Final Spring 2021 Flashcards
Bicornuate Uterus
Failure of the mullerian ducts to fuse
The Muscles that make up the pelvic diaphragm
Levator Ani and Coccyogeus
Follicles of the ovary are found in the;
Cortex
Arcuate Arteries are found it which layer of the uterus?
Myometrium
True of False
The pelvic cavity is divided into two regions based on an imaginary plane running from the sacral prominence to the upper margin of the symphysis pubis
True
During the luteal phase the corpus luteum produces which hormone in order to maintain the thickened endometrium?
Progesterone
Ovaries can typically be found;
Lateral to uterus and medial to the iliac artery and vein
Menarche
Onset of menses
The female cycle;
Day 1-5
*Menstrual* Uterine - period, Estrogen & progesterone Drop Hypothalamus - GnRH Pituitary- FSH *Follicular* Ovarian- Follicle development = estrogen
The female cycle;
Day 6-14
Proliferative
Uterine- “3 line sign” estrogen causes proliferative endometrium
Pituitary- LH
Ovulation (day 14)
Ovarian- corpus luteum makes progesterone to maintain thick endometrium for fertilized egg - (if NO hcg- corpus luteum resolves in 14days = back to day one)
Arteries of the uterus
Internal iliac artery > Uterine artery (menopause=^ resistance) > Myometrium arcuate artery > Deep endometrium Radial artery > Basal layer straight artery > spiral artery
Ligaments that support the uterus in the pelvis
Broad ligaments
Round ligaments
Ovarian suspensory ligamnets
Uterine position; Ante- Retro- Flexion- Version-
Ante- Forward
Retro- Backward
Flexion- Position of uterus
Version- Position of cervix
The widest portion of the fallopian tube where fertilization occurs;
Ampulla
The right ovarian vein drains into the;
The left ovarian vein drains into the;
IVC
Left renal vein
Mullerian duct
Form the upper vagina, cervix, uterus & fallopian tubes.
The most common abnormality when the mullerian duct fail to form
Unicornuate uterus
Vaginal atresia & imperforate hymen can be diagnosed by the development of;
Hematometra
Hematocolpos
Hematometrocolpos
In a post-menopausal women the uterine artery has a typical doppler waveform with what characteristics?
High resistance
Precocious puberty
Development of early secondary sexual characteristics due to hypothalamic disease
The average length & height (AP) dimensions of the nulliparous adult uterus are;
6x4cm
Fornicies
Circumferential recesses around the external cervix, formed by the attachment of the vaginal wall.
Normal endometrial thickness for a postmenopausal patient who is NOT on hormone replacement therapy is;
> 4mm
The endometrial measurement is obtained by measuring;
A double thickness AP measurement in the longitudinal plane
Pituitary Gland
Secretes FSH
Vesicouterine pouch
The peritoneal space anterior to the uterus
Sonography pelvic muscles appear
Hypoechoic
4 D’s of endometriosis
Dysmenorrhea- pain before & during menses
Dyschezia - pain with bowel movements
Dyspareunia - pain with intercourse
Dysuria- difficult/painful urination
Adenomyosis
Diffuse, benign invasion of endometrial tissue into the myometrium.
Appearance of an incompetent cervix;
Shortened
Cervical polyp
The most common benign neoplasm of the cervix
Endometriosis may be defined as;
Ectopic endometrial tissue
Sonographic appearance of an endometrioma is;
- ) A discrete, thick-walled oval mass
- ) Heterogeneous structure
- ) A mass that contains low-level echos; &/or exhibits ETT
Leiomyoma located;
- ) Within the myometrium
- ) Directly beneath the endometrium
- ) On the outer surface of the uterus
- ) Growing out of the uterus attaches by a stalk
Leiomyoma located;
- ) Within the myometrium - Intramural
- ) Directly beneath the endometrium - Submucosal
- ) On the outer surface of the uterus - Subserosal
- ) Growing out of the uterus attaches by a stalk - Pedunculated
Some effects of Tamoxifen therapy
- Endometrial hyperplasia
- Increased endometrial thickness
- Increased risk of endometrial cancer
Sonographic findings of endometrial carcinoma
- Increased uterine size
- Thickening of the endometrial tissue
- Fluid in the endometrial cavity
Sonographic feature of leiomyomas
- Complex, well circumscribed attenuating uterine mass
- Distortion of the normal uterus contour
- Displacement of the normal linear endometrial “strip”
Women with a HX of PID are at risk for;
- Tubal scaring
- Ectopic pregnancy
- Perionitis
Gartner’s duct cyst
Found in the Vaginal canal
Nabothian cyst
Cervix
Oophoritis
Inflammation of the ovary
Abnormal Vaginal bleeding may be associated with;
- Endometritis
- Multiple myomas
- Endometrial polyps
Endometrioma (Chocolate cyst)
Cyst associated with endometriosis
Endometrial polyp sonographic findings?
Procedure to help enhance visualization of the polyp separate from the endometrium?
Stalk/base with blood flow
Sonohysterography
PID is most frequently caused by what?
STD/STI sexually transmitted organisms
Sonographic/clinical findings of Tubo-Ovarian abscess
A complex adnexal mass
High WBC
Extreme pelvic pain
Fever
Sonographic/ clinic signs for a most likely dx of Pyosalpinx
Right sided pelvic pain
Purulent vaginal discharge
Tubular structure in the right adnexa with low level echos
Causes of uterine calcifications
Fibroids, calcified arcuate arteries
The sonographic findings of a properly placed IUD
- Hyperechoic with reverberation & Shadows
2. Centrally located within the body/fundus of the uterus.
Adenomyosis clinical findings
- Dysmenorrhea & pelvic pain
- Diffusely enlarged uterus
- Myometrium has a heterogenous echo texture & streaky shadowing.
Endometrial polyps sonographic findings
Typically hyperechoic to surrounding endometrial tissue, & blood flow can be seen at eh stalk/base
Endometrial leiomyomas sonographic findings
Hypo or isoechoic with calcifications and shadowing
Leiomyosarcoma of the uterus
Malignant tumor of the uterus
Androgen
The substance that stimulates the development of male characteristics
Cystadenoma
The most common cystic ovarian tumor
Teratoma
Benign tumor of the ovary comprised of hair, muscle, teeth and fat
Theca Lutein
Serous cystadenoma
Fibroma
Forms of typically benign ovarian tumors
Theca lutein cysts sonographic/clinical findings
Markedly elevated bata HCG levels
Ovaries are covered in multiseptated cysts bilaterally
Laparoscopy is indicated if an ovarian cyst measures;
Over 10cm
The malignant ovarian mass associated with pseudomyxoma peritonel
Mucinous cystadenocarcinoma
Dysgerminoma
Malignant ovarian tumor that contains elements of germ cells
Sonographic sign associated with an ovarian dermoid tumor, when only the anterior aspects of the mass are seen as a bright reflection and the rest of the mass is obscured by shadowing.
Tip of the iceberg sign
Serous Cystadenoma
The most common benign ovarian tumor of epithelial origin
Stein-Leventhal
String of pearls appearance
Thecoma tumor
Estrogen producing
Ovarian Fibroma
Associated with Meigs syndrome
What ovarian tumor is associated with virilization due to excess androgen production?
Sertoli-Leydog tumor
Polycystic ovarian syndrome - clinical/sonographic findings
- Amenorrhea, obesity, anovulation
2. Small cyst located peripherally on the ovaries, bilateral, enlarged ovaries, string of pearls.
Corpus luteum
Produces progesterone
Sonographic findings of;
Benign ovarian mass
&
Malignancy ovarian mass
Benign - Anechoic with good ETT, thin walled, smooth/well defined borders, round in both plans
Malignant- Complex texture, irregular shape, ill defined/irregular borders, thick wall, shadowing
Acute vs. Chronic Torsion
Acute - Hypoechoic, acute/sharp pain, little to no blood flow, enlarged, complex
Chronic- Increased echogenicity, shrunken, dull aches, no blood flow, necrotic
Meigs’ syndrome
Pleural effusion, solid benign pelvic mass, asities
Functional cysts
Follicular cyst
Theca luteal cyst
Corpus luteum cyst
These cysts are response to the female natural cycle
3 ways that ovarian malignancy can spread
- Arterial & venous system spread
- Direct invasion
- Lymphatic spread
After the morula enters the uterine cavity fluid passes over it & it divides into two layers & becomes the _________. The inner cell layer is called the ______ & the outer cell layer is called the ________.
After the morula enters the uterine cavity fluid passes over it & it divides into two layers & becomes the -BLASTOCYST- The inner cell layer is called the -EMBRYOBLAST- & the outer cell layer is called the -TROPHOBLAST-.
Ampulla
The portion of the fallopian tube where fertilization happens & the most common area for an ectopic pregnancy to occur
Zygote
Newly fertilized egg
The normal gestational sac grows approximately how fast?
1mm/day
Decidua Capsularis
The portion of the endometrium that closes over & surrounds the blastocyst
Decidua Basalis
The portion of the endometrium that lies between the blastocyst & the uterine muscle which will become the maternal side of the placenta
Decidua Parietalis
The portion of the decidualized endometrium that lines the uterine cavity
In a normal first trimester pregnancy, how often should the levels of hCG double?
Every 36-48 hours
Sonographic findings associated with a normal first 1st trimester pregnancy
- Ultrasound finding of a double decidual sign
- A cystic structure seen in the fetal head called the rhombencephalon
- The midgut herniates into the umbilical cord at eight weeks gastation
Embryonic cardiac activity during the first trimester
- Cardiac activity should be seen on an endovaginal sonogram when the crown rump length is 5mm
- Cardiac activity may not be seen when the embryo is first identified using endovaginal sonography
- A fetal heart rate <100 bpm may indicate fetal demise
Crown Rump Length
The most accurate method used to date first trimester pregnancies
Complete abortion
When the uterus empties itself of all products of conception
The chorion & the Amnion fuse at approximately…….
12-16 wks
Hydatidiform (molar) pregnancy
- Beta hCG levels are very high
- The patient;s uterus measures large for dates
- The patient may have hyperemesis
When performing a transabdominal ultrasound, a yolk sac should be visualized when the MSD is;
20 mm
Conditions can be associated with abnormally high hCG
- Incorrect dates
- Gestational trophoblastic disease
- Multiple gestations
Missed abortion
- Mild pelvic pain
- No vaginal bleeding
- No cardiac activity of movement
- Gestational sac is located in the lower uterine segment rather than the fundal region
What is the mass most commonly seen during a normal first trimester pregnancy?
Corpus luteal cyst
To differentiate an early intrauterine pregnancy from a pseudo-gestational sac, it helps to visualize;
The yolk sac
Heterotopic pregnancy
An intrauterine & extrauterine simultaneous pregnancy
Nuchal translucency measurements can only be obtained between what weeks of gestation?
11 & 13 weeks gestation
Ectopic pregnancy Clinical signs Sonographic appearance & Risk factors
- Clinical signs- Vaginal bleeding, positive pregnancy test, hCG levels will not be as high as expected & enlarged uterus
- Sonographic appearance - No intrauterine pregnancy visualized, adnexal mass, possible free fluid
- Risk factors- Previous ectopic pregnancy, Hx of PID & Infertility treatments
Sonographic/clinical signs & etiology of Gestational trophoblastic disease (AKA - Molar pregnancy)
- Sonographically- Bilateral theca lutein cysts, enlarged uterus
- Clinical - Vaginal bleeding, hyperemesis
- Etiology- Abnormal fertilization
