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OBGYN > broken lady bits > Flashcards

broken lady bits Flashcards

1
Q

congenital ut anomalies aka __

A

müllerian duct anomalies

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2
Q

what happens if there is failure of mullerian duct organogenesis

A

one or both ducts underdevelop

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3
Q

result of bilaterally underdeveloped organogenesis

A

uterine agenesis or hypoplasia

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4
Q

result of unilateral failure of organogenesis

A

unicornuate ut

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5
Q

what is the result of failure of fusion step of mullerian duct development

A

bicornuate or didelphys ut

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6
Q

most congenital malformations are due to incomplete fusion of the __

A

ureterogenital primordium (ut and upper vagina)

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7
Q

lower segments of mullerian ducts fuse to form __

A

ut, cx, and upper vagina

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8
Q

what is the result of failure of septal resorption step of mullerian duct development

A

septate ut

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9
Q

what are the 6 I’s (causes of congenital ut anomalies)

A

idiopathic
inherited
intrauterine infections
ionizing radiation
ingestion of drugs
in utero exposure to DES

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10
Q

what does DES stand for

A

diethylstilbestrol

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11
Q

there is a greater incidence of congenital ut anomalies among pts that are __

A

infertile

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12
Q

what is most common association with congenital ut anomalies

A

unilateral renal agenesis

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13
Q

what is the rate of congenital ut anomaly with unilat renal agenesis

A

55-75%

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14
Q

what is rate of renal anomalies when there is a case of congenital ut anomaly

A

20-30%

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15
Q

which congenital ut anomaly is associated with the highest incident of renal anomalies (nearly 50%)

A

unicornuate ut

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16
Q

renal tissue cannot develop without __

A

ureteric bud

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17
Q

renal agenesis occurs due to a failure of __

A

ureteric bud to form from distal end of Wolffian

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18
Q

what constitutes a recurrent abortion

A

> /= 3 losses in a row

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19
Q

what is the most accurate imaging modality for ut anomalies

A

MRI

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20
Q

what is likely the ut anomaly when seeing a blind ended vagina

A

uterine agenesis

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21
Q

does a unicornuate ut have fallopian tube

A

yes

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22
Q

unilateral mullerian duct agenesis results in __

A

unicornuate ut

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23
Q

incomplete development of one mullerian duct results in the formation of a __

A

rudimentary horn

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24
Q

how many ovaries does a unicornuate ut have

A

2
develop independently

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25
Q

which side is most common for rudimentary horn

A

right

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26
Q

two types of rudimentary horns

A

non obstructed (soft tissue iso mass)
obstructed (functioning endo)

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27
Q

double ut aka

A

didelphys

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28
Q

didelphys due to near complete failure of __

A

fusion

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29
Q

can you see a vaginal septum on u/s

A

very difficult unless obstructed

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30
Q

name of congenital anomaly with 2 separate, symmetrical ut bodies

A

uterus didelphys

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31
Q

didelphys associated with infertility T/F

A

false- if anything, 2x chance lol

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32
Q

bicornuate ut aka

A

bicornis

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33
Q

name of congenital anomaly where incomplete fusion of ut at level of the body/fundus

A

bicornuate

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34
Q

name of congenital anomaly with 2 cornu and 2 cervices

A

bicornuate bicollis

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35
Q

name of congenital anomaly with 2 cornu and 1 cervix

A

bicornuate unicollis

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36
Q

bicornuate fundal cleft __ cm sonographic to distinguish heart shape from septate

A

> 1 cm

coronal EV most reliable plane of section

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37
Q

__ required to make final diagnosis of bicornuate ut

A

MRI and physical exam

otherwise hard to delineate 1 or 2 cervices

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38
Q

what is the reproductive outcome of bicornuate uterus

A

highest rate of incompetent cervix

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39
Q

name of congenital anomaly with partial or complete failure of septum resorption after mullerian duct fusion

A

septate uterus

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40
Q

septate ut aka

A

uterus septus
failure of resorption

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41
Q

what are the two types of septate ut

A

septate (septum extends to internal os)
subseptate (partial)

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42
Q

which is the most common congenital ut anomaly

A

subseptate uterus (partial septum)

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43
Q

what is the distinguishing feature of septate vs bicornuate ut

A

septate <1cm concave fundal contour

bicornuate >1cm convex heart shape fundus

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44
Q

in septate ut, the septum is composed of __

A

poorly vascularized fibromuscular tissue

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45
Q

reproductive outcome of septate ut

A

poor

abnormal fetal lie and presentation
postpartum bleeding and secondary RPOC

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46
Q

reproductive outcome of unicornuate ut

A

related to infertility and pregnancy loss

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47
Q

is differentiating septate v. bicornuate important? why?

A

tx is different
septate requires hysteroscopic resection of ut

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48
Q

name of congenital anomaly with saddle-like defect to fundal ut cavity

A

arcuate ut

normal serosal contour

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49
Q

arcuate ut is arguably a __

A

normal variant

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50
Q

reproductive outcome of arcuate ut

A

slight risk of spontaneous abortion and premature labour

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51
Q

what is the rate of ut anomaly to female fetuses exposed to DES in utero

A

66%

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52
Q

what are the complications with DES daughters

A

congenital anomalies of repro tract

clear cell adenocarcinoma of upper vagina

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53
Q

what would you expect to see with a DES daughter’s pelvic scan

A

small, T shaped endo cavity

small ut (hypoplasia)

ut constriction rings (aka narrowing stenoses)

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54
Q

what is the gold standard for assessing DES malformation

A

MRI

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55
Q

reproductive outcome of DES malformation

A

ectopic (due to abnormal fallopian tubes)

spontaneous abortion

premature labour (cervical incompetence)

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56
Q

term for accumulation of blood in ut and vagina

A

hematometrocolpos

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57
Q

vaginal septum has __ origin

A

mullerian origin

usually related to cranial vagina

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58
Q

vaginal septum most commonly associated with __

A

ut didelphys

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59
Q

open or closed vaginal septum associated with ut didelphys is called a

A

longitudinal septum

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60
Q

a closed vaginal septum resulting in hematocolpos or hematometrocolpos with primary amenorrhea is referred to as

A

a transverse septum

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61
Q

__ covers and obstructs the vaginal canal

A

imperforate hymen

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62
Q

imperforate hymen mimics __ but is not a mullerian defect

A

low transverse septum

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63
Q

what is a mechanical cause of primary amenorrhea

A

imperforate hymen

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64
Q

NSA, adolescent with cyclic pelciv pain lasting several days (pubertal age) with primary amenorrhea likely experiencing

A

imperforate hymen

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65
Q

term for vaginal agenesis and uterine hypoplasia/agenesis

A

MRKH

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66
Q

MRKH stands for

A

Mayer-Rokitansky-Kuster-Hauser syndrome

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67
Q

cause of MRKH

A

unknown

normal external genitalia, ovaries, and tubes

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68
Q

what is likely happening to a pt with blood distended ut and absent vagina

A

MRKH syndrome

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69
Q

what is the average size of hydatid cyst of morgagni

A

<1cm
often too small to see with u/s

simple paraovarian cyst separate from ovary

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70
Q

gartner duct cysts potential remnants of __

A

wolffian ducts

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71
Q

mucus-filled cysts within myometrium are called

A

nabothian cysts

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72
Q

nabothian cysts aka

A

blocked glands

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73
Q

what is the ddx for a gartner duct cyst

A

Bartholin gland cyst

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74
Q

term for new but abnormal growth of a tumour

A

neoplasm

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75
Q

is a neoplasm benign or maignant

A

can be either

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76
Q

an abnormal increase in no. of normal cells

A

hyperplasia

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77
Q

an abnormal increase in the size of normal cells

A

hypertrophy

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78
Q

term for the inability to conceive within 12 months of regular attempts

A

infertility

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79
Q

a woman >/= 35 y is considered infertile if unsuccessful when trying for __ months

A

6

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80
Q

rates of primary infertility have __ in the last 20 y

A

increased

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81
Q

term for the inability to conceive or maintain a pregnancy after having been successful at least once

A

secondary infertility

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82
Q

what are the risk factors for infertility

A

age
smoking/alcohol use
over/underweight
excessive exercise
caffeine
PID
endometriosis

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83
Q

causes of infertility

A

inability for:
production of oocytes
oocytes meeting
implantation
carrying to viability

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84
Q

what is the rate of male factor in infertility

A

40%

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85
Q

what is the most common cause of female factor infertility

A

tubal disease
(secondary to PID, endometriosis, previous ectopic)

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86
Q

female causes of infertility

A

tubal disease
ovarian dysfunction
cervical factor
ut abnormalities (myomas, septate congenital, etc)

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87
Q

how do you dx DES malformation

A

hestersalpingography

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88
Q

increased risk of __ of vagina, infertility, spontaneous abortion and preterm delivery with DES malformation

A

clear cell adenocarcinoma of the vagina

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89
Q

infertility due to presence of synechiae (+/- calcifications)

A

Asherman syndrome

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90
Q

Asherman syndrome presents secondary to __

A

scarring from trauma or sx
ie. D&C

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91
Q

3 important tests for infertility in female

A

tubal patency
uterine disease
assessment of ovarian reserve

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92
Q

a decline in no. of follicles and oocyte quality is a diminished __

A

ovarian reserve

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93
Q

ART stands for

A

assistive reproductive therapy

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94
Q

what role does u/s have in ART

A

ovarian follicle count for reserve assessment

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95
Q

the timed hormonal injections which stimulate follicular development and ovulation is called

A

ovarian hyperstimulation therapy

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96
Q

ovarian hyperstimulation therapy may cause __

A

OHSS (ovarian hyperstimulation syndrome)

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97
Q

common signs of OHSS are

A

theca lutein cysts
pelvic pain
abdominal distention

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98
Q

common OHST drugs

A

clomephene citrate (Clomid, Serophene) -> stimulates pituitary

human menopausal gonadotropin (Perganol, Repronex) -> stimulates ovary directly

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99
Q

diameter of follicle with OHST pre ovulation

A

~20mm

+/- cumulus oophorus

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100
Q

OHSS most commonly occurs with which rx

A

pergonal and reprones (hMG)

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101
Q

IVF stands for

A

in vitro fertilization

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102
Q

IUI stands for

A

intrauterine insemination

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103
Q

GIFT stands for

A

gamete intrafallopian transfer

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104
Q

ZIFT stands for

A

zygote intrafallopian transfer

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105
Q

ICSI stands for

A

intracytoplasmic sperm injection

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106
Q

what is the most common ART technology used

A

IVF

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107
Q

ovum and sperm combined in a dish, resultant zygote transferred to ut at blastocyst stage

A

IVF

~5 days after conception

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108
Q

pregnancy rate of IVF

A

30-40%

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109
Q

live birth rate of IVF largely depends on __

A

age of pt

<35 y 32%
>40 y 12%

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110
Q

parameters positively affecting pregnancy rate is presence/absence/direction of __

A

subendometrial myometrial contractions

**dr. lyons publication
retrograde motion (cx to fund) at peak incidence during preovulatory period

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111
Q

heterotopic pregnancy incidence increased with __

A

IVF

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112
Q

frozen sperm inserted directly into the ut

A

IUI

used with male factor infertility

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113
Q

laparoscope used to insert ovum and sperm directly into fallopian tube

A

GIFT

used for cervical factor and unexplained infertility

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114
Q

GIFT requires a normal __

A

fallopian tube

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115
Q

2 step procedure
1 - ovum fertilized in lab dish
2 - transfer to fallopian tube

A

ZIFT

transfer of zygote

most invasive

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116
Q

single sperm injected into ovum and returned to ut in ~5 days is

A

ICSI

transfer of blastocyst

used for severe male factor infertility or repeated failed IVF

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117
Q

abnormal development, growth or differentiation of cells is

A

dysplasia

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118
Q

adnexal masses are most commonly __

A

ovarian

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119
Q

ovarian masses are most commonly __

A

cystic

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120
Q

large ovarian masses can cause __

A

hydronephrosis

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121
Q

bilateral ovarian dysgenesis aka

A

streak ovaries

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122
Q

streak ovaries primarily associated with __

A

Turner syndrome

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123
Q

what chromosomal abnormality is 45x0

A

turner syndrome

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124
Q

absence of all or part of one x chromosome is

A

turner syndrome

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125
Q

characteristics of person with turner syndrome

A

short stature
absence of secondary sexual characteristics
infantile genetalia
streak ovaries

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126
Q

hypoplastic ovaries with nonfunctional tissue called

A

streak ovaries

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127
Q

streak ovaries are a result of hormonal disruption;

__ EST, __ FSH, __ LH

A

low est
high fsh
high lh

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128
Q

additional ovaries that develop separate from normal ovary called

A

supernumerary ovaries

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129
Q

additional ovary that is attached to an ovary is called

A

accessory ovary

*functional

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130
Q

what is the most common cause of palpable adnexal masses in young adult females of reproductive age

A

non neoplastic ovarian pathology

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131
Q

sonographic detection and characterization of ovarian pathology is __ acurate

A

highly

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132
Q

what differentiates a normal follicle from a follicular cyst

A

> 2.5 cm

will not ovulate or rupture

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133
Q

follicular cyst should regress spontaneously within __

A

3 months

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134
Q

follicular cysts may secrete __

A

estrogen

can cause menstrual disturbance

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135
Q

what is the difference between a CL and a CL cyst

A

CL cyst is persistent

*failure of resorption
*bleeding into CL

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136
Q

CL cyst may secrete __

A

progesterone

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137
Q

normal CL secretes __

A

prog and est

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138
Q

normal CL stimulated by __ that triggered ovulation

A

LH surge

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139
Q

CL cyst often associated with

A

missed or delayed periods

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140
Q

CL cysts are usually __ in size

A

3-5 cm

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141
Q

CL cyst of pregnancy secretes __

this secretion is taken over by placenta after __ GA and CL resolves

A

progesterone
12w GA

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142
Q

what is difference between corpus albicans and corpus albicans CYST

A

trick q. unable to ddx from CL

but no hormonal activity

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143
Q

a cyst into which there has been bleeding

A

hemorrhagic

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144
Q

the 2 most common types of hemorrhagic cysts

A

corpus hemorrhagicum (CL)
endometrioma

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145
Q

most patients with hemorrhagic cysts relay what clinical signs

A

acute, onset lower abd pain

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146
Q

what is the evolution of a hemorrhagic cyst

A

1 - acute hemorrhage
2 - clot formation
3 - clot retraction

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147
Q

sonographic appearance of early hemorrhagic cyst

A

blood is echogenic as it clots
*various appearances of mixed, diffuse and fibrin mesh

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148
Q

sonographic appearance of late stage hemorrhagic cyst

A

decreasing echogenicity as the clot lyses

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149
Q

what is the vascularity of a hemorrhagic cyst

A

avascular

can be flow in wall

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150
Q

what are the 2 forms of endometriosis

A

diffuse
localized (endometrioma)

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151
Q

which type of endometriosis is more common

A

diffuse

endo implants throughout peritoneum

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152
Q

endometrioma aka

A

chocolate cyst

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153
Q

what is the relationship of endometrioma to hormones

A

does not secrete

is affected by cyclic est and prog levels (cyclic bleeding)

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154
Q

clinical hx with endometriosis

A

+/- dysmenorrhea
+/- dyspareunia
+/- infertility

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155
Q

what is the slam dunk characteristic of endometrioma

A

calcifications in cyst wall

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156
Q

what can happen to endometriomas within pregnant pts

A

decidualization of the wall

results in solid, VASCULAR mural mass that CANNOT be ddx from malignancy

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157
Q

what causes theca lutein cysts

A

hyperstimulated ovaries (hCG) -abnormal pregnancy (GTD, hydrops, multiples)
-normal pregnancy (rare)
- ART

or oversensitive ovaries

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158
Q

theca lutein cysts regress when __ is removed

A

hormonal stimulus

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159
Q

in normal ovary, __ line the functional cysts

A

theca cells

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160
Q

would you expect to see ascites with theca lutein cysts

A

no

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161
Q

theca lutein cysts are always __

A

bilateral

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162
Q

theca lutein cysts occurring with a normal IUP and normal levels of hCG is referred to as

A

hyperreactio luteinalis

ovaries are just really sensitive to hCG

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163
Q

term for small, simple cyst in or on a post-menopausal ovary

A

serous inclusion cyst

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164
Q

what is the typical size of a serous inclusion cyst

A

<2.5-3cm

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165
Q

how do you distinguish a serous inclusion cyst from an ovarian or paraovarian cyst

A

you cannot

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166
Q

what is the speculated cause of a serous inclusion cyst

A

cyst pinched off from indentations in the surface epithelium of the ovary

no hormonal activity

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167
Q

what is the alternate name for PCOS

A

Setin-Leventhal syndrome (SLS)

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168
Q

what type of hormonal disorder is PCOS

A

endocrine
metabolic

**not an ovarian disease

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169
Q

what is the most common hormonal disorder among females of reproductive age

A

PCOS

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170
Q

PCOS associated with chronic __ due to hormonal imbalance

A

anovulation

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171
Q

clinical features of PCOS

A

amenorrhea
hirsutism
obesity
+/- infertility
+/- serum androgens

high LH
normal to low FSH
ratio results in ++ androgens in ratio

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172
Q

causes of PCOS

A

excess insulin
heredity
exposure to ++ androgen as fetus
low grade inflammation (insulin resistance and cholesterol accumulation)

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173
Q

risks from PCOS

A

endometrial hyperplasia (due to chronic hyperestrogenism)

DM2

cardiovascular/cerebrovascular disease. (increased lipids)

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174
Q

diagnosis of PCOS

A

clinical and chemical

**need hormonal assays to confirm

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175
Q

what ‘sign’ is associated with PCOS

A

‘string of pearls’

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176
Q

what sono ‘sign’ is seen with theca lutein cysts

A

‘soap bubble’
‘spoke wheel’

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177
Q

sonographic features of serial ultrasounds in positive PCOS case

A

lack of follicular development

lack of dominant follicle

no change to thickened endometrium

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178
Q

what is usual cause of ovarian torsion

A

enlarged ovary due to a mass

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179
Q

ovarian torsion is the twisting of the __

A

vascular pedicle

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180
Q

which ligaments are involved with ovarian torsion

A

ovarian ligament
infundibulopelvic ligament

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181
Q

clinical features of ovarian torsion

A

acute onset lower abdominal pain

one side more painful than contralateral

**may be mistaken for appendicitis if on RT

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182
Q

with torsion, ovary may swell to the point of __

A

rupture

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183
Q

sonographic features of ovarian torsion

A

enlarged, hypoechoic ovary
tender with pressure
+/- cyst; thick walls!!
+/- FF in PCDS

decreased or absent flow
** blood flow may be seen due to anastomosis between ovarian and uterine arteries

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184
Q

sonographic feature of twisted vascular pedicle

A

‘whirlpool’ sign

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185
Q

sono feature of ovarian torsion with hemorrhage or infarction

A

cystic or complex adnexal mass with fluid debris level or septa

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186
Q

what masses may have echogenic foci

A

dermoid cysts
inclusion cysts
endometriomas
psammoma bodies

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187
Q

what are psammoma bodies

A

sand-like calcifications in serous cystadenocarcinomas

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188
Q

name for development of an ovarian cyst after oopherectomy

A

ovarian remnant syndrome

likely due to a small portion of ovary not being resected

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189
Q

ovarian remnant syndrome clinical sign

A

chronic pelvic pain

usually happens with patients that had a lot of adhesions at time of sx

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190
Q

sono features of ruptured ovarian cyst

A

u/s may be normal

cyst may still be present

+/- FF

**echogenic FF requires ruling out an ectopic pregnancy if pt of reproductive age

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191
Q

the majority of malignant ovarian neoplasms occur in __ menopausal patients

A

post menopausal

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192
Q

what are the subtypes of ovarian neoplasms

A

epithelial

germ cell

stromal

metastatic

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193
Q

__ neoplasms originate in tissue that surrounds the ovary

A

epithelial

accounts for 90% of cases

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194
Q

__ neoplasms original in the cells that produce eggs

A

germ cell

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195
Q

__ neoplasms originates in the tissues that hold ovaries together and hormone producing tissues

A

stromal

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196
Q

what are the 2 most common types of ovarian neoplasms

A

cystic teratoma (dermoid)

serous cystadenoma

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197
Q

what are the 3 types of epithelial tumours

A

adenoma

carcinoma

adenocarcinoma

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198
Q

benign epithelial neoplasm from glandular cells

A

adenoma

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199
Q

malignant epithelial neoplasm

A

carcinoma

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200
Q

malignant epithelial neoplasm derived from glandular cells

A

adenocarcinoma

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201
Q

of, resembling or producing serous fluid

A

serous tumour

epithelial

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202
Q

of, relating to or covered with mucus

A

mucinous tumour

epithelial

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203
Q

which is more common - serous or mucinous epithelial tumours

A

serous

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204
Q

which is typically larger - serous or mucinous epithelial tumours

A

mucinous

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205
Q

cystadenomas and cystadenocarcinomas can be __

A

serous or mucinous

pre or post menopause

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206
Q

what is the single most common ovarian epithelial tumour

A

serous cystadenoma

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207
Q

clinical symptoms of cystadenomas and cystadenocarcinomas

A

few, if any symptoms

increasing abdominal girth
occasional pain (hemorrhage, torsion, infection)

menstrual disturbance (uncommon)

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208
Q

what is the most common ovarian malignancy

A

serous cystadenocarcinoma

209
Q

mucinous cystadenocarcinoma associated with __

A

pseudomyxoma peritonei
(mucinous implants on peritoneal surfaces and gelatinous ascites throughout abdomen)

210
Q

the __ complicated, the __ likely to be malignant regarding epithelial tumours

A

more complicated, more likely

211
Q

solid, unilateral epithelial tumour of post-menopausal women. majority are benign

A

Brenner tumour

212
Q

what factors increase risk with ovarian malignancy

A

peri-post menopause

low parity

early menarche

late menopause

breast cancer with HRT (ie Tamoxefin)

family hx (BRCA 1 or 2)

endometriosis

213
Q

peak incidence of ovarian malignancy in __ year olds

A

51-60

214
Q

what are some methods for prevention of ovarian malignancy

A

5 years on BCP

multiple pregnancies

breast feeding

prophylactic bilateral oopherectomy

215
Q

symptoms of ovarian malignancy

A

“silent killer” usually very vague and not diagnosed until very late

**is leading cause of death due to gyne malignancy

216
Q

which serum is used to help diagnose ovarian malignancy

A

serum CA125

cancer antigen (elevated in 80% of advanced ovarian epithelial cancer)

217
Q

is serum CA125 sensitive or specific

A

NOT specific to ovarian cancer as it is elevated with many others

ie. pancreatic, lung, liver and with other conditions like cirrhosis, endometriosis, etc.

218
Q

u/s is reliable at differentiating benign from malignant ovarian tumours - t/f

A

false

219
Q

sonographic guidelines for malignancy

A

thick septations
mural nodules
irregular walls
solid > cystic
larger in size >10cm
vascular, low resistance
ascites

220
Q

sonographic guidelines for benign tumour

A

no septations
no mural nodules
thin walls
hemorrhagic

221
Q

flow in septations or mural nodules of an ovarian lesion suggests __

A

malignancy

222
Q

what is the major mode of spread with ovarian malignancy

A

intraperitoneal metastasis

less common is:
direct invasion to surrounding structures
lymphatic dissemination
hematogenous dissemination

222
Q

how many stages are in ovarian malignancy

A

3

223
Q

complications of ovarian malignancy

A

ascites
bowel obstruction

223
Q

progressive accumulation of mucinous tumour cells that have implanted in the peritoneal cavity

A

pseudomyxoma peritonei

rare malignant growth associated with mucinous cystadenocarcinoma

224
Q

pseudomyxoma peritonei most often mets from __

A

mucinous appendix tumours

225
Q

what type of ovarian tumour is move prevalent in children and young adult females

A

germ cell tumours

226
Q

what are the 3 types of germ cell tumours

A

teratoma
dysgerminoma
choriocarcinoma

227
Q

what is the most common ovarian teratoma

A

dermoid cyst

228
Q

what is the most common ovarian neoplasm

A

dermoid cyst

229
Q

teratoma is derived from which germ layers

A

all three

  • endoderm
  • mesoderm
  • ectoderm
230
Q

benign cystic teratoma aka

A

dermoid cyst

231
Q

benign mature teratoma aka

A

dermoid cyst

232
Q

dermoid cyst derived from __ type of germ cell

A

ectoderm
(skin, teeth, hair, fat)

233
Q

what is the most common complication with a dermoid cyst

A

ovarian torsion

234
Q

dermoid cyst related to which sonographic sign

A

‘tip of the iceberg’ sign

235
Q

hyperechoic, shadowing mural nodule seen with dermoid cyst called __

A

‘dermoid plug’

Rokitansky nodule

236
Q

dermoid cyst similar appearance and often mistaken for __

A

surrounding bowel

237
Q

malignant teratoma aka

A

squamous cell carcinoma

rare; can arise from within a dermoid

238
Q

most common malignant gyne tumour during childhood

A

dysgerminoma

*can be bilateral

239
Q

what is likely dx with a child having a positive pregnancy test

A

dysgeminoma

5% secrete hCG

240
Q

sonographic features of dysgerminoma

A

solid, lobulated mass
nonspecific appearance

vascular

241
Q

which is the highly malignant germ cell tumour

A

pure ovarian choriocarcinoma

*can be bilateral

242
Q

which tumour secretes hCG in the absence of ongoing pregnancy

A

ovarian choriocarcinoma

243
Q

which tumour is more common to occur secondary to an abnormal pregnancy

A

ovarian choriocarcinoma

*primitive placental tissue

244
Q

what are the types of stromal tumours

A

ovarian fibroma
granulosa cell
granulosa-theca cell
Sertoli-Leydig

245
Q

most common stromal tumour

A

ovarian fibroma

usually unilateral

246
Q

ovarian fibromas may produce __

A

estrogen

*rarely

247
Q

are ovarian fibromas benign?

A

yes

248
Q

sono features of ovarian fibroma

A

non specific
solid, hypoechoic mass
+/-shadow
PCDS fluid
minimal to moderate vasculature

249
Q

what are the pitfalls of ovarian fibroma

A

pedunculated subserosal myoma
endometrioma

250
Q

ovarian fibroma with GROSS ascites and pleural effusion is __

A

Meigs’ syndrome

*usually benign

251
Q

majority of granulosa and granulosa-theca cell tumours occur in __ menopausal patients

A

post

252
Q

most of granulosa and granulosa-theca cell tumours secrete __

A

estrogen

*children can present with precocious puberty
*increased risk of endo hyperplasia and carcinoma in adults

253
Q

what is the malignant potential of granulosa and granulosa-theca cell tumours

A

low potential for maligancy

254
Q

which ovarian tumour can cause children to present with precocious puberty

A

granulosa and granulosa-theca cell tumours (stromal)

255
Q

sono features of granulosa and granulosa-theca cell tumours

A

non specific
smaller = solid
larger = cystic

vascular

256
Q

Sertoli-Leydig tumour aka

A

androblastoma

arrhenoblastoma

257
Q

which stromal tumour secretes testosterone

A

Sertoli-Leydig

258
Q

which ovarian tumour is derived from male embryological cells and present in female ovaires

A

Sertoli-Leydig

*androgen secretings
*virilization effects

259
Q
A
260
Q

Sertoli-Leydig occurs mostly in what age group

A

either young or old

*trick question

261
Q

majority of Sertoli-Leydig tumours are __

A

benign

have malignant potential though

262
Q

what are virilization effects

A

amenorrhea or oligomenorrhea

hirsutism

acne

voice deepening

clitoromegaly

263
Q

sono features of Sertoli-Leydig

A

non specific

264
Q

what are the most common mets to the ovary

A

Krukenberg tumours

265
Q

what is the primary cancer associated with Krukenberg tumours

A

GI cancers

266
Q

what is the prognosis of Krukenberg tumours

A

poor

solid and ALWAYS bilateral

267
Q

does the absence of internal flow rule out a neoplasm

A

no, neoplasms can still be cystic.

but internal flow indicates we are dealing with neoplasm .

268
Q

what is the expected vascular resistance of a benign neoplasm

A

high resistance

269
Q

any infection causing inflammatory disease of the uterus, tubes, ovaries, and general pelvis

A

PID

270
Q

what is most common reason for PID

A

STI

271
Q

rare cause of PID

A

tuberculosis

272
Q

what is peak incidence for PID

A

20-24y old

increased risk with intercourse at early age, multiple sexual partners, IUCD, multiple douching, etc.

273
Q

what are the infection pathways of PID

A

ascending (STI)

descending (sx)

hematogenous (tuberculosis)

274
Q

complication of PID

A

tubal damage (increased risk of ectopic and infertility)

chronic pain (adhesions)

hydrosalpinx

275
Q

clinical signs of PID

A

2/3 asymptomatic

276
Q

signs of acute PID

A

pelvic pain, discharge, fever, increased WBC

277
Q

signs of chronic PID

A

non specific
palpable adnexal mass
dull pelvic pain

278
Q

ddx of PID

A

acute appendicitis
endometriosis
ectopic pregnancy
ovarian tumour

279
Q

tx of pID

A

antibiotic to both sexual partners

u/s guided abscess drainage

280
Q

big role of EV for PID dx

A

assess tenderness with probe pressure

281
Q

general progression of PID

A

endometrITIS

acute alpingitis/oophoritis/hydrosalpinx

pyosalpinx/ tubo-ovarian COMPLEX

tubo-ovarian ABCESS

advanced adhesions

peritonitis

pelvic abscess

282
Q

sono features of endometritis

A

hyperechoic, heterogeneous, thickened endo

FF or fluid levels in ut cavity may indicate pyometra

283
Q

inflammatory thickening of fallopian tube

A

acute salpingitis

284
Q

signs of acute salpingitis

A

pelvic pain
fever
dyspareunia
leukocytes

285
Q

sono ‘sign’ with acute salpingitis

A

‘cogwheel’ sign

nodular, thick tubular adnexal mass
- dilated, tortuous
- wall thickness ~>5mm

286
Q

what is important additional assessment for suspected oophoritis

A

check with Doppler to r/o torsion

assess tenderness

287
Q

key features of hydrosalpinx vs. acute salpingitis

A

NON TENDER

associated with CHRONIC PID
- sequela of acute PID

does not usually change over time (serial u/s)

288
Q

sono ‘sign’ associated with hydrosalpinx

A

‘beads on a string’ sign

  • chronic remnants of cogwheel sign
289
Q

ddx of hydrosalpinx

A

adnexal cyst

290
Q

obstructed tube adhered to ovary +/- pyosalpinx

A

tubo-ovarian COMPLEX

  • assess with compression
  • can’t separate but both tube and ovary are distinct, identifiable structures
291
Q

advanced inflammatory mass involving tube (pyosalpinx) and ovary with extensive adhesion formation

A

tubo-ovarian ABSCESS

  • ovary and tube are not identified separately (appear like one big mass)
  • often bilateral
292
Q

__ flow in wall of tubo-ovarian abscess

A

increased flow

inner hyperechoic regions due to presence of purulent material

293
Q

sono sign associated with pelvic adhesions

A

‘frozen pelvis’ sign

difinitive dx by laparoscopy

294
Q

associated problems with advanced adhesive disease

A

chronic pain
infertility
bowel complications
- ie gross ascites

295
Q

lining of peritoneal cavity and most of abdominal and pelvic organs inflammed

A

peritonitis

  • can be diffuse or localized

may result from infection or from a non-infectious process

296
Q

sono features of peritonitis

A

non specific
ascites (+/- septations +/- echoes)
thickened GI tract walls
abscess formation

297
Q

clinical name of pus in cul de sac

A

pelvic abscess

associated with PID, sx, appendicitis, or inflammatory disease

298
Q

sonofeatures of pelvic abscess

A

adnexal fluid collection with debris
- may contain gas

tender with comp

no internal flow but may show peripheral flow

299
Q

clinical syndrome resulting from spread of PID around the liver

A

Fitz-Hugh-Curtis syndrome

perihepatitis

300
Q

patient presents with acute PID symptoms and associated RUQ abdominal pain

A

likely perihepatitis (FHC syndrome)

ddx GB disease

301
Q

sono features of FHC syndrome

A

fitz-hugh-curtis

perihepatic abscess (RUQ fluid)

thickened RIGHT anterior pararenal fat (compare RK and LK)

inflammation of GB

302
Q

genital tuberculosis likely originates in __

A

fallopian tubes

303
Q

how is genital TB different from normal PID progression

A

PID progression starts in endo and spreads to tubes

genital TB starts in tubes
*thus may impair reproductive function

304
Q

signs of genital TB

A

non specific
pelvic pain
AUB
infertility

305
Q

sono features of genital TB

A

varies
- can appear normal
- may progress from acute salpingitis through remaining stages of PID
- BILAT involvement of tubes is COMMON

306
Q

what is the diff between genital and pelvic TB

A

pelvic is usually secondary to TB elsewhere in the body
- hematogenous or lymphatic spread of bacteria to pelvis

307
Q

what is the type of spread of pelvic TB

A

hematogenous or lymphatic spread of bacteria to pelvis

grayish TB stud the peritoneal cavity including the serosal surface of organs

308
Q

what does pelvic TB mostly affect

A

tubes and uterus (serosal surfaces - does not penetrate mucosa)

309
Q

pelvic TB is __ in north america

A

rare

310
Q

clinical signs of pelvic TB

A

non specific

pelvic pain generalized

311
Q

sono features of pelvic TB

A

uterine serosal nodularity

ascites

omental thickening (CAKE)

bilad adn cystic masses

intraperitoneal fluid and adhesions

312
Q

ovarian fluid normally absorbed by the peritoneum gets trapped by extensive pelvic adhesions

A

peritoneal inclusion cysts

(paraovarian)

313
Q

likely hx associated with peritoneal inclusion cysts

A

previous hx of sx or PID

associated with pain

314
Q

peritoneal inclusion cysts are post inflammatory __ from the trapped fluid

A

pseudocysts

315
Q

pelvic adhesions __ the rate of peritoneal fluid absorption

A

decrease

*thus increase risk of peritoneal inclusion cysts forming

316
Q

sono features of peritoneal inclusion cyst

A

similar to paraovarian

fluid collection (pus or fluid) around ovary with SEPTATIONS
- ‘spider web’ appearance

may mimic ovarian neoplasms

tender with comp

317
Q

role of u/s with peritoneal inclusion cysts

A

dx inflammatory mass (debris? tender?)

monitor size with serial studies

guided placement of drainage catheter

318
Q

estrogen-dependent, chronic, inflammatory process

A

endometriosis

319
Q

one of the most common gyne diseases - affecting 15% premeno pt and account for 50% of pt experiencing chronic pelvic pain/ infertility

A

endometriosis

320
Q

two forms of endometriosis

A

diffuse (throughout peritoneum)

focal (blood-filled pseudocyst = endometrioma)

321
Q

speculated causes of endometriosis (2)

A
  1. chronic retrograde flow of menstrual blood through the tubes into pelvis; implanting and proliferating endo cells with cyclic bleeding
  2. cells that retain embryonic capacity to differentiate in response to hormonal stimulation
322
Q

what is the most common site of endometriosis implants

A

ovary

323
Q

risk factors for endometriosis

A

genetics
previous infections
nullparity
++incidence in pt that have had laparoscopy

324
Q

signs and symptoms of endometriosis

A

asymptomatic
**premenstrual pain
dysmenorrhea
chronic cyclic pelvic pain
dyspareunia
increased risk of infertility or ectopic pregnancy

325
Q

symptoms of endometriosis depend on __ of endometrial lesions

A

site, size and number

326
Q

what is the gold standard for dx endometriosis

A

direct visualization and biopsy via laparoscopy

MRI best imaging modality

327
Q

how many stages of endometriosis are there

A

4

328
Q

in a pregnant pt, within an ovary is seen a solid vascular mural nodule that cannot be differentiated from malignancy. what is the ddx

A

decidualized endometrioma

329
Q

sono ‘sign’ associated with severe endometriosis

A

‘kissing ovaries’

330
Q

endometriosis increases risk of ___ (type of ovarian malignancy) by 3x

A

clear cell carcinoma

331
Q

endometriosis significantly increases risk of ___ (type of skin malignancy)

A

cutaneous melanoma
*from melanocytes

332
Q

partial hysterectomy aka

A

subtotal

333
Q

what is the diff between a total and a subtotal hysterectomy

A

subtotal leaves the cervix behind

334
Q

what is the difference between a hysterectomy with bilat salpingo-oopherectomy and a RADICAL hysterectomy

A

upper vagina and surrounding tissues (including nodes) are removed in a RADICAL hysterectomy

335
Q

vaginal cuff signs of malignancy

A

> 2.1 cm AP

mass

areas of high echogenicity

336
Q

what is most common type of LSCS incision

A

Kerr incision

337
Q

postpartum endometritis most common after __ delivery

A

csec

338
Q

sono features of post partum endometritis

A

thickened, hyperechoic +/- heterogeneous endo

fluid

+/- gas bubbles (suggests bacterial abscess)

339
Q

ovarian vein thrombosis or thrombophlebitis may occur __ hours postpartum

A

48-96 hours

340
Q

ovarian vein thrombosis or thrombophlebitis is caused by __ and spread of bacterial infection from endometritis

A

venous stasis

341
Q

what is the biggest concern regarding ovarian vein thrombosis or thrombophlebitis

A

pulmonary emboli

342
Q

sono features of ovarian vein thrombosis or thrombophlebitis

A

adn mass lateral to ut and anterior to psoas m.

dilated ovarian vein with echogenic thrombus

dilated IVC with echogenic thrombus

absence of flow

343
Q

majority of ovarian vein thrombosis or thrombophlebitis occur on which side

A

RIGHT (90%)

*retrograde flow on left protecting vein during pueperium

344
Q

what is pueperium

A

the 6 weeks post partum when the mother’s uterus adjusts back to normal

345
Q

sono features of RPOC

A

thickened endo

heterogeneous mass

variable Doppler

346
Q

common gyne complications from radiation and chemo treatment

A

radiation cystitis (associated with dysuria and diminished baldder volume)

vesicovaginal fistula (b/t bladder and vagina)

347
Q

__ allows for continuous, involuntary discharge of urine into the vagina

A

vesicovaginal fistula

348
Q

__ insertes into the cx for tx of cervical cancer

A

cesium implants

*interstitial brachytherapy

349
Q

acute appendicitis is the inflammation of the __ appendix in RLQ

A

vermiform

350
Q

most common cause of acute appendicitis in children

A

lymphoid hyperplasia

351
Q

most common cause of acute appendicitis in adults

A

fecalith

352
Q

most common position of appendix

A

oblique and vertical

inferior and medial to CECUM

anterior and medial to PSOAS m.

lateral to iliac vessels

353
Q

appendix is __ to iliac vessels

A

lateral

354
Q

where is the appendix if it is retrocecal

A

curled posterior to the cecum

355
Q

clinical manifestation of acute appendicitis

A

periumbilical pain, shifting to McBurney’s point

anorexia
nausea
vomiting
leukocytes
fever/chills

356
Q

where is McBurney’s point

A

1/3 distant from ASIS to umbilicus

357
Q

McBurney’s point is site of __ tenderness and pain with acute appendicitis

A

rebound

358
Q

ddx of acute appendicitis

A

PID
ovarian cyst bleeding/rupture
ovarian torsion

359
Q

which probe should you use to find acute appendicitis

A

linear array 5MHz minimum

AND MILK IT (graded pressure)

360
Q

what is expected of acute appendicitis with compression

A

non compressible

point tenderness

361
Q

acute appendicitis AP diameter

A

> 6 mm

wall >2 mm

362
Q

what flow do you expect in acute appendicitis

A

flow in the wall

363
Q

sono features of acute appendicitis

A

blind ended, finger like tubular structure connected to cecum

non compressible

point tenderness

fecalith (hyperechoic focus with shadowing)

adjacent FF

hyperechoic surrounding fat

364
Q

inflammatory spreading deep into the layers of the terminal ileum and/or colon

A

Crohn’s disease

365
Q

inflammation of small pouches in the wall of the colon

A

diverticulitis

366
Q

long-lasting inflammation and ulcers to the innermost lining of the colon and rectum

A

ulcerative colitis

367
Q

what sono ‘sign’ is associated with inflamed bowel

A

‘pseudo kidney’ sign

368
Q

grossly dilated, fluid filled loops bowel

A

consistent with bowel obstruction

369
Q

hematoma communicating with the artery forms outside the artery

rare complication of gyne sx from trauma to arterial wall (ie ut artery)

A

arterial pseudoaneurysm

*not truly an aneurysm (breach in vessel wall)

370
Q

sono features of arterial pseudoaneurysm

A

2D - pulsating, hypoechoic lesion inside UT

CD - turbulent flow

Pulsed - pan-diastolic flow reversal

371
Q

what sono sign is associated with arterial pseudoaneurysm

A

yin yang sign
*blood flows in during systole, out during diastole

372
Q

abnormal connection between an artery and vein

A

ateriovenous fistula (AVF)

may be congenital, sx created, or acquired

373
Q

dilated, tortuous pelvic veins > 5 mm AP

A

pelvic varicosities

374
Q

most common associations with pelvic varicosities

A

multiple pregnancies

retroverted uterus

375
Q

signs symptoms of pelvic varicosities

A

asymptomatic or associated with pelvic congestion syndrome

376
Q

pelvic varicosities more common on which side

A

LEFT

dur to less efficient drainage of left ovarian vein

377
Q

extensive pelvic varicosities; associated with chronic pain, dyspareunia and ovarian point tenderness on physical exam

A

pelvic congestion syndrome

378
Q

sono features of pelvic congestion syndrome

A

multiple dilated pelvic veins

dilated arcuate veins in outer myo

thickened endo

polycystic changes to ovaries

tender EVS compression over dilated veins

dilated ovarian vein with REVERSED flow

variable venous waveforms with valsalva and upright

379
Q

pelvic congestion syndrome often associated with __

A

reflux of the internal iliac veins

380
Q

what is the most important role of a sonographer regarding assessment of postsurgical masses

A

CORRELATION WITH CLINICAL HISTORY

*abscess, lymphocele, urinoma, hematoma, seroma

381
Q

encapsulated collection of urine formed spontaneously, from renal injury or sx intervention

A

urinoma

382
Q

site specific pelvic hematomas that are extraperitoneal (3)

A

rectus sheath
space of Retzius
bladder flap

383
Q

a rectus sheath hematoma is __ peritoneal

A

extraperitoneal

caused by muscle or artery tears

384
Q

symptoms of rectus sheath hematoma

A

acute, sharp persistent NON RADIATING pain

385
Q

location variants of rectus sheath hematoma depend on whether it is superior or inferior to __

A

the arcuate line

inferior means it can cross misline

386
Q

can rectus sheath hematomas track into the peritoneal cavity

A

no

387
Q

where is the space of Retzius

A

between the symphysis and the bladder

388
Q

space of Retzius aka

A

retropubic space

prevesicular space

389
Q

space of Retzius usually contains __

A

subcutaneous fat

390
Q

a hematoma in the retropubic space may displace the bladder which way

A

posteriorly

391
Q

vesicouterine fold of peritoneum incised during low cervical csec is called

A

bladder flap

*incision separates baldder from uterus to expose lower uterine segment

392
Q

is a seroma associated with infection

A

no. it is a collection of serous fluid within tissue. May form in the defect left after a resolved hematoma

393
Q

paraovarian cysts aka

A

paratubal cysts, broad ligament cysts

any cyst not arising from ovary or tube

394
Q

paraovarian cysts arise from __

A

remnants of embryonic genital ducts

*though other adn cysts can be described as paraovarian if they are separate from ovary

395
Q

sign and symptoms of paraovarian cysts

A

generally asymptomatic

pain associated with pressure effects, hemorrhage, or infeciton if cyst is large

396
Q

sono features of paraovarian cysts

A

unilateral

generally small <5 cm

simple

separate from ovary

397
Q

what should be checked when finding a large paraovarian cyst

A

kidneys
*may compress adjacent ureters causing hydro

398
Q

caused by invasion of either inflammatory cells or neoplastic cells

A

pelvic lymphadenopathy / adenopathy

399
Q

neoplastic pelvic lymphadenopathy is most often metastatic from __

A

cx or endo cancers

400
Q

complex adnexal masses aka

A

CHEETAH

cystadenoma
hemorrhagic cyst
endometrioma
ectopic
teratoma
abscess
hydrosalpinx

401
Q

incidence of __ increases dramatically postmenopause

A

ovarian cancer

402
Q

neonatal ovarian cysts cause by __

A

stimulation of fetal ovaries by maternal hormones

ddx mesenteric or enteric cysts

403
Q

neonate ovarian cysts of what size may present with torsion

A

> 4cm

404
Q

internal reproductive organs of one sex while echibiting some external physical characteristic of opposite sex

A

pseudohermaphroditism

405
Q

both male and female sexual characteristics and organs - presence of ovarian and testicular tissue (ovotestis)

A

true hermaphroditism

406
Q

true hermaphroditism aka

A

chimerism

407
Q

what is the common karyotype of chimerism

A

46XX

408
Q

what presentation is femal pseudohermaphroditism

A

masculinization
46XX

fetal exposure to excessive androgens

409
Q

what is the most common cause of female pseudohermaphroditism

A

congenital adrenal hyperplasia

410
Q

what is the presentation of male pseudohermaphroditism

A

undermasculinization
46XY

inadequate production of testosterone and mullerian-inhibiting factor (MIF) by fetal testes

411
Q

what gene mutation can alter development of sexual characteristics

A

congenital adrenal hyperplasia

*abnormally low production of cortisol resulting in hyperplasia and overactivity of steroid-producing cells of adrenal cortex

412
Q

genital presentation of male pseudohermaphroditism

A

severe micropenis
empty scrotum

413
Q

genital presentation of female pseudohermaphroditism

A

enlarges clitoris with fused, prominent labia

presence of ut and ovaries internally

414
Q

most common cause of precocious puberty

A

idiopathic

415
Q

what is the most common prepubertal uterine mass

A

rhabdomyosarcoma

416
Q

what is the most common prepubertal ovarian mass

A

cystic teratoma (dermoid)

417
Q

what are the main causes of primary amenorrhea

A

Mayer-Rokitansky-Kuster-Hauser syndrome

imperforate hymen

Turner syndrome

418
Q

syndrome causing vaginal agenesis, uterine hypoplasia/ agenesis with presence of ovaries, external genetalia and tubes

A

Mayer-Rokitansky-Kuster-Hauser syndrome

MRKH

419
Q

what is the karyotype of MRKH syndrome

A

normal
46xx

420
Q

what is the karyotype for Turner syndrome

A

45, x0

421
Q

which syndrome is associated with streak ovaries

A

turner

422
Q

short stature, webbed neck, absence of secondary sexual characteristics, affecting only females

A

turner syndrome

423
Q

main causes of secondary amenorrhea

A

pregnancy
functional ovarian cyst
PCOS

424
Q

urachal fistula open to the bladder aka

A

patent urachus

425
Q

cysts that arise from urachal remnant called

A

urachal cyst

426
Q

sono features of urachal cyst

A

anterior, ML cyst between bladder and umbilicus

typically small (<5cm) simple cyst

can infect or hemorrhage

427
Q

what are the 3 presentations of urachal cyst

A

simple urachal cyst

urachal sinus communicating with bladder

patent urachus

428
Q

are urachal cysts tender

A

they can be

429
Q

involuntary leakage of urine associated with increase in vesicular pressure

A

USI (urinary stress incontinence)

430
Q

what gyne pathology is associated with pleural effusion

A

Meigs syndrome

gyne malignancy

pseudomyxoma peritonei

severe OHSS

431
Q

para-aortic lymphadenopathy may be associated with __

A

cervical, endometrial, or ovarian cancers

432
Q

peritoneal mets associated with

A

ovarian cancer

433
Q

leiomyoma aka

A

fibroma
fibromyoma
myoma
fibroid

benign tumour

434
Q

what is a fibroid made of

A

smooth muscle and collagen

435
Q

what is the most common uterine mass

A

myoma

436
Q

epidemiology of myoma

A

obesity
heredity
nulliparous
>30 years old
25% white
50% black

estrogen dependent

437
Q

at what point in a womans life are myomas less likely to grow

and why

A

before puberty or after menopause

because they are estrogen dependent

438
Q

what is the most common classification of a fibroid

A

intramural

entirely within the myometrium

no distortion of uterine contour

439
Q

which classification of myoma distorts the endo contour because of its placement within the inner myometrium

A

submucosal

440
Q

which classification of myoma causes changes to the uterine contour

A

subserosal

441
Q

what are the two types of myoma that can be ‘cornual’ and affect tubal patency

A

intramural or subserosal

442
Q

name for myoma in the broad ligament sheets that may be pedunculated

A

intraligamentary

*subserosal

443
Q

which classification of myoma is most likely to cause hydronephrosis

A

intraligamentary subserosal

444
Q

which classification of myoma may cause ureteral obstruction

A

cervical myoma

445
Q

usualy symptom of myoma

A

asymptomatiic

446
Q

general symptoms of myomas

A

*depends on type, size, no.

hypermenorrhea
pelvic pain
dysmenorrhea
pressure related effects
infertility
pregnancy related disorders

447
Q

which classifications of myomas are most likely to affect fertility

A

cornual and submucosal

448
Q

uterine artery embolization can treat which classifications of fibroids

A

intramural or submucosal

449
Q

ddx of submucosal myoma

A

endo polyp

450
Q

what can help dx a submucosal myoma

A

sonohysterography

451
Q

ddx of hyperechoic myoma

A

uterine lipoma

*u/s cannot distinguish

452
Q

what type of degenerative change of a myoma is expected with torsion

A

necrosis from vascular impairment

453
Q

what type of degenerative change of a myoma is expected following necrotic or hyaline degredation and liquification

A

cystic degeneration

454
Q

what is red or carneous degeneration (of myoma)

A

localized hemolysis resulting in necrosis

  • occurs frequently in pregnancy
455
Q

what type of degenerative change of a myoma is expected with localized hemolysis resulting in necrosis

A

calcific

*more common in larger myomas where the blood supply is compromised

456
Q

what type of degenerative change of a myoma is expected with malignant changes within a formerly benign myoma

A

sarcomatous degeneration

457
Q

red degeneration of myoma during pregnancy associated with __

A

acute pain and tenderness

458
Q

uterine lipoma aka

A

leiomyolipoma

lipoleiomyoma

fibromyolipoma

myolipoma

*NOT LIPOSARCOMA

459
Q

what vascularity is expected in a uterine leiomyolipoma

A

avascular

460
Q

uterine lipoma vs. dermoid cyst - what would you look for

A

origin of mass
document 2 normal ovaries or inability to confirm

461
Q

most common location of uterine sarcoma

A

myometrium

can still happen within endo or myoma

462
Q

what is the most common type of sarcoma

A

leiomyosarcoma

463
Q

what is the most common presentation for ut sarcoma

A

post meno AUB

464
Q

sarcoma characteristics

A

rapid, sudden growth

solid mass often with cystic component

local invasion (most common) or mets

465
Q

Doppler for ut sarcoma

A

higher peak systolic velocities

variable flow

466
Q

term for migration of endo glands from stratum basalis into myometrium

A

adenomyosis

467
Q

what are the types of adenomyosis

A

focal (adenomyoma)

diffuse (infiltrative)

468
Q

most common demographic for adenomyosis

A

parous pt in 30s and 40s

*estrogen dependent
*decreases after menopause

469
Q

speculative causes of adenomyosis

A

direct invasion from csec

deposits from developing a fetus

deposits after labour and delivery (break in normal boundary between endo and myo)

470
Q

signs of adenomyosis

A

dysmenorrhea

ut enlargement

hypermenorrhea (more blood)

pain, tenderness

dyspareunia

471
Q

sono features of adenomyosis

A

streaky shadowing
refractive b/c lower velocity

heterogeneous, bulky ut

eccentric enlargement of endo

cysts

focally tender

scattered vascularity

+/- calcs

472
Q

what type of shadowing artifact causes myomas to shadow

A

attenuating shadows

473
Q

what is AVM

A

arteriovenous MALFORMATION

*all AVM are AVF but not all AVF are AVM

474
Q

what is the most common type of AVF

A

acquired
*trauma, sx, GTD

475
Q

abnormal development of primitive vessels

A

AVM

476
Q

symptoms of AVF

A

metrorrhagia
ut pain
catastrophic hemorrhaging with D&C

477
Q

sono features of AVF

A

non specific

subtle heterogeneous myo

tubular spaces within myo

intramural ut, endo, or cx mass

prominant parametrial vessels (within tissues joining cx and bladder)

478
Q

Doppler of AVF

A

intense colour signals with aliasing

high PSV (suggestive of AV shunting)

low resistance flow

479
Q

mucus-filled cervical cysts called

A

nabothian

480
Q

nabothian cysts associated with subclinica __

A

cervicitis

481
Q

nabothian cysts may cause the blockage of a gland due to __

A

inflammation and metaplasia

482
Q

what role does u/s play in cervical cancer

A

NO ROLE in dx or staging
(done with biopsy)

u/s helpful in assessing associated conditions
*urinary obstruction
*radiation cystitis from therapy *vesicovaginal fistula

483
Q

sono features of cervical cancer

A

cervical enlargement

evidence of invasion

ut cavity fluid

pelvic lymphadenopathy

hydronephrosis

ascites, PE

liver mets

484
Q

clinical cymptoms of radiation cystitis

A

bladder wall thickening (inflammation) secondary to radiation tx of cervix

focal or diffuse

485
Q

narrowing of cx canal

A

cervical stenosis

486
Q

causes of cx stenosis

A

postmenopausal cervical atrophy

benign or malignant disease of ut

radiation fibrosis

487
Q

cervical stenosis may be associated with __

A

ut enlargement and pain

ut filling with fluid

488
Q

what is the medical term for normal tissue folds in the cervical canal

A

plicae palmatae

489
Q

increased incidence in vaginal cancer with __ exposure

A

DES in utero

490
Q

localized, mass-like overgrowth of normal endometrial tissue

A

polyp

made of glands and stroma

491
Q

higher incidence of endo polyps in __

A

anovulatory patients

492
Q

signs and symptoms of endo polyps

A

frequently asymptomatic

AUB (most common)

symmetric ut enlargement

prolapse into cx

pregnancy failure

493
Q

what are the cystic areas within a polyp

A

dilated glandular tissue

494
Q

what menstrual phase is best for sonographically assessing an endo polyp

A

early proliferative (day5~)

because endo SHOULD be thin

495
Q

generalized overgrowth of endo

A

endometrial hyperplasia

496
Q

what is the most common cause of AUB

A

endo hyperplasia

497
Q

who is most likely to experience endo hyperplasia

A

PCOS

chronic anovulatory cycles

obesity

unopposed estrogen HRT

498
Q

normal endo measurements for post menopausal pt

A

</= 5 mm (bleeding)

</= 8 mm (not bleeding)

499
Q

what is the most common gyne malignancy

A

endo carcinoma (adenocarcinoma)

500
Q

strong association of endo carcinoma with __

A

unopposed estrogen HRT in post meno pts

501
Q

most common sign/ symptom of endo carcinoma

A

painless post meno bleeding

502
Q

risk factors for endo carcinoma

A

hormone imbalance

nulliparous

obesity

unopposed est HRT

503
Q

why is MRI important for dx endo carcinoma

A

shows extent of myometrial invasion

504
Q

associated findings with endo carcinoma

A

pelvic lymphadenopathy

parametrial invasion

myometrial invasion

505
Q

what is the tamoxifen effect

A

prevents estrogen from stimulating tumour growth in breast

increases risk of endo cancer in post meno pt because STIMULATES hyperplasia, polyps and cancer

506
Q

sono features of tamoxifen effect

A

endo hyperplasia

cystic changes to endo/subendo

polyps

+/- ut growth

+/- myoma growth

+/- ovarian cysts

507
Q

synechiae aka

A

endo adhesions

Asherman syndrome

508
Q

associations with synechiae

A

infertility and miscarriage

509
Q

causes of endo microcalcifications

A

normal post partum

endometritis

PID

post sonohysterography

post ut artery embolization

AVF

510
Q

the calcification of dead, damaged or degenerative tissue

A

dystrophic calcification

related to previous instrumentation

511
Q

echogenic foci in endo from retained fetal tissue called

A

osseuos metaplasia

512
Q

association with osseous metaplasia

A

secondary infertility

513
Q

most common associations with endometritis

A

PID

postpartum

post instrumentation

514
Q

symptoms of endometritis

A

AUB

fever

pain

515
Q

myometrial calcifications causes

A

myomas (dystrophic calc)

adenomyosis

walls of collapsed cysts

516
Q

alternative to hysterectomy for heavy bleeding

A

endo ablation

517
Q

which layer of tissue is removed with endo ablation

A

functional and basal endo

OBGYN (8 decks)

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