Ovarian disorders

Question 1

what is a normal menstrual frequency?

Answer 1

24-38 days
~ 5 days
~40ml/cycle

Question 2

Asymptomatic with mild, nonspecific GI symptoms or pelvic pressures

Advanced → abdominal pain, bloating, palpable mass with ascites

Answer 2

ovarian tumors

Question 3

BRCA genes
First-degree relatives
Most are benign –
Cysts
Neoplasms
Cancer: malignant tumors are leading cause of death from gyn cancer

WIDE range of types and patterns

Answer 3

ovarian tumors

Question 4

Serum CA 125: elevated in those with ovarian cancer, but not useful in screening (can be elevated in benign)

hCG, LD, alpha-fetoprotein tumor markers

TV US to screen high-risk patients, color doppler to differentiate

Answer 4

ovarian tumors

Question 5

how do you treat ovarian tumors?

Answer 5

Simple cysts up to 10cm: monitor

Larger/symptomatic cysts: surgical eval

Malignant ovarian mass: surgical eval

Benign neoplasms: tumor excision or unilateral oophorectomy

Question 6

What are the types of simple ovarian cysts?

Answer 6

follicular
corpus luteum
theca lutein

Question 7

Asymptomatic but bleeding and torsion can occur

Large = aching pelvic pain, dyspareunia, AUB associated with disturbance in ovulatory pattern

Answer 7

follicular cysts

Question 8

MC functional cyst as a result from failure in ovulation

Answer 8

follicular cysts

Question 9

how do you treat follicular cysts?

Answer 9

Most disappear spontaneously w/n 60 days without treatment
OCPs help normal rhythm

Question 10

Associated with amenorrhea or delayed menstruation (simulates ectopic pregnancy)
Torsion – peritoneal signs, acute abdomen, hypovolemic shock

Answer 10

corpus luteum cysts

Question 11

Thin-walled unilocular cysts ranging in size
Ass w/ torsion of ovary, causing severe pain

Answer 11

corpus luteum cysts

Question 12

How do you treat corpus luteum cysts?

Answer 12

Laparoscopy or laparotomy to control hemorrhage
Unless acute complications develop, symptomatic therapy

Regress after 1-2 months and OCPs recommended

Question 13

Pelvic heaviness sensation or aching, intraperitoneal bleeding if ruptured

Answer 13

theca lutein cysts

Question 13

Elevated levels of chorionic gonadotropin – hydatidiform mole or choriocarcinoma, fertility treatments

Bilateral and filled with clear, straw-colored fluid

Answer 13

theca lutein cysts

Question 14

how do you treat theca lutein cysts?

Answer 14

Disappear spontaneously after termination of molar pregnancy, treatment of choriocarcinoma, or d/c of fertility therapy
Surgery if torsion or hemorrhage

Question 15

Chronic pelvic pain, dyspareunia, dysmenorrhea, subfertility
endometriosis
Accumulation of fluid and blood from endometriotic foci

Answer 15

endometriomas

Question 16

“Chocolate cysts” - thick, brown blood debris inside
– CA-125 elevated but NOT malignant cause

Answer 16

endometriomas

Question 17

how do you treat endometriomas?

Answer 17

Monitor or excise if >5cm. symptomatic

Question 18

What are the 3 types of ovarian neoplasms?

Answer 18

epithelial, sex cord, germ cell

Question 19

What’s the most common ovarian neoplasm?

Answer 19

epithelial

Question 20

Test of choice for ovarian neoplasms?

Answer 20

pelvic US

Question 21

How do you treat ovarian neoplasms?

Answer 21

Theocoma - surgery

Teratoma - surgery

Question 22

Early – poorly defined or vague

Later – increased abdominal girth, pelvic/abdominal pain, bloating, urinary symptoms, early satiety

Nausea or anorexia due to ascites, dyspnea
Menstrual irregularities

Answer 22

ovarian cancer

Question 23

What are RF for ovarian cancer?

Answer 23

Nulligravida, smoking, obesity, early menarche (<12), late menopause (>50), infertility
PROTECT: OCP use, tubal ligation, BF, progesterone

Prepubescent child and postmenopausal woman > risk of malignancy

Question 24

majority of ovarian cancers are

Answer 24

epitheleal

Question 25

Pelvic exam: solid, fixed irregular adnexal mass Abdominal distention, ascites, upper abdominal mass → rectal exam to evaluate occult blood → breast exam → lymph nodes - supraclavicular and inguinal areas (Sister Mary Joseph) LABS: all – CBC, electrolytes, hCG CA-125 in postmenopausal women HE4 - monitoring CA 19-9 Investigational biomarkers young/adolescent – serum AFP, LDH, hCG Malignant pleural effusion confirms disease Pelvic US – presence CT/MRI → CXR to exclude metastatic disease Mammography

Answer 25

ovarian cancer

Question 26

how do you treat ovarian cancer?

Answer 26

Surgery + chemotherapy – mets: abdominal/pelvic CT + MRI – CA-125 baseline and track – genetic testing

Question 27

Severe, unilateral pain in lower abdomen, gradual or sudden N/V Sudden resolution = necrosis

Answer 27

ovarian torsion

Question 28

Adolescents Postmenopausal women are more at risk for

Answer 28

ovarian torsion

Question 29

TVUS w/ doppler → detect decreased or absent blood flow to ovary CT better imaging if other pathology is suspected

Answer 29

ovarian torsion

Question 30

how do you treat ovarian torsion?

Answer 30

Hospitalize, urgent consult Laparoscopic surgery

Question 31

Menstrual abnormalities (amenorrhea to heavy menstrual bleeding), infertility, skin disorders (hirsutism, acne), insulin resistance Obesity, HTN, type 2 DM

Answer 31

PCOS

Question 32

Endocrine disorder of unknown etiology – Ovarian hormonal dysregulation → increased LH Functional ovarian hyperandrogenism → insulin-resistant hyperinsulinism

Answer 32

PCOS

Question 33

what criteria is used for PCOS?

Answer 33

Rotterdam Criteria Hyperandrogenism Ovulatory dysfunction Polycystic ovaries

Question 34

LABS: Elevation in serum androgen levels Increased ratio of LH:FSH (>2:1) Lipid abnormalities, insulin resistance Pelvic US: bilateral enlarged ovaries + multiple ovarian cysts with a “string of pearls” appearance

Answer 34

PCOS

Question 35

how do you treat PCOS?

Answer 35

Obese ⇒ weight reduction + exercise Combined OCP if no desire for pregnancy – alt: progestin or hormonal IUD Metformin for symptomatic and safe for pregnancy Seeking pregnancy (for fertility): letrozole, clomiphene Hirsutism: spironolactone, topical eflornithine cream, laser therapy

Question 36

failure of follicle rupture during ovulation can cause

Answer 36

follicular cyst

Question 37

failure of corpus luteum regression after ovulation can cause

Answer 37

corpus luteum

Question 38

a dermoid cyst is caused by

Answer 38

overproduction of hormones (hCG) leading to false growth of a "baby" (not actual baby, just has the weird stuff of it)