Reproductive Region

Question 1

How to differentiate a ruptured ovarian cyst from an ectopic pregnancy?

Answer 1

Both can have similar pain, nausea, bleeding, pelvic/cervical tenderness, adnexal mass.
Ectopic pregnancy - reproductive age
Ruptured ovarian cyst - fevers, usually preceded by activity or sex

Question 2

What is a spermatocele?

Answer 2

Hypoechoic cysts of epididymis

Question 3

What is a varicocele and what is it worrisome for?

Answer 3

Dilation of pampiniform plexus? - worrisome for renal cell cancer

Question 4

What is a seminoma? Signs? Treatment?

Answer 4

MC testicular tumor.
NO AFP elevation.
All get orchiectomy and XRT. Chemo if mets.

Question 5

What are signs of a non-Seminoma?
Treatment?
Types?

Answer 5

AFP elevation.
All get orchiectomy and retroperitoneal dissection. Stage 2 or more get chemo.

Embryonal, teratoma, choriocarcinoma, yolk sac

Teratomas more likely to metastasize and not respond to chemo

Question 6

What is a hydrocele?

Answer 6

Fluid build up, transilluminates - if acute and in an adult suspect tumor somewhere

Question 7

What is the most common malignancy in men 15-35?

Answer 7

Testicular cancer

Question 8

What is the testicular lymphatic drainage?

Answer 8

Right - paracaval and interaortocaval

Left - para-aortic

Question 9

What are the markers of an ovarian tumor?

Answer 9

CA 125 tumor marker

Inhibin A and B - hormones normally produced by ovaries. Also, used as tumor marker in mucinous epithelial carcinoma and granulosa cell tumors.

AFP - ovarian germ cell tumor marker

Question 10

Prostate cancer spreads how?

Answer 10

LYMPHATICALLY, usually to bone

Question 11

What are the stages of ovarian cancer?

Answer 11

1 - one or both ovaries involved

2 - extension beyond ovaries but still in pelvis

3 - abdomen involved

4 - distant mets

Question 12

Ovarian granulosa cell tumors are followed by?

Answer 12

Inhibin

Question 13

1. Endometrial cancer is treated with?
2. If poorly differentiated?
3. If serous or clear cell type?
4. If histology shows risk for recurrence - poorly differentiated
5. If disease is spread outside the uterus

Answer 13

1. Resection
2. Pelvic and para-aortic lymphadenectomy will be needed due to risk of LN spread
3. Omentectomy
4. Radiation
5. Chemotherapy

Question 14

When performing a radical orchiectomy, the surgery should be performed by what approach?

Answer 14

Inguinal approach, NOT scrotal!

Question 15

If the scrotum is surgically violated, metastatic spread to what nodes can occur?
What does it expose the immune system to?

Answer 15

Retroperitoneal and the inguinal nodes.

Haploid cells of the testes.

Question 16

An anechoic unilocular cyst in a postmenopausal woman is low or high risk?
What surveillance should be done?

Answer 16

Low risk

Repeat ultrasound in 3 months along with a CA-125 level