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OB/GYN REVIEW > GYN > Flashcards

GYN Flashcards

1
Q

What is contained in the true pelvis?

A 
reproductive organs
bladder
distal ureters
bowel
pg. E 6, O 296
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2
Q

What are the osseous ligaments?

A 
sacroiliac 
sacrosciatic
sacrococcygeal
pubic
pg. E 7
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3
Q

What ligament(s) support the cervix?

A

Cardinal (laterally)

pg. E 7, O 298

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4
Q

What ligament(s) support the uterus?

A

Broad (laterally)
Round (anteriorly)
Uterosacral (posteriorly)
pg. E 7, O 298

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5
Q

What ligament(s) support the ovaries?

A

Broad
Suspensory aka Infundibulopelvic (laterally)
Ovarian (inferiorly)
Mesovarian (posteriorly)

pg. E 7, O 298

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6
Q

What ligament(s) support the fallopian tubes?

A

Broad (laterally)
Round (anteriorly)
pg. E 7, O 298

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7
Q

Where is the rectus abdominis located?

A

Anterior abdominopelvic wall

pg. E 9

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8
Q

Where is the psoas major muscle located?

A

Posterior abdominopelvic wall

pg. E 9, O 297

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9
Q

Where is the iliacus muscle located?

A

Laterally in the false pelvis

pg. E 9

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10
Q

Where is the levator ani group located?

A

Middle, anterior pelvic floor

pg. E 9, O 297

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11
Q

Where is the coccygeous muscle located?

A

Posterior pelvic floor

pg. E 9

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12
Q

Where are the piriformis muscles located?

A

Posterior wall in true pelvis

pg. E 9, O 297

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13
Q

Where are the obturator internus muscles located?

A

Lateral wall in true pelvis

pg. E 9, O 297

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14
Q

What is formed by the psoas major and iliacus muscles?

A

iliopsoas muscles

pg. O 297

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15
Q

How long is the typical vagina?

A

7-10 cm

pg. E 10

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16
Q

What are the typical dimensions of the menarche nulliparous uterus?

A

6-8.5 x 3-5 x 3-5 cm

pg. O 302

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17
Q

What are the typical dimensions of the menarche multiparous uterus?

A

8-10.5 x 3-5 x 5-6 cm

pg. O 302

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18
Q

What are the typical dimensions of the premenarche uterus?

A

2-4 x 0.5-1 x 1-2 cm

pg. O 302

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19
Q

What are the typical dimensions of the postmenopausal uterus?

A
  1. 5-7.5 x 2-3 x 4-6 cm

pg. O 302

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20
Q

What is the isthmus of the uterus?

A

Lower uterine segment

pg. E 11 O 301

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21
Q

What are the layers of the uterus?

A

Perimetrium (serosa)
Myometrium
Endometrium
pg. E 11-12 O 300

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22
Q

What is the inner portion of the myometrium called?

A

Junctional zone

pg. E 11 O 300

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23
Q

What are the 2 layers of the endometrium? Which is located where?

A 
Basal layer (deep)
Functional layer (superficial, sheds)
pg. E 11 O 301
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24
Q

What is anteversion?

A

Uterus tilted forward upon cx ( 90 degrees or less)

pg. E 13 O 303

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25
Q

What is retroversion?

A

Uterus tilted down towards cx (90 degrees or less)

pg. E 13 O 303

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26
Q

What is anteflexion?

A

Uterus bent on cx ( greater than 90 degrees)

pg. E 13 O 303

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27
Q

What is retroflexion?

A

Uterus curved backward on cx (greater than 90 degrees)

pg. E 13 O 303

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28
Q

What does dextro- and levo- mean?

A

Right and Left

pg. O 303

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29
Q

Which uterine position is most common?

A

Anteversion

pg. E 13

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30
Q

What is the size of premenopausal ovaries?

A
  1. 5 x 2 x 1.5 cm

pg. E 15 O 305

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31
Q

What is the size of postmenopausal ovaries?

A

2 x 1 x 0.5 cm

pg. E 15 O 305

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32
Q

How long are the fallopian tubes?

A

7-14 cm

pg. E 16 O 307

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33
Q

What are the parts of the fallopian tube beginning near the uterus?

A 
Interstitial portion
Isthmus
Ampulla
Infundibulum
pg. E 16 O 306
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34
Q

Where is the Space of Retzius and what are the other name(s)?

A

Between bladder and symphysis pubis
Retropubic and Prevesical space
pg. E 17 O 299

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35
Q

Where is the Vesicouterine pouch and what are the other name(s)?

A

Between uterus and bladder
Anterior cul-de-sac
pg. E 17 O 299

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36
Q

Where is the Retrouterine pouch and what are the other name(s)?

A

Between rectum and uterus
Posterior cul-de-sac and Pouch of Douglas
pg. E 17 O 299

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37
Q

What are the branches of the uterine artery?

A

(superficial to deep)
Arcuate > radial > spiral
(periphery) > myometrium > endometrium
pg. E 18 O 298

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38
Q

Where does cervix get it’s blood supply?

A

Uterine arteries

pg. O 298

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39
Q

Where does vagina get it’s blood supply?

A

Uterine arteries

pg. O 298

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40
Q

Where do ovaries get blood supply?

A

primary- ovarian arteries
secondary - uterine arteries
pg. O 298

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41
Q

What hormone(s) are produced by the hypothalamus and secreted by the pituitary gland?

A

FSH and LH

pg. E 22 O 316

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42
Q

What does FSH stimulate?

A

Stimulates ovaries to develop follicles
and estrogen
pg. E 22 O 316

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43
Q

What does LH stimulate?

A

Stimulates maturation of follicles
and progesterone
pg. E 22 O 316

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44
Q

What are the ovarian phases?

A

Follicular (days 1-14)
Ovulation (day 14)
Luteal (days 15-28)
pg. E 23 O 320

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45
Q

What are the uterine phases of the menstrual cycle?

A

Menstrual (days 1-5)
Proliferative (days 6-14)
Secretory (days 15-28)
pg. E 24 O 317

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46
Q

What happens in the follicular phase?

A

FSH increases, Ovarian follicles increase in size

pg. E 23 O 320

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47
Q

What happens at ovulation?

A

Graafian follicle ruptures

pg. E 23 O 321

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48
Q

What is Mittelschmerz?

A

unilateral pelvic pain occurring mid cycle, associated with ovulation
pg. E 23 O 321

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49
Q

What happens in the luteal phase?

A

Corpus luteum forms
if fertilized it will continue to secrete progesterone
if fertilization does not occur it regresses
pg. E 23 O 322

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50
Q

What is the sonographic appearance of the endometrium during the early and late menstrual phases?

A

Early - Thin hypoechoic line 4-8mm
Late - Thin hyperechoic line 2-3mm
1-4mm
pg. E 24 O 317

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51
Q

What is the sonographic appearance of the endometrium during the early and late proliferative phases?

A

Early - thin hyperechoic line 4-6mm
Late - thick 3 line sign 4-8mm
4-8mm
pg. E 24 O 318

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52
Q

What is the sonographic appearance of the endometrium during the secretory phase?

A

Thick, hyperechoic line
7-14mm
pg. E 24 O 319

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53
Q

What is menorrhagia?

A

heavy flow during cyclic menstrual bleeding

pg. E 26

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54
Q

What is polymenorrhea?

A

cycles less than 21 days apart

pg. E 26

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55
Q

What is oligomenorrhea?

A

cycles more than 35 days apart

pg. E 26

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56
Q

What is metrorrhagia?

A

irregular, frequent bleeding

pg. E 26

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57
Q

What is menometrorrhagia?

A

irregular bleeding in both frequency and volume

pg. E 26

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58
Q

What is dysmenorrhea?

A

painful bleeding

pg. E 26

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59
Q

What is amenorrhea?

A

absence of menstrual flow

pg. E 26

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60
Q

If a patient is using oral contraceptive pills, what will not occur and what will be observed?

A

Ovulation will not occur
No dominant follicles
Endometrium remains small throughout cycle
pg. E 26 O 324

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61
Q

What is the sonographic appearance of an IUD?

A

Hyperechoic to endometrium
Located in the fundus
Posterior shadowing
pg. E 27 O 324

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62
Q

What IUDs are used today and what are the shape(s)?

A

Paraguard (Copper T-shape)
Mirena and Skyla (hormone releasing plastic T)
pg. E27 O 324

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63
Q

What are other IUDs are there and what is the shape of each?

A 
Copper T (T-shape)
Saf-T-Coil
Lippes Loop
Progestasert (hormonal)
pg. E 27 O 324
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64
Q

What is infertility? How often does it occur?

A

Inability to achieve pregnancy after 1 year of trying
1/7 American couples
pg. E 28 O 345

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65
Q

What can be done to help couples achieve pregnancy?

A

Ovulation induction
Ovulation monitoring
Assisted reproductive technologies
pg. E 29 O 345

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66
Q

What is IVF?

A

In-vitro fertilization- incubation of oocytes and sperm and catheter deliver into uterus
pg. E 29 O 345

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67
Q

What is ZIFT?

A

Zygote Intrafallopian Tube Transfer
Zygote is placed into fallopian tube
pg. E 29 O 345

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68
Q

What is GIFT?

A

Gamete Intrafallopian Tube Transfer
Sperm and ova are placed into fallopian tube
pg. E 29 O 345

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69
Q

What is Ovarian Hyperstimulation Syndrome?

A

Ovaries have multiple bilateral ovarian cysts due to excessive stimulation of the ovaries
pg. E 30

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70
Q

What is the normal cx to uterus size in a newborn?

A

2: 1

pg. E 32 O 302

71
Q

What are the indications for imaging a pediatric pelvis?

A 
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
72
Q

What is precocious puberty?

A

onset of secondary sexual characteristics prior to age 8

pg. E 33

73
Q

What is hydrometrocolpos?

A

Fluid in UT and VAG

pg. E 34

74
Q

What is hematocolpos?

A

Blood in VAG

pg. E 34

75
Q

What is the sonographic finding of hydrometrocolpos?

A 
Hypoechoic VAG/ENDO
posterior acoustic enhancement
Possible internal echoes
Hydronephrosis, if severe
pg. E 34
76
Q

What should a postmenopausal endometrium measure with and without HRT?

A

4-5 mm w/o HRT w/ bleeding
<8 mm w/ HRT; w/o HRT asymptomatic pt
pg. E 36

77
Q

What is the most common reason for postmenopausal bleeding?

A

Exogenous estrogen administration w/ HRT
Endometrial atrophy w/o HRT
pg. E 38

78
Q

What is tamoxifen?

A

A chemotherapeutic agent used for pt w/ breast ca. It can increase risk for endometrial ca.
pg. 38

79
Q

What is complete/partial agenesis of VAG, CX, UT, and FT?

A

Failure of Mullerian ducts to form/develop
Complete absence
pg. E 41 O 303

80
Q

What is a unicornate uterus?

A

Unilateral development of Mullerian ducts
Laterally positioned small UT
pg. E 41 O 304

81
Q

What is a didelphys uterus?

A

No fusion of Mullerian ducts
2 UT, CX, and VAG
pg. E 41 O 303

82
Q

What is a bicornuate uterus?

A

Partial fusion of Mullerian ducts
Deep notch in UT, 2 endometriums
pg. E 41 O 303

83
Q

What is a septate uterus?

A

Complete fusion of Mullerian ducts w/ failure to reabsorb septum
Indentation in fundus
pg. E 41 O 303

84
Q

What is an arcuate uterus?

A

Complete fusion of Mullerian ducts w/ almost compete resorption of septum
Mild superior separation of endo only
pg. E 41 O 303

85
Q

What is a Gartner’s duct cyst?

A

Anterolateral vaginal cyst

pg. E 42 O 331

86
Q

What is the most common neoplasm of the uterus?

A

Intramural leiomyoma

pg. E 43 O 331

87
Q

Where is the submucosal fibroid located?

A

Within endometrium, most symptomatic

pg. E 43 O 332

88
Q

Where is the intramural fibroid located?

A

Within myometrium

pg. E 43 O 332

89
Q

Where is the subserosal fibroid located?

A

Beneath perimetrium

pg. E 43 O 332

90
Q

Where can a fibroid be pedunculated?

A

Submucosal
Subserosal
pg. E 43 O 332

91
Q

What are the clinical signs of myomas?

A 
Heavy periods
Enlarged UT on pelvic exam
Increasing pain
Infertility
pg. E 44 O 332
92
Q

What are the sonographic findings of leiomyomas?

A

Lobulated hypoechoic mass
Shadowing
Whorled texture
pg. E 44 O 332

93
Q

Are leiomyosarcomas common or rare?

A

Rare

pg. E 44 O 332

94
Q

How do leiomyosarcomas appear under ultrasound?

A

Identical to benign fibroids
Heterogenous
Grow rapidly
pg. E 44

95
Q

What is adenomyosis?

A

Growth of endometrial tissue into myometrium; focal or diffuse
pg. E 45 O 332

96
Q

What are the sonographic findings of adenomyosis?

A 
Enlarged UT
Heterogenous myometrium
"Venetian blind" shadowing
High vascularity
pg. E 45 O 332
97
Q

Cervical cancer is the ____ most common GYN malignancy.

A

2nd; 3rd

E 45; O 332

98
Q

What are the risk factors associated with cervical carcinoma?

A 
HPV infection
Early sexual activity
Multiple sex partners
Smoking
OCP use
pg. E 45 O 332
99
Q

What are the symptoms associated with cervical ca?

A 
Vaginal bleeding (most common)
Palpable mass
Weight loss
Asymptomatic
pg. E 45 O 332
100
Q

What are the sonographic findings of cervical cancer?

A 
Normal in early disease
Enlarged cx
Similar to fibroid 
Hydronephrosis
pg. E 45 O 332
101
Q

What are the sonographic findings of a nabothian cyst?

A

Small anechoic structure in cervix

pg. E 46 O 332

102
Q

What is hydrometra?

A

Fluid in the endometrial cavity

pg. E 46 O 333

103
Q

What is a uterine arteriovenous malformation?

A

Sonographically it is abundant flow low resistance on spectral Doppler
pg. E 46

104
Q

What is the most common GYN malignancy?

A

Endometrial carcinoma

pg. E 47 O 333

105
Q

Who does endometrial carcinoma most commonly occur in?

A

Postmenopausal women
Obesity
Hx tamoxifen therapy
pg. E 47 O 333

106
Q

What are the clinical signs of endometrial carcinoma?

A

Postmenopausal vaginal bleeding
Hypermenorrhea premenopausal
Pain
pg. E 47 O 333

107
Q

What are the sonographic findings of endometrial carcinoma?

A

Heterogenous endometrium
Thickened endo
Complex endo mass
pg. E 47 O 333

108
Q

What is the most common cause of abnormal uterine bleeding?

A

Endometrial hyperplasia

pg. E 48

109
Q

What can cause endometrial hyperplasia?

A

Hormone replacement therapy (most common)

pg. E 48 O 333

110
Q

What are the clinical findings of endometrial hyperplasia?

A

Similar to endo carcinoma (it can lead to it)
Abnormal bleeding
pg. E 48 O 333

111
Q

What are the sonographic findings of endometrial hyperplasia?

A

Thickened endo
Smooth, homogenous
pg. E 48 O 333

112
Q

What are the clinical signs of endometrial polyps?

A

Asymptomatic
Abnormal bleeding
Infertility
pg. E 49 O 333

113
Q

What are the sonographic findings of endometrial polyps?

A

Echogenic mass in endo
Possible vascular stalk
pg. E 49 O 333

114
Q

What is a saline infusion sonohysterography?

A

Hysterosonography
Saline inserted into endometrium
Can look for polyps, cysts, myomas, scarring
pg. E 50

115
Q

What is Asherman syndrome?

A

Patient has adhesions in the endometrium from a dilate and currate or infection
pg. O 333

116
Q

What are the sonographic findings of Asherman syndrome?

A

Cannot distinguish endo
Bright echoes w/in endo
pg. O 333

117
Q

What is a follicular ovarian cyst?

A

Overstimulation of a follicle that fails to rupture typically 3-8 cm
pg. E 52

118
Q

What is a corpus luteal cyst?

A

Cyst occurring after ovulation
Typically regresses if not pregnant
Typically persist into the 1st trimester
pg. E 52

119
Q

What are theca lutein cysts?

A

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

120
Q

What are the sonographic finding of a theca lutein cyst?

A

Multilocular
Bilateral
Largest of functional cysts
pg. E 53 O 334

121
Q

What is a hemorrhagic cyst?

A

Large changing its appearance w/ time
Cystic –> solid –> internal echoes
pg. E 53

122
Q

What is ovarian torsion?

A

Partial or complete rotation of ovary

pg. E 54 O 336

123
Q

What is the sonographic appearance of ovarian torsion?

A

Enlarged ovary
Absent spectral Doppler flow
No venous flow
pg. E 54 O 336

124
Q

What is polycystic ovarian syndrome?

A 
Stein-Leventhal syndrome 
"String of pearls" cysts on ovaries
Infertility
Obesity
Amenorrhea
Hirsutism
pg. E 55 O 334
125
Q

What is another name for PCOS?

A

Stein-Leventhal Syndrome

pg. E 55 O 334

126
Q

What is another name for an epithelial tumor?

A

Cystadenoma or cystadenocarcinoma

pg. O 334

127
Q

Malignant epithelial tumors account for approximately ___% of all ovarian malignancies.

A

90%

pg. E 56

128
Q

What are the 5 categories of epithelial tumors?

A 
Serous
Mucinous
Endometroid 
Clear cell
Transitional cell (Brenner) 
pg. E 56
129
Q

What is the 2nd most common benign tumor of the ovary?

A

Serous cystadenoma

pg. O 334

130
Q

What does serous cystadenoma appear like on ultrasound?

A 
Anechoic
Sharp margins
Unilocular
Septations 
pg. E 57 O 334
131
Q

What does a serous cystadenocarcinoma appear as on ultrasound?

A 
Anechoic sometimes w/ echogenic material 
Multilocular
Septations
Ascites 
pg. E 57 O 334
132
Q

What does mucinous cystadenoma appear as on ultrasound?

A 
Multilocular
Thick septations
Echoes
Up to 50 cm
pg. E 57
133
Q

What does a mucinous cystadenocarcinoma appear as on ultrasound?

A

Multiloculated
Echogenic material w/in
15-30 cm
pg. E 58

134
Q

Are transitional cell (Brenner) tumors typically benign or malignant?

A

Benign

pg. E 58 O 335

135
Q

What are germ cell tumors?

A

Benign cystic teratoma (dermoid)
Dysgerminoma
Endodermal sinus tumor
pg. E 59

136
Q

What is the most common germ cell tumor?

A

Benign cystic teratoma (dermoid)

pg. E 59 O 334

137
Q

What is in a teratoma?

A 
Fat
Hair
Skin
Teeth
pg. O 334
138
Q

What does a dermoid look like sonographically?

A 
"Tip of the iceberg" - solid, complex mass w/ bright echoes
Thick septations
Calcifications
Located superior to uterus
Dirty shadow
pg. E 60 O 334
139
Q

Is a dysgerminoma benign or malignant?

A

Malignant

pg. E 60 O 335

140
Q

What is the sonographic appearance of a dysgerminoma?

A 
Multilobulated
Solid
Typically unilateral 
Variable size
pg. E 60 O 335
141
Q

What age group is typically affected by germ cell tumors?

A

Under 30 years old

pg. E 59 O 335

142
Q

What are the different sex cord stromal tumors?

A 
Fibroma
Thecoma 
Granulosa cell tumor
Sertoli-Leydig tumors
pg. E 61
143
Q

Are fibromas benign or malignant?

A

Benign

pg. E 61 O 335

144
Q

What are the sonographic findings of a fibroma?

A 
Homogenous hypoechoic mass
Posterior acoustic shadowing
Pedunculated
Associated w/ ascites and pleural effusion
pg. E 61 O 335
145
Q

At what age are stromal tumors most common?

A

Menopausal women

pg. E 61 O 335

146
Q

What is Meig’s syndrome?

A

ascites and pleural effusion occuring with an ovarian mass

pg. E 61 O 331

147
Q

Are thecomas typically benign or malignant?

A

benign

pg. E 62 O 335

148
Q

What are the sonographic findings of a thecoma?

A 
Solid hypoechoic mass
Posterior acoustic shadowing
Unilateral
Abnormally thickened endometrium
pg. E 62 O 335
149
Q

What is the reason granulosa cell tumors are produced?

A

Hormones, the tumor produces estrogen

pg. E 62 O 335

150
Q

What are the sonographic findings of a granulosa cell tumor?

A

Solid or complex
Abnormally thickened endometrium
pg. E 62 O 335

151
Q

What are the sonographic findings of a Sertoli-Leydig tumor?

A

Similar to granulosa, solid/complex

pg. E 62

152
Q

Ovarian cancer is the ___ leading cause of cancer death.

A

5th

pg. E 64

153
Q

Paraovarian cysts result from the remnants of the _______.

A

Wolffian ducts

pg. E 66

154
Q

What are the sonographic characteristics of a paraovarian cyst?

A

simple cyst adjacent to the ovary

pg. E 66 O 343

155
Q

What is the sonographic appearance of PID?

A 
Normal
Thick and hypervascular endometrium
Tubular adnexal structures
Adnexal mass
pg. E 69 O 344
156
Q

What is endometriosis?

A

ectopic location of endometrial tissue

pg. E 70 O 343

157
Q

What is localized endometriosis called?

A

endometrioma

pg. E 70 O 343

158
Q

What is another term for endometrioma?

A

chocolate cyst

pg. E 70 O 343

159
Q

Sonographically what does an endometrioma look like?

A

Hypoechoic homogenous (solid, cystic, or complex) mass
difficult to visualize by sonography
pg. E 71 O 343

160
Q

What is a Krukenberg tumor?

A

Type of metastatic ovarian carcinoma arising from the GI primary
pg. E 63 O 343

161
Q

What is a tuboovarian abscess?

A

Multilocular mass in the adnexa from a pelvic infection

pg. O 344

162
Q

What RI is considered a malignancy for ovaries?

A

<0.4

pg. H 1006

163
Q

What are possible complications of sonohysterography?

A

Vasovagal response
Pelvic infection
Vaginal bleeding
URR Exam

164
Q

If a patient is suspected to have ovarian torsion what should be adjusted when using Doppler?

A

Decrease color Doppler velocity scale
Increase color gain
URR Exam

165
Q

Is normal ovarian flow low or high resistive?

A

Low resistive

URR Exam

166
Q

What hormone is suppressed with oral contraceptives?

A

FSH

167
Q

What does a sertoli-leydig cell tumor produce?

A

Testosterone

168
Q

What are the other names for a Sertoli-Leydig cell tumor?

A

Androblastoma

Arrhenoblastoma

169
Q

What are the typical Doppler waveforms obtained from the uterine artery in a nulligravida UT?

A

High resistance

High velocity

170
Q

Where does the left ovarian vein drain into?

A

Left renal vein

171
Q

Which hormone is responsible for ovulation?

A

Estrogen

172
Q

If a mucinous ovarian malignancy ruptured, what could develop?

A

Psuedomyxoma peritonei

173
Q

What hormone is responsible for proliferation of the endometrium?

A

Estrogen

174
Q

What hormone is responsible for final maturation of the follicle and ovulation?

A

LH

OB/GYN REVIEW (16 decks)

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