QUESTION: 29

A 37-year-old rural female patient developed pain in the lower abdomen and pelvic regions. Her physician suspects a ruptured ectopic pregnancy. However, because of the isolation of the rural community, no medical imaging or laboratory procedure is available and the physician decides to perform a culdocentesis. In the latter procedure, the needle will aspirate from which of the following spaces?

ovarian fossa
rectouterine pouch
uterine body
uterine cervix
vesicouterine pouchAnswer:

Answer(s): B

Explanation:

In culdocentesis, the needle is inserted through the posterior fornix of the vagina and fluid is aspirated from the rectouterine pouch. If nonclotting blood is collected then the likelihood of a ruptured ectopic pregnancy is high. This procedure is rapid and inexpensive, however, serum progesterone level assay or ultrasonography are preferred methods. The ovarian fossa (choice A) or vesicouterine pouch (choice E) are not used in culdocentesis. The uterine body (choice C) and cervix (choice D) would not reveal blood from a ruptured ectopic pregnancy and thus are also not used in culdocentesis.

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QUESTION: 30

Arrow 4 in following figure, is pointing to which of the following structures?

abdominal aorta
colon
liver
spleen
stomach

Answer(s): D

Explanation:

The spleen (arrow 4) lies to the left of the abdominal cavity. It is in contact with the left side of the stomach (arrow 2) and lodges against the left paravertebral gutter. The abdominal aorta (choice A, arrow 5) is seen as the circular structure immediately anterior to the vertebra. The colon (choice B, arrow 3) is the convoluted structure to the left anterior aspect of the abdominal cavity. The large liver (choice C, arrow 1) occupies most of the right side of the abdominal cavity. The stomach (choice E, arrow 2) is located between the colon and the liver, and in this case, contains liquid contrast material.

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QUESTION: 31

An elderly resident of a nursing home fell down the front steps and subsequently became disoriented and lethargic. He is brought to the emergency room where an emergency MRI reveals that he has developed hydrocephalus due to a small hemorrhage obstructing the foramina of Monro. The foramina of Monro allow for communication between which of the following?

fourth ventricle and cerebral aqueduct
fourth ventricle and subarachnoid space
lateral ventricles and third ventricle
third ventricle and cerebral aqueduct
third ventricle and fourth ventricle

Answer(s): C

Explanation:

The foramina of Monro form the communication between the lateral ventricles and the third ventricle. The cerebral aqueduct of Sylvius flows caudally into the fourth ventricle (choice A). The lateral foramina of Luschka and the median foramen of Magendie allow for communication between the fourth ventricle and the subarachnoid space. The third ventricle communicates posteriorly with the cerebral aqueduct of Sylvius (choice D). Thus, the third and fourth ventricle communicate by way of this cerebral aqueduct.

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QUESTION: 32

Which of the following is the correct sequence of erythroid differentiation?

proerythroblast, basophilic erythroblast, polychromatophilic erythroblast, normoblast, reticulocyte, mature erythrocyte
proerythroblast, normoblast, reticulocyte, polychromatophilic erythroblast, basophilic erythroblast, mature erythrocyte
proerythroblast, polychromatophilic erythroblast, basophilic erythroblast, reticulocyte, normoblast, mature erythrocyte
proerythroblast, reticulocyte, normoblast, polychromatophilic erythroblast, basophilic erythroblast, mature erythrocyte
proerythroblast, reticulocyte, polychromatophilic erythroblast, normoblast, basophilic erythroblast, mature erythrocyte

Answer(s): A

Explanation:

The correct sequence of erythroid differentiation is indicated by choice A. Erythrocyte differentiation in the adult occurs exclusively in the bone marrow and consists of several cellular changes. The cell size decreases: proerythroblast 1419 m in diameter; basophilic erythroblast 1316 m; polychromatophilic erythroblast 1215 m; normoblast, reticulocyte, and mature erythrocyte 810 m. Condensation of the nuclear chromatin and decrease in nuclear diameter occur from the proerythroblast to the normoblast stage with ejection of the nucleus. Subsequent ejection of remaining organelles occurs in the reticulocyte to give rise to the mature erythrocyte. The maturing cells change their staining affinity because the increased hemoglobin in the cytoplasm results in increased acidophilia, whereas the decrease in the ribosome numbers in the cytoplasm results in decreased basophilia.
Choices B, C, D, and E are incorrect sequences.

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