GYNO FINAL Flashcards
(120 cards)
1
Q
A
2
Q
*

A
Dermoid Tumor
-dermoid mesh
3
Q

A
Dermoid Cyst
-tip of the iceburg
4
Q

A
Testes
- low level echogenicity
- 7-10 mm diameter
- mediastinum teste and epididymus (not seen until after puberty)
5
Q
*

A
Dermoid Tumor
-dermoid mesh
6
Q

A
Dermoid Cyst
-tip of the iceburg
7
Q

A
Testes
- low level echogenicity
- 7-10 mm diameter
- mediastinum teste and epididymus (not seen until after puberty)
8
Q
*

A
Bicornate Uterus
- best seen in trans
- bicornate and didelphys -not associated w/ infertility
- duplicated uterus w/ common cervix
9
Q
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A
Bicornate Uterus
- best seen in trans
- bicornate and didelphys -not associated w/ infertility
- duplicated uterus w/ common cervix
10
Q

A
Uterus w/ Fibroids
- fibroid usually has rounded borders
- fibroids are estrogen dependant and grow during pregnancy
- may cause infertility
11
Q
*

A
submucosal fibroids
- look how each fibroid interfaces w/ endometrial lining
12
Q
*

A
Uterine Polyp
- polyp outlined w/ SIS
- color doppler demonstrating vascular pedicle
13
Q
*

A
Uterine Polyp
(on a stalk)
14
Q

A
Uterine Synechia
- synechia shows up as linear strands of scar tissue extending from one side of uterus to other
15
Q

A
Follicles
- 1st image: follicular phase
- 2nd image: dominant follicle
16
Q

A
Polycystic Ovarian Syndrome“string of pearls”
- 12 or more follicles measuring 2-9 mm;
ovarian volume > 10 cm3
- often occurs w/ clinical triad:
- olgiomenorrhea, hirsutism, obesity
- immature follicles continue to produce estrogen and androgen which inhibits pit gland.
- Pit gland produces more LH than FSH –> follicle to remain in arrested state of development- no mature ova released w/ ovulation
- chronic elevation of estrogen

17
Q

A
peritoneal inclusion cysts
18
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endometriosis
- most common benign gynecologic disease
- in 10-25% of women w/ gyn disease
- in 40% of women w/ infertility
assess thickness and echogenicity pattern
increased thickness 2-3 mm –> 12-14 mm
- measure long plane
- outer to outer - double layer thickness
- normal pattern - trilaminar
- thin endometrium - < 8mm (in secretory phase)
- -decreased fertility
19
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A
measuring endometrium
20
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Ovarian Stimulation
- administer clomiphene (Clomid) or gonadotropin (Pergonal) day 3-5 in normal cycle
- enlarges multiple follicles instead of just one dominant follicle
- US monitors # and size of follicles day 8-14 (follicular phase)
- count all follicles > 1cm or 10mm
- optimum follcile size = 15-20 mm
- hCG may be given IM to trigger ovulation w/ retrieval 30-34 hours later
21
Q

A
Oocyte retrieval
- oocyte fertilization in dish and incubated for 3 to 5 days before embryo transfer
22
Q

A
US guided embryo transfer
23
Q

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Ovarian Hyperstimulation Syndrome
- this is a complication of assisted reproductive technology
- enlarged ovaries, multiple cysts, abd ascites, pleural effusions
- more common w/ PCOS
- mild ovarian enlargement 5- 10 cm

24
Q
A

A
interstitial/ cornual
25
B

isthmus
26
C

abdominal
27
D

ampulary
28
E

fimbrial
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F

ovary
30
G

cornual/ interstitial
31
H

fornix
32
I

cervical
33
J

body of uterus
34
K

abdominal peritoneum
35
What is seen inside this double decidual sac sign?

yolk sac
36


37

interstitial pregnancy
* endometrial cavity line does not enlcose gestational sac
* absence of surrounding myometrium - pregnancy look like it is at the edge of the right side of uterus
* **most life threatening**

38

cervical ectopic pregnancy
39

**abdominal ectopic pregnancy**
* pregnancy develops w/in the peritoneal cavity

42
1.

uterine fundus
43
2

fallopian tube
44
3

fimbriae
45
4

myometrium
46
5

endometrium
47
6

uterine isthmus
48
7

lateral fornix
49
8

vagina
50
9

ectocervix
51
10

endocervix
52
11

ovarian ligament
53
12

ovary
54
benign smooth muscle cell tumor; few appear in the cervix

cervical leiomyoma (fibroid)
*

55
fluid filled uterus

hydrometra
56
blood filled.

hematometra

57
1
## Footnote
**leiomyoma locations**

pedunculated or intracavitary
58
2
leiomyoma locations

Ovary
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3
leiomyoma locations

submucosal
60
4
leiomyoma locations

uterus
61
5
leiomyoma locations

cervix
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6
leiomyoma locations

subserosal
63
7
leiomyoma locations

intramural
64
most common gynecologic tumor of childbearing age women, and is more common in black women?

**submucosal leiomyoma** (common location)
* fibroid is anterior & is pushing endometrium posterior
* smooth muscle cell tumor
* encapsulated with pseudocapsule
* fibrosis w/ degenerative changes
* out grow their blood supply and atrophy
* estrogen dependant
* pregnancy and tamoxifen = ↑ growth (size)
* menopause w/o HRT = ↓ growth (size)
* **Clinical findings**: irreg bleeding, menorrhagia, menometrorrhagia, enlarged uterus, infertility, pee alot
* **on US: (variable)** enlarged uterus w/ irregular wall, bright echoes w/ clcifications & shadowing, discrete mass

65
**very common** benign disease of the uterus; infiltration of endometrial tissue from stratum basalis into myometrium?

**adenomyosis**
* Ectopic endometrial tissue within myometrium
* More common posterior uterus
* Does not bleed with hormone cycle
* Product of multiple pregnancies
* Elevated estrogen levels
hypermenorrhea, menorrhagia, metrorrhea, dysmenorrhea
on US:
* Diffuse uterine enlargement
* Thickening posterior myometrium
* Small myometrial cysts - swiss cheese or honeycomb - non vascular
* Subendometrial cysts
* Myometrial heterogenicity with ill-defined endometrial borders
* May mimic fibroid
* MRI characterizes adenomyosis better

66
overgrowth of endometrial tissue covered by epithelium containing glands, stroma, blood vessels

uterine polyps
* peri & post menopausal women -more common & associated w/ bleeding
* menstruating women - asociated w/ infertility & menometrorrhagia
* differential: hyperplasia, submucosal leiomyoma, or endometrial cancer
* doppler shows a feeding artery in a pedicle
67

synechiae
* intrauterine adhesions (Asherman's Syndrome)
* found after trauma or surgery, uterine curettage
* cause of infertility or pregnancy loss
* better seen in gravid uterus, secretory phase
* adhesion bridging bands of tissue- thin membrane or thick broad based adhesion
* can be divided under hysteroscopy
68

IUCD in place
69
small endocrine structure that develops w/in a ruptured ovarian follicle and secretes progesterone and estrogen

corpus luteum cyst

70
requires 3 things: smooth walls, fluid filled, acoustic enhancement

simple cyst
is usually benign
71

corpus luteum cyst
72

ovarian hyperstimulation syndrome (OHSS)
* complication of ovulation induction
* **mild**
* pelvic discomfort, ovaries enlarged \< 5cm
* **severe**
* ****severe pelvic pain
* distended abd.
* ovaries enlarged \>10cm
* **ascites, pleural effusions**
* w/ treatment - resolves in 2-3 weeks
73
12 or more follicles measuring 2-9 mm and ovarian volume greater than 10 cm3

polycystic ovarian syndrome (PCOS)
* very common
* **"string of pearls"**
* stein leventhal syndrome
* infertility, oligomenorrhea, hirsutism & obesity
* bilateral enlarged polycystic ovaries
* common cause of infertility and miscarriage
* diagnosis usually made by hormone levels
74

endometriosis
* functional endometrial tissue present outside the uterus
* diffuse is more common
* localized = chocolate cyst
* bleeds cyclically

75

dermoid tumor
tip of the iceberg sign
76

dermoid cyst
dermoid mesh
77

hydrosalpinx
fluid in the fallopian tube

78
1
Blood supply to pelvis

internal iliac artery
79
2.
Blood supply to pelvis

tubal branch of uterine artery
80
3.
Blood supply to pelvis

ovarian branch of uterine artery
81
4.
Blood supply to pelvis

infundibulopelvic ligament
82
5
Blood supply to pelvis

ureter
83
6
Blood supply to pelvis

uterine artery
84
7
Blood supply to pelvis

vaginal artery
85
8
Blood supply to pelvis

internal pudendal artery
86
9
Blood supply to pelvis

azygos arteries
87
10
Blood supply to pelvis

cervical branch of the uterine artery
88
1
genital tract

uterine (fallopian) tube
89
2
genital tract

cornu
90
3
genital tract

fundus
91
4
genital tract

corpus
92
5
genital tract

isthmus
93
6
genital tract

cervix
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7
genital tract

rugae of mucosal lining
95
8
genital tract

adventitia
96
9
genital tract

muscular wall
97
10
genital tract

mucosa
98
11
genital tract

vagina
99
12
genital tract

external os
100
13
genital tract

lateral vagina fornix
101
14
genital tract

internal os
102
15
genital tract

serosa
103
16
genital tract

myometrium
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17
genital tract

uterine cavity
105
18
genital tract

endometrium
106
Uterine Position Variations

107
2
fallopian tube

infundibulum
108
3
fallopian tube

fimbriae
109
4
fallopian tube

ovarian ligament
110
5
fallopian tube

interstitial portion
111
6
fallopian tube

isthmus
112
7
fallopian tube

ampulla
113
what endometrial phase is this "thin line"?

early proliferative
114
what endometrial phase is this "three line sign"?

classic proliferative
115
what endometrial phase is this thickened ?

secratory phase
116
what phase?
what position?

early secretory
retroflexed to the right
117
what phase?

secratory phase
118
what flexion?

anteflexed
119
what flexion?

anteflexed
120
what flexion?

retroflexed
154
indications for 1st trimester exam
* Confirmation of IUP vs. EUP
* Define cause of bleeding
* Pelvic Pain
* Viability
* # of embryos
* Gestational age
* Detect anomalies
* R/O hydatidform mole
* Adjunct to CVS, amnio, embryo transfer, IUD removal
* \*\*First trimester exam performed only when deemed necessary\*\*
155
indications for 2nd & 3rd trimester exam
* Gestational Age
* Fetal Growth
* Vaginal Bleeding
* Abd/Pelvic pain
* Incompetent cervix
* Determine fetal presentation
* # fetuses
* Size discrepance to dates
* Pelvic mass
* Suspected hydatidform mole
* Cervical cerclage placement
* R/O ectopic
* Fetal viability
* Uterine abnormality
* Evaluate fetal well-being
* Amniotic fluid
* Placental abruption
* External cephalic version
* Premature rupture membranes and/or labor
* Abnormal chemical markers
* F/U fetal anomaly
* History prev congenital anomaly
* Eval for late to prenatal care