Female Reproductive Pathology — MCQ Quiz | MCQ Quiz | OmpathStudy Kenya

Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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

Accepted Answer

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

Question 4

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

Accepted Answer

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

Question 5

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

Accepted Answer

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.

Question 6

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

Accepted Answer

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

Question 7

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

Accepted Answer

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

Question 8

HPV oncoprotein E7 drives cervical carcinogenesis primarily by:

Accepted Answer

Inactivating the Rb tumour suppressor protein — E7 binds and inactivates Rb, promoting uncontrolled cell cycle progression. E6 targets p53.

Question 9

CIN III differs from CIN I histologically primarily by showing:

Accepted Answer

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.

Question 10

Which statement about the quadrivalent HPV vaccine is correct?

Accepted Answer

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.

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

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.

Question 13

The diagnosis of chronic endometritis specifically requires the presence of:

Accepted Answer

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.

Question 14

Adenomyosis differs from endometriosis in that adenomyosis:

Accepted Answer

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.

Question 15

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

Accepted Answer

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.

Question 16

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

Accepted Answer

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.

Question 17

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

Accepted Answer

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.

Question 18

Anovulatory cycles cause abnormal uterine bleeding because:

Accepted Answer

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.

Question 19

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

Accepted Answer

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%.

Question 20

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

Accepted Answer

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.

Question 21

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

Accepted Answer

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.

Question 22

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

Accepted Answer

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.

Question 23

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

Accepted Answer

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.

Question 24

Leiomyomas are most correctly described as arising from:

Accepted Answer

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.

Question 25

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

Accepted Answer

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.

Question 26

Which complication of salpingitis directly results from adhesions of the tubal plicae?

Accepted Answer

Increased risk of tubal ectopic pregnancy — Adhesions of the tubal plicae narrow the tubal lumen, impeding passage of the fertilised ovum and significantly increasing the risk of tubal ectopic pregnancy.

Question 27

In which group of women is fallopian tube carcinoma particularly increased?

Accepted Answer

Women with BRCA gene mutations — BRCA mutation carriers have significantly increased risk of fallopian tube carcinoma. In prophylactic oophorectomy specimens, 10% had occult malignancy equally split between ovary and fallopian tube.

Question 28

Polycystic ovarian disease is characterised by which combination of biochemical abnormalities?

Accepted Answer

High LH, low FSH, and excess androgens — PCOS is characterised by excess androgen production, elevated LH, and low FSH. The absence of corpora lutea on histology reflects the failure of ovulation.

Question 29

A 35-year-old woman is found to have a large ovarian cyst filled with clear serous fluid and papillary projections. Psammoma bodies are noted histologically. What is the most likely diagnosis?

Accepted Answer

Serous cystadenoma — Psammoma bodies — concentrically laminated calcified concretions — are characteristic of serous tumours. They are found at the tips of papillary projections.

Question 30

High-grade serous ovarian carcinoma is most strongly associated with mutations in which gene?

Accepted Answer

TP53 — 96% of high-grade serous ovarian carcinomas harbour TP53 mutations. Low-grade serous tumours are associated with KRAS, BRAF, or ERBB2 mutations instead.

Question 31

Which feature best distinguishes a primary ovarian mucinous tumour from a Krukenberg tumour?

Accepted Answer

Primary mucinous tumours tend to be unilateral and large — Primary ovarian mucinous tumours are typically unilateral and large. Krukenberg tumours are metastatic mucinous adenocarcinomas from the GI tract and are characteristically bilateral.

Question 32

Pseudomyxoma peritonei is most commonly caused by:

Accepted Answer

Metastasis from a gastrointestinal primary, usually the appendix — Although ovarian mucinous tumours can seed the peritoneum, pseudomyxoma peritonei is most commonly caused by metastasis from the GI tract, primarily the appendix.

Question 33

Ovarian endometrioid carcinoma is notable because 15–30% of cases are associated with:

Accepted Answer

Concomitant endometrial carcinoma — 15–30% of women with ovarian endometrioid carcinoma have a concomitant endometrial carcinoma. Both share PTEN mutations reflecting similar pathogenetic mechanisms.

Question 34

The Brenner tumour of the ovary is characterised histologically by nests of:

Accepted Answer

Transitional-type epithelium resembling urinary tract in abundant stroma — Brenner tumour contains nests of transitional-type epithelium resembling the urinary tract within abundant fibrous stroma. Most are benign and unilateral.

Question 35

A 16-year-old girl presents with a large solid ovarian mass containing immature neural tissue and areas of necrosis. What is the most likely diagnosis?

Accepted Answer

Immature malignant teratoma — Immature malignant teratomas occur in young women with a mean age of 18 years. They contain immature elements including neuroepithelium, which is particularly ominous.

Question 36

Which rare complication can occur in women with mature cystic teratomas containing neural tissue?

Accepted Answer

Limbic encephalitis as a paraneoplastic phenomenon — Limbic encephalitis is a rare paraneoplastic complication of mature teratomas containing neural tissue. It typically remits after tumour resection.

Question 37

CA-125 is most useful clinically in ovarian cancer for which purpose?

Accepted Answer

Monitoring response to treatment in diagnosed cases — CA-125 is elevated in 75–90% of epithelial ovarian cancers but is also elevated in benign conditions, limiting its screening value. Its greatest utility is monitoring treatment response.

Question 38

Ascending placental infection most commonly presents histologically as:

Accepted Answer

Acute chorioamnionitis with neutrophilic infiltration — Ascending bacterial infections cause acute chorioamnionitis — neutrophilic infiltration of the chorioamnion with oedema and congestion. Extension to the cord causes funisitis.

Question 39

Which group of organisms is associated with haematogenous placental infection causing villitis?

Accepted Answer

Toxoplasma, rubella, CMV, herpes, and syphilis — Haematogenous infections cause villitis and include the TORCH organisms — Toxoplasma, Others (syphilis, listeria), Rubella, CMV, and Herpes simplex virus.

Question 40

In more than 90% of ectopic pregnancies, implantation occurs in which site?

Accepted Answer

Fallopian tube — Over 90% of ectopic pregnancies are tubal. Chronic inflammation and scarring of the oviduct account for approximately 50% of cases. The remainder have no identifiable anatomic cause.

Question 41

Rupture of an ectopic tubal pregnancy produces which morphologic finding within the tube?

Accepted Answer

Haematosalpinx with intraperitoneal haemorrhage — The invading placenta burrows through the oviduct wall, producing haematosalpinx — intratubal haematoma — and intraperitoneal haemorrhage, which causes shock.

Question 42

All gestational trophoblastic tumours share which clinically useful feature?

Accepted Answer

They all elaborate hCG detectable in blood and urine — All gestational trophoblastic tumours elaborate hCG, which aids diagnosis and allows monitoring of treatment response. Levels much higher than normal pregnancy suggest choriocarcinoma.

Question 43

A complete hydatidiform mole differs from a partial mole in that a complete mole:

Accepted Answer

Is diploid with all genetic content of paternal origin — A complete mole is diploid (46,XX or 46,XY) with all chromosomes of paternal origin, arising when two spermatozoa or a diploid sperm fertilise an empty egg.

Question 44

What percentage of complete hydatidiform moles progress to give rise to choriocarcinoma?

Accepted Answer

Approximately 2 to 3% — 80–90% of moles resolve after curettage. 10% of complete moles are invasive, but only 2–3% give rise to choriocarcinoma.

Question 45

Gestational choriocarcinoma differs histologically from hydatidiform mole because choriocarcinoma:

Accepted Answer

Contains no chorionic villi and is composed of anaplastic trophoblasts — Choriocarcinoma contains no chorionic villi. It is composed entirely of anaplastic cytotrophoblasts and syncytiotrophoblasts invading the myometrium and vessels.

Question 46

Why does gestational choriocarcinoma respond better to chemotherapy than gonadal choriocarcinoma?

Accepted Answer

Paternal antigens trigger a maternal immune response aiding clearance — Placental choriocarcinoma carries paternal antigens absent in gonadal tumours. A maternal immune response against these foreign antigens acts as an adjunct to chemotherapy.

Question 47

The placental site trophoblastic tumour is distinguished from other trophoblastic tumours by:

Accepted Answer

Production of human placental lactogen with only slight hCG elevation — Intermediate trophoblasts produce little hCG but abundant hPL. This distinguishes placental site trophoblastic tumour from other gestational trophoblastic diseases.

Question 48

The core pathophysiologic defect in preeclampsia is:

Accepted Answer

Inadequate remodelling of spiral arteries causing placental hypoxia — In preeclampsia, trophoblasts fail to adequately remodel spiral artery walls. The retained musculoelastic walls keep channels narrow, causing placental hypoxia and downstream effects.

Question 49

HELLP syndrome complicates approximately what percentage of severe preeclampsia cases?

Accepted Answer

Approximately 10% — HELLP syndrome — Haemolysis, Elevated Liver enzymes, Low Platelets — complicates approximately 10% of severe preeclampsia cases and reflects end-organ microangiopathy.

Question 50

Clear cell adenocarcinoma of the vagina in young women is most strongly associated with:

Accepted Answer

In utero exposure to diethylstilbestrol — Clear cell adenocarcinoma of the vagina develops in young women whose mothers took DES during pregnancy. DES causes vaginal adenosis, which is the precursor lesion.

Female Reproductive Pathology — MCQ Quiz | MCQ Quiz | OmpathStudy Kenya

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