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Oncology EMQ Test Part 2

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1) A compound that is elevated in women with an ovarian dysgerminoma.

2) A 40 year old nulliparous woman had a cervical

smear showing severe dyskaryosis. Colposcopy with

diathermy loop excision has been performed and the

histology shows CIN III which has been completely

excised

3) Stage 1 uterine (endometrial) cancer.

4) A 28-year-old woman attends her GP surgery for a routine cervical smear. The

examination is difficult and an ‘inadequate’ result is returned.

5) A 90-year-old woman is diagnosed with vulval cancer. Imaging suggests

metastases to both inguinofemoral and pelvic lymph nodes.

6) A healthy 60-year-old woman with a BMI of 28 kg/m2

presents with lower

abdominal pain and bloating. An ultrasound scan demonstrates a unilocular cyst

of 4 cm diameter with a solid component. There is no ascites. Her serum CA125 is

40 IU/l.

 

7) A 31-year-old woman attends her GP surgery for a cervical smear. This is reported

as low-grade dyskaryosis and an HPV test is organised. Unfortunately, the HPV

test is inadequate.

8) A 70-year-old postmenopausal woman presents with vulval itching. On exami￾nation, she has a narrow introitus. The skin over the labia, the perineal area and

the genitocrural folds is thin and dry, with white discoloration and superfi cial

excoriations. A skin biopsy reveals atrophic epidermis with hyperkeratosis and

superfi cial dermal hyalinisation with lymphocytic infi ltrates.

9) A 65-year-old woman is referred urgently with weight loss, abdominal bloating

and urinary urgency. An ultrasound scan demonstrates a multicystic mass

with solid areas and ascites. Her serum CA125 is 100 IU/l. A CT scan confirms

a suspicious mass. Which management should be recommended by the

multidisciplinary team?

10) A 26-year-old patient has had a routine smear which revealed borderline squamous cell

changes on cytology. She has had a high-risk HPV DNA test that has been reported to

be positive.

 

11) A compound belonging to the transforming growth factor-β (TGF-β) superfamily,

produced by both the Sertoli cells of the testis and granulosa cell tumours of the

ovary.

12) A woman is diagnosed with cervical cancer. The carcinoma has extended into the

pelvic sidewall. On rectal examination, there is no cancer-free space between the

tumour and the pelvic sidewall. The tumour involves the lower third of the vagina.

There is unilateral hydronephrosis.

13) A 35-year-old woman attends her GP surgery for a cervical smear having never

had a smear in the past. A result of high-grade dyskaryosis is returned.

14) A 65-year-old woman has an incidental finding of an ovarian cyst during an MRI

scan to evaluate her spine. A follow-up ultrasound confirms this to be a simple

cyst with a maximum diameter of 4.5 cm. Her serum CA125 is 5 IU/l. The woman

is asymptomatic.

15) A 53 year old asymptomatic post menopausal

woman has a cervical smear showing no dyskaryotic

cells but no evidence of transformation zone

sampling. The cervix was well visualised and normal

and she has previously had regular smears which

have all been negative.

16) A 34-year-old woman has a routine smear test that has revealed a low-grade dyskaryosis.

She has a test of triage which has been reported to be negative.

A 50-year-old woman undergoes her routine cervical screening. The results are reported

as high-grade moderate dyskaryosis.

17) A 37-year-old woman presents to the clinic for her routine smear. The report reads as

follows: CGIN, endocervical cells with changes of CGIN seen.

18) A 5-year-old girl presents with burning on micturition and vulva I scratching.

On examination the vulva is noted to have a well-demarcated white area around

the introitus. The overlying skin appears thin with extensive fi ssuring. The peri￾anal area is not involved.

19) A 23-year-old woman presents with vulval itching. On examination there is a

well-demarcated symmetrical lesion involving the labia major and minor and

extending to the genitocrural folds. The lesions appear beefy red with scaling.

A biopsy shows papillomatosis, parakeratosis and neutrophil exocytosis.

20) A 23-year-old woman presents with a two-year history of vulval,

perineal and perianal irritation. The vulva is red, excoriated and

there areas of white, thickened skin. Application of 3% Acetic

acid shows areas of mosaic and coarse punctuation.

21) A 26-year-old woman undergoes her first cervical routine screening test. Her smear is

reported as borderline squamous cell changes.

22) A 26-year-old woman presents to the gynaecology OPD with an ultrasound scan of her

pelvis for menorrhagia. It reports an anechoic ovarian cyst of 28 mm × 37 mm on the

right side. No other abnormal findings are reported.

23) A 40 year old woman presents with a 12 months history of vague

abdominal discomfort that did not respond to simple analgesia.

Ultrasound scan shows bilateral complex ovarian cysts with right

sided hydronephrosis and ascites. Her CA-125 is 1500iu

24) A 54-year-old woman presents with abdominal pain and has had an ultrasound scan

done. It showed an ovarian cyst which triggered a transvaginal scan. Pain has resolved

now. A 46-mm cyst with a thin wall within with normal CA 125 is noted. She has a

repeat scan after 2 months that shows a 58 mm cyst with similar features and normal

tumour markers. No new symptoms are noted.

25) A 30-year-old woman undergoes colposcopic treatment for cervical intraepithelial

neoplasia (CIN) 3. Histology shows incomplete excision at the ectocervical

margin but complete excision at the endocervical margin

26) A 50-year-old woman undergoes her routine cervical screening. The results are reported

as high-grade moderate dyskaryosis.

27) A frail 90-year-old woman presents with abdominal discomfort and bloating. She

has mitral stenosis and atrial fibrillation. She has urinary frequency and nocturia.

An ultrasound scan reveals a 10 cm simple ovarian cyst. Her serum CA125 is

2 IU/l.

28) A 32 year old teacher has been referred to the

gynaecology clinic because of marked anxiety since

her friend died suddenly from ovarian cancer at the

age of 35 years. She has no family history of ovarian

cancer and enquires about the likelihood of any

woman developing the disease.

29) A steroid that is almost undetectable in the non-pregnant female, but whose levels

rise >1000-fold during pregnancy.

30) A 60-year-old woman has an ultrasound scan done for non-specific abdominal pain and

is found to have an ovarian cyst of 28 mm which is fluid filled. The Ca 125 is normal and

the RMI is 100. She is advised a further scan after 4 months. The cyst has not changed

in nature and the size is 22 mm.

31) A 20 year old woman is admitted with sudden onset left sided

pelvic pain 23 days after her LMP. Her pregnancy test is negative

and her symptoms are improving with simple analgesia. Pelvic

ultrasound scan shows a 5cm left ovarian cyst with internal

echoes consistent with a haemorrhagic cyst.

32) Stage 2 carcinoma of the cervix.

 

33) A 47 year old woman complains of a 3 months history of vulval

irritation and superficial dyapareunia. The vulval skin is thin and

white with fissures and narrowing of the introitus and fusion of

the labia minora over the clitoris

34) A 40-year-old woman has her routine smear at the Community Gynaecology clinic.

The smear is reported as borderline dyskaryosis.

35) A 68 year old woman attends the gynaecology clinic

4 weeks after TAH + BSO for endometrial carcinoma.

The histology shows that the tumour had extended to

involve the cervix and she has been advised to have

radiotherapy. She enquires about the survival rate for

women with similar tumours.

 

36) A 34-year-old woman presents with a burning sensation in the vulval region.

On examination the vulva is erythematous with marked oedema and numerous

small superfi cial ulcerations. The inguinal lymph nodes are enlarged and

tender.

37) A 52-year-old woman presents to her GP surgery for a repeat smear as her previous

routine smear 6 months ago was inadequate. The second sample now has been reported

as inadequate too.

38) Stage 3 ovarian cancer.

39) A 43-year-old woman has a routine Pap smear. It is reported negative for cervical cell

dyskaryosis. However, endometrial clusters of cells are noted. Her last menstrual period

was 10 days ago, and she has regular periods.

40) A 60-year-old woman has a laparoscopic bilateral oophorectomy for a persistent

ovarian cyst. Her serum CA125 is 50 IU/ml. The ovarian capsule is noted to

be intact, but during the course of the operation, the cyst ruptures. Peritoneal

washings prior to the rupture are clear. The contralateral ovary is normal.

Histology confirms an ovarian carcinoma.

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