O.B. Review

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subchorionic hemorrhagia is a common consequence of

Implantation of the conceptus

Describe the typical sonographic appearance of Asherman syndrome

Inability to distinguish an endometrial cavity

What fetal position is at most risk for cord prolapse

Incomplete breech

When measuring the mean sac diameter, the calipers should be placed from the:

Inner wall to inner wall

Which segment of the fallopian tube connect with the uterus

Interstitial

The innermost layer of the myometrium is termed the:

Junctional Zone

Levels of follicle-stimulating hormone begin declining in the:

Late follicular phase

Which portion of the fetal heart is located closest to spine

Left atrium

Abdominal Circumference is measured at the level of the

Liver

The material collecting in the fetal intestines is termed:

Meconium

An ovarian mass combined with pleural effusion and ascites resolving after surgery is known as:

Meigs syndrome

A patient complains of heavy menstrual cycles. This is most consistent with:

Menorrhagia

Krukenberg tumors are a result of

Metastatic disease

Acute pelvic pain during the periovulatory phase is termed

Mittelschmerz

Obstruction of an inclusion cyst results in a(n)

Nabothian cyst

What uterine anomaly is not likely to cause infertility

Nabothian cyst

A fetus presents with multicystic dysplastic renal disease. The amniotic fluid volume is expected to appear

Normal

What is a sonographic finding in cases of asymmetric intrauterine growth restriction

Normal biparietal diameter

Describe the expected sonographic findings with asymmetric intrauterine growth restriction

Normal head circumference and decrease in abdominal circumference

Which pelvic ligament extends from the cornua of the uterus to the medial aspect of the ovary?

Ovarian ligament

What pelvic structure is not lined by the peritoneum

Ovary

Visualization of a corpus luteal cyst indicates

Ovulation has occurred

A small echogenic focus within the left ventricle of the fetal heart is most likely the

Papillary muscle

A cystic structure located in the inferior broad ligament is most suspicious for a(n)

Parovarian cyst

Fixation of the ovaries posterior to the uterus is a sonographic finding associated with

Pelvic Inflammatory Disease

Ovarian Volume is the highest during the:

Peri-ovulatory Phase

Hirsutism is a clinical symptom of

Polycystic ovarian disease

Which hormone helps to prepare the endometrium for implantation of the blastocyst

Progesterone

What are the functions of amniotic fluid

Protect fetus from injury allow free fetal movement maintains intrauterine temperature

A nodular tubular adnexal mass demonstrating posterior acoustic enhancement is most suspicious for

Salpingitis

Inflammation within the fallopian tube is termed

Salpingitis

Progesterone levels increase in the:

Secretory Phase

Approximately 15% of postmenopausal patients will exhibit a(n)

Simple ovarian cyst

A patient presents with a history of a leiomyoma. Which location will most likely cause infertility

Submucosal

What fibroid location is most likely to cause menorrhagia

Submucosal

Insertion of the umbilical cord into the abdominal wall of the fetus is located at a level

Superior to the bladder

A small cluster of ovarian cysts is a common sonographic finding associated with

Surface Epithelial cysts

If a patient displays an endometrial thickness of 2.0cm, it is considered:

Suspicious for proliferation of the endometrium

Scarring within the endometrium caused by invasive procedures is termed

Synchiae

What best describes the intention of the cephalic index

The cephalic index helps to determine the normality of the fetal head shape

Accurately description of the perimetrium

The serosal surface of the uterus is termed the "perimetrium"

Hyperstimulation of the ovaries will likely result in:

Theca Lutein Cysts

What ovarian neoplasms will most likely demonstrate posterior acoustic shadowing

Thecoma

Describe the expected appearance of the endometrium in a patient using oral contraceptives

Thin echogenic line

The endometrial cavity in patients using hormone contraceptive therapy appears on ultrasound as a:

Thin, echogenic linear structure

In the transverse plane, the normal fetal spine appears on ultrasound

Three equidistant ossification centers surrounding the spinal canal

If a fetus is lying perpendicular to the maternal sagittal plane, the fetal presentation is:

Transverse

Retained products of conception can be a contributing factor of:

Trophoblastic Disease

What structure secretes human chorionic gonadotropin

Trophoblastic tissue

A 25-year old woman presents with high-grade fever, pelvic pain and leukocytosis. An ill-defined, complex mass is identified in the left adnexa. Based on this clinical history, the sonographic finding is most suspicious for:

Tuboovarian abscess

Secondary blood supply to the ovaries is through the:

Uterine Arteries

What most accurately describes an endometrioma

a collection of ectopic endometrial tissue

Presence of an embryo without visualization of the amnion is considered

a normal finding

echogenic debris swirling within the amniotic cavity is:

a normal sonographic finding

The single most sensitive indicator of intrauterine growth restriction is:

abdominal circumference

The single most useful biometric parameter to assess fetal growth is the

abdominal circumference

The region including the ovary and fallopian tube is termed

adnexa

Which of the following lines the chorion and contains the fetus

amnion

Which technique is both valid and reproducible when assessing amniotic fluid volume

amniotic fluid index

Which portion of the biophysical profile study is a chronic marker of fetal hypoxia

amniotic fluid volume

The best diagnostic accuracy of intrauterine growth restriction is offered when evaluating the:

amniotic fluid volume, estimated fetal weight and maternal blood pressure

Which uterine postion displays the fundus of the uterus anterior to the cervix

anteflexion

Cavum septum pellucidi is located in the

anterior portion of the fetal brain

Multiple serpentine vascular structures within the myometrium in a patient complaining of abnormal bleeding following a recent dilation currettage procedure is most suspicious for which abnormality

arteriovenous fistula

Left ventricular outflow tract denotes the

ascending aorta

Assessment for the presence of an ovarian cyst or dominant follicle is scheduled

before initiating ovarian induction therapy

What structure implants into the endometrium

blastocyst

What term indicates the fetal head is located in the uterine fundus

breech

What is the best description of the sonographic appearances of uterine synechiae

bright band of echoes within the endometrium

Which of the following is the 1st system to function in the developing embryo

cardiovascular

Head circumference is measured at a level to include the:

cavum septum pellucidi and tentorium

Nuchal thickness is measured in a plane to include the:

cerebellum, cisterna magna, cavum septum pellucidi

If the maternal alpha-fetoprotein level is decreased, the sonographer should carefully evaluate for:

chromosomal abnormalities

In a biophysical profile, which of the following will document fetal tone

complete episode of flexion to extension and back to flexion

What plane demonstrates the normal fetal spine as three parallel hyperechoic lines on ultrasound

coronal

Which of the following is the most accurate method of measuring gestational age yolk sac diameter mean sac diameter crown-rump length biparietal diameter

crown-rump length

A hyperechoic focus within a mature follicle most likely represents

cumulus

An ill-defined multilocular, complex ovarian mass is most suspicious for...

cystadenocarcinoma

A 50 year old patient presents with a history of abdominal distention. In the left adnex, a 10cm, multilocular mass is identified. This mass most likely represents:

cystadenoma

A rapid inreasing pelvic mass is most suspicious for a(n)

cystadenoma

A reproductive-age patient demostrates a complex adnexal mass with a diffusely bright internal echoes. These sonographic findings most likely describe a:

cystic teratoma

Which of the following is the most common benign ovarian neoplasm: Fibroma cystoadenoma cystic teratoma endometrioma

cystic teratoma

Which ovarian abnormalities may contain skin and hair

cystic teratoma

If fertilization does not occur, the corpus luteum will:

decrease in size and progesterone levels will decrease

Macrosomia and polyhydramnios encountered in the third trimester should raise suspicious of maternal

diabetes mellitus

A patient presents with a history of an intramural leiomyoma. An intramural leiomyome

distorts the myometrium

A fetus presenting in the breech position during the third trimester may demonstrate a cranial shape that is termed

dolichocephalic

Normal human chorionic gonadotropin levels should

double every 30 to 48 hours

The most common ovarian malignancy occuring in childhood is a:

dysgerminoma

When measuring endometrial thickness, calipers should be placed from...

echogenic interface to echogenic interface

The mean sac diameter measures gestational age before visualization of the

embryo

gestational week 6 through 10 constitute the

embryonic phase

Tamoxifen therapy is most likely to affect which of the following structures

endometrium

The spiral artery provides the primary blood supply to what structure

endometrium

Which hormones reflects the activity of the ovaries

estradiol

Which fertility assistance program inserts oocytes and sperm into the fallopian tube

gamete intrafollicular transfer

Metastatic lesions in the adnexa are more commonly associated with a primary malignancy of the

gastrointestinal tract

Which of the following abnormalities is most likely a consequence of pelvic inflammatory disease

hydrosalpinx

Sonographic appearance of a normal small bowel during the second trimester is described as:

hyperechoic compared to the liver

Visualization of pelvic ligaments appears on sonography as:

hyperechoic linear structures

What complication is most likely associated with ovulation induction therapy

hyperstimulation syndrome

The most common maternal factor associated with intrauterine growth restriction is...

hypertension

A common sonographic finding associated with an endometrioma

hypoechoic, homogenous adnexal mass

The pelvis is divided into the true and false pelvis by the:

iliopectineal line

Regeneration of the endometrium occurs as a result of

increase in estrogen levels

Oligohydramnios in the third trimester is most likely a result of

infantile polycystic renal disease

The umbilical arteries arise from which vessels

internal iliac arteries

The most common location for a uterine leiomyoma to develop is:

intramural

Sonographic appearance of ovarian carcinoma is generally described as a(n)

irregular, hypoechoic ovarian mass

The secondary yolk sac

is located in the chorionic cavity

Congenital uterine anomalies are associated with co-existing anomalies of the

kidneys

A patient presents with a history of postmenopausal bleeding. A heterogenous intrauterine mass is identified on sonography. On the basis of the clinical history, the sonographic findings are most suspicious for:

leiomyosarcoma

Which of the following formulas calculates the mean sac diameter of the gestational sac? length + height + width length + Width/ Height length + Height + Width/3 length x Height x Width/3

length+height+width/3

Intrauterine growth restriction most severely affects which fetal body organ

liver

Which ovarian phase has a constant life span

luteal

Ovarian volume is lowest during the...

luteal phase

What hormone stimulates ovulation

luteinizing hormone

What condition increases fetal risk of injury during vaginal delivery

macrosomia

A solid mass of cells formed by proliferation of a fertilized ovum is termed the:

morula

Which of the following complications is commonly associated with in vitro fertilization hyperstimulation multiple gestations ectopic pregnancy spontaneous abortion

multiple gestations

The pelvic floor is formed by pelvic...

muscles and ligaments

Chorionic villi are more prolific

near the implantation site

Subcutaneous accumulation of fluid behind the fetal neck measuring 3mm in thickness is a(n)

normal finding in the late 1st trimester

Risk factors associated with developing endometrial carcinoma include

obesity, diabetes mellitus and nulliparity

Which of the following muscles abuts the lateral walls of the urinary bladder: iliopsoas; piriformis; levator ani; obturator internus

obturator internus

With the gamete intrafollicular transfer technique, the

oocytes and sperm are transferred to the fallopian tube

A large multicystic ovarian mass, in an ovarian stimulated patient, is most suspicious for

ovarian hyperstimulation syndrome

An early onset of puberty may be the result of a(n)

ovarian neoplasm

A coexisting adnexal mass is commonly associated with which of the following ovarian pathologies

ovarian torsion

Mittelschmerz is associated with

ovulation

The surface region located below the pelvic floor is called

perineum

A patient presents with lower abdominal pain and a palpable pelvic mass. A septated fluid collection surrounds a normal appearing right ovary. The patient has a previous history of a ruptured appendix. Based on this clinical history, the sonographic finding is most suspicious for which pathology?

peritoneal inclusion cyst

When measuring amniotic fluid volume, the transducer must remain

perpendicular to the maternal coronal plane and parallel to the maternal sagittal plane

Luteinizing hormone is secreted by the

pituitary gland

A transverse fetal position in the late third trimester of pregnancy is most likely associated with

placenta previa

What is the most common cause of painless vaginal bleeding during the third trimester

placenta previa

Asymmetric intrauterine growth restriction is usually a result of:

placental insufficiency

A patient presents with a positive pregnancy test and an hGC level of 750 mIU/mL. Based on this clinical history, what would best describe the sonographic findings

possible small gestational sac on transvaginal imaging

The flanged portions of the iliac bones form the...

posterior border of the false pelvis

A pregnancy is post-term when the:

pregnancy is longer than 42 weeks

The section of time previous to the onset of menstruation is termed

premenarche

If fertilization occurs, the corpus luteum will continue to secrete

progesterone

On serial examinations, a parovarian cyst will

remain unchanged

It is common to visualize a small amount of free fluid in the the:

retrouterine pouch or pouch of douglas

The endometrium displays the greatest thickness during the:

secretory phase

Which congenital uterine anomaly does not distort the normal contour of the fundus

septate uterus

What most accurately describes the sonographic appearance of a peritoneal inclusion cyst

septated fuid collection surrounding an ovary

Decreases in estrogen in postmenopausal patients can decrease cervical mucus and can also:

shorten vaginal length

Fluid within the endometrial cavity is:

should not be included in the endometrial measurement

a rapid decline in serial hCG levels will most likely correlate with a(n)

spontaneous abortion

A fibroid is most likely to cause irregular uterine bleeding in which location

submucosal

which uterine anomaly most likely demonstrates a small dimple in the fundus

subseptate

The most common location of a cystic teratoma is

superior to the fundus

The uterosacral ligament extends from the lateral margins of the sacrum to the...

superior uterus

The ovary is attached to the pelvic sidewall by the...

suspensory ligament

Doppler of the umbilical artery evaluates fetal well-being using the

systolic/diastolic ratio

Which imaging plane is optimal for evaluating the fetus for facial cleft

tangential

Visualization of the fetal gallbladder signifies

the presence of a biliary tree

Describe the sonographic appearance of the endometrium during the late proliferation phase

thick, hypoechoic functional layer and a hyperechoic basal layer

hyperemesis is a common clinical finding associated with:

trophoblastic disease

A total breakdown of the normal adnexal anatomy is a sonographic finding associated with

tuboovarian abscess

In premenarche, the size of the uterus cervix is expected to be:

twice as large as the corpus

Which area of the embryo attaches to the amnion

umbilical insertion

Oxygenated blood enters the fetus through the:

umbilical vein

Failure of the Mullerian ducts to fuse will most likely result in...

uterine didelphys

The cornua of the uterus is located between the:

uterine fundus and fallopian tube

What is a common clinical symptom associated with adenomyosis

uterine tenderness

Partial fusion of the caudal Mullerian ducts will most likely result in an anomaly of the:

uterus

Which of the following is an abnormal finding in a 1st trimester pregnancy: prominent cystic structure in the posterior brain visualization of the amnion without an embryo fetal heart rate of 100 beats per minute herniation of the fetal bowel into the umbilical cord

visualization of the amnion without an embryo

The biophysical profile is a sonographic method of evaluating fetal

well-being

A garner cyst is located

within the vagina

During ovarian induction therapy, follicles are only measured when exceeding

1.0 cm

Normal measurement of the laternal ventricle atria should not exceed

10mm

The anterior - posterior diameter of the cisterna magna should not exceed

10mm

Ventriculomegaly is suspected when the lateral ventricle measurement exceeds

10mm

Human chorionic gonadotropin peaks at the

10th gestational week

Initial visualization of the hyperechoic choroid plexuses is expected near the

10th gestational week

The term embyro is used to describe a developing zygote through the:

10th gestational week

during the mid luteal phase full luteal function is expected if the endometrial thickness is at least

11 mm

The optimal gestational age for measuring fetal nuchal translucency is from

11 weeks 0 days to 13 weeks 6 days

Ossification of the cranium begins around the:

11th gestational week

Infertility is suggested when conception does not occur within

12 months

In the menarche patient, the endometrial thickness should not exceed...

14 mm

Maternal hypertension is defined as a systolic pressure above

140 mm/Hg

Normally, the chorionic cavity should no longer be visible after how many gestational weeks

16

On transvaginal imaging, in a normal pregnancy, cardiac activity must be identified within a gestational sac with a mean sac diameter of

16mm

The normal length of the cervical os will vary, but it measures a minimum of

2.5cm

Measurement of the nuchal thickness is accurate up to

20 weeks

During the ovulatory phase, normal estradiol levels range between

200 and 400 pg/ml

The length of a normal menstrual cycle ranges between

21 and 35 days

Choroid plexus cysts will normally regress by:

23 weeks

Polyhydramnios demonstrates an amniotic volume index greater than

24 cm

Interval fetal growth can be determined with sonographic examinations performed a minimum of how many weeks apart

3

The distal femoral epiphysis is consistently visualized by:

32 weeks

Visualization of the proximal tibial epiphysis first occurs around

35 weeks' gestation

The biparietal diameter measurement is taken at the level of the

3rd Ventricle

Macrosomia is defined as a newborn weight

4000g

In the late second trimester, anterior - posterior diameter of the normal renal pelvis should not exceed:

4mm

What structure is not identified in the biparietal diameter

4th Ventricle

Oligohydramnios is defined as an amniotic fluid index below

5 cm

The endometrium is generally thinnest between days

6-9

Biophysical Profile Results: 35 week fetus demonstrates a complete extension and flexion of lower extremities, four separate fetal movements, amniotic fluid volume of 10cm and a normal stress test. Fetal diaphragm or breathing motion is not identified. The BPP score would be...

8

Thickness of an asymptomatic postmenopausal endometrium denying hormone replacement therapy should not exceed

8mm

Overall accuracy in sonographic estimation of fetal weight during the third trimester is:

95%

What measurement is a good predictor of fetal growth

Abdominal circumference

What is a possible cause for elevated maternal alpha-fetoprotein

Abdominal wall defect

What is the most accurate description of endometriosis is

Active endometrial tissue invading the peritoneal cavity

Multiparity is a risk factor associated with what abnormality

Adenomyosis

Ovarian torsion is commonly associated with a coexisting:

Adnexal mass

What structure(s) produces small amounts of estrogen

Adrenal Gland

When can a systolic to diastolic ratio of the umbilical artery be used to evaluate fetal well-being

After the 30th week of gestation

What provides important information about fetal renal function

Amniotic Fluid Volume

Assessing the total amount of amniotic fluid within the gestational sac using the sum of four equal quadrants is termed:

Amniotic fluid index

The fallopian tube divides into which segments

Ampulla, interstitial, infundibulum, Isthmus

Polycystic ovarian disease can result from:

An endocrine imbalance

Which of the following correctly measures endometrial thickness: A-P Dimension in coronal plane Transverse dimension in coronal A-P Dimension in sagittal plane A-P Diameter in the transverse plane

Anterior - Posterior dimension in sagittal plane

The Vesicouterine pouch is located

Anterior to the uterus and posterior to the urinary bladder

Prominent anechoic structures near periphery of the uterus most likely represent...

Arcuate vessels

Inability to distinguish the endometrial cavity is an identifiable sonographic finding in:

Asherman syndrome

Intrauterine growth restriction is defined as a fetal weight

At or below the 10th percentile for gestational age

An asymptomatic postmenopausal patient displays a 3.0cm simple ovarian cyst. This finding is considered

Benign

What is most widely used when determining gestational age in the second trimester

Biparietal diameter

Estimated fetal weight is most commonly calculated using what biometric parameter

Biparietal diameter, head circumerence and abdominal circumference

Which of the following attaches to the ovary: Peritoneum Broad ligament Tunica Albuginea Ovarian Ligament

Broad ligament

Documentation of fetal position demonstrates a frank breech presentation. This means the fetal head is located in the superior portion of the uterus and the:

Buttocks presenting with fetal feet near the head

Visualization of which brain structure excludes most midline brain abnormalities

Cavum Septum Pellucidum

The most common maternal cause of macrosomia is:

Diabetes Mellitus

The decidua capsularis and decidua parietalis produce the

Double Decidua sign

What maternal condition is most likely to result in a growth restricted fetus

Drug abuse

A common symptom of endometriosis is

Dysmenorrhea

The fetus becomes the major producer of amniotic fluid in the:

Early Second trimester

Which if the following endometrial phases demonstrates the thinnest dimension

Early proliferation

A corpus luteum is most likely misdiagnosed as a(n)

Ectopic Pregnancy

Hypervascularity within the endometrium is a characteristic finding in:

Endometritis

Which of the following is an acquired cause of infertility endometritis bicornuate uterus meigs syndrome Gartner duct cyst

Endometritis

Monitoring of which hormone is routine during ovarian induction therapy

Estradiol

Which of the following is an abnormal sonographic finding during the 1st trimester of pregnancy no amnion adjacent to an embryo no yolk sac within a MSD of 10mm no yolk sac within a MSD of 15mm no embryo within a MSD of 20mm

Failure to demonstrate a yolk sac within a MSD of 10mm when using the transvaginal approach

Ectopic pregnancies are commonly located in the

Fallopian Tube

pseudocyesis is a condition associated with

False pregnancy

What ovarian neoplasms demonstrates sonographic characteristics similiar to a leiomyoma

Fibroma

Symmetric intrauterine growth restriction is more commonly a result of

First trimester insult

Which of the following is not a sonographic finding in pelvic inflammatory disease Normal - appearing pelvis complex tubular adnexal mass Focal hypoechoic adnexal mass thick and hypervascular endometrium

Focal hypoechoic adnexal mass

Which of the following hormone levels can be slightly higher after menopause estrogen progesterone luteinizing hormone follicle-stimulating hormone

Follicle-stimulating hormone (FSH)

What ovarian phase coincides with the proliferation phase of the endometrium

Follicular

Pelvic Inflammatory disease is best described an a(n)

General classification of inflammatory conditi0ons

Estrogen is primarily secreted by the

Graafian follicle

Comparison of the abdominal circumference to the head circumference during the early third trimester demonstrates

Head circumference slightly larger than the abdominal circumference

Abnormal accumulation of blood within the vagina is termed

Hematocolpos

An extrauterine and intrauterine pregnancy is termed

Heterotopic pregnancy

With ovarian induction therapy, intramuscular injection of what hormone triggers ovulation

Human Chorionic Gonadotropin

A large cystic mass posterior and lateral to the uterus in a patient with a history of a previous pelvic infection is most suspicious for a(n)

Hydrosalpinx


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