MCQ Quiz: Diseases Exam!

The image provided shows a characteristic finding of Candida spp, which is the presence of pseudohyphae. Candida spp is a common cause of vaginitis and can cause symptoms such as burning sensation on urination, sticky off-white vaginal discharge, erythema, and inflammation of the vulvar area. The use of oral contraceptives and doxycycline can disrupt the normal vaginal flora and predispose to Candida overgrowth. Therefore, Candida spp is the most likely cause of her vaginitis.

Neisseria gonorrhoeae and Chlamydia trachomatis are the two most likely agents to cause Pelvic Inflammatory Disease (PID) in an infected but untreated woman. PID is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. Both Neisseria gonorrhoeae and Chlamydia trachomatis are sexually transmitted infections that can ascend the reproductive tract and cause inflammation and infection in these organs. It is important to diagnose and treat these infections promptly to prevent the development of PID and its associated complications.

The patient's complaint of irregular menstrual cycles, along with the presence of galactorrhea (abnormal lactation), suggests a hormonal imbalance. Elevated prolactin levels can cause disruption of the normal menstrual cycle and lead to irregular periods. Prolactin is a hormone released by the pituitary gland that stimulates milk production in the breasts. When levels are elevated, it can interfere with the normal release of other hormones involved in menstruation. This is a common cause of irregular menstrual cycles in women.

Prostaglandin E2 is the most likely cause of the patient's cervical dilatation. Prostaglandin E2 is known to play a role in cervical ripening and dilation during pregnancy. It helps to soften and thin the cervix, preparing it for labor and delivery. This hormone is produced by the uterus and is responsible for initiating contractions and promoting cervical dilation. Therefore, the presence of prostaglandin E2 can explain the observed cervical dilatation in this patient.

Insulin growth factor 1 (IGF-1) is a hormone that is primarily produced in the liver in response to growth hormone stimulation. It plays a crucial role in fetal growth and development. Elevated levels of IGF-1 can lead to fetal overgrowth, resulting in a large for gestational age baby. This is likely the cause of the woman's fetal overgrowth in this scenario.

Oral contraceptive use does not cause dysmenorrhea because it works by suppressing ovulation and thinning the uterine lining, which can lead to lighter and less painful periods. Dysmenorrhea is typically caused by increased uterine prostaglandins, which cause the uterus to contract and can result in pain during menstruation. Adenomyosis and endometriosis are both conditions that can cause dysmenorrhea due to the presence of abnormal tissue growth in the uterus or outside of it. Cervical stenosis, a condition where the cervix is narrowed or closed, can also cause dysmenorrhea as it can obstruct the flow of menstrual blood.

Combined oral contraceptive pills contain both estrogen and progestin hormones. These hormones work together to suppress the production of androgens, which are responsible for the growth of unwanted hair in polycystic ovarian syndrome (PCOS). By decreasing ovarian androgen synthesis, the pills help to regulate hormone levels and reduce the symptoms of PCOS, including excessive hair growth.

The presence of numerous, loosely arranged cells with a high nuclear-cytoplasmic ratio suggests abnormal cell growth, which is a characteristic of cervical dysplasia. The white epithelium punctuation and mosaic pattern seen on colposcopy are also consistent with cervical dysplasia. Adenocarcinoma of endocervix and clear cell carcinoma are types of cervical cancer, but the given information does not indicate the presence of cancer. Chronic cervicitis is inflammation of the cervix, which may cause some cell changes, but it would not typically present with the specific features mentioned. Herpes simplex virus infection would not cause the cellular changes described.

Inflammatory carcinoma is an aggressive form of breast cancer that is characterized by the invasion of cancer cells into the lymphatic vessels of the skin, leading to the obstruction or plugging of these vessels. This results in the characteristic symptom of redness and swelling of the breast, often resembling an infection or inflammation. Therefore, the correct answer is "Cutaneous lymphatics plugged with tumor cells."

The most suitable contraceptive method for a breastfeeding woman who is 7 days postpartum is a Levonorgestrel-intrauterine device. This method is safe to use while breastfeeding and does not affect the quality or quantity of breast milk. Combined oral contraceptives containing estrogen are not recommended for breastfeeding women as they may decrease milk production. Estrogen patches also contain estrogen and should be avoided. Tubectomy is a permanent surgical method and may not be suitable for someone who wants a reversible form of contraception. Danazol is not a contraceptive method but a medication used to treat certain gynecological conditions.

http://upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Verrucous_carcinoma.jpg/640px-Verrucous_carcinoma.jpg

Verrucous carcinoma is an uncommon variant of squamous cell carcinoma. This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as "Snuff dipper's cancer." It is a diffuse, papillary, non metastasizing, well differentiated, malignant neoplasm of epidermis or oral epithelium. Several subtypes have been described. Most patients with verrucous carcinoma have a good prognosis. Local recurrence is not uncommon, but metastasis to distant parts of the body is rare. Patients with oral verrucous carcinoma may be at greater risk of a second oral squamous cell carcinoma, for which the prognosis is worse.

Genital warts (or Condylomata acuminata, venereal warts, anal warts and anogenital warts) is a highly contagious sexually transmitted disease caused by some sub-types of human papillomavirus (HPV). It is spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Warts are the most easily recognized symptom of genital HPV infection, where types 6 and 11 are responsible for 90% of genital warts cases.

Although it is estimated that only a "small percentage" (between 1% and 5%)of those infected with genital HPV develop genital warts, those infected can still transmit the virus. Other types of HPV also cause cervical cancer and probably most anal cancers, however it is important to underline that the types of HPV that cause the overwhelming majority of genital warts are not the same as those that can potentially increase the risk of genital or anal cancer. HPV prevalence at any one time has been observed in some studies at 27% over all sexually active people, rising to 45% between the ages of 14 and 19.

Dysgerminoma of the ovary and yolk sac tumor are both germ cell tumors that arise from the same embryonic precursor cells. They are both malignant tumors and commonly occur in young women. Both tumors are characterized by the presence of large, uniform cells with clear cytoplasm and prominent nucleoli. They also share similar histological features, such as the presence of Schiller-Duval bodies. Therefore, yolk sac tumor is the most similar to dysgerminoma of the ovary in terms of origin and biology.

Idiopathic hirsutism refers to excessive hair growth in women with normal hormone levels. In this case, the woman has normal levels of testosterone, DHEA-S, and urine 17 ketosteroids and corticosteroids, ruling out other possible causes such as Sertoli-Leydig cell tumor, Thecoma, Granulosa cell tumor, or Cushing syndrome. Therefore, idiopathic hirsutism is the most likely cause of her hirsutism.

The best explanation for the presence of red, patchy, diffuse lesions on the vaginal wall and cervix, along with vaginal adenosis and chronic inflammation, is Mullerian glandular epithelium. Mullerian glandular epithelium refers to the epithelial cells that line the reproductive organs in females, including the vagina and cervix. In this case, the presence of Mullerian glandular epithelium suggests a metaplastic change in the vaginal tissue, which can cause symptoms such as persistent vaginal discharge and dyspareunia. The chronic inflammation seen on histopathologic examination further supports this explanation.

The correct answer is "This lesion is fragile and may bleed." This is because the question mentions that the patient presented with nipple discharge and had a lesion that was excised. Fragility and bleeding are common characteristics of benign lesions, whereas malignant lesions are more likely to be firm and non-bleeding. Therefore, the correct statement suggests that the lesion is benign and further surgery may not be necessary.

The correct answer is follicular cyst. A follicular cyst is a common type of ovarian cyst that forms when a follicle in the ovary fails to rupture and release an egg. It is typically filled with fluid and is usually asymptomatic. In this case, the patient's history of recurrent right lower abdominal pain and the presence of a solitary cystic mass on ultrasound are consistent with a follicular cyst. The absence of calcifications helps to differentiate it from other types of ovarian masses such as serous cystadenoma, mucinous cystadenoma, cystic teratoma, and dysgerminoma.

The woman in question has invasive colon cancer and hundreds of polyps, indicating a high risk for developing other gastrointestinal (GI) malignancies. Therefore, she will continue to require upper GI endoscopy every 2-3 years as part of her medical surveillance evaluations. This is important to detect and monitor for any potential development of malignancies in the upper GI tract, such as gastric or esophageal cancer. The other options listed (annual ophthalmic exam, breast MRI, endometrial biopsy every 2 years, and screening skin exam for melanoma yearly) are not directly related to her condition and do not address the increased risk of GI malignancies.

The patient's statement that "My sister is not at increased risk for breast cancer" should make the counselor most concerned that she does not fully understand the results. This is because the patient's sister, who is 30 years old, may still be at risk for developing breast cancer even if the patient herself tested negative for the BRCA1 and BRCA2 genetic mutations. The counselor should explain that the negative test results only apply to the patient and do not guarantee that her sister is not at increased risk.