O&G Written - Ovarian disorders

Question 1

Rotterdam criteria for PCOS

Answer 1

Need 2/3 for Dx

Clinical or lab evidence of high androgens (LH>FSH)
Polycystic ovaries on USS
Clinical features - oligomenorrhoea for 6 months

Question 2

Management options for PCOS (fertility desired)

Answer 2

Metformin

Clomifene

Gonadotrophins

Letrozole (not licensed)

Laparoscopic ovarian drilling - diathermy/laser therapy

Question 3

Management options for PCOS (fertility not desired)

Answer 3

COCP

For hirsutism:
Cyproterone acetate (anti androgen)
Spironolactone
Eflornithine = topical anti androgen for facial hair

Metformin

Question 4

Medical management of endometriosis

Answer 4

Non hormonal: Paracetamol +/- NSAIDs
Hormonal: COCP, implant, IUS

2nd line (or requiring fertility) = refer to secondary care for GnRH analogues e.g. leuprorelin

Question 5

Surgical management of endometriosis

Answer 5

Laparoscopic ablation/excision
Laser Tx of endometriotic cysts
+ post-op hormonal Tx if not wanting fertility

Hysterectomy + bilateral sapling-oophorectomy (radical)

Question 6

Types of physiological ovarian cyst

Answer 6

follicular - non rupture of dominant follicle or failure of atresia in non-dominant follicles

corpus luteum - failure of breakdown (after no fertilisation), becomes filled with blood/fluid

Question 7

Cyst associated with pseudomyxoma peritonei

Answer 7

Mucinous cystadenoma

type of benign epithelial / surface derived cyst

Question 8

USS features of complex cyst

Answer 8

Multi loculated

Containing solid mass

Question 9

USS features of simple cyst

Answer 9

Thin walled
Non loculated
<5cm

Question 10

Management of simple ovarian cyst

Answer 10

Reassurance

Repeat USS in 8 weeks (3 menstrual cycles)

Question 11

Management of complex ovarian cyst

Answer 11

Tx as malignant until confirmed

Bloods - CA125, AFP, b-hCG (premenopausal women)
Cystectomy

Question 12

Key features of malignant serous cystadenocarcinoma

Answer 12

Psammoma bodies (collection of calcium_
Often bilateral

Question 13

Key features of Brenner tumour

Answer 13

Walthard cell rests (benign clusters of epithelial cells)

‘Coffee bean’ nuclei

Question 14

Most common benign ovarian tumour

Answer 14

Overall = serous cystadenoma

<30yo = (mature cystic) teratoma / dermoid cyst

Question 15

Key features of (malignant) Dysgerminoma

Answer 15

Secrete beta-hCG and LDH
Hypercalcaemia?

Associated with turner’s syndrome

Question 16

Key features of (malignant) Dysgerminoma

Answer 16

Secrete beta-hCG and LDH
Hypercalcaemia?

Associated with turner’s syndrome

Question 17

Key features of Yolk sac tumour

Answer 17

Secrete AFP

Schiller-Duval bodies on histology

Question 18

Key features of Krukenberg tumour

Answer 18

Mucinous tumour (gastric mainly) metastasised to ovary

80% bilateral

Abdo/pelvic pain
Ascites
Poor appetite

Question 19

Meig;s syndrome - associated tumour type?

Answer 19

Benign fibroma

Question 20

Meig’s syndrome - key features

Answer 20

Benign ovarian tumour
Ascites
Pleural effusion

Tx = surgical removal of tumour, drain ascites + pleural effusion

Question 21

Key features of granulosa cell tumour

Answer 21

Malignant

Produces oestrogen –> precocious puberty or PMB, endometrial hyperplasia

Histology: Call-Exner bodies

Question 22

Key features of Sertoli-Leydig tumour

Answer 22

Benign

Produce androgens –> hirsutism, amenorrhoea

Associated with Peutz-Jegher syndrome

Question 23

Initital work up for suspected ovarian cancer

Answer 23

CA-125 for any woman >50yo with many abdo Sx
TV (and TA?) USS

Referral to secondary care if ascites / mass on USS

Question 24

Components of risk malignancy index

Answer 24

Menopause status
TV USS findings
CA-125