FCPS Part-2 Written -General gynecology and gynecologic oncology

1. What is the mechanism responsible for inactivation and immortaliztion of human papillomavirus oncogene E6 ?

2. A 36years old woman diagnosed with squamous cell carcinoma of cervix. Lesion was 4cm. she undergoes a radical hysterectomy, bilateral pelvic and para-aortic lymph nodes dissection. On final pathalogy report the parametria are noted to contain tumor. What stage is her cervical cancer?

3. A 38yr old women diagnosed with stage IIB cervical cancer. She had positron emission tomography scanning that shows positive pelvic lymph nodes. a laparoscopic extraoperitoneal para-aortic lymph dissection was planned to confirm the findings of PET scan. Histological review shows that the para-aortic nodes are positive for tumor. What is the most appropriate treatment?

4. Which histologic subtype of cervical cancer is associated with peutz-jeghers syndrome?

5. Which of the following is the most commonly used radiation sensitizer for the treatment of cervical cancer?

6. A 65 yr old postmenopausal woman presents for her annual checkup with complains of vulvar pruritus. On examination A thickened, white plaque is noted on her vulvar skin. What is the most appropriate next step?

7. What is the risk of lymph node metastasis with squamous cell carcinoma of the vulva with 2mm depth of invasion?

8. A 58 yr old postmenopausal woman with complaints of vulvar bleeding and pain. On examination a 4.5 cm anterior vulvar tumor is noted. Inguinal adenopathy is absent. Vulvar biopsy reveals invasive squamous cell carcinoma. What is most appropriate management?

9. A 57yr old postmenopausal women present with a 3cm lesion located on her left labium minora . her left groin lymph nodes are also enlarged but are non fixed . Which is most appropriate treatment?

10. A 53 years old woman diagnosed with a 3cm right vulvar basal cell carcinoma that lies 2cm from the midline. There is no associated inguinal lymph adenopathy . What is the most appropriate treatment for midline and that lacks?

11. Which of the following is not a known risk factor for primary vaginal cancer?

12. Which vaccine preventable human papillomavirus type is most commonly identified in vaginal cancer?

13.  What is the approximate 5yr survival rate for a patient with stage 2 squamous cell cancer of vagina who was treated with external beam radiotherapy and brachytherapy 1year back, who has the experienced a local recurrence with no evidence of metastatic disease?

14. A 3 year old girl presented with C/O vaginal bleeding. on examination there is a polypoid mass at the vaginal opening. She is diagnosed with sarcoma botryoides. Which of the following is correct consideration as the most appropriate treatment of her malignancy?

15. A 56 years old woman presents with postmenopausal spotting and pelvic pain and is a diagnosed with adenocarcinoma of the vagina. Which of the following most commonly gives rise to histologic type of vaginal cancer?

16. A 60yr old woman undergoes TAH+BSO with bilateral pelvic and para-aortic lymph nodes dissection for endometrial cancer. Histologic evaluation reveals a grade 2 endometrial adenocarcinoma with >50% myometrial invasion, lymphovascular space invasion and positive washings. All Other surgical specimens are benign. What stage is she assigned according to FIGO criteria?

17.  A 47yr old woman undergoes TAH+BSO with bilateral pelvic and para-aortic lymphadenectomy for endometrial cancer. Histologic evaluation reveals a grade 2 endometrial adenocarcinoma arising in the uterus, with 30% myometrial invasion and with endocervical gland extensions. What is her FIGO stage?

18. A 75 yr old woman is diagnosed with a grade 1 endometrial adenocarcinoma of uterus by endometrial biopsy. She has a body mass index of 45kg/m2, has uncontrolled type 2 diabetes mellitus. She had a prior right below the knee amputation and is wheelchair bound. What is the most appropriate management?

19. A 68yr old woman has multiple episodes of postmenopausal bleeding. An endometrial biopsy reveals papillary serous carcinoma. At exploration there is carcinomatosis and omental cake formation. In addition to TAH+BSO  what other management is most appropriate?

20. A 62 yr old women has a history of surgery for stage IA garde1 endometrial adenocarcinoma of uterus,. She develops c/o vaginal bleeding and biopsy of a 1cm mass at her vaginal apex reveals recurrent uterine cancer. What is the most appropriate treatment if no metastatic disease is found during further evaluation?

21. What percentage of stage1 epithelial cancer have a normal cancer antigen 125(CA125)level?

22. A 29 years old woman resent with complaints of increasing abdominal distension, constipation and weight loss. her Abdominopelvic computed tomography reveals 13cm right adnexal mass with retroperitoneal lymphadenopathy. Her CA 125 levels are 45 U/ml. Her Beta hcg is less than 5 IU/ml, alpha fetoprotien and LDH are normal. Her serum calcium levels are 15 mg/dl. What is most likely diagnosis?

23. With optimally debulked (< 1cm residual disease) stage 3 epithelial ovarian cancer which of the following chemotherapy regimen is associated with longest overall survival rate for women?

24. A 3years old woman with history of stage 3C ovarian cancer who underwent optimal cytoreductive surgery followed by cycles of intraperitoneal cisplatin and paclitaxel. She complains of bloating and decreased appetite 4 months after completion of chemotherapy and is suspected to have a recurrence. She complains of bloating and decreased appetite. Which of the following is the most appropriate treatment?

25. Which of following cell types of ovarian cancer is not associated with endometriosis?

26. an 18 years old presents with  c/o primary amenorrhea .on  examination breasts are tanner stage 4 and pubic and axillary hairs are absent. Also a blind ending vagina is identified. What is likely diagnosis in this patient?

27. a 15 years old woman with c/o primary amenorrhea. on  examination breasts are  tanner stage 4. Which of the following tests is an appropriate first step of management?

28. an 18years old girl presents with c/o primary amenorrhea. She responds to progesterone withdrawal test. Which of the following is her most likely diagnosis?

29. A 26 years old patient presents with 6 months history of amenorrhea. She is diagnosed with hyperprolactinemia. Lab test measuring which of following should also be obtained?

30. an 18years old girl presented with c/o secondary amenorrhea. She previously had regular menses. She is also diagnosed with anorexia nervosa from last 1 year. Which of following is likely to be seen in this patient?

31. a 25 years old woman  presents with irregulasr menstrual cycles from last 7 months. She is never been pregnant. Her physical examination shows acanthosis nigricans, clitoromegaly, temporal balding. Ovarian hyperthecosis is suspected. Which of the following finding is most characteristic to this condition?

32. a 22 years old nulligravida presents with 10months history of irregular menses. Her BMI is 32kg/m2 . she is diagnosed with PCOS, which of the following is most likely her lipid profile status?

33. a 30years old woman presents with C/O of  secondary amenorrhea from last 5months. Her examination shows severe acne and hirsutism. During evaluation she is diagnosed as a c/o  PCOS . on labs she is having an elevated DHEAS level of 750 microgram per deciliter. What is best test to order next?

34. a 27 years old woman is diagnosed with PCOS . she has  type 2 obesity. she had 8-10 normal menses per year for last several years. She doesnot want to concieve and does not desire any further intervention if not medically necessary. Counseling includes recommendations for all of the following except?

35. A 25 years old obese woman presents with c/o menstrual irregularity. Her physical examination shows a round moon like face and proximal muscle weakness. Which of the following is most likely to lead to correct diagnosis for this patient?

36. which of the following is the limitation of pipelle sampler used for endometrial biopsy in evaluation of abnormal uterine bleeding?

37. a 60 years old patient presented with C/O acute heavy menstrual bleeding. she was admitted for management of heavy bleeding. She has H/O breast cancer. She is also taking oral antgicoagulants for recently diagnosed DVT . Which of the following management options is LEAST suitable for this patient?

38. a 27years old woman  presents with complaint of heavy menstrual bleeding . she also gives history of new onset dysmenorrheal from last 4 months. Given the additional symptom which of the following is least likely?

39. A 27years old patient presents in emergency with 1 day history of heavy vaginal bleeding. She is not in shock. Speculum examination shows bleeding from cervical os with continued pooling of blood in vagina. Lab studies show moderate anemia. Which of following is most suitable first line management for control of acute heavy bleeding?

40. a 29years old woman has history of recurrent bartholian gland abscess. She had 2 incision and drainage procedures previously. Which of the following would provide most definitive treatment for her condition?

41. a 19 years old woman presents with C/O worsening dysmenorrhea and chronic pelvic pain from last 1 year. Her TVS  shows unicornuate uterus and an obstructed cavitary rudimentary horn. Of other mullerian anomalies which of following is least likely to pose a similar risk for endometriosis development?

42. Which of following mechanism is the most likely to cause infertility in women with endometriosis?

43. A 24 years old woman with recently endometriosis laproscopically. She complains of worsening dysmenorrhea, dysuria, urinary urgency. Her  urinanalysis and urine cultures are negative for infection. Which of the following would be least suitable for further evaluation of this patient?

44. A 24 years old woman diagnosed with stage 2 endometriosis. She has been put on medical treatment but wass not responding to initial treatment in terms improved symptoms is now pain free after administration of a GNRH agonist 1 month ago. However she now complains of poor sleep due to vasomotor symptoms, decreased libido, dysparunia secondary to vaginal dryness. Which of the following agents taken orally daily might be least effective for this patient?

45. Which of the following surgical approach is most likely to benefit the patient with deeply infiltrating lesions in endometriosis?

46. A 66 years old postmenopausal woman has fallen twice in the last 2 months. U plan  DEXA which shows a total hip T-score of -2.0 . You plan a therapy with bisphosphonates, but she is concerned that she will have a difficulty remaining adherent to a daily pill. Which of the following oral options offer a  more convenient once monthly dosing schedule?

47. Which of following is not indicated for osteoporosis treatment?

48. A 54 years old postmenuausal woman has C/O vasomotor symptoms and vaginal dryness from last 1 year. She wants to start hormonal therapy. She doesn’t give any H/O surgery. Which is the most appropriate treatment option for her?

49. A 53 years old postmenopausal woman wants bioidentical hormone via subdermal implant for her postmenopausal symptoms. Counselling regarding such therapy should include which of the following point?

50. A 58 years old postmenopausal woman has C/O persistent hot flushes. she had previously undergone mastectomy for breast cancer but has had no other surgeries. Which of the following is not acceptable?