8 - gynaecology mcqs - 51 to 55

Question 51
A 28-year-old woman goes to her physician for a routine examination. She is sexually active. Pelvic examination reveals no abnormalities. A Pap smear is obtained. The cytopathology report indicates the presence of severely dysplastic cells. A biopsy of the cervix is performed, and on microscopic examination shows cervical intraepithelial neoplasia III (CIN III). Infection with which of the following organisms is most likely to cause her disease?
A Herpes simplex virus infection
B Epstein-Barr virus
C Candida albicans
D Human papillomavirus
E Trichomonas vaginalis
F Gardnerella vaginalis
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(D) CORRECT. HPV infections can lead to squamous epithelial dysplasia and carcinoma.
(A) Incorrect. HSV produces an infection with recurrent crops of painful vesicles, but these lesions are no pre-neoplastic.
(B) Incorrect. EBV infection is not characteristic for the genital tract.
(C) Incorrect. Candidal infections can produce vaginitis, but are not premalignant.
(E) Incorrect. Trichomonal infections are typically mild and do not presage CIN.
(F) Incorrect. G. vaginalis is a cause for bacterial vaginosis, not dysplasia.
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Question 52
A 23-year-old woman is admitted to the hospital with a one day history of increasing obtundation. On physical examination her temperature is 37.3 C, pulse 85/minute, respirations 16/minute, and blood pressure 90/45 mm Hg. A culdocentesis yields no blood. Laboratory studies show a positive pregnancy test. Her CBC shows a WBC count of 11,400/microliter, Hgb 10.6 g/dL, Hct 31.1%, MCV 95 fL, and platelet count 26,400/microliter. Schistocytes are noted on the peripheral blood smear. Her protime is 44 sec, partial thromboplastin time 61 sec, and D-Dimer 16 microgm/mL. A urinalysis dipstick examination shows no blood, protein, or glucose. Which of the following problems is most likely to explain her condition?
A Placental infarction
B Eclampsia
C Amniotic fluid embolus
D Retained dead fetus
E Ruptured tubal ectopic
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(D) CORRECT. This complication results in release of thromboplastin into the circulation, promoting disseminated intravascular coagulation (DIC) ith consumption of clotting factors and thrombocytopenia.
(A) Incorrect. Most placental infarcts are small and insignificant and do not lead to disseminated intravascular coagulation (DIC).
(B) Incorrect. Eclampsia can uteroplacental insufficiency with ischemia, leading to endothelial injury that promotes disseminated intravascular coagulation (DIC). However, there should be hypertension, proteinuria, and seizures.
(C) Incorrect. This is a rare complication of late third trimester pregnancy with a high mortality rate. Thromboplastins released into the circulation promotes disseminated intravascular coagulation (DIC). However, patients typically present with dypsnea.
(E) Incorrect. The shock resulting from the rupture leads to hypoxia and endothelial damage with resultant disseminated intravascular coagulation (DIC). However, in this case the culdocentesis was negative.
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Question 53
A 22-year-old woman passed grape-like masses of tissue per vagina in the 16th week of her first pregnancy. She had not felt any fetal movement at any time. On physical examination she measured 18 weeks in size. A D&C is then performed, yielding about 1000 cc of 0.5 to 1.5 cm fluid-filled vesicles. Microscopic examination of this tissue shows large avascular villi along with trophoblastic proliferation. Which of the following is the best method to employ for her follow-up?
A Chest radiograph
B Serum beta-HCG
C Endometrial biopsy
D Pelvic ultrasound
E Pap smear
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(B) CORRECT. She has a hydatidiform mole. Persistence or an increase in the HCG level should suggest that trophoblastic disease is still present, such as invasive mole or choriocarcinoma.
(A) Incorrect. The appearance of lung metastases from a choriocarcinoma arising in this hydatidiform mole would be a late finding.
(C) Incorrect. The biopsy might not pick up invasive mole or metastatic choriocarcinoma.
(D) Incorrect. The ultrasound could demonstrate mass lesions, but these would not be early findings.
(E) Incorrect. A Pap smear is relatively insensitive for endometrial lesions, and it certainly would not indicate invasive mole or metastasis of a choriocarcinoma.
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Question 54
A 23-year-old woman goes to the emergency room because of the sudden onset of lower abdominal pain. Pelvic examination reveals a normal sized uterus and normal appearing cervix and vagina. However, there is marked tenderness upon palpation of the left adnexal region. A transvaginal ultrasound demonstrates no intrauterine gestational sac, but there is a 2 cm left adnexal mass. Culdoscocentesis yields bloody fluid. Which of the following is most useful procedure to perform at this point for the patient?
A Serum complement determination
B Urinalysis with microscopic examination
C Pap smear
D Serum beta-HCG
E Endometrial biopsy
F WBC count
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(D) CORRECT. You should strongly suspect an ectopic pregnancy in this setting.
(A) Incorrect. Complement levels are used to solve complex problems with autoimmune diseases, which are chronic in nature.
(B) Incorrect. A routine urinalysis does not include a pregnancy test or a determination of HCG level.
(C) Incorrect. Besides, this is not a 'STAT' test. The Pap smear is useful for screening for dysplasia or carcinoma and for some infections.
(E) Incorrect. The endometrial biopsy might be a next step with a positive HCG to help determine if the pregnancy is ectopic.
(F) Incorrect. She does not have a reported fever. Although an inflammatory process is possible, there is a diagnosis higher on the list here.
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Question 55
A 20-year-old woman has had irregular menstrual bleeding for the past 6 months. On physical examination there are no abnormal findings. Laboratory studies show a negative pregnancy test. A D&C is performed and microscopic examination shows dyssynchronous endometrial glands and stroma of anovulatory cycles. Following the procedure she ceases to have menstrual bleeding. Which of the following is the most likely diagnosis?
A Endometriosis
B Asherman syndrome
C Prolactinoma
D Ovarian failure
E Oral contraceptive use
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(B) CORRECT. This is a very rare complication of a D&C procedure in which endometrium, including the stratum basalis, is removed.
(A) Incorrect. Endometriosis is best known as a cause for pelvic pain, though it may cause irregular menstrual cycles. It is unlikely to cause amenorrhea.
(C) Incorrect. Elevated prolactin levels can produce amenorrhea along with galactorrhea. The onset is not related to a D&C procedure.
(D) Incorrect. Ovarian failure is unlikely to have a relationship to a D&C.
(E) Incorrect. Oral contraceptives produce more regular cycles.

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