USMLE题库Genitourinary11-20.pptx

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USMLE题库Genitourinary11-20

Genitourinary 题库 Q 11 A 25-year-old sexually active woman complains of abnormal vaginal bleeding, nausea and vague abdominal discomfort. Dilation and curettage is performed and material resembling a bunch of grapes is evacuated from the uterus. The level of which of the following hormones should be closely monitored in this patient over the next year? A. Alpha-fetoprotein (AFP) B.Human chorionic gonadotropin (β?-hCG) C. Progesterone D. Lactate dehydrogenase (LDH) E. Estradiol F. Carcinoembryonic antigen (CEA) A 11 Correct answer: B Hydatidiform moles characteristically have the macroscopic appearance of a Ubunch of grapes.11 Hydatidiform moles are the result of trophoblast proliferation. Microscopic examination of a complete mole would reveal large villi with decreased villous blood vessels and proliferation of the villous trophoblastic lining. Fetal tissue is absent. A complete mole will cause vaginal bleeding during the first trimester of pregnancy. The size of uterus may be out of proportion to the gestational age. Some patients have severe nausea and vomiting as the result of increased hCG secretion by the proliferating trophoblast. Excessive hCG also stimulates ovarian growth and can cause the formation of theca-lutein cysts. In the majority of patients with a complete mole, evacuation leads to recovery. In some, however, an invasive mole (penetrates the uterine wall) or choriocarcinoma (malignancy of trophoblastic cells) may develop. An invasive mole would consist of hydropic villi and proliferated trophoblast, while choriocarcinoma would contain atypical cytotrophoblastic and syncytiotrophoblastic cells with foci of hemorrhage and necrosis. Invasive moles and choriocarcinomas can be detected by serial measurements of hCG levels and are treated with chemotherapy. (Choice A) An elevated alpha-fetoprotein (AFP) level in a pregnant woman may suggest the presence of a fetal neural tube defect. Other possible causes of an elevated AFP level include underestimation

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