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RDS Test 2 > B8.024 Cystic Ovaries > Flashcards

B8.024 Cystic Ovaries Flashcards

1
Q

ddx of RLQ pain with negative Bhcg

A 
acute appendicitis
gastroenteritis
diverticulitis or perf
crohns, UC
ileus
ovarian cyst
tubo-ovarian abscess
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2
Q

acute appendicitis

A

pain around the umbilicus progressing to right lower abdomen
vomiting
fever
tachycardia

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3
Q

gastroenteritis

A 
diarrhea
vomiting
abdominal pain
lack of energy
dehydration
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4
Q

diverticulitis/perf

A 
abdominal pain
nausea
vomiting
fever
bloating or gas
constipation
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5
Q

crohn’s or UC

A

abdominal pain
cramping
diarrhea
+/- blood in stool, fever, chills, fatigue, dehydration

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6
Q

ileus

A 
abdominal discomfort
loss of appetite
feeling of fullness
constipation
inability to pass gas
bloating
excessive belching
nausea/vomiting
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7
Q

typical ovarian cyst symptoms

A

lower abdomen pain, fullness or heaviness
bloating/swelling
severe pain before or after menstruation
dyspareunia

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8
Q

tubo-ovarian abscess

A

fever

chandelier sign

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9
Q

types of of ovarian cysts

A 
functional cyst (follicular, corpus luteal)
mucinous cystadenoma
mature teratoma
cancer
endometrioma
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10
Q

what is an ovarian cyst

A

solid or fluid filled sac or pocket within or on the surface of an ovary

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11
Q

ovarian cyst epidemiology

A

common in all age groups

  • most common among repro aged women
  • > 3 mil per year
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12
Q

how are ovarian cysts diagnosed

A

transvaginal pelvic US

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13
Q

majority of ovarian cysts symptoms

A

physiologic

asymptomatic

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14
Q

follicular ovarian cysts

A

follicle fails to rupture

often resolves spontaneously

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15
Q

corpus luteum ovarian cyst

A

CL fails to regress
may produce progesterone
may be hemorrhagic

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16
Q

hemorrhagic ovarian cyst

A

blood filled follicular or luteal cyst

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17
Q

mucinous cystadenoma

A

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

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18
Q

mature teratoma

A

dermoid
germ cell tumor
may contain ectoderm, mesoderm, endoderm derived tissues

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19
Q

endometrioid cyst

A

manifestation of endometriosis
endometrial tissue on ovary
chocolate cyst

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20
Q

clinically important parameters provided by transvaginal ultrasound

A
  1. determination of the presence or absence of relatively small masses (5-10 cm)
  2. determination of the origin of a mass (uterine, ovarian, tubal) and whether or not it has torsed
  3. detailed eval of internal consistency of cyst
  4. guiding transvaginal aspiration
  5. evaluation of endometrial or myometrial disorders related to pelvic masses
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21
Q

what are you looking for on US when examining internal consistence of a cyst

A

presence or absence or polypoid excrescences, septations, or internal consistencies (blood, pus, serous fluid)

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22
Q

appearance of mature teratoma on imaging

A

hyperechogenic interfaces on cystic mass

can have calcifications

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23
Q

appearance of simple/follicular cyst on imaging

A

thin smooth wall
anechoic contents
no or only few septa
no debris

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24
Q

appearance of typical endometrioma on imaging

A

thick wall
homogeneous low level internal echoes
occasionally wall calcifications

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25
Q

appearance of hemorrhagic cyst on imaging

A

fishnet weave/ fine reticular pattern

sign of clotting within the cyst

26
Q

appearance of mucinous cystadenoma on imaging

A

thin septations
may demonstrate echogenic material (mucin)
similar to cervical epithelium

27
Q

appearance of a potentially malignant cyst on imaging

A

thick > 3 mm septations

complex

28
Q

how to rule out a torsion when looking at a cyst

A

doppler imaging

“ring of fire” appearance signifies NO torsion (blood flow still present)

29
Q

how does the presentation of an endometrioma differ from a functional cyst

A

presents with chronic pain, not usually acute onset

30
Q

what does periumbilical ecchymosis result from

A

retroperitoneal bleeding

in context of ovarian cyst: rupture

31
Q

treatment of ruptured CL syst

A

surgical removal
exploratory laparoscopy
need exogenous progesterone support after surgery to prevent miscarriage

32
Q

diagnostic workup for amenorrhea with hyperandrogenism

A 
thyroid problems (TSH)
rare enzyme defects (CAH)
excessive stress hormones (cushing)
tumors
excessive growth hormone (IGF-1)
33
Q

PCOS criteria

A
  1. polycystic ovaries
  2. high androgen levels
  3. irregular periods
34
Q

appearance of PCOS on US

A

strand of pearls

12 or more follicles seen on ovary

35
Q

clinical manifestations of high androgen levels

A

acne
hair
-loss: male patterned
-growth: face, chest, back

36
Q

lab manifestations of high androgen levels

A

DHEAS

testosterone

37
Q

abnormal menstrual cycles in PCOS

A

35 days or longer
heavy bleeding
problems with ovulation

38
Q

PCOS causes

A 
endocrine disruptors
genetic
differences in androgen receptor or sex hormone binding globulin (SHBG)
gestational hyperglycemia
in utero exposure to androgens
39
Q

evolutionary paradox of PCOS

A

viability advantage

decreased fertility

40
Q

treatment of PCOS acne

A

OTC: benzoyl peroxide, salicylic acid
prescription: topical/oral antibiotics, combined oral contraceptives, topical/oral retinoids

41
Q

treatment of PCOS male patterned hair loss

A 
topical minoxicil (rogaine)
spironolactone - androgen receptor blocker
combined estrogen and progesterone
ketoconazole
propecia (blocks DHT)
42
Q

treatment of PCOS male patterned hair growth (hirsutism)

A 
combined oral contraceptives
spironolactone (6 months)
propecia
flutamide
metformin
laser therapy
vaniqua (topical, 4-8 weeks)
43
Q

systemic health problems seen with PCOS

A 
heart disease
obesity
diabetes
mood/sleep disorders
cancer
liver disease
infertility
44
Q

PCOS and heart disease

A 
increased risk factors:
1. metabolic syndrome
2. high cholesterol
3. high blood pressure
4. obesity
3x increased risk:
-stroke
-heart attack
45
Q

diagnosis of metabolic syndrome

A

3/5 risk factors

  • BP >130/85
  • waist circumference >35 in
  • fasting glucose >100
  • HDL <50
  • triglycerides >150
46
Q

relationship between PCOS and metabolic syndrome

A

21-40% of PCOS women have metabolic syndrome

half of this group is NOT obese

47
Q

cholesterol abnormalities in PCOS

A

low HDL
high triglycerides
high LDL

48
Q

treatment of high cholesterol in PCOS

A

statin: decreases cholesterol production

low cholesterol diet/excerise

49
Q

high BP in PCOS

A

systolic >140
diastolic >90
risk of heart disease, renal failure, stroke
narrowed blood vessels from damaged lining increased pressure

50
Q

treatment of high BP in PCOS

A

weight loss
smoking cessation
decreased alcohol use
BP meds: HCTZ, labetolol

51
Q

obesity in PCOS

A

5-10% weight loss may:

  • improve ovulation
  • lower male hormone levels
  • improve metabolic abnormalities
52
Q

treatment of obesity in PCOS

A

diet
exercise
meds
surgery

53
Q

relationship between PCOS and diabetes

A 
increased risk of developing diabetes
-11.9% in PCOS females > 30
-1.4% in non-PCOS females > 30
insulin resistance prevalence
-40% in PCOS females
54
Q

assessment of glycemic control in PCOS

A

no recommended screening test for insulin resistance
measure HbA1c
2h glucose tolerance

55
Q

use of metformin in PCOS

A

improves body’s ability to process insulin
decreases androgen levels
improves ovulation but does not improve chance of live birth
1-4 pills/day

56
Q

risk/side effects of metformin in PCOS

A

lactic acidosis
GI distress
weight loss

57
Q

mood conditions in PCOS

A

30% have depression

34% have anxiety

58
Q

sleep disturbances in PCOS

A

5x more likely to have sleep apnea

  • periods of not breathing with sleep
  • shortened sleep may lead to earlier death
59
Q

PCOS and cancer

A

2-3x increased risk of endometrial cancer

-increased endometrial growth with anovulation

60
Q

typical response to PCOS treatment

A

all symptoms improved after 6 months

61
Q

spironolactone in PCOS

A

potent antagonist of androgen receptor

locks T receptors and decreases T production

RDS Test 2 (24 decks)

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