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Special Pops Exam 1 > Ovarian and Uterine Diseases -> > Flashcards

Ovarian and Uterine Diseases -> Flashcards

1
Q

What is an ovarian cyst?

A

A fluid or semi-liquid filled sac which forms on or inside an ovary

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2
Q

Are most ovarian cysts benign or malignant?

A

Benign

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3
Q

Do most ovarian cysts require surgery?

A

No, most resolve without

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4
Q

At what stage of life can ovarian cysts form?

A

Any: infancy to menopause

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5
Q

Epidemiology of ovarian cysts?

A

10-20%

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6
Q

Risk factors for ovarian cysts?

A

Infertility tx, Tamoxifen (benign functional cysts), 2nd trimester of pregnancy (hCG peak), hypothyroidism, smoking, tubal ligation (functional cysts)

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7
Q

3 layers of ovarian tissue?

A

Epithelium, stroma, germ cells

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8
Q

Each layer of ovarian tissue can produce what types of cysts?

A

Benign, malignant, cystic, solid

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9
Q

ddx?

A
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10
Q

Which ovarian cysts are most common and typically asymptomatic?

A

Follicular

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11
Q

Size range of follicular ovarian cysts?

A

3-15 cm

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12
Q

Which ovarian cysts may cause dull pelvic pain?

A

Corpus luteal cysts

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13
Q

Which ovarian cysts are considered functional (physiologic) cysts?

A

Follicular and Corpus luteal

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14
Q

Characteristics of follicular functional cysts?

A

Form when follicle fails to rupture, asymptomatic, simple/unilocular cyst, 3-15cm, often regress spontaneously

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15
Q

Characteristics of corpus luteum functional cysts?

A

Form when there is failure of corpus luteum to regress in 14 days, smaller/3-6cm, firm/solid, more likely to have pain, delayed menses

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16
Q

Oocyte cycle?

A
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17
Q

What may cause a theca-lutein ovarian cyst?

A

High levels of hCG in molar pregnancy, choriocarcinoma, or fertility tx

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18
Q

Characteristics of theca-lutein cysts?

A

Bilateral, massive ovarian enlargement, prone to torsion/hemorrhage/rupture, benign, usually resolve after tx of underlying issue

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19
Q

What causes a luteoma of pregnancy?

A

Proliferation of luteinized stromal cells

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20
Q

Characteristics of a luteoma of pregnancy?

A

Multifocal, bilateral, 5-10cm, hormonally active (androgens), maternal virilization (30%), female fetus virilization (50%)

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21
Q

When do luteomas of pregnancy typically resolve?

A

After delivery

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22
Q

What are endometriomas?

A

Blood filled cysts from ectopic endometrium (chocolate cysts)

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23
Q

What are endometriomas associated with?

A

Endometriosis

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24
Q

What kind of cysts are involved with PCOS?

A

Multiple cystic follicles 2-5mm

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25
Q

What are neoplastic cysts?

A

Overgrowth of cells in the ovary

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26
Q

Are neoplastic cysts malignant or benign?

A

Can be either, yet malignant can form from any cell type

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27
Q
A
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27
Q
A
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28
Q

What are teratomas?

A

Cysts that contain all 3 embryonic germ layers (dermoid cysts)

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28
Q

Most common cell type which causes malignant neoplastic cysts?

A

Surface epithelium (mesothelium)

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29
Q

Do most ovarian cysts cause symptoms?

A

No, most asx

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30
Q

When will malignant cysts tend to cause sx?

A

Late stages

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31
Q

What kind of pain is caused by torsion or rupture of an ovarian cyst?

A

Severe, sudden, unilateral, sharp pain which could radiate to the upper thigh

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32
Q

What can bring on an ovarian cyst rupture/torsion?

A

Exercise, trauma, coitus

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33
Q

Possible symptoms of ovarian cysts?

A

Difficult bowel movements, frequent urination, irregular menses, dyspareunia (genital pain), abdominal bloating/fullness, early satiety, indigestion, heartburn, tenesmus

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34
Q

What triad of symptoms can be caused by endometriomas?

A

Dysmenorrhea, infertility, dyspareunia

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35
Q

What symptoms can be caused by PCOS?

A

Hirsutism, infertility, oligomenorrhea, obesity, acne

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36
Q

Who are ovaries normally palpable in? When should ovaries be non-palpable?

A

Palpable: thin, premenopausal pt
Non-palpable: post-menopausal pt

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37
Q

Large cysts can be palpable, yet what may interfere with palpation?

A

Ascites

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38
Q

Cysts may be _____ to palpation?

A

tender

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39
Q

Ruptured ovarian cysts can cause a patient to become ________ ________.

A

Hemodynamically unstable

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40
Q

Labs for ovarian cyst diagnosis?

A

Urine preg test, CBC (bleeding/infection), urinalysis (?), endocervical swabs (check for chlamydia/gonorrhea), cancer antigen 125 (CA125)

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41
Q

CA125 tests are most useful in conjunction w/ what modality?

A

US

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42
Q

Should CA125 be drawn in acute care settings?

A

No, elevated in cyst rupture, infections, hemorrhage, endometriosis

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43
Q

What lab can help evaluate ovarian cancer progression?

A

CA125

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44
Q

Transvaginal US appearance of normal ovary?

A

2.5cm - 5cm long, 1.5 - 3cm wide, 0.6 - 1.5cm thick

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45
Q

What is the primary tool for ovarian cysts eval?

A

Transvaginal US -> can show morphology and resolution

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46
Q

Simple ovarian cyst appearance on tansvag US?

A

thin walled, uniform, 2.5-15cm diameter

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47
Q

Ovarian torsion appearance on tansvag US?

A

ovarian edema from blocked lymphatic drainage *colored US will show bloodflow

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47
Q

Complex ovarian cyst appearance on tansvag US?

A

multilocular, thick walled, projects into lumen

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48
Q

When is abdominal US used?

A

Large masses and complications, other organs, ascites

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49
Q

Treatment for ovarian cysts?

A

Simple: most require no tx, resolve in ~60d

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50
Q

Tx for neonatal/fetal cysts?

A

Most small and involute w/in first few mos of life, monitor w/ serial US

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51
Q

Tx for ovarian cysts in pregnancy?

A

Most resolve by 14-16wks
if persist and US not suggestive of malignancy –> watch
if sx, pain, rapid growing –> surgery considered after 1st trimester if needed

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52
Q

Management of pre-menopausal asx simple cysts?

A

<8cm on US, normal CA125, rpt US in 8-12 wks

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53
Q

Management of postmenopausal ovarian cysts?

A

If asx, <5cm:
-rpt US in 4-6wks w/ CA125 studies
-half will resolve in 2mos
-if rising CA125 or size, consider surgery

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54
Q

Why is follow up important with ovarian cysts?

A

Malignancy risk rises from 13% in premenopausal to 45% in postmenopausal

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55
Q

Tx for persistent simple ovarian cysts >5-10cm?

A

Laparotomy or laparoscopy
-confirm dx, assess if malignant, obtain fluid, remove cyst w or w/o ovary, assess other ovary/organs

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56
Q

3 complications of ovarian cysts?

A

Rupture, hemorrhage, torsion

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57
Q

What serves as major blood supply and support of the ovaries?

A

Ovarian ligament and vessels (comes from pelvic side wall)

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58
Q

Median age for ovarian torsion?

A

28

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59
Q

20% of ovarian torsions happen when?

A

Pregnancy

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60
Q

How does ovarian torsion occur?

A

Ovary flips over, cuts off blood supply, ovarian tumors (benign or malignant) involved in 50-60% cases (usually dermoid)

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61
Q

2/3 of ovarian torsions are on which side?

A

Right

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62
Q

Presentation of those w/ ovarian torsion?

A

Hx of cyst/pain w/ sex, exercise, trauma
Sx of acute unilateral sharp pain, vomiting, pelvic mass, leukocytosis, fever

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63
Q

PE for ovarian torsion?

A

Nonspecific/variable: tender unilateral pelvic mass, absence of tenderness does not r/o

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64
Q

Tests for ovarian torsion?

A

US w/ color doppler, presence of blood flow on doppler does not r/o

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65
Q

Tx for ovarian torsion?

A

Oophrectomy or untwisting if done immediately

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66
Q

Complications of ovarian torsion?

A

Infection, peritonitis, sepsis, adhesions, chronic pain

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67
Q

Women with PCOs have abnormalities with the metabolism of what?

A

Androgens and estrogen

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68
Q

Cause of PCOS?

A

Unknown but possible abnormal function of hypothalamic-pituitary-ovary (HPO) axis

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69
Q

Pathology of PCOS?

A

Peripheral insulin resistance/hyperinsulinemia, ovaries bilaterally enlarged and spherical w/ multiple 1cm follicles arranged along periphery
“string of pearls”

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70
Q

Hx of those w/ PCOS?

A

Menstrual disorders, hirsutism, infertility, obesity/metabolic syndrome, T2DM, sleep apnea

71
Q

PE for PCOS?

A

Hirsutism/virilizing signs, obesity, acanthosis nigricans, HTN, enlarged ovaries

72
Q

Rotterdam criteria for diagnosing PCOS?

A

2 of the following:
-polycystic ovaries on US, signs of excess androgen (acne, hirsutism, temporal balding, male pattern hair loss), menstrual irreg
*AND r/o Cushing syndrome, adrenal hyperplasia, androgen-secreting tumors

73
Q

DDx for PCOS?

A

Amenorrhea, Cushing synd, Acromegaly, Hyperprolactinemia, hyper/hypo thyroid, ovarian tumors

74
Q

Labs for PCOS?

A

TFTs, serum prolactin, free androgen index, serum hCG, oral glucose tolerance test, infertility w/u

75
Q

Imaging for PCOS?

A

Transvag US

76
Q

Tx for PCOS?

A

Lifestyle changes: diet/exercise
Meds for anovulation/menstrual irreg/hirsutism/acne: oral contraceptives
Endocrinology consult: thyroid/pituitary causes
Surgery: restore ovulation –> electrocautery, laser drilling

77
Q

Special considerations for those w/ PCOS?

A

High risk for COVID-19 (T2DM, NAFLD->MASLD steatotic liver dz, CVD), depression, fertility eval

78
Q

Are most ovarian neoplasms benign or cancerous?

A

Benign

79
Q

What guides the dx/tx of ovarian neoplasms?

A

Age and type of mass

80
Q

What % of ovarian neoplasms are epithelial cystadenomas?

A

60-80% (serous, mucinous, endometrioid, clear cell, transitional cell/benner tumors)

81
Q

Who are serous cystadenomas common in?

A

Peri/postmenopausal *benign

82
Q

What are the largest tumors in the human body?

A

Mucinous cystadenomas

83
Q

What % of ovarian neoplasms are germ cell tumors?

A

20% (mature teratomas aka dermoid cysts)

84
Q

What % of ovarian neoplasms are stromal tumors?

A

*% (thecoma, fibroma, hilus cell)

85
Q

Mucinous or cystadenocarcinoma (epithelial cystadenomas) characteristics?

A

malignant or benign, look cimilar to serous cysts, can be very large

86
Q

Germ cell tumor (mature teratoma/dermoid) characteristics?

A

40-50% of all benign ovarian neoplasms, usually asx unless torsion/rupture, 15% bilateral (may grow up to several kg)

87
Q

Thecomas (stromal neoplasm) are usually found in which pts?

A

Postmenopausal (tumor produces estrogen)

88
Q

Fibromas (stromal neoplasm) are usually found in which pts?

A

Perimenopausal women (incidental finding or >20cm)

89
Q

What is Meig’s syndrome?

A

Ascites, Pulmonary embolism, benign ovarian fibroma

90
Q

What do Hilus cell tumors (Sertoli-Leydig/Hilar-Leydig) (stromal neoplasm) secrete?

A

Androgens (hirsutism, virilization, menstrual irreg)

91
Q

Characteristics of stromal fibromas?

A

Solid mass (benign or malignant)

92
Q

Treatment of ovarian neoplasms?

A

Surgical excision w/ exploration of abdomen, possible unilateral oophrectomy, based on pathology of neoplasm, options weighed if fertility is a concern

93
Q

Why are malignant ovarian neoplasms called “the silent killer”?

A

Any ovarian neoplasm can be malignant, all 3 layers have malignant counterparts, presentation is vague

94
Q

1 cause of GYN cancer deaths?

A

Ovarian CA

95
Q

Survival rate for ovarian CA?

A

Low d/t not being diagnosed until later stages

96
Q

Most common type of ovarian CA?

A

Epithelial *MC > Germ cell > Stromal

97
Q

Majority of epithelial neoplasms causing ovarian CA?

A

Serous: bilateral and dx late

98
Q

Diagnosis rate of mucinous (epithelial) neoplasms causing ovarian CA?

A

usually early dx & unilateral

99
Q

Endometrioid and clear cell neoplasms (epithelial) causing ovairan CA are associated w/ what?

A

Endometriosis

100
Q

A majority of stromal tumors causing ovarian CA are what type?

A

Granulosa-Theca cell tumors (hormone secretors!)

101
Q

Risk factors for ovarian CA?

A

FAMILY HX** (BRCA1, BRCA2), inc age, nulliparity, early menarche (<12), late menopause (>50), caucasian>hispanic>AA>asian, infetility

102
Q

Protective factors against ovarian CA?

A

Use of OCPs (50% reduction w/ 15yrs use), breast feeding, multiple pregnancies

103
Q

BRCA1 has what lifetime risk of ovarian CA?

A

35-45%

104
Q

Family hx alone has what time of lifetime risk of ovarian CA?

A

2-10%

105
Q

BRCA2 has what lifetime risk of developing ovarian CA?

A

15-24%

106
Q

Familial ovarian CA runs in what descents?

A

Ashkenazi jewish, french canadians, icelandic

107
Q

Prevention for those w/ fam hx of ovarian CA?

A

Annual US, prophylactic ovary removal

107
Q

Sx of ovarian CA?

A

Inc. abdominal girth, abdominal pain, early satiety, urinary frequency/urgency, weight gain, change in bowel habits

108
Q

PE for ovarian CA?

A

Ascites, pelvic mass (usually fixed, hard, irreg), pleural effusion

109
Q

How to diagnose ovarian CA?

A

Transvag US (complex cystic/solid mass), elevated CA125, elevated Inhibin B (granulosa cell tumors, epithelial mucinous tumors), surgical tissue dx

110
Q

Testing for ovarian CA per Society of Gynecologic Oncology?

A

CT of abdomen, pelvis, chest

111
Q

Testing for ovarian CA per National Comprehensive Cancer Network Guidelines?

A

US and/or abd/pelvic CT or MRI, CXR

112
Q

If there are upper GI sx with ovarian CA, what tests should be done?

A

Upper/Lower endoscopy, barium enema, upper GI series

113
Q

What evaluation is done for dx/staging of ovarian CA?

A

Surgical

114
Q

Treatment for ovarian CA?

A

Surgery, chemo, marker evaluation (CA125)

115
Q

What is the most common benign neoplasm of the uterus?

A

Leiomyoma (fibroids)

116
Q

Who is Leiomyoma (fibroids) most common in?

A

Women 40+, AA

117
Q

Pathology of Leiomyoma (fibroids)?

A

Arise from smooth muscle, usually benign, tissue examination needed for dx

118
Q

Types of fibroids?

A

Intramural, pedunculated subserosal, pedunculated submucosal, subserosal, submucosal

119
Q

Presentation of uterine fibroids (Leiomyoma)?

A

Heavy menses: usually d/t submucosal fbroids (cannot be felt on exam), pelvic fullness, inc abd girth, frequent urination, dypareunia, lower back pain or no sx

120
Q

Diagnostics for fibroids (Leiomyoma)?

A

US (abd or transvag), MRI, CT, Hystersalpingogram (HSG): Fluoroscopy, Sonohystogram (injects water into uterus and uses ultrasound)

121
Q

Hystersalpingogram (HSG): Fluoroscopy process?

A

Contrast (iodine) injected into uterus through catheter, uterine cavity and fallopian tubes opacified on image

122
Q

Treatment option 1 for fibroids?

A

Watchful waiting

123
Q

Treatment option 2 for fibroids?

A

Multivitamin, iron supplements, NSAIDS, hormonal tx (w/ caution): estrogen-progestin OCP, Levonorgestrel releasing uterine system, progestin implants/inj/pills, gonadotropin releasing agents

124
Q

Treatment option 3 for fibroids?

A

Hysteroscopy, removal of submucosal fibroids using electrocautery wire (hysteroscopic myomectomy)
*large submucosal fibroids not eligible)

125
Q

Treatment option 4 for fibroids?

A

Endometrial ablation: radiofrequency, freezing, heated fluid, microwave, cautery

126
Q

Treatment option 5 for fibroids?

A

Embolization: using arterial catheterization synthetic emboli are introduced to artery feeding fibroid

127
Q

Treatment option 6 for fibroids?

A

Hysterectomy *most utilized, 70% of all fibroid procedures in US

128
Q

Treatment option 7 for fibroids?

A

Myomectomy: hysteroscopic, laparoscopic, abdominal
*monitor for reoccurrence @ 3mos, 6mos, yearly

129
Q

Treatment option 8 for fibroids?

A

Focused ultrasound surgery: high intensity US energy to induce coagulative necrosis of fibroids

130
Q

Most common diagnosed GYN malignancy?

A

Endometrial CA (ovarian is #2)

131
Q

Most common population who develop endometrial CA?

A

Women 70+, white>AA

132
Q

RF for endometrial CA?

A

Age, obesity, DM, HTN, nulliparity, late menopause, early menses, caucasian, PCOS, chronic anovulation, hx of breast CA, hereditary nonpolyposis colorectal CA, Tamoxifen, Estrogen alone

133
Q

What reduces the chance of developing endometrial CA?

A

Cigarette smoking

134
Q

Pathophys of endometrial CA?

A

Precursor lesion, endometrial hyperplasia (thickening of endometrium, thicker lining = heavier period, can slowly progress to CA if untreated)

135
Q

Presentation of endometrial CA?

A

Heavy bleeding, postmenopausal bleeding

136
Q

Sx of endometrial CA?

A

Abnormal menses in 80%, postmenopausal bleeding
advanced: abd pain, bloating, weight loss, change in bowel/bladder habits

137
Q

Classic presentation of someone with endometrial CA?

A

Obese, nulliparous, infertile, HTN, DM, white women

138
Q

PE of endometrial CA?

A

Uterus can be normal size

139
Q

Labs for endometrial CA?

A

CBC, UA, endocerv/vag cytology, glucose, LFT, BUN/CR
*40% missed on pap
*CA125 not utilized

140
Q

All post menopausal women w/ endometrial cells on routine pap require what?

A

Eval for uterine CA w/ endometrial sampling

141
Q

Tests for endometrial CA?

A

US: thickening of endometrium (if <4mm no D&C unless bleeding continues), D&C: definitive for dx, endometrial biopsy for dx

142
Q

Differential dx for endometrial CA?

A

Polyps, fibroids, cervical CA

143
Q

Tx for endometrial CA?

A

Surgery (hysterectomy, bilat salpingo-oophrectomy, pelvic lymphadenectomy), radiation (indicated if invasion of myometrium), hormonal tx w/ progesterone

144
Q

Prognosis for endometrial cancer?

A

Good, many found in stage 1 bc of recognizable sx (10% of postmenopausal bleeding = cancer)

145
Q

Surveillence/follow up after tx for endometrial CA?

A

Every 3-4 mos for 1st 2 years (85% recurrence happens in first 2 yrs), then q6mos for next 3 yrs, then annually

146
Q

Each post-CA visit for endometrial CA involves what?

A

Pelvic exam, pap, lymph node survey, CXR annually

147
Q

Uterine sarcoma accounts for how many uterine malignancies?

A

3-4%
Carcinosarcomas > Leiomyosarcomas > endometrial stromal sarcomas

148
Q

Average age of dx of uterine sarcoma?

A

50

149
Q

Are uterine sarcomas aggressive?

A

YES, poor prognosis

150
Q

Who are uterine sarcomas more common in?

A

AA

151
Q

Presentation of uterine sarcoma?

A

Abornmal bleeding, pelvic pain, constipation, urinary frequency, uterus enlarged, if advanced inguinal/supraclavicular node metastases

152
Q

How to dx uterine sarcoma?

A

Endometrial bx, D&C, if indeterminate –> laparotomy (check all viscera/nodes)

153
Q

Workup for uterine sarcoma?

A

Labs: CBC, US, LFT
Imaging: CXR, Abd/pelvic CT/US, sigmoidoscopy, cystoscopy

154
Q

Tx for uterine sarcoma?

A

Surgery, chemo, radiation

155
Q

Complications of uterine sarcoma?

A

Anemia, sepsis, uterine rupture, hemorrhage, metastasis, ascites

156
Q

Pathophys of uterine adenomyosis?

A

extension of endometrial glands into uterine musculature

157
Q

S/SX of uterine adenomyosis?

A

Severe dysmenorrhea, heavy bleeding, chronic pelvic pain, may be asx

158
Q

PE for uterine adenomyosis?

A

Enlarged boggy uterus

159
Q

Dx for uterine adenomyosis?

A

Clinical, r/o other major causes of bleeding/pain
Endometrial bx, D&C or hysteroscopy will r/o endometrial CA

160
Q

Labs for uterine adenomyosis?

A

Pregnancy, anemia, TFT, pituitary dysfunction, bleeding d/o, STIs

161
Q

Imaging for uterine adenomyosis?

A

Transvag US: diffusely enlarged, globular, asymmetric uterus, myometrial mass w/ ill defined borders

162
Q

Tx for uterine adenomyosis?

A

Anti-inflammatory drugs & hormonal therapy, hysterectomy

163
Q

What is endometriosis?

A

When endometrial tissue grows outside of the endometrial cavity in pre-menopausal women (usually 20-30’s)
*primary cause of infertility

164
Q

RF for endometriosis?

A

Fam hx, early menses, long duration of menstrual flow, heavy bleeding, shorter cycles

165
Q

Protective factors for endometriosis?

A

Regular exercise, higher parity, longer duration of lactation

166
Q

Pathophys of endometriosis?

A

Ectopic endometrial tissues –> ectopic foci respond to cyclic hormonal fluctuations same way as normal intrauterine endometrium –> leads to pain/adhesions

167
Q

Common sites of implantation for endometriosis?

A

Ovary MC, fallopian tubes, uterine cul de sac, uterosacral ligaments, uterus, colon, lung (recurrent right pneumothorax at time of menses = catamenial pneumo), brain (catamenial seizures), scar tissue

168
Q

S/Sx of endometriosis?

A

Extent does not correlate w sx, may be asx
Sx: dysmenorrhea, dyspareunia, infertility, chronic pelvic pain, cyclic pains at implantation sites

169
Q

PE for endometriosis?

A

May have no evidence, *tender nodules on posterior uterus of cul-de-sac, pain w/ uterine motion, uterus may be fixed/retroverted from adhesions, tender adnexal mass (endometrioma), implants in healed wounds

170
Q

Dx of endometriosis?

A

Direct visualization of lesions/implants REQUIRED (laparoscopy)
*imaging does not help unless to r/o other d/o

171
Q

Workup for endometriosis?

A

Detailed H&P, urine culture, UA, CBC, cervical gram stain/culture, US, MRI, CT, FNA

172
Q

Complications of endometriosis?

A

Adhesions, infertility, chronic pain, endometriomas, obstruction/impairment of organs, catamenial pneumo (72 hours prior/post menses), catamenial seizures

173
Q

Tx for endometriosis depends on what?

A

Based on severity, location, desire for childbearing: medical or surgcial

174
Q

First line medical tx for endometriosis?

A

6-9 month trial of NSAIDs & hormonal tx (interrupt cycles of endometrial tissue)

175
Q

Second line medical tx for endometriosis?

A

High dose progestin (Medrocyprogesterone acetate) Danazole (pseudomenopause),
GnRH agonsists (suppresses FSH/LH, dec estrogen and implantation) -> limited to 6mos

176
Q

Surgical tx for severe endometriosis?

A

Conservative (preserve fertility): attempt to destroy endometriotic tissue, remove adhesions, remove endometriomas

Definitive: total abdominal hysterectomy, bilateral salpingo-oophrectomy (BSO-TAH) and excision of adhesions/implants)

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