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Generalist Exam Questions > OB 1 > Flashcards

OB 1 Flashcards

1
Q

What is the formula for MSD?

A

L+W+H / 3

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2
Q

MSD of what measurement with absent fetal pole indicates pregnancy failure (missed miscarriage) seen via EV?

A

> 25mm

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3
Q

When the MSD measures what via EV, should a YS be visible?

A

8mm

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4
Q

On TA, at what measurement of MSD should we see a yolk sac?

A

20mm

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5
Q

On TA, at what measurement MSD should a fetal pole be visible?

A

> or =25mm

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6
Q

What is a normal yolk sac measurement?

A

<6mm

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7
Q

What is the minimum number of weeks where we can accurately date a pregnancy?

A

7W 0D

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8
Q

What landmarks should be seen within the BPD and HC measurement?

A

CSP
IHF
Thalamus

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9
Q

What landmarks should be seen when assessing cerebellum?

A

CSP
Falx
Cerebellar hemispheres

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10
Q

What is the ideal measurement plane for an accurate CRL?

A

Sagittal

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11
Q

How many mm should a CRL be to establish dates?

A

10mm

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12
Q

What is known as the stretching of ligaments and shifting of bones to accommodate the enlarging uterus during pregnancy?

A

Ligamentous laxity

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13
Q

What is the most serious cause of pelvic pain in the pregnant patient ?

A

Ectopic

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14
Q

A threatened miscarriage is vaginal bleeding prior to how many weeks?

A) <20
B) <15
C) <12
D) <10

A

<20

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15
Q

What percent of pregnancies result in spontaneous abortion before 20 weeks?

A

10-20%

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16
Q

Wha is a blighted ovum?

A

Gestational sac with no contents

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17
Q

A demise is an embryo of how many mm without cardiac activity?

A

5mm

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18
Q

A crescent-shaped sonolucent fluid collection between the gestational sac and the uterine wall is evidence of a?

A

SCH

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19
Q

Genetic testing can tell you the chance of your baby having what 3 abnormalities?

A

1) trisomy 21
2) trisomy 18
3) ONTD

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20
Q

When can an NT test be done?

A

Between 11 W 0 D and 13 W 6 D

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21
Q

What percentage of pregnancy losses are due to genetic abnormalities?

A

50-70%

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22
Q

Implantation occurs how many days after ovulation?

A

6 days

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23
Q

What decidua becomes the maternal portion of the placenta?

A

Basalis

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24
Q

What structure becomes the embryonic placenta?

A

Chorion Frondosum

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25
Q

What is the first structure seen sonographically within the gestational sac?

A

SECONDARY yolk sac

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26
Q

Which embryonic structure migrates from the yolk sac to the gonadal ridges during 6th week of development?

A

Allantois - blood vessels of the allantois become umbilical arteries

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27
Q

What is responsible for forming the primary yolk sac?

A) Cytotrophoblast
B) Epiblast
C) Synciotrophoblast
D) Hypoblast

A

Hypoblast

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28
Q

What is responsible for forming the amnion?

A) Cytotrophoblast
B) Epiblast
C) Synciotrophoblast
D) Hypoblast

A

Epiblast

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29
Q

What brain structure can be seen at 7 weeks?

A

Rhombencephalon

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29
Q

HcG is produced by what structure?

A) Cytotrophoblast
B) Epiblast
C) Synciotrophoblast
D) Hypoblast

A

C

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29
Q

How many days after conception does the heart beat?

A

23 days / 5 weeks

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30
Q

When can the ventricles in the brain be seen?

A

8-9 weeks

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31
Q

When can the CP be seen?

A

9-19 weeks

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32
Q

When do limb buds form and embryonic gut herniates into umbilical cord?

A

8 weeks

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33
Q

When should the umbilical herniation measure?

A

<7mm

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34
Q

At how many weeks does the gut recede back into the abdomen?

A

12 weeks

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35
Q

What are the 3 layers of the blastocyst?

A

Trophoblast - outer layer that forms the maternal placenta
Blastocele - fluid filled cavity
Embryoblast -froms embryo

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36
Q

What are the ball of cells called once egg is fertilized and travels down fallopian tubes?

A

Morula

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37
Q

How many standard deviations below the mean for GA is suspicious of IUGR?

A

2

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38
Q

A uterus LARGE for GA may be due to what? (4)

A

1)Fibroids
2) Incorrect dates
3) Multiple gestations
4) Molar pregnancy

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39
Q

Anembryonic pregnancy is also known as what?

A

Blighted ovum

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40
Q

What kind of abortion is known as “anembryonic pregnancy or embryo demise that has not yet been expelled from the uterus”?

A

Missed abortion

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41
Q

What kind of abortion is known as “placental or fetal tissue has been expelled but some products of conception remain in the uterus”?

A

Incomplete abortion

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42
Q

What are the SF of RPOC?

A

1) thickened endometrium
2) vascularity within endo
3) hyperechoic tissue in uterus

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43
Q

What kind of abortion is known as “profuse bleeding and the cervical os has begun to dilate”?

A

Impending/inevitable abortion

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44
Q

What kind of abortion is known as an “empty low-lying GS with an open cervix”?

A

Impending abortion

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45
Q

Gestational trophoblastic disease is also known as what?

A

Molar pregnancies

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46
Q

What is the difference between a complete and partial hydatidiform molar pregnancy?

A

Complete: the egg has 0 chromosomes, but one sperm donates 23 chromosomes - will NOT see fetal tissue

Partial: A normal egg is fertilized by sperm that duplicates itself, resulting in 69 chromosomes - May see an embryo and placenta with be thick and hydropic

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47
Q

What percentage of patients with complete molar pregnancies develop bilateral, enlarged ovaries with multiple theca lutein cysts, a result of hyperstimulation from the elevated hCG?

A

46%

48
Q

Do partial or complete molar pregnancies have a higher incidence of developing a choriocarcinoma?

A

Complete

49
Q

What abnormality may be described as “cystic to solid areas of necrosis, coagulated blood, or tumor tissue invading and extending as a mass outside the uterine wall with metastatic lesions located in the liver?

A

Choriocarcinoma due to a molar pregnancy

50
Q

What abnormality occurs when the neural tube fails to close at the base of the skull?

A

Anencephaly

51
Q

What abnormality causes a developing baby’s brain to not properly separate into the right and left hemispheres?

A

Holoprosencephaly

52
Q

What abnormality is describes as a cystic dilation of the fourth ventricle that fills the posterior fossa and extends into the cisterna magna AND hypoplasia or complete agenesis of the cerebellar vermis?

A

Dandy-walker

53
Q

What abnormality occurs when the superior neural tube does not close completely?

A

Encephalocele

54
Q

What abnormality occurs when the abdominal wall does not develop and thus the peritoneal cavity is open to the extraembryonic coelom and the fetus is attached to the placenta?

A

Body stalk anomaly

55
Q

What abnormality is known as malformation of the lymphatic system, which is also called nuchal edema or increased NT?

A

Cystic hygroma - associated with turners syndrome AKA monosomy X

56
Q

Megacystitis is the enlargement of the bladder measuring what?

A

LBD > or = to 7mm

57
Q

What is the difference between a true umbilical cyst and pseudocyst?

A

True - from fluid of the embryo and usually resolves

Pseudo - fluid from inside the umbilical cord and is associated with genetic abnormalities

58
Q

What is the most common defect of the hand and foot?

A

Polydactyly

59
Q

At 6 weeks GA, what HR is bradycardia and tachy?

A

Brady - <90 bpm
Tachy - >155 bpm

60
Q

What does PUBS stand for and what is it also known as?

A

Percutaneous Umbilical Blood Sampling AKA cordocentesis

61
Q

What are the two most common clinical techniques for obtaining living fetal cells?

A

Amniocentesis and Chorionic villus sampling (CVS)

62
Q

When is an appropriate GA range to perform amniocentesis?

A

14-20 weeks

63
Q

Indications for amniocentesis?

A

-AMA
-Patient anxiety
-Increased or decreased levels of MSAFP
-Lung maturity assessment
-Isoimmunization status
-Previous pregnancy of known abnormalities

64
Q

When would we use CVS vs. amnio?

A
  1. Earlier results than amnio - 24-48 hours vs 7-10 days
  2. Can be performed earlier - b/w 9-12 weeks after LMP
65
Q

What is a normal cut off for NT assessment?

A

< or equal to 2.9mm

66
Q

What is the gestational period to perform an NT test?

A

11W 0 D to 13 W 6 D

67
Q

What CRL must a fetus be to perform an NT test?

A

45-84mm

68
Q

What kind of tissue is sampled in CVS?

A

Trophoblastic tissue

69
Q

Ectopic pregnancies account for what percent of all pregnancies?

A

2%

70
Q

What is the classic triad for ectopic pregnancies?

A

Bleeding, pain, palpable adnexal mass

71
Q

Where do ectopic pregnancies most often occur?

A

Fallopian tubes (95%) - most commonly in ampullary portion (70%)

72
Q

What is the rarest ectopic?

A

C-section scar

73
Q

What is a heterotopic pregnancy?

A

One normal IUP and one ectopic - the IUP survives in 66% of all heterotopics

74
Q

Absence of an IUP with BhCG above what level should prompt careful evaluation for ectopic pregnancy?

A

1500-2500 mIU/mL

75
Q

What SF is the most obvious indicator of an ectopic?

A

Free fluid

76
Q

What are the three treatments for ectopics?

A

1) Expectant management - when there is no GS and BhCG levels decline

2) Medical treatment - those whos BhCG <5000 and hemodynamically stable

3) Surgical treatment - for those hemodynamically UNSTABLE

77
Q

What drug is used for medical treatment for an ectopic?

A

Methotrexate

78
Q

How many week is pregnancy vs how many weeks INCLUDING LMP

A

38 weeks pregnant

40 weeks includes LMP

79
Q

Fertilization occurs in the ampullary portion of the fallopian tube how many hours after ovulation?

A

24-36

80
Q

Implantation occurs how many days after conception?

A

6 days

81
Q

What vessels are formed by the blood vessels of the allantois?

A

Umbilical arteries

82
Q

The yolk sac cells contribute to the development of what fetal systems? (3)

A

Respiratory
Digestive
Urogenital

83
Q

By the end of the 5th week/beginning of sixth, the embryo can be detected endovaginally at how man mm in length?

A

2-4 mm

84
Q

The intra-decidual sign can be seen how early via ultrasound?

A

3W 4D

85
Q

The yolk sac can be seen by EV at how many weeks and transabdominally at how many weeks?

A

EV - 5 wks
TA - 6-7 wks

86
Q

What fetal head structure appears as a diamond shaped sonolucent structure posteriorly at 7 wks?

A

Rhombencephalon

87
Q

What is the average HR of a fetus at 5 wks GA?

A

110

88
Q

What hormone do we detect in pregnancy?

A) Alpha - HCG
B) Beta - HCG

A

Beta

89
Q

What kind of ectopic pregnancy has a 2.5-5x greater probability of hemorrhage?

A) Cornual
B) Interstitial
C) Intramural
D) Ampullary

A

Interstitial because it’s close to uterine arteries

90
Q
A
91
Q

Abdominal Pregnancies have been reported in what structures?

A
  • Uterine surface
  • Spleen
  • Liver
  • Diaphragm
  • Bowel
  • Omentum
  • Broad Ligament
  • Large Vessels
  • Cul- de-sacs
92
Q

How do you differentiate between a pseudosac and true GS?

A

True GS - vascular and has double decidual sac sign

Pseudo - Avascular and only single sac sign

93
Q

DZ twins make up 70% of twins and are influenced by what factors?

A
  1. AMA
  2. Genetic
  3. Environmental
  4. ART
94
Q

Dizygotic twins will always have two?

A) Chorions
B) Amnions
C) Placentas

A

Placentas - the number of chorions = the number of placentas

2 placentas =2 chorions = DC/DA

95
Q

What sign represents a Di/Di pregnancy?

A

Lamda/twin peak sign

96
Q

What sign represents a Mono/di pregnancy?

A

T-sign

97
Q

Number of YS will be the same number as?

A) GS
B) Amnions
C) Placentas
D) Chorions

A

Amnions

98
Q

At how many weeks is amnionicity and chorionicity determined?

A

11-14 weeks

99
Q

What is TRAP sequence?

A

Twin Reversed Arterial Perfusion AKA Acardiac twinning

One twin = pump twin

Other twin = acardiac twin

Arterial-to-arterial and venous-to-venous anastomoses occur on the surface of the shared placenta

100
Q

What are some SF in TRAP sequence?

A
  • Polyhydramnios
  • Acardiac twin only has lower extremities and pelvis
  • Retrograde UA flow into acardiac twin
  • CHF in normal twin due to increased load
101
Q

What is TTTS?

A

Twin to Twin transfusion syndrome

Donor twin - returning blood from donor twin gets shunted directly to recipient. Donor twin becomes smaller with Oligo

Recipient - gets larger with Poly

102
Q

What abnormality causes the appearance of a “stuck twin” ?

A

TTTS

103
Q

What type of twins have the highest risk of cord entanglement, TTTS, premature birth & congenital
abnormalities?

A) DC/DA
B) MC/DA
C) MC/MA

A

MC/MA

103
Q

The majority of multiple gestations are due to what?

A

ART

103
Q

What percentage of twins will have a vanishing twin in the first trimester?

A

20%

103
Q

What abnormality in known as fetal loss occurring in the second or third trimester or within a MZ twin gestation and appears ‘paper like’ ?

A

Fetus Papyraceus

103
Q

What type of pregnancy occurs with TRAP sequence? What type of pregnancy occurs with TTTS?

A

TRAP - MC/MA

TTTS - MC/DA - usually presents in 2nd trimester

104
Q

What is the normal measurement of a yolk sac?

A

2-6mm

105
Q

In early pregnancy, size of gestational sac should increase by how many mm per day?

A) 1mm
B) 2mm
C) 3mm
D) 4mm

A

A

106
Q

Nuchal translucency should not exceed what measurement?

A) 2.0mm
B) 2.5mm
C) 3.0mm
D) 3.5mm

A

2.5mm

107
Q

What is the most dangerous type of ectopic pregnancy?

A) Ampullary
B) Interstitial
C) Ovarian
D) Fimbrial

A

Interstitial as it’s such close proximity to uterine artery

108
Q

What is seen with a “double bleb” sign?

A) Amnion and chorion
B) Amnion and YS
C) Chorion and YS
D) Two gestational sacs

A

Amnion and YS

109
Q

When does normal embryonic gut herniation occur?

A) 5 wks
B) 6 wks
C) 7 wks
D) 8 wks

A

D - 8 wks

110
Q

What linear structure can be seen connecting the embryo and YS?

A) Amniotic band
B) Chorionic villi
C) Umbilical cord
D) Vitelline duct

A

D

111
Q

Prior to the 2nd trimester, what abnormality can pregnancy induced hypertension be a cause of?

A

Molar pregnancy

112
Q

In what portion of the fallopian tube does fertilization occur?

A

Ampullary - 24 to 36 hours after ovulation

113
Q

A MSD of 2-3mm correlates to what GA?

A) 4 weeks
B) 5 weeks
C) 6 weeks
D) 7 weeks

A

B

114
Q

MSD grows by how much per week?

A) 0.5mm
B) 1mm
C) 1.5mm
D) 2mm

A

1mm/week

115
Q

How much do embryos grow per day?

A) 0.5-1mm
B) 1-1.5mm
C) 1-2mm
D) 2-3mm

A

1-2 mm/day

Generalist Exam Questions (21 decks)

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