WEBPATH FEMALE GENITAL PATHOLOGY

A 33-year-old woman taking oral contraceptives for a year has noted vaginal bleeding Microglandular hyperplasia
that is not severe, but it occurs nearly every day over the past 5 weeks. On pelvic forms a mass lesion grossly,
examination, there is a 0.7 cm polypoid mass noted to extend outward from the and must be distinguished
endocervical region. The ectocervix appears normal. The uterus is normal in size. The from adenocarcinoma
adnexa have no palpable masses. A biopsy of this lesion is performed. Which of the histologically. Some cases
following microscopic findings is most likely to be found in this lesion? may occur in the setting of
A Endocervical adenocarcinoma oral contraceptive use, but a
causal relationship is not well
B Clear cell adenocarcinoma established.
C Microglandular hyperplasia
D Sarcoma botryoides
E Endocervical polyp
F Follicular cervicitis

A 48-year-old woman has noted a small amount of irregular vaginal bleeding for the Fibrothecomas and
past 2 months. She has a pelvic examination that reveals no cervical lesions, and a Pap granulosa cell tumors can be
smear that shows no abnormal cells. Next, an endometrial biopsy is performed, and estrogen producing. The
there is microscopic evidence for endometrial hyperplasia. An abdominal ultrasound excessive estrogen drives
reveals a solid right ovarian mass. Which of the following neoplasms is this woman is endometrial hyperplasia,
most likely to have? which can progress to
A Mature cystic teratoma atypical hyperplasia, which
can progress to endometrial
B Choriocarcinoma carcinoma.
C Sertoli-Leydig cell tumor
D Fibrothecoma
E Krukenberg tumor
F Cystadenocarcinoma

A 51-year-old perimenopausal woman has had vaginal bleeding for the past 6 months. Also called paratubal cysts,
On physical examination she has an enlarged, nodular uterus. A hysterectomy is these are common incidental
performed. The surgeon notes several 0.2 to 1 cm translucent, smooth-surfaced, thin- findings. They are
walled, fluid-filled cysts near the fimbriated end of the right fallopian tube. Which of embryologic remnants of the
the following is the most likely diagnosis for these cysts? wolffian duct. They are not
A Gartner duct cysts related to neoplasia. This
woman had leiomyomas of
B Krukenberg tumors the uterus which led to the
C Parovarian cysts hysterectomy.
D Pelvic inflammatory disease
E Mucinous cystadenomas
F Fibrocystic disease
G Omphalomesenteric duct cyst

A 36-year-old woman has had episodes of lower abdominal and pelvic pain for the Pain is a key feature of
past 10 years. A bimanual pelvic examination reveals no abnormalities. A Pap smear is endometriosis. The foci of
negative. She has an abdominal ultrasound scan that reveals no abnormalities. She endometriosis are most
undergoes laparoscopy, and several 0.2 to 0.5 cm brown nodular lesions are seen on often found on serosal
serosal surfaces of the uterus, fallopian tubes, and appendix. These lesions are surfaces in the pelvis, but can
be found in other locations
excised. Which of the following microscopic findings is most likely to be present in such as the surface of the
these lesions? bowel. Endometrial glands,
A Endometrial stroma stroma, and hemorrhage are
microscopic features.
B Mesothelial cells
C Metastatic adenocarcinoma
D Capillary proliferation
E Granulomatous inflammation

A 47-year-old woman has noted a pressure sensation, but no pain, in her pelvic region Ovarian carcinomas are often
for the past 5 months. On physical examination there is a right adnexal mass. An associated with ascites,
ultrasound scan shows a 10 cm fluid-filled cystic mass in the right ovary, along with because they have a
ascitic fluid. A fine needle aspirate of the mass is performed and cytologic propensity to seed
examination of clear fluid aspirated from the mass reveals clusters of malignant throughout the peritoneal
epithelial cells surrounding psammoma bodies. Which of the following neoplasms is cavity. Psammoma body
she most likely to have? formation is common to
A Endometrioid carcinoma malignant serous tumors of
the ovary.
B Serous cystadenocarcinoma
C Malignant mesothelioma
D Mature cystic teratoma
E Squamous cell carcinoma

A representative of the law firm of Flotsam, Flotsam & Jetsam enters your office and It is unlikely that a significant
serves you with a subpoena that requires you to appear in regard to litigation by one lesion will be missed in four
of your former patients, a 31-year-old woman who is claiming that your malpractice consecutive Pap smears,
led to medical expenses, pain, and suffering because she developed invasive cervical which is the reason for
carcinoma. She was last seen in your office 10 years ago. She had been your patient annual Pap smears. The
for 5 years, receiving Pap smears in 4 of those 5 years. Your records indicate that she natural history of the
had no abnormal Pap smears. After discussion with your malpractice carrier's progression from dysplasia
attorney, which of the following conclusions is most appropriate? to invasive carcinoma is
A The patient should have continued to return for yearly Pap smears usually a decade or more, so
there is plenty of time to
B You are at fault in this case and should avoid a trial make a diagnosis and treat
C The laboratory to which the Pap smears were sent is at fault for missing conservatively. Cervical
abnormal cells carcinoma is a preventable
condition.
D Nothing anyone could have done would have prevented this carcinoma
E The patient's health insurer is at fault for not covering the full cost of Pap smear
testing

A quality assurance (QA) project is done by a group of physicians staffing an The Pap smear is a very
outpatient clinic to study rates of false negative Pap smears. The QA project reveals useful test if performed
that one physician has accounted for half of all the false negative Pap smears properly. Proper patient
collected by the group over the prior year, when compared to follow-up testing. The identification is key to any
physician's collection techniques are analyzed, and of the following procedures laboratory testing procedure.
practiced, which is the only one that is appropriate?
A Wrote the patient's name on the slides
B Air-dried the slides prior to shipping
C Advised the patient to have intercourse the day prior to the appointment
D Scheduled the patient visit during the menstrual phase of her cycle
E Advised the patient to douche the day prior to the appointment

A 30-year-old infertile woman has had episodic lower abdominal and pelvic pain for 2 These 'powder burns' are
years. A physical examination, including pelvic exam, reveals no abnormalities. A Pap typical for the small
smear shows only a few trichomonads and no dysplastic cells. A laparoscopy is hemorrhagic foci of
performed, and the gynecologist notes the presence of several blue to red 0.2 to 0.4 endometriosis on pelvic
cm slighted raised lesions scattered on the pelvic peritoneum in the cul-de-sac and peritoneum that can produce
broad ligaments. Which of the following is the most likely diagnosis? so much discomfort for their
A Metastatic adenocarcinoma size.

B Neisseria gonorrheae infection

A 43-year-old woman has noted menstrual periods that have been exceptionally The most common neoplasm
heavy, lasting 6 to 8 days, for 4 months. She has also noted minor intermenstrual of the uterus is a leiomyoma.
bleeding. On physical examination her uterine cervix appears normal, and a Pap They can be multiple, can
smear shows no abnormal cells. Pelvic examination reveals that the uterus is enlarged slowly enlarge, and can lead
to twice normal size and is nodular. There are no adnexal masses. Which of the to abnormal bleeding.
following is the most likely diagnosis?
A Endometrial carcinoma
B Leiomyomata
C Ectopic pregnancy
D Endometriosis
E Secondary syphilis

A 43-year-old woman has noted increasing abdominal discomfort for the past year. This is a classic appearance
On physical examination, there is no tenderness. Bowel sounds are present. She has for ovarian serous tumor,
no vaginal bleeding. An abdominal ultrasound reveals a 7 cm left adnexal mass. A and most of them are benign
total abdominal hysterectomy is performed. Pathologic examination of the ovarian or borderline, particularly if
mass reveals it is unilocular, filled with watery fluid, and lined with papillary presenting in reproductive
excrescences. On microscopic examination there is no infiltration of the underlying years. However, the gross
stroma. Which of the following neoplasms is this woman most likely to have? appearance alone is not
A Granulosa-theca cell tumors diagnostic, and a borderline
serous tumor must be
B Mature cystic teratomas distinguished
C Fibrosarcoma with metastases microscopically. Invasiveness
would suggest malignancy.
D Borderline serous tumor
E Clear cell carcinomas

A 28-year-old sexually active woman undergoes a routine examination. Pelvic HPV infections can lead to
examination reveals no abnormalities. A Pap smear is obtained. The cytopathology squamous epithelial
report indicates the presence of severely dysplastic cells (high grade squamous dysplasia and carcinoma,
intraepithelial lesion, or HSIL). A biopsy of the cervix is performed, and on microscopic particularly infection with
examination shows cervical intraepithelial neoplasia III (CIN III). Infection with which high grade subtypes such as
of the following organisms is most likely to cause her disease? HPV 16 and 18. The HPV
A Herpes simplex virus infection vaccine immunizes agains
these subtypes, as well as
B Epstein-Barr virus the most common subtypes
C Candida albicans 6 and 11 associated with
condyloma.
D Human papillomavirus
E Trichomonas vaginalis
F Gardnerella vaginalis

A 23-year-old woman has a 1 day history of increasing obtundation. On physical This complication results in
examination her temperature is 37.3°C, pulse 96/minute, respirations 18/minute, and release of thromboplastin
blood pressure 90/45 mm Hg. A culdocentesis yields no blood. Abdominal ultrasound into the circulation,
shows an intrauterine gestational sac and 12 week fetus. Laboratory studies show a promoting disseminated
positive pregnancy test. She has a WBC count of 11,400/microliter, Hgb 10.6 g/dL, Hct intravascular coagulation
31.1%, MCV 95 fL, and platelet count 26,400/microliter. Schistocytes are noted on her (DIC) ith consumption of
peripheral blood smear. Her protime is 44 sec, partial thromboplastin time 61 sec, and clotting factors and
D-Dimer 16 microgm/mL. A urinalysis dipstick examination shows no blood, protein, thrombocytopenia. In this
or glucose. Which of the following complications of pregnancy is most likely to explain case, the ultrasound showed
her condition? an intrauterine pregnancy
A Placental infarction was present.

B Eclampsia
C Amniotic fluid embolus
D Retained dead fetus
E Ruptured tubal ectopic

A 22-year-old woman passes grape-like masses of tissue per vagina in the 16th week She has a hydatidiform mole.
of her first pregnancy. She had not felt any fetal movement at any time. On physical Persistence or an increase in
examination she measures 18 weeks in size. A D&C is performed, yielding 1000 cc of the HCG level should suggest
0.5 to 1.5 cm fluid-filled vesicles. Microscopic examination of this tissue shows large that trophoblastic disease is
avascular villi along with trophoblastic proliferation. Which of the following is the best still present, such as invasive
method to employ for her follow-up care? mole or choriocarcinoma.
A Chest radiograph
B Serum beta-HCG
C Endometrial biopsy
D Pelvic ultrasound
E Pap smear

A 23-year-old woman has the sudden onset of lower abdominal pain. Pelvic You should strongly suspect
examination reveals a normal sized uterus and normal appearing cervix and vagina. a ruptured ectopic pregnancy
However, there is marked tenderness upon palpation of the left adnexal region. A in this setting. The pregnancy
transvaginal ultrasound shows no intrauterine gestational sac, but there is a 2 cm left test would likely have been
adnexal mass. Culdoscocentesis yields bloody fluid. Which of the following is most performed first.
useful procedure to aid in diagnosis? Culdocentesis with blood
A Serum complement determination suggests that the ectopic has
ruptured, which is a medical
B Microscopic urinalysis emergency.
C Pap smear
D Serum beta-HCG
E Endometrial biopsy
F WBC count

A 20-year-old woman has had irregular menstrual bleeding for the past 6 months. On This is a very rare
physical examination there are no abnormal findings. Laboratory studies show a complication of a D&C
negative pregnancy test. A D&C is performed and microscopic examination shows procedure in which
dyssynchronous endometrial glands and stroma of anovulatory cycles. Following the endometrium, including the
procedure she ceases to have menstrual bleeding. Which of the following is the most stratum basalis, is removed,
likely diagnosis? preventing normal growth
A Endometriosis and cycling of the
endometrium.
B Asherman syndrome
C Prolactinoma
D Ovarian failure
E Oral contraceptive use

A 14-year-old girl has had pelvic pain for the past 3 months. She has not yet noted Following the onset of
passing menstrual blood. She has not had any sexual activity. She refuses physical menarche, the blockage to
examination, but an abdominal ultrasound shows fluid distending the vagina. Which menstrual flow from the
of the following is the most likely diagnosis? imperforate hymen leads to
A Cervical condyloma an accumulation of blood in
the vagina, called
B Endometriosis hematocolpos.
C Cervical gonorrhea
D Imperforate hymen
E Ruptured Bartholin cyst

A 64-year-old woman has had itching with irritation of the vulvar region, along with Lichen sclerosus et
vaginal dryness, for the past 8 months. On physical examination she has pale grey atrophicus is typically seen
patches from 1 to 2 cm in size on the vulva. Biopsy of one lesion is performed and on after menopause and is
microscopic examination shows epithelial thinning, dermal fibrosis, and perivascular slowly progressive. It may
chronic inflammation. Which of the following is the most likely diagnosis? predispose to infection.
A Squamous cell carcinoma Lichen sclerosis itself is not
premalignant, but persons
B Lichen sclerosus with it have a slightly
C Condyloma acuminatum increased risk for cancer.
D Adenosis
E Extramammary Paget disease
F Dermatophyte infection

For the past year, a 50-year-old woman has noted that her menstrual periods have Leiomyosarcomas of the
been exceptionally heavy and last 7 to 9 days. She has noted occasional minor uterus are uncommon
intermenstrual bleeding. For the past 3 months, she has been taking supplemental malignant neoplasms. They
dietary iron for iron deficiency anemia. On pelvic examination, the uterine cervix do not arise from
appears normal, but the uterus is enlarged to twice normal size. Transvaginal leiomyomas. They are larger
ultrasound reveals the presence of a 9 cm solid mass in the uterus. A hysterectomy is and more cellular than
performed, and on gross inspection with sectioning the uterus a reddish-tan mass is benign leiomyomas, and
found with a fleshy cut surface. Microscopically the mass is highly cellular, with leiomyosarcomas have
mitotic figures. At least 20%
spindle cells having hyperchromatic nuclei and 10 to 20 mitoses per high power field. of women have at least one
Which of the following is the most likely diagnosis? leiomyoma, but
A Endometrial polyp leiomyosarcomas are rare.
However, a large cellular
B Adenomyosis mass with mitoses is less
C Embryonal rhabdomyosarcoma likely to be a leiomyoma.
Postmenopausally, most
D Atypical hyperplasia
leiomyomas stop growing or
E Leiomyosarcoma even regress
F Malignant mixed mullerian tumor

A 31-year-old G3 P2 woman is at 14 weeks gestation, but has noted a small amount of Invasive moles constitute
vaginal bleeding for the past 2 weeks. Laboratory studies show an HCG level of about 10% of gestational
650,000 U/L. An ultrasound shows a 'snowstorm' for intrauterine contents but no trophoblastic disease. The
identifiable fetus. A D&C is performed with evacuation of 500 mL of grape-like failure of the HCG to
vesicles. A month later her vaginal bleeding persists and her serum beta-HCG is diminish to near negative
35,000 U/L. Which of the following pathologic abnormalities is most likely to be following the D&C suggests
present in this woman? residual gestational
A Pulmonary metastases trophoblastic disease, either
invasive mole or less
B Tubal ectopic pregnancy frequently choriocarcinoma.
C Endometritis
D Placental site trophoblastic tumor
E Invasive mole

A 33-year-old woman and her husband have wanted a child, but she has been unable PID leads to scarring that
to conceive for the past 10 years. She has mild pelvic pain, but regular menstrual interferes with movement of
cycles. On physical examination the cervix and vagina appear normal. The uterus and the ovum released from the
adnexal regions are normal on palpation. A pelvic ultrasound shows no lesions. A Pap ovary down the fallopian
smear is normal. Her husband's sperm count is normal. Which of the following is most tube. PID can lead to
likely to be the cause for her infertility? infertility. Assisted
A Adenomyosis reproductive technology
would be needed in her case.
B Adenohypophyseal prolactinoma
C Pelvic inflammatory disease
D Mature cystic teratoma
E Chronic cervicitis

A 38-year-old woman has noted intermenstrual spotting of blood for the past 3 Although DES has not been
months. On pelvic examination, she has a nodular 2 x 3 cm mass in the upper vagina. used for decades, the
Biopsy of the mass is performed and on microscopic examination shows a clear cell women who were exposed
carcinoma. Which of the following risk factors probably preceded development of this to it in utero are past age 40
carcinoma? and now developing
A Human papilloma virus infection adenosis and clear cell
carcinoma.
B Endometriosis
C Irregular menstrual cycles
D Diethylstilbestrol exposure
E Precocious pseudopuberty
A 19-year-old woman has noted increasing size and number of warty lesions on her Condyloma accuminatum is
external genitalia for the past 5 years. On physical examination she has several pink- one of the manifestations of
tan rounded 1 to 2 cm slightly raised, rough lesions on the perineum and vulva. Biopsy human papillomavirus
of one lesion is performed and on microscopic examination shows acanthosis of infection (HPV). The most
squamous epithelium along with koilocytosis. Which of the following is the most likely common subtypes associated
risk factor for these lesions? with condyloma are 6 and
A Irritant chemical exposure 11. Though condyloma is not
premalignant, the risk factor
B Oral contraceptive use is the same, and she could
C Candida vulvovaginitis acquire subtypes of HPV,
such as 16 and 18, that do
D Multiple sexual partners
increase the risk for
E Turner syndrome squamous dysplasias and
carcinomas of the cervix. The
HPV vaccine will protect
against subtypes 6, 11, 16,
and 18.
A 40-year-old woman has experienced pelvic discomfort for over a month, along with The abundant hair is typical
a 4 kg weight loss, nervousness, and diaphoresis. A pelvic examination reveals a large for the ectodermal
left adnexal mass that, on transvaginal ultrasound, appears as a discrete 10 cm cystic component of a mature
and solid mass. The uterus appears normal in size. A Pap smear is normal. The mass is cystic teratoma, but
removed and on gross pathologic examination is filled with hair and sebum, along mesodermal and
with solid tan areas next to the smooth-surfaced outer wall. Which of the following endodermal components will
laboratory test findings is most likely to have been present just prior to her surgery? also be present. The
A Thyroxine of 11.3 microgm/dL historical findings here are
consistent with
B HCG of 45,000 IU/L hyperthyroidism and suggest
C Potassium of 2.9 mmol/L that this teratoma also has
thyroid tissue, known as
D Estradiol of 1700 pg/mL
struma ovarii when the
E Cancer antigen 125 of 540 U/mL majority of the teratoma is
composed of thyroid tissue.
It is a rare cause for
hyperthyroidism.
A 32-year-old G3 P2 woman goes for a routine prenatal check at 12 weeks gestation. No fetus is present in this
On physical examination she is found to be large for dates, and no fetal heart tones case, only grape-like
are audible. An ultrasound is performed and revealed that no fetus was present, only chorionic villi that produce
many echogenic cystic areas within the uterus. Which of the following is the most the echogenic effect on
likely diagnosis? ultrasound. Complete mole is
A Invasive mole the most common form of
gestational trophoblastic
B Partial hydatidiform mole disease.
C Placental site trophoblastic tumor
D Choriocarcinoma
E Complete hydatidiform mole

A 37-year-old woman goes to her physician for a routine checkup. On physical An HSIL is equivalent to
examination there are no abnormal findings. A Pap smear is taken and cytologically cervical intraepithelial
there are dysplastic cells present. A cervical biopsy is performed. Microscopic neoplasia (CIN) III, or severe
examination shows dysplasia involving the full thickness of the cervical epithelium. dysplasia. With proper
Which of the following is the most likely diagnosis? therapy, the lesion will be
A High grade squamous intraepithelial lesion (HSIL) removed and not be given a
B Severe chronic cervicitis with herpes simplex virus (HSV) chance to progress to
invasive carcinoma.
C Diethylstilbestrol (DES) exposure
D Endocervical adenocarcinoma
E Extramammary Paget disease

Two weeks after delivery of a normal healthy term infant boy following an The retained placental
uncomplicated pregnancy, a 25-year-old woman still has a vaginal discharge fragements are a source for
consisting of dark brown, foul-smelling material. Her temperature is 37.4°C. On pelvic infection producing an acute
examination, the uterus is slightly enlarged and she has pelvic tenderness. Laboratory endometritis. A D&C must be
studies show her serum beta-HCG is negative. Which of the following conditions is she done to remove the
most likely to have? fragments. At the time of
A Invasive mole delivery, the placenta should
be checked for
B Degenerating uterine leiomyoma completeness; a missing
C Postpartum pituitary necrosis cotyledon suggests
incomplete placental
D Endometriosis
delivery.
E Retained products of conception

A 39-year-old woman has had dysmenorrhea for 7 months. On pelvic examination, Adenomyosis can produce
there are no adnexal masses, and the cervix appears normal, but the uterus is three diffuse uterine enlargement.
times normal size. The uterus appears to be symmetrically enlarged on abdominal
ultrasound, with no masses present and an endometrial cavity that is nearly normal in
size. A Pap smear is normal. Her serum pregnancy test is negative. A total abdominal
hysterectomy is performed. Which of the following microscopic findings is most likely
to be present in her uterus?
A Atypical glands invading through the uterine wall
B Large avascular villi with trophoblastic proliferation
C Hyperchromatic and pleomorphic smooth muscle cells
D Extensive acute inflammation
E Endometrial glands and stroma in the myometrium

A 15-year-old girl has had irregular menstrual cycles for 5 months. She had menarche Anovulatory cycles occur
at age 13. There are no abnormal physical examination findings. An endometrial most often at the time of
biopsy is taken on post-ovulatory day 9 and shows proliferative phase endometrium. menarche, menopause, or
Which of the following is the most likely diagnosis? with ovarian dysfunction
A Adenomyosis such as in polycystic ovarian
disease. The endometrium is
B Anovulatory cycles not cycling normally.
C Endometrial adenocarcinoma
D Leiomyomata
E Oral contraceptive use
F Ovarian thecoma

A 29-year-old woman has had dyspareunia for the past 2 months. She has had only This is a Gartner duct cyst,
one sexual partner--her husband. She is G2 P2. On physical examination there are no which is a remnant of the
abnormal findings except for a small but slightly tender 1.5 cm mass located in the mesonephric duct in the
right lateral wall of her vagina. The lesion is excised. On gross examination this mass is lateral vaginal wall. Such
cystic and fluid filled. On microscopic examination the cyst is lined by a cuboidal lesions can be multiple.
epithelium. Which of the following is the most likely etiology for this lesion? There is no risk for
A Bacterial vaginosis malignancy. A Bartholin
gland (greater vestibular
B Embryologic remnant gland) cyst may arise in the
C Gonoccocal infection vagina, just inside the
entrance in the posterior
D Metastatic adenocarcinoma
vestibule.
E Oral contraceptive use
F Foreign body

A 33-year-old woman has an infertility workup. Her BMI is 32. Hirsutims is noted. On She has polycystic ovarian
pelvic examination, bilateral adnexal masses are palpated. Transvaginal ultrasound syndrome (PCOS), and the
examination shows a normal sized uterus, but the ovaries are enlarged and have a enlarged ovaries reflect
dozen peripheral echogeni follicles. Laboratory studies show hyperglycemia and abnormal hormonal balance
increased androgenic steroids. For which of the following conditions is she at greatest that leads to anovulation and
risk? infertility. Obesity with
A Endometrial hyperplasia insulin resistance and
diabetes mellitus often
B Adenomyosis accompany PCOS. The
C Malignant mixed mullerian tumor hormonal excess drives
endometrial hyperplasia,
D Chronic endometritis
which can be atypical and
E Borderline mucinous tumor progress to carcinoma.

A 24-year-old woman is G2 P1. Her first pregnancy resulted in a normal term birth. This is triploidy. In a partial
Now at 15 weeks gestation, a prenatal checkup reveals that she has a blood pressure hydatidiform mole, a fetus is
of 140/90 mm Hg. An ultrasound is performed that reveals no fetal cardiac motion. present but malformed and
Misoprostol induction is performed for termination of the pregnancy. Examination of small for gestational age.
the malformed stillborn fetus reveals that it is small for gestational age and has 3,4 Only occasional villi, or none
syndactyly bilaterally, an indented nasal bridge, and a two vessel cord. The placenta is at all, may be grape-like, but
small for gestation and has scattered 0.5 cm grape-like villi. A chromosome analysis there is trophoblastic
performed on the placental tissue will most likely demonstrate which of the following proliferation typical of molar
karyotypes? pregnancy. A partial mole
A 46, XX pregnancy is unlikely to go to
term, and it is unlikely to
B 69, XXY progress to choriocarcinoma.
C 45, X
D 47, XX, +18
E 23, X
F 47, XYY
G 47, XXX

16-year-old girl has not begun menstruation. Physical examination reveals that she She has primary
has breast development, but a short vagina and no palpable uterus or adnexa, only amenorrhea. The findings
bilateral inguinal masses. She appears otherwise normally developed. Which of the point to the rare testicular
following laboratory tests would be most appropriate to order on this girl? feminization (androgen
insensitivity syndrome),
A Chromosome analysis with a karyotype of 46, XY.
B Serum estrogen The inguinal masses are
the testes.
C Assay for luteinizing hormone
D Serum cortisol
E Serum testosterone
F Magnetic resonance imaging of brain

A 38-year-old healthy woman has had a white, curd-like vaginal discharge for the past Vaginal yeast infections are
week. There is no bleeding. A Pap smear demonstrates normal appearing squamous quite common. Fungal
epithelial cells along with scattered neutrophils and budding cells with pseudohyphae. vulvovaginitis is the second
Which of the following infectious agents is most likely to be present in this woman? most common cause of
A Treponema pallidum vaginal infections in the U.S.
(Bacterial vaginosis is the
B Neisseria gonorrhea most frequent cause).
C Chlamydia trachomatis The Candida organisms have
the morphologic appearance
D Herpes simplex virus
with budding cells, often
E Escherichia coli with pseudohyphae.
F Gardnerella vaginalis
G Trichomonas vaginalis
H Candida albicans
I Human papillomavirus

A 35-year-old woman has had dull pelvic pain for 4 months. A pelvic examination She has findings of pelvic
reveals a normal appearing cervix, a normal sized uterus, and a large tender right inflammatory disease (PID)
adnexal mass. Ultrasound reveals an 8 cm cystic, fluid-filled mass involving the right complicated by a tubo-
adnexal region. At laparotomy, there are many filmy fibrous adhesions in the pelvis. ovarian abscess. These are
The mass is excised and on gross examination is found to have a thin wall and is filled potential complications of
with purulent exudate. Microscopically, there are thin remnants of fallopian tube and sexually transmitted diseases
ovary comprising the wall of the mass, with numerous neutrophils filling the lumen. caused by gonorrhea or
Which of the following infectious agents is most likely to have produced these chlamydial infections most
findings? often.
A Human papillomavirus
B Mycobacterium tuberculosis
C Trichomonas vaginalis
D Candida albicans
E Neisseria gonorrheae

Abnormal bleeding per vagina for the past 5 months prompts a 62-year-old woman to She could have an ovarian
see her physician. She has never been pregnant and went through menopause 10 tumor producing estrogen,
years previously. On physical examination her BMI is 33. There are no abnormal and the granulosa cell tumor
findings on physical examination. An endometrial biopsy is performed and on is most likely to do that, of
microscopic examination shows a well-differentiated endometrial adenocarcinoma. the ones listed. Her obesity is
Which of the following ovarian neoplasms is she most likely to have? a risk factor for endometrial
A Papillary serous cystadenocarcinoma carcinoma as well.

B Krukenberg tumor
C Mucinous cystadenoma
D Granulosa cell tumor
E Immature teratoma
A 28-year-old woman develops the sudden onset of severe lower abdominal pain. On Cases of pelvic inflammatory
physical examination there is tenderness to palpation of the right lower quadrant. disease (PID) are usually due
Laboratory studies show her serum pregnancy test is positive. An ultrasound scan to gonorrhea or chlamydial
does not reveal a gestational sac in the uterus, but there is a right adnexal mass. The infection, which are sexually
development of these findings is most closely related to past infection with which of transmitted diseases. The
the following organisms? tubal scarring from the
A Treponema pallidum inflammation leads to an
increased risk for ectopic
B Human papillomavirus pregnancy
C Neisseria gonorrheae
D Candida albicans
E Group B Streptococcus

A 44-year-old woman has had irregular menstrual periods for the past 9 months. On The malignant mixed
physical examination she has an enlarged uterus. An ultrasound scan shows a 9 cm mullerian tumor typically has
solitary, solid mass in the uterus. A total abdominal hysterectomy is performed. Gross malignant components that
examination of the irregular reddish-tan mass located in the myometrium shows are both epithelial and
bundles of smooth muscle cells along with heterogenous elements of pleomorphic stromal. The stromal
cartilaginous cells. There are also areas with poorly differentiated gland formation. component does not always
Mitotic figures are frequent. Which of the following neoplasms is she most likely to resemble just smooth muscle
have? but may have sarcomatous
A Leiomyosarcoma elements resembling other
mesodermal tissues.
B Sarcoma botryoides
C Malignant mixed mullerian tumor
D Endolymphatic stromal myosis
E Leiomyoma with focal degeneration

A 72-year-old woman has had fatigue for the past year, along with episodes of vaginal The unopposed estrogen
bleeding. On physical examination there are no abnormal findings. Laboratory studies drives the hyperplasia,
show Hgb 9.1 g/dL, Hct 26.5%, MCV 72 fL, platelet count 158,000/microliter, and WBC which if atypical carries an
count 7150/microliter. An endometrial biopsy is performed and on microscopic increased risk for
examination shows atypical adenomatous hyperplasia. Which of the following is the development of an
most likely risk factor for development of her disease? endometrial
adenocarcinoma.
A Human papillomavirus infection
B Long term intrauterine contraceptive device use
C Chronic endometritis
D Pelvic inflammatory disease
E Unopposed estrogenic stimulation

A 56-year-old G0 P0 woman reports vaginal bleeding in the past 2 months. Her last This history points to a
menstrual period was 6 years ago. On physical examination there are no abnormal possible endometrial
findings. Which of the following procedures is most appropriate to perform on this carcinoma, and nulliparity
woman? increases the risk.
A Endometrial biopsy
B Pap smear
C Vaginal culture
D Colposcopy
E CT scan

A 50-year-old woman has experienced mild pelvic discomfort for 3 months. On Ovarian serous tumors are
physical examination there are bilateral adnexal masses. A pelvic CT scan reveals bilateral more often than
irregular unilocular cystic, bilateral mass lesions in the region of the ovaries. One is 10 other ovarian tumors. Serous
cm and the other is 8 cm in size. Which of the following types of neoplasm is most cystadenocarcinomas are
likely to be present in this woman? bilateral in about 2/3 of
A Mature cystic teratoma cases. They are usually cystic.

B Serous cystadenocarcinoma
C Endometrioid carcinoma
D Fibrothecoma
E Mucinous cystadenoma