Ch. 20 Postmenopausal Sono & Sonohysterography

Question 1

Cessation of menstruation with advanced age, median age of 51 (42-58)

Answer 1

menopause (climacteric)

Question 2

During menopause follicles cease to mature resulting in a considerable reduction in the amounts of ___ & ___.

Answer 2

estrogen, progesterone

Question 3

Without menstruation what happens to the ovaries and uterus?

Answer 3

undergoes atrophy, ovaries become more echogenic, Along with the decrease in uterine size, the mucosal layer of the uterus—the endometrium—begins to become atrophic as menstruation comes to an end.

Question 4

Menopause puts women at an increased risk for developing?

Answer 4

coronary heart disease, osteopenia (bone density that is lower than normal), osteoporosis (bone loss that predisposes the individual to fractures)

Question 5

Often used to combat the reduction of estrogen circulating in the female body after menopause and prevent their symptoms is called

Answer 5

hormone replacement therapy (HRT)

Question 6

has been shown to significantly reduce the risk of developing osteoporosis and coronary heart disease, with possible associated reduction in risk for developing colon cancer and Alzheimer disease.

Answer 6

Estrogen replacement therapy (ERT)

Question 7

___ exposure on the endometrium increase the risk for endometrial hyperplasia, endometrial carcinoma.There may also be an increased risk of developing breast cancer, thromboembolism, hypertension, and, possibly, diabetes in patients who are on _____.

Answer 7

unopposed estrogen; ERT

Question 8

Before performing a postmenopausal pelvic sonogram it is vital to inquire if the patient is on what because it influence the appearance of the endometrium?

Answer 8

hormone replacement therapy (HRT)

Question 9

The vagina also becomes smaller and decreases in caliber. The breasts tend to accumulate more adipose or fat tissue within them. Patients undergoing menopause may also suffer from night sweats or hot flashes, mood changes, depression, dyspareunia, dysuria, and a decrease in libido. Pts undergoing this are in what?

Answer 9

Menopause

Question 10

These hormones, when used in conjunction, act upon the endometrium and in effect induce a menstrual cycle. Combined________, when used consistently, can reduce the risk of developing endometrial carcinoma but cannot eliminate it entirely.

Answer 10

Estrogen-progestin therapy

Question 11

The most common cause of PMB(postmenopausal bleeding) is _______.

Answer 11

endometrial atrophy

Question 12

Endometrial atrophy (59%), uncontrolled HRT, endometrial hyperplasia (10%), endometrial polyps (9%), submucosal or intracavitary leiomyoma, endometrial carcinoma (5% to 10%), and some ovarian tumors are among the differential abnormalities that can be linked to ______

Answer 12

PMB

Answer 13

double-layer thickness

Question 14

Normal Endometrial Thickness:(mm)Positive postmenopausal vaginal bleeding_____

Answer 14

≤4

Question 15

Normal Endometrial Thickness:
Negative postmenopausal vaginal bleeding_____

Answer 15

≤8

Question 16

Endometrial thickness threshold of ___ is used for patients with postmenopausal vaginal bleeding (PMB).

Answer 16

4-5mm

Question 17

If the endometrium measures less than 5 mm, the bleeding is typically caused by ______

Answer 17

endometrial atrophy

Question 18

The endometrium will appear thin and should not exceed 5 mm, although, with ______, the endometrium typically measures 4 mm or thinner. The endometrium may also contain some intracavitary fluid.

Answer 18

atrophy

Question 19

Results from the unopposed stimulation of estrogen on the endometrium and is a common cause of abnormal vaginal bleeding

Answer 19

endometrial hyperplasia ( an increase in the number of endometrial cells)

Question 20

_______may also be caused by polycystic ovary syndrome, obesity, tamoxifen therapy for breast cancer, or estrogen-producing ovarian tumors, such as the ovarian thecoma or granulosa cell tumor.

Answer 20

Endometrial hyperplasia

Question 21

benign ovarian sex cord-stromal tumor that produces estrogen in older women

Answer 21

thecoma

Question 22

Sonographic Findings of______:
1.Thickened echogenic endometrium
2. Small cystic spaces within the endometrium or appear diffusely echogenic

Answer 22

Endometrial Hyperplasia

Question 23

Clinical Findings of _______:
Abnormal uterine bleeding (any age)
Polycystic ovary syndrome
Obesity
Tamoxifen therapy

Answer 23

Endometrial hyperplasia

Question 24

Clinical Findings of______:
Postmenopausal bleeding
Intermenstrual bleeding
Enlarged uterus
Elevation of CA-125

Answer 24

Endometrial Carcinoma

Question 25

Sonographic Findings of ______:
1.Thickened endometrium (with variable appearance)
2.Heterogeneous uterus
3Enlarged uterus with lobular contour
4.Endometrial fluid
5.Polypoid mass within the endometrium

Answer 25

Endometrial Carcinoma

Question 26

The most common female genital tract malignancy with PMB being the most common clinical presentation, peak incidence 50-65

Answer 26

endometrial carcinoma

Question 27

Endometrial carcinoma is most often in the form of

Answer 27

adenocarcinoma

Question 28

What tumors of endometrial carcinoma have a poorer prognosis?

Answer 28

tumors penetrating into the surrounding myometrium

Question 29

has been linked with unopposed estrogen therapy, nulliparity, obesity, chronic anovulation, Stein–Leventhal syndrome, estrogen-producing ovarian tumors, and the use of tamoxifen.

Answer 29

endometrial carcinoma

Question 30

In the presence of endometrial carcinoma pulsed doppler of the uterine cavity with indicate?

Answer 30

low impedance flow

Question 31

Suspicion of endometrial carcinoma typically leads to an endometrial biopsy, endocervical curettage, cancer antigen______ testing, and, in most confirmed cases, the performance of a total abdominal hysterectomy with a bilateral salpingo-oophorectomy

Answer 31

125 (CA-125)

Question 32

the removal of the uterus and cervix

Answer 32

total abdominal hysterectomy

Question 33

the surgical removal of both ovaries and fallopian tubes

Answer 33

bilateral salpingo-oophorectomy

Question 34

Endometrial polyps are linked to what during reproductive years?

Answer 34

infertility

Question 35

_______, which may be benign or malignant, are small nodules of hyperplastic endometrial tissue that may cause abnormal vaginal bleeding in both postmenopausal and perimenopausal woman.

Answer 35

Endometrial polyps

Question 36

A key clinical feature of patient with an endometrial polyp is ______

Answer 36

intermenstrual bleeding

Question 37

Clinical Findings of_____:
Can be asymptomatic
Menometrorrhagia
Intermenstrual bleeding
Has been linked with infertility in reproductive-aged group

Answer 37

endometrial polyp

Question 38

Sonographic Findings of _____:
1Focal thickening of the endometrium
2Diffuse thickening of the endometrium

-have many different shapes including a broad base, or can be pedunculated (grows off a stalk), and if large may prolapse through the cervix
-often contains a small vessel and have cystic areas within it

Answer 38

endometrial polyp

Question 39

Treatment for endometrial polyp

Answer 39

polypectomy(surgical removal of polyp), hysteroscopy(endoscopy of the uterine cavity)

Question 40

Polyps are better visualized with the use of ______(SIS) . Three-dimensional sonography can be used to better demonstrate polyps as well

Answer 40

saline infusion sonohysterography

Question 41

a sonographic procedure that uses saline instillation into the endometrial cavity and fallopian tubes to evaluate for internal abnormalities

Answer 41

saline infusion sonohysterography

Question 42

estrogen-producing tumors such as the _____, which is mostly benign, have been shown to cause abnormal thickening of the endometrium with subsequent vaginal bleeding. In addition, the malignant serous and mucinous cystadenocarcinomas have been associated with vaginal bleeding.

Answer 42

thecoma

Question 43

Elevation of this tumor marker has been linked with cancers of the ovary, endometrium, breast, gastrointestinal tract, and lungs. However, _____ may also be elevated in some benign conditions, such as endometriosis, pelvic inflammatory disease, fibroids, and even pregnancy.

Answer 43

CA-125

Question 44

______is a breast cancer drug that inhibits the effects of estrogen on the breast, thus slowing the growth of malignant breast cells. ______ can also be used in the treatment of female infertility

Answer 44

Tamoxifen

Question 45

been linked with the development of endometrial hyperplasia, endometrial polyps, and endometrial carcinoma. Sonographically, _____ will cause cystic changes to occur within the endometrium, and it produces a more heterogeneous and thickened endometrial appearance

Answer 45

Tamoxifen

Question 46

______will be outlined by the saline and seen projecting into the uterine cavity from the endometrium, whereas the ______ will have a layer of endometrium overlying the mass and originate in the myometrium. Contraindication for SIS includes patients who are pregnant or have known pelvic infections

Answer 46

Endometrial polyps;submucosal fibroid

Question 47

_______(HyCoSy), also referred to as sonohysterosalpingography, which further assesses for patency of the fallopian tubes, may also be used by some institutions for various reason

Answer 47

Hysterosalpingo-contrast sonography

Question 48

is a radiographic procedure and thus uses a contrast agent and fluoroscopy to analyze the uterine cavity and fallopian tubes for patency.

Answer 48

hysterosalpingography

Question 49

is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilation and curettage (D&C).

Answer 49

Asherman syndrome

Question 50

a procedure in which the cervix is dilated and the uterine cavity is scraped with a curette

Answer 50

dilation and curettage (D&C)

Question 51

Clinical Findings of _____:
1.History of D&C, trauma, and uterine surgery
2.Recurrent pregnancy loss, and/ or infertility
3.Amenorrhea or hypomenorrhea

Answer 51

Asherman syndrome

Question 52

Sonographic Findings of ____:
Bright areas within the endometrium
Sonohysterography findings include bright bands of tissue traversing the uterine cavity

Answer 52

Asherman syndrome

Question 53

measurement of the endometrium from basal layer to basal layer excluding both the adjacent hypoechoic myometrium and the intracavitary fluid (if present)

Answer 53

double-layer thickness