Gynecology: Uterine and Vaginal Pathologies
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1
Gartner's duct cyst is the most common benign finding of which organ?
Vagina
2
Gartner's duct cyst is a remnant of which embryologic structure?
Mesonephric duct
3
What does the word root "metra" mean?
Uterus
4
What does the word root "colpos" mean?
Vagina
5
What is fluid in the uterus called?
Hydrometra
6
What is blood in the uterus called?
Hematometra
7
What is pus in the uterus called?
Pyometra
8
What is blood in the vagina called?
Hematocolpos
9
What is blood in both the vagina and uterus called?
Hematometrocolpos
10
What is the most common benign finding of the cervix?
Nabothian cyst
11
What is another name for a Nabothian cyst?
Epithelial inclusion cyst
12
What is the typical size of a Nabothian cyst?
Less than 2 cm
13
A cervical polyp is attached to the wall by what structure?
Pedicle
14
Cervical polyps are most often seen in which patients?
Peri and postmenopausal multigravidas
15
What is an obstructed cervical canal called?
Cervical stenosis
16
What is the most common tumor of the female pelvis?
Leiomyoma
17
What hormone do fibroids depend on for growth?
Estrogen
18
Which breast cancer drug may increase fibroid size?
Tamoxifen
19
What common condition may increase fibroid size due to high estrogen?
Pregnancy
20
Do fibroids grow after menopause without HRT?
No
21
What is the most common fibroid location?
Intramural
22
What is the most symptomatic fibroid type?
Submucosal
23
Which fibroid type lies beneath the endometrium?
Submucosal
24
Which fibroid type is located within the myometrium?
Intramural
25
Which fibroid type lies beneath the perimetrium?
Subserosal
26
Which fibroid type may appear as an extrauterine mass?
Subserosal
27
A pedunculated fibroid projecting into the endometrial cavity is which type?
Submucosal
28
A pedunculated fibroid projecting outward into the pelvis is which type?
Subserosal
29
What term means arising outward from the surface?
Exophytic
30
What term means attached by a stalk?
Pedunculated
31
Which fibroid type is located between the layers of the broad ligament?
Intraligamentous
32
Which fibroid type is located within the uterine cavity?
Intracavitary
33
What is a rare malignant fibroid called?
Leiomyosarcoma
34
Why do fibroids degenerate?
They outgrow their blood supply
35
In which degeneration does smooth muscle become fibrous?
Hyaline
36
In which degeneration does liquefaction occur?
Cystic
37
Calcific degeneration most often occurs after what life stage?
Menopause
38
Do fibroids strongly attenuate or enhance the sound beam?
Attenuate
39
What transducer frequency should be used for a large fibroid uterus?
Lower frequency
40
What is the most common cause of uterine calcifications?
Fibroids
41
Arcuate artery calcifications occur in the periphery in postmenopausal, diabetic and which other patients?
Hypertensive
42
What is surgical removal of a fibroid called?
Myomectomy
43
Which fibroid treatment blocks the blood supply with particles?
Uterine artery embolization
44
Uterine artery embolization causes the fibroid to become what?
Necrotic
45
Which fibroid treatment uses heat to ablate tissue under MRI guidance?
HIFU
46
What is ectopic endometrial tissue within the myometrium called?
Adenomyosis
47
What is the focal form of adenomyosis called?
Adenomyoma
48
In which part of the uterus is adenomyosis most common?
Posterior
49
Does adenomyosis have defined or indistinct borders?
Indistinct
50
Which imaging modality is more specific than ultrasound for adenomyosis?
MRI
51
Adenomyosis often coexists with what other pathology?
Leiomyomas
52
Adenomyosis shows posterior enhancement or shadowing?
Enhancement
53
Adenomyosis is most common after which type of uterine surgery?
C-section
54
The textbook calls adenomyosis the internal or external form of endometriosis?
Internal
55
What is endometrial tissue growing outside the uterus called?
Endometriosis
56
What is the leading theory for the cause of endometriosis?
Retrograde menstruation
57
What is the textbook name for the retrograde menstruation theory?
Transtubal migration
58
What life stage brings relief of endometriosis symptoms?
Menopause
59
How many times more likely are endometriosis patients to develop ovarian cancer?
4.2
60
Which form of endometriosis is most common but rarely seen on ultrasound?
Diffuse
61
Which stage of endometriosis is most likely to be detected by ultrasound?
Stage III
62
Which endometriosis stage has multiple dense adhesions?
Stage IV
63
At which endometriosis stage do the ovaries first become involved?
Stage III
64
What is painful menstruation called?
Dysmenorrhea
65
What is painful intercourse called?
Dyspareunia
66
What is painful or difficult urination called?
Dysuria
67
What is painful or difficult defecation called?
Dyschezia
68
What is focal endometriosis called?
Endometrioma
69
What is the nickname for an endometrioma?
Chocolate cyst
70
What is the most common site of endometrioma implantation?
Ovary
71
Are endometriomas usually unilateral or bilateral?
Bilateral
72
What is the most common internal appearance of a chocolate cyst?
Uniform low-level echoes
73
Endometriomas show posterior enhancement or shadowing?
Enhancement
74
What two emergencies can an enlarging endometrioma cause?
Rupture or torsion
75
Do endometriomas typically cause acute or chronic symptoms?
Chronic
76
What procedure is used to diagnose and stage endometriosis?
Laparoscopy
77
About what percentage of endometriosis cases involve the ovaries?
80%
78
What is abnormal thickening of the endometrium called?
Endometrial hyperplasia
79
What is the most common cause of abnormal bleeding in pre and postmenopausal women?
Endometrial hyperplasia
80
What premenopausal endometrial thickness suggests hyperplasia?
Greater than 14 mm
81
What postmenopausal endometrial thickness suggests hyperplasia?
Greater than 5 to 8 mm
82
What endometrial thickness suggests hyperplasia in a patient on tamoxifen?
Greater than 10 mm
83
What endometrial thickness is acceptable on estrogen/progesterone combo HRT?
Up to 15 mm
84
What does unopposed estrogen mean?
Estrogen without progesterone
85
Premarin is what type of HRT?
Unopposed estrogen
86
What does anovulatory mean?
No ovulation
87
Why do anovulatory cycles lead to unopposed estrogen?
No corpus luteum to make progesterone
88
Which malignant ovarian tumor produces estrogen?
Granulosa cell tumor
89
Which benign ovarian tumor produces estrogen?
Thecoma
90
Does endometrial hyperplasia have well-defined or ill-defined margins?
Well-defined
91
What is an overgrowth of endometrial tissue on a stalk called?
Endometrial polyp
92
What is the most common presentation of an endometrial polyp?
Asymptomatic
93
How many feeding vessels does an endometrial polyp typically have on Doppler?
One
94
A cavity mass with multiple feeding vessels is more likely what?
Fibroid
95
What is the first thing to do after introducing yourself to a patient?
Take a history
96
What does LMP stand for?
Last menstrual period
97
What is one of the most common indications for pelvic ultrasound?
Pelvic pain
98
What is an elevated white blood cell count called?
Leukocytosis
99
What is an acute bladder infection called?
Acute cystitis
100
Name the three classic causes of acute pelvic pain: torsion, ectopic pregnancy and what else?
Ruptured ovarian cyst
101
Menstrual pain from normal menstruation is called what?
Primary dysmenorrhea
102
Menstrual pain from pathology is called what?
Secondary dysmenorrhea
103
What is the lack of menarche by age 16 called?
Primary amenorrhea
104
What is the most common cause of secondary amenorrhea?
Pregnancy
105
What is uterine bleeding at irregular intervals called?
Metrorrhagia
106
About what fraction of postmenopausal patients have endometrial carcinoma?
1 in 10
107
What is the ALARA intensity limit set by the AIUM?
100 mW/cm2
108
Which approach is used when a TV exam cannot be performed?
Transperineal
109
What is the main reason to scan for a lost IUD?
Confirm it is within the endometrial cavity
110
Which view best shows the full shape of an IUD?
3D coronal
111
The ovaries are identified anterior to which vessels?
Internal iliac vessels
112
What landmark is used for the cervix and lower uterine segment?
Vagina
113
In which view is uterine width measured?
Transverse or coronal
114
Uterine length is measured from where to where?
Fundus to cervix
115
What bladder state is required for a transabdominal pelvic exam?
Full
116
What bladder state is required for a transvaginal exam?
Empty
117
What patient position is used for a transabdominal pelvic exam?
Supine
118
What patient position is used for a TV exam?
Supine with pelvic elevation
119
Why is the pelvis elevated for a TV exam?
So the probe handle doesn't hit the table
120
What is the TA scan area for a pelvic exam?
Below the umbilicus
121
Does TV have a larger or more limited field of view than TA?
More limited
122
Why does TV have better resolution than TA?
Higher frequency
123
How long should a probe soak in Cidex OPA?
10 to 20 minutes
124
How long is a Trophon cycle?
7 minutes
125
What condition must a probe be in before going into the Trophon?
Clean and dry
126
Name two other high-level disinfectants besides Cidex OPA and Trophon.
Glutaraldehyde and hydrogen peroxide
127
What should be used to scan over an open surgical wound?
Sterile probe cover and sterile gel
128
Should barium studies be done before or after pelvic ultrasound?
After
129
Why must barium studies be done after ultrasound?
Barium is a strong attenuator
130
Does iodinated contrast interfere with ultrasound?
No
131
What procedure gives a magnified view of the vagina and cervix?
Colposcopy
132
Where are the incisions made for a laparoscopy?
Sub-umbilical and suprapubic
133
What procedure scrapes the endometrium with a curette?
D&C
134
Which procedure is performed blindly?
D&C
135
What procedure lets the doctor directly visualize inside the uterus?
Hysteroscopy
136
What is pregnancy tissue left in the uterus called?
Retained products of conception
137
Which hysterectomy removes the uterus only?
Partial or subtotal
138
Which hysterectomy removes the uterus and cervix?
Total
139
Which hysterectomy removes the uterus, cervix and upper vagina?
Radical
140
What is removal of an ovary called?
Oophorectomy
141
What is removal of a fallopian tube called?
Salpingectomy
142
What procedure infuses sterile saline to evaluate the endometrium?
Sonohysterography
143
What procedure removes a cone-shaped portion of the cervix?
Cone biopsy
144
What procedure destroys the endometrial lining?
Endometrial ablation
145
In a pediatric uterus, the cervix makes up what fraction of uterine length?
2/3
146
What is the length of a pediatric uterus?
1 to 3 cm
147
What is the average size of an adult nulliparous uterus?
8 x 5 x 4 cm
148
Parity can increase uterine size by how much in each dimension?
1 cm or more
149
What is the average size of a normal ovary?
3 x 2 x 2 cm
150
What is the formula for ovarian volume?
L x W x H x 0.523
151
Around which cycle day does a follicle become dominant?
Day 8 to 9
152
What size does a dominant follicle reach?
2 to 2.5 cm
153
What happens to ovary size after menopause?
Shrinks
154
Which pelvic muscle is found at the posterior lateral corners of the bladder?
Obturator internus
155
Which pelvic muscle angles caudally toward the inferior bladder?
Levator ani
156
Which pelvic muscle is seen in the greater pelvis?
Iliopsoas
157
Which deep pelvic muscle can be mistaken for an ovary?
Piriformis
158
What is another name for the posterior cul-de-sac?
Pouch of Douglas
159
What is the most posterior and inferior peritoneal space?
Posterior cul-de-sac
160
Is a small amount of cul-de-sac fluid normal in an asymptomatic patient?
Yes
161
What is the formula for resistive index?
(A - B) / A
162
What is another name for the resistive index?
Pourcelot index
163
What is the formula for the S/D ratio?
A / B
164
What is the formula for the pulsatility index?
(A - B) / mean
165
In Doppler indices, what does A represent?
Peak systolic velocity
166
In Doppler indices, what does B represent?
End diastolic velocity
167
Little to no diastolic flow indicates high or low resistance?
High
168
Greater diastolic flow indicates high or low resistance?
Low
169
Where should the uterine artery be sampled?
Lateral to the cervix/LUS
170
Is the non-gravid uterine artery high or low resistance?
High
171
In which phase is uterine artery resistance highest?
Proliferative
172
What is the uterine artery RI in the proliferative phase?
0.88
173
Do postmenopausal women have higher or lower uterine artery resistance?
Higher
174
Where are the arcuate arteries located?
Periphery of the uterus
175
Calcification in the myometrium from prior D&C is called what?
Dystrophic calcification
176
Where is the optimal place to assess the ovarian artery?
Ovarian and uterine artery anastomosis
177
Is the ovarian artery high or low resistance in the follicular phase?
High
178
What happens to ovarian artery resistance on the dominant follicle side during the luteal phase?
Drops
179
Is the corpus luteum in first trimester pregnancy high or low resistance?
Low
180
High estrogen causes vasodilation or vasoconstriction?
Vasodilation
181
Low estrogen causes vasodilation or vasoconstriction?
Vasoconstriction
182
Is the postmenopausal ovarian artery high or low resistance?
High
183
What frequency transducer is used for TA pelvic scanning?
3.5 to 5 MHz
184
What frequency transducer is used for TV pelvic scanning?
7.5 MHz or greater
185
What should you do first once the probe is on the patient?
Survey scan
186
In which image are uterine length and AP measured?
Sagittal midline
187
Per AIUM, how are uterine length and AP oriented to each other?
Perpendicular in the same image
188
In which plane is the endometrium measured?
Sagittal
189
How is the endometrium measured when fluid is in the cavity?
Measure each layer and add them
190
How many planes should pathology be shown in to confirm it is real?
Two
191
Name the four criteria for characterizing pathology.
Location, size, contour, internal consistency
192
Smooth borders suggest benign or malignant?
Benign
193
Spiculated irregular borders suggest benign or malignant?
Malignant
194
Thin septations without flow suggest benign or malignant?
Benign
195
Large calcifications suggest benign or malignant?
Benign
196
Microcalcifications suggest benign or malignant?
Malignant
197
Internal blood flow in a mass suggests benign or malignant?
Malignant
198
Ascites with a pelvic mass suggests benign or malignant?
Malignant
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