OB/GYN Registry Review Flashcards
Bony boundaries of the pelvis
sacrum
coccyx
innominate bones (ilium, ischium, pubic symphysis)
innominate bones include:
ilium
ischium
pubic symphysis
imaginary line from pubic symphysis to sacral prominence (top of sacrum)
linea terminalis
are deep and below the linea terminalis
true pelvis
The true pelvis includes:
bladder
small bowel
ascending and descending colon
rectum
uterus
ovaries
fallopian tubes
internal iliacs
5 muscles
hammock shaped muscles that give support to pelvic organs;
pelvic diaphragm
The pelvic diaphragm includes:
levator ani and coccygeus muscles
The true pelvic muscles are located posterior toL
bladder
vagina
rectum
O.P.I. muscles in the adnexa
obturator internus
piriformis
iliopsoas
The obturator internus muscle is located ____ to the bladder
lateral
The pirfiormis is located _____
posterolateral
The iliopsoas is located ____
anterolateral
appear as ovoid hypoechoic structures that elongate in the sagittal plane in the adnexa; adjacent or lateral to bladder/ovaries/uterus
O.P.I muscles
double fold of peritoneum. From lateral sides of uterus to walls of pelvis
broad ligaments
located between folds of peritoneum. Only ligaments every visualized on sono, only when there is pelvic ascites
round ligaments
contains vasculature of uterus
cardinal ligaments
______ are when fluid can collect in the pelvis
intraperitoneal cavities
The retropubic space or _______ is located ____ to the bladder
space of Retzius
anterior
lower quadrants of abdomen and lateral spaces to uterus
adnexa
The anterior cul-de-sac or ______ is located between the ____ and _____
vesicouterine pouch
bladder
uterus
The posterior cul-de-sac or ______ or ______ is located between the _____ and _____
rectouterine pouch
pouch of Douglas
uterus
rectum
The uterine arteries are branches of the:
internal iliac arteries
The ______ supply the periphery of myometrium
arcuate arteries
The _____ supply deeper into the myometrium
radial arteries
The ___ and ____ arteries supply the layers of the endo.
straight
spiral
The straight arteries feed the _____ layer of the endometrium
basal
The spiral arteries feed the _____ layer of the endometriu,
functional
The ovarian arteries originate from the ____
aorta
The ovaries receive a dual blood supply from the _____ and _____ arteries
ovarian
uterine
The uterine veins return or drain into the ______
internal iliac veins
The right ovarian vein drains into the ______
IVC
The left ovarian vein drains into the _______
left renal vein
longest vein in the pelvic vessel
left ovarian vein
The uterus is a ______peritonal organ
retro
The uterus is located _____ to the rectum
anterior
The uterus is located ____ to the bladder
posterior
The uterus is bound laterally by the ____ ligament
broad
The uterus is developed from the fusion of paired ______
Mullerian ducts
Four divisions of the uterus
fundus
corpus
isthmus
cervix
most superior and widest portion of the uterus
fundus
The fallopian tubes attaches to the _____
uterine cornu
The body of the uterus; the largest area
corpus
the lower uterine segment of the uterus in pregnancy
isthmus
internal and external os.
cervix
The ______ opens into the vaginal canal (most inferior part)
external os
The external os is surrounded by ______
vaginal fornix
Three layers of the uterus
serosa
myometrium
endometrium
The serosa layer is also known as the
perimetrium
Outermost layer of the uterus
serosa/perimetrium
muscular layer of the uterus
myometrium
mucosal layer of the layers consisting of the basal and functional layers
endometrium
prominent uterus due to maternal hormone stimulation. Cervix is enlarged with approximate 2:1 ratio (double the size) to the body
neonatal uterus
uterus is tubular in shape
: body = cervix
prepubertal uterus
increase in fundal diameter = pear shaped uterus
pubertal uterus
during the reproductive years the fundus of the uterus measures between __ and __ cm
6
8
decreased uterine size (4-6 cm)
menopausal uterus
body of uterus tilts forward; 90 degree angle with cervix
anteverted uterus
body of uterus folds forward; comess in contact with the cervix
anteflexed uterus
body of uterus tilts back and comes in contact with back of cervix
retroflexed uterus
body of uterus tilts back without a bend
retroverted uterus
oviducts, uterine tubes, salpinges
fallopian tubes
Fallopian tubes are between __-__ cm long
7
12
The fallopain tubes extend from the ____ within the broad ligaments to the ____
cornu
adnexa
Means of fertilization and transportation to the uterus
fallopian tubes
Tiny, hairlike structures, located inside the fallopian tubes that move back and forth to aid in the movement of the fertilized ovum
cilia
5 segments of the fallopian tube
interstitial, isthmus, ampulla, infundibulum, fimbria
The most proximal portion of the fallopian tubes; where the tube attaches to the cornu
interstitial
“bridge” of the fallopian tubes that connects the interstiital portion to the ampulla portion
isthmus
The longest and most tortuous segment of the fallopian tube
ampulla
The most common location of fertilization and ectopics
ampulla
distal and widest portion of the fallopian tubes
infundibulum
fingerlike extensions at the end of the infundibulum that draw the unfertilized egg into the tube
fimbria
The ovaries are ______, _____ organs
intraperitoneal
endocrine
The ovaries and surrounded by ____ muscles and _____ vessels
OPI
internal iliac
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 _____ and ____
estrogen
progesterone
The ovaries and stimulated by ____ and ___
FSH
LH
The outer cortex of the ovary is the side of:
oogenesis/follicles
The medulla of the ovaries houses the
vasculature
lymphatics
Ovarian volume equation
L x H x W x 0.523
The dominant follicle of the ovary
Graafian
Thecal internal cells of follicles produce _____
estrogen
Ovum is inside of the ______ of dominant follicle (seen as a daughter cyst within dominant follicle_
cumulus oophorus
Ovulation will occur within ___ hours of seeing cumulus oophorus within the dominant follicle
36
The ___ ruptures the Graafian follicle
LH
The Graafian follicle is replaced by the ______
corpus luteum
The corpus luteum releases _____
progesterone
When the corpus luteum regresses, the ______ takes its place
corpus albicans
The hypothalamus releases _____ to regulate release of hormones by the anterior pituitary gland.
gonadrotropin releasing hormone
The pituitary gland releases _____
FSH
stimulates ovaries to develop follicles and maturation of the dominant follicle
FSH
The follicles produce _____
estrogen
As the dominant follicle reaches maturity, there is a peak in _____ levels
estrogen
The peak in estrogen levels signs the pituitary gland to release the ____ surge
LH
The LH surge stimulates the rupture of the dominant follicle -
ovulation
The ruptured dominant follicle is known as the _____
corpus luteujm
The corpus luteum secretes _____ and small amounts of _____
progesterone
estrogen
The endometrium is directly affected by ______ and _____
progesterone
estrogen
______ thickens the endometrium
estrogen
______ maintains the thickened endometrium and prepares for implantation
progesterone
If no pregnancy occurs, the corpus luteum regresses and ______ levels drop.
progesteron
When the ______ decreases, the endometrium begins to slough off and menses begin
progesterone
follicular phase of ovary
days 1-14
FSH stimulates follicle development and dominant follicle matures increasing to about 2.5-2.7 cm until ovulation around day 14. Follicles release estrogen
follicular phase of ovary
menstrual phase of endometrium
days 1-5
menses and shedding of endometrium (no specific appearance)
menstrual phase of endometrium
proliferative phase of endometrium
days 6-14
The endometrium changes so much during this phase, so we must use ___ and ___ depending on where we are in this phase
early proliferative
late proliferative
immediately following menses, endometrium is thin, echogenic and measures no more than 4mm
early proliferative phase of endometrium
The late proliferative phase is also known as the
periovulatary phase
The endometrium will reach 6-10 mm and appears as a “3 line sign”
late proliferative phase of endometrium
The echogenic rim of the three line sign is the _____
basal layer
The hypoechoic border of the three line sign is the _______
functional layer
ovulation occurs of day __
14
LH surges cause rupture of the dominant follicle, releasing ovum. Free fluid may settle in the posterior cul de sac
ovulation
When calculating the ovulation day=
subtract 14 from the number of total cycle days
luteal phase of the ovary
days 15-28
Graafian follicle becomes corpus luteum which produces progesterone to maintain endo thickness., Towards the end of the phase corpus luteum regresses if no fertiliation
luteral phase of ovary
progesterone maintains endos thickness to prepare for implantation. Endo appears thick and echogenic and measures 7-16mm.
secretory phase of endo
Menses normally begins day ___ due to the progesterone drop
28
Follicular goes with ____
proliferative
ovulation goes with _____
late proliferative
Luteal goes with _____
secretory
of pregnancies
gravida
of pregnancies carried to term
para
transabdominal prep
full bladder
transvaginal prep
empty bladder
a-
without/none
dys-
abnormal/painful
hyper-
increased
hypo-
decreased
oligo- l
less
poly-
many
sub-
under
intra-
inside
inter-
between
hydro-
fluid
hemato-
blood
meno-
heavy
metro-
irregular
-menorrhea
menses
-rrhagia
bleeding
-uria
urination
-pareunia
intercourse
-plasia
growth
-genesis
formation
-oma
mass
-itis
infection
-colpos
vagina
-metra
uterus
-salpinx
fallopian tubes
“middle pain” in the middle of the cycle, near ovulation
Mittelschmerz
failure to have menses by the age of 16. Never reached menarche.
primary amennorhea
menses stopped
secondary amennorhea
incomplete, abnormal fusion or lack of formation of paired Mullerian ducts. May be associated with menstrual disorders, infertility, and OB complications
congenital malformation
There is an increased risk of congenital malformations of the uterus with fetal exposure to ____
DES
drug given to treat threatened miscarriages in the 70s
DES
Most commonly associated uterine congenital malformation with exposure to DES is:
T shaped uterus
mildest of call uterine congenital malformations; normal contour, slight indentation of fundal endometrium
arcuate uterus
AKA Bircornus unicollis; 1 endo cavity that divides into 2 at the fundus, “Y” shaped. Uterine fundus has a concave contour.
bicornuate uterus
normal uterine contour with 2 separate endo cavities
supseptate uterus
most common congenital uterine anomaly
septate uterus
2 completely separate endo cavities; uterine contour is concave at fundus
septate uterus
complete lack of fusion. 2 vaginas, cervices, and uteris
didelphys
lack of formation of one duct. single horn
unicornuate uterus
congenital malformations of vagina
vaginal atresia and imperforate hymen
The most common cause of pain and primary amennorhea in an adolscent girl
imperforate hymen
distention of uterus, vagina, or both with anechoic or complex fluid. fluid accumulated proximal to level of blockage
sonographic findings of vaginal atresia and imperforate hymen
absent or closed vagina; so it cannot be distended. Only uterus and cervix will be distended with fluid or blood
vaginal atresia
Vaginal atresia is associated with:
hydrometra or hematometra
closed hymen, everything above it can be extended
imperforate hymen
imperforate hymen is associated with:
hydrocolpos
hydrometracolpos
hematometracolpos
invasion of endometrial tissue into the myometrium
adenomyosis
focal mass like adenomyosis
adenomyoma
Adenomyosis has an increased risk in patients with ____
fibroids
dysmennorhea
menometrrohagia
pelvic pain
dyspareunia
multiparous
adenomyosis
enlarged uterus with diffusely heterogeneous myometrium
thickening of the posterior uterus
small cystic spaces scattered throughout myo (linear striations”
adenomyosis
fibroid or myoma
leiomyoma
benign smooth muscle tumor of the uterus
leiomyoma
most common benign gyn tumor
leiomyoma
leading cause of hysterectomy and gyn surgery
leiomyomaL
Leiomyomas are stimulated by _____
estrogen
abnormal bleeding
pelvic distention
pressure
infertility
urinary frequency
leiomyoma
hypoechoic mass with poor through transmission; bulky enlarged uterus
leiomyoma
most common leiomyoma
intramural
leiomyoma located within the muscle wall of the uterus. May make the whole uterus bulky but not not directly change the controu
intramujral
growth under the serosal layer, distorts the outer contour of the uterus
subserosa leiomyoma
Adjacent to endo and distorts contour of endo. Most likely to cause bleeding issues.
submucosal leiomyoma
A type of subserosal myoma that grows out and attaches by a stalk. May resemble adnexal masses. Most likely cause abdominal distension or pelvic pressure
peducunculated leiomyoma
malignant form of fibroids
leiomyosarcoma
Leiomysarcomas are associated with a rapid increase in growth. There are most commonly found in ______ and _____ women.
perimenopausal
postmenopausal
most common female malignany under the age of 50
cervical carcinoma
May present as a heterogenos, enlarged cervix or focal mass within the cervix
cervical carcinom,a
common and usually incidental finding. Benign retention cysts within the cervix. Usually simple but may contain debris or septations. Asymptomatic
Nabothian cysts
small cyst located along the vaginal wall. asymptomatic
gartner duct cyst
When the myometrial walls are separating at the csection scar
csection dehiscence
placed in the uterine cavity to prevent implantation of the fertilized ovum
IUD
echogenic linear echo with posterior shadowing or reverberation artifact noted centrally within the endometrial cavity
IUD
IUD Copper 7, Copper T, Mirena, Skyla all appear:
linear
Lippes loop IUD appears:
5 equally spaced dots with posterior shadowing
thickening of the endometrium
endometrial hyperplasia
Endometrial hyperplasia results from _________
unopposed estrogen stimulation
Endometrial hyperplasia may be secondary to ____
PCOS
Endometrial hyperplasia is most likely diagnosed in a ______ patient with a thickened endometrium
post menopausal
postmenopausal bleeding
uterine bleeding
history of PCOS
hormone regulation therapy or tamoxifen treatment
endometrial hyperplasia
abnormal thickening on the endo
heterogeneous mass with cystic changes
endometrial hyperplasia
normal limits of endometrium in the early proliferative phase of menstrual cycle
4-6 mm
Normal limits of endometrium in the late proliferative phase of menstrual cycle
6-10 mm
Normal limits of endometrium in the secretory phase of the menstrual cycle
less than or equal to 16 mm
most common gyn malignancy
endometrial carcinoma
endometrial carcinoma is a type of ______
adenocarcinoma
linked with nulliparity, obesity, chronic anovulation, estrogen-producing ovarian tumors, tamoxifen, and HRT
endometrial carcinoma
postmenopausal bleeding
uterine bleeding
elevated CA-125
endometrial carcinoma
abnormal thickening of the endo/heterogenous with cystic changes
enlarged heterogenous uterus
polypoidal mass within endo with increased vascularity
low resistance flow
endometrial carcinoma
small nodules of hyperplastic endometrial tissue
endometrial polyps
most likely reason for abnormal bleeding/ thick endo in reproductive age patient
endometrial polyps
intermenstrual bleeding
menometrrohagia
infertility
may be asymptomatic
endometrial polylpsf
single polyp: focal thickening of endo
multiple polpys: diffuse thickening
echogenic nodules with vascular stalk
endometrial polyps
thinning (atrophy) of endo in postmenopausal patients
endometrial atrophy
most common cause of postmenopausal bleeding
endometrial atrophy
thin endometrium less than or equal to 4mm
possibly intracavitary fluid
endometrial atrophy
adhesions or synechaie within the uterine cavity as result of scar formation after surgery, D&C
Asherman syndrome
amennorhea or hypomennorhea
hx of miscarriages or surgery
Asherman syndrome
thin endo with echogenic regions/scarring
On SIS- webb-like or stringy appearance and visualization of the synechaie
Asherman Syndrome
PCOS is an ____ disorder
endocrine s
hormonal imbalance and chronic anovulation. Menstrual cycle if unable to function normally, follicles do not mature leading to anovulation
PCOS
most common cause of infertility
PCOS
stenin-leventhal (hirsutism, obesity, amennorhea or hypomennorhea, infertility)
PCOS
bilaterally enlarged ovaries with multiple small follicles along periphery “string of pearls”; secondary endometrial hyperplasia
PCOS
ectopic endometrial tissue outside the uterus into the adnexa
endometriosis
The endometrial implants attach anywhere in the pelvic/abdominal cavity and localize forming blood-filled cysts called _____ or _____
endometriomas
chocolate cysts
Most common location of endometriosis
ovaries
dysmennorhea
dyspareunia
chronic pelvic pain
painful bowel movements
infertility
nulliparity
reproductive age
endometriosisj
cystic mass with low-level echoes, anechoic, or complex with posterior enhancement
may demonstrate fluid-fluid level
endometriosis
most common adnexal mass
follicular cysts
Graafian follicle that fails to rupture and continues to enlarge >3cm. May also be due to hyperstimulation from infertility treatment such as clomid or perganol
follicular cysts
most common adnexal mass in pregnancy
corpus luteal cyst
Cyst that is typically hemorrhagic and has a “lacy” appearance
corpus luteal cyst
located adjacent to ovary. Typically <2cm and asymptomatic. NOT physiologic
paraovarian cysts
found only with elevated levels of HCG. May coincide with gestational trophoblastic disease or associated with multiple gestations due to high HCG
theca lutein cysts
Bilaterally enlarged multilocated ovarian cysts “grape clusters”; no normal ovarian parenchyma
theca lutein cysts
most common benign ovarian tumor
cystic teratoma
A cystic teratoma is also known as a
dermoid
Germ cell tumor most often seen in reproductive age; retained of unfertilized ovum that is composed of 3 layers (ectoderm, mesoderm, and endoderm); may include tissues, bones, hair, fat, sebum, cartilage, teeth, etc.
cystic teratoma/dermoid
The most common complication of a cystic teratoma
ovarian torsion
complex, cystic, solid mass
“tip of the icebery”, posterior shadowing
Dermoid plug: poor thru transmission
dermoid mesh: produced by hair, numerous line echoes
cystic teratoma
most common solid benign tumor
fibroma
Most likely tumor to be associated with Meigs syndome
fibroma
The _____ is NOT associated with estrogen production
fibroma
solid hypoechoic mass with poor through transmission
fibroma
ascites and pleural effusion in the presence of a benign ovarian tumor
meigs syndrome
transitional cell tumor that are small, solid, and unilateral with calcifications
Brenner tumor
The _____ and _____ tumor do not produce estrogen
fibroma
Brenner
sex cord stromal tumors, which are frequently related to hormone production, in these cases estrogen
thecoma and granulosa cell tumors
Unopposed estrogen stimulation leads to ______ and possibly _____
endometrial hyperplasia
carcinoma
most common estrogenic tumor
Granulosa cell tumor
unilateral and typically postmenopausal; growers larger and faster than the thecoma; 10-15% chance of developing endometrial carcinoma due to consistent estrogen stimulation = bleeding
granulosa cell tumor
In pediatrics, the ______ causes pseudoprecocious puberty, has a malignant potential
granulosa cell tumor
most often seen in postmenopausal patient with postmenopausal bleeding. Generally unilateral and hypoechoic
thecoma
2 types of cystadenomas
serous
mucinous
50-70% are benign
large and typically bilateral cysts with septations
serous
serous cystadenoma
larger than serous and usually unilateral
septations and presence of internal debris helps to distinguish
mucinous
mucinous cystadenoma
most common ovarian malignancy
serous cystadenocarcinoma
similar to serous cystadenoma but with more prominent papillary projections (mural wall nodules/irregularities) and thicker septations
serous cystadenocarcinoma
will present with intraperitoneal extensions of mucin-secreting cells that appear to similar to complex ascites
mucinous cystadenocarcinoma
complex ascites
pseudomyxoma peritonei
weight loss
pelvic pressure/swelling
abnormal bleeding
elevated CA-125
acute abdominal pain with torsion or supture
cystadenocarcinoma
cystic mass with thick septations and papillary projections with internal vascularity
abnormal decreased resistance flow patterns
cystadenocarcinoma
metastasis from GI tract (usually stomach/gastric)
bilateral ovarian masses and ascites
Patient may be asymptomatic or have weight loss and pelvic pain
Krukenburg tumor
Sex-cord stromal tumor associated with virilization.
patient presents with abnormal menstruation and hirsutism
most commonly found in women younger than 30
may be benign or malignant
Sertole-Leydig tumor
The Sertoli-Leydig cell tumor is also known as
androblastoma
Most common malignant germ cell tumor
dysgerminoma
most often seen in young patients and may be found in pregnancy; Children present with precocious puberty; elevated hcg in nongravid female
dysgerminoma
development of masculine qualities and physical characteristics
virilization
male version of dysgerminoma
seminoma
tumor marker for dysgerminoma
elevated serum lactate dehydrogenase
The yolk sac tumor is also known as:
endodermal sinus tumor
second most common malignant germ cell tumor
yolk sac tumor
characterized by rapid growth, presents in females less than 20 years old, and elevated AFP in non-gravid female
yolk sac tumor
results from ovary twisting on its mesenteric connection and cutting off blood supply t
ovarian torsion
Ovarian torsion can be complete or partial since the ovary has:
dual blood supply
Ovarian torsion most commonly happens on the ____ side
right
Ovarian torsion is most commonly caused by:
ovarian mass or cyst
enlarged heterogenous ovary within diminished or lack of blood flow; hemorrhagic cyst or tumor may be present
ovarian torsion
______ is determined by the demands of the organs
resistance
Malignant masses have ____ resistance
low
Abnormal patterns expected with malignancy
resistive index <0.4
elevated velocity >15 cm/s
absence of diastolic notch
Normal ovarian flow is _____ resistive (less diastole) during menstrual and early proliferative phases because the demands for blood are low.
higher
The most accurate time to Doppler the the ovary
menstrual and early proliferative phase
The non-gravid uterus is normally ____ resistance as there is an overall low demand for blood supply.
high
abnormal connections between arterial and venous channels
arteriovenous malformations
Most likely to be formed after pregnancy or miscarriage of D/C
arteriovenous malformations
On Pulsed Wave Doppler in the presence of an arteriovenous malformation, the flow will be ____ velocity, _____, and ____ resistance
high
turbulent
low
higher resistance = ____ diastolic flow
less
lower resistance = _____ diastolic flow
more
infection of the upper genital tract
PID
most common initial clinical presentation of PID is:
vaginitis
Most common cause of PID is:
STDs
active infection/inflammation of PID
acute PID
