EBCOG Part 1 2 Weeks Crash Course Oncology,FSRH,BAASH Day 1

Options for questions 1-3

 

 

 A.No action necessary

B.Perform cervical cytology in 1 year’s time

C.Perform cervical cytology in 3 years’ time

D.Perform colposcopic guided biopsy

E.Perform human papillomavirus (HPV) test of cure at 6 months follow-up.

F.Perform HPV triage testing

G.Refer to gynaecologist

H.Repeat cervical cytology in 3 months’ time

I.Repeat cervical cytology in 6 months’ time

J.eturn to routine recall

K.Excision procedure.

For each of the following clinical scenarios, what is the most appropriate management from the list above? Each option may be used once, more than once or not at all.

 

1. A 38-year-old woman attends her GP surgery for a routine cervical cytology after primary screening being positive for hrHPV test. Cytological triage shows the result as ASCUS. She wants to know the definitive diagnosis?

2.A 35-year-old woman attends her GP surgery after primary screening being positive for hrHPV test, for a cervical cyotology and her result of HSIL, is returned.

3.A 35-year-old woman attends her GP surgery after primary screening being positive for hrHPV test, for a cervical cyotology and her result of HSIL. She undergoes colposcopic directed biopsy which upheld the diagnosis as HSIL. What is the further management?

Option list for Questions 4-5 

 

A.Azathioprine

B.Canesten cream

C.Cyclosporine

D.Clobetasol cream

E.Imiquimod

F.Methotrexate

G.Moisturisers

H.Mycophenolate

I.Prednisolone

J.Reassurance and counselling to break the itch cycle

I.Wide local excision and groin node dissection

for each of the following cases, select the single most appropriate treatment. Each option may be used once, more than once or not at all.

 

4. A 70-year-old woman presents with a 3 cm squamous cell cancer on her cell cancer on her right labia

5.A 45-year-old woman presents with multicentric VIN.

Option list for Questions   6 – 8

 

A.Stage 0 vagina carcinoma

B.Stage I vaginal carcinoma

C.Stage Ia vulval cancer

D.Stage Ib vulval cancer

E.Sage II vaginal carcinoma

F.Stage II vulval cancer

G.Stage III vaginal carcinoma

H.Stage III vulval cancer

I.Stage IVa vaginal carcinoma

J.Stage IVa vulval cancer

K.Stage IVb vaginal carcinoma

L.Stage IVb vulval cancer

M.VAIN (vaginal intraepithelial neoplasia) I

N.VAIN II

O.VAIN III

P.VIN I

Q.VIN II

R.VIN III

 

Instructions: The following patients presented with symptoms of either vulval or vaginal malignancy. They were examined and ancillary investigations were undertaken prior to staging the disease. Select from the option list above the single most appropriate stage of the carcinoma. Each option may be selected once, more than once or not at all.

 

6. A 75-year-old woman presented with an ulcer on the vulva which was biopsied. This has been confirmed on histology to be carcinoma of the vulva confined to the vulva and with a maximum diameter of 1.5 cm.

7.An 82-year-old woman has just had an examination under anaesthesia and a biopsy of a suspicious lesion of the vulva. The lesion, which was confined to the left labium majorum, measured 3.5 cm. There were no palpable groin nodes. This has now been confirmed to be squamous carcinoma of the vulva.

8.A 78-year-old woman presents with a mass on the vulva which extends into the lower vagina. She has bilaterally enlarged groin nodes. A biopsy of the mass has confirmed it to be carcinoma of the vulva.

Options  9 - 11

A.Excisional biopsy

B.Exfoliative cytology

C.5- florouracil staining.

D.Iodine stain

E.Incisional biopsy

F.Three incision

G.Vulvul cytology

H.Radical excision

 

9.A 60-year-old woman presented with vulval itching and soreness of 3 months duration. She was examined and found to have a well-circumscribed raised whitish area on the left vulva. A tissue is taken that contains the interface between normal and abnormal epithelium and that is large enough for the pathologist to adequately provide evidence of substage (Stage I vulval carcinoma) is called?

10. A 74-year-old presents with a localized small area of redness on the right labium majus. There is no associated bleeding and it is not irritating. She is examined and found to have a well-circumscribed discrete superficial lesion measuring 1x1cm, which is thought to be vulval intraepithelial neoplasia with a low suspicion of invasive disease. There are no palpable lymph nodes. This lesion is removed under general anesthesia such that all the abnormal epithelium is included. It is malignant, but the tissue removed is needed to provide a tumor-free zone of 1 cm (after fixation) on all dimensions is called?

11. A gynecological oncologist removes a 2-cm lesion of the right labium marjoram from a 78-year-old woman who presented with pain and itching of 6months duration. Examination in the clinic has revealed a small pigmented swelling that measured 1.5 x 2 cm in diameter with no associated lymphadenopathy. Lesion is proved to be SCC on biopsy. The removed lesion is complete with at least 2 cm (after fixation) on all sides is called?

Questions   12 -14

Option list for Questions  

A.Stage IAI

B.Stage IA2

C.Stage IB1

D.Stage IB2

E.Stage IIA1

F.Stage IIA2

G.Stage IIB1

H.Stage IIIA

I.Stage IIIB

J.Stage IVA

K.Stage IVB

 

For each of the following clinical findings, select the correct stage from the options listed above. Each option may be used once, more than once or not at all.

 

12.A 3cm squamous cell carcinoma of cervix, no extension to uterus, parametria or vagina on imaging or examination under anaesthetic.

13.A large cervical tumour with involvement of the lower third of the vagina, parametria but no bladder or bowel involvement or distant metastasis.

14. A 2 cm cervical tumour but with involvement of upper two thirds of the vagina and parametrial invasion. There is no evidence of extension to pelvic side wall or lower third of vagina or distant organs.

EMQ :  15 -19

 

 For each description below choose the single most appropriate answer from the above list of options.Each option maybe used once or more than once or not at all.

 

A.Chemotherapy                                                                  

B.Radiotherapy                                                                   

C.Radical hysterectomy & pelvic lymphadenectomy     

D.LLETZ                                                                                   

E.Simple hysterectomy

F.Annual smear exam

G.No further treatment

H.Intracavitary radiotherapy chemotherapy

I.ERT & brachytherapy

J.Palliative multidisciplinary care

K.Laproscopic lympadenectomy

L.Radical trachelectomy & pelvic LND

M.chemotherapy +ERT +Brachytherapy

N.subtotal hysterectomy

O.pelvic exenteration

P.cone biopsy of cervix

 

15.32 year old nullipara has cancer cells on routine PAP smear.subsequent colposcopy ,biopsy ,EUA ,MRI & cystoscopy show a lesion confined to cervix with dimension of 5x4.8 cm. She has been trying for a pregnancy .What is the most appropriate option.

16.  30 year old nullipara has a smear showing possible cancer cells. Subsequent investigations reveal a lesion confined to cervix with max dimension of 1.5cm .She has been trying for a pregnancy for past 6 months. What is the most appropriate option?

17.56 year old ,with no previous smear presents with postmenopausal bleding. Investigations show a bulky cervical cancer with extension to bladder mucosa & spread confined to liver capsule. What is the appropriate treatment option?

18. 45 year old parous lady presents with postcoital bleeding. She has never had a smear before. She has a cervical carcinoma extending to parametrium with left sided hydronephrosis. What is the most appropriate treatment option?

19.50 year old lady wa referred to colposcopy with severe dyskaryosis. Colposcopy showed changes consistent with cervical intra epithelial carcinoma III.LLETZ was performed. Histopathology confirmed a cervical tumour to a depth of 2mm. Excisional margins were clear of the disease. What is the most appropriate treatment option?

Option list for Questions 20 -21

 

A.Azathioprine

B.Canesten cream

C.Cyclosporine

D.Clobetasol cream

E.Imiquimod

F.Methotrexate

G.Moisturisers

H.Mycophenolate

I.Prednisolone

J.Reassurance and counselling to break the itch cycle

I.Wide local excision and groin node dissection

 

for each of the following cases, select the single most appropriate treatment. Each option may be used once, more than once or not at all.

20.A 70-year-old woman presents with a 3 cm squamous cell cancer on her cell cancer on her right labia

21.A 45-year-old woman presents with multicentric VIN.

Option list for Questions   22- 24

 

A.Stage 0 vagina carcinoma

B.Stage I vaginal carcinoma

C.Stage Ia vulval cancer

D.Stage Ib vulval cancer

E.Sage II vaginal carcinoma

F.Stage II vulval cancer

G.Stage III vaginal carcinoma

H.Stage III vulval cancer

I.Stage IVa vaginal carcinoma

J.Stage IVa vulval cancer

K.Stage IVb vaginal carcinoma

L.Stage IVb vulval cancer

M.VAIN (vaginal intraepithelial neoplasia) I

N.VAIN II

O.VAIN III

P.VIN I

Q.VIN II

R.VIN III

Instructions: The following patients presented with symptoms of either vulval or vaginal malignancy. They were examined and ancillary investigations were undertaken prior to staging the disease. Select from the option list above the single most appropriate stage of the carcinoma. Each option may be selected once, more than once or not at all.

22.A 75-year-old woman presented with an ulcer on the vulva which was biopsied. This has been confirmed on histology to be carcinoma of the vulva confined to the vulva and with a maximum diameter of 1.5 cm.

23.An 82-year-old woman has just had an examination under anaesthesia and a biopsy of a suspicious lesion of the vulva. The lesion, which was confined to the left labium majorum, measured 3.5 cm. There were no palpable groin nodes. This has now been confirmed to be squamous carcinoma of the vulva.

24. A 78-year-old woman presents with a mass on the vulva which extends into the lower vagina. She has bilaterally enlarged groin nodes. A biopsy of the mass has confirmed it to be carcinoma of the vulva.

Options  - 25 -27

A.Excisional biopsy

B.Exfoliative cytology

C.5- florouracil staining.

D.Iodine stain

E.Incisional biopsy

F.Three incision

G.Vulvul cytology

H.Radical excision

 

25.A 60-year-old woman presented with vulval itching and soreness of 3 months duration. She was examined and found to have a well-circumscribed raised whitish area on the left vulva. A tissue is taken that contains the interface between normal and abnormal epithelium and that is large enough for the pathologist to adequately provide evidence of substage (Stage I vulval carcinoma) is called?

26. A 74-year-old presents with a localized small area of redness on the right labium majus. There is no associated bleeding and it is not irritating. She is examined and found to have a well-circumscribed discrete superficial lesion measuring 1x1cm, which is thought to be vulval intraepithelial neoplasia with a low suspicion of invasive disease. There are no palpable lymph nodes. This lesion is removed under general anesthesia such that all the abnormal epithelium is included. It is malignant, but the tissue removed is needed to provide a tumor-free zone of 1 cm (after fixation) on all dimensions is called?

27.A gynecological oncologist removes a 2-cm lesion of the right labium marjoram from a 78-year-old woman who presented with pain and itching of 6months duration. Examination in the clinic has revealed a small pigmented swelling that measured 1.5 x 2 cm in diameter with no associated lymphadenopathy. Lesion is proved to be SCC on biopsy. The removed lesion is complete with at least 2 cm (after fixation) on all sides is called?