Ch. 42 Female Pelvis Flashcards
List 7 questions the sonographer should ask the patient when doing a pelvic sonogram
- when was the first day of your last period 2. how many times have you been pregnant/ how many children have you had 3. do you take hormones 4. have you ever had cancer 5. what symptoms do you have 6. do your physician perform a pelvic exam 7. have you had any gynecologic surgeries
T/F. the most complete pelvic sonogram includes includes both transabdominal and transvaginal approaches
true
T/F. transvaginal sonography provides a more “global” survey than transabdominal sonography
false
T/F. transvaginal sonography should be performed while the patient has a full bladder
false
T/F. the full bladder provides an acoustic window for transabdominal pelvic sonography
true
T/F. transvaginal sonography should be performed on pre menarche girls
false
T/F. all adults can tolerate transvaginal sonography
false
T/F. no consent is required before performing transvaginal sonography
false
T/F. transvaginal sonography utilizes higher frequencies than transabdominal sonography
true
T/F. transvaginal sonography has better resolution than transabdominal sonography
true
T/F. It is OK to perform transvaginal sonography without a probe cover
false
T/F. The transvaginal probe should be soaked in a high level disinfectant solution between patients
true
T/F. Care should be used to not use anything that interferes with sperm function when performing transvaginal sonography on infertility patients
true
The _______ may be mistaken for ovaries, fluid collections, or masses
pelvic muscles
The _______ is seen as a hammock-shaped structure posterior to the bladder and vagina when angling caudally from the superior bladder
levator ani muscle
The _______ muscle is located laterally in the pelvis and is used as a landmark for locating the iliac vessels and ovaries
iliopsoas muscle
During the secretory phase of the menstrual cycle, the ______ of the uterine arterial vessels decreases slightly
resistive index
At and just after ovulation, the ______ of the ovarian blood flow decreases
resistive index
The _______ are often seen in the periphery of the uterus and should not be mistaken for pathology
arcuate vessels
Small cysts located near the cervical canal are called
nabothian cysts
Ovarian volume is calculated by which formula
L x W x H x .523
On transvaginal scanning in the sagittal plane, the ______ uterus will extend toward the left side of the monitor screen
anteflexed
On transvaginal scanning in the sagittal plane, the ______ uterus will extend toward the right side of the monitor screen
retroflexed
Angle the transvaginal probe _____ to visualize the cervix
posteriorly
______ scanning is better for visualizing the endometrium
transvaginal
______ scanning is better for measuring the length of the uterus
transabdominal
The normal measurement of the endometrium depends on the woman’s ______ status
hormonal
______ scanning is superior for evaluating large ovarian masses and their origin
transabdominal
______ scanning is superior for evaluating the general location of the ovary
transabdominal
_______ scanning is superior for evaluating fine details of ovarian structure
transvaginal
______ scanning is superior for performing doppler of the ovaries
transvaginal
Normal endometrial thickness
14mm
Upper normal in late secretory phase
7-14mm (luteal)
______ is a procedure that involves injecting sterile saline or contrast into the uterine cavity and then imaging with transvaginal sonography
sonohysterography
Endometrial masses and polyps are often best evaluated with ______
sonohysterography
The difference between the peak systole and the peak diastole is the ______ ratio
S/D ratio
The doppler measurement that uses peak systole minus peak diastole divided by the mean over one cardiac cycle is the ______ index
pulsatility
Sonohysterography is usually performed on premenopausal women between days ______ of the menstrual cycle
6 and 10
Limitations of translabial scanning may be overcome by which one of the following
elevating the patients hips
Which of the following refers to a horizontal plane through the longitudinal axis of the body to image structures from anterior to posterior
coronal
What power level should be used and why
lower, reduce acoustic exposure
What are you evaluating with color and spectral doppler with the ovaries
trophoblastic flow when searching for pregnancy (intrauterine or ectopic)
What unit will be show for ovary measurements during transvaginal
cm
What plane is the obturator internus best seen in
transverse plane when angling up from symphysis pubis
What is the appearance of the obturator internus
ovoid hypoechoic structure lateral to the uterus
What may be mistaken for an ovary
obturator internus
Seen as hammock shaped hypoechoic area posterior to the uterus/vagina
levator ani
hypoechoic structure with linear striations that runs obliquely from superior to inferior at the lateral sides of the pelvis
ilopsoas
Major landmark for locating the ovaries- especially in the sagittal plane
iliopsoas
Doppler flow characteristics of uterine arteries
moderate to high velocity/high resistance flow
Uterine arteries have ______ resistance in postmenopausal women than reproductive age
higher
Doppler flow characteristics of radial arteries
higher resistance flow in the proliferative phase than secretory
Doppler flow characteristics of ovarian arteries in follicular phase
low velocity high resistance
Doppler flow characteristics of ovarian arteries in postmenopausal women
RI approaches 1.0 with increasing age
Where do you generally evaluate uterine vasculature
lower uterine segment near internal os of cervix
When you evaluate ovarian flow adjacent to and within ovary, you will usually see
ovarian branch of the uterine artery more easily
Infer diagnostic information by evaluating the ______ of the flow
resistance
high resistance=
low diastolic flow
low resistance=
high diastolic flow
Resistive index (RI)=
PSV-EDV/PSV
Normal RI for the uterus in proliferative phase
.88
The RI of the uterine artery usually ______ just before ovulation and continuing throughout the secretory phase
decreases
Why does the RI of the uterine artery decrease before ovulation and through secretory phase
more diastolic flow due to a little less resistance
Ovarian flow changes during the ovarian cycle- proliferative phase (developing follicles)
high resistance, low velocity
Ovarian flow changes during the ovarian cycle- ovulation
resistance decreases (more diastolic flow) and peak velocity increases
What is the RI during ovulation
.44
Ovarian flow changes during the ovarian cycle- secretory phase
resistance increases slightly just before menses
_______ of the uterus sometimes become prominent and should not be mistaken for masses
arcuate vessels
Arcuate vessels are more prominent during
proliferative and early secretory phase
Sonographic appearance of normal myometrium should be
homogenous with smooth walls
What changes dramatically depending on which part of the menstrual cycle the patient is in
endometrium
What does the endometrium look like days 1-4
early menstruation, the endometrial canal appears as a hypoechoic central line representing blood and tissue
What does the endometrium look like days 3-7
menses progresses, the hypoechoic area that represents blood is sloughed off, see thin echogenic line
What does the endometrium look like during days 5-9
proliferative phase, see thin echogenic line with hypoechoic halo (3 lines)
What does the endometrium look like days 10-14
late proliferative phase, thickened echogenic central line still with hypoechoic halo
What does the endometrium look like days 15-28
secretory phase, endometrium is at its greatest thickness and echogenicity with posterior acoustic enhancement
Endometrial changes occur in response to
estrogen and progesterone
Normal endometrial thickness
4-14mm
Upper normal in late secretory phase
7-14mm (luteal)
The fallopian tube leaves the _____ of the uterus and travels _____ through the _____ in the ______
cornua, laterally, broad ligament, mesosalpinx
______ and the ______ area can be seen as a hypoechoic linear structure passing laterally from the mid/sup uterus towards the ovary
broad ligament, mesosalpinx
If there is fluid, blood or pus in the fallopian tube, it will be seen as
anechoic/hypoechoic tortuous structure in the adnexa
If there is pelvic ascites, the normal fallopian tubes can be seen
outlined by fluid
Ovaries usually lie next to the ______ and the ______
psoas muscle, iliac vessels
Follow _______ from uterus to ovary in ______ plane
broad ligament, transverse
Ovary position is affected by
bladder volume, previous pregnancies and peristalsis of the bowel
At mid-cycle, graafian follicle can measure up to
2.4cm
Hysterosonography is used during
transvaginal
It is important to perform sonohysterography during
proliferative phase of cycle- ASAP after menses
Post menopause sonohysterography should be performed
at any time unless patient is on cyclic HRT, then should schedule during withdrawl or progesterone phase
Most reliable method to differentiate between polyp and fibroid is by
echogenicity
30% of postmenopausal bleeding caused by
endometrial polyps
10-20% of postmenopausal bleeding is caused by
endometrial cancer
Frequently used in breast cancer patients as estrogen suppressor
tamoxifen
Tamoxifen is a weak estrogen stimulant and there is a slight increased risk of
endometrial hyperplasia, endometrial polyps
endometrial cancer
Due to increased specificity and detailed anatomy visualized _______ is advocated by some as a first line evaluation of abnormal uterine bleeding
sonohysterography
