OB GYN CTL Gynecology Pathology

A 12yr old presents with pelvic pain and gloating. She states she has not yet had her first menstrual cycle. The ultrasound findings are most suggestive of: A: thecoma B: hematometrocolpos C: endometriosis D: endometrial hyperplasia

B Hematometrocolpos is usually caused by an imperforate hymen. The menstrual blood becomes trapped in the uterus causing dilatation.

Which of the following is least likely to cause PID? A: ruptured appendix B: lithium exposure C: TORCH infections D: tuberculosis

B Lithium exposure is related to cardiac malformation of the fetal heart (Ebstein syndrome). Causes for PID include chlamydia (#1), gonorrhea, TORCH infections, poor hygiene, tuberculosis, non-sterile surgical instruments, child birth, intrauterine contraception, intercourse with a man with urethritis, and ruptured appendix.

Malignant germ cell tumors of the ovary: A: are treated with methotrexate injections B: are most commonly seen in patients 5-25yrs of age C: demonstrate significantly reduced CA125 levels D: cause significant pain, bleeding and thrombosis of the ovarian vein

B Malignant germ cell tumors arise from germ cells of ovary. They cause elevated CA125 levels. These tumors are most common in children and young adults age 5-25yrs. Ex: dysgerminoma, endodermal sinus tumor, solid teratoma, choriocarcinoma

Which of the following ovarian tumors most commonly occurs in the postmenopausal woman? A: serous cystadenoma B: granulosa cell tumor C: teratoma D: Sertoli-Leydig cell tumor

B Most common in premenopausal - cystic teratome (dermoid cyst), serous cystadenoma, mucinous cystadenoma, Sertoli-Leydig cell tumor Most common in postmenopausal - granulosa cell tumor (theca luteal cell tumor), thecoma, fibroma

A 64 yr old female presents for a pelvic ultrasound due to left sided pain and bloating. The exam demonstrates a 4cm cystic mass with numerous thick septations and small loculations that give it a honeycome appearance. There is also a 7mm solid nodule on the lateral aspect of the cyst. These findings are most consistent with: A: serous cystadenocarcinoma B: mucinous cystadenocarcinoma C: mucinous cystadenoma D: Brenner tumor

B Mucinous cystadenoma typically occurs in postmenopausal women. It presents as a large cystic mass with septations and low level echoes from mucin within. Thin septations = benign; thick septations/solid nodules = malignant. Nodules with a diameter of >5mm have a higher chance of malignancy. The cyst is multilocular and more locules of a smaller size with a honeycomb appearance indicate malignancy.

The image displayed is from pelvic ultrasound from a 27yr old female complaining of pelvic fullness. The findings on the image are consistent with: A: ovarian lymphoma B: ovarian hyperstimulation syndrome C: bilateral endometriosis D: Krukenberg tumors

B Note the size of both ovaries and the free fluid in the pelvis. This image is taken after the retrieval process has been performed. Note the multiple collapsed follicles on the left ovary. The endometrium also appears to be in the secretory phase. This patient has completed a round of stimulation treatments recently.

Ovarian malignancy: A: requires monthly screening protocols for those with a family history B: is most commonly diagnosed at stage III or greater C: is the 2nd leading cause of cancer death in women D: will cause decreased serum levels of CA125

B Ovarian Cancer Facts: 5th leading cause of cancer death in women Most women have stage III or greater when diagnosed Postmenopausal ovaries should not exceed 2cm in any dimension or 8cc volume Increased risk for ovarian cancer with echogenic foci in ovarian parenchyma Screening performed annually for those with a family history Elevated CA125 levels are commonly associated

Ovarian hyperstimulation syndrome: A: causes the uterine muscularis to become edematous B: increases the risk for ovarian torsion C: causes the ovaries to atrophy and testosterone levels rise D: leads to reduced blood flow within the ovarian tissue surrounding the follicles

B Ovarian hyperstimulation can lead to enlarged ovaries (>5cm) that are engorged with follicles. This causes an increased risk for ovarian torsion. The endometrium (not the muscularis) may become edematous in response to the increased hormonal levels.

What is demonstrated on the image? A: polycystic ovary B: ovarian hyperstimulation C: endometrioma D: hemorrhagic cyst

B Polycystic ovary disease leads to the formation of multiple small cysts along the periphery of the organ. Endometriomas generally have internal echoes due to bleeding into the cyst. Multiple dominant follicles are present with little visible ovarian parenchyma which are signs of hyperstimulation.

____ fibroids can distort the uterine contour while ____ fibroids can irritate the endometrial lining causing increased bleeding. A: submucosal; subserosal B: subserosal; submucosal C: submucosal; pedunculated D: interstitial; pedunculated

B Subserosal fibroids can distort the uterine contour while submucosal fibroids can irritate the endometrial lining causing increased bleeding.

What is the first stage of PID that is identified sonographically? A: endometritis B: hydrosalpinx C: pyosalpinx D: tubo-ovarian abscess

A 4 Stages of PID: PID is an ascending infection, starts in uterus and moves upward into tubes/ovaries Acute endometritis, endometrial fluid/debris/air, fluid in posterior cul-de-sac Acute salpingitis, fluid or pus within tubes, "shaggy" appearance of tube walls Acute tubo-ovarian abscess Chronic infection

Which type of ovarian tumor is referred to as displaying the sonographic "tip of the iceberg" sign due to a high fat/bony content? A: cystic teratoma B: angiomyolipoma C: cystadenocarcinoma D: Brenner's tumor

A A dermoid cyst is usually composed of ectodermal tissues such as bone, hair and teeth causing a strong anterior reflection and posterior shadowing.

A patient presents with moderate RLQ pain and a low grade fever. An US exam of the area demonstrates a 7mm thick aperistaltic tube that is noncompressible. Which of the following best describes the findings? A: appendicitis B: pelvic congestion C: intussusception D: peritoneal inclusion cyst

A A thickened aperistaltic tube that is noncompressible is a hallmark sign of appendicitis. Bowel segments can be thickened, aperistaltic and noncompressible but will not appear as a blind ended tube.

Which of the following is a failure to form defect of the uterus that is commonly associated with ipsilateral renal agenesis? A: unicornuate uterus B: arcuate uterus C: bicornuate uterus D: uterine didelphys

A A unicornuate uterus is caused by the failure of one of the mullerian ducts to form. A single horn forms on an asymmetrically shaped uterus with lateral displacement. Ipsilateral renal agenesis or pelvic kidney are commonly associated renal defects. A bicornuate uterus and uterine didelphys are failure of fusion defects. An arcuate uterus is a failure of resorption defect. Most uterine defects are associated with abnormal developments in the urinary system.

Which of the following is a benign uterine condition characterized by invasion of the myometrium by endometrial tissue? A: adenomyosis B: endometriosis C: stage I endometrial carcinoma D: Fitz-Hugh-Curtis syndrome

A Adenomyosis is a benign uterine condition characterized by invasion of the myometrium by endometrial tissue. Endometriosis is the ectopic placement of endometrial tissue outside the uterus. Endometrial carcinoma is a malignant condition that causes myometrial invasion.

Which of the following is associated with Asherman syndrome? A: amenorrhea B: menometrorrhagia C: dysuria D: elevated CA 125

A Asherman syndrome refers to adhesions of the endometrial lining due to uterine trauma. Common symptoms include amenorrhea, hypomenorrhea, recurrent miscarriage and infertility.

Which of the following is the most commonly occurring germ cell tumor of the ovary? A: benign cystic teratoma B: malignant dysgerminoma C: embryonal cell carcinoma D: yolk sac tumor

A Benign cystic teratoma is the most commonly occurring germ cell tumor of the ovary.

Which of the following findings is most suggestive of significant cervical stenosis in a 34 year old female? A: hematometra B: hematometrocolpos C: hydrosalpinx D: hydrometrocolpos

A Cervical stenosis refers to narrowing of the cervical canal. It can be caused by tumors, infection, polyps, scar tissue formation prior surgery or radiation therapy. In postmenopausal patients, fluid is retained in the endocervical canal. In premenopausal patients, it can cause amenorrhea and hematometra. Because the blockage is at the cervix, the vagina would not be dilated with fluid accumulation from the blockage = no hematometrocolpos or hydrometrocolpos.

A 19yr old female presents for a pelvic ultrasound due to intermittent pelvic pain on the left side and abnormal menstrual cycles. She states she has had no recent sexual activity, but her last LMP was 10 weeks ago and she recently had a positive home pregnancy test. The ultrasound demonstrates a sold mass with cystic degeneration on the left ovary. These findings are most suggestive of: A: choriocarcinoma B: serous cystadenocarcinoma C: mucinous cystadenocarcinoma D: Krukenberg tumor

A Choriocarcinoma of the ovary is an aggressive malignancy most common in patient 5-25yrs of age. It causes elevated bhCG levels that can lead to a positive urine pregnancy test in a non-pregnant female. It can cause precocious puberty. The mass formation is usually unilateral and very large. Both types of cystadenocarcinoma are primarily cystic with nodule formation and/or septations. Krukenberg tumors are solid, but usually bilateral.

Which of the following is a sonographic characteristic that strongly suggests a malignant ovarian tumor? A: papillary excrescences B: multiple thin septations C: anechoic fluid in the posterior cul-de-sac D: posterior enhancement

A Common signs of ovarian malignancy: Papillary excrescences Mural nodules The more solid areas present, the greater the likelihood that a malignancy is present Irregular walls Thick septations Can contain echogenic material (mucin or protein debris) Ascites is a sign of peritoneal spread

Which of the following is a common cause of dysfunctional uterine bleeding? A: hormone replacement therapy B: leiomyomas C: endometrial carcinoma D: endometrial polyps

A Dysfunctional uterine bleeding (DUB) is caused by abnormalities in the endocrine system, while abnormal uterine bleeding (AUB) is caused by uterine lesions. PCOS, oral contraceptive use and HRT can cause DUB. AUB is caused by fibroids, polyps, and other uterine lesions.

Which of the following is the most common gynecological cancer? A: endometrial carcinoma B: leimyosarcoma C: mucinous adenocarcinoma of the ovary D: serous adenocarcinoma of the ovary

A Endometrial carcinoma is the most common gynecological cancer.

Endometrial polyps most commonly form in the endometrial canal near the ____. A: uterine fundus B: vaginal canal C: cervix D: uterine isthmus

A Endometrial polyps most commonly form in the endometrial canal near the uterine fundus.

The findings on the image are most suggestive of: A: a 3D image of normal Essure microinserts B: a 3D image of normal Mirena IUD placement C: a 2D image of normal essure microinserts D: a 3D image of an abnormal Mirena IUD placement

A Essure devices are used to obstruct the fallopian tubes to prevent pregnancy. TV ultrasound can be used to localize the position of the devices. After implantation, the scar tissue that forms will obstruct the fallopian tubes and prevent pregnancy. Hysterosalpingography performed 3 months after the procedure should demonstrate NON-patent tubes with no fluid filling tubes and entering pelvis.

What is the most common uterine mass/tumor? A: leiomyoma B: endometrial polyp C: serous cystadenoma D: Brenner's tumor

A Fibroids are the most common acquired uterine abnormality.

The follicular ring sign is associated with: A: ovarian torsion B: ovarian hyperstimulation syndrome C: normal intrauterine pregnancy D: ectopic pregnancy

A Follicular ring sign - perifollicular hyperechoic rim, 1 to 2 mm in thickness, identified around the peripheral ovarian follicles of a torsed ovary.

Which of the following is related to abnormal testosterone production? A: hirsutism B: dyspareunia C: dysmenorrhea D: menometrorrhagia

A Hirsutism refers to male pattern hair growth in a female. This is a common symptom of disorders related to androgen production such as polycystic ovarian disease and androblastomas.

All of the following are associated with a small amount of fluid in the endometrial canal of a 62 yr old female, except? A: ectopic pregnancy B: endometrial hyperplasia C: endometrial atrophy D: cervical stenosis

A It is highly unlikely that a female would still be ovulating at age 62 making an ectopic pregnancy impossible.

A lipoleiomyoma will be hyperechoic to the myometrium due to increased levels of: A: fatty tissue B: striated muscle tissues C: connective tissue D: ectodermal tissue

A Lipoleiomyomas form due to degeneration of smooth muscle cells in a leiomyoma. The symptoms are similar to leiomyomas of the same size and location. Sonographic findings include: hyperechoic fatty mass with a partially hypoechoic muscular rim, posterior acoustic attenuation.

What does McBurney's point refer to? A: the most common location of the appendix B: the point of greatest tenderness in the RLQ in a patient with endometriosis C: the point where the two halves of the uterus merge together during development D: the location of the tip of the endometrial canal

A McBurney's point refers to the most common location of the appendix in the RLQ. It relates to the point of greatest tenderness in a patient with appendicitis.

Which of the following ovarian tumors is commonly a part of Meigs Syndrome? A: fibroma B: androblastoma C: cystadenoma D: teratoma

A Meigs syndrome = pelvic ascites and pleural effusion with benign ovarian tumor (fibroma 80-90%, thecoma, granulosa cell tumor).

The formation of bilateral solid ovarian neoplasms is highly suspicious for: A: Krukenberg tumors B: dysgerminoma C: serous cystadenoma D: yolk sac tumor

A Metastasis to the ovaries is usually a bilateral process characterized by the formation of Krukenberg tumors. Common primaries include GI tract (#1), pancreas and breast.

Which of the following is not an expected finding with metritis? A: leukopenia B: leukocytosis C: endometritis D: pelvic inflammatory disease

A Metritis refers to inflammation of the uterus. Increased levels of white blood cells (leukocytosis) and infection are related to metritis. Leukopenia refers to low levels of white blood cells.

A/an ____ is a type of germ cell malignancy of the ovary, while a ____ is an epithelial-stromal malignancy of the ovary. A: dysgerminoma; serous cystadenocarcinoma B: endometrioid tumor; dysgerminoma C: mucinous cystadenocarcinoma; serous cystadenocarcinoma D: serous cystadenocarcinoma; mucinous cystadenocarcinoma

A Most ovarian malignancies originate from the epithelial-stromal tissues. Serous cystadenoma, mucinous cystadenocarcinoma, endometrioid, transitional cell, and clear cell tumors are epithelial-stromal tumors. Dysgerminoma is a germ cell tumor of the ovary.

All of the following are associated symptoms/complications related to the findings displayed on the image, except: A: alopecia B: amenorrhea C: infertility D: hirsutism

A Polycystic ovarian disease is demonstrated on the image. Note the "string of pearls" formation of the follicles along the rim of the ovary. Alopecia refers to the loss of hair from the body and has not been associated with PCOD.

Polycystic ovarian disease usually demonstrates multiple follicles: A: <10mm along the periphery of the ovary B: <20mm along the periphery of the ovary C: >15mm centrally and along the periphery of the ovary D: <5mm centrally and along the periphery of the ovary

A Polycystic ovarian disease usually demonstrates multiple follicles <10mm along the periphery of the ovary. This finding is described as the string of pearls sign.

Primary amenorrhea refers to: A: the absence of menarche after age 15 years B: the onset of menarch before age 8 years C: amenorrhea caused by a vaginal mass D: amenorrhea caused by a foreign object in the vagina

A Primary amenorrhea refers to the absence of menarche after age 15 years.

In stage I endometrial cancer, the cancer has invaded the: A: myometrium in the body of the uterus B: the cervix C: pelvic lymph nodes D: ovaries

A Stage 0 = precancerous cells Stage I = confined to the body of the uterus (invades myometrium) Stage II = extends into the cervix Stage III = extends into true pelvis Stage IV = metastasis

Which type of fibroid disturbs and distorts the endometrial layer and causes the most dysfunctional uterine bleeding of all types of fibroids? A: submucosal B: subserosal C: intramural D: interstitial

A Submucosal - beneath the endometrial layer Interstitial or intramural - within the myometrium Subserosal - between the outer layer of the uterus and myometrium

Spotting between cycles and infertility are common symptoms related to: A: endometrial polyp B: Gartner duct cyst C: endometriosis D: hematometra

A Symptoms of endometrial polyps include abnormal premenopausal or postmenopausal bleeding and infertility history. Polyps do not usually cause pain or cramping with the abnormal bleeding. Endometriosis causes heavier than normal regular cycles.

A 26 yr old presents with pelvic pain and discharge for 3 weeks, LMP 3.5 weeks ago, G1, P2. What findings are displayed on the image provided? A: dilated, anechoic fallopian tube medial to the ovary, AKA hydrosalpinx, consistent with probably PID B: dilated pelvic veins adjacent to the ovary which can be a complication for mothers of mulitple births C: dilated fallopian tube with internal debris and nodularity consistent with carcinoma formation D: none of the above

A The anechoic tubular structure is medial to the ovary where the fallopian tube is normally located. The patient symptoms are consistent with a possible pelvic infection.

Which of the following is the most likely symptom of endometriosis? A: menorrhagia B: amenorrhea C: hypomenorrhea D: menometrorrhagia

A The ectopic endometrial tissue will allow the same hormonal cycle as the normal endometrium. Most patients exhibit regular cycles but have very heavy and painful menses = menorrhagia. Hypomenorrhea indicates lighter menses and amenorrhea indicates absent menses. Menometrorrhagia indicates irregular menses with heavy bleeding.

A patient presents with irregular bleeding and pelvic pain for the last two months. Which of the following statements best describes the image displayed? A: there is a subserosal fibroid present with an IUD in the uterine cervix B: there is a submucosal fibroid present C: there is a tampon present in the cervix D: there are multiple fibroids present in the body of the uterus and cervix

A The hypoechoic mass with shadowing in the anterior uterus consistent with a fibroid. The fibroid is located just beneath the outer layer of the uterine wall which indicates a subserosal fibroid. The echogenic linear structure with shadowing located in the cervix is consistent with an IUD that is displaced.

What is the most common cause of the uterine abnormality on the image? A: imperforate hymen B: trauma C: endometriosis D: ovarian hyperstimulation

A The image demonstrates hematometrocolpos. The blood from menses is unable to escape the uterus/vagina. This is most commonly caused by an imperforate hymen.

A 65 yr old postmenopausal female presents with a recent history of spotting. She does take a regimen of tamoxifen from a previous diagnosis of breast cancer but no other medications are used. Which of the following statements is true regarding the ultrasound findings? A: the endometrium is thickened and heterogeneous which can be normal in a patient using tamoxifen B: the uterus is atrophied and fibroids have formed causing the heterogeneous appearance C: the endometrium is thickened and heterogeneous due to the presence of polyps D: the endometrium is thickened and heterogeneous which is abnormal and D&C should be performed to rule out adenocarcinoma

A The uterus demonstrates a heterogeneous texture with calcifications seen in the periphery. The endometrium is very heterogeneous and thickened. Tamoxifen can cause the endometrium to appear thickened, irregular, and cystic.

Where is the fibroid located in the uterus? A: anterior fundal B: posterior fundal C: anterior cervix D: posterior body

A The uterus is retroflexed and the fibroid is located on the anterior fundus.

A patient presents for a first trimester scan due to an enlarged uterus and right ovary on clinical exam. The uterus demonstrates a molar pregnancy. Which of the following is an expected ovarian finding? A: theca lutein cyst B: thecoma C: dermoid cyst D: androblastoma

A Theca lutein cysts are associated with increased levels of hCG in the blood. Molar pregnancy causes excessive levels of hCG in the blood.

Which of the following is a benign tumor that can lead to fibroid enlargement and postmenopausal bleeding? A: thecoma B: leiomyosarcoma C: endodermal sinus tumor D: dermoid cyst

A Thecoma tumors on the ovary typically produce estrogen which can lead to fibroid growth and postmenopausal bleeding.

All of the following can cause an echogenic endometrium, except: A: cyst formation B: normal secretory phase C: endometritis D: IUD present

A Uterine cyst formation is rare but would appear as a round, anechoic structure within the uterine tissue.

A patient presents for a pelvic ultrasound due to a palpable, pliable, rounded, mobile mass in the vaginal canal. What will be the most likely findings on the exam? A: fibroid B: Gartner cyst C: Brenner cyst D: Nabothian cyst

B A Gartner cyst is a cyst that forms in relation to the Gartner ducts in the vagina.

A patient presents with RLQ pain increasing over the last few months. The pelvic ultrasound demonstrates an abnormal ovary that contains a 3cm echogenic mass. The posterior borders of the mass are difficult to assess due to the presents of dirty shadowing. These findings are most suggestive of: A: porcelain cyst B: ovarian teratoma C: theca lutein cyst D: mucinous adenocarcinoma

B A dermoid is an ovarian teratoma which is a type of germ cell tumor. The mass is composed of dense ectodermal tissues that cause dirty shadowing.

A hypoechoic mass with benign characteristics is identified in the right ovary of a 6yr old female. Her lab results demonstrate moderate levels of estrogen in the blood. Which of the following is a differential for these findings? A: Brenner tumor B: granulosa cell tumor C: androblastoma D: Krukenberg tumor

B A granulosa cell tumor, AKA theca cell tumor, is most commonly a unilateral finding of a hypoechoic mass in a postmenopausal woman. If the tumor is identified in a young patient, it can lead to precocious puberty. The tumor is most commonly benign and produces estrogen.

Which of the following types of ovarian cysts is formed by bleeding into a functional cyst? A: endometrioma B: hemorrhagic cyst C: theca lutein cyst D: dermoid cyst

B A hemorrhagic cyst is formed when bleeding occurs in a simple cyst. An endometrioma is an ectopic mass of endometrial tissue. A theca lutein cyst is a very large functional cyst related to high hCG levels.

Which of the following describes a way to differentiate uterine adenomyosis from a leiomyomatous uterus? A: adenomyosis demonstrates significant posterior enhancement, while a leiomyomatous uterus will demonstrate varying degrees of shadowing B: a leiomyomatous uterus will have a lobulated uterine contour, while adenomyosis demonstrates a smooth uterine contour C: the sonographic appearance of both abnormalities is essentially the same and MRI is usually performed to make the differentiation D: leiomyomas will demonstrate increased vascularity centrally, while tissue affected by adenomyosis are avascular

B Adenomyosis leads to an enlarged globular uterus with smooth contour (fibroid formation usually causes lobulated uterine contour). Adenomyosis causes diffuse increase in vascularity of the affected area (fibroids demonstrate peripheral vascularity).

The uterus is enlarged and demonstrates multiple myometrial cysts <6mm in size and several subendometrial echogenic nodules. What is the most likely cause for these findings? A: endometrial atrophy B: adenomyosis C: endometrial carcinoma D: endometrial abscess

B Adenomyosis refers to the abnormal location of endometrial tissue in the myometrium. Sonographic Findings: Thickened, heterogeneous myometrium Subendometrial echogenic nodules Small myometrial cysts / subendometrial cysts (<6mm) "Swiss cheese" appearance of muscle Striated vertical edge shadows/"venetian blind" shadowing without a discrete mass Enlarged globular uterus with smooth contour

____ is the most common adnexal mass. A: dermoid B: ovarian cyst C: serous cystadenocarcinoma D: fibroid

B An ovarian cyst is the most common adnexal mass. The cystic teratoma (dermoid) is the most common solid ovarian tumor.

Benign unilocular cysts usually do not exceed a diameter of ____. A: 3cm B: 5cm C: 6cm D: 8cm

B Benign unilocular cysts usually do not exceed a diameter of 5cm. A cyst that is larger than 5cm is usually malignant.

All of the following are common sonographic signs of chronic PID, except: A: beads on a string sign B: endometritis C: tubular, thin walled, anechoic, avascular adnexal structure D: peritoneal inclusion cyst

B Chronic PID: hydrosalpinx, thin-walled fallopian tube (<5mm) Beads-on-a-string sign - remnants of the endosalpingeal folds demonstrate multiple 2-3mm nodules that project into the lumen A peritoneal inclusion cyst may also be seen as a loculated fluid collection surrounding the uterus and ovaries. Hydrosalpinx and pyosalpinx are differentiated from pelvic veins using color Doppler. Hydrosalpinx and pyosalpinx are differentiated from bowel loops by visualizing peristalsis within the bowel.

Which of the following ovarian tumors contains both epithelial and stromal components? A: serous cystadenoma B: cystadenofibroma C: mucinous cystadenoma D: thecoma

B Cystadenofibroma is composed of epithelial and stromal tissues of the ovary. Epithelial cells make up the cystadenoma. A thecoma is composed of theca cells.

Which of the following terms refers to pain associated with sexual intercourse? A: amenorrhea B: dyspareunia C: menorrhagia D: mittelschmerz

B Dyspareunia refers to pain associated with sexual intercourse. Amenorrhea refers to the absence of menstruation. Mittelschmerz refers to the pain associated with ovulation. Menorrhagia refers to excessive bleeding with menstruation.

Which of the following is not an expected finding with Fitz Hugh Curtis syndrome? A: peritonitis B: Krukenberg tumor C: inflammation Glisson's capsule D: PID

B Fitz Hugh Curtis syndrome involves a pelvic inflammatory disease that progresses into the right upper quadrant. Ascites forms in the Morrison pouch. Peritonitis can lead to the formation of perihepatic adhesions.

Perihepatic adhesions and peritonitis are seen with: A: serous cystadenoma B: Fitz-Hugh-Curtis syndrome C: dermoid cyst D: endodermal sinus tumor

B Fitz-Hugh-Curtis syndrome refers to PID that leads to inflammation of Glisson's capsule, peritonitis and perihepatic adhesions.

Which of the following statements best describes the findings on the image? A: there is a fibroid forming in the endometrial canal B: there is an endometrial polyp and a small amount of fluid in the endometrial canal C: there is a blighted ovum with a fetal pole and diminishing gestational sac D: there is mass of ectopic endometrium surrounded by a small amount of fluid in the endometrial canal due to endometriosis

B The endometrial canal is dilated with fluid. Note the visiblity of the smooth endometrial lining of the uterine cavity that demonstrates the presence of a mass within the canal. There is no sign of a decidual reaction or amniotic sac that would be seen with pregnancy. The hyperechoic mass of tissue, similar in appearance in normal endometrial tissue, has smooth, round borders and no posterior shadowing. Fibroids normally exhibit a different sonographic appearance and rarely form within the uterine cavity. The sonographic appearance of the mass and the location WITHIN the canal should lead you to a diagnosis of a polyp.

The findings on the image are expected in patients with: A: twin gestation B: ovarian hyperstimulation syndrome C: normal ovulation D: multiple large uterine fibroids

B The image demonstrates ascites with fluid in Morrison's pouch. It is a common finding with ovarian hyperstimulation syndrome, Meigs syndrome and Fitz Hugh Curtis syndrome.

A 25yr old presents with pelvic pain and hypermenorrhea with each menstrual cycle. Her LMP was 21 days ago and her cycle is usually regular at every 29 days. She has never been pregnant. the findings on the image are most suggestive of: A: thecoma B: endometrioma C: theca lutein cyst D: fibroma

B The patient has regular cycles that are painful and heavy which are symptoms of endometriosis. The ovary demonstrates several cysts with homogeneous internal debris (blood). An endometrioma is also called a chocolate cyst.

Hematometra refers to ____, while hematometrocolpos refers to ____. A: blood dilating the uterine cavity; pus dilating the uterine cavity B: blood dilating the uterine cavity, cervix and vagina; blood dilating the uterine cavity C: blood dilating the uterine cavity; blood dilating the uterine cavity, cervix and vagina D: pus dilating the uterine cavity; blood and pus dilating the uterine cavity

C -colpos = accumulation of fluid, blood and/or pus in the vagina due to obstruction of genital tract -metra = accumulation of fluid, blood and/or pus in the uterine cavity due to obstruction of genital tract -metrocolpos = accumulation of fluid, blood and/or pus in the vagina, cervix and uterine cavity due to obstruction of genital tract Hydro- = fluid Hemato- = blood Pyo- = pus Hematometrocolpos (blood fills the uterine cavity, cervix and vagina) is commonly caused by imperforate hymen Hematometra - demonstrates enlarged uterus, fluid filled uterine cavity with low level echoes, normal vagina/cervix Pyometra and pyometrocolpos are related to fever, leukocytosis, PID

All of the following are common sonographic signs of acute PID, except: A: free fluid in the pelvis B: > or = 5mm wall thickness of the fallopian tube C: thin walled, anechoic avascular adnexal structure D: cogwheel sign

C 4 Stages of PID: Stage 1: acute endometritis Stage 2: acute salpingitis - thick-walled with acute infection (>5mm); cogwheel sign Stage 3: acute tubo-ovarian abscess Stage 4: chronic infection; hydrosalpinx with thin-walled fallopian tube (<5mm); beads-on-a-string sign

A patient presents for a pelvic ultrasound with a history of GI tract carcinoma. Which of the following is a potential sonographic finding on the pelvis? A: lymphadenopathy and bilateral ovarian cyst formation B: Krukenberg tumor of the ovary and peritoneal cysts C: lymphadenopathy and Krukenberg tumor of the ovary D: lymphadenopathy and Brenner tumor of the ovary

C A Krukenberg tumor of the ovary is a metastatic tumor most commonly from a GI primary. Lymphadenopathy refers to the enlargement of lymph nodes. This is a common finding in the area of a malignancy. The liver should also be evaluated for metastasis in cases of Krukenberg tumor formation.

Which of the following is a failure of fusion defect of the uterus that is commonly associated with ipsilateral renal agenesis? A: arcuate uterus B: septate uterus C: bicornuate uterus D: imperforate hymen

C A bicornuate uterus is a failure of fusion defect. The two mullerian ducts do not fuse properly and there are two separate uterine tracts with a bicornuate uterus. 80% of cases of bicornuate uterus are associated with renal defects, typically ipsilateral agenesis. An arcuate uterus and septate uterus are failure of resorption defects. Most uterine defects are associated with abnormal developments in the urinary system.

What type of fibroid is seen on the image displayed? A: intramural B: pedunculated C: subserosal D: submucosal

C A fibroid that has formed just beneath the endometrial layer of the uterus is referred to as submucosal. Fibroids that form within the muscle layer are termed intramural fibroids. If the fibroid forms just beneath the outer uterine layer it is referred to as a subserosal fibroid. Least commonly, pedunculated fibroids form adjacent to the uterus and are only attached with a small stalk.

Which of the following is associated with precocious puberty? A: mucinous adenoma B: cystic teratoma C: granular cell tumor D: serous adenoma

C A granular cell tumor secretes estrogen that causes postmenopausal bleeding and breast changes. If found in young patients, it leads to precocious puberty.

A 64 year old female presents for a pelvic ultrasound due to pain and bloating. She has no surgical history and takes no medications. The ultrasound exam demonstrates a normal uterus, left ovary, and a single 5cm unilocular, anechoic cyst of the right ovary. These findings are most suggestive of: A: functional cyst B: mucinous cystadenoma C: serous cystadenoma D: papillary cystadenoma

C A large, anechoic, unilocular cyst in a postmenopausal woman is most likely a serous cystadenoma. Although serous cystadenoma are more prevalent in women 20-50, they can occur in postmenopausal women. A postmenopausal patient that is not taking hormones or other medications that might influence ovarian function will not have a functional cyst. Papillary cystadenoma will demonstrate papillary excrescences. Mucinous cystadenoma will demonstrate loculations and internal debris.

A peritoneal inclusion cyst is commonly associated with: A: a congenital malformation B: multiple vaginal births C: prior c-section D: serous cystadenocarcinoma

C A peritoneal inclusion cyst is commonly associated with pelvic surgery. A simple cystic structure forms within the peritoneum after post-surgical healing occurs. The cyst is not related to the ovary or ovarian fossa but is related to the area of the prior surgery.

A 20 year old female complains of dysmenorrhea and menorrhagia. She states her menstrual cycle occurs every 28 days and her LMP was 21 days ago. The image displayed is from the transvaginal scan performed for this patient. Which of the following is the most likely diagnosis for the findings displayed? A: hematometrocolpos B: pyosalpinx C: endometrioma D: adenocarcinoma

C Adenocarcinoma usually affects the uterus and cystadenocarcinoma affects the ovaries and has a complex appearance. Pyosalpinx would present as an infection and demonstrate fluid collections and debris levels in structures adjacent to the ovary. The image displays an endometrioma with homogeneous texture and mild posterior enhancement. Painful, heavy bleeding is also consistent with endometriosis.

A 30yr old female presents for a pelvic ultrasound due to amenorrhea. She states her cycles slowed and stopped over the last few months. She also complains of reduced breast size. These clinical findings are most suggestive of: A: fibroma B: thecoma C: arrhenoblastoma D: teratoma

C Arrhenoblastoma is also known as a Sertoli-Leydig cell tumor. It is usually benign and occurs in premenopausal patients, age 20-40yrs. The tumor causes increased testosterone levels which can lead to masculinization (virilization). Oligomenorrhea occurs as the tumor grows and testosterone increases, amenorrhea develops. Virilization refers to a female that develops male sex characteristics, such as hirsutism, male pattern baldness, voice deepening and breast atrophy.

What is the most common cause for postmenopausal bleeding? A: fibroids B: endometrial hyperplasia C: endometrial atrophy D: endometrial adenocarcinoma

C As the endometrium atrophies and thins in the postmenopausal patient, a small amount of vaginal bleeding can occur. This is the most common cause of postmenopausal bleeding. Ultrasound will demonstrate an endometrium <5mm in thickness if the bleeding is due to normal changes with menopause.

Which of the following is the leading cause of infertility? A: tubal damage from PID B: sperm abnormalities C: anovulation D: endometriosis

C Causes of infertility include ovulation difficulties, endometriosis, fibroids, tubal damage, abnormal sperm, and IUD. Ovulatory difficulties are the msot common cause.

Which of the following findings is most suggestive of cervical stenosis in a 64 year old female? A: hydrometrocolpos B: hydrosalpinx C: hydrometra D: hematometrocolpos

C Cervical stenosis refers to narrowing of the cervical canal. It can be caused by tumors, infection, polyps, scar tissue formation prior surgery or radiation therapy. In postmenopausal patients, it can cause amenorrhea and hematometra. Because the blockage is at the cervix, the vagina would not be dilated with fluid accumulation from the blockage = no hematometrocolpos or hydrometrocolpos.

Chronic pelvic inflammatory disease can lead to: A: an emergency salpingectomy B: an emergency hysterectomy C: the formation of cervical polyps D: the formation of a uterine septum

C Chronic PID leads to hydrosalpinx, thin-walled, nodular fallopian tube, and peritoneal inclusion cyst formation. It has also been associated with cervical polyp formation.

Congenital uterine anomalies can be caused by improper fusion of the ____. A: Meckel ducts B: Nabothian ducts C: Mullerian ducts D: Gartner ducts.

C Congenital uterine anomalies are caused by improper formation, fusion, separation or absence of the Mullerian ducts.

A ____ fibroid is located beneath the endometrium and a ____ fibroid is located within the myometrium. A: subserosal, submucosal B: subserosal, submucosal C: submucosal, interstitial D: pedunculated, subserosal

C Fibroids: Submucosal - beneath the endometrium Interstitial - within the myometrium (also called intramural) Subserosal - beneath the outer layer of the uterine wall (the serosa) Pedunculated - attached by a stalk to the uterus

A negative urine sliding sign is most suggestive of: A: bicornuate uterus B: normal anatomy C: extrapelvic endometriosis D: pelvic inflammatory disease

C In patients with suspected endometriosis, the uterine sliding technique can be performed to evaluate extrapelvic involvement. Gentle transducer pressure is applied to evaluate the motion of the rectum across the posterior aspect of the uterus and cervix. The sliding sign is positive of normal motion is observed. If no motion is observed, extrapelvic endometriosis is suspected and laparascopy will be performed.

Which of the following has the lowest risk of torsion? A: 4cm solid ovarian mass B: 4cm cystic ovarian mass C: 4cm subserosal fibroid D: 4cm pedunculated leiomyoma

C Large ovarian masses and pedunculated leiomyomas have an increased risk of torsion. A subserosal fibroid is within the myometrium, beneath the uterine serosa. The risk of torsion is extremely low.

A 55 year old female presents for a follow up pelvic ultrasound due to pelvic pain, vaginal spotting and an enlarged uterus on clinical examination. The prior exam 4 months ago demonstrated a 4cm intramural fibroid and 6mm endometrium. She has no history of hormone replacement therapy, but does take tamoxifen regularly. The current ultrasound exam demonstrates a 7mm endometrium and a 6cm intramural, non-circumscribed, heterogenous, hypoechoic mass in the body of the uterus. These findings are most suggestive of: A: leiyomyoma B: adenocarcinoma C: leiomyosarcoma D: cervical carcinoma

C Leiomyosarcoma is a rare, malignant tumor of myometrium. They are usually found in females in their mid 50s. Other risk factors include nulliparity, obesity, radiation therapy and tamoxifen use. The symptoms are very similar to a benign leiomyoma and they are very hard to differentiate from benign leiomyoma sonographically. They do demonstrate a rapid increase in size with degenerative changes and internal necrosis. They are typically an intramural mass with blurred borders due to infiltration. The pelvic region should be evaluated for metastasis and lymphadenopathy.

Risk factors associated with leiomyosarcoma include nulliparity, obesity, prior history of pelvic radiation and: A: prior C-section B: recurrent pelvic inflammatory disease C: tamoxifen use D: polycystic ovarian disease

C Leiomyosarcoma is a rare, malignant tumor of myometrium. They are usually found in females in their mid 50s. Other risk factors include nulliparity, obesity, radiation therapy and tamoxifen use. The symptoms are very similar to a benign leiomyoma. They are very hard to differentiate from benign leiomyoma sonographically. They do demonstrate a rapid increase in size with degenerative changes and internal necrosis. They are typically an intramural mass with blurred borders due to infiltration. The pelvic region should be evaluated for metastasis and lymphadenopathy.

Which of the following is a part of Meigs syndrome? A: leiomyomas and hydronephrosis B: renal agenesis C: ascites and pleural effusion D: ascites, pleural effusion and scalp edema

C Meigs syndrome = pelvic ascites and pleural effusion with benign ovarian tumor, most commonly a fibroma.

Most primary malignancies of the ovary originate in the ____. A: space between the fimbriae of the fallopian tube and the ovary B: medulla tissues C: epithelial-stromal tissues D: lateral region of the ovary

C Most primary malignancies of the ovary originate in the epithelial-stromal tissues. Serous, mucinous, endometrioid, transitional cell and clear cell tumors are epithelial-stromal tumors.

A 26 yr old female presents with pelvic pain and prior left oophorectomy due to cyst formation. What abnormality is indicated by the calipers on the image? A: the calipers are measuring a large echogenic mass with dirty shadowing which most likely represents a large fecalith in the bowel B: the calipers are measuring a large echogenic mass with dirty shadowing which most likely represents an obstruction in the bowel C: the calipers are measuring a large echogenic mass with posterior shadowing which most likely represents a dermoid cyst D: none of the above

C Note the classic "tip of the iceberg" sign of the dermoid within the ovarian tissue. Note the small area of visible ovarian tissue with follicles adjacent to the echogenic dermoid formation.

Which of the following statements about polycystic ovarian disease (PCOD) is false? A: PCOD is a part of called Stein-Leventhal syndrome B: PCOD is identified sonographically as numerous small follicles in the ovary, usually located along the periphery C: PCOD is related to tachycardia, weight loss and HTN D: PCOD has been related to infertility issues

C PCOD usually seen with obesity, hirsutism, and excess body hair.

Which of the following can cause fibroid enlargement or endometrial thickening in a postmenopausal patient? A: ovarian theca lutein cyst B: cessation of estrogen replacement therapy C: ovarian thecoma D: cessation of tamoxifen treatment

C Tamoxifen and ERT cause bleeding in postmenopausal women. Stopping the therapy would reduce the chances of PM bleeding. Ovarian thecomas produce estrogen and if present in a menopausal patient, they could cause vaginal bleeding. The estrogen levels can also cause fibroids to grow.

An ovarian mass with the dot-dash pattern internally is most likely: A: a mucinous adenocarcinoma B: a dysgerminoma C: a teratoma D: a mucinous adenoma

C The dot-dash pattern refers to the sonographic appearance of the dermoid mesh. Short and long echogenic lines caused by hair in the mass can be identified in an ovarian teratoma.

The image of the cervix demonstrates which of the following? A: normal cervix with echogenic area due to perpendicular incidence with two layers of the cervical canal B: normal cervix with normal placement of an IUD C: normal cervix with abnormal placement of an IUD D: normal cervix with tampon inserted

C The echogenic linear structure within the cervix is consistent with an IUD. The uterine fundus is the correct location for the IUD.

What type of fibroid is seen in the image displayed? A: subserosal B: pedunculated C; submucosal D: intramural

C The fibroid has formed just beneath the endometrial layer of the uterus which is referred to as submucosal. Fibroids that form within the muscle wall layer are termed intramural fibroids. If the fibroid forms just beneath the outer uterine layer it is referred to as a subserosal fibroid. Least commonly, pedunculated fibroids form adjacent to the uterus and are only attached with a small stalk.

All of the following are associated risk factors for the findings displayed, except: A: estrogen replacement therapy B: polycystic ovarian disease C: multiparous D: tamoxifen therapy

C The image demonstrates uterine adenocarcinoma. Nulliparous women have shown a much higher incidence of adenocarcinoma. A multiparous woman would have a low risk of incidence of the abnormality. There are several other factors increase the risk of endometrial cancer, such as taking estrogen after menopause, birth control pills, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnany, obesity, certain ovarian tumors, and polycystic ovarian syndrome.

Uterine and/or vaginal prolapse is associated with weakness of which pelvic muscles? A: obturator internus B: piriformis C: levator ani D: rectus abdominis

C The levator ani and coccygeus muscles form the floor of the pelvis. If these muscles weaken, prolapse of the pelvic organs can occur.

Acute ovarian torsion: A: will present as an atrophied ovary with no blood flow detected by color Doppler B: is most common in postmenopausal patients C: is considered a critical finding that requires immediate intervention D: is associated with large, pedunculated leiomyomas

C The ovary will enlarge in the acute phase of torsion due to obstructed outflow. Complete torsion will demonstrate an absence of blood flow in the ovary. Ovarian torsion is considered a critical finding that requires immediate intervention. It most commonly occurs in pediatric patients. Ovarian hyperstimulation syndrome and ovarian tumors increase the risk of torsion.

The whirlpool sign is demonstrated with: A: hydrosalpinx B: ectopic pregnancy C: ovarian torsion D: molar pregnancy

C The torsion of the vascular pedicle may appear as an ill-defined adnexal mass adjacent to the ovary. In cross section, the adjacent mass can have a target appearance = "whirlpool" sign.

Incomplete resolution of which embryologic structure can cause a cystic formation between the abdominal wall and the anterior bladder wall? A: ductus venosus B: umbilical vein C: urachus D: ectoderm

C The urachus is involved in urinary bladder development. Incomplete resolution of the urachus can leave a cystic remnant. A cystic mass identified between the anterior wall of the abdomen and the anterior wall of the bladder is referred to as a urachal cyst.

Which of the following maternal abnormalities can be caused by a large fibroid uterus? A: gestational diabetes B: systemic HTN C: hydronephrosis D: pulmonary vein dilatation

C The uterus can cause extrinsic compression of the distal ureters which causes hydronephrosis.

Formation of which of the following ovarian neoplasms is related to the function of the ovary? A: thecoma and fibroma B: mucinous cystadenocarcinoma C: corpus luteal cyst and theca lutein cyst D: fibroma and endodermal sinus tumor

C Theca lutein cysts and corpus luteal cysts form as a reaction to changes in the hormone levels in the body.

A T-shaped uterus is most commonly associated with: A: personal history of smoking B: personal exposure to diethylstilbestrol C: maternal exposure to diethylstilbestrol D: maternal alcohol abuse

C Women took diethylstilbestrol to prevent spontaneous abortion 1940 - 1960. Daughters of these women have demonstrated uterine anomalies including a T-shaped uterus.

A paraovarian cyst is also known as: A: Morgagni or Gartner duct cyst B: Gartner duct or mesonephric cyst C: meonephric cyst or Nabothian cyst D: Morgagni or mesonephric cyst

D A Gartner duct cyst is located in the vaginal tract. Paraovarian cysts arise from the tissues of the broad ligament, composed of predominantly mesothelium. They can also form paramesonephric cysts AKA Mullerian cysts and mesonephric or fallopian tube remnants (mesonephric cyst or Wolffian cyst). A hydatid cyst of Morgagni is an acquired cyst of the broad ligament.

A Rokitansky nodule is commonly identified with what type of pelvic mass? A: serous cystadenoma B: mucinous cystadenoma C: focal adenomyosis D: cystic teratoma

D A Rokitansky nodule is another term used to describe the dermoid plug.

A hypoechoic mass with benign characteristics is identified in the right ovary of a 60yr old female. Her lab results demonstrate moderate levels of estrogen in the blood. Which of the following is a differential for these findings? A: Krukenberg tumor B: Brenner tumor C: androblastoma D: granulosa cell tumor

D A granulosa cell tumor, AKA theca cell tumor, is most commonly a unilateral finding of a hypoechoic mass in a postmenopausal woman. The tumor is most commonly benign and produces estrogen.

A patient presents for an ultrasound due to the uterine size not matching the high levels of bhCG for expected age of the pregnancy. The uterus is enlarged with a heterogeneous mass in the uterine cavity that appears to have invaded the uterine wall into the peritoneum. The pelvic nodes appear normal and the liver is clear. These findings are most consistent with: A: choriocarcinoma B: retained products of conception C: hydatidiform mole D: chorioadenoma destruens

D A hydatidiform mole is contained within the uterus. Chorioadenoma destruens refers to an invasive malignant molar pregnancy. The mass of abnormal tissue will usually only invade the uterus and surrounding pelvic structures. Choriocarcinoma can have the same heterogeneous appearance but normally spreads through the uterus and metastasizes to the liver.

A patient presents with an LMP 7 weeks ago. Her chart shows she has been treated three times for PID over the last 4 years. This patient has an increased risk of ____. A: molar pregnancy due to the possible fibrosis of the tubes and uterine cavity from the PID B: spontaneous abortion due to the fibrosis of the uterine cavity from the PID C: conjoined twins due to the possible adhesions in the uterus from the PID D: ectopic pregnancy due to possible tubal adhesions from the PID

D A patient presents with an LMP 7 weeks ago. Her chart shows she's been treated three times for PID over the last 4 years. This patient has an increased risk of ectopic pregnancy due to possible tubal adhesions from the PID.

Which uterine abnormality is described as causing a swiss cheese appearance of the uterus on ultrasound? A: choriocarcinoma B: chorioangioma C: placenta accreta D: adenomyosis

D Adenomyosis refers to the abnormal location of endometrial tissue within the myometrium. Classic signs include subendometrial echogenic nodules and/or small myometrial cysts / sub endometrial cysts. This leads to a "holey" or swiss cheese" appearance.

Which of the following symptoms is associated with hematometrocolpos? A: menometrorrhagia B: dyspareunia C: menorrhagia D: amenorrhea

D Amenorrhea refers to the absence of menstruation. If the vaginal opening is blocked, blood from menses will collect in the vagina, cervix and uterus.

An endometrial polyp would be described as: A: malignant overgrowth of the endometrial tissue B: stage I of PID C: stage I of endometrial adenocarcinoma D: focal hypertrophy of the endometrium

D An endometrial polyp is a focal benign overgrowth of the endometrium. They can be single or multiple. The patient may present with abnormal bleeding and infertility history.

All of the following sonographic findings are associated with ovarian hyperstimulation syndrome, except? A: ascites B: pleural effusion C: bilateral ovarian enlargement >5cm D: increased echogenicity of the ovaries

D Ascites and pleural effusion can be associated with ovarian hyperstimulation due to changes in blood and reduced renal filtration function. The ovaries are enlarged bilaterally (>5cm) with the formation of numerous cysts over 2cm.

Ascites is a complication of ____, while pseudomyxoma peritonei is a complication of ____. A: endometriosis; endometritis B: thecoma; fibroma C: serous cystadenocarcinoma; arrhenoblastoma D: serous cystadenocarcinoma; mucinous cystadenocarcinoma

D Ascites is a complication of serous cystadenocarcinoma, while pseudomyxoma peritonei is a complication of mucinous cystadenocarcinoma.

____ syndrome refers to intrauterine adhesions of the endometrial lining caused by C-section or D&C. A: DiGeorge B: Fitz-Hugh-Curtis C: Mirizzi D: Asherman

D Asherman syndrome refers to intrauterine adhesions of the endometrial lining caused by C-section of D&C. It is related to reduced fertility and increased risk of miscarriage.

What congenital abnormality is seen on the image? A: uterine subseptus B: uterine bicornis bicollis C: uterine arcuatus D: uterine bicornis unicollis

D BiCORNis - 2 uterine horns UniCOLLis - one cervix

Cervical carcinoma is ____, while endometrial carcinoma is ____. A: treated by uterine artery ablation; treated by endometrial ablatio B: most common in postmenopausal women; most common in premenopausal women C: treated by surgical removal, treated by dilatation and evacuation D: most common in premenopausal women, most common in postmenopausal women

D Cervical carcinoma is most common in premenopausal women, while endometrial carcinoma is most common in postmenopausal women. Both are treated by surgical intervention and possible radiation or chemotherapy.

A 45 year old female presents for a pelvic ultrasound due to dysmenorrhea for 2 cycles. She recently finished 6 weeks of radiation treatment for a mass in the sacrum. Lab testing demonstrates normal findings, but leukopenia is present. What is the most likely cause of the findings on the image? A: pelvic inflammatory disease B: imperforate hymen C: endometrial carcinoma D: cervical stenosis

D Cervical stenosis refers to narrowing of the cervical canal caused by inflammation and scar tissue. It is caused by tumors, infection, polyps, scar tissue formation from radiation therapy or prior surgery. Fluid is retained in the endocervical canal - hydrometra Blood retained in the endocervical canal - hematometra Pus formation in the endometrial canal - pyometra Recent radiation treatment of the pelvic area can cause inflammation in surrounding tissues. The echogenic fluid in the endocervical canal indicates a low blood cell count, which is common after radiation therapy. An infection would demonstrate leukocytosis.

The most common complication of a germ cell tumor of the ovary is: A: adhesions B: infertility C: rupture D: torsion

D Cystic Teratoma (Dermoid Cyst): Most common benign neoplasm of the ovary Most common occurring germ call tumor of the ovary Most common complex mass during pregnancy Contains ectodermal elements - skin, hair, teeth, and fat Usually found in women of child bearing age Usually asymptomatic Slow growing Usually unilateral and almost always benign Most common complication is torsion Leakage can result in peritonitis

Which of the following terms refers to excessive menstrual bleeding? A: mittleschmerz B: amenorrhea C: dyspareunia D: menorrhagia

D Dyspareunia refers to pain associated with sexual intercourse. Amenorrhea refers to the absence of menstruation. Mittelschmerz (incorrectly spelled, BTW), refers to the pain associated with ovulation. Menorrhagia refers to excessive bleeding with menstruation.

Which of the following ovarian neoplasms is composed of ectodermal tissues? A: Brenner tumor B: mucinous cystadenoma C: serous cystadenoma D: cystic teratoma

D Ectodermal tissue refers to teeth, hair, bone tissue. A cystic teratoma (dermoid) is composed of a mixture of ectodermal tissue.

Which ovarian tumor causes serum levels of alpha fetoprotein to rise? A: dysgerminoma B: Krukenberg tumor C: mucinous cystadenocarcinoma D: yolk sac tumor

D Endodermal sinus tumor, AKA yolk sac tumor, is highly malignant. They usually present in adolescence and cause increased AFP levels in the blood. The other choices are related to elevated CA125 levels.

When comparing the sonographic appearance, a thecoma resembles a/an ____ and a granulosa cell tumor resembles a/an ____. A: androblastoma; mucinous cystadenoma B: fibroma; dermoid tumor C: dermoid tumor; fibroma D: fibroma; androblastoma

D Fibromas and thecomas are generally hypoechoic with posterior shadowing. Granulosa cell tumors and androblastomas are generally complex with cystic components.

The image demonstrates findings associated with a prior uterine procedure. What procedure did the patient have? A: Essure implants B: dilatation and evacuation C: cerclage insertion D: C-section

D Note the abnormal course of the endometrial canal as it reaches the cervix. There is a mild upward curve at the junction. The myometrial outline is also blurred in the area. This is the classic appearance of a normal C-section scar. Essure implants require a coronal view for visualization. A cerclage is removed at delivery.

A patient presents with menorrhagia and mild midline, lower pelvic pain. The most likely diagnosis for the findings on the image is: A: fibroid formation B: hydatidiform mole C: leiomyosarcoma D: adenomyosis

D Note the mottled appeaerance of the myometrium. Adenomyosis can lead to a swiss cheese appearance of the uterus.

A patient presents with amenorrhea and hirsutism. If the right ovary has the same appearance, which of the following could be used to describe the findings on the image? A: normal ovary with multiple follicles B: partial ovarian torsion C: ovarian hyperstimulation D: possible Stein-Levanthal syndrome

D Note the multiple small follicles that are lining the periphery of the ovary. Bilateral PCOD is also known as Stein-Levanthal syndrome. Stein-Leventhal syndrome includes PCOD, amenorrhea, hirsutism and obesity. Ovarian hyperstimulation leads to the formation of multiple dominant follicles.

Which of the following is true regarding differentiation of a submucosal fibroid from an endometrial polyp? A: fibroids always form within the tissue, while polyps always form on a thin stalk B: hypersalpingography can be used to effectively differentiate a fibroid from a polyp in nearly all patients C: multiple fibroids usually form, while polyps usually are solitary in formation D: fibroids are normally more hypoechoic, while polyps tend to be more hyperechoic

D Polyps can be single or multiple and usually appear isoechoic or hyperechoic to the endometrium. Submucosal fibroids are usually hypoechoic to the surrounding tissues. Saline sonohysterography can be used to differentiate a submucosal fibroid from a polyp.

Pseudomyxoma peritonei is a complication of which type of ovarian tumor? A: dermoid cyst B: serous cystadenoma C: endodermal sinus tumor D: mucinous cystadenocarcinoma

D Pseudomyxoma peritonei is a complication of mucinous cystadenocarcinoma. The mucus secretions from the tumor enter the peritoneal cavity and compress the organs causing symptoms of pain, bowel obstruction, and/or urinary obstruction.

Which of the following patients has the highest risk of developing pyometra? A: 15 yr old female with an imperforate hymen B: 24 year old female with an IUD C: a 40 year old female with fibroids D: 70 year old female with uterine adenocarcinoma

D Pyometra refers to the accumulation of pus in the uterine cavity. The median age of presentation is 65 years. Most cases are in postmenopausal females with underlying uterine/endometrial malignancy. Other less common causes include foreign bodies, puerperal infections or uterine anomalies. Symptoms include purulent vaginal discharge and pelvic pain. It can lead to uterine rupture and peritonitis. Treatment involves removing the pus by drainage through the cervix and antibiotics. Any associated malignancy would need to be treated separately.

Virilization is associated with: A: Krukenberg tumor B: granular cell tumor C: endometrioma D: androblastoma

D Sertoli-Leydig cell tumor AKA androblastoma AKA arrhenoblastoma is an ovarian tumor that secretes testosterone. The testosterone levels cause hirsutism, male pattern baldness, decreased breast size and deepening of the voice.

Endometrial hyperplasia in a premenopausal female is diagnosed when the endometrial thickness in the secretory phase exceeds ____. A: 10mm B: 12mm C: 14mm D: 18mm

D The endometrium in the secretory phase is considered normal when the thickness is between 9 and 18mm.

What is the round, anechoic structure demonstrated on the image? A: a pedunculated ovarian cyst B: large nabothian cyst C: urinary bladder D: paraovarian cyst

D The image demonstrates a paraovarian cyst. A nabothian cyst would be found in the cervix. The bladder would demonstrate a thick muscular wall and would not normally be identified in this sagittal plane.

A 66yr old female presents for a pelvic ultrasound due to abnormal vaginal discharge, pelvic pain and bloating. The attached image is from the ultrasound exam. These findings are most suggestive of: A: pyometra and cervical carcinoma B: hematometra and an large endometrial polyp C: hydrometrocolpos and cervical carcinoma D: hydrometra and cervical carcinoma

D The image demonstrates cervical carcinoma, which is most common in postmenopausal women. Note the bladder anterior to the mass/cervix. Anechoic fluid is seen in the endometrial cavity due to the obstruction by the mass. Because the fluid is anechoic, and the patient is postmenopausal, it is most likely serous fluid and not menstrual blood or pus. -metra = uterus, -colpos = vagina. The fluid is only present in the uterus because the cervix is blocked. The patient has cervical cancer and hydrometra.

What is the most common cause for pelvic inflammatory disease? A: tuberculosis B: poor hygiene C: bladder infection D: chlamydia

D The most common cause for pelvic inflammatory disease is chlamydia.

The most common type of müllerian duct anomaly is: A: uterine didelphys B: bicornuate uterus C: arcuate uterus D: septate uterus

D The most common type of müllerian duct anomaly is septate uterus or uterine septus. Bicornuate uterus is the most common anomaly of FUSION but not the most common uterine anomaly overall.

A 30yr old patient presents with pelvic pressure and dyspareunia for a pelvic ultrasound, 1 year post hysterectomy. Which of the following statements best describes the findings displayed? A: a large complicated nabothian cyst is present B: there is a large chronic hematoma remaining in the cervix C: there has been fibroid formation within the remaining uterine tissue left behind unintentionally D: there is a solid mass in the cervix, most likely carcinoma

D The solid mass is too homogeneous to be a fibroid forming in the remaining tissues. A hematoma and a nabothian cyst would both present with a different appearance and varying enhancement. The image displays a solid tumor related to cervical carcinoma.

____ and granulosa cell tumors are benign ovarian neoplasms that secrete estrogen. A: mucinous cystadenomas B: fibromas C: Sertoli Leydig cell tumors D: thecomas

D Thecomas and granulosa cell tumors are benign ovarian neoplasms that secrete estrogen.

Which of the following is not a defect caused by failure of fusion of the Mullerian ducts? A: uterine bicornis, bicollis B: uterine bicornis, unicollis C: uterine didelphys D: uterine arcuatus

D Uterine arcuatus is a failure of dissolution anomaly.

A patient presents for a pelvic ultrasound due to suspected uterine didelphys. If the exam is positive for the anomaly, what do you expect to find on the exam? A: single uterine body connected to two cervices and two vaginal canals B: a right and left uterine body, with a single cervix and vaginal canal C: a right and left uterine body and cervix that are both connected to a single vaginal canal D: a right and left uterine body, cervix and vaginal canal

D Uterine didelphys demonstrates two separate uterine bodies, cervices and vaginal canals.

Which of the images demonstrates an subseptate uterus? A B C D

Image A: subseptate uterus - note the distance measured from the cornual plane to the fundus is greater than 5mm. This measurement is used to differentiate a septate uterus (complete or partial) from a bicornuate uterus. The angle between the horns is also acute with a depth to the endometrium estimated at greater than 1.5 cm. This method is used to differentiate a septate and arcuate uterus. Image B: bicornuate uterus - note the distance measured from the cornual plane to the fundus is less than 5mm. A septate uterus (complete or partial) has a greater than 5mm deistance to the fundus and a bicornuate uterus has a less than 5mm distance to the fundus. Image C: arcuate uterus - note the distance measured from the cornual plane to the fundus is greater than 5mm. This measurement is used to differentiate septate uterus (complete or partial) from a bicornuate uterus. The angle between the horns is also obtuse with a depth to the endometrium estimated at less than 1.5 cm. This method is used to differentiate a septate and arcuate uterus. Image D: normal uterus, no dip and rounded fundus.

Which of the images demonstrates an arcuate uterus? A B C D

Image A: subseptate uterus - note the distance measured from the cornual plane to the fundus is greater than 5mm. This measurement is used to differentiate a septate uterus (complete or partial) from a bicornuate uterus. The angle between the horns is also acute with a depth to the endometrium estimated at greater than 1.5 cm. This method is used to differentiate a septate and arcuate uterus. Image B: bicornuate uterus - note the distance measured from the cornual plane to the fundus is less than 5mm. A septate uterus (complete or partial) has a greater than 5mm deistance to the fundus and a bicornuate uterus has a less than 5mm distance to the fundus. Image C: arcuate uterus - note the distance measured from the cornual plane to the fundus is greater than 5mm. This measurement is used to differentiate septate uterus (complete or partial) from a bicornuate uterus. The angle between the horns is also obtuse with a depth to the endometrium estimated at less than 1.5 cm. This method is used to differentiate a septate and arcuate uterus. Image D: normal uterus, no dip and rounded fundus.