DMS OB CH 60 & 61

Question 1

The following abnormalities refers to a fetus with a significantly narrow chest diameter

Answer 1

asphyxiating thoracic dystrophy and

thanatophoric dwarfism

Question 2

Most important determinant for fetal viability

Answer 2

adequacy of pulmonary (lung) development

Question 3

Identify normal sonographic criteria for fetal thorax

Answer 3

examined in both transverse and coronal planes, symmetrically bell shaped,
ribs form lateral margins,
clavicles form upper margins,
diaphragm forms lower margins,
lungs serve as lateral borders for the heart and lie superior to the diaphragm,
thorax normally slightly smaller than abd cavity,
central portion of the thorax is occupied by the mediastinum

Question 4

Evaluation of the normal fetal thorax should include what

Answer 4

transverse, coronal, and/or parasagittal
evaluate chest: size, shape, symmetry
evaluate heart: position, size, rate, pericardial fluid
evaluate pulmonary texture
centrally positioned mediastinum

Question 5

Level at which we take the chest circumference

Answer 5

made in the transverse plane at the level of the four chamber view of the heart

Question 6

Fetal breathing

Answer 6

becomes more prominent in the 2nd and 3rd trimesters
spends 1/3 of its time breathing
seesaw movements of chest and and for at least 20 sec
absent if doesn’t occur within 20 min
may use color doppler to detect breathing through nostrils

Question 7

Axis for the heart..how many degrees

Answer 7

normal cardiac axis ranges from 22-75 degrees (average, 45 degrees)

Question 8

Sonographic findings for ccam…all types

Answer 8

Type I: single or multiple large cysts 2 cm in diameter, good prognosis after resection of affected lung
Type II: multiple small cysts, < 1cm in diameter, echogenic, high incidence of other anomalies
Type III: large, bulky, noncystic lesions producing mediastinal shift, poor prognosis, usually only one lobe is affected, associated polyhydramnios and anasarca

Question 9

Diaphragmatic hernia that occur anterior and medial..which foramen do they come from

Answer 9

foramen of Morgagni

Question 10

Which of the lung cysts is most common prenatally

Answer 10

bronchogenic cyst

Question 11

Severity of pulmonary hypoplasia depends on what

Answer 11

depends on when it occurred during pregnancy, its severity, and its duration

Question 12

Supernumerary lobe of lung is called what

Answer 12

pulmonary sequestration

Question 13

Normal sonographic appearance of fetal chest

Answer 13

examined in both transverse and coronal planes, symmetrically bell shaped,
ribs form lateral margins,
clavicles form upper margins,
diaphragm forms lower margins,
lungs serve as lateral borders for the heart and lie superior to the diaphragm,
thorax normally slightly smaller than abd cavity,
central portion of the thorax is occupied by the mediastinum

Question 14

Normal fetal lungs..appearance on ultrasound

Answer 14

homogenous with moderate echogenicity
early in gestation, lungs are similar to or slightly less echogenic than the liver
increased echogenicity as gestation progresses
overlying ribs and acoustic enhancement
US cannot assess lung maturity

Question 15

Sonographic findings of pulmonary sequestration

Answer 15

echogenic solid mass resembling lung tissue
usually in lower lobe of lung
rarely occurs below diaphragm
associated with hydrous and polyhydramnios, diaphragmatic hernia, gastrointestinal anomalies
normal intra-abdominal anatomy
intralobar: spherical, favorable prognosis
extralobar: cone shaped or triangular, poor prognosis

Question 16

Congenital bronchial atresia is most commonly found in which lobe

Answer 16

left upper lobe

Question 17

Most common type of diaphragmatic hernia

Answer 17

occurs posteriorly and laterally in the diaphragm, foramen of Bochdalek

Question 18

Abnormalities within the thoracic cavity..which one doesn’t belong

Answer 18

pulmonary hypoplasia, cystic lung masses, bronchogenic cysts, pleural effusion (hydrothorax), solid lung masses, pulmonary sequestration, congenital cystic adenomatoid malformation, congenital bronchial atresia

Question 19

Diaphragmatic hernia..what happens if it is a left sided or right sided hernia

Answer 19

Left: intrathoracic stomach, displaced cardiac apex, cardiomediastinal shift, intrathoracic liver, small right lung, small left ventricle of heart
Right: liver in chest, possibly collapsed bowel, heart deviated far to the left, abnormal stomach alignment,

Question 20

Mortality rate at birth for fetus with diaphragmatic hernia

Answer 20

high mortality rate (75%)

Question 21

Rupture of amnion that leads to entrapment or entanglement

Answer 21

amniotic band syndrome

Question 22

Defect in lower abdominal wall and anterior wall of bladder

Answer 22

bladder exstrophy

Question 23

Anomaly with large cranial defects, facial clefts, large body wall defects, and limb abnormalities

Answer 23

limb-body wall complex

Question 24

Gastroschisis is a consequence of atrophy of what

Answer 24

right umbilical vein or a disruption of the omphalomesenteric artery

Question 25

Bladder exstrophy..what else may accompany that

Answer 25

omphalocele, inguinal hernia, undescended testes, anal problems

Question 26

Which abdominal wall defects are most common

Answer 26

gastroschisis, omphalocele, umbilical hernia

Question 27

What process is needed for the closing of the abdominal wall

Answer 27

folding-6th week, helps the embryo transform itself into a cylindrical shape

Question 28

Normal embryological herniation of the bowl permits what

Answer 28

permits the development of the intraabdominal organs and allows necessary bowel rotation, permits the bowel to rotate around the SMA

Question 29

If a 19 week fetus has elevated msafp..what is the problem

Answer 29

gastroschisis

Question 30

5 defects of pentalogy of Cantrell

Answer 30

cleft distal sternum, diaphragmatic defect, midline anterior ventral wall defect, defect of the apical pericardium with communication into the peritoneum, internal cardiac defect

cardiac defects, cleft lip, encephalocele, exencephaly, sirenomelia

Question 31

Most dramatic finding in ectopia cordis

Answer 31

the presence of a heart outside the thoracic cavity, a portion or all of the heart may protrude through the defect in the sternum

Question 32

High omphalocele or supraumbilical may be found in which condition

Answer 32

pentalogy of Cantrell

Question 33

Limb body wall defects are more common on which side

Answer 33

left side

Question 34

Notably dilated free floating bowel loops…which abd wall defect

Answer 34

gastroschisis

Question 35

Membrane that covers an omphalocele..what it consists of

Answer 35

membrane consists of amnion and peritoneum

Question 36

What does the umbilical vein drain

Answer 36

umbilical veins drain the placenta, body stalk, and the evolving abd wall

Question 37

Hepatic bud enlarges and the right umbilical vein atrophies during what gestational week

Answer 37

7th week

Question 38

Abnormalities of the thoracic cavity include…list them

Answer 38

pulmonary hypoplasia, cystic lung masses, bronchogenic cysts, pleural effusion (hydrothorax), solid lung masses, pulmonary sequestration, congenital cystic adenomatoid malformation (CCAM), congenital bronchial atresia

Question 39

Pulmonary hypoplasia

Answer 39

caused by a decrease in the number of lung cells, airways, and alveoli, with a resulting decrease in organ size and weight
small, inadequately developed lungs
most commonly occurs after prolonged oligohydramnios or secondary to a small thoracic cavity caused by a structural or chromosomal abnormality
prognosis is grave, 80% dying after birth

Question 40

Common abnormalities associated with pulmonary hypoplasia

Answer 40

AFI volume reduced
kidney abnormalities
severe IUGR 
early rupture of membranes
page 1314-1315

Question 41

If you encounter fetal pleural effusions you should make a careful search of something specific

Answer 41

lung, cardiac, and diaphragmatic lesions

evaluation for signs of hydrops (ascites, scalp edema, tissue edema)

Question 42

diaphragmatic hernia Is frequently associated with other abnormalities…pick the one that doesn’t fit

Answer 42

tetralogy of Fallot, renal agenesis, cystic dysplasia, ureteropelvic junction obstruction, holoprosencephaly, hydrocephalus, spinal anomalies, clubbed feet, hemivertebrae, absent ribs, ambiguous genitalia, imperforate anus, annular pancreas, absent GB

Question 43

Presence of pleural effusion may cause this to occur

Answer 43

compress lung tissue causing pulmonary hypoplasia

Question 44

Gastroschisis

Answer 44

a periumbilical defect nearly always located to the right of the umbilicus
an opening in the layers of the abd wall with herniation of the bowel and infrequently the stomach and genitourinary organs but rarely the liver
not known to be genetically transmitted
small (2-4 cm in size)
located next to the umbilical cord insertion
small bowel is always found in the herniation
coexisting anomalies are rare…just gastrointestinal problems may arise
alpha-fetoprotein levels are high
more common in males
1.75-2.5 in 10,000 births

Question 45

Omphalocele

Answer 45

when bowel loops fail to return to the abd
midline defect of abd muscles, fascia, and skin
herniation covered by a membrane
1) contain the liver within the sac
2) contain a variable amount of bowel without liver
associated chromosomal defects

Question 46

If scoliosis is with omphalocele…what is that

Answer 46

limb-body wall complex (or body-stalk anomaly)

Question 47

Low omphalocele..what other things need to be considered

Answer 47

bladder or cloacal exstrophy
anal atresia
spina bifida
lower-limb defects

Question 48

Beckwith wiedemann…what doesn’t belong

Answer 48

rare group of disorders having in common the coexistence of an omphalocele, macroglossia, and visceromegaly
sporadic cases
macrosomia, macroglossia, visceromegaly, embryonic tumors (Wilm’s tumor, hepatoblastoma, neuroblastoma, rhabdomyosarcoma), omphalocele, growth acceleration, neonatal hypoglycemia, ear creases, polyhydramnios