Question 56
A 14-year-old girl has had pelvic pain for the past 3 months. She refuses physical examination. She has not had any sexual activity. She has not had a menstrual period. Which of the following is the most likely diagnosis?
A Cervical condyloma
B Endometriosis
C Cervical gonorrhea
D Imperforate hymen
E Ruptured Bartholin's cyst
------------------------------------------------------
(D) CORRECT. Following the onset of menarche, the blockage to menstrual flow leads to an accumulation of blood in the vagina, called hematocolpos.(A) Incorrect. Condylomas consist of thickened epithelium that does not bleed.(B) Incorrect. Endometriotic lesions are usually located on serosal surfaces in the pelvis and abdomen. There is minimal hemorrhage just at the site of the lesion itself. The onset of pelvic pain is typically at a later age than that of this patient.(C) Incorrect. Gonorrhea can produce inflammation, but not hemorrhage. Gonorrhea is a sexually transmitted disease.(E) Incorrect. A Bartholin's cyst will contain clear fluid, and when inflamed may contain purulent material.
--------------------------------------------------------------
Question 57.
A 64-year-old woman has had itching with irritation of the vulvar region, along with vaginal dryness, for the past 8 months. On physical examination there are pale grey patches from 1 to 2 cm in size on the vulva. Biopsy of one lesion is performed and on microscopic examination shows epithelial thinning, dermal fibrosis, and perivascular chronic inflammation. Which of the following is the most likely diagnosis?
A Squamous cell carcinoma
B Lichen sclerosus
C Condyloma acuminatum
D Adenosis
E Extramammary Paget disease
F Dermatophyte infection
-----------------------------------------------------------
(B) CORRECT. Lichen sclerosus et atrophicus is typically seen after menopause and is slowly progressive. It may predispose to infection, but is not premalignant.(A) Incorrect. This is a neoplasm that would lead to a mass with malignant squamous epithelial cells.(C) Incorrect. This is a 'venereal wart' from human papillomavirus infection, leading to verrucous white plaques that histologically have epithelial hyperplasia.(D) Incorrect. Vaginal adenosis may occur in women with exposure to diethylstilbestrol in utero.(E) Incorrect. This is a red, crusted area that has clusters of malignant epithelial cells within the epidermis and its appendages.(F) Incorrect. This would be an uncommon location for such an infection. There would likely be hyperkeratosis and minimal inflammation.
-----------------------------------------------------
Question 58
For the past year, a 50-year-old woman has noted that her menstrual periods have been exceptionally heavy, lasting 7 to 9 days. She has noted occasional minor intermenstrual bleeding. For the past 3 months, she has been taking supplemental dietary iron for iron deficiency anemia. On pelvic examination, the uterine cervix appears normal, but the uterus is enlarged to twice normal size. Transvaginal ultrasound reveals the presence of a 9 cm solid mass in the uterus. A hysterectomy is performed, and on gross inspection with sectioning the uterus a reddish-tan mass is found with a fleshy cut surface. Microscopically the mass is highly cellular, with spindle cells having hyperchromatic nuclei and 10 to 20 mitoses per high power field. Which of the following is the most likely diagnosis?
A Endometrial polyp
B Adenomyosis
C Leiomyoma
D Ectopic pregnancy
E Leiomyosarcoma
F Malignant mixed mullerian tumor
-----------------------------------------------------------------
(E) CORRECT. Leiomyosarcomas of the uterus are uncommon malignant neoplasms. They do not arise from leiomyomas. They are larger and more cellular than benign leiomyomas, and have mitotic figures.(A) Incorrect. The endometrial polyp is composed of both glands and stroma.(B) Incorrect. Adenomyosis, which is the presence of endometrial glands in the uterine myometrium, results in diffuse uterine enlargement, and is not very common.(C) Incorrect. At least 20% of women have at least one leiomyoma, but leiomyosarcomas are rare. However, a large cellular mass with mitoses is less likely to be a leiomyoma. Postmenopausally, most leiomyomas stop growing or even regress.(D) Incorrect. An ectopic is a more acute process, when rupture occurs, though the course may be weeks. An ectopic is located outside the uterus, typically in a fallopian tube.(F) Incorrect. A malignant mixed mullerian tumor 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; these heterologous elements can resemble malignant cartilage or bone. The 3MT also tends to be a large, bulky mass.
-----------------------------------------------------------------
Question 59
A 31-year-old G3 P2 woman is at 14 weeks gestation, but has noted a small amount of vaginal bleeding for the past 2 weeks. Laboratory studies show an HCG level of 650,000 U/L. An ultrasound shows a "snowstorm" for intrauterine contents but no identifiable fetus. A D&C is performed with evacuation of 500 mL of grape-like vesicles. A month later her vaginal bleeding persists and her serum beta-HCG is 35,000 U/L. Which of the following pathologic abnormalities is most likely to be present in this woman?
A Pulmonary metastases
B Tubal ectopic pregnancy
C Endometritis
D Placental site trophoblastic tumor
E Invasive mole
---------------------------------------------------------------
(E) CORRECT. Invasive moles constitute about 10% of molar pregnancies. The failure of the HCG to diminish to near negative following the D&C suggests residual gestational trophoblastic disease.(A) Incorrect. Such masses would be typical for metastatic choriocarcinoma, but choriocarcinoma complicates only about 2 to 3 % of molar pregnancies.(B) Incorrect. If the pregnancy were tubal, it would not typically last more than a month before rupture of the tube occurred.(C) Incorrect. An endometritis would not account for a continued high HCG level.(D) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited to the pregnancy.-------------------------------------------------
Question 60
A 33-year-old woman and her husband have wanted a child, but she has been unable to conceive for the past 10 years. She has mild pelvic pain. She has regular menstrual cycles. On physical examination the cervix and vagina appear normal. The uterus and adnexal regions are normal on palpation. A pelvic ultrasound shows no lesions. A Pap smear is normal. Her husband's sperm count is normal. Which of the following is most likely to be the cause for her infertility?
A Adenomyosis
B Prolactinoma
C Pelvic inflammatory disease
D Teratoma
E Chronic cervicitis----------------------------------------------------
(C) CORRECT. PID leads to scarring that interferes with movement of the ovum released from the ovary down the fallopian tube.(A) Incorrect. Adenomyosis can produce irregular cycles and irregular vaginal bleeding. The uterus is typically enlarged.(B) Incorrect. Amenorrhea and dysmenorrhea are the classic findings from the secretion of prolactin by a pituitary adenoma. There is often galactorrhea as well.(D) Incorrect. A teratoma is most often unilateral, though occasionally bilateral. It produces a mass lesion that can often be felt, and it should be found with ultrasound.(E) Incorrect. Many women have some degree of chronic cervicitis.
---------------------------------------------------------------
No comments:
Post a Comment