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Free STEP2 Exam Braindumps (page: 32)

Page 32 of 185
PDF with 738 Questions

A63-year-old woman has a 3-cm pruritic lesion on her right labia majora that she has noted for approximately 9 months. She has been treated with various topical creams and ointments for vulvar candidiasis without resolution of her symptoms or lesion. When you examine this woman, the lesion is still present. Which of the following is the most appropriate intervention?

  1. Papanicolaou (Pap) smear of the lesion
  2. colposcopy of the lesion
  3. biopsy of the lesion
  4. wide local excision of the lesion
  5. vulvectomy

Answer(s): C

Explanation:

Vulvar carcinoma must be considered in any postmenopausal woman with pruritus, especially in the presence of a visible lesion. The appropriate management is to biopsy the lesion after disinfecting the area and infiltrating with 1% Xylocaine. A34 mm dermal punch is useful to obtain the biopsy. Colposcopy alone is less reliable for vulvar lesions compared to cervical abnormalities because the technique requires the topical application of 35% acetic acid, which penetrates a keratinized squamous epithelium (the vulva) less than a nonkeratinized squamous epithelium (the cervix). Multiple biopsies should be obtained for a large, confluent lesion or a multifocal vulvar lesion. Wide local excision may be appropriate for small lesions, but is more difficult in an outpatient setting. Vulvectomy is reserved for women with biopsy-proven vulvar carcinoma.



A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.

Which of the following is the stage of her cervical cancer?

  1. IA
  2. IB
  3. IIB
  4. IIIB
  5. IV

Answer(s): D

Explanation:

Cancer of the cervix that has not invaded cervical stroma is stage 0 carcinoma in situ. Cancer that has invaded the cervical stroma but has not spread beyond the cervix is stage I. Involvement of the upper vagina or parametria (but not to the pelvic sidewall) is stage II. Stage III is involvement of the lower third of the vagina (IIIA) or parametria to the pelvic sidewall (IIIB). Extension outside the reproductive tract is stage IV.



A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.

To complete the staging of her cancer according o International Federation of Gynecology and Obstetrics (FIGO) standards, she should have hich of the following?

  1. lymphangiogram
  2. pelvic venogram
  3. cystoscopy
  4. magnetic resonance imaging (MRI) scan f her abdomen
  5. laparoscopy

Answer(s): C

Explanation:

The intent of staging is to judge the results of various treatments and to compare treatment results worldwide. Because advanced procedures such as venography, lymphangiography, MRI or CT scans, and laparoscopy are not universally available, staging of cervical cancer remains primarily clinical. Such tests as cystoscopy, proctosigmoidoscopy, barium enema, IVP, and plain radiographs of the abdomen and chest are permitted. Evidence of mucosal cancer confirmed by biopsy at the time of cystoscopy changes her diagnosis to stage IV cervical cancer.



A 48-year-old woman had a biopsy of a friable, bleeding lesion on her cervix. She had not had a pelvic examination or Pap smear for about 12 years. The biopsy is reported as invasive squamous cell carcinoma of the cervix. On bimanual examination, there is induration to the side wall of her pelvis.

Which of the following is the most important prognostic factor for 5-year survival after appropriate treatment of cervical cancer?

  1. presence of high-risk strains of human papilloma virus (HPV)
  2. stage of the cancer
  3. age of the patient
  4. histologic grade of the tumor
  5. presence of positive regional (pelvic) lymph nodes

Answer(s): B

Explanation:

Stage of the cancer is the most important prognostic factor. Women with stage IA cervical cancer have a 95% 5-year survival. This decreases progressively to 80, 64, 38, and 14% for stages IB, II, III, and IV, respectively. The other choices are prognostic factors but relate to the stage of the cancer. Women with high-risk serotypes (strains) of HPV tend to develop cervical neoplasia at a younger age. More advanced stages of cervical cancer tend to have less differentiated tumors and a greater probability of pelvic and paraaortic lymph node metastasis. Pelvic lymph node metastasis will be found in 5% or fewer of women with stage I cervical cancer, with a progressive increase as the stage advances to 55% of women with stage IV cervical cancer



Page 32 of 185



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Alken commented on January 04, 2025
No comments yet Still watching the pattern of exam
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Allen commented on January 04, 2025
Nice approach
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