Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Women's Health > Ovarian Disorders - Exam 3 > Flashcards

Ovarian Disorders - Exam 3 Flashcards

1
Q

What is the normal size for a functional ovarian cysts? Do they always have to be symptomatic?

A

3-10cm

NO! some do not have any symptoms

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

What will large/symptomatic functional ovarian cysts present like?

A

menstrual irregularities

pelvic pressure or pain

Large: constipation or urinary frequency

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

What are the symptoms of functional ovarian cysts a result of? 3 things

A

Rupture of contents (chemical peritonitis)

Torsion of enlarged ovaries

Mechanical pressure

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

How do you dx functional ovarian cysts? What is the MC type of functional ovarian cysts?

A

pelvic US

follicular cysts

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

What are follicular cysts due to?

A

Due to failure in ovulation, incomplete development and it does NOT rupture and the fluid does NOT get completely reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the s/s of follicular cysts?

A

usually asymptomatic!!

but may see bleeding and torsion

large cysts: aching pelvic pain and dyspareunia

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

What is the tx for follicular cysts? When should the patient follow up?

A

observation and expectant management, can treat symptoms if needed

Usually resolve spontaneously within 2 months but need to monitor clinically and f/u with imaging for 2-3 menstrual cycles

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

If you are going to tx follicular cysts with something besdies expectant management, what would you choose?

A

OCPs: but does NOT speed up resolution of cysts

or cystectomy

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

What causes a corpus luteum cysts? **Associated with pts taking ______ (drug). These can sometimes mimic _____

A

accumulation of fluid inside a corpus luteum

clomiphene (Clomid)

s/s can sometimes mimic an ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

______ s/s include asymptomatic or local pain, tenderness, amenorrhea or delayed menstruation. What can it lead to?

A

Corpus Luteum Cysts

May lead to ovarian torsion or cyst rupture
and bleeding

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

If a corpus luteum cysts ruptures, why is this a bad thing?

A

Severe bleeding/rupture - acute abdomen,
hypovolemic shock

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

What is the tx for a corpus luteum cyst? What is the tx for a more severe presentation?

A

management symptoms and monitor, usually resolves sponataneously within 2 months

OCPs or surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

______ is the US finding associated with corpus luteum cysts

A

“ring of fire” appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the cause of theca lutein cysts? Are they usually unilateral or bilateral? What are they filled with? Describe their appearance

A

elevated levels of hCG

Hydatidiform mole, choriocarcinoma, multiple gestation, hCG therapy

Often occur bilaterally, filled with clear fluid

May occur as multiple simultaneous cysts

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

What are the s/s of a theca lutein cyst?

A

usually minimal symptoms

May have pelvic heaviness or aching

May see rupture and bleeding or ovarian torsion

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

What am I?
What is the tx?
How long does it take to see a resolution?

A

theca lutein cysts

tx the symptoms and the underlying cause, will resolve once the hCG levels return to normal (BUT the pt WILL have symptoms!!)

May take MONTHS to resolve

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

_____ is needed if there is torsion of hemorrhage for a theca lutein cyst

A

surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the underlying cause of an endometriomas? What pt population? They may develop ______. What is another name for them?

A

endometric foci on ovarian surface

Seen in patients with endometriosis

May develop fibrous enclosure

“chocolate cysts”

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

What are s/s of endometriomas? What cancer marker can be elevated?

A

pelvic pain, dyspareunia,
dysmenorrhea, infertility

CA-125 may be elevated

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

What am I?
What is the tx?

A

endometriomas

removed laparoscopically

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

_____ is an ovarian cyst that is filled with various types of tissue. Give some tissue examples

A

dermoid cyst

Fatty material, hair, teeth, bits of bone, cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

_____ of ovarian cysts in premenopausal women are dermoid cysts and arise from _____. What is important to note?

A

10-15%

arise from germ cells

Rarely neoplastic but may rupture

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

______ develop from cells on the outer surface of the ovary. Usually _____ but can grow very large and cause pain

A

cystadenomas

benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What am I?

A

cystadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What am I?
dermoid cyst
26
What is another name for polycystic ovarian syndrome? What is it characterized by?
Stein-Leventhal Syndrome endocrinopathy so it is NOT isolated to just the GYN system and a complex multivariable disorder persistent anovulation
27
What are some things associated with persistent anovulation that you will see in polycystic ovarian syndrome?
Enlarged polycystic ovaries Secondary amenorrhea or oligomenorrhea Obesity, hirsutism, infertility
28
How common is PCOS? What are the 2 MC symptoms?
10% prevalence hirsute: 60-90% obesity: 50-80%
29
_____ prevalence in 1st degree relatives of PCOS pts. What relationship is thought to be damaged?
20-40% Hypothalamic-pituitary-ovarian dysfunction: with altered LH action and altered flliculogenesis
30
The etiology of PCOS is unclear, what 3 things may potentially contribute to the thought process?
Hypothalamic-pituitary-ovarian dysfunction: Altered LH action, altered folliculogenesis Insulin resistance and obesity Hyperandrogenism
31
diagnosis of PCOS is based on the _____ criteria. must have ___ of the following
Rotterdam Criteria at least 2 of the following must be present: Oligo-ovulation (oligomenorrhea) or anovulation (amenorrhea) Hyperandrogenism: including male pattern hair loss or growth Polycystic ovaries on US
32
Describe the ovaries of pt with PCOS
“Oyster ovaries” - enlarged and sclerocystic ovaries; smooth, pearl-white surfaces without indentations
33
How are PCOS and infertility related?
PCOS is a leading cause of female infertility increased early pregnancy loss (30-50%) and increased pregnancy complications
34
What are some gynecologic symptoms of PCOS?
Menstrual abnormalities Ovarian cysts Pelvic pain or pressure Endometrial neoplasia
35
What are some psychosocial symptoms of PCOS?
Anxiety, depression Low self-esteem Negative body image Decreased quality of life
36
What are some constitional/endocrine symptoms of PCOS? What do you NOT tend to see?
Weight gain or obesity Insulin resistance Sleep apnea NAFLD Dyslipidemia Metabolic syndrome do NOT have: NO increased muscle mass, decreased breast size, deepened voice, clitoromegaly
37
What are some dermatologic s/s of PCOS?
hirsutism acne, oily skin, dandruff male pattern hair loss acanthosis nigricans
38
In hirsutism, where on the body are the pts likely to experience new hair growth? How common is it?
coarse, dark hairs in male pattern (face, chest, stomach, back) 70-80% cases - 2o PCOS
39
Which regards to hormone levels, what will you see in PCOS in terms of androgens, SHBG and LG/FSH ratio?
Androgens - mildly elevated testosterone, androstenedione, DHEA SHBG - decreased Increased ratio of LH to FSH
40
What will PCOS due to a pt's lipid panel?
Lipid abnormalities - high LDL and TG, low HDL
41
What will a pelvic US reveal in PCOS?
Pelvic US may reveal multiple follicles/cysts bilaterally "ring of bubbles"
42
PCOS will have signs of _____ on diagnostic testing. Including what 3 things?
anovulation Persistently high LH and low FSH Low day-21 progesterone level Anovulation on sonographic follicular monitoring
43
What am I? What dx?
"ring of bubbles" PCOS
44
What is the tx for PCOS in patients with 8-12 periods a year, with MILD hyperandrogenism and do NOT wish to conceive? What do you need to confirm before proceeding?
observation with regular screening for lipids, DM and weight **Need to make sure the patient is SATISFIED with observation**
45
What is the major lifestyle change that is beneficial in PCOS?
5-10% weight loss can restore normal ovulatory cycles in some patients well balanced hypocaloric diet
46
After lifestyle changes, ____ should be considered for the treatment of PCOS
combination oral contraceptives
47
**Why is combination oral contraceptives preferred in PCOS? Specifically which meds?
**Induce regular menses and antagonizes endometrial proliferation Reduce androgen levels → suppress FSH/LH release, increase SHBG Chose COCs with progestins that have less androgenic properties: Norethindrone, norgestimate, desogestrel, drospirenone
48
____ needs to be order in a PCOS pt who has not had menses in more than 4 weeks
pregnancy test first!! before starting COCs
49
**Why is progesterone only therapy NOT preferred in PCOS? When is it used?
**Does not treat hyperandrogenic symptoms used mainly in pts who cannot take COC and helps prevent endometrial hyperplasia
50
_____ is used in PCOS as an insulin sensitizing agent. Why do people use it? _____ can also be used due to SE of weight loss
metformin May increase spontaneous ovulation induction GLP-1 agonists
51
What is the important pt education point with regards to hirsutism and PCOS? What are the tx options?
many treatments require 6-12 months! this is not an overnight fix!! COCs GnRH agonists depilation epilation androgen receptor antagonists 5-alpha-reductase inhibitors
52
What is the difference between depilation and epilation?
Depilation - hair removal above skin surface Shaving, topical chemical depilatories Epilation - removal of entire hair shaft Mechanical, electrolysis, laser
53
_____ is the androgen receptor antagonists often used in combination with COCs to help with hirsutism. What may it cause? Is it safe in pregnancy?
spironolactone may cause metrorrhagia NOT safe in pregnancy
54
_______ are 5-alpha-reductase inhibitors that help to decrease testosterone conversion. Are they safe to use in pregnancy?
Finasteride, dutasteride NOT safe to use in pregnancy
55
The tx aimed at managing acne in PCOS focuses on ????
involves lowering androgen levels or you can just treat it like acne: topical retinoids, benzoyl peroxide, isotretinoin, topical or systemic antibiotics
56
_____ is the dietary supplement that may help improve _____. What 2 additional things may it help with?
Myo-Inositol insulin sensitivity may help ovulatory frequency and weight loss
57
________ is a new emerging therapy in PCOS that may help slow GnRH pulses in PCOS patients. Early studies showed improved ___ and ____ levels
NK3 antagonists / Kappa-receptor agonists LH testosterone levels
58
_____ is used first line in PCOS to help ovulation induction despite being off-label. When is it given? What are the DDI?
Letrozole (Femara) Given days 3-7 of menstrual cycle to produce a larger amount of FSH methadone/levomethadone, tamoxifen
59
What are the advantages of Letrozole (Femara) when compared to clomiphene citrate?
Higher rates of live birth, especially in obese women shorter 1/2 life (48 hours vs 2 weeks with clomid)
60
_____ MOA inhibits aromatase, the enzyme that converts androgens to estrogens. What does this result in?
Letrozole (Femara) Increased production of GnRH → FSH/LH
61
______ MOA binds to hypothalamus, blocking estrogen receptors. What does this result in?
Clomiphene citrate (Clomid) SERM Increased production of GnRH → FSH/LH
62
What are the serious SE of Clomiphene citrate (Clomid)? What is the highlighted one?
alopecia, increased risk of ovarian or endometrial cancer, **ovarian hyperstimulation syndrome**, uterine fibroid enlargement
63
What are the DDI of Clomiphene citrate (Clomid)? Clomid induces ovulation in ____, but successful pregnancy in only ____
drugs that act on HPO axis (e.g., estrogens, SERMs, aromatase inhibitors, gonadotropins, GnRH agonists) 75-80% 30-40%
64
_____ can be used alone or in combo with clomiphene to induce ovulation in PCOS pts
metformin
65
______ can be used to induce ovulation in pts with PCOS and causes ovulation in ____ and pregnancy in _____. What are the pts at high risk for?
Exogenous gonadotropins 72% pregnancy in 45% high risk for ovarian hyperstimulation syndrome
66
Why is ovarian hyperstimulation syndrome bad?
due to vascular hyperpermeability - 3rd spacing of fluid
67
____ Ovarian Hyperstimulation Syndrome: bloating, N/V/D, weight gain Ovaries enlarged 5-12 cm; mild ascites
mild
68
______ Ovarian Hyperstimulation Syndrome: increased weight gain (>2 lbs/d), N/V/D, dark urine, oliguria, thirst, dry skin and hair
moderate
69
______ Ovarian Hyperstimulation Syndrome: SOB, pleural effusion, severe oliguria, pain in the calf / chest / abdomen, hemoconcentration, thrombosis, respiratory distress
severe
70
What is the tx for ovarian hyperstimulation syndrome? What medication is better than _____
Supportive; resolves 1-2 wks after d/c medication Lower incidence with Clomid than synthetic FSH
71
What are the 2 surgical tx options for PCOS?
Laparoscopic ovarian surgery: cauterization, laser “drilling,” biopsies Oophorectomy
72
What can cauterization, laser “drilling,” biopsies as surgical tx for PCOS cause?
May induce ovulation in patients unresponsive to medical therapy
73
Ovarian torsion is a ______. What is the underlying cause in 50-80% of cases? What is another likely cause?
surgical emergency!! ovarian enlargement (think cysts) 10-22% of torsion cases occur during pregnancy
74
What is the classic presentation of an ovarian torsion?
sudden onset, severe, unilateral, lower abd. pain Pelvic pain ovarian mass N/V fever Over 50% on right side; may radiate to flank, thigh or groin
75
______ is the MC presenting symptom in ovarian torsion. _____ is also super common presenting factor
pelvic pain: 90% ovarian mass: 86-95%
76
______ is the imaging study of choice in ovarian torsion. What are some specific findings? _____ should be ordered next
US with doppler that shows abnormal blood flow to ovary Multiple follicles rimming an enlarged ovary “Bulls’-eye”, “whirlpool”, “snailshell” pregnancy test
77
What is the tx for ovarian torsion? What does a black-blue discoloration indicate?
sx!! detorsion of the adnexa Persistent black-blue discoloration is NOT pathognomonic for necrosis
78
If you remove an ovary of a pregnant lady before 10 weeks, what should you do next?
If ovary removed prior to 10 weeks, progestational support given to maintain pregnancy
79
______ is the MC source of ovarian cancer. Accounts for ____ of all malignant ovarian tumors. When does it occur?
Epithelial ovarian cells >90% Typically occur in pts near or at menopause
80
____ are serous cystadenocarcinomas and are associated with ____ serum marker
75% CA-125
81
_____ ovarian cancer presents in their 20-30s and have a ____ prognosis than epithelial ovarian cells. What cancer markers?
Germ cell tumors better prognosis Associated with AFP, hCG, LDH
82
______ account for 5-8% of ovarian cancer and are associated with ____ and _____
Sex Cord-Stromal Tumors estrogen and androgens
83
________ ovarian cancer is associated with inhibin
Granulosa cell tumors inhibin
84
____% of ovarian cancers are due to metastases
5% due to metastases
85
_____ is the strongest risk factor for ovarian cancer
positive family hx! 10-15% of pts will have a family hx
86
What are the risk factors for ovarian cancer?
family hx increased age white smoking GYN: early menarche, late menopause, endometriosis, nulligravidity
87
What factors REDUCE the risk of ovarian cancer?
oral contraceptive pill use breastfeeding progesterone therapy tubal ligation Hysterectomy/Salpingectomy
88
**What is a female pt's lifetime risk of ovarian cancer?
1.3%
89
Pts with the BRCA1 gene have a ____ lifetime risk for ovarian cancer. BRCA2 gene have a ___ lifetime risk of ovarian cancer
BRCA1 - 35-45% BRCA 2 - 15-24%
90
pts with Hereditary Nonpolyposis Colorectal Cancer syndrome have a ___ lifetime risk of ovarian cancer
3-14% increased risk of colon, breast and endometrial CA
91
can offer _____ to women with a known genetic predisposition. What age is preferred?
prophylactic bilateral salpingo-oophorectomy Better to do by age 35 if possible
92
What are some s/s of late stage ovarian cancer?
increased abdominal girth (ascites) nausea anorexia dyspnea (pleural effusions) early stage ovarian cancer s/s are very non-specific: bloating, abd. pain, early satiety, indigestion, urinary frequency or urgency, dyspareunia, fatigue, back pain
93
What is the classic PE finding for ovarian cancer? What lymph node?
solid, fixed, irregular adnexal mass but unilateral cystic masses are benign in 95% of cases Lymphadenopathy - inguinal, Sister Mary Joseph’s nodule (belly button)
94
_____ cancer marker is elevated in ___ of early cases of ovarian cancer and ____ of late cases. Is it more helpful in pre or post menopausal women? What is the big takeaway?
CA-125 50% early and 80% late More useful in postmenopausal Normal CA-125 does not exclude diagnosis of cancer!
95
_____ is used first when dx ovarian cancer, then _____. ____ is definitive dx
pelvic US CT or MRI bx and tissue pathology
96
**What finding on pelvic US is super bad in terms of ovarian cancer dx?
omental "cake" metastases NOT a good thing!
97
What is the tx for EOC ovarian cancer? elevated ____ predicts persistent disease
sx! for both definitive dx and staging Removal of tumor and contralateral adnexa even if grossly normal, perform hysterectomy and infracolonic omentectomy aka they are taking a TON of structures with it!! chemo usually starting 4-6 weeks after sx elevated CA-125 predicts persistent disease
98
What is the tx for germ cell ovarian cancer?
sx! including removal of involved adnexa but MAY PRESERVE normal-appearing contralateral adnexa and uterus sx is considered curable in the majority of cases but chemo and radiation can be helpful
99
____ is the 2nd MC gyn malignancy but is the #1 _____. What type of ovarian cancer has the better 5 year survival rate?
ovarian cancer MC cause of death in gyn malignancies Germ cell tumors usually have better 5-yr survival rates than EOCs
100

Women's Health (16 decks)

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