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RD7.{1,6} | Imaging in Obstetrics, Gynecology and Breast Care — Graded Quiz
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Why is transvaginal ultrasound preferred as the first imaging test across obstetric and gynaecological evaluation of PCOD, ectopic pregnancy and infertility?
Correct. TVS gives high-resolution pelvic detail with no ionising radiation, which is the governing safety principle in reproductive-age women.
Radiation safety drives modality choice in O&G: ultrasound first, ionising imaging avoided in pregnancy.
TVS is first-line because it is radiation-free and high-resolution for the pelvis; it does not assess tubal patency directly nor replace beta-hCG.
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An older ultrasound report (Rotterdam 2003 era) states one ovary contains 14 follicles of 2–9 mm. Using the criteria appropriate to that era, how is this best classified?
Correct. The older Rotterdam 2003 threshold is ≥12 follicles (2–9 mm) per ovary; 14 meets it. Modern high-frequency transducers use ≥20. Morphology remains one of three Rotterdam criteria.
PCOM thresholds: ≥12 (older/Rotterdam 2003) vs ≥20 (modern high-frequency transducer).
Older/Rotterdam 2003 threshold = ≥12 follicles per ovary; modern high-frequency = ≥20. Fourteen meets the older threshold but is still only one of three criteria.
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A haemodynamically unstable woman with a positive pregnancy test, severe abdominal pain and a large amount of free fluid in the pelvis and Morrison's pouch on ultrasound is being managed. What does this picture most likely represent and what is the priority?
Correct. Free fluid extending to Morrison's pouch with haemodynamic instability in a pregnant woman indicates ruptured ectopic with haemoperitoneum; the patient needs resuscitation and urgent surgery, not more imaging.
Unstable + free fluid + positive hCG = ruptured ectopic; resuscitation and surgery, not further imaging.
Instability + large free fluid (haemoperitoneum) + positive pregnancy test = ruptured ectopic. Resuscitate and operate; do not delay for further imaging.
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A stable woman has a positive pregnancy test, a beta-hCG of 900 IU/L and an empty uterus on transvaginal ultrasound. What is the most appropriate next step?
Correct. With beta-hCG below the discriminatory zone an empty uterus may reflect a very early intrauterine pregnancy. This is a pregnancy of unknown location managed with serial beta-hCG and repeat imaging in a stable patient.
Empty uterus + hCG below discriminatory zone in a stable patient = pregnancy of unknown location; serial hCG and rescan.
Below the discriminatory zone an empty uterus is non-diagnostic — it may be a normal early pregnancy. In a stable patient, follow with serial beta-hCG and repeat ultrasound.
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In the workup of female infertility, transvaginal ultrasound is used to assess ovarian reserve. Which sonographic measurement best reflects ovarian reserve?
Correct. The antral follicle count on transvaginal ultrasound is the sonographic marker of ovarian reserve; follicular tracking assesses ovulation and the cavity is assessed for lesions.
TVS assesses ovarian reserve (antral follicle count), ovulation (follicular tracking) and uterine cavity.
Ovarian reserve is reflected by the antral follicle count on TVS, not by endometrial thickness, tubal calibre or cervical length.
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Which imaging test best assesses the uterine cavity for lesions such as submucosal fibroids or polyps in an infertility workup?
Correct. Saline infusion sonohysterography distends the uterine cavity with saline to outline intracavitary lesions such as polyps and submucosal fibroids. HSG mainly assesses tubal patency.
SIS distends and delineates the uterine cavity (polyps, submucosal fibroids); match the modality to the factor tested.
Cavity lesions are best shown by saline infusion sonohysterography (SIS). HSG mainly addresses tubal patency; mammography and radiographs are irrelevant here.
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A 45-year-old woman with a strong family history and a confirmed BRCA mutation is considered high-risk for breast cancer. Beyond mammography, which modality is most appropriate for high-risk surveillance and disease staging?
Correct. Breast MRI is indicated for high-risk screening (e.g., BRCA carriers) and for staging the extent of disease, complementing mammography and ultrasound.
Breast modalities by indication: mammography (screening >40), ultrasound (dense/young/pregnant, adjunct), MRI (high-risk screening and staging).
Breast MRI is the high-risk screening and staging tool; the other options do not image the breast for this purpose.
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A screening mammogram is reported as BI-RADS 0. What does this category mean and what is the next step?
Correct. BI-RADS 0 means the assessment is incomplete; further imaging or comparison with prior studies is required before a definitive category is assigned.
BI-RADS 0 = incomplete → recall for additional imaging/priors; the final category drives management.
BI-RADS 0 = incomplete, needing additional imaging or priors. It is not benign (2), probably benign (3), highly suspicious (5) or known cancer (6).
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