OBG-female physiology

Question 1

the endometrium and ovaries respond to ______ and ______ levels in the blood

Answer 1

estrogen and progesterone

Question 2

blood levels are controlled by a ______ between the ovaries and the hypothalamus

Answer 2

feed back mechanism

Question 3

when serum estradiol falls below a certain serum concentration, the hypothalamus produces ______

Answer 3

Gn RH = gonadotropin releasing hormone

Question 4

the pituitary gland is then stimulated to produce ______ and ______

Answer 4

FSH = follicle stimulating hormone and LH = leuteniting hormone

Question 5

as follicles grow, increasing estradiol levels within follicles help them ______ to the LH, with eventual ovulation

Answer 5

respond

Question 6

the bleeding and shedding of the endometrial lining that occurs at approximately monthly intervals from menarche to menopause

Answer 6

menstruation

Question 7

the onset of menses, usually at 11-14 years

Answer 7

menarche

Question 8

termination of regular menses, usually between 45-55 years old

Answer 8

menopause

Question 9

termination of regular menses prior to age 40

Answer 9

premature menopause

Question 10

the bladder is adequately full for transabdominal pelvic US, when the dome of the bladder extends above the ______

Answer 10

uterine fundus

Question 11

transabdominal followed by transvaginal US is the ______ for pelvic US

Answer 11

standard of care

Question 12

what are the 3 contradictions to transvaginal US?

Answer 12

virginity, 3rd trimester bleeding, and postmenopausal vaginal stenosis (due to lack of estrogen)

Question 13

what are the 3 ovarian phases?

Answer 13

follicular phase, ovulation, and luteal phase

Question 14

in this ovarian phase the egg is surrounded by a fluid, FSH stimulating dominate egg (follicle), the dominate follicle (graffian follicle) moves to the surface (cortex) of the ovary

Answer 14

Follicular phase (day 1-14)

Question 15

several follicles develop each month, the dominate follicle is identified about day ______ when it measures 10mm, size is larger than others

Answer 15

8

Question 16

the dominate follicle grows linearly, approximately ______ per day, max diameter varies between ______

Answer 16

2-3mm, 15-30mm

Question 17

any follicle greater than ______ will likely ovulate, a line of decreased reflectivity (hypoechoic) around the follicle suggest that ovulation will occur in ______

Answer 17

11mm, 24 hours

Question 18

presents of cumulus oophorus (mural nodule in the follicle) suggest ovulation will within ______ hours

Answer 18

36

Question 19

in this ovarian phase there is a surge of LH, then rupture of follicular membrane within 24-36 hours of the LH surge

Answer 19

ovulation (day 14)

Question 20

what are the sonographic findings indicating that ovulation has occurred?

Answer 20

sudden decrease in follicular size and free fluid in pouch of douglas or adnexa

Question 21

at this ovarian phase there is a crater left by the expulsion of the ovum, the crater is filled with a fatty, yellowish cell type (corpus luteum or “yellop body”)

Answer 21

luteal phase (day 15-28)

Question 22

______ secretes progesterone and smaller amounts of estrogen to prepare and maintain the endometrium for implantation

Answer 22

corpus luteum

Question 23

if there is a pregnancy, the pregnancy produces ______ (positive preg test), which stimulates the corpus luteum to produce progesterone. If not pregnant, drop in progesterone and menstruation begins

Answer 23

BhC6

Question 24

what are the sonographic findings in luteal phase?

Answer 24

replacement of dominate follicle with an echogenic structure representing thrombus, small irregular cystic masses with irregular borders and low level echoes (the blood inside), its hypervascular with low resistance flow

Question 25

what are the 3 uterine phase?

Answer 25

menstrual phase, proliferative phase, and secretory phase

Question 26

______ is a catabolic process in which the ends is shed if implantation does not occur

Answer 26

menstruation (day 1-5)

Question 27

______ phase is desquanation and sloughing of the superficial layer of endometrium and blood cells, expelled in the form of menses

Answer 27

menstrual

Question 28

what is the sonographic findings of the menstrual cycle?

Answer 28

thick, echogenic prior to onset of menses complex at beginning of menses very thin (2mm) after menses

Question 29

______ phase- regeneration and proliferation of endometrium, stimulates by estrogen which is secreted by the development of follicles

Answer 29

proliferative

Question 30

what are the sonographic findings in proliferative phase?

Answer 30

"triple stripe" or tri layered endometrium, hypoechoic area around prominent midline echo

Question 31

______ phase- at ovulation, the endometrium prepares for possible implantation of a fertilized ovum, progesterone from corpus luteum causes edematous, spongy endometrium

Answer 31

secretory (day 15-28)

Question 32

without BhC6 from a fertile egg, the progesterone production from corpus luteum ______, causing menses

Answer 32

falls

Question 33

what are the sonographic findings in secretory phase?

Answer 33

thick, echogenic endometrium, 14-16 mm, no triple stripe

Question 34

______ pills contain both estrogen and progesterone, taken everyday for 20-21 days to prevent ovulation, no dominate follicle. the endometrium growth often is suppressed, so endometrium measurements will not be observed

Answer 34

oral contraceptive pills

Question 35

______ can lest 5-10 years depending on the type, seen as an echogenic line with posterior shadow.

Answer 35

IUD (intra uterine contraceptive device)

Question 36

______ is the inability of a man and women to achieve a pregnancy after at least 1 year of regular sexual intercourse without birth control

Answer 36

infertility (1 in 7 american couples affected)

Question 37

what can cause infertility in females?

Answer 37

no ovulation or abnormal ovulation, transport/tubal factors (adhesion from infection), endometrioris, uterine factors like leiomyomas (fiborials), polycystic ovarial disease, and cervical mucus non alkaline

Question 38

pelvic ultrasound is first line evaluation for fertility workup, ultrasound is also used in fertility clinics to ______ and ______ follicles

Answer 38

count and evaluate

Question 39

what are the drugs for ovulation induction?

Answer 39

clonyphane citrate (clomid), stimulate released FSH or LH (gonadotropens), metformin (glucophoge), and porlodel

Question 40

with ______ ovaries are stimulated to produce follicles, transvaginal ultrasound is preformed daily to monitor follicles

Answer 40

invitrofertilization (IVF)

Question 41

which invitrofertilization, oocytes are aspirated and incubated with sperm, ______ fertilized eggs are transferred to uterine cavity

Answer 41

2-4

Question 42

with ______ embryo (zygote or ferilized egg) is placed in the fallopian tube instead of the uterus

Answer 42

Zygote Intrafallopian tube transfer (ZifT)

Question 43

with ______ sperm and ova is placed in fallopian tube

Answer 43

Gamete intrafallopian tube transfer (GIFT)

Question 44

with ______ sperm it placed into uterus

Answer 44

intrauterine insemination (IUI)

Question 45

what are the two complications of fertility treatment?

Answer 45

ovarian hyper stimulated syndrome and multiple gestations

Question 46

______ is large simple cysts with a diameter grater than 5 cm, bilateral, and may have acites and pleural effusion

Answer 46

ovarian hyper stimulated syndrome (OHSS)

Question 47

mild cases of OHSS usually resolve spontaneously following the next menstrual cycle, sever cases are associated with a mortality rate up to ______, may require hospitalization for connection of fluid/electrolyte imbalances

Answer 47

50%

Question 48

with ______ there is higher risks to mother and high premature delivery

Answer 48

multiple gestations

Question 49

excessive volume during cyclic menstrual bleeding

Answer 49

hypermenorrhea

Question 50

an abnormally small amount of menstrual bleeding

Answer 50

hypomenorrhea

Question 51

frequent menstrual bleeding occurring less than 21 days apart

Answer 51

polymenorrhea

Question 52

menstrual bleeding occurring more than 35 days apart

Answer 52

oligomenorrhea

Question 53

irregular, frequent bleeding

Answer 53

metrorrhagia

Question 54

bleeding that is irregular in both frequency and volume

Answer 54

menometrorrhagia

Question 55

bleeding that occurs between normal cycles

Answer 55

intermenstrual bleeding

Question 56

intermenstrual bleeding is OC or HRT

Answer 56

breakthrough bleeding

Question 57

bleeding after vaginal intercourse

Answer 57

postcoital bleeding

Question 58

painful bleeding

Answer 58

dysmenorrhea

Question 59

absence of menstrual flow; may be primary- patient has never had a period or secondary - patient had period but they stopped

Answer 59

amenorrhea

Question 60

bleeding occurring 1 year after menopause

Answer 60

post menopausal bleeding

Question 61

abnormal bleeding from an essentially normal uterus

Answer 61

dysfunctional uterine bleeding (DUB)