KMU Past Paper Practice

Question:

A 37-year-old woman with persistent oncogenic HPV infection undergoes colposcopy. A high-grade epithelial lesion is centered near the squamocolumnar junction of the cervix. Which feature best explains the susceptibility of this site to HPV-related neoplasia?

Correct Answer: Actively metaplastic epithelium is susceptible to oncogenic HPV infection

Explanation: The cervical transformation zone contains actively changing metaplastic epithelium, making it particularly vulnerable to persistent high-risk HPV infection and neoplastic transformation.

Question:

A cervical epithelial lesion from a woman with persistent high-risk HPV infection shows continued proliferation despite significant DNA damage. Loss of a tumor-suppressor pathway that normally promotes growth arrest and apoptosis is suspected. Which viral-host interaction best explains this finding?

Correct Answer: E6-mediated loss of p53 tumor-suppressor function

Explanation: High-risk HPV E6 interferes with p53, allowing genetically damaged cells to survive and continue proliferating instead of undergoing normal growth arrest or apoptosis.

Question:

A 35-year-old woman receiving long-term immunosuppressive therapy after organ transplantation has persistent high-risk HPV infection and develops a high-grade cervical epithelial lesion. Which mechanism best explains her increased risk of progression?

Correct Answer: Reduced immune clearance allows persistence of oncogenic HPV

Explanation: Effective immunity helps clear HPV infection. Immunosuppression favors viral persistence, increasing the chance that high-grade precursor lesions will develop and progress.

Question:

During pelvic examination, a woman is found to have a bulky cervical tumor projecting outward from the cervical surface. The mass is irregular, friable and bleeds easily on contact. Which gross growth pattern is being described?

Correct Answer: Exophytic fungating cervical growth

Explanation: An exophytic or fungating cervical carcinoma projects from the surface and is characteristically friable because malignant tissue and its vessels are easily disrupted.

Question:

A 43-year-old woman has a 3-cm visible invasive cervical carcinoma. Imaging shows that the tumor remains confined to the cervix, with no vaginal, parametrial, nodal or distant involvement. Which stage group best describes the disease?

Correct Answer: Stage I

Explanation: Invasive cervical carcinoma confined to the cervix belongs to Stage I; extension beyond the cervix moves the disease into higher stage groups.

Question:

A 29-year-old nulliparous woman is diagnosed with a very early invasive cervical carcinoma that fulfills criteria for conservative treatment. She strongly wishes to preserve fertility. Which management principle is most appropriate?

Correct Answer: Selected fertility-preserving excisional treatment

Explanation: Carefully selected women with very early cervical carcinoma may undergo conservative fertility-preserving treatment when oncological criteria are satisfied.

Question:

A cervical cancer-control program identifies high-grade precursor lesions in asymptomatic women and ensures timely treatment before stromal invasion develops. Which preventive principle best explains how this strategy reduces invasive cancer?

Correct Answer: It interrupts progression during the detectable preinvasive phase

Explanation: Screening works because cervical carcinogenesis commonly includes a detectable precursor phase that can be treated before invasive disease develops.

Question:

A 57-year-old woman undergoes hysterectomy for an endometrial malignancy. Histology shows crowded back-to-back malignant glands with reduced intervening stroma and focal areas of solid epithelial growth. Which tumor is most consistent with this pattern?

Correct Answer: Endometrioid carcinoma

Explanation: Endometrioid carcinoma characteristically forms crowded malignant glands resembling endometrial glands, with increasing solid growth in less differentiated areas.

Question:

A 72-year-old woman has a high-grade papillary endometrial malignancy arising in an atrophic endometrium. The tumor shows marked nuclear atypia and behaves aggressively. Which molecular abnormality is most characteristic of this pathway?

Correct Answer: TP53 pathway abnormality

Explanation: High-grade serous endometrial carcinoma typically develops through an estrogen-independent pathway and characteristically shows TP53 abnormalities.

Question:

A hysterectomy specimen from a 64-year-old woman contains a malignant lesion arising from the endometrial lining. Which gross appearance would be most consistent with a primary endometrial carcinoma?

Correct Answer: Polypoid mass projecting into the uterine cavity

Explanation: Endometrial carcinoma may form a polypoid or exophytic mass projecting into the uterine cavity and can also produce diffuse endometrial thickening.

Question:

A 63-year-old woman has operable endometrial carcinoma confined to the uterus. She has completed childbearing and is medically fit for surgery. Which treatment principle forms the basis of management for localized disease?

Correct Answer: Hysterectomy with bilateral adnexal removal and appropriate staging

Explanation: Surgery is central to treatment of operable localized endometrial carcinoma, with removal of the uterus and both adnexa and appropriate staging assessment.

Question:

Two women have endometrial carcinomas of similar stage. The pathology report of one tumor identifies malignant cells within vascular and lymphatic spaces surrounding the tumor. Which feature in this report is most concerning for an increased risk of spread?

Correct Answer: Lymphovascular invasion

Explanation: Tumor within lymphatic or vascular channels provides a route for regional and distant dissemination and is therefore an unfavorable pathological feature.

Question:

A 70-year-old woman develops recurrent endometrioid endometrial carcinoma after previous treatment. The tumor is considered hormone-responsive, and further surgery is not appropriate. Which broad treatment modality may have a role in this situation?

Correct Answer: Hormonal therapy

Explanation: Hormonal treatment may be useful in selected hormone-responsive advanced or recurrent endometrial carcinomas when appropriate for the clinical setting.

Question:

A 56-year-old woman with a known gastric malignancy is found to have bilateral ovarian masses. Pathological assessment indicates that the ovarian lesions represent secondary deposits rather than a primary ovarian neoplasm. How should these tumors be classified?

Correct Answer: Metastatic ovarian tumors

Explanation: Ovaries can receive metastatic deposits from extra-ovarian primary malignancies; these are classified separately from primary epithelial, germ-cell and stromal tumors.

Question:

A 45-year-old woman undergoes removal of a very large ovarian cystic mass. The external surface is smooth, and the cut surface shows numerous locules filled with thick mucinous material without destructive invasion. Which diagnosis is most likely?

Correct Answer: Mucinous cystadenoma

Explanation: Benign mucinous ovarian tumors can become very large and characteristically form multiloculated cystic masses containing mucinous material.

Question:

Histological examination of an aggressive epithelial ovarian carcinoma shows complex papillary and solid architecture with marked nuclear atypia. Which additional microscopic feature would most strongly support serous differentiation?

Correct Answer: Papillary structures containing psammoma bodies

Explanation: Serous ovarian carcinoma commonly shows complex papillary architecture, marked atypia and may contain laminated calcifications called psammoma bodies.

Question:

An ovarian epithelial malignancy in a 56-year-old woman is being classified histologically. Which microscopic finding would most strongly support a clear-cell carcinoma?

Correct Answer: Clear cytoplasm with characteristic hobnail-type cells

Explanation: Ovarian clear-cell carcinoma characteristically contains tumor cells with clear cytoplasm, and hobnail-type cells may be prominent microscopically.

Question:

A 22-year-old woman has an ovarian germ-cell malignancy containing choriocarcinomatous differentiation. Which serum marker would be most useful for supporting evaluation and follow-up?

Correct Answer: β-hCG

Explanation: Choriocarcinomatous tumor components produce β-hCG, making it useful for assessing and monitoring appropriate ovarian germ-cell malignancies.

Question:

A 67-year-old woman with advanced ovarian carcinoma develops sudden unilateral leg swelling and pain. Doppler assessment confirms a deep venous thrombosis. Which complication of malignancy best explains this event?

Correct Answer: Venous thromboembolism associated with malignancy

Explanation: Advanced malignancy produces a prothrombotic state, increasing the risk of deep venous thrombosis and other venous thromboembolic events.

Question:

A 60-year-old woman undergoes surgical treatment for epithelial ovarian carcinoma and requires postoperative systemic therapy because of the extent of disease. Which chemotherapy principle is most consistent with standard undergraduate management of this malignancy?

Correct Answer: Platinum-based chemotherapy commonly combined with a taxane

Explanation: Platinum-based chemotherapy, commonly combined with a taxane, is a central systemic treatment principle for epithelial ovarian carcinoma when chemotherapy is indicated.