adnexal mass

Question 1

when are simple cysts physiologic and okay?

Answer 1

during the reproductive years. we don’t typically worry about them unless they are complex

Question 2

when do we worry about cysts in ovaries?

Answer 2

pre and postmenopasual women —these are usually cancerous

Question 3

what test for cysts?

Answer 3

transvaginal ultrasound (MRI is too expensive).

Question 4

what does a simple cyst look like on ultrasound

Answer 4

no septations, anechoic, only one color and homogenous. SMALL. <3cm ignore
<10cm probably nothing, watch it. if fails to resolve, then remove.
looks like a bag of black fluid. NOTHING ELSE.

Question 5

what does a complex cyst look like?

Answer 5

BIG. septations, disconinuous and discolored. multilocular and echoic. multiple structure.
large >10cm

Question 6

what don’t we do with simple cysts

Answer 6

1) aspiration
2) contraceptives
3) MRI (not needed)

Question 7

what are th types of complex cysts

Answer 7

endometrioma, teratoma, ectopic, tubo-ovarian abscess, and cancers

Question 8

what is a Teratoma and when do we see it?

Answer 8

large benign tumors usually in young women that complain of weight gain –typically asymptomatic. These usally contain hair and teeth. We only remove the cyst since mostly these are found in younger women so we want to protect fertility. cystectomy

Question 9

what is endometrioma

Answer 9

chocolate cyst. Is a complex cyst.

Question 10

what is endometriosis and what causes it?

Answer 10

dysplaced endometrial tissue. estrogen responsive, so recurs with cycles. retrograde flow of menses?
peritoneal seeding.

Question 11

how does endometriosis present?

Answer 11

dysperunia, infertility, dysmenorrhea

Question 12

what is the diagnosis of chocolate cyst?

Answer 12

endometrioma and endometriosis. also treating with OCon and it if it improves then the diagnosis is endometriosis

Question 13

treatment for endometriosis

Answer 13

managing pelvic/abdominal pain (NSAIDs). gain control of the axis –OCPs/GNRH analogs-luprolide/danosol.

Question 14

what is the treatment of endometrioma?

Answer 14

find the chocolate cyst with laproscopy with ablation. burn it away after finding it

Question 15

what causes ectopic pregnancy

Answer 15

early implantation –usually something causing stricture. PID

Question 16

most common region of ectopic

Answer 16

ampulla.

Question 17

how does this present?

Answer 17

pregnancy. abdominal pain, UPT positive, amenorrhea.

Question 18

what is the discriminatory zone

Answer 18

b-hCG measurement >2000 this is the level of b-hCG expected to correlate with findings on ultrasound

Question 19

what are the treatments for ectopic

Answer 19

1) salpingostomy (suck out zygote, leave the tube)
2) salpingectomy (remove the tube –typically used when ruptured)
3) methotrexate –early

Question 20

when to use methotrexate

Answer 20

1) b-hCG <5,000
2) no fetal cardiac activity
3) size <3-4cm

Question 21

how does ovarian torsion presents

Answer 21

typically with sudden crushing abdominal pain that comes out of no where

Question 22

how to diagnose ovarian torsion

Answer 22

with dopler ultrasound

this is a surgical emergency

Question 23

what is a tuboovarian abscess

Answer 23

essential PID

Question 24

what causes PID

Answer 24

gonorrhea and chlamydia

Question 25

how is tuboovarian treated?

Answer 25

same as PID.

Question 26

how does TOA present

Answer 26

cervical motion tenderness, adnexal tenderness, uterine tenderness. abdominal/pelvic pain. fever and leukocytosis –not needed to meet criteria.
presence of white cells on wet prep increases the chances that PID is there.

Question 27

how do we identify the abscess?

Answer 27

ultrasound.

Question 28

treatment of PID/TOA

Answer 28

IV –cefoxiton + doxcycline + metranidazole.

or clindamyocin + metranidazole

Question 29

what happens if the TOA does not improve

Answer 29

surgical draining.