Pelvic Sonography: Ovarian Anatomy, Uterine Vasculature, and Menstrual Cycle

Comprehensive practice flashcards reviewing ovarian anatomy, uterine vasculature, hormone pathways, endometrial phases, and pelvic recesses based on lecture material.

What are the typical shape and length of normal ovaries in an adult female?

Normal ovaries are typically almond-shaped and measure approximately $3\,\text{cm}$ in length.

From which structures are the ovaries suspended within the pelvis?

They are suspended from the broad ligament by a fold of peritoneum called the mesovarium, and supported laterally by the suspensory ligament.

How does venous drainage differ between the right and left ovaries?

The right ovarian vein drains directly into the inferior vena cava (IVC), whereas the left ovarian vein drains into the left renal vein.

What is the longest pelvic vessel in female anatomy?

The left ovarian vein.

What are the two main structural layers of the ovary and their components?

The outer cortex, which consists of follicles appearing as small fluid-filled pockets on ultrasound, and the central medulla, which contains blood vessels.

What are the primary functions and hormones produced by the ovaries?

The ovaries produce the ovum (egg) and store/secrete the hormones estrogen and progesterone.

What is the correct order of blood flow through the uterine arterial system from origin to endometrium?

Uterine artery $\rightarrow$ arcuate arteries $\rightarrow$ radial/straight arteries $\rightarrow$ spiral arteries.

Which uterine arteries course along the periphery or border of the myometrium?

Arcuate arteries.

Which specialized arteries supply the endometrium and are shed during menses?

Spiral arteries.

What specific clinical history date must always be obtained prior to a pelvic ultrasound?

The first day of the patient's last menstrual period (LMP).

What is the medical definition of polymenorrhea?

Menstrual cycles occurring at abnormally frequent intervals of less than $21$ days.

What is oligomenorrhea?

Abnormally light or infrequent menses occurring at intervals greater than $35$ days.

What is dysmenorrhea?

Painful menses.

On what day does ovulation typically occur in a standard $28$-day menstrual cycle?

Day $14$.

Approximately how many oocytes is each ovary equipped with at birth?

Approximately $200,000$ oocytes in each ovary.

Which hormone released by the anterior pituitary stimulates ovarian follicles to mature during the first half of the cycle?

Follicle Stimulating Hormone (FSH).

What is a mature, dominant follicle termed, and what is its expected size before ovulation?

A Graafian follicle, measuring approximately $2\,\text{cm}$ right before ovulation.

What hormonal event triggers the rupture of the Graafian follicle and ovulation?

A surge in Luteinizing Hormone (LH) occurring $24$ to $36$ hours prior to ovulation.

What is Mittelschmerz?

A German word meaning 'middle pain,' referring to the sudden, sharp pelvic pain experienced on the ovulating side during follicular rupture.

Which phase of the ovarian cycle always lasts $14$ days and does not vary in length?

The luteal phase.

What hormone is secreted by an implanted conceptus to preserve the corpus luteum in early pregnancy?

Human chorionic gonadotropin (hCG).

What are the three distinct endometrial phases seen across the cycle?

The menstrual phase (days $1$ to $5$), proliferative phase (days $5$ to $14$), and secretory phase (days $15$ to $28$).

What characteristic sonographic sign appears during the late proliferative endometrial phase?

The 'three-line sign' or trilaminar appearance.

What is the expected endometrial thickness range during the secretory phase?

$7$ to $14\,\text{mm}$.

What is the correct technique for measuring the endometrial stripe sonographically?

Measure from outer echogenic wall to outer echogenic wall in the sagittal plane, excluding the hypoechoic inner myometrial halo.

What is the normal endometrial thickness threshold in an untreated postmenopausal patient?

The endometrium should measure no more than $5\,\text{mm}$.

What is the maximum normal endometrial thickness in a postmenopausal patient receiving Hormone Replacement Therapy or Tamoxifen?

Up to $8\,\text{mm}$.

What is menorrhagia?

Abnormally heavy or prolonged menstrual bleeding.

What updated terminology replaced Polycystic Ovarian Syndrome (PCOS) as of May?

Polyendocrine Metabolic Ovarian Syndrome (PMOS).

What are the alternate names for the vesicouterine pouch?

Anterior cul-de-sac.

What are the alternate names for the rectouterine pouch?

Posterior cul-de-sac or Pouch of Douglas.

What is the most common site for fluid accumulation in the female pelvis?

The posterior cul-de-sac (rectouterine pouch/Pouch of Douglas), because it is the most dependent/inferior space.

What is the alternate name for the retropubic space, where is it located, and what does it typically contain?

Space of Retzius; located between the anterior bladder wall and the symphysis pubis, it normally contains fat.

What is the most common anatomical orientation of the uterus?

Anteverted.