Time limit: 0
Quiz Summary
0 of 38 Questions completed
Questions:
Information
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
Results
Quiz complete. Results are being recorded.
Results
0 of 38 Questions answered correctly
Your time:
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
| Average score |
|
| Your score |
|
Categories
- Not categorized 0%
- NBME 7 BLOCK 4 0%
Would you like to submit your quiz result to the leaderboard?
![captcha]()
Loading
| Pos. | Name | Entered on | Points | Result |
|---|---|---|---|---|
| Table is loading | ||||
| No data available | ||||
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- Current
- Review
- Answered
- Correct
- Incorrect
-
Question 1 of 38
1. Question
A 19-year-old woman comes to the office for evaluation of amenorrhea. The patient underwent menarche at age 12, and she previously had menses regularly every 25-28 days. However, for the past year, her menses have been irregular, and her last menstrual period was 3 months ago. The patient has no significant medical history, eats mainly fruits and vegetables, and exercises regularly at a local gym. On further questioning, she expresses concern about being overweight and asks for suggestions on cutting down her caloric intake. BMI is 18 kg/m2. The patient is thin and has dry skin covered by fine, downy hair. A pregnancy test is negative. Which of the following laboratory findings are most likely present in this patient?
CorrectIncorrect -
Question 2 of 38
2. Question
A 22-year-old woman presents to clinic for a medical check-up. She has been diagnosed with Turner’s syndrome. Cardiovascular examination reveals no abnormalities of the heart or aorta. She asks about her chances of having a baby. Which of the following methods could be used to achieve pregnancy in this patient?
CorrectIncorrect -
Question 3 of 38
3. Question
An autopsy is performed on a 17-year-old girl after a fatal aortic dissection. On gross examination, the uterus appears small and underdeveloped. Light microscopic examination shows the ovaries are primarily composed of connective tissue. Which of the following additional abnormalities is most likely to be found in this patient?
CorrectIncorrect -
Question 4 of 38
4. Question
A 10-year-old girl is brought to the office for evaluation of short stature. She was an average-sized infant, but over the past few years, her height growth velocity has plateaued. The patient has not menstruated and has no symptoms. She takes no medications, has no allergies, and has received all recommended immunizations. Menarche occurred in her mother at age 14 and both of her parents are tall. The patient’s height is at the <5th percentile and weight is at the 50th percentile for age and sex. She has no breast buds and no axillary or pubic hair. She has a low hairline, a short and wide neck, a broad chest, and widely spaced nipples. Which of the following is the most likely underlying mechanism for this patient’s condition?
CorrectIncorrect -
Question 5 of 38
5. Question
A 15-year-old girl is brought to the physician for evaluation of primary amenorrhea. Her mother is concerned because her other daughters had menarche before age 13. Vital signs are normal. The patient is at the 5th percentile for height and 20th percentile for weight. Examination shows a high arched palate and Tanner stage I breasts with inverted and widely spaced nipples. Further evaluation would most likely show which of the following?
CorrectIncorrect -
Question 6 of 38
6. Question
The following vignette applies to the next 2 items. The items in the set must be answered in sequential order. Once you click Proceed to Next Item, you will not be able to add or change an answer.
A 36-year-old woman comes to the office after she noticed some lumps under her arm while getting dressed. She says she feels fine and has no other symptoms. Her medical history is significant for hypothyroidism. Family history is negative. On physical examination, her body mass index is 24 kg/m2. Breast examination shows nontender left axillary lymphadenopathy. The patient is sent for an ultrasound-guided biopsy. Microscopy of the tissue specimen shows clumps of cells that have positive immunohistochemical staining for cytokeratin.
Item 1 of 2
These cells most likely belong to which of the following lineages?
CorrectIncorrect -
Question 7 of 38
7. Question
Item 2 of 2
The cells identified by the special immunohistochemical stain are shown to overexpress a 185 kD glycoprotein that spans the cell membrane and has tyrosine kinase activity in the intracellular domain. Which of the following is the most likely function of this protein?
CorrectIncorrect -
Question 8 of 38
8. Question
A 47-year-old woman, gravida 2 para 2, comes to the office after noticing a pea-sized lump in her right breast while taking a shower. Her medical history is significant for 3 pack-years of cigarette use during her 20s. She underwent infertility treatment and in vitro fertilization for both of her pregnancies. The patient has no family history of breast or ovarian cancer. A clinical breast examination confirms the presence of a firm, fixed nodule in the right breast with a small patch of overlying puckered skin. Mammogram findings are highly suspicious for malignancy, and a needle biopsy reveals infiltrating ductal carcinoma. A right mastectomy and axillary lymph node dissection are scheduled. Overexpression of which of the following markers is most likely to be associated with aggressive disease in this patient?
CorrectIncorrect -
Question 9 of 38
9. Question
A 47-year-old woman comes to the office with a red rash on her breast that has been present for approximately 2 months. The rash is itchy, and the skin feels rough to the touch. The itching has worsened in the past few weeks, and moisturizers have provided no relief. The patient has a history of surgery for bilateral silicone breast implants 10 years ago. Temperature is 37 C (98.6 F). Physical examination shows redness and swelling of the right breast without any discrete masses. The overlying skin is indurated with a dimpled texture, and several enlarged, hard lymph nodes are palpated in the right axilla. The left breast is normal. Which of the following is the most likely cause of this patient’s skin changes?
CorrectIncorrect -
Question 10 of 38
10. Question
A 12-month-old girl is brought to the clinic for evaluation of pain. Over the last few weeks, the parents have noticed that the patient tends to cry and appear uncomfortable when she sits down. More recently, the patient has started to cry when the parents try to put her in her car seat. Examination shows a firm, tender mass along the coccyx region. Imaging reveals a tumor in the sacrococcygeal area. The mass is excised, revealing the presence of hair, teeth, skeletal muscle, and intestinal epithelium. This patient’s tumor most likely originated from the same type of embryonic cell as which of the following malignancies?
CorrectIncorrect -
Question 11 of 38
11. Question
A 34-year-old man is found to have low sperm count during an infertility evaluation. The patient has no chronic medical conditions but has a history of testicular trauma from a motorcycle accident several years ago. Vital signs are within normal limits and physical examination shows no abnormalities. Further evaluation reveals the patient has developed antisperm antibodies. This patient’s testicular trauma most like damaged an anatomic barrier formed from which of the following components?
CorrectIncorrect -
Question 12 of 38
12. Question
A 50-year-old woman, gravida 0 para 0, comes to the office for an annual checkup. She has no family history of cancer. Breast examination is normal. Screening mammography reveals microcalcifications, and the patient undergoes breast biopsy. Histopathology reveals ducts distended by pleomorphic cells with prominent central necrosis. The lesion does not extend beyond the ductal basement membrane. Which of the following is the most likely site of origin of this patient’s lesion?
CorrectIncorrect -
Question 13 of 38
13. Question
A 1-month-old boy is brought to the emergency department due to acute onset fussiness. The child was born at term without complications. Temperature is normal. Examination shows a right-sided inguinal hernia that is not reducible. The penis appears normal, but the testes are not palpable. Imaging reveals a mass adjacent to the herniated bowel in the right inguinal canal. During surgical exploration, the mass is consistent with a testicle; an attached epididymis and vas deferens are identified. The left testicle is identified intraabdominally. However, the gonads also appear to be associated with fallopian tubes and a uterus. This patient’s findings are most likely due to a lack of which of the following hormones?
CorrectIncorrect -
Question 14 of 38
14. Question
A 22-year-old man comes to the emergency department due to a painful erection that developed spontaneously 6 hours ago. The erection has not subsided despite using an ice pack and taking pain medication at home. There is no history of trauma. The patient has a history of sickle cell disease and is taking no new medications. Examination shows a rigid penis with a soft glans. Aspiration of the corpus cavernosum reveals dark blood, with blood gas analysis showing the following values: pH, 7.21; PO2, 26 mm Hg; and PCO2, 68 mm Hg. Which of the following is the most likely cause of this patient’s current condition?
CorrectIncorrect -
Question 15 of 38
15. Question
A 36-year-old woman, gravida 2 para 1, at 34 weeks gestation is brought to labor and delivery due to heavy vaginal bleeding. She has had no contractions, leakage of fluid, or recent trauma. The patient has received no prenatal care. Her first pregnancy ended in a full-term cesarean delivery. Temperature is 37.2 C (99 F), blood pressure is 134/86 mm Hg, and pulse is 98/min. On speculum examination, there is active heavy bleeding. An emergency cesarean delivery is performed. After delivery of the infant, the placenta cannot be removed and remains densely adherent to the uterine wall. An emergency hysterectomy is performed. Pathologic examination will most likely show which of the following?
CorrectIncorrect -
Question 16 of 38
16. Question
A 14-year-old boy is brought to the office due to right breast enlargement. The patient says that he developed mild tenderness of the area 3 months ago and is distressed by its appearance. He is otherwise healthy and takes no daily medications. The patient does not use alcohol or recreational drugs. Height and weight are at the 80th and 60th percentile, respectively. Temperature is 36.7 C (98.1 F) and blood pressure is 112/62 mm Hg. Physical examination shows mild facial acne and the presence of hair on the upper lip and in the axillae. The right breast is enlarged with a 2-cm, firm, mildly tender mass under the nipple-areolar complex. There is no associated erythema or adenopathy. No palpable masses are present on the left. External genitalia are consistent with sexual maturity rating (Tanner stage) 4. The remainder of the examination is unremarkable. Which of the following is the best next step in management of this patient’s condition?
CorrectIncorrect -
Question 17 of 38
17. Question
A 31-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the emergency department due to increased swelling in her face and lower extremities. She has noticed a sudden onset of swelling and a 2.72-kg (6-lb) weight gain in the last day. The patient has not urinated in the last 12 hours despite an increase in fluid intake. She has a twin pregnancy and no chronic medical conditions. Blood pressure is 154/98 mm Hg, and pulse is 98/min. Bladder catheterization yields a total of 10 mL of dark urine. Urinalysis shows no red blood cells. Which of the following pathologic factors is the most likely cause of this patient’s decreased urine output?
CorrectIncorrect -
Question 18 of 38
18. Question
A 24-year-old woman comes to the office for an infertility evaluation. The patient has had irregular menstrual cycles for the past 5 years, with menstrual periods every 2-3 months. Medical history is notable for an appendectomy 8 years ago but is otherwise not significant. The patient takes no medications. Blood pressure is 125/86 mm Hg and pulse is 72/min. BMI is 33 kg/m2. Physical examination shows facial acne and excessive hair growth on the upper lip and chin. Which of the following pathologic findings is most likely to be seen in this patient?
CorrectIncorrect -
Question 19 of 38
19. Question
A 33-year-old woman comes to a fertility clinic for evaluation. The patient has been attempting to conceive for a year. She has been monogamous for 5 years with a male partner and he has had a semen analysis with adequate sperm motility, volume, and count. The patient used oral contraceptives for 15 years but stopped a year ago. Since then, her menses have occurred every 27-31 days with 4-6 days of bleeding. Seven years ago, she was treated with ceftriaxone after presenting to the emergency department with fever, abdominal pain, and vaginal discharge. Which of the following is the most likely factor contributing to this patient’s infertility?
CorrectIncorrect -
Question 20 of 38
20. Question
A 41-year-old woman comes to the office after a positive home urine pregnancy test. Her last menstrual period was 12 weeks ago. For the past month, the patient has had increasing nausea. She vomits several times a day and has difficulty keeping any food down. The patient has 3 children, all born at term via cesarean section. On this visit, ultrasound demonstrates echogenic intrauterine tissue without an amniotic sac and multiple bilateral ovarian cysts. Hydropic villi are evacuated from the uterus during dilation and curettage. Which of the following should be closely monitored in this patient after the procedure?
CorrectIncorrect -
Question 21 of 38
21. Question
A 36-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the office for a prenatal visit. The patient has noticed some ankle swelling at the end of the day that is relieved with elevating her legs, but she has no other concerns. The pregnancy has been uncomplicated, and her only medications are a prenatal vitamin and iron supplement. The patient has no chronic medical conditions. She does not use tobacco or alcohol. Blood pressure is 118/78 mm Hg and pulse is 72/min. BMI is 30 kg/m2. Fetal heart tones are normal. There is trace bilateral pedal edema to the shins. Physical examination is otherwise unremarkable. Urinalysis shows no protein. Compared to a nonpregnant state, which of the following cardiac changes are most likely to be found in this patient?
CorrectIncorrect -
Question 22 of 38
22. Question
A 19-year-old man comes to the emergency department due to intense scrotal pain over the past 6 hours. The pain started shortly after participating in a soccer game; he does not recall any specific trauma. The patient took ibuprofen at home with minimal relief. He is sexually active and has been treated twice in the past for Neisseria gonorrhoeae. Temperature is 36.9 C (98.5 F), blood pressure is 110/86 mm Hg, and pulse is 92/min. On examination, there is no inguinal adenopathy. There is significant discomfort with scrotal examination primarily on the right where a high-riding swollen mass is palpated within the hemiscrotum. The left testicle is palpated lower in the scrotum. Which of the following additional physical examination findings is most likely present in this patient?
CorrectIncorrect -
Question 23 of 38
23. Question
A 29-year-old woman, gravida 2 para 1, at 32 weeks gestation comes to the emergency department due to heavy vaginal bleeding. The bleeding started an hour ago. It was light initially and associated with only mild abdominal pain, but both the bleeding and the pain have increased, and now the pain is constant and severe. The patient has no chronic medical conditions. Her prior pregnancy was a term vaginal delivery complicated by preeclampsia with severe features. Blood pressure is 156/98 mm Hg, and pulse is 112/min. The uterus is firm and tender. Pelvic examination reveals heavy bleeding from the cervical os. Which of the following is the most likely cause of this patient’s current presentation?
CorrectIncorrect -
Question 24 of 38
24. Question
A 25-year-old primigravida at 37 weeks gestation is brought to the emergency department with constant, excruciating abdominal pain and sudden vaginal bleeding for the past 3 hours. The patient is Rh negative and received Rh(D) immunoglobulin at 28 weeks gestation. She has no chronic medical conditions and takes no medications. Blood pressure is 160/100 mm Hg and pulse is 118/min. Physical examination shows a firm and tender uterus. Speculum examination reveals a moderate amount of bleeding coming from an open cervical os. Fetal heart tracing shows a baseline of 105/min and no variability. Which of the following is the most likely cause of this patient’s bleeding?
CorrectIncorrect -
Question 25 of 38
25. Question
A 29-year-old woman is brought to the emergency department after a syncopal episode while getting out of bed. Yesterday, the patient developed right-sided abdominal pain, which has spread across the lower abdomen over the past few hours. She also noticed a blood stain on her underwear after the syncopal episode. Her last menstrual period was 8 weeks ago. The patient uses condoms intermittently for contraception. Temperature is 37 C (98.6 F), blood pressure is 90/60 mm Hg, and pulse is 125/min. The patient has diffuse lower abdominal pain with rebound tenderness and voluntary guarding. Pelvic examination shows cervical motion tenderness and right-sided adnexal tenderness; no masses are palpated. Which of the following is the most likely diagnosis for this patient?
CorrectIncorrect -
Question 26 of 38
26. Question
A 55-year-old postmenopausal woman comes to the office due to abdominal distension and decreased appetite. She also has lost 4.5 kg (9.9 lb) unintentionally over the past few months. The patient has no chronic medical conditions and takes no medications. She had 1 vaginal delivery in her 20s and has had no abdominal surgery. The patient had multiple abnormal Pap tests in the past and had a cervical conization at age 38; she did not receive the human papillomavirus vaccine. The patient does not use tobacco, alcohol, or illicit drugs. BMI is 24 kg/m2. Imaging studies reveal a right-sided ovarian mass and a large accumulation of free peritoneal fluid. A serum CA-125 level is elevated. Which of the following would most likely have reduced the risk of this patient’s current condition?
CorrectIncorrect -
Question 27 of 38
27. Question
A 41-year-old woman, gravida 3 para 2, at 34 weeks gestation comes to the office for a routine prenatal visit. For the past 2 weeks, the patient has had increasing pain over the pubic symphysis that is unrelieved with acetaminophen or warm compresses. She has had no dysuria, hematuria, contractions, or vaginal bleeding. The patient has hypothyroidism that is well controlled with levothyroxine. Vital signs are normal. Examination shows a tender, slightly widened pubic symphysis. Sensation is intact. Which of the following hormones is the most likely underlying cause of this patient’s pain?
CorrectIncorrect -
Question 28 of 38
28. Question
A 26-year-old woman, gravida 1 para 0, at 36 weeks gestation comes to the office for a routine prenatal visit. She has had no headaches, changes in vision, or right upper quadrant pain. Fetal movement is normal. The patient has no chronic medical conditions, and her pregnancy has been uncomplicated. Blood pressure today is 150/100 mm Hg, and a repeat measurement is 154/102 mm Hg. All other vital signs are normal. Urinalysis shows 2+ protein. This patient’s condition is most likely due to decreased activity of which of the following?
CorrectIncorrect -
Question 29 of 38
29. Question
A 19-year-old woman, gravida 1 para 0, at 29 weeks gestation comes to the emergency department due to severe right upper quadrant pain. The patient suddenly developed the pain this evening after dinner. The pain was associated with acute nausea and vomiting. She has no headaches or visual changes. The patient has no chronic medical conditions and takes no daily medications. Temperature is 36.7 C (98.1 F), blood pressure is 160/100 mm Hg, and pulse is 84/min. The abdomen is tender over the right upper quadrant, but no rebound or guarding is present. Hemoglobin is 8 g/dL. Urinalysis shows 3+ protein. Which of the following associated laboratory changes are most likely to be seen in this patient?
CorrectIncorrect -
Question 30 of 38
30. Question
A 16-year-old girl comes to the emergency department with vaginal bleeding. Her last menstrual period was 12 weeks ago. She is sexually active and does not use contraception. The patient had a miscarriage last year that required a dilation and curettage. Urine pregnancy test is positive. Transvaginal ultrasound demonstrates an intrauterine gestational sac without fetal cardiac activity, and a dilation and curettage is performed. Pathology shows fetal tissue, focal trophoblastic hyperplasia, and some enlarged villi interspersed with normal villi. Which of the following is the most likely diagnosis?
CorrectIncorrect -
Question 31 of 38
31. Question
A 20-year-old woman comes to the office due to 6 hours of right lower quadrant pain. The pain came on suddenly and has become intense and constant. She has been unable to eat or drink today due to nausea and frequent vomiting. The patient has had 2 sexual partners in the last year and has a history of chlamydial cervicitis. She takes ibuprofen for dysmenorrhea on the first day of her menses. The patient has a 6-cm, right ovarian cyst, which was noted on ultrasound last year. Her last menstrual period was 3 weeks ago. Temperature is 37.2 C (99 F), blood pressure is 110/80 mm Hg, and pulse is 104/min. Abdominal examination shows tenderness to deep palpation in the right lower quadrant. Urine pregnancy test is negative. Leukocyte count is 8,000/mm3. Which of the following is the most likely diagnosis?
CorrectIncorrect -
Question 32 of 38
32. Question
A 35-year-old nulliparous woman is diagnosed with cervical intraepithelial neoplasia grade 3. The patient has been sexually active for 15 years and has had 3 lifetime partners. She has been monogamous with her current partner for several months and has a progestin-releasing intrauterine device for contraception. The patient has never used condoms, and she douches regularly. Menarche occurred at age 9, and menses recur every 28 days and last 3 days. The patient had a plantar wart a few years ago which resolved on its own, but otherwise has no chronic medical conditions. Her mother was diagnosed with endometrial cancer at age 42. Which of the following risk factors contributed the most to the development of this patient’s cervical abnormalities?
CorrectIncorrect -
Question 33 of 38
33. Question
A 24-year-old woman comes to the emergency department due to lower abdominal cramping and vaginal bleeding. The patient started to have vaginal spotting a few days ago but has had slightly increased bleeding with painful lower abdominal cramping since this morning. She is sexually active, and her last menstrual period was 5 weeks ago. Blood pressure is 130/80 mm Hg and pulse is 100/min. Diffuse tenderness to palpation is present over the lower abdomen. On speculum examination, the cervix is closed and there is dark red blood coming from the cervical os. Bimanual examination reveals a small uterus and a 3-cm mass in the left adnexa. Quantitative serum β-hCG level is 1,200 mIU/mL (normal: <5). Which of the following is the most likely underlying cause of this patient’s presentation?
CorrectIncorrect -
Question 34 of 38
34. Question
A newborn is being evaluated in the nursery. The patient was born at term via spontaneous vaginal delivery to a 23-year-old woman. The mother developed dark terminal facial hair and a deepened voice during the pregnancy. The delivery was unremarkable, and the patient’s vital signs are within normal limits. Examination shows ambiguous genitalia and clitoromegaly. Laboratory studies reveal elevated serum levels of testosterone and androstenedione. Karyotype testing shows a 46,XX genotype. Ultrasound of the newborn shows a normal-sized uterus. This infant’s presentation is most likely due to deficiency of which of the following enzymes?
CorrectIncorrect -
Question 35 of 38
35. Question
A 28-year-old woman, gravida 2 para 2, comes to the office with worsening shortness of breath over the past week. She had a recent episode of hemoptysis. The patient has also had ongoing vaginal bleeding after an uncomplicated vaginal delivery of her son 9 weeks ago. She has no bleeding elsewhere, and she has not resumed sexual intercourse. On physical examination, the patient’s uterus is enlarged and the adnexa are normal. Laboratory studies show markedly increased β-hCG levels. Chest radiograph shows multiple bilateral lung nodules. Which of the following would most likely be found on endometrial curettage in this patient?
CorrectIncorrect -
Question 36 of 38
36. Question
A 38-year-old woman comes to the emergency department due to an acute episode of heavy menstrual bleeding. The patient has a history of menorrhagia, with monthly cycles lasting 7-10 days and brisk blood flow with the passage of large clots. Pelvic examination reveals an enlarged fibroid uterus, and she is found to have significant anemia due to blood loss. The patient is prescribed continuous leuprolide therapy. After several weeks, which of the following sustained hormonal changes are expected to have occurred as a result of the treatment?
CorrectIncorrect -
Question 37 of 38
37. Question
A 38-year-old woman, gravida 3 para 2, at 35 weeks gestation comes to the emergency department due to sudden-onset visual changes and headache. The patient reports “spots” in her vision for the past few hours and an occipital headache. She took a dose of acetaminophen, but it did not improve her symptoms. The patient’s pregnancy has been complicated by gestational diabetes mellitus requiring insulin. Blood pressure is 168/114 mm Hg and pulse is 90/min. The pupils are equal and reactive to light. Extraocular movements are intact. Visual field testing shows partial loss of vision bilaterally. Which of the following is the most likely cause of this patient’s symptoms?
CorrectIncorrect -
Question 38 of 38
38. Question
A 49-year-old woman comes to the office for evaluation of abnormal uterine bleeding. The patient has had irregular menses for the past 2 years, but now she has been bleeding daily for 2 weeks. She also has had increased abdominal bloating and pressure but no constipation or diarrhea. Medical history includes early-stage breast cancer diagnosed at age 45 and managed with tamoxifen for the past 4 years. On examination, there is a midline, immobile pelvic mass at the level of the umbilicus. The patient undergoes hysterectomy with bilateral salpingo-oophorectomy. The final pathology report notes nuclear atypia and numerous mitoses in the affected portion of the myometrium. Which of the following is the most likely diagnosis?
CorrectIncorrect