Disorders of the Ovaries and Fallopian Tubes- Ross

Question 1

What is an adnexal mass?

Answer 1

a growth that occurs in or near the uterus, ovaries, fallopian tubes, and the connecting tissues. They’re usually benign, but are sometimes cancerous. Some of them are filled with fluid, and some are solid

Question 2

Adnexal masses should be evaluated with what type of imaging?

Answer 2

U/S first

Question 3

A 25 year old woman presents to you for routine annual WWE. She has had two routine vaginal deliveries and is otherwise healthy. She smokes 1 pk/day, has no GYN complaints. LMP 3 weeks ago.
PE: Left ovary enlarged to 5cm in diameter.
Which of the following is the best recommendation to this patient?
A. Order CA-125 testing
B. Order outpatient diagnostic laparoscopy
C. Order ultrasound
D. Order a CT scan of the pelvis
E. Admit to the hospital for exploratory laparotomy

Answer 3

C. Order ultrasound

Question 4

What are functional cysts and what are the two types?

Answer 4

SOMETIMES A NORMAL MONTHLY FOLLICLE KEEPS GROWING, WHEN THAT HAPPENS, IT IS KNOWN AS A FUNCTIONAL CYST.

1. Follicular cyst (failure of ovulation)
2. Corpus luteum cyst

Question 5

This is the most common type of functional cyst.

Answer 5

follicular cyst

Question 6

A patient comes in for a routine WWE for her IUD. On U/s you notice a follicular cyst. The patient states she is asymptomatic. What is the best thing to do next?

Answer 6

-Watch and wait because these are usually benign and reappear in 6 weeks with U/S

Question 7

A patient presents with amenorrhea and localized pain/tenderness in her lower left abdomen. You get a U/S and notice a corpus luteum cyst. What do you tell the patient the next steps are?

Answer 7

Watch and wait because they usually regress in 1-2 months

Question 8

A patient presents with anovulation, increased hair on her face and body and she is obese. What should be at the top of your ddx?

Answer 8

Polycystic ovarian syndrome

Question 9

What is the next step in diagnosing PCOS?

Answer 9

U/S

Question 10

What is the treatment for PCOS?

Answer 10

Lifestyle changes

• OCPs can help regulate cycle abnormalities
• Metformin can help with insulin resistance and hormone control

Question 11

You should NOT give patients with PCOS this med because it can cause abnormal genitalia development in males?

Answer 11

Spironolactone

Question 12

PCOS can lead to _________ ________ which can be treated with progesterone?

Answer 12

endomerial hyperplasia

Question 13

What are some things that can put you at risk for ovarian cancer?

Answer 13

• smoking
• multiple sex partners
• BRCA gene
• nulliparity (never given birth)

Question 14

80& of all malignant ovarian tumors are what?

Answer 14

Epithelial ovarian cancers

Question 15

Older women tend to get _______ ovarian cancer and young women tend to get _______ cell ovarian cancer

Answer 15

endometrial and germ

Question 16

What are markers for ovarian cancer?

Answer 16

CA-125 and He4

Question 17

This type of tumor accounts for 75%-85% of all epithelial ovarian neoplasms and develop from ovarian tissue and may be filled with a watery mucous

Answer 17

serous tumors

Question 18

chocolate cysts

Answer 18

endometrioid tumors

noncancerous, fluid-filled cysts that typically form deep within the ovaries.

Question 19

A very young patient comes in with her mom. Her mother is concerned that the patient is so young and she is beginning to hit puberty. WHat could the cause of this be?

Answer 19

Granulosa cell stromal tumor which produces estrogen

*pt should get an U/S

Question 20

This type of stromal tumor contains lipid containing cells that produce estrogen. A common symptom is post menopausal bleeding

Answer 20

thecoma stromal tumor

Question 21

A sertioli-leydig tumor secretes excessive amounts of ________

Answer 21

testosterone

Question 22

This type of gynecological tumor is typically an incidental finding, does not produce hormones, occurs close to menopausal age and is a part of meig’s syndrome (triad of benign ovarian tumor, ascites and pleural effusion)

Answer 22

fibroma

Question 23

A patient presents with acute severe abdominal pain localized to one side. How do we dx whatever this patient has?

Answer 23

U/S with doppler

Question 24

This is a common complication of PID due to an STI

Answer 24

pyosalpinx (when the fallopian tube is filled with pus)

Question 25

This dx is made based on presence of cervical motion tenderness, or uterine adenexal tenderness bilaterally

Answer 25

pelvic inflammatory disease

Question 26

Treatment for PID?

Answer 26

Ceftriaxone + doxy +/- metronidazole