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MCQ revision Kira > GONC > Flashcards

GONC Flashcards

1
Q

All of the following statements about ovarian thecomata are correct EXCEPT that ovarian thecomata

a. have a recognised association with endometrial hyperplasia.
b. are characteristically unilateral.
c. characteristically occur before puberty.
d. may present with virilising symptoms.
e. are typically benign.

A

c. characteristically occur before puberty.

O

Classified as sex cord-stromal
10% are androgenic

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2
Q

A 59 yo lady with a 6cm ovarian mass. What is the probability of malignancy?

A - 15%
B - 30%
C - 45%
D - 60%
E - 80%
A

A - 15%

*CHECK

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3
Q

16 yo girl presents with pelvic discomfort and a complex cystic mass was found on US. At laparotomy, an immature teratoma was found in the right ovary. Most appropriate Mx:

a - RSO
b - R ovarian cystectomy
c - R ovarian cystectomy & wedge biopsy of L ovary
d - TAH, BSO omentectomy
e - RSO & wedge biopsy of L ovary
A

a - RSO

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4
Q

What percentage of benign mucinous tumour that are bilateral?

A

<5%

Less than serous cystadenoma (20-25%)

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5
Q

During surgery on an 11yo girl, a stage 1A grade 1 10cm malignant (immature) teratoma is found in the left ovary. Initial therapy should include

a. LSO
b. BSO
c. TAH, BSO, omentectomy, post operative irradiation
d. TAH, BSO, omentectomy, post operative chemotherapy

A

a. LSO

O

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6
Q

Current knowledge about HPV indicates that

a. HPV DNA sequences are found in most SCC’s of the vulva and cervix
b. HPV replication in the cytoplasm causes the koilocytic cell
c. Dysplasia associated with HPV infection is not a ‘true’ precursor of cancer
d. HPV16 is generally associated with benign condylomas

A

a. HPV DNA sequences are found in most SCC’s of the vulva and cervix

O

HPV replication occurs in the nucleus

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7
Q

Intraoperative findings that are indications for abandoning radical hysterectomy for cervical cancer include all of the following EXCEPT

a. Stage 2A disease with a unilateral 30mm diameter ovarian cyst
b. Intraperitoneal metastasis
c. Parametrial/pelvic side wall disease
d. Unresectable pelvic nodal disease

A

a. Stage 2A disease with a unilateral 30mm diameter ovarian cyst

O

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8
Q

A 28yo woman has USO for a germ cell tumour and completed chemo 6 months ago. She wants to get pregnant. You advise her

a. She has a high risk of malformation because of the chemo
b. She should wait until the effects of the chemo on the residual ovary wear off
c. She is unlikely to be ever able to conceive as the chemo usually causes ovarian failure
d. The chemotherapy used has a variable effect on reproductive function
e. Every pregnancy should be checked out wither with CVS or amniocentesis

A

d. The chemotherapy used has a variable effect on reproductive function

O

BEP chemotherapy

  • Bleomycin
  • Etoposide
  • Cisplatin (P for platinum)
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9
Q

Which statement regarding Adenocarcinoma In Situ is LEAST correct

a. HPV type 18 is the most commonly associated serotype
b. Cone biopsy with clear margins carries >20% chance of disease above the cervical canal
c. ‘Skip lesions’ are uncommon relative to squamous carcinoma in situ
d. Extrafascial simple hysterectomy is optimal treatment if childbearing complete

A

c. ‘Skip lesions’ are uncommon relative to squamous carcinoma in situ

O

HPV 18 accounts 50% of adenocarcinoma (c.f. 15% of SCC)

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10
Q

Endodermal sinus tumours of the ovary (Yolk sac tumours) are characteristically associated with elevated levels of

a. Alpha fetoprotein
b. Beta HCG
c. Carcinoembryonic antigen (CEA)
d. CA125

A

a. Alpha fetoprotein

O

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11
Q

Which of the following statements is least correct?

a. The lifetime risk of breast cancer is approximately 9%
b. The lifetime risk of breast cancer is approximately 50% in BRCA1 and BRCA2 gene carriers
c. Hereditary non polyposis colorectal cancer (HNPCC) is associated with an increased risk of endometrial cancer
d. Hereditary non polyposis colorectal cancer (HNPCC) is associated with an increased risk of ovarian cancer

A

b. The lifetime risk of breast cancer is approximately 50% in BRCA1 and BRCA2 gene carriers

O
BRCA1 80%
BRCA2 50%

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12
Q

Advantages of surgery over radiation therapy for cervical cancer include all of the following EXCEPT:

a. Emotional satisfaction that the tumour has been removed
b. Higher cure rate
c. Accuracy of surgical staging
d. Preservation of the ovaries
e. Complications are more readily corrected

A

b. Higher cure rate

O

https://pubmed.ncbi.nlm.nih.gov/2289354/

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13
Q

A 27yo presents with acute virilisation and normal pelvic examination. Investigations show serum LH = 2 [4-25], FSH = 3 [3-25], 17-OH progesterone = 2.9 [<5.5], testosterone = 8.9 [0.5-2.5], DHEAS = 5.3 [0.9-11.7]. Which is the MOST LIKELY diagnosis?

a. PCOS with insulin resistance
b. Sertoli Leydig cell tumour
c. Adrenal cortical adenoma
d. Cushing syndrome
e. Late onset Congenital adrenal hyperplasia

A

b. Sertoli Leydig cell tumour

Pure sertoli cells only produce oestrogen (+/- renin)
- Can be a/w HTN, hypokalaemia
Pure leydig cells are androgen secreting

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14
Q

Each of the following is an ovarian germ cell neoplasm except for

a. Gonadoblastoma
b. Gynandroblastoma
c. Embryonal carcinoma
d. Endodermal sinus tumour
e. Polyembryoma

A

b. Gynandroblastoma

O

Gynandroblastoma is a subtype of ovarian sex cord-stromal tumor and is usually observed in young women

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15
Q

The primary group of lymph nodes that drain the vulva are the

a. Deep inguinal
b. Superficial inguinal
c. Deep femoral
d. Obturator

A

b. Superficial inguinal

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16
Q

A woman diagnosed with endometrial cancer gives a family history of her father and paternal grandmother having bowel cancer, and paternal uncle having bowel and renal cancer. Genetic studies should be carried out looking for evidence of which gene mutation?

a. C-myc gene
b. BRCA-2 gene
c. HNPCC gene
d. P53 gene (Li Fraumeni) gene mutation

A

c. HNPCC gene

O

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17
Q

Which of the following is the most likely source of metastasis to the ovary?

a. Thyroid
b. Pancreas
c. Lung
d. Breast
e. Kidney

A

d. Breast

O

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18
Q

A 36yo woman is referred for persistent intermenstrual and post coital bleeding over 6 months. A PAP smear done by her GP is reported as LSIL with numerous inflammatory cells present. Speculum examination shows a friable fungating mass 2cm in diameter on the posterior lip of the cervix. There is no evidence of extension into the parametrium or uterosacral ligaments and the uterus is normal sized and mobile. The MOST APPROPRIATE investigation is

a. Examination under anaesthesia
b. Colposcopy and punch biopsy
c. Cone biopsy
d. Intravenous pyelogram

A

b. Colposcopy and punch biopsy

O

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19
Q

Which ONE of the following is the optimal therapy for persistent non metastatic gestational trophoblastic neoplasia in a 26yo nulliparous woman?

a. Multiagent chemotherapy
b. Single agent chemotherapy
c. Prophylactic cerebral irradiation
d. Pelvic irradiation
e. Total abdominal hysterectomy

A

b. Single agent chemotherapy

O

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20
Q

The percentage of invasive cervical carcinoma missed on colposcopic examination without biopsy is best estimated at

a. 9%
b. 14%
c. 27%
d. 55%

A

c. 27%

O

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21
Q

Adenocarcinoma of the cervix

a. Is equally as radiosensitive as squamous cell carcinoma
b. Contraindicates ovarian conservation
c. Contraindicates exogenous oestrogen
d. All of the above

A

a. Is equally as radiosensitive as squamous cell carcinoma

O

  • Viral- and immune-mediated, no hormonal effect
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22
Q

Endometrial cystic glandular hyperplasia is most likely to be found in a woman

a. With adenomyosis
b. With Type 2 Diabetes mellitus
c. On combined HRT
d. On biphasic oral contraception
e. On cyclical HRT
f. On Depo Provera

A

b. With Type 2 Diabetes mellitus

O

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23
Q

Which is NOT a risk factor for endometrial cancer?

a. Smoking
b. High animal fat diet
c. Early menarche
d. Late menopause

A

a. Smoking

O

ALL others including high animal fat diet are risk factors. Smoking is protective in post menopausal cancers, not pre menopausal

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24
Q

Which of the following statements regarding cervical dysplasia is LEAST correct?

a. HPV serotypes 16, 18, 45 and 46 are high risk serotypes for progression to invasive cancer
b. HPV serotypes 6, 11, 42, 43 and 44 are low risk serotypes for progression to invasive cancer
c. HPV serotypes 31, 33, 35, 51 and 52 are the serotypes most commonly seen with genital warts
d. First intercourse at a young age, smoking and multiple sexual partners are independent risk factors for progression of dysplasia to invasive cancer

A

c. HPV serotypes 31, 33, 35, 51 and 52 are the serotypes most commonly seen with genital warts

O

Warts: 90% HPV strains 6 and 11 - low risk
(as well as 16, 18, 31, 33, 45, 52, 58)

High-risk HPV - 14 most oncogenic HPV types:
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68

25
Q

Which of the following statements is LEAST correct?

a. The lifetime risk of ovarian cancer is approximately 1%
b. The lifetime risk of ovarian cancer is approximately 50% in BRCA1 gene carriers
c. The lifetime risk of ovarian cancer is approximately 20% in BRCA2 gene carriers
d. The BRCA1 and BRCA2 genes also increase the risk of Fallopian tube cancers
e. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or BRCA2 as primary peritoneal cancer may still occur

A

e. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or BRCA2 as primary peritoneal cancer may still occur

O

26
Q

The primary purpose of administering intracavitary irradiation (pre or post operatively) to a patient with endometrial cancer is to prevent recurrence at the

a. Vaginal cuff
b. Pelvic wall
c. Pelvic peritoneum
d. Pelvic lymph nodes

A

a. Vaginal cuff

O

27
Q

Which one of the following statements concerning pseudo myxoma peritonei is CORRECT? Pseudo myxoma peritonei:

A. requires leakage from a parent cyst for the development of the condition.
B. responds to treatment with alkylating agents.
C. is characteristically associated with intestinal obstruction.
D. responds to treatment with total abdominal irradiation

A

C. is characteristically associated with intestinal obstruction.

O

28
Q

Signet ring cells are characteristic findings in which of the following tumours of the ovary?

A. Brenner tumour
B. Krukenberg tumour
C. Dermoid cyst
D. Endometrioid carcinoma
E. Dysgerminoma
A

B. Krukenberg tumour

O

29
Q

Which of the following is a risk factor for the development of uterine sarcoma?

A. Use of exogenous oestrogens
B. Multiparity
C. Family history
D. Prior pelvic irradiation
E. Multiple sex partners
A

D. Prior pelvic irradiation

O

30
Q

The lifetime risk for ovarian cancer in a woman with one first degree relative with ovarian cancer is about:

A. 0.1%.
B. 1%.
C. 5%.
D. 15%.
E. 25%
A

C. 5%.

O

31
Q

A 55-year-old woman has been treated for stage III ovarian carcinoma by hysterectomy, bilateral salpingo-oophorectomy, and 80% reduction of the tumour mass, followed by multiple-agent chemotherapy. She now has large intra-abdominal masses. Further therapy is not possible. Her terminal state is most likely to be associated with:

A. intestinal obstruction.
B. ureteral obstruction.
C. urinary retention.
D. brain metastases.

A

A. intestinal obstruction.

32
Q

Regarding spread of patterns of cervical cancer, each of the following is a nodal group with primary lymphatic drainage from the cervix except:

a) Paracervical LN
b) Internal iliac LN
c) External iliac LN
d) Obturator LN
e) Inguinofemoral LN

A

e) Inguinofemoral LN

This is primarily vulval drainage

33
Q

A woman with BRCA 1 has breast
cancer and ovarian cancer. What is the histology likely
to show?

A. Progesterone receptor negative breast cancer, mucinous ovarian cancer
B. Progesterone receptor negative breast cancer, serous ovarian cancer
C. Oestrogen receptor positive breast cancer, mucinous ovarian cancer
D. Oestrogen receptor positive breast cancer, serous ovarian cance

A

B. Progesterone receptor negative breast cancer, serous ovarian cancer

E agrees

34
Q

A woman in her 30’s with postcoital and IMB attends her LMO. She is referred to you with a Pap smear
showing CIN2 and many inflammatory cells. On speculum examination she has an exophytic lesion on the posterior lip; the reminder of the examination is unremarkable. Your next step in managements is:

a) colposcopy
b) punch biopsy
c) cone biopsy
d) antibiotics

A

a) colposcopy

35
Q

A 47 y.o. woman with irregular heavy bleeding has a curette. Pathology shows atypical adenomatous
hyperplasia. What is the best treatment?

a) Medroxyprogesterone acetate 100mg IM monthly
b) Total abdominal hysterectomy
c) Non-steroidal anti-inflammatories
d) Hysteroscopy to rule out cancer, then rollerball diathermy
e) Nd-YAG laser endometrial ablation

A

b) Total abdominal hysterectomy

Milford

36
Q

What degree of cervical dysplasia must be treated in pregnancy?

a) HPV
b) CIN2
c) CIN3
d) All of the above
e) None of the above

A

e) None of the above

37
Q

The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is:

a. 1%.
b. 5%.
c. 10%.
d. 15%.
e. 20%.

A

a. 1%.

O

IA1 - (<3mm stromal invasion) incidence of positive LNs is <1%
IA2 - (3-5mm stromal invasion) - 7-8% LN involvement

38
Q

Number of women diagnosed with breast cancer at 35 years

a) 1:3600
b) 1:1400
c) 1:600
d) 1:200.

A

c) 1:600

Milford

*CHECK
Quoted figures are 1:204 chance of being diagnosed in the next 10 years. Not sure what the risk is at this specific age

39
Q

In a patient with ovarian carcinoma and negative 2nd look laparotomy, chance of disease recurrence is

a) 0-20%
b) 20-40%
c) 40-60%
d) 60-80%
e) 80-100%

A

c) 40-60%

* Bryony guessed C but says silly question

40
Q

Which of the following statements is TRUE about endocervical brushes for obtaining cervical cytology?

A. Have been proven to have a higher detection rate of cervical neoplasia than the moistened cotton swab
B. Can be used instead of the spatula
C. Are very effective in obtaining endocervical cellular elements
D. Are recommended for use during pregnancy

A

C. Are very effective in obtaining endocervical cellular elements

O

41
Q

Nipple discharge occurs in approximately what PERCENT of women with breast cancer?

A. 3%
B. 13%
C. 23%
D. 33%
E. 43%
A

A. 3%

O

<5%

42
Q

A 28year old G3P2 woman presents at 16weeks with a threatened miscarriage. On speculum exam there is an obvious carcinoma on the cervix, 3cm in diameter. A biopsy shows poorly differentiated adenocarcinoma. The MOST APPROPRIATE next step is

A. MRI
B. Treatment with radiation therapy
C. Termination of pregnancy then reassessment
D. Conservative management until fetal viability

A

A. MRI

O

Can’t give radiation in pregnancy
EUA is of limited value - go by clinical staging
MRI will determine if chemo required

As long as no nodal or parametrial invasion this would be stage IB2. Must consider TOP (rad hyst with pregnancy in situ <20weeks) vs pregnancy continuation and CS, rad hysterectomy approx 34weeks.

43
Q

Which HPV type is most often associated with invasive cervical carcinoma?

A. 6
B. 11
C. 18
D. 31
E. 35
A

C. 18

O

44
Q

You have just made the diagnosis of atypical endometrial hyperplasia in a 32 year-old woman with PCO who wants to retain her fertility. She is concerned about developing carcinoma. Which of the following is true about this patient’s condition?

a. Her risk of developing cancer approaches 50%
b. If cancer occurs it is likely to be grade 2 or 3
c. If cancer occurs it is likely to be deeply invasive
d. Her risk of cancer will be reduced if she becomes ovulatory

A

d. Her risk of cancer will be reduced if she becomes ovulatory

Milford

45
Q

Endometrial cystic hyperplasia most likely to be associated with?

a. Maturity onset diabetes
b. Adenomyosis
c. Biphasic OCP
d. Combined HRT
e. Tamoxifen

A

e. Tamoxifen

Milford

46
Q

What is next management in 40 year-old P3 who has had a cone biopsy showing 1 mm of invasive ca and clear margins?

a. Nil further
b. Simple TAH
c. Radical hysterectomy
d. TAH/BSO

A

b. Simple TAH

Milford

*CHECK

Stage1A1 cervical cancer - treatment is either cold knife cone or simple hysterectomy. Would says this is adequate treatment…?

47
Q

The following statements about cervical cancer are proven true except?

a. Celibacy protects women from Ca cervix
b. Having a circumcised male partner is protective for the women
c. First intercourse after 27 yrs associated with lower incidence of Ca cx
d. Divorced women have a greater incidence of Ca cx than married women
e. Prostitutes have a higher incidence than a control population

A

d. Divorced women have a greater incidence of Ca cx than married women

Milford

48
Q

A 45 yo woman underwent primary cytoreductive surgery for a stage 3 epithelial ovarian cancer. After 6 courses of cisplatin and cyclophosphamide a second look operation was positive. She developed progressive abdominal disease during second line treatment with intraperitoneal cisplatin and 5FU. Trials of carboplatin and a new drug failed to control her disease. She is admitted in a severely malnourished condition with a small bowel obstruction.
The statement that best reflects the patient’s current management is?

a. Because of her age, she should be urged to undergo a second trial of investigational chemo
b. Home TPN should be instituted as soon as possible
c. Discussion of NFR status should be avoided because emotional trauma may result
d. Relief of pain and vomiting is likely to be this patient’s foremost concern

A

d. Relief of pain and vomiting is likely to be this patient’s foremost concern

Milford

49
Q

Woman with large pelvic mass. Pre op CXR showed no pleural effusion. Operative findings include ascites and bilateral multiloculated 8 cm cystic ovaries. Papillary tumour nodules ranging from 0.5 - 1.5 cm in diameter were present on pelvic peritoneum, small bowel mesentery and serosa and
liver capsule. Microscopic disease in aortic lymph nodes. Cytology of ascites negative.
Stage of ovarian cancer?

a. 2c
b. 3a
c. 3b
d. 3c
e. 4

A

d. 3c

3 as outside pelvis
C as lymph nodes involved even though deposits are <2cm

https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/FIGO-Staging-classification-for-cancer-of-the-ovary,-fallopian-tube,-and-peritoneum.pdf?ext=.pdf

50
Q

Which of the following is a type of epithelial tumour of the ovary?

a. Embryonal cancer
b. Dysgerminoma
c. Endometrioid carcinoma
d. Endometrioma
e. Endodermal sinus tumour

A

c. Endometrioid carcinoma

Milford

51
Q

Ovarian cancer assoc with Peutz-Jegher syndrome?

a. Papillary serous cancer
b. Mucinous
c. Endometrial ca
d. Clear cell ca
e. Sex cord stromal

A

e. Sex cord stromal

Milford

PJS is autosomal dominant

52
Q

Regarding Meigs syndrome

a. It is associated with fibromas > 10 cm
b. Pleural effusions are composed of peritoneal fluid
c. Pleural effusions are more common on the left side

A

a. It is associated with fibromas > 10 cm

Milford

Most commonly with bening ovarian tumors e.g. fibroma. Effusions more common on RIGHT and com

53
Q

Acute left heart failure is most likely to occur with which antineoplastic agent?

a. Vincristine
b. Cisplatin
c. Bleomycin
d. Doxorubicin
e. Cyclophosphamide

A

d. Doxorubicin

Is an anthracycline

Milford

54
Q

60yo woman with PMB and D&C revealed poorly differentiated endometrial adenocarcinoma. Management?

a. Pfannenstiel incision & TAH/BSO
b. Vertical incision & TAH/BSO
c. Vertical incision & Wertheim’s radical hysterectomy
d. Vertical incision & TAH/BSO, PLND
e. Radiotherapy
f. Chemotherapy

A

d. Vertical incision & TAH/BSO, PLND

Milford

55
Q

Which of the following is the commonest tumour of the round ligament?

a. Paramesonephric tumour
b. Mesonephric tumour
c. Leiomyoma
d. Gartner’s duct tumour
e. Metastatic carcinoma

A

c. Leiomyoma

Milford

56
Q

Post-menopausal lady with TAH/BSO for fibroids. On sectioning leiomyosarcomatous change found in one fibroid. Subsequent management?

a. Radioactive gold
b. Watch carefully
c. Pelvic lymphadenectomy
d. Radiotherapy
e. Chemotherapy

A

b. Watch carefully

Milford

If confined to the uterus and had total hysterectomy and tubes/ovaries (if postmenopausal) no need for adjuvant treatment.

57
Q

Metastatic carcinoma of the vagina account for > 50% of cases. The most common primary is from?

a. Ovary
b. Cervix
c. Kidney
d. Endometrium
e. Fallopian tube

A

b. Cervix

Milford

58
Q

Which of the following combinations is correct?

A) Struma Ovari - carcinoid tumour
B) Lymphocystic infiltration and large vacuolated cells - dysgerminoma
C) Leimyosarcoma - 7 mitotic figures / 10 HPF
D) Cystic endometrial hyperplasia - endometrial cancer
E) Sarcoma botryoides - mesonephric duct

A

B) Lymphocystic infiltration and large vacuolated cells - dysgerminoma

MCQ revision Kira (21 decks)

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