GYN Test #1 - CH 41, 42, & Congenital Anomalies Supplemental PDF

I put questions from the study guide, homework for CH 41 and the Supplement PDF, as well as stuff from the slides that I have trouble remembering.

Which one of the following arteries is the blood supply to the zona basalis?

Spiral

What is the physiologic status of prepuberty?

Premenarche

Which of the following ligaments contains the uterine blood vessels and nerves?

Broad

Bending forward of the fundus and body of the uterus toward the cervix is called which one of the following positions?

Anteflexion

Which of the following is the most accurate measurement for the menarcheal uterus?

8cm long and 4 cm wide

The superficial layer of glands of the endometrium is called which one of the following?

Zona functionalis

The ovary produces two hormones. Estrogen is secreted by __________, whereas progesterone is secreted by the __________ ?

Follicles; corpus luteum

The release of an egg from the ruptured follicle is termed which one of the following?

Ovulation

The vagina has two sources of blood supply; they are the:

Uterine artery and vaginal artery

The ovary receives its primary blood supply from which one of the following arteries?

Ovarian

Which one of the following portions of the fallopian tube is the longest?

Ampulla

T/F The internal mucous membrane of the fallopian tube is continuous with the endometrium?

True

In postmenopausal patients who are not on hormone replacement therapy, an endometrial thickness less than (blank) millimeters (mm) is considered benign?

5

Which one of the following statements is false?

The ovaries are suspended from the anterior aspect of the broad ligaments

The left ovarian vein drains into which one of the following veins?

Left renal

The ovaries are laterally supported by which one of the following ligaments?

Suspensory

A mature follicle is known as a (blank) follicle?

Graffian

A mature follicle typically measures (blank) cm right before ovulation?

2

The endometrium demonstrates the “three-line” sign in which one of the following phases?

Proliferative

The rectouterine space is also known as which one of the following?

Posterior cul-de-sac

The pelvic recess between the anterior bladder wall and pubic symphysis is which one of the following?

Space of Retzius

Abnormally heavy or long menses is termed?

Menorrhagia

Which one of the following ligaments provides support to the cervix to the pelvic sidewall?

Cardinal

Depending on the menstrual cycle, the inner lining of the uterine cavity that appears echogenic to hypoechoic on ultrasound is which one of the following structures?

Endometrium

Menarche may be defined as which one of the following?

The state after reaching puberty during which menses normally occurs every 28 days

Which one of the following are small vessels found along the periphery of the uterus?

Arcuate vessels

The endometrium is at its greatest thickness and echogenicity with posterior enhancement in which one of the following phases?

Luteal

The thickness of the endometrium should be measured in which one of the following planes?

Longitudinal

The middle layer of the uterus is which one of the following?

Myometrium

Flexion refers to the axis of the uterine body and fundus relative to the what?

Cervix

Which of the following is the term used for painful periods?

Dysmenorrhea

The duplication of the uterus with a common cervix is a (blank) uterus?

Bicornuate

A blood-filled vagina and uterus is known as what?

Hematometrocolps

Which one of the following demonstrates a small and laterally positioned uterus?

Unicornuate uterus

A fluid filled vagina is called which one of the following conditions?

Hydrocolpos

A complete duplication of the uterus, cervix, and vagina is a (blank) uterus?

Didelphys

In which one of the following conditions may blood be seen in the cervix and uterine cavities?

Vaginal atresia

Congenital anomalies of the uterus have a high association with which anomaly?

Renal

Types of mullerian abnormalities include all of the following except:

Improper location of the ovaries

Which one of the following organs should be evaluated in children with precocious puberty?

Adrenal gland

A congenital anomaly of the uterus in which two closely spaced uterine cavities are seen with only one fundus is what?

septate uterus

Which one of the following uterine conditions has the highest incidence of fertility problems?

Septate uterus

The bilobed uterine cavity with wide-spaced cavities and a low incidence of fertility complications is what?

Bicornuate uterus

Precocious puberty is the onset of puberty before how many years of age?

8

What are the ligaments of the uterus?

Broad ligament, mesosalpinx, mesovarium, mesometrium, round, ovarian, cardinal, utero-sacral

Didelphys

RARE ASF; Complete duplication of uterus, cervix & vagina; not usually associated with fertility problems so it doesn’t usually require treatment unless problems occur

Unicornuate aka Hemi-uterus

Uterus is formed from only 1 of the paired Mullerian ducts while the other duct does not develop; Related to infertility and pregnancy loss;

• Long and slender like a cold cigarrete

• Deviated to one-side like a broken nose

• Difficult to differentiate from normal UT on US

Septate Uterus

Most common Mullerian anomaly; 2 UT cavities and single fundus, outside of the UT has a normal shape; The UT cavity is partitioned by a longitudinal septum; Can be surgically removed

Bicornuate Uterus

Duplication of uterus with common CX; 2 UT bodies (horns), 2 EMC, wide UT body, fundal notch

• Heart shaped uterus (so cute)

• Low incidence of fertility complications, usually not treated

Phases of the menstrual cycle in order:

1. Menstrual phase (menses) - Days 1-5

2. Proliferative phase (before ovulation) - Days 6-13

3. Ovulation (that girl, she gets her own day) - Day 14

4. Secretory Phase (post ovulation) - Day 15-28

Phases of the ovarian cycle in order:

1. Follicular phase - Day 1 - ovulation phase of menstrual cycle

2. Luteal Phase - Begins with ovulation (lines up with the secretory phase of the menstrual cycle

What are the common muscles seen on US?

1. Obturator internus

2. Levator ani

3. Piriformis (maybe)

What are the normal measurements of the ovaries?

In a menarcheal female: 3cm L x 2cm W x 1 H cm

For volume cm³ = (L x W x H) x 0.5

VOLUME VARIES BY HORMONAL STATUS; ALWAYS MEASURE IN 3 DIMENSIONS

What are the normal measurements of the uterus for premenarcheal/prepubertal?

1-3cm L x .5-1cm W

Obviously lower numbers since puberty hasn’t hit

What is the ratio of cervix/ UT for a premarcheal/prepubertal patient?

Cervix/ UT ratio = 2:1

Again, puberty hasn’t happened so why would the uterus be big? 🤔

What is the uterus size of a menarcheal patient?

Adult - nulliparous (has not given birf 😛): 6-8cm L x w 3-5cm W x 3-5cm H

• of course an adult would have a bigger uterus

• Multiparity (having lots of kids) increase the sis of uterus by like 1-2cm 😱

What is the cervix to uterus ratio for a menarcheal, nulliparous adult?

CX/UT ratio = 1:2

What is the uterus size of a menarcheal, adult (parous)?

8-10cm L x 5-6cm W. x 5-6cm H

• Remember, this patient has had kids so ofc their uterus will be bigger/da biggest

What is the cervix to uterus ratio of a menarcheal, parous, adult?

CX/UT ratio 1:2

What is the uterus size of a postmenopausal women?

3-5cm L. x 2-3cm W. x 2-3cm H

• Obviously was able to shrink down because they haven’t had kids in a minute and won’t anymore

What is the cervix to uterus ratio of a postmenopausal women?

CX/UT ratio = 1:1

• Just remember the basic ahh number

What are the normal measurements of the fallopian tubes?

10-12 cm long and 1-4mm in diameter

• NOTICE ITS CM AND MM

What are the different positions of the uterus?

• Anteverted, Anteflexed, Retroverted, Retroflexed

Anteverted uterine position characteristics

Cervix tilts anteriorly towards bladder (cervix is attracted to the bladder 😍) and cervix forms a crisp ahh, 90 degree or smaller angle with da vaginal canal

What are characteristics of anteflexed uterine

Uterus tilts anteriorly and UT fundus and body are curved forward upon the cervix like a crooked finger

What are characteristics of retroverted uterus?

Cervix tilts posteriorly (to da back) and forms a <90 degrees angle with da vagina

Characteristics of a retroflexed uterus?

UT tilts posteriorly and da fundus and body are curved back upon the cervix like a crooked finger

What is another name for the unicornuate uterus?

Hemi-uterus

When is unicornuate uterus suspected?

When UT appears small and laterally positioned

Complete septum

Septate uterus septum when the total length of the cavity and the cervix resulting in a double CX and possibly vagina

Partial/incomplete septum or Subseptae uterus

Type of septate uterus septum where only the superior part of the cavity has a septum

Arcuate uterus

Mildest version of septate uterus

What happens if pregnancy implants along the septum of a septate uterus?

There is an inadequate blood supply

Commit this to memory!

What is in the posterior cavity of the pelvic cavity?

Rectum, Colon, Ileum

• Notice how all of them relate to dookie which comes out the posterior 🤔

What is in the anterior portion of the pelvic cavity?

Bladder, ureters, uterus, vagina, ovaries, fallopian tubes

The boney pelvis is divided into two continuous compartments. What are they

1. True pelvis

2. False pelvis

What is the lowest margin of pelvic cavity called?

Pelvic diaphragm

What is the area below the pelvic floor called

Perinuem

Characteristics of false pelvis

AKA pelvis major, greater pelvis (for being the false pelvis it sure has some mighty names smh)

Part of the abdominal cavity

True Pelvis characteristics

AKA minor pelvis,or lesser pelvis (it’s the og but clearly doesn’t get enough appreciation. Whatchu mean lesser and minor pelvis 😔) anyways, it lies inferior to the pelvic brim

Psoas major

Pelvic muscles that lies laterally to the spine and descends inferiorly on the anterior side wall

Iliacus muscle

Found on the pelvic side wall (more in depth definition look at ch 41 terms)

Pirformis muscle

Muscle of the pelvis where sacrum runs along posterior lateral wall

Obturator internus

Muscle of the pelvis that arises from the anterolateral pelvic wall and may be seen on US

Levator ani

Found in the anterior pelvic floor as a group of three muscles

1. PUBOCCYGEOUS

2. PUBORECTALIS

3. ILIOCOCCYGEOUS

extends across the pelvic floor and may be seen on US; joins coccygeus muscle to form pelvic diaphragm

Coccygeus muscle

Found on the posterior pelvic floor where it joins the levator and to form the PELVIC DIAPHRAGM; it is basically the floor of the pelvis

How do pelvic muscles appear on US

Appear hypoechoic with hyperechoic striations and vary in shape

How does the obturator internus look like on US

Hypoechoic, Ovid shaped, lateral to the bladder (image is TRV)

How does the levator ani look on US

Hypoechoic and hammock shaped. To demonstrate, angle from the most superior aspect of the urinary bladder, caudally

Characteristics of the urinary bladder

• in the anterior portion of pelvic cavity, posterior to symphasis pubis and anterior to vagina

• Muscular sac that has a thick ahh wall

• It’s functional is to collect and store urine until it emptied through the urethra

What happens when the urinary bladder becomes distended?

It becomes thin (skinty), the contours vary as it expands, and also displaces adjacent structures/organs

What is the trigone region of the bladder

It is on the lower, posterior wall of bladder, the orifice of the ureters, and has ureteral jets

What da helly are the ureters

Two tubes that carry urine from kidneys to bladder and enter posteroinferior to the bladder at he trigone; not normally seen unless obstructed

Utueral jets

The swirling of urine seen with color Doppler in US

Characteristics of the vagina

• Collapsible muscular tube that lies posterior to the urinary bladder and anterior to the rectum. It extends from the external genitalia (vulva) to the cervix of the uterus

• Approx. 9 inches long

how is the vagina normally directed?

Upward and backward, forming a 90 degree angle with da cervix

Forncies are?

The arch like recesses as a result of the uterine cervix protruding into the upper portion of the vaginal canal

Parts of the vaginal vascular system

Arterial supply

• Vaginal artery and uterine artery

Venous return

• internal iliac vein

Characteristics of the uterus

Hollow and pear shaped (body tea) and divided into the fundus, body, and cervix. Suspended by the broad ligament - anterior, lateral, and posterior