Endometritis and Synechiae
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1
Endometritis is an infection of which layer?
Endometrium
2
Name the three causes of endometritis listed on the slide.
PID, RPOC and instrumentation
3
What is the most common cause of fever in the postpartum patient?
Endometritis
4
Up to what thickness is a postpartum endometrium considered normal?
20 mm
5
A postpartum endometrium over 20 mm raises concern for endometritis, hemorrhage or what?
RPOC
6
What does RPOC stand for?
Retained products of conception
7
What are endometrial adhesions called?
Synechiae
8
What is another name for synechiae?
Asherman's syndrome
9
What causes synechiae?
Surgical procedures or trauma
10
Synechiae can cause infertility or what?
Repeated pregnancy loss
11
Synechiae may appear as what on TV?
Hypoechoic bands
12
What procedure is most useful for diagnosing synechiae?
Sonohysterography
13
What is a common cause of postmenopausal bleeding?
Endometrial atrophy
14
Endometrial atrophy is caused by a lack of which hormone?
Estrogen
15
Which endometrial layer thins in atrophy, exposing vessels?
Basal layer
16
Does atrophy cause a thin or thick endometrium?
Thin
17
What does SIS stand for?
Saline infused sonohysterography
18
On which cycle days is SIS performed in premenopausal women?
Days 6 to 10
19
Is SIS a sterile or non-sterile procedure?
Sterile
20
Fluid in the posterior cul-de-sac during SIS indicates what?
At least one tube is patent
21
On SIS, how many feeding vessels does a polyp have?
One
22
On SIS, a cavity mass with multiple vessels is likely what?
Myoma
23
Name an SIS indication related to uterine shape present from birth.
Congenital anomalies
24
What is the purpose of an IUD?
Birth control
25
On which cycle days is an IUD placed?
Days 5 to 7
26
Where should an IUD be positioned?
Midline in the endometrium
27
What does an eccentric IUD position suggest?
Perforation into the myometrium
28
When does IUD perforation almost always occur?
During initial insertion
29
IUD use increases the risk of infection and what type of pregnancy?
Ectopic
30
Where are Essure coils placed?
Interstitial portion of the fallopian tubes
31
Which IUD has no hormones?
Copper (Paragard)
32
What shape does a Copper 7 IUD show on ultrasound?
Echogenic 7 shape
33
What shape do Mirena and Kyleena show on ultrasound?
Echogenic T shape
34
Which IUD appears as multiple dashed echogenic lines?
Lippes loop
35
What view best shows the full shape of an IUD?
3D coronal
36
What does PID stand for?
Pelvic inflammatory disease
37
What is the most common location of infection in PID?
Fallopian tubes
38
What is infection of the fallopian tube called?
Salpingitis
39
What is infection of the ovary called?
Oophoritis
40
What are the two most common bacteria causing PID?
Chlamydia and gonorrhea
41
Besides STIs, name a procedure that can cause PID by pushing contrast through the tubes.
HSG
42
Untreated PID increases the risk of ectopic pregnancy and what?
Infertility
43
What does etiology mean?
Cause of a disease
44
In which direction does PID spread?
Upward and outward
45
What is infection spread through the blood called?
Hematogenous spread
46
PID from appendicitis is which route of spread?
Direct spread
47
Name a foreign object that increases PID risk.
IUD
48
What is the most common symptom of PID?
Pelvic pain
49
Pain in PID worsens with what type of motion?
Cervical motion
50
What is pus in the fallopian tube called?
Pyosalpinx
51
What is fluid in the fallopian tube called?
Hydrosalpinx
52
Short linear echoes within a dilated tube represent what?
Tubal folds
53
How do you tell a hydrosalpinx from a vessel?
Color Doppler shows no flow
54
How thick is a normal fallopian tube when outlined by fluid?
Less than 5 mm
55
Stage I PID involves which structure?
Endometrium
56
Stage II PID involves which structure?
Fallopian tubes
57
Stage III PID involves which structures?
Ovaries and broad ligament
58
What does TOA stand for?
Tubo-ovarian abscess
59
What makes a TOA a true TOA?
Ovarian parenchyma involvement
60
Is TOA usually unilateral or bilateral?
Bilateral
61
A TOA may be unilateral with an IUD or what other cause?
Direct spread from adjacent infection
62
When the ovary cannot be separated from the inflamed tube, what is it called?
Tubo-ovarian complex
63
Do TOA walls appear thick or thin?
Thick
64
Does a TOA show increased or decreased vascularity?
Increased
65
Gas in an abscess shows what artifact?
Comet tail
66
What is inflammation of the abdominal cavity lining called?
Peritonitis
67
Peritonitis from PID can involve which two urinary structures?
Bladder and ureter
68
What does loculated fluid mean?
Walled off into pockets
69
Which PID complication spreads infection to the perihepatic space?
Fitz-Hugh-Curtis syndrome
70
Fitz-Hugh-Curtis RUQ pain worsens with what?
Breathing, coughing or movement
71
Fitz-Hugh-Curtis is most often caused by which bacteria?
Gonorrhea
72
Fitz-Hugh-Curtis pain can mimic pain from which organ?
Gallbladder
73
In chronic PID, what shape does the fallopian tube take?
Sausage-shaped
74
What sign describes pelvic organs appearing centrally merged in chronic PID?
Indefinite uterus sign
75
What can be used to distinguish bowel from PID?
Water enema
76
Dilated tubes in PID can encircle the ovaries like what?
Lunar crescents
77
Previous PID with a positive pregnancy test raises risk for which rare pregnancy?
Heterotopic
78
What does AVM stand for?
Arteriovenous malformation
79
Is an AVM more commonly congenital or acquired?
Acquired
80
What causes an acquired AVM?
Trauma or surgery
81
An AVM is associated with what type of bleeding?
Heavy bleeding
82
What Doppler resistance does an AVM show?
Low resistance
83
What Doppler velocity does an AVM show?
High velocity
84
What is the treatment for an AVM?
Embolization
85
Which procedure could cause massive hemorrhage in an undiagnosed AVM?
D&C
86
Pelvic congestion syndrome is a source of what type of pain?
Chronic pelvic pain
87
What causes pelvic congestion syndrome?
Incompetent ovarian vein valves
88
What maneuver increases vein size in pelvic congestion?
Valsalva
89
What are dilated, tortuous veins called?
Varicosities
90
What is the most common type of vaginal cancer?
Squamous cell
91
Which type of vaginal cancer is more likely to spread to the lungs and lymph nodes?
Adenocarcinoma
92
Is primary vaginal cancer or metastasis to the vagina more common?
Metastasis
93
What role does ultrasound play in vaginal cancer?
Staging
94
What is the most common type of cervical cancer?
Squamous cell
95
What is the precursor to cervical cancer?
Cervical dysplasia
96
Which virus is a major risk factor for cervical cancer?
HPV
97
What is the most common symptom of cervical cancer?
Post-coital bleeding
98
How does the cervix usually appear in stage I and II cervical cancer?
Normal
99
Which cervical cancer stage may show hydronephrosis?
Stage III
100
Which cervical cancer stage involves the bladder or rectum?
Stage IV
101
A solid cervical lesion may mimic what benign mass?
Cervical myoma
102
Which modality is excellent for staging cervical cancer?
MRI
103
Name the three ways cervical cancer is diagnosed.
Pap smear, cone biopsy, colposcopy
104
What does FIGO stand for?
International Federation of Gynecology and Obstetrics
105
Cervical cancer stage 0 is called what?
Carcinoma in situ
106
Cervical cancer confined to the cervix is which stage?
Stage I
107
Cervical cancer extending to the upper 2/3 of the vagina is which stage?
Stage II
108
Cervical cancer extending to the lower 1/3 of the vagina or pelvic wall is which stage?
Stage III
109
Cervical cancer spreading beyond the true pelvis is which stage?
Stage IV
110
What does LEEP stand for?
Loop electrosurgical excision procedure
111
Which procedure removes the cervix and upper vagina but keeps the uterus?
Radical trachelectomy
112
What is the most common gynecologic malignancy?
Endometrial cancer
113
What percentage of endometrial cancers are confined to the uterus?
75%
114
What is the most common type of endometrial cancer?
Endometrioid adenocarcinoma
115
What percentage of atypical endometrial hyperplasia progresses to carcinoma?
25%
116
A thickened endometrium is considered cancerous until proven otherwise; what is this phrase?
Guilty until proven innocent
117
Most endometrial cancer patients present with what symptom?
Postmenopausal bleeding
118
In which decades of life is endometrial cancer usually diagnosed?
6th or 7th
119
An intact endometrial halo suggests what level of invasion?
Superficial
120
How is endometrial cancer definitively diagnosed?
Endometrial biopsy
121
Endometrial cancer confined to the uterine body is which stage?
Stage I
122
Endometrial cancer invading the cervix is which stage?
Stage II
123
Endometrial cancer invading the vagina, adnexa or pelvic nodes is which stage?
Stage III
124
Endometrial cancer with distant metastases is which stage?
Stage IV
125
How common is fallopian tube cancer?
1 to 2%
126
What is the most common type of fallopian tube cancer?
Adenocarcinoma
127
Which gene mutation increases fallopian tube cancer risk?
BRCA
128
What does BRCA stand for?
Breast cancer gene
129
Is nulliparity a risk factor for fallopian tube cancer?
Yes
130
Is primary tube cancer or metastasis to the tube more common?
Metastasis
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