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

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

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

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

  
  
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  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

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

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

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  a) Cyclophosphamide is the most cytotoxic agent for gonads

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

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

  
  
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  d) Abdominal radiation is less toxic than chemotherapy.

  
  
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  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?

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  a) embryo cryopreservation

  
  
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  b) ovarian stimulation with oocyte cryopreservation

  
  
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  c) ovarian cortical fragments cryopreservation

  
  
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  d) whole ovary cryopreservation

  
  
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  e) in vitro maturation

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

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  a) embryo cryopreservation

  
  
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  b) ovarian stimulation with oocyte cryopreservation

  
  
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  c) ovarian cortical fragments cryopreservation

  
  
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  d) whole ovary cryopreservation

  
  
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  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:

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

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

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

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

  
  
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  e) whole ovary transplantation has the highest success rate.

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

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

  
  
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  b) Chemotherapy is best avoided after 35 weeks of pregnancy

  
  
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  c) Dosages of chemotherapy should be higher during pregnancy

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

  
  
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  e) The placenta is a barrier that protects the fetus

Concerning surgery during pregnancy, the following statements are true:

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

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

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

  
  
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  d) Laparoscopy should be avoided during pregnancy.

  
  
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  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:

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

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

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

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

  
  
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  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:

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

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

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

  
  
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  d) CIN tends to progress more rapidly during pregnancy

  
  
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  e) Conisation is preferably performed in the third trimester

The following is/are true concerning Doxorubicin and amenorrhea:

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  a) Amenorrhoea is more likely in reduced doses

  
  
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  b) Doxorubicin based chemotherapy causes amenorrhea in almost 60%

  
  
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  c) Amenorrhoea is more likely with added fluorouracil and cyclophosphamide

  
  
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  d) Is less likely in young patients

  
  
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  e) Amenorrhoea in older women is usually permanent

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

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  a) Temporary amenorrhea

  
  
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  b) Permanent amenorrhea

  
  
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  c) Menorrhagia

  
  
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  d) Irreversible anovulation

  
  
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  e) Hot flushes and night sweats

Aromatase inhibitors induce:

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  a) multiple ovulations

  
  
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  b) one ovulation

  
  
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  c) permanent amenorrhea

  
  
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  d) anovulatory cycles

  
  
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  e) irreversible anovulation

Tamoxifen therapy:

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

  
  
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  b) is never used with GnRH analogues

  
  
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  c) should be continued for 2 years

  
  
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  d) may induce hot flushes

  
  
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  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:

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

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

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

  
  
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  d) Radiotherapy is always to be avoided during pregnancy

  
  
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  e) Iodinated and gadolinium contrast media can safely be used

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

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  a) Epithelial endometrioid

  
  
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  b) Germ cell tumors

  
  
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  c) Clear cell carcinoma

  
  
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  d) Granulosa cell tumors

  
  
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  e) Theca-stroma cell tumors

Common genetic alterations in endometriosis and ovarian cancer include:

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  a) Over-expression of the Bcl gene

  
  
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  b) Decreased expression of the Bax gene

  
  
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  c) Over-expression of the Bax gene

  
  
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  d) PTEN inactivating mutations

  
  
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  e) P53 inactivating mutations

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

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  a) Multiparous women

  
  
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  b) Women over the age of 40

  
  
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  c) Women with severe (stage IV) endometriosis

  
  
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  d) Women that had fertility treatments and conceived.

  
  
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  e) Women who received treatment with GnRH analogues

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

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  a) A strong family history of breast cancer

  
  
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  b) Mucinous tumours

  
  
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  c) High stage

  
  
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  d) Poor response to platinum chemotherapy

  
  
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  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:

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  a) Prophylactic oophorectomy totally removes cancer risk

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

  
  
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  c) Following prophylactic oophorectomy, HRT is contraindicated

  
  
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  d) Ovarian screening should be performed yearly with TVUS

  
  
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  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:

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

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

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

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

  
  
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  e) Individuals with variants of unknown significance should have PBSO

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

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  a) Amsterdam positive family history

  
  
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  b) Synchronous colon and endometrial cancer

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

  
  
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  d) Synchronous endometrial and ovarian cancer

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

The following are components of the metabolic syndrome:

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  a) Hyperinsulinaemia

  
  
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  b) Hypertension

  
  
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  c) High high-density lipoprotein cholesterol

  
  
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  d) Hyperglycaemia

  
  
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  e) Breast Cancer

Polycystic ovary syndrome:

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

  
  
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  b) the combination of anovulation and high testosterone is diagnostic

  
  
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  c) affects about 20% of the general population

  
  
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  d) always result in obesity, hirsuitism and infertility

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

Hyperandrogenaemia:

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  a) is the result of adrenal tumours in most cases

  
  
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  b) can result in increased oestrogen production through peripheral aromatisation

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

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

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

Breast cancer:

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  a) is more common in women with type II diabetes

  
  
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  b) has been confirmed to be associated with polycystic ovaries

  
  
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  c) in premenopausal women has been linked with obesity

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

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

Ovarian cancer relative risk:

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

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

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

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

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

Endometrial cancer relative risk:

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

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

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

  
  
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  d) It is similar between the different histological types

  
  
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  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:

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  a) Shorter duration of treatment

  
  
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  b) Enabling oocyte retrieval at any time of the cycle

  
  
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  c) Eliminating the need for medication

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

  
  
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  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:

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  a) In vitro maturation

  
  
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  b) In vitro fertilization

  
  
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  c) Oocyte vitrification

  
  
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  d) Embryo vitrification

  
  
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  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:

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

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

  
  
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  c) Oocyte vitrification provides higher pregnancy rates than slow freezing

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

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