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OB/GYN > EXAM #1: PELVIC MASSES > Flashcards

EXAM #1: PELVIC MASSES Flashcards

1
Q

What is the definition of adnexa?

A

“Parts attached to the uterus” i.e.

1) Ovaries
2) Fallopian tubes
3) Uterine ligaments

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2
Q

You find an adenxal mass on US. What is the next step?

A
  • Rexamine in 1x month OR

- Laproscopy

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3
Q

How are folliular and CL cysts managed?

A
  • Typically the cyst will regress in a month or two

- Hormone suppression may prevent future cysts

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4
Q

When is operative management indicated for a pelvic cyst?

A

1) Child with pelvic mass
2) Persistent cyst greater than 6cm or symptomatic
3) Menopausal woman with persistent or complex mass

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5
Q

What are the major risks associated with a persistent ovarian cyst?

A

1) Rupture

2) Ovarian torsion (adnexal torsion)

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6
Q

How can a ruptured ovarian cyst be managed?

A

1) Culdocentesis

2) Surgery

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7
Q

What is the most common etiology of ovarian torsion?

A

Benign cystic teratoma

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8
Q

How is ovarian torsion diagnosed?

A

Ultrasound w/ doppler flow

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9
Q

How is ovarian torsion managed?

A

Immediate surgical intervention

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10
Q

What is the most common malignant ovarian tumor?

A

Serous Cystadenocarcinoma

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11
Q

What is the histologic marker for a serous cystadenocarcinoma?

A

Psammoma bodies

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12
Q

What is the most common malignant tumor among children and adolescents?

A

Dysgerminoma

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13
Q

What are the tumor markers associated with Dysgerminomas?

A

LDH

B-hCG

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14
Q

Clinically, what are the concerning features indicating that an adnexal mass is malignant?

A
  • Post-menopausal female
  • Bilateral
  • Solid
  • Irregular
  • Thick-walled
  • Fixed
  • Rapid growth
  • Associated ascites
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15
Q

If a post-menopausal female on estrogen replacement therapy presents to your office asymptomatic. On exam her right ovary is enlarged. What is the next best step in her work-up?

A

TVUS

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16
Q

TVUS on the post-menopausal female in your office shows a cyst that is less than 1cm, what should you do?

A

No follow-up necessary

17
Q

TVUS on the post-menopausal female in your office shows a cyst that is 2-7cm, what should you do?

A

Repeat TVUS in 1 year

18
Q

TVUS on the post-menopausal female in your office shows a cyst that is greater than 7cm, what should you do?

A

Further imaging and surgical evaluation

19
Q

TVUS on the post-menopausal female in your office shows a cyst that is hemorrhagic; she is early-menopause. What next?

A

Repeat US in 6-12 weeks

20
Q

TVUS on the post-menopausal female in your office shows a cyst with a nodule that is without flow; she is late-menopause. What next?

A

Surgical evaluation/ MRI

21
Q

What is a uterine leiomyoma?

A

Uterine fibroid i.e. proliferation of smooth muscle with a pseudocapsule of muscle fibers

22
Q

What age are uterine leiomyomas more common?

A

5th decade

23
Q

What race shows a perdominance for uterine leiomyomas?

A

African American

24
Q

What are the different classes of uterine leiomyomas? Where are these different classes of leiomyomas located?

A

1) Intramural= in the uterine wall
2) Subserosal= beneath the uterine serosa
3) Submucosal= beneath the endometrium

25
Q

How do leiomyomas change with estrogen?

A

Get bigger with estrogen

26
Q

What is the malignant form of a leiomyoma?

A

Leiomyosarcoma

27
Q

What are the red flags for a leiomyosarcoma?

A

1) Post-menopausal bleeding
2) Rapidly enlarging uterine mass
3) Unusual vaginal bleeding
4) Pelvic pain

28
Q

How will a leiomyoma feel on exam?

A

“Lumpy”

29
Q

What is one of the major complications of a very large uterine fibroid?

A

Pressure on the ureter creating:

1) Hydroureter
2) Hydronephrosis

30
Q

How are leiomyomas diagnosed?

A

1) Physical exam
2) US
3) CT/MRI

31
Q

How will a leiomyoma feel on exam?

A
  • Midline
  • Irregular
  • Mobile
  • Hard
32
Q

What are the medical treatment options for leiomyomas?

A

1) Progestin supplementation to minimize bleeding
2) High dose NSAID or Tranexamic acid to treat menorrhagia
3) GnRH agonists to reduce size (esp. pre-op)

33
Q

What surgical procedure can be done for a leiomyoma to preserve fertility?

A

Myomectomy i.e. simply removing the fibroid

*25% of women will end up getting a hysterectomy

34
Q

What is the definitive treatment for leiomyomas?

A

Hysterectomy

35
Q

What surgical procedure can be done to treat the bleeding abnormalities of a leiomyoma?

A

Endometrial ablation

36
Q

What is myolysis?

A

Laproscopic thermal, radiofrequency or cryoablation of leiomyoma tissue

37
Q

What is the IR procedure to treat a leiomyoma? What is a major contraindication for this procedure?

A

Uterine Artery Embolization

*Do NOT do if patient desires future pregnancy

OB/GYN (19 decks)

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