GYN and GYNONC

1
GYN and GYN-ONC
2
I voted in this presidential election.

• Yes
• No

3
Year in OB residency

• Medical student
• PGY-1
• PGY-2
• PGY-3
• PGY-4
• PGY

4
I expect to work (hours/week)

• lt30
• 30-39
• 40-49
• 50-59
• 60-69
• 70-79
• 80

5
I have/will have/want to havechildren during
residency.

• Yes
• No
• Dont know
• Dont want to know
• Dont want to answer

6
A 12 y.o. girl presents with a pelvic mass. All
of the following are on the differential except

• Germ cell tumor
• Inflammatory mass
• Adrenal mass
• Pregnancy
• Functional ovarian cyst

7
The next best test would be

• Pelvic US
• CT or MRI
• Diagnostic laparoscopy
• Bimanual exam including rectal exam

8
43 y.o. woman presents with a pelvic mass. All
of the following are suspicious for malignancy
except

• Complexity on US
• Irregular cyst wall
• Less than 5cm
• Bilateral cysts
• Solid mass

9
24 y.o. pregnant woman presents with large
bilateral cystic ovaries on US. The most likely
diagnosis is

• Multiple gestation
• Appendicitis
• PCOS
• Molar pregnancy
• Ovarian cancer

10
An 18 y.o. patient presents with LSIL from her
PCP. She has been sexually active since age 14
with 9 total partners. What is the next best step?

• Cryotherapy
• Colposcopy with biopsy
• Colposcopy with biopsy/ECC
• Follow up in 1 year
• Colposcopy only

11
She is lost to follow-up, but is diagnosed with
LSIL from planned parenthood 1 year later and
referred to you. What is the next best step?

• Cryotherapy
• Colposcopy with biopsy
• Colposcopy with biopsy/ECC
• Follow up in 1 year
• Colposcopy only

12
She is lost to follow-up, but unexpectedly
presents to your office for annual exam. A pap
smear done then shows LSIL. What is the next
best step?

• Cryotherapy
• Colposcopy with biopsy
• Colposcopy with biopsy/ECC
• Follow up in 1 year
• Colposcopy only

13
A 22 y.o. is referred to you for ASCUS. All of
the following are correct options except

• Colposcopy
• HPV typing
• Repeat pap in 1 year.
• Repeat pap in 6 months.

14
You have chosen HPV typing. It comes back
positive for high risk. What is your next best
step?

• Colposcopy
• HPV typing again in 1 year
• Cryotherapy
• Repeat pap smear in 6 months.
• Colposcopy with biopsy/ECC

15
A 23 y.o. G1P0 is diagnosed with LSIL on her new
OB visit. All of the following are correct
except

• Colposcopy
• Colposcopy with biopsy of suspicous lesion
• Defer colposcopy until 6 weeks PP.
• Colposcopy with true ECC if no lesion is seen.

16
A 24 y.o. presents with HSIL. Colposcopy is
performed which reveals CIN1. All of the
following are appropriate except

• LEEP
• CKC
• Repeat Colpo in 12 months.
• Repeat Pap and Colpo in 6 12 months.
• Review of slides by pathology

17
A 19 y.o. patient presents with biopsy proven
CIN2. What is the next best step?

• LEEP
• Repeat Colpo and Pap Q6mos for 2y.
• Repeat Colpo and Pap Q12 mos for 2y.
• Repeat Colpo and Pap Q3 mos for 1y.

18
A 19 y.o. patient presents with biopsy proven
CIN3. What is the next best step?

• LEEP
• Repeat Colpo and Pap Q6mos for 2y.
• Repeat Colpo and Pap Q12 mos for 2y.
• Repeat Colpo and Pap Q3 mos for 1y.

19
34 y.o. G3P2002_at_28wks presents with a 3cm
cervical CA lesion with no extension or
parametrial involvement. You next best step is

• Continue pregnancy to term, C/S, radical hyst
  with pelvic nodes
• Continue pregnancy to term, C/S, radiation tx.
• Delivery at 34 weeks, C/S, radical hyst with
  pelvic nodes
• Delivery at 34 weeks, C/S, radiation tx.

20
All of the following are associated with an
increased risk of breast cancer except

• Current OCP use
• Race
• Family history
• Induced abortions
• Menarche

21
Which type of breast cancer is the most common

• Invasive lobular
• Infiltrating ductal
• Mucinous
• Papillary
• Inflammatory

22
Which type of breast cancer has the worst
prognosis

• Invasive lobular
• Infiltrating ductal
• Mucinous
• Papillary
• Inflammatory

23
What percent of breast cancers are linked to
BRCA1 and 2?

• lt1
• 1
• 5
• 15
• 50

24
What tumor is hCG a marker for?

• Dysgerminoma
• Embryonal carcinoma
• Endodermal sinus tumor (yolk sac)
• Immature Teratoma
• Choriocarcinoma

25
What tumor is AFP a marker for?

• Dysgerminoma
• Embryonal carcinoma
• Endodermal sinus tumor (yolk sac)
• Immature teratoma
• Choriocarcinoma

26
What tumor is LDH a marker for?

• Dysgerminoma
• Embryonal carcinoma
• Endodermal sinus tumor (yolk sac)
• Immature teratoma
• Choriocarcinoma

27
Germ cell tumors
1- Borderline elevations in case reports (lt16
ng/ml).2- Low level (lt100 IU/L) seen in
dysgerminomas with either nondysgerminomatous
elements or syncytiotrophoblastic cells.
28
What is the most common ovarian germ cell tumor?

• Immature teratoma
• Dysgerminoma
• Mature teratoma
• Granulosa cell
• Endodermal sinus tumor (yolk sac)

29
All the following are characteristics of
granulosa cell tumors except

• Endometrial hyperplasia/cancer
• Precocious puberty in girls
• Breast tenderness
• Abdominal mass
• Pyelonephritis/ Hydronephrosis

30
Which of the following vaccines are indicated for
a healthy 19y.o. woman at college

• Hepatitis A
• Meningococcal
• Hepatitis B
• Herpes Zoster
• Influenza

31
Vaccinations

• Td Q10y
• HPV lt26 yo
• MMR 1 dose in adulthood or documented immunity.
• Varicella If no evidence of immunity.
• Influenza High risk or personal preference.
• Pneumococcal High risk or asplenia
• HepA High risk
• HepB High risk lots of other indications.
• Meningococcal Asplenia and first-year college
  dorm students. Africa.
• Zoster Adults gt 60y.o. regardless of prior
  episode.

32
What is the most common cancer diagnosed in
pregnancy?

• Breast CA
• Thyroid CA
• Cervical CA
• Lymphoma
• Ovarian CA

33
Most ovarian cancer tumor markers are unaffected
by pregnancy.

• True
• False

34
The risk of fetal malformations for pregnant
women on chemotherapy is highest

• First 4 weeks of gestation.
• 4-13 weeks
• 13-26 weeks
• 26 weeks to term

35
33 y.o. G1P0 _at_10 weeks presents with Stage IIB
ovarian cancer. Her oncologist resected all
visible disease. The next step in management is

• Delivery at 34 weeks by C/S, second look
  laparotomy and initiate chemo.
• Induced Ab now and initiate chemo.
• Initiate chemo, delivery at term.
• Initiate chemo, delivery at 34 weeks.
• Delivery at term, followed by chemotherapy.

36
33 y.o. G1P0 _at_10 weeks presents with Stage IIIC
ovarian cancer. Her oncologist resected all
visible disease. The next step in management is

• Delivery at 34 weeks by C/S, second look
  laparotomy and initiate chemo.
• Induced Ab now and initiate chemo.
• Initiate chemo, delivery at term.
• Initiate chemo, delivery at 34 weeks.
• Delivery at term, followed by chemotherapy.

37
All of the following are risk factors for HPV
infection except

• Young age at first intercourse
• Partners with multiple partners
• Hx of other STD
• Oral genital contact only
• Smoking
• Use of OCPs

38
All of the following techniques can be used to
identify vulvar dysplasia except

• Visual detection
• Pap of vulva
• Biopsy of vulva
• Toluidine blue staining of vulva
• Vinegar soak of perineal areas

39
How is vulvar cancer staged?

• Physical exam
• Surgically
• Microscopically
• Combination

40
DES exposure has been linked to vaginal cancer.
In what year was the incidence of vaginal cancer
the highest?

• 1970
• 1975
• 1980
• 1985
• 1990
• 2000
• 2008

41
What was the total number of cases that year?

• lt50
• 100
• 1000
• 5000
• gt5000