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Question 1 of 23
1. Question
A pharmaceutical researcher performs preclinical testing on a novel chemotherapeutic drug. When rat embryos are exposed to this drug during an early stage of organogenesis, they develop severe skeletal malformations. Further genetic analysis reveals that the drug causes mutations in numerous homeobox genes containing highly conserved 180 base pair DNA sequences. The genes affected by this drug most likely code for which of the following proteins?
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Question 2 of 23
2. Question
A 27-year-old nulligravid woman comes to the office for a routine visit. Medical history is significant for epilepsy that is well controlled with valproate and chronic hypertension for which she takes nifedipine. She hopes to conceive in the next few months and plans to start prenatal vitamins soon. The patient takes no other medications and does not use tobacco, alcohol, or illicit drugs. Blood pressure is 120/80 mm Hg. Physical examination is normal. If the patient conceives now, her fetus is at increased risk for which of the following anomalies?
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Question 3 of 23
3. Question
A newborn boy is in the neonatal intensive care unit for mechanical ventilation due to pulmonary hypoplasia. He was born via spontaneous vaginal delivery at 30 weeks gestation to a 41-year-old woman who did not receive prenatal care. The mother had assumed her amenorrhea was due to early menopause, which runs in her family. She took multiple medications for poorly controlled hypertension before realizing she was pregnant. Prenatal ultrasound demonstrated severe oligohydramnios for which delivery was induced. Examination of the infant shows an intubated and sedated boy whose weight is at the third percentile. The temporal, occipital, and parietal bones are underdeveloped, and the right lower limb is shortened and contracted. Which of the following mechanisms is the most likely cause of this neonate’s abnormalities?
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Question 4 of 23
4. Question
A 34-year-old woman, gravida 0, comes to the office for evaluation of pregnancy. Menarche was at age 12, and her menstrual cycles are regular; they occur every 30 days with 5 days of menses. The patient and her husband have been trying to conceive for the past 6 months and plan intercourse during her fertile window according to an ovulation predictor kit. She has no medical conditions, takes no medications, and has no allergies. BMI is 23 kg/m2. Vital signs and physical examination are normal. If fertilization and implantation occurred in this cycle, when would the β-hCG level first be detectable in the serum?
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Question 5 of 23
5. Question
A 32-year-old woman, gravida 4 para 0, comes to the office for evaluation of recurrent pregnancy loss. She has had 4 consecutive spontaneous abortions with the same partner. The patient has menstrual cycles approximately 28 days apart, with light bleeding for 2-3 days. She has no chronic medical conditions and takes no daily medications. The patient does not use tobacco, alcohol, or illicit drugs. Results of her hysterosalpingogram are shown in the exhibit. Failure of which of the following processes is the most likely underlying mechanism of this patient’s condition?
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Question 6 of 23
6. Question
A 22-year-old woman at 14 weeks gestation comes to the physician for a prenatal visit. She reports feeling well with the exception of some mild fatigue. Her pregnancy has been uncomplicated to date. On physical examination, the patient’s abdomen appears larger than would be expected at 14 weeks. An obstetrical ultrasound reveals twins, a male and a female. Which of the following describes the most likely type of twin placentation in this patient?
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Question 7 of 23
7. Question
A 15-year-old girl is brought to the office due to amenorrhea. She has never menstruated, but her mother underwent menarche at age 14. The patient has no chronic medical conditions and takes no medications. She does not use tobacco, alcohol, or illicit drugs. The patient plays violin for her high school orchestra and is the captain of her junior varsity tennis team. She is not sexually active. Height is 175.3 cm (5 ft 9 in) and weight is 65 kg (143.3 lb). BMI is 21.2 kg/m2. Examination shows fully developed secondary sexual characteristics. Pelvic ultrasound shows a shortened vaginal canal with a rudimentary uterus. Which of the following is the most likely diagnosis?
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Question 8 of 23
8. Question
In normal female development, non-fusion of the urethral folds forms the labia minora and the vestibule of the vagina. In males, non-fusion of the urethral folds would most likely result in which of the following?
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Question 9 of 23
9. Question
An autopsy is performed on a stillborn fetus delivered at 20 weeks gestation to a 35-year-old primigravida. The woman’s pregnancy was unremarkable, and she received routine prenatal care. Noninvasive prenatal testing was performed earlier in the pregnancy and revealed a 46,XY fetus. Further work-up reveals a loss of function mutation of the androgen receptor gene on the X chromosome, resulting in complete androgen insensitivity. Which of the following phenotypes is most likely to be present in this fetus?
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Question 10 of 23
10. Question
A 33-year-old man comes to the office due to episodic headaches for several months accompanied by sweating and feelings of anxiety that spontaneously resolve after 15-30 minutes. He has no other medical conditions and takes no medications. His brother recently had surgery to treat hyperparathyroidism. Blood pressure is 180/110 mm Hg, and pulse is 102/min. Laboratory results show normal serum electrolytes and renal function. CT scan of the abdomen reveals a mass in the right adrenal gland. Which of the following cells have the same embryological origin as the tissue responsible for this patient’s current condition?
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Question 11 of 23
11. Question
A 22-year-old woman with no prenatal care has a normal vaginal delivery. On physical examination, the infant’s external genitalia are atypical and ambiguous. There is an intermediate clitorophallic length and a perineal urethral opening. Well-circumscribed, mobile masses are palpable bilaterally in the inguinal area. Vital signs are normal. Serum testosterone level is within normal limits. A karyotype is performed and shows 46,XY. This infant most likely has a deficiency in which of the following enzymes?
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Question 12 of 23
12. Question
A 6-year-old boy is brought to the office by his mother due to behavioral difficulties at school. His teacher has said, “He interrupts the class, doesn’t listen, and cannot sit still for more than a few minutes.” He has been sent home on a few occasions for hitting other children and taking their toys. The patient was adopted at age 6 months and his birth history is unknown. He runs around the office playing with various toys and is easily distracted. Vital signs are within normal limits. Weight and height are tracking on the 10th percentile, and head circumference is below the 5th percentile for age and sex. Physical examination reveals short palpebral fissures, a smooth philtrum, thin upper lip, and difficulty with both gross and fine motor coordination. Which of the following is the likely cause of this patient’s condition?
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Question 13 of 23
13. Question
A 31-year-old man comes to the emergency department complaining of right-sided scrotal pain and swelling that has gradually worsened over the last 3 days. His temperature is 38.3 C (101 F). On physical examination, his right hemiscrotum is warm, tender, and erythematous. The cremasteric reflex is present. A scrotal ultrasound reveals a fluid collection consistent with a superficial scrotal abscess. Which of the following lymph node groups is most likely to be tender and swollen?
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Question 14 of 23
14. Question
A 24-year-old primigravid patient at 38 weeks gestation undergoes vaginal delivery of healthy twins after a prolonged labor course. Shortly after the placenta is delivered, profuse vaginal bleeding and a boggy uterus are noted on examination. Uterine massage and uterotonic medications fail to stop the bleeding. The patient is taken to the operating room for a laparotomy. Control of this patient’s bleeding can best be achieved through bilateral ligation of which of the following arteries?
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Question 15 of 23
15. Question
A 23-year-old man comes to the physician complaining of right-sided testicular swelling. He first noticed the swelling 1 week ago while getting ready for work. He denies any testicular pain or history of trauma. However, he has noticed a heavy, pressing sensation involving his scrotum and lower abdomen. Physical examination reveals asymmetric swelling of the right testis, and subsequent ultrasonography shows a solid testicular mass. If malignant, this patient’s tumor is most likely to spread to which of the following lymph node groups?
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Question 16 of 23
16. Question
A 28-year-old woman, gravida 1 para 0, at 38 weeks gestation undergoes spontaneous vaginal delivery. After an uncomplicated delivery of the fetus and placenta, a maternal laceration is noted at the posterior vaginal opening through the vaginal mucosa and submucosa. Which of the following structures is most likely damaged in this patient?
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Question 17 of 23
17. Question
A 23-year-old primigravida woman has a vaginal delivery of a 3600-g (7 lb 15 oz) infant after a protracted labor. The patient has had no pain medications or epidural analgesia during delivery. She sustains a second-degree perineal laceration, and repair is planned. Prior to administering local anesthesia, the physician palpates for distinct bony protrusions located on the posterolateral vaginal sidewalls; a firm band can be felt running medially and posteriorly from each of the bilateral bony protrusions. The anesthetic agent is injected around the bony prominence. Which of the following nerves is most likely blocked by this injection?
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Question 18 of 23
18. Question
A 62-year-old man comes to the office due to an elevated prostate-specific antigen level on a screening test. When asked about genitourinary symptoms, the patient says, “It often takes a bit of time before my urine starts flowing,” but he has no other problems. Abdominal and external genital examinations are unremarkable. Digital rectal examination reveals hard prostate nodules. A biopsy confirms adenocarcinoma, and the patient undergoes a radical prostatectomy. During the surgery, the nerves within the fascia surrounding the gland are inadvertently injured. Which of the following is the most likely consequence of the nerve injury?
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Question 19 of 23
19. Question
A 45-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He has lower abdominal pain and a sensation of bladder fullness, but has been unable to urinate since the collision. Trauma work-up is notable for bruising over the chest and suprapubic tenderness. CT scan of the chest, abdomen, and pelvis reveals rib fractures and a pelvic fracture. Which of the following portions of the urogenital tract is most likely injured in this patient?
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Question 20 of 23
20. Question
A 63-year-old postmenopausal woman comes to the office due to right-sided lower abdominal pain for the last 5 months. The patient has had no changes in bowel or bladder habits, no increase in abdominal girth or bloating, and no early satiety. Physical examination shows a soft abdomen with slight tenderness to palpation over the right lower quadrant. On pelvic examination, the uterus is small and the right adnexa is enlarged. Transvaginal ultrasound shows a normal uterus; a unilateral, 3.5-cm, complex ovarian mass with cystic and solid components; and no free fluid in the pelvis. Surgery is planned to remove the right ovary, including the mass. To avoid excessive bleeding, which of the following structures should be ligated during the oophorectomy?
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Question 21 of 23
21. Question
A 52-year-old man comes to the office for a painless mass in his right groin. He noticed the mass several weeks ago, and it has slowly enlarged. The patient has a history of HIV, for which he takes antiretroviral therapy. He has not had any new sexual partners recently. Temperature is 37.1 C (98.8 F). On examination, several enlarged, hard lymph nodes are palpated in the right inguinal area inferior to the inguinal ligament. An excisional biopsy is performed, and histopathology shows malignant cells. The malignant cells found in this patient most likely originated from which of the following sites?
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Question 22 of 23
22. Question
A newborn girl is being evaluated in the nursery. She was born at term via spontaneous vaginal delivery. Examination shows fusion of the third and fourth fingers bilaterally with an extra digit present between these 2 fingers. The remainder of the examination is unremarkable. Laboratory work-up confirms a mutation in HOXD13, a gene involved in regulating craniocaudal body patterning during embryonic development. This gene encodes a protein that directly regulates body patterning by which of the following mechanisms?
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Question 23 of 23
23. Question
A newborn boy is being evaluated in the nursery. The patient was born at 39 weeks gestation via cesarean delivery to a 30-year-old primigravida. Head circumference, weight, and length are at the 75th to 90th percentiles. The anterior fontanelle is open and soft. The neck is supple. Cardiopulmonary examination is unremarkable, and the abdomen is soft. The back appears unremarkable. Hip examination shows no hip clicks. Both feet are plantar flexed and adducted with the soles pointing medially. There is resistance to range of motion assessment in both feet. Muscle tone is normal and newborn reflexes are intact. The abnormal findings on this patient’s physical examination most likely represent which of the following types of congenital anomalies?
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