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OB/GYN review > Test 1 Part 2 > Flashcards

Test 1 Part 2 Flashcards

1
Q

what is endometriosis?

A

result of functioning endometrial tissue being located outside of the uterus

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2
Q

when is endometriosis stimulated?

A

hormonally stimulated during the reproductive years and can affect 25%-35% of infertile women

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3
Q

what are symptoms of endometriosis?

A
  • pelvic pain
  • dyspareuinia
  • abnormal uterine bleeding
  • dysmenorrhea
  • can be asymptomic
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4
Q

endometriosis can be _____ or ________

A

localized or diffuse

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5
Q

where is the most common place for endometriosis to occur?

A

ovaries

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6
Q

how is endometriosis treated?

A

medically with hormones

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7
Q

what is endometrioma also known as?

A

chocolate cyst

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8
Q

how does an endometrioma appear?

A

a mass involving the ovary

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9
Q

what is the classic sonographic sign of an endometrioma?

A
  • well defined
  • thin-walled mass containing low level echoes
  • internal echoes with through transmission
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10
Q

endometrioma may be unilocular or multilocular are are frequently __________

A

multiple in number

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11
Q

what are other sonogrpahic features of endometrioma?

A
  • masses with thick walls
  • internal septations
  • fluid/debris levels in the depensant portion of lesion
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12
Q

how are endometriomas most easily characterized?

A

transvaginally

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13
Q

what is polycystic ovarian syndrome (PCOS)?

A

an endocrine disorder that produces anovulation and results in infertility

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14
Q

PCOS has high levels of what?

A

androgen hormones

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15
Q

what are the clinical symptoms of PCOS?

A
  • infertiity
  • early pregnancy loss
  • hirtusism
  • acne
  • amenorrhea
  • asymptomatic
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16
Q

how is the diagnosis made for PCOS?

A

evaluation of the clinical presentation and hormone levels

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17
Q

why may PCOS patients be monitored?

A

PCOS may incur the risks associated with unopposed estrogen and may be monitored for endometrial carcinoma and breast cancer

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18
Q

what is the sonographic appearance of PCOS?

A
  • bilateral ovaries that contain multiple smal follicles
  • follicles usually in periphery
  • STRING OF PEARLS
  • ovaries have increase in stromal echogenicity
  • normal or large in size
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19
Q

what is the sonographic criteria for PCOS?

A
  • presence of 12 or more follicles measuring 2-9 mm OR

- increased ovarian volume greater than 10 mL

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20
Q

what is the summary of criteria for diagnosing PCOS?

A
  • Oligoovulation or anovulation
  • clinical or biochemical signs of hyperandrogenism
  • polycystic ovaries
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21
Q

what modality is superior for detecting and determining the type of anomaly present in ovaries?

A

3D imaging and MRI

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22
Q

what is helpful for diagnosing anomalies?

A

Hysterosalpingogram

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23
Q

a defect can be removed during a ___________

A

hysteroscopy

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24
Q

the development of the uterus is closely associated with the development of what system?

A

excretory system

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25
Q

when a uterine anomaly is identified, what should also be evaluated for the presence of congenital anomalies?

A

kidneys

unilateral renal ageneis or renal ectopia

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26
Q

what is uterus didelphys?

A

complete failure of the mullerian ducts to fuse together

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27
Q

what is the sonographic appearance of a uterus didelphys?

A
  • 2 seperate endometrial echo complexes
  • a deep fundal notch is present, seperated widely with a full complement of myometrium
  • 2 cervices and vagina
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28
Q

what may occur with uterus didelphys?

A

hematocolpos or hematometracolpos

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29
Q

what is a bicornuate uterus?

A

duplication of the uterus entering 1 cervix or 2 cervices with only 1 vagina

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30
Q

how does bicornuate uterus occur?

A

results from partial fusion of the mullerian ducts during embryologic development

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31
Q

what is Bicornis bicollis?

A

duplication of both cervix and uterus

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32
Q

what is Bicornis unicollis?

A

duplication of the uterus without duplication of the cervix

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33
Q

what is the sonographic appearance of a bicornuate uterus?

A
  • shows a deep fundal notch
  • endometrial echoes appear as 2 different complexes widely seperated
  • same appearance as uterus didelphys in fundal region
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34
Q

how can bicornuate uterus and uterus didelphys be differentiated?

A

with identification of duplication of the vaginal canal, which is evident in uterus didelphys

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35
Q

what is the most common congenital uterine abnormality?

A

septate uterus

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36
Q

how does septate uterus occur?

A

result of a failure in reabsorption of the median septum

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37
Q

what is the treatment for a septate uterus?

A

can have septum removed via hysteroscopy if infetility occurs

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38
Q

what is the mildest congenital uterine abnormality?

A

arcuate uterus

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39
Q

what is an arcuate uterus?

A

minor lack of fusion of the fundal region that results in a slight depresion in that area

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40
Q

does an arcuate uteris considered to be an infertility issue?

A

no

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41
Q

what is the sonogrpahic appearance of an arcuate uterus?

A

normal with no change to external uterine contour and the uterine cavity is slightly concave

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42
Q

what plays a key role in the evaluation and managment of infertility treatment?

A

sonography

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43
Q

depending of the specific cause for infertility, what may be the treatment for infertility?

A
  • ovarian stimulation to induce ovulation
  • intrauterine semination
  • in virtro fertilization
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44
Q

how is stimulation of the ovaries often monitored?

A

with serum estradiol level and transvaginal sonogrpahy to determine follicle size and number

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45
Q

what is ovarian hyperstimulation?

A

serious complication that can result from stimultion of the ovaries for induction of ovulation

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46
Q

how do theca lutein cysts occur?

A

ovaries massivly enlarge with multiple luteinized follicles

47
Q

what causes theca lutein cysts?

A

excessive human chorionic gonadotropin levels

48
Q

what can ascites and pleural effusions devlop and lead to?

A

hypovolemia
hypotension
impaired renal function

49
Q

what are indications that may prompt a sonographic evaluation to assess for an ovarian mass?

A
  • pelvic pain
  • pelvic fullness
  • palpable mass
  • fam history of ovarian or breast cancer
50
Q

when an adnexal mass is discovered during sonogram, what should be evaluated?

A
  • location
  • echotexture
  • size of mass
  • any associated findings such as ascites
  • cystic, solid, complex?
  • acoustic enhancement or atten.
  • presence on internal echoes by optimized gain and freq
  • loculation, thickness, iregularity
  • apply colour
51
Q

what needs to be considered when scanning for ovarian pathology?

A
  • patients age
  • menstraul status
  • symptoms
  • fam history
52
Q

who is more likely to present with benign ovarian pathology?

A

women in their reporductive years

53
Q

who is at a higher risk for malignant ovarian pathology?

A

postmenopausal women and women of reproductive years and fam history of ovarian or breast cancer

54
Q

when can a functional or physiologic cyst occur?

A

of an ovarian follicle or corpus luteum fails to regress, it can continue to fill with fluid

55
Q

what does the term functional cyst mean?

A

means that the cyst is ovarian in origin and responds to cyclic hormonal changes

56
Q

what are one of the most common causes of ovarian enlargment in young women?

A

follicular cysts

57
Q

when do follicular cysts occur?

A

when a dominant follicle fails either to ovulate or to regress

58
Q

what are hemorrhagic cysts?

A

functional cysts bleeding inside

59
Q

what are theca lutein cysts?

A

functional cysts related to human chorionic gonadotropin exposure

60
Q

what are nonfunctional cysts?

A

refer to cysts that do not respond to cyclic hormonal stimulation

61
Q

what are examples of nonfunctional cysts?

A

endometriomas
paraovarian cyst
peritoneal inclusion cysts

62
Q

where do paraovarian cysts originate?

A

from the wolffian structures located in the broad ligament

63
Q

what term describes the appearance of hemorrhagic cyst?

A

fishnet

64
Q

what causes the ovary to enlarge with ovarian torsion?

A

lack of venous drainage

65
Q

what can cause the ovary to infarct and necrose in ovarian torsion?

A

compromised arterial perfusion

66
Q

when does ovarian torsion usually occur?

A

childhood or reproductive years

67
Q

what presents clinically with ovarian torsion?

A
  • severe pain
  • nausea
  • vomiting
  • may be palpable mass
68
Q

what is the most widely used serum tuor marker for epithelial ovarian cancer?

A

antigen 125 (CA 125)

69
Q

what is done when a womens serum concentration of CA 125 is elevated?

A

transvaginal sonography may be preformed to assess for an ovarian mass

70
Q

Only _________ of women with stage 1 epithelial ovarian cancer have elevated serum levels

A

50%-60%

71
Q

what is used for screening when a women has a high risk of ovarian cancer?

A

combination of CA 125 with transvaginal sonography

72
Q

who has a higher risk of a malignant ovarian neoplasm? premenopausal or postmenopausal?

A

postmenopausal

73
Q

what are ovarian neoplasms classified by?

A

type of ovarian tissue

  • germ cell
  • epithelial
  • sex cord-stromal tumors
74
Q

what type of tumors are the 2 most common types of ovarian neoplams?

A

germ cell tumors

75
Q

what are the 2 most common types of ovarian neoplasms?

A
  • benign cystic teratoma

- surface epithelial-serous cystadenoma

76
Q

who are germ cell tumors most commonly found in?

A

young women

77
Q

who are epithelial tumors more common in?

A

women in thier fourth and fifth decades

78
Q

Metastatic ovarian disease is a __________source of ovarian neoplasms

A

fourth

79
Q

what is the sonogrpahic apperance of metastatic disease?

A
  • pattern recognotion
  • morphologic recognition
  • doppler features
  • clinical signs and symotoms
  • consideration of age
  • menpausal status
80
Q

what is another name for bengin cystic teratomas?

A

cystic teratomas
dermoids
dermoid cyst

81
Q

what are benign cystic teratomas composed of?

A

3 germ cell layers:

  • ectoderm
  • mesoderm
  • endoderm
82
Q

what do germ cells form?

A
  • teeth
  • bone
  • skin
  • fingernails
  • hair
  • fat
  • sebum
83
Q

what does a cystic teratoma usually contain?

A

sebum with varying amounts of fat, hair, teeth, and bone fragments

84
Q

what are sonographic signs of cystic teramtoma?

A
  • tip of the iceberg
  • fat/fluid level
  • dermoid plug
  • dermoid mesh
85
Q

are ovarian dysgerminomas malignant or benign?

A

malignant

86
Q

what may patients with malignant dysgerminoma present with?

A

abdominal enlargment because of palpable mass or pain or menstrual abnormalities

87
Q

what is the most common ovarian tumor among women 50 years or older and account for most malignant ovarian neoplams?

A

epithelial ovarian neoplams

88
Q

what are the most common types of epithelial neoplams?

A
  • serous and mucinous cystadenoma or cystadenocarcinoma
  • borderline ovrian tumors
  • endometroid tumors
  • OTHER=clear cell tumor and brenner or transitional cell tumor
89
Q

what are the most common type of epithelial neoplams?

A

serous cystadenoma and cystandenocarcinoma

90
Q

who does serous cystadenoma (benign form) occur in?

A

most frequently in women 40-50 years old

91
Q

who does serous cystadenocarcinoma (malignant form) occur in?

A

perimenopausal and postmenopausal women

92
Q

what does a serous cystandenoma look like?

A
  • simple cyst
  • thin septations
  • papillary projections or both
93
Q

what is pseudomyxoma peritonei?

A

rupture of mucinous cystadenoma and cystadenocarcinoma tumor capsule may cause spillage of the gelantinous contents into the abdomen

94
Q

what may an endometriod tumor be associated with?

A

endometrial adenocarcinoma and endoetriosis

95
Q

About________ of endometrioid tumors are malignant

A

80%

96
Q

what is the second most common malignant epithelial tumor?

A

endometroid tumor

97
Q

what are brenner tumors also known as?

A

transitional cell tumors

98
Q

are brenner tumors usually benign or malignant?

A

benign

99
Q

what is the size of brenner tumors usually?

A

usually less than 2cm in diameter and rarely exceed 10cm

100
Q

what are brenner tumors usually associated with?

A

ipsilateral cystic neoplasm such as a cystadenoma or cystic teratoma

101
Q

what do sex cord-stromal tumors arise from?

A

sex cords of the embryonic gonad and from the ovarian stroma

102
Q

what are the most common sex cord-stromal tumors?

A
  • granulosa cell tumor
  • sertoli-leydig cell tumor (adroblatoma)
  • fibroma
  • thecoma
103
Q

what tumor often secrete estrogen-thickened endometrium?

A

granulosa cell tumor

104
Q

what can excess estrogen in children cause?

A

precocious puberty or premature breast development

105
Q

what may sertoli-leydig tumors produce?

A

testosterone and occasionly estrogen

106
Q

what do fibromas consist of?

A

fibrous tissue, are not hormonally active, and tend to be asymptomatic

107
Q

what do thecomas consist of?

A

variable combination of thecal and fibrous tissue

108
Q

what causes meigs syndrome?

A

benign solid ovarian mass of which fibroma is the most common

109
Q

what is associated with meig’s syndrome?

A

presence of ascites and a pleural effusion

110
Q

what are the most common tumors to metastasize to the ovary?

A

tumors of the breast and of the GI tract

111
Q

what can metastasize to the ovaries?

A

endometrial carcinoma

112
Q

what is a krukenburg tumor?

A

tumors containing mucin-secreting signet ring cells, which arise from the GI tract

113
Q

what is the size of a cyst versus a follicle?

A

over 2-3cm

OB/GYN review (8 decks)

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