Week 6 HW
What path does arterial blood take to supply the uterus? Aorta - common iliac arteries - external iliac arteries - uterine arteries Aorta - gonadal arteries - uterine arteries Aorta - gonadal arteries - ovarian arteries - uterine arteries Aorta - common iliac arteries - internal iliac arteries - uterine arteries
Aorta - common iliac arteries - internal iliac arteries - uterine arteries
Which of the following best describes a thick-walled cystic mass with internal echoes that was demonstrated on day 20 of the menstrual cycle and resolved by day 5 of the following cycle? Corpus luteum Follicle Hemorrhagic cyst Follicular retention cyst
Corpus luteum
Which of the following is not an indication for a pelvic sonogram? Evaluation of the renal pelvis Evaluation and monitoring of infertility Evaluation of dysmenorrhea Postmenopausal bleeding
Evaluation of dysmenorrhea
A 49-year-old female patient presents with symptoms of night sweats, dyspareunia, hot flashes, and a decrease in libido. What is the most likely cause? Osteroporosis Menopause Ovarian teratoma Coronary artery disease
Menopause
What is the most common indication for performing postmenopausal sonography? Postmenopausal bleeding Urinary frequency Palpable pelvic mass Dysmenorrhea
Postmenopausal bleeding
What is the term used to describe pus in the endometrial cavity? Pyometra Hematometra Pyocolpos Pyometrocolpos
Pyometra
Which arteries in the uterus feed the functional layer of the endometrium? Radial arteries Arcuate arteries Straight arteries Spiral arteries
Spiral arteries
What is the primary role of gonadotropin-releasing hormone? Stimulates release of hormones by the anterior pituitary gland. Regulates release of hormones by the hypothalamus. Restricts the release of hormones from the thalamus. Allows for communication between the hypothalamus and the thalamus.
Stimulates release of hormones by the anterior pituitary gland.
Why does menstruation cease at menopause? The anterior pituitary gland stops producing follicle-stimulating hormone causing the cycle to stop. The thalamus stops producing luteinizing hormone which halts the cycle. The ovaries stop producing estrogen and progesterone which halts the cycle. Atrophy of the ovaries stops follicles from developing halting the cycle.
The ovaries stop producing estrogen and progesterone which halts the cycle.
What are the three peritoneal spaces in the pelvic cavity? posterior cul-de-sac, anterior cul-de-sac, and vesico-uterine pouch posterior cul-de-sac, anterior cul-de-sac, and interstitial space posterior cul-de-sac, pouch of Douglas, and anterior cul-de-sac posterior cul-de-sac, anterior cul-de-sac, and prevesical space
posterior cul-de-sac, anterior cul-de-sac, and prevesical space
What days of the menstrual cycle correlate with the menstrual phase? 1 to 5 1 to 14 22 to 28 15 to 21
1 to 5
What is the normal cervix:uterus ratio in a prepubertal female? 1:2 2:1 1:3 1:1
2:1
Which of the following terms describes a straight uterus that tilts forward in the body forming a 90° angle with the vagina? Anteverted Retroflexed Retroverted Anteflexed
Anteverted
Which of the following best describes a uterus that has two separate endometrial canals but a single cervix? Subseptate uterus Bicornuate uterus Septate uterus Uterus didelphys
Bicornuate uterus
What do the STAR criteria refer to? Criteria for ovarian assessment Criteria of an abscess Criteria of a simple cyst Criteria for determining staging of ovarian cancer
Criteria of a simple cyst
What is the most likely cause of postmenopausal bleeding when the endometrial thickness measurement is <5 mm? Endometrial hyperplasia Endometrial carcinoma Endometrial atrophy Uncontrolled HRT
Endometrial atrophy
A 70-year-old patient presented with vaginal bleeding. Ultrasound revealed a focal area of thickening with myometrial distortion and increased vascularity. What is the most likely course of action? Follow-up scan in 3 months Endometrial biopsy ASAP Hysterectomy ASAP Dilation and curettage then follow-up in 6 months
Endometrial biopsy ASAP
What is the main risk associated with estrogen hormone replacement therapy (HRT)? Thromboembolism Hypertension with associated diabetes Endometrial hyperplasia and endometrial carcinoma Endometrial atrophy
Endometrial hyperplasia and endometrial carcinoma
What is the term used to describe the inner layer of the uterine wall? Myometrium Endometrium Serosal layer Perimetrium
Endometrium
Which method of interrogation of the female pelvis is best for demonstrating the endometrium? Transabdominal scan Translabial scan Endocervical scan Endovaginal scan
Endovaginal scan
The endometrial cavity is contiguous with which other part of the female pelvis? Vagina Myometrium Fallopian tube lumen Ovary
Fallopian tube lumen
A patient presents with a history of PID, right upper quadrant (RUQ) pain, fluid in Morison's pouch and elevated liver enzymes. Sonography of the RUQ reveals adhesions between the liver and right hemi-diaphragm. What is the most likely diagnosis? Hepatitis Cholecystitis Pseudomyxoma peritonei Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis syndrome
What layer of the endometrium is shed every month during menstruation? Perimetrium Functional layer Basal layer Submucosal layer
Functional layer
What are the four major divisions of the uterus? Fundus, corpus, fallopian tubes, and cervix Fundus, corpus, isthmus, and cervix Fundus, corpus, cervix, and vagina Fundus, body, corpus, and vagina
Fundus, corpus, isthmus, and cervix
What is a possible complication of chronic PID? Appendicitis Pyelonephritis Infertility Chlamydia
Infertility
Which other organ(s) should be interrogated if uterine anomalies are demonstrated? Kidneys Bladder Spleen Liver
Kidneys
What is the cause for increased risk of coronary artery disease and osteoporosis after menopause? Calcium uptake is inhibited by lack of circulating estrogen It is coincidental, these risks increase with advanced age Decreased progesterone levels in the blood Lack of circulating estrogen in the blood
Lack of circulating estrogen in the blood
Which part of the pelvic space contains the uterus and ovaries? Linea terminalis Major pelvis False pelvis Lesser pelvis
Lesser pelvis
Weakness in which of the following muscles leads to prolapse of the uterus? Piriformis Levator ani Coccygeus Iliopsoas
Levator ani
Why is it important to document the type of hormone replacement a patient is taking prior to completing their sonogram? Uterine size will vary with the type of HRT used. Uterine proportions will vary depending on the type of HRT used. The number of follicles demonstrated in the ovaries will vary depending on the type of HRT used. Normal endometrial thickness measurements will vary depending on the type of HRT used.
Normal endometrial thickness measurements will vary depending on the type of HRT used.
A patient presents with mittelschmerz. Sonography demonstrated a small amount of free fluid in the right adnexa. What is the likely cause? Rupture of nabothian cyst Ovulation Rupture of endometrioma Ruptured hemorrhagic cyst
Ovulation
What is the term used to describe a cyst located in the broad ligament? Paraovarian cyst Follicular retention cyst Corpus luteal cyst Theca lutein cyst
Paraovarian cyst
Which pelvic muscle group is most often mistaken for ovaries? Levator ani Coccygeus Piriformis Obturator internus
Piriformis
A patient presents with a history of hirsutism, amenorrhea, and enlarged ovaries. What should the sonographer be looking for on the exam? Asherman syndrome Polycystic ovary syndrome (PCOS) Endometrial polyp Theca leutein cysts
Polycystic ovary syndrome (PCOS)
Where is free fluid most likely to collect in the female pelvis? Space of Retzius Vesicouterine pouch Pouch of Douglas Anterior cul-de-sac
Pouch of Douglas
During which phase of the menstrual cycle is the endometrium at its thickest? Proliferative phase Menstrual phase Secretory phase Luteal phase
Secretory phase
Which potential space lies between the urinary bladder and the pubic symphysis? Vesicouterine space Rectouterine space Pouch of Douglas Space of Retzius
Space of Retzius
Which of the following can result in endometrial hyperplasia? Tamoxifen therapy Nausea and vomiting Precocious puberty Fertility drugs
Tamoxifen therapy
Which of the following is a true statement with respect to fallopian tubes? Adenocarcinoma of the fallopian tube should be considered whenever a solid mass is identified within the adnexa. The fallopian tube is usually only identified if there is an obstruction and it is distended with fluid. Infection of the fallopian tube is called pelvic inflammatory disease. The most common location for and ectopic pregnancy is in the infundibulum.
The fallopian tube is usually only identified if there is an obstruction and it is distended with fluid.
What are the sonographic features of endometritis? Thickened endometrium with increased blood flow Thin atrophic endometrium Thickened irregular endometrium with intraluminal fluid/gas with ring-down artifact Hyperechoic mass within the endometrium with blood flow demonstrated
Thickened irregular endometrium with intraluminal fluid/gas with ring-down artifact
A patient presented with pelvic pain, infertility, and a palpable right adnexal mass. Sonography demonstrated a multicystic complex right adnexal mass with dirty shadowing and bilateral hydrosalpinx. What is the most likely diagnosis? Vaginitis Acute pelvic inflammatory disease Tubo-ovarian abscess Appendicitis
Tubo-ovarian abscess
Which of the following is a risk factor for developing pelvic inflammatory disease (PID)? Bladder infection Utilization of and intrauterine contraceptive device Pyelonephritis Late menarche
Utilization of and intrauterine contraceptive device
A patient presents with fever, leukocytosis, purulent vaginal discharge, and dyspareunia. On ultrasound, the uterus was ill-defined and the endometrium appeared irregular and thickened. What is the most likely diagnosis? Endometrial hyperplasia Hydrosalpinx Tubo-ovarian abscess Pelvic inflammatory disease
Pelvic inflammatory disease
A sonogram of a postpubertal woman demonstrated a 5-cm simple cyst on the left ovary. A follow-up exam 3 months later demonstrates a normal ovary. What do these findings likely represent? Resolution of a follicular retention cyst Resolution of a hemorrhagic cyst Resolution of corpus luteum Resolution of endometriosis
Resolution of a follicular retention cyst
What is the most commonly visualized pelvic muscle that is often mistaken for an ovary? evator ani muscle coccygeus muscle piriformis muscle iliopsoas muscle
piriformis muscle
What does the term dextroverted uterus describe? A uterus that tilts posteriorly. A uterus that tilts anteriorly. A uterus that tilts to the left. A uterus that tilts to the right.
A uterus that tilts to the right.
What is the most dependent portion of the peritoneum called? pouch of Douglas retropubic space vesicouterine pouch Morrison's pouch
pouch of Douglas
Which two ligaments are not true ligaments? uterosacral and broad ligaments uterosacral and round ligaments suspensory and broad ligaments cardinal and suspensory ligaments
suspensory and broad ligaments
Which uterine ligament is responsible for uterine orientation? transversal ligament uterosacral ligament broad ligament round ligament
uterosacral ligament
What is responsible for the development of follicles on the ovaries? Releases estrogen that causes thickening of the endometrium. Releases progesterone that induces secretory activity of endometrium. Release of follicle-stimulating hormone by the anterior pituitary gland. Release of luteinizing hormone by the anterior pituitary gland.
Release of follicle-stimulating hormone by the anterior pituitary gland.
What structures make up the posterior boundary of the pelvic cavity? Ischium and pubic symphysis Sacrum and coccyx Ischium and sacrum Ilium and pubic symphysis
Sacrum and coccyx
What is the most common cause of nosocomial infections? Respiratory infections from poor ventilation Intravenous bag allowed to run dry Methicillin resistant Staphylococcus aureus from use of nonsterilized transducers Urinary tract infection from poor catheter care
Urinary tract infection from poor catheter care
Which disorder presents with leukocytosis? Ectopic pregnancy Leiomyoma Pelvic inflammatory disease Endometrial carcinoma
Pelvic inflammatory disease
What causes the endometrium to become thicker in the first phase of the menstrual cycle? Increased progesterone levels Increased estrogen levels Increased levels of follicle-stimulating hormone Increased levels of luteinizing hormone
Increased estrogen levels
Which pelvic muscles supply support to the pelvic organs? Levator ani and coccygeus Piriformis and levator ani Obturator internus and piriformis Coccygeus and piriformis
Levator ani and coccygeus
What is the most common cause of secondary amenorrhea? Congenital obstruction Imperforate hymen Endocrine disorder Pregnancy
Pregnancy
What happens to the corpus luteum if there is no implantation? Luteinizing hormone levels increase causing a decrease in the progesterone levels causing reabsorption of the corpus luteum. The corpus luteum becomes the corpus albicans due to a decrease in estrogen and progesterone levels. Luteinizing hormone levels drop resulting in regression of the corpus luteum. Progesterone levels drop and result in resorption of the corpus luteum.
The corpus luteum becomes the corpus albicans due to a decrease in estrogen and progesterone levels.
75-year-old patient presents with vaginal bleeding. Previous ultrasound was negative for any structural abnormalities and she is not taking HRT. Endometrial thickness was 17 mm. What is the most likely cause for the bleeding? Endometrial atrophy Endometrial hyperplasia Endometrial polyps Submucosal leiomyoma
Endometrial hyperplasia
What is the definition of primary amenorrhea? No menstrual cycle in a pregnant patient. At least 12 months without a menstrual cycle in a postmenarchal patient. Termination of menstrual cycle prior to menopause. Menarche has not occurred by age 16 in a female patient.
Menarche has not occurred by age 16 in a female patient.
Fifty percent of PID cases are caused by which of the following? Sexually transmitted diseases Abscessed appendix Multiple sexual partners Ruptured colonic diverticulum
Sexually transmitted diseases
What are the two phases of the ovarian cycle? Proliferative and secretory Follicular and luteal Proliferative and luteal Follicular and proliferative
Follicular and luteal
What happens to the dominant follicle during the luteal phase? It becomes the corpus albicans in preparation for the next cycle. It becomes the corpus luteum, produces estrogen which prepares the endometrium for implantation. It becomes the corpus luteum, produces progesterone, preparing the endometrium for implantation. It continues to grow until progesterone levels drop, then it regresses.
It becomes the corpus luteum, produces progesterone, preparing the endometrium for implantation.
Which of the following is false with respect to theca lutein cysts? Hyperemesis and pelvic fullness often present with theca lutein cysts. Patients presenting with multiple gestations or gestational trophoblast disease have a higher risk of developing theca lutein cysts. Sonographically, theca lutein cysts present as bilateral large multiloculated ovarian cystic masses. They are found when hCG levels are decreased.
They are found when hCG levels are decreased.
What is the most common benign ovarian tumor that results from the retention of an unfertilized ovum? Granulosa cell tumor Sebaceous cyst Thecoma Dermoid
Dermoid
What happens to the corpus luteum if a pregnancy occurs? It can reach a size of up to 10 cm but should resolve by 16 weeks of gestation. Production of hCG maintains the corpus luteum throughout the pregnancy. It resolves by the 6th week of pregnancy. It produces estrogen required to maintain the pregnancy.
It can reach a size of up to 10 cm but should resolve by 16 weeks of gestation.