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Flashcards in GONC Deck (26)
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1

Regarding thecoma. Which is wrong?

A - usually benign
B - commonly unilateral
C - associated with virilisation
D - may be associated with endometrial hyperplasia
E - usually occurs in pre-pubertal girls

E - usually occurs in pre-pubertal girls

2

A 59 yo lady with a 6cm ovarian mass. What is the probability of malignancy?

A - 15%
B - 30%
C - 45%
D - 60%
E - 80%

A - 15%

3

16 yo girl presents with pelvic discomfort and a complex cystic mass was found on US. At laparotomy, an immature teratoma was found in the right ovary. Most appropriate Mx:

a - RSO
b - R ovarian cystectomy
c - R ovarian cystectomy & wedge biopsy of L ovary
d - TAH, BSO omentectomy
e - RSO & wedge biopsy of L ovary

a - RSO

4

What percentage of benign mucinous tumour that are bilateral?

<5%

Less than serous cystadenoma (20-25%)

5

During surgery on an 11yo girl, a stage 1A grade 1 10cm malignant (immature) teratoma is found in the left ovary. Initial therapy should include

a. LSO
b. BSO
c. TAH, BSO, omentectomy, post operative irradiation
d. TAH, BSO, omentectomy, post operative chemotherapy

a. LSO

6

Current knowledge about HPV indicates that

a. HPV DNA sequences are found in most SCC’s of the vulva and cervix
b. HPV replication in the cytoplasm causes the koilocytic cell
c. Dysplasia associated with HPV infection is not a ‘true’ precursor of cancer
d. HPV16 is generally associated with benign condylomas

a. HPV DNA sequences are found in most SCC’s of the vulva and cervix

7

3. Intraoperative findings that are indications for abandoning radical hysterectomy for cervical cancer include all of the following EXCEPT

a. Stage 2A disease with a unilateral 30mm diameter ovarian cyst
b. Intraperitoneal metastasis
c. Parametrial/pelvic side wall disease
d. Unresectable pelvic nodal disease

a. Stage 2A disease with a unilateral 30mm diameter ovarian cyst

8

A 28yo woman has USO for a germ cell tumour and completed chemo 6 months ago. She wants to get pregnant. You advise her

a. She has a high risk of malformation because of the chemo
b. She should wait until the effects of the chemo on the residual ovary wear off
c. She is unlikely to be ever able to conceive as the chemo usually causes ovarian failure
d. The chemotherapy used has a variable effect on reproductive function

d. The chemotherapy used has a variable effect on reproductive function

BEP chemotherapy
- Bleomycin
- Etoposide
- Cisplatin (P for platinum)

9

Which statement regarding Adenocarcinoma In Situ is LEAST correct

a. HPV type 18 is the most commonly associated serotype
b. Cone biopsy with clear margins carries >20% chance of disease above the cervical canal
c. ‘Skip lesions’ are uncommon relative to squamous carcinoma in situ
d. Extrafascial simple hysterectomy is optimal treatment if childbearing complete

c. ‘Skip lesions’ are uncommon relative to squamous carcinoma in situ


HPV 18 accounts 50% of adenocarcinoma (c.f. 15% of SCC)

10

Endodermal sinus tumours of the ovary (Yolk sac tumours) are characteristically associated with elevated levels of

a. Alpha fetoprotein
b. Beta HCG
c. Carcinoembryonic antigen (CEA)
d. CA125

a. Alpha fetoprotein

11

Which of the following statements is least correct?
a. The lifetime risk of breast cancer is approximately 9%
b. The lifetime risk of breast cancer is approximately 50% in BRCA1 and BRCA2 gene carriers
c. Hereditary non polyposis colorectal cancer (HNPCC) is associated with an increased risk of endometrial cancer
d. Hereditary non polyposis colorectal cancer (HNPCC) is associated with an increased risk of ovarian cancer

b. The lifetime risk of breast cancer is approximately 50% in BRCA1 and BRCA2 gene carriers

12

Advantages of surgery over radiation therapy for cervical cancer include all of the following EXCEPT
a. Emotional satisfaction that the tumour has been removed
b. Higher cure rate
c. Accuracy of surgical staging
d. Preservation of the ovaries

b. Higher cure rate

13

A 27yo presents with acute virilisation and normal pelvic examination. Investigations show serum LH = 2 [4-25], FSH = 3 [3-25], 17-OH progesterone = 2.9 [<5.5], testosterone = 8.9 [0.5-2.5], DHEAS = 5.3 [0.9-11.7]. Which is the MOST LIKELY diagnosis?

a. PCOS with insulin resistance
b. Sertoli Leydig cell tumour
c. Adrenal cortical adenoma
d. Cushing syndrome
e. Late onset Congenital adrenal hyperplasia

b. Sertoli Leydig cell tumour

Pure sertoli cells only produce oestrogen (+/- renin)
- Can be a/w HTN, hypokalaemia
Pure leydig cells are androgen secreting

14

Each of the following is an ovarian germ cell neoplasm except for
a. Gonadoblastoma
b. Gynandroblastoma
c. Embryonal carcinoma
d. Endodermal sinus tumour
e. Polyembryoma

b. Gynandroblastoma

Gynandroblastoma is a subtype of ovarian sex cord-stromal tumor and is usually observed in young women

15

The primary group of lymph nodes that drain the vulva are the
a. Deep inguinal
b. Superficial inguinal
c. Deep femoral
d. Obturator

b. Superficial inguinal

16

A woman diagnosed with endometrial cancer gives a family history of her father and paternal grandmother having bowel cancer, and paternal uncle having bowel and renal cancer. Genetic studies should be carried out looking for evidence of which gene mutation?
a. C-myc gene
b. BRCA-2 gene
c. HNPCC gene
d. P53 gene (Li Fraumeni)

c. HNPCC gene

17

Which of the following is the most likely source of metastasis to the ovary?
a. Thyroid
b. Pancreas
c. Lung
d. Breast
e. Kidney

d. Breast

18

A 36yo woman is referred for persistent intermenstrual and post coital bleeding over 6 months. A PAP smear done by her GP is reported as LSIL with numerous inflammatory cells present. Speculum examination shows a friable fungating mass 2cm in diameter on the posterior lip of the cervix. There is no evidence of extension into the parametrium or uterosacral ligaments and the uterus is normal sized and mobile. The MOST APPROPRIATE investigation is
a. Examination under anaesthesia
b. Colposcopy and punch biopsy
c. Cone biopsy
d. Intravenous pyelogram

b. Colposcopy and punch biopsy

19

Which ONE of the following is the optimal therapy for persistent non metastatic gestational trophoblastic neoplasia in a 26yo nulliparous woman?

a. Multiagent chemotherapy
b. Single agent chemotherapy
c. Prophylactic cerebral irradiation
d. Pelvic irradiation
e. Total abdominal hysterectomy

b. Single agent chemotherapy

20

The percentage of invasive cervical carcinoma missed on colposcopic examination without biopsy is best estimated at
a. 9%
b. 14%
c. 27%
d. 55%

c. 27%

21

Adenocarcinoma of the cervix
a. Is equally as radiosensitive as squamous cell carcinoma
b. Contraindicates ovarian conservation
c. Contraindicates exogenous oestrogen
d. All of the above

a. Is equally as radiosensitive as squamous cell carcinoma

22

Endometrial cystic glandular hyperplasia is most likely to be found in a woman
a. With adenomyosis
b. With Type 2 Diabetes mellitus
c. On combined HRT
d. On biphasic oral contraception

b. With Type 2 Diabetes mellitus

23

Which is NOT a risk factor for endometrial cancer?
a. Smoking
b. High animal fat diet
c. Early menarche
d. Late menopause

a. Smoking

24

Which of the following statements regarding cervical dysplasia is LEAST correct?
a. HPV serotypes 16, 18, 45 and 46 are high risk serotypes for progression to invasive cancer
b. HPV serotypes 6, 11, 42, 43 and 44 are low risk serotypes for progression to invasive cancer
c. HPV serotypes 31, 33, 35, 51 and 52 are the serotypes most commonly seen with genital warts
d. First intercourse at a young age, smoking and multiple sexual partners are independent risk factors for progression of dysplasia to invasive cancer

c. HPV serotypes 31, 33, 35, 51 and 52 are the serotypes most commonly seen with genital warts


High-risk HPV - 14 most oncogenic HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68

25

Which of the following statements is LEAST correct?
a. The lifetime risk of ovarian cancer is approximately 1%
b. The lifetime risk of ovarian cancer is approximately 50% in BRCA1 gene carriers
c. The lifetime risk of ovarian cancer is approximately 20% in BRCA2 gene carriers
d. The BRCA1 and BRCA2 genes also increase the risk of Fallopian tube cancers
e. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or BRCA2 as primary peritoneal cancer may still occur

e. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or BRCA2 as primary peritoneal cancer may still occur

26

The primary purpose of administering intracavitary irradiation (pre or post operatively) to a patient with endometrial cancer is to prevent recurrence at the
a. Vaginal cuff
b. Pelvic wall
c. Pelvic peritoneum
d. Pelvic lymph nodes

a. Vaginal cuff