O&G

Question 0

Empty sac

Answer 0

Normal early IUP
Anembryonic gestation
Ectopic pregnancy (pseudogestational sac)

Question 1

Causes of first trimester bleeding

Answer 1

Pregnancy related:

• Normal IUP
• Abortion
• Ectopic
• GTD
• Subchorionic haemorrhage

Unrelated to pregnancy

• Polyp
• Cancer
• Vaginal ulcers

Question 2

Echogenic central cavity

Answer 2

Normal pregnancy
Ectopic pregnancy with decidual reaction
Abortion (retained products)

Question 3

Complex intrauterine mass

Answer 3

Missed abortion with placental hydropic degeneration
Foetal demise with retained tissue
Molar pregnancy
Degenerated uterine fibroid
Endometrial carcinoma

Question 4

Elevated AFP

Answer 4

Foetal abnormalities
- NTD, abdominal wall defects, cystic hygroma, GIT obstruction, atresia, liver disease, renal disease

Incorrect dates
Multiple gestation
Foetal demise
Low birth weight
Placental abnormalities

Question 5

Low AFP

Answer 5

Down syndrome
Trisomy 18
Incorrect dates

Question 6

Diffusely enlarged placenta (>4cm thick)

Answer 6

Hydrops
Maternal diabetes
Maternal anaemia
TORCH
Intraplacental haematoma
Molar change/partial mole

Question 7

Three typical findings of ectopic pregnancy

Answer 7

Complex adnexal mass
Free pelvic fluid
Tubal ring

Question 8

Abnormal placental echotexture

Answer 8

Partial mole
Hydropic placenta
Haemorrhage or abruption
Chorioangioma
Venous lakes, fibrin, interval loud thrombosis etc

Question 9

Solitary umbilical artery

Answer 9

Trisomy 13 or 18
Structural anomalies (holopresencephaly, skeletal dysplasia, hydrocephalus, omphalocele, hydrothorax, diaphragmatic hernia)

Question 10

Third trimester bleeding

Answer 10

Placenta praevia
Placental abruption
Cervical lesions
Idiopathic

Question 11

Pleural effusion - foetal chest

Answer 11

Unilateral: CHD, sequestration, CCAM
Bilateral: hydrops, pulmonary lymphangiectasia
Uni or bilateral: idiopathic, infection, chromosomal anomalies

Question 12

Absent stomach bubble

Answer 12

Oligohydramnios
Swallowing abnormality (CNS defect)
Oesophageal atresia
CDH
Situs
Risk of chromosomal abnormalities (trisomy 18)

Question 13

Double bubble

Answer 13

Ladd’s bands
Annular pancreas
Duodenal atresia
Stenosis of the duodenum

Question 14

Dilated bowel

Answer 14

Atresia
Stenosis
Volvulus
Meconium ileus
Enteric duplication
Hirschsprung's

Question 15

Echogenic bowel

Answer 15

Normal variant during 2nd trimester
Cystic fibrosis
Down syndrome
IUGR
CMV

Question 16

Abdominal calcification

Answer 16

Bowel related
- meconium peritonitis, meconium ileus, atresia, volvulus

Other organs
- renal, liver (TORCH), neuroblastoma, teratoma, foetal gallstones

Question 17

Hydronephrosis

Answer 17

PUJ obstruction
UVJ obstruction (primary megaureter)
Duplex collecting system
Bladder outlet obstruction
Prune belly
Caudal regression
Maternal drugs
Ectopic ureterocoele

Question 18

Foetal hydronephrosis

Answer 18

Follow up if > 7mm after 32 weeks

> 10mm always pathological

Question 19

Cystic abdominal structures

Answer 19

Hydronephrosis
Fluid filled dilated bowel
Ascites
Meconium pseudocyst
Cysts eg Mesenteric, urachal, duplication, ovarian, choledochal

Question 20

Ascites

Answer 20

Hydrops
Urine ascites
Meconium peritonitis
Infection
Pseudo ascites

Question 21

Causes of thickened endometrium

Answer 21

Early pregnancy
Ectopic pregnancy
RPOC
Anovulatory cycles
Tamoxifen
HRT

Question 22

Risk factors for endometrial carcinoma

Answer 22

HRT
Tamoxifen
Age
Family history
Past history of unopposed oestrogen exposure
Hypertension
Obesity and diabetes

Question 23

Staging of endometrial carcinoma

Answer 23

1. Limited to body of uterus
2. Cervical stromal involvement
3. Local or regional spread of tumour
   3a. Invades body of uterus and/or adnexae
   3b. Vaginal or parametrial involvement
4. Rectum, bladder or distant metastasis

Question 24

Cervical cancer staging

Answer 24

1. Confined to cervix
2. Beyond cervix, not to pelvic sidewall or lower third of vagina
3. Lower third of vagina
4. Extension beyond pelvis or involvement of bladder/rectum

Question 25

Causes of polyhydramnios

Answer 25

Maternal: diabetes, HTN, maternal CHF

Foetal: CNS lesions, proximal GIT obstruction (oesophageal/duodenal/jejunal atresia), abdominal wall defects, chest masses, CVD abnormalities, twin-twin transfusion, hydrops

Idiopathic (65%)

Mild > 11cm pocket
Moderate 12-15
Severe > 16

Question 26

Causes of oligohydramnios

Answer 26

Drugs
Renal abnormalities
IUGR
Premature rupture of membranes
Chromosomal anomalies (18, 13)

Question 27

Ovarian cancer staging

Answer 27

1. Tumour limited to ovaries
2. Involves both ovaries with pelvic extension
3. Peritoneal implants outside the pelvis or retroperitoneal lymph node metastasis
4. Distant metastases including liver parenchyma

Question 28

Causes of IUGR

Answer 28

Maternal
- HTN, diabetes, renal, cardiac, SLE, smoking, alcohol, drugs, infection

Multiple gestation

Placental insufficiency

Question 29

Causes of foetal hydrops

Answer 29

Immune

Non immune

• chromosome
• cardiac
• in utero infection
• foetal tumours
• metabolic (gaucher)
• skeletal dysplasias
• high output flow states eg vein of Galen malformation
• thoracic abnormalities causing venous ovstruction

Question 30

Nuchal translucency

Answer 30

> 3mm 11-14 weeks gestation

> 6mm 16-20 weeks gestation

Question 31

Features of trisomy 21

Answer 31

Cardiac defects
Ventriculomegaly
Duodenal atresia
Pyelectasis
Hyperechoic bowel
Omphalocele
Short femora and humeri

Question 32

Features of Turner Syndrome

Answer 32

Short stature
Ovarian dysgenesis
Congenital lymphedema
Cystic hygroma

Question 33

Trisomy 18

Answer 33

Cystic hygroma
Growth restriction
Abnormal extremities (clenched hands and overlapping digits)
Choroid plexus cysts

Question 34

Trisomy 13

Answer 34

Holopresencephaly
Cleft lip and palate
Polydactyly
Renal and cardiac anomalies

(Patau syndrome)