B8.024 - Big Case Cystic Ovaries

Question 1

what is an essential part of an work up of a woman presenting with abdominal tenderness

Answer 1

beta HCG

Question 2

Differential dx for RLQ pain with negative beta HCG

Answer 2

acute appendicitis, gastroenteritis, diverticulitis, IBD, ileus, ovarian cyst, tubo ovarian abscess

Question 3

presentation of appendicitis

Answer 3

pain around umbilicus that progresses to right lower abdomen, vomiting, fever, tachycardia

Question 4

gastroenteritis presentation

Answer 4

diarrhea, vomiting, abdominal pain, fever, lack of engery, dehydration

Question 5

diverticulitis/perf presntation

Answer 5

abdominal pain. nausea, vomiting, fever, bloating or gas, constipation

Question 6

IBD presentation

Answer 6

abdominal pain, cramping, diarrhea, blood in stool maybe, fever, chills fatigue. dehydration

Question 7

ileus presentation

Answer 7

abdominal discomfort, loss of appetite, feeling of fullness, constipation, inability to pass gas bloating, abdominal discomfort excessive belching, nausea, vomiting

Question 8

ovarian cyst presentation

Answer 8

lower abdominal pain, fullness or heaviness, bloating or swelling, severe pain before or during menstrual cycles, dyspareunia

Question 9

tubo ovarian abscess presentation

Answer 9

presents with fever, chandelier sign

Question 10

types of functional cysts

Answer 10

follicular or corpus luteal, common and may rupture. Often hemorrhagic

Question 11

what is a mucinous cystadenoma

Answer 11

benign tumor of the ovary, torsion can occur with greater than 4 cm

Question 12

what is a mature teratoma

Answer 12

ovarian germ cell tumor, torsion can occur when greater than 4 cm

Question 13

complication of ovarian cancer

Answer 13

torsion

Question 14

endometrioma presents

Answer 14

with chronic pain, common

Question 15

what is an ovarian cyst

Answer 15

solid or fluid filled sac or pocket within or on the surface of an ovary most common in reproductive aged women

Question 16

how do you diagnose ovarian cyst

Answer 16

pelvic ultrasound

Question 17

sx of ovarian cyst

Answer 17

irregular menstrual cycles, pelvic pain or pressure, dyspareunia sometimes asx

Question 18

types of ovarian cysts

Answer 18

follicular, corpus luteum, hemorrhagic, mucinous cystadenoma, mature teratoma, endometrioid

Question 19

follicular cysts

Answer 19

follicle fails to rupture, often resolves spontaneously

Question 20

corpus luteum cyst

Answer 20

CL fails to regress, may produce progesterone, may be hemorrhagic

Question 21

hemorrhagic cysts

Answer 21

blood filled follicular or luteal

Question 22

mucinous cystadenoma

Answer 22

lined by columnar epithelium, typically similar to endocervical epithelium, secrete gelatinous mucin

Question 23

mature teratoma

Answer 23

germ cell tumor, may contain ectoderm, endoderm derived tissues

Question 24

endometrioid

Answer 24

manifestation of endometriosis, endometrial tissue on ovary, chocolate cyst

Question 25

diagnostic test for ovarian cysts

Answer 25

transvaginal ultrasound

Question 26

what are the clinically important parameters that transvaginal ultrasound can help with

Answer 26

eval of small masses, origin of mass, torsion, internal consistency, presence of septae

Question 27

imaging of mature teratoma

Answer 27

hyperechoic interfaces in a cystic mass

Question 28

imaging of a simple/follicular cyst

Answer 28

thin smooth wall, anechoic contetns, no or only few septa

Question 29

typical endometrioma on imaging

Answer 29

thick wall, homogenous low level internal echoes, occasionally wall calcifications

Question 30

mucinous cystadenoma on imaging

Answer 30

thin septations, may demonstrate echogenic material (mucin)

Question 31

what does the presence of complex septations on ovarian cyst imaging mean

Answer 31

could be malignant basically not a good sign

Question 32

imaging of hemorrhagic cyst

Answer 32

fishnet weave/fine reticular pattern

Question 33

how do you rule in / out torsion

Answer 33

torsion can be dx on doppler ultrasound bc you can see if blood flow has been restricted or nott

Question 34

management of ruptured corpus luteal cyst

Answer 34

surgery. need exogenous progesterone support after surgery to prevent miscarriage

Question 35

diangostic workup for amenorrhea hyperandrogenism

Answer 35

thyroid - TSH rare enzyme defects - 17 - OHP CAH stress hormomne - cushing 24 hr free cortisol tumors - testosterone, DHEAS, prolactin excessive growth hormone - IGF -1

Question 36

what is PCOS

Answer 36

polycystic ovaries high androgen levels irregular periods

Question 37

how do you diagnose polycystic ovaries

Answer 37

strand of pearls, 12 or more follicles seen on ovary

Question 38

how do you diagnose high androgen levels

Answer 38

signs like acne, hair (growth, loss) Labs (DHEAS, T)

Question 39

what is an irregular period

Answer 39

35 day or longer cycle heavy bleeding problems with ovulation

Question 40

what causes PCOS?

Answer 40

endocrine disruptors, genetic, diff in androgen receptors or SHBG, gestational hyperglycemia, in utero exposure to androgen. evolutionary paradox

Question 41

how do you manage high androgen levels

Answer 41

tx acne with bonzoyl peroxide, siacylic acid, topical/oral antibiotics, OC, retinoids tx MPB with rogaine, spironolactone, combined estrogen and progesterone, ketoconazole, propecia (blocks DHT), metformin, flutamide, vaniqa

Question 42

health problems with PCOS

Answer 42

heart disease, obesity, DM, mood/sleep disorders, cx, liver disease, infertility

Question 43

metabolic syndrome

Answer 43

dx with 3/5: HTN (\>130/85) WC \>35 in fasting glucose \>100 HDL \<50 TG \>150

Question 44

tx of PCOS and high cholestrol

Answer 44

statins - cause birth defects

Question 45

dangers of high BP

Answer 45

systolic \>140 diastolic \>90 risk of heart disease, renal failure, stroke narrowed blood vessels from damaged lining increases pressures

Question 46

how do you assess glycemic control in PCOS

Answer 46

HbA1c 2h glucose tolerance

Question 47

use of metformin in PCOS

Answer 47

biguanide, improves bodys ability to process insulin decreases androgen levels, improves ovulation but does not improve chance of live birth can cause lactic acidosis, GI distress, wt loss

Question 48

PCOS affect on mood and sleep

Answer 48

more likely to have depression and anxiety 5x more likely to have sleep apnea

Question 49

PCOS affect on cancer risk

Answer 49

2-3x more likely to have endometrial uterine cancer increased endometrial growth in anovulation