CNM Board Exam Review
Questions with Accurate Answers
according to Dr. Pfeifer, what are the 2 main types of congenital abnormalities of
the female reproductive tract? correct answer 1) defects of VERTICAL fusion
(connection between uterus & vagina)
2) defects of LATERAL fusion (canalization of reproductive tract)
based on what findings do you classify invasive ductal carcinoma and invasive
lobular carcinoma? correct answer * classification is based on the location of the
carcinoma in situ that gave rise to the invasive carcinoma
* invasive ductal carcinoma arises from DCIS
* invasive lobular carcinoma arises from LCIS
besides the BRCA genes, what dominant alleles have been associated with breast
cancer in GWAS studies? correct answer * FGFR2 (RR = 1.26)
* TNRC9 (RR = 1.20)
these are risk modifiers for women who have the BRCA1/BRCA2 mutations
complete mole or partial mole?
* extremely elevated hCG
* cellular atypia
* embryonic development correct answer * extremely elevated hCG: complete
mole
* cellular atypia: complete mole
,* embryonic development: partial mole
cytologically, how is DCIS different from normal ductal epithelium correct answer
DCIS: (standard signs of malignancy)
* enalrged cells
* high N:C ratio
* prominent nucleoli
* increased mistoses
do we do routine screening for HPV in all women? why or why not? correct
answer * HPV screening is only done as a primary screen for women over 30
* why? because HPV a) is so common in young people and b) most often is self-
resolving, that it is a much less meaningful test for younger women than for older
women
during pregnancy, what happens to the clotting factor levels in a woman's blood?
what is the overall effect on her clotting? correct answer * estrogen increases the
synthesis of clotting factors (I, VII, VIII, IX & X) and decreases fibrinolysis
(plasminogen)
* therefore, pregnancy = a hypercoagulable state
factors considered when staging breast cancer? correct answer mnemonic: TMN
* Tumor size
* Metasteses?
* lymph Nodes
(stages)
,for a woman with a founder mutation in BRCA1 gene, what is the risk of
developing breast cancer in her lifetime? ovarian cancer? what about for a man?
correct answer * breast cancer: 60-80%
* ovarian cancer: 50-60%
* man: breast = 1-5%, prostate = 2-3%
for a woman with a founder mutation in BRCA2 gene, what is the risk of
developing breast cancer in her lifetime? ovarian cancer? what about for a man?
correct answer * breast cancer: 60-80%
* ovarian cancer: 50%
* man: breast = 5-10%, prostate = 15-25%!!!
for dizygotic twins, how many possible placentas are there? chorions? correct
answer normally, dizygotic twins either have:
A) 2 separate placentas, each with its own chorion, or
B) a fused placenta and chorion, but with 2 amniotic sacs
for monozygotic twins, what configuration of placentas/chorions/amnions is most
common? next most common? least common? correct answer monozygotic
twins:
A) most common (~2/3): common placenta & chorion with 2 amniotic sacs
B) next most common (~1/3): 2 separate placentas, each with its own chorion
C) least common (~5%): share same chorion and amnion (this is the situation in
which conjoined twins develop)
, for women >30 years old, what test should always be administered along with a
pap smear? why? correct answer HPV test!
* why? because the prevalence of HPV (the main risk factor for cervical cancer) is
lower in women > 30 and is therefore a more meaningful surrogate marker for
cancer risk
* a normal pap combined with a negative HPV test allows a woman to increase
the interval between future screenings
how are fetal lungs different than fully-developed lungs? correct answer * blood
vessels are distant from airspaces (decreased gas exchange)
* alveoli don't form until 7 months gestation and don't expand well (atelectasis)
* inadequate surfactant
how do BRCA1 & BRCA2 mutations differ in the hormone-dependency status of
the breast cancers they cause? correct answer * BRCA1 mutation+ breast CA: 85%
are estrogen receptor negative (E-independent)
* BRCA2 mutation+ breast CA: more like sporadic tumors (more often E-
dependent)
how do E & P levels change during labor/delivery? what effect does each have?
correct answer * E increases, upregulating gap junctions and oxytocin receptors in
myometrium
* P decreases, releasing the breaks on uterine contractions
how do LSIL and HSIL appear on colposcopy and biopsy? correct answer
Questions with Accurate Answers
according to Dr. Pfeifer, what are the 2 main types of congenital abnormalities of
the female reproductive tract? correct answer 1) defects of VERTICAL fusion
(connection between uterus & vagina)
2) defects of LATERAL fusion (canalization of reproductive tract)
based on what findings do you classify invasive ductal carcinoma and invasive
lobular carcinoma? correct answer * classification is based on the location of the
carcinoma in situ that gave rise to the invasive carcinoma
* invasive ductal carcinoma arises from DCIS
* invasive lobular carcinoma arises from LCIS
besides the BRCA genes, what dominant alleles have been associated with breast
cancer in GWAS studies? correct answer * FGFR2 (RR = 1.26)
* TNRC9 (RR = 1.20)
these are risk modifiers for women who have the BRCA1/BRCA2 mutations
complete mole or partial mole?
* extremely elevated hCG
* cellular atypia
* embryonic development correct answer * extremely elevated hCG: complete
mole
* cellular atypia: complete mole
,* embryonic development: partial mole
cytologically, how is DCIS different from normal ductal epithelium correct answer
DCIS: (standard signs of malignancy)
* enalrged cells
* high N:C ratio
* prominent nucleoli
* increased mistoses
do we do routine screening for HPV in all women? why or why not? correct
answer * HPV screening is only done as a primary screen for women over 30
* why? because HPV a) is so common in young people and b) most often is self-
resolving, that it is a much less meaningful test for younger women than for older
women
during pregnancy, what happens to the clotting factor levels in a woman's blood?
what is the overall effect on her clotting? correct answer * estrogen increases the
synthesis of clotting factors (I, VII, VIII, IX & X) and decreases fibrinolysis
(plasminogen)
* therefore, pregnancy = a hypercoagulable state
factors considered when staging breast cancer? correct answer mnemonic: TMN
* Tumor size
* Metasteses?
* lymph Nodes
(stages)
,for a woman with a founder mutation in BRCA1 gene, what is the risk of
developing breast cancer in her lifetime? ovarian cancer? what about for a man?
correct answer * breast cancer: 60-80%
* ovarian cancer: 50-60%
* man: breast = 1-5%, prostate = 2-3%
for a woman with a founder mutation in BRCA2 gene, what is the risk of
developing breast cancer in her lifetime? ovarian cancer? what about for a man?
correct answer * breast cancer: 60-80%
* ovarian cancer: 50%
* man: breast = 5-10%, prostate = 15-25%!!!
for dizygotic twins, how many possible placentas are there? chorions? correct
answer normally, dizygotic twins either have:
A) 2 separate placentas, each with its own chorion, or
B) a fused placenta and chorion, but with 2 amniotic sacs
for monozygotic twins, what configuration of placentas/chorions/amnions is most
common? next most common? least common? correct answer monozygotic
twins:
A) most common (~2/3): common placenta & chorion with 2 amniotic sacs
B) next most common (~1/3): 2 separate placentas, each with its own chorion
C) least common (~5%): share same chorion and amnion (this is the situation in
which conjoined twins develop)
, for women >30 years old, what test should always be administered along with a
pap smear? why? correct answer HPV test!
* why? because the prevalence of HPV (the main risk factor for cervical cancer) is
lower in women > 30 and is therefore a more meaningful surrogate marker for
cancer risk
* a normal pap combined with a negative HPV test allows a woman to increase
the interval between future screenings
how are fetal lungs different than fully-developed lungs? correct answer * blood
vessels are distant from airspaces (decreased gas exchange)
* alveoli don't form until 7 months gestation and don't expand well (atelectasis)
* inadequate surfactant
how do BRCA1 & BRCA2 mutations differ in the hormone-dependency status of
the breast cancers they cause? correct answer * BRCA1 mutation+ breast CA: 85%
are estrogen receptor negative (E-independent)
* BRCA2 mutation+ breast CA: more like sporadic tumors (more often E-
dependent)
how do E & P levels change during labor/delivery? what effect does each have?
correct answer * E increases, upregulating gap junctions and oxytocin receptors in
myometrium
* P decreases, releasing the breaks on uterine contractions
how do LSIL and HSIL appear on colposcopy and biopsy? correct answer
