Penny Gynecology Study Q & A
During the secretory phase, the endometrial thickness typically ranges from:
7 mm to 14 mm
Which of the following ovarian masses would be most likely associated with Meigs syndrome?
Fibroma Benign ovarian masses that may be complicated by a condition known as Meigs syndrome, which is defined as ascites and pleural effusion in the presence of a benign ovarian tumor.
Which of the following is not associated with polycystic ovarian syndrome?
Menometrorrhagia Excessive bleeding from the uterus in duration and amount. Patients with PCOS typically have anovulatory cycles, infertility, hirsutism, amenorrhea and are obese.
Which of the following would be an associated clinical finding of a patient suffering from endometriosis?
Pelvic pain The common clinical findings of endometriosis include pelvic pain, dyspareunia, and infertility. Patient may also have dysmenorrhea, oligomenorrhea, painful bowel movements, or may be completely asymptomatic.
Which of the following statements is true concerning the normal prepubertal uterus?
The cervix is larger than the uterine fundus
Which hormone encourages the induction of salt and water retention, and stimulates contractile motions to occur within the uterine myometrium and the fallopian tubes?
Estrogen
All of the following are true statements concerning leiomyosarcoma except:
Leiomyosarcoma is a benign fibroid that contains varying amount of calcifications. The leiomyosarcoma is the malignant counterpart of the normally benign leiomyoma (fibroid).
Which of the following hormones is released by the anterior pituitary gland?
Luteinizing hormone The anterior lobe of the pituitary gland is responsible for the release of two chief hormones that influence the menstrual cycle: follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Follicular ovarian cysts result from:
Maintaining the graafian follicle
Which of the following would not be a clinical finding in a 13-year-old who is suffering from hematometrocolpos?
Menorrhagia
Which term is described as bleeding from the uterus at any time?
Metrorrhagia
While acquiring a 21-year-old patient's clinical history, you discover that she complains of pain at mid-cycle. This is termed:
Mittelschmerz
Upon ultrasound examination of the pelvis in a patient with free fluid, you discover that fluid has collected between the uterus and the rectum. All of the following are synonyms for this area except:
Morrison's pouch
Which of the following ovarian masses would be most likely associated with pseudomyxoma peritonei?
Mucinous cystadenocarcinoma The mucinous cystadenocarcinoma is associated with a condition known as pseudomyxoma peritonei, which describes the intraperitoneal extension of mucin-secreting cells that result from the rupture of this mucinous tumor.
A 26-year-old patient presents to the ultrasound department with a history endometriosis. Which of the following would be the least likely clinical finding for this patient
Multigravida
Which of the following is not associated with an increase in the likelihood of developing endometrial carcinoma?
Multiparity
Which of the following is true of Nabothian cysts?
Nabothian cysts are located within the cervix and are benign.
Which of the following pelvic muscles would be best described as the paired pelvic muscles located lateral to the ovaries?
Obturator internus muscles
Which of the following arteries supplies blood directly to the ovary?
Ovarian and uterine arteries
A 72-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of weight loss, pelvic pressure and swelling, and elevated CA 125. Which of the following would most likely be discovered during the sonogram?
Ovarian serous cystadenocarcinoma
Dyspareunia denotes:
Painful intercourse
Small cysts located adjacent to the ovary are referred to as:
Paraovarian cysts
Which of the following statements is not true concerning fibroids?
Patients who have fibroids rarely have adenomyosis. Adenomyosis is often present in the uterus afflicted with fibroid tumors
A 25-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of fever, chills, pelvic pain, purulent vaginal discharge, and elevated white blood cell count. Which of the following would be the most likely diagnosis?
Pelvic inflammatory disease
The late proliferative phase may be referred to as the:
Periovulatory phase The proliferative phase may be divided into two phases, early and late, with the late proliferative phase often being referred to as the periovulatory phase.
The endocrinologic ovarian disorder linked with infertility and chronic anovulation is:
Polycystic ovarian disease
A 29-year-old obese patient presents to the ultrasound department for a pelvic sonogram with a history of infertility. Sonographically, her ovaries appear enlarged and have multiple small cysts along their periphery. These findings are most suggestive of:
Polycystic ovary disease
A 6-year-old female patient presents to the ultrasound department for a pelvic sonogram. She has breast development and pubic and axillary hair. Which of the following would be the most likely cause of these clinical findings?
Precocious puberty
If a young lady does not experience menarche before age 16, she is said to have:
Primary amenorrhea May be caused by congenital abnormalities or congenital obstructions, such as an imperforate hyman
Which phase would the endometrium be in on day 8 of the menstrual cycle?
Proliferative phase
Which of the following is described as pus formation within the endometrium in the presence of pelvic inflammatory disease?
Pyometra
Which of the following pelvic muscles would be noted within the anterior body wall?
Rectus abdominis muscle The recuts abdominis muscle extend from the xyphoid process to the sternum to the pelvis in the midline
Endometrial polyps are best visualized with:
Saline infusion sonohysterography
The luteal phase of the ovarian cycle coincides with which phase of the endometrial cycle?
Secretory Following ovulation, the ovary begins the luteal phase, while the endometrium enters the secretory phase.
What phase of the endometrial cycle would a non-pregnant patient be in if her endometrium sonographically appeared thickened and echogenic?
Secretory phase Following ovulation, the secretory endometrium is maintained by the production of progesterone, as the endometrium becomes thickened and echogenic in appearance and measures between 7 and 14 mm.
An illness resulting from another disease, trauma, or injury describes what term?
Sequela
Which of the following would be described as the most common malignancy of the ovary?
Serous cystadenocarcinoma
Which laboratory value would be most likely elevated in the presence of an ovarian dysgerminoma?
Serum lactate dehydrogenase
The area located between the anterior wall of the urinary bladder and symphysis pubis that contains extraperitoneal fat is referred to as the:
Space of Retzius
Which of the following describes the stage ovarian carcinoma when the tumor involves one or both ovaries, with confirmed peritoneal metastasis outside of the pelvis and/or regional lymph node involvement?
Stage III
Which of the following would not be considered a risk factor for developing pelvic inflammatory disease?
Stein-Leventhal syndrome Stein-Leventhal, or polycystic ovary syndrome, is not associated with pelvic inflammatory disease. Previous history of PID, the utilization of an IUD, postabortion, post childbirth, douching, multiple sexual partners, and early sexual contact have all been established as risk factors for developing PID. PID may manifest after pelvis surgery, accompany tuberculosis, or occur in association with an abscessed appendix or ruptured colonic diverticulum.
Straight arteries
Supply blood to the basal layer of the endometrium
Which of the following would most likely lead to endometrial hyperplasia?
Tamoxifen Tamoxifen is a breast cancer drug that inhibits the effects of estrogen on the breast. It can cause endometrial hyperplasia
Which of the following is not true of the dysgerminoma?
The dysgerminoma is the second most common benign tumor of the ovary. IT is the most common malignant germ cell tumor of the ovary
The menstrual cycle commences with:
The first day of menstrual bleeding
Infertility is defined as:
The inability to conceive a child after 1 year of unprotected intercourse
Which of the following statements is not true concerning the ovaries?
The ovaries are exocrine glands that release estrogen and progesterone. The ovaries form in the upper abdomen and descend into the pelvis in utero. The ovaries are paired, oval shaped, intraperitoneal organs that have a dual blood supply from both the ovarian artery and ovarian branches of the uterine arteries. As endocrine glands, the ovaries are responsible for releasing estrogen and progesterone in varying amounts throughout the menstrual cycle.
Which of the following statements is not true of the ovarian thecoma?
Thecomas are malignant ovarian sex cord-stromal tumor. A thecoma is a benign ovarian sex cord-stromal tumor. Thecomas are most often found in postmenopausal women. They are estrogen-producing tumors; therefore, patients often complain of postmenopausal vaginal bleeding associated with the unconstrained estrogen stimulation upon the endometrium.
Which of the following statements is true of dermoids?
They are commonly found in the reproductive age group. May also be found in the postmenopausal age group. They are not malignant, but have malignant potential, and they do not produce estrogen.
A 31-year-old patient presents to the ultrasound department with a history of an adnexal mass discovered on a CT examination of the pelvis. Sonographically, only the anterior element of the mass is seen, while the greater part of the mass is obscured by shadowing. What are these sonographic findings indicative of?
Tip of the iceberg sign These findings are indicative of a cystic teratoma or dermoid mass of the ovary. The "tip of the iceberg" sign denotes the sonographic appearance of the mass when only the anterior element of the mass is seen, while the greater part of the mass is obscured by shadowing.
Which of the following is described as the development of adhesions within the pelvis that lead to the fusion of the ovaries and the tubes?
Tubo-ovarian complex As PID progresses and reaches beyond the fallopian tubes, the ovaries and peritoneum become involved. Consequently, adhesions develop within the pelvis that lead to the fusion of the ovaries and the dilated tubes, a condition known as tubo-ovarian complex.
Which of the following supplies blood to the ovary?
Uterine artery The ovaries have a dual blood supply. Each ovary receives its nourishment from an ovarian artery and a uterine artery.
Which of the following would be described as a benign, smooth muscle tumor of the uterus?
Uterine leiomyoma A leiomyoma is a benign, smooth muscle tumor of the uterus that may also be referred to as a fibroid or uterine myoma
Which of the following is not a division of the uterus?
Vagina
The most common initial clinical presentation in the early stages of pelvic inflammatory disease is:
Vaginitis
Spiral arteries
supply blood to the decidual or functional layer or the endometrium
What hormone, when unimpeded and allowed to be produced in excess, increases the likelihood of developing endometrial carcinoma?
Estrogen
A 34-year-old patient presents to the ultrasound department for a pelvic ultrasound. According to her last menstrual period, she is on day 12 of her current cycle. Sonographically, you visualize a 2.3 cm round, anechoic structure on the left ovary. Which of the following is most likely?
Graafian follicle
Which of the following would be best described as the most proximal segment of the fallopian tube?
Interstitial
Which of the following is the most common location for a uterine leiomyoma?
Intramural Within the myometrium
Days 1 through 5 of the menstrual cycle correlate with:
Menses
What is the sonographic "string of pearls" sign indicative of?
Polycystic ovary disease
The type of ovarian cysts associated with ovarian hyperstimulation syndrome are most likely
Theca lutein cysts
The administration of diethylstilbestrol during pregnancy in the 1970's has been linked with:
Uterine malformation in the exposed fetus
A 55-year-old patient presents to the ultrasound department with a history of tamoxifen use. What sonographic endometrial appearance would be most likely demonstrated in this patient?
Diffusely heterogeneous and thickened endometrium
During which endometrial phase will the endometrium appear thin and echogenic?
Early proliferative Following menses, the endometrium appears as a thin, echogenic line. Thus, the early proliferative endometrium appears echogenic and thin and typically measures 4 mm and 8 mm on day 8 of the cycle.
hich of the following would not cause thickening of the endometrium?
Endometrial atrophy
What phase of the ovarian cycle would a non-pregnant patient be in if her endometrium sonographically appeared thickened and echogenic?
Luteal phase
A simple appearing cyst, that produces posterior enhancement, is discovered within the cervix of a patient who is complaining of menstrual discomfort. You suspect a Nabothian cyst. Which of the following is a true statement concerning Nabothian cysts?
Nabothian cysts are typically asymptomatic Nabothian cysts are common findings on a routine ultrasound exam. These benign retention cysts are located within the cervix and may cause cervical enlargement on physical examination.
Which uterine anomaly would be described as the uterus that has a normal uterine contour with an endometrium that branches into two horns?
Subseptate uterus
Days 15-28 of the menstrual cycle correlate with:
The luteal phase of the ovarian cycle. The second phase of the ovarian cycle, days 15-28, is termed the luteal phase. After the graafian follicle ruptures, it is temporarily turned into an endocrine gland in the form of the corpus luteum.
Which of the following statements is not true of theca lutein cysts?
Theca lutein cysts are large cysts that are frequently unilateral. These large cysts are frequently bilateral, multiloculated, and may reach sizes up to 15 cm. They are found in the presence of elevated levels of HCG, typically in excess of 100,000 mIU/mL. Multiple gestations would have higher levels of HCG and therefore increase the likelihood of developing theca lutein cysts. Patients who have such high levels of HCG may suffer from hyperemesis and complain of pelvic fullness. Large ovarian masses have the potential to cause ovarian torsion.
In the early proliferative phase, the endometrial thickness typically ranges from:
4 mm to 8 mm
The average age for menopause to occur is:
51
During the periovulatory phase, the endometrial thickness typically ranges from:
6 mm to 10 mm
Which of the following would be the most likely sonographic appearance of a fibroid?
A solid, hypoechoic mass that produces posterior shadowing
What clinical finding could be described as a change in menstrual bleeding patterns from either endocrine abnormalities or lesions within the uterus?
Abnormal uterine bleeding
Which of the following clinical findings is most indicative of ovarian torsion?
Acute unilateral pelvic pain
A 41-year-old multiparous patient presents to the ultrasound department for a pelvic sonogram with a history of dysmenorrhea, pelvic pain, and dyspareunia. The sonographic findings of this examination include an enlarged uterus, myometrial cysts, and thickening of the posterior myometrium. What is the most likely diagnosis?
Adenomyosis
The thickness measurement of the endometrium obtained with sonography should include all of the following except the:
Adjacent hypoechoic myometrium
A post pubertal patient with an ovarian yolk sac tumor would most likely have an elevation in what lab?
Alpha-fetoprotein
Which of the following is a clinical finding suspicious of Asherman syndrome?
Amenorrhea Asherman syndrome is the presence of intrautering adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilatation and curettage. The adhesions may cause amenorrhea, pregnancy
Which of the following is another name for the Sertoli-Leydig cell tumor of the ovary?
Androblastoma Sex cord-stromal ovarian neoplasm
Which of the following would not increase the likelihood of developing endometrial carcinoma?
Anorexia Endometrial carcinoma has been linked with unopposed estrogen therapy, nulliparity, obesity, chronic anovulation (Stein-Leventhal syndrome), estrogen-producing ovarian tumors, and the use of tamoxifen.
The space located between the posterior urinary bladder wall and the fundus of the uterus is the:
Anterior cul-de-sac
The typical position of the uterus is referred to as:
Anteversion
Which of the following would not be associated with endometrial thickening during menopause?
Atrophy of the endometrium
Which ovarian mass results from the retention of an unfertilized ovum that differentiates into the three germ cell layers?
Cystic teratoma The most common benign ovarian tumor is the cystic teratoma, or dermoid cyst. Dermoids result from the retention of an unfertilized ovum that differentiates into the three germ cell layers. Therefore, these germ cell tumors are composed of ectoderm, mesoderm, and the endoderm.
Which of the following would not be an associated clinical finding of an intramural uterine leiomyoma?
Dyspareunia
Which of the following is typically not a clinical manifestation of endometrial polyps?
Dyspareunia Dyspareunia, or painful intercourse, is not typically a clinical finding of endometrial polyps. Clinically, patients may present with menometrorrhagia and/or intermestrual bleeding, or may even be asymptomatic.
Which of the following would not cause thickening of the endometrium?
Endometrial atrophy
You are performing a pelvic sonogram on a 65-year-old patient for pelvic pain. The endometrial thickness appears symmetric, echogenic, and measures 5 mm. Which of the following statements is true?
Endometrial atrophy is the most likely cause of this appearance The endometrium will appear thin and will not measure more than 5 mm in the presence of endometrial atrophy. Endometrial carcinoma, a polyp, and hyperplasia typically lead to a thickening of the endometrium beyond 5 mm.
Which of the following is associated with polycystic ovary disease?
Endometrial carcinoma Polycystic ovarian disease (PCOD) is an endocrinologic ovarain disorder linked with infertility. Patients suffer from chronic anoculation as a result of hormonal imbalances. High levels of unopposed estrogen stimulation on the endometrium, as seen in patient suffering from PCOD, have also been linked to the subsequent development of endometrial and breast cancer.
A 45-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of intermenstrual spotting. Sonographically, a focal thickening of the endometrium is noted. What is the most likely diagnosis?
Endometrial polyp Clincally, patients with an endometrial polyp often present with intermenstrual bleeding. The sonographic appearance of an endometrial polyp ranges from a focal echogenic area of thickening within the endometrium if solitary and small, to diffuse thickening of the endometrium in the presence of multiple or large polyps.
Which of the following ovarian masses would be best described as a benign, blood-containing tumor that forms from the implantation of ectopic endometrial tissue?
Endometrioma An endometrioma is a benign, blood-containing tumor that forms from the implantation of ectopic endometrial tissue, a condition known as endometriosis.
What hormone initiates the proliferation and thickening of the endometrium by encouraging the growth and expansion of the spiral arteries and glands within the functional layer of the endometrium?
Estrogen Estrogen is initially produced by the theca internal cells of the secondary follicles during the first part of the menstrual cycle. During this phase, estrogen initiates the proliferation and thickening of the endometrium by encouraging the growth and expansion of the spiral arteries and glands within the functional layer of the endometrium.
The fingerlike projections that extend from the infundibulum are the:
Fimbria
The ovarian cycle consists of the:
Follicular phase and luteal phase
Which of the following is not a layer of the vaginal wall?
Fornix The vagina is composed of three layers: inner mucosal layer, middle muscular layer and an outer layer that may be referred to as the adventitia
Which of the following would be a true statement concerning the incidence of gynecologic malignancies?
Gynecologic malignancies typically occur after menopause
Upon endovaginal sonographic interrogation of the endometrium in a 29-year-old patient, a structure is noted with the endometrium that produces posterior shadowing and an "entrance and exit echo". What is the most likely etiology of this finding?
Intrauterine contraceptive device
Which of the following best describes a graafian follicle?
It is a secondary follicle
Why would a patient be given progesterone along with estrogen, instead of estrogen alone, for hormone replacement therapy?
Estrogen given in conjunction with progesterone decreases the likelihood of a patient developing endometrial carcinoma
A patient presents with a history of excessive bleeding at the time of menstruation in amount and duration. What term describes this clinical condition?
Menorrhagia
A 29-year-old patient presents to the ultrasound department with an indication of suspected endometriosis. Which of the following clinical findings would be least likely in a patient with endometriosis?
Multigravida
Stein-Leventhal syndrome is associated with:
Polycystic ovary disease Stein-Leventhal syndrome is associated with PCOD. Stein-Leventhal syndrome is characterized by amenorrhea, hirsutism, and obesity
A 28-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of infertility, dysmenorrhea, dyspareunia, and a palpable left adnexal mass. You suspect endometriosis. Sonographically, what is the most common sonographic appearance of the adnexal mass that will be identified in this patient?
Predominantly cystic mass with low-level internal echoes
Which of the following would be considered the endometrial phase on day 18 of the menstrual cycle?
Secretory phase The endometrial phases consist of a proliferative phase and secretory phase. The secretory lasts from days 14-28 of the menstrual cycle
Which of the following would be most likely seen in a patient with a human chorionic gonadotropin level of 100,000 mIU/mL?
Theca lutein cysts Largest and least common of the functional cysts. They are found in the presence of elevated levels of HCG, typically in excess of 100,000 mIU/mL
Monthly symptoms of menstruation without bleeding describes:
Cryptomenorrhea
A 60-year-old patient presents to the ultrasound department for vaginal spotting. Which of the following ovarian tumors could possibly be a cause of postmenopausal vaginal bleeding?
Granulosa cell tumor Because of its estrogen-producing potential, a granulosa cell tumor may cause postmenopausal patients to suffer from vaginal bleeding.
Arcuate arteries
Located along the periphery of the uterus
Stein-Leventhal syndrome is characterized by all of the following except:
Menorrhagia The syndrome associated with polycystic ovary disease is called polycystic ovarian syndrome or Stein-Leventhal syndrome. Stein-Leventhal syndrome is characterized by amenorrhea, hirsutism, and obesity.
A patient with the diagnosis of pelvic inflammatory disease presents to the ultrasound department for an abdominal sonogram. Fluid is noted between the right hepatic lobe and the right kidney. Which of the following is the name of this site?
Morrison pouch
Incomplete fusion, partial fusion, or agenesis of which of the following will result in an anatomic variant of the uterus, cervix, and/or vagina.
Mullerian ducts The uterus, vagina, and fallopian tubes develop from the paired mullerian ducts (paramesonephric ducts). Thus incomplete fusion, partial fusion, or agenesis of the mullerian ducts will result in an anatomic variant (congenital malformation) of the uterus, cervix, and/or vagina.
A 31-year-old patient presents to the ultrasound department for a pelvic sonogram from the emergency room with a history of pelvic tenderness, dyspareunia, vaginal discharge, and fever. Sonographically, the endometrium appears thickened and irregular. The borders of the uterus and ovaries appear ill-defined and fallopian tubes are dilated and filled with echogenic material. Which of the following is the most likely diagnosis?
Pelvic inflammatory disease With PID, the uterus may show signs of a thickened, irregular endometrium, which is often indicative of endometritis. The uterus and ovaries can also have ill-defined borders and the fallopian tubes may contain fluid. Echogenic fluid within the tube can be indicative of pyosalpinx. Patients can present with fever, pelvic tenderness, dyspareunia, vaginal discharge and fever.
This type of ovarian abnormality would be most likely seen in a patient suffering from gestational trophoblastic disease or ovarian hyperstimulation syndrome?
Theca lutein cysts Largest and least common of the functional cysts. They are found in the presence of elevated levels of HCG, typically in excess of 100,000 mIU/ml.
What is the most likely effect of postmenopausal hormone replacement therapy upon the sonographic appearance of the endometrium?
Thickens the endometrium to a variable degree Comparable with the endometrium in the premeonpausal female.
The uterus is considered to be:
A retroperitoneal organ bounded anteriorly by the urinary bladder and posteriorly by the rectum
Which of the following is typically not a cause of female infertility?
Adenomyosis
Rather than preventing pregnancy from occurring, uterine malformations often lead to repeated abortions as a result of structural abnormalities within the uterus. Which of the following is considered to be the most common structural defect of the uterus?
Bicornuate uterus
Which of the following is not a typical sonographic finding of adenomyosis?
Calcifications within the endometrium Calcifications within the endometrium are not a common sonongraphic feature of adenomyosis. Sonographically, the uterus typically appears diffusely enlarged and heterogeneous. There may be indistinct hypoechoic or echogenic areas scattered throughout the myometrium, with small myometrial cysts noted as well. Thickening of the posterior myometrium can also be recognized. There may also be an ill-defined interface between myometrium and endometrium.
Which of the following is considered to be the most common female malignancy in women younger than age 50?
Cervical carcinoma
Which of the following is not a commonly encountered intrauterine devices?
Copper 8
The physiologic cyst that forms after ovulation has occurred is termed the:
Corpus luteum
A 39-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of tubal ligation, vaginal bleeding, and a positive pregnancy test. Which of the following would be most likely?
Ectopic pregnancy
Which of the following would most likely not be a cause of abnormal uterine bleeding with increased endometrial thickening?
Endometrial atrophy Can cause abnormal uterine bleeding but does not cause the endometrium to thicken
Which hormone is responsible for the creation of multiple follicles on the ovary during the first half of the menstrual cycle?
Follicle stimulating hormone
The proliferative phase of the endometrial cycle coincides with which phase of the ovarian cycle?
Follicular Following menses, the ovary is within the follicular phase while the endometrium is within the proliferative phase
Which portion of the endometrium varies in thickness throughout the menstrual cycle?
Functional layer
Which of the following is not a typical clinical feature of a patient who has adenomyosis?
Infertility
The uterine arteries are branches of the:
Internal iliac arteries The paired right and left uterine arteries are branches of the internal iliac arteries. They supply blood to the uterus, the fallopian tubes, and the ovaries, and courses along the lateral aspect of the uterus within the folds of the broad ligaments.
During pregnancy, which of the following uterine divisions may be referred to as the lower uterine segment?
Isthmus
A 42-year-old patient presents to the ultrasound department with a history of a myomectomy and uterine artery embolization. These two procedures are used to treat:
Leiomyoma Myomectomy is the surgical removal of a fibroid and may be performed abdominally or laparoscopically. Another alternative treatment for fibroids involves uterine artery embolization, which is used to inhibit blood supply to the mass.
The ovary consists of two parts. Which portion contains the ovarian vasculature and lymphatics?
Medulla Ovary consists of an outer cortex and inner medulla. The medulla contains the ovarian vasculature and lymphatics, while the cortex involves the mass of the ovary and is the site of oogenesis.
A 26-year-old patient presents to the ultrasound department with a history endometriosis. Which of the following would be the least likely clinical finding for this patient?
Multigravida The age of the patienst iwth endometriosis at the time of diagnosis is typically between 25 to 35 years, with the common clinical findings being pelvic pain, dyspreunia, and infertility. Patient may also have dysmenorrhea, oligomenorrhea, painful bowel movements, or may be completely asymptomatic. Multigravida is defined as a pregnant woman with one or more previous pregnancies.
A 29-year-old patient presents to the ultrasound department for an endovaginal sonogram with a history of menorrhagia. A thorough examination of uterus reveals a 10 mm anechoic, round structure within the cervix that exhibits posterior enhancement. Which of the following is the most likely explanation for this mass?
Nabothian cyst Nabothian cysts are common findings on routine ultrasound examinations. These benign retention cysts are located within the cervix and may cause cervical enlargement on physical examination
What hormone is responsible for maintaining the thickness of the endometrium and inducing the secretory activity of the endometrium?
Progesterone During the second half of the menstrual cycle, following ovulation, progesterone is produced by the corpus luteum of the ovary. Progesterone is responsible for maintaining the thickness of the endometrium and inducing the secretory activity of the endometrium as the endometrium is prepared for implantation.
A patient presents to the ultrasound department for an abdominal sonogram. She is 54-years-old, complains of weight loss, and has a recently discovered ovarian mucinous cystadenocarcinoma. The sonographic findings of the abdominal sonogram include the discovery of multiple hepatic lesions, probably consistent with metastasis. Which stages of ovarian cancer is confirmed with these findings?
Stage III
The type of ovarian cysts associated with ovarian hyperstimulation syndrome are most likely:
Theca lutein cysts Women who are undergoing ovulation induction by means of hormone administration are at an increased risk for developing ovarian hyperstimulation syndrome. The ovaries can enlarge, often measuring between 5 and 12 cm. The ovary will also contain multiple large follicles known as theca lutein cysts.
Myometrial cysts are a common sonographic feature of what abnormality?
Adenomyosis A common sonographic feature of adenomyosis is myometrial cysts. There may be indistinct hypoechoic or echogenic areas scattered throughout the myometrium as well.
Which of the following would be best described as ectopic endometrial tissue within the myometrium of the uterus?
Adenomyosis Invasion of endometrial tissue into the myometrium of the uterus
Which of the following would be best described as the longest and most tortuous segment of the fallopian tube?
Ampulla The ampulla is the longest and most tortous segment of the tube. The ampulla is a significant portion of the tube because it is the location of fertilization and the area where ectopic pregnancies often embed.
The sonographic analysis of a 22-year-old female pelvis reveals that the uterine body tilts forward and comes in contact with the cervix. This uterine position is referred to as:
Anteflexion
Because of their sonographic appearance, which of the following masses would be most likely misdiagnosed as a pedunculated uterine leiomyoma?
Brenner tumor The sonographic appearance of a Brenner tumor is that of a solid, hypoechoic mass. This appearance can mimic that of a pedunculated uterine leiomyoma or fibroid. Other ovarian tumors, like the
A 48-year-old patient presents to the ultrasound department with massive ascites. Within the pelvis, you visualize two echogenic structures extending from the lateral aspect of the uterus to the side walls of the pelvis in the transverse plane. What do these structures most likely represent?
Broad ligaments When surrounded by free fluid, the dense broad ligaments may be identified as echogenic structures extending from the lateral borders of the uterus bilaterally.
Which of the following laboratory values would be most likely elevated in the presence of an ovarian cystadenocarcinoma?
CA-125 Though not always specific, patients with an ovarian malignancies may have an elevated CA-125, which is a protein that is increased in the blood of women with ovarian cancer and other abnormalities.
Progesterone is produced by the:
Corpus luteum During the second half of the menstrual cycle, following ovulation, progesterone is produced by the corpus luteum of the ovary.
Which of the following would be the most likely symptom of a patient complaining of a "lost intrauterine contraceptive device"?
Cramping
A 28-year-old asymptomatic patient presents to the ultrasound department with a history of a palpable right adnexal mass on physical examination. Sonographically, a complex, most cystic mass is noted within the right adnexa. It contains an echogenic structure that produces some posterior shadowing. What is the most likely etiology of this mass?
Cystic teratoma Patients with cystic teratomas, or dermoids, are most often asymptomatic. The sonographic appearance of a cystic teratoma has been well documented, and it has most often been described as a complex or partially cystic mass in the ovary that includes one or more echogenic structures. They frequently will contain fully formed or rudimentary teeth that produce posterior shadowing.
Which of the following ovarian tumors typically contains elements of bone, hair, sebum, fat, cartilage, and digestive elements?
Dermoid Cystic teratomas, or dermoids, are composed of ectoderm, mesoderm, and endoderm. As a result of the combination of these germ cells, a cystic teratoma may contain any number of tissues, including glandular thyroid components, bone, hair, sebum, fat, cartilage and digestive elements.
Which of the following would be least likely associated with dilation of the fallopian tube?
Endometrial polyp An endometrial polyp, found within the uterine cavity, would be the least likely among this list to lead to obstruction of the fallopian tube with subsequent dilation.
Ectopic endometrial tissue that undergoes physiological changes as a result of stimulation by the hormones of the menstrual cycle is referred to as:
Endometriosis
The theca internal cells of the secondary follicles produce what hormone during the first part of the menstrual cycle?
Estrogen The ovary produces two hormones during the menstrual cycle, estrogen and progesterone. Estrogen is produced throughout the menstrual cycle. Estrogen is initially produced by the theca internal cells of the secondary follicles during the first part of the menstrual cycle.
During the follicular phase of the ovarian cycle, what hormone is produced by the anterior pituitary gland?
Follicle stimulating hormone
A 32-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of dysmenorrhea. A 12 mm anechoic mass is noted within the vagina. Which of the following is the most likely explanation for this mass?
Gartner's duct cyst
All of the following are female factors that contribute to infertility except:
History of cesarean section
A two-day old female newborn presents to the ultrasound department with a history of a palpable pelvic mass. Sonographically, the uterus and vagina appear enlarged and both contain simple appearing fluid. This finding is termed:
Hydrometracolpos
Which term indicates fluid accumulation within the uterus and vagina?
Hydrometrocolpos Is the fluid accumulation within the uterus and vagina. Hydrocolpos describes the condition in which the vagina is distended with simple, anechoic fluid, and is seen more often in the neonatal period. As the vagina distends with fluid, excessive amounts may lead to further accumulation of the fluid into the uterus, a condition known as hydrometrocolpos.
True precocious puberty is associated with:
Intracranial tumors Precocious puberty is pubertal development before the age of 8. The diagnosis of precocious puberty typically constitutes an endocrinologic workup to evaluate gonadrotropin levels. True precocious puberty is associated with intracranial tumors or may simply be idiopathic.
Which of the following would be considered the most common benign gynecologic tumors?
Leiomyoma A leiomyoma is a benign, smooth muscle tumor of the uterus that may also be referred to as a fibroid or uterine myoma. Leiomyomas are the most common benign gynecologic tumors and are the leading cause of hysterectomy and genecologiv surgery.
An 18-year-old female patient presents to the ultrasound department for a pelvic sonogram with severe right lower quadrant pain, nausea, and vomiting. She has a negative pregnancy test, normal white blood cell count, and does not complain of any menstrual inconsistency. Sonographically, an enlarged, multicystic mass is noted in the right adnexa. While no right ovary is noted with sonography, the left ovary appears normal. Upon color Doppler interrogation of the structure, no flow is demonstrated. What are these findings most indicative of?
Ovarian torsion
Which of the following statements is not true concerning ovarian torsion?
Ovarian torsion occurs most often on the left side.....(it occurs most often on the right, with most common cause being an ovarian cyst or mass, such as the benign cystic teratoma or paraovarian cyst. Ovarian hyperstimulation can lead to ovarian torsion, and has been discovered in the fetus.)
The most common clinical finding in patients who are experiencing endometrial atrophy is:
Postmenopausal vaginal bleeding In the postmenopausal patient, the endometrium often bleeds spontaneously secondary to atrophy. As a result, the most common cause of postmenopausal vaginal bleeding is endometrial atrophy.
Which of the following is not a layer of the uterine wall?
Premitrium The outermost layer is referred to as the serosal layer or perimetrium, which is continuous with the fascia of the pelvis. The middle layer is the myometrium or muscular layer, which constitutes the bulk of the uterine tissue, providing the area where contractile motion occurs. The inner mucosal layer of the uterus is referred to as the endometrium.
Which of the following would describe the build-up of pus within the fallopian tube, secondary to infection?
Pyosalpinx
Which of the following statements is true concerning the basal layer of the endometrium?
The basal layer is the outermost layer of the endometrium
A 38-year-old patient presents to the ultrasound department for a pelvic sonogram. She states that her doctor told her that her uterus extended above her umbilicus. She also complains of pelvic pressure, menorrhagia, and constipation. Sonographically, which of the following would be most likely discovered during this study?
Uterine leiomyoma Given the patients clinical findings, multiple uterine leiomyoma are most likely present. Clinical findings include pelvic pressure, menorrhagia, palpable abdominal mass, enlarged uterus, urinary frequncy, dysuria, constipation, and possibly infertility.
A patient presents to the ultrasound department with a history of hydronephrosis. Which of the following would be the least likely pelvic cause of this abnormality?
Adenomyosis Ectopic endometrial tissue locate within the myometrium of the uterus. It is not associated with dilation of the renal collection system (hydronephrosis). A uterine fibroid, large ovarian tumor, and pregnancy can all contribute to hydronephrosis.
Which of the following would be the least likely clinical finding in a 40-year-old patient with a history of multiple fibroids?
Atrophic uterus Clinical findings of fibroids include pelvic pressure, menorrhagia, palpable abdominal mass, enlarged uterus, urinary frequency, dysuria, constipation, and possibly intertility. An atrophic uterus is smaller than normal uterus.
The production of human chorionic gonadotropin maintains what structure on the ovary?
Corpus luteum With a developing pregnancy, the cells that surround the blastocyst, the syncytiotrophoblastic cells (trophoblastic cells), produce human chorionic gonadrotropin (hCG). The production of hCG maintains the corpus luteum of the ovary. Thus hCG allows the corpus luteum to continue to produce progesterone, which in turn maintains the thickness of the endometrium so that implantation can take place.
Which of the following statements is not true of menopause?
During menopause, estrogen and progesterone levels increase As menopause approaches, the follicles that normally develop on the ovary are less responsive to the hormones produced by the anterior pituitary gland. During menopause, follicles on the ovary cease to mature, resulting in a considerable reduction in the amount of estrogen and progesterone. Estrogen and progesterone are the hormones released by the ovary that facilitate menses. Without estrogen and progesterone, menstruation ceases and the uterus and ovaries decrease in size. Though smaller, the uterus will maintain its adult shape. The ovaries will also become smaller and more echogenic. Consequently, during postmenopause, the ovaries lack follicles and are often difficult to image, secondary to their small size and lack of follicular developement.
Which of the following may be described as a "chocolate cyst?"
Endometrioma Hemorrhage from endometriosis forms into focal areas of bloody tmors know as endometriomas. These lesions have been termed "chocolate cysts" because of their blood content.
Which of the following would not be a likely cause of postmenopausal bleeding?
Endometriosis Endometrial atrophy, uncontrolled hormone replacement therapy, endometrial hyperplasia, endometrial polyps, submucosal or intracavitray leiomyoma, endometrial carcinoma, and some ovarian tumors are all among the list of differential abnormalities that can be linked to vaginal bleeding in the postmenopausal population. Endometriosis is not typically discovered in the postmenopausal patient.
The use of an intrauterine device has been linked with an increased risk for all of the following except:
Endometriosis Has been linked with pelvic inflammatory disease, ectopic pregnancy and spontaneous abortions
A 26-year-old patient presents with a history of pelvic inflammatory disease. She complains of right upper quadrant tenderness. What is this finding most indicative of?
Fitz-Hugh-Cutis syndrome Patients suffering from salpingitis may present clinically with symptoms resembling cholecystitis. Pelvic infections, such as chlamydia or gonorrhea, can actually lead to a perihepatic infection and the subsequent development of adhesions located between the liver and diaphragm. As a result, the liver capsule can become inflamed, thus leading to a clincal presentation much like gallbladder disease. This event is called Fitz-Hugh-Cutis syndrome. Free fluid may be noted within the hepatorenal space (Morrison pouch) with this condition.
A build-up of simple serous fluid within the fallopian tube is termed:
Hydrosalpinx The fallopian tubes may become distended secondary to obstruction or infection. The fluid contained within the distended tubes could be simple serous fluid, blood, or pus. Simple serous fluid within the tube is termed hydrosalpinx.
Which of the following best describes the sonographic appearance of an ovarian fibroma?
Hypoechoic mass
Which of the following would be a cause for hematometrocolpos in a teenage girl?
Imperforate hymen Teenage girls may have hematometrocolopos, a condition when both the uterine cavity and vagina are filled with blood. This obstruction is frequently associated with the presence of an imperforate hymen. Clincally, these young girls present with amenorrhea, cyclic abdominal pain, an abdominal mass, enlarged uterus, and possibly urinary retention
A 55-year-old patient, with a history of gastric carcinoma, presents to the ultrasound department for a pelvic sonogram. She states that her gynecologist felt something in her pelvis during her physical examination. Sonographically, you visualize a solid, hypoechoic mass on the left ovary. This mass most likely represents a:
Krukenberg tumor A Krukenberg tumor is a malignant ovarian tumor that metastasized form the gastrointestinal tract, most frequently the stomach
A 23-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of vague pelvic discomfort and a negative pregnancy test. She is uncertain of the date when her last menstrual period started. Sonographically, the endometrium displays a stark contrast in echogenicity between the functional and basal layer of the endometrium. The basal layer appears echogenic, while the functional layer appears hypoechoic. The endometrial thickness is 7.5 mm. What phase of the endometrial cycle is the patient most likely in?
Late proliferative During the late proliferative phase, or periovulatory phase, the endometrial layers display a stark contrast and can measure between 6 and 10 mm. The outer echogenic basal layer surrounds the more hypoechoic functional layers, while the functional layer is seperated by the echogenic endometrial stripe. This finding is referred to as the "three line" sign.
Among this list of vessels, which would have the longest length?
Left ovarian vein The right ovarian vein drains into the distal anterior aspect of the IVC. The ovarian arteries branch from the distal anterior aspect of the abdominal aorta. The left ovarian vein drains into the left renal vein. Therefore, the left ovarian vein is longer than the right ovarian vein, and the ovarian arteries.
Sonographically, a thickened, heterogeneous endometrium is noted in a patient who complains of pelvic pain and dyspareunia. Which of the following clinical findings would be most suggestive of endometritis and not adenomyosis?
Leukocytosis Patients with adenomyosis typically do not have an elevation in leukocytosis
Which of the following would be considered a hammock shaped pelvic muscle group located between the coccyx and pubis?
Levator ani muscle The levator ani muscle is a hammock shaped pelvic muscle group located between the coccyx and pubis. It is comprised of the iliococcygeus, pubococcygeus, and puborectalis. A weakening in the levator ani muscles could result in prolaps of the pelvic organs.
A 38-year-old patient presents to the ultrasound department with a history of oliguria, abdominal distension, and a history of clomid treatment. Which of the following disorders would be most likely discovered during this exam?
Ovarian hyperstimulation syndrome Women who are undergoing ovulation induction by means of hormone administration are at an increased risk for developing ovarian hyperstimulation syndrome (OHS). The ovaries can enlarge, often measuring between 5 and 12 cm. The ovary will also contain multiple large follicles known as theca lutein cysts. In cases of severe OHS, patients have nausea, vomiting, and abdominal distension, ovarian enlargement, an electrolyte imabalance, and oliguria, with sonographic signs of ascites and pleural effusions.
All of the following are branches of the uterine artery except:
Segmental Branches of the uterine artery include the arctuate arteries, which may be visualized with Doppler interrogation along the lateral aspect of the myometrium. The arcuate vessels further progress within the uterus and eventually become the radial arteries, whcih supply blood to the deeper layers of the myometrium. The radial arteries then divide into both the straight arteries and spiral arteries. The spiral arteries are the tiny, coiled vessel that supply blood to the functional layer of the endometrium.
A small amount of fluid is discovered between the urinary bladder and uterus during a routine sonographic examination of the female pelvis. Which of the following is the proper name of this space?
Vesicouterine pouch The anterior cul-de-sac is located between the uterus and the urinary bladder. It may also be referred to as the vesicouterine pouch.
