POCUS - OB/GYN

Question 1

The anterior and posterior cul-de-sacs are within what body cavity?

Answer 1

The peritoneum

Question 2

Most women have a _______-verted uterus.

Answer 2

ante

Question 3

The non-gravid uterus is usually how long?

Answer 3

7-8 cm

It’s usually 4 cm wide and 4 cm deep.

Question 4

A ___________ uterus has one cervix and two uterine bodies.

Answer 4

bicornuate

Didelphus has two cervixes.

Question 5

The __________ ligament connects the ovaries to the uterine body.

Answer 5

broad

Question 6

A normal ovary has what dimensions?

Answer 6

2 cm x 2 cm

Question 7

True or false: the uterus is usually midline.

Answer 7

True, but many women will have tilting to one side or another

Question 8

What clips do you need in assessing a fetus?

Answer 8

• Video scanning through the whole child to demonstrate intrauterine pregnancy
• Still video demonstrating movement
• M-mode of heartbeat
• Video of heart beating

Question 9

Which transducer should you use for the transabdominal fetal US?

Answer 9

Curvilinear

Question 10

The sagittal transabdominal exam should be done with the probe indicator in the __________ direction. `

Answer 10

cephalad

Question 11

The endometrial stripe is more _______-echoic than the myometrium.

Answer 11

hyper

Question 12

In the transverse transabdominal exam, the probe indicator points to the patient’s ________.

Answer 12

right

Question 13

Up until ______ weeks, no intrauterine pregnancy can be detected on TVUS.

Answer 13

4.5

Question 14

The __________ is the first TVUS sign of a pregnancy and shows up at ________ weeks.

Answer 14

gestational sac; 4.5-5

Question 15

The __________ sac is within the _________ sac.

Answer 15

yolk; gestational

Question 16

The embryo is typically visible by ______ weeks via TVUS.

Answer 16

6

Question 17

If a first-trimester pregnant woman is thin, you can use the __________ probe.

Answer 17

linear

Question 18

True or false: the endovaginal US is best done with a full bladder.

Answer 18

False

Empty bladder is best.

Question 19

The endovaginal US should be inserted with the dot in the ____________ position when doing the sagittal exam.

Answer 19

12 o’clock

Question 20

Before you push the endocavitary probe farther in, try ______________.

Answer 20

fanning from side to side to see if the uterus pops into view

This is important not just for the comfort of the woman, but also because you can easily bypass the uterus and scan into bowel.

Question 21

The transverse endovaginal exam should be done with the indicator dot in the ___________ direction.

Answer 21

patient’s right

Question 22

The endometrium is ________-genic compared to the myometrium.

Answer 22

hyper

Question 23

It’s not an IUP until you can see ______________.

Answer 23

the yolk sac or embryo – more than just the gestational sac which could be a pseudo-gestational sac

Question 24

The ____________ sac is usually visible by about 5.5 weeks and a quantitative hCG of 5,000.

Answer 24

yolk

Question 25

A yolk sac w/ an echogenic center is consistent with _____________.

Answer 25

pregnancy failure

Question 26

True or false: the embryo is within the yolk sac.

Answer 26

False The embryo is within the amniotic sac.

Question 27

The embryo is usually visible by _______ weeks and a quant of _________.

Answer 27

6 weeks; 15,000

Question 28

Cardiac activity should be seen when the crown-rump length is _______.

Answer 28

> 5 mm

Question 29

Crown-rump length should not be used when the embryo can __________.

Answer 29

flex

Question 30

When the crown-rump length is > 5 mm, the HR should be > what?

Answer 30

110 Less than 5 mm should be 80-90 BPM.

Question 31

Measure the HR with ________ mode.

Answer 31

M

Question 32

Before diagnosing an IUP, you need to verify in two planes that the gestational sac is surrounded by at least __________ of myometrium.

Answer 32

5 mm This is because an interstitial ectopic can be surrounded by myometrium on one side but not another.

Question 33

The embryo closest to the _________ is referred to as embryo A.

Answer 33

cervix

Question 34

Pregnancy failure is diagnosed by gestational sac > ___ mm w/ no yolk sac or embryo.

Answer 34

16 mm

Question 35

Yolk sac greater than _____ mm is suspicious for pregnancy failure.

Answer 35

7

Question 36

What scans are needed for an ectopic evaluation?

Answer 36

- Transabdominal sagittal and transverse looking at the uterus and adnexa - Transvaginal sagittal and transverse looking at the uterus and adnexa - Morrison's pouch

Question 37

Definitive ectopic findings are seen in only ___% of ectopic pregnancies.

Answer 37

20

Question 38

What features suggest pseudogestational sac?

Answer 38

Located centrally (as opposed to eccentrically) within the endometrial cavity and with only one layer of wall instead of the double decidual sign

Question 39

The trilaminar sign is sensitive for what?

Answer 39

Ectopic pregnancy This is three echogenic lines in the uterus with no fluid between.

Question 40

What is the differential for an anechoic structure in the cervical canal?

Answer 40

- Cervical ectopic pregnancy - Miscarriage in process - Nabothian cyst

Question 41

The incidence of heterotopic pregnancy in women who've undergone IVF treatment is as high as ________.

Answer 41

1:50

Question 42

Fetal cardiac activity is typically only detectable after _____ weeks gestation.

Answer 42

6

Question 43

The ovaries are ___________ to the internal iliac vessels.

Answer 43

anteromedial

Question 44

In the transverse transvaginal exam, the indicator is pointed toward the patient's ____________.

Answer 44

right

Question 45

What common pathology shows up as an anechoic circle in the lower uterine segment?

Answer 45

Nabothian cyst These are endocervical glands that become filled with fluid.

Question 46

How do you discriminate between a Nabothian cyst and a cervical ectopic pregnancy?

Answer 46

Nabothian cysts have no surrounding desidual reaction and are located within the myometrium

Question 47

The outermost layer of the uterus that fibroids can be in is called what?

Answer 47

Subserousal

Question 48

What are the findings of ovarian torsion?

Answer 48

Enlarged ovary Heterogenous appearance (due to ischemia) Twisted pedicle Absent flow (usually a late finding) Whirlpool sign

Question 49

How can you tell a high-resistance waveform?

Answer 49

There will be an abrupt cutoff of the spectral waveform in diastole

Question 50

How do theca lutein cysts appear?

Answer 50

Bilateral enlarged ovaries with multiple thin walled cysts These are often seen in molar pregnancies.

Question 51

How many cysts per ovary are needed for PCOS diagnosis?

Answer 51

25

Question 52

The cysts of PCOS are typically what size?

Answer 52

2-9 mm

Question 53

Where are the cysts in PCOS typically located?

Answer 53

Peripherally

Question 54

Other than an ectopic pregnancy, what adnexal masses also have the ring of fire sign?

Answer 54

Corpus luteum cysts If you can determine that it is intraovarian then you can be sure it is a corpus luteum cyst, otherwise you may not be able to distinguish them

Question 55

In what two scenarios is it normal to see dilated fallopian tubes (i.e., hydrosalpinx)?

Answer 55

After a hysterectomy or tubal ligation

Question 56

Dilated fallopian tube has what classic US appearance?

Answer 56

Serpiginous tube

Question 57

What is one sign that pelvic fluid is pathogenic?

Answer 57

Echogenic fluid Physiologic fluid will never have internal echos.

Question 58

What are the rough markers of small, moderate, and large volume free pelvic fluid?

Answer 58

Small: isolated to the lower uterine segment Moderate: rises above the lower uterine segment (to the mid uterus) but there is no connection to fluid beyond the uterus Large: extends beyond the uterus to the peritoneum

Question 59

Lie refers to what aspect of the fetus?

Answer 59

"Lie" refers to if the baby is in plane with the mother, transverse, or oblique

Question 60

Sonographically, what does twin A and twin B refer to?

Answer 60

Twin B is the one farther from the cervix

Question 61

What are the two ways of measuring amniotic fluid?

Answer 61

Maximum vertical pocket and amniotic fluid index MVP is preferred -- recently shown to have just as good diagnostic sensitivity for oligo- and polyhydramnios with decreased rates of obstetric intervention and similar rates of maternal adverse outcomes.

Question 62

How do you measure MVP?

Answer 62

Sagittal orientation, sweep through, find the deepest pocket free of fetal parts and cord

Question 63

What is normal MVP?

Answer 63

2 - 8 cm

Question 64

What is normal AFI?

Answer 64

5 - 20 cm (in 2nd and 3rd trimesters)

Question 65

How do you measure AFI?

Answer 65

Same as MVP: sagittal orientation, divide into quarters, sum the deepest pocket in each

Question 66

What is the most common cause of 3rd trimester vaginal bleeding?

Answer 66

Placenta previa

Question 67

With placental localization, it's most important to find the ________ edge.

Answer 67

inferior Seeing the inferior edge is needed to rule or placenta previa.

Question 68

What are the three grades of placenta previa?

Answer 68

Low-lying: placenta is within 2 cm of the os Marginal: placenta is on the edge of the cervical os Complete: placenta covers the os

Question 69

Where is BPD measured?

Answer 69

At the level of the septum pellucidum

Question 70

Where on the skull (like, the leading edges) is BPD measured?

Answer 70

Outer skull to inner skull

Question 71

How is head circumference measured?

Answer 71

At the level of the septum pellucidum, fit an ellipse on the outside of the parietal bones

Question 72

What are the landmarks of abdominal circumference?

Answer 72

Above the kidneys (they should not be seen), below the heart (also should not be seen), visualizing the aorta, umbilical vein, and stomach

Question 73

Measure abdominal circumference on the ______ of the skin.

Answer 73

outer (like HC)

Question 74

When measuring femur length, do not include the _____________.

Answer 74

epiphyses