Question 76
A 28-year-old woman develops the sudden onset of severe lower abdominal pain. On physical examination there is tenderness to palpation of the right lower quadrant. Laboratory studies show her serum pregnancy test is positive. An ultrasound scan does not reveal a gestational sac in the uterus, but there is a right adnexal mass. The development of these findings is most closely related to past infection with which of the following organisms?
A Treponema pallidum
B Human papillomavirus
C Neisseria gonorrheae
D Candida albicans
E Group B Streptococcus
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(C) CORRECT. Many cases of pelvic inflammatory disease (PID) are due to gonorrhea. The tubal scarring from the inflammation leads to an increased risk for ectopic pregnancy(A) Incorrect. Syphilis can produce a chancre of the external genitalia or cervix.(B) Incorrect. HPV is associated with increased risk for squamous epithelial dysplasias.(D) Incorrect. Candida is the cause for vaginitis.(E) Incorrect. This organism presents the greatest risk as an intrauterine infection resulting in stillbirth in the third trimester.
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Question 77
A 45-year-old woman has had irregular menstrual periods for the past 9 months. On physical examination she has an enlarged uterus. An ultrasound scan shows a 9 cm solitary, solid mass in the uterus. A total abdominal hysterectomy is performed. Gross examination of the irregular reddish-tan mass located in the myometrium shows bundles of smooth muscle cells along with heterogenous elements of pleomorphic cartilaginous cells. There are also areas with poorly differentiated gland formation. Mitotic figures are frequent. Which of the following neoplasms is she most likely to have?
A Leiomyosarcoma
B Sarcoma botryoides
C Malignant mixed mullerian tumor
D Endolymphatic stromal myosis
E Leiomyoma
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(C) CORRECT. The malignant mixed mullerian tumor typically has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues.(A) Incorrect. The leiomyosarcoma is distinguished from a leiomyoma by the cellularity and the mitotic rate, but it is composed only of cells resembling smooth muscle.(B) Incorrect. Sarcoma botryoides is a rare neoplasm most likely to occur in the vagina of a child. It is composed of primitive cells most resembling an embryonal rhabdomyosarcoma.(D) Incorrect. This rare condition consists of endometrial stromal cells extending into the body of uterus and beyond.(E) Incorrect. A leiomyoma should not have a significant mitotic rate.
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Question 78
A 72-year-old woman has been feeling tired for the past year. She has had episodes of vaginal bleeding during this time. On physical examination there are no abnormal findings. Laboratory studies show Hgb 9.1 g/dL, Hct 26.5%, MCV 72 fL, platelet count 158,000/microliter, and WBC count 7150/microliter. An endometrial biopsy is performed and on microscopic examination shows atypical adenomatous hyperplasia. Which of the following is the most likely risk factor for development of her disease?
A Human papillomavirus infection
B Long term use of an intrauterine contraceptive device
C Chronic endometritis
D Pelvic inflammatory disease
E Unopposed estrogenic stimulation
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(E) CORRECT. The unopposed estrogen drives the hyperplasia, which if atypical carries an increased risk for development of an endometrial adenocarcinoma.(A) Incorrect. HPV infection mainly produces lesions of squamous epithelium of external genitalia and cervix, such as dysplasias and carcinoma.(B) Incorrect. An IUD can cause endometritis, but not a preneoplastic lesion.(C) Incorrect. Chronic endometritis is not generally known as an antecedent to preneoplastic or neoplastic conditions.(D) Incorrect. PID can produce inflammation with scarring, mainly of tubes and ovaries.
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Question 79
A 56-year-old G0 P0 woman reports vaginal bleeding in the past 2 months. Her last menstrual period was 6 years ago. On physical examination there are no abnormal findings. Which of the following procedures is most appropriate to perform on this woman?
A Endometrial biopsy
B Pap smear
C Vaginal culture
D Colposcopy
E CT scan
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(A) CORRECT. This history points to a possible endometrial carcinoma, and nulliparity increases the risk.(B) Incorrect. CIN is less likely than an endometrial lesion in this setting.(C) Incorrect. An infection would be unlikely to cause bleeding.(D) Incorrect. This will show cervical lesions, not endometrial.(E) Incorrect. The possible causes of uterine bleeding cannot be distinguished by CT (or MRI) scan.
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Question 80
A 50-year-old woman has experienced mild pelvic discomfort for 3 months. On physical examination there are bilateral adnexal masses. A pelvic CT scan reveals irregular unilocular cystic, bilateral mass lesions in the region of the ovaries. One is 10 cm and the other is 8 cm in size. Which of the following types of neoplasm is most likely to be present in this woman?
A Mature cystic teratoma
B Serous cystadenocarcinoma
C Endometrioid carcinoma
D Fibrothecoma
E Mucinous cystadenoma
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(B) CORRECT. Ovarian serous tumors are bilateral more often than other ovarian tumors. Serous cystadenocarcinomas are bilateral in about 2/3 of cases.(A) Incorrect. Teratomas of the ovary are bilateral in about 10 to 15% of cases.(C) Incorrect. These are bilateral in about 40% of cases; however, they tend to be solid masses.(D) Incorrect. These are unlikely to be bilateral; they are solid masses(E) Incorrect. Benign mucinous ovarian tumors are bilateral in about 5% of cases. Malignant mucinous ovarian tumors are bilateral about 20% of the time. They tend to be multilocular.
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