Reproduction MCQ's Flashcards
(18 cards)
Question:
A 39-year-old woman has noted a pressure sensation, but no pain, in her pelvic region for the past 5 months. On physical examination, there is a right adnexal mass. An ultrasound scan shows a 10 cm fluid-filled cystic mass in the right ovary, along with ascitic fluid. A fine needle aspirate of the mass is performed, and cytologic examination of clear fluid aspirated from the mass reveals clusters of malignant epithelial cells surrounding psammoma bodies. Which of the following neoplasms is she most likely to have?
A. Endometrioid carcinoma
B. Serous cystadenocarcinoma
C. Malignant mesothelioma
D. Mature cystic teratoma
E. Squamous cell carcinoma
Correct answer: B. Serous cystadenocarcinoma
Explanation:
This 39-year-old woman presents with:
A large ovarian cystic mass
Ascites
Cytology showing malignant epithelial cells with psammoma bodies
These findings are classic for serous cystadenocarcinoma, the most common malignant ovarian tumor, especially of epithelial origin.
Key Diagnostic Clue:
Psammoma bodies (calcified concentric lamellae) are highly associated with:
Serous cystadenocarcinoma
Also seen in papillary thyroid cancer and meningioma, but not in this context
Why not the others?
A. Endometrioid carcinoma – also an epithelial ovarian tumor, but psammoma bodies are not characteristic
C. Malignant mesothelioma – arises from peritoneum, rare in women, no psammoma bodies
D. Mature cystic teratoma – benign germ cell tumor, no malignant cells or psammoma bodies
E. Squamous cell carcinoma – rare in the ovary, often arises from malignant transformation of a teratoma
Conclusion:
Large ovarian cyst + ascites + malignant cells + psammoma bodies = Serous cystadenocarcinoma (B).
Question:
A 35-year-old woman was last seen by a general practitioner 10 years ago. She had received Pap smear testing in 2 of the 5 years prior. She had no abnormal Pap smears. She now presents with vaginal spotting. On pelvic examination, an ulcerated cervical lesion is noted, and microscopic examination of cells from this lesion shows squamous cell carcinoma. Which of the following conclusions is most appropriate regarding these findings?
A. The patient should have continued to return for regular Pap smears
B. Herpes simplex viral infection contributed to this problem
C. The laboratory to which the Pap smears were sent is at fault for missing abnormal cells
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
Correct Answer: A. The patient should have continued to return for regular Pap smears
Explanation:
Cervical cancer, particularly squamous cell carcinoma, develops over years from precursor lesions that can be detected through regular Pap smear screening. Although this patient had two normal Pap smears within a 5-year window, she did not continue regular screening over the next 10 years. Regular screening is crucial for early detection and intervention before progression to invasive cancer. Therefore, the most appropriate conclusion is that she should have continued with regular Pap smears.
Question:
A 23-year-old woman has a 1-day history of increasing obtundation. She is 12 weeks pregnant with a positive intrauterine pregnancy on ultrasound. Vitals show hypotension. Lab findings reveal anemia, thrombocytopenia, prolonged PT and PTT, elevated D-dimer, and schistocytes. Urinalysis is normal. Which of the following pregnancy complications is most likely causing her condition?
A. Placental infarction
B. Eclampsia
C. Amniotic fluid embolus
D. Retained dead fetus
E. Ruptured tubal ectopic
Correct answer: D. Retained dead fetus
Explanation:
This patient presents with signs of disseminated intravascular coagulation (DIC):
Low platelets (26,400/µL)
Elevated PT (44 sec) and PTT (61 sec)
Elevated D-dimer (16 µg/mL)
Schistocytes on smear → microangiopathic hemolytic anemia
Anemia and hypotension (90/45 mmHg)
No vaginal bleeding or other infection signs
Key clue: Presence of a 12-week fetus with signs of systemic illness (obtundation) and no fetal viability mentioned, suggestive of fetal demise.
Retained dead fetus syndrome is a known cause of chronic DIC in pregnancy, due to release of thromboplastin-like substances from the dead fetus into maternal circulation.
Why not other options?
A. Placental infarction – doesn’t typically cause DIC
B. Eclampsia – usually presents with hypertension, proteinuria, and seizures
C. Amniotic fluid embolus – presents acutely with respiratory distress, not obtundation and labs like this
E. Ruptured ectopic – causes acute abdomen, shock, and positive culdocentesis (this patient’s was negative)
Thus, retained dead fetus is the most likely cause.
Correct answer: D. Granulosa cell tumour
Explanation:
This postmenopausal woman presents with:
Irregular vaginal bleeding
Endometrial hyperplasia on biopsy
Solid ovarian mass on imaging
These findings strongly suggest excess estrogen production, which stimulates endometrial proliferation.
Granulosa cell tumor:
A sex cord–stromal tumor of the ovary.
Produces estrogen → causes endometrial hyperplasia and abnormal uterine bleeding.
Commonly presents in middle-aged or postmenopausal women.
Often associated with Call-Exner bodies histologically (not needed here for diagnosis).
Why not others?
A. Mature cystic teratoma – usually benign, doesn’t secrete estrogen, often asymptomatic.
B. Choriocarcinoma – hCG-secreting, aggressive, not associated with endometrial hyperplasia.
C. Sertoli-Leydig cell tumor – secretes androgens → virilization, not estrogen.
E. Krukenberg tumor – metastatic gastric cancer, usually bilateral, not estrogenic.
F. Cystadenocarcinoma – epithelial tumor, usually presents with ascites and mass effect, not estrogen production.
So the ovarian tumor causing estrogen excess and endometrial hyperplasia is most likely a Granulosa cell tumor (D).
Correct answer: B. 21α-Hydroxylase
Explanation:
This newborn has:
Ambiguous genitalia
46,XX karyotype
Markedly elevated 17-hydroxyprogesterone
These are classic signs of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, the most common form of CAH.
Key Features of 21α-Hydroxylase Deficiency:
↓ Cortisol and ↓ aldosterone production
↑ ACTH → adrenal hyperplasia
Shunting to androgen pathway → virilization of female (46,XX) infants → ambiguous genitalia
↑ 17-hydroxyprogesterone (diagnostic marker)
Why not the others?
A. 11β-Hydroxylase – causes ambiguous genitalia + hypertension (due to deoxycorticosterone), not high 17-OHP
C & D. 3α-/3β-Hydroxysteroid dehydrogenase – rare; affects both androgen and cortisol pathways; less specific lab pattern
E. 5α-Reductase – affects DHT production in 46,XY, leads to undervirilization in males, not 46,XX females
Bottom line:
Ambiguous genitalia in a 46,XX newborn with elevated 17-hydroxyprogesterone = 21α-hydroxylase deficiency.
Correct answer: B. Nonseminomatous germ cell tumor
Explanation:
This 28-year-old man presents with:
A testicular mass
Markedly elevated alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) levels
Partially necrotic mass on ultrasound
These features are classic for a nonseminomatous germ cell tumor (NSGCT), such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, or mixed germ cell tumor.
Key distinguishing lab marker:
AFP is never elevated in seminomas
AFP is commonly elevated in NSGCTs, particularly yolk sac tumors and embryonal carcinoma
LDH can be elevated in both seminomatous and nonseminomatous types, but is nonspecific
Why not the other options?
A. Leydig cell tumor – may produce hormones (androgens/estrogens), not AFP
C. Sertoli cell tumor – rare, usually hormonally silent or estrogenic, no AFP elevation
D. Teratoma – in adults, often part of NSGCTs; pure teratomas don’t typically raise AFP (unless mixed)
E. Testicular lymphoma – most common in older men, not young adults; AFP not elevated
Conclusion:
Elevated AFP + testicular mass in young male = Nonseminomatous germ cell tumor.
Explanation:
This 30-year-old woman presents with:
Chronic pelvic and lower abdominal pain
Infertility
Normal pelvic exam and Pap smear
Laparoscopy findings of bluish-red raised lesions on pelvic peritoneum
These are classic features of endometriosis, particularly:
“Powder-burn” lesions (bluish-red spots)
Commonly found in the cul-de-sac, broad ligaments, ovaries, etc.
Associated with pain, dysmenorrhea, and infertility
Why not the other options?
A. Metastatic adenocarcinoma – not typical in young women with chronic pelvic pain and infertility; would not show small blue-red lesions.
B. Neisseria gonorrhoeae infection – acute PID symptoms (fever, discharge); not consistent with chronic symptoms and laparoscopy findings.
D. Candidiasis – affects the vagina/vulva; would show white discharge and itching, not peritoneal lesions.
E. Leiomyomata (fibroids) – benign uterine tumors; do not cause peritoneal lesions.
Conclusion:
Chronic pelvic pain, infertility, and laparoscopic “powder-burn” lesions = Endometriosis (C).
Correct answer: D. Serum beta-hCG
Explanation:
This patient presents with:
Sudden onset lower abdominal pain
Adnexal tenderness + mass
No intrauterine pregnancy on ultrasound
Bloody fluid on culdocentesis
These are classic signs of a ruptured ectopic pregnancy, most likely in the left fallopian tube.
Key Diagnostic Step:
A serum beta-hCG is critical to confirm pregnancy, especially when no intrauterine gestational sac is seen on ultrasound. If hCG is elevated and no intrauterine pregnancy is visualized, ectopic pregnancy is highly likely.
Why not others?
A. Serum complement – used for autoimmune diseases (e.g., lupus); not helpful here
B. Urinalysis – rules out UTI, but not related to suspected ectopic
C. Pap smear – screens for cervical cancer, not acute pelvic pain
E. Endometrial biopsy – invasive and not useful acutely
F. WBC count – may show leukocytosis but is nonspecific
Conclusion:
In a reproductive-aged woman with acute pain, adnexal mass, and no intrauterine pregnancy on US, the most useful next step is serum beta-hCG (Answer D).
Correct answer: D. Imperforate hymen
Explanation:
This 14-year-old girl presents with:
Pelvic pain for 3 months
No history of menstruation (primary amenorrhea)
No sexual activity
Ultrasound showing fluid distending the vagina
Classic Diagnosis:
Imperforate hymen – a congenital anomaly where the hymen fails to perforate during fetal development. This leads to retained menstrual blood (hematocolpos) after menarche, which causes:
Pelvic/abdominal pain
Mass effect or bulging hymen
No visible menses
Ultrasound showing fluid in the vagina confirms hematocolpos due to outflow obstruction.
Why not the others?
A. Cervical condyloma – HPV-related; external lesions, no fluid accumulation
B. Endometriosis – can cause pelvic pain, but unlikely at 14 before menses and no fluid accumulation in vagina
C. Cervical gonorrhea – needs sexual activity, causes cervicitis, not vaginal fluid collection
E. Ruptured Bartholin cyst – would cause localized vulvar pain/swelling, not vaginal fluid buildup
Conclusion:
Primary amenorrhea + pelvic pain + fluid-filled vagina on ultrasound = Imperforate hymen (D).
orrect answer: D. Transrectal route; multiple random biopsies of the prostate
Explanation:
This 59-year-old man:
Has markedly elevated PSA
No palpable nodules on digital rectal exam (DRE)
Has a family history of prostate cancer
To evaluate elevated PSA and rule out prostate cancer, the standard diagnostic approach is:
🔍 Transrectal ultrasound (TRUS)-guided multiple core biopsies
Why option D is correct:
Transrectal route allows close access to the posterior prostate (most common cancer location)
Multiple random (systematic) biopsies increase diagnostic yield, especially in non-palpable disease
Why other options are incorrect:
A & B (Cystoscopy guided) – used for urethral/bladder evaluation, not for prostate biopsy
C. Transperineal fine-needle aspiration – less commonly used, lower sensitivity
E. Single biopsy – insufficient; prostate cancer can be multifocal and missed on single sample
Conclusion:
For elevated PSA with normal DRE, best next step is multiple transrectal biopsies → Answer D.
Correct answer: A. Chloride level in the sweat
Explanation:
This 25-year-old man has:
Azoospermia
Recurrent pneumonia and hospitalizations
Digital clubbing
Bilateral absence of the vas deferens
These are classic features of Cystic Fibrosis (CF), especially the congenital bilateral absence of the vas deferens (CBAVD) in males, which leads to obstructive azoospermia despite normal hormone levels and testicular function.
Confirmatory test:
Sweat chloride testing is the gold standard for diagnosing CF.
Why not the others?
B. Cilia motility – tests for Primary Ciliary Dyskinesia, which can also cause infertility and lung issues, but vas deferens is present
C. Alpha-1 antitrypsin – related to liver disease and early-onset emphysema, not CBAVD
D. FSH/LH – normal in obstructive azoospermia from CF
E. IgA – screens for selective IgA deficiency, not relevant here
F. Testosterone – would be normal in CF-related infertility
Conclusion:
This is a classic case of Cystic Fibrosis with CBAVD, and sweat chloride test (A) confirms the diagnosis.
Correct answer: C. Pelvic inflammatory disease
Explanation:
This 43-year-old woman has:
10 years of infertility
Mild pelvic pain
Regular menses
Normal uterus but mildly tender adnexa
Slightly thickened fallopian tubes on ultrasound
These findings strongly suggest chronic pelvic inflammatory disease (PID), which is a common cause of tubal factor infertility due to scarring and obstruction of the fallopian tubes from prior infections (often subclinical).
Why not the others?
A. Adenomyosis – causes painful, heavy menses and a globular, enlarged uterus; not primarily associated with infertility
B. Adenohypophyseal prolactinoma – causes amenorrhea or galactorrhea, not present here
D. Mature cystic teratoma – benign ovarian tumor, often asymptomatic and not associated with infertility
E. Chronic cervicitis – may cause discharge or cervical tenderness, but doesn’t explain tubal abnormalities
Conclusion:
Infertility + adnexal tenderness + thickened fallopian tubes = Pelvic inflammatory disease (C).
