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Women's > MCQ > Flashcards

MCQ Flashcards

1
Q

Cholestasis of pregnancy

A

.

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2
Q

Breast MRI enhancment patterns

A

Rapid early enhancement with washout suspicious for malignancy
If intermediate early enhancement, may be type 1 (persistant, most benign but could still be malignant) type 3 (plateau - suspicious), or type 3 (washout - highly suspicious)

Peripheral enhancement first is suspicious for malignancy
Central more benign

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3
Q

Benign breast ultrasound features

A 
Marked hyperechogenicity
Thin echogenic pseudocapsule
Wider than tall / parallel
Circumscribed
Ellipsoid
Gentle lobulations
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4
Q

Malignant breast ultrasound features

A 
Spiculate - most specific
Taller than wide
Angular or microlobulated
Shadowing
Markedly hypoechoic
Calcs
Poorly defined margin
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5
Q

Linguine sign

A

Hypoinense lines on MR

Intracapsular silicone implant rupture

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6
Q

Tomosynthesis radiation dose

A

Single DBT images has dose similar to single FFDM image

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7
Q

Atypical ductal hyperplasia on biopsy

A

Spectrum of change from normal, to flat epithelial atypia, to atypical ductal hyperplasia, to DCIS
If core biopsy shows ADH, treat with open biopsy - 18% are upstaged to DCIS or invasive carcinoma

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8
Q

Cleopatra view

A

AKA axillary view

A supplementary exaggerated CC to see the axillary tail, performed if a lesion is only seen in the axilla on MLO

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9
Q

Failed pregnancy

A 
CRL >/= 7mm with no heartbeat
MSD >/= 25mm with no embryo
Absence of embryo with heartbeat:
2 weeks after GS without yolk sac
11 days after GS with yolk sac
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10
Q

Cervical carcinoma

A

High T2 signal compared with background low signal Cervix
T2 to assess parametrial invasion to see if surgical candidate - if T2 hypointense cervical ring intact, parametrial infasion unlikely.
CT is primarily for assessing adenopathy (although MR can do similar?)
Most are squamous - HPV 16 and 18
Several adenocarcinoma types- clear cell, endometrioid, mucinous, serous
Also neuroendocrine (small) and adenosquamous) - small cell have a poor outcome
Adenos generally though to give higher rates of mets - thoracic and adrenal

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11
Q

Ovarian cycle

A 
Proliferative - becomes trilaminar
Secretory - uniformly hyperechogenic
Imaging best performed in early proliferative
Proliferative = follicular
Secretory = luteal
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12
Q

Twin demise

A

Flatenned remnant known as fetus papyraceus
Surviving co-twin at risk of growth restriction, encephalomalacia and microcephaly
Twin embolisation syndrome a rare complication - multi-organ ischaemia, usually antecedent twin-twin transfusion syndrome

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13
Q

Fitz-Hugh-Curtis syndrome

A

Perihepatitis from peritoneal spread of infection in PID

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14
Q

Molar pregnancy

A

Complete, 90% diploid 46XX (less commonly XY) - single sperm or less likely two sperm
Partial, triploid 69XXY, normally from two separate sperm, one X and one Y (other triploid combos possible)
Complete - multiple intrauterine cystic space - bunch of grapes or snow storm
Partial - large cystic placenta and growth retarded fetus

Increased incidence in Asia

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15
Q

Physiological gut herniation of fetus

A

Should not be seen after 12 weeks

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16
Q

Ultrasound screening

A

Unacceptably high rates of biopsy of benign lesions

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17
Q

How many Ca does screening miss

A

1 in 8 pre-menopausal, 1 in 10 post

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18
Q

Clinical exam breast sensitivity

A

Detects 50% of cancers, including 5% of cancers not visible on mammography. May modestly improve early detection

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19
Q

Mammogram timing

A

Early follicular phase, as breasts are less dense

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20
Q

Fibroadenoma, epi

A

Commonest breast lesion in <40

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21
Q

Stellate

A

93% are malignant.

Most invasive breast cancers are stellate (2:1 stellate:circular)

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22
Q

Radial scar

A

Must have no skin thickening or retraction
Long spicules with intervening lucencies, different on different projections
AKA complex sclerosing lesion
Removed as can have associated carcinoma which is not distinguished on core biopsy
Black star - lucent centre (different from carcinoma)

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23
Q

Single reader v double reader v CAD

A

Routine use of CAD significantly increases recall rates. No significant effect on positive predictive value for biopsy – can increase detection rate by 4.7%, sensitivity by 4%.
CADET II study showed cancer detection rates attained with single reading with CAD were equivalent to those attained with double reading.
Performed equally well at recalling patients with cancer in whom the predominant radiologic feature was either a mass or a microcalcification.
Double reading showed superior performance for parenchymal deformities and in women with denser background pattern – i.e. CAD poor at detecting architectural distortion.
Single reader with CAD was better than double reading for asymmetric densities, but the number of these is small and accounted for only 35 of cancers.

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24
Q

Digital mammography

A

40% more sensitive with no change in recall rate

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25
Q

MRI indications

A 
Lump with normal mammogram and USS
Young with BRCA (annual from 30)
Dense breast and LCIS
Staging multicentric multifocal disease
Positive node with negative uss and mammo
Post surgical review of lumpectomy
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26
Q

Maternal AFP

A

Elevated in 80% of cases with open spina bifida
Normal in most fetuses with closed spina bifida
Also elevated in omphalocele, multiple fetuses
And liver tumours and germ cell tumours (esp. yolk sac tumour)
Elevated in placental chorioangioma (the most common placental tumour)

Reduced in Trisomies and Turners

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27
Q

Spina bifida

A

Associated with trisomy 18, 13
Limb anomalies - DDH, talipes, rockerbottom feet
Neurenteric cysts
Lemon skull, banana cerebellum/Chiari

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28
Q

Pregnancy screening

A

1st trimester:
Nuchal translucency, PAPP-A, HCG
1:300 or less is increased risk - offer diagnostic testing
<3mm is normal nuchal translucency 11.3-13.6 weeks, manigified, neutral neck, midline, fluid behind neck (CRL 45-84mm)

2nd trimester:
AFP, HCG, oestriol and inhibin A

In Downs, HCG up and PAPP-A down. AFP would also be down. Inhibin A higher, oestriol lower

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29
Q

Ovarian tumour markers

A

CA125
AFP - teratomas and yolk sac tumours (esp)
bHCG - small number of dysgerminomas

(AFP positive in mothers with fetuses with neural cord defects)

30
Q

Endodermal sinus tumour

A

Is a synonym for yolk sac tumour

31
Q

Ovarian cystadenoma

A

Serous unilocular
Serous more commonly bilateral (15% v 5%) (65% of malignant serous bilateral, 15% benign - 60% are benign, 25% malignant)
Serous more common
Mucinous multiloculated thin septations, and more commonly calcify (mural), and tend to be larger. 80% of mucinous are benign
Serous have papillary projections, psammoma bodies
Serous associated with BRCA1

Serous 60% benign, 25% malignant, rest boderline
Mucinous 80% benign 10% malignant, rest boderline

Mucinous associated with KRAS mutation

32
Q

CMV

A

Necrotising inflammation
90% asymptomatic (in utero infection)
Prominent cytomegalic cells with intranuclear and intracytoplasmic inclusions
Tendendy to localise in ependymal and subependymal regions of brain.

33
Q

Duodenal atresia

A

30% have Downs

Present in 3-5% of Downs

34
Q

Meckel Gruber syndrome

A

Triad
Renal cystic dysplasia
Occipital encephalocele / holoprosencephaly
Post axial polydactyl (post axial is ulnar side)
AR
AKA pseudotrisomy 13

35
Q

Cleft palate

A 
Approximately 1:1000
Amniocentesis as high rate of chromosomal abnormality
1-4 classification
1 lip
2 palate
3 bilateral lip
4 lip and palate
50% 4, 25% 1 and 25% 2
36
Q

Hydrops

A 
Immune - rhesus
Non-immune - heart failure, infection, 
Parvovirus is the most common infection to cause hydrops
TORCH
Aneuploidy
Turners - lymphatic failure

Any cause of failure - shunts from tumours, vascular malformations,
Fetal anaemia - beta thalassamia not til 6-9 months. Homozygous alpha may be commonest cause of fetal hydrops in some parts of world
Errors of metabolism
CPAM could cause caval compression

37
Q

CPAM

A

Can cause caval compression and hydrops (33-80%), (although another source said 10%, and false when asked if most cases have an effusion)
polyhydramnios from oesophageal compression (25-75%)

38
Q

Single umbilical artery

A 
IUGR
Velamentous cord
Trisomy (if other abnormalities)
Renal agenesis same side
Sirenomelia / mermaid syndrome
39
Q

Ovarian sex-cord stromal

A

Granulosa (5% bilateral - most common oestrogenic tumour of ovary, 50% post-menopause, 45% pre)
Thecoma
The above two produce oestrogen, cause precocious puberty or endometrial hyperplasia / carcinoma
Sertoli-Leydig - rare, virilisation (testosterone)
Fibroma - most common one to cause Meigs (90% of M if fibroma. 40% of F causes Meigs)

40
Q

Physiologic bowel herniation

A

Should not be seen after 12-13 weeks

41
Q

Polycystic ovary syndrome

A 
Clinical and biochemical diagnosis
Peripheral cysts - 12 or more follicles in each ovary (Rotterdam - new study says 25)
"String of pearls"
2-9mm
Volume of ovary > 10mL
2 out of 3 of
Oligomenorrhoea
Clinical and biochemical hyperandrogenism
Polycystic ovaries on ultrasound
AND
Exclusion of other causes

Can cause endometrial hyperplasia / cancer / polyps
20% of reproductive age women

42
Q

Ovarian hyperstimulation syndrome

A

Bilateral ovaries > 5mL
Numerous large follicular cysts, with increased blood flow
Echogenic stromal tissue
Ascites and effusions

43
Q

Ectopic pregnancy

A

2% of all pregnancies

44
Q

Clinodactyly

A

Angulation at interphalangeal joint, typically 5th finger
Associated with aneuploidy - Down (60%), 18, Klinefelter, Turner
(In Downs often also have hypoplasia of middle phalanx of 5th)

45
Q

Uterine malformations, outcomes

A

Bicornuate similar to general population

Didelphus and septate have increased miscarriage rates- 30% and 60%

46
Q

Twin peak sign / lambda sign

A

Sign of dichorionicity - placental tissue on separating membrane

47
Q

Tuberculous salpingitis

A

Thickwalled, cystic masses

Painful, afebrile

48
Q

Molar pregnancy

A

Complete mole haploid - 2 sperm empty egg or duplicated single sperm
Partial mole - two sperm in an egg with chromosomes - triploid
Bilateral theca lutein cysts from high HCG - upto 50%, more common in complete

Invasiv mole 5-10%
Choriocarcinoma 1-5%

49
Q

Echogenic bowel

A 
Soft marker of T21
CF
Intra-amniotic haemorrhage with swallowed blood products
CMV
IUGR
Fetal hypoxia
Hydrops
50
Q

Placental praevia

A

Low lying <2cm
Marginal covers part of cervix but not os
Partial - partially covers os
Complete

51
Q

Omphalocele

A

Associated with trisomies - 18 most common, also 13 and 21. And Turners, Klinefelters
Beckwith Weidemann
Bladder exstrophy and cloacal exstrophy
Raised maternal AFP (along with neural cord defects more commonly, and tumours)

52
Q

Toxoplasmosis

A

Calc in thalamus, basal ganglia, choroid plexus. If just periventricular think CMV or TS
Microcephaly and mental retardation
Or macrocephaly from aqueduct stenosis
Head size may return to normal

53
Q

Fetal heart rate

A

100bpm 5-6 weeks

140-160 at 8 weeks

54
Q

Monozygotic twins

A

MCDA 60%, DCDA 30%, MCMA 10%

55
Q

Number of yolk sacs

A

Is equal to the number of amnions

56
Q

Fused placentas, twins

A

Dichorionic can fuse, giving appearance of monochorionicitiy

57
Q

DCDA twins

A

2/3 dizygotic, 1/3 monozygotic

58
Q

FIGO cervical cancer staging

A

.

59
Q

Cervical MR appearance

A

T1 uniform intermediate
High T2 mucosa
Low T2 fibrous inner zone
Intermediate T2 outerzone continuous with myometrium

60
Q

Fetal enteric duplication cyst

A

80% cystic, 20% tubular - more likely to communicate with GI tract
Located in the mesentery
30% will have associated abnormalities - GI for hindgut and spine for foregut

61
Q

Urinary tract

A

In the fetus, ureteric dilatation more significant than renal pelvis dilatation, which may be normal

62
Q

Fetal pleural effusion

A 
Most commonly chylo
Associated with Aneuploidy
Hydrops
(and pulmonary masses e.g CPAM, sequestration, cardiac disease)
May get secondary polyhydramnios

10% resolve spontaneously
May require thoracocentesis or thoracoamniotic shunting if large or recurrent
Karyotyping advised -6% abnormal

63
Q

Normal placenta

A

> 2cm thick

Thinned in diabetes, HTN. Puts fetus at risk of growth restriction

64
Q

Abruption

A

Clinical diagnosis. Ultrasound may be negative.
Marginal most common
Separation of chorionic plate and placenta (pre-placental collection)
Raised placental edge in 50%

65
Q

Pseudoomphalocele

A

Deformation of abdomen from transducer pressure, and oblique scan angle. More common in oligohydramnios
Also physiological gut herniation at early gestation

66
Q

Twins

A 
80% Didi, monodi 30%, mm 1%
5x risk of preterm delivery
MCMA 54% perinatal mortality
Didi 10%
md 20%
67
Q

TTTS

A

10-20% of monochorionic pregnancies

More common if diamniotic

68
Q

Maternal diabetes

A

Associated with:
Heart - VSD, truncus transposition
Lung - RDS, TTN
GI - situs, meconium plug
CNS - lots - neural tube, holoprosencephaly, caudal regression, sirenomelia
Renal - agenesis, hydronephrosis, ureteric duplication
Skeletal - polydactyly, syndactyly
Other - poly, macrosomia, IUGR, single UA

69
Q

Fetal intracranial calc

A

Toxoplasmosis and CMV - toxo random, CMV periventricular
Tumours
Sturge Weber and TS

70
Q

Mega cisterna magna

A

> 10mm antenatally

Trisomy 18, CMV, infarction

71
Q

2,59,uterine cancer staging (endometrial), ovarian, others?

A

.

72
Q

Chorioangioma

A

.

Women's (5 decks)

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