20-24 Flashcards
(354 cards)
1
Q
A syndrome characterized by endometrial adhesions that typically occur as a result of scar formation after some types of uterine surgery
A
Asherman Syndrome
2
Q
Cessation of menstruation with advanced age
A
Menopause/ climacteric
3
Q
During menopause, follicles cease to mature, resulting in a considerable reduction in the amounts of :
A
estrogen, progesterone
4
Q
The ovaries become more ______ during post-menopause and lack follicles.
A
echogenic
5
Q
The decrease in estrogen by the ovaries has other physiologic consequences:
A
decrease in uterine size, mucosal layer begins to become atrophic, the vagina becomes smaller, breasts tend to accumulate more adipose or fat tissue
6
Q
Patients undergoing menopause may also suffer from:
A
night sweats, mood changes, depression, dyspareunia, dysuria, and a decrease in libido.
7
Q
Lack of circulating estrogen during and after menopause, there is a notable increase in risk for:
A
coronary heart disease and an increase threat for developing osteopenia and osteoporosis
8
Q
_________ is often used to combat the reduction of estrogen circulating in the female body after menopause and to prevent post-menopausal symptoms
A
HRT - hormone replacement therapy
9
Q
___________ has been shown to significantly reduce the risk of developing osteoporosis and coronary heart disease, with a possible reduction in the risk of developing colon cancer and Alzheimer’s disease
A
ERT estrogen replacement therapy
10
Q
Unopposed ERT is not combined with :
A
progesterone therapy
11
Q
Unopposed ERT has been shown to increase the risk of developing :
A
endometrial hyperplasia and endometrial carcinoma also could be an increased risk of developing breast cancer thromboembolism, hypertension, and possibly diabetes
12
Q
What do physicians use to attempt to reduce the risks associated with unopposed ERT:
A
progesterone therapy, progestin therapy
13
Q
the sonographic appearance of a pt on ERT and thickness of the endometrium are variable and comparable to:
A
premenopausal female
14
Q
A common indication for postmenopausal ultrasound is:
A
postmenopausal bleeding
15
Q
Complications that may lead to postmenopausal bleeding:
A
endometrial atrophy, uncontrolled HRT, endometrial hyperplasia, endometrial polyps, submucosal or intracavitary leiomyoma, endometrial carcinoma, and some ovarian tumors
16
Q
Post-menopausal endometrial thickness measurement should not include:
A
adjacent hypoechoic myometrium and is considered accurate only when double-layer thickness measurement is performed without the inclusion of endometrial fluid
17
Q
The post-menopausal bleeding patient’s endometrial thickness should not exceed
A
4-5 mm
18
Q
If the measurement of the endometrium is less than 5 mm in the post-menopausal bleeding patient the bleeding is typically caused by
A
endometrial atrophy
19
Q
The asymptomatic patient, post-menopausal patient, with no vaginal bleeding can have an endometrial thickness of up to :
A
8 mm
20
Q
The most common cause of postmenopausal bleeding is :
A
endometrial atrophy
21
Q
_______ results from the unopposed stimulation of estrogen on the endometrium.
A
Endometrial Hyperplasia
22
Q
Sonographic appearance of endometrial hyperplasia
A
thickened echogenic endometrium, small cystic spaces within the endometrium
23
Q
Clinical findings of endometrial hyperplasia
A
Abnormal uterine bleeding (any age), polycystic ovary syndrome, obesity, tamoxifen therapy
24
Q
Most common female genital tract malignancy, with post-menopausal bleeding
A
endometrial carcinoma
25
Endometrial Carcinoma is most often in the form of :
adenocarcinoma
26
Adenocarcinoma and endometrial carcinoma have been linked with :
unopposed estrogen therapy, nulliparity, obesity, chronic anovulation, stein-Leventhal syndrome, estrogen-producing ovarian tumors, and the use of tamoxifen
27
Sonographic findings of endometrial carcinoma:
thickened endometrium, heterogeneous uterus, enlarged uterus with lobular contour, endometrial fluid, polypoid mass within the endometrium
28
_________ are small nodules of hyperplastic endometrial tissue that may cause abnormal vaginal bleeding
endometrial polyps
29
_______ is a breast cancer drug that inhibits the effects of estrogen on the breast.
tamoxifen
30
________ is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a dilation and curettage
Asherman syndrome
31
Sonographic findings of Asherman Syndrome
Bright areas within the endometrium, sonohysterography findings include bright bands of tissue traversing the uterine cavity
32
______ an infection of the upper genital tract
Pelvic inflammatory disease
33
Inflammation of the fallopian tubes
salpingitis
34
Patients suffering from salpingitis from PID may present clinically with symptoms resembling :
cholecystitis
35
Pelvic infections such as chlamydia or gonorrhea can actually lead to perihepatic infection and the subsequent development of adhesions located between the liver and diaphragm this event is called:
Fitz-Hugh-Curtis syndrome
36
PID has been linked with infertility and:
ectopic pregnancy
37
Clinical findings of salpingitis
findings consistent with PID, pelvic tenderness, fever, leukocytosis
38
Sonographic appearance of salpingitis
Distended fallopian tube filled with echogenic material (pus) or anechoic fluid, Hyperemic flow within or around the affected fallopian tube depicted with color doppler, nodular, thickened wall of the fallopian tube
39
As PID progresses and reaches beyond the fallopian tubes, the ________ and ____ become involved
ovaries and peritoneum
40
As PID progresses; adhesions develop within the pelvis that leads to the fusion of the ovaries and dilated tubes a condition known as:
Tubo-ovarian complex
41
Further progression of tubo-ovarian complex leads to a :
tubo-ovarian abscess
42
Sonographic findings of tubo-ovarian complex
thickened, irregular endometrium, pyosalpinx or hydrosalpinx, cul-de-sac fluid, multicystic and solid complex adnexal masses, ovaries, and tubes recognized as distinct structures, but the ovaries will not be separated from the tube by pushing the vaginal probe
43
Sonographic findings of tubo-ovarian abscess
thickened, irregular endometrium, pyosalpinx or hydrosalpinx, cul-de-sac fluid, multicystic and solid complex adnexal mass(es), Complete loss of borders of all adnexal structures, and the development of a conglomerated adnexal (possibly bilateral) mass
44
What is termed the inability to conceive a child after 1 year of unprotected intercourse:
Infertility
45
Congenital uterine malformations often lead to:
Repeated abortions
46
________ is functional ectopic endometrial tissue located outside of the uterus.
Endometriosis
47
Implantation of ectopic endometrial tissue may be the result of endometrial tissue being passed through the :
Fallopian tubes during menstruation
48
Endometriosis can be located anywhere in the pelvis, the most common location is:
The ovaries
49
Hemorrhage of the ectopic endometrial tissue often occurs and results in:
Endometriomas
50
Typical age of diagnosis for endometriosis :
25-35
51
Common clinical findings of endometriosis:
Pelvic pain, dysparenunia, infertility.
| May also have dysmenorrhea, menorrhagia, painful bowel movements, or be completely asymptomatic
52
AKA stein-leventhal syndrome
Polycystic ovary syndrome
53
PCOS is characterized by:
Amenorrhea, hirtuism, and obesity
54
PCOS has been cited as the most common cause of :
Androgen excess/hyperandrogenism
55
Established clinical criteria for PCOS diagnosis :
Oligo/anovulation, blood work indicative of hyperandrogenism, Sonographic findings consistent with PCOS
56
Sonographic appearance of PCOS
Often enlarged ovaries, contain multiple small follicles along periphery, “string of pearls” sign
57
For the imaging diagnosis of PCOS it has been suggested that one or both ovaries should contain:
12 or more follicles that measure between 2-9 mm, ovarian volume should not exceed 10mL
58
What can be used to evaluate the patency of the Fallopian tubes?
Hysterosalpingography, hysterosalpingsonography, or hysterosalpingo-contrast-sonography
59
When the endometrium does not develop appropriately in the luteal phase (as a result of reduced progesterone production by the ovary) is termed:
Luteal phase deficiency
60
Adhesions within the uterine cavity often cause:
Infertility or lead to recurrent early pregnancy loss
61
Sonographic findings of asherman syndrome
Bright areas within the endometrium, sonohystography findings include bright bands of tissue traversing the uterine cavity
62
Fibroids that are __________ or __________ in location may distort the endometrium, thus preventing implantation of products of conception.
Intracavitary/ submucosal
63
Clinical findings of leiomyoma
Pelvic pressure, menorrhagia, palpable abdominal mass, enlarged, bulky uterus, dysuria, constipation, infertility
64
With assisted reproductive technology (ART) what is usually done to increase follicular development in order to extract multiple oocytes
Ovarian stimulation
65
______________ requires that a mature ovum be extracted from the ovary, fertilization takes place outside of the body.
In vitro fertilization
66
In-vitro fertilization: 4-8 developing embryos are placed into the uterus by means of a:
Catheter
67
The means by which twins, triplets, quadruplets, and quintuplet pregnancies are reduced :
Selective reduction/multi fetal pregnancy reduction
68
A additional technique of ART where the fertilization takes places in the Fallopian tubes:
Gamete intrafallopain tube transfer (GIFT)
69
GIFT requires that ooccytes and sperm be placed in the Fallopian tube via:
Laparoscopy
70
Zygote intrafallopian tube transfer is a method that requires the zygote be inserted :
Into the Fallopian tube
71
Patients who are being treated with ART are at an increased risk for :
Ectopic pregnancy, multiple gestations, ovarian hyper stimulation syndrome
72
Stimulation of the ovaries by hormonal therapy:
Ovulation induction
73
Drug that is used to stimulate the pituitary gland to secrete increased amounts of FSH:
Clomid/ clomiphene citrate
74
Fertility drug which is a hormone extracted from the urine of post menopausal women:
Pergonal
75
Pergonal is a mixture of what?
FSH and luteinizing hormone
76
Pergonal is often given in conjunction with
hCG
77
Ovulation induction dramatically increases risk of:
Multiple gestations and OHS
78
During OHS ovaries ______ and can measure:
Enlarge
| 5-12 cm
79
With OHS the ovaries contain:
Multiple large follicles/ theca lutein cysts
80
_______ is administered as part of ovulation induction, and theca lutein cysts occur due to these high levels
hCG
81
__________ can occur due to the large theca lutein cysts, results in acute pelvic pain.
Ovarian torsion
82
In cases of severe OHS patients have :
Nausea, vomiting, abdominal distention, ovarian enlargement, electrolyte imbalance, and oligoria
83
Sonographic signs of OHS
Cystic enlargement > 5cm, ascites, possible pleural effusion
84
OHS can initiate :
Renal failure, thromboembolism, and acute respiratory distress syndrome
85
Reversible form of contraception
IUD or IUCD
86
Small plastic T shaped IUD that releases small amounts of progestin to impede implantation
Mirena
87
T-shaped IUD utilizes copper to inhibit sperm transport, or to prevent fertilization or transplantation
Paragard
88
IUDs should be located within what portion of the endometrium?
Fundal
89
Sonographic appearance of lippes loop IUD
5 equally spaced shadowing structures
90
IUDs that have the Sonographic finding of T-shape
Copper T, mirena, paragard
91
Sonographic appearance of the dalkon shield
Shadowing ovoid shape device
92
IUDs create posterior shadowing and have been described as producing an “_________________” on sonogram
Entrance and exit echo
93
If the IUD is not located in the endometrium then what should be explored ?
Existence of myometrial perforation
94
Patients that have an IUD perforated into the uterine wall will often complain of what?
Irregular or heavy bleeding and cramping
95
The use of IUDs has been linked with:
PID, ectopic pregnancy, and spontaneous abortions
96
Birth control pills produce an _________ cycle.
Anovulatory
97
Permanent form of birth control that uses small coils placed into the proximal isthmic segment of the Fallopian tubes
Easier device
98
Sonographically how will the essure device appear
Bilateral echogenic linear structures with proximal isthmic segments of the Fallopian tubes best seen in the transverse plane
99
Female sterilization in the form of ___________________ offers another permanent pregnancy prevention method
Tubal ligation
100
If a patient presents to ultrasound with hx of tubal ligation and a positive pregnancy test what should be suspected?
Ectopic pregnancy
101
A normal pregnancy lasts for:
9 months, 40 weeks, 280 days
102
In the early first trimester if TA imaging is used pt should have a :
Distended urinary bladder
103
When a patient is in their late 2nd or 3rd trimester the gravid uterus can compress on the maternal IVC causing :
supine hypotensive syndrome
104
______ denotes the number of times a woman has been pregnant.
gravidity
105
________ denotes the number of pregnancies that led to the birth of a fetus at or beyond 20 weeks or an infant who weighed at least 500g.
parity
106
In the 2nd trimester painless vaginal bleeding is most often associated with:
placenta previa
107
In the 2nd trimester painful vaginal bleeding may occur as a result of:
placental abruption
108
The triple screen consists of :
hCG, MSAFP, estriol
109
The quadruple screen consists of:
hCG, MSAFP, estriol, and inhibin A
110
Some medical institutions provide an earlier test than the customary triple screen performed between 11-14 weeks, what is this an analysis of?
hCG, pregnancy-associated plasma protein a PAPP-A, combined with fetal NT
111
A newer blood test is available, which is a type of cell-free fetal DNA testing. Can reveal gender and is also highly accurate in detecting chromosomal anomalies:
MaterniT21plus
112
Measurements that are obtained in the first trimester:
the yolk sac, gestational sac, CRL, NT
113
The purpose of a BPP is :
to investigate for signs of fetal hypoxia and to assess overall fetal wellbeing.
114
Standard Fetal Measurement for AC:
Measured in an axial plain, taken around the abdomen at the level of the umbilical vein and fetal stomach.
115
Standard Fetal measurement for HC:
Measured at the outer perimeter of the skull at the level of the 3rd ventricle, thalamus, CSP, and falx cerebri
116
Standard Fetal measurement for FL:
Measured at the long axis of the femoral shaft when the ultrasound beam is perpendicular to the shaft
117
Standard fetal measurement of BPD:
Measured from the outer edge of the proximal skull to the inner edge of the distal skull at the level of the 3rd ventricle, thalamus, CSP, and falx cerebri
118
A type of reverberation artifact caused by several small, highly reflective interfaces such as gas bubbles
comet tail artifact
119
Caused by attenuation of the sound beam:
shadowing
120
An artifact that appears as a solid streak or a chain of parallel bands radiating away from a structure:
ringdown
121
How long should one episode of breathing last during a fetal BPP in order to receive 2 points?
30s
122
How many fetal body movements must be visualized in order to receive 2 points?
3 or more gross body movements
123
_______ presentation is the most common fetal presentation.
cephalic
124
The most common pelvic mass associated with pregnancy is:
Corpus luteal cyst
125
Pregnant patients, who complain of RLQ could be suffering from?
acute appendicitis
126
_______________ is most often secondary to the large size of the uterus with subsequent transient asymptomatic obstruction of the ureters.
Hydronephrosis/ dilation of the renal collecting system
127
MSAFP will ________ with Anencephaly
increase
128
Edwards syndrome (trisomy 13) will decrease which triple/quadruple screenings/additional labs
hCG, estriol, MSAFP, inhibin A, and PAPP-A
129
Cephalocele will _______ MSAFP
increase
130
Trisomy 21 (down syndrome) will increase which labs:
hCG, inhibin A
131
MSAFP will _______ with gastroschisis
increase
132
Spina-bifida (meningocele or myelomeningocele) will cause MSAFP to:
increase
133
An ectopic pregnancy will show a decrease in which labs?
hCG, hematocrit
134
Turner syndrome will cause a decrease in which labs?
hCG with hydrops, MSAFP, estriol, inhibin A (with hydrops, PAPP-A
135
A mature ovum is released through ovulation at around day:
14
136
A sperm which can live up to _______ hours unites with the egg in the distal 1/3 fallopian tube
72 hours
137
Conception usually occurs within ________ after ovulation.
24 hours
138
The combination of the sperm and ovum produces a structure referred to as the:
zygote
139
The zygote undergoes rapid cellular division and eventually forms into a cluster of cells called:
morula
140
The morula continues to differentiate and form into a structure known as:
blastocyst
141
The outer tissue layer of the blastocyst is comprised of :
trophoblastic cells
142
The trophoblastic cells produce which pregnancy hormone?
hCG
143
The inner part of the blastocyst will develop into:
embryo, amnion, umbilical cord, and primary and secondary yolk sacs
144
The outer part of the trophoblastic tissue will develop into :
placenta and chorion
145
On day ____ or ____ of the menstrual cycle, the blastocyst begins to implant into the decidualized endometrium at the level of the fundus.
20/21
146
By how many days has complete implantation occurred:
28
147
The implantation of the blastocyst within the endometrium may cause some women to experience vaginal bleeding, referred to as:
implantation bleeding
148
Primary yolk sac regresses during which week:
4, and two separate membranes are formed
149
When two separate membranes are formed from the primary yolk sac, the outer membrane represents:
chorionic sac/ gestational sac
150
Within the gestational sac is the :
amnion or amniotic sac
151
By the end of the 4th week, the ________ becomes wedged in between two membranes in an area called the chorionic cavity or extraembryonic coelom.
secondary yok sac
152
The developing embryo is located between the yolk sac and the ______ at four weeks.
amnion
153
When the developing embryo is located between the yolk sac and the amnion (at 4 weeks) _______ is formed.
alimentary canal
154
The ______ will become the fetal head and spine.
neural tube
155
The alimentary canal will become:
foregut, midgut, and hindgut
156
The lab used to detect pregnancy:
hCG
157
hCG is produced throughout pregnancy by the:
placenta
158
In the first trimester what maintains the corpus luteum cyst of the ovary so that progesterone can continue to produce:
hCG
159
hCG is detected in the maternal blood as early as:
23 days
160
What is the earliest definitive sign of an IUP
Gestational sac
161
The period given to describe the earliest sonographic detection of an IUP is termed the:
discriminatory zone
162
Typically at 5 weeks, a _____ gestational sac will be seen
5mm
163
Normal hCG levels double every ________
48 hours
164
the _________ of the endometrium is essentially the first sonographically identifiable sign of pregnancy:
decidual reaction
165
The decidual endometrium will appear:
thick and echogenic as a result of the continued production of progesterone
166
Earliest gestational sac is seen: _______ and will grow at a rate of ______ per day
5 weeks/1mm
167
The intradecidual sign can be misdiagnosed because it may resemble :
psuedogestational sac of an ectopic pregnancy
168
The double sac sign denotes the typical appearance of the two distinct layers of the decidua:
decidua capsularis (inner) and decidua parietalis (outer layer)
169
The space between the gestational sac and the amniotic sac, the location of the secondary yolk sac
chorionic cavity
170
the decidualized tissue at the implantation site containing the chorionic villi, the fetal contribution of the placenta:
chorion frondosum
171
The portion of the chorion that does not contain chorionic villi
chorion laeve
172
Fingerlike extension of trophoblastic tissue that invades the decidualized endometrium
chorionic villi
173
The endometrial tissue at the implantation site. The maternal contribution of the placenta:
decidua basalis
174
The portion of the decidua opposite the uterine cavity, across from the decidua basalis:
decidua capsularis
175
the decidualized tissue along the uterine cavity adjacent to the decidua basalis
decidua parietalis
176
The earliest sonographic measurement that can be obtained to date the pregnancy:
gestational sac
177
The gestational sac measurement can be used until there is a :
fetal pole
178
By adding ____ to the MSD sonographers can obtain an estimate for the gestational age in days.
30
179
An irregularly shaped gestational sac and MSD of > _____ that does not contain a fetal pole are both signs of potential pregnancy failure:
25
180
The first structure seen with sonography within the gestational sac is the :
secondary yolk sac
181
The yok sac produces ____ and plays an important role in angiogenesis and hematopoiesis during early development
AFP
182
The yolk sac is connected to the embryo by the _____, aka omphalomesenteric duct.
vitelline duct
183
The gestational sac consists of 2 cavities:
chorionic cavity and amniotic cavity
184
The chorionic cavity lies between:
amnion and chorion
185
The chorionic cavity contains:
yolk sac and fluid
186
The amniotic cavity contains :
simple-appearing amniotic fluid and the developing embryo
187
The amnion and chorion typically fuse around:
middle of the first trimester but may not be totally fused until 16 weeks gestation
188
By week ____ the embryo can be seen located within the amniotic cavity adjacent to the yolk sac
6
189
Sonographic documentation of heart activity being present between:
5 and 6 weeks
190
Heart motion can be detected in a _____ mm embryo and with motion certainly evident within the ____ mm embryo
4/5
191
Embryonic HR of _________ bpm between 5-6 weeks is normal
100-110
192
The most accurate sonographic measurement of pregnancy is:
CRL
193
Fetal limb buds are identified by:
7 weeks
194
At 7 weeks ______ is proportionally larger than the body.
head
195
Within the fetal head, a cystic structure may be noted - this most often represents: (7-8 wks)
rhombencephalon/hindbrain
196
The rhombencephalon will eventually develop into the:
4th ventricle
197
As early as 8 weeks, the _____ may be visualized in the upper abdomen.
stomach
198
________ begins at 8 weeks, which marks the developmental stage when the midgut migrates into the base of the umbilical cord.
physiologic bowel herniation
199
IF physiologic bowel herniation does not resolve by _____ weeks, a follow-up exam is warranted.
12 weeks
200
The developing placenta may be noted at the _________ as a well-defined crescent-shaped homogeneous mass of tissue.
end of the first trimester
201
The placenta is formed by the :
decidua basalis, the maternal contribution
| chorion frondosum, the fetal contribution
202
The term nuchal refers to the_____
neck
203
the nuchal translucency is represented by a thin membrane along the __________ aspect of the fetal neck.
posterior
204
The most common abnormalities associated with increased NT are:
trisomy 21, trisomy 18, Turner syndrome, and congestive heart failure
205
The NT is optimally measured between:
11-13weeks and 6 days
| when CRL measures between 45-84mm
206
The fetus may be seen resting on the ______ and this should not be confused for a prominent NT
amnion
207
The normal range of thickness of NT is based on the ___________, although most often a measurement of _____ between 11-13 weeks 6 days is considered abnormal.
gestational age; 3 mm
208
It has been recognized with many down syndrome fetuses, the nasal bone is either ______ or _______ between 11-13 weeks.
hypoplastic or absent
209
Visualizing the nasal bone separate from the overlying nasal skin will provide an _______ sign in the normal fetus.
equal
210
The most common pelvic mass associated with pregnancy is:
ovarian corpus luteum cyst
211
The corpus luteum of pregnancy is a _____ cyst that is maintained during the 1st trimester by ______, which is produced by the developing placenta.
functional; hCG
212
The corpus luteum secretes ________ and thereby maintains the thickness of the endometrium
progesterone
213
Typically the corpus luteum measures between :
2-3 cm
| may continue to grow up to 10cm
214
The circumferential rim of the corpus luteum typically produces what type of waveform:
low resistance spectral doppler
215
The calipers during NT measurement must be placed ______ to the long axis of the fetus.
perpendicular
216
An ectopic pregnancy is also referred to as:
extrauterine pregnancy EUP
217
_______ is the most common cause of pelvic pain with a positive pregnancy test.
EUP
218
The most common location for EUP is :
within the fallopian tube, the specifically ampullary portion of the tube
219
Contributing factors for ectopic pregnancy:
previous ectopic, previous tubal surgery, hx of pelvic inflammatory disease, undergoing fertility treatment, previous or present use of an IUD, multiparity, advanced maternal age
220
When a patient has a EUP and coexisting IUP it is termed:
heterotopic pregnancy
221
The classic clinical triad of an EUP includes:
pain, vaginal bleeding and palp abdominal pelvic mass
222
______ can be helpful in determining EUP because a normal IUP should double every 48 hours.
hCG
223
___________ pregnancies are considered potentially life-threatening because the pregnancy may progress normally until a spontaneous rupture occurs.
interstitial
224
__________ is a drug used to medically treat an EUP
methotrexate
225
Sonographic findings of ectopic pregnancy:
the extrauterine gestational sac containing a yolk sac, adnexal ring sign, complex adnexal mass, a large amount of free fluid within the pelvis or in Morison pouch, complex free fluid could represent hemoperitoneum, pseudogestational sac, poor decidual reaction, an endometrial cavity containing blood
226
Benign ________________ often referred to as molar pregnancy or hydatidiform mole, is a group of disorders that result from an abnormal combination of male and female gametes.
Gestational trophoblastic disease
227
The most common form of the gestational trophoblastic disease:
complete molar pregnancy
228
The most common forms of malignant GTD are:
invasive mole, choriocarcinoma
229
(GTD) The most common sites of metastatic involvement are :
lugs, liver, and vagina
230
Patients who present with a diagnosis of molar pregnancy are often referred for:
chest radiographs or other studies for further evaluation of metastasis
231
Treatment for molar pregnancy:
D&C, hCG monitoring, hysterectomy, & possibly chemo
232
Clinical findings of GTD
hyperemesis gravidarum,
markedly elevated hCG ( potentially higher than 100,000 mIU per mL),
heavy vaginal bleeding with possible passage of grape-like molar clusters,
hypertension,
uterine enlargement
hyperthyroidism
233
Sonographic findings of complete molar pregnancy
complex mass within the uterus,
color doppler may reveal hypervascularity around the mass but not within it,
vesicular snow storm secondary to placental enlargement, multiple cysts replacing the placental tissue (hydropic chorionic villi),
bilateral ovarian theca lutein cysts
234
Partial or incomplete molar pregnancy may be accompanied by a coexisting:
triploid fetus, parts of the fetus, or amnion
235
With partial or incomplete molar pregnancy how will hCG present:
Normal, minimally elevated
236
Invasive molar pregnancy invades:
the myometrium and may also invade through the uterine wall and into the peritoneum
237
___________ is diagnosed when there is no evidence of a fetal pole or yolk sac within the gestational sac
blighted ovum/anembryonic gestation
238
Clinical findings of Blighted ovum:
vaginal bleeding, reduction of pregnancy symptoms, low hCG
239
_____________ is defined by the death of the embryo or fetus.
embryonic demise/fetal demise
240
Cardiac activity should be detected in a pole that measures:
4-5mm
241
The normal embryonic HR at 6 weeks is typically between
100-110
242
absent cardiac activity when the CRL is below _______ is suspicious for pregnancy failure
7mm
243
________ is essentially a bleed between the endometrium and the gestational sac.
subchorionic hemorrhage
244
subchorionic hemorrhage results from the:
implantation of the fertilized ovum into the uterus with subsequent low-pressure bleeding or spotting.
245
By ________ the neural plate the structure that will form the central nervous system has developed.
4.5
246
The proper measurement of the lateral ventricle is taken at the :
atria
247
Where are the mid cerebral arteries located in the circle of Willis
laterally - bilaterally
248
The rhombencephalon aka:
hindbrain
249
The skull consists of _______ cranial bones.
8
250
Premature fusion of the sutures is termed:
craniosynostosis
251
Craniosynostosis leads to :
an irregular shaped skull
252
Spaces that exist between the forming fetal skull bones are referred to as:
fontanelles or soft spots
253
The opening in the base of the cranium through which the spinal cord travels:
foramen magnum
254
The brain can be divided into two main parts:
cerebrum and cerebellum
255
The cerebral hemispheres are linked in the midline by the :
corpus callosum
256
Three protective tissue layers that cover the brain and spinal cord are termed:
meninges
257
The innermost layer of the meninges :
pia mater
258
The middle layer of the meninges is the:
arachnoid membrane
259
The dense, outermost layer of the meninges is the :
dura mater
260
The corpus callosum should be completely intact between:
18-20 weeks
261
The absence of all or part of the corpus callosum is termed:
agenesis of the corpus callosum
262
The midline brain structure is located in the anterior portion of the brain between the frontal horns of the lateral ventricles. (box-shaped)
Cavum Septum pellucidum
263
The ______ does not communicate with the ventricular system, and its absence is associated with multiple cerebral malformations.
CSP
264
The two lobes of the thalamus are located on both sides of the:
3rd ventricle
265
The thalamus should not be confused with the ____________________, which are more inferiorly positioned in the brain.
cerebral peduncles
266
The ventricular system is composed of ____ ventricles, whose primary function is to provide cushioning for the brain.
4
267
Each ventricle is lined by a membrane called the :
ependyma
268
What is responsible for the production of cerebrospinal fluid in the fetus:
choroid plexus
269
Each lateral ventricle communicates with the 3rd ventricle in the midline of the brain at the:
foreman Monro
270
The third ventricle is located between:
the two lobes of the thalamus
271
The third ventricle connects to the fourth ventricle inferiorly by means of a long tubelike structure called:
the aqueduct of sylvius/cerebral aqueduct
272
The fourth ventricle is located ________ to the cerebellum.
anterior
273
The two lateral apertures (in the fourth ventricle) are also referred to as:
foramina of luschka
274
The foramina of luschka allow CSF to travel from the 4th ventricle to the:
subarachnoid space around the brain
275
Another opening of the fourth ventricle, which is located midline and is the median aperture is also known as:
foramen of magendie
276
Foramen of magendie alllows CSF to pass from the 4th ventricle to the _________________
cisterna magna and subarachnoid space
277
CSF flows ________ and around the spinal cord
inferiorly
278
____________ are responsible for the reabsorption of CSF into the venous system.
arachnoid granulations/arachnoid villi
279
The cisterna magna, located in the _____ fossa of the cranium.
posterior
280
The cerebellum is located in the ______ fossa of the cranium.
posterior
281
The cerebellum consists of two hemispheres right and left that are coupled at the midline by the:
cerebellar vermis
282
The normal cerebellum is what shape:
dumbbell or figure 8 shaped
283
BPD measurement of the fetal head can be taken starting between:
13-14 weeks
284
BPD is obtained in what plane:
axial
285
What should be seen in the BPD/HC measurement
CSP, thalamus, and falx
286
cephalic index =
BPD/OFD x 100
287
Head shape that is considered round or short and wide.
brachycephalic
288
The head shape that is elongated, narrow head:
dolichocephaly, scaphocephaly
289
A cephalic index of less than _______ denotes a dolichocephalic shape.
75
290
Cephalic index of more than ____ denotes brachiocephalic shape.
85
291
The lateral ventricle is measured in the transaxial plane at the level of the :
atrium
292
The calipers are placed at the level of the _____ of the choroid plexus for a measurement of the lateral ventricles.
glomus
293
The normal lateral ventricle does not typically measure more than:
10mm
294
Enlargement beyond 10 mm of the lateral ventricles is referred to as:
ventriculomegaly/ hydrocephalus
295
The cerebellum grows at a rate of _____ per week between 14-21 weeks
1mm
296
The depth of the cisterna magna should not measure more than
10 mm
297
The depth of the cisterna magna should not measure less than:
2 mm
298
Measurement of the cisterna magna more than 10 mm is consistent with :
mega cisterna magna and dandy-walker complex
299
A measurement of the cisterna magna less than 2 mm is worrisome for:
Arnold-chiari II malformation
300
The buildup of CSF within the ventricular system secondary to some type of obstruction:
obstructive hydrocephalus
301
________ has been cited as the most common cranial abnormality.
ventriculomegaly
302
____________ sign describes the echogenic choriod plexus hanging lump surrounded by CSF.
dangling choroid sign
303
__________________ is apparent when the obstruction lies outside the ventricular system
communicating hydrocephalus
304
_____________ is when the obstruction level is located within the ventricular system.
non-communicating hydrocephalus
305
The most common cause of hydrocephalus in utero
aqueductal stenosis
306
The cerebral aqueduct (aqueduct of Sylvius), is located between :
3rd and 4th ventricles
307
An obstruction (stenosis) at the aqueduct of Sylvius would cause :
3rd ventricle and both lateral ventricles to expand - 4th ventricle remains normal.
308
Fatal condition in which the entire cerebellum is replaced by a large sac containing CSF
hydranencephaly
309
With hydranencephaly, there is no cerebral ______ present
mantle
310
Midline brain anomaly that is associated with not only brain aberrations but also atypical facial structures.
holoprosencephaly
311
3 types of holoprosencephaly
alobar, semilobar, and lobar
312
With alobar holoprosencephaly the cortex can take on three basic shapes
pancake, cup, or ball
313
The most severe form of holoprosencephaly :
alobar
314
Alobar holoprosencephaly is diagnosed when there is the absence of:
corpus callosum, CSP, 3rd ventricle, intrahemispheric fissure, falx
315
___________ or _________ is present in 50-70% of fetuses diagnosed with holoprosencephaly
Trisomy 13, patau syndrome
316
Sonographic findings of alobar holoprosencephaly:
Horseshoe-shaped monoventricle, fused echogenic thalami, absence of the CSP, interhemispheric fissure, falx cerebri, corpus callosum, third ventricle, Normal cerebellum and brain stem
317
Cerebellar vermis is either completely absent or hypoplastic, as a result, the tentorium, the structure that separates the cerebrum from the cerebellum, is elevated. This represents what malformation:
dandy-walker malformation
318
Facial anomalies of alobar holoprosencephaly:
cyclopia, hypotelerism, proboscis, cleft lip, anophthalmia, cebocephaly
319
If the cerebellar vermis is absent and the 4th ventricle is enlarged then _________ must be suspected
DWM - Dandy walker
320
The corpus callosum is completely formed by:
18 weeks
321
Most often if the corpus callosum is absent then:
the CSP will be as well
322
In the normal brain, the sulci within the cerebrum typically travel _______ to the corpus callosum, but with agenesis of the corpus callosum, they tend to have a more ________ or radial arrangement. (spoke wheel pattern)
parallel/perpendicular
323
Associated with the development of fluid-filled clefts within the cerebrum.
schizencephaly
324
The Sonographic appearance of open lip schizencephaly is that of a cerebrum containing __________ clefts filled containing anechoic CSF.
gray matter lined
325
A rare condition in which a cyst communicates with the ventricular system:
porencephaly
326
Porencephaly can occur after the fetus has experienced _________ within one or both cerebral hemispheres.
hemorrhage
327
Condition in which there are no gyri within the cerebral cortex
lissencephaly
328
________ and ______ are the most common neural defects.
anencephaly and spina bifida
329
________ in a woman's diet significantly reduces the likelihood of her fetus developing a neural tube defect.
.4mg of folate
330
______ is defined as the absence of the cranial vault above the bony orbits.
acrainia
331
_______ is considered when there are no cerebral hemispheres present - where as _________ denotes a normal amount of cerebral tissue
anencephaly/ exencephaly
332
Sonographic appearance of anencephaly:
froglike facies, bulging eyes, and absence of the cranial vault.
333
Clinical findings of acrania/anencephaly:
elevated MSAFP
334
Spina bifida may result in a mass protruding form the spine, this mass can be referred to as a __________ or ________.
meningocele/myelomeningocele
335
Most common location of spina bifida is :
the distal lumbosacral region
336
Frontal horns will be small and slitlike, whereas the occipital horns will be enlarged, this describes what condition of the fetal skull?
colpocephaly
337
Sonographic signs of Arnold Chiari II malformation
lemon sign, banana sign, obliterated cisterna magna, colpocephaly, enlarged Massa intermedia, hydrocephalus, an open spinal defect
338
protrusions of intracranial contents through a defect in the skull:
cephalocele
339
The most common location for a cephalocele
occipital region
340
what are the contents of a meningocele?
meninges only
341
what are the contents of an encephalocele:
brain tissue only
342
what are the contents of an encephalomeningocele
both meninges and brain tissue
343
encephalomeningocystocele
meninges, brain tissue, and lateral ventrical
344
Most common in utero infection:
cytomegalovirus
345
Sonographic intracranial findings consistent with intrauterine infections:
are the calcifications around the ventricles and ventriculomegaly
346
Most common intracranial tumor in utero:
teratoma
347
Most common risk factor for fetal intrauterine intracranial hemorrhage :
maternal platelet disorders
348
The normal cerebral circulation typically yields a _______ impedance doppler pattern, with the continuous forward flow throughout the cardiac cycle.
high
349
Doppler of the _____ has been shown effective at evaluating for potential hypoxia.
MCA
350
The resistance pattern of the MCA should be _____ than that of the umbilical artery
greater
351
An arteriovenous malformation that occurs within the fetal brain:
Vein of Galen aneurysm
352
Sonographic findings of a vein of Galen aneurysm :
large, anechoic mass within the midline of the cranium, when using color doppler will fill with turbulent venous and arterial flow
353
Fetus suffering from the vein of Galen aneurysm will also have signs of :
hydrops and cardiomegaly
354
Clinical findings of Vein of Galen Aneurysm: (neonatal)
congestive heart failure
