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
*
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
Q
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
A
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
29
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
59
3
leiomyoma locations
submucosal
60
4
leiomyoma locations
uterus
61
5
leiomyoma locations
cervix
62
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
94
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
104
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
