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O&G Flashcards

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1
Q

septate, bicorniate and didelphys uterus

A

septate: smooth fundus. can appear to have 2 cervices
bicornuate: indented fundus. 1 cervix
didelphys: complete. indented fubdus, 2 cervices and 2 vaginas.

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2
Q

placenta praevia spectrum and grade

A

still crosses os at 28wks. can’t dx b4 20wks. repeat at 32 wks
low lying. less than 2cm from OS Partial praevia. partially covers os Complete praevia. total coverage of os
Increased risk APH and acretta. Follow up at 30wks to see if regresses

grade 1. edge within 5cm
grade 2. marginal. tissue reaches but doesn’t cover
grade 3. partially covers OS
grade 4. complete

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3
Q

placenta acretta

A

acretta. abnormal adherence to myometrium. prominent venous lakes. increased risk with previous c section or placenta praevia. worry if anterior placenta and previous section
incretta. infiltrates withing myometrium
percretta. within myometrium. no or very little plane between myometrium vessels and bladder on doppler

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4
Q

placental abruption

A

premature separation b4 20wks
antepartum haemorrhage
retro placental clot

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5
Q

circumvillate placenta

A

placental shelf at edge, lifts up

can infarct or haemorrhage

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6
Q

succenturiate lobe

A

2 lobes. put doppler between and check no vessels, esp along os. do PV
associated with praevia and retained products

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7
Q

abnormal cord insertion into placenta

A

marginal. within 2cm from edge.
velamentous. inserts direct to wall/membranes, not into placenta. vessels run between insertion and placenta
associated IUGR, vasa praevia ( vessels across os) and haemorrhage

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8
Q

amniotic band and shelf

A

shelf. thin band that runs entire length of uterine wall. has base (thick) and free edge. can have flow.
band. free floating blind end in anion with intact end to chorion. can entrap limbs and cause structures.

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9
Q

uterine cord

A

2aa, 1vv.
normal RI <0.55
normal PI <1.4

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10
Q

MCA artery doppler

A

mum sitting up or on rt side
normally has high resistance flow with no antegrade diastolic (below line)
reduced flow suggests head sparing and cerebral redistribution. IUGR progression.

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11
Q

IUGR

symmetric or asymmetric

A

symmetric. all parameters are down. EFW <10%
associated with trisomy 13 or 18, TORCH, etoh, smoking, heroin

asymmetric. placental insufficiency or pre eclampsia.
HC normal, AC reduced. increased HC/AC ratio. check MCA for sparing. look at bone density and shape.

must comment on foetal movements, liquor volume and umbilical aa SD and PI.

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12
Q

polyhydramnios

A 
>25cm after 20wk
idiopathic
dm
cns or neural tube defect                                                              Hydrops                                                                                                                          TTTS
cardiovascular abnormal.  svt
CPAM
hernia
GI obstruction                                                                            Microcephaly (rubella or CMV in utero,  trisomy, Syndromic ie walker Warburg mm dystrophy)
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13
Q

most common virus causing hydrops

A

pavovirus

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14
Q

CCAM types

A

type 1. most common. large cysts 2-10cm size
type 2. cysts <2cm size. associated with renal agenesis, Pulm sequestration and cardiac anomalies
type 3. unlined cysts. usually only affects 1 lobe. can’t ddx from type 1
type 0. rare. global arrest of lung development. postnatal fatal.

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15
Q

commonest cause of hydronephrosis in utero

A

PUJ obstruction.
high risk renal injury with minor trauma.
bilateral 30%. L>R.
congenital is usually idiopathic. other causes: extrinsic compression (vessel, fibrosis or mass), pelvic trauma, infection with scar

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16
Q

TTTS in mono/di chorion, Moni/di amnionic

A

exclusively monochorionic pregnancies

MCDC, MCDA

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17
Q

Nuchal translucency thickness

A

> 3mm, but must correlate with maternal bloods also
- bHCG, AFP, oestriol, pregnancy associated plasma protein (PAP).
look at heart.

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18
Q

yolk sac present

A

5-6 weeks

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19
Q

hydrops fetalis

A

immune/rhesus incompatible
non inmune/rhesus compatible: cardiac> chromosomal 18, 13, 21, turners > infection (pavovirus B19, TORCH) > chest (CPAM), Urinary tract obst, TTTS, sacroccygeal tumors, anemia, skeletal dysplasia, vv galen

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20
Q

TTTS stages

A
  1. visible bladder. normal US
  2. empty bladder. normal UA
  3. empty bladder. UA doppler abnormal
  4. hydrops in recipient
  5. demise of either twin
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21
Q

eccentric gestational sac

A

Interstitial ectopic
high in fundus, off centre. corneal.
low near cervix - c-scar or classic c scar
*mention myometrium thickness as <3mm associated with risk perforation. Uterine anomaly. bicorniate or septate

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22
Q

ectopic vs miscarriage

A

ectopic has decidual reaction and rim of vascular it.

ectopic won’t move on probe palpation.

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23
Q

mx ectopic

A

medical: not ruptured, asymptomatic, <3cm
methotrexate wither systemic or direct injection (kcl first to kill pregnancy)

surgical: ruptured, symptoms

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24
Q

failed early pregnancy

A

MSD >25mm with no embryo
CRL >7mm with no heartbeat
*CRL out ranks MSD. repeat US in 7-14 days if borderline

suspected failed:
CRL <7mm with no heartbeat
MSD: 16-24mm with no embryo
enlarged (>7mm), calcified or irregular yolk sac
irregular gestational sac
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25
hydatiform mole
gestational trophoblastic disease teens, 40-50yo and Asians complete: diploid 46XX partial: abnormal fetus. triploid 69XXXY bunch of grapes on US with enlarged uterus and elevated bHCG complete can progress to invasive or choriocarcinoma
26
MCMA MCDA DCDA DCMA
DC. lambda sign. twin peaks. thick | DA. T sign. thin
27
oligohydramnios
DRIPC Demise or drugs Renal agenesis, posterior urethral valves, MCDA. check PUJ and bladder IUGR PROM or post dates Chromosomal abnormalities 18, 21, 13, turners *Check pulm hypoplasia, limbs for club foot or deformity, facial deformity, UA for IUGR
28
intrauterine hydrocephalus
>10mm diameter later ventricles at atrium non obstructive. hemorrhage, infection obstructive. spina bifide, aqueduct stenosis, chiari, dandy walker, encephalocele
29
normal intrauterine renal pelvic diammeter
7mm
30
cisterna magna c/w dandy walker
cisterna doesn't have a connection to 4th ventricle | dandy walker has small posterior fossa
31
ovarian cysts - simple
<5cm premenopausal or <1cm postmenopausal - leave alone. 5 -7cm pre (1-7cm postmenopausal) - f/u yearly US >7cm needs gynae rv +/- MRI for possible infiltration
32
ovarian cyst - haemorrhagic
<5cm no fu >5cm - fu in 6-12 weeks to ensure resolution in post menopausal need follow up at any size. * hypoechoic with lace like internal echos. +/- concave solid part that has no flow.
33
malignant breast ca
95% adenocarcinoma 5% phylloides, lymphoma, sarcoma, scc, mets (melanoma, lymphoma). 2nd to skin ca in frequency. 2nd to lung ca in cause of death risks. hormones (early menarche, late menopause), nulliparity, obesity, oestrogen. genetic brca 1 & 2, le fraumeni, Cowden, HTT, peutz jagher.
34
non invasive breast cancer vs invasive
invasive has breached the basement membrane | they all arise in terminal duct/lobule unit
35
non invasive breast ca
DCIS. branching linear micro calcs that spread along the duct. comedocarcinoma, papillary, Micropapillary, solid, cribriform. LCIS. usually incidental finding on bx as no calcification. more likely to be bilateral or multilocul and can recur in either breast as ductal or lobular more common in younger women than DCIS * both can become invasive around 1% per year.
36
invasive breast ca
breached basement membrane upper outer most common schirrhous (dense collagen), stelate or well cx. subtypes. - NOS. worst prog, high grade - Medullary. poor prog as rapid growth and local aggressive. looks like fibro adenoma. younger (50s). BRCA 1 - Lobular. poorly seen as little desmoplastic reaction and no ca+. Indian ink cells in loose clusters. multicentric or bilateral can occur - Mucinous. older women with slow growth and good prog. cells float in mucin. soft and gelatinous. - Tubular. spiculated mass in younger. slow growth with best prognosis.
37
first trimester bleeding
Normal implantation bleed, miscarriage (MSD >25mm, CRL >7mm with no FHB), ectopic, GTD, Subchorionic haemorrhage (>50% high risk)
38
Empty gestational sac
Blighted ovum (MSD >25mm with no embryo) Ectopic with pseudogestational sac (central cf eccentric location in uterus, no yolk sac, irregular/pointed shape)
39
Echogenic endometrial cavity
Early IUP, Ectopic, retained products, emdometritis
40
Complex intrauterine mass
Missed miscarriage with RPOC, molar, degenerative fibroid, endometrial ca (>5mm postmenopausal with bleed, >11mm without bleed)
41
High risk aneuploidy
Increased maternal age Increased nuchal translucency >3mm Increased beta hcg Decreased PAPP-A Absent echogenic nasal bone
42
Nuchal translucency method
Nasal bone in view, echogenic dot Head neutral Calipers on inside of echogenic lines at widest part CRL 45 - 84mm 11-13.6wks
43
Increased nuchal translucency
>3mm Chromosomal. 13, 18, 21 Non chromosomal. cardiac defect, skeletal dysplasia, oomphalocele, VACTERL
44
Enlarged placenta
>4cm thick Hydrops, maternal DM, maternal anaemia, TORCH, GTD, haematoma
45
Small placent
Hypoperfusion Maternal HTN, Toxaemia, severe DM, IUGR
46
Hypoechoic placental focus
Venous lake (assoc. accretta), Placental haemorrhage, GTD (partial mole), Infarct (can be echogenic or ca+), chorioangioma (benign placental vascular tumor), submucosal fibroid
47
Single vessel cord
Trisomy 18, 13, structural anomalies (renal agenesis, face, limbs, heart), IUGR Follow up trimester 3 to assess growth. risk IUGR
48
Mass in cord
Haematoma, Haemangioma, cyst, varix
49
Small baby
Incorrect dates, small baby from small parents, IUGR IUGR is symmetric (growth restriction in all paremeters. due to foetal problem) or asymmetric (AC most affected. due to placental problem) EFW <10% for GA
50
Symmetric IUGR
Chromosomal. 13, 18, 21 Congenital malformation. Anencephaly, Diaph hernia, oomphalocele, Gastroschesis, Renal agenesis Multiple gestations
51
Asymmetric IUGR
Placental Abnormal trophoblastic invasion, multiple placental infarcts, abnormal cord insertion, placenta praevia, circumvillate placenta, chorioangiomata
52
Strawberry skull, Microcephaly, Choroid plexus cyst, Absent Corpus callous, Facial cleft, Micrognathia, Cystic hygroma, Diaph hernia, Oomphalocele, Duodenal atresia, Hydrops, Short femur, Overlapping fingers, Polydactyly, Tallipes
Strawberry skull - 18, Microcephaly - 13, turners Choroid plexus cyst- 21, 18, Absent Corpus callousum - 18, Facial cleft - 18, 13 Micrognathia - 13 Cystic hygroma - turners Diaph hernia - 18, 13, Oomphalocele - 18, 13, Duodenal atresia - 21, Hydrops - 21, turners Short femur - all Overlapping fingers - 18 Polydactyly - 13 Tallipes - 18, 13
53
Asymmetric twin size
Normal variant is <20% EFW difference - Foetal demise or TTTS (monochorionic) donor twin is underperfused and stuck, absent or reversed UA flow recipient twin is oedematous, normal size, absent DV
54
Lemon head
Myelomeningocele with chiari II, encephalocele, DW malformation
55
Cloverleaf skull
Craniosynostosis (multiple), thanatrophic dwarfism
56
Frontal bossing
Achondroplasia, thanatrophic dwarfism, acromegaly, cleidocranial dysostosis
57
ventriculomegaly
atrial width >10mm Chiari II, meningocele, spina bifida, DW malformation, Aqueduct stenosis (congenital Web, infection or haemorrhage), Agenesis corpus callosum, Congenital infection
58
Hyperechoic brain focus
Haemorrhage, teratoma, lipoma cc
59
Posterior fossa malformations
Normal cisterna magna is <10mm Chiari, dandy walker
60
Posterior cystic head/neck mass
Cystic hygroma (turners, trisomy 18, 13, 21). look for aortic coarctation Encephalocele Myelomeningocele c spine Haemangioma
61
Anterior head/neck cystic mass
Teratoma (cystic and solid), Haemangioma, brachial cleft cyst (anterolateral), thyroglossal duct cyst (midline)
62
solid or echogenic pulmonary mass
CPAM, CDH, Pulm sequestration (look for aa), CLE filled with fluid, bronchial atresia, Mucous plus, teratoma
63
hyperechoic cardiac focus
Normal variant, trisomy 21 (soft marker), rhabdomyosarcoma (esp TS), teratoma, haemangioma
64
Absent gastric bubble
Should be visible by 19wk. Rescan in 30 mins - Oesoph atresia (18 and 21), CDH, oligohydramions, impaired swallowing (CNS defect, facial cleft, skeletal dysplasia with narrow chest) *Look for VACTERL, T18/21 and polyhydramnios (suggests oesoph atresia)
65
abdo ca+
Meconium peritonitis, TORCH, neuroblastoma, teratoma
66
echogenic bowel
as bright as iliac bone CF, T21, IUGR, CMV infection, swallowed blood, mec peritonitis
67
anterior abdominal wall defect
midline. physiological (b4 12wks), oomphalocele (trisomy) lateral. gastroschisis infra umbilical. bladder or cloaca exostrophy
68
hydronephrosis
AP diamm >4cm T1, >7mm T2. Upper tract: PUJ obst (most common), reflux, primary mega ureter (VUJ obst), duplex Lower tract: PUV, urethral stricture or agenesis, caudal regression sx, ectopic ureterocele, prune belly sx
69
Big echogenic kidneys
PCKD, t13, Meckle gruber, Renal vv thrombosis *t13. look for cardiac abno, cystic hygroma, facial cleft *Meckle g. look for encephalocele, polydactyly
70
Big bladder
PUV, prune belly, urethral/cloaca atresia
71
Absent bladder
failure of urine production - Bilateral renal agenesis, bilateral MCDK, bilateral PUJ, ARPCKD, severe IUGR failure to store or displaces bladder - Bladder exostrophy, cloaca exostrophy, ruptured bladder *rescan in 30 min incase empty
72
Reduced femur length
Short parents, IUGR, chromosomal, skeletal dysplasia
73
Fractures
OI, hypophosphataemia, skeletal dysplasia (Achondroplasia. .. just a little short)
74
third trimester bleeding
placenta praevia, Placental abruption, cervical lesions
75
c section complication
RPOC, haematoma or infection (pelvic collection), endometritis
76
Shadowing in endometrium
IUD, ca+ in fibroid or Tb, pyometria with gas
77
focal enlargement of uterus
fibroid, adenomyosis (venetian blind, posterior wall), inflammation (PID, surgery), endometriosis, tumor
78
thickened endometrium
>5mm post menopausal with haemorrhage, >8mm without haemorrhage - pregnancy related. normal, ectopic, RPOC, GTD - post menopause. Endometrial hyperplasia, endometrial polyp, endometrial cancer, HRT
79
Cystic adnexal mass
Follicle. <25mm Follicular cyst >25mm Too many follicles (PCOS, hyperstimulation) Non neoplastic mass. Haem cyst (lace like), endometrioma (low echo), ectopic Neoplastic mass. surface epithelial tumor (serous, mucinous, endometrial, brenner), GCT (dermoid. + ca+ and fat) Tube. hydrosalpinx (PID, endometriosis, Adhesions, surgery)
80
Complex pelvic mass CHEETAH
Cystadenoma, Haem cyst, Ectopic, Endometrioma, Teratoma, Abscess (look for appendicits), Haematoma
81
Bilateral ovarian mass
Endometrioma, serous epithelial (cystadenocarcinoma), endometrioid tumour, dermoid cyst, mets (krukenberg GIT)
82
Ovarian mass pearls
Serous cystadenoma are thin walled uni or multilocular. common Mucinous cystadenoma are lass common, big and multilocular Endometrial hyperplasia is associated with endometrioid carcinoma, granulosa cell tumor and thecoma Solid ovarian tumours are fibroma and brenner Malignant germ cell tumours are large and predominantly solid. younger women, prominent fibrovascular septa. correlate with serum tumor markers Tumours with strong enhancing solid parts are stromal or sertoli leydig
83
Enlarged ovary with multiple peripheral follicles
PCOS, ovarian torsion, ovarian hyperstimulation
84
PCOS
Ovary volume >10cc, >12 follicles in ovary 2-9mm each. Only need 1 ovary involved to dx Correlate with clinical sx such as hirsutism and anovulation
85
Dilated fallopian tubes
Infection, tumour (endometrial or tubal carcinoma), endometriosis
86
Tubal filling defect
polyp, gas bubble, silicon inject, tubal pregnancy, neoplasm
87
Tubal irregulariry
Inflammatory PID or Tb, salpingitis isthma nodosa, adenomyosis, endometriosis, post op
88
IOTA benign. SUMS - flow, Malig MAPS. +flow
Benign. - Unilocular - Solid part <7mm - Shadowing - Smooth multilocular <10mm size - No flow Malignant - Solid irregular - Ascities - Multilocular, irregular, solid >10mm - >4 papillary projections - Strong flow *1+ malig with no benign needs gynae on rv *1+ benign with no malignant ok *All other are indeterminate and need gynae rv
89
Breast calcification. Benign
Skin ca+ - Lucent centre, eggshell Rim/eggshell - <1mm thick, peripheral. oil cyst or cyst wall Vascular ca+ Rod like large - plasma cell mastitis. smooth, linear rods Round punctuate - Homogenous, evenly scattered. Isolated clusters need bx Milk of ca+ - teacup sediment. fuzzy/smudged on CC, teacup on lat Coarse ca+ popcorn - Large >2-9mm. papilloma, haemangioma, Hamartoma Dystrophy coarse irregular ca+ post rxt or sx Suture ca+
90
Breast ca+ Suspect
Amorphous powderish Coarse heterogenous Fine pleomorphic granular. vary shale and size. DCIS Fine linear branching. high grade DCIS
91
Breast ca+ distibution
Diffuse/scattered. usually benign Regional. Large volume of breast tissue. malignancy less likely Grouped/clustered. Occupy a small volume of tissue Segmental. deposits in ducts and branches. bad Linear. In a line
92
Male breast lump
gyneacomastia- flame shaped, most common, subareaolar. unilateral or bilateral asymmetric lipoma Breast ca. IDC. eccentric to nipple Mets (melanoma, lipoma) **Palpable breast mass in male - proceed to US
93
Causes of gyneacomastia
SCARE M Seminoma, Cirrhosis, Anabolic steroids, Renal failure, Estrogen, Marajuana.
94
Unilateral nipple changes
Pagets disease of nipple. DCIS Inflamm breast ca Mastitis Eczma. resolves with steroids. looks like pagets
95
Skin thickening. diffuse
Bilateral - HRT, Lactation, post reduction mammo pasty, CCF, SVC obst, Lymphoedema, Renal failure Unilateral - Inflamm breast ca, lymphoma/Leukaemia, Lymphatic obstruction (spread ca to axilla), Acute mastitis, abscess, radiation, post sx
96
Skin thickening. focal
carcinoma, intra dermal met, skin lesion (wart, mole, seborrheic keratitis. lucent rim around), Plasma cell mastitis, dermatitis, trauma, mondors disease (thrombosis of superficial vv)
97
Subcutaneous/superficial breast mass
sebaceous cyst, epidermoid, focal infection
98
Breast mass with echogenic halo on US
Haematoma (thick, changes with time, go in and look for skin trauma or take hx), abscess, carcinom
99
tallipes association
t18, neural tube defects, congenital joint contractures
100
calcified axillary LN breast
Gold in RA, treated Lymphoma, mets (ovarian, mucinous)

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