Module 4: Gynae/ Obs / Breast Flashcards
1
Q
how does a uterus change shape over time
A
infant - larger than expect. large cervix
prepuberyty - elongates
puberty - pear
2
Q
Tuners syndrome gonads
A
Streaky ovaries and pre-puberty uterus
3
Q
mullerian ducts make
A
uterus and upper 2/3 of the vagina
fallopian tubes
4
Q
what makes the bottom 1/3 f the vagina
A
the urogenital sinsus
5
Q
Urogenital sinus makes
A
Prostate
Lower 1/3 of the vagina
6
Q
uterus cleavage happens in what direction
A
bottom to top
7
Q
three types of uterine failure
A
failire to form
fail to fuse
fail to cleave
8
Q
Uterus didelphys is what
A
seperate uterus . fail to fuse.
9
Q
vaginal ax of uterus didelphys
A
vaginal septa
10
Q
feature of septate uterus
A
septum remains between the two uterine cavities
11
Q
mullerian agenesis is called what syndrome
A
Mayer Rokitansky Kuster Hauser Syndrome
12
Q
Features of mullerian agenesis
A
vaginal atresia
absent uterus / abnormal
normal ovaries
(often have kidney issues)
13
Q
mullerian agenesis is a type of what uterine malfunction
A
failire to form
14
Q
unicornate uterus is what type
and why is it painful
A
failure to form
endometrial tissue inside non communicating horn(hemi uterus)
15
Q
complete uterine duplication is called
A
Uterus didelphys
16
Q
DES related anomaly
A
T shaped ueterus from drug.
and vaginal clear cell carinoma
17
Q
failure to cleave results in what
A
thick septate
18
Q
biconruate vs septate
A
fundal contour is heart shaped in bicornuate
19
Q
contraindications to salphyngogram
A
bleeding
infection
pregnancy
allergy
20
Q
contraindications to salphyngogram
A
bleeding (menstruation)
infection
pregnancy
allergy
21
Q
contraindications to salphyngogram
A
bleeding (menstruation) do d7.
infection
pregnancy
allergy
22
Q
appearance of salpingitis isthmica nodosa
A
nodular scarring of fallopian tubes
23
Q
features of endometritis
A
post birth
spectrum of pid
24
Q
features of endometritis
A
post birth
spectrum of pid
thickened endometrial cavity
25
endometritis can progress to having gas and pus and is called
pyometrium
26
fibroids are made of
smooth muscle
27
fibroids are made of
smooth muscle
28
fibroids are made of
smooth muscle
29
fibroids are made of
smooth muscle
30
fibroids are made of
smooth muscle
31
features of endometritis
post birth
spectrum of pid
thickened endometrial cavity
31
fibroids are made of
smooth muscle
32
endometritis can progress to having gas and pus and is called
pyometrium
33
most common location of fibroids
intramural
34
peripheral popcorn calcifcaiton of uterin fibroid seen on which modality
plain film
35
fibroids on mri
T1 dark (to intermeidate)
T2 dark
variable enhacnement
36
what are the 4 tpyes of degeneration of uterine fibroids
Hyaline
Red 9carneous)
Myxoid
Cystic
37
hyaline degeneration
MRI findings and why
T2 dark
outstrips blood supply.
proteinacious tissue.
T2 dark, no enhacnement
38
Red (carneous) degeneration of fibroid
MRI and why
peripheral T1 high signal .
occurs in pregnancy, from venous thrombosis.
39
myxoid degenerative change apperaance on mRI
T2 bright.
40
what is the feature of a leiomyosarcoma ?
rapid growth and necrosis
41
what is adenomyosis
endometrial tissue has entered the myometrium layer.
causes enlarged uterus
42
thickening of the junctional zone of uterus to more than 12mm...
with T2 bright cystic foci...
adenomyosis
43
post menopausal endometrial thickening
what measuremnt is concerning and require sampling
5mm
44
what type of tumour will thicken the endometrium and why
Granulosa cell tumours
- oestrogen secreting
Hereditory nonpolyposis colon cancer
45
what effect does tamoxifen have on the uterus
increases endometrial cancer risk due oestrogen effect on the uterus
depsite being a blocker of estrogen in the breasat
46
tamoxifen endometrial thickness gets a pass up to
8mm
47
endometrial fluid in a post menopausal mass means
cervical stenosis or an obstructing mass
48
cervical cancer - staging for surgery
IIA or below is surgery
49
IIb cervical cancer (parametrial invasion) get
chemo and radiation
50
what is the parametrium ?
fibrous band between the supravaginal cervix and bladder
51
primary vaginal masses
what types of cancer
clear cell adenocarcinoma
scc
rhabdomyosarcoma - paeds
52
most common cancer of the vagina
squamous cell carcinoma
53
Who gets vaginal celar cell ADENO carcinoma
mothers took DEX
T shaped uterus
54
Vaginal rhabdomyosarcoma has what age distribution
2- 6
14 - 18
55
metastatic spread to the upper vagina wall
anterior vs posterior
anterior from genital
posterior from GI tract
56
nabothian cysts are found where?
Cervix
epithelium plugging of mucous glands
57
Gartner duct cyxsts are found where
anterior lateral wall of vagina.
due to incomplete regression of the wolfian ducts
58
skene gland cysts are found where
periurethral glands
59
ovaries
haemorrage in a cystic mass means it is
benign
60
Normal vs abnromal ovary size cut off
15ml
post menopause 6ml
61
dominant follicle can be what size?
2cm
62
what is an cumulus oophorus?
cells that protrude into a mature dom follice, imminent ovulation
63
what does clomiphene citrate do?
forces matuation of multiple bilateral ovarian cysts
64
theca lutein cyst will have what appearance
spoke wheel from multiple large cysts
65
what causes theca lutein cysts
overstimulation of b-HCG
66
what are the sequelae of ovarian hyperstimulation syndrome?
theca lutein cysts, ascites, pleural effusion event pericardial effusions.
hypovolaemic shock
67
why do you do a PET in the first week of the menstrual cycle?
beacuse ovaries can be on HOT depending on cycle
68
menopause is defined as
1 whole year without menses
69
postmenoausal ovary abnormal is when its above normal limit orrrrrr
twice the size of the other one
70
PET ovaries on post menopausal is
ABNORMAL
71
ovarian cyst rules
under3cm simple - nothing
3-5cm - report but no f/u
>5cm - described and f/u considered
>7cm MRI or surgical referral
get an US if found on ct/mri
72
what are the ovaria sinister 6
physio follicles
corpora lutea
haemohagic cysts
endometriomas
benign cystic teratomas
polycystic ovaries
73
a peristent cyst may be called....
a nonfunctioning cyst
normally change after 6 weeks with hormones
74
ring of fire seen around ovarian lesion
corpus luteum
but could also be ectopic pregnancy
75
endometriosis triad
infertility
dysmenorrhea
dyspareunia
76
what will an endometrioma look like
rounded mass
homogenous low level internal echoes
increased through transmission
echogenic foci on wall
77
endometrioma can (1% ) become what cancer
note need to be like 9cm and older than 45
endometrioid or clear cell carcinoma
78
what is the most sensitive imaging feature on MRI for the diagnosis of malignany in an endometrioma
enhancing mural nodule
79
endometrioma on MRI
T1 bright -blood
T2 - dark (iron)
fat sat, won't suppress (not a teratoma)
80
hameorrhagic cyst
lacy fishnet appearance
classsic or having bled into it
different apeparance ot an endometrioma
81
haemorrhagic cyst in early post menopause ladies?
postmenopausal women may ovulate
can follow up in 6 weeks as haemorrhagic cysts should disappear
82
Dermoids affect what age?
20s to 30s
83
what does tip of the icerberg sign mean?
US, absorbed by the mass at the top
84
dermoid on MRI
T1 and fat sat b ehaviour
T1 bright - fat
supress
T2 bright
haemorrhagic cysts and endometriomas dont suppress
85
Endometrioma on MRI
T1 bright
not suppress on fat sat
T2 dark - shading
86
dermoids can (1%) turn into what cancer with what risk factors
squamous cell CA
10cm +
older than >50
87
PCOS on US how many cysts
10 or more
88
do ovaries have to be enlarged in PCOS
no
89
where in the ovary are cancers found
within ovary
outside often benign
90
what measurement is thick counted at for septations
3mm
91
nodule with flow or mutliple thin or thick speations need to
refer to surgeons
92
Solid nodules without flow, why do we need an MRI
to ensure not a dermoid plug
if not to surgeons
93
appearance of serous tumours?
unilocular
few septations
can be bilateral
papillary projections suggest malignancy
94
mucinous ovarian (cystadencarcinoma) appearance
what can you get from this
large
multiloculated with thin septa
can get pseudomyxoma peritonei
95
risk factor for mucinous ovarian cystadencarcinoma
smoking
96
endometroid ovarian cancer
25% will have concomitant
endometrial cancer
(ovary is the met)
97
ovarian mass and endometrial thickening can be caused by what two conditions
Endometroid cancer
Granulosa Theca Cell Tumour
98
adult big fucking mass
differentials can be
Ovarian masses
desmoids (gardner syndrome)
sarcomas
99
ovarian fibroma on US
hypoechoic and solid
100
MRI findings of ovarian fibroma
T1 and T2 dark
T2 dark rim
101
what is Meigs syndrome
Ascites
pleural effusion
benign ovarian tumour
102
what's fibromatosis
tumor LIKE enlargement of ovaries.
omental fibrosis and sclerosing peritonitis.
103
Brenner Tumour is also called
Ovarian transitional cell carcinoma
104
struma ovarii are a subtype of
teratoma
105
imaging appearance of struma ovarii
multilocualar
cystic mass
INTENSE solid component enhacnes
Low T2 in cyst (thick colloid)
106
struma ovarii contain what kind of tissue
THYROID
107
krukenburg ovary tumour
mets from GI
108
ovarian torsion normally due to
cyst or tumour causing the torsion
109
Imaging features of torted ovary
Unilateral, enlarged (over4cm)
Mass on the ovary
peripheral cysts
free fluid
lack of arterial or venous flow
110
what is the significane of flow in a large ovary considered for torsion
dual blood supply
so can be torted and still have blood flow
111
PID infeciton types
gonorrhea or chlamydia
112
PID imaging of utersu
undefined.
salpinx
113
paraovarian cyst is caused by what
congenital remnant from the wolffian duct
114
ovarian vein thrombophlebitis can affect
postpartum women
acute pelvic pain and fever!
115
CT appearance of ovarian vein thrombophlebitis
enhancgin wall and low attenuation thrombus in the expected location of the ovarian vein
can move on to a pulmonary embolus
116
how is a peritoneal inclusion cyst formed?
adheisions surround an ovary which has unresorbed secretions causing a passive mass
117
Gestational trophoblastic disease causes a rise in what homrone and subsequent symptom
bHCG
vomitting
118
three types of getsationaltrophoblastic disease
Hydatidiform mole/
invasive mole
partial and complete
choriocarcinoma
119
what is the difference betweena complete mole and partial mole
comple
- involves entire placenta. diploid karyotype. no fetus.
partial
- partial placenta. may see fetal parts. diffuse anechoic lesions. triploid
120
what is an invasive mole
invades the myometrium
121
choriocarcinoma. how does it spread
locally then by blood.
122
US appearance of choriocarcinmoa
highly echogenic solid mass
123
treat choriocarcinoma
methotrexate
124
what is the intradecidula sign a sign of
early pregnancy
125
signs the yolk sac has gone bad
too big 6mm
too small 3mm
solid or calcified
126
what is the double bleb sign
earliest view of embryo which is flat between the
amniotic sac
yolk sac
127
what is meant by an anembryonic pregnancy
gestation al sac without an embryo
128
causes of anembryonic pregnancy
very early pregnancy
non-viable pregnancy
129
what is a pseudogestational sac
in ectopic pregancy
endometrium is pumped up from the hormones
130
List some criterie for fetal demise
diagnostic
>7mm crown-rump length + no heartbeat
no embryo + sac diameter of >25mm
No embryo + heartbeat > 11days after a scan that showed a gest sac/yolk sac
no embryo with heartbeat >2wk after a scan that showed a a gestation sac with no yolk sac
131
list some criteria for suspicious for pregnancy failure
no embryo and >6wks from last period
no embryo with sac 16-24mm
no embryo with heartbeat - 13 days post scan gest sac without yolk sac
no embryo with heartbeat 10 days after a scan that showed a gest sac with a yolk sac
132
what is subchorionic haemorrhage
heamorrhage around the chorion. more haemorrhage risks aboriton.
a little haemorrhage is common
133
what are the high risk factors for ectopic pregnancy
PID hx
tubal surgery
endometriosis
ovulation induction
previous ectopic
use of an IUD
134
which part of the fallopian tubes do ectopics normally happen in?
isthmic portion
135
what is the sing to look for on US of ectopic pregnancy
Tubal ring sign
136
four standard measurements of fetal growth are
Biparietal at thalamus, outer to inner.
head circumference
abdominal circumference - level of umbilical vein and left portal vein
femur length - not including epiphysis
137
age in the first trimester is made from the
crown rump length
138
second and third gestational age is...
composite GA (BPD, HC, AC, FL) as discussed above
139
Readings suggestive of an IUGR
weight below 10th percentile
FL / AC > 23.5
Umbilical artery systolic /diastolic ratio > 4.0
140
IUGR is categorised into two groups which are
symmetrical
asymmetricla
141
asymmetrical IUGR
head sparing, 3rd trimester.
High BP
Severe malnutrition
Ehlers Danlos
142
Symmetric IUGR
global growth restriction does not spare the head and all of pregnancy.
Casued by TORCH, EtoH, anemia, chromsomonal abnormality
issues
143
THE RESISTANCEin the umbilical artery should WHAT with gestational age
decrease
144
why can T1 daibetic mothers also have small babies
hypoxia from microvascular disease in the placenta
145
ppost natal complications of macrosomnia
neonatal
hypoglycaemia
meconium aspiration
146
Erbs palsy damages what nerve roots
C5 6
147
amniotic fluid isurine after how many weeks
16
148
Amniotic fluid index (AFI)
abnormal is
<5 (Oligohydramnios)
>20(Polyhydramnios)
149
Normal fetal lungs
look like liver
150
Normal midgut henriation happens around what time?
9 - 11 weeks
151
placentra too thin - size is
<1cm
152
placenta too thick - size is
>4cm
153
causes of thin placenta
Maternal DM
Trisomy 13 or 18
Toxemia of pregnancy
htn
154
causes of placenta too thick
fetal hydrops
Mat DM
maternal anaemia
congenital fetal cancer
congenitla infeciton
placental abruption
155
Types of variant placental morpholog y
Bilobed
succenturiate lobe - accessory lobe
circumvallate placenta - rolled edges
156
Risks of bilobed placenta
T2 Vasa previa
PPH
velamentous insertion of the cord
157
Risk of succenturiate lobe
T2 vasa previa, PPH
158
risk of circumvallate placenta
placental abruption
iUGR
159
what is placenta previa
low lying placenta
painless vaginal bleeding in third trimester.
US needs to be empty bladder
160
what time can you see the placenta?
8 weeks
161
how to discern placental abruption from fibroids/myometrial contracitons
disruption of the retropplacental complex of blood vessels vs displacing the complex
162
types of placenta insertion
Accreta - into endometrium
increta - into myo
percreta- into serosa
163
placenta chorioagnioma - how are they diagnosed
hamartoma of the placenta
have foetal circulation.
hypoechoic near cord insertion.
if big >4cm cna sequester platelets
164
How to discern a placental chorioagnioma vs placental hematoma?
pulsating doppler flow in chorioangioma
hematoma does not have doppler flow
165
what are the vessels of the normal cord
2 arteries and 1 vein
166
risk factors for single artery in umbilical cord
material diabetes
twins
167
marginal cord inseriotn
seen more in twins
nearly velamenrtous insertion:
cord is more to the side and inserts placenta through the membranes
168
what is vasa previa
fetal fessels cross the internal cervical os
169
What are the two types of vasa previa
1 and 2.
T1 - velamentous cord inseriton
T2 - bilobed placenta or succenturiate lobe
170
nuchal cord
around the neck
171
umbilical cord cysts
peripheral name vs central name
peripheral - omphalomesenteric
central - allontoic cyst
172
US findings for Downs
Congenital heart disease (VSD)
Duodenal atreisa
Short femur
echogenic bowel
choroid plexus cyst
nuchal translucency
nuchal fold thickness
echogenic focus in cardiac ventricle
173
nuchal tranlucency measurement
>3mm is abnromal.
174
what is amniotic bands syndrome
fetus hasn't stayed in the amniotic cavity.
gone into the fibrous and stiky chorionic cavity - amputated limbs
175
Causes of hydrops
TORCH
Turners
Twin related stuff
Alpha thalassemia
US - pleura effusion, pericardial effusion, sub cut edema.
176
what is the big three appearance on US of hydrops
Body wall edema
pleural effusion
ascites
177
Lemon and banana signs are seen in what conditions
Spina bifida
chiari II
178
facial clefts are associated with...
30% of the time chromosomal abnormality
179
a posterior neck mass looking complex in a fetus
cystic hygroma
180
cystic hygroma are ax with
Turners and downs
181
Ventriculomegaly. size
ventricular atrium diameter > 10mm
182
most common neural tube defect is
anencephaly
183
all kids with congenital diaphragmatic hernia will also have
malrotation
184
fetal heart rate parameteres
100 - 180
185
normal fetal bowel is isoechoic to the
liver
186
ddx for hyperechoic bowel in fetus
CF
Trisomies
Viral infections
Bowel atresia
187
most common tumour of the fetus/infant
sacrococcygeal teratoma
188
short femur think of
Downs
Skeletal dysplais a
189
define incompetant cervix
shortened endocervical distance of < 2.5cm.
risk premature delivery
190
maternal hydronephrosis, how common is this?
80% get it
mechanical
mostly on the right
191
what things grow in pregnancy
splenic artery aneurysms
renal amls
fibroids
192
Uterine rupture happens where and when
Where - location of prior C section
When - 3rd trimester
193
HELLP syndrome causes what
raised LFT
low platelets
haemolysis.
severe form of pre-eclampsia
194
what is peripartum cardiomyopathy?
dilated myopathy in the last 1 to 5 months
195
Cardiac MRI findings in peripartum cardiomyopathy are
depressed function
non-vascular territory subepicardial late Gd enhancement
196
What happens in sheehans?
large volume haemorrhage with the enalrged pituitary which happens in pregnancy
197
MRI appearance of sheehans
Acutely bright
late may have an enhancing rim sign
198
Ovarian vein thrombophlebitis risk factors are
c section
endometritis
199
ovarian vein thromboplhebitis - which side is afffect more?
right side more
200
Retained products of conception
associations
MTOP
Second Trimester miscarriage
placenta accreta
201
US appearance of endometiritis
thickened
heterogenous endometrium with or without fluid
202
with twins what is the percentage difference between them that would be considered a significant difference
15%
203
Twin Twin transfusion occurs in which types of twin?
Monochorionic twins with a vascular communication in the placenta
204
What are the outcomes for Monochorionic twin twin transufison
skinny and chubby
skinny is "stuck to the wall of the uterus."
chubby can get hydrops and die.
skinny gets high resitance umbilical artery spectrum
205
What happens in twin reversed arterial perfusion syndrome ?
pump twin pumps blood into the other twin. due to intraplacental shunting
get an acardiac twinv
206
of twins, if one dies which part of the pregnancy is this more of an issue in
later
207
What is twin twin embolization syndrome ?
embolized necrotic dead fetus transferred to the living fetus.
DIC, ischaemia, infarction
208
twin twin embolization syndrome can only happen in what kind of pregnancy
monochorionic
209
the nipple is made of what tissue
smooth muscle
210
how many ductalvopening on a nipple
5-10
211
nipple inversion vs retraction>?
inversion - invaginates
retraction - pulled back
212
Nipple on contrast MRI does what
enhance
213
what are the ligaments taht hold the breasts up called
Coopers ligaments
214
what happens in architectual distoraiton?
Its coopers ligaments being distorted / straightened
especially in surgical / radial scars and IDC
215
what to think of asymetrical brast
normal
unless new.
invasive lobular breast cancer can shrink a breast
216
a terminal lobule ductal unit is significant in cancer for what reason
a lot of cancers start here
217
what journey does milk take anatomically
Temrinal duct lobule unit
lobule
major duct
lactiferous sinus
218
which type of calcifications within the ducts should be a concer
ones that follow the ducts.
linear / segmental
219
blood supply of breast tissue
internal mammory artery (60%)
LATERAL THORACIC INTERCOSTAL PERFORATORS
220
BREAST LYMPH
97% TO THE AXILLA
rest to internal mammory
221
mets to the internal lymph nodes will be from
a medial mass
222
lymph node levels what are they
1 - 3, rotternode
lateral to pec minor
under pec minor
media to pec minor
rotter node - between the pec maj and min
223
sternalis is only seen on which breast mammography view
CC only
nevel mlo
224
estrogen effect in puberty on the duct
elongate and branch
225
progesterone effect in puberty on lobules
proliferate
226
when are the follicular and luteal phases of the cycle
follicular 7-14
luteal 15 - 30
227
Estrogen dominates in which phase
follicular
228
Progesterone dominates in which phase?
luteal
229
breast changes in pregnancy
tubes and ducts prolierate
breast gets denser
hypoechoic on US
230
brast change perimenopausal
shortening of the follicular phase - more progesterone
more breast pain
more fibrocystic change
more breast cyst formation
231
menopause breast changes
lobules go down
ducts stay or ectatic.
fibroadenomas will degenerate with the lack of estrogen
232
breast changes with HRT
painful breast
more dense
fibroadenomas can grow
233
what can cause the breasts to be dense on imaging
prolcatinoma
antipsychotic mds
234
galactocele can appear as what
fat fluid level behind the areolar
235
posterior nipple line needs to reach what to be considered adequate
pec major
236
why would a woman have an LMO rather than an MLO
kyphosis
pectus excavatum
avoid a pacemaker or line
237
when to use an LM or ML?
aim is to move the insepected portion closer to the receptor.
Item on lateral edge do an ML.
if on medial edge do an LM.
238
three tpyes of calc seen on breast imaging
how to call them
artifact
benign
suspicious
239
classic artefacts mimics of calc
deodrant
zinc oxide
metaliic
240
breast calc terminology
BENIGN END
scattered
regional
grouped
linear
segmental
CONCERNING
241
what are dermal calcification
found anywhere women sweat
242
how to confirm dermal calc
ask for tangential view
243
feature of vascular calcification
linear paraller
244
popcorn calc associate dto
degenerating fibroadneoma
245
secretary calc have what buzzword
cigar shaped with a lucent centre
246
why do people get secretary clac
duct has involuted so are there in people 10 -20 years after the menopause
247
what are eggshell calc related to
fat necrosis from trauama
248
dystrophic calc will apeear
bigger than fat necrossi
but aetioogy is the same
249
tea cupped calc
firocystic change
250
posterior nipple line should be what distance on the
1cm
251
