OB/GYN DMS

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Lissencephaly

"Smooth brain"; condition where there is little to no gyri or sulci within cerebral cortex

dizygotic twins

- Often called fraternal twins, occurring when two eggs each get fertilized by two different sperm, resulting in two zygotes in the uterus at the same time -Will usually demonstrate two chorions, two amnions and two placentas (can appear as one large placenta) -Can be same sex or different -Most common type of twins

Trisomy 21 is associated with

- increased nuchal translucency - low AFP - Increased NSF thickness - absent nasal bone - frontal bossing - foreshortened femur and humerus - echogenic bowel - EIF - ASVD - hypoplasia of the midline phalanx of the 5th digit

Trisomy 18 (Edwards Syndrome)

-3 copies of chromosome 18 -2nd most common trisomy -Usually lethal in utero or just after birth -Low levels of AFP, Estriol, hcG, and PAPP-A -Renal agenesis -2VC -strawberry shaped skull -IUGR -CP cysts -Esophageal atresia -Polyhydraminos -Omphalocele -Clenched hands -Rocker bottom feet

symptoms of preeclampsia

-BP greater 140/90 -Edema -Proteinuria -Sudden maternal weight gain -Low platelet count -Increased LFTS

Chorioangioma

-Benign highly vascular tumors of the placenta, large ones can cause IUGR, Hydrops and Abruption -Associated with polyhydraminos

Symptoms with retained products of conception

-Fever -Anemia -Fatigue

Hypophosphatasia

-Lethal -Rare metabolic bone disease characterized by the deficiency of alkaline phosphatase.

limb-body wall complex

-Lethal defect caused by amniotic band syndrome. -Limbs may be absent. -Abdominal contents are not covered. - Cord very short or absent

Congenital Cystic Adenomatoid Malformation (CCAM)

-Most common chest mass identified in fetus -Usually unilateral but effects the entire lung Macrocystic- (I) 2-10 cm Most commmon Medium cystic (II) Or microcystic (III) <0.5 cm.

Thanatophoric skeletal dysplasia

-Most lethal type of skeletal dysplasia -Autosomal dominant -Macrocrania, cloverleaf skull -Frontal bossing -Short ribs -Pear or belly shaped thorax -Pulmonary hypoplasia -Polyhydraminos -Severe micromelia -Bowing of long bones

Amniocentesis screens for:

-Rh disease -Spinal defects;increased acetlycholinesterase/ACHE -Lung maturity/ lecithin-sphingomyelin ratio is the modt common reason for testing -DNA testing -Karyotyping

Fetal lung volumetry performed with 3D should be used to diagnose

-Skeletal dysplasia Pulmonary hypoplasia is a common finding with skeletal dysplasia and fetal lung volumetry performed by 3D sonography more accurately predicts pulmonary hypoplasia than thoracic circumference.

Signs of fetal demise that occured more than a week ago

-Spalding's sign: suture overlap on skull -Deuel's Sign: Scalp edema -Robert's Sign: Air in circulatory system Abnormally low AFI Fetal edema Amnion and chorion separation

Which arteries supply the functionalis layer of the endometrium?

-Spiral -Straight arteries supply the basalis layer of the endometrium

Lobar holoprosencephaly

-The least severe form of the holoprosencephaly - Absence of the septum pellucidum - This is a failure to CLEAVE - Brain cleavage happens form back to front (so this is just a failure to cleave the front) - The thalami are almost COMPLETELY SEPERATE - Basically you just have fusion of the anterior horns of the ventricles (which means you know NO septum pellucidum)

IUGR is associated with

-methotrexate use -alcohol consumption -maternal smoking

Alobar holoprosencephaly

-most severe form of holoprosencephaly --characterized by a single common ventricle and a malformed brain

monozygotic twins

-twins who are genetically identical -most are diamniotic

The R.I of the umbilical artery should be under

0.8

BPP/ requirement for tone

1 tone movement within 30 mins

TV sonography can detect embryologic changes in the uterus about _______ earlier than transabdominal techniques.

1 week

gestational sac should be seen when bhCG reaches what

1,000 mIU/mL

4 stages of PID

1. Acute Endometritis 2. Acute Salpingitis- thick-walled acute infection (>5mm); Cogwheel sign 3. Acute tubo-ovarian abscess 4. Chronic infection: hydrosalpinx with thin-walled fallopian tube (>5mm) Beads on a string sign

Shone Complex

1. Coarctation of the aorta 2. Subaortic stenosis 3. Parachute mitral valve 4. supramitral ring

The nuchal translucency is measured at what gestational age?

11-14 wks

Fetal kidneys can be identified as early as ______ wks Fetal bladder can be identified as early as _______ wks

12 10

At what fetal age do the kidneys begin to produce urine?

12 wks

FL can be measured as early as

12 wks gestation

At what fetal age do the kidneys begin to produce urine?

12 wks. Completely taken over fluid production by 16 wks

conjoined twins are caused by cleavage of the morula after day ____ of pregnancy

13

Pentology of Cantrell is associated with which trisomies

13 and 18

Fetal stomach should be visualized by

14 weeks

GENETIC AMNIOCENTESIS IS PERFORMED AT WHAT GESTATIONAL AGE

15 wks

The normal cranium should be identified by ____ wks GA

15 wks. by this time, the cranial bones should have ossified, the shape/size should be normal, and the bony calvarium should properly surround brain tissues.

The secretory phase occurs

15-28

Chromosomal defects may be present in a pregnancy where the chorion and amnion have not fused by _____ wks gestational age

16 weeks. At the start of week 12, the amnion and chorion begin to fuse and should be complete by week 14. If not fused by 16 wks, 60% usually have other anomalies.

Embryo should be seen with MSD >

16mm

Which trisomy is commonly associated with a strawberry shaped fetal skull

18

A diagnosis of IUGR is made when biometric measurements are more than __ deviations below normal

2

An increase in ______ degrees celsius or more in the womb can have adverse effects on the pregnancy

2

Greater than ___ mm thickness indicates dichorionic twins

2

The S/D ratio in the umbilical artery should be less than

2

The corpus in a multiparous uterus is usually at least ____________ the cervix.

2 times the length of.

Fetal growth follow up exams should be performed at an interval of

2 weeks or more

Standard BPD accurately provides GA before ______ wks gestation

20

Glucose sampling is usually performed at ______ wks gestation

24-28

Post menopausal ovaries should not exceed ______ in any dimension

2cm

Measure how many cycles for umbilical dopper

3

BPP/ requirement for gross movement

3 movements within 30 mins

Triploidy

3 sets of all three chromosomes

Accuracy of predicting age in first trimester are accurate within

3-5 days

Twins will exhibit the same growth pattern as a fetus in a singleton pregnancy until __________ weeks

30

During a 30 minute BPP what is the minimum amount of fetal breathing

30 seconds

The fetal testicles usually descend into the scrotum before ____ weeks gestation.

34

32 cell blastocyst enters the uterus approx ________ days after fertilization and implants into the endometrium _________ days post fertilization

4-5 5-7

Macrosomia describes a fetus weighing more than

4000g

A fetus with male genitalia and ovaries would be described as:

46XX intersex

A fetus with male genitalia and ovaries would be described:

46XX intersex

A female with female genitalia and testes would be described as

46XY

Preeclampsia is associated with placental insufficiency and oligohydraminos. What AFI value would be associated with preeclampsia?

4cm Oligo = below 5 cm AFI Poly= above 24 AFI

Discordant twin growth is present when there is more than ________ difference in fetal weight between the two fetuses

500g

On TV sonography, cardiac activity should be seen in a CRL of ______ or greater

5mm

The post partum period ususally lasts

6-8 wks

The neural tube closes by

6th week gestation

Organogenesis of a fetus is normally complete by

8 weeks

Average nulliparous uterus size

8 x 5 x 3cm

If the gestational sac measures 30x 30x 40 mm what is the estimated age of the pregnancy?

9 weeks + or - 14

RI of an ovarian mass suggesting malignancy

<.4

PI of an ovarian mass suggesting malignancy

<1.0

On TV US the minimum MSD that should always demonstrate a normal IUP is:

>16 mm MSD should always demonstrate a fetal pole TV >25mm MSD should always demonstrate a fetal pole TA

What AFI would be associated with Spina Bifida?

>20cm

Brachycephaly

A CI is >85%, rounded head, BPD elongated more to fit OFD, more commonly a normal variant than anomaly. When abnormal can be associated with Trisomy 21 and spina bifida.

If the stomach and the heart are visible in the same transverse image

A diaphragmatic hernia is present

Asymmetric IUGR

AC measures more than 2 deviations smaller than HC for the current gestational age.

The triple screen test evaluates

AFP, bHCG, and estriol

Eagle-Barrett syndrome

AKA prune belly syndrome Deficiency of abdominal musculature -weakened abdominal musculature with significantly dilated bladder, ureters, and kidneys -distended bladder with bilateral hydronephrosis -oligohydraminos -pulmonary hypoplasia usually making this abnormality lethal -posterior urethral valves is the most common cause

Heart defect associated with ellis van creveld syndrome

ASD

Ebstein's anomaly

Abnormal placement of tricuspid valve Tricuspid flaps fused to inside of right ventricle; creates constant opening between atrium & ventricle more inferiorly to the apex of the right ventricle.

If the cranium is not identified in a 16 wk fetus ________ should be expected.

Acrania

Benign uterine condition characterized by invasion of the myometrium by endometrial tissue

Adenomyosis Endometriosis is implantation of endo outside of the uterus

Neuroblastoma

Adrenal malignancy seen in children

Steroli leydig cell tumor

Also called androblastoma malignant ovarian tumor that raises testosterone levels

The most common place for normal egg fertilization is in which of the following segments of the fallopian tube?

Ampulla

An egg that is fertilized by two sperm will have

An extra full set of chromosomes = Triploidy

Virilization (masculinization) is associated with

Androblastoma Steroli Leydig Tumor AKA Arrhenoblastoma AKA Androblastoma, is a benign ovarian tumor that secretes testosterone. It can cause hirsutism, male pattern baldness, decreased breast size, and deepening of the voice

An intrauterine fetal blood transfusion may be used to treat what?

Anemia and severe immune hydrops

Defects caused by failure of neurulation during fetal develoment

Anencephaly, spina bifida, encephaloceles, and myelomeningoceles

Most common cause of of CSF obstruction and ventriculomegaly

Aqueductal Stenosis

If a fetus has autosomal dominant polycystic kidney disease (ADPKD):

At least one parent has it.

Placental thickness should be measured

At the cord insertion site

The uterine artery is best sampled at:

At the level of the cervix

Enlared echogenic kidneys with oligohydraminos

Austomosomal Recessive Polycystic Kidney Disease

Which of the follwing structures is located anterior to the ovary? A. ureter B. rectus abdominis muscle 3. internal iliac vein 4. internal iliac artery

B. Rectus abdominis muscle

Brenner tumor

BENIGN. similar to other solid ovarian neoplasms, particularly fibromas, and can also be confused with pedunculated leiomyomas. They are mainly hypoechoic solid masses. Calcifications have been reported in 50% of Brenner tumors on ultrasound.

Macrocephaly is identified when

BPD and HC are 2 or more standard deviations above the average for gestational age

Premature delivery is

Before 37 wks

The ratio of kidney diameter to the abdominal diameter should be

Between 0.23-02.7 for the entire pregnancy

Normal AFI but non visualization of bladder

Bladder exstrophy- epispadias complex

Hematometra refers to ____________ while Hematometrocolpos refers to _________________

Blood dilating the uterine cavity; Blood dilating the uterine cavity, cervix, and vagina

Turners Syndrome

Born with a single X chromosome. (short, webbed neck, different physical sexual development.)

increase in distolic flow in the MCA is indicitave of

Brain sparing

Which of the following is not true regarding a cystic hygroma? A. Usually presents as a thin walled cystic mass with septations B. Similar in appearance to encephalocele or myelomeningocele C. Strong association with trisomy 18 D. Associated with hydrops, pleural effusion, and anasarca

C. Cystic hygroma is strongly associated with chromosomal abnormalities which effect AFP levels, (downs syndrome-low AFP, turners syndrome-low AFP)

erythoblastosis fetalis

Caused by an Rh+ father and baby and an Rh- mother Can lead to immune fetal hydrops Commonly treated by fetal blood transfusion

Congenital high airway obstruction syndrome (CHAOS)

Caused by an obstruction in the fetal upper airway. Complete atresia of the airway is commonly associated with a tracheoesophageal fistula. Common sonographic findings include: dilated, fluid-filled trachea, bilateral symmetrically enlarged hyperechoic lungs, and flattened or everted hemidiaphragms.

cystic hygroma

Cavernous lymphangioma of the neck. Associated with Turner syndrome.

A cisterna magna measuring greater than 10 mm is a common finding with

Cerebellar agenesis and dandy walker malformation

You are performing a third trimester scan with possible oligohydraminos. Which of the following should be evaluated to find the cause?

Cervix for dilation and leakage, and kidneys being present. If one or both kidneys are absent, oligohydraminos will be present.

Most common cause of PID

Chlamydia

Most common cause of pleural effusion in a fetus

Chlyothorax

Early onset of IUGR in the first trimester is usually symmetric and associated with

Chromosomal anomalies

Imaging the fundus of an anteverted uterus, the handle of the transvaginal probe should be angled:

Closer to the bed

levocardia

Condition whereby the heart is in the normal left side of the thoracic cavity, but the remaining organs are transposed to the side opposite to their normal position.

Functional tissue of the ovary

Cortical tissue (thinner in postmenopausal women)

Allantoic cyst

Cyst of the umbilical cord

Ovarian tumor that contains both epithelial and stromal components

Cystadenofibroma

The autosomal recessive disorder that is associated with meconium ileus and fetal bowel obstruction

Cystic fibrosis

Cystic hygroma is strongly associated with chromosomal abnormalities which effect ______

Cystic hygroma is strongly associated with chromosomal abnormalities which effect AFP levels; Down Syndrome (Low AFP), Turner Syndrome (low AFP).

Ovarian tumor that demonstrates "tip of the iceburg sign"

Cystic teratoma

A rotikansky nodule is commonly identified with what type of pelvic mass?

Cystic teratoma. Rotikansky nodule is another term used to describe dermoid plug

Most common reported intrauterine infection during pregnancy

Cytomeglavirus

Multiple small calcifications are identified in the fetal liver and brain. Mild ventriculomegaly is also noted. What is the most likely cause of these findings?

Cytomeglovirus infection

A patient presents for an ultrasound due to uterine size not matching the leveles of bhCG for expected age of pregnancy. The uterus is enlarged with a large heterogenous mass that seems to have invaded the uterine wall into the peritoneum. The pelvic nodes are normal and the liver is clear. These findings are most consistent with: A. choriocarcinoma B. hydatidform mole C. retained products of conception D. chorioadenoma destruens

D. Chorioadenoma destruens Chorioadenoma destruens refers to an invasive molar pregnancy. The mass of abnormal tissue will only invade the uterus and surrounding pelvic structures. A hydatidifrom mole is contained to the uterus.

Which of the following demonstrates normal flow in a fetus with anemia? A. umbilical vein B. descending aorta C. middle cerebral artery D. umbilical artery

D. Umbilical Artery The uterine and umbilical artery flow resistance/velocity is usually normal and not helpful in the diagnosis of fetal anemia. Blood flow velocitites

Which of the following would be differential diagnosis for cystic formation in the posterior fossa

Dandy Walker Malformation and Blake pouch cyst

Which of the following can predict erythroblastosis fetalis using a sample of amniotic fluid

Delta OD450- evaluates excessive amounts of billirubin from fetal anemia

Agenesis of corpus callosum can be ruled out by

Demonstration of normal cavum septum pellucidum. The choroids should also be evaluated for the classic teardrop appearance.

"Tip of the iceberg" sign is associated with:

Dermoid cyst

Double bleb sign

Description of the distinctive sonographic appearance of the embryonic disk situated between the newly developed amniotic cavity and secondary yolk sac within the chorionic cavity at 4-5 weeks gestational age.

Trophoblastic cells

Develop chorionic villi into the placenta, produce progesterone and hcg, involved with implantation

Echogenic foci in the myometrium could most likely be caused by?

Diabetes

If the fetus are two different genders, this indicates

Dizygous twins

Elevated serum levels of lactate dehydrogenase are related to which of the following ovarian neoplasms?

Dysgerminoma The only ovarian tumor that effects LDH. It also increases bhCG and CA 125

What phase is the endometrium the thinnest?

Early proliferative

The term used described a thoracic defect where the heart is herniated outside the chest wall

Ectopia cordis

Chorioangiomas are associated with

Elevated MSAFP

Most common in the amish country and presents as mesomelia, polydactly, narrow thorax, and cardiac defects?

Ellis Van Creveld Syndrome

Absence of cardiac activity on 9 mm is indicative of

Embryonic demise

What can cause increased CA125?

Endometriosis, PID, fibroids, endometrial carcinoma, ovarian carcinoma

Ring down artifact (sound meets air) can be seen with:

Endometritis (will cause production of air in endometrial canal)

Oxygenated blood from the placenta....

Enters the umbilical vein, then the left portal vein or ductus venosus, then the IVC, then the right atrium

Most primary malignancies of the ovary originate in the

Epithileal stromal tissues

Which hormone stimulates the cervix to produce mucous just prior to ovulation?

Estrogen

what is responsible for stimulating the contraction of the fallopian tubes to propel the egg toward the uterine cavity?

Estrogen

What should you evaluate if there is suspected amniotic band syndrome?

Evaluate for assymetric facial clefting in the coronal plane.

Bladder exstrophy

Eversion of the posterior bladder through the anterior bladder wall and Lower abdominal wall

Primary ammenorrhea

Failure to menstruate by 15-16 years of age in someone with secondary sexual characteristics

In most cases, UNIlateral renal agenesis will demonstrate what?

Fetal Bladder and normal AFI. Bilateral renal agenesis will demonstrate no bladder and polyhydraminos.

10 weeks to delivery

Fetus Zygot until 10 weeks

Most common mass seen with pregnancy?

Fibroid

Perihepatic adhesions and peritonitis are seen with:

Fitz-Hugh-Curtis Syndrome Fitz Hugh Curtis Syndrome is a complication of PID leading to inflammation of the glissons capsule, perihepatic adhesions and peritonitis.

The sonographic appearance of hydrancephaly

Fluid filled sacs of cerebrospinal fluid in the cranial cavity, varying amounts of tissue remain as atrophy and necrosis occurs

The ovary is found in the

Fossa of Waldeyer

Placental thickness should be equal to

GA in weeks + 10mm (Ex: 20 week pregnancy placental should be 30mm)

Cyst that forms from Gartner ducts in the vaginal canal

Gartner cyst

Robert's Sign

Gas in the fetal circulatory system

What anomaly involves the fetal digestive system and has been associated with maternal use of aspirin during pregnancy?

Gastroschisis

Maternal ibuprofen use has been associated with

Gastroschisis and premature closure of ductus arteriosus

Donor twin in twin to twin transfusion will demonstrate

Growth restriction, appears to be stuck to wall due to oligohydraminos

A patient presents for a fetal anatomy scan due to a recent cytomegalovirus. Which of the following supplemental measurements should be performed during the exam to evaluate the effects of the virus?

Hepatic length Any infections in the TORCH category can lead to hepatomegaly and splenomegaly.

If maternal syphillis goes untreated, what change will be seen in the fetus?

Hepatomegaly -Syphilis can cause premature aging of the placenta and swelling of the fetal liver and spleen. If untreated with pinicillin, the fetus can demonstrate blindness, deafness, deformity of the face, and central nervous system problems.

Cloacal Extrosphy

Herniation in the pelvis involving the intestines and or/bladder

Which of the following is the most common type of non lethal skeletal dysplasia?

Heterozygous achondroplasia

First trimester uterine artery resistance should be

High

What kind of doppler will partial ovarian torsion demonstrate?

High resistance

Which of the following describes the doppler waveforms obtained from the non gravid uterus?

High velocity, high resistance

Which of the following describe a PW doppler tracing obtained from tissues surrounding the dominant follicle?

High velocity, low resistance flow

Hirchsprung's disease

Hirschsprung's disease (congenital megacolon) EXPECTED FINDINGS: Dilated bowel loops throughout fetal abdomen

Symmetric or midline clefts are associated with

Holoprosencephaly

The binocular distance should be measured in suspected cases of:

Holoprosencephaly and midface hypoplasia. Turner syndrome is also associated with facial defects.

Abnormal fluid retention in at least 2 fetal structures

Hydrops

Recipient twin in twin to twin transfusion will demonstrate

Hydrops, heart failure, and polyhydraminos due to increased arterial flow in the placenta

IDDM/NIDDM is associated with

IUGR

What is a sign of maternal HTN on u/s?

IUGR Maternal HTN can cause placental insufficency and thinning of the placenta which can lead to IUGR

Quad screen results for a fetus with Trisomy 21 would include which of the following?

Increased hCG and decreased MSAFP Decreased PAPP-A are also associated with Trisomy 21

In a fetus with IUGR, you would expect to see ______ flow in the MCA, and _______ flow in the umbilical artery doppler

Increased; Decreased

Cullen Sign

Indicates ruptured ectopic

When imaging the fundus of the retroverted uterus, the transducer should be angled so that the handle:

Is farther from the bed

When evaluating a patient for a large fibroid mass, what other organs should be evaluated as well?

Kidneys for hydronephrosis. Large masses in the uterus or ovaries can lead to extrensic compression of the ureters causing hydronephrosis.

nagaele's rule

LMP + 7 days - 3 months + 1 year

Calculating ovarian volume

LXWXHX0.523

Which form of achondrogenesis is least severe?

Langer-Saldino

Placental Lakes

Large pools of maternal slow moving (non turbulent) venous blood within the placenta.

The left ovary empties into the ________. The right ovary empies into the ______.

Left renal vein; IVC

When a malignant neoplasm is identified on the right ovary what other structures should be evaluated for possible involvement?

Liver, bladder, and pelvic lymph nodes

Second and 3rd trimester uterine artery resistance should be

Low

Which of the following describes the doppler waveforms obtained from the uterine artery of the gravid uterus?

Low resistance, average velocity

Normal flow patterns in the ovary

Low velocity, low resistance

Gestational diabetes is associated with

Macrosomia

A patient presents for a limited follow exam after the previous demonstrated possible hydrocephalus. What should you do first to evaluate the fetus for hydrocephalus?

Measure the lateral ventricles

A calcification in the fetal liver is associated with:

Meconium peritonitis

Most likely symptom of endometriosis?

Menorrhagia

Where should UA be sampled

Mid cord

Low hCG levels could mean

Miscalculation of age Miscarriage or blighted ovum Ectopic

Acute onset of maternal HTN in the first trimester is a strong indicator of

Molar pregnancy

One ys with two embryos indicates

Monoamniotic twins

Cranial vessels should ALWAYS be

Monophasic with forward flow

A paraovarian cyst is also known as

Morgangi or mesonephric cyst

Malformation of the cloaca

Most common cause of fetal urethral valve obstruction in females

Rhabdomyoma

Most common pediatric tumor of the heart. They have been associated with tuberous sclerosis.

Unilateral enlargement of one kidney containing multiple cysts varying in size

Multicystic dysplastic kidney

In stage 1 endometrial cancer, the cancer has invaded the ______ but is still confined to the uterus

Myometrium

Unilateral renal agensis may result in

Normal amniotic fl

Risk factors of endometrial cancer

Nulliparity, obesity, early menarche (<12 yrs), late onset of menopause, high-fat diet, endometrial hyperplasia, family history, and infertility, birth control pills, tamoxifen, pcos

Chiari II malformation

Obliteration of the cisterna magna, lemon sign, banana sign

Hydrancephaly is caused by

Obstruction of the ICA which leads to cerebral tissue destruction

The majority of encephaloceles are located in the _______ region.

Occipital

Asymmetric IUGR

Occurs due to shunting of the brain that is normally intended for the abdomen. This is the fetal response to diminished flow. Flow is rerouted to the brain to spare its growth.

Will spina bifida aperta, or oculta have increased AFP levels?

Oculta will demonstrate normal AFP levels. AFP levels will increase with open defects of the fetal structure.

theca lutein cyst

Often bilateral/multiple. Due to gonadotropin stimulation. Play an important role in the development of the corpus luteum. Associated with choriocarcinoma and moles.

What is related to increased AFP levels?

Omphalocele, multiple gestation,

Chiari II malformation is strongly associated with

Open spina bifida

The AV canal defect is a combination of:

Ositum primum ASD and inlet VSD

How should you measure the endometrium?

Outer edge of the functionalis layer to the outer edge of the opposing functionalis layer

OFD measurement

Outer skull to outer skull

A patient with RLQ pain increasing over the last few months. The exam contains an abnormal right ovary with a 3 cm echogenic mass. The posterior borders of the mass are difficult to assess due to dirty shadowing.

Ovarian Teratoma (Can often contain hair, teeth, bone, thyroid, etc). - A dermoid is an ovarian teratoma which is a type of germ cell tumor. The mass is composed of thick ectodermal tissues that causes dirty shadowing.

Krukenburg

Ovarian metastisis from GI tract. Bilateral solid ovarian tumors

The whirlpool sign is demonstrated with

Ovarian torsion

The follicular ring sign is associated with what

Ovarian torsion Follicular ring sign- perifollicular hyperechoic rim, 1 to 2 mm in thickness, identified

Estrogen stimulates the endometrium to thicken before _____________. Progesterone stimulates endometrial thickening in the ____________ phase for possible implantation. If implantation does not occur, progesterone levels decrease and menses occurs.

Ovulation; secretory phase

Increased resistance to blood flow indicated the fetus is not receiving

Oxygen, nutrients

Which of the following is most likely to cause polyhydraminos, fetal ascites, and hepatomegaly?

Parvovirus infection

which uterine wall layer is composed of fibrous connective tissue?

Perimetrium. the uterine serosa is also called the perimetrium

A/an ______ can lead to the initial onset of ovulation and uterine enlargement in females __________ years old.

Pituitary tumor; less than 8 yrs old

What is described as invasion of the placental chorionic villus through the myometrium and uterine wall?

Placenta Percreta

Hypoechoic areas in the placenta that displays turbulent flow on color doppler evaluation

Placenta accreta

Maternal cocaine abuse is associated with what critical findings on ultrasound?

Placental abruption and premature birth

IUGR after 30 wks is usually asymmetric and related to

Placental insufficiency

IUGR can be associated with

Placental thinning, increased S/D ratio in the umbilical artery, high resistance with absent diastolic flow

Most common spinal abnormality seen in skeletal dysplasia

Platyspondyly

Most common cause of fetal bladder rupture

Posterior urethral valves

If the radiologist suspects Potter Syndrome and requests that you perform a thoracic circumference. How will this measurement assist in the diagnosis?

Potter Syndrome usually demonstrates a bell/pear-shaped thorax that is much more narrow than the abdominal cavity. Pulmonary hypoplasia is common with Potter Syndrome due to the oligohydraminos caused by renal agenesis.

Associated with a bell shaped thorax

Potter syndrome, thanaotophoric skeletal dysplasia, and osteogenesis imperfects

TORCH infections

Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR Toxoplasmosis Other = syphillis, varicella, HIV Rubella Cytomegalovirus Herpes Simplex

What is responsible for the early symptoms of pregnancy such as nausea and vomiting

Progesterone

What does PHI stand for?

Protected health information

Non visualization of fetal abdominal muscles, urinary tract abnormalities, and undescended testes are a classic triad of signs of

Prune Belly Syndrome

You are evaluating a 20 wk old fetus for size and anatomy evaluation. A mildly hyperechoic, homogeneous, triangular shaped mass is identified inferior to the level of the heart in the right chest cavity. The remainder of the chest cavity and heart is normal. This is consistent with:

Pulmonary Sequestrian

The right ventricle send deoxygenated blood to the lungs through the _____________. The oxygenated blood leaves the lungs through ___________________ to enter __________________

Pulmonary artery Pulmonary veins Left atrium

What does the three vessel view consist of?

Pulmonary artery, aorta, and superior vena cava

What is the most common cause of death in lethal skeletal dysplasia?

Pulmonary hypoplasia. (Narrow chest with short ribs, limiting lung formation)

Muscles of the Greater Pelvis

Rectus Abdominis Transverse Abdominis Psoas Major Iliopsoas

When evaluating a small embryo for cardiac cavity it is important to:

Reduce the size of field of view and increase frame rate

What is a disadvantage of transvaginal sonography?

Reduced field of view. (Disadvantage when evaluating enlarged uterus or ovaries that set high in the adnexa.

Placental insufficiency will cause _______ flow in the umbilical artery

Reduced, absent, or reversed diastolic flow

Colpocephaly

Refers to the abnormal dilation of the posterior horns of the lateral ventricles (tear drop shaped)- common sign of agenesis of the corpus callosum

Doliocephaly

Refers to the fetal head that is more elongated with a longer OFD, much greater than the BPD measurement. Associated with breech presentation, holoprosencephaly, and oligohyrdraminos.

Rejection

Removes unwanted echoes

Which of the following artifact causes decreased visualization of the cerebral hemisphere closest to the transducer face?

Reverberation

The first cardiac chamber to recieve oxygenated blood from the placenta

Right atrium

The highest concentration of oxygen in the heart is in the

Right atrium

The normal direction of flow through the fetal foramen ovale is

Right atrium to left atrium

Which of the following is NOT a potential complication of a sonohystogram? A. Vasovagal response B. Allergy to contrast C. Vaginal bleeding D. Pelvic infection

Saline is used for a sonohystogram and does not cause an allergic reaction

Most common type of mullerian duct anomaly

Septate uterus

Levels that will increase with dysgerminoma

Serum hCG, serum CA 125, serum lactate dehydrogenase

Femur length >2 standard deviations below the mean for the gestational age indicates

Skeletal dysplasia

Holt-Oram Syndrome

TBX5, AD Radial and ulnar bones, heart disease thumb looks like its got a rubber band around it

Which pedal abnormality is commonly seen with spina bifida?

Talipes Equinovarus (Club foot) is a pedal abnormality that is commonly seen with spina bifida.

Which cranial structures should be visualized in the head when performing a fetal head circumference in the proper location?

Thalamus, cavum septum pellucidum, and third ventricle

A clover leaf skull is associated with which skeletal dysplasia?

Thanatophoric dysplasia (most common type of lethal skeletal dysplasia) Also associated with: -Short ribs -Pulmonary hypoplasia -Polyhydraminos -Severe micromelia -Bowing of long bones

Most common type of lethal skeletal dysplasia?

Thanatophoric skeletal dysplasia

A 26 yr old patient presents with acute left lower quadrant pain and vomiting. You see this. What should be done next to evaluate the patient?

The acute onset of pain correlates with ovarian torsion. Color doppler should be applied to evaluate vascularity.

cogwheel sign

The cogwheel sign refers to an imaging appearance in pelvic imaging of thickening loops of the Fallopian tube seen on cross-section

What 2 muscles form the pelvic diaphragm?

The levator ani and coccygeus muscle

Dwarphism occurs when

The limbs are abnormally shortened with a relatively normal HC and AC

Blood entering the fetus in the umbilical vein is divided between

The portal vein and the ductus venosus

How can you differentiate between the portal vein and gallbladder in the fetal abdomen?

The umbilical vein is located centrally in the abdomen while the portal vein is located to the right between the right and left lobes of the liver.

How can you differentiate a uretocele from obstruction of the uteropelvic junction of the kidney?

The ureter will be dilated with a ureterocele, but not with a UPJ obtruction

Benign ovarian tumor that secrete estrogen can lead to fibroid enlargement and postmenopausal bleeding

Thecoma

________ and granulosa cell tumors are benign ovarian neoplasms that secrete estrogen.

Thecomas

Which of the following best describes the sonographic appearance of a patient in day 20 of their menstrual cycle?

Thich and hyperechoic

What will a patient who is taking Tamoxifen endometrium appear like?

Thick, heterogeneous, cystic

Associations of inevitable abortions vs. threatened abortions

Threatened: Bleeding, cramping, cervix closed Inevitable: Bleeding more than one week, cramping, cervical dilation

Three copies of the 23 human chromosomes results in a diagnosis of

Triploidy

A cephalic index of 90% in a 28 wk fetus can indicate which of the following?

Trisomy 21 and Brachycephaly

The chorionic villi and membrane are formed by

Trophoblastic cells

What embryologic structure produces progesterone and bHCG?

Trophoblastic cells.

Cystic hygroma is associated with

Turner syndrome Down syndrome (trisomy 21) Klinefelter syndrome (XXY) Trisomy 18, 13

The corpus in the multiparous is usually at least _____ the size of the cervix

Twice

There are several cysts in the lung that measure 2-4 cm. This finding most likely indicates:

Type I congenital cystic adenomatoid malformation

Which type of osteogenesis imperfecta has the poorest outcome?

Type II

Theca call tumor/ Granulosa cell tumor

Unilateral hypoechoic mass on postmenopausal women. The tumor is most commonly benign and produces estrogen

Incomplete resolution of which embryologic structure can cause a cystic formation between the abdominal wall and anterior bladder wall

Urachus

How can you differentiate between an ectopic pregnancy in the ampullary region of the tube from an ovarian mass?

Use the TV probe to apply pressure in the adnexal region of the ovary and mass to observe the motion of the mass

incarcerated uterus

Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.

IVF: embryo is placed in the __________, Zift: embryo is placed in the _______________

Uterus

Potential complication of succenterate placenta

Vasa previa

Intracranial anomaly that causes an increased amount of flow within the venous system causing fluid accumulation, CHF, and hydrops.

Vein of Galen aneurysm

During what week of the menstrual cycle is best to evaluate a patient for normal cysts and a possible right ovarian cyst?

Week 1 The endo should be its thinnest and no dominant follicles should be formed at this time.

Minimum sensitivity

When you start by making the TGC flat then increase gain from minimum value, the point at which the echo appears on screen

epispadias

a congenital abnormality in males in which the urethra is on the under surface of the penis can cause obstruction and lead to megacystitis and significant hydronephrosis

Tetralogy of Fallot

a congenital malformation of the heart involving four distinct defects 1. Overriding aorta 2. Pulmonic Stenosis 3. VSD 4. Right ventricular hypertrophy

erythroblastosis fetalis

a disorder that results from the incompatibility of a fetus with Rh-positive blood and a mother with Rh-negative blood, causing red blood cell destruction in the fetus; a blood transfusion is necessary to save the fetus

Beckwith-Wiedemann syndrome

a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver. -Most common findings are a triad of macrosomia, macroglossia, and omphalocele. Polyhydraminos is usually seen

Schizencephaly

a rare condition characterized by abnormal openings or clefts in the cerebral hemispheres

Pulmonary sequestration

a separate mass of nonfunctioning lung tissue with its own blood supply On U/S it appears as an echogenic triangular shaped mass in the fetal chest

Primigravida

a woman who is pregnant for the first time

If the ED flow is low, absent, or reversed in the umbilical cord that is

abnormal

hydrocephalus

abnormal accumulation of fluid (CSF) in the brain. Measure lateral ventricles

Athrogryposis

abnormal curvature of joints/long bones in two or more areas

diaphragmatic hernia

abnormal displacement of organs through the muscle separating the chest and abdomen

Chlyothorax

accumulation of lymph from the GI tract in the pleural space

A sample of amniotic fluid should be tested for increased levels of _______________ that indicate the presence of neural tube defects

acetylcholinesterase

The fetal structures within the omphalocele are protected by a membrane composed of

amnion and peritoneum

Clinodactyly

arching of the 4th and 5th digits toward the thumbs

encircle the periphery of the uterus

arcuate arteries

If fertilization occurs ______ will stop the regression of the CL cyst so that it can produce progesterone and create the decidual reaction

bHCG

straight arteries supply the __________ and spiral arteries supply the _____________

basal layer of the endometrium; functional layer of the endometrium

Most common occuring germ cell tumor of the ovary

benign cystic teratoma

Mucinous cystadenoma

benign tumor of the ovary that contains thin-walled multilocular cysts

HCG peaks at what week?

by 10wks 100,000 mL

Stage II endometrial cancer

carcinoma involves the *corpus and the cervix*

What can be measured that is usually consistent with GA for a fetus with IUGR?

cerebellar diameter

Fetal component of placenta

chorion fondusum

Most common cause of fetal demise in first trimester

chromosomal abnormalities

DES exposure in utero

clear cell adenocarcinoma of the vagina, uterine malformation (in their children), ectopic pregnancy

foramen ovale

connects the two atria in the fetal heart

battledore placenta

cord insertion into the margin of the placenta

Most common type of ovarian tumor

cystadenoma

Dandy-Walker malformation

cystic dilation of the fourth ventricle, absent cerebellum

An encephalocele can easily be mistaken for a

cystic hygroma

late proliferative phase

days 10 to 14 of the menstrual cycle; ovulation occurs; the endometrium increases in thickness and echogenicity

secretory phase

days 15-28. endometrium is thick and hyperechoic

early proliferative phase

days 5-9 of the menstrual cycle; endometrium appears as a single thin stripe with a HYPOECHOIC halo encompassing it; creates the "3 line sign"

How to measure binocular distance?

distance between lateral orbit walls, inner wall to inner wall.

The best time to visualize a polyp, when the endometrium is at its thinnest

early proliferative

Spatial compounding requires a transducer that can perform:

electronic steering

Spotting between cycles and infertility are common symptoms of

endometrial polyp

Stage III endometrial cancer

extends into true pelvis

where along the cord is highest resistance

fetal cord insert

The fetal umbilical artery branches from the

fetal internal iliac arteries

if the ductus venosus flow is abnormal you will see

flow reversal in diastole

During renal development, the kidneys normally migrate __________________

from the pelvic region superiorly into the lower abdomen

BPP/ requirement for fetal breathing

full 30 sec within 30 mins

encephalocele

herniation of brain tissue through a gap in the skull

A trident hand is commonly seen with which skeletal anomaly?

heterozygous achondroplasia

Phenylketonuria

high levels of phenylalanline associated with microcephaly, cardiac defects, and IUGR

Hypotelorism is associated with

holoprosencephaly (midline defects of the brain), microcephaly, cyclopia, craniosynostoses

Absent cavum septum pellucidum and septo optic dysplasia are common findings with

holoprosencephaly, shcizencepaly

The most common cause of pelvic congestion

incompetent left ovarian vein

as the pregnancy progresses, the sonographic appearance of the fetal lungs will

increase in echogenicity

theca lutein cyst are associated with

increased levels of bhCG

which portion of the fallopian tube is described as trumpet shaped?

infundibulum

osteogenesis imperfecta

inherited condition of deformed and abnormally brittle bones. can be diagnosed as early as 15 wks and ruled out if boney structures appear normal by 17 wks.

An abnormally short fetal neck with fixed posterior flexion

iniencephaly

The uterine artery is a branch of

internal iliac artery

Caudal Regression Syndrome

lack of development of the caudal spine and cord that may occur in the fetus of a diabetic mother

hCG in non pregnant females should be

less than 5.0

Muscles that form the pelvic floor

levator ani and coccygeus

What fetal structure produces AFP?

liver and yolk sak

thymus gland

located in the mediastinal cavity anterior to and above the heart; secretes thymosin

Dysgerminoma

malignant germ cell tumor, associated with streak gonads of Turner's.

choriocarcinoma

malignant, trophoblastic tumor of the placenta

An autosomal dominant disorder

may be inherited from one parent who is affected. Dominant means the nonfunctional gene of the gene-pair is able to override the normal gene. A person affected by an autosomal dominant trait has a 50 percent chance of passing it on to his/her offspring.

Twin-twin transfusion syndrome

monozygotic, monochorionic twins usually the same sex donor twin growth restricted, appears to be stuck to wall due to oligo AKA stuck twin syndrome Recipient twin will develop hydrops and heart failure, polyhydraminos due to increase arterial flow from the placenta

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges

posterior urethral valves

most common cause of bladder outlet obstruction in the male neonate

What urinary anomaly is caused by a urinary obstruction in the first trimester and leads to renal cyst formation and ureteral atresia?

multicystic kidney disease usually unilateral because the obstruction occurs early in the pregnancy

Meconium peritonitis

multiple echogenic foci in the fetal bowel, liver, and peritoneum accompanied by polyhydraminos and fetal ascites.

CDH is most commonly seen

on left side

Noonan Syndrome

one of four chromosomes is affected. Noonan affects both boys and girls equally. -Referred to as the male version of turners syndrome -Common associated defects include congenital heart defects, short stature, mental deficiency, and abnormal facial features such as hypertelorism and low set ears

spina bifida aperta

open (non-skin-covered lesions) neural tube defects, such as myelomeningocele and meningocele

Spalding's sign

overlapping of the skull bones caused by liquefaction on the brain

Fitz-Hugh-Curtis syndrome

pelvic infection that extends to liver capsule and right upper quadrant. Ascites forms in Morrison's pouch. Peritonitis can lead to the formation of perhepatic adhesions.

circumvallate placenta

placental condition in which the chorionic plate is smaller than the basal plate; the margin is raised with a rolled edge Appears as rolled or curled placental edges. Increased risk of abruption

placental abruption

premature separation of the placenta. Requires immediate delivery of baby

left atrium receives blood from

pulmonary veins

which arteries course through the myometrium?

radial arteries

Pentalogy of Cantrell

rare anomaly with five defects:sternum defect, diaphragm defect., omphalocele, intracardiac anomalies, and ectopia cordis

A patient presents for a pelvic ultrasound due to suspected uterine didelphys, if the exam is positive for the anomaly what could you suspect to see?

right and left uterine body, cervix, and vaginal canal

Deuel's sign

scalp edema

luteinizing hormone (LH)

secreted by the pituitary gland to promote ovulation

The femoral lengths are usually _______ in cases of IUGR.

shortened

CHILD syndrome

skeletal dysplasia only affecting one side of the body

Asherman syndrome

surgical removal of stratum basalis, causing scarring and secondary amenorrhea -amenorrhea -hypomenorrhea -recurrent miscarriage and infertility

Epignathus

teratoma located in the oropharynx

registration accuracy

the ability of the system to place reflections in proper positions while imaging from different orientations

Thanatophoric dysplasia

the most common lethal skeletal dysplasia characterized by a cloverleaf skull with frontal bossing and hydrocephalus. Shortened limbs

Craniosynostosis

the premature fusing of the skull bones causing an abnormally shaped calvarium and facial features. It can restrict cerebral growth and development.

Methotrexate is used for

to cause involution of early ectopic pregnancies and preserve fertility so surgical intervention doesn't scar the fallopian tube

The number of yolk sacs can be used

to determine the amniocity of the multifetal pregnancy.

where to perform measurement for nuchal skin fold

transverse view of cranium at view of cerebellum and cisterna

Spina bifida is best demonstrated

transverse view of the spine

Shortened humerus can assist in diagnosis of

trisomy 21

two uterine horns, one cervix

uterine bicornis unicollis

how can you differentiate uterine synechia from aminotic bands associated with fetal abnormalities?

uterine synechia do not attach to the fetus while amniotic bands do attach to the fetus

Meckel's diverticulum

when the yolk sac persists into adult life as diverticulum in the ileum portion of the bowel

An autosomal recessive disorder

will appear only in children of parents who both carry the gene


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