Gross Anatomy and Embryology Test

Question 1

A 45-year-old woman has a uterine leiomyoma that is 5 cm in diameter and is pressing on the urinary bladder, causing urinary frequency. Which of the following is the most likely location of the leiomyoma?

Accepted Answer

Subperitoneally on the anterior surface of the uterine corpus

Answer

A leiomyoma (fibroid) pressing on the urinary bladder and causing urinary frequency indicates an anterior location. Specifically, a subperitoneal (subserosal) fibroid on the anterior surface of the uterine corpus would be positioned to exert pressure on the adjacent bladder, leading to symptoms like frequency.

Question 2

A 5-year-old girl is brought to the emergency department because of fever and severe abdominal pain. Acute appendicitis is diagnosed. In the examination room, she keeps her right hip flexed and resists active extension of the hip. The inflamed structure associated with these symptoms is most likely in contact with which of the following structures?

Accepted Answer

Psoas major muscle

Answer

The patient's symptoms of keeping the right hip flexed and resisting extension are indicative of a positive psoas sign. This occurs when an inflamed appendix (especially a retrocecal appendix) irritates the psoas major muscle, which lies posterior to the appendix. Flexing the hip relieves tension on the muscle, while extension stretches it, causing pain.

Question 3

A 61-year-old man comes to the physician because of a 3-month history of episodes of headache, heart palpitations, and excessive sweating. He has had a 10-kg (22-lb) weight loss during this period. While being examined, during an episode his blood pressure is 210/110 mm Hg. Physical examination shows no other abnormalities. Urine studies show increased catecholamine concentrations. A CT scan of the abdomen is most likely to show a mass in which of the following locations?

Accepted Answer

Adrenal glands

Answer

The classic triad of headache, palpitations, and sweating, along with paroxysmal hypertension and weight loss, strongly suggests a pheochromocytoma. This diagnosis is confirmed by elevated urinary catecholamines. Pheochromocytomas are neuroendocrine tumors that typically arise from chromaffin cells in the adrenal medulla.

Question 4

A 6-year-old boy has a large intra-abdominal mass in the midline just above the symphysis pubis. During an operation, a cystic mass is found attached to the umbilicus and the apex of the bladder. Which of the following is the most likely diagnosis?

Accepted Answer

Urachal cyst

Answer

The urachus is an embryonic remnant of the allantois that connects the fetal bladder to the umbilicus. If the urachus fails to involute completely, it can form a cyst, which is typically located in the midline between the umbilicus and the bladder apex, precisely matching the description of the mass found in this patient.

Question 5

A 55-year-old man who has alcoholic cirrhosis is brought to the emergency department because he has been vomiting blood for 2 hours. He has a 2-month history of abdominal distention, dilated veins over the anterior abdominal wall, and internal hemorrhoids. Which of the following veins is the most likely origin of the hematemesis?

Accepted Answer

Left gastric vein

Answer

In alcoholic cirrhosis, portal hypertension leads to the development of portosystemic shunts. Hematemesis in this context is most commonly due to ruptured esophageal varices, which form as a result of increased pressure in the left gastric (coronary) vein, a tributary of the portal vein, anastomosing with esophageal veins.

NBME Practice Test

NBME Practice Test

Gross Anatomy and Embryology Test