Edelman Cards OB 1
What are the bones of the pelvic skeleton?
What is the innominate bone made of?
How is the true and false pelvis divided?
sacral promontory to the pubis symphysis
What are the ligaments of the uterus and ovaries
What ligaments maintain the uterine forward position?
When can the pelvic ligaments be seen on ultrasound?
only in the presence of ascites
What muscles are sonographically visible?
obturator internus muscle
levator ani muscle
levator ani muscle
obturator internus muscle
When is the bladder full enough for a transabdominal exam?
when the domw of the bladder extends above the uterine fundus
Why should the bladder be empty for a transvag exam?
to place the organs closer to the probe
What is the names given to the gutters between the vagina and cervix?
Which fornix is the most likely to contain gravity dependent fluid, while the patient is supine?
What are the parts of the uterus from inferior to superior?
What is the name of the two openings of the cervix?
What are the layers of the uterus?
What are the layers of the endometrium?
How should the endometrium be measured?
anterior to posterior
How should the endometrium be measured with fluid within?
two sides then added
What are the uterine positions?
antiflexed (toward bladder)
retroflexed (toward rectum)
What is the most common uterine position?
Where are the follicles produced within the uterus?
What is the ovarian volume and measurement of premenopausal patient?
3.5 x 2.0 x 1.5 cm
What is the ovarian volume and measurement of menopausal patient?
2.0 x 1.0 x 0.5 cm
What are the parts of the fallopian tubes from proximal to distal?
Where is the space of retzius?
between the pubic bone and anterior uterine wall
what are other names for the space of retzius?
Where is the vesicouterine space?
Where is the rectouterine space?
What is another name for the rectouterine space?
Pouch of Douglas
What is the significance of complex fluid within the pelvic recesses?
can be associated with hemorrhage or infection
What arteries feed the uterus?
uterine arteries branch from the internal iliacs
What arteries feed the ovaries?
ovarian artery branched from the aorta (gonadal)
What veins drain the ovaries?
right ovarian drains into IVC
left ovarian drains into the left renal vein
Why are dilated veins near the uterus significant?
may be associated with the pelvic congestion syndrome?
What is GnRH?
gonadotropic releasing hormone secreted by the hypothalamus
when serum estadiol levels fall
stimulates FSH and LH from anterior pituitary
What is FSH?
Follicle Stimulating Hormone secreted by the anterior pituitary gland
stimulates growth and development of ovarian folicles
What is LH?
Lutenizing hormone secreted by the anterior pituitary gland
stimulates maturation of ovarian follicles and is responsible for graafian follicle rupture causing ovulation
What is the role of estrogen?
estrogen is secreted by the ovarian follicles and corpus luteum
Creates proliferative endometrium
What is the role of proestrogen?
secreted by the corpus luteum and placenta during pregnancy
Maintains secretory endometrium
What are the ovaian phases?
follicular phase: 1 - 14 days
luteal phase: 15 - 28 days
What is a graffian follicle?
the dominant follicle that ruptures during ovulation
How big can the graafian follicle get?
15 - 30 mm
- proliferative = 4 - 8 mm (4 - 14 days)
- early proliferative = hypoechoic
- later proliferative = tri layered
- secretory = 8 - 16 mm (hyperechoic) (14 - 26 days)
What is the spectral Doppler patterns of the uterine arteries?
*uterine and radial higher velocity and resistance in proliferative phase
What is the spectral Doppler patterns of the ovarian arteries?
What is the spectral Doppler patterns of the ovarian arteries after ovulation?
impedance drops on the side with dominant follicle resulting in low resistance
What is the sonographic appearance of an IUD?
What is IVF?
in vitro fertilization
- ovarian stimulation
- needle aspiration
- catheter delivery into uterus
What is IVF with ZIFT?
zygote interfallopian tube transfer
What is IVF with Gift?
gamete intrafallopian tube transfer
sperm and egg placed in fallopian tube for fertilize
What is IUI?
sperm placed in fundus
What is OHSS?
ovarian hyperstimulation syndrome
excessive stimulation of ovaries with fertility druge
What is the sonographic appearance of OHSS?
bilateral large simple cysts > 5 cm
What is the sonographic appearance of the normal pediatric uterus?
2.5 - 3 cm length
cervix = 1/2
body = 1/2
What is precocious puberty?
onset of secondary sex characteristics before the age of 9
* can be caused by hypothalmic tumor
What is hematocolpus in adolescence generally secondary to ?
What is hematocolpus?
vagina fills with menstrual blood
What is hematometrocolpus?
expanded fluid filled vaginal cavity and uterus
What is the most common cause of post-menopausal bleeding in women not receiving HRT?
other causes ?
estrogen producing tumor of ovary
What is tamoxifen?
nonsteroidal antiestrogen used as a chemotherapeutic agent
patients with breast cancer
What is the sonographic appearance of patients taking tamoxifen?
subendometrial cysts (between endo & myo)
What are the mullerian duct abnormalities?
What is the most common mullerian duct anomaly?
What should the sonographer also look for when mullerian anomolies are found?
What is the most common tumor of the female pelvis?
What are the different types of fibroids?
submucous (most symptomatic)
What are all the different names for fibroids?
What are the clinical symptoms of fibroids?
alterations in menstrual flow
What is the sonographic appearance of fibroids?
lobulated uterine contour
whorled internal architecture
displacement of endometrial echoes
hypoechoic adnexal mass
What is adenomyosis?
invasion of endometrial glands and stroma into myometrium
What is the sonographic appearance of adenomyosis?
diffuse or focal
Venetian blind type shadowing
What is the most common GYN malignancy?
What are the risk factors of endometrial cancer?
HRT - menopausal
atypical hyperplasia of endometrium
What are the clinical signs of endometrial cancer?
pain from uterine distension
What is the sonographic appearance of endometrial cancer?
thickening > 4-5 mm
fluid in endometrium cavity
What is a nabothian cyst?
mucus retention cysts in the cervix
due to obstructed and dilated endocervical glands
What is a Gartner's duct cyst?
failure of disaperance of wolffian (mesonephric) ducts
What is a paraovarian cyst?
arise from the persistance of the cephalad portion of wolffian duct
appear as cyst next to ovary
What may be encountered while scanning a patient whose mother took DES?
What is endometrium hyperplasia?
proliferation of endometrial glandular tissue
What are the causes of endometrium hyperplasia?
estrogen producing tumors
What is the clinical signs in patients with endometrium hyperplasia?
What is the sonographic protocol for endometrium hyperplasia?
performed immediately following menses
What is an endometrial polyp?
localized overgrowth of endometrial tissue
What is the sonographic appearance of an endometrial polyp?
may be echogenic mass
hard to see without sonohistogram
What is the clinical presentation of endometrial polyp??
What is the most common cause of ovarian enlargement in young women?
What are the physiologic cysts?
What is a theca lutein cyst?
cysts originate when HCG is elevated to an abnormally high level,
*Typically associated with gestational trophoblastic conditions
What are follicular cysts caused by?
over stimulation of follicle that fails to rupture
What is the sonographic appearance of a follicular cyst?
exceeding 3 cm
What is the maximum measurement of a normal dominant follicle?
What is the sonographic appearance of a corpus luteum cyst?
thick hyperechoic irregular walls
What does a corpus luteal cyst secrete?
*small amount of estrogen
When does the corpus luteal cyst usually resolve?
What is the sonographic appearance of a theta luteal cyst?
biateral large multilocular ovarian cysts
What is the clinical presentation of a patient with a hemorrhagic ovarian cyst?
acute onset of pelvic pain
What is the sonographic appearance of a hemorrhagic ovarian cyst?
acute: hyperechoic (mimicking a solid mass but with posterior acoustic enhancement
What factors may predispose a patient to ovarian torsion?
What is the sonographic appearance of ovarian torsion?
absent color and spectral
# 42 ALARA
What is PCOS?
Polycystic ovarian syndrome
endocrinologic disorder of chronic anovulation
What is another name for PCOS?
What is the clinical presentation of PCOS?
What is the sonographic appearance of PCOS?
multiple small cysts (12 or more)
string of pearls
enlarged or normal size ovaries
What is the sonographic appearance of serous ovarian tumors?
possible internal thin-walled septations
multple papillary projections or sepations
echogenic material internally
What is the sonographic appearance of mucinous ovarian tumors?
thick numerous septations
fine gravity dependent echoes
multple papillary projections
echogenic material internally
What condition may occur with patients with mucinous ovarian tumors?
penetration of the tumor casule or rupture into peritoneal cavity
What is the most commonly encountered germ cell tumors of the ovary?
benign cyctic teratoma
What is the sonographic appearance of benign cyctic teratoma?
# 47 more
mostly cystic adnexal mass
complex mass with calcifications
tip of iceberg
which malignant germ cell tumor may be seen in younger women?
endodermal sinus tumor
What is a dysgerminomas?
homologous to testicular seminoma
What is an endodermal sinus tumor?
yolk sac tumor
w/ elevated AFP
What is Meigs syndrome?
fibrous ovarian tumor
What is the sonographic appearance of ovarian fibroma?
What hormones are secreted by Thecoma?
What hormones are secreted by granulosa cell tumor?
What hormones are secreted by androblastoma?
Ovarian metastases are most likely to arise from which primary malignancies?
What is a krukenberg tumor?
arise from GIT
What is CA 125?
biological tumor marker elevated in women with ovarian cancer
What is the most deadly GYN cancer?
What is PID?
pelvic inflammatory disease
usually sexually transmitted infection
What are the clinical symptoms of PID?
lower abdominal pain
purulent vaginal discharge
cervical motion tenderness
constant dull pain
What is dyspareunia?
pain with sexual activity
What are the stages of PID?
Stage 1: early PID - endometritis
Stage 2: acute/subacute salpingitis / pyosalpinx
Stage 3: severe - broad ligament and ovarian involvement
What is the sonographic appearance of stage 1 PID?
thickened irregular endometrium
fluid in post cul-de-sac
What is the sonographic appearance of stage 2 PID?
dilated tube with debris
What is the sonographic appearance of stage 3 PID?
TOA - complex adnexal mass
TOC - visible inflamed tube and ovary
What is the sonographic appearance of stage chronic PID?
uterus and ovaries central in pelvis
What is endometriosis?
presence of functional endometrial tissue outside of the endometrium and myometrium
diffuse or focal
What is a chocolate cyst?
discrete mass of endometriosis
What are the stages of endometriosis?
stage 1: minimal
stage 2: mild presence of adhesions
stage 3: moderate ovary involvement
stage 4: severe multiple adhesions
At what stage is endometriosis lore likely to show on U/S?
stage 3 with ovarian involvement
What are the clinical signs of endometriosis?
- 4 ds
dysmenorrhea - painful menses
dyspareunia - painful sex
dysuria - difficult urination
dyschezia - difficult defecation
What is the sonographic appearance of endometriosis?
well defined unilocular
posterior acoustic enhancement
What type of endometriosis is rarely detected with U/S?
What is autosomal dominant?
only takes one parent
What is autosomal recessive?
takes two parents