Ch. 42 Sonographic and Doppler Evaluation of the Female Pelvis

The thickness of the endometrium should be measured in which one of the following planes? a. Transverse b. Longitudinal c. Coronal d. Oblique

ANS: B The thickness of the endometrium should be measured in the longitudinal plane.

The transvaginal transducer should be soaked in disinfectant between uses for a minimum of _______________. a. 3 to 5 minutes b. 10 to 20 minutes c. 30 to 60 minutes d. 1 to 2 hours

ANS: B The transvaginal transducer should be soaked in disinfectant between uses for a minimum of 10 to 20 minutes. The amount of time may differ for products from different manufacturers. Extended soaking may damage or degrade the transducer.

It is easier to view ovaries in ____.

TV

Where are nabothian cyst usually located?

cervix

In a pregnancy there will be ____ RI blood flow.

low

Ovaries are ____ resistance.

low

The levator ani muscles are ___ ___ and ___ to the obt. internus.

medial, inferior, and posterior

Calcifications may be seen in the arcuate arteries in ___ & ____ pts.

post menopausal & diabetic

Sections of the obturator internus are seen at the ____ corners of the bladder.

posterolateral

What kind of patients should not have a TV exam?

premanarche & menopausal

If the bladder is not completely empty in a transvaginal exam, what artifacts may be seen?

reverberation

Bony pelvis resembles a ____ or ____ in shape.

ring or funnel

The patient should drink ___ oz of fluid ___ hour(s) before an exam?

-32 oz -1 hour

In a TA U/S the pts bladder should be ____. In TV U/S the pts bladder should be ____.

-full -empty

In a retroverted uterus, how would we see it on the screen?

-fundus is on the right -cervix is on the left

Neonatal Cervix = ____ cervix Prepubescent = cervix is ____ uterine length Nulliparous = cervix is ____ uterine length Postmenopausal = cervix is ____ uterine length

-prominent -2/3 -1/3 -2/3

Saline infused sonography is known as? What does it evaluate?

-sonohysterography -thickness of endo

The uterus is supplied by the ____ artery. Which arises from the ANT branch of the ____?

-uterine -internal iliac artery

the uterus is supplied by the ______ artery. Where does it arise from?

-uterine artery -internal iliac artery

The Sonohysterography should be done between days ____-____ of the uterine cycle.

6-10

Which one of the following are small vessels found along the periphery of the uterus? a. Uterine arteries b. Arcuate vessels c. Iliac arteries d. Peripheral vessels

ANS: B The arcuate vessels are found along the periphery of the uterus.

Flexion refers to the axis of the uterine body relative to the ___________. a. fundus b. cervix c. vagina d. cornua

ANS: B Flexion refers to the axis of the uterine body relative to the cervix.

Sonohysterography is usually performed on premenopausal women between days ________ of the menstrual cycle. a. 3 and 5 b. 6 and 10 c. 10 and 14 d. 21 and 28

ANS: B Sonohysterography is usually performed on premenopausal women between days 6 and 10 of the menstrual cycle.

The difference between the peak systole and the peak diastole is the __________. a. LS ratio b. S/D ratio c. D/S ratio c. CI ratio

ANS: B The S/D ratio is the difference between the peak systole and the peak diastole.

To image the fundus of the uterus with transvaginal sonography, the transducer should be angled so that the handle is positioned as described in which one of the following? a. Closer to the bed b. Farther from the bed c. Lateral to the patient d. Perpendicular to the patient

ANS: A Advancing the transducer slightly and angling it anteriorly (move handle closer to the bed) is often necessary to visualize the uterine fundus in transvaginal sonography.

Menarche may be defined as which one of the following? a. The state after reaching puberty during which menses occur every 21 to 28 days b. When menses have ceased permanently c. Time before the onset of menses d. Midcycle

ANS: A Menarche is the state after reaching puberty in which menses occur every 21 to 28 days.

The Doppler measurement that uses peak systole minus peak diastole divided by the mean over one cardiac cycle is the ________________ index. a. pulsatility b. resistive c. mean systolic d. mean diastolic

ANS: A The pulsatility index uses peak systole minus peak diastole divided by the mean over one cardiac cycle.

After the transducer has been soaked in a glutaraldehyde-type solution, which one of the following is an important step to ensure safe handling? a. Check the cord for damage. b. Wear gloves when handling the transducer. c. Immediately place the transducer into a protective container. d. Thoroughly rinse the transducer with water.

ANS: B When handling glutaraldehyde, the sonographer is required to wear gloves. Some manufacturers recommend the use of safety goggles.

Arcuate artery calcifications may be observed in patients who are _______________. a. pregnant b. perimenopausal c. postmenopausal d. premenopausal

ANS: C Calcified arcuate arteries are a normal aging process that may be accelerated in the patient with diabetes.

Nabothian cysts are found near which one of the following anatomic structures? a. Isthmus b. Vagina c. Endocervical canal d. Peritoneum

ANS: C Cervical inclusion cysts known as nabothian cysts are visualized near the endocervical canal.

Limitations of translabial scanning may be overcome by which one of the following? a. Emptying the patient's bladder b. Elevating the patient's head c. Elevating the patient's hips d. Assuming the left lateral decubitus position

ANS: C Elevating the patient's hips may overcome some limitations in translabial scanning.

Which one of the following techniques uses a catheter inserted into the endometrial cavity with the insertion of saline or contrast media to fill the endometrial cavity to demonstrate abnormalities within the cavity or uterine tube? a. Transvaginal b. Perineal c. Sonohysterography d. Transendometrography

ANS: C Sonohysterography is a technique that uses a catheter inserted into the endometrial cavity with the insertion of saline or contrast media to fill the endometrial cavity to demonstrate abnormalities within the cavity or uterine tube.

Symmetrical bilateral pelvic masses are likely to be which one of the following? a. Ovarian cysts b. Uterine fibroids c. Pelvic muscles d. Iliac vessels

ANS: C Symmetric bilateral pelvic masses are likely to be pelvic muscles.

The Doppler measurement that takes the highest systolic peak minus the highest diastolic peak divided by the highest systolic peak is which one of the following? a. Pulsatility index b. Mean Doppler gradient c. Pourcelot resistive index d. Mean systolic measurement

ANS: C The Pourcelot resistive index takes the highest systolic peak minus the highest diastolic peak divided by the highest systolic peak.

The thin outer layer of the uterus is separated from the immediate layer by which one of the following? a. Peripheral arteries b. Uterine arteries c. Arcuate vessels d. Radial arteries

ANS: C The arcuate vessels separate the thin outer layer from the immediate layer in the uterus.

Which one of the following techniques is the best way to measure the cervical-fundal dimension of the uterus? a. Transvaginal b. Translabial c. Transabdominal d. Endorectal

ANS: C The transabdominal image is the best way to measure the length of the uterus.

On the sagittal image with endovaginal sonography, the cervix of an anteverted uterus is seen in the _____________ of the screen, whereas the fundus of the anteverted uterus is found in the _____________ of the screen. a. upper portion; lower portion b. right side; lower portion c. left side; right side d. right side; left side

ANS: D On the sagittal image with endovaginal sonography, the cervix of an anteverted uterus is seen in the right side of the screen, whereas the fundus of the anteverted uterus is found in the left side of the screen.

In transvaginal scanning, the scanning plane that is 90 degrees from the sagittal plane is the ______________ plane. a. transverse b. parasagittal c. axial d. coronal

ANS: D The coronal plane is 90 degrees from the sagittal plane in transvaginal scanning.

The endometrium is at its greatest thickness and echogenicity with posterior enhancement in which one of the following phases? a. Menses b. Proliferative c. Ovulatory d. Luteal

ANS: D The endometrium is at its greatest thickness and echogenicity with posterior enhancement during the secretory (luteal) phase.

Depending on the menstrual cycle, the inner lining of the uterine cavity that appears echogenic to hypoechoic on ultrasound is which one of the following structures? a. Myometrium b. Perineum c. Endouterine d. Endometrium

ANS: D The endometrium is the inner lining of the uterine cavity that appears echogenic to hypoechoic on ultrasound, depending on the menstrual cycle.

The middle layer of the uterus is which one of the following? a. Serosa b. Endometrium c. Body d. Myometrium

ANS: D The myometrium is the middle layer of the uterus.

On transabdominal imaging of the female pelvis, the distended urinary bladder: a. is an acoustic window to view the pelvic anatomy. b. serves as a "cystic" reference. c. displaces the bowel into the false pelvis. d. All of the above are correct.

ANS: D The urinary bladder is used as an acoustic window and landmark for visualizing pelvic anatomy, serves as a "cystic" reference, and displaces the bowel into the false pelvis.

The obturator interns is ____ to the true pelvis.

anterolateral

Post menopausal women have ovarian ____.

atrophy

In a anteverted uterus, how would we see it on the screen?

fundus is on the left -cervix is on the right

The ovaries are supplied by which arteries?

ovarian and uterine arteries

S/D ratio

peak systole / end diastole

pulsatility index

peak systolic - end diastolic / mean velocity

Pourcelot resistive index

peak systolic - end diastolic / peak systolic

The vagina is supplied by what two arteries?

vaginal and uterine arteries

If a TV exam is to be done on a fertility patient, what should be used as lubricant and why?

water because gel has a negative effect on sperm mobility