Midterm OB/GYN ~ Sept 2025

Chapter 41 - 52

MC benign cyst in vagina

Gartner Duct Cyst

MC congenital abnormality in the female GI TRACT

• results in

  • hydrometra

  • hematometra

  • pyometra

Imperforated Hymen

MC area of intraperitoneal fluid collection

can happen in anterior cul-de-sac

Posterior Cul-de-sac

Cervix normal measurement

2- 4 CM

MC benign cystic lesion

• caused by

  • chronic cervitis

  • <2 cm cysts

Nabothian Cyst

• Irregular bleeding

• benign

• may be pedunculated

• 45 - 60 yrs (late middle ages)

Cervical Polyp

• caused by

  • radiation

  • surgery

  • infection

  • menopause

• post meno - hydro/hemato/pyo metra

• pre meno - inferility, cramps, irregular or no period

Cervical stenosis

Mc cervical malignancy

• vaginal discharge/bleeding

Cervical Carincoma (MC: squamous cell carcinoma)

• congenital anomaly

• incomplete mullerian duct fusion

Bicornuate uterus

• 2 uterus

• 2 cervix

• Failure of mullerian duct fusion

• congenital anomaly

Uterus Didelphys

MC uterine position

Anteverted

Anteflexed

Retroverted

Retroflexed

MC uterine pelvic tumor

• > 30 yrs

• Black women

• estrogen-dependent

  • pelvic pain

  • pain

  • heavy or irregular bleeding

Leiomyoma (Fibroid)

What kind of fibroid is this?

Has a stalk

Pedunculated Fibroid

• Heavy bleeding

• pregnancy loss

• Infertility

• wha location is this?

Intramural (within myometrium)

Fil in blank

Intramural Fibroid

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Submuosal Fibroid

• bleeding

• ANEMIA

• fertility issues

what location is this

Submucosal (in endo)

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Subserousal Fibroid

• sometimes pedunculated (stalk)

Subserousal (outside)

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Intracavitary Fibroid

what location is this fibroid in ?

Intracavitary

Fibroid location chart

• form of endometriosis (WITHIN MYOMETRIUM)

• benign, ectopic occurrence of endometrial tissue invasion

• OLDER WOMEN

• MULTIPARIOUS

  • heavy, painful periods

  • tenderness

  • Hypermenorrhea (heavy bleeding)

  • metorrhea (irregular bleeding)

Adenomyosis

MC cause of abnormal uterine bleeding in PRE and POST menopausal

• estrogen stimulation (PCOS, obesity)

• pre meno > 14mm

• post meno > 8 mm

• precursor to cancer

Endometrial Hyperplasia

In menstrual phase, how thick is endo

2 -3 mm

In proliferative phase, how thick is endo?

4 -6mm

In periovulatory phase, how thick is endo?

6-8 mm

In secretory phase, how thick is endo?

8-15 mm

• peri/post meno

• (Premenopause → Perimenopause → Menopause → Postmenopause)

• Menometrorrhagia (heavy, long, irregular bleeding)

• infertility

• Use color = highly vascular

• Use sonohysterography

attached to the endometrium by a narrow or sometimes broad stalk.

Endometrial Poylp

• POSTPARTUM patients

• PID pts

• use of instrumentation causing infection

  • fever / HIGH WBC

  • pelvic pain

  • low back pain

  • vaginal bleeding

Endometritis

• results from

  • trauma

  • surgery

  • D&C

  • C-section

  • Postpartum curettage

Synechiae

• MC gynecologic MALIGNANCY in North America

• postmeno

• estrogen-therapy

• tamoxifen

• pre meno

  • anovulatory cycles

  • obesity

• pelvic pain

Endometrial Carcinoma

• Happens when a dominant follicle fails to rupture or reseals (failed ovulation)

• Usually >2.5 cm, typically up to 8–10 cm

• Simple cyst

  • anechoic

  • clear thin walls

  • posterior enhancement

    • asymptomatic

    • dull, adnexal pressure

    • adnexal pain

Follicular cyst(Functional cyst)

Ruptured dominant follicle normally becomes this.

• Complex cyst

• thick walls

• 1- 10 cm

• “Ring of Fire”

• Internal echoes with cystic fluid / blood

• irregular mens cycle

• pain

• mimic ectopic pregnancy

• rupture

Corpus Luteum Cyst

MC benign tumor of the ovary

• abdominal pain / enlargement / pressure

• complex solid mass with fat, teeth, hair, cartilage, bone

• “tip of iceberg"

Immature type-

• malignant, rare

• 10 - 20 yrs

• AFP = HIGH

Teratoma (Dermoid Cyst)

• endocrine disorder

• Chronic anovulation

• late teens - 20’s

• hirsutism

• obesity

• infertility

• irregular periods/no period

• high LH

• low FSH

• Includes stein- leventhal syndrome

• “string of pearls” appearance

ENLARGED CYSTS

PCOS (Polycystic Ovarian Syndrome)

2nd MC epithelial malignancy

1st MC is serous cystadenocarcinoma (also epithelial)

• 50 - 60 yrs

Endometroid

• elements from endocervix or bowel

• 100 LBS

• often in 40-70 yrs old

• benign, common

• large complex mass

• 20-25% of all benign ovarian neoplasms

• 5-10% of all malignant ovarian neoplasms

• 15-20% bilateral when malignant

Mucinous Cystadenoma

Definition: middle cycle pain

“Mittelshmerz”

MC ovarian MALIGNANCY

Serous Cystadenocarcinoma

• invades OUTSIDE THE UTERUS

• 15% are pre-meno

• chronic pelvic pain

• DYSMENORRHEA = painful menses

• Infertility

• painful sex

• irregular bleeding

• lower, abd pain

Endometriosis

What is seen here

IUCD (Intrauterine Contraceptive Device)

• 40 - 70 yrs

• leads to pseudomyxoma peritone (ascites thick)

• large, multiloculated, THICK, irregular walls

• menopausal women 10%

• pelvic pressure

• pain when ruptured

• bloating

• weight loss

Mucinous Cystadenocarcinoma

“Chocolate cyst”

• heavy menses

• well-defined

• infertility

• spotting

• chronic lower back pain

Endometrioma

• 4th leading cause of death

• 40 - 60 yrs

• Family HX

• Infertility

• NULLIPARITY

• abdominal pain

• abdominal swelling

• Indigestion

• weight change

• urinary urgency

Ovarian Carcinoma

MC in children + adolescents

• Rt ovary 3 x more likely

  • Sudden, severe pain

  • nausea/vomiting

  • fever

  • palpable mass

Ovarian Torsion

• Masculinization is taken over by anovulation

• < 30 yrs

• LOW menses

• NO menses

• Produces Androgens

• benign

• Virilization (deep voice)

Arrhenoblastoma / Androblastoma

• sudden pelvic pain

• causes internal bleeding into a follicular cyst or corpus luteum cyst

• Hours/days after:

  • highly echogenic due to clot formation
    

• Several days after

  • increasingly complex appearance

Hemorrhagic Cyst

• Wolfian duct remnants

• 10% of all adnexal masses

• BROAD LIGAMENT location

• benign cyst

• 20 -40 yrs

• mesothelial/paranephric origin

• asymptomatic

Para-ovarian Cyst

• MC malignancy in CHILDHOOD

• high AFP and beta HCG

Dysgerminoma

• BENIGN Small, solid, hypoechoic tumor
  ASSOCIATED W/ MIEG'S
  No internal cystic structures
  (u) No calcifications, but possible
  
  *Very similar to granulosa cell tumor

Brenner's Tumor

Gastric adenocarcinoma with ovarian metastases

Krukenberg Tumor

• Iatrogenic (treatment-caused) complication from ovulation induction

• Mild - pelvic discomfort

• Severe - severe pelvic pain + abdominal distention

• 5-10 cm

Ovarian Hyperstimulation Syndrome (OHSS)

• 20-24 yrs

• intense pelvic pain

• dull, aching tenderness

• fever

• DISCHARGE

• RUQ pain

  • Risk factors

    • early sex

    • multiple partners

    • STD

    • IUCD

    • douching

    • postsurgical/post abortion

Pelvic Inflammatory Disease (PID)

• PID caused by GONORRHEA

• RUQ pain

• related to PID

Fitz- Hugh Curtis Syndrome

• pelvic pain

• fever

• adnexal tenderness

• PID complication

Tubo-ovarian Abscess

• secondary to PID, endometriosis

• infertility

• pelvic pain

Hydrosalpinx (Fluid in Fallopian tube)

• Chronic PID

• SEVERE pelvic pain

• fever

Pyosalpinx (Pus in fallopian tube)

• pelvic discomfort

• fullness

• LOW-grade fever

• pelvic tenderness

• related to PID

Salpingitis

Total # of pregnancies (including current)

Gravidity

Total # of births given

Parity

3rd parameter after Gravity and Parity

Preterm & Stillborn

4th parameter after Gravity and Parity

Losses & Abortions

5 parameter after Gravidity and Parity

Living children

1st Trimester is how long

13 weeks and 6 days

2nd Trimester is how long

14 wks - 26 2ks + 6 days

3rd Trimester is how long

27 wks → delivery

< 90 BPM is considered what

Bradycardia

> 160/170 BPM is considered what

Tachycardia

What two measurements are taken in the 1st Trimester?

• CRL (crown to rump)

• Yolk Sac

What is measured that is should be < 3.5 mm in the first trimester?

Nuchal Translucency

Gestational Age (Menstrual age / LMP) is 2 weeks after or before the conceptual age (embryonic age)

If your gestational age is 8 weeks, the actual embryo is about 6 weeks old.

After

Conception → 12 days is considered what

Zygote

Implantation → 10 wks is considered what

Embryo

10+ weeks → delivery is considered what

Fetus

Menses cycle,

days 1-14 is considered what phase?

Menstruation phase

Menses cycle,

days 5-14 is considered what

Proliferative Phase

Proliferative phase is aligned with what ovarian phase?

• see TRI -laminar sign (three line sign)

• THIN ENDO

• high estrogen

• ovulation occurs on day 14

Follicular phase

Menses cycle,

Days 15-28 is considered what phase?

Secretory phase

The secretory phase is aligned with what ovarian phase?

• ruptured follicle becomes Corpus luteum

• produces progesterone

• ENDO THICKENS

• if no pregnancy, estrogen and progesterone DECLINE

Luteal phase

The next period starts on _____ which is the end of the cycle

Day 28

Positive HCG, but there’s fluid + adnexal mass =

Ruptured ectopic pregnancy

What is 1?

Intramural

what is 2?

Pedunculated

What is 3?

Intracavitary

what is 4?

submucosal

what is 5?

subserousal

How to write this ?

SAG UTERUS ML, Fibroid 2

intramural fibroid is seen within the myometrium of the uterus

• up to ~2.5 cm (normal)

• aka graafian follice

• normal ovulation

Dominant follicle

Greater than what measurement is considered a surgical consult for an follicular cyst?

> 5 cm

Menstrual week 3 = how much beta hcg?

35-50 miu/ml

Menstrual week 4, how much beta hcg?

45-426 miu/ml