adnexal mass Flashcards Preview

OB/GYN > adnexal mass > Flashcards

Flashcards in adnexal mass Deck (29)
Loading flashcards...
1
Q

when are simple cysts physiologic and okay?

A

during the reproductive years. we don’t typically worry about them unless they are complex

2
Q

when do we worry about cysts in ovaries?

A

pre and postmenopasual women —these are usually cancerous

3
Q

what test for cysts?

A

transvaginal ultrasound (MRI is too expensive).

4
Q

what does a simple cyst look like on ultrasound

A

no septations, anechoic, only one color and homogenous. SMALL. <3cm ignore
<10cm probably nothing, watch it. if fails to resolve, then remove.
looks like a bag of black fluid. NOTHING ELSE.

5
Q

what does a complex cyst look like?

A

BIG. septations, disconinuous and discolored. multilocular and echoic. multiple structure.
large >10cm

6
Q

what don’t we do with simple cysts

A

1) aspiration
2) contraceptives
3) MRI (not needed)

7
Q

what are th types of complex cysts

A

endometrioma, teratoma, ectopic, tubo-ovarian abscess, and cancers

8
Q

what is a Teratoma and when do we see it?

A

large benign tumors usually in young women that complain of weight gain –typically asymptomatic. These usally contain hair and teeth. We only remove the cyst since mostly these are found in younger women so we want to protect fertility. cystectomy

9
Q

what is endometrioma

A

chocolate cyst. Is a complex cyst.

10
Q

what is endometriosis and what causes it?

A

dysplaced endometrial tissue. estrogen responsive, so recurs with cycles. retrograde flow of menses?
peritoneal seeding.

11
Q

how does endometriosis present?

A

dysperunia, infertility, dysmenorrhea

12
Q

what is the diagnosis of chocolate cyst?

A

endometrioma and endometriosis. also treating with OCon and it if it improves then the diagnosis is endometriosis

13
Q

treatment for endometriosis

A

managing pelvic/abdominal pain (NSAIDs). gain control of the axis –OCPs/GNRH analogs-luprolide/danosol.

14
Q

what is the treatment of endometrioma?

A

find the chocolate cyst with laproscopy with ablation. burn it away after finding it

15
Q

what causes ectopic pregnancy

A

early implantation –usually something causing stricture. PID

16
Q

most common region of ectopic

A

ampulla.

17
Q

how does this present?

A

pregnancy. abdominal pain, UPT positive, amenorrhea.

18
Q

what is the discriminatory zone

A

b-hCG measurement >2000 this is the level of b-hCG expected to correlate with findings on ultrasound

19
Q

what are the treatments for ectopic

A

1) salpingostomy (suck out zygote, leave the tube)
2) salpingectomy (remove the tube –typically used when ruptured)
3) methotrexate –early

20
Q

when to use methotrexate

A

1) b-hCG <5,000
2) no fetal cardiac activity
3) size <3-4cm

21
Q

how does ovarian torsion presents

A

typically with sudden crushing abdominal pain that comes out of no where

22
Q

how to diagnose ovarian torsion

A

with dopler ultrasound

this is a surgical emergency

23
Q

what is a tuboovarian abscess

A

essential PID

24
Q

what causes PID

A

gonorrhea and chlamydia

25
Q

how is tuboovarian treated?

A

same as PID.

26
Q

how does TOA present

A

cervical motion tenderness, adnexal tenderness, uterine tenderness. abdominal/pelvic pain. fever and leukocytosis –not needed to meet criteria.
presence of white cells on wet prep increases the chances that PID is there.

27
Q

how do we identify the abscess?

A

ultrasound.

28
Q

treatment of PID/TOA

A

IV –cefoxiton + doxcycline + metranidazole.

or clindamyocin + metranidazole

29
Q

what happens if the TOA does not improve

A

surgical draining.