Summary ARDMS® SPI OB/GYN BOARD Comprehensive Exam Review
ARDMS® SPI OB/GYN BOARD Comprehensive Exam Review Guide Updated fall 2022/23. ____ is most effective at determining myometrial invasion and cervical extension of carcinoma - MRI ______ -_____ mo fluid with oligo - 300-500 ______ is used to evaluate uterus and ovaries when sono is inconclusive - MRI _________ _______ attach to the endo and will become the fetal side of the placenta - chorion frondosum _________ drops in the periovulatory and luteal phase - resistance _________ is the first test of choice for GYN imaging because of low cost and accuracy - sonography __________ arteries branch off of the radial arteries to feed the functional layer of the endo - spiral become longer and more tortuous in the secretory phase of menses __________ artery is found lateral to the uterine body around the level of the isthmus - uterine ___________ arteries branch off of the arcuate arteries and course toward the center to feed the inner ___________ and _____________ - Radial Myometrium and endo ____________ arteries branch off of the radial arteries to feed the basal layer of the endo - straight ___-____ml fluid with poly - **surge in ___ stimulates ovulation** - lutenizing hormone (LH) #1 cause 3rd trimester bleeding - placenta previa 2 cervical clerage techniques - shridokar macdonald - less complicated 2 lab tests to develop amount of HCG in maternal blood - second international standard -half the value of IRP international reference preparation -twice 2nd IS 2 most common causes of PID - gonorrhea and chlamydia 3 layers of fallopian tubes - outer serosa middle muscular internal mucosal 3 layers of myometrium - outer- adjacent to serosa and separated fro intermediate by arcuate vessels intermediate- THICKEST inner- thin layer adjacent to endo 3 parts of primitive brain - forebrain (prosencephalon) midbrain (mesencephalon) hindbrain (rhombencephalon) 3 planes for 3-D imaging - A,B,C 3rd most common GYN malign in US - cervical cancer detection typically by PAP smears 4 body ratios - HC/AC FLBPD FL/HC FL/AC 4 functions of the YS - transfer of nutrients hematopoiesis angiogenesis formation of digestive tract 4 risk factors for preterm births - multiple pregnancy preterm rupture of membranes prior history of preterm birth prior history of cervical surgery 4 types sacrococcygeal teratoma - 1. predominately external, with minimal pre sacral component 2. predom external, with significant intrapelvic component 3. internal, with abdominal extension 4. entirely internal with no external component 14-15 week placenta sono - well established prominent hypo echoic retroplacental vessels 70-80% endo carcinomas occur in ________________ women - postmenopausal 95% germ cell tumors are benign _______ ________ - cystic teratomas a ______ is formed when fluid enters between the cells creating a fluid filled cyst lined with trophoblastic cells - blastocyst a follicle may be called a cyst if it measures greater the n _____cm - 2.5 a myoma that demonstrates rapid growth in peri or post menopausal woman, is suspicious for - malignancy A surge of ____ triggers ovulation. - LH a thicker membrane is associated with _________ gestations - dichorionic A urine pregnancy test checks for presence of - hCG, does not confirm amount of it false negative- woman is preg but test is neg false positive- not preg but test is pos abdomen radiograph - useful for finding IUD if not seen on US abdominal wall observations 2nd and 3rd tri - cord insertion site skin line intact check for gastrischisis or omphalocele abnormal CM - greater tham 10mm enlarged can be associated with DWM megacisterna magna associated with trisomy 18 abnormal fluid collections within uterine cavity most common in - premenarchal patients abnormal MCA doppler signs - decreased resistance increased PSV abnormal nuchal fold - 6mm abnormal nuchal fold values - 5-6mm, associated with trisomy 21 abnormal nuchal translucency associated with - aneuploidy fetal cardiac anomalies cystic hygroma abnormal umbilical artery characteristic - high resistance decreased diastolic flow absent diastolic flow after 18 weeks reversed end diastolic flow Abortion will cause hCG levels to - fall to zero absent cranium in what pathologies - anencephaly and exencephaly demineralized in osteogenesis imperfecta type 2 achiria - absence of a hand achondrogenesis - Rare, lethal condition resulting in abnormal development of bones & cartilage failure of ossification process, lethal, form of short limbed dysplasia achondroplasia - A form of human dwarfism, autosomal dominant, more common skeletal dysplasia acrania - absence of the skull brain is present ***** elevated AFP acromelia - Shortening of distal segment of limb (hands and feet) adenomyosis - growth of endometrium into the muscular portion of the uterus posterior wall of uterus most affected AFI criteria - poly - 24 cm oligo - 5cm after 4-6 hours, sperm secretes _________, an enzyme believed to be able to dissolve a portion of the ovum membrane - hyaluronidase after 24 weeks, the renal size is typically equal to - weeks of gestation after regression of corpus luteum in ovarian cycle, what happens - spiral arteries in endo atrophy, causing bleeding low estrogen levels trigger FSH menstrual cycle begins AFV is ___ml at 12 weeks, and __ml at term - 60, 1000 agenesis of corpus callous associated with - trisomy 18 and 13 holoprosencephay medial facial clefts dandy walker agenesis of the corpus callosum - failure of development of the corpus callous may be partial or complete if isolated may be asymptomatic all dizygotic gestations are - Dichorionic and dizygotic each embryo will have its own amnion, chorion, placenta, and YS alobar holoprosencephaly - most sever form, large single ventricle with minimal amount of surrounding tissue fused hemispheres and absence of falx and corpus callous, and CSP fused thalami hypotelorism,cyclopia, midline facial clefts alpha fetoprotein blood test - for screening of neural tube defects and other fetal and pregnancy related disorders American institute of ultrasound in medicine guidelines for 1st trimester sono - 1. evaluate GS 2. establish viability 3. establish fetal number 4. evaluate and document uterus, adnexa, and cul-de-sac corpus luteum will be evident until 12 weeks amniocentesis - most common invasive technique preferred over CVS amniotic band syndrome - fetal malformations caused by fibrous strands of ruptures amnion entangling or trapping fetal parts amnion ruptures during first trimester amniotic band syndrome - multiple fibrous strands of amnion that develop in utero that may entangle fetal parts unknown cause amniotic sheets - associated with uterine synechiae ampulla of fallopian tubes - longest and most coiled portion of fallopian tubes 5cm an embryonic pregnancy or blighted ovum - gestational sac with no evidence of embryo hCG initially rise then plateau MSD too small for GA GS large and lacking embryo anencephaly - absence of skull and brain portions of midbrain and brain stem may be present anomalies associated with maternal type 1 diabetes - neural tube defects- spina bifida, anencephaly, caudal regression syndrome cardiac anomalies- transposition of great vessels, teratologyfallot renal abnormalities- hydro, renal ageneiss GI- duodenal or anorectal atresia anomalous pulmonary venous connection - abnormal connection between one or more of the pulm veins and the atria instead of connecting to LA, some connect to RA anopthalmia - results fro failure of the optic vesicle to form demonstrates absence of the globe and often the orbit on the axial view another name for cordocentesis - percutenaous umbilical blood sampling Anterior cul-de-sac (vesicouterine pouch) - Area between the uterus and bladder usually empty but may contain bowel anterior pituitary gland role of menstrual cycle - stimulates changes in the ovaries FSH- stimulated follicular growth and development of ovarian cortex LH- stimulated ovulation, formation of corpus luteum aortic arch view - candy cane apodia - absence of foot arnold chiari type II associated with - spinal dysraphia arnold chiari type II malformation - displacement of cerebellar vermis, fourth ventricle, and medulla oblongata through foramen magnum into the upper cervical canal around day 21, the blastocyst will shed the zona pellucida so it can attach and implant into the _____________ lining - endometrial ARPKD sonography - bilateral enlarged kidneys ,echogenic bladder present or small oligo associated abnormalities with dandy walker malformation - CNS 50-70% of the time ventriculomegaly agenesis of corpus callous spinabifida microcephaly associated anomalies with AVSD - tetralogy of fallot double outlet right ventricle coarction of aorta sub aortic stenosis ventricular hypoplasia pulmonary valve stenosis associated defects from systemic lupus - spontaneous abortion IUGR stllbirth congenital heart block associated fetal effects maternal diabetes - macrosomia poly placentomegaly associations lissencephaly - agenesis of corpus callous dandy walker associations with ventriculomegaly - CNS spina bifida dandy walker emcephalocele hears issues renal malformations asymmetric IUGR - abdomen is proportionately smaller for GA than the head and extremities brain sparing- circulation to brain at the expense of other fetal organs atrial flutter bpm - 300 atrioventricular septal defect - may be referred to as endocardial cushion defect or AV canal defect defect in central part of heart combination of premium ASD and VSD attachment of a single chorion results in what sono appearance - T sign autosomal dominant - one parent may possess abnormal gene autosomal recessive - both parents must possess abnormal gene Average age of natural menopause - 51 average CM measurements - 3-8mm average ovarian volume during menarchal years - 10cm^3 axial skeleton components - cranium, ribs, scapula, clavicles, spine basal layer of endo - zona basalia thin, deep remains intact during menses battledore placenta - cord insertion into the margin of the placenta, also called marginal cord associated with IUGR benefits of estrogen HRT - relief of postmenopausal symptoms decreases risk of osteoporosis decreases risk of colorectal cancer benign cyst in cervix resulting from obstructed dilated transcervical gland - nabothian cyst bicornuate uterus - Partial fusion of the Müllerian ducts Two uterine horns Two cervices one vagina two endo cavities in transverse bilateral or double left sidedness heterotaxy - right isomerism or polysplenia both lungs have 3 lobes bilateral or double right sidedness heterotaxy - Ivemark syndrome, right isomerism, or asplenia left lung will be tri lobe, LA will have similar features of RA f RA Bilateral renal agenesis - incompatible with life POTTER facies Bilateral renal agenesis sono - severe oligo pulmonary hypoplasia absent kidneys and ureters adrenals may mimic kidneys facial anomalies (flat, twisted face) bilateral tubal ligation - tubes are cut, burned, or blocked with rings, bands, or clips to prevent sperm from reaching egg bladder must be seen by - 12-13 weeks blastocyst sheds ------- ------ and begins implantation - zona pellucida bochdalek hernia - defect in posterolateral aspect of the diaphragm, most common BPP components - 1) Fetal breathing movements:30-60 seconds of sustained fetal breathing 2) Gross body movements: 3 or more 3) Fetal tone: one episode of extension with return to flexion 4) Reactive fetal heart rate: non stress test 5) Qualitiative amniotic fluid volume brachiocephaly - shortened occipital diameter resulting in round head shape associated with chromosomal abnormalities brachiocephaly cephalic index - 85% bradycardia - 100 before 6.2 weeks 120 between 6.3 and 7 weeks bradycardia - 100bpm bradycardia - 100bpm decrease in average fetal heart rate often secondary to extra cardiac causes, such as head or cord compression, hypoxia, or maternal drugs Brenner tumor (transitional cell tumor) - uncommon, rarely malignant, asymptomatic, benign solid mass associated with Meig's syndrome broad ligament - The ligament extending from the lateral margins of the uterus to the pelvic wall; keeps the uterus centrally placed and provides stability within the pelvic cavity. bronchopulmonary sequestration - pulmonary lesion compromised of lung tissue that is separated from normal tracheobronchial tree bronchopulmonary sequestration sono - echogenic mass at base of lung may be triangular good prognosis by the time conception reaches the uterine cavity, it contains about 12-15 cells and is called a - morula by what week do intestines herniate into the base of the umbilical cord form? by what week do they return to the abdomen cavity by? - week 8 week 12 CAM associations - hydrops fatal poly mediastinal shift camptomelic dyplasia sono - bowing of long bones IUGR bell shaped chest eleven pairs of ribs hydrocephalus facial anomalies poly abnormal genatalia talipes equinovarus camptomelic dysplasia - characterized by abnormal curvature of the long bones autosomal dominant tibia and femur most affected camptomelic dysplasia associations - renal anomalies cardiac anomalies CNS anomalies cardiac anomalies typically associated with - chromosomal anomalies cardiac axis is how may degrees - 45 and occupy 1/3 thoracic area cardinal ligaments - help anchor the cervix caudal end of paired Mullerian ducts fuse to form __________ and upper __________ - uterus and upper vagina caudal regression - complete or partial agenesis of the sacrum caudal regression associated with - genitourinary defects GI abnormalities cardiac abnormalities neural tube abnormalities caudal regression more common in what type of mothers - diabetes type I causes of encephalocele - possibly by amniotic bands associated with meckel gruber syndrome causes of hydranencephaly - occlusion of the carotid arteries in first or early second trimester possibly from infection causes of incompetent cervix - -Cervical trauma: laceration, ionization, excessive cervical dilation before curettage, therapeutic abortion -DES exposure causes of infertility - PCOS dominant follicle matures but does not rupture (lutenized enraptured follicle syndrome) inadequate production of progesterone septet uterus diethylstilbestrol exposure (small T shaped uterus, tubal deformity) cervical factors causes of large placenta - diabetes anemia intraplacental hemorrhage causes of oligo - premature rupture of membranes post term pregnancy genitourinary abnormalities chromosomal anomalies IUGR maternal hypertension causes of premature placental maturation - maternal hypertension cigarette smoking IUGR multiple gestation causes of talipes - oligo amniotic band syndrome uterine tumors spina bifida chromosomal anomalies causes or thin placenta - diabetes intrauterine infection chromosomal anomaly eccentric cord insertion cells develop into a _____ while traveling through the tube - morula cephalic index ratio - BPD/OFDx100 normal is between 70-85% 70= dolichocephaly 85= brachycephaly cephalic position - head located at cx cerebellar vermis - hemispheres should not have fluid between them after 18 weeks small of absent in DWM cerebellum is the portion of the brain that assists in - balance cerebellum measures __mm perGestational week - 1mm cerivcal funneling - protrusion of membranes into interval cervical os early sign of cervical incompetence beak like protrusion of fluid at internal os cervical cancer most commonly affects women ages ____-___ - 30-40 cervical spine ossifies around lumbar spine - 15-16 18 cervix is held in place by what ligaments - uterosacral characteristics of achondroplasia - micromelia (short limbs) frontal bossing depressed nasal bridge chiari 2 malformation associated with - spina bifida choriocarcinoma - highly metastatic trophoblastic cancer diagnosis bases on hCG levels and evidence of mets choriocarcinoma mets site - lungs, spleen, kidney, intestines, liver, brain chorion frondusom of placental site invades ___________ ______ and anchors placenta - decidua basalis chorionic villi embedded in decidua basalis are called - chorion frondosum chorionic villus sampling indications - AMA 35 precious hx trisomy parental chromosome rearrangement X linked recessive disorder mendelian disorder choroid plexus cysts - should resolve by 26 weeks if larger, possibly associated with trisomy 18 chronic maternal hypertension - present before 20 weeks primary/secondary-casued by renal, endocrine, or neurologic disorders chronic PID - -Extensive fibrosis and adhesion's may obscure the margins of the pelvic organs, which blend into a large, ill defined mass. -Subacute condition. chronicity other name - placentation Circumvallate or Circummarginate Placenta: - abnormal attachment of placental membranes to fetal placental surface membranes insert inward from edge towards center of placenta circummarginate describes a flat or smooth membrane transition circumvallate has a raised or rolled edge classifications of placenta previa - 1. Marginal: near the cervical os, but not covering 2. Partial: covering some of the cervix 3. Complete: covering all of cervical os 4. low lying cleft involving hard and soft palate without cleft lip results from - failure of maxilla, primary, and secondary palates to fuse cleft lip and palate associations - trisomy 13 CNS anomalies cardiac anomalies teratogens holoprosencephaly amniotic band syndrome cleft lip and palate usually form due to - failed fusion of the maxilla, primary, and secondary palates cleft lip results from lack of fusion of __________ _________ with the nasal prominence on one or both sides - maxillary prominence clinical associations endometritis postpartum - fever uterine tenderness abnormal bleeding odorous lochia clinical presentation triad ectopic - vaginal bleeding abnormal palpable adnexal mass pelvic pain possible cervical tenderness or shock clinical signs HELLP - hypertension, edema, abdominal pain clinical symptoms and associations with smaller for GA - small for dates Hx SGA infant preeclampsia hypertension clinical symptoms previa - painless vaginal bleeding presents in second and third trimesters clinodactyly - abnormal curvature of the digit in the medial or lateral direction cloacal exstrophy - lack of separation of urogenital septum from rectum clover leaf shaped skull associated with - thanatophoric dwarfism coexistant mole - twin gestation in which one twin is normal and the other is a mole collapsed tube consisting of an outer muscular layer and inner mucosal layer - vagina colon distinguishable after - 22 weeks hypo echoic tubular structure surrounding periphery of abdomen , toward full term, same echogenicity as liver common, benign cystic lesion typically arising from the anterior vaginal wall - gartner's duct cyst fluid filled cyst within vagina, multiple complete breech - hips and knees flexed complete hydatidiform mole - mose common form of GTD benign trophoblastic tumor confined to endometrial cavity no fetus complex endocrinology disorder resulting in oligomenorrhea and chronic an ovulation - PCOS complications of dermoid tumor - torsion, rupture complications of GTN - caused by elevated hCG hyperemesis thecalutein cysts early preeclampsia hyperthyroidism complications of multiple gestations - prematurity growth restriction increased incidence of congenital abnormalities (monozygotic) cerebral palsy monochorionic pregnancy have a morality rate 2-3 times that of dichorionic twins compression of lower uterine segment mimics - elongated cervix congenital diaphragmatic hernia - Herniation of abdominal contents into the thoracic cavity through the diaphragm usually on left side compression of lung may cause pulm hypoplasia congenital uterine anomalies result when _________ _______ fail to form or fuse properly - mullerian ducts conjoined twins - incomplete division of embryonic disc resulting in shared organs and body parts consequences of thrombophilias - more likely to develop thromboembolism while pregnant DVT or pulmonary embolus IUGR spontaneous aboriton constant low levels of estrogen from oral contraceptives inhibit __________ and _______ - LH surge and ovulation continuous HRT - daily dosage of estrogen and progestin causes excessive endometrial proliferation cord entanglement - MUST BE monamniotic (1 sac) -- cords can interact. lack of a dividing membrane allows the twins to become entangled in each others umbilical cords , possibly resulting in cord knots increased risk of fetal demise corpus (body) of uterus - largest portion of the uterus uterine cavity centrally located here corpus luteum formation is influenced by - LH corpus luteum may be evident after - ovulation hypo structure in periphery of ovary irregular borders low levels representing hemorrhage corpus luteum produces __________ - progesterone in second half of cycle corpus luteum produces what hormones - estrogen and progesterone coruna of uterus - lateral portions of the funds which connects to the interstitial portion of the tubes cranial ends of Mullerian unfused ducts form the ____________ - paired fallopian tubes cranial meningocele - herniated contents includes only meninges and CSF craniofacial defects of amniotic band syndrome - non central cephalocele asymmetric face facial clefts anencephaly acrania Craniopagus Conjoined Twins - joined at head craniosynostosis - the premature fusing of the skull bones caused asymmetric head shape CRL multiple gestation - difference greater than 5 days of each fetus is abnormal abnormal AC is diameter 20mm CX cancer symptoms - asymptomatic if early vaginal discharge palp pelvic mass cyclopia - midline fusion of orbits, resulting in single orbit cyclopia associations - holoprosencephaly teratogen exposure cytomegalovirus cyst that occurs when dominant follicle fails to ovulate or involute - follicular cyst cystic adenomatoid malformation - benign lung tumor multi cystic mass within the lung consisting of primitive lung tissue and abnormal bronchial and bronchiolar strucues usually unilateral affecting certain lobe decrease in size late in pregnancy cystic hygroma - developmental anomaly of lymphatic origin resulting in large cystic masses in the neck, axilla, or mediastinum cystic hygroma associations - turner syndrome trisomy 21 and 18 hydrous congenital heart defects cytomegalovirus TORCH - most common cause of intrauterine infections IUGR microcephaly intracranial infections seizures blindness dandy walker complex - congenital malformation of posterior fossa consisting of : dysgenesis of cerebellar vermix dandy walker malformation - Congenital failure of cerebellar vermis to develop splayed cerebellum dandy walker malformation - small of absent cerebellar vermis large fourth ventricle which communicates with posterior fossa fluid collection CM enlargement Days 1-13 menstrual cycle - preovulatory follicular phase of ovarian cycle proliferative phase of the uterine cycle Days 1-13 ovarian cycle - follicular phase day 1- FHS stimulates growth of multiple follicles day 4-5- primary follicle fills with fluid and is known as a secondary follicle days 6-9 uterine cycle - endo is thin hyper line early proliferative days 6-13 ovarian cycle - preovulatory cycle Graffian follicle will continue to grow, bulging on surface of ovary 2-2.4 cm, other follicles degenerate days 10-14 uterine cycle - late proliferative hypo functional layers will be surrounded by hyper basal layers causing triple layer appearance 4-8mm thickness Days 15-28 menstrual cycle - post ovulatory luteal phase ovarian cycle secretory phase uterine cycle days 15-28 of ovarian cycle - luteal phase ruptured graffan follicle becomes a corpus luteum "yellow body" CONT
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