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RDS Test 2 Lees > B8.024 - Big Case Cystic Ovaries > Flashcards

B8.024 - Big Case Cystic Ovaries Flashcards

1
Q

what is an essential part of an work up of a woman presenting with abdominal tenderness

A

beta HCG

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2
Q

Differential dx for RLQ pain with negative beta HCG

A

acute appendicitis, gastroenteritis, diverticulitis, IBD, ileus, ovarian cyst, tubo ovarian abscess

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3
Q

presentation of appendicitis

A

pain around umbilicus that progresses to right lower abdomen, vomiting, fever, tachycardia

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4
Q

gastroenteritis presentation

A

diarrhea, vomiting, abdominal pain, fever, lack of engery, dehydration

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5
Q

diverticulitis/perf presntation

A

abdominal pain. nausea, vomiting, fever, bloating or gas, constipation

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6
Q

IBD presentation

A

abdominal pain, cramping, diarrhea, blood in stool maybe, fever, chills fatigue. dehydration

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7
Q

ileus presentation

A

abdominal discomfort, loss of appetite, feeling of fullness, constipation, inability to pass gas bloating, abdominal discomfort excessive belching, nausea, vomiting

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8
Q

ovarian cyst presentation

A

lower abdominal pain, fullness or heaviness, bloating or swelling, severe pain before or during menstrual cycles, dyspareunia

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9
Q

tubo ovarian abscess presentation

A

presents with fever, chandelier sign

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10
Q

types of functional cysts

A

follicular or corpus luteal, common and may rupture. Often hemorrhagic

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11
Q

what is a mucinous cystadenoma

A

benign tumor of the ovary, torsion can occur with greater than 4 cm

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12
Q

what is a mature teratoma

A

ovarian germ cell tumor, torsion can occur when greater than 4 cm

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13
Q

complication of ovarian cancer

A

torsion

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14
Q

endometrioma presents

A

with chronic pain, common

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15
Q

what is an ovarian cyst

A

solid or fluid filled sac or pocket within or on the surface of an ovary most common in reproductive aged women

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16
Q

how do you diagnose ovarian cyst

A

pelvic ultrasound

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17
Q

sx of ovarian cyst

A

irregular menstrual cycles, pelvic pain or pressure, dyspareunia sometimes asx

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18
Q

types of ovarian cysts

A

follicular, corpus luteum, hemorrhagic, mucinous cystadenoma, mature teratoma, endometrioid

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19
Q

follicular cysts

A

follicle fails to rupture, often resolves spontaneously

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20
Q

corpus luteum cyst

A

CL fails to regress, may produce progesterone, may be hemorrhagic

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21
Q

hemorrhagic cysts

A

blood filled follicular or luteal

22
Q

mucinous cystadenoma

A

lined by columnar epithelium, typically similar to endocervical epithelium, secrete gelatinous mucin

23
Q

mature teratoma

A

germ cell tumor, may contain ectoderm, endoderm derived tissues

24
Q

endometrioid

A

manifestation of endometriosis, endometrial tissue on ovary, chocolate cyst

25
Q

diagnostic test for ovarian cysts

A

transvaginal ultrasound

26
Q

what are the clinically important parameters that transvaginal ultrasound can help with

A

eval of small masses, origin of mass, torsion, internal consistency, presence of septae

27
Q

imaging of mature teratoma

A

hyperechoic interfaces in a cystic mass

28
Q

imaging of a simple/follicular cyst

A

thin smooth wall, anechoic contetns, no or only few septa

29
Q

typical endometrioma on imaging

A

thick wall, homogenous low level internal echoes, occasionally wall calcifications

30
Q

mucinous cystadenoma on imaging

A

thin septations, may demonstrate echogenic material (mucin)

31
Q

what does the presence of complex septations on ovarian cyst imaging mean

A

could be malignant

basically not a good sign

32
Q

imaging of hemorrhagic cyst

A

fishnet weave/fine reticular pattern

33
Q

how do you rule in / out torsion

A

torsion can be dx on doppler ultrasound bc you can see if blood flow has been restricted or nott

34
Q

management of ruptured corpus luteal cyst

A

surgery. need exogenous progesterone support after surgery to prevent miscarriage

35
Q

diangostic workup for amenorrhea hyperandrogenism

A

thyroid - TSH

rare enzyme defects - 17 - OHP CAH

stress hormomne - cushing 24 hr free cortisol

tumors - testosterone, DHEAS, prolactin

excessive growth hormone - IGF -1

36
Q

what is PCOS

A

polycystic ovaries

high androgen levels

irregular periods

37
Q

how do you diagnose polycystic ovaries

A

strand of pearls, 12 or more follicles seen on ovary

38
Q

how do you diagnose high androgen levels

A

signs like acne, hair (growth, loss)

Labs (DHEAS, T)

39
Q

what is an irregular period

A

35 day or longer cycle

heavy bleeding

problems with ovulation

40
Q

what causes PCOS?

A

endocrine disruptors, genetic, diff in androgen receptors or SHBG, gestational hyperglycemia, in utero exposure to androgen. evolutionary paradox

41
Q

how do you manage high androgen levels

A

tx acne with bonzoyl peroxide, siacylic acid, topical/oral antibiotics, OC, retinoids

tx MPB with rogaine, spironolactone, combined estrogen and progesterone, ketoconazole, propecia (blocks DHT), metformin, flutamide, vaniqa

42
Q

health problems with PCOS

A

heart disease, obesity, DM, mood/sleep disorders, cx, liver disease, infertility

43
Q

metabolic syndrome

A

dx with 3/5:

HTN (>130/85)

WC >35 in

fasting glucose >100

HDL <50

TG >150

44
Q

tx of PCOS and high cholestrol

A

statins - cause birth defects

45
Q

dangers of high BP

A

systolic >140 diastolic >90

risk of heart disease, renal failure, stroke

narrowed blood vessels from damaged lining increases pressures

46
Q

how do you assess glycemic control in PCOS

A

HbA1c

2h glucose tolerance

47
Q

use of metformin in PCOS

A

biguanide, improves bodys ability to process insulin

decreases androgen levels, improves ovulation but does not improve chance of live birth

can cause lactic acidosis, GI distress, wt loss

48
Q

PCOS affect on mood and sleep

A

more likely to have depression and anxiety

5x more likely to have sleep apnea

49
Q

PCOS affect on cancer risk

A

2-3x more likely to have endometrial uterine cancer

increased endometrial growth in anovulation

50
Q
A

RDS Test 2 Lees (2 decks)

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