Help Me I'm Bleeding
An 18-year-old nulligravid woman presents for evaluation of heavy regular menses. She was recently diagnosed with anemia by her primary care provider and began taking iron supplementation. In addition to a full history and physical examination, what serum laboratory testing is indicated?
PT/PTT
A 59-year-old white postmenopausal woman presents with bilateral adnexal masses. On ultrasonographic evaluation, the masses are found to have both cystic and solid components. Her serum CA 125 concentration is 150 U/mL. Which factor in her presentation is associated with the greatest increased risk for ovarian malignancy?
AGE
A 16-year-old nulligravid adolescent presents to the emergency department with sudden onset of right-sided pelvic pain, nausea, and vomiting. On admission, her heart rate is 110 beats per minute and temperature is 38.1° C (100.6° F). A urine pregnancy test result is negative. On abdominal and bimanual examination, you note right lower quadrant tenderness and rebound tenderness, and you palpate a 6-cm adnexal mass. Her white blood cell count is 12,000/mm3. What is the most likely diagnosis?
Ovarian Torsion
The most frequently encountered site of endometriosis lesions
Ovaries
This state has more bourbon barrels than people.
Kentucky
16 million aging bourbon barrels compared to a human population of about 4.5 million
A 22-year-old nulligravid woman presents to your clinic for heavy menstrual periods. She reports that her periods occur every 25 days, with bleeding lasting 5 days. She requires 4-5 regular tampons per day on her heaviest flow days. Which aspect of her menstrual cycles is abnormal?
Nothing!
A 27-year-old nulligravid woman is undergoing an evaluation for infertility. Transvaginal ultrasonography shows a 5-cm, homogeneous-appearing cyst containing low-level echoes within the right ovary. She is asymptomatic, and her serum CA 125 concentration is 250 U/mL. What is the best next step in management?
Serial Ultrsounds
Which side is more likely to torse and why
Right side
Mobile Cecum vs Fixed sigmoid colon
A patient with refractory endometriosis begins treatment with a GnRH agonist. Which adverse effect is most concerning with prolonged therapy?
Loss of bone mineral density
GnRH agonists create a hypoestrogenic state, causing vasomotor symptoms, vaginal dryness, and bone mineral density loss.
This 2019 Marvel cinematic event briefly became the highest-grossing movie of all time, concluding a 22-film superhero storyline
Avengers Endgame
A 38-year-old nulligravid woman presents with heavy regular menses despite high-dose cyclic oral contraceptive therapy. Her medical and surgical histories are normal. She does not take other medications. The results of recent serum laboratory testing were normal, including thyroid function tests. Pelvic ultrasonography shows a normal-sized uterus with a 1.2-cm endometrial echocomplex and normal-appearing ovaries. What is the best next step in management?
EMB
A 31-year-old patient with infertility undergoes transvaginal ultrasound. A 5-cm ovarian cyst has homogeneous, low-level internal echoes described as a “ground-glass” appearance.
Endometrioma
The ovarian artery arises from what structure
Abdominal Aorta
The ovarian artery arises from the aorta below the renal artery.
A 32-year-old patient is considering a hysterectomy with salpingo-oophorectomy for endometriosis-associated pelvic pain. What is the risk of symptom recurrence after definitive surgical therapy for endometriosis?
15%
In the summer of 2002, he had a chart-topping hit with "Hot in Herre.
Nelly
What characteristic finding on pelvic ultrasonographic evaluation is most strongly suggestive of adenomyosis?
Myometrial Cysts
In a 61-year-old woman with a 7-cm solid adnexal mass and new-onset postmenopausal bleeding, which serum tumor marker is most likely to be elevated?
inhibin
Name two common ultrasound finding of ovarian torsion (there are more than 2!)
- Twisted Pedicle with a bullseye or whirlpool appearance
- Unilateral ovarian displacement
- Unilateral enhanced ovarian echogenicity
A 35-year-old patient with endometriosis undergoes a hysterectomy with bilateral salpingo-oophorectomy. What is the most common site of recurrence of endometriotic lesions after surgery?
Large Bowel
This pop star is named in honor of her grandfather William; the rest of her name is Pirate Baird O'Connell.
Billie Eilish
A 38-year-old woman, gravida 2, para 2, presents with intermenstrual spotting. Physical examination results do not indicate a likely etiology of her bleeding. Transvaginal ultrasonography findings suggest a possible endometrial polyp, but the results are not diagnostic. What is the best next step (in OFFICE) in evaluation?
Saline Infusion Sonogram
Name three ultrasound features that increase concern for malignancy in an adnexal mass
Solid components, papillary projections, irregularity, thick septations, internal vascularity, ascites, or evidence of metastatic disease.
What is the sensitivity of ultrasound in diagnosing ovarian torsion
72.1 - 92% sensitive (more sensitive in adolescents)
A 40-year-old patient complains of pelvic pain, back pain, and dyspareunia 2 years after total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesions for stage IV endometriosis. She denies hot flushes and vaginal dryness. She denies medical problems and is not currently taking medication. Pelvic examination is remarkable for significant pelvic tenderness. Laboratory values are as follows: follicle-stimulating hormone, 10 IU/dL; estradiol, 40 pg/mL. A pelvic sonogram demonstrates a 3-cm mass in the left pelvis. What is the most likely diagnosis?
Ovarian Remnant Syndrome
This country spans across a staggering 11 different time zones, more than any other nation on Earth
Russia