Cervical carcinoma

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					. Risk factors of cervical carcinoma include:
A. Prolonged unopposed effect of estrogen.
B. Nulliparity or low parity.
C. Infection with HPV.
D. Early age of marriage.
E. Late menopause.

. Cervical intraepithelial neoplasia (CIN):
A. Arise from the squamo-columnar junction.
B. May regress spontaneously.
C. Usually become invasive within 1-2 years.
D. Appear as a red area on the ectocervix.
E. May be completely treated by conization.

. Cervical intraepithelial neoplasia (CIN):
A. Is also known as ectropion.
B. Is usually asymptomatic.
C. May present with contact bleeding.
D. May present with intermenstrual bleeding.
E. May present with vaginal discharge.

. Microinvasive carcinoma of the cervix:
A. May be diagnosed by cervical smear.
B. May invade to a depth of 5 mm.
C. Has a maximum width of 7 mm.
D. May invade lymphatic channels.
E. Is treated by Wertheim's operation.

. Spread of carcinoma of the cervix commonly includes:
A. The ureter.
B. The parametrium.
C. The obturator lymph nodes.
D. The inguinal lymph nodes.
E. The vagina.

. Stage I cancer cervix:
A. Is confined to the uterus.
B. May not be visible on clinical examination.
C. May be associated with hydroureter or hydronephrosis.
D. May be associated with lymphatic spread to iliac nodes.
E. May be treated by external or internal irradiation.
In stage II carcinoma of the cervix:
A. The growth is confined to the cervix.
B. There may be extension to the body of the uterus.
C. There may be extension to the upper 1/3 of the vagina.
D. The tumor is fixed to the lateral pelvic wall.
E. The treatment is either radiotherapy or Wertheim's operation.

. Endocervical carcinoma
A. Is usually an adenocarcinoma.
B. Causes a barrel shaped cervix.
C. Usually causes death from local invasion before metastases.
D. May occur in younger women.
E. May be treated by hysterectomy and radiotherapy.

. Cervical smears:
A. Should be taken every 10 years.
B. Should be fixed immediately.
C. Should be stained with Schiller's iodine.
D. Cases showing inflammatory changes should be referred for colposcopy.
E. Cases showing dysplastic changes should be referred for guided biopsy.

         . A pap smear shows mild dysplasia, the next step in
management would include:
A. Cone biopsy.
B. Treatment of inflammation.
C. Repeating the smear.
D. Hysterectomy.
E. Hysteroscopy.

Schiller's iodine applied the cervix will stain:
A. A dysplastic area.
B. A carcinoma.
C. An erosion.
D. Normal columnar epithelium.
E. Mature squamous epithelium.
. Colposcopy:
A. The squamo-columnar junction is usually visible at the internal os.
B. The transformation zone is usually visible at the external os.
C. Acetic acid is applied to keep the cervix wet.
D. Leucoplakia becomes visible after acetic acid application.
E. Non-visualization of the transformation zone is an indication for 4 quadrant biopsy.

. Conization (cone biopsy) of the cervix:
A. Should be done in all cases of CIN.
B. Should be done in all cases of symptomatic cervical erosion.
C. Is indicated when the upper end of the lesion cannot be visualized.
D. Is indicated when the squamo-columnar junction cannot be visualized.
E. Increases the risk of abortion in subsequent pregnancies.
. Investigations for adequate staging of cancer cervix include:
A. Bimanual examination under anesthesia.
B. PR examination under anesthesia.
C. Cystoscopy.
D. Lymph node biopsy.
E. Lymphangiography.

. A carcinoma of the cervix extending to the upper part of the anterior
vagina may be treated by:
A. Internal irradiation.
B. External irradiation.
C. Whole pelvic irradiation.
D. Internal irradiation and hysterectomy.
E. Wertheim's operation.

. Structures removed in Wertheim's operation include:
A. The uterus.
B. The cervix.
C. The upper 2/3 of vagina.
D. The parametrium.
E. The pelvic and femoral lymph nodes.

. Indications of Wertheim's operation include:
A. Cancer cervix associated with pelvic infection.
B. Cancer cervix associated with prolapse.
C. Radiosensitive tumors.
D. Cancer cervix associated with pregnancy.
E. Some cases of malignant ovarian tumors.

. Radiotherapy for cancer cervix:
A. May be curative or palliative.
B. Has the same results as Wertheim's operation for stage I lesions.
C. Is contraindicated in the presence of active infection.
D. Should not be used after Wertheim's operation.
E. Consists of either external or internal irradiation.

. Complications of radiotherapy for cancer cervix include: .
A. Flaring of infection.
B. Pulmonary embolism.
C. Stress incontinence.
D. Vesico-vaginal fistula.
E. Bleeding per rectum
10- Which one of the following is not associated with cervical carcinoma?
    A) Multiple sexual partners
    B) Human papilloma virus (HPV)
    C) Young age at first sexual intercourse
    D) Intrauterine contraceptive devices (IUCDs)
11- In cervical cancer Stage Ib, which of the following is true?
    A) Tumor has spread to adjacent organs.
    B) Tumor involves the lower one-third of the vagina
    C) Clinically apparent lesion involving only the cervix.
    D) Tumor has spread to the upper two-thirds of the vagina and does not involve the
13- A 42-year-old woman comes for her routine annual examination. She
    has recently been divorced, and she acquired a new sexual partner
    within the past 6 months. She has no history of abnormal Pap test
    results. Her examination is unremarkable, but her Pap tests result
    indicates atypical squamous cells of undetermined significance
    (ASCUS). The most appropriate management is:
    A) Repeat Pap test in 6 months
    B) Colposcopy
    C) Viral testing for human papillomavirus (HPV) subtype
    D) Screening of new partner for HPV
15- A 26-year old woman who is at 12 weeks of gestation comes for a
    follow-up visit after her Pap test result at 8 weeks of gestation showed
    a low-grade squamous intraepithelial lesion (LSIL). The next step in
    management should be :
    A) Cone biopsy
    B) Loop electrosurgical excision procedure (LEEP)
    C) Colposcopy
    D) No further procedure until after delivery
    E) Repeat Pap smear in 3 months
19- A 46-year-old woman presents with postcoital bleeding. Pelvic
    examination reveals a large fungating cervical lesion, 8 cm in maximum
    diameter, with parametrial extension on the right. Cervical biopsy
    demonstrates moderately differentiated squamous cell carcinoma with
    lymphovascular space involvement. Baseline laboratory studies reveal
    a normal serum creatinine and normal blood urea nitrogen, serum
    hemoglobin of 11.2 mg/dL, and normal liver function. Chest X-ray
    shows no evidence of disease, and computed tomography scan shows
    no evidence of lymphadenopathy or liver disease. The patient is fully
    active and able to engage in her usual daily activities. The currently
    recommended therapy for her is:
    A) whole abdominal radiation therapy
    B) pelvic radiation therapy followed by brachytherapy
    C) cisplatin (Platinol) chemotherapy concurrent with pelvic radiation therapy
        followed by brachytherapy
    D) pelvic radiation therapy followed by extrafascial hysterectomy
    E) radical abdominal hysterectomy followed by pelvic radiation therapy followed by
23- Cancer of the cervix, all are true EXCEPT:
    A) has reduced in incidence due to cervical screening programmes
    B) cigarette smoking is a risk factor
    C) the incidence is inversely related to social class
    D) is usually adenocarcinoma
29- Exfoliative cytology is useful for the diagnosis of:
    A) Meningioma
    B) Multiple Myeloma
    C) Cervical cancer
    D) Teratoma of ovary
30- Carcinoma cervix may be caused by which of the following?
    A) Herpes simplex type I
    B) Syphilis
    C) Papilloma virus
    D) Trichomonas.
37- The following are the factors associated with CIN EXCEPT:
    A) Onset of coitus at early stage
    B) Multiple sexual partners
    C) Lower socioeconomic status
    D) Nulliparity
    E) History of venerial disease
44- A 55 year old lady presenting to outpatient department with
  postmenopausal bleeding for 3 months, has a 1x1 cm nodule on the
  anterior lip of cervix. The most appropriate investigation to be done
  subsequently is:
    A) Pap smear.
    B) Punch biopsy.
    C) Endocervical curettage.
    D) Colposcopy
47- The time span over which a percentage of women with untreated CIN
  will develop cancer. Choose the single most likely time or time-interval:
    A) 3-6 months
    B) 12 months
    C) 24-36 months
    D) 3-10 yrs
    E) 30 years
48- The age at which the peak incidence of cervical carcinoma develops.
  Choose the single most likely time or time-interval:
    A) 30 years
    B) 45 years
    C) 50 years
    D) 55 years
    E) 65 years
49- The interval for cervical smears to be taken in a woman treated I year
   previously for CIN 2. Choose the single most likely time or time-interval:
    A) 3-6 months
    B) 12 months
    C) 24-36 months
    D) 3-10 yrs
    E) 30 years
50- The time scale within which the 50% of the patients with recurrent
   disease will present, following treatment for stage IB cervical cancer.
   Choose the single most likely time or time-interval:
    A) 12 months
    B) 24-36 months
    C) 3-10 yrs
    D) 30 years
E) 45 years

60- Regarding Wertheim's hysterectomy
    A) Only palpably enlarged lymph nodes are removed.
    B) It is the treatment of choice for Stage III carcinoma of the cervix.
    C) The ovaries can be conserved.
    D) It can be followed by adjuvant radiotherapy.
66- Cervical Polyps, All are true except:
    A) are commonly pre-malignant
    B) are associated with abnormal bleeding
    C) may be fibroids
    D) can cause postcoital bleeding
67- The Cervical Smear, all are false EXCEPT:
    A) should be performed routinely every five years
    B) may show evidence of endometrial cancer
          inflammatory" smears should be repeated after three years
    D) accurately reflects cervical pathology
72- Early symptoms of invasive cancer of the cervix may include all
      A) Increased vaginal discharge
      B) Leg pain
      C) Postcoital bleeding
      D) Metrorrhagia
80- Occult invasive cervical cancer, all are false EXCEPT:
      A) Is stage Ib
      B) Associated with microinvasive carcinoma on pathological assessment
      C) Rarely is associated with lymph node metastasis
      D) Cannot be diagnosed by colposcopy
81- In cervical cancer , all are true EXCEPT:
      A) The potential of rnicroinvasion depends on confluence
      B) The potential of rnicroinvasion depends on volume
     C)  If endothelial lined channels contain tumour, then lymphatic spread is likely to
         have occurred
      D) Where the depth of invading nests of cells exceed 5 mm then cone biopsy is
82- In the treatment of stage Ib carcinoma of the cervix by Wertheim's
    hysterectomy, all are not true EXCEPT:
      A) associated with a urinary fistula rate of 10%
      B) cause bladder atonia
      C) associated with survival rates of about 80% if only one to four pelvic lymph
         nodes are involved
      D) Not associated with femoral nerve damage
83- A 25-year old nulliparous woman is referred from her general
    practitioner with an abnormal smear, This could mean all of the
    following EXCEPT:
      A) That the smear is unsatisfactory
      B) That there are inflammatory changes
      C) That there is cervical intraepithelial neoplasia (CIN)
      D) That there is a human papilloma virus (HPV) type 3 infection
84- Colposcopy , all are not true EXCEPT:
      A) Acetic acid coagulates protein in the nuclei and cytoplasm
      B) Only areas of intraepithelial neoplasia appear white
      C) In CIN grade III the intercapillary distance is decreased
      D) An abnormal vascular pattern suggests invasive disease
      E) Columnar epithelium stains dark brown with Schiller's iodine
85- The following are characteristic features of HPV infection EXCEPT:
      A) Koilocytic atypia
      B) Multinucleation
      C) No abnormal mitotic figures
      D) Nuclear abnormalities in the basal layers
86- The following statements are not true concerning treatment of CIN
      A) The best long-term success rates have been reported using laser therapy
      B) To be effective local destruction to depth of 10 mm is required
      C) Cone biopsy is indicated where there is colposcopic suspicion of an invasive
      D) No long-term follow-up is required if hysterectomy is performed
87- Management of invasive cancer of the cervix, all are not true EXCEPT:
      A) In stage Ib tumours the size of the tumour has little relevance to the 5-Year
      B) In stage II disease there is extension of the tumour from the cervix into the
         uterine cavity
      C) Barrel-shaped endocervical lesions have a worse prognosis than cervical
         cancers of a similar stage
      D) Adenocarcinoma of the cervix has a poorer survival stage for stage than
         squamous lesions
88- Pelvic exenteration is contraindicated where:
     A)  There is unilateral leg edema and sciatica
     B) There is pelvic fibrosis
     C) The patient is sexually active
     D) There is central recurrence after radiotherapy
130- A patient in her first trimester of pregnancy is diagnosed with invasive
   cervical cancer. Treatment would include:
  A) waiting until after delivery before treatment
  B) frequent pap.smear through gestation
  C) Termination of the pregnancy and concomitant or subsequent radiation or
      surgery as soon as possible)
  D) delivery by cesarean section at term
  E) radiation only
137- Most deaths from cervical carcinoma can be attributed to:
  A) local extension
  B) metastasis to the centra! Nervous system
  C) metastasis to the liver and lungs
  D) iatrogenic causes
  E) none of the above
139- An exentration procedure for recurrent cervical cancer would include
   all of the following EXCEPT:
  A) removal of the bladder
  B) removal of the uterus
  C) removal of the symphysis
  D) removal of the rectum
  E) removal of the pelvic nodes
144- Carcinoma in situ of the cervix is characterized by all of the following
  A) involvement of the entire thickness of the squamous epithelium
  B) cells resembling those of invasive carcinoma
  C) evidence of stromal invasion
  D) complete loss of stratification
  E) occasional regression and disappearance
147- An intravenous pyelogram showing hydronephrosis in the work-up of
   a cervical cancer otherwise confined to a normal size cervix would
  A) stage I
  B) stage II
  C) stage III
  D) stage IV
  E) none of the above
148- True statements about clear cell adenocarcinoma of the cervix and
   vagina include the following EXCEPT:
  A) It has been related lo prenatal DBS exposure
  B) It shows a hobnail pattern on microscopic examination
  C) It usually appears as an exophytic lesion
  D) Affected women are best treated with radiotherapy
       152- A patient presents with a Pap smear showing mild dysplasia. The next
          steps in management would include which of the following?
         A) hysterectomy
         B) repeat Pap smear
         C) cone biopsy
         D) colposcopy
       154- Cervical carcinoma is considered invasive when there are all of the
         following EXCEPT:
         A) a breakthrough of the basement membrane
         B) penetration of the stroma
         C) involvement of the lymphatics
         D) involvementoftheendocervical glands
         E) All of the above
       172- Studies show that cervical cancer is associated with which of the
         A) early first coitus
         B) incidence of cigarette smoking
         C) nulliparity
         D) use of oral contraceptives

12-As regarding cancer cervix Say true or false and explain why
        a. Cancer cervix can affect immune compromised ladies.
        b. Cancer cervix is higher in smoker females.
        c. Type 15 HPV virus is highly oncogenic for cancer cervix.
        d. Surgical treatment can be applied for stage I or II. cancer cervix with pregnancy before
           fetal viability is an indication for Upper segment C.S
        e. Parametric infiltration is a common feature of stage I disease.
        f. Malignancy starts at the transformation zone.
        g. Lymphatic spread starts when the infiltration of the basement membrane is more then 5
           mm in depth.
        h. Radiotherapy can effectively kill cancer cells in the lymph nodes.
        i. Colopscopy should detect the transformation zone completely to be satisfactory.
        j. It is more common in those starting sexual activity after age of 40 years.
        k. Abnormal cervical erosion or suspicious cervix are early signs of C.I.N
        l. Adenosquamous carcinoma is the commonest pathological types
        m. Most of the adenocarcinoma of the cervix arise fro the endocervical canal.
        n. Cervical stump carcinoma spread late to the bladder.
        o. Adenocarcinoma of the cervix has a much better prognosis.
        p. Menorrhagia is the commonest type of bleeding with cancer cervix.
        q. Routine removal of the para-aortic nodes is essential with Werthiem’s operation.
        r. Intracaviatery irradiation is applied to treat cases cancer in the lymph nodes.
        s. Avascular necrosis of the urter is common after Werthiem’s operation.
        t. Cervical stump carcinoma is best to be treated surgically.
        u. Pelvic infection is the major contraindication for radiotherapy.
        v. Werthiem;s operation has a higher mortality rte compared by radiotherapy.
  w. Shauta operation may be tried in stage III cancer cervix.
  x. Pelvic exenteration is done for poor surgical risk cases.
  y. Surgical staging of cancer cervix can determine the line and extent of treatment.
  z. Cystoscopy should be done for all cases of diagnosed cancer cervix.
  aa. Recurrent cancer cervix is best treated surgically.
  bb. Small cell carcinoma is best treated by radiotherapy.
  cc. Combined surgery and radiotherapy gives the best results.

(1)Which of the following statements is true:
A) Ectopy means ectropion.
B) Ectopy means eversion of the endocervix.
C) Ectopy means erosion of the cervix.
D) Ectopy means cervical ulcer.
E) All of the above.

(2)Contraceptive pills cause the following:
A) Glandular hyperplasia and hypersecretion.
B) Stromal oedema.
C) Increased stromal vascularity.
D) All of the above.
E) None of the above.

(3)The increased risk of developing cancer cervix in pill
users is due to the following causes EXCEPT:
A) Early sexual life.
B) Multiple partners.
C) Glandular hyperplasia.
D) Sexual overactivity.
E) More susceptibility to contract sex-transmitted HSV2,

(4)When a cervical polyp is removed, the most important
part to be examined is:
A) Tip
B) Base
C) Middle part..
(5)A pedunculated small reddish mass protruding outside
the endocervix, may be:
A) Cancer cervix.
B) Granulomatous mass.
C) Adenomatons polyp.
D) All of the above.
E) None of the above.

(6)In a 50-year old patient, polypectomy is done for
metrorrhagia, Which of the following is true.
A) Fracional curettage is not needed.
B) Fractional curettage is advisable.
C) Fractional curettage is mandatory.

(7)In acute cervicitis, the following treatment-modalities are true
A) Limitation of sexual activity.
B) Proper antibiotics.
C) Analgesics.
D) Cauterization.

(8)With chronic cervicitis, which of the following is
A) Angry red cervix.
B) Mucopurulent discharge.
C) Cervical erosion.
D) Nabothian follicle.
E) All of the above.

(9)Chronic cervicitIs, may be associated with the following
A) Leucorrhoea.
B) Low abdominal pain.
C) Backache.
D) Menorrhagia.
E) Contact bleeding.
(10)Cervical T.B. is caused by which strain of T.B:
A) Bovine Mycobacterium.
B) Human mycobacterium.
C) Avian mycobacterium.
D) Mycobacterium murine.
E) Mycobacterium vole.

(11)In Cervical T.B., which of the following is NOT TRUE:
A) The cervix is ulcerated, distorted and mimics malignancy.
B) There is slight bleeding precipitated by contact.
C) It predisposes to cancer cervix.
D) Pap. Smear and cervical biopsy are mandatory.
E) Endometrial curettage should be done.

(12)Cervical chancre is associated with the following
A) 2nd site of chancre in the female genital tract after vulva.
B) Ulcer with indurated base and punched-out edge.
C) Erosion covered with grey membranous exudates.
D) Painful.
E) Post-coital bleeding.

                        CANCER CERVIX
(1)In the oetiology of cervical dysplasia and cancer cervix,
which of the following is MOST TRUE:
A) Both are caused by HPV.
B) Both are, PROBABLY, venereal disease.
C) They are associated with smoking, multiparity & obesity.
D) Both have genetic predisposition.
E) Both are caused by HSV-2.

(2)As regards HPV, following is true EXCEPT:
A) 80% of normal women have HEV/DNA (16, 18) in their
cervical tissue.
B) 80 – 90% of dysplastic cells contain HPV sequences.
C) HPV 6,11 are associated with severe forms of dysplasia.
D) It is sex-transmitted.
E) Causes vacuolation of vaginal cells in pap-smear.

(3)Which of following is TRUE as regards Herpes simplex
A) Sufficient evidence correlates HSV2 to cancer cervix.
B) May cause of warty mass on the cervix.
C) Genital region can be affected by HSV-1.
D) All of the above.
E) None of the above.

(4)Synonems for cervical intraepithelial neoplasia include:
A) Carcinoma in situ.
B) Cervical dysplasia.
C) Squamons intraepithelial lesion.
D) All of the above.

(5)The most common method for diagnosis of CIN is:
A) Complaints of abnormal discharge.
B) Postcoital bleeding.
C) Chronic pelvic pain.
D) Vaginal WET smear.
E) Abnormal Pap. Smear.

(6)In Schiller’s Iodine test, the following is true, EXCEPT:
A) Schiller’s positive areas are stained brown.
B) Schiller’s positive areas are not stained brown.
C) Not all positive areas are malignant or premalignant.
D) Schiller’s positive areas are to be biopsied.

(7)In CIN the following is true EXCEPT:
A) CIN I has irrigular enlarged nuclei with abnormal mitosis.
B) CIN III includes severe dysplasia and carcinoma in situ.
C) CIN III lesions gradually blend will the adjacent normal
D) Histological examination is needed to exclude active
E) CIN may involve the cervical glands.

(8)Cellualr atypia involving the basal cervical epithelium and
more than one half of epithelial thickness is:
A) Adenocarcinoma.
B) Microinvasive carcinoma.
D) Carcinoma in – situ.
E) Invasive squamous cell carcinoma.

(9)In 40-year-old patient, clinically normal but with Pap.
Smear “High Grade Squamons lntraepithelial lesion, “H-
SIL”, is managed by:
A) Fractional curettage.
B) Reexamination with colposcope-directed biopsy.
C) Repeat Pap-smear.
D) Punch biopsy.
E) Immediate hysterectomy

(10)Unsatisfactory Pap. Smear may b e due to:
A) Missing endocervical sampling.
B) Severe vaginitis.
C) Extensive malignant necrosis.
D) Misreading.
E) All of the above.

(11)In Pap-smear, false-negative results are found in:
A) Less than 10%.
B) 25%.
C) 50%.
D) More than 50%.

(12)In sexually active females, Pap. Test is done:
A) Quarterly.
B) Half-annually.
C) Annually.
D) Every 3 years.
E) When attending a gyn. Clinic.

(13)Colposcopy permits one to:
A) View the cervix at 1 – 4 power magnification.
B) See the entire transition zone in all patients.
C) Choose the most suspicous site to biopsy.
D) Treat invasive cancer with a biopsy.
E) Make the diagnosis of cancer.

(14)On colposcopy, the factor MOST SUSPICIOUS for
invasive cervical carcinoma is:
A) Aceto - white area.
B) Leukoplakia.
C) Abnormal blood vessels.
D) Punctation.
E) Mosaic pattern.

(15)Leucoplakia refers to:
A) A microscopic lesion.
B) A white lesion.
C) Shrinking atrophy.
D) A cancer.

(16)About colposcopy, which of the following is correct:
A) Mosaic pattern suggests CIN lesion.
B) Punctate pattern suggests CIN lesion.
C) Atypical blood vessels suggest invasive carcinoma.
D) CIN III is clearly delineated.
E) All of the above.

(17)Choose the correct statement as regards colposcopy:
A) It provides a magnification of approximately x 50.
B) It obviates the need for tissue diagnosis.
C) Aceto-white epithelium, in a young woman, mostly
indictes squamous metaplasia.
D) Transformation zone is found medial to squomo-columnar
E) Leucoplakia becomes visible after acetic acid application.

(18)The following statements are true, as regards
colposcopy, EXCEPT:
A) Vascular pattern is apparent after use of green filter.
B) The transformation zone is absent in young adults.
V) Squamo-columnar junction is MOSTLY found at the
external os.
D) Immature squamous metaplasia mimics neoplasia.
E) Trichomonas vaginitis produces a punctate vascular

(19)Microcolpohysteroscopy, entails the, following EXCEPT:
A) Endometrail cavity, endocervical canal and vagina are
B) The hysteroscope is used.
C) The colposcope is used.
D) Detects the transformation zone in a post menopausal
E) Allows for biopsy of an endocervical lesion.
(20)Limitations of colposcopy include.., EXCEPT:
A) It is poorly specific (30% false positive).
B) Cannot be done during pregnancy.
C) Endocervix cannot be visualized.
D) Inaccessable for screening.
E) Cannot distinguish between CIN and condylomate
accuminata, without vascular pattern.

(21)Power of magnification of the colposcope is:
A) 10x to 40x.
B) 50x to 75x.
C) 80x to 100x.
D) 100x to 150x
E) 200 x.

(22)Columnar epithelium of endocervix appears as, at
A) Irrigular surface with long papilla.
B) Grape-like after acetic acid application.
C) Deep clefts.
D) All of the above.
E) None of the above.

(23)The squamocolumnar junction is present in:
A) The external os.
B) Outside the external os.
C) Inside the endocervical canal.
D) Position changes with age.
E) Transitional zone.

(24)Conization would be INAPPROPRIATE WHEN:
A) There is disparity between Pap. Smear and biopsy
B) When microinvasive carcinoma is found at biopsy.
C) Biopsy reports deeply invasive carcinoma.
D) Inadequate colposcopy.
E) All of the above.

(25)Advantages of conization are:
A) Safe procedure.
B) Accurate diagnosis.
C) May be therapeutic.
D) Endocervical involvement-detection
E) Suitable for large lesions.
F) All of the above.

(26)Following is true, about coinization, EXCEPT
A) Needs general anesthesia.
B) May be followed by cervical stenosis.
C) Compromizes cervical function.
D) Risky if done during pregnancy (abortion, bleeding).
E) Adequate for treatment of adenocarcinoma in-situ.

(27)Conization is not always curative. The risk of recurrence
of cervical malignancy after conization is:
A) 5%.
B) 10%.
C) 20%.
D) 30%.
E) 50%.

(28)CIN may progress to invasive carcinoma, within ten
years in up to which percentage of patients:
A) 5%.
B) 30%.
C) 60%.
D) 80%.
E) 100%.

(29)CIN, may regress spontaneously:
A) True
B) False

(30Most cervical cancers arise in:
A) Internal os.
B) Endocervical canal.
C) Squamocolumnar junction.
D) Isthmus.
E) External os.

(31)In cervical adenocarcinoma, there is.. EXCEPT:
A) Incidence 15 – 20% of all cervical carcinoma.
B) Manifests early in tumour-life.
C) Cervix is barrel-shaped, rock-hard on palpation.
D) May develop after DES exposure.
E) May be seen in children 12 years old.

(32)In clinical-stage I cervical carcinoma, lymph node
involvement is present in:
A) Less than 1%.
B) 5%.
C) 15%.
D) 25%.
E) 50%.
(33)In micro-invasive cancer cervix (Stage IA), lymph node
involvement is found in:
A) Less than 1%.
B) 5%.
C) 15%.
D) 25%.
E) 50%.

(34)Cancer cervix with parametric involvement not reaching
the pelvic wall, and bilateral hydronephrosis due to ureteric
obstruction by malignant tissue is staged as:
A) Stage O.
B) Stage IA
C) Stage IB.
D) Stage IIA
E) Stage IIB
F) None of the above.

(35)Cancer cervix with involvement of the upper third of
vagina ONLY, and at cystoscopy, bullous oedema of the
bladder is found. It is stage:
A) O.
B) I
F) IV.

(36)Prognosis and clinical behaviour of cervical
adenocarcinoma as compared to squamous carcinoma,
stage to stage are:
A) Same.
B) Worse.
C) Better.

(37)Cancer cervix infilterating the stroma to a 7 mm depth
with vascular space involvement is stage as:
A) O.
B) IA1.
C) IA2
D) II.
F) IV.

(38)All following statements are true as regards prognosis
of cervical corcinoma EXCEPT:
A) Age of patient.
B) Histological type.
C) Vascular space involvement.
D) Histological grade.
E) It depends only on staging of cancer cervix.
F) Lymph node involvement.
G) Size of the tumour.

(39)Clinical staging, of cancer cervix, will correlate with
surgical finding in accuracy of which percentage:
A) 10.
B) 25.
C) 50.
D) 75.
E) 100.

(40)Cancer cervix stage III is assigned when
A) Carcinoma infiltrating, the bladder.
B) Carcinoma involving the distal vaginal wall.
C) Carcinoma involving the parametrium short of pelvic wall.
D) Carcinoma with pelvic lymph node involement.
E) Carcinoma with bullous oedema of the bladder.

(41)Often, the first symptom of cancer cervix is:
A) Leg pain.
B) Pain with intercourse.
C) Pruitus vulvae.
D) Vaginal bleeding.
E) Weight loss.

(42)A buky friable papillary mass, growing from the cervix is
BEST termed:
A) Exophytic.
B) Endophytic.
C) Ulcerative.
D) Nodular.
E) Oedematous.

(43)Which of the following carcinomas carries the poorest
prognosis (other factors being equal):
A) Well-differentiated keratinizing large-cell squqmous
B) Poorly-differentiated, large-cell squamous carcinoma.
C) Well-differentiated, keratinizing small-cell squamous
D) Poorly differentiated, small-cell squamous carcinoma.
E) Adenocarcinoma.

(44)A cervical ulcer is BEST evaluated by:
A) Repeated examination.
B) Pap. Smear.
C) Colposcopy.
D) Punch biopsy.
E) Hysterectomy.

(45)42-year old woman, with postcoital spotting, shows
circumscribed red area in the cervix. It could be.
A) Condylomatra.
B) T.B ulcer.
C) Ectopoy.
D) Ectropion.
E) Cancer.
F) All of the above.

(46)43-year old woman, with normal pelvic findings and
suspicious Pap. Smear, shows invasive carcinoma of the
cervix on colposcopically-dircted biopsy. Next management
A) Cone biopsy.
B) Hysterectomy (radical).
C) Metastatic evaluation.
D) Irradiation.
E) Both irradiation and radical hysterectomy.
(47)Limitations of cryosurgery for CIN include the following
A) Does not allow for histological tissue sampling
B) Does not deal with endocervical lesions.
C) Painful procedure.
D) Not suitable for lesions > 1 cm.
E) High failure rate (6 – 32%) and in CIN III it is 20 – 40%.

(48)Side Effects of Cryocautery are:
A) Uterine cramping.
B) Light headedness.
C) Dizziness.
D) Excessive watery discharge.
E) All of the above.

(49)Laser treatment of CIN suffers the following
A) High cost.
B) Special training.
C) Not superior to cryotherapy with lesions < 1 cm.
D) All of the above.
E) None of the above.

(50)Following statements are true as regards laser
vaporization of CIN, EXCEPT:
A) Uses carbon dioxide.
B) Done without general anaesthesia.
C) Obviates the need for biopsy.
D) Can destroy up to 7 mm depth.
E) 90% cure rate.

(51)In LEEP (loop Electrosurgical Excision Procedure), the
following statements are true, EXCEPT:
A) High power (35 – 55 watts) is used.
B) Tiny loop (0.5 mm).
C) There is little thermal damage.
D) Electron flow will create high velocity steam current which
will cut in tissues.
E) Suitable for large CIN lesions.
(52)The majority of deaths for cervical carcinoma are due to:
A) Local spread, obstructing the ureters causing renal
B) Brain metastasis with resultant cerebral failure.
C) Hoemorrhage into the pelvis from vascular erosion by
D) Pulmonary failure secondary to lung metastasis.
E) Bone metastasis causing injuries to the central nervous

(53)The approximate five-year survival rate for all stages of
cervical carcinoma (together) is:
A) 15%
B) 35%.
C) 50%.
D) 65%.
E) More than 65%.

(54)Occult carcinoma of the cervix is:
A) Stage IA.
B) Microinvasive.
C) Best treated by cone biopsy.
D) Found incidentally in hysterectomy specimens.
E) Frequently associated with negative cytology.

(55)Conization is indicated in:
A) Cases with endocervical involvemnt.
B) Unvisualized squamo columnar junction..
C) Unsatisfactory calposcopic findings.
D) Large lesions.
E) All of the above.

(56)Whertheim’s hysterectomy is chosen for cases of :
A) Stage Ia1.
B) Stage Ia2.
C) Stabe Ib.
D) Stage IIa.
E) Stage IIb.
(57)In a 26-year old patient with stage I cancer cervix, choice
of treatment modality takes the following in consideration:
A) Desire to maintain reproductive life.
B) Size of tumour.
C) Depth of invasion.
D) Vascular space involvement.
E) All of the above.

(58)Extended radical hysterectomy (Meig’s or type III
hysterectomy)is indicated in stages of cancer cervix:
A) Ib.
B) IIa
C) IIb.
E) (a + b).
F) (a + C)
G) (b + c).

(59)Mark the “true” step in radical hysterectomy:
A) Dissection is carried down to the deep inginal nodes.
B) The uterine vessels are ligated medial to the ureters.
C) The common iliac nodes are removed.
D) Ureter is dissected FREE from pelvic brim to bladder.

(60)In radical hysterectomy, which statement in
A) Suction drainage of the pelvic floor reduces the incidence
of lymphocyst formation.
B) Bladder atony is common after operation.
C) The obturator nerve is rarely seen.
D) Genito-femoral nerve is frequently damaged.
E) The superior vesical artery is not ligated.

(61)In stage I cervical carcinoma, the ovaries SHOULD be
A) Yes.
B) No.
(62)Radiotherapy of cancer cervix is associated with the
following EXCEPT:
A) Reduced incidence of lymph-node involvement at
subsequent lymphadenectomy.
B) More effective in cases of adenocarcinoma than in
squamous cell carcinoma.
C) Megavoltage therapy has a lower incidence of skin
damage than autovoltage (200 – 300 Kv).
D) Point A is 2 cm above the lateral fornix and 2 cm lateral to
the central canal of the cervix.
E) Oestrogen therapy prevents vaginal atrophy.

(63)The most common post-operative complication of
radical hysterectomy is:
A) Intra-operative death.
B) Genito-urinary fistula.
C) Bowel injury.
D) Premature menopouse.

(64)The following procedures can be performed for cases of
cancer cervix with pregnancy less than 20 weeks EXCEPT:
A) Repeated Pap. Smear.
B) Expert colposcopy.
C) Conization.
D) I.V.P. for staging.
E) Cystoscopy for staging.

(65)During early pregnancy (less than 20 weeks), cancer
cervix (stage Ib and more) is treated by:
A) Expectant treatment till viability.
B) Conization and follow-up till viability.
C) As in the none pregnant state.
D) All of the above.
E) None of the above.

(66)Criteria to treat micro-invasive cervical carcinoma by
conization include the following EXCEPT:
A) Microinvasim ≤ 3 mm.
B) No vascular space involvement.
C) Desire to preserve fertility.
D) Margins are free from CIN.
E) All of the above.
F) None of the above.

(67)In terminal carcinoma, which of the following is true:
A) It is painless.
B) Lung and/or liver secondaries are common.
C) Requires urinary diversion.
D) Pelvic exentraion is done.
E) Intrathecal alcohol injection is recommended.

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Description: 18 Oct 2010‏ – Cervical cancer (choice B) is the gynecologic type that causes the ... It is essential to document successful treatment with a follow-up urine ...