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DUTEC 120 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

conceptual age is same as

A

embryologic age

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2
Q

conceptual/embryologic age counts from

A

first day of conception

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3
Q

gestational age is same as

A

menstrual age

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4
Q

gestational age starts counting from

A

1st day of LMP

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5
Q

what “age” is used to date pregnancy

A

gestational age

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6
Q

why are 1st trimester US not normally performed

A

Insonation
may not see embryo yet
can’t help embryo before 12 weeks

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7
Q

what is embryo initially sustained by

A

yolk sac and ovary

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8
Q

at what point is it a zygote

A

conception - 12 days

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9
Q

at what point is it an embryo

A

implantation to 10 weeks

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10
Q

at what point is it a fetus

A

10 weeks or more

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11
Q

when does the heart reach adult configuration

A

8 weeks

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12
Q

when does normal gut herniation occur and when it is abnormal

A

9.5-12.5 weeks

abnormal if not by 14 weeks

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13
Q

equation for gestational age

A

conceptual age + 2 weeks (14 days)

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14
Q

when does fertilization occur

A

1-2 days after ovulation

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15
Q

what determines sex of the baby

A

sperm

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16
Q

what is a proper location for implantation

A

uterine fundus

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17
Q

what does blastocyst contain

A

trophoblastic cells and “inner cell mass” forming embryo

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18
Q

what stimulates maternal pregnancy responses

A

trophoblastic cells secreting hCG

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19
Q

what does hCG from trophoblastic cells do

A

causes endometrium to convert to decidua

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20
Q

what is the purpose of decidua

A

nourish early pregnancy

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21
Q

when does blastocyst enter the uterus

A

4-5 days post fertilization

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22
Q

when does implantation occur?

A

12 days post ovulation

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23
Q

what allows implantation to occur

A

proteolytic enzymes produced by trophoblasts

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24
Q

what are lacunae

A

blood pools created by erosion of maternal capillaries to nourish trophoblastic cells

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25
Q

what is placenta and fetal/maternal circulation made out of

A

lacunae

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26
Q

what does inner cell mass mature into in a consepsus

A

bilaminar embryonic disk (embryo and promary yolk sac)

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27
Q

when is primary yolk sac pinched off

A

23 days GA

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28
Q

how is primary yolk sac pinched off

A

by entra embryonic celom

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29
Q

when is secondary yolk sac seen

A

1st trimester

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30
Q

when are amniotic and chorionic cavities seen

A

1st trimester

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31
Q

location of chorion and amnion

A

chorion is outer
amnion is inner
fused when placenta forms

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32
Q

how much does embryo grow

A

1mm/day

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33
Q

when are major internal/external structures developed

A

week 4-10 (embryonic phase)

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34
Q

when does initial heartbeat occur

A

5.5-6 weeks

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35
Q

what is normal CRL by end of 10th week

A

35mm

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36
Q

when is beginning of fetal period

A

last 2 weeks of 1st trimester

weeks 11 and 12

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37
Q

what is normal fetal head size at the end of 1st trimester

A

half of CRL

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38
Q

when is fetal anatomy fully developed?

A

late frist trimester

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39
Q

what is the goal of sonography in late first trimester

A

anomaly detection

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40
Q

what improves diagnosis of IUP or ectopic

A

US and hCG levels

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41
Q

normal gestational sac hCG SIS on TAS

A

> 1800 mIU/ml

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42
Q

normal gestational sac hCG SIS on TVS

A

> 500 mIU/ml

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43
Q

hCG level of ectopic pregnancies

A

lower than normal

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44
Q

normal IUP hCG increase in

A

2x every 2 days

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45
Q

what happens to hCG before spontaneous nonviable expulsion

A

they fall

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46
Q

when do hCG levels plateau/decline

A

9-10 weeks

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47
Q

what should you suspect if hCG plateau’s later than 9-10 weeks

A

trisomy 21

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48
Q

screening marker for Down’s and when it’s performed

A

hCG levels in 1st and 2nd trimester

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49
Q

PAPP-A

A

produced by trophoblastic (placental cells)
Bone and tissue formation
increases with advancing gestation

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50
Q

PAPP-A in Downs

A

lower initially

NOT USEFUL IN 2ND TRIMESTER

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51
Q

Strogenst biochemical marker for Downs at 9-11 weeks

A

PAPP-A

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52
Q

components of 1st trimester eval (5)

A
  1. locate gestational sac (scan uterus and adnexa)
  2. measure embryo and/or sac
  3. m-mode for cardiac activity
  4. fetal number and chorionicity
  5. evaluation of uterus, adnexa and cul-de-sac
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53
Q

when can you see embryo on TVS

A

5.5 weeks

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54
Q

appearance of IUP at 5 weeks on TVS

A

1-2mm sac (echogenic ring, sonolucent center representing chorionic cavity)

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55
Q

portion on myometrial/burrowing side

A

decidua basalis

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56
Q

villi covering ebryo

A

decidua capsularis

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57
Q

normal features of gestational sac (5)

A
  1. round/oval
  2. fundal location
  3. eccentrically placed
  4. smooth contours
  5. DDS wall thickness >3mm
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58
Q

implantation in lower uterine segment is associates with _____ and ____

A

placenta accreta and placenta previa

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59
Q

When is yolk sac seen?

A

MSD >12mm

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60
Q

When is embryo seen? (MSD measurement and GA)

A

MSD >18mm

5.5-6 weeks

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61
Q

how fast does gestational sac grow?

A

1mm/day

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62
Q

when does embryonic heart motion begin?

A

5.5 weeks

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63
Q

what is a good landmark to image embryo in early pregnancy

A

yolk sac

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64
Q

functions of yolk sac (3)

A
  1. provide nutrients
  2. hematopoiesis
  3. development of endoderm (forming primitive gut)
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65
Q

when does yolk sac detaches from yolk stalk (and embryo)

A

8 weeks

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66
Q

failure to visualize yolk sac with min ______mm MSD on TVS is abnormal

A

12

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67
Q

yolk sac should be seen within MSD of _______ and always be seen with MSD _____

A

10-15mm

20mm

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68
Q

Growth rate of yolk sac compared to MSD

A

0.1mm/ml MSD

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69
Q

normal diameter of yolk sac should be less than _____

A

6mm

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70
Q

chorion and amnion fuse at how many weeks GA

A

12

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71
Q

what is it called when bilaminar disk becomes trilaminar

A

gastrulation

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72
Q

when does gastrulation occur

A

5th week GA

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73
Q

When does organogenesis begin

A

5th week

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74
Q

CRL at 5.5 weeks

A

3mm

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75
Q

heart beat should be seen by the time CRL is ______

A

> 4mm

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76
Q

when does embryonic curling begin?

A

6.2 weeks

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77
Q

where are the dumping grounds for embryonic waste

A

chorionic cavity and placenta later

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78
Q

when does fusion of chorionic and embryonic cavities occur

A

14-15 weeks

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79
Q

when does trilaminar disk fold into c shape and what is it called

A

6th week

curling

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80
Q

what is yolk stalk made out of

A

head, caudal portions and lateral folds

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81
Q

what becomes of dorsal aspect of yolk sac

A

foregut, midgut, hindgut, GI tract, liver, biliary tract and pancreas

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82
Q

what is umbilical cord made out of

A

yolk stalk connecting stalk and allantios

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83
Q

what does spine develop from and when does it close

A

ectoderm to neural tube. Closes at 6th week GA

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84
Q

whats visualized at 7 weeks in cranium?

8 weeks?

A

single vesicle

3 vesicles

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85
Q

Rhombencephalon divides into which 2 cavities and forms ______

A

cephalic - metencephalon
caudal - myelencephalon
forming cystic rhomboid fossa

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86
Q

when does midline falx form

A

9 weeks GA

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87
Q

when is cerebellum fused

A

10 weeks

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88
Q

when are brain structures complete

A

shortly after 10 weeks

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89
Q

when do limb buds develop

A

6th and 7th week

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90
Q

when are hands and feet completely formed

A

10 weeks

91
Q

when are limbs identified and why

A

10 weeks because you can see calcifications of long bones

92
Q

when does calcification of clavicle begin?

A

8 weeks

93
Q

when are frontal and cranial bones occified

A

9 weeks

94
Q

anterior abdominal wall developed by _____

A

6 weeks

95
Q

anterior abdominal wall forms from:

A

fusion of four ectomesodermal body folds

96
Q

primitive gut is formed :

A

6 weeks. when dorsal yolk sac incorporates into embryo

97
Q

midgut forms _____

A

small bowel, cecum, ascending colon, proximal transverse colon

98
Q

how is yolk stalk formed

A

when amniotic cavity expansion pulls yolk sac away from embryo

99
Q

when does midgut loop return to fetal abdomen

A

11th week

100
Q

echogenic mass within the umbilical cord is most likely ____

A

normal bowel herniation

101
Q

what can bowel herniation be confused with

A

omphalocele or gastroschisis

102
Q

first organ to function in an embryo

A

heart

103
Q

start of fetal heart beat (weeks and days)

A

5-5.5 weeks

35 days

104
Q

cardiac activity should always be seen by _______ or ______ CRL

A

46 days GA

>4mm CRL

105
Q

fetal heart rates

A

90-115 bpm at 6 weeks
140-160 bpm at 9 weeks
140 bpm through remainder of 1st and 2nd trimester

106
Q

heartbeat of _____bpm provides discrimination for maternal heartbeat

A

100 bpm

107
Q

determination of GA is done by (2)

A

CRL and gestational sac size

108
Q

gestational sac size is accurate until

A

8 weeks

109
Q

When measuring MSD, where should the calipers be placed

A

inner to inner

110
Q

equation for menstrual age

A

MSD + 30 (in days)

menstrual age / 7 = in weeks

111
Q

most accurate dating parameter in obstetrics first 12 weeks GA

A

CRL

112
Q

why is CRL not accurate after 12 weeks

A

due to curling of fetus

113
Q

what does the triple screen test measure

A

AFP, hCG, Estiol

114
Q

Measurements/Procedures of 1st trimester risk assessment (4)

A

amniocenthesis
triple screen
chorionic villi sampling
NT measurement

115
Q

in what plane should NT measurement be taken

A

midsagittal with head in neutral position

116
Q

down syndrome phenotype

A

small nose and mid-face hypoplasia

117
Q

twin gestations have ______ times greater mortality rate

A

7-10

118
Q

increased risk for twin mortality when _______ (2)

A

they’re monozygotic and share membrane components

119
Q

early sign of twin to twin transfusion syndrome

A

difference in NT measurements

120
Q

which type of twin pregnancy is most common

A

dichorionic/diamniotic

dizygotic

121
Q

presentation of dichorionic and diamniotic pregnancy

4

A

two separate sacs
thick dividing membrane
fraternal
twin peak sign

122
Q

monochorionic diamniotic twins (MCDA) (4)

A

single gestational sac
2 amnions
2 yolk saks
2 embryos

123
Q

how does MCDA pregnancy occur

A

separation of single zygote in blastocyst phase

124
Q

Monochorionic Monoabnionic pregnancy presentation (5)

A 
1 sac
1 yolk sac
1 amniotic membrane
2 embryos
must deliver early to prevent entanglement
125
Q

when can cystic rhomboid fossa be seen sonographically

A

8-11 weeks

126
Q

when are cerebral hemispheres seen

A

9 weeks

127
Q

when is choroid plexus seen

A

9 weeks

128
Q

goal of sonography is 1st trimester (6)

A
  1. visualization of gestational sac (IUP or ectopic)
  2. embryonic demise or living
  3. high risk monitoring
  4. number of embryos, chorionicity and amnionicity
  5. gestational dating
  6. diagnosis of fetal anomalies
129
Q

what percentage of pregnancies are miscarried?

A

15%

130
Q

most common presentation for pregnancy complications

A

vaginal bleeding

131
Q

when pregnant lady has vaginal bleeding, what should you investigate (4)

A

embryo, heart beat, yolk sac, RPOC

132
Q

another name for placenta

A

frondosum

133
Q

what does detachment of placenta result in

A

hematoma and vaginal bleeding

134
Q

hemorrhage contiguous with placental edge is most likely ______

A

placental hematoma

135
Q

placental hematoma can be caused by

A

trauma or MVA

136
Q

why do placental hematomas “not” cause bleeding

A

because they’re within the chorion and no communication with endo

137
Q

most common cause of 1st trimester bleeding

A

subchorionic hemorrhage

138
Q

hemorrhage found between myometrium and gestational sac

A

subchorionic

139
Q

hemorrhage between placenta and uterus

A

subchorionic

140
Q

lucency posterior to placenta is most likely from

A

abruptio placentae

141
Q

T or F:

subchorionic hemorrhage is avascular

A

true

142
Q

where is the bleed seen in subchorionic hemorrhage

A

adjacent to gestational sac

143
Q

characteristics of absent intrauterine sac (3)

A

empty uterus
absence of adnexal masses or free fluid
positive hCG levels

144
Q

how fast doe the embryo grow during 1st tri

A

1mm/day

145
Q

differentials for abnormally thick endo (4)

A

intrauterine blood
RPOC
decidual reaction with ectopic
decidual changes from early pregnancy

146
Q

incomplete abortion sono findings (2)

A

intact sac with nonviable embryo

collapsed or misshapen sac

147
Q

sono signs of RPOC (4)

A

endo >8mm
increased vascularization of endo
color Doppler strongly positive
obvious fetal parts

148
Q

what can RPOC be mistaken for

A

blood clots

149
Q

conditions associated with empty gestational sac (3)

A

normal IUP

150
Q

gest sac is seen TA ad TV when MSD is _____ and GA is _______

A

5mm

4-5 weeks

151
Q

GA growth rate

A

1mm/day

152
Q

GA at which SAB can be made

A

6.4 weeks

153
Q

hCG in anembryonic pregnancy

A

rise but not at a rapid rate

154
Q

appearance of anembryonic pregnancy

A

large

empty gest sac

155
Q

MSD growth rate ____

abnormal if ____

A

1.13mm/day

156
Q

trophoblastic reaction in ABNORMAL IUP (4)

A

irregular
absent DDSS
trophoblastic reaction

157
Q

clinical hallmark of gestational trophoblastic disease (5)

A
  1. vaginal bleeding in 1st and early 2nd trimester

elevated hCG (>100k)

hyperemesis gravidarum (N/V, weight loss, dehydration)
preeclampsia (HTN and proteinuria)
AFP low

158
Q

US presentation of a mole (10)

A 
distorted sac
thin, weakly echogenic or irregular choriodecidual reation
absence of DDSS
MSD >10mm
snowstorm
cluster of grapes
bilateral adnexal fullness
theca lutein cysts
uterus larger than date

echogenic soft tissue with cystic spaces representing hydropic chorionic villi

159
Q

molar pregnancy may simulate (4)

A

missed abortion
incomplete abortion
blighted ovum
hydropic degeneration of placenta

160
Q

malignant forms of trophoblastic disease (2)

A

invasive mole

choriocarcinoma

161
Q

where does choriocarcinoma metastasize to? (3)

A

liver, lungs, brain

162
Q

vaginal bleeding, dyspnea, abdominal pain and neurologic symptoms are consistent with

A

choriocarcinoma

163
Q

when is heart tube formed

A

3.5-5weeks

164
Q

when do yolk sac and gestational sac diverge

A

after 7 weeks

165
Q

embryonic heart rates of _____ are abnormal

A

170

166
Q

heart rate of >170bpm may lead to (2)

A

heart failure and hydrops

167
Q

expected YS growth

A

.3mm/day

168
Q

side by side appearance of amnion and yolk sac is seen between ____ and ____ week and is known as ______

A

5-7the week

double bleb sign

169
Q

mean amniotic sac diameter should be __________

A

equal to CRL

170
Q

risk factors of ectopic (5)

A 
PID
IUD
fallopian tube surgeries
infertility treatment
history of ectopic pregnancies
171
Q

clinical findings in ectopic (4)

A

vaginal bleeding
empty uterus
adnexal mass
positive pregnancy test

172
Q

sites of ectopic pregnancy (6)

A 
fallopian tube
ovary
broad ligament
peritoneum
cervix
cornua
173
Q

which ectopic location is the most dangeour

A

interstitial fallopian tube near cornu

174
Q

how many percent of patients with ectopic pregnancy have pseudogestational sac

A

20

175
Q

what is the difference between pseudogestational sac and normal gestational sac

A

pseudo - no embryo or YS
centrally located
gestational sac - all pregnancy parts and ESSENTRICALLY placed

176
Q

how many live ectopic pregnancies are identified on TA

A

10%

177
Q

most frequent finding with ectopic pregnancy

most specific finding in ectopic pregnancy

A

extrauterine sag

live embryo

178
Q

presentation of extrauterine gestational sac

A

thickened echogenic ring (representing trophoblastic tissue or chorionic villi)
separate from ovary

179
Q

doppler RI in ectopic pregnancy

A
180
Q

complex adnexal mass differential for ectopic

A

peritoneal hematoma

hematosalpinx

181
Q

when you see fluid in the cul-de-sac, where else should you look and why

A

gutters, RUQ and LUQ

to see extent/volume

182
Q

why is interstitial/cornual pregnancy most life threatening

A

b/c of parauterine and myometrial vasculature causing life-threatening hemorrhage

183
Q

ectopic pregnancy with increased risk of hysterectomy

A

cervical

184
Q

nuchal translucency definition

A

max thickness of subcutaneous lucency at back of neck between 11 and 14 weeks GA

185
Q

what does thickened NT hint

A

genetic syndromes

186
Q

age and size requirements for NT measurements

A

11 weeks to 13 weeks 6 days

45mm to 84mm

187
Q

first trimester evaluation can be done for what anomalies? (5)

A 
NT
presence/absence of nasal bone
tricuspid regurg
abnormal flow in ductus venosus
abnormalities of hind brain
188
Q

when are 4 chamber heart and great vessels seen

A

12 weeks

189
Q

markers for cardiac defects (5)

A

increased NT
tricuspid regurg
reversal/absence of flow in ductus venosus
ectopia cordis and limb body wall complex

190
Q

when is embryonic head identified

A

7 weeks

191
Q

dominant structure seen in cranium at 1st trimester

A

choroid plexus

192
Q

acrania

A

partial or complete absence of cranium

193
Q

what is acrania predecessor for

A

anencephaly

194
Q

sign associated with acrania

A

mickey mouse head

195
Q

anencephaly

A

absence of brain and cranial vault
cerebral hemispheres are missing or small
base of skull may be preserved

196
Q

cephalocele

A

midline cranial defect with herniation of brain and meninges

197
Q

iniencephaly

A

defect occiput involving foramen magnum

retroflexion of spine (occipital cranium directed toward lumbar spine)

open spinal defect

198
Q

ventriculomegaly

A

dilation of ventricular system without cranial enlargement

199
Q

when does ventriculomegaly occur

A

after 11 weeks

200
Q

how does ventriculomegaly appear

A

enlarged ventricles

compression and thinning of chorioid plexus “dangling” in lateral ventricle

201
Q

holoprosencephaly

A

complete to partial failure of cleavage of prosencephalon with facial dysmorphism

prosencephalon does not differentiate into cerebral hemispheres and lateral ventricles

202
Q

what are three types of holoprosencephaly

A

alobar
semilobar
lobar

203
Q

which type of holoprosencephaly is the worst and how does it present (6)

A

alobar

single ventricle, small cerebrum, fused thalami, agenesis of corpus callosum and falx cerebri

204
Q

dandy-walker malformation

A

dilation of 4th ventricle

dysgenesis or agenesis or cerebellar vermis

205
Q

when does dandy-walker occur

A

6-7 weeks GA

206
Q

US presentation of dandy walker (3)

A

posterior fossa cyst continuous with 4th ventricle
absent cerebellum
dilated 3rd and lateral ventricles

207
Q

Spina bifida

A

failure of neural tube to close after 6 weeks

208
Q

appearance of spina bifida

A

spinal irregularities or bulging within posterior contour

extrusion of mass from vertebral column

209
Q

clinical signs of spina bifida (2)

A 
lemon sign (scalloping of frontal bones)
banana sign (curved appearance of cerebellum)
210
Q

normal abdominal herniation measurements

A

6-9mm at week 8

5-6mm at week 9

211
Q

at what measurement should gut herniation be considered abnormal

A

> 6mm

212
Q

when is urinary bladder normally seen

A

10-12 weeks

213
Q

what causes large urinary bladder

A

obstructive uropathy (especially at the level of urethra)

214
Q

one of the most common abnormalities seen on US in 1st tri

A

cystic hygroma

215
Q

what is cystic hydroma associated with

A

trisomies (turner’s)

216
Q

where is cystic hygroma visualized

A

posterior next and upper thorax

217
Q

what measurement of neck thickening is abnormal

A

> 3mm

218
Q

differential considerations for umbilical cord cysts (6)

A 
amniotic inclusion cysts
omphalomesenteric duct cyst
allantoic cysts
vascular anomalies
neoplasms
wharton's jelly abnormalities
219
Q

most common ovarian mass in 1st tri

A

corpus luteum cyst

220
Q

typical measurement for corpus luteum cyst

A
221
Q

color flow of corpus luteum

A

ring of increased vascularity
low resistance
high diastolic

222
Q

when should a corpus luteum cyst regress by

A

16-18 weeks

223
Q

what can corpus luteum cyst mimmic (4)

A

hematosalpinx
ectopic pregnancy
ovarian neoplasm
hematomas

DUTEC 120 (3 decks)

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