Gyne Long Exam 5

GYNE LONG EXAM 5 PREMALIGNANT AND MALIGNANT LESIONS VULVA AND VAGINA 1. Lichen sclerosus is a change in vulvar skin that often appears whitish. It also is described as the following EXCEPT: a. The epithelium is become markedly thick including the ________. b. Inflammation is usually present c. Studies show small premalignant d. Tumors develop usually in clitoral in location 2. Pruritic erythematous lesions of the vulva with large cell microscopic finding are characteristic of a. Paget’s disease b. Carcinoma in situ c. Verrucous carcinoma d. Lichen sclerosis

11. Endodermal sinus tumor of the vagina can be monitored by what tumor marker Answer: AFP 12. What is the most common histologic type of primary vaginal cancer Answer: Squamous cell carcinoma 13. Most cervical neoplasia will start at Answer: Transformation zone 14. Human papilloma type cause of genital warts Answer: HPV 6,11

CERVIX

3. Major symptom in most vulvar atypia a. Mass b. Itchiness ?? c. Numbness d. Discharge

15. Most effective screening tool in the detection of cervical cancer Answer: Pap smear

4. The best diagnostic procedure in evaluating vulvar lesions: a. Biopsy 5. Vulvar cancer that extends to the anus is what stage? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 6. Tumors of the upper 3rd of the vagina will drain into which node? a. Pelvic nodes 7. What is the most frequently used modality of treatment of sqamous cell carcinoma of vagina? a. Vaginectomy b. Radiation c. Chemotherapy 8. Most cases of VAIN occur in? Answer: Upper 3rd 9. What vaginal malignancy occurs primarily after 14 years of age and is associated to prenatal exposure (to DES) Answer: Clear cell adenocarcinoma ldmf2012

10. The vaginal cancer involving subvaginal tissue with pelvic wall but no pelvic node extension a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

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16. A 30 year old G3P2 asymptomatic woman had routine annual pap smear. The result of her pap smear showed squamous metaplasia. What do you do next? a. Refer for colposcopy. b. Do a cervical punch biopsy. c. Do a Schiller’s test d. Advise a repeat pap smear. 17. A 40 year-old G1P1 patient with CIN 3 had a Schiller’s done. On Schiller’s test you would expect the cervical lesion stain-Answer: Yellow 18. Ablative therapy for CIN will include which of the following a. Cryotherapy b. Loop electrosurgical procedure c. Loop d. Hysterectomy 19. The Atypical squamous cell of undetermined significance should be managed with: a. Repeat pap smear after 6 months b. HPV testing c. Colposcopy d. Any of the above

20. The prevalence of squamous cell carcinoma of cervix is highest in which condition a. Frequent sexual intercourse b. Sex at a young age c. Late menopause d. Alcoholic 21. Most common histology type of cervical cancer Answer: Squamous large cell non keratinizing 22. Cervical cancer which shows unilateral hydronephrosis in IVP Answer: Stage 3b

34. Stage 2 endometrial carcinoma will include the endometrium and Answer: Cervix 35. The broad ligament lymphatics drain at which group of nodes a. Pelvic node 36. The primary treatment for all patients with endometrial carcinoma a. Complete surgical staging 37. Finding>5-10 / hpf mitosis with cytologic atypia will lead to diagnosis of a. Leiomyosarcoma

23. Radical hysterectomy with pelvic node adenectomy is indicated for: Answer: Stage Ib1 24. Most effective screening for cervical cancer Answer: Pap smear

38. Treatment of endometrial sarcoma will be: Answer: Surgical removal

ADNEXA

27. Approximately 5 percent of cases of endometrial carcinoma, diagnosed at what age group? Answer: < 40

39. Structures of adnexa except: a. Ovaries b. Fallopian tube c. Broad ligament d. Round ligament 40. Pathology of reproductive organ that is often mistaken for adnexal mass a. Peritoneal cyst b. Intraligamentary myoma c. Omental cyst d. All of the above 41. Most common cell type of ovarian cancer a. Epithelial

28. Which type of hyperplasia which mostly lead to endometrial carcinoma Answer: Complex atypical hyperplasia

42. Most common neoplastic ovarian tumor following menarche a. Mature cystic teratoma

29. Endometrium with dilated glands, with abundant stroma and some outpouchings Answer: Simple hyperplasia

43. Ovarian cyst highly associated with Hydatidiform mole a. Theca lutein cyst 44. Incidence of ovarian neoplasm being malignant in menopause a. 45% 45. Ovarian mass associated with dyspareunia highly suggestive of a. Mittelschmerz b. Endometriosis c. FT ca d. Meig’s syndrome 46. Meigg;s syndrome triad except: a. Pleural effusion b. Ascites c. Ovarian fibroma d. Bipedal edema

25. Most common type of vaginal bleeding in cervical cancer a. Post coital bleeding

UTERUS 26. Most common age group affected by endometrial adenocarcinoma a. Perimenopausal and postmenopausal

30. Glands are crowded, with complex outpouchings, with very little stroma Answer: Complex 31. Most frequent symptom of women with endometrial hyperplasia a. Abnormal vaginal bleeding 32. On TVS, which of the following shows a lack of endometrial pathology? a.