Path 22a Flashcards

A patient has pelvic pain and purulent-appearing discharge. Most likely pathogen?
A. HSV-1
B. VZV
C. HSV-2
D. CMV

During active genital HSV, latency is established in:
A. Lumbosacral nerve ganglia
B. Dorsal root ganglia (cervical)
C. Trigeminal ganglion
D. Enteric plexuses

Pregnant patient with primary active genital HSV at delivery. Best management?
A. Vaginal delivery, observe lesions
B. Vacuum-assisted vaginal delivery
C. Forceps-assisted vaginal delivery
D. Cesarean section

Molluscum contagiosum is caused by a:
A. Herpesvirus
B. Poxvirus
C. Papillomavirus
D. Adenovirus

MCV-2 is most commonly transmitted via:
A. Sexual contact
B. Fomites
C. Respiratory droplets
D. Insect vectors

Pearly dome-shaped papules with central dimple suggest:
A. Condyloma acuminatum
B. Genital herpes
C. Molluscum contagiosum
D. Syphilitic chancre

Molluscum viral inclusions are located in the:
A. Nucleolus
B. Cytoplasm
C. Mitochondria
D. ER lumen

Thick vulvovaginal erythema and swelling with “curd-like” discharge is most associated with:
A. Trichomonas vaginalis
B. HSV-2
C. Molluscum contagiosum
D. Candida

The discharge classically described for Candida is:
A. Curd-like discharge
B. Thin gray discharge
C. Frothy green discharge
D. Bloody mucoid discharge

Trichomonas vaginalis is best described as a:
A. Encapsulated yeast
B. Gram-negative diplococcus
C. Flagellated protozoan
D. Obligate intracellular bacterium

Post–spontaneous/induced abortion infections that can cause PID are often:
A. Chlamydial infections
B. Puerperal infections
C. Viral infections
D. Mycobacterial infections

Puerperal infections spread upward via:
A. Direct arterial spread
B. Perineural spread
C. Lymphatic and venous channels
D. Transplacental spread

Compared with gonococcal PID, puerperal infections tend to inflame:
A. Deeper organ layers
B. Superficial mucosa
C. Cervical epithelium
D. Serosal surfaces

Smooth white vulvar plaques that enlarge/coalesce suggest:
A. Vulvar papillomatosis
B. Lichen sclerosus
C. Squamous papilloma
D. Trichomoniasis

Advanced lichen sclerosus can lead to:
A. Labial hypertrophy
B. Cervical dilation
C. Endometrial hypertrophy
D. Constricted vaginal orifice

Key histologic feature of lichen sclerosus is:
A. Epidermal thinning
B. Epidermal acanthosis
C. Full-thickness atypia
D. Koilocytosis

Squamous cell hyperplasia (lichen simplex chronicus) is driven by:
A. HPV integration
B. Chronic scratching/rubbing
C. Estrogen deficiency
D. Acute gonococcal infection

Squamous cell hyperplasia is characterized by:
A. Dermal mucin deposition
B. Epidermal thinning
C. Loss of rete ridges
D. Epidermal thickening

Both lichen sclerosus and squamous hyperplasia often show:
A. Koilocytosis
B. Full-thickness dysplasia
C. Hyperkeratosis
D. Caseating granulomas

Vulvar squamous papillomas are best described as:
A. Malignant ulcerative tumors
B. Benign exophytic papilloma
C. Pigmented melanocytic lesions
D. Deep infiltrative nodules

Most common histologic type of vulvar cancer is:
A. Basal cell carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Melanoma

Basaloid and warty vulvar carcinomas arise from:
A. Differentiated VIN
B. Lichen sclerosus
C. Squamous papillomatosis
D. Classic VIN

Keratinizing vulvar SCC most often arises from:
A. Classic VIN
B. Squamous papilloma
C. Papillary hidradenoma
D. Differentiated VIN

Differentiated VIN is most associated with a history of:
A. Recurrent trichomoniasis
B. Chronic lichen sclerosus
C. Primary HSV infection
D. Molluscum contagiosum

A sharply circumscribed nodule on labia majora/interlabial fold suggests:
A. Bartholin cyst
B. VIN lesion
C. Papillary hidradenoma
D. Condyloma lata

Papillary hidradenoma histology shows:
A. Sheets of atypical keratinocytes
B. Koilocytes with perinuclear halos
C. Granulomatous inflammation
D. Two-layer glandular lining

Basaloid and warty vulvar carcinomas are:
A. Unrelated to HPV
B. HPV-related
C. Always estrogen-driven
D. Always postmenopausal only

Basaloid and warty vulvar carcinomas typically occur:
A. At younger ages
B. Only after menopause
C. Only during pregnancy
D. Only in adolescence

A vulvar carcinoma subtype is not HPV-related. Which is it?
A. Basaloid squamous carcinoma
B. Warty squamous carcinoma
C. Keratinizing squamous carcinoma
D. Clear cell carcinoma

Keratinizing vulvar SCC occurs most often in:
A. Older women
B. Teenagers
C. Children
D. Pregnant patients

Keratinizing vulvar SCC is best described as:
A. Rare, younger onset
B. Equal to warty types
C. Less common than basaloid
D. More common than warty

Pruritic red, crusted, maplike vulvar lesion suggests:
A. Lichen sclerosus
B. Extramammary Paget disease
C. Squamous papilloma
D. Condyloma lata

Extramammary Paget disease is usually on the:
A. Labia majora
B. Cervix
C. Endocervix
D. Vaginal fornix

A lateral vaginal wall cyst from duct rests is:
A. Müllerian cyst
B. Gartner duct cyst
C. Bartholin cyst
D. Nabothian cyst

Gartner duct cysts are most often found on the:
A. Posterior vaginal wall
B. Cervical os
C. Labia minora
D. Lateral vaginal walls

Gartner duct cysts are typically:
A. Submucosal, fluid-filled cysts
B. Solid ulcerated plaques
C. Keratin-filled epidermoid cysts
D. Deep infiltrative masses

Virtually all primary vaginal cancers are:
A. Adenocarcinoma
B. Melanoma
C. Squamous cell carcinoma
D. Leiomyosarcoma

Primary vaginal SCC is strongly associated with:
A. Low-risk HPV
B. EBV infection
C. HSV infection
D. High-risk HPV

Vaginal SCC often arises from a premalignant:
A. CIN
B. VAIN
C. VIN
D. AIS

The cervical site most susceptible to HPV is:
A. Mature ectocervix
B. Endocervical glands
C. Immature metaplastic cells
D. Myometrial smooth muscle

HPV primarily infects which epithelial cells?
A. Immature basal cells
B. Mature superficial cells
C. Keratinized surface cells
D. Columnar ciliated cells

HPV cannot infect directly the:
A. Basal squamous cells
B. Mature superficial squamous cells
C. Immature metaplastic cells
D. Parabasal squamous cells

HPV infection of vagina/vulva usually requires:
A. Intact epithelium
B. High progesterone
C. High estrogen
D. Surface epithelial damage

Low-risk HPV dysregulates growth via:
A. Wnt pathway
B. Notch pathway
C. Hedgehog pathway
D. TGF-β pathway

LSIL typically shows HPV replication that is:
A. Absent
B. Low
C. High
D. Integrated only

Most LSIL lesions:
A. Regress spontaneously
B. Metastasize early
C. Require hysterectomy
D. Progress rapidly

In HSIL, HPV replication tends to be:
A. Very high
B. Unchanged
C. Variable
D. Low

HSIL most characteristically shows:
A. Normal maturation
B. Increased maturation
C. Arrested epithelial maturation
D. Keratin pearl formation

HSIL carries a:
A. Negligible cancer risk
B. High cancer progression risk
C. Risk only in pregnancy
D. Risk only postmenopause

A benign exophytic lesion causing spotting arises in the:
A. Ectocervix surface
B. Vaginal introitus
C. Labia majora
D. Endocervical canal

Endocervical polyps contain:
A. Dense collagen stroma
B. Caseating granulomas
C. Loose fibromyxoid stroma
D. Solid atypical nests

Endocervical polyps commonly present with:
A. Thick curd discharge
B. Irregular bleeding/spotting
C. Frothy green discharge
D. Vesicular vulvar pain

Endocervical polyps are lined by:
A. Mucus-secreting endocervical glands
B. Keratinized squamous epithelium
C. Transitional urothelium
D. Ciliated tubal epithelium

HPV reaches target cells mainly through:
A. Hematogenous spread
B. Lymphatic invasion
C. Epithelial breaks at SCJ
D. Transplacental passage

HSIL reflects progressive cell-cycle deregulation by:
A. Candida
B. HPV
C. HSV
D. MCV

Gartner duct cysts derive from:
A. Müllerian duct
B. Urogenital sinus
C. Cloacal membrane
D. Wolffian duct

Which IHC pair is most associated with HPV-related SIL?
A. ER and PR
B. CD3 and CD20
C. Ki-67 and p16
D. PAS and mucicarmine

Why can Ki-67 appear in upper epithelium in HPV lesions?
A. E6/E7 block cell-cycle arrest
B. p53 hyperactivation halts mitosis
C. Estrogen withdrawal accelerates turnover
D. Hypoxia induces senescence pathways

Most common HPV type in both LSIL/HSIL?
A. HPV-6
B. HPV-11
C. HPV-18
D. HPV-16

About what fraction of LSIL is HPV-associated?
A. About 20%
B. About 80%
C. About 40%
D. About 60%

About what fraction of HSIL is HPV-associated?
A. Nearly 100%
B. About 80%
C. About 60%
D. About 40%

Most common histologic subtype of cervical cancer?
A. Small cell carcinoma
B. Adenosquamous carcinoma
C. Squamous cell carcinoma
D. Clear cell carcinoma

Second most common cervical cancer type is:
A. Neuroendocrine carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Sarcoma botryoides

Precursor lesion for cervical adenocarcinoma?
A. CIN III
B. Classic VIN
C. Differentiated VIN
D. Adenocarcinoma in situ

Tumor with malignant glandular + squamous cells?
A. Adenosquamous carcinoma
B. Adenocarcinoma
C. Squamous carcinoma
D. Neuroendocrine carcinoma

Which category tends to progress faster and worse?
A. Keratinizing squamous carcinomas
B. Classic VIN lesions
C. Adenocarcinoma and neuroendocrine
D. Endocervical polyps

Advanced cervical carcinoma spreads mainly by:
A. Hematogenous dissemination
B. Direct extension
C. Transcoelomic seeding
D. Perineural invasion

Cervical cancer confined to cervix is stage:
A. Stage II
B. Stage III
C. Stage I
D. Stage IV

Carcinoma in situ (CIN III/HSIL) is stage:
A. Stage 0
B. Stage I
C. Stage II
D. Stage III

Beyond cervix, not pelvic wall; vagina not lower third:
A. Stage III
B. Stage II
C. Stage IV
D. Stage I

Pelvic wall involvement and lower third vagina:
A. Stage I
B. Stage II
C. Stage IV
D. Stage III

Beyond true pelvis or bladder/rectum mucosa:
A. Stage IV
B. Stage III
C. Stage II
D. Stage I

Rectal exam shows no tumor-free space. Stage?
A. Stage II
B. Stage IV
C. Stage III
D. Stage I

Hydronephrosis in cervical cancer suggests extension to:
A. Paracervical soft tissue
B. Ureters
C. Vagina
D. Rectum

HPV vaccination is routinely recommended for:
A. Girls only
B. Boys only
C. Pregnant patients only
D. Girls and boys

Anovulatory cycles cause endometrium exposure to:
A. Excess progesterone
B. Excess androgens
C. Unopposed estrogens
D. Unopposed inhibin

Anovulatory endometrium typically lacks:
A. Glandular secretory changes
B. Squamous metaplasia
C. Koilocytosis
D. Viral inclusions

Another progesterone-dependent feature absent in anovulation:
A. Increased mitoses only
B. Basal vacuolization only
C. Keratin pearl formation
D. Stromal predecidualization

Progesterone is absent in anovulation because:
A. Placenta fails to form
B. No corpus luteum forms
C. Theca cells stop aromatase
D. Pituitary secretes excess prolactin

Postpartum fever with uterine tenderness most suggests:
A. Chronic endometritis
B. Endometriosis
C. Cervical ectropion
D. Acute endometritis

Acute endometritis is most linked to infections after:

A. Ovulation
B. Delivery or miscarriage
C. Menopause
D. HPV vaccination

Endometriosis is best defined as:
A. Ectopic endometrial tissue outside uterus
B. Endometrial atrophy in uterus
C. Tubal squamous metaplasia
D. Cervical gland hyperplasia

Most common site for endometriosis is:
A. Myometrium
B. Cervix
C. Ovaries
D. Liver capsule

A common endometriosis location is the:
A. Fallopian fimbriae
B. Rectovaginal septum
C. Urinary bladder mucosa
D. Ovarian medulla

In HPV-related SIL, Ki-67 staining often extends into:
A. Basal layer
B. Stromal fibroblasts
C. Glandular lumen
D. Upper epithelial layers

Strong p16 staining most supports:
A. Candida infection
B. HSV infection
C. High-risk HPV infection
D. Trichomonas infection

Roughly what percent of cervical cancers are SCC?
A. About 80%
B. About 15%
C. About 5%
D. About 40%

Endometriotic stromal cells generate excess estrogen due to increased:
A. 5α-reductase activity
B. Sulfatase activity
C. Aromatase expression
D. COMT activity

Endometriosis has been reported in men treated for prostate cancer with:
A. High-dose estrogens
B. High-dose androgens
C. Radiation alone
D. GnRH agonists only

A medication class beneficial in endometriosis targets which enzyme?
A. COX-1
B. 5α-reductase
C. Desmolase
D. Aromatase

Which hormone most directly enhances persistence of endometriotic tissue?
A. Progesterone
B. Estrogen
C. Inhibin
D. Prolactin

A woman with endometriosis has higher risk for certain ovarian cancers. The underlying condition is:
A. Endometriosis
B. Adenomyosis
C. Endometritis
D. PCOS

Likely precursor to endometriosis-related ovarian carcinoma:
A. Adenomyosis
B. Endometrial polyp
C. Atypical endometriosis
D. Non-atypical hyperplasia

Adenomyosis is defined as endometrial tissue within the:
A. Serosa
B. Myometrium
C. Endocervix
D. Vagina

Microscopy shows irregular stromal nests ± glands within uterine wall. Diagnosis?
A. Endometrial polyp
B. Endometrial hyperplasia
C. Endometriosis
D. Adenomyosis

Endometrial polyps can come from using:
A. Letrozole
B. Leuprolide
C. Tamoxifen
D. Clomiphene

Tamoxifen’s tissue-selective action is best described as:
A. Agonist breast, antagonist endometrium
B. Antagonist breast, agonist endometrium
C. Antagonist breast, antagonist endometrium
D. Agonist breast, agonist endometrium

A common cause of abnormal uterine bleeding and frequent precursor to carcinoma:
A. Adenomyosis
B. Endometriosis
C. Cervicitis
D. Endometrial hyperplasia

Endometrial hyperplasia is most strongly linked to:
A. Prolonged estrogenic stimulation
B. Chronic progesterone exposure
C. High prolactin states
D. Acute bacterial infection

The estrogen source driving hyperplasia may be:
A. Only ovarian
B. Endogenous or exogenous
C. Only exogenous
D. Only adrenal

Common genetic alteration in hyperplasia and endometrial carcinoma:
A. APC loss
B. BRCA1 loss
C. RB1 loss
D. PTEN inactivation

PTEN loss most directly overactivates which pathway?
A. PI3K/AKT pathway
B. JAK/STAT pathway
C. Notch pathway
D. Hedgehog pathway

Germline PTEN mutations causing high endometrial cancer risk:
A. Lynch syndrome
B. Li-Fraumeni syndrome
C. Cowden syndrome
D. Peutz-Jeghers syndrome

Cowden syndrome is strongly associated with increased:
A. Colon and gastric cancers
B. Ovarian and pancreatic cancers
C. Liver and lung cancers
D. Breast and endometrial cancers

Endometrial hyperplasia is classified as:
A. Non-atypical or atypical
B. Serous or mucinous
C. Diffuse or nodular
D. Simple or cystic

Atypical endometrial hyperplasia is also called:
A. VIN
B. VAIN
C. Endometrial intraepithelial neoplasia
D. Adenocarcinoma in situ

Cardinal feature of non-atypical hyperplasia:
A. Stromal invasion
B. Increased gland-to-stroma ratio
C. Koilocytosis
D. Caseating granulomas

Atypical hyperplasia is best described as:
A. Complex glands with nuclear atypia
B. Simple glands without atypia
C. Pure stromal overgrowth
D. Surface ulceration only

Most common type of endometrial carcinoma:
A. Type II carcinoma
B. Clear cell carcinoma
C. Serous carcinoma
D. Type I carcinoma

Enzyme high in endometriotic stroma but absent in normal endometrial stroma:
A. 5α-reductase
B. Aromatase
C. DNMT1
D. Myeloperoxidase

Endometriosis increases risk of which ovarian cancer subtypes?
A. Serous and mucinous
B. Dysgerminoma and yolk sac
C. Endometrioid and clear cell
D. Granulosa and thecoma

Estrogen’s main effect in endometriosis is to:
A. Induce rapid tissue necrosis
B. Enhance tissue survival
C. Block aromatase transcription
D. Prevent stromal proliferation

A uterine wall lesion containing endometrial stroma ± glands is located in the:
A. Endometrium
B. Cervical stroma
C. Myometrium
D. Vaginal submucosa

Tamoxifen-associated endometrial polyps best reflect tamoxifen acting as:
A. Weak endometrial estrogen agonist
B. Pure endometrial estrogen antagonist
C. Pure progesterone agonist
D. Aromatase inhibitor

Complex gland crowding with nuclear atypia is:
A. Atypical hyperplasia
B. Non-atypical hyperplasia
C. Endometrial polyp
D. Adenomyosis

Type I endometrial carcinomas are also called:
A. Serous carcinomas
B. Clear cell carcinomas
C. Endometrioid carcinomas
D. Mixed Müllerian tumors

Type I endometrioid carcinoma typically arises in the setting of:
A. Endometrial atrophy
B. Endometrial hyperplasia
C. Cervical dysplasia
D. Myometrial fibrosis

Type I tumors share risk factors with hyperplasia, including:
A. Obesity and diabetes
B. Smoking and HPV
C. Early menopause only
D. Hyperprolactinemia

Atypical hyperplasia and endometrial carcinoma commonly share mutations in:
A. TP53
B. PTEN
C. RB1
D. APC

This supports atypical hyperplasia as a:
A. Late metastasis marker
B. Precursor to carcinoma
C. Non-neoplastic change
D. Treatment complication

Common mutations in type I endometrioid carcinomas increase signaling through:
A. MAPK/ERK
B. JAK/STAT
C. PI3K/AKT
D. Notch

PI3K/AKT signaling in endometrial cells tends to augment:
A. Androgen receptor targets
B. Estrogen receptor targets
C. Progesterone receptor targets
D. p53-dependent targets

Endometrioid carcinoma gross pattern can be:
A. Only diffuse infiltrative
B. Only polypoid
C. Ulcerative
D. Local polypoid or diffuse

Typical spread for endometrioid carcinoma occurs via:
A. Lymphatics invasion then extension
B. Hematogenous invasion then extension
C. Myometrial invasion then extension
D. Transcoelomic invasion then extension

Endometrioid adenocarcinomas are characterized by glands resembling:
A. Tubal epithelium
B. Normal endometrial epithelium
C. Squamous epithelium
D. Cervical mucus glands

Type II endometrial carcinomas most often arise in:
A. Hyperplasia
B. Endometrial atrophy
C. Pregnancy
D. Endometritis

Type II (serous) carcinomas are by definition:
A. Well differentiated
B. Poorly differentiated
C. Low grade
D. Benign

Most common subtype of type II endometrial carcinoma:
A. Endometrioid
B. Mucinous
C. Serous carcinoma
D. Adenosquamous

Tumor suppressor mutated in ≥90% of serous carcinomas:
A. PTEN
B. BRCA1
C. TP53
D. MLH1

Precursor lesion of serous endometrial carcinoma:
A. EIN
B. Endometrial intraepithelial carcinoma
C. CIN III
D. VAIN

Endometrial intraepithelial carcinoma consists of:
A. Cells identical to serous carcinoma
B. Benign glands only
C. Stromal invasion present
D. Squamous metaplasia only

Serous carcinomas often arise in:
A. Enlarged gravid uteri
B. Small atrophic uteri
C. Hypertrophic uteri
D. Adolescent uteri

Serous carcinomas are often:
A. Tiny and superficial
B. Bulky or deeply invasive
C. Always polypoid only
D. Always mucinous

Incidence of endometrial carcinoma peaks in:
A. Teen years
B. 20–30
C. 35–45
D. Postmenopausal 55–65

Serous carcinoma occurs more frequently in women of:
A. Asian descent
B. African American descent
C. Native American descent
D. Hispanic descent

Serous carcinoma contributes to mortality in African American women being:
A. 2-fold higher
B. 10-fold higher
C. Equal to Caucasian women
D. Lower than Caucasian women

Typical presenting symptom aiding early detection for Serous carcinoma:
A. Purulent cervical discharge
B. Postmenopausal vaginal bleeding
C. Cyclic pelvic pain only
D. Urinary retention

For Serous carcinoma, Postmenopausal bleeding may occur with:
A. Excess leukorrhea
B. Frothy green discharge
C. Curdy discharge
D. Vesicular lesions

Malignant mixed Müllerian tumors are typically:
A. Small and cystic
B. Bulky/polypoid
C. Flat plaques
D. Papillary fronds only

Histology of malignant mixed Müllerian tumor shows:
A. Pure adenocarcinoma only
B. Adenocarcinoma + malignant mesenchyme
C. Pure sarcoma only
D. Pure squamous nests

Malignant mixed Müllerian tumors most often occur in:
A. Premenopausal teens
B. Postmenopausal women
C. Pregnant women
D. Men

Typical presentation of malignant mixed Müllerian tumors:
A. Vaginal bleeding
B. Painless vulvar papules
C. Amenorrhea only
D. Galactorrhea

Diagnosis of adenosarcoma requires:
A. Malignant glands, benign stroma
B. Malignant stroma, benign abnormal glands
C. Benign glands, benign stroma
D. Malignant glands, malignant stroma

Adenosarcomas are commonly seen in:
A. 4th–5th decade
B. 1st–2nd decade
C. 7th–8th decade
D. Childhood only

Adenosarcomas are generally:
A. High grade aggressive
B. Low grade malignancy
C. Always metastatic
D. Always benign

Type I endometrioid tumors are associated with unopposed:
A. Estrogen stimulation
B. Progesterone stimulation
C. Inhibin stimulation
D. Oxytocin stimulation

Oophorectomy benefits endometrial stromal adenosarcoma because of:
A. Progesterone replacement effect
B. HPV eradication mechanism
C. Estrogen withdrawal effect
D. Iron chelation effect

Low-grade endometrial stromal sarcoma commonly shows:
A. JAZF1–SUZ12 fusion
B. PTEN–TP53 fusion
C. MED12–RB1 fusion
D. KRAS–APC fusion

JAZF1 most directly encodes a:
A. Histone acetyltransferase
B. Cell-surface receptor
C. Spindle checkpoint kinase
D. Transcriptional repressor

SUZ12 is best linked to:
A. Microtubule polymerization
B. Repressive histone marks
C. Steroid hormone cleavage
D. Viral capsid assembly

MED12 mutations occur in ~70% of uterine:
A. Endometrial polyps
B. Leiomyomas
C. Granulosa tumors
D. Stromal sarcomas

MED12 mutations are virtually unique to:
A. Müllerian epithelial tumors
B. Germ cell tumors
C. Sex cord tumors
D. Uterine smooth muscle tumors

MED12 mutations are seen in:
A. Leiomyomas and leiomyosarcomas
B. Adenomatoid tumors only
C. Paratubal cysts only
D. Serous carcinomas only

A uterine leiomyosarcoma most often metastasizes by:
A. Perineural spread
B. Transcoelomic seeding
C. Hematogenous spread
D. Direct extension only

Most typical distant metastasis site for leiomyosarcoma:
A. Thyroid
B. Lungs
C. Spleen
D. Pancreas

Distant spread pattern most consistent with leiomyosarcoma:
A. Omentum, peritoneum, ovaries
B. Pelvic nodes, inguinal nodes
C. Skin, liver, adrenal
D. Lung, bone, brain

Regurgitation theory of endometriosis proposes ectopic implants via:
A. Direct cervical invasion
B. Sexual transmission
C. Retrograde menstrual flow
D. Hematogenous emboli only

“Benign metastases” theory proposes endometriosis spreads via:
A. Blood and lymphatics
B. Retrograde flow only
C. Surface inoculation only
D. Ovulation-related rupture

Most common primary fallopian tube lesion:
A. Serous carcinoma
B. Salpingitis nodosa
C. Endometriosis plaque
D. Paratubal cysts

Paratubal cysts are typically:
A. Solid nodules, hemorrhagic
B. Translucent cysts, clear fluid
C. Papillary masses, mucin-filled
D. Ulcerated plaques, crusted

Benign fallopian tube tumor is usually:
A. Adenomatoid tumor
B. Dysgerminoma
C. Brenner tumor
D. Choriocarcinoma

Tubal adenomatoid tumors often occur:
A. Intramucosal only
B. Endometrial stroma only
C. Subserosal or mesosalpinx
D. Cervical transformation zone

Tubal adenomatoid tumor counterpart occurs in:
A. Endocervix
B. Breast ducts
C. Bartholin gland
D. Testis or epididymis

PCOS is best defined by:
A. Hyperandrogenism with chronic anovulation
B. Hypoandrogenism with ovulation
C. Progesterone excess only
D. Estrogen deficiency only

PCOS reflects dysregulation of enzymes in:
A. Collagen synthesis
B. Androgen biosynthesis
C. Heme synthesis
D. Bile acid synthesis

PCOS increases endometrial risk via increased free:
A. Progesterone
B. Testosterone
C. Estrone
D. Inhibin

In PCOS, increased free estrone raises risk of:
A. Cervical dysplasia
B. Ovarian torsion
C. Vaginal SCC
D. Endometrial hyperplasia/carcinoma

Stromal hyperthecosis is seen most often in:
A. Adolescents
B. Postmenopausal women
C. Pregnancy
D. Prepubertal girls

Stromal hyperthecosis classically shows:
A. Bilateral uniform ovarian enlargement
B. Unilateral ovarian atrophy
C. Small ovaries with fibrosis
D. Calcified cortical plaques

Microscopy in stromal hyperthecosis shows:
A. Koilocytosis with halos
B. Caseating granulomas
C. Hypercellular stroma, luteinization
D. Glands invading myometrium

Virilization in stromal hyperthecosis is:
A. Less than PCOS
B. More striking than PCOS
C. Absent versus PCOS
D. Identical to PCOS

Cystic ovarian follicles can arise from:
A. Luteal cyst rupture
B. Teratoma degeneration
C. Tubal epithelial rests
D. Unruptured Graafian follicles

Cystic follicles can also form when follicles:
A. Rupture then immediately seal
B. Never reach antral stage
C. Implant in myometrium
D. Become malignant rapidly

Most primary ovarian neoplasms derive from:
A. Germ cell lineage
B. Müllerian epithelium
C. Smooth muscle lineage
D. Neural crest lineage

Benign ovarian tumor with cystic areas:
A. Adenofibroma
B. Cystadenofibroma
C. Cystadenoma
D. Borderline serous tumor

Benign ovarian tumor with mainly fibrous areas:
A. Adenofibroma
B. Cystadenoma
C. Mature teratoma
D. Fibrosarcoma

Benign ovarian tumor with cystic and fibrous areas:
A. Cystadenoma
B. Adenofibroma
C. Dysgerminoma
D. Cystadenofibroma

Stromal hyperthecosis is also called:
A. Endosalpingiosis
B. Adenomyosis
C. Cortical stromal hyperplasia
D. Endometrial atrophy

An ovarian tumor described as borderline/malignant with a cystic component is:
A. Adenofibroma
B. Cystadenocarcinoma
C. Cystadenoma
D. Fibroma

Benign ovarian tumors are more common in:
A. Women age 20–45
B. Women age 45–65
C. Postmenopausal women only
D. Prepubertal girls only

Malignant ovarian tumors are more common in:
A. Women age 20–45
B. Adolescents
C. Women age 45–65
D. Children

Type I ovarian carcinomas are typically:
A. Low-grade tumors
B. High-grade serous tumors
C. Always mucinous tumors
D. Always germ cell tumors

Type I ovarian carcinomas often arise with:
A. Endometriosis or borderline tumors
B. STIC lesions only
C. HPV-associated lesions
D. Leiomyomas

Type II ovarian carcinomas are best described as:
A. Low-grade endometrioid tumors
B. High-grade serous carcinomas
C. Benign cystic neoplasms
D. Borderline mucinous tumors

Type II ovarian carcinomas arise from:
A. Endometriosis implants
B. Serous borderline tumors
C. Serous intraepithelial carcinoma
D. Granulosa cell tumors

Most common malignant ovarian tumor type:
A. Serous tumors
B. Mucinous tumors
C. Clear cell tumors
D. Brenner tumors

Serous tumors are typically:
A. Solid-only neoplasms
B. Cystic neoplasms
C. Purely stromal tumors
D. Always bilateral fibromas

Germline mutations increasing ovarian cancer risk include:
A. PTEN and TP53
B. KRAS and BRAF
C. MLH1 and MSH2
D. BRCA1 and BRCA2

Low-grade serous carcinomas often arise with:
A. Serous borderline tumors
B. STIC lesions
C. Endometriosis only
D. Vaginal SCC

High-grade serous carcinomas often arise from:
A. Serous borderline tumors
B. In situ lesions in fimbriae
C. Ovarian fibromas
D. Cervical HSIL

Serous tubal intraepithelial carcinoma (STIC) is associated with sporadic:
A. Low-grade mucinous cancers
B. High-grade serous ovarian cancers
C. Endometrioid hyperplasia
D. Leiomyosarcoma

Women with BRCA mutation and strong family history may undergo:
A. Prophylactic hysterectomy only
B. Prophylactic salpingo-oophorectomy
C. Cervical conization
D. Endometrial ablation

High-grade serous tumors commonly show mutations in:
A. KRAS
B. BRAF
C. TP53
D. ERBB2

Low-grade serous tumors more often show mutations in:
A. KRAS/BRAF/ERBB2
B. TP53
C. PTEN
D. APC

STIC lesions are identical to high-grade serous carcinoma except they lack:
A. Necrosis
B. Papillary architecture
C. Pleomorphism
D. Invasion

Mucinous tumors occur most frequently in:
A. Childhood
B. Middle adult life
C. After menopause
D. Before puberty

Mucinous tumors rarely occur:
A. In middle adult life
B. In adolescence only
C. Before puberty or after menopause
D. In reproductive years

Mucinous tumors are:
A. Benign only
B. Borderline mostly
C. Benign mostly
D. Borderline only

A large unilateral ovarian mass shows mucinous epithelium. Which mutation is most consistent?
A. TP53 mutation
B. KRAS mutation
C. FOXL2 mutation
D. PTEN mutation

Which feature best fits mucinous ovarian tumors?
A. Surface commonly involved
B. Usually bilateral disease
C. Diffuse peritoneal implants
D. Surface rarely involved

Histology shows tubular glands resembling endometrium. Tumor type?
A. Endometrioid ovarian tumor
B. Serous cystadenocarcinoma
C. Mucinous cystadenoma
D. Dysgerminoma

Endometrioid ovarian carcinomas may coexist with:
A. PCOS
B. Salpingitis
C. Endometriosis
D. Leiomyomas

Endometrioid carcinoma + endometriosis often share mutations affecting:
A. Hedgehog and Wnt
B. PI3K/AKT and mismatch repair
C. JAK/STAT and p53
D. EGFR and ALK

Endometrioid ovarian carcinomas are usually:
A. High-grade tumors
B. Borderline only
C. Always metastatic
D. Low-grade tumors

Large epithelial cells with clear cytoplasm suggest:
A. Serous carcinoma
B. Mucinous carcinoma
C. Clear cell carcinoma
D. Transitional cell tumor

Transitional cell tumors of the ovary are usually:
A. Benign
B. Highly malignant
C. Always bilateral
D. Always functional

Ovarian carcinoma seeds peritoneum via capsule. Expected finding?
A. Hyperandrogenism
B. Chylous pleural effusion
C. Pelvic inflammatory disease
D. Massive ascites

Most ovarian carcinomas present with:
A. Cyclic bleeding only
B. Lower abdominal pain, enlargement
C. Postcoital spotting only
D. Acute fever and discharge

Benign ovarian teratomas are commonly called:
A. Dermoid cysts
B. Serous cysts
C. Brenner tumors
D. Krukenberg tumors

Mature (benign) teratoma is occasionally linked to:
A. Lambert-Eaton syndrome
B. Hashimoto encephalopathy
C. Inflammatory limbic encephalitis
D. Guillain-Barré syndrome

A teratoma causes flushing and wheeze. Most likely syndrome?
A. Cushing syndrome
B. Carcinoid syndrome
C. Turner syndrome
D. Conn syndrome

An 18-year-old has malignant ovarian teratoma. Type?
A. Immature teratoma
B. Mature teratoma
C. Struma ovarii
D. Dermoid cyst

Most dysgerminomas are:
A. Bilateral tumors
B. Multifocal tumors
C. Capsular-seeding tumors
D. Unilateral tumors

Rapidly growing pelvic mass in a child suggests:
A. Brenner tumor
B. Thecoma
C. Yolk sac tumor
D. Endometrioma

Ovarian choriocarcinoma (nongestational) is typically:
A. Chemo-sensitive, favorable outcome
B. Chemo-resistant, often fatal
C. Slow-growing, indolent course
D. Benign, hormonally silent

Granulosa cell tumors are usually:
A. Benign, potentially malignant
B. Bilateral, potentially malignant
C. Nonfunctional, potentially malignant
D. Unilateral, potentially malignant

FOXL2 mutations are common in:
A. Adult granulosa tumors
B. Yolk sac tumors
C. Mucinous carcinomas
D. Dysgerminomas

Tumors composed predominantly of theca cells are:
A. Usually malignant
B. Usually borderline
C. Almost always benign
D. Always metastatic

Plump spindle stromal cells with lipid droplets indicates:
A. Fibroma
B. Thecoma
C. Dysgerminoma
D. Brenner tumor

Most fibromas, fibrothecomas, and thecomas are:
A. Benign
B. Highly malignant
C. Always bilateral
D. Often metastatic

Over half of Sertoli-Leydig tumors show mutation in:
A. KRAS
B. TP53
C. FOXL2
D. DICER1

DICER1 mutations primarily disrupt:
A. DNA mismatch repair
B. Steroid receptor binding
C. microRNA regulation
D. Collagen cross-linking

A pregnancy-associated ovarian mass mimics corpus luteum. Diagnosis?
A. Pregnancy luteoma
B. Krukenberg tumor
C. STIC lesion
D. Endometrioma

Pregnancy luteoma may cause:
A. Maternal hypocalcemia
B. Virilization in female infants
C. Severe hyperprolactinemia
D. Autoimmune oophoritis

Metastatic GI carcinoma to ovaries is termed:
A. Brenner tumor
B. Dermoid cyst
C. Krukenberg tumor
D. Thecoma

Krukenberg tumor is classically:
A. Unilateral, serous papillary
B. Pure squamous morphology
C. Clear-cell, endometrial-type
D. Bilateral mucin signet-ring cells

In mucinous ovarian tumors, laterality is most often:
A. Unilateral
B. Bilateral
C. Diffusely multifocal
D. Always midline

Clear cell ovarian carcinoma most resembles:
A. Secretory-phase normal endometrium
B. Hypersecretory gestation endometrium
C. Atrophic endometrium
D. Proliferative-phase endometrium