Female Reproductive Pathology — MCQ Quiz – 75 MCQs | Kenya MBChB

75 Year 3: Female Reproductive System Pathology exam questions on Female Reproductive Pathology — MCQ Quiz for medical students. Includes MCQs, answers, explana

This MCQ set contains 75 questions on Female Reproductive Pathology — MCQ Quiz in the Year 3: Female Reproductive System Pathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: Which HPV subtypes are most strongly associated with condylomata acuminata of the vulva?

  1. A. HPV 16 and 18
  2. B. HPV 31 and 33
  3. C. HPV 6 and 11
  4. D. HPV 45 and 52

Correct answer: C – HPV 6 and 11

HPV 6 and 11 are low-risk subtypes causing condylomata acuminata with low malignant transformation risk.

Q2: A postmenopausal woman has white parchment-like vulvar plaques with vaginal orifice constriction. What is the most likely diagnosis?

  1. A. Extramammary Paget disease
  2. B. Squamous cell carcinoma
  3. C. Lichen simplex chronicus
  4. D. Lichen sclerosus

Correct answer: D – Lichen sclerosus

Lichen sclerosus causes epidermal thinning, white plaques, and vaginal constriction. It carries a 1–5% risk of progressing to SCC.

Q3: The hallmark histologic feature of HPV infection seen in condylomata acuminata is:

  1. A. Koilocytosis with perinuclear vacuolization
  2. B. Psammoma bodies at papillary tips
  3. C. Hobnail cells lining glandular spaces
  4. D. Cambium layer beneath the epithelium

Correct answer: A – Koilocytosis with perinuclear vacuolization

Koilocytosis — perinuclear cytoplasmic vacuolization with wrinkled nuclear contours — is the hallmark cytopathic effect of HPV infection.

Q4: A vulvar lesion shows large pale intraepidermal cells with mucin confirmed by PAS staining. What is the diagnosis?

  1. A. Vulvar melanoma
  2. B. Lichen sclerosus with atypia
  3. C. Squamous cell carcinoma in situ
  4. D. Extramammary Paget disease

Correct answer: D – Extramammary Paget disease

Paget disease shows large pale epithelioid cells with PAS-positive mucin. Mucin positivity distinguishes it from melanoma, which lacks mucin.

Q5: Which best distinguishes vulvar Paget disease from Paget disease of the breast?

  1. A. Breast Paget disease lacks association with carcinoma
  2. B. Vulvar Paget disease usually has no underlying tumour
  3. C. Vulvar Paget disease is caused by high-risk HPV infection
  4. D. Breast Paget disease shows no intraepidermal Paget cells

Correct answer: B – Vulvar Paget disease usually has no underlying tumour

Unlike breast Paget disease, which is almost always associated with underlying carcinoma, vulvar Paget disease usually has no demonstrable underlying tumour.

Q6: A middle-aged smoker develops a multifocal warty poorly differentiated vulvar carcinoma. Which precursor lesion is most likely involved?

  1. A. Lichen sclerosus with reactive changes
  2. B. Lichen simplex chronicus
  3. C. Vulvar intraepithelial neoplasia
  4. D. Condyloma lata of secondary syphilis

Correct answer: C – Vulvar intraepithelial neoplasia

HPV-related vulvar carcinoma in younger women is preceded by VIN. Cigarette smoking and immunodeficiency increase the risk of progression.

Q7: Which organism is responsible for the greatest proportion of cervicitis cases in STD clinics?

  1. A. Chlamydia trachomatis
  2. B. Neisseria gonorrhoeae
  3. C. Herpes simplex virus type 2
  4. D. Trichomonas vaginalis

Correct answer: A – Chlamydia trachomatis

C. trachomatis accounts for up to 40% of cervicitis in STD clinics and causes prominent lymphoid follicles on histology.

Q8: HPV oncoprotein E7 drives cervical carcinogenesis primarily by:

  1. A. Upregulating apoptotic signalling pathways
  2. B. Activating the PTEN tumour suppressor gene
  3. C. Integrating into the host mitochondrial genome
  4. D. Inactivating the Rb tumour suppressor protein

Correct answer: D – Inactivating the Rb tumour suppressor protein

E7 binds and inactivates Rb, promoting uncontrolled cell cycle progression. E6 targets p53.

Q9: CIN III differs from CIN I histologically primarily by showing:

  1. A. Dysplasia confined to the lower third of epithelium
  2. B. Prominent koilocytosis throughout all epithelial layers
  3. C. Full thickness epithelial atypia with absent koilocytosis
  4. D. Mild nuclear enlargement limited to basal layer only

Correct answer: C – Full thickness epithelial atypia with absent koilocytosis

CIN III shows near-complete loss of maturation affecting virtually all layers. Koilocytosis, prominent in CIN I, is typically absent in CIN III.

Q10: Which statement about the quadrivalent HPV vaccine is correct?

  1. A. It covers all known oncogenic HPV serotypes effectively
  2. B. It eliminates the need for routine cervical cancer screening
  3. C. It is only effective when given before any sexual activity
  4. D. It protects against HPV types 6, 11, 16, and 18

Correct answer: D – It protects against HPV types 6, 11, 16, and 18

The quadrivalent vaccine covers types 6, 11, 16, and 18. It does not replace screening because other oncogenic types exist and many women are already infected.

Q11: A cervical tumour encircles the cervix and penetrates the underlying stroma deeply. This morphologic appearance is called:

  1. A. Polypoid carcinoma
  2. B. Barrel cervix
  3. C. Exophytic carcinoma
  4. D. Microinvasive carcinoma

Correct answer: B – Barrel cervix

When tumour encircles the cervix and invades the stroma, it produces a barrel cervix identifiable on direct palpation.

Q12: The most common cause of death in advanced invasive cervical carcinoma is:

  1. A. Haematogenous metastasis to the liver
  2. B. Disseminated intravascular coagulation
  3. C. Brain metastasis from lymphatic spread
  4. D. Renal failure from ureteral obstruction

Correct answer: D – Renal failure from ureteral obstruction

Most patients with advanced cervical cancer die from local invasion. Ureteral and bladder obstruction leading to renal failure is the most common cause of death.

Q13: The diagnosis of chronic endometritis specifically requires the presence of:

  1. A. Neutrophils in the endometrial glands
  2. B. Granulomas within the myometrium
  3. C. Plasma cells in the endometrial stroma
  4. D. Lymphocytes in the superficial endometrium

Correct answer: C – Plasma cells in the endometrial stroma

Lymphocytes are normally present in the endometrium and are not diagnostic. Plasma cells are the key diagnostic requirement for chronic endometritis.

Q14: Adenomyosis differs from endometriosis in that adenomyosis:

  1. A. Involves functioning endometrium that bleeds cyclically
  2. B. Commonly affects distant sites like the lungs and bone
  3. C. Derives from the basalis layer and does not bleed cyclically
  4. D. Forms chocolate cysts within the ovarian parenchyma

Correct answer: C – Derives from the basalis layer and does not bleed cyclically

Adenomyosis derives from the stratum basalis which does not respond to hormonal cycling. Endometriosis contains functioning endometrium that undergoes cyclic bleeding.

Q15: Which theory of endometriosis best explains its occurrence in the lungs and skeletal muscle?

  1. A. Metaplastic transformation of coelomic epithelium
  2. B. Retrograde menstruation through fallopian tubes
  3. C. Direct implantation during surgical procedures
  4. D. Vascular or lymphatic dissemination of endometrial cells

Correct answer: D – Vascular or lymphatic dissemination of endometrial cells

Vascular and lymphatic dissemination explains how endometrial tissue reaches distant sites like the lungs, heart, and skeletal muscle where retrograde flow cannot reach.

Q16: Why are COX-2 inhibitors and aromatase inhibitors useful in treating endometriosis?

  1. A. They directly destroy ectopic endometrial implants surgically
  2. B. They block HPV-related proliferation of endometrial cells
  3. C. They reduce prostaglandin E2 and local oestrogen production
  4. D. They stimulate progesterone receptors in the myometrium

Correct answer: C – They reduce prostaglandin E2 and local oestrogen production

Endometriotic tissue has high aromatase activity and elevated PGE2, promoting local oestrogen and survival of ectopic tissue. Both drug classes target these mechanisms.

Q17: Histologic diagnosis of endometriosis requires at least two of which three features?

  1. A. Koilocytosis, stromal fibrosis, and haemosiderin pigment
  2. B. Endometrial glands, endometrial stroma, and haemosiderin pigment
  3. C. Chocolate cysts, psammoma bodies, and stromal fibrosis
  4. D. Columnar epithelium, myxoid stroma, and lymphoid follicles

Correct answer: B – Endometrial glands, endometrial stroma, and haemosiderin pigment

The three diagnostic features are endometrial glands, endometrial stroma, and haemosiderin pigment. At least two must be present to confirm the diagnosis histologically.

Q18: Anovulatory cycles cause abnormal uterine bleeding because:

  1. A. Excess progesterone prevents normal endometrial shedding
  2. B. Oestrogen excess without progesterone leads to unstable endometrium
  3. C. Low oestrogen levels cause endometrial atrophy and bleeding
  4. D. Androgen excess directly stimulates endometrial breakdown

Correct answer: B – Oestrogen excess without progesterone leads to unstable endometrium

Without ovulation, there is no progesterone from the corpus luteum. Unopposed oestrogen keeps the endometrium in a proliferative phase that is prone to irregular breakdown.

Q19: Complex endometrial hyperplasia with cellular atypia carries what approximate risk of progression to carcinoma?

  1. A. Less than 1%
  2. B. Around 5 to 10%
  3. C. Between 20 and 50%
  4. D. Greater than 75%

Correct answer: C – Between 20 and 50%

Complex hyperplasia with atypia carries a 20–50% risk of progression to endometrial carcinoma, the highest risk category. Without atypia the risk is less than 5%.

Q20: Which tumour suppressor gene is most commonly mutated as an early event in endometrioid endometrial carcinoma?

  1. A. TP53
  2. B. BRCA1
  3. C. RB1
  4. D. PTEN

Correct answer: D – PTEN

PTEN inactivating mutations are early events in endometrioid carcinoma, dysregulating the PI-3-kinase/AKT pathway. TP53 mutations are characteristic of serous type carcinoma.

Q21: Serous endometrial carcinoma differs from endometrioid carcinoma in that serous carcinoma:

  1. A. Arises in the setting of oestrogen excess and hyperplasia
  2. B. Occurs in perimenopausal women with obesity and diabetes
  3. C. Shows tubular gland formation resembling normal endometrium
  4. D. Arises on a background of atrophy and has TP53 mutations

Correct answer: D – Arises on a background of atrophy and has TP53 mutations

Serous carcinoma arises in older postmenopausal women on a background of atrophy. Nearly all cases harbour TP53 mutations and are high-grade by definition.

Q22: A woman with Cowden syndrome has a germline mutation that increases her risk of endometrial carcinoma. Which gene is mutated?

  1. A. BRCA2
  2. B. MLH1
  3. C. PTEN
  4. D. TP53

Correct answer: C – PTEN

Cowden syndrome is caused by germline PTEN mutations. PTEN loss dysregulates PI-3-kinase/AKT signalling, significantly increasing the risk of endometrioid endometrial carcinoma.

Q23: Which histologic feature is most characteristic of leiomyosarcoma but not leiomyoma?

  1. A. Whorled pattern of smooth muscle bundles
  2. B. Foci of calcification within the tumour
  3. C. Tumour necrosis with cytologic atypia and mitoses
  4. D. Intramural location within the myometrium

Correct answer: C – Tumour necrosis with cytologic atypia and mitoses

Leiomyosarcoma requires all three features for diagnosis: tumour necrosis, cytologic atypia, and mitotic activity. Leiomyomas may show mitoses alone without fulfilling malignancy criteria.

Q24: Leiomyomas are most correctly described as arising from:

  1. A. Endometrial stromal cells of the basalis layer
  2. B. Smooth muscle cells of the myometrium
  3. C. Mesenchymal cells of the parametrium
  4. D. Fibroblasts within the endometrial stroma

Correct answer: B – Smooth muscle cells of the myometrium

Leiomyomas are benign tumours arising from smooth muscle cells of the myometrium. They are monoclonal and oestrogen-sensitive, shrinking after menopause.

Q25: A leiomyosarcoma is discovered in a postmenopausal woman. Which statement about its origin is correct?

  1. A. It arises from malignant transformation of a pre-existing leiomyoma
  2. B. It develops from endometrial glandular epithelium
  3. C. It arises de novo from myometrial mesenchymal cells
  4. D. It originates from parametrial stromal fibroblasts

Correct answer: C – It arises de novo from myometrial mesenchymal cells

Leiomyosarcomas arise de novo from myometrial mesenchymal cells, not from pre-existing leiomyomas. They are almost always solitary and occur in postmenopausal women.

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