Gyne: LE 4 // Reviewer // 2014 2015 10.

Pap smear reporting in cervical intraepithelial neoplasia

a. Every 6 months for 2 years
1. The prevalence of SCCA of the cervix is highest in which condition? b. Every 6 months for 5 years
a. Women who have frequent sexual intercourse c. Annually for 10 years
b. Women who have first intercourse at an early age d. Every year, indefinitely
c. Women with late menopause
d. Women who are alcoholic beverage drinkers 11. Atypical squamous cells of undetermined significance is managed as:
a. Repeat Pap smear after 6 months
2. Most common histological type of cervical carcinoma b. HPV-DNA testing
a. Invasive SCCA, large cell keratinizing type c. Colposcopy
b. Adenocarcinoma d. AOTA
c. SCCA, large cell keratinizing type
d. Invasive SCCA, large cell non-keratinizing type 12. At what age does Pap smear can withhold if there are no abnormalities?
a. 60
3. Most cervical intraepithelial neoplasia would start at the b. 65
a. Ectocervix c. 70
b. Endocervix d. 75
c. Transformation zone
d. Cervicovaginal junction 13. Most common type of ovarian tumor
a. Epithelial
4. What HPV subtype causes genital warts? b. Germ cell tumor
a. 6 and 11 c. Sex cord tumor
b. 11 and 18 d.
c. 16 and 18
d. 6 and 8 14. Endoderma sinus tumor marker
a. Alpha feto protein
5. Most effective screening test for cervical CA b.
a. Transvaginal ultrasound c.
b. Colposcopy d.
c. CA 125
d. Pap smear 15. Vaginal tumor with no lymph node involvement involving the subvaginal tissue within the pelvic
wall.
6. A 30 year old, G3P3, asymptomatic woman had her routine annual pap smear. Smear showed a. Stage I
squamous metaplasia. What would you do next? b. Stage II
a. Refer to colposcopy c. Stage III
b. Do a cervical punch biopsy d. Stage IV
c. Do a schillers test
d. Advise a repeat pap smear 16. Vaginal malignancy occurs primarily after 14 years of age and is associated with prenatal
exposure to DES
7. A 40 year old G1P1 patient with cervical intraepithelial neoplasia 3 had a schillers test done on her. a. Clear cell carcinoma
You expect the cervix b.
a. Dark brown c.
b. Blue d.
c. Black
d. Yellow 17. Most cases of VAIN occur in the
a. Upper 1/3 of the vagina
8. Ablative therapy for CIN includes which of the following b.
a. Cryotherapy c.
b. LEEP d.
c. Large loop excision of the transformation zone
d. Hysterectomy 18. Tumors of the upper 1/3 of the vagina will drain into
a. Inguinal nodes
9. At what age does pap smear start according to GOG? b. Pelvic node like obturator nodes
a. 18 c.
b. 19 d.
c. 20
d. 21


19. Vulvar mass extending to the anus 28. In the acronym RADAR steps in abuse work the first letter A stands for
a. Stage I a. Ask direct questions only for VAWC suspects
b. Stage II b. Ask direct questions
c. Stage III c. Ask direct questions only for adults
d. Stage IV d. Ask indirect questions to prevent embarrassment

20. Best diagnostic procedure in evaluating vulvar masses 29. A phase in the cycle of violence where the relationship seems to be working, no abuse is taking
a. Pap smear place. This may diminish and disappear altogether as the cycle shortens
b. Toludene blue a. Build up phase
c. Colposcopy b. Explosive phase
d. Biopsy c. Remorse phase
d. Honeymoon phase
21. Vulvar atypia manifests as:
a. Itchiness 30. A phase in the cycle of violence where the relationship seems to be working, but new incidents of
b. Discharge abuse are taking place in increasing frequency
c. Numbness a. Build up phase
d. Mass b. Explosive phase
c. Remorse phase
22. Thinning of the vulvar epithelium, loss of rete edges d. Honeymoon phase
a. Pagets disease
b. CA in situ
c. Verrucous CA
d. Lichen sclerosis
Violence Against Women and Children
23. Lichen sclerosis, changes in the vulvar skin that often appears whitish. Its also described as the - RADAR
following, EXCEPT: o Routine screening for all
a. Markedly thickened epithelium o Ask direct questions
b. Studies show small premalignant potential o Document findings
c. Inflammation is usually present o Assess patient safety and plan
d. Tends to be clitoral in location o Review patient options and referrals
24. Violence Against Women (VAW) is any act of _______________ that results in, or is likely to
result in physical, sexual or psychological harm or suffering to women, including threats of such acts, Pediatric and Adolescent Gynecology
coercion or arbitrary deprivation of liberty, whether occurring in public or private life - Vulvovaginitis
a. Gender based violence o Most common cause of vulvar symptoms
b. Sex based violence o Sign: Pruritus
c. Women based violence - Cervix
d. Female based violence o Only palpable structure during prepubertal stage
- CASE:
25. Marital rape, now recognized under Philippine laws, means o Pinworm
a. A man may be charged with rape if he forces his wife to have sex with him o Itching at night
b. A man may be charged with rape if he forces his live-in girlfriend to have sex with him o Scotch tape swab
c. A man may be charged with rape if he forces his wife to have sex with his friend - Secretions during prepubertal stage
d. A man may be charged with rape if he forces his daughter to have sex with him o Neutral, alkaline
o Absence of lactobacilli
26. Collective term to mean warning signals that need further investigation in VAW e.g. vague
illnesses, serious psychosocial problems, physical injuries that do not match history Vulvar CA
a. Red flags in VAWC - FIGO Staging for Vulvar CA
b. Pathognomonic of VAWC o Stage I - Tumor confined to the vulva or perineum. No nodal metastasis.
c. Red herrings in VAWC o Stage II - Tumor of any seize with extension to adjeacent lower perineal
d. Sign and symptoms of VAWC structures, with negative nodes.
o Stage III - Tumor of any size with or without extension to adjacent perineal
27. In the acronym RADAR steps in abuse work the first letter R stands for structures, with positive inguino-femoral lymph nodes
a. Random screening for some o Stage IV - Tumor invades other regional or distant structures
b. Routine screening for all - Management:
c. Routine counseling for all suspects o Tumor of less than 2cm - Radical local excision with or without unilateral
d. Routine referral to barangay health worker for all groin node dissection
o Tumor of more than 2cm - Radical local excision with inguinofemoral
lymphadenectomy


Vaginal CA
- Usually occur as SCCA in women > 60 years old
- Management:
o Stage I
Less than 0.5 cm
Wide local excision or total vaginectomy or brachytherapy
More than 0.5 cm
Radiotheraphy
Radical hysterectomy with lymphadenectomy
Lower third of the vagina
Radical vaginectomy with inguinal lymphadenectomy
o Stage II
Radiation with chemotherapy
Radical vaginectomy or pelvic exenteration with or without RT
o Stage III - Radiation with chemotherapy
o Stage IVA - Preoperative radiation
o Stage IVB - Radiotherapy with chemotherapy

Premalignant Disease of the Vulva and Vagina

- Lichen sclerosus risk of malignancy: 1-4%
- Diagnosis: Keyes punch biopsy
- Microscopic features
o Hyperkeratosis
o Epithelial thickening with flattening of rete pegs
o Atrophy of the epithelium
o Homogenous collagen in the papillary dermis with lymphocytic infiltrate
- Treatment:
o Testosterone
o Progesterone
o Clobetasol propionate
- VIN histopathologic subtypes and associations

Usual: Warty, Basaloid Differentiated: Simplex

Age Pre monopausal Post menopausal
Overall % VIN 95% 5%
HPV Associated Yes No
HPV Type 16 N/A
Risk Factor Smoking, immunocompromised None
Distribution Multifocal Unifocal, unicentric
Background history Lichen sclerosus
Warty basaloid SCCA
Progression Keratinizing SCCA
Invasive CA

- Risk of preogression to invasive cancer is higer for those who are older and
immunocompromised
- Management of VIN:
o Surgical excision
o Carbon dioxide laser
o 5FU cream
o Imiquimod 5%
o Therapeutic vaccines