Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 2
Techniques Used for Imaging in Gynecology

2–1. Which sonographic feature, as demonstrated here, is characteristic of cysts?

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a. Acoustic window

b. Acoustic shadowing

c. Acoustic enhancement

d. Tip of the iceberg sign

2–2. Characteristics of the Doppler technology illustrated below include all EXCEPT which of the following?

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a. Scaling of color

b. More sensitive to low flow velocities

c. Directionality of blood flow with dual colors

d. Quantitative measurement of impedance to red blood cell velocity

2–3. Which of the following statements is true when performing saline infusion sonography?

a. SIS is best performed within the first 10 days of the menstrual cycle.

b. Touching the uterine fundus when advancing the catheter should be avoided as it can cause pain and false-positive results.

c. The uterine isthmus and endocervical canal should be evaluated as the catheter is withdrawn under sono-graphic visualization.

d. All of the above

2–4. Ovarian volume is one of the criteria for the sonographic diagnosis of polycystic ovaries. What is the formula to calculate ovarian volume, where A, B, and C are the ovarian diameters in centimeters?

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Reproduced, with permission, from Hoffman BL: Pelvic mass. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 17-11.

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2–5. The sonographic appearance of the endometrium during the menstrual cycle correlates with the phasic changes in its histologic anatomy. Which phase of the cycle is depicted with the classic trilaminar appearance as shown below?

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a. Menstrual

b. Secretory

c. Proliferative

d. Periovulatory

2–6. Sonographic features of adenomyosis, as depicted below, include all EXCEPT which of the following?

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a. Hypoechoic linear striations

b. Anechoic areas within the myometrium

c. Well-defined endometrial–myometrial junction

d. Asymmetrically thickened and heterogeneous myometrium

2–7. Saline infusion sonography (SIS) may be used to evaluate which of the following clinical situations?

a. Evaluating endometrial thickness in women taking tamoxifen and who have bleeding

b. Determining whether an intrauterine device (IUD) is embedded

c. Defining endometrial lesions such as polyps and submucosal fibroids

d. All of the above

2–8. Which sonographic characteristic has been proven most important in distinguishing between a hemorrhagic cyst and an endometrioma?

a. Retracting clot

b. Fluid-debris levels

c. Increased through-transmission

d. Change in the internal structure over time

2–9. The classic sonographic features of the neoplasm shown here include which of the following?

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a. Hyperechoic linear echoes

b. Cystic areas with round echogenic mural nodules

c. Hyperechogenic mass with “tip of the iceberg” sign

d. All of the above

2–10. Morphologic scoring systems used to predict the probability of malignancy of an ovarian mass include which of the following parameters?

a. Tumor size

b. Presence of a solid component

c. Color content of the tumor using color Doppler

d. All of the above

2–11. Which of the following statements regarding the use of sonography in the evaluation of pelvic inflammatory disease (PID) is true?

a. In early disease, most cases show anatomic changes.

b. Sonographic changes of the fallopian tubes are the least specific landmarks of PID.

c. The ovary can become involved as the disease progresses, creating a tuboovarian complex or abscess.

d. Large studies evaluating the sensitivity and specificity of sonography in this clinical setting are abundant.

2–12. What is the single most important sonographic finding for exclusion of an ectopic pregnancy?

a. Complex adnexal mass

b. Free fluid in the cul-de-sac

c. Identification of an intrauterine pregnancy

d. Ectopic pregnancy cannot be diagnosed sonographically

2–13. Uses of sonography in the evaluation and treatment of infertility include which of the following?

a. Endometrial cavity evaluation

b. Monitoring of folliculogenesis in normal and stimulated cycles

c. Demonstration and characterization of congenital uterine anomalies

d. All of the above

2–14. In gynecology, three-dimensional (3-D) sonography aids in the assessment of which of the following conditions?

a. IUD identification and positioning

b. Diagnosis of congenital müllerian anomalies

c. Calculation of ovarian volume and antral follicle counts

d. All of the above

2–15. All of the following statements are true regarding compression sonography of the lower extremities EXCEPT which one?

a. Normal venous sonography findings do not necessarily exclude pulmonary embolism.

b. Impaired visibility, noncompressibility, and the typical echo pattern of a thrombosed vein confirm the diagnosis.

c. Compression sonography, combined with color Doppler, is the initial test currently used to detect deep-vein thrombosis.

d. Compression sonography is as accurate in the diagnosis of distal (calf vein) thromboses as in proximal (popliteal or femoral vein) thromboses.

2–16. Your patient, who underwent hysterectomy 3 months ago, complains of urine leakage from her vagina. You suspect she has developed a vesicovaginal fistula. Which of the following radiologic tests is the most appropriate to order in her evaluation?

a. Intravenous pyelography (IVP)

b. Voiding cystourethrography (VCUG)

c. Computed tomography (CT) of the pelvis

d. Positive pressure urethrography (PPUG)

2–17. Which of the following is NOT a contraindication to this radiologic technique?

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Reproduced, with permission, from Halvorson LM: Evaluation of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 19-5A.

a. Pregnancy

b. History of PID

c. Iodine allergy

d. Acute pelvic infection

2–18. Which of the following statements regarding bone densitometry methods is true?

a. Dual-energy x-ray absorptiometry (DEXA) is the best technique for axial osteopenia evaluation.

b. Quantitative computed tomography (QCT) is best at evaluating the bone mineral density in the high-turnover cortical bone.

c. Quantitative sonography (QUS) is a recently validated alternative technique to dual-energy x-ray absorptiometry (DEXA).

d. Dual-energy x-ray absorptiometry (DEXA) is a three-dimensional technique that can distinguish between cortical and trabecular bone.

2–19. Computed tomography (CT) is well suited to diagnose which of the following gynecologic surgical complications?

a. Small bowel obstruction

b. Ureteral disruption or obstruction

c. Abdominal-pelvic abscesses or hematomas

d. All of the above

2–20. Which of the following statements is true regarding imaging techniques for the evaluation and surveillance of gynecologic malignancies?

a. Sonography is the most frequently used modality for this purpose.

b. CT is more sensitive in the detection of intraperitoneal metastases rather than bulky metastases.

c. There are few data to support use of positron emission tomography (PET) imaging in gynecologic malignancies.

d. Magnetic resonance (MR) imaging is now often preferable to CT because MR does not use radiation and provides multiplanar views of the pelvis.

2–21. Which of the following statements is true regarding magnetic resonance (MR) imaging?

a. Relaxation time properties are the factors principally responsible for contrast among tissues.

b. Water-containing organs, such as the bladder, will appear bright on T1-weighted images and dark on T2-weighted images.

c. Images are constructed based on the radiofrequency signal emitted by oxygen nuclei after they have been “excited” by radiofrequency pulses.

d. MR contrast, such as gadolinium, is given in concentrations and doses significantly higher than that used in CT imaging and is unsafe in patients with mildly compromised renal function.

2–22. Contraindications to this imaging modality include all EXCEPT which of the following?

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Image contributed by Dr. Samuel C. Chao.

a. Intrauterine device

b. Cochlear implant copper

c. Intracranial aneurysm clips

d. Internal cardiac pacemaker or defibrillator

2–23. Uses of magnetic resonance (MR) imaging in gynecology include all EXCEPT which of the following?

a. Diagnosis of adenomyosis

b. Initial evaluation of suspected gynecologic disease

c. Detailed characterization of congenital müllerian anomalies

d. Evaluation of endometrial lesions when sonography is nondiagnostic in a patient who is a poor surgical candidate

2–24. All of the following statements are true regarding the use of magnetic resonance (MR) imaging in conjunction with uterine artery embolization (UAE) EXCEPT which of the following?

a. Postprocedural evaluation of UAE is more accurately made by sonography.

b. MR imaging is the diagnostic method of choice for preoperative evaluation for UAE.

c. Leiomyomas with negligible enhancement and high signal intensity on T1-weighted sequences do not respond well to UAE.

d. Hypervascularity, which is seen as bright signal on T2-weighted images after contrast, correlates with a good predicted response to UAE.

2–25. In comparison to myomectomy or uterine artery embolization (UAE), magnetic resonance imaging guidance of focused ultrasound (MRgFUS) therapy for the treatment of leiomyomas has been shown to have which of the following attributes?

a. Is more cost-effective

b. Has fewer major adverse events

c. Stabilizes leiomyoma size over time

d. Gradually improves patient symptoms

Chapter 2 ANSWER KEY

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