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ob/gyn ESP > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Levator ani muscle

A

Forms the pelvic floor along with the piriformis muscles, supports and positions the pelvic organs. Posterior to vagina and cx. Medial to obturator internus muscles.

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2
Q

Illiopsoas muscles

A

Lateral landmark of the true pelvis. Course anterior and lateral through the false pelvis

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3
Q

Piriformis muscles

A

Arise from the sacrum, form part of the pelvic floor. Posterior to the uterus, ovaries, vagina, and rectum. Course diagonally to the obturator internus muscle

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4
Q

Psoas muscles

A

Arises from the lumbar spine. Course laterally and anteriorly into the false pelvis. Round in shape in thetransverse plane.

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5
Q

Obturator internus muscles

A

Lateral margins of the true pelvis. Posterior and medial to the Illiopsoas muscles. Level of that vagina, lateral to the ovaries abutting the lateral walls of the urinary bladder.

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6
Q

Broad ligament

A

Creates the retrouterine in the vesicouterine pouches. Provides a small amount of support to the uterus

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7
Q

Cardinal ligament

A

Extends across the pelvic floor, firmly supports the cervix, attaches at the isthmus portion of the uterus

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8
Q

Round ligament

A

Arises in the uterine cornua, anterior to the fallopian tubes, helps to maintain anteflexion of the uterine body and fundus, Contracts during labor.

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9
Q

Suspensory ligament

A

Also known as infundibulopelvic ligament, extends from the lateral portion of the ovary to the pelvic sidewall.

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10
Q

Uterosacral ligament

A

Extends from the upper cervix to the lateral margins of the sacrum, firmly supports the cx

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11
Q

Arcuate vessels

A

Prominent vascular structures in the outer one third of the myometrium

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12
Q

Internal iliac arteries

A

Posterior to the uterus and ovaries, A.k.a. hypogastric arteries, supply the bladder uterus vagina and rectum give rise to the uterine arteries

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13
Q

Ovarian arteries

A

Slightly inferior to the renal arteries, Course medial within the suspensory ligaments, primary blood supply to the ovaries

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14
Q

Ovarian veins

A

Course within the suspensory ligaments, right ovarian vein empties directly into the IVC, left ovarian vein empties into the left renal vein

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15
Q

Uterine arteries

A

Medial in that elevator ani muscles, Ascend on a tortuous, course lateral to the ut within the broad ligament.Supply the cervix vagina uterus ovaries and fallopian tube

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16
Q

Perimetrium

A

Serosal or external surface of the ut

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17
Q

Endometrium

A

Mucous membrane lining the uterine cavity composed of two layers: functional and basal

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18
Q

Uterine isthmus

A

Located between the survey and body of the uterus, termed lower uterine segment during pregnancy

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19
Q

Uterine arteries?

A

Demonstrate a high resistance flow pattern, resistive index of the arcuate arteries range between .86+ or -.04 (reproductive) and .89+ or -.06 (post menopause)

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20
Q

Normal sonographic appearance of the endometrium is?

A

Outer basal layer appears hypoechoic, inner functional layer typically appears hyperechoic

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21
Q

What is the location of the uterus?

A

Stationed in the pelvis, anterior to the rectum, and for scarier to the urinary bladder

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22
Q

How do we measure the endometrium?

A

Anterior-posterior thickness is measured in the sagittal plane, measured from echogenic interface to echogenic interface(functional layer) thin hypoechoic area (basal layer) is not included in the measurement

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23
Q

Premenarche uterine size:

A

2-4 x .5-1 x 1-2cm

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24
Q

Uterine menarche size?

A

6-8.5 x 3-5 x 3-5 cm nulliparus

8-10.5 x 3-5 x 5-6 cm
Parous

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25
Q

Postmenapausal uterine size?

A

3.5-7.5 x 2-3 x 4-6 cm

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26
Q

Anteflexion

A

Uterine fundus bends on the cervix

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27
Q

Anteversion

A

Cx forms an angle less than or equal to 90° with vaginal canal, most common uterine position

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28
Q

Retroflexion

A

Uterine fundus or body curved backward on the cx, cx remains in the anteverted position

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29
Q

Retroversion

A

Cx forms in less than 90° with a vaginal canal, uterus and cervix display a posterior tilt

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30
Q

Arcuate ut?

A

Septum between the mullerian ducts is almost complete resorption of septum with only mild indention of the endo of the fundus. My separation of the superior endo.

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31
Q

Bicornuate ut?

A

Partial fusion of the mullerian ducts. Deep notch in the fundus, 2 distinct endos separated by a small amount of myometrium

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32
Q

Didelphys ut?

A

Complete failure of the myllerian ducts to fuse, wide separation between two distinct uterine fundi (trvs plane) 2 separate cx, possible septated vagina

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33
Q

Septae ut?

A

Complete fusion of the mullerian ducts with failure to completely reabsorb the septum, 2 uterine cavities and one uterine fundus. Wide separation within the endo cavity by fibrous tissue or myometrium

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34
Q

Subseptae ut?

A

Thinseparation within the endo cavity by fibrous tissue or myometrium

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35
Q

Unicornuate ut?

A

Unilateral development of the paired mullerian ducts, small uterine size, lateral uterine position

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36
Q

OVs

A

Dual blood supply through the ovarian and uterine arteries

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37
Q

Estrogen is produced by?

A

Secreted by the follicle

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38
Q

Progesterone is secreted by?

A

The corpus luteum

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39
Q

Loc of ovs?

A

Intraperitonea, medial to the external illiac vessels, anterior to the internal illiac vessels and ureter, posterior to the fallopian tubes and broad ligament

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40
Q

Nomal sono appearance of ovs?

A

Ovoid medium-level echogenic structure, isoechoic compared to the normal ut

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41
Q

PW of ov?

A

During menses and early prolifirative phases, the ovarian artery demonstrates a high resistance and low flow velocity. RI ranges from .4-.8
PI ranges from .6-2.5

42
Q

Ovs size?

A

2.5-5 x .6-2.2 x 1.5 -3 cm

43
Q

Divisions of the FTS:

A

Interstitial, isthmus, ampulla ( most common area of ect preg) infundibulum

44
Q

Size of the FTs?

A

7-12 cm 8-10 mm in diameter

45
Q

Bladder

A

Postvoid residual normally should mot exceed 20 ml. Bladder wall thickness should not exceed 5mm

46
Q

Bladder diverticulum?

A

Anechoic pedunculation of the uri bladder

47
Q

Bladder ureterocele:

A

Hyperechoic septation seen within the bladder @ the ureteric orifice ( UTI)

48
Q

Bladder calculus

A

Hyperechoic focus within the bladder, shadowing (hematuria)

49
Q

Cystitis

A

Infection, dysuria, frequency, leukocytosis. Increase in bladder wall thickness

50
Q

Bladder malignancy

A

Transitional cell carcinoma, painless hematuria, frequency, dysuria, echogenic mass, irregular margins.

51
Q

Bladder polyp:

A

Frequency, echogenic intraluminal mass, vascular flow

52
Q

What does menstruation depend on?

A

The functional integrity of the hypothalamus, pituitary gland, and ovarian axis

53
Q

Estradiol is?

A

Primarily reflects the activity of the ovs, during pregnancy, levels will stedealy rise.

54
Q

Estrogen

A

Normal levels: 5-100ug/24 h, primary female sex hormone. Produces by developing follicles and placenta. FSH and LH stimulate production of estrogen in ovs.

55
Q

FSH

A

Secreted by the anterior pituitary gland, initiates follicular growth and and stimulates the maturation of the graafian follicle

56
Q

LH?

A

Essential in both males and females for reproduction, secreted by anterior pituitary gland, increasing estrogen levels stimulate LH production, triggers ovulation and initiates the conversion of rhe residual follicle into a corpus luteum. LH surge typically lasts on the 48 hours

57
Q

Progesterone

A

Produced in the adrenal gland’s, corus luteum, Brain and placenta. Prepares the Endo or possible implantation or starting the next menstrual cycle

58
Q

Endometrium

A

Endo thickness should not exceed 14 mm, Endo without HRT should not exceed 8 mm and it is consistently benign when measuring 5 mm or less

59
Q

Menstrual phase of endo

A

Early phase: hi point point central line during menstruation measuring 4 to 8 mm. Late phase: then discrete hyperechoic line postmenstruation measuring 2 to 3 mm

60
Q

Proliferation phase

A

Days 6 to 14 increasing estrogen levels regenerate a functional layer, coincides with the follicular phase of the ovary. Early phase: days 6 to 9 thin echogenic Endo measuring 46 mm. Late phase: days 10 to 14. A triple line Measuring 6 to 10 mm thick hypoechoic functional layer and hyperechoic basal layer

61
Q

Secretory phase

A

Days 15 to 28 functional layer continues to thicken. Functional layer appears hyperechoic, basal layer appears hypoechoic, acoustic enhancement, greatest thickness measuring 7 to 14 mm

62
Q

Ovaries

A

Visualization of a cumulus opphorus indicates follicular maturity, with ovulation typically occurring within 36 hours. LH usually reaches its peak10-11 hrs before ovulation

63
Q

Secretory phase

A

Days 15 to 28 functional layer continues to thicken. Functional layer appears hyperechoic, basal layer appears hypoechoic, acoustic enhancement, greatest thickness measuring 7 to 14 mm

64
Q

Ovaries

A

Visualization of a cumulus opphorus indicates follicular maturity, with ovulation typically occurring within 36 hours. LH usually reaches its peak10-11 hrs before ovulation

65
Q

Follicular phase

A

Early phase: days 1-5 multiple small anechoic functional cysts
Late phase: days 6-13, graafian follicle reahes 2-4 cm in diameter before ovulation

66
Q

Ovulatory phase

A

Occurs @ the rupture of the graafian follicle, day 14. Minimal amount of cul-de-sac fluid

67
Q

Luteal phase

A

Days 15-28, constant 14 day lifespan. Corpus luteum grows for 7-8 days, secreting some estrogen and an increasing amount of progesterone. If no fertilization cl regresses after 9 days

68
Q

Hemorrhagic cyst

A

Severe acute pain, nausea, vomitting, low grade fever

69
Q

Cystic teratoma (dermoid)

A

Most common primary ovarian neoplasm, “ tip of the iceberg” commonly located superior to the uterine fundus

70
Q

Mucinous cystadenoma

A

Pelvic pain, irregular menses, bloating, multilocular anechoic mass, generally unilateral

71
Q

Serous cystadenoma

A

Pelvic pain, irregular menses, bloating

72
Q

Theca lutein cysts

A

Assoc with high levels of hCG, multilocular cystic structure, bilateral condition

73
Q

Hyperplesia

A

Proliferation of the endometrial lining

74
Q

Intramural leiomyoma

A

Mass distorting the myometrium, most common loc

75
Q

Submucosal leiomyoma

A

Mass distorting the endo, least common but most likely to cause symptoms

76
Q

Fibroma

A

Rare, benign stromal tumor, pelvic pain or fullness, menopause

77
Q

Thecoma

A

Pelvic pain or pressure, menopause

78
Q

when does a corpus luteum resolve?

A

by 16 weeks

79
Q

what is the max measurement of a normal dominant follicle?

A

3 cm

80
Q

what is a theca lutein cyst?

A

the largest of functional cysts, multilocular and bilateral, associated with gestetional throphoblastic disease

81
Q

Rt sided ovarian torsion can mimic what?

A

acute appendicitis

82
Q

any pt with a suspicious ovarian mass, should be evaluated in what other areas?

A

peritoneum, lymp nodes, liver and pleural space

83
Q

endometriosis:

A

is the presence of functional endometrial tissue outside of the endo and myometrium

84
Q

endometrioma

A

localized endometrial tissue, “chocolate cyst”

85
Q

when in an NT performed?

A

between 11.5-13.5 weeks, greater than 3 mm is abnormal

86
Q

an abnormal NT in the presence of a normal karyotype is associated with what?

A

increased incidence of congenital heart disease

87
Q

what do low levels of PAPP-A and beta-hCG levels indicate?

A

abnormal implantation, poor placentation, or risk of trisomy 21

88
Q

when is CVS performed?

A

between 9 and 12 weeks gestation

89
Q

what are the components of quad screening, and when is it performed?

A

during the second trimester, MS-AFP, hCG, inhibin A, and uE3.

90
Q

trisomy 18, Edward’s syndrome labs:

A

decreased, MS-AFP, decreased hCG, and decreased uE3

91
Q

trisomy 21, Down syndrome labs:

A

decreased MS-AFP, increased hCG, decreased eU3 and increased inhibin-A

92
Q

when is amniocentesis usually performed?

A

at around 16 weeks gestation

93
Q

when does the morula enter the ut?

A

4 days after fertilization

94
Q

when does the blastocyst implant itself in the endo?

A

7 days post-fertilization

95
Q

when do the amnion and chorion fuse?

A

12-16 weeks

96
Q

when is the yolk sac present?

A

when MSD is greater than or equal to 8 mm TV

97
Q

when should the yolk sac be seen transabdominally?

A

by 7 weeks with sac measuring 20 mm

98
Q

when is the rhombencephalon observed in the embryo?

A

between 8-11 weeks

99
Q

NT:

A

should be performed in a sag plane, between 11.5-13.5 weeks. measurement should not exceed 3 mm.

100
Q

NF:

A

should be performed in a trv plane, between 15-21 weeks, measurement should not exceed 6 mm.

101
Q

when do fetal testes descend into the scrotum?

A

between 26-34 weeks gestation

ob/gyn ESP (2 decks)

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