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Women's Health > Lecture 12: Ovarian Disorders > Flashcards

Lecture 12: Ovarian Disorders Flashcards

1
Q

A large functional ovarian cyst can often cause these 2 symptoms:

A
  • Constipation
  • Urinary Frequency

Crushing bladder or rectum

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2
Q

The ideal way to identify a functional ovarian cyst is via…

A

Pelvic US

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3
Q

The MC type of functional ovarian cyst is a…

A

Follicular ovarian cyst

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4
Q

The primary cause of a follicular cyst is….

A

Failure to develop during ovulation

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5
Q

Usually, one would expect someone with a small follicular cyst to show signs of…

A

Nothing

Asymptomatic usually

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6
Q

Someone with a LARGE follicular cyst might complain of… (2)

A
  • Aching pelvic pain
  • Dyspareunia
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7
Q

The initial approach to management of a follicular cyst is…

A

Observation

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8
Q

If a patient has a particularly large follicular cyst, you might suggest that they get a

A

Cystectomy

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9
Q

A corpus luteum cyst is primarily due to

A

Failure to involute

Normal formation. Abnormal involution.

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10
Q

A corpus luteum cyst can mimic a …. pregnancy

A

Ectopic

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11
Q

A severely bleeding/ruptured corpus luteum cyst can eventually lead to…

A
  • Acute abdomen
  • Hypovolemic shock
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12
Q

The general approach to managing corpus luteum cysts is…

A

Observation.

Only manage if symptomatic

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13
Q

The cause of a theca lutein cyst is usually

A

Elevated hCG

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14
Q

Theca lutein cysts often occur bilaterally and are filled with…

A

Clear fluid

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15
Q

Generally, the MC complaint related to a theca lutein cyst is…

A

Pelvic heaviness/aching

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16
Q

Generally, the approach to management for theca lutein cysts is…

A

Treat underlying cause or observe

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17
Q

Endometriomas are typically seen in patients that suffer from…

A

Endometriosis

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18
Q

Endometriomas, also known as chocolate cysts, are caused by….

A

Endometric foci on the ovarian surface.

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19
Q

Besides pelvic pain and dysmenorrhea and infertility, a lab/tumor marker that may be elevated with endometriomas is….

A

CA-125

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20
Q

Generally, the approach to tx for an endometrioma is…

A

Same as endometriosis.

Can remove laparoscopically

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21
Q

Dermoid cysts are known for being filled with…

A

Weird stuff: fat, hair, teeth, bone, cartilage

a common ovarian cyst in PREmenopausal women

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22
Q

A dermoid cyst is more likely to occur in pre or postmenopausal women?

A

Pre

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23
Q

The main concern with a cystadenoma is that…

A

It grows so big

Benign

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24
Q

PCOS/Stein-Leventhal Syndrome is characterized by persistent anovulation, due to… (3)

A
  • Enlarged polycystic ovaries
  • Secondary amenorrhea or oligomenorrhea
  • Obesity, hirsutism, infertility
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25
Q

Half of PCOS are ….
The Other half of PCOS are ….

A
  • 50% Hirsute
  • 50% or more obese

Hairy

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26
Q

Generally, there are 4 possible etiologies for PCOS, which are…

A
  • Genetics
  • HPO dysfunction (altered LH/folliculogenesis)
  • Insulin resistance/obesity
  • Hyperandrogenism
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27
Q

The diagnosis of PCOS requires at least 2 of the following 3 criteria:

A
  1. Oligomenorrhea/amenorrhea (same as ovulation)
  2. Hyperandrogenism
  3. PCOS on US showing Oyster ovaries
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28
Q

The leading cause of female infertility is…

A

PCOS

Lots of pregnancy complications

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29
Q

Overall, PCOS results in a….

A

Decreased quality of life

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30
Q

Most hirsutism cases are caused by

A

Secondary to PCOS

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31
Q

Although PCOS can result in some male features, you will NOT SEE

A

Virilization

Muscle mass, breast size changes, deepened voices, clitoromegaly

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32
Q

T/F You can see acanthosis nigricans in PCOS as well

A

True

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33
Q

Which hormone is generally decreased in PCOS?

A

SHBG

Sex hormone binding globulin

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34
Q

Pelvic US for PCOS will show…

A

Multiple cysts/follicles BILATERALLY

20-25+

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35
Q

What hormone levels correspond to anovulation?

A

Persistently high LH and low FSH

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36
Q

Generally, pts with PCOS that have regular periods and mild hyperandrogenism with no desire to conceive should be managed via…

A
  • Regular screenings for lipids, DM, and wt
  • Lifestyle changes (wt loss)
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37
Q

COCs are used for PCOS treatment cause they do two things:

A
  1. Induce regular menses (estrogen)
  2. Antagonize endometrial proliferation (progesterone)
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38
Q

A female patient with PCOS on COCs has not had menses for 4 weeks. The first test you order is…

A

pregnancy test

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39
Q

You have a patient with PCOS that has a hx of VTE or something that contraindicates estrogen. The hormone therapy they would best benefit from is…

Honestly i forgot what estrogen does lmao

A

Progesterone-only therapy

Oral or IUD

40
Q

Progestone-only therapy cannot treat a set of symptoms in PCOS, which is…

A

Hyperandrogenism symptoms

41
Q

PCOS is similar to DM2 in its effect on insulin, so the first-line tx to improve insulin sensitization is….

A

METFORMIN

42
Q

Your patient with PCOS is tired of all this hair on her chest. You recommend that they take….

A

COCs

First-line tx

43
Q

Your patient with PCOS is tired of hair on their chest but they have a hx of VTE or something that contraindicates estrogen. In order to tx their hirsutism pharmacologically, you would recommend… but it has a big SE of …

A

GnRH agonists, but warn about BONE LOSS

44
Q

The two non-pharm ways of treating hirsutism are…

A
  • Depilation (hair removal ABOVE skin)
  • Epilation (complete hair removal)
45
Q

The issue with using eflornithine hydrochloride/Vaniqa cream for hirsutism is that…

A

It does not permanently remove hair, it just stops it from growing.

46
Q

Spironolactone oftens works great in combo with contraceptives for hirsutism in PCOS; however, it needs to be stopped if the patient develops…

A

Pregnancy

47
Q

5-alpha-reductase inhibitor use in females with PCOS is dangerous if they are pregnant and…

A

Their fetus is male

BPH tx drug

48
Q

The primary etiology to tx acne 2/2 PCOS is…

A

Lowering androgen levels

COCs, spironolactone/finasteride, + acne meds

49
Q

…. Treatments generally do not improve acanthosis nigricans

A

Topical

You need like oral metformin

50
Q

The first-line tx to induce ovulation in someone with PCOS is…

A

Wt loss and exercise

51
Q

The first line medication to induce ovulation in pts with PCOS is…

A

Letrozole

Aromatase inhibitor

52
Q

The advantages of letrozole over clomiphene citrate/clomid for ovulation induction in PCOS are… (5)

A
  • More monofollicular development
  • Shorter half-life (48 hrs vs 2wk)
  • No antiestrogen effect on endometrium
  • Lower serum estradiol levels
  • Higher rates of live birth, esp in obese women

Letrozole for Live (births)!

53
Q

The most serious side effect of clomiphene citrate/clomid is…

A

Ovarian hyperstimulation syndrome

54
Q

Clomiphene citrate/clomid interacts with any drug that acts on the HPO axis, such as … (5)

A
  • Estrogens
  • SERMs
  • Aromatase inhibitors
  • Gonadotropins
  • GnRH agonists
55
Q

Although clomiphene citrate can induce ovulation 75% of the time in PCOS, the issue lies with…

A

The pregnancy is only successful 40% of the time

56
Q

The issue with exogenous gonadotropins to induce ovulation in PCOS is…

A

High risk of ovarian hyperstimulation syndrome

57
Q

The primary pathology of ovarian hyperstimulation syndrome is…

A

Vascular hyperpermeability (3rd spacing)

58
Q

Generally, mild ovarian hyperstimulation syndrome presents with… (3)

A
  • Bloating
  • N/V/D
  • Wt gain
59
Q

A patient with PCOS that recently took clomiphene citrate to get pregnancy has developed oliguria, polydipsia, dark urine, and has increased her wt by abt 2 lbs/day. You suspect she is suffering from (severity) ….

A

Moderate Ovarian Hyperstimulation Syndrome

60
Q

Generally, to treat Ovarian Hyperstimulation Syndrome, you would first…

A

D/C med (most likely synthetic FSH, then clomid)

Supportive care, as it resolves in 1-2 weeks upon med DC

61
Q

PCOS can be treated surgically via…

A
  • Laparoscopic ovarian surgery (lots of little holes)
  • Oophorectomy

Stab the ovaries or take em out

62
Q

The MCC of ovarian torsion is…

A

Ovarian enlargement

63
Q

If ovarian torsion occurs, the tx is…

A

Surgery

64
Q

Classically, ovarian torsion presents with

A
  • Sudden onset
  • Severe, unilateral lower abd pain
  • Usually right side

Can also see fever, N/V, adnexal mass on exam, vaginal bleeding

Can also present with just pain and no tenderness (:

65
Q

The imaging of choice for ovarian torsion is…

A

Sonography

66
Q

A sonographic study of an ovarian torsion would probably show…

A
  • Multiple follicles rimming an enlarged ovary
  • Bulls-eye, whirlpool, snailshell
67
Q

Tx of an ovarian torsion is accomplished via 2 possible ways:

A
  • Laparoscopic detorsion
  • Laparotomy detorsion

Cystectomy done during or after.

68
Q

If an ovarian torsion turns necrotic, the only tx is…

A

Oophorectomy

69
Q

Post-op ovarian torsion monitoring includes making sure the patient doesn’t develop… (3)

A
  • Fever
  • Leukocytosis
  • Peritonitis
70
Q

The MC source of ovarian cancer is from … cells

A

Epithelial ovarian cells (EOC)

>90% of all malignant ovarian tumors

71
Q

Ovarian cancer tends to occur in pts right around…

A

Menopause

72
Q

75% of all epithelial ovarian cells tend to result in…

A

Serous cystadenocarcinomas

73
Q

The tumor marker most associated with ovarian cancer is…

A

CA-125

Also for endometriomas i think

74
Q

Germ cell tumors have a better prognosis than EOC, and the labs they are most associated with are… (3)

A
  • AFP
  • hCG
  • LDH
75
Q

When do germ cell tumors tend to appear?

A

20s-30s

76
Q

Granulosa cell tumors are most associated with the hormone…

A

Inhibin

77
Q

Sex Cord-Stromal Tumors are most commonly associated with the hormone…

A

estrogen

78
Q

The strongest positive risk factor for ovarian cancer is…

A

Positive FHx

79
Q

What are the 5 negative risk factors associated with ovarian cancer?

A
  • OCP use
  • BFeeding
  • Progesterone therapy
  • Tubal ligation
  • Hysterectomy/Salpingectomy
80
Q

The oncogenes most associated with Ovarian cancer are…

A

BRCA1 (highest) and BRCA2

81
Q

The 3 ethnicities with the highest hereditary risk of ovarian cancer?

A
  • Ashkenazi Jewish
  • French Canadian
  • Icelandic descent
82
Q

This condition is primarily associated with increased CRC risk, but also slightly increases ovarian cancer risk. It is…

A

Hereditary Nonpolyposis CRC Syndrome

Lynch syndrome

83
Q

The prophylactic surgery offered to women with a strong genetic predisposition to ovarian cancer is…

A

Bilateral salpingo-oophorectomy

BSO, removal of tubes + ovaries

84
Q

Why is ovarian cancer not commonly caught early?

A

Vague symptoms. Not severe enough to seek medical attention.

85
Q

Some of the late signs of ovarian cancer include… (4)

A
  • Ascites
  • Nausea
  • Anorexia
  • Dyspnea
86
Q

The classic finding for ovarian cancer on physical exam is a…

A

Solid, fixed, irregular adnexal mass

87
Q

LAN in what two areas might make ovarian cancer suspicious?

A
  • Inguinal
  • Sister Mary Joseph’s nodule
88
Q

What serum tumor marker is elevated in over 80% of late ovarian cancer cases?

A

CA-125

89
Q

CA-125 levels are only useful in women that are ….

A

postmenopausal

Only order it in someone over 50

90
Q

Generally in younger patients, the preferred lab studies to check for ovarian cancer are…

A
  • AFP
  • LDH
  • hCG

Germ cell tumors are more likely in a younger pt.

91
Q

What lab study is generally used to MONITOR ovarian cancer?

Not for screening!

A

HE4

92
Q

On Pelvic US, what findings are most suggestive of cancer?

A
  • Solid
  • Septations
  • Ascites
93
Q

The definitive dx of ovarian cancer requires…

A

Biopsy and pathology

94
Q

For EOC cancers, the treatment is…

A

Surgical intervention via tumor removal and contralateral adnexa removal.

Hysterectomy and infracolonic omentectomy are often performed

95
Q

Persistent ovarian cancer dz despite chemotherapy and surgery is suggested by…

A

Elevated CA-125

i feel like theyre gunna want this exact number memorized…

96
Q

Unlike EOC ovarian cancers, germ cell tumors do not require the removal of…

A

Contralateral adnexa if normal-appearing.

97
Q

Overall, ovarian cancer is the …. MC gyn malignancy and the MCC of death in GYN malignancies

A

2nd MC

Endometrial is #1

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