Latihan dasar stase obsgyn

Gynecologic oncology: premalignant and Malignant disease of the lower genital tract – vulva, vagina, and cervix
1. Which of the following is etiologic agent (or immediate precursor lesion) for vulvar cancer?
(A) squamous cell hyperplasia
(B) atrophic dystrophy
(C) chronic granulomatous diseases
(D) chronic irritation
(E) unknown

2. A 56-year-old woman has a biopsy-proven vulvar intraepithelial neoplasia (VIN III). She undergoes a wide excision and return 3 months later with vulvar pruritus. How do you advise her?
(A) Steroid cream on the vulva will reduce the itching.
(B) She may need a repeat biopsy.
(C) There is minimal chance of cancer.
(D) There is minimal chance of recurrence.
(E) If there is a recurrence, it will regress spontaneously.
3. Which of the following characterize paget’s disease of the vulva?
(A) recurrences are infrequent after treatment
(B) frequent association with other invasive carcinomas
(C) appears as a solitary hypopigmented lesion
(D) is treated with laser vaporization
(E) occurs predominantly in premenopausal women
4. Which of the following types of vulva cancer occurs most commonly?
(A) Paget's
(B) squamous
(C) melanoma
(D) adenocarcinoma
(E) basal cell
(A)
(B)
(C)
(D)
(E) clear cell carcinoma
condyloma acuminate
adenocarcinoma
hidradenoma
urethral caruncles





5. A 48-years-old woman has a large verrucous lesion of her vulva. Such a lesion is most likely which of the following





6. Which of the following is the most common symptom of vulvar carcinoma in elderly woman?
(A) abnormal bleeding
(B) a foul smell
(C) pruritus
(D) vulvar atrophy
(E) painful intercourse
7. A blue swelling on the vulva is most likely to be which of the following?
(A) a melanoma
(B) a varicosity
(C) endometriosis
(D) a cyst of the canal of Nuck
(E) a hemangioma

8. A 1-cm vulvar carcinoma with tumor-positive unilateral nodes and no distant spread would be which FIGO (international Federation of Gynecologu and obstetrics) stage?
(A) I
(B) II
(C) III
(D) IV
(E) cannot be staged without further information

9. A 58-years-old woman has a 1-cm vulvar ulcer. A biopsy shows invasive squamous cell carcinoma with more than 1 mm of stromal invasion. Which of the following is the preferred treatment?
(A) Burow's soaks
(B) 5-fluorouracil (5-FU) cream
(C) radiotherapy
(D) radical local excision and ipsilateral inguinofemoral lymph node dissection
(E) radical hysterectomy and node dissection

10. If the lymph nodes in the preceding case are negative, the 5-years survival should be about what percentage?
A. 12%
B. 25%
C. 52%
D. 78%
E. 90%




11. Which of the following is the most common complication of radical vulvectomy?
(A) debilitating edema of the lower extremities
(B) pulmonary embolism
(C) necrotizing fasciitis
(D) breakdown of the surgical wound
(E) urinary and rectal incontinence

12. A 72 years old woman has had a radical vulvectomy for stage II squamous cell vulvar cancer. She want to know the most likely site of recurrence if thetumor comes back. Which of the following can you correctly tell her?
(A) at the site of tumor resection
(B) in the bladder or rectum
(C) in the scalene lymph nodes
(D) the chest
(E) the upper leg

13. Which of the following tumors of the vulva has the best prognosis?
(A) stage I verrucous carcinoma
(B) melanoma
(C) stage I squamous cell cancer of vulva
(D) basal cell carcinoma
(E) rhabdomyosarcoma

14. The most common method of giagnosing carcinoma of the vagina is which of the following?
(A) bleeding from the tumor bed
(B) pain with intercourse
(C) Papanicolaou smear screening
(D) incidental discovery on bimanual examination of the pelvis
(E) colposcopic prophylaxis in high-risk patients

15. The offspring of women who were exposed to the diethylstilbestrol (DES) during gestation do not have an in creased risk of which of the following?
(A) vaginal adenosis
(B) adenocarcinoma of the ovary
(C) clear cell carcinoma of the vagina
(D) squamous intraepithelial lesion of the cervix
(E) clear cell carcinoma of the cervix

16. Whichof the following malignancies tends to metastasize to the vagina most frequently?
(A) ovarian
(B) endometrial
(C) bowel
(D) bladder
(E) melanomas

17. Which of the following is a malignant tumor of the vagina of young children that appears clinically as a mass of grape-like edematous polyps?
(A) Emphysematous vaginitis
(B) squamous cell carcinoma
(C) sarcoma botryoides
(D) adenocarcinoma
(E) choriocarcinoma

18. A 72-years-old woman has carcinoma of the vagina that has reached the lateral pelvic wall. What stage is it?
(A) 0
(B) I
(C) 11
(D) III
(E) IV

19. Which of the following is the most likely histolohy of vaginal carcinoma in this woman?
(A) melanoma
(B) verrucous
(C) clear cell
(D) adenocarcinoma
(E) squamous cell

20. A 72 years old woman with a vaginal cancer is found on physical examination to have tumor extending from the lateral vaginal wall tu the pelvic sidewall. Which of the following is the BEST treatment for her?
(A) total vaginectomy
(B) upper vaginectomy
(C) chemotherapy
(D) radiation therapy
(E) exenteration

21. Which of the following is the most common method used to diagnose cervical intraepithelial neplasia (CIN)?
(A) complaints of abnormal discharge
(B) postcoital bleeding
(C) chronic pelvic pain
(D) vaginal wet preparation
(E) abnormal Pap smears

22. Which of the following is TRUE concerning the etiology of cervical dysplasia and cervical cancer?
(A) Human papillomavirus (HPV) is the major causal agent.
(B) They are associated with obesity.
(C) They are associated with nulliparity.
(D) There is a strong genetic component to the development of cervical cancer.
(E) They are the direct result of cigarette-smoking.

23. Which of the following is TRUE regarding HPV?
(A) Only 20% of sexually experienced women will be infected with HPV.
(B) The virus is transient for most women.
(C) Most women with HPV will go on to develop warts, CIN, or cancer.
(D) Other cofactors such as cigarette smoking and altered immune response have not been shown to be related to the development of cervical neoplasia.
(E) There are only 10 subtypes of HPV

24. A 40 years woman is seen for a routine examination. Her menses hae been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her pap smear is returned as “High-grade squamous intraephitelial laesion. “The performance of which of the following options is the BEST course of action?
(A) immediate wide-cuff hysterectomy
(B) repeated Pap smears at 3-month intervals
(C) fractional dilation and curettage (D&C)
(D) punch biopsy of anterior cervical lip
(E) colposcopy with biopsy

25. The colposcope permits one to do which of the following?
(A) view the cervix at 1 to 4 power magnification
(B) see the entire transition zone in all patients
(C) choose the most suspicious areas on the cervical portio to biopsy
(D) treat invasive cancer with a biopsy
(E) make the diagnosis of cancer

26. What does leukoplakia refer to?
(A) a microscopic lesion
(B) atrophy
(C) a cancer
(D) a white patch
(E) an ulcer

27. Conization of the cervix would be inappropriate in which of the following instances?
(A) when there is disparity between Pap smear and biopsy results
(B) when colposcopy is inadequate
(C) when microinvasion is diagnosed by biopsy
(D) when deeply invasive cancer is shown on a biopsy
(E) for treatment of biopsy-proven CIN III

28. In treating CIN III, cryotherapy has a failure rate of about what percentage?
(A) I to 5%
(B) 10 to 20%
(C) 25 to 30%
(D) 35 to 40%
(E) >40%

29. Often, the first symptom of cervical cancer is which of the following?
(A) leg pain
(B) pain with intercourse
(C) vaginal bleeding
(D) weight loss
(E) vulvar pruritus

30. Where do most cervical cancers arise?
(A) on the portio vaginalis
(B) at the internal os
(C) in the endocervix
(D) at the squamocolumnar junction
(E) at the external os

31. What percentage of clinical stage I carcinomas of the cervix will have lymphatic spread?
A. 0%
B. 5%
C. 15%
D. 25%
E. 40%

32. Which of the following factors is most indicative - of invasive cancer on colposcopic examination?
(A) white epithelium
(B) leukoplakia
(C) abnormal blood vessels
(D) punctation
(E) mosaic pattern
33. If a nonhealing ulcer is seen on the cervix, it is best evaluated by which of the following?
(A) repeat examination
(B) Pap smear
(C) punch biopsy
(D) cone biopsy
(E) vaginal steroid cream

Questions 34 and 35
A 43-years-old woman had a suspicious Pap smear and a normal pelvic examination. A colposcopically directed biopsy of a normal-appearing cervix revealed invasive carcinoma.
34. Which pf the following should should be the next step in the care of the patient?
a. Metastatic ealution
b. Conization
c. Radical hysterectomy
d. Radiation therapy
e. Both irradiation and radical hysterectomy
35. The woman had a negative metastic workup. Her clinical examination shows cancer growth shown in figure 21-1. Her preliminary clinical stage is which of the following?
a. I A
b. I B
c. II A
d. II B
e. C
36. Biopsy-proven carcinoma in situ of the uterine cerix, if otherwise untreated, will progress to invasive cancer in up to what percentage of patiens?
a. <5%
b. 30%
c. 50%
d. 70%
e. >90%
37. The majority of deaths from cervical carcinoma are due to which of the following?
(A) local spread obstructing the ureters, causing renal failure
(B) brain metastasis with resultant cerebral hemorrhage
(C) hemorrhage into the pelvis from erosion of vessels by the tumor
(D) pulmonary failure secondary to metastatic disease filling the lungs
(E) bone metastasis causing crush injuries to the central nervous system
38. The 5-year survival rate for stage IV inva¬sive cervical cancer is approximately what percentage?
(A)
(B)
(C)
(D)
(E) >1%
10%
20 to 30%
50%
80%

39. Extent of spread being equal, which of the following carcinomas of the cervix has the poorest prognosis?
(A) well-differentiated, keratinizing, large cell squamous carcinoma
(B) undifferentiated, large cell squamous carcinoma
(C) differentiated, small cell squamous carcinoma
(D) undifferentiated, small cell squamous carcinoma
(E) papillary adenocarcinoma
40. Which of the following is the BEST term for a bulky, friable, papillary tumor mass growing from the cervix?
(A) exophytic
(B) endophytic
(C) nodular
(D) ulcerating
(E) edematous
41. A 34-year-old woman is 16 weeks pregnant and has a Pap smear suspicious for cancer. How do you advise her?
(A) have colposcopy with biopsy
(B) have colposcopy, but biopsy is too risky in pregnancy
(C) have a repeat Pap smear in 3 months
(D) undergo a termination of pregnancy and then undergo complete evaluation
(E) have cervical Ionization
42. Vaginal intraepithelial neoplasia is most commonly found in which part of the vagina?
(A) the upper one-third
(B) the mid-vagina
(C) the distal. vagina
(D) at the hymenal ring
(E) the posterior fourchette
43. The preferred treatment for stage I vaginal car¬cinoma confined to the upper one-third of the lateral vagina in a 29-year-old woman would be which of the following?
(A) intravaginal, 5-FU
(B) upper vaginectomy
(C) simple hysterectomy and upper vaginectomy
(D) radical hysterectomy, pelvic lymphadenectomy, and partial vaginectomy
(E) anterior exenteration
44. Which of the following are not true regarding cancer of the vulva?
(A) it is often associated with a long history of vulvar pruritus, discomfort, or a bloody discharge.
(B) It will often appear as a growth on the labia.
(C) Biopsy is necessary to make the diagnosis
(D) Often requires radical vulvectomy with a inguinofemoral lymph node dissection.
(E) The peak incidence occurs between ages 40 and 50.
45. A 45-years-old present with a history with a history of post coital spotting. Examination of the cervix reveals a raised/reddened well-circumscribed lesion next to the os. The most likely diagnosis is which of the following?
(A) carcinoma
(B) condyloma lata
(C) ectropion
(D) cervical polyp
(E) nabothion cyst
46. The treatmen of carcinoma of the cervix during pregnancy should depend on all except which of the following?
(A) the recommendation of the oncologist
(B) the religious and moral belief of the patient
(C) the trimester of the pregnancy
(D) the stage of the lesion
(E) the length of the cervix
47. A 42-years-old woman undergoes a radical hysterectomy and requires postop radiation. During the radiation. Therapy she return complaining of watery vaginal discharge and recurrent urinary tract infections. Of the following four test, which would not be helpful in the evalution?
a. intravenous pyelogram
b. cystoscopy
c. wet mount
d. sigmoidoscopy
e. inject diluted methylene blue in sterile water into the bladder and examine the vagina.
48. A 35 years old female with stage IIB squamous cell carcinoma of the cervix will receive radiation. Regarding reproductive changes, how do you advise her?
a. ovaries are radiresistant
b. fertility can be maintained
c. radiation will likely result in endometrial ablation
d. younger patients are more susceptible to radiation-induced castraction
e. there is no change in vaginal function
49. A 46 years obese woman smokes two packs of cigarettes a day. She had a radical hysterectomy with a para-aortic and pelvic lymph adnectomu for stage IB squamous cell carcinoma of the cervix. At surgery she was found to have dense pelvic small bowel adhesions from a prior ruptured appendix and appendectomy. Lymph nodes were positivefor cancer cells. In discussing postoperative radiation, you counsel her that she has an increased related complication because of which of the following?
A. obesityion
B. excision of lymph nodes
C. decreased bowel motility from adhesions
D. age
E. stage of the cancer

50. which of the following is false regarding atypical squamous cells of undetermited significance (ASCUS)?
A. the risk of CIN II or III on biopsy is 5 to 17%
B. the risk of invasive cervical cancer is 0,1%
C. represent a minority of abnormal paps per years in U>S women
D. may be related to atrophy in postmenopausal women
E. may be associated with HPV
51. of the following management options for ASCUS, which is least acceptable?
A. check for HPV high-risk subtype; if negative follow-up in 12 months with pap
B. repeat pap in 12 months
C. immediate colposcopy
D. repeat pap in 4 to 6 months
E. if atrophy is present, treat with vaginal estrogen and repeat pap
52. A 48-years-old postmenopausal woman present for routine gynecologic examination. The examination is normal, homewer the pap return atypical glandular cells (AGC). Which whould be the most appropriate management for this patient?
A. repeat pap in 4 to 6 months
B. treat with intravaginal estrogen and repeat pap
C. perform cone biopsy of the cervix
D. perform colposcopy, cervical and endometrial biopsies
E. refer to GYN Oncology