broken lady bits Flashcards
(519 cards)
1
Q
congenital ut anomalies aka __
A
müllerian duct anomalies
2
Q
what happens if there is failure of mullerian duct organogenesis
A
one or both ducts underdevelop
3
Q
result of bilaterally underdeveloped organogenesis
A
uterine agenesis or hypoplasia
4
Q
result of unilateral failure of organogenesis
A
unicornuate ut
5
Q
what is the result of failure of fusion step of mullerian duct development
A
bicornuate or didelphys ut
6
Q
most congenital malformations are due to incomplete fusion of the __
A
ureterogenital primordium (ut and upper vagina)
7
Q
lower segments of mullerian ducts fuse to form __
A
ut, cx, and upper vagina
8
Q
what is the result of failure of septal resorption step of mullerian duct development
A
septate ut
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
10
Q
what does DES stand for
A
diethylstilbestrol
11
Q
there is a greater incidence of congenital ut anomalies among pts that are __
A
infertile
12
Q
what is most common association with congenital ut anomalies
A
unilateral renal agenesis
13
Q
what is the rate of congenital ut anomaly with unilat renal agenesis
A
55-75%
14
Q
what is rate of renal anomalies when there is a case of congenital ut anomaly
A
20-30%
15
Q
which congenital ut anomaly is associated with the highest incident of renal anomalies (nearly 50%)
A
unicornuate ut
16
Q
renal tissue cannot develop without __
A
ureteric bud
17
Q
renal agenesis occurs due to a failure of __
A
ureteric bud to form from distal end of Wolffian
18
Q
what constitutes a recurrent abortion
A
> /= 3 losses in a row
19
Q
what is the most accurate imaging modality for ut anomalies
A
MRI
20
Q
what is likely the ut anomaly when seeing a blind ended vagina
A
uterine agenesis
21
Q
does a unicornuate ut have fallopian tube
A
yes
22
Q
unilateral mullerian duct agenesis results in __
A
unicornuate ut
23
Q
incomplete development of one mullerian duct results in the formation of a __
A
rudimentary horn
24
Q
how many ovaries does a unicornuate ut have
A
2
develop independently
25
which side is most common for rudimentary horn
right
26
two types of rudimentary horns
non obstructed (soft tissue iso mass)
obstructed (functioning endo)
27
double ut aka
didelphys
28
didelphys due to near complete failure of __
fusion
29
can you see a vaginal septum on u/s
very difficult unless obstructed
30
name of congenital anomaly with 2 separate, symmetrical ut bodies
uterus didelphys
31
didelphys associated with infertility T/F
false- if anything, 2x chance lol
32
bicornuate ut aka
bicornis
33
name of congenital anomaly where incomplete fusion of ut at level of the body/fundus
bicornuate
34
name of congenital anomaly with 2 cornu and 2 cervices
bicornuate bicollis
35
name of congenital anomaly with 2 cornu and 1 cervix
bicornuate unicollis
36
bicornuate fundal cleft __ cm sonographic to distinguish heart shape from septate
>1 cm
coronal EV most reliable plane of section
37
__ required to make final diagnosis of bicornuate ut
MRI and physical exam
otherwise hard to delineate 1 or 2 cervices
38
what is the reproductive outcome of bicornuate uterus
highest rate of incompetent cervix
39
name of congenital anomaly with partial or complete failure of septum resorption after mullerian duct fusion
septate uterus
40
septate ut aka
uterus septus
failure of resorption
41
what are the two types of septate ut
septate (septum extends to internal os)
subseptate (partial)
42
which is the most common congenital ut anomaly
subseptate uterus (partial septum)
43
what is the distinguishing feature of septate vs bicornuate ut
septate <1cm concave fundal contour
bicornuate >1cm convex heart shape fundus
44
in septate ut, the septum is composed of __
poorly vascularized fibromuscular tissue
45
reproductive outcome of septate ut
poor
abnormal fetal lie and presentation
postpartum bleeding and secondary RPOC
46
reproductive outcome of unicornuate ut
related to infertility and pregnancy loss
47
is differentiating septate v. bicornuate important? why?
tx is different
septate requires hysteroscopic resection of ut
48
name of congenital anomaly with saddle-like defect to fundal ut cavity
arcuate ut
normal serosal contour
49
arcuate ut is arguably a __
normal variant
50
reproductive outcome of arcuate ut
slight risk of spontaneous abortion and premature labour
51
what is the rate of ut anomaly to female fetuses exposed to DES in utero
66%
52
what are the complications with DES daughters
congenital anomalies of repro tract
clear cell adenocarcinoma of upper vagina
53
what would you expect to see with a DES daughter's pelvic scan
small, T shaped endo cavity
small ut (hypoplasia)
ut constriction rings (aka narrowing stenoses)
54
what is the gold standard for assessing DES malformation
MRI
55
reproductive outcome of DES malformation
ectopic (due to abnormal fallopian tubes)
spontaneous abortion
premature labour (cervical incompetence)
56
term for accumulation of blood in ut and vagina
hematometrocolpos
57
vaginal septum has __ origin
mullerian origin
usually related to cranial vagina
58
vaginal septum most commonly associated with __
ut didelphys
59
open or closed vaginal septum associated with ut didelphys is called a
longitudinal septum
60
a closed vaginal septum resulting in hematocolpos or hematometrocolpos with primary amenorrhea is referred to as
a transverse septum
61
__ covers and obstructs the vaginal canal
imperforate hymen
62
imperforate hymen mimics __ but is not a mullerian defect
low transverse septum
63
what is a mechanical cause of primary amenorrhea
imperforate hymen
64
NSA, adolescent with cyclic pelciv pain lasting several days (pubertal age) with primary amenorrhea likely experiencing
imperforate hymen
65
term for vaginal agenesis and uterine hypoplasia/agenesis
MRKH
66
MRKH stands for
Mayer-Rokitansky-Kuster-Hauser syndrome
67
cause of MRKH
unknown
normal external genitalia, ovaries, and tubes
68
what is likely happening to a pt with blood distended ut and absent vagina
MRKH syndrome
69
what is the average size of hydatid cyst of morgagni
<1cm
often too small to see with u/s
simple paraovarian cyst separate from ovary
70
gartner duct cysts potential remnants of __
wolffian ducts
71
mucus-filled cysts within myometrium are called
nabothian cysts
72
nabothian cysts aka
blocked glands
73
what is the ddx for a gartner duct cyst
Bartholin gland cyst
74
term for new but abnormal growth of a tumour
neoplasm
75
is a neoplasm benign or maignant
can be either
76
an abnormal increase in no. of normal cells
hyperplasia
77
an abnormal increase in the size of normal cells
hypertrophy
78
term for the inability to conceive within 12 months of regular attempts
infertility
79
a woman >/= 35 y is considered infertile if unsuccessful when trying for __ months
6
80
rates of primary infertility have __ in the last 20 y
increased
81
term for the inability to conceive or maintain a pregnancy after having been successful at least once
secondary infertility
82
what are the risk factors for infertility
age
smoking/alcohol use
over/underweight
excessive exercise
caffeine
PID
endometriosis
83
causes of infertility
inability for:
production of oocytes
oocytes meeting
implantation
carrying to viability
84
what is the rate of male factor in infertility
40%
85
what is the most common cause of female factor infertility
tubal disease
(secondary to PID, endometriosis, previous ectopic)
86
female causes of infertility
tubal disease
ovarian dysfunction
cervical factor
ut abnormalities (myomas, septate congenital, etc)
87
how do you dx DES malformation
hestersalpingography
88
increased risk of __ of vagina, infertility, spontaneous abortion and preterm delivery with DES malformation
clear cell adenocarcinoma of the vagina
89
infertility due to presence of synechiae (+/- calcifications)
Asherman syndrome
90
Asherman syndrome presents secondary to __
scarring from trauma or sx
ie. D&C
91
3 important tests for infertility in female
tubal patency
uterine disease
assessment of ovarian reserve
92
a decline in no. of follicles and oocyte quality is a diminished __
ovarian reserve
93
ART stands for
assistive reproductive therapy
94
what role does u/s have in ART
ovarian follicle count for reserve assessment
95
the timed hormonal injections which stimulate follicular development and ovulation is called
ovarian hyperstimulation therapy
96
ovarian hyperstimulation therapy may cause __
OHSS (ovarian hyperstimulation syndrome)
97
common signs of OHSS are
theca lutein cysts
pelvic pain
abdominal distention
98
common OHST drugs
clomephene citrate (Clomid, Serophene) -> stimulates pituitary
human menopausal gonadotropin (Perganol, Repronex) -> stimulates ovary directly
99
diameter of follicle with OHST pre ovulation
~20mm
+/- cumulus oophorus
100
OHSS most commonly occurs with which rx
pergonal and reprones (hMG)
101
IVF stands for
in vitro fertilization
102
IUI stands for
intrauterine insemination
103
GIFT stands for
gamete intrafallopian transfer
104
ZIFT stands for
zygote intrafallopian transfer
105
ICSI stands for
intracytoplasmic sperm injection
106
what is the most common ART technology used
IVF
107
ovum and sperm combined in a dish, resultant zygote transferred to ut at blastocyst stage
IVF
~5 days after conception
108
pregnancy rate of IVF
30-40%
109
live birth rate of IVF largely depends on __
age of pt
<35 y 32%
>40 y 12%
110
parameters positively affecting pregnancy rate is presence/absence/direction of __
subendometrial myometrial contractions
**dr. lyons publication
retrograde motion (cx to fund) at peak incidence during preovulatory period
111
heterotopic pregnancy incidence increased with __
IVF
112
frozen sperm inserted directly into the ut
IUI
used with male factor infertility
113
laparoscope used to insert ovum and sperm directly into fallopian tube
GIFT
used for cervical factor and unexplained infertility
114
GIFT requires a normal __
fallopian tube
115
2 step procedure
1 - ovum fertilized in lab dish
2 - transfer to fallopian tube
ZIFT
transfer of zygote
most invasive
116
single sperm injected into ovum and returned to ut in ~5 days is
ICSI
transfer of blastocyst
used for severe male factor infertility or repeated failed IVF
117
abnormal development, growth or differentiation of cells is
dysplasia
118
adnexal masses are most commonly __
ovarian
119
ovarian masses are most commonly __
cystic
120
large ovarian masses can cause __
hydronephrosis
121
bilateral ovarian dysgenesis aka
streak ovaries
122
streak ovaries primarily associated with __
Turner syndrome
123
what chromosomal abnormality is 45x0
turner syndrome
124
absence of all or part of one x chromosome is
turner syndrome
125
characteristics of person with turner syndrome
short stature
absence of secondary sexual characteristics
infantile genetalia
streak ovaries
126
hypoplastic ovaries with nonfunctional tissue called
streak ovaries
127
streak ovaries are a result of hormonal disruption;
__ EST, __ FSH, __ LH
low est
high fsh
high lh
128
additional ovaries that develop separate from normal ovary called
supernumerary ovaries
129
additional ovary that is attached to an ovary is called
accessory ovary
*functional
130
what is the most common cause of palpable adnexal masses in young adult females of reproductive age
non neoplastic ovarian pathology
131
sonographic detection and characterization of ovarian pathology is __ acurate
highly
132
what differentiates a normal follicle from a follicular cyst
>2.5 cm
will not ovulate or rupture
133
follicular cyst should regress spontaneously within __
3 months
134
follicular cysts may secrete __
estrogen
can cause menstrual disturbance
135
what is the difference between a CL and a CL cyst
CL cyst is persistent
*failure of resorption
*bleeding into CL
136
CL cyst may secrete __
progesterone
137
normal CL secretes __
prog and est
138
normal CL stimulated by __ that triggered ovulation
LH surge
139
CL cyst often associated with
missed or delayed periods
140
CL cysts are usually __ in size
3-5 cm
141
CL cyst of pregnancy secretes __
this secretion is taken over by placenta after __ GA and CL resolves
progesterone
12w GA
142
what is difference between corpus albicans and corpus albicans CYST
trick q. unable to ddx from CL
but no hormonal activity
143
a cyst into which there has been bleeding
hemorrhagic
144
the 2 most common types of hemorrhagic cysts
corpus hemorrhagicum (CL)
endometrioma
145
most patients with hemorrhagic cysts relay what clinical signs
acute, onset lower abd pain
146
what is the evolution of a hemorrhagic cyst
1 - acute hemorrhage
2 - clot formation
3 - clot retraction
147
sonographic appearance of early hemorrhagic cyst
blood is echogenic as it clots
*various appearances of mixed, diffuse and fibrin mesh
148
sonographic appearance of late stage hemorrhagic cyst
decreasing echogenicity as the clot lyses
149
what is the vascularity of a hemorrhagic cyst
avascular
can be flow in wall
150
what are the 2 forms of endometriosis
diffuse
localized (endometrioma)
151
which type of endometriosis is more common
diffuse
endo implants throughout peritoneum
152
endometrioma aka
chocolate cyst
153
what is the relationship of endometrioma to hormones
does not secrete
is affected by cyclic est and prog levels (cyclic bleeding)
154
clinical hx with endometriosis
+/- dysmenorrhea
+/- dyspareunia
+/- infertility
155
what is the slam dunk characteristic of endometrioma
calcifications in cyst wall
156
what can happen to endometriomas within pregnant pts
decidualization of the wall
results in solid, VASCULAR mural mass that CANNOT be ddx from malignancy
157
what causes theca lutein cysts
hyperstimulated ovaries (hCG) -abnormal pregnancy (GTD, hydrops, multiples)
-normal pregnancy (rare)
- ART
or oversensitive ovaries
158
theca lutein cysts regress when __ is removed
hormonal stimulus
159
in normal ovary, __ line the functional cysts
theca cells
160
would you expect to see ascites with theca lutein cysts
no
161
theca lutein cysts are always __
bilateral
162
theca lutein cysts occurring with a normal IUP and normal levels of hCG is referred to as
hyperreactio luteinalis
ovaries are just really sensitive to hCG
163
term for small, simple cyst in or on a post-menopausal ovary
serous inclusion cyst
164
what is the typical size of a serous inclusion cyst
<2.5-3cm
165
how do you distinguish a serous inclusion cyst from an ovarian or paraovarian cyst
you cannot
166
what is the speculated cause of a serous inclusion cyst
cyst pinched off from indentations in the surface epithelium of the ovary
no hormonal activity
167
what is the alternate name for PCOS
Setin-Leventhal syndrome (SLS)
168
what type of hormonal disorder is PCOS
endocrine
metabolic
**not an ovarian disease
169
what is the most common hormonal disorder among females of reproductive age
PCOS
170
PCOS associated with chronic __ due to hormonal imbalance
anovulation
171
clinical features of PCOS
amenorrhea
hirsutism
obesity
+/- infertility
+/- serum androgens
high LH
normal to low FSH
ratio results in ++ androgens in ratio
172
causes of PCOS
excess insulin
heredity
exposure to ++ androgen as fetus
low grade inflammation (insulin resistance and cholesterol accumulation)
173
risks from PCOS
endometrial hyperplasia (due to chronic hyperestrogenism)
DM2
cardiovascular/cerebrovascular disease. (increased lipids)
174
diagnosis of PCOS
clinical and chemical
**need hormonal assays to confirm
175
what 'sign' is associated with PCOS
'string of pearls'
176
what sono 'sign' is seen with theca lutein cysts
'soap bubble'
'spoke wheel'
177
sonographic features of serial ultrasounds in positive PCOS case
lack of follicular development
lack of dominant follicle
no change to thickened endometrium
178
what is usual cause of ovarian torsion
enlarged ovary due to a mass
179
ovarian torsion is the twisting of the __
vascular pedicle
180
which ligaments are involved with ovarian torsion
ovarian ligament
infundibulopelvic ligament
181
clinical features of ovarian torsion
acute onset lower abdominal pain
one side more painful than contralateral
**may be mistaken for appendicitis if on RT
182
with torsion, ovary may swell to the point of __
rupture
183
sonographic features of ovarian torsion
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
184
sonographic feature of twisted vascular pedicle
'whirlpool' sign
185
sono feature of ovarian torsion with hemorrhage or infarction
cystic or complex adnexal mass with fluid debris level or septa
186
what masses may have echogenic foci
dermoid cysts
inclusion cysts
endometriomas
psammoma bodies
187
what are psammoma bodies
sand-like calcifications in serous cystadenocarcinomas
188
name for development of an ovarian cyst after oopherectomy
ovarian remnant syndrome
likely due to a small portion of ovary not being resected
189
ovarian remnant syndrome clinical sign
chronic pelvic pain
usually happens with patients that had a lot of adhesions at time of sx
190
sono features of ruptured ovarian cyst
u/s may be normal
cyst may still be present
+/- FF
**echogenic FF requires ruling out an ectopic pregnancy if pt of reproductive age
191
the majority of malignant ovarian neoplasms occur in __ menopausal patients
post menopausal
192
what are the subtypes of ovarian neoplasms
epithelial
germ cell
stromal
metastatic
193
__ neoplasms originate in tissue that surrounds the ovary
epithelial
accounts for 90% of cases
194
__ neoplasms original in the cells that produce eggs
germ cell
195
__ neoplasms originates in the tissues that hold ovaries together and hormone producing tissues
stromal
196
what are the 2 most common types of ovarian neoplasms
cystic teratoma (dermoid)
serous cystadenoma
197
what are the 3 types of epithelial tumours
adenoma
carcinoma
adenocarcinoma
198
benign epithelial neoplasm from glandular cells
adenoma
199
malignant epithelial neoplasm
carcinoma
200
malignant epithelial neoplasm derived from glandular cells
adenocarcinoma
201
of, resembling or producing serous fluid
serous tumour
epithelial
202
of, relating to or covered with mucus
mucinous tumour
epithelial
203
which is more common - serous or mucinous epithelial tumours
serous
204
which is typically larger - serous or mucinous epithelial tumours
mucinous
205
cystadenomas and cystadenocarcinomas can be __
serous or mucinous
pre or post menopause
206
what is the single most common ovarian epithelial tumour
serous cystadenoma
207
clinical symptoms of cystadenomas and cystadenocarcinomas
few, if any symptoms
increasing abdominal girth
occasional pain (hemorrhage, torsion, infection)
menstrual disturbance (uncommon)
208
what is the most common ovarian malignancy
serous cystadenocarcinoma
209
mucinous cystadenocarcinoma associated with __
pseudomyxoma peritonei
(mucinous implants on peritoneal surfaces and gelatinous ascites throughout abdomen)
210
the __ complicated, the __ likely to be malignant regarding epithelial tumours
more complicated, more likely
211
solid, unilateral epithelial tumour of post-menopausal women. majority are benign
Brenner tumour
212
what factors increase risk with ovarian malignancy
peri-post menopause
low parity
early menarche
late menopause
breast cancer with HRT (ie Tamoxefin)
family hx (BRCA 1 or 2)
endometriosis
213
peak incidence of ovarian malignancy in __ year olds
51-60
214
what are some methods for prevention of ovarian malignancy
5 years on BCP
multiple pregnancies
breast feeding
prophylactic bilateral oopherectomy
215
symptoms of ovarian malignancy
"silent killer" usually very vague and not diagnosed until very late
**is leading cause of death due to gyne malignancy
216
which serum is used to help diagnose ovarian malignancy
serum CA125
cancer antigen (elevated in 80% of advanced ovarian epithelial cancer)
217
is serum CA125 sensitive or specific
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
u/s is reliable at differentiating benign from malignant ovarian tumours - t/f
false
219
sonographic guidelines for malignancy
thick septations
mural nodules
irregular walls
solid > cystic
larger in size >10cm
vascular, low resistance
ascites
220
sonographic guidelines for benign tumour
no septations
no mural nodules
thin walls
hemorrhagic
221
flow in septations or mural nodules of an ovarian lesion suggests __
malignancy
222
what is the major mode of spread with ovarian malignancy
intraperitoneal metastasis
less common is:
direct invasion to surrounding structures
lymphatic dissemination
hematogenous dissemination
222
how many stages are in ovarian malignancy
3
223
complications of ovarian malignancy
ascites
bowel obstruction
223
progressive accumulation of mucinous tumour cells that have implanted in the peritoneal cavity
pseudomyxoma peritonei
rare malignant growth associated with mucinous cystadenocarcinoma
224
pseudomyxoma peritonei most often mets from __
mucinous appendix tumours
225
what type of ovarian tumour is move prevalent in children and young adult females
germ cell tumours
226
what are the 3 types of germ cell tumours
teratoma
dysgerminoma
choriocarcinoma
227
what is the most common ovarian teratoma
dermoid cyst
228
what is the most common ovarian neoplasm
dermoid cyst
229
teratoma is derived from which germ layers
all three
- endoderm
- mesoderm
- ectoderm
230
benign cystic teratoma aka
dermoid cyst
231
benign mature teratoma aka
dermoid cyst
232
dermoid cyst derived from __ type of germ cell
ectoderm
(skin, teeth, hair, fat)
233
what is the most common complication with a dermoid cyst
ovarian torsion
234
dermoid cyst related to which sonographic sign
'tip of the iceberg' sign
235
hyperechoic, shadowing mural nodule seen with dermoid cyst called __
'dermoid plug'
Rokitansky nodule
236
dermoid cyst similar appearance and often mistaken for __
surrounding bowel
237
malignant teratoma aka
squamous cell carcinoma
rare; can arise from within a dermoid
238
most common malignant gyne tumour during childhood
dysgerminoma
*can be bilateral
239
what is likely dx with a child having a positive pregnancy test
dysgeminoma
5% secrete hCG
240
sonographic features of dysgerminoma
solid, lobulated mass
nonspecific appearance
vascular
241
which is the highly malignant germ cell tumour
pure ovarian choriocarcinoma
*can be bilateral
242
which tumour secretes hCG in the absence of ongoing pregnancy
ovarian choriocarcinoma
243
which tumour is more common to occur secondary to an abnormal pregnancy
ovarian choriocarcinoma
*primitive placental tissue
244
what are the types of stromal tumours
ovarian fibroma
granulosa cell
granulosa-theca cell
Sertoli-Leydig
245
most common stromal tumour
ovarian fibroma
usually unilateral
246
ovarian fibromas may produce __
estrogen
*rarely
247
are ovarian fibromas benign?
yes
248
sono features of ovarian fibroma
non specific
solid, hypoechoic mass
+/-shadow
PCDS fluid
minimal to moderate vasculature
249
what are the pitfalls of ovarian fibroma
pedunculated subserosal myoma
endometrioma
250
ovarian fibroma with GROSS ascites and pleural effusion is __
Meigs' syndrome
*usually benign
251
majority of granulosa and granulosa-theca cell tumours occur in __ menopausal patients
post
252
most of granulosa and granulosa-theca cell tumours secrete __
estrogen
*children can present with precocious puberty
*increased risk of endo hyperplasia and carcinoma in adults
253
what is the malignant potential of granulosa and granulosa-theca cell tumours
low potential for maligancy
254
which ovarian tumour can cause children to present with precocious puberty
granulosa and granulosa-theca cell tumours (stromal)
255
sono features of granulosa and granulosa-theca cell tumours
non specific
smaller = solid
larger = cystic
vascular
256
Sertoli-Leydig tumour aka
androblastoma
arrhenoblastoma
257
which stromal tumour secretes testosterone
Sertoli-Leydig
258
which ovarian tumour is derived from male embryological cells and present in female ovaires
Sertoli-Leydig
*androgen secretings
*virilization effects
259
260
Sertoli-Leydig occurs mostly in what age group
either young or old
*trick question
261
majority of Sertoli-Leydig tumours are __
benign
have malignant potential though
262
what are virilization effects
amenorrhea or oligomenorrhea
hirsutism
acne
voice deepening
clitoromegaly
263
sono features of Sertoli-Leydig
non specific
264
what are the most common mets to the ovary
Krukenberg tumours
265
what is the primary cancer associated with Krukenberg tumours
GI cancers
266
what is the prognosis of Krukenberg tumours
poor
solid and ALWAYS bilateral
267
does the absence of internal flow rule out a neoplasm
no, neoplasms can still be cystic.
but internal flow indicates we are dealing with neoplasm .
268
what is the expected vascular resistance of a benign neoplasm
high resistance
269
any infection causing inflammatory disease of the uterus, tubes, ovaries, and general pelvis
PID
270
what is most common reason for PID
STI
271
rare cause of PID
tuberculosis
272
what is peak incidence for PID
20-24y old
increased risk with intercourse at early age, multiple sexual partners, IUCD, multiple douching, etc.
273
what are the infection pathways of PID
ascending (STI)
descending (sx)
hematogenous (tuberculosis)
274
complication of PID
tubal damage (increased risk of ectopic and infertility)
chronic pain (adhesions)
hydrosalpinx
275
clinical signs of PID
2/3 asymptomatic
276
signs of acute PID
pelvic pain, discharge, fever, increased WBC
277
signs of chronic PID
non specific
palpable adnexal mass
dull pelvic pain
278
ddx of PID
acute appendicitis
endometriosis
ectopic pregnancy
ovarian tumour
279
tx of pID
antibiotic to both sexual partners
u/s guided abscess drainage
280
big role of EV for PID dx
assess tenderness with probe pressure
281
general progression of PID
endometrITIS
acute alpingitis/oophoritis/hydrosalpinx
pyosalpinx/ tubo-ovarian COMPLEX
tubo-ovarian ABCESS
advanced adhesions
peritonitis
pelvic abscess
282
sono features of endometritis
hyperechoic, heterogeneous, thickened endo
FF or fluid levels in ut cavity may indicate pyometra
283
inflammatory thickening of fallopian tube
acute salpingitis
284
signs of acute salpingitis
pelvic pain
fever
dyspareunia
leukocytes
285
sono 'sign' with acute salpingitis
'cogwheel' sign
nodular, thick tubular adnexal mass
- dilated, tortuous
- wall thickness ~>5mm
286
what is important additional assessment for suspected oophoritis
check with Doppler to r/o torsion
assess tenderness
287
key features of hydrosalpinx vs. acute salpingitis
NON TENDER
associated with CHRONIC PID
- sequela of acute PID
does not usually change over time (serial u/s)
288
sono 'sign' associated with hydrosalpinx
'beads on a string' sign
- chronic remnants of cogwheel sign
289
ddx of hydrosalpinx
adnexal cyst
290
obstructed tube adhered to ovary +/- pyosalpinx
tubo-ovarian COMPLEX
- assess with compression
- can't separate but both tube and ovary are distinct, identifiable structures
291
advanced inflammatory mass involving tube (pyosalpinx) and ovary with extensive adhesion formation
tubo-ovarian ABSCESS
- ovary and tube are not identified separately (appear like one big mass)
- often bilateral
292
__ flow in wall of tubo-ovarian abscess
increased flow
inner hyperechoic regions due to presence of purulent material
293
sono sign associated with pelvic adhesions
'frozen pelvis' sign
difinitive dx by laparoscopy
294
associated problems with advanced adhesive disease
chronic pain
infertility
bowel complications
- ie gross ascites
295
lining of peritoneal cavity and most of abdominal and pelvic organs inflammed
peritonitis
- can be diffuse or localized
may result from infection or from a non-infectious process
296
sono features of peritonitis
non specific
ascites (+/- septations +/- echoes)
thickened GI tract walls
abscess formation
297
clinical name of pus in cul de sac
pelvic abscess
associated with PID, sx, appendicitis, or inflammatory disease
298
sonofeatures of pelvic abscess
adnexal fluid collection with debris
- may contain gas
tender with comp
no internal flow but may show peripheral flow
299
clinical syndrome resulting from spread of PID around the liver
Fitz-Hugh-Curtis syndrome
perihepatitis
300
patient presents with acute PID symptoms and associated RUQ abdominal pain
likely perihepatitis (FHC syndrome)
ddx GB disease
301
sono features of FHC syndrome
fitz-hugh-curtis
perihepatic abscess (RUQ fluid)
thickened RIGHT anterior pararenal fat (compare RK and LK)
inflammation of GB
302
genital tuberculosis likely originates in __
fallopian tubes
303
how is genital TB different from normal PID progression
PID progression starts in endo and spreads to tubes
genital TB starts in tubes
*thus may impair reproductive function
304
signs of genital TB
non specific
pelvic pain
AUB
infertility
305
sono features of genital TB
varies
- can appear normal
- may progress from acute salpingitis through remaining stages of PID
- BILAT involvement of tubes is COMMON
306
what is the diff between genital and pelvic TB
pelvic is usually secondary to TB elsewhere in the body
- hematogenous or lymphatic spread of bacteria to pelvis
307
what is the type of spread of pelvic TB
hematogenous or lymphatic spread of bacteria to pelvis
grayish TB stud the peritoneal cavity including the serosal surface of organs
308
what does pelvic TB mostly affect
tubes and uterus (serosal surfaces - does not penetrate mucosa)
309
pelvic TB is __ in north america
rare
310
clinical signs of pelvic TB
non specific
pelvic pain generalized
311
sono features of pelvic TB
uterine serosal nodularity
ascites
omental thickening (CAKE)
bilad adn cystic masses
intraperitoneal fluid and adhesions
312
ovarian fluid normally absorbed by the peritoneum gets trapped by extensive pelvic adhesions
peritoneal inclusion cysts
(paraovarian)
313
likely hx associated with peritoneal inclusion cysts
previous hx of sx or PID
associated with pain
314
peritoneal inclusion cysts are post inflammatory __ from the trapped fluid
pseudocysts
315
pelvic adhesions __ the rate of peritoneal fluid absorption
decrease
*thus increase risk of peritoneal inclusion cysts forming
316
sono features of peritoneal inclusion cyst
similar to paraovarian
fluid collection (pus or fluid) around ovary with SEPTATIONS
- 'spider web' appearance
may mimic ovarian neoplasms
tender with comp
317
role of u/s with peritoneal inclusion cysts
dx inflammatory mass (debris? tender?)
monitor size with serial studies
guided placement of drainage catheter
318
estrogen-dependent, chronic, inflammatory process
endometriosis
319
one of the most common gyne diseases - affecting 15% premeno pt and account for 50% of pt experiencing chronic pelvic pain/ infertility
endometriosis
320
two forms of endometriosis
diffuse (throughout peritoneum)
focal (blood-filled pseudocyst = endometrioma)
321
speculated causes of endometriosis (2)
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
what is the most common site of endometriosis implants
ovary
323
risk factors for endometriosis
genetics
previous infections
nullparity
++incidence in pt that have had laparoscopy
324
signs and symptoms of endometriosis
asymptomatic
**premenstrual pain
dysmenorrhea
chronic cyclic pelvic pain
dyspareunia
increased risk of infertility or ectopic pregnancy
325
symptoms of endometriosis depend on __ of endometrial lesions
site, size and number
326
what is the gold standard for dx endometriosis
direct visualization and biopsy via laparoscopy
MRI best imaging modality
327
how many stages of endometriosis are there
4
328
in a pregnant pt, within an ovary is seen a solid vascular mural nodule that cannot be differentiated from malignancy. what is the ddx
decidualized endometrioma
329
sono 'sign' associated with severe endometriosis
'kissing ovaries'
330
endometriosis increases risk of ___ (type of ovarian malignancy) by 3x
clear cell carcinoma
331
endometriosis significantly increases risk of ___ (type of skin malignancy)
cutaneous melanoma
*from melanocytes
332
partial hysterectomy aka
subtotal
333
what is the diff between a total and a subtotal hysterectomy
subtotal leaves the cervix behind
334
what is the difference between a hysterectomy with bilat salpingo-oopherectomy and a RADICAL hysterectomy
upper vagina and surrounding tissues (including nodes) are removed in a RADICAL hysterectomy
335
vaginal cuff signs of malignancy
> 2.1 cm AP
mass
areas of high echogenicity
336
what is most common type of LSCS incision
Kerr incision
337
postpartum endometritis most common after __ delivery
csec
338
sono features of post partum endometritis
thickened, hyperechoic +/- heterogeneous endo
fluid
+/- gas bubbles (suggests bacterial abscess)
339
ovarian vein thrombosis or thrombophlebitis may occur __ hours postpartum
48-96 hours
340
ovarian vein thrombosis or thrombophlebitis is caused by __ and spread of bacterial infection from endometritis
venous stasis
341
what is the biggest concern regarding ovarian vein thrombosis or thrombophlebitis
pulmonary emboli
342
sono features of ovarian vein thrombosis or thrombophlebitis
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
majority of ovarian vein thrombosis or thrombophlebitis occur on which side
RIGHT (90%)
*retrograde flow on left protecting vein during pueperium
344
what is pueperium
the 6 weeks post partum when the mother's uterus adjusts back to normal
345
sono features of RPOC
thickened endo
heterogeneous mass
variable Doppler
346
common gyne complications from radiation and chemo treatment
radiation cystitis (associated with dysuria and diminished baldder volume)
vesicovaginal fistula (b/t bladder and vagina)
347
__ allows for continuous, involuntary discharge of urine into the vagina
vesicovaginal fistula
348
__ insertes into the cx for tx of cervical cancer
cesium implants
*interstitial brachytherapy
349
acute appendicitis is the inflammation of the __ appendix in RLQ
vermiform
350
most common cause of acute appendicitis in children
lymphoid hyperplasia
351
most common cause of acute appendicitis in adults
fecalith
352
most common position of appendix
oblique and vertical
inferior and medial to CECUM
anterior and medial to PSOAS m.
lateral to iliac vessels
353
appendix is __ to iliac vessels
lateral
354
where is the appendix if it is retrocecal
curled posterior to the cecum
355
clinical manifestation of acute appendicitis
periumbilical pain, shifting to McBurney's point
anorexia
nausea
vomiting
leukocytes
fever/chills
356
where is McBurney's point
1/3 distant from ASIS to umbilicus
357
McBurney's point is site of __ tenderness and pain with acute appendicitis
rebound
358
ddx of acute appendicitis
PID
ovarian cyst bleeding/rupture
ovarian torsion
359
which probe should you use to find acute appendicitis
linear array 5MHz minimum
AND MILK IT (graded pressure)
360
what is expected of acute appendicitis with compression
non compressible
point tenderness
361
acute appendicitis AP diameter
>6 mm
wall >2 mm
362
what flow do you expect in acute appendicitis
flow in the wall
363
sono features of acute appendicitis
blind ended, finger like tubular structure connected to cecum
non compressible
point tenderness
fecalith (hyperechoic focus with shadowing)
adjacent FF
hyperechoic surrounding fat
364
inflammatory spreading deep into the layers of the terminal ileum and/or colon
Crohn's disease
365
inflammation of small pouches in the wall of the colon
diverticulitis
366
long-lasting inflammation and ulcers to the innermost lining of the colon and rectum
ulcerative colitis
367
what sono 'sign' is associated with inflamed bowel
'pseudo kidney' sign
368
grossly dilated, fluid filled loops bowel
consistent with bowel obstruction
369
hematoma communicating with the artery forms outside the artery
rare complication of gyne sx from trauma to arterial wall (ie ut artery)
arterial pseudoaneurysm
*not truly an aneurysm (breach in vessel wall)
370
sono features of arterial pseudoaneurysm
2D - pulsating, hypoechoic lesion inside UT
CD - turbulent flow
Pulsed - pan-diastolic flow reversal
371
what sono sign is associated with arterial pseudoaneurysm
yin yang sign
*blood flows in during systole, out during diastole
372
abnormal connection between an artery and vein
ateriovenous fistula (AVF)
may be congenital, sx created, or acquired
373
dilated, tortuous pelvic veins > 5 mm AP
pelvic varicosities
374
most common associations with pelvic varicosities
multiple pregnancies
retroverted uterus
375
signs symptoms of pelvic varicosities
asymptomatic or associated with pelvic congestion syndrome
376
pelvic varicosities more common on which side
LEFT
dur to less efficient drainage of left ovarian vein
377
extensive pelvic varicosities; associated with chronic pain, dyspareunia and ovarian point tenderness on physical exam
pelvic congestion syndrome
378
sono features of pelvic congestion syndrome
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
pelvic congestion syndrome often associated with __
reflux of the internal iliac veins
380
what is the most important role of a sonographer regarding assessment of postsurgical masses
CORRELATION WITH CLINICAL HISTORY
*abscess, lymphocele, urinoma, hematoma, seroma
381
encapsulated collection of urine formed spontaneously, from renal injury or sx intervention
urinoma
382
site specific pelvic hematomas that are extraperitoneal (3)
rectus sheath
space of Retzius
bladder flap
383
a rectus sheath hematoma is __ peritoneal
extraperitoneal
caused by muscle or artery tears
384
symptoms of rectus sheath hematoma
acute, sharp persistent NON RADIATING pain
385
location variants of rectus sheath hematoma depend on whether it is superior or inferior to __
the arcuate line
inferior means it can cross misline
386
can rectus sheath hematomas track into the peritoneal cavity
no
387
where is the space of Retzius
between the symphysis and the bladder
388
space of Retzius aka
retropubic space
prevesicular space
389
space of Retzius usually contains __
subcutaneous fat
390
a hematoma in the retropubic space may displace the bladder which way
posteriorly
391
vesicouterine fold of peritoneum incised during low cervical csec is called
bladder flap
*incision separates baldder from uterus to expose lower uterine segment
392
is a seroma associated with infection
no. it is a collection of serous fluid within tissue. May form in the defect left after a resolved hematoma
393
paraovarian cysts aka
paratubal cysts, broad ligament cysts
any cyst not arising from ovary or tube
394
paraovarian cysts arise from __
remnants of embryonic genital ducts
*though other adn cysts can be described as paraovarian if they are separate from ovary
395
sign and symptoms of paraovarian cysts
generally asymptomatic
pain associated with pressure effects, hemorrhage, or infeciton if cyst is large
396
sono features of paraovarian cysts
unilateral
generally small <5 cm
simple
separate from ovary
397
what should be checked when finding a large paraovarian cyst
kidneys
*may compress adjacent ureters causing hydro
398
caused by invasion of either inflammatory cells or neoplastic cells
pelvic lymphadenopathy / adenopathy
399
neoplastic pelvic lymphadenopathy is most often metastatic from __
cx or endo cancers
400
complex adnexal masses aka
CHEETAH
cystadenoma
hemorrhagic cyst
endometrioma
ectopic
teratoma
abscess
hydrosalpinx
401
incidence of __ increases dramatically postmenopause
ovarian cancer
402
neonatal ovarian cysts cause by __
stimulation of fetal ovaries by maternal hormones
ddx mesenteric or enteric cysts
403
neonate ovarian cysts of what size may present with torsion
>4cm
404
internal reproductive organs of one sex while echibiting some external physical characteristic of opposite sex
pseudohermaphroditism
405
both male and female sexual characteristics and organs - presence of ovarian and testicular tissue (ovotestis)
true hermaphroditism
406
true hermaphroditism aka
chimerism
407
what is the common karyotype of chimerism
46XX
408
what presentation is femal pseudohermaphroditism
masculinization
46XX
fetal exposure to excessive androgens
409
what is the most common cause of female pseudohermaphroditism
congenital adrenal hyperplasia
410
what is the presentation of male pseudohermaphroditism
undermasculinization
46XY
inadequate production of testosterone and mullerian-inhibiting factor (MIF) by fetal testes
411
what gene mutation can alter development of sexual characteristics
congenital adrenal hyperplasia
*abnormally low production of cortisol resulting in hyperplasia and overactivity of steroid-producing cells of adrenal cortex
412
genital presentation of male pseudohermaphroditism
severe micropenis
empty scrotum
413
genital presentation of female pseudohermaphroditism
enlarges clitoris with fused, prominent labia
presence of ut and ovaries internally
414
most common cause of precocious puberty
idiopathic
415
what is the most common prepubertal uterine mass
rhabdomyosarcoma
416
what is the most common prepubertal ovarian mass
cystic teratoma (dermoid)
417
what are the main causes of primary amenorrhea
Mayer-Rokitansky-Kuster-Hauser syndrome
imperforate hymen
Turner syndrome
418
syndrome causing vaginal agenesis, uterine hypoplasia/ agenesis with presence of ovaries, external genetalia and tubes
Mayer-Rokitansky-Kuster-Hauser syndrome
MRKH
419
what is the karyotype of MRKH syndrome
normal
46xx
420
what is the karyotype for Turner syndrome
45, x0
421
which syndrome is associated with streak ovaries
turner
422
short stature, webbed neck, absence of secondary sexual characteristics, affecting only females
turner syndrome
423
main causes of secondary amenorrhea
pregnancy
functional ovarian cyst
PCOS
424
urachal fistula open to the bladder aka
patent urachus
425
cysts that arise from urachal remnant called
urachal cyst
426
sono features of urachal cyst
anterior, ML cyst between bladder and umbilicus
typically small (<5cm) simple cyst
can infect or hemorrhage
427
what are the 3 presentations of urachal cyst
simple urachal cyst
urachal sinus communicating with bladder
patent urachus
428
are urachal cysts tender
they can be
429
involuntary leakage of urine associated with increase in vesicular pressure
USI (urinary stress incontinence)
430
what gyne pathology is associated with pleural effusion
Meigs syndrome
gyne malignancy
pseudomyxoma peritonei
severe OHSS
431
para-aortic lymphadenopathy may be associated with __
cervical, endometrial, or ovarian cancers
432
peritoneal mets associated with
ovarian cancer
433
leiomyoma aka
fibroma
fibromyoma
myoma
fibroid
benign tumour
434
what is a fibroid made of
smooth muscle and collagen
435
what is the most common uterine mass
myoma
436
epidemiology of myoma
obesity
heredity
nulliparous
>30 years old
25% white
50% black
estrogen dependent
437
at what point in a womans life are myomas less likely to grow
and why
before puberty or after menopause
because they are estrogen dependent
438
what is the most common classification of a fibroid
intramural
entirely within the myometrium
no distortion of uterine contour
439
which classification of myoma distorts the endo contour because of its placement within the inner myometrium
submucosal
440
which classification of myoma causes changes to the uterine contour
subserosal
441
what are the two types of myoma that can be 'cornual' and affect tubal patency
intramural or subserosal
442
name for myoma in the broad ligament sheets that may be pedunculated
intraligamentary
*subserosal
443
which classification of myoma is most likely to cause hydronephrosis
intraligamentary subserosal
444
which classification of myoma may cause ureteral obstruction
cervical myoma
445
usualy symptom of myoma
asymptomatiic
446
general symptoms of myomas
*depends on type, size, no.
hypermenorrhea
pelvic pain
dysmenorrhea
pressure related effects
infertility
pregnancy related disorders
447
which classifications of myomas are most likely to affect fertility
cornual and submucosal
448
uterine artery embolization can treat which classifications of fibroids
intramural or submucosal
449
ddx of submucosal myoma
endo polyp
450
what can help dx a submucosal myoma
sonohysterography
451
ddx of hyperechoic myoma
uterine lipoma
*u/s cannot distinguish
452
what type of degenerative change of a myoma is expected with torsion
necrosis from vascular impairment
453
what type of degenerative change of a myoma is expected following necrotic or hyaline degredation and liquification
cystic degeneration
454
what is red or carneous degeneration (of myoma)
localized hemolysis resulting in necrosis
* occurs frequently in pregnancy
455
what type of degenerative change of a myoma is expected with localized hemolysis resulting in necrosis
calcific
*more common in larger myomas where the blood supply is compromised
456
what type of degenerative change of a myoma is expected with malignant changes within a formerly benign myoma
sarcomatous degeneration
457
red degeneration of myoma during pregnancy associated with __
acute pain and tenderness
458
uterine lipoma aka
leiomyolipoma
lipoleiomyoma
fibromyolipoma
myolipoma
*NOT LIPOSARCOMA
459
what vascularity is expected in a uterine leiomyolipoma
avascular
460
uterine lipoma vs. dermoid cyst - what would you look for
origin of mass
document 2 normal ovaries or inability to confirm
461
most common location of uterine sarcoma
myometrium
can still happen within endo or myoma
462
what is the most common type of sarcoma
leiomyosarcoma
463
what is the most common presentation for ut sarcoma
post meno AUB
464
sarcoma characteristics
rapid, sudden growth
solid mass often with cystic component
local invasion (most common) or mets
465
Doppler for ut sarcoma
higher peak systolic velocities
variable flow
466
term for migration of endo glands from stratum basalis into myometrium
adenomyosis
467
what are the types of adenomyosis
focal (adenomyoma)
diffuse (infiltrative)
468
most common demographic for adenomyosis
parous pt in 30s and 40s
*estrogen dependent
*decreases after menopause
469
speculative causes of adenomyosis
direct invasion from csec
deposits from developing a fetus
deposits after labour and delivery (break in normal boundary between endo and myo)
470
signs of adenomyosis
dysmenorrhea
ut enlargement
hypermenorrhea (more blood)
pain, tenderness
dyspareunia
471
sono features of adenomyosis
streaky shadowing
*refractive b/c lower velocity*
heterogeneous, bulky ut
eccentric enlargement of endo
cysts
focally tender
scattered vascularity
+/- calcs
472
what type of shadowing artifact causes myomas to shadow
attenuating shadows
473
what is AVM
arteriovenous MALFORMATION
*all AVM are AVF but not all AVF are AVM
474
what is the most common type of AVF
acquired
*trauma, sx, GTD
475
abnormal development of primitive vessels
AVM
476
symptoms of AVF
metrorrhagia
ut pain
catastrophic hemorrhaging with D&C
477
sono features of AVF
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
Doppler of AVF
intense colour signals with aliasing
high PSV (suggestive of AV shunting)
low resistance flow
479
mucus-filled cervical cysts called
nabothian
480
nabothian cysts associated with subclinica __
cervicitis
481
nabothian cysts may cause the blockage of a gland due to __
inflammation and metaplasia
482
what role does u/s play in cervical cancer
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
sono features of cervical cancer
cervical enlargement
evidence of invasion
ut cavity fluid
pelvic lymphadenopathy
hydronephrosis
ascites, PE
liver mets
484
clinical cymptoms of radiation cystitis
bladder wall thickening (inflammation) secondary to radiation tx of cervix
focal or diffuse
485
narrowing of cx canal
cervical stenosis
486
causes of cx stenosis
postmenopausal cervical atrophy
benign or malignant disease of ut
radiation fibrosis
487
cervical stenosis may be associated with __
ut enlargement and pain
ut filling with fluid
488
what is the medical term for normal tissue folds in the cervical canal
plicae palmatae
489
increased incidence in vaginal cancer with __ exposure
DES in utero
490
localized, mass-like overgrowth of normal endometrial tissue
polyp
made of glands and stroma
491
higher incidence of endo polyps in __
anovulatory patients
492
signs and symptoms of endo polyps
frequently asymptomatic
AUB (most common)
symmetric ut enlargement
prolapse into cx
pregnancy failure
493
what are the cystic areas within a polyp
dilated glandular tissue
494
what menstrual phase is best for sonographically assessing an endo polyp
early proliferative (day5~)
because endo SHOULD be thin
495
generalized overgrowth of endo
endometrial hyperplasia
496
what is the most common cause of AUB
endo hyperplasia
497
who is most likely to experience endo hyperplasia
PCOS
chronic anovulatory cycles
obesity
unopposed estrogen HRT
498
normal endo measurements for post menopausal pt
499
what is the most common gyne malignancy
endo carcinoma (adenocarcinoma)
500
strong association of endo carcinoma with __
unopposed estrogen HRT in post meno pts
501
most common sign/ symptom of endo carcinoma
painless post meno bleeding
502
risk factors for endo carcinoma
hormone imbalance
nulliparous
obesity
unopposed est HRT
503
why is MRI important for dx endo carcinoma
shows extent of myometrial invasion
504
associated findings with endo carcinoma
pelvic lymphadenopathy
parametrial invasion
myometrial invasion
505
what is the tamoxifen effect
prevents estrogen from stimulating tumour growth in breast
increases risk of endo cancer in post meno pt because STIMULATES hyperplasia, polyps and cancer
506
sono features of tamoxifen effect
endo hyperplasia
cystic changes to endo/subendo
polyps
+/- ut growth
+/- myoma growth
+/- ovarian cysts
507
synechiae aka
endo adhesions
Asherman syndrome
508
associations with synechiae
infertility and miscarriage
509
causes of endo microcalcifications
normal post partum
endometritis
PID
post sonohysterography
post ut artery embolization
AVF
510
the calcification of dead, damaged or degenerative tissue
dystrophic calcification
related to previous instrumentation
511
echogenic foci in endo from retained fetal tissue called
osseuos metaplasia
512
association with osseous metaplasia
secondary infertility
513
most common associations with endometritis
PID
postpartum
post instrumentation
514
symptoms of endometritis
AUB
fever
pain
515
myometrial calcifications causes
myomas (dystrophic calc)
adenomyosis
walls of collapsed cysts
516
alternative to hysterectomy for heavy bleeding
endo ablation
517
which layer of tissue is removed with endo ablation
functional and basal endo
