A 45-year-old male entered the emergency department with a complaint of severe abdominal pain. During physical examination it is observed that his cremasteric reflex is absent. Which of the following nerves is responsible for the efferent limb of the cremasteric reflex?

A 32-year-old woman was admitted to the hospital with a complaint of pain over her umbilicus. Radiographic examination revealed acute appendicitis. The appendix was removed successfully in an emergency appendectomy. One week postoperatively the patient complained of paresthesia of the skin over the pubic region and the anterior portion of her perineum. Which of the following nerves was most likely injured during the appendectomy?

A 23-year-old pregnant woman visits her gynecologist for her routine ultrasound checkup. Ultrasonographic examination reveals unilateral renal agenesis and oligohydramnios. Which of the following conditions most likely occurred?

An 18-year-old female gymnast is admitted to the hospital with pelvic pain. Physical examination reveals that the patient has a history of primary amenorrhea and an imperforate hymen. Which of the following is the most likely explanation for this condition?

A 2-week-old boy presented with persistent swelling of his left scrotum, but there has been no noticeable
discomfort. Physical examination shows bilateral descended
testicles with an enlarged, fluctuant left hemi-scrotum that transilluminates brightly.
No inguinal or abdominal masses are present. The most likely cause of this patient's
condition is a swelling in which of the following locations?

A 31-year-old man comes to the emergency department complaining of right-sided scrotal pain and swelling that has gradually worsened over the last 3 days. His temperature is 38.3 C (101 F). On physical examination, his right hemiscrotum is warm, tender, and erythematous. The cremasteric reflex is present. A scrotal ultrasound reveals a fluid collection consistent with a superficial scrotal abscess.
Which of the following lymph node groups is most likely to be tender and swollen?

A 24-year-old woman is admitted to the hospital with lower abdominal pain. A CT examination reveals an abnormal mass occupying the left adnexa in the pelvis. During the surgical procedure the ureter and the structures immediately medial to the ureter are identified. Which of the following vascular structures crosses the ureter just lateral to the cervix of the uterus?

A 21-year-old man comes to the emergency department due to 2 days of gross
hematuria. He reports passage of small blood clots in urine but has had no pain,
dysuria, or similar symptoms in the past. The patient has no prior medical problems
and does not take any medications. He does not use tobacco, alcohol, or illicit
drugs. His younger sister has sickle cell disease. His temperature is 36.7 C (98 F).
blood pressure is 120/70 mm Hg, and pulse is 100/min. Abdominal and
genitourinary examination is unremarkable. Which of the following is the most likely
cause of this patient's hematuria?
A. Acute pyelonephritis
B. Amyloidosis
C. Hemolytic-uremic syndrome
D. Hypersensitivity interstitial nephritis
E . Ischemic tubular necrosis
F. Papillary necrosis

Renal papillary necrosis classically presents with gross hematuria, acute flank pain,
and passage of tissue fragments in urine. It is most commonly seen in patients with
sickle cell disease or trait, diabetes mellitus, analgesic nephropathy, or severe
obstructive pyelonephritis.

A 17-year-old female presents to your office with urinary frequency, urgency, and
burning during urination. She has also noticed a scant vaginal discharge. The
symptoms started two days ago. Which of the following additional findings would be
most suggestive of pyelonephritis in this patient?
• A. Abdominal pain
• B. Fever
• C. Microscopic hematuria
• D. Bacteriuria
• E. White blood cell casts
F. Sterile pyuria

A 17-year-old female presents to your office with urinary frequency, urgency, and
burning during urination. She has also noticed a scant vaginal discharge. The
symptoms started two days ago. Which of the following additional findings would be
most suggestive of pyelonephritis in this patient?
• A. Abdominal pain
• B. Fever
• C. Microscopic hematuria
• D. Bacteriuria
• E. White blood cell casts