20-24 Flashcards
A syndrome characterized by endometrial adhesions that typically occur as a result of scar formation after some types of uterine surgery
Asherman Syndrome
Cessation of menstruation with advanced age
Menopause/ climacteric
During menopause, follicles cease to mature, resulting in a considerable reduction in the amounts of :
estrogen, progesterone
The ovaries become more ______ during post-menopause and lack follicles.
echogenic
The decrease in estrogen by the ovaries has other physiologic consequences:
decrease in uterine size, mucosal layer begins to become atrophic, the vagina becomes smaller, breasts tend to accumulate more adipose or fat tissue
Patients undergoing menopause may also suffer from:
night sweats, mood changes, depression, dyspareunia, dysuria, and a decrease in libido.
Lack of circulating estrogen during and after menopause, there is a notable increase in risk for:
coronary heart disease and an increase threat for developing osteopenia and osteoporosis
_________ is often used to combat the reduction of estrogen circulating in the female body after menopause and to prevent post-menopausal symptoms
HRT - hormone replacement therapy
___________ has been shown to significantly reduce the risk of developing osteoporosis and coronary heart disease, with a possible reduction in the risk of developing colon cancer and Alzheimer’s disease
ERT estrogen replacement therapy
Unopposed ERT is not combined with :
progesterone therapy
Unopposed ERT has been shown to increase the risk of developing :
endometrial hyperplasia and endometrial carcinoma also could be an increased risk of developing breast cancer thromboembolism, hypertension, and possibly diabetes
What do physicians use to attempt to reduce the risks associated with unopposed ERT:
progesterone therapy, progestin therapy
the sonographic appearance of a pt on ERT and thickness of the endometrium are variable and comparable to:
premenopausal female
A common indication for postmenopausal ultrasound is:
postmenopausal bleeding
Complications that may lead to postmenopausal bleeding:
endometrial atrophy, uncontrolled HRT, endometrial hyperplasia, endometrial polyps, submucosal or intracavitary leiomyoma, endometrial carcinoma, and some ovarian tumors
Post-menopausal endometrial thickness measurement should not include:
adjacent hypoechoic myometrium and is considered accurate only when double-layer thickness measurement is performed without the inclusion of endometrial fluid
The post-menopausal bleeding patient’s endometrial thickness should not exceed
4-5 mm
If the measurement of the endometrium is less than 5 mm in the post-menopausal bleeding patient the bleeding is typically caused by
endometrial atrophy
The asymptomatic patient, post-menopausal patient, with no vaginal bleeding can have an endometrial thickness of up to :
8 mm
The most common cause of postmenopausal bleeding is :
endometrial atrophy
_______ results from the unopposed stimulation of estrogen on the endometrium.
Endometrial Hyperplasia
Sonographic appearance of endometrial hyperplasia
thickened echogenic endometrium, small cystic spaces within the endometrium
Clinical findings of endometrial hyperplasia
Abnormal uterine bleeding (any age), polycystic ovary syndrome, obesity, tamoxifen therapy
Most common female genital tract malignancy, with post-menopausal bleeding
endometrial carcinoma
Endometrial Carcinoma is most often in the form of :
adenocarcinoma
Adenocarcinoma and endometrial carcinoma have been linked with :
unopposed estrogen therapy, nulliparity, obesity, chronic anovulation, stein-Leventhal syndrome, estrogen-producing ovarian tumors, and the use of tamoxifen
Sonographic findings of endometrial carcinoma:
thickened endometrium, heterogeneous uterus, enlarged uterus with lobular contour, endometrial fluid, polypoid mass within the endometrium
_________ are small nodules of hyperplastic endometrial tissue that may cause abnormal vaginal bleeding
endometrial polyps
_______ is a breast cancer drug that inhibits the effects of estrogen on the breast.
tamoxifen
________ is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilation and curettage
Asherman syndrome
Sonographic findings of Asherman Syndrome
Bright areas within the endometrium, sonohysterography findings include bright bands of tissue traversing the uterine cavity
______ an infection of the upper genital tract
Pelvic inflammatory disease
Inflammation of the fallopian tubes
salpingitis
Patients suffering from salpingitis from PID may present clinically with symptoms resembling :
cholecystitis
Pelvic infections such as chlamydia or gonorrhea can actually lead to perihepatic infection and the subsequent development of adhesions located between the liver and diaphragm this event is called:
Fitz-Hugh-Curtis syndrome
PID has been linked with infertility and:
ectopic pregnancy
Clinical findings of salpingitis
findings consistent with PID, pelvic tenderness, fever, leukocytosis
Sonographic appearance of salpingitis
Distended fallopian tube filled with echogenic material (pus) or anechoic fluid, Hyperemic flow within or around the affected fallopian tube depicted with color doppler, nodular, thickened wall of the fallopian tube
As PID progresses and reaches beyond the fallopian tubes, the ________ and ____ become involved
ovaries and peritoneum
As PID progresses; adhesions develop within the pelvis that leads to the fusion of the ovaries and dilated tubes a condition known as:
Tubo-ovarian complex
Further progression of tubo-ovarian complex leads to a :
tubo-ovarian abscess
Sonographic findings of tubo-ovarian complex
thickened, irregular endometrium, pyosalpinx or hydrosalpinx, cul-de-sac fluid, multicystic and solid complex adnexal masses, ovaries, and tubes recognized as distinct structures, but the ovaries will not be separated from the tube by pushing the vaginal probe
Sonographic findings of tubo-ovarian abscess
thickened, irregular endometrium, pyosalpinx or hydrosalpinx, cul-de-sac fluid, multicystic and solid complex adnexal mass(es), Complete loss of borders of all adnexal structures, and the development of a conglomerated adnexal (possibly bilateral) mass
What is termed the inability to conceive a child after 1 year of unprotected intercourse:
Infertility
Congenital uterine malformations often lead to:
Repeated abortions
________ is functional ectopic endometrial tissue located outside of the uterus.
Endometriosis
Implantation of ectopic endometrial tissue may be the result of endometrial tissue being passed through the :
Fallopian tubes during menstruation
Endometriosis can be located anywhere in the pelvis, the most common location is:
The ovaries
Hemorrhage of the ectopic endometrial tissue often occurs and results in:
Endometriomas
Typical age of diagnosis for endometriosis :
25-35
Common clinical findings of endometriosis:
Pelvic pain, dysparenunia, infertility.
May also have dysmenorrhea, menorrhagia, painful bowel movements, or be completely asymptomatic
AKA stein-leventhal syndrome
Polycystic ovary syndrome
PCOS is characterized by:
Amenorrhea, hirtuism, and obesity
PCOS has been cited as the most common cause of :
Androgen excess/hyperandrogenism
Established clinical criteria for PCOS diagnosis :
Oligo/anovulation, blood work indicative of hyperandrogenism, Sonographic findings consistent with PCOS
Sonographic appearance of PCOS
Often enlarged ovaries, contain multiple small follicles along periphery, “string of pearls” sign
For the imaging diagnosis of PCOS it has been suggested that one or both ovaries should contain:
12 or more follicles that measure between 2-9 mm, ovarian volume should not exceed 10mL
What can be used to evaluate the patency of the Fallopian tubes?
Hysterosalpingography, hysterosalpingsonography, or hysterosalpingo-contrast-sonography
When the endometrium does not develop appropriately in the luteal phase (as a result of reduced progesterone production by the ovary) is termed:
Luteal phase deficiency
Adhesions within the uterine cavity often cause:
Infertility or lead to recurrent early pregnancy loss
Sonographic findings of asherman syndrome
Bright areas within the endometrium, sonohystography findings include bright bands of tissue traversing the uterine cavity
Fibroids that are __________ or __________ in location may distort the endometrium, thus preventing implantation of products of conception.
Intracavitary/ submucosal
Clinical findings of leiomyoma
Pelvic pressure, menorrhagia, palpable abdominal mass, enlarged, bulky uterus, dysuria, constipation, infertility
With assisted reproductive technology (ART) what is usually done to increase follicular development in order to extract multiple oocytes
Ovarian stimulation
______________ requires that a mature ovum be extracted from the ovary, fertilization takes place outside of the body.
In vitro fertilization
In-vitro fertilization: 4-8 developing embryos are placed into the uterus by means of a:
Catheter
The means by which twins, triplets, quadruplets, and quintuplet pregnancies are reduced :
Selective reduction/multi fetal pregnancy reduction
A additional technique of ART where the fertilization takes places in the Fallopian tubes:
Gamete intrafallopain tube transfer (GIFT)
GIFT requires that ooccytes and sperm be placed in the Fallopian tube via:
Laparoscopy
Zygote intrafallopian tube transfer is a method that requires the zygote be inserted :
Into the Fallopian tube
Patients who are being treated with ART are at an increased risk for :
Ectopic pregnancy, multiple gestations, ovarian hyper stimulation syndrome
Stimulation of the ovaries by hormonal therapy:
Ovulation induction
Drug that is used to stimulate the pituitary gland to secrete increased amounts of FSH:
Clomid/ clomiphene citrate
Fertility drug which is a hormone extracted from the urine of post menopausal women:
Pergonal
Pergonal is a mixture of what?
FSH and luteinizing hormone
Pergonal is often given in conjunction with
hCG
Ovulation induction dramatically increases risk of:
Multiple gestations and OHS
During OHS ovaries ______ and can measure:
Enlarge
5-12 cm
With OHS the ovaries contain:
Multiple large follicles/ theca lutein cysts
_______ is administered as part of ovulation induction, and theca lutein cysts occur due to these high levels
hCG
__________ can occur due to the large theca lutein cysts, results in acute pelvic pain.
Ovarian torsion
In cases of severe OHS patients have :
Nausea, vomiting, abdominal distention, ovarian enlargement, electrolyte imbalance, and oligoria
Sonographic signs of OHS
Cystic enlargement > 5cm, ascites, possible pleural effusion
OHS can initiate :
Renal failure, thromboembolism, and acute respiratory distress syndrome
Reversible form of contraception
IUD or IUCD
Small plastic T shaped IUD that releases small amounts of progestin to impede implantation
Mirena
T-shaped IUD utilizes copper to inhibit sperm transport, or to prevent fertilization or transplantation
Paragard
IUDs should be located within what portion of the endometrium?
Fundal
Sonographic appearance of lippes loop IUD
5 equally spaced shadowing structures
IUDs that have the Sonographic finding of T-shape
Copper T, mirena, paragard
Sonographic appearance of the dalkon shield
Shadowing ovoid shape device
IUDs create posterior shadowing and have been described as producing an “_________________” on sonogram
Entrance and exit echo
If the IUD is not located in the endometrium then what should be explored ?
Existence of myometrial perforation
Patients that have an IUD perforated into the uterine wall will often complain of what?
Irregular or heavy bleeding and cramping
The use of IUDs has been linked with:
PID, ectopic pregnancy, and spontaneous abortions
Birth control pills produce an _________ cycle.
Anovulatory
Permanent form of birth control that uses small coils placed into the proximal isthmic segment of the Fallopian tubes
Easier device
Sonographically how will the essure device appear
Bilateral echogenic linear structures with proximal isthmic segments of the Fallopian tubes best seen in the transverse plane
Female sterilization in the form of ___________________ offers another permanent pregnancy prevention method
Tubal ligation
If a patient presents to ultrasound with hx of tubal ligation and a positive pregnancy test what should be suspected?
Ectopic pregnancy
A normal pregnancy lasts for:
9 months, 40 weeks, 280 days
In the early first trimester if TA imaging is used pt should have a :
Distended urinary bladder
When a patient is in their late 2nd or 3rd trimester the gravid uterus can compress on the maternal IVC causing :
supine hypotensive syndrome
______ denotes the number of times a woman has been pregnant.
gravidity
________ denotes the number of pregnancies that led to the birth of a fetus at or beyond 20 weeks or an infant who weighed at least 500g.
parity
In the 2nd trimester painless vaginal bleeding is most often associated with:
placenta previa
In the 2nd trimester painful vaginal bleeding may occur as a result of:
placental abruption
The triple screen consists of :
hCG, MSAFP, estriol
The quadruple screen consists of:
hCG, MSAFP, estriol, and inhibin A
Some medical institutions provide an earlier test than the customary triple screen performed between 11-14 weeks, what is this an analysis of?
hCG, pregnancy-associated plasma protein a PAPP-A, combined with fetal NT
A newer blood test is available, which is a type of cell-free fetal DNA testing. Can reveal gender and is also highly accurate in detecting chromosomal anomalies:
MaterniT21plus
Measurements that are obtained in the first trimester:
the yolk sac, gestational sac, CRL, NT
The purpose of a BPP is :
to investigate for signs of fetal hypoxia and to assess overall fetal wellbeing.
Standard Fetal Measurement for AC:
Measured in an axial plain, taken around the abdomen at the level of the umbilical vein and fetal stomach.
Standard Fetal measurement for HC:
Measured at the outer perimeter of the skull at the level of the 3rd ventricle, thalamus, CSP, and falx cerebri
Standard Fetal measurement for FL:
Measured at the long axis of the femoral shaft when the ultrasound beam is perpendicular to the shaft
Standard fetal measurement of BPD:
Measured from the outer edge of the proximal skull to the inner edge of the distal skull at the level of the 3rd ventricle, thalamus, CSP, and falx cerebri
A type of reverberation artifact caused by several small, highly reflective interfaces such as gas bubbles
comet tail artifact
Caused by attenuation of the sound beam:
shadowing
An artifact that appears as a solid streak or a chain of parallel bands radiating away from a structure:
ringdown
How long should one episode of breathing last during a fetal BPP in order to receive 2 points?
30s
How many fetal body movements must be visualized in order to receive 2 points?
3 or more gross body movements
_______ presentation is the most common fetal presentation.
cephalic
The most common pelvic mass associated with pregnancy is:
Corpus luteal cyst
Pregnant patients, who complain of RLQ could be suffering from?
acute appendicitis
_______________ is most often secondary to the large size of the uterus with subsequent transient asymptomatic obstruction of the ureters.
Hydronephrosis/ dilation of the renal collecting system
MSAFP will ________ with Anencephaly
increase
Edwards syndrome (trisomy 13) will decrease which triple/quadruple screenings/additional labs
hCG, estriol, MSAFP, inhibin A, and PAPP-A
Cephalocele will _______ MSAFP
increase
Trisomy 21 (down syndrome) will increase which labs:
hCG, inhibin A
MSAFP will _______ with gastroschisis
increase
Spina-bifida (meningocele or myelomeningocele) will cause MSAFP to:
increase
An ectopic pregnancy will show a decrease in which labs?
hCG, hematocrit
Turner syndrome will cause a decrease in which labs?
hCG with hydrops, MSAFP, estriol, inhibin A (with hydrops, PAPP-A
A mature ovum is released through ovulation at around day:
14
A sperm which can live up to _______ hours unites with the egg in the distal 1/3 fallopian tube
72 hours
Conception usually occurs within ________ after ovulation.
24 hours
The combination of the sperm and ovum produces a structure referred to as the:
zygote
The zygote undergoes rapid cellular division and eventually forms into a cluster of cells called:
morula
The morula continues to differentiate and form into a structure known as:
blastocyst
The outer tissue layer of the blastocyst is comprised of :
trophoblastic cells
The trophoblastic cells produce which pregnancy hormone?
hCG
The inner part of the blastocyst will develop into:
embryo, amnion, umbilical cord, and primary and secondary yolk sacs
The outer part of the trophoblastic tissue will develop into :
placenta and chorion
On day ____ or ____ of the menstrual cycle, the blastocyst begins to implant into the decidualized endometrium at the level of the fundus.
20/21
By how many days has complete implantation occurred:
28
The implantation of the blastocyst within the endometrium may cause some women to experience vaginal bleeding, referred to as:
implantation bleeding
Primary yolk sac regresses during which week:
4, and two separate membranes are formed
When two separate membranes are formed from the primary yolk sac, the outer membrane represents:
chorionic sac/ gestational sac
Within the gestational sac is the :
amnion or amniotic sac
By the end of the 4th week, the ________ becomes wedged in between two membranes in an area called the chorionic cavity or extraembryonic coelom.
secondary yok sac
The developing embryo is located between the yolk sac and the ______ at four weeks.
amnion
When the developing embryo is located between the yolk sac and the amnion (at 4 weeks) _______ is formed.
alimentary canal
The ______ will become the fetal head and spine.
neural tube
The alimentary canal will become:
foregut, midgut, and hindgut
The lab used to detect pregnancy:
hCG
hCG is produced throughout pregnancy by the:
placenta
In the first trimester what maintains the corpus luteum cyst of the ovary so that progesterone can continue to produce:
hCG
hCG is detected in the maternal blood as early as:
23 days
What is the earliest definitive sign of an IUP
Gestational sac
The period given to describe the earliest sonographic detection of an IUP is termed the:
discriminatory zone
Typically at 5 weeks, a _____ gestational sac will be seen
5mm
Normal hCG levels double every ________
48 hours
the _________ of the endometrium is essentially the first sonographically identifiable sign of pregnancy:
decidual reaction
The decidual endometrium will appear:
thick and echogenic as a result of the continued production of progesterone
Earliest gestational sac is seen: _______ and will grow at a rate of ______ per day
5 weeks/1mm
The intradecidual sign can be misdiagnosed because it may resemble :
psuedogestational sac of an ectopic pregnancy
The double sac sign denotes the typical appearance of the two distinct layers of the decidua:
decidua capsularis (inner) and decidua parietalis (outer layer)
The space between the gestational sac and the amniotic sac, the location of the secondary yolk sac
chorionic cavity
the decidualized tissue at the implantation site containing the chorionic villi, the fetal contribution of the placenta:
chorion frondosum
The portion of the chorion that does not contain chorionic villi
chorion laeve
Fingerlike extension of trophoblastic tissue that invades the decidualized endometrium
chorionic villi
The endometrial tissue at the implantation site. The maternal contribution of the placenta:
decidua basalis
The portion of the decidua opposite the uterine cavity, across from the decidua basalis:
decidua capsularis
the decidualized tissue along the uterine cavity adjacent to the decidua basalis
decidua parietalis
The earliest sonographic measurement that can be obtained to date the pregnancy:
gestational sac
The gestational sac measurement can be used until there is a :
fetal pole
By adding ____ to the MSD sonographers can obtain an estimate for the gestational age in days.
30
An irregularly shaped gestational sac and MSD of > _____ that does not contain a fetal pole are both signs of potential pregnancy failure:
25
The first structure seen with sonography within the gestational sac is the :
secondary yolk sac
The yok sac produces ____ and plays an important role in angiogenesis and hematopoiesis during early development
AFP
The yolk sac is connected to the embryo by the _____, aka omphalomesenteric duct.
vitelline duct
The gestational sac consists of 2 cavities:
chorionic cavity and amniotic cavity
The chorionic cavity lies between:
amnion and chorion
The chorionic cavity contains:
yolk sac and fluid
The amniotic cavity contains :
simple-appearing amniotic fluid and the developing embryo
The amnion and chorion typically fuse around:
middle of the first trimester but may not be totally fused until 16 weeks gestation
By week ____ the embryo can be seen located within the amniotic cavity adjacent to the yolk sac
6
Sonographic documentation of heart activity being present between:
5 and 6 weeks
Heart motion can be detected in a _____ mm embryo and with motion certainly evident within the ____ mm embryo
4/5
Embryonic HR of _________ bpm between 5-6 weeks is normal
100-110
The most accurate sonographic measurement of pregnancy is:
CRL
Fetal limb buds are identified by:
7 weeks
At 7 weeks ______ is proportionally larger than the body.
head
Within the fetal head, a cystic structure may be noted - this most often represents: (7-8 wks)
rhombencephalon/hindbrain
The rhombencephalon will eventually develop into the:
4th ventricle
As early as 8 weeks, the _____ may be visualized in the upper abdomen.
stomach
________ begins at 8 weeks, which marks the developmental stage when the midgut migrates into the base of the umbilical cord.
physiologic bowel herniation
IF physiologic bowel herniation does not resolve by _____ weeks, a follow-up exam is warranted.
12 weeks
The developing placenta may be noted at the _________ as a well-defined crescent-shaped homogeneous mass of tissue.
end of the first trimester
The placenta is formed by the :
decidua basalis, the maternal contribution
chorion frondosum, the fetal contribution
The term nuchal refers to the_____
neck
the nuchal translucency is represented by a thin membrane along the __________ aspect of the fetal neck.
posterior
The most common abnormalities associated with increased NT are:
trisomy 21, trisomy 18, Turner syndrome, and congestive heart failure
The NT is optimally measured between:
11-13weeks and 6 days
when CRL measures between 45-84mm
The fetus may be seen resting on the ______ and this should not be confused for a prominent NT
amnion
The normal range of thickness of NT is based on the ___________, although most often a measurement of _____ between 11-13 weeks 6 days is considered abnormal.
gestational age; 3 mm
It has been recognized with many down syndrome fetuses, the nasal bone is either ______ or _______ between 11-13 weeks.
hypoplastic or absent
Visualizing the nasal bone separate from the overlying nasal skin will provide an _______ sign in the normal fetus.
equal
The most common pelvic mass associated with pregnancy is:
ovarian corpus luteum cyst
The corpus luteum of pregnancy is a _____ cyst that is maintained during the 1st trimester by ______, which is produced by the developing placenta.
functional; hCG
The corpus luteum secretes ________ and thereby maintains the thickness of the endometrium
progesterone
Typically the corpus luteum measures between :
2-3 cm
may continue to grow up to 10cm
The circumferential rim of the corpus luteum typically produces what type of waveform:
low resistance spectral doppler
The calipers during NT measurement must be placed ______ to the long axis of the fetus.
perpendicular
An ectopic pregnancy is also referred to as:
extrauterine pregnancy EUP
_______ is the most common cause of pelvic pain with a positive pregnancy test.
EUP
The most common location for EUP is :
within the fallopian tube, the specifically ampullary portion of the tube
Contributing factors for ectopic pregnancy:
previous ectopic, previous tubal surgery, hx of pelvic inflammatory disease, undergoing fertility treatment, previous or present use of an IUD, multiparity, advanced maternal age
When a patient has a EUP and coexisting IUP it is termed:
heterotopic pregnancy
The classic clinical triad of an EUP includes:
pain, vaginal bleeding and palp abdominal pelvic mass
______ can be helpful in determining EUP because a normal IUP should double every 48 hours.
hCG
___________ pregnancies are considered potentially life-threatening because the pregnancy may progress normally until a spontaneous rupture occurs.
interstitial
__________ is a drug used to medically treat an EUP
methotrexate
Sonographic findings of ectopic pregnancy:
the extrauterine gestational sac containing a yolk sac, adnexal ring sign, complex adnexal mass, a large amount of free fluid within the pelvis or in Morison pouch, complex free fluid could represent hemoperitoneum, pseudogestational sac, poor decidual reaction, an endometrial cavity containing blood
Benign ________________ often referred to as molar pregnancy or hydatidiform mole, is a group of disorders that result from an abnormal combination of male and female gametes.
Gestational trophoblastic disease
The most common form of the gestational trophoblastic disease:
complete molar pregnancy
The most common forms of malignant GTD are:
invasive mole, choriocarcinoma
(GTD) The most common sites of metastatic involvement are :
lugs, liver, and vagina
Patients who present with a diagnosis of molar pregnancy are often referred for:
chest radiographs or other studies for further evaluation of metastasis
Treatment for molar pregnancy:
D&C, hCG monitoring, hysterectomy, & possibly chemo
Clinical findings of GTD
hyperemesis gravidarum,
markedly elevated hCG ( potentially higher than 100,000 mIU per mL),
heavy vaginal bleeding with possible passage of grape-like molar clusters,
hypertension,
uterine enlargement
hyperthyroidism
Sonographic findings of complete molar pregnancy
complex mass within the uterus,
color doppler may reveal hypervascularity around the mass but not within it,
vesicular snow storm secondary to placental enlargement, multiple cysts replacing the placental tissue (hydropic chorionic villi),
bilateral ovarian theca lutein cysts
Partial or incomplete molar pregnancy may be accompanied by a coexisting:
triploid fetus, parts of the fetus, or amnion
With partial or incomplete molar pregnancy how will hCG present:
Normal, minimally elevated
Invasive molar pregnancy invades:
the myometrium and may also invade through the uterine wall and into the peritoneum
___________ is diagnosed when there is no evidence of a fetal pole or yolk sac within the gestational sac
blighted ovum/anembryonic gestation
Clinical findings of Blighted ovum:
vaginal bleeding, reduction of pregnancy symptoms, low hCG
_____________ is defined by the death of the embryo or fetus.
embryonic demise/fetal demise
Cardiac activity should be detected in a pole that measures:
4-5mm
The normal embryonic HR at 6 weeks is typically between
100-110
absent cardiac activity when the CRL is below _______ is suspicious for pregnancy failure
7mm
________ is essentially a bleed between the endometrium and the gestational sac.
subchorionic hemorrhage
subchorionic hemorrhage results from the:
implantation of the fertilized ovum into the uterus with subsequent low-pressure bleeding or spotting.
By ________ the neural plate the structure that will form the central nervous system has developed.
4.5
The proper measurement of the lateral ventricle is taken at the :
atria
Where are the mid cerebral arteries located in the circle of Willis
laterally - bilaterally
The rhombencephalon aka:
hindbrain
The skull consists of _______ cranial bones.
8
Premature fusion of the sutures is termed:
craniosynostosis
Craniosynostosis leads to :
an irregular shaped skull
Spaces that exist between the forming fetal skull bones are referred to as:
fontanelles or soft spots
The opening in the base of the cranium through which the spinal cord travels:
foramen magnum
The brain can be divided into two main parts:
cerebrum and cerebellum
The cerebral hemispheres are linked in the midline by the :
corpus callosum
Three protective tissue layers that cover the brain and spinal cord are termed:
meninges
The innermost layer of the meninges :
pia mater
The middle layer of the meninges is the:
arachnoid membrane
The dense, outermost layer of the meninges is the :
dura mater
The corpus callosum should be completely intact between:
18-20 weeks
The absence of all or part of the corpus callosum is termed:
agenesis of the corpus callosum
The midline brain structure is located in the anterior portion of the brain between the frontal horns of the lateral ventricles. (box-shaped)
Cavum Septum pellucidum
The ______ does not communicate with the ventricular system, and its absence is associated with multiple cerebral malformations.
CSP
The two lobes of the thalamus are located on both sides of the:
3rd ventricle
The thalamus should not be confused with the ____________________, which are more inferiorly positioned in the brain.
cerebral peduncles
The ventricular system is composed of ____ ventricles, whose primary function is to provide cushioning for the brain.
4
Each ventricle is lined by a membrane called the :
ependyma
What is responsible for the production of cerebrospinal fluid in the fetus:
choroid plexus
Each lateral ventricle communicates with the 3rd ventricle in the midline of the brain at the:
foreman Monro
The third ventricle is located between:
the two lobes of the thalamus
The third ventricle connects to the fourth ventricle inferiorly by means of a long tubelike structure called:
the aqueduct of sylvius/cerebral aqueduct
The fourth ventricle is located ________ to the cerebellum.
anterior
The two lateral apertures (in the fourth ventricle) are also referred to as:
foramina of luschka
The foramina of luschka allow CSF to travel from the 4th ventricle to the:
subarachnoid space around the brain
Another opening of the fourth ventricle, which is located midline and is the median aperture is also known as:
foramen of magendie
Foramen of magendie alllows CSF to pass from the 4th ventricle to the _________________
cisterna magna and subarachnoid space
CSF flows ________ and around the spinal cord
inferiorly
____________ are responsible for the reabsorption of CSF into the venous system.
arachnoid granulations/arachnoid villi
The cisterna magna, located in the _____ fossa of the cranium.
posterior
The cerebellum is located in the ______ fossa of the cranium.
posterior
The cerebellum consists of two hemispheres right and left that are coupled at the midline by the:
cerebellar vermis
The normal cerebellum is what shape:
dumbbell or figure 8 shaped
BPD measurement of the fetal head can be taken starting between:
13-14 weeks
BPD is obtained in what plane:
axial
What should be seen in the BPD/HC measurement
CSP, thalamus, and falx
cephalic index =
BPD/OFD x 100
Head shape that is considered round or short and wide.
brachycephalic
The head shape that is elongated, narrow head:
dolichocephaly, scaphocephaly
A cephalic index of less than _______ denotes a dolichocephalic shape.
75
Cephalic index of more than ____ denotes brachiocephalic shape.
85
The lateral ventricle is measured in the transaxial plane at the level of the :
atrium
The calipers are placed at the level of the _____ of the choroid plexus for a measurement of the lateral ventricles.
glomus
The normal lateral ventricle does not typically measure more than:
10mm
Enlargement beyond 10 mm of the lateral ventricles is referred to as:
ventriculomegaly/ hydrocephalus
The cerebellum grows at a rate of _____ per week between 14-21 weeks
1mm
The depth of the cisterna magna should not measure more than
10 mm
The depth of the cisterna magna should not measure less than:
2 mm
Measurement of the cisterna magna more than 10 mm is consistent with :
mega cisterna magna and dandy-walker complex
A measurement of the cisterna magna less than 2 mm is worrisome for:
Arnold-chiari II malformation
The buildup of CSF within the ventricular system secondary to some type of obstruction:
obstructive hydrocephalus
________ has been cited as the most common cranial abnormality.
ventriculomegaly
____________ sign describes the echogenic choriod plexus hanging lump surrounded by CSF.
dangling choroid sign
__________________ is apparent when the obstruction lies outside the ventricular system
communicating hydrocephalus
_____________ is when the obstruction level is located within the ventricular system.
non-communicating hydrocephalus
The most common cause of hydrocephalus in utero
aqueductal stenosis
The cerebral aqueduct (aqueduct of Sylvius), is located between :
3rd and 4th ventricles
An obstruction (stenosis) at the aqueduct of Sylvius would cause :
3rd ventricle and both lateral ventricles to expand - 4th ventricle remains normal.
Fatal condition in which the entire cerebellum is replaced by a large sac containing CSF
hydranencephaly
With hydranencephaly, there is no cerebral ______ present
mantle
Midline brain anomaly that is associated with not only brain aberrations but also atypical facial structures.
holoprosencephaly
3 types of holoprosencephaly
alobar, semilobar, and lobar
With alobar holoprosencephaly the cortex can take on three basic shapes
pancake, cup, or ball
The most severe form of holoprosencephaly :
alobar
Alobar holoprosencephaly is diagnosed when there is the absence of:
corpus callosum, CSP, 3rd ventricle, intrahemispheric fissure, falx
___________ or _________ is present in 50-70% of fetuses diagnosed with holoprosencephaly
Trisomy 13, patau syndrome
Sonographic findings of alobar holoprosencephaly:
Horseshoe-shaped monoventricle, fused echogenic thalami, absence of the CSP, interhemispheric fissure, falx cerebri, corpus callosum, third ventricle, Normal cerebellum and brain stem
Cerebellar vermis is either completely absent or hypoplastic, as a result, the tentorium, the structure that separates the cerebrum from the cerebellum, is elevated. This represents what malformation:
dandy-walker malformation
Facial anomalies of alobar holoprosencephaly:
cyclopia, hypotelerism, proboscis, cleft lip, anophthalmia, cebocephaly
If the cerebellar vermis is absent and the 4th ventricle is enlarged then _________ must be suspected
DWM - Dandy walker
The corpus callosum is completely formed by:
18 weeks
Most often if the corpus callosum is absent then:
the CSP will be as well
In the normal brain, the sulci within the cerebrum typically travel _______ to the corpus callosum, but with agenesis of the corpus callosum, they tend to have a more ________ or radial arrangement. (spoke wheel pattern)
parallel/perpendicular
Associated with the development of fluid-filled clefts within the cerebrum.
schizencephaly
The Sonographic appearance of open lip schizencephaly is that of a cerebrum containing __________ clefts filled containing anechoic CSF.
gray matter lined
A rare condition in which a cyst communicates with the ventricular system:
porencephaly
Porencephaly can occur after the fetus has experienced _________ within one or both cerebral hemispheres.
hemorrhage
Condition in which there are no gyri within the cerebral cortex
lissencephaly
________ and ______ are the most common neural defects.
anencephaly and spina bifida
________ in a woman’s diet significantly reduces the likelihood of her fetus developing a neural tube defect.
.4mg of folate
______ is defined as the absence of the cranial vault above the bony orbits.
acrainia
_______ is considered when there are no cerebral hemispheres present - where as _________ denotes a normal amount of cerebral tissue
anencephaly/ exencephaly
Sonographic appearance of anencephaly:
froglike facies, bulging eyes, and absence of the cranial vault.
Clinical findings of acrania/anencephaly:
elevated MSAFP
Spina bifida may result in a mass protruding form the spine, this mass can be referred to as a __________ or ________.
meningocele/myelomeningocele
Most common location of spina bifida is :
the distal lumbosacral region
Frontal horns will be small and slitlike, whereas the occipital horns will be enlarged, this describes what condition of the fetal skull?
colpocephaly
Sonographic signs of Arnold Chiari II malformation
lemon sign, banana sign, obliterated cisterna magna, colpocephaly, enlarged Massa intermedia, hydrocephalus, an open spinal defect
protrusions of intracranial contents through a defect in the skull:
cephalocele
The most common location for a cephalocele
occipital region
what are the contents of a meningocele?
meninges only
what are the contents of an encephalocele:
brain tissue only
what are the contents of an encephalomeningocele
both meninges and brain tissue
encephalomeningocystocele
meninges, brain tissue, and lateral ventrical
Most common in utero infection:
cytomegalovirus
Sonographic intracranial findings consistent with intrauterine infections:
are the calcifications around the ventricles and ventriculomegaly
Most common intracranial tumor in utero:
teratoma
Most common risk factor for fetal intrauterine intracranial hemorrhage :
maternal platelet disorders
The normal cerebral circulation typically yields a _______ impedance doppler pattern, with the continuous forward flow throughout the cardiac cycle.
high
Doppler of the _____ has been shown effective at evaluating for potential hypoxia.
MCA
The resistance pattern of the MCA should be _____ than that of the umbilical artery
greater
An arteriovenous malformation that occurs within the fetal brain:
Vein of Galen aneurysm
Sonographic findings of a vein of Galen aneurysm :
large, anechoic mass within the midline of the cranium, when using color doppler will fill with turbulent venous and arterial flow
Fetus suffering from the vein of Galen aneurysm will also have signs of :
hydrops and cardiomegaly
Clinical findings of Vein of Galen Aneurysm: (neonatal)
congestive heart failure
