DMS 1119 OB/GYN Final
A patient is scanned for a biophysical profile (BPP). The fetus demonstrates 3 gross movements, 1 episode of tone, absent fetal breathing and a largest vertical pocket measurement of 4 cm. What is the BPP score?
6/8
What criteria is used to classify placentomegaly?
> 4 cm
Which sonographic exam is used to assess fetal hypoxia?
Biophysical profile
What is the most common renal anomaly?
Duplex collecting system
If polyhydramnios is demonstrated on fetal ultrasound, what gastrointestinal abnormalities are most likely?
Esophageal or duodenal atresia
What is the term used as a diagnosis to describe an infant that is smaller than expected for gestational age?
IUGR
What is the sonographic appearance of the proliferative endometrium?
Three-line sign (echogenic basal layer - hypoechoic functional layer - echogenic canal - hypoechoic functional layer - echogenic basal layer)
A fetal sonogram demonstrates a normal left kidney but the right has a severely dilated renal pelvis and dilated proximal ureter, the rest of the urinary system is normal. What is the most likely cause?
Ureteropelvic junction obstruction
A fetus that presents with anal atresia, ventricular septal defects, and a renal anomaly is likely presenting with which of the following disorders?
VACTERL association
What is the result of abnormal anastomoses of placental vessels?
acardiac twin
Absence of the cavum septum pellucidum is suggestive of which of the following conditions?
agenesis of the corpus callosum
Which of the following is a transitional cell tumor that often resembles a uterine fibroid?
brenner tumor
Which ovarian tumor presents with elevated serum lactate dehydrogenase and precocious puberty if it presents in a child?
dysgerminoma
Which of the following is an indication for a first-trimester sonogram?
elevation of suspected ectopic pregnancy
What are the four major divisions of the uterus?
fundus, corpus, isthmus, and cervix
What heart structure contains a natural opening to allow blood to shunt from the right side of the heart to the left side of the heart in the fetus?
interatrial septum
Which of the following is commonly associated with Beckwith-Weidemann syndrome?
macroglossia
Which of the following measurements is used to estimate gestational age in the first trimester?
mean sac diameter
What is the term used to describe an abnormally small chin?
micrognathia
This ovarian malignancy most often presents as large multi-loculated cystic masses with papillary projections and material.
mucious cystadenoma
Which of the following is a possible complication of introduction of intrauterine contraceptive devices?
perforation of the myometrium
________ is defined as the onset of puberty in girls before the age of 8 years.
precocious puberty
During the ________ phase of the menstrual cycle the endometrium at its thickest.
secretory
____________ is the most common uterine congenital anomaly.
septate uterus
What is the most appropriate plane to obtain an intraorbital distance
transverse plane at level of orbits
How does blood get from the placenta to the fetal heart?
umbilical vein > ductus venosus > IVC > right ventricle
While scanning an 11 week pregnancy, you come across a mid-gut herniation, this is:
a normal finding
Which of the following disorders presents with vaginal bleeding, low hCG, decreased symptoms of pregnancy, and a poor decidual reaction with an empty gestational sac?
anembryonic pregnancy
What parts of the female pelvis define the vesicouterine space?
anterior surface of the uterus and posterior surface of the bladder
What part of the blastocyst implants in the endometrium during implantation?
chorionic villus
What are the sonographic features of achondrogenesis?
Micromelia, absent mineralization of the fetal bones, enlarged skull, and polyhydramnios
What renal anomaly is caused by obstruction of the fetal ureter, usually in the first trimester?
Multicystic dysplastic kidney
What is the most accurate sonographic method for dating a pregnancy?
crown rump length prior to 14 weeks gestation
What makes up the maternal portion of the placenta?
decidua basalis
What is the first definitive sonographic sign of an intrauterine pregnancy?
double sac sign
What is the most common gynecologic malignancy in the United States?
endometrial carcinoma
Which of the following is consistent with a finding of Turner syndrome?
fetuses present with cystic hygroms
What fetal presentation is observed if the fetal buttocks are at the cervix and the legs are extended in front of the fetal face?
frank breech
How would you describe the echotexture of the normal uterus?
homogeneous
A fetal heart sonogram demonstrates a small left ventricle, aortic stenosis, and absent mitral valve. What do these findings suggest?
hypoplastic left heart syndrome
Weakness in which of the following muscles leads to prolapse of the uterus?
levator ani
A patient presents with mittelschmerz. Sonography demonstrated a small amount of free fluid in the right adnexa. What is the likely cause?
ovulation
Where is free fluid most likely to collect in the female pelvis?
pouch of douglas
During a fetal heart scan, a hyperechoic mass is identified in the left ventricle; multiple hyperechoic masses were also demonstrated in the renal cortex of both kidneys. What is the most likely diagnosis?
rhabdomyoma with tuberous sclerosis
What is the term used to describe an additional small lobe of placenta separate from the main segment?
succenturiate lobe
A sonogram demonstrates a placental cord insertion at the edge of the placenta with the vessels lying over the internal os. What is this disorder?
vasa previa
If while scanning you suspect an ectopic pregnancy, where would you most likely find free fluid in the abdomen?
between the liver and right kidney
Which of the following best describes a uterus that has two separate endometrial canals but a single cervix?
bicornuate uterus
Which of the following best describes a thick-walled cystic mass with internal echoes that was demonstrated on day 20 of the menstrual cycle and resolved by day 5 of the following cycle?
corpus luteum
What is the most common malignant ovarian tumor?
serous cystadenocarcinoma
An asymptomatic patient presents with bilateral large anechoic lesions that contain septations and papillary projections. What does this most likely represent?
serous cystadenoma
What anatomic landmarks do sonographers use for the abdominal circumference measurement?
stomach and umbilical/portal vein
A patient presented with pelvic pain, infertility, and a palpable right adnexal mass. Sonography demonstrated a multicystic complex right adnexal mass with dirty shadowing and bilateral hydrosalpinx. What is the most likely diagnosis?
tubo-ovarian abscess
What is a life-threatening complication resulting from the death of a monochorionic twin?
twin embolization syndrome
What complications are associated with a circumvallate placenta?
vaginal bleeding and placental abruption
What is term used to describe the death of a twin fetus in the first trimester that is reabsorbed?
vanishing twin
Which imaging modality if often needed to determine uterine anomalies?
MRI
Which of the following is a false statement with respect to differentiating the appearance of a leiomyosarcoma from that of a leiomyoma?
only leiomyosarcoma will be singular
This patient presents with an elevated hCG, left sided pelvic pain, and an elevated WBC. What is the most likely diagnosis?
ruptured ectopic pregnancy
Fertilization usually occurs in the __________ portion of the fallopian tube.
ampulla
Where does fertilization usually occur?
ampulla of fallopian tube
What imaging plane best demonstrates the disparity in chest to abdomen size found in thanatophoric dysplasia?
Sagittal image through chest and abdomen
A twin gestation demonstrates a 25% difference in fetal weight between the two gestations, what is the most likely explanation?
Twin-twin transfusion syndrome
How can the sonographer distinguish a nabothian cyst from a cervical carcinoma?
a cervical carcinoma will demonstrate a solid mass whereas a nabothian cyst will have all of the characteristics of a simple cyst
A fetal ultrasound demonstrates a large protruding tongue, hepatoblastoma, and an omphalocele. What syndrome does this represent?
beckwith-weidemann syndrome
What pelvic disorder will present with a history of dysmenorrhea and dyspareunia?
endometriosis
A patient presents for a dating ultrasound at 7 weeks gestation with right lower quadrant pain and a palpable right adnexal mass. Sonography demonstrates an intrauterine pregnancy and an ovarian cyst with a thickened wall and internal echoes. What is the most likely diagnosis?
hemorrhagic corpus luteal cyst
A patient presents with amenorrhea, cyclic abdominal pain, and an enlarged uterus. Sonography demonstrates hydrometrocolpos. What is the most likely cause?
imperforate hymen
What is the definition of primary amenorrhea?
menarche has not occurred by age 16 in a female patient
Which malignant ovarian tumor is often associated with pseudomyxoma peritonei?
mucinous cystadenocarcinoma
What is the term used to describe an umbilical cord that is around the fetal neck?
nuchal cord
List at least one risk factor for developing leiomyosarcoma.
nulliparity, 50 years or older, obesity, history of pelvic radiation, and tamoxifen exposure
What is the term used to describe more than five digits?
polydactyly
What layer of the endometrium is shed every month during menstruation?
functional layer
What term describes shortening of the proximal portions of the limbs?
Rhizomelia
A 38-year-old patient presents for routine ultrasound; triple screen showed low maternal serum alpha-fetoprotein (MSAFP), elevated human chorionic gonadotropin (hCG), and low estriol. Sonographic findings included absent nasal bone, macroglossia, and clinodactyly. Which of the following is the most likely diagnosis?
down syndrome
What is the most appropriate plane to obtain an intraorbital distance?
transverse plane at level of orbits
What chromosomal abnormality is associated with the lack of a nasal bone?
trisomy 21
What is the most common malignant neoplasm of the vagina and uterus in the pediatric female?
rhabdomyosarcoma
What is an ovarian complication of a molar pregnancy?
theca lutein cyst
Why are assisted reproduction patients prone to ovarian hyperstimulation syndrome?
they have elevated human chorionic gonadotropin levels from ovulation induction
Sonographic features of narrowing of the aortic arch, enlargement of the right ventricle, and enlargement of the pulmonary artery are characteristics of what heart defect?
coarctation of the aorta
How can salpingitis be demonstrated on ultrasound if there is no fluid collection in the tube?
color doppler should be used to demonstrate hyperemic flow
Presentation of the umbilical cord in advance of fetal presenting part during labor and delivery is termed
cord prolapse
Which of the following is false with respect to the nuchal translucency (NT) exam?
crown rump length must be between 40 mm and 80 mm at the time of exam
What is the term used to describe fusion of the orbits?
cyclopia
Which pelvic mass presents sonographically as a cystic mass with homogenous low-level internal echoes?
endometrioma
While scanning a fourteen year old transabdominal pelvis you notice what appears to be a uterine didelphys. What should you do next?
finishing scanning the pelvis then move to the kidneys
What are the two phases of the ovarian cycle?
follicular and luteal
Sonography demonstrated a large soft tissue mass with low to moderate amplitude echoes in the uterus containing fluid filled spaces. The patient demonstrated elevated hCG and an enlarged UT; her doctor was unable to detect a fetal heartbeat. What is the most likely diagnosis?
hydatidiform mole
A 27 year old pregnant patient presents to her Obstetrician's office for another first trimester ultrasound of this pregnancy with a history of G5, P0, A5 due to the patient's clinical history of pregnancy loss. According to the patient's last menstrual period, the patient should be 8 weeks, 4 days. The patient reports no known complications with this pregnancy. The first ultrasound revealed a viable pregnancy with a gestational sac, yolk sac and fetal pole identified with a FHR of 155bpm. Upon transvaginal evaluation of the patient's uterus, the sonographer again identifies a gestational sac, yolk sac and fetal pole with a FHR of 85bpm. Based on the clinical and sonographic findings, what do you suspect?
impending fetal demise
A patient presents with acute left pelvic pain, vaginal bleeding, low hCG for gestational age, and low hematocrit. Sonography demonstrates a small irregular shaped cystic area in the endometrial canal, an adnexal ring sign in the left adnexa, and free fluid in the cul-de-sacs and adnexas. What is the most likely diagnosis?
left ectopic pregnancy
Which of the following is a false statement with respect to spina bifida?
spaying of the vertebral laminae is the easiest to demonstrate on a sagittal image of the spine
What is the term used to describe a twin that is in close association with the uterine wall?
stuck twin
Which of the following is a true statement with respect to fallopian tubes?
the fallopian tube is usually only identified if there is an obstruction and it is distended with fluid
Treating every patient fairly with respect and compassion can be achieved by practicing:
the golden rule
Which of the following statements with respect to the placenta is false?
the placenta produces progesterone to maintain the corpus luteum
What should the sonographer do for their patient if they are suffering from supine hypotensive syndrome?
put patient into left lateral decubitus postition
A 23 year old pregnant patient presents to her Obstetrician's office for a first trimester ultrasound of this pregnancy with a history of G2, P1, A0. According to the patient's last menstrual period, the patient should be 5 weeks, 4 days. The patient reports no known complications with this pregnancy. Upon transvaginal evaluation of the patient's uterus, the sonographer is unable to identify a gestational sac. The sonographer identifies an anechoic structure within the patient's right ovary, while the left ovary and bilateral adnexas appear unremarkable. The patient's physician orders lab work which reveals a quantitative beta hCG of 2,323. Based on the clinical and sonographic findings, what do you suspect should be the next step in the patient's care?
repeated beta hCG in 48 hours
At what time during development must division of an egg take place for a monochorionic monoamniotic pregnancy to occur?
after day 8
What is the most common benign vaginal neoplasm in the pediatric population?
gartner cyst
What is a heterotopic pregnancy?
Twin gestation, where one gestation is implanted in the uterus and the other has an ectopic implantation.
A 24 year old female patient presents to the Emergency Department with complaints of right shoulder pain. The Emergency Department physician orders a urinalysis on the patient prior to sending the patient to Radiology for diagnostic testing, which reveals a positive qualitative beta hCG. With this information, the physician orders a transvaginal ultrasound. The patient is unaware of the date of her last menstrual period as she had an IUD placed one year ago after the birth of her first child. Upon transvaginal evaluation of the patient's uterus, the sonographer identifies a complex fluid collection surrounding an echogenic structure producing posterior shadowing. The sonographer also identifies a small, oval complex structure within the cervix. Bilateral ovaries and adnexa appear unremarkable. Based on the clinical and sonographic findings, what do you suspect?
cervical ectopic pregnancy
A sonographer can BEST distinguish between a gastroschisis and an omphalocele by visualizing the:
cord insertion
Which of the following pathologies has clinical presentation that includes hyperemesis, extremely elevated hCG, enlarged uterus and heavy vaginal bleeding?
gestational trophoblast disease
A sonogram of a postpubertal woman demonstrated a 5-cm simple cyst on the left ovary. A follow-up exam 3 months later demonstrates a normal ovary. What do these findings likely represent?
resolution of a follicular retention cyst
What is the most common benign ovarian tumor that results from the retention of an unfertilized ovum?
dermoid
Which of the following best describes the sonographic appearance of ovarian torsion?
diminished blood flow along with enlarged hypoechoic ovary with peripheral follicles
What is the most common type of twinning?
dizygotic twinning
What is the most likely explanation for abnormal uterine bleeding with an endometrial measurement of <5 mm in a postmenopausal patient?
endometrial atrophy
Which of the following can be a precursor for endometrial carcinoma?
endometrial hyperplasia
What is the term used to describe the inner layer of the uterine wall?
endometrium
What does the term polydactyly describe?
extra digits on hands and/or feet
What divides the cerebral right hemisphere from the left hemisphere?
falx cerbi
A patient presents with a history of PID,right upper quadrant (RUQ) pain, fluid in Morison's pouch and elevated liver enzymes. Sonography of the RUQ reveals adhesions between the liver and right hemi-diaphragm. What is the most likely diagnosis?
fitz-hugh-curtis syndrome
What is the term used to describe orbits that are widely spaced apart?
hypertelorism
What does the T sign represent?
monochorionic diamniotic pregnancy
What type of twinning is most likely to result in conjoined twins?
monochorionic monoamniotic pregnancy
If a patient presents with free fluid in the pelvic spaces, where else should the sonographer interrogate?
morison pouch
Which imaging modality has proven to be able to distinguish between benign and malignant lesions?
none
Which part of the female pelvis has a dual blood supply?
ovary
Which of the chromosomal abnormalities often presents with an inconclusive triple screen with sonographic features of holoprosencephaly and facial anomalies?
patau syndrome
What normal anatomic variant may be demonstrated on a pelvic sonogram?
pelvic kidney
What is the most common hormonal disorder among women of reproductive age?
polycystic ovarian syndrome
If a patient has menstrual cycles that are 17 days apart, what would you describe this as?
polymenorrhea
Which of the following maternal problems is at increased risk for mothers expecting multiple gestations?
preeclampsia and anemia
Which patient population has a predisposition for placenta previa?
previous cesarean sections
Which arteries in the uterus feed the functional layer of the endometrium?
radial arteries spiral arteries
What is the term used to describe an anechoic structure located in the fetal head in an 8 week gestation?
rhombencephalon
What structures make up the posterior boundary of the pelvic cavity?
sacrum and coccyx
Fifty percent of PID cases are caused by which of the following?
sexually transmitted diseases
What is the term used to describe a disorder where there is an extra copy of a chromosome?
trisomy
What is the most common cardiac defect?
ventricular septal defect
What is the path of venous drainage from the left ovary?
Ovarian vein - left renal vein - IVC
Early sexual contact, multiple sex partners, and/or history of STDs are all risk factors are associated with what disease?
PID
A fetal sonogram demonstrates a cloverleaf-shaped skull, hydrocephalus, and telephone receiver-shaped long bones. What skeletal dysplasia is most likely?
Thanatophoric dysplasia
What term is used to describe the normal location of the ovaries?
adnexa
A 66 year old patient presents with abdominal pain and vaginal bleeding. While scanning the pelvis you notice an Ill-defined or sausage-shaped solid mass and pelvic ascites. What pathology is present in this patient?
fallopian tube carcinoma
The endometrial cavity is contiguous with which other part of the female pelvis?
fallopian tube lumen
What are the four biophysical features used combined with an NST for a BPP?
fetal movement, fetal tone, fetal breathing, amniotic fluid volume
What ovarian neoplasm is a result of metastases of a gastrointestinal cancer?
kurkenberg tumor
What is the normal situs and lie of the fetal heart?
left chest with apex forming a 45-degree angle with the fetal spine
What is the path of venous drainage from the right ovary?
ovarian vein - IVC
What appears sonographically as a crescent-shaped sonolucent or complex fluid collection between the gestational sac and uterus?
subchorionic hemorrhage
What criteria should be observed when assessing both left and right ventricular outflow tracts?
the aorta and pulmonary artery should crisscross each other
What is the most common chromosomal abnormality?
trisomy 21
Fundal height measurement is an inexpensive tool that is used during prenatal visits. After 20 weeks of gestation, a difference of greater than _____ cm is suspicious for growth restriction.
3
If a patient has a human chorionic gonadotropin (hCG) level of 100, in how many days should it be possible to visualize a gestational sac?
4 days
What is the upper limit of normal for renal pelvis diameter in an 18-week fetus?
4 mm
At what gestational age should an abdominal wall defects be considered a fetal pathology?
>12 weeks
What is the term used to describe a condition where there is an abnormal number of whole chromosomes?
Aneuploidy
A fetal sonogram reveals a lower abdominal wall mass inferior to the umbilicus, absence of the urinary bladder, and normal amniotic fluid. What disorder does this represent?
Bladder exstrophy
Which fetal brain structures should be visualized in the axial plane used to measure the biparietal diameter?
CSP, thalamus, and falx cerebri
What is a secondary method for detecting absence of fetal kidneys?
Color Doppler will demonstrate absence of renal arteries
What sonographic sign indicates a female fetus?
Hamburger sign
What imaging plane is best to demonstrate absence of the nasal bone?
Sagittal midline image through the fetal face
What is the cause of hypospadias?
Shortened urethra
What is the initial source of progesterone and estrogen if fertilization occurs?
corpus luteum
What is a possible complication of salpingitis due to PID?
ectopic pregnancy
Sonographic features of choroid plexus cysts, micrognathia, rocker bottom feet, omphalocele, and single umbilical artery are consistent with what chromosomal abnormality?
edwards syndrome
A fetus is shown to have bowel floating around in the amniotic fluid herniated through a defect on the right side of a normal cord insertion. What is the likely diagnosis?
gastroschisis
A fetal ultrasound demonstrated ethmocephaly, cyclopia, and cleft palate. Which of the following disorders is most likely?
holoprosencephaly
A patient presents with a lateral ventricle measurement of 22 mm, dangling choroid, and the BPD and HC measure 3 weeks greater than the gestational age. What is the most likely diagnosis?
hydrocephalus
Newborns affected by IUGR have many problems after birth. Some immediate neonatal risks include all of the following except:
hyperglycemia
What is the leading maternal cause of intrauterine growth restriction?
hypertension
The four-chamber view is best for demonstrating which of the following?
hypoplastic right heart
Endovaginal sonography is contraindicated for which of the following patient populations
infants and children
What is a possible complication of chronic PID?
infertility
What happens to the corpus luteum if a pregnancy occurs?
it can reach a size of up to 10 cm but should resolve by 16 weeks of gestation
The lateral ventricle measurement on a 21-week fetus is 13 mm, what is the implication of this measurement?
it indicates ventriculomegaly
Which of the following pathologies is most likely to be demonstrated in a 12-year-old female patient?
ovarian torsion
What is the most common cause of painless vaginal bleeding in the second and third trimesters?
placenta previa
What is the leading cause of first-trimester vaginal bleeding in the presence of a closed cervix?
subchorionic hemorrhage
A patient presents with an enlarged bulky uterus and menorrhagia. Which of the following is most likely to be the cause?
submucosal leiomyoma
An IUGR fetus is defined as a sonographic estimated fetal weight less than the __________ percentile for gestational age.
10th
At what gestational age should the kidneys be visualized on transabdominal sonography?
15 and 18 weeks
At what gestational age should physiologic bowel herniation be resolved?
16 weeks
How many ossification centers should be present for each vertebrae?
3
What does G4P3A1 represent?
4 pregnancies, 3 births at ≥ 20 weeks gestation, 1 failed gestation
What is considered a normal range for amniotic fluid index?
5 - 25 cm
A sonogram demonstrates bilaterally enlarged echogenic fetal kidneys, no detectable urinary bladder, and oligohydramnios. What is the most likely diagnosis?
Autosomal recessive polycystic kidney disease
If multicystic dysplastic kidney disease is bilateral, what are the associated sonographic findings?
Bilateral multiple smooth-walled noncommunicating cysts of varying sizes in the area of the renal fossa, absence of bladder, and oligohydramnios.
Which of the following is a nonlethal skeletal dysplasia that presents with rhizomelia, macrocrania, frontal bossing, and trident hands?
Heterozygous achondroplasia
A male fetus is demonstrated to have bilateral hydronephrosis with hydroureter, dilated bladder, and dilated urethra. What is the cause of these findings?
Posterior urethral valves
Which of the following disorders results from persistent bladder outlet obstruction?
Prune belly syndrome
Bilateral renal agenesis, inadequately functioning kidneys, or obstruction of the urinary tract can lead to which of the following?
Pulmonary hypoplasia
What is the most frequent cause of oligohydramnios?
Renal anomalies
If fusion of the lower extremities, renal agenesis, and oligohydramnios are demonstrated on sonography, what abnormality is indicated?
Sirenomelia
A fetus is demonstrated to have a horseshoe shaped monoventricle, fused thalami and absent falx. Which of the following is the most likely diagnosis?
alobar holoprosencephaly
A fetus demonstrates absence of the cornea on a coronal view of the fetal face. What abnormality does this represent?
anopthalmia
All of the following are risk factors for developing an ectopic pregnancy except?
anterior placenta
Which of the following terms describes a straight uterus that tilts forward in the body forming a 90° angle with the vagina?
anteverted
Which of the following is most likely to increase the risk of multiple gestations?
assisted reproductive therapy
Which type of growth restriction begins in the third trimester and is physically characterized as discordant biometric growth pattern?
asymmetric IUGR
What is the cause of adenomyosis?
basal layer endometrial tissue invades the myometrium
What measurements are correlated to determine an estimated fetal weight?
biparietal diameter (BPD), head circumference, abdominal circumference (AC), and femur length (FL)
If a fetus has a heart rate of 74 BPM, is this:
bradycardia
A fetus is demonstrated to have very close set orbits and a small nose with a single nostril. What does this represent?
cebocephaly
