Title GYNE Cervical Cancer July 2025 (FOR DISTRIBUTION).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 2 Cervical Punch Biopsy showed: Score 3. WHAT IS THE HISTOPATHOLOGIC DIAGNOSIS? (0.5 point) (0.5 point) ● Squamous cell carcinoma, keratinizing Transvaginal/Transabdominal ultrasound: The uterus is anteverted measuring 6.5 x 5.5 x 5.4 cm. The cervix is bulky measuring 5.0 x 4.5 x 5.3 cm, with a 3.5 x 3.0 x 3.0 cm heterogenous mass at the anterior cervical lip with moderate flow on color flow mapping. The endometrium is 0.76 cm. The right ovary measures 1.8 x 1.2 cm. The right ovary measures 2.5 x 2.3 cm while the left ovary measures 2.0 x 1.7 cm. There is no free fluid in the cul-de-sac. There is an enlarged node at the left external iliac measuring 2.0 x 1.0 cm. The liver parenchyma seems homogenous. Both renal calyces are not dilated. Abdominopelvic CT scan: Enlarged cervix, neoplastic process is considered. Enlarged enhancing lymph nodes at the left pelvic area, probably metastatic. CXR: Lung fields are clear. Heart is not enlarged. Atherosclerotic aorta. Degenerative osseous changes. Blood tests Urinalysis Hemoglobin 85 Creatinine 71 RBC 48-50
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 3 Hematocrit 30 AST 26 WBC 1-3 RBC 2.63 ALT 21 Epithelial cells moderate WBC 10.79 Mg 0.91 Bacteria few Platelet 462 K 3.8 Mucus moderate Blood type B+ Pregnancy Test: Negative Points Score 4. WHAT IS THE COMPLETE DIAGNOSIS? (1 point) ● Squamous cell carcinoma, cervix, stage IIIC1(r) (0.5 point) ● Anemia (0.25 point) ● G4P4 (4004) (0.25 point) 5. WHAT ADDITIONAL TESTS COULD YOU REQUEST FOR TO SPECIFICALLY CLASSIFY THIS PATIENT BASED ON THE 2020 WHO CLASSIFICATION OF CERVICAL CANCER? (0.5 point) (0.5 point) ● p16 immunostain 6. WHAT IS THE APPROPRIATE MANAGEMENT FOR THIS PATIENT? (1.5 points) (0.5 point each) ● Pelvic radiation therapy concurrent with weekly chemotherapy followed by brachytherapy ● Correction of anemia ● Refer to Gynecologic Oncology 7. IF THE SAME PATIENT TURNED OUT TO BE PREGNANT AT 20 WEEKS AND 5 DAYS AGE OF GESTATION, WHAT DIAGNOSTIC EXAMINATIONS (0.25 each) ● Chest X-ray with abdominal shield ● Whole Abdomen/transvaginal Ultrasound ● MRI without contrast
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 4 WILL YOU REQUEST? (1.25 points) ● CBC, blood typing ● Liver and renal function tests 8. HOW WILL YOU MANAGE THE CASE? (1.25 point) ● Multidisciplinary management and counselling of the patient (0.5 point) ● Neoadjuvant chemotherapy (0.25 point) ● Cesarean/abdominal delivery at 34-36 weeks AOG following antenatal corticosteroids (0.25 point) ● Pelvic radiation therapy concurrent with weekly chemotherapy followed by brachytherapy (0.25 point) 9. WHAT ETHICAL PRINCIPLE CAN BE APPLIED IN THIS SITUATION OF ADMINISTERING NEOADJUVANT CHEMOTHERAPY IN A PREGNANT PATIENT WITH CERVICAL CANCER? (0.5 point) (0.5 point) The principle of double effect 0.5 TOTAL 9