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118 and 119 > Chapter 43 > Flashcards

Chapter 43 Flashcards

1
Q

Gartner’s Duct Cysts are congenital and usually isolated. What are they remnants of?

A

the Wolffian duct

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2
Q

Where are Gartner’s Duct Cysts found? Do they appear irregular?

A

The cyst forms on anterior wall of
vaginal canal. Their sonographic appearance is normal of a cystic structure.

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3
Q

What is the most common congenital abnormality of the female genital tract?

A

An imperforate hymen.

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4
Q

An imperforate hymen is a hymen without a hole for fluid. This leads to amenorrhea and pelvic pain. How does it appear sonographically?

A

With anechoic fluid buildup in the endometrium.

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5
Q

List three results of an obstruction of the uterus/vagina.

A

hydrometra, hematometra, and pyometra.

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6
Q

Define hydrometra, hematometra, and pyometra

A

The accumulation of fluid, blood, pus

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7
Q

Are solid masses in the vagina common or rare?

A

Rare

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8
Q

Is sonography used for diagnosis of cancer in the vagina?

A

No, but sonography might be used for staging

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9
Q

What are vaginal adenocarcinoma and rhabdomyosarcoma. and how do you scan them?

A

Solid masses usually in areas of necrosis, scanned translabially

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10
Q

A vaginal cuff can be seen in hysterectomy patients after surgery. What is the size limit of a vaginal cuff?

A

2.1 cm

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11
Q

If a vaginal cuff is large or contains mass or high echogenicity, would you consider it normal?

A

No, you should assume it’s malignant ESPECIALLY if a patient has hx of cancer.

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12
Q

Nodular areas in the vaginal cuff may be due to postirradition fibrosos. Who would need to be concerned about this?

A

Patients who previously had radiation to pelvis

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13
Q

What is the minimim of fluid that can be detected via Transvaginal ultrasound?

A

as little as 5 ml

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14
Q

The posterior cul-de-sac is a frequent site for collection of intraperitoneal fluid. Is this normal?

A

It can be normal IF the fluid is a small amount and there is no other pathology.

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15
Q

Pathologic fluid collections in the cul-de-sacs could be associated with…?

A

ascites, ectopic pregnancy, hemorrhagic cysts, or infection

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16
Q

the cervical canal extends from the internal os where it joins the uterine cavity to…?

A

the external os, which proects into the vaginal canal.

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17
Q

how long is the cervix?

A

2-4 cm

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18
Q

What are chronic inflammatory retention cysts in the cervix.

A

Nabothian Cysts

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19
Q

Are Nabothian Cysts benign or malignant? What are the symptoms?

A

They are benign and asymptomatic

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20
Q

What are cervical polyps and are they malignant or benign?

A

They are a benign condition that arises from hyperplastic protrusion of epithelium of cervix.

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21
Q

What is the most likely factor of cervical polyps? Who is most likely to develop them?

A

Chronic inflammation is the most likely factor. Woman in late middle age are most likely to develop them.

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22
Q

What are Liomyomas also known as?

A

Fibroids

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23
Q

A small percentage of leiomyomas occur in the cervix.
What are leiomyomas and are they malignant or benign?

A

Myoma Tumors. They are benign

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24
Q

What are the symptoms of a patient with small myomas?

A

The patient is asymptomatic

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25
Q

What are the symptoms of a patient with enlarged myoma?

A

Bladder or bowel obstruction. Myoma may also be pedunculated and prolapse into the vaginal canal.

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26
Q

What is cervical stenosis (narrowing)?

A

Obstruction of cervical canal at internal or external os

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27
Q

Is cervical stenosis a congenital or aquired condition?

A

It is an aquired condition

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28
Q

What are the symptoms of cervical stenosis in menopausal patients?

A

patients are asymptomatic, though uterus may be distended and filled with fluid

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29
Q

What are the symptoms of cervical stenosis in PREmenopausal patients?

A

abnormal bleeding, oligomenorrhea, amenorrhea,
cramping, dysmenorrhea, or infertility.

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30
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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31
Q

What is a precursor to Cervical Carcinoma

A

Cervical Dysplasias (abnormal cells) that could be considered mild, moderate, or severe

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32
Q

How does Cervical Carcinoma appear sonographically?

A

mass behind the bladder, obstruction of ureters, invasion of bladder

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33
Q

Who is affected by Cervical Carcinoma? How is it discovered?

A

It affects women of menstrual age and is discovered by pap smears.

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34
Q

What sonography techniques are used to image the cervix or lower uterus when we are unable ot perform a transvaginal exam?

A

Translabial or Transperinieal Sonography

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35
Q

What is the most common gynecologic tumor occurring in 20-30 % of women above the age of 30?

A

Leiomyomas or Fibroids or Uterine Myomas

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36
Q

Fibroids are most common in what demographic?

A

African American women (aged 30+)

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37
Q

What are symptoms of Fibroids

A

enlarged uterus, excess bleeding, pain

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38
Q

What could happen when Leiomyomas degenerate?

A

Internal calcifications and/or internal bleeding

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39
Q

Myomas are estrogen dependent. What does this mean during pregnancy?

A

Myomas may increase in size, but about 1/2 show little change during pregnancy.

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40
Q

Are Fibroids common in postmenopausal women? Why?

A

No, most decrease in size after menopause because of the lack of estrogen.

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41
Q

What happens to Fibroids during hormone replacement therapy?

A

They may increase in size.

42
Q

If a myoma rapidly increases in size, what should you assume? Who should be especially worried?

A

It might be malignant, it is especially suspicious in a postmenopausal patient.

43
Q

Define a submusosal location for Fibroids and resulting symptoms.

A

projecting into endometrial cavity. heavy bleeding and infertility may occur.

44
Q

Define a intramural location for Fibroids and resulting symptoms.

A

Within the myometrium.
enlargement causing pressure on surrounding organs, Infertility, or pregnancy loss may occur

45
Q

Define a subserosal location

A

Projecting from the myometrium to utside the uterus.
may enlarge and cause pressure to surrounding organs.

46
Q

Where are Fibroids most commonly found?

A

Intramural- within the myometrium

47
Q

Explain what a pedunculated fibroid might look like.

A

hanging intracavitary or attached to the outside of the uterus by a thread.

48
Q

In case of infertility or submucosal myoma, what would the likely treatment be?

A

Myomectomy surgery (removal of the myoma)

49
Q

What is the most common cause of uterine calcifications?

A

Myoma

50
Q

Aside from myoma, what is another cause of uterine calcifications?

A

Arcurate Artery Calcification in uterus

51
Q

Arcurate artery calcification is thought to occur as consequence of calcific sclerosis. What is another name for this?

A

Monckebergs’s arteriosclerosis

52
Q

What might arcurate artery calcification indicate?

A

underlying disease, such as
diabetes, hypertension, or renal failure

53
Q

Is Adenomyosis benign or malignant?

A

Benign

54
Q

What is adenomyosis? Where is it most commonly located?

A

occurrence of endometrial tissue within myometrium. Common in the posterior aspect

55
Q

60% of women expereince symptoms with adenomyosis . What symptoms are usually experienced?

A

abnormal bleeding, prolonged bleeding, and in 25% of patients pelvic pain.

56
Q

How might adenomyosis present sonographically?

A

uterine enlargement especially the posterior myometrium, myometrial cysts,

57
Q

Adenomyosis is a hemorrhage in endometrial tissue that appears as small hypoechoic myometrial cysts. What will this look like sonographically?

A

Enhancement behind the cysts, this is sometimes called venetian blinds.

58
Q

Uterine Arteriovenous Malformations are abnormal connections of veins and arteries within the uterus. Are they Congenital or Acquired?

A

They can be congenital or acquired from pelvic trauma or surgery.

59
Q

How might Uterine Arteriovenous Malformations appear sonographically?

A

Anechoic structures within the pelvis. ColorFlow is used to show blood flow within the anechoic structures.

60
Q

What is a Uterine Leiomyosarcoma?

A

A solid, rapidly growing tumor rising from the myometrium or endometrium, but commonly found in the Fundus.

61
Q

How common is Uterine Leiomyosarcoma?

A

Rare, they account for 1% of uterine malignancies. They are most common in women aged 40-60.

62
Q

How might a Uterine Leiomyosarcoma look sonographically?

A

solid or mixed-solid and cystic texture

63
Q

most Endometrial Pathologies are likely to cause what symptom? What demographic is this especially prevalent?

A

abnormal bleeding, especially in post-menopausal patients

64
Q

Tamoxifen is a hormone replacement medication. What does it do? When is it used?

A

Binds to estrogen receptors to block estrogen. It’s used most commonly in post-menopausal women with bresat cancer

65
Q

What is sonohysterography? What is it used for?

A

saline infused sonography is used to distend the endometrium for evaluation

66
Q

When would sonohysterography be performed in a pre-menopausal woman?

A

post-menses, usually
between days 6 and 10.

67
Q

Endometrial Hyperplasia might be a precursor of endometrial cancer. How does it look sonographically?

A

abnormal thickening of
endometrium, possible irregular bleeding

68
Q

What is unopposed estrogen

A

When the body does not have enough progesterone to balance out estrogen levels.

69
Q

What is unopposed estrogen (premarin) associated with?

A

Increased risk of endometrial hyperplasia or carcinoma in menopausal patients

70
Q

In meopausal women, what combination produces endometrial atrpohy after 3-6 months?

A

Continuous estrogen and progesterone regimens.

71
Q

What are the symptoms of a combination of estrogen and progesterone regimens? Does it increase risk of cancer?

A

It does not usually increase the risk of endometrial cancer. Symptoms may include bleeding, bloating, depression, etc.

72
Q

How does a sequential estrogen and progesterone regimen work?

A

Patient takes estrogen (Premarin) for the first half of the month, and progesterone (Provera) during the second half.

73
Q

What are some benefits to taking estrogen?

A

Aleviates some menopausal symptoms, reduces risk of bone diseaes, heart attacks

74
Q

What are some benefits to taking progesterone?

A

reduces endometrial atrophy and hyperplasia/cancer

75
Q

What are some negative effects to taking estrogen?

A

increases risk of endometrial hyperplasia/cancer

76
Q

What are some negative effects to taking progesterone?

A

increases risk of breast cancer, causes irritability, depression in somes women

77
Q

What is a polyp?

A

Overgrowths of endometrial tissue covered by epithelium

78
Q

Are endometrial polyps benign or malignant? What are their symptoms?

A

Benign. May be asymptomatic or have uterine bleeding

79
Q

What are the three shapes of an endometrial polyp

A

Pedunculated, broad based, thin stalked

80
Q

What are endometrial polyps associated with in menstruating women?

A

menometrorrhagia or infertility

81
Q

How would an endometrial polyp appear sonographically?

A

hypoechoic or isoechoic region
within endometrium. may appear as round echogenic mass

82
Q

What is endometritis?

A

Endometritis is an infection within endometrium of the uterus

83
Q

What are symptoms of endometritis

A

Intense pelvic pain. Endometrial thickening or fluid, Low back or abdominal pain and fever

84
Q

When might a postparum patient develop endometritis?

A

after prolonged labor, rupture of membranes, or by retaining products of conception

85
Q

How does endometritis appear sonographically?

A

irregular endometrium possibly with fluid, increased vascularity, possible pus in cul-de-sac

86
Q

Who does synechiae affect? What are possible symptoms?

A

women post-trauma or surgery. symptoms may be infertility or repeated loss of pregnancy

87
Q

How might synechiae appear sonographically?

A

bright echos in endometrial cavity. hyperechoic band anterior to posterior.

88
Q

when is it easiest to see synechiae?

A

In secretory phase, in a gravid uterus, or with fluid distending cavity.

89
Q

What is the most common gynecologic malignancy in North America?

A

endometrial carcinoma

90
Q

What hormone therapy is commonly associated with endometrial carcinoma?

A

replacement estrogen therapy

91
Q

What is the earliest change of endometrial carcinoma? What are other symptoms?

A

Thickened endometrim. some patients experience uterine bleeding.

92
Q

only 10% of women with post-menopausal uterine bleeding have what malignacy?

A

endometrial carcinoma

93
Q

How does endometrial carcinoma appear sonographically?

A

enlarged uterus, thickened endometrium, possible internal cystic areas

94
Q

What might occur as a result of ectopic pregnancy, endometritis, myomas, or recent abortion?

A

small endometrial fluid collections

95
Q

are large collections of endometrial fluid suspicious?

A

yes

96
Q

When might pyometra occur?

A

with uterine cancer

97
Q

what are symptoms that might occur with large endometrial fluid collections?

A

abdominal pain/ mass, vaginal bleeding, fever

98
Q

What is an Intrauterine Contraceptive Device? (IUD or IUCD)

A

Devices placed in uterine cavity during menses for purpose of birth control

99
Q

What should happen if IUD is not felt and not found with sonography?

A

radiograph should be done

100
Q

What is the difference between Paraguard and Mirena IUDs?

A

Paraguard is plastic wrapped in
copper whereas Mirena is plastic that releases low amounts of progestin

101
Q

Where should the IUD be placed Should it be inside the uterine wall?

A

T-shaped at the top of the endometrium near the fundus. NOT imbedded in any uterine walls.

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