Premalignant and Malignant Diseases of the Lower Genital Tract—Vulva, Vagina, and Cervix
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Question 1 of 46
1. Question
1. A 65-year-old woman returns for the results of her vulvar biopsy. Which of the following is the etiologic agent (or immediate precursor lesion) for vulvar cancer?
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Question 2 of 46
2. Question
2. A 56-year-old woman has a biopsy-proven vulvar intraepithelial neoplasia (VIN III). She undergoes a wide excision and returns 3 months later with vulvar pruritus. What should you advise the patient?
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Question 3 of 46
3. Question
3. A 65-year-old woman presents with complaints of vulvar redness, pruritus, and occasional weeping from the skin. Examination reveals ery-thematous, eczematoid of the labia minora, and periclitoral area. This is consistent with Paget’s disease of the vulva. Which of the following characterizes Paget’sdisease of the vulva?
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Question 4 of 46
4. Question
4. Which of the following types of vulvar cancer occurs most commonly?
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Question 5 of 46
5. Question
5. A 48-year-old woman presents with a large verrucous lesion of her vulva. It is not particularly painful, but the appearance is worrisome to the patient. Such a lesion is most likely which of the following?
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Question 6 of 46
6. Question
6. Which of the following is the most common symptom of vulvar carcinoma in elderly women?
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Question 7 of 46
7. Question
7. A 1-cm vulvar carcinoma with tumor-positive unilateral nodes and no distant spread would be in which FIGO (International Federation of Gynecology and Obstetrics) stage?
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Question 8 of 46
8. Question
8. A 58-year-old woman has a 1-cm vulvar ulcer. A biopsy shows invasive squamous cell carcinoma with more than 1 mm of stromal invasion. Which of the following is the preferred treatment?
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Question 9 of 46
9. Question
9. A 58-year-old woman has a 1-cm vulvar ulcer. A biopsy shows invasive squamous cell carcinoma with more than 1 mm of stromal invasion. If the lymph nodes in this case are negative, the 5-year survival should be approximately what percentage?
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Question 10 of 46
10. Question
10. A 58-year-old woman has a 1-cm vulvar ulcer. A biopsy shows invasive squamous cell carcinoma withmore than 1 mm of stromal invasion. This patient undergoes radical vulvectomy. Which of the following is the most common complication of radical vulvectomy?
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Question 11 of 46
11. Question
11. A 72-year-old woman has had a radical vulvectomy for stage II squamous cell vulvar cancer. She wants to know the most likely site of recurrence if the tumor comes back. Where would the tumor most likely appear?
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Question 12 of 46
12. Question
12. Which of the following tumors of the vulva has the best prognosis?
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Question 13 of 46
13. Question
13. A 56-year-old woman presents with painless mild vaginal spotting. She had a hysterectomy at age 40 for persistent cervical dysplasia. She is otherwise healthy and takes no medications. On further review of symptoms, she has occasional urgency and dysuria. On pelvic examination, a 0.5-cm lesion is felt and visualized in the anterior vagina. What is the next step in the evaluation or treatment of this lesion?
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Question 14 of 46
14. Question
14. A 30-year-old woman presents for her annual examination. On history, she reports that her mother was prescribed diethylstilbestrol (DES) during the pregnancy with her. Which of the following conditions is she most at risk for as a result?
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Question 15 of 46
15. Question
15. Which of the following is a malignant tumor of the vagina of young children that appears clinically as a mass of grape-like edematous polyps?
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Question 16 of 46
16. Question
16. A 72-year-old woman complains of vaginal bleeding. On evaluation, a 2-cm vaginal lesion is found in the upper third of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall. On biopsy, vaginal carcinoma is confirmed.What stage cancer does this patient most likely have?
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Question 17 of 46
17. Question
17. A 72-year-old woman complains of vaginal bleeding. On evaluation, a 2-cm vaginal lesion is found in the upper third of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall. On biopsy, vaginal carcinoma is confirmed. Which of the following is the most likely histology of vaginal carcinoma in this woman?
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Question 18 of 46
18. Question
18. A 72-year-old woman complains of vaginal bleeding. On evaluation, a 2-cm vaginal lesion is found in the upper third of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall. On biopsy, vaginal carcinoma is confirmed. Which of the following is the best treatment for her?
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Question 19 of 46
19. Question
19. Which of the following is the most common method used to diagnose cervical intraepithe-lial neoplasia (CIN)?
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Question 20 of 46
20. Question
20. Which of the following reflects the etiology of cervical dysplasia and cervical cancer?
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Question 21 of 46
21. Question
21. Which of the following reflects HPV?
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Question 22 of 46
22. Question
22. A 40-year-old woman is seen for a routine examination. Her menses have been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial lesion.” Which of the following options is the best course of action?
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Question 23 of 46
23. Question
23. A 40-year-old woman is seen for a routine examination. Her menses have been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial lesion.” The colposcope permits one to do which of the following?
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Question 24 of 46
24. Question
24. A 40-year-old woman is seen for a routine examination. Her menses have been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial lesion.” Under colposcopic examination, a distinct area of acetowhite change is noted with associated coarse pattern vessels and punctation. This is consistent with what histologic finding on directed biopsy?
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Question 25 of 46
25. Question
25. A 40-year-old woman is seen for a routine examination. Her menses have been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial lesion. Conization of the cervix would be inappropriate in which of the following instances?
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Question 26 of 46
26. Question
26. A 40-year-old woman is seen for a routine examination. Her menses have been regular, and she has no complaints. Findings, including those on pelvic examination, are normal. Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial lesion.” This patient has biopsy-proven CIN III. She requests cryotherapy for treatment. Cryotherapy is appropriate to consider in which clinical circumstance?
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Question 27 of 46
27. Question
27. A 25-year-old woman presents with irregular vaginal bleeding. She is otherwise healthy and uses condoms for contraception. She smokes occasionally and takes no medications. Her aunt had cervical cancer and she is worried that she may also have cervical cancer. What is the most common symptom associated with cervical cancer?
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Question 28 of 46
28. Question
28. When sampling the cervix for a Pap smear, it is critical to sample which area since it is the most likely source of cervical cancer. Where do most cervical cancers arise?
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Question 29 of 46
29. Question
29. What percentage of clinical stage I carcinomas of the cervix will have lymphatic spread?
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Question 30 of 46
30. Question
30. If a nonhealing ulcer is seen on the cervix, it is best evaluated by which of the following?
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Question 31 of 46
31. Question
31. A 48-year-old woman presents for her routine annual examination. Her last Pap smear was more than 10 years ago. She has had occasional abnormal Pap smear during her lifetime, but no treatments were recommended. Otherwise, she has mild hypertension and is on a beta-blocker. On examination, she has a normal pelvic examination, but her Pap smear reveals high-grade squamous intraepithelial lesion (SIL). A colposcopically directed biopsy reveals invasive squamous cell carcinoma. Which of the following should be the most appropriate next step in the care of the patient?
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Question 32 of 46
32. Question
32. A 48-year-old woman presents for her routine annual examination. Her last Pap smear was more than 10 years ago. She has had occasional abnormal Pap smear during her lifetime, but no treatments were recommended. Otherwise, she has mild hypertension and is on a beta-blocker. On examination, she has a normal pelvic examination, but her Pap smear reveals high-grade squamous intraepithelial lesion (SIL). A colposcopically directed biopsy reveals invasive squamous cell carcinoma. The woman had a negative metastatic workup. Her clinical examination shows cancer growth shown in Figure 21–1. Her preliminary clinical stage is which of the following?
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Question 33 of 46
33. Question
33. The majority of deaths from cervical carcinoma are due to which of the following?
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Question 34 of 46
34. Question
34. The 5-year survival rate for stage IV invasive cervical cancer is approximately what percentage?
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Question 35 of 46
35. Question
35. Which of the following is the best term for a bulky, friable, papillary tumor mass growing from the cervix?
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Question 36 of 46
36. Question
36. A 34-year-old woman G1 is 16 weeks pregnant and has a Pap smear suspicious for cancer. How do you advise her?
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Question 37 of 46
37. Question
37. A 65-year-old woman presents with vaginal discharge and rare mild bleeding. She had a cone of the cervix for CIN III 20 years ago. She has since had a complete hysterectomy for uterine fibroids. You perform a pelvic examination and see an irregular area in the vagina. Vaginal col-poscopy and directed biopsy reveal vaginal intraepithelial neoplasia (VAIN). VAIN is most commonly found in which part of the vagina?
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Question 38 of 46
38. Question
38. The preferred treatment for a 1.5-cm stage I vaginal carcinoma confined to the upper one-third of the lateral vagina in a 29-year-old woman would be which of the following?
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Question 39 of 46
39. Question
39. A 42-year-old presents with a history of post-coital spotting. Examination of the cervix reveals a raised/reddened well-circumscribed lesion next to the os. Which of the following is the most likely diagnosis?
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Question 40 of 46
40. Question
40. The treatment of carcinoma of the cervix during pregnancy should depend on all except which of the following?
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Question 41 of 46
41. Question
41. A 42-year-old woman with cervical cancer undergoes a radical hysterectomy and requires postoperative radiation. During the radiation therapy she returns complaining of watery vaginal discharge and recurrent urinary tract infections. Which of the following would be the first test to perform to evaluate the most likely cause of the discharge?
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Question 42 of 46
42. Question
42. A 35-year-old woman with stage IIB squamous cell carcinoma of the cervix will receive radiation. Regarding reproductive changes, how should you advise her?
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Question 43 of 46
43. Question
43. A 46-year-old obese woman smokes two packs of cigarettes a day. She had a radical hysterectomy with a para-aortic and pelvic lym-phadenectomy for stage IB squamous cell carcinoma of the cervix. At surgery she was found to have dense pelvic small-bowel adhesions from a prior ruptured appendix and appendectomy. Lymph nodes were positive for cancer cells. In discussing postoperative radiation, you counsel her that she has an increased rate of radiation-related complication because of which of the following?
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Question 44 of 46
44. Question
44. A 24-year-old healthy woman has her routine examination and Pap smear. Her Pap smear is atypical squamous cells of undetermined significance (ASCUS). Which of the following reflects our current knowledge about ASCUS?
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Question 45 of 46
45. Question
45. A 48-year-old postmenopausal woman presents for routine gynecologic examination. The examination is normal; however, the Pap smear returns atypical glandular cells (AGCs). What would be the most appropriate management for this patient?
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Question 46 of 46
46. Question
46. A 30-year-old woman presents for her annual examination. She inquires whether she should receive the HPV vaccine. For which patient population is the HPV vaccine FDA approved?
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