Myultrasoundtutor quizzes (Part 1) Flashcards
Gynecology
What 2 bony boundaries are most posterior and inferior and form the back wall of the pelvis?
1) Sacrum
2) Coccyx
What structure are the innominate bones?
bones of the hips
Name the 3 bones that form the innominate
1) ilium
2) ischium
3) pubic symphysis
The imaginary line from the symphysis to sacral prominence is called?
Linea Terminalis
Where is the true pelvis located?
deep and below the linea terminalis
The bladder, small bowel, ascending and descending colon, rectum, uterus, ovaries, fallopian tubes, internal iliacs, and 5 muscles make up:
a) true pelvis
b) deep pelvis
a) true pelvis
Name the 5 true pelvic muscles
1) levator ani
2) coccygeus
3) obturator internus
4) piriformis
5) iliopsoas
Name the 2 muscles that make up the pelvic diaphragm
1) levator ani
2) coccygeus
This muscle is hammock shaped and gives support to the pelvic organs
Pelvic diaphragm
This muscle is identified scanning transverse inferiorly at the level of the vagina posterior to the bladder, vagina, and rectum
Pelvic diaphragm
Name the 3 muscles located in the adnexa
1) obturator internus
2) piriformis
3) iliopsoas
What adnexa muscle is located lateral to the bladder?
Obturator internus
What adnexa muscle is located posterolateral?
piriformis
What adnexa muscle is located anterolateral?
Iliopsoas release
What muscles appear as ovoid hypoechoic structures that elongate in sagittal and are adjacent or lateral to the bladder, ovaries, and uterus?
Adnexa “OPI” muscles
What ligament is only ever visualized when there is pelvic ascites?
Broad ligament
Name the uterine ligament that is a double fold of peritoneum that is on the lateral sides of the uterus to the wall so the pelvis that support the pelvic organs
Broad ligament
Name the uterine ligament that is between the folds of the broad ligament and supports the fundus of the uterus
Round ligament
Name the uterine ligament that contains the vasculature of the pelvis
Cardinal ligament
What is another name for the retropubic space?
Space of Retzius
This space is located anterior to the bladder
Retropubic space
This space is located in the lower quadrants of the abdomen and are lateral spaces to the uterus
Adnexa
What is another name for the anterior cul de sac?
Vesicouterine pouch
What space is located between the bladder and uterus and is anterior to the uterus
Anterior cul de sac
What is another name for the posterior cul de sac?
Rectouterine pouch or pouch of Douglas
Name the space that is located between the uterus and rectum
Posterior cul de sac
What is another name for the internal iliac artery
hypogastric artery
The uterine arteries are branches of what artery?
Internal iliac artery
What artery is a ?periphery of the myometrium?
Arcuate arteries
What arteries are located deeper into the myometrium?
Radial arteries
Name the 2 arteries that are layers of the endometrium
1) straight
2) spiral
The ovarian arteries originate from what?
The aorta
What is another name for the ovarian arteries?
Gonadal arteries
The uterine veins return or drain into ?
Internal iliac veins
The right ovarian vein drains into?
IVC
the left ovarian vein drains into?
Left renal vein
This vein is the longest pelvic muscle
Left ovarian vein
Name the organ that is located anterior to the rectum, posterior to the bladder, and bound laterally by the broad ligament
Uterus
This part of the uterus is the most superior and widest
Fundus
What part of the uterus is the body and is the largest area
Corpus
The _____ is called the lower uterine segment in pregnancy
Isthmus
The ________ ______ opens into the vaginal canal and is surrounded by vaginal fornix
External os
Name the 3 layers of the uterus
1) serosa
2) myometrium
3) endometrium
What is another for the serosa layer of the uterus?
Perimetrium
This layer of the uterus is outermost /organ fasica
Serosa
What layer of the uterus is the mucosal layer that consists of 2 layers
Endometrium
The endometrium consists of 2 layers the basal and functional. Which layer is shed during menses?
Functional
This type of uterus the body tilts forward 90 degree angle with the cervix
a) anteversion
b) anteflexion
c) retroflexion
d) retroversion
a) anteversion
This type of uterus the body folds forward and comes in contact with the cervix
a) anteversion
b) anteflexion
c) retroflexion
d) retroversion
b) anteflexion
This type of uterus the body tilts back and comes in contact with the back of the cervix
a) anteversion
b) anteflexion
c) retroflexion
d) retroversion
c) retroflexion
This type of uterus the body tilts back without a bend
a) anteversion
b) anteflexion
c) retroflexion
d) retroversion
d) retroversion
What muscle group can be visualized lateral to the urinary bladder?
a) obturator internus
b) obturator externus
c) psoas major
d) pelvic diaphgram
a) obturator internus
What structure replaces the Graffian follicle?
a) cumulus oophorus
b) corpus albicans
c) corpus luteum
d) ovarian medulla
c) corpus luteum
Where is the most likely location for fluid to collect post-ovulatory?
a) retropubic space
b) endometrial cavity
c) anterior cul de sac
d) rectouterine pouch
d) rectouterine pouch
The ovaries are:
a) endocrine glands
b) exocrine glands
a) endocrine glands
The ______ ligament supports the ovary from the lateral side of the uterus to the ovary
ovarian
The ______ ligament supports the ovaries from the lateral pelvic side walls
Suspensory
The ovaries produce what 2 hormones?
1) estrogen
2) progesterone
The ovaries are stimulated by?
1) FSH
2) LH
How do you calculate ovarian volume?
L x W x H x 0.523
What section of the fallopian tube traverses the uterine cornu?
a) isthmus
b) interstitial
c) ampulla
d) cilia
b) interstitial
What marks the most inferior part of the cervix?
a) internal os
b) vagina
c) external os
d) isthmus
c) external os
Where does the uterine blood supply originate?
a) internal iliac vein
b) hypogastric artery
c) aorta
d) uterus
b) hypogastric artery
-blood supply is referring to the artery. The uterine artery originates or arises from the internal iliac artery
Fertilization is most likely to occur where?
a) ampulla
b) infundibulum
c) endometrial cavity
d) uterine cornu
a) ampulla
What best describes the neonatal uterus?
a) cervix is approx twice the size of the corpus
b) fundus is twice the size of the uterine body
c) uterine fundus is same size as the cervix
d) entire uterus is small and tubular in shape
a) cervix is approx twice the size of the corpus
What muscle group is most likely to be identified while imaging inferiorly at the level of the vagina?
a) iliopsoas
b) psoas major
c) rectus abdominis
d) coccygeus
d) coccygeus
What is the superficial layer of the endometrium?
a) functional layer
b) serosal layer
c) perimetrium
d) basal layer
a) functional layer
The gonadal arteries orginate from what vessel?
a) common iliac arteries
b) internal iliacc arteries
c) aorta
d) uterine arteries
c) aorta
What muscles would be most likely mistaken as ovaries or adnexal masses?
a) obturator internus
b) gemellus
c) levator ani
d) psoas major
a) obturator internus
The uterus is bounded anteriorly by what structure?
a) rectum
b) bladder
c) space of Retzius
d) round ligament
b) bladder
What hormone is responsible for ovulation?
a) Estrogen
b) gonadotropin releasing hormone
c) luteinizing hormone
d) follicle stimulating hormone
c) luteinizing hormone
A 28 year old patient typically has a 26 day menstrual cycle. What ovarian phase would she be at day 14 of her current cycle?
a) follicular
b) periovulatory
c) luteal
d) secretory
c) luteal
What best describes the effects of the release of progesterone?
a) endometrial shedding
b) thickens the functional layer
c) maintains the thickness of the endometrium
d) thickening of the basal layer
c) maintains the thickness of the endometrium
What dimension is the upper limit of normal for the reproductive age endometrium?
a) 16 mm
b) 8 mm
c) 4 mm
d) 22 mm
a) 16 mm
What would be the expected endometrial appearance during the luteal phase?
a) trilaminar
b) thin and echogenic
c) thick and echogenic
d) thick and hypoechoic
c) thick and echogenic
What is responsible for releasing estrogen?
a) follicles
b) corpus albicans
c) pituitary gland
d) corpus luteum
a) follicles
What event in the menstrual cycle occurs due to the drop in progesterone?
a) corpus luteal regression
b) endometrial thickening
c) ovulation
d) endometrial shedding
d) endometrial shedding
What best describes the late proliferative endometrium?
a) hypoechoic basal and echogenic functional layer
b) echogenic basal and functional layer
c) echogenic basal and hypoechoic functional layer
d) hypoechoic basal and functional layer
c) echogenic basal and hypoechoic functional layer
The maximum measurement of the endometrium immediately following menses should measure no more than?
a) 4 mm
b) 10 mm
c) 6 mm
d) 18 mm
a) 4 mm
Immediately following menses is the thinnest at 4 mm. Early proliferative up to 6 mm. Late proliferative up to 10 mm and secretory up to 16 mm
What stimulates follicular development?
a) FSH
b) estrogen
c) LH
d) HCG
a) FSH
What hormones is endometrial tissue responsive to?
a) estrogen and progesterone
b) LH and progesterone
c) FSH and estrogen
d) FSH and LH
a) estrogen and progesterone
The endometrium is stimulated by estrogen and progesterone. Estrogen thickens and progesterone maintains
What is the function of estrogen?
a) endometrial shedding
b) stimulates ovulation
c) maturation of the follicle
d) endometrial thickening
d) endometrial thickening
What hormone stimulates rupture of the graafian follicle?
a) follicle stimulating hormone
b) progesterone
c) estrogen
d) luteinizing hormone
d) luteinizing hormone
The ovaries respond to FSH and LH. FSH develops and matures the follicle. LH ruptures it
During what phase does the endometrium appear thick and echogenic?
a) proliferative
b) secretory
c) follicular
d) periovulatory
b) secretory
What endometrial appearance would correlate with the periovulatory phase?
a) multi layered
b) thin and echogenic
c) anechoic
d) thick and echogenic
a) multi layered
When approximately would a peak in estrogen occur?
a) day 1
b) day 7
c) day 14
d) day 28
c) day 14
What term describes a patient that no longer experiences a menstrual cycle?
a) arrhagia
b) oligomenorrhea
c) amenorrhea
d) menomenorrhea
c) amenorrhea
What is the Mullerian malformation that occurs most frequently?
a) bicornuate uterus
b) septate uterus
c) arcuate uterus
d) uterus didelphys
b) septate uterus
What is the most likely sonographic appearance of a 14 year old with vaginal atresia?
a) hematometra
b) meatocolpos
c) hydrocolpos
d) hematosalpinx
a) hematometra
of pregnancies is called?
Gravida
of pregnancies carried to term is called?
Para
_______ ________ is a person who has not reached menarche by age 15
Delayed menses
_______ ________ is when a person experiences puberty changes by the age of 8
Precocious puberty
The prefix “a” means
without/non
The prefix “dys” means
abnormal/painful
The prefix “sub” means
under
The prefix “hemato” means
Blood
The prefix “meno” means
Heavy
The prefix “metro” means
irregular
The suffix “menorrhea” means
menses
The suffix “rrhagia” means
Bleeding
The suffix “pareunia” means
Intercourse
The suffix “plasia” means
Growth
the suffix “oma” means
Mass
The suffix “colpos” means
Vagina
The suffix “metra” means
Uterus
“Middle pain” pain in middle of cycle near ovulation is called
Mittelschmertz
Failure to have a menses by the age of 16 or never reached menarche is called?
Primary amenorrhea
When a menses stops this is called?
Secondary amenorrhea
During the 70s what drug was given to women to treat threatened miscarriages?
DES
What is the most commonly shaped uterus that is associated with DES?
T shaped
What uterus is normal contour, with a slight indentation of the fundal endometrium that mimics a normal uterus?
Arcuate
What is another name for a bicornuate uterus?
Bicornis Unicollis
What type of uterus has 1 endometrial cavity that divides into 2 at the fundus is “Y” shaped and the uterine fundas has concave contour
Bicornuate
What type of uterus has a normal uterine contour with 2 separate endometrial cavities?
Subseptate
What is the most common congenital uterine anomaly?
Septate
What type of uterus has 2 completely separate endometrial cavities and the uterine contour is concave at the fundus
Septate
What type of uterus has a complete lack of fusion. 2 vaginas, cervices, and uteri?
Didelphys
What type of uterus has a lack of formation of one duct and has a single horn?
Unicornuate
What is the most common cause of a congenital malformation of the vagina?
Imperforate hymen
When there is vaginal atresia what will be distended?
The uterus and cervix
A absent or closed vagina is called?
Vaginal atresia
Hydrometra and hematometra are 2 examples of what?
Vaginal atresia
_______ _______= a closed hymen
Imperforate hymen
Hydrocolpos, hydrometracolpos, and hematometracolpos are examples of what?
Imperforate hymen
Which of the following is caused by lack of formation of one of the Mullerian ducts?
a) uterine agenesis
b) uterus didelphys
c) unicornuate uterus
d) bicornuate uterus
c) unicornuate uterus
-Lack of formation means one duct never was there in the first place. So just a smaller uterus with one cornu will be there
When encountering a congenital uterine malformation, what also should be evaluated for congenital anomalies?
a) ovaries
b) posterior cul-de-sac
c) left ovarian vein
d) kidneys
d) kidneys
What is the most likely finding associated with a patient presenting with pelvic pain and primary ameorrhea?
a) hydrometra
b) hematometra
c) hydrocolpos
d) hematometracolpos
d) hematometracolpos
-The most common diagnosis in a patient with this clinical history is imperforate hymen. q
Hydrocolpos is usually secondary to what?
a) cervical stenosis
b) vaginal atresia
c) endometrial cancer
d) imperforate hymen
d) imperforate hymen
-Hydrocolpos= fluid in the vaginal canal. This must be caused by imperforate hymen. Vaginal atresia would have a closed vaginal canal
What part of the cycle corresponds with Mittelschmerz?
a) menstruation
b) regression of corpus luteum
c) ovulation
d) start of endometrial thickening
c) ovulation
What term best describes painful menstruation?
a) dyspareunia
b) dysmenorrhea
c) hypermenorrhea
d) metrorrhagia
b) dysmenorrhea
What is the definition of infertility ?
a) unsuccessful conception after 6 months of unprotected intercourse
b) unsuccessful conception after 3 months of unprotected intercourse
c) unsuccessful conception after 2 years of unprotected intercourse
d) unsuccessful conception after 1 year of unprotected intercourse
d) unsuccessful conception after 1 year of unprotected intercourse
What does metrorrhagia mean?
Irregular bleeding
What does menorrhagia mean?
Heavy bleeding
What does hypermenorrhea mean?
Increased menstrual flow
what does oligomenorrhea mean?
A greater than 35 day cycle
What does polymenorrhea mean?
Less than 21 day cycle
What term describes a benign cyst of the vaginal canal?
a) gartner duct cyst
b) nabothian cyst
c) fornix cyst
d) adenomyosal cyst d)
a) gartner duct cyst
A 32 year old patient is presenting with urinary frequency and pelvic pressure. What diagnosis is most likely?
a) leiomyosarcoma
b) adenomyosis
c) cervical carcinoma
d) leiomyomatous uterus
d) leiomyomatous uterus
A patient is referred for an ultrasound to confirm IUD placement. What description best describes a normal finding?
a) hyperechoic reflection within the isthums
b) hypoechoic with shadowing throughout the endometrium
c) reverberation artifact within the cavity extending to fundus
d) hyperechoic with reverberation within the fundus only
c) reverberation artifact within the cavity extending to fundus
What is the most common benign mass of the cervix?
a) gartner duct cyst
b) leiomyoma
c) nabothian cyst
d) cervical adenoma
c) nabothian cyst
Which artifact is most likely seen with an IUD?
a) reverberation
b) mirror image
c) edge shadowing
d) posterior enhancement
a) reverberation
Whats the most common gynecological malignancy under the age of 50?
a) leiomyosarcoma
b) ovarian cystadenocarcinoma
c) cervical carcinoma
d) endometrial carcinoma
c) cervical carcinoma
Small myometrial cystic areas, thickening of the myometrium, abnormal bleeding, and dysmenorrhea all describe what condition?
a) adenomyosis
b) endometrial carcinoma
c) endometriosis
d) endometrial hyperplasia
a) adenomyosis
What clinical history best corresponds to a diagnosis of adenomyosis?
a) infertility
b) secondary amenorrhea
c) acute pelvic pain
d) dsymenorrhea
d) dsymenorrhea
Posterior thickening of the myometrium is most often related to what?
a) fibroids
b) congential malformations
c) adenomyosis
d) cervical cancer
c) adenomyosis
Focal mass like adenomyosis is called?
Adenomyoma
Dysmenorrhea, menometrorrhagia, pelvic pain, dyspareunia and being multiparous what clinical signs of what uterine pathology?
Adenomyosis
What is the most common benign gyn tumor?
Leiomyoma
What uterine tumor is a benign smooth muscle tumor and is the leading cause of hysterectomy and gyn surgery?
Leiomyoma
What uterine tumor is stimulated by estrogen?
Leiomyoma
Clinically this uterine tumor causes abnormal bleeding, pelvic distention, pressure, infertility and urinary frequency
Leiomyoma
Sonographically this uterine tumor appears as a hypoechoic mass with poor thru transmission with a bulky enlarged uterus
Leiomyoma
What fibroid is the most common?
a) intramural
b) subserosal
c) submucosal
d) pedunculated
a) intramural
This fibroid is located within the muscle wall of the uterus and makes the whole uterus bulky but does not change the countour
a) intramural
b) subserosal
c) submucosal
d) pedunculated
a) intramural
What fibroid grows under the serosal layer and distorts the outer contour?
a) intramural
b) subserosal
c) submucosal
d) pedunculated
b) subserosal
What fibroid is adjacent to the endo and distorts the contour of the endo?
a) intramural
b) subserosal
c) submucosal
d) pedunculated
c) submucosal
What fibroid is a type of subserosal myoma that grows out and attaches by a stalk?
a) intramural
b) subserosal
c) submucosal
d) pedunculated
d) pedunculated
This type of fibroid is malignant and will cause a rapid increase in growth most commonly found in perimenopausel and postmenopausel women
Leiomyosarcoma
What is the most common female malignancy under the age of 50?
Cerival carcinoma
What presents as heterogenous, enlarged cervix or a focal mass within the cervix?
Cervical carcinoma
Thickening of the endometrium is called what?
Endometrial hyperplasia
What results from unopposed estrogen stimulation?
Endometrial hyperplasia
Clinically what is the result of post menopausel bleeding, abnormal bleeding, history of PCOS, HRT or Tamoxifen treatment?
Endometrial hyperplasia
What is the most likely diagnosis in a post-menopausel patient with a thickened endometrium?
Endometrial hyperplasia
Sonographically this appears as an abnormally thickened endometrium that is heterogenous with cystic changes
Endometrial hyperplasia
If a postmenopausel women has no bleeding and is asymptomatic what is the upper limit of normal for the endometrium?
< 8mm
If a post menopausel women is bleeding and is asymptomatic what is the upper limit of normal for the endometrium?
< 5 mm
In a reproductive aged patient what is the upper limits of normal for the endometrium if they are in the early proliferative stage?
4-6 mm
In a reproductive aged patient what is the upper limits of normal for the endometrium if they are in the late proliferative stage?
6-10 mm
In a reproductive aged patient what is the upper limits of normal for the endometrium if they are in the secretory phase?
<16 mm
What is the most common GYN malignancy?
Endometrial carcinoma
Clinically what is seen in postmenopausel bleeding, abnormal uterine bleeding, and elevated CA-125?
Endometrial carcinoma
Sonographically this appears as abnormal thickening of the endometrium/heterogenous with cystic changes, an enlarged/heterogenous uterus, polypoidal mass within the endo with increased vascularity, and low resistance flow
Endometrial carcinoma
What is the most likely reason for abnormal bleeding/ thick endo in a reproductive age patient? (unless with a diagnosis of PCOS)
Endometrial polyps
Saline infused sonohysterography is best to visualize?
Endometrial polyps
What are small nodules of hyperplastic endometrial tissue that are most likely seen as focal or diffuse thickening of the endometrium?
Endometrial polyps
Thinning of the endometrium in postmenopausel patients is called?
Endometrial atrophy
What is the most common cause of post menopausel bleeding?
Endometrial atrophy
What is the most likely finding and diagnosis in a post menopausel bleeding patient with no other history
Endometrial atrophy
This appears as a thin endometrium < 4 mm and possible intracavity fluid
Endometrial atrophy
Adhesions or synechiae within the uterine cavity as a result of scar formation after a surgery or D&C is called?
Asherman syndrome
Clinically this is the cause of amenorrhea, hypomenorrhea, a history of miscarriages, or surgery
Asherman syndrome
Songraphically this appears as a thin endometrium with echogenic regions/scarring
Asherman syndrome
Which is most likely associated with cystic changes of the endometrium?
a) hormone replacement therapy
b) adenomyosis
c) tamoxifen treatment
d) intrauterine device
c) tamoxifen treatment
What is the most likely diagnosis in a 70 year old patient with vaginal bleeding?
a) endometrial atrophy
b) endometrial carcinoma
c) hyperplastic polyp
d) uterine fibroid
a) endometrial atrophy
A 12 mm irregular, heterogenous endometrium is documented in a patient with post-menopausel bleeding. What information would aid in the differentiation of hyperplasia vs carcinoma?
a) B-mode appearance
b) previous tamoxifen therapy
c) duration of bleeding
d) CA-125 value
d) CA-125 value
What is the typical effect of tamoxifen on the endometrium?
a) myometrial cystic changes
b) cystic changes in a thinned endometrium
c) endometrial cavity fluid
d) thickened endometrium with cystic changes
d) thickened endometrium with cystic changes
What is the most likely sonographic appearance of the endometrium in a patient complaining of post menopausal bleeding?
a) endometrium measuring < 4mm
b) thickened and cystic endometrium
c) focal echogenic thickening
d) endometrial synechiae
a) endometrium measuring < 4mm
Hormone replacement therapy is related to what typical endometrial appearance?
a) focal thickening of the endometrium
b) thickened, echogenic endometrium
c) cyclic changes of the endometrium
d) cystic changes with endometrial thickening
c) cyclic changes of the endometrium
A 24 year old patient with a history of PCOS presents with abnormal bleeding. What is the most likely diagnosis?
a) Ruptured ovarian cyst
b) endometrial polyps
c) endometrial hyperplasia
d) asherman syndrome
c) endometrial hyperplasia
- The patient history of PCOS predisposes her to endometrial hyperplasia due to chronic anovulation and increased estrogen levels
What is the normal maximum dimension of the endometrium in the reproductive age group?
a) 22 mm
b) 16 mm
c) 6 mm
d) 8 mm
b) 16 mm
An elevation in which hormone will increase the likelihood of the patient developing endometrial carcinoma?
a) estrogen
b) FSH
c) hCG
d) progesterone
a) estrogen
What is the normal maximum dimension of the endometrium in a patient experiencing post menopausal bleeding?
a) 4mm
b) 14 mm
c) 8 mm
d) 5 mm
d) 5 mm
What is the most likely cause of endometrial thickening in the reproductive age patient?
a) endometrial hyperplasia
b) endometrial carcinoma
c) asherman syndrome
d) endometrial polyp
d) endometrial polyp
What is the most common cause of infertility?
PCOS
Clinically this pathology is related to Stein-Leventhal syndrome
PCOS
Sonographically this pathology has bilateral enlarged ovaries with multiple small follicles along the periphery “string of pearls” and is secondary to endometrial hyperplasia
PCOS
Ectopic endometrial tissue outside the uterus into the adnexa is most likely?
Endometriosis
Where is the most common location for endometriosis to develop?
Ovaries
What are 2 other names for blood-filled cysts?
1) endometriomas
2) chocolate cysts
dysmenorrhea, dyspareunia, chronic pelvic pain, painful bowel movements, infertility, nulliparity that are in reproductive age patients are clinical signs of?
Endometriosis
Sonographically this pathology appears as a cystic mass with low level echoes, anechoic, or complex with posterior enhancement
Endometriosis
What is the common adnexal mass?
Follicular cyst
What is the most common adnexal mass in pregnancy?
Corpus luteal cyst
_______ ________ ________ is caused by hCG found in fertility treatments
Ovarian hyperstimulation syndrome
Sonographically this pathology presents as bilaterally enlarged multiloculated ovarian cysts “grape clusters” with no normal ovarian parenchyma
Theca Lutein cysts
This type of cyst is found only with elevated levels of hCG >100,000
Theca Lutein cysts
What is the most common benign ovarian tumor?
Dermoid cyst
What is another name for a cystic teratoma
Dermoid cyst
What is the most common complication of a dermoid cyst?
Ovarian torsion
What is the most common solid benign tumor?
Fibroma
A fibroma is most like associated with what syndrome?
Meigs syndrome
Ascites, pleural effusion and in the presence of a benign ovarian tumor is associated with what syndrome?
Meigs
Sonographically what looks like a solid hypoechoic mass with poor thru transmission?
Fibroma
What tumor is a transitional cell tumor that is small, solid, and unilateral with calcifications
Brenner tumor
Fribromas and Brenner tumors do not produce what?
a) estrogen
b) progesterone
a) estrogen
What mass is associated with hirsutism and menstrual disturbances?
a) polycystic ovaries
b) granulosa cell tumor
c) sertoli-Leydig tumor
d) dysgerminoma
c) sertoli-Leydig tumor
What abnormality can be found in the presence of ascites and pleural effusion?
a) dermoid
b) fibroma
c) krukenberg tumor
d) ovarian torsion
b) fibroma
During a pelvic sonogram, a 1.8 cm cyst adjacent to the ovary is documented. What is the etiology of the cyst?
a) follicular cyst
b) corpus luteum
c) cystadenoma
d) paraovarian cyst
d) paraovarian cyst
Name the 2 types of cystadenomas
1) serous
2) mucinous
Which cystadenoma are benign large and typically bilateral with septations?
a) serous
b) mucinous
a) serous
Which cystadenoma is typically larger and usually unilateral with the presence of septations and internal debris?
a) serous
b) mucinous
b) mucinous
What is most common ovarian malignancy?
Serous cystadenocarcinoma
Intraperitoneal extensions of mucin-secreting cells that appear similar to complex ascites is termed?
pseudomyxoma peritonei
Clinically this malignancy presents as weight loss, pelvic pressure/swelling, abnormal bleeding, GI symptoms, elevated CA-125, acute abdomen pain associated with torsion or rupture
Cystadenocarcinoma
Sonographically what malignancy appears as a cystic mass with thick septations and papillary projections with internal vascularity
Cystadenocarcinoma
Name the 2 estrogen producing ovarian tumors
1) thecoma
2) granulosa cell tumor
What is the most common estrogenic tumor?
Granulosa cell tumor
What ovarian tumor is most often seen in postmenopausal patients with post menopausal bleeding?
Thecoma
Metastasis from the GI tract that presents with bilateral ovarian masses and ascites is most likely?
Krukenburg tumor
What is another name for Sertoli-Leydig cell tumor?
Androblastoma
What sex cord stromal tumor is most commonly found in women < 30 years old and may be benign or malignant?
Sertoli-Leydig cell tumor
What is the most common malignant germ cell tumor?
Dysgerminoma
What tumor is related to elevated hCG levels in a nongravid female?
Dysgerminoma
This tumor is most often found in young patients <30 years of age and may be found in pregnancy with the tumor maker of serum lactate deyhydrogenase
Dysgerminoma
What is another name for yolk sac tumor?
Endodermal sinus tumor
What is the second most common malignant germ cell tumor?
Yolk sac tumor
This tumor is characterized by growth and presents in females less than 20 years old and has elevated AFP in the nongravid female
Yolk sac tumor
Ovarian torsion is most common on which side?
a) right side
b) left side
a) right side
What doppler settings should be set to identify ovarian torsion?
Low scale/PRF and low wall filter
Songraphically what pathology presents as a enlarged ovary with diminished or lack of blood flow?
Ovarian torsion
What mass is related to estrogen production?
a) dysgerminoma
b) endometrioma
c) sertoli-Leydig cell tumor
d) granulosa cell tumor
d) granulosa cell tumor
What usually occurs secondary to PCOS?
a) endometrial hyperplasia
b) endometriosis
c) ovarian torsion
d) theca lutein cysts
a) endometrial hyperplasia
Which of the following could possibly be related to post menopausal bleeding?
a) teratoma
b) endometrioma
c) fibroma
d) thecoma
d) thecoma
What adnexal abnormality is associated with gastric cancer?
a) Krukenberg tumor
b) pseudomyxoma peritonei
c) Meigs syndrome
d) brenner tumor
a) Krukenberg tumor
Which of the following is most likely to be associated with Meigs syndrome?
a) mucinous cystadenocarcinoma
b) thecoma
c) krukenberg tumor
d) fibroma
d) fibroma
Pseudomyxoma peritonei is associated with which of the following masses?
a) androblastoma
b) endometrioma
c) serous cystadenocarcinoma
d) mucinous cystadenocarcinoma
d) mucinous cystadenocarcinoma
What ovarian mass is related to elevated levels of hCG in the non-pregnant female?
a) dysgerminoma
b) seminoma
c) yolk sac tumor
d) sertoli-leydig tumor
a) dysgerminoma
-dysgerminoma is associated with hCG in a nongravid female
-Yolk sac tumor is associated with AFP in a non-gravid female
A large adnexal cyst with thick septations and papillary projections is documented. This finding most likely corresponds with what diagnosis?
a) serous cystadenoma
b) serous cystadenocarcinoma
c) mucinous cystadenoma
d) mucinous cystadenocarcinoma
b) serous cystadenocarcinoma
- Thick septations and papillary projections are findings suggestive of malignancy. Serous cystadenocarcinoma is the best choice because it is the most common
What would be most likely be related to infertility?
a) chocolate cyst
b) krukenberg tumor
c) adenomyosis
d) theca lutein cyst
a) chocolate cyst
- Causes for infertility are either functional (PCOS) or conditions that damage the ovaries, tubes, or endometrium such as endometriosis, PID, or polyps
What sonographic feature would be most consistent with acute PID?
a) anechoic tubular structure within the adenexa
b) heterogenous myometrium with posterior thickening
c) bilateral complex masses with increased peripheral vascularity
d) enlarged ovary with diminished or absent doppler signals
c) bilateral complex masses with increased peripheral vascularity
What doppler arterial signal is normally expected in the non-gravid uterus?
a) triphasic and pulsatile
b) monophasic and high resistance
c) low velocity and low resistance
d) high velocity and low resistance
b) monophasic and high resistance
What clinical finding is most likely associated with chronic PID?
a) leukocytosis
b) hypomenorrhea
c) post-menopausel bleeding
d) dysmenorrhea
b) hypomenorrhea
What finding is most likely to be documented in an afebrile 30 year old female with acute right lower quadrant pain?
a) absent doppler signals in an enlarged ovary
b) hyperemia in an enlarged ovary
c) turbulent flow within the myometrium
d) low resistance signals within the adnexa
a) absent doppler signals in an enlarged ovary
What is the most common initial clinical presentation of acute PID?
a) menorrhagia
b) acute pelvic pain
c) leukocytosis
d) vaginitis
d) vaginits
How can endometriosis be differentiated from endometrial hyperplasia?
a) clinical symptoms
b) color doppler patterns
c) uterine enlargement
d) patient age
a) clinical symptoms
-these 2 may be similar sonographically. Endometritis is only found in the presence of acute PID which means the patient will have symptoms of infection
When evaluating an infertility patient, what signs would be indicative of chronic PID?
a) tubo-ovarian complex
b) hyperemia along salpinx wall
c) complex ovarian cyst
d) ovarian mass with septations
a) tubo-ovarian complex
What is a sonographic finding consistent with acute PID?
a) hydrosalpinx
b) pyosalpinx
c) free fluid in the cul-de-sac
d) complex ovarian cyst
b) pyosalpinx
-sonographic finding specifically found in the presence of acute PID are: endometriosis and pyosalpinx. Hydrosalpinx and TOA can be seen with acute, but can be seen with chronic as well
What is the most common cause of pelvic inflammatory disease?
a) cesarean section
b) abortion
c) urinary tract infection
d) chlamydia
d) chlamydia
What sonographic finding is consistent in a patient presenting with acute pelvic pain, leukocytosis, and fever?
a) enlarged avascular ovary
b) vaginitis
c) endometritis
d) hemorrhagic ovarian cyst
c) endometritis
- The symptoms indicate infection. The only sonographic finding listed that goes with active infection is endometritis
What diagnosis is consistent with pelvic pain, irregular menses, and pelvic adhesions?
a) acute PID
b) pseduomyxoma peritonei
c) chronic PID
d) adenomyosis
c) chronic PID
When would be the most accurate time to perform doppler analysis of the ovaries?
a) periovulatory phase
b) luteal phase
c) secretory phase
d) early proliferative phase
d) early proliferative phase
What is a sonographic finding consistent with chronic PID?
a) comet tail artifact in endometrium
b) hyperemia of the salpinges
c) pyosalpinx
d) hydrosalpinx
d) hydrosalpinx
Chronic PID is not an active infection, it is the damage done by previous infection. A patient may have hydrosalpinx or TOA chronically after PID
Doppler analysis in the ovaries in the periovulatory and luteal phases commonly demonstrates what characteristics?
a) high resistive index
b) low resistance flow
c) decreased end diastolic flow
d) decreased peak systolic velocity
b) low resistance flow
- These phases require the greatest volume of flow for the ovary. The normal flow pattern during this time would be low resistance with an increased end diastolic and low pulsatility
What feature best corresponds to adenomyosis?
a) bulky, heterogenous myometrium with cystic spaces
b) hypoechoic mass with posterior shadowing
c) abnormal endometrial thickening
d) multiple echogenic regions within the myometrium
a) bulky, heterogenous myometrium with cystic spaces
What is the most common bengign ovarian solid tumor?
a) dysgerminoma
b) brenner tumor
c) dermoid
d) fibroma
d) fibroma
What blood test can reveal the probability of malignancy in the presence of an abnormally thickened endometrium?
a) AFP
b) hCG
c) lactate dehydorgenase
d) CA-125
d) CA-125
What complication is most often associated with a fibroma?
a) Ovarian hyperstimulation syndrome
b) Meigs syndrome
c) Stein leventhal syndrome
d) ashermans syndrome
b) Meigs syndrome
What is the most common congenital uterine abnormality?
a) bicornus unicollis
b) imperforate hymen
c) nabothian cyst
d) septate uterus
d) septate uterus
Which of the following conditions is most likely to demonstrate a reverberation artifact?
a) pyosalpinx
b) endometritis
c) adenomyosis
d) hematometra
b) endometritis
What would cause an elevation in the serum AFP in a non-gravid patient?
a) yolk sac tumor
b) dermoid
c) theca lutein cysts
d) cystadenocarcinoma
a) yolk sac tumor
What is the most likely diagnosis in a patient with clinical findings of dysmenorrhea, hypermenorrhea, and muliparity?
a) adenomyosis
b) Ashermans syndrome
c) Endometriosis
d) polycystic ovarian disease
a) adenomyosis
What condition is most likely to be a factor in infertility?
a) paraovarian cyst
b) dermoid
c) adenomyosis
d) chronic PID
d) chronic PID
What is Ashermans syndrome?
a) hyperstimulation of ovarian follicles
b) scarring of the uterine cavity
c) infertility, hirsutism, and amenorrhea
d) metastasis to the ovaries
b) scarring of the uterine cavity
Which scenario would lead to further investigation with sonohysterography with saline infusion?
a) endometrial hyperplasia
b) subserosal myoma
c) adenomyosis
d) endometrial synechiae
d) endometrial synechiae
What vessel supplies a layer of the endometrium?
a) spiral artery
b) radial artery
c) basal artery
d) arcuate artery
a) spiral artery
Which pelvic vessel is most likely to become abnormal?
a) left ovarian vein
b) right uterine vein
c) left uterine vein
d) right ovarian vein
a) left ovarian vein
What endometrial measurement is abnormal in the post-menopausel patient?
a) 8 mm
b) 6 mm
c) 9 mm
d) 5 mm
c) 9 mm
-non-bleeding <8 mm
-bleeding <5 mm
Fluid in the posterior cul-de-sac in the reproductive age patient is most likely the result of what event?
a) Ovulation
b) Ovarian torsion
c) Menstruation
d) Regression of the corpus luteum
a) Ovulation
Which fibroid distorts the peripheral contour?
a) intramural
b) subserosal
c) intracavity
d) submucosal
b) subserosal
What abnormality is most likely to result in first trimester miscarriages?
a) adenomyosis
b) endometriosis
c) cystic teratoma
d) ashermans syndrome
d) ashermans syndrome
what is the significance of pyometra?
a) pus within the vaginal canal
b) pus within the endometrial cavity
c) pus within the fallopian tube
d) pus within the myometrium
b) pus within the endometrial cavity
What muscle group forms the pelvic floor and provides support to the pelvic organs?
a) piriformis
b) levator ani
c) psoas major
d) obturator externus
b) levator animation
What hormone is responsible for the maturation and preparation of the Graffian follicle for ovulation?
a) follicle stimulating hormone
b) gonadrotropin-releasing hormone
c) estrogen
d) luteinizing hormone
a) follicle stimulating hormone
A patient presents to the ER with acute pelvic pain and negative hCG. which of the following is the most likely differential diagnosis?
a) PCOS
b) ovarian torsion
c) fibroma
d) hydrosalpinx
b) ovarian torsion
What hormone is responsible for the appearance of the secretory endometrium?
a) estrogen
b) progesterone
c) luteinizing hormone
d) hCG
b) progesterone
Approximately what day would the trilaminar appearance be imaged in a patient with a 26 day cycle?
a) 18
b) 26
c) 14
d) 12
d) 12
What characteristics are most suggestive of ovarian malignancy?
a) calcifications with posterior shadowing
b) thick septations and papillary projections
c) septations and internal debris
d) low resistance doppler patterns
b) thick septations and papillary projections
