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OB/GYN > Disorders of the Ovary > Flashcards

Disorders of the Ovary Flashcards

1
Q

What are the four types of ovarian cysts?

A

Follicular cysts
Corpus luteum cysts
Theca leutein cysts
Endometriomas

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2
Q

Which type of ovarian cyst is described below?

Simple cysts resulting from failure of ovulation

Fluid of incompletely developed follicle is not reabsorbed, producing an enlarged cyst

Typically asymptomatic - However bleeding and torsion can occur

A

Follicular cysts

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3
Q

Most follicular cysts typically disappear spontaneously within what time frame?

A

60 days

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4
Q

What type of medication has been recommended for follicular cysts but may not produce quicker resolution than expectant management, however may keep new cysts from forming

A

OCPs

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5
Q

Which type of ovarian cyst is described below?

Thin-walled unilocular cysts

Sizes from 3-11cm

When corpus luteum exceeds 3cm, it becomes known as a cyst

A

Corpus Luteum Cyst

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6
Q

Which type of ovarian cyst is described below?

Associated with pregnancy (increased gonadotropins)

More common with multiple gestations and trophoblastic disease

Typically bilateral

Multicystic

A

Theca Lutein Cyst

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7
Q

Which type of ovarian cyst is described below?

Benign

Palpable mass on ovary

Occur as a consequence of ovarian endometriosis

Grow up to 6-8cm

“chocolate cysts”

A

Endometriomas

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8
Q

Most Corpus Luteum cysts typically disappear spontaneously within what time frame?

A

Typically resolves over 1-2 months in menstruating patients

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9
Q

Which ovarian cyst is typically seen in first trimester of pregnancy?

A

Corpus Luteum Cyst

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10
Q

A patient with a Corpus Luteum Cyst typically presents with this triad of signs/symptoms

A

Unilateral lower quadrant pain

Missed period

Adnexal enlargement on PE

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11
Q

In a case of suspected corpus luteum cyst, what other condition needs to be ruled out ASAP in the workup?

A

ectopic pregnancy

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12
Q

What type of medication is used for prevention of corpus luteum cysts?

A

OCPs

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13
Q

Recurrent hemorrhagic corpus luteum cysts should raise suspicion of what?

A

bleeding disorder

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14
Q

What is a complication of a corpus luteum cyst to keep in mind?

A

If rupture occurs, may require surgery to stop the bleeding

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15
Q

What is the least common functional cyst?

A

Theca Lutein Cyst

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16
Q

What ovarian cyst is associated with pregnancy
(increased gonadotropins), especially with multiple
gestations?

A

Theca Lutein Cyst

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16
Q

“chocolate cysts”

A

Endometriomas

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17
Q

Polycystic Ovarian Syndrome is also known as what?

A

Stein-Leventhal syndrome

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18
Q

Common endocrine disorder with unknown etiology

Affects 5-10% of reproductive age women

Characterized by persistent anovulation

A

Polycystic Ovarian Syndrome

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19
Q

Unrecognized and untreated Polycystic Ovarian Syndrome is an important risk factor for what disease process?

A

CVD

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20
Q

Persistent anovulation in polycystic ovarian syndrome leads to what complications/conditions?

A

Enlarged polycystic ovaries

Secondary amenorrhea or oligomenorrhea

Infertility issues

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21
Q

What are the essentials of diagnosis for polycystic ovarian syndrome?

A

Clinical or biochemical evidence of hyperandrogenism

Oligoovulation or anovulation

Polycystic ovaries on ultrasound

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22
Q

What is the “typical patient” for polycystic ovarian syndrome?

A

Typically an obese female with hirsutism with or without acanthans nigricans who is complaining of either missed periods or infertility

Has many signs of metabolic syndrome

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23
Q

List some signs and symptoms of polycystic ovarian syndrome?

A

Infertility
Chronic menstrual irregularities
Hyperandrogenism
Insulin Resistance
Obesity
Hirsutism
Virilization
Amenorrhea
Abnormal uterine bleeding
Normal menstruation
Acanthosis nigricans

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24
Q

What ultrasound sign is a classic finding of polycystic ovarian syndrome?

A

“string of pearls” sign

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25
Q

What are some disorders to keep in mind for a differential diagnosis of polycystic ovarian syndrome, since these conditions also present with high androgen levels with anovulation and polycystic ovaries?

A

Cushing Syndrome

CAD – congenital adrenal hyperplasia

Androgen secreting adrenal tumors

26
Q

What is a major treatment of PCOS?

A

Exercise and weight control

27
Q

In PCOS, this medication is used to reduce insulin-resistance, thus targeting the pathophysiologic basis for PCOS

A

Metformin

28
Q

This condition is a gynecological emergency and results in hypoxia and necrosis of ovary leading to an acute abdomen

A

Ovarian Torsion

29
Q

twisting of ovary or ovary + tube

A

Ovarian Torsion

30
Q

This gynecological emergency can be seen during treatment of infertility with ovulation-inducing medications

A

Ovarian Torsion

31
Q

Acute onset of severe abdominal/pelvic pain often accompanied by nausea and vomiting is the common presentation of what gynecological emergency?

A

Ovarian Torsion

32
Q

What is the clinical definition of infertility in women <35?

A

Women < 35 years: failure to conceive after 12 months of frequent,
unprotected sex

33
Q

What is the clinical definition of infertility in women >35?

A

Women >35 years: failure to conceive after 6 months

34
Q

List some common causes of infertility

A

PCOS
Thyroid disorders
Hyperprolactinemia
History of PID
endometriosis

35
Q

What is the most common teratoma?

A

dermoid cyst

36
Q

A benign germ cell neoplasm

A

Teratoma

37
Q

What is the median age for a teratoma?

A

30 year olds

38
Q

What is the malignancy risk for a teratoma?

A

<1% malignancy risk

39
Q

What percentage of teratomas are bilateral?

A

10-20%

40
Q

What is the pathophysiology of teratomas?

A

Derived from primary germ cells

Contain well-differentiated tissue from all embryonic germ layers

41
Q

What is a risk of teratoma to be worried about and why?

A

High fat content

Causing buoyant tendency in the pelvis 🡪 HIGH risk of torsion!!

42
Q

A surgical removal of a teratoma is the treatment due to the risk of these two complications

A

ovarian torsion

Spillage of contents can lead to chemical peritonitis

43
Q

Benign germ cell tumor

Usually found in young women

Typically asymptomatic finding on bimanual exam

A

Dermoids

44
Q

What percentage of dermoids are bilateral?

A

15%

45
Q

Second most common gynecologic malignancy

A

Ovarian Cancer

46
Q

Most common cause of death of women who develop a gynecologic
malignancy – 50% morbidity

A

Ovarian Cancer

47
Q

What is the lifetime risk of ovarian cancer?

A

1%

48
Q

This is a disease of post-menopausal women, with the highest incidence between 65-74 y/o

A

Ovarian Cancer

49
Q

What therapy does not increase risk of ovarian cancer

A

HRT

50
Q

What percentage of ovarian cancers develop sporadically?

A

90%

51
Q

A familial pattern is seen in patients with family history containing which genes/conditions?

A

BRCA 1

BRCA 2

HNPCC

52
Q

Why is ovarian cancer usually diagnosed at Stage III or IV?

A

Typically develops with few signs or symptoms until the disease is widely disseminated throughout the abdomen

Early diagnosis is difficult due to lack of effective screening tools

53
Q

What is the most common type of ovarian cancer?

A

Epithelial Cell tumors

54
Q

What are the different types of ovarian cancers and how are they categorized?

A

categorized by the cell type

Epithelial Cell tumors
Germ Cell tumors
Stromal Cell tumors

55
Q

List some risk factors for ovarian cancer

A

Genetics (highest) – 8-13% have a genetic predisposition
Early menarche
Late menopause
Nulligravidity/nulliparity
Infertility (NOT infertility treatment)
Endometriosis
Older age
First degree relatives
Environmental

56
Q

What are the lifetime risks of developing ovarian cancer with the BRCA mutations?

A

BRCA1: 50% lifetime risk

BRCA2: 27% lifetime risk

57
Q

What are the lifetime risk of developing ovarian cancer with Lynch Syndrome (HNPCC)?

A

12% lifetime risk

58
Q

What are some environmental risk factors for ovarian cancer?

A

Talc
Smoking
Diet high in fat
Lack of exercise
obesity

59
Q

What are some protective factors against ovarian cancer?

A

Multiparity
OCPs - 5 year usage = 50% reduction
Breastfeeding
Chronic anovulation
Total hysterectomy
Bilateral tubal ligation

60
Q

What is an imperfect test but could potentially help in the screening of ovarian cancer?

A

Ca-125 cancer antigen (>35 is abnormal)

61
Q

Why is Ca-125 cancer antigen an imperfect test for ovarian cancer?

A

May also be elevated in multiple other cancers or disorders – limits its usefulness in premenopausal women

Normal CA-125 does not rule out ovarian cancer

False positives and negatives

62
Q

When elevated in a post-menopausal woman with a pelvic mass, high suspicion but NOT diagnostic for cancer

A

CA-125

63
Q

CA-125 has a better use for what in ovarian cancer?

A

Baseline measurement is useful for evaluating success of treatment – good marker for treatment progress

OB/GYN (14 decks)

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