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Gynecological DMS 113 > GYNO FINAL > Flashcards

GYNO FINAL Flashcards

1
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2
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*

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Dermoid Tumor

-dermoid mesh

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3
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Dermoid Cyst

-tip of the iceburg

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4
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Testes

  • low level echogenicity
  • 7-10 mm diameter
  • mediastinum teste and epididymus (not seen until after puberty)
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5
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*

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Dermoid Tumor

-dermoid mesh

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6
Q
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Dermoid Cyst

-tip of the iceburg

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7
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Testes

  • low level echogenicity
  • 7-10 mm diameter
  • mediastinum teste and epididymus (not seen until after puberty)
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8
Q

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Bicornate Uterus

  • best seen in trans
  • bicornate and didelphys -not associated w/ infertility
  • duplicated uterus w/ common cervix
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9
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Bicornate Uterus

  • best seen in trans
  • bicornate and didelphys -not associated w/ infertility
  • duplicated uterus w/ common cervix
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10
Q
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Uterus w/ Fibroids

  • fibroid usually has rounded borders
  • fibroids are estrogen dependant and grow during pregnancy
  • may cause infertility
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11
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submucosal fibroids

  • look how each fibroid interfaces w/ endometrial lining
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12
Q

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Uterine Polyp

  • polyp outlined w/ SIS
  • color doppler demonstrating vascular pedicle
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13
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Uterine Polyp

(on a stalk)

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14
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Uterine Synechia

  • synechia shows up as linear strands of scar tissue extending from one side of uterus to other
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15
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Follicles

  • 1st image: follicular phase
  • 2nd image: dominant follicle
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16
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Polycystic Ovarian Syndrome“string of pearls”

  • 12 or more follicles measuring 2-9 mm;

ovarian volume > 10 cm3

  • often occurs w/ clinical triad:
    • olgiomenorrhea, hirsutism, obesity
  • immature follicles continue to produce estrogen and androgen which inhibits pit gland.
  • Pit gland produces more LH than FSH –> follicle to remain in arrested state of development- no mature ova released w/ ovulation
  • chronic elevation of estrogen
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17
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peritoneal inclusion cysts

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18
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endometriosis

  • most common benign gynecologic disease
  • in 10-25% of women w/ gyn disease
  • in 40% of women w/ infertility

assess thickness and echogenicity pattern

increased thickness 2-3 mm –> 12-14 mm

  • measure long plane
  • outer to outer - double layer thickness
  • normal pattern - trilaminar
  • thin endometrium - < 8mm (in secretory phase)
    • -decreased fertility
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19
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A

measuring endometrium

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20
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Ovarian Stimulation

  • administer clomiphene (Clomid) or gonadotropin (Pergonal) day 3-5 in normal cycle
    • enlarges multiple follicles instead of just one dominant follicle
  • US monitors # and size of follicles day 8-14 (follicular phase)
    • count all follicles > 1cm or 10mm
  • ​optimum follcile size = 15-20 mm
  • hCG may be given IM to trigger ovulation w/ retrieval 30-34 hours later
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21
Q
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Oocyte retrieval

  • oocyte fertilization in dish and incubated for 3 to 5 days before embryo transfer
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22
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US guided embryo transfer

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23
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Ovarian Hyperstimulation Syndrome

  • this is a complication of assisted reproductive technology
  • enlarged ovaries, multiple cysts, abd ascites, pleural effusions
    • more common w/ PCOS
    • mild ovarian enlargement 5- 10 cm
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24
Q

A

A

interstitial/ cornual

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25
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B

A

isthmus

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26
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C

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abdominal

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27
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D

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ampulary

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28
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E

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fimbrial

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29
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F

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ovary

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30
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G

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cornual/ interstitial

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31
Q

H

A

fornix

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32
Q

I

A

cervical

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33
Q

J

A

body of uterus

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34
Q

K

A

abdominal peritoneum

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35
Q

What is seen inside this double decidual sac sign?

A

yolk sac

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36
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37
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interstitial pregnancy

  • endometrial cavity line does not enlcose gestational sac
  • absence of surrounding myometrium - pregnancy look like it is at the edge of the right side of uterus
  • most life threatening
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38
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A

cervical ectopic pregnancy

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39
Q
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abdominal ectopic pregnancy

  • pregnancy develops w/in the peritoneal cavity
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42
Q

1.

A

uterine fundus

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43
Q

2

A

fallopian tube

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44
Q

3

A

fimbriae

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45
Q

4

A

myometrium

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46
Q

5

A

endometrium

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47
Q

6

A

uterine isthmus

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48
Q

7

A

lateral fornix

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49
Q

8

A

vagina

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50
Q

9

A

ectocervix

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51
Q

10

A

endocervix

52
Q

11

A

ovarian ligament

53
Q

12

A

ovary

54
Q

benign smooth muscle cell tumor; few appear in the cervix

A

cervical leiomyoma (fibroid)

*

55
Q

fluid filled uterus

A

hydrometra

56
Q

blood filled.

A

hematometra

57
Q

1

leiomyoma locations

A

pedunculated or intracavitary

58
Q

2

leiomyoma locations

A

Ovary

59
Q

3

leiomyoma locations

A

submucosal

60
Q

4

leiomyoma locations

A

uterus

61
Q

5

leiomyoma locations

A

cervix

62
Q

6

leiomyoma locations

A

subserosal

63
Q

7

leiomyoma locations

A

intramural

64
Q

most common gynecologic tumor of childbearing age women, and is more common in black women?

A

submucosal leiomyoma (common location)

  • fibroid is anterior & is pushing endometrium posterior
  • smooth muscle cell tumor
  • encapsulated with pseudocapsule
  • fibrosis w/ degenerative changes
  • out grow their blood supply and atrophy
  • estrogen dependant
    • pregnancy and tamoxifen = ↑ growth (size)
    • menopause w/o HRT = ↓ growth (size)
  • Clinical findings: irreg bleeding, menorrhagia, menometrorrhagia, enlarged uterus, infertility, pee alot
  • on US: (variable) enlarged uterus w/ irregular wall, bright echoes w/ clcifications & shadowing, discrete mass
65
Q

very common benign disease of the uterus; infiltration of endometrial tissue from stratum basalis into myometrium?

A

adenomyosis

  • Ectopic endometrial tissue within myometrium
  • More common posterior uterus
  • Does not bleed with hormone cycle
  • Product of multiple pregnancies
  • Elevated estrogen levels

hypermenorrhea, menorrhagia, metrorrhea, dysmenorrhea

on US:

  • Diffuse uterine enlargement
  • Thickening posterior myometrium
  • Small myometrial cysts - swiss cheese or honeycomb - non vascular
  • Subendometrial cysts
  • Myometrial heterogenicity with ill-defined endometrial borders
  • May mimic fibroid
  • MRI characterizes adenomyosis better
66
Q

overgrowth of endometrial tissue covered by epithelium containing glands, stroma, blood vessels

A

uterine polyps

  • peri & post menopausal women -more common & associated w/ bleeding
  • menstruating women - asociated w/ infertility & menometrorrhagia
  • differential: hyperplasia, submucosal leiomyoma, or endometrial cancer
  • doppler shows a feeding artery in a pedicle
67
Q
A

synechiae

  • intrauterine adhesions (Asherman’s Syndrome)
    • found after trauma or surgery, uterine curettage
  • cause of infertility or pregnancy loss
  • better seen in gravid uterus, secretory phase
  • adhesion bridging bands of tissue- thin membrane or thick broad based adhesion
  • can be divided under hysteroscopy
68
Q
A

IUCD in place

69
Q

small endocrine structure that develops w/in a ruptured ovarian follicle and secretes progesterone and estrogen

A

corpus luteum cyst

70
Q

requires 3 things: smooth walls, fluid filled, acoustic enhancement

A

simple cyst

is usually benign

71
Q
A

corpus luteum cyst

72
Q
A

ovarian hyperstimulation syndrome (OHSS)

  • complication of ovulation induction
  • mild
    • pelvic discomfort, ovaries enlarged < 5cm
  • severe
    • ​severe pelvic pain
    • distended abd.
    • ovaries enlarged >10cm
    • ascites, pleural effusions
    • w/ treatment - resolves in 2-3 weeks
73
Q

12 or more follicles measuring 2-9 mm and ovarian volume greater than 10 cm3

A

polycystic ovarian syndrome (PCOS)

  • very common
  • “string of pearls”
  • stein leventhal syndrome
    • infertility, oligomenorrhea, hirsutism & obesity
  • bilateral enlarged polycystic ovaries
  • common cause of infertility and miscarriage
  • diagnosis usually made by hormone levels
74
Q
A

endometriosis

  • functional endometrial tissue present outside the uterus
  • diffuse is more common
  • localized = chocolate cyst
  • bleeds cyclically
75
Q
A

dermoid tumor

tip of the iceberg sign

76
Q
A

dermoid cyst

dermoid mesh

77
Q
A

hydrosalpinx

fluid in the fallopian tube

78
Q

1

Blood supply to pelvis

A

internal iliac artery

79
Q

2.

Blood supply to pelvis

A

tubal branch of uterine artery

80
Q

3.

Blood supply to pelvis

A

ovarian branch of uterine artery

81
Q

4.

Blood supply to pelvis

A

infundibulopelvic ligament

82
Q

5

Blood supply to pelvis

A

ureter

83
Q

6

Blood supply to pelvis

A

uterine artery

84
Q

7

Blood supply to pelvis

A

vaginal artery

85
Q

8

Blood supply to pelvis

A

internal pudendal artery

86
Q

9

Blood supply to pelvis

A

azygos arteries

87
Q

10

Blood supply to pelvis

A

cervical branch of the uterine artery

88
Q

1

genital tract

A

uterine (fallopian) tube

89
Q

2

genital tract

A

cornu

90
Q

3

genital tract

A

fundus

91
Q

4

genital tract

A

corpus

92
Q

5

genital tract

A

isthmus

93
Q

6

genital tract

A

cervix

94
Q

7

genital tract

A

rugae of mucosal lining

95
Q

8

genital tract

A

adventitia

96
Q

9

genital tract

A

muscular wall

97
Q

10

genital tract

A

mucosa

98
Q

11

genital tract

A

vagina

99
Q

12

genital tract

A

external os

100
Q

13

genital tract

A

lateral vagina fornix

101
Q

14

genital tract

A

internal os

102
Q

15

genital tract

A

serosa

103
Q

16

genital tract

A

myometrium

104
Q

17

genital tract

A

uterine cavity

105
Q

18

genital tract

A

endometrium

106
Q

Uterine Position Variations

A
107
Q

2

fallopian tube

A

infundibulum

108
Q

3

fallopian tube

A

fimbriae

109
Q

4

fallopian tube

A

ovarian ligament

110
Q

5

fallopian tube

A

interstitial portion

111
Q

6

fallopian tube

A

isthmus

112
Q

7

fallopian tube

A

ampulla

113
Q

what endometrial phase is this “thin line”?

A

early proliferative

114
Q

what endometrial phase is this “three line sign”?

A

classic proliferative

115
Q

what endometrial phase is this thickened ?

A

secratory phase

116
Q

what phase?

what position?

A

early secretory

retroflexed to the right

117
Q

what phase?

A

secratory phase

118
Q

what flexion?

A

anteflexed

119
Q

what flexion?

A

anteflexed

120
Q

what flexion?

A

retroflexed

154
Q

indications for 1st trimester exam

A
  • Confirmation of IUP vs. EUP
  • Define cause of bleeding
  • Pelvic Pain
  • Viability
  • # of embryos
  • Gestational age
  • Detect anomalies
  • R/O hydatidform mole
  • Adjunct to CVS, amnio, embryo transfer, IUD removal
  • **First trimester exam performed only when deemed necessary**
155
Q

indications for 2nd & 3rd trimester exam

A
  • Gestational Age
  • Fetal Growth
  • Vaginal Bleeding
  • Abd/Pelvic pain
  • Incompetent cervix
  • Determine fetal presentation
  • # fetuses
  • Size discrepance to dates
  • Pelvic mass
  • Suspected hydatidform mole
  • Cervical cerclage placement
  • R/O ectopic
  • Fetal viability
  • Uterine abnormality
  • Evaluate fetal well-being
  • Amniotic fluid
  • Placental abruption
  • External cephalic version
  • Premature rupture membranes and/or labor
  • Abnormal chemical markers
  • F/U fetal anomaly
  • History prev congenital anomaly
  • Eval for late to prenatal care

Gynecological DMS 113 (26 decks)

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