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Normal Pelvis 2

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1

Where is the pelvic cavity?

the part of the abdominal cavity that lies below the pelvic brim

2

What lies within the posterior pelvic cavity?

rectum

ilium

colon

3

What lies within the anterior pelvic cavity?

bladder

ureters

ovaries

fallopian tubes

uterus

vagina

4

What bones make up the pelvis?

sacrum

coccyx

2 innominate bones

5

What bones make up the innominate bone?

ileum

ischium

pubis

6

What is the false pelvis?

area of the abdominal cavity that is cradled by the iliac crest

7

What is the true pelvis?

bowl shaped posterior & inferior cavity that extends backwards into skeletal framework

8
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no data

9

What separates the true and false pelvis?

linea terminalis

10

Where does the linea terminalis lie?

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extends from the sacral promontory to the pubic symphysis

11

What is the lateral landmark of the true pelvis?

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iliopsoas muscle

12

What makes up the iliopsoas?

psoas

iliacus

13

Where is the psoas?

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originates off the lumbar vertebra comes together with the iliacus

14

What is most frequently mistaken for an ovary?

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psoas

15

What is the posterior border of the true pelvis?

sacrum

coccyx

16

What marks the anterior border of the true pelvis?

pubic symphysis

17

What is the most posterior muscle of the true pelvis?

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piriformis

overlies the sacrum

18

What is the interior border of the true pelvis?

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obturator internus

19

What makes up th pelvic diaphragm?

levator ani muscle

coccygeus

20

What is the purpose of the pelvic diaphragm?

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supports and positions the organs of the pelvis

rectal continence

urethral continence

21

What is the levator ani?

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hammock

supports and positions

22

What makes up the levator ani muscle?

pubococcygeus

iliococcygeus

23

What is the most anterior portion of the pelvic diaphragm?

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Pubococcygeus muscle

24

What is the most lateral portion of the pelvic diaphragm?

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Iliococcygeus muscle

25

What is the most posterior portion of the pelvic diaphragm?

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Coccygeus muscle

26

How long is the vagina?

10 cm

27

Where is the vagina?

anterior to the rectum

28

What does class 2 congenital anomalies tend to have?

Class 2 = unicornate

contralateral agenesis of the kidneys

29

What is continuous with the endometrium?

vagina

30

Where is the vesicouterine pouch?

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anterior to the uterus

31

Where is the rectouterine pouch?

posterior to the uterus

32

What is another name for the rectouterine pouch?

pouch of douglas

33

Where is the space of Retzius?

located posterior to the pubic symphysis and anterior to the urinary bladder

34

What is another name for the space of Retzius?

retropubic space

prevesical space

35

What is retroflexed?

flexed toward rectum

36

Where is the fornix?

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upper end of the vagina near the external os

37

Where is the round ligament?

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runs through inguinal canal

provides support from above (below?)

38

Where is the broad ligament?

uterine cornea to anterior lateral walls of the pelvis

lateral aspect of uterus to lateral wall of pelvis

39

When is early menses?

1 - 4 days

40

What provides the characteristic forward bend of the uterus?

broad ligament??

Round!

41

name the parts of the uterus

fundus

body/corpus

isthmus

cervix

42

When can body and isthmus be distinguished?

during pregnancy

43

What lies on either side of the cervix?

internal os

external os

44

What is the largest organ in the female pelvis?

uterus

*when bladder is empty

45

What shape is the uterus?

pear shape

46

What is anteflexed?

card image

normal position

47

What is retroverted?

straight up

48

WHat is retroflexed?

flexed toward rectum

49

How long is the cervix?

3cm

50

What is the endometrium?

inner lining

thin smooth muscle layer

51

What is the myometrium?

muscularis

middle layer

52

What is the myometrium made up of?

longitudinal smooth muscle

circular smooth muscle

53

What is the perimetrium?

outer serosa layer

54

Where is the arcuate arteries of the uterus?

between the myometrium and perimetrium

55

What provides posterior uterine support?

uterosacral ligament

56

What is the size of the uterus in a pre-pubertal?

6/8 - 3/5

mostly cervix

57

What is the size of the uterus in a post-menopausal?

3/5 - 2/3

1/2 cervix - 1/2 uterus

58

What is the size of the uterus in a nulliparous?

6/8 - 3/5

6 - 4 - 3

59

What is the size of the uterus in a multiparous?

8/10 - 5/6

8 - 4 - 3

60

What does the endometrium consist of?

functional layer (zona functionalis)

deep basil layer ( zone basalis)

61

What is the function of the zona functionalis?

prepared layer for pregnancy

sheds mucus and stroma

62

What is stroma?

structural cells

tissue

63

What is the function of zona basalis?

replaces functional layer

with coils that run through functionalis

64

What is the length of the fallopian tubes?

12 cm

65

Where does the fallopian tubes attach to the uterus?

cornea

66

What is the widest section of the fallopian tubes?

ampulla

67

Where does fertilization usually occur?

ampulla

68

What is the menstrual cycle based on?

functional integrity of the hypothalamic, pituitary, ovaries

69

What is estrogen?

secondary sex characteristics

prepares lining for anticipation of fertilized egg

70

What is the function of progesterone?

supports pregnancy by maintaining walls of uterus

peaks at 7 days or 21 days

71

What is the function of the ovaries?

estrogen

progesterone

72

Name the fallopian tube anatomy?

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fimbriae

infundibulum

ampulla

isthmus

interstitial

73

Name the parts of the broad ligament.

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mesosalpinx - between ovary and fallopian

mesometrium - surrounds uterus

mesovarian - near ovary

74

What is the formula for ovarian volume?

H * W * L* 0.523

75

What is the ovarian volume of premenstrual?

3 cm3

76

What is the ovarian volume of menstrual?

9.8 cm3

77

What is the ovarian volume of postmenopausal?

5.8 cm3

78

Where is the ovaries formed?

posterior abdomen

79

How are the ovaries described?

nude

80

Where are the ovaries located?

waldeyer's fossa

81

What does the ovarian medulla consist of?

blood vessels

nerves

lymphatics

82

What does the ovarian cortex consist of?

follicles

83

What is the blood supply of the ovaries?

ovarian branch of uterine artery

ovarian artery

84

Where are hormones produced in the ovaries?

Cortex

85

What is the outer capsule?

tunica albuginea

86

What is the size of the ovaries in a normal menstruating women?

3 * 2 * 2

varies with menstrual history

87

When can ovarian follicles be seen?

4 mm

88

What is the mean size of dominant ovarian follicles (mature)?

20 mm

89

Explain the hormones of the menstrual cycle.

hypothalamic - FSHRF & LHRF

Pituitary gland - FSH & LH

Ovaries - estrogen & progesterone

Luteinizing hormone and follicle-stimulating hormone, which are produced by the pituitary gland, promote ovulation and stimulate the ovaries to produce estrogen and progesterone .Estrogen and progesterone stimulate the uterus and breasts to prepare for possible fertilization. The cycle has three phases: follicular (before release of the egg), ovulatory (egg release), and luteal (after egg release)

90

What is the function of FSH

causes graafian follicle (dominant) ripening

91

graafian has double a

no data

92

What is the function of LH?

degeneration and rupture of graafian follicle

93
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no data

94

What happens to progesterone if no implantation occurs?

progesterone dips

lining degenerates

95

When in early menses?

1 - 4 days

96

When is late menses?

3 - 7 days

97

When is the proliferative phase?

5 - 9 days

98

When is the late proliferative phase?

10 - 14 days

99

When is the luteal phase?

15 - 27 days

100
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What is a colpos?

vagina

101

What is hydrocolpos?

vagina filled with serous fluid

102

What is hydrometrocolpos

vagina and uterus filled with serous fluid

103

What do the genitals develop from?

two mullerian ducts

104

What is a paramesonephric duct?

mullerian duct

105

Until what week are genital organs not discernable?

9 weeks

106

When is external development of the genitalia complete?

12 weeks

107

What is another name for paramesonephric cyst?

hydatid cyst of morgani

108

What stimulates formation of male genitals?

XY get testosterone bath

9-12 weeks

109

What is hematometrocolpos?

blood in the uterus and vagina

110

What are congenital class 1 anomalies?

vaginal atresia

transverse vaginal septum

incomplete hymen

111

What is vaginal atresia?

closed or missing vagina

failure to form

112

What is transverse vaginal septum?

septum transversely through the vagina

113

What is the U/S findings of class 1 congenital anomalies?

hydrocolpos

hydrometrocolpos

hematometrocolpos

114

What will congenital anomalies sometimes affect?

what percent?

kidneys

80% will also have kidney anomalies

115

What is the presentation of class 1 congenital anomalies?

pain

infertility

miscarriage

premature labor

116

What percentage of women will have congenital anomalies?

0.5%

117

Name congenital anomalies in order by class.

2 unicornate

3 didelphys

4 bicornuate

5 septated

6 arcuate

118

What are class 2 congenital anomalies?

unicornate uterus

cigar-shaped

119

What can class 2 congenital anomalies cause?

Class 2 = unicornate

infertility

pregnancy loss

120

What is the opening of the fallopian tubes called on the outside?

cornea

121

What is the opening of the fallopian tubes called on the inside?

osteum

122

What does class 2 congenital anomalies tend to have?

Class 2 = unicornate

contralateral agenesis of the kidneys

123

What is the U/S findings of class 2 anomalies?

Class 2 = unicornate

long narrow uterus

laterally tilted

124

What is class 3 congenital anomalies?

didelphys uterus

complete duplication

125

What is the U/S findings of class 3 congenital anomalies

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class 3 = didelphys

double donut

126

What can class 3 congenital anomalies cause?

class 3 = didelphys

bleeding from one side during pregnancy

127

What is a class 4 congenital anomalies?

bicornuate uterus

128

What is the U/S findings of a class 4 congenital anomalies?

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class 4 = bicornate

129

What is class 5 congenital anomalies?

septated uterus

can extend into the vagina

130

What class congenital anomalies with cause the highest incidence of infertility problems?

class 5 septated uterus

131

What is the treatment of class 5 congenital anomalies?

class 5 = septated uterus

hysteroscope cutting the septum out

132

What is a class 6 congenital anomalies?

arcuate uterus

T-shaped uterus

133

What is the cause of class 6 congenital anomalies?

class 6 = arcuate

fetal exposure to DES

134

What is DES?

diethylstilbestrol

synthetic estrogen

135

What can class 6 congenital anomalies cause?

multiple miscarriages

still births

136

What is a mosaic?

both testicular and ovarian tissue

true hemaphrodite

137

What is a pseudo hermaphrodite?

mother passes too much androgens to XX baby appears as XY

138

What is precocious puberty?

enlargement of the uterus prior to age 8

139

How is sonography used with precocious puberty?

initially to evaluate size of uterus and ovaries

follow response to treatment

140

What is the main danger of precocious puberty?

can be caused by a tumor on the pituitary gland

141

What is premenarche?

before puberty

142

What is menarche?

beginning of menses

143

What is menopausal?

menses ceases

144

What is the pelvic gold standard?

TA & TV

145

What can overdistension of the bladder cause?

compression & displacement

146

What transducer is used in a transabdominal exam?

3.5 MHz sector

147

Why is it important to fill the bladder before starting a transabdominal exam?

bladder is used as a window

148

What additional images should be taken during a pelvic exam?

if mass is found kidneys & morrisons pouch should be imaged

149

What transducer is used for a transvaginal exam?

5 MHz sector

150

What orientation is used during a transvaginal exam?

sagittal

coronal

151

What is PID usually caused by?

STD

152

What is the sonographic appearance of PID?

Free fluid

Mild uterine enlargement

Distortion of normal anatomy

Endometrial fluid or thickening

153

What does a patient with PID usually present with?

severe pain

154

What is Salpingitis?

an infection and inflammation in the fallopian tubes. *associated with PID

155

What is the sonographic appearance of Salpingitis?

Nodular thickening

Irregularity of tube

diverticula

156

What is Hydrosalpinx?

distally blocked fallopian tube filled with serous

*commonly caused from PID or endometriosis.

157

What is the sonographic appearance of Hydrosalpinx?

Fluid filled

Irregular

Can be complex

158

What is Pyosalpinx?

fallopian tube filled with pus

*commonly caused from PID or endometriosis

159

What is the sonographic appearance of Pyosalpinx?

Complex mass

Septations

Usually in cul-de-sac

160

What is Tuboovarian Abscess (TOA)?

Pus filled fallopian tube and para ovarian area.

161

What is the sonographic appearance of Tuboovarian Abscess (TOA)?

Complex adnexa mass

Septations

Irregular margins

162

What is a Pelvis Abscess?

Pelvis Abscess: Complex mass found in cul-de-sac

*Sonography guided drainage procedures

163

What is the sonographic appearance of Pelvis Abscess?

Complex mass

Septations

Irregular margins

164

What is Endometritis?

inflammation of the lining of the uterine lining caused by infection.

165

What is the sonographic appearance of Endometritis?

Echogenic endometrium

Thickening

Fluid in endometrium

166

What is Endometriosis?

Endometriosis: Functioning endometrial tissue outside the uterus. Can occur in any part of the body.

Cyclically bleeds with hormones.

Occurs with PID and postpartum

167

What is the sonographic appearance of Endometriosis?

Endometrium appears prominent & irregular

Gas bubbles

Endometrial fluid

168

What is another name for Endometriosis?

Chocolate cysts

169

What is Adenomyosis?

Endometrial tissue within the myometrium.

170

What is the sonographic appearance of Adenomyosis?

Diffuse uterine enlargement

Small myometrial cysts

171

What is the presentation of Adenomyosis?

heavy painful menses

172

What is Cervix Leiomyoma?

no data

173

What is the sonographic appearance of Cervix Leiomyoma?

no data

174

What is Cervical Polyps?

no data

175

What is the sonographic appearance of Cervical Polyps?

no data

176

What is Nabothian cysts?

no data

177

What is the sonographic appearance of Nabothian cysts?

no data

178

What is Cervical Stenosis?

no data

179

What is the sonographic appearance of Cervical Stenosis?

no data

180

What is the purpose of U/S with Cervical Carcinoma?

Ultrasound may be used for staging cervical CA.

Trans vag is better for cervical evaluation of lesion

181

What is the best way of detection of lymph node involvement of cervical carcinoma

CT & MRI is better for lymph node involvement

182

What is Leiomyomas?

Most common cause of uterine enlargement

Very common in 20 to 50% of reproductive age women

183

Who has greater chance of getting a leiomyoma?

30+

afro-amer

asian

184

Where do leiomyomas originate?

smooth muscle of the uterus

1 cell divided repeatedly and forms a rubbery mass

185

are fibroids encapsulated?

no they have a peusdocapsule made out of compressed myometrial muscle

186

What is menorrhagia?

heavy menstration

187

What is dyspareunia?

painful intercourse

188

What is metrorrhagia?

bleeding inbetween

189

What is the sonographic appearance of Leiomyomas?

Deformed bladder

Focal heterogenicity

Heterogenicity through out

Hyper, *****Hypo

Calcifications

190

What is the presentation of Leiomyomas?

pain

increased bleeding

infertility

frequency

back pain

dragging

dyspareunia

metrorrhagia

191

What are diffuse fibroids?

small heterogeneous

* can't be seen

192

What type of fibroids are the least common?

submucosal

193

What type of fibroid are most symptomatic?

submucosal

194

Why do we call fibroids greedy?

they look for nearest blood vessel

kill vessel by overwhelming

become necrosis then calcify

195

What is another name for Leiomyomas?

Fibroids

196

What is Uterine Sarcoma?

malignant tumor of connective tissue

uncommon

rapidly growing tumor of post menopausal

Less than 5% of malignancies

197

What is the sonographic appearance of Uterine Sarcoma?

Hyper, hypo

Calcifications

Looks like fibroid or endometrial carcinoma

198

What is the cause of Uterine Sarcoma?

degenerating enlarging postmenopausal fibroids

199

What is Uterine Calcifications?

Most commonly caused by degenerating fibroids

200

Exam question

white dots of calsification

arcuate arteries

201

How thick should the endometrium be during menstrual phase?

days 1-5

2-4 mm

202

How thick should the endometrium be during postmenstrual phase?

days 6-9

4-6 mm

203

How thick should the endometrium be during proliferative phase?

days 6-13

6-8 mm

204

How thick should the endometrium be during secretory phase?

days 14 - 28

8-10 mm

205

What are the ovarian stages?

1-13 follicular phase

14-28 luteal phase

206

What is the sonographic appearance of Uterine Calcifications?

Hyperechoic

207

What is Endometrial Hyperplasia?

results from unopposed estrogen

best measured after menses for thinnest measurement

208

What is the sonographic appearance of Endometrial Hyperplasia?

Premenopausal : 14 mm

Post menopausal : 8 mm

Sequentially stimulated: 15 mm

209

What is the U/S findings of class 2 anomalies?

Class 2 = unicornate

long narrow uterus

laterally tilted

210

What is the sonographic appearance of Endometrial Polyps?

Echogenic

211

What is the presentation of Endometrial Polyps?

asymptomatic

uterine bleeding

212

What is Endometrial Carcinoma?

usually adenocarcinoma

MRI is best

213

Who usually gets Endometrial Carcinoma?

postmenopausal 50+

214

How do you differentiate benign and malignant uterine thickening?

Uterine artery Doppler

215

What is normal endometrium thickness?

> 6

216

What does an endometrial measurement under 5mm indicate?

good

217

WHat is the size of the endometrium for a women on HRT?

> 8 mm

218

What is the sonographic appearance of Endometrial Carcinoma?

Early: Thickened endometrium

Later: lobulated contour

Mixed echogenicity

Fluid collection

219

What is the presentation of Endometrial Carcinoma?

irregular bleeding

220

What can cause large endometrial fluid collection?

congenital:

  • vag atresia
  • incomplete hyman

acquired

  • cervical stenosis from instrumentation
  • childbirth
  • malignancy
221

What is the presentation of large endometrial fluid collection?

amenorrhea

painfully enlarged uterus

completely asymtomatic

222

What is amenorrhea?

an abnormal absence of menstruation.

223

What will cancer do to high resistance vessels?

turn to low resistance

224

What is Small Endometrial Fluid Collections?

less than 2 ml

225

What is the sonographic appearance of Small Endometrial Fluid Collections?

Visible with

Menstruating women

Ectopic pregnancy

Endometritis

Degenerating fibroids

Recent abortion

226

What is Large Endometrial Fluid Collections?

greater than 4 ml

227

What is the sonographic appearance of Large Endometrial Fluid Collections?

Visible with

Myometra

Hematometra

Cervical stenosis

Centrally cystic

Round

Enlarged uterus

228

What is the presentation of Large Endometrial Fluid Collections?

abdominal mass

pain

elevated WBC

minimal bleeding

229

What is Lost IUD?

No string manually palpitated

Beta HCG neg - MD explores uterine cavity

Beta HCG pos – ultrasound

Radiogragph performed

Ultrasound used to locate IUD and fetus

230

What is done when an IUD is lost?

pregnancy test - neg

  • hook extracted
  • if failed order U/S

preg test - pos

  • U/S
231

What is IUCD?

intrauterine contraceptive device

-england

232

What is sonographic appearance of IUD?

double line echo

-characteristic of united states IUD

233

What are the old styles of IUD?

Copper T

Copper 7

234

New style IUD

saf-T-coil = swirly T

Antigon device = 1 slant

Lippes loop = snake

235

Where is the lippes loop common?

eastern europe

236

Where should the an IUD lie within the uterus?

withing endometrial cavity at fundus

237

What can a bad insertion of an IUD cause?

perforation of uterus

238

What is the symptoms of perforation of uterus?

pain

cramping

239

What is usually the cause of IUP?

shifted IUD

240

What is an IUP?

intrauterine pregnancy

241

What is a mirrana coil used for?

hormone replacement for abnormal uterine bleeding (AUB)

contraceptive

*plastic

242

What is the dalkin shield?

looks like dream catcher

caused pain & suffering

bleeding and complications

243

What must happen when an IUD is in place?

position evaluated weekly

palpation of string

244

What is the sonographic appearance of Lost IUD?

Within endometrial canal

245

What are the complications of an IUD?

Increased risk of PID (usually long term use)

Increased risk of ectopic

Increased risk of tuboovarian abscesses

actinomycosis

246

What is actinomycosis?

rare bacterial infection caused by actino mycosis israelii

247

What is Ectopic Pregnancy?

Pos pregnancy endovaginally with no IUP

248

What percentage of ectopic pregnancies occur in the fallopian tubes?

95%

249

What percentage of ectopic pregnancies occur in the ovary?

0.5%

250

What percentage of ectopic pregnancies occur in the ampulla?

85%

251

What percentage of ectopic pregnancies occur in the isthimus?

5%

252

What percentage of ectopic pregnancies occur in the cervix?

1%

253

What is the sonographic appearance of Ectopic Pregnancy?

Adnexa mass

Free fluid

254

What is the normal size of the ovaries?

3 x 2 x 2

255

What is the volume of the ovaries?

10cm3

256

What is the formula for ovarian volume?

L * W * H * 0.523

MUST BE cm

257

What is Simple Ovarian cysts?

no data

258

What is the sonographic appearance of Simple Ovarian cysts?

Thin walls

Anechoic

Well defined edges

Posterior enhancement

259

What is the sign and symptoms of a benign adnexal cysts?

pain discomfort

irregular period (skippy

260

When does a cyst need intervention?

greater than 5 cm

fine needle aspiration

261

What is a follicular cyst called that is larger than 3 cm?

ovarian cyst

262

What do the follicles produce?

ovum

estrogen

progestrogen

263

What day should the dominant follicular cyst rupture?

14

264

what happens to the corpus luteal cyst of menstruation If there is no implantation by day 21?

regresses

265

what happens to the corpus luteal cyst of menstruation if there is implantation?

corpus luteal cyst of pregnancy

grows and becomes cystic again

produces progesterone

266

What is Benign Follicular Adnexal Cysts?

follicle fails to rupture and release egg

267

What is the sonographic appearance of Benign Follicular Adnexal Cysts?

Unilateral

2 cm to 20 cm

Simple cyst looking

268

What is Benign Corpus Luteum Adnexal Cysts?

remains after mature follicle releases egg.

Largest at 10 -12 weeks

Gone by 16 weeks

269

What is the sonographic appearance of Benign Corpus Luteum Adnexal Cysts?

Sonographic Appearance:

Hemorrhagic appearance

Can look like ectopic

270

What are the pitfalls of Hemorrhagic Cysts?

posterior enhancement

271

What are the complications of Hemorrhagic Cysts?

grow large

torsion

pain

272

What is the sonographic appearance of Hemorrhagic Cysts?

usually appears as simple cyst

complex

internal echoes

273

What is Parovarian Cysts?

arise from broad ligament region

make up 10% of adnexal masses

looks like ovarian cyst

remnant of mullerian duct / paramesonephric system

274

What is the presentation of Parovarian Cysts?

rarely symptomatic

275

What is Theca Lutein Cysts (TLC)?

associated with highly elevated cystic masses

Common with: trophoblastic disease, multiple gestations, fertility drugs, molar pregnancy

276

What is a molar pregnancy?

occurs when 2 sperm fertilize egg or sperm with no DNA

must be terminated ASAP

277

What is a symptom of ovarian hyperstimulation?

elevated Beta HCG

nausea

vomiting

pain

abdominal distension

278

What is the treatment of TLC

stop fertility treatment

279

How long does it take for Beta HCG levels to return to normal after removal of molar pregnancy?

12 weeks

280

How long does it take for TLC to regress to normal after removal of molar pregnancy?

16 weeks

281

What can develop after the evacuation of a molar pregnancy?

aggressive malignant, choriocarcinoma - can cause TLC

282

What is the sonographic appearance of Theca Lutein Cysts?

Large

Bilateral

multiloculated

fragile

283

What is Polycystic Ovaries?

endocrine disorder associated with anovulation.

284

What is another name for Polycystic Ovaries?

stein leventhals

285

What is the sonographic appearance of Polycystic Ovaries?

Multiple follicular cysts

Greater than 5 – 1 cm cysts per ovary

enlarged ovaries > 10 cm3

increased stroma

286

What is the presentation of Polycystic Ovaries?

Hypertension

Diabetes

infertility

Oligomenorrhea

hirsutism

287

What is hirsutism?

excessive hair

288

How is the diagnosis of Polycystic Ovaries?

elevated

FSH

LH

enlarged ovaries

10+ follicles

289

What is Postmenopausal simple cysts?

3 cm to 5 cm normal

290

Are Postmenopausal simple cysts malignant?

unlikely

291

What is done if Postmenopausal simple cysts are malignant?

removal of ovary and possible fallopian tubes

292

endovaginal is no good for ovarian cancer screening

no data

293

What is the best screening method for ovarian cancer?

CA125 marker (cancer antigen 125) elevated in 85%

high false positive

294

Ultrasound is used to characterize a mass, what percent of simple cysts are benign?

97%

295

How many times in a lifetime will a women ovulate?

400

296

What is the risk with a complex mass in the ovaries?

malignancy

297

How many neoplasms can a woman produce?

100

298

What is Ovarian Neoplasms?

describe morphology but unable to distinguish tumor type

299

What is the sonographic appearance of Ovarian Neoplasms?

Simple cyst – benign

Complex – suspect malignancy

300

What is Benign epithelial tumors?

Adenoma

fibroadenoma solid, cystadenoma cystic

301

How many epithelial tumors are benign?

70%

302

Where do adenoma rise from?

glandular tissue

303

What does a cystadenoma consist of?

serous

mucous

304

What is the sonographic appearance of Benign epithelial tumors?

Thin walls

305

What is Malignant epithelial tumors?

Adenocarcinoma

fibroadenocarcinoma solid

cystadenocarcinoma cystic

306

What is the sonographic appearance of Malignant epithelial tumors?

Thick walls

307

What is Mucinous Cystadenoma?

benign, unilateral

up to 30 cm

any age

uncommon to rupture

308

What is the sonographic appearance of Mucinous Cystadenoma?

cystic

multicystic but looks like septated, multiseptated

309

What is Mucinous Cystadenocarcinoma?

malignant counterpart of Mucinous Cystadenoma

40 - 60 years

bilateral

up to 50 cm

increased risk of rupture

310

What is the sonographic appearance of Mucinous Cystadenocarcinoma?

contains gelatinous material

311

WHat are the complications of rupture of a Mucinous Cystadenocarcinoma?

pseudomyxoma - peritonei fills the abdomen

seeds continue to produce malignant mucous

looks like complex ascites

312

What is Serous Cystadenoma?

2nd most common tumor of the ovaries

common

benign

unilateral

313

What is the presentation of Serous Cystadenoma?

pain / pressure

314

What is the s of Sonographic appearance serous Cystadenoma?

septated

loculates

no one description

315

What is Serous Cystadenocarcinoma?

malignant

60 - 80% ovarian cancer cases

316

What is the sonographic appearance of Serous Cystadenocarcinoma?

thick septations

papillary projections

ascites

internal echoes

look for vascularities

317

What is Dermoids?

most common ovarian neoplasm

Normally found in menache women

318

What is another name of ovarian dermoids?

benign cystic terotoma

319

What can ovarian dermoids contain?

fat

teeth

bone

cartilage

hair

320

Where do ovarian dermoids originate?

primitive tissue

321

What is the sonographic appearance of Dermoids?

Variable

322

What is Stroma Tumors?

Fibroma – rare, causes Migs syndrome

Granulosa – rare, feminizing noplasm

Arrhenoblastoma – masculinizing ovarian tumor

323

What is a sex cord stromal tumor?

AKA stromal tumor

324

What is a solid adnexal masses?

AKA stromal tumor

325

What is a Fibroma?

rare, causes Migs syndrome

postmenopausal

326

What is the presentation of a ovarian fibroma?

pelvic pain and pressure

327

What is the sonographic appearance of Migs syndrome?

solid ovarian mass

ascites

pleural effusion

328

What is a ovarian Arrhenoblastoma?

masculinizing ovarian tumor

child bearing age - 20 to 45

329

What is the presentation of ovarian Arrhenoblastoma?

pain / pressure

flat breast

Amenorrhea

330

What is a ovarian Granulosa?

rare, feminizing neoplasm

331

What does a ovarian Granulosa do to a postmenopausal women?

firm breast

vag bleeding

332

What does a ovarian Granulosa do to a prepubescent girls?

causes precocious puberty

333

What is the sonographic appearance of ovarian Granulosa?

solid

internal echoes

no through transmission

334

What is the sonographic appearance of Stroma Tumors?

no data

335

What is Ovarian Carcinoma?

leading cause of GYN death

80% women over 50

Staging has subunits

125 blood levels help with staging

336

What is the sonographic appearance of Ovarian Carcinoma?

Not simple cyst

solid mass

mixed echogenicity

irregular borders

no through transmission

337

In postmenopausal women what happens with a cystic mass greater than 5 cm on the ovary?

get it out

338

What percentage are first seen by doctor in late stage of Ovarian Carcinoma?

70 %

339

What blood tests are used to diagnose Ovarian Carcinoma?

CA125 marker will be elevated

but high false positive

340

What is the presentation of Ovarian Carcinoma?

vague abdominal pain

* like indigestion

341

What are the risk factors for ovarian carcinoma?

infertility

nulliparity

late menopause

family history

342

More women die from ovarian carcinoma than ______ and _____ combined.

uterine & cervical

343

If ovarian carcinoma is limited to just the ovary what stage is it in?

1

344

If ovarian carcinoma is limited to the pelvis what stage is it in?

2

345

If ovarian carcinoma is limited to the abdomen what stage is it in?

3

346

If ovarian carcinoma is beyond the abdomen what stage is it?

4

347

What is the sonographic appearance of Ovarian Torsion?

twisting of ovary, often on right

Childhood or adolescence

low flow

no flow

348

What is accompanied by ovarian torsion 50 to 80% of the time?

mass on ovary

349

With ovarian torsion how often is there a palpable mass on the ovary?

50%

350

Are the majority of ovarian torsion on the left or right side?

right

351

What is Ovarian Torsion?

Unilateral decrease in ovarian blood flow

352

What is Ovarian Hyperstimulation Syndrome?

no data

353

What is the sonographic appearance of Ovarian Hyperstimulation Syndrome?

no data

354

What is U/S used to assess in a fertility workup?

ovarian flow

endometrial thickness

patency of tubes with sonohysterography

follicle harvesting guidance

placement after in vitro

355

What is the cause of 20 to 40% fertility problems?

tubal obstruction

356

What is the cut off size of follicles with fertility treatments?

16 mm

357

What are complications of fertility treatments?

presents with thicker lutea cysts

hypovolemia - if rupture, ascites

increased risk of OHSS if patient has polycystic ovaries

358

What are the 3 types of gestational trophoblastic Dz?

hydatidiform Mole

invasive mole

malignant choriocarcinoma

359

What does trophoblastic tissue arise from?

placental chorionic villi

360

What is another name for hydatidiform Mole?

benign molar pregnancy

361

WHat makes up 80% of gestational trophoblastic Dz?

benign molar pregnancy

362

WHat makes up 15% of gestational trophoblastic Dz?

invasive mole

363

WHat makes up 5% of gestational trophoblastic Dz?

malignant choriocarcinoma

364

What are the two types of hydatidiform Mole?

complete

partial

365

What is a complete mole?

no fetal pole

sperm fertilizing an empty egg

366

What is a partial mole?

2 sperm fertilizing 1 egg

367

What is a tripoidy?

partial mole

sperm fertilizing an empty egg

368

What happens in 1 in 1200-2000 pregnancies?

hydatidiform Mole

369

Who has a higher incidence of a hydatidiform Mole?

older women

women with previous mole

370

What is the presentation of a hydatidiform Mole?

vaginal bleeding

large for date

extremely high HCG

N & V

371

What is the sonographic appearance of an early hydatidiform Mole?

similar to a blighted ovum

thick myometrium

NO IUP

large ovarian cysts

372

What is the sonographic appearance of a second trimester hydatidiform Mole?

large

mixed soft tissue mass within endometrial cavity

grapelike appearance

373

What is chorio?

related to placentia

374

What are the complications of a hydatidiform Mole?

hemorrhage of theca lutean ovarian cyst

Vaginal bleeding w/ anemia

pulonary embolism

progression to invasive mole or malignant choriocarcinoma

375

How many normal cases of coexisting mole and fetus?

less than 30

376

What is an invasive mole?

chorioadenoma destruens

penetrates through the myometrium

invasive but not metastic

villous pattern is perserved

377

What is the complications of chorioadenoma destruens?

benign until breaks out of uterus

invades adjacent organs

can move through bloodstream causing PE

378

What is malignant choriocarcinoma?

malignant form of trophoblastic disease

379

What is the chance of malignant choriocarcinoma?

1 in 30,000 to 40,000

380

How many cases of malignant choriocarcinoma start from a molar pregnancy?

50%

381

How many cases of malignant choriocarcinoma start from an abortion?

25%

382

How many cases of malignant choriocarcinoma start from a normal pregnancy?

22%

383

How many cases of malignant choriocarcinoma start from an ectopic pregnancy?

3%

384

What is the sonographic appearance of malignant choriocarcinoma?

invasion into the myometrium

necrosis causes mixed mass

distal mets (liver & lung)

invasion into the pelvic cavity

no villi - purely cellular lesion

385

What is the presentation of malignant choriocarcinoma?

bleeding and hemorrhage

386

What is the treatment for trophoblastic disease?

D & C

chest xray

chemotherapy

radiation

surgery

387

Who should a women follow up with after trophoblastic disease?

oncologist

388

What should not happen for 1 year after trophoblastic disease?

pregnancy

389

How many moles are complete moles?

80%

390

How many moles are benign?

95%

391

How long will Hcg levels be high after treatment of trophoblastic disease?

12 weeks

392

How long will the thicker lutean cyst resolve?

16 weeks

393

What are the reasons for a 1st trimester scan?

confirm IUP

rule out ectopic

vaginal bleeding

confirm multiple gestation

pelvic mass

determine uterine abnormalities

394

What is the protocol for an early (4 weeks) 1st trimester exam?

Pelvic protocol +

GSS measurement (mean sac diameter)

395

At what time should a sating scan be done?

12 weeks

396

What should be written on the worksheet of an early 1st trimester exam

cystic collection in UT?

ectopic can not be rules out

397

What is the protocol for an (5+ weeks) 1st trimester exam?

Pelvic protocol +

crown rump length x3

m-mode heart rate

fetal number

398

Presence or absence of cardiac activity should be reported

Why?

sign of viability

399

What is the heart rate in the early embryonic development (6 weeks)?

90 bpm

400

What is the heart rate mid trimester (9 weeks)?

170 bpm

401

after 12 weeks what is the heart rate?

120 - 160 bpm

402

How is the fetal number documented?

count embyros

count yolk sac

count heart beats

403

What can cause confusion when counting fetuses?

implantation bleeds around 6 weeks

404

Wht is evaluation of the uterus, adnexa structures and cul-de-sac important in a 1st trimester exam?

allows recognition of incidental findings

fibroids

ovarian masses

free fluid

405

Remember everyone is 3rd party to patient!!!!

no data

406

Explain the path of ovum to implantation

ovum

fertilization

zygote

cleavage

morula

uterine cavity

blastocyst

implantation

+Hcg

407

What is the fertilized egg called?

zygote

408

What is a zygote called once it reaches 16 cells?

morula

409

How many sperm are deposited?

300 million

410

How many sperm enter vagina

1%

3000

411

How long a journey is the trip to the ovum?

10 hours

412

where does fertilization usually occur?

ampulla

413

What is happening at 2 weeks LMP?

thick endometrium

ovarian cyst with follicle 20 mm - 24 mm

follicle rupture

fertilization in distal tube

no sonographic findings

414

What is mittelschmerz?

ovulation pain

415

What happens to Hcg levels just before expulsion of a fetus?

plummet

416

What is usually Hcg levels of an abnormal pregnancy?

lower than normal

417

What produces Hcg?

trophoblastic tissue

418

How early will Hcg test positive?

early as 4 weeks

419

What is happening at 3 - 4 weeks LMP?

travel through the fallopian tubes

growth of blastocyst

implantation into the endometrium

no sonographic findings

420

Explain Hcg levels compared to growth of gestational sac?

proportional until 8 weeks then plateau

421

What happens to Hcg beyond 16 weeks?

drops off

can test negative for preg

422

What is the epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish nutrient circulation

card image

Syncytiotrophoblast

invades maternal wall and creates spaces called lacunae

423

What flows through the lacunae?

maternal blood flow

424

What is the lacunae called once maternal blood flows through it?

lacunae network

425

What are the two parts of the outer cell mass?

Syncytiotrophoblast

cystrophoblast

426

What is the inner cell mass?

trophoblast

427

What is extraembryonic material?

trophoblast

428

What is embryoblast or bilateral embryonic disc material?

trophoblast

429

When is Hcg produced?

as soon as implantation

430

What is the purpose of Hcg?

supports the corpus luteum cyst of pregnancy

431

What is the purpose of the corpus luteum cyst of pregnancy?

produces progesterone and small amounts of estrogen to support decidualized tissue

432

What is a cytotrophoblast composed of?

many chorionic villi

433

What is multiple chorionic villi called?

chorion frondosum

434

What is the purpose of chorionic villi?

extend into the inter villi spaces of the lacunae network

to facilitate exchange of ox and nutrients

435

When does the corpus luteum cyst of pregnancy start to regress?

12 weeks

436

Why does the corpus luteum cyst of pregnancy regress?

placenta is ready to take on function of producing progesterone and small amounts of estrogen

437

What happens to beta Hcg the first 6 weeks?

doubles every 48 hours

438

What happens to beta Hcg between 6 & 8 weeks?

doubles every 3 days

439

What are the components of the placenta?

fetal & maternal

440

What is the fetal part of the placentia called?

chorion frondosum

441

What is the maternal part of the placentia called?

Decidua basalis

442

What happens week 4 after LMP?

implanted blastocyst & chorion villi branches

missed first period & light spotting

gestational sac / chorion cavity may occur

double decidua vs pseudosac

no embryo or sac can be seen

GSD < 10 mm

transvaginally is best

443

Where does implantation occur?

decidua basalis

444

What is decidua vera?

everything except where implantation occurs

445

What is decidua parietalis?

decidua vera

446

What is the detection threshold?

at what level beta Hcg is at when pregnancy can be seen on U/S

447

What is the detection threshold for transabdominal U/S?

1800 miu/ml

448

What is the detection threshold for transvaginal U/S?

500 miu/ml

449

When does the primary yolk sac become the secondary yolk sac?

23 days

450

What structure will be the earliest structure seen?

secondary yolk sac

451

What is the role of the yolk sac?

nutrients

hemopoiesis

formation of GIT

development of sex gland

452

Where is the yolk sac located?

between the amnion and chorion

453

When is the yolk sac reabsorbed?

12 weeks

454

What predicts viable pregnancy 90% of the time?

yolk sac

455

When the MSD is ____ the yolk sac should be seen.

> 10 mm

456

The normal diameter of the yolk sac should not exceed ____?

5.6 mm

457

What is the normal diameter of the yolk sac?

4 mm

458

What is a large yolk sac associated with?

chomosomal abnormalities

459

When does the amnion meet the chorion?

16 weeks

460

What is the sonographic appearance of the gestational sac?

best in fundus

round / oval

decidua wall thickness > 3 mm

461

In early pregnancy how much does the gestational sac grow?

1 mm per day

462

When the MSD is 10 mm what should be seen?

yolk sac

463

When the MSD is 18 mm what should be seen?

embryo

464

When can embryo be positively identified?

fetal heart motion seen

465

When is fetal heart motion seen?

5.3 - 5.5 weeks

466

When will the heart reach its adult configuration?

8 weeks

467

What is the MSD?

Mean sac diameter

(L + W + H)mm / 3

468

What does the MSD + 30 =

menstrual age in days

469

CRL cm + 6 =

gestational age

470

What is the double bleb sign?

amnion

yolk sac

embryo

471

What is the signent sign?

double bleb sign

472

What causes yolk stalk?

at beginning of 6 weeks

constriction of yolk sac

473

How much does a normal embryo grow per day?

1 mm per day

474

What is another name for chorionic cavity?

embyonic coelum

475

What occurs in the 6th week LMP?

CRL ranges 4mm - 9mm

heart beat should be seen

93 - 166 bpm

GSD 18mm - 26 mm

476

What happens in the 7th week LMP?

head is half size of the body

slow embryonic movements

umbilicus formed

477

How is the umbilicus formed?

yolk stalk fused with body stalk

between 7 & 8 weeks


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