Week 2

Question 1

Fallopian tubes are divided into what?

Answer 1

1) intramural/interstitial 2) isthmic 3) ampulla 4) infundibulum (ends in fimbriae)

Question 2

What shape are the ovaries?

Answer 2

Elliptical

Question 3

What is the surface of the ovaries?

Answer 3

Germinal epithelium

Question 4

What type of peritoneal are the ovaries considered?

Answer 4

Intraperitoneal

Question 5

What is the normal size of the ovaries?

Answer 5

L=2.5-5cm W=1.5-3cm AP=0.6 to 2.2cm

Question 6

How to calculate the volume of the ovaries?

Answer 6

V = LxWxAP (0.52)

Question 7

What suspends the ovaries?

Answer 7

1) Ovarian ligament 2) Infundibulopelvic ligament (suspension ligament) 3) Mesovarium

Question 8

What is the ovarian ligament?

Answer 8

Extends from the uterine cornu to the ovary

Question 9

What is the infundibulopelvic ligament?

Answer 9

Runs with the ovarian vessels and lymphatics, passes from pelvic brim to lateral pole of ovary, suspends the superior pole of ovary from posterolateral pelvic wall at the brim of the true pelvis

Question 10

What is the mesovarium?

Answer 10

Short double layer of peritoneum extending from the posterior surface of the broad ligament, provides minimal suspensory effect but is the primary route of access for vessels entering the ovarian hilum

Question 11

What makes up the capsule of the ovary?

Answer 11

Beneath the germinal epithelium is a thin layer of fibrous tissue, which forms the tunica albusinea ‘white coat’ or ‘capsule of the ovary’.

Question 12

What is the cortex?

Answer 12

The bulk of ovarian substance; contains a large number of developing follicles.

Question 13

What is the medulla?

Answer 13

The center of the ovary which contains the blood vessels.

Question 14

What is the ovarian blood supply?

Answer 14

Ovarian arteries originate from the aorta, run downwards over the psoas muscle with the ureters, cross over the common iliac arteries, and run through the infundibulopelvic ligament to reach the ovarian hilum.

Question 15

What drains the pelvic organs and muscles?

Answer 15

The internal iliac vein.

Question 16

What is the course of the ovarian vein?

Answer 16

Ovarian veins follow the same course as ovarian arteries until they reach the abdomen; the right ovarian vein drains directly into the IVC, while the left ovarian vein drains into the left renal vein.

Question 17

What is the blood supply to the uterus?

Answer 17

1) Uterine arteries (bilateral from internal iliac arteries) at cervix to fundus along lateral edge. 2) The arcuate arteries form the uterine arteries and circle the uterus beneath the peritoneum. 3) Arcuate arteries give off radial arteries which extend through myometrium to endometrium. 4) Once the myometrium-endometrium border is crossed, radial arteries become basal arteries. 5) Spiral arteries project further into the endometrium and terminate in a capillary network that serves the functional layer of the endometrium.

Question 18

What are radial arteries?

Answer 18

Arcuate arteries give off these branches which extend through the myometrium towards the endometrium.

Question 19

What are basal arteries?

Answer 19

Short arteries that terminate in a capillary bed supplying the basal layer of the endometrium.

Question 20

What are spiral arteries?

Answer 20

Arteries that project further into the endometrium and terminate in a capillary network supplying the functional layer of the endometrium.

Question 21

What undergoes substantial anatomical changes during the menstrual cycle?

Answer 21

Spiral arteries.

Question 22

What drains into the common iliac veins?

Answer 22

Venous plexus, which forms at the sides of the cervix.

Question 23

What probe do you use for transabdominal (TA) ultrasound?

Answer 23

3.5 to 5 MHz linear array probe.

Question 24

What probe do you use for transvaginal (TV) or endovaginal ultrasound?

Answer 24

8 MHz or higher with an empty bladder.

Question 25

What are patient instructions for TA ultrasound?

Answer 25

Full urinary bladder. Drink 3-4 x 8 oz of water 1 hour prior to the exam.

Question 26

What are the landmarks for the uterus?

Answer 26

1) Symphysis pubis 2) Vagina 3) Bladder.

Question 27

Where do we measure the uterus?

Answer 27

Sagittal length from fundus to cervix; AP length measured in long axis perpendicular to length; Tx width measurement taken at fullest point.

Question 28

What is the myometrium examined for?

Answer 28

Changes in contour, echotexture, echogenicity, and masses.

Question 29

Where are the ovaries located during an ultrasound of the adnexa?

Answer 29

Anterior to the internal iliac (hypogastric) vessels.

Question 30

What direction/orientation is the transducer inserted in the TV scan plane sagittal?

Answer 30

Transducer is inserted with the flat part along the top of the handle directed anteriorly, and the beam in the AP direction.

Question 31

In EVS examination, which part of the screen corresponds to which part of the patient's body?

Answer 31

Bottom - patient's head (superior), Top - patient's feet (inferior), Left - patient's belly (anterior), Right - patient's back (posterior).

Question 32

How is the probe oriented in a TV scan plane coronal?

Answer 32

Probe is rotated 90° and counterclockwise.

Question 33

What probe do you use for a Transkerineal scan and why do we do this type of scan, how is the patient positioned?

Answer 33

Curvilinear TA probe is placed beneath labia on perineum to image the cervix and lower uterine segment. This type of scan is used to assess cervical length and placenta localization. Patient is in lithotomy position, which is the same as TV.

Question 34

How much saline is infused during a sonohysterogram/saline infusion and what approach is taken for this kind of scan?

Answer 34

20cc of saline is infused into the endocanal using the TV approach.

Question 35

What are the indications for a SIS?

Answer 35

1) Thickened endometrium (to rule out polyp, submucosal fibroid, synechia, endometrial hyperplasia) 2) Infertility investigation 3) Uterine congenital defect.