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Patho OB > GTD > Flashcards

GTD Flashcards

1
Q

question

A

answer

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2
Q

a predominant maternal risk factor for molar pregnancy includes which of the following?

a. Advanced maternalage
b. Prior cesarean delivery
c. Type 2 diabetes mellitus
d. African American ethnicity

A

a. Advanced maternalage

also very young and prior h.mole

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3
Q

which of the following histological changes, as shown here, are characteristic of hydatidiform mole?

a. Chronic villitis and inclusion bodies
b. Cytotrophoblast and syncysiotrophoblast
c. Villous lymphocytic infiltrates and syncytial knots
d. Trophoblast proliferation and villous stromal edema

A

d. Trophoblast proliferation and villous stromal edema

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4
Q

hydatidiform moles are characterized by the lack of/presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of/presence of villi.

A

hydatidiform moles are characterized by the presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of villi.

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5
Q

Partial Mole

Karyotype
Preliminary diagnosis
uterine size

A

Karyotype - 69XXX or 69XXY
Preliminary diagnosis - missed abortion
uterine size - small for dates

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6
Q

Partial Mole

theca-lutein cysts
initial hCG level
rate of subsequent GTN

A

theca-lutein cysts - rare
initial hCG level - <100,000
rate of subsequent GTN - 1-5%

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7
Q

Complete Mole

Karyotype
Preliminary diagnosis
uterine size

A

Karyotype - 46XX
Preliminary diagnosis - molar gestation
uterine size - large for dates

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8
Q

Complete Mole

theca-lutein cysts
initial hCG level
rate of subsequent GTN

A

theca-lutein cysts - 25-30%
initial hCG level - >100,000
rate of subsequent GTN 15-20%

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9
Q

Partial Mole

embryo-fetus
amnion, fetal erythrocytes
villous edema

A

embryo-fetus - often present
amnion, fetal erythrocytes - often present
villous edema - focal

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10
Q

Partial Mole

throphoblastic proliferation
trophoblast atypia
p57 immunostaining

A

throphoblastic proliferation - focal, slight to moderate
trophoblast atypia - mild
p57 immunostaining - positive

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11
Q

Complete Mole

embryo-fetus
amnion, fetal erythrocytes
villous edema

A

embryo-fetus - absent
amnion, fetal erythrocytes - absent
villous edema - widespread

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12
Q

Complete Mole

throphoblastic proliferation
trophoblast atypia
p57 immunostaining

A

throphoblastic proliferation - slight to severe
trophoblast atypia - marked
p57 immunostaining - negative

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13
Q

With regard to molar pregnancies, what does the
term “androgenesis” refer to?

a. Increased placental androgen production
that promotes villous edema
b. Development of a zygote that contains
only maternal chromosomes
c. Increased placental androgen production
the leads to maternal virilization
d. Development of a zygote that contains only paternal chromosomes

A

d. Development of a zygote that contains only paternal chromosomes

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14
Q

Increased serum free thyroxine levels in women with hydatidiform moles stem from increases in which of the following:

A. Maternal estrogen levels
B. Fetal thyroxine production
C. Maternal progesterone levels
D. Maternal B-HCG levels

A

D. Maternal B-HCG levels

thyrotropin-like effects of hCG frequently cause serum free thyroxine (fT4) level to be levated and TSH levels to be decreased

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15
Q

(-) p57 immunostaining

a. incomplete mole
b. complete mole

A

b. complete mole

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16
Q

Triploid diandric monogenome

A. Partial mole
B. Complete mole
C. Invasive mole
D. Choriocarcinoma

A

A. Partial mole

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17
Q

Marked trophoblast atypia

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

B. Complete Mole

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18
Q

As gestation advances, symptoms tend to be more/less pronounced with complete complete mole compared to partial mole

A

As gestation advances, symptoms tend to be MORE pronounced with complete complete mole compared to partial mole

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19
Q

What is the phenomenon called when high serum hCG levels cause a false negative? Why?

A

Hook effect; excessive hCG level oversaturate the assay’s targeting antibody and create a falsely low reading

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20
Q

sonography yields a “snowstorm” appearance

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

B. Complete Mole

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21
Q

sonography yields a thickened, multicystic placenta along with a fetus or at least fetal tissue

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

A. Partial Mole

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22
Q

Sonography yields multi-cystic findings

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

A. Partial Mole

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23
Q

p57 is a nuclear protein whose gene is maternally/paternally imprinted and maternally/paternally expressed

A

p57 is a nuclear protein whose gene is paternally imprinted and maternally expressed

24
Q

In addition to partial moles, what are the two conditions in which p57 is strongly expressed?

A

normal placentas

spontaneous pregnancy losses with hydropic degerneration

25
Q

what is the preferred method of molar evacuation?

A

suction curetage

26
Q

Criteria for diagnosis of gestational trophoblastic neoplasia, which of the ff is included?

A. Rising B-hcg levels
B. Plateued B-hcg levels
C. Persistent high B-hcg levels
D. Aota

A

C. Persistent high B-hcg levels

27
Q

What is the most common finding in GTN?

A

irregular bleeding associated with uterine subinvolution

28
Q

How are placental tumors clinically classified?

A

aggressive invation into the myometrium and propensity to metastasize

29
Q

the diagnosis of gestational trophoblastic neoplasia
typically is determined by which of the following?

a. Histologic tissue evaluation
b. Serum b-hCG levels
c. Physical examination findings
d. CT imaging

A

b. Serum b-hCG levels

30
Q

true evidence-based risks for future pregnancy following treatment of gestational trophoblastic disease include which of the following?

a. Decreased fertility
b. Increased risk of preterm labor
c. Increased risk of placenta accreta
d. Increased risk of a second molar pregnancy

A

d. Increased risk of a second molar pregnancy

31
Q

35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.

how will you manage this case?

a. Hysterectomy
b. Suction curettage
c. Hysterotomy
d. expectant

A

b. Suction curettage

32
Q

35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.

according to the WHO modified prognostic scoring
system that was adapted by the international federation of Gynecology and Obstetrics
(FIGO), what is the score of this patient?

a. 3
b. 4
c. 5
d. 6

A

a. 3

1 - missed abortion
1 - b-hCG 100,000
1 - largest tumor size 4cm

33
Q

What are the parameters for WHO prognostic scoring?

A 
age
antedecent pregnancy
interval after index pregnancy
pretreatment serum b-hCG
largest tumor size
site of metastases
number of metastases
previous failed chemotherapy drugs
34
Q

How do prognostially score age

A

0 - <40

1 - >40

35
Q

How do prognostially score antecedent pregnancy

A

0 - mole
1 - abortion
2 - term

36
Q

How do prognostially score interval after index pregnancy

A

0 - <4 mo
1 - 4-6 mo
2 - 7-12 mo
4 - >12

37
Q

How do prognostially score pretreatment serum b-hCG

A

0 - < 10.3
1 - 10.3 - 10.4
2 - 10.4 - 10.5
4 - > 10.5

38
Q

How do prognostially score largest tumor size

A

0 - <3 cm
1- 3-4 cm
2 - >5cm

39
Q

How do prognostially score site of metasases

A

1 - spleen, kidney
2 - GI
4 - liver, brain

40
Q

How do prognostially score number of metasases

A

1 - 1-4
2 - 5-8
4 - >8

41
Q

How do prognostially score previous failed chemotherapy drugs

A

2 - 1

4 - >2

42
Q

chemotherapeutic agents in the EMA-CO regimen include all EXCEPT which of the following?

a. Methotrexate
b. Etoposide
c. Cisplatin
d. Actinomycin-D

A

c. Cisplatin

EMA-CO
Etoposide
MTX
actinomycin D
Cyclophasphamide
oncovin
43
Q

Factors that predispose patient to trophoblastic neoplasia

A 
. Complete moles
. Older maternal age
. Uterine size large for gestational age
. Theca-lutein cysts >6cm
. Slow decline in b-hCG levels
44
Q

Criteria for diagnosis of gestational trophoblastic neoplasia

A. Rising B-hcg levels
B. Plateued B-hcg levels
C. Persistent high B-hcg levels
D. Aota

A

. Rising B-hcg levels: >10% for 3 weekly consecutive measurements
. Plateued B-hcg levels: ±10% for 4 measurements during a period of 3 weeks or longer
. Persistent high B-hcg levels for 6 months
. Histological criteria for chiriocarcinoma

45
Q

Which is common to follow h. moles and ininvasive moles?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

46
Q

Characterised by extensivei tissue invasion by trophoblas and whole villi, penetration deep into the myometrium, and sometimes peritonum, parametrium or vaginal vault

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

47
Q

Which is locally aggressive but less prone to metastasize?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

48
Q

Most common type of trophoblastic neoplasm to follow a term pergnancy or miscarriage?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

49
Q

Composed of cells reminiscent of early cytrophoblast and syncytiotrophoblast, and contains no villi

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

50
Q

Rapidly growing tumor invades both myometrium and blood vessels to create hemorrhage and necrosis. Tumor spread outward and become visible on the uterine serface as dark, irregular nodules

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

51
Q

Metastases often develop early and are generally blood-borne.

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

52
Q

Often accompanied by ovarian theca-lutein cysts

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

53
Q

tumor arises from intermediate trophoblasts

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

54
Q

Serum b-hCG level may be ony modestly elevated and have high proportion of free b.hCG as a diagnosis

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

55
Q

Resistant to chemotherapy (2)

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

d. epithelioid trophoblastic tumor

56
Q

Preferred treatment is hysterectomy (2)

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

d. epithelioid trophoblastic tumor

57
Q

Develops from chorionic-type intermediate trophoblast

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

d. epithelioid trophoblastic tumor

Patho OB (12 decks)

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