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126 Cards in this Set
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Follow up of cystic ovarian structures is recommended if |
They exceed 3 cm |
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Simple cyst |
Anechoic Thin wall Post enhancement Unilocular |
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Most common cause of ovarian enlargement in young women |
Functional cysts |
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Functional cysts |
Result from gonadotrophins stimulation |
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Functional cysts types |
Follicular cysts Corpus luteum cysts Theca lutein cysts |
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Follicular cysts |
Non ruptured follicle 3-8 cm |
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Corpus luteal cysts |
After ovulation Secrete progesterone and a bit of estro Rarely exeed 4cm |
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If pregnant what happen to corpus luteum cyst |
Persists until 16 wks Produces progesterone |
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If not pregnant what happens to corpus luteum cyst? |
Grow and hemorrage into lumen |
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Theca lutein cysts |
Multilocular Bilateral
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Causes of theca lutein cyst |
High levels of hCG (Molar or fertility hcg) |
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Do theca lutein cyst secrete hormones? |
Nope |
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Largest of functional cysts? |
Theca lutein cysts |
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Hemorrhagic ovarian cyst |
Subacute |
Acute |
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Clinical sign of hemorragic cyst |
Acute pain |
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Ovarian torsion |
Complete or partial rotation of the ovarian pedicle |
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Ovarian torsion compromises |
Lymphatic and venous drainage causing congestion and edema Leading to loss of arterial flow |
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Clinical sign of ovarian torsion |
Sudden pelvic pain May be confused with appendicitis |
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Risk factors for ovarian torsion |
Mobile adnexa- children Pregnancy Ovarian mass or cyst |
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Ovarian torsion is most common in |
Children |
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Ovarian torsion ultrasound |
Enlarged ovary- more midline positioned Multiple follicles Affected flow Wirlpool sign-twisted ovarian vessels
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Venous flow in ovarian torsion |
Lost first Absent |
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Arterial flow in ovarian torsion |
Lost second May be present ,dampened ,or absent Compare both ovaries |
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Ovarian torsion |
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Polycystic ovarian syndrome |
Stein-Leventhal Syndrome Chronic anovulation |
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PCOS diagnosed |
Through Clinical and serologic findings |
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Clinical sign of PCOS |
Infertility Obesity Hirutism Amenorrhea |
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How many follicles in one PCOS ovary |
More than 12-19 follicles |
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Ovarian volume in PCOS |
More than 10 cm3 |
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PCOS is uni or bilateral? |
Always BILATERAL |
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PCOS |
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Make up 90% of all ovarian malignancies |
Epithelial tumors |
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Epithelial ovarian tumors derive from |
Surface epithelium that covers the ovary |
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Epithelial tumors |
Serous Mucinous Endometroid Clear cell Transitional cell -brenner Think about layers ;serosa mucosa endometrioum |
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Serous tumors |
Serous cystadenomas-benign Serous cystadenocarcinomas-malign |
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Most common ovarian carcinoma |
Serous cystadenocarcinoma |
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Serous cystadenoma |
Large Anechoic Thin septations Unilocular |
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Serous cystadenocarcinoma |
Multilocular Papillary projection Echogenic foci Ascites |
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Mucinous tumors |
Mucinous cystadenoma- benign Mucinous cystadenocarcinoma-malig |
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Mucinous tumors cause |
Pseudomyxoma peritonei |
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Mucinous cystadenomas are |
Unilateral 30-50 |
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Mucinous cystadenocarcinoma |
20% bilateral Large multilocular cysts up to 30 cm Echogenic material and papillary extensions |
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Mucinous cystadenoma |
Multiloculated thicker septation cysts up to 50 cm Gravity dependent echoes |
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Transitional cell tumors |
Brenner Fibroepithelioma BENIGN TUMORS |
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Endometroid tumors |
80% malignant but better prognosis than other epithelial cancers |
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Endometroid tumors |
Make up 25% of ovarian cancer |
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Endometroid tumors are identical to |
Endometrial adenocarcinoma |
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30% of ovarian endometroid tumors pt will have |
Endometrial cancer |
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Clear cell tumors |
Malignant |
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Histological variant of endometroid and serous carcinomas |
Clear cell tumors |
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Mets make up |
10% of ovarian tumors |
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Most comon sites of ovarian mets are |
Breast GI |
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Ovarian cancer that arises from GI |
Krukeberg tumor
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Ovarian mets are usually |
Bilateral |
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Krukenberg tumor are usually bi but if uni are most common in |
Rt side |
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The fifth leading cause of cancer death |
Ovarian cancer |
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The fifth most frequent cancer in women |
Ovarian cancer |
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Ovarian cancer is |
Silent Most will habe late stages when discovered and 5yrs survival rate is 30-50% |
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Risk for ovarian ca |
Family hx of breast or ovarian ca Nulliparity or unsuccessful pregnancies 50+ Early menses/ late meno |
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Screening for ovarian ca |
CA-125 SONOGRAPHY |
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For pt with suspected ovarian mass check |
Peritoneum Liver Pleural space |
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Highly suggestive of ovarian carcinoma |
Ovarian mass Elevated CA -125 |
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Paraovarian cysts |
Parovarian cysts Remnants of Wolfian ducts Adjacent to ovary |
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Bladder abnormalities |
Distal ureteral stone Cystitis Bladder wall neoplasm Bladder diverticulum Neurogenic bladder |
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Neurogenic bladder |
Malfunction Enlarged bladder with/w/o debris |
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Distal ureteral stone in tvag |
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PID |
Inflamation of pelvic and adnx structure |
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PID is |
An ascending infection from cervix to fallopian tubes and adnexa |
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Most common cause of PID |
sexually transmited infections and polymicrobial Chlamydia Gonorrhea E.coli |
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PID may also be caused from |
D & C , HSG, ruptured app, abortion etc |
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Stages of PID |
I- endometritis II- salpingitis III- TOA (SEVERE) |
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Chronic PID |
Indefinite uterus sign= lobster claw sign
Adhesion causes pelvic organs to merge centrally |
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Endometritis in early PID |
Air bubbles in endo |
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Pyosalpinx in stage II PID |
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Stage III PID |
TOA |
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Hydrosalpinx |
Chronic PID- resolved pyosalpinx |
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Clinical signs with PID |
Fever Leukocytosis Pain Dyspareunia Cx motion |
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Endometriosis |
Ectopic endometrial tissue outside uterus |
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Most common endometriosis ectopic site |
Ovary |
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Endometriosis can be |
Asymptomatic Severe pain |
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Endometriosis types |
Diffuse-hard to detect on US focal- endometrioma |
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Clinical signs of endometriosis |
Infertility Pain - 4D: Dyspareunia Dysmenorrhea Dysuria Dyschezia
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Dyschezia |
Difficult defecation |
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Focal endometriosis |
Endometrioma Chocolate cyst |
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Stages of endometriosis |
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Germ cell tumors |
Ovarian tumors |
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Germ cell tumors |
Derive from germ cells of embrionic gonads |
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Germ cell tumors in adults are mostly |
Benign- cystic teratoma |
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Germ cell tumors in kids and adolescents are mostly |
Malignant |
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3 Germ cell tumors |
Benign cystic teratoma-dermoid cyst Dysgerminoma- malig Yolk sac tumor-malig
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Benign cystic teratoma-BCT |
dermoid cyst Usually benign |
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Malignant version of teratomas |
Imature teratoma- teratocarcinoma |
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Teratoma findings |
Tip of iceberg Dermoid mesh Dermoid plug |
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Teratomas can show up differently on us depending on |
Their content : hair, teeth |
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Dermoid mesh |
Hair fibers - linear echogenic |
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Dermoid plug |
Echogenic mural nodule in cystic mass Shadowing |
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Tip of iceberg dermoid |
Highly echogenic mass that shadows posteriorly |
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Dysgerminoma |
Highly malignant but highly radiosensitive |
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Dysgerminoma occur |
Before 30 yrs old |
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Equivalent of dysgerminoma in males |
Seminoma |
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Marker for dysgerminoma |
High serum lactate dehydrogenase |
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Most common germ cell malignancy |
Dysgerminoma |
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Second most common germ cell malignancy |
Yolk sac tumors |
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Most common germ cell tumor |
Benign cystic Teratoma/ dermoid cyst |
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Most common complication of dermoid cyst/BCT |
Ovarian torsion |
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Yolk sac tumors |
Endodermal sinus tumors |
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Yolk sac tumors |
Malignant |
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Yolk sac tumors |
Occur in young adulthood 20-30 |
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Yolk sac tumors |
Highly malignant and metastize fast |
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Marker for yolk sac tumors |
High AFP High LDH |
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Sex cord stromal tumors arise from |
Sex cords or ovarian stroma |
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4 Sex cord stomal tumors TheFAG |
Fibroma Thecoma Androblastoma Granulosa cell tumors |
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Fibromas |
Benign |
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Fibroma is assoc with |
MEIGS SYNDROME |
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Meigs syndrome |
Ascites and pleural eff as a result of a benign ovarian tumor |
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Thecoma |
Usually benign Post menopausal |
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Thecomas produce |
Estrogen Endo changes in post meno |
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Thecomas look like |
Fibroma on ultrasound Hypo mass with shadowing |
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Fibroma looks like a |
Pedunculated uterine fibroid Hypo with shadowing |
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Granulosa cell tumors |
Produce estrogen Same as thecomas Post meno |
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Sertoli leydig tumor |
Arrhenoblastoma Androblastoma |
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Sertolu leydig cell tumor |
Produce testosterone - virilization Look like granulosa cell tumor 20% malignant Are rare tumors |
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Germ cell tumors |
DDY |
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Sex cord and stoma tumors -TheFAG |
Produce hormones |
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Which ovarian tumor produces estrogen |
Thecoma Granulosa |
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Which ovarian tumor produces testosteron |
Sertoli leyding tumor |
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