Chapter 17: The Uterus and The Vagina Flashcards
a focal mass of adenomyosis
adenomyoma
the benign invasion of endometrial tissue into the myometrium of the uterus
adenomyosis
failure of an organ or structure to grow during embryologic development
agenesis
the absence of menstruation
amenorrhea
the uterine body tilts forward and comes in contact with the cervix, forming an acute angle between the body and the cervix
anteflexion
the typical version of the uterus where the uterine body tilts forward, forming a 90 degree angle with the cervix
anteversion
a benign cyst that is located in one of the Bartholin glands in the region of the vulva
Bartholin duct cyst
the outer layer of the endometrium
basal layer
a common uterine anomaly in which the endometrium divides into two horns; also referred to as bircornis unicollis
bicornuate uterus
limp
boggy
pelvic ligament that extends from the lateral aspect of the uterus to the side walls of the pelvis
broad ligament
an overgrowth of epithelial cells within the cervix resulting in a broad based or pedunculated mass of tissue
cervical polyp
the rigid region of the uterus between the isthmus and the vagina
cervix
physical defects that are present in a person at birth; may also be referred to as congenital anomalies
congenital malformations
areas just inferior to the fundus of the uterus where the fallopian tubes are attached bilaterally
cornua (uterus)
the uterine body
corpus
the long axis of the uterus deviating to the right of the midline
dextroverted uterus
a drug administered to pregnant woman from the 1940s to the 1970s to treat threatened abortions and premature labor that has been linked with uterine malformation in the exposed fetus
DES
difficult or painful defecation
dyschezia
difficult or painful menstruation
dysmennorhea
painful sexual intercourse
dyspareunia
painful or difficult urination
dysuria
area that lies between the two layers of endometrium; may also be referred to as the uterine cavity
endometrial cavity
the inner mucosal layer of the uterus
endometrium
the inferior portion of the cervix that is in close contact with the vagina
external os
fibroid
leiomyoma
the functional inner layer of the endometrium that is altered by the hormones of the menstrual cycle
functional layer
the most superior and widest portion of the uterus
fundus
a benign cyst located within the vagina
Gartner duct cyst
blood accumulation within the vagina
hematocolpos
blood accumulation within the uterine cavity
hematometra
blood accumulation within the uterus and vagina
hematometrocolpos
fluid accumulation within the vagina
hydrocolpos
fluid accumulation within the uterus and vagina
hydrometrocolpos
the surgical removal of the uterus
hysterectomy
a radiographic procedure that uses a dye instilled into the endometrial cavity and fallopian tubes to evaluate for internal abnormalities
hysterosalpingography
the surgical repair of a uterine septum in a septate uterus using hysteroscopy
hysteroscopic uterine septoplasty
a vaginal anomaly in which the hymen has no opening, therefore resulting in an obstruction of the vagina
imperforate hymen
the superior portion of the cervix closest to the isthmus
internal os
a leiomyoma located within the uterine cavity
intracavitary
location of a leiomyoma within the myometrium of the uterus
intramural
area of the uterus between the corpus and the cervix
isthmus
a benign, smooth muscle tumor of the uterus; may also be referred to as a fibroid or uterine myoma
leiomyoma
the malignant manifestation of a leiomyoma
leiomyosarcoma
the long axis of the uterus deviating to the left of midline
levoverted uterus
the term used for the isthmus of the uterus during pregnancy
lower uterine segment
a fibroid treatment that utilizes focused high-frequency, high-energy ultrasound guided by MRI to heat and destroy fibroid tissue
magnetic resonance imaging-guided high-intensity focused ultrasound
excessive and prolonged bleeding at irregular intervals
menorrhagia
paired embryonic ducts that develop into the female urogenital tract
Mullerian ducts
having birthed more than one child
multiparous
the surgical removal of a myoma (fibroid) of the uterus
myomectomy
the muscular layer of the uterus
myometrium
benign cysts located within the cervix
nabothian cysts
the first 4 weeks (28 days) after birth
neonatal
never given birth
nulliparous
the total number of pregnancies in which the patient has given birth to a fetus at or beyond 20 weeks gestational age or an infant weighing more than 500g
parity
something that grows off of a stalk
pedunculated
the outer layer of the uterus; may also be referred to as the serosal layer
perimetrium
pubertal development before the age of 7; the early development of pubic hair, breast, or genitals
precocious puberty
secondary sexual development induced by sex steroids or from other sources such as an ovarian tumor, adrenal tumor, or steroid use
pseudoprecocious puberty
the uterine body tilts backward and comes in contact with the cervix, forming an acute angle between the body and the cervix
retroflexion
the uterine body tilts backward, without a bend where the cervix and body meet
retroversion
a sonographic procedure that uses saline instillation in the endometrial cavity, and, possibly, the fallopian tubes to evaluate for internal abnormalities; also referred to as sonohysterography
saline infusion sonohysterography
common congenital malformation of the uterus that results in a single septum that separates two endometrial cavities
septate uterus
the outermost layer of the uterus; may also be referred to as the perimetrium
serosal layer
a leiomyoma that distorts the shape of the endometrium
submucosal
congenital malformation of the uterus that results in a normal uterine contour with an endometrium that branches into two horns
subseptate uterus
location of a leiomyoma in which the tumor grows outward and distorts the contour of the uterus
subserosal
twisting
torsion
congenital malformation of the uterus that results in a uterus with one horn
unicornuate uterus
procedure used to block the blood supply to a leiomyoma
uterine artery embolization
uterine myoma
leiomyoma
congenital malformation of the uterus that results in the complete duplication of the uterus, cervix, and vagina
uterus didelphys
occlusion or imperforation of the vagina; can be congenital or acquired
vaginal atresia
the portion of the vagina remaining after a hysterectomy
vaginal cuff
recesses of the vagina
vaginal fornices
collective term for the mons pubis, labia majora, and labia minora, vestibule, Bartholin gland, and clitoris
vulva
cyclic pelvic pain, enlarged uterus, abdominal pain, urinary retention, amennorhea
Vaginal obstructions
distention of the uterus or vagina or both with anechoic or complex fluid
vaginal obstruction
uterine enlargement, boggy, tender uterus, dysmennorhea, menometrorrhagia, pelvic pain, dyschezia, dyspareunia, multiparous
adenomyosis
diffusely enlarged uterus, hypoechoic or echogenic areas adjacent to endometrium, heterogenous myometrium, myometrial cysts, ill-defined interface between myometrium and endometrium, thickening of the fundus or posterior myometrium
Adenomyosis
pelvic pressure, menorrhagia, palpable pelvic mass, enlarged bulky uterus, urinary frequency, dysuria, constipation, infertility
uterine leiomyoma
hypoechoic mass within the uterus, posterior shadowing from the mass, may have calcifications or cystic components
uterine leiomyoma
pelvic pressure and pain, menorrhagia, palpable abdominal mass, enlarged bulky uterus, urinary frequency, dysuria, constipation
leiomyosarcoma
rapidly growing mass within the uterus, hypoechoic mass within the uterus, posterior shadowing, may have calcifications or cystic components
leiomyosarcoma
anechoic mass within the cervix, may be multiple, may be complex
Nabothian cyst
anechoic or complex mass within the vagina
Gartner Duct Cyst
painful swelling and enlargement in the area of the vulva, fever, dysuria, dyspareunia
Bartholin Duct Cyst or Abscess
simple cyst; abscess may contain debris and produce dirty shadowing, Color Doppler may provide evidence of hyperemia due to infection
Bartholin Duct Cyst or Abscess
early development of secondary sexual characteristics with menses, ovulation, and elevated gonadotropin levels
isosexual precocity
characterized by isolated pubic hair development and increased levels of adrenal androgens
premature adrenarche
characterized by isolated breast development with normal prepubertal hormones
premature thelarche
body changes typically occurring at puberty, such as enlargement of breasts and growth of pubic hair
secondary sexual characteristics
a condition in which a female develops physical changes that are associated with male hormones (androgens) such as hair growth
virilization
Genetic gender is determined at ____ or _____
fertilization
conception
Female development requires the absence of ______
testosterone
Gender is not typically apparent until about the ____ week of embryonic life
12th
The uterus, vagina, and fallopian tubes develop from paired ______
Mullerian ducts
Mullerian ducts are also known as:
paramesonephric ducts
pear shaped, retroperitoneal organ
uterus
The uterus lies anterior to the ____ and posterior to the _____
rectum
urinary bladder
The uterus is bounded laterally by the ______
broad ligaments
The primary function of the _____ is to provide a place for the products of conception to implant and develop
uterus
Four major divisions of the uterus
fundus
corpus
isthmus
cervix
most superior and widest portion of the uterus
fundus
Each fallopian tube attaches to the uterus at the level of the uterine horns called the:
cornua
largest part of the uterus
corpus
The corpus is ____ to the fundus
inferior
area located between the corpus and the cervix
isthmus
During pregnancy the isthmus may be referred to as the _____
lower uterine segment
rigid component of uterus
cervix
The cervix is _____ to the isthmus
inferior
Portion of the uterus that projects into the vagina
cervix
The cervix is marked superiorly by the _____, which is in contact with the isthmus
internal os
The cervix is marked posteriorly by the _____ which is in close contact with the vagina.
external os
tubular organ that extends from the external os of the cervix to the external genitalia
vagina
envelope inferior aspect of cervix
vaginal fornices
3 layers of vagina
inner mucosal layer
middle muscular layer
outer adventitia layer
The uterine wall consists of three layers:
serosal layer or perimetrium
myometrium or muscular layer
endometrium
component shed during menstruation
functional layer of endo
also referred to as the uterine cavity
endometrial cavity
The neonatal uterus may exhibit distinct endo echoes in the 1st week of life as a result of _______
maternal hormone stimulation
The neonatal uterus appears as:
prominent tubular structure
Normal prepubertal uterus cervix to uterus ratio
2:1
Nulliparous adult uterus length and AP
6-8.5 cm
2-4 cm
Multiparous adult uterus length and AP
8-10.5 cm
3-5 cm
Postmenopausal adult uterus length and AP
3.5-7.5 cm
1.7-3.3 cm
uterine position in which the body tilts forward or anteriorly forming a 90 degree angle with vagina
anteversion
denotes position in which uterine body folds forward, possibly coming in contact with the uterus
anteflexion
position in which uterine body tilts backward or posteriorly, without a bend where the cervix and body meet
retroversion
uterine body tilts backward and actually comes in contact with cervix
retroflexion
uterus located more on the left
levoverted
uterus located more on the right
dextroverted
Uterine malformations are a result of fusion anomalies of the ______
Mullerian ducts
common uterine anomaly that is present when the endometrium divides into two endometrial cavities with one cervix, with a prominent concavity noted in the outline of the uterine fundus
bicornuate uterus
uterus has only one horn
unicornuate uterus
uterus that has two completely separate uterine cavities separated by an AP septum
septate uterus
characterized by an incomplete septum, has a narrow contour with an endometrium that branches into two horns
subseptate uterus
subtle variant in which endo has a concave contour at the uterine fundus
arcuate uterus
completed duplication of vagina, cervix, and uterus
uterus didelphys
drug administered to pregnant women from the 1940s to the 1970s to treat threatened abortions and premature labor; have been linked to menstrual disorders, infertility, and OB complications
DES
The ______ uterus explicit connection with spontaneous abortion
septate
radiographic study that utilizes contrast to evaluate uterine cavity and fallopian tubes
hysterosalpingography
resection of septum
hysteroscopic uterine septoplasty
vagina distended with simple, anechoic fluid
hydrocolpos
blood components from menstruation retained in uterine cavity or vagina
hematometra/ hematrocolpos
condition when both the uterine cavity and vagina are filled with blood
hematometrocolpos
invasion of endometrial tissue into myometrium
adenomyosis
common cause of abnormal uterine bleeding
adenomyosis
In adenomyosis, the basal layer of endometrium can often extend into the myometrium at depths of at least ___mm
2.5
focal adenomyosis in the form of a mass
adenomyoma
uterus will appear diffusely enlarged and heterogenous, may be indistinct hypoechoic or echogenic areas scattered throughout myometrium with small myometrial cysts
Adenomyosis
Adenomyosis is often present in a uterus affected by:
fibroid tumors
risk factors for adenomyosis
early menarche
shorter menstrual cycles
benign, smooth muscle tumor of the uterus
leiomyoma
most common gynecologic tumors
leiomyoma
leading cause of hysterectomy and gynecologic surgery
leiomyoma
solid, hypoechoic masses that produce posterior shadowing, may have calcifications or cystic components
leiomyoma
leiomyoma located within the myometriu m
intramural
most common location of leiomyomas
intramural
leiomyoma that grows outward and distorts contour of uterus, pedunculated, associated with broad ligament, may undergo torsion
subserosal
leiomyoma located adjacent to endometrial cavity; often distort shape of endometrium
submucosal
leiomyoma located within the uterine cavity; usually lead to abnormal uterine bleeding because of location in relation to endo
intrcavitary
Fibroid growth is associated with ____ stimulation
estrogen
____ or _____ fibroids may lead to infertility
intracavitary
submucosal
Leiomyosarcoma are most commonly found in
African American Women
The median age for leiomyosarcomas is:
54
benign retention cysts located within the cervix
Nabothian cyst
most common female malignancy in women younger than 50
cervical carcinoma
The greatest risk factor for cervical carcinoma is:
HPV
imhomogenous, bulky, enlarged cervix or as a focal mass within the cervix
cervical carcinoma
The cervical width should not exceed ___ cm
4
In patients with a hysterectomy, the cervical remnant should not exceed ___ cm in AP
4.4
The vaginal cuff should not exceed __ cm
2
narrowing of the endocervical canal
cervical stenosis
overgrowth of epithelial cells within the cervix, resulting in broad based or pedunculated mass of tissue; chronic inflammation, bleeding, possible infection
cervical polyp
within vagina on wall; typically small; asymptomatic; remnants of mesonephric or Wolffian duct; anechoic or complex
Gartner Duct Cyst
benign cyst that is located within one of the Bartholin glands in the region of the vulva
Bartholid duct cyst
mucus-secreting glands, located on posterolateral aspect of vaginal orifice
Bartholin glands
pubertal development before the age of 7
precocious puberty
hormone produced by the hypothalamus
gonadotropin-releasing hormone
may be associated with intracranial tumors, infection, congenital abnormality, or traumatic injury to hypothalamus
true precocious puberty
The brain tumor most likely associated with true precocious puberty
hypothalamic hamartoma
Pseduoprecious puberty has been linked to _____, ______, and _____ tumors
ovarian
adrenal
liver
Adrenal tumors may also lead to:
congenital adrenal hyperplasia
absent or incomplete breast development after age of 12
Delayed puberty
also known as monsomy X or gonadal dysgenesis
Turner syndome
small stature, webbed neck, poor breast development, rudimentary ovaries, primary amennorhea
Turner Syndrome
What is the brain tumor that is most likely associated with precocious puberty?
hypothalamic hamartoma
Which of the following would be found in the region of the vulva?
a. Gartner duct cyst
b. Nabothian cyst
c. Cervical polyp
d. Bartholin cyst
d
What is dyschezia?
painful defecation
What is another name for the perimetrium?
Serosal layer
Which of the following is the term for the accumulation of blood within the endometrium?
a. hydrometra
b. hydrocolpos
c. hematocolpos
d. hematometra
d
Which of the following may stimulate leiomyoma growth?
a. Follicle-stimulating hormone
b. Prolactin
c. estrogen
d. luteinizing hormone
c
In postpubertal young girls, what is a likely cause of cyclic abdominal pain, amenorrhea, and an enlarged uterus?
imperforate hymen
What word part means horn?
cornu
Which of the following is characterized by an incomplete septum and a normal uterine contour with an endometrium that branches into two horns?
a. uterus didelphys
b. unicornuate uterus
c. subseptate uterus
d. septate uterus
c
What layer of the endometrium is typically affected by adenomyosis?
Basal
All of the following are parts of the uterus except:
a. corpus
b. fundus
c. cervix
d. vagina
d
What is the most common caused of delayed puberty in the presence of an elevation in follicle-stimulating hormone?
gonadal dysgenesis
Which of the following is thought to be remnants of the Wolffian duct?
a. Nabothian cyst
b. Gartner duct cyst
c. Bartholin duct cyst
d. Leiomyoma
b
Which of the following fibroid locations would most likely result in abnormal uterine bleeding because of its relationship to the endometrium?
a. submucosal
b. intramural
c. subserosal
d. subserosal pedunculated
a
All of the following are sonographic findings consistent with adenomyosis except:
a. diffuse, enlarged uterus
b. myometrial cysts
c. hypoechoic areas adjacent to the endometrium
d. complex adnexal mass
d
The largest part of the uterus is the:
corpus
Which of the following would be most indicative of a leiomyosarcoma?
a. vaginal bleeding
b. rapid growth
c. dysuria
d. large hypoechoic mass
b
The inferior portion of the cervix closest to the vagina is the:
external os
The inner mucosal lining of the uterus is the:
endometrium
Difficult or painful intercourse is referred to as:
dyspareunia
What congenital malformation of the uterus is common and has a clear association with an increased risk for spontaneous abortion?
septate uterus
Absence of menstruation is referred to as:
amenorrhea
The invasion of endometrial tissue into the myometrium of the uterus is referred to as:
adenomyosis
Pseudoprecocious puberty may be associated with all of the following except:
a. ovarian tumor
b. adrenal tumor
c. liver tumor
d. brain tumor
d
The layer of the endometrium that is significantly altered as a result of hormonal stimulation during the menstrual cycle is the:
functional layer
The most superior and widest portion of the uterus is the:
fundus
A 24 year old female patient presents to the sonography department for a pelvic sonogram with an indication of pelvic pain. Upon sonographic interrogation, the sonographer notes an anechoic mass within the vagina. This mass most likely represents a(n):
Gartner duct cyst
What section of the uterus is also referred to as the lower uterine segment?
isthmus
The outer layer of the endometrium is the:
basal layer
Which of the following would be considered the more common uterine anomaly?
a. bicornis univernus
b. bicornis bicollis
c. uterus didelphys
d. septate uterus
d
The rigid region of the uterus located between the vagina and the isthmus is the:
cervix
Upon sonographic evaluation of a patient complaining of abdominal distention, you visualize a large, hypoechoic mass distorting the anterior border of the uterus. What is the most likely location of this mass?
subserosal
A simple fluid accumulation within the vagina secondary to an imperforate hymen is:
hydrocolpos
The uterine position in which the corpus tilts forward and comes in contact with the cervix describes:
anteflexion
What leiomyoma location would have an increased risk to undergo torsion?
pedunculated
A 13 year old girl presents to the sonography department with a history of cyclic pain, abdominal swelling, and amennorhea. Sonographically, you visualized an enlarged uterus and a distended vagina that contains anechoic fluid with debris. What is the most likely diagnosis?
hematocolpos
All of the following are clinical findings associated with leiomyoma except:
a. myometrial cysts
b. infertility
c. palpable pelvic mass
d. menorrhagia
a
The surgical removal of a fibroid is termed:
myomectomy
Which of the following is typically not a clinical complaint of women who are suffering from adenomyosis?
a. amenorrhea
b. dysmennorhea
c. dyspareunia
d. menometrorrhagia
a
The paired embryonic ducts that develop into the female urogenital tract are the:
Mullerian ducts
Precocious puberty is defined as the development of pubic hair, breasts and genitals before the ago of:
7
Abnormally heavy and prolonged menstrual flow between periods is termed:
menometrorrhagia
Leiomyomas that project from a stalk are termed:
pedunculated
Congenital malformation of the uterus that results in complete duplication of the genital tract is:
uterus didelphys
A 38 year old female patient presents to the sonography department for a pelvic sonogram with an indication of pelvic pain. Upon sonography interrogation, the sonographer notes an anechoic mass within the cervix. This mass most likely represents a:
nabothian cyst
Leiomyosarcoma of the uterus denotes:
a. the benign invasion of endometrial tissue into the myometrium
b. the ectopic location of endometrial tissue in the adnexa
c. the malignant counterpart of a fibroid
d. an anechoic, simple cyst located within the cervix
c
The location of a fibroid within the myometrium is termed:
intramural
The superior portion of the cervix is the:
internal os
Anechoic fluid noted distending the uterus and vagina within a pediatric patient is termed:
hydrometrocolpos
The normal position of the uterus is:
anteverted
The area of attachment of the fallopian tubes to the uterus is the:
cornua
The recesses of the vagina are the:
fornices
A patient presents to the sonography department for a pelvic sonogram with a history of adenomyosis that was diagnosed following an MRI of the pelvis. What are the most likely sonographic findings?
a. Complex, bilateral adenexal masses
b. myometrial cysts with enlargement of the posterior uterine wall
c. endometrial thinning and cervical dilation
d. uterine atrophy with bilateral ovarian cysts
b
