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70 Cards in this Set
- Front
- Back
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What is the classic clinical triad for ectopic pregnancy
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irregular bleeding
abdominal or pelvic pain palpated tender adnexal mass |
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What are some characteristics that puts a patient at high risk for ectopic pregnancy
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abnormal fallopian tubes
IUD IVF history of prior ectopic pregnancy |
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What are 3 causes of abnormal fallopian tubes
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infection
pelvic surgery congenital |
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What are the locations for an ectopic pregnancy
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fallopian tubes (97%)
ovary (1%) broad ligament/peritoneal surface (?) cornua (2%) |
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What percent of ectopic pregnancies are in the fallopian tube and ovaries
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fallopian tubes (97)
ovary (1) |
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Can an ectopic pregnancy occur in the cervix or a c-section scar
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yes
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What is a heterotopic pregnancy
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a concominant intrauterine and extrauterine pregnancy
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What is a common cause of heterotopic pregnancy
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IVF
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If the CRL is 5mm should there be a heart rate
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yes
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If the mean sac diameter is 8mm should you see a yolk sac
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yes
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What is a fetal pole
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is a thickening on the margin of the yolk sac of a fetus during pregnancy.
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If there is no IUP seen and a positive pregnancy what is the risk of an ectopic pregnancy
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55%
(may be SAB or too early to detect) |
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What is seen in a ectopic pregnancy
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complex fluid in cul de sac
echogenic ring (gestional sac, yolk sac, fetal pole) |
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What is a yolk sac
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The yolk sac is a membranous sac attached to an embryo, providing early nourishment in the form of yolk
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Why is the yolk sac an important structure to be visualized
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It is a critical landmark, identifying a true gestation sac at around 5 weeks
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What is the anatomy of the yolk sac
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At the end of the fourth week the yolk sac presents the appearance of a small pear-shaped vesicle (umbilical vesicle) opening into the the vitelline duct.
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What is the viteline duct
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the vitelline duct, also known as the omphalomesenteric duct, is a long narrow tube that joins the yolk-sac to the midgut lumen of the developing fetus
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What is another name for the vitelline duct
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omphalomesenteric duct
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What are the two membranes of the gestational sac
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the inner membrane is the amnion
the outer membrane is the chorionic sac |
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What is in the aminion membrane of the gestational sac
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the amionic fluid and the fetus
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What is the function of the allantois
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This sac-like structure is primarily involved in nutrition and excretion, and is webbed with blood vessels.
The function of the allantois is to collect liquid waste from the embryo, as well as to exchange gases used by the embryo. |
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What are the structures that attach to the amniotic membrane
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the allantois (waste, gas exchange)
the umbilical vessels vitteline duct (food) |
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Are the allantois, umbilicals and vitteline duct and yolk sac inside the the chorion (until 14-16th week when the amnion and chorion fuse)
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yes (remember the gestional sac is made up of the amnion (inner membrane) and the chorion (outer membrane)
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what is the term gestational sac refering to
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the amniotic sac which contains the chorion and the amnion membrain
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What struture is between the amnion membrane and the chorion
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the yolk sac and vitteline duct
and the allantois, umbilical vessels which go to the placenta |
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What is the risk of an ectopic pregnancy if you do not see an iUP
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55%
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What are the findings of an ectopic pregnancy
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free fluid
adnexal mass (echogenic ring, gestational sac, yolk sac and fetal pole) |
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What is often mistaken for an ectopic pregnancy
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a corpus luteum
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If there is an echogenic ring in the ovary is it an ectopic
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probably not, this may be a corpus luteum cyst, ectopics are usually seperate
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What is the risk of ectopic if there is no IUP and pelvic fluid in the culd sac
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75%
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What is the size for deciding to excise a adnexal mass
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see my notes
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What are characteristic of a benign cyst in a premenopausal women
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anechoic, thin walled
no more than 1-2 thin septations |
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What is the characteristic appearance of a dermoid cyst on US
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a mass with high amplitude regional echoes and acoustic shadowing
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Is a unilocular hemorrhagic cyst worrisome
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no
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When is a cyst non-worrisome in a post menopausal women
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unilocular, thin walled, anechoic cyst that are less then 5 cm
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What may be seen inside a hemorrhagic cyst
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internal lace like fibrinous bands
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What are 3 benign complex cyst
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endometrioma
dermoid cyst hemorrhagic cyst |
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What is the characteristic appearance of an endometrioma
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internal low level echoes
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What are you looking for in an endometrioma
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mural nodules that may indicate malignancy
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What are 5 characteristics that may indicate malignancy
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irregular walls
mural or septal nodules thick septations large multiseptated solid |
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What is the next step if a lesion is suspected to be malignant on US
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MRI unless there is high clinical suspicion then surgery or CT/mri for staging
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When is the most common time for ovarian torsion to occur
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during pregnancy
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What percent of ovarian torsions occur during pregnancy
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20%
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What is the more common side of ovarian torsion
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the right side
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What are the clinical symptoms of ovarian torsion
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acute severe, unilateral pain, anorexia, N/V, intermittent pain may precede acute symptoms
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Is a torsed ovary usually enlarged
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yes, it is usually greater than 4cm
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What is the texture of a torsed ovary
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heterogeneous
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What causes the heterogenity of a torsed ovary
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edema, hemorrhage, necrosis
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What happens to the ovarian follicles on a ovarian torsion
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the follicles are pushed to the periphery
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What percent of pt with ovarian torsion have pelvic fluid
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87%
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What percent of patients with ovarian torsion have the whirlpool/target sign
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88%
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What is the whirpool or target sign
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this is a twisted vascular pedicle
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Does the presence of flow exclude the possibility of torsion
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no
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What percent of ovarian torsion have no flow
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only 40%
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Can ovarian flow be intermittent during torsion
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yes
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If a pt has S/S of ovarian torsion but has flow can you exlude torsion
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absolutely not
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What are 5 characteristics of an ovarian torstion
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enlarged ovary
peripheral follicles heterogeneous decreased or absent flow (not always) fluid in the cul de sac |
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What does the target sign look like
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swirly pattern in the broad ligament
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What is the highest predictive value of a torsed ovary
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enlarged ovary with abnormal doppler and fluid in the cul de sac
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What are normal premenopausal
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menstraul 1-4mm
proliferative 4-8 mm secretory 8-16 mm |
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What is a normal value for a post menopausal endometrium if the pt is bleeding
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5mm
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What is a normal value for a post menopausal endometrium if the pt is not bleeding
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8mm
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If the edometrial stripe is less than 5mm and the pt is bleeding what is the most likely cause
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atropy
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If the ES is greater than 5 mm and the patient is bleeding what is the most likely cause
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carcinoma, hyperplasia, polyps
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Is post menopausal fluid in the endometrial canal ever normal
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no
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What is the most common cause of fluid in the endomentrial canal in a post menopausal women
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cervical stenosis
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What are other causes of fluid in the canal in a post menopausal women
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obstructing malignant tumor (endometrial or cervical)
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What drug causes enlargement of the endometrium
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tamoxifen
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What drug causes endometrial hyperplasia and cystic changes
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tamoxifen
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What does the hyperplastic and cystic changes associated with tamoxifen look like
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cystic endometrial carcinoma
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