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(AY21/22 Updated) Pelvi-abdominal

Masses
1.
A 17 year old girl without a significant past medical history has been diagnosed
and treated for ovarian yolk-sac tumour.

 
Which tumour marker would be most appropriate to use for follow up?
 

alpha-fetoprotein

Lactate dehydrogenase

CA125

Inhibin

hCG

2.
A 38-year-old woman, Para 2 presents with a 2-year history of painful, heavy
periods. She bleeds for 10 days each month. She feels her abdomen has become
bloated over the same time period. She feels tired most of the time, especially
during her menses but denies any loss of appetite or loss of weight. She also
complains of occasional constipation. The family physician has palpated a large,
abdominal mass arising from the pelvis that feels firm. He estimated that the
centrally located abdominal mass is of 28 weeks' gestation size.

 
What is the most likely diagnosis from the above history and examination?
 

Ovarian tumour

Endometrial polyp

Endometriosis

Ascites secondary to malignancy

Fibroid uterus

3.
 A 65 year old para 2 is referred for a chief complaint of progressively increasing
abdominal girth over the last 3 weeks.  Her referring physician has found an
abdominal mass.  She reports that her last menstrual period was at age 50 and
she denies any postmenopausal bleeding.  The patient reports being
constitutionally well with no significant symptoms of pain and is able to void without
difficulty. Her social, family, medical and surgical histories are non-contributory. 
She had 2 normal vaginal deliveries.   Physical examination reveals a 15cm mobile
mass that is grossly smooth and moves with the uterus.  You correctly counsel her
that
most masses in women her age are malignant.

the risk of malignancy is higher because of her age.

the mass has likely developed because of her lifestyle.

her risk of malignancy would have been lower if she had never been pregnant.

her risk of an ovarian malignancy is low.

4.
A 55 year old woman has been referred for postmenopausal bleeding. Pelvic
ultrasound revealed the presence of cystic spaces in the endometrium and an
endometrial thickness of 15 mm. She has previously used tamoxifen for 5 years
for breast cancer.
What is the best management option?
Do nothing as she did not have any bleeding

MRI

Hysterectomy

Endometrial sampling

Mirena IUS insertion

5.
A 34 year old woman is being investigated for primary infertility. She has been
treated for a previous Chlamydia infection. Her pelvic ultrasound shows a tubular
structure and incomplete septation with no abnormal blood flow seen around this
structure. What is the most likely ultrasound diagnosis from this appearance?
  
Tubo-ovarian abscess

Endometrial polyp

Haemorrhagic ovarian cyst

Ovarian tumour

Hydrosalpinx

6.
A 70 year old para 3 is referred for a chief complaint of abdominal distention. The
A&E physician who examined her reports palpating a vague abdominal mass. She
reports that her last menstrual period was at age 50 and she denies any
postmenopausal bleeding. She is not in any distress, and is able to tolerate diet
although she reports decreased appetite and is able to void without issue. Her
social, family, medical and surgical histories are non-contributory. She had 1
normal vaginal delivery and 2 cesarean sections. Physical examination reveals a
15cm fixed mass and a positive fluid wave, the abdomen is otherwise mildly
distended. Her vital signs are stable. The next MOST APPROPRIATE step in her
management is

to order an oesophago-gastro-duodenoscopy (OGD) and colonoscopy to rule out a gastrointestinal

primary.

to order that she be “nil by mouth” and prepared for exploratory surgery as this is likely to be cancer.

to order an ultrasound of the pelvis.

to order a mammogram to rule out a breast primary.

since there is fluid, order that the fluid be aspirated.

7.
A nulliparous 18-year-old sexually active woman, whose last menstrual period was
2 months ago, presents to emergency with a 2-day history of worsening abdominal
pain, nausea and vomiting. She is not septic or dehydrated, but is in pain.
 Examination demonstrates a tender, distended abdomen, but no rebound or
guarding. She is afebrile, normotensive and not tachycardic.
What would be the first differential diagnosis you would like to rule out in this
scenario?
 
Ovarian tumour

Appendicitis

Ectopic pregnancy

Pelvic inflammatory disease

Ovarian cyst accident

8.
A 27 year old illustrator is concerned about a blood test result from a recent health
screen that was provided for by her company.  Her serum CA125 level was
reported as 47 IU/L (normal is <35 IU/L).  She reports being well with no functional
complaints.  Her medical, surgical and family histories are non-contributory.  She
does not smoke.  She uses condoms every time she has sex.  Her menstrual
periods are regular and she remembers this because her last menstrual period
started on the day that she had gone for the health screen. 
You correctly counsel her that
 

the ovaries and breasts of her and her first degree female relatives will need to be evaluated for a
possible familial cancer given her young age and raised CA125.

she will likely need chemotherapy as the raised CA125 level is suggestive of an ovarian malignancy.

she should seek care with a gynaecologic oncologist to ensure a better outcome for her ovarian
cancer.

the CA125 result is consistent with menstruation and inappropriate for screening in the general
population.

she should be prepared for exploratory surgery.

9.
A 20 year old lady has 5 days' history of abdominal pain and vomiting. On
examination, there is tenderness in the right iliac fossa. On pelvic examination,
there is a normal-sized anteverted uterus and a smooth, firm and mobile right
adnexal mass. The urine pregnancy test is negative. Pelvic ultrasound shows a 10
× 13 cm right adnexal mass with cystic and solid components and no free fluid was
seen. What is your most likely diagnosis?

Fibroid uterus

Hemorrhagic cyst

Endometrioma
 Germ cell tumour of ovary

Ectopic pregnancy

10.
A 53 year old woman is referred to gynaecology clinic with a 12 month history of
bloating and intermittent pelvic pain. She is still having regular periods and has no
other medical or surgical history of note.

What is the most important first investigation to perform?

 
MRI pelvis

Diagnostic laparoscopy

Endocervical swabs for chlamydia and gonorrhoea

Endometrial sampling

ultrasound pelvis

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