MCQ Book Questions

Q60642. A 45-year-old obese woman (BMI = 32 kg/m2) with a history of diabetes and poorly controlled hypertension complains of increased menstrual blood fl ow of 3 months in duration. An endometrial biopsy is shown in the image. Which of the fol- lowing most likely accounts for the pathogenesis of endome- trial hyperplasia in this patient?

Q60643. The patient described in Question 27 undergoes surgery to have the mass removed. Histologic examination of the surgi- cal specimen is shown in the image. The arrow points to a calcifi ed focus (psammoma body). This neoplasm most likely originated from which of the following ovarian cells/tissues?

Q60644. Which of the following statements best characterizes the endo- crine status of the malignant cells in the patient described in Questions 27 and 28?

Q60645. A 50-year-old woman presents with a 1-month history of intermittent vaginal bleeding. A Pap smear is normal. Pel- vic examination reveals a left adnexal mass. A uterine curet- tage shows complex endometrial hyperplasia without atypia. A CT scan of the abdomen reveals a 5-cm mass replacing the left ovary. The patient undergoes hysterectomy and bilateral salpingo-oophorectomy. Histologic examination of the ovar- ian mass is shown in the image. Which of the following is the appropriate pathologic diagnosis?

Q60646. A 40-year-old woman presents with a 5-year history of dys- menorrhea. Physical examination and endocrine studies are normal. A hysterectomy is performed. Histologic examination of the uterine wall reveals areas of extensive adenomyosis. Which of the following best describes this patient’s uterine pathology?

Q60647. A 60-year-old women presents with a 2-week history of uter- ine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis?

Q60648. A 25-year-old woman is referred to the gynecologist for treat- ment of infertility. The patient is obese (BMI = 32 kg/m2) and has pronounced facial hair. She states that she has always had irregular menstrual periods. On gynecologic examination, both ovaries are found to be symmetrically enlarged. This patient’s ovaries would likely show which of the following pathologic fi ndings?

Q60649. Endocrine studies of the woman described in Question 25 would most likely show which of the following results in the serum?

Q60650. A 20-year-old woman presents with increasing abdominal girth of 3 months in duration. Physical examination reveals ascites. A pelvic examination discloses a right ovarian mass. A 7-cm ovarian mass is removed at surgery. The histologic appearance of this ovarian neoplasm (shown in the image) most closely resembles which of the following malignant neo- plasms seen in males?

Q60651. A 60-year-old woman presents with a 1-year history of vul- var itching, bleeding, and infl ammation. Physical examina- tion reveals a 1-cm exophytic mass on the labium major. Biopsy of the mass is shown in the image. These neoplastic cells would most likely express which of the following tumor markers?

Q60652. A 40-year-old woman presents with 6 months of increasing abdominal girth. Gynecologic examination reveals large bilateral ovarian masses. The patient undergoes bilateral oophorectomy. The pathology report reads “Krukenberg tumor,” and the histo- pathologic fi ndings are shown in the image. Which of the fol- lowing tests would likely provide the highest diagnostic yield?

Q60653. A 15-year-old girl presents with left lower abdominal pain. She has noted recent enlargement of her breasts. Her last men- strual period was 10 weeks ago. She denies having had sex- ual intercourse. Serum levels of hCG are markedly elevated. Which of the following is the most likely diagnosis?

Q60654. A 41-year-old immigrant woman from Asia presents for prenatal care. Her uterus is signifi cantly larger than expected, and her serum hCG level is much higher than expected for her due date. No fetus is found on ultrasound examination. The abnormal placenta is removed. One month later, this patient presents to the emergency room with abdominal pain. Explor- atory laparotomy reveals rupture of the posterior uterine fundus with grape-like tissue extruding from the defect. Two liters of blood are present in the abdominal cavity. Histologic examination of the uterine mass is shown in the image. The arrows point to syncytial cells. Which of the following is the most likely diagnosis?

Q60655. A 34-year-old woman in the third trimester of her second pregnancy presents with a 1-week history of vaginal bleeding. The patient subsequently gives birth to a healthy female at 35 weeks of gestation. Immediately after delivery, the patient begins to hemorrhage transvaginally. The bleeding cannot be controlled, and the patient undergoes emergency hysterec- tomy. Examination of the hysterectomy specimen reveals pen- etration of chorionic villi deep into the myometrium, causing failure of the placental tissue to fully separate from the uterine wall. Which of the following best describes the uteroplacental abnormality seen in this patient?

Q60656. A 22-year-old woman presents to the emergency room with a 2-hour history of acute abdominal pain and vaginal bleed- ing. Her vital signs are normal. Physical examination reveals blood oozing from the vaginal opening. Laparotomy shows an enlarged right fallopian tube with hemorrhage and rup- ture. What is the most likely cause of hemorrhage in this patient?

Q60657. A 25-year-old woman in the last trimester of her fi rst preg- nancy presents for a routine obstetric evaluation. Her blood pressure is 160/100 mm Hg, and her pulse is 75 per minute. Physical examination shows pitting edema of the extremi- ties. Urinalysis demonstrates 3+ proteinuria. Which of the following is the most dangerous complication of preeclampsia in this patient?

Q60658. A 17-year-old woman presents to her gynecologist with a 5-day history of vaginal bleeding. A home pregnancy test had been positive 1 week previously. This morning, the patient passed tissue with the appearance of small grapes. An ultra- sound shows a dilated endometrial cavity but no evidence of a fetus. Endometrial evacuation of the uterus by suction curet- tage reveals grapelike clusters, with individual units measur- ing up to 5 mm in diameter (shown in the image). Cytogenetic examination of this tissue will most likely demonstrate which of the following genetic patterns?

Q60659. A 56-year-old woman presents with a 3-month history of vagi- nal bleeding. A cervical Pap smear reveals malignant, glandu- lar epithelial cells. This patient most likely has a neoplasm originating in which of the following anatomic locations?

Q60660. A 20-year-old woman presents for a complete physical exami- nation. During the pelvic examination, a 5-cm cystic mass is found in the region of the right ovary. Radiographs show focal calcifi cations in the mass. The tumor is removed, and the sur- gical specimen is shown in the image. Which of the following is the most likely diagnosis?

Q60661. A 43-year-old woman presents with a 6-month history of increasing abdominal girth. On physical examination, there is pronounced ascites. Pelvic examination reveals a left adnexal mass. A 6-cm ovarian tumor is removed. The tumor is solid and white. Histologically, it is composed of cells resembling normal ovarian stroma surrounded by collagen fi bers. Which of the following is the appropriate diagnosis?