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113 Cards in this Set

  • Front
  • Back
Name the 4 bones of the pelvis
1. Sacrum
2. Coccyx
3. 2 innominate bones
(ischium, ilium, pubis)
Where is the True Pelvis?
inferior to the sacral prominence
Where is the False Pelvis?
From the sacral prominence to the upper margin of the pubic symphysis
What are the 4 suspensory ligaments of the UTERUS?
1. Cardinal
2. Broad
3. Sacro-uterine
4. Round
Where is the Cardinal ligament?
Superior and Lateral to the uterus and inferior from the vagina
Where is the Broad ligament?
Lateral from the uterus
Where is the sacro-uterine ligament?
Posterior to the cervix
Where is the round ligament?
Anterior and inferior to the broad ligament
What are the 3 suspensory ligaments of the OVARY?
1. Ovarian
2. Mesovarian
3. Infundibulopelvic
Where is the Ovarian ligament?
From the inferior border of the ovary to the uterine cornu
Where is the Mesovarian ligament?
From the ovary to the posterior broad ligament
Where is the infundibulopelvic?
Superior to the broad ligament
Where is the Psoas muscle?
From the lower thoracic spine stretching lateral/anterior and going to the lateral/anterior abdomen and ending at the lesser trochanters
What muscle merges with the Psoas muscle to form the lateral margin of the pelvis?
The Iliacus muscles

Inferior to the iliac crest
What are the plevic diaphragm muscles and their purpose?
1. Levator ani
2. Coccygeus

they form the perineum and hold the pelvic organs in place with abdominal pressure
Where and how would you see the Obturator Internus on ultrasound?
1. thin/hyperechoic
2. imaged TRVS
3. seen at Post/Lat edge of bladder when angling inferiorly
Where is the Dome of the bladder?
the superior concavity
Which of the vaginal fornices is the smallest?
Whis is the largest?
Anterior - smallest
Posterior - largest
- frequent site of fluid
What are the characteristics of the body of the uterus?
- contains the uterine cavity
- extends lateral at cornua
- widens above tubes (fundus)
- isthmus turns to CVX at internal OS
- isthmus is the lower uterine segment
What are the 3 layers of the uterus?
- mucosa (endometrium)- varies in thickness from 1mm - 8mm

- muscularis (myometrium) - thick, 3 layered.

- perimetrium (serosa) - not usually seen on ultrasound
How big is a Pediatric uterus?
3.3 x .75 cm
How big is a premenarchal uterus?
4.3 x 1.3 cm
How big is a nulliparous uterus?
8 x 3 cm
How big is a multiparous uterus?
9 x 4 cm
How big is a postmenopausal uterus?
it varies based on the the # of pregnancies and amount of time since menopause
What are the follicles found in the outer layer of the overy (cortex) called?
Primordial follicles
What is the volume range of a premenopausal ovary?
5.1 cm3 - 3.2 cm3

volume depends on where in cycle
How do you compute volume?
l x w x h x .523
What are the 3 regions of the fallopian tubes?
- intramural (interstitial)

- isthmus

- ampullary - LONGEST
- extends and terminates at infundibulum
- distal part has fimbria
What are the 3 pelvic peritoneal recesses?
- Space of Retzius - between anterior bladder and pubic bone

- Vesicouterine pouch - ANTERIOR CUL-DE-SAC - usually has nothing but possibly loops of bowel

- Rectouterine space - POST CUL-DE-SAC - POUCH OF DOUGLAS - common site for free fluid
What supplies the ovaries with blood?
The ovarian arteries

Branches of the aorta
What supplies the uterus with blood?
The uterine arteries

Branches of the Anterior/Internal iliacs
What does Low Resistance mean?
tissue that nees constant blood supply so there is always antegrade flow
What does High Resistance mean?
tissue has fewer blood vessels and receives little or no flow in diastole
What are some Low resistance tissues?
- Brain
- Kidneys
- Malignant tissue
- Trophoblastic tissue
What are some High resistance tissues?
- skeletal muscles (at rest)
- Non-dominant ovaries
What are the endocrine organs that regulate menses?
- hypothalamus
- pituitary
- ovaries
What does the hypothalamus do in the menses cycle?
Produces gonadotropin (GnRH) that stimulates the pituitary
What does the pituitary do in the menses cycle?
Produces follicle stimulating hormone (FSH) and Leutinizing hormone (LH) that stimulates the ovary
What does the ovary do in the menses cycle?
the FSH triggers production of estrogen and causes follicles to grow

the LH triggers ovulation in the dominant follicle
What does the dominant follicle become after ovulation?
A corpus luteum
What does the corpus luteum do in the menses cycle?
It produces progesterone
If there is no fertilization, what does the corpus luteum do?
It stops producing progesterone and signals the hypothalamus to begin again
How does the ovary appear in the follicular phase of ovulation?
- has a dominant follicle around day 8 (10 mm)
- follicle grows 1-3mm/day
- may have decreased reflectivity 24 hrs from ovulation
- may see cumulus oophorus
How does the ovary appear at ovulation?
- the dominant follicle decreases
- free fluid may be seen in the PCDSq
How does the ovary appear during the luteal phase of ovulation?
- the corpus luteum will have a varied appearance
- doppler flow will by hypervascular around corpus luteum
How does the endometrium appear during the Proliferative Phase?
hypoechoic around a midline echo. Becomes isoechoic at end of proliferative phase
- measures 6-8 mm
How does the endometrium appear during the Secretory Phase?
more vascular and echogenic
- midline echo not seen
- possible posterior enhancement
- measures up to 18mm
Define Hypomenorrhea
small amount of bleeding
Define Hypermenorrhea (Menorrhagia)
large amount of bleeding
Define polymenorrhea
frequent bleeding
(sooner than every 21 days)
Define oligomenorrhea
infrequent bleeding
(over 35 days apart)
Define menometrorrhagia
irregular frequency AND volume
Define dysmenorrhea
painful menses
Define amenorrhea
absence of menses

- primary - never had one
- secondary - stopped having them
Describe a normal postmenopausal uterus
- uterus and cvx proportional
- endometrium thin <8mm
- may have small amt of fluid in endo
- the lower the estrogen, the smaller the stripe
- if on hormones, will resemble premenopausal endometrium (up to 8mm)
What 2 things does Hormone Replacement Therapy do?
- can alleviate symptoms of menopause

- can prevent severe osteoporosis and improve cardio risk
What are the risks of Hormone Replacement Therapy?
- increases chance of hyperplasia

- increases chance of endometrial carcinoma
What are the sizes of the endometrium if:
1. unopposed estrogen
2. estrogen phase of HRT
3. progesterone phase of HRT
4. continuous combos
1. up to 8mm
2. 10-12mm
3. below 10-12mm
4. less than 8mm
What is Tamoxifin?
A nonsteroid anti-estrogen used in patients with cetain types of breast cancer
What can Tamoxifen make the endometrium look like?
- may have subendometrial cysts
- may cause endometrial hyperplasia
- may cause endometrial carcinoma
What are the 5 causes of POSTmenopausal bleeding?
- endometrial apathy (MOST COMMON)
- HRT (estrogen causes)
- endometrial carcinoma
- cervical carcinoma
- estrogen-producing tumor of the ovary
What is the appearance of the uterus and ovaries in a NEONATE
cvx - 2 x length of body
endometrium - bright/echogenic
ut lenght - 3 x .5-1 cm
ov location - anywhere between the kidneys and the true pelvis
What is te appearance of the uterus and ovaries in a PREPUBERTAL patient?
cvx - equal to body length
ut lenth - 2.5 - 3 cm
endometrium - not well seen
ovaries - small cysts may be seen (9-17mm)
What are the 6 reasons for scanning a pediatric pelvis?
- r/o ovarian cyst
- assess ovaries if PCOD suspected
- r/o ovarian neoplasm
- r/o congenital ut abnormalities
- determine presence/absence of ut and vag in newborn with ambiguous genitalia
- eval ut and ovs in precocious puberty (eary menses)
Define Hydrocolpos
fluid in vagina or uterine cavity
- Common reason- imperforate hymen
Define hematrometra
blood in uterus
Define Hydrometrocolpos
fluid in uterus AND vagina
Define Pyometrocolpos
Pus in the uterus and vagina
What might you see in a hydrocolpos peds patient?
- hypoechoic distention of endeometrium or vagina
- posterior enhancement
- internal echos may be see (clot)
- hydronephrosis may be present (severe cases)
What are 6 uses or ultrasound in reproduction?
- establishes normal anatomy
- monitors follicular growth
-confirms ovarian response to drugs
-identifies hyperstimulated ovaries
-Guides oocyte removal
-guides cath placement in IVF, ZIFT, GIFT or intrauterine insemination
What is Ovarian hyperstimulation syndrome?
a condition from excessive stimulation of ovaries
When does Ovarian hyperstimulation syndrome happen?
MOST COMMON - women on infertility drugs
- women with PCOD
- young/lean women
- more severe in pts that conceive
What does Ovarian hyperstimulation syndrome look like?
- bilateral large simple cysts
- diameter over 5 cm
- resembles theca lutein cysts
Why would you scan IUD patients?
- to confirm IUD position
- to document myometrial penetration
What might you see in patients on OCPs? (Oral Contraception)
- ovaries may not have dominant follicle
- endometrial growth may be small
- endometrial thickness can help determine if OCP amount is correct (if for bleeding)
What are the four categories of anomalous internal genitalia?
- Failure of formation
- Failure of fusion
- Failure of dissolution
(if septem doesn't dissolute - septate uterus
- Failure of structures to disappear
(MOST COMMON OUTCOME - Gartner's Duct Cyst
What other anatomy should you check if you see anomalous internal genitalia?
The urinary tract
What are the 3 other names for Fibroids?
- Leiomyomas
- Fibromyomas
- Myomas
Where are these fibroids:
1. intramural
2. submucosal
3. subserosal
4. exophytic
5. pedunculated
6. interligamentous
7. cervical
1. myometrium
2. against endometrium
3. along outer uterine wall
4. growing out of the uterus
5. attached by a stalk
6. in the broad ligament
7. cervix
What are symptoms of leiomyomas?
- heavy menses (menometrorrhagia)
- enlarged uterus
- alteration of menses flow
- pelvic pain
What is the appearance of a pelvis with a myoma?
- well seen hypoechoic mass
- increased attenuation
- calcifications
- distortion of uterine contour
- compression on post bladder wall
What is Adenomyosis?
A benign diffuse infiltrate of the myometrium by endometrial glands
- often posterior
- appears as focal areas of decreased echogenicity with possible cysts
- uterus usually enlarged
What is the MOST COMMON GYN malignancy?
Endometrial carcinoma
What are the risk factors for endometrial carcinoma?
- Obesity
- Premenopausal - anovulatory
- Postmenopausl - if on HRT
- hx of atypical hyperplasia
- hx of tamoxifen use
- strong fam hx of ut cancer
What are the signs of endometrial carcinoma?
premenopause - hypermenorrhea or intermentsrual flow and pain
postmenopause - vaginal bleeding
What will you see with endometrial carcinoma?
- alteration of the size/shape of the uterus (usually increased)
- thickenings and irregular endometrial tissue
- fluid in the endometrial cavity
What is endometrial hyperplasia?
proliferation of endometrial glandular tissue
- similar appearance to carcinoma
How would you determine with ultrasound if hyperplasia is present?
- scan immediately after menses
Should have:
- smooth endometerial borders
- homogeneous texture
- thickness (pre) >14mm
- thickness (post) >5mm (on estrogen)
- thickness (post on both)
>8mm - estrogen phase
<8mm - progesterone phase
What symptoms might a patient have if they have endometrial polyps?
- usually asymptomatic
might have:
- infertility
- abnormal uterine bleeding
- postmenopausal bleeding
What might you see if a patient has endometrial polyps?
- thickened enometrial stripe
- a discrete mass in the endometrium
- a vascular stalk
- it may not be seen different from hyperplasia
What is the best evaluation for endometrial polyps?
Sono HSG
What are functional cysts?
hormaonally active cysts from normal stimulation
- nml size - .5-3cm
What are the 4 categories of functional cysts?
- follicular
- corpus luteum
- corpus luteum of pregnancy
- theca lutein
What is a follicular cyst?
A dominant follicle that doesn't release the ovum or regress in ovulation
What is a corpus luteum cyst?
The follicle that remains after the ovum is released and may grow or break
What is a corpus luteum cyst in pregnancy?
The remaining follicle that persists and produces progesterone
What is a theca lutein cyst?
The cyst that results from overstimulation by high levels of HcG
- associated with trophoblastic disease
What are the features of a simple cyst?
- anechoic
- well defined borders
- posterior enhancement
What are the features of an Acute Hemorrhagic cyst?
- hyperechoic
- well defined walls
- mimics solid mass
- posterior enhancement
What are the features of a Subacute Hemorrhagic cyst?
- complex echogenicity
- internal echos
- possible fluid levels
Who are the risks for ovarian torsion?
- pre-existing mass or cyst
- children
- young women with mobile anexa
- pregnant women
What is the most common symptom of ovarian torsion?
Acute adnexal pain
What might you see with ovarian torsion?
- large ovaries with multiple follicles
- no color doppler or spectral doppler
- may be adnexal mass
- arterial flow, but no venous flow
What is another name for Polycystic Ovarian Syndrome?
Stein-Levanthal Syndrome
What is Polycystic Ovarian Sydrome associated with?
Chronic Anovulation
What might you see with Polycystic ovarian Syndrome?
- bilateral multiple cysts of various sizes
- normal size but many tiny cysts
- multiple cysts from 2-10mm around border on EV
What is the MOST COMMON ovarian Neoplasm?
Surface Epithelial-Stromal Tumors
How common are surface epithelial-stromal tumors?
65-75% of ovarian neoplasms
89-90% of ALL ovarian malignancies
What are the 5 categories for Epithelial-Stromal Tumors?
- Serous
- Mucinous
- Endometrioid
- Clear Cell
- Transitional Cell (Brenners)
What might benign serous tumors of the ovary look like?
- sharp margins
- anechoic
- large but unilocular with thin lined septations
What might malignant serous tumors of the ovary look like?
- multilocular
- multiple papillary projections
- multiple septations
- multiple echogenic foci
- may have echogneic material
- usually associated with ascites
What is Pseudomyxoma peritonei?
gelatinous material sprad into the peritoneal cavity by mucin-secreting cells from a benign or malignant mucinous epithelial tumor
- may look like ascites with septations