OnlineMedEd: Gynecology - "Adnexal Mass"

Question 1

How can age help you narrow your differential of adnexal masses?

Answer 1

• Premenarchal: likely cancer (germ cell tumors)
• Reproductive age: probably a cyst
• Postmenopausal: likely cancer (epithelial cell)

Question 2

The best initial evaluation for an adnexal mass is ________________.

Answer 2

TVUS

Question 3

Give the major distinctions on complex vs. simple cyst.

Answer 3

Simple: 
•Small
• Hypoechoic
•Unilocular
•Homogenous

Complex: 
•Large
• Hyperechoic
•Multilocular
• Heterogeneous

Question 4

What is ACOG’s size limit for cyst removal?

Answer 4

10 cm

Question 5

Why is cystectomy recommended for the management of teratomas?

Answer 5

Most often teratomas occur in younger women, and they frequently show up on the other side. If you remove one and then it shows up on the other side and remove that one, then she’s in menopause.

Question 6

List the triad for endometriosis.

Answer 6

• Infertility
• Dyspareunia
• Dysmenorrhea

Question 7

What is the most common site of ectopic implantation?

Answer 7

Ampulla

“There are an AMPLe amount of ectopics in the AMPuLla.”

Question 8

The ß-hCG should be less than ___________ and the gestational sac should be less than _________ to use methotrexate in an ectopic pregnancy.

Answer 8

5,000; 3 cm

Question 9

You need a TVUS with ____________ to fully diagnose ovarian torsion.

Answer 9

doppler

Question 10

Why don’t all TOAs need to be drained?

Answer 10

The ovaries are vascular enough that, like the lungs, antibiotics can treat them alone.

Question 11

What two combinations of antibiotics can treat TOA?

Answer 11

• Clindamycin, gentamicin, and metronidazole

* Cefoxitin, doxycycline, and metronidazole