OB/GYN Boards Review Pt 1

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dorkfork
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269425
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OB/GYN Boards Review Pt 1
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2014-11-15 13:38:18
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GYN
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  1. The uterine size in
    a nulliparous patient is ______ compared to the uterine size in a multiparous
    woman.
    Smaller
  2. The failure of one half of the uterus to develop is called:
    Uterus unicollis
  3. The typical sonographic pattern of the endometrial cavity during the latter portion of the secretory phase is:
    Diffusely hyperechoic
  4. By rate of incidence, a predominantly solid pelvic mass is most likely arising from:
    Uterus
  5. The typical sonographic pattern for small uterine fibroids is
    Hypoechoic
  6. A 49 year old patient presents with menorrhagia. all of the following conditions are included in the clinical differential diagnosis except:
    Endometrial hyperplasia
  7. Complete duplication of the uterus, cervix and vagina is called:
    Uterus didelphis

  8. This endometrial pattern corresponds to:
    Secretory

  9. The classification of the position of this fibroid would be:
    Subserosal
  10. A 33 year old patient presents with severe menstrual cramps and mid-cycle bleeding. Bimanual pelvic examination revealed a right adnexal mass. Sonographic examination demonstrates a 4 x 5 cm adnexal mass that demonstrates the "ground glass" internal pattern with distal acoustic enhancement. Based on the clinical history and sonographic patterns, this most likely represents:
    Endometrioma
  11. The upper limit anterior-posterior diameter of the endometrium during the late secretory phase is ___ mm.
    14
  12. A sonographer has discovered a uterine anomaly during the performance of a routine pelvic sonogram. The sonographer should next evaluate the:
    Kidneys
  13. Sonographic evaluation of the cervix reveals several 5-10mm cysts. These most likely represent:
    Nabothian cysts
  14. The most likely uterine fibroid position that produces abnormal bleeding and increased risk of infection is:
    Submucosal
  15. The most common cause of pelvic inflammatory disease is:
    Sexually transmitted diseases

  16. Based on the sonographic patterns, this most likely represents:
    Endometrial polyp
  17. Tamixfen therapy is most likely to affect which of the following structures?
    Endometrium
  18. The positional anomaly where the uterine body is bent posteriorly in relation to the cervix is:
    Retroflexion
  19. Obstruction of a cervical duct can result in:
    Nabothian cyst
  20. Abnormal deposition of endometrium within the myometrium is termed:
    Adenomyosis

  21. Based on this endovaginal image, this pattern corresponds to:
    Periovulatory
  22. The malignant counterpart of the benign fibroid is:
    Leiomyosarcoma
  23. The most frequent location of a uterine fibroid is:
    Intramural
  24. A 56 year old patient presents with vaginal bleeding. She has been postmenopausal for 3 years. Sonographic examination demonstrates an inhomogeneous endometrium with ill-defined borders. Power Doppler demonstrates an irregular flow pattern.  It measures 15 mm in the anterior-posterior dimension. Based on this history and sonographic pattern, this most likely represents:
    Endometrial carcinoma
  25. A patient has worn an IUCD for the past 4 years. She now presents with bilateral pelvic pain, fever and an elevated WBC. Sonographic examination demonstrates a septated cystic mass in the posterior cul de sac. This most likely represents:
    Abscess
  26. A 13 year old presents with pelvic pain. She has not started menses. Sonographic evaluation demonstrates a significant fluid collection within the endometrial, endocervical and endovaginal cavities. This pattern is most frequently associated with:
    Imperforate hymen


  27. The classification of the fibroid indicated by the white line is:
    Submucosal
  28. The formation of multiple adhesions within the endometrial cavity is termed:
    Asherman syndrome
  29. A 22 year old patient presents with severe menstrual cramps, spotting between periods and is currently undergoing evaluation for the cause of her infertility. Pelvic sonography demonstrates bilateral, thick-walled cysts with a hypoechoic internal pattern. This most likely represents:
    Endometriomas
  30. A 33 year old patient is taking Pergonal as part of her infertility treatment. Sonographic examination at approximately mid-cycle demonstrates bilateral, multiple cysts measuring between 3-5 cm. A significant amount of free fluid is seen in the posterior cul de sac. Based on this history and the sonographic findings, this most likely represents:
    Ovarian Hyperstimulation Syndrome
  31. The typical size of a mature follicle in a non-stimulated cycle is ___ cm.
    2
  32. A 26 year old patient is 10 weeks gestational age by her LMNP. She now presents with an episode of right adnexal pain. Sonographic examination demonstrates a 3 cm. right ovarian cyst containing some echogenic debris. This most likely represents:
    Corpus luteum cyst
  33. A 32 year old patient presents with right adnexal pain. Sonographic examination demonstrates a 4 cm. anechoic right ovarian cyst. Repeat sonographic examination performed six weeks later fails to demonstrate a right ovarian cyst. Based on these findings, this most likely represents:
    Follicular cyst
  34. Sonographic evidence of ovulation in spontaneous cycles includes all of the following EXCEPT:
    Enlarged ovary
  35. A 56 year old patient has a history of carcinoma of the stomach. Physical examination revealed bilateral adnexal masses. Sonography demonstrates bilateral, irregular hypoechoic adnexal masses. Based on this history and the sonographic findings, this most likely represents:
    Kruckenberg tumors
  36. A simple cyst is demonstrated in the adnexa. The borders of the ovary are clearly defined and intact. This most likely represents:
    Paraovarian cyst
  37. Ovarian carcinoma will most likely metastasize to the:
    Liver
  38. Which of the following is an ovarian neoplasm that is associated with autonomous estrogen secretion?
    Thecoma
  39. A 50 year old patient presents with ascites and hydrothorax. This condition is called:
    Meig's syndrome
  40. A 21 year old patient presents with irregular, infrequent menstrual cycles since the age of 16. Endovaginal sonography demonstrates bilaterally enlarged ovaries containing numerous immature follicles. This most likely represents:
    Polycystic Ovary Syndrome
  41. Which of the following will not cause adhesions and fixation of the pelvic structures on an endovaginal examination?
    Benign cystic teratoma
  42. A 56 year old patient presents with indigestion and a sonograhic examination of the right upper quadrant is ordered by the patient's physician. Sonographic examination of the right upper quadrant reveals ascites. Examination of the pelvis demonstrates viscous ascites, hyperechoic masses attached to the posterior peritoneum and a complex right adnexal mass. Based on this history and the results of the sonographic examinations, this most likely represents:
    Ovarian carcinoma
  43. An 18 year old patient goes to the gynecologist for her initial examination. Bimanual pelvic examination reveals a left adexal mass. Sonographic examination demonstrates a complex mass including a discrete area of acoustic shadowing. Based on this history and the sonographic findings, this most likely represents:
    Cystic teratoma
  44. An infertility patient with a 28-day cycle is monitored with ultrasound to determine the ideal time of conception. On day 19 of her cycle, a single, anechoic cyst measuring 3.5 cm is found in her right ovary. Which of the following conclusions can be drawn?
    An unruptured follicle is present
  45. A 60 year old patient has noticed progressive abdominal enlargement over a four month period. There is no history of alcohol abuse and the patient denies pain. Based on this history, the sonographer should first examine the pelvis looking for evidence of:
    Cystadenoma/adenocarcinoma
  46. A 23 year old patient presents with left adnexal pain. Sonographic examination demonstrates a 4 cm. unilocular, anechoic left ovarian cyst. Repeat sonographic examination six weeks later again demonstrates the left ovarian cyst that now measures 6 cm. in size. This most likely represents:
    Serous cystadenoma
  47. The most common malignant ovarian cystic neoplasm is the:
    Serous cystadenocarcinoma
  48. A 25 year old patient presents with a three-month history of pelvic pain occurring at approximately 15 days after her menstrual period. Her last menstrual period was two weeks prior to the sonographic examination. The pelvic sonogram demonstrates normal ovaries. There is a small amount of fluid in the posterior cul de sac. This most likely represents:
    Post-ovulatory changes

  49. This 27 year old presents with a palpable adnexal mass that is tender. The size of this mass is 3 cm. Based on this history and the sonographic characteristics, the interpreting physician would recommend:
    Repeat sonographic examination in six weeks

  50. This 45 year old patient presents with unexplained weight gain. Based on the sonographic characteristics, this most likely represents:
    Mucinous cystadenoma

  51. Lable the potential spaces
    • Curved: Posterior cul de sac
    • Straight: Anterior cul de sac
  52. This 47 year old patient presents with irregular
    bleeding. Based on this image, this most likely represents:
    Endometrial polyp
  53. This 62 year old presents with a palpable adnexal mass. Based on this image, this most likely represents:
    Malignancy
  54. What muscles are labeled A and B in this image?
    • A: Iliopsoas
    • B: Obturator Internus
  55. This 60 year old patient presents with a 2 month history of vaginal bleeding. Based on this image, this most likely represents:
    Endometrial carcinoma
  56. This 12 year old complains of abdominal cramps and denies any previous menstrual periods. Based on this mid-line image of the pelvis, this most likely represents:
    Imperforate hymen
  57. This patient has a history of irregular periods and now presents for an infertility workup. Based on this image of the ovary, this most likely represents:
    Polycystic  ovarian syndrome
  58. This 25 year old had her last menstrual period two weeks prior to this sonographic examination. Based on this image, this most likely represents:
    Follicular cyst
  59. This 34 year old presents for infertility evaluation. Her periods are heavy and painful, and also experiences cramping pain at mid-cycle. Based on this image of the left adnexal area, this most likely represents:
    Endometrioma
  60. This 22 year old presents with a painless left adnexal mass on her recent bimanual pelvic examination. Based on this image of the left adnexal area, this most likely represents:
    Cystic teratoma
  61. Based on this transverse image of the uterus, the most likely type of anomaly is:
    Bicornuate
  62. This 35 year old patient presents with an enlarged uterus on bimanual pelvic evaluation. Based on this image, this most likely represents:
    Leiomyoma (fibroid)
  63. Based on this endometrial pattern, the menstrual/ovulatory phase is:
    Late proliferative
  64. Based on this image, the uterine position would be classified as:
    Retroflexion
  65. This patient had a "lumpectomy" for breast cancer three months ago and now presents with vaginal bleeding. Based on this image, this most likely represents:
    Tamoxifen therapy

  66. Based on the sonographic characteristics of this ovarian mass, this most likely represents:
    Mucinous cystadenoma

  67. This 27 year old patient presents with pelvic fullness. Based on these images, this most likely represents:
    Serous cystadenoma

  68. This patient is 24 hours post partum and now presents with severe right adnexal pain. Based on this power Doppler image of the right ovary, this most likely represents:
    Torsion

  69. The displayed sonographic pattern is most typical for:
    Serous cystadenocarcinoma

  70. The muscle labeled "A" is:
    Obterator inturnus

  71. This image was obtained in a 55 year old patient who has not had a menstrual period in two years. She has recently experienced some vaginal spotting. Based on this image, this most likely represents:

  72. What ovarian neoplasms are associated with the displayed endometrial abnormality?

  73. Based on this endovaginal image in a 25 year old patient, the menstrual phase corresponding to this pattern is:
    Early proliferative

  74. Based on this 3D image of the uterus, which of the following uterine anomalies is LEAST likely?
    Didelphis

  75. Name the pelvic muscle imaged
    • A- Iliopsoas
    • B- Levator Ani

  76. Based on the findings displayed in this image, the most likely associated ovarian neoplasm is:

  77. This 56 year old patient had a partial gastrectomy for stomach carcinoma one year ago and now presents with a palpable adenxal mass on bi-manual physical examination. Based on this image and Doppler evaluation, this most likely represents:
    Kruckenberg tumor

  78. This 52 year old patient has a history of breast carcinoma and now presents with irregular vaginal bleeding. Based on this endovaginal image, this most likely represents:
    Tamoxifen-induced changes
  79. Anterior cul de sac AKA
    Uteovesical pouch
  80. Posterior cul de sac AKA
    Pouch of Douglas
  81. These muscles are located posterior to the ovaries
    Piriformas
  82. Portion of the broad ligament that extends from infundibulum of Fallopian tube to pelvic sidewall:
    • Infundibulo-pelvic ligament
    • Contains ovarian artery and vein
  83. Relationship of ovarian artery, vein, and ovary.
    • Anterior to posterior>> O.V.A
    • Ovary, vein, artery
  84. Pelvic ligament visualized in presence of ascities:
    Round ligament
  85. Normal post pubertal ovarian size
    3 x 2 x 1.5 cm
  86. Hormones secreted by ovaries
    • Estrogen
    • Progestrogen
  87. Estrogen
    • Secreted by follicles and placenta
    • Promotes regeneration of endometrium after menses
    • Promotes myometrial contractions
  88. Progesterone
    • Secreted by corpus luteum and placenta
    • Promotes build of lush endometrium for pregnancy
    • Decreases myometrial contractions to maintain lining for pregnancy
  89. Proliferative phase
    Day 1-15
  90. Secretory phase
    Day 14 through 28
  91. Corpus albicans
    Degenerated corpus luteum
  92. Hypothalamus secretes ____ which triggers secretion of ____.
    Secretes GnRh which tirggers secretion of FSH
  93. FSH triggers granulosa cells of follicles to secrete _____.
    Estradiol
  94. What stimulates secretion of LH?
    Rising levels of estradiol
  95. When does LH peak?
    10-12 hours prior to ovulation
  96. What triggers the production of progesterone?
    LH
  97. At what time do LH levels begin to fall in the case of no fertilization?
    day 23-25
  98. Mentrual sonographic pattern
    Thin broken echogenic line
  99. Sonographic pattern of the proliferative endometrium
    • Hypoechoic thickening 4-8 mm
    • Periovulatory
    • 3 lines
  100. Secretory sonographic pattern
    • After ovulation
    • Hyperechoic thickening 4-14 mm
  101. Uterus didelphis
    2 vaginia, 2 cervix, 2 uteri
  102. Bicornuate uterus unicollis
    2 uterus, 1 cervix, 1 vagina
  103. Bicornuate uterus bicollis
    2 uterus, 2 cervix, 1 vagina
  104. Arcuate uterus
    Partial indentation of the fundus with duplication of superior EC
  105. Most common fibroid to producce bleeding
    Submucosal
  106. Submucosal fibroid location
    Located within the myometrium and displaces the EC
  107. Intramural fibroid location
    • Within the layers of the myometrium and expands laterally
    • Does not displace EC
  108. Subserosal fibroid
    • Located adjacent to parametrium
    • Contour abnormality
  109. Pedunculated fibroid
    • Subserosal fibroid can become pedunculated
    • Connected by a stalk
  110. Lipoleomyoma
    Cervical fibroid
  111. Most common malignancy of vagina/uterus in children
    Sarcoma Botryoides- grape like cluster of tumors within uterus/cervix
  112. Gartner duct cyst
    Remnant of the wolfian duct
  113. Hydrometra vs hydrocolpus
    Fluid in the uterus vs fluid in the vagina
  114. Cause for hematometrocolpus
    Imperforate hymen
  115. Post menopausal woman with 3mm EC and bleeding... most likley cause
    Atrophy
  116. Causes of endometrial thickening
    • Endometritis (PID)
    • Adhesions
    • Hyperplasia
    • Polyps
    • CA
    • Submucosal fibroid
  117. Most frequent cause of uterine bleeding
    Endometrial hyperplasia
  118. Endometritis
    • Infection of the endometrium
    • Can present with a fluid-fluid level
    • Collections of air and or debris within the EC
  119. Adenomyosis
    • Endometrial tissue within the myometrium
    • Internal endometriosis
    • "Ground glass" pattern
    • MRI = best to detect
  120. Endometrioma
    • Endometriosis of the ovary
    • Cystic mass containing endometrial tissue that develope on ovaries
    • Well defined, thick walled, low level echoes, enhancement
  121. Ovarian volume 1 year post menopause vs 15 years
    8 cm at 1 year; 2 cm at 15 years
  122. Theca lutein cysts are seen with
    • Most frequently seen with gestational trophoblasitc disease
    • Ovarian hyperstimulation syndrome
    • Hydatidiform mole
  123. Sonographic pattern of theca lutein cysts:
    • 3-20 cm
    • Bilateral- may contain septa and have low level echoes
  124. Turners syndrome
    • Small uterus
    • No ovaries
  125. Sonographic pattern of PCOS
    • 12+ follicles per ovary measuring 2-9 mm
    • 25% appear normal
  126. Sonographic features of a benign ovarian neoplasm
    • Less than 5 cm
    • Thin walls, well defined boarders
    • Purely cystic with thin septa
    • High RI or no flow
    • Avascular nodules
  127. Sonographic features of a malignant ovarian neoplasm
    • >10cm
    •  Thick wall
    • Ill defined, or irregular borders
    • Solid or complex internal pattern
    • Thick or irregular septa
    • Papillary projections, echogenic solid nodules
  128. Most common cystic neoplastic mass of the ovary (no follicle)
    • Serous cystadenoma
    • Unilateral and multilocular
  129. Mucinous cystadenoma
    • Multilocular cystic mass
    • Less common than serous
    • Large ovarian cyst
    • Contains viscous fluid
  130. Serous cystadenoma
    • Unilocular cystic mass
    • 24% bilateral
    • Clear or mildly echogenic fluid
    • Thin septa
  131. Most common hormone secreting tumor
    Granulosa cell tumor (secretes estrogen)
  132. Raresolid ovarian tumor that secretes angrogen
    Sertoli Leydig cell tumor

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