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L3 (1ST BMEX) > GYNE2 > Flashcards

GYNE2 Flashcards

1
Q

The area of the cervix where dysplasia and cancer can be found

A. Squamocolumnar junction
B. Transformation zone
C. Ectocervix
D. Endocervix

A

B. Transformation zone

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2
Q

Staging of cervical cancer involves

A. clinical staging
B. surgical staging
C. clinical + sonologic findings
D. clinical and surgical staging

A

A. clinical staging

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3
Q

A patient diagnosed with Cervical Ca St 1B1 underwent radical hysterectomy. Intraoperatively, some of the lymph nodes are already involved and positive for metastases. What is the stage of the patient post op?

A. 1B1
B. IIB
C. IIIB
D. IVA

A

A. 1B1

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4
Q

Considered as the mainstay of treatment for cervical cancer because it can be done to all stages

A. Surgery
B. Chemotherapy
C. Radiotherapy
D. Chemoradiation

A

C. Radiotherapy

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5
Q

Which of the following is essential for the diagnosis of cervical cancer?

A. CT scan of the whole abdomen
B. MRI of the pelvis
C. Lymphangiography
D. Cervical punch biopsy

A

D. Cervical punch biopsy

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6
Q

Which of the following is not a requirement for the diagnosis of cervical cancer?

A. Fine needle aspiration of scan detected suspicious lymph nodes
B. Pelvic exam including rectovaginal exam
C. Cervical punch biopsy
D. Colposcopy

A

A. Fine needle aspiration of scan detected suspicious lymph nodes

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7
Q

Tumor dissemination in cervical cancer is dependent on

A. immune status of an individual
B. invasiveness of the local lesion
C. involvement of lymphatics
D. type of cancer

A

B. invasiveness of the local lesion

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8
Q

Post-coital bleeding for 3 months’ duration. Pelvic exam: fungating friable mass 5x4 cm on 3 to 5 o’clock position. Rectovaginal exam: nodular parametria extended to the pelvic wall

A. 1B2
B. IIB
C. IIIB
D. IVA

A

C. IIIB

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9
Q

Treatment of choice for cervical cancer stage IIA1

A. Radical hysterectomy alone
B. Total hysterectomy with or without bilateral salpingo-oophorectomy
C. Chemotherapy
D. Radical hysterectomy with pelvic and paraaortic node dissection

A

D. Radical hysterectomy with pelvic and paraaortic node dissection

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10
Q

Concurrent chemoradiation of cervical cancer causes which type of electrolyte abnormality?

A. Hypermagnesemia
B. Hypercalcemia
C. Hypokalemia
D. Anemia

A

C. Hypokalemia

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11
Q

A patient with cervical CA underwent radiation. Which of the following is not a major sequela of radiation?

A. Vaginal stenosis
B. Small bowel obstruction
C. Malabsorption
D. Steatorrhea

A

D. Steatorrhea

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12
Q

Which of the following is not a poor prognosis of a cervical cancer patient?

A. Lymph node metastases
B. Endometrial invasion
C. Stromal invasion of less than 1/3
D. Positive line for surgical resection

A

C. Stromal invasion of less than 1/3

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13
Q

Which of the following HPV types is closely associated with CIN 2&3?

A. HPV 45
B. HPV 35
C. HPV 11
D. HPV 40

A

A. HPV 45

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14
Q

Which of the following HPV proteins inactivates p53 cell regulation proteins?

A. E2
B. E4
C. E6
D. E7

A

C. E6

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15
Q

M.R., a 45yo undergone hysterectomy for pelvic endometriosis. The most appropriate cervical screening test for her is

A. Pap smear
B. VIA
C. HPV DNA
D. No screening test

A

D. No screening test

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16
Q

JT, a 30-year-old G7P6, separated from her husband and now living with her second partner who is a widower and whose wife died from cervical cancer. She then should ideally undergo cervical cancer screening

A. every two years
B. every 3 years
C. every year
D. every 5 years

A

D. every 5 years

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17
Q

Considered a late symptom of cervical cancer

A. Hypogastric pain and dysuria
B. Foul vaginal discharge
C. Postcoital bleeding
D. Abnormal vaginal bleeding

A

B. Foul vaginal discharge

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18
Q

Which of the following examinations can investigate metastasis?

A. Bimanual pelvic exam
B. Colposcopy
C. Pap smear
D. Cystoscopy

A

A. Bimanual pelvic exam

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19
Q

Upon pelvic examination, a 6-cm necrotic fungating mass occupying the lower lip of the cervix, uterus was not enlarged, adnexae had no palpable mass and parametria were smooth. This is a case of cervical cancer

A. 1A1
B. 1A2
C. 1B1
D. 1B2

A

D. 1B2

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20
Q

Surgery is indicated up to which stage of cervical cancer?

A. Stage 1A2
B. Stage 1B1
C. Stage 2A1
D. Stage 2A2

A

C. Stage 2A1

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21
Q

Which is considered a postoperative complication of radical surgery for cervical cancer?

A. Urinary dysfunction
B. Anesthetic complications
C. Hemorrhage Intraoperative complication D. Transfusion reaction

A

A. Urinary dysfunction

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22
Q

Which of the following infections is a risk factor for cervical cancer?

A. Gonorrhea
B. Trichomoniasis
C. Chlamydia trachomatis
D. Syphilis

A

C. Chlamydia trachomatis

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23
Q

Long term use of OCP is considered a risk factor for cervical cancer. Which hormone is responsible?

A. Progesterone
B. Progestins
C. Estradiol
D. Norethisterone

A

C. Estradiol

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24
Q

The mechanism of cigarette smoking in cervical carcinoma

A. Increasing Langerhans cell
B. Direct mutagenic effect on the cervical epithelium
C. Reduction of blood folate levels
D. Increasing immunity against HPV

A

B. Direct mutagenic effect on the cervical epithelium

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25
Q

When should screening for cervical cancer be discontinued?

A. Once menopaused
B. 3 consecutive negative Pap smears in a 50 years old, sexually active, cervix
C. Age ≥ 70 years old with intact cervix plus ≥ 3 consecutive normal smears
D. No abnormal cytology within 5 years prior to the age of 70

A

C. Age ≥ 70 years old with intact cervix plus ≥ 3
consecutive normal smears

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26
Q

Which of the following poses the greatest risk in the development of endometrial cancer?

A. Nulliparity
B. Obesity
C. Late onset of menopause
D. Use of OCP

A

B. Obesity

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27
Q

In the prevention of endometrial cancer, the best option is

A. serial pelvic ultrasound
B. use of combined oral contraceptives
C. weight reduction and maintenance
D. endometrial sampling

A

B. use of combined oral contraceptives

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28
Q

Breast cancer patients are commonly put on tamoxifen therapy. What is the best means to monitor these patients and prevent endometrial malignancy?

A

None

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29
Q

Which of the following manifestations is the most common in endometrial CA?

A. Postcoital bleeding
B. Bloating
C. Postmenopausal bleeding
D. Pelvic pain

A

C. Postmenopausal bleeding

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30
Q

The gold standard for the endometrial CA with focal lesions <50% involvement of the myometrium

A. Transvaginal ultrasound
B. Fractional curettage
C. Hysteroscopic guided endometrial biopsy
D. Endometrial biopsy

A

C. Hysteroscopic guided endometrial biopsy

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31
Q

Stage of endometrial CA where there is already vaginal/parametrial involvement

A. Stage 1B
B. Stage 2
C. Stage 3
D. Stage 3B

A

D. Stage 3B

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32
Q

Screening test for endometrial cancer

A. Endometrial biopsy
B. Pap smear
C. No screening test
D. Ultrasound

A

C. No screening test

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33
Q

A postmenopausal of 5 years came in for vaginal spotting for 3 days. Ultrasound of the pelvis was requested. What level of endometrial thickness is normal in this case?

A. 8 mm
B. 4 mm
C. 10 mm
D. 6 mm

A

B. 4 mm

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34
Q

Which of the following should an endometrial biopsy be done?

A. Breast cancer patient not on tamoxifen
B. Abnormal uterine bleeding for patients >35yo
C. Massive obesity
D. On OCP

A

B. Abnormal uterine bleeding for patients >35yo

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35
Q

Which of the following is a late sign of endometrial cancer?

A. Abnormal vaginal discharge
B. Abnormal vaginal bleeding
C. Leg edema
D. Urinary symptoms

A

D. Urinary symptoms

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36
Q

Clinical diagnosis of endometrial cancer involves

A. clinical evaluation
B. surgical findings
C. clinical and surgical findings
D. clinical and histopath findings

A

B. surgical findings

37
Q

Clinical staging for endometrial cancer is only important in this aspect

A. Preparation for surgery
B. Postoperative assessment
C. Evaluation of metastasis
D. Outcome of surgery

A

C. Evaluation of metastasis

38
Q

A 45-year-old came in for abnormal vaginal bleeding. Endometrial biopsy revealed endometrial cancer. What should be the next step done to the patient?

A. Determine extent of the disease
B. Determine the prognosis
C. Determine immune status of the patient
D. Determine the suitability of radiotherapy

A

A. Determine extent of the disease

39
Q

A 58-year-old nulliparous came in for vaginal spotting for 5 days. TVS revealed a thickened endometrium of 25 mm. What is the next step in managing the patient?

A. TAHBSO
B. Fractional curettage
C. Endometrial biopsy
D. Bilateral pelvic examination

A

A. TAHBSO

40
Q

A 49-year-old, G0 came in for vaginal bleeding of 3 months’ duration. She had her menopause 2 years ago. Ultrasound noted thickened endometrium 20 mm. Intraoperatively, a thickened endometrium was noted with a necrotic mass occupying more than 1/2 of the myometrium at 9-12 o’clock position. What is the indication for lymphadenectomy in this case?

A. Cervical involvement
B. Grossly positive pelvic nodes
C. Lower uterine segment involvement
D. Tumor with full thickness of the myometrium invasion

A

D. Tumor with full thickness of the myometrium invasion

41
Q

Which type of endometrial CA has a poorer prognosis?

A. Type I
B. Type II
C. Type III
D. Type IV

A

B. Type II

42
Q

Factors not included in the management of endometrial cancer

A. Presence of cytologic atypia
B. Wish for future childbearing
C. Comorbidities
D. Hormone receptivity of tumor

A

D. Hormone receptivity of tumor

43
Q

A G3P3 (3002) had vaginal spotting for 5 months and underwent endometrial biopsy which showed simple hyperplasia without atypia. Which of the following is not part of the treatment goals for this case?

A. Stop progression to invasive ca
B. Reversion to normal endometrial function
C. Complete clearance of disease
D. Prevent hysterectomy

A

D. Prevent hysterectomy

44
Q

Which of the following types of endometrial CA is aggressive in nature, poor prognosis, and Psammoma bodies are seen?

A. Papillary serous
B. Mucinous
C. Endometroid
D. Clear bodies

A

A. Papillary serous

45
Q

Which of the following variables is significant for the survival of endometrial cancer?

A. Histologic grade
B. Stage
C. Tumor grade
D. Depth of endometrial invasion

A

B. Stage

46
Q

Type of endometrial CA whose cells have a hobnail configuration arranged in papillae with hyalinized stalks

A. Serous
B. Mucinoid
C. Endometrioid
D. Clear cell

A

D. Clear cell

47
Q

Which of the following variables is strongly associated with prognosis of endometrial cancer?

A. Histologic grade
B. Stage
C. Tumor grade
D. Depth of endometrial invasion

A

A. Histologic grade

48
Q

The risk of carcinoma in patients whose biopsy revealed complex hyperplasia with atypia

A. 1%
B. 29%
C. 3%
D. 8%

A

B. 29%

49
Q

What is the endometrial cancer stage where the paraaortic nodes were positive but the pelvic nodes were negative?

A. Stage 3A
B. Stage 3B
C. Stage 3C1
D. Stage 3C2

A

D. Stage 3C2

50
Q

Which of the lymphatic drainage sites in endometrial carcinoma is/are most important clinically?

A. Vaginal
B. Femoral
C. Inguinal
D. Pelvic/Paraaortic

A

D. Pelvic/Paraaortic

51
Q

Which of the following is the current recommendation for screening for cervical cancer?

A. Co-testing
B. Pap smear
C. Liquid-based cytology
D. Primary HPV Test

A

D. Primary HPV Test

52
Q

Rose, a 26-year-old, G1P1, diagnosed with Carcinoma in situ of the cervix is best managed by:

A. Cryosurgery
B. Conization
C. Electrocautery
D. Hysterectomy

A

B. Conization

53
Q

The most common mode of spread of squamous cell carcinoma of the cervix.

A. Hematogenous
B. Vertical spread
C. Horizontal spread
D. Direct local invasion

A

D. Direct local invasion

54
Q

Which is not considered as primary prevention for cervical carcinoma?

A. Screening with pap smear
B. HPV Vaccination
C. Lifetime monogamy
D. Abstinence

A

A. Screening with pap smear

55
Q

In pregnant patients with premalignant condition of the cervix, which is not acceptable?

A. Endocervical curettage
B. Immediate colposcopy
C. Observe
D. Defer colposcopy after 6 weeks AOG.

A

A. Endocervical curettage

56
Q

Which of the following procedures does not affect the FIGO staging of endometrial cancer?

A. Infracolic omentectomy
B. Hysterectomy
C. Lymph node dissection
D. Peritoneal cytology

A

D. Peritoneal cytology

57
Q

A 30-year-old, G1P1 came in for pap smear. She had her last pap smear (conventional cytology) last January which was negative for intraepithelial lesion and malignancy. She was so anxious because her friend died of cervical cancer. What is the next best step?

A. Repeat conventional cytology.
B. Do liquid-based cytology.
C. Reassure the patient.
D. Do co-testing.

A

C. Reassure the patient.

58
Q

Which of the following management should be considered as the first line of management of cases of non- atypical hyperplasia?

A. LNG IUS
B. Endometrial ablation
C. Endometrial curettage
D. Hysterectomy

A

A. LNG IUS

59
Q

The mainstay in the management of invasive cervical cancer is:

A. Radiotherapy
B. Chemoradiotherapy
C. Surgery
D. Neoadjuvant chemotherapy

A

A. Radiotherapy

60
Q

Grade 1 nuclear grading or differentiation of endometrial carcinoma will show these characteristics:

A. Large, pleomorphic nuclei, coarse chromatin, large irregular nucleoli
B. Irregular, oval nuclei, chromatin clumping, moderate sized nucleoli
C. Small pyknotic nuclei
D. Round to oval nuclei, even distribution of chromatin, inconspicuous nucleoli

A

D. Round to oval nuclei, even distribution of chromatin, inconspicuous nucleoli

61
Q

A 40-year-old G2P2 (2002) came in due to postcoital bleeding of 6 months duration. Pelvic exam revealed a 2 cm lesion at the anterior lip of the cervix which bleeds to touch. Sidewalls are free of lesion. What is the stage of the disease?

A. Carcinoma in situ
B. Stage IB
C. Stage IIA
D. Stage IIB

A

B. Stage IB

62
Q

Type of endometrial carcinoma associated with hyperestrogenism.

A. Associated with P53 hyperexpression
B. Show aggressive clinical course
C. Associated with poor histologic type
D. Tends to be well differentiated endometrioid type

A

D. Tends to be well differentiated endometrioid type

63
Q

What is the gold standard for diagnostic evaluation of post-menopausal women with abnormal uterine bleeding in whom endometrial hyperplasia or carcinoma is a possibility?

A. MRI
B. Transvaginal ultrasound
C. Hysterectomy
D. Endometrial sampling

A

D. Endometrial sampling

64
Q

FIGO Stage II Endometrial Cancer is defined as:

A. Tumor extends outside the pelvis or involves the bladder or rectum.
B. Tumor invades cervical stroma, but not beyond the uterus.
C. Tumor confined to the corpus uteri
D. Tumor extends outside the uterus but not outside
the pelvis.

A

B. Tumor invades cervical stroma, but not beyond the uterus.

65
Q

This is the most dependent variable associated with survival for cervical CA.

A. Lymph node status
B. Depth of invasion
C. Paracervical tissue involvement
D. Tumor size

A

A. Lymph node status

66
Q

Very effective in reversing endometrial hyperplasia.

A. Testosterone
B. Estrogen
C. Progesterone
D. Androgen

A

C. Progesterone

67
Q

A 42-year-old G1P1 (1001) came in with a histopath result of endometrioid adenocarcinoma. The tumor was confined within the endometrium. Bilateral adnexae, peritoneal fluid cytology, lymph nodes were negative for malignancy. What is the stage of the disease?

A. II
B. IB
C. IA
D. IIIA

A

C. IA

68
Q

The stage of endometrial cancer where radiotherapy is used as an initial treatment.

A. 3 and 4
B. 2,3,4
C. 4 only
D. All stages

A

D. All stages

69
Q

The most frequent cause of death from cervical carcinoma is:

A. Hemorrhage
B. Infection
C. Uremia
D. Distant metastases

A

C. Uremia

70
Q

When compared to squamous cell carcinoma, adenocarcinoma of the cervix has this characteristic:

A. More common
B. More frequently found in young women
C. Less apt to be cured by radiation therapy
D. Has better cure rate than operation

A

C. Less apt to be cured by radiation therapy

71
Q

Which of the following immunohistochemical stain when positive will indicate that the tumor is primarily cervical in origin?

A. p16
B. Progesterone receptors
C. Vimentin
D. Estrogen receptors

A

A. p16

72
Q

The adjuvant treatment in endometrial cancer is commonly based on which of these prognostic factors?

A. Stage, age of patient, tumor grade, LVSI
B. Stage, size, uterine depth, LVSI
C. Stage, age of patient, uterine depth, residual
disease
D. Stage, comorbidities, tumor grade, size of tumor

A

A. Stage, age of patient, tumor grade, LVSI

73
Q

The most common complication of radiation therapy for cervical cancer.

A. Vaginal stenosis
B. Bone marrow suppression
C. Urinary fistula
D. Diarrhea

A

D. Diarrhea

74
Q

Backache or pain of sciatic distribution is due to:

A. Lumbar metastasis
B. Effect of the irradiation therapy
C. Bone metastasis
D. Invasion of the sacral plexus by the tumor

A

D. Invasion of the sacral plexus by the tumor

75
Q

A tumor marker that will differentiate between an endocervical and endometrioid pattern of adenocarcinoma of the cervix.

A. CA 125
B. Carcinoembryonic antigens
C. DNA Polymerase
D. AFP

A

B. Carcinoembryonic antigens

76
Q

How is the diagnosis of endometrial carcinoma established?

A. Endometrial biopsy
B. Laparoscopy
C. History of postmenopausal bleeding
D. Thickened endometrium by TVS

A

A. Endometrial biopsy

77
Q

Which of the following is considered as a normal colposcopic finding?

A. Mosaicism at the endocervical canal
B. Corkscrew appearance of blood vessels on green filter
C. Acetowhitening extending into the cervix
D. Uptake of lugols Iodine

A

D. Uptake of lugols Iodine

78
Q

In endometrial hyperplasia, the most important determinant of malignant potential is:

A. Mitotic rate
B. Cellular atypia
C. Grading
D. Obesity

A

B. Cellular atypia

79
Q

In patients with abnormal uterine bleeding secondary to hyperplasia who were treated with progesterone, when is the best time to repeat the biopsy?

A. 3 months
B. 5 months
C. 6 months
D. 4 months

A

A. 3 months

80
Q

Postmenopausal women with abnormal uterine bleeding should have a:

A. Endometrial biopsy
B. Thyroid panel
C. Total hysterectomy
D. Pregnancy test

A

A. Endometrial biopsy

81
Q

Histologic features of koilocytosis signifies:

A. Malignancy
B. HPV cytopathic effect
C. Inflammation
D. Normal findings

A

B. HPV cytopathic effect

82
Q

Progestin therapy in endometrial hyperplasia is BEST administered through what route?

A. Intrauterine
B. Intramuscular
C. Intravenous
D. Oral

A

A. Intrauterine

83
Q

Endometrial carcinoma is least likely if the endometrial thickness is less than:

A. 10 mm
B. 4 mm
C. 6 mm
D. 8 mm

A

B. 4 mm

84
Q

A 45-year-old, G1P1 patient stands 5 feet and weighs 200 lbs. complains of menometrorrhagia. She has history of diabetes and hypertension. What type of malignancy is associated with her profile?

A. Ovarian
B. Endometrial
C. Tubal
D. Cervical

A

B. Endometrial

85
Q

A 52-year-old, obese, hypertensive and diabetic woman has a poorly differentiated endometrial carcinoma. Uterine cavity measures 10 cm in depth and the endocervix has stromal invasion of endometrial carcinoma. No other structure is involved. What is the stage of her disease?

A

Stage II

86
Q

A pregnant woman has invasive cervical cancer. Which of the following is true?

A. The tumor is apt to recur in the site of episiotomy.
B. Birth through the cancerous cervix markedly improves the prognosis.
C. Stage for stage and survival is the same as in non- pregnant.

A

C. Stage for stage and survival is the same as in non- pregnant.

87
Q

In cancer of the cervix in pregnancy, therapeutic decisions are based on the following except

A. Wishes of the mother
B. Duration of the pregnancy
C. Decision of the oncologist
D. Stage of the cancer

A

C. Decision of the oncologist

88
Q

Schiller’s test is used for:

A. Tubal patency
B. Cervical cancer screening
C. Endometrial status evaluation
D. Cervical mucus examination

A

B. Cervical cancer screening

89
Q

A 53 year old G7P7 (7007) consulted due to fish – wash vaginal discharge and on and off vaginal bleeding. Pelvic exam showed the cervix to be converted to a 6x5 cm nodular, fungating mass extending to the right lateral fornix, the right parametria nodular and fixed while the left was free. Based on the information given, this patient can be clinically staged as:

A

IIIB

L3 (1ST BMEX) (18 decks)

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