PID, PCOS, and Ovarian Masses

Question 1

What are the risk factors for PID?

Answer 1

Young age
Multiple sex partners
Unprotected intercourse
Prior history of PID
Instrumentation (IUD insertion, Endomertial biopsy)
Lower genital tract infection (gonorrhea, chlamydia, BV)

Question 2

PID is predominantly cause by which organism(s)?

Answer 2

Gonorrhea and Chlamydia

Question 3

What are the clinical manifestations of PID?

Answer 3

Fever
Purulent endocervical discharge
Pelvic pain
Peritoneal irritation
Uterine and adnexal tenderness
Pelvic mass

Question 4

What must be included in the differential diagnosis of PID?

Answer 4

Ectopic pregnancy
Appendicitis
Ruptured ovarian cyst
Adnexal torsion
Diverticulitis

Question 5

What goes into an evaluation of PID?

Answer 5

CBC
Pregnancy test
Screens for gonorrhea, chlamydia, and other STDs
US
Laparoscopy

Question 6

What is the outpatient treatment for PID?

Answer 6

Ofloxacin (400mg) or levofloxacin (500mg) PLUS metronidazole (500mg), both twice daily x 14 days

Ceftrriaxone (250mg IM) PLUS doxycycline (100mg twice daily x 14 days +/- metronidazole (500mg twice daily x 14 days)

Question 7

What is the inpatient treatment for PID?

Answer 7

Cefotetan PLUS doxycycline (2g q 12hr, 100mg q 12hr)

Clindamycin PLUS gentamycin (900mg q 8 hr, 7mg/kg/IBW q 24 hr)

Question 8

What are the long term sequelae of PID?

Answer 8

Infertility
Ectopic pregnancy
Chronic pelvic pain

Question 9

What is PCOS?

Answer 9

Polycystic ovarian syndrome- a common but complex disorder caused by abnormalities in the hypothalmus, pituitary gland and ovary.
One of the major causes of irregular or absent menses
Important cause in infertility
One of the most common causes of hirsutism

Question 10

What are the clinical manifestations of PCOS?

Answer 10

Irregular or absent menses
Obesity
Adrogen excess (acne, hirsutism)
Infertility
Enlarged polycystic ovaries

Question 11

What goes into the evaluation of PCOS?

Answer 11

LH- usually elevated
FSH- rule out premature menopause
Testosterone- identify ovary as source of androgen excess
DHEA-sulfate- identify adrenals as source of androgen excess
Prolactin- elevated prolactin may cause amenorrhea
TSH- Hypothyroidism may cause amenorrhea
Insulin:glucose ratio- PCOS->hyperinsulinism

Question 12

What are the long term sequelae of PCOS?

Answer 12

Persistent infertility
Endometrial hyperplasia
Endometrial cancer

Question 13

What is the treatment for PCOS?

Answer 13

Depends on the patients desires:
No pregnancy/no contraception- withdraw with Provera q 2 months
No pregnancy w/contraception- oral contraception
Pregnancy- Clomiphene citrate, bromocriptine (elevated PRL), metformin (hyperinsulinism)

Question 14

What are the most common masses found in women of reproductive age?

Answer 14

functional cysts, may resolve spontaneously

OCs may hasten resolution

Question 15

What are the ovarian neoplasms site of origin?

Answer 15

epithelium, germ cells and stroma

Question 16

What are the key features of serous epithelial ovarian neoplasms?

Answer 16

more common in older patients, more likely to be bilateral

Question 17

What are the key features of mucinous epithelial ovarian neoplasms?

Answer 17

may grow to a large size

Question 18

What are the key features of germ cell ovarian neoplasms?

Answer 18

more common in younger patients

Question 19

What are the key features of stromal cell ovarian neoplasms?

Answer 19

hormonally active- estrogen or androgenic effects

Question 20

What goes into the evaluation of an ovarian neoplasm?

Answer 20

Mammogram- exclude metastatic breast cancer
colonoscopy- exclude primary or metastatic colorectal cancer
US- assess for uterine vs adnexal mass
CA 125- differentiate benign from malignant mass
Exploratory laparotomy- confirm histologic diagnosis

Question 21

How do you manage an ovarian neoplasm?

Answer 21

Surgery- removal of ovary, removal of uterus, tubes, both ovaries, omentum, and lymph nodes
Irradiation
Chemotherapy

Question 22

What does the treatment of PCOS depend on?

Answer 22

The patients desire for pregnancy, need for contraception, and pressence or absence of hirusitism

Question 23

What is the most common cause of ovarian neoplasm in women of reproductive age?

Answer 23

cystic teratoma

Question 24

Why is the overall prognosis of ovarian masses poor?

Answer 24

In advanced stages at the time of diagnosis

Question 25

What is the most appropriate imaging study to assess for an ovarian mass?

Answer 25

US