510 Obstetrics and Gynecology Board Review •••
❍ What is Gardnerella and what is its importance in the female genital tract?
It is a small gram-negative rod that can cause vaginitis and is associated with “clue cells” that are epithelial cells
covered by bacteria.
❍ What is the best preparation by which one can demonstrate Trichomonas vaginalis at the time of pelvic
examination?
The use of a wet mount is ideal because one can see the flagellated and motile organism swimming in the saline
after direct application to the slide from a sampling of the cervix.
❍ What is uterus didelphys?
This is a congenital abnormality whereby the patient has a double uterus accompanied by a septate or double
vagina as a result of lack of complete fusion of the Müllerian ducts.
❍ In a setting of chronic cervicitis, you note a prominent plasma cell infiltrate and distinct germinal center
formation. What organism should you suspect most strongly as the etiologic agent?
Chlamydia trachomatis.
❍ What organism should you suspect in a case of chronic cervicitis where there is significant epithelial
spongiosis (intraepithelial edema)?
Trichomonas vaginalis.
❍ In the pathogenesis of cervical cancer in relation to HPV, what does the E7 viral oncogene do?
The E7 protein binds to the retinoblastoma gene and displaces some normal transcription factors. This affects
normal cell cycle regulation and likely plays a role in the development of carcinoma.
❍ Is there a uniform progression in cervical squamous cell carcinoma from cervical intraepithelial neoplasia
(CIN) I to CIN III and subsequent invasive squamous cell carcinoma?
No. Some lesions clearly do not arise from CIN I. As stated before, the majority of lesions never progress at all.
❍ How commonly do patients with CIN III who have been treated progress to invasive squamous cell
carcinoma?
About 1 in 500.
❍ At what age are you most likely to find a patient with anovulatory cycles?
They occur most commonly at menarche and in perimenopausal women.
❍ What are the most common sites of endometriosis?
(1) Ovaries.
(2) Uterine ligaments.
(3) Rectovaginal septum.
(4) Pelvis.
(5) Previous laparotomy scars.
(6) Umbilicus, vagina, vulva, and appendix.