The following statement(s) is/are correct concerning ovarian tissue cryopreservation and transplantation:

• a) Ovarian tissue cryopreservation is the only current option for fertility preservation in children.

• b) Heterotopic transplantation may be indicated if the pelvis is not suitable for transplantation due to previous radiation or severe scar formation

• c) Cryopreservation of intact human ovary with its vascular pedicle is an effective means of fertility preservation in humans

• d) Animal studies have demonstrated that GnRH agonist treatment does not prevent primordial follicle depletion after the xenografting of ovarian tissue with or without gonadotropin stimulation

• e) The risk of ovarian metastasis is classified high in patients with leukemia.

The following statement(s) is/are true about gonadotoxicity:

• a) Cyclophosphamide is the most cytotoxic agent for gonads

• b) Procarbazine is a chemotherapeutic agent that does not cause premature ovarian failure (POF).

• c) Methotrexate is considered to be low risk for gonadal dysfunction.

• d) Abdominal radiation is less toxic than chemotherapy.

• e) Bone marrow transplantation is the treatment posing the greatest risk of POF.

Which fertility preservation option could be proposed to a 6-year-old girl diagnosed with thalassemia major, prior to bone marrow transplantation?

• a) embryo cryopreservation

• b) ovarian stimulation with oocyte cryopreservation

• c) ovarian cortical fragments cryopreservation

• d) whole ovary cryopreservation

• e) in vitro maturation

Which fertility preservation option could be proposed to a 22-year-old woman diagnosed with leukemia, prior to chemotherapy?

• a) embryo cryopreservation

• b) ovarian stimulation with oocyte cryopreservation

• c) ovarian cortical fragments cryopreservation

• d) whole ovary cryopreservation

• e) in vitro maturation

In case of premature ovarian failure (POF) in a patient with stored ovarian tissue who wishes to undergo ovarian tissue transplantation:

• a) ovarian tissue transplantation is not a safe option after Hodgkins lymphoma.

• b) orthotopic ovarian fragment transplantation is the most effective way to restore fertility.

• c) heterotopic transplantation may restore endocrine function, but not natural fertility.

• d) ovarian fragment transplantation can be proposed if the patient is cured of leukemia.

• e) whole ovary transplantation has the highest success rate.

Concerning the administration of chemotherapy, the following statement(s) is/are true:

• a) All cytotoxic drugs can be used after the first trimester of pregnancy

• b) Chemotherapy is best avoided after 35 weeks of pregnancy

• c) Dosages of chemotherapy should be higher during pregnancy

• d) Administration of chemotherapy during the second or third trimester increases the incidence of congenital malformations

• e) The placenta is a barrier that protects the fetus

Concerning surgery during pregnancy, the following statements are true:

• a) Pregnant patients should be positioned in left lateral tilt.

• b) Pregnant women have an increased risk of post-surgery thrombosis.

• c) Pregnant women should not have strong painkillers post-surgery.

• d) Laparoscopy should be avoided during pregnancy.

• e) The preferred timing for surgery in pregnancy is the second trimester.

Concerning the impact of chemotherapy on the fetus /neonate / child, the following statement(s) is/are true:

• a) Chemotherapy during the second and third trimesters of pregnancy alters the development and neurological, psychological performance of the children

• b) Anthracyclines administered during pregnancy affect fetal and neonatal cardiac development

• c) Chemotherapy during the second and third trimester does not increase the rate of fetal malformations during the pregnancy

• d) Postnatal pancytopenia may occur after administration of chemotherapy during pregnancy

• e) The birth weight is lower when the children have been exposed to chemotherapy during pregnancy

Concerning pre-invasive lesions of the cervix during pregnancy, the following statement(s) is/are true:

• a) The incidence of pre-invasive lesions during pregnancy are extremely rare

• b) The diagnosis of pre-invasive lesions by colposcopy and cytology is more difficult during pregnancy

• c) Biopsy of the cervix should be avoided because of the high risk of bleeding and miscarriage

• d) CIN tends to progress more rapidly during pregnancy

• e) Conisation is preferably performed in the third trimester

The following is/are true concerning Doxorubicin and amenorrhea:

• a) Amenorrhoea is more likely in reduced doses

• b) Doxorubicin based chemotherapy causes amenorrhea in almost 60%

• c) Amenorrhoea is more likely with added fluorouracil and cyclophosphamide

• d) Is less likely in young patients

• e) Amenorrhoea in older women is usually permanent

In women younger than 35 years, chemotherapy is likely to induce:

• a) Temporary amenorrhea

• b) Permanent amenorrhea

• c) Menorrhagia

• d) Irreversible anovulation

• e) Hot flushes and night sweats

Aromatase inhibitors induce:

• a) multiple ovulations

• b) one ovulation

• c) permanent amenorrhea

• d) anovulatory cycles

• e) irreversible anovulation

Tamoxifen therapy:

• a) is used when estrogen receptors (ER) and progesterone receptors (PR) are negative

• b) is never used with GnRH analogues

• c) should be continued for 2 years

• d) may induce hot flushes

• e) is safe for the embryo if a pregnancy occurs

Concerning the use of ionizing radiation during pregnancy, the following statement(s) is/are true:

• a) Diagnostic procedures with an associated radiation dose of less than 100 mSv cause no direct measurable harmful effects.

• b) The ALARA principle means that all radiation doses should be avoided.

• c) Standard guidelines exist on the performance and acquisition parameters for diagnostic procedures in pregnant patients

• d) Radiotherapy is always to be avoided during pregnancy

• e) Iodinated and gadolinium contrast media can safely be used

Which of the following tumour types are associated with endometriosis associated ovarian cancer?

• a) Epithelial endometrioid

• b) Germ cell tumors

• c) Clear cell carcinoma

• d) Granulosa cell tumors

• e) Theca-stroma cell tumors

Common genetic alterations in endometriosis and ovarian cancer include:

• a) Over-expression of the Bcl gene

• b) Decreased expression of the Bax gene

• c) Over-expression of the Bax gene

• d) PTEN inactivating mutations

• e) P53 inactivating mutations

The risk for subsequent development of breast cancer in women with endometriosis is increased in:

• a) Multiparous women

• b) Women over the age of 40

• c) Women with severe (stage IV) endometriosis

• d) Women that had fertility treatments and conceived.

• e) Women who received treatment with GnRH analogues

Ovarian cancers in germline mutation BRCA1 carriers are commonly associated with:

• a) A strong family history of breast cancer

• b) Mucinous tumours

• c) High stage

• d) Poor response to platinum chemotherapy

• e) Family history of male breast cancer

With regards to management of women with a BRCA1 or BRCA2 mutation, which of the following statement(s) is/are true:

• a) Prophylactic oophorectomy totally removes cancer risk

• b) Prophylactic oophorectomy reduces breast cancer risk in all carriers by 50%

• c) Following prophylactic oophorectomy, HRT is contraindicated

• d) Ovarian screening should be performed yearly with TVUS

• e) Breast screening should be carried out in accordance with the National Breast screening programme

The following statement(s) regarding ovarian cancer susceptibility genes is/are true:

• a) Direct sequencing is used to detect all mutations in BRCA1 and BRCA2

• b) Pathogenic mutations in BRCA1 and BRCA2 are mainly protein truncating mutations

• c) Mutation analysis should be performed in families with a 20% chance of detecting mutation

• d) Mutation analysis is only undertaken on individuals affected with cancer

• e) Individuals with variants of unknown significance should have PBSO

The following are strong predictors (>20%) of germline mutation in the MMR gene:

• a) Amsterdam positive family history

• b) Synchronous colon and endometrial cancer

• c) Early onset endometrial cancer in a woman with no family history of LS cancers.

• d) Synchronous endometrial and ovarian cancer

• e) MSI in a colon tumour from an individual with FH colon cancer

The following are components of the metabolic syndrome:

• a) Hyperinsulinaemia

• b) Hypertension

• c) High high-density lipoprotein cholesterol

• d) Hyperglycaemia

• e) Breast Cancer

Polycystic ovary syndrome:

• a) can be diagnosed by the presence of polycystic ovarian appearances on ultrasound alone.

• b) the combination of anovulation and high testosterone is diagnostic

• c) affects about 20% of the general population

• d) always result in obesity, hirsuitism and infertility

• e) when resulting in prolonged amenorrhoea increases the risk of endometrial cancer.

Hyperandrogenaemia:

• a) is the result of adrenal tumours in most cases

• b) can result in increased oestrogen production through peripheral aromatisation

• c) has been associated with an increased risk of endometrial cancer in human epidemiological studies.

• d) can be suspected when the sex hormone binding globulin concentration is reduced, despite androgen concentration being normal.

• e) increases the risk of breast cancer by direct proliferative action on the mammary epithelium

Breast cancer:

• a) is more common in women with type II diabetes

• b) has been confirmed to be associated with polycystic ovaries

• c) in premenopausal women has been linked with obesity

• d) has been associated with hyperinsulinaemia which can induce increased ovarian testosterone production

• e) is more common in women with increased ovarian testosterone production

Ovarian cancer relative risk:

• a) Decreases by 20% for each 5 years of oral contraceptive use

• b) Women with genetic predisposition to ovarian cancer development do not have any beneficial effect from oral contraceptive use

• c) It is almost 50% for 15 years of oral contraceptive use

• d) Remains stable at its reduced levels irrespective of the time passed from oral contraceptive last use

• e) Is similar between the different histological types of tumours after oral contraceptives use

Endometrial cancer relative risk:

• a) Decreases by 50% for 4 years of oral contraceptive use and by 70% for 12 years of use

• b) Begins to rise from its reduced levels after ceasing oral contraceptive use

• c) A significant beneficial effect remains a long time after ceasing

• d) It is similar between the different histological types

• e) Begins to decrease with the onset of oral contraceptive use

Which of the below can be considered as advantages of IVM over IVF for fertility preservation in cancer patients:

• a) Shorter duration of treatment

• b) Enabling oocyte retrieval at any time of the cycle

• c) Eliminating the need for medication

• d) Avoiding the increase in estrogen levels in patients with estrogen sensitive tumors

• e) A reduced risk of metastases

Based on currently available data, which treatment below is associated with a higher incidence of congenital abnormalities in children:

• a) In vitro maturation

• b) In vitro fertilization

• c) Oocyte vitrification

• d) Embryo vitrification

• e) The incidence of congenital abnormalities is not increased following the above treatments.

Which of the following statement(s) is/are true for cryopreservation of human oocytes and embryos:

• a) Slow freezing is associated with lower survival rates for oocytes

• b) Vitrification has a higher cryo-survival rate for human embryos

• c) Oocyte vitrification provides higher pregnancy rates than slow freezing

• d) Current data demonstrates a trend towards increased pregnancy rates following vitrification of embryos as compared with slow freezing

• e) Improvements in pregnancy rates with vitrification vs slow freezing are statistically significant