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Kim's > O&G > Flashcards

O&G Flashcards

1
Q

septate, bicorniate and didelphys uterus

A

septate: smooth fundus. can appear to have 2 cervices
bicornuate: indented fundus. 1 cervix
didelphys: complete. indented fubdus, 2 cervices and 2 vaginas.

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2
Q

placenta praevia spectrum and grade

A

still crosses os at 28wks. can’t dx b4 20wks. repeat at 32 wks
low lying. less than 2cm from OS Partial praevia. partially covers os Complete praevia. total coverage of os
Increased risk APH and acretta. Follow up at 30wks to see if regresses

grade 1. edge within 5cm
grade 2. marginal. tissue reaches but doesn’t cover
grade 3. partially covers OS
grade 4. complete

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3
Q

placenta acretta

A

acretta. abnormal adherence to myometrium. prominent venous lakes. increased risk with previous c section or placenta praevia. worry if anterior placenta and previous section
incretta. infiltrates withing myometrium
percretta. within myometrium. no or very little plane between myometrium vessels and bladder on doppler

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4
Q

placental abruption

A

premature separation b4 20wks
antepartum haemorrhage
retro placental clot

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5
Q

circumvillate placenta

A

placental shelf at edge, lifts up

can infarct or haemorrhage

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6
Q

succenturiate lobe

A

2 lobes. put doppler between and check no vessels, esp along os. do PV
associated with praevia and retained products

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7
Q

abnormal cord insertion into placenta

A

marginal. within 2cm from edge.
velamentous. inserts direct to wall/membranes, not into placenta. vessels run between insertion and placenta
associated IUGR, vasa praevia ( vessels across os) and haemorrhage

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8
Q

amniotic band and shelf

A

shelf. thin band that runs entire length of uterine wall. has base (thick) and free edge. can have flow.
band. free floating blind end in anion with intact end to chorion. can entrap limbs and cause structures.

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9
Q

uterine cord

A

2aa, 1vv.
normal RI <0.55
normal PI <1.4

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10
Q

MCA artery doppler

A

mum sitting up or on rt side
normally has high resistance flow with no antegrade diastolic (below line)
reduced flow suggests head sparing and cerebral redistribution. IUGR progression.

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11
Q

IUGR

symmetric or asymmetric

A

symmetric. all parameters are down. EFW <10%
associated with trisomy 13 or 18, TORCH, etoh, smoking, heroin

asymmetric. placental insufficiency or pre eclampsia.
HC normal, AC reduced. increased HC/AC ratio. check MCA for sparing. look at bone density and shape.

must comment on foetal movements, liquor volume and umbilical aa SD and PI.

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12
Q

polyhydramnios

A 
>25cm after 20wk
idiopathic
dm
cns or neural tube defect                                                              Hydrops                                                                                                                          TTTS
cardiovascular abnormal.  svt
CPAM
hernia
GI obstruction                                                                            Microcephaly (rubella or CMV in utero,  trisomy, Syndromic ie walker Warburg mm dystrophy)
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13
Q

most common virus causing hydrops

A

pavovirus

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14
Q

CCAM types

A

type 1. most common. large cysts 2-10cm size
type 2. cysts <2cm size. associated with renal agenesis, Pulm sequestration and cardiac anomalies
type 3. unlined cysts. usually only affects 1 lobe. can’t ddx from type 1
type 0. rare. global arrest of lung development. postnatal fatal.

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15
Q

commonest cause of hydronephrosis in utero

A

PUJ obstruction.
high risk renal injury with minor trauma.
bilateral 30%. L>R.
congenital is usually idiopathic. other causes: extrinsic compression (vessel, fibrosis or mass), pelvic trauma, infection with scar

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16
Q

TTTS in mono/di chorion, Moni/di amnionic

A

exclusively monochorionic pregnancies

MCDC, MCDA

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17
Q

Nuchal translucency thickness

A

> 3mm, but must correlate with maternal bloods also
- bHCG, AFP, oestriol, pregnancy associated plasma protein (PAP).
look at heart.

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18
Q

yolk sac present

A

5-6 weeks

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19
Q

hydrops fetalis

A

immune/rhesus incompatible
non inmune/rhesus compatible: cardiac> chromosomal 18, 13, 21, turners > infection (pavovirus B19, TORCH) > chest (CPAM), Urinary tract obst, TTTS, sacroccygeal tumors, anemia, skeletal dysplasia, vv galen

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20
Q

TTTS stages

A
  1. visible bladder. normal US
  2. empty bladder. normal UA
  3. empty bladder. UA doppler abnormal
  4. hydrops in recipient
  5. demise of either twin
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21
Q

eccentric gestational sac

A

Interstitial ectopic
high in fundus, off centre. corneal.
low near cervix - c-scar or classic c scar
*mention myometrium thickness as <3mm associated with risk perforation. Uterine anomaly. bicorniate or septate

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22
Q

ectopic vs miscarriage

A

ectopic has decidual reaction and rim of vascular it.

ectopic won’t move on probe palpation.

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23
Q

mx ectopic

A

medical: not ruptured, asymptomatic, <3cm
methotrexate wither systemic or direct injection (kcl first to kill pregnancy)

surgical: ruptured, symptoms

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24
Q

failed early pregnancy

A

MSD >25mm with no embryo
CRL >7mm with no heartbeat
*CRL out ranks MSD. repeat US in 7-14 days if borderline

suspected failed:
CRL <7mm with no heartbeat
MSD: 16-24mm with no embryo
enlarged (>7mm), calcified or irregular yolk sac
irregular gestational sac
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25
Q

hydatiform mole

A

gestational trophoblastic disease
teens, 40-50yo and Asians
complete: diploid 46XX
partial: abnormal fetus. triploid 69XXXY
bunch of grapes on US with enlarged uterus and elevated bHCG
complete can progress to invasive or choriocarcinoma

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26
Q

MCMA MCDA DCDA DCMA

A

DC. lambda sign. twin peaks. thick

DA. T sign. thin

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27
Q

oligohydramnios

A

DRIPC
Demise or drugs
Renal agenesis, posterior urethral valves, MCDA. check PUJ and bladder
IUGR
PROM or post dates
Chromosomal abnormalities 18, 21, 13, turners *Check pulm hypoplasia, limbs for club foot or deformity, facial deformity, UA for IUGR

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28
Q

intrauterine hydrocephalus

A

> 10mm diameter later ventricles at atrium
non obstructive. hemorrhage, infection
obstructive. spina bifide, aqueduct stenosis, chiari, dandy walker, encephalocele

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29
Q

normal intrauterine renal pelvic diammeter

A

7mm

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30
Q

cisterna magna c/w dandy walker

A

cisterna doesn’t have a connection to 4th ventricle

dandy walker has small posterior fossa

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31
Q

ovarian cysts - simple

A

<5cm premenopausal or <1cm postmenopausal - leave alone.
5 -7cm pre (1-7cm postmenopausal) - f/u yearly US
>7cm needs gynae rv +/- MRI for possible infiltration

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32
Q

ovarian cyst - haemorrhagic

A

<5cm no fu
>5cm - fu in 6-12 weeks to ensure resolution
in post menopausal need follow up at any size.
* hypoechoic with lace like internal echos. +/- concave solid part that has no flow.

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33
Q

malignant breast ca

A

95% adenocarcinoma
5% phylloides, lymphoma, sarcoma, scc, mets (melanoma, lymphoma).
2nd to skin ca in frequency. 2nd to lung ca in cause of death
risks. hormones (early menarche, late menopause), nulliparity, obesity, oestrogen. genetic brca 1 & 2, le fraumeni, Cowden, HTT, peutz jagher.

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34
Q

non invasive breast cancer vs invasive

A

invasive has breached the basement membrane

they all arise in terminal duct/lobule unit

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35
Q

non invasive breast ca

A

DCIS.
branching linear micro calcs that spread along the duct.
comedocarcinoma, papillary, Micropapillary, solid, cribriform.

LCIS.
usually incidental finding on bx as no calcification.
more likely to be bilateral or multilocul and can recur in either breast as ductal or lobular
more common in younger women than DCIS

  • both can become invasive around 1% per year.
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36
Q

invasive breast ca

A

breached basement membrane
upper outer most common
schirrhous (dense collagen), stelate or well cx.

subtypes.

  • NOS. worst prog, high grade
  • Medullary. poor prog as rapid growth and local aggressive. looks like fibro adenoma. younger (50s). BRCA 1
  • Lobular. poorly seen as little desmoplastic reaction and no ca+. Indian ink cells in loose clusters. multicentric or bilateral can occur
  • Mucinous. older women with slow growth and good prog. cells float in mucin. soft and gelatinous.
  • Tubular. spiculated mass in younger. slow growth with best prognosis.
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37
Q

first trimester bleeding

A

Normal implantation bleed, miscarriage (MSD >25mm, CRL >7mm with no FHB), ectopic, GTD, Subchorionic haemorrhage (>50% high risk)

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38
Q

Empty gestational sac

A

Blighted ovum (MSD >25mm with no embryo) Ectopic with pseudogestational sac (central cf eccentric location in uterus, no yolk sac, irregular/pointed shape)

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39
Q

Echogenic endometrial cavity

A

Early IUP, Ectopic, retained products, emdometritis

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40
Q

Complex intrauterine mass

A

Missed miscarriage with RPOC, molar, degenerative fibroid, endometrial ca (>5mm postmenopausal with bleed, >11mm without bleed)

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41
Q

High risk aneuploidy

A

Increased maternal age Increased nuchal translucency >3mm Increased beta hcg Decreased PAPP-A Absent echogenic nasal bone

42
Q

Nuchal translucency method

A

Nasal bone in view, echogenic dot Head neutral Calipers on inside of echogenic lines at widest part CRL 45 - 84mm 11-13.6wks

43
Q

Increased nuchal translucency

A

> 3mm Chromosomal. 13, 18, 21 Non chromosomal. cardiac defect, skeletal dysplasia, oomphalocele, VACTERL

44
Q

Enlarged placenta

A

> 4cm thick Hydrops, maternal DM, maternal anaemia, TORCH, GTD, haematoma

45
Q

Small placent

A

Hypoperfusion Maternal HTN, Toxaemia, severe DM, IUGR

46
Q

Hypoechoic placental focus

A

Venous lake (assoc. accretta), Placental haemorrhage, GTD (partial mole), Infarct (can be echogenic or ca+), chorioangioma (benign placental vascular tumor), submucosal fibroid

47
Q

Single vessel cord

A

Trisomy 18, 13, structural anomalies (renal agenesis, face, limbs, heart), IUGR Follow up trimester 3 to assess growth. risk IUGR

48
Q

Mass in cord

A

Haematoma, Haemangioma, cyst, varix

49
Q

Small baby

A

Incorrect dates, small baby from small parents, IUGR IUGR is symmetric (growth restriction in all paremeters. due to foetal problem) or asymmetric (AC most affected. due to placental problem) EFW <10% for GA

50
Q

Symmetric IUGR

A

Chromosomal. 13, 18, 21 Congenital malformation. Anencephaly, Diaph hernia, oomphalocele, Gastroschesis, Renal agenesis Multiple gestations

51
Q

Asymmetric IUGR

A

Placental Abnormal trophoblastic invasion, multiple placental infarcts, abnormal cord insertion, placenta praevia, circumvillate placenta, chorioangiomata

52
Q

Strawberry skull, Microcephaly, Choroid plexus cyst, Absent Corpus callous, Facial cleft, Micrognathia, Cystic hygroma, Diaph hernia, Oomphalocele, Duodenal atresia, Hydrops, Short femur, Overlapping fingers, Polydactyly, Tallipes

A

Strawberry skull - 18, Microcephaly - 13, turners Choroid plexus cyst- 21, 18, Absent Corpus callousum - 18, Facial cleft - 18, 13 Micrognathia - 13 Cystic hygroma - turners Diaph hernia - 18, 13, Oomphalocele - 18, 13, Duodenal atresia - 21, Hydrops - 21, turners Short femur - all Overlapping fingers - 18 Polydactyly - 13 Tallipes - 18, 13

53
Q

Asymmetric twin size

A

Normal variant is <20% EFW difference - Foetal demise or TTTS (monochorionic) donor twin is underperfused and stuck, absent or reversed UA flow recipient twin is oedematous, normal size, absent DV

54
Q

Lemon head

A

Myelomeningocele with chiari II, encephalocele, DW malformation

55
Q

Cloverleaf skull

A

Craniosynostosis (multiple), thanatrophic dwarfism

56
Q

Frontal bossing

A

Achondroplasia, thanatrophic dwarfism, acromegaly, cleidocranial dysostosis

57
Q

ventriculomegaly

A

atrial width >10mm Chiari II, meningocele, spina bifida, DW malformation, Aqueduct stenosis (congenital Web, infection or haemorrhage), Agenesis corpus callosum, Congenital infection

58
Q

Hyperechoic brain focus

A

Haemorrhage, teratoma, lipoma cc

59
Q

Posterior fossa malformations

A

Normal cisterna magna is <10mm Chiari, dandy walker

60
Q

Posterior cystic head/neck mass

A

Cystic hygroma (turners, trisomy 18, 13, 21). look for aortic coarctation Encephalocele Myelomeningocele c spine Haemangioma

61
Q

Anterior head/neck cystic mass

A

Teratoma (cystic and solid), Haemangioma, brachial cleft cyst (anterolateral), thyroglossal duct cyst (midline)

62
Q

solid or echogenic pulmonary mass

A

CPAM, CDH, Pulm sequestration (look for aa), CLE filled with fluid, bronchial atresia, Mucous plus, teratoma

63
Q

hyperechoic cardiac focus

A

Normal variant, trisomy 21 (soft marker), rhabdomyosarcoma (esp TS), teratoma, haemangioma

64
Q

Absent gastric bubble

A

Should be visible by 19wk. Rescan in 30 mins - Oesoph atresia (18 and 21), CDH, oligohydramions, impaired swallowing (CNS defect, facial cleft, skeletal dysplasia with narrow chest) *Look for VACTERL, T18/21 and polyhydramnios (suggests oesoph atresia)

65
Q

abdo ca+

A

Meconium peritonitis, TORCH, neuroblastoma, teratoma

66
Q

echogenic bowel

A

as bright as iliac bone CF, T21, IUGR, CMV infection, swallowed blood, mec peritonitis

67
Q

anterior abdominal wall defect

A

midline. physiological (b4 12wks), oomphalocele (trisomy) lateral. gastroschisis infra umbilical. bladder or cloaca exostrophy

68
Q

hydronephrosis

A

AP diamm >4cm T1, >7mm T2. Upper tract: PUJ obst (most common), reflux, primary mega ureter (VUJ obst), duplex Lower tract: PUV, urethral stricture or agenesis, caudal regression sx, ectopic ureterocele, prune belly sx

69
Q

Big echogenic kidneys

A

PCKD, t13, Meckle gruber, Renal vv thrombosis *t13. look for cardiac abno, cystic hygroma, facial cleft *Meckle g. look for encephalocele, polydactyly

70
Q

Big bladder

A

PUV, prune belly, urethral/cloaca atresia

71
Q

Absent bladder

A

failure of urine production - Bilateral renal agenesis, bilateral MCDK, bilateral PUJ, ARPCKD, severe IUGR failure to store or displaces bladder - Bladder exostrophy, cloaca exostrophy, ruptured bladder *rescan in 30 min incase empty

72
Q

Reduced femur length

A

Short parents, IUGR, chromosomal, skeletal dysplasia

73
Q

Fractures

A

OI, hypophosphataemia, skeletal dysplasia (Achondroplasia. .. just a little short)

74
Q

third trimester bleeding

A

placenta praevia, Placental abruption, cervical lesions

75
Q

c section complication

A

RPOC, haematoma or infection (pelvic collection), endometritis

76
Q

Shadowing in endometrium

A

IUD, ca+ in fibroid or Tb, pyometria with gas

77
Q

focal enlargement of uterus

A

fibroid, adenomyosis (venetian blind, posterior wall), inflammation (PID, surgery), endometriosis, tumor

78
Q

thickened endometrium

A

> 5mm post menopausal with haemorrhage, >8mm without haemorrhage - pregnancy related. normal, ectopic, RPOC, GTD - post menopause. Endometrial hyperplasia, endometrial polyp, endometrial cancer, HRT

79
Q

Cystic adnexal mass

A

Follicle. <25mm Follicular cyst >25mm Too many follicles (PCOS, hyperstimulation) Non neoplastic mass. Haem cyst (lace like), endometrioma (low echo), ectopic Neoplastic mass. surface epithelial tumor (serous, mucinous, endometrial, brenner), GCT (dermoid. + ca+ and fat) Tube. hydrosalpinx (PID, endometriosis, Adhesions, surgery)

80
Q

Complex pelvic mass CHEETAH

A

Cystadenoma, Haem cyst, Ectopic, Endometrioma, Teratoma, Abscess (look for appendicits), Haematoma

81
Q

Bilateral ovarian mass

A

Endometrioma, serous epithelial (cystadenocarcinoma), endometrioid tumour, dermoid cyst, mets (krukenberg GIT)

82
Q

Ovarian mass pearls

A

Serous cystadenoma are thin walled uni or multilocular. common Mucinous cystadenoma are lass common, big and multilocular Endometrial hyperplasia is associated with endometrioid carcinoma, granulosa cell tumor and thecoma Solid ovarian tumours are fibroma and brenner Malignant germ cell tumours are large and predominantly solid. younger women, prominent fibrovascular septa. correlate with serum tumor markers Tumours with strong enhancing solid parts are stromal or sertoli leydig

83
Q

Enlarged ovary with multiple peripheral follicles

A

PCOS, ovarian torsion, ovarian hyperstimulation

84
Q

PCOS

A

Ovary volume >10cc, >12 follicles in ovary 2-9mm each. Only need 1 ovary involved to dx Correlate with clinical sx such as hirsutism and anovulation

85
Q

Dilated fallopian tubes

A

Infection, tumour (endometrial or tubal carcinoma), endometriosis

86
Q

Tubal filling defect

A

polyp, gas bubble, silicon inject, tubal pregnancy, neoplasm

87
Q

Tubal irregulariry

A

Inflammatory PID or Tb, salpingitis isthma nodosa, adenomyosis, endometriosis, post op

88
Q

IOTA benign. SUMS - flow, Malig MAPS. +flow

A

Benign. - Unilocular - Solid part <7mm - Shadowing - Smooth multilocular <10mm size - No flow Malignant - Solid irregular - Ascities - Multilocular, irregular, solid >10mm - >4 papillary projections - Strong flow *1+ malig with no benign needs gynae on rv *1+ benign with no malignant ok *All other are indeterminate and need gynae rv

89
Q

Breast calcification. Benign

A

Skin ca+ - Lucent centre, eggshell Rim/eggshell - <1mm thick, peripheral. oil cyst or cyst wall Vascular ca+ Rod like large - plasma cell mastitis. smooth, linear rods Round punctuate - Homogenous, evenly scattered. Isolated clusters need bx Milk of ca+ - teacup sediment. fuzzy/smudged on CC, teacup on lat Coarse ca+ popcorn - Large >2-9mm. papilloma, haemangioma, Hamartoma Dystrophy coarse irregular ca+ post rxt or sx Suture ca+

90
Q

Breast ca+ Suspect

A

Amorphous powderish Coarse heterogenous Fine pleomorphic granular. vary shale and size. DCIS Fine linear branching. high grade DCIS

91
Q

Breast ca+ distibution

A

Diffuse/scattered. usually benign Regional. Large volume of breast tissue. malignancy less likely Grouped/clustered. Occupy a small volume of tissue Segmental. deposits in ducts and branches. bad Linear. In a line

92
Q

Male breast lump

A

gyneacomastia- flame shaped, most common, subareaolar. unilateral or bilateral asymmetric lipoma Breast ca. IDC. eccentric to nipple Mets (melanoma, lipoma) **Palpable breast mass in male - proceed to US

93
Q

Causes of gyneacomastia

A

SCARE M Seminoma, Cirrhosis, Anabolic steroids, Renal failure, Estrogen, Marajuana.

94
Q

Unilateral nipple changes

A

Pagets disease of nipple. DCIS Inflamm breast ca Mastitis Eczma. resolves with steroids. looks like pagets

95
Q

Skin thickening. diffuse

A

Bilateral - HRT, Lactation, post reduction mammo pasty, CCF, SVC obst, Lymphoedema, Renal failure Unilateral - Inflamm breast ca, lymphoma/Leukaemia, Lymphatic obstruction (spread ca to axilla), Acute mastitis, abscess, radiation, post sx

96
Q

Skin thickening. focal

A

carcinoma, intra dermal met, skin lesion (wart, mole, seborrheic keratitis. lucent rim around), Plasma cell mastitis, dermatitis, trauma, mondors disease (thrombosis of superficial vv)

97
Q

Subcutaneous/superficial breast mass

A

sebaceous cyst, epidermoid, focal infection

98
Q

Breast mass with echogenic halo on US

A

Haematoma (thick, changes with time, go in and look for skin trauma or take hx), abscess, carcinom

99
Q

tallipes association

A

t18, neural tube defects, congenital joint contractures

100
Q

calcified axillary LN breast

A

Gold in RA, treated Lymphoma, mets (ovarian, mucinous)

Kim's (6 decks)

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