Menstrual Cycle Quiz
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Questions and Answers

Which layer of the uterus is responsible for the functional part of the endometrial cycle?

  • Myometrium
  • Basal layer
  • Serosa
  • Endometrium (correct)

    • What anatomical part of the uterus is located at the upper portion?

  • Fundus (correct)
  • Cervix
  • Isthmus
  • Body/corpus

    • What is the primary function of FSH in the menstrual cycle?

  • Stimulates growth of ovarian follicles (correct)
  • Regulates progesterone levels
  • Triggers ovulation
  • Initiates menstrual shedding

    • During which phase of the menstrual cycle do estrogen levels significantly rise due to follicular growth?

    <p>Follicular Phase</p> Signup and view all the answers

    Which arteries supply the myometrium of the uterus?

    <p>Radial arteries</p> Signup and view all the answers

    How does blood flow in the uterine arteries change during the secretory phase compared to the proliferative phase?

    <p>Decreases in resistance</p> Signup and view all the answers

    What triggers the LH surge that leads to ovulation?

    <p>Rise in estrogen from the ovaries</p> Signup and view all the answers

    What is the fate of the corpus luteum if fertilization occurs?

    <p>Continues producing progesterone due to hCG</p> Signup and view all the answers

    What is the maximum diameter of a follicle before ovulation occurs?

    <p>15-30 mm</p> Signup and view all the answers

    Which structure is replaced with a yellowish fatty substance after ovulation?

    <p>Corpus luteum</p> Signup and view all the answers

    What is the sonographic appearance of the endometrium during the secretory phase?

    <p>Hyperechoic and thickest</p> Signup and view all the answers

    What sign indicates ovulation may occur within 24 hours?

    <p>Line of decreased reflectivity around follicle</p> Signup and view all the answers

    Which hormone surge leads to the rupture of the follicle?

    <p>LH</p> Signup and view all the answers

    What is the typical size range of an ovary in a premenopausal woman?

    <p>3.5 x 1.5 cm</p> Signup and view all the answers

    What is the appearance of the endometrium at the end of the menstrual phase?

    <p>Thin and slightly irregular</p> Signup and view all the answers

    What does the presence of a corpus albicans indicate?

    <p>Regressed corpus luteum</p> Signup and view all the answers

    How should the endometrium be measured for evaluation?

    <p>AP measurement on sagittal image without fluid</p> Signup and view all the answers

    During which phase is the endometrial appearance described as a triple layer sign?

    <p>Proliferative phase</p> Signup and view all the answers

    Which pelvic ligament connects the lateral ovary to the posterolateral pelvic wall?

    <p>Infundibulopelvic ligament</p> Signup and view all the answers

    How does the endometrium typically appear in a post-menopausal woman not on HRT?

    <p>Less than 5 mm thick</p> Signup and view all the answers

    What is menorrhagia characterized by?

    <p>Heavy or long periods at usual times</p> Signup and view all the answers

    Which pelvic space is most likely to have fluid accumulation?

    <p>Posterior cul de sac</p> Signup and view all the answers

    What condition does oligomenorrhea indicate?

    <p>Abnormally short or light periods</p> Signup and view all the answers

    Which muscle is most likely to be mistaken for an ovary during an examination?

    <p>Iliopsoas</p> Signup and view all the answers

    What is the primary purpose of having a full bladder during transabdominal scanning?

    <p>Acts as a sonographic window and moves bowel out of the way</p> Signup and view all the answers

    What part of the fallopian tubes is most commonly the site of fertilization?

    <p>Ampulla</p> Signup and view all the answers

    What are the anterior pelvic compartments primarily housing?

    <p>Bladder and reproductive organs</p> Signup and view all the answers

    Which statement correctly describes metrorrhagia?

    <p>Irregular bleeding between periods</p> Signup and view all the answers

    What is a common consequence of pregnancy regarding kidney function?

    <p>Hydronephrosis due to ureter compression</p> Signup and view all the answers

    Which condition describes the cessation of menses in women who previously menstruated?

    <p>Secondary amenorrhea</p> Signup and view all the answers

    Which of the following structures lies between the pubic symphysis and the urinary bladder?

    <p>Space of Retzius</p> Signup and view all the answers

    What is the size measurement range for a normal uterus?

    <p>6-8 cm length, 3-5 cm A/P and transverse</p> Signup and view all the answers

    Which of the following conditions is not a contraindication for endovaginal ultrasound?

    <p>Age of patient under 18</p> Signup and view all the answers

    What is the primary purpose of hCG in fertility treatments?

    <p>To trigger ovulation</p> Signup and view all the answers

    Which procedure involves the placement of zygotes into the fallopian tubes?

    <p>Zygote Intrafallopian Tube Transfer (ZIFT)</p> Signup and view all the answers

    What does ovarian hyperstimulation syndrome commonly result from?

    <p>Excessive stimulation of the ovaries</p> Signup and view all the answers

    What is the sonographic appearance of ovarian hyperstimulation syndrome?

    <p>Cysts larger than 5 cm bilaterally</p> Signup and view all the answers

    What defines true precocious puberty?

    <p>Early release of gonadotropins</p> Signup and view all the answers

    Which condition is hydrocolpos commonly associated with in pediatric patients?

    <p>Imperforate hymen</p> Signup and view all the answers

    In post-menopausal women, what happens to the endometrial stripe measurements?

    <p>Decreases in size</p> Signup and view all the answers

    How can the endometrial thickness vary for women undergoing hormone replacement therapy (HRT)?

    <p>Can reach up to 12 mm during estrogen phase</p> Signup and view all the answers

    What is a common indicator for performing a pelvic ultrasound in pediatric patients?

    <p>To rule out ovarian cyst complications</p> Signup and view all the answers

    What is hematocolpos?

    <p>Blood in the vagina</p> Signup and view all the answers

    What might severe cases of ovarian hyperstimulation syndrome require?

    <p>Hospitalization for fluid correction</p> Signup and view all the answers

    What characterizes precocious pseudo puberty?

    <p>Development of sexual characteristics without gametogenesis</p> Signup and view all the answers

    What does the acronym IVF stand for?

    <p>In Vitro Fertilization</p> Signup and view all the answers

    What is the primary purpose of using a probe cover during an ultrasound examination?

    <p>To prevent cross-contamination</p> Signup and view all the answers

    Which of the following is NOT an indication for performing a pelvic ultrasound?

    <p>Predicting menstrual cycle</p> Signup and view all the answers

    How do combined oral contraceptive pills primarily prevent pregnancy?

    <p>By inhibiting ovulation</p> Signup and view all the answers

    What is the sonographic appearance of an intrauterine device (IUD)?

    <p>Echogenic and shadowing</p> Signup and view all the answers

    Which type of IUD utilizes natural progesterone and is effective for one year?

    <p>Progestasert</p> Signup and view all the answers

    What hormonal IUD is known for its long-term effectiveness of up to five years?

    <p>Mirena</p> Signup and view all the answers

    What is a common reason for referring a patient for an ultrasound when they have an IUD?

    <p>Confirm string visibility</p> Signup and view all the answers

    Which of the following is a complication that can occur with an IUD?

    <p>Myometrial embedment</p> Signup and view all the answers

    Which factor is NOT a male factor contributing to infertility?

    <p>Tubal issues</p> Signup and view all the answers

    What is the role of ultrasound in the diagnosis of infertility?

    <p>Monitoring follicle development</p> Signup and view all the answers

    What is the primary use of Clomiphene Citrate in infertility treatment?

    <p>To induce ovulation</p> Signup and view all the answers

    What characteristic does the endometrium typically exhibit when altered by oral contraceptives?

    <p>Thinned and flat</p> Signup and view all the answers

    What hormonal mechanism does a device like Mirena utilize to affect the menstrual cycle?

    <p>Delays follicle rupture</p> Signup and view all the answers

    Which of the following is a sign indicating potential complications with an IUD that warrants an ultrasound evaluation?

    <p>Increased menstrual flow</p> Signup and view all the answers

    What is the most common cause of post-menopausal bleeding without hormone replacement therapy (HRT)?

    <p>Endometrial atrophy</p> Signup and view all the answers

    What does a thin endometrium measuring 4 mm or less typically indicate?

    <p>Atrophic endometrium</p> Signup and view all the answers

    What is one of the primary uses of Doppler ultrasound in evaluating endometrial thickening?

    <p>Distinguishing benign from malignant causes</p> Signup and view all the answers

    What is Tamoxifen primarily used for?

    <p>Chemotherapy in breast cancer</p> Signup and view all the answers

    What is CA-125 known to signal when elevated?

    <p>Ovarian cancer</p> Signup and view all the answers

    Why is it important to perform both transabdominal and transvaginal ultrasound in post-menopausal evaluation?

    <p>To locate the ovaries accurately based on their position</p> Signup and view all the answers

    What indicates the presence of Nabothian cysts in the cervix?

    <p>History of prior infection</p> Signup and view all the answers

    What typically complicates visualization of the ovaries in post-menopausal patients?

    <p>Loops of bowel in the pelvis</p> Signup and view all the answers

    What does hydrosalpinx represent?

    <p>Fluid-filled fallopian tube</p> Signup and view all the answers

    What condition is most commonly associated with the occurrence of endometrial carcinoma?

    <p>Endometrial atrophy</p> Signup and view all the answers

    What can increase the risk of endometrial carcinoma related to Tamoxifen use?

    <p>Changes to the endometrial lining</p> Signup and view all the answers

    What is considered an abnormal echotexture in the myometrium during an ultrasound?

    <p>Heterogeneous areas</p> Signup and view all the answers

    What is one of the indications for sonography in a post-menopausal patient?

    <p>Examine ovaries and uterus for palpable mass</p> Signup and view all the answers

    What is the significance of obtaining lab values before performing an OB ultrasound in the first trimester?

    <p>To evaluate beta-hCG levels for proper pregnancy confirmation</p> Signup and view all the answers

    What hormone is primarily produced by trophoblastic tissues to support early pregnancy?

    <p>Human chorionic gonadotropin (hCG)</p> Signup and view all the answers

    Which of the following conditions can a lower than expected hCG level indicate?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    What is a potential indicator of higher than expected hCG levels?

    <p>Incorrect gestational dating</p> Signup and view all the answers

    What is the earliest intra-gestational sac anatomy typically visualized during an ultrasound?

    <p>Yolk sac</p> Signup and view all the answers

    How is gestational age typically determined in obstetric practice?

    <p>From the first day of the last menstrual period</p> Signup and view all the answers

    Which statement accurately describes conceptual age?

    <p>Begins from the day of conception</p> Signup and view all the answers

    When does the heart of the embryo typically begin to beat?

    <p>By about 6 weeks of gestation</p> Signup and view all the answers

    What does the trophoblast form after implantation?

    <p>Chorionic villi</p> Signup and view all the answers

    Which layer of the embryo will develop into the digestive system?

    <p>Endoderm</p> Signup and view all the answers

    What might vaginal bleeding during early pregnancy indicate?

    <p>Potential ectopic pregnancy</p> Signup and view all the answers

    What primarily contributes to the fetal part of the placenta?

    <p>Trophoblastic tissues</p> Signup and view all the answers

    Why might a patient report vaginal bleeding prior to receiving a positive pregnancy test?

    <p>Implantation bleeding is possible</p> Signup and view all the answers

    When should the yolk sac be visualized transvaginally?

    <p>When the gestational sac measures 12 mm</p> Signup and view all the answers

    What is the gestational sac's expected growth rate per day?

    <p>1 mm</p> Signup and view all the answers

    What is the most accurate method of dating a pregnancy sonographically?

    <p>Crown rump length</p> Signup and view all the answers

    At what measurement should the embryo be visualized sonographically?

    <p>When the gestational sac measures 16 mm transvaginally</p> Signup and view all the answers

    What is the significance of a calcified yolk sac?

    <p>It is seen with embryonic demise</p> Signup and view all the answers

    When should cardiac activity be visualized in an embryo?

    <p>By the end of the 8th week</p> Signup and view all the answers

    What is the primary function of the yolk sac?

    <p>Provides nutrients to the developing embryo</p> Signup and view all the answers

    What signifies a physiologic omphalocele?

    <p>Midgut herniation into the umbilical cord</p> Signup and view all the answers

    What happens to the yolk sac by 12 weeks of pregnancy?

    <p>It is no longer seen</p> Signup and view all the answers

    What does a small gestational sac (GS) indicate regarding the risk of spontaneous abortion?

    <p>High risk of abortion</p> Signup and view all the answers

    What is the role of the trophoblastic tissue during early pregnancy?

    <p>It provides nutrients and oxygen to the developing embryo</p> Signup and view all the answers

    What is the expected appearance of the gestational sac (GS)?

    <p>Round, oval, or teardrop shaped with echogenic borders</p> Signup and view all the answers

    What is the measurement method for the mean sac diameter (MSD)?

    <p>Length x Width x Height / 3</p> Signup and view all the answers

    What should be expected during the middle of the first trimester regarding the amnion and chorion?

    <p>They begin to fuse</p> Signup and view all the answers

    Which of the following is a sign of an inevitable abortion?

    <p>Cervical dilation &gt;3mm</p> Signup and view all the answers

    What is the primary characteristic of a threatened abortion?

    <p>The cervix remains closed</p> Signup and view all the answers

    What old term refers to an anembryonic pregnancy?

    <p>Blighted ovum</p> Signup and view all the answers

    Which symptom is commonly associated with ectopic pregnancy?

    <p>Severe abdominal pain</p> Signup and view all the answers

    What distinguishes a heterotopic pregnancy?

    <p>Simultaneous intrauterine and ectopic pregnancies</p> Signup and view all the answers

    What is a key sonographic finding indicative of a septic abortion?

    <p>Enlarged uterus with internal gas bubbles</p> Signup and view all the answers

    Which measurement indicates an anembryonic pregnancy on sonography?

    <p>Gestational sac 25 mm or larger without an identifiable embryo</p> Signup and view all the answers

    In the context of ectopic pregnancy, what does the 'ring of fire' refer to?

    <p>Color Doppler signal around the trophoblastic tissue</p> Signup and view all the answers

    What is a clinical sign indicative of ectopic pregnancy?

    <p>Amenorrhea and positive pregnancy test</p> Signup and view all the answers

    Which of the following is NOT a clinical sign of an inevitable abortion?

    <p>High beta-hCG levels</p> Signup and view all the answers

    What is a common risk factor contributing to the increase in ectopic pregnancies?

    <p>Rise in pelvic inflammatory disease (PID)</p> Signup and view all the answers

    What does a pseudo gestational sac indicate?

    <p>Fluid in the endometrial cavity without a double sac sign</p> Signup and view all the answers

    What sonographic finding is common in an ectopic pregnancy?

    <p>Presence of free fluid in the cul-de-sac</p> Signup and view all the answers

    What distinguishes monochorionic-diamniotic twins from other types of twins?

    <p>They share one chorionic sac, two amniotic membranes, and two yolk sacs.</p> Signup and view all the answers

    What indicates a normal finding when observing an echogenic area protruding from the fetal abdomen at around 9 weeks?

    <p>It measures less than 7mm and resolves back into the abdominal cavity.</p> Signup and view all the answers

    Which of the following best describes dizygotic twins?

    <p>They result from two separate ova and are typically dichorionic and diamniotic.</p> Signup and view all the answers

    Which factor is NOT considered a common teratogen?

    <p>Conceiving a child after age 35.</p> Signup and view all the answers

    What is the definition of a chromosomal abnormality?

    <p>A genetic defect identifiable microscopically.</p> Signup and view all the answers

    What does the term 'euploid' refer to?

    <p>A normal set of chromosomes.</p> Signup and view all the answers

    What is the main purpose of nuchal translucency screening?

    <p>To screen for chromosomal abnormalities.</p> Signup and view all the answers

    How do maternal diseases like diabetes affect fetal development?

    <p>They increase the risk of growth restrictions and anomalies.</p> Signup and view all the answers

    What distinguishes autosomal dominant inheritance patterns from autosomal recessive patterns?

    <p>Traits appear in each generation for autosomal dominant but may skip generations in autosomal recessive.</p> Signup and view all the answers

    What is a characteristic of chemical teratogens?

    <p>Their effects vary widely depending on the substance.</p> Signup and view all the answers

    Which maternal risk factor is related to the likelihood of producing offspring with genetic anomalies?

    <p>Advanced maternal age.</p> Signup and view all the answers

    What condition results from the presence of an extra chromosome?

    <p>Trisomy.</p> Signup and view all the answers

    What increases the risk of congenital malformations during pregnancy?

    <p>Use of certain medications.</p> Signup and view all the answers

    What is the significance of an abnormal nuchal translucency (NT) measurement when combined with a normal karyotype?

    <p>It suggests screening for congenital heart defects is necessary.</p> Signup and view all the answers

    What does a low level of PAPP-A and Beta-HCG generally indicate?

    <p>Potential abnormal implantation or Trisomy 21.</p> Signup and view all the answers

    What is the outcome of autosomal recessive inheritance patterns?

    <p>The trait can skip generations.</p> Signup and view all the answers

    At what gestational age is chorionic villus sampling (CVS) typically performed?

    <p>9 to 12 weeks.</p> Signup and view all the answers

    Which markers are included in a quad screen test?

    <p>MSAFP, hCG, uE3, Inhibin-A.</p> Signup and view all the answers

    What is the primary purpose of amniocentesis?

    <p>To evaluate amniotic fluid levels of various substances and perform chromosomal karyotyping.</p> Signup and view all the answers

    How does the presence of trophoblastic vascular waveforms relate to a complete abortion?

    <p>They may persist for up to three days post-abortion.</p> Signup and view all the answers

    What does an elevated MSAFP indicate in a pregnancy?

    <p>Potential complications such as open neural tube defects.</p> Signup and view all the answers

    What characterizes a missed abortion?

    <p>Cardiac activity is absent, but the embryo remains retained.</p> Signup and view all the answers

    What are the expected marker levels in a fetus with Trisomy 21?

    <p>Decreased MSAFP, increased hCG, decreased uE3, increased Inhibin-A.</p> Signup and view all the answers

    When is the use of dye during amniocentesis most critical?

    <p>In multiple gestation pregnancies to ensure each sac is only tapped once.</p> Signup and view all the answers

    What markers are typically decreased in a fetus diagnosed with Trisomy 18?

    <p>MSAFP and uE3.</p> Signup and view all the answers

    What is the main reason for performing cell-free DNA testing?

    <p>To screen for increased risk of Trisomy 21, 18, or 13.</p> Signup and view all the answers

    What does the presence of chromosomal abnormalities typically lead to?

    <p>Increased likelihood of fetal demise or abnormal pregnancy outcomes.</p> Signup and view all the answers

    What contributes to the insufficiency of visualizing an intrauterine pregnancy to rule out ectopic pregnancy?

    <p>Visualization may miss signs of a coexisting ectopic pregnancy.</p> Signup and view all the answers

    How does the pseudo gestational sac differ from a true gestational sac?

    <p>The pseudo gestational sac shows a decidual reaction.</p> Signup and view all the answers

    What structure allows the majority of blood in the fetal right atrium to bypass the lungs?

    <p>Ductus arteriosus</p> Signup and view all the answers

    Why is the fetal liver's demand for oxygenated blood lower compared to after birth?

    <p>The liver does not perform detoxification in the womb.</p> Signup and view all the answers

    What is one potential consequence of excessive ultrasound energy exposure to fetal tissues?

    <p>Learning disabilities.</p> Signup and view all the answers

    What is the significance of the thermal index in ultrasound imaging?

    <p>It estimates the rise in tissue temperature.</p> Signup and view all the answers

    When is an ultrasound examination considered potentially harmful in terms of temperature elevation?

    <p>Elevation to above 4 degrees C.</p> Signup and view all the answers

    What is the primary characteristic of gestational trophoblastic disease?

    <p>Abnormal proliferation of trophoblastic tissues</p> Signup and view all the answers

    What happens to the mechanical index as the frequency of an ultrasound beam increases?

    <p>It decreases.</p> Signup and view all the answers

    Which treatment is commonly used for a complete hydatiform mole?

    <p>Suction curettage</p> Signup and view all the answers

    What is a significant risk following treatment for a hydatiform mole?

    <p>Recurrence of molar pregnancy</p> Signup and view all the answers

    Which structural change does the left umbilical vein undergo after birth?

    <p>Converts into the Ligamentum Teres.</p> Signup and view all the answers

    What characteristic distinguishes a partial mole from a complete mole?

    <p>Presence of fetal tissue</p> Signup and view all the answers

    What is a recommended practice to minimize exposure during ultrasound examinations?

    <p>Limit the time of the examination.</p> Signup and view all the answers

    What is the main role of the Ductus Venosus in fetal circulation?

    <p>To connect the umbilical vein to the IVC.</p> Signup and view all the answers

    What is an invasive mole also known as?

    <p>Chorioadenoma destruens</p> Signup and view all the answers

    Which factor influences how ultrasound can lead to cavitation effects in tissues?

    <p>Intensity of the sound wave.</p> Signup and view all the answers

    What typically triggers the appearance of theca lutein cysts in patients?

    <p>Elevated hCG levels</p> Signup and view all the answers

    What is a common finding for choriocarcinoma on ultrasound?

    <p>Irregular complex mass with marked vascularity</p> Signup and view all the answers

    What is the typical focus of ultrasound energy when attempting to decrease the mechanical index?

    <p>To set the focal zone further away from the transducer.</p> Signup and view all the answers

    What defines a complete abortion?

    <p>All products of conception are expelled</p> Signup and view all the answers

    What is the most common outcome of women who have a molar pregnancy?

    <p>They may have a residual hydatiform mole</p> Signup and view all the answers

    How does choriocarcinoma differ from an invasive mole?

    <p>Metastatic potential</p> Signup and view all the answers

    What is associated with an elevated hCG level in gestational trophoblastic disease?

    <p>Theca lutein cysts</p> Signup and view all the answers

    What differentiates a mole with a coexisting normal fetus from gestational trophoblastic disease?

    <p>Two separate conceptions</p> Signup and view all the answers

    What is a common clinical finding in gestational trophoblastic disease?

    <p>Enlarged uterus</p> Signup and view all the answers

    In cases of ectopic pregnancy, what increases the likelihood of recurrence?

    <p>Previous pelvic inflammatory disease</p> Signup and view all the answers

    Which type of ovarian tumor is most common in postmenopausal women and primarily produces estrogen?

    <p>Granulosa Cell Tumor</p> Signup and view all the answers

    What is a characteristic feature of Sertoli-Leydig tumors?

    <p>Unilateral and often malignant</p> Signup and view all the answers

    What type of cyst arises from the broad ligament and typically has thin walls?

    <p>Paraovarian cyst</p> Signup and view all the answers

    What is the primary source of metastatic ovarian tumors?

    <p>Breast and gastrointestinal tract cancers</p> Signup and view all the answers

    What is a common clinical presentation of patients with androgen-producing tumors?

    <p>Excessive facial hair growth</p> Signup and view all the answers

    Which of the following tumors is characterized by the presence of mucin-filled signet-ring cells?

    <p>Krukenberg tumor</p> Signup and view all the answers

    Which type of ovarian tumor has a high percentage of malignancy and is primarily seen in women under 30 years of age?

    <p>Dysgerminoma</p> Signup and view all the answers

    Which tumor is most likely associated with endometrial hyperplasia due to excess estrogen production?

    <p>Granulosa Cell tumor</p> Signup and view all the answers

    What distinguishes transitional cell tumors in the ovaries?

    <p>Represents a higher percentage of ovarian neoplasms</p> Signup and view all the answers

    What is the typical sonographic appearance of Krukenberg tumors?

    <p>Bilateral solid hypoechoic or complex masses</p> Signup and view all the answers

    What is the maximum Thermal Index (TI) that should be maintained during ultrasound procedures?

    <p>1.0</p> Signup and view all the answers

    Which uterine anomaly is characterized by having two completely separate uteri and cervixes?

    <p>Uterus didelphys</p> Signup and view all the answers

    What condition is likely suggested by the presence of heavy menstrual bleeding, frequent urination, and may involve leiomyomas?

    <p>Leiomyomas</p> Signup and view all the answers

    What is a common characteristic of a T-shaped uterus, often associated with DES syndrome?

    <p>Small uterus without a bulging fundus</p> Signup and view all the answers

    Which type of uterine fibroid occurs within the wall of the uterus?

    <p>Intramural fibroid</p> Signup and view all the answers

    In which condition might you find a fluid collection in the uterus, potentially detected after menarche?

    <p>Hydrometra</p> Signup and view all the answers

    What is a common sign of cervical cancer in women?

    <p>Post coital vaginal bleeding</p> Signup and view all the answers

    What type of cyst is commonly asymptomatic and results from an obstructed transcervical gland?

    <p>Nabothian cyst</p> Signup and view all the answers

    In the context of ultrasound, how should the Mechanical Index (MI) be maintained?

    <p>As low as possible</p> Signup and view all the answers

    What is the term for the congenital absence of the vagina?

    <p>Vaginal atresia</p> Signup and view all the answers

    What imaging finding might suggest the presence of endometrial hyperplasia?

    <p>Focal or diffuse thickening of the endometrium</p> Signup and view all the answers

    Which condition might present as a vascular plexus of arteries and veins without an intervening capillary network?

    <p>Uterine AVM</p> Signup and view all the answers

    What is a rare tumor derived from smooth muscle of the uterus and might mimic leiomyomas?

    <p>Leiomyosarcoma</p> Signup and view all the answers

    What is a common treatment method for heavy vaginal bleeding due to uterine AVM?

    <p>Embolization of the feeding vessels</p> Signup and view all the answers

    What is the most common cause of abnormal uterine bleeding?

    <p>Proliferation of endometrial glandular tissue</p> Signup and view all the answers

    In postmenopausal women, when is an endometrial thickness greater than 5mm considered significant?

    <p>When using hormone replacement therapy</p> Signup and view all the answers

    Which clinical sign is characteristic of endometrial carcinoma?

    <p>Early vaginal bleeding</p> Signup and view all the answers

    Which of the following statements about endometrial polyps is true?

    <p>They may contribute to infertility.</p> Signup and view all the answers

    What appearance do intrauterine synechiae or adhesions typically have on imaging?

    <p>Thin membrane or bridging bands of tissue</p> Signup and view all the answers

    What does the presence of small cystic areas in the endometrium indicate?

    <p>Normal physiological changes</p> Signup and view all the answers

    Which factor is typically associated with ovarian torsion?

    <p>Presence of a pre-existing cyst</p> Signup and view all the answers

    Which hormone imbalance is commonly observed in patients with PCOS?

    <p>High estrogens and low FSH</p> Signup and view all the answers

    How can sonohysterography be beneficial in evaluating uterine conditions?

    <p>It differentiates between polyps and submucosal leiomyomas.</p> Signup and view all the answers

    What is a characteristic sonographic appearance of a corpus luteum cyst?

    <p>Thick hyperechoic walls with echogenic internal content</p> Signup and view all the answers

    What percentage of serous and mucinous tumors are classified as borderline?

    <p>10-15%</p> Signup and view all the answers

    Which type of epithelial tumor accounts for the majority of malignant ovarian tumors?

    <p>Serous tumors</p> Signup and view all the answers

    Which statement about hemorrhagic cysts is true?

    <p>They can mimic a ruptured ectopic pregnancy.</p> Signup and view all the answers

    What is the condition described by the triad of pleural effusion, ascites, and benign ovarian tumors?

    <p>Meig's syndrome</p> Signup and view all the answers

    What is the appearance of a normal physiologic cyst on ultrasound?

    <p>Anechoic, unilocular, and thin-walled</p> Signup and view all the answers

    What condition is characterized by multiple tiny cysts around the periphery of the ovaries?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What is the typical age range for women who develop transitional cell tumors?

    <p>40-80 years</p> Signup and view all the answers

    Which type of ovarian tumor is identified as having complex but predominantly cystic appearance?

    <p>Clear cell tumors</p> Signup and view all the answers

    What clinical sign is associated with intrauterine synechiae?

    <p>Recurrent pregnancy loss</p> Signup and view all the answers

    What is the 5-year survival rate for dysgerminomas, the most common malignant germ cell tumor?

    <p>90%</p> Signup and view all the answers

    Which type of tumor arises from primitive germ cells of the embryonic gonads?

    <p>Dysgerminoma</p> Signup and view all the answers

    What is the most common benign germ cell tumor of the ovary, also known as a dermoid cyst?

    <p>Cystic teratoma</p> Signup and view all the answers

    What percentage of endometrioid tumors are malignant, generally having a better prognosis than serous or mucinous carcinomas?

    <p>80%</p> Signup and view all the answers

    Which benign ovarian tumor may lead to Meig's syndrome by causing ascites and pleural effusion?

    <p>Fibroma</p> Signup and view all the answers

    Which tumor type is described as having irregular borders, loss of definition, and likely to present with pelvic pressure and abdominal pain when ruptured?

    <p>Mucinous tumors</p> Signup and view all the answers

    What type of neoplasm is classified under sex cord-stromal tumors?

    <p>Granulosa tumor</p> Signup and view all the answers

    In which type of tumor would you expect to see areas of hemorrhage and necrosis present?

    <p>Dysgerminoma</p> Signup and view all the answers

    What is the sonographic appearance of a benign cystic teratoma?

    <p>Highly echogenic with 'tip of the iceberg' sign</p> Signup and view all the answers

    Study Notes

    Uterus Anatomy and Layers

    • The uterus has three layers: endometrium, myometrium, and serosa.
    • Anatomic parts include the fundus, body (corpus), isthmus, and cervix.

    Uterine and Ovarian Arterial Vascularity

    • Uterine arteries supply the perimetrium/serosa, arcuate arteries supply the myometrium, radial arteries supply the myometrium.
    • Basal arteries supply the basal layer, spiral arteries supply the functional layer of the endometrium.
    • Ovarian arteries (gonadal arteries) are lateral branches of the aorta, anastomosing with uterine arteries.
    • Flow velocity and resistance in arcuate and radial arteries vary through the menstrual cycle and with age (e.g., high resistance in proliferative phase, postmenopausal women).

    Venous Drainage

    • Right gonadal vein drains into the inferior vena cava (IVC)
    • Left gonadal vein drains into the left renal vein.

    FSH and LH Roles in Menstrual Cycle

    • FSH: Stimulates follicle growth and development. Theca cells produce estrogen, stimulating endometrial growth. Only one follicle typically matures (Graafian follicle).
    • LH: Triggers follicle maturation and rupture (ovulation). Stimulates progesterone production which peaks after ovulation. LH surge (days 10 to 12 before ovulation) triggers ovulation. Progesterone maintenance triggers shedding if fertilization does not occur. hCG signals corpus luteum to continue progesterone production if fertilization occurs.

    Ovarian Phases

    • Follicular Phase (days 1-14): FSH stimulates follicle expansion and movement to the ovary's surface. Follicles grow (2-3 mm/day). A follicle over 11 mm likely ovulates (max 15-30 mm). Decreased reflectivity around a follicle suggests impending ovulation (within 24 hours). Presence of cumulus oophorus suggests ovulation within 36 hours.
    • Ovulation (day 14): LH surge causes follicle rupture. Findings post-ovulation include decreased follicle size, free fluid in posterior cul-de-sac; mittelschmerz (mid-cycle pain) may be present.
    • Luteal Phase (days 15-28): Expelled ovum site becomes corpus luteum. Produces progesterone for endometrial maintenance for implantation. In the absence of hCG, corpus luteum regresses. Corpus albicans will appear as small, rounded, hyperechoic areas.

    Pelvic Ligaments

    • Broad ligament extends from uterus to lateral pelvic wall.
    • Round ligament is anterior and inferior, connecting uterine cornua to anterior pelvic wall.
    • Infundibulopelvic ligament connects lateral ovary to posterolateral pelvic wall. Contains ovarian vessels and nerves.

    Ovary Anatomy

    • Almond-shaped, approximately 3 cm long (premenopausal), 2 x 0.5 cm (postmenopausal).
    • Posterior to uterus near cornua.
    • Medial to external iliac vessels, anterior to internal iliac vessels and ureter.
    • Supported by ovarian ligaments and suspensory (infundibulopelvic) ligament.
    • Layers: outer cortex, inner medulla (blood vessels, connective tissue), hilum (vessels, nerves).

    Corpus Luteum

    • A yellowish fatty substance replacing ruptured follicle; filled with fluid; thick-walled; anechoic cyst appearance.
    • Regresses to Corpus albicans if not maintained by hCG. Corpus albicans appears as small rounded hyperechoic areas.

    Pelvic Muscles

    • Pelvic muscles appear as hyperechoic striations, forming pelvic space borders.
    • Rectus abdominis (anterior wall), iliopsoas (can mimic ovary), iliacus (lateral margins), obturator internus (triangular), levator ani (anterior/middle pelvic floor).

    Pelvic Bones

    • Sacrum, coccyx, ilium, ischium, pubis compose the pelvis.

    Endometrium Changes (Contraceptives/Post-Menopause)

    • Oral Contraceptives: Anovulatory endometrium, thin and echogenic throughout the menstrual cycle.
    • Post-Menopause: < 5mm (no HRT), ≤ 8mm (with HRT). Endometrium appearance similar to premenopausal with HRT, thickening may occur.

    IUD Sonographic Appearance

    • Highly reflective and echogenic with reverberation and shadow casting.

    Amenorrhea

    • Primary: Delayed menarche (before 16 yrs in some sources) due to congenital factors or ovarian dysfunction. Secondary: Cessation of prior menstruation due to infection, trauma, ovarian dysfunction, or endocrine disturbances such as pituitary disease.

    Pelvic Spaces

    • Posterior cul-de-sac (Rectouterine space/Pouch of Douglas): Deepest space, posterior to uterus, anterior to rectum. Fluid normal, especially with menstruation or post-ovulation.
    • Anterior cul-de-sac (Utero-vesicle pouch): Between posterior bladder and anterior uterus.
    • Space of Retzius: Between pubic symphysis and anterior bladder.

    Other Terms

    • Menorrhagia: Heavy or prolonged periods at usual times.
    • Metrorrhagia: Bleeding between periods.
    • Menometrorrhagia: Heavy bleeding at irregular intervals.
    • Oligomenorrhea: Abnormally short or light periods (associated with PCOS, stress, chronic illness).
    • Polymenorrhea: Frequent periods
    • Dysmenorrhea: Painful periods (associated with endometriosis).
    • Multiparous: Having given birth more than once.
    • Nulliparous: Having given birth to no children.
    • Nulligravida: Never pregnant.
    • Gravidity: Number of pregnancies.
    • Parity: Number of live births.

    Ultrasound Techniques

    • Transabdominal: Full bladder used for wider field of view, lower resolution.
    • Transvaginal: Empty bladder, higher resolution, narrow field of view.
    • Contraindications TV: Pregnant patients with premature rupture of membranes, vaginal conditions, patient consent, pediatric patients.

    Pelvic Ultrasound Indications

    • Pelvic pain, masses, endocrine abnormalities (PCOS), amenorrhea, abnormal bleeding, infertility, infections, congenital anomalies, etc.

    Infertility Drugs

    • Clomiphene Citrate (Clomid, Serophene): Tablets to induce ovulation, used for infrequent or long cycles.
    • Gonadotropins (Repronex, Follistim, Pergonal, Bravelle, Fertinex, Metrodin, Gonal-F): Injections to induce egg release after follicle development.
    • Metformin (Glucophage): Insulin-lowering medication, commonly used for PCOS.
    • hCG (Pregnyl, Novarel, Ovidrel, Profasi): Triggers ovulation with other drugs.
    • Parlodel and Dostinex: Reduce prolactin levels, used for pituitary tumors.

    Infertility Procedures

    • IVF (In-vitro fertilization): Ovarian stimulation, oocyte aspiration, sperm incubation, embryo catheterization in uterus.
    • ZIFT (Zygote Intrafallopian Tube Transfer): Zygote placed in fallopian tube.
    • GIFT (Gamete Intrafallopian Tube Transfer): Sperm and ova placed in fallopian tube.
    • IUI (Intrauterine Insemination): Ultrasound guidance for sperm placement in uterine fundus (useful for motility issues).

    Ovarian Hyperstimulation Syndrome (OHSS)

    • Excessive ovarian stimulation (infertility drugs), often more severe in conceivers.
    • Findings: large ovarian cysts (> 5 cm), bilateral, may resemble theca lutein cysts; ascites, pleural effusion, potential for fatal complications.

    Pediatric Pelvic Ultrasound

    • Infant: Cervix twice body length; echogenic endometrium; ~3 cm length, 0.5-1 cm AP diameter; ovaries in various locations.
    • Childhood: Uterus regresses; endometrial stripe not easily outlined (until ~7 years). Follicular development occurs before menarche.

    Pediatric Ultrasound Indications

    • Ovarian cysts, PCOS, neoplasms, congenital anomalies, ambiguous genitalia, precocious puberty assessment.

    Precocious Puberty

    • Sexual characteristics before age 8 (true vs. pseudo puberty).
    • True: Early but normal gonadotropin secretion, idiopathic (most common), congenital adrenal hyperplasia possible cause.
    • Pseudo: Abnormal estrogen exposure, often a hormone-producing tumor.

    Hormone/Fluid Terminology

    • Hemato: Blood
    • Pyo: Pus
    • Hydro: Water
    • Metro: Uterus
    • Colpos: Vagina; e.g., hydrometrocolpos (fluid in uterus and vagina).

    Hydrocolpos

    • Fluid (blood/pus) collection in vagina, may involve cervix and uterus, usually imperforate hymen in children.
    • Findings: hypoechoic, distended endometrial cavity/vagina; posterior acoustic enhancement; echoes may be present (severe obstruction); assess for genitourinary anomalies.

    Post-Menopausal Pelvis

    • Uterus decreases in size (rapidly first 5 years, gradually). Cervix may be larger than body later in life. Myometrium can have calcifications. Fluid in endometrial cavity is normal. Endometrial stripe < 8mm (asymptomatic).

    HRT and Endometrial Thickness

    • Normal endometrial values in HRT users are still being established.
    • Imaging during estrogen phase is preferable.
    • Endometrium ≤ 8 mm with estrogen-only HRT.
    • Endometrium ≤ 12 mm during estrogen phase, decreasing during progesterone phase.

    Post-Menopausal Bleeding Causes

    • Exogenous estrogen (HRT), endometrial atrophy (common without HRT), endometrial carcinoma (common GYN cancer), cervical carcinoma, estrogen-producing ovarian tumor.

    Tamoxifen

    • Non-steroidal antiestrogen for breast cancer; can cause endometrial changes and increase risk of endometrial cancer.
    • Ultrasound helpful for evaluating vaginal bleeding in Tamoxifen users; look for subendometrial cysts, cystic areas, endometrial hyperplasia, increased tissue growth.

    Uterine Artery Doppler

    • Low sensitivity and specificity for distinguishing benign/malignant endometrial thickening; not routinely used as a primary diagnostic tool.

    Post-Menopausal Ovaries

    • Difficult to visualize due to lack of follicles, small size.
    • Use both transabdominal and transvaginal. Transabdominal for visualization of the high pelvis or hysterectomy patients. Applying pressure with the hand to help visualize.
    • Avoid misinterpreting other structures as ovaries.

    CA-125

    • Serum marker for ovarian cancer, elevated in ~80% of epithelial ovarian cancers.

    Endometrial Atrophy (Post-Menopausal Bleeding)

    • Atrophied endometrium can be friable and bleed easily. Thin endometrium (< 4 mm) may reduce the need for biopsy.

    Nabothian Cysts

    • Common in postmenopausal cervix; likely secondary to prior infection; avoid confusing with adnexal disease.

    Uterine Calcifications (Post-Menopause)

    • Degenerated fibroids, arcuate artery calcification.

    First Trimester Pelvic Ultrasound

    • Fetus development, growth, & well-being.
    • Fetal growth, position, gestational age estimation.
    • Vaginal bleeding, suspected multiple pregnancies, hydatidiform mole, ectopic pregnancy, IUD evaluation.

    First Trimester Lab Values

    • Obtain LMP, GPA details, medications, clinical problems, previous pregnancy issues, and hCG levels.

    Early Pregnancy Terminology

    • Conceptual age: From conception.
    • Gestational age: From first day of last menstrual period (LMP).
    • Qualitative hCG: Detects presence (urine test).
    • Quantitative hCG: Provides specific hCG blood levels.
    • Gametes: Reproductive cells (sperm and egg).
    • Zygote: Fertilized cell.
    • Morula: Dividing cells in oviduct, entering uterus.
    • Blastomere: Cells in 2/4 cell stages.
    • Blastocyst: Collection of cells implanting in endometrium.
    • Blastocele: Inner fluid cavity.
    • Trophoblast: Outer layer, producing hCG.
    • Inner cell mass: Differentiates to layers (endoderm, mesoderm, ectoderm).
    • Decidua (basalis, capsularis, parietalis): Endometrial tissues related to implantation.

    hCG Levels and Abnormal Findings

    • Higher than expected: Incorrect dates, gestational trophoblastic disease, multiple gestations.
    • Lower than expected: Incorrect dates, ectopic pregnancy, embryonic problems.

    First Sonographic Evidence of Pregnancy

    • Gestational sac. Seen transvaginally at hCG > 1000-2000 mIU (3rd IRP), transabdominally at 5+ weeks.

    Gestational Sac Appearance

    • Round, oval, or teardrop-shaped. Located mid- or near fundus. Double decidual sign. Intact borders. ~1 mm/day growth. Yolk sac seen when MSD ≥ 8 mm (TV).

    Mean Sac Diameter (MSD)

    • Measured from inner to inner in 3 planes and averaged. Calculated with formula: MSD = Length * Width * Height / 3.
    • MSD + 30 = gestational age in days.

    Yolk Sac Abnormalities

    • Calcified yolk sac, large yolk sac or absent yolk sac indicates possible embryonic demise.

    Embryo Visualization

    • Seen transvaginally at 16 mm MSD or transabdominally at 25 mm MSD.

    Crown-Rump Length (CRL)

    • Most accurate dating method (first trimester), measured from head to rump excluding limbs. Accurate to about 3-5 days, inaccurate after 11 weeks.
    • CRL (mm) + 42 ≈ Gestational age in days

    Cardiac Activity Visualization

    • Primordial heart begins beating around 6 weeks.
    • Should be seen by 46 days or CRL > 4 mm (rates vary).

    Fetal Brain Anatomy

    • Visualizable at 9 weeks; cerebral hemispheres, choroid plexus filling ventricles.

    Types of Twins

    • Monozygotic (MZ): One ovum divides (identical).
      • Monochorionic-diamniotic (MCDA): One chorion, two amnions; common.
      • Monochorionic-monoamniotic (CMMA): Extremely high risk of problems; one chorion, one amniotic membrane.
    • Dizygotic (DZ): Two ova (fraternal); two separate sacs.

    Omphalocele

    • Protruding midgut that usually returns to abdominal cavity by week 12.

    First Trimester Abnormalities

    • Threatened abortion: Bleeding, cramping, closed cervix.
    • Missed abortion: Embryo without cardiac activity; closed cervix.
    • Incomplete abortion: Some products retained after expulsion. Complete abortion: All products expelled.
    • Anembryonic pregnancy: No embryo develops; gestation sac may enlarge slightly.
    • Septate uterus, bicornuate uterus, didelphys uterus, uterine AVM

    Ectopic Pregnancy

    • Implantation outside the uterus; most common in fallopian tubes.
    • Clinical signs: Amenorrhea, positive pregnancy test, spotting/bleeding, adnexal tenderness/mass, pelvic pain, shoulder pain.
    • Sonographic findings (grayscale & vascular): Empty uterus; extrauterine embryo, free fluid (possible), double decidual sign.
    • Treatment: Laparoscopic surgery, expectant management, methotrexate.

    Gestational Trophoblastic Disease (GTD)

    • Abnormal proliferation of trophoblast tissue.
    • Complete hydatidiform mole: Most common GTD type; hydropic villi, no fetal tissue. Enlarged, echogenic mass in uterus.
    • Partial hydatidiform mole: Mostly 1 maternal / 2 paternal chromosome sets; abnormal fetal tissue.
    • Treatment: Suction curettage (D&C), hysterectomy.

    Invasive mole and choriocarcinoma

    • Invasive mole (chorioadenoma destruens): Mole penetrates myometrium; malignant, but not metastatic.
    • Choriocarcinoma: Rare, infiltrates myometrium, highly vascular; malignant, metastatic.

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    Test your knowledge on the menstrual cycle and its phases. This quiz covers key concepts such as the layers of the uterus, hormone functions, and blood flow changes during the cycle. Perfect for students of anatomy and physiology.

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