ARDMS Obstetrics Exam 326 Questions with verified Answers,100% CORRECT

ARDMS Obstetrics Exam 326 Questions with verified Answers What is the first trimester risk sonographic examination also called? - CORRECT ANSWER The nuchal translucency examination What does the nuchal translucency examination measure? - CORRECT ANSWER 1. Measurement of the nuchal translucency 2. CRL (Crown-Rump Length) 3. Visualization of the fetal nasal bone What does the standard obstetric sonography examination evaluate? - CORRECT ANSWER 1. Gestational age by fetal biometry 2. Fetal number 3. Placental position 4. Cardiac activity 5. AFI (Amniotic Fluid Index) 6. Fetal anatomic survey Define gravidity - CORRECT ANSWER The number of pregnancies Define parity - CORRECT ANSWER A numeric system that describes all possible pregnancies What are the numbers representing in the parity numeric system? - CORRECT ANSWER 1. Full term pregnancies 2. Premature births and stillborns 3. Miscarriages or termination 4. Living children What is the standard way to date a pregnancy? - CORRECT ANSWER LMP (Last Menstrual Period) Pregnancy is divided into how many trimesters? - CORRECT ANSWER 3 How long is the first trimester? - CORRECT ANSWER From beginning of the pregnancy to 13 weeks and 6 days. How long is the second trimester? - CORRECT ANSWER From 14 weeks to 26 weeks and 6 days. How long is the third trimester? - CORRECT ANSWER Begins at 27 weeks gestation until term. What is Nagele's rule? - CORRECT ANSWER EDD (Estimated Due Date) = 3 months from LMP + 7 days What fetal biometry is used in the estimate in fetal weight? - CORRECT ANSWER AC (Abdominal Circumference) What is conceptual age also known as? - CORRECT ANSWER Embryonic age What is conceptual age? - CORRECT ANSWER With conception as the first day of pregnancy What is gestational age? - CORRECT ANSWER Considers the first day of the last menstrual period as the beginning of gestation What is gestational age also known as? - CORRECT ANSWER Menstrual age What is the conceptus called during the implantation process? - CORRECT ANSWER A zygote What is the zygote called from the implantation to 10 weeks? - CORRECT ANSWER An embryo What is the embryo called after the 10 weeks? - CORRECT ANSWER A fetus What is the cell division process of a zygote? - CORRECT ANSWER 1.Rapid cellular division forms the 16-cell morula 2.Further division brings the morula to the blastocyst stage 3.The blastocyst contains trophoblastic calls. 4.The trophoblastic cells begin to secrete hCG True or False hCG levels plateau and decline while normal gestation continues. - CORRECT ANSWER True Increased hCG levels can be used s a screening marker for Down syndrome during the first and second trimester. What does the anechoic center is the first trimester represent? - CORRECT ANSWER Chorionic cavity What does the echogenic rim surrounding the chorionic cavity represent in the first trimester ultrasound? - CORRECT ANSWER Desidual reaction What is the first structure seen in the intragestational sac? - CORRECT ANSWER The secondary yolk sac What are the functions of the secondary yolk sac? - CORRECT ANSWER 1. Provision of nutrients to the embryo 2. Hematopoiesis (the formation of blood or of blood cells) 3. Development of the embryonic endoderm What should a talk sac NOT exceed? - CORRECT ANSWER 6mm *Enlarged yolk sacs may have threatening outcomes True or False The number of yolk sacs are not consistent with the number of amnion membranes - CORRECT ANSWER False It is very consistent with the number amnion membranes When is the yolk sac reabsorbed and never seen again? - CORRECT ANSWER 12 weeks Define chorioamniotic fusion - CORRECT ANSWER Fusion of the membranes When does chorioamniotic fusion occur? - CORRECT ANSWER 14-15 weeks What creates the yolk stalk? - CORRECT ANSWER Narrowing between the embryo and the yolk sac The dorsal portion of the yolk sac is incorporated into the embryo and gives rise to what structures? - CORRECT ANSWER -Foregut, midgut, and hindgut -Entire gestational tract -Liver -Biliary tree -Pancreas What are the three primary vesicles within the fetal brain? - CORRECT ANSWER - Prosencephalon - Mesencephalon - Rhombencephalon What does the rhombencephalon divide into? - CORRECT ANSWER - Metencephalon (Cephalic portion) - Myelencephalon (Caudal portion) What appears in the 4-5 week of gestation? - CORRECT ANSWER The gestational sac What appears in the 5th week of gestation? - CORRECT ANSWER Yolk sac What is seen in the 5.5-6 weeks of gestation? - CORRECT ANSWER Fetal heartbeat What is two structures are seen sonographically in the 7.5 weeks of gestation? - CORRECT ANSWER -Spine -Lower limbs When are the upper limbs seen sonographically? - CORRECT ANSWER 8 weeks When are the the body movements and midline falx seen? - CORRECT ANSWER 9 weeks What is seen sonographically in the 9.5 week of gestation? - CORRECT ANSWER -Midgut herniation -Choroid plexus -Hindbrain What forms the fourth ventricle and part of the aqueduct of Sylvius? - CORRECT ANSWER The enclosing of the rhomboid fossa by the medulla, medullar oblongata, and the cerebellum. What is the first organ to function within the embryo? - CORRECT ANSWER The fetal heart What parameters for a first trimester sonographic gestational dating may be used? - CORRECT ANSWER 1. CRL (Crown-Rump Length) 2. MSD (Gestational sac size) How should a sonographer measure the MSD? - CORRECT ANSWER The sonographer should only measure the gestational sac fluid space not the echogenic decidua. How to calculate the MSD - CORRECT ANSWER Length (mm) + Width (mm) / 3 = MSD How to calculate the menstrual age - CORRECT ANSWER MSD (mm) + 30 = Menstrual age (*days) Menstrual age (days) / 7 = Menstrual age (*weeks) What is the marker for the beginning of CRL measurements? - CORRECT ANSWER The embryonic heart motion The CRL is considered accurate until what week? - CORRECT ANSWER 12th week Why is the CRL not considered accurate after 12 weeks? - CORRECT ANSWER Because at this time the fetus begins to "curl" into the fetal position, making the measurement of length more difficult. What measurements are used after 13 weeks (second trimester) for pregnancy dating? - CORRECT ANSWER 1. BPD (Biparietal Diameter) 2. FL (Femur Length) What combined test is the standard for first trimester risk assessment? - CORRECT ANSWER 1. Maternal age 2. The nuchal translucency measurement 3. Biochemistry analyses for hCG and PAPP-A What is the small pocket of fluid along the back of the fetus? - CORRECT ANSWER Nuchal translucency What sonographic appearance is associated with trisomy 21 in the first trimester? - CORRECT ANSWER Absence of the fetal nasal bone True or False A multiple gestation pregnancy is a high risk pregnancy - CORRECT ANSWER True Twin gestations have a seven to ten times greater mortality rate then singletons. *This risk increases when the twins are monozygotic and share membrane components How would a dichorionic and diamniotic twin appear sonographically? - CORRECT ANSWER Appear as two separate gestational sacs with individual trophoblastic tissue. *Which allows the appearance of thick dividing membrane. How would a monochorionic and monoamniotic twin appear sonographically? - CORRECT ANSWER Appear as one gestational sac containing: -One yolk sac -One amniotic membrane -Two embryos within a single amniotic cavity What may an early sign of twin-to-twin transfusion? - CORRECT ANSWER Differences in the NT measurements Define threatened abortion - CORRECT ANSWER Pregnancies of fewer than 20 weeks with a: -Heartbeat -Viable embryo -Vaginal Bleeding What is the diagnosis of a threatened abortion? - CORRECT ANSWER It is made when the cervix is long and closed in a patient with vaginal bleeding Define embryonic demise - CORRECT ANSWER The term is used when there is clear evidence of a nonviable embryo What is another term for blighted ovum? - CORRECT ANSWER Anembryonic pregnancy Define a blighted ovum - CORRECT ANSWER A gestational sac in which the embryo fails to develop or stops developing at such an early stage that it is imperceptible by ultrasound. What is there term used for when the embryonic placenta becomes detached resulting in a hematoma? - CORRECT ANSWER Placental hematoma What is another term used for embryonic placenta? - CORRECT ANSWER Frondosum Would a placental hematoma have symptoms? Why? - CORRECT ANSWER No it will be asymptomatic because they are within the chorionic sac and have no communication with the endometrium. What is the most common occurrence of bleeding in the first trimester? - CORRECT ANSWER Subchorionic hemorrhage What are the clinical findings presented in subchorionic hemorrhage? - CORRECT ANSWER -Bleeding, spotting or uterine cramping *If the hemorrhage becomes large enough it can lead to SPL (Spontaneous Pregnancy Loss) What are the sonographic findings of subchorionic hemorrhage? - CORRECT ANSWER -The appearance of bleeding varies with the stage of its organization. -In time the hemorrhage becomes more anechoic -May be seen between the uterine wall and the fetal membrane. At what rate does the normal embryo grow? - CORRECT ANSWER 1mm per day What is the ideal method to examine the early gestational sac? - CORRECT ANSWER Transvaginal sonography What is the typical sonographic appearance of a blighted ovum? - CORRECT ANSWER A large empty gestational sac that does not demonstrate a yolk sac, an amnion, or an embryo. Define gestational trophoblastic disease - CORRECT ANSWER A proliferative disease of the trophoblast that occurs after an abnormal conception. What are the three types of the benign form of gestational trophoblastic disease, called hydatiform? - CORRECT ANSWER -Partial -Complete -Coexistent What is the more malignant form called in gestational trophoblastic disease? - CORRECT ANSWER Invasive mole OR choriocarcinoma What is the clinical hallmark for gestational trophoblastic disease? - CORRECT ANSWER -Vaginal bleeding -Serum levels of beta-hCG are dramatically elevated In which hydatiform mole will the serum alpha-fetoprotein levels be notably low? - CORRECT ANSWER Complete hydatiform mole How does a partial hydatiform mole commonly occur? - CORRECT ANSWER When a normal egg is fertilized by two sperm. *Fetal parts mat develop concurrently with abnormal trophoblastic disease. How does a complete hydatiform mole commonly occur? - CORRECT ANSWER When an egg is without a nucleus is fertilized by one normal sperm. *Trophoblastic tissue proliferates, but no fetal parts ever develop. What is the sonographic hallmark of a hydatiform mole? - CORRECT ANSWER "Snowstorm" appearance What is the sonographic appearance of molar pregnancy? - CORRECT ANSWER -Moderately echogenic soft tissue filling the uterine cavity that is filled with small cystic spaces representing chorionic villi. *May not be apparent initially, but will present with advancing time. -May reveal an enlarged uterus larger than dates and filled with heterogenous patter (Cluster of grapes) -Bilateral adnexal fullness that may represent ovarian enlargement of THECA LUTEIN CYST What is the primary treatment of a molar pregnancy? - CORRECT ANSWER Uterine curettage followed by serial serum hCG levels Describe the sonographic appearance of partial mole? - CORRECT ANSWER -Placenta is grossly enlarged and engorged in cystic spaces *Which represent the hydraulic villi. What cyst is commonly reported with molar pregnancies? - CORRECT ANSWER Theca lutein cyst *Will be demonstrated as enlarged ovaries with multiple cystic areas throughout What are the terms used for the malignant forms of trophoblastic disease? - CORRECT ANSWER -Invasive mole -Choriocarcinoma When does an invasive mole occur? - CORRECT ANSWER When the hydraulic villi of a partial or complete hydatiform mole invade the myometrium and may further the uterine wall. If the invasive mole is persistent postoperatively what is it referred to as? - CORRECT ANSWER Persistent trophoblastic disease What are the clinical symptoms of a molar pregnancy? - CORRECT ANSWER -Vaginal bleeding -Dyspnea -Abdominal pain Choriocarcinoma is a fast growing tumor and commonly metastasizes to the ______, _____, and _____ - CORRECT ANSWER -Lungs -Liver -Brain Variations in embryonic cardiac rate during the first trimester range between __-__ beats per minute - CORRECT ANSWER -90 -170 Cardiac rates less than 90 within the first trimester is considered _____. - CORRECT ANSWER - To have a poor prognosis Where does the embryonic disk lie? - CORRECT ANSWER Between the amnion and the yolk sac Define an ectopic pregnancy - CORRECT ANSWER A pregnancy located outside of the central/fundal of the uterus. What are the classical clinical findings associated with an ectopic pregnancy? - CORRECT ANSWER -Vaginal bleeding -Empty uterus -The presence of an adnexal mass -Positive pregnancy Which ectopic pregnancy is potentially the most life threatening? - CORRECT ANSWER Interstitial pregnancy What is the difference between a pseudogestational sac and a normal gestation? - CORRECT ANSWER 1. Psuedogestational sacs do not contain a living embryo or yolk sac 2. Pseudogestational sacs are centrally located within the endometrial cavity, unlike the burrowed gestational sac, which is eccentrically placed. 3. Homogenous level echoes are commonly observed in the pseudogestational sac, unlike in normal gestational sacs. What is a critical tip when there is suspicion of an ectopic pregnancy? - CORRECT ANSWER Examining the adnexa carefully What makes an interstitial pregnancy so life threatening? - CORRECT ANSWER The site involves the parauterine and myometrial vasculature, creating life threatening hemorrhage when rupture occurs. What is the internationally accepted standard for nuchal translucency? - CORRECT ANSWER -Fetuses must be 11 to 13 weeks and 6 days -The CRL must be betweenn 45mm and 84mm -The sonographic MUST obtain an optimal image of the midsagittal plane -The embryo must be away from the the amniotic membrane with the head in the neutral position. *With no hyperextension or flexion. What are markers for cardiac defects? - CORRECT ANSWER -Increased NT -Tricuspid Regurgitation -Reversal or absent flow in the ductus venosus. What is the dominant structure seen within the embryonic cranium in the first trimester? - CORRECT ANSWER Choroid plexus *Which fill the lateral ventricles What cystic structure within the posterior aspect of the embryonic brain is confused with an abnormality? - CORRECT ANSWER The rhombencephalon (Hindbrain) Define hydranencephaly - CORRECT ANSWER Brain necrosis resulting from occlusion of the internal carotid arteries. Define acrania - CORRECT ANSWER Complete or partial absence of the cranium *It is thought to be the predecessor of anencephaly Describe the sonographic hallmark of acrania? - CORRECT ANSWER "Mickey Mouse" head Define anencephaly - CORRECT ANSWER Congenital absence of the brain and cranial vault With the cerebral hemispheres missing or reduced to small masses Define cephalocele - CORRECT ANSWER A midline cranial defect in which there is a herniation of the brain and meninges Define ventriculomegaly - CORRECT ANSWER Dilation of the ventricular system WITHOUT enlargement of the cranium What is the sonographic hallmark of ventriculomegaly - CORRECT ANSWER The choroid plexus is shown to be "dangling" within the dilated lateral ventricle Define holoprosencephaly - CORRECT ANSWER The failure of the prosencephalon differentiating into cerebral hemispheres and lateral ventricles between the 4th-8th gestational weeks. What are the different types of holoprosencephaly? - CORRECT ANSWER -Alobar -Semilobar -Lobar Which of the three types of holoprosencephaly is the most severe? - CORRECT ANSWER Alobar What does lobar holoprosencephaly consist of? - CORRECT ANSWER -Single ventricle -Small cerebrum -Fused thalami -Agenesis of the corpus callosum and falx cerebri What is the normal fetal brain appearance before 9 weeks? - CORRECT ANSWER Appears to have a single ventricle until the falx cerebri develops. *After 9 weeks. Define Dandy-Walker malformation - CORRECT ANSWER Results from cystic dilation of the fourth ventricle. With: -Dysgenesis or complete agenesis of the cerebellar vermis -Frequent hydrocephaly When does Dandy-Walker malformation occur? - CORRECT ANSWER 6th-7th week Describe Dandy-Walker malformation sonographically - CORRECT ANSWER -Large posterior fossa cyst continuos with the 4th ventricle -Absent cerebellum -Dilated third and lateral ventricles. Describe spina bifida - CORRECT ANSWER Results from the neural tube failing to close after 6 weeks. Describe spina bifida sonographically - CORRECT ANSWER -Spinal irregularities within the posterior contour of the fetal spine. -Extrusion of a mass from the vertebral column. -Lemon sign (scalloping of the frontal bones) -Banana sign (curved appearance of the cerebellum) When will the cranial signs of spina bifida be more appreciated? - CORRECT ANSWER 12 weeks Describe the normal bowel herniation sonographically - CORRECT ANSWER Will appear as an echogenic mass at the BASE of the umbilical cord between 8-12 weeks Any gut herniation larger than ___ should be considered suspicious and should be followed for resolution after __ weeks and __ days. - CORRECT ANSWER 1. 6mm 2. 11 weeks 3. 5 days What anterior wall defect is commonly on the RIGHT of the umbilical cord? - CORRECT ANSWER Gastrochesis What anterior wall defect is commonly at the BASE of the umbilical cord? - CORRECT ANSWER Omphalocele When does the fetal bladder become sonographically apparent? - CORRECT ANSWER 10 - 12 weeks Describe obstructed uropathy sonographically - CORRECT ANSWER A very large urinary bladder that may be large enough to extend out of the pelvis and into the fetal abdomen and even protrude outside the body (bladder exstrophy) What is the most commonly seen abnormality seen within the 1st trimester? - CORRECT ANSWER Cystic hygroma Cystic hygromas seen early in life have a high association with chromosomal abnormalities. The most common abnormalities are trisomies __, __, __. - CORRECT ANSWER -13 -18 -21 Trisomy 13 is also known as ___________. - CORRECT ANSWER Patau syndrome Trisomy 18 is also known as ______. - CORRECT ANSWER Edwards syndrome Trisomy 21 is also known as _____. - CORRECT ANSWER Down syndrome Where would a cystic hygroma be seen in the first trimester? - CORRECT ANSWER The posterior aspect of the fetal neck and upper thorax If a cystic hygroma or nuchal thickening is seen in the first trimester what would be required? - CORRECT ANSWER -Genetic counseling -Sonographic monitering What is the most common ovarian mass seen in the first trimester of pregnancy? - CORRECT ANSWER Corpus luteum cyst What is the typical measurement and visualization of a corpus luteum cyst? - CORRECT ANSWER -Less then 5cm -Does not contain septations If a corpus luteum cyst contains septations, echogenic debris, and measures more then 10 cm what would that suggest? - CORRECT ANSWER Secondary to internal hemorrhage Normally, corpus lute cysts regress and are not seen beyond __ to __ weeks' gestation. - CORRECT ANSWER 16 to 18 weeks If fibroids coexist with a first trimester pregnancy what should be identified in relation to the fibroids? - CORRECT ANSWER The placenta and the cervix Why would fibroids increase in size during the first and beginning of the second trimester? - CORRECT ANSWER Estrogen stimulation Rapdily growing fibroids may compress the gestational sac causing _____. - CORRECT ANSWER Spontaneous abortion What can be confused with a fibroid? - CORRECT ANSWER A uterine contraction How can a sonographer tell the difference between a uterine contraction and a fibroid? - CORRECT ANSWER Observe the focal lesion over time (typically 20-30 minutes), the contraction should disappear whereas a fibroid will persist. Describe a yolk sac sonographically - CORRECT ANSWER A small, spherical structure with an anechoic center within the gestational sac. What should a normal yolk sac measure? - CORRECT ANSWER 6mm What is the most accurate sonographic measurement during the first trimester? - CORRECT ANSWER CRL (Crown Rump Length) Why is the CRL no longer considered accurate after the 12th week of gestation? - CORRECT ANSWER Because of the flexion and extension of the active fetus. What is the first and most widely accepted means of measuring the fetal head and estimating fetal age? - CORRECT ANSWER BPD (Biparietal Diameter) What level should the BPD be measured at? - CORRECT ANSWER At the level of the thalamus and the cave septum pellucidum How should the calipers be placed to measure the BPD? - CORRECT ANSWER Outer edge to inner edge (Leading edge) What is another valuable measurement of the fetal head to asses gestational age? - CORRECT ANSWER Head circumference What is the cephalic index formula? - CORRECT ANSWER BPD/OFDx100 -Biparietal diameter -Occipitofrontal diameter What is the normal cephalic index? - CORRECT ANSWER 75% to 85% Define Brachycephaly - CORRECT ANSWER When the head is elongated in the tv plane (BPD) and shortened in the anteroposterior diameter (OFD). If the CI is greater than 85%, what does that suggest? - CORRECT ANSWER Brachycephaly Define Dolichocephaly - CORRECT ANSWER The head is shortened in the tv plane (BPD) and elongated in the anteroposterior diameter (OFD). If the CI is less than 75%, what does that suggest? - CORRECT ANSWER Dolichocephaly What measurement is more useful as a growth parameter than predicting gestational age? - CORRECT ANSWER Abdominal circumference (AC) What level should the abdominal circumference be measured? - CORRECT ANSWER In the tv plane at the level of the umbilical vein as it joins the left portal vein within the liver How should an abdominal circumference be measured? - CORRECT ANSWER The calipers should be placed along the external perimeter of the fetal abdomen to include subcutaneous soft tissue Which measurement is about as accurate as BPD in determining gestational age? - CORRECT ANSWER Femur Length (FL) What parameter can be used when the fetal head cannot be measured? - CORRECT ANSWER FL What is considered preterm? - CORRECT ANSWER The fetus is born before 38 weeks What is considered term? - CORRECT ANSWER The fetus born between 38 and 42 weeks What is considered postterm? - CORRECT ANSWER The fetus being born after 42 weeks ________ is best described as a decreased rate of fetal growth. - CORRECT ANSWER Intrauterine Growth Restriction (IUGR) What is the difference between SGA (Small for Gestational Age) and IUGR? - CORRECT ANSWER SGA describes the fetus with a weight below the 10th percentile without a cause while IUGR is SGA as a RESULT of pathologic processes. What are the two basic clarifications of IUGR? - CORRECT ANSWER -Symmetric -Asymmetric Which IUGR is usually the result of a first trimester insult? - CORRECT ANSWER Symmetric IUGR Which IUGR begins late in the second and third trimester and usually results from placental insufficiency? - CORRECT ANSWER Asymmetric IUGR Define symmetric IUGR - CORRECT ANSWER A fetus that is classified as small in ALL physical parameters Define asymmetric IUGR - CORRECT ANSWER Caused by placental insufficiency Which IUGR is more common? - CORRECT ANSWER Asymmetric IUGR What measurement is useful in differentiating symmetric and asymmetric IUGR? - CORRECT ANSWER The HC to AC ratio What is a BPP (Biophysical Profile)? - CORRECT ANSWER Determines fetal well being What are the five components of BPP? - CORRECT ANSWER 1. NST (Cardiac nonstress test) 2. Fetal breathing 3. Fetal movement 4. Fetal tone 5. AFI (Amniotic fluid index) What is a true breathing movement considered to be? - CORRECT ANSWER Simutaneous inward movement of the chest wall with outward movement of the anterior abdominal wall during inspiration Define macrosomia - CORRECT ANSWER Birth weight of 4000g or greater = the 90 percentile for estimated gestational age What is macrosomia most commonly a result of? - CORRECT ANSWER Poorly controlled maternal diabetes mellitus Describe pregnancy-induced hypertension - CORRECT ANSWER When the placenta develops poorly the blood supply to the fetus may be restricted. Define eclampsia - CORRECT ANSWER The occurrence of seizures or coma in a preeclamptic patient define preeclampsia - CORRECT ANSWER Pregnancy condition in which high blood pressure develops with proteinuria or edema. *If the hypertension is neglected the patient may develop seizures that can be life-threatening to both the mother and fetus. What does severe preeclampsia usually indicate? - CORRECT ANSWER -The patient should be delivered immediately What exists if a pregnant woman vomits so much that she develops dehydration and electrolyte imbalance? - CORRECT ANSWER Hyperemesis gravidarum What are the 5 signs of fetal death? - CORRECT ANSWER -Absent heartbeat -Absent fetal movement -Spalding sign (Overlapping skull bones) -Exaggerated curvature of the spine -Gas in the fetal abdomen What are the two types of twin pregnancies? - CORRECT ANSWER -Dizygotic -Monozygotic Dizygotic is also called _____ twins. - CORRECT ANSWER Fraternal Monozygotic is also called _____ twins. - CORRECT ANSWER Identical Describe a dizygotic twin - CORRECT ANSWER Arises from two SEPARATELY fertilized ova and each ovum implants its own: -Placenta -Chorion sac -Amnion sac Describe a monozygotic twin - CORRECT ANSWER Arises from a SINGLE fertilized egg resulting in two genetically identical fetuses If the division of monozygotic twins occurs early (0-4 days) post conception there will be _____ and _____. - CORRECT ANSWER 2 Amnions (Diamniotic) 2 Chorions (Dichorionic) If the division of monozygotic occurs 4-8 days there will be _____ and _____. - CORRECT ANSWER 1 Amnion (Monoamniotic) 2 Chorions (Dichorionic) If the division of monozygotic twins occurs after 8 days there will be _____ and _____. - CORRECT ANSWER 1 Amnion (Monoamniotic) 1 Chorion (Monochorionic) If the division of monozygotic twins occurs after 13 days the division may be incomplete and _____ may result. - CORRECT ANSWER Conjoined twins Conjoined twins may be joined at a variety of sites. Name at least 2 different sites. - CORRECT ANSWER 1. Head 2. Thorax 3. Abdomen 4. Pelvis Which type of monozygotic pregnancy is associated with umbilical cord entanglement, which cuts off the blood supply to the fetuses? - CORRECT ANSWER Monoamniotic sac What is the difference between twin-to-twin transfusion syndrome and fetus papyraceous? - CORRECT ANSWER Twin-to-twin is the phenomenon where one twin vanishes and the other continues to grow while the fetus papyraceous is when the fetus is too large for reabsorption the fetus is flattened. Name the three genetic testing done to diagnose congenital anomalies - CORRECT ANSWER 1. Chorionic villus sampling 2. Amniocentesis 3. Cordocentesis 4. Quadruple screen What is a chorionic villus sampling? - CORRECT ANSWER It is an ultrasound guided biopsy of the placenta. What are the advantages to CVS (Chorionic villus sampling)? - CORRECT ANSWER 1. Performed early in the pregnancy (10-14 weeks) 2. Results are available within one week; Earlier results allow more options for the parents What is an amniocentesis? - CORRECT ANSWER Is a test offered to expectant parents who are at risk for a chromosomal abnormality. In where amniotic fluid is taken from the uterus to be tested for chromosomal abnormalities. When is an amniocentesis performed? - CORRECT ANSWER 15 -20 weeks of gestation What is the optimal collection site for an amniocentesis? - CORRECT ANSWER Away from the fetus, umbilical cord, placenta, and near the midline to avoid maternal uterine vessels What is a cordocentesis? - CORRECT ANSWER A method in which fetal blood is obtained through a needle aspiration of the umbilical cord. What is a major protein in fetal serum that is produced by the yolk sac in early gestation and later by the liver? - CORRECT ANSWER Alpha-fetoprotein Where will you find AFP? - CORRECT ANSWER -Fetal spine -Gastrointestinal tract -Liver -Kidneys How is AFP transported into the amniotic fluid? - CORRECT ANSWER By fetal urination and reaches maternal blood circulations through the fetal membranes. When is the ideal time to sample the MSAFP? - CORRECT ANSWER 15-18 week gestations, when it's at its peak. What is a quadruple screening? - CORRECT ANSWER A biochemical screening test used in the early second trimester. Quadruple screening combines what three serum markers? - CORRECT ANSWER -AFP -hCG -Unconjugated estriol What is one of the most common chromosomal disorder? - CORRECT ANSWER Trisomy 21 a.k.a Down Syndrome What is the common sonographic features of Trisomy 21? Name at least 3 - CORRECT ANSWER -Nuchal thickness (6mm) -Heart defects -Duodenal atresia -Flattened or absent nasal bridge -Echogenic bowel -Protruding tongue What is trisomy 18 also known as? - CORRECT ANSWER Edward's Syndrome What are the common sonographic appearance of trisomy 18? Name at least 3 - CORRECT ANSWER -Heart defects -Choriod plexus cyst -Clenched hands -Micrognathia -Renal abnl -Cleft lip and palate -Omphalocele -Cerebellar hyperplasia -Clubbed foot What is Patau's syndrome also known as? - CORRECT ANSWER Trisomy 13 What are the common sonographic appearances of trisomy 13? Name at least 3 - CORRECT ANSWER -Holoprosencephaly -Heart defects -Cleft lip and palate -Omphalocele -Renal abnl -Meningomyelocele -Micrognathia -Clubbed foot The prognosis of _____ is extremely poor, with 80% of infants dying within the first month. - CORRECT ANSWER Trisomy 13 What is triploidy the result of? - CORRECT ANSWER An ova fertilized by two sperm What are the common sonographic appearances of triploidy? Name at least 3 - CORRECT ANSWER -Hydatiform placental degeneration -Heart defects -Renal abnl -Omphalocele -Cranial defects (Holoprosencephaly, Dandy-Walker Malformation, agenesis of the corpus callosum) -Facial defects (Hypertelorism, cleft lip and palate, and micrognathia) What is a major role of the placenta? - CORRECT ANSWER To permit the exchange of oxygenated blood with deoxygenated fetal blood. What are the two components of the placenta? - CORRECT ANSWER 1. The maternal portion 2. The fetal portion What is the maternal portion of the placenta also known as? - CORRECT ANSWER Deciduas basalis What is the fetal portion of the placenta also known as? - CORRECT ANSWER Chorion frondosum What is the deciduas basalis of the placenta formed by? - CORRECT ANSWER The endometrial surface _____ blood passes through the umbilical vein into the fetal abdomen. - CORRECT ANSWER Oxygenated Where is the attachment of the umbilical cord normally placed? - CORRECT ANSWER Usually near the center of the placenta What is a battledore placenta? - CORRECT ANSWER When the umbilical cord inserts itself at the margin of the placenta, within 10mm from the edge. What velamentous placenta? - CORRECT ANSWER An umbilical cord that inserts itself on the membranes What is vasa previa? - CORRECT ANSWER What the umbilical cord is positioned across the internal os _____ occurs when the placenta implants itself within the lower uterine segment. - CORRECT ANSWER Placenta previa The umbilical cord is surrounded by a mucoid connective tissue called _____. - CORRECT ANSWER Wharton's Jelly The normal umbilical cord has one large _____ and 2 smaller _____. - CORRECT ANSWER -Vein -Arteries What are Braxton-Hicks contractions? - CORRECT ANSWER focal myometrial contractions that may mimic a fibroid. For the sonographer to visualize the internal os of the cervix, a (Sagittal or Transverse) image of the lower uterine segment and cervix should be obtained. - CORRECT ANSWER Sagittal When there are additional placental lobes joined to the main placenta by blood vessels _____ should be considered. - CORRECT ANSWER Succenturiate lobe What is succenturiate lobe also known as? - CORRECT ANSWER Accessory lobe What is placental migration? - CORRECT ANSWER The concept that the placenta changes its position within the uterine cavity. A placenta previa should not be diagnosed before __ weeks' gestation. - CORRECT ANSWER 20 What is suggested when the placenta is abnormally thick and measures greater than 4cm? - CORRECT ANSWER Placentomegaly What are the 4 different types of placental previa? - CORRECT ANSWER -Complete -Partial -Marginal -Low lying Define a complete placental previa - CORRECT ANSWER The cervical internal os is completely covered by the placenta Define a partial placental previa - CORRECT ANSWER The placenta covers the cervical internal os partially Define marginal placental previa - CORRECT ANSWER The placenta doesn't cover the cervical internal os but its edge comes to the margin of the os Define a low lying placenta - CORRECT ANSWER The placenta is implanted in the lower uterine segment but its edge does not reach the edge of the cervical internal os _____ is defined as an abnormal penetration of placental tissue beyond the endometrial lining of the uterus. - CORRECT ANSWER Placental invasion What are the three variants of placental invasion? - CORRECT ANSWER -Accreta -Increta -Percreta What type of placental invasion involves the chorionic villi attaching to the myometrium WITHOUT muscular invasion? - CORRECT ANSWER Placenta accreta _____ is the further extension of the chorionic villi into the myometrium. - CORRECT ANSWER Placenta increta What type of placental invasion involves the penetration of the chorionic villi THROUGH the uterus? - CORRECT ANSWER Placenta percreta True or False: The risk of placenta accreta increases in patients with placenta previa and uterine scar from previous c-section. - CORRECT ANSWER True What is placental hemorrhage? - CORRECT ANSWER Bleeding from the placenta from any cause. What refers to the separation of the normally implanted placenta prior to term delivery? - CORRECT ANSWER Placental abruption What is the difference between retroplacental abruption and marginal abruption? - CORRECT ANSWER Retroplacental results from a rupture of spiral arteries and is a HIGH PRESSURE bleed Marginal results from tears of the marginal veins and is a LOW PRESSURE bleed. What is marginal placental abruption also known as? - CORRECT ANSWER Subchorionic bleeds What are some clinical symptoms of a complete molar pregnancy? - CORRECT ANSWER -Elevated hCG (which causes vomiting and nausea) -Vaginal bleeding -Uterine size larger than dates Vascular connections within the cord serve a reverse function in the fetus; the vein carries _____ blood to the fetus, whereas the arteries bring _____ blood back to the placenta. - CORRECT ANSWER -Oxygenated -Deoxygenated What is suggested when the umbilical cord is not attached to the middle of the placenta but to the edge of the placenta? - CORRECT ANSWER Battledore placenta Describe the doppler waveform of a fetus with IUGR? - CORRECT ANSWER Shows no diastolic flow and has a prominent systolic flow. Name a few structures that produces amniotic fluid - CORRECT ANSWER -Umbilical cord -The membranes -Lungs -Skin -Kidneys What are the 6 functions of amniotic fluid? - CORRECT ANSWER -Allows movement -Allows symmetrical growth -Acts as a reservoir -Maintains a constant temperature -Protects the fetus -Prevents the amnion from adhering to the embryo What is suggested when the amniotic fluid is too high? - CORRECT ANSWER Polyhydramnios What is polyhydramnois also known as? - CORRECT ANSWER Hydramnios What is suggested when the amniotic fluid is too low? - CORRECT ANSWER Oligohydramnios What method is used most frequently for evaluating and quantifying amniotic fluid volume at different intervals during a pregnancy? - CORRECT ANSWER AFI When the AFI is less than 5cm, what does that correlate with? - CORRECT ANSWER Oligohydramnios When the AFI is greater than 24cm, what does that correlate with? - CORRECT ANSWER Polyhydramnios What are the different types of ROM (Rupture of membranes)? - CORRECT ANSWER -PROM (Premature Rupture of Membranes) -PPROM (Preterm Premature Rupture of Membranes) -SPROM (Spontaneous Premature Rupture of Membranes) What syndrome is described as the rupture of the amnion during early pregnancy leads to subsequent entanglement of various fetal parts resulting in amputation. - CORRECT ANSWER Amniotic band Syndrome In cases of _____, a great difference is seen between the amount of serous fluid being produced and the amount being absorbed. This disparity leads to an accumulation of fluid within the fetus. - CORRECT ANSWER Hydrops fetalis How many ways can edema manifest itself? - CORRECT ANSWER -Pleural effusion -Ascites -Cardiac effusion -Skin edema or anasarca What type of manifestation of edema will show the sonographic characteristics of anechoic fluid filling the thoracic cavity or even outlining the fetal lungs? - CORRECT ANSWER Pleural effusion What type of manifestation of edema will show the sonographic characteristics of anechoic fluid surrounding abdominal and pelvic organs and the umbilical insertion? - CORRECT ANSWER Ascites What is the manifestation of edema called skin edema? - CORRECT ANSWER An increased skin thickening around the skull, neck, extremities, or abdomen. *When skin edema is massive, encasing most of the body, the term anasarca is used. What would you call a placenta that is thickened and measuring greater han 4-4.5 cm? - CORRECT ANSWER Placental edema Normally, a small amount of fluid is noted in the pericardial cavity, particularly in the apex. However if the fluid collection measures greater than 2mm, _____ is considered. - CORRECT ANSWER Pericardial effusion _____ results from a malformation of the lymphatic system that leads to single or multiloculated lymph-filled cavities around the neck. - CORRECT ANSWER Cystic hygroma Define anencephaly - CORRECT ANSWER Absence of the fetal brain due to the failure of closure of the neural tube at the cranial end. What are some of the sonographic characteristics of anencephaly? - CORRECT ANSWER -Absence of the brain and cranial vault -Bulging fetal orbits, giving the fetus a frog-like appearance. What is also known as exencephaly? - CORRECT ANSWER Acrania What lethal anomaly manifests as absence of the cranial bones with the presence of complete but abnormal development of the cerebral hemispheres? - CORRECT ANSWER Acrania How can the sonographer distinguish the difference between acrania and anencephaly? - CORRECT ANSWER -The lack of a frog-like appearance Define encephalocele - CORRECT ANSWER Herniation of the meninges and brain through the defect in the calvarium. Define cranial meningocele - CORRECT ANSWER Herniation of ONLY the meninges through the defect in the calvarium _____ is a neural tube defect in which the meninges alone OR the meninges and the brain herniate through a defect in the calvarium. - CORRECT ANSWER Cephalocele What are the differences between an encephalocele and a cranial meningocele sonograhically? - CORRECT ANSWER -A crianial meningocele will appear cystic while the encephalocele will appear more solid. What is the sonographic appearance of cephaloceles? - CORRECT ANSWER -A bony defect in the skull -Ventriculomegaly -An extracranial mass ______ encompasses a wide range of vertebral defects that result from failure of neural tube closure. - CORRECT ANSWER Spina Bifida What does the term Spina Bifida mean? - CORRECT ANSWER That there is a cleft or opening in the spine. What type of spina bifida involves the protrusion of only the meninges through the defect? - CORRECT ANSWER Meningocele What type of spina bifida involves the protrusion of both meninges and neural elements through the defect? - CORRECT ANSWER Myelomeningocele What cranial sonographic appearances are associated with spina bifida? - CORRECT ANSWER -Lemon sign -Obliteration of the cistern magna -Banana cerebellum shape sign -Ventriculomegaly What are the some of the sonographic appearances of spina bifida? - CORRECT ANSWER -Splaying of the post. ossification centers with a V or U configuration -Protrusion of a saclike structure -A cleft in the skin What manifests wot agenesis or hypoplasia of the cerebellar vermis with resulting dilation of he 4th ventricle and enlargement of the posterior fossa? - CORRECT ANSWER Dandy-Walker malformation ______ is diagnosed when there is no falx cerebri to separate both hemispheres. - CORRECT ANSWER Holoprosencephaly How types of holoprosencephaly are there? - CORRECT ANSWER 3 What are the three types of holoprosencephaly? - CORRECT ANSWER -Alobar -Semilobar -Lobar What is the most severe form of holoprosencephaly? - CORRECT ANSWER Alobar holoprosencephaly What is the most mild form of holoprosencephaly? - CORRECT ANSWER Lobar holoprosencephaly What is alobar holorpsencephaly characterized by? - CORRECT ANSWER -Fused ventricles -Fused thalamus -Absence of the IHF, CSP, and CC What is semi lobar holoprosencephaly characterized by? - CORRECT ANSWER -Fused ventricles with partial formation of the occipital horns -Partial of complete fusion of the thalamus -Small portion of IHF & falx -Absent CC & CSP What is lobar holoprosencephaly characterized by? - CORRECT ANSWER -Almost complete division of the ventricles -Absent CSP _____ is often associated with facial abnormalities. - CORRECT ANSWER Holoprosencephaly What is a major sonographic characteristic agenesis of the CC have? - CORRECT ANSWER Vampire wing sign Define hydranencephaly - CORRECT ANSWER The destruction of the cerebral hemispheres by occlusion of the ICA's What is the difference between hydrocephalus and ventriculomegaly? - CORRECT ANSWER Vetriculomegaly refers to dilation of the ventricles Hydrocephalus refers to ventriculomegaly AND enlargement of the fetal head. When the obstruction in hydrocephalus is within the ventricular system what is it called? - CORRECT ANSWER Noncommunicating hydrocephalus When the obstruction in hydrocephalus is outside of the ventricular system what is it called? - CORRECT ANSWER Communicating hydrocephalus Aqueductal stenosis would be referred to as? - CORRECT ANSWER Noncommunicating hydrocephalus An arachnoid cyst would be referred to as? - CORRECT ANSWER Communicating hydrocephalus What are some sonographic characteristics of hydrocephalus? - CORRECT ANSWER -Ventriculomegaly -"Dangling" choroid plexus -Fetal head enlargement True or False: The thorax is normally slightly bigger than the abdominal cavity. - CORRECT ANSWER False; It is slightly smaller than the abdominal cavity. _______ is a blockage of the duodenal lumen by a membrane that prohibits the passage of swallowed amniotic fluid. - CORRECT ANSWER Duodenal atresia What is the classic sonographic appearance of duodenal atresia? - CORRECT ANSWER "double bubble" sign How does a sonogapher support the finding of a three vessel cord? - CORRECT ANSWER View the bladder and view in color doppler the arteries on either side of the bladder. True or False: The posterior urethral valve occurs only in male fetuses and is manifested by the presence of a valve in the posterior urethra. - CORRECT ANSWER True. What findings correspond with the inferior poles of both kidneys are fused while in the pelvis? - CORRECT ANSWER Horseshoe kidney What is infantile polycystic kidney disease also known as? - CORRECT ANSWER Autosomal recessive polycystic kidney What is infantile polycystic kidney disease characterized by? - CORRECT ANSWER development of small cysts in both kidney and liver cysts What is dilation of the renal pelvis that occurs in response to a blockage of urine at some junction in the urinary system? - CORRECT ANSWER Hydronephrosis _______ occurs at the junction between the renal pelvis and ureter. - CORRECT ANSWER Uteropelvic Junction Obstruction True or False: Uterovesical junction obstruction commonly presents with dilation of the lower end of the ureter. - CORRECT ANSWER True What obstruction is produced by a congenital membrane within the posterior valve? - CORRECT ANSWER Posterior Urethral Valve Obstruction What does posterior urethral valve obstruction result in? - CORRECT ANSWER The inability of urine to pass through the urethra and into the amniotic fluid Describe the classic sonographic appearance of posterior urethral obstruction. - CORRECT ANSWER Keyhole sign What renal congenital defect results with males? - CORRECT ANSWER Anterior urethral valves What are the differences between an encephalocele and a cranial meningocele sonograhically? - CORRECT ANSWER