OB Quiz 2

Fetal skin thickening, called anasarca, is considered when the skin thickness reaches or exceeds ____ cm. A) 0.1 B) 0.5 C) 1.0 D) 5.0

0.5

At what gestational age should the kidneys always be visualized on transabdominal sonography? A) 15 weeks B) 11 weeks C) 12 weeks D) 18 weeks

15 weeks

Ultrasonographically, fetal gender cannot be anatomically differentiated until: A) 10 weeks gestation B) 13 weeks gestation C) 16 weeks gestation D) 20 weeks gestation E) 23 weeks gestation

16 weeks gestation

The optimal period to examine fetal cardiac anatomy is _________ A) 18 to 24 weeks B) 12 to 33 weeks C) 14 to 18 weeks D) 24 weeks to term

18 to 24 weeks

Skeletal anomalies are suspected when the long bones measure more than _____ SD below the mean. A) 1 B) 2 C) 3 D) 4

2

Sonographic findings associated with osteogenesis imperfecta may not be apparent before: A) 12 weeks' gestation B) 18 weeks' gestation C) 24 weeks' gestation D) 28 weeks' gestation

24 weeks' gestation

How many ossification centers should be present for each vertebra? A) 3 B) 2 C) 1 D) 4

3

The fetal bladder should fill and then empty again approximately every: A) 5-10 minutes B) 10-15 minutes C) 30-45 minutes D) 60-75 minutes E) 120 minutes

30-45 minutes

The distal femoral epiphysis is consistently visualized by: A) 20 weeks B) 28 weeks C) 32 weeks D) 35 weeks

32 weeks

Visualization of the proximal tibial epiphysis first occurs around: A) 20 weeks' gestation B) 24 weeks' gestation C) 30 weeks' gestation D) 35 weeks' gestation

35 weeks' gestation

In the late second trimester, anterior—posterior diameter of the normal renal pelvis should not exceed: A) 1 mm B) 4 mm C) 7 mm D) 10 mm

4 mm

In the body of a normal fetus the heart is positioned at an angle: A) 35° to the right of midline B) 35° to the left of midline C) 45° to the right of midline D) 45° to the left of midline E) 55° to the left of midline

45° to the left of midline

The nuchal fold should not exceed ______ mm in a normal pregnancy, when measured prior to 21 weeks. A) 3 B) 10 C) 6 D) 2

6

At what gestational age should abdominal wall defects be visualized? A) >12 weeks B) 8 weeks C) <22 weeks D) 27-40 weeks

>12 weeks

Transabdominal ultrasound reveals a soft-tissue mass protruding from the anterior wall of the fetus just inferior to the cord insertion. The diagnostic possibilities include: A) Bladder exstrophy B) Cloacal exstrophy C) Gastrointestinal teratoma D) A and B E) All of the above

A and B

Visualization of the fetal heart and stomach in their correct positions rules out: A) Congenital diaphragmatic hernia B) Duodenal atresia C) Situs inversus D) A and B E) All of the above

A and B

If you were observing the fetal forearm in the anatomical position, which of the following statements about the ulna would be TRUE? A) The ulna is longer than the radius proximally B) The ulna is positioned lateral to the radius C) The ulna and the radius end at the same level distally. D) A and B. E) A and C.

A and C

A patient presents with vaginal bleeding in the second trimester. Which of the following is not a probable cause? A) Placental abruption B) A chorioangioma C) Retroplacental hemorrhage D) Placenta previa E) Subchorionic hematoma

A chorioangioma

Lack of bony ossification, severely shortened limbs, and a small chest all describe: A) Osteogenesis imperfecta type III B) Heterozygous achondroplasia C) Short rib polydactyly syndrome D) A lethal skeletal dysplasia

A lethal skeletal dysplasia

If a femur length measurement falls below 2 standard deviations for GA, what is the most likely consideration? A) Amelia B) Mesomelia C) A possible skeletal dysplasia D) IUGR

A possible skeletal dysplasia

Which of the following sonographic measurements is least accurate for determining gestational age? A) FL B) CRL C) AC D) BPD E) HC

AC

When you have demonstrated the fetal stomach transversely at the level of the portal vein, you are at the appropriate level for: A) Cord insertion B) Thoracic circumference C) Abdominal circumference D) Fetal kidneys E) Three-vessel cord

Abdominal circumference

What are the sonographic features of caudal regression syndrome? A) Fusion of the lower extremities, renal agenesis, and oligohydramnios B) Absent sacrum, clubfeet C) Complex mass off distal fetal spine, hydronephrosis, and fetal hydrops D) Radial ray defect

Absent sacrum, clubfeet

Which of the following is most essential for fetal lung development in utero? A) Lecithin and sphingomyelin B) Fetal "breathing" episodes at least 2 times every 30 minutes C) Amniocentesis in the 3rd trimester to assess lung maturity D) Adequate amniotic fluid volume

Adequate amniotic fluid volume

The fetal kidneys are most commonly located A) At the level and posterior to the cord insertion B) Slightly superior and adjacent to the fetal stomach C) Adjacent to the fetal spine bilaterally D) Adjacent and inferior to the cord insertion E) At the level and posterior to the fetal diaphragm

Adjacent to the fetal spine bilaterally

What is demonstrated in this image? A) Renal fossa B) Kidney C) Pelvis D) Adrenal gland E) Glisson's capsule

Adrenal gland

Which of the following is/are similar to the kidneys sonographically, and are sometimes mistaken for normal kidneys in the developing fetus? A) Duodenum B) Ascending and descending colon C) Adrenal glands D) Gallbladder

Adrenal glands

Caudal regression syndrome is associated with: A) Diabetes B) Mermaid sign C) Sirenomelia D) B and C E) All of the above

All of the above

Fetal lung maturity is best determined by: A) Biometric evaluation B) Echogenicity of lungs C) Chorionic villus sampling D) Amniocentesis E) Alphafetoprotein levels

Amniocentesis

In image arrow C is pointing to the: A) Right ventricle B) Right atrium C) Right ventricular outflow tract D) Right pulmonary artery E) Aorta

Aorta

Premature atrial contractions: A) Are common and benign B) Always require treatment C) Are rare D) Are associated with pulmonary atresia E) Are associated with a ventricular septal defect

Are common and benign

This fetal lung (asterisk) is more echogenic than the contralateral lung because of: A) Artifact B) Tracheal atresia C) Fetal lung maturity D) Congenital diaphragmatic hernia E) Differential blood flow

Artifact

Bowing of the femur can be a result of: A) Hypophophatasia B) Artifact C) Sirenomielia or artifact D) Artifact or dysplasia E) Achondrogenesis, artifact, or dysplasia

Artifact or dysplasia

Label A in this image demonstrates an example of: A) Left atrium B) Transverse aorta C) Ascending aorta D) Descending aorta E) Diaphragm

Ascending aorta

If Ebstein anomaly is present in a fetus, what sonographic finding will be demonstrated? A) Absence of right ventricle B) Absence of atrial septum C) Atrialized right ventricle D) Mitral regurgitation

Atrialized right ventricle

Which of the following disorders occurs due to the abnormal development of the endocardial cushion? A) ventricular septal defect B) Atrioventricular septal defect C) Atrial septal defect D) Ebstein anomaly

Atrioventricular septal defect

Large echogenic kidneys bilaterally are a sonographic finding associated with: A) Renal dysplasia B) Posterior urethral valve syndrome C) Wilm's tumor D) Autosomal recessive polycystic kidney disease E) Multicystic dysplastic kidney

Autosomal recessive polycystic kidney disease

Sirenomelia is associated with: A) Deuel's sign B) Diabetic mothers C) Fusion of the lower limbs D) A and B E) B and C

B and C

You are measuring abdominal circumference. You choose to do so at the level of the: A) Fetal kidneys B) Fetal stomach C) Cord insertion site D) Fetal gallbladder E) B and D

B and D

A fetal ultrasound demonstrates a large protruding tongue, hepatoblastoma, and an omphalocele. What syndrome does this represent? A) Turner syndrome B) Beckwith-Weidemann syndrome C) Down syndrome D) Tuberous sclerosis

Beckwith-Weidemann syndrome

In the image, what is the least likely diagnosis? A) Bilateral renal agenesis B) Bilateral MCDK C) Bilateral renal obstruction D) Unilateral megaloureter

Bilateral renal agenesis

What is the main feature of Potter syndrome? A) Unilateral renal agenesis B) Bilateral renal agenesis C) Bilateral pelvic kidneys D) Bilateral renal agenesis with genital atresia

Bilateral renal agenesis

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? A) Bladder exstrophy B) Prune belly syndrome C) Potter syndrome D) Omphalocele

Bladder exstrophy

Lethal skeletal anomalies may include any of the following sonographic findings except: A) Severe micromelia B) Hypoplastic thorax C) Multiple long bone fractures and callus formation D) Bowed long bones

Bowed long bones

The image below is a longitudinal view through the gravid uterus. What is the fetal position? A) Transverse, head to maternal left B) Vertex C) Transverse, head to maternal right D) Cephalic E) Breech

Breech

The ratio of BPD to OFD determines the: A) CI B) HC C) AC D) EFW

CI

Which of the following disorders is associated with uncontrolled pre-gestational maternal diabetes? A) Caudal regression syndrome B) Thanatophoric dysplasia C) Osteogenesis imperfecta D) Radial ray syndrome

Caudal regression syndrome

In this image, arrow A represents the: A) Laminae B) Spinal cord C) Centrum D) Transverse process E) Intervertebral disc

Centrum

What is the likely diagnosis if echogenic foci are seen in the right abdomen that produce acoustic shadowing? A) Choledochal cyst B) Cholelithiasis C) Cholecystitis D) Cholangitis

Cholelithiasis

A small, rounded echogenic structure within the left ventricle of a fetal heart most likely is: A) Ventricular septum B) Aortic semilunar valve C) Chordae tendineae/papillary muscle D) Left ventricular embolus E) CHF

Chordae tendineae/papillary muscle

The congenital absence of the kidneys bilaterally and severe oligohydramnios suggest: A) Classic Potter's syndrome B) Potter's syndrome Type I C) Potter's syndrome Type II D) Potter's syndrome Type III E) Potter's syndrome Type IV

Classic Potter's syndrome

What is the term used to describe absence of the middle fifth phalanx (often observed in trisomy 21)? A) Syndactyly B) Clinodactyly C) Polydactyly D) Arthrogryposis

Clinodactyly

Which of the following head shapes are associated with thanatophoric dysplasia? A) Strawberry B) Lemon C) Cloverleaf D) Brachycephaly E) Frontal bossing

Cloverleaf

What is talipes? A) Polydactyly B) Clubfoot C) Cleft lip D) Rocker bottom E) None of the above

Clubfoot

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? A) Coarctation of the aorta B) Tetralogy of fallot C) Ebstein anomaly D) Transposition of the great arteries

Coarctation of the aorta

How is the level of echogenicity of bowel determined? A) Compared to the echogenicity of the pelvic bones B) Compared to the echogenicity of the bladder C) Compared to the echogenicity of the liver D) Compared to the echogenicity of renal cortex

Compared to the echogenicity of the pelvic bones

Sonographic visualization of a cystic fluid-filled collection adjacent and posterior to the heart most likely represents: A) Cystic adenomatoid malformation B) Congenital diaphragmatic hernia C) Pleural effusion D) Cardiac cyst E) Aortic aneurysm

Congenital diaphragmatic hernia

A fetus is demonstrated to have a mass in the lung that has both cystic and solid components. Pleural effusion is also present. What disorder is indicated? A) Pulmonary hypoplasia B) Pulmonary sequestration C) Cystic adenomatoid malformation D) Rhabdomyoma

Cystic adenomatoid malformation

In the same image arrow B indicates the: A) Left atrium B) Transverse aorta C) Ascending aorta D) Descending aorta E) Diaphragm

Descending aorta

Arrow C is pointing to which of the following structures? A) Left atrium B) Transverse aorta C) Ascending aorta D) Descending aorta E) Diaphragm

Diaphragm

The term double bubble denotes: A) Fetal stomach next to heart B) Dilated duodenum next to the fetal stomach C) Bilateral hydronephrosis D) Choledochal cyst next to stomach E) Urachal cyst next to bladder

Dilated duodenum next to the fetal stomach

Echogenic bowel is usually associated with: A) Classic Potter's syndrome B) Fetal alcohol syndrome C) Turner's syndrome D) Down's syndrome E) Trisomy 18

Down's syndrome

What is the shunt in the fetal circulation allowing blood to bypass the fetal lungs after passing through the right ventricle? A) Ductus venosus B) Foramen ovale C) Ductus terres D) Ductus arteriosus

Ductus arteriosus

Which of the following heart anomalies is associated with pentalogy of Cantrell? A) Ectopia cordis B) Pleural effusion C) Pericardial effusion D) Diaphragmatic hernia

Ectopia cordis

All of the following may be associated with sono finding in the image except: A) Choledochal cyst B) Down syndrome C) Polyhydramnios D) Esophageal atresia E) Cardiac anomalies

Esophageal atresia

The fluid-filled stomach should always be visualized in the fetal left upper quadrant. If it is not seen during the course of an exam, one should suspect: A) Duodenal atresia B) Pyloric stenosis C) Esophageal atresia D) Jejunoileal obstruction E) Ulcerative colitis

Esophageal atresia

If polyhydramnios is demonstrated on fetal ultrasound, what gastrointestinal abnormalities are most likely? A) Esophageal or duodenal atresia B) Omphalocele or gastroschisis C) Meconium ileus or anorectal atresia D) Omphalocele or anorectal atresia

Esophageal or duodenal atresia

The gender of this fetus is: A) Male B) Female C) Ambiguous D) XY E) A and D

Female

Second-trimester obstetrical ultrasound examinations are better than first-trimester sonograms in determining: A) Gestational age of the fetus B) Fetal birth weight C) Fetal position D) Fetal anatomy E) Fetal life

Fetal anatomy

This image best demonstrates: A) Gastroschisis B) Pleural effusion C) Fetal demise D) Fetal ascites E) None of the above

Fetal ascites

What plane of the fetal heart will best demonstrate Tetralogy of Fallot? A) Four chambers B) Left ventricular outflow tract (LVOT) C) Right ventricular outflow tract (RVOT) D) Four chambers, LVOT and RVOT are all required

Four chambers, LVOT and RVOT are all required

To what is the arrow pointing in this image? A) Umbilical vein B) Stomach C) Hepatic veins D) Gallbladder E) Portal vein

Gallbladder

If echogenic bowel is diagnosed, what other abnormalities should be investigated? A) Renal abnormalities B) Skeletal dysplasia C) Gastrointestinal obstruction D) Cardiac abnormalities

Gastrointestinal obstruction

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? A) Hirschsprung disease B) Anorectal atresia C) Gastroschisis D) Omphalocele

Gastroschisis

Which abdominal wall defect causes a drastic increase in maternal serum alpha-fetoprotein? A) Limb-body wall complex B) Physiologic hernia C) Gastroschisis D) Omphalocele

Gastroschisis

If a fetus is diagnosed with Beckwith-Weidemann syndrome, which abdominal abnormality should be investigated? A) Duodenal atresia B) Choledochal cysts C) Gallstones D) Hepatomegaly

Hepatomegaly

What is the most common abnormality of the fetal liver? A) Portal hypertension B) Hepatomegaly C) Hepatitis D) Hepatoblastoma

Hepatomegaly

Which of the following is a nonlethal skeletal dysplasia that presents with rhizomelia, macrocrania, frontal bossing, and trident hands? A) Limb-body wall complex B) Heterozygous achondroplasia C) Achondrogenesis D) Thanatophoric dysplasia

Heterozygous achondroplasia

A male fetus presents with a large fluid collection in the scrotum. What is the term used to describe this finding? A) Hypospadias B) Hydrocele C) Cliteromegaly D) Inguinal hernia

Hydrocele

All of the following may be associated with a UPJ obstruction except: A) Dilated renal pelvis B) Hydronephrosis C) Renal cortical thinning D) Oligohydramnios E) Hydroureter

Hydroureter

All of the following may be associated with a UPJ obstruction except: A) Renal cortical thinning B) Hydronephrosis C) Oligohydramnios D) Hydroureter E) Dilated renal pelvis

Hydroureter

The abnormality seen is most likely: A) Hypoplastic left heart syndrome B) Transposition of the great arteries C) CCAM type III D) Pulmonary sequestration E) Congenital diaphragmatic hernia

Hypoplastic left heart syndrome

Double right outlet is almost always associated with: A) Pulmonary atresia B) Aortic stenosis C) Hypoplastic left ventricle D) Arrhythmia E) Premature ventricular contractions (PVC)

Hypoplastic left ventricle

The four-chamber view is best for demonstrating which of the following? A) Hypoplastic right heart B) aortic stenosis C) Pulmonary stenosis D) Coarctation of the aorta

Hypoplastic right heart

The appendicular skeleton includes all of the following bones except: A) Tibia B) Femur C) Clavicles D) Iliac bone E) Humerus

Iliac bone

In which of the following locations does the developing embryo grow? A) Beneath the decidua basalis B) In the chorionic cavity C) Inside the amnion D) In the yolk sac

Inside the amnion

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? A) Interatrial septum B) Interventricular septum C) Foramen ovale D) Endocardial cushion

Interatrial septum

Arrow B is pointing to the: A) Laminae B) Spinal cord C) Centrum D) Spinous process E) Intervertebral disc

Laminae

Normally, the anatomic structure closest to the spine in a four-chamber view of the fetal heart is the: A) Right atrium B) Left atrium C) Right ventricle D) Left ventricle E) Apex

Left atrium

The image is a transverse view through the gravid uterus, and the fetus is in breech presentation. What anatomic structure is indicated by the arrow? A) Left kidney B) Right adrenal gland C) Right kidney D) Left adrenal gland

Left kidney

A female fetus presents with a cystic mass in the left pelvis. The bladder and both kidneys are normal as is the amniotic fluid. What is the most likely diagnosis? A) Prune belly syndrome B) Left ovarian cyst C) Adrenal hemorrhage D) Neuroblastoma

Left ovarian cyst

A sonogram demonstrates a fetus with the abdominal surface connected to the placenta, scoliosis, and no evidence of an umbilical cord. What abnormality does this represent? A) Amniotic band syndrome B) Omphalocele C) Kyphosis D) Limb-body wall complex

Limb-body wall complex

Of the following anomalies involving abdominal wall defects, which is usually NOT compatible with life? A) Omphalocele B) Gastroschisis C) Bladder exstrophy D) Cloacal exstrophy E) Limb/body wall complex

Limb/body wall complex

What ultrasound modality would you use to prove fetal life on a frozen image? A) B-mode B) A-mode C) M-mode D) 3-D E) Static scanning

M-mode

Which of the following syndromes is associated with autosomal recessive polycystic kidney disease, occipital encephalocele, and polydactyly? A) Meckel-Gruber syndrome B) Potter syndrome C) Down syndrome D) Edward Syndrome

Meckel-Gruber syndrome

Cardiac and mediastinal shift may be present with all of the following abnormalities except: A) Cardiac tumor B) Congenital diaphragmatic hernia C) Meconium peritonitis D) Pleural effusion E) CCAM

Meconium peritonitis

Which of the following is NOT associated with fetal hydrops? A) Pleural effusion B) Anasarca C) Megacystis D) Ascites E) Pericardial effusion

Megacystis

A spinal defect containing meninges and neural tissue is called a/an: A) Encephalocele B) Spina bifida C) Meningocele D) Meningomyelocele E) Omphalocele

Meningomyelocele

What are the sonographic features of achondrogenesis? A) Phocomelia, early onset of ossification, large skull, and polyhydramnios B) Micromelia, narrow chest with distended abdomen, small skull, and polyhydramnios C) Micromelia, absent mineralization of the fetal bones, enlarged skull, and polyhydramnios D) Rhizomelia, absent mineralization of the skull, and oligohydramnios

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? A) Pelvic kidney B) Potter syndrome C) Multicystic dysplastic kidney D) Autosomal recessive polycystic kidney disease

Multicystic dysplastic kidney

The arrowhead is pointing to: A) Subcutaneous fat B) Spinal canal C) Retroperitoneal fluid D) Muscle E) Ascites

Muscle

All of the following may be associated with CCAM except: A) Polyhydramnios B) Madiastinal shift C) Oligohydramnios D) Pulmonary hypoplasia E) Fetal hydrops

Oligohydramnios

Which of the following is often associated with chromosomal abnormalities and ascites? A) Gastroschisis B) Omphalocele C) Limb-body wall complex D) Physiologic herniation

Omphalocele

Which of the following is most likely to correlate with chromosomal abnormalities? A) Omphalocele containing only bowel B) Omphalocele containing bowel and liver C) Gastroschisis D) Physiologic gut herniation

Omphalocele containing only bowel

The fetal heart occupies: A) One-fourth of the chest cavity pointing toward the right side of the fetus B) One-third of the chest cavity pointing toward the right side of the fet us C) One-half of the chest cavity pointing toward the left side of the fetus D) One-third of the chest cavity pointing toward the left side of the fetus E) One-fourth of the fetal chest cavity medially

One-third of the chest cavity pointing toward the left side of the fetus

Fracture of the femur can be a result of: A) Osteogenesis imperfecta B) Artifact C) Osteogenesis imperfecta and artifact D) Artifact and dysplasia E) Osteogenesis imperfecta, artifact, and dysplasia

Osteogenesis imperfecta and artifact

Lethal skeletal anomalies include all of the following except: A) Osteogenesis imperfecta type I B) Congenital hypophosphatasia C) Homozygous dominant achrondroplasia D) Camptomelic dysplasia E) Achrondogenesis

Osteogenesis imperfecta type I

What lethal skeletal dysplasia has the distinct characteristic of deformation of the skull with transducer pressure? A) Osteogenesis imperfecta type II B) Achondrogenesis C) Achondroplasia D) Thanatophoric dysplasia

Osteogenesis imperfecta type II

What sonographic feature definitively identifies transposition of the great vessels? A) Outflow tracts are parallel to each other B) Outflow tracts crisscross each other C) Overriding aorta D) Presence of a ventricular septal defect

Outflow tracts are parallel to each other

What best describes the anatomy demonstrated by the arrows in this longitudinal image of the fetal spine? A) Lamina B) Centrum C) Transverse process D) Pedicles and lamina E) Dural sac

Pedicles and lamina

Which of the following disorders includes omphalocele, ectopia cordis, cleft sternum, diaphragmatic hernia, and pericardial defects? A) Pentalogy of Cantrell B) Turner syndrome C) Tetralogy of Fallot D) VACTERL syndrome

Pentalogy of Cantrell

In this image the arrows point to: A) Cardial myopathy B) Congestive heart failure C) Pleural effusion D) Pericardial effusion E) Fetal ascites

Pericardial effusion

Clinodactyly refers to: A) Wide-spaced digits B) Absence of digits C) Increased number of digits D) Permanent curvature or overlapping digits E) Fusion of the digits

Permanent curvature or overlapping digits

A first-trimester ultrasound is performed at 9 weeks gestation and herniation of bowel is demonstrated into the base of the umbilical cord. What does this most likely represent? A) Limb-body wall complex B) Physiologic midgut herniation C) Gastroschisis D) Omphalocele

Physiologic midgut herniation

This image reveals a(n): A) Anasarca B) Abdominal ascites C) Pleural effusion D) Thickened diaphragm E) Pneumothorax

Pleural effusion

What is being measured in this transverse image through the region of the fetal kidneys? A) Normal right kidney B) Polycystic kidney C) Multicystic kidney D) Dilated renal pelvis E) Mass of unknown etiology

Polycystic kidney

A male fetus is demonstrated to have bilateral hydronephrosis with hydroureter, dilated bladder, and dilated urethra. What is the cause of these findings? A) Bilateral ureteropelvic junction obstruction B) Bilateral ureterovesicle obstruction C) Bilateral ureterocele D) Posterior urethral valves

Posterior urethral valves

The bladder of the male fetus is sometimes enlarged because of: A) Imperforate hymen B) Posterior urethral valves C) Glands imperfecta D) Ureteropelvic junction E) Ectopic ureterocele

Posterior urethral valves

If one identifies a dilated bladder, megaureters, and hydronephrosis, one should suspect: A) Stone B) Imperforate hymen C) Posterior urethral valves (PUV) obstruction D) Ureteropelvic junction obstruction (UPJ) E) Ureterovesical junction obstruction (UVJ)

Posterior urethral valves (PUV) obstruction

A congenital diaphragmatic hernia can be associated with all of the following EXCEPT: A) Abnormal shift of the fetal heart B) Compression of the fetal lungs C) Pulmonary hyperplasia D) Failure of the diaphragm to form properly E) Neural tube defects

Pulmonary hyperplasia`

Bilateral renal agenesis, inadequately functioning kidneys, or obstruction of the urinary tract can lead to which of the following? A) Limb anomalies B) Hydrops C) Pulmonary hypoplasia D) Anal atresia

Pulmonary hypoplasia

A cystic structure seen in the fetal thorax may be all of the following except: A) Pulmonary sequestration B) Fetal stomach C) CCAM type II D) Pleural effusion

Pulmonary sequestration

What is the most frequent cause of oligohydramnios? A) Abdominal wall anomalies B) Cardiac anomalies C) Gastrointestinal anomalies D) Renal anomalies

Renal anomalies

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? A) Rhabdomyoma with tuberous sclerosis B) Angiomyolipoma, with Down syndrome C) Adenocarcinoma with angiomyolipoma D) Trisomy 21 with adenocarcinoma

Rhabdomyoma with tuberous sclerosis

What term describes shortening of the proximal portions of the limbs? A) Rhizomelia B) Mesomelia C) Acromelia D) Phocomelia

Rhizomelia

What is demonstrated by arrow A in this short-axis view of the fetal heart? A) Right ventricle B) Right atrium C) Right ventricular outflow tract D) Right pulmonary artery E) Aorta

Right atrium

Arrow B is pointing to: A) Right ventricle B) Right atrium C) Right ventricular outflow tract D) Right pulmonary artery E) Aorta

Right ventricle

In this image the arrow labeled A points to the: A) Right atrium B) Left atrium C) Right ventricle D) Left ventricle E) Ventricular septum

Right ventricle

The arrowhead points to what heart chamber? A) Right atrium B) Left ventricle C) Left atrium D) Right ventricle

Right ventricle

In the same image, the anatomy to which arrow D is pointing is best described as the: A) Right ventricle B) Right atrium C) Right ventricular outflow tract D) Right pulmonary artery E) Aorta

Right ventricular outflow tract

What imaging plane(s) is best for demonstrating a Bochdalek hernia? A) Sagittal and coronal views of the right abdomen/chest B) Sagittal and coronal views of the left abdomen/chest C) Sagittal and transverse views of the left abdomen/chest D) Coronal and transverse views of the right abdomen/chest

Sagittal and coronal views of the left abdomen/chest

What imaging plane best demonstrates the disparity in chest to abdomen size found in thanatophoric dysplasia? A) Coronal image through chest and abdomen B) Sagittal image through chest and abdomen C) Transverse image of both chest and abdomen with circumference measurements D) Axial image of chest and thorax

Sagittal image through chest and abdomen

What scan planes are typically used to image the fetal spine? A) Sagittal and transverse B) Sagittal, coronal, and transverse C) Axial, sagittal, and coronal D) Axial, coronal, and transverse

Sagittal, coronal, and transverse

This image demonstrates: A) Club foot B) Talipes C) Rocker bottom D) Polydactyly E) Sandal gap deformity

Sandal gap deformity

What is the term used to describe a lateral curvature of the spine? A) Kyphosis B) Scoliosis C) Kyphoscoliosis D) VACTERL association

Scoliosis

The red arrows are pointing to: A) Fetal anasarca B) Amniotic bands C) Septations of a cystic hygroma D) A large myelomeningocele

Septations of a cystic hygroma

What is the cause of hypospadias? A) Shortened urethra B) Shortened ureters C) Undescended testicles D) Stimulation from maternal hormones

Shortened urethra

The arrows in the image on the following page demonstrate: A) Hemivertebra B) Spina bifida C) Spondylolisthesis D) Rachischisis E) Scoliosis

Spina bifida

Which of the following disorders will demonstrate a normal maternal serum alpha-fetoprotein value? A) Anencephaly B) Gastroschisis C) Spina bifida occulta D) Spina bifida aperta

Spina bifida occulta

In the same image, to what, specifically, is arrow C pointing? A) Laminae B) Spinal cord C) Centrum D) Spinous process E) Intervertebral disc

Spinous process

What are the arrows pointing to in this image? A) Splaying of the transverse processes B) Splaying of the laminae C) Spalding's sign D) Anasarca E) None of the above

Splaying of the laminae

Fetal teratomas that arise from the distal sacrum and coccyx may have all of the following sonographic characteristics except: A) Solid and cystic components B) Hypervascular flow C) Splaying of the posterior lumbar spine ossifications D) Posterior acoustic enhancement E) Posterior acoustic shadowing

Splaying of the posterior lumbar spine ossifications

A fetal sonogram demonstrates a cloverleaf-shaped skull, hydrocephalus, and telephone receiver-shaped long bones. What skeletal dysplasia is most likely? A) Achondrogenesis B) Achondroplasia C) Thanatophoric dysplasia D) Osteogenesis imperfecta

Thanatophoric dysplasia

What criteria should be observed when assessing both left and right ventricular outflow tracts? A) The aorta and pulmonary artery should crisscross each other. B) The aorta should be positioned anterior to the pulmonary artery. C) The ductus arteriosus should be demonstrated opening between the aorta and pulmonary artery. D) The location of the mitral valve and tricuspid valves should be assessed.

The aorta and pulmonary artery should crisscross each other

Regarding the image below, which of the following statements is least likely true? A) The fetus has developed ascites because of the existing abnormality B) The fetal lung parenchyma is replaced by cysts C) The fetal lung parenchyma is normal echogenicity D) There is mass effect on the right hemidiaphragm

The fetal lung parenchyma is normal echogenicity

Immediately posterior to the fetal stomach in the image is a slightly hypoechoic structure. What is that structure? A) The placenta B) The fetal liver C) Fetal lung parenchyma D) Fluid in the fetal abdomen E) The fetal spleen

The fetal spleen

Which of the following statements is true? A) The prominent echogenic structures seen in the apex of the left ventricle are moderator bands B) The flap of the foramen ovale is never seen sonographically C) The atrioventricular valves are only seen when imaging the heart in the long axis D) The flap of the foramen ovale opens from the right atrium into the left atrium

The flap of the foramen ovale opens from the right atrium into the left atrium

The red arrow is pointing to: A) A pulmonary sequestration B) The fluid-filled fetal stomach C) A hypoechoic lung mass D) A congenital diaphragmatic hernia E) The fetal spleen

The fluid-filled fetal stomach

Which of the following provides important prognostic information about fetal renal function? A) The presence and evaluation of amniotic fluid by approximately 9 weeks gestation B) The presence and evaluation of urine in the fetal bladder and amniotic fluid by approximately 13 weeks gestation C) The size of the fetal kidneys D) Amniotic fluid volume at term E) None of the above

The presence and evaluation of urine in the fetal bladder and amniotic fluid by approximately 13 weeks gestation

An omphalocele may be differentiated sonographically from a gastroschisis by: A) The absence of a membranous covering B) The presence of a membranous covering C) Edamatous bowel in the defect D) Elevated MSAFP E) The presence of associated anomalies (most commonly cardiac anomalies)

The presence of a membranous covering

The arrow in the image below is pointing to what anatomic structure? A) The spinal cord B) The esophagus C) The trachea D) The thoracic aorta E) The superior vena cava

The thoracic aorta

When obtaining a fetal AC, which of the following should not be visualized? A) The portal vein B) The fluid-filled stomach C) The umbilical cord insertion D) The right adrenal gland

The umbilical cord insertion

Longitudinal and transverse views of the fetal spine are routine on fetal exam. When the normal fetal spine is imaged transversely, the sonogram demonstrates: A) Two ossification centers positioned an equal distance apart and tapering toward the sacrum B) Two ossification centers positioned an equal distance apart and splaying outward at the level of the sacrum C) Three ossification centers, two posterior and one anterior, with the two posterior centers pointing away from each other D) Three ossification centers, two posterior and one anterior, with the two posterior centers pointing toward each other E) Three ossification centers, two anterior and one posterior, with the two posterior centers pointing toward each other

Three ossification centers, two posterior and one anterior, with the two posterior centers pointing toward each other

If esophageal atresia is diagnosed, what tracheal abnormality may also be present? A) Rhabdomyoma of the trachea B) Tracheal atresia C) Tracheoesophageal fistula D) Tracheal sequestration

Tracheoesophageal fistula

Which of these congenital cardiac abnormalities cannot be diagnosed with the four-chamber view? A) Hypoplastic left ventricle B) Ventricular septal defect C) Transposition of the great vessels D) Av block E) Pulmonary atresia

Transposition of the great vessels

What imaging plane will best demonstrate the abdominal cord insertion to rule out abdominal wall abnormalities? A) Transverse abdomen just superior to the kidneys B) Coronal at the level of the J-hook C) Transverse abdomen at the level of the diaphragm D) Sagittal midline of the abdomen and chest

Transverse abdomen just superior to the kidneys

The arrow in this image points to the: A) Transverse spine B) Transverse diaphragm C) Transverse spinal cord D) Transverse aorta E) Transverse IVC

Transverse aorta

In the same image, arrow B demonstrates the: A) Aortic semilunar valve B) Pulmonary semilunar valve C) Tricuspid valve D) Mitral valve E) Ventricular septum

Tricuspid valve

Thoracic circumference is measured in the: A) True transverse view just below the fetal diaphragm and just above fetal four-chamber heart B) True transverse view at the level of fetal four-chamber heart C) True longitudinal view at the level of fetal four-chamber heart D) Longitudinal view at the level of the diaphragm and just below fetal four-chamber heart E) True transverse view just below the fetal diaphragm and at the level of fetal heart motion

True transverse view at the level of fetal four-chamber heart

Hypoplastic left heart syndrome is associated with which of the following? A) Ebstein anomaly B) Beckwith-Weidemann syndrome C) Down syndrome D) Turner syndrome

Turner syndrome

___________ is a non-lethal long bone dysplasia; A) thanatophoric dysplasia B) achondrogenesis C) homozygous achondroplasia D) Type I osteogenesis imperfecta

Type I osteogenesis imperfecta

How does blood get from the placenta to the fetal heart? A) Umbilical artery > Common iliac artery > Inferior vena cava (IVC) B) Umbilical artery > Ductus venosus > Left portal vein > IVC > Right ventricle C) Umbilical vein > Ductus venosus > IVC > Right ventricle D) Umbilical vein > Ductus arteriosus > IVC > Right ventricle

Umbilical vein > Ductus venosus > IVC > Right ventricle

Which of the following is NOT associated with oligohydramnios? A) PROM B) Intrauterine growth restriction (IUGR) C) Posterior urethral valves obstruction (PUV) D) Unilateral ureteropelvic junction (UPJ) obstruction E) Potter's Type I

Unilateral ureteropelvic junction (UPJ) obstruction

If arrow B is pointing to the bladder, arrow A is most likely pointing to the following structure superior to the bladder: A) Double bubble B) Urachal cyst C) Omphalocele D) Megacystis E) Torsion

Urachal cyst

The most likely cause of unilateral hydronephrosis is: A) Posterior urethral valve obstruction B) Multicystic kidney disease C) Wilm's tumor D) Ureteropelvic junction obstruction E) Prune Belly syndrome

Ureteropelvic junction obstruction

The basic guidelines for obstetrical scanning require us to take four fetal measurements. Which of the following is NOT one of those measurements? A) BPD B) Head circumference C) Ventricular diameter D) Abdominal circumference E) Femur length

Ventricular diameter

What is the most common cardiac defect? A) Hypoplastic right heart syndrome B) Hypoplastic left heart syndrome C) Atrial septal defect D) Ventricular septal defect

Ventricular septal defect

Which of the following measurements is a good predictor of fetal growth? A) femur length B) biparietal diameter C) head circumference D) abdominal circumference

abdominal circumference

Herniated contents of an omphalocele are covered by a membrane consisting of: A) chorion and amnion B) amnion and peritoneum C) Wharton jelly and amnion D) peritoneum and Wharton jelly

amnion and peritoneum

Which of the following abnormalities increases the risk of fetal injury? A) uterine shelf B) amniotic bands C) amniotic sheets D) amniochorionic separation

amniotic bands

Left ventricular outflow tract denotes the: A) ascending aorta B) papillary muscle C) descending aorta D) pulmonary artery

ascending aorta

Which of the following would least likely be associated with thanatophoric dysplasia? A) cloverleaf skull B) severe micromelia C) polyhydramnios D) bowing of bones secondary to fractures

bowing of bones secondary to fractures

Sonographic visualization of the tibia and fibula in the same scanning plane as the metatarsals of the foot is associated with _________ A) clubfoot B) amniotic band syndrome C) Trisomy 18 D) caudal regression syndrome

clubfoot

Which of the following planes demonstrate the normal fetal spine as three parallel hyperechoic lines on ultrasound? A) axial B) sagittal C) coronal D) transverse

coronal

A fetus presenting in the breech position during the third trimester may demonstrate a cranial shape that is termed: A) lemon sign B) dolichocephalic C) brachycephalic D) strawberry sign

dolichocephalic

Fetal blood passes from the pulmonary trunk to the aorta via the _______________: A) ductus arteriosus B) ductus venosus C) foramen ovale D) hypogastric arteries

ductus arteriosus

Fetal blood passes from the umbilical vein to the portal vein to the inferior vena cava via the: A) foramen ovale B) ductus venosus C) hypogastric arteries D) ductus arteriosus

ductus venosus

"Double bubble" is a sonographic sign associated with: A) spina bifida B) hydronephrosis C) duodenal atresia D) esophageal atresia

duodenal atresia

The "double bubble" sign is associated with: A) bivascular cord B) duodenal atresia C) conjoined twins D) ectopic pregnancy

duodenal atresia

Which of the following abnormalities is not associated with pulmonary hypoplasia? A) duodenal atresia B) skeletal dysplasia C) diaphragmatic hernia D) infantile polycystic renal disease

duodenal atresia

The fetus becomes the major producer of amniotic fluid in the: A) late first trimester B) early second trimester C) late second trimester D) early third trimester

early second trimester

A consistently small fetal stomach on serial sonograms is most suspicious for which abnormality? A) omphalocele B) duodenal atresia C) esophageal atresia D) diaphragmatic hernia

esophageal atresia

Amniotic band syndrome may result in: A) polyhydramnios B) placenta accreta C) an acardiac twin D) fetal amputation

fetal amputation

Which of the following would be least useful to evaluate in a fetus with a suspected skeletal dysplasia? A) mineralization of spine B) size and shape of thorax C) fetal gender D) hands and feet E) amniotic fluid index

fetal gender

The sonographic findings are most suspicious for: A) gastroschisis B) omphalocele C) fetal hydrops D) pseudoascites

fetal hydrops

A diagnosis of clubfoot may be made with persistent abnormal inversion of the: A) foot B) ankle C) foot parallel to the lower leg D) foot perpendicular to the lower leg

foot perpendicular to the lower leg

An asymptomatic patient presents for a secondtrimester fetal screening examination. The arrow identifies which of the following structures? A) hydroureter B) gallbladder C) umbilical vein D) right portal vein

gallbladder

Opening in the layers of the abdominal wall with evisceration of the bowel describes which of the following abnormalities: A) gastroschisis B) omphalocele C) umbilical hernia D) intussusception

gastroschisis

Comparison of the abdominal circumference to the head circumference during the early third trimester demonstrates a(n): A) equal head circumference compared to abdominal circumference B) abdominal circumference twice as large as the head circumference C) head circumference slightly larger than the abdominal circumference D) abdominal circumference slightly larger than the head circumference

head circumference slightly larger than the abdominal circumference

Orbital distance measurement would be most helpful in which of the following conditions? A) occipital encephalocele B) spina bifida C) holoprosencephaly D) hydrocephalus

holoprosencephaly

A sagittal image of the fetal abdomen most likely demonstrates: A) renal cyst B) hydronephrosis C) duodenal atresia D) diaphragmatic hernia

hydronephrosis

Associated findings with this abnormality include: A) spinal defect B) cranial defect C) hydronephrosis D) polyhydramnios

hydronephrosis

Sonographic appearance of a normal small bowel during the second trimester is described as: A) hyperechoic compared to bone B) hyperechoic compared to the liver C) hypoechoic compared to the spleen D) hypoechoic compared to the large bowel

hyperechoic compared to the liver

Decreased intraorbital distance is: A) micrognathia B) hypotelorism C) hypertelorism D) proboscis

hypotelorism

Oligohydramnios in the third trimester is most likely a result of: A) duodenal atresia B) diaphragmatic hernia C) infantile polycystic renal disease D) cystic adenomatoid malformation

infantile polycystic renal disease

The triscuspid valve inserts _______ to the mitral valve. A) posterior B) anterior C) superior D) inferior

inferior

Which landmark localizes the appropriate level for measuring the abdominal circumference? A) stomach B) gallbladder C) cord insertion D) junction of the left and right portal veins

junction of the left and right portal veins

Abdominal circumference is measured at the level of the: A) liver B) spleen C) kidneys D) umbilical cord insertion

liver

Peritoneal calcifications with associated dilated loops of bowel and polyhydramnios visualized in a 30-week fetus most likely represent: A) intussusception B) arteriosclerosis C) hyperechoic bowel D) meconium peritonitis

meconium peritonitis

The echogenic structure seen normally in the right ventricle is the ____________ A) moderator band B) tricuspid valve C) hypertrophied myocardium D) rhabdomyoma

moderator band

An oblique sonogram of the fetal abdomen most likely demonstrates: A) hydronephrosis B) duodenal atresia C) infantile polycystic disease D) multicystic dysplastic kidney

multicystic dysplastic kidney

Demonstration of multiple unilateral renal cysts is most suspicious for: A) infantile polycystic disease B) multicystic dysplastic kidney C) cystic adenomatoid malformation D) ureteropelvic junction obstruction

multicystic dysplastic kidney

This coronal sonogram of a 26-week fetus most likely demonstrates a(n): A) abnormal thorax B) normal diaphragm C) abnormal stomach D) abnormal bowel pattern

normal diaphragm

In the late second trimester, which sonographic finding consistently displays with renal agenesis? A) facial cleft B) omphalocele C) oligohydramnios D) skeletal dysplasia

oligohydramnios

Which of the following conditions will likely occur because of this abnormality? A) fetal hypoxia B) placentomegaly C) polyhydramnios D) oligohydramnios

oligohydramnios

Demonstration of fetal bone fractures raises suspicion for which skeletal abnormality? A) achondroplasia B) achondrogenesis C) thanatophoric dysplasia D) osteogenesis imperfecta

osteogenesis imperfecta

Which skeletal anomaly is associated with in-utero fractures? A) osteogenesis imperfecta type II B) thanatophoric dysplasia C) achondrogenesis D) arthrogryposis

osteogenesis imperfecta type II

A small echogenic focus within the left ventricle of the fetal heart is most likely the: A) mitral valve B) foramen ovale C) pulmonary vein D) papillary muscle

papillary muscle

Fetal lung maturity can be detected via amniocentesis by presence of _________ A) alpha feto protein B) lecithin-sphingomyelin C) phosphatidyl-glycerol D) acetylcholinesterase

phosphatidyl-glycerol

The most common fetal thoracic abnormality is _____________ A) diaphragmatic hernia B) pleural effusion C) pulmonary sequestration D) cystic adenomatoid malformation

pleural effusion

A dilated fetal urinary bladder with a "keyhole" sign in a male fetus is indicative of: A) ureterovesicular junction obstruction B) ureteropelvic junction obstruction C) posterior urethral valve obstruction D) Potter's syndrome

posterior urethral valve obstruction

A non-functioning mass of lung tissue with its own blood supply from the aorta is: A) bronchogenic cyst B) cystic adenomatoid malformation C) diaphragmatic hernia D) pulmonary sequestration

pulmonary sequestration

The sonogram displays which of the following cardiac structures? A) aortic arch B) foramen ovale C) left ventricular outflow tract D) right ventricular outflow tract

right ventricular outflow tract

An asymptomatic patient arrives for a second trimester fetal surveillance examination. A sagittal image of the fetal body is most suspicious for: A) fetal demise B) chorioangioma C) myelomeningocele D) sacrococcygeal teratoma

sacrococcygeal teratoma

A plantar image of the fetal foot shows a sonographic finding termed: A) sandal toe B) thumb toe C) rocker foot D) hammer toe

sandal toe

A sagittal image of the lower spine is most suspicious for: A) spina bifida B) umbilical cord C) cystic hygroma D) caudal regression

spina bifida

The arrow identifies which of the following fetal structures? A) stomach B) renal cyst C) gallbladder D) renal pelvis

stomach

Fusion of the fingers or toes is termed: A) talipes B) syndactyly C) polydactyly D) clinodactyly

syndactyly

Which skeletal abnormality is most likely to demonstrate a cloverleaf skull? A) achondroplasia B) achondrogenesis C) osteogenesis imperfecta D) thanatophoric dysplasia

thanatophoric dysplasi

Visualization of the fetal gallbladder signifies: A) normal liver function B) a normal fetal karyotype C) the presence of the pancreas D) the presence of a biliary tree

the presence of a biliary tree

The best scan plane to demonstrate spina bifida in a fetus is: A) coronal B) transverse C) sagittal D) longitudinal

transverse

Which classification of osteogenesis imperfecta is the most severe? A) type I B) type II C) type III D) type IV

type II

The most common sonographic finding associated with multicystic renal dysplasia is: A) unilateral multicystic kidney B) bilateral multicystic kidneys C) unilateral enlarged hyperechoic kidney D) bilateral enlarged hyperechoic kidneys

unilateral multicystic kidney

A cystic mass seen between the fetal anterior wall and the fetal bladder most likely represents: A) urachal cyst B) ovarian cyst C) sacrococcygeal teratoma D) normal intestine

urachal cyst

The most common congenital heart defect is __________ A) Tetralogy of Fallot B) patent ductus arteriosus C) ventricular septal defect D) hypoplastic left heart

ventricular septal defect