WEEK 6 END OF WEEK FORMATIVE

Question 1

Which of the following is not a subtype of endometrial carcinoma? A - Endometrioid B - Choriocarcinoma C - Serous D - Clear Cell E - Mucinous

Answer 1

B - Choriocarcinoma

Question 2

What are the different types of endometrial carcinoma?

Answer 2

Type 1 - Endometrioid (and mucinous) endometrial carcinoma Type 2 - Serous (and clear cell) carcinoma

Question 3

Which of the following does not apply to a uterine leiomyoma? A - benign tumour of smooth muscle B - often multiple C - may present with menorrhagia D - growth is oestgoen dependent E - uncommon neoplasm

Answer 3

E - uncommon neoplasm

Question 4

A leiomyoma, also known as fibroids, is a benign smooth muscle tumor What is a maligannt smooth muscle tumour known as?

Answer 4

This would be a leiomyosarcoma

Question 5

Which of the following statements regarding endometriosis is true? OPTIONS: A Ovarian endometriosis is rare B The disease is more common among multiparous women C Defined as endometrial glands and stroma outside the uterine cavity D Rarely symptomatic E The risk is increased for women using oral contraceptives

Answer 5

A - ovarian endometriosis is rare

Question 6

What are risk factors for endometriosis?

Answer 6

Nullparity Low BMI Early menarche/late menopause Multiparity and combined oral contraceptive have a negative association with endometriosis ie they decrease the risk of the disease occurring

Question 7

Which of the following is not a germ cell neoplasm? OPTIONS: A Dysgerminoma B Teratoma C Granulosa cell tumour D Embryonal carcinoma E Yolk sac tumour

Answer 7

C - Granulosa cell tumour - this is a sex cord / stromal tumour

Question 8

What do granulosa cell tumours produce? How may they present?

Answer 8

These tumours can produce oestrogens May cause precocious puberty if in a young female or Post-menopasual bleeding

Question 9

What is the most common malignant primitive germ cell tumour? What electrolyte is this tumour associated with an increase in? What age group does this tumour occur in?

Answer 9

Dysgerminoma Associated with an increase in calcium and occurs almost exclusively in children and young adults -average age 22

Question 10

Which of the following statements do not apply to an ovarian teratoma? OPTIONS: A Often contains adipose tissue B Always benign C Can include well developed teeth D May be bilateral E Can present acutely with torsion

Answer 10

B - always benign Mature teratomas include dermoid cysts and are generally benign. Immature teratomas may be cancerous

Question 11

Which of the following muscles covers the majority of the pelvic side wall? OPTIONS: A coccygeus B levator ani C obturator internus D pirifomis E puborectalis

Answer 11

B - obturator internus The obturator internus covers the obturator membrane - can see the obturator internus laterally here Piriformis covers the posterior pelvic wall

Question 12

What makes up the levator ani?

Answer 12

Levator ani - puborectalis, pubococcygeus, iliococcygeus

Question 13

Lymph from the gonads drains to which of the following lymph node groups? OPTIONS: A Deep inguinal B External iliac C Inferior mesenteric D Lumbar (caval/aortic) E Superficial inguinal

Answer 13

D - Lumbar (caval/aortic)

Question 14

What is the major advantage of MRI over CT scan for imaging the pelvis in females of reproductive age? OPTIONS: A Rapid image acquisition time B Suitable for patients with claustrophobia and pacemaker C No ionising radiation D Provides good tissue resolution on lungs, abdomen and pelvis for accurate cancer staging E Readily available as a ‘bed-side’ imaging test

Answer 14

C - No ionising radiation The CT is quicker for acquisition than MRI MRI cant have any metal for the scan CT provides good lung, abdo and pelvic resolution

Question 15

MRI scan is far better than CT scan in depicting the local disease extent in staging of cervical cancer. Which of these features cannot be assessed on MRI of pelvis performed for staging cervical cancer? OPTIONS: A Parametrial invasion B Tumour infiltration into rectum and bladder C Extension of cancer into uterus and vagina D Distant metastases to lungs and mediastinum E Metastatic involvement of pelvic lymph nodes

Answer 15

D - distant metastases to lungs and mediastinum

Question 16

Factors that increase the risk of developing breast cancer include all of the following except: OPTIONS: A Early menarche B Late menopause C Nulliparity D First or second trimester miscarriage E Age >30 years at time of first pregnancy

Answer 16

It is the increased exposure to oestogen that increases the risk of breast cancer D - first or second trimester miscarriage doesnt increase the risk of developing breast cancer

Question 17

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Answer 17

D - 25 year old with a 2cm ER negative tumour with clear surgical margins (whole breast radiotherapy) and boost

Question 18

Which of the following statements regarding the menopause is FALSE? A The menopause is retrospective diagnosis which can only be made following 1 year of amenorrhoea B FSH levels should be routinely checked in all women, with a single level over 30IU/l being diagnostic of menopause C The ovaries contain a finite number of oocytes which decrease steadily until they become deplete at the time of menopause D The average age of menopause in the UK is 51 years E Peri-menopausal symptoms can begin a number of years prior to the last menstrual period

Answer 18

B - FSH levels should be routinely checked in all women, with a single level over 30IU/l being diagnostic of menopause

Question 19

Which of the following statements regarding Hormone Replacement Therapy (HRT) is TRUE? A Oestrogen only HRT should be given routinely to women with a uterus B The risk of breast cancer with HRT is not affected by age or duration of use C Continuous combined HRT is suitable for use in peri-menopausal women prior to their last menstrual period D The Mirena IUS can be used for up to 5 years to provide endometrial protection in conjunction with oestrogen-only HRT E All vaginal bleeding within 6 months of starting HRT should be investigated

Answer 19

D - the Mirena IUS can be used for up to 5 years to provide enometrial protection in conjunction with oestrogen only HRT Oestrogen only HRT can only be given to women who have had a hysterectomy Sequential combined HRT should be used in perimenopasual women

Question 20

The risk of malignancy index (RMI) for calculating the likelihood of ovarian cancer is calculated according to the following OPTIONS: A CEA level x ultrasound score x menopausal score B CA125 level x ultrasound score x eGFR C CA125 level x ultrasound score x age of patient D CA125 level x ultrasound score x menopausal score E CA125 level x CT score x menopausal score

Answer 20

D - CA125 score x ultrasound score x menopasual score Refer when RMI >250

Question 21

An ovarian mucinous cystadenoma is OPTIONS: A A malignant epithelial ovarian tumour B An ovarian germ cell tumour C A benign epithelial ovarian tumour D Likely to have metastasised from elsewhere E Unlikely to present with a pelvic mass

Answer 21

C - a benign epithelial ovarian tumour Cystoadencarcioma - malignant epithelial ovarian tumour (get serous, endometrioid, mucinous, clear cell and Brenner)

Question 22

A fibroid uterus OPTIONS: A Cannot grow bigger than a 4 month pregnancy ( 20 weeks size, up to the umbilicus) B Is likely to be malignant C Needs to be removed surgically if causing symptoms D Usually causes severe pain and tenderness E May present with urinary urgency, frequency or incontinence

Answer 22

E - May present with urinary urgency, frequency or incontinence Fibroids can cause menorrhgia, and pain (red degeneration of fibroid - due to thrombosis of vessels during pregnancy) Fertility problems also

Question 23

A large endometriotic ( chocolate) cyst OPTIONS: A Is usually asymptomatic B Is a type of cancer C Can present with a pelvic mass and high CA125 level D Is a type of haematoma E Will not rupture

Answer 23

C - can present with a pelvic mass and high CA125 level

Question 24

The condition most likely to be associated with a normal CA125 level OPTIONS: A Liver disease associated with ascites B Peritonitis C Endometriosis D Uterine Leiomyoma E Ovarian cancer

Answer 24

D - uterine leiomyoma

Question 25

Name conditions that can cause increased CA125?

Answer 25

Raised in ≈80% ovarian cancers. Normal level does not exclude cancer Moderate elevation seen in numerous situations e.g. * Endometriosis * Peritonitis/infection * pregnancy * Pancreatitis * Ascites from any cause.e.g. liver disease * Other malignancies gynae/non gynae.