Chapter 20 - Postmenopausal Sonography & Sonohysterography

Question 1

irregular bands of tissue

Answer 1

adhesions

Question 2

lack of ovulation

Answer 2

anovulation

Question 3

a syndrome characterized by endometrial adhesions that typically occur as a result of scar formation after some types of uterine surgery

Answer 3

Asherman syndrope

Question 4

the surgically removal of both ovaries & both fallopian tubes

Answer 4

bilateral salpingo-oophorectomy

Question 5

another name for menopause

Answer 5

climacteric

Question 6

the buildup of plaque within the arteries that supply the myocardium of the heart

Answer 6

coronary heart disease

Question 7

a procedure in which the cervix is dilated and the uterine cavity is scraped with a curette

Answer 7

dilation & curretage

Question 8

measurement of the endometrium from basal layer to basal layer excluding both the adjacent hypoechoic myometrium & the intracavitary fluid ( if present)

Answer 8

double layer thickness

Question 9

hormone replacement therapy that involves the administration of synthetic estrogen

Answer 9

estrogen replacement therapy

Question 10

the medical treatment used to accommodate the reduction of estrogen and progesterone that occurs during menopause

Answer 10

hormone replacement therapy

Question 11

an increase in the number of cells of a tissue or an organ

Answer 11

hyperplasia

Question 12

endoscopy of the uterine cavity

Answer 12

hysteroscopy

Question 13

the spread of cancer from a distant site

Answer 13

metastasis

Question 14

having birthed no children

Answer 14

nulliparity

Question 15

a bone density that is lower than normal

Answer 15

osteopenia

Question 16

bone loss that predisposes the indivdual of fractures

Answer 16

osteoporisis

Question 17

time prior to menopause

Answer 17

perimenopausal

Question 18

the surgical removal of a polyp

Answer 18

polypectomy

Question 19

shaped like a polyp

Answer 19

polypoid

Question 20

vaginal bleeding after the onset of menopause

Answer 20

postmenopausal vaginal bleeding

Question 21

the time after menopause

Answer 21

postmenopause

Question 22

the time directly after giving birth and extending to about 6 weeks

Answer 22

postpartum

Question 23

a hormone replacement therapy that involves administering synthetic progesterone

Answer 23

progesterone therapy

Question 24

the presence of pus within the uterus

Answer 24

pyometra

Question 25

a sonographic procedure that uses saline instillation into the endometrial cavity & fallopian tubes to evaluate for internal abnormalities

Answer 25

saline infusion sonohysterography

Question 26

adhesions

Answer 26

synechiae

Question 27

benign ovarian sex cord-stromal tumor that produces estrogen in older women

Answer 27

thecoma

Question 28

the formation of a clot within a blood vessel with the potential to travel a distant site and cause an occlusion

Answer 28

thromboembolism

Question 29

the removal of the uterus & cervix

Answer 29

total abdominal hysterectomy

Question 30

Estrogen replacement therapy (ERT) reduces the risk of developing what

Answer 30

Osteoporosis Coronary heart disease colon cancer alzheimer disease

Question 31

What is HRT used for

Answer 31

Used to combat the reduction of estrogen (to prevent menopausal symptoms)

Question 32

Unopposed (ERT) increased the risk of which condition

Answer 32

``` Endometrial carcinoma (>5mm) breast cancer thromboemobilsim hypertension possibly, diabetes ```

Question 33

Combined estrogen and progesterone therapy can eliminate the chances of endometrial carcinoma? True or false

Answer 33

Appearance and thickness is variable (looks like normal menstrual cycle)

Question 34

What is a common indication for postmenopausal sonography?

Answer 34

``` Endometrial atrophy uncontrolled HRT Endometrial Hyperplasia Endometrial Polyps Submucosal/Intracavitary leiomyoma Ovarian tumors ```

Question 35

What is the normal endometrial thickness with no postmenopausal bleeding?

Answer 35

<8mm

Question 36

What is the normal endometrial thickness with positive postmenopausal bleeding ?

Answer 36

<5mm

Question 37

What is the most common cause of post menopausal bleeding??

Answer 37

endometrial atrophy

Question 38

Sonographic appearance of endometrial atrophy?

Answer 38

1. thin endometrium <5mm | 2. Intracavitary fluid may be seen

Question 39

What is common cause of abnormal vaginal bleeding

Answer 39

Endometrial Hyperplasia *perimenopausal patients (also can be in postmenopausal women and women in reproductive years)

Question 40

What is endometrial hyperplasia a result from?

Answer 40

Results from the unopposed stimulation of estrogen of the endometrium

Question 41

Which risk or form of endometrial hyperplasia may progress to endometrial cancer

Answer 41

Atypical adenomatous hyperplasia (often in post menopausal women)

Question 42

Clinical findings of Endometrial hyperplasia

Answer 42

1. Abnormal uterine bleeding 2. PCOS 3. Obesity 4. Tamoxifen therapy estrogen producing ovarian tumors (if patent on Tamoxifen therapy endometrial Cancer >10mm)

Question 43

Sonographic findings of endometrial hyperplasia

Answer 43

1. Thickened echogenic endometrium (>8mm) 2. small cystic areas within the endometrium (ESP says: - Premenopausal women EC>14mm) -patient on Tamoxifen EC>10mm -Postmenopausal women on estrogen only EC>5mm -Postmenopausal women in estrogen phase can be up to 8mm, then in progesterone phase, EC decreases

Question 44

Endometrial polyp

Answer 44

Small nodules of hyperplastic endometrial tissue may cause abnormal vaginal bleeding in both postmenopausal or Perimenopausal women

Question 45

What will an endometrial polyp most often contain?

Answer 45

A small vessel and have cystic areas within it

Question 46

How are endometrial polyp most often contain?

Answer 46

A small vessel and have cystic areas within it

Question 47

How are endometrial polyps better visualized

Answer 47

Using sale infusion sonohysterography

Question 48

What are the treatment of endometrial polyps

Answer 48

polypectomy with use of hysteroscopy

Question 49

Clinical findings of endometrial polyps

Answer 49

1. can be aysmptomatic 2. menometrorrhagia 3. intermenstrual bleeding 4. infertility

Question 50

Sonographic findings of endometrial polyps

Answer 50

1. Focal thickening of endometrium 2. diffuse thickening of endometrium * discrete mass in the endometrium, focal, round and echogenic * possibly vascular stalk demonstrated with color doppler

Question 51

What is the most common encountered gynecologic malignancy? | ( female genital tract malignancy?

Answer 51

Endometrial carcinoma

Question 52

Endometrial Carcinoma is most often in the form of

Answer 52

adenocarinoma

Question 53

Endometrial carcinoma occurs in

Answer 53

postmenopausal women

Question 54

endometrial carcinoma are associated with what rosk

Answer 54

1. Nulliparity 2. Obesity 3. Chronic Anovulation 4. Stein-Leventhal Syndrome (PCOS) 5. hx of Tamoxifen therapy 6. Estrogen producing tumors 7. Postmenopausal, with an increased risk if on estrogen replacement therapy 8. Strong family hx of uterine cancer

Question 55

What is the peak age incidence when diagnosing endometrial carcinoma

Answer 55

50-65

Question 56

Which tumors have a poorer prognosis with endometrial carcinoma

Answer 56

Tumors with penetration into the surrounding myometrium have a poorer prognosis. than those confirmed to the endometrium

Question 57

What type of flow will endometrial carcinoma have with pulse doppler?

Answer 57

low impedance flow in the presence of endometrial carcinoma

Question 58

Suspicion of endometrial carcinoma lead to what

Answer 58

1. endometrial biopsy 2. endocervical curettage 3. CA-125 testing 4. total abdominal hysterectomy 5. bilateral salpino-oopherectomy

Question 59

Clinical findings of endometrial carcinoma

Answer 59

1. post menopausal bleeding 2. intermenstrual bleeding 3. enlarged uterus 4. increased C-125 levels 5. Pain as a result of uterine distention

Question 60

Sonographic findings of endometrial carcinoma

Answer 60

1. thickened endometrium 2. heterogenous uterus 3. enlarged uterus with lobular contour 4. endometrial fluid 5. polypoid mass with endo 6. inhomogenetiy and thickenign of endometrial echoes (>4-5mm) especially in post menopausal woman (varies w/ patients hormone status