MCQ

1.A 50-year-old woman who works as a secretary comes to the physician because of numbness and tingling in her hands. On examination, the patient is found to have decreased sensation in all of her fingers except her fifth digit. Which of the following muscles is most commonly weakened in patients with this condition?
(A) Adductor pollicis
(B) Dorsal interossei
(C) Lumbricals (3 and 4)
(D) Opponens digiti minimi
(E) Opponens pollicis

2.A 21-year-old woman with no family or personal history of breast cancer presents with a small, firm mass in the lower inner quadrant of her right breast that seems mobile when palpated. It is nontender. There are no overlying skin changes or nipple discharge. Which of the following would most likely be found on biopsy of this mass?

(A) Blue dome cysts and some atypical epithelial hyperplasia
(B) Cells in a single fi le formation
(C) Fibrosing stroma around normal-looking glands
(D) Large cells with clear “halos”
(E) Multicentric lobes with lymphocytic infiltrate

ANS:The correct answer is C. Fibroadenomas are the most common tumor in young women, presenting as small,firm, mobile masses. They are not associated with malignancy. On histology, fibrosing stroma is seen around normal duct and gland structures.

Answer A is incorrect. Blue dome cysts are seen in fibrocystic diseases of the breast. These lesions have associated risks of carcinoma with the presence of atypia.
Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.
Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.
Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.

3,A 39-year-old woman, gravida 3, para 2, at 20 weeks' gestation comes to the physician because of fevers, chills, and a cough for the past week. Her prenatal course had been otherwise unremarkable. Her temperature is 38.0 C (100.4 F), blood pressure is 100/60 mm Hg, pulse is 98/min, and respirations are 14/min. Examination demonstrates crackles and harsh breath sounds at the right lung base. The physician recommends a chest x-ray, but the patient is concerned about radiation exposure during pregnancy. Which of the following is the most appropriate response?

(A) Exposure from a chest x-ray does not cause harmful fetal effects
(B) Exposure from a chest x-ray leads to birth defects
(C) Exposure from a chest x-ray leads to spontaneous abortion
(D) When chest x-ray has occurred, fetal pneumonia is more common
(E) When chest x-ray has occurred, termination should be considered

ANS:The correct answer is A. Exposure to radiation, particularly in the form of an x-ray, is a major cause of anxiety for pregnant patients. There is a generally held belief that exposure to any radiation during pregnancy will lead to miscarriage or birth defects. There is no evidence, how ever, of any increase in spontaneous abortion or fetal anomalies at doses of radiation less than 5 rad. This dose is above the level of radiation exposure of diagnostic procedures. The fetal exposure from a chest x-ray with 2 views is approximately 0.05 mrad. This amount is several orders of magnitude below the 5 rad limit. Therefore, it is currendy believed that x-ray exposure from any single diagnostic procedure will not cause harm to the fetus. This patient has signs and symptoms consistent with pneumonia and could therefore benefit from a chest xray. She should be reassured that the exposure to the fetus from a chest x-ray is minimal and has not been shown to cause birth defects or fetal loss.

A chest x-ray exposes the fetus to minute amount of radiation compared with the amount needed to cause birth defects (choice B). 
There is no evidence that the exposure of 0.02 to 0.07 mrad of radiation caused by a chest x-ray leads to spontaneous abortion (choice C).
To state that when chest x-ray has occurred, fetal pneumonia is more common (choice D) is incorrect. The presence or absence of a fetal infection is not dependent on a chest x -ray being performed to evaluate for maternal pneumonia.
To state that when chest x-ray has occurred, termination should be considered (choice E) is incorrect.
Exposure to x-ray during pregnancy is not an indication for therapeutic abortion.