Gynae - Ovarian

Question 1

features of PCOS?

Answer 1

obese
hypertension
acne
hirsutism
alopecia
irregular periods
insulin resistance

Question 2

what is the diagnostic criteria for PCOS?

Answer 2

rotterdam (must have 2)

clinical/biochem evidence of hyperandrogenism

PCOS on scan (>12 follicles or volume >10cm)

oligo/amenorrhoea

Question 3

Ix for PCOS?

Answer 3

LH/FSH
testosterone
SHBG
OGTT
lipids
TVUS

Question 4

Tx for PCOS?

Answer 4

wt loss
stop smoking

COCP/mirena
dianette (for acne/hirsutism)

Question 5

what infertility Tx can be given in PCOS?

Answer 5

clomifene
metformin
ovarian drilling
IVF

Question 6

what are those with PCOS at risk of?

Answer 6

T2DM
CVS problems
endometrial hyperplasia/cancer

Question 7

what drug can be given to those with PCOS to help with weight loss? how does it work?

Answer 7

orlistat

lipase inhibitor, stops fat absorption in the intestines

Question 8

in PCOS, what happens to the hormones?

Answer 8

insulin increased
promotes androgen release
supresses SHBG
halts follicle development

no ovulation, no progesterone, unopposed oestrogen production

Question 9

risk factors for ovarian cysts?

Answer 9

pre menopause
early menarche
PCOS
pregnant
endometriosis

Question 10

features of ovarian cysts?

Answer 10

pelvic mass
pain
torsion 
abdo mass
bloating

Question 11

what is a follicular cyst?

Answer 11

when follicle fails to rupture and release an egg

Question 12

what cysts are associated with pregnancy?

Answer 12

corpus luteum cyst

Question 13

what cysts are associated with torsion?

Answer 13

dermoid cysts

come from germ cells (teratomas)

Question 14

what markers are used to investigate germ cell tumours?

Answer 14

AFP
HCG
LDH

Question 15

what Ix should be done for ovarian cysts? if raised, what next?

Answer 15

Ca-125

2wk referral for US

Question 16

Tx for
<5cm
5-7cm
>7cm

cysts in premenopausal women?

Answer 16

<5cm resolve in 3 cycles
5-7cm yearly monitoring (US)
>7cm CT/imaging

Question 17

what is the triag in Meig’s syndrome?

Answer 17

pleural effusion (transudate <30g/L)
ascites
ovarian fibroma

Question 18

risk factors for ovarian torsion?

Answer 18

pregnancy
benign mass (dermoid cyst)
pre menarche

Question 19

features of torsion?

Answer 19

sudden unilateral pain
N+V
adenexal tenderness
palpable mass

Question 20

Ix and findings for torsion?

Answer 20

US

whirlpool sign

Question 21

Tx for torsion?

Answer 21

laproscopic detorsion/oophorectomy

Question 22

risk factors for ovarian cancer?

Answer 22

>50
increased ovulations
FHx (BRCA)
HNPCC
not breastfeeding 
obese
smoking

Question 23

features of ovarian cancer?

Answer 23

bloating 
reduced appetite
wt loss
pain
ascites
urinary symptoms
bowel changes 
SOB
mass

Question 24

what are clear cell tumours associated with? are these malignant?

Answer 24

endometriosis
lynch syndrome

MALIGNANT

Question 25

what types of ovarian cancer exist? what is the most common?

Answer 25

epithelial (most common)
germ cell
sex cord

Question 26

Ix for ovarian cancer?

Answer 26

Ca 125
CEA 
FBC, HCG, LFTs, TFTs
US
CT
cytology if ascites/pleural effusion

Question 27

what can cause a raised Ca 125?

Answer 27

fibroids
pelvic infection
liver disease
pregnancy
endometriosis

Question 28

staging of ovarian cancer?

Answer 28

1A - one ovary
B - two

2A - fallopian tubes
B - bowel/bladder

3A - lining of abdo
B - <2cm on abdo
C - lymph nodes

Question 29

Tx for ovarian cancer?

Answer 29

1B-2 - fertility conserving surgery

+ chemo