OB/GYN Registry review Flashcards
–Placenta Accreta
invasion of the chorionic tissue through the endometrium and attaches to the myometrium
Placenta Increta
Chorionic tissue invades the myometrium
Placenta Percreta
Chorionic tissue extends through the uterine wall to the bladder and adjacent pelvic structures
Sign of fetal distress identified by ultrasound late in pregnancy
Meconium, fetal waste that accumulates in the bowel in the 3rd trimester
The autosomal recessive genetic disorder that is associated with meconium ileus and fetal bowel obstruction is
Cystic Fibrosis
___________________ would be consistent with increase in the AP renal pelvic diameter between the second and third trimesters.
Ureterocele, vesicoureteral reflux, UPJ obstruction, UVJ obstruction and MCKD
Streak gonads and infertility are associated with what fetal syndrome
Turner
Syndactyly refers to :
webbing between the digits
Clinodactyly refers to:
arching of the 4th and 5th digits toward the thumb
Underdevelopment of the left heart structures
Hypoplastic left heart syndrome
Highly vascular, benign mass of the placenta that is associated with polyhydramnios
Chorioangioma
____________________ is seen in about 90% of fetuses in a partial molar pregnancy
triploidy
__________________ is common with Potter syndrome due to the _________________ caused by ___________________________
Pulmonary hypoplasia, oligohydramnios, renal agenesis
The majority of encephaloceles are located in the _______________region of the cranium
occipital
Maternal alcoholism is most associated with
IUGR
microcephaly
hypotelorism
cardiac defects
Which type of osteogenesis imperfecta has the poorest prognosis?
type II
A Foramen of Bochdalek hernia involves:
Hernia on the left side of the fetus
Foreshortened distal limbs
mesomelia
Foreshortened hand and foot bones
acromelia
Foreshortening of the entire limb
micromelia
Foreshortening of the proximal limbs
rhizomelia
Bilaterally enlarged echogenic fetal kidneys with a normal bladder is most suggestive of :
autosomal dominant polycystic disease
What causes potter facies?
renal agenesis. Potter facies are facial anomalies caused by low fluid.
During which week of the menstrual cycle is best to evaluate a patient with normal cycles and a possible ovarian cyst.
Week one when endometrium is thinnest and no dominant follicles on the ovary
Which view is best for demonstrating the posterior and lateral ossification centers of the vertebra?
Transverse
Number and stage of embryos to be transferred during a sonography guided embryo transfer must be documented on:
the signed informed consent form
What is coelocentesis?
Sample of coelomic fluid from around the amniotic sac. Can be performed as early as 6 weeks.
How do you measure endometrial thickness when fluid is not present in the endometrium?
Measure from the outer edge of functionalis layer to the outer edge of the opposing funtionalis layer
Femur/foot ratio is useful in diagnosis of
skeletal dysplasia. Normal = 0.99 plus or minus 0.06
abnormal < 0.87
To improve imaging of a fetus of an obese mother :
Place the patient in a modified sims position
How do you document the presence of a marginal cord insertion
measure the distance from the placental cord insertion to the edge of the placenta
A femur length > 2 SD below the expected gestational age indicates the strong possibility of:
skeletal dysplasia
Infection, uterine perforation, hematometra, and thermal injury to adjacent structures are all potential complications of:
endometrial ablation
Primary purpose of performing serial doppler evaluations of the umbilical artery
To assess for signs of placental insufficiency
When evaluating a patient for the antral follicle count, the transvaginal exam should be performed:
between day 2 and 4 of the menstrual cycle
Best way to evaluate agenesis of the corpus callosum
transverse axial view of the fetal head with the beam perpendicular to the parietal bones
Cardiotocography is used to document findings in a:
contraction stress test
Fetal lung volumetry performed with 3D sonography should be used to help diagnose:
skeletal dysplasia
___________________ would benefit from a sonohysterogram
suspected focal endometrial hyperplasia
Standard BPD accurately provides an estimated gestation age before _______________ weeks gestation
20
metrorrhagia
intermittent vaginal bleeding between cycles
Best way to evaluate for atrioventricular septal defect
transverse view of the fetal chest at the level of the four chamber heart. commonly associated with trisomy 21
Best technique to evaluate the cisterna magna
axial view of the posterior fossa with an AP measurement of the posterior fossa
Most helpful view for detecting facial defects associated with skeletal dysplasia
midsagittal
Formula for estimated age of pregnancy with gestational sac measurement
GSDmm + 30 days
Example: 30+30+39 = 99/3 = 33 mm mean sac diameter
33+30 = 63 days or 9 weeks
Sonoelastography would be helpful in the evaluation of
fibroids and polyps
Which view of the heart is preferred to evaluate possible muscular VSD
4 chamber view
During BPP to assign 2 points for fetal breathing you must observe
30 seconds of fetal breathing
Gross movement during BPP
3 within 30 minutes
Muscle tone movement during BPP
1 tone movement within 30 min
AFI during BPP
> 5.0 cm
Estrogen therapy cause an increased risk of:
thrombosis
Most important plane used to evaluate a fetus with suspected limb body wall complex
Coronal view. Limb body wall is commonly associated with severe scoliosis. The excessive lateral curvature of the spine is best seen in the coronal view
Which procedure has the highest risk of fetal demise?
Periumbilical blood sampling
What is the philtrum?
Vertical groove in the upper lip located between the base of the nose and the border of the upper lip.
Accuracy of biometric measurements for predicting gestational age in the third trimester is within:
21 days
Normal left and right ventricular outflow tract views can rule out : (4 chamber heart view)
Ebsteins anomaly
If the heart and stomach are visible on the same transverse view:
a diaphragmatic hernia is present
Premenopausal women are more susceptible to _______________ formation while postmenopausal women are more susceptible to___________________ formation.
mucinous cystadenoma
mucinous cystadenocarcinoma
___________ hormone stimulates the formation of the cervical mucous plug found with pregnancy
Progesterone
The corpus luteal cyst secretes:
progesterone
A trident hand is commonly seen with which skeletal abnormality
heterozygous achondroplasia
Cervix longer than body
prepubertal
body fundus of uterus longer than cervix
Nulliparous
ratio of uterus and cervix remain the same
postmenopausal
1:1 ratio of cervix and body/fundus of uterus
premenopausal
cervix and corpus of equal length
premenopausal nulliparous
Which hormone causes the endometrium to thicken during the proliferative phase
Estrogen
What muscles originate from the sacrum and connect to the greater trochanters to form the posterior wall of the pelvis
piriformis
The corpus in a multiparous uterus is usually at least __________ the cervix
2 times the length
Dominant ovarian follicle grows at a rate of ___________ prior to ovulation
2-3 mm per day
Early proliferative phase, day 5-9 the endometrium is:
thin line
Late proliferative phase day 10-14 the endometrium is
thicker and trilaminar
Secretory phase day 15 - 28 the endometrium is:
thick and hyperechoic
Ligaments that provide support for the ovary
mesovarium, infundibulopelvic and ovarian
Which hormone stimulates the cervix to produce mucous just prior to ovulation
Estrogen
The isthmus connects what two segments of the fallopian tube?
Interstitial and ampulla
What is the following is responsible for stimulating the contraction of the fallopian tubes to propel the egg toward the uterine cavity?
Estrogen
The greater pelvis is also know as the
False pelvis and contains the bowel
What carries blood to the uterine arteries?
anterior branch of the internal iliac arteries
Ligament that connects the medial ovary t the lateral uterine wall
ovarian
Ligament that supports the ovary and fallopian tubes within the pelvis and attaches t the lateral pelvic wall
Suspensory
Muscles that form the lateral pelvic walls
Obturator Internus
The rectus abdominis is _________ to the ovary
anterior
The broad ligaments envelops the_____________________
fallopian tubes
Grand multiparity
woman who has delivered 5 or more infants who have achieved a gestational age of 24 weeks or more
Portion of the peritoneum connecting the anterior ovary to posterior broad ligament
Mesovarium
What uterine ligaments are composed of peritoneum
suspensory and broad ligaments
What muscle connects the coccyx and pubis bones and houses the openings for the urethra, vagina and rectum?
levator ani
_________________ stimulates the endometrial proliferation in the secretory phase to prepare for implantation.
progesterone
Postmenopausal endometrium with no symptoms and not taking hormones should not exceed
8mm
Postmenopausal endometrium with bleeding should not exceed
5 mm
Which layer of the uterine wall is composed of fibrous connective tissue?
perimetrium
The internal iliac artery normally courses ___________ _____________ to the internal iliac vein
anterior lateral
What is the term for the free margin of the broad ligament where vessels and the fallopian tube travels?
Mesosalpinx
The ovary is normally found in the _______________ fossa
fossa of waldeyer
Absence of hands
Acheira
Absence of feet
Apodia
Destruction of red blood cells of the neonate by maternal immunoglobulin G antibodies
Erythroblastosis
Placenta previa should not be diagnosed before
16 weeks
midline facial clefting, ocular abnormalities, echogenic kidneys and microcephaly is most likely
Trisomy 13
Taxoplasmosis infection is associated with
IUGR
Ventriculomegaly and calcifications in the liver and brain are associated with
Cytomegalovirus
HELLP Syndrome
Hemolysis of RBC’s, and elevated liver function test, low platelet count. Preeclampsia is associated with the HELLP Syndrome
Laboratory findings in a mother with preeclampsia would demonstrate
Low platelet count and increased liver function test
Most common chest mass identified in a fetus
Congenital Cystic Adenomatoid Malformation (CCAM)
Type I Macrocystic
Type II Medium cystic
Type III Microcystic (most common)
Cleidocranial dysplasia
Autosomal dominant condition characterized by clavicular aplasia or hypoplasia
What two blood vessels form the lateral border of the thymus gland?
right and left internal mammary arteries
Treacher Collins Syndrome
Mandibulofacial Dysostosis. Autosomal dominant disorder that is associated with small mandible, micrognathia, holoprosencephaly and cleft palate
Capomelic Dysplasia
A rare form of lethal short limbed dwarfism. Characterized by hypomineralizaiton of short bowed or curved limbs, most commonly the lower leg bones
Fetal Frontomaxillary Facial (FMF) is measured in a fetus with
Trisomy 21 (much larger in these patients)
Spina Bifida (much smaller in these patients)
Cranial ossification begins in the _________week and the full calvarium is usually visible by the ______________ week.
9th
12th
If calvarium is not identified by the 16th week, acrania should be suspected
Polyhydraminos is associated with
holoprosencephaly
Congenital cystic adenomatoid malformation
cystic hygroma
Oligohydramnios is commonly seen with
pulmonary hypoplasia
Lethal skeletal dysplasia typically has a FL/AC ratio less than
0.16
What will be demonstrated as hypoechoic areas within the placenta that display turbulent flow on color doppler?
placenta accreta
Congenital Diaphragmatic Eventration
Developmental defect of the muscular portion of the diaphragm. Mimics the appearance of a hernia with abdomen contents appearing to be in the chest cavity.
Craniosynostosis
premature ossification of one or more skull sutures causing abnormally shaped calvarium and abnormal facial features. Can present as clover leaf or strawberry skull
Prune belly syndrome
triad of signs, non visualization of abdominal muscles, urinary tract abnormalities and undescended testes. Most commonly caused by posterior urethral valves
Difference between porencephalic cyst and arachnoid cyst
porencephalic cyst are within the brain tissue and communicate with the ventricular system while arachnoid cyst form between the brain tissue and the calvarium
Disorder of bony demineralization. Severe micromelia, poor ossification , multiple fractures. Low levels of alkaline phosphatase. Increased echogenicity of the falx cerebri
Hypophosphatasia
Preeclampsia is associated with placental insufficiency and oligohydramnios. Oligohydramnios is diagnosed when the 4 quadrant AFI is below
5 cm
IUGR identified in the second trimester is usually associated with
chromosomal abnormalities
Most skeletal dysplasias are associated with
polyhydramnios
Pierre Robin sequence includes
micrognathia, retrognathia and an isolated cleft palate
Echogenic bowel, meconium peritonitis, meconium ileus, and absent gallbladder are most suggestive of:
Cystic Fribrosis
Smooth brain tissue with absence of sulci and gyri indentations.
Lissencephaly. Best evaluated using MRI
How to differentiate megacisterna magna from Dandy Walker malformation
a normal cerebellar vermis is usually seen with megacisterna magna but not with Dandy Walker
Ellis Van Creveld syndrome
autosomal recessive disorder that is most common in the amish communities. Associated with mild to moderate mesomelia, short ribs, narrow thorax, ploydactyly and atrail septal defect
Spina bifida cystica
cystic formation at eh defect in the spine. Cyst can contain meninges and or spinal cord tissues.
Abnormally short neck with fixed posterior flexion is called
iniencephaly
A cisterna magna that measures greater than 10 mm is a common finding with
cerebellar agenesis and dandy walker malformation
Which skeletal dysplasia only affects one side of the body
CHILD Syndrome - Congenital Hemiddysplasia with Ichthyosiform Erythroderma and Limb defects on one side of the body
What indicates abnormal fetal growth in twins
28% difference in EFW between fetuses
Spina Bifida is associated with
polyhydraminos
hypoplastic left heart is commonly associated with
double outlet right ventricle
Autosomal recessive disorder
required two copies of an abnormal non sex chromosome to be present in order for the trait to develop
Arthrogryposis
contraction and loss of movement in multiple joints. Bilateral talipes, deformed elbows, wrists, ankles, knees and hips
Most common cerebral finding with cytomegalovirus
hyperechoic periventricular halo and septations within the occipital horns
Potters syndrome is always
lethal to the fetus because of renal agenesis
Mandible anomalies are associated wit increased risk of
acute neonatal respiratory distress
failure of neurulation
failure to close. open neural tube
Most common cause of pleural effusion in a fetus
chylothorax
A dilated third ventricle, colpocephaly and the sunburst sign in the cerebral tissues are findings of
agenesis of the corpus callosum
bulging forehead, increased cephalic index midface and orbital hypoplasia and polysyndactyly of the hands and feet are suggestive of
Apert syndrome
What is caused by arteriovenous malformation in the placenta?
twin to twin transfusion
Most severe for of spina bifida
Rachischisis
Cullen sign
indicates ruptured ectopic
Deuel sign
scalp edema
spalding sign
suture overlap on skull
Robert sign
air in circulatory system
Choriocarcinoma of the ovary
aggressive malignancy most common in patients between 5 - 25 years of age. Elevated levels of bhCG. Can lead to positive pregnancy test.
common cause of dysfunctional uterine bleeding
hormone replacement therapy
Spotting between cycles and infertility are common symptoms of
endometrial polyps
Fitz Hugh Curtis syndrom
PID that leads to inflammation of Glissons capsule, peritonitis and perihepatic adhesions
metritis
inflammation of the uterus
Csystic teratoma (dermoid cyst) most common in
premenopausal women
Ovarian tumor most commonly in postmenopausal women
granulosa cell tumor(theca lutea cell tumor, thecoma, fibroma
unicornuate uterus is commonly associated with
ipsilateral renal agenesis
Asherman syndrome
adhesions of the endometrial lining due to uterine trauma. Common symptoms include amenorrhea, hypomenorrhea, recurrent miscarriage and infertility
Ovarian mass with dot dash pattern is most likely
teratoma
Benign unilocular cyst usually do not exceed a diameter of
5 cm
Chorioadenoma destruens
invasive malignant molar pregnancy
Arrhenoblastoma
Sertoli-Leydig cell tumor (androblastoma). Usually benign in premenopausal patients age 20-40. Increased testerone levels which can lead to masculinization (virilization)
Tumor associated with precocious puberty
granular cell tumor
Which tumor is composed of epithelial and stromal tissues of the ovary
cystadenofibroma
Ovarian neoplasm composed of ectodermal tissue
cystic teratoma
paraovarian cyst is also know as
morgagni or mesonephric cyst
polycystic ovarian disease usually demonstrates multiple follicles:
< 10 mm along the periphery of the ovary
Lithium exposure is related to
cardiac malformation of the fetal heart
Leiomyosarcoma
Rare malignant tumor of the myometrium usually found in females in their mid 50’s.
Most commonly occurring germ cell tumor of the ovary
benign cystic teratoma
Cogwill sign
Acute salpingitis- thick walled acute infection with PID
Peritoneal inclusion cyst commonly associated with
prior c-section
Most primary malignancies of the ovary originate in
the epithelial stromal tissues
Most common type of mullerian duct anomaly
septate uterus
Normal endometrial thickness in the secretory phase is
9-18mm
What is the first stage of PID that is identified sonographically
Endometritis
Thecomas and Fibromas are generally
hypechoic with posterior shadowing
Granulosa cell tumors and androblastomas are generally
complex with cystic components
Uterine arcuatus is a failure of
dissolution anomaly
Rokitansky nodule is another name for
dermoid plug ( cystic teratoma)
Microtia
small ears
Eagle Barrett Syndrom
Prune belly syndrome weakend abdominal wall musculature with significantly dilated bladder ureters and kidneys
ectopia cordis, club foot and asymmetric cleft lip/palate
Amniotic band sequence
Most common anomaly of the umbilical cord
single artery
maternal history of hyperparathyroidism or hypothroidism has what effect on the fetus
fetal demise
Characteristics of multicystic kidney disease
multiple noncommunicating cyst that do not connect to a dilated ureter
If the LVOT and RVOT are parallel as they exit the fetal heart
complete transposition of the great vessels is demonstrated
Truncus arteriosus
single large outflow tract with malalignment VSD
The fetal cranial suture located between the parietal bone and occipital bone is the
lambdoidal suture
A heart rate using M mode should be sonographically obtainable with endovaginal imaging when the crown rump length measures:
4 -5 mm
Location of the ductus arterious is:
between the pulmonary artery and aortic arch
Umbilical arteries carry
deoxygenated blood from the fetus back to the placenta
What term refers to the number of eggs that are fertilized
Zygosity
Dizogotic twinning always result in
dichorionic, diamniotic twins
The uterus is considered a:
retroperitoneal organ
Prepubertal uterus:
cervix is larger than the uterine fundus
The ovaries are ___________ glands
endocrine
Which hormone initiates the proliferation and thickening of the endometrium
Estrogen
Which hormone encourages the induction of salt and water retention, and stimulates the contractile motions to occur within the uterine myometrium and the fallopian tubes
Estrogen
Progesterone is produced by:
The corpus luteum
What hormone is responsible for maintaining the thickness of the endometrium and inducing secretory activity
Progesterone
Beta hCg maintains:
corpus luteum
Opening between the atrial septum
Foramen ovale
upper limit of normal for yolk sac
5.9 mm
Intracranial clefting of cerebral hemispheres
schizencephaly
Sonographic view that best demonstrates the presence of three vessel cord
axial view of cord
Congenital condition most likely related to oligohydraminos
autosomal recessive polycystic kidney disease
Deficiency related to acrainia
folate
Most common malignant germ cell tumor
Dysgerminoma
What hormone is responsible for stimulating the corpus luteum in early pregnancy
hCG`
PW doppler of the MCA, an elevated end diastolic velocity is documented, what condition may this cause
hypoxia
Gestational sac measuring 5 mm is _____________ weeks, 18mm is _____________ weeks
6.5 and 8 weeks
In what space is the secondary yolk sac located?
Intraembryonic coelem
What hormone stimulates proliferation of the functional endometrial layer
estrogen
What biometry measurements are necessary to calculate cephalic index
BPD and OFD
What scanning technique is best for color assessment of the presence of renal arteries
coronal
To measure resistive index measure
peak systolic and end diastole
