Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SG F3 E5 > ovarian disorders > Flashcards

ovarian disorders Flashcards

1
Q

PCOS is characterized by

A

chronic anovulation
polycystic ovaries
hyperandrogenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PCOS is associated with these diseases

A 
hirsutism 
obesity 
DM 
CBD 
metabolic syndrome 
dyslipidemia 
NAFLD 
OSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology behind PCOS

A

Abnormal androgen and estrogen metabolism
Unregulated androgen control
Insulin resistance= hyperinsulinemia
Decreased adiponectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the hormonal inhibitions in PCOS

A

Inhibin (released from granulosa cells) inhibits FSH

Estrone (released from adipocytes) inhibits FSH= less aromatase= androgens NOT converted to estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does high insulin affect PCOS

A
  • Positive feedback on androstenedione, making more testosterone, and more estrone, therefor further inhibiting FSH
  • Increased LH secretion
  • Decreases SHBG and IGF= more free testosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does decreased adiponectin affect PCOS

A

It is an insulin sensitizer, and regulates lipid metabolism and glucose levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does increased LH stimulate

A

Theca cells to produce androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does adipose to to androgens

A

converts them to estrogen, which causes negative feedback to the anterior pituitary, decreasing FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does PCOS present

A 
Infertility (PCOS is MCC***) 
Oligomenorrhea, Amenorrhea (anovulation) 
Obesity 
acne
hirsutism
male pattern baldness 
acanthosis nigricans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NIH 1990 criteria for PCOS (disorder of ovarian androgen excess) Dx says

A

Must have: oligomenorrhea + hyperandrogenism

Must exclude: hyperprolactinemia, CAH, and Cushing’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Rotterdam 2003 crteria for PCOS says

A

Need 2/3: Ovulatory dysfunction, hyperandrogenism, or polycystic ovaries (12+ follicles)
Must exclude related disorders
(this criteria expands on the NIH criteria, does not replace it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To have PCOS you must exclude

A 
premature ovarian failure 
physical stress 
obesity 
anovulation 2/2 d/c hormonal contraceptives 
pituitary adenoma/ hyperprolactinemia 
thyroid disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

First line test if you suspect PCOS

A 
Ultrasound! you may see: 
12+ follicles, 2-9 mm in diameter 
"string of pearls" 
ovarian volume >10mL 
No evidence of dominant follicle or corpus luteum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

To evaluate hyperandrogenism, start with

A

total testosterone. If normal (40-60), no further eval.

If >60, more testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Further testing for hyperandrogenism (total testosterone >60) includes

A

17-OH progesterone (8AM): if >200, CAH
DHEA-S: >700, adrenal source of androgens
Cortisol: >10mcg, cushings
Prolactin: >25 is elevated. normal is PCOS (?)
TSH: Hyperthyroid causes oligo/amenorrhea
B-HCG: always order if amenorrhea!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other PCOS labs to get are

A

Fasting glucose
OGTT or HbA1c
Lipid profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat PCOS

A 
Weight loss (increase SHBG, decrease free T) 
Metformin IF hyperinsulinemic 
COC (w/ low androgen) 
Fertility consult 
Provera (endometrial protection) 
Life-long lifestyle modification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can you add to metformin to help treat infertility

A

Clomid!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you treat hirsutism

A

COC!

+/- antiandrogen (spironalactone), Topical vaniqa (anti-protozoal), mechanical hair removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

COC effects include

A

Increase SHBG= less free T

Decrease LH= decrease T production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risks for PCOS include

A 
Endometrial hyperplasia 
T2DM 
HTN 
HLD 
CVD
stroke 
infertility 
metabolic syndrome 
sleep apnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should the ovaries feel like by age

A

Pre-menarche: not palpable
Reproductive: palpable 50% of time
Peri-menopause: very likely to have functional cysts
Post-menopause: not palpable w/in 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are characteristics of benign adnexal masses (US)

A 
thin walls 
<3cm pre-menopause, <1cm post (simple cyst) 
hyperechoic (teratoma) 
linear curved pattern (hemorrhagic) 
homogenous echoes (endometrioma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are characteristics of malignant adnexal masses on US

A

Thick separations >2mm
solid, nodular
increased blood flow to solid component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Functional ovarian cysts include
Follicular cysts (MC**) Corpus luteum cysts Theca Lutein cysts
26
Non-functional ovarian neoplasms include
Epithelial cell: serous, mucinous, endometrioid Germ cell: benign cystic teratoma Stromal cell: granulosa, sertoli-leydig, ovarian fibroma
27
What is the normal ovarian cycle
- At start of each cycle, many primordial follicles fill with follicular fluid. - ONE follicle in ONE ovary matures into Graafian follicle, and has the ovum (other non-dom follicles regress) - At ovulation, Graafian follicle ruptures and ovum is released, becoming corpus luteum - No fertilization= corpud luteum degenerates into corpus albicans - Fertilization= corpus luteum persists and secretes progesterone to support pregnancy
28
Describe Follicular cysts
2-8cm non-malignant regress after 1-2 cycles occur 2/2 failure of mature follicle to rupture and release ovum, or, failure of non-dom follicles to regress
29
Describe a corpus luteum cyst
3-11 cm Regress after 1-2 cycles After ovulation, blood accumulates in cavity of corpus luteum stimulating resorption. If resorption does NOT occur and CL is >3cm, it's a cyst If corpus does not rupture, you don't get a drop in progesterone, and miss a period
30
Describe Theca lutein cysts
Seen with high HCG levela (abn pregnancy) 2/2 Hydatidiform moles, choriocarcinoma, clomid therapy Bilateral Clear, straw fluid Regress spontaneously w/ underlying d/o Tx more likely to have septations
31
Describe a Serous cystadenoma
MC epithelial cell neoplasm, MC in 30-50 y/o 70% benign, 20% malignant Treat w/ surgery (cyctectomy or oopherectomy)
32
Describe a mucinous cystadenoma
15% malignancy rate get very large US shows multiocular septations Treatment is surgical
33
Describe a benign cystic teratoma
MC in reproductive aged women (30) Originate from primordial cells and found along the path of germ cells from yolk sac to gonads Composed of well differentiated tissue from ectoderm, mesoderm, or endoderm (germ cell)
34
Benign cystic teratomas contain
keratinized squamous lining with abundant sebaceous and apocrine glands Ectoderm is MC origin (hair, teeth, etc)
35
How do teratomas present
Asymptomatic! found via pelvic exam or incidentally on imaging Pelvic pain (2/2 torsion or rupture) Urinary frequency/urgency, back pain *Pelvic mass on bimanual exam
36
Labs for a teratoma should include
``` Transvaginal US (unilateral, complex cyst) CEA, CA-125, AFP, bets HCG (should all be normal) ```
37
How do you treat a teratoma
Laparotomy vc Laparoscopy Ovarian cystectomy vs Oopherectomy 10% recurrence
38
Describe Theca cell tumors
produce ESTROGEN! develop along female cell types can be malignant. develop across lifespan
39
Describe Sertoli-Leydig cell tumora
produce ANDROGENS! develop along male gonadal tissue type can be malignant. develop across lifespan
40
Describe how ovarian fibromas present
MC in middle age, NO hormone production result from spindle cell collagen production Small, solid tumors with smooth surface. Associated with ascites
41
Ovarian cancer has the highest incidence among
women >63
42
RF for ovarian cancer include
``` nulliparity early menarche, late menopause infertility endometriosis FHx ovarian, colorectal, or breast CA (BRCA 1/2, Lynch) High saturated animal fat diet obesity talcum powder Turner's syndrome ERT caucasian ```
43
How can you reduce the risk of ovarian cancer
``` multiparity breast feeding long term oral contraceptive use (5 years) B/l tubal ligation low fat diet *B/l salpingectomy ```
44
What are the 4 major histologic types of ovarian cancer
Epithelial Germ cell Sex cord and stromal Neoplasm mets to ovary
45
Epithelial ovarian cancer subcategories are
- High grade serous carcinoma: MC, arise in fallopian tube - Endometrioid: arise from ovary, but look like endometrium - Clear cell carcinoma: arise from ovary, malignant transformation of endometriosis - Mucinous carcinoma: arise from cervix, but look like cervical epithelium
46
What is the pathophys theory behind ovarian cancer (ovary theory)
Follicular rupture= ovarian epithelial trauma Incessant ovulation and subsequent epithelial repair leads to malignant transformation associated with endometrioid, clear cell, and mucinous ovarian cancer (not serous)
47
What is the fallopian tube theory behind ovarian cancer
-Mutant p53 (tumor suppressor) creates a signature on the distal fallopian tube -Distal fallopian tube is where epithelial stem cells are susceptible to DNA damage and malignant change -Serous tubal intraepithelial cancer results STIC is a precursor to high grade serous papillary cancer
48
The fallopian tube theory confirms why
salpingectomy is considered a method to reduce risk of ovarian cancer No fallopian tube= No signature= no STIC= no cancer
49
What are the types of germ cell ovarian cancers
``` Dysgerminoma Endodermal sinus tumor Immature teratoma Mixed Embryonal tumors ```
50
How do germ cell ovarian cancers usually grow
quickly, with lymph spread, MC unilaterally, containing a mix of tumor types *They make markers that help with treatment response!
51
Describe a dysgerminoma
MC germ cell ovarian tumor Unilateral MC in women <30 Produce LDH, some produce hCG
52
Describe endodermal sinus tumors
``` Rare Bilateral Occur in childhood and teens Most rapid growing of germ cell neoplasm Produce AFP ```
53
Describe an immature teratoma
MC <20 Unilateral Produce AFP
54
Describe Embryonal carcinomas
Rare Occur in childhood and teens Rapid growth, extensive spread Produce AFP and HCG
55
What are the sex cord/stromal ovarian cancers
Granulosa cell, and Sertoli-Leydig
56
Describe a Granulosa cell ovarian cancer
MC Causes hyperestrogenism= precocious puberty, post-menopausal bleeding Seen in 50's
57
Describe a Sertoli-Leydig stromal cell ovarian cancer
Rare Causes hyperandrogenism Seen in 30's-40's
58
MC ovarian cancer symptoms are
``` Abdominal bloating or distention Abd/pelvic pain Decreased energy (lethargy) Early satiety Urinary urgency ```
59
Other ovarian cancer Sx are
``` increased abd size indigestion constipation back pain unexplained weight loss abnormal vaginal bleeding ```
60
Acute symptoms associated with ovarian cancer are
Pleural effusion | Bowel obstruction
61
On an ovarian cancer physical exam you MC see
Ascites inguinal LAD pelvic mass
62
Ovarian cancer imaging should include
transabd/transvag US mammogram/colonoscopy CT MRI CXR CA-125 (will be >65 is epithelial cancer) hCG, AFP, LDH (will be high with germ cell tumors)
63
Why don't we screen with CA-125
-Because it can be elevated with other conditions, like: endometriosis, uterine leiomyomata PID pregnancy menstruation cirrhosis -Also, it is only elevated 50% of the time in early stage ovarian cancer, and even less in late stage
64
How is ovarian cancer staged
FIGO!
65
Treatment for ovarian cancer includes
Surgery (remove tumor and mets, peritoneal washing, remove nodes, hysterectomy) Chemo (Paclitaxel and Carboplatin 6 cycles at 3 wk intervals)
66
Why do we want to diagnose early (obvs, but like why)
you can preserve the contralateral adnexa and uterus

SG F3 E5 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions