Reproductive

Question 1

Ovarian oestrogen secreting tumours?

Answer 1

Ovarian thecoma
Ovarian granulosa cell tumours

Question 2

What do testicular epidermoid cysts looks like on USS

Answer 2

Round hypoechoic mass
Onion skin layering

Question 3

What is struma ovarii?

Answer 3

Mature teratoma containing mostly thyroid tissue

Question 4

What are the radiological features of molar pregnancy?

Answer 4

1st trimester: Intrauterine mass with snowstorm appearance on USS.
2nd trimester: Bunch of grapes on USS.

+/- fetal parts

Question 5

What is Meigs syndrome?

Answer 5

Ovarian fibroma
Ascites
Pleural effusion

Question 6

What is Ovarian hyperstimulation syndrome?

Answer 6

Complication of controlled ovarian stimulation.
Ascites, pleural effusions, and intravascular fluid depletion.
Theca lutein cysts.

Question 7

What is a Brenner tumour?

Answer 7

Benign epithelial tumour of the ovaries.
Appear fibrous and have calcification

Question 8

Which uterine developmental abnormality has the highest risk of fertility issues?

Answer 8

Septate uterus (flat fundus Vs heart shaped fundus of bicornuate/Didelphis)

Question 9

What is Salpingitis Ithmica Nodosa (SIN)

Answer 9

Nodular scarring of the fallopian tube. Basically it’s diverticulosis of the fallopian tubes secondary to inflammation/infection.

High association with infertility and ectopic pregnancy

Question 10

What is Ashermans syndrome?

Answer 10

Intrauterine adhesions. Secondary to prior surgery, infection, or pregnancy.
Clinically can result in infertility.

Question 11

Classic imaging features of adenomyosis?

Answer 11

Thickening of the junctional zone >12mm
Can have high T2 signal in junctional zone or myometrium (cystic change)

Question 12

What is the main malignant cancer of the uterus?

Answer 12

Adenocarcinoma
Rarely leiomyosarcoma (fibroid malignant transformation.)

Question 13

How does endometrial cancer typically enhance?

Answer 13

Typically enhances less than the myometrium

Question 14

What are the USS imaging appearances of endometrial polyps?

Answer 14

Hyperechoic
Single feeding vessel on Doppler

Question 15

What is the most common type of cervical and vaginal cancer, and what condition increases the risk of developing it?

Answer 15

Squamous cell
Related to HPV

Question 16

Where are Bartholin cysts typically found?

Answer 16

BARTHOLIN cysts are cysts of the mucin secreting glands and found BELOW the pubic symphysis.
Can become infected.

Question 17

Where are Nabothian cysts found?

Answer 17

By the cervix

Question 18

Where are Gartner cysts found?

Answer 18

Anterior, lateral, or upper vagina

Question 19

What are the simple ovarian cyst follow up criteria?

Answer 19

Pre menopausal:
<3cm - normal
3-5cm - report presence, no follow up
>5cm - follow up in 3-12 months based on suspicion

Postmenopausal:
<1cm - normal
1-3cm - report presence, no follow up
>3cm - follow up in 3-12 months based on suspicion

Question 20

What are the USS appearances of haemorrhagic cyst?

Answer 20

Lacy fishnet appearance
Absent Doppler flow

Question 21

What is the most common ovarian neoplasm is patients<20y.

Answer 21

Ovarian teratoma

Question 22

What are the USS features of a dermoid cyst?

Answer 22

Fat containing cystic mass with a hyperechoic mural module (Rokitanski nodule)

Question 23

What cancer can endometriomas turn into?

Answer 23

Clear cell and endometroid ovarian cancer.
Will look like a solid nodule with blood flow in a endometrioma.

Question 24

What cancer can teratomas turn into?

Answer 24

Squamous cell cancer

Question 25

Most common type of ovarian cancer?

Answer 25

Serious ovarian cystadenoma/adenocarcinoma

Question 26

What is an endometroid ovarian cancer?

Answer 26

Second most common ovarian cancer. Associated with endometriosis. Can grow within endometriomas. Bilateral in 25-40% of cases.

Question 27

What is a Krukenberg tumour?

Answer 27

GI metastasis to the ovary

Question 28

What is a choriocarcinoma?

Answer 28

Highly aggressive, highly vascular malignancy of the testes, uterus or ovary. Highly elevated bHcg Haematogenous spread, usually to lungs.

Question 29

Isolated orchitis usually occurs from what infections?

Answer 29

Mumps TB

Question 30

What nodes do testicular cancers metastasize to?

Answer 30

Retroperitoneal nodes at level of renal hilum.

Question 31

What are the most common testicular tumors?

Answer 31

Germ cell tumour (90%): - Seminoma (50%) - Non Seminoma (50%) (Teratoma, yolk sac, mixed germ cell) (Non germ cell i.e. Sertoli and leydig cell are 10%).

Question 32

Typical USS appearance of Seminoma?

Answer 32

Hypoechoic, homogeneous, microcalc Classically replace the whole testicle.

Question 33

Non Seminoma tumour typical USS appearance?

Answer 33

Heterogeneous with cystic spaces and calcifications

Question 34

Most common testicular tumour in >60y?

Answer 34

Testicular lymphoma

Question 35

What condition is Sertoli tumours associated with?

Answer 35

Peutz-Jeghers Syndrome

Question 36

What testicular tumors elevate BhCG?

Answer 36

Seminoma Choriocarcinoma

Question 37

What testicular tumors elevate AFP?

Answer 37

Mixed germ cell Yolk sac

Question 38

What is Zinner syndrome?

Answer 38

Wolffian duct anomalies: - unilateral renal agenesis - ipsilateral seminal vesicle cyst - ejaculatory duct obstruction

Question 39

Classical presentation of adrenal rests?

Answer 39

Bilateral solid testicular masses and congenital adrenal hyperplasia.

Question 40

How does testicular sarcoidosis classically present?

Answer 40

Bilateral multiple testicular AND epididymal masses.

Question 41

Where are seminal vesicle cysts typically and what are they associated with?

Answer 41

Lateral to bladder Aquired - Polycystic kidney disease Congenital - Renal agenesis + ejaculatory duct obstruction = Zinner syndrome

Question 42

What does Uterine AVM look like on USS?

Answer 42

Tubular anechoic structures in myometrium. High velocity colour on Doppler flow.

Question 43

How do you define a cystocele?

Answer 43

Bladder prolapse into the vagina. Bladder decent >1cm below pubococcygeal line.

Question 44

What are the 4 types of fibroid degeneration?

Answer 44

Hyaline - fibroid outstrips blood supply Red - venous thrombosis ( in pregnancy) Myxoid Cystic

Question 45

What are the MRI appearances of uterine fibroids?

Answer 45

Classic fibroid T1 Dark T2 Dark C Homogeneous

Question 46

What are MRI appearance of hyper cellular fibroid?

Answer 46

T1 Dark T2 Bright C Homogeneous Respond well to embolisation

Question 47

How do fibroids undergo malignant transformation?

Answer 47

Leiomyosarcoma Look like a fibroid but rapidly enlarge with areas of necrosis

Question 48

What is the upper limit for endometrial thickness in postmenopausal women?

Answer 48

4-5mm >5mm should get a biopsy

Question 49

What is the upper limit of normal for endometrial thickness in women on Tamoxifen?

Answer 49

12mm

Question 50

How does Tamoxifen affect the endometrium?

Answer 50

Sub endometrial cysts Endometrial polyps

Question 51

What is the difference between cervical cancer stage 2a and 2b?

Answer 51

2a spread beyond the cervix, NO parametrial invasion - Surgery 2b spread beyond the cervix, WITH parametrial involvement - Chemo radiotherapy

Question 52

What tumours metastasise to the anterior upper wall of the vagina?

Answer 52

Upper genital tract tumours (90%) (Posterior wall is GI tract tumours)

Question 53

What tumours metastasise to the posterior lower wall of the vagina?

Answer 53

GI tract tumours (90%) (Anterior wall is upper genital tract tumours)

Question 54

Where are Skene gland cysts found?

Answer 54

Paraurethral Can cause recurrent UTI and urethral obstruction.

Question 55

What are theca lutein cysts?

Answer 55

Multilocular cyst related to ovarian hyper stimulation. Typical spoke wheel appearance. Seen in molar and multiple pregnancies

Question 56

How can you differentiate corpus luteum cyst from ectopic pregnancy?

Answer 56

Ectopic - thick echogenic rim, ring of fire, separate from ovary Corpus luteum - thin echogenic rim, ring of fire, moves with ovary

Question 57

How can you differentiate Brenner tumour from fibroma?

Answer 57

Both are fibrous Brenner tumours have calc in 80% Fibromas no calc

Question 58

What are the causes of hydrosalpinx?

Answer 58

PID Tubal cancer Torsion Endometriosis Hysterectomy

Question 59

What is a peritoneal inclusion cyst?

Answer 59

Occurs when adhesions envelope an ovary. Adhesions cannot absorb the normal secretions of the ovary and so they collect and form a cyst. Risk factors include: PID Endometriosis Surgery

Question 60

What is the Gleason grade Vs Gleason score?

Answer 60

Gleason grade is the histological pattern, 1-5. Higher grade is worst. Gleason score is the total of the two most common histological patterns. 3+4, or 4+3. The first number is the most common pattern in the sample

Question 61

What does J shaped/hockey stick ureter signify in regards to the prostate?

Answer 61

Enlarged prostate - BPH

Question 62

Most common bilateral testicular malignancy?

Answer 62

Testicular lymphoma

Question 63

How is the UK breast screening programme work?

Answer 63

All women aged 50 up to 71 are invited for breast screening every 3 years.

Question 64

What day of the hormone cycle is MRI and Mammography best performed?

Answer 64

Follicular phase - day 7-14

Question 65

What does involution of fibroadenomas look like on mammography?

Answer 65

Course "pop corn" like calcification.

Question 66

How can you differentiate Phyllodes tumour from fibroadenomas?

Answer 66

Age, growth, mets. Middle age to older women (fibroadenoma in young women). Rapid growth. Haematogenous mets (lung/bone).

Question 67

Most common metastases to the breasts?

Answer 67

Lymphoma