Uterus/adnexa Flashcards

1
Q

What is the position of the uterus on this image?

A

Anteverted retroflexed

  • Version (think vagina): angle b/w cervical axis & vagina.
    • In this case, the cervix is angled forward relative to the vagina = anteverted.
  • Flexion (think fundus): angle b/w the uterine body/fundus & cervix at the isthmus.
    • In this case, the body/fundus is directed posteriorly, so retroflexed.
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2
Q
  • What are the most common GU & non-GU sites for DIE?
A
  • GU: uterosacral ligament.
  • Non-GU: rectosigmoid colon.
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3
Q

What structures do the Mullerian ducts form? …and not?

A

Form: uterus, fallopian tubes, upper 2/3 vagina

Do not form: ovaries

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4
Q

What structure forms the lower 1/3 vagina?

A

Urogenital sinus

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5
Q

In what direction does fetal uterine cleavage occur?

A

From bottom to top.

Hence, septae are formed, often extending from the top and only partially to the bottom.

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6
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome?

A

3 features:

  • Vaginal atresia.
  • Absent or rudimentary uterus: unicornuate or bicornuate.
  • Normal ovaries (so clearly this is a Mullerian issue).
  • The kidneys have issues (agenesis, ectopia) in 50% of cases.
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7
Q

What is the issue you need to look out for w/unicornuate uterus?

A
  • 40% will have issues w/the ipsilateral kidney: agenesis.
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8
Q

Uterus didelphys:

  1. What are the 3 features?
  2. What is the prevalence of a vaginal septum?
A
  1. Didelphys, so two: uteri, cervixes & upper vaginas.
  2. 75% will have a septum.
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9
Q

Bicornuate uterus:

  1. In what % is a vaginal septum present?
  2. Name the 2 types.
A
  1. 25% (so less than didelphys, which is 75%).
  2. Unicollis or bicollis: 1 or 2 cervixes.
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10
Q

What type of cancer is associated w/a T-shaped uterus?

A

Vaginal clear cell.

From DES exposure.

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11
Q

Septate uterus:

  1. In what 2 ways, morphologically, is this different from bicornuate?
  2. What is an imaging pitfall with these and HSG?
A
  1. Has a convex fundus (bicornuate has a cleft >1cm); has a fibrous or muscular septum (bicornuate has a myometrial septum).
  2. On HSG can look like a bicornuate or unicornuate or didelphys, so need MRI.
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12
Q

Is arcuate uterus associated w/infertility or obstetric complications?

A

NO! Neither.

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13
Q

HSGs:

  1. Best time to perform & reason?
  2. 4 contraindications?
  3. 3 phases of the menstrual cycle & days?
A
  1. Proliferative phase of cycle, i.e., day 7-10 (7-14 technically).
  2. PID, pregnancy, contrast allergy, active bleeding (day 0-7).
  3. 3 phases:
  • Menstrual: 0-7
  • Proliferative: 7-14
  • Secretory: 14-28
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14
Q
A
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15
Q

Malignant transformation is a rare complication of endometriosis.

  1. What is the rate of xsformation?
  2. What is the most common malignant neoplasm arising from endometriosis?
A
  1. 1%
  2. Endometrioid carcinoma
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16
Q

Which mullerian uterine anomalies are associated w/renal abnormalities?

A

Unicornuate, didelphys & bicornuate. That is, all those w/abnormal outer contours.

Septate is not!

17
Q

What is the most constant finding in ovarian torsion?

A

Unilaterally enlarged ovary. This is true even when there is Doppler flow.

18
Q

DDx of an abnormally thickened endometrium in a postpartum female?

A
  • hyperplasia
  • polyps
  • submucosal fibroid
  • endometrial carcinoma

If the woman is bleeding then an endometrium >5mm is abnormal & should be sampled.

19
Q

Outline the recommendations for adnexal simple cysts in post-men women.

A
  • Simple cysts <=1cm are inconsequential; no f/u at all.
  • 1-7cm: almost certainly benign; yearly f/u w/US is recommended.
  • >7cm: may be difficult to assess w/US; MR or surgical evaluation.
20
Q

Incidence of dermoid torsion or malignant xsformation?

A

2%

21
Q

What will help to eliminate the artifact in this image?

A
  • This is reverberation artifact.
  • Occurs when sound reflects off strong acoustic interfaces in the near field, & the returning pulse is strong enough to reflect off the transducer & back into the body so that it interacts w/the same near-field interfaces a 2nd or multiple more times.
  • It is often quite obvious in cystic structures.
  • Decrease/eliminate by:
    • decreasing power output & gain
    • reposition the transducer so that the cystic structure is no longer in the near field
22
Q

Name the most common etiology of abnormal vaginal bleeding in pre- & post-men women.

A

endometrial polyps