Case study

General Instructions: Choose the letter of the correct answer and also provide an explanation to
justify your answer. Please cite your references. Please avoid copy pasting your explanations
from the internet as it will be only a guide in justifying your answer. Try to construct your own
sentences.

1. A 33-year-old woman with an average menstrual cycle of 28 days comes in for a routine
Pap smear. It has been 35 days since the start of her last menstrual period, and a
vaginal smear reveals clumps of basophilic cells. As her physician you suspect which of
the following?

a. She will begin menstruating in a few days.

b. She will ovulate within a few days.
c. Her serum progesterone levels will be found to be very low.
d. There will be detectable levels of human choriogonadotropin (hCG) in her serum
and urine.
e. She is undergoing early menopause.

ANSWER:

D. Since there is a delay in her menstruation and the presence of basophilic cells
in a vaginal smear are evident, then the patient is probably pregnant. Having basophilic
cells in a vaginal smear with the pap-staining method means both progesterone and
estrogen are present. In that case, there will be detectable levels of human chorionic
gonadotropin in her serum and urine because hCG is a hormone that supports the
normal development of an egg in a woman’s ovary. It is produced by the cells that
surrounds a growing embryo.

2. A 17-year-old girl with a history of pelvic inflammatory disease presents at the

emergency department with severe pain in her lower right side that came on fairly
quickly. Upon questioning she replies that her last menstrual period was 6 weeks ago
and that she has never missed a period before. The doctor suspects she has an ectopic
pregnancy and this are quickly confirmed by ultrasound testing. The surgeon removes
her right uterine tube which is inflamed, scarified, and contains the implanted embryonic
tissue in the region where fertilization normally occurs. Where is this?

a. The uterine part of the oviduct

b. The ampulla region with highly folded mucosa
c. The only oviduct region attached to the mesosalpinx
d. The infundibulum region with fimbriae
e. The isthmus region

ANSWER:

B. The patient suffered pain in her lower right side and is suspected having
ectopic pregnancy. The region where the surgeon removed the inflamed right uterine
tube that contains the implanted tissue is in the ampulla region with highly folded
mucosa. The ampulla region is where fertilization and early cleavage of the fertilized
ovum normally occurs and is most often the site for ectopic implantation.
 3. A 42-year-old woman visits her physician complaining of recurrent vaginal yeast
infections. The doctor explains the likelihood that the woman’s vaginal lining is
temporarily out of proper acid-base balance, leading to the increased susceptibility to
yeast infections. The normally low pH in the vagina is maintained by which of the
following?

a. A proton pump in the epithelial cells similar to that in osteoclasts and parietal
cells
b. Secretions derived from intracellular carbonic acid
c. Secretion of lactic acid by cells of the stratified squamous epithelium
d. Bacterial metabolism of glycogen to produce an organic acid
e. Synthesis and accumulation of acid hydrolases in the epithelium

ANSWER:

D. The normally low pH in a woman’s vagina is maintained by bacterial

metabolism of glycogen to produce an organic acid. The vagina normally has a healthy
balance of yeast and bacteria. Estrogen is a hormone that helps lactobacilli to grow.
Lactobacillus is the most common normal bacterial flora which secretes hydrogen
peroxide and convert sugars to lactic acid and maintain a vaginal pH of 3.8 – 4.2. But if
there is something wrong with the balance, a fungus called candida will grow out of
control and cause yeast infection. A higher vaginal pH level will give a perfect
environment for unhealthy bacteria to live and grow. It will only put you at risk of various
infections such as vaginal yeast infection and may cause fishy odor with an unusual
gray, white, or yellow vaginal discharge. Proper acid-base balance is important.

References:

A.Carretero, ... M. Navarro, in Morphological Mouse Phenotyping, 2017

Blostein F, et al. Recurrent vulvovaginal candidiasis. Annals of Epidemiology.

2017;27:575

Kelli L. Boyd, ... Katherine N. Gibson-Corley, in Comparative Anatomy and Histology

(Second Edition), 2018

Vaginal yeast infections. Office on Women’s Health. https://www.womenshealth.gov/a-z-

topics/vaginal-yeast-infections. Accessed Aug. 26, 2018.

Zer Vue, ... Richard R. Behringer, in Encyclopedia of Reproduction (Second Edition),

2018