LE3 Gyne Flashcards

Question

1. Which of the following has no risk factor for cancer? A. Simple fibroadenoma B. Complex fibroadenoma C. Duct papilloma D. Atypical lobular hyperplasia

Answer 1

A. Simple fibroadenoma Rationale: Simple fibroadenomas are considered benign with no associated increased risk of breast cancer, whereas complex fibroadenomas, duct papillomas, and atypical lobular hyperplasia are associated with a slightly increased risk of developing breast cancer.

Answer 2

B. Upper outer Rationale: The majority of breast malignancies occur in the upper outer quadrant, which contains the most glandular tissue.

Answer 3

A. It is most clinically important form of mastitis Rationale: Acute mastitis is the most clinically significant form of mastitis and occurs mainly during breastfeeding, often requiring antibiotics for treatment.

Answer 4

B. Duct ectasia Rationale: Duct ectasia is characterized by the dilatation and shortening of the breast duct, often leading to periductal inflammation and sometimes nipple discharge.

Answer 5

B. Fat necrosis Rationale: Fat necrosis commonly results from trauma, such as a seatbelt injury, and can present as a palpable lump in the breast.

Answer 6

B. Fibrocystic disease Rationale: Fibrocystic disease is a non-proliferative condition that often presents with firm, rubbery masses in the breast. These changes are benign and common in reproductive-aged women.

Answer 7

A. Pericanalicular Rationale: Pericanalicular fibroadenomas are characterized by prominent fibrotic stroma, leading to more fibrosis compared to intracanalicular types. The pericanalicular type has more stromal proliferation, whereas the intracanalicular type has less fibrosis and compresses the ductal elements.

Answer 8

A. Duct papilloma Rationale: Duct papilloma, a benign tumor of the breast ducts, may present with serous or bloody nipple discharge.

Answer 9

C. It can only be distinguished by histology Rationale: Phyllodes tumors are a spectrum of fibroepithelial tumors that can be benign, borderline, or malignant. They can only be definitively distinguished from other fibroepithelial lesions by histology.

Answer 10

C. 50-59 Rationale: The peak incidence of breast cancer occurs between the ages of 50-59, with the highest age-specific incidence rate observed in this group.

Answer 11

C. Female undergoing radiotherapy for Hodgkin's disease Rationale: Females are more at risk of breast cancer than males. Additionally, patients who have undergone high-dose radiotherapy for Hodgkin's disease have an increased risk of developing breast cancer, which is higher than that of women taking oral contraceptives or without known risk factors.

Answer 12

B. Cerebrospinal fluid (CSF) Rationale: Common sites of metastasis for breast cancer include the lungs, bones, brain, liver, and skin. The CSF is not a common site for breast cancer metastasis.

Answer 13

B. Invasive lobular carcinoma Rationale: Invasive lobular carcinoma is more likely to present with bilateral and multicentric involvement compared to invasive ductal carcinoma, which is often unilateral. A BI-RADS 4 score indicates suspicion for malignancy, requiring biopsy.

Answer 14

D. A & B Rationale: Breast cancer screening is recommended for women aged 50 and older, as well as those aged 45-49. Routine screening is not typically recommended for women under 40 without known risk factors, as the benefits do not outweigh the risks. However, mammography may be considered for women over 40 based on individual risk assessment and clinical decision.

Answer 15

B. T2 N1 M0 Rationale: A 3 cm tumor falls under T2, and the presence of movable lymph nodes classifies it as N2. Since there is no evidence of metastasis, M0 is used.

Answer 16

C. Needs additional imaging Rationale: A BI-RADS 0 finding means that the imaging is incomplete, and additional imaging is needed to provide a final assessment.

Answer 17

C. Women with clinically involved nodes Rationale: Women with clinically positive nodes usually proceed directly to axillary dissection rather than a biopsy for further evaluation. Lymph node biopsy is indicated for assessment of axillary status in specific situations, such as in tumors greater than 3 cm or multifocal disease.

Answer 18

D. Radical mastectomy Rationale: Radical mastectomy involves the removal of the entire breast, levels I, II, and III of the axillary lymph nodes, and the chest wall muscles beneath the breast.

Answer 19

D. A and B Only Rationale: Adjuvant chemotherapy is recommended for patients with positive margins and those with ≥ 4 positive lymph nodes. T3 and T4 tumors may also benefit from adjuvant chemotherapy, depending on the individual case.

Answer 20

B. 25-35% Rationale: After breast-conserving surgery, the risk of local recurrence is 25-35%, making adjuvant radiotherapy an important component of treatment to reduce this risk.

Answer 21

B. Every 3 months for the 1st year, then six monthly for 5 years, then annual review thereafter Rationale: For patients with primary breast cancer, follow-up should be every 3 months for the first year, every six months for the next five years, and annually thereafter to monitor for recurrence and manage side effects of treatment.

Answer 22

B. (+) Axillary LN Rationale: The involvement of axillary lymph nodes is the most significant prognostic factor for breast cancer, as it correlates with the risk of recurrence and overall survival.

Answer 23

B. It does not go through the basement membrane Rationale: DCIS is a non-invasive form of breast cancer that is confined to the ductal system and does not penetrate the basement membrane, making it an early-stage cancer.

Answer 24

D. A and B only Rationale: Nipple retraction and peau d'orange are classic signs of breast cancer. Nipple retraction occurs when the tumor involves the ducts, while peau d'orange results from obstruction of lymphatic drainage.

Answer 25

A. The cysts are lined with epithelium Rationale: Fibrocystic changes involve cysts that are lined with epithelial cells. These changes are common and benign, particularly in women of reproductive age.

Answer 26

B. Age, gender, and family history in immediate relatives Rationale: Age, female gender, and family history of breast cancer in immediate relatives are key risk factors that have a significant impact on the risk of developing breast cancer.

Answer 27

C. Reassure and observe Rationale: Breast lumps that appear during mid-cycle are often hormonal and benign in nature. Reassurance and observation are appropriate, with further evaluation if the lump persists.

Answer 28

B. Cells arranged in spaces Rationale: Cribriform ductal carcinoma in situ is characterized by cells arranged in well-defined spaces, giving the appearance of "sieve-like" or "cribriform" patterns.

Answer 29

B. Scirrhous Rationale: Scirrhous carcinoma, or invasive ductal carcinoma of no special type, is the most common form of invasive ductal carcinoma. It is characterized by its hard, dense nature due to abundant fibrous stroma.

Answer 30

C. Usually large and frequently benign but also has a malignant variant; excise with a 1-2 cm margin Rationale: Phyllodes tumors are large fibroepithelial lesions that are usually benign but can have malignant variants. They are excised with a margin of 1-2 cm to ensure complete removal.

Answer 31

E. All of the above (AOTA) Rationale: Mammography is capable of detecting non-palpable cancers in up to 50% of cases. Additionally, about one-third of palpable breast cancers may not be detected by mammography, and its sensitivity tends to increase with age due to changes in breast density.

Answer 32

D. A and C only Rationale: Nulliparity and a high-fat, high-calorie diet are associated with an increased risk of developing breast cancer. Oophorectomy before the age of 35 actually decreases the risk due to reduced hormone exposure.

Answer 33

B. Axillary lymph node dissection is not necessary for malignant cystosarcoma phyllodes Rationale: Axillary lymph node dissection is generally not necessary for phyllodes tumors, even if they are malignant, as these tumors rarely spread to the lymph nodes.

Answer 34

D. A and C only Rationale: Clustered microcalcifications are often indicative of early carcinoma and require localization excision for definitive diagnosis. Intense interlobular fibrosis and epithelial proliferation may also suggest carcinoma.

Answer 35

A. The standard treatment is subcutaneous mastectomy Rationale: Subcutaneous mastectomy is the standard treatment for persistent or symptomatic gynecomastia, particularly when it is resistant to other therapies.

Answer 36

C. Complete excision with a 1 cm margin Rationale: A mole that bleeds is suspicious for malignancy, and complete excision with an appropriate margin is necessary to ensure complete removal and to obtain a definitive diagnosis.

Answer 37

B. Melanoma Rationale: Melanoma is the malignant counterpart of a nevus, arising from melanocytes and presenting a risk of metastasis if not diagnosed early.

Answer 38

B. Asymmetry Rationale: Asymmetry is a concerning feature of a nevus and may indicate malignant transformation. Other warning signs include irregular borders, varied colors, and a diameter larger than 6 mm.

Answer 39

A. Vulvar fibroma Rationale: Vulvar fibroma is a benign, solid, pedunculated mass. The appropriate treatment is surgical excision with histopathological examination to confirm the diagnosis.

Answer 40

C. Excise and send for biopsy Rationale: Treatment for a vulvar fibroma is surgical excision. The tissue should be sent for biopsy to confirm the diagnosis and rule out malignancy.

Answer 41

D. Compression and ice pack Rationale: A small hematoma can often be managed conservatively with compression and ice packs to reduce swelling and prevent expansion. Surgery or drainage may be needed for larger or expanding hematomas.

Answer 42

D. Contact dermatitis Rationale: The patient's symptoms are consistent with contact dermatitis, possibly triggered by the use of a new fabric softener. This condition can cause irritation, inflammation, and a leathery appearance of the vulva if exposure continues.

Answer 43

B. Topical or systemic steroids Rationale: The treatment for contact dermatitis includes topical or systemic steroids to reduce inflammation and itching. This helps break the itch-scratch cycle and prevents further skin damage.

Answer 44

C. Posterior fornix Rationale: The posterior fornix is the most common site for post-coital laceration due to its vulnerability during intercourse.

Answer 45

B. Suture the laceration under anesthesia Rationale: The appropriate management for a laceration in the posterior fornix is to suture it under anesthesia to control the bleeding and promote healing.

Answer 46

C. Cervical stenosis Rationale: The combination of amenorrhea, a palpable hypogastric mass, and a negative pregnancy test suggests cervical stenosis. This condition can lead to the accumulation of menstrual blood, causing a mass effect.

Answer 47

B. Transvaginal ultrasound Rationale: A transvaginal ultrasound is the most appropriate initial diagnostic procedure to evaluate a pelvic mass and confirm the presence of cervical stenosis.

Answer 48

B. Cervical dilation Rationale: The treatment for cervical stenosis involves cervical dilation to relieve the obstruction and allow normal flow of menstrual blood.

Answer 49

B. Imperforate hymen Rationale: At puberty, an imperforate hymen may present with a bulging mass seen at the vaginal introitus. The mass is caused by hematocolpos, which gives a dark or bluish hue. The presence of primary amenorrhea and a bulging mass is indicative of imperforate hymen.

Answer 50

C. Advise surgery to relieve the obstruction Rationale: The treatment for an imperforate hymen is to surgically incise the hymen to relieve the obstruction and allow drainage of the accumulated menstrual blood (hematocolpos).

Answer 51

C. Smoking Rationale: Leiomyomas are associated with family history, early menarche, and obesity. Smoking is not considered a risk factor for leiomyomas and, in fact, has been found to have an inverse relationship with the development of fibroids.

Answer 52

B. Most myomas begin as intramural myoma Rationale: Leiomyomas, also known as fibroids, most commonly start as intramural myomas, which grow within the muscular wall of the uterus. They may later extend to become submucosal or subserosal.

Answer 53

D. Endometrioma Rationale: Endometriomas are ovarian cysts caused by endometriosis, typically located in the ovaries rather than the uterus. The other conditions listed involve the uterus and could present with similar symptoms.

Answer 54

C. Myoma with carneous degeneration Rationale: Carneous degeneration (or red degeneration) is a type of myoma degeneration that is common in pregnancy due to the increased vascularity of the uterus and can lead to an enlarged uterus.

Answer 55

C. Abnormal microvascular pattern and function of the vessels of the endometrium Rationale: The abnormal microvascular pattern and function of the endometrial vessels are responsible for the abnormal uterine bleeding commonly associated with leiomyomas.

Answer 56

D. Leiomyosarcoma Rationale: Rapid enlargement of the uterus in a postmenopausal woman with multiple myomas raises suspicion for leiomyosarcoma, a rare but aggressive form of cancer.

Answer 57

C. Total hysterectomy and bilateral salpingo-oophorectomy (THBSO) Rationale: Due to the suspicion of malignancy (leiomyosarcoma), the recommended management is THBSO to remove the uterus, fallopian tubes, and ovaries for complete treatment.

Answer 58

B. Myomectomy Rationale: For a woman of reproductive age with a large intramural myoma who desires future fertility, the appropriate management is myomectomy to remove the fibroid while preserving the uterus.

Answer 59

C. Myomectomy Rationale: Myomectomy is indicated for a patient with a symptomatic large intramural myoma who has not completed childbearing. The indications include persistent abnormal bleeding, pain, and a myoma larger than 8 cm. Contraindications for myomectomy include pregnancy, advanced adnexal disease, malignancy, and when enucleation would leave a non-functional uterus.

Answer 60

B. GnRH agonist Rationale: GnRH agonists, such as leuprolide acetate, are used to reduce the size of the myoma and relieve symptoms. This approach is especially useful in patients who decline surgical management or wish to delay surgery.

Answer 61

B. Adenomyosis Rationale: Adenomyosis is characterized by an enlarged, globular uterus and heavy menstrual bleeding. It occurs due to the presence of endometrial tissue within the myometrium, leading to diffuse enlargement.

Answer 62

E. All of the above (AOTA) Rationale: During mastectomy, the surgical plane involves multiple anatomical landmarks, including the costocoracoid fascia, the latissimus dorsi, and the rectus abdominis muscles, which are relevant for adequate resection and proper anatomical orientation.

Answer 63

B. Ovarian torsion Rationale: Ovarian torsion often occurs in the presence of an ovarian mass, such as a dermoid cyst, and typically presents with sudden severe pain. Pediatric and adolescent patients are at increased risk due to longer ovarian ligaments.

Answer 64

C. Untwist then cystectomy Rationale: Management of ovarian torsion includes conservative untwisting of the torsed ovary and preservation of the adnexa. If a mass is present, cystectomy can be performed.

Answer 65

C. Surgery is considered if the cyst is complex, >5 cm, and abnormal CA-125 Rationale: For perimenopausal or postmenopausal women, the risk of malignancy is higher, especially with complex cysts greater than 5 cm or abnormal CA-125 levels. Therefore, surgical management should be considered.

Answer 66

D. Ruptured corpus luteum Rationale: A ruptured corpus luteum is a common cause of acute pelvic pain in reproductive-aged women, particularly during the luteal phase of the menstrual cycle. The patient's presentation of severe pain with a history of missed menses is consistent with this diagnosis.

Answer 67

B. Plateau phase Rationale: During the plateau phase of the sexual response cycle, sustained engorgement of the areola and breast tissue occurs. This phase follows the initial excitement phase and precedes orgasm.

Answer 68

D. Resolution phase Rationale: During the resolution phase, there is a gradual loss of muscle tension, relaxation, and return to the unexcited state. Blood vessels open to drain the engorged pelvic and genital regions, marking the end of the physiological sexual response.

Answer 69

C. Orgasm phase Rationale: The orgasm phase is characterized by the release of accumulated tension, resulting in a pleasurable and highly gratifying experience. It is the culmination of the physical and emotional aspects of sexual arousal.

Answer 70

C. Orgasm phase Rationale: The orgasm phase involves rhythmic contractions of the pelvic voluntary muscles, which occur in both males and females, contributing to the intense sensations experienced during orgasm.

Answer 71

A. Excitement phase Rationale: During the excitement phase, muscle tension increases in both males and females as the body becomes physiologically aroused in response to sexual stimulation. This heightened state of arousal prepares the body for the plateau and orgasm phases.

Answer 72

B. Plateau phase Rationale: During the plateau phase, heart rate, respiratory rate, and blood pressure increase as sexual arousal is sustained and intensified. These physiological changes prepare the body for the orgasm phase.

Answer 73

D. Resolution phase Rationale: The resolution phase is marked by a sense of well-being, relaxation, and often fatigue. This phase follows the orgasm and allows the body to return to its baseline state.

Answer 74

A. Excitement phase Rationale: The excitement phase is characterized by initial sexual arousal, leading to erection in males and an upward movement of the testicles. This phase also involves vasocongestion and increased muscle tension.

Answer 75

C. Orgasm phase Rationale: The orgasm phase is marked by rhythmic contractions of pelvic muscles, muscle spasms in other parts of the body (such as the feet), and ejaculation in males. It is the peak of the sexual response cycle.

Answer 76

A. Excitement phase Rationale: During the excitement phase, there is increased blood flow to the genital area, causing dilation of the vaginal canal and production of lubrication in preparation for intercourse.

Answer 77

B. Plateau phase Rationale: In the plateau phase, the areola swells and the breasts become engorged due to increased blood flow, further enhancing sexual arousal.

Answer 78

B. Plateau phase Rationale: The plateau phase is marked by sustained engorgement of the genitals, increased muscle tension, and elevated vital signs, preparing the body for the peak of sexual arousal—the orgasm phase.

Answer 79

A. Excitement phase Rationale: During the excitement phase, increased blood flow can lead to a flushed appearance of the skin, often referred to as the "sex flush," which is an early sign of physiological arousal.

Answer 80

B. Plateau phase Rationale: During the plateau phase, the clitoris becomes highly sensitive as sexual arousal intensifies. This increased sensitivity helps prepare for orgasm.

Answer 81

A. Sexual desire Rationale: Sexual desire refers to the interest or motivation to engage in sexual activity. In the absence of sexual activity, an individual may still experience desire but may not be engaging in sexual behavior.

Answer 82

B. Sexual arousal Rationale: Sexual arousal disorder involves the persistent or recurrent inability to achieve or maintain sufficient lubrication or swelling during sexual activity. It can be influenced by psychological factors such as guilt, anxiety, and fear.

Answer 83

B. Sexual arousal Rationale: The inability to have vaginal lubrication is a hallmark of female sexual arousal disorder, which affects the excitement phase of the sexual response cycle.

Answer 84

C. Orgasm Rationale: Rapid ejaculation is related to the orgasm phase and is often referred to as premature ejaculation, which occurs sooner than desired during sexual activity.

Answer 85

B. Sexual arousal Rationale: Erectile dysfunction is an arousal disorder, where a male has difficulty attaining or maintaining an erection sufficient for sexual activity.

Answer 86

B. Sexual arousal Rationale: Impotence, or erectile dysfunction, is a form of sexual arousal disorder in males, affecting the ability to achieve or maintain an erection.

Answer 87

D. Sexual pain Rationale: Dyspareunia is the medical term for persistent or recurrent genital pain associated with sexual intercourse, categorized as a sexual pain disorder.

Answer 88

D. Sexual pain Rationale: Dyspareunia is a type of sexual pain disorder that causes genital pain before, during, or after sexual intercourse.

Answer 89

A. Sexual desire Rationale: Sexual aversion is related to a loss of desire, where an individual may have diminished or absent sexual interest, sometimes accompanied by an aversion to sexual activities.

Answer 90

D. Sexual pain Rationale: Vaginismus is an involuntary spasm of the vaginal muscles in response to attempted penetration, causing pain and preventing sexual intercourse. It is categorized as a sexual pain disorder.

Answer 91

C. Orgasm Rationale: This condition is associated with the orgasm phase, where ejaculation occurs but with reduced or absent pleasure, such as in retrograde ejaculation. It is a disorder related to the orgasmic phase of the sexual response cycle.

Answer 92

B. Wellness Rationale: Sexual activity can be an indicator of overall wellness, contributing to physical, emotional, and mental health, and can serve as a marker for an individual's well-being.

Answer 93

B. Self-validation Rationale: Self-validation is related to the process by which individuals affirm and accept their identity, including gender identity as a man or woman.

Answer 94

A. Procreation Rationale: Procreation is the primary biological function of sexual activity that ensures the survival of the species by facilitating reproduction.

Answer 95

A. Pleasure Rationale: Sensitivity to touch, especially in erogenous zones, is associated with the sensation of pleasure, an important aspect of sexual response.

Answer 96

A. Intimacy Rationale: A sexual relationship often involves intimacy, characterized by emotional closeness, trust, and bonding between partners.

Answer 97

B. Female Rationale: Women are often whole-body oriented in their sexual response, experiencing pleasure from touching across the entire body, rather than being solely focused on genital stimulation as men often are.

Answer 98

A. Aversion Rationale: Loss of sexual desire can manifest as aversion, where individuals experience diminished or absent desire, and in some cases, a negative response to sexual stimuli.

Answer 99

B. Male Rationale: Men are often conditioned to focus on genital stimulation during sexual activity, whereas women tend to be more whole-body oriented in their response.

Answer 100

C. Sexuality Rationale: Sexuality encompasses the totality of being male or female, including physical, biological, psychological, sociological, and ethical dimensions of an individual's identity and relationships.

Answer 101

B. Vaginismus Rationale: Vaginismus is a condition characterized by involuntary spasms of the pelvic floor muscles, causing pain and preventing vaginal penetration, often resulting from anxiety or fear of penetration.