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WorksheetsOvarian Carcinoma: Symptom and Ultrasound Characteristics
Total questions: 92
Worksheet time: 46mins
Which of the following symptom combinations is most consistent with ovarian carcinoma?
Cyclic pelvic pain, dysmenorrhea, heavy menses, weight gain
Vague abdominal/pelvic pain, abdominal distention, increased abdominal girth, and pressure
Fever, chills, nausea, and acute infection
Sudden lower quadrant pain with vaginal bleeding
Which symptom may indicate advanced ovarian carcinoma due to systemic effects?
Localized cramping during menstruation
Unexplained weight loss and manifestations of hormone activity
Increased appetite and weight gain
Constipation relieved with bowel movements
On ultrasound, which ovarian mass characteristics are most suspicious for ovarian carcinoma?
Simple cyst with thin walls and posterior enhancement
Unilocular cyst with smooth margins
Large complex mass with multiseptations and daughter cysts
Small anechoic cyst with no internal echoes
Which Doppler finding is commonly associated with malignant ovarian tumors such as ovarian carcinoma?
High resistance blood flow
Absent blood flow
Low resistance blood flow
Peripheral flow only
What is the most common type of ovarian carcinoma?
Mucinous carcinoma
Endometrioid carcinoma
Clear cell carcinoma
Serous cystadenocarcinoma
What best describes a dermoid cyst?
A functional ovarian cyst that resolves spontaneously
A malignant ovarian tumor composed of immature tissues
A teratoma containing mature tissues such as skin, hair, and sweat glands
A fluid-filled cyst formed from follicular rupture
Gestational trophoblastic disease (GTD) is best defined as which of the following?
A placental infection caused by bacterial overgrowth
A gestational event involving abnormal proliferation of the trophoblast due to an abnormal karyotype
A benign ovarian condition unrelated to pregnancy
A fetal chromosomal abnormality without placental involvement
Which form of GTD is classified as a benign trophoblastic disease?
Choriocarcinoma
Invasive mole (chorioadenoma destruens)
Hydatidiform mole
Placental site tumor
An invasive mole (chorioadenoma destruens) is best described as which type of gestational trophoblastic disease?
Benign, noninvasive trophoblastic disease
Malignant, metastatic trophoblastic disease
Malignant, non-metastatic trophoblastic disease
Benign placental abnormality
Which form of GTD is considered a malignant metastatic trophoblastic disease?
Hydatidiform mole
Invasive mole
Placental polyp
Choriocarcinoma
What is considered a normal endometrial thickness in a postmenopausal woman not on hormone replacement therapy (HRT)?
Less than 3 mm
Less than 5 mm
Less than 8 mm
Less than 10 mm
In a postmenopausal woman receiving hormone replacement therapy (HRT), what is the maximum normal endometrial thickness?
Up to 5 mm
Up to 6 mm
Up to 7 mm
Up to 8 mm
Tamoxifen is best described as which of the following?
A progesterone-only medication used to suppress ovulation
A partial estrogen receptor antagonist used in postmenopausal women with estrogen receptor–positive breast cancer that has estrogen effects on the uterus
A chemotherapy agent that destroys trophoblastic tissue
A gonadotropin-releasing hormone agonist with no uterine effects
Which endometrial ultrasound appearance is most commonly associated with tamoxifen use?
Thin, smooth endometrium measuring less than 5 mm
Uniform echogenic endometrium without cystic changes
Thickened, irregular, cystic endometrium measuring up to 8 mm
Absent endometrial stripe
Fitz-Hugh–Curtis syndrome occurs as a result of which condition?
A. A primary liver infection
B. Progression of pelvic inflammatory disease (PID) to peritonitis
C. Direct trauma to the liver capsule
D. Congenital inflammation of the peritoneum
The perihepatic inflammation seen in Fitz-Hugh–Curtis syndrome is caused by which mechanism?
Hematogenous spread of infection to the liver parenchyma
Direct extension from the gallbladder
Free fluid traveling up through the right or left flank
Obstruction of the biliary ducts
What is the normal size of a Graafian follicle at maturity?
1.0 cm
1.5 cm
2.0 cm
3.0 cm
Which of the following clinical findings is commonly associated with gestational trophoblastic disease (GTD)?
Regular vaginal bleeding with normal uterine size
Irregular vaginal bleeding during pregnancy, discrepant uterine height, hyperemesis, and pre-eclampsia
Postmenopausal bleeding with pelvic pain
Asymptomatic pregnancy with normal uterine growth
In the first trimester, GTD may mimic or be confused with which of the following conditions?
Ectopic pregnancy and ovarian torsion
Placenta previa and uterine rupture
Blighted ovum, missed abortion, degenerating leiomyoma, hydropic placenta, endometrial cancer, and adenomyosis
Normal intrauterine pregnancy
Which second-trimester ultrasound finding is most characteristic of gestational trophoblastic disease?
Well-formed fetus with normal placenta
Simple cystic ovarian mass only
Soft tissue mass with sonolucent areas of different sizes producing a “snowflake or lacey pattern” with absence of fetal parts
Thin endometrium with no internal echoes
Which additional ultrasound findings may be seen in advanced GTD?
Small uterus for gestational age with hyperechoic myometrium
Uterus large for dates, hypoechoic myometrium, and bilateral theca lutein cysts
Normal myometrium with unilateral ovarian cysts
Free pelvic fluid without uterine changes
Which of the following represents appropriate treatment and follow-up options for gestational trophoblastic disease?
Expectant management only
Antibiotic therapy and bed rest
Dilation and curettage (D&C), beta-hCG testing, oral contraceptives for one year, and possible surgery, radiation, or chemotherapy
Hormone replacement therapy alone
If a patient has a large fibroid uterus, which imaging modality is most appropriate for evaluation?
Transvaginal ultrasound
Transabdominal ultrasound
MRI only
CT scan
Which of the following is a common clinical finding associated with uterine fibroids?
Hyperemesis gravidarum
Pelvic pain, menorrhagia, asymptomatic, bladder/rectum pressure, infertility, spontaneous abortion
Sudden abdominal trauma
Postmenopausal bleeding only
Which of the following best describes the ultrasound appearance of fibroids?
Thin, uniform endometrium with posterior enhancement
Well-defined masses with whorled appearance, hypoechoic to anechoic, possibly with cystic degeneration or calcifications
Complex ovarian mass with septations and daughter cysts
Free fluid with echogenic debris only
Fibroids can cause reproductive complications including:
Hyperemesis and pre-eclampsia
Infertility and spontaneous abortion
Ovarian torsion and cyst rupture
Endometriosis and adenomyosis
Which clinical symptom combination might prompt an ultrasound evaluation for fibroids?
Sudden right lower quadrant pain with nausea
Bladder/rectum pressure, pelvic pain, menorrhagia, or asymptomatic enlarged uterus
Mild fatigue and anemia only
Fever and pelvic infection
Which of the following clinical findings may be associated with pyosalpinx?
Severe acute abdominal pain with hypotension
Asymptomatic presentation, pelvic fullness or discomfort, and low-grade fever
Sudden onset of heavy vaginal bleeding
High-grade fever with chills and jaundice
On ultrasound, a pyosalpinx is most likely to appear as:
Thin-walled anechoic cyst in the ovary
Pus-filled irregular fallopian tube, possibly with internal echoes
Well-circumscribed, uniformly hyperechoic uterine mass
Free fluid only in the posterior cul-de-sac
Which ultrasound characteristics are consistent with pyosalpinx?
A. “String of beads” appearance, 3–8 cm ovoid shape, acoustic enhancement
B. Simple, unilocular ovarian cyst with smooth walls
C. Large complex fibroid with whorled pattern
D. Hyperechoic endometrium with posterior shadowing
The size range of a pyosalpinx on ultrasound is typically:
1–2 cm
3–8 cm
10–15 cm
Less than 1 cm
Sonohysterography is best described as:
MRI evaluation of the endometrium after contrast injection
Saline-infused sonography used to evaluate the endometrium
Transabdominal ultrasound performed during menstruation
CT scan with oral contrast to evaluate uterine shape
The primary purpose of sonohysterography is to:
Measure ovarian volume and detect cysts
Further evaluate an abnormally thickened endometrium
Assess tubal patency for infertility only
Detect fibroids and calcifications exclusively
A complete failure of the Müllerian ducts to fuse during fetal development results in:
Septate uterus
Bicornuate uterus
Uterus didelphys
Unicornuate uterus
Which of the following best describes the ultrasound appearance of postmenopausal ovaries?
Easily visualized, enlarged, with multiple follicles
Difficult to visualize, smaller in size, follicles absent
Enlarged, hyperechoic, with cystic areas
Normal size with dominant follicle
Postmenopausal ovaries are typically described as:
Hypoechoic with absent follicles
Hyperechoic with multiple cysts
Isoechoic with visible dominant follicles
Anechoic and enlarged
Which of the following ultrasound findings is most suggestive of ovarian malignancy?
Small, simple cyst with thin walls
Large complex mass, multiseptated, possibly with daughter cysts
Hyperechoic, well-circumscribed ovarian nodule
Uniform anechoic cyst with posterior enhancement
A Doppler evaluation of a suspicious ovarian mass most likely shows:
High-resistance blood flow
No blood flow
Low-resistance blood flow
Peripheral flow only
Which ovarian cells are responsible for producing androgens?
Granulosa cells
Theca cells
Corpus luteum cells
Follicular stem cells
The most common primary cancer that results in a Krukenberg tumor originates from the:
Breast
Gastrointestinal (GI) tract
Lung
Ovary
Which type of fibroid is most likely to cause significant symptoms such as abnormal bleeding or infertility?
Subserosal
Intramural
Submucosal
Pedunculated
Which type of benign ovarian tumor is most commonly associated with ascites?
Dermoid cyst
Ovarian fibroma (Meigs syndrome)
Serous cystadenoma
Endometrioma
Which of the following ovarian tumors is typically cystic and arises from sex-cord stromal or epithelial origin?
Theca cell tumor
Granulosa cell tumor
Brenner tumor
Sertoli-Leydig tumor
Which ovarian tumor is typically solid, often small, and of epithelial origin?
Fibroma
Brenner tumor
Serous cystadenoma
Teratoma
Which of the following ovarian tumors is typically cystic?
Granulosa cell tumor
Brenner tumor
Serous cystadenoma
Sertoli-Leydig tumor
Which ovarian tumor is generally classified as solid on ultrasound?
Mucinous cystadenoma
Fibroma
Granulosa cell tumor
Theca cell tumor
Which of the following tumors is more likely to be cystic rather than solid?
Brenner tumor
Teratoma
Granulosa cell tumor
Sertoli-Leydig tumor
Which of the following ovarian tumors is typically solid and may produce hormonal effects?
Theca cell tumor
Mucinous cystadenoma
Fibroma
Sertoli-Leydig tumor
Which type of fibroid is most common and develops within the myometrium?
Subserosal
Pedunculated
Intramural (interstitial)
Submucosal
A fibroid that grows near the peritoneal surface of the uterus and may distort its contour is classified as:
Submucosal
Subserosal
Intramural
Pedunculated
Which type of fibroid forms and grows near the endometrium, potentially distorting the endometrial stripe?
Intramural
Subserosal
Submucosal
Pedunculated
A fibroid that arises from a subserosal fibroid and grows away from the myometrium on a pedicle is called:
Submucosal fibroid
Pedunculated fibroid
Intramural fibroid
Interstitial fibroid
Adenomyosis is best described as:
Ectopic occurrence of endometrial tissue within the myometrium, commonly mistaken for leiomyoma
Endometrial tissue growing on the ovary
Fibroids located subserosally on the uterus
Hyperplasia of the endometrium due to estrogen therapy
Which group of women is most at risk to develop uterine fibroids?
Postmenopausal women
Dark-skinned women
Women with a history of ectopic pregnancy
Women with polycystic ovarian syndrome
Which term describes the tipping of the entire uterus toward the sacrum?
A. Retroflexion
B. Retroversion
C. Anteflexion
D. Anteversion
Which term refers to the bending of the uterine fundus toward the rectum?
Retroversion
Retroflexion
Anteflexion
Anteversion
Backward displacement of the entire uterus is called:
Retrocession
Retroflexion
Anteversion
Anteflexion
Which term describes the bending of the uterine fundus toward the anterior abdominal wall?
Retroversion
Retroflexion
Anteversion
Anteflexion
Which ultrasound finding is most consistent with ovarian hyperstimulation syndrome (OHSS)?
Unilateral ovarian cyst with hyperechoic foci
Bilateral enlarged ovaries filled with small cysts, with ascites
Normal-sized ovaries with dominant follicle
Solid ovarian mass with calcifications
What is the most dependent potential space in the true pelvis?
Anterior cul-de-sac (vesico-uterine pouch)
Posterior cul-de-sac (pouch of Douglas / recto-uterine pouch)
Retropubic space (space of Retzius)
Broad ligament space
The right ovarian vein drains into which structure?
Right renal vein
Inferior vena cava (IVC)
Left renal vein
Portal vein
The left ovarian vein drains into which structure?
Inferior vena cava (IVC)
Left renal vein
Right renal vein
Common iliac vein
The anterior cul-de-sac is also known as:
Pouch of Douglas
Vesico-uterine pouch
Recto-uterine pouch
Retroperitoneal space
The posterior cul-de-sac is also called:
Vesico-uterine pouch
Space of Retzius
Recto-uterine pouch or pouch of Douglas
Broad ligament space
The anterior cul-de-sac (vesico-uterine pouch) is located:
Between the bladder and the uterus
Between the uterus and the rectum
Between the anterior bladder wall and the pubic symphysis
Between the ovaries
The posterior cul-de-sac (recto-uterine pouch) is located:
Between the bladder and the uterus
Between the uterus and the rectum
Between the anterior bladder wall and the pubic symphysis
Between the bladder and the pubic bone
The space of Retzius is also called:
Vesico-uterine pouch
Pouch of Douglas
Retropubic space
Recto-uterine pouch
The space of Retzius (retropubic space) is located:
Between the bladder and the uterus
Between the uterus and the rectum
Between the anterior bladder wall and the pubic symphysis
Between the ovaries and the broad ligament
During menstruation, which layer of the uterus is sloughed off?
Myometrium
Endometrium (functional layer / stratum functionalis)
Perimetrium
Basal layer of the endometrium
Functional or physiologic cysts of the ovary are typically:
Related to neoplastic growth only
Related to reproductive function
Always malignant
Only associated with postmenopausal women
Which of the following are examples of functional ovarian cysts?
Follicular cyst, corpus luteum, theca lutein cyst, germ cell tumor
Serous cystadenoma, mucinous cystadenoma, Brenner tumor
Fibroma, granulosa cell tumor, Sertoli-Leydig tumor
Endometrioma, dermoid, Krukenberg tumor
The term for excessive bleeding during menstruation is:
Dysmenorrhea
Menorrhagia
Metrorrhagia
Oligomenorrhea
Stein-Leventhal syndrome is another name for:
Endometriosis
Polycystic ovarian syndrome (PCOS)
Adenomyosis
Pelvic inflammatory disease
Which of the following symptoms is commonly associated with PCOS / Stein-Leventhal syndrome?
Hypothyroidism, hair loss, amenorrhea
Obesity, menstrual abnormality (oligomenorrhea/amenorrhea), virilization/hirsutism, infertility
Severe pelvic pain during menses only
Postmenopausal bleeding and hot flashes
Which assisted reproductive technique involves retrieving mature ova from the ovaries and fertilizing them outside the body before transferring embryos to the uterus?
GIFT (Gamete Intrafallopian Transfer)
IVF (In-Vitro Fertilization)
IUI (Intrauterine Insemination)
ZIFT (Zygote Intrafallopian Transfer)
Which technique requires at least one normal, patent fallopian tube to be performed?
IVF
GIFT
IUI
Egg freezing
The main difference between IVF and GIFT is:
IVF places sperm directly in the uterus, GIFT fertilizes outside the body
IVF fertilization occurs in vitro (outside the body), GIFT fertilization occurs in vivo (inside the body)
IVF requires patent fallopian tubes, GIFT does not
There is no difference; both techniques are identical
A Sertoli-Leydig tumor (Arrhenoblastoma) is best described as:
A common epithelial ovarian tumor in postmenopausal women
A rare sex cord–stromal ovarian tumor (<0.5% of ovarian tumors) that occurs mostly in women under 30
A benign cystic ovarian tumor with no hormonal effects
A germ cell tumor producing estrogen
Which hormone is typically secreted by a Sertoli-Leydig tumor, causing masculinization in affected women?
Estrogen
Progesterone
Testosterone
FSH
Meigs’ syndrome is characterized by which classic triad?
Malignant ovarian tumor, ascites, pleural effusion
Benign ovarian tumor, ascites, pleural effusion
Endometrioma, pelvic pain, irregular bleeding
Fibroma, hydrothorax, hematuria
Pseudomyxoma peritonei is most commonly produced by:
Ruptured serous cystadenoma
Ruptured mucinous cystadenocarcinoma
Ruptured dermoid cyst
Ruptured endometrioma
Which of the following best describes the pathophysiology of pseudomyxoma peritonei?
Free fluid accumulates in the pelvis without mucin
Thick mucin builds up in the abdominal cavity and can compress vital structures
Simple ascites due to liver failure
Fluid-filled cysts form only within the ovaries
Which of the following is a common clinical finding in ectopic pregnancy?
Negative pregnancy test with pelvic pain
Positive pregnancy test, vaginal bleeding/spotting, amenorrhea, abdominal pain (may refer to shoulder), adnexal mass
Postmenopausal bleeding only
Chronic dysmenorrhea without positive pregnancy test
Which ultrasound finding may indicate an ectopic pregnancy?
Gestational sac clearly seen in the endometrium
Uterus without gestational sac, possibly with a pseudogestational sac
Simple ovarian cyst only
Thickened endometrium without free fluid
Which of the following adnexal findings may be seen in ectopic pregnancy on ultrasound?
A. Anechoic simple cyst only
B. Complex adnexal mass and fluid in posterior cul-de-sac or Morison’s pouch
C. Hyperechoic ovarian nodule without free fluid
D. Normal adnexa with no mass
Which rare scenario may occur in ectopic pregnancy?
Concurrent ectopic pregnancy and intrauterine pregnancy (IUP)
Ectopic pregnancy with multiple ovarian cysts only
Ectopic pregnancy with postmenopausal bleeding
Ectopic pregnancy with thickened endometrium only
A primordial follicle is best described as:
A mature ovarian follicle ready for ovulation
The most immature stage of ovarian follicle, consisting of an immature oocyte surrounded by a single layer of flat granulosa cells
A cystic ovarian structure formed post-ovulation
A corpus luteum in early development
Which of the following components are present in a primordial follicle?
Secondary oocyte and multiple layers of granulosa cells
Primary oocyte and follicle cells
Zygote and zona pellucida
Corpus luteum and theca cells
Which of the following is a typical clinical presentation of ovarian torsion?
Gradual onset mild pelvic discomfort with postmenopausal bleeding
Sudden onset severe pelvic pain, nausea, vomiting, fever, palpable adnexal mass, intermittent pain weeks before
Chronic dysmenorrhea only
Asymptomatic pelvic mass detected incidentally
Which group of patients is most at risk for ovarian torsion?
Postmenopausal women
Children and women under 30
Women with PCOS over age 40
Women with uterine fibroids only
Which of the following ultrasound findings is most indicative of ovarian torsion?
Hyperechoic ovary with normal size and blood flow
Hypoechoic, enlarged ovary, free fluid in the pelvis, absent flow on Doppler
Small ovary with multiple follicles and increased blood flow
Normal ovary with cystic degeneration only
Prior intermittent episodes of pelvic pain in a patient may suggest which gynecologic emergency?
Endometriosis
Ovarian torsion
Pelvic inflammatory disease
Fibroid degeneration
