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J Repro > Ovaries > Flashcards

Ovaries Flashcards

1
Q

is PCOS common

A

yes

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2
Q

‘pearl necklace on outside of ovaries’

A

polycystic ovarian syndrome (PCOS)

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3
Q

what chronic condition can cause PCOS

A

diabetes

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4
Q

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

A

immature follicles

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5
Q

how does PCOS present in terms of menstruation

why

A

amenorrhoea

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

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6
Q

blood progesterone levels in PCOS

why

A

low

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

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7
Q

presentation of PCOS (4)

A

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

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8
Q

investigations for PCOS

A

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

US - see polycystic ovaries

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9
Q

are androgens high or low in PCOS

A

high = acne, hirsutism etc

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10
Q

LH in PCOS

A

high

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11
Q

treatment of PCOS first line (do both)

A

weight loss and diet

clomifene citrate - anti oestrogen

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12
Q

why do you give an anti oestrogen in PCOS

A

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

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13
Q

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

A

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

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14
Q

aetiology of premature ovarian failure (POF) (4)

A

idiopathic
autoimmune
genetic - turners
iatrogenic - chemo

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15
Q

how does premature ovarian failure present

in what age

A

amenorrhoea <40yo

infertility (no eggs being released)

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16
Q

what MSK problem does POF present with

why

A

osteoporosis

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

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17
Q

LH FSH and oestrogen levels in POF

A

low oestrogen

high FSH and LH to compensate for low oestrogen

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18
Q

treatment of POF

A

HRT eg COCP

vit D and Ca supplements, bisphosphonates - for osteoporosis

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19
Q

treatment of POF and wanting kids

A

egg donation and IVF

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20
Q

investigations for POF

A

endocrine profile

pregnancy test - to exclude pregnancy

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21
Q

what is endometriosis

A

presence of endometrial glands and stoma outside the uterine cavity

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22
Q

what causes endometriosis

A

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

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23
Q

presentation of endometriosis

A

menorrhagia
chronic pelvic/abdo pain
infertility

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24
Q

investigations for endometriosis

A

TVUS

laparoscopy - see chocolate cysts

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25
Q

chocolate cysts on laparoscopy of ovaries

A

endometriosis

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26
Q

why are the cysts brown (‘chocolate’) in endometriosis

A

collection of blood

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27
Q

management of endometriosis

A

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

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28
Q

are functional ovarian cysts normal

A

yes

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29
Q

risk factors for ovarian tumours (4)

A

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

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30
Q

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

A

COCP

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31
Q

which gene increases your risk of ovarian cancer

A

BRCA gene

32
Q

where do mets that end up on ovaries usually come from

A

stomach

33
Q

what type of cancer is most common on the ovaries

A

epithelial carcinoma

34
Q

what are the 4 categories of ovarian tumours (4 places they can occur)

which is by far the most common

A

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

35
Q

what are the 3 types of epithelial ovarian tumour

A

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

36
Q

most common type of epithelial ovarian tumour

A

serous tumour

37
Q

what % of ovarian serous tumours are malignant

A

30%

38
Q

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

A

serous ovarian tumours

39
Q

name of malignant serous ovarian tumour

A

serous cystadenocarcinoma

40
Q

name of benign serous ovarian tumour

A

serous cystadenoma

41
Q

name of malignant mucinous ovarian tumour

A

mucinous cystadenocarcinoma

42
Q

name of benign mucinous ovarian tumour

A

mucinous cystadenoma

43
Q

what % of ovarian mucinous tumours are malignant

A

5% (95% benign)

44
Q

what kind of epithelium is in brenner ovarian tumours

A

transitional cell epithelium

45
Q

what is another differential for brenner ovarian tumours (transitional tumours)

think about it!!

A

mets from bladder (bc bladder is normally transitional cells)

46
Q

what is the most common type of germ cell ovarian tumour

A

teratoma (aka dermoid cyst)

47
Q

ovarian tumour in children

A

probs teratoma

48
Q

what does a teratoma look like on pathology

A

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

49
Q

ovarian tumour with tooth in it

A

teratoma (dermoid cyst)

50
Q

what are the 4 types of germ cell ovarian tumour

A

teratoma (dermoid cyst)
yolk sac tumour
choriocarcinoma
dysgerminoma

51
Q

what does a yolk sac tumour secrete

A

AFP (alpha fetoprotein)

52
Q

what does a choriocarcinoma secrete

A

hCG

53
Q

which type of ovarian tumour commonly occurs after complete molar pregnancies

A

choriocarcinoma

54
Q

are teratomas benign or malignant

A

benign

55
Q

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

A

malignant

56
Q

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

A

fibroma
granuosa-theca cell tumours
Sertoli-Leydig cell tumours

57
Q

ovarian fibroma with ascites and pleural effusion

A

meigs syndrome

58
Q

what do Sertoli-Leydig cell ovarian tumours secrete

A

androgens

59
Q

presentation of Sertoli-leydig cell ovarian tumours

A

hirsutism (from increased androgen production)

60
Q

what do granulosa-theca cell tumours secrete

A

oestrogens

61
Q

presentation of granulosa-theca cell tumours

A

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

62
Q

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

A

fibroma

63
Q

where is spread of ovarian tumours common to

why

A

peritoneum

bc ovaries are actually in peritoneum!

64
Q

presentation of ovarian tumours

A

abdo distention
pelvic mass
pelvic pain
weight loss, fatigue

65
Q

investigations for ovarian tumours

A

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

66
Q

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

A

CT/MRI/CXR for staging/spread

67
Q

staging of ovarian cancer in 1 ovary

A

1A

68
Q

staging of ovarian cancer in 2 ovaries

A

1B

69
Q

staging of ovarian cancer with local spread to bowel/bladder

A

2

70
Q

staging of ovarian cancer with abdo mets

A

3

71
Q

staging of ovarian cancer with distant mets eg liver

A

4

72
Q

management of ovarian tumour

A

chemo and surgery

73
Q

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

A

CA125

74
Q

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

A

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

75
Q

complication of dermoid ovarian cysts (teratomas)

how does it present

A

ovarian cyst torsion
sudden pelvic pain

mainly happens in teratomas bc heavy, but can happen in any

76
Q

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

A

necrosis = lose ovary

J Repro (28 decks)

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