Chapter 23: Benign And Malignant Tumours Of The Uterus And Ovary Flashcards
You are a trainee intern in a general practice with Sefina, a 47 year old para 2 Samoan woman who presents with six months of increasing urinary frequency and nocturia. She is otherwise well. Her periods have not been irregular or become heavier. Contraception is vasectomy. She is due for a smear and her smear history is normal. General examination is normal. On abdominal examination a firm mass about 14/40 size is arising from the pelvis in the midline. On bimanual examination her uterus is bulky and a 14 week size with a smooth outline. Sefina asks you what the mass that you can feel is? Which of the following is the MOST APPROPRIATE response?
A. It is most likely to be fibroids affecting the function of the uterus
B. It is most likely to be a growth on the bladder wall, putting pressure on the bladder
C. It is most likely to be fibroids that are putting pressure on her bladder
D.It is most likely to be fibroids affecting the kidneys
E. It is most likely to be a growth on the ovaries putting pressure on the bladder
C. It is most likely to be fibroids that are putting pressure on her bladder
Kay is a 66 year old nulliparous Pākehā woman who presents to you, as a trainee intern in a general practice, with four episodes of vaginal bleeding in the past 3 months. Each episode is painless, unprovoked, and lasts up to 5 days. Her menopause was 12 years ago and she has not taken any hormone replacement therapy. She has not had a cervical smear for 20 years. Speculum and bimanual examinations are normal and there is some blood at the cervical external os. You take a cervical smear. The smear returns as normal. Which of the following options should be the next investigation arranged?
A. A transvaginal pelvic ultrasound
B. A hysteroscopy
C. A transabdominal pelvic ultrasound
D. An MRI
E. A sonar hysterogram
A. A transvaginal pelvic ultrasound
You are a trainee intern in a gynaecology clinic with Anahera, a 66 year old P3G3 wahine Māori who has been referred because of four episodes of vaginal bleeding in the past 3 months. Each episode was painless, unprovoked, and lasted 5 days. Her menopause was 12 years ago and she has not taken any hormone replacement. A recent cervical smear was normal. A transvaginal ultrasound arranged by the GP showed the uterus had an endometrial thickness of 12 millimetres (normal postmenopausal< 5mm); the ovaries were normal. On speculum examination the cervix was stenosed and a pipelle is unable to be passed. Which of the following is the most appropriate next step in the management?
A. Repeating the cervical smear
B. Reassurance and review with a repeat transvaginal ultrasound in 6 weeks
C. Arranging a hysteroscopy and D and C under general anaesthetic
D. Arranging a total hysterectomy and bilateral salpingo-oophorectomy
E. Prescribing oestrogen cream
C. Arranging a hysteroscopy and D and C under general anaesthetic
You are a trainee intern in a gynaecology clinic with Susie, a 66 year old para 3 Pākehā woman who presented two weeks ago with 3 episodes post-menopausal bleeding. Each episode was painless, unprovoked, and lasted 5 days. Her menopause was 12 years ago and she has not taken any hormone replacement. A cervical smear the GP took was normal. A transvaginal ultrasound prior to referral showed an endometrial thickness of 12 millimetres (normal postmenopausal< 5mm); the uterus was small, and the ovaries were not seen. A Pipelle endometrial biopsy was undertaken two weeks ago and has been reported as a well differentiated endometrial adenocarcinoma. A CXR was clear. Susie has a BMI of 36 but otherwise keeps good health. Which of the following treatment options should be recommended for her by the Gynaecology Oncology MDM?
A. Chemotherapy
B. A vaginal hysterectomy
C. High dose oral progestogen therapy
D. Total hysterectomy and bilateral salpingo-oophorectomy plus or minus pelvic lymph node dissection
E. Pelvic radiation therapy
D. Total hysterectomy and bilateral salpingo-oophorectomy plus or minus pelvic lymph node dissection
You are a trainee intern in a gynaecology ward admitting Ellie, a 24 year old nulliparous Pākehā woman who has presented with 4 hours of acute abdominal pain. The pain came on suddenly when she got out of bed this morning. She describes it as severe and doubles her over. It is worse in her right iliac fossa. Her periods have been normal and her last period was three weeks ago. She had the same pain two weeks ago (but not as severe) when showering, but this episode settled in about ten minutes. On general examination, she is not shocked but is obviously distressed with the pain. She has right iliac fossa tenderness with rebound. A bimanual pelvic examination reveals a right adnexal mass about 8cm in size. Which of the following is the most likely clinical diagnosis?
A. Ovarian torsion
B. Rupture of an ovarian germ cell tumour causing Intraperitoneal haemorrhage
C. Acute appendicitis
D. Rupture of an ovarian epithelial tumour causing Intra-abdominal haemorrhage
E. A ruptured ectopic pregnancy
A. Ovarian torsion
You are a trainee intern in a general practice reviewing Shuko, a 69 year old nulliparous Asian woman who presented three days ago with a 3 month history of lower abdominal swelling. On abdominal examination, a large right non-tender adnexal mass was noted. Shuko had no vaginal bleeding. You are seeing her back with results. The ultrasound shows a cystic and solid 15cm right adnexal mass, and a left ovary that is 5cms in size, and also has cystic and solid features. There was a small amount of free peritoneal fluid. A CA-125 level arranged three days ago is 3875 iu/L (N < 35 iu/L). Which of the following is her most likely diagnosis?
A. Krukenberg tumour
B. Mucinous ovarian cystadenoma
C. Endometrioid adenocarcinoma
D. Granulosa cell tumour
E. Ovarian serous carcinoma
F. Benign cystic teratoma
G. Brenner tumour
E. Ovarian serous carcinoma
You are a trainee intern in a gynaecology clinic seeing Marika, a 30 year old wahine Māori, for a post-operative check. She had a right salpingo-oophorectomy for a 15cm ovarian cyst. Ultrasound had shown it was a solid and cystic mass with areas of calcification. Her Ca l25 was 22 U/ml (N<35). The pathology report reads “Sections show ovary in which there is a multiloculated cyst. The cyst contains sebaceous material and hair. Within the wall are skin, gland and cysts lined by bronchial type epithelium. Also noted is mature glial tissue and bone.” Which of the following is the most likely diagnosis?
A. Mature cystic teratoma (dermoid)
B. Mucinous cyst adenocarcinoma
C. Serous cyst adenoma
D. Low-grade serous cyst adenocarcinoma
E. Malignant teratoma
F. Mucinous cyst adenoma
G. Krukenberg tumour
A. Mature cystic teratoma (dermoid)
You are a trainee intern in a gynaecology acute assessment unit admitting Haeata, a 23 year old Māori woman who has been referred because of four hours of severe left lower abdominal pain four hours that started when she got out of bed. Her periods are irregular and her last period was six weeks ago. She uses condoms for contraception. On examination she is haemodynamically stable and not shocked. There is deep left iliac fossa tenderness but without rebound. Pelvic examination reveals a normal vagina, cervix and uterus. There is tenderness and fullness in the left adnexa. Which of the following is the most important INITIAL diagnostic investigation?
A. Hb and WCC
B. Endometrial biopsy
C. Urinalysis with microscopy
D. Cervical smear
E. Transvaginal ultrasound
F. Urine beta HCG
F. Urine beta HCG
You are a trainee intern in a gynaecology clinic with Heather, a 64 year old nulliparous NZ European woman who has been referred because of lower abdominal discomfort and distension increasing over the last three months. She has a suprapubic swelling arising from the pelvis that is 16/40 pregnancy size. She has not lost any weight. She has had no vaginal bleeding. Menopause was age 55. Her CA125 is 350 (n<35) IU/L. A representative picture from the USS is:
Ultrasound
Which of the following is the most likely diagnosis?
A. A granulosa cell tumour of the ovary
B. A follicular cyst
C. An ovarian teratoma
D. An ovarian serous or mucinous cystadenoma
E. An ovarian serous or mucinous cystadenocarcinoma
E. An ovarian serous or mucinous cystadenocarcinoma
You are a trainee intern in a gynaecology clinic with Ngaio, a 66 year para 4 wahine Māori, who has attended with her whanau. She has been referred because of 3 months of increasing lower abdominal discomfort and distension, and a suprapubic mass arising from the pelvis and equivalent to a 18/40 pregnancy size. She has not lost any weight or had any vaginal bleeding. She had her menopause when aged 56. You arrange a CT scan and a CA125 which suggest the most likely diagnosis is an ovarian carcinoma, with no obvious evidence of metastatic disease. A chest XRay is normal. Which of the following will be the most important in determining the stage of her ovarian cancer?
A. CEA, Ca19-9 and inhibin levels
B. Laparoscopy
C. MRI pelvis and chest
D. BRCA gene testing
E. Laparotomy
E. Laparotomy
