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