a = new Array(217);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. This is an uncommon lesion that is unlikely to be present at this age."
a[2] = f + "(B) Incorrect. This unusual lesion is more likely to occur in the vagina of women who were exposed to diethylstilbestrol in utero when their mothers took this drug."
a[3] = f + "(C) CORRECT. Microglandular hyperplasia is a mass lesion grossly, and must be distinguished from adenocarcinoma histologically. Some cases may occur in the setting of oral contraceptive use, but a causal relationship is not well established."
a[4] = f + "(D) Incorrect. This rare tumor, a form of embryonal rhabdomyosarcoma, is seen in the vagina of young girls."
a[5] = f + "(E) Incorrect. Endocervical polyps occur in about 2 to 5% of women but is not specifically related to oral contraceptive use."
a[5.1] = f + "(F) Incorrect. Follicular cervicitis appears grossly as erythema and irregular surface features of the cervix, but not a mass."
a[6] = f + "(A) Incorrect. Struma ovarii is one variant of a 'dermoid' cyst that secretes significant amounts of a hormone. Such benign teratomas are invariably cystic and usually filled with hair and sebum from a prominent ectodermal component."
a[7] = f + "(B) Incorrect. However, theca-lutein cysts of the ovary may occur with molar pregnancy."
a[8] = f + "(C) Incorrect. However, Sertoli-Leydig cell tumor can produce virilizing symptoms."
a[9] = f + "(D) CORRECT. Fibrothecomas and granulosa cell tumors can be estrogen producing. The excessive estrogen drives endometrial hyperplasia, which can progress to atypical adenomatous hyperplasia, which can progress to carcinoma."
a[10] = f + "(E) Incorrect. This tumor represents a metastatic adenocarcinoma (usually from a gastric primary)."
a[10.1] = f + "(F) Incorrect. Though cystadenocarcinoma is one of the more common ovarian neoplasms, it is not likely to be a source of steroid hormone secretion. Cystadenocarcinomas are likely to be cystic and not solid."
a[11] = f + "(A) Incorrect. Such cysts are found in the anterolateral vaginal wall. They are derived from embryologic wolffian duct rests."
a[12] = f + "(B) Incorrect. These are metastatic adenocarcinomas, typically from the stomach."
a[13] = f + "(C) CORRECT. Also called paratubal cysts, these are common incidental findings. They are embryologic remnants of the wolffian duct. They are not related to neoplasia. This woman had leiomyomas of the uterus which led to the hysterectomy."
a[14] = f + "(D) Incorrect. PID leads to inflammation with fibrosis, which may result in tubo-ovarian abscess."
a[15] = f + "(E) Incorrect. These are usually solitary large bulky tumors of the ovary."
a[15.1] = f + "(F) Incorrect. Fibrocystic disease (or fibrocystic changes) is a diagnosis applied to the breast."
a[15.2] = f + "(G) Incorrect. A remnant of the embryologic omphalomesenteric duct may be found anywhere from umbilicus to small bowel; the most common remnant is a Meckel diverticulum."
a[16] = f + "(A) CORRECT. Pain is a key feature of endometriosis. The foci of endometriosis are most often found on serosal surfaces in the pelvis, but can be found in other locations such as the surface of the bowel. Endometrial glands, stroma, and hemorrhage are microscopic features."
a[17] = f + "(B) Incorrect. Endometriosis does not undergo malignant transformation and it is not associated with mesothelial lesions."
a[18] = f + "(C) Incorrect. Endometriosis (which has glands) is a benign process and not neoplastic."
a[19] = f + "(D) Incorrect. Though hemangiomas can be found at a variety of lcoations and can be multiple, they are not typically associated with pain."
a[20] = f + "(E) Incorrect. Granulomatous inflammation of the pelvis is uncommon; it is unlikely to be hemorrhagic."
a[21] = f + "(A) Incorrect. An endometrioid carcinoma of the ovary is usually a solid mass. Cells from such a carcinoma arising in the uterus are usually shed into the endometrial cavity, and psammoma body formation does not occur."
a[22] = f + "(B) CORRECT. Ovarian carcinomas are often associated with ascites, because they have a propensity to seed throughout the peritoneal cavity. Psammoma body formation is common to malignant serous tumors of the ovary."
a[23] = f + "(C) Incorrect. Though clusters of mesothelioma cells might be difficult to distinguish from adenocarcinoma, mesotheliomas are quite rare and they do not make psammoma bodies."
a[24] = f + "(D) Incorrect. A mature cystic teratoma would not have malignant elements."
a[25] = f + "(E) Incorrect. An adenocarcinoma at this site is extremely rare."
a[26] = f + "(A) CORRECT. It is unlikely that a signficicant lesion will be missed in four consecutive Pap smears, which is the reason for annual Pap smears. The natural history of the progression from dysplasia to invasive carcinoma is usually a decade or more, so there is plenty of time to make a diagnosis and treat conservatively. Cervical carcinoma is a preventable condition."
a[27] = f + "(B) Incorrect. You have not seen the patient for 10 years, during which time a lesion had plenty of time to develop."
a[28] = f + "(C) Incorrect. It is highly unlikely that abnormal cells would be missed in four Pap smears."
a[29] = f + "(D) Incorrect. Invasive cervical carcinomas are potentially preventable through Pap smear screening and simple observation on pelvic examination."
a[30] = f + "(E) Incorrect. Policies vary markedly, but this is an inexpensive test worth getting regardless of the coverage."
a[31] = f + "(A) CORRECT. The Pap smear is a very useful test if performed properly. Proper patient identification is key to any laboratory testing procedure."
a[32] = f + "(B) Incorrect. Once the cells are smeared on the slide, they must be fixed quickly to avoid air-drying artefact, which interferes with cytologic interpretation."
a[33] = f + "(C) Incorrect. Any lubricant will interfere with collection and interpretation of the specimen."
a[34] = f + "(D) Incorrect. Patients should be instructed to schedule an appointment to collect a Pap smear when they are not in the menstrual phase of the cycle."
a[35] = f + "(E) Incorrect. Patients should be advised not to douche, as this interferes with the Pap test."
a[36] = f + "(A) Incorrect. Metastases should produce mass lesions, and she would become severly debilitated after several years with an extensive carcinoma."
a[37] = f + "(B) Incorrect. Gonorrheal infections can produce salpingitis that can be severe, but it usually resolves in several weeks, though pelvic inflammatory disease can continue to produce pain. There is scarring, but no focal red or blue lesions."
a[38] = f + "(C) CORRECT. These 'powder burns' are typical for the small hemorrhagic foci of endometriosis on pelvic peritoneum that can produce so much discomfort for their size."
a[39] = f + "(D) Incorrect. Yeast infections involve the vagina, producing discharge and local irritation."
a[40] = f + "(E) Incorrect. Leiomyomata can be large enough to cause pelvic discomfort, but they are firm masses."
a[41] = f + "(A) Incorrect. An endometrial carcinoma does not greatly enlarge the uterus. They are most common in postmenopausal women."
a[42] = f + "(B) CORRECT. The most common neoplasm of the uterus is a leiomyoma. They can be multiple and can lead to abnormal bleeding."
a[43] = f + "(C) Incorrect. An ectopic pregnancy is most likely to occur in the fallopian tube, leading to a small mass that ruptures and bleeds, producing a medical emergency. The blood may extend into the peritoneal cavity, where it can be detected by culdocentesis."
a[44] = f + "(D) Incorrect. Endometriosis consists of small foci no more than a few millimeters in size. Sometimes a focus of endometriosis can give rise to an endometrioma, a mass lesion filled with blood, but these are typically external to the uterus, most often involving ovary."
a[45] = f + "(E) Incorrect. Syphilis can produce a 'hard' painless chancre on external genitalia or cervix, but no masses."
a[46] = f + "(A) Incorrect. Granulosa-theca cell tumors or fibrothecomas are solid tumors."
a[47] = f + "(B) Incorrect. Such 'dermoid cysts' are often filled with sebaceous material and lots of hair."
a[48] = f + "(C) Incorrect. This is rare. Sarcomas are typically large, solid masses."
a[49] = f + "(D) CORRECT. This is a classic appearance for ovarian serous cystadenocarcinoma. However, the gross appearance alone is not diagnostic, and a borderline serous tumor must be distinguished microscopically."
a[50] = f + "(E) Incorrect. Clear cell carcinomas of the ovary are usually solid tumors."
a[51] = f + "(A) Incorrect. HSV produces an infection with recurrent crops of painful vesicles, but these lesions are no pre-neoplastic."
a[52] = f + "(B) Incorrect. EBV infection is not characteristic for the genital tract."
a[53] = f + "(C) Incorrect. <I>Candida</I>l infections can produce vaginitis, but are not premalignant."
a[54] = f + "(D) CORRECT. HPV infections can lead to squamous epithelial dysplasia and carcinoma, particularly high grade subtypes such as HPV 16 and 18. The HPV vaccine immunizes agains these subtypes, as well as the most common subtypes 6 and 11 associated with condyloma."
a[55] = f + "(E) Incorrect. Trichomonal infections are typically mild and do not presage CIN."
a[55.1] = f + "(F) Incorrect. <I>G. vaginalis</I> is a cause for bacterial vaginosis, not dysplasia."
a[56] = f + "(A) Incorrect. Most placental infarcts are small and insignificant and do not lead to disseminated intravascular coagulation (DIC)."
a[57] = f + "(B) Incorrect. Eclampsia can uteroplacental insufficiency with ischemia, leading to endothelial injury that promotes disseminated intravascular coagulation (DIC). However, there should be hypertension, proteinuria, and seizures."
a[58] = f + "(C) Incorrect. This is a rare complication of late third trimester pregnancy with a high mortality rate. Thromboplastins released into the circulation promotes disseminated intravascular coagulation (DIC). However, patients typically present with dypsnea."
a[59] = f + "(D) CORRECT. This complication results in release of thromboplastin into the circulation, promoting disseminated intravascular coagulation (DIC) ith consumption of clotting factors and thrombocytopenia."
a[60] = f + "(E) Incorrect. The shock resulting from the rupture leads to hypoxia and endothelial damage with resultant disseminated intravascular coagulation (DIC). However, in this case the culdocentesis was negative and the pregnancy was intrauterine."
a[61] = f + "(A) Incorrect. The appearance of lung metastases from a choriocarcinoma arising in this hydatidiform mole would be a late finding, and after persistence of an elevated HCG."
a[62] = f + "(B) CORRECT. She has a hydatidiform mole. Persistence or an increase in the HCG level should suggest that trophoblastic disease is still present, such as invasive mole or choriocarcinoma."
a[63] = f + "(C) Incorrect. The biopsy might not pick up invasive mole or metastatic choriocarcinoma."
a[64] = f + "(D) Incorrect. The ultrasound could demonstrate mass lesions, but these would not be early findings."
a[65] = f + "(E) Incorrect. A Pap smear is relatively insensitive for endometrial lesions, and it certainly would not indicate invasive mole or metastasis of a choriocarcinoma."
a[66] = f + "(A) Incorrect. Complement levels are used to solve complex problems with autoimmune diseases, which are chronic in nature."
a[67] = f + "(B) Incorrect. A routine urinalysis does not include a pregnancy test or a determination of HCG level."
a[68] = f + "(C) Incorrect. Besides, this is not a 'STAT' test. The Pap smear is useful for screening for dysplasia or carcinoma and for some infections."
a[69] = f + "(D) CORRECT. You should strongly suspect a ruptured ectopic pregnancy in this setting. The pregnancy test would likely have been performed first."
a[70] = f + "(E) Incorrect. The endometrial biopsy might be a next step with a positive HCG to help determine if the pregnancy is ectopic."
a[70.1] = f + "(F) Incorrect. She does not have a reported fever. Although an inflammatory process is possible, there is a diagnosis higher on the list here."
a[71] = f + "(A) Incorrect. Endometriosis is best known as a cause for pelvic pain, though it may cause irregular menstrual cycles. It is unlikely to cause amenorrhea."
a[72] = f + "(B) CORRECT. This is a very rare complication of a D&C procedure in which endometrium, including the stratum basalis, is removed, preventing normal growth and cycling of the endometrium."
a[73] = f + "(C) Incorrect. Elevated prolactin levels can produce amenorrhea along with galactorrhea. The onset is not related to a D&C procedure."
a[74] = f + "(D) Incorrect. Ovarian failure is unlikely to have a relationship to a D&C."
a[75] = f + "(E) Incorrect. Oral contraceptives produce more regular cycles."
a[76] = f + "(A) Incorrect. Condylomas consist of thickened epithelium that does not bleed."
a[77] = f + "(B) Incorrect. Endometriotic lesions are usually located on serosal surfaces in the pelvis and abdomen. There is minimal hemorrhage just at the site of the lesion itself. The onset of pelvic pain is typically at a later age than that of this patient."
a[78] = f + "(C) Incorrect. Gonorrhea can produce inflammation, but not hemorrhage. Gonorrhea is a sexually transmitted disease."
a[79] = f + "(D) CORRECT. Following the onset of menarche, the blockage to menstrual flow from the imperforate hymen leads to an accumulation of blood in the vagina, called hematocolpos."
a[80] = f + "(E) Incorrect. A Bartholin cyst will produced a localized mass that will contain clear fluid, and when inflamed may contain purulent material."
a[81] = f + "(A) Incorrect. This is a neoplasm that would lead to a mass with malignant squamous epithelial cells."
a[82] = f + "(B) CORRECT. Lichen sclerosus et atrophicus is typically seen after menopause and is slowly progressive. It may predispose to infection. Lichen sclerosis itself is not premalignant, but persons with it have a slightly increased risk for cancer."
a[83] = f + "(C) Incorrect. This is a 'venereal wart' from human papillomavirus (HPV) infection, leading to verrucous pink to white plaques that histologically have epithelial hyperplasia and koilocytosis."
a[84] = f + "(D) Incorrect. Vaginal adenosis may occur in women with exposure to diethylstilbestrol in utero."
a[85] = f + "(E) Incorrect. This is a red, crusted area that has clusters of malignant epithelial cells within the epidermis and its appendages."
a[85.1] = f + "(F) Incorrect. This would be an uncommon location for such an infection. There would likely be hyperkeratosis and minimal inflammation."
a[86] = f + "(A) Incorrect. The endometrial polyp is composed of both glands and stroma."
a[87] = f + "(B) Incorrect. Adenomyosis, which is the presence of endometrial glands in the uterine myometrium, results in diffuse uterine enlargement, and is not very common."
a[88] = f + "(C) Incorrect. At least 20% of women have at least one leiomyoma, but leiomyosarcomas are rare. However, a large cellular mass with mitoses is less likely to be a leiomyoma. Postmenopausally, most leiomyomas stop growing or even regress."
a[89] = f + "(D) Incorrect. Atypical hyperplasia may precede endometrial carcinoma. The hyperplasia is not a mass lesion and is unlikely to increase the size of the uterus."
a[90] = f + "(E) CORRECT. Leiomyosarcomas of the uterus are uncommon malignant neoplasms. They do not arise from leiomyomas. They are larger and more cellular than benign leiomyomas, and leiomyosarcomas have mitotic figures."
a[90.1] = f + "(F) Incorrect. A malignant mixed mullerian tumor has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues; these heterologous elements can resemble malignant cartilage or bone. The 3MT also tends to be a large, bulky mass."
a[91] = f + "(A) Incorrect. Pulmonary masses would be typical for metastatic choriocarcinoma, but choriocarcinoma complicates only about 2 to 3 % of molar pregnancies."
a[92] = f + "(B) Incorrect. If the pregnancy were tubal, it would not typically last more than a month before rupture of the tube occurred, and the HCG level, not high to begin with, would fall soon thereafter."
a[93] = f + "(C) Incorrect. An endometritis would not account for a continued high HCG level."
a[94] = f + "(D) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited."
a[95] = f + "(E) CORRECT. Invasive moles constitute about 10% of gestational trophoblastic disease. The failure of the HCG to diminish to near negative following the D&C suggests residual gestational trophoblastic disease."
a[96] = f + "(A) Incorrect. Adenomyosis can produce irregular cycles and irregular vaginal bleeding. The uterus is typically enlarged."
a[97] = f + "(B) Incorrect. Amenorrhea and dysmenorrhea are the classic findings from the secretion of prolactin by a pituitary adenoma. There is often galactorrhea as well."
a[98] = f + "(C) CORRECT. PID leads to scarring that interferes with movement of the ovum released from the ovary down the fallopian tube. PID can lead to infertility. Assisted reproductive technology would be needed in her case."
a[99] = f + "(D) Incorrect. A teratoma is most often unilateral, though occasionally bilateral. Teratomas are mass lesions that can often be felt, and should be evident with ultrasound."
a[100] = f + "(E) Incorrect. Many women have some degree of chronic cervicitis, and this has no significant impact upon fertility."
a[101] = f + "(A) Incorrect. HPV infections are associated with increased risk for cervical neoplasia."
a[102] = f + "(B) Incorrect. Endometriosis is a risk for endometrioid carcinoma decades later."
a[103] = f + "(C) Incorrect. Such irregular cycles are a risk for development of endometrial carcinoma."
a[104] = f + "(D) CORRECT. Although DES has not been used for decades, the women who were exposed to it are past age 40 and now developing adenosis and clear cell carcinoma."
a[105] = f + "(E) Incorrect. This could occur with an ovarian neoplasm, such as a granulosa-theca cell tumor, that secretes estrogen."
a[106] = f + "(A) Incorrect. Condylomas are usually raised white wart-like lesions."
a[107] = f + "(B) Incorrect. Most occur on the external genitalia and perineum, and some on the cervix."
a[108] = f + "(C) Incorrect. There is an association with human papillomavirus (HPV) infection."
a[109] = f + "(D) CORRECT. Condyloma is one of the manifestations of human papillomavirus infection (HPV). The most common subtypes associated with condyloma are 6 and 11. Though condyloma is not premalignant, the risk factor is the same, and she could acquire subtypes of HPV, such as 16 and 18, that do increase the risk for squamous dysplasias and carcinomas of the cervix. The HPV vaccine will protect against subtypes 6, 11, 16, and 18."
a[110] = f + "(E) Incorrect. They are most common in sexually promiscuous persons (or persons whose sexual partners are promiscuous)."
a[111] = f + "(A) CORRECT. The abundant hair is typical for the ectodermal component of a mature cystic teratoma, but mesodermal and endodermal components will also be present. The historical findings here consistent with hyperthyroidism suggest that this one has thyroid tissue, also called struma ovarii when the majority of the teratoma is composed of thyroid tissue. It is a rare cause for hyperthyroidism."
a[112] = f + "(B) Incorrect. An elevated HCG could indicate an intrauterine pregnancy or a choriocarcinoma. A few choriocarcinomas are associated with hyperthyroidism. Grossly, choriocarcinomas are not discrete masses, but bloody messes."
a[113] = f + "(C) Incorrect. Hypokalemia is seen with aldosteronomas of the adrenal gland."
a[114] = f + "(D) Incorrect. Elevated estrogen levels are seen with pregnancy, but high levels such as this are rarely present, even with neoplasms such as thecomas."
a[115] = f + "(E) Incorrect. The CA-125 is a marker for ovarian malignancies."
a[116] = f + "(A) Incorrect. An invasive mole is less common than a complete mole."
a[117] = f + "(B) Incorrect. A fetus is usually present with a partial mole."
a[118] = f + "(C) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited to the pregnanc."
a[119] = f + "(D) Incorrect. Choriocarcinomas are solid, but hemorrhagic lesions that invade the myometrial wall, though the uterus can be enlarged. They can follow a hydatidiform mole."
a[120] = f + "(E) CORRECT. No fetus is present, only grape-like chorionic villi that produce the echogenic effect on ultrasound. Complete mole is the most common form of gestational trophoblastic disease."
a[121] = f + "(A) CORRECT. An HSIL is equivalent to cervical intraepithelial neoplasia (CIN) III, or severe dysplasia. With proper therapy, the lesion will be removed and not be given a chance to progress to invasive carcinoma."
a[122] = f + "(B) Incorrect. Inflammation will produce some inflammatory atypia, but not dysplasia."
a[123] = f + "(C) Incorrect. DES exposure in utero predisposes women to vaginal clear cell carcinoma and to adenosis."
a[124] = f + "(D) Incorrect. DES exposure can lead to microglandular hyperplasia and to vaginal clear cell carcinomas."
a[125] = f + "(E) Incorrect. This is seen on the vulva and consists of malignant cells in the epithelium that are mucin positive, indicating adenocarcinoma."
a[126] = f + "(A) Incorrect. Her beta-HCG is negative, so molar pregnancy is ruled out."
a[127] = f + "(B) Incorrect. A leiomyoma may degenerate and abort following delivery, but this is a rare event."
a[128] = f + "(C) Incorrect. Anterior pituitary necrosis leads to lack of lactation and other evidence for hypopituitarism which are signs of Sheehan syndrome. This typically occurs when there is marked hypotension from blood loss at the time of delivery."
a[129] = f + "(D) Incorrect. Endometriosis is the presence of endometrial glands and stroma outside the endometrium, producing pain but no discharge."
a[130] = f + "(E) CORRECT. The retained placental fragements are a source for infection producing an acute endometritis. A D&C must be done to remove the fragments. At the time of delivery, the placenta should be checked for completeness; a missing cotyledon suggests incomplete placental delivery."
a[131] = f + "(A) Incorrect. An endometrial adenocarcinoma is most likely to occur at a postmenopausal age, and it is not likely to greatly enlarge the uterus."
a[132] = f + "(B) Incorrect. The avascular villi with trophoblastic proliferation are features of a molar pregnancy."
a[133] = f + "(C) Incorrect. A leiomyosarcoma is usually a large, solitary mass."
a[134] = f + "(D) Incorrect. Endometritis does not typically enlarge the uterus."
a[135] = f + "(E) CORRECT. Adenomyosis can produce diffuse uterine enlargement."
a[136] = f + "(A) Incorrect. Adenomyosis is uncommon at this age. It could produce irregular bleeding. The uterus is usually enlarged."
a[137] = f + "(B) CORRECT. Anovulatory cycles occur most often at the time of menarche, menopause, or with ovarian dysfunction such as in polycystic ovarian disease. The endometrium is not cycling normally."
a[138] = f + "(C) Incorrect. Endometrial adenocarcinoma is rare at this age."
a[139] = f + "(D) Incorrect. Leiomyomas may produce irregular bleeding. It would be rare to have leiomyomas of sufficient size to produce problems at her age."
a[140] = f + "(E) Incorrect. Oral contraceptive use produces regular menstrual cycles."
a[140.1] = f + "(F) Incorrect. Ovarian thecomas could produce estrogens and cause endometrial hyperplasia and bleeding. An ovarian tumor is rare at her age, and it would produce a mass lesion."
a[141] = f + "(A) Incorrect. DES exposure leads to vaginal adenosis and to clear cell carcinomas."
a[142] = f + "(B) CORRECT. This is a Gartner duct cyst, which is a remnant of the mesonephric duct in the lateral vaginal wall. They can be multiple. There is no risk for malignancy. A Bartholin gland cyst may arise in a similar location."
a[143] = f + "(C) Incorrect. Gonorrhea is more likely to produce a urethritis, cervicitis, or pelvic inflammatory disease. It is unlikely to produce a mass lesion of the vagina."
a[144] = f + "(D) Incorrect. Carcinomas are uncommon at her age. The vagina is an uncommon site for metastases."
a[145] = f + "(E) Incorrect. Oral contraceptive use does not lead to vaginal mass lesions."
a[145.1] = f + "(F) Incorrect. Objects inserted are likely to be large and smooth-surfaced, though local trauma with abrasion or contusion is possible."
a[146] = f + "(A) CORRECT. An endometrioid carcinoma can develop in the setting of endometriosis. These processes can occur decades apart."
a[147] = f + "(B) Incorrect. Adenomyosis does not carry a risk for development of any epithelial or stromal neoplasm."
a[148] = f + "(C) Incorrect. A 3M tumor may have an epithelial component, but it is not related to ovarian endometroid carcinoma."
a[149] = f + "(D) Incorrect. Chronic endometritis is not associated with malignancies, but the uterine bleeding that could occur must be distinguished from that caused by a carcinoma."
a[150] = f + "(E) Incorrect. Atypical endometrial hyperplasia is a precursor to endometrial carcinoma."
a[151] = f + "(A) Incorrect. The 46, XX karyotype would be appropriate for a normal female fetus. It could also be seen with a complete mole in which no fetus would be present."
a[152] = f + "(B) CORRECT. In a partial hydatidiform mole, a fetus is present but malformed and small for gestational age. Only occasional villi, or none at all, may be grape-like, but there is trophoblastic proliferation typical of molar pregnancy. A partial mole pregnancy is unlikely to go to term."
a[153] = f + "(C) Incorrect. The 45, X karyotype is seen with Turner syndrome, one of the more common chromosomal abnormalities seen with fetal losses. It is not accompanied by placental changes of molar pregnancy."
a[154] = f + "(D) Incorrect. Trisomy 18 leads to an abnormal appearing fetus with clenched hands (not syndactyly), and the placenta may be small, but does not show changes of molar pregnancy."
a[155] = f + "(E) Incorrect. The 23, X karyotype is that of an unfertilized ovum or a sperm."
a[155.1] = f + "(F) Incorrect. This karyotype is indicative of Klinfelter syndrome, seen in nearly normal appearing males with oligospermia."
a[155.2] = f + "(G) Incorrect. This is the 'superfemale' karyotype with only mild mental retardation."
a[156] = f + "(A) CORRECT. She has primary amenorrhea. The findings point to the rare testicular feminization (androgen insensitivity syndrome), with a karyotype of 46, XY. The inguinal masses are the testes."
a[157] = f + "(B) Incorrect. This would be more useful for workup of secondary amenorrhea."
a[158] = f + "(C) Incorrect. This would be more useful for workup of secondary amenorrhea."
a[159] = f + "(D) Incorrect. A serum cortisol would be useful for workup of congenital adrenal hyperplasia."
a[160] = f + "(E) Incorrect. This is more useful for workup of male infertility or developmental problems."
a[160.1] = f + "(F) Incorrect. It is unlikely that her problems can be explained by a neoplasm of the brain, including the pituitary."
a[161] = f + "(A) Incorrect. This is the causative agent for syphilis, which as a primary lesion causes a hard chancre."
a[162] = f + "(B) Incorrect. Gonorrhea is more of a cause for vaginitis in children."
a[163] = f + "(C) Incorrect. <I>Chlamydia trachomatis</I> is a sexually transmitted disease that is unlikely to produce a marked vaginal exudate."
a[164] = f + "(D) Incorrect. HSV infection leads to the recurrent appearance of crops of painful vesicles, typically on the external genitalia."
a[165] = f + "(E) Incorrect. Gram negative enteric bacterial infections are not common at this site."
a[165.1] = f + "(F) Bacterial vaginosis is caused by overgrowth of a variety of bacteria (<I>Gardnerella vaginalis</I>, Prevotella, Mobiluncus, Peptostreptococcus, Mycoplasma hominis, etc.) in the vagina. It differs from fungal vulvovaginitis in that (1) there is usually a rather unpleasant and quite noticeable 'fishy' odor; (2) the vaginal discharge is homogenous, lower in viscosity, and uniformly coats the vaginal walls; and (3) the vaginal pH is usually >4.5."
a[165.2] = f + "(G) Incorrect. Trichomonas vulvovaginitis is caused by the protozoan Trhicomonas vaginalis. It differs from fungal vulvovaginitis in that there is a profuse, homogenous vaginal discharge that usually has a yellow or greenish-yellow color. Vaginal pH is usually > 5.0, and the 'fishy' odor may or may not be present. Trichomonas vulvovaginitis is diagnosed by observation of motile trichomonads and large numbers of PMNs in a vaginal smear."
a[165.3] = f + "(H) CORRECT. Vaginal yeast infections are quite common. Fungal vulvovaginitis is the second most common cause of vaginal infections in the U.S. (Bacterial vaginosis is the most frequent cause). The <I>Candida</I> organisms have the morphologic appearance with budding cells, often with pseudohyphae."
a[165.4] = f + "(I) Incorrect. HPV is a cause for condyloma and for squamous dysplasias and carcinomas, not vaginosis."
a[166] = f + "(A) Incorrect. HPV is a sexually transmitted disease that affects the external genitalia and cervix."
a[167] = f + "(B) Incorrect. Tuberculosis is a rare infection of the female genital tract that can produce a chronic endometritis or a chronic salpingitis."
a[168] = f + "(C) Incorrect. Trichomonal infections are not very severe. They typically involve the vagina."
a[169] = f + "(D) Incorrect. Yeast infections are a nuisance, but not severe, and involve the vagina."
a[170] = f + "(E) CORRECT. She has findings of pelvic inflammatory disease (PID) complicated by a tubo-ovarian abscess. These are potential complications of sexually transmitted diseases caused by gonorrhea or chlamydial infections most often."
a[171] = f + "(A) Incorrect. Cystadenocarcinomas are epithelial tumors unlikely to secrete estrogen."
a[172] = f + "(B) Incorrect. A Krukenberg tumor represents metastatic disease of the ovary, most often from a gastrointestinal malignancy (such as primary gastric adenocarcinoma)."
a[173] = f + "(C) Incorrect. Cystadenomas, which are of epithelial origin, are not likely to secrete estrogen."
a[174] = f + "(D) CORRECT. She could have an ovarian tumor producing estrogen, and the granulosa cell tumor is most likely to do that, of the ones listed. Her obesity is a risk factor for endometrial carcinoma as well."
a[175] = f + "(E) Incorrect. Immature teratomas contain primitive elements with neural differentiation and are unlikely to secrete estrogens."
a[176] = f + "(A) Incorrect. Syphilis can produce a chancre of the external genitalia or cervix."
a[177] = f + "(B) Incorrect. HPV is associated with increased risk for squamous epithelial dysplasias."
a[178] = f + "(C) CORRECT. Cases of pelvic inflammatory disease (PID) are usually due to gonorrhea or chlamydial infection, which are sexually transmitted diseases. The tubal scarring from the inflammation leads to an increased risk for ectopic pregnancy"
a[179] = f + "(D) Incorrect. <I>Candida</I> is a cause for vaginitis."
a[180] = f + "(E) Incorrect. This organism presents the greatest risk as an intrauterine infection resulting in stillbirth in the third trimester."
a[181] = f + "(A) Incorrect. The leiomyosarcoma is distinguished from a leiomyoma by the cellularity and the mitotic rate, but it is composed only of cells resembling smooth muscle."
a[182] = f + "(B) Incorrect. Sarcoma botryoides is a rare neoplasm most likely to occur in the vagina of a child. It is composed of primitive cells most resembling an embryonal rhabdomyosarcoma."
a[183] = f + "(C) CORRECT. The malignant mixed mullerian tumor typically has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues."
a[184] = f + "(D) Incorrect. This rare condition consists of endometrial stromal cells extending into the body of uterus and beyond."
a[185] = f + "(E) Incorrect. A leiomyoma should not have a significant mitotic rate."
a[186] = f + "(A) Incorrect. HPV infection mainly produces lesions of squamous epithelium of external genitalia and cervix, such as dysplasias and carcinoma."
a[187] = f + "(B) Incorrect. An IUD can cause endometritis, but not a preneoplastic lesion."
a[188] = f + "(C) Incorrect. Chronic endometritis is not generally known as an antecedent to preneoplastic or neoplastic conditions."
a[189] = f + "(D) Incorrect. PID can produce inflammation with scarring, mainly of tubes and ovaries."
a[190] = f + "(E) CORRECT. The unopposed estrogen drives the hyperplasia, which if atypical carries an increased risk for development of an endometrial adenocarcinoma."
a[191] = f + "(A) CORRECT. This history points to a possible endometrial carcinoma, and nulliparity increases the risk."
a[192] = f + "(B) Incorrect. CIN is less likely than an endometrial lesion in this setting."
a[193] = f + "(C) Incorrect. An infection would be unlikely to cause bleeding."
a[194] = f + "(D) Incorrect. This will show cervical lesions, not endometrial."
a[195] = f + "(E) Incorrect. The possible causes of uterine bleeding cannot be distinguished by CT (or MRI) scan."
a[196] = f + "(A) Incorrect. Teratomas of the ovary are bilateral in about 10 to 15% of cases."
a[197] = f + "(B) CORRECT. Ovarian serous tumors are bilateral more often than other ovarian tumors. Serous cystadenocarcinomas are bilateral in about 2/3 of cases."
a[198] = f + "(C) Incorrect. Ovarian endometrioid carcinomas tend to be solid and unilateral."
a[199] = f + "(D) Incorrect. These are unlikely to be bilateral; they are solid masses"
a[200] = f + "(E) Incorrect. Benign mucinous ovarian tumors are bilateral in about 5% of cases. Malignant mucinous ovarian tumors are bilateral about 20% of the time. These mucinous tumors tend to be multilocular."