CORE - Reproductive Flashcards
1
Q
Linea terminalis
A
separates the true and false pelvis
2
Q
Varicocele measurement
A
> 2 mm
3
Q
Most common mets to testis
A
RCC, prostate
4
Q
Upper limit of normal epididymis
A
10 mm
5
Q
Most common extra-testicular mass (adult)
A
spermatic cord lipoma
6
Q
Most common extra-testicular mass (child)
A
rhabdomyosarcoma
7
Q
Most common epididymal neoplasm
A
adenomatoid tumor of the tunica albuginea (benign)
8
Q
Tunical cyst (or tunica albuginea cyst)
A
small, anechoic; located eccentrically along the capsule of the testis; often p/w palpable nodule
9
Q
Bilateral testicular masses DDx
A
lymphoma, mets, sarcoid, adrenal rests
10
Q
T2 hypointense lesion in prostate DDx
A
prostate cancer, hemorrhage, prostatitis
11
Q
Chorioadenoma destruens
A
complete mole that invades the myometrium
12
Q
Fetal cystic pelvic mass with a “daughter cyst”
A
pathognomonic for an ovarian cyst
13
Q
Prosencephalon
A
forebrain
14
Q
Rhombencephalon
A
hindbrain
15
Q
Progression of incompetent cervix shape
A
T => Y => V => U
16
Q
Pediatric ovarian neoplasms
A
GCTs are most common regardless of age (also most common amongst malignant ovarian tumors)
17
Q
Serous cystadenoma (ovary) - unilocular or multilocular?
A
unilocular, often bilateral
18
Q
Mucinous cystadenoma (ovary) - unilocular or multilocular?
A
multilocular, unilateral; assoc. with smoking
19
Q
Fetal ventriculomegaly
A
> 10 mm across the atria of the ventricles, or >3 mm of separation between choroid plexus and medial wall of the lateral ventricle
20
Q
Uterus-cervix ratio (by age)
A
0.5 at birth (cervix 2x as large), 1.0 at puberty, 2.0 in adults
21
Q
Turner syndrome (GU findings)
A
streak ovaries, 0.5 uterus-to-cervix ratio, horseshoe kidney
22
Q
Mullerian ducts
A
forms uterus, fallopian tubes, and upper 2/3 of vagina
23
Q
Urogenital sinus
A
forms lower 1/3 of vagina and prostate
24
Q
Wolffian ducts
A
forms seminal vesicles, epididymis, and vas deferens
25
Mayer-Rokitansky-Kuster-Hauser syndrome
Mullerian agenesis
26
Mullerian agenesis (3 features)
rudimentary uterus, vaginal atresia, normal ovaries; assoc. with renal agenesis or ectopia
27
Unicollis vs. bicollis bicornuate uterus
refers to number of cervices (1 or 2)
28
Stuff that can be shown on HSG
adenomyosis, Asherman syndrome, salpingitis isthmica nodosa, uterine anomalies, tubal sclerosing devices
29
Contraindications to HSG
active infection (PID), contrast allergy, active bleeding, pregnancy
30
Ideal timing of HSG (menstrual cycle)
days 7-10
31
Asherman syndrome
a.k.a. intrauterine adhesions; due to prior infection, D&C, or pregnancy
32
Venetian blind sign
uterine fibroid
33
MRI characteristic of fibroids associated with a better IR treatment prognosis
increased T2 signal, enhancing
34
Fibroid degeneration types
hyaline (most common), red/carneous (pregnancy), myxoid, cystic
35
Fibroid with peripheral rim of high T1 signal
red/carneous type of degeneration; during pregnancy
36
Fibroid with high T2 signal
myxoid type of degeneration
37
Fibroid with low T2 signal
hyaline type of degeneration (most common)
38
Rapidly enlarging fibroid
suspicious for malignant transformation (leiomyosarcoma); may also see areas of necrosis
39
Thickened junctional zone with scattered T2 bright foci
adenomyosis (foci represent cystic change)
40
Endometrial thickening + ovarian mass
granulosa-theca cell tumor, or endometroid carcinoma (ovary) + endometrial cancer
41
Endometrial thickness necessitating biopsy
>5 mm + PMB, or >8 mm (no PMB)
42
Syndrome associated with increased risk of endometrial cancer
HNPCC (30-50x)
43
Tamoxifen changes (uterus)
subendometrial cysts, endometrial polyps; increased risk of endometrial cancer
44
Endometrial fluid in a post-menopausal patient
cervical stenosis or an obstructing mass
45
Work-up for post-menopausal uterine bleeding
US => if endometrium is too thick => biopsy => if concern for higher stage disease => MRI for extent
46
Enhancement of endometrial cancer
homogeneous, but LESS than the adjacent myometrium; mildly T2 hyperintense, restricts on DWI
47
Critical stage for endometrial cancer
stage 2 (cervical stromal invasion); change to pre-operative radiation and from TAH => radical hysterectomy
48
Most important MR sequence for staging of endometrial cancer
post-gad
49
Critical stage for cervical cancer
stage 2B (parametrial invasion = disruption of T2 hypo ring); change from surgical resection to chemoradiation
50
Phase of menstrual cycle assoc. with trilaminar appearance of the endometrium
late proliferative (days 10-14)
51
Most common cancer of vagina
squamous cell carcinoma (related to HPV)
52
Met to anterior wall of upper 1/3 of the vagina
from upper genitourinary tract (90%)
53
Met to posterior wall of lower 1/3 of the vagina
from GI tract (90%)
54
Cyst in anterior-lateral wall of upper vagina
Gartner duct cyst; due to incomplete regression of Wolffian ducts
55
Cyst below pubic symphysis near anus (females)
Bartholin cyst ('B' for Butthole and Below pubic symphysis)
56
Cyst below pubic symphysis between urethra and vagina canal
Skene gland cyst; may cause recurrent UTI or urethral obstruction
57
Segments of fallopian tube
from medial to lateral: intersitium >> isthmus >> ampulla >> infundibulum
58
Ovaries with multiple large cysts
theca-lutein cysts due to increased hCG; multiple, bilateral
59
Causes of theca-lutein cysts
multiple gestations, molar pregnancy, clomiphene or gonadotropins
60
Ovarian hyperstimulation syndrome
due to fertility treatment; abdominal pain, ovary >5 cm, ascites or hydrothorax; may see theca-lutein cysts
61
Maximum ovarian volume in a post-menopausal patient
6 cc
62
Ovarian simple cyst - indication for annual US follow-up
>5 cm in pre-menopause, >1 cm in post-menopause
63
Ovarian simple cyst - indication for MRI or surgical evaluation
>7 cm in pre or post-menopause
64
Physiologic cyst (ovary)
simple cyst <3 cm; represents a normal follicle (or corpus luteum)
65
Follicular cyst (ovary)
simple cyst >3 cm; follicle that did not undergo ovulation; resolves in 2-3 cycles usually
66
Corpus luteum cyst (ovary)
when corpus luteum fails to regress
67
Hemorrhagic cyst (ovary)
hemorrhage into a functional cyst (most commonly a corpus luteum cyst); resolves in 2-3 cycles usually
68
Most common location for ectopic pregnancy
tubal (ampullary segment most commonly)
69
Ovarian cyst with internal echoes and echogenic foci along wall
endometrioma
70
Malignant transformation in ovaries + risk factors
endometrioma => clear cell or endometroid, mature cystic teratoma => SCC; risk factors for both are size and age
71
Decidualized endometrioma
solid nodule with internal flow in an endometrioma; seen in pregnancy; mimic for malignant degeneration
72
MRI characteristics of endometrioma vs. teratoma
endometrioma is T1 bright, T2 dark ("shading"); teratoma is T1/T2 bright (dark on fat sat)
73
Hemorrhagic cyst in a 70 y/o
cancer until proven otherwise (old people shouldn't have cysts to hemorrhage into)
74
Ovarian cysts that resolve in 2-3 cycles (typically)
follicular cysts, hemorrhagic cysts
75
PCOS numbers
>12 follicles per ovary, each <9 mm, ovarian volume >10 cc
76
Most common type of ovarian malignancy
serous cystadenocarcinoma
77
Cystic ovarian mass with papillary projections
malignancy (serous > mucinous)
78
Endometroid carcinoma of the ovary
2nd most common ovarian malignancy; large solid and cystic mass; may arise from an endometrioma; 25% also have endometrial cancer; 15% bilateral
79
B.F.M. (adult)
ovarian masses (serous or mucinous), desmoid, sarcoma
80
T1/T2 dark ovarian mass (no calcification)
fibroma/fibrothecoma (benign); middle-aged women
81
T2 dark ovarian mass with calcification
Brenner tumor (benign); 50-70 y/o
82
Meigs syndrome
benign ovarian tumor (fibroma most commonly), ascites, pleural effusion; treatment is resection only
83
Ovarian fibromatosis
tumor-like enlargement of ovaries due to fibrosis (T1/T2 dark); assoc. with omental fibrosis and sclerosing mesenteritis
84
Ovarian transitional cell carcinoma
a.k.a. Brenner tumor
85
Bilateral solid ovarian masses
consider mets
86
Ovarian size suggestive of torsion
>4 cm (unilateral)
87
Pelvic inflammatory disease
hydrosalpinx, thickened tube, +/- internal debris; may progress to TOA
88
Paraovarian cyst
congenital, remnant of Wolffian duct; separate from ovary; followed if >5 cm
89
Most common side for ovarian vein thrombophlebitis
right (80%); typically postpartum; may cause PE; treatment with antibiotics + heparin
90
Peritoneal inclusion cyst
adhesions (prior surgery or inflammatory disease) encapsulate an ovary => secretions result in cystic collection
91
Complete mole
46XX, no fetal parts, "snowstorm", cysts within molar tissue; more common type of hydatidiform mole
92
Partial mole
69XXX, fetal parts; thickened cystic placenta
93
Invasive mole
typically after treatment of a hydatidiform mole; invasion into myometrium
94
Penile fracture is defined by...
disruption of corpora cavernosa and tunica albuginea
95
Main sequences for evaluation of the peripheral and transitional zones (prostate)
ADC/DWI for peripheral zone, T2 for transitional zone (both start with 'T')
96
Median lobe hypertrophy
protrusion of median lobe of prostate into bladder base
97
BPH volume
>30 cc
98
Indications for prostate MRI
high risk screening (high PSA or rising PSA with negative bx), staging
99
Most common zone for prostate cancer
peripheral zone (70%)
100
Zone involved in BPH
transitional zone (most commonly)
101
MRI characteristics of prostate cancer
low T2, low ADC, restricts on DWI +/- early enhancement
102
Best study to look for prostate mets
bone scan
103
Prostate cancer staging - confined to prostate
T2/stage 2 or lower (lots of factors involved in deciding between stage 1 & 2)
104
Prostate cancer staging - extracapsular extension
T3 => stage 3
105
Prostate cancer staging - seminal vesicle invasion
T3 => stage 3
106
Peripheral zone focus with low T2 and high T1 signal (prostate)
post-biopsy hemorrhage; prostate cancer is not T1 bright
107
Prostatic utricle cyst associations
hypospadia, prune belly syndrome, Down syndrome, unilateral renal agenesis, imperforate anus
108
Mullerian duct cyst complication
may develop cancer
109
Congenital seminal vesicle cyst associations
ADPKD, unilateral renal agenesis, ureteral ectopia
110
Acquired seminal vesicle cyst associations
related to BPH, post-surgical, or post-infectious
111
Midline male pelvic cyst DDx
Mullerian duct cyst, prostatic utricle cyst, ejaculatory duct cyst
112
Midline male pelvic cyst extending above the prostate
Mullerian duct cyst (prostatic utricle cysts rarely extend above the prostate)
113
Testicular fracture vs. rupture
rupture is assocated with disruption of tunica albuginea and goes to surgery
114
Congenital abnormality associated with testicular torsion
bell clapper deformity
115
Isolated orchitis
mumps
116
Epidermoid cyst + treatment (testis)
"onion skin" appearance, relatively hypovascular, benign; Tx enucleation or orchiectomy
117
Calcified vas deferens
seen in diabetics and hyperparathyroidism
118
Male urethra runs within the cavernosa or spongiosum
corpus spongiosum
119
Peyronie's disease
penile fracture => scarring => deformity/curvature
120
Testicular malignancy that mets hematogenously
choriocarcinoma (other testicular malignancies met via lymphatics); elevated hCG
121
Increased risk of testicular cancer
cryptorchidism, gonadal dysgenesis, Klinefelter's, orchitis, caucasian
122
Most common testicular tumor
seminoma (radiosensitive => best prognosis)
123
Homogeneously hypoechoic testicular mass without calcifications
seminoma (radiosensitive => best prognosis)
124
Heterogeneously hypoechoic testicular mass with calcifications
NSGCT; may also contain cystic components
125
Older male with multiple hypoechoic testicular masses
lymphoma
126
African-American male with hypoechoic testicular mass
sarcoid; must also consider testicular cancer, but consider sarcoid if race is mentioned
127
Nodal mets in testicular cancer
retroperitoneal nodes are considered regional (N), however pelvic, external iliac, and inguinal nodes are metastatic (M)
128
Testicular tumor associated with gynecomastia
Leydig cell tumor
129
Sertoli cell tumor associations (males)
Peutz-Jegher, Klinefelter's
130
Bilateral absence of vas deferens
cystic fibrosis
131
Complications of cryptorchidism
malignancy, infertility, torsion, bowel incarceration (due to hernia)
132
Infertile male with anosmia
Kallman syndrome
133
Infertile tall male with gynecomastia
Klinefelter syndrome
134
Infertile male with lactation
pituitary adenoma
135
Embryo vs. fetus (by week)
embryo <10 weeks, fetus >10 weeks
136
OB - bleeding with closed cervix, no passage of products
threatened abortion
137
OB - bleeding with open cervix, no passage of products
inevitable abortion
138
Significance of double decidual sac sign
signifies an intra-uterine pregnancy
139
MSD when yolk sac should be seen
>8 mm; no yolk sac => guarded prognosis
140
MSD when embryo should be seen
>25 mm; no embryo => failed pregnancy
141
CRL when heart beat should be seen
>7 mm; no heart beat => failed pregnancy
142
Situations where pregnancy can be declared "failed"
MSD >25 mm without an embryo, CRL >7 mm without a heart beat; also two additional situations based on follow-up
143
Increased risk of ectopic pregnancy
h/o PID, tubal surgery, endometriosis, ovulation induction, previous ectopic, use of IUD
144
Risk of interstitial ectopic
catastrophic hemorrhage
145
Gestational sac should be seen at what hCG level on TV US?
hCG >2000
146
Elevated hCG + moderate free fluid (no other findings)
70% PPV for ectopic
147
Risks associated with IUDs
increased risk of infection (esp. actinomyces), ectopic, and uterine perforation
148
BPD and HC are recorded at what level?
level of the thalami; BPD is outer to inner
149
Femur length technique
longest dimension of femur; epiphysis is NOT included
150
Abdominal circumference is recorded at what level?
junction of umbilical vein and PV; stomach should also be visible
151
Estimated fetal weight
calculated by machine based on BPD+AC or AC+FL
152
Findings suggestive of IUGR
EFW below 10th percentile, FL/AC ratio >23.5, umbilical artery systolic/diastolic ratio >4.0
153
Most common cause for development of oligohydramnios in 3rd TM
IUGR associated with placental insufficiency
154
Causes of asymmetric IUGR
HTN, severe malnutrition, Ehlers-Danlos
155
Causes of symmetric IUGR
TORCH, fetal alcohol syndrome, maternal drug abuse, chromosomal abnormalities, anemia
156
High umbilical artery systolic/diastolic ratio
seen in IUGR and pre-eclampsia; normal ratio is 2-3 at 32 weeks
157
Components of biophysical profile
amniotic fluid, fetal movement, fetal tone, fetal breathing, non-stress test; score of 8-10 is 'normal'
158
Macrosomia
large baby (>90th percentile); most commonly due to maternal diabetes
159
Complications of macrosomia
shoulder dystocia, brachial plexus injury, meconium aspiration, neonatal hypoglycemia
160
Erb's palsy
injury to upper trunk of brachial plexus (C5-6); most commonly from shoulder dystocia; aplastic or hypoplastic humeral head
161
Criteria for oligohydramnios
AFI <5 cm
162
Criteria for polyhydramnios
AFI >20 cm or single pocket >8 cm
163
Normal cisterna magna measurement
2-10 mm; if too large => Dandy-Walker
164
Echogenic focus in the ventricle
calcified papillary muscle; assoc. with increased risk of Down syndrome
165
Single artery adjacent to bladder (fetal ultrasound)
2-vessel cord
166
Echogenic bowel (greater than bone) + associations
assoc. with increased risk of Down syndrome, TORCH, CF; may also be a normal finding
167
Omphalocele or gastroschisis should not be diagnosed before...
13 weeks (due to physiologic midgut herniation)
168
Venous lake
normal finding in placenta; hypoechoic +/- slow flow
169
Placental thickness in fetal hydrops
thickened placenta (>4 cm)
170
Placental thickness in placental insufficiency
thinned placenta (<1 cm)
171
Bilobed placenta
two near equal-sized lobes
172
Succenturiate placenta
one or more small accessory lobes
173
Risks associated with bilobed or succenturiate placenta
type 2 vasa previa, postpartum hemorrhage from retained placental tissue, velamentous insertion of cord (bilobed only)
174
Circumvallate placenta
rolled edges with smaller chorionic plate
175
Risks associated with circumvallate placenta
IUGR, placental abruption
176
Painless vaginal bleeding in 3rd trimester
placenta previa; treatment is C-section
177
Risk factors for placental abruption
hypertension, cocaine
178
"Moth-eaten" or "swiss cheese" placenta
placenta accreta; vascular channels may extend into myometrium (myometrium may be thinned)
179
Risk factors for placenta accreta
prior C-section, placenta previa, advanced maternal age
180
Anterior placenta with history of C-section
consider placenta accreta
181
Most common benign tumor of placenta
chorangioma (well-circumscribed hypoechoic mass near cord insertion)
182
Normal umbilical cord vessels
2 arteries, 1 vein
183
Significance of two-vessel cord
normal variant, with an association with chromosomal anomalies (need to look for them)
184
Velamentous cord insertion
cord inserts into fetal membranes outside placental margin; seen more in twins with increased risk of IUGR and growth discordance
185
Marginal cord insertion
within 2 cm of placental margin
186
Vasa previa - type 1 vs. type 2
type 1 = velamentous cord insertion; type 2 = bilobed or succenturiate placenta
187
Umbilical cord cysts (2 types)
omphalomesenteric duct cyst (peripheral), allantoic cyst (central)
188
Fetal ultrasound findings associated with Down syndrome
endocardial cushion defect, duodenal atresia, echogenic bowel, calcified papillary muscle, nuchal translucency, nuchal fold thickening, absent nasal bone, sandal toe gap
189
Choroid plexus cyst (antenatal)
trisomy 18 > trisomy 21, Klinefelter's
190
Correct positioning for nuchal translucency
tip of nose, nasal bone, hard palate, and diencephalon should be visible; neck in neutral position
191
Increased nuchal translucency measurement
>3 mm; measured in late 1st
192
Correct positioning for nuchal fold thickness
at level of thalami, cavum septum pallucidum, and cerebellar hemispheres
193
Increased nuchal fold thickness measurement
>6 mm
194
Most common cause of fetal hydrops
non-immune (TORCH, twin-related stuff, cardiovascular anomalies, chromosomal abnormalities); immune type is caused by Rh sensitization (from prior pregnancy)
195
Diagnosis of fetal hydrops
2 of ascites, pleural effusion, pericardial effusion, subcutaneous edema; may also have polyhydramnios
196
Lemon-shaped skull
Chiari II; resolves in 3rd trimester
197
Cerebral findings in Chiari II (not exhaustive)
small posterior fossa, obstructive hydrocephalus, callosal dysgenesis, tectal beaking, absent septum pallicidum
198
Most common cause of congenital obstructive hydrocephalus
aqueductal stenosis
199
Cystic hygroma + associations
congenital lymphangioma in posterior neck; Turner's > Down's
200
Most common neural tube defect
anencephaly
201
Most common tumor of the fetus or infant
sacrococcygeal teratoma (posterior > dumbbell > anterior)
202
Short femur length
consider skeletal dysplasia (especially achondroplasia)
203
Criteria for cervical incompetence
<3 cm in length; increased risk of premature delivery
204
Treatment for cervical incompetence
cerclage before 24 weeks, bedrest after 24 weeks
205
Stuff that grows during pregnancy
baby, splenic artery aneurysms, renal AMLs, fibroids
206
Risk factors for uterine rupture
prior C-section, unicornuate uterus, prior uterine currettage, interstitial implantation, "trapped uterus"
207
Subcapsular hepatic hematoma in pregnant woman
HELLP syndrome (most severe form of pre-eclampsia)
208
Sheehan syndrome + findings
pituitary apoplexy (necrosis) following large volume hemorrhage; T1 bright, rim enhancement
209
RPOC associations
medical abortion, 2nd trimester miscarriage, placenta accreta
210
Absent cavum septum pellicidum DDx (between weeks 18-37)
callosal agenesis, holoprosencephaly, septo-optic dysplasia; normal finding <18 or >37 weeks
211
Twin peak sign
dichorionic diamniotic pregnancy
212
T sign
monochorionic pregnancy
213
Twin-twin transfusion
in monochorionic pregnancies; donor does better, recipient develops hydrops
214
Stuck twin
donor twin in twin-twin transfusion (due to oligohydramnios)
215
Reversal of umbilical arterial and venous flow in one twin
TRAP; normal flow pattern in "pump" twin, reversal of flow in acardiac twin
216
Fetal hydronephrosis measurement
≥10 mm axial diameter of renal pelvis (always abnormal); <4 mm is normal
217
Chorionicity is deteremined at __ days and amnionicity at __ days
4 days and 8 days, respectively
218
Twin reversed arterial perfusion (TRAP)
acardiac twin and "pump" twin; only occurs in monochorionic pregnancies
219
Scrotal pearl
from prior torsion of appendix testis
220
Testicular adrenal rests association
congenital adrenal hyperplasia
221
Most common testicular malignancy of 2nd decade
choriocarcinoma
222
Normal placental thickness
1-4 cm
223
Diagnostic criteria for microlithiasis (testis)
5 or more microcalcifications PER FIELD
224
Granulosa-theca cell tumor (ovary)
releases estrogen => precocious puberty
225
Sertoli-Leydig cell tumor (ovary)
releases androgens => virilization
226
Cystic rhombencephalon
normal between weeks 6-8 of gestation
