Week 5 pt 1 highlights

Question 1

Define adnexal space

Answer 1

The area between the lateral pelvic wall and the cornu of the uterus

Question 2

An adnexal mass is a _______ that develops near the uterus, generally in the ovaries or fallopian tubes

Answer 2

growth

Question 3

Are adnexal masses malignant?

Answer 3

Often not malignant, but can be

Question 4

Adnexal neoplasms:
1) Most common ___ and ___ decades of life.
2) 1/___th of cancers are hereditary
3) Lifetime risk is 1 in ______.

Answer 4

1) 5th and 6th
2) 1/5th
3) 1 in 70

Question 5

What are 3 risk factors for adnexal neoplasms?

Answer 5

1) Nulliparity
2) Primary infertility
3) Endometriosis

Question 6

True or false: Long-term suppression of ovulation may protect against the development of ovarian cancer.

Answer 6

True

Question 7

Evaluation of Ovarian Disease: List 1 thing PE should include

Answer 7

Bimanual Exam

Question 8

What is the primary imaging tool for adnexal masses?

Answer 8

Pelvic ultrasound

Question 9

Adnexal masses:
Simple, __________ cysts less than 10 cm in diameter confirmed by transvaginal ultrasonography are almost universally __________ and may safely be followed without ____________ regardless of age

Answer 9

unilocular; benign; intervention

Question 10

Adnexal mass: List 2 complications of simple, unilocular cysts less than 10cm

Answer 10

Ovarian torsion or cyst rupture

Question 11

Give an example of when CA-125 may be a helpful test

Answer 11

If concerned abt malignancy of an adnexal mass

Question 12

USPSTF recommends _____[for/against]______ general population screening for ovarian cancer

Answer 12

against

Question 13

Who is screening for ovarian CA appropriate for? When?

Answer 13

Women w FHx; q 6months with CA 125 and TVUS beginning between 30-35yo
OR
5 to 10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family

Question 14

True or false: Normal ovarian size varies throughout a woman’s life

Answer 14

True

Question 15

List 3 ultrasound features suspicious for malignancy

Answer 15

1) Solid
2) Excrescences
3) Internal septa or papillae

Question 16

Presence of ___________= very suspicious for malignant process

Answer 16

ascites

Question 17

Papillary Excrescenses: ___________ suggestive of malignancy

Answer 17

highly

Question 18

Follicular cysts:
1) How do you Dx?
2) How do you usually Tx?

Answer 18

1) Pelvic u/s
2) Most spontaneously resolve within 6 weeks

Question 19

What are the 2 types of corpus luteum cysts? Which is more common?

Answer 19

1) Slightly enlarged (more common)
2) Rapidly enlarging (luteal phase cyst)

Question 20

What is the least common functional cyst?

Answer 20

Theca Lutein Cyst

Question 21

Benign Ovarian Neoplasms: What are the 3 main kinds?

Answer 21

1) Epithelial Cell Tumors
2) Germ cell tumors
3) Stromal cell tumors

Question 22

Benign Ovarian Neoplasms: What are the 4 types of epithelial cell tumors?

Answer 22

1) Serous
2) Mucinous
3) Endometrioid
4) Brenner cell tumor

Question 23

Benign Ovarian Neoplasms: Epithelial cell neoplasms:
1) Most common epithelial cell tumor is what? Is it benign?
2) How do you Tx mucinous epithelial cell tumors?

Answer 23

1) Serous cystadenoma; 20-30% are malignant
2) Surgery

Question 24

Benign Ovarian Neoplasms: Epithelial cell neoplasms:
1) What are most endometroids?
2) Which kind is uncommon?

Answer 24

1) Endometriomas (“chocolate cyst”)
2) Brenner Cell Tumors

Question 25

Most common tumor found in women of all ages is what?

Answer 25

Benign cystic teratoma (dermoid cyst) (a germ cell neoplasm)

Question 26

Stromal Cell Neoplasms are ____________ tumors (produce hormones) and have ___________ potential

Answer 26

functioning; malignant

Question 27

What may contribute to s/sx of precocious puberty in peds patients?

Answer 27

Stromal cell neoplasms

Question 28

What are 2 types of stromal cell neoplasms?

Answer 28

1) **Granulosa theca cell tumors**: estrogen producing 2) **Sertoli-Leydig cell tumors**: androgen producing

Question 29

Ovarian fibroma + ascites + right pleural effusion is called what?

Answer 29

Meigs syndrome

Question 30

How do you initially manage postmenopausal adnexal masses?

Answer 30

TVUS and serum tumor markers (CA-125, HE4)

Question 31

What is concerning for postmenopausal adnexal masses?

Answer 31

>3cm (big thing to know here)

Question 32

What is used to categorize ovarian malignant neoplasms?

Answer 32

Cell Type Origin

Question 33

List the 3 categories of malignant ovarian neoplasms

Answer 33

1) Malignant Epithelial Cell Tumors (most common) 2) Malignant Germ Cell Tumors 3) Malignant Stromal cell Tumors

Question 34

Borderline Ovarian Tumors/ Borderline malignancies: 1) Who are they more common in? 2) What is the prognosis? 3) What is the Tx?

Answer 34

1) Premenopausal women (30-50yo) 2) Good prognosis 3) Unilateral oophorectomy and follow up if trying to preserve fertility

Question 35

Epithelial Cell Ovarian Carcinoma: What is the most common? Describe these

Answer 35

Malignant epithelial serous tumors; Multiloculated + have psammoma bodies

Question 36

Epithelial Cell Ovarian Carcinoma: List the 3 kinds

Answer 36

1) Malignant epithelial serous tumors 2) Malignant mucinous epithelial tumor 3) Heredity Epithelial Ovarian Cancer

Question 37

Epithelial Cell Ovarian Carcinoma: Which is assoc. with pseudomyxoma peritonei?

Answer 37

Malignant mucinous epithelial tumor

Question 38

Most common ovarian cancers in women <20 y/o is what?

Answer 38

Germ Cell Tumors

Question 39

Germ Cell Tumors: List 2 kinds. Which is Radiosensitive and chemosensitive?

Answer 39

1) Dysgerminomas: Radiosensitive and chemosensitive 2) Immature Teratoma

Question 40

Germ Cell Tumors: List 2 rare kinds

Answer 40

1) Endodermal Sinus Tumor 2) Embryonal Cell Carcinomas tx: Surgical resection of ovary + chemotherapy

Question 41

Gonadal Stromal Cell Tumors: Which secretes estrogen? Which secretes testosterone?

Answer 41

1) Granulosa Cell Tumor: estrogen 2) Sertoli-Leydig Tumors: testosterone

Question 42

Malignant Mesodermal Sarcomas: Are these easy to treat or aggressive?

Answer 42

Aggressive (usually Dx late)

Question 43

Give an example of Cancer Metastatic to the Ovary. What site does it usually originate from?

Answer 43

Krukenberg tumor; GI tract and Breast most common

Question 44

Uterine Tube Disease: Can you usually palpate tubes?

Answer 44

No

Question 45

List 2 Benign Diseases of the Uterine Tube and Mesosalpinx

Answer 45

1) Para-ovarian Cysts 2) Hydatid Cysts of Morgagni

Question 46

Name a type of Carcinoma of the Uterine Tube

Answer 46

Primary Uterine Tube Carcinoma

Question 47

Management of Ovarian and Uterine Tube Cancers includes what 3 things?

Answer 47

1) Cytoreductive surgery + Chemotherapy [if persists] 2) Radiation therapy

Question 48

Ovarian Cancer: Follow up should incl. what things?

Answer 48

1) Clinical history and examination (bimanual, pelvic, abd, etc) 2) Various imaging studies (U/S and/or CT)

Question 49

Define menopause

Answer 49

Permanent cessation of menses after a significant decrease in ovarian estrogen production *12 consecutive months with no menstrual bleeding*

Question 50

LH Stimulation: Theca cells in the ovarian stroma produce testosterone and ______________

Answer 50

androstenedione

Question 51

___________is the primary estrogen hormone; _______________ converts to this

Answer 51

Estrone; Androstenedione

Question 52

Decreased estrogen production can lead to a variety of effects, such as what 2 things?

Answer 52

1) Menstrual Cycle Alterations (follicular phase changes) 2) Vasomotor instability (hot flashes)

Question 53

Osteoporosis: What are 2 scans/ tools?

Answer 53

FRAX tool and DEXA scan

Question 54

Encourage ___________________________________ to protect bones and DEXA scans to evaluate bone density.

Answer 54

Calcium 1200mg/Vitamin D 800 IU t

Question 55

Bone demineralization: What 2 things is it assoc. with?

Answer 55

Decreased estrogen and low BMI

Question 56

Primary Ovarian Insufficiency occurs in ____% of women who cease menses before 40

Answer 56

1%

Question 57

Primary Ovarian Insufficiency is confirmed by what?

Answer 57

FSH levels >30mIU/mL on two separate occasions (seems important)

Question 58

Primary Ovarian Insufficiency occurs in ____% of women who cease menses before 40

Answer 58

1%

Question 59

You should never give _____________ without progestin

Answer 59

estrogen

Question 60

What method of estrogen admin is unpredictable?

Answer 60

IM