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

C. HSV-2

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

A. Lumbosacral nerve ganglia

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

D. Cesarean section

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

B. Poxvirus

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

A. Sexual contact

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

C. Molluscum contagiosum

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

B. Cytoplasm

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

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

A. Curd-like discharge

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

C. Flagellated protozoan

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

B. Puerperal infections

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

C. Lymphatic and venous channels

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

A. Deeper organ layers

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

B. Lichen sclerosus

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

D. Constricted vaginal orifice

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

A. Epidermal thinning

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

B. Chronic scratching/rubbing

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

D. Epidermal thickening

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

C. Hyperkeratosis

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

B. Benign exophytic papilloma

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

C. Squamous cell carcinoma

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

D. Classic VIN

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

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

B. Chronic lichen sclerosus

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

C. Papillary hidradenoma

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

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

B. HPV-related

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

A. At younger ages

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

C. Keratinizing squamous carcinoma

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

A. Older women

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

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

B. Extramammary Paget disease

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

A. Labia majora

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

B. Gartner duct cyst

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

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

A. Submucosal, fluid-filled cysts

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

C. Squamous cell carcinoma

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

D. High-risk HPV

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

B. VAIN

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

C. Immature metaplastic cells

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

A. Immature basal cells

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

B. Mature superficial squamous cells

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

D. Surface epithelial damage

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

B. Notch pathway

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

C. High

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

A. Regress spontaneously

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

D. Low

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

C. Arrested epithelial maturation

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

B. High cancer progression risk

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

D. Endocervical canal

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

C. Loose fibromyxoid stroma

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

B. Irregular bleeding/spotting

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

A. Mucus-secreting endocervical glands

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

C. Epithelial breaks at SCJ

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

B. HPV

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

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

C. Ki-67 and p16

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

A. E6/E7 block cell-cycle arrest

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

D. HPV-16

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

B. About 80%

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

A. Nearly 100%

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

C. Squamous cell carcinoma

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

B. Adenocarcinoma

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

D. Adenocarcinoma in situ

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

A. Adenosquamous carcinoma

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

C. Adenocarcinoma and neuroendocrine

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

B. Direct extension

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

C. Stage I

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

A. Stage 0

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

B. Stage II

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

D. Stage III

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

A. Stage IV

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

C. Stage III

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

B. Ureters

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

D. Girls and boys

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

C. Unopposed estrogens

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

A. Glandular secretory changes

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

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

B. No corpus luteum forms

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

D. Acute endometritis

Acute endometritis is most linked to infections after:

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

B. Delivery or miscarriage

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

A. Ectopic endometrial tissue outside uterus

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

C. Ovaries

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

B. Rectovaginal septum

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

D. Upper epithelial layers

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

C. High-risk HPV infection

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

A. About 80%

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

C. Aromatase expression

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. High-dose estrogens

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

D. Aromatase

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

B. Estrogen

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

A. Endometriosis

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

C. Atypical endometriosis

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

B. Myometrium

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

D. Adenomyosis

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

C. Tamoxifen

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

B. Antagonist breast, agonist endometrium

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

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

A. Prolonged estrogenic stimulation

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

B. Endogenous or exogenous

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

D. PTEN inactivation

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

A. PI3K/AKT pathway

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

C. Cowden 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

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

A. Non-atypical or atypical

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

C. Endometrial intraepithelial neoplasia

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

B. Increased gland-to-stroma ratio

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

A. Complex glands with nuclear atypia

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

B. Aromatase

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

C. Endometrioid and clear cell

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

B. Enhance tissue survival

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

C. Myometrium

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

A. Weak endometrial estrogen agonist

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

A. Atypical hyperplasia

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

C. Endometrioid carcinomas

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

B. Endometrial hyperplasia

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

A. Obesity and diabetes

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

B. PTEN

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

B. Precursor to carcinoma

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

C. PI3K/AKT

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

B. Estrogen receptor targets

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

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

C. Myometrial invasion then extension

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

B. Normal endometrial epithelium

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

B. Endometrial atrophy

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

B. Poorly differentiated

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

C. Serous carcinoma

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

C. TP53

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

B. Endometrial intraepithelial carcinoma

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

A. Cells identical to serous carcinoma

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

B. Small atrophic uteri

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

B. Bulky or deeply invasive

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

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

B. African American 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

A. 2-fold higher

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

B. Postmenopausal vaginal bleeding

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

A. Excess leukorrhea

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

B. Bulky/polypoid

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

B. Adenocarcinoma + malignant mesenchyme

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

B. Postmenopausal women

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

A. Vaginal bleeding

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

B. Malignant stroma, benign abnormal glands

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

A. 4th–5th decade

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

B. Low grade malignancy

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

A. Estrogen stimulation

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

C. Estrogen withdrawal effect

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

A. JAZF1–SUZ12 fusion

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

D. Transcriptional repressor

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

B. Repressive histone marks

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

B. Leiomyomas

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

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

C. Hematogenous spread

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

B. Lungs

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

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

C. Retrograde menstrual flow

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

A. Blood and lymphatics

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

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

B. Translucent cysts, clear fluid

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

A. Adenomatoid tumor

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

C. Subserosal or mesosalpinx

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

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

A. Hyperandrogenism with chronic anovulation

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

B. Androgen biosynthesis

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

C. Estrone

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

D. Endometrial hyperplasia/carcinoma

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

B. Postmenopausal women

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

A. Bilateral uniform ovarian enlargement

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

C. Hypercellular stroma, luteinization

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

B. More striking than PCOS

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

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

A. Rupture then immediately seal

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

B. Müllerian epithelium

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

C. Cystadenoma

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

A. Adenofibroma

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

D. Cystadenofibroma

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

C. Cortical stromal hyperplasia

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

B. Cystadenocarcinoma

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

A. Women age 20–45

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

C. Women age 45–65

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

A. Low-grade tumors

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

A. Endometriosis or borderline tumors

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

B. High-grade serous carcinomas

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

C. Serous intraepithelial carcinoma

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

A. Serous tumors

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

B. Cystic neoplasms

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

D. BRCA1 and BRCA2

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

A. Serous borderline tumors

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

B. In situ lesions in fimbriae

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

B. High-grade serous ovarian cancers

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

B. Prophylactic salpingo-oophorectomy

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

C. TP53

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

KRAS/BRAF/ERBB2

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

D. Invasion

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

B. Middle adult life

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

C. Before puberty or after menopause

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

C. Benign mostly

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

A. TP53 mutation

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

D. Surface rarely involved

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

A. Endometrioid ovarian tumor

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

C. Endometriosis

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

B. PI3K/AKT and mismatch repair

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

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

C. Clear cell carcinoma

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

A. Benign

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

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

B. Lower abdominal pain, enlargement

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

A. Dermoid cysts

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

C. Inflammatory limbic encephalitis

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

B. Carcinoid syndrome

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

A. Immature teratoma

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

D. Unilateral tumors

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

C. Yolk sac tumor

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

B. Chemo-resistant, often fatal

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

D. Unilateral, potentially malignant

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

A. Adult granulosa tumors

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

C. Almost always benign

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

B. Thecoma

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

A. Benign

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

D. DICER1

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

C. microRNA regulation

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

A. Pregnancy luteoma

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

B. Virilization in female infants

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

C. Krukenberg tumor

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

D. Bilateral mucin signet-ring cells

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

A. Unilateral

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

B. Hypersecretory gestation endometrium