Menstrual Cycle, Ovarian Tumors, and Infertility
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Questions and Answers

Which statement about mature cystic teratomas is true?

  • Torsion is common, while cyst rupture is rare. (correct)
  • They frequently rupture during pregnancy.
  • They are always malignant.
  • They are benign tumors that generally do not undergo torsion.
  • Which tumor antigen is correctly paired with its ovarian tumor?

  • Cancer antigen 19-9 (CA19-9)—dysgerminoma
  • β-human chorionic gonadotropin—mucinous epithelial ovarian carcinoma
  • α-fetoprotein (AFP)—granulosa cell tumor
  • Lactate dehydrogenase—yolk sac tumor and embryonal cell carcinoma (correct)
  • Which clinical criterion should prompt referral to a gynecologic oncologist?

  • Presence of ascites (correct)
  • Patient's history of breast cancer (correct)
  • CA125 level of 30 U/mL
  • Patient's age under 30
  • Which of the following is NOT a side effect of aromatase inhibitors?

    <p>Increased muscle mass (C)</p> Signup and view all the answers

    Which condition is commonly diagnosed among causes of chronic pelvic pain?

    <p>Irritable bowel syndrome (C), Endometriosis (D)</p> Signup and view all the answers

    Which patient complaints are NOT suggestive of interstitial cystitis?

    <p>Stress urinary incontinence (C)</p> Signup and view all the answers

    What is the typical lesion diagnostic of interstitial cystitis during cystoscopy called?

    <p>Hunner ulcer (D)</p> Signup and view all the answers

    Which statement is FALSE regarding the development of the hypothalamic–pituitary-ovarian axis in female fetuses?

    <p>GnRH pulse generator is active from birth. (D)</p> Signup and view all the answers

    What is the most likely mechanism for urinary frequency and incomplete bladder emptying in a woman with large fibroids?

    <p>Compression of the bladder by the fibroid (D)</p> Signup and view all the answers

    What is the initial management for a woman presenting with irregular bleeding and anemia due to uterine fibroids?

    <p>Iron supplementation and hormonal therapy (D)</p> Signup and view all the answers

    What is the most suitable treatment for a 35-year-old woman with heavy bleeding and multiple fibroids who prefers minimally invasive options?

    <p>Uterine artery embolization (C)</p> Signup and view all the answers

    What is the best initial management for a pregnant woman diagnosed with a large intramural fibroid during her first trimester?

    <p>Conservative observation (B)</p> Signup and view all the answers

    Which of the following is NOT a use of magnetic resonance imaging in gynecologic malignancies?

    <p>All of the above (D)</p> Signup and view all the answers

    Early pregnancy loss is most common in women with which condition?

    <p>Systemic lupus erythematosus with antiphospholipid antibodies (D)</p> Signup and view all the answers

    Sonographically, endometriomas are typically described as which of the following?

    <p>Cystic with diffuse internal low-level echoes (D)</p> Signup and view all the answers

    Mature ovarian cystic teratomas account for what approximate proportion of ovarian neoplasms?

    <p>One in five (B)</p> Signup and view all the answers

    What is the most likely diagnosis for a woman with heavy menstrual bleeding, pelvic pressure, and a well-defined uterine wall mass?

    <p>Uterine fibroid (D)</p> Signup and view all the answers

    For a woman with prolonged heavy periods and frequent urination due to a large submucosal fibroid, what is the best initial treatment option?

    <p>Hormonal therapy (e.g., GnRH agonists) (C)</p> Signup and view all the answers

    In evaluating a case of infertility where a mass distorts the uterine cavity, which condition should be included in the differential diagnosis?

    <p>Submucosal uterine fibroid (B)</p> Signup and view all the answers

    What is the most likely complication for a patient with sudden-onset pelvic pain, fever, and a tender mass, who has a history of uterine fibroids?

    <p>Degenerating fibroid (C)</p> Signup and view all the answers

    What is the next best step to confirm the diagnosis in a woman with heavy menstrual bleeding and an irregularly enlarged uterus?

    <p>Pelvic ultrasound (D)</p> Signup and view all the answers

    What is the most appropriate treatment option for a woman with severe menstrual pain and multiple fibroids who wishes to preserve her fertility?

    <p>Surgical myomectomy (D)</p> Signup and view all the answers

    Which of the following presentations is most characteristic of pelvic inflammatory disease?

    <p>Tender abdominal mass with fever (A)</p> Signup and view all the answers

    What is a common symptom associated with uterine fibroids, especially when they are submucosal?

    <p>Heavy menstrual bleeding (C)</p> Signup and view all the answers

    What is the most appropriate management of a 4.2-cm simple right ovarian cyst in a neonate?

    <p>Observation with repeat sonography (C)</p> Signup and view all the answers

    Which statement is true regarding polycystic ovarian syndrome (PCOS)?

    <p>It is the most common cause of chronic anovulation. (C)</p> Signup and view all the answers

    Which of the following is NOT a component of the Rotterdam criteria for diagnosing PCOS?

    <p>Peripheral distribution of ovarian follicles on sonography (C)</p> Signup and view all the answers

    What is the most common endocrine disorder affecting reproductive-aged women?

    <p>Polycystic ovarian syndrome (B)</p> Signup and view all the answers

    Which hormone has higher circulating levels in first-degree male relatives of women with PCOS?

    <p>Testosterone (B)</p> Signup and view all the answers

    In PCOS, altered GnRH pulsatility leads to what predominant change in hormone levels?

    <p>Increased levels of luteinizing hormone (A)</p> Signup and view all the answers

    What characterizes the clinical presentation of an 18-year-old nulligravida with primary amenorrhea who has vaginal bleeding following a progesterone withdrawal test?

    <p>Polycystic ovarian syndrome (C)</p> Signup and view all the answers

    Which of the following conditions is most likely to present with amenorrhea in a young woman?

    <p>Polycystic ovarian syndrome (A)</p> Signup and view all the answers

    Flashcards

    Mature cystic teratomas: Torsion vs. rupture

    Mature cystic teratomas are benign tumors that often undergo torsion, but cyst rupture is rare.

    Mature solid teratomas: Malignant nature

    Solid teratomas are malignant tumors that arise from the proliferation of multiple germ cell lines.

    CA19-9 association

    Cancer antigen 19-9 (CA19-9) is a tumor antigen associated with mucinous epithelial ovarian carcinoma.

    AFP association

    α-fetoprotein (AFP) is a tumor marker associated with dysgerminoma.

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    β-hCG association

    β-human chorionic gonadotropin (β-hCG) is a tumor marker associated with granulosa cell tumor.

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    LDH association

    Lactate dehydrogenase (LDH) is a tumor marker associated with yolk sac tumor and embryonal cell carcinoma.

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    Referral criteria for pelvic mass

    Ascites, a history of breast cancer, and a CA125 level exceeding 35 U/mL are clinical criteria that warrant referral to a gynecologic oncologist for a newly diagnosed pelvic mass in a premenopausal woman.

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    Hunner ulcer

    Hunner ulcer, a reddish-brown mucosal lesion with small radiating vessels, is considered diagnostic of interstitial cystitis during cystoscopy.

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    Myomectomy

    Surgical procedure to remove fibroids from the uterus, preserving the uterus.

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    Hysterectomy

    Surgical removal of the uterus, potentially including the cervix and/or surrounding structures.

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    Uterine artery embolization

    Procedure that blocks blood flow to fibroids by injecting tiny particles into uterine arteries.

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    Endometrial ablation

    Procedure that destroys the lining of the uterus, often used to treat heavy menstrual bleeding.

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    Compression of the bladder by fibroid

    Most common cause of urinary symptoms in women with fibroids, due to pressure on the bladder.

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    Iron supplementation and hormonal therapy

    Initial treatment for irregular bleeding and anemia in women with fibroids, addressing both iron deficiency and hormonal imbalances.

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    Uterine artery embolization

    Minimally invasive approach for treating fibroids in women who desire fertility preservation.

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    Conservative observation

    Best initial approach for a pregnant woman with a fibroid, monitoring for any complications.

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    Uterine Fibroid

    A benign tumor of the uterus, commonly causing heavy menstrual bleeding, pelvic pressure, and irregular uterine enlargement.

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    Neonatal Ovarian Cyst

    A benign condition found in newborns, characterized by a cyst on the ovary. It is often discovered incidentally during sonography and usually resolves on its own.

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    GnRH Agonists

    A hormonal treatment option for uterine fibroids, often used to shrink the fibroids and reduce symptoms. It works by temporarily suppressing estrogen production.

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    Polycystic Ovarian Syndrome (PCOS)

    A common endocrine disorder affecting women of reproductive age. It's characterized by irregular cycles, cysts on the ovaries, and excess androgen levels.

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    Submucosal Uterine Fibroid

    A condition where the uterine cavity is distorted by a mass, often found in the context of infertility investigations.

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    Polycystic appearing ovaries

    A condition where the ovaries are enlarged and contain multiple follicles, usually detected by ultrasound.

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    Oligoovulation or anovulation

    Refers to infrequent or absent ovulation, a key symptom of PCOS.

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    Degenerating Fibroid

    A serious complication of uterine fibroids, characterized by sudden pelvic pain, fever, and a tender mass. It occurs when the fibroid experiences degeneration or inflammation.

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    Pelvic Ultrasound

    A non-invasive imaging technique used to visually assess the uterus, ovaries, and other pelvic organs. Often used to diagnose fibroids, cysts, and other uterine abnormalities.

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    Clinical or biochemical signs of hyperandrogenism

    A medical term for the signs of increased male hormones in the body, such as acne, excess hair growth, or irregular periods.

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    Dehydroepiandrosterone sulfate (DHEAS)

    A hormone directly linked to PCOS, often found in higher levels in male relatives of women with PCOS.

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    Follicle-stimulating hormone (FSH)

    A hormone that stimulates follicle growth and development in the ovaries, its release patterns are affected in PCOS.

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    Progestins

    A hormonal therapy for uterine fibroids, but primarily used to treat heavy menstrual bleeding and menorrhagia.

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    Luteinizing hormone (LH)

    A hormone that triggers ovulation and is affected in PCOS, leading to irregular cycles and potentially infertility.

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    Study Notes

    Menstrual Cycle

    • Average duration: 28 days (other options include 21, 35, and 40 days)
    • Ovulation hormone: Luteinizing hormone (LH)
    • Endometrial thickening phase: Luteal phase
    • Estrogen's role: Promotes endometrial growth
    • Phase after ovulation: Luteal phase
    • Progesterone levels (no fertilization): Decrease, leading to menstruation
    • Follicle development hormone: Follicle-stimulating hormone (FSH)

    Ovarian Tumors

    • Most common benign tumor: Serous cystadenoma
    • Typical symptom: Abdominal bloating and pelvic pain
    • Imaging for ovarian tumors: Pelvic ultrasound
    • Most likely malignant tumor type: Epithelial tumors
    • Tumor marker for ovarian cancer: CA-125
    • Other tumor markers: Beta-hCG, AFP, CEA

    Infertility

    • Definition of infertility: Inability to conceive after 12 months of regular, unprotected intercourse
    • Hormone for ovarian reserve: Anti-Müllerian hormone (AMH)
    • Fallopian tube blockage test: Hysterosalpingography (HSG)
    • Infertility causes: Polycystic ovary syndrome (PCOS), endometriosis, low body weight
    • Scarring/adhesion cause: Endometriosis
    • Lifestyle factor affecting male fertility: Smoking
    • Ovulation-stimulating medication: Clomiphene citrate

    Gynecological Examination & Procedures

    • First step: Taking the patient's medical history
    • Vaginal canal/cervix exam tool: Speculum
    • Pap smear purpose: Detect cervical cell abnormalities
    • Imaging for uterus/ovaries/fallopian tubes: Ultrasound
    • Pelvic organ assessment: Bimanual examination

    Specific Clinical Cases (Page 5)

    • Severe pelvic pain during menstruation, painful intercourse, and ultrasound showing ovarian cysts: Likely diagnosis is endometriosis.
    • Chronic pelvic pain, heavy periods, and infertility issues: Likely diagnosis is endometriosis.
    • Endometriosis with increasing pain despite hormonal therapy: Laparoscopic surgery is a potential next treatment option.
    • Painful urination and rectal pain during menstruation accompanied by lower abdominal pain: Possible impacted endometrial tissue in the bladder and bowel.
    • Endometriosis, desire to maintain fertility: Conservative laparoscopic surgery might be indicated.
    • Endometriosis and persistent symptoms: GnRH agonists are a potential medication for symptom management.

    IUD Insertion

    • Optimal IUD insertion time: 4-6 days or 14-16 days of the menstrual cycle

    Acute Abdomen in Gynecology

    • Common causes: Ectopic pregnancy, endometriosis, uterine fibroids, and ovarian cysts
    • Symptom of ruptured ectopic pregnancy: Severe pelvic pain and vaginal bleeding
    • Imaging for gynecological acute abdomen: Ultrasound
    • First-line treatment for a ruptured ovarian cyst: Surgical intervention (if bleeding is severe)
    • Condition requiring emergency treatment: Ovarian torsion
    • Symptom of PID (Pelvic Inflammatory Disease): Pelvic pain, fever, and vaginal discharge
    • Risk factor for ectopic pregnancy: Previous history of PID
    • Blood test for ectopic pregnancy: Serum hCG

    Assisted Reproductive Technologies (ART)

    • ART purposes: Overcome infertility, restore fallopian tube patency, and stimulate ovulation/spermatogenesis
    • Artificial Insemination (AI): Introduction of sperm into the uterus
    • Main causes of anovulation: Hypothalamic-pituitary insufficiency, hypothalamic-pituitary dysfunction, polycystic ovaries

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    Description

    Explore the essentials of the menstrual cycle, common ovarian tumors, and the definitions and causes of infertility. This quiz covers hormone roles, tumor markers, and diagnostic procedures, providing a comprehensive overview of reproductive health topics. Test your understanding of these vital medical concepts.

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