B.Pelvic inflammatory disease sive yeast infection E.Tubal pregnancy Ans:E The patient has an ectopic pregnancy.Conditions predisposing to ectopic pregnancy inchude chronic sapingitis which may be caused by gonorrhea,intrauterine tumors and endometriosis.Molar pregnancy or gestationa trophoblastic disease developing outside the uterus is rare.Syphilis is not likely to produce a tubal mass with acute symptoms.Candida produces cervicitis and vaginitis but is rarely invasive or extensive in immunocompetent patients. 7.A 62-year-old obese nulliparous woman had an episode of vaginal bleeding,which produced only about 5 ml of blood.On pelvic examination,there appears to be no enlargement of the uterus,and the cervix appears normal.A Pap smear shows cells consistent with adenocarcinoma.Which of the following conditions is MOST LIKELY to have contributed to the development of this malignancy? A Adenomvosis B.Chronic endometritis Endometrial hyper plasia omavirus infectior E.Use oforal contraceptives Ans:C This patient has endometrial carcinoma. Estrogen stimulation from anovulatory cycles,nulliparity.obesity and exogenous estrogens (in higher amounts than found in birth control pills)give rise to endometrial hyperplasia which can progress to endometrial carcinoma ifestrogen stimulation continues.Atypical endometrial hyperplasia progresses to endometrial cancer in about 25%of cases.Chronic endometritis does not give rise to endometrial cancer,nor does human papilloma virus infection.HPV is associated with cervical squamous carcinoma.Adenomyosis increases the size of the uterus,and is not a risk factor for endometrial carcinoma 005 8.A 22-year-old woman,G2,P 1,is in the early second trimester.She has noted a small amount of vaginal bleeding for the past week and has had marked nausea and vomiting for several weeks.On physical examination,the uterus measures large for dates.Ultrasound shows intrauterine contents with a"snowstorm appearance,"and no fetus is identified.The gross appearance of tissue obtained by dilation and curettage is shown above.Which of the following substances is MOST LIKELY to be increased in the serum? A.Acetylcholinesterase B. Pelvic inflammatory disease C. Syphillis D. Invasive yeast infection E. Tubal pregnancy Ans: E The patient has an ectopic pregnancy. Conditions predisposing to ectopic pregnancy include chronic salpingitis which may be caused by gonorrhea, intrauterine tumors and endometriosis. Molar pregnancy or gestational trophoblastic disease developing outside the uterus is rare. Syphilis is not likely to produce a tubal mass with acute symptoms.Candida produces cervicitis and vaginitis but is rarely invasive or extensive in immunocompetent patients. 7. A 62-year-old obese nulliparous woman had an episode of vaginal bleeding, which produced only about 5 ml. of blood. On pelvic examination, there appears to be no enlargement of the uterus, and the cervix appears normal. A Pap smear shows cells consistent with adenocarcinoma. Which of the following conditions is MOST LIKELY to have contributed to the development of this malignancy? A. Adenomyosis B. Chronic endometritis C. Endometrial hyperplasia D. Human papillomavirus infection E. Use of oral contraceptives Ans: C This patient has endometrial carcinoma. Estrogen stimulation from anovulatory cycles, nulliparity, obesity and exogenous estrogens (in higher amounts than found in birth control pills) give rise to endometrial hyperplasia which can progress to endometrial carcinoma if estrogen stimulation continues. Atypical endometrial hyperplasia progresses to endometrial cancer in about 25% of cases. Chronic endometritis does not give rise to endometrial cancer, nor does human papilloma virus infection. HPV is associated with cervical squamous carcinoma. Adenomyosis increases the size of the uterus, and is not a risk factor for endometrial carcinoma. 8. A 22-year-old woman, G 2, P 1, is in the early second trimester. She has noted a small amount of vaginal bleeding for the past week and has had marked nausea and vomiting for several weeks. On physical examination, the uterus measures large for dates. Ultrasound shows intrauterine contents with a "snowstorm appearance," and no fetus is identified. The gross appearance of tissue obtained by dilation and curettage is shown above. Which of the following substances is MOST LIKELY to be increased in the serum? A. Acetylcholinesterase