FINAL: ch 14-35
An IUGR fetus is defined as a sonographic estimated fetal weight less than the __________ percentile for gestational age.
10th
At what gestational age should physiologic bowel herniation be resolved?
12 weeks
At what gestational age should the kidneys be visualized on transabdominal sonography?
18 weeks
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
How many ossification centers should be present for each vertebrae?
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
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 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
At what gestational age should an abdominal wall defects be considered a fetal pathology?
>12 weeks
While scanning an 11 week pregnancy, you come across a mid-gut herniation, this is:
A normal finding
What is the result of abnormal anastomoses of placental vessels?
Acardiac twin
At what time during development must division of an egg take place for a monochorionic monoamniotic pregnancy to occur?
After day 8
Absence of the cavum septum pellucidum is suggestive of which of the following conditions?
Agenesis of the corpus callosum
Maternal exposure to which of the following can cause growth restriction, mental impairment, malformed ears, microcephaly, and immune dysfunction in the fetus?
Alcohol
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
A fetal ultrasound demonstrates a large protruding tongue, hepatoblastoma, and an omphalocele. What syndrome does this represent?
Beckwith-Weidemann syndrome
Which fetal brain structures should be visualized in the axial plane used to measure the biparietal diameter?
CSP, thalamus, and falx cerebri
A fetus is demonstrated to have very close set orbits and a small nose with a single nostril. What does this represent?
Cebocephaly
Which of the following procedures can determine fetal karyotype at the earliest gestational age?
Chorionic villi sampling
What part of the blastocyst implants in the endometrium during implantation?
Chorionic villus
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
What is a secondary method for detecting absence of fetal kidneys?
Color Doppler will demonstrate absence of renal arteries
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 time of exam
What is the most accurate sonographic method for dating a pregnancy?
Crown rump length prior to 14 weeks gestation
What is the term used to describe fusion of the orbits?
Cyclopia
What makes up the maternal portion of the placenta?
Decidua basalis
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
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 is the term used to describe a condition where there is an abnormal number of whole chromosomes?
Aneuploidy
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
What is the most common type of twinning?
Dizygotic twinning
What is the first definitive sonographic sign of an intrauterine pregnancy?
Double sac sign
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 common renal anomaly?
Duplex collecting system
Sonographic features of choroid plexus cysts, micrognathia, rocker bottom feet, omphalocele, and single umbilical artery are consistent with what chromosomal abnormality?
Edwards syndrome
What is the cause of immune hydrops?
Erythroblastosis fetalis
If polyhydramnios is demonstrated on fetal ultrasound, what gastrointestinal abnormalities are most likely?
Esophageal or duodenal atresia
Which of the following is not a reason to perform an ultrasound on a postpartum female?
Evaluation for postpartum ovarian artery thrombophlebitis
Which of the following is an indication for a first-trimester sonogram?
Evaluation of suspected ectopic pregnancy
What does the term polydactyly describe?
Extra digits on hands and/or feet
What divides the cerebral right hemisphere from the left hemisphere?
Falx cerbri
Which of the following is consistent with a finding of Turner syndrome?
Fetuses present with cystic hygroma.
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
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
Which of the following pathologies has clinical presentation that includes hyperemesis, extremely elevated hCG, enlarged uterus and heavy vaginal bleeding?
Gestational trophoblast disease
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 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
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
What is the normal situs and lie of the fetal heart?
Left chest with apex forming a 45-degree angle with the fetal spine
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
What is the most appropriate plane to obtain an intraorbital distance
Transverse plane at level of orbits
What is the most appropriate plane to obtain an intraorbital distance?
Transverse plane at level of orbits
What is the term used to describe a disorder where there is an extra copy of a chromosome?
Trisomy
What chromosomal abnormality is associated with this findings in this image? (no nasal bone)
Trisomy 21
What is the most common chromosomal abnormality?
Trisomy 21
Which of the following is commonly associated with Beckwith-Weidemann syndrome?
Macroglossia
What is a common complication of gestational diabetes?
Macrosomia
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
What are the sonographic features of achondrogenesis?
Micromelia, absent mineralization of the fetal bones, enlarged skull, and polyhydramnios
What is a life-threatening complication resulting from the death of a monochorionic twin?
Twin embolization syndrome
What is a heterotopic pregnancy?
Twin gestation, where one gestation is implanted in the uterus and the other has an ectopic implantation.
A twin gestation demonstrates a 25% difference in fetal weight between the two gestations, what is the most likely explanation?
Twin-twin transfusion syndrome
What does the T sign represent?
Monochorionic diamniotic pregnancy
What type of twinning is most likely to result in conjoined twins?
Monochorionic monoamniotic pregnancy
What renal anomaly is caused by obstruction of the fetal ureter, usually in the first trimester?
Multicystic dysplastic kidney
What is the term used to describe an umbilical cord that is around the fetal neck?
Nuchal cord
Which of the chromosomal abnormalities often presents with an inconclusive triple screen with sonographic features of holoprosencephaly and facial anomalies?
Patau syndrome
Which maternal population has a higher risk for developing preeclampsia and/or eclampsia?
Patients with hypertension
What is the most common cause of painless vaginal bleeding in the second and third trimesters?
Placenta previa
What is the term used to describe more than five digits?
Polydactyly
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 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 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 should the sonographer do for their patient if they are suffering from supine hypotensive syndrome?
Put patient into left lateral decubitus position.
A patient presents to the department 2 weeks after delivering her first child. She had an uncomplicated pregnancy and delivery. Her complaints are of bleeding, low-grade fever, and general malaise. On clinical exam, she complained of a tender uterus. The pregnancy test was negative and there was no indication of infection in her urine. What is the best diagnosis based on her signs and symptoms?
RPOC
What is the most frequent cause of oligohydramnios?
Renal anomalies
How does blood get from the placenta to the fetal heart?
Umbilical vein > Ductus venosus> IVC > Right ventricle
When percutaneous umbilical cord sampling is performed under ultrasound guidance, what segment of cord is most often accessed?
Umbilical vein at placental cord insertion site
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
What is the most common complication of amniocentesis?
Uterine contractions and cramping
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 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
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
What is the most common cardiac defect?
Ventricular septal defect
Where does fertilization usually occur?
ampulla of fallopian tube
What measurements are correlated to determine an estimated fetal weight?
biparietal diameter (BPD), head circumference, abdominal circumference (AC), and femur length (FL)
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
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 term describes shortening of the proximal portions of the limbs?
Rhizomelia
What is the term used to describe an anechoic structure located in the fetal head in an 8 week gestation?
Rhombencephalon
This patient presents with an elevated hCG, left sided pelvic pain, and an elevated WBC. What is the most likely diagnosis?
Ruptured Ectopic Pregnancy
What imaging plane best demonstrates the disparity in chest to abdomen size found in thanatophoric dysplasia?
Sagittal image through chest and abdomen
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
If fusion of the lower extremities, renal agenesis, and oligohydramnios are demonstrated on sonography, what abnormality is indicated?
Sirenomelia
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
What appears sonographically as a crescent-shaped sonolucent or complex fluid collection between the gestational sac and uterus?
Subchorionic hemorrhage
What is the leading cause of first-trimester vaginal bleeding in the presence of a closed cervix?
Subchorionic hemorrhage
What is the term used to describe an additional small lobe of placenta separate from the main segment?
Succenturiate lobe
Which of the following is not a typical use of amniocentesis in the third trimester?
Test for fetal lung maturity
A fetal sonogram demonstrates a cloverleaf-shaped skull, hydrocephalus, and telephone receiver-shaped long bones. What skeletal dysplasia is most likely?
Thanatophoric dysplasia
What criteria should be observed when assessing both left and right ventricular outflow tracts?
The aorta and pulmonary artery should crisscross each other.
A sonographer can BEST distinguish between a gastroschisis and an omphalocele by visualizing the:
cord insertion
Presentation of the umbilical cord in advance of fetal presenting part during labor and delivery is termed
cord prolapse
What are the four biophysical features used combined with an NST for a BPP?
fetal movement, fetal tone, fetal breathing, amniotic fluid volume
What is the term used to describe orbits that are widely spaced apart?
hypertelorism
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 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
What anatomic landmarks do sonographers use for the abdominal circumference measurement?
stomach and umbilical/portal vein
What does advanced maternal age represent?
≥ 35 years old
Which of the following statements with respect to the placenta is false?
The placenta produces progesterone to maintain the corpus luteum.
What sonographic sign indicates a female fetus?
Hamburger sign
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
Which of the following is a nonlethal skeletal dysplasia that presents with rhizomelia, macrocrania, frontal bossing, and trident hands?
Heterozygous achondroplasia
A fetal ultrasound demonstrated ethmocephaly, cyclopia, and cleft palate. Which of the following disorders is most likely?
Holoprosencephaly
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 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
What is an ovarian complication of a molar pregnancy?
Theca lutein cyst
A fetal heart sonogram demonstrates a small left ventricle, aortic stenosis, and absent mitral valve. What do these findings suggest?
Hypoplastic left heart syndrome
The four-chamber view is best for demonstrating which of the following?
Hypoplastic right heart
What is the term used as a diagnosis to describe an infant that is smaller than expected for gestational age?
IUGR
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
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 sonographic exam is used to assess fetal hypoxia?
Biophysical profile
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
If a fetus has a heart rate of 74 BPM, is this:
Bradycardia
