Select Topics Exam 2 Review
12 weeks scoliosis club foot
A genetic amnio can be done as early as _____ weeks, but can cause fetal _____ or _____ due to reduced amount of amniotic fluid.
Ovarian cancer
A long term risk of OHS is:
4-8 2-3
AP endo measurements: start of menses: __-___ mm. End of menses: __-__ mm.
surveillance of ovulation induction and oocyte retrieval
ART relies extensively on U/S guidance for:
hematoma fetal heart rate days to weeks
After a transcervical CVS testing approach, the instruments are removed and the patient is re-scanned for evidence of a _____ and to document _____ before being released. Follow up U/S performed at intervals from a few ___to____ later.
1. Image survey of the uterus with endometrial measurements 2. Endometrial biopsy may be performed based on what is seen.
After filling the endometrium with saline during a saline-infused sonohysterography, what are your next steps (2)?
Physician will insert a speculum into the vagina and clean the cervix with an antiseptic solution
After the preliminary scan, what are the next steps for the physician when performing an endometrial biopsy?
Speculum Catheter Chorion frondosum
After the vagina and cervix are cleaned for a trascervical approach CVS testing, the vaginal _____ is inserted and then the ______ is guided through the cervix into the uterus. Tissue samples are then obtained from the _____ ______.
1. Cleanse the external os 2. Insert the catheter through the cervix into the endometrium with U/s guidance. 3. Fill the endo with sterile saline
After you do the preliminary imaging for a saline-infused sonohysterography, the physician will(3):
- info is relayed - manner
Always be careful in what ____ ___ ______ to the patient and the _______ in which it is relayed.
Outpatient
An Amniocentesis is an _____ procedure in the U/S department with a signed consent form.
1. Chromosomal abnormalities 2. AFAFP levels 3. Acetylcholinesterase
An amnio fluid sample test includes karyotyping for (3):
1. L/S Ratio (lecithin/sphingomyelin) 2. PG (phosphatidylglycerol)
An amniocentesis determines fetal lung maturity in late pregnancy by evaluating:(2)
32 lung maturity
An amniocentesis is performed after ____ weeks GA to determine fetal ____ ____ prior to C-section or inducing labor.
blood
An embryoscopy detects fetal anomalies and can obtain samples of ____ to evaluate it for disorders.
bilateral
Are dermoids frequently uni or bilateral
1. Chromosomal abnormalities 2. Biochemical or metabolic disorders 3. Thalassemia (hemolytic anemia) 4. Sickle Cell disease
CVS testing can detect(4):
amniocentesis .05-1%
CVS testing is similar to an ______ with comparable fetal loss rate of (___-___%)
Yes, both oral and written
Can medico-legal implications result from oral interpretation from the sonographer?
- mild to acute abdominal pain/palpable mass causing pressure - may torse or hemorrhage
Dermoids are usually asymptomatic but may cause what? (2)
physician
Do not make judgment on the patient's ______ during the exam.
discourage
Does the FDA and medical community encourage or discourage commercial imaging?
Placental cord insertion site to placenta
During a PUBS/Cordocentesis, the puncture occurs at the:
1. Location and depth of the fluid pocket 2. Fetal position 3. Placental location 4. Fetal heart rate
During a preliminary scan for an amniocentesis, image the (4):
right angle 20-30 acetylcholinesterase
During an amniocentesis, the physician creates a sterile field and inserts the needle using a ___ ____ approach (usually) to observe it entering the uterine cavity. They then withdraw ___-___ ml of fluid for chromosomal analysis and AFP evaluation. If performed due to known fetal anomaly, ______ and viral studies (TORCH titers) are evaluated.
chorionic cavity first trimester
During an embryoscopy the transcervical endoscope is inserted into the ____ _____ during the ____ _____.
1. Asses the number of follicles and size of follicles bilaterally during days 8-14 of the cycle (follicular phase) 2. Determine which ovary will produce the dominant follicle(s)
During ovarian induction therapy, U/S is used as follow up to: (2)
serum estradiol follicular growth hCG
During ovarian induction therapy, U/s is correlated with ____ ____ levels to ensure adequate ____ _____. _____ may also be given to trigger ovulation.
hypoechoic central line thin
Endometrial cycle without fertilization: 1. Menstrual phase: days 1-5: early menses: endo appears as _____ ____ ____ representing fresh blood surrounded by hyperechoic endo. After shedding, endo is ____ and irregular.
1-5 spiral arterioles zona functionalis
Endometrial cycle without fertilization: 1. Menstrual phase: days ___-___: Before menses endo is thick and echogenic. Declining progesterone cause ___ ____ to constrict which results in ischemia and shedding of the ____ _____.
5-14 estrogren 5-9 10-14 ovulation
Endometrial cycle without fertilization: 2. Proliferative phase: days __-___. Regrowth of endo occurs due to _____ released by ovarian follicles. early proliferative = days __-___ late= days __-___. Phase ends with ______.
3-line 6mm 10mm
Endometrial cycle without fertilization: 2. Proliferative phase: endo appears as single stripe surrounded by hypoechoic halo zona functionalis which is surrounded by thin echogenic zona basalis. This is referred to as the ___ ___ phase. Endo measurements: early proliferative: ___ mm. Late= ___ mm
15-28/29 7 days
Endometrial cycle without ovulation: 3. Secretory phase: begins after ovulation on days ______. Endo increases thickness and echogenicity. Progesterone levels increase to prepare for blastocyst and peak ___ days post-ovulation. Without ovulation, corpus luteum degenerates and progesterone decreases to cause menses and the cycle begins again.
6-10
Endometrial hyperplasia is best assessed days ___ - ___ of cycle?
- broad ligament - mesosalpinx
Fallopian tubes lie in a fold of the ______ ligament called the _________.
Cordocentesis aka Percutaneous Umblical Blood (cord) Sampling (PUBS)
Fetal blood obtained through needle aspiration of the umbilical vein in the cord to analyze chromosomes is known as:
fallopian tube stimulated follicles
GIFT requires at least one patent ___ ____ for the procedure. Oocytes are retrieved from ____ _____.
15-18 high risk 1-3
Genetic amnio is performed from __ -__ weeks GA to learn genetic information about fetuses in ___ ____ patients. Results take ___-___weeks.
18-22mm
How big is a graafian follicle?
through rigorous standard of training and CE
How do sonographers ensure an appropriate level of competence?
departmental policy will clarify
How do you know if you can disclose heartbeat, gender, viability, etc. without making a diagnosis?
- pelvic discomfort without significant weight gain - ovaries enlarged but less than 5cm in diameter
How does mild hyperstimulation present in OHS?
- severe pelvic pain, abdominal distention, and ovaries greater than 10 cm - ascites, pleural effusions, numerous large cysts through periphery of ovary
How does severe hyperstimulation present in OHS?
endo biopsy
How is endo CA diagnosed?
3 cm
How long are ovaries?
10 cm
How long is the vaginal canal?
- greater than 14 mm in premenopausal women - greater than 8mm in post
How thick is the endometrium with endometrial hyperplasia?
1. Infertility for unexplained reasons 2. Low sperm count 3. Endometriosis
IVF is performed due to: (3)
More extensive testing is required for a diagnosis
If a NIPT comes back abnormal,:
mid 6 10 thinnest
If a patient is pre-menopausal, a saline-infused sonohysterography should be performed ____-cycle between days ___ and ___ when endometrium is the ______.
NEVER
If recording is permitted, ______ record the entire study or include medical terms. Only show/label general parts like hand, foot, face, etc.
1. Hypotension 2. Oliguria 3. Electrolyte abnormalities 4. Blood clots 5. Ovarian torsion
If sever, OHS can cause: (5)
1-2
If sonographer wishes to allow family, only admit ____-____ people at a time.
indigo carmine first penetrated mono-amniotic
If there are multiple fetuses when doing an amniocentesis, each fetal sac is entered. To ensure of this, 1-2 ml of ____ ____ dye is injected into the ___ sac. Clear amniotic fluid with the second sac puncture assures us that it was not accidentally ____ with the first stick. If it shows in the second sac it could mean a puncture of __-___ twins.
Kidneys (because they develop at the same time from the same thing)
If there is a missing ovary, what organ should you check for anomalies as well?
- annotate - tone of voice - facial expressions
If you suspect an abnormality, do NOT ________ anything that the patient may read on the screen. Also, don't show concern through ____ _____ _____ or ______ ______.
DES
In the 1940's to 70's, pregnant women were given ___ to prevent miscarriage.
national standards
In the even of litigation, ______ ______ apply, regardless of the department/facility policy.
2nd trimester
In what trimester does the mother's attachment to the baby grow most rapidly?
1. Thickened endometrium on U/S 2. Abnormal uterine bleeding 3. Infertility/habitual abortions 4. Pre/post-op eval after removing fibroids/polyps
Indications for a saline-infused sonohysterography (4):
yes, IF the patient is interested
Is it okay to show the heartbeat or fetal movement?
NO
Is it the right of the patient to have visitors during the procedure?
no
Is spectral doppler a good indicator for determining if a thyroid nodule is cancerous?
1. Pedunculated 2. Sub-serosal 3. Intramural 4. Submucosal 5. Cervical
Label the fibroids according to their locations:
- Kidneys -Ureters -Bladder -Adrenal Glands -Great Vessels -Pancreas -Uterus -Prostate
List the retroperitoneal organs(8):
Krukenberg's tumor (GI tract: stomach (most common), intestine, or GB)
Mets to the ovary occurs what major primary CA?
- adenocarcinomas - post-menopause women - with irregular bleeding
Most endo CA's are __________ occurring in ___________ women with ________ _______.
chromosomal disorders and genetic conditions
NIPT screens for:
1. Weight gain 2. Enlarged ovarian cyst 3. Ascites/pleural effusions
OHS can result in: (3)
1. Fertility drugs followed by hCG 2. Polycystic ovaries (may occur spontaneously and unrelated to fertility treatments)
OHS is most common with: (2)
1. CRL measurement 2. Shape of uterus 3. Direction of uterine axis
On a transcervical CVs testing approach, what 3 things are noted?
LH 24-36
Ovarian cycle without fertilization: 1. Follicular phase: As ______increases, it stops the production of FHS and stimulates rapid secretion of ___ (surge) ___-____ hours before ovulation.
2.5
Ovarian cycle without fertilization: 2. Ovulatory phase: Day 14: Dominant follicle reaches ___ cm and ovulation occurs.
corpus luteum progesterone 9-11 corpus albicans menses
Ovarian cycle without fertilization: 3. Luteal phase: days 15-28: follicle becomes a ____ ____ which secretes _____ to maintain secretory endo incase implantation occurs. In absence of conception (no hCG), corpus luteum degenerates after ___-___ days into ___ _____. As progesterone levels decrease, ____ occurs.
Pituitary FSH LH
Ovarian cycle without fertilization: 1. Follicular phase: day 1-13 Hypothalamus releases GRH which stimulates the _____ to release ____ which produces 10-20 follicles and ____ which is in charge of ovulation.
2-3 10
Ovarian cycle without ovulation: 1. Follicular phase: Ovary produces a dominant follicle which grows __-___mm per day and measures ___mm by day 8.
Low Low Lots
Ovarian doppler waveform should present _____ velocity and ____ resistance because there is ____ of blood flow to the ovaries.
- anterior to ureter and internal iliacs - medial to iliopsoas muscles, and external iliacs
Ovaries are anterior to what 2 things? Medial to what 2 things?
- back - broad ligament - mesovarium
Ovaries are suspended from the ______ of the ______ ligament in a fold called the ________.
- bilaterally - 2-6mm ("string of pearls") - thickened endo - due to elevated estrogen
PCOS presents with _______ enlarged polycystic ovaries, that contain multiple ____ - ____mm follicles around the periphery of the ovary. Also, a ________ _______ due to elevated _______.
Linea Terminalis
Pelvis is divided into true and false pelvis by an imaginary line between the superior aspect of the sacral premonitory and the pubic symphysis called the:
1. Fetal heart rate 2. Fluid pockets accessed 3. If placenta was traversed, image placenta and monitor site for bleeding.
Post puncture images of an amniocentesis include (3):
kidneys
Reproductive organs develop alongside what?
Ectopic pregnancy Uterine abscess or TOA ¡UD can embed in endometrium or perforate myometrium & lead to fibrosis IUD usage w/pregnancy increases risk of spontaneous abortion May be able to remove IUD safely in 1st trimester After that, removal may initiate abortion
Risk factors associated with IUD usage:
NO
Should you offer advice or an opinion on abnormalities, fetal therapy/surgery, abortions, etc.?
1. Tubal disease 2. Endometriosis 3. Cervical problems 4. Luteal (ovulatory) phase abnormalities 5. Delayed childbearing
Some of the most common causes of infertility are:(5)
Hyperechoic endo with blurred line. Endo at its greatest thickness and echogenicity, with posterior enhancement, corpus luteum present Endo = 7-14 mm
Sonographic appearance of secretory phase: Endo measurement:
98 special circumstances
The FISH test is ___% accurate in predicting if baby will have normal chromosome patterns and is only offered in ____ ______.
13 18 21 sex chromosomes X and Y
The FISH test only examines the most common abnormal chromosomes such as (4):
1. Obturator internus 2.Piriformis 3. Pelvic diaphragm
The ____ pelvis is below the linea terminalis line. It contains these muscles: (3)
False 1. iliopsoas 2. Rectus abdominus 3. Transverse abdominus
The _____ pelvis is above the linea terminalis and contains the these muscles:(3)
16-20 mm
The average size of a mature follicle is:
-Pubococcygeus - extends from pubic bone to coccyx; most anterior & medial pair visible by U/S -Iliococcygeus - ischial spine to coccyx
The levator ani muscles consist of:
Amniocentesis
The most common invasive technique that allows continuous monitoring of the needle under U/S to obtain living fetal cells or cell products from amniotic fluid is an:
In Vitro Fertilization (IVF) with embryo transfer
The most common type of ART where the oocyte is retrieved and fertilized in a lab is:
Fetal surgery
The most dangerous form of fetal therapy is:
1. Levator ani (2 muscles forming a hammock across the pelvic floor) 3. Coccygeus (most posterior, anterior to to coccyx)
The pelvis diaphragm is a groups of 3 skeletal muscles making up the pelvic floor formed by:
1. Fetal parts 2. Placenta 3. Umbilical cord 4. Near maternal midline to avoid maternal uterine vessels
The preliminary scan performed for an amniocentesis locates the fluid pocket free of (4):
follicular Luteal
The proliferative phase corresponds with the _____ ovarian phase. The secretory phase corresponds with the ____ ovarian phase.
- retain or deny - an abnormality
The radiologist or referring physician has the right to _____ or _____ a patient a videotape or photo if ____ _______ is suspected.
insertion
The risk of uterine perforation due to an IUD is highest during:
1. The patient is supine 2. The placenta is accessed through the anterior pelvic wall
The transadbonimal CVS testing approach is performed the same as transcervical except:
1 cm
There must be ___ ____ depression in the uterine fundus to differentiate a bicornuate from a septated uterus.
1. Infertility 2. Pregnancy loss 3. Renal agenesis on contralateral side of the horn
Unicornuate uterus results in:(3)
Fluorescent In Situ Hybridization (FISH) 24-48
Used in addition to amnio, a rapid method for performing karyotype of fetal skin cells is known as: It results faster than amnio and may be available within ___-___ hours.
Secretory
Uterine didelphis is best seen in the _____ phase.
- tone of voice - body actions
Watch your _____ ___ _____ and your _____ _____ while scanning.
- ovarian - infundibulopelvic/ suspensory
What 2 ligaments support the ovaries?
- pubococcygeus - iliococygeus
What 2 muscles form levator ani?
- broad - round - cardinal - uterosacral
What 4 ligaments suspend the uterus in midline?
- heartbeat (viability) - multi-gestation - GA - growth rate - anomalies - fetal distress - long-term developmental disorders
What 7 things can be documented and are advantages to routine scanning?
10-14 weeks GA
What GA is CVS testing performed?
1. Hysterosonogram (HSG) 2. Sonohysterogram (SHG)
What are 2 other terms used interchangeably with Saline-Infused Sonohysterography?
- distracts sonographer - puts undue stress on sonographer if anomaly is seen and family members keep asking questions
What are disadvantages to family members being in the room? (2)
1. Ovarian hyperstimulation syndrome (OHS) 2. Multi-gestation 3. Ectopic/heterotopic pregnancy
What are some complications of ovarian induction therapy? (3)
elevated AFP and hCG
What are the 2 labs associated with germ cell tumors?
- zona functionalis: superficial (sheds) - zona basalis: deep (stroma and mucosal glands)
What are the 2 layers of endometrium?
- tunica albuginea - germinal epithelium (covers albuginea)
What are the 2 layers of the cortex?
- Cortex: outer - Medulla: inner
What are the 2 layers of the ovary?
- high risk scan - level II scan
What are the 2 other names for selective scanning/screening?
- professional misconduct - misinterpreting and reporting a diagnosis - failure to provide for patient safety during procedure
What are the 3 complications from invasive procedures that can lead to litigation for sonographers?
- Iliopsoas - Rectus abdominis - transverse abdominis
What are the 3 false pelvis muscles?
- Endometrium: inner - myometrium: muscular - perimetrium (serosa): outer
What are the 3 uterine wall layers?
- satisfies patient/ob request - encourages family-centered sonography - enhances family bonding - enhances attractiveness of diagnostic medical ultrasound
What are the 4 advantages to recording an exam?
- failure to conform to a standard of care during exam - performing an incomplete study and "missing an abnormality - misdiagnoses due to imaging or instrumentation - complications from invasive procedures
What are the 4 areas that can lead to litigation for sonographers?
- distracts sonographer's concentration - extends scan time and patient exposure - pts or family misunderstood what they are viewing when tech or physician is not there to interpret - can be used as evidence if fetal anomalies surface or malpractice alleged
What are the 4 disadvantages to recording an exam?
- Interstitia: enters cornua - Isthmus: short and straight - Ampulla: mid, longest and coiled - Infundibulum: distal, closest to ovary, contains fimbriae
What are the 4 parts of the fallopian tubes?
- rectus abdominus (anterior to bladder) - iliopsoas (lateral to bladder) - obturator internus (posterolateral border of bladder) - levator ani (inferior to cx/vagina) - piriformis (posterolateral to body of uterus)
What are the 5 muscles seen sonographically?
- Fundus: superior - Body (corpus): mid - Cervix: lower - Isthmus (LUS): between body and cx - Cornua: lateral uterus when tubes enter
What are the 5 parts of the uterus?
- cost - safety concerns - variability in knowledge and skills of operator and interpreter - variability in equipment - pt outcome may not be improved by routine imaging - many insurances now only pay for 1 scan unless problems occur
What are the 6 disadvantages to routine scanning?
- obesity - hypertension - diabetes - * endo hyperplasia - * tamoxifen - * prolonged intake of estrogen to alleviate post-menopausal symptoms
What are the 6 risk factors for Endo CA?
1. Performed earlier in pregnancy than genetic amniocentesis testing 2. Results available within 1 week (Earlier results allow parents more options including abortion or genetic counseling)
What are the advantages of CVS testing(2)?
- familial bonding - provides support if mother is anxious about the pregnancy
What are the advantages to family members being in the room? (2)
- 6mm for early - 10mm for late
What are the ap endo measurements for early and late proliferative phase?
- 6-10 right before - 7-14 right after
What are the ap endo measurements right before and right after ovulation?
- obesity - hirsutism (lots of hair due to elevated androgen) - infertility (due to anovulation) - oligomenorrhea (due to elevated estrogen but not progesterone)
What are the clinical indications of stein-leventhal syndrome? (OHIO)
1. Active genital/vaginal tract infection 2. Presence of IUD 3. Stenosis of cervical os
What are the contraindications for CVS testing(3)?
1. Pregnancy 2. PID (should complete round of antibiotics prior to procedure)
What are the contraindications for a saline-infused sonohysterography (2)?
1. Pregnancy Notify physician if patient: 2. Has medication allergies 3. Has bleeding disorders or takes blood thinners 4. Has had a recent vaginal/cervical/pelvic infection 5. Has heart/lung problems
What are the contraindications for an endometrial biopsy(5)?
1. Increased risk for limb deformities if performed before 8w GA 2. May be a discrepancy in chromosome results among the cells obtained from the chorion, amniotic fluid and the newborn 3. Can cause oligohydramnios as pregnancy progresses which can result in fetal scoliosis.
What are the disadvantages of CVS testing(3)?
§Asymptomatic §Enlarged uterus §Pelvic or low back pain §Menorrhagia §Menstrual irregularity
What are the indications for a fibroid?
1. Determine the cause of heavy prolonged or irregular uterine bleeding in pre and post menopausal women. 2, Differentiate endometrial hyperplasia from endometrial cancer.
What are the indications for an endometrial biopsy(2)?
1. Pipette 2. D&C 3. Vabra aspiration 4. Jet Irrigation
What are the methods for performing an endometrial biopsy (4)?
- T-shaped uterus (endometrium) - Constricting bands in uterus - Incompetent cervix - Intrauterine wall defects -Increased risk of cervical/testicular cancer -Fetal limb defects -Decrease in fertility
What are the most significant defects from Diethylstilbestrol(DES) syndrome?
8 cm long, 5 cm wide, 3 cm thick (AP)
What are the normal measurements for a menarche uterus?
On TV, image the uterus and measure the thickets part of the endometrium in sag
What are the preliminary steps to performing an endometrial biopsy?
1. Prevent life of physical suffering from congenital abnormality 2. Ease potential economic burdens that may be caused by the condition after birth.
What are the primary reasons for performing fetal surgery(2)?
Uterus bicornis unicollis - bicornuate uterus w/one short cx Uterus bicornis bicollis - bicornuate uterus w/two cervices
What are the two variations of bicorunate uterus (expained)?
multiple pregnancies and deliveries with subsequent uterine shrinking or due to elevated estrogen levels
What causes adenomyosis?
blockage of the endocervical (nabothian) ducts
What causes nabothian cysts?
Nabothian cyst/epithelial inclusion cysts
What cyst appears as cystic like lesions in the cx, is asymptomatic, and is an incidental finding in middle-aged women?
dermoid plug (mixture of matted hair and sebum)
What does the mural nodule represent?
- bladder - intestines - genital tract - ovaries - muscles
What does the true pelvis contain? (5)
mullerian (paramesonephric) ducts
What ducts fuse midline to form the uterus, fallopian tubes, and upper 1/3 of the vagina?
only ectodermal tissue (skin elements)
What germ layer does a dermoid contain?
- Estrogen (follicles) - Progesterone (corpus luteum)
What hormone is produced by follicles? by corpus luteum?
tamoxifen
What hormone used to prevent reoccurrence of breast CA can cause endo hyperplasia?
FSH and LH
What hormones does the pituitary gland release during ovulation?
Saline-infused sonohysterography
What interventional procedure is this?
Stein-Leventhal Syndrome
What is a common variation of PCOS?
Embryoscopy
What is a specialized prenatal test that allows direct viewing of the embryo by a trans-cervial endoscope?
the invasion of endometrial tissue into the myometrium (considered a type of "internal endometriosis")
What is adenomyosis?
RhoGAM
What is administered within 72 hours after CVS testing to Rh negative women to prevent sensitization problems in future pregnancies?
guest can come in after diagnostic exam is completed to see fetal heartbeat/highlights
What is an alternative for having guests come in with the patient?
Non-invasive Prenatal Testing (NIPT)
What is another term for Cell-free Fetal DNA testing?
type of germ cell tumor
What is embryonal cell carcinoma?
overgrowth of endometrium due to unopposed estrogen
What is endometrial hyperplasia?
abnormal thyroid levels
What is precocious puberty associated with?
Acetylcholinesterase
What is specific for detecting open neural tube defects and is preferred to be tested after 20 weeks because AFP analysis is no longer sensitive?
Leiomyoma (Fibroid)
What is the Most common tumor of female pelvis Prevalent in African Americans Arise after menarche & regress after menopause, implicating estrogen as cause?
- 2-3mm at the end - 4-8mm at start
What is the ap endo measurement at the end of menses? start of menses?
- completely cystic or cystic with echogenic mural nodule - ill-defined acoustic shadowing obscuring posterior wall creating "tip of the iceberg" sign
What is the appearance of a dermoid?
- U.S. = $600-1,000 - European Countries = $50-100
What is the cost range of routine scanning in the U.S? European countries?
- Low FSH, High LH - Hyperandrogenization (abnormal estrogen and androgen production)
What is the diagnosis of PCOS based on?
thickened endo
What is the earliest sign of endo CA?
precocious puberty
What is the early development of gonads and secondary characteristics with ovulation usually by age 8?
- Linea terminalis - between superior aspect of sacral promontory and symphysis pubis
What is the imaginary line that divides the pelvis and where is it located?
myometrium
What is the largest uterine wall layer and contains arcuate vessels?
Endometrial hyperplasia
What is the most common cause of abnormal uterine bleeding in post-menopausal pts?
Endometrial CA
What is the most common gynecologic malignancy in the US?
Benign cystic teratoma (dermoid)
What is the most common ovarian neoplasm?
anteversion (forward tilt)
What is the most common uterine position?
Serosa (perimetrium)
What is the outer most layer of the uterine wall?
abnormal uterine bleeding or discharge with or without pain
What is the primary symptom of endo CA?
To investigate the cause of thickened endometrium and detect uterine abnormalities.
What is the purpose of performing a saline-infused sonohysterography?
1. Evaluate abnormalities of endometrial maturation 2. Monitor ovulatory cycle to identify variations 3. Monitor follicular development 4. Guide follicular aspiration to harvest eggs 5. Guide insertion of fertilized or unfertilized eggs into fallopian tube or uterus
What is the role of U/S with fertility treatments?(5)
CA 125
What is the serum marker for ovarian cancer?
U/S is used to detect abnormalities and to follow up with fetal therapy.
What is the sonographers role with indirect fetal therapies?
Map the area of interest and monitor/ guide the procedure.
What is the sonographers role with invasive fetal therapies?
May deviate endometrium from its central location Frequently indent urinary bladder Usually homogeneous & hypoechoic to uterus Older fibroids contain calcification & may show anechoic areas from necrosis, which causes pelvic pain
What is the sonographic appearance of a fibroid?
Small and laterally positioned uterus
What is the sonographic appearance of a unicornuate uterus?
Cx may or may not be absent Fluid (blood) in uterus &/or cx (same finding for imperforate hymen)
What is the sonographic appearance of vaginal atresia?
fornix
What is the upper end of the vagina surrounding the cx called?
Volume = L x W x H x 0.523 Used to measure the volume of the ovary and the bladder.
What is the volume formula and what 2 structures is it used with?
endometrial hyperplasia
What is thought to be a precursor to endometrial cancer?
Submucosal
What kid of fibroid deforms endometrial cavity Least common type, but most likely to cause symptoms Causes heavy bleeding ?
Tubal Embryo Transfer (TET)
What kind of ART fertility treatment occurs when the embryo is placed into the tube directly through laparoscope or transcervical approach?
Zygote Intrafallopian Tube Transfer (ZIFT)
What kind of ART fertility treatment occurs when the oocytes are retrieved by TV U/S and fertilized in vitro (lab), but placed in the fallopian tube as 1 day old zygotes and allows the embryo to develop in the tube and propel into the endometrium naturally?
Intrauterine (artificial) Insemination
What kind of ART infertility treatment is used for male infertility or sperm donors (AID) and occurs when abnormal sperm and other debris is removed to produce a healthy concentrated sample of mobile sperm and is the injected into the uterine fundus via catheter?
Gartner's duct cyst
What kind of cyst is common and usually asymptomatic, but if large could cause pressure and obstruct vaginal canal?
Fetal surgery
What kind of fetal therapy is used for decompression of fetal cyst, shunt placement in fetal hydronephrosis or hydrocephaly, and draining abnormal fluid collections off the fetus?
Fetal surgery
What kind of fetal therapy requires exposing the uterus and making an incision to correct fetal abnormalities?
Pedunculated
What kind of fibroid is found on stalks some distance from uterus - may torse leading to severe pelvic pain
Intramural
What kind of fibroid is w/in myometrium Most common May deform myometrium, enlarge & put pressure on adjacent organs?
Submucosal and intramural
What kind of fibroids are known for affecting fertility?
Chorionic Villus Sampling (CVS)
What kind of genetic testing consist of an U/S guided biopsy to obtain tissue from the chorion frondosum?
Non-invasive Prenatal Testing: NIPT (AKA Cell-free Fetal DNA: cffDNA)
What kind of genetic testing requires a blood draw to evaluate circulating fetal DNA in the maternal blood stream?
Ovarian induction therapy
What kind of infertility treatment does this coincide with?
Ovarian Induction Therapy
What kind of infertility treatment occurs when ovarian follicles are stimulated by medications such as clomid and pergonal to cause multiple follicles to enlarge?
Genetic amniocentesis
What kind of procedure is this?
Bicornuate Uterus
What kind of uterine anomaly is Bi-lobed uterine cavity w/wide-spaced horns. 2 endos 1 uterus. Assoc/w unilateral renal agenesis
Retroflexion
What kind of uterine position has a backward bend of the fundus toward the posterior cul-de-sac?
Anteversion
What kind of uterine position has a forward tilt and it the most common?
Retroversion
What kind of uterine position has a posterior tilt toward the rectum?
Anteflexion
What kind of uterine position has the fundus and body flexed forward onto the bladder?
cystic areas due to bleeding
What may be seen in the myometrium with adenomyosis?
dermoid plug
What may have fat-fluid levels with high amplitude echoes that shadow?
- fear of labor/delivery and readjusting in life after baby - physically uncomfortable in the late pregnancy - may act of lifestyle changes and pull away/ exhibit nesting behavior - come to accept individuality of the child and exhibit readiness for pregnancy to end
What may the mother go through with her emotions during the 3rd trimester?
- may be excited about becoming a mother, or depressed about loss of control of her body - may choose to positively interact w/ other preggers and attend classes - attachment to baby grows most rapidly in this trimester
What may the mother go through with her feelings during the 2nd trimester
- attempting to adjust to reality of pregnancy - if unplanned, may be uncertain (ambiguous) - may express pride in woman/motherhood, share feers, doubts, uncertainty, or act of decision to terminate pregnancy
What may the mother go through with her feelings during the first trimester?
OB
What modality has more lawsuits than any area of sonography?
- obturator internus - piriformis - levator ani - coccygeus
What muscles are part of the true pelvis?(4)
commercial imaging
What occurs when non-medical individuals/companies/sonographers own ultrasound machines and provide keepsake recordings of pregnancies for monetary gain?
Ovarian hyperstimulation syndrome (OHS)
What pathology is associated with ovarian induction therapy and causes too many follicles to be stimulated?
Anterior cul-de-sac (vesicouterine pouch)
What pelvic space is a shallow space between the bladder and the uterus?
Space of retzius
What pelvic space is between anterior bladder wall & symphysis pubis?
Posterior cul-de-sac (recto-uterine or pouch of Douglas)
What pelvic space is between posterior uterus & anterior rectum - most dependent space?
describe, don't diagnose
What phrase tells us that sonographers make technical impressions not diagnostic interpretations?
Saline-Infused Sonohysterography
What procedure is known as when they inject sterile saline into the endometrium under TA/TV guidance?
Transcervical CVS testing
What procedure is this?
dermoid mesh
What refers to multiple linear hyperechoic interfaces (hair) floating within a dermoid cyst?
if preliminary reports by sonographer are required and boundaries of the sonographer's duty
What should a policy or sonographer job description address to avoid medico-legal implications.
Ovarian hyperstimulation syndrome (OHS)
What syndrome is a frequent complication of fertility drugs?
PUBS/cordocentesis
What test is most commonly performed for transfusions to treat fetal isoimmunization and can have results within 2-3 days?
Gamete Intrafallopian Tube Transfer (GIFT)
What type of ART fertility treatment occurs when the oocyte and sperm are placed in the fallopian tube through fimbrated end under U/S guidance?
Selective scanning (screening)
What type of scanning refers to systematic searches that use special techniques or measurements and are conducted to separate specific abnormalities from normally progressing pregnancies?
glandular tissue (sweat, apocrine, sebaceous)
What type of tissues are associated with dermoids? (answer is not ectodermal tissue)
Vaginal atresia
What uterine anomaly occurs when there is an absent vaginal canal due to segmental mullerian agenesis or incomplete vaginal agenesis? Suspected when a young girl reaches puberty w/o menstruation Can present in neonate as large cystic pelvic-abdominal mass due to stimulation from maternal hormones causing hydrometrocolpos
Unicornuate uterus
What uterine anomaly occurs when there is half a uterus w/only one fallopian tube Caused by agenesis of mullerian duct one uterine horn, one cervix, and one vagina
retroflexion
What uterine position has a backward bend of fundus toward posterior cul-de-sac?
retroversion
What uterine position has a posterior tilt toward rectum?
endometrium sagittal
When doin a saline-infused sonohysterography, start by scanning TV to image and measure the thickest part of the ______ in the _____ plane.
during 2nd trimester as anatomy scans
When is routine scanning usually performed?
Warmed fluids
When performing fetal surgery, ____ _____ are continuously infused into the uterus to keep the amniotic fluid level safe for the mother and baby.
On the outer layer of the serosa and projecting outward of the uterus.
Where is a sub-serosal fibroid located?
in the posterior wall
Where is adenomyosis most intensive?
where they are not between the sonographer and the patient or the sonographer and the monitor
Where should guests be required to sit?
Zona Basalis
Which endometrial layer is the deepest and contains stroma and mucosal glands?
Assisted Reproductive Technologies (ART)
Which fertility treatment option encompasses all procedures that try to initiate pregnancy through retrieval of oocytes from ovaries?
Zona functionalis
Which layer of the endometrium is the most superficial and sheds during menarche?
Jet irrigation
Which method for obtaining an endometrial biopsy sprays a liquid to wash/slough off endometrium? A brush may be used to remove some of the lining before washing.
Dilation & curettage (D&C)
Which method for obtaining an endometrial biopsy uses a sharp edged tool called a curette to scape a small sample and collect it with a syringe or suction?
Pipette method
Which method for obtaining an endometrial biopsy uses a straw like device to suction a small sample from the endometrium? It is typically quick and not very painful.
Vabra inspiration
Which method for obtaining an endometrial biopsy uses an electronic suction device that can be uncomfortable?
D&C
Which method of obtaining an endometrial biopsy is performed to control heavy bleeding or to find the cause of bleeding and requires either a local anesthetic (U/S dept) or general anesthesia (OR)
internal os
Which opening is between cx and endo?
external os
Which opening is between cx and vagina?
Rectus abdominus
Which pelvic muscle is Paired muscles on anterior wall of abdominopelvic cavity - Xiphoid to symphysis - Wrapped in rectus sheath - Fuse in midline at linea alba?
Transverse abdominus
Which pelvic muscle is innermost muscle on anterolateral wall, deep to internal & external oblique muscles?
Piriformis
Which pelvic muscle is nposterior aspect of true pelvis Posterior to uterus nAnterior to sacrum, extends from sacrum to greater trochanter, Commonly mistaken for enlarged ovaries on U/S?
Obturator internus
Which pelvic muscle nform lateral walls of true pelvis, Lateral to bladder at level of uterine corpus (body), Attach to medial aspect of greater trochanter posteriorly?
Routine scanning
Which type of scanning consists of regular scans of an unvarying nature, applied to each and every pregnancy?
Uterus Didelphys
Which uterine anomaly is a Complete duplication 2vaginas, 2 cervices, & 2 uteri and endos Due to bilateral arrested development of mullerian ducts Rare - each uterus functions separately & each can sustain a normal pregnancy
Bicornuate uterus with rudimentary horn
Which uterine anomaly is when one uterine horn is undeveloped and non-communicating? Embryo can last in it 12-16 weeks before uterine rupture
Septate uterus
Which uterine anomaly occurs when Two closely spaced endometrial cavities w/one fundus & two cervices or a vaginal septum Highest incidence of fertility problems
Endometrium
Which uterine layer is the innermost and contains the zona functionalis and basalis?
Myometrium
Which uterine layer is the largest, made of muscle and contains the *arcuate arteries*?
cardinal ligament
Which uterine ligament extends across the pelvic floor laterally (like a bird)?
Uterosacral ligament
Which uterine ligament is from lateral uterine isthmus downward along rectum?
cardinal and uterosacral
Which uterine ligaments cause prolapse?
anteflexion
Which uterine position has fundus and body flexed forward onto bladder?
Anteverted
Which uterine position?
Retroverted
Which uterine position?
both sonographer and referring physician
Who is obligated to attain and maintain competence for optimal patient care?
- no clinical indications - safety concerns - cost - lack of established standards/protocols - inconsistent quality of operators, interpreters, and equipment
Why is routine scanning continuously debated in the US? (5)
they may be contemplating abortion
Why should you not force the mother to view the screen?
TA or transcervical, whichever provides better visualization of pelvis organs.
With CVS testing the preliminary scan can be performed by:
1. Viable IUP 2. Relationship of uterus/cervix with the path of the catheter (influenced by fullness of the bladder) 3. Uterine masses or potential problems that may interfere with the catheter 4. Gestational age 5. Location of placenta.
With CVS testing, the preliminary scan includes documentation of (5):
48-72 laparoscopy U/S hCG Progesterone 12
With IVF, after the oocyte is retrieved, it is then incubated in the lab for ___-___ hours. The embryo is transferred through the cervix into the endometrium by ______ or ____ guidance. Following the transfer, ____ or _____ injections are given to improve chance of implantation into the endometrium. hCG will be positive aprox ___ days after if successful.
still in the womb closed
With fetal surgery, it is performed on baby while ____ ___ ___ ____, then the uterus is ____.
Indirect
With fetal therapies, a ______ approach is when a physician enters the uterus, amniotic cavity or fetus to administer (inject) agents such as hormones or RBC's.
Indirect
With fetal therapies, a ______ approach uses drugs to manipulate the physiologic status of the fetus.
lithotomy povidone iodine
With the transcervical approach for CVS testing, the mother is placed in the _____ position and the vagina and cervix are cleaned with ______ ______.
- No information - 3rd parties ( spouse, sex partner, and family)
___ _______, including fetal gender, should be disclosed to ___ _____ without permission or the implied consent of the patient.
40 40 20
___% of infertility cases are due to female reproductive disorder. ____% of cases are due to male factor causes. ____% of cases are unexplained
Infertility
_____ is known as the inability to conceive after 12 moths of unprotected sex.
- False pelvis - above linea terminalis - contains muscles and intestines
_______ pelvis (major/greater pelvis) is _______ the linea terminalis and contains ______ and _______.
Nothing
_______ should be included on the CD/DVD that was not included on the diagnostic study.
10 10-22 week
a NIPT can be performed anytime after ___ weeks. ___-_____ weeks are the ideal time to performed. Results come back within about a:
Broad ligament
double fold of peritoneum from cornua to lateral pelvic wall -Divide true pelvis into ant & post parts -Not true ligaments; provide minimal support nsuspensory ligaments -Ovaries attach to posterior surface?
Round ligament
fibrous cord between broad ligament layers Extend from uterine cornua Maintain forward bend of uterus?
1. Broad ligament 2. Round ligament 3. Cardinal ligament 4. Uterosacral ligament
the 4 uterine ligaments:
