Final Review Flashcards
Which one of the following statements about diffuse endometriosis is false?
A)Endometriosis is easily diagnosed by sonography
B) it is the most common form of endometriosis
C) it’s appearance is similar to PID
D) Endometriosis leads to disorganization of pelvic anatomy
Endometriosis is easily diagnosed by sonography
During in vitro fertilization the optimal placement of an embryo is within 2 cm of the Apex of…
Uterine fundus
The T-shaped uterus is a congenital anomaly caused by…
Exposure to DES
Infertility
Infertility in 40% of patients is attributed to men
Infertility is the inability to conceive within 12 months with regular coitus
Infertility 20% of patients is atributable to either the man or the woman or is unexplained
Mucinous cystadenoma is
- The most common cystic tumor
- Unilateral
- Large cystic mass with multilocular cystic spaces
Tends to have a narrow base attachment to the endometrium with a vascular pedicle feeding it
Endometrial polyp
The most common malignancy of the ovary
Serous cystadenocarcinoma
A patient with an ovarian mass presents with an elevated serum AFP, what’s the most likely diagnosis
Yolk sac tumor
A tumor that mad mimic gas or feces in the pelvis is
Dermoid
A normal endometrial response associated with overstimulation is an increasing thickness between 2 to 3 mm and ____ mm
12-14
In the luteal phase the endometrial lining may be thinner than expected from an in adequate level of which hormone?
Progesterone
Para ovarian cyst’s arise from what structure
Broad ligament
The partial or complete rotation of the ovarian pedicle on its axis is…
Ovarian torsion
Inflammation of the fallopian tube
Salpingitis
Perihepatic inflammation ascending from a pelvic infection is called
Fritz-Hugh-Curtis syndrome
A dominant follicle grows at a rate of _____ to ____ mm per day
1-3 mm per day
What uterine anomaly is most frequently associated with a high incidence of infertility
Septate uterus
Used as a substitute for LH in o trigger ovulation
hCG
Bicornuate uterus is a congenital malformation that results from incomplete fusion of the
Mullerian ducts
The most common cause a fever and postpartum patients is
Endometritis
Mucinous cystadenocarcinoma most frequently occurs in women over the age of
40
A dermoid tumor typically contains tissues originating from
Endoderm, ectoderm, mesoderm
When does ovarian flow show the greatest resistance on PW Doppler
During menstruation
Endocrine disorder associated with chronic anovulation
Polycystic ovarian syndrome
The sonographic appearance of an ovarian dermoid tumor in which only the anterior elements of the mass can be seen, while the greater part of the mass is obscured by shadowing is consistent with
Tip of the iceberg
Demonstrates enlarged ovaries with multiple cysts, abdominal ascites and pleural effusion
Ovarian hyperstimulation
Infection within the uterine serosa and broad ligaments
Parametritis
The malignant ovarian mass that is associated with pseudomyxoma peritoneum is
Mucinous cystadenocarcinoma
An endometrioma most likely appears as a
Mostly cystic mass with low level echoes
Risk factors for PID
IUD
Post childbirth
Multiple sex partners
Ovarian mass that contains fat, sebum and teeth
Dermoid
A 55-year-old patient presents to the sonography department with a history of pelvic pressure, abdominal swelling, and abnormal uterine bleeding. A pelvic sonogram reveals a large multiloculated cystic mass with papillary projections
Serous cystadenocarcinoma
Theca lutein cysts are associated with high levels of which hormone
hCG
Hormone that can be correlated with follicle size to determine the likelihood of ovulation
Estradiol
Cyst that occurs when a dominant follicle does not succeed in ovulating but remains active although immature
Follicular cyst
A pelvic abscess will likely appear as
Complex cul-de-sac mass that distorts the pelvic anatomy
Patients with polycystic ovarian syndrome have the diagnostic triad of all of the following except
Dyspareunia
And ovary is generally considered abnormal and suggestive for malignancy if its volume is _____ the size of the contralateral ovary
Twice
Lack of progesterone production is known as
Luteal phase deficiency
Estrogen producing ovarian tumor
Thecoma
A specific diagnosis of a para ovarian cyst is possible only by
Demonstrating an ipsilateral ovary separate from the cyst
Ovarian induction therapy requires documentation of all follicles greater than ___ in both longitudinal and transverse plane
10mm
Adnexal pathology associated with Meigs syndrome
Ovarian fibroma
Stage two of ovarian carcinoma is limited to
Both ovaries
The occurrence of having both an intrauterine and extrauterine pregnancy at the same time describes
Heterotopic pregnancy
During which phase is the endometrial triple line sign visualized
Proliferative
Pelvic organ more commonly involved with metastatic disease
Ovaries
Producing more luteinizing hormone than follicle-stimulating hormone results in which condition
Polycystic ovarian syndrome
PID is an inclusive term that refers to
Oophoritis
Parametritis
Myometriris
In the early disease, the clinical presentation of both PID and endometriosis may mimic
Functional bowel disease
Inflammation of the serous membrane lining the abdominal cavity and covering the viscera is
Peritonitis
The malignant ovarian tumor with gastrointestinal origin is the
Krukenburg tumor
Granulosa cell tumor
May cause torsion
Comprised of cells resembling Graafian follicle
Estrogenic
The fallopian tubes are evaluated by a sonographic and saline examination to determine what characteristic
Patency
The patients who undergo assisted reproductive procedures have an increased risk factor for a ____ pregnancy
Heterotopic
Functioning endometrial tissue is present outside of the uterus in what condition
Endometriosis
A complex adnexal mass most likely represents
Pyosalpix
What ovarian mass is associated with virilization
Sertoli-Leydig cell tumor
On a baseline pelvic ultrasound, and ovarian cyst greater than ___ could interfere with ovarian stimulation and may represent a persistent follicle
15mm
Fusion of the inflamed dilated tube and ovary is called
Tubo-ovarian complex
When evaluating the patient who is in fertile, in addition to assessing structural anatomy, the sonographer should evaluate that
Endometrium
What tumor will most likely have a moth-eaten appearance on sonography
Metastatic tumor
Stein-Leventhal syndrome is characterized by
Obesity, hirsutism, and infertility
And asymptomatic 32 year old woman is diagnosed with a left adnexal mass on physical examination. A history of PID has been reported. Trans abdominal and transvaginal images demonstrate an anechoic tubular structure in the lower left quadrant
Hydrosalpinx
Sexually transmitted PID is spread via
Mucosa of the pelvic organs
What is the cause of irregular bleeding and a thickened endometrium in a patient with polycystic ovarian syndrome
Chronic elevation of estrogen
The most common cause of PID
Sexually transmitted diseases
A 25-year-old woman complains of painful menstrual cycles and infertility. Transabdominal and transvaginal images demonstrate a hypoechoic well-defined adnexal mass. Normal ovaries are seen bilaterally. This sonographic appearance most likely represents what
Endometrioma
What is a method of fertilizing the human oocyte outside the body
In Vitro Fertilization
Patients with ovarian Hyperstimulation Syndrome are at increased risk for
Ovarian torsion
An infection that involves the fallopian tube and the ovary is called what
Tubo-ovarian abscess
Formula for ovarian volume
.523 x Length x Width x Height
What principle directs the sonographer to do no harm
Nonmaleficence
A malignant form of gestational trophoblastic disease is
Choriocarcinoma
Complications of placenta previa include
Postpartum hemorrhage, premature delivery, maternal hemorrhage
A patient presents for a sonogram. Upon examination, no intrauterine pregnancy can be seen. What are the differential diagnosis
Normal four week pregnancy, ectopic pregnancy, non-developing pregnancy
And embryonic heartbeat should be visible when the crown rump length measures
4mm
The feudal contribution of the placenta is the
Chorion frondosum
The cavity in which the fetus exits is called the
Amniotic
Using a transvaginal approach the first structure visualize within a gestational sack is
Secondary yolk sac
The interface between the decidua capsularis and the echogenic vascular decidua on the opposite wall of the endometrial cavity forms what
Double decidual sign
To calculate the mean sac diameter of a gestational sack what formula is used
(Length x Width X height)/3
A patient presents with a recent history of bright red vaginal bleeding.
Complete placenta previa
A marginal placenta previa demonstrates
The placenta touches but does not cross the internal cervical os
Maternal serum hCG levels in a normal intrauterine pregnancy at less than seven weeks should
Double every 48 hours
The double bleb sign refers to the song graphic presentation of
The amnion and adjacent yolk sac
An ovum without an embryo is known as
Anembryonic pregnancy
The primary cause of placentomegaly is
Maternal diabetes
The fusion of the chorion and amnion occurs between
14 and 15 weeks
Fetal anatomy may be adequately assessed after ____ weeks gestation
18 weeks
_______ Is a focal discrete lesion caused by ischemic necrosis in the placenta
Placental infarct
The trophoblastic cells produce
HCG
The most accurate measurement of gestational age during the first trimester is
Crown rump length
An ectopic pregnancy most commonly occurs in
Fallopian tube
The placenta is considered too thick when it measures
Greater than 4 cm
The velamentous placenta refers to
A membranous insertion of the cord
Ultrasound is able to determine all of the following except
Exact date of delivery
This structure was discovered during a routine obstetric exam for gestational dating. It most likely represents
Chorioangioma
The beta hCG levels plateau and subsequently decline, whereas the gestational sack continues to grow, after _____ weeks
9-10
Typically the yolk sac resorbs and is no longer visible sonographically by _____ weeks
12 weeks
Implantation of the blastocyst into the uterine decidua is completed within ____ days after fertilization
12
The presence of one or more accessory lobes connected to the body of the placenta by blood vessels is a _____ placenta
Succenturiate
In transabdominal scanning, a normal gestational sac can be consistently demonstrated when the beta hCG level is
3000 mIU/ml
The second trimester is between _______ gestational weeks
14-26
Which grade refers to a placental appearance showing a uniform echogenicity with no calcifications and a smooth chorionic plate
Grade 0
Fertilization typically occurs within ____ after ovulation
24 hours
The attachment of the placental membranes to the fetal surface of the placenta describes
Circummarginate placenta
The major functioning units of the placenta are
Chorionic villi
What location of an ectopic pregnancy includes an increased risk of a massive hemorrhage with rupture that may lead to hysterectomy or even death
Near the uterine cornu
The structure created by the union of sperm and egg
Zygote
Severe blood loss may occur with placenta ____
Percreta
Nuchal translucency must be measured between
11-13 weeks and 6 days
The maternal side of the placenta is the decidua ____
Basalis
Abnormality that might demonstrate a small placenta
Aneuploidy
A placenta previa can be ruled out if the placental edges at least how far from the internal cervical os
2cm
In early pregnancy, the gestational sack grows at a rate of
1 mm per day
An anechoic or hypoechoic crescent-shaped area located between the gestational sac and the myometrium represents
Subchorionic hemorrhage
A patient presents for a transvaginal ultrasound. She reports heavy vaginal bleeding and pelvic cramping. Her pregnancy test is positive. When performing her ultrasound, you discover an embryo measuring six weeks five days with a heart rate of 110 bpm. You also see a subchorionic hemorrhage. What is the correct diagnosis
Threatened abortion
On transabdominal imaging, an over distended bladder may give a false impression of
Placenta previa
Multiple tiny clusters of grape like echoes within the uterine cavity best describe what
Gestational trophoblastic disease
In the first trimester, herniated bowel will return within the abdominal cavity by the ___ week
12th
What would be most likely confused for a uterine Leiomyoma
Myometrial contraction
An embryo with cardiac activity must be identified once the gestational sack measures ____
25 mm
What increases the likelihood of developing placenta previa
Previous c section
The serum level of beta hCG is _______ with gestational trophoblastic disease
Dramatically elevated
The best sonographic correlation in the diagnosis of an ectopic pregnancy is the combination of free pelvic fluid and
Adnexal mass
Compared with a normal intrauterine pregnancy, the ectopic pregnancy will have a
Lower hCG
The most common pelvic mass seen in a first trimester pregnancy
Corpus luteum cyst
A circumscribed complex mass protruding from the fetal surface of the placenta is demonstrated on ultrasound. This appears most likely represents
Chorioangioma
With transvaginal ultrasound, an abnormal pregnancy is suspected when the yolk sac is not visualized with a minimum mean sac diameter of
12 mm
What laboratory test is used to indicate pregnancy when the values are elevated
HCG
The most common site of fibrin deposition is which of the following
Beneath the chorionic plate of the placenta
The growth of the chorionic villi superficially on the myometrium describes
Placenta acreta
A marginal insertion of the umbilical cord into the placenta is what
Battledore placenta
From the time of implantation until the end of the 10th week menstrual age the conceptus is called
Embryo
An embryo becomes a fetus after ____ weeks menstrual age
10 weeks
Embryos with heart rate below _____ beats per minute generally have a poor prognosis
90
An incomplete abortion is defined as
Spontaneous abortion with retained products of conception
Fetal sonography with or without Doppler should be performed
With a valid medical reason
What is the stage of the conceptus that implants within the decidualized endometrium
Blastocyst
What is associated with an abnormal NT
Cardiac defects, trisomy 18, trisomy 21
What ovarian pathology is associated with hydatidiform mole?
Theca-Lutein Cyst
The diameter of the normal yolk sac should never exceed
6mm
When the ovary is in the luteal phase, the endometrium is in the
Secretory
The ovary receives its blood supply from what arteries
Uterine and ovarian arteries
The hormone responsible for the final maturation of the follicle and for ovulation
LH
What structure lies above the utero-ovarian ligament, round ligament, and tubo-ovarian vessels
Fallopian tube
The most common cause of uterine calcification is
Myomas
What portion of the fallopian tube is the most coiled
Ampulla
Small vessels found along the periphery of the uterus
Arcuate vessels
The release of an egg from the ruptured follicle is termed
Ovulation
A mature follicle is known as a ______ follicle
Graafian
Flexion refers to the axis of the uterine body relative to the
Cervix
A small percentage of leiomyoma’s are located in what structure
Cervix
What technique uses a catheter inserted into the endometrial cavity with the insertion of saline or contrast to fill the endometrial cavity to demonstrate abnormalities
Sonohysterography
The thickness of the endometrium should be measured in what plane
Longitudinal
On ultrasound, the characteristic appearance of a degenerating leiomyoma is
Heterogeneous
Uterine arteriovenous malformation usually involves the
Myometrium
The endometrium is at its greatest thickness and echogenicity with posterior enhancement in which corresponding ovarian phase
Luteal
Which ligament contains uterine blood vessels and nerves
Broad
Sonohysterography is usually performed on pre-menopausal women between days ____ of the menstrual cycle
6-10
Arcuate artery calcifications may be observed in patients who are
Postmenopausal
Fluid noted posterior to the uterus would most likely be located within the
Pouch of Douglas
The ovaries are laterally supported by what ligaments
Suspensory, infundibulopelvic
A 28 year old woman reports left lower quadrant pain. Her last menstrual period was two weeks earlier. Sonographically , the uterine body displays a highly echogenic linear structure in the endometrial cavity. This most likely represents
IUD
Menarche may be defined as
The state after reaching puberty during which menses occur every 21 to 28 days
A benign invasion of endometrial tissue into the myometrium is known as
Adenomyosis
FSH is produced by
Anterior pituitary gland
A patient presents to the sonography department with a history of uterine prolapse. what best describes this disorder
A condition that results from the weakening of the pelvic diaphragm muscles and allows for the displacement of the uterus often through the vagina
In post menopausal patients who are not on hormone replacement therapy, an endometrial thickness of less than ___ millimeters is considered benign
5 mm
Most common finding in endometrial carcinoma
Abnormal thickening of the endometrial cavity, usually with irregular bleeding in perimenopausal and postmenopausal women
The left ovarian vein drains into
Left renal vein
The most common benign tumor of the uterus
Leiomyoma
The floor of the pelvis is formed by the
Levator ani muscles
A 60 y/o patient presents to the emergency department with sudden onset of vaginal bleeding. The sonographic examination reveals and endometrium that measures 4 mm. There are no other significant findings. What is the most likely diagnosis
Endometrial atrophy
Endometrial hyperplasia develops from
Unopossed estrogen stimulation
The most common gynecologic malignancy in the United States
Endometrial
The superficial layer of glands and stroma of the endometrium is called
Zona functionalis
Limitations of trans labial scanning may be overcome by
Elevating the patients hips
The curving forward of the fundus and body of the uterus on the cervix is called
Anteflexion
Fibroid location that will most likely cause heavy irregular uterine bleeding
Submucosal
Complications in delivery may occur with pregnancy if a fibroid is located in or near what structure
Near the cervix
The pelvic recess between the anterior bladder wall and the pubic synthesis is
Space of Retzius
The clinical signs of a 32-year-old woman with an enlarged uterus on physical examination and a history of cyclic profuse and prolonged bleeding with increasing pain most likely represents
Leiomyoma
Depending on the menstrual cycle, the inner lining of the uterine cavity that appears echogenic to hypoechoic on ultrasound is which structure
Endometrium
Hydrometra appears sonographically as
Sonolucent fluid collection in the uterine canal
What is the physiological status of pre-puberty called
Premenarche
Days 6-13 in the uterus are considered the ____ phase
Proliferative
The thin outer layer of the uterus is separated from the intermediate layer by
Arcuate vessels
What muscle group may be seen in the false pelvis along the lateral side wall of the pelvis
Iliopsoas
The endometrium demonstrates the three line sign in what phase
Proliferative
In transvaginal scanning, the true scanning plane that is 90° from the sagittal plane is the _____ plane
Coronal
The most likely result of an acquired condition with obstruction of the cervical canal
Cervical stenosis
The term that refers to mid cycle or ovulatory pain
Mittelschmerz
Nabothian cyst’s are found near what atomic structure
Endocervical canal
Muscles found in the true pelvis
Iliociccygeus, levator ani, obturator internus
The middle layer of the uterus
Myometrium
In the secretory phase, the endometrium should be measured from the _____ layer to the _____ layer
Hyperechoic, hyperechoic
Which vessel provides the best landmark for localizing the ovary
Internal iliac artery
A mature follicle typically measures ____ right before ovulation
2cm
In a patient after a hysterectomy, the normal vaginal cuff should not exceed
2cm
The most common site for a leiomyoma to occur
Intramural
An 80-year-old patient presents for sonographic evaluation for vaginal bleeding. What is most important to obtain
Endometrial thickness measurement
Irregular, acyclic bleeding is defined as
Amenorrhea
In what structure would a Gartners duct cyst be found
Vagina
The retrouterine space is also known as
Posterior cul-de-sac
The ovary produces two hormones. Estrogen is secreted by _____, whereas progesterone is secreted by the ____
Follicles, corpus luteum
The hormone responsible for proliferation of the endometrium is
Estrogen
What condition is described as a hyperplastic protrusion of the epithelium of the cervix that may be broad-based or pedunculated
Cervical polyp
The normal size of the menarchal uterus should measure ____ long and ______ wide
8cm, 4cm
A female patient who is over the age of 18 and has never had a menstrual cycle is said to have
Primary amenorrhea
A three day postpartum woman complains of intense pelvic pain. Sonographically, the uterus appears hypoechoic with an irregular endometrium. This condition most likely represents
Endometritis
Symmetrical bilateral pelvic mass like structures are likely to be
Pelvic muscles
Which of the following ligaments provides support to the cervix
Cardinal and uterosacral
The paired embryonic ducts that develop into the female urogenital tract are
Mullerian ducts
Patients on tamoxifen therapy have an increased risk of
Endometrial hyperplasia, endometrial polyp, endometrial carcinoma
The first phase of the ovarian cycle
Follicular phase
Asherman syndrome is associated with
Endometrial adhesions
The vagina has two sources of blood supply, they are
Uterine artery and vaginal artery
Abnormally heavy or long menses is termed
menorrhagia
Most common form of endometrial carcinoma
Adenocarcinoma
What ligament occupies the space between the layers of another ligament and occurs in front of and below the Fallopian tubes
Round
During which days of the menstrual cycle does blood flow to the ovaries have the highest resistance in the lowest diastolic flow
First 10 days
What is another name for endodermal sinus tumor
Yolk sac tumor
