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obstetric - gynecol STEP 2 > ovaries > Flashcards

ovaries Flashcards

1
Q

Premature ovarian failure - definition / presentation and endocrine profile

A

premature atresia of ovarian follicles in women of reproductive age
- signs of menopause after puberty but before 40
endocrine profile: low estrogen, high LH, FSH

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2
Q

Polysystic ovarian (Stein-Leventhal) syndrome - mechanism

A

hyperinsulinemia and/or insulin resistance is hypothesized to alter hypothalamic hormonal feedback response –> high LH/FSH –> increased androgen production from theca cells (LH) (–> hirsutism) but low estrogen (no FSH on granulosa), low rate of follicular maturation –> unruptured follicles (cysts) + anovulation

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3
Q

Polysystic ovarian (Stein-Leventhal) syndrome - estrogen levels (mechanism)

A
  1. low 17β -estradiol (low FSH –> no aromatization granulosa cells)
  2. high estrone (aromatization of androgen on adiposse tissue)
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4
Q

Polysystic ovarian (Stein-Leventhal) syndrome - increased risk of … (and mechanism)

A
  1. endometrial cancer 2ry to unopposed estrogen from repeated anovulatory cycles
  2. Ovarian neoplasm
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5
Q

Ovarian cysts - types (MC?)

A
  1. follicular cysts (mc)

2. Theca lutein cyst

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6
Q

ovarian follicular cysts / associated with

A

distention of unruptured graafian follicle

associated with: 1. hyperestrogenism 2. endometrial hyperplasia

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7
Q

ovarian follicle cyst may be associated with

A
  1. hyperestrogenism

2. endometrial hyperplasia

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8
Q

Theca-lutein cyst - definition/mechanism / associated with

A

often bilateral/multiple due to gonadotropin stimulation

- choriocarcinoma / hydatidiform moles

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9
Q

increased risk for ovarian neoplasm

A
  1. advanced age
  2. infertility
  3. endometriosis
  4. Polysystic ovarian syndrome
  5. genetics (BRCA1/2 Lynch syndrome, family history)
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10
Q

decreased risk for ovarian neoplasm

A
  1. previous pregnancies
  2. history of breastfeeding
  3. OCPs
  4. tubal ligation
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11
Q

Benign ovarian neoplasms (MC?)

A
  1. serous cystadenoma
  2. mucinous cystadenoma
  3. endometrioma
  4. mature cystic teratoma (dermoid cyst)
  5. Brenner tumor
  6. fibromas
  7. thecoma
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12
Q

MC ovarian tumor in females 10-30

A

Mature teratoma of ovary (dermoid cyst)

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13
Q

Thecoma - characteristic, presentation

A

like granulosa cell tumors –> may produce estrogen

usually presents as abnormal uterine bleeding in postmenopausal women

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14
Q

malignant Ovarian neoplasms (MC?)

A
  1. Granulosa cell tumor
  2. serous cystednocarcinoma (MC)
  3. Mucinous cystedonacarcinoma
  4. immature teratoma
  5. yolk sac (endodermal sinus) tumor
  6. Krukenber tumor
  7. dysgerminoma
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15
Q

granulosa tumor - pathogenesis - histology

A

sex cord-stromal tumore
high estradiol and inhibin
- histology: Call-Exner bodies (cells in rosette pattern)

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16
Q

Granulosa cell tumor - clinical features

A
  1. complex ovarian mass
    jevenile subtype: precocious puberty
    adult: brest tenderness, abnormal uterine bleeding
    postmenopausal bleeding
17
Q

granulosa cell tumor - management

A 
endometrial biopsy (endometrial cancer)
surgery (tumor staging)
18
Q

how to check the quality of ovaries

A

measure FSH at day 3

19
Q

infertility due to diminished ovarian reserve - characteristics

A

regular menstrual cycles and decreased oocyte number + quality

20
Q

ovarian cancer - screening

A

there is no screening

21
Q

ovarian torsion - treatment

A

laparoscopy with detorsion
ovarian cystecomy
oophorectomy if nerosis or malignancy

22
Q

ovarian torsion - RF

A
  1. ovarian mass
  2. reproductive age
  3. infertility treatment with ovulation induction
23
Q

Causes of hyperandrogenism in pregnancy - types and risk for fetal virilization

A
  1. Luteoma –> high
  2. theca luteum cyst –> low
  3. Krukenberg tumor –> high
24
Q

Causes of hyperandrogenism in pregnancy - Krukenberg tumor - maternal clinical features

A

bilateral solid ovarian masses on U/S

metastases from GI tract ca

25
Q

Causes of hyperandrogenism in pregnancy - Luteoma - maternal clinical features

A
  • yellow or yellow brown masses (often with areas of hemorrhage) of large lutein cells
  • solid ovarian masses on U/S (50% are bilateral)
  • regress spontaneously after delivery
  • 30% symptoms of hyperandrogenism
26
Q

Causes of hyperandrogenism in pregnancy - theca luteum cyst - maternal clinical features

A
  • bilateral cysts on U/S
  • associated with molar pregnancy + multiple gestation
  • regress spontaneously after delivery
27
Q

ruptured ovarian cyst - clinical presentation / US findings

A

sudden onsetm severe, unilateral lower abd pain immediately followgin strenuous or sexual activity
U/S: pelvic free fluid

28
Q

ovarian mass in postemeupausal patients is investigated by

A

pelvic U/S and CA-124 –> IF NO MALIGNANT FEATRUES ON u/s AND NO HIGH ca-125 –> –> OBSERVATION WITH U/S
- IF 1 OF THEM IS SUSUCPICIOUS –> MRI or CT

29
Q

PCOS - levels of FSH, GNRH, estrogen

A
  • increased estrogen
  • increased GnRH
  • normal FSH
    INCREASED LH:FSH
30
Q

Polycystic ovarian syndrome - symptoms

A

Symptoms in women of reproductive age:

  1. amenorrhea or irregular menses
  2. Hisrutism and obesity
  3. acne
  4. DM2
31
Q

Polycystic ovarian syndrome - diagnosis

A

pelvic US: bilaterally enlarged ovaries with multiple cysts present
free testosterone elevated (2ry to high androgens)
LH to FSH RATIO MORE THAN 3:1

32
Q

Polycystic ovarian syndrome - treatment

A
  1. Weigh loss (decrease insulin resistance)
  2. OCP control the amounts of estrogn and progestin that are in the body –> control androgens and prevent endometrial hyperplasia (ONLY if they do not want children)
  3. Clomiphene and metformin (if they want to conceive)
  4. ketoconazole / spironolactone
33
Q

rupture ovarian cyst - fever

A

NO

just diffuse abd pain

34
Q

epithelial ovarian Ca - management

A

exploratory laparotomy

35
Q

ruptured ovarian cyst - clinical presentation / US findings

A

sudden onsetm severe, unilateral lower abd pain immediately followgin strenuous or sexual activity
U/S: pelvic free fluid

36
Q

teratoma in U/S

A

calcifications

hyperechoic

obstetric - gynecol STEP 2 (22 decks)

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