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Women's imaging > Obstetric ultrasound > Flashcards

Obstetric ultrasound Flashcards

1
Q

first trimester ultrasound should include visualization of

A

location and appearance of gestational sac, presence or absence of a yolk sac and embryo, crown-rump-length, cardiac activity, fetal number, fetal neck region for nuchal translucency, uterus and adnexa

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2
Q

second and third trimester ultrasound should include visualization of

A

fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal measurements (biometry), fetal number, fetal anatomic survey, maternal cervix and adnexa

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3
Q

potential cavitation and tissue disruptive effects from ultrasound are most significant in what trimester when embryologic tissues are tiny and loosely tethered

A

first

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4
Q

thermal effects from ultrasound are more significant in what trimester, when bone is present increasing sound absorption and heating

A

second and third trimesters

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5
Q

serum pregnancy test is defined as positive with values of

A

above 5 mIU/ml

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6
Q

first trimester ultrasound covers the period from conception to the end of

A

13th menstrual week

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7
Q

Normal or not: no visible ultrasound findings up to 5 weeks GA

A

normal

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8
Q

size of GS at approximately 5 weeks GA

A

2-3 mm

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9
Q

true or false: absence of intradecidual sign or double decidua sign does not exclude an intrauterine pregnancy

A

true

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10
Q

yolk sac appears at approximately what week and provides provides a definitive evidence of a gestational sac

A

5.5 weeks GA (>8 mm mean sac diameter)

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11
Q

embryo is visible at what week

A

6 weeks, with mean sac diameter of 10 mm

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12
Q

embryonic cardiac activity is visible at what week

A

6 weeks GA

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13
Q

normal embryonic heart rate at 6.2 to 7 weeks is how many beats per minute

A

100-120

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14
Q

after 7 weeks, embryonic heart rate is

A

137-144 bpm

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15
Q

first ultrasound evidence of intrauterine pregnancy is visualization of a

A

gestational sac

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16
Q

tiny well-defined cystic structure implanted within the echogenic decidua seen as early as 4.5 weeks

A

intradecidual sign

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17
Q

refers to the endometrium of pregnant uterus

A

decidua

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18
Q

normal appearance of gestational sac

A

smoothly contoured, round or oval, fluid-containing structure positioned within the endometrium near the fundus of the uterus

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19
Q

normal gestational sac has an echogenic border of

A

greater than 2 mm thick, which represents the choriodecidual reaction

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20
Q

double decidua sign is produced by

A

visualization of 3 layers of decidua early in pregnancy

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21
Q

lines the endometrial cavity

A

decidua vera/parietalis

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22
Q

covers the gestational sac

A

decidua capsularis

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23
Q

contributes to the formation of the placenta at the site of implantation

A

decidua basalis

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24
Q

free margin of the gestational sac consists of

A

chorion and decidua capsularis

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25
Q

normal thickness of chorion and decidua capsularis

A

at least 2 mm thick

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26
Q

first structure seen with US within the gestational sac and is definitive in identifying a gestational sac

A

yolk sac

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27
Q

it is a 2 to 6 mm diameter, spherical, cystic structure that is connected to the mid-gut of the embryo by a thin stalk, the vitelline duct

A

yolk sac

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28
Q

remnant of the connection of the vitelline duct (aka omphalomesenteric duct) to the distal ileum

A

meckel diverticulum

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29
Q

earliest site of blood cell formation in the embryo. it floats freely in fluid between the amniotic and chorionic membranes

A

yolk sac

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30
Q

yolk sac should always be visualized in normal pregnancy in gestational sacs of what size of MSD by transvaginal utz

A

8 mm MSD

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31
Q

yolk sac disappears at what Gestational age

A

12 weeks

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32
Q

plate-like structure at the periphery of yolk sac

A

embryo

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33
Q

embryo develops in the _____, while the yolk sac resides in the ______

A

embryo- amniotic cavity; yolk sac- chorionic cavity

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34
Q

the appearance of two adjacent cystic structures, the amnionic sac containing the embryo and yolk sac has been termed the

A

double bleb sign

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35
Q

embryos as small as how many mm can be detected by transvaginal utz

A

2 mm

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36
Q

the embryo, amniotic cavity and chorionic cavity enlarge proportionally untill about how many weeks

A

10 weeks GA

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37
Q

fetal urine production starts at what week

A

10 weeks

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38
Q

at 10 weeks, the amniotic cavity then enlarges faster than the chorionic cavity with fusion of the amnion and chorion at what week

A

14 to 16 weeks

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39
Q

develops on the ovary at the site of dominant follicle from which ovulation ocurred

A

corpus luteum

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40
Q

secretes estrogens, progesterones and other hormones that are essential for establishing and maintaining pregnancy

A

corpus luteum

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41
Q

immediately following ovulation, the corpus luteum appears as an area of

A

focal hemorrhage in the ovary

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42
Q

At what weeks GA does the hindbrain (rhombencephalon) forms a prominent cystic structure, which represents a normal cystic phase

A

6-8 weeks GA

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43
Q

Rudimentary brain structure that becomes the normal fourth ventricle and posterior fossa

A

Rhombencephalon

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44
Q

At what week does the gut herniates into the base of the umbilicus forming a physiologic omphalocele seen as protruding midline anterior abdominal wall mass 6-9 mm in size

A

9-11 weeks

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45
Q

diagnosis of pregnancy failure: no embryonic heartbeat with CRL of ___ mm

A

> /= 7mm

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46
Q

diagnosis of pregnancy failure: no embryo with mean sac diameter of ___ mm

A

> /= 25 mm

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47
Q

diagnosis of pregnancy failure:no embryo with heartbeat of ___ weeks after US that showed a gestational sac without a yolk sac

A

> /= 2 weeks

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48
Q

diagnosis of pregnancy failure: no embryo with heartbeat ___ days after US that showed a gestational sac with a yolk sac

A

> /= 11 days

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49
Q

suspicious but not diagnostic of pregnancy failure (pregnancy of uncertain viability): crown-rump-length of ___ mm with no heartbeat

A

<7 mm

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50
Q

suspicious but not diagnostic of pregnancy failure (pregnancy of uncertain viability): MSD of ___ mm with no embryo

A

16-24 mm

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51
Q

suspicious but not diagnostic of pregnancy failure (pregnancy of uncertain viability): no embryo with heartbeat ____ days after US that showed a gestational sac without a yolk sac

A

7-13 days

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52
Q

suspicious but not diagnostic of pregnancy failure (pregnancy of uncertain viability): no embryo with heartbeat ___ days after US that showed a gestational sac with a yolk sac

A

7-10 days

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53
Q

empty amnion. pregnancy failure or pregnancy of uncertain viability

A

pregnancy of uncertain viability

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54
Q

suspicious but not diagnostic of pregnancy failure (pregnancy of uncertain viability): yolk sac size

A

larger than 7 mm

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55
Q

less than 5 mm difference between mean sac diameter and CRL. pregnancy failure or pregnancy of uncertain viability?

A

pregnancy of uncertain viability

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56
Q

if findings tagged as pregnancy of uncertain viability, follow-up US examination in ____ days is appropriate

A

7-10 days

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57
Q

risk factors for ectopic pregnancy

A

tubal ligation, previous tubal surgery, PID, previous ectopic pregnancy, presence of an IUD, endometriosis, in vitro fertilization, history of smoking prior to conception, previous endometrial or myometrial surgery

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58
Q

abortion is termination of pregnancy before ___ weeks GA

A

20 weeks GA

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59
Q

up to how many percent of spontaneous abortions have chromosomal abnormalities

A

60%

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60
Q

refers to the occurrence of vaginal bleeding and uterine cramping with a closed cervical os in early pregnancy

A

threatened abortion

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61
Q

refers to presence of residual products of conception within the uterus

A

incomplete abortion

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62
Q

fetus has died but remains within the uterus

A

missed abortion

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63
Q

habitual abortion is defined as ____ successive spontaneous abortions

A

3 or more

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64
Q

pregnancy in which the embryo has dies and is no longer visible, or never developed

A

anembryonic pregnancy or blighted ovum

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65
Q

gestational sac is considered abnormal if it demonstrates the following features

A

large size (> 25 mm MSD), without an embryo or yolk sac, distorted shape, irregular contour, thin or weak choriodecidual reaction, absence of a double decidual sac or abnormal position

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66
Q

this feature of the gestational sac have reported a 100% specificity and positive predictive value for identification of nonviable pregnancy

A

large sac size without visualized yolk sac or embryo and a distorted sac contour

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67
Q

term used for the presence of an intrauterine gestational sac with no embryonic heartbeat and no findings of definite pregnancy failure

A

intrauterine pregnancy of uncertain viability

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68
Q

describes the situation of a woman with a positive urine or serum pregnancy test and no intrauterine or ectopic pregnancy on TVS examination

A

pregnancy of unknown location

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69
Q

At what gCG level is a viable intrauterine pregnancy unlikely

A

> /= to 3000 IU/mL

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70
Q

a nonspecific intrauterine fluid collection with smooth rounded or oval contours and with no yolk sac or embryo and normal adnexa most likely represents a

A

an intrauterine pregnancy, however, ectopic pregnancy is not completely excluded. intrauterine fluid may represent a gestational sac

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71
Q

if pregnancy is uncertain if intrauterine or not, follow-up US and hCG determination should be done in how many weeks

A

7-10 weeks as long as the patient is hemodynamically stable

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72
Q

major cause of pregnancy related maternal deaths

A

ectopic pregnancy

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73
Q

those susceptible to ectopic pregnancy include

A

history of PID, tubal surgery, endometriosis, ovulation induction, previous ectopic pregnancy or use of IUD

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74
Q

most ectopic pregnancies occur in the

A

fallopian tube

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75
Q

ectopic pregnancy in the fallopian tube usually occurs at what area

A

ampulla

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76
Q

uncommon sites for ectopic pregnancy

A

interstitial portion of fallopian tube, abdominal cavity, ovary and cervix

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77
Q

most specific finding of ectopic pregnancy

A

live embryo with heartbeat outside of the uterus

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78
Q

US findings in ectopic pregnancy include demonstration of an extrauterine gestational sac appearing as a fluid containing structure with an echogenic right, called the

A

tubal ring sign

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79
Q

true or false: corpus luteal cysts always arise from the ovary

A

true

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80
Q

blood in the uterine cavity produces cystic-appearing mass termed a _____ seen in 10 to 20% of ectopic pregnancies

A

pseudogestational sac

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81
Q

a true gestational sac is differentiated from a “pseudosac” by the presence of

A

yolk sac or embryo

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82
Q

a ____ sign suggests a true gestational sac, but is not always reliable

A

double decidua sign

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83
Q

pseudosacs are located _____ within the uterine canal whereas a normal gestational sac is ______

A

pseudosacs- centrally, true gestational sac- eccentrically implanted within the decidua

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84
Q

Doppler studies demonstrate _____ with pseudosacs and _____ with true gestational sacs

A

absent or minimal peritrophoblastic flow with pseudosacs and high-velocity, low impedance flow with true gestational sacs

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85
Q

ectopic pregnancy in this location is associated with high incidence of severe maternal hemorrhage

A

intersitital

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86
Q

implantation in this region of the fallopian tube (myometrial portion) allows development of pregnancy up to 16 weeks with large supplying arteries, A fundal gestational sac is eccentric and the adjacent myometrium is thinned to less than 5mm. it can be confused with a pregnancy in one horn of bicornuate uterus

A

interstitial

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87
Q

ectopic pregnancy in this region is common with IUD in place

A

ovarian

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88
Q

ectopic pregnancy in this region is associated with marked increase in maternal mortality because of growth of the pregnancy is unrestricted

A

abdominal

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89
Q

ectopic pregnancy in this region shows an hourglass shaped uterus

A

cervical

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90
Q

medical management of ectopic pregnancy

A

oral methotrexate or local injection of methotrexate or potassium chloride

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91
Q

up to how many percent of ectopic pregnancies resolve spontaneously

A

15%

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92
Q

in general, quantitative hCG levels are expected to double approximately every

A

2 days

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93
Q

develop because of venous bleeding from separation of the margin of placenta

A

subchorionic hemorrhage

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94
Q

in subchorionic hemorrhage, hematoma collects preferentially beneath the ____ becuase it is more easily separated from the myometrium than the placenta

A

chorion

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95
Q

nonspecific term that refers to small collections of blood at the site of attachment of the chorion to the endometrium. these are in essence small areas of subchorionic hemorrhage that occur early in pregnancy

A

implantation bleeding

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96
Q

retained products of conception has a variant appearance of thickened endometrium of up to

A

> 10 mm

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97
Q

group of neoplasms that range from benign to highly malignant in which all are derived from abnormal placental tissues and occur as sequelae to pregnancy

A

gestational trophoblastic disease

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98
Q

both benign and malignant GTD tumors produce

A

hCG

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99
Q

woman over age ___ with a prior history of molar pregnancy are at increased risk for GTD

A

40

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100
Q

most common and most benign form of GTD

A

hydatidiform mole

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101
Q

form of H.mole that involves the entire placent, lacks a fetus and is diploid in karyotype

A

complete/classic mole

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102
Q

form of H.mole that involves only a portion of the placenta and is associated with an abnormal fetus that is triploid in karyotype (due to fertilization of an ovum by 2 sperm

A

partial mole

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103
Q

true or false: molar pregnancy may occassionally appear as an anechoic fluid collection that mimics anembryonic pregnancy

A

true

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104
Q

seen as large, septated, bilateral cysts massively enlarging the ovaries in 25- 65% cases of molar pregnancy

A

theca lutein cysts

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105
Q

theca lutein cysts result from

A

hyperstimulation of the ovaries by high circulating levels of hCG and are most commonly seen in molar pregnancy in the second trimester

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106
Q

refers to invasion of molar tissue into, but usually not beyond the myometrium

A

invasive mole (chorioadenoma destruens)

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107
Q

highly aggressive malignancy that forms only trophoblast without any villous structure. it is locally invasive and spreads into the myometrium and parametrium, and hematogeneously metastasizes to any site of the body

A

choriocarcinoma

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108
Q

serum hCG levels that rise or plateau in the 8-10 weeks following evaluation of molar pregnancy suggest

A

invasive or metastatic gestational trophoblastic disease

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109
Q

clinical dating of pregnancy is based on

A

LMP, PE assessment of uterine size

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110
Q

sonographic dating of pregnancy

A

based on measurements of fetal parameters used to document growth

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111
Q

these terms are usually considered to be synonymous terms and are based on the average 28-day menstrual cycle

A

gestational age and menstrual age

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112
Q

used inthe first trimester to estimate GA when no embyro is visualized

A

gestational sac

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113
Q

mean sac diameter is accurate to within approximately ___ week of menstrual age

A

1 week

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114
Q

measured from the top of the head to the bottom of the torso of the visualized embryo or fetus

A

crown rump length

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115
Q

CRL is useful until about __ weeks GA, when other measurements become more accurate

A

12 weeks

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116
Q

biparietal diameter and head circumference is measured at what level on an axial image of the fetal head

A

at the level of 3rd ventricle and thalamus

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117
Q

elongated skull

A

dolicocephaly

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118
Q

round skull

A

brachycephally

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119
Q

relatively independent of head shape

A

HC

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120
Q

abdominal circumference is measured at what level

A

level of intrahepatic portion of umbilical vein

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121
Q

true or false: GA estimates are most accurate in early pregnancy and become progressively less accurate as the pregnancy advances

A

true

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122
Q

a fetus or newborn i considered SGA if its weight is below the ___ percentile for GA

A

10th

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123
Q

pattern of growth impairement occurs early in the ____ trimester and tends to be symmetrical

A

second

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124
Q

growth impairment that are asymmetrical occurs in

A

late second and third trimester

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125
Q

at what trimester of growth impairment does the fetal abdomen may become disproportionally small relative to the head and femur because of diminished glycogen stores in the fetal liver and decreased or absent subcutaneous fat

A

late second and third trimester

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126
Q

cause of 80% of intrauterine growth retardation that is prone to asymmetric growth restriction

A

uteroplacental insufficiency

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127
Q

multiparameter approach for IUGR include

A

estimated fetal weight, amniotic fluid volume and presence of absence of maternal hypertension

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128
Q

IUGR is diagnosed confidently when the EFW is below the ___ percentile

A

5th

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129
Q

when EFW is betweent the 5th and 20th percentile, IUFR is diagnosed if these are also present

A

oligohydramnios, maternal hypertension

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130
Q

normal fetal weight gain in the third trimester is ____ g/week

A

100 to 200 grams/week

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131
Q

oligohydramnios has an AFI of

A

5 cm or less

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132
Q

test to identify compromised fetuses

A

biophysical profile

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133
Q

four parameters that assess for acute hypoxia

A

reactive fetal heart rate (nonstress test), respiratory activity, gross motor movements, fetal tone

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134
Q

one parameter thatn evaluates for chronic hypoxia

A

amniotic fluid volume

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135
Q

in BPS, a score of 2 in one parameter is given for

A

normal response

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136
Q

a BPS score of 0 in one parameter means

A

abnormal

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137
Q

fetus is at extreme risk for fetal demise within 1 week if the BPS score has a total of

A

0-2

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138
Q

there is no immediate risk if the BPS total score is

A

8 or 10

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139
Q

umbilical artery circulation to the placenta is normally ___ impedance manifest by high blood flow velocities in late diastole on spectral Doppler waveforms

A

low impedance

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140
Q

fetal arterial doppler findings of ____, is strongly predictive of severe fetal compromise

A

systolic to diastolic ratio of 4 or greater, or absence of forward flow in diastole

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141
Q

ominious finding in fetal arterial Doppler indicative of high risk for fetal demise within 1 to 7 days if the fetus is left in utero

A

reversal of flow in diastole

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142
Q

carries more than 80% of fetal cerebral blood flow and is accessible to Doppler interrogation

A

middle cerebral artery

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143
Q

in normal fetal brain, MCA circulation shows a

A

high vascular resistance pattern with little or no forward flow in late diastole

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144
Q

fetal macrosomia is defined as EFW above the

A

90th percentile for GA or a fetal weight above 4000 g

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145
Q

risk factors for fetal macrosomia

A

DM, maternal obesity, previous history of macrosomic infant, excessive weight gain during pregnancy

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146
Q

complications of macrosomia manifest at delivery include

A

shoulder dystocia, traumatic delivery, fractures, brachial plexus injury, perinatal asphyxia, neonatal hypoglycemia and meconium aspiration

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147
Q

most common solid pelvic masses encountered during pregnancy

A

uterine leiomyomas

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148
Q

most common cystic pelvic masses found in pregnancy

A

corpus luteal cysts

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149
Q

internal hemorrhage in the corpus luteal cysts may cause increase in size of up to

A

10-15 cm in size

150
Q

most of the corpus luteal cysts regress by how many weeks

A

16 to 18 weeks GA

151
Q

forms due to an exaggerated corpus luteum response to high levels of hCG. they appear as bilateral multicystic enlargement of the ovaries. occurs with GTD, pregnancy more than one fetus, or associated with the use of ovulation-inducing drugs

A

theca lutein cysts

152
Q

single most common cause of a poor neonatal outcome

A

preterm delivery

153
Q

normal cervical length throughout gestation

A

26 to 50 mm

154
Q

cervical length is measured in

A

sagittal plane between the internal os marked by a V-shaped notch and the external os marked by a triangular echodensity

155
Q

dilatation of the cervical canal of ___mm is indicative of cervical incompetence

A

> 8mm

156
Q

normal placenta is first apparent on US at what week, as a focal thickening at the periphery of the gestational sac

A

8 weeks

157
Q

disc like shape of the placenta becomes evident at what week

A

12 weeks

158
Q

by this week, the placenta appears finely granular and homogeneous with a smooth covering chorionic membrane along its fetal surface

A

18 weeks

159
Q

prominent sonographic landmark of placenta

A

retroplacental complex of decidual and myometrial veins

160
Q

as gestation advances, placenta appears

A

more heterogeneous, with focal echolucencies owing to venous lakes and area of fibrin deposition

161
Q

normal placenta has a maximum thickness of __ cm and a minimal thickness of ___ cm

A

maximum thickness of 4 cm and minimal thickness of 1 cm

162
Q

thick placentas are associated with

A

maternal diabetes, maternal anemia, hydrops from immune and nonimmune causes, chronic uterine infections and placental abruption

163
Q

thin placentas are associated with

A

preeclampsia, placental insufficiency and trisomies 13 and 18

164
Q

present when a part or all of the placenta covers the internal cervical os

A

placenta previa

165
Q

risk factors for placenta previa include

A

scarring of the lower uterine segment associated with previous cesarean sections, previous placenta previa and multiple previous pregnancies

166
Q

placenta previa usually present with ____ in the 3rd trimester

A

painless vaginal bleeding

167
Q

present when placental blood vessels or the umbilical cord are adherent to the membranes that cover the cervix

A

vasa previa

168
Q

risk factors for vasa previa

A

placenta previa, low-lying placenta, multiple gestation, succenturiate lobe , velamentous cord insertion

169
Q

an accessory placental lobe separate from the main placenta

A

succenturiate lobe

170
Q

umbilical cord inserts into the chorioamniotic membranes at the margin of the placenta

A

velamentous cord insertion

171
Q

defined as the premature separation of a normally positioned placenta from the myometrium

A

placental abruption

172
Q

placental separation is associated with

A

hemorrhage from maternal vessels at the base of the placenta

173
Q

subchorionic hemorrhage is also called

A

marginal abruption

174
Q

retroplacental hemorrhage is usually arterial or venous

A

arterial

175
Q

abnormal adherence of the placenta to the uterine wall

A

placenta accreta

176
Q

invasion of the uterine wall by the placenta is referred to as

A

placenta increta

177
Q

penetration of the uterine wall by the placenta is

A

placenta percreta

178
Q

usually present in placenta accreta, approximately 88% of cases

A

placenta previa

179
Q

benign vascular placental mass supplied by the fetal circulation

A

chorioangioma

180
Q

most common tumor of the placenta

A

chorioangioma

181
Q

normal umbilical cord consists of

A

two arteries and one vein surrounded by wharton jelly

182
Q

normal diameter of umbilical cord

A

1-2 cm

183
Q

single artery umbilical cord is associated with what anomalies

A

cardiac, urinary tract, CNS malformations, omphalocele, trisomy 13 and 18

184
Q

outer layer of placenta

A

chorion

185
Q

inner layer of placenta

A

amnion

186
Q

chorion and amnion are separated by fluid until what week before it fuses

A

14 to 16 weeks

187
Q

true or false: occassional persistence of chorioamniotic separation into third trimester is believed to be of no clinical significance

A

true

188
Q

caused by early disruption of the amnion, enabling the fetus to enter the chorionic cavity

A

amniotic band syndrome

189
Q

early disruption of amnion in amniotic band syndrome happens at what week

A

before 10 weeks GA

190
Q

membranous structures that project into the uterine cavity

A

amniotic sheets/uterine synechia

191
Q

dialysate of maternal serum in early pregnancy

A

amniotic fluid

192
Q

major source of amniotic fluid as pregnancy advances

A

fetal urine

193
Q

turnover of amniotic fluid occurs every how many hours

A

3 hours

194
Q

fetus swallows amniotic fluid at a rate of ___ cc/24 hours

A

450 cc

195
Q

essential in promoting normal development and maturation of fetal lungs

A

amniotic fluid

196
Q

suspended particles in amniotic fluid visualized by US are attributable to

A

normal vernix, blood or meconium

197
Q

AFI is measured by

A

measuring the vertical diameter of the deepest pockets of fluid in the 4 quadrants of uterus and adding these values together

198
Q

normal AFI

A

5 to 20 cm

199
Q

polyhydramnios represent excessive amount of amniotic fluid greater than

A

2L at delivery, AFI of more than 20 cm or a single fluid pocket greaster than 8 cm

200
Q

if there is failure of fetal abdomen to be in contact with both anterior and posterior uterine wall after 24 weeks GA, this can be considered

A

polyhydramnios

201
Q

associated anomalies with polyhydramnios include

A

anencephaly, encephalocele, GI obstruction, abdominal wall defects, achondroplasia and hydrops (isoimmunization)

202
Q

oligohydramnios is diagnosed with AFI of

A

less than 5 cm, largest fluid pocket is less than 1 cm

203
Q

major complication of severe oligohydramnios is

A

fetal lung immaturity

204
Q

fetus sharing a placenta

A

monochorionic

205
Q

each fetus having its own placenta

A

dichorionic

206
Q

twins that share a single amniotic cavity

A

monoamniotic

207
Q

have the highest morbidity, including conjoined twinning and intertwining of umbilical cords

A

monoamniotic

208
Q

definitive proof of lower-risk dichorionic twinning

A

two separate placentas, determination that the twins are of different sex

209
Q

chorionicity is best determined at what weeks

A

11 to 14 weeks GA

210
Q

presence of two yolk sacs is evidence of

A

diamniotic twins

211
Q

about half of diamniotic twins will have

A

fused placenta

212
Q

visualization of membranes separating twins confirms

A

diamniotic twins

213
Q

twins that have usually vascular anastomoses at the placental level, making them at risk for twin transfusion syndrome and twin embolization syndrome

A

monochorionic twins

214
Q

shunting of blood from one twin to the other through vascular connections in the placenta

A

twin-to-twin transfusion syndrome (TTTS(

215
Q

tiny AV anastomosis in the placenta that allow slow transfusion of blood from the donor twin to recipient twin resulting in anemia in the donor and polycythemia in the recipient

A

twin anemia-polycythemia sequence (TAPS)

216
Q

placenta may show an echogenic thickened section supplying the donor and a thin hypoechoic section supplying the recipient

A

twin anemia-polycythemia sequence (TAPS)

217
Q

large AV anastomosis usually near a common cord insertion site results in a pump twin who perfuses a severely malformed acardiac twin

A

twin reversed arterial perfusion sequence (TRAP)

218
Q

in TRAP sequence, high output cardiac failure develops in what twin

A

pump twin who is driving blood thru both fetuses

219
Q

blood products from the dead twin are shunted through placental interconnections to the live twin, resulting in disseminated intravascular coagulopathy and multifocal tissue infarction

A

twin embolization syndrome

220
Q

majority of serious structural birth defects can be detected at what GA

A

18 to 22 weeks

221
Q

defined as having one or more extra, or missin, chromosomes in a cell

A

aneuploidy

222
Q

most common aneuploidies

A

trisomy 21, 18 and 13

223
Q

first trimester aneuploidy screening is generally performed between

A

11 and 14 weeks

224
Q

first trimester aneuploidy screening include

A

NT measurement, serum free B-hCG or total hCG and pregnancy-associated plasma protein A anylate levels (PAPP-A)

225
Q

normal echolucent space between the spine and overlying skin at the back of fetal neck

A

nuchal translucency

226
Q

normal nuchal translucency measures

A

less than 3 mm

227
Q

at what CRL is nuchal translucency may be measured

A

CRL of 45 to 84 mm

228
Q

quadruple marker screen is best performed between what weeks

A

16 and 18 weeks GA

229
Q

four maternal plasma substances measured in the quad screen are

A

hCG, AFP, dimeric inhibin A and unconjugated estriol

230
Q

penta screen testing include

A

hCG, AFP, dimeric inhibin A and unconjugated estriol, hyperglycosylated hCG

231
Q

evaluates short segments of fetal DNA derived from placenta in maternal plasma

A

cell-free DNA screening

232
Q

nuchal fold measurement associated with down syndrome

A

> or = to 5 mm

233
Q

nuchal fold is measured at what trimester

A

second, 18-22 weeks GA

234
Q

absent nasal bone is associated with

A

trisomies 21, 13 and 18

235
Q

echogenic intracardiac focus is associated with

A

down syndrome

236
Q

short femur and humerus (<0.9) is associated with

A

down syndrome

237
Q

pyelectasis refers to size of renal pelvis of up to

A

> or = to 4 mm

238
Q

pyelectasis is associated with

A

down syndrome

239
Q

hyperechoic bowel is associated with

A

down syndrome

240
Q

refers to thickness of skin overlying the back of the neck and occipital bone seen in the second trimester when NT is no longer present

A

nuchal fold

241
Q

nuchal fold is measured at the level of

A

thalamus and cerebellar hemispheres

242
Q

nuchal fold is measured between the

A

occipital bone and skin surface

243
Q

nuchal fold thickness is considered reliable only between what weeks

A

15 and 20 weeks GA

244
Q

chorionic villous sampling is performed between

A

10 and 13 weeks GA by transcervical or transabdominal US-guided needle puncture of the placenta

245
Q

amniocentesis is generally performed bewteen

A

15 and 20 weeks GA

246
Q

most common chromosome abnormality, increasing in incidence and currently occuring in 1 of 800 births

A

trisomy 21

247
Q

major structural defects in down fetuses include

A

congenital heart disease (endocardial cushion defect, VSD, TOF), duodenal atresia, ventriculomegaly and tracheoesophageal atresia

248
Q

second most common chromosome abnormality occuring in 1 in 3000 births

A

trisomy 18

249
Q

chromosome abnormality associated with IUGR, complex congenital heart disease, choroid plexus cyst, congenital diaphragmatic hernia, omphalocele, neural tube defects, Dandy-walker complex, clenched hands and single UA

A

trisomy 18

250
Q

third ventricle appears as a single echogenic line to a slit-like structure less than ___ mm in width

A

3.5

251
Q

axial plane at the level of the ventricular atria

A

transventricular plane

252
Q

dominant landmark of transventricular plane is

A

echogenic choroid plexus, which normally fills the atrium nearly complete

253
Q

measurements of atrial diameter made perpendicular to the walls do not normally exceed ___ mm

A

10 mm

254
Q

axial scan in approximately 10 to 15 degrees of inclination from the canthomeatal line

A

transcerebellar plane

255
Q

anatomic landmarks of transcerebellar plane

A

inferior portion of 3rd ventricle, cerebellar hemispheres outlined by fluid in the cisterna magna

256
Q

normal cisterna magna measures

A

2-11 mm in width

257
Q

a small cisterna magna (<2mm) suggests a

A

Chiari II malformation, or massive ventriculomegaly

258
Q

large cisterna magna may be due to

A

normal variant (mega-cisterna magna) or indicate Dandy walker malformation, arachnoid cyst or cerebellar hypoplasia

259
Q

categories of ventriculomegaly

A

obstructive hydrocephalus (osbtruction to flow of CSF), cerebral atrophy (ex vacuo), maldevelopment (agenesis of corpus callosum)

260
Q

diagnosis of ventriculomegaly include

A

atrium of > 10 mm, separation of choroid plexus from ventricular wall by > 3mm and a “dangling choroid”

261
Q

most common cause of ventriculomegaly in the fetuses are

A

chiari II malformation and aqueductal stenosis

262
Q

absent skull conditions

A

anencephaly, amniotic band syndrome, acrania

263
Q

absent or incomplete falx with cortical mantle condition

A

holoprosencephaly

264
Q

absent or incomplete falx without cortical mantle condition

A

hydranencephaly

265
Q

extracranial cysts

A

cystic hygroma, encephalocele, meningocele

266
Q

bilateral intracranial cysts

A

hydrocephalus

267
Q

midline intracranial cysts

A

Dandy-walker, arachnoid cyst, Vein of Galen Aneurysm

268
Q

Unilateral intracranial cysts

A

arachnoid cyst, porencephalic cyst, unilateral hydrocephalus

269
Q

most common fetal neural tube defect

A

anencephaly

270
Q

include absence of cranial vault and cerebral hemispheres above the lebel of the orbits

A

anencephaly

271
Q

fluid and/or brain tissue filled sacs that protrude through a defect in the bony calvarium

A

cephaloceles

272
Q

cephaloceles are commonly seen in what region of the brain

A

occipital

273
Q

cephalocele that only contain CSF

A

meningocele

274
Q

cephalocele that contain CSF and brain tissue

A

encephalocele

275
Q

refers to a spectrum of spinal abnormalities resulting from failure of complete closure of neural tube

A

spina bifida

276
Q

nonfusion of vertebral arches with intact skin

A

spina bifida occulta

277
Q

protruding sacs with spinal cord or nerve roots

A

myelomeningocele

278
Q

totally open spinal defect

A

myeloschisis

279
Q

spina bifida most commonly occurs in

A

lumbosacral region

280
Q

US findings include outward splaying, rather than inward convergence of the laminae, defect in the soft tissue overlying the bony abnormality and a protruding sac containing fluid and often neural tissues

A

spina bifida

281
Q

functional neuromuscular defect associated with spina bifida

A

club foot deformities and dislocated hips

282
Q

refers to bossing of frontal bones

A

lemon sign

283
Q

produced by compression of the cerebellar hemispheres into a banana shape

A

banana sign

284
Q

chiari II is associated with ___ 95% of the time

A

myelomeningocele

285
Q

consist of caudal displacement of cerebellar tonsils, pons and medulla, fourth ventricle is elongated, posterior fossa is small and cisterna magna is obliterated

A

chiari II

286
Q

spectrum of disorders characterized by a failure of prosencephalon to divide and form the separate right and left hemispheres and thalami

A

holoprosencephaly

287
Q

includes facial anomalies namely hypotelorism, cyclopia, proboscis

A

holoprosencephaly

288
Q

most severe form of holoprosencephaly and demonstrates absence of the falx and interhemispheric fissure with a single midline ventricle

A

alobar holoprosencephaly

289
Q

refers to total detruction of cerebral cortex, believed to be caused by the occlusion of ICA

A

hydranencephaly

290
Q

maldevelopment of the roof of the 4th ventricle. cisterna magna is enlarged and communicates directly with 4th ventricle through its absent roof. posterior fossa is enlarged and tentorium is elevated. cerebellar hemispheres are usually hypoplastic. hydrocephalus is usually present

A

Dandy-walker malformation

291
Q

arachnoid cysts and large cisterna magna are differentiated from Dandy-walker malformation

A

lack of communication with the 4th ventricle

292
Q

true or false: choroid plexus cysts themselves cause no clinical problem and nearly always resolve

A

true

293
Q

choroid plexus cysts are associated with what aneuploidy

A

trisomy 18

294
Q

true or false: choroid plexus cysts are not associated with Down syndrome

A

true

295
Q

most common type of cleft lip and palate

A

lateral cleft

296
Q

associated anomalies with cleft lip and palate

A

polydactyly, congenital heart disease and trisomy 21

297
Q

median cleft lip or palate is associated with

A

holoprosencephaly

298
Q

fluid collection in the fetal neck caused by failure of the lymphatic system to develop normal connections with venous system in the neck

A

cystic hygroma

299
Q

in US, it demonstrates a bilateral nuchal cystic mass with a prominent midline septum that represents the nuchal ligament

A

cystic hygroma

300
Q

cystic hygroma is associated with

A

down syndrome, turner syndrome, trisomy 18 and 13

301
Q

refers to pathologic accumulation of fluid in body cavities and tissues

A

fetal hydrops

302
Q

caused by blood group incompatibility between mother and fetus that causes pathologic fluid accumulation in body cavities and tissues

A

immune hydrops

303
Q

hydrops that is caused by a host condition including cardiac disorders, infections, chromosomal anomalies, twin pregnancy, urinary obstruction and umbilical cord complications

A

nonimmune hydrops

304
Q

treatment for immune hydrops

A

fetal transfusion

305
Q

disorder in which abdominal contents protrude into the thorax through defects in the diaphragm

A

congenital diaphragmatic hernia

306
Q

majority of congenital diaphragmatic hernia occurs on what side

A

left

307
Q

mortality is hight in fetuses with congenital diaphragmatic hernia due to

A

pulmonary hypoplasia

308
Q

congenital hamartomatous lesion of the lung that usually affects one lobe

A

cystic adenomatoid malformation

309
Q

CAM type in which single or multiple cysts are present larger than 2 cm

A

type 1

310
Q

CAM type with multiple smaller cysts of uniform size less than 2 cm

A

type 2

311
Q

CAM type with lesions appearing as echogenic solid masses because the cysts are microscopic

A

type 3

312
Q

mass of lung tissue supplied by systemic arteirs and separated from its normal bronchial and pulmonary vascular connections

A

pulmonary sequestration

313
Q

type of pulmonary sequestration that is contained within the pleural covering of an otherwise normal lobe of the lung. pulmonary venous drainage is maintained

A

intralobar

314
Q

pulmonary sequestration type that appears as accessory lobes, contained within their own pleura and supplied by both systemic arteries and veins

A

extralobar

315
Q

more common form of pulmonary sequestration

A

intralobar

316
Q

major cause of neonatal morbidity and mortality and is the most common major anomaly in the neonate affecting 1 in 200 live births

A

fetal cardiac anomalies

317
Q

routine screening views of the heart include

A

four-chamber heart view, RVOT, LVOT

318
Q

in four-chamber view of heart in US, apex of normal heart is directed at the left anterior chest wall at how many degrees on the same side of the fetal stomach

A

45 degree angle

319
Q

in the fetal heart, which is bigger in size, atria or ventricles?

A

atria; ventricles are equal in size and slightly smaller

320
Q

LVOT view is obtained by

A

angling the transducer from the position of four chamber view toward the right shoulder

321
Q

on this view of the heart on US, the aortic valve and origin of the aorta from the left ventricle are seen

A

LVOT view

322
Q

RVOT view is obtained by

A

angling the transducer slightly from the LVOT view

323
Q

on this view of the heart on US, the origin of pulmonary artery to the bifurcation into right and left pulmonary arteries are seen

A

RVOT view

324
Q

normal liver appearance in fetus, which lobe is larger

A

left

325
Q

half the fetal blood that it carries goes directly to the IVC via ductus venosus

A

umbilical vein

326
Q

venous supply of the fetal liver is from

A

left portal vein

327
Q

appearance of fetal adrenal gland

A

up to 20 times larger in relative size because of the “fetal zone”

328
Q

swallowing begins at what week

A

11 to 12 weeks GA

329
Q

fetal stomach should be filled with swallowed fluid by

A

18 weeks GA

330
Q

peristalsis in small bowel loops can be seen at what trimester

A

3rd

331
Q

visualized fetal small bowel loops are normally of what size

A

6 mm in diameter, less than 15 mm in length

332
Q

colon is visualized at what week

A

after 20 weeks

333
Q

the colon progressively fills with meconium but does not exceed what size

A

23 mm in diameter

334
Q

length of normal kidney in mm is approximately equal to

A

GA in weeks

335
Q

if stomach is absent, patient may be reexamined after how many hours

A

1 hour

336
Q

causes of absent fetal stomach include

A

obstruction (esophageal atresia, chest mass), impaired swallowing (facial clefts and neuromuscular disorders), low amniotic fluid volume and stomach in an abnormal location (diaphragmatic hernia)

337
Q

descriptive fluid distention of the stomach and proximal duodenum

A

double bubble

338
Q

fluid distention of the duodenum is abnormal and indicative of

A

duodenal atresia or stenosis, annular pancreas or volvulus

339
Q

in double bubble sign, what aneuploidy may be present

A

down syndrome

340
Q

dilatation of fetal small bowel of greater than 6 mm may be due to

A

jejunal or ileal atresia or stenosis, volvulus, meconium ileus, enteric duplication

341
Q

causes small bowel obstruction by impaction of abnormally thick meconium in the distal ileum

A

meconium ileus

342
Q

meconium ileus is nearly always associated with

A

cystic fibrosis

343
Q

results from perforation of a bowel segment due to spillage of meconium into the peritoneal cavity causing a sterile peritonitis that results in calcifications on peritoneal surfaces, loculated fluid-filled masses within the peritoneal cavity (meconium pseudocysts), ascites, bowel dilation and polyhydramnios

A

meconium peritonitis

344
Q

cause of meconium peritonitis is commonly not identified but may be due to

A

vascular insult to small bowel. meconium ileus (cystic fibrosis), bowel atresia, volvulus

345
Q

echogenic bowel may be due to

A

cystic fibrosis, chromosome abnormalities (trisomy 21 and 18), small bowel atresia, volvulus and fetal viral infection (CMV)

346
Q

most common cause of hydronephrosis in fetus are

A

ureteropelvic junction obstruction, ectopic ureterocele, posterior urethral valves

347
Q

definitive evidence of significant hydronephrosis

A

renal pelvis greater than 10 mm AP diameter or greater than 50% of the AP diameter of kidney in axial section or unequivocal caliectasis

348
Q

minimal dilation of the renal pelvis is most often due to

A

physiologic vesicoureteral reflux

349
Q

physiologic vesicoureteral reflux is normal during what trimester

A

second and third

350
Q

a fluid filled renal pelvis larger than 3 mm warrants attention because it may be a sonographic marker of

A

aneuploidy (Down syndrome) or an early indicator of congenital urinary obstruction

351
Q

elective postnatal US of equivocal cases of mild dilation of renal pelvis should be done how many weeks of age to avoid underestimation of hydronephrosis because of the normal oliguria that occurs during early postnatal period

A

1 to 2 weeks

352
Q

appears as multiple noncommunicating renal cysts of varying sizes

A

multicystic dysplastic kidneys

353
Q

polycystic kidney disease with nonfunctioning kidneys, associated with severe oligohydramnios and is not compatible with life

A

multicystic dysplastic kidneys

354
Q

massive enlargement of both kidneys associated with oligohydramnios suggests ___. kidneys are predominantly echogenic with sonolucent rim

A

autosomal recessive polycystic disease

355
Q

kidneys are enlarged but lack sonolucent rim of autosommal polycystic kidney disease

A

autosomal dominant polycystic kidney disease

356
Q

affected kidneys are hydronephrotic, with increased parenchymal echogenicity and parenchymal cysts of varying sizes. kidneys may be dysplastic without cysts being evident on US

A

obstructive uropathy such as posterior urethral valves

357
Q

results from a defect in the anterior abdominal wall nearly always on the right side of umbilicus. bowel herniates through the defect and floats freely in the amniotic fluid with no covering membrane

A

gastroschisis

358
Q

true or false: gastroschisis is most commonly an isolated defect without chromosomal anomaly or risk of recurrence

A

true

359
Q

more serious abdominal wall defect that is about equal in frequency to gastroschisis. defect is midline at the umbilicus with herniation of abdominal contents into the base of umbilical cord

A

omphalocele

360
Q

in omphalocele, what commonly herniates

A

liver and bowel

361
Q

the membrane that covers the omphalocele consits of

A

peritoneum and amnion

362
Q

most common site for teratoma

A

sacrococcygeal

363
Q

commonly affected gender in teratoma

A

female

364
Q

ratio of FL to footh length of less than 1 suggest

A

skeletal dysplasia

365
Q

an FL to foot length ratio of more than 1 suggest

A

constitutionally small or growth-retarded fetus

366
Q

most common lethal skeletal dysplasia

A

thanatophoric dwarfism

367
Q

this include small thorax, cloverleaf skull, large head, hydrocephalus, and polyhydramnios

A

thanatophoric dwarfism

368
Q

an autosomal dominant trait that is lethal in homozygous form and nonlethal in heterozygous form. shows proximal limb shortening in US

A

achondroplastic dysplasia

369
Q

heterogeneous group of disorders with both autosomal dominant and recessive inheritance patterns. hallmark of disease is osteoporosis, that manifest as diminished bone echogenicity. additional findings include bone thickening with fractures and callus formation, bone boweing, small chest and protuberant abdomen

A

osteogenesis imperfecta

370
Q

clenched hands with overlapping index fingers suggests

A

trisomy 18

371
Q

polydactyly and polycystic kidneys suggest

A

Meckel-Gruber syndrome

372
Q

hypoplasia of middle phalanx of fifth digit in association with femur and humerus shortening suggests

A

down syndrome

Women's imaging (6 decks)

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