Reviewer - LE4

  Gyne: LE 4 // Reviewer // 2014 – 2015 1. The prevalence of SCCA of the cervix is highest in which condition? a. Women who have frequent sexual intercourse b. Women who have first intercourse at an early age c. Women with late menopause d. Women who are alcoholic beverage drinkers 2. Most common histological type of cervical carcinoma a. Invasive SCCA, large cell keratinizing type b. Adenocarcinoma c. SCCA, large cell keratinizing type d. Invasive SCCA, large cell non-keratinizing type 3. Most cervical intraepithelial neoplasia would start at the a. Ectocervix b. Endocervix c. Transformation zone d. Cervicovaginal junction 4. What HPV subtype causes genital warts? a. 6 and 11 b. 11 and 18 c. 16 and 18 d. 6 and 8 5. Most effective screening test for cervical CA a. Transvaginal ultrasound b. Colposcopy c. CA 125 d. Pap smear 6. A 30 year old, G3P3, asymptomatic woman had her routine annual pap smear. Smear showed squamous metaplasia. What would you do next? a. Refer to colposcopy b. Do a cervical punch biopsy c. Do a schiller’s test d. Advise a repeat pap smear 7. A 40 year old G1P1 patient with cervical intraepithelial neoplasia 3 had a schiller’s test done on her. You expect the cervix a. Dark brown b. Blue c. Black d. Yellow 8. Ablative therapy for CIN includes which of the following a. Cryotherapy b. LEEP c. Large loop excision of the transformation zone d. Hysterectomy 9. At what age does pap smear start according to GOG? a. 18 b. 19 c. 20 d. 21

 

10. Pap smear reporting in cervical intraepithelial neoplasia a. Every 6 months for 2 years b. Every 6 months for 5 years c. Annually for 10 years d. Every year, indefinitely 11. Atypical squamous cells of undetermined significance is managed as: a. Repeat Pap smear after 6 months b. HPV-DNA testing c. Colposcopy d. AOTA 12. At what age does Pap smear can withhold if there are no abnormalities? a. 60 b. 65 c. 70 d. 75 13. Most common type of ovarian tumor a. Epithelial b. Germ cell tumor c. Sex cord tumor d. 14. Endoderma sinus tumor marker a. Alpha feto protein b. c. d. 15. Vaginal tumor with no lymph node involvement involving the subvaginal tissue within the pelvic wall. a. Stage I b. Stage II c. Stage III d. Stage IV 16. Vaginal malignancy occurs primarily after 14 years of age and is associated with prenatal exposure to DES a. Clear cell carcinoma b. c. d. 17. Most cases of VAIN occur in the a. Upper 1/3 of the vagina b. c. d. 18. Tumors of the upper 1/3 of the vagina will drain into a. Inguinal nodes b. Pelvic node like obturator nodes c. d.

  19. Vulvar mass extending to the anus a. Stage I b. Stage II c. Stage III d. Stage IV

28. In the acronym RADAR steps in abuse work the first letter A stands for a. Ask direct questions only for VAWC suspects b. Ask direct questions c. Ask direct questions only for adults d. Ask indirect questions to prevent embarrassment

20. Best diagnostic procedure in evaluating vulvar masses a. Pap smear b. Toludene blue c. Colposcopy d. Biopsy

29. A phase in the cycle of violence where the relationship seems to be working, no abuse is taking place. This may diminish and disappear altogether as the cycle shortens a. Build up phase b. Explosive phase c. Remorse phase d. Honeymoon phase

21. Vulvar atypia manifests as: a. Itchiness b. Discharge c. Numbness d. Mass 22. Thinning of the vulvar epithelium, loss of rete edges a. Paget’s disease b. CA in situ c. Verrucous CA d. Lichen sclerosis 23. Lichen sclerosis, changes in the vulvar skin that often appears whitish. It’s also described as the following, EXCEPT: a. Markedly thickened epithelium b. Studies show small premalignant potential c. Inflammation is usually present d. Tends to be clitoral in location 24. Violence Against Women (VAW) is “any act of _______________ that results in, or is likely to result in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life” a. Gender based violence b. Sex based violence c. Women based violence d. Female based violence 25. Marital rape, now recognized under Philippine laws, means a. A man may be charged with rape if he forces his wife to have sex with him b. A man may be charged with rape if he forces his live-in girlfriend to have sex with him c. A man may be charged with rape if he forces his wife to have sex with his friend d. A man may be charged with rape if he forces his daughter to have sex with him 26. Collective term to mean warning signals that need further investigation in VAW e.g. vague illnesses, serious psychosocial problems, physical injuries that do not match history a. Red flags in VAWC b. Pathognomonic of VAWC c. Red herrings in VAWC d. Sign and symptoms of VAWC 27. In the acronym RADAR steps in abuse work the first letter R stands for a. Random screening for some b. Routine screening for all c. Routine counseling for all suspects d. Routine referral to barangay health worker for all

 

30. A phase in the cycle of violence where the relationship seems to be working, but new incidents of abuse are taking place in increasing frequency a. Build up phase b. Explosive phase c. Remorse phase d. Honeymoon phase

Violence Against Women and Children RADAR o Routine screening for all o Ask direct questions o Document findings o Assess patient safety and plan o Review patient options and referrals Pediatric and Adolescent Gynecology Vulvovaginitis o Most common cause of vulvar symptoms o Sign: Pruritus Cervix o Only palpable structure during prepubertal stage CASE: o Pinworm o Itching at night o Scotch tape swab Secretions during prepubertal stage o Neutral, alkaline o Absence of lactobacilli Vulvar CA FIGO Staging for Vulvar CA o Stage I Tumor confined to the vulva or perineum. No nodal metastasis. o Stage II Tumor of any seize with extension to adjeacent lower perineal structures, with negative nodes. o Stage III Tumor of any size with or without extension to adjacent perineal structures, with positive inguino-femoral lymph nodes o Stage IV Tumor invades other regional or distant structures Management: o Tumor of less than 2cm Radical local excision with or without unilateral groin node dissection o Tumor of more than 2cm Radical local excision with inguinofemoral lymphadenectomy

  Vaginal CA Usually occur as SCCA in women > 60 years old Management: o Stage I § Less than 0.5 cm • Wide local excision or total vaginectomy or brachytherapy § More than 0.5 cm • Radiotheraphy • Radical hysterectomy with lymphadenectomy § Lower third of the vagina • Radical vaginectomy with inguinal lymphadenectomy o Stage II § Radiation with chemotherapy § Radical vaginectomy or pelvic exenteration with or without RT o Stage III Radiation with chemotherapy o Stage IVA Preoperative radiation o Stage IVB Radiotherapy with chemotherapy

Premalignant Disease of the Vulva and Vagina Lichen sclerosus – risk of malignancy: 1-4% Diagnosis: Keyes punch biopsy Microscopic features o Hyperkeratosis o Epithelial thickening with flattening of rete pegs o Atrophy of the epithelium o Homogenous collagen in the papillary dermis with lymphocytic infiltrate Treatment: o Testosterone o Progesterone o Clobetasol propionate VIN histopathologic subtypes and associations Usual: Warty, Basaloid

Differentiated: Simplex

Age

Pre monopausal

Post menopausal

Overall % VIN

95%

5%

HPV Associated

Yes

No

HPV Type

16

N/A

Risk Factor

Smoking, immunocompromised

None

Distribution

Multifocal

Unifocal, unicentric

Background history

Lichen sclerosus

Progression

-

 

Warty basaloid SCCA Invasive CA

Keratinizing SCCA

Risk of preogression to invasive cancer is higer for those who are older and immunocompromised Management of VIN: o Surgical excision o Carbon dioxide laser o 5FU cream o Imiquimod 5% o Therapeutic vaccines