Female imaging Flashcards
- Regarding uterine leiomyomas, which of the following are correct? (T/F)
(a) Simple leiomyomas can metastasise.
(b) Cystic degeneration occurs in 30% of cases.
(c) Red degeneration is associated with the contraceptive pill.
(d) Calcification is usually peripheral.
(e) They are typically of low T2 signal relative to the surrounding myometrium.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
In leiomyomas (fibroids) cystic degeneration is rare, seen only in 4 % cases. Calcification is seen associated with red degeneration, and is typically scattered and amorphous marking the site of hyaline degeneration.
- Which of the following statements are correct? (T/F)
(a) The risk of an ectopic pregnancy is higher in patients with a unicornuate uterus.
(b) Nabothian cysts occur in the posterolateral wall of the lower third of the vagina.
(c) The uterus is derived from the paired mullerian ducts.
(d) A unicornuate uterus is rarely associated with other anomalies.
(e) Gartner’s duct cysts are typically located anterolateral to the upper two thirds of the vagina.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Bartholin’s cyst occurs in posterolateral wall of lower third of vagina. Mucous retention within endocervical glands is known as nabothian cyst and can be seen in any wall of cervix. 40% cases of unicornuate uterus is associated with renal and ureteric anomalies
- Regarding polycystic ovaries, which of the following are correct? (T/F)
(a) Cysts of 5-8mm are characteristically present throughout the ovary.
(b) They are seen in patients with trophoblastic disease.
(c) There is an increased risk of endometrial carcinoma.
(d) The ovaries are enlarged on ultrasonography in 95% of cases.
(e) There is a decrease in the ratio of luteinising hormone to follicular stimulating hormone.
Answers:
(a) Not correct.
(b) Not correct.
(c) Correct.
(d) Not correct
(e) Not correct.
Explanations:
The cysts are typically subcapsular in polycystic ovaries with central stroma showing increased echogenicity. In 25% cases ovaries are hypoechoic with no demonstrable follicle. The ovaries are bilaterally enlarged (more than 14 cm3) in 70% cases and of normal size in 30% cases. There is increase in ratio of luteinising hormone to follicular stimulating hormone resulting in immature follicles. Trophoblastic disease typically causes hyperstimulation of ovaries with multiseptated cysts secondary to increased HCG levels.
- Which of the following are correct regarding ovarian cancer: (T/F)
(a) It is the commonest gynaecological malignancy.
(b) It is associated with colorectal cancer.
(c) CA-125 is specific for ovarian cancer.
(d) CT only has a pre-operative staging accuracy of 50%.
(e) Doppler ultrasound may help with differentiating benign from malignant disease.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Endometrial cancer is the most common gynaecological malignancy. CA-125 is not specific for ovarian cancer, it is increased in benign conditions like fibroids, endometriosis and inflammatory pelvic disease. CT only has a pre-operative staging accuracy of 70% - 90%.
- Which of the following are correct regarding concerning ovarian teratomas: (T/F)
(a) Mature teratomas are usually multi-loculated.
(b) They are a known cause of peritonitis.
(c) Fat attenuation on CT is diagnostic for mature cystic teratomas.
(d) Sebaceous fluid has low signal on T1 weighted MR.
(e) Calcification indicates a malignant teratomas.
Answers:
(a) Not correct.
(b) Correct.
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Mature Teratomas are unilocular. Sebaceous fluid has high signal on T1WI. Calcification outside the mural nodule is suspicious of malignancy.
- Which of the following are correct regarding mullerian duct abnormalities: (T/F)
(a) The upper two thirds of the vagina arise from the mullerian ducts.
(b) Affect 1-5% of women of reproductive age.
(c) Uterus didelphys is the most common anomaly.
(d) Septate uterus is associated with infertility.
(e) Are associated with renal agenesis.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
0.1% to 0.5% women of reproductive age are affected by congenital abnormalities of uterus. Approximately 25% of patients with anomaly have sub-fertility
- Which of the following are correct regarding characteristic MRI features of adenomyosis: (T/F)
(a) Foci of high signal within the myometrium on T1 weighted MRI.
(b) Focal thickening of the junctional zone.
(c) Foci of high signal within the myometrium on T2 weighted MRI.
(d) Significant displacement of the endometrial cavity.
(e) Large feeding vessels.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
On MRI adenomyosis and leiomyoma have overlapping features. Features favouring adenomyosis are: 1) poorly defined borders 2) oval shaped lesion along endometrium 3) minimal mass effect on endometrium relative to size of lesion 4) linear striations perpendicular to endometrium radiating into myometrium 5) absence of large feeding vessels.
(GIT) 38. In recurrent cervical cancer, which of the following are correct? (T/F)
(a) Hydronephrosis occurs in 70% of cases.
(b) Para-aortic nodes are generally involved before pelvic side-wall nodes.
(c) Liver metastases occur in 30% of cases.
(d) The rectum is rarely involved.
(e) Adrenal gland involvement is rare.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
The paracervical, parametrial, obturator and iliac nodes are involved first. Later there is spread to the common iliac and para-aortic nodes with worse prognosis. The adrenal glands is next common solid organ involvement after liver. The kidneys and pancreas are involved rarely. The recurrent tumour commonly involve the rectum and recto-vaginal fistula may develop.
(GIT) 39. Which of the following are correct regarding ovarian cancer? (T/F)
(a) The liver is the most common site of haematogenous metastasis.
(b) Serous cystadenocarcinoma contains calcification in 30% of cases on CT.
(c) Mediastinal lymph node involvement is a rare finding.
(d) About 75% of ovarian neoplasms are benign.
(e) Lesions greater than 4cm on CT are suggestive of malignancy.
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
In the ovary cancer, lymph node spread is typically along the path of the gonadal vessels to the para-aortic nodes and along the parameterial channels to the external iliac and hypogastric group.
- Regarding ultrasonography in the first trimester of pregnancy, which of the following are correct? (T/F)
(a) Gestational sac volume is the most accurate estimate of gestational age in the first 8 weeks of pregnancy.
(b) The diameter of the yolk sac should not be more than 5mm.
(c) The yolk sac is normally identified before the foetal pole.
(d) A normal intrauterine gestational sac and foetal pole exclude an ectopic pregnancy.
(e) Cardiac pulsation becomes visible at the beginning of the eighth postmenstrual week.
Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Once the fetus can be identified (5-6wks) then crown to rump length (CRL) is the most accurate measurement. The biparietal diameter becomes the most accurate towards end of the first trimester. Cardiac pulsation is visualized as soon as a fetal pole is visualized i.e. at 6 weeks postmenstrual week on TAS. A coexistent intrauterine and ectopic pregnancy (heterotopic pregnancy) is extremely rare (1 in 30000 pregnancy).
- Which of the following statements are correct? (T/F)
(a) An empty gestational sac with a mean sac diameter of 10mm and an elevated â human chorionic gonadotrophin (HCG) is consistent with a blighted ovum.
(b) Beta-HCG levels double every week in the first 8 weeks of pregnancy.
(c) An absent intrauterine pregnancy on ultrasonography and â-HCG levels between 1000 and 2000 IU is highly suspicious of an ectopic pregnancy.
(d) Vaginal bleeding is not usually associated with an ectopic pregnancy.
(e) The risk of a second ectopic pregnancy is 10%.
Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Beta-HCG levels double every 2-3 days in the first 8 weeks of pregnancy. Vaginal bleeding is seen in 75%-85% cases of ectopic pregnancies. The risk of second ectopic pregnancy is 25%.
- An axial ultrasonographic section through the foetal head measurement of the biparietal diameter (BPD) should include which of the following? (T/F)
(a) The third ventricle.
(b) The thalami.
(c) The cavum septum pellucidum.
(d) A continuous echogenic midline.
(e) The cerebellum.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
BPD is used for estimating the gestational age after 12 weeks. Its accuracy declines after 28 weeks after which it is combined with second measurement like femur length.
- Regarding foetal anomalies, which of the following are correct? (T/F)
(a) The nuchal-fold thickness is most prominent between 11 and 13 weeks.
(b) Endocardial cushion defects are strongly associated with Down’s syndrome.
(c) The triple screen for Down’s syndrome refers to the combination of maternal alpha-fetoprotein, oestriol and HCG levels.
(d) Short femur and humerus lengths are indicators of Down’s syndrome.
(e) Separation of the big toe from the remaining toes is a strong sign of Down’s syndrome.
Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Other associations with Down’s syndrome are membranous ventricular septal defects, ostium primum atrial septal defects, cleft mitral valve, patent ductus arteriosus, 11 pairs of ribs and hypersegmented manubrium (90%). Separation of the big toe from remaining toes (sandal sign) is a weak sign of Down’s synd.
- The following are correct regarding transabdominal ultrasound in early pregnancy: (T/F)
(a) Yolk sac is only visible from 7 weeks onwards.
(b) Gestational sac should be visible at 4 weeks.
(c) The earliest ultrasound sign of pregnancy is fundal endometrial thickening.
(d) Cardiac movement should be identifiable in the foetus at 6.5 weeks.
(e) Biparietal diameter can be used to predict gestational age from 7 weeks
Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Yolk sac is visible from 6 weeks onwards and gestational sac from 5 weeks onwards. Biparietal diameter is used to predict gestational age from 12 to 28 weeks.
- Which of the following are correct regarding gestational trophoblastic disease: (T/F)
(a) Young maternal age is a risk factor.
(b) It is associated with theca-lutein cysts.
(c) A predominantly echo-poor mass is seen on ultrasound.
(d) Invasive mole develops in approximately half of cases.
(e) Raised human chorionic gonadotrophin is seen in upto 80% of cases.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Gestational trophoblastic disease is associated with increased maternal age, presents as an echogenic mass with invasive mole developing in 12%-15% of cases. Raised human chorionic gonadotrophin is seen in 100% cases.
