OB/GYN Registry Review part 2 Flashcards
damage that is done from PID
chronic PID
history of STDs
fever
chills
pelvic pain/tenderness
purulent vaginal discharge
vaginal bleeding
dyspareunia
leukocytosis
acute PID
endometritis
pyosalpinx or hydrosalpinx
free fluid CDS
complex adnexal masses
acute PID
chronic pelvic or abdominal pain
infertility
palpable adnexal mass
irregular menses
vaginal discharge
chronic PID
hydrosalpinx
adhesions seen as echogenic bands within tube
complex adnexal masses
chronic PID
confined to uterus. Evidence of endometritis. Thickened endo, heterogeous with maybe blood or pus; comet tail/reverb artifacts classic
stage 1 PID
spread into tubes and adnexa, evidence of salpingitis, hydrosalpinx, or pyosalpinx. Hyperemia of tube may also be documented
stage 2 PID
severe progression of infection in adnexa. Bilateral complex adnexal masses known as TOA. Once it’s reached this stage, it will always remain chronic.
stage 3 PID
PID progression into adnexa. Adhesions develop between tubes and ovaries leading to fusion
tubo-ovarian complex
The first trimester is weeks __-__
1-13
Fertilization usually occurs in the ____
ampulla
Fertilzation usually occurs with ___ hours of ovulation
24
Once conception occurs, the fertilized egg is termed a:
zygote
At 3-4 days after fertilization, the cluster of cells of the zygote is called the:
morula
By day 5, 1st time cell differentiation takes place and it is now a _____
blastocyst
outer ring of trophoblastic cells begin to produce HCG.
trophoblaster
Endometrium prepares for implantation and becomes decidualized called the:
decidual reaction
The outer layer of the trophoblast will eventually become the ____ and ______
chorion
placenta
inner cell mass that will develop into embryo, amnion, cord, and yolk sacs
embryoblast
Implantation occurs __-__ days after fertilization
7
9`
Finger-like projections of the trophoblast called ______ form links into decidualized endometrium
chorionic villi
Implantation is complete by day ___ from LMP
28
HcG levels double every ___ hours until __ weeks
48
9
earliest visible sign of pregnancy is a ______
decidualized endo
By ____-____ mIU/mL HCG the gestational sac should be seen by TV
1000
2000
By _____ mIU/mL the gestation sac should be seen by TA
3500
Mean sac diamater length equation
lenth + width + height divided by 3
The gestation sac grows by __ mm per day
1
The first definitive sign of IUP is:
gesational sac with yolk sac
The gestational sac with yolk sac should be visualized by a MSD of __ mm
10
The gestational sac should be located in the space of the chorionic cavity between the amnion and chorion
extraembryonic coelem
The _______ is responsible for producing AFP, angiogenesis, and hematopoeisis.
Secondary yolk sac
The secondary yolk sac connects to the embryo by the _____
vitelline duct
The _______ visualized as a round, anechoic with thin echogenic rim and measuring <6mm
secondary yolk sac
“double bleb sign”
enlarged yolk sac next to amnion
Enlarged yolk sac indicates:
impending demise
By __ weeks the fetal pole is visualized
6
The fetal pole must be seen by MSD of ___ mm
25
Most reliable estimation of gestational age
CRL
Starting at 6 weeks, the fetal pole grows __ mm per day
1
Calculation of gestational age from CRL
CRL (cm) + 6.5 = GA (in weeks)
Cardiac activity must be noted by __ mm CRL
5
formation of limb buds and fetal head appears larger than body
7 weeks
cystic structure noted within the head at 8 weeks
rhombencephalon
The rhombencephalon evetually develops into the _____
fourth ventricle
_______ is a normal migration of midge bowel into the base of the umbilical cord.
physioloigical bowel herniation
Physiological bowel herniation should be completed by ___ weeks
12
embryonic phase has ended and is now referred to as a FETUS
10 weeks
Fetal limbs and facial profile/cranium should be clearly evaluated and normalized. May also be documented: heart, stomach, cord insert, and possibly bladder
11 weeks
Within the fetal head, lateral ventricles filled with echogenic ______ on either side of the ______
choroid plexus
falx cerebri
By the end of the 1st trimester, see as well-defined, cresent shaped and slightly echogenic mass of tissue.
placenta and umbilical cord
The placenta and umbilical cord are formed by _____ (maternal) and _____ (fetus)
decidual basalis
chorion frondosum
First trimester screening happens between:
11 weeks and 13 weeks 6 days
the fluid filled layer between the fetus and skin layer and should never measure more than 3mm
nuchal transclucency
NT may also be enlarged with trisomy __
13
The CRL should measure between ___-___ mm
45
84`
a pregnancy located anywhere other than the central uterine cavity
ectopic pregnancy
Most common cause of pelvic pain with positive pregnancy test
ectopic pregnancy
The most common location of an ectopic pregnacny
ampulla of the fallopian tube
Most dangerous ectopic pregnancy
interstitial
IUP and coexisting ectopic
heterotopic pregnancy
pain
bleeding
palpbale mass
lower than expected hCG
low hematocrit
should pain
ectopic pregnancy
extrauterine GS “live” ectopic
complex adnexal mass or adnexal ring sign
free or complex fluid in pelvis
pseudogestational sac
poor decidual reaction in endometrium
ectopic pregnancy
gestational trophoblastic disease also known as
molar pregnancy
abnormal combination of male and female gametes resulting in rapid proliferation of trophoblastic cells (what will form the placenta)
gestational trophoblastic disease
Trophoblasts produce:
HCG
placenta grows out of control, takes over, and undergoes degeneration become complex with cystic changes
gestational trophoblastic disease
most common GTD
complete hydatidform mole
absence of fetus or gestational sac. Benign with malignant potential. Contained within myometrium, clear defined borders.
complete hydatidform mole
coexisting IUP/GS and possibly fetus. minimal malignant potential
partial hydatidform mole
molar pregnancy that becomes malignant and invades into myometrium, through uterine wall into peritoneum
invasive molar (chorioadenoma destruens)
most malignant progressive form with possible mets to lung (most common), liver, and brain
choriocarcinoma
hyperemesis
markedly elevated HCG
bleeding
enlarged uterus
hypertension
GTD
large complex mass with uterus “vesicular snowstorm”
multiple cystic areas throughout “swiss cheese”
loss of myometrium or borders if invasive
bilateral theca lutein cysts
GTD
An anembryonic pregnancy is also known as:
blighted ovum
large gestational sac without yolk sac or embryo based on sac size
anembryonic pregnancy
GS >10mm + no YS
anembryonic pregnancy
GS >25mm + no FP
anembryonic pregnancy
death of embryo or fetus
fetal demis
Demise is confirmed by a fetal pole > __ mm with no ____
5
cardiac activiity
termination of pregnancy before viability whether elective or not
abortionm
miscarriages are also known as:
spontaneous abortions
spotting
low fetal heart rate
threatened miscarriagesp
spotting
low HCG
intact demise
missed abortion
heaving bleeding
+ HCG
retained products of conception
incomplete abortion
bleeding
- HCG
normal endometrium
complete abortion
cramping/spotting
low lying GS
inevitable abortion
implies the miscarriage is still in process and there are retained products of conception with internal flow within the cavity
incomplete miscarriage
miscarriage is done, cavity is empty, endo is thin
complete miscarriage
bleed between endometrium and gestational sac
subchorionic hemorrhage
crescent-shaped hypoechoic or medium level echoes area adjacent to the sac
subchorionic hemorrage
may appear as round masslike area within the myometrium but will disappear within 30 minutes
contractions
most common pelvic mass in 1 trimester
corpus luteum of pregnancy
physiologic, functional cyst that maintains endo by secreting progesterone, maintained by HCG, usually 2-3 cm but may grow large up to 10 cm
corpus luteum of pregnancy
The second trimester is weeks __-__
13
26
The quadruple screen
HCG
AFP
estriol
inhibin A
HCG, estriol, and inhibin A are produced by the ______
placenta
AFP is produced by the _____
fetujs
“open” or protruding fetal abnormalities will show elevated ___
AFP
Most common cause of abnormal serum screening
incorrect dates
baby is parallel to mother
longitudinal lie
head presenting or closest to cervix
cephalic or vertex
feet first
complete breech
buttocks closest to the cervix
frank breech
one leg closest to the cervix
footling breech
fetus lie is perpendicular to mother
transverse lie
Long baby and clockwise
cephalic
long baby and counter
breech
trans baby and clockwise
head right
trans baby and counter
head left
spine to stomach is
clockwise
The heart is initially __ tubes that fuse and fold to form ___ chambers
2
4
The heart begins to contract at ___ days gestation (5 weeks)
36
The heart is detected on US by CRL of __mm
5
NL heart rate first trimester
120-180
The heart is fully formed by ___ weeks
10
The apex of the heart is angled to the ____ of midline at a 45 degree angle from the ______.
left
spine
The heart occupies ___ of the chest
1/3
________ is confirmed with imageing of fetal lie, stomach and apex pointing to the left of fetus
situs solitus
normal cardiac position
levocardia
abnormal cardiac situs, apex pointing to the right of the chest
dextrocardia
chamber closest to spine (posterior) and descending aorta is _____
left atrium
Chamber closest to the sternum (anterior) is the ______
right ventricle
The left and right ventricles are separated by the _______
interventricular septum
The left and right atria are separated by the _____ which opens at ______
atrial septum
Foramen Ovale
The moderator band is located within the ______
right ventricle
The left atrium opens into the left ventricle through the _____
mitral valve
The right atrium opens into the right ventricle through the ______
tricuspid valve
LVOT should outflows onto to ____
aorta
The ___ side of the heart and ____ supplies blood to most of the body
left
aorta
Three bypasses of the fetal heart
ductus venosus
foramen ovale
ductus arteriosus
______ carries oxygen-rich blood from the placenta to the fetus
umbilical vein
The umbilical vein travels superiorly into the liver and connects to the ______
left portal vein
Some of the blood bypasses the liver via the ______ and goes into the ____
ductus venosus
IVC
The IVC and SVC drain into the _____
right atrium
Some of the blood travels through the ______ into the left atrium
foramen ovale
The blood that continues from the right atrium through the ______, into right ventricle, and out through MPA
triscupid valve
From the MPA, some of the blood is shunted via the _______ into the aorta to bypass the lungs
ductus arteriosus
Blood returning to the heart through pulmonary veins drains into the _____
left atrium
Blood from the left atrium continues through _____, into left ventricle, and out through the aorta.
mitral valve
Deoxygenated blood returns to the placenta through the ______ that branch from the internal iliac arteries.
umbilical arteries
umbilical vein to IVC shunt
ductus venosus
right atrium to left atrium shunt
right atrium to left atrium
MPA to aorta shunt
ductus arteriosus
small or absent left ventricle; may be caused by aortic atresia, aortic stenosis, coarctation
hypoplastic left heart syndrome
Hypoplastic left heart syndrome has a connection with trisomy ___
13
Small or absent right ventricle; caused from pulmonary stenosis or triscupid atresia
hypoplastic right heart
accumulation of fluid in 2 fetal body cavities, can be caused by heart failure, tumors, syndromes, and others
hydrops fetalis
opening or hole in the ventricular septum
ventricular septal defects
most common cardiac defect
ventricular septal defects
VSDs are associated with trisomy ___
21
absence of a segment of atrial septum
atrial septal defects
also known as endocardial cushion defect or AV canal defect
atrioventricular septal defects
lack of development of central part of heart.
atrioventricular septal defects
AVSDs are associated with trisomy ___
21
Tricuspid valve is incorrectly positioned apically within the RV. Commonly associated with triscupid regurgitation, ASDs, tetralogy of Fallot, transposition of great vessels, and coarctation.
Ebstein anomaly
combination of the following 4 findings:
overriding aorta
VSD
Pulmonary stenosis
RV hypertrophy
Tetraology of Fallot
Most common fetal cardiac tumor
rhabdomyoma
echogenic tumors within the myometrium. Associated with tuberous sclerosis, cardiac failure, fetal hydrops
rhabdomyoma
calcification of papillary muscle or chordae tendonae usually seen in left ventricle
echogenic intracardiac focus
EIF is a “soft marker” for trisomy
21
heart located outside the chest through defect in sternum; associated with Pentalogy of Cantrell; elevated AFP
ectopia cordis
Great vessels
aorta and MPA
Aorta arises from RV and MPA arises from LV
transposition of the great vessels
narrowing of aorta arch
coarctation of the aorta
commonly located between left subclavian artery and ductus arteriosus; assocated findings are RV and MPA enlargement
coarctation of aorta
fluid located around the heart; associated with hydrops
pericardial effusion
fluid surrounding the lungs; associated with hydrops or other chest pathology
pleural effusion
“bat wing” sign
bilateral pleural effusions
underdevelopment of the lungs
pulmonary hypoplasia
Most common cause of chest mass causing pulmonary hypoplasia is ______
diaphragmatic hernia
most common chest mass
diaphragmatic hernia
most common reason for cardiac malpositioning
diaphragmatic hernia
Most common chest mass causing pulmonary hypoplasia
diaphragmatic hernia
A diaphragmatic hernia is most common on the ____ side
left
A ______ hernia containing stomach, bowel, and left lobe of liver
Bochdalek
A right sided hernia through the ______ may allow enite liver into chest. The heart will be pushed to the left.
foramen of Morgagni
A congenital pulmonary airway malforation is also known as
cystic adenomatoid malformation
mass consisting of abnormal bronchial and lung tissue; causes displacement of heart to contralateral to side; normally regresses spontaneously or if large, can lead to hydrops or pulmonary hypoplasia
cystic adenomatoid malformation
most common type of cystic adenomatoid malformation. Macrocystic, large visualized cysts
Type I
Cystic adenomatoid malformation mixed, cystic, and solid appearing
type 2
cystic adenomatoid malforation microcystic, cysts are too small to be visualized, entire mass is echogenic
type 3
echogenic mass of nonfunctiong lung tissue with own blood supply
pulmonary sequestration
The skull is made up of ___ cranial bones connected by _____
8
sutures
The opening in the base of cranium that allows passage of spinal canal
Foramen magnum
two hemispheres divided by the interhemispheric fissue
cerebrum
The cerebrum contains ___ and ___
sulci
gyri
The cerebrum is covered by 3 layers of meninges:
pia mater
arachnoid
dura mater
a double fold of dura mater which separates the two hemispheres
falx cerebri
seen as an echogenic line perpendicular to beam in axial plane
falx cerebri
Box-shaped, midline brain structure seen between frontal horns of lateral ventricles
Cavum Septum Pellucidum
The ____ does not communicate with the ventricular system
CSP
The CSP closes after ___ weeks
37
2 lobes of ____ located on either side of falx
thalamus
The ______ connects the 2 lobes of the thalamus together and the ____ travels within
massa intermedia
3rd ventricle
produces and transports CSF to cushion the brain
Ventricular system
Lateral ventricles contain ______ which produce CSF
choroid plexus
CSF flows to third ventricle via the ______
foramen of Monro
The third ventricle connects to the fourth ventricle through the _____
aqueduct of Sylvius
From the fourth ventricle, CSF flows through openings called ______ and _______ into cisterna magna and then subarachnoid space
foramina of Luschka
foramen of Magendie
Imaged superior to level of thalamus
lateral ventricles
Normal lateral ventricle measurement
<10 mm
2 lobes that are joined by cerebellar vermis forming dumbbell shape. The fourth ventricle travels between.
cerebellum
posterior fossa of brain, largest cistern in head
cisterna magna
normal measurement of cisterna magna
2-10mm
Nuchal thickness to should be measured:
outer cranium to outer skin
Normal nuchal thickness
<6mm
level of thalamus: may be included: CSP, falx, third ventricle, lateral ventricles; not included: cerebellum, cisterna magna, orbits
HC
most accurate for gesetational age in second trimester
HC
BPD proper measurement
outer to inner
indicates head shape; ratio of BPD/OFD
cephalic index
<0.75 cephalic index
dolichocephaly (flattened)
0.75 to 0.85 cephalic index
mesocephaly (normal)
> 0.85 cephalic index
brachycephaly (circular)
enlargement of the ventricles
ventriculomegaly
most common brain abnormality
ventriculomegaly
Ventriculomegaly due to obstruction
hydrocephaly
LV >10mm at atrium and “dangling choroid” sign
hydrocephaly
most common cause of hydrocephalus is
aqueductal stenosis
narrowing of cerebral aqueduct causing dilatation of third and left ventricle
aqueductal stenosis
ventriculomegaly + dilated 3rd ventricle
aqueductal stenosis
cerebral tissue is replaced by fluid; no cerebral hemispheres; only brain stem/ basal ganglia present
hydranencephaly
varying degrees of absence of midline and fusion of non-midline brain structures starting anteriorly; associated with midline facial defects
holoprosencephaly
Holoprosencephaly has a strong association with trisomy:
13
minimal fusion; absent CSP/CC; fused frontal horns; rest intact, “heart-shape” frontal horns
lobar holoprosencephaly
partial fusion LV and thalami, partial falx, absent CSP/CC, “butterfly shaped LV”
semilobar holoprosecenphaly
most severe form of holoprosencephaly
alobar
no midline separation of hemispheres. Midline brain structures are absent and non-midline are fused. Absence of CC, CSP, 3rd ventricle, and falx. “Horse-shoe shaped” monoventricle, fused thalami; FATAL
alobar holoprosencephaly
one eye
cyclopia
no eyes
anophthalmia
closed spaced eyes
hypothalmia
1 nostril and hypotelorism
cebocephaly
no nose, proboscis, hypotelorism
Ethmocephaly
absence of defect of the cerebellar vermis causing fourth ventricle to dilate and cisterna magna to enlarge. Cerebellar lobes will be splayed and fourth ventricle between them. Often associated with other midline brain defects
Dandy-Walker Malformation
cisterna magna > 10mm, dilated 4th ventricle, splayed cerebellar lobes “key-hole appearance”
Dandy-Walker Malformation
enlarged cisterna magna >10mm but no keyhole sign (normal 4th ventricle)
mega cisterna magna
arteriovenous malformation: connection between an artery and vein, anechoic tubular mass midline brain with turbulent color flow patterns. Associated with CHF and Hydrops
Vein of Galen Aneurysm
both sides with rim/dangling choroids
hydrocephaly
fluid filled cranium with no rim
hydranencephaly
horseshoe
alobar holoprosencephaly
butterfly
semilobar holoprosencephaly
heart frontal horns
Lobar holoprosencephaly
Key-hole
Dandy walker Malformation
Central tube with color
Vein of Galen
Absence of corpus callosum
agenesis of corpus callosum
Agenesis of corpus callosum is associated with trisomies
13
18
frequently encountered on routine sonos. Usually regress by third trimester
choroid plexus cysts
Choroid plexus cysts are a soft marker for trisomy
18
fluid-filled clefts within cerebrum
schizencephaly
cyst that communicates with ventricular system caused by hemorrhage, ischemia, vascular occlusion
porencephaly
“smooth brain”, no sulci/gyri with the cortex, only diagnosed in the third trimester
lissencephaly
No sulci/gyri within the cortex
agyria
most common intracranial tumor
teratoma
neural tube fails to close or form properly
increased risk with maternal diabetes, valproic acid, folate deficiency
neural tube defects
Most common NTDs
anencephaly
spina bifida
Open defects have an increased:
AFP
absence of cranial vault above the eyes; can be with or without brain
acrania
Acrania shows elevated ____
AFP
no cerebral hemispheres
anencephaly
normal amount of brain tissue with no skull, will appear as a misshapen head with no hyperechoic bone surrounding head
exencephaly
neural tube fails to close and there is a gap between the vertebrae/splaying of the vertebral laminae
Spina bifida
2 types of spina bifida
occulta (closed)
aperta (open)
covered by skin and no herniation of spinal cord outside of body, defect in vertebrae only. Normal AFP. Postnatal: sacral dimple, lipoma, excessive hair
spina bifida occulta
most common spina bifida
spina bifida aperta
not covered by skin and result in herniation of spina contents; elevated AFP
spina bifida aperta
contain meninges only, cystic appearance
meningoceles
most common; contains meninges and nerve roots, more complex in appearance
myelomeningocele
Presence of open spina bifida; pulls down on spinal contents causing cranial malformations
Arnold Chiari II malformation
Lemon shaped head
Banana cerebellum
Obliterated cisterna magna
Arnold-Chiari II malformation
Herniation of intracranial contents through opening in skull
Ceohalocele/encephalocele
Most common place for cephalocele/encephalocele herniation
Occipital
Cephalocele associated with
Meckel-Gruber syndrome
“Star gazer”
Ineincephaly
Hyper extension of neck; closed NTD. AFP may be normal
Ineincephaly
one orbit. lateral to medial edge of orbit
ocular diameter
between the 2 eyes. medial (inner) sides of both eyes
interocular diameter
both eyes. lateral edges of both orbits
binocular diameter
no orbits;
anophthalmia
anophthalmia is associated with trisomy:
13
one fused eye
cyclopia
cyclopia is assocated with trisomy:
13
closely spaced eyes
hypotelorism
Hypotelorism is associated withtrisomy:
13
far apart orbits
hypertelorism
small orbits
microphthalmia
often seen with eye abnormalities; false nose/ projection replacing or above nose
proboscis
abnormal/incomplete close of the lip and/or palate; can be unilateral, bilateral, midline, or eccentric. May be isolated or associated with holoprosencephaly and trisomy 13 and amniotic band syndrome
cleft lip and palate
Nuchal thickening is associated with trisomy
21
> 6mm measurement of nuchal fold posterior neck 18-23 weeks
nuchal thickening
Flattened or absent nasal bone is associated with trisomy
21
large tongue/protuberance of tongue
macroglossia
macroglossia is associated with trisomy
21
small mandible and recessed chin
micrognathia
Micrognathia is associated with trisomy
18
Cystic hygromas are associated with:
Turners syndrome
abnormal accumulation of lymphatic fluid under the skin. Most common within neck, but may be seen in the axilla; often leads to hydrops
cystic hygroma
The axial skeleton consists of:
cranial and spinal bones
The appendicular skeleton consists of:
limbs and pelvis
Long bones
femur and humerus
The _____ of the long bones should not be included in measurement
epiphysis
