chapter 48 green boxes

Question 1

sonographic findings

<60 bpm

Answer 1

embryonic bradycardia

Question 2

sonographic findings

>170 bpm

Answer 2

embryonic tachycardia

Question 3

sonographic findings

empty uterus

no adenexal mass

no free fluid in pelvis

positive hCg levels with rapid decline

Answer 3

complete abortion

Question 4

sonographic findings

variable findings:

intact gestational sac with nonviable embryo to collapsed sac

thickend endometrium > 8 mm

retained embryonic parts

Answer 4

incomplete abortion

Question 5

sonographic findings

large (>18 mm) empty gestatoinal sac with failure to develope

no yolk sac amnion or embryo

Answer 5

anembryonic pregnancy

Question 6

sonographic findings

uterus larger than dates

“snowstorm” of multiple tiny clusters of grapelike echoes within the uterine cavity

Theca lutei cysts may be present

Answer 6

Molar pregnancy

hyperemesis

increased hCG levels

bleeding

preeclampsia

Question 7

abnormal uterine pregnancies

absence of cardiac motion in embryos 5mm or larger

absence of cardiac motoin after 6.5 menstrual weeks

Answer 7

embryo

Question 8

abnormal uterine pregnancies

large yolk sac or amnion without a viable embryo

calcified yolk sac

Answer 8

yolk sac and amnion

Question 9

abnormal uterine pregnancies

> 18 mm lacking a viable embryo

> 8 mm lacking a visible yolk sac

Answer 9

large gestational sac

Question 10

abnormal uterine pregnancies

irregular or misshapen

Answer 10

shape

Question 11

abnormal uterine pregnancies

conrnual, low or hour glassing through cervical os

Answer 11

position

Question 12

abnormal uterine pregnancies

irregular

absent double decidual sac finding

thin trophoblastic reactoin < 2mm

intratrophoblastic venous flow

Answer 12

trophoblastic reaction

Question 13

abnormal uterine pregnancies

gestational sac growth of <0.6mm per day

absent embryonic growth

Answer 13

growth

Question 14

abnormal uterine pregnancies

discrepance in sac size with hCG levels

Answer 14

hCG correlation

Question 15

first trimester pelvic mass

>5 mm in size

internal septations and debris (secondary to hemorrhage)

increased vascularity surrounding corpus luteum

Answer 15

corpus luteum syst

differentials

dermoid

ovarian cancer

Question 16

first trimester pelvic mass

increased hormone stimulatoin growth

may compress gestational sac

various sonographic patterns, hypoechoic, echogenic, isoechoic when compared with myometrium

increased size causes uterine endometrial deformity

Answer 16

uterine leiomyoma

differentials

uterine contractions

dermoid

Question 17

normal vs ectopic pregnancy

normal early intrauterine pregnancy (3-4 weeks)

recent spontaneous abortion

Answer 17

empty uterus

Question 18

normal vs ectopic pregnancy

yolk sac present

burrowed gestational sac eccentrically postitioned in uterus (usually in fundus)

no internal echoes seen within the gestatoinal sac

peritrophoblastic flow around sac

low resistive flow pattern

Answer 18

normal itrauterine pregnancy

IUP

Question 19

normal vs ectopic pregnancy

intrauterine saclike structure

yolk sac not present

pseudosac seen in central locatoin in uterus

homogenoeous echoes within pseudosac

no peritrophoblastic flow

high resistive patter

Answer 19

ectopic pregnancy with pseudogestational sac

differentials

intrauterine debris

incomplete spontaneous abortion

intrauterine blood

Question 20

normal vs ectopic pregnancy

pseudogestational sac

extrauterine sac in adenexa with thickened echogenic ring

gestational sac or yolk sac

Answer 20

ectopic pregnancy

differentials

incomplete spontaneous abortion

intrauterine blood or fluid in the cul-de-sac

Question 21

normal vs ectopic pregnancy

simultaneous intrauterine pregnancy and ectopic pregnancy

findings for both IUP and ectopic

Answer 21

heterotopic pregnancy

differentials

normal IUP and pelvic mass

Question 22

normal vs ectopic pregnancy

found in segment of fallopian tube

rupture with hemorrhage

eccentric intrauterine gestational sac with incomplete myometrial mantel surrouding sac

Answer 22

interstitial pregnancy

differentials

ectopic pregnancy

pelvic mass

Question 23

normal vs ectopic pregnancy

pseudogestational sac of ectopic pregnancy

Answer 23

nonviable intrauterine pregnancy

differentials

embryo, no cardiac motion/nonliving intrauterine pregnancy

embryo cardiac motoin/living intrauterine pregnancy

Question 24

cranial anomalies

abnormal mineralization of bony structures (lack of echogenicity)

abnormal shaped “mickey mouse” head

Answer 24

acrania

Question 25

cranial anomalies

absence of cranium superior to orbits with preservation of base of skull and face

brain may project from open cranium

Answer 25

anencephaly

Question 26

cranial anomalies

midline cranial defect

herniation of brain and meninges

Answer 26

cephalocele

Question 27

cranial anomalies

defect in occiput involving the foramen magnum

extreme retroflexion of spine

open spinal defect

Answer 27

iniencephaly

Question 28

cranial anomalies

dilation of ventricular system without enlargement of cranium

compressed choroid plexus

lncreased cerbrospinal fluid

dangling choriod in dilated lateral ventricle

Answer 28

ventriculomegaly

Question 29

cranial anomalies

failure of prosencephalon to differentiate into cerebral hemispheres and lateral ventrilces between 4th and 8th weeks

complete to partial failure of cleavage of prosencephalon

facila dysmorphism

remember brain appears to be single ventrilce until falx cerebri develope after 9 weeks

Answer 29

holoprosencephaly

Question 30

cranial anomalies

6th -7th week of gestation

cystic dilatoin of 4th ventricle

dysgenesis or agenesis of cerebellar vermis and hydrocephaly

elevated tentrium

Answer 30

Dadny-Walker malformation