Ovarian disorders Flashcards

Question

co-cyprindiol (Dianette)

Answer 1

increases risk of VTE | stop after 3 months

Answer 2

facial hirsutism takes 6-8 weeks to see a significant improvement hirsutism will stop within two months of stopping eflornithine

Answer 3

``` co-cyprindiol first line Topical adapalene (a retinoid) ``` Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%) Topical azelaic acid 20% Oral tetracycline antibiotics (e.g. lymecycline)

Answer 4

Metabolic disorders, impaired glucose tolerance and T2DM CVD OSA Infertility Recurrent miscarriage Pregnancy complications, pre-eclampsia and gestational diabetes Endometrial cancer, exposure to high levels of oestrogen Psychological disorders: anxiety and depression

Answer 5

``` Nulliparity Early menarche Late menopause Hormone replacement therapy containing oestrogen only Smoking Obesity ```

Answer 6

Multiparity Combined contraceptive methods Breastfeeding

Answer 7

BRCA 1&2 | HNPCC (Lynch II syndrome)

Answer 8

menopausal status USS score CA125

Answer 9

incidental and asymptomatic chronic pain pressure in bladder/ bowel causing constipation or frequency acute pain: bleeding into cyst, rupture or torsion bleedng per vagina

Answer 10

``` Bloating Change in bowel habit Change in urinary frequency Weight loss Irritable bowel syndrome Bleeding per vagina ```

Answer 11

non-neoplastic | benign neoplastic

Answer 12

functional | pathological

Answer 13

epithelial tumours benign germ cell tumours sex-cord stromal tumours

Answer 14

follicular cysts | corpus luteal cysts

Answer 15

endometrioma polycystic ovaries theca lutein cyst

Answer 16

serous cystadenoma mucinous cystadenoma brenner tumour

Answer 17

mature cystic teratoma (Dermoid cyst)

Answer 18

<3cm | represent developing follicle in first half of menstrual cycle

Answer 19

<5cm | luteal phase of menstrual cycle after formation of corpus luteum

Answer 20

These are also called chocolate cysts and are present in those with endometriosis. There has been bleeding into the cyst resulting in the appearance.

Answer 21

An ultrasound diagnosis. The ovaries contrain more than 12 antral follicles, or ovarian volume greater than 10ml. The classic ‘ring of pearls’ sign is seen on ultrasound scanning. PCO is present as one of the features of polycystic ovarian syndrome (Rotterdam criteria criteria). Isolated PCO does not equate to PCOS.

Answer 22

These result as a consequence of markedly raised hCG e.g. molar pregnancy. They regress upon resolution of the raised hCG.

Answer 23

reflects the most common type of malignant ovarian tumour and is usually unilocular with up to 30% being bilateral.

Answer 24

these are often multiloculated and usually unilateral.

Answer 25

unilateral with a solid grey or yellow appearance.

Answer 26

10% are bilateral, usually occur in young women and occur frequently in pregnancy. As germ cell in origin they can contain teeth, hair, skin and bone.

Answer 27

the most common stromal tumour. Important to know about as up to 40% present with Meig’s syndrome which is the association between these tumours and ascites/pleural effusion.

Answer 28

CA125 does not need to be undertaken when the diagnosis of a simple ovarian cyst has been made ultrasonographically. The CA125 can be raised by anything that irritates the peritoneum, so in premenopause there are numerous benign triggers for an increase. Lactate dehydrogenase, alphafetoprotein and hCG should be measured in all women under 40 due to the possibility of germ cell tumours. Rescan a cyst in 6 weeks. If it is persistent then monitor with ultrasound an CA125 3-6 monthly and calculate RMI. If persistent or over 5cm consider laparoscopic cystectomy or oophorectomy.

Answer 29

``` Low RMI (less than 25): follow up for 1 year with ultrasound and CA125 if less than 5cm. Moderate RMI (25-250): bilateral oophorectomy and if malignancy found then staging is required (with completion surgery of hysterectomy, omentectomy +/- lymphadenectomy). High RMI (over 250): referral for staging laparotomy ```

Answer 30

Serous cystadenocarcinoma – characterised by Psammoma bodies. Mucinous cystadenocarcinoma – characterised by mucin vacuoles.

Answer 31

All patients with suspected ovarian cancer should have basic blood tests included FBC, U&E, LFT and albumin. In the UK, NICE recommends abdominal and pelvic ultrasound for pelvic masses, from which the RMI can be calculated.

Answer 32

In cases of confirmed cancer, chest x-ray and CT abdomen/pelvis should be undertaken for staging and pre-operative purposes.

Answer 33

Surgery – staging laparotomy for those with a high RMI with attempt to debulk the tumour. Adjuvant chemotherapy – recommended for all patients apart from those with early, low grade disease and uses platinum based compounds. Follow up – involves clinical examination and monitoring of CA125 level for 5 years with intervals between visits becoming further apart according to risk of recurrence.