OB/GYN EOR Exam Top Scoring Questions and Answers
____cancer is the most common gynecological cancer in the US. The MC type is ____followed by mucinous, clear cell, and squamous cell. - ANSWER-Endometrial, Adenocarcinoma
Endometrial cancer: The most common route of spread is _____. - ANSWER-via direct extension of tumor downward toward cervix or outward through myometrium and serosa
The most common precursor of endometrial cancer is ____. - ANSWER-endometrial hyperplasia
Pathology: 80% is Type I and occurs in women with history of chronic ____unopposed by progestin. 20% is Type II and ____independent --- associated with mutation in p53 tumor suppressor gene...no identifiable risk factors - ANSWER-estrogen exposure; estrogen independent
What are the top 4 prognostic factors for endometrial cancer? - ANSWER-older age, histological grade, histological type, myometrial invasion
What are the 6 risk factors for endometrial cancer? - ANSWER-nulliparity, DM, obesity, late menopause, tamoxifen, unopposed estrogen therapy
Women with a family history of ____are at a significantly increased risk -- lifetime incidence up to 30%. What screening must these patients undergo? - ANSWER-colon cancer/Lynch syndrome, yearly endometrial biopsy starting at age 35
MC s/s for endometrial cancer? - ANSWER-irregular bleeding
In more advanced disease, what might be seen? - ANSWER-pelvic pain/mass, weight loss, stigmata of DM, patulous cervical os/firm/expanded, ascites, hepatosplenomegally
What is the test of choice for endometrial cancer? - ANSWER-endometrial biopsy
For a woman with abnormal vaginal bleeding, what is included in the work up? - ANSWER-CBC for anemia, TSH, prolactin, FSH/estradiol, CA-125 for ovarian cancer
What is the primary treatment for endometrial cancer? - ANSWER-TAH-BSO (total abdominal hysterectomy-bilateral salpingo-oophorectomy), radiation, and lymph node sampling The risk of endometrial hyperplasia can be reduced almost completely with the use of _____or_____. - ANSWER-oral contraceptives or cyclic progestin therapy
With stage I disease, the _____is the strongest predictor of survival? - ANSWER-depth of myometrial invasion
______has the highest mortality rate of all gyn cancers. Increased risk because of lack of effective screening tools. - ANSWER-Ovarian cancer
____&____ are the two highest risk factors for ovarian cancer followed by FH of ovarian
cancer and PMH of breast cancer. - ANSWER-BRCA1/BRCA2 gene and HPNCC (hereditary non-polyp colon cancer)
OVARIAN CANCER
1. ____are family history of ovarian and breast cancer, PMH of breast cancer, increased
age, early menarche, infertility, nulliparity, late menopause, and obesity.
2. ____are the use of OCPs, multiparity, breastfeeding, tubal ligation, and hystectomy. -
ANSWER-Risk Factors, Protective Factors
Ovarian cancer -- patients are often asymptomatic until disease is advanced. ______or a metastatic tumor implant in umbilicus can be associated with ovarian cancer. - ANSWER-Sister Mary Joseph nodule
_____is the test of choice for ovarian cancer. - ANSWER-pelvic u/s -- color Doppler imaging may enhance specificity
____masses in the ovary tend to be >8cm, solid, multilocular, bilateral with ascites, peritoneal masses, and lymphadenopathy. - ANSWER-Malignant
In 80% of women (50% in early disease) with epithelial ovarian cancer, ____tumor marker may be elevated. ___&___are also present. - ANSWER-CA-125; alpha-
fetoprotein, hcG
In pre-menopausal women with simple cystic mass <7.5cm, it may be ____for 4-
6weeks. Most resolve spontaneously. ____may be used for ovarian masses small enough to be removed with this approach. - ANSWER-observed; laparoscopy
Ovarian cancer: 75% of patients present with stage III/IV. What's involved in the primary
staging? - ANSWER-TAHBSO, omentectomy, peritoneal washings, pap smear of diaphragm, sampling of pelvic & para-aortic lymph nodes
In epithelial tumors (20% 5 year survival rate) and germ cell tumors (60-85% 5 year survival rate), multi-drug chemo is used. Chemo is not used in ____which has a 90% 5 year survival rate. - ANSWER-sex cord stroma
Ovarian cancer staging:
_____: growth limited to ovaries. _____: extension from ovaries to pelvis.
_____: extension to abdomen.
_____: distant metastasis (liver, lung). - ANSWER-Stage I, II, III, IV
___ ___is thought to be a precursor to cervical cancer. - ANSWER-Cervical dysplasia
_____infection is strongly linked to cervical neoplasia. - ANSWER-HPV infection 6, 11, 16, 18 -- 16 & 18 more linked
HPV 6 & 11 is associated with ____ or genital warts. - ANSWER-condylomata acuminata
Vaccine against HPV is recommended for all boys and girls aged 11-12 (3 injections over 6 months). What are the vaccinations and what strains do they cover? - ANSWER-
Gardasil - HPV 6, 11, 16, 18
Cervarix - HPV 16, 18
Other _______for CIN ie. cervical intraepithelial neoplasia include early age of 1st intercourse, early child-bearing, multiple sex partners, history of STI, low socioeconomic
class, African American, or smoking. - ANSWER-risk factors
Pap Smear reduces CIN incidence by 95% -- what are the recommendations for pap smear? - ANSWER-begin with in 3 years of becoming sexually active or age 21 whichever comes first -- until age 65 if 3 consecutive negative results
What's the most appropriate technique for histological evaluation of CIN? - ANSWER-
colposcopy with biopsies
Treatment for CINI? CINII? - ANSWER-CINI: colposcopy every 3-4 months - may resolve spontaneously
CINII: destruction/excision of lesions -- cryotherapy, laser therapy, LEEP, conization, CO2 laser
Treatment continued -- _______is more likely to lead to incompetent cervix than LEEP. ____is a well controlled method that minimizes tissue destruction -- it is colposcopy directed and requires special training. - ANSWER-Conization; CO2 laser
Most common s/s of cervical cancer are __, __, & __. Late symptoms are bladder and rectal dysfunction or fistulas and pain. - ANSWER-menorrhagia, postcoital bleeding, and cervical ulceration
Cervical cancer: ______is the cause of death in 10-20% of patients. - ANSWER-vaginal
hemorrhage -- ligation of hypogastric arteries may be lifesaving
_____is the most common cancer in women and 2nd leading cause of death in women. - ANSWER-Breast cancer What are the recommendations concerning self breast examinations? - ANSWER-Used to be SBE monthly >20yo and 5 days after menses -- NOW NOT recommended bc of increased incidence of unnecessary biopsy -- "self awareness now"
Greater than 50% of breast cancer occurs where? - ANSWER-upper outer quadrant
What is breast mass like if found? - ANSWER-nontender, irregular, firm, and immobile
What are the recommendations concerning mammograms and clinical breast exams? - ANSWER-annual mammogram >age 40; clinical breast exam annually after age 40, every 1-3 years ages 20-39 year old
What mammogram findings are suspicious for breast cancer? - ANSWER-speculated mass, asymmetric local fibrosis, microcalcifications
Other dx testing:
____is used to separate fluid-filled cysts from solid masses.
___, ___, or ___ are needed to make official diagnosis. - ANSWER-Ultrasound; FNA, biopsy, or excisional biopsy
Evaluation of abnormal findings:
1. Palpable cystic lesion means ____.
2. Recurrent cyst, bloody fluid means ____.
3. Solid, palpable mass <30yo means _____.
4. Solid, palpable mass >30 yo means _____.
5. Nondiagnostic FNA of solid mass means _____.
6. Nondiagnostic core-needle biopsy means _____.
7. Nonpalpable abnormal mammogram finding ____. - ANSWER-1. needle drainage
2. excision
3. FNA
4. core needle biopsy
5. excisional biopsy
6. excisional biopsy
7. wire guided excision
Types of invasive breast cancer:
a. 80-85% are _____.
b. 15-20% are _____ - estrogen receptor positive
c. ____are eczematous lesions.
d. ____breast carcinoma. - ANSWER-infiltrating invasive breast cancer, invasive lobular
carcinoma, Paget's disease of the breast, Inflammatory
_______dx test is used to help determine the need for chemotherapy for stage I or II hormone receptor positive. It looks at 21 genes with tumor to determine the likelihood of
cancer recurring or spreading. - ANSWER-Oncotype
