OBGYN Ch 43 Test Review

4. Hydrometra appears sonographically as a(n) _____ a. Sonolucent tubular structure in the adnexa b. Echogenic thickening of the endometrium c. Sonolucent fluid collection in the uterine canal d. Sonolucent fluid collection in the uterus, cervix, and vagina

ANS: C Fluid accumulation in the uterus is termed hydrometra

22. A 28-year-old woman reports left lower quadrant pain. Her last menstrual period was 2 weeks earlier. Sonographically, the uterine body displays a highly echogenic structure in the endometrial cavity. This appearance most likely represents which one of the following conditions? a. Endometritis b. Calcified submucosal fibroid c. Intrauterine contraceptive device (IUD) d. Calcified arcuate arteries

ANS: C Sonographically, an IUD appears as a highly echogenic structure in the endometrium of the uterine body.

6. Which one of the following conditions is described as a hyperplastic protrusion of the epithelium of the cervix that may be broad based or pedunculated? a. Cervical stenosis b. Pyometrium c. Cervical polyps d. Cervical obstruction

ANS: C a cervical polyp is a benign condition arising from the hyper plastic protrusion of the epithelium of the cervix

3. Complications in delivery may occur with pregnancy if a fibroid is located in or near which one of the following structures? a. Near the fundus b. Pedunculated off the fundus c. Near the cervix d. Near the ovary

ANS: C a fibroid locates in the lower uterine segment or cervix may interfere with a normal vaginal delivery

9. Which one of the following is most likely the result of an acquired condition with obstruction of the cervical canal? a. Leiomyoma b. Cervical c. Cervical stenosis d. Adenomyosis

ANS: C an acquired condition with obstruction of the cervical canal is most likely a result of cervical stenosis at the internal or external os. This condition may be a result of radiation therapy, previous come biopsy, postmenopausal cervical atrophy, chronic infection, or cervical carcinoma

15. Uterine arteriovenous malformation (AVM): a. Involves the endometrium b. Can be managed with dilation and curettage (D&C) c. Involves the myometrium d. Is always acquired

ANS: C uterine AVM usually involves the myometrium, but rarely the endometrium. The condition is typically acquired but may be congenital. A D&C could lead to catastrophic hemorrhaging

8. A small percentage of leiomyomas is located in which one of the following structures? a. Body b. Fundus c. Myometrium d. Cervix

ANS: D A small percentage of leiomyomas is located in the cervix.

21, Patients on tamoxifen therapy have an increased risk of which one of the following reactions? a. Endometrial hyperplasia b. Endometrial polyp c. Endometrial carcinoma d. All of the above reactions

ANS: D An increased risk of endometrial carcinoma, hyperplasia, and polyp has been reported in patients on tamoxifen therapy.

2. Which one of the following is the most common site for a leiomyoma to occur? a. Submucosal b. Subserosal c. Pedunculated d. Intramural

ANS: D An intramural (confined to the myometrium) is the most common site of a leiomyoma.

24. In which of the following structures might a Gartner's duct cyst be found? a. Fallopian tube b. Ovary c. Cervix d. Vagina

ANS: D The Gartner's duct cyst is the most common cystic lesion of the vagina.

12. The most common cause of uterine calcification is which one of the following? a. Adenomyosis b. Endometriosis c. Arcuate artery calcification d. Myomas

ANS: D myomas are the most common cause of uterine calcifications. A less common cause is arcuate artery calcification, visualized in the periphery of the uterus

18. A 3-d ay postpartum woman complains of intense pelvic pain. Sonographically, the uterus appears hypoechoic with an irregular endometrium. This condition most likely represents which one of the following? a. Adenomyosis b. Degenerating submucosal leiomyoma c. Endometritis d. Endometrial hyperplasia

ANS: C A clinical sign of endometritis is intense pelvic pain. It occurs most often in association with PID, postpartum, or instrument invasion.

5. A benign invasion of endometrial tissue into the myometrium is known as which one of the following conditions? a. Endometriosis b. Pelvic inflammatory disease (PID) c. Adenomyosis d. Endomyosarcoma

ANS: C Adenomyosis is a benign disease, commonly diffuse, with global infiltration of the endometrium

20. Only ___% of women with postmenopausal bleeding have endometrial carcinoma . a. 10 b. 25 c. 50 d. 75

ANS: A Although postmenopausal bleeding is the most common clinical sign of endometrial carcinoma , only 10 % of women with postmenopausal bleeding have endometrial carcinoma.

14. Which one of the following statements about adenomyosis is false? a. Elevated progesterone levels may promote the growth of myometrial islands of endometrium b. Adenomyosis can be managed with hormone therapy. c. Adenomyosis may cause abnormal uterine bleeding. d. Adenomyosis may cause pelvic pain during menstruation.

ANS: A Elevated estrogen levels may also promote the growth of myometrial islands of endometrial tissue.

17. Endometrial hyperplasia develops from which one of the following? a. Unopposed estrogen stimulation b. Unopposed progesterone stimulation c. Follicular-stimulating hormone d. Endometrial polyp

ANS: A Endometrial hyperplasia develops from unopposed estrogen stimulation.

10. The size and shape of the normal uterus are related to all of the following except: a. Family history b. Age c. Hormonal status d. Parity

ANS: A The size and shape of the normal uterus are related to age, hormonal status, and parity.

11. Which one of the following locations of a fibroid will most likely cause heavy irregular uterine bleeding? a. Subserosal b. Submucosal c. Intramural d. Pedunculated

ANS: B A submucosal fibroid displaces or distorts the endometrial canal with subsequent irregular or heavy uterine bleeding.

1. The clinical signs of a 32-year-old woman with an enlarged uterus on physical examination and a history of cyclic profuse and prolonged bleeding with increasing pain most likely represent which one of the following? a. Early pregnancy b. Leiomyoma c. Ruptured nabothian cyst d. Ruptured follicular cyst

ANS: B Clinical signs of uterine leiomyoma include irregular bleeding, menorrhagia, an enlarged uterus, pelvic pain, and bladder symptoms.

13. On ultrasound, the characteristic appearance of a degenerating leiomyoma is _____ a. Homogeneous b. Heterogeneous c. Isoechoic d. Anechoic

ANS: B Degenerating leiomyomas demonstrate cystic degeneration and appear complex or heterogeneous

7. Which one of the following sonographic characteristics is the most common finding in endometrial carcinoma? a. Abnormal thinning of the endometrial cavity, usually with irregular bleeding in postmenopausal women b. Abnormal thickening of the endometrial cavity, usually with irregular bleeding in perimenopausal and postmenopausal women c. Irregular bleeding d. Heavy bleeding with a thickening of the myometrium

ANS: B In endometrial carcinoma, the most common sonographic finding is an abnormally thickened endometrium. The most common clinical symptom is irregular uterine bleeding.

19. In postmenopausal patients, an endometrial thickness of less than _____ millimeters (mm) reliably excludes an endometrial abnormality. a. 4 b. 5 c. 8 d. 10

ANS: B In postmenopausal patients, an endometrial thickness of less than 5 reliably excludes an endometrial abnormality

23. Irregular, acyclic bleeding is defined as which one of the following? a. Menorrhagia b. Metrorrhea c. Dysmenorrhea d. Amenorrhea

ANS: B Metrorrhea is defined as irregular, acyclic bleeding.

16. The endometrium should be measured from ____ layer to ____ layer. a. Hypoechoic; hypoechoic b. Hyperechoic; hyperechoic c. Hyperechoic; hypoechoic d. Hypoechoic; hyperechoic

ANS: B The functionalis layers (hyperechoic layers) are only included in the measurement. The hypoechoic basalis layer is not included in the endometrial measurement.

25. In a patient after an hysterectomy, the normal vaginal cuff should not exceed ____ centimeters (cm). a. b. 2 c. d. 4

ANS: B The upper normal limit of a vaginal cuff in a patient after an hysterectomy is 2.1 cm.