Lesson 6 (Part 1)

Question 1

What are causes of a thick endometrium? (7)

Answer 1

1. Pregnancy
2. Hyperplasia
   - cystic
3. Polyps
4. Carcinoma
5. Fibroids
   - submucosal or intra-cavity
   - appear thick, but it is coming from the myometrium is a cause of bleeding
6. Endometritis
7. Adhesions

Question 2

What are causes of uterine bleeding in peri/postmenopausal bleeding? (5)

Answer 2

1. Hormone imbalance
2. Abnormal growths
3. Systemic diseases
4. Endometrial polyps
5. Atrophy

Question 3

Typical sonographic appearance of a thick endometrium? (3)

Answer 3

1. Polyp
2. Hyperplasia
3. Carcinoma

Question 4

Typical sonographic appearance of thin endometrium?

Answer 4

Atrophy

- on a postmenopausal female

Question 5

Typical sonographic appearance of hyper echoic? (3)

Answer 5

1. Polyp
2. Hyperplasia
3. Atrophy
   - thin line

Question 6

Typical sonographic appearance of inhomogenous?

Answer 6

Carcinoma

Question 7

Typical sonographic appearance of homogenous? (2)

Answer 7

1. Hyperplasia

2. Polyp

Question 8

Typical sonographic appearance of well defined? (2)

Answer 8

1. Hyperplasia

2. Polyp

Question 9

Typical sonographic appearance of cystic changes within?

Answer 9

Cystic hyperplasia

Question 10

Typical sonographic appearance of focal or diffuse?

Answer 10

Polyp

- but could also be carcinoma

Question 11

Typical sonographic appearance of irregular borders?

Answer 11

Carcinoma

Question 12

Typical sonographic appearance of invading the myometrium?

Answer 12

Carcinoma

Question 13

What distinguishes a polyp from submucosal fibroid sonographically? (6)

Answer 13

1. Polyp is hyper echoic
2. Polyp has a stalk
   - pedicle —> vascular
3. Polyp is homogeneous
4. Polyp arises from the endometrium
5. Submucosal fibroid displaces the endometrium
6. Submucosal fibroid is heterogeneous and has no stalk = no colour, and is hypo echoic)

Question 14

PMB

Answer 14

Postmenopausal bleeding

- symptomatic

Question 15

What is the most likely cause of PMB?

Answer 15

Endometrial atrophy

- less than 5mm

Question 16

What is considered an abnormal endometrial measurement associated with PMB?

Answer 16

5mm or less

Question 17

How can a sonographer tell if it is endometrial cancer?

Answer 17

They cant tell, they need to biopsy

Question 18

What endometrial measurement is considered normal in an asymptomatic patient?

Answer 18

8mm or less

Question 19

What measurement would they biopsy and why? (2)

Answer 19

1. Measure = over 11mm
2. Biopsy = correlates with a person bleeding
   - bleeding is symptomatic

Question 20

Name an ultrasound procedure that is ordered to provide more information regarding the endometrium

Answer 20

Sonohysteropgraphy

Question 21

Sonohysteropgraphy

Answer 21

Sterile saline into the endometrial cavity under the ultrasound guidance

Question 22

Name 2 types of endometrial biopsy’s and reason for doing one over the other?

Answer 22

1. Blind/ non directed
   - cant see
2. Hysteroscope
   - allows to see

Question 23

When is the best time to evaluate a menstruating women endometrium? (1) Why? (2)

Answer 23

1. When the endometrium is thin
   - early proliferative
2. Trying to find congenital anomalies
3. Trying to see if something is there that doesn’t belong
   - we can see it the best here
   this does not matter for a postmenopausal women

Question 24

What are common indications for an ovarian US? (4)

Answer 24

1. Pain
2. Palpable Mass
3. Irregular bleeding
4. Family history of ovarian tumour or cancer

Question 25

What are we looking for in an ovarian US? (5)

Answer 25

1. Ectopic pregnancy - if patient has positive B-hcg 2. Cysts 3. Tumours 4. Inflammatory Bowel Disease 5. Appendicitis

Question 26

What method of US is really good at looking at the ovaries?

Answer 26

Transvaginal

Question 27

Why is a transvaginal a better method of looking at the ovaries?

Answer 27

1. Better details 2. Not always seen transabdominally - due to bowel and gas

Question 28

What do normal follicles usually measure up to?

Answer 28

2. 5cm at maturity | - found 1st half of the menstrual cycle

Question 29

What happens with a follicular cyst?

Answer 29

The mature follicle fails to ovulate or involute

Question 30

What is the most common cause of ovarian enlargement in young women? (3)

Answer 30

1. Follicular 2. Corpus luteal 3. Theca luteal

Question 31

How does a follicular cyst develop?

Answer 31

If fluid in a nondominant follicle fails to resorb