SPEX Obstetrics and Gynecology 5 — Questions and Answers
Question 1: A 40-year-old woman with stage IIIC endometrial cancer (papillary serous histology) is status post-hysterectomy. What adjuvant therapy is most appropriate?
- Vaginal brachytherapy alone
- Observation only
- Chemotherapy plus external beam radiation (Correct answer)
- Progestins alone
Correct answer: Chemotherapy plus external beam radiation
High-risk endometrial cancer (papillary serous, stage IIIC) requires combination chemotherapy (carboplatin/paclitaxel) and radiation therapy to address both systemic and locoregional disease.
Question 2: A 17-year-old presents with cyclic pelvic pain, a normal pelvic exam, and MRI showing a hematocolpos with absent vaginal lumen. What is the diagnosis?
- Imperforate hymen
- Transverse vaginal septum (Correct answer)
- Labial fusion
- Müllerian agenesis
Correct answer: Transverse vaginal septum
A transverse vaginal septum causes outflow obstruction with hematocolpos; unlike imperforate hymen, the external genitalia appear normal and the obstruction is at a higher level.
Question 3: A 29-year-old with known endometriosis has a right ovarian cyst measuring 5 cm with 'ground glass' echotexture on ultrasound. CA-125 is 45 U/mL. What is the most appropriate management?
- Immediate laparotomy
- Oral contraceptives and repeat ultrasound in 6 weeks
- Laparoscopic cystectomy (Correct answer)
- GnRH agonist therapy for 6 months then reassess
Correct answer: Laparoscopic cystectomy
An endometrioma ≥4 cm in a patient planning fertility or with symptoms should be managed with laparoscopic cystectomy, which is superior to drainage or aspiration.
Question 4: A patient at 26 weeks is diagnosed with a cervical length of 1.8 cm on transvaginal ultrasound and has a prior preterm birth. Which intervention has the strongest evidence for reducing recurrent preterm birth?
- Oral progesterone
- Cerclage placement
- Vaginal progesterone (Correct answer)
- Activity restriction
Correct answer: Vaginal progesterone
Vaginal progesterone is recommended for asymptomatic women with a short cervix (≤25 mm) on ultrasound to reduce the risk of preterm birth.
Question 5: Which HPV genotype combination accounts for the majority of cervical cancer cases?
- HPV 6 and 11
- HPV 16 and 18 (Correct answer)
- HPV 31 and 33
- HPV 45 and 52
Correct answer: HPV 16 and 18
HPV 16 and 18 together cause approximately 70% of all cervical cancers, with HPV 16 being more associated with squamous cell carcinoma and HPV 18 with adenocarcinoma.
Question 6: A 34-year-old presents 6 weeks postpartum with persistent sadness, inability to care for her newborn, insomnia, and thoughts of harming herself. What is the diagnosis?
- Postpartum blues
- Postpartum depression (Correct answer)
- Postpartum psychosis
- Adjustment disorder
Correct answer: Postpartum depression
Postpartum depression presents beyond 2 weeks postpartum with depressive symptoms impacting function; suicidal ideation requires urgent evaluation and treatment with SSRIs ± therapy.
Question 7: A 62-year-old with vulvar squamous cell carcinoma has a 2.5 cm lesion confined to the vulva with 6 mm stromal invasion and no groin lymphadenopathy. What is the appropriate surgical management?
- Simple vulvectomy alone
- Radical wide local excision with bilateral inguinofemoral lymph node dissection
- Radical wide local excision with ipsilateral sentinel lymph node biopsy (Correct answer)
- Radiation therapy without surgery
Correct answer: Radical wide local excision with ipsilateral sentinel lymph node biopsy
For vulvar cancers with >1 mm invasion, radical excision is required; sentinel lymph node biopsy (ipsilateral for lateralized lesions) has replaced full groin dissection to reduce morbidity.
SPEX Obstetrics and Gynecology 5
A 40-year-old woman with stage IIIC endometrial cancer (papillary serous histology) is status post-hysterectomy.
What adjuvant therapy is most appropriate?