OB II Final Review Flashcards
1
Q
Manual acquisition is also called which one of the following?
A
Free-hand acquisition
2
Q
Three-dimensional (3-D) rendering that can look beyond the tissue surface is known as which one of the following renderings?
A
Transparent
3
Q
Images rendered in 3-D are usually classified into which two groups?
A
Surface and transparent
4
Q
The two main methods of acquisition are which of the following?
A
Manual and automatic
5
Q
X-ray mode is also known as which one of the following?
A
Transparent mode
6
Q
Small picture elements in a 3-D image are called which one of the following?
A
Voxels
7
Q
Which one of the following statements about the fetal face is false?
A
The modified coronal view is best to image a cleft lip and palate. (this is false)
8
Q
Extensive facial screening may be hindered by all of the following except:
A
Polyhydramnios
9
Q
Craniosynostosis may be defined as which one of the following?
A
Premature closure of the cranial sutures
10
Q
Which one of the following is the result from a malformation of the lymphatic system?
A
Cystic hygroma
11
Q
Which one of the following statements about the facial profile is incorrect?
A
The facial profile has a strawberry-shaped cranium, which is described as a bulging of the occipital bones.(this is false)
12
Q
Evaluation of the nasal triad should include all of the following except:
A
Nostril length
13
Q
Which one of the following statements about cleft lip and palate is false?
A
A complete bilateral cleft lip and palate is a small gap in the left upper lip on the modified coronal view; the nose is flattened and widened.
(this is false)
14
Q
Which one of the following statements about an epignathus is false?
A
Swallowing is not impaired in fetuses with epignathus.
this is false
15
Q
The most common neck mass is which one of the following?
A
Cystic hygroma colli
16
Q
What percentage of cystic hygromas is associated with chromosomal anomalies?
A
50
17
Q
The bridge of the nose originates from the ____________ prominence.
A
Frontal
18
Q
Proboscis suggests which one of the following abnormalities?
A
Holoprosencephaly
19
Q
The optimal gestational age for measuring the nuchal translucency is _______ weeks.
A
10 to 14
20
Q
The most common congenital anomaly of the face is which one of the following?
A
Cleft lip
21
Q
Differential considerations for cystic hygroma include all of the following except:
A
Differential consideration for cystic hygroma includes meningomyelocele, encephalocele, nuchal edema, brachial cleft cyst, cystic teratoma, and thyroglossal cyst. NOT GOITER
22
Q
Which one of the following terms describes a small chin?
A
Micrognathia
23
Q
Which one of the following statements about facial anomalies is correct?
A
Facial anomalies occur as isolated defects or as part of a syndrome.
24
Q
An elongated forehead in the sagittal plane and triangular in shape in the axial plane describes which one of the following abnormalities?
A
Trigonocephaly
25
Which one of the following statements about a fetal goiter is incorrect?
A fetal goiter appears heterogeneous.
| this is false
26
Ear malformation may be observed in which one of the following?
Goldenhar syndrome
27
Cleft lip with or without cleft palate is seen more frequently in which one of the following groups?
Native Americans
Cleft lip with or without cleft palate is seen in 1 in 150 to 200 births in Native Americans; in 1 in 350 births in Asians; in 1 in 600 births in Caucasians; and in 1 in 3000 births in African Americans.
28
Congenital anomalies of the face occur in 1 in ______ births.
600
29
An isolated unilateral cleft lip defect commonly originates:
On the left side of the face
30
Which one of the following statements about neck teratomas is incorrect?
They are usually located posteriorly.
| this is false
31
Which one of the following neural tube defects is characterized by a lack of development of the cerebral and cerebellar hemispheres and cranial vault and is an abnormality that is incompatible with life?
Anencephaly
32
What is Potters characterized by?
Renal agenesis
Oligo
Pulmonary hypoplasia
abnormal feet and hands
33
What are the classifications of cystic renal anomalies that Potters describes?
Type 1 : (AR) Infantile polycystic kidney
Type 2 : Adult multicystic dysplastic kidney
Type 3 : Adult polycystic kidney
Type 4 : Obstructive cystic
34
What is Multicystic dysplastic kidney disease?
Renal tissue replaced with cysts varying in size
Affected kidney nonfunctional
Most common in infants and neonates
Multiple non-communicating cyst
35
Which one of the following is the most severe form of holoprosencephaly, which is characterized by a single common ventricle and malformed brain? Orbital anomalies range from fused orbits to hypotelorism, with frequent nasal anomalies and clefting of the lip and palate.
Alobar
36
Which one of the following anomalies may be characterized by the presence of colpocephaly?
Agenesis of the corpus callosum
37
The absence of the cavum septi pellucidi is a distinguishing characteristic of which one of the following fetal anomalies?
Agenesis of the corpus callosum
38
Which one of the following defects is associated with Meckel-Gruber syndrome?
Encephalocele
Meckel-Gruber syndrome is characterized by an encephalocele, polydactyly, and polycystic kidneys. Anencephaly may result from a syndrome such as Meckel-Gruber.
39
Extrophy of the bladder
Occurs in males 1 in 50,000 births
40
What is extrophy of the bladder?
Protrusion of the posterior wall of the bladder which contain the trigone and ureteric orfices.
41
What causes extrophy of the bladder?
Defective closure of the inferior part of the abdominal wall durning 4th week gestation
42
Renal agenesis and infantile polycystic kidney are
Incompatible with life
43
Renal agensis
Absent of kidneys
| Absent of AF due to no urine production
44
When do the fetal kidneys become a major contributor to the amniotic fluid
14-16 weeks
| *observation of AF volume before 14-16 can not exclude renal agensis
45
With renal agensis what could the adrenal gland do?
Enlarge and mimic the kidney
46
Sono findings of Renal agensis
Severe oligo after 13-15 weeks
Persistent absent bladder
Failure to see kidneys
Abnormally small thorax
47
Facial anomalies in holoprosencephaly may represent all of the following except:
Hypertelorism
48
Which one of the following fetal head anomalies is characterized by the presence of a single primitive ventricle?
Holoprosencephaly
49
Which one of the following anomalies is characterized by the presence of a posterior fossa cyst and a splaying of the cerebellar hemispheres?
Dandy-Walker malformation
50
Which one of the following abnormalities is described as the congenital absence of the cerebral hemispheres resulting from an occlusion of the carotid arteries. The midbrain structures are present, and fluid replaces cerebral tissue.
Hydranencephaly
51
Ventriculomegaly is defined as lateral ventricular enlargement measuring greater than ____ millimeters (mm).
10
52
An open spinal defect characterized by a protrusion of meninges and spinal cord through the defect, usually within a meningeal sac, is called which one of the following?
Meningomyelocele
53
Conditions commonly associated with fetal hydrocephalus include all of the following except:
Choroid plexus cyst
Common causes of hydrocephalus include spina bifida, encephalocele, Dandy-Walker malformation, agenesis of the corpus callosum, holoprosencephaly, and aqueductal stenosis.
54
Ventriculomegaly coupled with an enlargement of the fetal head is called which one of the following?
Hydrocephalus
55
Which one of the following abnormalities is the most common open neural tube defect?
Anencephaly
56
Which one of the following fetal head anomalies is characterized by the presence of a single primitive ventricle?
Holoprosencephaly
57
A vein of Galen malformation is which one of the following abnormalities?
An aneurysm of the Galen vein
A rare arteriovenous malformation
A sporadic event
or ALL OF THE ABOVE
58
A form of holoprosencephaly characterized by a common ventricle, hypotelorism, and a nose with a single nostril is which one of the following?
Cebocephaly
59
Which one of the following statements about anencephaly is incorrect?
Anencephaly has a male prevalence.
60
Which one of the following statements about microcephaly is incorrect?
Microcephaly is an abnormally large head.
61
The differential considerations of anencephaly include all of the following except:
Arachnoid cyst
62
Which one of the following terms is used to describe the herniation of the meninges and brain through a calvarium defect?
Encephalocele
63
Differential considerations of Dandy-Walker malformation should include which one of the following?
Arachnoid cyst
64
What is Potters characterized by
Renal agenesis
Oligo
Pulmonary hypoplasia
abnormal feet and hands
65
What are the classifications of cystic renal anomalies that Potters describes
Type 1 : (AR) Infantile polycystic kidney
Type 2 : Adult multicystic dysplastic kidney
Type 3 : Adult polycystic kidney
Type 4 : Obstructive cystic
66
What is Multicystic dysplastic kidney disease
Renal tissue replaced with cysts varying in size
Affected kidney nonfunctional
Most common in infants and neonates
Multiple non-communicating cyst
67
What is Potters type 1 IPKD?
Each cyst not identified
Kidneys are enlarged due to dilated tubules
Dismal prognosis in severe IPKD
May occur as part of Meckel-Gruber or as a genetic syndrome
68
What tests can be done during the first trimester of pregnancy for determining chromosomal abnormalities?
PAPP-A and free beta- hCG
These are used in conjuction with ultrasound to measure nuchal translucency
69
What is the most common reason for hydronephrosis?
UPJ
70
Where does the obstruction occur in UPJ?
At the junction between the renal pelvis and ureter
71
UPJ is usually
Unilateral
72
Causes of UPJ
Bends and kinks in ureter
Adhesion
Abnormal outlet shape of the UPJ
Absent longitudinal muscle
73
What does PUV look like
Keyhole
74
Posterior urethral valve occurs in
males
75
Posterior urethral valve results in
Hydronephrosis
Hydroureters
Dilation of of bladder and posterior urethra
76
Renal pelvic shouldn't measure more than
4mm
77
Urerocele
Cystic dilation of the distal ureter
78
Why does hydronephrosis occurs
Response to blockage in the urinary system
79
What is the most common fetal anomaly?
Hydronephrosis
80
Quad screen
Used in early second trimester. Looks at AFP, hCG, unconjugated estriol, and dimeric inhibin-A
81
What is chorionic villus sampling?
Ultrasound directed biopsy of the placenta or chorionic villi. This is an alternative test used to obtain a fetal karyotype by the culturing of fetal cells similar to an amniocentesis.
Used in early pregnancy (10-12 weeks)
Done transcervically or transabdominally
Risk of fetal loss is 1-3%
82
What is an amniocentesis and what is the optimal collection site?
First was a technique to relieve polyhydramnios, predict Rh isoimmunization, and document fetal lung maturity. Now performed to determine karyotype as well.
Collection sites should be away from the fetus, placenta, umbilical cord, and near maternal midline to avoid maternal uterine vessels
83
Alpha-Fetoprotein (AFP)
Major protein in fetal serum and is produced by the yolk sac in early gestation and later by the fetal liver.
Found in the fetal spine, GI tract, liver and kidneys.
Can be measured in maternal serum (MSAFP) or in amniotic fluid (AFAFP). Considered abnormal when high or low
84
What is hydrops fetalis?
Condition in which excessive fluid accumulates within fetal body cavities.
May result from anasarca, ascites, pericardial effusion, pleural effusion, placental edema, and polyhydramnios
85
What is nonimmune hydrops?
Extensive fluid accumulation but is unrelated to the presence of maternal serum IgG antibody
86
Sono findings of hydrops
```
Scalp edema
Pleural effusion
Pericardial effusion
Ascites
Poly
Thickened placenta
```
Can be caused by fetal anemia
87
Trisomy 21 or Down's Syndrome
-Most common chromosomal disorder (1 in 600 births)
-Associated with AMA
-Sono associations:
Heart defects
Clenched hands
Omphalocele
Micrognathia
Talipes
Choroid plexus cyst
Congenital diaphragmatic hernia
Cerebellar hypoplasia
Meningiomylocele
SGA
IUGR and hydramnios
88
Trisomy 18 or Edwards syndrome
-Extra chromosome 18, second most common chromosomal abnormality (3 in 10,000 births)
-Sono associations:
Heart defects
Clenched hands
Omphalocele
Micrognathia
Talipes
Choroid plexus cysts
Renal anomalies
Cleft lip/palate
CDH
Cerebellar hypoplasia
Meningomyelocele
SUA
IUGR and hydramnios
89
Trisomy 13 or Patau's syndrome
-Extra chromosome 13, 1 in 5000 births, Fetus is affected by holoprosencephaly 40% of the time
-Sono associations:
Heart defects
Omphalocele
Polydactyly
Talipes
Cleft lip/palate
Renal anomalies
Meningomyelocele
Micrognathia
Holoprosencephaly
90
Turner's Syndrome
-Occurs in females only
-Not very good prognosis-high risk for in utero demise
-Those who do survive have ovarian dysgenesis and short stature
-Sono associations:
Cystic hygroma
Heart defects
Coarctation of aorta
Hydrops
Renal anomalies
91
Triploidy
-Complete extra set of chromosomes
-Often results in one ova being fertilized by two sperm
-Vast majority spontaneously abort prior to 20 weeks
-Sono associations:
Heart defects
Omphalocele
Renal anomalies
Cranial defects
Facial defects
92
VACTERL
Group of anomalies that may occur together
```
V ertebral defects
A nal atresia
C ardiac anomalies
T ransesophageal fistula
R enal anomalies
L imb dysplasia
```
93
Skeletal Dysplasia means
Abnormal growth and density of bone and cartilage.
94
Rhizomelia
Shortening of the proximal bones
| Humerus, Femur
95
Mesomelia
Shortening of the distal bones
| Radius, Ulna, Tibia, Fibula
96
Micromelia
Shortening of all long bones
97
Sono findings of Thanatophoric
```
Rhizomelia
Bowed long bones
Narrow thorax
Normal truck length
Large head
Frontal bossing
Hypertelorism
```
98
What are the complications of a diabetic mother?
- Increased risk for pregnancy-related complications, such as early and late trimester pregnancy loss and congenital anomalies
- Frequent hospitalizations for glucose control, serious infections such as pyelonephritis, and problems at time of delivery
99
Sono findings of a diabetic mother
- Increased risk of early demise and risk of 3rd trimester loss
- Poly
- Caudal regression syndrome (only seen in diabetic mothers)
- Neural tube defects, congenital heart defects
- Renal anomalies, GI defects, single umbilical artery
100
What are the risks of hypertension in pregnancy?
- Occurs frequently in high risk populations
- Places the mother and fetus at risk
- May be associated with small placentas because of the effect of the hypertension on the blood vessels
- Preeclampsia and eclampsia
101
What is preeclampsia?
High blood pressure develops with proteinuria or edema. Patient may develop seizures that can be life-threatening to both the mother and fetus.
102
What is eclampsia?
Occurrence of seizures or coma in a preeclamptic patient
103
When does the division of the zygote take place in a monoamniotic, monochorionic pregnancy?
After 8 days of conception
104
Uterine fibroids can cause what?
Pain or premature labor (delivery complications can occur depending on the location of the fibroid)
105
What is premature labor?
Onset of labor prior to 37 weeks of gestation
106
When does the division of the zygote take place in a diamniotic, dichorionic pregnancy?
Within the first three days of conception
107
What is fetus papyraceous mean?
If the fetus dies after reaching a size too large for resorption, the fetus becomes flattened from loss of fluid and most of its soft tissue
108
What are dyzygotic twins?
Fraternal twins
- Arise from two separately fertilized ova
- Each ovum implants separately in the uterus and develops its own placenta
109
What are monozygotic twins?
Identical
- Arise from a single fertilized egg, which divides, resulting in 2 genetically identical fetuses
- Very high-risk situation (increased risk for twin to twin transfusion)
- Depending on whether fertilized eggs divide early or late, there may be 1 or 2 placentas, chorions and amniotic sacs
110
What are the five types of conjoined twins?
1. Thoracopagus- joined at thorax
2. Omphalopagus- joined at anterior wall
3. Craniopagus- joined at cranium
4. Pyopagus- joined at ischial region
5. Ischiopagus- attached at buttocks
111
Poly-oli Sequence ("stuck twin" syndrome) is what?
DIamniotic pregnancy with poly in one sac and severe oligo and smaller twin in the othetr sac. This occurs around 16-26 weeks gestation
112
What is twin to twin transfusion?
When there is an arteriovenous shunt within the placenta meaning arterial blood from one twin is pumped into the venous system of the other.
- Donor twin: anemic, growth is restricted, less blood flow thru its kidneys, urinates less, develops oligo
- Recipient twin: too much blood, may be normal/large in size, excess blood flow to thru the kidneys, urinates too much, poly, may go into heart failure and become hydropic
113
What is an acardiac anomaly?
Rare, occurs in monochorionic twins
| One twin develops without a heart and often without an upper half of the body
114
What does the ductus venosus turn into after birth?
Ligamentum venosum
Forms about 2 weeks after birth
115
Achrodroplasia
Most common nonlethal skeletal dysplasia
80% of the cases are spontaneous mutation
Decreased endochondral bone formation which produce short squat bones
116
What is osteogenesis imperfecta
Disorder of the collagen production leading to brittle bones
1 in every 20,000 to 30,000 births it occurs
117
What is osteogenesis imperfecta type 2
```
Most severe lethal outcome
Autosomal recessive or dominant
Numerous fractures
Normal bone echogenicity
Moderate femur shortening
1 in every 60,000 births
Decreased mineralization of bone especially in the calvarium
```
118
What is Jeunes
```
Narrow thorax
Rhizomelia
Renal dysplasia
Polydactyly
1 in every 70,000 births
Autosomal recessive
Ranges in severity with most severe results in death due to pulmonary hypoplasia
```
119
What are some predisposing conditions to cord prolapse?
Abnormal fetal presentation,
Nonengagement of fetus due to prematurity,
Long umbilical cord,
Abnormal bony pelvic inlet,
Leiomyomas,
Polyhydramnios,
Vasa previa,
Velamentous insertion of the cord,
Marginal insertion of cord in low lying placenta,
Incompetent cervix with premature rupture of membranes.
120
Rocker bottom foot characteristics
Prominent heel and convex sole
121
What is Ellis-Van Creveld
Occurs in 200,000 births
More frequent in Amish community
Autosomal recessive
Also known as chondoectodermal dysplasia
122
Sono findings of Ellis-Van Creveld
```
Limb shortening
Polydactly
Heart defects (50%)
May have narrow thorax
Death up to 50%
Survivors are short with normal intellect
```
123
Which two structures fuse together to make the umbilical cord?
Omphalomesenteric (yolk stalk) and allantois ducts
124
What is the normal length of the umbilical cord?
40-60 cm
125
What are bronchogenic cysts?
Abnormal budding of the foregut and lack any communication with the trachea or bronchial tree.
Occur within mediastinum or lung.
Amniotic fluid volume is normal
Most common lung mass
126
The cord includes how many arteries and veins?
2 arteries
| 1 vein
127
What is the length of a short cord?
less than 35 cm
128
What is the length of a long cord?
Greater than 80 cm
129
What are the two types of diaphragmatic hernias and where are each of them located?
Foramen of Bochdalek (most common)= posteriorly and laterally, left
Foramen of Morgagni= anteriorly and medially
130
What are some associations with Velamentous placental cord insertion?
```
Higher risk of lower birth weight
Small for gestational age
Preterm delivery
Low Apgar scores
Abnormal intrapartum fetal heart rate pattern
```
131
What are some predisposing conditions to cord prolapse?
Abnormal fetal presentation,
Nonengagement of fetus due to prematurity,
Long umbilical cord,
Abnormal bony pelvic inlet,
Leiomyomas,
Polyhydramnios,
Vasa previa,
Velamentous insertion of the cord,
Marginal insertion of cord in low lying placenta,
Incompetent cervix with premature rupture of membranes.
132
What is the most important determinant for fetal viability?
Pulmonary development
133
What 3 things do we look at in the fetal chest?
Size
Shape
Symmetry
134
What is the normal degree of a cardiac axis?
22-75 degrees
| 45 degrees being average
135
What is amniotic band syndrome?
The rupture of the amnion, which leads to entrapment/entanglement of the fetal parts by the "sticky" chorion. Early entrapment may lead to severe craniofacial defects and internal malformations. Late entrapment leads to amputations or limb restrictions.
136
What is CCAM(Congenital Cystic Adenomatoid Malformation)
Multi cystic mass within the lung consisting of primitive lung tissue and abnormal bronchial and bronchiolar-like structures
Type 1: macro cystic
Type 2: macrocystic w/ microcystic
Type 3: microcystic
137
The severity of pulmonary hypoplasia depends on ____.
When pulmonary hypoplasia occurred during pregnancy, its severity, and its duration.
Prognosis is grave; 80% die after birth
138
What is pulmonary hypoplasia?
Reduction in lung volume resulting in small, inadequately developed lungs
Most commonly occurs from prolonged oligo or secondary to small thoracic cavity
139
If you see pleural fluid, you should be looking at what structure very carefully?
Lung, Heart, and Diaphragmatic lesions.
140
A big pleural effusion could cause ____.
Impairment of the lungs, which may result in pulmonary hypoplasia
141
What are the coexisting anomalies that you may find with esophageal atresia? How often do these anomalies occur?
Coexisting anomalies occur in 50-70% fetuses
| ```
Anomalies include:
Anorectal atresia
Vertebral defects
Heart defects
Renal Anomalies
Limb Anomalies
VACTERL
```
142
Normal embryologic herniation of the bowel allows what to occur?
it allows the abdominal cavity to catch up to the midgut. The midgut grows fast than the abdominal cavity. Intestines return by 11th or 12th week gestation.
143
What is omphalocele?
Congenital anterior abdominal wall defect in which abdominal organs (Liver, bowel, stomach) are atypically located within the umbilical cord and protrude outside the wall; develops when there is a midline defect of the abdominal muscles, fascia, and skin; covered in a membrane consisting on amnion and peritoneum
144
What are the associated anomalies of omphalocele?
Complex cardiac disease (50-70%),
| GI, neural tube, and genitourinary tract anomalies (30-50%)
145
What is gastroscchisis?
Congenital defective opening in the wall of the abdomen just to the right of the umbilical cord; bowel and other organs (stomach and genitourinary organs, infrequently) may protrude outside the abdomen from this opening
146
Gastroschisis is a consequence of atrophy of what structure?
Right umbilical vein or a disruption of the omphalomesenteric artery
147
What is limb- body wall complex?
Anomaly associated with large cranial defects, facial clefts, body wall complex defects involving thorax, abdomen, or both, and limb defects. Occurs with the fusion of the amnion and chorion; amnion doesn't cover the umbilical cord normally but extends as a sheet from the margin of the cord and is continuous with both the body wall and the placenta.
148
Limb-body wall defects are more common on which side?
Left-side defects are three times more common than right
149
Which classification of osteogenesis imperfecta is most severe?
Type 2
150
What is pseudoascites?
Sonolucent band near the fetal anterior abdominal wall found in fetuses over 18 weeks gestation
151
What is duodenal atresia (double bubble)?
Blockage of the duodenal lumen by a membrane that prohibits the passage of swallowed amniotic fluid
Most cases are found below the ampulla and often coexist with annular pancreas
152
What percentage of fetuses with duodenal atresia have trisomy 21?
30%
153
What is thanatophoric dysplasia?
Lethal short-limb dwarfism (most common) characterized by a marked reduction in the length of the long bones, pear-shaped chest, soft tissue redundancy, and frequently clover-leaf skull deformity and ventriculomegaly
Sono findings:
- Bowed long bones
- Narrow thorax with normal trunk length
- Large head size
- Severely flattened vertebral bodies (platyspondyly)
- Frontal bossing
- Hypertelorism
154
What is the most common nonlethal skeletal dysplasia?
Achondroplasia
155
What might we be looking at if we see multiple fractures and a compressed calvarium?
Osteogenesis Imperfecta
156
What is the congenital collagen production disorder?
Osteogenesis Imperfecta
157
A small thorax, rhizomelia, renal dysplasia, and polydactyly describe ___.
Jeune's Syndrome
158
Clubfoot
1 in 400 births
Male predominance
More than 1/2 the cases are unilateral
159
Talipes
Majority of cases are idiopathic and isolated findings
160
Rocker-bottom foot
Characterized by prominent heel and convex sole
Associated with multple syndromes and chromosomal anomalies (especially trisomy 18)
161
What is the anomaly associated with the Amish community?
Ellis-Van Creveld syndrome (Chondectomdermal dysplasia)
162
Sono findings of Spina Bifida
- Splaying of posterior ossifaction centers with a V or U configuration
- Protrusion of saclike structure that may be anechoic (menigocele) or contain neural elements (myelomeningocele) -Cleft in skin
- Lemon shape head
- Obliteration of cisterna magna
- "Banana shape" cerebellum
- Ventriculomegaly
