Ovarian Disorders

Question 1

What is the most frequent cystic structure in the normal ovary?

Answer 1

Follicular (functional) Cyst

Question 2

T/F: The majority of follicular cysts are asymptomatic

Answer 2

True

Question 3

How are Follicular cysts diagnosed?

Answer 3

US

Pelvic Examination

Question 4

All women are ______ until proven otherwise

Answer 4

Pregnant

Question 5

What are defining characteristics of a benign ovarian cyst?

Answer 5

Unilateral Adenexa
Mobile
Mild to no pain

Question 6

What US findings are suggestive of a benign ovarian cyst?

Answer 6

Unilocular
Simple, Fluid Filled
No Septations

Question 7

When should you preform a follow up US when working up a benign ovarian cyst?

Answer 7

6-12 weeks

Question 8

When would you use OCPs to manage benign ovarian cysts?

Answer 8

To decrease the risk of recurrence

However, there is no real benefit over observation alone

Question 9

Why may a corpus luteum cyst result in a delayed onset of menses?

Answer 9

Corpus Luteum Cysts secrete progesterone which would delay menses

Question 10

When would surgery be indicated for treatment of Corpus Luteum Cyst?

Answer 10

If there was evidence of torsion or symptomatic rupture

***With surgery remember that the goal is ovarian tissue preservation

Question 11

T/F: A corpus Luteum Cyst is a non-functional cyst

Answer 11

False

It is a functional cyst

Question 12

Theca Lutein Cysts are almost always ________ (unilateral/bilateral)

Answer 12

Bilateral

Question 13

What is the most common cause of Theca Lutein Cysts?

Answer 13

Prolonged/Excess stimulation of ovaries by endogenous/exogenous Gn

Question 14

What is a unique US finding of Theca Lutein Cysts?

Answer 14

Multiple thin-walled cysts blaterally

Question 15

Is torsion common with Theca Lutein Cysts?

Answer 15

No, its rare

Question 16

How does a serous cystadenoma differ from a mucinous cystadenoma?

Answer 16

Serous: Filled with pale-yellow serous fluid, unilocular

Mucinous: Filled with sticky mucin, multiloculated

Question 17

T/F: Mucinous tumors are the largest of all ovarian tumors

Answer 17

True

Question 18

How are cystadenomas diagnosed?

Answer 18

US

Question 19

What is the mainstay of cystadenoma management?

Answer 19

Surgical Removal

Question 20

If a mucinous tumor is removed from an ovary, what additional surgical procedure needs to be preformed?

Answer 20

Appendectomy to r/o coexistent mucinous tumors

Question 21

What is a tubo-ovarian abscess?

Answer 21

Infectious process of the upper genital tract that creates an inflammatory mass involving the fallopian tube and ovary

Question 22

Are tubo-ovarian abscesses more likely tobe unilateral or bilateral?

Answer 22

Bilateral

Question 23

When would a tubo-ovarian abscess become a surgical emergency?

Answer 23

Sepsis

Signs of rupture

Question 24

What are THREE concerning chronic complications of a tubo-ovarian abscess?

Answer 24

Infertility
Tubal Occlusion
Ectopic Pregnancy

Question 25

How are tubo-ovarian abscesses managed?

Answer 25

1. IV ABx (Cover Gc/CHl) 2. Laparoscopy if worsening, not improvening, signs of rupture 3. Catheter from drainage

Question 26

An ___________ is an ovarian cystic mass arising from the growth of ectopic endometrial tissue within the ovary and is typically filled with a thick brown tar-like fluid.

Answer 26

Endometrioma (Chocolate Cyst)

Question 27

How are endometriomas diagnosed?

Answer 27

H&P consistent with endometriosis | US

Question 28

How are endometriomas managed?

Answer 28

Observation | Surgery (Pain relief, Malignancy, Infertility)

Question 29

A ______ is a benign neoplasm that contains tissue from all 3 germ layers

Answer 29

Teratoma

Question 30

What is the most common benign neoplasm in women < 35 y.o.?

Answer 30

Teratoma

Question 31

How are teratomas typically diagnosed?

Answer 31

Typically incidentally on pelvic exam, RR, or US

Question 32

Why is observation not an appropriate management for teratomas?

Answer 32

These will not go away

Question 33

What do you need to avoid during surgical removal of a teratoma?

Answer 33

Avoid spilling the contents to reduce risk of peritonitis

Question 34

What is the most common cause of hyperandrogenism and chronic anovulation?

Answer 34

PCOS

Question 35

What are the symptoms of hyperandrogenism in PCOS?

Answer 35

Acne | Hirsutism

Question 36

What are the metabolic symptoms of PCOS?

Answer 36

Obesity Insulin Resistence Hyperinsulinemia

Question 37

What are the THREE diagnostic criteria of PCOS?

Answer 37

1. Oligoovulation or anovulation 2. Hyperandrogenemia 3. Polycystic ovaries diagnosed by ultrasound

Question 38

What is first-line for PCOS management in non-diabetic patients?

Answer 38

OCPs

Question 39

What can be given to lower insulin levels in non-diabetic women with PCOS?

Answer 39

Metformin

Question 40

What is the classic US finding in PCOS?

Answer 40

String of Pearls

Question 41

A ______ ____ is a simple epithelial-lined cyst (rarely complex) or benign fibroid adjacent to the ovary, usually within the broad ligament

Answer 41

Paraovarian cyst/fibroid

Question 42

Are paraovarian cysts typically symptomatic?

Answer 42

No

Question 43

How are paraovarian cysts diagnosed?

Answer 43

US

Question 44

How are paraovarian cysts managed?

Answer 44

Typically observation ***Surgery if symptomatic

Question 45

Ovarian _____ is described as rotation of the ovary or the ovary and FT to such a degree as to occlude the vascular supply. Sx include..... Acute, severe, unilateral pain N/V

Answer 45

Ovarian Torsion

Question 46

How is an ovarian torsion diagnosed?

Answer 46

US with Doppler Studies

Question 47

T/F: Ovarian Torsion is a surgical emergency

Answer 47

True!!!!!

Question 48

What are TWO serum tumor markers?

Answer 48

CA 125 | HE4

Question 49

______ (ovarian/cervical) cancer is the most lethal form of tumor arising from the female reproductive tract

Answer 49

Ovarian Cancer

Question 50

90% of ovarian cancers are ______ (Epithelial/Stromal/Germinal)

Answer 50

Epithelial