Female reproductive histology US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Female reproductive histology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Female reproductive histology US Medical PG Question 1: A 26-year-old woman presents with vaginal discharge and dyspareunia. Wet mount microscopy shows clue cells. Which of the following additional findings would confirm the diagnosis?
- A. Pseudohyphae on microscopy
- B. Positive whiff test and vaginal pH > 4.5 (Correct Answer)
- C. WBCs > 10 per high power field
- D. Motile trichomonads
Female reproductive histology Explanation: ***Positive whiff test and vaginal pH > 4.5***
- The combination of **clue cells**, a **positive whiff test** (amine odor after adding KOH), and a **vaginal pH > 4.5** are diagnostic criteria for **bacterial vaginosis (BV)**.
- This classic triad, along with thin, homogeneous discharge, forms part of the **Amsel criteria** for diagnosing BV.
*Pseudohyphae on microscopy*
- **Pseudohyphae** are characteristic findings in **vulvovaginal candidiasis (yeast infection)**, not bacterial vaginosis.
- Candidiasis typically presents with thick, white, "cottage cheese-like" discharge and intense pruritus, which differs from the described symptoms.
*WBCs > 10 per high power field*
- An increased number of **white blood cells (WBCs)**, specifically polymorphonuclear leukocytes, suggests **inflammation** or infection but is typically *absent* or minimal in uncomplicated bacterial vaginosis.
- High WBC counts are more indicative of **trichomoniasis** or **cervicitis**.
*Motile trichomonads*
- The presence of **motile trichomonads** on wet mount microscopy is diagnostic for **trichomoniasis**, a sexually transmitted infection.
- While trichomoniasis can cause vaginal discharge and dyspareunia, its microscopic features are distinct from clue cells.
Female reproductive histology US Medical PG Question 2: A 47-year-old woman comes to the physician because of fatigue, difficulty falling asleep, and night sweats for the past 6 months. Over the past year, her menstrual cycle has become irregular and her last menstrual period was 2 months ago. She quit smoking 2 years ago. Pelvic exam shows vulvovaginal atrophy. A pregnancy test is negative. Which of the following changes is most likely to occur in this patient's condition?
- A. Decreased gonadotropin-releasing hormone
- B. Increased inhibin B
- C. Decreased luteinizing hormone
- D. Increased estrogen
- E. Increased follicle-stimulating hormone (Correct Answer)
Female reproductive histology Explanation: ***Increased follicle-stimulating hormone***
- The patient's symptoms (fatigue, insomnia, night sweats, irregular menses, 2 months amenorrhea, vulvovaginal atrophy) at age 47 are classic for **menopause**.
- During menopause, declining **ovarian function** leads to decreased estrogen and inhibin, which in turn causes the pituitary to release more **FSH** and LH via a feedback loop.
*Decreased gonadotropin-releasing hormone*
- **GnRH** levels are typically increased in menopause due to the lack of negative feedback from ovarian hormones, stimulating the pituitary.
- A decrease in GnRH would reduce pituitary gonadotropin secretion, which is contrary to what is observed in menopause.
*Increased inhibin B*
- **Inhibin B** is produced by ovarian granulosa cells and typically **decreases** significantly during the menopausal transition due to the reduced number of ovarian follicles.
- Decreased inhibin B contributes to the rise in FSH levels during menopause.
*Decreased luteinizing hormone*
- In menopause, both **LH** and FSH levels are **elevated** due to the loss of negative feedback from declining ovarian hormones like estrogen and inhibin.
- While FSH rises earlier and more dramatically, LH also increases.
*Increased estrogen*
- In menopause, the ovaries produce **significantly less estrogen**, leading to the classic symptoms like hot flashes and vaginal atrophy.
- The decline in estrogen is a primary hormonal change driving the menopausal transition.
Female reproductive histology US Medical PG Question 3: A researcher is studying the effects of hormones on different cells within the ovarian follicle. She adds follicle stimulating hormone (FSH) to a culture of ovarian follicle cells. She then measures the activity levels of different enzymes within the cells. Which enzyme and ovarian cell type would be expected to be stimulated by the addition of FSH?
- A. Desmolase; theca interna cell
- B. Aromatase; theca externa cell
- C. Aromatase; granulosa cell (Correct Answer)
- D. Desmolase; granulosa cell
- E. Aromatase; theca interna cell
Female reproductive histology Explanation: ***Aromatase; granulosa cell***
- **FSH** acts directly on **granulosa cells** to stimulate their proliferation and differentiation.
- One of the key functions of stimulated granulosa cells is the production of **aromatase**, an enzyme responsible for converting **androgens** (produced by theca cells) into **estrogens**.
*Desmolase; theca interna cell*
- **Desmolase** (specifically cholesterol desmolase, or CYP11A1) is found in **theca interna cells** and is responsible for converting cholesterol into **androgens**.
- Theca interna cell activity, including desmolase, is primarily stimulated by **LH**, not FSH.
*Aromatase; theca externa cell*
- The **theca externa cells** are primarily connective tissue and lack significant endocrine function, including aromatase activity.
- **Aromatase** is predominantly present in the granulosa cells.
*Desmolase; granulosa cell*
- While granulosa cells are crucial for estrogen synthesis via aromatase, they do not produce **desmolase**.
- **Desmolase** is the key enzyme in theca interna cells for androgen synthesis.
*Aromatase; theca interna cell*
- **Theca interna cells** produce **androgens** under the influence of **LH** and do not express **aromatase**.
- **Aromatase** is exclusively expressed in the **granulosa cells** and converts these androgens into estrogens.
Female reproductive histology US Medical PG Question 4: A 27-year-old woman visits her family physician complaining of the recent onset of an unpleasant fish-like vaginal odor that has started to affect her sexual life. She was recently treated for traveler’s diarrhea after a trip to Thailand. External genitalia appear normal on pelvic examination, speculoscopy shows a gray, thin, homogenous, and malodorous vaginal discharge. Cervical mobilization is painless and no adnexal masses are identified. A sample of the vaginal discharge is taken for saline wet mount examination. Which of the following characteristics is most likely to be present in the microscopic evaluation of the sample?
- A. Clue cells on saline smear (Correct Answer)
- B. Hyphae
- C. Motile flagellates
- D. Polymorphonuclear cells (PMNs) to epithelial cell ratio of 2:1
- E. Gram-negative diplococci
Female reproductive histology Explanation: ***Clue cells on saline smear***
- The symptoms of **fish-like vaginal odor**, **gray, thin, and malodorous discharge** are highly suggestive of **bacterial vaginosis (BV)**.
- **Clue cells** are **epithelial cells** covered in bacteria and are the hallmark diagnostic feature of BV on wet mount.
*Hyphae*
- **Hyphae** (or pseudohyphae) are characteristic of **candidiasis** (yeast infection).
- Candidiasis typically presents with **thick, white, cottage-cheese-like discharge** and **vaginal itching**, which are not described.
*Motile flagellates*
- **Motile flagellates** (specifically *Trichomonas vaginalis*) are characteristic of **trichomoniasis**.
- Trichomoniasis usually presents with **frothy, greenish-yellow discharge**, **cervical petechiae ("strawberry cervix")**, and **vulvar irritation**, which are absent here.
*Polymorphonuclear cells (PMNs) to epithelial cell ratio of 2:1*
- An elevated **PMN count** (especially a ratio like 2:1) is indicative of **vaginal inflammation** or **infection** such as cervicitis or trichomoniasis, but is typically **absent or low** in **bacterial vaginosis**.
- **Bacterial vaginosis** is characterized by a *decrease* in lactobacilli and an *overgrowth* of anaerobic bacteria, and often has **minimal host inflammatory response**.
*Gram-negative diplococci*
- **Gram-negative diplococci** are characteristic of **gonorrhea**, specifically *Neisseria gonorrhoeae*.
- Gonorrhea often presents with **purulent discharge**, **dysuria**, or can be **asymptomatic**, and is usually associated with **cervicitis**, which is not indicated by the painless cervical mobilization.
Female reproductive histology US Medical PG Question 5: A 24-year-old woman comes to the emergency department because of lower abdominal pain for 4 hours. She has had vaginal spotting for 2 days. Menses occur at irregular 20- to 45-day intervals and last for 3 to 7 days. Her last menstrual period was 8 weeks ago. She was treated for pelvic inflammatory disease at the age of 20 years with ceftriaxone and azithromycin. She is sexually active with one male partner and uses condoms inconsistently. Her pulse is 118/min, respirations are 20/min, and blood pressure is 118/66 mm Hg. Examination shows lower abdominal tenderness. Pelvic examination shows a closed cervix and a uterus of normal size with right adnexal tenderness. Her serum β-human chorionic gonadotropin concentration is 16,000 mIU/mL (N < 5). Transvaginal ultrasonography shows a 5-cm hypoechoic lesion at the junction of the fallopian tube and uterine cavity with a 3-mm layer of myometrium surrounding it. Which of the following is the most likely diagnosis?
- A. Placenta previa
- B. Interstitial pregnancy (Correct Answer)
- C. Incomplete hydatidiform mole
- D. Bicornuate uterus pregnancy
- E. Spontaneous abortion
Female reproductive histology Explanation: ***Interstitial pregnancy***
- The ultrasound finding of a **5-cm hypoechoic lesion at the junction of the fallopian tube and uterine cavity** with a **3-mm layer of myometrium surrounding it** is characteristic of an interstitial pregnancy.
- The patient's history of **pelvic inflammatory disease** increases the risk for ectopic pregnancy, and the symptoms of **abdominal pain**, **vaginal spotting**, and **elevated β-hCG** are consistent with an ectopic pregnancy.
*Placenta previa*
- This condition involves the **placenta covering the cervical os** and typically presents with **painless vaginal bleeding** later in pregnancy, which is not consistent with the patient's symptoms or ultrasound findings.
- While it involves abnormal placental implantation, it is a uterine pregnancy, and the ultrasound describes a lesion at the fallopian tube-uterine junction, not the cervix.
*Incomplete hydatidiform mole*
- An incomplete mole usually presents with **vaginal bleeding** and an **enlarged uterus for gestational age**, and ultrasound would show a **partially cystic placenta** with a fetal pole or heart activity.
- The β-hCG levels can be high, but the specific ultrasound finding of a lesion at the uterotubal junction is not consistent with a molar pregnancy.
*Bicornuate uterus pregnancy*
- While a bicornuate uterus is a uterine anomaly, pregnancy would still be **intrauterine**, albeit in one of the horns, and the ultrasound would show a pregnancy within such a horn, not an interstitial location with a thin myometrial layer.
- This condition does not explain the specific location and thin myometrial wall seen on ultrasound, which points to an ectopic pregnancy.
*Spontaneous abortion*
- Spontaneous abortion presents with **vaginal bleeding** and **abdominal pain**, but ultrasound would show either an **empty uterus** (complete abortion) or **retained products of conception** within the uterine cavity (incomplete abortion).
- The elevated β-hCG and the specific ultrasound finding of a mass at the uterotubal junction are not consistent with a spontaneous intrauterine abortion.
Female reproductive histology US Medical PG Question 6: A 43-year-old woman, gravida 2, para 2, comes to the physician because of a 6-month history of heavy, irregular menstrual bleeding. Pelvic examination shows blood and clots in the posterior fornix and normal-appearing internal and external genitalia. An endometrial biopsy specimen shows straight uniform tubular glands lined with tall pseudostratified columnar epithelial cells with high mitotic activity embedded in an edematous stroma. Increased activity of which of the following is directly responsible for the histologic appearance of the biopsy specimen?
- A. Theca externa cells
- B. Corpus luteum
- C. Aromatase (Correct Answer)
- D. 5-alpha-reductase
- E. Luteinizing hormone
Female reproductive histology Explanation: ***Aromatase***
- The biopsy findings (straight uniform tubular glands with high mitotic activity and pseudostratified columnar cells in an edematous stroma) are characteristic of **endometrial hyperplasia**, a condition often driven by **unopposed estrogen stimulation**.
- **Aromatase** is the enzyme responsible for converting androgens (such as androstenedione and testosterone) into estrogens (estrone and estradiol), thus directly contributing to the elevated estrogen levels causing the hyperplasia.
*Theca externa cells*
- **Theca externa cells** are primarily involved in the structural support of the follicle and do not directly produce significant amounts of hormones.
- The primary hormone production from the ovarian follicles comes from theca interna cells (androgens) and granulosa cells (estrogens).
*Corpus luteum*
- The **corpus luteum** is responsible for producing progesterone after ovulation. Its activity would lead to secretory changes in the endometrium, counteracting the proliferative effects of unopposed estrogen and typically reducing bleeding.
- Absence or dysfunction of the corpus luteum could lead to anovulatory cycles and prolonged estrogenic stimulation, but the corpus luteum itself does not directly cause hyperplasia by its own activity in this context.
*5-alpha-reductase*
- **5-alpha-reductase** converts testosterone into the more potent androgen, dihydrotestosterone (DHT).
- This enzyme is primarily active in androgen-sensitive tissues like the prostate, hair follicles, and skin, and its activity does not directly lead to endometrial hyperplasia.
*Luteinizing hormone*
- **Luteinizing hormone (LH)** triggers ovulation and stimulates the theca cells to produce androgens, which are then aromatized to estrogen by granulosa cells.
- While LH is essential for ovarian function, the direct cause of the endometrial hyperplasia in this scenario is the sustained high estrogen level, often due to anovulation or peripheral conversion, not the LH itself.
Female reproductive histology US Medical PG Question 7: A 22-year-old female presents to her physician for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not report any genitourinary symptoms. She takes oral contraceptives and does not use barrier contraception. The medical history is unremarkable. The vital signs are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant odor and numerous punctate red maculae on the ectocervix. The remainder of the exam is normal. Which of the following organisms will most likely be revealed on wet mount microscopy?
- A. Epithelial cells covered by numerous bacterial cells
- B. Chains of cocci
- C. Motile round or oval-shaped microorganisms (Correct Answer)
- D. Numerous rod-shaped bacteria
- E. Budding yeast cells and/or pseudohyphae
Female reproductive histology Explanation: ***Motile round or oval-shaped microorganisms***
- The symptoms of **frothy vaginal discharge**, **strawberry cervix** (punctate red maculae), and the patient's sexual history are classic for **Trichomonas vaginalis** infection.
- On **wet mount microscopy**, *Trichomonas vaginalis* appears as **motile, flagellated, pear-shaped protozoa** that are round or oval-shaped.
*Epithelial cells covered by numerous bacterial cells*
- This describes **clue cells**, which are characteristic of **bacterial vaginosis**.
- Bacterial vaginosis typically presents with a **fishy odor** and a thin, gray-white discharge, not frothy or associated with a strawberry cervix.
*Chains of cocci*
- While various cocci can be part of the vaginal flora or indicate infection, **chains of cocci** (e.g., *Streptococcus*) are not a primary diagnostic finding for the presented symptoms.
- This morphology is not characteristic of common causes of **vaginitis** like trichomoniasis, candidiasis, or bacterial vaginosis.
*Budding yeast cells and/or pseudohyphae*
- These findings are indicative of a **candidal vulvovaginitis (yeast infection)**.
- Candidiasis typically presents with a thick, **curd-like vaginal discharge**, severe itching, and redness, which differs from the frothy discharge and strawberry cervix described.
*Numerous rod-shaped bacteria*
- While rod-shaped bacteria (e.g., lactobacilli) are a normal part of the vaginal flora, a significant increase in specific types of rod-shaped bacteria, like **Gardnerella vaginalis**, in the absence of lactobacilli can indicate **bacterial vaginosis**.
- However, this finding alone does not uniquely describe the key clinical features of **frothy discharge** and **strawberry cervix** seen in this patient.
Female reproductive histology US Medical PG Question 8: A 4-week-old boy is brought to the emergency department with a 2-day history of projectile vomiting after feeding. His parents state that he is their firstborn child and that he was born healthy. He developed normally for several weeks but started to eat less 1 week ago. Physical exam reveals a small, round mass in the right upper quadrant of the abdomen close to the midline. The infant throws up in the emergency department, and the vomitus is observed to be watery with no traces of bile. Which of the following is associated with the most likely cause of this patient's symptoms?
- A. Chloride transport defect
- B. Recanalization defect
- C. Vascular accident
- D. Failure of neural crest migration
- E. Nitric oxide synthase deficiency (Correct Answer)
Female reproductive histology Explanation: ***Nitric oxide synthase deficiency***
- This symptom constellation points to **pyloric stenosis**, which is characterized by smooth muscle hypertrophy and concurrent deficiency of **nitric oxide synthase** and possibly **interstitial cells of Cajal** in the pylorus.
- The thickened pylorus creates an obstruction, leading to non-bilious projectile vomiting, an "olive-like" mass, and subsequent electrolyte imbalances.
*Chloride transport defect*
- A chloride transport defect, particularly in the **CFTR (cystic fibrosis transmembrane conductance regulator) gene**, is characteristic of cystic fibrosis.
- While cystic fibrosis can cause gastrointestinal symptoms like **meconium ileus** or malabsorption, it does not typically present with projectile vomiting and a palpable abdominal mass in this age group, nor is it the primary cause of pyloric stenosis.
*Recanalization defect*
- **Recanalization defects** refer to issues in the development of a lumen in structures that are initially solid during embryogenesis, such as the gut tube.
- This can lead to conditions like **duodenal atresia**, which typically presents with **bilious vomiting** (due to obstruction distal to the ampulla of Vater) and often a "double-bubble" sign on imaging, which is not described here.
*Vascular accident*
- A **vascular accident** in the gut can lead to conditions such as **necrotizing enterocolitis** in neonates or **bowel ischemia/infarction**.
- These conditions would typically present with symptoms like bloody stools, abdominal distension, lethargy, and systemic signs of illness, rather than isolated projectile vomiting and an abdominal mass.
*Failure of neural crest migration*
- **Failure of neural crest cell migration** is the underlying cause of **Hirschsprung disease**, where there is an absence of ganglion cells in the distal colon.
- This typically presents with **constipation**, abdominal distension, and failure to pass meconium, rather than projectile vomiting, and usually affects the large intestine.
Female reproductive histology US Medical PG Question 9: A 32-year-old woman presents with amenorrhea and galactorrhea. MRI shows a pituitary adenoma. Histological examination of the surgical specimen shows cells arranged in cords and nests with sinusoidal capillaries. Special staining reveals three distinct cell types: chromophobes (50%), acidophils (40%), and basophils (10%). Immunohistochemistry shows the tumor cells staining strongly for prolactin. Evaluate the relationship between normal pituitary architecture and tumor development to determine which cell type most likely gave rise to this neoplasm.
- A. Somatotrophs (acidophils producing growth hormone)
- B. Lactotrophs (acidophils producing prolactin) (Correct Answer)
- C. Corticotrophs (basophils producing ACTH)
- D. Gonadotrophs (basophils producing FSH/LH)
- E. Chromophobes (null cells with no secretory granules)
Female reproductive histology Explanation: ***Lactotrophs (acidophils producing prolactin)***
- These cells are classified as **acidophils** based on their staining characteristics and are responsible for the secretion of **prolactin**, consistent with the patient's **amenorrhea** and **galactorrhea**.
- Although the tumor specimen contains various cell types, the **immunohistostaining** specifically identifying **prolactin** confirms these cells as the source of the neoplasm.
*Somatotrophs (acidophils producing growth hormone)*
- While these are also **acidophilic** cells, they secrete **Growth Hormone (GH)**, and a tumor of this type would present with **acromegaly** or gigantism rather than galactorrhea.
- They do not typically stain for **prolactin**, unless the tumor is a rare plurihormonal adenoma, which is not indicated here.
*Corticotrophs (basophils producing ACTH)*
- These cells are **basophils** and produce **ACTH**; an adenoma arising from them would lead to **Cushing's disease** due to hypercortisolism.
- Histologically, they would not correspond to the strong **prolactin** staining observed in this immunohistochemical evaluation.
*Gonadotrophs (basophils producing FSH/LH)*
- These are **basophilic** cells that produce **FSH** and **LH**, and tumors originating from them are usually non-functional or present with mass effects rather than hormonal excess.
- They are clinically and histologically distinct from **prolactin-producing** lactotrophs.
*Chromophobes (null cells with no secretory granules)*
- **Chromophobes** lack significant cytoplasmic staining due to a lack of hormone granules; they often represent cells that have depleted their secretory stores.
- While they occupy 50% of the specimen, the **strong prolactin staining** identifies the active neoplastic process as originating from the hormone-producing lineage.
Female reproductive histology US Medical PG Question 10: A 65-year-old man with progressive shortness of breath undergoes transbronchial biopsy. Microscopy shows thickened alveolar septa with increased collagen deposition. Type I pneumocytes are decreased, and there is proliferation of type II pneumocytes. Alveolar macrophages are present. The patient has a history of environmental asbestos exposure 30 years ago. Evaluate the histological progression and synthesize the most likely diagnosis considering the temporal relationship and cellular changes.
- A. Chronic hypersensitivity pneumonitis with granulomas
- B. Idiopathic pulmonary fibrosis with usual interstitial pneumonia pattern
- C. Asbestosis with interstitial fibrosis and ferruginous bodies (Correct Answer)
- D. Sarcoidosis with non-caseating granulomas
- E. Acute respiratory distress syndrome with diffuse alveolar damage
Female reproductive histology Explanation: ***Asbestosis with interstitial fibrosis and ferruginous bodies***
- The histological findings of **thickened alveolar septa**, **type I pneumocyte loss**, and **type II pneumocyte hyperplasia** characterize chronic **interstitial fibrosis** consistent with **asbestosis** in the context of exposure.
- Asbestos fibers are ingested by **alveolar macrophages**, triggering a fibrogenic response that typically manifests after a **latency period** of 20 to 30 years.
*Chronic hypersensitivity pneumonitis with granulomas*
- This condition is an immunologic reaction to inhaled organic antigens, characterized by **poorly formed non-caseating granulomas**.
- While it causes **interstitial fibrosis**, it lacks the specific association with **asbestos exposure** and the long-term temporal progression described.
*Idiopathic pulmonary fibrosis with usual interstitial pneumonia pattern*
- **IPF** presents with a **Usual Interstitial Pneumonia (UIP)** pattern, featuring **fibroblastic foci** and **honeycombing** with temporal heterogeneity.
- While similar in appearance, this diagnosis is reserved for cases of **unknown etiology** where occupational exposures like asbestos are absent.
*Sarcoidosis with non-caseating granulomas*
- **Sarcoidosis** typically presents with **well-formed non-caseating granulomas** distributed along **lymphatic pathways** and bronchovascular bundles.
- It is a systemic disease that primarily affects **hilar lymph nodes**, which is not the pathology described in this biopsy.
*Acute respiratory distress syndrome with diffuse alveolar damage*
- **ARDS** is characterized by an acute onset with **hyaline membranes** lining the alveolar spaces during the **diffuse alveolar damage (DAD)** phase.
- The scenario describes a **chronic, progressive** clinical course rather than the acute, critical illness seen in respiratory failure.
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