Things i think i should know topic 4A - 4B

Question 1

What is the embryologic origin of the urogenital system?

Answer 1

the intermediate mesoderm along the posterior wall of the abdomen and both begin growth around the fourth week.

Question 2

What do the paramesonephric (Müllerian) ducts become in the female?

Answer 2

the fallopian tube, uterus, cervix and upper part of the vagina.

Question 3

When do male and female morphologic characteristics begin to form?

Answer 3

7th week

Question 4

What do the ovaries develop from?

Answer 4

Cortical cords, mesenchyme,

Question 5

Which ducts play an important part in the development of the male reproductive system?

Answer 5

Mesonephric (Wolffian ducts)

Question 6

Which ducts have a leading role in the development of the female reproductive system?

Answer 6

Paramesonephric (Mullerian ducts)

Question 7

Why do the mesonephric ducts of female embryos regress ?

Answer 7

The absence of testosterone

Question 8

Why do paramesonephric ducts develop?

Answer 8

paramesonephric ducts develop because of the absence of MIS • Mullerian inhibiting substance .

Question 9

What is the appendix vesiculosa

Answer 9

• cranial end of the mesonephric duct that may persist

Question 10

What are Gartner duct cysts ?

Answer 10

• Parts of the mesonephric duct, corresponding to the ductus deferens and ejaculatory duct, that may persist

Question 11

What is the hydatid of morgagni?

Answer 11

Part of the cranial end of the paramesonephric duct that does not contribute to the infundibulum of the uterine tube that may persist as a vesicular appendage

Question 12

What causes mullerian duct abnormalities?

Answer 12

Arrested development of the müllerian ducts, failure of fusion of the müllerian ducts, and/or failure of resorption of the median septum

Question 13

What are The most common types of MDAs to have associated renal anomalies ?

Answer 13

uterus didelphys (often with renal agenesis ipsilateral to an obstructed horn) and unicornuate uterus (usually renal agenesis ipsilateral to the side of the absent or rudimentary horn).

Question 14

What are the most common MDAs?

Answer 14

• septate uterus
• bicornuate uterus
• unicornuate uterus
• uterine didelphys

Question 15

What is the most common cause of uterine aplasia?

Answer 15

Mayer-Rokitansy-Kuster-Hauser syndrome, with most patients having uterine and vaginal agenesis

Question 16

What causes unicornate uterus?

Answer 16

• Arrested development of one Mullerian duct

Question 17

What causes uterus didelphys?

Answer 17

• Complete failure of fusion of the Mullerian ducts

Question 18

What causes a septate uterus?

Answer 18

• Failure of resorption of the median septum

Question 19

What are the common pathology of the myometrium?

Answer 19

Leiomyoma, leiomyosarcoma, adenomyosis, AVM, Lipoleiomyoma

Question 20

What are fibroids (leiomyoma) made up of?

Answer 20

Smooth muscle and connective tissue

Question 21

What can make a fibroid grow?

Answer 21

oestrogen

Question 22

What might the clinical presentation of fibroids be?

Answer 22

• may be free of symptoms
• may complain of a self-detected mass
• abnormal uterine bleeding
• acute or chronic pelvic pain
• pressure symptoms or secondary symptoms.

Question 23

How can fibroids affect structures around the uterus?

Answer 23

• Urinary frequency or urgency occurs because of diminished bladder capacity.
• Compression of the ureters may result in hydroureteronephrosis.
• A mass in the cul-de-sac may produce obstipation, constipation or haemorrhoids because of rectal pressure.

Question 24

What is the sonographic appearance of fibroids?

Answer 24

• Hypoechoic or heterogeneous solid mass
• Occasionally isoechoic
• occasionally hyperechoic (consider lipoleimyoma)
• Round or oval shape
• Distortion of external uterine contour or endometrium, depending on size and location
• If large enough will have mass effect on extra uterine structures
• Attenuation or shadowing
• Minority are Calcificied
• Cystic areas from degeneration or necrosis

Question 25

What can suggest a fibroid is malignant?

Answer 25

. Evidence of local invasion, distant metastasis or sudden accelerated growth in a previously static tumour and postmenopausal enlargement should suggest the possibility of a superimposed malignant process.

Question 26

What are some typical ultrasound appearances of adenomyosis?

Answer 26

o diffuse heterogenous attenuative change to the uterine texture; and/or o very small myometrial cysts without discrete lesions. o asymmetric thickening of myometrium o linear striations o ill-defined endometrium o should be associated with uterine tenderness o Always ask "Does this hurt?" as the transducer palpates the uterus.

Question 27

WHy would you defer assessment to another stage of the cycle when looking at the endometrium?

Answer 27

The secretory endometrium can potentially obscure pathology

Question 28

What are the normal values of endometrial thickness?

Answer 28

``` Premenopausal women: • menstrual phase 1-4 • proliferative phase 4-8 • secretory phase 7-14mm Postmenopausal women: • without HRT 5mm or less • with HRT 8 mm or less ```

Question 29

What are some causes of endometrial thickening?

Answer 29

* Pregnancy * Retained products of conception * Fibroids (submucosal or intracavitary) * Endometritis * Adhesions * Hyperplasia * Polyps * Cancer

Question 30

What Pathology of the endometrium most often presents as excessive or ill-timed bleeding?

Answer 30

* Atrophy * Hyperplasia * Polyp * Carcinoma * Endometritis * malposition of an intrauterine contraceptive device (IUD)

Question 31

What pathology of the endometrium can present as amenorrhoea or hypomenorrhoea?

Answer 31

* endometrial synechiae | * hematometrocolpos

Question 32

What pathology of the endometrium can present as infertility?

Answer 32

* polyp | * endometrial synechiae

Question 33

What pathology of the endometrium can present as pain?

Answer 33

* malposition of an IUD * polyp, especially those with a long stalk that protrude into the cervix * endometritis * hematometrocolpos

Question 34

What causes a large amount of PMB?

Answer 34

• endometrial atrophy accounts for a large proportion of cases of postmenopausal bleeding

Question 35

What is hydrometrocolpos and hematometrocolpos?

Answer 35

* Before puberty, the accumulation of secretions in the vagina and uterus is referred to as hydrometrocolpos. * After menstruation, hematometrocolpos results from the presence of retained menstrual blood

Question 36

What are some causes of endometrial hyperplasia?

Answer 36

• unopposed estrogen stimulation which could be due to o use of unopposed estrogen HRT o persistent anovulatory cycles (such as with polycystic ovarian syndrome) o obese women with increased production of endogenous estrogens o estrogen-producing tumors, such as ovarian granulosa cell tumors and thecomas.

Question 37

Why is endometrial hyperplasia a difficult to diagnose finding?

Answer 37

• hyperplasia has a nonspecific sonographic appearance, biopsy is necessary for diagnosis.

Question 38

What age group are endometrial polyps most commonly found in?

Answer 38

• frequently seen in perimenopausal and postmenopausal women

Question 39

What is the sonographic appearance of a polyp?

Answer 39

• may appear as nonspecific echogenic endometrial thickening • may be diffuse or focal • may also appear as a focal, round, echogenic mass within the endometrial cavity • At times cystic appearance and distend the endometrial cavity - may be a feeding artery present on colour (pedicle artery sign)

Question 40

What is the hyperechoic line sign?

Answer 40

The appearance of one or two well-defined short echogenic linear echoes at the polyp borders

Question 41

In what age group does endometrial carcinoma most commonly occur?

Answer 41

• Most (75%-80%) occur in postmenopausal women

Question 42

How does endometrial carcinoma commonly present?

Answer 42

Bleeding

Question 43

What are some risk factors for endometrial carcinoma?

Answer 43

o estrogen replacement therapy in postmenopausal women o anovulatory cycles in premenopausal women o obesity o diabetes o hypertension o low parity

Question 44

How can endometrial carcinoma cause hematometra?

Answer 44

• Endometrial carcinoma may also obstruct the endometrial canal, resulting in hematometra.

Question 45

HOw can endometrial carcinoma look on sonography?

Answer 45

• thickened endometrium • poor definition of the endometrial/myometrial interface • an indistinct endometrium in an enlarged uterus. - cystic hyperplasia

Question 46

What are the different stages of endometrial carcinoma?

Answer 46

* Stage IA, cancer is in the endometrium only or less than halfway through the myometrium * In stage IB, the tumor is still localized to the uterus but has spread halfway or more into the myometrium * In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus * In stage III, the cancer has spread outside of the uterus or into nearby tissues in the pelvic area * In stage IV, the cancer has spread to the inner surface of the urinary bladder or the rectum (lower part of the large intestine), to lymph nodes in the groin, and/or to distant organs, such as the bones, omentum, or lungs

Question 47

What are endometrial adhesions?

Answer 47

* (synechiae) are posttraumatic, postinfection, or postsurgical in nature * may be a cause of infertility or recurrent pregnancy loss.

Question 48

What is asherman syndrome?

Answer 48

• Asherman syndrome is the combination of synechiae that lead to menstrual dysfunction or infertility.

Question 49

Describe the appearance of RPOC?

Answer 49

* vascularized tissue in the endometrial cavity is usually indicative of RPOC * tissue that is not vascularized could be due to either blood clot or devascularized RPOC. * size of the suspected RPOC is important because that may guide therapy. * If RPOC are seen and they extend beyond the endometrial cavity into myometrium, this is indicative of an invasive placental condition such as placenta accreta.

Question 50

What is pstt?

Answer 50

• uncommon cause of postpartum bleeding • Should be considered when there are persistently low serum levels of human chorionic gonadotropin (hCG) and/or elevated levels of human placental lactogen Placental site trophoblastic tumor (PSTT)