Welcome to MedSmarter’s USMLE Style Question Break Down of the Week. For those preparing for the USMLE Step 1, this week we break down a high-yield Microbiology question. As always you want to begin by reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 30-year-old Female visits her physician with complaints of vaginal bleeding after sexual intercourse. She started menses at age 13 years and has 34-day cycles. She has had unprotected sex with multiple partners after becoming sexually active at age 19. She also states that she did not receive normal childhood vaccinations, as her parents didn’t believe in them. Cytologic Specimens are taken from the cervix and vagina. On microscopy, cervical cells have mitotic figures. What would most likely be present in the specimens that account for these findings?
A) Double-stranded DNA virus
B) Gram-nagative diplococci
C) Gram-positive cocci
D) Single-stranded RNA
E) Squamous calls covered with bacteria
The correct answer choice is A. The presence of mitotic figures in cervical cells suggests active cell division, which can be a result of a malignant transformation of normal cells. The large nuclei with open chromatin also indicate an abnormality in the cells. Given that the patient has a history of unprotected sex with multiple partners and did not receive normal childhood vaccinations, it is likely that the patient has an HPV infection. HPV is a double-stranded DNA virus that is known to cause cervical cancer in women. Therefore, the most likely cause of the abnormal cells seen in the cytologic specimens is an HPV infection.
Did you think the answer was different?
Did you think that the correct answer choice was other than A? You can view this video for a deeper discussion of why B, C, D, and E are not the correct answer choices.
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