Week 4 practice quiz Flashcards
Which of the following is the most common type of hysterectomy? Choose the best answer.
a) Total (removes uterus, cervix, the top portion of your vagina, most of the tissue that surrounds the cervix, and sometimes the pelvic lymph nodes)
b) Total (removes uterus and cervix, leaves ovaries)
c) Hysterectomy with oophorectomy (removes uterus, cervix, the top portion of your vagina, most of the tissue that surrounds the cervix, and sometimes the pelvic lymph nodes)
d) Radical hysterectomy (excision of the uterus en bloc with the parametrium and upper 1/3-1/2 of the vagina with likely bilateral pelvic lymph node dissection)
5) Radical hysterectomy (removes uterus, cervix, the top portion of your vagina, most of the tissue that surrounds the cervix, and sometimes the pelvic lymph nodes)
b) Total (removes uterus and cervix, leaves ovaries)
What is the most common reason for a hysterectomy?
a) Endometriosis
b) PCOS
c) Leiomyoma
d) Adenomyosis
c) Leiomyoma
A 24 year old patient comes in for a pap smear. It comes back with the result of an LSIL. What is your recommendation?
a) Redo the test in 2-4 months
b) Redo the test in 1 year + hrHPV testing
c) Redo the test in 3 years + hrHPV testing
d) Recommend her for expedited Tx
e) Return to clinic for colposcopy
b) Redo the test in 1 year + hrHPV testing
What pap smear category includes findings of CIN1 (low-grade dysplasia) and findings consistent with HPV infection? Choose the best answer.
a) LSIL
b) HSIL
c) ASC-US
d) ASC-H
a) LSIL
A patient has an abnormal pap smear. If they are older than ______ years, you should determine their immediate CIN3+ risk.
a) 18
b) 21
c) 25
d) 30
c) 25
A 22 year old patient has a CIN3 lesion. What is your next move?
a) Observation acceptable, treatment unacceptable
b) Observation preferred, treatment acceptable.
c) Either observation or treatment is acceptable
d) Treatment acceptable, observation unacceptable.
d) Treatment acceptable, observation unacceptable.
A 42 year old patient has an abnormal result on a pap smear. What is your next move?
a) Calculate her CIN3 risk
b) Treatment acceptable, observation unacceptable.
c) Either observation or treatment is acceptable
d) Colposcopy
a) Calculate her CIN3 risk
For high grade histologic cervical dysplasia, ___________ is preferred, and _________ is acceptable
a) Excision; ablation
b) Surgery; ablation
c) Excision; surgery
d) Observation; ablation
a) Excision; ablation
If your 30 year old patient has an immediate CIN3+ risk of 5%, what should you have them do?
a) Return for cytology + high risk HPV test in 1-2 years
b) Return for colposcopy
c) Immediate excision or ablation
d) Return for excision or ablation
e) None of the above
b) Return for colposcopy
Your 35 year old patient gets a pap smear and the results come back as ASC-US. What do you have them do?
a) Return for cytology + high risk HPV test in 1-2 years
b) Return for colposcopy
c) Immediate excision or ablation
d) Return for excision or ablation
b) Return for colposcopy
Which of the following was/were mentioned as a major risk factor for cervical neoplasia?
a) Lead exposure
b) Methamphetamine exposure
c) Diethylstilbestrol (DES) exposure
d) Marijuana use
e) All of the above
c) Diethylstilbestrol (DES) exposure
HSIL cytology that is HPV ____–positive in a patient over 25 has an immediate CIN 3+ of 60% and should receive expedited Tx
a) 12
b) 14
c) 16
d) 18
c) 16
Your patient, who doesn’t know her own age, has a pap smear result of AGC. What do you do?
a) Return for cytology + high risk HPV test in 1-2 years
b) Return for colposcopy + endocervical sampling
c) Immediate excision or ablation
d) Return for excision or ablation
e) Need to know the patient’s age to answer this question
b) Return for colposcopy + endocervical sampling
What is the most common kind of cervical cancer?
a) Small cell carcinoma
b) Adenosquamous carcinoma
c) Adenocarcinoma
d) Squamous cell carcinoma
e) Neuroendocrine carcinoma
d) Squamous cell carcinoma
A 50 year old female has been experiencing postcoital bleeding and watery discharge. She has had a recent STI test and it was all negative, but has not had a pap smear in over a decade. What should you be most concerned about?
a) Cervical cancer
b) Endometrial cancer
c) Leiomyoma
d) HIV
a) Cervical cancer
A patient has cervical cancer that has spread to the lower 1/3 of the vagina and the walls of the pelvis. It is blocking the ureters and her kidneys are affected. What stage of cervical CA does she have?
a) Stage 0
b) Stage I
c) Stage II
d) Stage III
e) Stage IV
d) Stage III
What is a Radical Trachelectomy?
a) Removal of the cervix and uterus.
b) Removal of the cervix, uterus, and upper portion of the vagina.
c) Removal of the cervix, surrounding tissues, and upper portion of the vagina.
d) Removal of the cervix, uterus, ovaries, surrounding tissues, and upper portion of the vagina.
e) It can mean all of the above
c) Removal of the cervix, surrounding tissues, and upper portion of the vagina.
What are the 2 most important prognostic factors for cervical cancer? Choose the best answer
a) Most important is disease stage, second most important is lymph node status
b) Most important is lymph node status, second most important is disease stage
c) Most important is location, second most important is disease stage
d) Most important is disease stage, second most important is cervical status
a) Most important is disease stage, second most important is lymph node status
15-61% with cervical cancer have persistent or recurrent disease after treatment, usually within the first ___________.
a) 6 months
b) 1 year
c) 2 years
d) 5 years
c) 2 years
Which is most correct about primary dysmenorrhea?
a) Due to uterine/pelvic pathology; more common in younger women
b) Due to excessive prostaglandin; more common in younger women
c) Due to uterine/pelvic pathology; more common in older women
d) Due to excessive prostaglandin; more common in older women
e) None of the above are correct.
b) Due to excessive prostaglandin; more common in younger women
Your 21 year old nulliparous patient has been experiencing spasmodic, colicky, labor like pain with a heavy, achy feeling in her lower abd. that begins 1-2 days before the onset of menstruation. She also endorses nausea and vomiting during this timeframe. She denies dyspareunia. Her menarche was at age 10 and she has a BMI of 33. What is her most likely diagnosis?
a) Chronic Pelvic Pain
b) Primary Dysmenorrhea
c) Secondary Dysmenorrhea
d) Endometrial cancer
e) Cervical cancer
f) None of the above
b) Primary Dysmenorrhea
Your 55 year old multiparous patient with a Hx of hormonal imbalance has been complaining of loss of appetite/ early satiety, rectal pain, dyspareunia, fever, and heavy menstrual flow. She denies any Hx of smoking, her BMI is 30, and she feels as though her Sx are linked to her menstrual cycle. What is her most likely diagnosis?
a) Chronic Pelvic Pain
b) Primary Dysmenorrhea
c) Secondary Dysmenorrhea
d) Endometrial cancer
e) Cervical cancer
f) None of the above
c) Secondary Dysmenorrhea
Vitamins ___ and ___ help with dysmenorrhea because they work to decrease arachidonic acid
a) D & E
b) B & E
c) A & E
d) A & D
b) B & E
A 35 year old African American patient comes in for a routine pelvic exam. You take a thorough history and find out that she is on a carnivore diet, drinks 3 glasses of wine a day, and experienced menarche at age 9. You perform the bimanual exam and note that her uterus feels irregularly enlarged, firm, asymmetrical, and kind of bumpy. She says she has no tenderness to palpation of the abdomen or uterus during the exam. What do you think her diagnosis is, what would be your first step to confirm it, and how would you treat it?
a) Endometriosis; pelvic u/s; myomectomy
b) Leiomyoma; hysteroscopy; myomectomy
c) Adenomyosis; hysteroscopy; myomectomy
d) Leiomyoma; pelvic u/s; no treatment needed at this time
e) Endometriosis; MRI; OCPs
d) Leiomyoma; pelvic u/s; no treatment needed at this time
“Uterosacral nodularity” is the hallmark finding of what?
a) Endometriosis
b) Leiomyoma
c) Adenomyosis
d) Endometrial CA
e) Cervical CA
f) Uterine sarcoma
a) Endometriosis
When endometrium grows into the muscular myometrium, this is called what?
a) Endometriosis
b) Leiomyoma
c) Adenomyosis
d) Endometrial CA
e) Cervical CA
f) Uterine sarcoma
g) None of the above
c) Adenomyosis
Laparoscopy is the gold standard for the diagnosis of what?
a) Endometriosis
b) Leiomyoma
c) Adenomyosis
d) Endometrial CA
e) Cervical CA
f) Uterine sarcoma
g) All of the above
a) Endometriosis
Per the powerpoint, a CA-125 marker may indicate which of the following?
a) Cervical CA
b) Endometrial CA
c) Vaginal CA
d) Metastatic breast CA
e) Uterine sarcoma
b) Endometrial CA
A mobile and “globular, boggy” uterus on physical exam is a sign of what?
a) Endometriosis
b) Leiomyoma
c) Adenomyosis
d) Endometrial CA
e) Cervical CA
f) Uterine sarcoma
g) Can be a sign of all of the above
c) Adenomyosis
You are unsure if your patient has leiomyoma or adenomyosis. What is the best way to determine management?
a) TVUS
b) Transabdominal ultrasound
c) Bimanual exam
d) CT scan
e) MRI
e) MRI
How do you definitively diagnose endometrial hyperplasia?
a) TVUS
b) MRI
c) CT scan
d) Endometrial biopsy
e) Any of the above
f) None of the above; requires blood work or genetic testing
d) Endometrial biopsy
Which of the following is the most common treatment for the most common genital tract malignancy?
a) Radical Trachelectomy (cervical CA)
b) Total abdominal hysterectomy with bilateral salpingo-oophorectomy (endometrial CA)
c) Radical hysterectomy (endometrial CA)
d) Laser Vaporization (cervical CA)
b) Total abdominal hysterectomy with bilateral salpingo-oophorectomy (endometrial CA)
You have a 70 year old patient with postmenopausal bleeding, unusual pelvic pain, and increased discharge. You take a thorough history, and she mentions that she took Tamoxifen for 6 years for her breast cancer (which she has since been cleared of). On bimanual exam, you note uterine enlargement and large masses that seem to be fibroids. What do you suspect her diagnosis is?
a) Endometriosis
b) Leiomyoma
c) Adenomyosis
d) Endometrial CA
e) Cervical CA
f) Uterine sarcoma
f) Uterine sarcoma
True or false: PCOS can lead to endometrial hyperplasia
True
True or false: Cone biopsies are usually performed under general or regional anesthesia
True
True or false: Pregnant women are NOT eligible for colposcopy
False; they are
True or false: There are no specific lab abnormalities required to diagnose dysmenorrhea.
True
True or false: Very few patients with endometriosis are asymptomatic.
False; many are asymptomatic
True or false: Dyspareunia is more common in adenomyosis than in endometriosis
False; it is more common in endometriosis
True or false: The only definitive treatment for adenomyosis is total hysterectomy (with ovaries conserved)
True
True or false: Endometrial cancer is 40% common in African American women
False; it’s more common in white women
True or false: Adenocarcinoma is the most common form of endometrial cancer
True
True or false: Methotrexate is an example of single-agent chemotherapy
True
True or false: Synthetic progesterone is never an appropriate monotherapy for endometrial hyperplasia
False; appropriate if there’s no atypia
True or false: Cowden Syndrome has an autosomal dominant inheritance
True
True or false: Pap smears do NOT test for gonorrhea or chlamydia
True
True or false: SILs refer to histologic findings
False; SILs are cytologic
What is the most common place for a molar pregnancy to metastasize?
Lungs
What is the most common cause of secondary dysmenorrhea?
a) Endometriosis
b) Pelvic inflammatory disease (PID)
c) Leiomyoma
d) Adenomyosis
a) Endometriosis
What is the first line of Tx for endometriosis?
OCPs + NSAIDs
Which type of endometrial cancer is estrogen-dependent? Is it more or less common?
Type 1; more common
If you have a concern about persistent GTD, your first step should be to order what?
Blood hCG
True or false: Organ transplant and HIV are both risk factors for cervical neoplasia
True
True or false: Vaginal bleeding during molar pregnancy is usually painful
False
True or false: Submucosal leiomyomas have the highest rate of infertility, and intramural leiomyomas are the most common
True
