Ultrasound
Adnexal masses
menopausal therapy
Masses Adnexal
100
Patient undergoes a sonogram notable for unilocular cyst with ground-glass content and papillations. These findings are suspicious for _______
Endometrioma
100
A 15yo female presents to the ED complaining of acute onset left lower quadrant pain of 3 hours duration. Pain is associated with nausea/vomiting. She denies vaginal bleeding, bowel issues. She has never had intercourse and is otherwise healthy. Her abdomen is markedly tending in the LLQ with guarding. She is afebrile. A CBC count is normal and bHCG is negative. Abdominal sono shows an 8cm simple cyst on her left ovary with normal blood flow. Her right ovary and uterus are unremarkable. What is the most appropriate course of action?
A) Diagnostic laparoscopy
B) General surgery consult
C) IV antibiotics
D) Pelvic examination
E) Repeat sonogram
What is diagnositc Laparoscopy?
100
A 53yo presents to clinic for annual visit. She has not had menses in 2 years. She complains today of severe hot flashes that occur 5-6 times per day. She also reports that she wakes up at least 2-3 times per night soaked in sweat. Which of the following is a contra-indication to hormone replacement therapy?
A) Active liver disease
B) Personal history of breast cancer
C) stroke or CAD
D) unexplained vaginal bleeding
e) All of the above
What is all of the above?
100
A 42-year-old woman is found to have a pelvic mass when she presents for her well-woman exami-
nation. She is asymptomatic and has no pain or abnormal bleeding. Transvaginal ultrasonography
reveals a normal uterus with a thin endometrium and a 5-cm cyst with a thin (1-mm) septation. The
best next step is
(A) endometrial biopsy
(B) ovarian cystectomy
(C) magnetic resonance imaging (MRI) of the abdomen and pelvis
(D) repeat ultrasonography in 3–6 months
(E) oophorectomy
What is repeat ultrasonography in 3–6 months
200
27yo presents with acute abdominal pain and fever. She's noted to have an elevated white count . An ultrasound is performed with the following findings:
notable for a cogwheel appearance; mixed echogenicity. These findings are most concerning for
A) Yolk Sac Tumor
B) Endometrioma
C) Tubo-ovarian abscess
D) Mucinous cystadenoma
What is a tuboovarian abscess?
200
A 59yo female prsents to the office with menometrorrhagia and abdominal pain. Workup reveals a large multicystic 12-cm mass in the pelvis. She undergoes an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and staging. Pathology reveales microscopic changes consistent with Call-Exner bodies. Which of the following is the most likely the diagnosis?
A) Fibroma
B) Granulosa cell tumor
C) Sclerosing stromal tumor
D) Sertoli-Leydig cell tumor
E) Stromal Luteoma
What is granulosa cell tumor
200
A 68-year-old woman presents for a gynecologic examination. She has been on menopausal hormone therapy for years to treat persistent vasomotor symptoms. She wants to know the risks of continuing the medication. In discussing oral hormone therapy (HT), you counsel her that in addition to vasomotor symptom reduction, the use of combination oral estrogen-progesterone therapy is associated with a decreased risk of
(A) breast malignancy
(B) colorectal malignancy
(C) coronary heart disease
(D) fractures
What are fractures?
200
A 24-year-old nulligravid woman presents to the emergency department with severe right lower quadrant pain with associated nausea and vomiting for the past 24 hours. Ultrasonography reveals a right-sided 6-cm unilocular ovarian cyst. The uterus and contralateral ovary appear normal. She undergoes laparoscopy, and intraoperatively the ovary appears ischemic and necrotic with poor blood flow and blue-black areas, which do not improve after detorsion. The best next step is to:
(A) conclude the procedure
(B) perform oophoropexy
(C) perform ovarian cystectomy
(D) perform salpingo-oophorectomy
What is perform ovarian cystectomy?
300
A 19yo patient presents to the ED with abdominal pain. An ultrasound is performed, notable for a left adnexal mass with a “cobweb”, “reticular pattern”
This mass is most likely a:
A) endometrioma
B) benign mucious cystadenoma
C) tuboovarian abscess
D) hemorrhagic cyst
What is a hemorrhagic cyst?
300
Sub-types of germ cell tumors include:
A) Dysgerminoma, yolk sac tumor, mature teratoma, Granulosa cell tumor
B) Yolk sac tumor, mature teratoma, choriocarcinoma, Dysgerminoma
C) Dysgerminoma, yolk sac tumor, Thecoma , choriocarcinoma
D) Granulosa cell, Thecoma, Dysgerminoma, Yolk sac tumor
What is Yolk sac tumor, mature teratoma, choriocarcinoma, Dysgerminoma
300
A 34 year-old woman gravity, two pair two presents with worsening hot flashes sleep disruption and vaginal dryness after undergoing a laparoscopic assisted vaginal hysterectomy with BSO two months ago to treat severe dysmenorrhea resulting from endometriosis. The operative report describes complete excision of the visible implants of endometriosis without complications she’s otherwise healthy on exam. Her blood pressure is 138/82 pelvic examination shows mild atrophy in an intact vaginal Apex with no lesions or tenderness the best next step in management of this patient’s symptoms is to initiate systemic therapy with:
A clonidine, B estrogen C gabapentin D paroxetine E micronize progesterone.
What is estrogen?
(Prolog q #1)
300
A 12-year-old adolescent presents with a 3-week history of intermittent right lower quadrant pain. She experienced menarche a few months ago, and her last menstrual period was just over 6 weeks ago. She reports no significant medical or surgical history. When interviewed in private, she confirms that she has had no previous sexual activity. Her abdominal examination reveals a large, firm, mildly tender, right-sided pelvic mass. Pelvic ultrasonography shows a small uterus, normal left ovary, and a 15-cm right ovarian mass with solid components, edema, and a moderate amount of free fluid in the pelvis. Serum laboratory values are bHCG 109, Ca125 130, LDH 850 AFP 8. This patient’s most likely diagnosis is
(A) dysgerminoma
(B) ectopic pregnancy
(C) hydatidiform mole
(D) immature teratoma
(E) mature cystic teratoma
What is dysgerminoma?
400
28 yo presents with acute RLQ pain. An ultrasound is performed, notable for a tubular and elongated cystic mass with incomplete septations or indentations along its walls with a cogwheel signs.
What is the likely diagnosis?
A) hemorrhagic cyst
B) hydrosalpinx
C) Endometrioma
D) ectopic
What is hydrosalpinx?
400
A 63-year-old woman, gravida 1, para 1, comes to your office for a follow-up visit for an asymptomatic left adnexal mass that was diagnosed 6 months ago on bimanual examination. Transvaginal ultrasonography at that time revealed a 7-cm simple adnexal cyst and a CA 125 level of 3 international units/mL. She is asymptomatic and reports no abdominal bloating or changes in bowel
movements or appetite. Physical examination reveals persistent left adnexal mass that is nontender and mobile. Repeat transvaginal ultrasonography was performed revealing a persistent 7-cm adnexal mass as visualized 
The best next step in her management is
(A) computed tomography (CT)
(B) repeat transvaginal ultrasonography in 6–12 months
(C) ultrasound-guided cyst aspiration
(D) laparoscopic salpingo-oophorectomy
(E) abdominal salpingo-oophorectomy
What is repeat us in 6-12 months?
400
A 64-year-old woman, para 2, presents for a well-woman examination. She has a history of estrogen receptor-positive breast cancer treated with lumpectomy and radiation therapy and is currently taking anastrozole. She drinks 3–4 glasses of wine a night and smokes half a pack of cigarettes per day. She has mild gastroesophageal reflux disease. Her medications include calcium and a vitamin D supplement. On physical examination, her body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is 22. A recent dual-energy X-ray absorptiometry scan noted a bone mineral density (BMD) score of –2.6 at the femoral neck. Her calcitonin and parathyroid hormone serum levels are in the normal range. In addition to smoking cessation and reduction in alcohol consumption, the best next step in medical management is to initiate
(A) calcitonin
(B) conjugated equine estrogen/bazedoxifene
(C) raloxifene
(D) teriparatide
(E) zoledronic acid
What is zoledronic acid?
400
A 28yo P3003 presents tothe ED with acute onset left pelvic pain. She was in her usual state of health until a sudden, stabbing pain began after she stood up from her chair at work. She describes the pain as 10/10, and has been anorexic since it started. Denies nausea and vomiting. Pain is nonradiating. She has no other PMH. NSVD x 3. On sono 10cm solid mass in LLQ with absent left adnexal arterial flow. She is immediately taken for laparoscopy and the mass is removed, sent for frozen section which shows that neuroectoderm predominates. Which of the following is most likely the diagnosis?
A) choriocarcinoma
B) embryonal carcinoma
c) immature teratoma
D) mature teratoma
E) polyembryony
What is immature teratoma?
500
A 28 yo LMP 10/17/2025 presents with vaginal bleeding and RLQ pain. An ultrasound is performed with power doppler imaging with a the following findings? 
What is the most likely diagnosis?
What is an ectopic pregnancy?
500
A 60-year-old postmenopausal woman presents with vaginal bleeding, breast tenderness, and pelvic pressure. Ultrasonography reveals a 1.2-cm endometrial stripe and a predominately solid 8-cm adnexal mass with intramural hemorrhage.
(A) Alpha-fetoprotein (AFP)
(B) Cancer antigen 19-9 (CA 19-9)
(C) Lactate dehydrogenase (LDH)
(D) Inhibin B
(E) Carcinoembryonic antigen
What is inhibin B?
500
A 55-year-old woman reports worsening hot flushes and chronic pelvic pain. She reports disrupted sleep.choose the most appropriate nonhormonal initial medication to manage menopausal hot flushes (A–E).
(A) Venlafaxine
(B) Paroxetine
(C) Gabapentin
(D) Clonidine
(E) Sertraline
What is gabapentin?
500
A 32-year-old woman, gravida 2, para 2, presents to your office for left lower quadrant pain and apersistent 9-cm left adnexal mass identified 6 months ago. She describes the pain as crampy and radiating to her left lower back. She reports no early satiety, bowel function changes, or bloating and no family history of ovarian or breast malignancies. Bimanual examination reveals an enlarged, mobile left adnexal mass. Transvaginal ultrasonography is performed (Fig. 81-1). She undergoes a laparoscopic resection of the cyst, during which there is leakage of the cyst contents. The factor in this patient’s history most associated with a risk of cyst recurrence is
(A) intraoperative cyst rupture
(B) laparoscopic approach for removal
(C) cyst diameter greater than 8 cm
(D) a multilocular cyst
(E) age older than 30 years
What is cyst diameter greater than 8cm?