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Reproductive Sonography > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

What is the most common cystic lesion in the vagina

A

Gartner’s Duct Cyst

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2
Q

What is a Bartholin’s cyst

A

Fluid-filled lump near the vaginal opening

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3
Q

What is the most common congenital lesion or abnormality in the vaginal region

A

Imperforated hymen

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4
Q

What are the problems that follow with a fully intact hymen

A

Vaginal opening is completely covered
Problems with menstruation, and release of fluid

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5
Q

With a fully intact hymen where does fluid go

A

Fluid will go back into the cervix and/or uterus

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6
Q

Inflammation of the vulva

A

Vulvitis

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7
Q

Small skin tags (growth) found in vagina that usually are not noticed

A

Vaginal polyp

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8
Q

Small pebbly growths that can be felt with a finger

A

Warts

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9
Q

What is the cause of genital warts

A

Humanpapilloma virus (HPV) passed during sex

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10
Q

HPV is considered a risk-factor for

A

Cancer

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11
Q

What is the most common solid lesion/cancer cell

A

Squamous (epithelial) cell carcinoma

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12
Q

This sarcoma is most common in children

A

Rhabdomyosarcoma

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13
Q

This sarcoma is most common in women over 50 years of age

A

Leiomyoma

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14
Q

Common STD that can cause cancer or genital warts

A

HPV (Humanpapilloma virus)

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15
Q

What cancers can HPV put people at risk to

A

Cervical, vulva, vagina, penis, anus

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16
Q

Unusual kind of skin cancer that arises from glandular cells

A

Paget’s Diseas of the Vuvla

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17
Q

Women with Paget’s disease of the vulva will appear

A

Red, velvety area with white islands of tissue on vulva

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18
Q

If a women has had a hysterectomy what do you measure?
What is the usual measurement for this?

A

Vaginal cuff
Typically should be 2.1 cm

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19
Q

Metra means

A

Uterus

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20
Q

T or F:
Cervix is not part of the uterus

A

False
Cervix is part of the uterus, VAGINA is not part of the uterus

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21
Q

Abnormal collection of watery-like fluid secretions within the uterine cavity

A

Hydrometra

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22
Q

Abnormal fluid (blood) collections in the uterine cavity

A

Hematometra

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23
Q

What is the result of hemoatometra

A

Obstruction of the genital tract

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24
Q

How will the uterine cavity and cervical canal appear when there is hematometra

A

Uterine cavity and cervical canal are anechoic and distended

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25
Q

Dilatation of the vaginal proximal to a congenital obsturction

A

Hydrocolpos

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26
Q

Blood-filled dilated vagina

A

Hematocolpos

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27
Q

What causes hematocolpos

A

Menstural blood in the setting of an anatomical obstruction, usually with an imperforate hymen

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28
Q

Colpos means

A

Vagina

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29
Q

Fluid accumulation invades the vagina and uterus

A

Hydrometrocolpos

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30
Q

What are the main causes of hydrometrocolpos

A

Intact hymen
Vaginal outflow obstruction and the accumulation of secretions

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31
Q

Blood-filled distended uterus and vagina

A

Hematometrocolpos

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32
Q

What are the main causes of hematometrocolpos

A

Anatomical mechanical obstruction precluding the evacuation of the menstrual blood
Usually postmenarche

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33
Q

This is a secondary infection that occurs as a result of hormonal changes in the female’s repro tract

A

Pyometra

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34
Q

Pyo means

A

Pus

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35
Q

Pyometra means

A

Puss in the endometrium

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36
Q

What are the other causes of pyometra

A

Stenosed cervical os
Uterine or cervical malignancy
Treatment with radiotherapy
Fibroid degeneration
Pus
Fluid secretions become mucinous and infectious

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37
Q

Congenital uterine anomalies occur in less than

A

5% of all women

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38
Q

Congenital anomalies usually develop in the ____ development of the:

A

Embryonic development
In the uterus and upper 3rd of the vagina

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39
Q

Congenital anaomalies are derived from
Occur during what period of pregnancy

A

Embryonic mullerian (paramesonephric) ducts
Durng 7-12 weeks of pregnancy

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40
Q

The cause anomalies

A

Improper fusions

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41
Q

Rare condition that causes to have only half a uterus

A

Unicornuate uterus

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42
Q

Unicornuate uterus is related to ___ and ___ loss

A

Infertility and pregnancy loss

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43
Q

How does a unicornuate uterus appear sonographically

A

Uterus long & slender (Cigar-shaped)
Deviated to one side
Renal agenesis (absence) can be present on the contralateral side
Suspected if uterus appears small and positioned more lateral

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44
Q

In the unicornuate uterus if the right Fallopian tube is missing affects what other structure

A

Right kidney may be abnormality or may be missing

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45
Q

This uterine pathology is difficult to diagnose because of there being 2 uterine cavities

A

Didelphys Uterus

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46
Q

Didelphys Uterus has complete duplication

A

Uterus, cervix, and vagina

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47
Q

Didelphys uterus are not usually associated with

A

Fertility problems

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48
Q

T or F:
There is no treatment for didelphys uterus

A

T

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49
Q

Di means

A

2

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50
Q

How does a didelphys uterus appear sonographically

A

2 endometrial echoes

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51
Q

What sonographic appearance helps distingush with a bicornuate uterus

A

External contour of the uterus

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52
Q

This pathology is the duplication of the uterus and sometimes cervix

A

Bicornuate uterus

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53
Q

The bicornuate uterus is a ___-lobed uterus that has a ____-spaced cavities

A

Bi-lobed
Wide-spaced cavities

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54
Q

This pathology has recurrent pregnancy loss and preterm labor are common

A

Bicornuate uterus

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55
Q

In the bicornuate uterus the uterus is duplicated but not

A

Not fully duplicated

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56
Q

Most common anomaly of the uterus

A

Septate uterus

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57
Q

How many uterine cavities does a septate uterus have

A

2

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58
Q

Septate uterus has incidence of ____

A

Infertility

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59
Q

Septate uterus is similar to

A

Didelphys uterus

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60
Q

T-shaped uterus/uterine anomaly is caused by

A

Diethlystilbestrol exposure (DES)

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61
Q

DES was give to women from ____’s-____’s
Given for:

A

1940’s-1970’s
Treatment of threatened abortion

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62
Q

How does a T-shaped uterus uterine anaomaly appear sonographically

A

Cavity is t-shaped

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63
Q

What are the 3 rare etiologies for sexual ambiguity

A

Male pseudohermaphroditism (46, XY)
Female pseudohermaphroditism (46, XX)
True hermaphroditism (46 XX/46 XY)

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64
Q

Type of intersex in which the testis are present but external genitalia are incompletely masculinized

A

Male pseudohermaphroditism (46, XY)

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65
Q

Caused by adrenal hyperplasia, which leads to increased androgen production responsible for masculinization of the external genitalia

A

Female pseudohermaphronditism (46, XX)

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66
Q

This is the most common cause of female virilization

A

Female pseudohermaphronditism (46, XX)

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67
Q

What does a child with female pseudohermaphroditism (46, XX) develop

A

Characteristics associated with male hormones (hirsutism)
Body hair
Muscle bulk
Deep voice

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68
Q

True hermaphroditism is what type of disorder of sex development

A

Ovotesticular disorder

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69
Q

Intersex condition in which an individual is born with both ovarian and testicular tissue

A

True hermaphroditism

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70
Q

In cases of true hermaphroditism this is a rare condition in which cells within the same person have different genetic makeup

A

Mosaicism

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71
Q

All sexual ambiguity rare etiology is considered what type of abnormalities

A

Chromosomal abnormalities

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72
Q

Which pair of chromosomes cause down syndrome

A

21st pair

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73
Q

40% of infertility happens on

A

Males behalf

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74
Q

Pseudo means

A

False

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75
Q

Chromosomal abnormalities can be passed down

A

Genetically

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76
Q

Rare etiology develops during what weeks of pregnancy

A

7-12 weeks of pregnancy

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77
Q

General terms for a variety of situations in which a person is born with repro or sexual anatomy that doesn’t fir the boxes of male or female

A

Intersex

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78
Q

46, XX - ______ disorder of sex development is a condition in which person with 2 __ chromosomes, normally found in ___ and result in having a ___ appearance

A

Testicular disorder, 2 X chromosomes, normaly found in females, results in male appearance

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79
Q

What is the role of sonography is causes of sexual ambiguity

A

May help identify the presence of uterus, vagina, ovaries, and testicles in the neonate or in utero

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80
Q

What is the treatment for sexual ambiguity

A

Surgical correction in infancy
Hormonal replacement therapy

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81
Q

Contraception is designed to

A

Prevent pregnancy

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82
Q

What are the hormonal contraceptive methods

A

Oral
DMPA (Depo-shot)
Implant
Post-coital (PCC)

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83
Q

Oral contrapceptives inhibit

A

Ovulation

84
Q

How is the depot-medrocyprogesterone acetate (DMPA) given
What does it inhibit

A

Injected every 3 months
Inhibits ovulation

85
Q

How are implants given
What do they inhibit

A

Inserted under the skin
Inhibits ovulation

86
Q

What is another name for th post-coital hormonal contraceptive (PCC)

A

Morning after pill

87
Q

What are the barrier intrauterine contraceptives

A

Diaphragm
Cervical cap
Condoms

88
Q

What are the surgical fertility control

A

Hysterectomy
Elective abortion
Tubal ligation

89
Q

Intrauterine Contraceptive Device is also known as

A

IUD

90
Q

What are the types of IUD

A

Progestaset
Paraguard Copper T

91
Q

What types of IUD’s are not on the market

A

Lippes Loop
Copper 7
Saf-T-Coil
Dalkon shield

92
Q

What is the sonographic appearance of an IUD

A

Highley reflective
Posterior shadowing

93
Q

The IUD is usually kept in the?
And is inserted in the?
Perforation usually happens?

A

Endometrium
Uterine cavity (endo) near fundus
Perferation usually happens after insertion

94
Q

Improper insertion of IUD can induce

A

Cramping and bleeding

95
Q

What are the risks of IUD with pregnancy
Embedding in the endo or superficial layers of the myometrium may lead to?

A

Spontaneous abortion
Fibrosis

96
Q

What is the abscess formation of IUD’s

A

Unilateral
Commonly arise from bacteria
Can have multiple septations
Appear anechoic to echogenic dependent on the amount of debris in the abscess

97
Q

What are the other 3 risks of having an IUD

A

Perforation
Lost IUD
PID (Pelvic Inflammatory Disease)

98
Q

Definition of infertility

A

Not being able to become pregnant after a year (12 months) of trying

99
Q

If a woman can get pregnant but keeps having miscarriages or stillbirths this is called

A

Infertility

100
Q

What are the most common causes of infertility

A

Ovulatory disorders
Low levels of gonadotropin releasing hormone (GnRH)
Premature ovarian failure
Polycystic ovarian disease
Tubal disease
Abnormal conception cycle

101
Q

Imbalance of the hormones that cause women to ovulate is called

A

Ovulatory disorders

102
Q

This is most common cause of anovulatory infertility

A

Polycystic ovarian disease (PCOS)

103
Q

A common sexually transmitted infection caused by bacteria and is the most common STI

A

Chlamydia

104
Q

What is an example of abnormal conception cycle

A

Diminished ovarian reserve (DOR)

105
Q

What is the size of the uterus in diminished ovarian reserve during ovulation

A

Less than 50% of its size at ovulation

106
Q

Salpi/o means

A

Fallopian tube

107
Q

Salpingitis

A

Inflammation of the fallopian tube

108
Q

What scan approach would you use for a pediatric uterus

A

Only transabdominal scan

109
Q

When does the pediatric uterus increase in size

A

Increases after age 7

110
Q

T or F:
You should do a transvaginal exam on pediatric even if the doctor tells you to

A

False!!!!!!
NO!

111
Q

When you need to do both transabdominal and transvaginal which do you start with?

A

Start with transabdominal, allow patient to empty their bladder, then floow up with an empty bladder for transvaginal scan

112
Q

What is the upper size limit of the vaginal cuff post-hysterectomy

A

2.1 cm

113
Q

What is the average length of cervix in a normal adult non-pregnant
Where do you measure it from

A

2-4 cm
Measured from internal os to external os

114
Q

What are the variations that can affect the size of the cervix

A

Age
Parity
Stage of menstrual cycle

115
Q

What is the most common bengin lesion in the cervix
What does it result from
How long will the cervix measure

A

Nabothian cysts
Chronic cervicitis
Less than 2 cm

116
Q

What is a cervical polyp
What is it caused by

A

Abnormal growths on the cervical canal
Caused by chronic cervical inflammation

117
Q

Cervical stenosis means

A

Narrowing of the cervix

118
Q

Cervical stenosis is ____ & ____
Results from

A

Acquired & obstruction
Results from chronic infection & previous cone biopsy

119
Q

What is a cone biopsy

A

Small operation to remove a cone shaped piece of tissue from the cervix

120
Q

Cervical cancer is a type of cancer that occurs in

A

Occurs in the cells of the cervix

121
Q

The cervix is the lower part of the ___ & connects to the ____

A

Uterus that connects to the vagina

122
Q

HPV plays a role in causing which type of cancer

A

Cervical cancer

123
Q

What is the most common type of cervical carcinoma
How do you detect it

A

Squamous cell carcinoma
Detect through PAP smears

124
Q

What are the 3 types of cervical carcinoma sonographic findings

A

Retrovesical (Behind the urinary bladder) mass
Obstruction of ureters
Invasion of bladder

125
Q

What are the 3 most common sonographic findings that indiciate uterine abnormality

A

Uterine enlargement
Thickened endometrium
Contour irregularity

126
Q

What are the 3 MAIN causes of uterine enlargement

A

Repro age
Post menopause
Pediatric

127
Q

What are the causes of uterine enlargement in the cause of repro age

A

Pregnancy
Fibroids (Leiomyomas)

128
Q

What is the most common cause of uterine enlargement

A

Fibroids (Leiomyomas)

129
Q

What are the causes of uterine enlargement in the case of post menopause

A

Fibroids
Endometrial pathology (Hyperplasia)

130
Q

What is the cause of uterine contour irregularity sonographically?
What are the developmental abnormalities that will cause the contour?

A

Often due to fibroids (Leiomyomas)
Bicornuate uterus

131
Q

What is the name of a uterine mass

A

Leiomyoma

132
Q

What are the clinical symptoms of a leiomyoma

A

Asymptomatic (mostly)
Pelvic pain/fullness
Increased abdominal girth
Enlarged uterus
Menorrhagia

133
Q

What is menorrhagia

A

Heavy or prolonged menstrual bleeding

134
Q

What are the major uterine fibroid symptoms

A

Heavy monthly periods
Pelvic pain and pressure
Constipation and bloating
Anemia
Pain during sexual intercourse
Frequent need to urinate
Chewing ice
Infertility

135
Q

What is the sonographic appearance of uterine masses

A

Classic appearance
Hypoechoic
Homogenous
Well-defined
Uterine contour irregularity
Uterine enlargement
Distortion of endometrium

136
Q

Transvaginal is better to see ____ fibroids

A

Smaller

137
Q

Transabdominal may be needed to see ____ fibroids

A

Larger

138
Q

What are the 4 common classifications of leiomyoma?
Where are they usually located?
Which is the most common?

A

Intramural (Myometrial) - Most common
Subserosal (Perimetrium)
Submucosal (Endometrial)
Pedunculated (Exophytic)

139
Q

This type of leiomyoma grows outside the uterus also known as the perimetrium

A

Subserosal

140
Q

This type of leiomyoma is pertaining to the growth outward
Is a ____ stalk
Where does this leiomyoma arise from

A

Pedunculated
Fibrous stalk
Arises from superior fundal region

141
Q

This uterine mass is most likely to be symptomatic (bleeding) and can cause complications during pregnancy

A

Submucosal

142
Q

What is the rare uterine mass that may obstruct the internal os?
What does it interfere with?
What does it interrupt?

A

Cervical myoma
Interfere with urinating, cause pain during sexual activity
Interrupt fetal devlivery

143
Q

Broad ligament myoma is very ___

A

Rare

144
Q

What happens to fibroids during pregnancy

A

Increase in size due to estrogen & decrease in echogenicity
Large fibroids may complete with placenta for uterine BV’s
May result in miscarriage or birth deformities

145
Q

Adenomyosis is also known as

A

Internal endometriosis

146
Q

What is adenomyosis?
How will it present?
How is it managed?

A

Endometrial implants lie deep within the endometrium
Present with pelvic cramping & dysmenorrhea
Managed with hormonal therapy or hysterectomy

147
Q

What is the sonographic appearance of adenomyosis

A

Wall may be hypoechoic, diffusely enlarged, small myometrial cysts

148
Q

What are the main causes of endometrial thickening

A

Incomplete abortion - Retained product of conception
Gestational trophoblastic disease - When sperm cell fertilizes an empty egg cell or 2 sperm cells fertilize a normal egg

149
Q

For younger women if you see their uterus is hyperechoic and larger than 15 cm you should immediately think

A

Pregnancy

150
Q

Development of uterine’s inner lining tissue outside of the uterus (ectopic endometrium)

A

Endometriosis

151
Q

Where can you find endometriosis?
Which cavities?

A

Found on structures within the abdominal and pelvic cavity
Ovaries
Fallopian tubes
Colon
Bladder

152
Q

What are the most common symptoms associated with endometrial abnormalities

A

Pain
Menstural irregularity with excessive bleeding

153
Q

What are the causes of endometriosis

A

Retrograde menstruation
Surgical scar implantation
Immune system disorder

154
Q

What are the risk factors of endometriosis

A

Never giving birth
Starting menses at early age
Having higher levels of estogen
1+ relative with this
Conditions that prevent passage of blood from the body during menstruation

155
Q

What is the sonographic finding for endometriosis
What is the treatment

A

Mostly hard to see on u/s, must tak tissue sample
Hormones, excision surgery

156
Q

What are 2 types abnormalities under endometrial thickening

A

Hyperplasia
Carcinoma

157
Q

Overgrowth of the endometrium, the lining of the uterus, that may progress to or coexist with endometrial cancer

A

Hyperplasia

158
Q

Sonohysterography is the best for imaging

A

Modality to image endometrium and its cavity

159
Q

Carcinoma in older women is

A

More critical but more treatable

160
Q

In younger women they can get ___ but can be

A

Cancer, but can be more difficult to treat

161
Q

Abnormal thickening of the lining of the endometrium

A

Endometrial hyperplasia

162
Q

What is the most common cause of endometrial hyperplasia

A

Postmenopausal bleeding

163
Q

Endometrial hyperplasia is indistinguishable from

A

Carcinoma on U/S

164
Q

In endometrial hyperplasia there is excess ___ without ___

A

Excess estrogen, without progesterone

165
Q

Endometrial hyperplasia usually occurs after

A

Menopause, when ovulation stops and progesterone is no longer made

166
Q

Up to ____ of endometrial ___ is believed to be preceded by ____

A

1/3 of endometrial carcinoma, preceded by hyperplasia

167
Q

This is required for endometrial hyperplasia

A

Biopsy is required for a definitive diagnosis

168
Q

2 reasons for NORMAL enlargement of the endometrium

A

Pregnancy
Luteal Phase

169
Q

Risk factors of endometrial hyperplasia

A

Older age at menopause
Early age when menstruation started

170
Q

Family ___ is important but, ____matters

A

History, lifestyle

171
Q

Signs and symptoms of endometrial hyperplasia

A

Bleeding during menstrual period heavier or last longer than usual
Menstrual cycle shorter than 21 days
Any bleeding after menopause

172
Q

When is the best time for U/S to view endometrial hyperplasia

A

Right after period because menses being shed

173
Q

Endometrial hyperplasia in premenopausal women this measurement in this phase is considered abnormal

A

> 15 mm in secretory phase

174
Q

Hyperplasia can be reliably excluded in patients only when the endometirum measures less than

A

6mm

175
Q

Postmenopausal endometrial hyperplasia has a thickness greater than ___ -thick
Thickness greater than ___mm is highley suggestive of ___ and ___ is needed
__mm with ___ bleeding should be biopsied as well

A

> 5mm thick
11mm - Highley suggestive of hyperplasia and biopsy needed
8mm with vaginal bleeding

176
Q

Inflammation of the inner lining of the uterus

A

Endometritis

177
Q

Endometritis is associated with?
Symptoms?
Most common cause?

A

PID (Pelvic inflammatory disease), abortion, menstruation, childbirth
Fever, lower abdominal pain, abnormal vaginal bleeding or discharge
Infection after childbirth (Postpartum)

178
Q

What is the sonographic appearance of endometitis

A

Gas bubbles (Rare)
Endometrial fluid
Irregular
Endometrium appears prominent

179
Q

Localized overgrowth of endometrial glands and stroma

A

Endometrial polyps

180
Q

Endometrial polyps are ____ or irregular ____

A

Asymptomatic or irregular bleeding

181
Q

What are the best scans for visualization of endometrial pathology

A

Transvaginal and sonohysterography

182
Q

What is the sonographic appearance of endometrial polyps

A

Broad based or penduculated mass
Discrete echogenic mass

183
Q

Leiomyosarcoma meaning
Is extremely ___ and ___

A

Malignant form of leiomyoma
Rare and aggressive

184
Q

Leiomyosarcoma may arise from

A

Existing fibroid

185
Q

Leiomyosarcomas are usually happening to women around ages

A

50-60

186
Q

Most common site of involvement of leiomyosarcoma

A

Retroperitoneum

187
Q

The leiomyosarcoma cannot be

A

Differentiated from benign fibroid on U/S

188
Q

What are the symptoms of leiomyosarcoma?
Symptoms indicating infection or inflammation?

A

Weight loss and vomiting
Fever, elevated WBC count

189
Q

What are the sonographic findings of a leiomyosarcoma

A

Resemble fibroids

190
Q

What is the most common gynecologic malignancy in U/S?
Incidence increasing with?

A

Endometrial carcinoma
Hormone replacement therapy and tamoxifen use

191
Q

Endometrial carcinoma are ____ & ___ and __% of cases seen in ____ women

A

Perimenopausal & Postmenopausal
75% seen in postmenopausal women

192
Q

What is the earliest change associated with endometrial carcinoma

A

Thickened endometirum

193
Q

Postmenopausal bleeding in endometrial thickness of < ___mm excludes significant ____ ____

A

<5mm
Excludes significant endometrial abnormalities

194
Q

What are the clinical symptoms of endometrical carcinoma

A

Bleeding
Large endometrial fluid collection

195
Q

Endometrial carcinoma is indistiguishable from?
Often carcinoma will appear?
Fluid may be seen in the?

A

Benign hyperplasia on U/S
Appear more irregular and thicker than benign hyperplasia
Seen in endometrial cavity with carcinoma

196
Q

What are the sonographic findings of the endometrial carcinoma

A

Myometrial invasion
Hypoechoic, echogenic

197
Q

Abnormal development of sexual maturity
What happens in girls and boys with this

A

Precocious Puberty
G - Ovulation before age 8
B - Sexual maturity before age 9

198
Q

Signs and symptoms of precocious puberty in girls

A

Early breast growth
Early first period (Menarche)

199
Q

Signs and symptoms of precocious puberty in boys

A

Enlarged testicles and penis
Facial hair (Usually first on upper lip)
Deepening voice

200
Q

Signs and symptoms of precocious puberty in boys and girls

A

Pubic or underarm hair
Rapid growth
Acne
Adult body odor

201
Q

Factors that increase a child’s risk of precocious puberty

A

Being girl
Being african-american
Being obese
Being exposed to sex hormones

202
Q

Risk factors of precocious puberty

A

Increased risk of precocious puberty
Having other medical conditions
Hyperthyroidism
Received radiation therapy of the central nervous system

203
Q

Precocious puberty may be a complication with what type of medical conditions

A

McCune-Albright Syndrome/Congenital Adrenal Hyperplasia

204
Q

Ovarian artery comes from

A

Aorta

205
Q

Vaginal, uterine, straight & spiral arteries come from

A

Internal iliac artery

206
Q

Arcuate artery originates from

A

Uterine artery

Reproductive Sonography (9 decks)

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