficiencies after extensive small bowel resection. Which physiologic process is most directly impaired?
Peristaltic mixing of chyme with pancreatic secretions
Surface area for nutrient absorption due to loss of intestinal mucosa
Cholecystokinin release from I cells
Acid secretion from gastric parietal cells
A 45-year-old woman presents with amenorrhea, visual field loss, and bitemporal hemianopsia. MRI reveals a sellar mass. Which hormonal change is most likely?
Elevated FSH and LH levels
Low prolactin level with high GnRH
High prolactin level with suppressed GnRH and reduced gonadotropins
High TSH with low free T4
A patient with long-standing inflammatory bowel disease develops primary sclerosing cholangitis. Which distinctive finding is most likely on cholangiography?
Uniform dilation of intrahepatic bile ducts
Abrupt cutoff of common bile duct
Alternating strictures and dilations producing a “beaded” appearance
Complete absence of extrahepatic ducts
A 60-year-old man with type 2 diabetes develops recurrent yeast infections and progressive proteinuria. Kidney biopsy shows thickened glomerular basement membrane and mesangial expansion. Which biochemical change is most responsible?
Activation of complement pathways
Increased renal prostaglandin production
Nonenzymatic glycosylation of proteins causing cross-linking of collagen
Deposition of immune complexes containing IgA
A patient with suspected gastric carcinoma undergoes endoscopy showing an ulcerated mass on the lesser curvature of the stomach. Which lymph nodes are most likely to first receive metastatic spread?
Mesenteric nodes
Left gastric lymph nodes
Pancreaticoduodenal nodes
Para-aortic nodes
