Ovaries

Question 1

is PCOS common

Answer 1

yes

Question 2

‘pearl necklace on outside of ovaries’

Answer 2

polycystic ovarian syndrome (PCOS)

Question 3

what chronic condition can cause PCOS

Answer 3

diabetes

Question 4

in PCOS there aren’t actually any cysts, what are they

Answer 4

immature follicles

Question 5

how does PCOS present in terms of menstruation

why

Answer 5

amenorrhoea

bc the immature follicles don’t burst
also FSH and LH imbalances

Question 6

blood progesterone levels in PCOS

why

Answer 6

low

bc progesterone is normally released form follicles, but these follicles are immature

Question 7

presentation of PCOS (4)

Answer 7

amenorrhoea (no eggs being released)
infertility (no eggs being released)
overweight
clinical hyperandrogenism - acne, hirsutism

Question 8

investigations for PCOS

Answer 8

endocrine profile - androgens, oestrogen, LH, FSH, TFTs

US - see polycystic ovaries

Question 9

are androgens high or low in PCOS

Answer 9

high = acne, hirsutism etc

Question 10

LH in PCOS

Answer 10

high

Question 11

treatment of PCOS first line (do both)

Answer 11

weight loss and diet

clomifene citrate - anti oestrogen

Question 12

why do you give an anti oestrogen in PCOS

Answer 12

anti oestrogen = decreases oestorgens = increased FSH and LH - ovulation can be induced

Question 13

treatment of PCOS second line after weight loss and clomifene citrate (4 options)

Answer 13

add metformin
gonadotrophin therapy (FSH And LH) - be wary of ovarian hyperstimulation syndrome
COCP - for hyperandrogenism
laparoscopic ovarian diathermy (drilling)

Question 14

aetiology of premature ovarian failure (POF) (4)

Answer 14

idiopathic
autoimmune
genetic - turners
iatrogenic - chemo

Question 15

how does premature ovarian failure present

in what age

Answer 15

amenorrhoea <40yo

infertility (no eggs being released)

Question 16

what MSK problem does POF present with

why

Answer 16

osteoporosis

oestrogen (normally released from functioning ovaries) = protective effects on bone

Question 17

LH FSH and oestrogen levels in POF

Answer 17

low oestrogen

high FSH and LH to compensate for low oestrogen

Question 18

treatment of POF

Answer 18

HRT eg COCP

vit D and Ca supplements, bisphosphonates - for osteoporosis

Question 19

treatment of POF and wanting kids

Answer 19

egg donation and IVF

Question 20

investigations for POF

Answer 20

endocrine profile

pregnancy test - to exclude pregnancy

Question 21

what is endometriosis

Answer 21

presence of endometrial glands and stoma outside the uterine cavity

Question 22

what causes endometriosis

Answer 22

retrograde menstruation - womb lining sheds backwards into fallopian tubes/ovaries/pelvic cavity, instead of in other direction

Question 23

presentation of endometriosis

Answer 23

menorrhagia
chronic pelvic/abdo pain
infertility

Question 24

investigations for endometriosis

Answer 24

TVUS

laparoscopy - see chocolate cysts

Question 25

chocolate cysts on laparoscopy of ovaries

Answer 25

endometriosis

Question 26

why are the cysts brown ('chocolate') in endometriosis

Answer 26

collection of blood

Question 27

management of endometriosis

Answer 27

NSAIDs - for pain COCP (progestogens) - mostly sufficient ablation/excision of endometrium hysterectomy

Question 28

are functional ovarian cysts normal

Answer 28

yes

Question 29

risk factors for ovarian tumours (4)

Answer 29

>50yo nulliparous (no babies) BRCA gene lynch syndrome

Question 30

which type of contraceptive is protective of ovarian cancer (ie give to those with lynch syndrome or BRCA gene)

Answer 30

COCP

Question 31

which gene increases your risk of ovarian cancer

Answer 31

BRCA gene

Question 32

where do mets that end up on ovaries usually come from

Answer 32

stomach

Question 33

what type of cancer is most common on the ovaries

Answer 33

epithelial carcinoma

Question 34

what are the 4 categories of ovarian tumours (4 places they can occur) which is by far the most common

Answer 34

epithelial tumours - most common (65%) germ cells tumours stroma/sex cord tumours secondary metastasis (eg from stomach)

Question 35

what are the 3 types of epithelial ovarian tumour

Answer 35

serous tumour mucinous tumour endometriod tumour brenner tumour (transitional tumour)

Question 36

most common type of epithelial ovarian tumour

Answer 36

serous tumour

Question 37

what % of ovarian serous tumours are malignant

Answer 37

30%

Question 38

which type of ovarian epithelial tumour has psammoma bodies (calcium filled)

Answer 38

serous ovarian tumours

Question 39

name of malignant serous ovarian tumour

Answer 39

serous cystadenocarcinoma

Question 40

name of benign serous ovarian tumour

Answer 40

serous cystadenoma

Question 41

name of malignant mucinous ovarian tumour

Answer 41

mucinous cystadenocarcinoma

Question 42

name of benign mucinous ovarian tumour

Answer 42

mucinous cystadenoma

Question 43

what % of ovarian mucinous tumours are malignant

Answer 43

5% (95% benign)

Question 44

what kind of epithelium is in brenner ovarian tumours

Answer 44

transitional cell epithelium

Question 45

what is another differential for brenner ovarian tumours (transitional tumours) think about it!!

Answer 45

mets from bladder (bc bladder is normally transitional cells)

Question 46

what is the most common type of germ cell ovarian tumour

Answer 46

teratoma (aka dermoid cyst)

Question 47

ovarian tumour in children

Answer 47

probs teratoma

Question 48

what does a teratoma look like on pathology

Answer 48

contains lots of diff epithelium = teeth, hair, skin, fat, brain tissue etc etc

Question 49

ovarian tumour with tooth in it

Answer 49

teratoma (dermoid cyst)

Question 50

what are the 4 types of germ cell ovarian tumour

Answer 50

teratoma (dermoid cyst) yolk sac tumour choriocarcinoma dysgerminoma

Question 51

what does a yolk sac tumour secrete

Answer 51

AFP (alpha fetoprotein)

Question 52

what does a choriocarcinoma secrete

Answer 52

hCG

Question 53

which type of ovarian tumour commonly occurs after complete molar pregnancies

Answer 53

choriocarcinoma

Question 54

are teratomas benign or malignant

Answer 54

benign

Question 55

apart from teratomas, are all other germ cell ovarian tumours (yolk sac carcinoma, dysgerminoma, choriocarcinoma) benign or malignant

Answer 55

malignant

Question 56

what are the 3 types of stromal/sex cord ovarian tumour

Answer 56

fibroma granuosa-theca cell tumours Sertoli-Leydig cell tumours

Question 57

ovarian fibroma with ascites and pleural effusion

Answer 57

meigs syndrome

Question 58

what do Sertoli-Leydig cell ovarian tumours secrete

Answer 58

androgens

Question 59

presentation of Sertoli-leydig cell ovarian tumours

Answer 59

hirsutism (from increased androgen production)

Question 60

what do granulosa-theca cell tumours secrete

Answer 60

oestrogens

Question 61

presentation of granulosa-theca cell tumours

Answer 61

precocious puberty <9yo abnormal uterine bleeding in adults from increased oestrogen secretion

Question 62

what type of sex cord/stromal ovarian tumour looks like a potato

Answer 62

fibroma

Question 63

where is spread of ovarian tumours common to why

Answer 63

peritoneum bc ovaries are actually in peritoneum!

Question 64

presentation of ovarian tumours

Answer 64

abdo distention pelvic mass pelvic pain weight loss, fatigue

Question 65

investigations for ovarian tumours

Answer 65

TVUS tumour markers - hCG, AFP biopsy - to see if benign or malignant

Question 66

once confirmed ovarian tumour on biopsy, what investigations do you want to do

Answer 66

CT/MRI/CXR for staging/spread

Question 67

staging of ovarian cancer in 1 ovary

Answer 67

1A

Question 68

staging of ovarian cancer in 2 ovaries

Answer 68

1B

Question 69

staging of ovarian cancer with local spread to bowel/bladder

Answer 69

2

Question 70

staging of ovarian cancer with abdo mets

Answer 70

3

Question 71

staging of ovarian cancer with distant mets eg liver

Answer 71

4

Question 72

management of ovarian tumour

Answer 72

chemo and surgery

Question 73

what tumour marker is used to assess progress with treatment of ovarian cancer

Answer 73

CA125

Question 74

why isn't CA125 diagnostic, but good for follow up

Answer 74

CA125 is a marker of peritoneal infection= can be raised in loads of things eg peritonitis, pregnancy

Question 75

complication of dermoid ovarian cysts (teratomas) | how does it present

Answer 75

ovarian cyst torsion sudden pelvic pain mainly happens in teratomas bc heavy, but can happen in any

Question 76

what can happen to the ovary if there is an ovarian cyst torsion

Answer 76

necrosis = lose ovary