1st trimester anatomy & pathology (12%)

Question 1

the most common place for normal egg fertilization to occur is within which of the following fallopian tube segments

a. isthmus
b. interstitial
c. infundibulum
d. ampulla

Answer 1

a.
the ampulla segment is the widest and longest portion of the fallopian tube and fertilization most commonly occurs there. for this reason it is the most common site of ectopic implantation

Question 2

when evaluating a first trimester fetus the reported crown rump length should be

a. the largest of at least 3 measurements
b. the smallest of at least 3 measurements
c. the largest of at least 5 measurements
d. the average of at least 3 measurements

Answer 2

d.

when evaluating a first trimester fetus the reported crown rump length should be the average of at least 3 measurements

Question 3

the number of yolk sacs
a. can be used to determine the amnionicity of the multifetal pregnancy
b. can be used to determine the chorionicity of the multifetal pregnancy
c. can only be assessed with transvaginal ultrasound
is irrelevant in first trimester ultrasound evaluation

Answer 3

a
the number of yolk sacs can be used to determine the amnioncity of the multifetal pregnancy. 2 embryos + 2 yolk sacs = diamoniotic pregnancy; 2 embryos + 1 yolk sac = monoamniotic pregnancy

Question 4

which of the following statements regarding twins is true

a. dizygous twins are always the same gender
b. conjoined twins are caused by cleavage of the morula within the first 4 days of pregnancy
c. most monozygous pregnancies are diamniotic
d. identical twins are always dizygotic

Answer 4

c
identical twins are always monozygotic. monozygous twins are always the same gender. conjoined twins are caused by cleavage of the morula after the 13th day of pregnancy. most monozygous pregnancies are diamniotic

Question 5

which of the following correctly describes how to perform a crown rump length on a 13 week fetus

a. measurements should demonstrate a straight line perpendicular to the long axis of the fetus
b. calipers placed on the inner edge of the skin of the fetal head and rump
c. fetal neck in neutral position with fluid between the fetal chin and anterior neck
d. parasagittal plane with the profile spine and rump visible

Answer 5

c
crown rump length:
fetus fills 2/3 of the field of view
midsagittal plane with the profile spine and rump visible
fetal neck in neutral position with fluid between the fetal chin and anterior neck
calipers placed on the outer edge of the skin of the fetal head and rump
measurement should demonstrate a straight line parallel to the long axis of the fetus
3 measurements are taken and the average reported

Question 6

how are the long bones of the extremities evaluated in a 13 week fetus with suspected cardiac defects

a. measure the femur length and compare to the humeral length
b. document 3 long bones are present in each extremity
c. the thicknesses of the femoral diaphyses are documented
d. document that there are at least two long bones in each extremity

Answer 6

b
when evaluating a late 1st trimester fetus (12-13 wees 6 days) 3 long bones pre extremity should be documented. long bone length measurements are reserved for cases of suspected skeletal dysplasia. the femur cannot be reliability measured until after 14 weeks gestation

Question 7

an ectopic pregnancy will almost always be seen on the _______

a. same side as the corpus luteal cyst
b. right side
c. opposite side from the corpus luteal cyst
d. left side

Answer 7

a
an ectopic pregnancy will almost always be seen on the same side as the corpus luteal cyst. the egg is released from the dominant follicle and a corpus luteum cyst forms. when the right ovary releases an egg it travels into the right fallopian tube. when the left ovary releases an egg it travels into the left fallopian tube. an ectopic implantation is most likely to occur in the ipsilateral fallopian tube

Question 8

mid tricuspid regurgitation in a first trimester fetus is suggestive of

a. IUGR
b. aneuploidy
c. normal fetus
d. maternal diabetes

Answer 8

b
tricuspid regurgitation of any level is suggestive of aneuploidy. trisomy 13, 18, 21 have been associated with tricuspid regurgitation in the 1st trimester

Question 9

which of the following is a possible maternal complication of diamniotic twins

a. twin to twin embolization
b. anemia
c. twin to twin transfusion
d. cord enlargement

Answer 9

b
maternal complications with multifetal pregnancy:
anemia
pre-clampsia/eclampsia
systemic HNT
placental abruption 
pre-term labor
post-partum hemorrhage

fetal complications with multifetal pregnancy:
increased risk of anomalies
umbilical cord knots/entanglement (monoamniotic twins)
cord compression
IUGR because placenta cannot meet fetal needs
difficult delivery compared to singleton pregnancy

Question 10

which if the following is a sonographic sign of an abnormal 8 week intrauterine pregnancy

a. yolk sac diameter 5mm
b. double bleb sign
c. gestational sac located in the lower uterine segment
d. fetal heart rate of 120bpm

Answer 10

c
if the gestational sac implants in the lower uterine segment the risk of the spontaneous abortion is increased significantly. the yolk sac is not abnormal until the diameter exceeds 6mm

Question 11

what is the minimum international reference preparation value for bhCG that indicates a gestational sac should definitely be visualized by transabdominal ultrasound

a. 1000 units/ml
b. 1500 units/ml
c. 2000 units/ml
d. 4000 units/ml

Answer 11

d
IRP levels for transabdominal ultrasound = 4000 units/ml is the minimum bhCG level for identifying an intrauterine pregnancy

Question 12

on transvaginal ultrasound the minimum mean sac diameter that should always demonstrate a yolk sac in a normal IUP is

a. 5mm
b. 20cm
c. 8mm
d. 10mm

Answer 12

c
on transvaginal ultrasound a mean sac diameter >8mm should demonstrate a yolk sac in a normal IUP and on transabdominal ultrasound a mean sac diameter >20mm should demonstrate a fetal pole in a normal IUP

Question 13

average normal heart rate in an early first trimester pregnancy is \_\_\_\_\_\_
a. <100bpm
b. 120-160bpm
c. 100-115bpm
d<137bpm

Answer 13

c

average normal heart rate in an early first trimester pregnancy is 100-115bpm

Question 14

a fetal heart rate ______ indicates a significant risk for demise in the first trimester

a. less than 160bpm
b. less than 80bpm
c. less than 140 bpm
d. greater than 100bpm

Answer 14

b
a fetal heart rate less than 80bpm indicates a significant risk for demise in the first trimester. the normal heart rate in the early first trimest is 100-115bpm

Question 15

at what gestational age does the CRL become less accurate for fetal dating

a. at 10th week
b. at the 12th week
c. at the 14th week
d. at the 16th week

Answer 15

b fetal curling can reduce the accuracy of the CRL measurement after the 11th week. fetal biometric measurements are used to determine fetal age after 12 weeks. biparietal diameter head circumference abdominal circumference and femur length

Question 16

visualization of which of the following can help differentiate a normal intrauterine pregnancy (IUP) from pseudo-gestational sac associated with an ectopic pregnancy

a. corpus luteal cyst
b. yolk sac
c. decreased resistance to flow in the uterine arteries
d. increased blood flow velocity in the uterine arteries

Answer 16

b
a gestational sac in the uterus with a yolk sac indicates an IUP is present. a pseudo-sac seen in the uterus with a ectopic pregnancy would not contain a yolk sac. both an ectopic and normal IUP can demonstrate a corpus luteal cyst and decreased resistance in the uterine arteries because these changes occur due to hormone stimulation that occurs with both types of pregnancy

Question 17

a patient is admitted to the hospital with a pelvic pain, no bleeding and vomiting. an LMP of 6 weeks ago and the pregnancy test that was performed was positive. serial hCG levels are assessed 36 hours apart. the first reading was 1500/ml and the second reading was 4500/ml. ultrasound is ordered to assess the pregnancy. what should you expect to find on the exam

a. normal IUP
b. molar pregnancy or normal IUP
c. multiple pregnancy or fetus with trisomy
d. molar pregnancy or multiple pregnancy

Answer 17

d
an ectopic pregnancy demonstrates a slowly rising hCG level. normal pregnancy will cause hCG levels to double every two days. after 36hrs, the hCG levels of a normal IUP should be about 2500-2700ml. at 4500ml, the hCG has already tripled in 36hrs. molar pregnancy will cause a rapid increased similar to the increase seen with multiple pregnancies

Question 18

the most common location of an ectopic pregnancy is

a. ampulla
b. interstitial
c. isthmus
d. cervical

Answer 18

a

the most common location for ectopic pregnancy is in the ampullary portion of the fallopian tube

Question 19

which of the following describes the sonographic appearance of a normal nasal bone in a 1st trimester fetus

a. single linear reflection that is parallel to the maxilla
b. two parallel line, resembles and equal sign (=)
c. an echogenic foci at the tip of the nose
d. three parallel lines that are perpendicular to the frontal bone

Answer 19

b
the normal nasal bone in a fetus is identified as a hyperechoic line that is posterior to the echogenic skin line. the nasal bone should be greater echogenicity to the skin reflection. the two echogenic lines are parallel and said to resemble and = sign

Question 20

the mean sac diameter in a normal IUP will demonstrate ______ increase in size per day up until the 10th week of gestation

a. 1mm
b. 2mm
c. 3mm
d. 4mm

Answer 20

a

the mean sac diameter in a normal IUP will demonstrate 1mm increase in size per day until the 10th week gestation

Question 21

which of the following demonstrates the lowest risk of embryonic demise

a. implantation in the lower uterine segment
b. TV ultrasound identifies a gestational sac with MSD 12mm and 5mm yolk sac but no embryo
c. thin, mildly echogenic trophoblastic reaction
d. multiple lobulations of the gestational sac

Answer 21

b
indications for embryonic demise include distorted sac shape, thin and weakly echogenic trophoblastic reaction, low implantation site. on transvaginal ultrasound, an embryo should be identified with a 16mm or greater MSD. a yolk sac less than 5.6mm in diameter is normal. the yolk sac should be identified with a 8mm or greater MSD

Question 22

the chorionic villi and membrane are formed from the

a. blastocyst
b. yolk sac
c. amnion
d. trophoblastic cells

Answer 22

d
trophoblastic cells - produce progesterone and hCG. involved with implantation, develop into chorionic villi then into placenta

Question 23

which of the following is most suggestive of an inevitable abortion

a. spotting for 2 days
b. cervical dilation over 3cm
c. cervical length over 3cm
d. presence of vernix in the amniotic fluid

Answer 23

b
inevitable abortion:
bleeding more than one week
cramping
PROM
cervical shortening <3cm
dilatation >2cm

Question 24

conception occurs approximately

a. 2 hours after ovulation
b. 7 days after ovulation
c. 4 weeks after the last menstruation
d. 2 weeks after the menstruation

Answer 24

d
conception occurs approximately 2 weeks after the last menstuation. an embryo that is described as 8 weeks from conception is the same as 10 weeks in gestational age reported on the ultrasound for that pregnancy. conceptual age: the exact date of conception +2 weeks = gestation age

Question 25

diabetes mellitus is associated with a. increased risk of embryonic demise and miscarriage in the first trimester b. early lung maturation c. fetal weight exceeding 4000 grams d. NT defects without other associated defects

Answer 25

a diabetes mellitus is associated with higher incidence of congenital anomalies than gestational diabetes, increased risk of embryonic demise and miscarriage in the first trimester, caudal regression, neural tube defects, anencephaly, microcephaly, duodenal and anal atresia, hydronephrosis, renal agenesis, VSD, ASD, coarctation, transposition, polydactyly, and club feet, single umbilical artery, IUGR and thinned placenta

Question 26

the chorionicity and amnionicity of a twin pregnancy is determined by a. timing of the cell division in the embryo b. number of choromosomes c. paternal genes d. timing of the cell division in the zygote

Answer 26

d the timing of the cell division determines the "type" of twins. monochorionic vs. dichorionic and monoamniotic vs diamniotic (or conjoined twins)

Question 27

an asymptomatic patient presents for a viability scan. using the transvaginal approach a 15mm fetal pole is identified without cardiac activity. the yolk sac is present within the gestation sac. which of the following best describes these findings. a. embryonic demise b. normal pregnancy too early to see cardiac activity at this size c. missed abortion d. blighted ovum

Answer 27

a a 15mm fetal pole indicates a 8 week 1 day old fetus. a blighted ovum would not have a fetal pole. a missed abortion refers to fetal death without evacuation for several months. the patients is asymptomatic with no bleeding. embryonic demise refers to death of the embryo

Question 28

which of the following types of twin gestation will have the highest risk for conjoined twins a. monochorionic/ monoamniotic b. monochorionic/ diamniotic c. dichorionic/ diamniotic d. dizygotic

Answer 28

a a diamninotic twin gestation will produce two separate amniotic sacs. a membrane will be identified that separates the fetus. a monoamniotic twin gestation will have no membrane to separate the fetuses. the absence of this membrane leads to increased risk for cord entanglement nuchal cord and conjoined twins

Question 29

which o the following types of twin gestation will have the thickest membrane between the fetuses a. monochorionic/ diamniotic b. monochorionic/ monoamniotic c. conjoined twins d. dichorionic/ diamniotic

Answer 29

d a dichrionic diamniotic twin gestation will produce two separate placentas and two amniotic sacs. a membrane will be identified that separates the fetuses . the membrane will be greater than 2nn in thickness

Question 30

which of the following carries the lowest risk of spontaneous abortion a. significant leakage of amniotic fluid b. vaginal spotting for the last 10 days c. gestational sac implanted in the endometrial cavity near the uterine cornua d. cervical os dilated to 4cm

Answer 30

c if the gestational sac implants in the lower uterine segment the risk of spontaneous abortion in increased significantly. other causes for increased risk of spontaneous abortion include cervical dilation >3cm. PROM extended period of bleeding (1wk+)

Question 31

the embryo of a normal pregnancy will increase in size approximately a. 1mm every 2 days b. 1mm every week c. 1mm every day d. 10mm every week

Answer 31

c | the embryo of a normal pregnancy will increase in size approximately 1mm per day

Question 32

which of the following is/are a sign of spina bifida in a 13 week fetus a. obliterated cisterna magna and intracranial translucency b. lemon sign c. narrow brainstem and dilated cisterna magna d. banana sign

Answer 32

a in early pregnancy the signs of spina bifida include compression of the choroid intracranial translucency and cisterna magna with an enlarged brainstem. these changes occur due to the posterior shift of the cranial contents. the typical banana and lemon sign are not well demonstrated in the first trimester because the cerebellum is not fully formed and the cranium is not fully ossified but vertebral evaluation is limited at this age

Question 33

the gestational sac with ______are the first signs of an intrauterine pregnancy see with ultrasound a. a corpus luteal cyst b. decidual reaction of the endometrium c. fluid in the endometrial canal d. fluid in the posterior cul-de-sac

Answer 33

b the first sign of an IUP seen on the ultrasound is the gestational sac with decidual reaction in in implantation. double decidual sac sign or intradecidual sign due to implantation seen at 5.5-6 weeks. if a patient with suspected pregnancy demonstrates a fluid filled structure in the endometrial canal but no decidual reaction the patient should be thoroughly evaluated for ectopic pregnancy

Question 34

which biometric measurement is not used to estimated fetal age in a detailed evaluation of a 3 week fetus a. biparietal diameter b. femur length c. abdomen circumference d. head circumference

Answer 34

b the femur length is not used in the late 1st trimester evaluation for fetal dating, but may be helpful for detection of abnormalities until after 14 weeks gestation

Question 35

an asymptomatic patient presents for a viability scan in the first trimester. the ultrasound exam demonstrates a fetal pole that measures at 7 weeks 2 days. a 7mm yolk sac is identified. the fetal HR is evaluated by m-mode and is estimated at 76bpm. there is no evidence of subchorionic hemorrhage. which of the following statements is true. a. blighted ovum is present b. the yolk sac is abnormally enlarged but the fetal heart rate is normal c. the fetal heart rate indicates potential demise but the yolk sac is normal d. the yolk sac is abnormally enlarged and the fetal heart rate is lower than normal

Answer 35

d there is not a fetal pole present in a blighted ovum. the normal yolk sac measures less than 5.6mm in the internal diameter. a fetus 6-9wks should have a heart rate over 100bpm. after 9wks the heart rate should stay above 140bpm. the average heart rate in the second trimester is 120-160bpm

Question 36

a patient presents for a pelvic ultrasound due to pain and bloating. her LMP was 5 weeks ago and bhCG levels are at 10unit/ml. a mild amount of anechoic fluid is noted in the posterior cul-de-sac. all of the following are a potential cause for the fluid accumulation except a. ovulation b. endometriosis c. ruptured appendix d. ectopic

Answer 36

d the bhCG levels indicate there is no pregnancy present. an ectopic pregnancy would cause bhCG levels of 1000units/ml plus in a 5 week gestation

Question 37

all of the following are layers of the endometrium that form with pregnancy except a. decidua accreta b. decidua basalis c. decidua parietalis d. decidua capsularis

Answer 37

a decidua capsularis - tissue that envelops he blastocyst after implantation decidua basalis - becomes maternal placenta blastocyst attaches to this layer decidua parietalis - other tissue not involved in the implantation process

Question 38

the ______ forms the outer layer of the placenta that is in contact with the endometrium a. yolk sac b. amnion c. blastocyst d. chorion

Answer 38

d | the chorion forms the outer layer of the placenta that is in contact with the endometrium

Question 39

implantation of the fertilized egg occurs day ______ of the pregnancy a. 20-23 b. 15-18 c. 18-20 d. 30-33

Answer 39

a | implantation of the fertilized egg occurs day 20-23 of the pregnancy

Question 40

what abnormality occurs when two sperm fertilize the same egg? a. trisomy 21 b. autosomal dominant x-linked disorder c. trisomy 18 d. tripoidy

Answer 40

d | an egg that is fertilized two sperm will have an extra full set of chromosomes = tripoidy

Question 41

what cardiac view is used to document proper fetal heart position on a first trimester exam a. 4 chamber view b. aortic arch view c. left ventricle outflow tract view d. 3 vessel trachea view

Answer 41

a color doppler can be used to demonstrate the fetal heart structure when screening for suspected defects. the 4 heart chamber view and 3 vessel trachea view can be documented later in the first trimester. the 4 chamber view is used to document chamber size heart position cardiac axis, the cardiac axis can more easily displayed using the 4 chamber view and color doppler

Question 42

``` regarding twin pregnancy if division of the zygote is not complete by day 13 of the gestation it will result in: a. conjoined twins b. monochorionic monoamniotic twins c. dichorionic diamniotic twins monochorionic diamniotic twins ```

Answer 42

a regarding twin pregnancy if division of the zygote occurs before day 4 of the gestation this will result in dichorionic/diamniotic twins. if the division of the zygote occurs between day 4 and 8 of the gestation this will result in monochorionic/diamniotic twins. if division of the zygote occurs between day 8 and 13 of the gestation this will result in monochorionic/monoamniotic twins. if the zygote is not complete by day 13 of the gestation this will result in conjoined twins

Question 43

preeclampsia in the first trimester of pregnancy is most commonly associated with a. embryonic demise b. IUGR c. molar pregnancy d. oligihydramnios

Answer 43

c preeclampsia in the first trimester of pregnancy is most commonly associated with molar pregnancy. if a normal IUP is present when preeclampsia manifests in the 2nd or 3rd trimester IUGR, oligohydramnios, aged placenta and fetal demise may occor

Question 44

in an early intrauterine pregnancy the amniotic sac and yolk sac are collectively called: a. the double sac sign b. the double bubble sign c. the double bleb sign d. the murphys sign

Answer 44

c at about the 5th week of pregnancy the amniotic sac and the yolk sac can be visualized adjacent to each other within the uterine cavity. the fetal pole is in between the two sacs. this refers to the double bleb sign and is a confirmation of an intrauterine pregnancy

Question 45

the earliest gestational age the gestation sac can be seen transvaginally is? a. 3 weeks b. 4 weeks c. 5 weeks d. 6 weeks

Answer 45

``` b transvaginally approch: gestation sac @ 4 wks yolk sac @ 5.5 weeks heart @ 6wks ```

Question 46

when evaluating the ductus venosus with spectral doppler a. high filter settings and slow sweep speed are preferred b. a 2-3mm sample is used c. color doppler is used to demonstrate the umbilical vein, ductus venosus and heart in the same image d. a left parasagittal view of the fetal trunk is obtained

Answer 46

c to evaluate the DV, obtain a right parasagittal view of the fetal trunk and apply color doppler to demonstrate the umbilical vein, ductus venosus and heart. a 1mm or less sample volume is used to avoid sampling adjacent vessels. a cursor angle of less than 30 degrees should be used for the sample. low filter settings and fast sweep speed will best display the A wave. a normal ductus venosus waveform is biphasic with a positive A-wave. an abnormal ductus venosus waveform demonstrates a negative or reversed A-wave.

Question 47

a patients presents for a fetal viability scan with an LMP 10 weeks ago. she has been experiencing light vaginal spotting for the last week. the transvaginal exam demonstrates a 2cm crescent shaped hypoechoic area between the chorion and right uterine wall. these findings are most suggestive of: a. normal first trimester pregnancy b. placental abruption c. partial molar pregnancy d. subchorionic hemorrhage

Answer 47

d a subchorionic hemorrhage causes vaginal spotting in the first trimester. bleeding occurs between the uterine wall and the chorion. the fluid accumulations are typically shaped. most resolve spontaneously, but can lead to spontaneous abortion

Question 48

one yolk sac with two embryos indicates: a. monoamniotic twins b. impending fetal demise c. dichorionic twins d. diamniotic twins

Answer 48

a | one yolk sac with two embryos indicates monoamniotic twins

Question 49

a patient with a history of an 8 week pregnancy presents for an ultrasound due to pelvic pain and moderate bleeding for the last 4 days. what is the most likely finding on todays exam? a. spontaneous abortion b. missed abortion c. subchorionic hemorrhage d. blighted ovum

Answer 49

a a spontaneous abortion refers to the uterus emptying itself of all products of conception. there is an increased risk of spontaneous abortion with cervical dilation >3cm, PROM, and extended include pelvic pain, cramping, moderate to heavy bleeding

Question 50

when evaluating the fetal heart in a 13 week 3 day fetus, the 4 chamber view with and without color and the 3 vessel trachea view with color are the part of the standard AIUM protocol. what other image must be recorded to demonstrate proper cardiac position and axis? a. fetal stomach b. sagittal midline thorax c. aortic arch d. left ventricular out flow tract

Answer 50

a the AIUM recommends 4 images to document the fetal heart in a late 1st trimester fetus. the 4 chamber view with and without color, the vessel trachea view with color and the fetal stomach. cardiac position and axis are compared to the position of the stomach. the apex of the heart should point toward the stomach and both structures should located on the left side of the fetus

Question 51

a 25yr old patient presents for a first trimester scan with uterine size consistent with a 12wk fetus but the LMP indicates a 7 week pregnancy. you identify a mass of mottled tissue with cystic components and internal blood flow that occupies the fundus of the uterine cavity. there is also a gestational sac with a 4mm embryo identified in the inferior portion of the endometrial canal. which of the following best describes these findings? a. adenomyosis with an impending abortion b. fundal uterine contraction with an impending abortion c. lower uterine segment ectopic d. partial molar pregnancy

Answer 51

d a partial molar pregnancy will demonstrate a molar pregnancy that coexists with an IUP. the IUP can be normal or abnormal. if it is abnormal, triploidy is a common finding. larger that dates is a common symptom or molar pregnancy due to the excessive overgrowth of the trophoblastic tissues

Question 52

which of the following is an expected finding with ectopic pregnancy a. intrauterine gestational sac surrounded by a double layer of echogenic trophoblastic tissue b. intrauterine gestational sac surrounded by a single layer of echogenic trophoblastic tissue c. complex intrauterine mass with increased peripheral vascularity d. abnormally elevated hCG levels

Answer 52

b the double sac sign or double decidual sign refers to two rings of decidual tissue surrounding the gestational sac. the characteristic is seen in an early IUP at about 5.5 weeks. an ectopic pregnancy would not cause the double decidual sac sign. a gestational sac with a single layer of endometrium surrounding it can be a sign of an ectopic pregnancy. a complex adnexal mass with increased peripheral vascularity is highly suggestive of an ectopic precnancy

Question 53

which of the following describes the function of the chorionic villi? a. to provide nourishment to the fetal blood b. to maintain intraplacental pressure c. to produce red blood cells d. to produce white blood cells

Answer 53

a maternal blood enters the intervillous spaces to deliver nutrients and oxygen to the fetus through the chorionic villi of the placenta. waste products are excreted into the blood before it exits the spaces to return to the maternal circulatory system

Question 54

what type of holoprosencephaly can be identified in a 13 weeks fetus? a. alobar b. septo-optic dysplasia c. semilobar d. lobar

Answer 54

a alobar holoprosencephaly in a first trimester fetus is defined as a single ventricle, fused thalami, with an absent corpus collosum. it is the most sever form and the only type that can be detected in later 1st trimester. the other forms are best evaluated in the 2nd trimester

Question 55

the yolk sac can first be visualized with transvaginal sonography at what gestational age? a. 6.5 weeks b. 6 weeks c. 6.2 weeks d. 5.5 weeks

Answer 55

``` d transvaginal approach: gestational sac @ 4 wks yolk sac @ 5.5 wks heart @ 6 wks ```

Question 56

all of the following are signs of embryonic demise except: a. double bleb sign b. distorted gestational sac c. calcified yolk sac d. 7mm yolk sac

Answer 56

a the double bleb sign is a sign of an early intrauterine pregnancy. an enlarged or calcifies yolk sac is a sign of embryonic demise. a distorted or irregular gestational sac is also indicative of demise

Question 57

to obtain a PW doppler evaluation of the tricuspid valve a. a view of the right ventricular outflow tract must be obtained b. place the cursor line parallel to the interventricular septum c. place the cursor line perpendicular to the interventricular septum d. at least 5 samples must be recorded

Answer 57

b a 4 chamber heart view is obtained. imaging the 4 chamber view with the interventricular septum perpendicular to the transducer face will improve the cursor position. a 2-3mm sample volume is placed parallel to the interventricular septum. the regurgitation should also typically be parallel to the septum. and an optimal sample should be obtained. flow reversal is seen in systole and the velocity is typically over 60cm/s. tricuspid regurgitation identified in a 1st trimester fetus is suggestive of aneuploidy (trisomy 13, 18, 21)

Question 58

which of the following statements is correct regarding multifetal pregnancy? a. fetus A is always the fetus closest to the uterine fundus b. multifetal pregnancies have reduced the risk of complications compared to a singleton pregnancy c. easiest to dertermine amnionicity/chorionicity in the first trimester, around 8 weeks gestation d. fetus B is always the fetus closest to the internal os

Answer 58

c when scanning multiple gestations it is easiest to determine amnionicity/chorionicity in the first trimester, around 8 weeks gestation. it is also important to document fetal number, placental location and number and look for a separating membrane. Fetus A is always the fetus closest to the internal os. if more than 2 fetuses present, document the other fetal locations relative to fetus A and location in uterus

Question 59

a 25yr old patient presents for a first trimester scan with uterine size consistent with a 12wk fetus but the LMP indicates a 7 week pregnancy. you identify a mass of mottled tissue with cystic components and internal blood flow that occupies the fundus of the uterine cavity. there is also a gestational sac with a 4mm embryo identified in the inferior portion of the endometrial canal. which of the following best describes these findings? a. adenomyosis with an impending abortion b. fundal uterine contraction with an impending abortion c. lower uterine segment ectopic d. partial molar pregnancy

Answer 59

d a partial molar pregnancy will demonstrate a molar pregnancy that coexists with an IUP. the IUP can be normal or abnormal. if it is abnormal, triploidy is a common finding. larger that dates is a common symptom or molar pregnancy due to the excessive overgrowth of the trophoblastic tissues

Question 60

a patient presents with an LMP of 7 weeks 4 days. the script states the fundal height is large for gestation age and acute onset of systemic HNT. these clinical findings are most suggestive of: a. molar pregnancy b. ectopic pregnancy c. heterotopic pregnancy d. multiple pregnancy

Answer 60

a | acute of maternal HNT in the first trimester is a strong indicator of a molar pregnancy

Question 61

with transabdominal ultrasound, a blighted ovum is diagnosed with a mean gestational sac diameter greater the ______ without a fetal pole present a. 25mm b. 20mm c. 35mm d. 15mm

Answer 61

a a blighted ovum is diagnosed with a mean gestation sac diameter greater than 25mm without a fetal pole present on a transabdominal ultrasound. a mean gestational sac diameter greater then 16mm without a fetal pole present on a transvaginal ultrasound also indicates anembryonic gestation. an enlarged yolk sac is associated finding

Question 62

the AIUM defines a late 1st trimester ultrasound evaluation as an exam performed on a fetus that is between: a. 10 and 12 weeks 6 days of age b. 12 and 13 weeks 5 days of age c. 11 and 13 weeks of age d. 9 and 11 weeks

Answer 62

b the AIUM defines a late 1st trimester ultrasound evaluation as an exam performed on a fetus that is between 12 weeks and 13 weeks 6 days

Question 63

what is the term for the level of bhCG in the blood that corresponds with the first sonographic visualization of the gestation sac? a. transitional zone b. proliferative zone c. quantitative zone d. discriminatory zone

Answer 63

d discriminatory zone refers to the minimum level of bhCG in the blood the corresponds with the first sonographic visualization of the gestational sac

Question 64

which of the following is a sign of impending fetal demise? a. robert sign b. spalding sign c. irregular gestational sac shape d. deuel sign

Answer 64

c expected poor outcomes include: irregular sac shape, low sac position, thin trophoblastic reaction, weakly echogenic trophoblastic reaction, heart rate <100bpm, abnormal yolk sac size and shape, and calcified yolk sac. the other three choices are sonographic signs of demise that are seen several days after demise occurs

Question 65

the embryo and yolk sac can be seen with TV ultrasound as early as a. 6.5 weeks b. 4 weeks c. 5.5 weeks d. 4.5 weeks

Question 66

the embryo and yolk sac can be seen with TV ultrasound as early as a. 6.5 weeks b. 4 weeks c. 5.5 weeks d. 4.5 weeks

Answer 66

c | the embryo and yolk sac can be seen with TV ultrasound as early as 5.5 weeks

Question 67

which of the following is the recommended method to document fetal number is an early pregnancy a. count the number of amniotic sacs, with or without an embryo b. count the number of visible embryos c. count the number of areas with early placenta formation d. count the number of yolk sacs present in the gestational sac(s)

Answer 67

b when documenting fetal number only count embryos. incomplete fusion of the amnion and chorion or elevation of the chorionic membrane by intrauterine hemorrhage can mimic the appearance of a second sac

Question 68

a patient who has a history of taking fertility medication presents for a fetal viability scan. the fetus is approximately 6 weeks old by LMP. serum levels were performed by her doctor 5 days ago and bhCG levels were 4000 units/ml. today the level of bhCG is 4300 units/ml. what is the most likely finding on the transvaginal US exam? a. molar pregnancy b. blighted ovum c. heterotopic pregnancy d. ectopic pregnancy

Answer 68

b the bhCG levels normally double every 48hrs so in 3 days the patients serum levels should be approximately 10000 bhCG with a normal IUP. an ectopic pregnancy will cause a slower rise in bhCG levels but only a 200 unit change over 5 days is much too small of a change for a live ectopic. the embryonic demise most likely occurred not long after the first serum level was assessed. if another serum level is performed in 24hrs, the bhCH levels should decrease significantly. molar pregnancy leads to increased bhCG levels

Question 69

on transvaginal sonography, cardiac activity must be identified in an embryo with a CRL of ______ or greater to be considered a viable IUP a. 7mm b. 10mm c. 4mm d. 2mm

Answer 69

a on TV sonography, cardiac activity should first be identified in an embryo with a CRL of 5mm at 6 weeks gestation. cardiac activity must be seen in embryos with a 7mm and greater CRL or demise is suspected. if the embryo is smaller that 7nn and no cardiac activity is identified, a short follow up exam should be considered to document fetal viability

Question 70

a normal ductus venosus waveform in the first trimester fetus demonstrates: a. a continuous antegrade flow pattern with limited pulsatility b.

Question 70

a normal ductus venosus waveform in the first trimester fetus demonstrates: a. a continuous antegrade flow pattern with limited pulsatility b. a biphasic pattern with retrograde A-wave c. a triphasic flow pattern with 2 phases moving in the retrograde direction d. a biphasic pattern with antegrade A-wave

Answer 70

d in the first trimester a normal ductus venosus waveform is biphasic with a positive A-wave. an abnormal ductus venosus waveform demonstrates a negative or reversed A-wave, which suggests aneploidy may be present

Question 71

the first trimester of pregnancy is defined as: a. weeks 6 through 14 gestational age b. weeks 4 through 13 gestational age c. weeks 1 through 13 gestational age d. weeks 6 through 12 gestational age

Answer 71

c pregnancy consists of 3 trimesters 1st - week 1 through week 13 gestational age 2nd - week 14 through week 28 gestational age 3rd - week 29 until delivery

Question 72

fetal cardiac activity can first be visualized with transvaginal sonography at approximately what gestational age? a. 5 weeks b. 6 weeks c. 6.5 weeks d. 7 weeks

Answer 72

``` b transvaginal approach: gestational sac @ 4wks yolk sac @ 5.5wks heart @ 6wks ```

Question 73

during fetal development which of the following describes the fetal component of the placenta? a. amniotic membrane b. decidua basalis c. decidua capsularis d. chorion frondosum

Answer 73

d the chorion frondosum refers to the fetal position of the placenta located within the gestational sac. the decidua basalis refers to the placenta tissue attached to the uterine wall

Question 74

when the cephalic end of the neural tube fails to close, ______ occurs. when the distal end of the neural tube fails to close, ______ occurs a. trisomy 21, trisomy 18 b. hydranencephaly, hydrocephalus c. anencephaly, spinal bifida d. alobar holoprosencephaly, lobar holoprosencephaly

Answer 74

c when the cephalic end of the neural tube fails to close anencephaly occurs. when the distal end of the neural tube fails to close spina bifida occurs

Question 75

the yolk sac is considered normal size when the inner diameter is less than ______ a. 3mm b. 5mm c. 6mm d. 8mm

Answer 75

c | a yolk sac >6mm usually indicates a blighted ovum or fetal abnormalities if a fetal pole is detected

Question 76

An IRP bhCG level of ______ units/ml should definitely corresponding with visualization of an IUP by transvaginal ultrasound a. 1500 b. 500 c. 1000 d. 2000

Answer 76

d IRP levels for transvaginal ultrasound = 1000 - 2000 units/ml is the range of bhCG level for identifying an intrauterine pregnancy (IUP) an IUP can be identified at a minimum level of 1000 units/ml; if the level exceeds 2000 units/ml but MUST be identified if the level exceeds 2000 units/ml; if the level exceeds 2000 units/ml and no IUP is identified, an ectopic pregnancy should be suspected; if the level is between 1000 and 2000 units/ml and no IUP is identified a follow up exam will most likely be ordered once the level exceeds 2000 units/ml

Question 77

the embryo is most sensitive to teratogenic effects between ______ gestation a. 6 and 10 weeks b. 1 and 4 weeks c. 3 and 8 weeks d. 4 and 7 weeks

Answer 77

c | the embryo is most sensitive to teratogenic effects between 3 and 8 weeks

Question 78

which of the following is a characteristic of an incomplete abortion a. 1-2mm endometrial stripe b. slower than expected decrease in hCG levels c. slower than expected increase in hCG d. amenorrhea

Answer 78

b incomplete abortion occurs when only a portion of the products of conception expelled from the uterus. sonographic findings include thick irregular endometrium with fluid in canal. symptoms include cramping bleeding decreasing hCG but slower than expected if a complete abortion has occurred

Question 79

using transvaginal ultrasound the minimum mean sac diameter that should always demonstrate an embryo is a. 25mm b. 16mm c. 20mm d. 8mm

Answer 79

b > 16mm mean sac diameter should always demonstrate a fetal pole (TV) >25mm mean sac diameter should always demonstrate a fetal pole (TA)

Question 80

megacystitis in a first trimester is diagnosed when the bladder length us greater than or equal to a. 7mm b. 10mm c. 3mm d. 5mm

Answer 80

a megacystitis in a first trimester is diagnosed when the bladder length is greater that or equal to 7mm. it can be associated with aneuploidy

Question 81

a 26 yr old patient presents with a positive pregnancy test and an approximate age of 7 weeks 3 days from her LMP. beta hCG levels are significantly higher than a 7 week gestation. the exam shows a large heterogeneous solid mass measuring 6x4x3cm cm within the endometrial cavity. the uterus measures 10x6x5cm. what is the most likely explanation for the sonographic findings described? a. heterotopic pregnancy b. lieomyosarcoma c. hydatidiform mole d. chorioadenoma destruens

Answer 81

c a hydatidiform molar pregnancy is an abnormality of the placenta and rarely involves the formation of a fetus. it is marked by high levels of human chorionic gonadotropin (hCG). molar pregnancies grow much more rapidly compared to normal fetal growth. it has the appearance of a large and random collection of grape-like cell clusters. in some cases it can be malignant and requires chemotherapy or radiation treatment after surgical removal

Question 82

during fetal development which of the following describes the maternal component of the placenta a. amniotic membrane b. decidua basalis c. decidua capsularis d. chorion frondosum

Answer 82

b the chorion frondosum refers to the fetal portion of the placenta located within the gestational sac. the decidua basalis refers to the placental tissue attached to the uterine wall

Question 83

which of the following is associated with an inevitable abortion but is not present with a threatened abortion a. bleeding b. cramping c. low implantation d. dilated cervix

Answer 83

d threatened abortion - cramping, bleed, closed cervix inevitable abortion - bleeding more than a week cramping cervical dilation low implantation site can be associated with both types of abortions

Question 84

the discriminatory bhCG level refers to a. bhCG levels in blood that corresponds with the first possible sonographic visualization of the gestational sac b. bhCG levels in blood that MUST correspond with the sonographic visualization of the gestational sac c. bhCG levels associated with molar pregnancy d. bhCG levels associated with ectopic pregnancy

Answer 84

the discriminatory bhCG level refers to bhCG levels in the blood that MUST correspond with the sonographic visualization of the gestational sac. (5w 2d) the threshold levels refers to bhCG levels in blood that correspond with the first possible sonographic visualization of the gestational sac (4w 3d)

Question 85

the "twin peak" sign is associated with what type of pregnancy a. diamniotic/dichorionic b. monoamniotic/monochorionic c. diamniotic/monochorionic d. all monozygotic

Answer 85

a the twin peak sign refers t a triangular projection of placental tissue extending from the placental surface at the point where the two gestational sacs touch

Question 86

the most commonly identified predictor of poor outcome in a first trimester ultrasound is a. abnormally large yolk sac b. bradycardia c. subchorionic hemorrhage d. pseudosac in the endometrial canal

Answer 86

a an abnormally enlarged yolk sac (. 5.6 diameter) is the most commonly identified predictor of poor outcome in 1st trimester pregnancy ultrasound

Question 87

the double sac sign seen in early pregnancy refers to: a. the presence of monozygotic twins b. the presence of dizygotic twins c. amniotic sac and yolk sac are both visible with transvaginal sonography d. fluid filled gestational sac and fluid filled uterine cavity are both visible with transvaginal sonography

Answer 87

d the double sac sign seen in early pregnancy (about 5.5 weeks) refers to fluid filled gestational sac and fluid filled uterine cavity are both visible with transvaginal sonography. the double bleb sign refers to when the amniotic sac and yolk sac are both visible at about 5.5 weeks with transvaginal sonography

Question 88

what sonographic "sign" refers to the overlapping of the cranial sutures with fetal demise a. turner sign b. edward sign c. spalding sign d. gartner sign

Answer 88

c the spalding sign refers to the overlapping of the cranial sutures with fetal demise. the deuel sign refers to scalp edema associated with fetal demise. the robert sign refers to air in the abdominal vasculature that causes echogenic foci on ultrasound exam with fetal demise. these signs usually identified 1 week or more after the demise occurred

Question 89

what is he most common cause of demise in the first trimester a. uterine trauma b. chromosomal abnormalities c. maternal smoking d. prior history of abortion

Answer 89

b | the most common cause of demise in the first trimester is due to chromosomal abnormalities

Question 90

what are the two most common neural tube defects a. anencephaly and spina bifida b. holoprosencephaly and anencephaly c. cystic hygroma and spina bifida d. spina bifida and holoprosencephaly

Answer 90

a | anencephaly and spina bifida are the most common neural tube defects

Question 91

when is PW doppler appropriate to evaluate the first trimester fetus a. when fetal anemia is suspected b. PW doppler should never be used to evaluate a first trimester fetus c. when aneuploidy is suspected d. when IUGR is suspected

Answer 91

c PW doppler should not be used on the standard first trimester exam. if aneuploidy skeletal dysplasia or congenital heart disease is suspected then it is appropriate to evaluate the ductus venosus and the tricuspid valve. care must be taken to keep the thermal index at or below 0.7. IUGR and anemia are not typically diagnosed until the 2nd trimester or later

Question 92

in the 1st trimester the 4th ventricle is also called a. nuchal translucency b. cisterna magna c. intercranial translucency d. diencephalon

Answer 92

c the 4th ventricle is also called the intracranial translucency. compressed or absent 4th ventricle (IT) has been associated with spina bifida. enlargement of the 4th ventricle (IT) can be associated with the dandy walker syndrome

Question 93

if fertilization occurs ______ will stop the regression of corpus luteal cyst so that it can produce progesterone to stimulate the decidual reaction a. estrogen b. follicle stimulating hormone c. bhCG d. luteinizing hormone

Answer 93

c if fertilization occurs, bhCG will cause the corpus luteal cyst to not regress and produce progesterone to stimulate the decidual reaction

Question 94

which of the following correctly describes the nuchal translucency measurement a. multiple measurements should be obtained and the sum of all measurements is reported b. multiple measurements should be obtained and the largest one that follows the measurement criteria correctly is reported c. multiple measurements should be obtained and the average of all measurements is reported d. multiple measurements should be obtained and the smallest and that follows the measurements criteria correctly is reported

Answer 94

b multiple NT measurements should be obtained and the largest one that follows the measurement criteria correctly is reported

Question 95

a compressed or absent intracranial translucency in a 13 week fetus is an indicator for a. holoprosecephaly b. hydrocephalus c. spina bifida d. dandy walker malformation

Answer 95

c the 4th ventricle is also called the intracranial translucency. compressed or absent 4th ventricle (IT) has been associated with spina bifida. enlargement of the 4th ventricle (IT) can be associated with the dandy walker malformation

Question 96

what is the minimum international reference preparation value for bhCG that indicates a gestational sac should definitely be visualized by transvaginal ultrasound a. 1000 units/ml b. 500 units/ml c. 2000 units/ml b. 1500 units/ml

Answer 96

IRP levels for transvaginal ultrasound = 1000-2000 units/ml is the range of bhCG level for identifying an intrauterine pregnancy (IUP) and IUP can be identified at a minimum level of 1000 units/ml but MUST be identified if the level exceeds 2000 units/ml. if the level exceeds 2000 units/ml and no IUP is identified an ectopic pregnancy should be suspected. if the level is between 1000-2000 units/ml and no IUP is identified a follow up exam will most likely be ordered once the level exceeds 2000 units/ml

Question 97

which of the following is responsible for the symptoms of early pregnancy such as nausea and vomiting a. bhCG b. progesterone c. estrogen d. AFP

Answer 97

b progesterone: responsible for premenstrual symptoms and symptoms of pregnancy (nausea and vomiting); responsible for endometrial proliferation AFTER ovulation to prepare for implantation; blocks the development of new follicles; stimulates uterine blood supply for pregnancy; causes breast to prepare for lactation but inhibits lactation; causes formation of cervical mucus plug in pregnancy

Question 98

which of the following signs indicates an abnormal early pregnancy a. hegar sign b. murphy sign c. cullen sign d. chadwick sign

Answer 98

c the cullen sign indicates the presence of bluish discoloration around the maternal umbilicus. the discoloration is associated with an intraperitoneal hemorrhage. a ruptured ectopic could cause the bleed. pain bleeding and a positive pregnancy test accompanied by the cullen sign is highly suspicious for a ruptured ectopic. hegar sign refers to the softening of the lower uterine segment with pregnancy. the ob physician will palpate the uterus during the pelvic exam. chadwick sign refers to the bluish discoloration of the vaginal walls due to engorgement of the veins. this is a normal finding in early pregnancy. the OB physician will visualize this sign on the pelvic exam

Question 99

crown rump length (CRL) measures 7mm. what is the estimated gestational age of pregnancy a. 7 weeks b. 10 weeks c. 8 weeks d. 5 weeks

Answer 99

``` gestational age (days) - CRL + 42 GA = 7mm + 42 = 49 days 49 days = 7 weeks ```

Question 100

using transvaginal sonography, the yolk sac can be identified as early as week _____ of the pregnancy a. 3 b. 4 c. 5 d. 6

Answer 100

using transvaginal sonography the yolk sac can be identified as early as week 5 of the pregnancy. using transabdominal sonography, the yolk sac can be identified as early as week 7 of the pregnancy

Question 101

which of the following adnexal masses is a sign of a normal intrauterine pregnancy a. theca lutein cyst b. corpus luteum cyst c. chocolate cyst d. dermoid cyst

Answer 101

b the corpus luteal cyst produces progesterone in early pregnancy. it normally regresses by the 14th week of pregnancy because the placenta takes over progesterone production. a theca lutein cyst is usually related to a molar pregnancy or multiple pregnancy due to high hCG levels. a dermoid cyst and endometrioma are abnormalities of the ovary

Question 102

which if the following early embryologic structures produce progesterone a. trophoblastic cells b. blasrocyst c. zygote d. morula

Answer 102

a trophoblastic cells produce progesterone and bhCG in very early pregnancy. these cells develop into chorionic villi of the placenta

Question 103

while scanning an asymptomatic patient with a 10wk gestation you identify a complex cyst in the right ovary. this finding is most suggestive of a. dermoid cyst b. corpus luteal cyst c. theca luteal cyst d. dominant follicle

Answer 103

b the corpus luteal cyst produces progesterone in early pregnancy. it normally regresses by the 14th week of pregnancy because the placenta takes over progesterone production