Ovarian Cysts

Question 1

Ovarian cysts are fluid filled sacs that are related to fluctuating hormone levels as part of the menstrual cycle. Which 2 groups of women are most likely to experience ovarian cysts?

1 - premenopausal
2 - fertile women
3 - miscarriage women
4 - postmenopausal

Answer 1

1 - premenopausal
- most common in this group but less likely to become malignant

4 - postmenopausal
- increased risk of malignancy

Question 2

Patients with multiple ovarian cysts, described as a ring of pearly may be diagnosed with polycystic ovarian syndrome (PCOS). However, how many of the following, along with multiple ovarian cysts, must they have before being diagnosed with PCOS?

• Anovulation
• Hyperandrogenism
• Polycystic ovaries on ultrasound

1 - all 3
2 - 1 or more
3 - 2 or more

Answer 2

3 - 2 or more

Question 3

Most patients with ovarian cysts are symptomatic. However, patients can report all of the following symptoms EXCEPT which one?

1 - sudden and severe pain
2 - general pelvic pain
3 - bloating / full abdomen
4 - palpable pelvic mass

Ovarian cysts may present with acute pelvic pain if there is ovarian torsion, haemorrhage or rupture of the cyst.

Answer 3

1 - sudden and severe pain
- pain is typically dull in nature

• cysts are typically detected on scans for other investigations

Question 4

Most patients with ovarian cysts are symptomatic. However, patients can present with all of the following in an acute setting causing severe acute pain. Which of the following can cause this?

1 - ovarian torsion
2 - haemorrhage
3 - rupture of the cyst
4 - all of the above

Answer 4

4 - all of the above
- all of these must be treated immediately

Question 5

Which 2 of the following are physiological cysts?

1 - Corpus luteum cysts
2 - Follicular cysts
3 - Serous Cystadenoma
4 - Endometrioma

Answer 5

1 - Corpus luteum cysts
2 - Follicular cysts

• corpus luteum is what is left from the dominant follicle after rupture of the ovum during ovulation

Question 6

There a lots of different types of cysts. Which of the following matches the following description:

• developing follicle does not rupture during ovulation. They have thin walls, no internal structures and disappear after a few menstrual cycles.

1 - Corpus luteum cysts
2 - Follicular cysts
3 - Serous Cystadenoma
4 - Endometrioma

Answer 6

2 - Follicular cysts
- the most common type of ovarian cysts

Question 7

There a lots of different types of cysts. Which of the following matches the following description:

• corpus luteum fails to break down and instead fills with fluid. Can cause pelvic discomfort, pain or delayed menstruation and seen in early pregnancy.

1 - Corpus luteum cysts
2 - Follicular cysts
3 - Serous Cystadenoma
4 - Endometrioma

Answer 7

1 - Corpus luteum cysts

Question 8

There a lots of different types of cysts. Which of the following matches the following description:

• corpus luteum fails to break down and instead fills with fluid. Can cause pelvic discomfort, pain or delayed menstruation and seen in early pregnancy.

1 - Corpus luteum cysts
2 - Follicular cysts
3 - Serous Cystadenoma
4 - Endometrioma

Answer 8

Question 9

There a lots of different types of cysts. One category of these are called benign epithelial cysts derived from the epithelial cells surrounding the ovaries. Which matches the following definition?

• contain serous fluid and histologically have tubal origin

1 - Serous Cystadenoma
2 - Mucinous Cystadenoma
3 - Serous Cystadenoma
4 - Endometrioma

Answer 9

1 - Serous Cystadenoma
- most common epithelial cyst

Question 10

There a lots of different types of cysts. One category of these are called benign epithelial cysts derived from the epithelial cells surrounding the ovaries. Which matches the following definition?

• filled with thick mucoid fluid, larger than other epithelial cysts, and likely to have originated from endocervix

1 - Serous Cystadenoma
2 - Mucinous Cystadenoma
3 - Serous Cystadenoma
4 - Endometrioma

Answer 10

2 - Mucinous Cystadenoma

Question 11

There a lots of different types of cysts. One category of these are called benign epithelial cysts derived from the epithelial cells surrounding the ovaries. Which matches the following definition?

• typically benign, but can become malignant. Arise from uroepithelials cells and can contain transitional epithelium. Solid with a pale yellow tan and can be bilateral

1 - Serous Cystadenoma
2 - Mucinous Cystadenoma
3 - Serous Cystadenoma
4 - Brenner tumours

Answer 11

4 - Brenner tumours

Question 12

There a lots of different types of cysts. One category of these are called benign germ cysts. These are derived from germ cells (cells that become eggs in the ovaries). Which matches the following definition?

• commonly referred to as a dermoid cyst, median age at presentation is 30 y/o, can contain teeth, hair, bone and intestines, can undergo torsion.

1 - Mature solid teratoma
2 - Mucinous Cystadenoma
3 - Mature cystic teratoma
4 - Brenner tumours

Answer 12

3 - Mature cystic teratoma

• most common in premenopausal women

Question 13

There a lots of different types of cysts. One category of these are called benign germ cysts. These are derived from germ cells (cells that become eggs in the ovaries). Which matches the following definition?

• contains mainly neural elements and can undergo torsion.

1 - Mature solid teratoma
2 - Mucinous Cystadenoma
3 - Mature cystic teratoma
4 - Brenner tumours

Answer 13

1 - Mature solid teratoma
- they are solid in nature

Question 14

There a lots of different types of cysts. One category of these are called benign sex chord stromal cysts. These are derived from the stromal tissue (supportive tissue of ovaries) and sex cords (embryonic structures associated with the follicles). Which matches the following definition?

• benign solid tumour that can secrete estrogen, causing postmenopausal bleeding

1 - Mature solid teratoma
2 - Mucinous Cystadenoma
3 - Theca cell tumours
4 - Brenner tumours

Answer 14

3 - Theca cell tumours

Question 15

There a lots of different types of cysts. One category of these are called benign sex chord stromal cysts. These are derived from the stromal tissue (supportive tissue of ovaries) and sex cords (embryonic structures associated with the follicles). Which matches the following definition?

• rare, derived from stromal cells containing bundles of collagen and can be associated with ascites

1 - Fibroma
2 - Mucinous Cystadenoma
3 - Theca cell tumours
4 - Brenner tumours

Answer 15

1 - Fibroma

Question 16

When assessing a patient with suspected ovarian cysts the following symptoms can present:

• general pelvic pain
• bloating / full abdomen
• palpable pelvic mass

However, we need to rule out malignancy. Which of the following are signs of malignancy?

1 - Abdominal bloating
2 - Reduce appetite and arly satiety
3 - Weight loss
4 - Urinary symptoms
5 - Pain
6 - Ascites
7 - Lymphadenopathy
8 - all of the above

Answer 16

8 - all of the above

Question 17

Which of the following is NOT a risk factor for ovarian malignancy?

1 - Age
2 - Perimenopausal
3 - Increased number of ovulations
4 - Obesity
5 - Hormone replacement therapy
6 - Smoking
7 - Non-Breastfeeding (protective)
8 - Family history and BRCA1 and BRCA2 genes

Answer 17

2 - Perimenopausal
- post-menopausal is a risk factor though

Question 18

Which of the following is NOT a protective risk factor for ovarian malignancy?

1 - Later onset of periods (menarche)
2 - Early menopause
3 - Any pregnancies
4 - Use of the combined contraceptive pill
5 - Smoking
6 - Breastfeeding

Answer 18

5 - Smoking
- only protective in endometrial cancer

Question 19

Which of the following is the first line for diagnosing ovarian cysts?

1 - CA125
2 - hCG
3 - transvaginal ultrasound
4 - ovarian biopsy

Answer 19

3 - transvaginal ultrasound

Question 20

In addition to a transvaginal ultrasound, which of the following tests is the LEAST important from the list?

1 - pregnancy test
2 - FBC
3 - CRP and ESR
4 - high vaginal/cervical swabs

Answer 20

3 - CRP and ESR

Question 21

Cancer antigen 125 (CA-125) can be raised in ovarian cancer. Is this marker specific to just ovarian cancer?

Answer 21

• no
• associated with endometriosis, menstruation, benign ovarian cysts
• not a great measure but always one if ovarian cancer is suspected
• can be >35 IU/mL

Question 22

If a woman <40 y/o has a large complex ovarian mass they must have all of the following markers measured, EXCEPT which one?

1 - Lactate dehydrogenase (LDH)
2 - Alpha-fetoprotein (α-FP)
3 - Human chorionic gonadotropin (HCG)
4 - Creatine kinase

Answer 22

4 - Creatine kinase

Question 23

Ovarian cysts can be asymptomatic. In a women <40 y/o with no symptoms, what size mass has a low level risk for ovarian torsion?

1 - <2cm
2 - <5cm
3 - <7cm
4 - <10cm

Answer 23

2 - <5cm

• monitored using a transvaginal ultrasound, but most typically resolve on their own

Question 24

Simple cysts are fluid filled with a thin wall. Complex contains thicker fluid or blood, walls within the cyst (septations) or solid areas. in simple cysts 5-7cm in size in patient who is low risk and asymptomatic are reviewed how often?

1 - 12-weekly transvaginal ultrasound
2 - 6 monthly transvaginal ultrasound
3 - Yearly transvaginal ultrasound
4 - 2 yearly transvaginal ultrasound

Answer 24

3 - Yearly transvaginal ultrasound

• BUT cysts >5cm should always be considered for surgery for risk of torsion

Question 25

A functional cyst develops when the ovary fails to release an egg or when a follicle in the ovary continues to grow after an egg has been released. These cysts usually resolve without treatment. Non-functional cysts are less common and are cysts that grow without the influence of hormones. Which treatment can be effective at preventing the formation of functional cysts? 1 - methotrexate 2 - COC 3 - cortiocosteroids 4 - misoprostol

Answer 25

2 - COC - inhibits FSH and LH release and therefore no cycles

Question 26

The risk of malignancy index (RMI) estimates the risk of an ovarian mass being malignant. The RMI used which 3 of the following? 1 - ultrasound score 2 - hCG levels 3 - CA125 levels 4 - menopause status

Answer 26

1 - ultrasound score 3 - CA125 levels 4 - menopause status Scores - <25 = low risk (<3%) - 25-250 = moderate risk (20%) - >250 = high risk (30%) Ultrasound score = - no characteristics = 0 - characteristics = 1 - 2 or more characteristics = 2 scores are based on metastasis, ascites, cysts, solid multilocular bilateral area