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Oral board studying Prep book > Uterine fibroids, Adnexal masses > Flashcards

Uterine fibroids, Adnexal masses Flashcards

1
Q

What is a type 0 fibroid?

A

pedunculated intracavitary fibroid

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2
Q

What is a type 1 fibroid?

A

<50% intramural

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3
Q

What is a type 2 fibroid?

A

> 50% intramural

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4
Q

What is a type 3 fibroid?

A

100% intramural but contacts endometrium

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5
Q

What is a type 4 fibroid?

A

Intramural

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6
Q

What is a type 5 fibroid?

A

Subserosal fibroid with >50% intramural component

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7
Q

What is a type 6 fibroid?

A

Subserosal fibroid with < 50% intramural component

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8
Q

What is a type 7 fibroid?

A

Pedunculated subserosal fibroid

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9
Q

What are the different ways to treat uterine fibroids?

A
  1. Expectant managment
  2. Medical management
  3. Surgical management
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10
Q

Who are candidates for expectant management for uterine fibroids?

A

Asymptomatic
No desire for treatment

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11
Q

Who are candidates for medical management for uterine fibroids?

A

Symptomatic and no desire for surgical management

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12
Q

Which medications primarily address bleeding symptoms of uterine fibroids?

A
  1. Tranexamic acid
  2. GnRh antagonist ( elagolix)
  3. Levongestrel IUD
  4. Hormonal contraceptives
  5. NSAIDs
  6. Subdermal implant
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13
Q

Which medications can address the bulk symptoms of uterine fibroids?

A
  1. GnRh agonist (Lupron)
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14
Q

What are the surgical options for uterine fibroid management?

A
  1. Uterine artery embolization
  2. Ultrasound focused energy
  3. Endometrial ablation
  4. Myomectomy
  5. Hysterectomy
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15
Q

What women are uterine artery embolization not indicated in?

A
  1. Women desiring future fertility
  2. Postmenopausal women
  3. Contraindication to contrast use
  4. Asymptomatic uterine fibroids
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16
Q

What is a disadvantage to uterine artery embolization?

A

Reduction in ovarian function

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17
Q

What are the potential complications of uterine artery embolization?

A
  1. Symptomatic degeneration/pain
  2. Myometrial infarction/necrosis
  3. Myometritis
  4. Bacteremia
  5. Uterine perforation/intraperitoneal injury
  6. Hemorrhage
  7. Loss of ovarian function
18
Q

What is the most important independent risk factor for ovarian cancer?

A

Age

19
Q

Which adnexal masses can be managed expectantly?

A
  1. Simple cyst up to 10cm
  2. Endometrioma
  3. Hydrosalphinx
  4. Mature cystic teratoma
20
Q

What is the lifetime risk of ovarian cancer in the general population?

A

1%

21
Q

What is the lifetime risk of ovarian cancer when you have a family member with ovarian cancer?

A

5%

22
Q

What is the risk of ovarian cancer with BRCA 1 mutation?

A

40% by age 70

23
Q

What is the risk of ovarian cancer with BRCA 2 mutation?

A

20% by age 70

24
Q

What is the risk of ovarian cancer with Lynch syndrome?

A

5-10%

25
Q

What features on ultrasound gives an increased risk of malignancy?

A
  1. Septations
  2. Increased color doppler
  3. Size>10cm
  4. Solid components
  5. irregularity
  6. Free fluid
  7. Mural nodules
  8. papillary excrescences
26
Q

What things can cause elevated Ca-125?

A

Cancer
PID
Endometriomas
Pregnancy
Inflammatory conditions
NOn gyn malignancies

27
Q

What is an abnormal Ca 125 test for menopausal women?

A

> 35

28
Q

When is surgery indicated for adnexal mass?

A

Symptoms
Suspicion for malignancy

29
Q

IF you have a menopausal woman with a TOA what is the recommendation and why?

A

Recommendation is for surgery due to risk of malignancy

30
Q

What are tumor markers for adnexal mass?

A

CA125
CEA
CA19-9
HE4

31
Q

What are the imaging options for adnexal masses?

A

Ultrasound preferred
Can you MRI

32
Q

When do you refer to gyn oncology?

A

Premenopausal= Very elevated CA125, ascites, metastases

Postmenopausal= elevated CA125, ascites, nodular or fixed mass, abdominal metastases

33
Q

What patients are candidates for surgical management of adnexal mass?

A
  1. High risk mass on imaging (O-RAD 5 or signs of metastases)
  2. Postmenopausal patient + adnexal mass + elevated tumor marker
  3. Postmenopausal + large adnexal
  4. Postmenopausal + ORAD 4 + signs or symptoms of ovarian cancer
  5. Premenopausal + O-RAD 4 mass + very elevated CA125
  6. Premenopausal + suspected germ cell or sex chord stromal tumor
34
Q

Management of physiologic cyst on imaging measuring <5cm?

A

No follow up

35
Q

Management of physiologic cyst on imaging measuring >5cm?

A

Surveillance

36
Q

Management of asymptomatic endometrioma measuring <5cm?

A

Surveillance

37
Q

How to treat recurrent physiologic ovarian cyst?

A

Oral combined hormonal birth control

38
Q

Management of hydrosalphinx?

A

Asymptomatic does not require management or surveillance

Symptomatic requires evaluation to rule out other causes then removal

39
Q

Management of paratubal or paraovarian cyst?

A

Treat if symptomatic, concern for torsion or >10cm

40
Q

Recommended surveillance for low risk adnexal mass O-RAD 3?

A

3 months then 6 months

41
Q

Recommended surveillance for intermediate risk adnexal mass O-RAD 4?

A

Premenopausal= 6 weeks then every 3-6 months for 1 year

Postmenopausal= 6 weeks, 12 weeks then every 3-6 months for 1 year

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