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EXAM PREP 4
Gynecology
| Question | Answer |
|---|---|
| Benign conditions in the breast | Fat necrosis, acute mastitis, cystosarcoma phylodes, fibroadenoma |
| A type of intraductal tumor with extensive fibrous tissue proliferation. Focal calcifications may also be present. Nipple retraction is often present. | Schirrous Carcinoma |
| Sonographically, the breast may be characterized by? | An inhomogenous parenchymal pattern |
| Breast malignancies tend to grow within the ducts and often follow the ductal system. This is usually seen accurately in which plane? | Radial |
| True statements concerning breast cancer risk? | Older women are at increased risk for development of breast cancer compared with younger women, A signfiicant risk factor for development of breast cancer is a positive family history of breast cancer in first-degree relatives (mother, sister, daughter) |
| Ultrasound of the breast is often performed as an adjunctive imaging tool in? | To assess a smooth mammographic mass as cystic or solid, to further evaluate a palpable breast lump in a patient with very dense breast tissure and a negative mammogram, and to further evaluate a palpable breast lump in a patient with breast implants |
| The retromammary layer is sonographically imaged as? | Hypoechoic |
| What is termed intraductal solid carcinoma in which the lactiferous ducts are filled with a yellow paste-like material that looks like a small plug? | Comedocarcinoma |
| Characteristic findings of breast carcinoma | Inhomogenous low-level internal echo pattern with calcifications, attenuation of sound, and irregular margins |
| Three breast layers | Subcutaenous, retromammary, and mammary |
| What is a rare, predominantly benign neoplasm of the breast that accounts for less than 1% of all breast neoplasms? | Cystosarcoma Phyllodes |
| True or False: Ultrasound is more sensitive than mammography in the detection of microcalcifications due to the heterogenous appearance of normal breast tissue. | False |
| According to the American Cancer Society, all women should begin annual screening mammography and screening breast ultrasound at age? | 40 |
| What is the accurate position for the patient having an ultrasound of the right breast? | Left oblique, right arm above their head |
| A rare ductal carcinoma that accounts for approximately 3% of breast carcinomas | Colloid Carcinoma |
| The most characteristic finding of a fibroadenoma is? | Low-levels of homogenous echoes |
| The most common solid benign tumor of the breast is? | Fibroadenoma |
| True or False: Malignant masses in the breast often demonstrate increased vascularity within the lesion and often have a feeder vessel | True |
| The most important signs to look for in determining a cystic lesion of the breast? | Good through transmission, anechoic, and well-defined borders |
| A breast lesion that presents with well-defined borders, low-level internal echoes, and good through transmission most likely represents? | A hemorrhagic cyst |
| Complete absence of one or both breasts is called what? | Amastia |
| An extremely well-differentiated form of IDC that is usually less than 2cm in dimension | Tubular Carcinoma |
| In the case of a smooth mammographic mass that is cystic, the correlating sonographic mass will likely show which of the following features? | Anechoic/posterior acoustic enhancement |
| True or False: Ultrasound of the breast is the primary imaging tool of choice in evaluating a breast mass in a pregnant woman | True |
| True or False: Breast ultrasound is the imaging tool of choice to evaluate a breast mass in a teenage girl. | True |
| True or False: In the case of a benign fibroadenoma, the sonographic features of a smooth sharply circumscribed hypoechoic mass with homogenous echogenicity and mild posterior acoustic enhancement usually will be seen. | True |
| True or False: Breast ultrasound is the primary imaging tool of choice in screening a 45-year-old woman for any evidence of possible breast cancer. | False |
| After ovulation, progesterone is secreted by the? | Corpus Luteum |
| Lack of progesterone production is known as? | Luteal Phase Deficiency |
| Normal endometrial response associated with overstimulation is an increasing thickness between 2 to 3 mm and ? mm. | 12-14 |
| Ovarian induction therapy requires documentation of all follicles greater than ? mm in both longitudinal and transverse planes. | 10 |
| What is used as a substitute for LH to trigger ovulation? | HCG |
| On a baseline pelvic ultrasound, an ovarian cyst greater than ? mm could interfere with ovarian stimulation and may represent a persistent follicle. | 15 |
| When evaluating the patient who is infertile, in addition to assessing structural anatomy, the sonographer should evaluate the? | Endometrium |
| Producing more LH than FSH results in? | PCOS |
| Complications associated with assisted reproductive technologies include | Ectopic pregnancy, multiple gestations, and hyper stimulation |
| Which hormone, along with follicle size determine the approximate time of ovulation? | FSH |
| What tends to have a narrow base attachment to the endometrium with a vascular pedicle feeding it? | Endometrial Polyp |
| Patients who undergo assisted reproductive procedures have an increased risk factor for a ? pregnancy. | Heterotopic |
| In the luteal phase, the endometrial lining may be thinner than expected from an inadequate level of? | Progesterone |
| Multiple gestations occur in approximately ?% of IVF pregnancies. | 30 |
| True statements about infertility | -40% of cases attributable to men, 40% to women, and 20% to either the man or the woman or is unexplained -infertility is the inability to conceive within 12 months with regular coitus -infertility affects one in seven couples in US |
| Which syndrome demonstrates enlarged ovaries with multiple cysts, abdominal ascites, and pleural effusion? | OHSS |
| When pregnancy occurs, corpus luteum cysts regress and are typically not seen beyond ? weeks. | 12-16 |
| The symptoms of an ectopic pregnancy are vaginal spotting or bleeding, abdominal pain, amenorrhea, adnexal tenderness or palpable adnexal mass, and ? | A positive pregnancy test |
| A gestational sac in which the embryo fails to develop is described as? | Blighted ovum or anembryonic pregnancy |
| Findings in an ectopic pregnancy include? | Intraperitoneal fluid, adnexal mass, and no evidence of intrauterine pregnancy |
| Most frequent sonographic finding in an ectopic pregnancy? | Adnexal mass |
| Transvaginally, an embryo with cardiac activity must be identified when the mean sac diameter measures ? mm. | 25 |
| Most common pelvic mass seen in a first trimester pregnancy? | Corpus luteum cyst |
| The best sonographic correlation in the diagnosis of an ectopic pregnancy is the combination of no intrauterine pregnancy and? | Adnexal mass |
| An ectopic pregnancy most commonly occurs in? | Fallopian tube |
| Simultaneous intrauterine and extrauterine pregnancies | Heterotopic pregnancy |
| The increased risk of massive hemorrhage in an ectopic pregnancy is located? | Near the uterine cornua |
| The most potentially life threatening ectopic gestation is? | Interstitial |
| An increased risk of a complete hysterectomy is present when an ectopic pregnancy is located in? | Cervix |
| What is the gold standard for imaging the breasts? | MRI |
| DCIS aka intraductal carcinoma aka ductal carcinoma in situ | not invasive, has not spread from the ducts into the fatty tissue -100% cure rate with treatment |
| IDC aka invasive ductal carcinoma | accounts for 80% of breast cancers, invades the fatty tissue -can metastasize via the lymphatic system and blood stream |
| LCIS aka lobular carcinoma in situ | a marker for cancer, but NOT considered cancer -referred to lobular neoplasia |
| ILC aka invasive lobular carcinoma | begins in the lobule then extends into the surrounding fatty and connective tissue -poor survival rate compared with IDC |
| What is a category 1 Bi-RAID? | Negative |
| Category 2 BI-RAID | Benign findings |
| Category 3 BI-RAID | Probable benign findings/ initial short term follow-up |
| Category 4 BI-RAID | Suspicious abnormality/ consider biopsy |
| Category 5 BI-RAID | Highly suggestive of malignancy/ appropriate action needed |
| Benign tumor characteristics | Rubbery, mobile, and well-defined |
| Malignant tumor characteristics | Hard, irregular, and gritty |
| What benign breast pathology is most commonly seen in women aged 35-55? | FCC aka fibrocystic condition |
| What are the clinical symptoms of FCC? | pain with menstrual cycle, lump, and tenderness |
| Three categories of FCC | non proliferative lesions proliferative lesions without atypical changes (mildly) proliferative lesion with atypical changes (moderately) |
| Lipoma | made up of fatty tissue, could be glandular tissue |
| Fat Necrosis | Happens after injury to the breast fat, causing inflammatory response |
| Acute Mastitis | Results from trauma, infection, or obstruction of ducts -seen in lactating or breastfeedings mothers |
| Chronic Mastitis | Inflammation of glandular tissue -most often seen in menopausal women |
| Breast Abscess | Acute=poorly defined mature=well encapsulated and sharp borders clinical presentation: fever, swollen nodes |
| Intraductal Papilloma | Within acini cells clinical symptom: nipple discharge *rasberry like configuration on mammogram |
| Where do malignant breast pathologies often originate? | TDLU |
| Sarcomas | Arise from supportive or connective tissue |
| Carcinomas | Arise from epithelium |
| Papillary Carcinoma | Originally arises as an intraductal mass -represents 1-2% of all breast cancers -earliest clinical sign: bloody nipple discharge |
| Paget's disease | arises in the retroareolar ducts -grows in the direction of the nipple -accounts for 2.5% of all breast cancers, 50 years or older |
| Medullary Carcinoma | Densely cellular tumor -well-circumscribed -less than 5% of all breast cancers -occurs in women greater than 50 |
| What are the structural fertility issues? | septate, bicornuate, fibroids, and polyps |
| How does septate uterus affect fertility? | Causes implantation issues, 1st trimester miscarriages, MOST COMMON uterine anomaly |
| How do you fix septate uterus? | Septum removal |
| How does a bicornuate uterus affect fertility? | Causes cervical incompetence, funneling and opening -2nd trimester miscarriges bc of this |
| How do you fix a bicornuate uterus? | Clamping the cervix |
| How do uterine fibroids affect fertility? | Because they grow with estrogen |
| How do endometrial polyps affect fertility? | Cause synechiae/ asherman's syndrome, creating bands |
| What are the functional fertility issues? | PCOS, Hyperplasia, OHSS |
| What is PCOS? | An endocrine disorder caused by unopposed estrogen - NO OVULATION |
| What are the LH and FSH ratios in PCOS? | High LH and low FSH |
| What is the triad of symptoms with PCOS? | Hyperandrogenism, oligomenorrhea, and hirsutism (hair growth) |
| What does hyperplasia occur from? | PCOS |
| OHSS | Caused by fertility treatments -can cause theca lutein cysts |
| What are some fertility treatments? | Ovulation induction therapy, IUI, and IVF |
| Anembryonic/ blighted ovum | 1st trimester complication, HCG doubles at first then declines -embryonic sac present, no fetal pole |
| What does HCG do in an ectopic pregnancy? | Rises but then plateaus |
Created by:
marissagirl