Welcome to your Ovarian Pathology

A. Torsion ovary
B. Endometriosis
C. Renal disease
D. Primary malignant ovarian
E. Secondary malignant ovarian with suspected primary from GIT
F. Pelvic abscess
Choose the most appropriate diagnosis for the given clinical scenario from the options given. Each option may be used once or more than once or not at all.

1. 45-year-old menstruating regularly presented with history of abdominal distention, difficulty in breathing, dyspepsia, altered bowel habits and on examination was found to have ascites. On ultrasound examination was found to have normal uterus and ovaries with moderate ascites and no other abnormalities detected. The most likely cause is
2. 37 year old has presented to the emergency department with complaints of severe pain in abdomen following sexual intercourse. She gives a history of controlled ovarian stimulation for IVF. The most likely cause is
3. 40 year old mother of one child has presented with severe pain in abdomen, severe dysmenorrhoea and on ultrasound found to have complex ovarian mass and Ca-125 done was 432 units/ml. The most likely diagnosis is
A. Mini-laparotomy
B. Laparoscopic cystectomy
C. Expectant management
D. Laparotomy and cystectomy
E. Extension of the lateral ports
F. MRI
G. Umbilical port
H. Observation and repeat ultrasound after three cycles
Choose the most appropriate answer for the given clinical scenario from the options given. Each option may be used once or more than once or not at all.

4. Laparoscopic removal of a dermoid cyst measuring 5 cms is being done by a competent surgeon. Intraoperatively the cyst was aspirated and the cyst wall was placed in the tissue bag. The tissue bag with cyst should be removed through
5. 27year old, nulliparous women on transvaginal pelvic ultrasound for pain abdomen on and off for the past few weeks was found to have to have a simple ovarian cyst of 4.5cms in the right ovary. Now is asymptomatic. The appropriate management is
6. 34 year old was incidentally found to have a simple cyst of 6cms during an ultrasound done for symptoms suggestive of ureteric calculi one year back. On repeat ultrasound done for pain abdomen showed, the cyst was found to be 8cms simple cyst with no solid/papillary projections, no ascites. The best management option is
A. Laparoscopy, detorsion and interval cystectomy
B. Laparoscopy +/- detorsion
C. Laparoscopy and oophorectomy
D. Laparoscopy and detorsion and cystectomy
E. Expectant management
F. Laparoscopy, detorsion and oophoropexy
G. Laparoscopy
Choose the most appropriate management option for the clinical scenario given, the options can be used once or more than once or not at all.

7. 16 year old girl with history of polycystic ovaries and irregular periods presented with acute pain in abdomen for the past 10 yrs and was diagnosed to have ovarian torsion. The most appropriate management option is
8. 13 year old girl who has not attained menarche presented to the emergency department and she was strongly suspected to have ovarian torsion.
9. 18 year old girl presented to A&E, previously diagnosed to have PCOS and previously had history of ovarian torsions and managed conservatively.
10. 34 year old, presented with history of acute abdominal pain. On ultrasound was found to have ovarian cyst measuring 6-7 cms and torsion ovary was diagnosed.
11. 56 year old post menopausal women , presented to A & E with history of  acute abdominal pain for more than 2 days and not relieved with medications. She was diagnosed to have a cyst measuring 4cms with clear fluid with in it. The best management option is
A. FSH receptor antibodies
B. steroid cell antibodies
C. Fragile x full mutation testing
D. LH receptor antibodies
E. Fragile X permutation testitng
Choose the most appropriate investigation for the particular scenario given that would determine the cause:

12. 28 years old presented with 6 months amenorrhoea with symptoms of vaginal dryness, sleeplessness and had been previously diagnosed with adrenal autoimmunity disease. The investigation that would determine the cause of POI is
13. 20 years old female with autism has amenorrhoea for 4 months and symptoms of sleeplessness, vaginal dryness and itching and excessive sweating was suspected to have POI. The investigation that would diagnose the cause of POI is
A. Estradiol preparation
B. Oral estrogen and progesterone
C. Sequential estrogen and progesterone
D. Conjugated equine estrogen
E. Sequential estrogen and micronised progesterone
F. Ethinyl estradiol preparation
G. Transdermal estrogen and micronized progesterone
H. Cyclical Combined estrogen and progesterone
Choose the appropriate answer for the best kind of HRT to be started for the  women in the scenario given. The answers can be used once, more than once or not at all.

14. 37 year old women has presented with debilitating hotflushes and mood disturbances for the past 4 months and gives a history of 6 months amenorrhoea and is diagnosed to have POI. She gives history of migraine. What kind of HRT should be prescribed?
15. 38 year old underwent hysterectomy with bilateral oophorectomy as a risk reducing surgery 4 weeks back. She has presented with distressing postmenopausal symptoms. The HRT that should be prescribed to her is
16. 34 year old married recently desirous of fertility was diagnosed to have premature ovarian insufficiency. On investigating, found to be Turner mosaic. She was counselled regarding oocyte donation and is contemplating to undergo HRT. The best HRT management is
17. 35 year old diagnosed with Premature ovarian failure, does not have any medical or surgical problems. She wishes to start HRT for the symptoms of hotflushes, mood disturbances. The best HRT management option is