OB/GYN DMS
Lissencephaly
"Smooth brain"; condition where there is little to no gyri or sulci within cerebral cortex
dizygotic twins
- Often called fraternal twins, occurring when two eggs each get fertilized by two different sperm, resulting in two zygotes in the uterus at the same time -Will usually demonstrate two chorions, two amnions and two placentas (can appear as one large placenta) -Can be same sex or different -Most common type of twins
Trisomy 21 is associated with
- increased nuchal translucency - low AFP - Increased NSF thickness - absent nasal bone - frontal bossing - foreshortened femur and humerus - echogenic bowel - EIF - ASVD - hypoplasia of the midline phalanx of the 5th digit
Trisomy 18 (Edwards Syndrome)
-3 copies of chromosome 18 -2nd most common trisomy -Usually lethal in utero or just after birth -Low levels of AFP, Estriol, hcG, and PAPP-A -Renal agenesis -2VC -strawberry shaped skull -IUGR -CP cysts -Esophageal atresia -Polyhydraminos -Omphalocele -Clenched hands -Rocker bottom feet
symptoms of preeclampsia
-BP greater 140/90 -Edema -Proteinuria -Sudden maternal weight gain -Low platelet count -Increased LFTS
Chorioangioma
-Benign highly vascular tumors of the placenta, large ones can cause IUGR, Hydrops and Abruption -Associated with polyhydraminos
Symptoms with retained products of conception
-Fever -Anemia -Fatigue
Hypophosphatasia
-Lethal -Rare metabolic bone disease characterized by the deficiency of alkaline phosphatase.
limb-body wall complex
-Lethal defect caused by amniotic band syndrome. -Limbs may be absent. -Abdominal contents are not covered. - Cord very short or absent
Congenital Cystic Adenomatoid Malformation (CCAM)
-Most common chest mass identified in fetus -Usually unilateral but effects the entire lung Macrocystic- (I) 2-10 cm Most commmon Medium cystic (II) Or microcystic (III) <0.5 cm.
Thanatophoric skeletal dysplasia
-Most lethal type of skeletal dysplasia -Autosomal dominant -Macrocrania, cloverleaf skull -Frontal bossing -Short ribs -Pear or belly shaped thorax -Pulmonary hypoplasia -Polyhydraminos -Severe micromelia -Bowing of long bones
Amniocentesis screens for:
-Rh disease -Spinal defects;increased acetlycholinesterase/ACHE -Lung maturity/ lecithin-sphingomyelin ratio is the modt common reason for testing -DNA testing -Karyotyping
Fetal lung volumetry performed with 3D should be used to diagnose
-Skeletal dysplasia Pulmonary hypoplasia is a common finding with skeletal dysplasia and fetal lung volumetry performed by 3D sonography more accurately predicts pulmonary hypoplasia than thoracic circumference.
Signs of fetal demise that occured more than a week ago
-Spalding's sign: suture overlap on skull -Deuel's Sign: Scalp edema -Robert's Sign: Air in circulatory system Abnormally low AFI Fetal edema Amnion and chorion separation
Which arteries supply the functionalis layer of the endometrium?
-Spiral -Straight arteries supply the basalis layer of the endometrium
Lobar holoprosencephaly
-The least severe form of the holoprosencephaly - Absence of the septum pellucidum - This is a failure to CLEAVE - Brain cleavage happens form back to front (so this is just a failure to cleave the front) - The thalami are almost COMPLETELY SEPERATE - Basically you just have fusion of the anterior horns of the ventricles (which means you know NO septum pellucidum)
IUGR is associated with
-methotrexate use -alcohol consumption -maternal smoking
Alobar holoprosencephaly
-most severe form of holoprosencephaly --characterized by a single common ventricle and a malformed brain
monozygotic twins
-twins who are genetically identical -most are diamniotic
The R.I of the umbilical artery should be under
0.8
BPP/ requirement for tone
1 tone movement within 30 mins
TV sonography can detect embryologic changes in the uterus about _______ earlier than transabdominal techniques.
1 week
gestational sac should be seen when bhCG reaches what
1,000 mIU/mL
4 stages of PID
1. Acute Endometritis 2. Acute Salpingitis- thick-walled acute infection (>5mm); Cogwheel sign 3. Acute tubo-ovarian abscess 4. Chronic infection: hydrosalpinx with thin-walled fallopian tube (>5mm) Beads on a string sign
Shone Complex
1. Coarctation of the aorta 2. Subaortic stenosis 3. Parachute mitral valve 4. supramitral ring
The nuchal translucency is measured at what gestational age?
11-14 wks
Fetal kidneys can be identified as early as ______ wks Fetal bladder can be identified as early as _______ wks
12 10
At what fetal age do the kidneys begin to produce urine?
12 wks
FL can be measured as early as
12 wks gestation
At what fetal age do the kidneys begin to produce urine?
12 wks. Completely taken over fluid production by 16 wks
conjoined twins are caused by cleavage of the morula after day ____ of pregnancy
13
Pentology of Cantrell is associated with which trisomies
13 and 18
Fetal stomach should be visualized by
14 weeks
GENETIC AMNIOCENTESIS IS PERFORMED AT WHAT GESTATIONAL AGE
15 wks
The normal cranium should be identified by ____ wks GA
15 wks. by this time, the cranial bones should have ossified, the shape/size should be normal, and the bony calvarium should properly surround brain tissues.
The secretory phase occurs
15-28
Chromosomal defects may be present in a pregnancy where the chorion and amnion have not fused by _____ wks gestational age
16 weeks. At the start of week 12, the amnion and chorion begin to fuse and should be complete by week 14. If not fused by 16 wks, 60% usually have other anomalies.
Embryo should be seen with MSD >
16mm
Which trisomy is commonly associated with a strawberry shaped fetal skull
18
A diagnosis of IUGR is made when biometric measurements are more than __ deviations below normal
2
An increase in ______ degrees celsius or more in the womb can have adverse effects on the pregnancy
2
Greater than ___ mm thickness indicates dichorionic twins
2
The S/D ratio in the umbilical artery should be less than
2
The corpus in a multiparous uterus is usually at least ____________ the cervix.
2 times the length of.
Fetal growth follow up exams should be performed at an interval of
2 weeks or more
Standard BPD accurately provides GA before ______ wks gestation
20
Glucose sampling is usually performed at ______ wks gestation
24-28
Post menopausal ovaries should not exceed ______ in any dimension
2cm
Measure how many cycles for umbilical dopper
3
BPP/ requirement for gross movement
3 movements within 30 mins
Triploidy
3 sets of all three chromosomes
Accuracy of predicting age in first trimester are accurate within
3-5 days
Twins will exhibit the same growth pattern as a fetus in a singleton pregnancy until __________ weeks
30
During a 30 minute BPP what is the minimum amount of fetal breathing
30 seconds
The fetal testicles usually descend into the scrotum before ____ weeks gestation.
34
32 cell blastocyst enters the uterus approx ________ days after fertilization and implants into the endometrium _________ days post fertilization
4-5 5-7
Macrosomia describes a fetus weighing more than
4000g
A fetus with male genitalia and ovaries would be described as:
46XX intersex
A fetus with male genitalia and ovaries would be described:
46XX intersex
A female with female genitalia and testes would be described as
46XY
Preeclampsia is associated with placental insufficiency and oligohydraminos. What AFI value would be associated with preeclampsia?
4cm Oligo = below 5 cm AFI Poly= above 24 AFI
Discordant twin growth is present when there is more than ________ difference in fetal weight between the two fetuses
500g
On TV sonography, cardiac activity should be seen in a CRL of ______ or greater
5mm
The post partum period ususally lasts
6-8 wks
The neural tube closes by
6th week gestation
Organogenesis of a fetus is normally complete by
8 weeks
Average nulliparous uterus size
8 x 5 x 3cm
If the gestational sac measures 30x 30x 40 mm what is the estimated age of the pregnancy?
9 weeks + or - 14
RI of an ovarian mass suggesting malignancy
<.4
PI of an ovarian mass suggesting malignancy
<1.0
On TV US the minimum MSD that should always demonstrate a normal IUP is:
>16 mm MSD should always demonstrate a fetal pole TV >25mm MSD should always demonstrate a fetal pole TA
What AFI would be associated with Spina Bifida?
>20cm
Brachycephaly
A CI is >85%, rounded head, BPD elongated more to fit OFD, more commonly a normal variant than anomaly. When abnormal can be associated with Trisomy 21 and spina bifida.
If the stomach and the heart are visible in the same transverse image
A diaphragmatic hernia is present
Asymmetric IUGR
AC measures more than 2 deviations smaller than HC for the current gestational age.
The triple screen test evaluates
AFP, bHCG, and estriol
Eagle-Barrett syndrome
AKA prune belly syndrome Deficiency of abdominal musculature -weakened abdominal musculature with significantly dilated bladder, ureters, and kidneys -distended bladder with bilateral hydronephrosis -oligohydraminos -pulmonary hypoplasia usually making this abnormality lethal -posterior urethral valves is the most common cause
Heart defect associated with ellis van creveld syndrome
ASD
Ebstein's anomaly
Abnormal placement of tricuspid valve Tricuspid flaps fused to inside of right ventricle; creates constant opening between atrium & ventricle more inferiorly to the apex of the right ventricle.
If the cranium is not identified in a 16 wk fetus ________ should be expected.
Acrania
Benign uterine condition characterized by invasion of the myometrium by endometrial tissue
Adenomyosis Endometriosis is implantation of endo outside of the uterus
Neuroblastoma
Adrenal malignancy seen in children
Steroli leydig cell tumor
Also called androblastoma malignant ovarian tumor that raises testosterone levels
The most common place for normal egg fertilization is in which of the following segments of the fallopian tube?
Ampulla
An egg that is fertilized by two sperm will have
An extra full set of chromosomes = Triploidy
Virilization (masculinization) is associated with
Androblastoma Steroli Leydig Tumor AKA Arrhenoblastoma AKA Androblastoma, is a benign ovarian tumor that secretes testosterone. It can cause hirsutism, male pattern baldness, decreased breast size, and deepening of the voice
An intrauterine fetal blood transfusion may be used to treat what?
Anemia and severe immune hydrops
Defects caused by failure of neurulation during fetal develoment
Anencephaly, spina bifida, encephaloceles, and myelomeningoceles
Most common cause of of CSF obstruction and ventriculomegaly
Aqueductal Stenosis
If a fetus has autosomal dominant polycystic kidney disease (ADPKD):
At least one parent has it.
Placental thickness should be measured
At the cord insertion site
The uterine artery is best sampled at:
At the level of the cervix
Enlared echogenic kidneys with oligohydraminos
Austomosomal Recessive Polycystic Kidney Disease
Which of the follwing structures is located anterior to the ovary? A. ureter B. rectus abdominis muscle 3. internal iliac vein 4. internal iliac artery
B. Rectus abdominis muscle
Brenner tumor
BENIGN. similar to other solid ovarian neoplasms, particularly fibromas, and can also be confused with pedunculated leiomyomas. They are mainly hypoechoic solid masses. Calcifications have been reported in 50% of Brenner tumors on ultrasound.
Macrocephaly is identified when
BPD and HC are 2 or more standard deviations above the average for gestational age
Premature delivery is
Before 37 wks
The ratio of kidney diameter to the abdominal diameter should be
Between 0.23-02.7 for the entire pregnancy
Normal AFI but non visualization of bladder
Bladder exstrophy- epispadias complex
Hematometra refers to ____________ while Hematometrocolpos refers to _________________
Blood dilating the uterine cavity; Blood dilating the uterine cavity, cervix, and vagina
Turners Syndrome
Born with a single X chromosome. (short, webbed neck, different physical sexual development.)
increase in distolic flow in the MCA is indicitave of
Brain sparing
Which of the following is not true regarding a cystic hygroma? A. Usually presents as a thin walled cystic mass with septations B. Similar in appearance to encephalocele or myelomeningocele C. Strong association with trisomy 18 D. Associated with hydrops, pleural effusion, and anasarca
C. Cystic hygroma is strongly associated with chromosomal abnormalities which effect AFP levels, (downs syndrome-low AFP, turners syndrome-low AFP)
erythoblastosis fetalis
Caused by an Rh+ father and baby and an Rh- mother Can lead to immune fetal hydrops Commonly treated by fetal blood transfusion
Congenital high airway obstruction syndrome (CHAOS)
Caused by an obstruction in the fetal upper airway. Complete atresia of the airway is commonly associated with a tracheoesophageal fistula. Common sonographic findings include: dilated, fluid-filled trachea, bilateral symmetrically enlarged hyperechoic lungs, and flattened or everted hemidiaphragms.
cystic hygroma
Cavernous lymphangioma of the neck. Associated with Turner syndrome.
A cisterna magna measuring greater than 10 mm is a common finding with
Cerebellar agenesis and dandy walker malformation
You are performing a third trimester scan with possible oligohydraminos. Which of the following should be evaluated to find the cause?
Cervix for dilation and leakage, and kidneys being present. If one or both kidneys are absent, oligohydraminos will be present.
Most common cause of PID
Chlamydia
Most common cause of pleural effusion in a fetus
Chlyothorax
Early onset of IUGR in the first trimester is usually symmetric and associated with
Chromosomal anomalies
Imaging the fundus of an anteverted uterus, the handle of the transvaginal probe should be angled:
Closer to the bed
levocardia
Condition whereby the heart is in the normal left side of the thoracic cavity, but the remaining organs are transposed to the side opposite to their normal position.
Functional tissue of the ovary
Cortical tissue (thinner in postmenopausal women)
Allantoic cyst
Cyst of the umbilical cord
Ovarian tumor that contains both epithelial and stromal components
Cystadenofibroma
The autosomal recessive disorder that is associated with meconium ileus and fetal bowel obstruction
Cystic fibrosis
Cystic hygroma is strongly associated with chromosomal abnormalities which effect ______
Cystic hygroma is strongly associated with chromosomal abnormalities which effect AFP levels; Down Syndrome (Low AFP), Turner Syndrome (low AFP).
Ovarian tumor that demonstrates "tip of the iceburg sign"
Cystic teratoma
A rotikansky nodule is commonly identified with what type of pelvic mass?
Cystic teratoma. Rotikansky nodule is another term used to describe dermoid plug
Most common reported intrauterine infection during pregnancy
Cytomeglavirus
Multiple small calcifications are identified in the fetal liver and brain. Mild ventriculomegaly is also noted. What is the most likely cause of these findings?
Cytomeglovirus infection
A patient presents for an ultrasound due to uterine size not matching the leveles of bhCG for expected age of pregnancy. The uterus is enlarged with a large heterogenous mass that seems to have invaded the uterine wall into the peritoneum. The pelvic nodes are normal and the liver is clear. These findings are most consistent with: A. choriocarcinoma B. hydatidform mole C. retained products of conception D. chorioadenoma destruens
D. Chorioadenoma destruens Chorioadenoma destruens refers to an invasive molar pregnancy. The mass of abnormal tissue will only invade the uterus and surrounding pelvic structures. A hydatidifrom mole is contained to the uterus.
Which of the following demonstrates normal flow in a fetus with anemia? A. umbilical vein B. descending aorta C. middle cerebral artery D. umbilical artery
D. Umbilical Artery The uterine and umbilical artery flow resistance/velocity is usually normal and not helpful in the diagnosis of fetal anemia. Blood flow velocitites
Which of the following would be differential diagnosis for cystic formation in the posterior fossa
Dandy Walker Malformation and Blake pouch cyst
Which of the following can predict erythroblastosis fetalis using a sample of amniotic fluid
Delta OD450- evaluates excessive amounts of billirubin from fetal anemia
Agenesis of corpus callosum can be ruled out by
Demonstration of normal cavum septum pellucidum. The choroids should also be evaluated for the classic teardrop appearance.
"Tip of the iceberg" sign is associated with:
Dermoid cyst
Double bleb sign
Description of the distinctive sonographic appearance of the embryonic disk situated between the newly developed amniotic cavity and secondary yolk sac within the chorionic cavity at 4-5 weeks gestational age.
Trophoblastic cells
Develop chorionic villi into the placenta, produce progesterone and hcg, involved with implantation
Echogenic foci in the myometrium could most likely be caused by?
Diabetes
If the fetus are two different genders, this indicates
Dizygous twins
Elevated serum levels of lactate dehydrogenase are related to which of the following ovarian neoplasms?
Dysgerminoma The only ovarian tumor that effects LDH. It also increases bhCG and CA 125
What phase is the endometrium the thinnest?
Early proliferative
The term used described a thoracic defect where the heart is herniated outside the chest wall
Ectopia cordis
Chorioangiomas are associated with
Elevated MSAFP
Most common in the amish country and presents as mesomelia, polydactly, narrow thorax, and cardiac defects?
Ellis Van Creveld Syndrome
Absence of cardiac activity on 9 mm is indicative of
Embryonic demise
What can cause increased CA125?
Endometriosis, PID, fibroids, endometrial carcinoma, ovarian carcinoma
Ring down artifact (sound meets air) can be seen with:
Endometritis (will cause production of air in endometrial canal)
Oxygenated blood from the placenta....
Enters the umbilical vein, then the left portal vein or ductus venosus, then the IVC, then the right atrium
Most primary malignancies of the ovary originate in the
Epithileal stromal tissues
Which hormone stimulates the cervix to produce mucous just prior to ovulation?
Estrogen
what is responsible for stimulating the contraction of the fallopian tubes to propel the egg toward the uterine cavity?
Estrogen
What should you evaluate if there is suspected amniotic band syndrome?
Evaluate for assymetric facial clefting in the coronal plane.
Bladder exstrophy
Eversion of the posterior bladder through the anterior bladder wall and Lower abdominal wall
Primary ammenorrhea
Failure to menstruate by 15-16 years of age in someone with secondary sexual characteristics
In most cases, UNIlateral renal agenesis will demonstrate what?
Fetal Bladder and normal AFI. Bilateral renal agenesis will demonstrate no bladder and polyhydraminos.
10 weeks to delivery
Fetus Zygot until 10 weeks
Most common mass seen with pregnancy?
Fibroid
Perihepatic adhesions and peritonitis are seen with:
Fitz-Hugh-Curtis Syndrome Fitz Hugh Curtis Syndrome is a complication of PID leading to inflammation of the glissons capsule, perihepatic adhesions and peritonitis.
The sonographic appearance of hydrancephaly
Fluid filled sacs of cerebrospinal fluid in the cranial cavity, varying amounts of tissue remain as atrophy and necrosis occurs
The ovary is found in the
Fossa of Waldeyer
Placental thickness should be equal to
GA in weeks + 10mm (Ex: 20 week pregnancy placental should be 30mm)
Cyst that forms from Gartner ducts in the vaginal canal
Gartner cyst
Robert's Sign
Gas in the fetal circulatory system
What anomaly involves the fetal digestive system and has been associated with maternal use of aspirin during pregnancy?
Gastroschisis
Maternal ibuprofen use has been associated with
Gastroschisis and premature closure of ductus arteriosus
Donor twin in twin to twin transfusion will demonstrate
Growth restriction, appears to be stuck to wall due to oligohydraminos
A patient presents for a fetal anatomy scan due to a recent cytomegalovirus. Which of the following supplemental measurements should be performed during the exam to evaluate the effects of the virus?
Hepatic length Any infections in the TORCH category can lead to hepatomegaly and splenomegaly.
If maternal syphillis goes untreated, what change will be seen in the fetus?
Hepatomegaly -Syphilis can cause premature aging of the placenta and swelling of the fetal liver and spleen. If untreated with pinicillin, the fetus can demonstrate blindness, deafness, deformity of the face, and central nervous system problems.
Cloacal Extrosphy
Herniation in the pelvis involving the intestines and or/bladder
Which of the following is the most common type of non lethal skeletal dysplasia?
Heterozygous achondroplasia
First trimester uterine artery resistance should be
High
What kind of doppler will partial ovarian torsion demonstrate?
High resistance
Which of the following describes the doppler waveforms obtained from the non gravid uterus?
High velocity, high resistance
Which of the following describe a PW doppler tracing obtained from tissues surrounding the dominant follicle?
High velocity, low resistance flow
Hirchsprung's disease
Hirschsprung's disease (congenital megacolon) EXPECTED FINDINGS: Dilated bowel loops throughout fetal abdomen
Symmetric or midline clefts are associated with
Holoprosencephaly
The binocular distance should be measured in suspected cases of:
Holoprosencephaly and midface hypoplasia. Turner syndrome is also associated with facial defects.
Abnormal fluid retention in at least 2 fetal structures
Hydrops
Recipient twin in twin to twin transfusion will demonstrate
Hydrops, heart failure, and polyhydraminos due to increased arterial flow in the placenta
IDDM/NIDDM is associated with
IUGR
What is a sign of maternal HTN on u/s?
IUGR Maternal HTN can cause placental insufficency and thinning of the placenta which can lead to IUGR
Quad screen results for a fetus with Trisomy 21 would include which of the following?
Increased hCG and decreased MSAFP Decreased PAPP-A are also associated with Trisomy 21
In a fetus with IUGR, you would expect to see ______ flow in the MCA, and _______ flow in the umbilical artery doppler
Increased; Decreased
Cullen Sign
Indicates ruptured ectopic
When imaging the fundus of the retroverted uterus, the transducer should be angled so that the handle:
Is farther from the bed
When evaluating a patient for a large fibroid mass, what other organs should be evaluated as well?
Kidneys for hydronephrosis. Large masses in the uterus or ovaries can lead to extrensic compression of the ureters causing hydronephrosis.
nagaele's rule
LMP + 7 days - 3 months + 1 year
Calculating ovarian volume
LXWXHX0.523
Which form of achondrogenesis is least severe?
Langer-Saldino
Placental Lakes
Large pools of maternal slow moving (non turbulent) venous blood within the placenta.
The left ovary empties into the ________. The right ovary empies into the ______.
Left renal vein; IVC
When a malignant neoplasm is identified on the right ovary what other structures should be evaluated for possible involvement?
Liver, bladder, and pelvic lymph nodes
Second and 3rd trimester uterine artery resistance should be
Low
Which of the following describes the doppler waveforms obtained from the uterine artery of the gravid uterus?
Low resistance, average velocity
Normal flow patterns in the ovary
Low velocity, low resistance
Gestational diabetes is associated with
Macrosomia
A patient presents for a limited follow exam after the previous demonstrated possible hydrocephalus. What should you do first to evaluate the fetus for hydrocephalus?
Measure the lateral ventricles
A calcification in the fetal liver is associated with:
Meconium peritonitis
Most likely symptom of endometriosis?
Menorrhagia
Where should UA be sampled
Mid cord
Low hCG levels could mean
Miscalculation of age Miscarriage or blighted ovum Ectopic
Acute onset of maternal HTN in the first trimester is a strong indicator of
Molar pregnancy
One ys with two embryos indicates
Monoamniotic twins
Cranial vessels should ALWAYS be
Monophasic with forward flow
A paraovarian cyst is also known as
Morgangi or mesonephric cyst
Malformation of the cloaca
Most common cause of fetal urethral valve obstruction in females
Rhabdomyoma
Most common pediatric tumor of the heart. They have been associated with tuberous sclerosis.
Unilateral enlargement of one kidney containing multiple cysts varying in size
Multicystic dysplastic kidney
In stage 1 endometrial cancer, the cancer has invaded the ______ but is still confined to the uterus
Myometrium
Unilateral renal agensis may result in
Normal amniotic fl
Risk factors of endometrial cancer
Nulliparity, obesity, early menarche (<12 yrs), late onset of menopause, high-fat diet, endometrial hyperplasia, family history, and infertility, birth control pills, tamoxifen, pcos
Chiari II malformation
Obliteration of the cisterna magna, lemon sign, banana sign
Hydrancephaly is caused by
Obstruction of the ICA which leads to cerebral tissue destruction
The majority of encephaloceles are located in the _______ region.
Occipital
Asymmetric IUGR
Occurs due to shunting of the brain that is normally intended for the abdomen. This is the fetal response to diminished flow. Flow is rerouted to the brain to spare its growth.
Will spina bifida aperta, or oculta have increased AFP levels?
Oculta will demonstrate normal AFP levels. AFP levels will increase with open defects of the fetal structure.
theca lutein cyst
Often bilateral/multiple. Due to gonadotropin stimulation. Play an important role in the development of the corpus luteum. Associated with choriocarcinoma and moles.
What is related to increased AFP levels?
Omphalocele, multiple gestation,
Chiari II malformation is strongly associated with
Open spina bifida
The AV canal defect is a combination of:
Ositum primum ASD and inlet VSD
How should you measure the endometrium?
Outer edge of the functionalis layer to the outer edge of the opposing functionalis layer
OFD measurement
Outer skull to outer skull
A patient with RLQ pain increasing over the last few months. The exam contains an abnormal right ovary with a 3 cm echogenic mass. The posterior borders of the mass are difficult to assess due to dirty shadowing.
Ovarian Teratoma (Can often contain hair, teeth, bone, thyroid, etc). - A dermoid is an ovarian teratoma which is a type of germ cell tumor. The mass is composed of thick ectodermal tissues that causes dirty shadowing.
Krukenburg
Ovarian metastisis from GI tract. Bilateral solid ovarian tumors
The whirlpool sign is demonstrated with
Ovarian torsion
The follicular ring sign is associated with what
Ovarian torsion Follicular ring sign- perifollicular hyperechoic rim, 1 to 2 mm in thickness, identified
Estrogen stimulates the endometrium to thicken before _____________. Progesterone stimulates endometrial thickening in the ____________ phase for possible implantation. If implantation does not occur, progesterone levels decrease and menses occurs.
Ovulation; secretory phase
Increased resistance to blood flow indicated the fetus is not receiving
Oxygen, nutrients
Which of the following is most likely to cause polyhydraminos, fetal ascites, and hepatomegaly?
Parvovirus infection
which uterine wall layer is composed of fibrous connective tissue?
Perimetrium. the uterine serosa is also called the perimetrium
A/an ______ can lead to the initial onset of ovulation and uterine enlargement in females __________ years old.
Pituitary tumor; less than 8 yrs old
What is described as invasion of the placental chorionic villus through the myometrium and uterine wall?
Placenta Percreta
Hypoechoic areas in the placenta that displays turbulent flow on color doppler evaluation
Placenta accreta
Maternal cocaine abuse is associated with what critical findings on ultrasound?
Placental abruption and premature birth
IUGR after 30 wks is usually asymmetric and related to
Placental insufficiency
IUGR can be associated with
Placental thinning, increased S/D ratio in the umbilical artery, high resistance with absent diastolic flow
Most common spinal abnormality seen in skeletal dysplasia
Platyspondyly
Most common cause of fetal bladder rupture
Posterior urethral valves
If the radiologist suspects Potter Syndrome and requests that you perform a thoracic circumference. How will this measurement assist in the diagnosis?
Potter Syndrome usually demonstrates a bell/pear-shaped thorax that is much more narrow than the abdominal cavity. Pulmonary hypoplasia is common with Potter Syndrome due to the oligohydraminos caused by renal agenesis.
Associated with a bell shaped thorax
Potter syndrome, thanaotophoric skeletal dysplasia, and osteogenesis imperfects
TORCH infections
Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR Toxoplasmosis Other = syphillis, varicella, HIV Rubella Cytomegalovirus Herpes Simplex
What is responsible for the early symptoms of pregnancy such as nausea and vomiting
Progesterone
What does PHI stand for?
Protected health information
Non visualization of fetal abdominal muscles, urinary tract abnormalities, and undescended testes are a classic triad of signs of
Prune Belly Syndrome
You are evaluating a 20 wk old fetus for size and anatomy evaluation. A mildly hyperechoic, homogeneous, triangular shaped mass is identified inferior to the level of the heart in the right chest cavity. The remainder of the chest cavity and heart is normal. This is consistent with:
Pulmonary Sequestrian
The right ventricle send deoxygenated blood to the lungs through the _____________. The oxygenated blood leaves the lungs through ___________________ to enter __________________
Pulmonary artery Pulmonary veins Left atrium
What does the three vessel view consist of?
Pulmonary artery, aorta, and superior vena cava
What is the most common cause of death in lethal skeletal dysplasia?
Pulmonary hypoplasia. (Narrow chest with short ribs, limiting lung formation)
Muscles of the Greater Pelvis
Rectus Abdominis Transverse Abdominis Psoas Major Iliopsoas
When evaluating a small embryo for cardiac cavity it is important to:
Reduce the size of field of view and increase frame rate
What is a disadvantage of transvaginal sonography?
Reduced field of view. (Disadvantage when evaluating enlarged uterus or ovaries that set high in the adnexa.
Placental insufficiency will cause _______ flow in the umbilical artery
Reduced, absent, or reversed diastolic flow
Colpocephaly
Refers to the abnormal dilation of the posterior horns of the lateral ventricles (tear drop shaped)- common sign of agenesis of the corpus callosum
Doliocephaly
Refers to the fetal head that is more elongated with a longer OFD, much greater than the BPD measurement. Associated with breech presentation, holoprosencephaly, and oligohyrdraminos.
Rejection
Removes unwanted echoes
Which of the following artifact causes decreased visualization of the cerebral hemisphere closest to the transducer face?
Reverberation
The first cardiac chamber to recieve oxygenated blood from the placenta
Right atrium
The highest concentration of oxygen in the heart is in the
Right atrium
The normal direction of flow through the fetal foramen ovale is
Right atrium to left atrium
Which of the following is NOT a potential complication of a sonohystogram? A. Vasovagal response B. Allergy to contrast C. Vaginal bleeding D. Pelvic infection
Saline is used for a sonohystogram and does not cause an allergic reaction
Most common type of mullerian duct anomaly
Septate uterus
Levels that will increase with dysgerminoma
Serum hCG, serum CA 125, serum lactate dehydrogenase
Femur length >2 standard deviations below the mean for the gestational age indicates
Skeletal dysplasia
Holt-Oram Syndrome
TBX5, AD Radial and ulnar bones, heart disease thumb looks like its got a rubber band around it
Which pedal abnormality is commonly seen with spina bifida?
Talipes Equinovarus (Club foot) is a pedal abnormality that is commonly seen with spina bifida.
Which cranial structures should be visualized in the head when performing a fetal head circumference in the proper location?
Thalamus, cavum septum pellucidum, and third ventricle
A clover leaf skull is associated with which skeletal dysplasia?
Thanatophoric dysplasia (most common type of lethal skeletal dysplasia) Also associated with: -Short ribs -Pulmonary hypoplasia -Polyhydraminos -Severe micromelia -Bowing of long bones
Most common type of lethal skeletal dysplasia?
Thanatophoric skeletal dysplasia
A 26 yr old patient presents with acute left lower quadrant pain and vomiting. You see this. What should be done next to evaluate the patient?
The acute onset of pain correlates with ovarian torsion. Color doppler should be applied to evaluate vascularity.
cogwheel sign
The cogwheel sign refers to an imaging appearance in pelvic imaging of thickening loops of the Fallopian tube seen on cross-section
What 2 muscles form the pelvic diaphragm?
The levator ani and coccygeus muscle
Dwarphism occurs when
The limbs are abnormally shortened with a relatively normal HC and AC
Blood entering the fetus in the umbilical vein is divided between
The portal vein and the ductus venosus
How can you differentiate between the portal vein and gallbladder in the fetal abdomen?
The umbilical vein is located centrally in the abdomen while the portal vein is located to the right between the right and left lobes of the liver.
How can you differentiate a uretocele from obstruction of the uteropelvic junction of the kidney?
The ureter will be dilated with a ureterocele, but not with a UPJ obtruction
Benign ovarian tumor that secrete estrogen can lead to fibroid enlargement and postmenopausal bleeding
Thecoma
________ and granulosa cell tumors are benign ovarian neoplasms that secrete estrogen.
Thecomas
Which of the following best describes the sonographic appearance of a patient in day 20 of their menstrual cycle?
Thich and hyperechoic
What will a patient who is taking Tamoxifen endometrium appear like?
Thick, heterogeneous, cystic
Associations of inevitable abortions vs. threatened abortions
Threatened: Bleeding, cramping, cervix closed Inevitable: Bleeding more than one week, cramping, cervical dilation
Three copies of the 23 human chromosomes results in a diagnosis of
Triploidy
A cephalic index of 90% in a 28 wk fetus can indicate which of the following?
Trisomy 21 and Brachycephaly
The chorionic villi and membrane are formed by
Trophoblastic cells
What embryologic structure produces progesterone and bHCG?
Trophoblastic cells.
Cystic hygroma is associated with
Turner syndrome Down syndrome (trisomy 21) Klinefelter syndrome (XXY) Trisomy 18, 13
The corpus in the multiparous is usually at least _____ the size of the cervix
Twice
There are several cysts in the lung that measure 2-4 cm. This finding most likely indicates:
Type I congenital cystic adenomatoid malformation
Which type of osteogenesis imperfecta has the poorest outcome?
Type II
Theca call tumor/ Granulosa cell tumor
Unilateral hypoechoic mass on postmenopausal women. The tumor is most commonly benign and produces estrogen
Incomplete resolution of which embryologic structure can cause a cystic formation between the abdominal wall and anterior bladder wall
Urachus
How can you differentiate between an ectopic pregnancy in the ampullary region of the tube from an ovarian mass?
Use the TV probe to apply pressure in the adnexal region of the ovary and mass to observe the motion of the mass
incarcerated uterus
Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.
IVF: embryo is placed in the __________, Zift: embryo is placed in the _______________
Uterus
Potential complication of succenterate placenta
Vasa previa
Intracranial anomaly that causes an increased amount of flow within the venous system causing fluid accumulation, CHF, and hydrops.
Vein of Galen aneurysm
During what week of the menstrual cycle is best to evaluate a patient for normal cysts and a possible right ovarian cyst?
Week 1 The endo should be its thinnest and no dominant follicles should be formed at this time.
Minimum sensitivity
When you start by making the TGC flat then increase gain from minimum value, the point at which the echo appears on screen
epispadias
a congenital abnormality in males in which the urethra is on the under surface of the penis can cause obstruction and lead to megacystitis and significant hydronephrosis
Tetralogy of Fallot
a congenital malformation of the heart involving four distinct defects 1. Overriding aorta 2. Pulmonic Stenosis 3. VSD 4. Right ventricular hypertrophy
erythroblastosis fetalis
a disorder that results from the incompatibility of a fetus with Rh-positive blood and a mother with Rh-negative blood, causing red blood cell destruction in the fetus; a blood transfusion is necessary to save the fetus
Beckwith-Wiedemann syndrome
a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver. -Most common findings are a triad of macrosomia, macroglossia, and omphalocele. Polyhydraminos is usually seen
Schizencephaly
a rare condition characterized by abnormal openings or clefts in the cerebral hemispheres
Pulmonary sequestration
a separate mass of nonfunctioning lung tissue with its own blood supply On U/S it appears as an echogenic triangular shaped mass in the fetal chest
Primigravida
a woman who is pregnant for the first time
If the ED flow is low, absent, or reversed in the umbilical cord that is
abnormal
hydrocephalus
abnormal accumulation of fluid (CSF) in the brain. Measure lateral ventricles
Athrogryposis
abnormal curvature of joints/long bones in two or more areas
diaphragmatic hernia
abnormal displacement of organs through the muscle separating the chest and abdomen
Chlyothorax
accumulation of lymph from the GI tract in the pleural space
A sample of amniotic fluid should be tested for increased levels of _______________ that indicate the presence of neural tube defects
acetylcholinesterase
The fetal structures within the omphalocele are protected by a membrane composed of
amnion and peritoneum
Clinodactyly
arching of the 4th and 5th digits toward the thumbs
encircle the periphery of the uterus
arcuate arteries
If fertilization occurs ______ will stop the regression of the CL cyst so that it can produce progesterone and create the decidual reaction
bHCG
straight arteries supply the __________ and spiral arteries supply the _____________
basal layer of the endometrium; functional layer of the endometrium
Most common occuring germ cell tumor of the ovary
benign cystic teratoma
Mucinous cystadenoma
benign tumor of the ovary that contains thin-walled multilocular cysts
HCG peaks at what week?
by 10wks 100,000 mL
Stage II endometrial cancer
carcinoma involves the *corpus and the cervix*
What can be measured that is usually consistent with GA for a fetus with IUGR?
cerebellar diameter
Fetal component of placenta
chorion fondusum
Most common cause of fetal demise in first trimester
chromosomal abnormalities
DES exposure in utero
clear cell adenocarcinoma of the vagina, uterine malformation (in their children), ectopic pregnancy
foramen ovale
connects the two atria in the fetal heart
battledore placenta
cord insertion into the margin of the placenta
Most common type of ovarian tumor
cystadenoma
Dandy-Walker malformation
cystic dilation of the fourth ventricle, absent cerebellum
An encephalocele can easily be mistaken for a
cystic hygroma
late proliferative phase
days 10 to 14 of the menstrual cycle; ovulation occurs; the endometrium increases in thickness and echogenicity
secretory phase
days 15-28. endometrium is thick and hyperechoic
early proliferative phase
days 5-9 of the menstrual cycle; endometrium appears as a single thin stripe with a HYPOECHOIC halo encompassing it; creates the "3 line sign"
How to measure binocular distance?
distance between lateral orbit walls, inner wall to inner wall.
The best time to visualize a polyp, when the endometrium is at its thinnest
early proliferative
Spatial compounding requires a transducer that can perform:
electronic steering
Spotting between cycles and infertility are common symptoms of
endometrial polyp
Stage III endometrial cancer
extends into true pelvis
where along the cord is highest resistance
fetal cord insert
The fetal umbilical artery branches from the
fetal internal iliac arteries
if the ductus venosus flow is abnormal you will see
flow reversal in diastole
During renal development, the kidneys normally migrate __________________
from the pelvic region superiorly into the lower abdomen
BPP/ requirement for fetal breathing
full 30 sec within 30 mins
encephalocele
herniation of brain tissue through a gap in the skull
A trident hand is commonly seen with which skeletal anomaly?
heterozygous achondroplasia
Phenylketonuria
high levels of phenylalanline associated with microcephaly, cardiac defects, and IUGR
Hypotelorism is associated with
holoprosencephaly (midline defects of the brain), microcephaly, cyclopia, craniosynostoses
Absent cavum septum pellucidum and septo optic dysplasia are common findings with
holoprosencephaly, shcizencepaly
The most common cause of pelvic congestion
incompetent left ovarian vein
as the pregnancy progresses, the sonographic appearance of the fetal lungs will
increase in echogenicity
theca lutein cyst are associated with
increased levels of bhCG
which portion of the fallopian tube is described as trumpet shaped?
infundibulum
osteogenesis imperfecta
inherited condition of deformed and abnormally brittle bones. can be diagnosed as early as 15 wks and ruled out if boney structures appear normal by 17 wks.
An abnormally short fetal neck with fixed posterior flexion
iniencephaly
The uterine artery is a branch of
internal iliac artery
Caudal Regression Syndrome
lack of development of the caudal spine and cord that may occur in the fetus of a diabetic mother
hCG in non pregnant females should be
less than 5.0
Muscles that form the pelvic floor
levator ani and coccygeus
What fetal structure produces AFP?
liver and yolk sak
thymus gland
located in the mediastinal cavity anterior to and above the heart; secretes thymosin
Dysgerminoma
malignant germ cell tumor, associated with streak gonads of Turner's.
choriocarcinoma
malignant, trophoblastic tumor of the placenta
An autosomal dominant disorder
may be inherited from one parent who is affected. Dominant means the nonfunctional gene of the gene-pair is able to override the normal gene. A person affected by an autosomal dominant trait has a 50 percent chance of passing it on to his/her offspring.
Twin-twin transfusion syndrome
monozygotic, monochorionic twins usually the same sex donor twin growth restricted, appears to be stuck to wall due to oligo AKA stuck twin syndrome Recipient twin will develop hydrops and heart failure, polyhydraminos due to increase arterial flow from the placenta
spina bifida occulta
most common and least severe form of spina bifida without protrusion of the spinal cord or meninges
posterior urethral valves
most common cause of bladder outlet obstruction in the male neonate
What urinary anomaly is caused by a urinary obstruction in the first trimester and leads to renal cyst formation and ureteral atresia?
multicystic kidney disease usually unilateral because the obstruction occurs early in the pregnancy
Meconium peritonitis
multiple echogenic foci in the fetal bowel, liver, and peritoneum accompanied by polyhydraminos and fetal ascites.
CDH is most commonly seen
on left side
Noonan Syndrome
one of four chromosomes is affected. Noonan affects both boys and girls equally. -Referred to as the male version of turners syndrome -Common associated defects include congenital heart defects, short stature, mental deficiency, and abnormal facial features such as hypertelorism and low set ears
spina bifida aperta
open (non-skin-covered lesions) neural tube defects, such as myelomeningocele and meningocele
Spalding's sign
overlapping of the skull bones caused by liquefaction on the brain
Fitz-Hugh-Curtis syndrome
pelvic infection that extends to liver capsule and right upper quadrant. Ascites forms in Morrison's pouch. Peritonitis can lead to the formation of perhepatic adhesions.
circumvallate placenta
placental condition in which the chorionic plate is smaller than the basal plate; the margin is raised with a rolled edge Appears as rolled or curled placental edges. Increased risk of abruption
placental abruption
premature separation of the placenta. Requires immediate delivery of baby
left atrium receives blood from
pulmonary veins
which arteries course through the myometrium?
radial arteries
Pentalogy of Cantrell
rare anomaly with five defects:sternum defect, diaphragm defect., omphalocele, intracardiac anomalies, and ectopia cordis
A patient presents for a pelvic ultrasound due to suspected uterine didelphys, if the exam is positive for the anomaly what could you suspect to see?
right and left uterine body, cervix, and vaginal canal
Deuel's sign
scalp edema
luteinizing hormone (LH)
secreted by the pituitary gland to promote ovulation
The femoral lengths are usually _______ in cases of IUGR.
shortened
CHILD syndrome
skeletal dysplasia only affecting one side of the body
Asherman syndrome
surgical removal of stratum basalis, causing scarring and secondary amenorrhea -amenorrhea -hypomenorrhea -recurrent miscarriage and infertility
Epignathus
teratoma located in the oropharynx
registration accuracy
the ability of the system to place reflections in proper positions while imaging from different orientations
Thanatophoric dysplasia
the most common lethal skeletal dysplasia characterized by a cloverleaf skull with frontal bossing and hydrocephalus. Shortened limbs
Craniosynostosis
the premature fusing of the skull bones causing an abnormally shaped calvarium and facial features. It can restrict cerebral growth and development.
Methotrexate is used for
to cause involution of early ectopic pregnancies and preserve fertility so surgical intervention doesn't scar the fallopian tube
The number of yolk sacs can be used
to determine the amniocity of the multifetal pregnancy.
where to perform measurement for nuchal skin fold
transverse view of cranium at view of cerebellum and cisterna
Spina bifida is best demonstrated
transverse view of the spine
Shortened humerus can assist in diagnosis of
trisomy 21
two uterine horns, one cervix
uterine bicornis unicollis
how can you differentiate uterine synechia from aminotic bands associated with fetal abnormalities?
uterine synechia do not attach to the fetus while amniotic bands do attach to the fetus
Meckel's diverticulum
when the yolk sac persists into adult life as diverticulum in the ileum portion of the bowel
An autosomal recessive disorder
will appear only in children of parents who both carry the gene
