OBGYN TEST #3

the following steps can be taken to prevent what? 1. Give adequate doses of Rh immunization within 72 of delivery 2. RhoGAM is also given at 28th week of pregnancy 3. RhoGAM treatment must be repeated w/ each pregnancy, miscarriage, abortion & chorionic villi sampling.

(prevention of) maternal sensitization

hydrocephalus can be monitored by ultrasound until when?

1 year of age

bilateral choroid plexus cysts greater than ___ mm have a higher association with abnormal karyotype

10mm

Vacterl can be associated with what trisomy?

18

a strawberry shaped skull is commonly associated with what trisomy?

18

How many fetal compartments are filled to be considered hydrops?

2

the echogenicity of a hemorrhage decreases within how long? sonolucent areas still remain.

2-3 weeks

Microcephaly is when the HC measures greater than ___ standard deviations below normal.

3

where is the luschka & magendie located?

4th ventricle

for infants 6 months-1 year, what transducer should be used for intracranial scanning?

5.0 mHz

Diaphragmatic hernia has a ___ to ___ % mortatlity rate due to pulmonary hypoplasia

50-80%

With fetal hydrops the placenta is thickened by how many cm?

6

a nuchal fold measurement of ___mm or larger is considered abnormal

6mm

transducer used for intracranial scanning ?

7.5-10 mHz

when do most intracranial bleeds usually happen?

72 hours after birth

with fetal hydronephrosis the renal pelvis is dilated greater than ___mm

8mm

Non-immune hydrops account for ___% of hydrops

90

which type of holoprosencephaly is this? -single horseshoe shaped ventricle -fused thalami -associated with craniofacial abnormalities NO LOBE, NO SEPARATION = CYCLOPS

Alobar

what are the three types of holoprosencephaly?

Alobar, Semilobar, Lobar

omphalocele is covered by

Amnion & Peritoneal Sac

-Absence of cerebral hemispheres & overlying skull & scalp -only structures at base of brain are present.

Anencephaly

US APPEARANCE OF WHAT? -cranial vault absent -intracranial contents absent -orbits & face present -bulging eyes -short neck -polyhydramnios present in half of the cases

Anencephaly

What is the most common fetal congenital anomaly in CNS?

Anencephaly

-Common type of hydrocephalus -associated with spina bifida -portion of spinal cord is tethered & ends below L2 -cerebellum is pulled through cisterna magna

Arnold Chiari Malformation

spina bifida has a high association with what?

Arnold chiari malformation

Fetal hydrops are synonymous to:

Ascites, anasarca & edema

Divergence of the posterior elements of the fetal spine is suggestive of a) encephalocele b) meningocele c) hydrocele d) infantocele

B

the "sunburst" of the cerebral sulci is a sonographic finding of: A) DWM B) agenisis of the corpus collosum c)colpocephaly d) apert syndrome

B

what is dilation of lateral ventricles bilateral & severe

BAT WING sign

Amniotic band syndrome can be defined as : A) the separation of amnion and chorion in early pregnancy B) complications that arise from abruptia placenta C) wrapping of torn amnion around fetal extremities D) none of the above

C

what is the most common fetal chest mass?

CAM (cystic adenomatoid malformartion)

-Lethal -Autosomal recessive or sporadic -RARE

Campomelic dysplasia

Characteristics of what? -shortening & bowing of long bones of legs (tibia & fibula most affected) -narrow chest -large calvarium w/ small face -hypoplastic scapulae *CLUBBED FOOT CAN BE ASSOCIATED W/ THIS*

Campomelic dysplasia

-Medial deviation of the sole of the foot -may be isolated inherited genetic predisposition

Club foot

the following are associated with: -genetic syndromes (Trisomy 18) -spina bifida -caudal regression -muscular dystrophy -oligohydramnios

Club foot

-Increase in terminal respiratory elements leading to development of cysts -involves part or all of a lung lobe

Cystic Adenomatoid Malformation (CAM)

Which of the following terms best describes a skeletal dysplasia in which the proximal extremity is shortened? A) micromelia B) acromelia C) mesomelia D) rhizomelia

D

-Congenital brain malformation -characterized by incomplete formation of cerebellar vermis & dilation of 4th ventricle & enlargement of posterior fossa.

Dandy Walker Malformation

US appearance of what? -cystic enlargment of 4th ventricle -dilated 3rd ventricle -variable dilation of lateral ventricles -cerebral lobes split apart & abnormal shape

Dandy Walker Malformation

thought to be a result of obstruction of foramina of luschka & magendie

Dandy Walker Malformation

-Bowel & abdominal organs herniate into the thoracic cavity -may be associated with other congenital anomalies like trisomy 13 & 18

Diaphragmatic Hernia

Excessive accumulation of clear watery fluid in any of the tissues or cavities of the body.

Fetal Hydrops

US signs of what? -polyhydramnios -fetal skin edema (anasarca) - pleural effusion -scalp edema -pericardial fluid collection -fetal ascites

Fetal hydrops

Fetuses with anencephaly are often referred to as?

Frog babies

macrocephaly w/ protruding forehead is called what?

Frontal bossing

omphalocele is associated with what two things?

GI & cardiac anomalies

most common anomaly associated with gastroschisis is associated with the ?

GI Tract

Neural tube defects can result from?

Genetic mutation or be can be acquired

The instance when Rh negative woman was exposed to mother's Rh positive blood during birth, is called?

Grandmother theory

Many fetuses with hydrops also have what?

Hepatosplenomegaly

Failure of the prosencephalon to divide into double lobes of cerebral hemisphere

Holoprosencephaly

-autosomal dominant -THUMBS ABSENT -also associated w/ congenital abnormalities of the heart -also associated with phocomelia (rare deformity in which hand an feet are close to the trunk)

Holt Oram Syndrome

Total or near total absence of cerebral hemispheres (not developed or partially developed) The midbrain, basal ganglia, thalamus, & cerebellum are present

Hydranencephaly

US APPEARANCE of what? -no cerebral parenchyma -large anechoic areas surrounding mid brain

Hydranencephaly

Abnormal accumulation of serous fluid in the fetal tissues

Hydrops

US does not always identify the cause of what?

Hydrops

Another name for fetal hydrops

Hydrops fetalis

-Autosomal recessive disease -lack of fusion varies -not compatible with life if severe

IPKD

US appearance of what? -Enlarged bilateral kidneys -homogenous hyperechogenicity -severe oligohydramnios -Bladder not visualized

IPKD

osteogenesis is a what type of disorder?

Inherited

-seen in premature infants -hemorrhage is into ventricles or subependymal -may cause brain damage -Neurosonography used as screening what is this describing?

Intracranial hemorrhage

which type of holoprosencephaly is this? -nearly complete separation of cerebral hemispheres TOTAL SEPARATION

Lobar

-usually unilateral -amniotic fluid is usually normal -may be associated with other kidney abnormalities such as contralateral UPJ obstruction

Multicystic Dysplastic kidney

if the baby has SEVERE hemolytic disease what type of prenatal care is required?

Multiple prenatal transfusions via cord until 26-32 weeks, multiple transfusions & phototherapy.

Anomalies of the fetal head, neck & spine can be referred to as what?

Neural Tube Defects

The following are causes of what? -cardiovascular abnormality -chromosomal abnormalities -fetal structure abnormalities -anemia -infections (hep A, rubella, varicella) -genetic disorders (skeletal dysplasia) -idiopathic causes - maternal disorders -placental disorders

Non immune hydrops

what is used to change bilirubin into products which can pass through the baby's system.

Phototherapy

-having more than 5 fingers or toes -may be a dominant inherited trait -may be linked w/ some genetic diseases like trisomy 13,18,21 -ellis-van creveld syndrome -rubinstein-taybi syndrome

Polydactyly

US appearance of what? -enlarged bladder, thickened bladder wall -dilated ureters -Keyhole appearance due to dilated urethra

Posterior urethral valves

-Deficient abdominal musculature -cryptoorchidism -GI tract anomaly (PUV) -distended fetal abdomen w/ wrinkled appearance

Prune belly triad

Most people have ___ postive blood

Rh

The following are fetal effects of what disease? 1. Jaundice 2. Anemia 3. Brain damage 4. Heart failure 5. Death

Rh Disease

What is the most common cause of immune related hydrops

Rh disease

caused by an incompatibility between the blood of mother and fetus

Rh disease

during the first pregnancy there is little danger to __ fetus

Rh+

Shortening of proximal extremity is called what?

Rhizomelia

What are the 4 types of short limb dysplasia?

Rhizomelia, acromelia, mesomelia, micromelia

Your doctor is prescribing ________ because you are Rh-negative. During pregnancy, it is normal for a small amount of the baby's blood to enter your bloodstream. When the blood from your Rh-positive baby enters your Rh-negative bloodstream, there will be a blood type mismatch. This is called Rh-incompatibility. Your immune system sees the baby's red blood cells as "foreign" and will produce antibodies that try to eliminate them. ___________ if given to you at the right time, will prevent your immune system from reacting to your baby's blood.

RhoGAM

what is the most common tumor in neonates?

Sacrococcygeal teratoma

which type of holoprosencephaly is this? -More cerbral tissue present -occipital lobe present -Associated with cleft palate & lip PARTIAL SEPARATION

Semilobar

triggering of mother's defense system is known as?

Sensitization

Abnormal development of the cartilage & bones

Skeletal dysplasias

-Bladder and Bowel Dysfunction -paralysis of lower extremities -hydrocephalus all of these are associated with what?

Spina Bifida

Condition in which spinal cord or its coverings are not fully developed

Spina Bifida

US detection of what? -Splaying (splitting) of posterior ossification centers -V or U shape -May see cystic dilation adjacent to spine -elevated maternal serum AFP levels

Spina Bifida

Anencephaly is common in areas where (what other disease) is common?

Spina Bifida (UK)

5% of choroid plexus cysts are associated with ?

Trisomy 18

true or false: Amniotic band syndrome may cause amputations of limbs or digits.

True

what type of osteogenesis imperfecta is this? -autosomal, dominant, fragile bones, loose joints & growth deficiency, fractures occur after birth. -Life expectancy is normal

Type 1

what is the WORST type of osteogenisis imperfecta?

Type 2

what type of osteogenesis imperfecta is this? -Lethal new dominant mutations prenatal bone shortening & bowing due to fractures affecting long bones & ribs, decrease in acoustic shadowing

Type 2

what type of osteogenesis imperfecta is this? -autosomal dominant or recessive -fractures present at birth or happen when child begins to walk -bones become progressively deformed throughout life.

Type 3

what is the mildest form of osteogenesis imperfecta?

Type 4

what type of osteogenesis imperfecta is this? -Mildest form -short stature -bones fracture more easily

Type 4

if the baby has MODERATE hemolytic disease what type of prenatal care is required?

Usually one prenatal transfusion or neonatal treatment with multiple transfusions & phototherapy.

Vertebral anomalies Anal Atresia Cardiac anomalies Tracheo Esophageal fistula Renal anomalies Limb Dysplasia (more common in diabetic mother)

Vacterl Association

fluid around fetal lungs is normal or abnormal?

abnormal

the following are characteristics of what? -severe shortening of limbs -narrow thorax -short trunk -large head

achondrogenisis

what is the name of the LETHAL dysplasia?

achondrogenisis

The following are characteristics of what? -autosomal dominant, or spontaenous -most common NON - lethal type of dwarfism -rhizomelic limb bowing -frontal head bossing -trident finger confiuration -sometimes macrocephaly, or hydrocephaly

achondroplasia

trident finger is associated with?

achondroplasia

Distal extremity shortening (phalanges, metacarpals) is called what?

acromelia

This occurs when amnion ruptures & wraps around fetal structures

amniotic band syndrome

Rh diseases causes fetal _____ in the baby

anemia

location of morgagni diaphragmatic hernia?

anterior

classification of hydrocephalus?

aqueductal stenosis, communicating hydrocephalus, over production of CSF

the fetal lip typically closes by : a) 18 weeks b) 8 weeks c) 13 weeks d) 6 weeks

b

this sign describes the way the cerebellum is wrapped tightly around the brain stem as a result of spinal cord tethering

banana sign

fetal hydronephrosis is usually bilateral or unilateral?

bilateral (in 1/3 of cases)

When RBC's break down there is an increase in what?

bilirubin

-congenital defect of abdominal wall to develop over bladder -bladder may protrude through wall

bladder extrophy

US appearance of what? -Normal amniotic fluid -lack of visualization of bladder -echogenic mass protruding from lower abdominal wall in close association w/ umbilical arteries

bladder extrophy

what are the two types of diaphragmatic hernia?

bochdalek & morgagni

what is a complication of intracranial hemorrhage?

brain damage

another name for osteogenesis imperfecta

brittle bone disease

first most common cause of non immune related hydrops is?

cardiovascular abnormalities

Bony defect in calvarium with herniation of brain, and or meninges is what?

cephalocele

banana sign refers to the shape of what (arnold chiari malformation)

cerebellum

the _______ _______ is within the midbrain & connects the 3rd & 4th ventricle. Also contains CSF

cerebral aqueduct

what is the second most common location for spina bifida?

cervical area

second most common cause of non immune hydrops is what?

chromosomal abnormalities

premature closure of coronal and lambdoidal sutures produces what sign?

clover leaf sign

are fetal hydrocele common or uncommon?

common

what type of hydrocephalus can still flow between ventricles which remain open?

communicating hydrocephalus

severe bleeds can rupture into ventricular system or into surrounding ______ _______

cortical tissue

-Benign of lymphatic origin -can be located in axilla, groin, mediastinum & thorax

cystic hygroma

US appearance of what? unilocular, or multiocular cystic mass

cystic hygroma

the most frequently encountered chromosomal abnormality associated with holoprosencephaly is: a)triploidy b) trisomy 21 c) trisomy 18 d) trisomy 13

d

which of the following may also be referred to as turner syndrome? a) down syndrome b) trisomy 15 c) trisomy 13 d) monosomy x

d

US findings of what? -stomach, bowel, or other organ located in thorax -an AC measurement that is smaller than normal -may be associated with polyhydramnios

diaphragmatic hernia

what is lack of adequate communication between duodenum & stomach

duodenal atresia

early hemorrhages are highly ______

echogenic

-rare defect in abdominal wall -heart protrudes through extrathoracic sac -covered by skin or membrane

ectopic cordis

a cephalocele is also known as?

encephalocele

when do choroid plexus cysts usually resolve by?

end of second trimester

US of the fetal limbs document what 4 things?

existence, length, position, whether properly formed & ossified

omphalocele is also known as?

exomphalos

failure of lip fusion prior to 35 days from conception is termed what? (may be associated with brain anomalies or trisomies)

facial clefts

what is occipital encephalocele caused by?

failure of mural tube to close completely

Fluid in the fetal peritoneal cavity is called ?

fetal ascites

what can be seen with fetal hydrops, bowel perforation, urinary ascites due to bladder obstruction, heart failure, & twin twin & transfusion syndrome?

fetal ascites

fluid around fetal testicles

fetal hydrocele

Maternal polyhydramnios is linked with:

fetal skeletal dysplasia

how long does it take for fetal hydroceles to typically resolve?

first 9 months of life

what type of effects does hydrocephalus have on the brain?

flattening of brain parenchyma & intraparenchymal effusion

herniation of the viscera through a fissure off of midline

gastroschisis

each subsequent pregnancy poses a _____ (greater or smaller) risk for Rh disease in the baby

greater

Ectopic Cordis means:

heart outside

this disease occurs when baby's RBC's break down at a faster rate.

hemolytic disease

thought to be caused by bilateral blockage of the internal carotid arteries

hydranencephaly

Dilation of the ventricles with accumulation of CSF is what?

hydrocephalus

This is usually caused due to blockage of CSF drainage pathways ?

hydrocephalus

what is an abnormal increase in fluid in cerebral ventricles? (overproduction of csf)

hydrocephalus

pleural effusion is usually seen with fetal ________

hydrops

What are the two types of fetal hydrops?

immune and non-immune

fetal hydrops caused by Rh incompatibility are what?

immune hydrops

what is the cause of diaphragmatic hernia?

improperly fused or formed diaphragm

Autosomal recessive disease?

infantile polycystic kidney disease

Suspicions of what? -Respiratory distress syndrome -dropping hematocrit -Prematurity (Less than 32 weeks or 1850 grams)

intracranial hemorrhage

The following are locations of what? -immature subependymal germinal matrix of the caudate nucleus, choroid plexus, cerebellar area

intracranial hemorrhage

narrower portion of anterior portion of head (arnold chiari malformation)

lemon sign

-severe form of amniotic band syndrome OR early vascular accident causing disruptive body wall events -anomalies may include lateral body wall defects, thorax, abdomen, face, limbs, & spine -not compatible with life

limb body wall complex

what is the most common location for spina bifida?

lumbar sacral area

what protrudes with spina bifida?

meningocele-meninges

what is associated with microcephaly?

mental retardation

middle limb segment shortening, (radial, ulna, tibia, fibula) is called what?

mesomelia

small head

microcephaly

refers to entire extremity being short:

micromelia

Location of omphalocele is?

midline

US appearance of what? -multiple large anechoic cysts -largest is not centrally located -reniform shape may be absent -differential diagnosis could be hydronephrosis

multicystic dysplastic kidney

what is the most common renal dysplasia?

multicystic dysplastic kidney

-Diagnose & follow up on intracranial hemorrhage -evaluate for hydrocephalus -diagnose congenital abnormalities these are uses for what?

neonatal head scanning

are choroid plexus cysts harmful to baby?

no

if the baby has MILD hemolytic disease what type of prenatal care is required?

no prenatal treament required

congenital leukemia is associated with what?

non immune hydrops

communicating hydrocephalus is also known as what?

non obstructive hydrocephalus

fetal hydrops that are caused by CONGENITAL fetal anomalies & infections are what??

nonimmune hydrops

with gastroschisis umbilical cord insertion is normal or abnormal?

normal

in the western world, what is the most common location for a cephalocele?

occipital

small defect with no protrusion of meninges or cord

occult spina bifida

gastroschisis is less serious than ?

omphalocele

herniation of abdominal contents into base of umbilical cord

omphalocele

bones become increasingly _______ as pregancy progresses

ossified

-inherited disorder -disorder of production or secretion of collagen -abnormal fragility of the bones due to hypo-mineralization of entire skeleton -bones can be fractured or deformed easily -still birth possible due to cranial fracture

osteogensis imperfecta

this is used to change bilirubin into products which can pass through the baby's system.

phototherapy

mortality due to underlying cause or pulmonary hypoplasia is a cause of what?

pleural effusion

having 5 or more fingers or toes on lateral or medial side

polydactyly

Cephalocele is associated with?

polyhydramnios

cyst arising from the ventricle that develops as a consequence of parenchymal hemorrhage

porencephalic cyst

possible reasons for what? -previous normal pregnancy -ectopic pregnancy -spontaneous abortion -inadequate RhoGAM dosage -previous transfusions with RH+ blood -sensitization in utero "grandmother theory"

possible maternal sensitization

location of bochdalek diaphragmatic hernia?

posteolateral on the left

-Results when thin leaflets obstruct fetal urethra -occurs in male fetuses

posterior urethral valves

80% of cystic hygromas originate from ________ portion of neck

posterolateral

pulmonary hypoplasia has a poor ________

prognosis

-Hypoechoic ring around abdominal wall may simulate ascites -it represents the muscles of the abdominal wall

pseudo ascites

Babies that have campomelic dysplasia can die from _______ _______ because of small chest

pulmonary hypoplasia

Skeletal dysplasias are very common or rare?

rare

gastroschisis is not covered by ____ or ____

sac or membrane

-made up of all 3 germ layers -seen as mass extending from sacrum -may be benign or malignant -may be solid, mixed, interspersed with cystic components

sacrococcygeal teratoma

-development of fluid filled clefts within the cerebrum is -may be described as "open lip" or "closed lip" -may have association with exposure to some illicit drugs.

schizencephaly

skeletal dysplasias may not manifest until late _____ ______

second trimester (may not be severe enough to be detected)

with skeletal dysplasia, bones may be (4 things)

shortened, deformed, thinned, absent

fetal hydrocele is not clinically _________

significant

osteochondrodysplasia is another term for what?

skeletal dysplasia

defect in spine due to lack of fusion of 2 halves of vertebral arch is what?

spina bifida

hydrocephalus is associated most commonly with what?

spina bifida

what is the treatment for cystic hygromas?

surgery (removal of entire cyst to prevent it from coming back)

what is another term for Club Foot?

talipes equinovarus

The following are characteristics of what? -severely flattened vertebral bodies -extreme rhizomelia -bowed long bones -narrow thorax w/ protruding abdomen champagne cork appearance

thanatophoric dysplasia

most common dysplasia that is lethal

thanatophoric dysplasia

the following are abnormalities associated with what? -Frontal bossing -horseshoe kidney -atrial septal defects of the heart -imperforate anus -clover leaf skull -massive polyhydramnios

thanatophoric dysplasia

CAM involves all, or part of what?

the lung lobe

gastroschisis is located where?

to the right of midline

what are causes of microcephaly?

trisomies, exposure to environmental teratogens, uterine infections

cystic hygroma can be associated with what?

turner's syndrome

what are the four types of osteogenesis imperfecta?

type 1-4

Is CAM usually bilateral or unilateral?

unilateral

Is hemorrhage treatable or untreatable?

untreatable

what is the most common cause of fetal hydronephrosis?

ureteropelvis junction obstruction (UPJ)

where does intracranial hemorrhage go into ?

ventricles & subependymal

another way to refer to hydrocephalus?

ventriculomegaly

what is another name for hydrocephalus?

ventriculomegaly