Breast and Gynae and obstectrics Flashcards
(104 cards)
1
Q
what is basal-type breast carcinoma ?
A
triple negative phenotype (-HER2, -ER, -PR)
2
Q
what do milk of calcium calcifications represent ?
A
free floating calcium in tiny benign cysts
3
Q
what type of calcification is typical for fibroadenoma ?
A
popcorn like calcifications
4
Q
what is an oil cyst ?
A
where an area of fat necrosis gets walled off by fibrous tissue.
usually have egg shell calcification
5
Q
where do most breast cancers present ?
A
50% present in the upper outer quadrant
6
Q
following breast cancer treatment what is the mammography follow up regime ?
A
if < 50, have yearly mammograms until 50 - and then go onto the normal breast screening program
If >50 have yearly mammogram for 5 years, and then go onto normal breast screening programme
7
Q
At what week gestation should you see a gestational sac ?
A
5 weeks
8
Q
At what week gestation should you see a gestational sac ?
A
5 weeks
9
Q
How many weeks pregnant should you see a yolk sac ?
A
5.5 weeks
10
Q
How many weeks should you see an embryo ?
A
6 weeks
11
Q
If the CRL >7mm and there’s no heart beat , what does that indicate ?
A
A failed pregnancy
12
Q
Where do most ectopic pregnancies occur ?
A
The ampulla
13
Q
What is a heterotrophic pregnancy
A
IUP and Ectopic
14
Q
What are the 3 forms of gestational trophoblastic disease ?
A
Complete hydtatidform mole
Invasive mole
Choriocarcinoma
15
Q
What is a complete hydatidiform mole ?
A
Doesn’t contain any fetal parts ?
16
Q
Why do complete hydatidiform moles occur ?
A
loss of the eggs DNA prior to fertilzation by the sperm and usually 46 Karyotype
17
Q
What is the classic US appearance of a molar disease ?
A
Enlarged uterus, Multicystic bunch of grapes
18
Q
In a molar pregnancy, what often occurs in the ovaries ?
A
Theca lutein cysts due to the elevated HCG ?
19
Q
What is the treatment of a molar pregnancy ?
A
Endometrial suction curettage and 6 monthly follow up of HCG
20
Q
What causes a partial hydatitform mole. ?
A
Triploid pregnancy XXX or XXY is caused by 2 sperm fertilising the same egg
21
Q
What is chorionicity
A
Number of placentas
22
Q
What is amnionicity
A
The number of aminos
23
Q
What do monochorionic twins have ?
A
The same placenta
24
Q
What do monoamniotic twins have ?
A
A single amniotic sac and therefore share a placenta
25
What is zygosity
Number of fertilised eggs
26
What does the twin peak sign indicate ?
Dichorionic/diamniotic twins
27
What does a T -shape configuration of the placenta and insertion of the intertwin membrane indicate
Monochorionic / diamniotic twins
28
What is diagnostic of mono/mono twins ?
Intertwined cords
29
What are conjoined twins caused by ?
Late >13 days incomplete division of the embryo
30
What are the Ultrasound findings of twin-twin transfusion syndrome ?
Single shared placenta
Disproportionate fetal sizes with ? 25% discrepancy
Disproportionate amniotic fluid with small twin having oligohydramnios
31
When is nuchal translucency measured ?
At 11-14 weeks or CRL 45-85mm
32
What thickness of nuchal translucency warrants further investigation ?
3mm
33
When could a omphalocele or gastroschisis be diagnosed and why ?
After 13 weeks, as normal midgut herniation occurs in the first trimester and is usually complete by 13 weeks
34
What is the most sensitive and specific ultrasound finding of Down’s syndrome
Thickened nuchal fold
35
What is an abnormal measurement for nuchal fold ?
>6mm is a major marker for trisomy 21
36
What does cervical funnelling increase peoples risk of ?
Pre-term labour
37
Before 24 weeks, what is the treatment of cervical shortening ?
Cervical cerclage due to increased risk of pre-term labour
38
What does a single umbilical artery increase the risk of ?
Trisomy 13 and 18
39
What is velamentous insertion of the umbilical cord ?
Where the cord inserts outside the margin of the placenta, into the free membranes
40
What is vasa Previa?
Where the fetal placental vessels go across the internal cervical os
41
What is oligohydramnios most commonly associated with ?
IUGR
42
What can oligohydramnios result in ?
Hypoplastic lungs
43
What is potter sequence ?
Oligohydramnios resulting in :
Facial abnormalities
Club feet
MSK contractures - due to little space in the sac
44
What genitourinary problems can lead to oligohydramnios
Renal agenesis - death
Congenital bladder outlet obstruction
Bilateral ureteropelvic junction obstruction
Renal dysplasia - ARPKD
45
What causes polyhydramnios ?
Inability of the foetus to swallow :
1) Upper GI obstruction: duodenal or oesophageal atresia
2) Severe CNS anomlias - which causes difficulty in swallowing
3) twin to twin transfusions - with one twin with too much fluid and the other with no fluid
4) placental abnormalities
46
What is a succenturiate lobe ?
Island of placental tissue separate from the main placenta - but connected to the main placenta by blood vessels
47
When do you start to assess the placental position ?
In the 2nd trimester
48
What is the normal position of the placenta?
More than 2 cm from the internal os
49
What is placenta previa?
Where the placenta covers the entire internal os
50
What is placenta accreted ?
Deep attachment of the placenta into the myometrium - resulting in increased risk of haemorrhage at the time of placental separation
51
What is placenta percreta ?
Where the placenta PENETRATES through the serous to invade other structures - there is a focal bulge in the uterine wall
52
What does a chorioangioma look like on uS ?
Hypoechoic rounded mass in the placenta with a ectopic cystic areas and low resistance flow
53
What is fetal hydrops ?
Fluid overload state characterised by :
Ascitis
Pericardial or pleural effusion
Skin thickening
Polyhydramnios
Placental enlargement
54
How can the causes of polyhydramnios be classified?
Immune or non immune
55
What causes immune fetal hydrops ?
Fetal haemolytic anemia - usually rh antigen
56
What should the lateral ventricles measure ?
< 10mm
57
Why is AFP elevated in anencephaly ?
Due to direct exposure of the neural tissue to the amniotic fluid
58
What is ancephaly ?
Lack of development of the Calvary I’m and destruction of the fetal cerebral cortex
59
What’s the difference between a meningocele and an encephalocele ?
Meningocele - contains meninges
Encephalocele - contains neural tissue
60
What is a dandy walker malformation ?
Posterior fossa malformation ; triad of :
1 - hypoplasia of the vermis
2 - dilated 4th ventricle
3 - torcula lamboid inversion ( where the torcular is lying above the lamboid suture due to a very high tentorium )
61
What is a chiral 2 malformation ?
Small posterior fossa plus a neural tube defect - this results in descent of the cerebella vermis through the foramen magnum
62
What sign if very specific for chairi 2 malformation ?
Banana sign - flattening of the cerebellar
63
When does a normal corpus callosum develop ? Which way does it develop?
20 weeks
Develops from the selenium to the rostrum
64
What is the Viking helmet appearance seen in ?
Dysgenesis of the corpus callosum
65
What is hydranencephaly ?
Complete cortical destruction due to infarction or infection - where the brain parenchyma is replaced with fluid
66
Which condition are choroid plexus cysts seen in ?
Trisomy 18
67
What is a sacrococygeal Teratoma
Germ cell tumour of the sacrum
68
Which condition is an absent nasal bone seen in ?
Trisomy 21
69
What is micrognathia ?
Hypoplasia of the mandible resulting in a small chin
70
Where are morgani hernias located ?
Anterior on the right
71
Where do bochdalek hernias arise ?
Left posterior thorax
72
what is the difference between an immature and a mature teratoma
immature - malignant
mature - not malignant , also known as a dermoid cyst
73
what do dermoid cysts look like ?
usually contain fat - meaning that it is mature
contains calcification - which can cause posterior acoustic shadowing
74
what are the standard views performed at screening ?
MLO and CC
75
what is the most common cause of an ovarian torsion ?
corpus luteal cyst or follicular cyst
76
where are Gartner duct cysts located ?
anterior to the vaginal wall
77
where are skyene duct cysts located ?
inferior to the pubic symphysis but lateral to the urethral opening
78
what are popcorn calcifications seen in ?
benign fibroadenomas
79
which cancer is most frequently missed on US and mammography but can be detected on MRI
lobular cancer
80
which cancers don't require contrast for MRI pelvic staging?
rectal and cervical cancers
81
what are the IOTA rules ?
standardised rules for classifying ovarian lesions
82
what are the 'M' rules in the IOTA classification ?
Malignant findings :
Solid mass
Multilocular solid mass > 10cm
blood flow
ascites
>3 papillary structures
83
what is Salpingitis isthmica nodosa
nodular scarring of the Fallopian tube, thought to be due to previous PID
causes no spill on HSG with multiple tiny diverticular
84
what is a septate uterus associated with ?
renal abnormalities
85
what are the 4 ways a fibroid can degenerate ?
red
myxoid
cystic
hyaline
86
what signal do fibroids have on MRI ?
low signal on T2
87
what Is the most common type of fibroid degeneration ?
hyaline degeneration
88
what does gynaecomastia look like on US ?
flamed shame mass behind the nipple
89
what is CPAM
harmatous proliferation of small airways which communicate with the bronchial tree
90
what is pulmonary sequestration?
aberrant lung tissue with systemic blood supply
91
what is sequestration most commonly found ?
left lower lobe
92
on a fetal heart US what indicates the right ventricle ?
moderator band
93
what is the most common metal CHD ?
VSD
94
what is atrial spetal defect strongly associated with?
downs syndrome
95
what does transposition of the great arteries look like on fetal US
parallel course of the aorta and pulmonary artery .
the aorta arises from the RV ( identified with the moderator band )
96
what is meconium ileus
bowel obstruction caused by impacted meconium in a foetus with cystic fibrosis
97
does a omphalocele have peritoneal covering ?
yes
98
where does the umbilical cord insert in an omphalocele ?
centrally at the base of the herniated sac
99
what is an omphalocele ?
the most common anterior abdominal wall defect.
midline defect with herniation of intra-abdominal contents
100
how fast do fetal kidneys grow
1mm per week
so a 20 week foetus should have 20mm (2cm) kidneys
101
how would you see osteogenesis imperfect on us ?
short limbs, < 3SD
102
what are patients with beckwith-wideman syndrome at risk of developing ?
wilms tumour
103
what is the screening for beckwith-wiedemann syndrome
US every 3 months until 8 years
104
what is the difference between bicornate bicervix uterus and uterine didelphys ?
in uterine didelphys the uterine cavities don't communicate with each other
