Chapter 45 : Adnexal Pathology and Infertility

_________________ is an acquired cause of infertility ?

A. Endometritis - Is an ectopic location of functional endometrial tissue and attaches to the fallopian tubes, ovaries, colon, and bladder.

A large cystic mass posterior and lateral to the uterus in a patient with a history of a previous pelvic infection is most suspicious for an ________________ ?

A. Hydrosaplinx - Has to do with pelvic inflammatory disease, and endometriosis and postoperative adhesions

A nodular tubular adnexal mass demonstrating posterior acoustic enhancement is most suspicious for ______________ ?

A. Salpingitis - Is a pelvic infection and can have pelvic pain, fever, dysparenuia, and leukocytosis

During ovarian induction therapy, follicles are only measured when exceeding ______________ cm ?

B. 1.0 cm

_______________ most accurately describes an endometrioma ?

B. A collection of ectopic endometrial tissue - A collection of extravasated endometrial tissue, and is termed a chocolate cyst.

Fixation of the ovaries posterior to the uterus is a sonographic finding associated with __________________ ?

B. Endometriosis - A condition occurring when active endometrial tissue invades the peritoneal cavity. Is ectopic location of functional endometrial tissue.

Monitoring of ________________ hormone is routine during ovarian induction therapy ?

B. Estradiol

______________ abnormalities is most likely a consequence of pelvic inflammatory disease?

B. Hydrosaplinx - Is a dilation of the fallopian tube with fluid.

On serial examinations, a paraovarian cyst will ________________ ?

B. Remain unchanged - Stable size on serial sonograms

Inflammation with the fallopian tube is termed _______________ ?

B. Salpingitis - Is caused by pelvic infection, pelvic pain, fever, dysparenuia, and leukocytosis

Scarring within the endometrium caused by invasive procedures is termed ________________ ?

B. Synechiae - Is a scarring caused by previous dilation and curettage or spontaneous abortion ; demonstrated as hyperechoic band of echoes within the endometrial cavity

During the mid luteal phase, full luteal function is expected if the endometrial thickness is at least _____________ ?

C. 11 mm

Infertility is suggested when conception does not occur within _______________ months ?

C. 12 months - Is suggested when conception does not occur within 1 year, is caused by male or female reproductive abnormalities, fibroids are responsible for 15 % of infertility cases.

A common symptom of endometriosis is ___________________ ?

C. Dysmenorrhea - The clinical findings for endometriosis is dysmenorrhea, pelvic pain, irregular masses, dyspareunia and infertility

_______________ is not a sonographic finding in pelvic inflammatory disease ?

C. Focal hypoechoic adnexal mass - Is a normal pelvic appearance is thick and hypervasular endometrium, a complex tubular adnexal mass, and is ill-defined multilocular adnexal mass.

_______________ fertility assistance program inserts oocytes and sperm into the fallopian tube ?

C. Gamete intrafollicular transfer - It requires ovulation stimulation and retrival of oocytes, they are mixed with sperm and then are transferred into the fallopian tube.

Pelvic inflammatory disease is best described as an _________________ ?

C. General classification of inflammatory conditions - A general classification for inflammatory conditions of the cervix, uterus, ovaries, fallopian tubes, and peritoneal surfaces.

Krukenberg tumors are a result of ________________ ?

C. Metatatic disease - Metastatic lesions, with the primary lesion from gastric carcinoma.

_________________ complications is commonly associated with in vitro fertilization ?

C. Multiple gestations - Mature ova are aspirated with ultrasound guidance, fertilization is accomplished in a laboratory setting. Endometrium is prepared to accept embryos.

_______________ uterine anomalies is not likely to cause inferility ?

C. Nabothian Cyst - The causes of infertility are oviduct disease, congenital uterine anomalies, endometrial pathology, cervical mucus abnormality, nutritional factors, metabolic disorder, and synechiae

With the gamete intrafollicular transfer technique, the _________________ ?

C. Oocytes and sperm are transferred to the fallopian tube - It requires ovulation stimulation and retreval of oocytes, and they are mixed with sperm and then are transferred into the fallopian tube.

A cystic structure located in the inferior broad ligament is most suspicious for a ___________________ ?

C. Parovarian Cyst - Mesothelial in orgin, is typically located in the broad ligament and is not associated with a history of pelvic inflammation surgery, or endometriosis

_____________ most accurately describes endometriosis ?

D. Active endometrial tissue invading the peritoneal cavity - A condition occurring when active endometrial tissue invades the peritoneal cavity, ectopic location of functional endometrial tissue.

Assessment for the presence of an ovarian cyst or dominant follicle is scheduled _________________ ?

D. Before initiating ovarian induction therapy - The baseline study before therapy is to assess for the presence of an ovarian cyst or dominant follicles.

_________________ best describes the sonographic appearance of uterine synechiae ?

D. Bright band of echoes within the endometrium - Demonstrated as hyperechoic band of echoes within the endometrial cavity.

Metastatic lesions in the adnexa are more commonly associated with a primary malignancy of the _________________ ?

D. Gastrointestinal tract

With ovarian induction therapy, intramuscular injection of _____________ hormone triggers ovulation ?

D. Human chrionic gonadotropin - Estraidol levels are monitored for timing of intramuscular injection of hCG

_____________ complications is most likely associated with ovulation induction therapy ?

D. Hyperstimulation syndrome

A common sonograpic finding associated with an endometrioma is an __________________ ?

D. Hypoechoic, homogeneous adnexal mass - Focal collection of ectopic endometrial tissue and is termed a chocolate cyst.

A large multicystic ovarian mass, in an ovarian stimulated patient, is most suspicious for ____________________ ?

D. Ovarian hyperstimulation syndrome -

A patient presents with lower abdominal pain and a palpable pelvic mass. A septated fluid collection surrounds a normal-appearing right ovary. The patient has a previous history of a ruptured appendix. Based on this clinical history, the sonographic finding is most suspicious for __________________ pathologies ?

D. Peritoneal inclusion cyst - Is adhesion trap fluid normally produced by the ovary and previous abdominal surgery, trauma, pelvic inflammatory disease.

_______________ most accurately describes the sonographic appearance of a peritoneal inclusion cyst ?

D. Septated fluid collection surrounding an ovary - Is adhesions trap fluid normally produced by the ovary, previous abdominal surgery, trauma, pelvic inflammatory disease

A patient presents with a history of a leiomyoma, ___________ location will most likely cause infertility ?

D. Submucosal

A total breakdown of the normal adnexal anatomy is a sonographic finding associated with ____________________ ?

D. Tuboovarian abcess - Has to do with pelvic infection and sexually transmitted disease and can have severe pelvic pain, fever, leukocytosis, and nausea and vomiting.

A 25-year old woman presents with high-grade fever, pelvic pain, and leukocytosis. An ill-defined, complex mass is identified in the left adnexa. Based on this clinical history, the sonographic finding is most suspicious for ____________ ?

D. Tubovarian abscess - Is a pelvic infection that is usually a sexually transmitted disease.