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Matthew So

02.05.16
1. 46 year old woman is evaluated for irregular vaginal bleeding is found
to have invasive cervical cancer. She undergoes total abdominal
hysterectomy (ureter injury) and bilateral salpingo (FALLOPIAN
TUBES) oophorectomy. Pelvic lymphadenectomy was also
performed, during which several enlarged nodes around the pelvic
vessels were resected. A week after the surgery, the patient begins to
experience left-sided flank pain that radiates to the groin. Her
temperature is 36.1C (97F), blood pressure is 120/70 mm Hg, and
pulse is 84/min. On physical examination, there is a ballotable left
flank mass. Which of the following most likely accounts for this
physical exam finding?
A. Hydronephrosis
a. Ureter surgery water accumulating in the kidney.
b. Uterine artery cross with the ureter.
B. Interstitial nephritis
C. Renal cell carcinoma
a. Not related to cervical cancer
D. Renal cystic disease
E. Renal vein thrombosis
F. Vesicoureteral reflux
i. Fever
2. The patient has a strong family history of ovarian (breast cancer)
and uterine cancer. The cells identified by the special
immunohistochemical staining of the axillary lymph nodes are also
noted to overexpresss a 185 kD glycoprotein. This protein spans the
cell membrane and has intracellular tyrosine kinase activity. Which
of the following is the most likely function of this protein?
A. Acts as a sex hormone receptor
B. Accelerates cell proliferation
C. Governs intercellular binding
D. Induces cytokine release
E. Mediates endocytosis
3. Axillary lymph nodes excised from 36 year old female contains clumps
of cells that show positive immunohistochemical staining for
cytokeratin. These cells most likely belong to which of the following
lineages?
A. Lymphoid
B. Epithelial
C. Myeloid
D. Mesenchymal
E. Neuroendocrine
4. 57 year old man comes to ED due to fevers and painful motuh ulcers.
He recently began methotrexate(hepatic and renal injury) therapy for

psoriasis. However, the patient has mistakenly taken the medication


daily instead of 3 times a week. His past medical history is also
significant for hypertension and chronic kidney disease. Temperature is
38.1 C (100.6 F). Examination reveals multiple aphthous ulcers in the
oral pharynx. A complete blood cell count is as follows:
Hemoglobin 10.4 g/DL
Platelets 120,000/mm^3
Leukocytes 2,800/mm^3
Which of the following is the best next step in management?
a. Allopurinol
b. Amifostine
c. Dexrazoxane
d. Filgrastim
e. Folinic acid
f. Mesna
g. Ondasetron
5. Coronary angiography demonstrates several atherosclerotis lesions
in an asymptomatic 35-year-old Caucasian male. The lesions do not
cause significant coronary flow obstruction. High intraplaque
activity of which enzyme would predispose the patient to
myocardial infarction?
a. Prolyl hydroxylae
b. Lysyl oxidase
c. Procollagen peptidases
d. Metalloproteinases
i. Vascular remodeling
e. Heparinase

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