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OBGYN > Differential Diagnoses - Pelvic Masses > Flashcards

Differential Diagnoses - Pelvic Masses Flashcards

1
Q

t or f: ovarian masses less than 5 cm that are not suspicious of malignancy and asymptomatic are often observed - no surgical intervention needed

A

TRUE - larger cysts (greater than 5 cm) can be considered for surgical resection

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2
Q

which ovarian cysts are the most common functional cysts?

A

follicular cysts

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3
Q

what is the physiology behind the development of a follicular cyst?

A

failure of rupture or incomplete resorption of the ovarian follicle is what results in the cyst

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4
Q

what are the contents of a follicular cyst?

A

estrogen-rich fluid (ovarian cyst is granulosa cell lined)

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5
Q

t or f: follicular cysts are typically asymptomatic when small (less than 5 cm)

A

TRUE

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6
Q

what is the greatest risk for ovarian torsion?

A

large size

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7
Q

t or f: follicular cyst pain tend to be bilateral

A

FALSE - unilateral abdominal and pelvic pain with abrupt pain indicating possible ovarian torsion

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8
Q

what is a sign on US that indicates ruptured ovarian cyst?

A

fluid in the cul-de-sac

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9
Q

t or f: no treatment is necessary for most functional cysts

A

TRUE - most will resolve spontaneously within two months

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10
Q

t or f: OCP may aid in the resolution of ovarian cysts for symptomatic patients

A

TRUE - chronically symptomatic cysts can also be managed with OCP

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11
Q

what must be done if an ovarian cysts does not resolve on its own within two months?

A

laparotomy/laparoscopy to evaluate/rule out neoplasm/endometriosis

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12
Q

what are the two types of lutein cysts?

A

corpus luteal and theca lutein

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13
Q

bilateral theca lutein cysts are often seen in what situation?

A

molar pregnancies due to increased BHCG levels

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14
Q

what is the physiology of the corpus luteum cyst?

A

When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.

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15
Q

what type of adnexal pain is produced by corpus luteum cysts?

A

unilateral

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16
Q

what is the physiology behind a theca lutein cyst?

A

increased levels of HCG causes follicular overstimulation and leads to the development of these cysts

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17
Q

t or f: theca lutein cysts are often multiple and bilateral

A

TRUE

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18
Q

what is the etiology of the development of TOA (most of the time)?

A

abscess involving the ovary and fallopian tube is most often a consequence of PID

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19
Q

what kind of antibiotics should be used to treat TOA?

A

TOA is a polymicrobial process of broad-spectrum antibiotics should be used

20
Q

how does primary TOA develop?

A

as a result of a complication of an ascending infection of the reproductive tract

21
Q

how does secondary TOA develop?

A

as a result of something such as bowel pert or from general intraperitoneal spread of infection (TOA can also result in association with pelvic surgery or malignancy)

22
Q

what is one way to know that the pelvic was in fact a TOA?

A

the quick response to antibiotic treatment

23
Q

what is the treatment for TOA that does not respond to antibiotics?

A

laparoscopic or US guided drainage

24
Q

what is the medical term for chocolate cysts?

A

endometriomas

25
Q

what is the result of ectopic endometrial tissue in the ovary?

A

endometrioma

26
Q

t or f: 50% of women with endometriosis will develop an endometrioma

A

TRUE

27
Q

how is the definitive diagnosis of an endometrioma made?

A

laparoscopy and biopsy with hemosiderin laden macrophages

28
Q

t or f: the only treatment for endometriomas is surgical as medical therapy is completely ineffective

A

TRUE

29
Q

ultrasound findings include hypo echoic areas with calcifications and internal debris - what is the most likely diagnosis?

A

benign cystic teratoma

30
Q

what is the other name for a cystic teratoma

A

dermoid cyst

31
Q

what is the most common ovarian germ cell tumor?

A

dermoid cyst

32
Q

t or f: cystic teratomoas are more common in women over 50

A

FALSE! more common in young women aged 12–30

33
Q

what 3 types of tissue can be found within a cystic teratoma?

A

tissue of ectodermal, mesodermal and endodermal - remember, the tissue is mature (benign) and may include skin, bone, hair and teeth

34
Q

oocytes that are able to develop into teratomas undergo arrest in development after what stage of the cell cycle?

A

meiosis I

35
Q

almost all mature cystic teratomas have what karyotype?

A

46 XX

36
Q

what are the origins of the three main types of ovarian teratomas?

A

epthelium, sex cord and germ cells

37
Q

what is the treatment for a teratoma of the ovary?

A

excision (cystectomy) or oophrectomy for women no longer wanting to conceive

38
Q

t or f: nulliparity is a risk factor for ovarian teratomas

A

TRUE

39
Q

elevated serum of which CA marker indicates an increased likelihood that n ovarian tumor is malignant?

A

CA-125 (definitive diagnosis is biopsy)

40
Q

how is ovarian cancer staged?

A

surgically

41
Q

in women with early stage ovarian CA what is the TOC?

A

TAH w/ bilateral salpingo-oophorectomy

42
Q

leiomyomas are most commonly of which type?

A

subserousal

43
Q

which type of leiomyomas are most likely to present as menorrhagia?

A

submucosal and intramural

44
Q

t or f: pregnancy with fibroids increases carrier risks of abruption, dysfunctional bleeding and breech position.

A

TRUE

45
Q

t or f: about 3/4 of fibroids recur after myomectomy.

A

FALSE - more like 1/3

46
Q

what is the definitive treatment for fibroids?

A

hysterectomy

OBGYN (21 decks)

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