Ch. 42 Female Pelvis

Question 1

List 7 questions the sonographer should ask the patient when doing a pelvic sonogram

Answer 1

1. when was the first day of your last period 2. how many times have you been pregnant/ how many children have you had 3. do you take hormones 4. have you ever had cancer 5. what symptoms do you have 6. do your physician perform a pelvic exam 7. have you had any gynecologic surgeries

Question 2

T/F. the most complete pelvic sonogram includes includes both transabdominal and transvaginal approaches

Answer 2

true

Question 3

T/F. transvaginal sonography provides a more “global” survey than transabdominal sonography

Answer 3

false

Question 4

T/F. transvaginal sonography should be performed while the patient has a full bladder

Answer 4

false

Question 5

T/F. the full bladder provides an acoustic window for transabdominal pelvic sonography

Answer 5

true

Question 6

T/F. transvaginal sonography should be performed on pre menarche girls

Answer 6

false

Question 7

T/F. all adults can tolerate transvaginal sonography

Answer 7

false

Question 8

T/F. no consent is required before performing transvaginal sonography

Answer 8

false

Question 9

T/F. transvaginal sonography utilizes higher frequencies than transabdominal sonography

Answer 9

true

Question 10

T/F. transvaginal sonography has better resolution than transabdominal sonography

Answer 10

true

Question 11

T/F. It is OK to perform transvaginal sonography without a probe cover

Answer 11

false

Question 12

T/F. The transvaginal probe should be soaked in a high level disinfectant solution between patients

Answer 12

true

Question 13

T/F. Care should be used to not use anything that interferes with sperm function when performing transvaginal sonography on infertility patients

Answer 13

true

Question 14

The _______ may be mistaken for ovaries, fluid collections, or masses

Answer 14

pelvic muscles

Question 15

The _______ is seen as a hammock-shaped structure posterior to the bladder and vagina when angling caudally from the superior bladder

Answer 15

levator ani muscle

Question 16

The _______ muscle is located laterally in the pelvis and is used as a landmark for locating the iliac vessels and ovaries

Answer 16

iliopsoas muscle

Question 17

During the secretory phase of the menstrual cycle, the ______ of the uterine arterial vessels decreases slightly

Answer 17

resistive index

Question 18

At and just after ovulation, the ______ of the ovarian blood flow decreases

Answer 18

resistive index

Question 19

The _______ are often seen in the periphery of the uterus and should not be mistaken for pathology

Answer 19

arcuate vessels

Question 20

Small cysts located near the cervical canal are called

Answer 20

nabothian cysts

Question 21

Ovarian volume is calculated by which formula

Answer 21

L x W x H x .523

Question 22

On transvaginal scanning in the sagittal plane, the ______ uterus will extend toward the left side of the monitor screen

Answer 22

anteflexed

Question 23

On transvaginal scanning in the sagittal plane, the ______ uterus will extend toward the right side of the monitor screen

Answer 23

retroflexed

Question 24

Angle the transvaginal probe _____ to visualize the cervix

Answer 24

posteriorly

Question 25

______ scanning is better for visualizing the endometrium

Answer 25

transvaginal

Question 26

______ scanning is better for measuring the length of the uterus

Answer 26

transabdominal

Question 27

The normal measurement of the endometrium depends on the woman's ______ status

Answer 27

hormonal

Question 28

______ scanning is superior for evaluating large ovarian masses and their origin

Answer 28

transabdominal

Question 29

______ scanning is superior for evaluating the general location of the ovary

Answer 29

transabdominal

Question 30

_______ scanning is superior for evaluating fine details of ovarian structure

Answer 30

transvaginal

Question 31

______ scanning is superior for performing doppler of the ovaries

Answer 31

transvaginal

Question 32

Normal endometrial thickness

Answer 32

14mm

Question 33

Upper normal in late secretory phase

Answer 33

7-14mm (luteal)

Question 34

______ is a procedure that involves injecting sterile saline or contrast into the uterine cavity and then imaging with transvaginal sonography

Answer 34

sonohysterography

Question 35

Endometrial masses and polyps are often best evaluated with ______

Answer 35

sonohysterography

Question 36

The difference between the peak systole and the peak diastole is the ______ ratio

Answer 36

S/D ratio

Question 37

The doppler measurement that uses peak systole minus peak diastole divided by the mean over one cardiac cycle is the ______ index

Answer 37

pulsatility

Question 38

Sonohysterography is usually performed on premenopausal women between days ______ of the menstrual cycle

Answer 38

6 and 10

Question 39

Limitations of translabial scanning may be overcome by which one of the following

Answer 39

elevating the patients hips

Question 40

Which of the following refers to a horizontal plane through the longitudinal axis of the body to image structures from anterior to posterior

Answer 40

coronal

Question 41

What power level should be used and why

Answer 41

lower, reduce acoustic exposure

Question 42

What are you evaluating with color and spectral doppler with the ovaries

Answer 42

trophoblastic flow when searching for pregnancy (intrauterine or ectopic)

Question 43

What unit will be show for ovary measurements during transvaginal

Answer 43

cm

Question 44

What plane is the obturator internus best seen in

Answer 44

transverse plane when angling up from symphysis pubis

Question 45

What is the appearance of the obturator internus

Answer 45

ovoid hypoechoic structure lateral to the uterus

Question 46

What may be mistaken for an ovary

Answer 46

obturator internus

Question 47

Seen as hammock shaped hypoechoic area posterior to the uterus/vagina

Answer 47

levator ani

Question 48

hypoechoic structure with linear striations that runs obliquely from superior to inferior at the lateral sides of the pelvis

Answer 48

ilopsoas

Question 49

Major landmark for locating the ovaries- especially in the sagittal plane

Answer 49

iliopsoas

Question 50

Doppler flow characteristics of uterine arteries

Answer 50

moderate to high velocity/high resistance flow

Question 51

Uterine arteries have ______ resistance in postmenopausal women than reproductive age

Answer 51

higher

Question 52

Doppler flow characteristics of radial arteries

Answer 52

higher resistance flow in the proliferative phase than secretory

Question 53

Doppler flow characteristics of ovarian arteries in follicular phase

Answer 53

low velocity high resistance

Question 54

Doppler flow characteristics of ovarian arteries in postmenopausal women

Answer 54

RI approaches 1.0 with increasing age

Question 55

Where do you generally evaluate uterine vasculature

Answer 55

lower uterine segment near internal os of cervix

Question 56

When you evaluate ovarian flow adjacent to and within ovary, you will usually see

Answer 56

ovarian branch of the uterine artery more easily

Question 57

Infer diagnostic information by evaluating the ______ of the flow

Answer 57

resistance

Question 58

high resistance=

Answer 58

low diastolic flow

Question 59

low resistance=

Answer 59

high diastolic flow

Question 60

Resistive index (RI)=

Answer 60

PSV-EDV/PSV

Question 61

Normal RI for the uterus in proliferative phase

Answer 61

.88

Question 62

The RI of the uterine artery usually ______ just before ovulation and continuing throughout the secretory phase

Answer 62

decreases

Question 63

Why does the RI of the uterine artery decrease before ovulation and through secretory phase

Answer 63

more diastolic flow due to a little less resistance

Question 64

Ovarian flow changes during the ovarian cycle- proliferative phase (developing follicles)

Answer 64

high resistance, low velocity

Question 65

Ovarian flow changes during the ovarian cycle- ovulation

Answer 65

resistance decreases (more diastolic flow) and peak velocity increases

Question 66

What is the RI during ovulation

Answer 66

.44

Question 67

Ovarian flow changes during the ovarian cycle- secretory phase

Answer 67

resistance increases slightly just before menses

Question 68

_______ of the uterus sometimes become prominent and should not be mistaken for masses

Answer 68

arcuate vessels

Question 69

Arcuate vessels are more prominent during

Answer 69

proliferative and early secretory phase

Question 70

Sonographic appearance of normal myometrium should be

Answer 70

homogenous with smooth walls

Question 71

What changes dramatically depending on which part of the menstrual cycle the patient is in

Answer 71

endometrium

Question 72

What does the endometrium look like days 1-4

Answer 72

early menstruation, the endometrial canal appears as a hypoechoic central line representing blood and tissue

Question 73

What does the endometrium look like days 3-7

Answer 73

menses progresses, the hypoechoic area that represents blood is sloughed off, see thin echogenic line

Question 74

What does the endometrium look like during days 5-9

Answer 74

proliferative phase, see thin echogenic line with hypoechoic halo (3 lines)

Question 75

What does the endometrium look like days 10-14

Answer 75

late proliferative phase, thickened echogenic central line still with hypoechoic halo

Question 76

What does the endometrium look like days 15-28

Answer 76

secretory phase, endometrium is at its greatest thickness and echogenicity with posterior acoustic enhancement

Question 77

Endometrial changes occur in response to

Answer 77

estrogen and progesterone

Question 78

Normal endometrial thickness

Answer 78

4-14mm

Question 79

Upper normal in late secretory phase

Answer 79

7-14mm (luteal)

Question 80

The fallopian tube leaves the _____ of the uterus and travels _____ through the _____ in the ______

Answer 80

cornua, laterally, broad ligament, mesosalpinx

Question 81

______ and the ______ area can be seen as a hypoechoic linear structure passing laterally from the mid/sup uterus towards the ovary

Answer 81

broad ligament, mesosalpinx

Question 82

If there is fluid, blood or pus in the fallopian tube, it will be seen as

Answer 82

anechoic/hypoechoic tortuous structure in the adnexa

Question 83

If there is pelvic ascites, the normal fallopian tubes can be seen

Answer 83

outlined by fluid

Question 84

Ovaries usually lie next to the ______ and the ______

Answer 84

psoas muscle, iliac vessels

Question 85

Follow _______ from uterus to ovary in ______ plane

Answer 85

broad ligament, transverse

Question 86

Ovary position is affected by

Answer 86

bladder volume, previous pregnancies and peristalsis of the bowel

Question 87

At mid-cycle, graafian follicle can measure up to

Answer 87

2.4cm

Question 88

Hysterosonography is used during

Answer 88

transvaginal

Question 89

It is important to perform sonohysterography during

Answer 89

proliferative phase of cycle- ASAP after menses

Question 90

Post menopause sonohysterography should be performed

Answer 90

at any time unless patient is on cyclic HRT, then should schedule during withdrawl or progesterone phase

Question 91

Most reliable method to differentiate between polyp and fibroid is by

Answer 91

echogenicity

Question 92

30% of postmenopausal bleeding caused by

Answer 92

endometrial polyps

Question 93

10-20% of postmenopausal bleeding is caused by

Answer 93

endometrial cancer

Question 94

Frequently used in breast cancer patients as estrogen suppressor

Answer 94

tamoxifen

Question 95

Tamoxifen is a weak estrogen stimulant and there is a slight increased risk of

Answer 95

endometrial hyperplasia, endometrial polyps | endometrial cancer

Question 96

Due to increased specificity and detailed anatomy visualized _______ is advocated by some as a first line evaluation of abnormal uterine bleeding

Answer 96

sonohysterography