Repro Test 2 - Maki - Repro Imaging Of The Pelvis

Front 1

T/F: 90% of pelvis is imaged using CT, then MRI for specific cases

Back 1

TRUE

Front 2

What must we have in order for trans-abdominal US to be useful?

Back 2

Full Bladder for a acoustic wondow

Front 3

Which provides greater detail, Trans-abdominal or trans-vaginal US?

Back 3

trans-vaginal because we're closer (millimeters away) to the structures

Front 4

What can US help us assess?

Back 4

Uterine size, position, contour, endometrial lining, ovarian size and position, Adnexal or cul-de-sac fluid

Front 5

What are the advantages of US?

Back 5

No radiation

Can see images in real time

Portable

Independent from organ function

Ability to monitor blood flow

Front 6

How does an US of 3.5 compare to one of 12 mega Hz?

Back 6

3.4 = Less detail BUT goes deeper into body

12 = MORE detail but can't go as deep

Front 7

How does US work?

Back 7

Velocity of sound in soft tissue is nearly constant at 1500 m/sec (air and bone are very different from this)

Electrical energy is converted to US energy

Crystal in transducer resonates at a specific frequency

US penetrates tissues - it is transmitted, reflected, absorbed, or scattered

Front 8

What determines the reflection of US?

Back 8

reflection of US is determined by difference in acoustic impedance of tissue

Front 9

How does bone or calcium respond to US waves?

Back 9

They reflect them = Echogenic or posterior acoustic shadowing
= white

Front 10

How does water deal with US waves?

Back 10

Sonolucent = dark

Front 11

How does soft tissue deal with US waves?

Back 11

varrying shades of gray

Front 12

How does fat transmit US waves?

Back 12

white = echogenic

Front 13

How does Air transmit US waves?

Back 13

Air = very poor conductor of US waves = a limiting factor

Front 14

T/F: Air or gas renders diagnostic US useless

Back 14

TRUE

Front 15

T/F: Excessive soft tissue limits US effectiveness

Back 15

TRUE

Front 16

Which pt does US work best on, fat or thin?

Back 16

THIN

Front 17

What is the specialty of US?

Back 17

Distinguishing between cyst and solid mass

Finding fluid collections

Defining anatomy of an organ

Front 18

How does the uterus appear on US?

Back 18

pear-shaped smooth structure

Front 19

How do we view the endometrium on US?

Back 19

a central echogenic endometrial stripe varies in thickness but should not be more than 8mm

Front 20

T/F: Myometrial echogenicity is intermediate and consistent throughout

Back 20

TRUE

Front 21

Whats the typical uterine length

Back 21

5-8 cm long, 3.5-5 cm wide

Front 22

We do a sagital MRI of the pelvis, which shows fluid as white. What can we say about the type of MRI that was done?

Back 22

Its a T2

T2 = Bright fluid

T1 = Fluid is dark

Front 23

A pts US Shows small follicular cysts of 8-10 mm. Pathologic?

Back 23

NOPE, normal

Front 24

***KNOW: T/F: Fallopian tubes are usually visible on US

Back 24

FALSE

Fallopian tubes are not normally visible on US unless dilated or fluid filled

Front 25

Whats the normal appearance of the cul-de-sac and adnexal areas?

Back 25

NO FLUID (you CAN have a few cc's in pouch of Douglas)

Front 26

You see a uterine mass on US....whats on your differential?

Back 26

Endometrial carcinoma, Uterine trophoblastic disease, Sarcoma, Cervical Dysplasia

Front 27

***KNOW - Whats the most common uterine mass?

Back 27

Myoma (fibroid)

Front 28

We think a pt may have closed fallopian tubes. What study do you order?

Back 28

Hysterosalpingogram

Front 29

You see an ovarian mass on US. Whats on your differentials?

Back 29

Follicular cyst, corpus luteal cyst of pregnancy, endometrioma (chocolate cyst, emdometriosis), Hemorrhagic ovarian cyst, Serous cystadenoma, Mucinous cystadenoma

Front 30

Whats the most common ovarian cyst?

Back 30

Ovarian DERMOID cyst (=teratoma)

Front 31

Whats the second most common ovarian cyst after teratoma dermoid cyst?

Back 31

Cystadenoma

Front 32

In the female pelvis, what is the imaging study of choice?

Back 32

US

Front 33

A pt present with Abnormal vaginal bleeding, pain and an adnexal mass. What will you expect to see on US?

Back 33

We're thinking ectopic pregnancy,

so we'll see intrauterine pseudo-sac, adnexal mass, adnexal and/or cul de sac blood or fluid

Front 34

You see calcific changes in the testicles on a pt. Whats your course of action?

Back 34

follow up yearly

Front 35

Which provides better imaging, transabdominal or transvaginal?

Back 35

Transvaginal

Front 36

What are the indications for OB US?

Back 36

Dx and assessment of of early pregnancy (as early as 4.5 weeks)

Dx ectopic pregnancy

Dx miscariage (spontaneous abortion)

Assessment of fetal size, number and age

Placental Localization

Front 37

OTHER indications for OB US?

Back 37

Assessment of Amniotic fluid (polyhydraminos and oligohydramnios)

Dx of fetal malformation

Guidance for amniocentesis

Assessment of biophysical profile

Adnexal abnormalities

Front 38

How do we do fetal dating and measurement?

Back 38

Gestational sac measurements are accurate within 5 days (4.5 - 6 weeks)

Crown rump length is the most accurate measurement (7-12 weeks), within 3-4 days of age

Front 39

Whats the best way of confirming the gestational age (+ or - 7 days) of a preggo's fetus?

Back 39

CRL = Crown-Rump-Length

Front 40

Whats the smallest length the crown rump length is visible

Back 40

2-4mm

Front 41

How early can we see the fetal heart rate?

Back 41

6 weeks WITH HIGH RESOLUTION (Aliff/Lao say 7 weeks)

Front 42

When is Fetal heart rate usually seen for first time?

Back 42

7 weeks!

Front 43

At what sac size should we see embryo?

Back 43

18-25mm

Front 44

What is 3D or 4D US good for?

Back 44

Anomalies

Front 45

When do we check nuchal translucency?

Back 45

12-14 weeks

Fold at back of neck = marker for Downs, trisomy 13, 18, XO

-Marker for cardiac defects

Front 46

Define Biparietal diameter

Back 46

Diameter between the 2 sides of the head

Measured after 13 weeks (6-12 weeks = Fetal pole)
-increases from 2.4cm at 13 weeks to 9.5 cm at term

Front 47

T/F: Biparietal Diameter is considered unreliable during the later part of pregnancy

Back 47

TRUE

Front 48

Measuring the femur length is useful for what?

Back 48

Longitudinal growth of fetus

Front 49

*** KNOW : Whats the single most important measurement to make in late pregnancy?

Back 49

Abdominal Circumference = reflects fetal size rather than weight or age = useful in monitoring growth of fetus if done serially

Front 50

A pts mom had breast cancer at age 52. at what age should you tell your pt to begin screening?

Back 50

42

Front 51

A pt's breast mammography comes back with a report of 0/A. What do you tell your pt this means?

Back 51

Needs additional assessment

Front 52

A pt's breast mammography comes back with a report of 5/M. What do you tell your pt this means?

Back 52

Malignant - we're SURE its cancer

Front 53

What do these mean?

0/A
1/N
2/B
3/PB
4/S
5/M
6

Back 53

0/A - Needs additional assessment
1/N - Normal
2/B - Benign
3/PB - Probably Benign
4/S - Suspicious
5/M - Malignant
6 = KNOWN Breast Cancer

Front 54

What are the two categories of mammography?

Back 54

Screening - following guidelines

Diagnostic - Pt has breast pain or palpable mass OR has abnormal findings on screening mammography

Front 55

T/F: Dense breasts limit the usefulness of mammography

Back 55

TRUE

Front 56

When do we NOT do MRI of breasts for breast cancer?

When DO we do MRI of breasts for breast cancer?

Back 56

DO MRI = BRCA positive or greater than 20% risk based on gail model

Do NOT do MRI = pt has dense breasts or Hx of breast cancer

Front 57

Whats the sequence of imaging for breasts for breast cancer?

Back 57

Mammography --> Ultrasound --> MRI (only in very specific cases, ie BRCA positive or greater than 20% risk based on gail model)