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OB/GYN Board > Chapter 22: Adnexal Pathology and Infertility > Flashcards

Chapter 22: Adnexal Pathology and Infertility Flashcards

1
Q

Krukenberg tumors are a results of:

a. endometriosis
b. hyperstimulation
c. metastatic disease
d. asherman syndrome

A

C

Krukenberg tumors are metastatic lesion most commonly resulting from primary gastric carcinoma. Other primary structures may include breast, large intestine, and appendix

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2
Q

A cystic structure located in the inferior broad ligament is most suspicious for a:

a. hydrosalpnix
b. endometrioma
c. paraovarian cyst
d. serous cystadenoma

A

C

Paraovarian cysts are typically located in the broad ligament. The tubes is contained within the superior portion of the broad ligament

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3
Q

Which of the following most accurately describes endometriosis?

a. proliferation of endo lining
b. collection of ectopic endo tissue
c. ectopic endo tissue located in the myo
d. active endo tissue invading the peritoneal cavity

A

D

Endometriosis is a condition occuring when active endo tissue invades the peritoneal cavity. Endometriomas are collections of extrainvasive endo tissue

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4
Q

Infertility is suggested when conception does not occur within:

a. 6 mon
b. 9 mon
c. 12 mon
d. 24 mon

A

C

Infertility is suggested when conception does not occur w/in 1 year

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5
Q

Which of the following complications is commonly assoc with IVF?

a. hyperstimulation
b. ectopic pregnancy
c. multiple gestation
d. spontaneous abortion

A

C

Multiple embryos are transferred to the endo cavity, increasing the likelihood of multiple gestations and decreasing the likelihood of ectopic pregnancy

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6
Q

A 25 year old women presents w/ high grade fever, pelvic pain, and leukocytosis. An ill defined complex mass is identified in the left adnexa. Based on this clinical history, the sono findings is most suspicious for:

a. salpingitis
b. pyosalpingitis
c. endometritis
d. tuboovarian abscess

A

D

An ill defined complex adnexal mass in a patient with symptoms of an infection is most suspicious for a tuboovarian abscess

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7
Q

A patient presents with lower abd pain and a palpable mass. A septae fluid collection surrounds a normal appearing rt ov. The pt has a previous hx of a ruptured appendix. Based on this clinical hx, the sono findings is most suspicious for which of the following pathologies?

a. endometriosis
b. tuboovarian abscess
c. mucinous cystadenoma
d. peritoneal inclusion cyst

A

D

Peritoneal inclusion cyst are caused by adhesions trapping normal secretions produced by the ov. Clinical symtoms include lower abd pain and a palpable mass. Septated fluid collections surround a normal appearing ov is a common sono findings of peritoneal inclusion cyst.

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8
Q

With the gamete intrafollicular transfer technique, the:

a. embryos are transferred to the endo cavity
b. zygote are transferred to the endo cavity
c. oocytes and sperm are transferred to fallopian tube
d. oocytes and sperm are transferred to the endo cavity

A

C

The GIFT technique transfers oocytes and sperm into the fallopian tube. ZIFT transfers a zygote to the fallopian tubes. IVF transfer embryos to the endo cavity

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9
Q

Monitoring of which hormone is routine during ov induction therapy?

a. estrogen
b. estradiol
c. progesterone
d. FSH

A

B

Estradiol levels reflects the maturity of the estimulated follicles. The size and number of follicles, along with the estradiol level, determine when ovulation is induced

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10
Q

Metastatic lesions in the adnexa are more commonly assoc with a primary malignancy of the :

a. respiratory system
b. genitourinary tract
c. reproductive organs
d. gastrointestinal tract

A

D

Metastatic lesions in the adnexa (Krukenburg tumors) are more commonly assoc with a primary malignancy of the gastriontestinal tract

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11
Q

Which of the following abnormalities is most likely a consequency of PID?

a. adenomyosis
b. hydrosalpinx
c. endometriosis
d. parovarian cyst

A

B

Hydrosalpnix is a common consequence of PID. Parovarian cyst are typically located in the broad ligaments and are mesothelial in origin

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12
Q

During the mid luteal phase, full luteal function is expected if the endo thickness is at least:

a. 4 mm
b. 8 mm
c. 11 mm
d. 14 mm

A

C

Endometrial thickness not exceeding 8 mm during menstrual cycle is assoc with a decrease in fertility. A full luteal is expected if the endo is at least 11 mm in thickness in the midluteal phase

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13
Q

Which fertility assistance program inserts oocytes and sperm into the tube?

a. IVF
b. zygote intrafallopian transfer
c. gamete intrafollicular transfer
d. oocyte and sperm fallopian trfer

A

C

GIFT, or gamete intrafallopian transfer, mixes oocytes w/ sperm added to the tubes. ZIFT places a zygote in the tube. IVF places embryos in the endo

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14
Q

Which of the following complications is most likely assoc with ovulation induction therapy?

a. ectopic pregnancy
b. multiple gestation
c. spontaneous abortion
d. hyperstimulation syndrome

A

D

Ovarian hyperstimulation syndrome is the most likely complication assoc with ovulation induction therapy. US monitor the size and number of mature follicle to prevent hyperstimulation and to aid in the timing of ovulatory medication.

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15
Q

A large cystic mass posterior and lateral to the ut in a pt w/ a hx of previous pelvic infection is most suspicious for;

a. hydrosalpinx
b. endometrioma
c. parovarian cyst
d. corpus luteum cyst

A

A

Hydrosalpnix is a common complication of PID. Parovarian cyst is a possible differential consideration but it is not related to PID

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16
Q

Differential considerations for this pelvic mass would most likely include:

a. hydrosalpnix
b. simple cyst versus simple cyst
c. hydrosalpnix versus endometrioma
d. parovarian cyst vs endometrioma

A

b

A circular anechoic mass is identified contiguous with rt ov located between the ut and ov. This is more suspicious for a simple cyst vs parovarian cyst

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17
Q

Suggested follow-up care on this patient would most likely include:

a. surgical intervention
b. infertility assessment
c. sonogram in 6 to 8 w
d. sonogram in 2 to 3 w

A

C

Repeating the pelvic sonogram in 6 to 8 w is the most likely follow-up care on this pt. This will allow enough time for regression of simple cyst. The size of a parovarian cyst would remain unchanged. This cystic structure regressed and was no longer apparent in a follow-up sonogram 8 w later

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18
Q

A pt presents with a hx of dysparunia and irregular menstrual cycles. A complex mass is identified adj to normal appearing ov. Based on this clinical hx, the sono findings is most suspicious:

a. endometrioma
b. cystic teratoma
c. hemorrhagic cyst
d. pedunculated leiomyoma

A

A

A complex mass located in the adnexa adj to a normal ov is most suspicious for an endometrioma. Dermoid involve the ov.

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19
Q

A pt present w/ hx of a palpable pelvic mass. Additional questions show a hx of pelvic infection following an appendectomy. She denies pelvic pain or fever. The anechoic area in this sonogram is most suspicious for a:

a. hydroureter
b. hydrosalpnix
c. parovarian cyst
d. external iliac vein

A

A

Tubular anechoic structure courses directly to the left ov. In a pt with a previous hx of pelvic infection, this sono findings is most suspicious for a hydrosalpnix.

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20
Q

The ov most likely demonstrates a :

a. hemorrhagic cyst
b. suspicious solid mass
c. normal anatomic variant
d. suspicious isoechoic mass

A

C

An L shaped ov is a normal anatomic ov variant. This irregular contour can be misdiagnosed as an isoechoic ov or adnexal mass

21
Q

The sonogram most likely demonstrates:

a. hypostimulation syndrome
b. normal physiological cysts
c. polycystic ov disease
d. normal stimulated follicles

A

D

The presence of five similar sized follicles increases the likelihood of medical stimulation. At this point, the stimulated follicles are within normal limits. Continual monitoring to evaluate for hyperstimulation syndrome is likely

22
Q

A 32- yr pt presents with a hx of endometriosis, which is a result of:

a. previous PID
b. endometrial tissue within the myo
c. an accumulationg of ectopic endo tissue
d. endo tissue w/in peritoneal cavity

A

C

Endometriosis is the ectopic location of endo w/in peritoneal cavity. Adenomyosis describes the invasion of endo tissue within the mypmetrium. An accumulation of ectopic endo tissue describes an endometrioma.

23
Q

The adnexal mass is most likely a:

a. endometrioma
b. dermoid
c. hemorrhagic cyst
d. ectopic pregnancy

A

A

A hypoechoic adnexal mass in a pt w/ a hx of endometriosis is most likely an endometrioma

24
Q

A 55- yr old pt presents w/ a 6 mon hx of pelvic fullness. She has a hx of breast cancer and a recent diagnosis of metastatic liver disease. Based on this clinical hx, the sonographic findings are most suspicious for:

a. endometriomas
b. ov carcinoma
c. pedunctulated fibroids
d. Krukenberg tumors

A

D

Massive, bilateral enlargement of the ov or adnexae should raise the suspicion of Krukenberg tumors (metastatic lesions). Primary ov malgnancies are rarely mass

25
Q

An asymptomatic patient presents w/ a hx of a palpable pelvic mass on physical exams. Based on this clinical hx, the sonographic findings are most susicious for a:

a. hydrosalpnix
b. corpus luteum
c. parovarian cyst
d. physciological cyst

A

C

A round anechoic structure is identified between the lt and rt ov. There is a seperation between the masa dn lt ov. These sono findings are most suspicious for a parovarian cyst. A simple ov cyst is a possible differential consideration.

26
Q

A pt presents w/ a hx of palpable pelvic mass and the most recent menstrual period 2 w earlier. On furhter questioning, the pt admits to previous pelvic surgery for a ruptured appendix. A sonogram demonstrates the ov surrounded by anechoic fluid. Based on clinical hx, the sonographic findings are most suspicious for a:

a. parovarian cyst
b. serous cystadenoma
c. tuboovarian abscess
d. peritoneal inclusion cyst

A

D

Adhesion can trap fluid normally produced by the ov. A septated fluid collection surrounding an ov is most suspicious for a peritoneal inclusion cyst. Parovarian cyst are not assoc w/ previous oelvic surgery, appearing as a round anechoid mass between ut and ov.

27
Q

A patient presents with hx of infertility. The sono findings in this coronal sonogram are most suspicious for:

a. adenomyosis
b. subseptous ut
c. bicornuate ut
d. submucosal leiomyoma

A

B

The image demonstrates a septation in the fundal potion of the endo with a normal appearing ut contour. The fundal contour of the ut appears smooth and regular, ruling out a submucosal fibroid

28
Q

A pt presents with intermittent llq pain. Additional questioning shows a hx of chlamydia. Based on this clinical history, the sono findings are most suspicious for a:

a. hydroureter
b. hydrosalpnix
c. tuboovarian abscess
d. peritoneal inclusion cyst

A

B

An anechoic tubular structure contiguous w/ the lt ov in a pt w. a hx of intermittent pelvic pain and previous pelvic infection is most suspicious for a hydrosalpnix.

29
Q

An additional sono findings commonly assoc w/ this abnormality is:

a. ascites
b. hydrosalpnix
c. endometrioma
d. ectopic pregnancy

A

A

Ascites and pleural effusion are additional findings assoc with ovarian hyperstimulation syndrome

30
Q

PID is best described as a:

a. STD
b. specific inflammatory process of the oc
c. general classificatoin of inflammatory conditions
d. specific inflammatory condition of the tubes

A

C

PID is a general classification for inflammatory conditions of the cx, ut, ov, tubes, and peritoneal surfaces. It can be a result of a bacterial infection, diverticulitis, or appendicitis. Tuboovarian abcess is commonly a result of STD and pelvic infection

31
Q

During ov induction therapy, follicles are only measured when exceedings:

a. .5 cm
b. 1 cm
c. 2 cm
d. all follicles are measured

A

During ovarian inductions therapy, only follicles greater than 1 cm is measured

32
Q

Which of the following ut anomalies is not likely to cause infertility:

a. leiomyoma
b. septae ut
c. nabothian cyst
d. endo polp

A

C

Nabothian cyst are a common findings in the ut cx and would not likely cause infertility. A submucosal fibroid could cause infertility.

33
Q

On serial exams, a parovarian cyst will:

a. slowly resolve
b. remain unchanged
c. rapidly increase in size
d. cary according to the ovulatory phase

A

B

Parovarian cyst are not affected by cyclic changes in hormone levels and will generally remain the same size on serial exam

34
Q

A common symptom of endometriosis is:

a. amenorrhea
b. menorrhagia
c. dysmenorrhea
d. urinary frequency

A

C

Dysmenorrhea is a common symptoms assoc with endometriosis. Other symptoms may include pelvic pain, irregular menses, dysparunia and infertility

35
Q

Which of the following most accurately describes the sono appearence of a peritoneal inclusion cyst?

a. complex ov cyst
b. large unilocular adnexal mass
c. small cluster of ov cyst
d. septated fluid collection surrounding the ov

A

D

A peritoneal inclusion cyst is a result of adhesion trapping fluid normally secreted by the ov, creating a septated fluid collection around ov

36
Q

A common sono findings is assoc with an endometrioma is a:

a. irregular, hypo ov mass
b. well defined anechoic ov mass
c. heterogeneous, complex adnexal mass
d. hypo, homogeneous adnexal mass

A

D

A hypoechoic, homogeneous adnexal mass is the most common sono appearance assoc with an endometrioma. Other findings include fluid/fluid levels and internal solid component.

37
Q

Inflammation w/in the tube is termed:

a. adnexitis
b. salpinitis
c. pyosalpinx
d. hydrosalpinx

A

B

Salpingitis is a result of a pelvic infection causing inflammation w/in tube

38
Q

W/ ov induction therapy, intramuscular injection of what hormone triggers ovulation?

a. progesterone
b. luteinizing hormone
c. follicle stimulating hormone
d. hCG

A

D

Under normal circumstances, a surge in luteinizing hormone stimulates ovulation. W/ ov induction therapy, intramuscular injection of hCG triggers ovulation

39
Q

Scarring w/in the endo caused by invasive procedures is termed:

a. albicans
b. synechiae
c. hyperplasia
d. adenomyosis

A

B

Scarring w/in endo caused by prev D & C or spontaneous abortion, and they demonstrate as a bright band of echoes w/in endo

40
Q

Fixation of ov posterior to the ut is a sono findings assoc w/:

a. adenomyosis
b. endometriosis
c. tuboovarian abscess
d. PID

A

B

Fixation of the ov posterior to the ut is a sono finding in cases of endometriosis

41
Q 
A total breakdown of the normal adnexal anatomy is a sono findings is assoc w/:
a. pyosalpinx
b. endometriosis
c. Krukenberg
D. tuboovarian abcess
A

D

Depending on the severity of infection, a tuboovarian abcsess may present as a total breakdown of normal adnexal anatomy

42
Q

Which of the following is an acquired cause of infertility?

a. endometritis
b. bicornuate ut
c. meigs syndrome
d. gartner duct cyst

A

A

Inflammation of the endo is a acquired cause of infertility. Other acquired conditions include endometriosis, and Asherman syndrome. Congenital ut anomalies are not acquired conditions.

43
Q

Which of the following best describes the sono appearance of ut synchiae?

a. thick, irregular enod
b. hypo enod mass
c. irregular hypo myo mass
d. bright band of echoic w.in endo

A

D

Synechiae are result of scarring cause by prev D & C or spontaneous abortion, and they demonstrate as a bright band of echoes w/in endo

44
Q

Assessment for the presence of an ov cyst or dominant follicle is scheduled:

a. before IVF
b. after gamete intrafollicular transfer
c. before gamete intrafollicular transfer
d. before initiating ov induction therapy

A

D

A baseline study before starting ov induction therapy is performed to assess the ov for an ov cyst or dominant follicle and the ut for anomalies or abnormalities.

45
Q

Which of the following is not a sono finding in PID?

a. normal appearing pelvis
b. complex tubular adnexal mass
c. focal hypoechoic adnexal mass
d. thick and hypervascular endo

A

C

A focal hypo adnexal mass describes the sono appearance of an endometrioma. Sono findings in PID can vary from a normal appearing pelvis to an ill defined multilocular adnexal mass

46
Q

Which of the following is most accurately describes an endometrioma?

a. overgrowth of endo tissue
b. collection of ectopic endo tissue
c. ectopic location of active endo tissue
d. ectopic endo tissue w/in myo

A

B

Endometriomas are collections of ectopic endo tissue. Endometriosis is an acquired condition occuring when active endo tissue invades the peritoneal cavity (ectopic location of functional endo tissue) Endo tissue will attach to the tubes, ov, colon, and bladder. Adenomyosis is ectopic endo tissue w/in myo

47
Q

A pt presents with a hx of leiomyoma. Which location will most likely cause infertility?

a. serosal
b. subserosal
c. intramural
d. submucosal

A

D

A submucosal fibroid distorts the endo cavity sand is possible cause of infertility

48
Q

A nodular tubular adnexal mass demonstrating posterior acoustic enhancement is most suspicious for:

a. salpingitis
b. pyosalpinx
c. hydrosalpinx
d. endometrioma

A

A

Sono finding in salpingitis include a thick wall and a nodular tubular adnexal mass demonstrating posterior acoustic enhancement. Pyosalpinx attenuates the sound wave

49
Q

A large multicystic ov mass, in an ov stimulated pt, is most suspicious for:

a. corpus luteum
b. PCOS
c. multicystic ov disease
d. ovarian hyperstimulation syndrome

A

D

Ov hyperstimulation syndrome demonstrates as a multicystic ov mass generally measureing greater than 5 cm in diameter

OB/GYN Board (4 decks)

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