Obstetrics (#1)

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Obstetrics (#1)
2012-11-08 00:52:33

Quiz #1 Uterine Pathology Ovarian Pathology Extra Pelvic Pathology Infertility Contraceptives
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  1. Arrested development forms (2)
    Uterine aplasia: arrested bilateral

    Unicorn unicollis (1 ut; 1cx): arrested unilateral (rudimentary horn)

  2. Failure of Fusion forms (3)
    Didelphys (2ut; 2 cx): complete f of f

    Bicornis bicollis ( 2 ut; 2cx): partial

    • Bicornis unicollis (2ut;1cx): partial
  3. Failure of Resorption forms (3)
    • Septate UT: complete to cx
    • Subseptate UT: partial
    • Arcuate: almost resorption
  4. T shaped UT
    Caused by diethylstilbestrol (DES)
  5. Decent of UT down vaginal canal due to weak pelvis floor muscles
    Prolapsed UT
  6. Copper T, Copper 7, Lippes Loop, Safe T Coil, Chinese Ring, Mirena
    Types of IUCDs
  7. Complications of IUCD
    • Expulsion
    • Improper location
    • PID
    • Pregnancy
  8. Endometrium replaced with fibrous adhesions from previous D&C, multiple abortions, or infection causing loss of menstration and infertility
    Ashermans syndrome: appears as bridging bands of tissue distorting cavity
  9. Vascular plexus of arteries ad veins without intervening capillary network; may be congenital, mostly from trauma or injury
    AV malformation: pt experience metrorrhagia
  10. Multiplication of abnormal cells
  11. Mass of fibromuscular tissue; Influenced by estrogen
    • Leiomyoma(Fibroid)
    • Most common tumor of pelvis
    • Rarely malignant " leiomyosarcoma"
  12. Sonographic presentation of fibroids?
    • Hypoechoic; high attenuation
    • Enlarged UT with distortion of contour
    • May be necrotic or calcfic
  13. Symptoms associated with fibroids?
    • Menorrhagia (abnormal heavy bleeding)
    • Pain/pressure
    • Palpable on physical exam
    • Infertility
  14. Classifications of fibroids
    • Intramural: myometrium
    • *Submucosal: to UT cavity(produces symptoms)
    • *Subserosal: into peritoneum
    • *may be pedunculated
  15. T or F: leiomyomas are malignant
    • False (benign)
    • AKA Fibriod
  16. Lipocytes (fat) and fibromuscular tissue
    Lipoleiyoma: very echogenic and attenuating (no flow)

    DDx: dermoid; but within UT
  17. Malignant
    Degenerating fibroid appearance
    May see local invasion of surrounding organs/ hepatic mets
  18. Thick echogenic endometrium
    Causes post menopausal bleeding
    Strong association with HRT, obesity, HTN, DM, PCO, granulosa cell tumors
    • Endometrial cancer
    • *90% of all UT malignancies
  19. Stages of Endometrial Cancer?
    • Confined to endometrium
    • Confined to UT
    • Confined to Pelvis
    • Distal mets (liver)
  20. Non-steroidal anti-estrogen hormonal drug
    Treatment for breast cancer
    Tamoxifen: heterogeneous bizzare thickened endometrium

    DDx: hyperplasia, polyp, cancer
  21. DDx for Endometrial cancer
    • Endometrial hyperplasia
    • Endometrial polyp
  22. Inflammation of endometrium
    Occurs post parum, with PID, or after D&C
    • Endometritis: appears irregular; may demonstrate gas bubbles
    • *non neoplastic
  23. Cystic vascular structures surrounding UT
    Uterine Varicies "prominent arcuate vessels"
  24. Extension of endometrial tissue to myometrium (usually post wall)
    • Adenomyosis (endometriosis): slight diffuse UT enlargement, hypoechoic myometrium, can be focal like fibroid
    • Associated with pain and abnormal bleeding
  25. Endometrial growth extending into canal from a stalk
    • Endometrial polyp: thick echogenic endometrium with focal echogenic mass
    • DDx: endo ca or hyperplasia
  26. Unopposed estrogen stimulation from ovarian dysfunction
    * non neoplastic
    Occurs immediately after menarche and prior to menopause
    • Endometrial Hyperplasia: echogenic and thickened endometrium
    • Associated with irregular bleeding
    • DDx: endo ca. And polyp
  27. Hymen does not rupture causing retention of fluid in UT or vagina
    Imperforate hymen
  28. Retention of vaginal secretions pre-puberty
  29. Retention of blood in vagina post-puberty
  30. Retention of blood in UT (cx stenosis)
  31. Retention of fluid in vagina and UT (pre menses or post menopause)
  32. Retention of blood in vagina and UT
  33. Cysts along lateral or antrolateral vagina
    • Gartner duct cysts: mesonepheric duct remnants
    • Small, asymptomatic
    • May be associated with renal abnormality
  34. Multiple entrapped cervical secretions from cervisitis
    Nabothian cysts (retention cysts): common, vary in size
  35. Solid retrovesical mass, may cause obstruction and fluid retention
    Carcinoma of cx: usually dx clinically; u/s used to stage
  36. This is caused by trauma, D&C, DES, or idiopathic
    • Incompetent cx
    • My cause preterm labor
    • Tx with "cerciage" stitch
  37. External genitalia not clearly of either sex
    Ambiguous genitalia
  38. Possessing both male and female sex traits
  39. Possessing both ovarian and testicular tissue (infertile) may be due to fusion of 2 heterozygous twin zygotes after fertilization
    • True hermaphroditism
    • Increase risk for cancer
  40. Possessing chrom of one sex but developing sex traits of other
    • Male pseudo: genetically male (testes) with female characteristics ( breasts, etc) due to lack of androgens
    • Female pseudo: genetically female (ovaries) with male characteristics (penis, scrotum, etc) due to excessive androgens
  41. Infection of female genital tract
         caused by STD, pyogenic(IUCD, sx), abortion, Crohns
    Pelvic inflammatory disease(PID)
  42. Tubal walls thickened and edematous
    • Salpingitis
    • If tube is blocked (pyosalpinx)
    • If treated infected material is resorbed (hydrosalpinx - if fluid is not resorbed))* chronic
  43. Perihepatitis ( liver capsule) small absesses may lead to adhesions
    • Fitzhugh Curtis Syndrome
    • RUQ pain on inspiration
    • Increase liver enzymes
    • 5-10% have PID
  44. 50-80% asymptomatic, tenderness, vaginal discharge (endometritis)
    Thick endometrium, fluid in canal, or normal (difficult to dx)
    Stage 1 of PID
  45. Fever, chills, acute pelvic pain, abnormal bleeding (causes salpingitis)
    Pyosalpinx, hypo S shaped tubes with low level echoes
    Stage 2 of PID
  46. Tubo ovarian abscess, acute abd pain, increase WBC ( develops FHC)
    Multilocular mass, low level echos with fluid levels; multi complex masses, irregular borders, air in mass
    Stage 3 of PID
  47. Acute/subacute recurrence of PID
    Distended s shaped tubes (hydrosalpinx) thin walls
    • Chronic PID
    • DDx: ovarian cyst, small cystadenomas
  48. Growth of endometrial tissue outside UT cavity caused by retrograde tubal transmission; ? Estrogen stimulation
    Can cause adhesions
    • Endometriosis
    • DDx: hemorrhagic ovarian cyst, ovarian cyst adenoma, tubo-ovarian abscess
  49. Symptoms of endometriosis
    • Dysmenorrhea (painful)
    • Dysparunia (painful sex)
    • Infertility
    • Menorrhagia
    • Pabpable mass
  50. Sonographic presentation of endometriosis
    • Localized/focal "endometrioma":
    • Well defined predominately cystic mass with low level echoes, may see fluid level
    • AKA chocolate cyst
  51. Inability to conceive after 12 months of unprotected sex
  52. Woman causes of infertility 40%
    • Ovarian: dysfunction, inability to transport, adhesions, endometriosis
    • Uterine: fibroids, ashermans
    • Cervical
    • Immunologic
  53. Male causes of infertility 40%
    • Vairocele: congestion of veins in testes
    • Testicular failure: torsion, orchitis, cancer
    • Tubular obstruction
    • Cryptochi
  54. Endometriosis is commonly seen on u/s?
  55. (Functional Simple cystic Ovarian Mass)
    LH and FSH stimulate
    ovary to mature oocyte, follicles grow from 3 to 24 mm in about 10 days
    Evolves to corpus luteum after rupture
    Follicular Cysts
  56. (Functional simple cystic ovarian mass)
    Occurs after ovulation
    Resolves in 8 weeks without pregnancy, 12/15 weeks with pregnancy
    1-10cm odd shape
    Corpus luteum cysts
  57. Follicular or corpus luteum cysts growing large effort rupture
    Persistent cysts
  58. Bleeding into cysts
    May cause acute pain
    Hemorrhagic cysts
  59. (Physiological Simple cystic ovarian mass)
    Remnants of embryonic ducts
    Never surrounded by ovarian tissue
    • Paraovarian cyst
    • "Broad ligament"
    • "Paratubal"
  60. (Simple cystic)
    Located higher in abdomen (omentum)
    Omental cysts
  61. (Simple ovarian cysts)
    Mass located midline, anterior abdomen wall between umbilicus and bladder
    Urachal cysts
  62. (Multi bilateral ovarian cyst)
    Large mass caused by excessive hCG

    Associated with multi gestation, molar, choriocarcinoma, hyperstimulation
         May hemorrhage, rupture, torsion
    Theca luteum cysts
  63. Theca lutean cysts with ascites
    Pergonal overstimulation
  64. PCO
    • Polycystic ovaries
    • "Stein leventhal syndrome"
  65. (Multiple bilateral cystic masses)
    Unopposed estrogen with no LH surge
    Increase in androgen secretion/abnormal estrogen and androgen production (anovulation)
    Enlarged ovaries with multiple small cysts around periphery (string of pearls)
    • Polycystic ovaries
    • "Stein leventhal syndrome"
  66. Most extreme form of PCO?
  67. Symptoms of PCO
    • Obesity
    • Hirsuitism
    • Infrequent menses
    • Infertility
  68. (Multi Bilateral Cystic ovarian mass)
    Large, edematous
    ovaries with multiple cysts
    • Incomplete ovarian torsion
    • Evaluate with colour
    • May cause acute pain
  69. (Multiple bilateral cystic masses)
    Increased/decreased ovarian echo texture due to necrosis from this?
    Complete ovarian torsion
  70. (Mixed Solid/Cystic Ovarian Masses)
    Three types of neoplastic tumors?
    • Epithelial
    • Germ cell
    • Connective tissue tumors
  71. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Simple cystic tumor
    Benign, often unilateral
    Menstrating age group
    Variable size (larger), Multiple thin septations
    • Serous cystadenoma
    • *most common
  72. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Cystic ovary with irregular texture
    Large >10cm
    • Serous cystadenocarcinoma
    • * most common malignant
  73. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Mass with low level echos/complex
    May rupture due to size (15-30cm)
    Mucinous cystadenoma
  74. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Complex associated with ascites
    Often unilateral
    Risk of "pseudomyxoma peritoni"
    Mucinous cystadenocarcinoma
  75. (Mixed Solid/Cystic Ovarian masses)Epithelial

    Menopausal age >60yrs
    Large unilateral >10-15cm
    Complex - solid
    Associated with endometrial cancer
  76. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Variant of endometrioid
    • Clear cell carcinoma
    • "Mesonehroid"
    • "Mullerian duct origin"
  77. (Mixed Solid/Cystic Ovarian masses)Epithelial
    Solid hypoechoic
    • Brenners tumor
    • "Traditional cell tumor"
  78. (Mixed Solid/Cystic Ovarian masses)Germ Cell

    Predominatly complex with fat/fluid levels, calcifications (tip of iceberg)
    Risk of torsion
    • Cystic teratoma
    • "Mature teratoma"
    • "Dermoid"
  79. (Mixed Solid/Cystic Ovarian masses)Germ Cell
    Benign to highly malignant
    Young children and women
    • Solid teratoma
    • "Immature teratoma"
  80. (Mixed Solid/Cystic Ovarian masses)Germ Cell
    Highly radio sensitive
    Associated with choriocarcinoma
    • Dysgerminoma
    • (Counter part to seminoma)
  81. (Mixed Solid/Cystic Ovarian masses)Germ Cell


    Rapid growth
    Poor prognosis
    Increased AFP
    • Endodermal Sinus Tumor
    • "Yolk sac tumor"
  82. Three layers of germ cell
    • Mesoderm
    • Ectoderm
    • Endoderm
  83. (Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal

    Small masses with variable hemorrhagic changes
    Produces estrogen: precocious puberty
    • Granulosa cell tumor
    • "Theca luteal cell tumor"
    • "Thecoma"
  84. (Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal
    Usually benign
    Produces androgens
    • Androblastoma
    • "Sertoli-leydig cell tumor"
  85. (Mixed Solid/Cystic Ovarian masses) Sex Chord-Stromal
    Unilateral may be multiple masses 
    Post menopausal
    Solid (similar to fibroid)
    Associated with Meigs syndrome
  86. Hydro thorax and ascites with an ovarian mass
    Meigs Syndrome
  87. Bilateral metastatic ovarian tumors that produce mucin
    Krukenbergs tumor
  88. Bilateral
    Solid or necrotic
    Common from GI or Breast
    Secondary/metastatic ovarian tumors
  89. Ca 125
    Antibody detecting ovarian cancer
    Acronym for similar looking ovarian masses
    • Cystadenoma/ca
    • Hemorrhagic
    • Ectopic
    • Endometrioma
    • Teratoma
    • Hydrosalpinx
    • Abses