Ay yee GYN PRACTICAL EXAM #2 10/25/2017 Case Clinical hx Adequacy Diagnosis 1 | Age 29, LMP day 15, on BCP, hx of abnormal paps ‘Age 68, PM Argo lotsfoctors |Smol. cen Cyranowe of tu. Vier CC Cea 3 Age 38, LMP day 4 4 | Age 55, PM ‘Age 37, LMP day 21 6 | Age 24, regular periods 7 | Age 29, LMP day 13 8 | Age 51,no LMP 9 | Age 38, previous abnormal pap 10 | Age 40, no LMP‘Age 32, regular periods 12 [Age 74, PM 13, | Age 63, PM Abate [ S2ti factory! NILM EC wot pret Foliicular cervicit’s 14 | Age26, regular periods unknown aaJ 15 | Age 67, PM Asequnte (69h frctony Asc-H ; “ode EC wot premut Bacsing Deeg 16 | Age 42, LMP day 25 17 _| Age 18, LMP day 19 Asq vote (satis fretory tstu J EC pot femur apes! wok peru] 18 | Age37, PM 19 | Age 52, PM 20 | Age 31, LMP day 16AVAIUA AIRE yf . y GYN PRACTICAL EXAM #2 7 / Cc - / 10/25/2017 Case Clinical bx Adequacy Diagnosis” 1] Age29, LMP day 15, on BCP, | Mie quste (Sonsfactong [ASC —H gp | Bofabnermal paps A tone [remus Ua inFLavnons ony bey / Cr__| Age 68, PM Sra Seqrte fons Factory Uner tsfoctony . 2 Be to obscuring hice ® + Ce oY 4 ? ‘ngLovavadtion (mostly Woo?) 3 | Age 38, [MP day 4 abe que 7 satisfac AGS, NOS cf Wit blecBing breegvound L(G A 4 | Age 55, PM Ade quote [sobs factory NiLM 4 se EC/EM Wet pres. nae iw fer Saige 5S | Age 37, LMP day 21 Pee qt /srtis fectory NILM ce Te Rone pretest berctive Changer fey [Ee prereme HS infection 6 | Age 24, regular periods Abeque (62k 5 factory LStL. ES prevent wit [MPL muMrfo1y br. ct t eee preus “) 7 | Age 29, LMP day 13 Ab eg ate sehs factory | ILM a ye gone present [mae p= EC premut Squrimous mek PLSid fitient ¢ Age, no LMP A Wegpole abe foconj Angpicat enboceruicrt cli Aa Wetec preset No: 5 te Ha Ping 9 | Age 38, previous abnormal pap. MSequrte /satis actoy, ASC-H d ep €c { Witte inf Came mnfory ba TEM wo prescut | race arom 10 | Age 40, no LMP Abe. ete (64s factor Ay pleat nde Cor Heat ce a 3 Gets, fovor Leo pL asia Witt DLL Bing) b taf Lava Y h Ec presut ground *t 7 SH RP fer chr fAvoplaic 9 find WO grees te be A hawe Cube Crime tuner CHS sobs fr cfovry |— c11 [Age 32, regular periods | Rbequnte /sh% fret EC/EM preume NiLM Enoowedmosis iu the venue Cwox | 12 | Age 74, PM. Aieqvie SPS factory] AC CUS eK cr with some inflow el Ec/Em trot preset pact: ind i J er | Age 63, PM \ Lf Srvis rectory /rdequrte| Suiow ceil Cov cinoma v iS N*t Se] EMK 1 Of Ukwine Cores x equim as ‘Age 26, regular periods Adequate sabi Factory] ECEM wot present NILM Wit Sous Wf Lowen orp ree ground A q Leet ‘Age 67, PM spn ieohepechal Ditsar EY A dove = i bs curing blood rN a“ EM preset EM presut 7 4S ¥/o0 16 | Age 42, [MP day 25 Aoeqak Sak foctong Niem ? ce Trove k EC pieseut | Pory terrtosiz sa Corufloee Ohi fotr presut] a ‘Age 18, LMP day 19 (hreBeginke Laas factory ++ Bue te Sou obscuring) Hh is) | LS cue cmeeeees) es ystl- gery? 18 Age S7.PM Abate Hooks factory be weds gee - oi of EC prs wl Corncits | 4 pat ergible. body wrcre phages preeut = ‘Age 52, PM Abcguvte (o> ts factory | HSIL t bay per Ken tosis ECIEM wet prewat Ste a ‘Age 31, LMP day 16 Agequete (atisfocte SCC with godt WoLlve wie f Ee prose Intolare: Hl be Meno ce —> he nucleoli, tM/y yatio Cina ewpnwcleoti ) Clam bce grind Ine Biottaris / a mets Od In 94, lenous , User, has fer hye wr 9 Ws more Bre in sq. tam gludlyrr colsAvAINAa RIRIE G 4 i a %\ ) 4 7 — (1 / remate Genita tract Exam #2 ¢ ta} OCT. 25, 2017 6 } B/ I. Muiitiple choice question: 3 points each) 1. Atypical cells may present in the Pap smear in which of the following post therapies? Vv a) Electrocautery b) Cryotherapy / LEEP ©) lub @) All of the above 2. Which one of the following invasive neoplasms would have the best prognosis? @ Keratinizing SCC (TINOMO) / 5) Non-keralinizing SCC (T2N2M0) i c) Small cell cancer of the cervix (TIMONO) 4) Keratinizing SCC (T3N3M1) 3. The most common degenerative change in immature metaplastic cells which may be confused with adenocarcinoma is: @) Enlarged nuclei 'b)_Hyperchromasia < /0)_Cytoplasmic vacuoles \- Gy Biphasic eytoplasm ina DES exposed patient, it should be obtained from: a) sformation zone / (6) Lateral vaginal wall (7° Extemal os of cervix d) The labia majora 5. Malignant glandular cells that form strips, sheets, rosettes, and irregular masses tend to originate from: 3 a) Endometrial uf ’b) Endocervical c) Extrauterine a) Ovary 6. Vaginal Actinomyces infections are acquired most commonly through a) Sexual intercourse oft ©) Orogenital contact ©) Unclean bathtubs 4) Contaminated water 7. /Most common metastases from a distant site to a cervical Pap smear are: J a) Ovary, bladder, and pancreas ) Liver, pancreas, and colon ©) Lung, Breast, and ovary @ Ovary, GI tract, and bregst \IL. Scenario east x \. 16, If a fluid specimen cannot be processed immediately upon received, it should be placed in. oJ, a) Freezer (b) Refrigerator c) Incubator d) Ziploc bag 17. The chief complaint from women with uterine tumors is: a) Abdominal pain @ / Abnormal bleeding ©) Enlarged uterus d) Amenorrhea 18, Tumor.suppressor gene, p53, exerts its control on the cell cyele through the activation of (ay 2 (B) plé Hyperchromatic crowded clusters, strips, and sheets of epithelial cells Eecenirie nuclei with smooth nuclear membrane Finely to coarsely granular chromatin and prominent big ni Vacuolated cytoplasm Bloody and inflammatory background ‘These are most consistent with: oli C9) Endocervical adenocarcinoma ~~) “Exodus” and normal endometrial cells ©) Low grade endometrial adenocarcinoma @ Arypical endocervical cells 20. A 75-year-old woman went to the doctor's office for a routine Pap smear. The smear showed the following features: Granular, inflammatory, “blue blobs” background Small orangeophilic cells with pyknotic nuclei —9 Ps 2¥999 Sheets of small cells with oval to elongated, bland nuclei Numerous scattered bare nuclei in the smear ‘The smear probably represented: a) Paget's disease b) Carcinoma-in-sitw ‘> Atrophie vaginitis 4). Small cell squamous carcinomaFinely to coarsely granular, irregular chromatin distribution ‘The most likely diagnosis is: a) Reparative changes b) Carcinoma-in-situ ‘ ¢) Microinvasive carcinoma, Bi @ Non-keratinizing squamous cell carcinoma 25, A 30-year-old woman was seen by her gynecologist who noted that her cervix was inflamed. A Pap smear taken revealed the following: Single and small sheets of cells Nuclei with high N/C ratio Hyperchromatic nuclei, with occasional nucleoli Inflammatory and bloody background ‘The most likely diagnosis is: {a} Squamous cell carcinoma CO HSIL Microinvasive carcinoma @) Carcinoma-in-situ 26. A $5-year-old woman with history of colon cancer 3 years ago consulted her gynecologist for abnormal vaginal bleeding. A Pap smear revealed the following: Tall columnar cells Hyperchromatic, cigar shaped, basally located nuclei Coarse chromatin, large prominent nucleoli Dirty, bloody background ‘The most likely diagnosis is: (2). Endocervical adenocarcinoma 5 Seow oe 2) CO) Metastatic colorectal carcinoma i ec) Ovarian adenocarcinoma d) Clear cell carcinoma of uterus 27. An 80-year-old woman and revealed the following: postmenopausal bleeding. An ecto-endocervical smear was taken Keratin debris, and bloody background Orangeophilic, pleomorphic and bizarre shape cells Single cells and syncytial groups Coarse chromatin with pyknotic nuclei ‘The smear most likely represented: "Dz a) Endocervical adenocarcinoma ~ 6) Small eetl squamous carcinoma ¢c) \Keratinizing squamous cell carcinomaSingle, binucleated and multinucleated cells Single cell arrangement Iil-defined cytoplasmic borders, occasional pigmented cytoplasm Prominent big nucleoli ‘The most likely diagnosis is: }) Malignant melanoma b) Squamous cell carcinoma ¢) Herpes virus infection d) Adenocarcinoma 32. A 58-year-old woman presented to her gynecologist complaining of occasional spotting. A Pap smear revealed the following: Elevated estrogen effect level for a patient of this age . Moderately bloody background t Few groups of normal-appearing endometrial cells Histiocytic-like cells - ‘The most likely diagnosis is: 3 Endocervical polyp 4 Low grade endometrial adenocarcinoma [= Or docervical adenocarcinoma (@) Granulosa cell ovarian tumor 33. A 4l-year-old woman had a routine Pap smear performed which revealed the following features: fowded sheets of markedly atypical cells ort strips of cells with pscudostratified nuclei Occasional rosettes, glandular openings within the crowded sheets Frayed and feathering appearance to the cellar aggregates These changes are most suggestive of: a) Endocervical adenocarcinoma b) Carcinoma-in-situ ¢) Invasive squamous cell carcinoma 3 Adenocarcinoma-in-situ 34. A 67-year-old postmenopausal woman went to her doctor for vaginal spotting. Her Pap smear revealed the following features: Crowded groups of markedly atypical cells Pleomorphie nuclei with hyperchromasia Granular chromatin Bloody and necrotic debris ‘These changes are most suggestive of: Endocervical adenocarcinoma3D, Cr “ar Ceo ore ay " 2 2. Cecyical Endo ptyiosis Pee 2 Coy, PS % Fndome tink ty po Os - Gt Caneel t SoKiD b Cohesive s tight - 3D, CrousBed , over lapping QLadire tt goups ~ less of GALLI pes - Freq veut Shown fetiecs X vaqqed abo OP perce witha protivant nocley : = PoenQoshab hed Cesk chips ret ot Prenat - Heme cidain Gdn Wracve g bages K Ghonat spindle Cant x pret 3, IMiegoqLonBober bape plasx ~ Uniforwy glaBsle ceils wie tirade Or foment Hon - Gt a0 furent | OMe 2D, 3D or Singh - Gu es Seder - Oa toot was Sct, offen yrevolated S Span Heat of ton tone hig pee chrowsatic = Cry be inflawina tory or Use ew, Biathesis Leolk Preseak, Cow be moltiple ~ Mitotic ¥ Woptetc bodier often Prevent