GYN Flashcards
What is contained in the true pelvis?
reproductive organs bladder distal ureters bowel pg. E 6, O 296
What are the osseous ligaments?
sacroiliac sacrosciatic sacrococcygeal pubic pg. E 7
What ligament(s) support the cervix?
Cardinal (laterally)
pg. E 7, O 298
What ligament(s) support the uterus?
Broad (laterally)
Round (anteriorly)
Uterosacral (posteriorly)
pg. E 7, O 298
What ligament(s) support the ovaries?
Broad
Suspensory aka Infundibulopelvic (laterally)
Ovarian (inferiorly)
Mesovarian (posteriorly)
pg. E 7, O 298
What ligament(s) support the fallopian tubes?
Broad (laterally)
Round (anteriorly)
pg. E 7, O 298
Where is the rectus abdominis located?
Anterior abdominopelvic wall
pg. E 9
Where is the psoas major muscle located?
Posterior abdominopelvic wall
pg. E 9, O 297
Where is the iliacus muscle located?
Laterally in the false pelvis
pg. E 9
Where is the levator ani group located?
Middle, anterior pelvic floor
pg. E 9, O 297
Where is the coccygeous muscle located?
Posterior pelvic floor
pg. E 9
Where are the piriformis muscles located?
Posterior wall in true pelvis
pg. E 9, O 297
Where are the obturator internus muscles located?
Lateral wall in true pelvis
pg. E 9, O 297
What is formed by the psoas major and iliacus muscles?
iliopsoas muscles
pg. O 297
How long is the typical vagina?
7-10 cm
pg. E 10
What are the typical dimensions of the menarche nulliparous uterus?
6-8.5 x 3-5 x 3-5 cm
pg. O 302
What are the typical dimensions of the menarche multiparous uterus?
8-10.5 x 3-5 x 5-6 cm
pg. O 302
What are the typical dimensions of the premenarche uterus?
2-4 x 0.5-1 x 1-2 cm
pg. O 302
What are the typical dimensions of the postmenopausal uterus?
- 5-7.5 x 2-3 x 4-6 cm
pg. O 302
What is the isthmus of the uterus?
Lower uterine segment
pg. E 11 O 301
What are the layers of the uterus?
Perimetrium (serosa)
Myometrium
Endometrium
pg. E 11-12 O 300
What is the inner portion of the myometrium called?
Junctional zone
pg. E 11 O 300
What are the 2 layers of the endometrium? Which is located where?
Basal layer (deep) Functional layer (superficial, sheds) pg. E 11 O 301
What is anteversion?
Uterus tilted forward upon cx ( 90 degrees or less)
pg. E 13 O 303
What is retroversion?
Uterus tilted down towards cx (90 degrees or less)
pg. E 13 O 303
What is anteflexion?
Uterus bent on cx ( greater than 90 degrees)
pg. E 13 O 303
What is retroflexion?
Uterus curved backward on cx (greater than 90 degrees)
pg. E 13 O 303
What does dextro- and levo- mean?
Right and Left
pg. O 303
Which uterine position is most common?
Anteversion
pg. E 13
What is the size of premenopausal ovaries?
- 5 x 2 x 1.5 cm
pg. E 15 O 305
What is the size of postmenopausal ovaries?
2 x 1 x 0.5 cm
pg. E 15 O 305
How long are the fallopian tubes?
7-14 cm
pg. E 16 O 307
What are the parts of the fallopian tube beginning near the uterus?
Interstitial portion Isthmus Ampulla Infundibulum pg. E 16 O 306
Where is the Space of Retzius and what are the other name(s)?
Between bladder and symphysis pubis
Retropubic and Prevesical space
pg. E 17 O 299
Where is the Vesicouterine pouch and what are the other name(s)?
Between uterus and bladder
Anterior cul-de-sac
pg. E 17 O 299
Where is the Retrouterine pouch and what are the other name(s)?
Between rectum and uterus
Posterior cul-de-sac and Pouch of Douglas
pg. E 17 O 299
What are the branches of the uterine artery?
(superficial to deep)
Arcuate > radial > spiral
(periphery) > myometrium > endometrium
pg. E 18 O 298
Where does cervix get it’s blood supply?
Uterine arteries
pg. O 298
Where does vagina get it’s blood supply?
Uterine arteries
pg. O 298
Where do ovaries get blood supply?
primary- ovarian arteries
secondary - uterine arteries
pg. O 298
What hormone(s) are produced by the hypothalamus and secreted by the pituitary gland?
FSH and LH
pg. E 22 O 316
What does FSH stimulate?
Stimulates ovaries to develop follicles
and estrogen
pg. E 22 O 316
What does LH stimulate?
Stimulates maturation of follicles
and progesterone
pg. E 22 O 316
What are the ovarian phases?
Follicular (days 1-14)
Ovulation (day 14)
Luteal (days 15-28)
pg. E 23 O 320
What are the uterine phases of the menstrual cycle?
Menstrual (days 1-5)
Proliferative (days 6-14)
Secretory (days 15-28)
pg. E 24 O 317
What happens in the follicular phase?
FSH increases, Ovarian follicles increase in size
pg. E 23 O 320
What happens at ovulation?
Graafian follicle ruptures
pg. E 23 O 321
What is Mittelschmerz?
unilateral pelvic pain occurring mid cycle, associated with ovulation
pg. E 23 O 321
What happens in the luteal phase?
Corpus luteum forms
if fertilized it will continue to secrete progesterone
if fertilization does not occur it regresses
pg. E 23 O 322
What is the sonographic appearance of the endometrium during the early and late menstrual phases?
Early - Thin hypoechoic line 4-8mm
Late - Thin hyperechoic line 2-3mm
1-4mm
pg. E 24 O 317
What is the sonographic appearance of the endometrium during the early and late proliferative phases?
Early - thin hyperechoic line 4-6mm
Late - thick 3 line sign 4-8mm
4-8mm
pg. E 24 O 318
What is the sonographic appearance of the endometrium during the secretory phase?
Thick, hyperechoic line
7-14mm
pg. E 24 O 319
What is menorrhagia?
heavy flow during cyclic menstrual bleeding
pg. E 26
What is polymenorrhea?
cycles less than 21 days apart
pg. E 26
What is oligomenorrhea?
cycles more than 35 days apart
pg. E 26
What is metrorrhagia?
irregular, frequent bleeding
pg. E 26
What is menometrorrhagia?
irregular bleeding in both frequency and volume
pg. E 26
What is dysmenorrhea?
painful bleeding
pg. E 26
What is amenorrhea?
absence of menstrual flow
pg. E 26
If a patient is using oral contraceptive pills, what will not occur and what will be observed?
Ovulation will not occur
No dominant follicles
Endometrium remains small throughout cycle
pg. E 26 O 324
What is the sonographic appearance of an IUD?
Hyperechoic to endometrium
Located in the fundus
Posterior shadowing
pg. E 27 O 324
What IUDs are used today and what are the shape(s)?
Paraguard (Copper T-shape)
Mirena and Skyla (hormone releasing plastic T)
pg. E27 O 324
What are other IUDs are there and what is the shape of each?
Copper T (T-shape) Saf-T-Coil Lippes Loop Progestasert (hormonal) pg. E 27 O 324
What is infertility? How often does it occur?
Inability to achieve pregnancy after 1 year of trying
1/7 American couples
pg. E 28 O 345
What can be done to help couples achieve pregnancy?
Ovulation induction
Ovulation monitoring
Assisted reproductive technologies
pg. E 29 O 345
What is IVF?
In-vitro fertilization- incubation of oocytes and sperm and catheter deliver into uterus
pg. E 29 O 345
What is ZIFT?
Zygote Intrafallopian Tube Transfer
Zygote is placed into fallopian tube
pg. E 29 O 345
What is GIFT?
Gamete Intrafallopian Tube Transfer
Sperm and ova are placed into fallopian tube
pg. E 29 O 345
What is Ovarian Hyperstimulation Syndrome?
Ovaries have multiple bilateral ovarian cysts due to excessive stimulation of the ovaries
pg. E 30
What is the normal cx to uterus size in a newborn?
2: 1
pg. E 32 O 302
What are the indications for imaging a pediatric pelvis?
r/o ovarian cysts assess for PCOS r/o neoplasms r/o congenital anomalies determine presence/absence of UT in newborns w/ ambiguous genitalia precocious puberty r/o hydro/hematocolpos pg. E 33
What is precocious puberty?
onset of secondary sexual characteristics prior to age 8
pg. E 33
What is hydrometrocolpos?
Fluid in UT and VAG
pg. E 34
What is hematocolpos?
Blood in VAG
pg. E 34
What is the sonographic finding of hydrometrocolpos?
Hypoechoic VAG/ENDO posterior acoustic enhancement Possible internal echoes Hydronephrosis, if severe pg. E 34
What should a postmenopausal endometrium measure with and without HRT?
4-5 mm w/o HRT w/ bleeding
<8 mm w/ HRT; w/o HRT asymptomatic pt
pg. E 36
What is the most common reason for postmenopausal bleeding?
Exogenous estrogen administration w/ HRT
Endometrial atrophy w/o HRT
pg. E 38
What is tamoxifen?
A chemotherapeutic agent used for pt w/ breast ca. It can increase risk for endometrial ca.
pg. 38
What is complete/partial agenesis of VAG, CX, UT, and FT?
Failure of Mullerian ducts to form/develop
Complete absence
pg. E 41 O 303
What is a unicornate uterus?
Unilateral development of Mullerian ducts
Laterally positioned small UT
pg. E 41 O 304
What is a didelphys uterus?
No fusion of Mullerian ducts
2 UT, CX, and VAG
pg. E 41 O 303
What is a bicornuate uterus?
Partial fusion of Mullerian ducts
Deep notch in UT, 2 endometriums
pg. E 41 O 303
What is a septate uterus?
Complete fusion of Mullerian ducts w/ failure to reabsorb septum
Indentation in fundus
pg. E 41 O 303
What is an arcuate uterus?
Complete fusion of Mullerian ducts w/ almost compete resorption of septum
Mild superior separation of endo only
pg. E 41 O 303
What is a Gartner’s duct cyst?
Anterolateral vaginal cyst
pg. E 42 O 331
What is the most common neoplasm of the uterus?
Intramural leiomyoma
pg. E 43 O 331
Where is the submucosal fibroid located?
Within endometrium, most symptomatic
pg. E 43 O 332
Where is the intramural fibroid located?
Within myometrium
pg. E 43 O 332
Where is the subserosal fibroid located?
Beneath perimetrium
pg. E 43 O 332
Where can a fibroid be pedunculated?
Submucosal
Subserosal
pg. E 43 O 332
What are the clinical signs of myomas?
Heavy periods Enlarged UT on pelvic exam Increasing pain Infertility pg. E 44 O 332
What are the sonographic findings of leiomyomas?
Lobulated hypoechoic mass
Shadowing
Whorled texture
pg. E 44 O 332
Are leiomyosarcomas common or rare?
Rare
pg. E 44 O 332
How do leiomyosarcomas appear under ultrasound?
Identical to benign fibroids
Heterogenous
Grow rapidly
pg. E 44
What is adenomyosis?
Growth of endometrial tissue into myometrium; focal or diffuse
pg. E 45 O 332
What are the sonographic findings of adenomyosis?
Enlarged UT Heterogenous myometrium "Venetian blind" shadowing High vascularity pg. E 45 O 332
Cervical cancer is the ____ most common GYN malignancy.
2nd; 3rd
E 45; O 332
What are the risk factors associated with cervical carcinoma?
HPV infection Early sexual activity Multiple sex partners Smoking OCP use pg. E 45 O 332
What are the symptoms associated with cervical ca?
Vaginal bleeding (most common) Palpable mass Weight loss Asymptomatic pg. E 45 O 332
What are the sonographic findings of cervical cancer?
Normal in early disease Enlarged cx Similar to fibroid Hydronephrosis pg. E 45 O 332
What are the sonographic findings of a nabothian cyst?
Small anechoic structure in cervix
pg. E 46 O 332
What is hydrometra?
Fluid in the endometrial cavity
pg. E 46 O 333
What is a uterine arteriovenous malformation?
Sonographically it is abundant flow low resistance on spectral Doppler
pg. E 46
What is the most common GYN malignancy?
Endometrial carcinoma
pg. E 47 O 333
Who does endometrial carcinoma most commonly occur in?
Postmenopausal women
Obesity
Hx tamoxifen therapy
pg. E 47 O 333
What are the clinical signs of endometrial carcinoma?
Postmenopausal vaginal bleeding
Hypermenorrhea premenopausal
Pain
pg. E 47 O 333
What are the sonographic findings of endometrial carcinoma?
Heterogenous endometrium
Thickened endo
Complex endo mass
pg. E 47 O 333
What is the most common cause of abnormal uterine bleeding?
Endometrial hyperplasia
pg. E 48
What can cause endometrial hyperplasia?
Hormone replacement therapy (most common)
pg. E 48 O 333
What are the clinical findings of endometrial hyperplasia?
Similar to endo carcinoma (it can lead to it)
Abnormal bleeding
pg. E 48 O 333
What are the sonographic findings of endometrial hyperplasia?
Thickened endo
Smooth, homogenous
pg. E 48 O 333
What are the clinical signs of endometrial polyps?
Asymptomatic
Abnormal bleeding
Infertility
pg. E 49 O 333
What are the sonographic findings of endometrial polyps?
Echogenic mass in endo
Possible vascular stalk
pg. E 49 O 333
What is a saline infusion sonohysterography?
Hysterosonography
Saline inserted into endometrium
Can look for polyps, cysts, myomas, scarring
pg. E 50
What is Asherman syndrome?
Patient has adhesions in the endometrium from a dilate and currate or infection
pg. O 333
What are the sonographic findings of Asherman syndrome?
Cannot distinguish endo
Bright echoes w/in endo
pg. O 333
What is a follicular ovarian cyst?
Overstimulation of a follicle that fails to rupture typically 3-8 cm
pg. E 52
What is a corpus luteal cyst?
Cyst occurring after ovulation
Typically regresses if not pregnant
Typically persist into the 1st trimester
pg. E 52
What are theca lutein cysts?
Occur w/ high levels of hCG
Typically w/ gestational trophoblastic disease and hCG administration during infertility treatment
Do not secrete hormones
pg. E 53 O 334
What are the sonographic finding of a theca lutein cyst?
Multilocular
Bilateral
Largest of functional cysts
pg. E 53 O 334
What is a hemorrhagic cyst?
Large changing its appearance w/ time
Cystic –> solid –> internal echoes
pg. E 53
What is ovarian torsion?
Partial or complete rotation of ovary
pg. E 54 O 336
What is the sonographic appearance of ovarian torsion?
Enlarged ovary
Absent spectral Doppler flow
No venous flow
pg. E 54 O 336
What is polycystic ovarian syndrome?
Stein-Leventhal syndrome "String of pearls" cysts on ovaries Infertility Obesity Amenorrhea Hirsutism pg. E 55 O 334
What is another name for PCOS?
Stein-Leventhal Syndrome
pg. E 55 O 334
What is another name for an epithelial tumor?
Cystadenoma or cystadenocarcinoma
pg. O 334
Malignant epithelial tumors account for approximately ___% of all ovarian malignancies.
90%
pg. E 56
What are the 5 categories of epithelial tumors?
Serous Mucinous Endometroid Clear cell Transitional cell (Brenner) pg. E 56
What is the 2nd most common benign tumor of the ovary?
Serous cystadenoma
pg. O 334
What does serous cystadenoma appear like on ultrasound?
Anechoic Sharp margins Unilocular Septations pg. E 57 O 334
What does a serous cystadenocarcinoma appear as on ultrasound?
Anechoic sometimes w/ echogenic material Multilocular Septations Ascites pg. E 57 O 334
What does mucinous cystadenoma appear as on ultrasound?
Multilocular Thick septations Echoes Up to 50 cm pg. E 57
What does a mucinous cystadenocarcinoma appear as on ultrasound?
Multiloculated
Echogenic material w/in
15-30 cm
pg. E 58
Are transitional cell (Brenner) tumors typically benign or malignant?
Benign
pg. E 58 O 335
What are germ cell tumors?
Benign cystic teratoma (dermoid)
Dysgerminoma
Endodermal sinus tumor
pg. E 59
What is the most common germ cell tumor?
Benign cystic teratoma (dermoid)
pg. E 59 O 334
What is in a teratoma?
Fat Hair Skin Teeth pg. O 334
What does a dermoid look like sonographically?
"Tip of the iceberg" - solid, complex mass w/ bright echoes Thick septations Calcifications Located superior to uterus Dirty shadow pg. E 60 O 334
Is a dysgerminoma benign or malignant?
Malignant
pg. E 60 O 335
What is the sonographic appearance of a dysgerminoma?
Multilobulated Solid Typically unilateral Variable size pg. E 60 O 335
What age group is typically affected by germ cell tumors?
Under 30 years old
pg. E 59 O 335
What are the different sex cord stromal tumors?
Fibroma Thecoma Granulosa cell tumor Sertoli-Leydig tumors pg. E 61
Are fibromas benign or malignant?
Benign
pg. E 61 O 335
What are the sonographic findings of a fibroma?
Homogenous hypoechoic mass Posterior acoustic shadowing Pedunculated Associated w/ ascites and pleural effusion pg. E 61 O 335
At what age are stromal tumors most common?
Menopausal women
pg. E 61 O 335
What is Meig’s syndrome?
ascites and pleural effusion occuring with an ovarian mass
pg. E 61 O 331
Are thecomas typically benign or malignant?
benign
pg. E 62 O 335
What are the sonographic findings of a thecoma?
Solid hypoechoic mass Posterior acoustic shadowing Unilateral Abnormally thickened endometrium pg. E 62 O 335
What is the reason granulosa cell tumors are produced?
Hormones, the tumor produces estrogen
pg. E 62 O 335
What are the sonographic findings of a granulosa cell tumor?
Solid or complex
Abnormally thickened endometrium
pg. E 62 O 335
What are the sonographic findings of a Sertoli-Leydig tumor?
Similar to granulosa, solid/complex
pg. E 62
Ovarian cancer is the ___ leading cause of cancer death.
5th
pg. E 64
Paraovarian cysts result from the remnants of the _______.
Wolffian ducts
pg. E 66
What are the sonographic characteristics of a paraovarian cyst?
simple cyst adjacent to the ovary
pg. E 66 O 343
What is the sonographic appearance of PID?
Normal Thick and hypervascular endometrium Tubular adnexal structures Adnexal mass pg. E 69 O 344
What is endometriosis?
ectopic location of endometrial tissue
pg. E 70 O 343
What is localized endometriosis called?
endometrioma
pg. E 70 O 343
What is another term for endometrioma?
chocolate cyst
pg. E 70 O 343
Sonographically what does an endometrioma look like?
Hypoechoic homogenous (solid, cystic, or complex) mass
difficult to visualize by sonography
pg. E 71 O 343
What is a Krukenberg tumor?
Type of metastatic ovarian carcinoma arising from the GI primary
pg. E 63 O 343
What is a tuboovarian abscess?
Multilocular mass in the adnexa from a pelvic infection
pg. O 344
What RI is considered a malignancy for ovaries?
<0.4
pg. H 1006
What are possible complications of sonohysterography?
Vasovagal response
Pelvic infection
Vaginal bleeding
URR Exam
If a patient is suspected to have ovarian torsion what should be adjusted when using Doppler?
Decrease color Doppler velocity scale
Increase color gain
URR Exam
Is normal ovarian flow low or high resistive?
Low resistive
URR Exam
What hormone is suppressed with oral contraceptives?
FSH
What does a sertoli-leydig cell tumor produce?
Testosterone
What are the other names for a Sertoli-Leydig cell tumor?
Androblastoma
Arrhenoblastoma
What are the typical Doppler waveforms obtained from the uterine artery in a nulligravida UT?
High resistance
High velocity
Where does the left ovarian vein drain into?
Left renal vein
Which hormone is responsible for ovulation?
Estrogen
If a mucinous ovarian malignancy ruptured, what could develop?
Psuedomyxoma peritonei
What hormone is responsible for proliferation of the endometrium?
Estrogen
What hormone is responsible for final maturation of the follicle and ovulation?
LH
