Ovarian Cysts — MCQs
All of the following ovarian tumors usually occur bilaterally, except:
A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. An ultrasound (USG) of the patient was done. What will be the diagnosis?
In a suspected case of ovarian cancer, imaging work-up is required for all of the following EXCEPT:
What is the recommended treatment for a large functional ovarian cyst in a postpartum patient?
A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?
Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?
All of the following are the features of functional ovarian cyst EXCEPT:
A 30-year-old lady develops retention of urine in the 2nd trimester. The most probable cause is:
Which of the following statements about nabothian cysts is true?
An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
Ovarian Cysts Indian Medical PG Practice Questions and MCQs
Question 1: All of the following ovarian tumors usually occur bilaterally, except:
- A. Metastatic mass
- B. Dysgerminoma
- C. Dermoid cyst (Correct Answer)
- D. Adenoma of ovary
Explanation: ***Dermoid cyst*** - Dermoid cysts (mature cystic teratomas) are typically **unilateral** in about 85-90% of cases, with only 10-15% being bilateral. - They arise from **totipotential germ cells** and are benign tumors containing mature tissues like hair, teeth, or bone. - This is the **most common ovarian tumor** with predominantly unilateral presentation. *Metastatic mass* - Ovarian metastases, particularly from **gastrointestinal primaries (Krukenberg tumors)** and breast cancer, frequently involve both ovaries in **70-80% of cases**. - The bilateral presentation is due to **transcoelomic spread** or lymphatic/hematogenous dissemination. *Dysgerminoma* - While individual dysgerminomas may present unilaterally at diagnosis, they have a **significant propensity for bilateral involvement** when considering: - **Microscopic involvement** of the contralateral ovary (occult disease) - **Synchronous** bilateral disease in 10-15% of cases - Association with **gonadal dysgenesis** where bilateral gonadoblastomas may give rise to dysgerminomas - Among malignant germ cell tumors, dysgerminoma has the **highest rate of bilaterality**. *Adenoma of ovary* - Epithelial ovarian tumors, particularly **serous cystadenomas**, present bilaterally in approximately **20% of cases**. - **Mucinous cystadenomas** are less frequently bilateral (5%), but serous tumors show notable bilateral tendency. - The term "adenoma" here likely refers to benign epithelial neoplasms with bilateral potential.
Question 2: A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. An ultrasound (USG) of the patient was done. What will be the diagnosis?
- A. Theca lutein cysts
- B. Mucinous cystadenoma
- C. Polycystic Ovary Syndrome (PCOS)
- D. Ovarian Hyperstimulation Syndrome (OHSS) (Correct Answer)
Explanation: ***Ovarian Hyperstimulation Syndrome (OHSS)*** - The clinical presentation of infertility treatment followed by **ascites, abdominal pain, and dyspnea** is highly suggestive of OHSS. The ultrasound image shows **enlarged ovaries with multiple follicular cysts**, which is characteristic of severe OHSS. - OHSS is a potentially serious complication of **ovarian stimulation** during infertility treatment, where excessive ovarian response leads to systemic changes from increased vascular permeability. *Theca lutein cysts* - These cysts typically develop due to **excessive stimulation by hCG**, often seen with gestational trophoblastic disease or multiple pregnancies. - While they can be large and multiple, they are not typically associated with the rapid onset of severe systemic symptoms like **ascites and dyspnea** in the context of infertility treatment directly. *Mucinous cystadenoma* - This is a type of **benign ovarian tumor** that can grow very large and cause abdominal distension, but it is not typically associated with infertility treatment or the acute systemic symptoms of ascites and dyspnea as seen here. - Imaging would typically show a **multilocular cyst with internal septations**, not the numerous small follicular cysts seen in the image. *Polycystic Ovary Syndrome (PCOS)* - PCOS is a common cause of infertility, characterized by **anovulation, hyperandrogenism, and polycystic ovaries** on ultrasound (multiple small follicles in a string-of-pearls pattern). - While the ultrasound shares some similarities with multiple follicles, PCOS does not cause the acute symptoms of **ascites, abdominal pain, and dyspnea** that are directly linked to the rapid onset of severe OHSS.
Question 3: In a suspected case of ovarian cancer, imaging work-up is required for all of the following EXCEPT:
- A. Characterization of lesion
- B. Assess resectability
- C. Detection of adnexal lesion
- D. Staging (Correct Answer)
Explanation: ***Staging*** - **Clinical staging** for ovarian cancer is primarily surgical, meaning the definitive stage is determined during exploratory laparotomy rather than pre-operative imaging. - While imaging helps assess the extent of disease, the final **FIGO stage** relies on direct visualization and biopsy or resection of suspicious lesions during surgery. *Characterization of lesion* - Imaging modalities like **ultrasound**, **CT**, or **MRI** are crucial for determining features such as **cyst vs. solid**, size, septations, and presence of ascites, helping to differentiate benign from malignant masses. - This characterization guides the initial management plan, including the need for surgery or further investigations. *Assess resectability* - Imaging is essential to evaluate the **extent of tumor spread**, particularly to assess for widespread peritoneal carcinomatosis, bowel involvement, or distant metastases. - This information helps surgeons plan for optimal **cytoreductive surgery** and determine if a complete resection is feasible. *Detection of adnexal lesion* - The initial detection of an adnexal mass often occurs via imaging, typically **transvaginal ultrasound**, when a patient presents with symptoms or during a routine examination. - Imaging confirms the presence and location of the lesion, which is the first step in the diagnostic work-up for suspected ovarian cancer.
Question 4: What is the recommended treatment for a large functional ovarian cyst in a postpartum patient?
- A. Immediate removal
- B. Removal after 3 months (Correct Answer)
- C. Removal after 6 weeks
- D. Removal after 2 weeks
Explanation: ***Removal after 3 months*** - Functional ovarian cysts often regress spontaneously, especially in the **postpartum period** due to hormonal changes. Waiting 3 months allows time for **spontaneous resolution**, avoiding unnecessary surgical intervention. - Surgical intervention can be considered after this observation period if the cyst persists, grows, or causes symptoms, at which point the patient's **reproductive hormones** have typically returned to a more stable baseline. *Immediate removal* - This is generally not recommended for a functional ovarian cyst unless there are signs of **complications** such as torsion, rupture, or hemorrhage, which are not stated in the question. - Most functional cysts resolve on their own, and immediate surgery carries **surgical risks** without clear benefit in an uncomplicated scenario. *Removal after 2 weeks* - A 2-week observation period is likely too short to determine if a large functional ovarian cyst will resolve spontaneously in the postpartum period. - The hormonal fluctuations that influence these cysts can take longer to stabilize, making a **longer observation period** more appropriate. *Removal after 6 weeks* - While better than 2 weeks, 6 weeks might still be too early to conclude that a functional cyst will not resolve spontaneously, especially given the prolonged **hormonal changes** after childbirth. - A 3-month period provides a more robust timeframe for **spontaneous regression** before considering surgical intervention.
Question 5: A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?
- A. Laparoscopy for cyst removal
- B. Conservative with follow up ultrasound (Correct Answer)
- C. Laparotomy for cyst removal
- D. Medical treatment
Explanation: ***Conservative with follow up ultrasound*** - A 5cm **unilocular, echo-free ovarian cyst** in a 17-year-old with a normal **CA-125** (8 U/mL is well within the normal range, typically <35 U/mL) is highly suggestive of a **benign functional cyst**. - Expectant management with **serial ultrasound follow-up** is the most appropriate initial approach, as these cysts often resolve spontaneously. *Laparoscopy for cyst removal* - This is an **invasive procedure** that is not indicated for a likely benign, asymptomatic ovarian cyst, especially given the young age of the patient. - Surgical intervention would only be considered if the cyst persists, grows significantly, causes symptoms, or shows suspicious features on imaging. *Laparotomy for cyst removal* - **Laparotomy** is an even more invasive surgical approach than laparoscopy, involving a larger incision, and is reserved for cases where malignancy is strongly suspected or for very large, complex cysts that cannot be removed laparoscopically. - Given the benign characteristics of the cyst, this approach is unwarranted. *Medical treatment* - There is **no specific medical treatment** (e.g., medication) that effectively resolves functional ovarian cysts. - While hormonal contraceptives can sometimes suppress the formation of new functional cysts, they do not typically treat an existing one of this nature.
Question 6: Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?
- A. Serous cystadenoma
- B. Mucinous cystadenoma
- C. Dermoid cyst (Correct Answer)
- D. Theca lutein cyst
Explanation: ***Dermoid cyst*** - **Dermoid cysts**, or mature cystic teratomas, are the **most common ovarian tumors** to undergo torsion, especially during pregnancy due to their mobility and moderate size. - They are often **unilateral** and benign, containing various mature tissues such as hair, teeth, and sebaceous material. *Serous cystadenoma* - While common, **serous cystadenomas** are generally **less mobile** than dermoid cysts and thus have a lower propensity for torsion. - They are typically filled with **clear, watery fluid** and can grow to be quite large. *Mucinous cystadenoma* - **Mucinous cystadenomas** tend to be **larger** than dermoid cysts and are less prone to torsion due to their size and often fixed position within the pelvis. - They are filled with **thick, gelatinous mucin** and can reach massive sizes, sometimes filling the entire abdominal cavity. *Theca lutein cyst* - **Theca lutein cysts** are usually **bilateral** and occur with conditions like **gestational trophoblastic disease** or **ovarian hyperstimulation**. - While they can be large, their often bilateral nature and underlying pathological conditions make them **less likely to independently twist** as a primary event compared to a freely mobile dermoid cyst.
Question 7: All of the following are the features of functional ovarian cyst EXCEPT:
- A. Usually < 7 cm in diameter
- B. Unilocular
- C. Spontaneous regression occurs
- D. Usually symptomatic (Correct Answer)
Explanation: ***Correct Answer: Usually symptomatic*** - Functional ovarian cysts are typically **asymptomatic** and discovered incidentally during pelvic examination or imaging studies. - Most patients have no symptoms; when symptoms occur, they are usually mild (pelvic pressure, dull ache). - Being "usually symptomatic" is **NOT a feature** of functional cysts, making this the correct answer to this EXCEPT question. *Incorrect: Usually < 7 cm in diameter* - Most functional ovarian cysts (follicular cysts, corpus luteum cysts) are relatively small, typically measuring **less than 5-7 cm** in diameter. - Cysts larger than 7 cm may warrant further evaluation to rule out neoplastic etiology. - This **IS a feature** of functional cysts. *Incorrect: Unilocular* - Functional cysts are characteristically **simple in structure**: unilocular (single-chambered), thin-walled, containing clear anechoic fluid. - Complex features (septations, solid components, thick walls) suggest neoplastic or other pathologic cysts. - This **IS a feature** of functional cysts. *Incorrect: Spontaneous regression occurs* - Functional ovarian cysts are by definition **transient** and typically resolve spontaneously within **1-3 menstrual cycles** without intervention. - This self-limiting nature is a key characteristic distinguishing them from persistent or neoplastic cysts. - This **IS a feature** of functional cysts.
Question 8: A 30-year-old lady develops retention of urine in the 2nd trimester. The most probable cause is:
- A. Bladder neck obstruction due to ovarian cyst
- B. Fibroid uterus
- C. Retroverted uterus (Correct Answer)
- D. Neurogenic bladder
Explanation: ***Retroverted uterus*** - A **retroverted uterus** in the second trimester can become entrapped in the sacral hollow, obstructing the bladder neck as the uterus enlarges. - This anatomical position prevents the uterus from rising into the abdomen, leading to **urinary retention**. *Bladder neck obstruction due to ovarian cyst* - While an **ovarian cyst** *could* potentially cause bladder neck obstruction, it is a less common cause of urinary retention in the second trimester compared to an entrapped retroverted uterus. - The presence of an ovarian cyst specifically causing significant obstruction would usually present with additional symptoms related to the cyst itself. *Fibroid uterus* - **Uterine fibroids** can cause various obstetric complications, but significant urinary retention due to bladder neck obstruction in the second trimester is not a typical presentation. - Large fibroids may put pressure on the bladder, but direct obstruction leading to retention is less common than with an entrapped retroverted uterus. *Neurogenic bladder* - A **neurogenic bladder** is a disorder of bladder function due to neurological damage, and its onset would likely predate or not specifically coincide with the second trimester of pregnancy. - This condition involves issues with nerve signals to the bladder, which would not typically manifest acutely as urinary retention solely due to pregnancy unless there was an underlying neurological condition.
Question 9: Which of the following statements about nabothian cysts is true?
- A. It is a premalignant condition that requires excision.
- B. It is a malignant condition.
- C. Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands. (Correct Answer)
- D. It may be associated with chronic irritation and inflammation but is not defined by it.
Explanation: ***Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands.*** - **Nabothian cysts** form when the **squamous epithelium** of the ectocervix grows over the **columnar epithelium** of the endocervix during the process of **squamous metaplasia**. - This epithelial overgrowth obstructs the ducts of the **mucus-secreting endocervical glands**, leading to mucus retention and cyst formation. - This is the **classic pathophysiological mechanism** and the defining feature of nabothian cyst formation. *It is a premalignant condition that requires excision.* - **Nabothian cysts are completely benign** and have **no malignant or premalignant potential**. - They are **incidental findings** that require **no treatment** and can be safely observed. - Misclassifying them as premalignant would lead to unnecessary surgical interventions. *It is a malignant condition.* - **Nabothian cysts** are universally considered **benign retention cysts** with no malignant characteristics. - They are among the most common benign findings on cervical examination. *It may be associated with chronic irritation and inflammation but is not defined by it.* - While **chronic cervicitis** can be a predisposing factor for squamous metaplasia (which leads to nabothian cysts), this statement is **too vague** to be the best answer. - The **defining characteristic** of a nabothian cyst is the **anatomical mechanism** (squamous epithelium blocking glandular ducts), not the associated inflammatory conditions.
Question 10: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?
- A. Trichomoniasis
- B. Gonorrhoea (Correct Answer)
- C. Syphilis
- D. Candidiasis
Explanation: ***Gonorrhoea*** - This presentation, including **yellow/green vaginal discharge**, a **Bartholin cyst**, and **proctitis**, is highly suggestive of **gonorrhoea**. - *Neisseria gonorrhoeae* can cause inflammation in these specific areas and is a known cause of **infertility** due to pelvic inflammatory disease. *Trichomoniasis* - Characterized by a **frothy, foul-smelling, yellow-green discharge** and often involves **cervical petechiae** (strawberry cervix). - While it causes vaginal discharge, **Bartholin cysts** and **proctitis** are not typical features. *Syphilis* - The primary stage presents as a **painless chancre**, secondary syphilis involves a **rash** and **lymphadenopathy**, and tertiary syphilis has severe organ involvement. - It does not typically present with the specific combination of **Bartholin cyst**, vaginal discharge, and **proctitis**. *Candidiasis* - Causes a **thick, white, "cottage cheese-like" discharge** associated with significant **pruritus** and **vaginal irritation**. - It does not typically lead to **Bartholin cysts** or **proctitis**.
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