Chapter 40: Sonographic & Doppler Eval of Female Pelvis

Question 1

The Doppler measurement that takes the highest systolic peak minus the highest diastolic peak divided by the highest systolic peak is what?

Answer 1

Pourcelot Resistive Index

Question 2

What are the small vessels found along the periphery of the uterus?

Answer 2

arcuate vessels

Question 3

What is a horizontal plane through the longitudinal axis of the body to image structures from anterior to posterior?

Answer 3

coronal

Question 4

What is the pulsatility index?

Answer 4

the Doppler measurement that uses peak systole minus peak diastole divided by the mean over one cardiac cycle

Question 5

The endometrium is at its greatest thickness and echogenicity with posterior enhancement in which phase?

Answer 5

secretory

Question 6

The difference between the peak systole and the peak diastole is what?

Answer 6

S/D ratio

Question 7

To image the fundus with TV, how do you angle the handle?

Answer 7

towards the bed

Question 8

With EV sonography, the cervix of an anteverted uterus is seen to the _______ of the screen, while the fundus is seen to the ________ of the screen.

Answer 8

right, left

Question 9

Which plane should the endometrium be measured in?

Answer 9

longitudinal

Question 10

How long should a TV transducer be soaked in disinfectant between uses?

Answer 10

10-20 minutes

Question 11

Symmetrical bilateral pelvic masses are likely to be what?

Answer 11

pelvic muscles

Question 12

The thin outer layer of the uterus is separated from the intermediate layer by what?

Answer 12

arcuate vessels

Question 13

Flexion refers to the axis of the uterine body relative to the

Answer 13

cervix

Question 14

Nabothian cysts are found where?

Answer 14

endocervical canal

Question 15

Arcuate artery calcifications are observed in what patients?

Answer 15

postmenopausal and diabetic

Question 16

What technique is the best way to measure the cervical-fundal dimension of the uterus

Answer 16

transabdominal

Question 17

Sonohysterography is usually performed on premenopausal women between days _____-____ of the menstrual cycle.

Answer 17

6-10

Question 18

After soaking a transvaginal transducer in Cidex, what do you do?

Answer 18

rinse in water

Question 19

What are a few contraindications for TV U/S?

Answer 19

• age of patient
• patient discomfort
• patient refusal

Question 20

When a mass is found with U/S, what features should be characterized?

Answer 20

• location (intra or extrauterine)
• size
• external contour
• internal consistency

Question 21

With a retroverted uterus, which side of the screen would show the cervix?

Answer 21

left side, fundus on right

Question 22

For TV, when the probe is rotated 90 degrees from saggital plane, image orientation represents what?

Answer 22

coronal plane

Question 23

Movement of the TV transducer is centered around what?

Answer 23

introitus

Question 24

Describe the sections of the obturator internus muscle how they appear sonographically

Answer 24

seen at the posterior lateral corners of the bladder at the level of the vagina and cervix..muscle is hypoechoic and ovoid

Question 25

The levator ani muscle is best visualized how?

Answer 25

In the transverse plane with caudal angulation at the most inferior aspect of the bladder...it is hypoechoic, hammock-shaped area that is medial, caudal, and posterior to the obturator internus

Question 26

Where are the coccygeus and piriformis muscles located?

Answer 26

deep, cranially, and posteriorly

Question 27

What is the most common muscle to be mistaken for the ovary?

Answer 27

piriformus muscle

Question 28

Describe the uterine artery's Doppler waveform

Answer 28

high velocity, high resistance characteristics but this varies with the menstrual cycle

Question 29

What vessels can be used as landmarks for the lateral pelvis and ovary

Answer 29

internal iliac vessels

Question 30

Where is the internal iliac vessel commonly seen?

Answer 30

lateral and deep to ovary

Question 31

Describe the ovarian artery Doppler typical to the follicular phase

Answer 31

low velocity, high resistance

Question 32

When does the resistance in the ovarian artery on the side with the dominant follicle drop dramatically?

Answer 32

during the periovulatory or luteal phase..then it rises during the late luteal phase

Question 33

At the time of ovulation, what happens to velocity and RI?

Answer 33

both velocities increase and the RI decreases

Question 34

What are echogenic foci in the inner layer of the myometrium, which are usually nonshadowing thought to represent?

Answer 34

dystrophic calcification related to previous instrumentation

Question 35

Cervical inclusion cyst AKA

Answer 35

nabothian cyst

Question 36

What is the size and shape of the uterus related to?

Answer 36

age, hormonal status, and parity

Question 37

Prepubertally the cervix occupies how much of the uterine length?

Answer 37

2/3

Question 38

How large is the uterus prepubertally?

Answer 38

1-3cm in length, 0.5-1cm in width

Question 39

Describe the nulliparous cervix?

Answer 39

occupies 1/3 of uterine length

Question 40

Describe the nulliparous uterine size

Answer 40

6-8cm in length and 3-5 cm in width

Question 41

Describe the multiparous uterine size

Answer 41

an aditional 2cm in each direction from nulliparous

Question 42

How much of the uterine length does the postmenopausal cervix occupy?

Answer 42

2/3

Question 43

Describe the size of the postmenopausal uterus

Answer 43

3-5cm in length and 2-3 cm in width

Question 44

Which method is best for imaging endometrium?

Answer 44

TV

Question 45

Describe how the endometrial canal looks sonographically?

Answer 45

thin echogenic line as a result of specular reflections from the interface between the opposing surfaces of the endometrium

Question 46

How does the endometrial canal appear during menstruation?

Answer 46

hypoechoic central line representing blood and tissue

Question 47

Which endometrial phase corresponds to the 3 line sign

Answer 47

proliferative phase (late)

Question 48

T/F: fluid in the endometrial cavity should be included in the endometrial measurement?

Answer 48

False

Question 49

How may an infant's endometrium appear?

Answer 49

thick and echogenic

Question 50

During childbearing years, what is the range of endometrial thickness?

Answer 50

4-14mm

Question 51

During menopause what happens to the endometrium?

Answer 51

becomes atrophic because no longer under hormonal control

Question 52

Describe the postmenopausal endometrium without a hormone regimine?

Answer 52

a thin echogenic line measuring less than 8mm

Question 53

What is the normal cut-off measurement for a nonhormonally stimulated endometrium postmenopausally?

Answer 53

4-10mm

Question 54

When should patients be seen for further evaluation postmenopausally?

Answer 54

postmenopausal bleeding and endometrial double-layer thickness greater than 5mm

Question 55

Where are ovaries located compared to the internal iliacs?

Answer 55

antermedial

Question 56

Endovaginally, which plane is best to find the ovaries?

Answer 56

transverse

Question 57

Describe the ovaries during the proliferative phase?

Answer 57

many follicles may develop and increase in size until day 8 or 9 of the menstrual cycle

Question 58

Following ovulation, what happens within the ovary if no fertilization?

Answer 58

corpus luteum develops

Question 59

How do corpus luteum cysts appear sonographically?

Answer 59

unilocular, anechoic structures with well-defined thing walls and posterior enhancement

Question 60

What is the best marker for ID an ovary?

Answer 60

seeing a follicular cyst

Question 61

Normal range for Graafian follicle?

Answer 61

1.8-2.4 cm

Question 62

What is the best method for determining ovarian size?

Answer 62

volume

Question 63

How is ovarian volume calculated?

Answer 63

0.523 X length X widthX thickness

Question 64

A difference in size of one ovary greater than twice the volume of the contralateral ovary is considered

Answer 64

abnormal

Question 65

What is recommended for postmenopausal women with cysts greater than 5 cm and for those who have cysts containing septations or solid nodules in the ovaries?

Answer 65

surgery

Question 66

Focal calcifications in the ovary are thought to be

Answer 66

a stromal reaction to previous hemorrhage or infection..followups suggested to rule out neoplasm

Question 67

What is frequently the initial site for intraperitoneal fluid?

Answer 67

posterior cul-de-sac

Question 68

Why is sonohysterography used?

Answer 68

when the endometrium exceeds the normal thickness or shows focal areas of thickness for the patients clinical picture

Question 69

Hope this quiz is easier than last weeks!!

Answer 69

prolly wont be tho :(