Female system — Past Paper OmpathStudy

Female system — Questions and Answers Complete review bank: 40 questions recovered from all 27 source pages. 1. A 29-year-old woman taking oral contraceptives for a year has noted vaginal bleeding that is not severe, but it has occurred nearly every day over the past 5 weeks. On pelvic examination, there is a 0.7 cm polypoid mass noted to extend outward from the cervical os. The ectocervix appears normal. The uterus is normal in size. The adnexa have no palpable masses. A biopsy of this lesion is performed. Which of the following microscopic findings is most likely to be found in this lesion? A. Endocervical adenocarcinoma B. Clear cell adenocarcinoma C. Microglandular hyperplasia D. Sarcoma botryoides E. Endocervical polyp F. Follicular cervicitis Answer: C. Microglandular hyperplasia forms a mass lesion grossly, and must be distinguished from adenocarcinoma histologically. Some cases may occur in the setting of oral contraceptive use, but a causal relationship is not well established. 2. A 48-year-old woman has noted a small amount of irregular vaginal bleeding for the past 2 months. She has a pelvic examination that reveals no cervical lesions, and a Pap smear that shows no abnormal cells. Next, an endometrial biopsy is performed, and there is microscopic evidence for endometrial hyperplasia. An abdominal ultrasound reveals a solid right ovarian mass. Which of the following neoplasms is this woman is most likely to have? A. Mature cystic teratoma B. Choriocarcinoma C. Sertoli-Leydig cell tumor D. Fibrothecoma E. Krukenberg tumor F. Cystadenocarcinoma Answer: D. Fibrothecomas and granulosa cell tumors can be estrogen producing. The excessive estrogen drives endometrial hyperplasia, which can progress to atypical hyperplasia, which can progress to endometrial carcinoma. 3. A 51-year-old perimenopausal woman has had vaginal bleeding for the past 6 months. On physical examination she has an enlarged, nodular uterus. A hysterectomy is performed. The surgeon notes several 0.2 to 1 cm translucent, smooth-surfaced, thin-walled, fluid-filled cysts near the fimbriated end of the right fallopian tube. Which of the following is the most likely diagnosis for these cysts? A. Gartner duct cysts B. Krukenberg tumors C. Parovarian cysts D. Pelvic inflammatory disease E. Mucinous cystadenomas F. Fibrocystic disease G. Omphalomesenteric duct cysts Answer: C. Also called paratubal cysts, these are common incidental findings. They are embryologic remnants of the wolffian duct. They are not related to neoplasia. This woman had leiomyomas of the uterus which led to the hysterectomy. 4. A 36-year-old woman has had episodes of lower abdominal and pelvic pain for the past 10 years. A bimanual pelvic examination reveals no abnormalities. A Pap smear is negative. She has an abdominal ultrasound scan that reveals no abnormalities. She undergoes laparoscopy, and several 0.2 to 0.5 cm brown nodular lesions are seen on serosal surfaces of the uterus, fallopian tubes, and appendix. These lesions are excised. Which of the following microscopic findings is most likely to be present in these lesions? A. Endometrial stroma B. Mesothelial cells C. Metastatic adenocarcinoma D. Capillary proliferation E. Granulomatous inflammation Answer: A. Pain is a key feature of endometriosis. The foci of endometriosis are most often found on serosal surfaces in the pelvis, but can be found in other locations such as the surface of the bowel. Endometrial glands, stroma, and hemorrhage are microscopic features. 5. A 47-year-old woman has noted a pressure sensation, but no pain, in her pelvic region for the past 5 months. On physical examination there is a right adnexal mass. An ultrasound scan shows a 10 cm fluid-filled cystic mass in the right ovary, along with ascitic fluid. A fine needle aspirate of the mass is performed and cytologic examination of clear fluid aspirated from the mass reveals clusters of malignant epithelial cells surrounding psammoma bodies. Which of the following neoplasms is she most likely to have? A. Endometrioid carcinoma B. Serous cystadenocarcinoma C. Malignant mesothelioma D. Mature cystic teratoma E. Squamous cell carcinoma Answer: B. Ovarian carcinomas are often associated with ascites, because they have a propensity to seed throughout the peritoneal cavity. Psammoma body formation is common to malignant serous tumors of the ovary. 6. A 31-year-old woman was last seen by a physician 10 years ago. She had received Pap smear testing in 2 of the 5 years prior. She had no abnormal Pap smears. She now presents with vaginal spotting. On pelvic examination an ulcerated cervical lesion is noted and microscopic examination of cells from this lesion show squamous cell carcinoma. Which of the following conclusions is most appropriate regarding these findings? A. The patient should have continued to return for regular Pap smears B. Herpes simplex viral infection contributed to this problem C. The laboratory to which the Pap smears were se