OB/GYN Board Exam - Ultrasound (Basics)

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What does the vagina measure?

7-10 cm

The thickness of the enometrium varies. It measures ---- immediately following menses and ---- just prior to the beginning of menses.

1mm
8mm

What is the premenopausal ovarian size and volume?

3.5 x 2.0 x 1.5
9.8 cm3

What is the postmenopausal ovarian size and volume?

2.0 x 1.0 x 0.5
5.8 cm3

What is the uterine size from 2-8 years old?

3.3 cm
0.75 AP

What is the uterine size from 9-menarche?

4.3 cm
1.3 AP

What is the uterine size for nullparous?

8.0 cm
3.0 AP

What is the uterine size for multiparous?

9.0 cm
4.0 AP

What is the uterine size for postmenopausal women?

Varies, based on parity

What do the fallopian tubes measure?

7-14 cm

The space of Retzius is also called?

Retropubic space
Prevesical space

The Vesicouterine Space is also called?

Anterior cul-de-sac

The Rectouterine space is also called?

Pouch of Douglas
Posterior cul-de-sac

The anterior trunk vessels give rise to which arteries? OII SUUV

O - obturator
I - inferior vesicle
I - inferior gluteal

S - superior vesicle
U - umbilical
U - uterine
V - vaginal

The ovarian arteries are also known as:

Gonadal Arteries

Dilated tortuous veins near the uterus and/or in the adnexa (varicose veins) are a significant finding and may be associated with what?

Pelvic Congestion Syndrome

Doppler Characteristics - What are the uterine arteries?

Moderate to high velocity
High resistance

The Uterine arteries have higher resistance in which phase?

Proliferative (postmeno)

Radial arteries have higher resistance in which phase?

Proliferative (postmeno)

Doppler characteristics - What are the ovarian arteries in follicular phase?

Low velocity
High Resistance

In the periovulatory period and luteal phase, impedance ---- dramatically on the side of the ------- -------.

Drops
Dominant follicle
(lower PI & RI)

In postmenopausal women, the resistive index approaches ----- with increasing age.

1.0

Menarche is the onset of menses and usually occurs between what age?

11 and 14

Menopause occurs between what age?

44 and 55

Premature menopause occurs prior to what age?

40

When will the dominant follicle usually be identified? And how much will it measure?

Day 8
10 mm

Any follicle measuring greater than what will most likely ovulate?

>11 mm

Follicles grow linearly at a rate of what?

2-3 mm per day

The maximum measurement of a follicle varies between what?

15-30 mm

What suggests ovulation will occur within 24 hours?

Line of decreased reflectivity around the follicle.

What suggests ovulation will occur within 36 hours?

Presence of cumulus oophorus (mural nodule within the follicle).

A surge of LH causes rupture of the dominant follicle within:

24-36 hours

What is the maximum post menses AP diameter?

2 mm

How long does the proliferative phase last?

About 10 days

What is the maximum AP diameter of the endometrium in the secretory phase?

14-16 mm

Most patients on OCP's will not develop a dominant follicle but will have smaller ones measuring what in size?

5-19 mm

Female factors of infertility include: AT PEUC

A - anovulation/abnormal ovulation
T - Tubal/transport factors (adhesions, hydrosalpinx)

P - polycystic ovarian disease
E - endometriosis
U - uterine factors (fibroids, congenital)
C - cervical factors

What 4 things does sonography do for a baseline evaluation for IVF?

1. Establish
2. Monitor
3. Confirm
4. Guide

What are the types of Clomiphene Citrate?

Clomid
Serophene

What are the types of Gonadotropins?

Repronex
Follistim
Pergonal
Bravelle
Gonal-F

What is the type of Glucophage?

Metaformin

What do follicles typically measure when they are aspirated for IVF?

18-24 mm

What do ZIFT & GIFT stand for?

Zygote intrafallopian tube transfer
Gamete intrafallopian tube transfer

What does IUI stand for?

Intrauterine Insemination

In ZIFT, where is the zygote placed?

Fallopian tube

In GIFT, what is placed into the fallopian tube?

Sperm and Ova

In IUI, where is the sperm placed?

Uterine fundus

In IVF, where are the embryos placed?

Uterus

In OHSS, you find large simple with what ovarian diameter?

>5 cm

What do you call a small amount of fluid in the endometrial cavity?

Hydrometra

Postmenopause - The normal endometrial strip is less than what in a asymptomatic patient?

<8 mm

Postmenopause - What is considered a normal endometrial measurement if there is a history of bleeding?

4-5 mm

Postmenopause - what does the endometrium measure on a patient receiving unopposed estrogen only?

Up to 8 mm

Postmenopause - the endometrial strip measures up to --------- in estrogen phase, then ------- during progesterone phase.

10-12 mm
decreases

Postmenopause - What does the EC measure with continuous combined hormones?

<8 mm

What is the most common cause of postmeno bleeding?

Exogenous estrogen administration

What is the most common cause of postmeno bleeding in non HRT patients?

Endometrial atrophy

What are some causes of postmeno bleeding?

Endometrial carcinoma
Cervical carcinoma
Estrogen producing functional tumor of the OV (rare)

What is the most common congenital uterine anomaly with Failure of Formation?

Unicornuate uterus (partial agenesis)

What is the most common congenital uterine anomaly with Failure of Fusion?

Bicornuate Uterus

What is the most common congenital uterine anomaly with Failure of Dissolution?

Septate Uterus
Arcuate Uterus

What is the most common congenital uterine anomaly with Failure of Disappearance?

Gartner's Duct Cyst

What is associated with DES? VIP TIC

V - vaginal epithelial changes
I - intrauterine wall defects
P - poor pregnancy outcome

T - t-shaped UT
I - increased risk of CX carcinoma
C - constricting bands in the uterus

What are the 3 types of Vaginal Anomalies?

1. Vaginal Atresia
2. Vaginal Septa
3. Vaginal Duplication

What should you always evaluate in patients with congenital malformations?

The Urinary Tract

What is the most common tumor of the female pelvis?

Leiomyomas

Lieomyoma clinical signs include: I A IF HE

I - Infertility

A - alteration in NML menstrual flow

I - increasing pain with degenerative changes.
F - frequent urination

H - heavy periods (menometorrhagia)
E - enlarged UT

Lieomyoma - sono - SWWELPD

S - shadowing
W - well circumscribed
W - whirled interior architexture
E - extrinsic compression of post bladder wall
L - lobulated UT contour
P - pedunculated may appear as hypo adnexal mass.
D - displacement of endo echoes

Adenomyosis

Benign invasion of endometrial glands and stoma into the myometrium.

Adenomyosis occurs in ------- year old women with ------ and ------.

40-50
dysmenorrhea
irregular bleeding

Adenomyosis can produce myometrial cysts measuring what?

2-6 mm

"venetian blind" type shadowing is associated with what?

Adenomyosis

What is the most common encountered gynecologic malignancy?

Endometrial Carcinoma

Endometrial Carcinoma has a relationship with what?

Increased Estrogen

Endometrial Carcinoma - risk factors - OHH PS

O - obesity
H - history of atypical hyperplasia of endo
H - history of tamoxifen

P - postmeno, wtih increased risk if on ERT
S - strong family history of UT cancer

Endometrial Carcinoma - sono - II FAT

I - increased UT size
I - inhomogenicity

F - fluid in EC
A - alteration in size, shape, & sono texture of UT.
T - thickened endo (4-5 mm) esp in postmeno women

Endometrial Hyperplasia

Proliferation of endometrial glandular tissue.

What may Endometrial Hyperplasia be caused by?

Unopposed Estrogen Hormone Replacement Therapy

Endometrial Hyperplasia is a common cause of what?

UT bleeding

Endometrial Hyperplasia may be caused by: U POPE

U - unopposed EHRT

P - PCOD
O - obesity
P - persistent anovulatory cycles
E - estrogen producing tumors of the OV

Estrogen producing tumors of the ovaries include which 2 types?

Granulosa cell tumors
Thecomas

What is the endo measurement for Endometrial Hyperplasia in premeno women?

>14 mm

What is the endo measurement for Endometrial Hyperplasia in postmeno women on estrogen only?

>5 mm

What is the endo measurement for Endometrial Hyperplasia in postmen in estrogen phase?

up to 8 mm, decreases in progest. phase

Endometrial Polyps

Localized overgrowths of endo tissue.

What does SIS stand for?

Saline Infusion Sonohysterography

What is SIS also called?

Hystersonography

Follicular cysts usually measure:

3-8 cm

What is the maximum measurement of a normal dominant follicle?

3 cm

Corpus luteal cysts rarely exceed what size?

4 cm

Corpus luteal cysts can be seen with pregnancy but usually resolve by how many weeks?

16 weeks

What are the largest of the functional cysts?

Theca lutein cysts

Polycystic Ovarian Syndrome is also called:

Stein-Leventhal Syndrome

Multiple bilateral cysts are seen with PCOS, measuring:

<1 cm

How many follicles are seen per ovary with PCOS?

12-19 per ovary

PCOS can also have what kind of appearance?

"string of pearls" (peripheral cysts 2-6mm)

What are the 5 types of Epithelial Tumors?

1. Serous
2. Mucinous
3. Endometroid
4. Clear Cell
5. Transitional Cell (Brenner)

Pseudomyxoma Peritonei occurs with which type of tumors?

Mucinous

Sertoli-Leydig Tumor is also called:

Arrhenoblastoma / Androblastoma

How do Metastatic tumors spread?

1. Direct Invasion
2. Peritoneal fluid
3. Blood vessels and Lymphatics

Where does the Krukenberg Tumor arise from?

GI tract

PID is what kind of infection?

Ascending infection

Benign Serous Tumors - sono - LAPS

L - large, unilocular
A - anechoic
P - possibly internal thin-walled septations
S - sharply marginated

Malignant Serous Tumors - sono - MOM AP

M - multilocular
O - occasional echogenic material within
M - multiple papillary projections/septations

A - ascites
P - possible multiple echogenic foci

Endometriod Tumors - sono - MAP

M - mixed cystic & solid mass
A - associated enometrial abnormality
P - possibly areas of hemorrhage or necrosis

Fibroma - sono - PRASHH

P - posterior acoustic shadowing
R - rarely focal or diffuse calcifications
A - associated with ascites
S - similar to pedunculated fibroid or Brenner Tumor
H - homogeneous
H - hypoechoic

Thecoma - sono - HAPS

H - hypoechoic ovarian mass
A - abnormally thick endometrium
P - posterior acoustic shadowing
S - solid

Benign Mucinous Tumor - sono - M50FT

M - multiloculated
50 - 50cm (measures up to)
F - fine, gravity dependent echoes
T - thicker and more numerous septations

Malignant Mucinous Tumor - sono - MEM

M - multiloculated cystic lesion
E - echogenic material
M - measures 15-30 cm

Transitional/ Brenner - sono - HSMCM

H - hypoechoic
S - solid mass
M - may have small cystic spaces
C - calcifications
M - may mimic an ovarian fibroma

Dysgerminoma - sono - MSM

M - multiloculated solid mass
S - size variable
M - may be bilateral

BCT - sono - DFCP

D - diffusely echogenic
F - fat fluid level (change patient posistion)
C - complex with calcifications
P - predominantly cystic adnexal mass

Sertoli-Leydig - sono - SES

S - solid
E - echogenic mass
S - similar appearance to granulosa cell tumor

Krukenberg Tumor - sono - BASH

B - bilateral
A - ascites
S - solid
H - hypoechoic or complex

PID

Inflammation of pelvic and adnexal structures.

Hydrosalpinx

Collection of fluid within a scarred or obstructed fallopian tube.

What do you see with Stage I (early) PID?

Endometritis

What do you see with Stage II (subacute or acute) PID?

May produce pyosalpinx.

What do you see with Stage III (severe) PID?

May see TOA if purulent material leaks from the fimbriae.
May see Fritz-Hugh Curtis Syndrome.

What is Fritz-Hugh Curtis Syndrome?

Development of peritonitis and acute perihepatitis.

Which stage of PID do you have broad ligament and ovarian involvement?

Stage III

What stage do you see the "indefinite uterus sign"?

Chronic PID

What is it called when you have adhesions that may cause the pelvic organs to merge centrally?

"indefinite uterus sign"

What are the clinical signs of PID? FLLPPCC

F - fever
L - leukocytosis
L - lower abdominal pain
P - purulent vaginal discharge
P - pelvic tenderness
C - cervical motion tenderness
C - constant dull pain worsened by sex

What do you call painful intercourse?

Dyspareunia

PID - stage I - sono - TIFFD

T - thickening/irregularity of the endometrium
I - indistinct borders of pelvic structures
F - fluid, debris, or gas w/in EC
F - fluid in Posterior CDS
D - diffuse hypoechogenicity of uterus

PID - stage II - sono - PUST

P - pyosalpinx
U - unilateral but may be bilateral
S - shaggy tubal walls
T - tubular adnexal cystic masses

PID - stage III - sono - TIT

T - TOA (unilateral or bilateral w/ hyperemic flow)
I - indistinct walls surrounding the mass
T - TOC

What is TOC?

Tubo-ovarian complex
(Tube & ovary inflammed, no abscess)

PID - Chronic - sono

Hydrosalpinx
Indefinite uterus or lobster claw sign

Endometriosis

Functional endometrial tissue outside of the endometrium and myometrium.

Where can Endometriosis occur?

Anywhere in the pelvis
Ovaries (most common)
Fallopian Tubes
Broad Ligament
Posterior CDS
Pelvic peritoneum

Endometriosis is most common in what type of patients?

White
Reproductive age
Higher Socioeconomic status
Postponed having children till later in life

What are the 2 types of Endometriosis?

Diffuse (scattered minute implants)
Localized (Endometrioma)

What is Endometrioma referred to as?

Chocolate Cyst

How many stages are there with Endometriosis?

4

Endometriosis - Describe Stage I :

Minimal
Few or superficial implants

Endometriosis - Describe Stage II:

Mild
More implants and deeper involvement

Endometriosis - Describe Stage III:

Moderate
More implants
Ovaries affected
Adhesions

Endometriosis - Describe Stage IV:

Severe
Like stage III but with:
Multiple, more dense adhesions

What are the clinical signs of Endometriosis?

Chronic Pain
Infertility
4 D's

Endometriosis - What are the 4 D's?

Dysmenorrhea - painful period
Dyspareunia - painful sex
Dysuria - difficult urination
Dyschezia - difficult defecation

What is the measurement for an appendicitis?

> 6mm

What 3 things is bowel wall thickening associated with?

Diverticulitis
Gastroenteristis
Bowel-related abscesses

What is interstitial cystitis?

Bladder wall thickening (focal or diffuse)
History of UTI's

How can you confirm a bladder wall neoplasm?

By demonstrating vascular flow to the mass

Bladder Diverticulum

Urine filled outpouching of the bladder wall.

A Bladder Diverticulum may -------- on post-void scan.

Enlarge

Neurogenic Bladder

Urinary bladder malfunction due to neurologic deficit.
(lacks bladder control due to brain/nerve condition)

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