Menstrual Cycle Quiz

The uterus is composed of three layers: endometrium (inner lining), myometrium (muscle layer), and serosa (outer layer).

The uterus has distinct parts: fundus (top), body/corpus (main part), isthmus (narrowing), and cervix (lower part).

Uterine arteries supply blood to the uterus, branching into arcuate, radial, and basal arteries, with spiral arteries supplying the endometrium.

Ovarian arteries (branches of aorta) supply blood to the ovaries, anastomosing with uterine arteries.

Follicle-stimulating hormone (FSH) stimulates ovarian follicle growth and estrogen production.

Luteinizing hormone (LH) triggers ovulation and progesterone production.

The follicular phase of the menstrual cycle (days 1-14) is characterized by follicle development and rising estrogen levels.

hCG (Human Chorionic Gonadotropin) signals the corpus luteum to maintain progesterone levels if fertilization occurs, preventing the shedding of the uterine lining.

Follicles typically grow 2-3 millimeters per day.

A follicle greater than 11mm in diameter is likely to ovulate.

A decreased reflectivity line around the follicle suggests ovulation within 24 hours.

The presence of a Cumulus oophorus (nodule) suggests ovulation within 36 hours.

Ovulation typically occurs on day 14 of the menstrual cycle.

The corpus luteum manufactures and secretes progesterone to maintain the endometrium for implantation.

In the absence of HCG, the corpus luteum regresses and becomes a corpus albicans.

During menstruation, the endometrium is thin, slightly irregular, and measures around 2mm in thickness.

The hypoechoic area prior to ovulation and thickening up to 10 mm (isoechoic) during later proliferative phase.

The endometrium is thickest (7-14mm) and echogenic during the secretory phase.

Measure the endometrium's anterior-posterior (AP) thickness on a sagittal image, excluding fluid.

A thick-walled, anechoic cyst.

Mittelschmerz (unilateral pelvic pain) is often associated with ovulation.

Oral contraceptives repress the normal endocrine response, resulting in a thin, echogenic endometrium.

Without HRT, post-menopausal endometrium is typically <5mm; but with HRT, it could be up to 8mm.

Heavy or prolonged menstrual bleeding at usual time.

Bleeding between menstrual periods.

Combination of heavy bleeding and irregular periods.

Abnormally short or light menstrual periods.

Menstrual periods that occur too frequently.

Painful menstrual periods.

Having given birth to more than one child.

Having never given birth.

Deepest pelvic space, between uterus and rectum.

Pelvic space between bladder and uterus.

Delayed onset of menstruation beyond 16 or 18.

Cessation of menstruation in women who had previously menstruated.

Kidney swelling due to urine backup.

Anterior (bladder, reproductive organs) and posterior (rectum, colon).

Fertilization occurs in the ampulla of the fallopian tube.

Cleaning and preparing the ultrasound probe before use by disinfecting it, using a probe cover, and adding gel to ensure proper contact and image quality.

The process of taking off the probe cover and cleaning the probe immediately with detergent, water, and drying, ensuring thorough disinfection.

In endo vaginal scans, the two scanning planes are Sagittal and Coronal. Sagittal shows inferior/superior and anterior/posterior views. Coronal shows inferior/superior and right/left views.

Reasons for ordering a pelvic ultrasound include: Evaluating pelvic pain, masses, endocrine abnormalities, abnormal bleeding, infertility, infections, and more.

Oral contraceptives are divided into two types: Combined estrogen-progesterone (COC) pills and progesterone-only pills.

Oral contraceptives prevent pregnancy by inhibiting ovulation, the release of an egg.

IUDs (Intrauterine Devices) appear highly echogenic and reflective on ultrasound, often causing reverberation and casting a shadow.

IUDs prevent pregnancy by being placed in the uterine cavity and physically preventing the implantation of a fertilized egg. Properly placed IUDs require regular checks by the patient.

Types of IUDs include: Lippes Loop (obsolete due to infection risk), Dalkin Shield (removed from the market due to infection), Copper IUD (ParaGard - T-shaped, highly echogenic), and hormonal IUDs (Progestasert and Mirena).

Hormonal IUDs (Progestasert and Mirena) contain progesterone and can be used for contraception, endometrial hyperplasia, hormone replacement, and abnormal bleeding.

Mirena can alter the ovarian cycle by causing delayed atresia (follicle degeneration) and potentially leading to enlarged follicles.

Referral for ultrasound with an IUD may be due to: missing threads, abnormal flow, pain, signs of infection, amenorrhea, or concern for pregnancy.

Possible complications with IUD include: penetration/embedment, expulsion, abnormal position, fragmentation, pelvic infection, and pregnancy (intrauterine or ectopic).

Infertility can be caused by both female and male factors. Female factors include: ovulation issues, tubal problems, endometriosis, uterine abnormalities, PCOS, and cervical factors. Male factors include sperm quantity and quality issues.

Ultrasound helps diagnose and manage infertility by evaluating uterine anatomy, endocrine factors, endometrial thickness/texture, presence of lesions, monitoring follicle growth, confirming ovarian response to drugs, and guidance for oocyte retrieval.

Drugs used to induce ovulation include: Clomiphene Citrate (Clomid) for infrequent periods and Gonadotropins for mature follicle development before egg release. Glucophage (Metformin) can improve ovulation in PCOS patients.

hCG, alongside other medications, is used to stimulate ovulation, essentially giving the ovaries a nudge to release an egg.

These drugs help decrease prolactin levels and shrink pituitary tumors, which can sometimes interfere with fertility.

IVF involves stimulating the ovaries, collecting eggs, fertilizing them in a lab, and placing 2-4 embryos back in the uterus.

In ZIFT, the embryo or zygote is placed directly into the fallopian tube, not the uterus.

In GIFT, sperm and eggs are directly placed into the fallopian tube, allowing fertilization to happen naturally.

IUI involves using a catheter to deposit sperm into the uterine fundus, assisting sperm mobility.

OHSS occurs when ovaries are overstimulated, often due to fertility drugs, causing fluid buildup and potential complications.

OHSS appears as large, bilateral ovarian cysts (over 5 cm), resembling theca lutein cysts, often with ascites and pleural effusion.

The infant uterus has a disproportionately long cervix compared to the body, and a bright echogenic endometrium due to hormonal influence.

After infancy, the uterus regresses, and the endometrium is less noticeable until puberty, with occasional small cysts in the ovaries.

Pediatric pelvic ultrasound is used to investigate various conditions like ovarian cysts, polycystic ovarian disease, neoplasms, uterine anomalies, and precocious puberty.

Precocious puberty is the development of sexual characteristics before the age of 8, often due to early or abnormal hormone production.

True precocious puberty involves a normal hormonal pattern from the pituitary but happens early, sometimes due to hypothalamic issues.

Pseudopuberty is caused by abnormal estrogen exposure, leading to secondary sexual characteristics without true gametogenesis.

These prefixes refer to blood, pus, water, uterus, and vagina respectively, used to describe various conditions.

Hydrocolpos is a fluid collection, often blood or pus, within the vagina, sometimes extending to the cervix and uterus.

Hydrocolpos appears as a distended, hypoechoic endometrial cavity and/or vagina with posterior enhancement, sometimes with internal echoes.

Post-menopausal pelvic ultrasound reveals a smaller uterus (especially in the first 5 years), a larger cervix, and possibly myometrial calcifications.

Any bleeding from the genital tract of a woman that occurs for more than 12 months after the last menstrual cycle.

The most common cause of post-menopausal bleeding without HRT, characterized by a thin endometrium.

One of the most common gynecological cancers, it can present with abnormal bleeding after menopause.

A non-steroidal anti-estrogen medication used for some breast cancers.

This medication can cause changes in the endometrium and increase the risk of endometrial cancer.

Doppler assessment in the uterus can help distinguish between benign and malignant causes of endometrial thickening, but it's not highly accurate.

Often difficult to visualize due to their small size and lack of follicles.

A serum marker for ovarian cancer, elevated in over 80% of epithelial ovarian cancers.

Thin endometrium becomes fragile and easily damaged, leading to bleeding.

Commonly seen in the cervix of postmenopausal women, they are thought to be remnants of past infections.

Can be caused by degenerated fibroids and calcification of uterine arteries, especially in postmenopausal women.

Used together to visualize the ovaries, with transabdominal for higher pelvic views and transvaginal for better detail.

Dilated, cystic structure in the fallopian tube, often asymptomatic in postmenopausal women, related to previous infections or procedures.

Large amounts often indicate various pelvic diseases including malignant tumors.

Used to confirm pregnancy, assess fetal growth, check for abnormalities, and rule out ectopic pregnancy.

The time elapsed since the first day of the woman's last menstrual period (LMP), commonly used by sonographers and physicians. It includes an additional 2 weeks to account for the time between ovulation and conception.

The time elapsed since the fertilization of the egg, used by embryologists. It is calculated from the date of conception.

The amount of hCG in the blood should double every 48 hours in early pregnancy. This rapid increase is a key indication of a healthy pregnancy.

The level of hCG plateaus around 9 weeks of gestation, meaning it stops increasing rapidly. This is a normal part of pregnancy progression.

hCG is produced by the trophoblastic tissues, which will eventually become part of the placenta.

A simple pregnancy test that only detects the presence or absence of hCG in urine.

A blood test that measures the specific level of hCG in the bloodstream.

An hCG level of 1800 mIU/mL or higher is typically needed to visualize the gestational sac using endovaginal ultrasound.

A collection of organized cells that implants into the endometrium 7 days after fertilization. It contains the inner cell mass and the trophoblast layer.

The outer layer of the blastocyst. It produces hCG, which helps maintain the pregnancy by promoting the corpus luteum.

The earliest intra-gestational sac anatomy visible on ultrasound. It is a small, round structure within the gestational sac.

The maternal contribution to the placenta, formed from the endometrium where the blastocyst implants.

Fetal tissue that develops from the trophoblast and forms the basis of the placenta.

The placenta is formed from both maternal and fetal tissues. The maternal component comes from the decidua basalis, and the fetal component comes from the chorionic villi.

One chorionic sac, two amnions, two yolk sacs, and two embryos. This occurs when the fertilized egg splits early in development.

One shared chorionic sac and one amniotic membrane, with one or two yolk sacs and two embryos. This occurs when the fertilized egg splits later in development.

Two separate fertilized eggs (from two different ova) resulting in two distinct chorionic sacs and amnions, with thick septation between them. This is the most common type of twin gestation.

A substance that can cause abnormal structure in an embryo during its development. This includes environmental factors, physical agents, and chemical agents.

Certain structures in an embryo are more sensitive to specific teratogenic agents at specific times of development. A noxious event won't affect a structure if it occurs after its development is complete.

These include radiation, heat (hyperthermia), and mechanical factors.

These are substances like alcohol, antithyroid drugs, Coumadin, and Daunorubicin, which can cause various developmental malformations.

Maternal conditions like diabetes, sickle cell anemia, and exposure to teratogenic agents can affect the fetus.

A normal set of chromosomes, with 23 pairs in total.

An unbalanced set of chromosomes, with too many or too few chromosomes.

The presence of an extra chromosome in a pair.

The presence of an extra set of chromosomes (3n) instead of the usual two (2n).

The genetic makeup of an individual, representing the specific genes they possess.

The physical and physiological characteristics of an individual, resulting from the expression of their genes.

The yolk sac should be seen transvaginally when the gestational sac (MSD) measures 12 mm and transabdominally when the MSD is 10-15 mm. It should always be seen when MSD is 20 mm.

The yolk sac provides nutrients to the developing embryo, participates in hematopoiesis (blood cell formation), and contributes to the development of the embryonic endoderm, which forms the primitive gut.

The yolk sac is attached to the embryonic digestive system via a primitive digestive tube called the vitelline duct, also known as the omphalomesenteric duct or yolk stalk.

By the end of the third week, the chorion differentiates into the chorion frondosum (fetal contribution to the placenta) and the chorion leave (surrounds the gestational sac).

The amnion forms from the inner cell mass and expands to fill the chorionic cavity. It fuses with the chorion by the middle of the first trimester.

This sign is characterized by two echogenic lines surrounding the gestational sac. The outer line represents the decidua capsularis, and the inner line represents the decidua parietalis.

Trophoblastic tissue, responsible for supplying nutrients and oxygen to the embryo, exhibits high velocity, low resistance flow on Doppler spectrum.

A gestational sac (GS) should be seen with a normal intrauterine pregnancy when beta-hCG levels exceed 1000-2000 mIu/mL.

The GS is round, oval, or teardrop-shaped, located centrally or toward the uterine fundus, with echogenic and intact borders. It grows approximately 1 mm per day.

MSD is calculated by measuring the gestational sac in three planes and averaging the measurements. MSD (mm) + 30 = gestational age in days.

A calcified yolk sac is associated with embryonic demise, while an abnormally large yolk sac can indicate chromosomal abnormalities or other issues.

CRL is the most accurate method of dating a pregnancy sonographically, measured from the top of the head to the bottom of the rump, excluding the legs. CRL (mm) + 42 = gestational age in days.

Cardiac activity should always be seen by 46 days or when CRL exceeds 4 mm. The normal heart rate varies with age: 90 bpm at 6 weeks, and 140-160 bpm for the rest of pregnancy.

A group of conditions where trophoblastic tissue (placental cells) grows abnormally. It's caused by problems with the paternal genetic material.

The most common type of GTD where the chorionic villi are full of fluid, resembling a bunch of grapes, and no fetal tissue is present. It's associated with ovarian theca lutein cysts.

A less common GTD with some abnormal fetal tissue present alongside the hydropic chorionic villi. It usually involves an extra set of paternal chromosomes.

An aggressive form of GTD where the mole invades the uterine muscle and surrounding tissues. It's considered malignant but doesn't usually spread to other organs.

The most aggressive type of GTD, it can spread to other organs such as the lungs, liver, and brain. It's very rare but can arise from a molar pregnancy.

Ovarian cysts that form due to high levels of hCG, often associated with GTD and multiple pregnancies. They're usually harmless but can cause pain.

A medication used to treat GTD by stopping cell growth.

A minimally invasive surgery where a small camera and surgical tools are inserted through small incisions in the abdomen. It's used to remove GTD and perform other procedures.

A major surgery where the surgeon opens the abdomen to access the uterus and surrounding areas. It's used when more extensive procedures are necessary for GTD.

Waiting and monitoring the GTD without immediate treatment. This only applies when the woman is stable and the GTD is not aggressive.

Ultrasound images of GTD typically show an enlarged uterus, a mass of echogenic material (bright white), and low resistance flow. In hydatiform moles, the mass may appear cystic.

Treatment options for GTD include suction curettage, hysterectomy, and chemotherapy. Methotrexate is used to stop cell growth. Follow-up hCG levels are essential.

GTD can sometimes recur even after treatment. The risk of recurrence is higher with complete moles and persistent disease.

Women with GTD should avoid pregnancy for at least 6-12 months after treatment to ensure complete resolution of the abnormal tissue.

Excess fluid accumulation in the pleural cavity (chest cavity).

A benign ovarian tumor, most common in postmenopausal women. Produces estrogen.

A feminizing ovarian tumor composed of cells resembling the graafian follicle.

A rare ovarian tumor that produces androgens (testosterone).

Ovarian tumors arising from the spread of cancer from other parts of the body.

A bilateral ovarian tumor, typically solid, arising from metastasis from the gastrointestinal tract.

A cyst that arises from the broad ligament, separate from the ovary.

Benign ovarian cysts that occur during the menstrual cycle.

A hormonal disorder characterized by multiple cysts on the ovaries.

Two or more of the following clinical signs indicate an inevitable abortion: moderate cervical effacement, cervical dilation >3mm, bleeding for 7+ days, persistent cramping, and rupture of membranes.