OB GYN CTL 2nd/3rd Trimester Pathology P2

Which of the following has the greatest risk of maternal death? A: eclampsia B: gestational diabetes C: lupus D: preeclampsia

A A pregnant patient with eclampsia can suffer from acute onset of HTN with seizures, coma and even death if untreated.

____ is the term used to describe a thoracic defect where the heart has herniated outside the chest wall. A: ectopic cordis B: cloacal exstrophy C: allantoic cyst D: none of the above

A An allantoic cyst is a cyst of the umbilical cord. Cloacal exstrophy refers to a herniation in the pelvic area involving the intestines and/or bladder.

An abdominal wall abnormality that occurs with abdominal contents herniating through the abdominal wall layers outside the fetus is called? A: gastroschisis B: allantoic cyst C: omphalocele D: cloacal exstrophy

A An omphalocele refers to the herniation of the abdominal contents into the dilated base of the umbilical cord. An allantoic cyst is a cyst of the umbilical cord. Cloacal exstrophy refers to a herniation in the pelvic area involving the intestines and/or bladder.

The findings on the video are most suggestive of: A: arthrogryposis B: osteogenesis imperfecta C: achondroplasia D: rhizomelia

A Arthrogryposis refers to the contraction and or fixation of the extremity joins. The video demonstrates the arms and legs are fixed in the extended position and the hands are clenched. The legs demonstrate a typical finding of genu recurvatum, or the hyperextension of the knee so it appears to be benidng in the opposite direction.

Asherman syndrome is related to what 2nd trimester OB finding? A: uterine synechia B: limb body stalk syndrome C: increased thickness of nuchal skin fold D: skeletal dysplasia

A Asherman syndrome refers to the formation of scar tissue in the endometrium that results in adhesions. During pregnancy, the adhesions are demonstrated as linear bands of tissue connecting two uterine walls. They should have no effect on fetal motion and will not be connected to the fetus. These characteristics differentiate syndechia from amniotic bands that result in fetal defects.

Which of the following findings would rule out the possibility of posterior urethral valves in a male fetus? A: unilateral hydronephrosis B: keyhole bladder C: hydroureter D: weakened/thinned abdominal wall

A Both kidneys and ureters will be distended due to urine obstruction at the urethra. Unilateral hydronephrosis is most commonly related to ureter obstruction.

Which of the following is most common in the Amish community and presents as mesomelia, polydactyly and cardiac defects? A: Ellis van Creveld syndrome B: hypophosphatasia C: jeune dystrophy D: short rib polydactyly

A Ellis van Creveld syndrome is an autosomal recessive disorder that is most common in the Amish community and presents as mesomelia, polydactyly, narrow thorax and cardiac defects.

When performing the abdominal circumference measurement on an 18 week fetus, you note there is a fluid/debris level in the stomach with mildly echogenic debris . Which of the following is the most likely cause for the finding? A: recent amniocentesis B: heart failure C: cystic fibrosis D: trisomy 21

A Mildly echogenic debris in the fetal stomach usually indicates blood is present in the amniotic fluid. Placental abruption and a recent invasive procedure can cause blood to enter the amniotic fluid that is then swallowed by the fetus.

Most cases of duodenal atresia are associated with: A: polyhydramnios and symmetric growth restriction B: trisomy 13 C: oligohydramnios and asymmetric growth restriction D: Turner syndrome

A Most GI tract anomalies are associated with polyhydramnios and symmetric growth restriction because of the inability to swallow and process amniotic fluid.

An abdominal wall defect where the abdominal contents herniate into the base of the umbilical cord is called? A: omphalocele B: allantoic cyst C: gastroschisis D: marginal cord insertion

A Omphalocele is a herniation of the abdominal contents into a stretched part of the base of the umbilical cord. An allantoic cyst occurs in the umbilical cord. Gastroschisis occurs when the abdominal contents are herniated through the wall layers into the gestational sac. A marginal cord insertion refers to a placental cord insertion located at the outer edge of the placental tissue.

Pentalogy of Cantrell consists of a sternum defect, diaphragm defect, omphalocele, intracardiac anomalies and: A: ectopia cordis B: bladder exstrophy C: club foot D: renal agenesis

A Pentalogy of Cantrell consists of a sternum defect, diaphragm defect, omphalocele, intracardiac anomalies and ectopia cordis.

Which of the following is described as early separation of the placenta from the uterine wall? A: placental abruption B: placenta increta C: placenta accreta D: succenturiate placenta

A Placenta accreta and percreta refer to the invasion of the uterine wall by the chorionic material. A succenturiate lobe of placental tissue refers to a normal mass of ectopic placentl tissue. Abruption of the placenta can cause severe bleeding, maternal hypotension and severe pain.

A patient presents with a 33wk gestation with recent onset of intermittent light bleeding that is bright red. She does not have any associated pain or cramping. What is the most likely finding on the ultrasound exam? A: placenta previa B: placenta accreta C: premature rupture of membranes D: placental abruption

A Placenta previa is the #1 cause for painless bleeding in the 3rd trimester.

The most common cause of fetal bladder rupture is? A: posterior urethral valves B: ureterocele C: urethral calculi D: renal calculi

A Posterior urethral valves cause an obstruction to the outflow of urine through the urethra. The bladder becomes enlarged and hydronephrosis appears in the kidneys.

Which of the following is associated with oligohydramnios? A: Potter syndrome B: twins C: chorioangioma D: duodenal atresia

A Potter syndrome includes renal agenesis. Absent kidneys will cause a significant decrease in fluid production. Chorioangioma refers to a highly vascular, benign mass of the placenta that is associated with polyhydramnios. Twins will cause a significant increase in AFI levels. Duodenal atresia will render the fetus unable to process fluid through the GI tract and into the umbilical arteries, leading to fluid accumulation in the gestational sac.

Which of the following is strongly associated with supernumerary vessels in the umbilical cord? A: conjoined twins B: twin to twin transfusion syndrome C: trisomy 18 D: Turner syndrome

A Supernumerary Vessels indicates more than 3 vessels in the umbilical cord. When identified, the sonographer should differentiate how many arteries and how many veins present. This finding is strongly associated with conjoined twins.

A fetus demonstrates a pleural effusion, anasarca and an enlarged liver. Which of the following is the most likely cause for these findings? A: erythroblastosis fetalis B: maternal HTN C: uterine vein thrombosis D: maternal diabetes

A The findings listed indicate fetal hydrops. Erythroblastosis fetalis can lead to immune fetal hydrops. Maternal diabetes and HTN are more commonly seen with IUGR.

The sonographic appearance of hydranencephaly is: A: fluid filled sacs of cerebrospinal fluid in cranial cavity, varying amounts of tissue may remain as atrophy and necrosis occurs B: the cerebellum is usually absent or malformed with an enlarged cisterna magna C: an abnormal brain stem is usually identified with a cisterna magna <2mm D: a single large c-shaped ventricle is usually present

A The sonographic appearance of hydranencephaly usually demonstrates fluid filled sacs of cerebrospinal fluid in cranial cavity, varying amounts of tissue may remain as atrophy and necrosis occurs due to internal carotid artery obstruction. The cerebellum is not supplied with blood from the internal carotid artery so the brainstem is usually normal.

Which of the following types of placenta previa is defined as placental vessels crossing the internal os? A: vasa previa B: marginal previa C: velamentous previa D: partial previa

A Vasa Previa = vessels covering the internal os. Low lying placenta refers to when the placental tip is within 2cm of the internal os. Marginal previa refers to when the placental tip is located at the edge of the internal os. Partial previa refers to the internal os being partially covered by the placenta. A velamentous umbilical cord insertion refers to a placental insertion that attaches to the uterine wall and then travels into the placenta.

Which of the following can present as unilateral fetal hydronephrosis? A: posterior urethral valves B: ureteropelvic junction obstruction C: cloacal exstrophy D: bladder exstrophy

B A UPJ obstruction occurs as the junction of the ureter and renal pelvis. It is most commonly a unilateral abnormality that will cause uniilateral hydronephrosis and a normal bladder. The other choices can lead to hydronephrosis but it will present bilaterally.

A foramen of Bochdalek hernia involves: A: the abdominal wall inferior to the umbilicus B: the left side of the diaphragm C: the left side of the inguinal canal D: the abdominal wall superior to the umbilicus

B A foramen of Bochdalek hernia refers to a hernia on the left side of the fetal diaphragm. It is the most common type of diaphragmatic hernia.

A 50 yr old female presents for a pelvic ultrasound after ascites was identified on an upper abdominal exam. A thin walled, multiloculated cystic ovarian mass with papillary projections is identified on the right ovary. The left ovary and uterus are unremarkable. These findings are most suggestive of: A: dysgerminoma B: serous cystadenocarcinoma C: Krukenberg tumor D: theca lutein cyst

B A serous cystadenocarcinoma is the malignant version of the serous cystadenoma. The malignant multiloculated cystic mass usually demonstrates internal nodules or papillary projections. Ascites is also a common finding with these malignant pelvic tumors.

An epignathus refers to teratoma formation on the: A: cervical spine B: pharynx C: sacral spine D: cranium

B A teratoma can form in many locations in the fetus, usually along the midline of the body. Pharynx, neck, sacrum, brain, skull sutures. Teratoma formation from the pharynx is termed an epignathus.

What cranial abnormality is usually a normal variant, but has been associated with trisomy 21 and spina bifida? A: exencephaly B: brachycephaly C: encephalocele D: dolichocephaly

B Brachycephaly refers to a fetal head that is more rounded with the OFD shorter, closer to the BPD measurements; cephalic index > 85% (0.85). It is usually a normal variant but has been associated with trisomy 21 and spina vifida. Dolichocephaly refers to fetal head that is more elongated with a longer OFD, much greater than the BPD measurement. It is associated with breech presentation, holoprosencephaly and oligohydramnios. Acrania is also called exencephaly and indicates absence of the cranium.

Which of the following is the best differential diagnosis for the findings on the image? A: duodenal atresia B: congenital diaphragmatic eventration C: congenital cystic adenomatoid malformation D: pentalogy of Cantrell

B Congenital Diaphragmatic Eventration (CDE) is a developmental defect of the muscular portion of the diaphragm. It results in focal or diffuse weakness of the diaphragm (no holes, just weak muscles). It mimics the appearance of a hernia with the abdomen contents appearing to be in the chest cavity. CCAM is a cystic transformation of the lung tissues. Pentalogy of Cantrell is a group of defects that involve the anterior abdominal wall and sternum.

What findings are displayed on the image? A: chorioangioma B: umbilical cord cyst C: vasa previa D: placental abruption

B Cord cysts can form anywhere along the cord. If they are associated with a persistent urachus and found near the fetal end of the cord, they are called allantoic umbilical cord cyst.

In patients with agenesis of the corpus callosum, the lateral ventricular horns are displaced ____ and have a ____ appearance. A: medially; swiss cheese B: laterally; teardrop C: latearlly; swiss cheese D: medially; teardrop

B During ACC, the third ventricle enlarges, causing it to move more superiorly within the brain which displaces the body of both ventricles laterally. The majority of the fluid in the lateral ventricles will pool in the posterior horns due to the enlarged third ventricle. This will cause the teardrop appearance.

Which of the following is a common cause of abnormal uterine bleeding? A: polycystic ovarian syndrome B: leiomyomas C: hormone replacement therapy D: oral contraceptives

B Dysfunctional uterine bleeding (DUB) is caused by abnormalities in the endocrine system, while abnormal uterine bleeding (AUB) is caused by uterine lesions.

Which of the following is most suggestive of holoprosencephaly? A: bilateral cleft lip B: ethmocephaly C: bilateral cleft palate D: prominent falx cerebri

B Ethmocephaly is a midline facial defect that consists of hypotelorism, a proboscis, and no nose. It is associated with holoprosencephaly, which usually has related midline facial defects. A bilateral, or left and right side, cleft palate is not a midline defect. The falx cerebri is partially or completely absent in holoprosencephaly.

Which of the following are signs of fetal hydrops? A: theca lutein cyst and anasarca B: scalp edema and ascites C: skin edema and facial clefting D: pleural effusion and macrocystic lungs

B Hydrops fetalis is defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin/scalp edema. The most common appearance of hydrops includes fluid accumulation throughout the fetus, in the skin, scalp, abdomen, chest and pelvis. A theca lutein cyst occurs in the ovary.

Which of the following conditions will result in the most complications for the fetus? A: dextrocardia B: partial situs inversus C: complete situs inversus D: levocardia

B In partial or incomplete situs inversus, the heart is on the right but the liver is usually in the center of the body. There are two main types: left isomerism where both sides of the body resemble the left side OR right isomerism where both sides of the body resemble the right side. The varied degree of jumbled anatomy can lead to numerous complications. Levocardia is the normal heart position in the left chest. Dextrocardia refers to the heart located in the right chest. Complete situs inversus leads to less complications than partial because all organs switched places in a mirror image of normal.

Which of the following usually requires serial exams in the second and third trimester to make an accurate diagnosis? A: omphalocele B: kyphosis C: corrected transposition of the great arteries D: complete transposition of the great arteries

B Kyphosis refers to excessive posterior curvature of the upper thoracic spine. This is very difficult to diagnose in utero because of the curled position of the fetus. Serial exams can demonstrate the consistent abnormal appearance of the thoracic spine curvature. The other abnormalities can be identified on a single exam.

Microcephaly is defined as a head circumference measuring more than ____ standard deviation(s) from the normal mean for the expected gestational age. A: 1 B: 2 C: 3 D: 4

B Microcephaly is defined as a head circumference measuring more than 2 standard deviation(s) from the normal mean for the expected gestational age.

Omphaloceles are associated with all of the following except: A: advanced maternal age B: decreased AFP C: cardiac abnormalities D: chromosomal abnormalities

B Omphaloceles result in an increase in AFP, but not as significant as gastroschisis. They are also more commonly seen with chromosomal abnormalities than gastroschisis.

Which type of osteogenesis imperfecta has the poorest prognosis? A: type I B: type II C: type III D: type IV

B Osteogenesis imperfecta type II, can include an abnormally small, fragile rib cage and pulmonary hypoplasia. Infants with these abnormalities often die shortly after birth.

____ is/are the most common fetal arrhythmia, but is clinically insignificant in nearly all cases. A: complete heart block B: premature atrial contractions C: sinus bradycardia D: supraventricular tachycardia

B PACs are the most common fetal arrhythmia but is clinically insignificant in nearly all cases.

Which of the following is described as invasion of the placental chorionic villus deep into the uterine myometrium? A: placenta accreta B: placenta increta C: placenta percreta D: placenta myocreta

B Placenta accreta refers to invasion of the chorionic tissue through the endometrium and attaches to the myometrium. Placenta increta occurs when the chorionic tissue invades the myometrium. Placenta percreta occurs when the chorionic tissue extends through uterine wall to bladder and adjacent pelvic structures.

A patient presents with a 36wk gestation with an acute onset of pain and bright red bleeding. She has had 2 prior scans that were normal. Which of the following is the most common cause for the acute symptoms? A: placenta accreta B: placental abruption C: placenta percreta D: placenta previa

B Placental abruption is the most common pathological cause of bleeding late in pregnancy. Placenta previa is associated with painless bleeding. Placenta accreta and percreta refer to invasion of the uterine tissues by the placental tissue.

The most common type of conjoined twin is the: A: pyopagus B: thoracopagus C: craniopagus D: omphalopagus

B The thoracopagus conjoined twins are the most common single site of attachment.

The findings on the video are most suggestive of: A: congenital cystic adenomatoid malformation B: unilateral multicystic kidney disease C: posterior urethral valves D: anal atresia

B The video demonstrates a normal urinary bladder, dilated tortuous ureter and a kidney that is fully replaced by large cysts. Because the ureter and kidney are abnormal, the obstruction is in the distal ureter (ureterovesicular junction). Note the stomach is distended normally and does not connect to the cystic/tubular structures. If anal atresia was present, the dilated bowel would fill the abdomen, not be restricted to the right side of the fetal abdomen. Posterior urethral valves would cause bilateral dilatation of the ureters and hydronephrosis. CCAM is a lung abnormality.

A patient presents for a fetal ultrasound for a routine 1st trimester evaluation. The findings are most suggestive of: A: normal midgut herniation B: omphalocele and ectopia cordis C: vanishing twin syndrome D: cloacal exstrophy

B The video demonstrates an omphalocele and ectopia cordis. Note the umbilical cord membrane surrounds the abdominal mass. These two findings are highly suggestive of Pentalogy of Cantrell. Pentalogy of Cantrell is characterized by a combination of midline birth defects that typically involve the sternum, diaphragm, the pericardium, the abdominal wall, and the heart.

Which of the following is true regarding the findings displayed on the image? A: there is fetal ascites and pleural effusions B: there is fetal ascites C: there is edema of the skin of the fetal abdomen D: there is fetal ascites and skin edema of the abdomen

B There is ascites present in the abdomen surrounding the liver and bowel. The skin is not edematous and demonstrates a normal thickness. A pleural effusion is not present because there is no fluid superior to the diaphragm in the chest cavity.

An 18 week fetus demonstrates syndactyly, asymmetric IUGR, and flow reversal in the ductus venosus. These findings are most consistent with: A: Apert syndrome B: triploidy C: Turner syndrome D: trisomy 13

B Triploidy indicates 3 copies of all chromosomes for a total of 69. Common findings include: a large head, small body, syndactyly, Dandy Walker malformation, reversal of flow in the ductus venosus and cardiac defects.

Streak gonads and infertility are associated with what fetal syndrome? A: Edward syndrome B: Turner syndrome C: Holt Oram syndrome D: Noonan syndrome

B Turner syndrome always affects female patients and is associated with the replacement of the ovarian tissue and fibrous tissue. These fibrous tissues or streak gonads render the "ovaries" non-functional causing infertility. Adults with Turner syndrome demonstrate a short stature, webbed neck and infertility. It is also described as Monosomy X or 45X0

A dilated fetal rectum should raise a strong suspicion of: A: posterior urethral valves B: jejunal atresia C: anal atresia D: cystic fibrosis

C A dilated rectum is a typical finding in anal atresia. Fetal meconium begins to back up at the point of obstruction = anus if anal atresia is present. Jejunal atresia is obstruction in the small bowel. The colon and rectum would not receive any digestive material and woul dnot be dilated. Cystic vibrosis causes echogenic bowel. Posterior urethral valves would cause urinary bladder dilatation.

Midline facial defects, such as cyclopenia and proboscis, are commonly associated with: A: Ellis van Creveld syndrome B: oligohydramnios C: alobar holoprosencephaly D: amniotic band sequence

C Alobar holoprosencephaly presents as a single C-shaped ventricle with an absence or malformation of midline structures in cranium. This is also associated with midline facial defects. Oligohydramnios and amniotic band syndrome can cause asymmetric facial defects (not midline).

The majority of the encephaloceles are located in the ____ region of the cranium. A: frontal B: parietal C: occipital D: temporal

C An encephalocele is a herniation of brain matter through an abnormal opening in the cranium.

Which of the following would be most consistent with a unilateral increase in the anterior-posterior renal pelvic diameter between the second and third trimesters? A: autosomal dominant polycystic kidney disease B: normal variant C: ureterocele D: autosomal recessive polycystic kidney disease

C An increase in the APRPD between the second and third trimesters indicates higher possibility of postnatal abnormalities (vesicoureteral reflux, UPJ obstruction, UVJ obstruction, MCKD, ureterocele), polycystic kidney disease is a bilateral process, therefore any associated hydronephrosis would be bilateral in most cases.

Bilaterally enlarged, echogenic fetal kidneys with a normal bladder is most suggestive of: A: multicystic dysplastic kidney disease B: renal failure C: autosomal dominant polycystic disease D: autosomal recessive polycystic disease

C Autosomal dominant polycystic disease can demonstrate bilaterally enlarged, echogenic fetal kidneys with a normal bladder and AFI. The kidneys still function to produce urine and the bladder is visualized. Autosomal recessive polycystic disease can demonstrate bilaterally enlarged, echogenic fetal kidneys with a non-visualized bladder and oligohydramnios. Kidney function is severely decreased which causes oligohydramnios and prevents visualization of the bladder. Multicystic kidney disease is usually unilateral.

Which of the following terms describes a rounded head with a cephalic index > 85% (0.85)? A: bradycephaly B: dolichocephaly C: brachycephaly D: microcephaly

C Brachycephaly refers to a fetal head that is more rounded with the OFD shorter, closer to the BPD measurements; cephalic index >85% (0.85). Dolichocephaly refers to fetal head that is more elongated with a longer OFD, much greater than the BPD measurement.

The right fetal lung appears more echogenic than the left lung tissue in a fetus with hydrops. The doctor suspects congenital cystic adenomatoid malformation. What type of CCAM is demonstrated? A: type I B: type II C: type III D: type IV

C CCAM refers to the replacement of lung tissue with cyst formation which renders the lung tissue non-functional. Type I = macrocystic Type II = medium cystic Type III = microcystic Type III is commonly associated with hydrops and the lung tissue becomes echogenic because of the presence of mayn very tiny cysts; similar to the change in sonographic appearance of fetal kidneys with autosomal recessive PCKD.

Which of the following is the term used to describe a hypoechoic vascular mass adjacent to the cord insertion into the placenta? A: placental lake B: choriocarcinoma destruens C: chorioangioma D: placenta accreta

C Chorioangiomas are composed of a highly vascular malformation of chorionic tissue and are normally located at the placental cord insertion. They are the most common benign mass of the placenta.

Which of the following trisomies is most commonly seen with micrognathia? A: 9 B: 13 C: 18 D: 21

C Edward syndrome is trisomy 18. There are 3 copies of chromosome 18 which leads to the formation of multiple fetal defects.

Which trisomy is most commonly associated with a strawberry shaped fetal skull? A: 9 B: 13 C: 18 D: 21

C Edward's syndrome refers to trisomy 18 which includes a low AFP, strawberry shaped skull, esophageal atresia, clenched fists and rocker bottom feet.

Which of the following scenarios would NOT result in the diagnosis of fetal hydrops? A: scalp and skin edema, ascites B: scalp and skin edema C: isolated ascites D: scalp edema and ascites

C Hydrops fetalis is defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin/scalp edema.

Which of the following terms is defined as foreshortening of all portions of the limbs? A: achondroplasia B: rhizomelia C: micromelia D: mesomelia

C Mesomelia is foreshortened distal limbs. Acromelia is foreshortened hand and foot bones. Micromelia is a foreshortening of the entire limb. Rhizomelia is foreshortened proximal limbs. Achondroplasia refers to dwarfism.

Which of the following terms is defined as foreshortening of distal long bones (radius, ulna, tib/fib)? A: acromelia B: rhizomelia C: mesomelia D: micromelia

C Mesomelia is foreshortened distal limbs. Acromelia is foreshortened hand and foot bones. Micromelia is a foreshortening of the entire limb. Rhizomelia is foreshortened proximal limbs. Achondroplasia refers to dwarfism.

If the radiologist suspects Potter syndrome and requesets that you perform a thoracic circumference. How will this measurement assist in the diagnosis? A: Potter syndrome usually demonstrates a narrow thorax due to acardia B: Potter syndrome usually demonstrates cardiomegaly and a diaphragmatic hernia which will increase the size of the thoracic cavity C: Potter syndrome usually demonstrates a bell-shaped thorax that is much more narrow than the abdominal cavity D: Potter syndrome usually demonstrates pulmonary hyperplasia which leads to an enlarged thorax

C Pulmonary hypoplasia is common with Potter syndrome due to the oligohydramnios caused by renal agenesis. The chest is usually narrow compared to the abdomen. The thoracic shape is described as a bell or a pear. The thoracic circumference will be well below normal values.

A 27yr pregnant patient presents with bleeding and pain. Lab testing indicates lower bhCG than last reported. What is demonstrated on the image? A: molar pregnancy B: endometrial hyperplasia C: retained products of conception D: endometrial carcinoma

C Retained Products of Conception (RPOC) refers to persistence of placental and/or fetal tissue in the uterus following delivery, abortion or a miscarriage. The patient presents with fatigue, anemia, uterine bleeding, pelvic pain, and/or fever. It can be differentiated from molar pregnancy using bhCG levels. Molar pregnancy will increase bhCG levels, but the bhCG levels are decreasing/normal with RPOC. Sonographic Appearance: Endometrial thickness is > 5 mm following D&C or spontaneous abortion Variable amount of echogenic or heterogeneous material within the endometrial cavity Vascularty within the material helps to differentiate RPOC from intrauterine thrombus

Which of the following skeletal abnormalities is defined by the arching/curving of the 4th and 5th digits, toward the thumb, along the axis of the palm curvature? A: syndactyly B: polydactyly C: clinodactyly D: rocker bottom feet

C Syndactyly refers to the formation of skin webbing between the digits. Clinodactyly refers to the arching of the 4th and 5th digits toward the thumb. Polydactyly refers to the formation of extra digits on the hands or feet.

The Robert sign indicates: A: dizygotic twins B: skeletal dysplasia C: fetal demise D: monozygotic twins

C The Robert sign refers to free air in the circulatory system of the fetal abdomen that occurs with fetal demise.

What fetal anomaly is demonstrated on the image? A: schizencephaly B: alobar holoprosencephaly C: lobar holoprosencephaly D: dilated fetal stomach with duodenal atresia

C The axial image of the fetal head demonstrates the fusion of the anterior horns of the dilated lateral ventricles. This is the classic sign of lobar holoprosencephaly.

The findings demonstrated on the image are associated with what congenital anomaly? A: renal agenesis B: duodenal atresia C: posterior urethral valves D: anal atresia

C The keyhole bladder is a term used to describe the dilated urethra and urinary bladder caused by posterior urethral valves. Note the associated oligohydramnios.

Hypertelorism is most commonly caused by which of the following conditions: A: posterior encephalocele B: spina bifida C: anterior encephalocele D: cystic hygroma

C The other abnormalities listed are found on the posterior aspect of the fetus.

Which of the following is the most likely cause of the abnormality on the video? A: absence of an anal opening B: chromosomal abnormality C: right ureterovesicular junction obstruction D: ureteropelvic junction obstruction of the right kidney

C The video demonstrates a normal urinary bladder, dilated tortuous ureter and a kidney that is fully replaced by large cysts. Multicystic kidney disease is caused by an obstruction in utero. Because the ureter and kidney are abnormal, the obstruction is in the distal ureter (ureterovesicular junction). If just the kidney was affected, a ureteropelvic junction obstruction would be suspected. Note the stomach is distended normally and does not connect to the cystic/tubular structures. If anal atresia was present the dilated bowel would fill the abdomen, not be restricted to the right side of the fetal abdomen.

Which of the following correctly describes the fetal heart on the video? A: mesocardia B: dextrocardia C: marked levoposition D: marked dextroposition

C The video demonstrates marked levoposition of the heart as it is located completely on the left side of the body. No left lung is present = lung agenesis. The right lung appears normal as homogeneous echogenic tissue but enlarge to fill the right chest cavity completely. The normal position of the heart is more centered in the chest with the apex pointed toward the left side at a 45 degree angle. This is called levoposition. In this case the heart is completely on the left side, or marked levoposition, which is abnormal.

Which of the following findings is demonstrated on the video? A: lobar holoprosencephaly B: alobar holoprosencephaly C: fused anterior horns of the lateral ventricles D: dilated third ventricle

C The video demonstrates the cavum septum pellucidum (CSP) is absent. In the axial plane, the two parallel echogenic lines should be seen anterior to the thalamus at midline. The coronal view demonstrates the fused anterior horns of the lateral ventricles, which is common without the CSP.

The video clip is from a monochorionic monoamniotic twin pregnancy. The findings are most suggestive of: A: Vanishing Twin Syndrome B: a triploidy fetus and a normal fetus C: Twin Reversed Arterial Perfusion Sequence (TRAP syndrome) D: Twin Anemia-Polycythemia Sequence (TAPS)

C Twin Reversed Aterial Perfusion Sequence (TRAP syndrome) is also referred to as a parabiotic twin or acardiac twin. It is the most severe form of a twin to twin transfusion. It occurs in monochorionic pregnancies with a shared placenta. The acardiac twin has no cardiac structure or limited structures with no motion and multiple other abnormalities. The acardiac twin has noconnection to the placneta or arterial/venous circulation. The acardiac twin usually has missing and unrecognizable features. It also usually only develops a trunk and partial lower extremities. The umbilical arteries and vein of the acardiac twin join the arteries and vein of the donor twin. There is an AV malformation with the umbilical artery to artery shunt and venous to venous shunt from "normal" donor twin. The normal twin or "pump twin" eventually develops heart failure due to increased load and can also develop hydrops.

When evaluating a 28 week fetus, a small cystic structure is identified in the anterior abdomen, adjacent to the gallbladder. No flow is identified when color Doppler is applied. The stomach and urinary bladder are visible in their normal positions. AFI is 18cm. These findings are most consistent with: A: umbilical varix B: bladder exstrophy C: duodenal atresia D: choledochal cyst

D A choledochal cyst is a focal dilatation of the biliary tree. In a fetus, it is usually identified in the anterior abdomen, adjacent to the gallbladder. It can be mistaken for duodenal atresia. This fetus demonstrated a normal stomach and bladder. This indicates amniotic fluid is able to be processed normally by the fetus. Polyhydramnios is seen with duodenal atresia. An umbilical varix would fill with color upon Doppler evaluation.

Which of the following is associated with polyhydramnios? A: renal hypoplasia B: premature rupture of membranes C: renal agenesis D: chorioangioma

D Abnormal or absent kidneys will cause a significant decrease in fluid production. Premature rupture of the fetal membranes will cause a loss of the amniotic fluid. Chorioangioma refers to a highly vascular, benign mass of the placenta that is associated with polyhydramnios.

A fetus with male genitalia and ovaries would be described as: A: ambiguous genitalia B: 45XO C: 46XY intersex D: 46XX intersex

D Hermaphroditism is also known as intersex. A fetus with male genitalia and ovaries would be described as 46XX. A fetus with female genitalia and testes would be described as 46XY.

An abnormality of of renal fusion where the lower poles of the kidneys are connected across the midline of the abdomen is called: A: epispadias B: persistent cloaca C: cross fused renal ectopia D: horseshoe kidney

D Horseshoe kidney is the most common renal fusion defect. Usually the fusion occurs at the lower poles across the midline of the abdomen. The bridge of renal tissue crosses anterior to the aorta and called the isthmus. It is associated with other anomalies, Turner syndrome, trisomy 18 and 21. Cross fused renal ectopia refers to fusion of the kidneys on one side of the body.

While scanning the 4 chamber heart view in a fetus, you identify an enlarged right heart with a very small left ventricle and atrium. You move to the LVOT view and the ascending aorta is much smaller than normal. Which of the following explains these findings? A: pulmonary HTN B: Marfan syndrome C: Ebstein anomaly D: hypoplastic left heart

D Hypoplastic left heart syndrome reers to the underdevelopment of the left heart structures. If HLHS is identified in a female fetus, Turner syndrome should be suspected.

You identify a facial cleft, scoliiosis, gastroschisis and a very short of absent umbilical cord on a 25 weeks fetus. These findings are most suggestive of: A: Shone complex B: trisomy 21 C: tetralogy of Fallot D: limb-wall-body complex

D Limb Body Wall Complex is the most severe form of amniotic band sequence. It is characterized by very severe limb defects and anterior body wall defects. The diagnosis includes two or three of the following defects: exencephaly or encephalocele with facial clefts, thoracoschisis and/or abdominoschisis, and limb defects. In most cases the umbilical cord is very short or absent. If a cord is present, the insertion point into the placenta is usually normal. Shone complex and TOF are complex cardiac defects.

Which of the following is a sign of maternal HTN on the fetal ultrasound exam? A: placental thickness of 6cm B: macrocrania C: non-immune hydrops D: IUGR

D Maternal HTN can cause placental insufficiency. This can lead to thinning of the placenta and IUGR.

Multiple echogenic foci within the anterior abdomen of a fetus are indicative of: A: mesenchymal hamartoma B: anal or intestinal atresia C: biliary atresia D: bowel perforation or meconium peritonitis

D Multiple echogenic foci in the anterior abdomen indicate peritoneal calcifications. Bowel perforation and meconium peritonitis are associated with peritoneal calcifications.

Which of the following statements correctly describes oligohydramnios? A: fluid lvels below the 20th percentile for the gestational age B: AFI <8cm or single pocket less than 2 cm C: less than 1 cm pocket of fluid found, not containing fetal anatomy or cord D: AFI <5cm or single pocket less than 2 cm

D Oligohydramnios refers to an AFI <5cm, fluid levels below the 5th percentile for the gestational age or single pocket less than 2 cm of fluid.

Postpartum hemorrhage is a complication of all of the following, except? A: polyhydramnios B: macrosomia C: twin gestation D: IUGR

D Postpartum hemorrhage is associated with excessive uterine stretching. The uterus cannot contract well enough to slough off the small arteries involved in placental attachment and active bleeding occurs. Multiple gestations, polyhydramnios and macrosomia can contribute to excessive uterine stretching. IUGR would lead to a smaller fetus and less uterine stretching.

What causes Potter facies? A: holoprosencephaly B: polyhydramnios C: trisomy 21 D: renal agenesis

D Poter facies are facial anomalies caused by low fluid. Abnormalities of the urinary system, such as renal agenesis and posterior urethral valves, are typically the cause of the decreased AFI levels.

If maternal syphilis goes untreated, what change will be seen in the fetus? A: duodenal atresia B: splenic atrophy C: hydronephrosis D: hepatomegaly

D Syphilis can cause premature aging of the placenta and swelling of the fetal liver and spleen. If untreated with penicillin, the neonate can demonstrate blindness, deafness, deformity of the face, and central nervous system problems.

Which of the following intracranial anomalies is most commonly associated with fetal hydrops, ascites and congestive heart failure? A: holoprosencephaly B: schizencephaly C: intracranial bleed D: vein of Galen aneurysm

D The aneurysm of the vein of Galen leads to an AV malformation in the brain. This causes an increased amount of flow within the venous system causing fluid accumulation, hydrops and CHF.

When fetal hydronephrosis is suspected, how is it properly documented by ultrasound? A: obtain a coronal image of both kidneys and measure the minimum diameter of dilatation B: obtain a transverse image with the fetal spine at 12 or 6 o'clock and measure the minimum diameter of dilatation C: obtain a transverse image with the fetal spine at 9 or 3 o'clock and measure the maximum diameter of dilatation D: obtain a transverse image with the fetal spine at 12 or 6 o'clock and measure the maximum diameter of dilatation

D The anterior-posterior renal pelvic diameter (APRPD) is measured in fetuses with suspected hydronephrosis. The fetal spine should be at 12 or 6 o'clock and the diameter of the renal pelvis is measured at the maximal diameter. 2nd trimester - APRPD less than 4mm is considered normal pelvicaliectasis; severe hydronephrosis above 10mm APRPD 3rd trimester - APRPD less than 7mm is considered normal pelvicaliectasis; severe hydronephrosis above 15mm APRPD An increase in the APRPD betwen the second and third trimesters indicates a higher possibility of postnatal abnormalities. Moderate to severe hydronephrosis in the third trimester indicates a higher possibility of postnatal abnormalities

The autosomal recessive genetic disorder that is associated with meconium ileus and fetal bowel obstruction is: A: polycystic kidney disease B: erythroblastosis fetalis C: multicystic kidney disease D: cystic fibrosis

D The autosomal recessive genetic disorder that is associated with meconium ileus and fetal bowel obstruction is cystic fibrosis.

What intracranial sonographic sign causes the greatest suspicion of spina bifida? A: lemon sign B: teardrop sign C: lobster claw sign D: banana sign

D The banana sign is more accurate than the lemon sign in predicting spina bifida. The banana sign has been demonstrated in 99% of spina bifida cases. In agenesis of the corpus callosum, the lateral ventricular horns are displaced laterally and have a teardrop appearance.

The image of the cerebellum displays what sonographic "sign"? A: lemon sign B: string of pearls sign C: fruit salad sign D: banana sign

D The image demonstrates the "banana" sign which is the abnormal elongation of the cerebellum. Associated with spina bifida and Down's syndrome.

A triploidy fetus has: A: an extra chromosome 13 B: three sets of chromosome 13 C: 3 sets of chromosome 3 D: 3 sets of all 23 chromosomes

D The normal fetus has 23 pairs of chromosomes, 46 total. 22 pairs are called autosomes and they are the same in males and females. The 23rd pair are sex chromosomes related to male or female gender. A triploidy fetus has 3 sets of all 23 chromosomes, 69 total. A trisomy fetus has a single extra chromosome. Trisomy 18 has an extra chromosome 18.

Which of the following best describes the placenta in a fetus with triploidy? A: small, atrophic and malformed B: AP thickness <1.5cm C: contains 5 or more placental lakes D: AP thickness >4cm

D Triploidy is associated with placental thickening (>4cm AP tickness).

Turner syndrome is suspected. Which of the above images is most suggestive of that diagnosis? Use your mouse to position the cursor over the image and click to select your answer.

Image A demonstrates micrognathia and polyhydramnios. Image B is a cystic hygroma, which is a common finding in Turner syndrome. Image C is a clover-leave skull that is common with thanatophoric dysplasia. Image D demonstrates the double bubble sign that is common with trisomy 21.

Posterior urethral valves is suspected. Which of the above images is most suggestive of that diagnosis? Use your mouse to position the cursor over the image and click to select your answer.

Image A demonstrates significant bilateral hydronephrosis which is a key finding in posterior urethral valves. Image B indicates unilateral hydronephrosis, which is seen with a UPJ obstruction or ureterocele. Image C demonstrates multicystic kidney disease, which is associated with a unilateral obstruction in utero. Image D demonstrates bilateral renal agenesis, which is a key finding in Potter syndrome.

Which form of achondrogenesis is the least severe? A: Langer-Saldino B: type IV C: radial ray D: Parenti Franco

A Achondrogenesis is a rare form of short limb dwarfism that can be lethal due to pulmonary hypoplasia. The two types are Parenti Franco and Langer Saldino. The Langer Saldino type leads to less severe defects than Parenti Franco

A midline facial cleft is most commonly associated with what intracranial abnormality? A: holoprosencephaly B: hydrocephalus C: Dandy Walker malformation D: hydranencephaly

A Holoprosencephaly leads to various midline defects in the brain. When a midline facial cleft is detected, holoprosencephaly is usually present. Asymmetric clefting is a sign of amniotic band syndrome.

What is the most common abnormality of the fetal urinary system? A: hydronephrosis B: polycystic kidney disease C: multicystic kidney disease D: posterior urethral valves

A Hydronephrosis is the most common fetal renal abnormality.

All of the following are signs of fetal demise, except: A: Meckel sign B: Spalding sign C: scalp edema D: debris in amniotic fluid

A In a small amount of adults, the yolk sac persists as a diverticulum in the ileum portion of the bowel which is called Meckel diverticulum.

Which of the following is strongly associated with fetal dysphagia and polyhydramnios? A: Beckwith-Wiedemann syndrome B: Meckel Gruber syndrome C: Ebstein anomaly D: Potter syndrome

A Macroglossia is identified with Beckwith Wiedemann syndrome and leads to dysphagia with the inability to process the amniotic fluid. Polyhydramnios occurs due to decreased fetal use of the amniotic fluid.

What is demonstrated on the image? A: dilated urinary bladder B: normal fetal abdomen/pelvis C: cystic hygroma D: double bubble

A The coronal view of the fetus demonstrates the urinary bladder and dilated urethra = keyhole bladder. Note the associated oligohydramnios.

Which of the following statements is true regarding the measurement of the humerus? A: a short humerus measurement can assist in confirming the diagnosis of trisomy 21 B: the ratio of humerus length to femur length is normally <0.6 C: the humerus length usually exceeds the femur length in trisomy 21 D: the length of the humerus is best evaluated with the ultrasound beam parallel to the long axis of the bone

A The length of the humerus is best evaluated with the ultrasound beam perpendicular to the long axis of the bone. A foreshortened humerus is a soft marker for trisomy 21. This means that if there are other characteristics of trisomy 21, then a foreshortened humerus will help to confirm the diagnosis. Identifying a foreshortened humerus on an exam does not necessarily indicate trisomy 21. In the normal fetus, the humerus is slightly shorter than the femur. The femur and the humerus are both foreshortened with trisomy 21.

____ is the most common pathologic cause of significant 3rd trimester bleeding. ____ is the most common cause of painless 3rd trimester bleeding. A: placental abruption; placenta previa B: placenta accreta; placenta percreta C: placenta previa; placental abruption D: placenta percreta; placenta accreta

A The placenta is still in formation through the first trimester. During the 2nd trimester, the fetus and placenta will grow. In the 3rd term, the placenta begins to age and becomes denser, which can lead to an abruption. The placenta is ejected from the uterus with the birth of the baby. Placental abruption is the most common cause of significant bleeding in the 3rd trimester. It is associated with significant pain. Placenta previa is the most common cause of PAINLESS bleeding in the 3rd trimester.

The findings on the video are most suggestive of: A: pulmonary sequestration B: diaphragmatic hernia C: echogenic bowel D: congenital cystic adenomatoid malformation

A The video demonstrates an echogenic homogenous mass of tissue in the fetal chest, above the diaphragm. There is a feeder vessel supplying the mass from the thoracic aorta. These findings indicate pulmonary sequestration. The aortic feeder vessel aids in differentiation from microcystic CCAM, which would be supplied by pulmonary artery branches.

What chromosomal anomaly is seen in the fetus with most cases of partial molar pregnancy? A: triploidy B: trisomy 9 C: trisomy 18 D: trisomy 21

A Triiploidy is seen in about 90% of fetuses in a partial molar pregnancy.

Which of the following is NOT associated with esophageal atresia? A: tracheoesophageal fistula B: oligohydramnios early in the pregnancy C: small, fluid filled stomach D: trisomy 18

B Esophageal atresia is commonly associated with trisomy 18. Because a TE fistula is identified in most of these cases, amniotic fluid can still reach the stomach. Polyhydramnios forms later in the pregnancy due to the long-term inefficiency of fluid processing by the fetus.

During US evaluation of the fetal cord insertion of a 15wk fetus, a small herniation of the fetal bowel is noted in the base of the cord. Which of the following statements is true? A: after 12wks this finding is considered gastroschisis B: after 12wks this finding is considered an omphalocele C: an allantoic cyst of the umbilical cord is present which is a normal variant until 16wks gestation D: this is a normal finding and should resolve by 16wks gestation

B Herniation of the midgut at the base of the umbilical cord is a normal part of fetal formation but should resolve by 12wks gestation.

A calcification within the fetal liver is commonly associated with: A: renal calculi B: meconium peritonitis C: ambiguous genitalia D: umbilical vein thrombosis

B Intrauterine infection, meconium peritonitis and chromosomal abnormalities are related to single or multiple calcifications in the fetal liver. If these potential causes are ruled out, prognosis is good for the fetus and it is considered a normal variant.

A myelomeningocele refers to: A: herniation of meninges through a cranial opening B: herniation of meninges and neural tissue through a vertebral opening C: herniation of neural tissue through a cranial opening D: herniation of meninges through a vertebral opening

B Meningocele refers to herniation of meninges through an abnormal opening in the spine or cranium. Myelomeningocele refers to a herniation of meninges and neural tissue through an abnormal opening in the spine.

Which of the following terms is defined as foreshortening of proximal long bones (femur and humerus)? A: micromelia B: rhizomelia C: achondroplasia D: acromelia

B Mesomelia is foreshortened distal limbs. Acromelia is foreshortened hand and foot bones. Micromelia is a foreshortening of the entire limb. Rhizomelia is foreshortened proximal limbs. Achondroplasia refers to dwarfism.

Mild ventriculomegaly in the brain is diagnosed within what measurement range? A: 5-10mm B: 10-15mm C: 15-20mm D: 20-25mm

B Mild = 10-15mm Moderate = 16-20mm Severe = >20mm

Which of the following skeletal abnormalities is defined by the presence of webbing between the digits? A: polydactyly B: syndactyly C: clinodactyly D: micromelia

B Syndactyly refers to the formation of skin webbing between the digits. Clinodactyly refers to the arching of the 4th and 5th digits toward the thumb. Polydactyly refers to the formation of extra digits on the hands or feet.

The fetal structures within an omphalocele are protected by a membrane composed of: A: amnion and rectus sheath muscle B: amnion and peritoneum C: peritoneum and rectus sheath muscle D: peritoneum and retroperitoneum

B The fetal structures within an omphalocele are protected by a membrane composed of amnion and peritoneum.

The most common cause of cerebrospinal fluid obstruction and ventriculomegaly is: A: cerebellar agenesis B: aqueductal stenosis C: Dandy Walker malformation D: congenital hydrocephalus

B The most common cause of cerebrospinal fluid obstruction and ventriculomegaly is aqueductal stenosis.

A pregnant patient presents with a recent acute onset of hypertension, nausea and vomiting. She has no pain, cramping or vaginal bleeding. A prior ultrasound exam at 6 weeks indicates the pregnancy should not be 17 weeks 6 days in gestational age. Based on the findings demonstrated on the video, what maternal serum level will be abnormally elevated? A: inhibin A B: beta hCG C: acetylcholinesterase D: alpha fetoprotein

B The video demonstrates gestational trophoblastic disease. The acute onset of maternal HTN should cause suspicion of molar pregnancy. Significant elevation in bhCG levels are associated with molar pregnancy. The thick placenta demonstrated molar degeneration. The fetus has a narrow thorax and the head is larger than the body, increased HC/AC ratio. The bowel is mildly echogenic, but the abdominal wall is intact. Most fetuses associated with molar pregnancy have triploidy. Asymmetric IUGR with a large head and small body is a typical sign of triploidy.

What pedal abnormality is associated with trisomy 13 and 18? A: taliipes equinovarus B: polydactyly C: rocker bottom foot D: club foot

C A pedal anomaly refers to an anomaly of the foot. Rocker bottom foot is commonly associated with trisomy 9, 13 and 18.

Which of the followiing statements correctly describes cystic hygroma? A: demonstrates increased AFP when associated with Down's syndrome B: can appear complex when meninges is present in the cerebrospinal fluid C: demonstrates decreased AFP when associated with Turner syndrome D: most commonly occur on the posterior sacral spine

C Cystic hygromas are formed by a lymphatic system obstruction and are filled with lymphatic fluid. The cystic area usually demonstrates septations within the fluid. If it is an isolated finding, there is no change in AFP levels, AFP levels decrease with Turner syndrome and trisomy 21. The most common location is on the posterior neck (at the level of the cervical spine).

Which of the following is NOT commonly seen with Turner syndrome? A: hypoplastic left heart B: renal agenesis C: duodenal atresia D: streak gonads

C Cystic hygromas, lymphedema, HLHS, renal defects and streak gonads are commonly associated with Turner syndrome.

Which of the following trisomies has a significant association with choroid plexus cysts? A: 9 B: 13 C: 18 D: 21

C Edward syndrome has a significant association with choroid plexus cysts identified earlier in the pregnancy. Esophageal atresia, diaphragmatic hernia, strawberry shaped skull and clenched hands are also common anomalies seen with trisomy 18.

Which of the following is the least likely maternal complication of a multifetal pregnancy? A: postpartum hemorrhage B: hydronephrosis C: renal calculus D: preeclampsia

C Maternal complications of a multifetal pregnancy include anemia, preeclampsia/eclampsia, systemic HTN, placental abruption, pre-term labor, and post-partum hemorrhage.

Which of the following describes a sign of fetal distress identified by ultrasound late in the pregnancy? A: vernix in the amniotic fluid B: placenta calcification C: meconium in the amniotic fluid D: subchorionic hemorrhage

C Meconium is fetal waste that accumulates in the bowel in the 3rd trimester. If it is expelled into the amniotic fluid, the fetus is in distress. Vernix refers to the normal shedding of skin cells and ahri late in the pregnancy.

Which acronym describes when the amnion ruptures too early in the pregnancy? A: IUGR B: VACTRLS C: PROM D: TORCH

C PROM or premature rupture of membranes can lead to many complications including fetal distress, fetal demise and premature delivery. IUGR refers to intrauterine growth restriction of the fetus. VACTRLS refers to a syndrome of fetal anomalies: V - vertebral anomalies / dysgenesis, vascular anomalies; A - anal atresia; C - cardiac anomalies; T - tracheo-esophageal (T-E) fistula; R - renal anomalies, radial dysplasia; L - limb anomalies; S - single umbilical artery TORCH refers to intrauterine infections; toxoplasmosis, other, rubella, cytomegalovirus, herpes

Holoprosencephaly is commonly associated with what fetal syndrome? A: Noonan B: Turner C: trisomy 13 D: trisomy 21

C Patau (T13) syndrome is commonly associated with holoprosencephaly, ventriculomegaly, median clef lip, hypoplastic left heart and 2 vessel cord.

Which of the following is described as invasion of the placental chorionic villus through the myometrium and uterine wall? A: adenomyosis B: placenta increta C: placenta percreta D: placenta accreta

C Placenta accreta refers to invasion of the chorionic tissue through to endometrium and attaches to the myometrium. Placenta increta occurs when the chorionic tissue ivades the myometrium. Placenta percreta when the chorionic tissue extends through uterine wall to bladder and adjacent pelvic structures.

Which of the following statements is correct regarding autosomal dominant polycystic kidney disease? A: it is an acquired disorder of the kidneys B: neither parent must have the same abnormality C: both kidney(s) will be increased in size with multiple cysts D: it is usually fatal early in life

C The autosomal recessive (infantile) form of PCKD is always fatal. Microcysts form throughout the fetal renal parenchyma causing significant malfunction. If the fetus survives until birth, they die soon after. The autosomal dominant form of PCKD does not usually manifest until the fifth decade of life. It may affect renal function later in life but is not usually fatal. Both kidneys are affected if the genetic disorder is present. A dominant trait is passed on from a parent that has the same trait.

The arrows in the image are pointing to which of the following? A: an abnormal choroid plexus B: an abnormal thalamus C: an abnormal cerebellum D: a normal cerebellum

C The cerebellum is abnormal in appearance and demonstrates the banana sign. The normal cerebellum is "dumb bell" shaped.

Which of the statements is true regarding the findings on the image? A: the cervix is of normal length and demonstrates the normal position of the mucous plug at 38 wks gestation B: the cervix is abnormally shortened but a cerclage is in place to prevent early delivery C: the cervix is abnormally shortened and intervention is necessary to prevent early delivery D: the cervix is normal in length and but there is a bulging of the fetal membranes into the dilated cervix

C The cervix is abnormally dilated and foreshortened. Intervention should be performed as soon as possible. The most common procedure used to correct the issue is cerclage placement. Length < 2.5cm at GA < 30wks indicates potential preterm delivery. A cervical length less than 3.0 cm at GA <34 weeks indicates cervical incompetence. Dilated >2cm at anytime before expected delivery is abnormal. Funneling of membranes into the cervix increases the risk of early delivery.

Which of the following types of placenta previa is defined as placement of the placenta tip within 2cm of crossing the internal os? A: partial previa B: velamentous previa C: low lying placenta D: vasa previa

C Vasa Previa = vessels covering the internal os. Low lying placenta refers to when the placental tip is within 2cm of the internal os. Marginal previa refers to when the placental tip is located at the edge of the internal os. Partial previa refers to the internal os being partially covered by the placenta. A velamentous umbilical cord insertion refers to a placental insertion that attaches to the uterine wall and then travels into the placenta.

A cystic hygroma contains ____. A: meninges and cerebrospinal fluid B: cerebrospinal fluid C: amniotic fluid D: lymphatic fluid

D A cystic hygroma forms due to an obstruction of the lymphatic system.

A fused thalamus is identified in which of the following cranial abnormalities? A: semilobar holoprosencephaly only B: alobar holoprosencephaly only C: agenesis of the corpus callosum and alobar holoprosencephaly D: alobar and semilobar holoprosencephaly

D A fused thalamus is identified in alobar and semilobar holoprosencephaly. The cerebral tissues lack the normal separation and interhemispheric fissure.

Which type of aneuploidy is associated with a shortened middle phalanx of the fifth digit? A: triploidy B: trisomy 13 C: trisomy 18 D: trisomy 21

D Absence of the nasal bone and a shortened middle phalanx of the fifth digit are characteristics of trisomy 21 or Down's sydrome.

A 16wk fetus is referred for an anatomy scan. During the fetal head evaluation, the calvarium is found to be absent. Cerebral tissue is present, but has an irregular appearance. What is the diagnosis for the findings? A: Dandy-Walker malformation B: arhinia C: encephalocele D: acrania

D Acrania refers to the lack of formation of the calvarium portion of the skull. Brain tissue is usually present but malformed and misshapen.

Which of the following terms is described as an abnormal homogenous, soft tissue mass usually protruding from the anterior cranium or face with associated arhinia? A: anostomia B: epidermal cyst C: teratoma D: proboscis

D Arhinia refers to the absence of the nose, which is a complication usually seen with proboscis formation.

What are the common fetal findings when the mother has a history of HIV? A: macrocephaly, macroglossia, renal abnormalities B: polyhydramnios, anencephaly C: severe cardiac defects D: IUGR, hepatomegaly

D Because infection leads to placental insufficiency, IUGR is a common finding with maternal infections. Hepatosplenomegaly is also commonly seen with an infection.

Which of the following findings are most suggestive of Beckwith-Wiedemann syndrome? A: multicystic dysplastic kidneys and polydactyly B: oligohydramnios and esophageal atresia C: renal agenesis and mid-face hypoplasia D: macrosomia and polyhydramnios

D Beckwith-Wiedemann syndrome: Most common findings are a triad of macrosomia, omphalocele, and macroglossia. Polyhydramnios occurs in part due to swallowing difficulties and the fetal ability to process amniotic fluid is diminished.

Which pedal abnormality is commonly seen with spina bifida? A: rocker bottom foot B: polydactyly C: splayed digits D: talipes equinovarus

D Club foot (talipes equinovarus) is a pedal abnormality that is commonly seen with spina bifida.

Blood in the fallopian tubes is called ____ and pus in the fallopian tubes is called ____. A: hydrosalpinx; hematometrocolpos B: hematometrocolpos; pyometra C: hydrosalpinx; pyometra D: hematosalpinx; pyosalpinx

D Hydrosalpinx - fluid in the fallopian tubes Hematosalpinx - blood in the fallopian tubes Pyosalpinx - pus in the fallopian tubes

Maternal alcoholism is most associated with IUGR, microcephaly, hypotelorism and: A: macrosomia B: hydrocephalus C: trisomy 13 D: cardiac defects

D Maternal binge drinking can lead to fetal alcohol syndrome which is associated with IUGR, microcephaly, hypotelorism and cardiac defects. Trisomy 13 is a chromosomal abnormality. Hydrocephalus and macrosomia would indicate a large head/fetus.

Which of the following terms is defined as foreshortening of the bones in the hands and feet? A: micromelia B: mesomelia C: rhizomelia D: acromelia

D Mesomelia is foreshortened distal limbs. Acromelia is foreshortened hand and foot bones. Micromelia is a foreshortening of the entire limb. Rhizomelia is foreshortened proximal limbs. Achondroplasia refers to dwarfism.

A clover-leaf skull is commonly associated with which skeletal dysplasia? A: club foot B: achondrogenesis C: spina bifida D: thanatophoric dysplasia

D Thanatophoric dysplasia is associated with a clover shaped skull, pulmonary hypoplasia, short ribs, polyhydramnios, severe micromelia, and bowing of long bones. It is the most common lethal skeletal dysplasia.

Which of the following abnormalities is considered the most severe form of a twin to twin transfusion? A: conjoined twins B: acrania C: holoprosencephaly D: acardia

D The acardiac twin has no connection to the placenta. The umbilical arteries and vein join the arteries and vein of the donor twin. The donor twin or "pump twin" eventually goes into heart failure from pumping the blood of two fetuses.

The banana sign seen here is demonstrated in what % of patients with spina bifida? A: 50% B: 75% C: 85% D: 99%

D The banana sign is more accurate than the lemon sign in predicting spina bifida.

The most common intracardiac mass seen in a fetus is: A: myxoma B: fibroelastoma C: sarcoma D: rhabdomyoma

D The most common intracardiac mass seen in a fetus is rhabdomyoma. I tis composed of striated muscle cells and appears as an echogenic mass on the ultrasound exam. It is associated with maternal tuberous sclerosis.

The findings on the video are highly suggestive of: A: triploidy B: fetal alcohol syndrome C: vanishing twin syndrome D: pentalogy of Cantrell

D The video demonstrates an omphalocele and ectopia cordis. Note the umbilical cord membrane surrounds the abdominal mass. These two findings are highly suggestive of pentalogy of Cantrell. Pentalogy of Cantrell is categorized by a combination of midline birth defects that typically involve the sternum, diaphragm, the pericardium, the abdominal wall, and the heart.

While performing an anatomy scan on a 28wk gestation, you begin to image the umbilical cord. The cord appears abnormally thickened, but contains vessels of normal size and number. Which of the following could explain these findings? A: placental hypertension B: fetal hypertension C: flow reversal in the umbilical vein causing cord edema D: excessive Wharton jelly within the cord

D Wharton jelly surrounds the umbilical vessels within the cord. It acts as a cushion and a lubricant to allow the vessels to move and bend easily.

Chorioangioma is suspected. Which of the above images is most suggestive of that diagnosis? Use your mouse to position the cursor over the image and click to select your answer.

Image A is a solid hypervascular mass in the placenta that indicates a chorioangioma. Image B is an allantoic cyst in the umbilical cord. Image C is a partial molar pregnancy with a fetus and a molar pregnancy in the uterus. Image D is a Grade 3 placenta with placental lakes.

Which image is most suggestive of an amniotic band? Use your mouse to position the cursor over the image and click to set your answer.

Image top left: diamniotic twins with membrane separating gestational sace. Note the 2 placentas, one posterior and one anterior. Image top right: uterine syndechia - note the membrane is the same echogenicity as the uterine tissue and thicker than an amniotic membrane. It also does not touch the fetus. Bottom image: amniotic band - note the membrane is very thin and is in contact with the fetal structures.