LE5 Gyne

Question 1

26. 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 1

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

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 2

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

1. 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 3

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

2. 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 4

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

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

Answer 5

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

4. 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 6

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

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

Answer 7

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

6. 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 8

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

7. 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 9

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

8. 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 10

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

9. 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 11

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

10. 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 12

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

11. 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 13

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

12. 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 14

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

13. 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 15

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

14. 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 16

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

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

Answer 17

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

16. 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 18

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

17. 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 19

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

18. 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 20

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

19. 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 21

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

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

Answer 22

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

21. 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 23

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

22. 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 24

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

23. 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 25

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

24. 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 26

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

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

Answer 27

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

Identify the raised pigmented lesion on the vulva.

Answer 28

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

27. 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 29

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

28. 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 30

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

29. 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 31

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

30. 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 32

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

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

Answer 33

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

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

Answer 34

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

26. 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 35

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

27. 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 36

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

28. 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 37

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

29. 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 38

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

30. 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 39

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

31. 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 40

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

32. 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 41

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

33. 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 42

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

39. 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 43

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

40. 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 44

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

41. 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 45

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

Question 46

42. 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 46

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

43. 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 47

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

46. 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 48

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

78. 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 49

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

79. 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 50

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

80. 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 51

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

81. 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 52

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

82. 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 53

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

83. 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 54

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

84. 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 55

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

85. 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 56

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

86. 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 57

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

97. 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 58

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

98. 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 59

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

99. 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 60

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

100. 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 61

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

33. 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 62

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

34. 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 63

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

35. 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 64

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.

Question 65

36. A patient on tamoxifen asks about the risk of endometrial cancer. What should you tell her? A. Routine endometrial biopsy is necessary every 6 months B. Transvaginal ultrasound should be done annually C. Routine lab work including CBC, calcium, and liver function tests should be done D. Endometrial biopsy is only needed if endometrial thickness exceeds 5 mm

Answer 65

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).

Question 66

37. What is the treatment of choice for vulvar basal cell carcinoma? A. Radiation therapy B. Wide local excision C. Radical vulvectomy D. Chemotherapy

Answer 66

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.

Question 67

38. Which of the following statements about endometrial cancer is TRUE? A. It is the most common genital tract malignancy in the Philippines B. It is the third most common genital tract malignancy in the Philippines C. It is always associated with HPV D. It has a poorer prognosis than cervical cancer

Answer 67

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.

Question 68

39. Conization is indicated for the diagnosis of women with HSIL based on a Pap smear under which condition? A. The limits of the lesion cannot be visualized with colposcopy B. The squamo-columnar junction is not visualized C. Endocervical curettage histologic findings are positive for CIN 2 or 3 D. All of the above

Answer 68

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.

Question 69

40. Endometrial carcinoma is generally regarded as a hormone-dependent neoplasm for which of the following reasons? A. It arises in a milieu of unopposed estrogen B. It is preceded by endometrial hyperplasia C. It responds to progestin therapy D. All of the above

Answer 69

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.

Question 70

41. Which of the following is synonymous with Endometrial Intraepithelial Neoplasia (EIN)? A. Simple hyperplasia B. Complex atypical hyperplasia C. Clear cell carcinoma D. Papillary serous carcinoma

Answer 70

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.

Question 71

42. A 40-year-old woman with vaginal bleeding is diagnosed with complex atypical hyperplasia. Which of the following is true? A. Endometrial biopsy has a 10% chance of revealing endometrial cancer B. Endometrial biopsy has a 42% chance of detecting concurrent endometrial cancer C. Complex hyperplasia has no risk of malignancy D. Simple hyperplasia is highly malignant

Answer 71

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).

Question 72

44. Complex hyperplasia with atypia is associated with which of the following? A. It has no risk of malignancy B. 10% of cases progress to endometrial carcinoma C. 42% of women with complex atypical hyperplasia have endometrial carcinoma D. It cannot be diagnosed with endometrial biopsy

Answer 72

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.

Question 73

5. Which of the following is NOT a diagnostic test for endometrial cancer? A. Endometrial biopsy B. Transvaginal ultrasound C. Dilatation & curettage (D&C) D. Keyes-punch biopsy

Answer 73

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.

Question 74

46. A 50-year-old postmenopausal woman has had intermittent vaginal bleeding for 7 months. Ultrasound reveals a 3.8 mm endometrial mass. What is the next step? A. Observation B. Endometrial biopsy C. Hormone therapy D. Repeat ultrasound in 6 months

Answer 74

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.

Question 75

47. A patient presents with irregular vaginal bleeding and is diagnosed with hyperplasia without atypia. What is the recommended management? A. Hysterectomy B. Chemotherapy C. Progestin therapy D. Radiation therapy

Answer 75

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.

Question 76

48. A 29-year-old obese, nulligravid woman is diagnosed with complex atypical hyperplasia. What is the best treatment option? A. Observation B. High-dose progestin with periodic endometrial sampling C. Immediate hysterectomy D. Radiation therapy

Answer 76

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.

Question 77

49. A 55-year-old woman presents with vaginal bleeding. A biopsy confirms the diagnosis of endometrial adenocarcinoma. Which statement is TRUE? A. It is the most common genital malignancy B. It primarily occurs in premenopausal women C. It is associated with poor prognosis due to early metastasis D. High tumor grade, advanced stage, and lymphovascular invasion worsen prognosis

Answer 77

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

Question 78

50. Which histologic type of endometrial carcinoma has the WORST prognosis? A. Endometrioid adenocarcinoma B. Mucinous carcinoma C. Papillary serous carcinoma D. Clear cell carcinoma

Answer 78

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.

Question 79

51. A solid tumor is found on the endometrium with involvement of the cervical stroma. What is the FIGO stage? A. Stage IA B. Stage IB C. Stage II D. Stage IIIA

Answer 79

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.

Question 80

52. A 49-year-old woman undergoes surgery for endometrial cancer. A 2x3 cm tumor is found in the endometrium with NO myometrial invasion. What is the FIGO stage? A. Stage IA B. Stage IB C. Stage II D. Stage III

Answer 80

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.

Question 81

53. What is the best treatment option for a postmenopausal woman with confirmed Stage IA endometrial carcinoma? A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) B. Chemotherapy C. Radiation therapy only D. Hormonal therapy with progestins

Answer 81

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).

Question 82

53. What is the estimated 5-year survival rate for a patient with Stage IA endometrial carcinoma? A. 50% B. 70% C. 90% D. 40%

Answer 82

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.

Question 83

54. A patient’s tumor is well-differentiated with less than 5% solid components. What is the tumor grade? A. Grade 1 B. Grade 2 C. Grade 3 D. High grade

Answer 83

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

Question 84

55. Which of the following is considered a poor prognostic factor EXCEPT? A. Papillary serous carcinoma B. Clear cell carcinoma C. Poorly differentiated carcinoma D. Typical endometrioid adenocarcinoma

Answer 84

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.

Question 85

56. A patient with endometrial cancer presents with enlarged inguinal lymph nodes. What is the most likely route of spread? A. Bloodstream B. Round ligament C. Fallopian tubes D. Peritoneal fluid

Answer 85

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)

Question 86

57. What is the primary treatment for endometrial carcinoma? A. Chemotherapy B. Radiation therapy C. Concurrent chemoradiation D. Surgery

Answer 86

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.

Question 87

What is the most important predictor of survival in endometrial sarcoma? A. Tumor grading B. Histologic type C. Stage D. Age of the patient

Answer 87

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.

Question 88

59. A 48-year-old woman with endometrial stromal sarcoma (ESS) is found to have estrogen and progesterone receptors. What does this indicate? A. Resistance to hormone therapy B. Tumor is aggressive and unresponsive to treatment C. Tumor may respond to hormonal therapy D. No clinical significance

Answer 88

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.

Question 89

60. A 41-year-old woman undergoes total hysterectomy for a uterine mass. Histopathology shows >5 mitoses per 10 HPF. What is the most likely diagnosis? A. Endometrial carcinoma B. Endometrial stromal sarcoma C. Leiomyosarcoma D. Adenomyosis

Answer 89

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).

Question 90

61. What is the estimated lifetime risk for an individual to develop ovarian cancer? A. 0.5% B. 1.3% C. 5% D. 10%

Answer 90

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.

Question 91

62. An endometrial mass composed of both carcinomatous and sarcomatous elements is known as which of the following? A. Leiomyosarcoma B. Endometrial stromal sarcoma C. Mixed Müllerian tumor D. Clear cell carcinoma

Answer 91

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.

Question 92

59. A 48-year-old woman with Endometrial Stromal Sarcoma (ESS) is found to have estrogen and progesterone receptors. What is the clinical significance of this finding? A. The tumor is aggressive and unresponsive to treatment B. The tumor is resistant to hormonal therapy C. The tumor may respond to hormonal therapy D. No clinical significance

Answer 92

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)

Question 93

1. A 56-year-old woman presents with a 2 cm ulcerating lesion at the right labia majora, present for 5 months. A punch biopsy reveals squamous cell carcinoma. What is the most likely site of metastasis? A. Inguinal lymph nodes B. Para-aortic lymph nodes C. Pelvic lymph nodes D. Liver E. Lungs

Answer 93

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

Question 94

2. A 60-year-old woman presents with postmenopausal bleeding and is diagnosed with endometrial cancer after endometrial sampling. Which of the following is a risk factor for endometrial carcinoma? A. Nulliparity B. Diabetes C. Early menopause D. HPV infection E. Smoking

Answer 94

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.

Question 95

3. A 53-year-old woman with a history of stage 2 breast cancer has been taking tamoxifen for 3 years and complains of vaginal spotting. A transvaginal ultrasound shows thickened endometrium. What is the next best step? A. Observe, the transvaginal ultrasound might be a false positive B. Endometrial biopsy C. Repeat transvaginal ultrasound in 6 months D. Start progestin therapy E. Hysteroscopy

Answer 95

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.

Question 96

4. What autosomal dominant syndrome is characterized by germline defects in DNA repair genes and predisposes individuals to a 40-60% chance of developing endometrial and colon cancer? A. Lynch syndrome B. Li-Fraumeni syndrome C. BRCA1 mutation D. Cowden syndrome E. Peutz-Jeghers syndrome

Answer 96

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).

Question 97

5. Which of the following should be advised to a patient diagnosed with Lynch syndrome? A. Annual transvaginal ultrasound B. Routine endometrial biopsy every 10 years C. CA-125 monitoring D. Avoidance of OCPs E. Pelvic MRI every 5 years

Answer 97

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

Question 98

6. Which of the following increases the risk of endometrial cancer? A. Menopause at age 55 B. Multiparity C. Early menopause D. Use of combination OCPs E. Low BMI

Answer 98

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

Question 99

7. Which condition is synonymous with Endometrial Intraepithelial Neoplasia (EIN)? A. Complex hyperplasia with atypia B. Simple hyperplasia without atypia C. Endometrial stromal sarcoma D. Clear cell carcinoma E. Papillary serous carcinoma

Answer 99

✅ 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.

Question 100

11. A 40-year-old woman presents with vaginal bleeding and is diagnosed with complex atypical hyperplasia. Which of the following is true? A. Endometrial biopsy can have a 40% chance of detecting endometrial carcinoma B. Complex atypical hyperplasia always progresses to cancer C. Endometrial carcinoma is unlikely to develop in this patient D. The patient should be managed with observation only E. Complex atypical hyperplasia is considered benign

Answer 100

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).

Question 101

12. Which of the following is NOT a diagnostic test for endometrial cancer? A. Keyes-punch biopsy B. Endometrial biopsy C. Transvaginal ultrasound D. Dilatation & curettage (D&C) E. Hysteroscopy

Answer 101

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

Question 102

13. A 50-year-old postmenopausal woman has had intermittent vaginal bleeding for several months. Ultrasound reveals a 3.8 mm endometrial mass. What is the next step in management? A. Biopsy B. Observe and repeat ultrasound in 6 months C. Prescribe progesterone therapy D. Perform a hysterectomy immediately E. Reassure the patient and advise lifestyle modification

Answer 102

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.

Question 103

23. A 45-year-old G0 woman with a history of hypertension, diabetes, and PCOS presents with 2 weeks of vaginal bleeding. She has atrophic endometrial cells and was given estrogen-replacement therapy. Three months later, she experiences another episode of bleeding. What is the next best step? A. Assure that this is normal B. Start estrogen-progesterone therapy C. Perform an endometrial biopsy D. Increase the dose of estrogen therapy

Answer 103

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.

Question 104

24. A 29-year-old woman with hypertension and diabetes is diagnosed with Stage I endometrial carcinoma. What is the best therapeutic management? A. Chemotherapy B. Radiation therapy C. Progesterone therapy D. Surgery

Answer 104

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.

Question 105

25. A 35-year-old woman is diagnosed with endometrial cancer. Which of the following conditions is most likely present? A. Polycystic Ovarian Syndrome (PCOS) B. HPV infection C. BRCA1 mutation D. Smoking history

Answer 105

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.

Question 106

21. What is the primary treatment for endometrial cancer? A. Chemotherapy B. Radiation therapy C. Hormonal therapy D. Surgery E. Observation

Answer 106

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.

Question 107

23. A 45-year-old G0 woman with a history of hypertension, diabetes, and PCOS presents with 2 weeks of vaginal bleeding. She has atrophic endometrial cells and was given estrogen-replacement therapy. Three months later, she experiences another episode of bleeding. What is the next best step? A. Assure that this is normal B. Start estrogen-progesterone therapy C. Perform an endometrial biopsy D. Increase the dose of estrogen therapy

Answer 107

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.

Question 108

22. A patient is diagnosed with Stage 4A endometrial cancer. What is the extent of disease at this stage? A. Tumor invades the bladder and/or bowel mucosa B. Tumor is confined to the uterus C. Tumor has spread to the para-aortic lymph nodes D. Tumor has metastasized to the liver and lungs E. Tumor has spread to the cervix only

Answer 108

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.)

Question 109

24. A 29-year-old woman with hypertension and diabetes is diagnosed with Stage I endometrial carcinoma. What is the best therapeutic management? A. Chemotherapy B. Radiation therapy C. Progesterone therapy D. Surgery

Answer 109

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.

Question 110

59. A 48-year-old woman with Endometrial Stromal Sarcoma (ESS) has Estrogen-Progesterone receptors. Which of the following best describes the role of these receptors in cancer development? A. They function as oncogenes that suppress tumor growth. B. They allow cancer cells to attach to surrounding tissues. C. They are proteins that bind to hormones and promote tumor growth. D. They directly cause mutations in DNA.

Answer 110

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.

Question 111

60. A 41-year-old woman who underwent total hysterectomy with bilateral salpingo-oophorectomy (THBSO) was diagnosed with a tumor with >5 mitoses per high-power field. What is the most likely diagnosis? A. Leiomyoma B. Leiomyosarcoma C. Endometrial Stromal Sarcoma D. Adenosarcoma

Answer 111

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.

Question 112

61. What is an individual's lifetime risk of developing ovarian cancer? A. 0.5% B. 1.3% C. 5% D. 10%

Answer 112

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.

Question 113

62. An endometrial mass composed of both carcinomatous and sarcomatous components is classified as which type of tumor? A. Endometrial Stromal Sarcoma B. Leiomyosarcoma C. Carcinosarcoma D. Adenomyoma

Answer 113

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.

Question 114

63. The majority of ovarian cancers arise from which of the following? A. Genetic mutations (BRCA1/BRCA2) B. Hereditary syndromes C. Sporadic events D. Hormonal exposure

Answer 114

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).

Question 115

64. Which theory states that ovarian cancer is caused by repeated monthly damage due to ovulation? A. Incessant Ovulation Hypothesis B. Estrogen-Progesterone Hypothesis C. Ovarian Stem Cell Theory D. Serous Tubal Origin Theory

Answer 115

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).

Question 116

65. The Fallopian Tube Theory of Ovarian Cancer states that a precursor lesion in the fimbriae contributes to high-grade serous carcinoma. What is this lesion called? A. Endosalpingiosis B. Mesenchymal atypical cells C. Serous Tubal Intraepithelial Carcinoma (STIC) D. Papillary Serous Carcinoma

Answer 116

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.

Question 117

66. All of the following cancers originate from the ovarian stroma, EXCEPT: A. Serous Adenocarcinoma B. Epidermoid Carcinoma C. Sertoli-Leydig Cell Tumor D. Mucinous Carcinoma

Answer 117

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.

Question 118

67. Which of the following is associated with a decreased risk of ovarian cancer? A. Smoking B. Late menopause C. Long-term oral contraceptive (OCP) use D. Endometriosis

Answer 118

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.

Question 119

68. BRCA1 and BRCA2 mutations are associated with which hereditary cancer syndrome? A. None B. Hereditary Breast and Ovarian Cancer Syndrome C. Li-Fraumeni Syndrome D. Lynch Syndrome

Answer 119

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.

Question 120

69. A 71-year-old woman presents with abdominal enlargement and ascites. What is the next best step in diagnosis? A. X-ray B. Transvaginal Ultrasound C. Pelvic Examination D. MRI

Answer 120

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.

Question 121

70. A patient presents with an ovarian cystic mass that has no solid components and no blood flow. What is the most likely diagnosis? A. Malignant ovarian tumor B. Benign ovarian mass C. Serous cystadenocarcinoma D. Dysgerminoma

Answer 121

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.

Question 122

71. What is the most common ovarian malignancy among women of reproductive age? A. Mucinous Carcinoma B. Serous Adenocarcinoma C. Clear Cell Carcinoma D. Granulosa Cell Tumor

Answer 122

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.

Question 123

72. What is the most common malignant germ cell tumor of the ovary? A. Yolk Sac Tumor B. Immature Teratoma C. Dysgerminoma D. Choriocarcinoma

Answer 123

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.

Question 124

73. During surgery, the tissue surrounding the tumor breaks, potentially spreading cancer to the abdomen and pelvis. What is the correct FIGO stage? A. Stage IA B. Stage IC1 C. Stage IC2 D. Stage II

Answer 124

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.

Question 125

74. A patient with large abdominal masses and pleural effusion in one lung is classified under which FIGO stage? A. Stage IIIA B. Stage IIIB C. Stage IVA D. Stage IVB

Answer 125

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.

Question 126

75. What is the main histologic criterion that differentiates low malignant potential (LMP) ovarian tumors from invasive carcinoma? A. Nuclear atypia B. Absence of stromal invasion C. High mitotic rate D. Necrosis and hemorrhage

Answer 126

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.

Question 127

76. A 50-year-old woman underwent total hysterectomy with bilateral salpingo-oophorectomy (THBSO) for a low malignant potential (LMP) tumor. What is the best management? A. Chemotherapy B. Radiation therapy C. Regular follow-up D. Hormonal therapy

Answer 127

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.

Question 128

77. High-grade serous carcinoma arises from the fimbriated end of the fallopian tube through which molecular pathway? A. BRCA1/BRCA2 B. TP53 mutation pathway C. PI3K-AKT pathway D. Lynch syndrome pathway

Answer 128

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.

Question 129

78. What is the third most common genital tract malignancy in the Philippines? A. Cervical cancer B. Ovarian cancer C. Endometrial cancer D. Vaginal cancer

Answer 129

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.

Question 130

79. A 53-year-old woman undergoing surgery for ovarian cancer was diagnosed with endometriosis 10 years ago. What malignancy is associated with this history? A. Serous carcinoma B. Clear cell carcinoma C. Endometrioid adenocarcinoma D. Mucinous carcinoma

Answer 130

B. Clear cell carcinoma

Question 131

80. A 46-year-old woman presents with abdominal enlargement, a benign ovarian tumor, and pleural effusion. What is the likely diagnosis? A. Serous cystadenoma B. Thecoma C. Fibroma D. Meigs Syndrome

Answer 131

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.

Question 132

81. What is the most common germ cell tumor, characterized by the ability to produce adult tissues? A. Dysgerminoma B. Immature teratoma C. Dermoid cyst (Mature cystic teratoma) D. Yolk sac tumor

Answer 132

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.

Question 133

82. A 28-year-old woman presents with urinary frequency and a 9 cm benign ovarian tumor. What is the best treatment? A. Oophorectomy B. Oophorocystectomy C. Chemotherapy D. Radiation therapy

Answer 133

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.

Question 134

83. Which histologic ovarian cancer type is characterized by "hobnail cells"? A. Clear cell carcinoma B. Serous carcinoma C. Mucinous carcinoma D. Endometrioid carcinoma

Answer 134

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.

Question 135

84. What is the standard treatment for ovarian cancer? A. Surgery B. Chemotherapy C. Radiation therapy D. Targeted therapy

Answer 135

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.

Question 136

86. What is the most frequently found tissue in an immature teratoma? A. Bone B. Neural tissue C. Cartilage D. Skin

Answer 136

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.

Question 137

85. A 15-year-old girl presents with abdominal enlargement. What tumor markers should be ordered? A. CA-125 B. hCG, AFP, LDH, CA-125 C. BRCA1/2 D. CEA

Answer 137

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.

Question 138

87. The prognosis for patients with immature teratoma depends on which factor? A. Amount of mature and immature tissue B. Age at diagnosis C. Stage and grade D. Tumor location

Answer 138

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.

Question 139

88. This rare benign ovarian tumor contains thyroid tissue in more than 50% of the overall tumor. A. Mature cystic teratoma B. Struma ovarii C. Dysgerminoma D. Brenner tumor

Answer 139

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.

Question 140

89. A 28-year-old nulligravid woman presents with abdominal pain. A 10x9 cm solid ovarian mass is found. What is the most common malignant neoplasm detected in pregnancy? A. Endometrioid carcinoma B. Yolk sac tumor C. Dysgerminoma D. Serous adenocarcinoma

Answer 140

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.

Question 141

90. What histologic feature is characteristic of yolk sac tumors? A. Call-Exner bodies B. Psammoma bodies C. Schiller-Duval bodies D. Hobnail cells

Answer 141

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.

Question 142

91. What is the tumor marker of choice for granulosa cell tumors? A. CA-125 B. β-hCG C. Inhibin D. LDH

Answer 142

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.

Question 143

92. A 22-year-old nulligravid woman has a tumor involving the left ovary with visible tumor nodules. What is the next step? A. Hysterectomy with bilateral salpingo-oophorectomy B. Left salpingo-oophorectomy (LSO) C. Chemotherapy D. Cancer staging

Answer 143

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.

Question 144

93. A 51-year-old G2 woman presents with abdominal enlargement and vaginal bleeding. What is the most likely ovarian tumor? A. Serous cystadenoma B. Mucinous carcinoma C. Granulosa cell tumor D. Thecoma

Answer 144

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.

Question 145

94. Which statement is true about hydrops in fallopian tube cancer? A. It is associated with high fever and infection. B. It is characterized by cyclical pain relieved by the passage of vaginal discharge. C. It is always associated with Latzko’s triad. D. It does not cause any symptoms.

Answer 145

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.

Question 146

95. Which of the following is true about Latzko’s triad? A. It is pathognomonic for fallopian tube cancer but is present in only 15% of cases. B. It includes postmenopausal bleeding, fever, and pelvic mass. C. It is seen in over 90% of cases of fallopian tube carcinoma. D. It is used to diagnose ovarian cancer.

Answer 146

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.

Question 147

96. The following criteria should be satisfied for diagnosing an ovarian tumor, EXCEPT: A. The uterus and ovaries are normal in size. B. The tumor has a solid component. C. The fallopian tube is involved. D. The mass is detected on imaging.

Answer 147

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.

Question 148

97. The following is true about ovarian rupture during surgery, EXCEPT: A. Tumor rupture worsens prognosis by spreading cancer cells. B. Spontaneous tumor rupture has a poorer prognosis than intraoperative rupture. C. Ruptured tumors are staged as FIGO IC1. D. Tumor rupture improves survival compared to intact tumors.

Answer 148

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.

Question 149

98. A 51-year-old G2 woman presents with abdominal enlargement and vaginal bleeding. What is the most likely ovarian tumor? A. Serous cystadenocarcinoma B. Mucinous carcinoma C. Granulosa cell tumor D. Thecoma

Answer 149

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.

Question 150

99. A young patient undergoing surgery for epithelial ovarian cancer (EOC) may retain her uterus and contralateral ovary if: A. The tumor is confined to one ovary. B. There is evidence of capsule rupture. C. The tumor is poorly differentiated. D. The cancer has spread to the peritoneum.

Answer 150

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.

Question 151

100. What is the most common histologic type found in fallopian tube cancer? A. Serous adenocarcinoma B. Endometrioid carcinoma C. Mucinous carcinoma D. Clear cell carcinoma

Answer 151

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.

Question 152

47. A 48-year-old healthy postmenopausal woman undergoes a Pap smear, which reveals atypical glandular cells. She has no history of abnormal Pap smears. What is the next best step? A. Colposcopy, endometrial sampling, and dilatation & curettage B. Repeat Pap smear in 6 months C. Transvaginal ultrasound D. HPV co-testing E. Observation

Answer 152

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.

Question 153

48. A 15-year-old girl presents with breast enlargement and vaginal bleeding. Imaging reveals an 8 cm pelvic mass. What is the most likely etiology? A. Granulosa-theca cell tumor B. Dysgerminoma C. Yolk sac tumor D. Serous cystadenoma E. Mature teratoma

Answer 153

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.

Question 154

49. A 25-year-old woman is noted to have a 4 cm simple ovarian cyst on ultrasound. She has no pain, nausea, or vomiting. What is the next step? A. Expectant management B. Immediate surgical removal C. Chemotherapy D. Hormonal therapy E. Laparotomy

Answer 154

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.

Question 155

51. What is the best treatment for a suspected desmoid tumor in an 18-year-old nulliparous woman? A. Ovarian cystectomy B. Hysterectomy C. Chemotherapy D. Radiation therapy E. Tamoxifen

Answer 155

A. Ovarian cystectomy Rationale: Desmoid tumors are benign and can be managed with ovarian cystectomy.

Question 156

52. A 55-year-old woman presents with an abdominal mass and increased abdominal girth. On examination, there is shifting dullness and a fluid wave. What is the most likely malignancy? A. Ovarian cancer B. Endometrial cancer C. Cervical cancer D. Uterine sarcoma E. Breast cancer

Answer 156

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

Question 157

53. Which of the following are epithelial ovarian tumors? A. Endometrioid tumor B. Serous cystadenocarcinoma C. Mucinous cystadenoma D. Clear cell carcinoma E. All of the above

Answer 157

: E. All of the above Rationale: Epithelial ovarian tumors include serous, mucinous, endometrioid, and clear cell carcinomas.

Question 158

54. Which of the following are germ cell tumors of the ovary? A. Dysgerminoma B. Yolk sac tumor C. Immature teratoma D. Embryonal carcinoma E. All of the above

Answer 158

E. All of the above Rationale: Germ cell tumors originate from primitive germ cells and include dysgerminoma, yolk sac tumor, teratomas, and embryonal carcinoma.

Question 159

55. Which of the following are sex cord-stromal tumors of the ovary? A. Sertoli-Leydig tumor B. Granulosa cell tumor C. Thecoma D. Fibroma E. All of the above

Answer 159

E. All of the above Rationale: Sex cord-stromal tumors originate from gonadal stroma and include granulosa cell tumors, Sertoli-Leydig tumors, and fibromas.

Question 160

56. Which ovarian tumor is treated with laparoscopic ovarian cystectomy in a premenopausal woman? A. Endometriotic cyst B. Serous cystadenoma C. Mucinous cystadenoma D. Dermoid cyst E. All of the above

Answer 160

E. All of the above Rationale: Benign ovarian cysts in young women can be removed via laparoscopic cystectomy.

Question 161

57. A 40-year-old G3P3 presents with 3 months of abdominal enlargement. Imaging suggests ovarian cancer with possible omental metastasis. What type of surgery is recommended? A. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and cancer staging B. Ovarian cystectomy C. Unilateral salpingo-oophorectomy D. Omentectomy alone E. Chemotherapy first

Answer 161

A. TAH-BSO and cancer staging Rationale: Ovarian cancer treatment requires complete cytoreduction and staging surgery.

Question 162

4. How is carcinoma of the ovary staged? A. Surgically B. Clinically C. By tumor markers D. By imaging alone E. By biopsy

Answer 162

A. Surgically Rationale: Ovarian cancer is staged surgically according to FIGO criteria.

Question 163

65. CA-125 is elevated in which type of ovarian cancer? A. Serous cystadenocarcinoma B. Mucinous carcinoma C. Clear cell carcinoma D. Endometrioid carcinoma E. All of the above

Answer 163

A. Serous cystadenocarcinoma Rationale: CA-125 is primarily used as a tumor marker for serous ovarian carcinoma.

Question 164

66. Which of the following is true regarding CA-125? A. Serial values are used to assess response to treatment in malignant ovarian tumors B. It is useful for screening in asymptomatic women C. It is highly specific for ovarian cancer D. It is not elevated in any benign conditions E. It is only used in postmenopausal women

Answer 164

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.

Question 165

67. Which of the following is true regarding tumor markers in ovarian tumors? A. Inhibin levels are elevated in granulosa cell tumors B. β-hCG is a marker for mucinous carcinoma C. CA-125 is specific for all ovarian cancers D. LDH is elevated in epithelial ovarian cancer E. AFP is specific for dysgerminomas

Answer 165

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.

Question 166

71. What type of Gestational Trophoblastic Disease (GTD) is characterized by an extensively edematous placenta? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Invasive Mole D. Placental Site Trophoblastic Tumor

Answer 166

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.

Question 167

72. What type of GTD is deemed malignant due to its marked penetration and destruction of the myometrium, with the ability to metastasize? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Invasive Mole D. Placental Site Trophoblastic Tumor

Answer 167

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.

Question 168

73. Which type of hydatidiform mole has the highest risk of progressing to Gestational Trophoblastic Neoplasia (GTN)? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Both A and B D. None of the above

Answer 168

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.

Question 169

74. Which type of mole results from androgenesis? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Both A and B D. None of the above

Answer 169

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).

Question 170

75. Which type of hydatidiform mole does not involve the entire placenta and contains fetal embryonic tissue? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Both A and B D. None of the above

Answer 170

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.

Question 171

76. Which type of mole is characterized by a cluster of vesicles with variable dimensions? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Both A and B D. None of the above

Answer 171

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.

Question 172

77. A 18-year-old G1P0 presents with vaginal bleeding after 4 months of amenorrhea. Physical exam reveals an enlarged uterus (20-22 weeks AOG) with no fetal heart tones. What is the most likely diagnosis? A. Ectopic Pregnancy B. Threatened Abortion C. Molar Pregnancy D. A & B

Answer 172

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"

Question 173

78. A negative pregnancy test despite very high β-hCG levels is due to what phenomenon? A. Braxton Hicks Effect B. Ferguson Effect C. Ferning Effect D. Hook Effect

Answer 173

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.

Question 174

79. What is the sonographic appearance of a molar pregnancy? A. Snowstorm pattern B. Ground-glass appearance C. Double-ring sign D. Railroad track sign

Answer 174

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

Question 175

80. Immunostaining used to differentiate complete moles from partial moles? A. p53 B. p16 C. p57 KIP2 D. Ki-67

Answer 175

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.

Question 176

81. A 22-year-old G1P0 presents at 14 weeks with vaginal bleeding and is diagnosed with a molar pregnancy. What is the preferred treatment? A. Methotrexate B. Hysterectomy C. Suction Curettage D. Wait and monitor

Answer 176

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.

Question 177

2. A 40-year-old G6P5 (5-0-0-5) at 14 weeks is diagnosed with a molar pregnancy. What is the most appropriate management? A. Methotrexate B. Hysterectomy C. Suction Curettage D. Observation

Answer 177

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.

Question 178

83. A 37-year-old G2P1 (1001) at 18 weeks is diagnosed with a molar pregnancy. What is the preferred treatment? A. Methotrexate B. Hysterectomy C. Suction Curettage D. Expectant Management

Answer 178

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

Question 179

84. A 35-year-old G5P4 (4014) is in her 4th week post-suction curettage for a molar pregnancy. How should this be considered in the TPAL system? A. G5P4 (4014) B. G5P5 (5014) C. G6P5 (5015) D. G5P4 (4015)

Answer 179

B. G5P5 (5014) Rationale: A molar pregnancy is classified as an abortion in TPAL. The patient’s parity (P) increases by 1 after evacuation.

Question 180

85. A patient 4 weeks postpartum after curettage for molar pregnancy presents to the ER for irregular bleeding. PE reveals a uterus undergoing normal involution. What is the most likely diagnosis? A. Retained Products of Conception B. Incomplete Abortion C. Gestational Trophoblastic Neoplasia (GTN) D. Endometritis

Answer 180

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.

Question 181

86. When is the best time to obtain β-hCG levels post-evacuation of a molar pregnancy? A. 24 hours B. 48 hours C. 72 hours D. 1 week

Answer 181

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.

Question 182

87. What is the median time for β-hCG resolution in a complete molar pregnancy? A. 6 weeks B. 7 weeks C. 9 weeks D. 12 weeks

Answer 182

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.

Question 183

88. Once β-hCG becomes undetectable, how long should monthly β-hCG measurements continue? A. 3 months B. 6 months C. 9 months D. 12 months

Answer 183

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

Question 184

89. What form of contraception should NOT be used immediately after molar pregnancy evacuation? A. Oral Contraceptive Pills (OCP) B. Injectable Medroxyprogesterone Acetate C. Progestin Implant D. Intrauterine Device (IUD)

Answer 184

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.

Question 185

0. Which of the following is NOT a risk factor for Gestational Trophoblastic Neoplasia (GTN)? A. β-hCG level > 100,000 mIU/mL B. Uterine size larger than gestational age C. Theca-lutein cysts < 6 cm D. Slow decline in β-hCG levels

Answer 185

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.

Question 186

91. All of the following are criteria for the diagnosis of GTN EXCEPT? A. Histologic criteria for molar pregnancy B. Plateau of serum β-hCG for 3 weeks C. Serum β-hCG remains detectable for 6 months D. Rise of serum β-hCG by >10% over 3 readings

Answer 186

A. Histologic criteria for molar pregnancy Rationale: GTN is diagnosed based on persistently elevated or rising β-hCG levels, not histology.

Question 187

92. In the WHO Prognostic Scoring System for GTN, what score is considered high risk? A. 5 B. 6 C. 7 D. 10

Answer 187

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

Question 188

93. If GTN involves the upper vagina, what is the WHO Prognostic Score? A. 1 B. 2 C. 3 D. 4

Answer 188

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

Question 189

94. If GTN involves the lungs, what is the WHO Prognostic Score? A. 1 B. 2 C. 3 D. 4

Answer 189

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

Question 190

96. Which GTN arises from intermediate trophoblasts at the placental site? A. Choriocarcinoma B. Invasive Mole C. Placental Site Trophoblastic Tumor (PSTT) D. Epitheloid Trophoblastic Tumor (ETT)

Answer 190

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.

Question 190

95. What is the most common Gestational Trophoblastic Neoplasia (GTN) that frequently follows a hydatidiform mole? A. Choriocarcinoma B. Invasive Mole C. Placental Site Trophoblastic Tumor D. Epitheloid Trophoblastic Tumor

Answer 190

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

Question 191

97. Which GTN most commonly follows a term pregnancy or miscarriage? A. Choriocarcinoma B. Invasive Mole C. Placental Site Trophoblastic Tumor D. Epitheloid Trophoblastic Tumor

Answer 191

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).

Question 192

98. Which Gestational Trophoblastic Neoplasia (GTN) develops from chorionic-type intermediate trophoblast? A. Choriocarcinoma B. Invasive Mole C. Placental Site Trophoblastic Tumor (PSTT) D. Epithelioid Trophoblastic Tumor (ETT)

Answer 192

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.

Question 193

99. A 38-year-old G2P1 (1001) is diagnosed with an invasive mole confined to the uterus. What FIGO stage is this, and what is the best treatment option? A. Stage I, Single-Agent Chemotherapy B. Stage II, Multi-Agent Chemotherapy C. Stage III, EMA-CO D. Stage IV, High-Risk Chemotherapy

Answer 193

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.

Question 194

100. Which type of hydatidiform mole has a karyotype of 69,XY? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Invasive Mole D. Choriocarcinoma

Answer 194

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.

Question 195

31. The following are macroscopic descriptions of complete hydatidiform mole EXCEPT: A. Enlarged, edematous villi forming grape-like vesicles B. No fetal or embryonic tissue C. Placental tissues found in some areas of the endometrium D. Uterine enlargement beyond gestational age

Answer 195

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.

Question 196

32. Which of the following is a microscopic description of partial hydatidiform mole? A. Hydropic and normal villi B. Diffuse trophoblastic hyperplasia C. No fetal or embryonic tissue D. Enlarged edematous villi

Answer 196

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.

Question 197

33. Which of the following is a microscopic description of partial hydatidiform mole? A. Diffuse trophoblastic hyperplasia B. Presence of fetal tissue C. Hydropic and normal villi D. Avascular villi

Answer 197

C. Hydropic and normal villi Rationale: Partial moles display irregularly swollen villi, normal villi, and fetal remnants.

Question 198

4. What are the classic features of molar pregnancy? A. Vaginal bleeding B. Hyperemesis C. Abdominal pain D. AOTA (All of the Above)

Answer 198

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.

Question 199

35. Fecal incontinence is most commonly associated with: A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Invasive Mole D. Choriocarcinoma

Answer 199

A. Complete Hydatidiform Mole Rationale: Uterine overgrowth and trophoblastic invasion may cause mass effect on the rectum.

Question 200

36. Which GTD is associated with a triploid karyotype? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Choriocarcinoma D. Placental Site Trophoblastic Tumor

Answer 200

B. Partial Hydatidiform Mole Rationale: Partial moles are triploid (69,XXY, XXX, or XYY), resulting from dispermic fertilization.

Question 201

37. Which GTD lacks atypia in histology? A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Choriocarcinoma D. Invasive Mole

Answer 201

B. Partial Hydatidiform Mole Rationale: Partial moles have less trophoblastic hyperplasia, lacking atypia compared to complete moles.

Question 202

38. Markedly elevated β-hCG is most associated with: A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Normal Pregnancy D. Threatened Abortion

Answer 202

A. Complete Hydatidiform Mole Rationale: β-hCG levels in complete moles often exceed 100,000 mIU/mL.

Question 203

39. Diffuse trophoblastic invasion is characteristic of: A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Choriocarcinoma D. Placental Site Trophoblastic Tumor

Answer 203

A. Complete Hydatidiform Mole Rationale: Complete moles show diffuse trophoblastic hyperplasia, unlike partial moles.

Question 204

40. Post-molar malignancy sequelae is highest in: A. Complete Hydatidiform Mole B. Partial Hydatidiform Mole C. Epithelioid Trophoblastic Tumor D. Placental Site Trophoblastic Tumor

Answer 204

A. Complete Hydatidiform Mole Rationale: 15-20% of complete moles progress to GTN, whereas only 1-5% of partial moles do.

Question 205

41. A 30-year-old G4P2 (2012) at 16 weeks presents with profuse vaginal bleeding. BP: 80/60, CR: 105, RR: 24. What is the best initial step? A. Suction curettage B. Stabilize the patient C. Perform an immediate hysterectomy D. Obtain a β-hCG test

Answer 205

B. Stabilize the patient Rationale: Stabilization (IV fluids, blood transfusion if needed) is the priority before definitive management.

Question 206

42. A grape-like vesicular mass is found in the vaginal wall of a patient with an enlarged uterus (22 weeks AOG). What is the most likely diagnosis? A. Complete Mole B. Partial Mole C. Both A and B D. None of the above

Answer 206

A. Complete Mole Rationale: The classic "grape-like" appearance is characteristic of complete hydatidiform mole.

Question 207

43. What is the classic sonographic appearance of molar pregnancy? A. Snowstorm appearance B. Ground-glass appearance C. Double-ring sign D. Railroad track sign

Answer 207

A. Snowstorm appearance Rationale: "Snowstorm" sign on ultrasound is a hallmark of complete hydatidiform mole.

Question 208

44. What is the preferred management for molar pregnancy in a 30-year-old woman? A. Suction Curettage B. Hysterectomy C. Expectant Management D. Methotrexate

Answer 208

A. Suction Curettage Rationale: Preferred treatment for women desiring future fertility.

Question 209

45. What additional tests should be done in cases of molar pregnancy? A. CBC B. Chest X-ray C. Thyroid Function Tests (TFT) D. AOTA (All of the Above)

Answer 209

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.

Question 210

46. What is the recommended frequency for β-hCG monitoring post-molar evacuation? A. Every 1-2 weeks B. Every 3 weeks C. Every month D. Only once after evacuation

Answer 210

A. Every 1-2 weeks Rationale: Weekly to biweekly β-hCG levels until they normalize, followed by monthly monitoring for 6 months.

Question 211

47. Which malignant trophoblastic tumor consists of trimorphic proliferation of intermediate trophoblastic cells, syncytiotrophoblasts, and cytotrophoblasts? A. Choriocarcinoma B. Invasive Mole C. Placental Site Trophoblastic Tumor D. Epithelioid Trophoblastic Tumor

Answer 211

A. Choriocarcinoma Rationale: Choriocarcinoma is composed of syncytiotrophoblasts, cytotrophoblasts, and intermediate trophoblasts.

Question 212

48. What is the most common clinical manifestation of Gestational Trophoblastic Neoplasia (GTN)? A. Vaginal bleeding B. Persistent nausea and vomiting C. Pelvic pain D. Dyspnea E. Headache

Answer 212

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.).

Question 213

49. What is the most common site of metastasis for GTN? A. Lungs B. Liver C. Brain D. Kidneys

Answer 213

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

Question 214

50. Which of the following is NOT a risk factor for choriocarcinoma? A. Endometriosis B. Prior molar pregnancy C. History of miscarriage D. Advanced maternal age E. Prior term pregnancy

Answer 214

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.

Question 215

51. Which GTN occurs in reproductive-age women? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 215

D. All of the above Rationale: All GTNs can occur in reproductive-age women, though PSTT and ETT are rarer than choriocarcinoma.

Question 216

52. GTN that occurs after a previous pregnancy? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 216

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.

Question 217

53. Which GTN has vaginal bleeding as a clinical presentation? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 217

D. All of the above Rationale: Vaginal bleeding is a common feature of all GTNs, as they invade the endometrium and myometrium.

Question 218

54. Which GTN is associated with markedly increased serum β-hCG? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 218

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.

Question 219

55. Which GTN has a growth pattern of large tumor masses? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 219

D. All of the above Rationale: All three GTNs can form large tumor masses due to uncontrolled trophoblastic growth.

Question 220

56. Which GTN is associated with mild cytologic atypia? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 220

B. Placental Site Trophoblastic Tumor (PSTT) Rationale: PSTT shows mild cytologic atypia compared to choriocarcinoma, which exhibits more pleomorphism and hyperchromasia.

Question 221

57. Which GTN is most commonly located in the corpus of the uterus? A. Gestational Choriocarcinoma B. Placental Site Trophoblastic Tumor (PSTT) C. Epithelioid Trophoblastic Tumor (ETT) D. All of the above

Answer 221

D. All of the above Rationale: All three GTNs can involve the uterine corpus, but PSTT and ETT are more locally invasive.

Question 222

58. FIGO staging of GTN is based on: A. Anatomical staging B. Histological classification C. Hormonal response D. Tumor marker levels

Answer 222

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

Question 223

59. The WHO Prognostic Scoring System for GTN, as adopted by FIGO, is used to: A. Determine the risk for drug failure B. Identify the type of chemotherapy to use C. Differentiate benign from malignant GTN D. Determine the histological subtype

Answer 223

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).