Benign Gynecology Lesions

University:
University of California, San Diego
Course:
BIMM 100 | Molecular Biology
Academic year:

2025
Views:

424

Pages:

7
Author:

Aestherielle Seraphine

1. A 46-year-old with heavy menstrual bleeding has a uterine mass protruding into the cavity. Which myoma type most directly explains profuse bleeding due to endometrial disruption? A. FIGO Type 4 B. FIGO Type 2 C. FIGO Type 6 D. FIGO Type 7 Answer: B Rationale: Type 2 is submucosal with ≥50% intramural component and commonly causes heavy bleeding by disrupting/encroaching on endometrium. 2. A 52-year-old postmenopausal woman reports that her “known fibroid” rapidly enlarged over 3 months. What is the classic concern? A. Adenomyosis B. Leiomyosarcoma C. Nabothian cyst D. Endometrial polyp Answer: B Rationale: Rapid growth of a uterine myoma after menopause is a classic red flag for leiomyosarcoma. 3. A 33-year-old has acute hypogastric pain in pregnancy with a known fibroid. Pain improves with analgesics. Most likely diagnosis? A. Torsion of paratubal cyst B. Red (carneous) degeneration of myoma C. Pyosalpinx D. Ruptured corpus luteum cyst Answer: B Rationale: Red degeneration typically occurs in pregnancy due to vascular compromise within a fibroid and is usually managed conservatively. 4. A 39-year-old with dysmenorrhea and heavy bleeding has a diffusely enlarged, globular uterus. Ultrasound shows heterogeneous myometrium with a fan-shaped echo pattern. Diagnosis? A. Endometrial polyp B. Adenomyosis C. Submucosal myoma D. Nabothian cyst Answer: B Rationale: Fan-shaped echo pattern with heterogeneous thickened myometrium is a hallmark described for adenomyosis. 5. A 28-year-old has intermenstrual bleeding. TVUS after menstruation shows a focal echogenic lesion with a central feeding vessel. Best next step to diagnose and treat? A. Blind curettage only B. Hysteroscopic polypectomy C. Vaginal packing D. Laparoscopy Answer: B Rationale: Hysteroscopy allows direct visualization and complete removal of an endometrial polyp. 6. A cystic cervical lesion is best seen on transvaginal ultrasound, often multiple, and remains asymptomatic even if ≥3 cm. Most likely lesion? A. Gartner duct cyst B. Nabothian cyst C. Bartholin cyst D. Epidermal inclusion cyst Answer: B Rationale: Nabothian cysts are benign cervical retention cysts, often multiple and asymptomatic. 7. A Pap smear report states “inflammation present; no signs of malignancy.” The cervix has small translucent cysts. Best management? A. Immediate excision B. Antibiotics for 14 days C. Observation and routine screening D. Cryotherapy Answer: C Rationale: Nabothian cysts are benign; reassure if Pap smear is normal and continue routine screening. 8. A 50-year-old presents with a new 3-cm non-tender labial mass. Best management? A. Marsupialization B. Incision and drainage C. Excision to rule out malignancy D. Observation only Answer: C Rationale: New Bartholin-area masses in women >40 should be excised to exclude malignancy. 9. A 26-year-old has a fluctuant vulvar mass at the 7–8 o’clock position of the vaginal opening. It is painless and small. Best management? A. Broad-spectrum antibiotics B. Marsupialization C. Observation D. Hysterectomy Answer: C Rationale: Small asymptomatic Bartholin cysts can be observed. 10.A 29-year-old has a painful, erythematous vulvar swelling at 4–5 o’clock with fever. Next best step? A. Observation only B. Incision/drainage plus culture; antibiotics C. Polypectomy D. Topical estrogen Answer: B Rationale: Bartholin abscess requires drainage; culture may be obtained and antibiotics given when infected/systemic signs. 11.A benign vulvar solid mass is smooth, pedunculated, firm, and arises from labia majora. Diagnosis? A. Lipoma B. Fibroma C. Epidermal inclusion cyst D. Urethral caruncle Answer: B Rationale: Vulvar fibroma is a firm, often pedunculated benign lesion from labia majora. 12.A vulvar mass feels soft and compressible and arises from subcutaneous tissue of labia majora. Diagnosis? A. Fibroma B. Lipoma C. Myoma D. Bartholin cyst Answer: B Rationale: Lipomas are composed of adipose tissue and feel softer than fibromas. 13.A postmenopausal woman has a small, red, fleshy lesion at the posterior urethral meatus with dysuria. Most appropriate initial management? A. Topical estrogen B. Hysteroscopic resection C. Marsupialization D. Salpingectomy Answer: A Rationale: Urethral caruncle is associated with hypoestrogenism; topical estrogen is first-line. 14.A pediatric patient has a circumferential “donut-shaped” protrusion at the urethral opening. Most likely diagnosis? A. Urethral caruncle B. Urethral prolapse C. Cervical polyp D. Nabothian cyst Answer: B Rationale: In children, a circumferential protrusion is more consistent with urethral prolapse than caruncle. 15.A vaginal cyst in the upper half of the vagina is thin-walled and asymptomatic. It is a remnant of the mesonephric duct. Diagnosis? A. Mullerian cyst B. Gartner duct cyst C. Inclusion cyst D. Bartholin cyst Answer: B Rationale: Gartner duct cyst is a mesonephric (Wolffian) duct remnant. 16.A vaginal cyst is a remnant of the paramesonephric duct. Diagnosis? A. Gartner duct cyst B. Mullerian cyst C. Vestibular cyst D. Endometrial cyst Answer: B Rationale: Mullerian cyst arises from paramesonephric remnants. 17.A vaginal cyst in the lower third, posterior/lateral wall, occurs after repeated episiotomy. Pathogenesis? A. Persistence of mesonephric duct B. Invagination of vaginal mucosa during healing C. Obstruction of Bartholin duct D. Coelomic metaplasia Answer: B Rationale: Vaginal inclusion cysts form when epithelium is trapped beneath the surface after trauma/surgery. 18.A cervical polyp most commonly presents with: A. Amenorrhea B. Postcoital or intermenstrual bleeding C. Severe pelvic pain only during menses D. Acute abdomen Answer: B Rationale: Cervical polyps often cause bleeding (intermenstrual, postcoital, prolonged menses). 19.A long, narrow pedunculated polyp protruding through the external os in a reproductive-age woman is most likely: A. Cervical (ectocervical) polyp B. Endocervical polyp C. Nabothian cyst D. Urethral caruncle Answer: B Rationale: Endocervical polyps arise from the canal, tend to have long pedicles, and may prolapse through the os. 20.A short, broad-based polyp arising from the ectocervix is more common in: A. Adolescents B. Reproductive-age women C. Postmenopausal women D. Pregnant women only Answer: C Rationale: Cervical (ectocervical) polyps are described as more common among postmenopausal women. 21.A patient develops significant bleeding after polypectomy. Next best immediate management? A. Hysterectomy B. Vaginal packing C. GnRH injection D. Marsupialization Answer: B Rationale: Vaginal packing can manage significant bleeding after polypectomy. 22.Uterine myoma types 5–7 are primarily: A. Submucosal B. Intramural C. Subserosal D. Cervical Answer: C Rationale: FIGO types 5–7 are subserosal lesions. 23.A hybrid myoma labeled “2–5” means: A. Two separate myomas B. A myoma affecting endometrium (type 2) and serosa (type 5) C. A myoma only in cervix D. A myoma that cannot be classified Answer: B Rationale: By convention, first number is relationship to endometrium; second to serosa. 24.Saline infusion sonohysterography is most useful to: A. Distinguish dermoid cyst from serous cystadenoma B. Differentiate type 0 from types 1–2 submucosal myomas C. Confirm Nabothian cyst D. Diagnose urethral caruncle Answer: B Rationale: Saline outlines the uterine cavity, delineating intracavitary protruding lesions. 25.A fallopian tube appears as an elongated tubulocystic structure with anechoic fluid and incomplete septa from mucosal infolding. Diagnosis? A. Paratubal cyst B. Hydrosalpinx C. Dermoid cyst D. Nabothian cyst Answer: B Rationale: Hydrosalpinx shows dilated tube with infolding mimicking septa. 26.Which tubal lesion is most associated with systemic signs of infection even if small? A. Hematosalpinx B. Hydrosalpinx C. Pyosalpinx D. Paratubal cyst Answer: C Rationale: Pyosalpinx contains purulent material and is tied to PID with fever and toxicity. 27.A simple unilocular cyst adjacent to the fallopian tube, usually <3 cm, discovered incidentally. Best management? A. Immediate laparotomy B. Observation C. Broad-spectrum antibiotics D. Hysteroscopic resection Answer: B Rationale: Small asymptomatic paratubal cysts are monitored. 28.An ovarian tumor is solid, movable, non-tender, well-circumscribed, with minimal color flow, and has urothelial-like epithelium. Diagnosis? A. Brenner tumor B. Thecoma C. Fibroma D. Mature teratoma Answer: A Rationale: Brenner tumor contains transitional-type epithelium and is typically benign with minimal flow. 29.Triad of benign solid ovarian tumor + ascites + pleural effusion that resolves after excision describes: A. PCOS B. Meigs syndrome C. PID D. Ovarian torsion Answer: B Rationale: Meigs syndrome is classically fibroma with ascites and hydrothorax resolving after removal. 30.A postmenopausal woman has abnormal uterine bleeding and an ovarian tumor composed of estrogen-producing cells. Diagnosis? A. Thecoma B. Brenner tumor C. Dermoid cyst D. Serous cystadenoma Answer: A Rationale: Thecoma can cause hyperestrogenism leading to endometrial proliferation and bleeding. 31.An ovarian cyst with ground-glass homogeneous echoes on ultrasound and chocolate-colored contents grossly is: A. Serous cystadenoma B. Mucinous cystadenoma C. Endometriotic cyst (endometrial cyst) D. Follicle cyst Answer: C Rationale: Endometriotic cysts classically show a ground-glass echo pattern. 32.A complex ovarian cyst containing hair and sebaceous material; malignant transformation tends to arise in the Rokitansky nodule. Diagnosis? A. Mature cystic teratoma B. Theca lutein cyst C. Corpus luteum cyst D. Paratubal cyst Answer: A Rationale: Dermoid (mature teratoma) can contain hair/teeth; Rokitansky nodule is the solid projection. 33.A multilocular ovarian cyst with gelatinous contents and coarse internal echoes is most consistent with: A. Serous cystadenoma B. Mucinous cystadenoma C. Follicle cyst D. Nabothian cyst Answer: B Rationale: Mucinous cystadenoma is often multilocular with thick mucin producing internal echoes. 34.A pregnant patient at 8 weeks has an ovarian cyst with “ring-of-fire” vascularity on Doppler. Best management? A. Immediate excision B. Observe; repeat ultrasound at 14–16 weeks C. Hysteroscopic resection D. Salpingectomy Answer: B Rationale: Corpus luteum supports early pregnancy; follow-up imaging is recommended to confirm regression. 35.Bilateral multilocular cystic ovaries in a patient with very high β-hCG due to molar pregnancy suggests: A. Dermoid cysts B. Theca lutein cysts C. Endometriotic cysts D. Brenner tumors Answer: B Rationale: Theca lutein cysts are associated with high β-hCG states and usually regress when β-hCG declines. If you want, I can also generate a second set of 20 “consultant grilling” viva questions based on the same lesions (rapid-fire, one-line answers).