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l3 (1st bmex) > GYNE3 > Flashcards

GYNE3 Flashcards

1
Q

This screening test for ovarian cancer would best be done in one who has a family history of malignancy

A. Annual pelvic and rectal examination
B. Transvaginal ultrasound
C. Test for BRCA 1 and 2
D. CA125

A

C. Test for BRCA 1 and 2

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2
Q

This poses the greatest risk factor for ovarian cancer

A. Prolonged intake of fertility medications
B. BRCA1 gene mutation
C. BRCA2 gene mutation
D. Nulliparity

A

D. Nulliparity

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3
Q

The tumor marker for mucinous ovarian neoplasm

A. CEA
B. CA 125
C. hCG
D. Lactate dehydrogenase

A

A. CEA Previous whis answer
B. CA 125

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3
Q

Primary prevention of ovarian cancer involves

A. use of OCP
B. CA125 determination
C. VIA
D. Transvaginal ultrasound

A

A. use of OCP

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4
Q

Most common early symptom associated with ovarian cancer

A. Abdominal distention
B. Urinary frequency
C. Nonspecific GI symptoms
D. Anorexia

A

C. Nonspecific GI symptoms

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5
Q

A 52yo patient came due to an abdominal mass noted for 3 years. Ultrasound revealed a pelvoabdominal mass about 12x8 cm with a normal sized uterus. Which of the following would suggest a malignancy?

A. Thin septae
B. Cystic tumors
C. Presence of ascites
D. Small masses

A

C. Presence of ascites

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5
Q

Staging of ovarian cancer is by

A. clinical staging
B. surgical findings only
C. surgico-pathologic
D. clinical and surgical

A

B. surgical findings only
C. surgico-pathologic (in OB-GYN Pearls)

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6
Q

For younger patients with ovarian cancer who still want to have a family, what should be done during surgery?

A. Frozen section
B. Lymph node dissection
C. Remove the involved ovary alone
D. Infracolic omentectomy

A

C. Remove the involved ovary alone

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7
Q

A patient underwent surgery for ovarian mass, the left ovary was cystically enlarged to 8x8 cm. Cut section showed multiple solid necrotic areas. Peritoneal cytology revealed malignant cells. What is the stage?

A. IA
B. IB
C. IC2
D. IC3

A

D. IC3

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7
Q

Which of the following is a risk factor for ovarian CA?

A. Obesity
B. Infertility
C. Multiparity
D. Black race

A

B. Infertility

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8
Q

A patient complained of abdominal mass. On ultrasound, an 8x6 cm mass was seen on the right adnexa. What is the goal of surgery in this case?

A. Remove all visible disease
B. Kill all cancer cells
C. Reduce risk
D. Alleviate symptoms

A

A. Remove all visible disease

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9
Q

Lolita, a 67-year-old G0 was admitted due to abdominal pain. She was immediately scheduled for exploratory laparotomy. Upon incision of the peritoneum, there was massive ascites and the right ovary was enlarged to 20x25 cm with 1.5 cm ruptured site at its anterolateral aspect. The left ovary was grossly normal. There were no adhesions. Upon biopsy, the right ovary revealed clear cell carcinoma. FIGO staging for this case is

A. Stage IA
B. Stage IC1
C. Stage IC2
D. Stage IC3

A

D. Stage IC3

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9
Q

Which of the following is not helpful in the initial staging and follow-up in ovarian cancer?

A. Imaging studies
B. Tumor marker
C. Clinical evaluation
D. Patient profile

A

D. Patient profile

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9
Q

OCP use reduces the risk of which of the following type of ovarian cancer?

A. Germ cell tumor
B. Epithelioid
C. Sex cord stroma tumor
D. Steroid cell tumor

A

B. Epithelioid

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10
Q

A sex cord tumor which has estradiol as a tumor marker

A. Tumor of the theca-fibroma group
B. Thecoma
C. Granulosa cell tumor
D. Unclassified

A

C. Granulosa cell tumor

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11
Q

In an unaffected woman with BRCA1 mutation, what is the most effective way to reduce the risk of cancer and mortality?

A. Use of OCP
B. Prophylactic BSO
C. Serum CA125 monitoring
D. Transvaginal ultrasound

A

B. Prophylactic BSO

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12
Q

Which of the following is not an indication of low malignant potential in ovarian tumors?

A. Confined to ovary for a long time
B. Good prognosis
C. Premenopausal
D. Affects fallopian tube

A

D. Affects fallopian tube

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12
Q

Which of the following would benefit from neoadjuvant chemotherapy prior to surgery?

A. Low perioperative risk
B. Low benefit from attaining optimal cytoreduction
C. Small mass
D. Medically fit

A

B. Low benefit from attaining optimal cytoreduction

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13
Q

Metastatic tumor to the ovaries are frequently from this site

A. Lungs
B. GIT
C. Brain
D. Skin

A

B. GIT

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14
Q

A condition where abundant mucinous or gelatinous material in a pelvic or peritoneal cavity surrounded by a fibrous tissue is noted

A. Pseudomyxoma peritonei
B. Krukenberg tumor
C. Peritonealis disseminate
D. Pseudomucinous peritonei

A

A. Pseudomyxoma peritonei

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14
Q

Which of the following has a good prognosis?

A. Clear cell carcinoma
B. Mass ruptured preoperatively
C. Intraoperative tumor spillage
D. Densely adherent pelvic peritoneum

A

C. Intraoperative tumor spillage

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15
Q

This is the earliest and most common route of dissemination for ovarian epithelial carcinoma

A. Lymphatics
B. Hematogenous
C. Transcoelemic
D. In situ

A

C. Transcoelemic

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15
Q

The most common malignant germ cell tumor

A. Dysgerminoma
B. Granulosa cell tumor
C. Immature teratoma
D. Endodermal sinus tumor

A

A. Dysgerminoma

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16
Q

Which of the following utilizes immunostaining with cytokeratin and hPL?

A. Invasive mole
B. Choriocarcinoma
C. ETT
D. PSTT

A

D. PSTT

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16
Q

The characteristic feature of this germ cell tumor is the Schiller-Duval body

A. Dysgerminoma
B. Granulosa cell tumor
C. Choriocarcinoma
D. Endodermal sinus tumor

A

D. Endodermal sinus tumor

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17
Q

This carcinoma is extremely rare and is distinguished from choriocarcinoma of the ovary due to the absence of syncytiotrophoblastic and cytotrophoblastic cells

A. Endodermal sinus tumor
B. Immature teratoma
C. Embryonal carcinoma
D. Dysgerminoma

A

C. Embryonal carcinoma

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17
Q

Which of the following is least likely indicated in the development of GTN?

A. Live birth
B. Molar pregnancy
C. Missed abortion
D. Ovarian cyst

A

D. Ovarian cyst

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18
Q

10% of hydatidiform mole will develop into invasive mole and 15% of these will metastasize to which organ?

A. Liver, lung
B. Liver, vagina
C. Brain, kidney
D. Liver, brain

A

D. Liver, brain

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18
Q

Most common sign of GTN

A. Infection
B. Abdominal swelling
C. Vaginal bleeding
D. Vaginal mass

A

C. Vaginal bleeding

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19
Q

A 38 years old, G3P2 (2012) underwent suction curettage for complete mole. HCG remain elevated after 12 weeks post evacuation. What is the most possible diagnosis of this case?

A. PSTT
B. Invasive mole
C. Choriocarcinoma
D. ETT

A

B. Invasive mole

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20
Q

Which GTN has the propensity of lymphatic metastases?

A. ETT
B. Choriocarcinoma
C. Invasive mole
D. PSTT

A

D. PSTT

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20
Q

A friable vaginal mass about 3x3 cm was noted in a 42-year-old G5P5 (5005) whose last pregnancy was 8 months ago. CXRAY is negative. What is the stage of this patient?

A. I
B. II
C. III
D. IV

A

B. II

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21
Q

The diagnosis of GTN is least likely based on

A. ultrasound
B. hCG titer
C. clinical presentation
D. histopath findings

A

D. histopath findings

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21
Q

Treatment for stage IV patients with brain metastases

A. Radiotherapy alone
B. High dose EMACO with intrathecal chemotherapy
C. Dactinomycin with radiotherapy
D. Actinomycin

A

B. High dose EMACO with intrathecal chemotherapy

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22
Q

A patient diagnosed with choriocarcinoma was advised for radiotherapy. What is the indication for doing radiotherapy?

A. Lung metastasis
B. GIT metastasis
C. Minimized hemorrhage
D. Minimized size of lesion

A

B. GIT metastasis

22
Q

Which of the following is not considered an ultra-high risk for GTN?

A. Profuse vaginal bleeding
B. β-hCG >1 mIU/mL
C. Hemoptysis
D. Interval from last antecedent pregnancy is 12 months

A

D. Interval from last antecedent pregnancy is 12 months

23
Q

Tumor marker used to monitor treatment response in GTN

A. CEA
B. CA 19-9
C. HCG
D. AFP

A

C. HCG

24
Q

Pattern of spread of GTN

A. Hematogenous
B. Lymphatics
C. Transcoelomic
D. Airborne

A

A. Hematogenous

25
Q

What is the accepted treatment for stage III GTN?

A. Debulking
B. TAH
C. EMACO
D. Methotrexate + folinic acid

A

C. EMACO

26
Q

Remission of GTN is characterized by this level of hCG

A. One log fall of hCG from baseline
B. hCG fall one half from baseline
C. 3 normal hCG levels
D. 2 plateaus, 1 rise weekly

A

C. 3 normal hCG levels

26
Q

Secondary tumors that arise from GTN

A. Rectal cancer
B. Endometrial cancer
C. Oral cancer
D. Vaginal cancer

A

C. Oral cancer

27
Q

Pregnancy is avoided 2 years after having GTN. What is the rationale for this protocol?

A. Risk of hormonal changes may lead to tumor growth and relapse
B. Allow time for ova to rest
C. Pregnancy will increase the risk of another GTN
D. Majority of relapse occurs during the 2nd year

A

A. Risk of hormonal changes may lead to tumor growth and relapse

28
Q

Which of the following types of GTN secretes hPL?

A. PSTT
B. Invasive mole
C. Choriocarcinoma
D. ETT

A

A. PSTT

29
Q

A 38-year-old not desirous of pregnancy diagnosed with PSTT is recommended of what management?

A. EMACO
B. Hysteroscopic resection
C. TAH with methotrexate
D. Curettage

A

C. TAH with methotrexate

30
Q

A patient was suspected for GTN. Her last pregnancy was 5 years ago. She underwent hysterectomy. Immunostaining result was positive for p63 and cytokeratin 18, while negative for hCG. What is the diagnosis?

A. PSTT
B. Invasive carcinoma
C. ETT
D. Choriocarcinoma

A

C. ETT

30
Q

What type of GTN has a characteristic growth pattern of infiltrating single cell or confluent sheets?

A. Invasive mole
B. PSTT
C. ETT
D. Choriocarcinoma

A

B. PSTT

31
Q

Mainstay of treatment for PSTT and ETT

A. Chemotherapy
B. Radiotherapy
C. Surgery
D. Chemoradiotherapy

A

C. Surgery

31
Q

PSTT is most commonly preceded by what type of pregnancy?

A. Complete mole
B. Normal pregnancy
C. Partial mole
D. Invasive mole

A

B. Normal pregnancy

32
Q

Type of GTN where 50% of cases has a history of molar pregnancy?

A. ETT
B. PSTT
C. Invasive mole
D. Choriocarcinoma

A

D. Choriocarcinoma

33
Q

Serial CA 125 determinations may be used in endometriosis in:

A. Predicting the recurrence after therapy
B. Determining severity of condition
C. Planning in the management
D. Diagnosing the condition

A

A. Predicting the recurrence after therapy

34
Q

Farrah underwent curettage for vaginal bleeding. Histopath evaluation revealed gestational trophoblastic neoplasia composed primarily of intermediate Trophoblasts. What is the primary treatment?

A. Radiotherapy
B. Hysterectomy
C. Chemotherapy
D. No further treatment needed

A

B. Hysterectomy

35
Q

A patient underwent pelvic lap for an ovarian mass. Intraoperatively, the right ovary was cystically enlarged to 20 x 18 cm with solid areas and multiloculations noted. Peritoneal fluid cytology is negative. What is the stage of this patient based on the FIGO classification?

A. Tumor confined to ovaries
B. Tumor limited to 1 or both ovaries with pelvic extension or primary peritoneal cancer
C. Distant metastasis excluding peritoneal metastases
D. Tumor involves 1 or both ovaries or fallopian tubes or primary peritoneal cancer with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes.

A

A. Tumor confined to ovaries

36
Q

A 52-year-old presents with postmenopausal bleeding. Transvaginal ultrasound revealed a 9cm complex mass at the right adnexa and a thickened endometrium with cystic spaces. Endometrial biopsy revealed complex hyperplasia with atypia. If the ovarian tumor is related to the hyperplasia, what is it likely to be?

A. Endodermal sinus tumor
B. Serous cystadenocarcinoma
C. Granulosa cell tumor
D. Endometrioid cystadenocarcinoma

A

C. Granulosa cell tumor

37
Q

A 42-year-old G3P3003 has been diagnosed with choriocarcinoma 8 months after her term vaginal delivery of a healthy female neonate. Her β-hCG was 1 million mIU/mL and she had 3 cannonball lesions on chest Xray and a 1 cm lytic lesion in her lumbar spine on MRI. What is her stage based on the International Federation of Gynecology and Obstetrics staging system?

A. Stage IV
B. Stage III
C. Stage I
D. Stage II

A

A. Stage IV

38
Q

Which of the following necessitate further referral to a trophoblastic specialist?

A. Histopath reading of a choriocarcinoma
B. A missed abortion on ultrasound
C. Histopath reading of a complete mole
D. On and off spotting

A

A. Histopath reading of a choriocarcinoma

39
Q

A 55-year-old G4P4 (4004) has an enlarging abdomen. On abdominal and pelvic examination, there is a 15 x 10 cm cystic mass with solid areas, non-tender, mobile and a positive fluid wave. What is the next step in the evaluation?

A. Transvaginal ultrasound of the pelvis
B. CT scan
C. Diagnostic laparoscopy
D. MRI

A

A. Transvaginal ultrasound of the pelvis

40
Q

Hyperthyroidism is seen in 7% of patients with gestational trophoblastic neoplasia because of:

A. Decreased levels of FSH
B. Increased serum levels of free thyroxine
C. Decreased levels of free thyroxine
D. Increased serum levels of FSH

A

B. Increased serum levels of free thyroxine

40
Q

Patients diagnosed with low-risk non-metastatic disease are treated with this first-line drug which was known to be effective and well tolerated.

A. Dactinomycin
B. Methotrexate
C. Etoposide
D. Oncovin

A

B. Methotrexate

41
Q

Intrathecal Methotrexate maybe given instead of irradiation as an alternative for stage IV patients with brain metastases at what recommended dose of:

A. 20.5 mg
B. 2.5 mg
C. 12.5 mg
D. 10 mg

A

C. 12.5 mg

42
Q

Liver capsule involvement is noted in a patient who underwent pelvic lap for an ovarian mass. What stage is the patient?

A. IIIB
B. IIIA2
C. IIIC
D. IIIA1

A

C. IIIC

43
Q

Tumor characteristic that suggest malignancy.

A. Large solid tumors
B. Moveable and well delineated borders
C. Smooth surfaces
D. Cystic masses

A

A. Large solid tumors

44
Q

The most common site of metastasis for choriocarcinoma is the:

A. Ovaries
B. Kidneys
C. Lungs
D. Brain

A

C. Lungs

45
Q

The most common presentation of ovarian cancer is:

A. Pelvic mass
B. Pressure symptom
C. Abdominal pain
D. No symptoms

A

A. Pelvic mass

46
Q

This is a rare neoplastic proliferation of intermediate trophoblasts that invade the myometrium at the placental site after a pregnancy.

A. Invasive Mole
B. Placental Site trophoblastic tumor
C. Placental Site Nodule

A

B. Placental Site trophoblastic tumor

46
Q

Based in the WHO Prognostic Scoring System, if the score is more than 7, the patient is categorized as:

A. Middle risk
B. High risk
C. Low risk
D. Ultra-high risk

A

B. High risk

47
Q

A rare virilizing tumor of the ovary.

A. Polyembryoma
B. Mucinous cystadenocarcinoma
C. Dysgerminoma
D. Sertoli-Leydig cell tumor

A

D. Sertoli-Leydig cell tumor

48
Q

Tumor marker of endodermal sinus tumor.

A. CEA
B. AFP
C. hCG
D. CA 125

A

B. AFP

48
Q

A tumor marker of epithelial ovarian masses.

A. hCG
B. CA 125
C. Inhibin A and B
D. CEA

A

B. CA 125

49
Q

What type of gestational trophoblastic neoplasia arises primarily from a previous molar pregnancy?

A. Invasive mole
B. Placental Site Trophoblastic Tumor
C. Epithelioid Trophoblastic Tumor
D. Choriocarcinoma

A

A. Invasive mole

49
Q

The histologic feature that differentiates a borderline from an invasive ovarian tumor is:

A. Absence of stromal invasion
B. Nuclear stratification
C. Papillary formation
D. Tufted growth

A

A. Absence of stromal invasion

50
Q

Which of the following patterns of blood types is associated with highest risk of Choriocarcinoma?

A. Wife A; Husband A
B. Wife B; Husband A
C. Wife AB; Husband O
D. Wife A; Husband O

A

D. Wife A; Husband O

50
Q

A G3P3 patient is diagnosed to have Gestational Trophoblastic Neoplasia. What is the most likely histopathological type?

A. Placental Site Trophoblastic Tumor
B. Invasive mole
C. Choriocarcinoma
D. Epithelioid Trophoblastic Tumor

A

C. Choriocarcinoma

50
Q

What is the treatment of choice of GTN?

A. Do serial beta-hCG monitoring weekly and observe.
B. Surgery
C. Chemoradiation
D. Chemotherapy

A

D. Chemotherapy

50
Q

These are the features of an ultra-high-risk GTN except:

A. Beta-hCG > 1,000,000 mIU/ml
B. Large volume liver metastases
C. Histologic diagnosis of choriocarcinoma
D. Interval from last antecedent pregnancy 6 months

A

D. Interval from last antecedent pregnancy 6 months

51
Q

Pulmonary radiologic study of a patient with gestational trophoblastic neoplasia reveals metastatic lesion. What is the least Anatomic Stage?

A. Stage I
B. Stage IV
C. Stage II
D. Stage III

A

D. Stage III

51
Q

One of which is considered secondary prevention in ovarian cancer.

A. Breastfeeding
B. Careful bimanual and rectovaginal examination
C. Use of oral contraceptive pills
D. Pregnancy

A

B. Careful bimanual and rectovaginal examination

52
Q

The ovarian tumor with a characteristic “signet-ring” cells and primary gastro-intestinal involvement is:

A. Brenner’s tumor
B. Teratoma
C. Krukenberg tumor
D. Arrhenoblastoma

A

C. Krukenberg tumor

52
Q

The histologic feature or tumor marker associated with serous ovarian tumors:

A. Call-Exner body
B. Psammoma body
C. Alpha-fetoprotein
D. CA 125

A

B. Psammoma body

53
Q

A “second look” procedure in the management of ovarian neoplasm refers to:

A. Laparotomy done after the tumor has recurred
B. Laparoscopy done after primary debulking
C. Laparotomy done after 1 year of chemotherapy when no clinical evidence of disease exists
D. Laparoscopy done after primary chemotherapy

A

C. Laparotomy done after 1 year of chemotherapy when no clinical evidence of disease exists

54
Q

If you are suspecting an ovarian malignancy, the usual manifestation is:

A. Abdominal mass
B. Ascites
C. Vaginal bleeding
D. Abdominal pain

A

A. Abdominal mass

55
Q

A 65-year-old woman with 3 cm adnexal cyst was noted on routine pelvic exam. The appropriate treatment is:

A. Suppress the ovary with cyclic estrogen and progestin.
B. Repeat the examination in 2-4 months.
C. Offer reassurance.
D. Do transvaginal ultrasound.

A

D. Do transvaginal ultrasound.

55
Q

This is a rare trophoblastic neoplasm which is the malignant counterpart of the intermediate trophoblasts of the chorion leave.

A. Choriocarcinoma
B. Placental Site Trophoblastic Tumor
C. Invasive mole
D. Epithelioid Trophoblastic Tumor

A

D. Epithelioid Trophoblastic Tumor

56
Q

The cell origin of the most common type of ovarian neoplasm is:

A. Germ cells
B. Stromal cells
C. Lipoid cells
D. Epithelial cells

A

D. Epithelial cells

57
Q

What is the tumor marker for Placental Site Trophoblastic Tumor?

A. Alpha-fetoprotein
B. Human chorionic gonadotropin
C. Human placental lactogen
D. Carcinoembryonic antigen

A

C. Human placental lactogen

57
Q

Marie, a 56-year-old, postmenopausal, complains of ascites with abdominal mass and weight loss. Your most likely consideration is a carcinoma of the:

A. Vagina
B. Ovary
C. Cervix
D. Vulva

A

B. Ovary

57
Q

A 29-year-old G3P2 patient being monitored for hCG after evacuation of H. mole 6 weeks ago showed elevation of hCG titers for 3 consecutive determinations. What should be done?

A. Start chemotherapy
B. Advise need for hysterectomy because of probable persistent disease
C. Advise need for another curettage
D. Continue observing titers

A

A. Start chemotherapy

58
Q

The initial gastrointestinal organ that is affected in Krukenberg tumor of the ovary is the:

A. Small intestines
B. Rectum
C. Gallbladder
D. Pylorus

A

D. Pylorus

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