Penny Book OBGyn Review Questions

A 25-year-old gravid woman presents to the ultrasound department for a follow-up sonographic examination. In the prior report, you find that the fetus suffers from rhizomelia of the lower extremities. Rhizomelia relates to the: a) Nonexistence of the proximal segment of a limb b) Shortening of the proximal segment of a limb c) Absence of distal segment of a limb d) Bowing of the long bones

b) Shortening of the proximal segment of a limb Rhizomelia is defined as the shortening of the proximal segment of a limb. It is often a sonographic sign of achondroplasia.

The sonographic finding demonstrated in this image is a typical feature of: a) Osteogenesis imperfecta b) Turner syndrome c) Sirenomelia d) Limb-body-wall complex

b) Turner syndrome A cystic hygroma, seen in this image, is a common sonographic feature of Turner syndrome.

A dumbbell-shaped structure located inferior and posterior to the cerebrum is the: a) Cisterna magna b) Fourth ventricle c) Cerebellum d) Third ventricle

c) Cerebellum The normal cerebellum has a dumbbell shape and is located inferior and posterior to the cerebrum.

Monthly symptoms of menstruation without bleeding describes: a) Metrorrhagia b) Mittelschmerz c) Cryptomenorrhea d) Menometrorrhagia

c) Cryptomenorrhea Cryptomenorrhea is defined as monthly symptoms of menstruation without bleeding

a) Placenta percreta Placenta percreta would cause immediate postpartum bleeding.

Delayed postpartum bleeding would be caused by all of the following except: a) Placenta percreta b) Endometritis c) Retained products of conception d) A retained placenta

a) Follicular phase and luteal phase The ovarian cycle consists of two phases: the follicular phase and the luteal phase.

The ovarian cycle consists of the: a) Follicular phase and luteal phase b) Luteal phase and menstrual phase c) Follicular phase and secretory phase d) Proliferative phase and secretory phase

a) Cervical funneling The patient is suffering from funneling of the cervix, as demonstrated by the second set of caliper "2" in this image.

The sonographic image seen here is indicating: a) Cervical funneling b) Placenta previa c) Normal cervical length d) Vasa previa

a) Pyometra Pyometra is described as pus formation within the endometrium.

Which of the following is described as pus formation within the endometrium in the presence of PID? a) Pyometra b) Endometriosis c) Pyosalpinx d) Adenomyosis

a) All laboratory findings are decreased with Trisomy 18 All relevant maternal laboratory values are typically decreased with Edwards syndrome.

Which of the following maternal laboratory values would be elevated in the presence of Trisomy 18? a) All laboratory findings are decreased with Trisomy 18 b) Human chorionic gonadotropin c) Estriol d) Alpha-fetoprotein

c) Coronal Coronal imaging of the face is the optimal scan plane for demonstrating a unilateral cleft lip.

Which of the following scan planes would be best for demonstrating a unilateral cleft lip? a) Sagittal b) Oblique c) Coronal d) Transverse

d) Interstitial Within the cornu of the uterus lies the intramural extension of the fallopian tube known as the interstitial segment, the most proximal portion of the fallopian tube.

Which of the following would be best described as the most proximal segment of the fallopian tube? a) Ampulla b) Infundibulum c) Isthmus d) Interstitial

Which of the following is considered to be the most common chromosomal abnormality? a) Trisomy 13 b) Turner syndrome c) Trisomy 21 d) Trisomy 18

c) Trisomy 21 Down syndrome, or trisomy 21, is the most common chromosomal abnormality. It occurs in 1 in 500-800 pregnancies.

What is this diagram demonstrating? a) Monochorionic diamniotic b) Dichorionic monoamniotic c) Twinning d) Dichorionic diamniotic

d) Dichorionic diamniotic This diagram is demonstrating twins that have their own placenta and are located in their own amniotic sac. This is termed dichorionic diamniotic.

A 29-year-old patient presents to the sonography department for an endovaginal sonogram with a history of menorrhagia. A thorough examination of uterus reveals a 10-mm anechoic, round structure within the cervix that exhibits posterior enhancement. Which of the following is the most likely explanation for this mass? a) Nabothian cyst b) Intrauterine contraceptive device (IUD) c) Menstrual fluid d) Gartner duct cyst

a) Nabothian cyst Nabothian cysts are common findings on routine ultrasound examinations. These benign retention cysts are located within the cervix and may cause cervical enlargement on physical examination.

Which of the following would be considered the endometrial phase on day 18 of the menstrual cycle? a) Secretory phase b) Proliferative phase c) Luteal phase d) Periovulatory phase

a) Secretory phase The endometrial phases consist of a proliferative phase and secretory phase. The secretory phase lasts from days 14-28 of the menstrual cycle.

This diagram is demonstrating common features of: a) Trisomy 21 b) Trisomy 18 c) Triploidy d) Turner syndrome

a) Trisomy 21 Various sonographic features of Down syndrome include duodenal atresia, thickened nuchal translucency in the first trimester or increased nuchal fold thickness in the second trimester, pyelectasis, and absent nasal bones.

The average age for menopause to occur is: a) 60 b) 51 c) 48 d) 65

b) 51 Menopause, or climacteric, is the cessation of menstruation with advanced age. The average age that menopause occurs is 51.

During the secretory phase, the endometrial thickness typically ranges from: a) 4 mm to 8 mm b) 7 mm to 14 mm c) 6 mm to 10 mm d) 2 mm to 4 mm

b) 7 mm to 14 mm In the secretory phase, the endometrium typically measures between 7 and 14 mm.

b) Corpus luteum During the second half of the menstrual cycle, following ovulation, progesterone is produced by the corpus luteum of the ovary.

Progesterone is produced by the: a) Theca destruens b) Corpus luteum c) Corpus albicans d) Trophoblastic cells

d) Uterus didelphys Uterus didelphys is a congenital malformation of the uterus that results in the complete duplication of the uterus, cervix, and vagina.

The letter "E" in the image is depicting which uterine malformation? a) Subseptate uterus b) Septate uterus c) Bicornuate uterus d) Uterus didelphys

d) Pulmonary sequestration Among the listed choices, pulmonary sequestration is the best choice. The most common sonographic appearance of pulmonary sequestration is an echogenic, triangular-shaped mass within the fetal chest.

Upon sonographic analysis of a 31-week fetus, you visualize an echogenic, triangular-shaped mass within the fetal chest. Which of the following would most likely result in this manifestation? a) Pulmonary hyperplasia b) Diaphragmatic hernia c) Pulmonary hypoplasia d) Pulmonary sequestration

d) This is a normal measurement. Nuchal thickening ≥6 mm between 16 and 20 weeks is considered abnormal. Anything less than this, would be considered normal.

Upon ultrasound interrogation of the neck of a 19-week fetus, you discover that the nuchal thickness measures 4 mm in the anteroposterior dimension. Which of the following should be considered? a) Patau syndrome b) Edwards syndrome c) Down syndrome d) This is a normal measurement.

During the periovulatory phase, the endometrial thickness typically ranges from: a) 6 mm to 10 mm b) 4 mm to 8 mm c) 7 mm to 14 mm d) 3 mm to 4 mm

a) 6 mm to 10 mm In the periovulatory phase, the endometrium typically measures between 6 and 10 mm

This coronal image is indicative of: a) Cleft lip b) Cyclopia c) Gastroschisis d) Hypertelorism

a) Cleft lip This is an image of cleft lip.

Polyhydramnios and macrosomia in the third trimester would be indicative of which of the following? a) Maternal diabetes b) Fetal hypertension c) Gastroschisis d) Duodenal atresia

a) Maternal diabetes Maternal diabetes and a large fetus (macrosomia) discovered in the third trimester would be most likely among the list provided.

A 29-year-old patient presents to the ultrasound department with an indication of suspected endometriosis. Which of the following clinical findings would be least likely in a patient with endometriosis? a) Multigravida b) Dysmenorrhea c) Dyspareunia d) Painful bowel movements

a) Multigravida Endometriosis is most often associated with infertility. Multigravida is defined as a patient who has been pregnant more than once.

All of the following are causes of nonimmune hydrops except: a) Rh isoimmunization b) CAM c) Diaphragmatic hernia d) Turner syndrome

a) Rh isoimmunization Rh isoimmunization is associated with immune hydrops.

A patient presents to the ultrasound department for an abdominal sonogram. She is 54-yearsold, complains of weight loss, and has a recently discovered ovarian mucinous cystadenocarcinoma. The sonographic findings of the abdominal sonogram include the discovery of multiple hepatic lesions, probably consistent with metastasis. Which stages of ovarian cancer is confirmed with these findings? a) Stage III b) Stage II c) Stage VII d) Stage IV

a) Stage III Stage III is when the tumor involves one or both ovaries with confirmed peritoneal metastasis outside of the pelvis and/or regional lymph node involvement. In this case, the metastasis is apparent in the liver.

Which of the following statements is not true concerning fibroids? a) Elevated estrogen causes fibroids to enlarge. b) Patients who have fibroids rarely have adenomyosis. c) Fibroids may negatively impact fertility. d) Fibroids can inhibit vaginal delivery.

b) Patients who have fibroids rarely have adenomyosis. Adenomyosis is often present in the uterus afflicted with fibroid tumors.

The arrows in this image are indicating: a) Evidence of the "lemon sign" b) Normal splaying of the posterior ossification centers c) Abnormal splaying of the posterior ossification centers d) Evidence of the "banana sign"

c) Abnormal splaying of the posterior ossification centers Splaying of the laminae in the area of the defect is noted in this image of a fetus suffering from spina bifida.

Which of the following would not be a clinical finding in a 13-year-old who is suffering from hematometrocolpos? a) Abdominal pain b) Enlarged uterus c) Menorrhagia d) Urinary retention

c) Menorrhagia Menorrhagia is described as abnormally heavy and prolonged menstruation. This young lady is probably suffering from an imperforate hymen, in which case, she would be suffering from amenorrhea (no menstrual bleeding).

Which of the following is not a division of the uterus? a) Isthmus b) Fundus c) Vagina d) Corpus

c) Vagina The uterus can be divided into four major divisions: fundus, corpus, isthmus, and cervix.

d) Ampulla of the tube Conception, also referred to as fertilization, is the union of an ovum with a sperm. A sperm, which can live up to 72 hours, unites with the egg in the distal one-third of the fallopian tube, most likely in the ampulla.

Conception typically takes place in the: a) Isthmus of the tube b) Uterine fundus c) Cornu of the uterus d) Ampulla of the tube

a) The pulmonary artery should be located more posterior than the aorta and be noted crossing under the aorta to originate at the right ventricle. One important anatomic finding is the normal pulmonary artery should be positioned anterior to the aorta and should be visualized crossing over it.

Concerning the fetal outflow tracts, which of the following is not a true statement? a) The pulmonary artery should be located more posterior than the aorta and be noted crossing under the aorta to originate at the right ventricle. b) The outflow tracts should be comparable in size. c) The aortic outflow tract originates at the left ventricle. d) The pulmonary outflow tract originates at the right ventricle.

b) Menorrhagia The syndrome associated with polycystic ovary disease is called polycystic ovarian syndrome or Stein-Leventhal syndrome. Stein- Leventhal syndrome is characterized by amenorrhea, hirsutism, and obesity

Stein-Leventhal syndrome is characterized by all of the following except: a) Obesity b) Menorrhagia c) Amenorrhea d) Hirsutism

b) CAM The sonographic appearance of CAM most often appears as a mass that has both cystic and solid components. However, type III may appear similar to pulmonary sequestration, as it is echogenic in form, as seen in this image.

What is the most likely etiology of the structure identified by the large arrows in this image of the fetal chest? a) Diaphragmatic hernia b) CAM c) Pulmonary enlargement d) Pulmonary effusion

b) It is the decidualized tissue at the implantation site containing the chorionic villi. The chorion frondosum is the decidualized tissue at the implantation site containing the chorionic villi. It is the fetal contribution of the placenta.

Which of the following statements best describes the chorion frondosum? a) It is the endometrial tissue at the implantation site. b) It is the decidualized tissue at the implantation site containing the chorionic villi. c) It is the maternal contribution of the placenta. d) It is the portion of the decidua opposite the uterine cavity, across from the decidua basalis.

Which of the following is another name for the Sertoli-Leydig cell tumor of the ovary? a) Dysgerminoma b) Androblastoma c) Brenner tumor d) Endometrioma

b) Androblastoma A Sertoli-Leydig cell tumor, or androblastoma, is a sex cord-stromal ovarian neoplasm.

The sonographic investigation of an 18-week fetus reveals malposition of the heart and an anechoic mass noted adjacent to the fetal heart in the four-chamber heart view. Which of the following is the most likely diagnosis? a) Pleural effusion b) Diaphragmatic hernia c) Pulmonary hypoplasia d) Ectopic cordis

b) Diaphragmatic hernia The sonographic findings of a diaphragmatic hernia include malposition of the heart as a result of the stomach or other abdominal organs being located within the chest.

What hormone initiates the proliferation and thickening of the endometrium by encouraging the growth and expansion of the spiral arteries and glands within the functional layer of the endometrium? a) Human chorionic gonadotropin b) Estrogen c) Progesterone d) Follicle-stimulating hormone

b) Estrogen Estrogen is initially produced by the theca internal cells of the secondary follicles during the first part of the menstrual cycle. During this phase, estrogen initiates the proliferation and thickening of the endometrium by encouraging the growth and expansion of the spiral arteries and glands within the functional layer of the endometrium.

Which of the following is not a typical clinical feature of a patient who has adenomyosis? a) Dyspareunia b) Infertility c) Abnormal menstrual patterns d) Pelvic pain

b) Infertility Patients who have adenomyosis typically do not suffer from infertility.

Which of the following best describes a graafian follicle? a) It supports the pregnancy preceding the maturity of the placenta. b) It is a secondary follicle. c) It is the remnant of the corpus luteum. d) It is a primary follicle

b) It is a secondary follicle. The graafian follicle is the name of the dominant secondary follicle prior to ovulation.

Which of the following is the most common location of a diaphragmatic hernia? a) Right side b) Left side c) Midline d) Anterior

b) Left side The most common location of a diaphragmatic hernia is on the left side. This type may also be referred to as a Bochdalek hernia. The foramen of Bochdalek is located in the left posterolateral portion of the diaphragm.

This drawing is demonstrating what form of spinal abnormality? a) Spina bifida aperta b) Meningomyelocele c) Meningocele d) Spina bifida occulta

b) Meningomyelocele This drawing is demonstrating a meningomyelocele. Meningomyeloceles, also referred to as a myelomeningocele, contain meninges and nerve roots, as depicted in this image.

A patient presents with a history of excessive bleeding at the time of menstruation in amount and duration. What term describes this clinical condition? a) Cryptomenorrhea b) Menorrhagia c) Metrorrhagia d) Dysmenorrhea

b) Menorrhagia Menorrhagia is described as excessive bleeding at the time of menstruation in amount and duration.

Which of the following statements is true of omphaloceles? a) Omphaloceles typically have a right-paraumbilical location. b) Omphaloceles have a strong association with chromosomal abnormalities. c) Omphaloceles rarely result in postnatal surgery. d) Omphaloceles carry a better prognosis compared to gastroschisis.

b) Omphaloceles have a strong association with chromosomal abnormalities. Omphaloceles have a more significant risk for heart defects and chromosomal anomalies compared to gastroschisis. Trisomy 18 and trisomy 13, Turner's syndrome, and Beckwith-Wiedemann syndrome have all been linked with omphaloceles.

A 25-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of fever, chills, pelvic pain, purulent vaginal discharge, and elevated white blood cell count. Which of the following would be the most likely diagnosis? a) Missed abortion b) PID c) Stein-Leventhal syndrome d) Asherman syndrome

b) PID Clinically, patients with PID tend to have complaints such as fever, chills, pelvic pain, purulent vaginal discharge, vaginal bleeding, and dyspareunia. Leukocytosis is also present.

Which of the following pelvic muscles would be noted within the anterior body wall? a) Psoas major muscle b) Rectus abdominis muscle c) Levator ani muscle d) Piriformis muscle

b) Rectus abdominis muscle The rectus abdominis muscle extend from the xyphoid process of the sternum to the pelvis in the midline.

MCDK is thought to be caused by: a) Venereal diseases b) Intrauterine infections c) Early urinary obstruction d) Gestational diabetes

c) Early urinary obstruction MCDK is thought to be caused by an early, first-trimester obstruction of the urete

This mass in image was noted in the right adnexa in a postmenopausal female. The patient also had ascites and pleural effusion. Which of the following is the most likely diagnosis? a) Dingloma b) Cystic teratoma c) Fibroma d) Endometrioma

c) Fibroma The ovarian fibroma is a benign ovarian tumor most often discovered in middle-aged females. It may be complicated by Meigs syndrome, which is described as a benign ovarian mass in the presence of ascites and pleural effusion. Fibromas often appear solid and hypoechoic, and can therefore sonographically mimic the fibroid.

A 32-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of dysmenorrhea. A 12-mm anechoic mass is noted within the vagina. Which of the following is the most likely explanation for this mass? a) IUD b) Nabothian cyst c) Gartner duct cyst d) Menstrual fluid

c) Gartner duct cyst A Gartner duct cyst is typically small and located along the wall of the vagina.

The first structure that can be identified in the embryo is the: a) Gut b) Rhombencephalon c) Heart d) Stomach

c) Heart A heart rate using M-mode should be sonographically obtainable with endovaginal imaging when the crown rump length measures 4 to 5 mm. At this time, the head, gut, and rhombencephalon are too small to be identified.

Which of the following would be considered a benign and a common finding within the male fetal scrotum? a) Testicular torsion b) Varicocele c) Hydrocele d) Testicle enlargement

c) Hydrocele A hydrocele is a fluid collection within the scrotum between the two layers of the tunica vaginalis. Fetal hydroceles are common findings in utero and may become fairly large.

A sonographic examination of the fetal cranium reveals the presence of a monoventricle and fused thalami. Which of the following facial features would be least likely noted in the presence of these cranial findings? a) Ethmocephaly b) Cleft lip c) Hypertelorism d) Cyclopia

c) Hypertelorism These cranial sonographic findings are consistent with the diagnosis of holoprosencephaly. Holoprosencephaly is most often associated with hypotelorism, cebocephaly, ethmocephaly, cyclopia, and cleft lip with or without cleft palate.

A simple appearing cyst, that produces posterior enhancement, is discovered within the cervix of a patient who is complaining of menstrual discomfort. You suspect a nabothian cyst. Which of the following is a true statement concerning nabothian cysts? a) Nabothian cysts are malignant. b) Nabothian cysts do not produce posterior enhancement. c) Nabothian cysts are typically asymptomatic. d) Nabothian cysts are often a cause of menstrual discomfort.

c) Nabothian cysts are typically asymptomatic. Nabothian cysts are common findings on routine ultrasound examinations. These benign retention cysts are located within the cervix and may cause cervical enlargement on physical examination. They are typically asymptomatic.

Which of the following statements is true of omphaloceles? a) Omphaloceles carry a better prognosis compared to gastroschisis. b) Omphaloceles typically have a right-paraumbilical location. c) Omphaloceles have a strong association with chromosomal abnormalities. d) Omphaloceles rarely result in postnatal surgery.

c) Omphaloceles have a strong association with chromosomal abnormalities. Omphaloceles have a more significant risk for heart defects and chromosomal anomalies compared to gastroschisis. Trisomy 18 and trisomy 13, Turner's syndrome, and Beckwith-Wiedemann syndrome have all been linked with omphaloceles.

Which of the following clinical symptoms would be most common in a patient with these sonographic findings? a) Palpable pelvic mass, vaginal bleeding, dysuria b) High hematocrit, pain, hypertension c) Pain, vaginal bleeding, palpable pelvic mass d) Vaginal bleeding, hypertension, hyperemesis gravidarum

c) Pain, vaginal bleeding, palpable pelvic mass These clinical findings are considered the classic clinical triad for an ectopic pregnancy, as identifiable in this image.

All of the following would be associated clinical findings in this patient except: a) Closed cervix b) Uterine cramping c) Palpable bilateral adnexal masses d) Vaginal bleeding

c) Palpable bilateral adnexal masses This image yields sonographic findings consistent with a subchorionic hemorrhage. Recent bleeds are often hyperechoic or isoechoic to the placenta, while older bleeds may appear anechoic or even hypoechoic depending upon the age of the hemorrhage. A subchorionic hemorrhage results from the implantation of the fertilized ovum into the uterus with subsequent low-pressure bleeding. Though large bleeds may be associated with miscarriage and stillbirth, fetal activity is often a reassuring sign that the pregnancy will progress normally. They are not associated with bilateral adnexal masses.

During a 35-week gestation obstetrical sonogram, a solid tumor is noted within the placenta. You suspect a chorioangioma. Which of the following statements is not true of chorioangiomas? a) The chorioangioma is the most common placental tumor. b) Chorioangiomas are typically asymptomatic. c) Sonographically, a chorioangioma typically appears as a well-circumscribed anechoic mass within the placental substance. d) The most common location of a chorioangioma is adjacent to the umbilical cord insertion site at the placenta.

c) Sonographically, a chorioangioma typically appears as a wellcircumscribed anechoic mass within the placental substance. Sonographically, a chorioangioma will most often appear as a wellcircumscribed hypoechoic or hyperechoic mass within the placental substance.

Webbed toes are an example of: a) Phocomelia b) Mesodactyly c) Syndactyly d) Polydactyly

c) Syndactyly The word part "syn" means together, while "dactyly" refers to the digits. Therefore, syndactyly describes fusion of digits. An example of this disorder would be webbing of the toe

Which of the following is not true of the dysgerminoma? a) Children with ovarian dysgerminomas present with precocious puberty. b) The tumor marker used for dysgerminoma is an elevation in serum lactate dehydrogenase. c) The dysgerminoma is the second most common benign tumor of the ovary. d) The testicular equivalent of an ovarian dysgerminoma is the seminoma.

c) The dysgerminoma is the second most common benign tumor of the ovary. The dysgerminoma is the most common malignant germ cell tumor of the ovary.

The images seen here are transvaginal images of a multiparous patient who complained of dysmenorrhea, pelvic pain, and dyspareunia. Which of the following is demonstrated? a) Nabothian cyst b) Endometriosisc) Thecoma d) Adenomyosis

d) Adenomyosis Sonographically, the uterus will appear diffusely enlarged and heterogeneous. There may be indistinct hypoechoic or echogenic areas scattered throughout the myometrium, with small myometrial cysts noted as well. Thickening of the posterior myometrium can also be recognized, as seen in this image. The clinical presentation of adenomyosis is varied and nonspecific, with most women experiencing dysmenorrhea, menometrorrhagia, pelvic pain, and dyspareunia. Patients often have a tender uterus upon physical examination.

Upon sonographic examination of the pelvis in a patient with free fluid, you discover that fluid has collected between the uterus and the rectum. All of the following are synonyms for this area except: a) Posterior cul-de-sac b) Rectouterine pouch c) Pouch of Douglas d) Morrison pouch

d) Morrison pouch The posterior cul-de-sac may also be referred to as the pouch of Douglas or rectouterine pouch. Morrison pouch is located between the right kidney and liver.

If a young lady does not experience menarche before age 16, she is said to have: a) Primary amenorrhea b) Pseudoprecocious puberty c) Precocious puberty d) Secondary amenorrhea

a) Primary amenorrhea If an individual does not experience menarche before age 16, she is said to have primary amenorrhea. Primary amenorrhea may be caused by congenital abnormalities or congenital obstructions, such as an imperforate hymen.

Which of the following is not true of the dysgerminoma? a) The dysgerminoma is the second most common benign tumor of the ovary. b) The tumor marker used for dysgerminoma is an elevation in serum lactate dehydrogenase. c) The testicular equivalent of an ovarian dysgerminoma is the seminoma. d) Children with ovarian dysgerminomas present with precocious puberty.

a) The dysgerminoma is the second most common benign tumor of the ovary. The dysgerminoma is the most common malignant germ cell tumor of the ovary.

Which of the following would be least likely associated with an increased fetal nuchal translucency measurement in the first trimester? a) Trisomy 13 b) Trisomy 21 c) Turner syndrome d) Trisomy 18

a) Trisomy 13 Though it is possible for a fetus with Trisomy 13 (Patau syndrome) to have an increased nuchal translucency, among the list provided, it is the least likely.

Though an EIF may be seen in a normal fetus, which of the following chromosomal abnormalities would be most often associated with this finding? a) Trisomy 21 b) Trisomy 9 c) Trisomy 18 d) Triploidy

a) Trisomy 21 An EIF may be seen in the normal fetus. However, there have been studies that have linked the incidence of an EIF with trisomy 21, particularly if there is more than one EIF detected.

Which of the following is considered the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction? a) Ureteropelvic junction obstruction b) Ureterovesicular junction obstruction c) Vesicoureteral reflux d) Posterior urethral valves

a) Ureteropelvic junction obstruction Ureteropelvic junction (UPJ) obstruction is the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction. The UPJ is located at the junction of the renal pelvis and ureter.

Which of the following would be the most likely sonographic appearance of a fibroid? a) An echogenic mass that produces posterior acoustic enhancement. b) A solid, hypoechoic mass that produces posterior shadowing. c) A complex mass that produces posterior reverberation artifact. d) A cyst mass that produces posterior acoustic enhancement.

b) A solid, hypoechoic mass that produces posterior shadowing. Sonographically, a fibroid often appears as solid, hypoechoic mass that produces posterior shadowing.

Which of the following would be best described as ectopic endometrial tissue within the myometrium of the uterus? a) PID b) Adenomyosis c) Endometriosis d) Meigs syndrome

b) Adenomyosis Adenomyosis is characterized by the invasion of endometrial tissue into the myometrium of the uterus.

Which of the following best describes the sonographic appearance of an ovarian fibroma? a) Anechoic mass b) Hypoechoic mass c) Hyperechoic mass d) Complex mass

b) Hypoechoic mass Thecomas sonographically appear as hypoechoic, solid mass with posterior attenuation.

Which of the following is not a typical clinical feature of a patient who has adenomyosis? a) Abnormal menstrual patterns b) Infertility c) Pelvic pain d) Dyspareunia

b) Infertility Patients who have adenomyosis typically do not suffer from infertility.

Small cysts located adjacent to the ovary are referred to as: a) Cystic teratomas b) Thecomas c) Paraovarian cysts d) Cyclic cysts

c) Paraovarian cysts Parovarian cysts are small cysts located adjacent to the ovary. They may contain small amounts of hemorrhage and septations.

Which of the following is a clinical finding suspicious of Asherman syndrome? a) Hirsutism b) Polymenorrhea c) Tamoxifen therapy d) Amenorrhea

d) Amenorrhea Asherman syndrome is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilatation and curettage. The adhesions may cause amenorrhea, pregnancy loss, and/or infertility.

The measurement that is performed from the lateral margin of one orbit to the lateral margin of the other orbit is the: a) Interocular diameter b) Ocular diameter c) Intraocular diameter d) Binocular diameter

d) Binocular diameter The binocular diameter is performed from the lateral margin of one orbit to the lateral margin of the other orbit.

Which of the following would be considered the least accurate measurement in the estimation of gestationa in the presence of dolichocephaly? a) Transcerebellar diameter b) Head circumference c) Cephalic index d) Biparietal diameter

d) Biparietal diameter Dolichocephaly is described as an elongated, narrow head shape. Therefore, the biparietal measurement would be most affected and would be the least accurate among this list.

Which hormone encourages the induction of salt and water retention, and stimulates contractile motions to occur within the uterine myometrium and the fallopian tubes? a) Luteinizing hormone b) Testosterone c) Progesterone d) Estrogen

d) Estrogen Estrogen, produced by the ovary, encourages the induction of salt and water retention, and it also stimulates contractile motions to occur within the uterine myometrium and the fallopian tubes.

The proliferative phase of the endometrial cycle coincides with which phase of the ovarian cycle a) Menstrual b) Secretory c) Luteal d) Follicular

d) Follicular Following menses, the ovary is within the follicular phase while the endometrium is within the proliferative phase.

Which of the following would be most likely discovered in the fetus suffering from Beckwidth- Weidemann syndrome? a) Clubfeet b) Hydranencephaly c) Duodenal atresia d) Hepatomegaly

d) Hepatomegaly Beckwith-Wiedemann syndrome is a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver (hepatomegaly

d) Late proliferative During the late proliferative phase, or periovulatory phase, the endometrial layers display a stark contrast and can measure between 6 and 10 mm. The outer echogenic basal layer surrounds the more hypoechoic functional layer, while the functional layer is separated by the echogenic endometrial stripe. This finding is referred to as the "three-line" sign.

A 23-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of vague pelvic discomfort and a negative pregnancy test. She is uncertain of the date when her last menstrual period started. Sonographically, the endometrium displays a stark contrast in echogenicity between the functional and basal layer of the endometrium. The basal layer appears echogenic, while the functional layer appears hypoechoic. The endometrial thickness is 7.5 mm. What phase of the endometrial cycle is the patient most likely in? a) Menstrual b) Secretory c) Early proliferative d) Late proliferative

Which of the following arteries supplies blood directly to the ovary? a) Uterine arteries b) Ovarian arteries c) External iliac arteries d) Ovarian and uterine arteries

d) Ovarian and uterine arteries The ovaries have a dual blood supply via the ovarian and uterine arteries.

Potter's syndrome is associated with all of the following except: a) Pulmonary hypoplasia b) Abnormal facies c) Bilateral renal agenesis d) Polyhydramnios

d) Polyhydramnios Potter's syndrome is characterized by bilateral renal agenesis, abnormal facies, pulmonary hypoplasia, and limb abnormalities. Because of bilateral renal agenesis, and the fact that the fetal kidneys are responsible for creating the majority of amniotic fluid, Potter's syndrome is associated with oligohydramnios

Which of the following would be least expected to increase the risk of developing the sonographic findings seen in this transvaginal image? a) Prior history of PID b) Prior history of ectopic pregnancy c) Prior history of assisted reproductive therapy d) Prior history of miscarriage

d) Prior history of miscarriage An ectopic pregnancy is noted in this transvaginal image of the left adnexa. Having a history of miscarriage does not increase the risk of a developing an ectopic pregnancy with future pregnancies.

b) Autosomal recessive polycystic kidney disease (ARPKD) ARPKD may also be referred to as autosomal recessive polycystic renal disease and infantile polycystic kidney disease.

Infantile polycystic kidney disease is also referred to as: a) Obstructive cystic dysplasia b) Autosomal recessive polycystic kidney disease (ARPKD) c) Multicystic dysplastic kidney disease (MCDK) d) Autosomal dominant polycystic kidney disease (ADPKD)

a) Cisterna magna The cisterna magna, located in the posterior fossa of the cranium, is the largest cistern in the head. On sonography, the cisterna magna appears as an anechoic, fluid-filled space, posterior to the cerebellum, between the cerebellar vermis and the interior surface of the occipital bone.

The arrowhead in this image is located within the: a) Cisterna magna b) Cerebellum c) Cavum septum pellucidum d) Quadrageminal cistern

.Which of the following anomalies can be detected in the first trimester with endovaginal scanning? a) Anencephaly b) Osteogenesis imperfecta c) Achondroplasia d) Thanatophoric dysplasia

a) Anencephaly Anencephaly is a neural tube defect that is described as the absence of the cranium and cerebral hemispheres. These may be identified in the later part of the first trimester with careful examination of the fetal head.

All of the following would result in an increase in maternal serum alpha-fetoprotein except: a) Cebocephaly b) Gastroschisis c) Anencephaly d) Limb-body wall complex

a) Cebocephaly Cebocephaly is defined as close-set eyes (hypotelorism) and a nose with a single nostril.

A 19-year-old gravid patient presents to the ultrasound department with a history of light vaginal spotting and nausea. Sonographically, a single live intrauterine pregnancy is discovered. Within the right adnexa, a simple appearing cyst with a thick echogenic rim is noted. Interrogation with color Doppler reveals hyperemic flow within the borders of this mass. What is the most likely diagnosis? a) Corpus luteum cyst b) Tubo-ovarian abscess c) Heterotopic pregnancy d) Theca lutein cyst

a) Corpus luteum cyst A corpus luteum may appear as a simple cyst, as a complex cyst with hemorrhagic components, as a hypoechoic mass, or have a thick echogenic rim. The rim may reveal the "ring of fire" sign when color Doppler is utilized.

Which of the following ovarian masses would be most likely associated with Meigs syndrome? a) Fibroma b) Adenomyoma c) Endometrioma d) Ovarian cystadecarcinoma

a) Fibroma Fibromas are most often found in middle-aged women. They are benign ovarian masses that may be complicated by a condition known as Meigs syndrome, which is defined as ascites and pleural effusion in the presence of a benign ovarian tumor.

Which of the following would be defined as herniation of the membranes into the cervix? a) Funneling b) Parting c) Quickening d) Thinning

a) Funneling Funneling of the cervix is the result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix.

The most common abnormal findings on a prenatal sonogram are those of the: a) Genitourinary system b) Musculoskeletal system c) Cranium d) Gastrointestinal tract

a) Genitourinary system The most common abnormal findings on a prenatal sonogram are those of the genitourinary system. In fact, fetal hydronephrosis is the most common fetal abnormality noted during an obstetric sonogram.

The sonographic findings of a 30-week gestation include anophthalmia and a medium cleft lip. These findings would most likely be associated with which of the following? a) Holoprosencephaly b) Hydrocephalus c) Hydranencephaly d) Lissencephaly

a) Holoprosencephaly Holoprosencephaly is a midline brain anomaly that is associated with not only brain aberrations but also atypical facial structures like anophthalmia and medium cleft lip.

The sonographic findings in this image is consistent with: a) Holoprosencephaly b) Schizencephaly c) Dandy-Walker malformation d) Chiari II malformation

a) Holoprosencephaly This transaxial image of the fetal head demonstrates a monoventricle and fusion of the thalami, sonographic findings consistent with the diagnosis of holoprosencephaly.

The uterine arteries are branches of the: a) Internal iliac arteries b) Greater saphenous veins c) Inferior vena cava d) External iliac veins

a) Internal iliac arteries The paired right and left uterine arteries are branches of the internal iliac arteries. They supply blood to the uterus, the fallopian tubes, and the ovaries, and courses along the lateral aspect of the uterus within the folds of the broad ligaments.

The measurement being obtained in this image is the: a) Interolcular diameter b) Intraocular diameter c) Ocular diameter d) Binocular diameter

a) Interolcular diameter The interocular diameter is the length between the orbits.

b) Adenomyosis The clinical presentation of adenomyosis is varied and nonspecific, with most women experiencing dysmenorrhea, menometrorrhagia, pelvic pain, and dyspareunia. Patients often have a tender uterus upon physical examination. An important differentiation should be made between endometriosis and adenomyosis. Sonographically, the uterus will appear diffusely enlarged and heterogeneous. There may be indistinct hypoechoic or echogenic areas scattered throughout the myometrium, with small myometrial cysts noted as well. Thickening of the posterior myometrium can also be recognized. Patients with endometriosis tend to be younger and have fertility troubles, while those with adenomyosis are often older and multiparous (having birthed more than one child)

A 41-year-old multiparous patient presents to the sonography department for a pelvic sonogram with a history of dysmenorrhea, pelvic pain, and dyspareunia. The sonographic findings of this examination include an enlarged uterus, myometrial cysts, and thickening of the posterior myometrium. What is the most likely diagnosis? a) Leiomyosarcoma b) Adenomyosis c) Endometrial carcinoma d) Endometriosis

d) Leukocytosis Patients with endometritis often complain of dyspareunia, pelvic tenderness, fever, and will have evidence of leukocytosis. Patients with adenomyosis typically do not have an elevation in leukocytosis.

Sonographically, a thickened, heterogeneous endometrium is noted in a patient who complains of pelvic pain and dyspareunia. Which of the following clinical findings would be most suggestive of endometritis and not adenomyosis? a) Dysmenorrhea b) Menometrorrhagia c) Uterine enlargement d) Leukocytosis

d) Basal layer The placenta consists of three parts: the chorionic plate, the placental substance, and the basal layer. The chorionic plate is the element of the placenta closest to the fetus. The basal layer is the area adjacent to the uterus. The placental substance contains the functional parts of the placenta and is located between the chorionic plate and the basal layer.

The maternal surface of the placenta is referred to as the: a) Chorionic plate b) Chorion frondosum c) Placental substance d) Basal layer

a) Normal cord insertion The sonographic appearance of an omphalocele is that of a midline abdominal mass that contains bowel, liver, or other abdominal organs, as seen in this transverse image of the fetal abdomen. Trisomy 18 and trisomy 13, Turner's syndrome, and Beckwith-Wiedemann syndrome have all been linked with omphaloceles. Pentalogy of Cantrell is another group of anomalies that includes an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect, and pericardial defects. An elevated maternal serum alpha-fetoprotein level is also discovered through maternal serum screening. Since the umbilical cord inserts into this anterior abdominal wall mass, it is not considered to be normal cord insertion.

The sonographic findings demonstrated in this image of the fetal abdomen are associated with all of the following except: a) Normal cord insertion b) Pentalogy of Cantrell c) Elevated maternal serum alpha-fetoprotein d) Trisomy 18

a) Cystic hygroma The sonographic appearance of a cystic hygroma is that of a cystic neck mass divided in the midline by a thick fibrous band of tissue.

The sonographic findings in this image are most consistent with the diagnosis of which of the following? a) Cystic hygroma b) Choroid plexus cyst c) Arnold-Chiari II malformation d) Posterior encephalocele

d) Hydranencephaly Hydranencephaly is a fatal condition in which the entire cerebrum is replaced by a large sac containing cerebrospinal fluid. With hydranencephaly, the falx cerebri may be partially or completely absent, while the brainstem and basal ganglia are maintained and surrounded by cerebrospinal fluid. There will be no cerebral cortex identified as noted in this image.

The sonographic findings in this image are most consistent with which of the following? a) Dandy-Walker malformation b) Holoprosencephaly c) Hydrocephalus d) Hydranencephaly

c) Copper 8 Copper 8 is not an intrauterine device. Copper 7, Lippes loop, Mirena, Copper T, and Dalkon shield are all intrauterine devices.

Which of the following is not a commonly encountered intrauterine devices? a) Copper T b) Lippes loop c) Copper 8 d) Mirena

b) Fornix The vagina is composed of three layers: inner mucosal layer, middle muscular layer, and an outer layer that may be referred to as the adventitia.

Which of the following is not a layer of the vaginal wall? a) Adventitia b) Fornix c) Muscular d) Mucosal

b) Menometrorrhagia Menometrorrhagia is defined as excessive bleeding from the uterus in duration and amount. Patients with polycystic ovarian syndrome typically have anovulatory cycles, infertility, hirsutism, amenorrhea, and are obese.

Which of the following is not associated with polycystic ovarian syndrome? a) Hirsutism b) Menometrorrhagia c) Obesity d) Anovulatory cycles

a) They are more frequently found in males. Sacrococcygeal teratomas are more frequently discovered in female fetuses.

Which of the following is not true of sacrococcygeal teratoma? a) They are more frequently found in males. b) They may become malignant. c) They have potential to grow inside of the pelvis. d) They may appear complex or solid.

b) A patient with a history of prior cesarean section is at increased risk for both placenta previa and placenta accreta. The placenta may attach to a uterine scar following a previous cesarean section and/or after uterine surgery. This explains the association between anterior placenta previa and placenta accreta.

Which of the following statements is true concerning a possible link between placenta previa and placenta accreta? a) A patient with placental abruption is at increased risk for developing placenta previa and placenta accreta during the pregnancy. b) A patient with a history of prior cesarean section is at increased risk for both placenta previa and placenta accreta. c) A patient with a history of previous use of an intrauterine contraception device is at increased risk for developing both placenta previa and placenta accreta. d) A patient with a history of ovarian torsion is at increased risk for both placenta previa and placenta accreta.

c) Atrophy of the endometrium The typical sonographic appearance of endometrial atrophy is that of a thin endometrium.

Which of the following would not be associated with endometrial thickening during menopause? a) Endometrial polyps b) Endometrial hyperplasia c) Atrophy of the endometrium d) Endometrial carcinoma

A follow-up sonographic examination of a 27-week gestation is highly suspicious for IUGR. Which measurement is the best predictor of IUGR? a) Abdominal circumference b) Femur length c) Head circumference d) Crown rump length

a) Abdominal circumference The measurement that should be scrutinized closely in fetuses that are at risk for growth abnormalities is the abdominal circumference (AC), as it carries a sensitivity of greater than 95% for the diagnosis of IUGR.

Which of the following clinical findings is most indicative of ovarian torsion? a) Acute unilateral pelvic pain b) Chronic pelvis pain c) Nausea d) Purulent discharge

a) Acute unilateral pelvic pain Patients most often present with nausea, vomiting, and acute unilateral pelvic or abdominal pain. Acute pelvic pain would be the most specific finding for ovarian torsion

The thickness measurement of the endometrium obtained with sonography should include all of the following except the: a) Adjacent hypoechoic myometrium b) Basal layer of the endometrium c) Functional layer of the endometrium d) Endometrial stripe

a) Adjacent hypoechoic myometrium The thickness measurement of the endometrium obtained with sonography should not include the adjacent hypoechoic myometrium and is considered accurate when the "double-layer thickness" measurement is performed. The "double-layer thickness" includes only the distance from basal layer to basal layer, which includes both the functional layer and the endometrial stripe.

Which of the following would be best described as the longest and most tortuous segment of the fallopian tube? a) Ampulla b) Fimbria c) Infundibulum d) Isthmus

a) Ampulla The ampulla is the longest and most tortuous segment of the tube. The ampulla is a significant portion of the tube because it is the location of fertilization and the area where ectopic pregnancies often embed.

Which of the following could possibly be diagnosed at the end of the first trimester? a) Anencephaly b) Pulmonary hypoplasia c) Agenesis of the corpus callosum d) Ventricular septal defect

a) Anencephaly The fetal cranium should be visualized by the end of first trimester. Anencephaly is defined as the absence of the cranium and cerebral hemispheres.

A 37-year-old patient presents to the ultrasound department with a history of elevated maternal serum alpha-fetoprotein. The sonographic findings include a single live intrauterine pregnancy. An analysis of the fetal head reveals bulging eyes and absence of the cranial vault. These findings are most consistent with the diagnosis of: a) Anencephaly b) Hydranencephaly c) Semilobar Holoprosencephaly d) Encephalocele

a) Anencephaly The sonographic findings of anencephaly include "froglike" facies, or bulging eyes, and absence of the cranial vault.

Which of the following would be most likely associated with sirenomelia? a) Bilateral renal agenesis b) Polyhydramnios c) Radial ray defect d) Large sacrococcygeal teratoma

a) Bilateral renal agenesis Sirenomelia is also referred to as mermaid syndrome because of the fusion of the lower extremities that occurs with this disorder. Since bilateral renal agenesis often accompanies this condition, it is almost always lethal.

In the fetus, which of the following is responsible for creating cerebrospinal fluid? a) Choroid plexus b) Cavum septum pellucidum c) Corpus callosum d) Arachnoid granulations

a) Choroid plexus Within the atria of both lateral ventricles lies the echogenic configuration of the choroid plexus, the mass of cells responsible for cerebrospinal fluid production in the fetus. Choroid plexus may also be found in the roof of the third and fourth ventricles.

A deviation of a finger, as seen in the absence of the middle fifth phalanx, is termed: a) Clinodactyly b) Syndactyly c) Polydactyly d) Trident hand

a) Clinodactyly Clinodactyly is defined as the deviation of a finger. The word part "clino" literally means sloped, while "dactyly" refers to the digit.

The sonographic findings of a 24-week gestation include an enlarged cisterna magna that communicates with an enlarged fourth ventricle. These sonographic findings are most consistent with the diagnosis of: a) Dandy-Walker malformation b) Alobar holoprosencephaly c) Mega cisterna magna d) Arnold-Chiari II malformation

a) Dandy-Walker malformation The sonographic findings of Dandy-Walker malformation include the presence of an enlarged cisterna magna that communicates with a distended fourth ventricle through a defect in the cerebellum.

Which of the following statements is not true of menopause? a) During menopause, estrogen and progesterone levels increase. b) During menopause, the uterus will maintain its adult shape. c) During menopause, the follicles that normally develop on the ovary are less responsive to the hormones produced by the anterior pituitary gland. d) During menopause, the ovaries decrease in size.

a) During menopause, estrogen and progesterone levels increase. As menopause approaches, the follicles that normally develop on the ovary are less responsive to the hormones produced by the anterior pituitary gland. During menopause, follicles on the ovary cease to mature, resulting in a considerable reduction in the amount of estrogen and progesterone. Estrogen and progesterone are the hormones released by the ovary that facilitate menses. Without estrogen and progesterone, menstruation ceases and the uterus and ovaries decrease in size. Though smaller, the uterus will maintain its adult shape. The ovaries will also become smaller and more echogenic. Consequently, during postmenopause, the ovaries lack follicles and are often difficult to image, secondary to their small size and lack of follicular development.

Which of the following is typically not a clinical manifestation of endometrial polyps? a) Dyspareunia b) Intermenstrual bleeding c) Menometrorrhagia d) Asymptomatic

a) Dyspareunia Dyspareunia, or painful intercourse, is not typically a clinical findings of endometrial polyps. Clinically, patients may present with menometrorrhagia and/or intermenstrual bleeding, or may even be asymptomatic.

The sonographic findings of a 22-week fetus include micrognathia, bilateral choroid plexus cysts, and a strawberry-shaped skull. Which of the following would be the most likely diagnosis? a) Edwards syndrome b) Patau syndrome c) Fitz-Hugh-Curtis syndrome d) Down syndrome

a) Edwards syndrome Various sonographic features of Edwards syndrome (trisomy 18) include a strawberry-shaped skull, choroid plexus cysts, micrognathia, rockerbottom feet, and omphalocele.

You are performing a pelvic sonogram on a 65-year-old patient for pelvic pain. The endometrial thickness appears symmetric, echogenic, and measures 5 mm. Which of the following statements is true? a) Endometrial atrophy is the most likely cause of this appearance. b) Endometrial cancer is the most likely cause of this appearance. c) Endometrial hyperplasia should be highly suspected. d) An endometrial polyp should be highly suspected.

a) Endometrial atrophy is the most likely cause of this appearance. The endometrium will appear thin and will not measure more than 5 mm in the presence of endometrial atrophy. Endometrial carcinoma, a polyp, and hyperplasia typically lead to a thickening of the endometrium beyond 5 mm.

Which of the following ovarian masses would be best described as a benign, blood-containing tumor that forms from the implantation of ectopic endometrial tissue? a) Endometrioma b) Sertoli-Leydig cell tumor c) Cystic teratoma d) Krukenberg tumor

a) Endometrioma An endometrioma is a benign, blood-containing tumor that forms from the implantation of ectopic endometrial tissue, a condition known as endometriosis.

Which of the following may be described as a "chocolate cyst"? a) Endometrioma b) Theca lutein cysts c) Corpus luteum cyst d) Fibroma

a) Endometrioma Hemorrhage from endometriosis forms into focal areas of bloody tumors known as endometriomas. These lesions have been termed as "chocolate cysts" because of their blood content.

The use of an intrauterine device has been linked with an increased risk for all of the following except: a) Endometriosis b) Ectopic pregnancy c) Spontaneous abortions d) PID

a) Endometriosis The use of an intrauterine device has been linked with PID, ectopic pregnancy, and spontaneous abortions.

Which of the following sonographic findings is evident in this sagittal image of the fetal cranium? a) Enlarged cisterna magna b) Choroid plexus cyst c) Lissencephaly d) Agenesis of the corpus callosum

a) Enlarged cisterna magna Though this fetus is suffering from Dandy-Walker malformation, it is difficult to determine in this image. However, a clearly enlarged cisterna magna can be seen.

Which of the following may lead to a right-sided diaphragmatic hernia, in which case the entire liver may herniate into the fetal chest? a) Foramen of Morgagni hernia b) Pulmonary sequestration c) Foramen of Monro hernia d) Foramen of Bochdalek hernia

a) Foramen of Morgagni hernia Foramen of Morgagni, which is located right anteromedially within the diaphragm, may lead to a right-sided diaphragmatic hernia, thus allowing the entire liver to herniate into the chest.

All of the following are female factors that contribute to infertility except: a) History of cesarean section b) Polycystic ovarian disease c) Endometriosis d) Asherman syndrome

a) History of cesarean section Congenital uterine malformations, endometriosis, polycystic ovarian disease, tubal causes, Asherman syndrome, and uterine leiomyomas, may have some impact on female infertility. A prior cesarean section has not been shown to contribute to female infertility.

All of the following statements are true of gestational trophoblastic disease except: a) Hydatidiform mole is the least common form of gestational trophoblastic disease. b) A complete hydatidiform mole is characterized by absence of the fetus and amnion. c) Choriocarcinoma results from the malignant progression of a hydatidiform molar pregnancy. d) A partial mole may be accompanied by a triploid fetus.

a) Hydatidiform mole is the least common form of gestational trophoblastic disease. Hydatidiform mole is the most common form of gestational trophoblastic disease in which there is excessive growth of the placenta and high levels of human chorionic gonadotropin. It is typically benign.

A 23-year-old patient presents to the ultrasound department for a pelvic sonogram with a history of vague pelvic discomfort and a negative pregnancy test. She is uncertain of the date when her last menstrual period started. Sonographically, the endometrium displays a stark contrast in echogenicity between the functional and basal layer of the endometrium. The basal layer appears echogenic, while the functional layer appears hypoechoic. The endometrial thickness is 7.5 mm. What phase of the endometrial cycle is the patient most likely in? a) Late proliferative b) Early proliferative c) Menstrual d) Secretory

a) Late proliferative During the late proliferative phase, or periovulatory phase, the endometrial layers display a stark contrast and can measure between 6 and 10 mm. The outer echogenic basal layer surrounds the more hypoechoic functional layer, while the functional layer is separated by the echogenic endometrial stripe. This finding is referred to as the "three-line" sign.

Which of the following is true of nabothian cysts? a) Nabothian cysts are located within the cervix and are benign. b) Nabothian cysts are located within the vagina and are benign. c) Nabothian cysts are associated with dysmenorrhea. d) Nabothian cysts cause dyspareunia.

a) Nabothian cysts are located within the cervix and are benign. Nabothian cysts are common findings on routine sonographic examinations. These benign retention cysts are located within the cervix and may cause cervical enlargement on physical examination.

This diagram is demonstrating: a) Omphalocele b) Ectopic cordis c) Physiologic bowel herniation d) Gastroschisis

a) Omphalocele The evidence of persistent herniation of the bowel, and potentially other abdominal organs, into the base of the umbilical cord leads to the diagnosis of an omphalocele. An omphalocele is located within the midline of the abdomen. The umbilical cord will insert into this mass, as demonstrated by this diagram.

The classic symptoms of placental abruption include: a) Pain and vaginal bleeding in the third trimester b) Pain and vaginal bleeding in the first trimester c) No pain and no vaginal bleeding d) No pain and vaginal bleeding in the second trimester

a) Pain and vaginal bleeding in the third trimester With placental abruption, patients often present with vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness.

What is a common clinical finding in a patient with the sonographic findings demonstrated in this image? a) Painless vaginal bleeding b) Sever uterine contractions c) Uterine tenderness d) Pelvic pain

a) Painless vaginal bleeding This image is demonstrating placenta previa. The most common clinical presentation of placenta previa is painless vaginal bleeding in the second or third trimester.

The late proliferative phase may be referred to as the: a) Periovulatory phase b) Secretory phase c) Luteal phase d) Menstrual phase

a) Periovulatory phase The proliferative phase may be divided into two phases, early and late, with the late proliferative phase often being referred to as the periovulatory phase.

A second-trimester fetal sonogram is ordered secondary to increased fundal height. Polyhydramnios is identified and the femoral length that falls in the 5th percentile. Which of the following measurements would not be helpful? a) Renal length b) Head:Abdomen ratio c) Humerus length d) Fibula length

a) Renal length These sonographic findings suggest possible skeletal anomalies like achondroplasia (dwarfism). Renal length is not altered with skeletal abnormalities.

The letter "C" seen in this schematic image is most likely representing the: a) Spiral arteries b) Arcuate arteries c) Serosal arteries d) Straight arteries

a) Spiral arteries The spiral arteries supply blood to the decidual or functional layer of the endometrium.

Which of the following would be considered the most common intracranial tumor discovered in utero? a) Teratoma b) Lipoma of the corpus callosum c) Choroid plexus papilloma d) Rhabdomyoma

a) Teratoma The most common intracranial tumor found in utero is the teratoma.

Which of the following statements is not true of the ovarian thecoma? a) Thecomas are malignant ovarian sex cord-stromal tumor. b) Thecomas are estrogen-producing tumors. c) Thecomas are most often found in postmenopausal women. d) Thecomas may cause vaginal bleeding.

a) Thecomas are malignant ovarian sex cord-stromal tumor. A thecoma is a benign ovarian sex cord-stromal tumor. Thecomas are most often found in postmenopausal women. They are estrogenproducing tumors; therefore, patients often complain of postmenopausal vaginal bleeding associated with the unconstrained estrogen stimulation upon the endometrium.

Which of the following would be most likely associated with hypoplastic nasal bones? a) Trisomy 21 b) Turner syndrome c) Meckel-Gruber syndrome d) Triploidy

a) Trisomy 21 There are various sonographic findings consistent with the diagnosis of Down syndrome (Trisomy 21) including hypoplastic or absent nasal bones.

The term hypospadias denotes: a) A dilated fetal bladder and urethra in the presence of a bladder outlet obstruction b) Abnormal ventral curvature of the penis c) Undescended testicle(s) d) Maldevelopment of the testicle

b) Abnormal ventral curvature of the penis Hypospadias is an abnormal ventral curvature of the penis as a result of a shortened urethra that exits on the ventral penile shaft.

The findings in this image are most consistent with the diagnosis of a) Encephalocele b) Anencephaly c) Holoprosencephaly d) Microcephaly

b) Anencephaly As seen in this image, the sonographic appearance of anencephaly has been described as having "froglike" facies, or bulging eyes, and absence of the cranial vault.

Which of the following would not increase the likelihood of developing endometrial carcinoma? a) Unopposed estrogen therapy b) Anorexia c) Nulliparity d) Tamoxifen

b) Anorexia Endometrial carcinoma has been linked with unopposed estrogen therapy, nulliparity, obesity, chronic anovulation (Stein-Leventhal syndrome), estrogen-producing ovarian tumors, and the use of tamoxifen.

The typical position of the uterus is referred to as: a) Retroflexion b) Anteversion c) Prolapsed d) Retroversion

b) Anteversion Anteversion is the typical version of the uterus where the uterine body tilts forward forming a 90° angle with the cervix. The normal uterus can also be anteflexed.

Rather than preventing pregnancy from occurring, uterine malformations often lead to repeated abortions as a result of structural abnormalities within the uterus. Which of the following is considered to be the most common structural defect of the uterus? a) Septate uterus b) Bicornuate uterus c) Unicornuate uterus d) Uterus didelphys

b) Bicornuate uterus Bicornuate uterus is the most common structural defect of the uterus.

Which of the following would not be associated with polyhydramnios? a) Duodenal atresia b) Bilateral renal agenesis c) Pentalogy of Cantrell d) Esophageal atresia

b) Bilateral renal agenesis Somewhere around 12 weeks, the fetal kidneys begin to produce urine, a liquid that eventually comprises most of the amniotic fluid. Therefore, absence of the kidneys would result in oligohydramnios (decreased amniotic fluid) and in some cases anhydramnios (no amniotic fluid).

Which of the following is considered to be the most common female malignancy in women younger than age 50? a) Ovarian carcinoma b) Cervical carcinoma c) Endometrial carcinoma d) Lung cance

b) Cervical carcinoma Cervical carcinoma is the most common female malignancy in women younger than age 50.

Which of the following scan planes would be best for demonstrating a unilateral cleft lip? a) Sagittal b) Coronal c) Transverse d) Oblique

b) Coronal Coronal imaging of the face is the optimal scan plane for demonstrating a unilateral cleft lip.

The facial abnormalities in this image are indicative of: a) Ethmocephaly b) Cyclopia c) Cebocephaly d) Epignathus

b) Cyclopia This image is depicting cyclopia, which is fusion of the orbits. There is also a proboscis, which is a false nose or appendage, above the fused orbits.

A 28-year-old asymptomatic patient presents to the ultrasound department with a history of a palpable right adnexal mass on physical examination. Sonographically, a complex, most cystic mass is noted within the right adnexa. It contains an echogenic structure that produces some posterior shadowing. What is the most likely etiology of this mass? a) Fibroma b) Cystic teratoma c) Androblastoma d) Ovarian choriocarcinoma

b) Cystic teratoma Patients with cystic teratomas, or dermoids, are most often asymptomatic. The sonographic appearance of a cystic teratoma has been well documented, and it has most often been described as a complex or partially cystic mass in the ovary that includes one or more echogenic structures. They frequently will contain fully formed or rudimentary teeth that produce posterior shadowing.

Which of the following is represented in this image a) Craniosynostosis b) Encephalocele c) Agenesis of the corpus callosum d) Alobar holoprosencephaly

b) Encephalocele An occipital encephalocele is noted within this transaxial image of the fetal cranium.

This mass in the image was noted in the left adnexa in a 29-year-old patient complaining of left adnexal pain, infertility, menorrhagia, and dyspareunia. Which of the following is most likely? a) Adenomyoma b) Endometrioma c) Fibroma d) Cystic teratoma

b) Endometrioma This mass is an endometrioma, or chocolate cyst. Patients with endometriomas typically complain of pelvic pain, menorrhagia, dyspareunia, painful bowel movements, and/or infertility.

The sonographic findings seen in this image are indicative of: a) Unilateral renal agenesis b) Esophageal atresia c) Bilateral renal agenesis d) Physiologic bowel herniation

b) Esophageal atresia The congenital absence of part of the esophagus is termed esophageal atresia. The fetal stomach may appear sonographically small or completely absent with esophageal atresia and there will be evidence of polyhydramnios, as demonstrated in this image.

A 24-year-old patient presents to the sonography department with a history of vaginal bleeding with pregnancy. Sonographically, a gestational sac containing a single live embryo measuring approximately 7 weeks gestation based on crown rump length is identified. The yolk sac appears echogenic and produces acoustic shadowing. This is indicative of: a) Normal intrauterine pregnancy b) Impending embryonic demise c) Heterotopic pregnancy d) Blighted ovum

b) Impending embryonic demise Unfortunately, a yolk sac that is echogenic, abnormally shaped, or calcified carries an increased risk for ensuing embryonic demise.

Days 1 through 5 of the menstrual cycle correlate with: a) Luteal phase of the ovarian cycle b) Menses c) Ovulation d) Secretory phase of the endometrial cycle

b) Menses Days 1 through 5 of the menstrual cycle correlate with menses, at which time the endometrium is shed.

Mothers with pregestational diabetes, as opposed to gestational diabetes, have an increased risk of a fetus with: a) TORCH b) Neural tube defects c) Proteinuria d) DES

b) Neural tube defects Mothers with pregestational diabetes are more likely to have a fetus with a neural tube defect. The congenital anomalies most often encountered with pregestational diabetes include cardiac defects, neural tube defects, caudal regression syndrome, sirenomelia, and renal anomalies.

Which of the following would not typically be associated with oligohydramnios? a) Intrauterine growth restriction b) Omphalocele c) Premature rupture of membranes d) Infantile polycystic kidney disease

b) Omphalocele Omphaloceles are typically associated with polyhydramnios

A sonographic examination of a 34-week gestation fetus reveals the loss of normal hypoechoic interface between the placenta and myometrium. The placenta appears to have penetrated beyond the uterine wall and into the bladder as well. Which of the following describes this situation? a) Abruptio placenta b) Placenta percreta c) Placenta increta d) Placenta accreta

b) Placenta percreta Placena percreta is sonographically evident when there is a loss of the normal hypoechoic interface between the placenta and myometrium with penetration of the placenta beyond the serosa

This image is of a 30-year-old obese patient whose clinical history includes amenorrhea. She also has signs of hirsutism. Which diagnosis is most likely? a) Meigs syndrome b) Polycystic ovary disease c) Asherman syndrome d) Ovarian hyperstimulation syndrome

b) Polycystic ovary disease This image is of polycystic ovaries. The syndrome associated with this disease is called polycystic ovarian syndrome or Stein-Leventhal syndrome. Stein-Leventhal syndrome is characterized by amenorrhea, hirsutism, and obesity. Sonographically, the ovaries are often enlarged and contain multiple, small follicles along the periphery or throughout the ovary, with prominent echogenic stromal elements.

Upon ultrasound interrogation of the gravid uterus, you discover a fetal cranium obviously filled with anechoic fluid. You suspect hydranencephaly verse severe hydrocephalus. Which of the following would not be sonographic features of hydranencephaly? a) Absence of the falx cerebri b) Presence of a thin rim of cerebral cortex c) Presence of the basal ganglia d) Presence of the brainstem

b) Presence of a thin rim of cerebral cortex With hydranencephaly, there is typically no identifiable cerebral cortex. The falx cerebri may be partially or completely absent, while the brainstem and basal ganglia are maintained and surrounded by cerebrospinal fluid.

The arrows in this image are indicating: a) Anencephaly b) Scoliosis c) Kyphosis d) Hemivertebrae

b) Scoliosis Scoliosis is a deformity of the spine in which there is an abnormal lateral curvature. The spine will appear S shape in the affected region of scoliosis.

This transvaginal image is of a nongravid patient with a regular 28-day menstrual cycle. Based on the sonographic appearance of the endometrium, which phase of the endometrial cycle is this patient in? a) Periovulatory b) Secretory c) Menstrual d) Early proliferative

b) Secretory Following ovulation, the secretory endometrium is maintained by the production of progesterone, as the endometrium becomes thickened and echogenic in appearance.

This drawing is demonstrating what form of spinal abnormality? a) Meningocele b) Spina bifida occulta c) Spina bifida aperta d) Meningomyelocele

b) Spina bifida occulta This drawing is demonstrating spina bifida occulta. Although the vertebrae fail to close, there is no herniation of the spinal contents outside of the spinal column. In the postnatal period, spina bifida occulta is suspected when a sacral dimple, hemangioma, lipoma, or excessive hair, as seen in this image, is identified directly over the distal spine.

Which of the following describes the stage ovarian carcinoma when the tumor involves one or both ovaries, with confirmed peritoneal metastasis outside of the pelvis and/or regional lymph node involvement? a) Stage IV b) Stage III c) Stage 0 d) Stage II

b) Stage III Stage III is when the tumor involves one or both ovaries with confirmed peritoneal metastasis outside of the pelvis and/or regional lymph node involvement.

The letter "B" seen in this schematic image is most likely representing the: a) Myometrial arteries b) Straight arteries c) Arcuate arteries d) Spiral arteries

b) Straight arteries The straight arteries supply blood to the basal layer of the endometrium.

What are the small black arrows in this image indicating? a) The right kidney b) The adrenal gland c) The stomach d) An adrenal mass

b) The adrenal gland The small black arrows in this image are identifying the fetal adrenal gland.

Which of the following is not a true statement regarding the fetal heart? a) The embryonic heart begins as two tubes. b) The average fetal heart rate is 80 beats per minute. c) A heart rate using M-mode should be sonographically obtainable with endovaginal imaging when the crown rump length measures 4 to 5 mm. d) The apex of the heart is angled to the left of the midline, with the base closest to the spine.

b) The average fetal heart rate is 80 beats per minute. An average fetal heart rate is 140 beats per minute (bpm) during the third trimester, with a range of 110 to 180 bpm considered normal after the first trimester. A heart rate of 80 bpm would be considered bradycardia.

A 38-year-old gravid patient presents to the ultrasound department with a history of suspected fetal epignathus. Epignathus is best described as: a) A growth disorder synonymous with enlargement of several organs including the skull and tongue. b) The presence of an oral teratoma c) Close-set eyes and a nose with a single nostril d) A condition in which there is no nose and a proboscis separating two close-set orbits; associated with holoprosencephaly.

b) The presence of an oral teratoma Epignathus is an oral teratoma.

The type of ovarian cysts associated with OHS is most likely: a) Chocolate cysts b) Theca lutein cysts c) Paraovarian cysts d) Dermoid cysts

b) Theca lutein cysts Women who are undergoing ovulation induction by means of hormone administration are at an increased risk for developing OHS. The ovaries can enlarge, often measuring between 5 and 12 cm. The ovary will also contain multiple large follicles known as theca lutein cysts.

A patient at 33 weeks gestation becomes pale and sweaty during the course of a prolonged obstetric sonogram. The patient is in the supine position. What should you do? a) Place the patient in a semi-Fowlers position b) Turn the patient on her side c) Call a physician d) Ask the patient if she would like to discontinue the examination

b) Turn the patient on her side While evaluating the gravid patient, the sonographer should be aware of a unique situation that may arise during the exam. Patients in their late second or third trimester may suffer from supine hypotensive syndrome, which is a reduction in blood return to the maternal heart caused by the gravid uterus compressing the maternal inferior vena cava. Patients can complain of tachycardia, sweating, nausea, and pallor. The sonographer can assist the patient into a right lateral or left lateral position to alleviate symptoms.

A complication that carries a high mortality rate for monochorionic twins is: a) Conjoined twinning b) Twin-twin transfusion syndrome c) Thanatophoric dysplasia d) Schizencephaly

b) Twin-twin transfusion syndrome A complication that carries a high mortality rate for monochorionic twins is twin-twin transfusion syndrome. With twin-twin transfusion syndrome, shunting occurs from one twin to the other because of the shared placenta.

The administration of diethylstilbestrol during pregnancy in the 1970s has been linked with: a) Uterine variants in the mother b) Uterine malformation in the exposed fetus c) Ectopic pregnancy d) Spontaneous abortions

b) Uterine malformation in the exposed fetus Diethylstilbestrol (DES) was a drug administered to pregnant woman from the 1940s to the 1970s to treat threatened abortions and premature labor that has been linked with uterine malformation in the exposed fetus.

Which of the following is identified by the letter "E" in the image? a) Isthmus b) Vagina c) Fallopian tube d) Cervix

b) Vagina This is the vagina.

A small amount of fluid is discovered between the urinary bladder and uterus during a routine sonographic examination of the female pelvis. Which of the following is the proper name of this space? a) Pouch of Douglas b) Vesicouterine pouch c) Space of Retzius d) Perivesical pouch

b) Vesicouterine pouch The anterior cul-de-sac is located between the uterus and the urinary bladder. It may also be referred to as the vesicouterine pouch.

The production of human chorionic gonadotropin maintains what structure on the ovary? a)Corpus albicans b)Corpus luteum c)Graafian follicle d)Cumulus oophorus

b)Corpus luteum With a developing pregnancy, the cells that surround the blastocyst, the syncytiotrophoblastic cells (trophoblastic cells), produce human chorionic gonadotropin (hCG). The production of hCG maintains the corpus luteum of the ovary. Thus hCG allows the corpus luteum to continue to produce progesterone, which in turn maintains the thickness of the endometrium so that implantation can take place.

Myometrial cysts are a common sonographic feature of which abnormality? a) Uterine carcinoma b) Polycystic ovarian disease c) Adenomyosis d) Asherman syndrome

c) Adenomyosis A common sonographic feature of adenomyosis is myometrial cysts. There may be indistinct hypoechoic or echogenic areas scattered throughout the myometrium as well.

Which of the following would be the least likely clinical finding in a 40-year-old patient with a history of multiple fibroids? a) Infertility b) Dysuria c) Atrophic uterus d) Menorrhagia

c) Atrophic uterus Clinical findings of fibroids include pelvic pressure, menorrhagia, palpable abdominal mass, enlarged uterus, urinary frequency, dysuria, constipation, and possibly infertility. An atrophic uterus is smaller than normal uterus.

Which of the following are the extensions of trophoblastic tissue that invade the decidualized endometrium? a) Infundibular fimbria b) Chorion leave c) Chorionic villi d) Trophoblastic fimbria

c) Chorionic villi The chorionic villi are the fingerlike extensions of trophoblastic tissue that invade the decidualized endometrium.

Which of the following would not typically be associated with oligohydramnios? a) Infantile polycystic kidney disease b) Premature rupture of membranes c) Omphalocele d) Intrauterine growth restriction

c) Omphalocele Omphaloceles are typically associated with polyhydramnios.

The abnormality indicated by the arrows in this image is often associated with which of the following? a) Tetralogy of Fallot b) Agenesis of the corpus callosum c) Pentalogy of Cantrell d) Tetralogy of Monro

c) Pentalogy of Cantrell The arrows in this image are demonstrating a defect in the chest wall allowing the heart to be located on the outside of the chest. This is termed ectopic cordis. Pentalogy of Cantrell is a group of anomalies that includes an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect, and pericardial defects

The most common clinical finding in patients who are experiencing endometrial atrophy is: a) Purulent vaginal discharge b) Cervical stenosis c) Postmenopausal vaginal bleeding d) Uterine cramping

c) Postmenopausal vaginal bleeding In the postmenopausal patient, the endometrium often bleeds spontaneously secondary to atrophy. As a result, the most common cause of postmenopausal vaginal bleeding is endometrial atrophy

Which phase would the endometrium be in on day 8 of the menstrual cycle? a) Secretory phase b) Periovulatory phase c) Proliferative phase d) Luteal phase

c) Proliferative phase The endometrial phases consist of a proliferative phase and secretory phase. The proliferative phase of the endometrium occurs during the first half of the menstrual cycle.

The fetal cells that are attacked by the mother in cases of Rh sensitization are the: a) Acini cells b) Phagocytic cells c) Red blood cells d) White blood cells

c) Red blood cells With Rh sensitization, antibodies from the mother cross the placenta and begin to destroy the fetal red blood cells, resulting in fetal anemia, enlargement of the fetal liver and spleen, and the accumulation of fluid within the fetal body cavities.

The abnormality noted in this image is indicative of a) Pulmonary sequestration b) Cystic adenomatoid malformation (CAM) c) Rhabdomyoma d) Ventricular septal defect

c) Rhabdomyoma This image reveals the presence of several echogenic tumors within the fetal heart, most likely rhabdomyomas.

The sonographic findings in this image are most consistent with the diagnosis of: a) Holoprosencephaly b) Beckwidth-Weidemann syndrome c) Spina bifida d) Agenesis of the corpus callosum

c) Spina bifida This image shows signs of Arnold-Chiari II malformation which include the banana-shaped cerebellum and lemon-shaped skull. Arnold-Chiari II or Chiari II malformation is a group of cranial abnormalities associated with the neural tube defect spina bifida.

An elevated maternal serum alpha-fetoprotein (MSAFP) level is associated with all of the following except: a) Gastroschisis b) Multiple gestations c) Spina bifida occulta d) Spina bifida aperta

c) Spina bifida occulta Elevated MSAFP is associated with omphalocele, gastroschisis, multiple gestations, and open spina bifida (aperta). Closed spina bifida (occulta) typically does not result in an elevated MSAFP

Which of the following statements concerning this image is not true""? a) These findings are worrisome for chromosomal abnormalities. b) The appropriate measurement is typically obtained between 11 and 14 weeks gestation. c) The appropriate measurement is performed in the transverse plane to the fetus, with the fetus in a neutral position. d) There is an abnormal fluid collection posterior to the fetal neck.

c) The appropriate measurement is performed in the transverse plane to the fetus, with the fetus in a neutral position. The fetus has an obvious thickening of nuchal translucency. A nuchal translucency measurement is therefore needed. The appropriate measurement is performed in the sagittal plane to the fetus, with the fetus in a neutral position.

Which of the following statement concerning the decidualized endometrium is false? a) The decidual reaction is a result of the continued production of progesterone by the corpus luteum. b) The decidualized endometrium will appear thick and echogenic. c) The decidual reaction will appear similar to the early proliferative endometrium. d) The decidual reaction is evidence of a pregnancy.

c) The decidual reaction will appear similar to the early proliferative endometrium. The decidual reaction will appear thick and echogenic as a result of the continued production of progesterone by the corpus luteum. A decidual reaction is considered to be a nonspecific sonographic finding of pregnancy because the endometrium can also appear thick and echogenic during the secretory phase of the endometrial cycle.

Which of the following statements is not true concerning the ovaries? a) The ovaries form in the upper abdomen and descend into the pelvis in utero. b) The ovaries are intraperitoneal organs. c) The ovaries are exocrine glands that release estrogen and progesterone. d) The ovaries have a dual blood supply, from both the ovarian artery and ovarian branches of the uterine arteries.

c) The ovaries are exocrine glands that release estrogen and progesterone. The ovaries form in the upper abdomen and descend into the pelvis in utero. The ovaries are paired, oval-shaped, intraperitoneal organs that have a dual blood supply from both the ovarian artery and ovarian branches of the uterine arteries. As endocrine glands, the ovaries are responsible for releasing estrogen and progesterone in varying amounts throughout the menstrual cycle.

A sonographic examination is ordered for a postpartum patient suffering from excessive vaginal bleeding and possible retained products of conception. Sonographically, the uterus appears enlarged. Which of the following statements is true concerning the sonographic appearance of the postpartum uterus? a) The postpartum uterus never returns to the nongravid size. b) Only the endometrium appears thickened following childbirth. c) The postpartum uterus returns to its nongravid size 6 to 8 weeks after delivery. d) The postpartum uterus returns to its nongravid size 2 to 4 weeks after delivery.

c) The postpartum uterus returns to its nongravid size 6 to 8 weeks after delivery. The postpartum uterus returns to its nongravid size 6 to 8 weeks after delivery. Excessive and sustained postpartum vaginal bleeding may be the result of retained products of conception.

This diagram is demonstrating common features of: a) Trisomy 13 b) Trisomy 21 c) Trisomy 18 d) Triploidy

c) Trisomy 18 Various sonographic features of Trisomy 18 (Edwards syndrome) include a strawberry-shaped skull, choroid plexus cysts, club feet, and omphalocele.

Which of the following structures would not be identified at the correct level of the AC? a) Aorta b) Spine c) Umbilical artery d) Stomach

c) Umbilical artery The umbilical arteries are located in the fetal pelvis and would not be seen at the correct level for the AC.

A biophysical profile examination is performed at 32 weeks. Fetal breathing is seen, but there is no fetal movement. The amniotic fluid is 10 cm. A nonstress test is not performed. What is the biophysical profile score? a) 5 b) 2 c) 6 d) 4

d) 4 A biophysical profile score allocates 2 points for each of the following: fetal breathing, amniotic fluid greater than 2 cm, fetal movement, and fetal tone. This fetus demonstrated fetal breathing (2 points) and a normal amniotic fluid level (2 points).

Which of the following is a clinical finding suspicious of Asherman syndrome? a) Polymenorrhea b) Hirsutism c) Tamoxifen therapy d) Amenorrhea

d) Amenorrhea Asherman syndrome is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilatation and curettage. The adhesions may cause amenorrhea, pregnancy loss, and/or infertility

A follow-up sonographic examination of a 29-week pregnancy reveals that fetal head has grown at a normal rate but the abdomen has not. What are these findings consistent with? a) Femur-sparing IUGR b) Symmetrical IUGR c) Abdominal wall defects d) Asymmetrical IUGR

d) Asymmetrical IUGR Asymmetrical IUGR is often apparent when the AC is lacking, while all other measurements tend to be normal

Which of the following would not be least likely associated with microcephaly? a) TORCH infections b) Edwards syndrome c) Fetal alcohol syndrome d) Beckwith-Wiedemann syndrome

d) Beckwith-Wiedemann syndrome Beckwith-Wiedemann syndrome is a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver.

Which of the following best describes the location of the ductus arteriosis? a) Within the lower one-third of the ventricular septum b) Within the lower one-third of the atrial septum c) Between the aorta and left atrium d) Between the pulmonary artery and aortic arch

d) Between the pulmonary artery and aortic arch The ductus arteriosus is a fetal shunt that connects the pulmonary artery to the aortic arch. The blood leaves the right ventricle through the main pulmonary artery. The main pulmonary artery bifurcates into right and left, thus allowing a small amount of blood to travel to the respective lung.

Which ovarian mass results from the retention of an unfertilized ovum that differentiates into the three germ cell layers? a) Brenner tumor b) Sertoli-Leydig cell tumor c) Granulosa cell tumor d) Cystic teratoma

d) Cystic teratoma The most common benign ovarian tumor is the cystic teratoma, or dermoid cyst. Dermoids result from the retention of an unfertilized ovum that differentiates into the three germ cell layers. Therefore, these germ cell tumors are composed of ectoderm, mesoderm, and the endoderm.

Among the list below, which gastrointestinal abnormality is often discovered in the fetus with Down syndrome? a) Choledochal cyst b) Gastroschisis c) Hirschsprung's disease d) Duodenal atresia

d) Duodenal atresia Duodenal atresia has a proven association with Trisomy 21 (Down syndrome) and thus additional sonographic markers of Trisomy 21 should be aggressively investigated during the examination. Other associated anomalies include esophageal atresia, VACTERL syndrome, intrauterine growth restriction (IUGR), and cardiac anomalies.

Which term indicates fluid accumulation within the uterus and vagina? a) Hydrometro b) Hydrosalpinx c) Hydrocolpos d) Hydrometrocolpos

d) Hydrometrocolpos Hydrometrocolpos is the fluid accumulation within the uterus and vagina. Hydrocolpos describes the condition in which the vagina is distended with simple, anechoic fluid, and is seen more often in the neonatal period. As the vagina distends with fluid, excessive amounts may lead to further accumulation of the fluid into the uterus, a condition known as hydrometrocolpos.

This is an image of the right adnexa in a patient with known PID. What is the most likely diagnosis? a) Hypertrophic broad ligament b) Crohn disease c) Diverticulosis d) Hydrosalpinx

d) Hydrosalpinx This is an image of fluid within the fallopian tube, or hydrosalpinx.

This image is indicative of: a) Hypotelorism b) Hydrocephalus c) Anencephaly d) Hypertelorism

d) Hypertelorism This image represents an abnormal increased distance between orbits, termed hypertelorism.

Which of the following would be the most common cause of an abnormal maternal serum screening? a) Edwards syndrome b) Maternal weight c) Down syndrome d) Incorrect dating

d) Incorrect dating The most common cause of abnormal serum screening tests is incorrect dating of the pregnancy. Atypical first-trimester laboratory findings often lead to follow-up ultrasound examinations to date the pregnancy.

What is an expected future complication of the fetus that suffers from ADPKD? a) It will most likely die from congestive heart failure. b) It will most likely develop a cloacal anomaly. c) It will most likely die soon after birth secondary to pulmonary hypoplasia. d) It will most likely develop renal cysts late in adult life.

d) It will most likely develop renal cysts late in adult life. The cysts associated with ADPKD do not typically manifest until approximately the fifth decade of life. The individual may die from endstage renal failure. Adult renal cystic disease is also associated with the development of cysts within the liver, pancreas, and spleen.

Which of the following is not a feature of Tetralogy of Fallot? a) Overriding aortic root b) Ventricular septal defect c) Pulmonary stenosis d) Left ventricular hypertrophy

d) Left ventricular hypertrophy Tetralogy of Fallot consists of an overriding aortic root, ventricular septal defect, pulmonary stenosis, and right ventricular hypertrophy

Which of the following would be considered the most common benign gynecologic tumors? a) Dermoid tumor b) Ovarian cystadenoma c) Endometrioma d) Leiomyoma

d) Leiomyoma A leiomyoma is a benign, smooth muscle tumor of the uterus that may also be referred to as a fibroid or uterine myoma. Leiomyomas are the most common benign gynecologic tumors and are the leading cause of hysterectomy and gynecologic surgery.

A gravid 37-year-old patient presents to the ultrasound department with a history of "small for dates." Sonographic findings of the 28-week live intrauterine pregnancy include a sixth digit on the left hand, an occipital encephalocele, and bilateral enlarged echogenic kidneys. Which of the following would be most likely? a) Potter's syndrome b) Turner syndrome c) Beckwidth-Weidemann syndrome d) Meckel-Gruber syndrome

d) Meckel-Gruber syndrome Meckel-Gruber syndrome is associated with microcephaly, occipital encephalocele, polydactyly (extra digits) and polycystic kidneys.

The measurement that is performed from the lateral wall of the orbit to the medial wall of the same orbit is the: a) Intraocular diameter b) Binocular diameter c) Interocular diameter d) Ocular diameter

d) Ocular diameter The ocular diameter is performed from the lateral wall of the orbit to the medial wall of the same orbit.

Each fetal vertebra consists of: a) Two neural process and two central processes b) One neural process and two articular processes c) One centrum and three vertebral bodies d) One centrum and two neural processes

d) One centrum and two neural processes Each fetal vertebra consists of three echogenic ossification centers: one centrum and two neural processes.

Which of the following would describe the buildup of pus within the fallopian tube, secondary to infection? a) PID b) Hydrosalpinx c) Hematosalpinx d) Pyosalpinx

d) Pyosalpinx Pyosalpinx is the buildup of pus within a dilated fallopian tube. It may be associated with PID.

Endometrial polyps are best visualized with: a) Transabdominal pelvic sonography b) Computed tomography c) Endovaginal sonography d) Saline infusion sonohysterography

d) Saline infusion sonohysterography Polyps are better visualized with the use of saline infusion sonohysterography.

Infertility is defined as: a) The inability to conceive a child after 9 months of unprotected intercourse. b) The inability to conceive a child after 6 months of unprotected intercourse. c) The inability to conceive a child after 2 years of unprotected intercourse. d) The inability to conceive a child after 1 year of unprotected intercourse.

d) The inability to conceive a child after 1 year of unprotected intercourse. Infertility is defined as the inability to conceive a child after 1 year of unprotected intercourse.

Which of the following is not a characteristic of twin-twin transfusion syndrome? a) The donor twin is small and anemic b) There are multiple placental anastomoses c) The recipient is large and edematous d) The recipient twin is small

d) The recipient twin is small With twin-twin transfusion syndrome, shunting occurs from one twin to the other. The twin that shunts blood to the other is called the "donor" twin and is often smaller than the twin receiving extra blood, the "recipient" twin. The donor twin often suffers from anemia and growth restriction, while the recipient experiences hydrops and congestive heart failure

Within the fetal heart, one should recognize which structure is located between the right ventricle and right atrium? a) Ductus venosus b) Foramen ovale c) Bicuspid valve d) Tricuspid valve

d) Tricuspid valve Between the right ventricle and right atrium, one should visualize the tricuspid valve, and between the left ventricle and left atrium, the mitral valve (bicuspid valve) should be noted.

Which of the following is considered the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction? a) Posterior urethral valves b) Vesicoureteral reflux c) Ureterovesicular junction obstruction d) Ureteropelvic junction obstruction

d) Ureteropelvic junction obstruction Ureteropelvic junction (UPJ) obstruction is the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction. The UPJ is located at the junction of the renal pelvis and ureter.

Which of the following could not result from monozygotic twinning? a) monochorionic diamniotic b) dichorionic diamniotic c) monochorionic monoamniotic d) dichorionic monoamniotic

d) dichorionic monoamniotic There are three categories of monozygotic twins: monochorionic diamniotic, dichorionic diamniotic, and monochorionic monoamniotic.