Fill-In-The-Blank: these statements are conceptual; as such there may be other correct answers in addition to the ones provided.
Most cervical carcinomas are caused by infection with high-risk
Early HPV infection leads to Low-Grade Squamous Intraepithelial Lesions (LGSIL), of which spontaneously resolve
The mainstay of cervical cancer screen involves the smear
In general, LGSIL on a PAP smear with newly diagnosed HPV infection can be treated with
HGSIL on a PAP smear usually results in
A biopsy showing HGSIL or invasive carcinoma requires
Lichen sclerosis on the vulva can lead to , particularly in older women
Benign smooth muscle tumors of the uterus are called or
Deposits of endometrial tissue outside of the uterine cavity are called
Endometrial hyperplasia is driven by high levels and can lead to
Two common benign functional cysts of the ovary are the and cysts
Complex, multi-chamber cysts, particularly in older women, are more likely to be
The most common malignant tumor of the ovary is called
The most common benign germ cell tumor of the ovary is the
The most common malignant germ cell tumor of the ovary is the
Placenta accreta refers to placentas that are
Multiple Choice Questions:
1) You are attending a patient giving birth, the afterbirth (placenta) has not been expelled (is retained) and the patient is bleeding heavily through the vagina. Which of the following is the most likely cause: A molar pregnancy A placental chorangioma (tumor) An ectopic pregnancy A placenta accreta
Explanation: In patients with a placenta accreta, the placenta invades into the myometrium and does not detach from the uterus leading to hemorrhage. Treatment is emergency hysterectomy. NOTE: most cases of placenta accreta are diagnosed by ultrasound prior to birth.
2) You see a patient with post-menopausal bleeding. You perform an endometrial biopsy. The biopsy results come back as "normal endocervical tissue." What do you do next? This is a tricky one (read the diagnosis closely)! Watchful waiting Ultrasound exam Hormonal therapy Repeat endometrial biopsy / curettage Hysterectomy
Explanation: The biopsy report says "endocervical tissue" not "endometrial tissue," meaning that the biopsy needle didn't get into the endometrial cavity just the endocervical canal. Always think twice about unexpected pathology results. In this case, you still need a reason for the patient's bleeding; a re-biopsy or endometrial curettage is required.
3) You see a 25y.o. patient with newly diagnosed low-grade squamous intraepithelial lesion (LGSIL / LSIL) on a Pap smear. The patient's PCR test is negative for high-risk HPV. Typically you would recommend: Watchful waiting with a repeat Pap smear in one year Immediate repeat Pap smear Colposcopy and biopsy of the lesion Hysterectomy
Explanation: The vast majority of LGSIL go away with time and do not require treatment. An immediate repeat Pap smear will likely show the same thing as the first. A repeat Pap smear in a year's time will help determine if the patient has cleared the infection, is still infected, or has progressed to HGSIL. Colposcopy would be an alternative, particularly if the patient is PCR-positive for high-risk HPV.
4) You see a patient who has been unsuccessful getting pregnant. The patient is moderately obese and has irregular menstrual periods. You order an ultrasound of the ovary & fallopian tube, suspecting that the patient might have: An benign serous ovarian tumor High grade serous carcinoma Polycystic ovary syndrome Salpingitis
Explanation: This is the classic clinical presentation of polycystic ovary syndrome.
5) You are following up with a 32y.o. patient which has recently had an ovarian tumor removed. The pathology report calls the tumor a "dermoid cyst." You know the tumor is a: benign serous cyst benign teratoma benign sex cord / stromal tumor malignant teratoma malignant germ cell tumor high grade serous carcinoma
Explanation: A dermoid cyst is a simple form of benign teratoma.
6) You see a patient with dysmenorrhea and pain due to fibroids. Your chosen line of therapy would be: watchful waiting hormone therapy myomectomy (surgical removal of the fibroids) hysterectomy
Explanation: Uterine fibroids can be very debilitating, so watchful waiting is not ideal. Hormone therapy (of which there are many types) is the first line of therapy. Surgical procedures (myomectomy, hysterectomy) are last resorts.
7) You see a 57y.o. patient with a solid/cystic ovarian mass, diagnosed on ultrasound. The best next step would be: watchful waiting to see if the tumor changes size ultrasound guided needle biopsy of the lesion to rule in/out malignancy surgical excision of the lesion
Explanation: A cystic/solid lesion in a patient of that age has a high likelihood of being malignant, ruling out watchful waiting. In many locations (e.g. the breast) a suspicious lesion would be biopsied; however in the ovary a needle might open a tumor and spread it into the peritoneum. Consequently, surgical excision is the best option.