Ob final study guide Flashcards
1
Q
Obstetric sonography allows the clinician to assess the ______, ______, and _______ of the fetus.
A
development
growth
wellbeing
2
Q
_______ should be performed only when there is a valid medical reason and using the lowest possible ultrasound energy exposure settings
A
Fetal sonography
3
Q
The major biologic effects of ultrasound are believed to be _____ and ______ forces.
A
thermal
mechanical
4
Q
produced and collapse of gas filled bubbles
A
cavitation
5
Q
Sonographer can minimize thermal effects by:
A
not staying in one place too long
6
Q
ALARA
A
as low as reasonably achievable
7
Q
_____ is a higher ultrasound energy level and should be completed as quickly as possible to reduce thermal effects.
A
Doppler
8
Q
_____ is defined as systematic reflection on an analysis of morality. A study of what is good and bad and of moral duty and obligiation.
A
ethics
9
Q
A code of ethics for sonographers has been adopted by the:
A
Society of Diagnostic Medical Sonography
10
Q
_____ concerns right and wrong conduct and good and bad character. The production of cherished values that related to how a person interacts and lives in peace.
A
Morality
11
Q
_______ directs the sonographer to not cause harm.
A
nonmaleficience
12
Q
_______ is providing complete information and assuring comprehension
A
informed consent
13
Q
_______ by a patient or subject to a required or experimental procedure
A
voluntary consent
14
Q
______ is the greater balance of clinical “goods” over “harm. Meaning the exam must be justified and the clinical importance outweighs the possible harm caused by the exam.
A
Beneficence
15
Q
______ refers to a person’s capacity to formulate, express, and carry out value based preferences.
A
autonomy
16
Q
_______ means truthfulness.
A
veracity
17
Q
______ is the adherence to moral and ethical principles.
A
integrity
18
Q
______ is the ethical principle that requires fair distribution of benefits and burdens.
A
justice
19
Q
______ is the obligation of caregivers to protect clinical information about patients from unauthorized access.
A
confidentiality
20
Q
Indications for first trimester sonography
A
confirm IUP
evaluate suspected ectopic
estimate gestational age
diagnose multiple pregnancies
confirm cardiac activity
as an adjunct to interventional ultrasound guided procedures
21
Q
interventional ultrasound guided procedures
A
amniocentesis
chorionic villus sampling
embryo transfer
localization and removal of intrauterine devices
22
Q
_______ is a midline cranial defect in which there is herniation of the brain and meninges
A
cephalocele
23
Q
______ is a rare, lethal anomaly of cranial development. Primary abnormalities include: defect in occiput involving the foramen magnum, retroflexion of the spine, and open spinal defects
A
ineincephaly
24
Q
______ is the dilation of the ventricular system without enlargement of the cranium.
A
ventriculomegaly
25
______ is a congenital defect caused by an extra chromosome, which causes a deficiency in the forebrain. It is a malformation of the prosencephalon to differentiate into cerebral hemispheres and lateral ventricles between four and eight week.
Holoprosencephaly
26
______ result in a cystic dilation of the fourth ventricle with dysgenesis or complete agenesis of the cerebellar vermis and frequently hydrocephalus
Dandy-Walker malformation
27
______ is when the neural tube fails to close after 6 weeks gestation.
spina bifida
28
The banana sign is associated with _____
spina bifida
29
The lemon sign is associated with _____
scalloping the frontal bones
30
Abnormal wall defects
bowel herniation
gastroschisis
omphalocele
31
appears sonographically as an echogenic mass at the base of the cord between 8 and 12 weeks
bowel herniation
32
Bowel protrusion outside of the abdominal wall. Congenital fissure that remains open past 12 weeks in the wall of the abdomen just to the right of the umbilical cord
gastrochisis
33
abdominal wall defect where the liver, bowel, and stomach are typically located in the umbilical cord. Cannot be differentiated from normal physiological bowel migration until after 12 weeks
omphalocele
34
The fetal bladder is seen as __-__ weeks of gestation
10
12
35
________ is seen as a very large bladder because the obstruction does not allow the bladder to empty properly
obstructive uropathy
36
_______ is fluid filled structure of the with septations that typically surrounds the neck but may extend upward to the head or laterally to the body. it is one of the most common abnormalities seen sonographically in the first trimester
cystic hygroma
37
Cystic hygroma is associated with chromosomal abnormalities and most common are:
trisomy 13, 18, 21
38
In fetuses detected with cystic hygroma in the second and third trimesters, _______ is the most common karyotype abnormality
Turners syndrome
39
The ______ cyst is the most common ovarian/pelvic mass seen in the first trimester of pregnancy
corpus luteum
40
A gestational sac without an embryo may present:
a normal early IUP
abnormal IUP
pseudogestational sac in a patient with an ectopic pregnancy
41
________ , is a gestational sac in which the embryo fails to develop or stops developing at an early stage
anembryonic pregnancy
42
anembryonic pregnancy is also known as:
blighted ovum
43
__________ is when trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity.
gestational trophoblastic disease
44
Sonographic findings of Gestational Trophoblastic Disease
snowstorm appearance caused by hydatidform mole
cluster of grapes
increased blood flow
45
Embryonic bradycardia
<90 BPM
46
Embryonic tachycardia
>170 BPM
47
The amnion is best visualized transvaginally between the __ and __ week
5
7
48
Ectopic pregnancy is located outside the _______/_____ portion of the uterus.
central/fundal
49
One of the most emergent sonographic diagnoses
ectopic pregnancy
50
Approximately __% of maternal deaths are related to ectopic pregnancy.
10
51
Ectopic pregnancy occurs in the _______ in 95% of cases.
fallopian tubes
52
________ is simultaneous intrauterine and extrauterine pregnancy.
heterotopic pregnancy
53
_______ is in the fallopian tube at the cornua of the uterus
Interstitial
54
______ is the most life threatening kind of pregnancy because this area contains the parauterine and myometrial vasculature increasing the risk of massive hemorrhage.
interstitial pregnancy
55
_______ is when the gestational sac is within the cervix
cervical pregnancy
56
_______ frequently presents on ultrasound as an _______ shaped uterus
hourglass
57
______ is when the pregnancy is within the ovary
ovarian pregnancy
58
The maximum thickness of the subcuteaneous lucency at the back of the neck in an embryo at 11-14 weeks
nuchal translucency
59
Markers for cardiac anomalies
increased nuchal translucency
tricuspid regurgitation
reversal of flow in the ductus venosus
60
The partial or complete absence of the cranium
acrania
61
the congenital absence of the brain and cranial vault
anencephaly
62
By 8 weeks 3 primary vesicles seen within fetal brain
prosencephalon
rhombencephalon
mesencephalon
63
Around 20 weeks of gestation, a sonogram may demonstrate a cystic area within the cranium which is the ______
normal rhombencephalon
64
By 9 weeks the _____ has formed and the echoigenic _____ tissue is seen in the lateral ventricles
midline falx
choroid plexus
65
Limb buds are recognizable during the __ week of gestation
6th g
66
Hands and feet decelop later in the first trimester and completely formed the the end of the __ wek
10th
67
At __ weeks calcifications of the clavicle begins, floowed by ossification of the mandible, palate, vertebral column, and neural arches
8
68
Frontal cranial bones begin to calcify at __ weeks followed by long bones
9
69
Palate fusion occurs late in the ____ trimester.
first
70
____ and ____ are noted brightly echogenic structures by the 9th week
maxilla
mandible
71
Abdominal wall is developed by __ weeks of gestation
6
72
Midgut descends into the fetal abdomen at about __ weeks
11
73
Embryonic hear beat starts beating at approximately __ days
23
74
Normal heart rate 5 weeks
92-109 BPM
75
Normal heart rate 6 weeks
112-136 BPM
76
Normal heart rate 7 weeks
112-140 bpm
77
normal heart rate 8 weeks
126-160 BPM
78
Normal heart rate 9 weeks
126-150 BPM
79
Normal heart rate 10 weeks
126-150 BPM
80
Normal heart rate 11 weeks
120-150 BPM
81
Normal heart rate 12 weeks
125-160 BPM
82
Dizygotic twin pregnancies account for __% of all twins
70
83
Dizygotic twins are defined as _____ and _____
dichorionic
diamniotic
84
______ twin arise from two separately fertilized ova.
dizygotic
85
_____ and _____ twins appear as two separated gestational sacs
dichorionic
diamniotic
86
_________ twins appear to be contained within a single gestational/chorionic sac; two amnions; two yolk sacs, and two embryos are identified.
Monochorionic-diamniotic
87
___________ twin gestation is one gestational sac, one yolk sac and one amniotic membrane and two embryos within a single amniotic cavity.
monoamniotic-monochorionic
88
multiple pregnancies with chorionic sac
monochorionic
89
Most common presentation for complications in the first trimester is ______
bleeding or spotting
90
Most common reason for bleeding in the 1st trimester
subchorionic hemorrhage
91
Secondary yolk sac is formed at ___ days when the primary yolk sac is pinched off by the extra embryonic coelom
23
92
The embryonic phase is week __ through week __
4
10
93
During the _____ phase all the major internal and external structures begin to develop
embryonic
94
______ is the most accurate measrement for determining gestational age.
crown rump length
95
The crown length measurement is considered the most accurate through the __ week.
12
96
In early pregnancy, the gestational sac size grows at a rate of __ mm/day
1
97
An embryo with cardiac activity should be identified transvaginally when the gestational sac measures __-__ mm
16-20
98
Mean sac diameter formula
length + width + height/3
99
Initial heart beat occurs between __ - __ weeks
5.5
6
100
Ectopic pregnancies demonstrate a ____ hCG than intrauterine pregnancies
lower
101
The serum leve3l of beta hCG is dramatically elevated with ______
gestational trophoblastic disease
102
hCG is normal 7 week pregnancy doubles every ___ days
3.5
103
A normal gestational sac can be consistently demonstrated with transabdominal scanning when the beta hCG level is ____ mIU/ml
1800
104
AT __-__ weeks hCG levels plateau and subsequently decline while gestation continues
9
10
105
In ______ hCG levels are increased and they plateau much later and fall much more slowly
trisomy 21
106
Intrauterine pregnancy can be visualized sonographically during the __ week
fifth
107
______ is on the myometrium or burrowowing side of conception
decidua basalis
108
the interface between the decidua capsularis and the echogenic, highly vascular endometrium
double decidual sac sign
109
_____ is the earliest intragestational sac anatomy seen
yolk sac
110
_____ is usually seen from 5 weeks gestation
yolk sac
111
Visualization of the _____ predicts a viable pregnancy
yolk sac
112
The diameter of a normal yolk sac should never exceed __mm
6
113
Implantation of the blastocyst into the uterus decidua is completed within __ days after fertilization
12
114
The ______ that separates the amniotic cavity and the chorionic cavity is routinely seen after 5.5 weeks
amniotic membrane
115
Cranial neural folds and closure of the neuropore are completed by __ weeks, forming a cranial vault
7
115
describes all possible pregnancy outcomes
parity
116
the number of pregnancies including the present one
gravidity
117
First trimester is until ______
13 weeks 6 days
118
Second trimester is _____
14 weeks to 26 weeks 6 days
119
Third trimester is ______
27 weeks until term
120
Pregnancy duration
280 days
40 weeks
121
Naegules rule to estimate due date
EDD = LNMP - 3 months + 7 days
LNMP = EDD - 3 months + 7 days
122
_____ is the first dayt of pregnancy
conception
123
dates the pregnancy with the first day of the last menstrual period as the beginning of gestation
gestational age or menstrual age
124
Gestational age would add __ weeks onto the conceptual age
2
125
12 days after conception during the implantation process
zygote
126
After 10 weeks the embryo is called a ____
fetus
127
Trophoblastic cells secrete ____
hCG
128
a glycogen rich mucosa that nourishes the early pregnancy
decidua
129
____ causes the endometrium to convert to ______
decidua
130
Blastocyst typically eneter the uterus --_-- days after fertilization
4
5
131
Implantation into the uterine decidua is completeed within ___ days after fertilization
12
132
______ is the first stie of formation of red blood cells that will nourish the embryo
primary yolk sac
133
Two most common clinical techniques for obtaining living fetal cells or fetal cell products from the pregnant uterus for prenatal diagnosis
amniocentesis
chorionic villus sampling
134
sampling of fluid within the amniotic sac
amniocentesis
135
2 types of amniocentesis
genetic
lung maturity
136
Risk increases for chromonsomal abnormalities after the age of ___
35
137
Indications for amniocentesis
increased AFP
abnormally high MSAFP
abnormally low MSAFP
138
a prenatal test where a sample of chorionic villi is removed from the placenta for testing.
chronic villus sampling
139
Samples of the _______ tissue is used for genetic diagnosis in chorionic villus sampling
trophoblastic
140
Advantages of chorionic villus sampling
earlier genetic testing (9-12 weeks gestation
accuracy
141
disadvantages of chorionic villus sampling
induced fetal anomalies such as limb defects
cells may not represent karyotype
fetal loss
false positive results
142
percutanteous umbilical blood sampling is also known as _____
cordocentesis
143
144
the sampling of blood through the umbilical cord
PUBS
145
_____ carries a higher procedure related risk than either amniocentesis or CVS.
PUBS
146
a technique involving insertion of a needle through the vagina into the extra-amniotic cavity as early as 6 weeks for investigaion of early fetal physiology and pathophysiology
coelocentesis
147
disadvantages of coelecentesis
coelomich cells difficult to culture
nucal lucency and tab accuracy
procedure safety
148
the sampling of fluid from the posterior cul-de-sac to differentiate types of effusions such as clear fluid versus blood or pus
culdocentesis
149
an endovaginal procedure where a catheter is inserted and contrast is injected to evaluate endometrial polyps, Asherman Syndrome, and tubal patency
hysterosonosalpingography
150
fucntioning layer of the endometrium in the gravid woman
decidua
151
the area between the myometrium and the placenta
retroplacental
152
the mucous tissue surrounding the umbilical cord
Wharton jelly
153
The _____ connects tot he fetus and the placenta, and it serves as a lifeline of the fetus
umbilical cord
154
The umbilical cord is made up of 3 vessels, 2 _____ and 1 ____
arteries
vein
155
The arteries carry deoxygenated blood from the ____ to the _____
fetus
placenta
156
The vein brings dexygenated blood back from the ____ to the _____
placenta
fetus
157
The umbilical cord originates from the fusion of the ______ and ______ at approximately 7 weeks gestation.
yolk sac stalk
omphalomesenteric duct
158
umbilical cord abnormalities include:
cord insertion
knots
nuchal cord
single umbilical artery
prolapse/vasa previa
159
The placenta is composed of a _____ portion and a _____ portion.
maternal
fetal
160
The maternal portion of the placenta arises from the ______
endometrium
161
The fetal portion of the placenta arises from a section of the ______
chorionic sac
162
The _____ is the link between the mother and the fetus
placenta
163
Normal cord insertion into the placenta is approximately in the ______ portion
central
164
165
cord insertions near the margin
battledore placenta
166
Cord insertion below the edge of the placenta
velamentous insertion
167
Placental thickness greater than __ cm prior to 24 weeks gestation is considred abnormal
4
168
Placental thickness ____ with gestational age
increases
169
The placenta is responsible for the ____, ____, and ____ functions of the fetus
nutritive
respiratory
excretory
170
Placental grading is used to describe the appearance of the placenta based on the amount of ______
placental calcifications
171
Calcifications are rarely seen before ___ weeks gestation
37
172
Placental thinning of <2cm can be seen in:
maternal hypertension
preeclampsia
placental infarctions
intrauterine growth restriction (IUGR)
172
Thick placentas of greater than __ cm may be nonspecific and are usually associated with a normal outcome
4
172
Easrly maturation of the placenta is associated with _____
hypertension
172
the presence of mone or more accessory lobes
succenturiate
173
ring-shaped placenta that attaches circumferentially to the myometrium
annular placenta
174
a placented with a thickened rolled chorio amniotic membrane
circumvallate placenta
175
abnormal placenta locations
placenta previa
low lying placenta
176
Placenta is in the lower part of the uterus coving the internal os
placenta previa
176
A9n) _______ can mimic placenta previa
overfull bladder
177
Placental attachment disorders
placental accreta
placenta increta
placenta percreta
177
Risk factors for placenta previa
advanced maternal age
previous c section
multiple gestations
previous elective abortions
smoking
cocaine use
multiparity
178
chorionic villi adhere directly to but do not invade the myometrium
placental accreta
179
Most common location of placental accreta
lower uterine segment
180
chorionic villi invade the myometrium
placenta increta
181
chorionic villi invade through the myometriumchorionic villi invade through the myometrium into the uterine serosa and potentially into the surrounding tissue
placenta percreta
182
benign vascular malformation of the placenta arising from the primitive chorionic mesenchyme
chorioangioma
183
very rare and are usually benign but can also be highly malignant
teratoma
184
the premature separation of all or part of the placenta from the myometrium
placental abruption
185
Placental abruption is classified as:
marginal separation
partial separation
complete separation
186
the designation given to several disorders arising from either normal or abnormal fertilization of an ovum, resulting in neoplastic changes in the tropholblastic elements of a developing blastocyst
gestational trophoblastic disease
187
characterized by chorionic villi that are markedly hydropic and swollen, and proliferation of the trophoblast cell resulting in excessive production of beta-human chorionic gonadotropin levels
complete or partial hydatidform mole
188
Similar to invasive moles and are capable of metastaziing. 50% arise after a molar pregnancy
choriocarcinoma
189
rare placental vascular anomaly characterizzed by mesenchymal stem villous hyperplasia
placental mesenchymal disease (PMD)
190
umbilical jcor dabnormalities
vessel number
persistent right umbilical vein
umbilical vein varix
body stalk
limb body wall complexs
abnormal insertion site
umbilical cord cyst
abnormal cord posotion
191
right umbilical (portal) vein rather than the left side remains open
persistent right umbilical vein
192
focal dilation of the umbilical vein
umbilical vein varix
193
complete absence of the umbilical cord
body stalk
194
very short cord
limb body wall complex
195
cord insertion within 1 cm of the margin
Marginal (battledore) placenta
196
umbilical vessels separate and course between the amnion and chorion
velamentous cord insertion
197
some of the velamentous fetal vessels run in the lower uterine segment unprotected by Wharton jelly. They run over or near the region of the insneral os
vasa previa
198
echolucent area within the umbilical cord with the yolk sac defined as a separate structure
umbilical cord cyst
199
cord is wrapped around the neck of the fetusq
nuchal cord
200
Cord devliers before the fetus
prolapse cord
201
Umbilical cysts are defined as _____ or _____
true cysts
pseudocysts
202
_____ have no increased risk of choromosomal anomalies. They are usually located near the cord insertion of the fetal abdomen
true cyst
203
_____ have epithelia lining and represent localized edema of the Wharton jelly or aneurysm of an umbilical bein or artery; show positive association to structural and chromosomal defects
pseduocysts
204
Umbilical cord cyst may compress blood vessels and impair umbilical circulation causeing ______ of the fetus.
intrauterine demis
205
Conditions associated with mechanical vascular obstruction or compression of the umbilical cord vessels
long umbilical cord
narrow cord with diminished Wharton jelly
stricture
nucal body cords
true knots of the umbilical cord
umbilical prolapse
abnormal umbilical cord insertion
206
A long umbilical cord measures greater than
55 cm
207
Abnormal umbilical cord insertions
velamentous cord insertion
vasa previa
succenturiate lobe
208
Maternal infections associated with TORCH
toxoplasmosis, syphilis, hydrocephalus, varicella-zoster, hydrencephaly, parvovirus B19, rubella, cytomegalovirus, herpes
209
TORCH
toxoplasmosis
other
rubella
cytomegalovirus
herpes
210
_______ is the most common maternal disorder
diabetes mellitus
210
insulin dependent, juvenile onset diabetes
type I
211
Non-insulin dependent, adult onset diabetes
Type II
212
Diabetes diagnosed for the first time during pregnancy
gestational
213
Congenital anomalies in infants of diabetic mothers
skeletal anomalies
central nervous system anomalies
cardiac anomalies
renal anomalies
gastrointestinal anomalies
214
The glucose tolerance test is performed between weeks __ and ___
24
28
214
The development of maternal antibodies to the surface antigens of the fetal red blood cells
Rh Isoimmunization
215
Rh isoimmunization is associated with ______
thick placenta
216
a condition characterized by rapid destruction of the fetal red blood cells
erythroblastosis fetalis
217
When a Rh-negative mother carries a Rh positive fetus it can result in fluid overload known as _____
immune fetal hydrops
218
________ prevents Rhisoimmunization
RhoGAM injection
219
inherited disorder, affects the hemoglobin molecule in the blood
sickle cell disease
220
caused by premature red blood cell death
anemia
221
signs of sickle cell disease
fetal death
short femurs
IUGR
increased umbilical and uterine artery S/D ratio
222
high blood pressure during pregnancy and usually resolves upon partuition
pregnancy induced hypertension
223
Complications of hypertension during pregnancy
toxemia (preeclampsia)
hypertension
proteinuria edema
224
consists of all the complications of preeclampia and seizures or coma
eclampsia
225
Hypertension during pregnancy may also occur with the development of ______
toxemia
226
the term used to describe both 3D and 4D imaging
volume ultrasound
227
the automatic or manual acquisition and display of a series of 2D ultrasound
3D ultrasound
228
the continuously updated display of volume information, also known as real time of live 3D ultrasound
4D ultrasound
229
smallest unit of a 2D image
pixel
230
smallest unit of a 3D image
voxel
231
the tool used to measure the volume of an object such as an ovarian cyst
VOCAL
232
the technique used to acquire and display a volume data set of the fetal heart
STIC
233
the display of multiple planes at 90 degrees to each other
orthogonal
234
where the orthogonal planes interset on a 3D image
reference dot
235
display of parallel images similiar to CT and MRI
tomographic imaging
236
Render modes in 3D/4D ultrasound
surface rendering
threshold
eraser or scalpel
maximum, skeletal, or xray, inversion/minimum mode, glass body or transparency, VOCAL
237
removes unwanted structures
eraser or scalpel
238
displays boney structures
maximum, skeletal, or X-ray mode
239
demonstrates fluid filled structures
inversion/minimum modes
240
used in conjunction with with power Doppler
glass body or transparency
241
VOCAL
virtual organ computer aided analysis
242
determines how smooth a surface appears
surface smooth
243
adds texture to enhance details
surface texture
244
displays the structure as if its illuminated by light
gradient light
245
_____ is considered static
3D ultrasound
246
The ultrasound transducer makes a single sweep through the area of interest and the obtained volume is stored and viewed
3D ultrasound
247
live or real time 3D
4D ultrasound
248
the transducer sweeps back and forth continuously acquiring volume data
4D ultrasound
249
allows the fetus to move freely in the amniotic cavity
maintains intrauterine temperature
protects developing fetus from injury
amniotic fluid
250
Amniotic fluid abnormalities may be an indirect sign of an underlying anomaly such as:
neural tube defect
gastrointestinal disorder
251
The ______ forms early in life is filled with amniotic fluid
amniotic cavity
252
Amniotic fluid is produced by:
umbilical cord
the membranes
the lungs
skin
kidneys
253
The amount of amniotic fluid is regulated by:
fluid exchange within the lungs
production of fluid
removal of fluid by swallowing
membranes and cord
254
Fetal production or urine and the ability to swallow begins between __ and __ weeks gestation
8
11
255
Normal AFI correlates with an AFI of __-__ cm/
10
20
256
Low values of AFI
5-10 cm
257
Increased amniotic fluid
20-24 cm
258
decreased amniotic fluid
oligohydramnios
259
_______ is associated with infantile polycystic kidney disease, renal agenesis, dysplastic kidneys, chromosomal abnormalities
oligohydramnios
260
increased amniotic fluid
polyhydramnios
261
<5 cm with largest pocket measuring 2cm or less
oligohydramnios
262
>24 cm with the largest vertical pocket measuring 8 cm or more
polyhydramnios
263
AFV greater than 2000 mL
polyhydramnios
264
_______ is associated with cystic hygroma, coarction of the aorta, and anencephaly
polyhydramnios
265
the cause of various fetal malformations involving limbs, the craniofacial region and the trunk
amniotic band syndrome
266
consist of multiple fibrous strands of amnion that develop in utero that may entangle in fetal parts to cause malformations and amputations
amniotic band syndrome
267
non-floating bands crossing through the amniotic cavity
amniotic sheets
268
Amniotic sheets are _____ than amniotic bands
thicker
269
the disparity between amounts of serous fluid being produced and absorbed. It leads to accumulation of fluid or edema within the fetus that can be represented by: pleural effusion, ascites, cardiac effusion, skin edema, anasarca
hydrops
270
other fetal findings identified with _____ include: enlarged umbilical cord, polyhydramnios, and placental edema and enlarged liver and spleen
hydrops
