OBGYN 1 - Test 1
State the formula to calculate the ovarian volume
(L x W x H) x .523
Describe the location of the Space of Retzius.
-Anterior to the bladder. Prevesical/retropubic space. -Between the fascia of the abdominal wall and umbilical fascia.
List the two mechanisms by which the cervix tries to impede the upward migration of bacteria from the vagina
-Downward mucosal folds of the cervix tend to retard (movement of) bacteria. -Thick mucus grabs or traps bacteria
Which of the following statements is not true about the iliopsoas muscle?
-Formed by the iliacus and piriformis muscles (F) -Has a "bull's eye" sonographic appearance in the transverse plane (T) -Considered the lateral landmark of the true pelvis (T) -Identified as a bright reflector, positioned superio-laterally in sag plane (T)
Rugae are (select all that apply)
-Located in the vagina -Downward folds which prevent bacteria from entering uterus
Which of the following statements is NOT TRUE regarding the BODY of the uterus?
-On cross-section, it appears ovoid or round - T -The central cavity is a potential space for dynamic changes to occur - T -It is dome-shaped - F -It is the largest region of the uterus - T
Describe the Trigone region of the urinary bladder
-POSTERIOR WALL -WHERE URETERS AND URETHRA ENTER AND EXIT -MORE FIBROUS AND RIGID
Which of the following statements is not true about the levator ani muscle?
-Posterior posterior and lateral to the ovaries (T) -Forms the superior aspect of the pevlic cavity (F) -Also known as the pelvic diaphragm (T) -A group of several muscles (T)
All statements about the urinary bladder are false except
-The wall thickness should be 6mm when distended - F -The bladder is an acoustic standard for soft tissue organs of the pelvis - F -Near field artefact is a limitation of ultrasound technology - T -In a normal patient, the bladder contour is deltoid in shape - F
On transabdominal imaging of the female pelvis, the distended urinary bladder (select all that apply)
-serves as a "cystic" reference -is an acoustic window to view the pelvic anatomy -displaces bowel into the false pelvis
How many Graafian follicles can usually be seen in an ovary?
1 but sometimes 2
State the cervix to corpus ratio for each of the following stages:
1. Pre-menarchy 2:1 2. Adult Nulliparous 1:1 3. Multiparous 1:2
A non-dominant follicle is usually <___________ cm.
1.4 cm
A mature Graafian follice is typically ____________ cm.
2-2.5cm
A corpus luteum cyst may grow up to ______________ in size.
3 cm
What are the dimensions of a normal menarchal ovary?
3 x 2 x 1 cm. or (L) 2.2 - 5.0 cm (W) 1.5 - 2.5 cm (AP) .5 - 3.0 cm
The normal dimensions of an adult nulliparous uterus are
8 x 5 x 3
Name the 3 major body cavities
ABDOMINOPELVIC, CRANIAL, THORACIC
Using ultrasound terminology, the urinary bladder should appear
ANECHOIC
List 2 structures/spaces which lie posterior to the urinary bladder in females
ANTERIOR CUL DE SAC UTERUS COLON
The ureters course _______to the internal iliac artery and _______to the ovary
ANTERIOR, POSTERIOR
The ______ is located posterior to the urinary bladder
Anterior cul-de-sac
Describe the location of the anterior cul de sac.
Anterior to uterus and posterior to bladder.
Explain why the ovaries are considered "nude"?
Because they are not covered by the peritoneum
What is the location of the piriformis muscle
Begins at the sacrum and extends laterally to the greater sciatic foramen, forms posterior portion of pelvis, lies posterior to ovaries
what is retroflexion
Body and fundus tip backward at varying degrees over the cervix
What is anteflexion
Body and fundus tip foward anterior (onto empty bladder)
The region of the uterus where the fallopian tubes passes through the uterine wall and communicates with the uterine cavity is called the ________________.
CORNUA
The isthmus is the junction between the
CORPUS/body and cervix
A patient's last menstrual period was 17 days ago. she has a 28 day cycle. What will you expect to see in her ovary?
Collapsed Graafian Follicle or Corpus Luteum
The inner lining of the uterine cavity that appears echogenic to hypoechoic on ultrasound depending on the menstrual cycle is the:
ENDOMETRIUM
what is retroversion
Entire uterus tipped backward from cervix.
what is anteversion
Entire uterus tips forward (cervix to fundus) onto empty bladder
The Ovarian arteries originate from the internal iliac artery (IIA).
FALSE
The uterine arteries follow a caudal course along the lateral aspects of the uterus.
FALSE
The Space of Retzius contains mostly
FAT
The most superior region of the bladder is termed:
FUNDUS
Which part of the bladder is covered by peritoneum?
FUNDUS
The abdominopelvic cavity is one continuous region. T/F
False
The piriformis muscle is located anterior to the ovaries. T/F
False
List the three bones that make up the innominate bone
ILIUM ISCHIUM PUBIC
The uterus lies
In the true pelvis - T Below the Linea Terminalis - T Between the anterior cul de sac and Pouch of Douglas -T
Name the 5 bones that make up the pelvic skeleton
Innominate (Ilium, Ischium, Pubic), Sacrum and Coccyx
Which of the following is used to divide the pelvic cavity into the false pelvis and true pelvis?
LINEA TERMINALIS
The ovary receives its blood supply
Laterally from the gonadal artery and medially from uterine artery.
This muscle comprises the largest segment of the the pelvic diaphragm:
Levator ani
Which vaginal wall is greater in length?
POSTERIOR
The urinary bladder is located _______ to the pubic symphysis and _______ to the uterus.
POSTERIOR, ANTERIOR
The ______________________muscle is not a True pelvic muscle, because it originates in the abdominal cavity, however, it is routinely demonstrated on transverse ultrasound images of the female pelvis.
PSOAS MAJOR
The iliopsoas muscle is formed by the
PSOAS MAJOR AND ILIACUS
what are 2 structures/spaces which lie anterior to the bladder
PUBIC BONE SPACE OF RETZIUS FASCIA LIGAMENTS
Which of the following muscles do not lie within the true pelvis?
Piriformis Iliacus DOES NOT Levator Ani Obturator Internus
Where are each of these muscles located? (TP for True Pelvis, FP for False Pelvis)
Piriformis TP Rectus Abdominus FP Iliopsoas FP Levator Ani TP Obturator Internus TP CoccygeusTP
What is the most dependent portion of the peritoneal cavity in the supine patient?
Pouch of Douglas, Rectouterine sac, Posterior cul-de-sac.
List 3 reasons why the patient should have a full bladder for a gyn ultrasound exam?
Push bowel up and out of the way Tilt back uterus Reference point Contour of surrounding structures Landmark of pelvis
What is the most likely site for free peritoneal fluid to collect?
Rectouterine space
The False Pelvis is located superior or inferior to the pubic bone.
SUPERIOR
The ___________bone results from the fusion of 5 vertebrae.
Sacral
The imaginary line separating the False and the True pelvis extends from the _____ to the______.
Sacral promonence, pubic symphysis
What kind of endometrium would you expect to see in a patient with a collapsed Graafian follicle?
Secretory (thicker)
List the maximum endometrial measurements for the following:
Secretory phase - 14 Post-menopausal with bleeding -4 Post-menopausal without bleeding, no HRT -6 Post-menopausal with bleeding with HRT - 4 Post-menopausal with HRT - 8
The Aorta and the IVC change their relative positions at the bifurcation T/F
TRUE
The Space of Retzius is located anterior to the urinary bladder. T/F
TRUE
The uterine and ovarian arteries anastomose in the broad ligament and mesovarium.
TRUE
The function of the fallopian tube is to pick up and transport the egg from the surface of the ovary to the endometrial canal. How is this accomplished?
The tube (infundibulum fimbria ovarica) attracts the ovum from the ovary when the egg is released, it goes into the tube Cilia and peristalsis helps move it along with wave-like contractions.
Which of the following statements most accurately describes the anatomical relationship among the ovary, ureters and internal iliac vessels?
The ureters and internal iliac vessels both lie posterior to the ovary
What happens to the mucous membrane of the vagina during pregnancy?
Thickens under hormonal influence, forms mucuous plug
Name two reasons/factors as to why the bladder does not fill uniformly.
Trigone/difference in bladder wall Organs surrounding: space filling factor Status of Colon/Rectum
The uterus is located inferior to the linea terminalis. T/F
True
List 4 branches of the anterior trunk of the Internal Iliac Artery
UMBILICAL AND SUPERIOR VESICLE INFERIOR VESICLE UTERINE VAGINAL MIDDLE RECTAL ORBURATOR INTERNAL PUDENDAL INFERIOR GLUTEAL
Name the 3 openings of the anterior pelvic diaphragm
URETHRA, RECTUM, VAGINA
State the following mean ovarian volume (must include units):(3 points) a. Premenarchal b. Menstruating c. Post Menopausal
a. 3mL b. 9.8mL c 5.8mL
Fertilization takes place in the _________________ region of the fallopian tube.
ampulla
With an empty bladder, the normal position of the uterus is
anteverted, anteflexed
The thin outer myometrium of the uterus is separated from the inner myometrium by the:
arcuate arteries
What arteries are a landmark to identify the outer and intermediate layers of the myometrium?
arcuate arteries
A double fold of peritoneum that provides minimal suspension of the uterus
broad ligament
Extends from the cervix laterally to provide support to the lower part of the uterus
cardinal ligament
Hairlike projections inside the fallopian tube which transport the ovum
cilia
Define the Azygos arteries
collateralization of uterine arteries at midline
Bleeding with a follicle at ovulation is termed
corpus hemorrhagicum
The follicles are located in the ________________ portion of the ovary.
cortical
A dense layer of granulosa cells that surrounds the ovum in the developing follicle is called the
cumulus oophorus on ultrasound Corona radiata anatomically
From the free edge of the broad ligament, superior to inferior, select the correct order of the following:
fallopian tubes, round ligament, ovarian ligament
The ovaries are a retroperitoneal organ
false
The tunica albuginea is the outer most layer of the ovary.
false
The longest projecton of the fimbriae that connects to the ovary in an effort to attract the ovum is called the _________________
fimbria ovarica
Fingerlike projections of the infundibulum of fallopian tube
fimbriae
A ripening follicle is called a _______________ follicle.
graafian
The area where blood vessels enter and leave the ovary medially
hilum
Extends from lateral pelvic walls to the fallopian tube and ovary
infundibulopelvic ligament
The trumpet or funnel-shaped portion of the tube that creates a fistula with the peritoneal cavity is the ________________________.
infundibulum
Name the hypoechoic layer which surrounds the endometrium
inner layer of the myometrium
Which vessel provides the best landmark for localizing the ovary?
internal iliac artery
What vessel (s) help to identify the location of the ovaries and lies posterior/lateral to them?
internal iliacs
The narrowest section of the fallopian tube
interstitial
The narrowest portion of the fallopian tube, 1 mm in diameter, is the
interstitial (intramural)
Waldeyer's fossa
is bounded by the the obliterated umbilical artery anteriorly, the internal iliac artery and ureter posteriorly and the external iliac vein superiorly.
The right ovarian vein drains into the
ivc
The left ovarian vein drains into the
left renal vein
Short, double layer of peritoneum attaching ovary to Broad Ligament
mesovarium
The ______________is a fan-shaped muscle that covers most of the lateral wall of the true pelvis.
obturator internus
What vessels supply the ovary?
ovarian artery uterine artery
Connects the medial portion of the ovary to the uterine cornua
ovarian ligament
Name two functions of the ovaries:
ovulation, secretion of hormones
At the level of the cervix, what is the relationship of the ureter and the uterine artery.
perpendicular
The peritoneal reflection from the posterior wall of uterus to the anterior wall of the rectum
posterior cul de sac
MATCHING
precursor of the urinary and genital systems -Pronephros and Urogenital ridge develop into the genital systems -Mesonephric and paramesonephric ducts another name for Muellerian ducts -Paramesonephric ducts a cyst found around the vagina -GARTNER'S DUCT CYST this forms the lower 1/3 of the vagina -UROGENITAL SINUS
MATCHING 2
remnants of the Wolffian Ducts can be found here -BROAD LIGAMENT OR PARAMETRIUM develop into the urological system -METANEPHROS an example of maldevelopment of the Muellerian ducts -BICORNUATE UTERUS primordial form are gonads -OVARY AND TESTES ANOTHER NAME FOR WOLFFIAN DUCTS MESONEPHRIC DUCTS
Originates from the uterine cornua and inserts in the labia majora
round ligament
The endometrium is at its greatest thickness and echogenicity with posterior enhancement in the _____ phase.
secretory
Menarche may be defined as:
the state after reaching puberty in which menses occur every 21 to 28 days
The inner most lining of the fallopian tubes is continuous with the uterine and vaginal linings.
true
The mesoovarium is a specialized tissue which connects the ovary to the broad ligament.
true
Ovarian capsule
tunica albuginea
Vascular supply to the fallopian tubes is formed by anastomoses of the
uterine and ovarian arteries
Extends from upper cervix to the lateral margins of the sacrum
utero-sacral ligament
