LE5 Gyne Flashcards

Question 1

Q

Identify the histologic diagnosis in the provided image (Image 14).
A. Simple hyperplasia with atypia
B. Complex hyperplasia without atypia
C. Endometrial carcinoma
D. Endometrial stromal sarcoma

Answer

A

A. Simple hyperplasia with atypia

🔎 Rationale:

Simple hyperplasia with atypia shows increased gland-to-stroma ratio but retains glandular architecture.
Atypia refers to nuclear changes such as enlarged, irregular nuclei.
Progression risk to endometrial carcinoma is lower than complex hyperplasia with atypia.
📌 Source: Histologic classifications of endometrial hyperplasia

Question 2

Q

Identify the histologic diagnosis in the provided image (Image 15).
A. Complex hyperplasia with atypia
B. Simple hyperplasia without atypia
C. Endometrial carcinoma
D. Endometrial stromal sarcoma

Answer

A

A. Complex hyperplasia with atypia

🔎 Rationale:

Complex hyperplasia with atypia is characterized by irregularly shaped glands with little intervening stroma and nuclear atypia.
It has a high risk of progression to endometrial carcinoma (~29-42%).
📌 Source: Histologic classifications of endometrial hyperplasia

Question 3

Q

Most common high-risk HPV types responsible for cervical cancer are?
A. HPV 11 and HPV 18
B. HPV 6 and HPV 16
C. HPV 16 and HPV 18
D. HPV 31 and HPV 33

Answer

A

C. HPV 16 and HPV 18

📌 Rationale: HPV 16 and 18 are the most oncogenic types and are responsible for most HPV-related cancers. There are about 14 high-risk HPV types, but these two account for the majority of cervical cancer cases. (Document Reference: Cervical Cancer - Pathogenesis section)

Question 4

Q

A small percentage of women infected with HPV will develop cervical cancer within how many years?
A. 5-10 years
B. 10-15 years
C. 15-20 years
D. 20-25 years

Answer

A

C. 15-20 years

📌 Rationale: Persistent HPV infection is a necessary cause of cervical cancer, but it takes 10-20 years to progress in most cases. The progression is faster (as short as 5 years) in immunocompromised individuals, such as those with HIV. (Document Reference: Pathogenesis section - HPV infection remains for 10-20 years before becoming cancer)

Question 5

Q

The most common early symptom of cervical cancer is?
A. Pelvic pain
B. Unusual vaginal discharge
C. Weight loss
D. Lower back pain

Answer

A

B. Unusual vaginal discharge

📌 Rationale: The most common early signs of cervical cancer include abnormal vaginal discharge, abnormal vaginal bleeding, and heavier & longer menstrual cycles. Pelvic pain and weight loss are late-stage symptoms. (Document Reference: Clinical Manifestation section - Early/Past Early Symptoms)

Question 6

Q

Which of the following is TRUE regarding cervical cancer?
A. It is the 2nd most common malignancy in women
B. It is the 3rd most common malignancy among women
C. It is the most common malignancy in women
D. It is the least common gynecologic malignancy

Answer

A

B. It is the 3rd most common malignancy among women

📌 Rationale: Cervical cancer remains the 3rd most common malignancy among women worldwide and the most common gynecologic malignancy. (Document Reference: Epidemiology section, “Cervical cancer remains the 3rd most common malignancy among women and most common gynecologic malignancy.”)

Question 7

Q

Which of the following is NOT a risk factor for cervical cancer?
A. Smoking
B. No Pap smear
C. Nulliparity
D. Early coitarche

Answer

A

C. Nulliparity

📌 Rationale: High parity (multiple childbirths) is a risk factor for cervical cancer because it exposes the transformation zone of the cervix to HPV for an extended period. Nulliparity (having no children) is not a known risk factor. (Document Reference: Risk Factors Table - High Parity is listed as a risk, Nulliparity is NOT mentioned.)

Question 8

Q

A 22-year-old woman comes for cervical cancer screening. What is the recommended test?
A. HPV test
B. HPV + Pap smear
C. Pap smear
D. Acetowhite test

Answer

A

C. Pap smear

📌 Rationale: Women aged 21-29 should undergo Pap smear screening every 3 years. HPV testing is not recommended for women under 30 because HPV infection is common and often transient in this age group. (Document Reference: Screening Guidelines Table - “21-29 y/o → Pap every 3 years”)

Question 9

Q

A 35-year-old woman has a Pap smear result showing HSIL (High-Grade Squamous Intraepithelial Lesion). What is the next best step?
A. Repeat Pap smear after 6 months
B. Cervical biopsy
C. Colposcopy with possible cervical biopsy
D. HPV test

Answer

A

C. Colposcopy with possible cervical biopsy

📌 Rationale: HSIL (CIN 2, 3) is a high-risk precancerous lesion that requires further evaluation with colposcopy and possible biopsy. Pap smear should not be repeated, as HSIL requires immediate follow-up. (Document Reference: Management of Premalignant Lesions Table - HSIL → “Colposcopy with cervical biopsy”)

Question 10

Q

What is the recommended cervical cancer screening method for women aged 30 years and above?
A. Pap smear
B. Pap smear with colposcopy
C. HPV test with Pap smear
D. HPV test with colposcopy

Answer

A

C. HPV test with Pap smear

📌 Rationale: For women aged 30-65, the preferred screening method is co-testing (Pap smear + HPV test every 5 years). If HPV testing is not available, Pap smear alone every 3 years is also acceptable. (Document Reference: Screening Guidelines Table - “30-65 y/o → Pap + HPV every 5 years OR Cytology alone every 3 years”)

Question 11

Q

A woman underwent colposcopy for an abnormal HSIL result. What area should be biopsied?
A. Normal squamous epithelium
B. Acetowhitening area
C. Transformation zone only
D. Any random cervical site

Answer

A

B. Acetowhitening area

📌 Rationale: During colposcopy, acetic acid is applied to the cervix to highlight abnormal cells. Dysplastic cells with large nuclei reflect light and appear white (acetowhite lesions), which should be biopsied. (Document Reference: Colposcopy section - “Acetic acid washes away mucus and highlights abnormal areas by staining them white.”)

Question 12

Q

A 27-year-old HIV-positive woman asks how long she should continue Pap smear screening. What is the correct advice?
A. Every 3 years
B. Every year
C. Throughout her lifetime
D. Stop at age 65 if three negative results are documented

Answer

A

C. Throughout her lifetime

📌 Rationale: HIV-positive women should undergo lifetime cervical cancer screening. They should have Pap smears twice in the first year after HIV diagnosis, then annually if results are normal. This is because HIV leads to immunosuppression, making HPV infection more persistent and increasing cervical cancer risk. (Document Reference: HIV Screening Guidelines - “Screening should continue throughout a woman’s lifetime.”)

Question 13

Q

A woman who was vaccinated for HPV has not had a Pap smear in the past 5 years. What should she do?
A. No screening needed since she is vaccinated
B. Pap smear only
C. Pap smear + HPV test (Co-testing)
D. Colposcopy

Answer

A

C. Pap smear + HPV test (Co-testing)

📌 Rationale: Even if a woman is vaccinated against HPV, she still needs cervical cancer screening. The preferred method for women 30-65 years old is co-testing (Pap smear + HPV test every 5 years). Vaccination does not eliminate the need for screening. (Document Reference: Screening Guidelines Table - “Pap + HPV (co-testing preferred), every 5 years OR Cytology alone every 3 years.”)

Question 14

Q

What is the recommended Pap smear guideline for HIV-positive women?
A. Pap smear every 3 years
B. Pap smear every 5 years
C. Lifetime Pap smear screening
D. Stop at age 65 if negative for the past 10 years

Answer

A

C. Lifetime Pap smear screening

📌 Rationale: HIV-positive women require lifetime cervical cancer screening. Screening should begin within 1 year of first sexual contact or by age 21, whichever comes first. (Document Reference: HIV Screening Guidelines - “Screening should continue throughout a woman’s lifetime.”)

Question 15

Q

A cervical biopsy shows atypical cells with the presence of koilocytes. What is the diagnosis?
A. LSIL (CIN 1)
B. HSIL (CIN 2)
C. HSIL (CIN 3)
D. Invasive Squamous Cell Carcinoma

Answer

A

A. LSIL (CIN 1)

📌 Rationale: Koilocytes are hallmark cells of HPV infection and are commonly seen in Low-Grade Squamous Intraepithelial Lesion (LSIL), also known as CIN 1. CIN 1 is mild dysplasia and often resolves spontaneously but requires follow-up. (Document Reference: Premalignant Lesions Table - “LSIL (CIN 1) is characterized by koilocytosis and mild dysplasia.”)

Question 16

Q

A patient had a Pap smear that revealed HSIL. What is the next step in management?
A. Repeat Pap smear after 6 months
B. Colposcopy only
C. Excisional procedure
D. Watchful waiting

Answer

A

C. Excisional procedure

📌 Rationale: High-Grade Squamous Intraepithelial Lesion (HSIL) requires excisional procedures such as LEEP (Loop Electrosurgical Excision Procedure) or Cold Knife Conization to remove the affected area and prevent progression to invasive carcinoma. (Document Reference: Management of Premalignant Lesions - “HSIL requires excisional procedures.”)

Question 17

Q

What is the most common histologic type of cervical cancer?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Neuroendocrine carcinoma
D. Small cell carcinoma

Answer

A

A. Squamous cell carcinoma

📌 Rationale: Squamous cell carcinoma (SCC) accounts for about 70% of cervical cancer cases. It can be keratinizing or non-keratinizing. The second most common type is adenocarcinoma (25%), which arises from endocervical glandular cells. (Document Reference: Histologic Types - “Most common: Squamous (70%)”)

Question 18

Q

A 38-year-old woman presents with abnormal bleeding and a barrel-shaped cervix. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Endometrial cancer
D. Leiomyosarcoma

Answer

A

B. Adenocarcinoma

📌 Rationale: A barrel-shaped cervix is characteristic of cervical adenocarcinoma. Unlike SCC, adenocarcinoma grows endophytically, meaning it expands inside the cervix, making it harder to detect on physical exam. (Document Reference: Histologic Types - “Adenocarcinoma is often occult and may present as a barrel-shaped cervix.”)

Question 19

Q

A patient undergoing colposcopy is found to have pelvic lymph node involvement. What is the correct FIGO stage?
A. Stage IIIB
B. Stage IIIC1
C. Stage IVA
D. Stage IVB

Answer

A

B. Stage IIIC1

📌 Rationale: Stage IIIC1 indicates pelvic lymph node metastasis without para-aortic node involvement. If para-aortic lymph nodes were involved, it would be Stage IIIC2. (Document Reference: FIGO Staging Table - “IIIC1 = Pelvic lymph node involvement.”)

Question 20

Q

A patient undergoing colposcopy has blood-streaked stool. What is the correct FIGO stage?
A. Stage IIB
B. Stage IIIC2
C. Stage IVA
D. Stage IVB

Answer

A

C. Stage IVA

📌 Rationale: Stage IVA cervical cancer means the tumor has spread to adjacent pelvic organs, such as the bladder or rectum. Blood-streaked stool suggests rectal invasion. If the cancer had spread to distant organs, it would be Stage IVB. (Document Reference: FIGO Staging Table - “IVA = Spread to adjacent pelvic organs.”)

Question 21

Q

What is the treatment of cervical cancer that can be done at all stages?
A. Surgery
B. Concurrent chemoradiation
C. Palliative chemotherapy
D. Radiation therapy alone

Answer

A

B. Concurrent chemoradiation

📌 Rationale: Concurrent chemoradiation (radiation + platinum-based chemotherapy) is the standard treatment for cervical cancer from Stage I to Stage IV. Surgery is usually only an option for very early-stage disease (IA, IB1, IIA1), and even then, concurrent chemoradiation may still be preferred. (Document Reference: Treatment Table - “Concurrent chemoradiation can be done in Stages I-IV.”)

Question 22

Q

What is the definitive management for vulvar intraepithelial neoplasia (VIN)?
A. Topical imiquimod
B. Chemotherapy
C. Surgery
D. Radiation therapy

Answer

A

C. Surgery

📌 Rationale: Surgical excision is the definitive treatment for VIN. While topical treatments like imiquimod can be used for some cases, surgery (wide local excision, skinning vulvectomy) is the gold standard. (Document Reference: VIN Management Table - “Surgical excision is the mainstay of treatment.”)

Question 23

Q

A 55-year-old woman presents with atypical cells involving more than 2/3 of the vaginal epithelium. What is the most likely diagnosis?
A. VAIN 1
B. VAIN 2
C. VAIN 3
D. Vaginal squamous cell carcinoma

Answer

A

C. VAIN 3

📌 Rationale: Vaginal intraepithelial neoplasia (VAIN) is classified based on the extent of epithelial involvement.

VAIN 1 → Involves lower 1/3 of the epithelium
VAIN 2 → Involves 2/3 of the epithelium
VAIN 3 → Involves more than 2/3 of the epithelium and is considered carcinoma in situ. (Document Reference: VAIN Staging Table)

Question 24

Q

Which of the following is NOT a risk factor for vaginal intraepithelial neoplasia (VAIN)?
A. HPV infection
B. Smoking
C. Multiple sexual partners
D. Douching

Answer

A

D. Douching

📌 Rationale: HPV infection, smoking, and multiple sexual partners are established risk factors for VAIN. Douching is NOT a recognized risk factor for VAIN or cervical cancer. (Document Reference: Risk Factors for VAIN - “HPV, smoking, and sexual history are the main risks.”)

Question 25

Q

An 83-year-old patient presents with a dark pigmented lesion on the vulva. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Melanoma
C. Paget’s disease
D. Lichen planus

Answer

A

B. Melanoma

📌 Rationale: Melanoma is the second most common malignant neoplasm of the vulva and often presents as a dark pigmented lesion. It is more common in older patients (age >70) and has a poor prognosis. (Document Reference: Vulvar Cancer - “Melanoma is rare but common in older patients.”)

Question 26

Q

A 65-year-old woman presents with a bulging mass near the vaginal opening. What is the most likely diagnosis?
A. Bartholin’s gland cyst
B. Bartholin’s gland carcinoma
C. Vulvar abscess
D. Lipoma

Answer

A

B. Bartholin’s gland carcinoma

📌 Rationale: Bartholin’s gland cysts are common in younger women, but in postmenopausal women (>60 years old), a mass in this area should raise suspicion for Bartholin’s gland carcinoma. (Document Reference: Bartholin’s Gland Carcinoma - “Any Bartholin’s gland enlargement in postmenopausal women should be considered malignant until proven otherwise.”)

Question 27

Q

Identify the lesion: A soft, non-tender cystic mass near the vaginal opening.

Answer

A

Bartholin’s Gland Cyst

📌 Rationale: Bartholin’s gland cysts are fluid-filled masses located near the vaginal opening. They are usually painless unless infected. (Document Reference: Bartholin’s Gland Cyst - “Painless unless infected.”)

Question 28

Q

Identify the raised pigmented lesion on the vulva.

Answer

A

Melanoma

📌 Rationale: Vulvar melanoma presents as a darkly pigmented, raised lesion, often in elderly patients. It has a poor prognosis due to its aggressive nature. (Document Reference: Melanoma - “Raised pigmented lesion, poor prognosis.”)

Question 29

Q

Vulvar cancer with lymph node involvement is classified as what FIGO stage?
A. Stage II
B. Stage IIIA
C. Stage IIIC
D. Stage IV

Answer

A

C. Stage IIIC

📌 Rationale: Stage IIIC vulvar cancer indicates involvement of lymph nodes, regardless of tumor size. (Document Reference: Vulvar Cancer Staging - “IIIC = Lymph node involvement.”)

Question 30

Q

Which of the following is a method to prevent HPV-related infections?
A. Delaying sexual debut
B. Hormonal contraceptives
C. Avoiding alcohol
D. High parity

Answer

A

A. Delaying sexual debut

📌 Rationale: Delaying first sexual intercourse reduces the risk of early HPV exposure, lowering the chance of developing HPV-related cervical and vaginal neoplasms. (Document Reference: HPV Prevention - “Delaying sexual debut is a key primary prevention method.”)

Question 31

Q

What is the treatment approach for early-stage vulvar cancer?
A. Radical Local Excision
B. Vulvectomy
C. A or B
D. Chemotherapy and Radiation

Answer

A

C. A or B (Radical Local Excision/Vulvectomy)

📌 Rationale: Early-stage vulvar cancer is treated with surgical excision (Radical Local Excision or Vulvectomy). Chemotherapy and radiation are usually reserved for advanced or inoperable cases. (Document Reference: Vulvar Cancer Treatment - “Early-stage disease managed surgically.”)

Question 32

Q

Which of the following is NOT a method of preventing HPV-related infections?
A. HPV vaccination
B. Barrier contraceptive use
C. Regular screening
D. Bilateral Tubal Ligation (BTL)

Answer

A

D. Bilateral Tubal Ligation (BTL)

📌 Rationale: BTL prevents pregnancy but has no effect on HPV infection risk. HPV prevention is achieved through vaccination, safe sexual practices, and screening. (Document Reference: HPV Prevention - “BTL prevents pregnancy, not HPV infections.”)

Question 33

Q

Treatment for early-stage vulvar cancer consists of:
A. Radical Local Excision
B. Vulvectomy
C. A and B
D. Chemotherapy and Radiation

Answer

A

C. A and B (Radical Local Excision and Vulvectomy)

📌 Rationale: Surgical excision is the standard treatment for early-stage vulvar cancer. Advanced cases may require chemotherapy and radiation. (Document Reference: Vulvar Cancer Treatment - “Radical Local Excision and Vulvectomy are standard approaches.”)

Question 34

Q

Ways to prevent HPV-related infections, EXCEPT:
A. Abstinence
B. Pap smear
C. HPV vaccine
D. Tubal Ligation

Answer

A

D. Tubal Ligation

📌 Rationale: Tubal ligation (BTL) is a contraceptive method that prevents pregnancy but does not protect against HPV infection. The best ways to prevent HPV-related infections include:

Abstinence (eliminates exposure to HPV)
HPV Vaccination (protects against high-risk HPV strains)
Regular Pap Smear Screening (detects early pre-cancerous changes but does not prevent HPV itself)

Question 35

Q

A 48-year-old woman presents with post-coital vaginal bleeding and is found to have a cervical exophytic mass. A biopsy confirms cervical cancer, and molecular analysis of the specimen is performed. Which of the following HPV subtypes is most likely to be found?
A. HPV 6 & 11
B. HPV 16 & 18
C. HPV 31 & 33
D. HPV 45 & 52

Answer

A

B. HPV 16 & 18

📌 Rationale: HPV 16 and 18 are the most common high-risk HPV types associated with cervical cancer, responsible for approximately 70% of cases worldwide. (Document Reference: Pathogenesis - HPV 16 & 18 are the most oncogenic.)

Question 36

Q

The two most common high-risk HPV types causing cervical cancer in the Philippines are?
A. HPV 6 & 11
B. HPV 31 & 33
C. HPV 16 & 18
D. HPV 45 & 52

Answer

A

C. HPV 16 & 18

📌 Rationale: HPV 16 and 18 cause approximately 70% of all cervical cancer cases worldwide, including in the Philippines. (Source: HPV Centre & WHO)

Question 37

Q

A small percentage of women infected with HPV will develop cervical cancer in how many years?
A. 5-10 years
B. 10-15 years
C. 15-20 years
D. 25-30 years

Answer

A

C. 15-20 years

📌 Rationale: HPV infection can persist and lead to cervical cancer, but it typically takes 15-20 years for cancer to develop in immunocompetent individuals. (Document Reference: WHO Fact Sheet)

Question 38

Q

What is the most common symptom of early-stage cervical cancer?
A. Pelvic pain
B. Post-coital bleeding
C. Abnormal vaginal discharge
D. None

Answer

A

D. None

📌 Rationale: Early-stage cervical cancer is often asymptomatic, which is why routine screening is crucial. Symptoms such as vaginal bleeding or discharge usually occur in later stages. (Document Reference: Clinical Manifestation)

Question 39

Q

Which of the following statements is TRUE about cervical cancer?
A. Cervical cancer is the most common malignancy in women
B. Cervical cancer is the 3rd most common female cancer worldwide
C. Cervical cancer only occurs in women with HPV
D. Cervical cancer cannot be prevented

Answer

A

B. Cervical cancer is the 3rd most common female cancer worldwide

📌 Rationale: Cervical cancer remains the third most common malignancy in women worldwide and is the most common gynecologic cancer in low-income countries. (Document Reference: Epidemiology)

Question 40

Q

Which of the following is a risk factor for cervical cancer?
A. Smoking
B. Regular Pap smears
C. Nulliparity
D. Late age at first intercourse

Answer

A

A. Smoking

📌 Rationale: Smoking increases the risk of cervical cancer by impairing immune response and promoting persistent HPV infection. (Document Reference: Risk Factors Table)

Question 41

Q

A 28-year-old woman consults for cervical cancer screening. What is the recommended test?
A. HPV test alone
B. Pap smear alone
C. Pap smear + HPV co-testing
D. No screening needed

Answer

A

B. Pap smear alone

📌 Rationale: Women aged 21-29 should have a Pap smear every 3 years. HPV testing alone is an option for women 25-29, but Pap smear is preferred. (Document Reference: Screening Guidelines)

Question 42

Q

A 38-year-old woman (G2P2) has a Pap smear result showing HSIL. What is the next best step?
A. Repeat Pap smear in 6 months
B. HPV testing
C. Colposcopy with possible cervical biopsy
D. Immediate hysterectomy

Answer

A

C. Colposcopy with possible cervical biopsy

📌 Rationale: HSIL requires further evaluation with colposcopy and potential biopsy to rule out invasive cancer. (Document Reference: HSIL Management)

Question 43

Q

A cervical biopsy shows atypical cells and koilocytes occupying the lower 1/3 of the epithelium. What is the diagnosis?
A. CIN 1
B. CIN 2
C. CIN 3
D. Squamous cell carcinoma

Answer

A

A. CIN 1

📌 Rationale: CIN 1 (LSIL) involves dysplasia confined to the lower 1/3 of the epithelium and is often associated with HPV infection. Koilocytes are hallmark cells of HPV infection. (Document Reference: CIN Classification)

Question 44

Q

A 35-year-old woman with abnormal Pap smear underwent colposcopy-guided biopsy, which revealed HSIL. What is the recommended treatment?
A. Watchful waiting
B. Excisional procedure (LEEP or conization)
C. HPV vaccination
D. Repeat Pap smear in 6 months

Answer

A

B. Excisional procedure (LEEP or conization)

📌 Rationale: HSIL is managed with an excisional procedure such as LEEP or cold knife conization to remove pre-cancerous cells and prevent progression to cervical cancer. (Document Reference: HSIL Treatment)

Question 45

Q

What is the most common histologic type of cervical cancer?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Clear cell carcinoma

Answer

A

B. Squamous cell carcinoma

📌 Rationale: Squamous cell carcinoma (SCC) accounts for approximately 70% of cervical cancer cases. (Document Reference: Histologic Types Table)

Question 46

Q

A 39-year-old woman is diagnosed with cervical cancer that has spread to the right pelvic side wall. She has right hydronephrosis. What is the best treatment?
A. Surgery alone
B. Brachytherapy and external radiotherapy
C. Chemotherapy alone
D. HPV vaccination

Answer

A

B. Brachytherapy and external radiotherapy

📌 Rationale: Cervical cancer with pelvic side wall involvement (Stage IIIB) is treated with radiotherapy (external + brachytherapy) combined with concurrent chemotherapy. (Document Reference: Cervical Cancer Treatment)

Question 47

Q

Which of the following is a risk factor for cervical cancer?
A. Early age of coitus
B. Low parity
C. Late menopause
D. Lack of HPV vaccination

Answer

A

A. Early age of coitus

📌 Rationale: Early sexual activity increases HPV exposure risk, leading to a higher likelihood of cervical dysplasia and cancer. (Document Reference: Risk Factors Table)

Question 48

Q

A woman underwent total abdominal hysterectomy (TAH) for CIN 3. She asks if she still needs Pap smears. What is the correct advice?
A. She should continue to have Pap smears of the vaginal cuff
B. She no longer needs screening
C. HPV vaccination will prevent recurrence
D. Pap smear is only needed if symptoms appear

Answer

A

A. She should continue to have Pap smears of the vaginal cuff

📌 Rationale: Women who undergo hysterectomy for high-grade CIN (CIN 2/3) should continue vaginal Pap smear screening since they remain at risk for vaginal cancer. (Document Reference: Post-Hysterectomy Screening)

Question 49

Q

Vulvar cancer with involvement of lymph nodes is classified as which FIGO stage?
A. Stage IIB
B. Stage IIIA
C. Stage IIIC
D. Stage IVA

Answer

A

C. Stage IIIC

📌 Rationale: Stage IIIC vulvar cancer indicates lymph node involvement. If distant metastases are present, it would be Stage IV. (Document Reference: Vulvar Cancer Staging - “IIIC = Lymph node involvement.”)

Question 50

Q

A 53-year-old nulligravid woman underwent surgery for ovarian cancer. Her history revealed an untreated ovarian endometrioma diagnosed 10 years ago. What is the most likely histologic type of ovarian cancer?
A. Serous carcinoma
B. Mucinous carcinoma
C. Clear cell adenocarcinoma
D. Dysgerminoma

Answer

A

C. Clear cell adenocarcinoma

📌 Rationale: Clear cell carcinoma is strongly associated with a history of endometriosis or ovarian endometriomas. (Document Reference: Ovarian Cancer Risk Factors - “Endometriosis increases risk for clear cell adenocarcinoma.”)

Question 51

Q

A 46-year-old woman (G3P3) underwent total hysterectomy with bilateral salpingectomy for an ovarian mass. She had abdominal enlargement and pleural effusion. Histopathology confirmed a benign tumor, with no malignant cells in ascitic and pleural fluid. What is the most likely diagnosis?
A. Fibroma
B. Thecoma
C. Granulosa cell tumor
D. Dysgerminoma

Answer

A

A. Fibroma

📌 Rationale: Fibroma is a benign solid ovarian tumor associated with ascites and pleural effusion, known as Meigs syndrome. (Document Reference: Ovarian Tumors - “Fibroma with ascites and pleural effusion = Meigs syndrome.”)

Question 52

Q

What is the most common type of germ cell tumor characterized by its ability to produce adult tissues like teeth and hair?
A. Dysgerminoma
B. Yolk sac tumor
C. Mature cystic teratoma (Dermoid cyst)
D. Immature teratoma

Answer

A

C. Mature cystic teratoma (Dermoid cyst)

📌 Rationale: Mature cystic teratomas (dermoid cysts) are the most common germ cell tumors and contain fully differentiated tissues, such as hair, teeth, and sebaceous material. (Document Reference: Germ Cell Tumors - “Mature teratomas contain well-differentiated tissues.”)

Question 53

Q

A 28-year-old nulligravid woman presents with urinary frequency. Ultrasound shows a 9 cm benign tumor, likely a mature cystic teratoma. What is the recommended treatment?
A. Cystectomy
B. Hysterectomy
C. Salpingo-oophorectomy
D. Observation

Answer

A

A. Cystectomy

📌 Rationale: Cystectomy (removal of the cyst while preserving ovarian tissue) is the preferred treatment for young women with benign ovarian tumors to preserve fertility. (Document Reference: Management of Ovarian Tumors)

Question 54

Q

Which histologic type accounts for 5% of ovarian cancers and is characterized by hobnail cells protruding into glandular lumens?
A. Dysgerminoma
B. Immature teratoma
C. Clear cell carcinoma
D. Mucinous carcinoma

Answer

A

C. Clear cell carcinoma

📌 Rationale: Clear cell carcinoma comprises 5% of ovarian cancers and is characterized by hobnail cells. It is commonly associated with endometriosis. (Document Reference: Ovarian Cancer Histology)

Question 55

Q

What is the recommended adjuvant therapy for patients with frankly malignant ovarian cancer (Stage IC-IVB)?
A. Radiation therapy
B. Chemotherapy
C. Hormonal therapy
D. Surgery only

Answer

A

B. Chemotherapy

📌 Rationale: Patients with Stage IC-IVB ovarian cancer require adjuvant chemotherapy, typically with platinum-based regimens (e.g., carboplatin + paclitaxel). (Document Reference: Ovarian Cancer Treatment - “Chemotherapy is recommended for Stage IC-IVB.”)

Question 56

Q

A 15-year-old girl presents with abdominal enlargement. Ultrasound reveals a solid ovarian mass. What tumor markers should be requested?
A. CA-125, hCG, AFP, and LDH
B. CA-19-9 and CEA
C. BRCA1 and BRCA2
D. Estrogen and progesterone

Answer

A

A. CA-125, hCG, AFP, and LDH

📌 Rationale: These tumor markers are used to evaluate germ cell tumors:

CA-125 (epithelial ovarian tumors)
hCG (choriocarcinoma)
AFP (yolk sac tumors)
LDH (dysgerminoma)
(Document Reference: Tumor Markers in Ovarian Cancer)

Question 57

Q

What is the most frequently found immature tissue in immature teratomas?
A. Immature neuroepithelium
B. Immature cartilage
C. Immature muscle
D. Immature squamous cells

Answer

A

A. Immature neuroepithelium

📌 Rationale: Immature teratomas contain embryonal tissue, most commonly immature neuroepithelium, which is associated with aggressive behavior. (Document Reference: Germ Cell Tumors)

Question 58

Q

What is the most common histologic type of fallopian tube cancer?
A. Serous adenocarcinoma
B. Mucinous carcinoma
C. Clear cell carcinoma
D. Squamous cell carcinoma

Answer

A

A. Serous adenocarcinoma

📌 Rationale: Serous adenocarcinoma is the most common histologic type of fallopian tube carcinoma, resembling high-grade serous ovarian carcinoma. (Document Reference: Fallopian Tube Cancer Histology)

Question 59

Q

The field effect in peritoneal carcinoma suggests that:
A. Peritoneal cancer originates from mesothelial cells
B. The epithelium lining the abdominal cavity and germinal epithelium respond similarly to carcinogenic stimuli
C. BRCA mutations are not relevant to peritoneal carcinoma
D. Peritoneal carcinoma arises exclusively from ovarian cancer

Answer

A

B. The epithelium lining the abdominal cavity and germinal epithelium respond similarly to carcinogenic stimuli

📌 Rationale: The field effect theory states that peritoneal and ovarian cancers share a common carcinogenic response, explaining why some peritoneal carcinomas arise independently of ovarian cancer. (Document Reference: Peritoneal Carcinoma - “Field Effect Theory”)

Question 60

Q

Which statement is TRUE about ovarian tumor rupture during surgery?
A. Patients whose tumor structure remains intact during surgery have better survival rates than those with pre-surgical rupture
B. Tumor rupture has no effect on prognosis
C. Pre-surgical tumor rupture improves survival
D. Tumor rupture is an indication for chemotherapy

Answer

A

A. Patients whose tumor structure remains intact during surgery have better survival rates than those with pre-surgical rupture

📌 Rationale: Ovarian tumor rupture before surgery leads to intraperitoneal spread, worsening prognosis. Intraoperative rupture is also a risk but has a better outcome than preoperative rupture. (Document Reference: Ovarian Cancer Prognosis)

Question 61

Q

In a young patient undergoing surgery for epithelial ovarian cancer, the uterus and contralateral ovary may be preserved under which condition?
A. The tumor is bilateral
B. The tumor is poorly differentiated
C. The tumor is confined to one ovary, with no capsular invasion, and is well-differentiated
D. There is lymph node involvement

Answer

A

C. The tumor is confined to one ovary, with no capsular invasion, and is well-differentiated

📌 Rationale: Fertility-preserving surgery is an option in early-stage ovarian cancer if the tumor is unilateral, well-differentiated, and has no capsular breach or metastasis. (Document Reference: Fertility-Preserving Surgery in Ovarian Cancer)

Question 62

Q

A 45-year-old woman with a history of breast cancer presents for evaluation. What is the next step in management?
A. Perform an endometrial biopsy only if the endometrial thickness is >4 mm
B. Observe unless she has vaginal bleeding
C. If on tamoxifen and experiencing irregular bleeding, perform an endometrial biopsy
D. Routine transvaginal ultrasound is sufficient

Answer

A

C. If on tamoxifen and experiencing irregular bleeding, perform an endometrial biopsy

🔎 Rationale:

Tamoxifen increases the risk of endometrial hyperplasia and cancer but does not warrant routine screening unless the patient has abnormal bleeding.
Endometrial biopsy is only done if the patient has irregular bleeding, regardless of ultrasound findings.
“We only do biopsy kapag dinudugo. Pag walang dugo, walang biopsy kahit makapal ang endometrium sa ultrasound.”

Question 63

Q

An autosomal dominant syndrome characterized by germline defective DNA repair is associated with an increased risk of endometrial cancer. What should be advised for this patient?
A. Endometrial biopsy every 5 years
B. Routine pelvic examination only
C. Annual transvaginal ultrasound
D. OCPs as preventive therapy

Answer

A

C. Annual transvaginal ultrasound

🔎 Rationale:

Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer - HNPCC) increases the risk of endometrial and colon cancer (40-60% lifetime risk).
Recommended screening: Annual endometrial biopsy and transvaginal ultrasound for early detection.

Question 64

Q

Which of the following is NOT a risk factor for endometrial cancer?
A. Obesity
B. Late menopause (>55 years old)
C. Anorexia
D. Tamoxifen use

Answer

A

C. Anorexia

🔎 Rationale:

Risk factors for endometrial cancer include:
Unopposed estrogen stimulation (e.g., obesity, PCOS, tamoxifen)
More years of menstruation (early menarche, late menopause)
Nulliparity (never being pregnant)
Older age and hormone therapy
Lynch syndrome (HNPCC)
Anorexia does not increase risk—it reduces estrogen levels, which lowers the risk of endometrial hyperplasia and cancer.

Answer 65

A

C. Routine lab work including CBC, calcium, and liver function tests should be done

🔎 Rationale:

Tamoxifen acts as an anti-estrogen in the breast but as an estrogen agonist in the uterus, increasing the risk of endometrial hyperplasia and cancer.
Routine endometrial biopsy is NOT needed unless the patient has vaginal bleeding.
Patients on tamoxifen should have routine lab tests (CBC, liver function, calcium levels).

Answer 66

A

B. Wide local excision

🔎 Rationale:

Basal cell carcinoma of the vulva is treated with wide local excision, as it is a slow-growing tumor with low metastatic potential.
Lymph node dissection is not required unless deeper invasion is suspected.

Answer 67

A

B. It is the third most common genital tract malignancy in the Philippines

🔎 Rationale:

Endometrial cancer ranks 3rd among genital tract malignancies in the Philippines, after cervical cancer and ovarian cancer.

Answer 68

A

D. All of the above

🔎 Rationale:

Conization is recommended when the lesion cannot be fully assessed via colposcopy, when the squamo-columnar junction is not visualized, or if endocervical curettage is positive for CIN 2 or 3.

Answer 69

A

D. All of the above

🔎 Rationale:

Endometrial carcinoma is an estrogen-driven malignancy.
It develops in settings of unopposed estrogen stimulation (e.g., PCOS, obesity, late menopause, tamoxifen use).
It often follows endometrial hyperplasia and responds to progestin therapy in some cases.

Answer 70

A

B. Complex atypical hyperplasia

🔎 Rationale:

Complex atypical hyperplasia is now referred to as Endometrial Intraepithelial Neoplasia (EIN) in the updated WHO classification.
EIN is a premalignant lesion with a high risk (29-42%) of progression to endometrial carcinoma.

Answer 71

A

B. Endometrial biopsy has a 42% chance of detecting concurrent endometrial cancer

🔎 Rationale:

Complex atypical hyperplasia (EIN) is highly premalignant.
42% of women with complex atypical hyperplasia already have endometrial carcinoma at the time of hysterectomy.
Management:
Progestin therapy (if fertility is desired).
Hysterectomy (definitive treatment, especially in postmenopausal women).

Answer 72

A

C. 42% of women with complex atypical hyperplasia have endometrial carcinoma

🔎 Rationale:

Complex hyperplasia with atypia (Endometrial Intraepithelial Neoplasia - EIN) is highly premalignant.
42% of cases already have endometrial carcinoma at the time of hysterectomy.
D&C or endometrial sampling may miss areas of carcinoma mixed with hyperplasia.

Answer 73

A

D. Keyes-punch biopsy

🔎 Rationale:

Keyes-punch biopsy is used for diagnosing vulvar cancer, NOT endometrial cancer.
Endometrial biopsy and D&C are the preferred diagnostic tools for endometrial cancer.

Answer 74

A

B. Endometrial biopsy

🔎 Rationale:

Postmenopausal bleeding is always abnormal and must be evaluated.
Dr. Malig states that biopsy should be done immediately when there is bleeding, regardless of endometrial thickness.

Answer 75

A

C. Progestin therapy

🔎 Rationale:

Hyperplasia without atypia is managed with progestin therapy to thin the endometrial lining.
Medroxyprogesterone acetate or oral contraceptive pills (OCPs) can be used.

Answer 76

A

B. High-dose progestin with periodic endometrial sampling

🔎 Rationale:

Obesity is a risk factor for endometrial hyperplasia due to increased estrogen production.
In young patients who desire fertility, high-dose progestins (Megestrol Acetate 160 mg/day) are used with periodic biopsies.
If hyperplasia persists or progresses, hysterectomy is recommended.

Answer 77

A

D. High tumor grade, advanced stage, and lymphovascular invasion worsen prognosis

🔎 Rationale:

Endometrial adenocarcinoma is the 3rd most common genital tract malignancy.
It occurs primarily in postmenopausal women.
Poor prognostic factors include:
High tumor grade
Advanced surgical stage
Lymphovascular space invasion

Answer 78

A

D. Clear cell carcinoma

🔎 Rationale:

Clear cell carcinoma is highly aggressive with a poor prognosis.
It has a high likelihood of vascular invasion and distant metastasis.

Answer 79

A

C. Stage II

🔎 Rationale:

Stage II endometrial cancer involves the cervical stroma but remains confined to the uterus.
It requires hysterectomy and possibly adjuvant therapy.

Answer 80

A

A. Stage IA

🔎 Rationale:

Stage IA: Tumor is confined to the endometrium or has <50% myometrial invasion.
Stage IB: Tumor invades >50% of the myometrium.
Since there is no invasion, this is Stage IA.

Answer 81

A

A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO)

🔎 Rationale:

Surgery (TAHBSO) is the standard treatment for early-stage endometrial cancer (Stage IA).
Adjuvant therapy (radiation or chemotherapy) is considered for high-risk cases (e.g., high-grade tumors).

Answer 82

A

C. 90%

🔎 Rationale:

Stage IA endometrial cancer has an excellent prognosis with a 5-year survival rate of 90% if treated appropriately with surgery.
📌 Reference: FIGO Staging and 5-year survival rates for endometrial carcinoma.

Answer 83

A

A. Grade 1

🔎 Rationale:

Tumor grading is based on the percentage of solid components:
Grade 1 = Well-differentiated, <5% solid components
Grade 2 = Moderately differentiated, 6-50% solid components
Grade 3 = Poorly differentiated, >50% solid components

Answer 84

A

D. Typical endometrioid adenocarcinoma

🔎 Rationale:

Endometrioid adenocarcinoma has the best prognosis.
Papillary serous and clear cell carcinomas are highly aggressive with poor outcomes.
Poor differentiation (Grade 3) also correlates with poor prognosis.
📌 Reference: Histologic subtypes and prognostic factors in endometrial carcinoma.

Answer 85

A

B. Round ligament

🔎 Rationale:

Endometrial cancer spreads to the inguinal lymph nodes via the round ligament.
Other routes of spread include:
Pelvic & para-aortic lymph nodes
Peritoneal fluid (direct spread)
Fallopian tubes (retrograde spread)

Answer 86

A

D. Surgery

🔎 Rationale:

Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) is the standard treatment for endometrial cancer.
Adjuvant therapy (radiation or chemotherapy) is added based on risk factors.

Answer 87

A

C. Stage

🔎 Rationale:

Stage is the most important predictor of survival in endometrial sarcoma.
Higher stages correlate with poorer outcomes.
Other factors like tumor grade and histologic type also influence prognosis but are secondary to stage.

Answer 88

A

C. Tumor may respond to hormonal therapy

🔎 Rationale:

Endometrial stromal sarcomas often express estrogen and progesterone receptors.
Hormonal therapy (progestins, aromatase inhibitors) can be used to slow tumor progression.

Answer 89

A

C. Leiomyosarcoma

🔎 Rationale:

Leiomyosarcoma is a rare but aggressive smooth muscle tumor of the uterus.
Histologic criteria include >5 mitoses per 10 high-power fields (HPF).

Answer 90

A

B. 1.3%

🔎 Rationale:

The average woman’s lifetime risk of developing ovarian cancer is approximately 1.3%.
Risk increases with BRCA1/BRCA2 mutations or family history.

Answer 91

A

C. Mixed Müllerian tumor

🔎 Rationale:

Malignant Mixed Müllerian Tumor (MMMT) contains both epithelial (carcinomatous) and mesenchymal (sarcomatous) components.
It is highly aggressive with a poor prognosis.
📌 Reference: Histology of mixed Müllerian tumors.

Answer 92

A

C. The tumor may respond to hormonal therapy

🔎 Rationale:

Endometrial Stromal Sarcoma (ESS) is often estrogen and progesterone receptor-positive.
This means the tumor may respond to hormonal therapy, such as:
Progestins (e.g., Medroxyprogesterone acetate)
Aromatase inhibitors (e.g., Letrozole, Anastrozole)
GnRH agonists (e.g., Leuprolide)

Answer 93

A

A. Inguinal lymph nodes

🔎 Rationale:

Vulvar squamous cell carcinoma (SCC) primarily metastasizes to the inguinal lymph nodes.
Pelvic lymph node involvement occurs at later stages.
Distant metastasis to the lungs and liver is rare in early-stage disease.
📌 Source: Gyne LE 5.02 – Premalignant & Malignant Lesions of the Uterus

Answer 94

A

B. Diabetes

🔎 Rationale:

Diabetes is an independent risk factor for endometrial cancer.
Other major risk factors include:
Obesity
Late menopause (>55 years old)
Unopposed estrogen therapy
PCOS
HPV and smoking are risk factors for cervical cancer, not endometrial cancer.

Answer 95

A

B. Endometrial biopsy

🔎 Rationale:

Tamoxifen is an estrogen agonist in the uterus, increasing the risk of endometrial hyperplasia and carcinoma.
A thickened endometrium on ultrasound + vaginal spotting warrants an endometrial biopsy to rule out malignancy.
Observation is inappropriate as persistent vaginal bleeding requires further investigation.

Answer 96

A

A. Lynch syndrome

🔎 Rationale:

Lynch syndrome (Hereditary Nonpolyposis Colorectal Cancer - HNPCC) is caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2).
It significantly increases the risk of colorectal and endometrial cancer (40-60% lifetime risk).

Answer 97

A

A. Annual transvaginal ultrasound

🔎 Rationale:

Women with Lynch syndrome should undergo annual transvaginal ultrasound and endometrial biopsy starting at age 35.
Prophylactic hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) are recommended after childbearing.
📌 Source: Gyne LE 5.02 and Feedback

Answer 98

A

A. Menopause at age 55

🔎 Rationale:

Late menopause (>55 years) increases estrogen exposure, raising the risk of endometrial cancer.
Protective factors include:
Early menopause
Multiparity (progesterone exposure during pregnancy)
Use of combination OCPs

Answer 99

A

✅ Answer: A. Complex hyperplasia with atypia

🔎 Rationale:

Complex hyperplasia with atypia is now classified as Endometrial Intraepithelial Neoplasia (EIN) in the updated WHO system.
EIN has a 29-42% risk of progressing to endometrial carcinoma.

Answer 100

A

A. Endometrial biopsy can have a 40% chance of detecting endometrial carcinoma

🔎 Rationale:

Complex atypical hyperplasia (Endometrial Intraepithelial Neoplasia - EIN) is a premalignant condition.
Approximately 42% of cases of complex atypical hyperplasia are found to have endometrial carcinoma at the time of hysterectomy.
Management options include high-dose progestin therapy (for fertility preservation) or hysterectomy (definitive treatment).

Answer 101

A

A. Keyes-punch biopsy

🔎 Rationale:

Keyes-punch biopsy is used for diagnosing vulvar cancer, NOT endometrial cancer.
Preferred diagnostic methods for endometrial cancer include:
Endometrial biopsy (gold standard for outpatient diagnosis)
Transvaginal ultrasound (for initial evaluation of endometrial thickness)
Dilatation & Curettage (D&C) for inconclusive biopsy results
Hysteroscopy for direct visualization and biopsy

Answer 102

A

A. Biopsy

🔎 Rationale:

Postmenopausal bleeding is always abnormal and requires further evaluation.
Endometrial biopsy should be performed regardless of endometrial thickness if there is persistent vaginal bleeding.
Dr. Malig states that biopsy should be done immediately when bleeding is present, even if the ultrasound shows a thin endometrium.

Answer 103

A

C. Perform an endometrial biopsy

🔎 Rationale:

Postmenopausal bleeding after estrogen replacement therapy requires further evaluation.
Unopposed estrogen therapy increases the risk of endometrial hyperplasia and cancer.
PCOS is already a risk factor for endometrial carcinoma due to chronic anovulation and unopposed estrogen.
Endometrial biopsy is needed to rule out endometrial hyperplasia or malignancy.

Answer 104

A

D. Surgery

🔎 Rationale:

Stage I endometrial cancer is best managed with surgery (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy - TAHBSO).
Adjuvant therapy (radiation or chemotherapy) is considered for high-risk Stage I cases.
Progesterone therapy is only used in fertility-sparing cases.

Answer 105

A

A. Polycystic Ovarian Syndrome (PCOS)

🔎 Rationale:

PCOS is a major risk factor for endometrial cancer due to chronic anovulation and unopposed estrogen stimulation.
HPV infection is associated with cervical cancer, not endometrial cancer.
BRCA1 mutations increase the risk of ovarian and breast cancer, not primarily endometrial cancer.
Smoking is a risk factor for cervical cancer, but it has a paradoxically protective effect against endometrial cancer.

Answer 106

A

D. Surgery

🔎 Rationale:

Surgical management (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy - TAHBSO) is the gold standard for most cases of endometrial cancer.
Adjuvant therapy (radiation or chemotherapy) is considered based on the tumor grade, depth of invasion, and lymph node involvement.
Hormonal therapy (progestins) is used only for fertility-sparing management in select cases.

Answer 107

A

C. Perform an endometrial biopsy

🔎 Rationale:

Postmenopausal bleeding after estrogen replacement therapy warrants further investigation.
PCOS, diabetes, and obesity are risk factors for endometrial hyperplasia and cancer.
Endometrial biopsy is needed to rule out endometrial carcinoma or hyperplasia.

Answer 108

A

A. Tumor invades the bladder and/or bowel mucosa

🔎 Rationale:

FIGO Staging for Endometrial Cancer:
Stage I: Confined to the uterus
Stage II: Involves the cervix
Stage III: Spread to lymph nodes or adnexa
Stage IV: 4A = Tumor invades the bladder or bowel mucosa; 4B = Distant metastases (lungs, liver, etc.)

Answer 109

A

D. Surgery

🔎 Rationale:

Stage I endometrial cancer is best treated with Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAHBSO).
Adjuvant therapy (radiation or chemotherapy) is considered in high-risk Stage I cases.
Progesterone therapy is an option for fertility preservation but is not the standard treatment.

Answer 110

A

C. They are proteins that bind to hormones and promote tumor growth.

Rationale:

Receptors are proteins found in or on cells that bind to hormones in the blood.
Normal breast and some cancer cells (including ESS) have estrogen and progesterone receptors, which promote tumor growth when these hormones bind.
ESS is often hormone-sensitive, making hormonal therapy a treatment option.

Answer 111

A

B. Leiomyosarcoma

Rationale:

Leiomyosarcoma (LMS) is a rare and aggressive smooth muscle tumor that arises in hollow organs such as the uterus.
A key diagnostic feature is the presence of >5 mitoses per high-power field (HPF) in histology.
Unlike leiomyomas (benign fibroids), LMS is malignant and rapidly grows.

Answer 112

A

B. 1.3%

Rationale:

The general lifetime risk of ovarian cancer in women is 1.3%.
However, BRCA1/BRCA2 mutations or Lynch syndrome (HNPCC) increase the risk significantly.

Answer 113

A

C. Carcinosarcoma

Rationale:

Carcinosarcoma (also known as malignant mixed Müllerian tumor) contains both carcinomatous (epithelial) and sarcomatous (mesenchymal) components.
These tumors behave aggressively and are classified under high-risk endometrial cancers.

Answer 114

A

C. Sporadic events

Rationale:

Most ovarian cancers occur sporadically, meaning they arise from random mutations rather than inherited genetic predispositions.
Only 10-15% of ovarian cancers are hereditary (e.g., BRCA mutations, Lynch Syndrome).

Answer 115

A

A. Incessant Ovulation Hypothesis

Rationale:

The incessant ovulation hypothesis suggests that continuous ovulation causes repeated epithelial damage to the ovary, leading to DNA mutations and increased cancer risk.
Protective factors include pregnancy, OCP use, and breastfeeding (as they reduce ovulation).

Answer 116

A

C. Serous Tubal Intraepithelial Carcinoma (STIC)

Rationale:

Recent research suggests that most high-grade serous ovarian cancers originate from the fallopian tubes, not the ovary itself.
The precursor lesion is called “Serous Tubal Intraepithelial Carcinoma (STIC),” found in the fimbrial end of the fallopian tube.
STIC lesions have TP53 mutations, which are early genetic changes leading to ovarian carcinoma.

Answer 117

A

A. Serous Adenocarcinoma

Rationale:

Sex cord-stromal tumors originate from ovarian stroma, including Granulosa Cell Tumors and Sertoli-Leydig Cell Tumors.
Serous adenocarcinoma and mucinous carcinoma originate from the ovarian epithelium (not the stroma).
Epidermoid carcinoma is a rare ovarian malignancy that can arise from teratomas.

Answer 118

A

C. Long-term oral contraceptive (OCP) use

Rationale:

OCP use is one of the most protective factors against ovarian cancer (50% risk reduction for up to 25 years).
Late menopause increases risk (more ovulation = more DNA damage).
Endometriosis is associated with an increased risk of ovarian cancer, particularly clear cell and endometrioid types.
Smoking does not protect against ovarian cancer and is linked to mucinous ovarian carcinoma.

Answer 119

A

B. Hereditary Breast and Ovarian Cancer Syndrome

Rationale:

BRCA1 and BRCA2 mutations significantly increase the risk of both breast and ovarian cancer.
Li-Fraumeni Syndrome is associated with TP53 mutations.
Lynch Syndrome is linked to DNA mismatch repair gene mutations (MLH1, MSH2, MSH6, PMS2, EPCAM) and is primarily associated with colorectal and endometrial cancer.

Answer 120

A

B. Transvaginal Ultrasound

Rationale:

Transvaginal ultrasound (TVUS) is the most useful imaging modality for ovarian masses and has the highest sensitivity.
Pelvic examination can detect a large ovarian mass but is not accurate for small ones.
X-ray is not the primary diagnostic tool for ovarian cancer.
MRI may be used for further characterization but is not the first-line test.

Answer 121

A

B. Benign ovarian mass

Rationale:

A purely cystic ovarian mass without solid components and without blood flow is most likely benign.
Angiogenesis (new blood vessel formation) is a characteristic of malignant tumors, which is why malignant masses typically have increased blood flow on Doppler imaging.
Serous cystadenocarcinoma and dysgerminoma often show solid components and vascularization.

Answer 122

A

B. Serous Adenocarcinoma

Rationale:

Serous adenocarcinoma is the most common ovarian malignancy in reproductive-age women.
It accounts for the majority of epithelial ovarian cancers (EOCs).
Mucinous carcinoma is less common and more frequently seen in older women.
Clear cell carcinoma is associated with endometriosis.

Answer 123

A

C. Dysgerminoma

Rationale:

Dysgerminoma is the most common malignant germ cell tumor and accounts for 45% of malignant ovarian germ cell tumors.
Yolk sac tumors are the second most common and produce AFP.
Immature teratomas are rare but occur in young women.
Choriocarcinoma of ovarian origin is extremely rare.

Answer 124

A

B. Stage IC1

Rationale:

Stage IC1 refers to surgical spill, meaning that the tumor was confined to the ovary but ruptured during surgery, potentially allowing cancer cells to spread into the abdomen and pelvis.
Stage IC2 refers to capsule rupture before surgery or tumor on the ovarian surface.
Stage II and beyond indicate extraovarian spread.

Answer 125

A

C. Stage IVA

Rationale:

Stage IVA is defined as pleural effusion with positive cytology, meaning cancer cells are found in the fluid.
Stage IVB indicates distant metastases beyond the peritoneal cavity.

Answer 126

A

B. Absence of stromal invasion

Rationale:

Low malignant potential (LMP) tumors lack stromal invasion, distinguishing them from invasive carcinomas.
LMP tumors can still show nuclear atypia but do not invade surrounding tissue.

Answer 127

A

C. Regular follow-up

Rationale:

LMP tumors generally do not require chemotherapy unless they progress to invasive carcinoma.
Regular follow-up is sufficient to monitor for recurrence.

Answer 128

A

B. TP53 mutation pathway

Rationale:

High-grade serous ovarian carcinoma (HGSC) originates from serous tubal intraepithelial carcinoma (STIC) in the fimbriae of the fallopian tube.
The TP53 mutation is a hallmark of HGSC and is an early genetic event.

Answer 129

A

C. Endometrial cancer

Rationale:

Endometrial carcinoma is the third most common gynecologic malignancy in the Philippines.
Cervical cancer remains the most common, followed by ovarian cancer.

Answer 130

A

B. Clear cell carcinoma

Answer 131

A

D. Meigs Syndrome

Rationale:

Meigs Syndrome is characterized by a benign ovarian tumor (often a fibroma), ascites, and pleural effusion.
Symptoms resolve after tumor removal.

Answer 132

A

C. Dermoid cyst (Mature cystic teratoma)

Rationale:

Dermoid cysts contain mature tissues from all three germ layers (ectoderm, mesoderm, and endoderm).
They can include hair, teeth, and sebaceous material.

Answer 133

A

B. Oophorocystectomy

Rationale:

Oophorocystectomy (cyst removal) is the preferred treatment for benign ovarian tumors, preserving ovarian function.
Oophorectomy (removal of the entire ovary) is reserved for malignant cases.

Answer 134

A

A. Clear cell carcinoma

Rationale:

Clear cell carcinoma is histologically identified by hobnail cells, which are tumor cells with nuclei protruding into the glandular lumen.
It is associated with endometriosis.

Answer 135

A

B. Chemotherapy

Rationale:

Platinum-based chemotherapy (Carboplatin + Paclitaxel) is the standard treatment for advanced ovarian cancer.
Surgery is also crucial, but chemotherapy is necessary for most cases beyond Stage I.

Answer 136

A

B. Neural tissue

Rationale:

Immature teratomas contain immature neural elements, which determine tumor grade.
Higher amounts of immature neural tissue indicate a more aggressive tumor.

Answer 137

A

B. hCG, AFP, LDH, CA-125

Rationale:

In young patients with abdominal masses, germ cell tumors are suspected.
Tumor markers (hCG, AFP, LDH) help in diagnosis.

Answer 138

A

C. Stage and grade

Rationale:

The prognosis of immature teratomas depends on both FIGO stage and tumor grade.
Higher tumor grade (presence of more immature neural tissue) is associated with a worse prognosis.
Patients with Stage I disease generally have an excellent prognosis.

Answer 139

A

B. Struma ovarii

Rationale:

Struma ovarii is a rare monodermal teratoma that contains functional thyroid tissue (>50%).
It can cause hyperthyroidism due to excess thyroid hormone production.
It is usually benign but can rarely become malignant.

Answer 140

A

C. Dysgerminoma

Rationale:

Dysgerminoma is the most common malignant ovarian tumor detected during pregnancy.
It is a germ cell tumor and is highly curable with fertility-sparing surgery and chemotherapy.
It is associated with increased LDH as a tumor marker.

Answer 141

A

C. Schiller-Duval bodies

Rationale:

Schiller-Duval bodies are the pathognomonic histologic feature of yolk sac tumors.
They resemble glomeruli and are seen under microscopic examination.
Yolk sac tumors also produce AFP as a tumor marker.

Answer 142

A

C. Inhibin

Rationale:

Granulosa cell tumors secrete inhibin, which is the most reliable tumor marker for diagnosis and monitoring.
They can also cause hyperestrogenism, leading to endometrial hyperplasia or carcinoma.

Answer 143

A

D. Cancer staging

Rationale:

Cancer staging is crucial before definitive treatment in young women with ovarian tumors.
Surgical staging includes omentectomy, peritoneal washings, lymph node sampling, and tumor resection.

Answer 144

A

C. Granulosa cell tumor

Rationale:

Granulosa cell tumors produce estrogen, which can cause abnormal uterine bleeding in postmenopausal women.
They are often associated with endometrial hyperplasia or carcinoma.
Inhibin is the tumor marker of choice for monitoring.

Answer 145

A

B. It is characterized by cyclical pain relieved by the passage of vaginal discharge.

Rationale:

Hydrops tubae profluens refers to pain relieved by the sudden passage of fluid per vagina.
It occurs due to intermittent distension of the fallopian tube from accumulated fluid.

Answer 146

A

A. It is pathognomonic for fallopian tube cancer but is present in only 15% of cases.

Rationale:

Latzko’s triad consists of watery vaginal discharge, colicky lower abdominal pain, and a pelvic mass.
It is characteristic of fallopian tube cancer but is seen in less than 15% of cases.

Answer 147

A

A. The uterus and ovaries are normal in size.

Rationale:

Ovarian tumors typically present with an enlarged ovary, which is why normal-sized ovaries and uterus would not be consistent with the diagnosis of an ovarian tumor.
Other key criteria include tumor characteristics such as solid components, imaging findings, and sometimes involvement of adjacent structures.

Answer 148

A

D. Tumor rupture improves survival compared to intact tumors.

Rationale:

Tumor rupture allows cancer cells to spread within the peritoneal cavity, worsening prognosis.
Spontaneous rupture before surgery has a poorer prognosis than surgical rupture (IC1 staging).
Intact tumors have a better survival rate than ruptured tumors.

Answer 149

A

C. Granulosa cell tumor

Rationale:

Granulosa cell tumors are estrogen-secreting tumors that can cause abnormal uterine bleeding, particularly in postmenopausal women.
They are also associated with endometrial hyperplasia and endometrial carcinoma.

Answer 150

A

A. The tumor is confined to one ovary.

Rationale:

In young patients desiring fertility preservation, conservative surgery is possible if the tumor is:
Confined to one ovary (Stage IA)
No capsular rupture
Well-differentiated
More advanced disease requires complete surgical removal.

Answer 151

A

A. Serous adenocarcinoma

Rationale:

High-grade serous carcinoma is the most common histologic type of fallopian tube cancer.
It originates from the fimbrial end of the fallopian tube and follows the TP53 mutation pathway.

Answer 152

A

A. Colposcopy, endometrial sampling, and dilatation & curettage

Rationale:

Atypical glandular cells (AGC) in a postmenopausal woman may indicate endometrial or cervical pathology.
Colposcopy, endometrial biopsy, and D&C are recommended to rule out malignancy.

Answer 153

A

A. Granulosa-theca cell tumor

Rationale:

Granulosa-theca cell tumors secrete estrogen, leading to precocious puberty in young patients.
Other tumors do not typically produce hormones.

Answer 154

A

A. Expectant management

Rationale:

Simple ovarian cysts <5 cm in premenopausal women are usually functional and resolve spontaneously.
Follow-up ultrasound in 6–8 weeks is recommended.

Answer 155

A

A. Ovarian cystectomy

Rationale:

Desmoid tumors are benign and can be managed with ovarian cystectomy.

Answer 156

A

A. Ovarian cancer

Rationale:

Ascites and an adnexal mass are highly suggestive of ovarian cancer.
Ovarian malignancies frequently present with peritoneal spread.

Answer 157

A

: E. All of the above

Rationale:

Epithelial ovarian tumors include serous, mucinous, endometrioid, and clear cell carcinomas.

Answer 158

A

E. All of the above

Rationale:

Germ cell tumors originate from primitive germ cells and include dysgerminoma, yolk sac tumor, teratomas, and embryonal carcinoma.

Answer 159

A

E. All of the above

Rationale:

Sex cord-stromal tumors originate from gonadal stroma and include granulosa cell tumors, Sertoli-Leydig tumors, and fibromas.

Answer 160

A

E. All of the above

Rationale:

Benign ovarian cysts in young women can be removed via laparoscopic cystectomy.

Answer 161

A

A. TAH-BSO and cancer staging

Rationale:

Ovarian cancer treatment requires complete cytoreduction and staging surgery.

Answer 162

A

A. Surgically

Rationale:

Ovarian cancer is staged surgically according to FIGO criteria.

Answer 163

A

A. Serous cystadenocarcinoma

Rationale:

CA-125 is primarily used as a tumor marker for serous ovarian carcinoma.

Answer 164

A

A. Serial values are used to assess response to treatment in malignant ovarian tumors

Rationale:

CA-125 is not used for screening but is useful for monitoring response to treatment in ovarian cancer.

Answer 165

A

A. Inhibin levels are elevated in granulosa cell tumors

Rationale:

Granulosa cell tumors secrete inhibin, which serves as a tumor marker.
β-hCG is associated with choriocarcinoma, not mucinous carcinoma.

Answer 166

A

A. Complete Hydatidiform Mole

Rationale:
Complete hydatidiform mole (CHM) is characterized by extensive hydropic degeneration of chorionic villi, giving the placenta a grape-like appearance due to edematous vesicles. There is no fetal tissue present, and trophoblastic proliferation is diffuse.

Answer 167

A

C. Invasive Mole

Rationale:
Invasive mole is a type of Gestational Trophoblastic Neoplasia (GTN) that invades the myometrium, causing destruction of uterine tissues and has potential for metastasis. It most commonly arises after a complete mole.

Answer 168

A

A. Complete Hydatidiform Mole

Rationale:
GTN most commonly arises after a complete mole (15-20% risk) compared to a partial mole (1-5% risk). Complete moles lack fetal tissue and exhibit diffuse trophoblastic proliferation, increasing the risk of malignancy.

Answer 169

A

A. Complete Hydatidiform Mole

Rationale:
Complete hydatidiform mole results from androgenesis, where the fertilized ovum has only paternal chromosomes. This occurs when an empty egg is fertilized by a sperm that duplicates its genome (46,XX) or when two sperm fertilize an empty ovum (46,XY or 46,XX from dispermy).

Answer 170

A

B. Partial Hydatidiform Mole

Rationale:
Partial hydatidiform moles result from triploidy (69,XXY, XXX, or XYY) and contain fetal embryonic tissue, unlike complete moles, which lack fetal development. Only some villi are edematous, distinguishing it from the diffuse involvement of a complete mole.

Answer 171

A

A. Complete Hydatidiform Mole

Rationale:
The hallmark of a complete hydatidiform mole is the presence of multiple hydropic vesicles (“grape-like clusters”), which are enlarged, edematous chorionic villi.

Answer 172

A

C. Molar Pregnancy

Rationale:
Key features of molar pregnancy:

Uterus size larger than gestational age
No fetal heart tones
Vaginal bleeding
β-hCG markedly elevated
Ultrasound: “Snowstorm appearance”

Answer 173

A

D. Hook Effect

Rationale:
The Hook Effect occurs when extremely high levels of β-hCG oversaturate the assay antibodies, leading to falsely negative or low pregnancy test results. It is commonly seen in molar pregnancies and GTN.

Answer 174

A

A. Snowstorm pattern

Rationale:
A complete hydatidiform mole appears as a heterogeneous, echogenic mass with numerous anechoic cystic spaces resembling a snowstorm on ultrasound.

Answer 175

A

C. p57 KIP2

Rationale:

p57 KIP2 is absent in complete moles because it is maternally expressed.
Partial moles and normal pregnancy express p57 KIP2, helping in diagnosis.

Answer 176

A

C. Suction Curettage

Rationale:
Suction curettage is the gold standard for managing hydatidiform moles, especially in women who want future pregnancies. It is less invasive than a hysterectomy.

Answer 177

A

B. Hysterectomy

Rationale:
In multiparous women or those ≥40 years old, hysterectomy is often preferred because:

Higher risk of GTN (due to age and prior pregnancies).
Definitive treatment (no risk of recurrence in the uterus).
Avoids need for close β-hCG monitoring.

Answer 178

A

C. Suction Curettage

Rationale:
Suction curettage is the gold standard for molar pregnancy treatment in women who want future pregnancies.

Answer 179

A

B. G5P5 (5014)

Rationale:

A molar pregnancy is classified as an abortion in TPAL.
The patient’s parity (P) increases by 1 after evacuation.

Answer 180

A

C. Gestational Trophoblastic Neoplasia (GTN)

Rationale:

GTN should be suspected in a post-molar pregnancy patient with persistent or irregular bleeding.
Diagnosis is confirmed by persistently elevated or plateauing β-hCG levels.

Answer 181

A

B. 48 hours

Rationale:
β-hCG levels double approximately every 48 hours in a progressing pregnancy, making this the best time to assess decline post-evacuation.

Answer 182

A

C. 9 weeks

Rationale:

Complete moles take longer to resolve than partial moles.
The median time for complete mole β-hCG normalization is 9 weeks.

Answer 183

A

B. 6 months

Rationale:

After β-hCG normalization, monthly monitoring for 6 months is required to detect GTN early.

Answer 184

A

D. Intrauterine Device (IUD)

Rationale:

IUDs are avoided until β-hCG is undetectable due to the risk of uterine perforation in an invasive mole.
Hormonal contraceptives are preferred for reliable pregnancy prevention.

Answer 185

A

C. Theca-lutein cysts < 6 cm

Rationale:

Large theca-lutein cysts (>6 cm) are a risk factor for GTN, but smaller cysts (<6 cm) are not.

Answer 186

A

A. Histologic criteria for molar pregnancy

Rationale:

GTN is diagnosed based on persistently elevated or rising β-hCG levels, not histology.

Answer 187

A

C. 7

Rationale:
A WHO score ≥7 is considered high risk, requiring multi-agent chemotherapy.

Answer 188

A

B. 2

Rationale:
Metastases to the upper vagina = Score 2 in WHO GTN Prognostic Scoring.

Answer 189

A

C. 3

Rationale:
Metastases to the lungs = Score 3 in WHO GTN Prognostic Scoring.

Answer 190

A

C. Placental Site Trophoblastic Tumor (PSTT)

Rationale:

PSTT originates from intermediate trophoblasts at the placental site, has low β-hCG levels, and is chemotherapy-resistant.

Answer 191

A

B. Invasive Mole

Rationale:

Invasive mole is the most common GTN following a hydatidiform mole (50% of cases).

Answer 192

A

A. Choriocarcinoma

Rationale:

Gestational choriocarcinoma is the most common GTN following term pregnancy or miscarriage (25% of cases).
It spreads hematogenously and has early metastases (lungs, vagina, brain, liver).

Answer 193

A

D. Epithelioid Trophoblastic Tumor (ETT)

Rationale:

ETT originates from chorionic-type intermediate trophoblasts and mainly affects the uterus.
Findings: Irregular vaginal bleeding, low β-hCG levels, chemotherapy resistance.

Answer 194

A

A. Stage I, Single-Agent Chemotherapy

Rationale:

Stage I: GTN confined to the uterus.
Best treatment: Single-agent chemotherapy (Methotrexate or Actinomycin D) for low-risk cases.

Answer 195

A

B. Partial Hydatidiform Mole

Rationale:

Partial moles have triploid karyotypes (69,XXY, 69,XXX, or 69,XYY).
Caused by dispermic fertilization (two sperm fertilizing one egg).
Contains fetal tissue unlike complete moles.

Answer 196

A

C. Placental tissues found in some areas of the endometrium

Rationale:

Complete moles do NOT contain fetal or placental tissues.
The trophoblastic proliferation is diffuse, with villi appearing as clusters of vesicles.

Answer 197

A

A. Hydropic and normal villi

Rationale:

Partial moles have mixed villous populations, with both normal and hydropic villi.
Fetal tissue is present in contrast to complete moles.

Answer 198

A

C. Hydropic and normal villi

Rationale:

Partial moles display irregularly swollen villi, normal villi, and fetal remnants.

Answer 199

A

D. AOTA (All of the Above)

Rationale:

Heavy vaginal bleeding due to trophoblastic overgrowth.
Excessive nausea/vomiting (hyperemesis gravidarum) due to high β-hCG.
Abdominal pain due to uterine distension.

Answer 200

A

A. Complete Hydatidiform Mole

Rationale:

Uterine overgrowth and trophoblastic invasion may cause mass effect on the rectum.

Answer 201

A

B. Partial Hydatidiform Mole

Rationale:

Partial moles are triploid (69,XXY, XXX, or XYY), resulting from dispermic fertilization.

Answer 202

A

B. Partial Hydatidiform Mole

Rationale:

Partial moles have less trophoblastic hyperplasia, lacking atypia compared to complete moles.

Answer 203

A

A. Complete Hydatidiform Mole

Rationale:

β-hCG levels in complete moles often exceed 100,000 mIU/mL.

Answer 204

A

A. Complete Hydatidiform Mole

Rationale:

Complete moles show diffuse trophoblastic hyperplasia, unlike partial moles.

Answer 205

A

A. Complete Hydatidiform Mole

Rationale:

15-20% of complete moles progress to GTN, whereas only 1-5% of partial moles do.

Answer 206

A

B. Stabilize the patient

Rationale:

Stabilization (IV fluids, blood transfusion if needed) is the priority before definitive management.

Answer 207

A

A. Complete Mole

Rationale:

The classic “grape-like” appearance is characteristic of complete hydatidiform mole.

Answer 208

A

A. Snowstorm appearance

Rationale:

“Snowstorm” sign on ultrasound is a hallmark of complete hydatidiform mole.

Answer 209

A

A. Suction Curettage

Rationale:

Preferred treatment for women desiring future fertility.

Answer 210

A

D. AOTA (All of the Above)

Rationale:

Chest X-ray: Detects lung metastases.
CBC: Assesses anemia from vaginal bleeding.
TFT: Screens for thyrotoxicosis secondary to high β-hCG.

Answer 211

A

A. Every 1-2 weeks

Rationale:

Weekly to biweekly β-hCG levels until they normalize, followed by monthly monitoring for 6 months.

Answer 212

A

A. Choriocarcinoma

Rationale:

Choriocarcinoma is composed of syncytiotrophoblasts, cytotrophoblasts, and intermediate trophoblasts.

Answer 213

A

A. Vaginal bleeding

Rationale:

Persistent or irregular vaginal bleeding is the most common symptom of GTN.
Other symptoms include pelvic pain, enlarged uterus, and metastatic symptoms (dyspnea, neurological deficits, etc.).

Answer 214

A

A. Lungs

Rationale:

GTN metastasizes most commonly to the lungs (80%), followed by the vagina (30%), pelvis (20%), liver (10%), and brain (10%).

Answer 215

A

A. Endometriosis

Rationale:

Choriocarcinoma arises from trophoblastic tissue, not from endometrial pathology like endometriosis.
Risk factors include prior molar pregnancy, miscarriage, term pregnancy, and advanced maternal age.

Answer 216

A

D. All of the above

Rationale:

All GTNs can occur in reproductive-age women, though PSTT and ETT are rarer than choriocarcinoma.

Answer 217

A

D. All of the above

Rationale:

GTN can occur after any pregnancy, including molar pregnancy, miscarriage, or term pregnancy.
50% of GTN follows molar pregnancy, 25% follows miscarriage, 25% follows normal pregnancy.

Answer 218

A

D. All of the above

Rationale:

Vaginal bleeding is a common feature of all GTNs, as they invade the endometrium and myometrium.

Answer 219

A

A. Gestational Choriocarcinoma

Rationale:

Gestational choriocarcinoma has the highest β-hCG levels due to its aggressive trophoblastic proliferation.
PSTT and ETT have lower β-hCG levels than choriocarcinoma.

Answer 220

A

D. All of the above

Rationale:

All three GTNs can form large tumor masses due to uncontrolled trophoblastic growth.

Answer 221

A

B. Placental Site Trophoblastic Tumor (PSTT)

Rationale:

PSTT shows mild cytologic atypia compared to choriocarcinoma, which exhibits more pleomorphism and hyperchromasia.

Answer 222

A

D. All of the above

Rationale:

All three GTNs can involve the uterine corpus, but PSTT and ETT are more locally invasive.

Answer 223

A

A. Anatomical staging

Rationale:

FIGO GTN staging is based on anatomical spread of disease (uterus, vagina, lungs, distant metastases).

Answer 224

A

A. Determine the risk for drug failure

Rationale:

The WHO Prognostic Scoring System predicts the likelihood of chemotherapy resistance.
Scores ≤6 are low risk (single-agent therapy), whereas scores ≥7 are high risk (multi-agent chemotherapy needed).