MCQ Book Questions

Q60622. A 70-year-old man presents with pain in his back. Relevant clinical fi ndings include a rock-hard, enlarged prostate pal- pated on rectal examination. Radiologic studies show multi- centric, osteoblastic lesions of the lumbar vertebral bodies. The patient is treated with leuprolide acetate (lupron), an inhibitor of gonadotropin release by the pituitary. Which of the following statements best summarizes the rationale for this treatment?

Q60623. A 36-year-old woman presents with infertility. She complains of having had dull pelvic pain for 9 months, which is accen- tuated during menstruation. Physical examination and endo- crinologic studies are normal. Laparoscopy reveals multiple, small hemorrhagic lesions over the surface of both ovaries and fallopian tubes and abundant pelvic scarring. Which of the following is the most likely diagnosis?

Q60624. A 58-year-old woman complains of recent swelling in her vagina. There is a past medical history of prenatal exposure to diethylstilbestrol. Physical examination reveals a 3-cm fi rm mass in the anterior wall of the upper vagina. Biopsy of the vaginal mass will most likely show which of the following pathologic fi ndings?

Q60625. A 60-year-old woman presents with a 3-week history of a pain- ful genital lesion and bleeding. Physical examination reveals an exophytic, ulcerated 1-cm polypoid mass near the external end of the urethra. What is the most likely diagnosis?

Q60626. A 30-year-old woman presents with a 5-month history of increasing abdominal girth and pelvic discomfort. Imaging studies reveal a mass replacing the left ovary. A multilocular tumor fi lled with thick, viscous fl uid is removed (shown in the image). Tumor spaces are lined by mucinous, columnar epithelial cells, showing no evidence of atypia. There are no papillary structures and no evidence of stromal invasion. Which of the following is the appropriate pathologic diagnosis?

Q60627. The ovarian tumor described in Question 4 most closely resembles which of the following patterns of müllerian-type differentiation?

Q60628. A 59-year-old woman presents with a 2-year history of vul- var itching and burning. Physical examination reveals a red, moist lesion of the labium major. Biopsy reveals clusters of pale vacuolated cells within the epidermis that stain posi- tively for periodic acid-Schiff (PAS) and carcinoembryonic antigen (CEA). Which of the following is the most likely diagnosis?

Q60629. A 52-year-old woman with hypothyroidism presents with a 2-year history of vulvar itching and painful intercourse. Physi- cal examination reveals vulval white plaques, atrophic skin, and a parchment-like appearance. Biopsy of the lesion (shown in the image) demonstrates hyperkeratosis, loss of rete ridges, and a homogeneous, acellular zone in the upper dermis. This patient’s vulvar dermatitis is most commonly associated with which of the following underlying conditions?

Q60630. A 29-year-old woman is evaluated for an abnormal cervical Pap smear. Colposcopy reveals condyloma acuminatum of the exocervix. A biopsy of the cervix is shown in the image. PCR amplifi cation of this biopsy specimen will most likely demonstrate evidence of which of the following infectious agents?

Q60631. A 31-year-old Haitian woman is evaluated for infertility. Pel- vic examination shows a markedly enlarged vulva, inguinal lymph node enlargement, and rectal stricture. Biopsy of an inguinal lymph node reveals necrotizing granulomas, neutro- philic infi ltrates, and inclusion bodies within macrophages. Which of the following is the most likely etiology of infertility in this patient?

Q60632. A 35-year-old woman in Africa presents with fever, chills, and malaise. She further complains of a painful genital sore. She had sexual intercourse 5 days previously. Physical examina- tion reveals vesiculopustular lesions on the labium major and cervix. There is bilateral inguinal lymphadenopathy. A lymph node biopsy reveals granulomatous infl ammation. Which of the following is the most likely etiology of this constellation of signs and symptoms?

Q60633. A 28-year-old woman, who is 28 weeks pregnant, presents with vaginal bleeding. She does not have a history of uterine contractions. Pelvic examination reveals bright red blood in the endocervical canal. An ulcerated exophytic mass is identi- fi ed on the left side of the cervix. There is no evidence of direct tumor extension into the parametrium. The pelvic lymph nodes are slightly enlarged, raising the possibility of nodal involvement by the tumor. A Caesarian section is performed, followed by a radical hysterectomy. The cervix is shown in the image. Which of the following is the best prognostic indicator of survival in this patient?

Q60634. Imaging studies establish a diagnosis of stage IV cervical can- cer. If untreated, which of the following will be the most likely cause of death in the patient described in Question 15?

Q60635. A 50-year-old nulliparous woman with a history of diabetes complains that her menstrual blood fl ow is more abundant than usual. During the last two menstrual cycles, she noticed spotting throughout the entire cycle. The patient is obese (BMI = 32 kg/m2), and her blood pressure is 160/100 mm Hg. An ultrasound examination reveals a thickened endometrial stripe with a polypoid mass in the uterine fundus. The patient undergoes a hysterectomy. The uterus is opened to reveal a partially necrotic mass (shown in the image). A biopsy of the mass shows moderately differentiated adenocarcinoma. Which of the following represents the most likely precursor of this patient’s malignant disease?

Q60636. A 36-year-old woman is evaluated for an abnormal Pap smear. A cervical biopsy shows atypical squamous cells throughout the entire thickness of the epithelium, with no evidence of epi- thelial maturation (shown in the image). The basal membrane appears intact. What is the appropriate diagnosis?

Q60637. A 35-year-old woman presents with a 6-week history of vaginal discharge, which is occasionally blood tinged. Pelvic examination reveals a 2-cm pedunculated, lobulated, and smooth cervical growth; it is excised. Histologic examina- tion of the specimen would most likely reveal which of the following?

Q60638. A 33-year-old woman with a history of menorrhagia presents with a 6-month history of increasing fatigue. A CBC reveals a hypochromic, microcytic anemia (hemoglobin = 8 g/dL). Bimanual pelvic examination reveals an enlarged uterus with multiple, irregular masses. A hysterectomy is performed, and a sharply circumscribed fl eshy tumor is found within the uterine wall (shown in the image). Which of the following is the most likely cause of vaginal bleeding and anemia in this patient?

Q60639. A 52-year-old woman presents with chronic pelvic discomfort. A CT scan of the pelvis shows a 10-cm, well-circumscribed uterine mass. A hysterectomy is performed. On gross exami- nation, the mass is soft with areas of necrosis and irregular borders extending into the myometrium. Histologic examina- tion demonstrates large zones of necrosis surrounded by a rim of disorganized spindle cells that display numerous mitoses. Immunohistochemical staining for smooth muscle actin is positive. Which of the following is the most likely diagnosis?

Q60640. A 50-year-old woman complains of having intermenstrual bleeding for 4 months. A Pap smear is normal. An ultra- sound examination shows a mass in the endometrial cavity. The patient elects to undergo a hysterectomy. A large polyp is found upon opening the endometrial cavity (shown in the image). Histologic examination of this polyp will most likely show which of the following pathologic fi ndings?

Q60641. Neoplastic cells obtained from the patient described in Ques- tion 17 would most likely show loss of function of which of the following cell cycle control proteins?