Mehl. Other ovarian conditions (cysts) 03-24 (1)

Question 1

M. Presents as sudden, sharp pain in an adnexa (adnexa = combo of Fallopian tube + ovary). Dx?

Answer 1

Ruptured ovarian cyst

Question 2

M. The Q will often say there is 10-15 mL of serosanguineous fluid in pouch of Douglas on culdocentesis (means aspiration of pouch of Douglas).
The Q will say there is no mass / will not mention mass. Dx?

Answer 2

Ruptured ovarian cyst

Question 3

M. Ruptured ovarian cyst. CP?

Answer 3

Presents as sudden, sharp pain in an adnexa (adnexa = combo of Fallopian tube + ovary).

Question 4

M. Ruptured ovarian cyst. Tx?!!!

Answer 4

Treated symptomatically (i.e., NSAID). Do not do laparoscopy.

Question 5

M. - 3/4 Qs will give intermittent adnexal pain that becomes constant over hours to weeks (I’ve seen NBME give both time frames). Dx?

Answer 5

Adnexal/ovarian torsion

Question 6

M. 1/4 Qs will just say few-hour Hx of constant pain without the intermittent detail first. Dx?

Answer 6

Adnexal/ovarian torsion

Question 7

M. Presents as “large” adnexal mass (i.e., 8 x 12-cm). Dx?

Answer 7

Adnexal/ovarian torsion

Question 8

M. There will be no mention of fluid in pouch of Douglas. Dx?

Answer 8

Adnexal/ovarian torsion

Question 9

M. Adnexal/ovarian torsion Tx?

Answer 9

Treatment is laparoscopic detorsion.

Question 10

M. Adnexal/ovarian torsion. Tricky detail is that the biggest risk factor is a pre-existing anatomic abnormality (e.g., cyst). So if they say Hx of cyst + now has large adnexal mass and pain, that is torsion, not ruptured cyst.

Answer 10

.

Question 11

M. Arises from theca cells of the ovary; usually bilateral. Dx?

Answer 11

Theca-lutein cyst

Question 12

M. Frequently associated with conditions where hCG is very high, such as moles, multiple gestation pregnancies, or fertility drug use. Dx?

Answer 12

Theca-lutein cyst

Question 13

M. Theca-lutein cyst. Can occasionally bleed, where the answer is “hemorrhagic theca-lutein cyst” as a diagnosis of exclusion (i.e., we eliminate to get there), where endometrioid cyst can be eliminated because the Q won’t mention anything about dysmenorrhea or signs of endometriosis.

Answer 13

.

Question 14

M. Aka endometrioma, or “chocolate cyst.” Dx?

Answer 14

Endometroid cyst

Question 15

M. Endometroid cyst. Cyst filled with endometrial tissue that bleeds.

Answer 15

.

Question 16

M. Occurs in endometriosis (endometrial tissue growing outside the myometrium, usually on the ovary, as with this case; discussed more later). Dx?

Answer 16

Endometroid cyst.

Question 17

M. Dermoid cyst aka?

Answer 17

Aka mature cystic teratoma.

Question 18

M. Dermoid cyst - contains what?

Answer 18

Contains tissue from multiple germ layers – i.e., hair, skin, teeth, etc.
Can calcify.