benign condition of ovary and pelvis

Question 1

What are the types of ovarian cyst

Answer 1

Functional
Germ cell 
Epithelial
Inflammatory
Sex cord stromal

Question 2

types of functional ovarian cyst

Answer 2

follicular
thecal luteal
corpus luteum

Question 3

types of germ cell cyst

Answer 3

benign teratoma (dermoid)

Question 4

types of inflammatory cyst

Answer 4

tubo-ovarian abscess

endometrioma

Question 5

types of epithelial cyst

Answer 5

serous cystadenoma
mucinous cystadenoma
brenner tumour

Question 6

types of sex cord stromal cyst

Answer 6

fibroma

thecoma

Question 7

Ix of suspected torsion of cyst

Answer 7

TVUSS (TAUSS if never been sexually active)
MRI
Pregnancy test
INF markers to rule out appendicitis and tubo-ovarian abscess

Question 8

How big does it have to be for cyst diagnosis

Answer 8

> 3cm

ovulatory follicle can be 2.5cm

Question 9

Mx of ovarian cyst

Answer 9

If asymptomatic:
Simple and small (<50mm) - likely to be physiological, will resolve in 3 menstrual cycles. Don’t require follow up
simple and 50-70mm - yearly US follow up
>70mm - further ix either MRI or surgery (if dermoid take it out)

If acutely unwell:
urgent surgical exploration + Abx

Post-menopausal w/ solid or complex cyst:
suspicious so do TVUSS RMI

Question 10

What are corpus luteal cysts associated with

Answer 10

Occur after ovulation

Can rupture and be painful

Question 11

What are thecal luteal cyst associated w/

Answer 11

pregnancy (especially multiple)

resolve spontaneously

Question 12

What are inflammatory cysts associated with

Answer 12

PID

endometrioma are chocolate cyst with ground glass appearance on USS

Question 13

Indications for cystectomy of germ cell tumour

Answer 13

greater than 5cm
growing
symptomatic
NB - low risk of malignant transformation

Question 14

differences between serous and mucinous cystadenoma

Answer 14

Serous unilateral and unilocular

mucinous usually bilateral

Question 15

Epidemiology of epithelial cysts

Answer 15

Increase with age

Question 16

who gets sex cord stromal cysts

Answer 16

older women

Question 17

What is meig’s syndrome

Answer 17

ascites, ovarian fibromas, pleural effusion

NB. - fibromas often tort

Question 18

Features of thecoma

Answer 18

Oestrogen secreting

in older women can be a cause of PMB

Question 19

Physical examination findings suggestive of endometriosis

Answer 19

Thickening of uterosacral ligaments
Adnexal mass
fixed retroverted uterus
tenderness in pouch of douglas

Question 20

Use of imaging in endometriosis

Answer 20

TVUSS - see endometriomas (diagnostic for ovarian disease)
Can see rectal involvement
MRI - can see lesions >5mm

Question 21

Appearances of endometriosis on laparascopy

Answer 21

red
black matchstick
white fibrous

Question 22

medical mx of endometriosis

Answer 22

NSAIDs for pain (avoid codeine cause it can worsen co-existing IBS)
COCP (can take with pill free or continuously to induce amenorrhea til you want to conceive)
Progestogens (if COCP contraindicated) to induce amenorrhea
GnRH agonist (only use 6 months at a time or you will get osteoporosis)

Question 23

Surgical mx of endometriosis

Answer 23

fertility sparing:
laparascopic, will probably need medical adjunct to help

Hysterectomy +oophorectomy if they have finished family
may not cure everything
then start on oestrogen only HRT

Question 24

Causes of chronic pelvic pain

Answer 24

gynae
urological
GI
neuro

Question 25

RF for endometriosis

Answer 25

early menarche
FHx
nulliparity
prolonged menstruation (>5 days)
short menstrual cycles (<28 days)