[GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
**Question 1.** A 58‑year‑old woman presents with abdominal distension and a CA‑125 of
420 U/mL. Which imaging modality provides the most accurate assessment of peritoneal
disease extent for planning cytoreductive surgery?
A) Transvaginal ultrasound
B) Contrast‑enhanced CT abdomen/pelvis
C) PET/CT with FDG
D) MRI with diffusion‑weighted imaging
Answer: B
Explanation: Contrast‑enhanced CT is the standard pre‑operative study for ovarian cancer; it
best delineates peritoneal implants, ascites, and lymphadenopathy, guiding debulking strategy.
**Question 2.** Which of the following is the most appropriate pre‑operative cardiac
assessment for a 72‑year‑old patient with hypertension, diabetes, and an upcoming radical
hysterectomy?
A) Routine ECG only
B) Stress echocardiography
C) Coronary CT angiography
D) No cardiac testing needed if asymptomatic
Answer: B
Explanation: Stress echocardiography evaluates functional cardiac reserve and ischemia risk in
high‑risk patients undergoing major surgery, guiding peri‑operative management.
**Question 3.** A 32‑year‑old with stage IA endometrial cancer wishes fertility preservation.
Which regimen is considered standard for this scenario?
A) High‑dose progestin therapy (medroxyprogesterone acetate)
B) Immediate radical hysterectomy
C) Lymphadenectomy only
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
D) Observation without treatment
Answer: A
Explanation: High‑dose progestin therapy can induce regression in early, low‑grade endometrial
cancer, allowing future fertility while preserving the uterus.
**Question 4.** Which tumor marker is most specific for dysgerminoma, aiding in differential
diagnosis of an ovarian mass in a 20‑year‑old?
A) CA‑125
B) AFP
C) β‑hCG
D) LDH
Answer: D
Explanation: Elevated serum LDH is characteristic of dysgerminoma, whereas AFP and β‑hCG are
associated with non‑seminomatous germ cell tumors.
**Question 5.** In peri‑operative VTE prophylaxis for gynecologic oncology patients undergoing
major abdominal surgery, which regimen is recommended?
A) Low‑dose aspirin alone
B) Unfractionated heparin 5000 U subcutaneously q12h for 7 days
C) Warfarin started on postoperative day 1
D) No prophylaxis if ambulating early
Answer: B
Explanation: Subcutaneous unfractionated heparin (or low‑molecular‑weight heparin)
administered post‑operatively reduces VTE risk; aspirin alone is insufficient for high‑risk cancer
patients.
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
**Question 6.** During a radical hysterectomy, which nerve‑sparing technique reduces
postoperative bladder dysfunction?
A) Preservation of the hypogastric plexus
B) Transection of the uterosacral ligaments
C) Ligation of the uterine artery at its origin
D) Removal of the pelvic splanchnic nerves
Answer: A
Explanation: Preserving the hypogastric plexus maintains autonomic innervation to the bladder,
decreasing postoperative voiding dysfunction.
**Question 7.** Which of the following best describes the anatomic boundaries of the pelvic
sidewall lymphadenectomy?
A) From the external iliac vessels to the obturator nerve
B) From the obturator nerve to the sacral promontory, including common iliac nodes
C) Only the superficial inguinal nodes
D) Para‑aortic nodes up to the left renal vein
Answer: B
Explanation: Pelvic sidewall lymphadenectomy typically includes nodes from the obturator
space to the sacral promontory, encompassing external, internal, and common iliac nodes.
**Question 8.** In cytoreductive surgery for ovarian cancer, which organ resection is most
commonly required to achieve optimal debulking when disease involves the diaphragm?
A) Splenectomy
B) Partial diaphragmatic stripping
C) Hepatic wedge resection
D) Pancreatic tail resection
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
Answer: B
Explanation: Diaphragmatic stripping removes tumor implants on the peritoneal surface of the
diaphragm and is frequently needed for optimal cytoreduction.
**Question 9.** A patient undergoing debulking has an intra‑operative ureteral injury identified
intra‑operatively. What is the most appropriate immediate management?
A) Place a ureteral stent and complete the case
B) Perform ureteroureterostomy if injury is in the mid‑ureter
C) Nephrostomy tube placement only after surgery
D) Observation, as most injuries heal spontaneously
Answer: B
Explanation: Immediate repair, such as ureteroureterostomy for mid‑ureter injuries, prevents
postoperative complications; stenting alone may be insufficient for transection.
**Question 10.** Which of the following postoperative complications is most likely to present
with fever, tachycardia, and an elevated white count on postoperative day 3 after a radical
hysterectomy?
A) Pulmonary embolism
B) Anastomotic leak
C) Deep vein thrombosis
D) Urinary tract infection
Answer: B
Explanation: Anastomotic leaks often present early with systemic inflammatory response; fever,
tachycardia, and leukocytosis are classic signs.
**Question 11.** In the ERAS protocol for gynecologic oncology, which of the following is
recommended to reduce postoperative ileus?
Certification Exam Preparation
**Question 1.** A 58‑year‑old woman presents with abdominal distension and a CA‑125 of
420 U/mL. Which imaging modality provides the most accurate assessment of peritoneal
disease extent for planning cytoreductive surgery?
A) Transvaginal ultrasound
B) Contrast‑enhanced CT abdomen/pelvis
C) PET/CT with FDG
D) MRI with diffusion‑weighted imaging
Answer: B
Explanation: Contrast‑enhanced CT is the standard pre‑operative study for ovarian cancer; it
best delineates peritoneal implants, ascites, and lymphadenopathy, guiding debulking strategy.
**Question 2.** Which of the following is the most appropriate pre‑operative cardiac
assessment for a 72‑year‑old patient with hypertension, diabetes, and an upcoming radical
hysterectomy?
A) Routine ECG only
B) Stress echocardiography
C) Coronary CT angiography
D) No cardiac testing needed if asymptomatic
Answer: B
Explanation: Stress echocardiography evaluates functional cardiac reserve and ischemia risk in
high‑risk patients undergoing major surgery, guiding peri‑operative management.
**Question 3.** A 32‑year‑old with stage IA endometrial cancer wishes fertility preservation.
Which regimen is considered standard for this scenario?
A) High‑dose progestin therapy (medroxyprogesterone acetate)
B) Immediate radical hysterectomy
C) Lymphadenectomy only
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
D) Observation without treatment
Answer: A
Explanation: High‑dose progestin therapy can induce regression in early, low‑grade endometrial
cancer, allowing future fertility while preserving the uterus.
**Question 4.** Which tumor marker is most specific for dysgerminoma, aiding in differential
diagnosis of an ovarian mass in a 20‑year‑old?
A) CA‑125
B) AFP
C) β‑hCG
D) LDH
Answer: D
Explanation: Elevated serum LDH is characteristic of dysgerminoma, whereas AFP and β‑hCG are
associated with non‑seminomatous germ cell tumors.
**Question 5.** In peri‑operative VTE prophylaxis for gynecologic oncology patients undergoing
major abdominal surgery, which regimen is recommended?
A) Low‑dose aspirin alone
B) Unfractionated heparin 5000 U subcutaneously q12h for 7 days
C) Warfarin started on postoperative day 1
D) No prophylaxis if ambulating early
Answer: B
Explanation: Subcutaneous unfractionated heparin (or low‑molecular‑weight heparin)
administered post‑operatively reduces VTE risk; aspirin alone is insufficient for high‑risk cancer
patients.
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
**Question 6.** During a radical hysterectomy, which nerve‑sparing technique reduces
postoperative bladder dysfunction?
A) Preservation of the hypogastric plexus
B) Transection of the uterosacral ligaments
C) Ligation of the uterine artery at its origin
D) Removal of the pelvic splanchnic nerves
Answer: A
Explanation: Preserving the hypogastric plexus maintains autonomic innervation to the bladder,
decreasing postoperative voiding dysfunction.
**Question 7.** Which of the following best describes the anatomic boundaries of the pelvic
sidewall lymphadenectomy?
A) From the external iliac vessels to the obturator nerve
B) From the obturator nerve to the sacral promontory, including common iliac nodes
C) Only the superficial inguinal nodes
D) Para‑aortic nodes up to the left renal vein
Answer: B
Explanation: Pelvic sidewall lymphadenectomy typically includes nodes from the obturator
space to the sacral promontory, encompassing external, internal, and common iliac nodes.
**Question 8.** In cytoreductive surgery for ovarian cancer, which organ resection is most
commonly required to achieve optimal debulking when disease involves the diaphragm?
A) Splenectomy
B) Partial diaphragmatic stripping
C) Hepatic wedge resection
D) Pancreatic tail resection
, [GOC] Gynecologic Oncology Certifying
Certification Exam Preparation
Answer: B
Explanation: Diaphragmatic stripping removes tumor implants on the peritoneal surface of the
diaphragm and is frequently needed for optimal cytoreduction.
**Question 9.** A patient undergoing debulking has an intra‑operative ureteral injury identified
intra‑operatively. What is the most appropriate immediate management?
A) Place a ureteral stent and complete the case
B) Perform ureteroureterostomy if injury is in the mid‑ureter
C) Nephrostomy tube placement only after surgery
D) Observation, as most injuries heal spontaneously
Answer: B
Explanation: Immediate repair, such as ureteroureterostomy for mid‑ureter injuries, prevents
postoperative complications; stenting alone may be insufficient for transection.
**Question 10.** Which of the following postoperative complications is most likely to present
with fever, tachycardia, and an elevated white count on postoperative day 3 after a radical
hysterectomy?
A) Pulmonary embolism
B) Anastomotic leak
C) Deep vein thrombosis
D) Urinary tract infection
Answer: B
Explanation: Anastomotic leaks often present early with systemic inflammatory response; fever,
tachycardia, and leukocytosis are classic signs.
**Question 11.** In the ERAS protocol for gynecologic oncology, which of the following is
recommended to reduce postoperative ileus?
