Breast and Gynae and obstectrics Flashcards
what is basal-type breast carcinoma ?
triple negative phenotype (-HER2, -ER, -PR)
what do milk of calcium calcifications represent ?
free floating calcium in tiny benign cysts
what type of calcification is typical for fibroadenoma ?
popcorn like calcifications
what is an oil cyst ?
where an area of fat necrosis gets walled off by fibrous tissue.
usually have egg shell calcification
where do most breast cancers present ?
50% present in the upper outer quadrant
following breast cancer treatment what is the mammography follow up regime ?
if < 50, have yearly mammograms until 50 - and then go onto the normal breast screening program
If >50 have yearly mammogram for 5 years, and then go onto normal breast screening programme
At what week gestation should you see a gestational sac ?
5 weeks
At what week gestation should you see a gestational sac ?
5 weeks
How many weeks pregnant should you see a yolk sac ?
5.5 weeks
How many weeks should you see an embryo ?
6 weeks
If the CRL >7mm and there’s no heart beat , what does that indicate ?
A failed pregnancy
Where do most ectopic pregnancies occur ?
The ampulla
What is a heterotrophic pregnancy
IUP and Ectopic
What are the 3 forms of gestational trophoblastic disease ?
Complete hydtatidform mole
Invasive mole
Choriocarcinoma
What is a complete hydatidiform mole ?
Doesn’t contain any fetal parts ?
Why do complete hydatidiform moles occur ?
loss of the eggs DNA prior to fertilzation by the sperm and usually 46 Karyotype
What is the classic US appearance of a molar disease ?
Enlarged uterus, Multicystic bunch of grapes
In a molar pregnancy, what often occurs in the ovaries ?
Theca lutein cysts due to the elevated HCG ?
What is the treatment of a molar pregnancy ?
Endometrial suction curettage and 6 monthly follow up of HCG
What causes a partial hydatitform mole. ?
Triploid pregnancy XXX or XXY is caused by 2 sperm fertilising the same egg
What is chorionicity
Number of placentas
What is amnionicity
The number of aminos
What do monochorionic twins have ?
The same placenta
What do monoamniotic twins have ?
A single amniotic sac and therefore share a placenta
What is zygosity
Number of fertilised eggs
What does the twin peak sign indicate ?
Dichorionic/diamniotic twins
What does a T -shape configuration of the placenta and insertion of the intertwin membrane indicate
Monochorionic / diamniotic twins
What is diagnostic of mono/mono twins ?
Intertwined cords
What are conjoined twins caused by ?
Late >13 days incomplete division of the embryo
What are the Ultrasound findings of twin-twin transfusion syndrome ?
Single shared placenta
Disproportionate fetal sizes with ? 25% discrepancy
Disproportionate amniotic fluid with small twin having oligohydramnios
When is nuchal translucency measured ?
At 11-14 weeks or CRL 45-85mm
What thickness of nuchal translucency warrants further investigation ?
3mm
When could a omphalocele or gastroschisis be diagnosed and why ?
After 13 weeks, as normal midgut herniation occurs in the first trimester and is usually complete by 13 weeks
What is the most sensitive and specific ultrasound finding of Down’s syndrome
Thickened nuchal fold
What is an abnormal measurement for nuchal fold ?
> 6mm is a major marker for trisomy 21
What does cervical funnelling increase peoples risk of ?
Pre-term labour
Before 24 weeks, what is the treatment of cervical shortening ?
Cervical cerclage due to increased risk of pre-term labour
What does a single umbilical artery increase the risk of ?
Trisomy 13 and 18
What is velamentous insertion of the umbilical cord ?
Where the cord inserts outside the margin of the placenta, into the free membranes
What is vasa Previa?
Where the fetal placental vessels go across the internal cervical os
What is oligohydramnios most commonly associated with ?
IUGR
What can oligohydramnios result in ?
Hypoplastic lungs
What is potter sequence ?
Oligohydramnios resulting in :
Facial abnormalities
Club feet
MSK contractures - due to little space in the sac
What genitourinary problems can lead to oligohydramnios
Renal agenesis - death
Congenital bladder outlet obstruction
Bilateral ureteropelvic junction obstruction
Renal dysplasia - ARPKD
What causes polyhydramnios ?
Inability of the foetus to swallow :
1) Upper GI obstruction: duodenal or oesophageal atresia
2) Severe CNS anomlias - which causes difficulty in swallowing
3) twin to twin transfusions - with one twin with too much fluid and the other with no fluid
4) placental abnormalities
What is a succenturiate lobe ?
Island of placental tissue separate from the main placenta - but connected to the main placenta by blood vessels
When do you start to assess the placental position ?
In the 2nd trimester
What is the normal position of the placenta?
More than 2 cm from the internal os
What is placenta previa?
Where the placenta covers the entire internal os
What is placenta accreted ?
Deep attachment of the placenta into the myometrium - resulting in increased risk of haemorrhage at the time of placental separation
What is placenta percreta ?
Where the placenta PENETRATES through the serous to invade other structures - there is a focal bulge in the uterine wall
What does a chorioangioma look like on uS ?
Hypoechoic rounded mass in the placenta with a ectopic cystic areas and low resistance flow
What is fetal hydrops ?
Fluid overload state characterised by :
Ascitis
Pericardial or pleural effusion
Skin thickening
Polyhydramnios
Placental enlargement
How can the causes of polyhydramnios be classified?
Immune or non immune
What causes immune fetal hydrops ?
Fetal haemolytic anemia - usually rh antigen
What should the lateral ventricles measure ?
< 10mm
Why is AFP elevated in anencephaly ?
Due to direct exposure of the neural tissue to the amniotic fluid
What is ancephaly ?
Lack of development of the Calvary I’m and destruction of the fetal cerebral cortex
What’s the difference between a meningocele and an encephalocele ?
Meningocele - contains meninges
Encephalocele - contains neural tissue
What is a dandy walker malformation ?
Posterior fossa malformation ; triad of :
1 - hypoplasia of the vermis
2 - dilated 4th ventricle
3 - torcula lamboid inversion ( where the torcular is lying above the lamboid suture due to a very high tentorium )
What is a chiral 2 malformation ?
Small posterior fossa plus a neural tube defect - this results in descent of the cerebella vermis through the foramen magnum
What sign if very specific for chairi 2 malformation ?
Banana sign - flattening of the cerebellar
When does a normal corpus callosum develop ? Which way does it develop?
20 weeks
Develops from the selenium to the rostrum
What is the Viking helmet appearance seen in ?
Dysgenesis of the corpus callosum
What is hydranencephaly ?
Complete cortical destruction due to infarction or infection - where the brain parenchyma is replaced with fluid
Which condition are choroid plexus cysts seen in ?
Trisomy 18
What is a sacrococygeal Teratoma
Germ cell tumour of the sacrum
Which condition is an absent nasal bone seen in ?
Trisomy 21
What is micrognathia ?
Hypoplasia of the mandible resulting in a small chin
Where are morgani hernias located ?
Anterior on the right
Where do bochdalek hernias arise ?
Left posterior thorax
what is the difference between an immature and a mature teratoma
immature - malignant
mature - not malignant , also known as a dermoid cyst
what do dermoid cysts look like ?
usually contain fat - meaning that it is mature
contains calcification - which can cause posterior acoustic shadowing
what are the standard views performed at screening ?
MLO and CC
what is the most common cause of an ovarian torsion ?
corpus luteal cyst or follicular cyst
where are Gartner duct cysts located ?
anterior to the vaginal wall
where are skyene duct cysts located ?
inferior to the pubic symphysis but lateral to the urethral opening
what are popcorn calcifications seen in ?
benign fibroadenomas
which cancer is most frequently missed on US and mammography but can be detected on MRI
lobular cancer
which cancers don’t require contrast for MRI pelvic staging?
rectal and cervical cancers
what are the IOTA rules ?
standardised rules for classifying ovarian lesions
what are the ‘M’ rules in the IOTA classification ?
Malignant findings :
Solid mass
Multilocular solid mass > 10cm
blood flow
ascites
>3 papillary structures
what is Salpingitis isthmica nodosa
nodular scarring of the Fallopian tube, thought to be due to previous PID
causes no spill on HSG with multiple tiny diverticular
what is a septate uterus associated with ?
renal abnormalities
what are the 4 ways a fibroid can degenerate ?
red
myxoid
cystic
hyaline
what signal do fibroids have on MRI ?
low signal on T2
what Is the most common type of fibroid degeneration ?
hyaline degeneration
what does gynaecomastia look like on US ?
flamed shame mass behind the nipple
what is CPAM
harmatous proliferation of small airways which communicate with the bronchial tree
what is pulmonary sequestration?
aberrant lung tissue with systemic blood supply
what is sequestration most commonly found ?
left lower lobe
on a fetal heart US what indicates the right ventricle ?
moderator band
what is the most common metal CHD ?
VSD
what is atrial spetal defect strongly associated with?
downs syndrome
what does transposition of the great arteries look like on fetal US
parallel course of the aorta and pulmonary artery .
the aorta arises from the RV ( identified with the moderator band )
what is meconium ileus
bowel obstruction caused by impacted meconium in a foetus with cystic fibrosis
does a omphalocele have peritoneal covering ?
yes
where does the umbilical cord insert in an omphalocele ?
centrally at the base of the herniated sac
what is an omphalocele ?
the most common anterior abdominal wall defect.
midline defect with herniation of intra-abdominal contents
how fast do fetal kidneys grow
1mm per week
so a 20 week foetus should have 20mm (2cm) kidneys
how would you see osteogenesis imperfect on us ?
short limbs, < 3SD
what are patients with beckwith-wideman syndrome at risk of developing ?
wilms tumour
what is the screening for beckwith-wiedemann syndrome
US every 3 months until 8 years
what is the difference between bicornate bicervix uterus and uterine didelphys ?
in uterine didelphys the uterine cavities don’t communicate with each other
