WorksheetsDS 3262 Chapter 43: Pathology of the Uterus
Total questions: 210
Worksheet time: 2hrs 45mins
What is the most common cystic lesion of the vagina?
Hydrometra
Gartner’s Duct Cyst
Hematometra
Pyometra
How is a Gartner’s Duct Cyst typically discovered?
Routine pelvic exam
Incidentally during sonographic examination
Blood tests
MRI scan
Which of the following is a result of an imperforate hymen?
Uterine fibroids
Obstruction of the uterus and/or vagina
Ovarian cysts
Ectopic pregnancy
What is hydrometra?
Fluid accumulation in the uterus
Blood accumulation in the uterus
Pus accumulation in the uterus
Infection in the fallopian tubes
Which of the following can cause pyometra?
Imperforate hymen leading to uterine obstruction
Vaginal prolapse
Ovarian cyst rupture
Endometrial hyperplasia
Which of the following best describes pyometra?
Accumulation of pus in the uterus
Fluid build-up due to a blockage in the cervix
A condition related to ovarian cysts
Increased blood flow to the uterus
An imperforate hymen can lead to the accumulation of which of the following substances?
Amniotic fluid
Fluid (hydrometra), blood (hematometra), or pus (pyometra)
Hormones
Urea
What is the primary cause of hematometra?
Infection of the uterus
Obstruction of the menstrual outflow, leading to blood accumulation
Fluid accumulation due to hormonal imbalance
Ectopic pregnancy
What does hematometra refer to?
Accumulation of pus in the uterus
Accumulation of blood in the uterus
Accumulation of fluid in the uterus
Infection in the fallopian tubes
What is the vaginal cuff?
The outer muscular layer of the vaginal wall
A surgical closure at the top of the vagina after hysterectomy
A fold of peritoneum that supports the uterus
The opening of the cervix into the vagina
In post-hysterectomy patients, what is the upper size limit of a normal vaginal cuff on ultrasound?
1.5 cm
2.1 cm
3.0 cm
2.5 cm
Which of the following patients should raise the highest suspicion for malignancy if a vaginal cuff abnormality is seen?
A young woman with no surgical history
A postmenopausal woman with fibroids
A post-hysterectomy patient with a history of cancer
A pregnant woman with vaginal bleeding
The vaginal cuff is typically visualized in which type of patients?
Women with pelvic inflammatory disease
Pregnant patients
Post-hysterectomy patients
Women undergoing fertility treatments
What is another name for the retrouterine recess?
Fornix
Anterior cul-de-sac
Pouch of Douglas
Uterosacral recess
Where is the Pouch of Douglas located?
Between the bladder and uterus
Between the pubic bone and bladder
Between the uterus and rectum
Between the ovaries and fallopian tubes
Which of the following is a normal finding in the Pouch of Douglas in asymptomatic women?
Large amounts of echogenic material
Free fluid
Calcified debris
Hematoma
Fluid in the posterior cul-de-sac may be considered pathological if it is associated with which of the following?(Select the best answer)
Ovulation
Menstrual spotting
Ascites, hemorrhage, or infection
Uterine fibroids
Which of the following can lead to blood in the cul-de-sac?
Nabothian cyst
Hemorrhagic cyst rupture
Ovarian torsion
Simple ovarian cyst
What is the most common sonographic finding in the cervix?
Cervical carcinoma
Nabothian cysts
Endocervical polyp
Cervical ectopic pregnancy
Nabothian cysts are the result of which condition?
Endometriosis
Acute appendicitis
Chronic cervicitis
Vaginal cuff dehiscence
Nabothian cysts are most frequently seen in which group of patients?
Adolescent girls
Pregnant women
Middle-aged women
Elderly men
Which of the following best describes the sonographic appearance of a Nabothian cyst?
Solid and irregular
Multilocular with septations
Simple, round, anechoic lesion in the cervix
Echogenic with posterior shadowing
Where are Nabothian cysts typically located on ultrasound?
In the uterine fundus
Along the cervical canal
In the posterior cul-de-sac
On the ovaries
What is the typical sonographic appearance of a Nabothian cyst?
Hyperechoic with strong shadowing
Solid, vascular, and irregular
Round, fluid-filled, and anechoic
Septated with calcifications
What is the usual size of a Nabothian cyst?
Greater than 4 cm
Less than 2 cm
Exactly 3 cm
Variable but always larger than 5 cm
Which of the following may be seen within a Nabothian cyst, suggesting possible hemorrhage or infection?
Peripheral calcifications
Thick septations
Internal debris
Acoustic shadowing
What is the most likely contributing factor in the development of cervical polyps?
Estrogen deficiency
Ovarian cysts
Chronic inflammation
Cervical trauma
Cervical polyps are best described as:
Calcified lesions of the uterine fundus
Hyperplastic protrusions of the endocervix or ectocervix
Simple ovarian cysts
Hyperechoic fibroid tumors
Which of the following symptoms is commonly associated with cervical polyps?
Severe pelvic pain
Postmenopausal hot flashes
Irregular bleeding
Urinary retention
Which of the following best describes a pedunculated cervical polyp?
A broad-based fibroid mass in the uterine fundus
A cyst filled with clear fluid and surrounded by septations
A polyp with a stalk projecting out of the cervix
A solid, immobile mass with posterior shadowing
What is the difference between a pedunculated and a broad-based cervical polyp?
Pedunculated polyps are larger
Pedunculated polyps are cystic, broad-based are solid
Pedunculated have a stalk; broad-based attach directly without a stalk
Broad-based polyps only occur during pregnancy
Cervical leiomyomas represent what portion of all uterine leiomyomas?
The majority
A moderate amount
A small percentage
Over 50%
What is the typical symptom presentation of a small cervical leiomyoma?
Heavy menstrual bleeding
Asymptomatic
Severe cramping
Postmenopausal bleeding
What complications can arise from larger cervical leiomyomas?
Ovarian torsion
Vaginal dryness and infertility
Bowel or bladder obstruction
Fallopian tube blockage
Which of the following is true about some cervical leiomyomas?
They always remain inside the uterine cavity
They can be pedunculated and prolapse into the vaginal canal
They are always malignant
They are rarely seen on ultrasound
Which imaging technique enhances the visualization of cervical leiomyomas?
Hysterosalpingography
Abdominal X-ray
Sonohysterography
MRI only
Cervical stenosis refers to:
The abnormal widening of the cervical canal
A congenital malformation of the uterus
An acquired narrowing or obstruction of the cervical canal
An infection that affects the external os only
Which of the following is not a common cause of cervical stenosis?
Radiation therapy
Cone biopsy
Chronic infection
Uterine fibroid degeneration
Cervical stenosis can occur at which locations within the cervical canal?
Only at the internal os
Only at the external os
At either the internal or external os
Only at the cervical-vaginal junction
What ultrasound finding may suggest the presence of cervical stenosis
. Endometrial calcifications
Large ovarian cyst
Intracavitary fluid
Absence of uterine arteries
Postmenopausal cervical atrophy can lead to which condition?
Nabothian cyst formation
Cervical carcinoma
Cervical stenosis
Endometrial hyperplasia
What is the most common type of cervical cancer?
Adenocarcinoma
Transitional cell carcinoma
Squamous cell carcinoma
Small cell carcinoma
What does "carcinoma in situ" mean in the context of cervical cancer?
Cancer that has spread beyond the cervix
A tumor that arises from muscle tissue
Full thickness of epithelium is replaced by neoplastic cells
Benign growth confined to the outer cervix
Cervical carcinoma primarily affects which group of women?
Prepubescent girls
Postmenopausal women only
Women of menstrual age
Pregnant women
What are common clinical findings associated with cervical carcinoma?
Fever and pelvic pressure
Vaginal discharge or bleeding
Severe back pain and constipation
Painful urination and nausea
On ultrasound, which of the following may indicate advanced cervical carcinoma?
Ovarian cyst
Enlarged endometrium
Retrovesical mass
Simple fluid in cul-de-sac
What is the primary screening tool for detecting cervical cancer early?
Endometrial biopsy
Transvaginal ultrasound
CA-125 blood test
Papanicolaou smear (PAP smear)
What sonographic finding is most associated with cervical carcinoma?
Thin, smooth endometrial stripe
Simple ovarian cyst
Solid retrovesical mass
Hyperechoic endometrium with shadowing
What is commonly seen on color Doppler in cases of cervical carcinoma?
No flow
Decreased vascularity
Increased vascularity in the mass
Only venous flow
On transvaginal ultrasound, how does the cervical area typically appear when affected by carcinoma?
Enlarged and hypoechoic
Reduced in size and hyperechoic
Fluid-filled with septations
Not visible
Which ultrasound techniques may be used to evaluate cervical carcinoma and its spread to nearby structures?
Only abdominal ultrasound
EV, translabial, and transrectal ultrasound
Hysterosonography only
MRI is the only method
What adjacent organs might be evaluated for invasion by cervical carcinoma during ultrasound?
Kidneys and spleen
Ovaries and fallopian tubes
Bladder, ureters, vagina, and rectum
Liver and pancreas
Leiomyomas are also referred to as:
Adenomas
Cysts
Myomas or fibroids
Polyps
What are uterine leiomyomas composed of?
Glandular epithelial cells
Skeletal muscle and adipose tissue
Spindle-shaped smooth muscle cells and fibrous connective tissue
Cartilage and nerve fibers
What percentage of women over the age of 30 are affected by uterine leiomyomas?
5–10%
10–15%
20–30%
Over 50%
What is the most common gynecologic tumor?
Endometrial carcinoma
Ovarian cyst
Leiomyoma
Nabothian cyst
Leiomyomas are typically:
Single and poorly defined
Encapsulated and usually multiple
Always calcified
Fluid-filled and irregular
What is a pseudocapsule in relation to a leiomyoma?
A fluid layer surrounding a cyst
A hard calcified wall around a tumor
A thin capsule formed by compressed myometrium around the fibroid
A membrane formed by the endometrium
What percentage of leiomyomas contain calcification?
25%
5%
10%
50%
Which of the following is a possible content within leiomyomas?
Serous fluid
Hemorrhage
Follicular cells
Pus
Which of the following is not a common clinical finding associated with leiomyomas?
enlarged uterus
irregular heavy bleeding
pelvic pressure and pain
fever and chills
The term "menometrorrhagia" refers to:
Irregular ovulation
Absence of menstruation
Irregular heavy menstrual bleeding
Light spotting between periods
Leiomyomas are considered:
Testosterone-dependent
Estrogen-independent
Estrogen-dependent
Progesterone-resistant
What typically happens to leiomyomas during pregnancy?
They always shrink
They rupture
They may increase in size
They calcify immediately
Leiomyomas are associated with which pregnancy risk?
Gestational diabetes
Ectopic implantation
Elevated risk of pregnancy loss
High blood pressure only
In postmenopausal women, leiomyomas typically:
Continue growing rapidly
Rarely develop and often shrink
Turn into malignant tumors
Cause menometrorrhagia
Which medication may cause growth in leiomyomas?
Progesterone-only pills
Ibuprofen
Tamoxifen
Metformin
What effect does hormone replacement therapy (HRT) have on leiomyomas?
Causes immediate calcification
Prevents their development
May increase their size
Has no impact
Which type of leiomyoma is the most common?
Subserosal
Submucosal
Intramural
Pedunculated
Submucosal leiomyomas are known for:
Compressing the bladder
Causing cervical stenosis
Displacing or distorting the endometrial cavity with irregular or heavy bleeding
Only developing in postmenopausal women
Intramural leiomyomas are:
Found on the outer uterine wall
Confined to the myometrium
Protruding into the endometrial cavity
Attached to the ovary
Subserosal leiomyomas project from which surface of the uterus?
Endometrial
Cervical
Peritoneal
Vaginal
What is a possible appearance of a subserosal leiomyoma if it becomes pedunculated?
Appears as a fluid-filled ovarian cyst
Appears as an intrauterine adhesion
Appears as an extrauterine mass
Cannot be detected sonographically
Which of the following is a primary clinical problem associated with leiomyomas?
Amenorrhea
Menometrorrhagia or menorrhagia
Vaginal itching
Nausea and vomiting
Uterine leiomyomas can cause which of the following symptoms?
Uterine shrinking and tenderness
Pelvic pain and irregular uterine shape
Increased vaginal discharge only
Constipation and nausea
How might leiomyomas contribute to infertility?
By blocking cervical mucus
By causing hormone imbalance
By distorting the fallopian tube or endometrial cavity
By suppressing ovulation
Which urinary symptom is commonly associated with leiomyomas?
Urinary retention
Dysuria
Urinary frequency
Blood in urine
Which of the following is NOT a typical symptom of uterine leiomyomas?
Back pain
Sensation of pelvic pressure
Sudden weight loss
Irregular bleeding
What is a common sonographic appearance of the uterus with leiomyomas?
Thin, uniform endometrium
Uterine enlargement or irregular contour
Simple cyst within the endometrium
Normal uterus with no changes
Myomas typically appear sonographically as:
Hyperechoic only
Isoechoic with clear borders
Hypoechoic but may be hyperechoic
Anechoic with posterior enhancement
What sonographic texture pattern is commonly seen in the myometrium with leiomyomas?
Homogeneous
Heterogeneous
Cystic
Anechoic
What effect might extensive calcification of leiomyomas have on ultrasound imaging?
Improves image clarity
Allows easy identification of ovaries
Makes the uterus and adnexa difficult to image due to shadowing
Causes the uterus to become hyperechoic with posterior enhancement
When evaluating leiomyomas, which anatomical interface should you pay special attention to for contour distortion?
Endometrium and cervix
Fallopian tubes and ovaries
Uterus and bladder
Ovary and adnexa
What is the best imaging method for evaluating small fibroids less than 0.5 cm?
Transabdominal ultrasound
MRI
Transvaginal (EV) ultrasound
CT scan
Larger myomas usually appear on ultrasound as:
Homogeneous, round structures
Hyperechoic cysts
Causing heterogeneous uterine enlargement
Isoechoic with the bladder wall
Why is transabdominal sonography preferred for larger myomas?
It is more comfortable for the patient
It avoids radiation
It outlines the uterus better
It can assess ovarian follicles
What does cystic degeneration of a fibroid look like on ultrasound?
Solid echogenic mass
Anechoic ring with posterior enhancement
Areas of lucency within the myoma
Bright shadowing without mass
Why should individual fibroids be measured if they are discrete?
To determine if they are malignant
For accurate documentation and follow-up
To assess endometrial thickness
To distinguish from ovarian masses
What is the role of Doppler in evaluating fibroids?
To rule out calcification
To check for intracystic hemorrhage
To evaluate vascularity of the myomas
To confirm postmenopausal status
What is the most common cause of uterine calcifications?
Endometrial carcinoma
Ovarian cysts
Uterine fibroids
Cervical polyps
Which of the following is a less common cause of uterine calcification?
Cervical stenosis
Submucosal fibroid
Arcuate artery calcification
Endometriosis
Arcuate artery calcification is usually found:
In the endometrial cavity
Inside ovarian follicles
Along the peripheral uterus
In the fallopian tubes
Arcuate artery calcification may be associated with which of the following conditions?
Hypothyroidism and asthma
Hypertension, diabetes, and chronic renal failure
Obesity and anemia
Cushing's syndrome and PCOS
What is adenomyosis?
Cancer of the endometrium
Ectopic endometrial tissue within the cervix
Ectopic endometrial tissue within the myometrium
Infection of the uterine lining
Adenomyosis is considered a:
Malignant condition
Benign condition
Pre-cancerous condition
Rare genetic disorder
Which uterine wall is most commonly affected by adenomyosis?
Lateral wall
Posterior wall
Fundal wall
Cervical wall
What is focal adenomyosis also called?
Endometrioma
Fibroid
Adenomyoma
Subserosal nodule
Adenomyosis is more common in women who are:
Postmenopausal
Nulliparous and in their teens
Multiparous and older than those with endometriosis
Pregnant with twins
What percentage of women with adenomyosis present with heavy abnormal menses?
25%
40%
60%
75%
Which of the following is a less common symptom of adenomyosis, affecting approximately 25% of patients?
Vaginal discharge
Pelvic pain during menstruation
Irregular ovulation
Bloating
How large can the uterus become in patients with adenomyosis?
Half its normal size
Up to 3 times its normal size
Always remains normal
Twice the size of the cervix
On physical exam, how is the uterus typically described in a patient with adenomyosis?
Small, firm, and non-tender
Globular, boggy, and somewhat tender
Rigid, shrunken, and tender
Enlarged, lumpy, and hard
What is the most common sonographic finding in adenomyosis?
Endometrial calcification
Diffuse uterine enlargement
Endometrial stripe thickening
Hyperechoic ovarian cyst
Which uterine wall is often thickened in adenomyosis on ultrasound?
Anterior
Fundal
Lateral
Posterior
A key ultrasound feature of adenomyosis is an indistinct border between:
Uterus and bladder
Endometrium and myometrium
Cervix and fundus
Ovary and adnexa
What do small hypoechoic myometrial cysts with posterior acoustic enhancement most likely represent in adenomyosis?
Normal follicles
Hemorrhage
Calcifications
Nabothian cysts
What is an arteriovenous malformation (AVM)?
A type of uterine fibroid
Vascular plexus of arteries and veins without capillaries
A benign cyst in the cervix
A calcified uterine artery
AVMs most commonly involve which part of the uterus?
Endometrium
Cervix
Myometrium
Fallopian tubes
AVMs are considered:
Common and usually malignant
Rare and often benign
Rare and associated only with pregnancy
Common in postmenopausal women
Which of the following best describes the cause of uterine AVMs?
Always congenital
Only caused by trauma
Can be congenital or acquired (e.g., trauma, surgery, GTN)
Exclusively postmenopausal
In women of childbearing age, AVMs may clinically present as:
Amenorrhea
Heavy ovulation bleeding
Metrorrhagia with blood loss and anemia
Vaginal discharge
On gray-scale ultrasound, AVMs most often appear as:
Round hyperechoic solid masses
Serpiginous, anechoic structures
Well-defined cysts
Calcified fibroids
What sonographic appearance may AVMs have in the myometrium?
Simple cysts
Inhomogeneous echotexture with tubular spaces
Thin endometrial stripe
Homogeneous, well-circumscribed lesion
AVMs may appear in all the following uterine areas EXCEPT:
Intramural
Endometrial
Cervical
Ovarian
What does color Doppler demonstrate in AVM lesions?
Absence of flow
Shadowing artifact
Blood flow within anechoic spaces
Peripheral ring flow
Spectral Doppler of an AVM typically shows:
Low velocity, high resistance arterial flow
High velocity, low resistance arterial flow
Triphasic venous flow
No detectable flow
How should the endometrium be measured on ultrasound?
Along the transverse axis of the uterus
Including the cervix
Perpendicular to the long axis of the uterus
Obliquely across the fundus
What structure should NOT be included when measuring the endometrium?
Endometrial stripe
Hypoechoic halo
Myometrium
Uterine cavity
When measuring endometrial thickness, any fluid present should be:
Measured separately and added to the total
Included in the endometrial thickness
Ignored completely
Not included in the endometrial measurement
What is the main purpose of sonohysterography?
To measure ovarian follicles
To examine fibroids only
To evaluate a thickened endometrium
To scan the cervix for stenosis
Sonohysterography helps distinguish between:
Endometrial and myometrial layers
Hormonal and non-hormonal bleeding
Focal and diffuse endometrial abnormalities
Uterine and ovarian cysts
What type of catheter is used in sonohysterography?
Foley catheter
Central venous catheter
Hysterosalpingography catheter
PICC line
How is the catheter tip identified during sonohysterography?
With contrast dye
By the saline-filled balloon at the tip
By color Doppler imaging
By echogenic particles
What is injected through the catheter during sonohysterography?
Iodine
Glucose
Saline
Barium
When is sonohysterography ideally performed in premenopausal women?
During menstruation
Immediately after ovulation
Midmenstrual cycle (days 6–10)
During the luteal phase
In postmenopausal women, when can sonohysterography be performed?
Only during ovulation
Any time or after monthly bleeding if on hormone therapy
Only after menopause is confirmed by blood tests
During menstruation
Which of the following is a contraindication for performing sonohysterography?
History of fibroids
Recent miscarriage
Acute pelvic inflammatory disease (PID)
Endometrial atrophy
What is endometrial hyperplasia?
Thinning of the endometrial lining
Infection of the uterus
Abnormal thickening of the endometrium
Calcification of the uterine wall
What typically causes endometrial hyperplasia?
Low progesterone levels
Repeated infections
Prolonged estrogen stimulation
Trauma to the cervix
Endometrial hyperplasia is considered:
A benign condition with no long-term effects
A precursor to uterine prolapse
A potential precursor to endometrial cancer
A symptom of menopause
What is the most common cause of abnormal uterine bleeding in both premenopausal and postmenopausal women?
Cervical polyps
Uterine fibroids
Endometrial hyperplasia
Ovarian cysts
In premenopausal women, what endometrial thickness suggests hyperplasia?
More than 8 mm
More than 14 mm
More than 5 mm
More than 20 mm
What is the upper limit of normal endometrial thickness in asymptomatic postmenopausal women?
5mm
10mm
8mm
12mm
What is the normal endometrial thickness in postmenopausal women?
Less than 5 mm
Less than 8 mm
Less than 10 mm
Less than 12 mm
Women on sequential estrogen and progesterone replacement therapy may have endometrial thickness up to:
8 mm during the progesterone phase
12 mm during the estrogen phase
15 mm during the estrogen phase
5 mm during the entire cycle
When should the endometrium be studied in women on hormone replacement therapy?
Only during menstruation
At the beginning or end of the hormone cycle
Only during the estrogen phase
Any time during the cycle
How does the endometrium typically appear sonographically in cases of endometrial hyperplasia?
Thin and hypoechoic
Diffusely thick and echogenic with well-defined margins
Irregular and hypoechoic with poor margins
Calcified with strong posterior shadowing
In endometrial hyperplasia, which of the following may also be seen?
Multiple calcifications
Intramural masses
Small cysts within the endometrium
Cervical canal narrowing
Endometrial hyperplasia may present with which of the following patterns?
Only symmetrical thickening
Focal or asymmetrical thickening
Endometrial atrophy
Fluid-filled uterine cavity
What are endometrial polyps?
Cysts filled with blood in the uterine cavity
Overgrowths of endometrial tissue
Calcified uterine fibroids
Infections of the endometrium
Which of the following statements is true about endometrial polyps?
They are always singular
They always cause severe pain
20% of them are multiple
They are rarely found in postmenopausal women
Endometrial polyps are most frequently seen in:
Teenagers
Pregnant women
Perimenopausal and postmenopausal women
Women with polycystic ovary syndrome
What shape can endometrial polyps have?
Always round with thick walls
Only flat and broad
Pedunculated, broad based, or thin stalk
Irregular and calcified
In menstruating women, endometrial polyps may be associated with:
Amenorrhea
Menometrorrhagia or infertility
Ovarian torsion
Menopause
How do endometrial polyps typically appear on ultrasound?
As hyperechoic regions within the hypoechoic endometrium
As hypoechoic regions within the hyperechoic endometrium
As fluid-filled structures in the cervix
As calcified round masses near the ovary
What shape might an endometrial polyp appear as within the endometrial cavity?
Linear shadow
Irregular mass
Round echogenic mass
Large cystic lesion in the myometrium
Which of the following may be seen within an endometrial polyp?
Multiple calcifications
Fluid-filled ovarian follicles
Cystic areas
Thickened fallopian tubes
What vascular finding may help identify an endometrial polyp?
Enlarged uterine artery
Absent flow
Feeding artery in the stalk
High-resistance flow in the cervix
What improves the visualization of an endometrial polyp?
Transrectal scanning
The presence of intracavitary fluid
Patient fasting for 12 hours
Saline injection into the bladder
What is endometritis?
Inflammation of the cervix
Infection within the endometrium
Fibroid formation in the myometrium
Cyst formation in the ovaries
Which of the following conditions is most commonly associated with endometritis?
Menopause
Polycystic ovarian syndrome
Pelvic inflammatory disease (PID)
Uterine prolapse
What sonographic finding may suggest endometritis?
Enlarged ovaries
Absence of endometrial stripe
Thickening or fluid within the endometrium
Uterine calcifications
In what clinical situations is endometritis commonly seen?
Pregnancy and ovulation
Postpartum state and following instrumentation
Endometriosis and uterine fibroids
Menopause and hormone therapy
What is a common clinical symptom of endometritis?
Irregular bleeding
Amenorrhea
Intense pelvic pain
Urinary urgency
What is a typical sonographic appearance of the endometrium in endometritis?
Thin and smooth
Hyperechoic and uniform
Prominent and irregular
Completely calcified
A small amount of which of the following may be seen within the endometrium in endometritis?
Gas
Blood
Fluid
Calcium
What ovarian finding may be associated with endometritis?
Shrinkage of ovarian size
Enlarged ovaries with multiple cysts
Thick calcified walls
Loss of vascular flow
What is suggested by a fluid-filled tubular structure seen on ultrasound in the setting of endometritis?
Urethral blockage
Normal fallopian tube
Dilated fallopian tube
Absent ovary
A thickened tubal wall measuring 5 mm or more is indicative of what?
Chronic endometritis
Menopause
Acute disease
Endometrial cancer
As pelvic infection worsens, what may form and fuse the inflamed fallopian tube and ovary?
Endometrial polyps
Periovarian adhesions
Cervical fibroids
Ovarian cysts
What condition occurs when the inflamed tube and ovary become fused due to infection?
Ovarian torsion
Tubal carcinoma
Tubo-ovarian abscess
Endometrioma
Which of the following is a sonographic appearance of a tubo-ovarian abscess?
Homogeneous echogenic mass
Simple round anechoic cyst
Complex multiloculated mass with septations and internal echoes
Solid hyperechoic nodule
Which of the following may be seen within a tubo-ovarian abscess on ultrasound?
Calcified fibroids
Gas bubbles
Dermoid plug
Ovarian follicles
What sonographic artifact might be seen behind a tubo-ovarian abscess due to fluid content?
Reverberation
Posterior acoustic shadowing
Posterior acoustic enhancement
Mirror image artifact
What is another name for endometrial adhesions?
Endometritis
Endometriosis
Synechiae
Leiomyomas
Synechiae are most commonly associated with which of the following histories?
Menopause
Postmenstrual syndrome
Posttraumatic or postsurgical
Hormone therapy
Which of the following can synechiae potentially cause?
Polycystic ovaries
Irregular bleeding only
Infertility or recurrent pregnancy loss
Endometrial cancer
On sonographic examination, how do synechiae typically appear?
Hypoechoic rim around the uterus
Bright echoes within the endometrial cavity
Anechoic cysts in the cervix
Solid mass in the ovary
Why is synechiae difficult to diagnose with ultrasound?
The uterus is always enlarged
There is too much calcification
Diagnosis is difficult unless fluid distends the endometrial cavity
It always appears as a simple cyst
What is the most common gynecologic malignancy in North America?
Ovarian carcinoma
Cervical cancer
Endometrial carcinoma
Vulvar cancer
What type of cancer are most endometrial carcinomas?
Squamous cell carcinoma
Adenocarcinoma
Sarcoma
Transitional cell carcinoma
Endometrial carcinoma most commonly occurs in which group of patients?
Adolescent females
Premenopausal women
Postmenopausal women
Pregnant women
What is the most common clinical presentation of endometrial carcinoma?
Abdominal pain
Vaginal discharge
Uterine bleeding
Pelvic mass
Which of the following is strongly associated with endometrial carcinoma?
Progesterone therapy
Replacement estrogen therapy
Birth control pills
Smoking
In premenopausal women, what are two risk factors for developing endometrial carcinoma?
Smoking and alcohol
High calcium intake and stress
Anovulatory cycles and obesity
Fibroids and endometriosis
What is the earliest sonographic change seen in endometrial carcinoma?
Calcified fibroid
Endometrial thinning
Thickened endometrium
Uterine enlargement
Endometrial carcinoma can also be associated with which of the following conditions? (Select all that apply)
Endometrial hypertrophy
Endometrial polyp
Ovarian torsion
Cervical stenosis
In postmenopausal women, what endometrial thickness raises suspicion for endometrial carcinoma?
Greater than 2 mm
Greater than 3 mm
Greater than 4–5 mm
Greater than 6–7 mm
What should be suspected if a postmenopausal woman has an endometrial thickness >4–5 mm?
Normal hormonal variation
Endometrial carcinoma
Uterine atrophy
Ovarian cyst
What sonographic feature indicates myometrial invasion in endometrial carcinoma?
Smooth, uniform endometrium
Hypoechoic ovarian mass
Thickening and irregularity of the central endometrium with hyperdense structures in the myometrium
Thin endometrium with fluid
What imaging modality is typically used to evaluate endometrial carcinoma and myometrial invasion?
Abdominal radiograph
Hysterosalpingography
Endovaginal (EV) sonography
CT scan of the pelvis
What complication can occur if endometrial carcinoma obstructs the endometrial canal?
Hydrosalpinx
Hematometra
Ovarian torsion
Pyometra
What is Tamoxifen primarily used for?
Treatment of uterine fibroids
Hormone replacement therapy
Adjuvant therapy in breast cancer
Birth control
What is Tamoxifen primarily used for?
Treatment of uterine fibroids
Hormone replacement therapy
Adjuvant therapy in breast cancer
Birth control
Tamoxifen acts as what type of compound?
Estrogen agonist
Progestin
Antiestrogen compound
Aromatase inhibitor
Tamoxifen use is associated with an increased risk of which gynecologic malignancy?
Ovarian cancer
Cervical cancer
Endometrial carcinoma
Vaginal cancer
In endometrial carcinoma staging, what do stages I and II indicate?
Cancer has spread to distant organs
Cancer is limited to the ovaries
Cancer is confined to the uterus
Cancer is outside the pelvis
Which stages of endometrial carcinoma indicate extrauterine spread?
Stage 0
Stage I and II
Stage III and IV
Stage II only
Which of the following is NOT a condition commonly associated with small endometrial fluid collections?
Endometritis
Ectopic pregnancy
Recent abortion
Ovarian torsion
Small fluid collections within the endometrial cavity may be seen in all of the following except:
Degenerating myomas
Endometritis
Recent abortion
Normal ovulation
Degenerating myomas may lead to which of the following findings on ultrasound?
Adnexal masses
Small endometrial fluid collections
Ovarian cyst rupture
Cervical stenosis
What is the primary cause of large endometrial fluid collections?
Hormonal imbalance
Obstruction of the cervical os
Endometrial cancer
Ovarian cysts
What is the term for a fluid collection before menstruation due to cervical obstruction?
Hematometra
Pyometra
Hydrometrocolpus
Hematometrocolpos
What is the term for a fluid collection after menstruation due to cervical obstruction?
Hematometrocolpos
Endometrioma
Serometra
Hydrosalpinx
A patient with a large endometrial fluid collection may present with:
Fever and chills
Vaginal itching
Abdominal pain and an enlarged abdominal mass
Irregular heartbeat
On ultrasound, a large endometrial fluid collection may appear:
As a solid mass with shadowing
As a small, anechoic cyst
As a distended endometrial cavity, possibly with echogenic material
As a thickened myometrium with calcifications
What does the presence of echogenic material in a fluid collection suggest?
It’s a benign ovarian cyst
The patient has endometriosis
There may be pus or blood in the collection
It indicates a normal menstrual cycle
What uterine change is often associated with large endometrial fluid collections?
Small, fibrotic uterus
Moderately enlarged uterus
Prolapsed uterus
Thickened cervix
Hematometra refers to:
Infection in the uterus
Blood in the fallopian tubes
Distention of the endometrial cavity with blood
Fluid in the ovarian follicles
What is the most common cause of hematometra?
Uterine fibroids
Endometrial cancer
Cervical stenosis
Polycystic ovarian syndrome
When is an intrauterine contraceptive device (IUCD) typically placed?
After ovulation
During menopause
During menstruation
After childbirth only
How can a patient check for proper IUCD placement at home?
Abdominal ultrasound
Checking for the string via digital palpation of the cervix
Pelvic MRI
Urine test
Which imaging modality is used if the IUCD is not seen on sonography?
CT scan
MRI
Radiograph (X-ray)
PET scan
Sonography can detect which of the following IUCD-related complications?
String detachment only
Hormonal side effects
Malposition, perforation, or incomplete removal
Irregular ovulation
Which complications are patients with IUCDs at increased risk for?
Uterine fibroids and PCOS
Ectopic pregnancy and pelvic inflammatory disease (PID)
Cervical cancer and endometriosis
Endometrial hyperplasia and adenomyosis
A tubo-ovarian abscess (TOA) in IUCD users may present as:
A bilateral ovarian cyst
An endometrial polyp
A unilateral mass
A uterine fibroid
On ultrasound, an IUCD typically appears as:
Anechoic cystic structure
Highly echogenic linear structures in the endometrial cavity
Hypoechoic mass in the ovary
Thickened endometrium
The shafts of the IUCD appear on ultrasound as:
Single hypoechoic line
Double line
Cluster of dots
No visible structure
Which ultrasound artifact commonly occurs behind an IUCD?
Acoustic enhancement
Posterior shadowing
Ring-down artifact
Mirror image artifact
Uterine perforation caused by IUCD may be difficult to suspect until:
Routine checkup
An abscess or painful bowel involvement occurs
The patient experiences spotting
The IUCD string is visible
