Ob/Gyn Flashcards
Sonographic findings with Trisomy 18 include all of the following except (A) IUGR (B) clenched hands (C) holoprosencephaly (D) cystic hygroma
(D) Cystic hygroma is associated with Turner syndrome, not trisomy 18.
Paternally derived triploidy has the following sonographic markers
(A) complete mole
(B) severe asymmetrical IUGR
(C) large placenta with multiple cystic areas
(D) oligohydramnios
(E) A and D
(F) B and D
(C) Paternally derived triploidy is associated with a relatively well-grown fetus that has a proportionate head size. The placenta is large with multiple cystic spaces resembling a molar pregnancy. This accounts for 90% of triploidy.
Maternally derived triploidy has the following sonographic markers
(A) complete mole
(B) severe assymetrical IUGR
(C) large placenta with multiple cystic areas
(D) oligohydramnios
(E) AandD
(F) BandD
(F) Maternally derived triploidy is associated with a small placenta. The fetus has severe asymmetric growth restriction and oligohydramnios.
Amniotic fluid is withdrawn from the gestational sac. Performed after 14 weeks with a low loss rate. It has a 0.3% risk of miscarriage.
Amniocentesis
Performed 10–12 weeks. Cannot rule out spina bifida. Can test for karyotype only. AFP is a fetal protein that may be tested for by concentration levels in the amniotic fluid or in maternal serum.
Chorionic villi sampling (CVS)
Performed 11–14 weeks. Increased loss rate and associated with talipes equinovarus. Early loss rate is thought to be associated with the unfused chorion and amnion. They are difficult to penetrate and often require multiple sticks.
Early amniocentesis
“Tags” chromosomes 13,18,21, X and Y for quick preliminary results It is considered experimental and requires amniocentesis follow-up. Fluorescent chromosomal markers are introduced into the amniotic fluid that “tag” or attach to certain chromosomes. These markers and chromosomes fluorescence allow for early preliminary detection of chromosomal abnormalities.
Fluorescence in Situ Hybridization (FISH).
Technically difficult procedure that tests fetal blood. It involves an insertion of a needle into the fetal umbilical cord and the withdrawal of fetal blood. It may be used in cases of anhydramnios, testing for isoimmunization, fetal blood typing, hemophilias, and other disorders.
Percutaneous umbilical blood sampling (PUBS)
The most common twin zygocity is (A) conjoined twins (B) monochorionic/diamniotic (C) dichorionic/diamniotic (D) monochorionic/monoamniotic
(C) Seventy-five percent of twins are dizygotic.
The “twin peak” sign is
(A) also known as the beta sign
(B) a triangular projection of chorion into the dividing membrane
(C) a sonographic predictor for dizygotic twins
(D) B and C
(E) all of the above
(D) The twin peak is formed when the placental tissue migrates between the chorionic layers. This is 94–100% predictive of dizygotic twins.
Which of the following statements about conjoined twins is not true?
(A) 60% are born alive
(B) 56% of conjoined twins are fused on the ventral wall
(C) polyhydramnios is commonly present
(D) the largest risk of fetal demise is because of cord entanglement
(D) Forty percent of conjoined twins are born stillborn. Fifty-six percent of conjoined twins are thoracoomphalopagus, thoracopagus, and omphalopagus. Polyhydramnios is present 50% of the time. Commonly, there is one umbilical cord that may have an abnormal number of vessels and is shared by the conjoined fetuses.
Shortening of the proximal limb. Shortening of the humerus and femur.
rhizomelia
Shortening of the middle portion of the limb (forearms and lower leg bones). Shortening of the radius/ulna and tibia/fibula.
mesomelia
Shortening of all portions of a limb. Shortening of the entire limb, but can also refer to shortening of a limb without specific reference.
micromelia
Shortening of the hand and foot bones.
acromelia
The most common short limb syndrome is (A) achondrogenesis (B) thanatophoric dysplasia (C) osteogenesis imperfecta (D) jeune thoracic dystrophy
B) The occurrence rate for thanatophoric dysplasia is 1/6000–1/17,000 births. Sonographic findings are polyhydramnios, severe rhizomelia, and micromelia with bowing. The thorax is bell-shaped, and the cranium is cloverleaf-shaped with hydrocephaly and frontal bossing.
What sonographic findings would be identified in a fetus with heterozygous achondroplasia? (A) hydrocephaly (B) frontal bossing (C) “bell shaped” thorax (D) “trident hand” (E) A and C (F) B and D (G) all of the above
(F) Heterozygous achondroplasia accounts for 80% of achondroplasias. It is the most common form of genetic skeletal dysplasia. It is often not identified before 26–27 weeks
What is the most common congenital facial anomaly? (A) proboscis (B) hypotelorism (C) isolated cleft lip/palate (D) low set ears
(C) It has a variable prevalence, with Native American being the highest at 3.6/1000 births.
3-D surface rendering is used to (A) obtain volume measurements (B) obtain technically difficult images (C) image fetal spine (D) image fetal face
(D) Three-dimensional imaging of the internal organs is termed volume imaging. Three-dimensional images of surface structures, such as the fetal face, is surface rendering.
The earliest age at which a gestational sac may be visualized by transvaginal sonography is (A) 4 weeks (B) 6 weeks (C)8 weeks (D)10 weeks
(A) A gestational sac can be visualized by transvaginal scanning as early as 4 weeks.
The optimal time for imaging cardiac structures is (A) 14–18 weeks (B) 18–24 weeks (C) 24–28 weeks (D) 28–32 weeks
(B) Cardiac imaging can be done earlier than 18 weeks, but is dependent on maternal habitus. After 24 weeks, the fetal bones become denser and more cal- cified and begin to limit the sonographic windows that allow visualization of the cardiac structures.
3D volumetric reconstructions are used to show all of the following except (A) fetal face (B) fetal limbs (C) organs (D) digits
(A) Three-dimensional imaging of surface structures, such as the fetal face, is termed surface rendering.
By 12 weeks gestational age, the sonographer can identify what abnormalities? (A) conjoined twins (B) anencephaly (C) duodenal atresia (D) A and B (E) all of the above
(C) Although duodenal atresia has been detected in the first trimester, the classic “double bubble” sign is not usually present until the late second and early third trimesters.
An unexplained increased MSAFP3 can cause what third trimester complications? (A) premature rupture of membranes (B) placental abruption (C) preterm labor (D) A and B (E) all of the above
(E) When the increased AFP is unexplained, it is thought to be because of an increased placental transfer of AFP. The placental dysfunction can occur with various placental abnormalities that may cause third trimester complications.
A markedly increased MSAFP would be associated with (A) amniotic sheets (B) cloacal exstrophy (C) congenital diaphragmatic hernia (D) Smith-Lemli-Opitz syndrome
(B) Cloacal exstrophy is characterized by an abdominal wall defect inferior to the umbilical cord insertion with exstrophy of a cloacal sac and a neural tube defect. It is associated with a markedly increased MSAFP. Amniotic sheets and congenital diaphragmatic hernia do not increase MSAFP. Smith-Lemli-Opitz syndrome is associated with a low level of maternal uE3 and normal MSAFP.
If the triple marker screen shows a decreased AFP,
a decreased estriol, and a decreased hCG, the fetus
is at risk for
(A) trisomy 21
(B) Smith-Lemli-Opitz syndrome
(C) trisomy 18
(D) trisomy 13
(C) If AFP (<0.6 MoM), uE3 (<0.5 MoM), and hCG
(<0.3 MoM) are all decreased, the triple screen will
show an increased risk for trisomy 18.
Which is not a direct sonographic finding of posterior urethral valve obstruction? (A) "keyhole" bladder (B) anhydramnios (C) hydronephrosis (D) pulmonary hypoplasia
(D) Pulmonary hypoplasia can be assumed by the
small thoracic circumference and anhydramnios,
but underdeveloped fetal lungs are not visible by
sonography.
What cranial finding can cause congestive heart failure and hydrops? (A) vein of Galen aneurysm (B) periventricular leukomalacia (C) Dandy-Walker malformation (D) iniencephaly
(A) Vein of Galen aneurysm is an AV malformation located posterior to the third ventricle in the midline of the brain.
What is the name of the cardiac abnormality with
one outflow tract giving rise to both the pulmonary
and aortic branches and associated with a ventricular septal defect?
(A) truncus arteriosis
(B) double outlet right ventricle
(C) tetralogy of Fallot
(D) transposition of the great vessels
(A) Truncus arteriosis consists of one outflow tract overriding a VSD. The right ventricular outflow tract
is absent. Differential diagnosis includes tetralogy of
Fallot with pulmonary atresia. Identifying the pulmonary arteries branching from the main trunk would differentiate the defect.
The cardiac abnormality consisting of a VSD, an over-riding aorta, a small or atretic pulmonary trunk, and right ventricular hypertrophy describes (A) double outlet right ventricle (B) hypoplastic left heart syndrome (C) transposition of the great vessels (D) tetralogy of Fallot
(D) The most predictive sonographic findings is the
overriding aorta and VSD. If the VSD is perimem-branous, it will not appear on the four chamber view.
The right ventricle may appear larger than the left,
but this is not a consistent finding and is dependent
of the degree of pulmonary stenosis. Differential diag-
nosis would include truncus arteriosis.
Which of the following describes congenital cystic
adenomatoid malformation?
(A) may spontaneously regress
(B) poor survival rate
(C) divided into two subsets, solid and cystic
(D) none of the above
(A) Congenital cystic adenomatoid malformation
(CCAM) is divided into three subsets; macro, medium,
and microcystic. Survival rate combines all types and
sizes and is 75-80%. Studies have shown that CCAM
regresses 55-69% of the time.
Which of the following statements regarding congenital diaphragmatic hernia are true? (A) more commonly right sided than left sided (B) carries a poor prognosis (C) may be associated with chromosomal abnormalities (D) all of the above (E) A and C (F) B and C
(F) Congenital diaphragmatic hernia is left sided
75-90% of the time. Prognosis is poor, particularly if
the liver is herniated into the chest. Five to fifteen percent of congenital diaphragmatic hernias are associated with chromosomal abnormalities, commonly trisomy 18.
Esophageal atresia is
(A) diagnosed by ultrasound 90% of the time
(B) associated with oligohydramnios
(C) is a component ofthe VACTERL complex
(D) can be diagnosed in the first trimester
(D) Ninety percent of esophageal atresias have a
tracheoesophageal fistula. This allows amniotic
fluid to reach the stomach, but at a slower rate. The
stomach will be visualized, but may be smaller than
usual. Polyhydramnios occurs in the mid to late second trimester. The VACTERL complex is: vertebral
anomalies, anal atresia, cardiac abnormalities,
tracheoesophageal atresia, renal anomalies, and
limb anomalies. At least three of the anomalies
listed must be present to diagnosis the VACTERL
condition.
An increased MSAFP is associated with all of the following except (A) trisomy 21 (B) neural tube defect (C) maternal preeclampsia (D) gastroschisis
(A) Trisomy 21 is associated with a decreased MSAFP and an increased hCG.
The uterine ligament responsible for uterine orientation is (A) transversal ligament (B) broad ligament (C) uterosacral ligament (D) round ligament
(C) The uterosacral ligament is the distal portion of
the cardinal ligament. It anchors the cervix and is
responsible for uterine orientation.
Which two ligaments are not true ligaments? (A) uterosacral and broad ligament (B) suspensory and broad ligament (C) uterosacral and round ligament (D) cardinal and suspensory ligament
(B) Both the suspensory and broad ligaments are folds of peritoneum.
The most commonly visualized pelvic muscle often mistaken for an ovary is (A) piriformis muscle (B) levator ani muscle (C) coccygeus muscle (D) iliopsoas muscle
(D) The iliopsoas muscle runs laterally to the uterus, near the iliac vessels. In transverse, it is ovoid and hypoechoic and may be mistaken for an ovary.
The most dependent portion of the peritoneum is called (A) pouch of Douglas (B) vesicouterine pouch (C) retropubic space (D) none of the above
(A) The most dependent portion is the pouch of Douglas, or the posterior cul-de-sac. It is located posterior to the cervix and anterior to the rectum.
The three peritoneal spaces in the pelvic cavity are: (A) PCDS, ACDS, and vesicouterine (B) PCDS, pouch of Douglas, ACDS (C) PCDS, ACDS, and prevesical (D) PCDS, ACDS, and interstitial
(C) The posterior cul-de-sac (pouch of Douglas) is located posterior to the uterus. The anterior cul-de-sac (vesicouterine pouch) is located anterior to the uterus. The prevesical space (retropubic space) is anterior to the bladder. They form the peritoneal spaces of the pelvic cavity.
AIUM guidelines for cleaning a transvaginal probe are (A) clean with soap and water (B) immerse in disinfecting solution (C) clean with moist towelette (D) AandB (E) A and C (F) all of the above
(D) Transvaginal probes need to be cleaned with soap and water as well as soaked in a disinfecting solution. Transabdominal probes may be cleaned with a moist towelette.
An invasive mole is also known as (A) hydatidiform mole (B) triploid molar pregnancy (C) endometrioma (D) chorioadenoma destruens
(D) An invasive mole and a hydatidiform mole are excessive trophoblastic proliferation. Unlike the hyda-
tidiform mole, chorioadenoma destruens is malignant
and invades into the myometrium.
Which of the following is true regarding a hydatidiform mole and coexistent fetus?
(A) consistent with maternally derived trisomy 13
(B) consistent with paternally derived trisomy 13
(C) can progress to choriocarcinoma
(D) A and C
(E) Band C
(E) Paternally derived trisomy 13 presents with a large placenta sometimes termed a partial mole. Less commonly, a dizygotic pregnancy may occur. One fetus results from normal fertilization of one egg and a complete molar pregnancy results from the fertilization of the other egg. In those cases, it is possible for the hydatidiform mole to advance to choriocarcinoma.
In what portion of the fallopian tube does fertilization usually occur? (A) interstitial (B) isthmus (C) ampulla (D) infundibulum
(C) The ovum enters the fallopian tube at the fimbriated ends. It courses to the ampulla where fertilization occurs 24-36 hours after ovulation.
The sonographic appearance of an ectopic gestation
includes all of the following except
(A) increased endometrial lining
(B) irregular adnexal mass or ovarian mass with ring of color flow Doppler
(C) fluid in the cul-de-sac
(D) absence of sac within the uterus
(D) The decidual reaction may resemble an early intrauterine sac. A yolk sac or embryonic pole will confirm an intrauterine pregnancy.
Rank the following ectopic pregnancy implantation
sites from the most common to the least common.
(1) ampullary
(2) ovarian
(3) isthmus
(4) cervical
(A) 1,2,3,4
(B) 4,2,3,1
(C) 1,3,2,4
(D) 3,1,4,2
(C) The occurrence rates for ectopic locations are: ampullary-most common (75-80%) isthmus-second most common (10-15%) ovarian (0.5%) cervical (0.1%)
Fetal demise is the detection of an absent heart beat
after 16 weeks.
(A) True
(B) False
(B) Fetal demise is defined as an absence of fetal heart tones after 20 weeks.
Which of the following is not true of dysgerminoma?
(A) It is a solid malignant germ cell tumor of the ovary.
(B) It is a counterpart of seminoma of the testis.
(C) It is a relatively uncommon tumor accounting for about 2% of all ovarian cancers.
(D) 90% are unilateral.
(E) It is a solid benign tumor.
(E) Dysgerminoma is a malignant tumor.
Which of the following is not true of dermoid tumors?
(A) may cast an acoustic shadow
(B) encountered more in women over 40 years
(C) also called benign cystic teratoma
(D) most common benign germ cell tumor in the female
(E) unilateral in about 80% of cases
(F) The tumor has elements such as hair, tooth, bone, endoderm, ectoderm, mesoderm, and thyroid glandular tissue.
(G) may be echogenic because of fat content and
sonographically produce “tip of the iceberg” effect
(B) Dermoid cysts are more common in younger women.
The normal adult ovaries measure (A) 3 x 2 x 2 em (B) 2 x2 x4 em (C) 3 x 3 x 2 cm (D) 3 x 2 x 1 em
(A) Normal adult ovarian size is 3 x 2 x 2 cm.
The first definitive sonographic sign of an intrauterine pregnancy is (A) gestational sac (B) yolk sac (C) fetal pole (D) double decidua sign
(B) The first finding is a gestational sac, however ectopic pregnancies may also present with a pseudosac. A yolk sac is the earliest definitive sonographic sign of an intrauterine pregnancy.
What percentage of cardiac defects can be detected from the four-chamber view? (A) 50 (B) 65 (C) 80 (D) 85
(B) The detection rate is 65%, but may vary among patients depending on the maternal habitus, fetal position, AFV, ultrasound machine, and expertise of the sonographer and physician.
What percentage of cardiac defects can be detected
from the four-chamber view and outflow tracts?
(A) 50
(B) 65
(C) 80
(D) 85
(D) The detection rate is 85%, but may vary among
patients depending on the maternal habitus, fetal
position, AFV, ultrasound machine, and expertise of
the sonographer and physician.
A simple cyst may exhibit all of the following except (A) anechoic interior (B) posterior enhancement (C) thin walled (D) distal acoustic shadows
(D) Distal acoustic shadowing is associated with a solid mass.
The cyst commonly associated with hydatidiform mole is
(A) follicular
(B) paraovarian
(C) Theca lutein cysts are present in 18-37% of hydatidiform moles.
The most accurate method for establishing EDC is (A) first trimester ultrasound (B) second trimester ultrasound (C) LMP (D) Nagele's rule
(A) The CRL is the most accurate because fetal growth is very uniform and is rarely affected by pathological disorders. The choices C and D are based on
maternal LMP, which assumes ovulation on day 14.
The accuracy of gestational age in the first trimester is (A) 3-5 days (B) ± 10 days (C) ± 14 days (D) ± 21 days
(A) Fetal growth in the first trimester is very uniform, thus allowing for accurate dating.
The accuracy of gestational age from 13-20 weeks is (A) 3-5 days (B) ± 10 days (C) ± 14 days (D) ± 21 days
(B) Fetal growth is starting to show variation and multiple parameters are used to calculate the EDC.
Both of these factors allow for an increased range of
error.
The accuracy of gestational age from 20-30 weeks is (A) 3-5 days (B) ± 10 days (C) ± 14 days (D) ± 21 days
(C) Fetal growth is showing a moderate amount of variation, which allows for an increasing range of error.
The accuracy of gestational age in the third trimester is (A) 3--4 days (B) ± 10 days (C) ± 14 days (D) ± 21 days
(D) Fetal growth has a large amount of variation in the third trimester and obtaining the images for
The normal rise of hCG in a viable pregnancy should (A) double in 24 hours (B) double in 48 hours (C) double in 72 hours (D) double in 1 week
(B) The hCG doubles in approximately 48 hours until 6 weeks.
Conditions associated with a poorly rising or decreasing hCG include all of the following except (A) twin pregnancy (B) ectopic pregnancy (C) anembryonic demise (D) incorrect dates
(A) Twin pregnancy is associated with an elevated hCG.
An ovarian mass identified on sonogram is complex, predominately hypoechoic with septations. The patient complains of severe pain during menses. The most likely diagnosis is (A) corpus luteal cyst (B) granulosa cell (C) thecoma (D) endometrioma
(D) The internal component of an endometrioma is typically blood from bleeding ectopic endometrial tissue during menstruation. Differential diagnosis may include a dermoid tumor; however, most women tend to be asymptomatic with dermoids.
If a patient's LMP is 6/15/2001, by Nagele's rule, the EDC should be (A) 2/22/2002 (B) 2/30/2002 (C) 3/22/2002 (D) 3/30/2002
(C) Nagele’s rule is: (1) identify the LMP, (2) add 7 days, (3) subtract 3 months, and (4) add one year.
The differential diagnosis for a thick-walled ovarian cyst with blood flow surrounding the periphery is (A) follicular cyst (B) oocyte (C) corpus luteal cyst (D) all of the above
(C) A corpus luteal cyst and ectopic pregnancy may
mimic each other, and the sonogram should be cor-related with clinical findings.
The following are true characteristics of a mucinous cystadenoma except (A) the largest abdominal tumor (B) thick septations (C) benign (D) may have debris layering within cyst
(A) A mucinous cystadenoma is the largest ovarian tumor.
Another name for polycystic ovarian syndrome is (A) Stein-Leventhal syndrome (B) Seroli-Leydig cell (C) Brenner's tumor (D) Chocolate cyst
(A) Seroli-Leydig cell tumor is an androblastoma and Brenner’s cell tumor is a transitional cell tumor. Chocolate cyst is another name for endometrioma.
The etiology of hydatidiform mole is
(A) trophoblastic changes in a blighted ovum
(B) hydatid swelling of the retained placenta in a missed abortion
(C) fertilization of an ovum without any active chromosomal material
(D) A and B
(C) The etiology of hydatidiform mole is fertilization of an ovum without any active chromosomal material.
All of the following characteristics of color Doppler energy are false except
(A) CDE can determine the direction of blood flow
(B) CDE can determine the velocity of blood flow
(C) the different colors represent flow toward or away from the transducer
(D) CDE is based on the amplitude of the soundwave
(D) Blood flow direction and velocity are characteristics of color Doppler imaging.
The term trophoblast denotes
(A) the extra-embryonic peripheral cells of the blastocyst
(B) a rigid state of the flagellate microorganism
(C) the gestation sac
(D) the characteristics of a disease
(A) The extra-embryonic peripheral cells of the blastocyst. The trophoblast forms these cells, which form the wall of the blastocyst.
The mean diameter of a dominant follicular cyst at the time of ovulation is (A) 10mm (B) 15 mm (C) 20 mm (D) 25 mm
(C) By approximately day 14 of the menstrual cycle, one or more dominant follicles will reach a mean diameter of 20 mm with a hypoechoic rim.
The most common uterine tumor is (A) leiomyoma (B) adenomyosis (C) leiomyosarcoma (D) endometrial hyperplasia
(A) Leiomyomas are present in 25% of the female
population with a higher percentage in African American women and becoming more prevalent in
the fourth generation of life.
A complex adnexal mass is identified in a patient with tenderness and elevated temperature. The most likely diagnosis is (A) tubo-ovarian abscess (B) corpus luteal cyst (C) serous cystadenoma (D) Brenner's tumor
(A) The majority of tubo-ovarian abscesses are bacterial in origin. Symptoms are similar to other bacterial infections including pain, fever, and increased white blood cell count.
The endometrium can appear echogenic (1) in the secretory phase, (2) in patients with pelvic inflammatory disease, (3) after dilation and curettage, (4) in patients with endometritis, (5) after removal of an intrauterine contraceptive device (A) 1 and 3 only (B) 4 only (C) 1,2,3, and 5 (D) all of the above
(D) All of the above. Decidual proliferation in ectopic
pregnancy and endometrial carcinoma can also cause
the endometrium to appear echogenic.
The endometrial lining in postmenopausal women not on hormone replacement therapy should be less than (A) 10mm (B) 8mm (C) 6 mm (D) 2mm
(C) Normal endometrial lining in postmenopausal
women not on hormone replacement therapy is
<5-6 mm.
The endometrial lining in postmenopausal women on hormone replacement therapy should be less than (A) 10 mm (B) 8mm (C) 6mm (D) 2mm
(B) Normal endometrial lining in postmenopausal
women on hormone replacement therapy is <8 mm.
The best time to visualize a polyp is during what stage of the menstrual cycle? (A) menstruation phase (B) follicular phase (C) proliferative phase (D) secretory phase
(C) In the proliferative phase, the lining is thick, but the internal component is hypoechoic. This allows for the echogenic polyp to be seen. In the secretory phase, the entire endometrial lining is echogenic and will mask a polyp.
The date of the last menstrual period indicates
(A) the date when fertilization occurred
(B) the date when menstrual bleeding ended
(C) the date when ovulation occurred
(D) the date when menstrual bleeding began
(D) LMP refers to the first day of the last cycle.
Which of the following diagnoses does not mimic the sonographic characteristic of hydatidiform mole? (A) endometriosis (B) hematoma (C) uterine leiomyoma (D) anembryonic demise
(A) The differential diagnoses that may mimic hyda-tidiform moles are missed abortions, leiomyomas, and hematomas. Endometriosis is endometrial tissue outside of the endometrial lining.
What percentage of patients diagnosed with hyda-tidiform mole will usually follow a benign course? (A) 20 (B) 10 (C) 50 (D) 80
(D) 80
The uterus can be divided into regions. List them from inferior to superior. (A) cervix, isthmus, corpus, fundus (B) serosal, myometrial, endometrial (C) fundus, isthmus, corpus, cervix (D) cervix, corpus, isthmus, fundus
(A) The cervix is the most inferior portion of the uterus and invaginates into the vagina. Moving superiorly, the next section is the isthmus beginning at the internal os. The body, or corpus, of the uterus is the largest section of the uterus. The most superior portion is the fundus.
The uterine layers are (A) cervix, isthmus, corpus, fundus (B) serosal, myometrial, endometrial (C) fundus, isthmus, corpus, cervix (D) peritoneum, serosal, and myometrial
(B) The outer layer is the serosal, or peritoneal layer. The large muscular middle layer is the myometrium, and the inner layer is the endometrium.
Prepubertal uterus
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(C) The cervix is larger than the body of the uterus in prepuberty.
Adult nulliparous woman
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(B) If the woman has not delivered a child before, the cervix and corpus are equal in size.
Adult multiparous woman
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(A) After a full term pregnancy, the corpus is twice as long as the cervix.
The normal size of a multiparous uterus is (A) 5x4x3 cm (B) 7x5 x4 cm (C) 10x6x5 cm (D) 6x4x3 cm
(C) A nulliparous uterus is 8x5x4 cm. A post-menopausal uterus is 7x4x3 cm.
In postmenopausal women, the uterus will not atrophy as much in multi gravid women as nulligravid women
(A) true
(B) false
(B) False. The uterus atrophies equally in both multi-gravid and nulligravid women.
Congenital abnormalities of the uterus result from improper fusion of the (A) mesonephric ducts (B) paramesonephric ducts (C) Gartner's duct (D) Wolffian ducts
(B) Congenital abnormalities result from improper fusion of the mullerian, or paramesonephric ducts.
During the early proliferative phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mrn
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(A) The proliferative phase is day 5-9 postmenstruation.
During the periovulatory phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mm
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(C) The periovulatory, or late proliferative phase is day 10-14 postmenstruation.
During the secretory phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mm
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(D) The secretory phase is day 15-28 postmenstruation. The echogenicity is a result of edema of the
functional zone of the endometrium.
Women with endometriosis may have (A) dyspareunia (B) metromennorhagia (C) dysmenorrhea (D) all of the above
(D) Symptoms of endometriosis caused by adhesions
include dysmenorrhea, low back pain, dyspareunia
(painful sexual intercourse), irregular bleeding and
infertility.
Endometriosis is (A) ectopic endometrial tissue (B) benign invasion of endometrial tissue into the myometrium (C) endomyosarcoma with chocolate tissue (D) inflammation of the endometrium
(A) The most common locations for endometriosis
are: ovaries, uterine ligaments, rectovaginal septums,
posterior cul-de-sac, and pelvic peritoneum.
The most common location for a dermoid cyst is (A) posterior cul-de-sac (B) right adnexa (C) left adnexa (D) superior to the uterine fundus
(D) Dermoid tumors are most commonly located superior to the uterine fundus.
Macrosomia is (A) fetus weighing >4,000 g (B) fetus >90% for gestational age (C) fetus with a shoulder thickness >10 mm (D) LGA fetus
(A) A fetus greater than the 90th percentile for esti-
mated fetal weight is termed large for gestational age
(LGA). A fetus greater than 4000 g is macrosomic.
LGA is a term referring to (A) a fetus weighing >4,000 g (B) fetus >90% for gestational age (C) a clinical assessment of an increased fundal height (D) polyhydramnios
(B) LGA refers to a fetus measuring greater than
the 90th percentile for gestational age.
A macrosomic fetus is at risk for (A) shoulder dystocia (B) increased perinatal morality (C) prolonged labor (D) all of the above
(D) All of the above. Identification of a macrosomic fetus can alert the obstetrician to watch for complications of macrosomia during delivery.
Macrosomia may be associated with (A) IDDM (B) GDM (C) HTN (D) Rh isoimmunization (E) AandB
(E) Insulin-dependent diabetes mellitus (IDDM) and
gestational diabetes mellitus (GDM) may both cause
macrosomia. If the IDDM involves vascular disease,
the fetus may actually be at risk for intrauterine
growth retardation.
An increased fundal height may be caused by (A) macrosomic fetus (B) polyhydramnios (C) twins (D) all of the above
(D) Other causes for an increased fundal height include fibroids, incorrect dates, and molar pregnancy.
IUGR is (A) EFW <10% (B) decreased AFV (C) increased umbilical cord dopplers (D) abnormal growth ratios
(A) Although the other features, such as oligo-hydramnios, do often coexist and interact with IUGR,
the diagnosis of IUGR is a fetus <10% for gestational
age.
An increased HC/AC is a suggestion of (A) late onset ofIUGR (B) brain sparing effort (C) placental insufficiency (D) all of the above
(B) An increased HC/AC ratio is the result of redistribution of fetal blood away from the bowel and directed to the fetal head.
Causes of IUGR include (A) fetal infection (B) chromosomal abnormality (C) placental insufficiency (D) all of the above
(D) All of the above. IUGR may be found in chromosomal abnormalities, infection early in pregnancy, and placental insufficiency.
IUGR can be caused by all except (A) diabetes (B) maternal hypertension (C) chromosomal abnormalities (D) spina bifida
(D) Spina bifida is not associated with IUGR. Diabetes with vasculopathy, maternal HTN, and chromosomal abnormalities may all be associated with IUGR.
Doppler testing of vessels that may aid in the diagnosis of IUGR are (A) umbilical cord (B) straight sinus (C) celiac axis (D) jugular vein (E) A and C (F) all of the above
(A) An increase in systolic/diastolic ratio has been shown to have a correlation with placental insufficiency.
Doppler sampling of the maternal uterine artery <26 weeks shows a diastolic notch. This notch is indicative of (A) IUGR (B) maternal HTN (C) normal (D) A and B
(C) The diastolic notch is normal before 26 weeks and is related to trophoblastic invasion.
Rank the following in order of their neurologic development, earliest to latest. (A) Body motion (B) Fetal tone (C) Breathing (D) Fetal heart rate acceleration
(B) The central nervous center that regulates fetal tone functions first at 7.5-8.5 weeks.
(A) The central nervous center that regulates body movements starts functioning at 9 weeks.
(C) The central nervous center that regulates fetal breathing starts at 21 weeks.160.
(D) The central nervous center for fetal heart rate
reactivity functions by the end of the second trimester
or beginning of the third trimester.
Placental grading is an important component of BPP.
(A) true
(B) false
(B) Components of a BPP include flexion/extension, gross body movement, breathing, amniotic fluid, and NST.
The components of BPP are
(A) fetal breathing, Doppler, NST, gross body movement, and AFV
(B) placental grade, NST, gross body movement, and AFV
(C) NST, Doppler, gross body movement, AFV, and fetal flexion/extension
(D) AFV, gross body movement, fetal flexion/extension, fetal breathing, and NST
(D) If the component (i.e., movement) is present, it is given a score of two. If it is absent, it is given a zero with the total score being 10.
Fetal breathing must last how long to be counted in the BPP? (A) 20 seconds (B) 30 seconds (C) 1 minute (D) 2 minutes
(B) Fetal breathing must last at least 30 seconds in a 30-minute time period in order to score a 2 in the BPP.
In a normal fetus, if the middle cerebral artery is sampled, one would expect to find (A) an increased S/D ratio (B) a decreased S/D ratio (C) retrograde flow (D) absent flow
(A) In response to hypoxia, the fetus reroutes blood to
the brain in a brain-sparing effort. The middle cerebral artery is normally of higher resistance, but it will decrease to compensate for the increased blood flow
and brain-sparing effort.
The only purpose of amniotic fluid is to allow the fetal lungs to develop and to allow for fetal movement.
(A) true
(B) false
(B) Amniotic fluid also controls temperature, protects
the fetus, allows growth, and prevents infection.
The amniotic fluid production is performed primarily by the fetus after what gestational age in pregnancy? (A) 8 weeks (B) 10 weeks (C) 16 weeks (D) 25 weeks
(C) Although the kidneys produce some urine prior to 16 weeks, they do not take over the majority of urine production until after 16 weeks.
When does the amniotic fluid volume peak in preg-nancy? (A) 20 weeks (B) 24weeks (C) 33 weeks (D) 38 weeks
(C) The maximum amniotic fluid volume peaks at
approximately 33 weeks, and then begins to decline.
An exact volume of amniotic fluid can be determined
by measuring the four quadrants of the maternal abdomen.
(A) true
(B) false
(B) The exact uterine volume cannot be determined by the sonogram.
In the single pocket method, when is the diagnosis
of oligohydramnios made?
(A) a single pocket of 2 mm cannot be measured
(B) a single pocket of 1 cm cannot be measured
(C) a single pocket of 2 cm cannot be measured
(D) a single pocket of 4 cm cannot be measured
(B) This method is not as accurate as the amniotic fluid index.
In the amniotic fluid index method of measuring four quadrants, the diagnosis of oligohydramnios is made
(A) when the amniotic volume is less than 300 mL
(B) when the amniotic volume is less than 200 mL
(C) when the amniotic fluid index is less than the
10th percentile
(D) when the amniotic fluid index is less than the
2.5th percentile
(D) All four quadrants are added and compared to
an expected amniotic fluid volume for that fetus’ ges-
tational age. The normal range extends from 2.5% to
97.5%.
The nonspecific signs of fetal death are which of the
following: (1) echoes in the amniotic fluid, (2) the
absence of the falx cerebri, (3) a decrease in the bi-
parietal diameter (BPD) measurements, (4) a double
contour ofthe fetal head (sonographic halo sign).
(A) 3 and 4
(B) 4 only
(C) all of the above
(D) none of the above
(C) All of the above. Nonspecific signs of fetal death
are double contour of the fetal head caused by scalp
edema, absence of the falx cerebri because of lique-
faction of the brain, echoes in the amniotic fluid
because of fragmentation of the fetal skin, and a
decrease in biparietal diameter measurements
because of collapse of the cranial sutures after
death.
How long after fetal death can scalp edema be seen? (A) 2-3 days (B) 5-10 days (C) 10-20 days (D) 20-30 days
(A) Scalp edema can be seen 2-3 days, or 24-72 hours, after fetal death.
The term decidua denotes the transformed endo-metrium of pregnancy. The different regions of the
decidua are divided into
(A) two regions called decidua basalis and chorionic villi
(B) one region called decidual reaction
(C) three regions called decidua basalis, decidua
parietalis, and decidua capsularis
(D) three regions called endoderm, mesoderm, and
ectoderm
(C) The decidua of early intrauterine pregnancy is divided into decidua basalis, decidua parietalis (vera), and decidua capsularis. This marked hypertrophic
change in the endometrium occurs no matter where
the pregnancy is located. The uterine mucosa responds by a decidual reaction caused by hormonal stimuli. However, when an ectopic pregnancy occurs, the uterine decidua responds by a cast off-decidual cast. This should not be confused with the normal decidua in an early pregnancy.
Cystic masses in the vagina could include all of the following except (A) Gartner's duct cyst (B) Nabothian cyst (C) hematocolpos (D) vaginal agenesis
(D ) Vaginal agenesis is the absence of a vagina. Gartner’s duct cyst, Nabothian cyst, and hematocolpos will appear as a cystic mass in the vagina.
The functions of the secondary yolk sac are which of the following
(A) nutrients for the embryo
(B) hematopoiesis
(C) contributing to the development of the reproductive system
(D) all of the above
(D) All of the above. The functions of the yolk sac are: nutrition-transfer of nutrients to the embryo; hemopoiesis-blood cell development; and development of sex cells that later become spermatogonia or oogonia.
In about 2% of adults, the yolk sac persists as a diverticulum of the ileum. This is known as (A) Michael's diverticulum (B) Meckel's diverticulum (C) Turner's diverticulum (D) Smith's diverticulum
(B) The yolk sac reduces in size as pregnancy advances. However, it may persist throughout preg-
nancy and continue to persist into adulthood. In
about 2 of adults, the proximal intra-abdominal
part of the yolk sac is presented as a diverticulum of
the ilium, called Meckel’s diverticulum.
The location of the yolk sac is
(A) inside the umbilical cord
(B) inside the amniotic cavity
(C) in the chorionic cavity between the amnion and the chorion
(D) outside the chorionic cavity between the chorion and the endometrial wall
(C) The yolk sac is located adjacent to the embryonic plate in early pregnancy and is located within the chorion.
On transvaginal sonography, when is the yolk sac visible? (A) 4 weeks (B) 5.5 weeks (C) 6 weeks (D) 7 weeks
(B) The yolk sac may be visible as early as 5 weeks, but is virtually always seen by 5.5 weeks.
Arrange in sequence in the embryologic stages following fertilization: (A) morula, (B) cleavage, (C) zygote, (D) blastocyst
(C) Zygote
(B) Cleavage
(A) Morula
(D) Blastocyst
All of the following are complications of oligohydram- nios except (A) clubfeet (B) hand posturing (C) urethral stenosis (D) pulmonary hypoplasia
(C) Oligohydramnios can cause restrictive deformities such as clubfoot, hand posturing, and scoliosis due to restricted fetal movement. Oligohydramnios may also cause pulmonary hypoplasia. It will not cause urethral stenosis.
The umbilical cord S/D ratio normally
(A) increases throughout the pregnancy
(B) decreases throughout the pregnancy
(C) remains the same throughout pregnancy
(D) is controlled by the fetal cerebellum
(B) As the pregnancy advances, the placenta becomes
less resistive. This allows for more blood and oxygen
to reach the growing fetus.
Placental insufficiency is indirectly monitored by
(A) an increasing umbilical cord S/D ratio
(B) a decreasing umbilical cord S/D ratio
(C) Doppler of placental intervillous spaces
(D) Doppler of maternal arcuate arteries
An increasing S/D ratio of the umbilical cord is a sign of vascular resistance within the placenta, which ultimately leads to a decrease in oxygen to the
fetus.
The terminology vasa previa describes (A) placenta near the internal os (B) placenta touching the internal os (C) placenta crossing the internal os (D) placenta vessels crossing the internal os
(D) Vasa previa may also be described as a succenturiate placenta with vessels crossing the internal os.
The primary cause of third trimester bleeding is (A) placenta previa (B) preterm labor (C) cervical bleeding (D) abruption
(A) The incidence of placenta previa at term is 0.5-1% , with 90% of previas bleeding before 38 weeks.
An ectopic pregnancy will usually be on the same
side as the corpus luteal cyst.
(A) true
(B) false
(A) The ovum is usually found on the side of the corpus luteum from which it was released. It is possible for the ovum to contralaterally implant one-third of the time.
Which of the following statements is NOT TRUE concerning the yolk sac?
(A) The yolk sac should be included in measurements of CRL.
(B) The yolk sac shrinks as pregnancy advances.
(C) The yolk sac plays a role in blood development and transfer of nutrients.
(D) The yolk sac is attached to the body stalk and
is located between the amnion and chorion.
(A) The yolk sac lies in the chorionic cavity between
the amnion and chorionic sac. It measures 5 mm to
1 cm. The yolk sac shrinks as pregnancy advances.
It should not be measured in the CRL.
The vessels of the normal umbilical cord consist of
(A) two arteries, one vein
(B) two veins, one artery
(C) one artery, one iliac vein, and the iliac artery
(D) one artery, one vein
(A) The umbilical cord normally consists of two arteries and one vein.
The term "neural tube defect" refers to (A) spinal defect (B) open tube defect (C) anencephaly (D) cephalocele (E) all of the above
(E) Open tube defect, anencephaly, and cephalocele are part of the neural tube defect spectrum.
Myelomeningocele refers to the herniation of (A) meninges (B) meninges and neural tissue (e) meninges at the lumbar level (D) meninges and neural tissue below L5
(B) Herniation of meninges alone is termed a meningo-cele.
The most accurate way to diagnosis a spinal defect is
(A) in the longitudinal plane of the spine
(B) in the coronal plane of the spine
(C) in the sagittal plane of the spine
(D) the “lemon and banana” signs of the fetal cranium
(D) Cranial signs are present 99% of the time with spinal defects. The second most accurate technique would be visualizing the spine in the transverse plane of view, looking for vertebral splaying and a break in the skin line.
The ‘‘lemon” sign of the fetal cranium in diagnosing
spina bifida refers to
(A) the narrowing of the vertebral process at the area of the defect
(B) the overall appearance of the fetal spine in the presence of a defect
(C) the appearance of the cerebellum in the presence of a spinal defect
(D) the appearance of the fetal skull in the presence of a spinal defect
(D) The “lemon” refers to the narrowing of the parietal bones giving the appearance of a lemon-shaped cranium in the axial view.
The “banana” sign of the fetal cranium in diagnosing spina bifida refers to
(A) the narrowing of the vertebral process at the area of the defect
(B) the overall appearance of the fetal spine in the presence of a defect
(C) the appearance of the cerebellum in the presence of a spinal defect
(D) the appearance of the fetal skull in the presence of a spinal defect
(C) The ‘‘banana” refers to the displacement of the cerebellum inferiorly into the upper cervical canal. On transverse view, the cerebellum is small and resembles a banana.
The ''banana'' sign is present with spinal defects (A) 50% of the time (B) 75% of the time (C) 85% of the time (D) 99% of the time
(D) 99% of the time.
Which of the following is true about the “lemon” sign
and neural tube defects?
(A) The “lemon” sign is not as accurate as the ‘‘banana’’ sign.
(B) The “lemon” sign may be present in the normal fetus in the third trimester.
(C) The ‘‘lemon’’ sign can be artificially produced at the level of the ventricles.
(D) The “lemon” sign is a predictor for spina bifida.
(E) all of the above
(E) The lemon sign is found in 1-2% of normal fetuses.
The diagnosis of placenta previa is most accurately made
(A) transabdominally with a full maternal bladder
(B) transabdominally with an empty maternal bladder
(C) transrectally
(D) transvaginally
(D) There is no contraindication to scanning a placenta previa transvaginally, and it provides the most accurate diagnosis. Transabdominal scanning may give a false-positive caused by a full maternal bladder compressing the internal os or an inadequate view of the internal os.
The definition of “low lying placenta” in the third trimester is
(A) placental edge >3 cm from internal os
(B) placental edge <2 cm from internal os
(C) placental edge <3 cm from internal os
(D) placental edge in lower uterine segment
(B) If the placenta is greater than 2 cm from the internal os, a vaginal delivery is considered safe.
The rotation of the heart in the fetal chest should be
(A) 45° with apex pointed to the right
(B) 45° with apex pointed to the left
(C) 60° with apex pointed to the right
(D) the heart should not be rotated in fetal chest
(B) The normally positioned heart should be rotated
approximately 45° with the apex pointed to the left.
The fetal heart is horizontal in the chest because of (A) large spleen (B) flat diaphragm (C) large liver (D) large thorax
(C) The horizontal position of the fetal heart is largely due to a large liver size.
The majority of cephaloceles are parietal.
(A) true
(B) false
(B) 75% of cephaloceles are occipital.
What percentage of cephaloceles are occipital? (A) 50 (B) 60 (C) 75 (D) 99
(C) 75% of cephaloceles are occipital.
The diagnosis of ventriculomegaly may be made
when the ventricle measures
(A) greater than 10 mm in the posterior horn
(B) greater than 15 mm in the posterior horn
(C) when the third ventricle may be visualized
(D) when the choroid does not touch the medial
wall of the lateral ventricle
(A) In the absence of a spinal defect, if the lateral ventricles measure greater than 10 mm, it is commonly associated with an obstruction of the ventricular system.
The most common type of obstruction causing ven-triculomegaly is (A) Dandy-Walker malformation (B) communicating hydrocephalus (C) aqueductal stenosis (D) congenital hydrocephaly
(C) The order of occurrence of obstruction from
most common to least common is: aqueductal steno-
sis, communicating hydrocephaly, Dandy-Walker
malformation, congenital hydrocephaly.
Congenital hydrocephalus is
(A) genetically linked affecting both male and females
(B) able to be detected in both male and females by DNA testing
(C) expressed in males only
(D) A and C
(E) B and C
(F) all of the above
(E) Congenital hydrocephaly is an X-linked abnormality, with the expression in males and the females being carriers. It is able to be detected through DNA testing.
Mild ventriculomegaly is described as (A) posterior horn measuring > 15 mm (B) posterior horn measuring >5 mm (C) choroid is separated from the medial wall of the ventricle >5 mm (D) visualization of the third ventricle
(C) Mild ventriculomegaly may be described as a separation of choroid from the medial ventricular
wall >5 mm (but not dangling) or a measurement of
the ventricular atrium between 10 and 15 mm.
Mild ventriculomegaly may be associated with (A) agenesis of the corpus callosum (B) trisomy 21 (C) normal (D) all of the above
(D) Agenesis of the corpus callosum has mild ventri-culomegaly, but the ventricle is also shaped like a
“teardrop” in most cases. Mild ventriculomegaly has
been associated with trisomy 21, but may also a normal variant.
Other findings associated with a spinal defect are (A) clubfeet (B) ventriculomegaly (C) single umbilical artery (D) A and B (E) all of the above
(D) Clubfeet and ventriculomegaly have a strong associ-ation with spinal defects.
The severity of impairment in a child with hydrocephaly may be predicted by the severity of their fetal hydro-cephaly.
(A) true
(B) false
(B) The prognosis of hydrocephaly remains unclear from the prenatal imaging.
In the case of spina bifida, the fetal sonogram is able to accurately predict the child’s impairment.
(A) true
(B) false
(B) The site and extension of the lesion may aid in a very general prognosis, but it is impossible to accu-rately and clearly predict an individual fetus’ prognosis by in utero findings.
The cisterna magna is considered increased when
(A) the measurement is >5 mm
(B) the cerebellum may be seen outlined by fluid
(C) the cerebellar vermis is splayed
(D) the measurement is >10 mm
(D) The cisterna magna is enlarged if the measurement is greater than 10 mm.
Findings on ultrasound include an increased cisterna magna, agenesis of the cerebellar vermis with communication to the fourth ventricle and ventricu-lomegaly. The most likely diagnosis would be (A) Dandy-Walker malformation (B) Dandy-Walker malformation variant (C) arachnoid cyst (D) communicating hydrocephaly
(A) A true Dandy-Walker malformation must have
agenesis of the cerebellar vermis with communica-
tion to the fourth ventricle. A Dandy-Walker mal-formation variant is described as having some degree
of cerebellar vermis agenesis, but not complete agen-
esis. An arachnoid cyst will push the cerebellum
superiorly without splaying the cerebellum.
Findings on ultrasound include hydrocephaly, an enlarged cisterna magna, and an intact cerebellar
vermis elevated by a cyst in the posterior fossa. The
most likely diagnosis would be
(A) Dandy-Walker malformation
(B) Dandy-Walker malformation variant
(C) arachnoid cyst
(D) communicating hydrocephaly
(C) An arachnoid cyst will not cause splaying of the
cerebellum and the cerebellar vermis will be intact.
Other findings associated with Dandy-Walker malfor-mation include (A) holoprosencephaly (B) facial clefting (C) cardiac defects (D) all of the above
(A) Dandy-Walker malformation is associated with other midline defects including agenesis of the corpus callosum and cephaloceles, as well as holoprosen-
cephaly, clefting and cardiac defects. Dandy-Walker
malformation has a 50-70% risk of associated abnor-
malities.
Associated findings occur with Dandy-Walker malfor-mation (A) rarely (B) 10-25% of the time (C) 50-70% of the time (D) always
(C) Dandy-Walker malformation may occur as part of the mendelian disorder (abnormalities in multiple different organ systems) and is associated with chromosomal abnormalities.
Complications associated with Dandy-Walker mal-formation include (A) chromosomal abnormalities (B) subnormal intelligence after birth (C) increased neonatal death (D) A and B only (E) all of the above
(E) Subnormalintelligence is reported in 40-70% of
cases. Morbidity rates are 24%, but are improving
with increased anesthesia and surgical techniques.
The most common cause of hypotelorism is (A) Dandy-Walker malformation (B) Arnold-Chiari type II (C) Goldenhar syndrome (D) holoprosencephaly
(D) The most common cause of hypotelorism is holoprosencephaly. Hypotelorism is found in many
different syndromes and chromosomal abnormalities and is strongly associated with abnormalities of the brain.
Cyclopia, hypotelorism, proboscis, cebocephaly, and cleft lip/palate are (A) abnormal intracranial findings (B) abnormal facial findings (C) associated with hydrocephaly (D) all of the above
(B) Cyclopia-absent nose with protrusion of tissue
at level of eye sockets; hypotelorism-close set
orbits; cebocephaly-single nostril nose; and cleft
lip/palate are all abnormal facial findings strongly
associated with holoprosencephaly.
The most common chromosomal abnormality associated with holoprosencephaly is (A) trisomy 21 (B) trisomy 18 (C) trisomy 13 (D) Turner syndrome
(C) 30-50% of fetuses with holoprosencephaly have chromosomal abnormalities, the most common being trisomy 13.
The most common cause of hypertelorism is (A) anterior cephalocele (B) holoprosencephaly (C) hydranencephaly (D) craniosynostosis
(A) The most common cause of hypertelorism is a
defect that prevents the migration of the eyes to
their normal position. An anterior cephalocele is the
most common blockage of that migration.
Teratomas in pregnancy are located in (A) the sacrococcygeal region (B) intracranial (C) cervical (D) all of the above
(D) Teratomas can occur in many different locations.
The most common region is sacrococcygeal accounting
for 50% of fetal teratomas. The second most common
location is orofacial (including intracranial) and cervical, accounting for 5% of fetal teratomas.
Maternal Grave's disease and Hashimoto thyroiditis may cause what finding in the fetus? (A) fetal ascites (B) fetal goiter (C) oligohydramnios (D) there is no effect on the fetus
(B) Maternal Graves disease and Hashimoto thyroiditis produce antibodies that cross the placenta and may affect fetal thyroid production.
