GYN Flashcards
(174 cards)
1
Q
What is contained in the true pelvis?
A
reproductive organs bladder distal ureters bowel pg. E 6, O 296
2
Q
What are the osseous ligaments?
A
sacroiliac sacrosciatic sacrococcygeal pubic pg. E 7
3
Q
What ligament(s) support the cervix?
A
Cardinal (laterally)
pg. E 7, O 298
4
Q
What ligament(s) support the uterus?
A
Broad (laterally)
Round (anteriorly)
Uterosacral (posteriorly)
pg. E 7, O 298
5
Q
What ligament(s) support the ovaries?
A
Broad
Suspensory aka Infundibulopelvic (laterally)
Ovarian (inferiorly)
Mesovarian (posteriorly)
pg. E 7, O 298
6
Q
What ligament(s) support the fallopian tubes?
A
Broad (laterally)
Round (anteriorly)
pg. E 7, O 298
7
Q
Where is the rectus abdominis located?
A
Anterior abdominopelvic wall
pg. E 9
8
Q
Where is the psoas major muscle located?
A
Posterior abdominopelvic wall
pg. E 9, O 297
9
Q
Where is the iliacus muscle located?
A
Laterally in the false pelvis
pg. E 9
10
Q
Where is the levator ani group located?
A
Middle, anterior pelvic floor
pg. E 9, O 297
11
Q
Where is the coccygeous muscle located?
A
Posterior pelvic floor
pg. E 9
12
Q
Where are the piriformis muscles located?
A
Posterior wall in true pelvis
pg. E 9, O 297
13
Q
Where are the obturator internus muscles located?
A
Lateral wall in true pelvis
pg. E 9, O 297
14
Q
What is formed by the psoas major and iliacus muscles?
A
iliopsoas muscles
pg. O 297
15
Q
How long is the typical vagina?
A
7-10 cm
pg. E 10
16
Q
What are the typical dimensions of the menarche nulliparous uterus?
A
6-8.5 x 3-5 x 3-5 cm
pg. O 302
17
Q
What are the typical dimensions of the menarche multiparous uterus?
A
8-10.5 x 3-5 x 5-6 cm
pg. O 302
18
Q
What are the typical dimensions of the premenarche uterus?
A
2-4 x 0.5-1 x 1-2 cm
pg. O 302
19
Q
What are the typical dimensions of the postmenopausal uterus?
A
- 5-7.5 x 2-3 x 4-6 cm
pg. O 302
20
Q
What is the isthmus of the uterus?
A
Lower uterine segment
pg. E 11 O 301
21
Q
What are the layers of the uterus?
A
Perimetrium (serosa)
Myometrium
Endometrium
pg. E 11-12 O 300
22
Q
What is the inner portion of the myometrium called?
A
Junctional zone
pg. E 11 O 300
23
Q
What are the 2 layers of the endometrium? Which is located where?
A
Basal layer (deep) Functional layer (superficial, sheds) pg. E 11 O 301
24
Q
What is anteversion?
A
Uterus tilted forward upon cx ( 90 degrees or less)
pg. E 13 O 303
25
What is retroversion?
Uterus tilted down towards cx (90 degrees or less)
| pg. E 13 O 303
26
What is anteflexion?
Uterus bent on cx ( greater than 90 degrees)
| pg. E 13 O 303
27
What is retroflexion?
Uterus curved backward on cx (greater than 90 degrees)
| pg. E 13 O 303
28
What does dextro- and levo- mean?
Right and Left
| pg. O 303
29
Which uterine position is most common?
Anteversion
| pg. E 13
30
What is the size of premenopausal ovaries?
3. 5 x 2 x 1.5 cm
| pg. E 15 O 305
31
What is the size of postmenopausal ovaries?
2 x 1 x 0.5 cm
| pg. E 15 O 305
32
How long are the fallopian tubes?
7-14 cm
| pg. E 16 O 307
33
What are the parts of the fallopian tube beginning near the uterus?
```
Interstitial portion
Isthmus
Ampulla
Infundibulum
pg. E 16 O 306
```
34
Where is the Space of Retzius and what are the other name(s)?
Between bladder and symphysis pubis
Retropubic and Prevesical space
pg. E 17 O 299
35
Where is the Vesicouterine pouch and what are the other name(s)?
Between uterus and bladder
Anterior cul-de-sac
pg. E 17 O 299
36
Where is the Retrouterine pouch and what are the other name(s)?
Between rectum and uterus
Posterior cul-de-sac and Pouch of Douglas
pg. E 17 O 299
37
What are the branches of the uterine artery?
(superficial to deep)
Arcuate > radial > spiral
(periphery) > myometrium > endometrium
pg. E 18 O 298
38
Where does cervix get it's blood supply?
Uterine arteries
| pg. O 298
39
Where does vagina get it's blood supply?
Uterine arteries
| pg. O 298
40
Where do ovaries get blood supply?
primary- ovarian arteries
secondary - uterine arteries
pg. O 298
41
What hormone(s) are produced by the hypothalamus and secreted by the pituitary gland?
FSH and LH
| pg. E 22 O 316
42
What does FSH stimulate?
Stimulates ovaries to develop follicles
and estrogen
pg. E 22 O 316
43
What does LH stimulate?
Stimulates maturation of follicles
and progesterone
pg. E 22 O 316
44
What are the ovarian phases?
Follicular (days 1-14)
Ovulation (day 14)
Luteal (days 15-28)
pg. E 23 O 320
45
What are the uterine phases of the menstrual cycle?
Menstrual (days 1-5)
Proliferative (days 6-14)
Secretory (days 15-28)
pg. E 24 O 317
46
What happens in the follicular phase?
FSH increases, Ovarian follicles increase in size
| pg. E 23 O 320
47
What happens at ovulation?
Graafian follicle ruptures
| pg. E 23 O 321
48
What is Mittelschmerz?
unilateral pelvic pain occurring mid cycle, associated with ovulation
pg. E 23 O 321
49
What happens in the luteal phase?
Corpus luteum forms
if fertilized it will continue to secrete progesterone
if fertilization does not occur it regresses
pg. E 23 O 322
50
What is the sonographic appearance of the endometrium during the early and late menstrual phases?
Early - Thin hypoechoic line 4-8mm
Late - Thin hyperechoic line 2-3mm
1-4mm
pg. E 24 O 317
51
What is the sonographic appearance of the endometrium during the early and late proliferative phases?
Early - thin hyperechoic line 4-6mm
Late - thick 3 line sign 4-8mm
4-8mm
pg. E 24 O 318
52
What is the sonographic appearance of the endometrium during the secretory phase?
Thick, hyperechoic line
7-14mm
pg. E 24 O 319
53
What is menorrhagia?
heavy flow during cyclic menstrual bleeding
| pg. E 26
54
What is polymenorrhea?
cycles less than 21 days apart
| pg. E 26
55
What is oligomenorrhea?
cycles more than 35 days apart
| pg. E 26
56
What is metrorrhagia?
irregular, frequent bleeding
| pg. E 26
57
What is menometrorrhagia?
irregular bleeding in both frequency and volume
| pg. E 26
58
What is dysmenorrhea?
painful bleeding
| pg. E 26
59
What is amenorrhea?
absence of menstrual flow
| pg. E 26
60
If a patient is using oral contraceptive pills, what will not occur and what will be observed?
Ovulation will not occur
No dominant follicles
Endometrium remains small throughout cycle
pg. E 26 O 324
61
What is the sonographic appearance of an IUD?
Hyperechoic to endometrium
Located in the fundus
Posterior shadowing
pg. E 27 O 324
62
What IUDs are used today and what are the shape(s)?
Paraguard (Copper T-shape)
Mirena and Skyla (hormone releasing plastic T)
pg. E27 O 324
63
What are other IUDs are there and what is the shape of each?
```
Copper T (T-shape)
Saf-T-Coil
Lippes Loop
Progestasert (hormonal)
pg. E 27 O 324
```
64
What is infertility? How often does it occur?
Inability to achieve pregnancy after 1 year of trying
1/7 American couples
pg. E 28 O 345
65
What can be done to help couples achieve pregnancy?
Ovulation induction
Ovulation monitoring
Assisted reproductive technologies
pg. E 29 O 345
66
What is IVF?
In-vitro fertilization- incubation of oocytes and sperm and catheter deliver into uterus
pg. E 29 O 345
67
What is ZIFT?
Zygote Intrafallopian Tube Transfer
Zygote is placed into fallopian tube
pg. E 29 O 345
68
What is GIFT?
Gamete Intrafallopian Tube Transfer
Sperm and ova are placed into fallopian tube
pg. E 29 O 345
69
What is Ovarian Hyperstimulation Syndrome?
Ovaries have multiple bilateral ovarian cysts due to excessive stimulation of the ovaries
pg. E 30
70
What is the normal cx to uterus size in a newborn?
2: 1
| pg. E 32 O 302
71
What are the indications for imaging a pediatric pelvis?
```
r/o ovarian cysts
assess for PCOS
r/o neoplasms
r/o congenital anomalies
determine presence/absence of UT in newborns w/ ambiguous genitalia
precocious puberty
r/o hydro/hematocolpos
pg. E 33
```
72
What is precocious puberty?
onset of secondary sexual characteristics prior to age 8
| pg. E 33
73
What is hydrometrocolpos?
Fluid in UT and VAG
| pg. E 34
74
What is hematocolpos?
Blood in VAG
| pg. E 34
75
What is the sonographic finding of hydrometrocolpos?
```
Hypoechoic VAG/ENDO
posterior acoustic enhancement
Possible internal echoes
Hydronephrosis, if severe
pg. E 34
```
76
What should a postmenopausal endometrium measure with and without HRT?
4-5 mm w/o HRT w/ bleeding
<8 mm w/ HRT; w/o HRT asymptomatic pt
pg. E 36
77
What is the most common reason for postmenopausal bleeding?
Exogenous estrogen administration w/ HRT
Endometrial atrophy w/o HRT
pg. E 38
78
What is tamoxifen?
A chemotherapeutic agent used for pt w/ breast ca. It can increase risk for endometrial ca.
pg. 38
79
What is complete/partial agenesis of VAG, CX, UT, and FT?
Failure of Mullerian ducts to form/develop
Complete absence
pg. E 41 O 303
80
What is a unicornate uterus?
Unilateral development of Mullerian ducts
Laterally positioned small UT
pg. E 41 O 304
81
What is a didelphys uterus?
No fusion of Mullerian ducts
2 UT, CX, and VAG
pg. E 41 O 303
82
What is a bicornuate uterus?
Partial fusion of Mullerian ducts
Deep notch in UT, 2 endometriums
pg. E 41 O 303
83
What is a septate uterus?
Complete fusion of Mullerian ducts w/ failure to reabsorb septum
Indentation in fundus
pg. E 41 O 303
84
What is an arcuate uterus?
Complete fusion of Mullerian ducts w/ almost compete resorption of septum
Mild superior separation of endo only
pg. E 41 O 303
85
What is a Gartner's duct cyst?
Anterolateral vaginal cyst
| pg. E 42 O 331
86
What is the most common neoplasm of the uterus?
Intramural leiomyoma
| pg. E 43 O 331
87
Where is the submucosal fibroid located?
Within endometrium, most symptomatic
| pg. E 43 O 332
88
Where is the intramural fibroid located?
Within myometrium
| pg. E 43 O 332
89
Where is the subserosal fibroid located?
Beneath perimetrium
| pg. E 43 O 332
90
Where can a fibroid be pedunculated?
Submucosal
Subserosal
pg. E 43 O 332
91
What are the clinical signs of myomas?
```
Heavy periods
Enlarged UT on pelvic exam
Increasing pain
Infertility
pg. E 44 O 332
```
92
What are the sonographic findings of leiomyomas?
Lobulated hypoechoic mass
Shadowing
Whorled texture
pg. E 44 O 332
93
Are leiomyosarcomas common or rare?
Rare
| pg. E 44 O 332
94
How do leiomyosarcomas appear under ultrasound?
Identical to benign fibroids
Heterogenous
Grow rapidly
pg. E 44
95
What is adenomyosis?
Growth of endometrial tissue into myometrium; focal or diffuse
pg. E 45 O 332
96
What are the sonographic findings of adenomyosis?
```
Enlarged UT
Heterogenous myometrium
"Venetian blind" shadowing
High vascularity
pg. E 45 O 332
```
97
Cervical cancer is the ____ most common GYN malignancy.
2nd; 3rd
| E 45; O 332
98
What are the risk factors associated with cervical carcinoma?
```
HPV infection
Early sexual activity
Multiple sex partners
Smoking
OCP use
pg. E 45 O 332
```
99
What are the symptoms associated with cervical ca?
```
Vaginal bleeding (most common)
Palpable mass
Weight loss
Asymptomatic
pg. E 45 O 332
```
100
What are the sonographic findings of cervical cancer?
```
Normal in early disease
Enlarged cx
Similar to fibroid
Hydronephrosis
pg. E 45 O 332
```
101
What are the sonographic findings of a nabothian cyst?
Small anechoic structure in cervix
| pg. E 46 O 332
102
What is hydrometra?
Fluid in the endometrial cavity
| pg. E 46 O 333
103
What is a uterine arteriovenous malformation?
Sonographically it is abundant flow low resistance on spectral Doppler
pg. E 46
104
What is the most common GYN malignancy?
Endometrial carcinoma
| pg. E 47 O 333
105
Who does endometrial carcinoma most commonly occur in?
Postmenopausal women
Obesity
Hx tamoxifen therapy
pg. E 47 O 333
106
What are the clinical signs of endometrial carcinoma?
Postmenopausal vaginal bleeding
Hypermenorrhea premenopausal
Pain
pg. E 47 O 333
107
What are the sonographic findings of endometrial carcinoma?
Heterogenous endometrium
Thickened endo
Complex endo mass
pg. E 47 O 333
108
What is the most common cause of abnormal uterine bleeding?
Endometrial hyperplasia
| pg. E 48
109
What can cause endometrial hyperplasia?
Hormone replacement therapy (most common)
| pg. E 48 O 333
110
What are the clinical findings of endometrial hyperplasia?
Similar to endo carcinoma (it can lead to it)
Abnormal bleeding
pg. E 48 O 333
111
What are the sonographic findings of endometrial hyperplasia?
Thickened endo
Smooth, homogenous
pg. E 48 O 333
112
What are the clinical signs of endometrial polyps?
Asymptomatic
Abnormal bleeding
Infertility
pg. E 49 O 333
113
What are the sonographic findings of endometrial polyps?
Echogenic mass in endo
Possible vascular stalk
pg. E 49 O 333
114
What is a saline infusion sonohysterography?
Hysterosonography
Saline inserted into endometrium
Can look for polyps, cysts, myomas, scarring
pg. E 50
115
What is Asherman syndrome?
Patient has adhesions in the endometrium from a dilate and currate or infection
pg. O 333
116
What are the sonographic findings of Asherman syndrome?
Cannot distinguish endo
Bright echoes w/in endo
pg. O 333
117
What is a follicular ovarian cyst?
Overstimulation of a follicle that fails to rupture typically 3-8 cm
pg. E 52
118
What is a corpus luteal cyst?
Cyst occurring after ovulation
Typically regresses if not pregnant
Typically persist into the 1st trimester
pg. E 52
119
What are theca lutein cysts?
Occur w/ high levels of hCG
Typically w/ gestational trophoblastic disease and hCG administration during infertility treatment
Do not secrete hormones
pg. E 53 O 334
120
What are the sonographic finding of a theca lutein cyst?
Multilocular
Bilateral
Largest of functional cysts
pg. E 53 O 334
121
What is a hemorrhagic cyst?
Large changing its appearance w/ time
Cystic --> solid --> internal echoes
pg. E 53
122
What is ovarian torsion?
Partial or complete rotation of ovary
| pg. E 54 O 336
123
What is the sonographic appearance of ovarian torsion?
Enlarged ovary
Absent spectral Doppler flow
No venous flow
pg. E 54 O 336
124
What is polycystic ovarian syndrome?
```
Stein-Leventhal syndrome
"String of pearls" cysts on ovaries
Infertility
Obesity
Amenorrhea
Hirsutism
pg. E 55 O 334
```
125
What is another name for PCOS?
Stein-Leventhal Syndrome
| pg. E 55 O 334
126
What is another name for an epithelial tumor?
Cystadenoma or cystadenocarcinoma
| pg. O 334
127
Malignant epithelial tumors account for approximately ___% of all ovarian malignancies.
90%
| pg. E 56
128
What are the 5 categories of epithelial tumors?
```
Serous
Mucinous
Endometroid
Clear cell
Transitional cell (Brenner)
pg. E 56
```
129
What is the 2nd most common benign tumor of the ovary?
Serous cystadenoma
| pg. O 334
130
What does serous cystadenoma appear like on ultrasound?
```
Anechoic
Sharp margins
Unilocular
Septations
pg. E 57 O 334
```
131
What does a serous cystadenocarcinoma appear as on ultrasound?
```
Anechoic sometimes w/ echogenic material
Multilocular
Septations
Ascites
pg. E 57 O 334
```
132
What does mucinous cystadenoma appear as on ultrasound?
```
Multilocular
Thick septations
Echoes
Up to 50 cm
pg. E 57
```
133
What does a mucinous cystadenocarcinoma appear as on ultrasound?
Multiloculated
Echogenic material w/in
15-30 cm
pg. E 58
134
Are transitional cell (Brenner) tumors typically benign or malignant?
Benign
| pg. E 58 O 335
135
What are germ cell tumors?
Benign cystic teratoma (dermoid)
Dysgerminoma
Endodermal sinus tumor
pg. E 59
136
What is the most common germ cell tumor?
Benign cystic teratoma (dermoid)
| pg. E 59 O 334
137
What is in a teratoma?
```
Fat
Hair
Skin
Teeth
pg. O 334
```
138
What does a dermoid look like sonographically?
```
"Tip of the iceberg" - solid, complex mass w/ bright echoes
Thick septations
Calcifications
Located superior to uterus
Dirty shadow
pg. E 60 O 334
```
139
Is a dysgerminoma benign or malignant?
Malignant
| pg. E 60 O 335
140
What is the sonographic appearance of a dysgerminoma?
```
Multilobulated
Solid
Typically unilateral
Variable size
pg. E 60 O 335
```
141
What age group is typically affected by germ cell tumors?
Under 30 years old
| pg. E 59 O 335
142
What are the different sex cord stromal tumors?
```
Fibroma
Thecoma
Granulosa cell tumor
Sertoli-Leydig tumors
pg. E 61
```
143
Are fibromas benign or malignant?
Benign
| pg. E 61 O 335
144
What are the sonographic findings of a fibroma?
```
Homogenous hypoechoic mass
Posterior acoustic shadowing
Pedunculated
Associated w/ ascites and pleural effusion
pg. E 61 O 335
```
145
At what age are stromal tumors most common?
Menopausal women
| pg. E 61 O 335
146
What is Meig's syndrome?
ascites and pleural effusion occuring with an ovarian mass
| pg. E 61 O 331
147
Are thecomas typically benign or malignant?
benign
| pg. E 62 O 335
148
What are the sonographic findings of a thecoma?
```
Solid hypoechoic mass
Posterior acoustic shadowing
Unilateral
Abnormally thickened endometrium
pg. E 62 O 335
```
149
What is the reason granulosa cell tumors are produced?
Hormones, the tumor produces estrogen
| pg. E 62 O 335
150
What are the sonographic findings of a granulosa cell tumor?
Solid or complex
Abnormally thickened endometrium
pg. E 62 O 335
151
What are the sonographic findings of a Sertoli-Leydig tumor?
Similar to granulosa, solid/complex
| pg. E 62
152
Ovarian cancer is the ___ leading cause of cancer death.
5th
| pg. E 64
153
Paraovarian cysts result from the remnants of the _______.
Wolffian ducts
| pg. E 66
154
What are the sonographic characteristics of a paraovarian cyst?
simple cyst adjacent to the ovary
| pg. E 66 O 343
155
What is the sonographic appearance of PID?
```
Normal
Thick and hypervascular endometrium
Tubular adnexal structures
Adnexal mass
pg. E 69 O 344
```
156
What is endometriosis?
ectopic location of endometrial tissue
| pg. E 70 O 343
157
What is localized endometriosis called?
endometrioma
| pg. E 70 O 343
158
What is another term for endometrioma?
chocolate cyst
| pg. E 70 O 343
159
Sonographically what does an endometrioma look like?
Hypoechoic homogenous (solid, cystic, or complex) mass
difficult to visualize by sonography
pg. E 71 O 343
160
What is a Krukenberg tumor?
Type of metastatic ovarian carcinoma arising from the GI primary
pg. E 63 O 343
161
What is a tuboovarian abscess?
Multilocular mass in the adnexa from a pelvic infection
| pg. O 344
162
What RI is considered a malignancy for ovaries?
<0.4
| pg. H 1006
163
What are possible complications of sonohysterography?
Vasovagal response
Pelvic infection
Vaginal bleeding
URR Exam
164
If a patient is suspected to have ovarian torsion what should be adjusted when using Doppler?
Decrease color Doppler velocity scale
Increase color gain
URR Exam
165
Is normal ovarian flow low or high resistive?
Low resistive
| URR Exam
166
What hormone is suppressed with oral contraceptives?
FSH
167
What does a sertoli-leydig cell tumor produce?
Testosterone
168
What are the other names for a Sertoli-Leydig cell tumor?
Androblastoma
| Arrhenoblastoma
169
What are the typical Doppler waveforms obtained from the uterine artery in a nulligravida UT?
High resistance
| High velocity
170
Where does the left ovarian vein drain into?
Left renal vein
171
Which hormone is responsible for ovulation?
Estrogen
172
If a mucinous ovarian malignancy ruptured, what could develop?
Psuedomyxoma peritonei
173
What hormone is responsible for proliferation of the endometrium?
Estrogen
174
What hormone is responsible for final maturation of the follicle and ovulation?
LH
