US

Question 1

Major sonographic landmarks for IUP:

Answer 1

• Gestational sac
• double decidual sac sign (DDSS)
• yolk sac
• embryo
• cardiac activity

Question 2

Sonogrphic milestones:

Answer 2

By TVUS
GS seen at 5 wks
GS + yolk sac at 5.5 wks
GS + YS + fetal heart beat at 6 wks
-heartbeat should be seen when MSD reached 25 mm otherwise is anembryonic
(Findings seen 1 wk later with TAUS)

Question 3

Mirror image can happen commonly in highly reflected surfaces like:

Answer 3

Posterior wall of bladder and diaphragm

Question 4

Indications of early cord clamping:

Answer 4

• Maternal or fetal instability
• FGR baby with abnormal Doppler evaluation
• known heart disease in baby
• if cord is Avulsed

Question 5

In early pregnancy “missed pregnancy” to determine the viability use—— Doppler

Answer 5

Used pulsed Doppler rather than colour Doppler to not be confused by twinkling

Question 6

In UA Doppler usually avoid the high velocity sites (peri-abdominal entry and placenta insertion) except in:

Answer 6

• IUGR
• multiple pregnancy

Question 7

Spalding’s sign:

Answer 7

Overlapping of fetal skull bones due to shrinkage of cerebrum after fetal death.

Question 8

Roberts sign:

Answer 8

Presence of gas in the fetal large vessels (earliest sign seen after fetal death)

Question 9

amniotic fluid ‘sludge’ is an independent risk factor for:

Answer 9

for preterm prelabor rupture of membranes (PROM) and spontaneous preterm delivery.

Question 10

Signs of abnormal placental implantation in US:

Answer 10

1) intra-placental sonolucent lacunae “moth eaten” or “Swiss cheese”

Question 11

Signs of IUFD:

Answer 11

1) gas bubbles in great vessels( Robert’s sign)within 12 hrs in x-ray
2) halo’s sign +ve of head—due to scalp edema
3) overlapping of skull bone (Spalding sign)> 1 wk
4) decreased amniotic fluid volume
5) ball sign (hyperflexion/ hyperextension of spine)> 3-4 wks

Question 12

Tip: If you determine low-lying placenta by TVUS don’t exclude it later by TAUS

Answer 12

And if it migrate make sure to use Doppler to check there no remaining vessels behind

Question 13

Signs of placenta acreta

Answer 13

Loss of interphase of myometrium

Question 14

In premenopausal women had Simple ovarian cysts measuring <5 cm, next step?

Answer 14

do not require any treatment or follow-up.

likely to resolve within three menstrual cycles.

Question 15

In premenopausal Women with simple cysts measuring between 5 and 7 cm, management?

Answer 15

should have yearly ultrasound follow-up.

Question 16

For premenopausal women with simple cysts measuring >7 cm,
Next step?

Answer 16

either additional imaging (MRI) or surgical treatment should be considered, because these cannot be assessed completely by ultrasonography.

Question 17

For premenopausal women with complex ovarian masses or ultrasound features suggestive of malignancy, best step?

Answer 17

surgery is recommended. Depending on the patient’s preferences and fertility aims, the surgery may involve unilateral or bilateral salpingo-oophorectomy, collection of fluid for peritoneal cytology, inspection and biopsy from the peritoneal surfaces, omental biopsy, appendicectomy, and para-aortic lymph node sampling. Surgery can be performed via a laparoscopic or an open approach.

Question 18

If postmenopausal had Simple, unilateral, unilocular ovarian cysts, <5 cm in diameter, have a low risk of malignancy and in the presence of a normal serum CA-125 levels, management ?

Answer 18

can be managed conservatively.

Question 19

What increases the certainty that the sac represents an intrauterine pregnancy not a pseudosac

Answer 19

a. An echogenic rim along one side of the decidua
b. Two concentric echogenic rings surrounding the sac
c. A sac positioned eccentrically within the endometrium

Question 20

The accuracy of gestational age dating using the last menstrual period is affected by

Answer 20

a. Anovulatory bleeding
b. Menstrual cycle length
c. Oral contraceptive use

Question 21

Menstrual Age (weeks)and corresponding Embryologic Event/Sonographic/hCG Correlation
3 to 4
4
4 to 5
5 to 6
5 to 6

Answer 21

3 to 4>Implantation site – Decidual thickening
4> Trophoblast – Peritrophoblastic flow on color flow Doppler
4 to 5 Gestational sac typically visible when hCG reaches 1,500 to 2,000 mlU/mL
5 to 6> Yolk sac
5 to 6 > Embryo and cardiac activity

Question 22

Embryonic demise

Answer 22

an embryo with a crown-rump length >7 mm without cardiac activity.

Question 23

Anembryonic pregnancy

Answer 23

presence of a gestational sac >25 mm without evidence of embryonic tissues
(ie, yolk sac, embryo). This term is preferred to the older and less accurate phrase blighted ovum

Question 24

full bladder can create a false impression of a placenta Praevia.

Answer 24

T

Question 25

Ultrasonography is a preferred imaging modality for leiomyosarcoma and its characterizes

Answer 25

unclear boundary, low resistance and high velocity blood flow.

Question 26

US features of An endometrioma classically

Answer 26

is cystic with homogeneous, Iow-levd internal echoes often described as having “ground glass” echogenicity. Surrounding ovarian tissue is normal. these may have an identical appearance to hemorrhagic corpus luteum cysts. Reimaging 6 to 8 weeks later can help differentiate these two. Corpora lutea typically will resolve but endometriomas persist. Most endometriomas are unilocular, but one to four thin septations can be found.
Color Doppler TVS often demonstrates pericystic, but not intercystic flow.

Question 27

NT, abnormal level ? When it’s taken (GA and CRL)? What Aneuploidy detection rate?

Answer 27

Above or equal 3 mm or above 99th percentile for CRL.
Taken btw 10+6 wks - 13 wks +6 days
When CRL btw 45 mm- 84 mm
Aneuploidy detection rate: 64- 70 %

Question 28

Thickened Nuchal fold( the most powerful 2nd trimester marker), abnormal levels ? When is it done ?

Answer 28

Above or equal 6 mm from outer edge of the occipital bone to outer skin in the midline.
LR 11-18.6 sen: 40-50% specific: more than 99% for Down syndrome
Done btw 18-24

Question 29

In the assessment of Fetal Nasal Bone Imaging in the First Trimester 11–13+6 Weeks Scan (what is the landmarks that should be present)

Answer 29

Fetal nose bone and overlying skin
*The nasal tip
* 3rd and 4th ventricles

Question 30

The most powerful marker in the 2nd trimester for Down syndrome?

Answer 30

Thickened Nuchal fold

Question 31

Lemon head and banana sign is seen in

Answer 31

Herniation of cerebellum Arnold- chiari malformation which is associated with spina bifida

Question 32

Abnormal uterine Doppler velocimetry early in pregnancy associated with higher rates of

Answer 32

Preeclampsia, SGA, neonates, And delivery before 34 wks

Question 33

Ventriculomegaly definition

Answer 33

at any point in gestation, as a measurement of the atria of the lateral cerebral ventricles of 10 mm or greater on an axial image of the fetal head. Mild ventriculomegaly usually refers to a measurement of 10–15 mm. Approximately 40% of cases of ventriculomegaly have associated anomalies. The incidence of isolated ventriculomegaly is 0.5–1.5 out of 1,000 pregnancies. The presence of isolated ventriculomegaly is associated with approximately a 12% risk of fetal aneuploidy, with a likelihood ratio for Down syndrome of 25.

Question 34

echogenic bowel associated with

Answer 34

increased risk of neonatal cytomegalovirus infection, cystic fibrosis, intraamniotic bleeding, and fetal aneuploidy.It is associated with a 6.7-fold increased risk of Down syndrome.

Question 35

Characteristic sonographic abnormalities of Turner syndrome

Answer 35

cystic hygroma, hydrops fetalis, short femur, coarctation of the aorta, hypoplastic left heart, and renal anomalies.

Question 36

Diagnosticcriteriaof uterineadenomyosisinclude two of the five sonographic features on TVS:

Answer 36

(1) No distinction of the endometrial-myometrial junction; (2) asymmetry of the anterior and posterior myometrium; (3) subendometrial myometrial striations; (4) myometrial cysts and fibrosis; and (5) heterogeneous myometrial echotexture.

Question 37

The earliest sign seen in ultrasound of intrauterine pregnancy

Answer 37

Intradecidual sign

Question 38

Diamond ring sign

Answer 38

Sign seen in US when embryonic disk start to be seen adjacent to yolk sac at 6 weeks GA and CRL start to be used

Question 39

Dense material, such as bone. or a synthetic material, such as an intrauterine device (IUD), produces high-velocity reflected waves, also termed echo, which are displayed on a screen as white. These are described as

Answer 39

echogenic

Question 40

fluid in US generates few reflected waves, and appears black on screen described as

Answer 40

is anechoic

Question 41

Middle density tissues variably reSect waves to create various shades of gray, and images are described as

Answer 41

hypoechoic or hyperechoic relative to tissues immediately adjacent to them.

Question 42

Normal uterine artery pulsatility index (PI) is

Answer 42

0.5 - 1.5 at 20 weeks

Question 43

NT assessment detection rate

Answer 43

46 percent of major abnormalities were detected in low-risk, or unselected pregnancies.
In high-risk pregnancies, anomaly detection exceeded 60 percent. Detection rates are high for fetal anencephaly, alobar holoprosencephaly, and ventral wall defects.
Metanalysis (Karim, 2017).

Question 44

Examinations are classified as standard, specialized, or limited. Specialized examination types include

Answer 44

the detailed fetal anatomy examination, detailed evaluation for placenta accreta spectrum, fetal echocardiography, Doppler velocimetry, and the biophysical.

Question 45

Indications for Standard Second- and Third-trimester Ultrasound Examinations

Answer 45

Question 46

The American Institute of Ultrasound in Medicine (2018a) revised its prior 2013 standard ultrasound practice parameter to include the following updates:

Answer 46

1. Components added to the standard fetal anatomical survey are presence of the hands and feet, and when feasible, the three-vessel view and threevessel trachea views of the heart.
2. If the relationship between placenta and cervix cannot be assessed transabdominally, transvaginal evaluation should be performed. Transperineal evaluation remains an option but in our experience is rarely used.
3. If the cervix appears abnormal or is not adequately visualized transabdominally, transvaginal (or transperineal) examination is recommended. If cervical length assessment is requested, measurement should be based on a transvaginal image.
4. In the setting of velamentous cord insertion, color and pulsed Doppler ultrasound should be used to evaluate for vasa previa.

Question 47

The detailed fetal anatomy examination is also known as a targeted or 76811 examination indications:

Answer 47

Question 48

Fetal Echocardiography indications include

Answer 48

suspected fetal cardiac structural or functional abnormality;
heart rate abnormality or arrhythmia;
extracardiac anomaly or hydrops;
chromosomal abnormality;
nuchal translucency ≥3.5 mm;
in vitro fertilization;
monochorionic twin gestation;
first-degree relative to the fetus with a congenital cardiac defect; first- or second-degree relative to the fetus with a Mendelian syndrome and childhood cardiac manifestation; prior fetus with heart block in the setting of maternal anti-Ro or La antibodies; retinoid exposure; and metabolic risk factor such as pregestational diabetes or phenylketonuria (American Institute of Ultrasound in Medicine, 2020a).

Question 49

What is the detection rates of detailed ultrasound surveys performed in pregnancies at increased risk for anomalies?

Answer 49

may exceed 90 percent (Dashe, 2009; Levi, 1998). The sensitivity of the examination varies according to factors such as gestational age, maternal habitus, fetal position, equipment features, examination type, operator skill, and the specific abnormality. For example, maternal obesity lowers the anomaly detection rate by 20 percent (Dashe, 2009).

Question 50

Detection rates of selected abnormalities are as follows: anencephaly, – percent; spina bifida, – percent; hydrocephaly, – percent; cleft lip/palate, – percent; hypoplastic left heart, – percent; transposition of the great vessels, – percent; diaphragmatic hernia, – percent; gastroschisis, – percent; omphalocele, – percent; bilateral renal agenesis, – percent; posterior urethral valves, – percent; limb reduction defects, – percent; and clubfoot, – percent.

Answer 50

Detection rates of selected abnormalities are as follows: anencephaly, 98 percent; spina bifida, 89 percent; hydrocephaly, 82 percent; cleft lip/palate, 70 percent; hypoplastic left heart, 88 percent; transposition of the great vessels, 69 percent; diaphragmatic hernia, 73 percent; gastroschisis, 92 percent; omphalocele, 90 percent; bilateral renal agenesis, 94 percent; posterior urethral valves, 80 percent; limb reduction defects, 60 percent; and clubfoot, 60 percent. In contrast, anomalies with poor sonographic detection rates in the second trimester include microcephaly, choanal atresia, cleft palate, Hirschsprung disease, anal atresia, and congenital skin disorders.

Question 51

the sensitivity of ultrasound to identify placenta accreta, increta, and percreta was –, –, and – percent, respectively. Corresponding specificities were –, –, and – percent, respectively (Pagani, 2018).

Answer 51

the sensitivity of ultrasound to identify placenta accreta, increta, and percreta was 91, 93, and 89 percent, respectively. Corresponding specificities were 97, 98, and 99 percent, respectively (Pagani meta-analysis, 2018).

Question 52

Five ultrasound criteria assist with detection and characterization of PAS:

Answer 52

1. Placental lacunae, which are vascular spaces that may contain prominent color Doppler flow
2. Attenuation or thinning of the retroplacental myometrium, such that the smallest myometrial thickness measurement is <1 mm. This is also referred to as loss of the retroplacental clear space 3. Disruption of the bladder-uterine serosal interface, which appears as an irregular, echogenic boundary between the bladder and uterine serosa with gray-scale imaging 4. Bridging vessels, which are demonstrated with color Doppler to course from the placenta to the bladder-serosal interface
3. A placental “bulge” that pushes outward and distorts the contour of the uterus or other organs. In some cases of placenta percreta, a focal exophytic mass also is seen.

Question 53

What is the standard error for ultrasound estimates of fetal weight after the first trimester?

Answer 53

20%

Question 54

Why full bladder helpful in scanning non-pregnant lady transabdominally ?

Answer 54

full bladder is preferred for adequate viewing, as it pushes the uterus upward from behind the pubic symphysis and displaces small bowd from the field of view. Moreover, the bladder acts as an aeouttil: wind4w, to improve ultrasound wave transmission.

Question 55

Complications of SIS are minimal, and the risk of infection is percent (Bonnamy, 2002). The American College of Obstetricians and Gynecologists (2018) recommends prophylactic antibiotics for women with prior pelvic inBammatory disease (PID) or identified hydrosalpinges, in which cases doxycycline 100 mg orally twice daily is prescribed for 5 days.

Answer 55

Complications of SIS are minimal, and the risk of infection is <1 percent (Bonnamy, 2002). The American College of Obstetricians and Gynecologists (2018) recommends prophylactic antibiotics for women with prior pelvic inBammatory disease (PID) or identified hydrosalpinges, in which cases doxycycline 100 mg orally twice daily is prescribed for 5 days.

Question 56

Contraindications to SIS include

Answer 56

hematometra, pregnancy, active pelvic infection, or obstruction such as with an atrophic or stenotic cervix or vagina.

Question 57

In the reproductive years, a normal uterus measures approximately

Answer 57

7.5 X 5.0 X 2.5 em but is smaller in prepubertal, postmenopausal, or hypoestrogenized women.

Question 58

Ovarian volume ranges from

Answer 58

4 to 10 cubic centimeters depending on hormonal status (Cohen, 1990).

Question 59

Normal amount of pelvic free fluid

Answer 59

general sonographic evaluation of the pelvis, a small amount of free fluid, as little as 10 mL, is commonly present in the posterior cul-de-sac

Question 60

focused assessment with sonography for trauma (FAST) is a limited sonographic examination directed solely to hdp diagnosis intraperitoneal bleeding. With FAST, four specific areas are imaged:

Answer 60

perihepatic (right upper quadrant), perisplenic (left upper quadrant), pelvis, and pericardium.

However, FAST has a significant false-negative rate (Scalea, 1999). This stems in part from examination being carried out early when only a small amount of free fluid may have collected in dependent portions of the peritoneal cavity.

Question 61

bicornuate and septate uterine anoma~ lies are less confidently differentiated by traditional 2-D 1VS techniques. Ideally, the angle between the two endometrial cavities is — for bicornuate uterus, but —° for septate uterus. The fundal shape shows a>– cm notch for bicornuate uterus, but a <– cm notch for septate uterus

Answer 61

bicornuate and septate uterine anoma~ lies are less confidently differentiated by traditional 2-D 1VS techniques. Ideally, the angle between the two endometrial cavities is > or = 105° for bicornuate uterus, but < or = 75° for septate uterus. The fundal shape shows a > 1cm notch for bicornuate uterus, but a <1cm notch for septate uterus

Question 62

In US Detection or exclusion of abdominal wall defects should not be attempted until after — weeks

Answer 62

Detection or exclusion of abdominal wall defects should not be attempted until after 11 weeks (because of physiological hernia prior to that)

Question 63

Sonographic appearance of complete mole

Answer 63

Homogenous distribution of cystic areas within the uterus to be identified other common findings were one or several areas of fluid collections with irregular contours and thin walls.

Question 64

Doppler trick :)

Answer 64

AEDV flow before the 15th week is a normal physiological finding While aREDV flow during the 1st trimester is associated with chromosomal abnormalities, fetal cardiovascular defects,and significant mortality

Question 65

an abnormal ductus venosus Doppler waveform indicates what? Its uses?

Answer 65

indicates cardiac dysfunction. its routine use in surveillance of fetal-growth restriction is not recommended (SMFM, 2020). Ductus venosus Doppler is also used in the staging of twin-twin transfusion syndrome (Quintero, 1999). Abnormal Doppler indices reflect myocardial dysfunction and predict a poorer outcome (Banek, 2003). Additionally, this Doppler method can help monitor fetuses with congenital heart defects and supraventricular tachycardia (SVT) (Seravalli, 2016). SVT can induce a reversible cardiomyopathy that may lead to hydrops. Ductus venosus Doppler patterns may aid prediction and monitor improvement following treatment. Thus, ductus venosus Doppler may have a role in monitoring pregnancies at increased risk for fetal cardiovascular decline (Baschat, 2010).

Question 66

Uterine artery doppler implications

Answer 66

In a study of 30,519 unselected British women, uterine artery velocimetry was assessed at 22 to 24 weeks’ gestation (Smith, 2007). The risk of fetal death before 32 weeks, when associated with abruption, preeclampsia, or fetal-growth restriction, was significantly linked to high-resistance flow. However, technique standards and criteria to define an abnormal test are lacking. Thus, uterine artery Doppler studies are not considered standard practice in either low- or high-risk populations (Society for Maternal-Fetal Medicine, 2020).

Question 67

According to the American College of Obstetricians and Gynecologists (2021a), a normal antepartum fetal test result is highly reassuring that a stillbirth will not occur within 1 week. What is the Stillbirth Rates within 1 Week of a Normal Antepartum Fetal Surveillance Test?

Answer 67

Question 68

transthalamic view

Answer 68

This is a transverse image that includes the midline falx cerebri, cavum septum pellucidum, thalami, and insula.The cerebral hemispheres should appear symmetric, and the cerebellum should not be visible.

Question 69

Throughout the second and third trimesters, the femur length to abdominal circumference ratio is normally 20 to 24 percent. If this ratio is below 18 percent, a —– —- should be considered, particularly if other long-bone measurements are lagging

Answer 69

Throughout the second and third trimesters, the femur length to abdominal circumference ratio is normally 20 to 24 percent. If this ratio is below 18 percent, a skeletal dysplasia should be considered, particularly if other long-bone measurements are lagging.

Question 70

The cisterna magna should measure between – and – mm throughout the second trimester and may reach – mm in the latter part of the third trimester. It becomes effaced when the Chiari II malformation is present.

Answer 70

The cisterna magna should measure between 2 and 10 mm throughout the second trimester and may reach 12 mm in the latter part of the third trimester. It becomes effaced when the Chiari II malformation is present.

Question 71

If the cisterna magna is enlarged, the differential diagnosis includes

Answer 71

absence of all or part of the vermis, a cyst such as an arachnoid cyst within the posterior fossa, or mega-cisterna magna, which is a diagnosis of exclusion and has an excellent prognosis.

Question 72

The cisterna magna should measure between – and – mm throughout the second trimester and may reach – mm in the latter part of the third trimester.

Answer 72

The cisterna magna should measure between 2 and 10 mm throughout the second trimester and may reach 12 mm in the latter part of the third trimester.

Question 73

If the cisterna magna is enlarged, the differential diagnosis includes

Answer 73

absence of all or part of the vermis,It becomes effaced when the Chiari II malformation is present

Question 74

Agenesis of the corpus callosum has characteristic sonographic findings. Which are

Answer 74

The frontal horns are widely separated, and the occipital horns are rounded— which is called colpocephaly. Together these findings give the lateral ventricles a teardrop shape. A normal cavum septum pellucidum is not visible because of frontal horn displacement. In the midline, bundles of Probst represent fiber tracts that no longer cross in the midline. Ventriculomegaly is not uncommon, and without the corpus callosum bordering the third ventricle superiorly, the third ventricle may be elevated and mildly enlarged.

Question 75

Single deepest pocket measurement criteria

Answer 75

The single deepest pocket of fluid is measured in a sagittal plane with the ultrasound transducer held perpendicular to the floor and parallel to the long axis of the woman. A pocket should be at least 1 cm wide to be considered adequate, and the measurement should not include fetal parts or loops of umbilical cord. Color Doppler is generally used to verify that umbilical cord is not within the measurement. The measurement is considered normal if it is >2 cm and <8 cm. Values below and above this range indicating oligohydramnios and hydramnios

Question 76

Holoprosencephaly
Extra digit
Midline cleft palates defect
Is triad of

Answer 76

Parau trisomy 13

Question 77

Tear drop appearance of ventricles

Answer 77

Absent corpus callosum