Lecture 12: Ovarian Disorders Flashcards
1
Q
A large functional ovarian cyst can often cause these 2 symptoms:
A
- Constipation
- Urinary Frequency
Crushing bladder or rectum
2
Q
The ideal way to identify a functional ovarian cyst is via…
A
Pelvic US
3
Q
The MC type of functional ovarian cyst is a…
A
Follicular ovarian cyst
4
Q
The primary cause of a follicular cyst is….
A
Failure to develop during ovulation
5
Q
Usually, one would expect someone with a small follicular cyst to show signs of…
A
Nothing
Asymptomatic usually
6
Q
Someone with a LARGE follicular cyst might complain of… (2)
A
- Aching pelvic pain
- Dyspareunia
7
Q
The initial approach to management of a follicular cyst is…
A
Observation
8
Q
If a patient has a particularly large follicular cyst, you might suggest that they get a
A
Cystectomy
9
Q
A corpus luteum cyst is primarily due to
A
Failure to involute
Normal formation. Abnormal involution.
10
Q
A corpus luteum cyst can mimic a …. pregnancy
A
Ectopic
11
Q
A severely bleeding/ruptured corpus luteum cyst can eventually lead to…
A
- Acute abdomen
- Hypovolemic shock
12
Q
The general approach to managing corpus luteum cysts is…
A
Observation.
Only manage if symptomatic
13
Q
The cause of a theca lutein cyst is usually
A
Elevated hCG
14
Q
Theca lutein cysts often occur bilaterally and are filled with…
A
Clear fluid
15
Q
Generally, the MC complaint related to a theca lutein cyst is…
A
Pelvic heaviness/aching
16
Q
Generally, the approach to management for theca lutein cysts is…
A
Treat underlying cause or observe
17
Q
Endometriomas are typically seen in patients that suffer from…
A
Endometriosis
18
Q
Endometriomas, also known as chocolate cysts, are caused by….
A
Endometric foci on the ovarian surface.
19
Q
Besides pelvic pain and dysmenorrhea and infertility, a lab/tumor marker that may be elevated with endometriomas is….
A
CA-125
20
Q
Generally, the approach to tx for an endometrioma is…
A
Same as endometriosis.
Can remove laparoscopically
21
Q
Dermoid cysts are known for being filled with…
A
Weird stuff: fat, hair, teeth, bone, cartilage
a common ovarian cyst in PREmenopausal women
22
Q
A dermoid cyst is more likely to occur in pre or postmenopausal women?
A
Pre
23
Q
The main concern with a cystadenoma is that…
A
It grows so big
Benign
24
Q
PCOS/Stein-Leventhal Syndrome is characterized by persistent anovulation, due to… (3)
A
- Enlarged polycystic ovaries
- Secondary amenorrhea or oligomenorrhea
- Obesity, hirsutism, infertility
25
Half of PCOS are ....
The Other half of PCOS are ....
* 50% Hirsute
* 50% or more obese
| Hairy
26
Generally, there are 4 possible etiologies for PCOS, which are...
* Genetics
* HPO dysfunction (altered LH/folliculogenesis)
* Insulin resistance/obesity
* Hyperandrogenism
27
The diagnosis of PCOS requires at least **2 of the following 3 criteria**:
1. Oligomenorrhea/amenorrhea (same as ovulation)
2. Hyperandrogenism
3. PCOS on US showing **Oyster ovaries**
28
The leading cause of female infertility is...
PCOS
| Lots of pregnancy complications
29
Overall, PCOS results in a....
Decreased quality of life
30
Most hirsutism cases are caused by
Secondary to PCOS
31
Although PCOS can result in some male features, you will NOT SEE
Virilization
| Muscle mass, breast size changes, deepened voices, clitoromegaly
32
T/F You can see acanthosis nigricans in PCOS as well
True
33
Which hormone is generally decreased in PCOS?
SHBG
| Sex hormone binding globulin
34
Pelvic US for PCOS will show...
Multiple cysts/follicles BILATERALLY
| 20-25+
35
What hormone levels correspond to anovulation?
Persistently high LH and low FSH
36
Generally, pts with PCOS that have **regular periods and mild hyperandrogenism with no desire to conceive** should be managed via...
* Regular screenings for lipids, DM, and wt
* Lifestyle changes (wt loss)
37
COCs are used for PCOS treatment cause they do two things:
1. Induce regular menses (estrogen)
2. Antagonize endometrial proliferation (progesterone)
38
A female patient with PCOS on COCs has **not had menses for 4 weeks**. The **first test** you order is...
pregnancy test
39
You have a patient with PCOS that has a hx of VTE or something that contraindicates estrogen. The hormone therapy they would best benefit from is...
| Honestly i forgot what estrogen does lmao
Progesterone-only therapy
| Oral or IUD
40
Progestone-only therapy cannot treat a set of symptoms in PCOS, which is...
Hyperandrogenism symptoms
41
PCOS is similar to DM2 in its effect on insulin, so the first-line tx to improve insulin sensitization is....
METFORMIN
42
Your patient with PCOS is tired of all this hair on her chest. You recommend that they take....
COCs
| First-line tx
43
Your patient with PCOS is tired of hair on their chest but they have a hx of VTE or something that contraindicates estrogen. In order to tx their hirsutism pharmacologically, you would recommend... but it has a big SE of ...
GnRH agonists, but warn about BONE LOSS
44
The two **non-pharm** ways of treating hirsutism are...
* Depilation (hair removal ABOVE skin)
* Epilation (complete hair removal)
45
The issue with using eflornithine hydrochloride/Vaniqa cream for hirsutism is that...
It does not permanently remove hair, it just stops it from growing.
46
Spironolactone oftens works great in combo with contraceptives for hirsutism in PCOS; however, it needs to be stopped if the patient develops...
Pregnancy
47
5-alpha-reductase inhibitor use in females with PCOS is dangerous if they are pregnant and...
Their fetus is **male**
| BPH tx drug
48
The primary etiology to tx acne 2/2 PCOS is...
Lowering androgen levels
| COCs, spironolactone/finasteride, + acne meds
49
.... Treatments generally do not improve acanthosis nigricans
Topical
| You need like oral metformin
50
The first-line tx to induce ovulation in someone with PCOS is...
Wt loss and exercise
51
The first line medication to induce ovulation in pts with PCOS is...
Letrozole
| Aromatase inhibitor
52
The advantages of letrozole over clomiphene citrate/clomid for ovulation induction in PCOS are... (5)
* **More monofollicular** development
* Shorter half-life (48 hrs vs 2wk)
* **No antiestrogen effect** on endometrium
* Lower serum estradiol levels
* **Higher rates of live birth, esp in obese women**
## Footnote
Letrozole for Live (births)!
53
The most serious side effect of clomiphene citrate/clomid is...
Ovarian hyperstimulation syndrome
54
Clomiphene citrate/clomid interacts with any drug that acts on the HPO axis, such as ... (5)
* Estrogens
* SERMs
* Aromatase inhibitors
* Gonadotropins
* GnRH agonists
55
Although clomiphene citrate can induce ovulation 75% of the time in PCOS, the issue lies with...
The pregnancy is only successful 40% of the time
56
The issue with exogenous gonadotropins to induce ovulation in PCOS is...
High risk of ovarian hyperstimulation syndrome
57
The primary pathology of ovarian hyperstimulation syndrome is...
Vascular hyperpermeability (3rd spacing)
58
Generally, mild ovarian hyperstimulation syndrome presents with... (3)
* Bloating
* N/V/D
* Wt gain
59
A patient with PCOS that recently took clomiphene citrate to get pregnancy has developed oliguria, polydipsia, dark urine, and has increased her wt by abt 2 lbs/day. You suspect she is suffering from (severity) ....
Moderate Ovarian Hyperstimulation Syndrome
60
Generally, to treat Ovarian Hyperstimulation Syndrome, you would first...
D/C med (most likely synthetic FSH, then clomid)
| Supportive care, as it resolves in 1-2 weeks upon med DC
61
PCOS can be treated surgically via...
* Laparoscopic ovarian surgery (lots of little holes)
* Oophorectomy
| Stab the ovaries or take em out
62
The MCC of ovarian torsion is...
Ovarian enlargement
63
If ovarian torsion occurs, the tx is...
Surgery
64
Classically, ovarian torsion presents with
* Sudden onset
* **Severe, unilateral** lower abd pain
* **Usually right side**
| Can also see fever, N/V, adnexal mass on exam, vaginal bleeding
## Footnote
Can also present with just pain and no tenderness (:
65
The imaging of choice for ovarian torsion is...
Sonography
66
A sonographic study of an ovarian torsion would probably show...
* Multiple follicles rimming an enlarged ovary
* **Bulls-eye, whirlpool, snailshell**
67
Tx of an ovarian torsion is accomplished via 2 possible ways:
* Laparoscopic detorsion
* Laparotomy detorsion
| Cystectomy done during or after.
68
If an ovarian torsion turns necrotic, the only tx is...
Oophorectomy
69
Post-op ovarian torsion monitoring includes making sure the patient doesn't develop... (3)
* Fever
* Leukocytosis
* Peritonitis
70
The MC source of ovarian cancer is from ... cells
Epithelial ovarian cells (EOC)
| >90% of all malignant ovarian tumors
71
Ovarian cancer tends to occur in pts right around...
Menopause
72
75% of all epithelial ovarian cells tend to result in...
Serous cystadenocarcinomas
73
The tumor marker most associated with ovarian cancer is...
CA-125
| Also for endometriomas i think
74
**Germ cell tumors** have a better prognosis than EOC, and the labs they are most associated with are... (3)
* AFP
* hCG
* LDH
75
When do germ cell tumors tend to appear?
20s-30s
76
Granulosa cell tumors are most associated with the hormone...
Inhibin
77
Sex Cord-Stromal Tumors are most commonly associated with the hormone...
estrogen
78
The strongest positive risk factor for ovarian cancer is...
Positive FHx
79
What are the 5 negative risk factors associated with ovarian cancer?
* OCP use
* BFeeding
* Progesterone therapy
* Tubal ligation
* Hysterectomy/Salpingectomy
80
The oncogenes most associated with Ovarian cancer are...
BRCA1 (highest) and BRCA2
81
The 3 ethnicities with the highest hereditary risk of ovarian cancer?
* Ashkenazi Jewish
* French Canadian
* Icelandic descent
82
This condition is primarily associated with increased CRC risk, but also slightly increases ovarian cancer risk. It is...
Hereditary Nonpolyposis CRC Syndrome
| Lynch syndrome
83
The prophylactic surgery offered to women with a strong genetic predisposition to ovarian cancer is...
Bilateral salpingo-oophorectomy
| BSO, removal of tubes + ovaries
84
Why is ovarian cancer not commonly caught early?
Vague symptoms. Not severe enough to seek medical attention.
85
Some of the **late signs** of ovarian cancer include... (4)
* Ascites
* Nausea
* Anorexia
* Dyspnea
86
The classic finding for ovarian cancer on physical exam is a...
**Solid**, **fixed**, irregular adnexal mass
87
LAN in what two areas might make ovarian cancer suspicious?
* Inguinal
* Sister Mary Joseph's nodule
88
What serum tumor marker is elevated in over 80% of **late ovarian cancer** cases?
CA-125
89
CA-125 levels are only useful in women that are ....
postmenopausal
| Only order it in someone over 50
90
Generally in **younger patients**, the preferred lab studies to check for **ovarian cancer** are...
* AFP
* LDH
* hCG
| Germ cell tumors are more likely in a younger pt.
91
What lab study is generally used to MONITOR ovarian cancer?
| Not for screening!
HE4
92
On Pelvic US, what findings are most suggestive of cancer?
* Solid
* Septations
* Ascites
93
The definitive dx of ovarian cancer requires...
Biopsy and pathology
94
For EOC cancers, the treatment is...
Surgical intervention via **tumor removal and contralateral adnexa removal.**
| Hysterectomy and infracolonic omentectomy are often performed
95
Persistent ovarian cancer dz despite chemotherapy and surgery is suggested by...
Elevated CA-125
| i feel like theyre gunna want this exact number memorized...
96
Unlike EOC ovarian cancers, germ cell tumors do not require the removal of...
Contralateral adnexa if normal-appearing.
97
Overall, ovarian cancer is the .... MC gyn malignancy and the MCC of death in GYN malignancies
2nd MC
| Endometrial is #1
