GynObs

Question 1

Reliable morphologic criteria to diagnose IUP on TVS

Answer 1

Mean sac diameter 8mm - should see yolk sac

MSD 16mm - shd see embryo

CRL 5mm - shd see HR

Question 2

Adnexal findings of an ectopic pregnancy

Answer 2

Free fluid
Adnexal mass : echogenic; ring of fire, gestational sac, yolk sac, fetal pole
Look for ovarian tissue around corpus luteum ( ovarian ectopic 1%)

Question 3

Intrauterine findings in ectopic pregnancy

4

Answer 3

Normal ET
Thickened/heterogeneous
Decidual cysts
Pseudogestational sac ( 5%)

Question 4

Mature teratoma
USS features
3

Answer 4

dot-dash pattern
Dermoid plug (echogenic)
Fat globules (echogenic)

Question 5

Ovarian torsion
imaging findings
7

Answer 5

Enlarged > 4cm
Heterogeneous 40%
Follicles pushed to periphery 74%
Pelvic fluid 87%
Twisted vascular pedicle 88%
No flow 40%, no venous flow 33-93%
Lead mass ( mature dermoid) often > 4cm

Question 6

Placental grading of maturity

4

Answer 6

0 - smooth chorionic plate, homogeneous substance

1 - random echogenic areas

2- basal echogenic line, comma like indentations in the chorionic plate

3 - echo poor areas in substance, deep indentations in the chorionic plate, irregular echogenic areas

Question 7

Biophysical profile:
0-10 score
Each variable :
0-abnormal;
2 -normal

Answer 7

NST(FHR) - reactive
Fetal breathing - 1 episode of >20s within 30”
Fetal movement - min 2 discrete episodes
Fetal tone - 1 epi flexion/extension extremities or spine
AFV - > 2cm pocket

Question 8

UA systolic/diastolic ratio

placental end shows more end diastolic flow

Answer 8

Varies with gestational age
Systolic velocity/diastolic (50th percentiles) 
20/52 - 4 
30/52 - 2.83
40/52 - 2.18

Opposite in fetal MCA( high RI is normal , always higher than UA) but decreases with GA.

Question 9

Uterine adenomyosis
demo
Types
RF

Answer 9

premenopausal, multiparous
40-50, prior uterine surgery
HSG- pseudosacculations
MRI- T2 bright ectopic endometrial glands, T2 dark due to hypertrophic sm reaction
Diffuse - entire interface, > 12mm junctional zone (indirect)

Focal ( adenomyoma) - elliptical mass ( T2 bright foci)

Gradual enhancement
Elliptical shape
Lack of mass effect on endometrium
Ill-defined margins

Question 10

Adenomyotic cyst

Answer 10

looks like an endometrioma in the myometrium

T2 bright surrounded by dark

Intramural or subserosal

Question 11

Degeneration of fibroid types and RF

6

Answer 11

Non degenerated - well defined, homogeneous T2 low, post CE

Hyaline : low T2, var T1

Myxoid - V high T2, min CE

Calcific - low T2/signal void

Cystic - high T2, no CE

Red/haemorrhagic - infarction, peri/diffuse T1 high

Fatty

Question 12

Cellular leiomyoma

Answer 12

Increased T2
Compact smooth muscle
homogeneous CE

Question 13

Uterine Sarcoma

Types 4

Answer 13

mesenchymal
1-3%
Carcinosarcomas 40%
Leiomyosarcomas 40%
Endometrial stromal sarcomas 10-15%
Undifferentiated sarcomas 5-10%

Question 14

Carcinosarcoma
demo
RF

Answer 14

v. aggressive
metaplastic (mixed)
post menopausal
1/3rd have hx pelvic irradiation
cf endo : larger, deeper myometrial invasion
Diff restriction ( inc cellularity)
CE more than endometrium

Question 15

Leiomyosarcoma

Answer 15

1-2% uterine malignancies
>40 yrs
40% uterine sarcomas
Irregular margin
Variable T1/T2 SI
No Ca
Avidly CE

Question 16

Endometrial carcinoma

Answer 16

PMB, ET > 5mm
2 types - endometrioid, papillary serous, clear cell

T2 intermediate SI relative to endometrium

CE- earlier than endometrium but LESS than normal myometrium

Diffusion restricts

Question 17

Cervical cancer

Answer 17

FIGO clinical staging ( developing world)

T2 intermediate in cervical stroma ( Eq JZ)

Question 18

MRI breast features of invasive ductal carcinoma

Answer 18

Rim/inhomogeneous CE
Plateau/washout
(enhances to atleast 60% above baseline)
(5% less CE)
multifocal disease
Nipple/chest wall involvement

Question 19

Invasive lobular breast carcinoma MRI

demo

Answer 19

10-15%
mammogram underestimates 20-40%
upto 50% multifocal, bilateral
Typical washout CE
Architectural distortion

Question 20

Inflammatory breast ca

MRI

Answer 20

skin CE + thickening
CE of coopers ligaments
Not MRI dx
Skin biopsy

Question 21

Post radiotherapy changes in breast ca MRI

Answer 21

9-12m marked CE > patchy

18m - fibrosis and less CE

Question 22

Fat necrosis on MRI

Answer 22

spiculated CE ( may have washout)
check non FS T1 ( central fat signal)

Question 23

Benign Lymph node MRI characteristics

Answer 23

Typical reniform shape
Intense CE +/- washout
High T2 signal
Fatty hilum T1 non FS