Quiz 1 Flashcards
1
Q
is the uterus retro or intra?
A
retroperitoneal
2
Q
what is the name of the portion of the uterus where the fallopian tubes enter?
A
cornua
3
Q
where does the vagina run?
A
midline, runs from the cervix to the external genitalia
4
Q
what are the 3 layers of the uterus?
A
- perimetrium
- myometrium
- endometrium
5
Q
what layer of the uterus takes up most of the uterus?
A
myometrium
6
Q
what are the 3 layers of the myometrium?
A
- inner layer (subendometrial halo)
- intermediate
- outer
7
Q
what are the 2 layers of the endometrium?
A
- superficial functional layer
- deep basal layer
8
Q
which layer sloughs off during mences?
A
superficial functional layer
9
Q
what are the ligaments of the uterus?
A
paired: -broad -cadinal -uterosacral -round single: -posterior -anterior
10
Q
where do the broad ligaments coarse?
A
lateral uterus to lateral pelvic walls
11
Q
cardinal ligaments
A
lower extension of broad ligament
12
Q
round ligament
A
upper outer angles of uterus through inguinal canal and attach labia majora
13
Q
uterosacral ligaments
A
posterior uterus to sacrum
14
Q
anterior ligament
A
anterior uterus to posterior bladder
15
Q
posterior ligament
A
posterior uterus to rectum
16
Q
what does the posterior ligament form?
A
pouch of douglas
17
Q
what are the functions of the uterus?
A
- fertilization in the endometrial lining and develops within UT
- myometrial contractions at labour
- myometrial contraction during menstruation
18
Q
what is the primary arterial supply to the uterus?
A
internal iliac arteries
19
Q
for uterine positions, what is flexion?
A
axis of the uterine body relative to the cervix
20
Q
for uterine positions, what is version?
A
axis of the cervix relative to the vagina
21
Q
how long are the fallopian tubes?
A
7-12 cm
22
Q
what are the 4 portions of the fallopian tubes?
A
- intramural
- isthmus
- ampulla
- infundibulum
23
Q
what is the narrowest portion of the fallopian tube?
A
intramural
24
Q
what portion of the fallopian tube is tortuous and the largest portion?
A
ampulla
25
are the ovaries intra or retro?
intra
26
if the uterus was tiled to the left, where would the ovaries lie?
the left ovary would be superior to the fundus and the right ovary would be lateral
27
what are the parts of an ovary?
- germinal epithelium
- tunica albuginea
- cortex
- medulla
28
where do follicles of the ovary develop and mature?
cortex
29
what is the medulla composed of?
fibrous tissue and blood vessels
30
what are the ligaments of the ovary?
- mesovarian
- ovarian
- suspensory
31
mesovarian ligament
anterior surface of ovary to posterior broad ligament
32
ovarian ligament
lower pole of ovary to uterus
33
suspensory ligament
upper pole to lateral pelvis wall
34
where do the ovarian vessels and nerves run?
suspensory ligament
35
where do the ovarian arteries come off of?
aorta
36
where does the ovarian veins drain?
right drains into the IVC and left into the left renal vein
37
what is adnexa?
everything lateral to the uterus
38
where does a full bladder push the uterus?
up and more posterior
39
which is larger, a infantile uterus or a neonate?
neonate due to maternal hormone stimulation
40
what is the size of an adult uterus?
7-8cm length x 5 cm width x 4 cm AP
41
what is the size of a menopausal uterus?
3.5-6.5 cm (L) x 1.2-1.8 cm (AP)
42
what is the echogenicity of a adult uterus?
myometrium low to medium echogenicity
43
what is the echotexture of a adult uterus?
homogenous
44
what is the appearance of a postmenopausal uterus?
- smaller size
- can have calcifications in the arcuate arteries
- small echogenic foci within inner myometrium
45
what are the phases of the endometrial phase?
- early proliferative phases
- late proliferative phase
- secretory phase
- menses
46
what is the thickness of the endometrium in the early proliferative phase?
4-8 mm
47
what is the thickness of the endometrium in the late proliferative phase?
6-10 mm
48
what is the thickness of the endometrium in the secretory phase?
7-14 mm
49
what is the average size of ovaries in the reproductive age?
approx. 6 cc
| upper limits are 18 cc
50
when are the ovaries small?
young females and small again in postmenopausal women
51
what do ovaries look like sonographically?
- oval shaped
- anechoic follicles
- depends in the stage of the persons cycle
52
what phases of the ovarian cycle correspond to endo changes?
-follicular and luteal phase
53
what does the rectum measure?
17-20 cm from internal anal
54
what do we typically not see in ultrasound with the rectum?
recto sigmoid junction
55
where does the sigmoid colon begin around?
fundus of uterus
56
what is the posterior pelvic muscle
iliopsoas
57
what are the muscles if the pelvic floor?
- levator ani (pubococcygeus and iliococcygeus)
| - coccygeus
58
what are the lateral pelvic wall muscles?
- obturator internus
| - piriforris (posterior)
59
what muscle can be confused with an ovary on ultrasound?
piriformis
60
what is the echogenicity of muscles?
moderate echogenicity with echogenic striations seen long axis veiw
61
what is the perineum?
skin covered muscular region between vaginal orifice and anus
62
where does the perineum extend?
pubic symphysis anteriorly to the coccyx posteriorly. lateral borders are the ischial tuberosity's
63
where is the gonadotropin releasing hormone produced?
hypothalmus
64
what does the gonadotrophin releasing hormone stimulate?
pituitary gland
65
what does the pituitary gland release?
lutenizing hormone and follicle stimulating hormone
66
what do the ovaries produce and what does it stimulate?
produce estrogen and stimulates hypothalmus
67
what initiates the process of follicular development in the first place?
Early in the menstrual cycle, the pituitary secretes rising levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) which causes the growth of 4 to 12 primordial follicles into primary ovarian follicles.
68
What hormone is primarily responsible for ovulation? what day does ovulation occur?
the primary hormone responsible for ovulation is the luteinizing hormone. The spike in LH as well as ovulation occurs on day 14. This is due to the decrease of estrogen and no fertilization.
69
What hormone does the granulosa cells produce?
estradiol
70
What parts of the dominant follicle are expelled with the ovum at ovulation?
At ovulation, the Graafian follicle ruptures and releases the ovum which consists of the secondary oocyte, zona pellucida, and coronal radiata into the infundibular projections of the fallopian tube.
71
What is the corpus Luteum? What hormone does it primarily produce?
The corpus luteum is a hormone secreting structure that develops in the ovary after an ovum is released. The primary hormone produced in the corpus luteum is progesterone.
72
What happens to the corpus luteum if fertilization does not occur and why?
If not fertilized, the corpus luteum stops producing progesterone and decays after approximately 10 days and degenerates into the corpus albicans.
73
If fertilization occurs what is the corpus luteals role during the first 11 to 12 weeks of pregnancy.
The corpus luteum produces progesterone until week 7-9 until the embryo (hCG) is able to provide its own to sustain the pregnancy. The corpus luteum is supported by the hCG and at about 10 weeks it begins to decrease in size.
74
What hormones are involved in the growth of the endometrium and where are these hormones produced?
Estrogen and progesterone are the hormones involved in the thickening of the endometrium. Progesterone is produced by the ovaries, placenta, and adrenal glands and estrogen is produced primarily in the ovaries. Estrogen causes the growth of the lining and progesterone causes it to slough of if fertilization does not occur.
75
where does the estrogen come from which initiates the growth of the endometrium after menses?
FSH and LH are produced by gonadotropins from the pituitary gland which stimulate the production of estrogen and progesterone. Estrogen is produced by granulosa cells within the ovaries, whereas progesterone is produced by the corpus luteum.
76
When does the estrogen peak day?
Estrogen peaks at approximately day 13- right before ovulation/at the very end of the secretory phase.
77
4. What happens to the endometrium after ovulation and what hormone is dominant?
Once ovulation occurs, progesterone causes the glands in the endometrium to begin secreting a nourishing substance, which is the secretory phase of the menstrual cycle. Progesterone is the dominant hormone following ovulation.
78
what does IUCD stand for?
Intrauterine contraceptive device
79
where is the IUCD inserted?
into the endometrium
80
what do IUCD's trigger?
“Foreign Body reaction” inflammatory response
81
what is IUCD toxic to?
sperm and probably ova
| prevents fertilization
82
what do some IUCD's release?
progesterone acting similarly to oral contraceptives "mirena"
83
what are the different types of IUCD's?
- copper T
- copper 7
- lippies loop
- safe-T-coil
84
what does "mirena' IUCD do?
- Releases progesterone thickens cervical mucus causing barrier to sperm
- Makes lining inhospitable to implantation
85
what is the sonographers role when scanning for IUCD?
-location of the IUCD
86
where is the IUCD suppost to be located?
within the uterus in the superior aspect within the endometrium (fundus)
87
can IUCD be seen on transabdominal?
yes but cannot determine location (need transvaginal)
88
if an IUCD is not within the uterus, where would it be?
- too low in the lower uterine segment
- perforated the myometrium
- in the adnexa
89
what is the sonographic appearance of an IUCD?
- highly echogenic
- some posterior shadowing
- copper is made of metal so there is a more prominent shadow
90
what are some complications of IUCD's?
- infection
- perforation
- malposition
- incomplete removal
- located in the adnexa/pelvic region
- pregnancy
91
if ultrasound cannot find IUCD what happens?
pelvic X-ray will show entire pelvic region
92
is IUCD seen in 1st trimester pregnancy?
IUD is seen on U/S maybe removed
93
is IUCD seen in 2nd and 3rd trimester pregnancy?
can not always be seen, just leave in
94
what is an advantage for transabdominal ultrasound?
global view
95
what are the disadvantages for transabdominal ultrasound?
- Limited patients ability to hold and fill bladder, obese patients, retroverted uterus (beyond focal zone of transducer)
- Not as good for adnexal masses
96
what must be done before an transvaginal ultrasound?
- acoustic gel is placed within probe cover (ask about allergies)
- sterile gel is applied to outer service to facilitate insertion
97
what are the 8 steps to cleaning a TVP probe?
1. Remove probe cover
2. Wipe off excess gel
3. Swish in enzymatic solution
4. Rinse with water
5. Soak in Cidex OPA or similar cleaner for 12 minutes
6. Rinse in 3 consecutive water containers ( 1 minute for each container)
7. Wipe off probe and check for residue
8. place in storage area
98
how long must you soak transducer in Cidex OPA for?
12 minutes
99
what is perimenopause?
Stage in women’s reproductive life when the ovaries gradually produce less estrogen
100
when does menopause start?
12 months without menses when ovulation no longer occurs
101
when does perimenopause usually occur?
starts in womens 40's sometimes 30's
102
can perimenopausal women still become pregnant?
yes
103
what is Hormone Replacement Therapy?
supplement with estrogen alone or estrogen and progesterone in combination during and after menopause
104
what happens to our hormones during menopause?
decrease in estrogen and progesterone
105
what are some symptoms of menopause?
- hot flashes
- vaginal dryness
- night sweats
106
what is estrogens role in the uterus?
helps thicken endometrium
107
what else does estrogen do?
- influences way body uses calcium
- Maintains healthy level of cholesterol
- Keeps vagina healthy
108
what happens if there is Lowered or fluctuating estrogen levels?
- menopausal symptoms
| - osteoporosis
109
why is progesterone taken?
makes lining shed each month
110
what are the types of HRT?
- estrogen therapy
| - progesterone/progestin-estrogen therapy
111
estrogen therapy
lowest dose to relieve symptoms
| -pill, patch, or cream
112
Progesterone/Progestin-Estrogen Therapy
progestin is a synthetic form of progesterone
113
what are the risks of HRT?
- Increased risk of endometrial cancer (if not taking progesterone)
- Increased risk of stroke and blood clots
- Increased risk of Breast cancer when taking estrogen-progestin combo
- Increased risk of heart disease
114
what structure has colour looking like a ring of fire?
corpus luteum
