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146 Cards in this Set
- Front
- Back
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What are advantages of transvaginal imaging?
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1. See organs without bowel obstruction
2. Accurate endometrial measurements 3. impreoved resolution for uterus and ovaries |
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What are the disadvantages of transvaginal imaging?
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1. Limited field of view
2. lack of penetration on large fibroids 3. Male techs need a chaperone 4. patient may refuse the test 5. cannot be performed on virgins/ under age 18 years |
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What is it called when the uterus is angled to the right?
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Dextroposed
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What is it called when the uterus is angled to the left?
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Levoposed
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If a patients presents with an unusual large amount of fluid in the posterior cul de sac, what could be that cause?
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PID
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What are the normal meaurements for the uterus for the different stages?
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1. reproductive: 6-9 cm
2. Menapause: 3-7 cm 3. pre-puberty: 2-4cm 4. Postpartum: > greater than 10 cm |
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what are the various shapes the uterus can be found in?
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1. Normal
2. Bicorunate 3. Didelphys 4. Unicornis |
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if a patients mother took DES while she was pregnant, what would her utuers look like?
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T shaped uterus, this can not be corrected
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The pelvis is separated into a true and false pelvis- what anatomy belongs in the true pelvis?
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(Ovaries, uterus, bowel)
1. anterior- pubis, pubic rami, sacrum, coccyx 2. Lateral- ilium, ishium, pelvic floor muscles |
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What anatomy is found in the false pelvis?
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false- is bordered by the iliac bones, the base of the sacrum, and the abdonminal wall
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what muscles are present in the pelvis?
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iliopsoas, obturator, broad ligament, ovarian ligament
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This is inferior to the iliac artery on transverse view
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Ilipsoas muscle
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Where is the obturator muscle located?
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Lateral to the sides of bladder wall and adjacent to ovaries
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This is adjacent to the uterus and periotoneal walls
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Broad ligament
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What connects the ovaries to the uterine wall?
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Ovarian Ligament
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What two arteries feed the uterus?
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Uterine and internal iliac arteries
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What are the stages of the endometrium in a menstuating woman?
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1. proliferative stage- 2-4mm
2. Ovularoty stage- 7-8mm 3. Secretory stage- 9-15mm |
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In a post menopausal woman, her endometrium should never measure more than what?
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4-5mm
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What ducts form the femal internal genitalia?
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The wolffian and Mullerian Ducts
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What are the 4 fusion anomalies associated with the uterus?
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1. total failure fusion= didelphys uterus
2. Partial fusion= combination of either septate or bicournate 3. Non development of mullerian duct= unicornis 4. arrcuate- indentation of the endometrium |
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which fusion anomalies of the uterus are associated with renal anomalies?
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1. partial fusion= septate or bicournuate uterus
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If there is build up of fluid in the endometrium what is it called?
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hydrometrocolpos
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When there is blood built up in the endometrium, what is it called?
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Hematometrocolpos
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When endometrial tissue growns within the myometrium, what it known as?
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Adenomyosis
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What is themost common pelvic tumor?
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Leiomyoma- composed of smooth muscle and connective tissue
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What nationalities are most liekly to suffer from fibroids?
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1. African Americans
2. Asians 3. Jewish |
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What are the 5 terms used to describe location of fibroids?
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1. Submucosal
2. intraumural 3. subserosal 4. pedunculated 5. broad ligament |
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What cancer has the same appearnce of a fibroid that is fast growing and malignant?
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Leiomyosarcoma
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Sonographically describe a fibroid:
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It has decreased penetration with irregualr walls and a decreased echo texture. If it is degenerative, it will have calcifications
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Where can nabothian cysts be found?
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In the cervix
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Where can Gardner cysts be found?
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Within the vagina
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What is the most common type of squamous cell cancer of the cervix?
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Adenocarcinomas
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What are the different types of IUD's
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1. Copper coated T/7
2. Paraguard 3. Progestasert 4. Mirena 5. Lippes Loop 6. Dalkon Shield 7. Saf-t- coil |
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What causes a permanent blockage of the fallopian tubes to prevent unwanted pregnancy?
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Essure
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How does fibroid embolization work?
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an embolization material is injected into the uterine arteries to prevent blood supply to the uterus
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What are the 7 endometrial disorders that may present with excessive or unexpected uterine bleeding?
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1.endometrial cancer
2. Tamoxifen therapy 3. Fibroids 4. Adenomyosis 5. Hyperplasia 6. poor corpus luteum function 7. Polyps |
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What causes adenocarcinoma? and who is usually affected by it?
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It is caused by high estrogen and no progestin. It is lmost commonly seen in post menopausal women and obese women
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What drug is given to brest cancer patients that can also cause thickening and bleeding of the endometrium with some cystic areas?
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Tamoxifen
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what are reason homrmo replacement therapy is given to women?
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1. To help with the symptoms of meopause such as hot flashes
2. It reverses endometrial regression and decreases the effect of the ovary not producing estrogen |
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Endometrial hyperplasia is a precursor to what?
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Endometrial Cancer
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what effect does tamoxifen therapy have on the uterus?
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it causes the endometrium to thicken (endometrial hyperplasia) and it can lead to endometrial cancer
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what drugs are given as an alternative to tamoxifen?
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1. Premenopausla women- Evista
2. Post menopasual women- remidex or femara |
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what are polyps?
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They are an overgrowth of the endometrial glands and stroma that is covered by endometrial epithelium
- they are more echogenic than surrounding tissue |
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what is the highest cause of irregular bleeding and infertiltiy in women?
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Submucosal fibroids
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what are some pathologies that are better visualized with a sonohysterogram?
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1. Fibroids
2. Polyps 3. uterine synechiae 4. Ashermans syndrome |
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Describe how a sonohysterogram is performed?
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catheter is placed up through the vagina/cervix and into the endometrium. A vaginal probe is inserted into vagina- Dr will inject 20cc of sterile saline into the endometrial canal to dilate the wall to check for patholy along the walls-
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What is another name for the ovarian fossa?
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Fossa Waldeyer
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What are the normal sizes of the ovaries in the 3 stages?
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1. Prepuberty- 1.5cm
2. mensturating- 2.5 cm 3. postmenopausal- 1.0 cm |
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By what age does a woman only have 10% of her eggs remaining?
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At 30 years old
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What makes up 75-80% of ovarian neoplasms and arepresents 90% of ovarian malignancies?
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Epithelial cell lesions
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Germ cells make up what % of ovarian masses?
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20%
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What are the 4 tissue types that make up the ovary>
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1. Epithalia
2. Germ cell 3. Stromal cell 4. coelomic cell |
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What are the 2 types of epitelial cell lesions?
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1. Serous Lesions
2. Mucinous lesions |
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What make up germ cell masses?
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Benign teratomas, also called dermoids
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What are sex cord tumors composed of and what % do they make up of ovarian masses?
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composed of Stroma cells and make up 10%
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What masses fall under the category of cystic in the ovaries?
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1. Physiologic cysts
2. Hemorrhagic cysts 3. Tubo-ovarian complexes 4. endometriomas / paratubal 5.Ovarian teratomas 6. Mural nodules (cystic and solid components = cystadenocarcniomas |
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What masses fall under the catergory of solid in the ovaries?
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1. Metastases
2. Adenocarcinomas 3. Mural nodules = papillary projections |
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What % of ovarian masses are bening VS malignant and also metastatic?
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1. Benign 80%
2. Malignant 10-15% 3. Metastatic 5% |
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Malignant lesions are seen in how many women over the age of 40?
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1 in 70
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what are the size of fallopian tubes in length?
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7-12 cm
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Where are the fallopian tubes the narrowest?
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at the interstitial end
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Fluid collection in the fallopian tubes is known as what?
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Hydrosalpinx
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At times an egg can be seen inside the graffian follice, what is this called?
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Cumulus Oophorous
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What is a paraovarian cyst and what is another name for it?
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it is a cyst adjacent to the ovary and next to the tube
It is also called Morgagni Cysts |
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What is a cyst filled with blood called? Sonographically describe it
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Hemorrhagic cyst
Internal uniform echoes or clot adherent to it and may have spider web like septate |
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What is a theca lutein cyst? What causes it?
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It is a large cyst that may be multilocular that is caused by hyperstimulation of the ovary with HcG
Twin pregnancy, molar pregnancy and use of infertility drugs cause theca lutein cysts |
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what is a theca lutein cyst?
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It is a large cyst that may be multilocular that is caused by hyperstimulation of the ovary by HcG
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What causes theca lutein cysts?
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Twin pregnancy, molar prgnancy and use of infertility drugs
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at what week in gestation should th corpus lutein cyst regress?
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by 14 weeks
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What is a serous inclusion cyst?
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It is a thin walled, clear cyst that is possibly hemorrhacig and funcitonless
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Serous inclusion cysts affect who? At what point would they operate on this cyst?
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It affects postmenopausal women
If the cyst is greater than 5 cm and it does not regress 70% regress |
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What are considered physiologic ovarian cysts?
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1. Follicular
2.Hemorrhagic 3. Corpus luteum 4. Simple cysts 5. paraovarian 6. theca lutein cysts |
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what are considered non- neoplastic ovarian cysts?
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1. Simple cysts
2. hemorrhagic 3. ovarian hyperstimulation 4. ovarian torision 5. para-ovarian 6. PCOS 7. Endometrioma 8. Serous inclusion 9. Neonatal Cysts 10. PID |
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What is polycystic ovarian syndrome? what is the songraphic "sign"
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It is an endocrine disorder that has an imbalance of LH and FSH and patients suffer from choronic annovulation. The ovaries becomine enlarged by 2 to 5 times their original size.
Sonographic sign is string of pearls- |
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What is the most common benign gynecologic disease and is associated with 40% of infertility patients
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endometriosis
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what is a chocolate cyst?
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Endometrioma-
it is a cyst within the ovary with a thick wall and homogenous, uniform low level echoes ( may look hemorrhagic) |
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What is the most common ovarian infection?
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PID
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What is PID?
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IT is a bacterial infectino that can migrate from the fallopian tubes into the ovaries causeing cyst enlargement with septaew and fee fluid in the pelvis
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where is ovarian torision most commonly seen?
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with young girls and pregnant women
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what is a complex ovarian mass?
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It is composed of both cystic and solid components and it may have either thick or thin septae with possible mural nodules (papillary projections)
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What is a gastric cancer that can migrate to the ovaries?
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Krukenbergs Tumor
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what accounts for 30% of all serous tumors?
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Benign serous cystadeomas
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mucinous tumors account for what % of benign tumors?
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20%
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What cancer accounts for 90% of ovarian cancers? What is its appearance?
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1. Serous cystadenocarcinoma
2. It is locular with thin walls and papillary projections |
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What is the difference inappearance between a mucinoous tumor and a mucinous cystadenocarcinoma?
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mucinous tumor will have thick and numerous septations
mucnious cystadenocarcinoma will also have thick numerous septations but with numerous papillary projections |
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what is a dermoid cyst?
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It is composed of 3 layers of germ cells filled with fatty material, hair, bone, teeth
They can occur bilaterally and are more common in reproductive years |
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What is a fibroma? What "syndrome" is it part of?
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1. it is a sex cord stomal mass that is highly vascular- it is a fibrous ovarian tumor- this looks like a fibroid with a mixed echo texture
This is part of Meig's syndrome (Brenner Tumor) |
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Where is metastatic canver to the ovaries most likely to come from?
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Intestines, gastric, breast
This is spread by genital tract or directly such as a tube or uterus |
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What are the risk factors of ovarian cancers?
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1. Family history of ovarian cancer on mothers side
2. BCP (associated with breast cancer) 3. Low parity 4. infertility of use of infertilty drugs (clomid) 5. Type A blood 6. Pelvic infections 7. over the age of 55 |
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If a patient is over 55 what % have a chance of developing ovarian cancer
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55%
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If a patient is under 55 years old, what is the % of developing ovarian cancer
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5%
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What is the leading cause of death from gynecological reasons?
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Ovarian cancer
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Most women who get ovarian cancer are post menopausal with an occurance of how many women?
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1 in 70
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What blood test is uded to screen for ocarian cancer? What are the normal values?
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CA 125 seroum antigen blood test
0-35 U/mL |
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What should the PI and RI numbers be to be considered normal?
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PI- Greater than or equal to 1.0
RI- Greater than or equal to 0.7 |
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What can cause false elevation of the Ca 125 blood test?
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1. Ist trimester pregnancy
2. endometriosis 3. adenomyosis 4. pancreatitis 5. menstruation 6. PID 7. Renal failure 8. liver disease 9. ectopic pregnancy 10. Fibroids 11. Cirrhoisis |
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what may cause an elevation in the Ca 125 blood test that is not related to ovarian cancer but is related to another malignancy?
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1. Colon cancer
2. breast cancer 3. hepatic tumor 4. fallopian tube cancer 5. lung tumor 6. cervical cancer 7. biliary tumors 8. endometrial Cancer |
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normal ovarian arterial flow has what kind of resistance?
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High
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Ocarian cancers are hight vascualr with what resitance in the walls?
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Low resistance
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what is the best time to take a Dopple sample of ovarian arterial flow?
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days 3-7 in a menstruating woman
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At what point in a menstruating womans cycle would she have low resistance clow and it be normal?
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mid cycle and during secretory phase
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when it comes to infertility how much of it has to do with women, men and both?
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1. Females- 40$
2. Males 40% 3. Both 20% |
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what are the 5 most common casuses of a womens infertility and what % does each account for?
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1. Tubal 30-40%
2. Endometrium/ uterus 30-50 % 3. Cervical 10% 4. ovulatory- 40 % |
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what drugs are used to induce ovualtion? and what days in a patients cycle?
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1. clomid
2. hMG Given on days 2-7 |
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How much do follices grow per day?
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2-3 mm per day
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At what size are graffin follices matured?
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18-24 mm
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when a patient is undergoing inducitno of ovualtion, what protocol is followed
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Patient will most leikey be scanned every other day to watch follicles grow-
On day 14 ovulation will occur by a surge of LH of HcG will be given IM to induce the ovluation 9If needed) at this time an IUI will be preformed by injecitn sperm into the fundus of the the uterus |
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What blood test is used to check for a mature follice?
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Estradiol blood test
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some physicians perform clomid in how many cycles?
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3 cycles
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what are the cycles of Clomid given before referring to an infertility specialist
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1. 50mg
2. 100 mg 3. 150mg |
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list the infertiltiy drugs that correspond to the hormones
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FSH & LH = menopur/ repronex- HmG
FSH = bravelle/ follistin/ Gonal- F Suppression= lupron/ ganirelix porgesterone= endometrin/ progesterone in oil IM injection HcG= human chorinoic gonadortropin |
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why is HcG used in infertilyu patients?
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To stimulate ovualtion and to promote increased hormons to support a zygote
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What are other infertility drugs athat you should be familiar with?
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1. letrozole and Anastrozole
2. parlodel 3. Pergonal (creates hyperstimulation) 4. Repronex 5. Humegon (urine derived injectable FSH) 6. Metrodine, Follistim |
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What patients are most likely to IVF/ET
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1. patients with diseased/absent fallopian tubes
2. Patients with failed clomid cycles |
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how does IVF/ET work?
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1. Fertility drugs are given from day 3-15
2. When follicles reach a size of 17-20mm they are aspirated with a needle guyide by a transvaginal ultrasound 3. Aspirated egg is placed in a petri dish with sperm for fertilization 4. After 2-3 days they are transferred into the uterus by using a catheter guided by TV US or TA US referred to as ZIFT (Zygote intrafallopian transfer) or embryo transfer |
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What is the GIFT procedure?
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Gamete intrafallopian transfer
1. The ova and sperm are transferred into the fallipian tube by a catheter, this was utilized in the 1980's and had a high rate of ectopic pregnancies Success rate was ~ 12-30% |
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What hormone can cause problems with the growth of the endometrium causing infertility?
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Progesterone
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What can cause a cervix to be incompetent?
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1. DES
2. Trauma 3. Cervical procedures ( conization for the HP virus) |
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What is Aschermans syndrome?
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It is destruction of the endometrium from scarring and bands of tissue (synehcie) in the cavity
Causes amenorrhea |
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What is ashermans syndrome caused by?
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1. abortions
2. D&C's 3. tuberculosis |
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True of false- you can have tuberculosis besides your lungs?
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True
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What is hydrosalpinx and what causes it?
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it is a fluid filled fallopian tube caused by adhesion of the tube at the fimbriated poriton
STD's, endometriosis or ectopic pregnancies could cause this |
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What is the best method to diagnose tubal infertiltiy
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Hysterosalpingography ( Xray procedure)
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what is endometriosis?
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It is a condition where endometrial tissue grows out side of the uterus and can adhere to ovaries, uterine ligaments, fallopian tubes, cul de sacs and peritoneum
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What problems have an effect on ovualtion?
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1. Benign cysts
2. hemorrhagic cysts 3. dermoids 4. endometriomas 5. POS 6. Amenorrhea |
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If a patient suffers from amenorrhea what might a doctor recommend to remedy the problem?
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1. Weight loss
2. BCP |
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What is the normal amount of spen that should be in 1 ml?
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20 Million motile sperm
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what infertilit problems do men suffer from?
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1.Varicoceles- can create blockage
2. Do not produce enought sperm- may need a donor |
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How are varicoceles corrected in men?
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Treated with catheter embolizatino by a urologist
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what are some complications of IVF?
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1. multiple gestations
2. ectopic pregnancy 3. spontaneous abortion 4. ovarian hyperstimulation syndrome 5. heterotopic pregnancy |
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What complications do women with ovarian hyperstimulation syndrome suffer from?
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1. The ovaries can grow to more than 10cm
2. they will have ascites that can resolve in 3-7 days if they don become pregnant but if they do it could tak e6-8 weeks to resolve 3. the ascites can reduce the caridac output which could mean with lasix treatment and or hospitalization |
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What is a prenatal diagnosis?
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It gives couples the abiltiy to know chances of genetic disease that they may face and the use of US to diagnois structrual abnormalities
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Ultrasound diagnoisis what type of abnormailies
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structual
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what are some choromosomal disorders and %
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0.9% trisomy/sex disroders. Physical or cognitive disorders
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what are some single gene/ menelian disorders and %
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1. Cystic fibroissis
2. sickle cell disease 3. tach sachs Both parents are carriers 1% |
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what are some polygenic/mulitfactorial disorders (spina bifida/ organ) and the %
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bone/ abdomen defects and > less than 5%
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what are some teratogenic enviornmental effects and the %?
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4% exposure to harmful chemicals
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what are some harmful chemicals while pregnant?
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Thaliomide- drug used for morning sickness and caused "flipper babies" (Phocomelia babies)
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1 RAD exposure in pregnancy can cause what?
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1. microcephaly
2. Cardiac defects 3. IUGR 4. Preterm birth |
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Chromosonal abnormailites occur in how many newborns and occur more because of what?
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1.occur in 0.5% of newborns
2. occurs more with increased maternal age which is due to nondysfunciton of the ova |
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nondysfunction of the ova results in what?
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95% trisomy 21 (maternal) and 5% paternal
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Explain the techinique for an amniocentesis
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1. find area free of placenta and head
2. mark area with pen cap 3. wash area with betadine 4. inject local anesthetic 1% lidocaine 5. have transducer in sterile cover 6. choose site away from head and placenta 7. place probe at right angle to need site on side of maternal abdomen |
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Why do you discard the first 2-3 cc during an amnio?
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possbile maternal cells/ blood contamination
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what does it mean if fluid is yellow/brown or red during an amniocentesis?
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1. yellow is normal
2. brown is old blood 3. red is placenta blood contamination |
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Do you refridgerate sample for an amniocentesis?
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NO- place in brown bag or tubes to prevcent denaturing of proteins from the light
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what is the US appearccen with a tight amnion?
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1. placentomegaly
2. oliogohydraminos |
