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Generalist Exam Questions > Female Pelvis > Flashcards

Female Pelvis Flashcards

1
Q

What 2 anomalies are due to “failure of resorption of the median septum?”

A
  1. Septate uterus
  2. Subseptate
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2
Q

What 2 uterine anomalies are due to “failure of fusion”?

A
  1. Bicornuate uterus
  2. Didelphys uterus
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3
Q

What are the names of cysts located in the anterolateral wall of the vagina?

A

Gartner Duct cysts

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4
Q

What is the most common benign neoplasms of the cervix?

A

Polyps

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5
Q

What may cause endometrial hyperplasia?

A

Increased estrogen levels and can increase the risk of cancer

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6
Q

What is the most common cause of abnormal uterine bleeding in women?

A

Endometrial hyperplasia

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7
Q

What may cause Asherman’s syndrome/synechiae?

A

Adhesions to the endometrium may be due to C-section or D&C procedures - trauma to uterine lining

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8
Q

What abnormality occurs when a C/S scar ruptures?

A

Uterine dehisence

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9
Q

What is the most common tumor of the female pelvis?

A

Leiomyomas

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10
Q

Where is the most common location that PID affects in a female internally?

A

Fallopian tubes - salpingitis

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11
Q

What is the difference between adenomyosis and endometriosis?

A

Endometriosis: ectopic endometrial tissue outside the uterus and will often see “chocolate cysts” within the ovary

Adenomyosis: ectopic endometrial tissue confined within myometrium.

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12
Q

What pathology should be considered upon poor visualization of the junction between the endometrium and myometrium?

A

Adenomyosis

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13
Q

What is the most common clinical presentation of endometrial cancer?

A

Bleeding - usually diagnosed in the 6th or 7th decade

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14
Q

About 80 percent of all endometrial cancers are:

A) Leiomyosarcoma
B) Adenocarcinoma

A

Adenocarcinoma

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15
Q

What measurement in postmenopausal women not on HRT) should cause suspicion for carcinoma?

A

> 5mm

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16
Q

What is the most common germ cell tumor of the pelvis?

A

Cystic teratoma AKA dermoid - aged 20-40

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17
Q

The most common type of benign cystic ovarian tumor?

A

Cystadenomas - aged 20-50’s

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18
Q

What type of ovarian tumor/growth are estrogen producing?

A

Thecoma/ theca cell tumour

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19
Q

What is Meig’s syndrome?

A

Triad: ovarian neoplasm, pleural effusion, escites

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20
Q

What hormone related to the menstrual cycle is released from the hypothalamus?

A) FSH
B) GnRH
C) LH
D) Progesterone

A

GnRH

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21
Q

What hormone related to the menstrual cycle is released from the anterior pituitary?

A) Estrogen
B) GnRH
C) LH
D) Progesterone

A

LH

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22
Q

FSH is responsible for secretion of what hormone?

A) Estrogen
B) GnRH
C) LH
D) Progesterone

A

Estrogen

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23
Q

LH is responsible for secretion of what hormone?

A) Estrogen
B) GnRH
C) LH
D) Progesterone

A

Progesterone

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24
Q

What hormone stimulates ovulation?

A

LH

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25
Q

What are the phases of the ovarian cycle?

A

Follicular phase - 1-13

Ovulation - day 14

Luteal phase - 15-28

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26
Q

What hormones are secreted by the ovaries?

A

Estrogen, progesterone, inhibin

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27
Q

What hormones are secreted by the POSTERIOR pituitary? (2)

A

ADH
Oxytocin

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28
Q

What hormone stimulates the endometrium to thicken before ovulation occurs?

A) Estrogen
B) GnRH
C) LH
D) Progesterone

A

Estrogen

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29
Q

What hormone prepares the endometrium for implantation?

A) Estrogen
B) GnRH
C) LH
D) Progesterone

A

Progesterone

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30
Q

What is the term for a menstrual cycle < 21 days?

A

Polymenorrhea

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31
Q

What is the term for a menstrual cycle > 35 days?

A

Oligomenorrhea

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32
Q

What are the three phases of menses?

A

Menstruation: days 1-5, endometrium thinnest <4mm

Proliferative: days 6-10, “three line sign”, endometrium 5-8mm

Days 11-13: “three line sign”, endo = 11mm

Secretory: Days 14-28, endo =9-16mm

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33
Q

What layer of the endometrium is shed during menses?

A

Functional layer

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34
Q

What is a normal endometrial thickness for post-menopausal women?

A

<4-5mm

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35
Q

What might cause of postmenopausal bleeding?

A

1) Endo atrophy
2) Endo hyperplasia
3) Fibroids
4) Endo polyps
5) Endo cancer

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36
Q

For post-hysterectomy patients, what do the terms “partial”, “total”, and “radical” mean?

A

Partial - uterus is only taken out - cx and upper vagina remain

Total - uterus, cervix, and upper vagina are taken out

Radical - EVERYTHING including ovaries and fallopian tubes are removed

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37
Q

About 80 percent of all endometrial cancers are called?

A

Adenocarcinomas

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38
Q

At what age is endometrial cancer typically diagnosed?

A

6th-7th decade

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39
Q

What is the most common clinical indication of endometrial carcinoma?

A

Vaginal bleeding

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40
Q

Choose the most accurate representation of a uterine leiomyosarcomas?

A) rare and slow growing
B) rare and fast growing
C) common and slow growing
D) common and fast growing

A

B - rare and fast growing

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41
Q

What age range is typical for fallopian tube cancer?

A) 40-50
B) 40-60
C) 50-60
D) 50-70

A

40-60

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42
Q

What type of carcinoma in the female pelvis has a “cogwheel” sign in TRV?

A

Fallopian tube

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43
Q

What is the greatest risk factor for the development of cervical carcinoma?

A

HPV

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44
Q

When does cervical cancer typically occur?

A

Under 50

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45
Q

Thick, irregular walls or thick septations within the ovary greater than what measurement may be associated with inflammation, endometriosis, or malignancy?

A

3mm

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46
Q

What type of ovarian cyst may occur when a patient has very high HcG?

A

Theca lutein

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47
Q

What type of ovarian cyst may results in an acute case of pelvic pain?

A

Hemorrhagic

48
Q

25 year old patient presents with localized pain and tenderness, nausea, vomiting, and a palpable pelvic mass. What is the likely diagnosis?

A

Ovarian torsion

49
Q

Ultrasound appearance of ovarian torsion?

A
  1. Avascular
  2. Enlarged ovary with edema >4cm
  3. possibly heterogenous
50
Q

What is the most common androgen disorder?

A

PCOS

51
Q

What is PCOS also known as?

A

Stein-Leventhal syndrome

52
Q

What is the most common benign adnexal neoplasms? (2)

A

Benign cystic teratoma (germ cell tumor)
Cystadenoma (epithelial)

53
Q

What is the most common germ cell tumor of the pelvis and what age do they typically present?

A

Benign cystic teratomas - 20-40s

54
Q

What are benign cystic teratomas also known as?

A

Dermoid tumours

55
Q

What is the most common type of benign cystic ovarian tumor and what age does it present?

A

Cystadenoma - 20-50’s

56
Q

What age group do Brenner tumours typically occus?

A

50-70

57
Q

What kind of ovarian tumour secretes estrogen?

A

Thecoma

58
Q

SF of thecomas?

A

Solid, hypoechoic mass, possibly with cystic changes and calcifications.

59
Q

What is the most common reported symptom of ovarian malignancy?

A

Abdominal bloating

60
Q

What type of tumour is Brenners tumor/what cells does it arise from?

A) Epithelial
B) Transitional
C) Germ
D) Muscle

A

B - transitional

61
Q

What kind of fibroid is associated with a higher likelihood of interfering with the menstrual cycle?

A

Sub-mucosal - pushes into the endometrium

62
Q

What is the most common uterine pathology among pediatrics?

A) Fibroids
B) PCOS
C) Endometriosis
D) PID

A

PID

63
Q

What pathology occurs when “PID migrates to the upper right abdomen causing perihepatitis. This manifests as right chest/RUQ pain and adhesion formation in the RUQ”?

A

Fitz-Hugh Curtis AKA peri-hepatitis

64
Q

What is a common finding in Chronic PID?

A

Hydrosalpinx

65
Q

What is the hallmark appearance of adenomyosis on U/S?

A

Cannot delineate the border between myometrium and endometrium - commonly occurs in women 30-40’s

66
Q

What is the most common gynecologic malignancy?

A) Ovarian cancer
B) Endometrial cancer
C) Fallopian tube cancer
D) Cervical cancer

A

Endometrial - most commonly adenocarcinomas - most commonly present as abnormal uterine bleeding

67
Q

Patient presents with back pain and pain with intercourse. Upon receiving her history, you learn she has suffered from HPV. What is most likely going on?

A

Cervical cancer - m/c squamous cell carcinoma

68
Q

PMS is typically associated with what hormone?

A) Progesterone
B) Testosterone
C) Estrogen
D) Both A and C

A

Progesterone

69
Q

What is the potential space around the vagina known as?

A

Fornix

70
Q

Features of endometrial atrophy?

A) Asymptomatic and hypoechoic endo cavity
B) Symptomatic and hypoechoic endo cavity
C) Asymptomatic and fluid filled endo cavity
D) Symptomatic and fluid filled endo cavity

A

C) Asymptomatic and fluid within endo cavity

71
Q

Where can the uterine artery typically be seen?

A

Lateral to cx

72
Q

How much does the dominant follicle grow per day until ovulation?

A) 1-2mm
B) 2-3mm
C) 3-4mm
D) 4-5mm

A

2-3mm

73
Q

During pregnancy, what hormones are responsible for the mom to develop gallstones?

A) Progesterone
B) Testosterone
C) Estrogen
D) Both A and C

A

D

74
Q

Granulosa cell tumors are:

A) Benign and estrogenic
B) Benign and not hormone dependent
C) Malignant and estrogenic
D) Malignant and not hormone dependent

A

A

75
Q

What week can a pregnancy test be positive after conception?

A

1-2 wks

76
Q

The uterine artery banches off what vessel?

A

Internal iliac

77
Q

In a non-pregnant patient, does the uterine artery have high or low resistance?

A

High resistance

78
Q

Flow in the ovarian artery is most commonly seen in what phase of the ovarian cycle?

A) Follicular
B) Ovulation
C) Secretory
D) Luteal

A

Luteal

79
Q

Choose the most correct statement:

A) Ovarian artery branches off the external iliac, Lt uterine vein branches of LRV and Rt uterine vein branches off IVC

B) Ovarian artery branches off the internal iliac, Lt uterine vein branches of LRV and Rt uterine vein branches off IVC

C) Ovarian artery branches off the external iliac, Lt and Rt uterine veins branch off IVC

D) Ovarian artery branches off the internal iliac, Lt and Rt uterine veins branch off IVC

A

B

80
Q

What are the precursors to ovaries and testes?

A) Mullerian ducts
B) Cortical cords
C) Primordial germ cells
D) Gonadal ridges

A

Gonadal ridges

81
Q

The anterior cul-de sac is AKA?

A

Vesicouterine = b/w bladder and anterior uterus

82
Q

The posterior cul-de sac/ pouch of Douglas is known as?

A

Rectouterine = b/w uterus and rectum

83
Q

What pelvic muscle is seen on U/S deep to kidney?

A

Psoas major

84
Q

What fertility treatment occurs when a fertilized egg is transferred into fallopian tube laparascopically?

A) GIFT
B) ZIFT
C) IVF
D) ICSI

A

ZIFT

85
Q

What fertility treatment is used when the male is infertile?

A) GIFT
B) ZIFT
C) IVF
D) ICSI

A

ICSI

86
Q

What is the size of an ovarian follicle vs ovarian cyst?

A

Ovarian cysts are usually > 3cm, so if its <3cm it is most likely a follicle

87
Q

PCOS is also known as what?

A

Stein-Leventhal syndrome

88
Q

M/C SF appearance of PCOS?

A

String of pearls = peripheral follicles
>20 follicles
>10cc ovarian volume

89
Q

Which symptom is not involved with Stein Leventhal Syndrome?

A) Obesity
B) Infertility
C) Hirsituism
D) Menorrhagia

A

D - it involves OLIGO

90
Q

What layers are included in a benign cystic teratoma?

A) Ectoderm and Mesdoderm
B) All three layers
C) Mesoderm and Endoderm
D) Endoderm and ectoderm

A

B

91
Q

Most malignant tumors of the ovary show what kind of flow signals?

A) High resistance
B) High impedance
C) Low impedance
D) None of the above

A

C

92
Q

Female with menorrhagia and lower back pain can signify what abnormality?

A) Endometrial polyp
B) PCOS
C) Fibroid
D) Endometrial CA

A

C

93
Q

Symptoms of endometriosis?

A

Variable = dysmenorrhea, menorrhagia, dyspareunia, cyclic pain

94
Q

What is a sertoli leydig cell tumor also known as?

A

Androblastoma - secretes androgens

95
Q

30 year old patient has a history of infertility, what is the most common finding?

A) Endometrial hyperplasia
B) Uterine polyp
C) Nabothian cyst
D) Adenomyoisis

A

B - polyps can cause infertility issues

96
Q

In a post-menopausal patient, what does endometrial atrophy appear like?

A

Fluid within endo canal

97
Q

SF features of Krukenberg tumour?

A) Unilateral, hyperechoic
B) Bilateral, hyperechoic
C) Unilateral, hypoechoic
D) Bilateral hypoechoic

A

B - “moth eaten” appearance

98
Q

What was the purpose of DES?

A

Prevent spontaneous abortion

99
Q

Post menopausal women NOT on HRT should have an endometrial thickness under what?

A) 3mm
B) 4mm
C) 5mm
D) 6mm

A

C

100
Q

The normal endometrium of a postmnopausal women should appear?

A) Thin and smooth
B) Hypoechoic
C) Thickened and cystic
D) Fluid filled

A

A

101
Q

Endometrial cancer is most commonly seen in women over the age of?

A

60 - most common symptoms = postmenopausal bleeding and metrorrhagia

102
Q

What is the normal cervical length of a nulliparous woman?

A) 1-2cm
B) 2-3cm
C) 3-4cm
D) 4-5cm

A

B

103
Q

What muscle forms the lateral pelvic sidewall?

A) Iliopsoas
B) Obturator internus
C) Levator Ani
D) Coccygeus

A

B

104
Q

The levator ani muscles are at the level of?

A) Uterine corpus
B) Cx
C) Vagina
D) Uterine fundus

A

C

105
Q

The pelvic floor is formed by what muscles?

A) Iliopsoas
B) Obturator internus
C) Levator Ani
D) Coccygeus

A

C

106
Q

What is another name for the hypogastric artery?

A) Common iliac A
B) External iliac A
C) Internal iliac A
D) Femoral A

A

C

107
Q

What is the primary blood supply for the uterus, vagina, urinary bladder, and most of the muscles of the pelvic floor?

A) Common iliac A
B) External iliac A
C) Internal iliac A
D) Femoral A

A

C

108
Q

Where does the gonadal artery arise from?

A) Renal A
B) Internal iliac A
C) External iliac A
D) Aorta

A

D

109
Q

What vessel does the left ovarian vein drain into?

A) IVC
B) Left renal vein
C) Internal iliac V
D) External iliac V

A

B

110
Q

What is the normal orientation of the uterus?

A) Anteverted
B) Anteflexed
C) Retroverted
D) Retroflexed

A

A

111
Q

What ligament is responsible for anchoring the uterine fundus and tilting it forward in the pelvis?

A) Cardinal ligament
B) Ovarian ligament
C) Round ligament
D) Broad ligament

A

C

112
Q

Which of the following is not a true ligament but simply a double fold of peritoneum?

A) Cardinal ligament
B) Ovarian ligament
C) Round ligament
D) Broad ligament

A

D

113
Q

What surface of the broad ligament do the ovaries attach to?

A) Posterior
B) Anterior
C) Lateral
D) Medial

A

A

114
Q

Doppler of arterial waveform of a dominant ovary in premenopausal woman shows what kind of waveform?

A) High velocity, high resistance
B) Low velocity, low resistance
C) High velocity, low resistance
D) Low velocity, high resistance

A

B

115
Q

Doppler waveform of the uterine artery show what?

A) High velocity, high resistance
B) Low velocity, low resistance
C) High velocity, low resistance
D) Low velocity, high resistance

A

A

116
Q

The muscles frequently mistaken for enlarged ovaries are:

A) Iliopsoas
B) Obturator internus
C) Piriformis
D) Iliacus

A

C

Generalist Exam Questions (21 decks)

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