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OB Pathology > Ch. 41-43, 48, 51-52 > Flashcards

Ch. 41-43, 48, 51-52 Flashcards

1
Q

UT size, USA

A

6-8 x 3-5 x 3-5 cm

homogeneous mid-gray

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2
Q

Endo size, USA

A

menarche 4-14mm; post-men 4-10mm

hypo area surrounding echogenic endo stripe

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3
Q

OV size, USA

A

3 cm length

ovoid mid-gray w/ or w/o follicles

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4
Q

Leiomyomas aka myomas or fibroids

A

Most common gyne tumor
UT irregularity, enlargement, infertility
Early signs are enlarged UT or distorted contour
May: shadow, have cystic or hyperech areas

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5
Q

Submucosal Leiomyoma

A

Distorts Endo
Irregular, heavy bleeding, infertility
Hypoechoic w/in or displacing endo

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6
Q

Intramural Leiomyoma

A

Within myometrium
Infertility or recurrent PG loss
Hypoechoic w/in wall

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7
Q

Subserosal Leiomyoma

A

Projects out of myometrium
Enlarges and causes pressure
Hypoechoic w/in wall, distorting UT contour

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8
Q

Pedunculated Leiomyoma

A

Subserosal on long STALK; can migrate and implant into surrounding structures
Hypoechoic mass near UT

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9
Q

Intracavitary Leiomyoma

A

Pedunculated submucosal; extends into UT cavity; can pass through CX
Well-defined hypoechoic mass w/shadowing

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10
Q

Hydrometra

A

Accumulation of fluid in endo cavity from cx stenosis

Central cystic area

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11
Q

Pyometra

A

Associated w/UT cancer and infection

Central cystic area w/echogenic debris

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12
Q

Adenomyosis

A

Benign, endometriosis (ectopic endometrium) w/in the myometrium; mostly posterior
Diffuse UT enlarge w/ thickened posterior myometrium; indistinct border btwn endo and myometrium

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13
Q

Endometriosis

A

Ectopic functioning endo tissue that cyclically bleeds
Anywhere in pelvis; diffuse or localized
USA varies; OVs may adhere to structures

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14
Q

PID

A 
Pelvic infection (endometritis, salpingitis, hydrosalpinx, pyosalpinx, TOA); bilateral fluid/pus in pelvis
USA- FF in c-d-s, incr. vasc, thickened endo, fluid w/in endo, enlarged ov w/multiple cysts and indistinct margins
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15
Q

Cervical Stenosis

A

Acquired obstruction of cx canal

Distended, fluid-filled UT; intracavitary FF

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16
Q

Cervical Polyps

A

Benign hyperplastic; may protrude out of CX; late-middle ages
USA- may not be seen or hypoechoic-echogenic

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17
Q

Endometrial Carcinoma

A

Most common gyne malignancy in N America
Thickened endo (>4-5mm) w/myometrial invasion; enlarged UT w/irregular areas of low echoes
FF and symptoms incr. risk of malign.

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18
Q

UT calcifications

A

Calcium deposits occur on walls of UT; caused by myomas and arcuate artery calc. (Monckeberg’s arteriosclerosis- can indicate underlying disease such as diabetes, htn, and renal failure).
Focal areas of increased echogenicity w/shadowing or as peripheral echogenic rim

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19
Q

Endometritis

A

Endometrium infection;
From PID, postpartum, pelvic instruments;
Intense pelvic pain
Prominent endo, irregular, or both w/small amount of fluid; ff or pus in c-d-s

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20
Q

UT AVM

A

Vascular network of arteries and veins w/o intervening capillary network; usually myometrium;
US- serpiginous anechoic structures; tubular structures w/in myometrium

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21
Q

Endo Hyperplasia

A

Overgrowth of endo from unopposed estrogen stimulation;
Abnormal UT bleeding; may precede Endo CA
US- abnormal diffuse thickened endo

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22
Q

Post menopausal bleeding

A

Most pts are experiencing endo atrophy but may need more evaluation if it’s thickened.

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23
Q

IUD

A

Strings hang thru cx;

US- echogenic linear structure in endo cavity w/in UT body.

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24
Q

Menorrhagia

A

Prolonged/profuse bleeding;

Assoc w/ adenomyosis

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25
Q

Metrorrhea

A

Irregular acyclic bleeding;

Assoc w/ adenomyosis

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26
Q

Dysmenorrheal

A

Pelvic pain during menses;

Assoc w/ adenomyosis

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27
Q

Amenorrhea

A

Absent menses

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28
Q

Gartner’s Duct Cyst

A

Most common cystic lesion of vagina; usually found incidentally;
US- true cyst- anechoic w/enhancement

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29
Q

Vaginal cuff

A

After hysterectomy; should be

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30
Q

Theca-lutein cysts

A

Largest functional ov cyst; assoc w/elevated hcg and gestational trophoblastic disease

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31
Q

Teratoma

Aka Dermoid

A

Solid tumor composed of germ layers; teeth, bones, fat;
Present as abdominal mass or pain or asymptomatic;
US- varies w/elements; small to 40 cm; echogenic components w/shadowing; “tip of the ice berg”

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32
Q

Endometrioma “chocolate cyst”

A

Localized endometriosis frequently found in ov, c-D-s, posterior UT, etc.
US- focal cystic mass w/diffuse low level echoes and enhancement

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33
Q

Paraovarian cyst

A

Cyst adjacent to ov arising from broad ligament;

US- normal ipsalateral ov close to but separate from cyst; may have echoes from blood

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34
Q

Mucinous cystadenoma

A

Benign ov tumor; thin walled multilocular cyst; can be very large(>100 lbs)
US- simple or septated cyst, often containing internal echoes w/compartments differing in echogenicity

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35
Q

Mucinous cystadenocarcinoma

A

Malignant ov tumor; may become very large;

US- thick septations w/irregular walls and papillary projections and echogenic material.

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36
Q

Serous cystadenoma

A

2nd most common benign tumor of ov (after Dermoid).
Smaller than mucinous
US-unilocular, homogeneous, often bilateral and w/calcs

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37
Q

Serous cystadenocarcinoma

A

Most common ov CA. May be bilateral w/multilocular cysts;

US- smaller than mucinous, irregular borders, calcs, ascites

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38
Q

Arrhenblastoma

A

Maculinizing ov tumor;
Pelvic mass, amenorrhea, infertility
Peak at 25-45 yrs
US- solid mass w/cystic parts, loculated, encapsulated, unilateral sizes 2-30cm

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39
Q

Sertoli-Leydig Cell tumor

aka Androblastoma

A

Women under 30
Unilateral, virilization, excess estrogen
May become malignant
US-solid, hypoechoic mass

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40
Q

Granulosa

A

Feminizing, resembles Graafian follicle
Precocious puberty, vag bleeding, full breasts
May twist/rupture leading to Meig’s (ascites or pleural effusion)
US-similar to endometrioma (cystic w/diffuse low level echoes)

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41
Q

Dysgerminoma

A

Rare malignant germ cell tumor

Solid ov mass is women

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42
Q

Fibroma

A

Benign mass from ov stroma (fibrous), rarely functioning

US-unilateral w/variable appearance, hypoechoic w/shadowing, may be pedunculated and prone to torsion

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43
Q

Corpus luteum

A

Small endocrine structure that develops from a ruptured follicle and secretes progesterone and estrogen.

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44
Q

Corpus luteum cyst

A

Can result from failure of resorption or from excess bleeding into the corpus luteum. If ovum fertilized, CL cyst of pregnancy continues through 1st trimester w/max. size at 10 weeks and resolution by 12-16 weeks

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45
Q

Nabothian cysts

aka Epithelial inclusion cyst

A

From dilated transcervical glands- common in mid-aged women;

46
Q

Follicular cyst

A

Mature follicle that fails to ovulate; unilateral, asymptomatic,

47
Q

Hemorrhagic cyst

A

From internal hemorrhage of follicular of corpus luteum cysts; acute pelvic pain
US-varies w/amount and age of hemorrhage; acute is hyperechoic and may look solid w/enhancement; appears more echogenic w/time

48
Q

Metastatic Disease

A

CA spreads from other organs- most often in OV;
US- bilateral, ascites, solid or solid w/”moth-eaten” cystic pattern;
Lymphoma to ov US- solid, hypoechoic mass

49
Q

Ovarian Torsion

A

Twisted ov, common w/adnexal masses; surgical emergency;
US-enlarged swollen ov, usually >4cm;
Classic US-multiple tiny follicles around a hypoechoic mass
Common US- solid adnexal mass, absent blood flow

50
Q

PCOS

A

Endocrine disorder w/chronic anovulation;
Stein-Leventhal (infertility, oligomenorrhea, hirsutism, obesity)
US-OVs normal or enlarged w/echogenic stroma, bilaterally multiple small follicles “string of pearls”

51
Q

Ovarian hyperstimulation syndrome

A

Seen in PTs undergoing ovulation induction following FSH or GnRH, followed by hcG (infertility treatment)
US-enlarged OVs w/multiple cysts, ascites, pleural effusion

52
Q

Ovarian cancer

A

“Silent cancer” because usually not detected until stage II or III
Stage I- limited to OVs w/ascites
Stage II- limited to pelvic organs w/ascites
Stage III- Limited to abdomen outside pelvis and small bowel
Stage IV- Hematogenous (liver parenchyma) and beyond abdomen

53
Q

Common Cystic or Homogeneous OV masses

A 
Follicular
Corpus luteum of pregnancy
Cystic teratoma
Paraovarian cyst
Hydrosalpinx
Endometrioma
Hemorrhagic cyst
54
Q

Common Complex Masses of OV

A 
Cystadenoma
Dermoid cyst
Tubo-ovarian abscess
Ectopic PG
Granulosa cell tumor
55
Q

Common Solid Masses of OV

A 
Solid teratoma
Adenocarcinoma
Arrhenoblastoma
Fibroma
Dysgerminoma
Torsion
56
Q

Salpingitis

A

Fallopian tube infection; acute, subacute, or chronic
Presents as pelvic fullness w/fever or asymptom.
US-nodular thickening, irregular tube w/diverticula, tortuous

57
Q

Pyosalpinx

A

Pus in inflamed fallopian tube as result of obstruction

US- complex mass; pus w/in dilated tube very thick=hypoechoic

58
Q

Oophoritis

A

Form of PID that is infection of the OV

US-enlarged OV w/ multiple cysts and indistinct margins, incr. vascularity

59
Q

Tubo-ovarian Abscess (TOA)

A

Infection of fallopian tube and ov; adhesions fuse the inflamed ov and tube together, causing abscess
US-complex mass w/septations, irregular margins, and internal echoes, usually in c-d-s

60
Q

Parametritis

A

PID infection of UT serosa and broad ligaments

61
Q

Myometritis

A

PID infection of UT wall

62
Q

Peri-ovarian inflammation

A

PID infection surrounding OV

US-enlarged ov w/multiple cysts, indistinct margins

63
Q

Tubo-ovarian complex

A

Fusion of inflamed dilated fallopian tube and ov

US-complex mass w/septations, irregular margins, and internal echoes, usually in c-d-s

64
Q

Perihepatic inflammation/ Fritz-Hugh-Curtis syndrome

A

PID travels upward through right flank and mimics GB, liver, kidney pain (commonly w/gonorrhea)
US-hypoechoic rim along liver margin between liver and the adjacent ribs

65
Q

Peritonitis

A

Inflammed peritoneum caused by infectious organisms (from instrumentation, surgery, female genital tract, etc.)
US-loculated areas of fluid w/in pelvis, paracolic gutters, and mesenteric reflections; ascites; abscess w/gaseous bubbles

66
Q

Pelvic abscess

A

Infectious process in pelvis (bladder, ureter, bowel, adnexa)
US-loculated areas of fluid w/in pelvis; ascites; abscess w/gaseous bubbles

67
Q

Ectopic Pregnancy

A

Pg outside of UT fundus; pelvic pain, vaginal bleeding, empty UT, adnexal mass, positive pg test.
Most often in fallopian tube, but can be in OV, broad ligament, peritoneum, cx, and cornua
Complications include hemorrhage, hysterectomy, death
US- complex adnexal mass w/empty UT; may have concurrent IUP or pseudoGS

68
Q

Fetal cardiac activity

A

When GS= 9mm or TV CRL= 4mm

69
Q

Anembryonic pregnancy/Blighted ovum

A

GS in which embryo fails to develop or stops developing before detectable on US. GS may continue to grow and hcG may still rise. MSD

70
Q

Gastroschisis

A

Opening in abdomen wall, usually to right of umb. cord; bowel and organs may protrude outside of abdomen
US-anterior wall defect containing bowel, commonly to the right of umb. cord insert

71
Q

Midgut herniation

A

Normal bowel herniation into umb. cord to allow for fetal growth
US- echogenic mass at base of umb. cord between 8-12 weeks.

72
Q

Omphalocele

A

Bowel and/or abdominal organs herniate into umb. cord abnormally; bowel-only are highly assoc w/cardiac, cns, renal, and chromosomal anomalies
US-organ herniation in the cord at any GA; bowel herniated into cord beyond 12 weeks; look for cord membrane around herniation

73
Q

Iniencephaly

A

Rare, lethal cranial development abnormality w/ 1) defect in the occiput 2) extreme retroflexion of spine “star gazer” 3) open spinal defects

74
Q

Anencephaly

A

Absence of brain and cranial vault w/cerebral hemispheres missing or reduced to small masses
US-seen near end of 1st trimester; absence of cranium superior to orbits; brain may be projecting from open cranium

75
Q

Acrania

A

Partial/complete absence of cranium; ossification of cranium should begin after 9 weeks
US- abnormal shaped head “Mickey Mouse” head, lacking echogenic bony cranium

76
Q

Spina bifida

A

Neural tube fails to close after 6 weeks’ GA; detected at end of 1st trimester
US- spinal irregularities or bulging of posterior contour of spine; extrusion of mass from vertebral column; Cranial signs- lemon (scalloping frontal bones) and banana (curved looking cerebellum)

77
Q

Dandy-Walker malformation

A

Cystic dilation of the 4th ventricle w/dysgenesis or complete agenesis of cerebellar vermis; hydrocephaly; Reported as early as 11 weeks
US- large posterior fossa cyst continuous w/4th ventricle, absent cerebellum, dilated 3rd and lateral ventricles

78
Q

Cystic hygroma/ Turner’s syndrome

A

Dilation of jugular lymph sacs b/c of improper drainage of lymphatic system into venous system. Lg, septated hygromas assoc w/Turner’s and Down’s, CHF, and fetal demise in utero
US- vary in size, fluid structure on posterior aspect of fetal neck and upper thorax; may have nuchal thickening

79
Q

Pseudogestational sac

A

False intraUT sac w/ectopic pg. 1)pseudoGS does not contain live embryo or YS 2)is centrally located w/in endo 3)often contains homogeneous level echoes
US-sac w/o YS, centrally in UT, homogeneous echoes; no peritrophoblastic flow

80
Q

Gestational trophoblastic disease aka Molar PG

A

Trophoblastic tissue overtakes pregnancy; partial/complete
US-varies w/age; “snowstorm” appearance of hydatidiform mole; distorted GS shape w/thin, weak choriodecidual reaction; absence of double decidual sign; “cluster of grapes”

81
Q

Complete abortion

A

all POCs expelled; may have bleeding and cramping

US- empty UT; no adnexal mass; no FF; positive hcG levels w/rapid decline

82
Q

Incomplete spontaneous abortion

A

POCs remain in UT; may have bleeding and cramping

US-variable; intact GS w/nonviable embryo to collapsed sac; thickened endo >8mm; RPOCs

83
Q

Subchorionic hemorrhage

A

Low pressure bleed from implantation btwn myometrium and margins of GS; can lead to PG loss if large enough
US-crescent-shaped collection; echotexture depends on time (decr. echogenicity w/time); extension of hemorrhage toward placental margin

84
Q

Placental hematoma

A

Embryonic placenta detaches, resulting in hematoma w/in chorionic sac; asymptom.; may lead to fetal loss
US-similar to subchorionic (hyper- then hypo- then anechoic)

85
Q

Tachycardia/Bradycardia

A

Fetal heart rate 90-170
Brady assoc w/poor prognosis
Tachy leads to heart failure and fetal hydrops

86
Q

Cervical/Cornual PG complications

A

Very vascular areas- cornual may be worst. Hemorrhage upon rupture may result in uncontrolled bleeding and hysterectomy

87
Q

Nuchal translucency

A

Max thickness of subcutaneous lucency at back of neck at 11-14 weeks; incr. measure assoc w/trisomy, etc.
US-fetus 11-13 wks 6 days, CRL btwn 45-84mm; image midsagittal plane w/embryo away from amniotic membrane and head in neutral position.

88
Q

Macrosomia/Gest Diabetes/Placenta

A

Birth weight >4000g (above 90th percentile)
1)Generally large (genetics, long pg, etc)
2)Large w/large shoulders (diabetes)
3)Large head only (genetics/pathology)
US-Biometry measurements; placental thickness >5cm

89
Q

Heterotopic Pregnancy

A

Simultaneous IUP and ectopic; very rare

US-IUP w/extrauterine sac in adnexa w/thickened echogenic ring

90
Q

Macrosomic Index

A

Chest circumference-BPD

91
Q

Caudal regression syndrome

A

Lack of development of caudal spine and cord- seen almost exclusively w/diabetic mothers

92
Q

Conjoined twins

A 
Incomplete embryo division after day 13
Thoracopagus (joined at thorax)
Omphalopagus (joined at anterior wall)
Craniopagus (joined at cranium; syncephalus=conjoined twins w/1 head)
Pygopagus (joined at ischial region)
Ischiopagus (joined at buttocks)
93
Q

Monozygotic

A

One zygote splits to form identical twins
0-4 days: Di Di
4-8 days: Mono Di
8-13 days: Mono Mono

94
Q

Di Di

A

Thick membrane between embryos and GS “twin peaks” or delta sign

95
Q

Mono Di

A

Most common monozygotic

thin membrane btwn embryos “floating”

96
Q

Mono Mono

A

No separation of embryos

Risk of cord entanglement

97
Q

Dizygotic

A

Fraternal twins arise from 2 separate fertilized ova

Placentas may fuse but still have 2 distinct blood circulations separate from each other

98
Q

Preeclampisa/Eclampsia

A

Pregnancy induced HTN w/proteinuria; edema; assoc w/small placentas and IUGR
US-monitor AFI and fetal growth

99
Q

Hyperemesis Gravidarum

A

Excessive vomiting in pg leads to dehydration and electrolyte imbalance
US-R/O other causes of vomiting (gallstones, ulcers, trophoblastic disease-by demo viable IUP)

100
Q

Fetal hydrops- immune

A

Fluid collections caused by Rh incompatibility
US-scalp edema, pleural effusion, pericardial effusion, ascites, polyhydramnios, thickened placenta
Doppler of middle cerebral artery demo fetal anemia (increased velocity)

101
Q

Fetal hydrops- nonimmune

A

Fluid collections in at least 2 areas of fetus; pleural, pericardial, ascites, skin edema
US-extensive fluid or ff in fetal tissues or body cavities

102
Q

Alloimmune thrombocytopenia

A

Mother’s immune response to fetal platelets (like Rh response); leads to fetus w/very low platelet count; risk of cerebral hemorrhage in utero
US- evidence of fetal hemorrhage

103
Q

Hypertensive pregnancies

A

High blood pressure; small placentas; IUGR; eclampsia

US-monitor AFI and fetal growth; Doppler for maternal and fetal circulation status

104
Q

Spalding sign

A

Fetal death- overlap of skull bones

105
Q

Fetus papyraceous

A

Fetal death of a vanishing twin when too large to reabsorb; fetus markedly flattened from loss of fluid and most of the soft tissue

106
Q

Poli-oli sequence “Stuck twin”

A

Diamniotic pg w/polyhydramnios in 1 GS and severe oligohydramnios and smaller twin in the other; assoc w/twin-to-twin transfusion
US- smaller twin appears stuck in position w/in UT

107
Q

Premature labor

A

Before 37 weeks GA; preterm infants have greater risk for problems (respiratory, intracranial hemorrhage, bowel immaturity, feeding problems)

108
Q

Acardiac anomaly

A

Rare in monochorionic twins where 1 twin develops w/o a heart and often w/o upper half of body

109
Q

Twin-to-twin transfusion

A

An AV shunt develops w/in placenta causing arterial blood from 1 twin to pump into venous system of other twin; Donor twin becomes anemic and IUGR w/oligohydramnios; Recipient twin may be large, have polyhydr, go into heart failure
US- growth discordance, AFI for both

110
Q

Predictors of discordance in twin growth

A

Difference in: EFW of more than 20%
BPD of 6mm
AC of 20mm
FL of 5mm

OB Pathology (2 decks)

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