Ch. 50 Abnormal 1st Trimester Pregnancy

Question 1

The dominant structure seen in the embryonic cranium during the 1st trimester is the

Answer 1

choroid plexus

Question 2

_____ is a congenital malformation of the brain and face caused by failure of the telecephalon to completely develop

Answer 2

holoprosencephaly

Question 3

Ossification of the cranium is completed in the 1st trimester

Answer 3

false

Question 4

If an embryonic cranial abnormality is suspected in the 1st trimester

Answer 4

the fetus is rescanned after 14 weeks

Question 5

An echogenic mass in the base of the umbilical cord joining the embryonic abdomen at 10 weeks may be

Answer 5

Normal herniation of the gut outside the abdominal wall or omphalocele

Question 6

Omphaloceles containing only bowel are easily diagnosed in the 1st trimester

Answer 6

false

Question 7

Omphaloceles are associated with chromosomal anomalies

Answer 7

true

Question 8

______ is one of the most common congenital defects seen in the 1st trimester

Answer 8

cystic hygroma

Question 9

Can hydrocephalus be diagnosed in the 1st trimester of pregnancy

Answer 9

no, 14 weeks

Question 10

Cystic hygroma is caused by abnormal development of the

Answer 10

lymphatic system

Question 11

Cystic hygroma is associated with ______, especially when diagnosed in the 1st trimester

Answer 11

chromosomal abnormalities

Question 12

_______ is the most common chromosomal abnormality that occurs in fetuses who are diagnosed with cystic hygroma in the 2nd or 3rd trimesters

Answer 12

turners syndrome

Question 13

A cystic structure arising from the posterior fetal neck and upper thorax seen in the 1st trimester is most likely a

Answer 13

cystic hygroma

Question 14

A nuchal translucency measurement of more than _____mm is always abnormal

Answer 14

2.5mm

Question 15

The upper limit of normal for nuchal translucency _____ with increasing gestational age up to 14 weeks

Answer 15

increases

Question 16

Nuchal translucency measurements should be performed with _____ imaging

Answer 16

TA or TV

Question 17

The magnification of the image is not important when measuring nuchal translucency

Answer 17

false

Question 18

_____ of fetuses with trisomy 21 will have abnormal nuchal translucency

Answer 18

70%

Question 19

______ are associated with increased nuchal translucency, even if the karotype is normal

Answer 19

cardiac defects

Question 20

Increased nuchal translucency is associated with which of the following

Answer 20

trisomy 13,18,21 and triploidy

Question 21

______ is a gel like substance that surrounds and cushions the vessels of the umbilical cord

Answer 21

whartons jelly

Question 22

If an umbilical cord cyst is seen in the late 2nd trimester, genetic analysis may be indicated

Answer 22

true

Question 23

A common cause of 1st trimester vaginal bleeding is

Answer 23

ectopic pregnancy and retroplacental hematoma

Question 24

_____ is caused by a separation of part of the placenta from the uterine wall

Answer 24

retroplacental hematoma

Question 25

The larger the retroplacental hematoma is, the less likely it is that the pregnancy will be lost

Answer 25

false

Question 26

The _____ is the most common ovarian mass seen in the 1st trimester of pregnancy

Answer 26

corpus luteum cyst

Question 27

Corpus luteum cysts are usually not seen after _____ weeks

Answer 27

18

Question 28

Ovarian cysts that persists into the 2nd or 3rd trimesters are at higher risk for

Answer 28

torsion

Question 29

Why is it important to document the location of the placenta in relation to uterine fibroids

Answer 29

because they reduce the source of blood supply for the placenta if they are located beneath it

Question 30

Fibroids frequently grow during pregnancy due to

Answer 30

estrogen stimulation

Question 31

_____ may be mistaken for a fibroid

Answer 31

focal uterine contractions

Question 32

One of the most important diagnoses made by sonography is

Answer 32

ectopic pregnancy

Question 33

Why has the incidence of ectopic pregnancy increased in recent years

Answer 33

increase risk with PID, IUD, infertile patients and endometriosis

Question 34

The most common symptom of ectopic pregnancy is

Answer 34

acute pelvic pain

Question 35

The bleeding associated with ectopic pregnancy is caused by

Answer 35

invasion of the fallopian tube by trophoblastic tissue

Question 36

Sonographically, the absolute positive diagnosis of ectopic pregnancy is made by

Answer 36

identification of a gestational sac outside the uterus

Question 37

The most common site of ectopic pregnancy is

Answer 37

fallopian tube

Question 38

Why is it important for the sonographer to know which preparation or standard is used by the lab for quantitative HCG levels

Answer 38

because IRP numbers are twice 2IS at the same time of pregnancy

Question 39

A fluid collection often seen in the uterine cavity in cases of ectopic pregnancy is called a

Answer 39

pseudogestational sac

Question 40

How does the sonographer distinguish pseudogestational sac from intrauterine pregnancy

Answer 40

no fetal pole or yolk sac, filled with low level echoes, no trophblastic flow

Question 41

Doppler flow around a gestational sac is

Answer 41

low resistance and high velocity

Question 42

Flow pattern with low resistance and high velocity is referred to as

Answer 42

trophoblastic flow

Question 43

Mandy came to the emergency room complaining of severe pelvic pain. Bloodwork revealed a positive pregnancy test. Transvaginal sonography demonstrated an empty uterus, a right adnexal mass, and free fluid in the pelvis with a sand-like texture. No definite gestational sac was seen. What is most likely the diagnosis? What does the right adnexal mass represent? Why does the free fluid have echoes?

Answer 43

ectopic pregnancy, hematoma from ruptured tube, blood

Question 44

Which imaging method is used when imaging ectopic pregnancy

Answer 44

TA and TV

Question 45

Define heterotopic pregnancy

Answer 45

coexisting and intrauterine pregnancies

Question 46

`What treatments increase the risk of heterotopic pregnancy

Answer 46

in patients undergoing ovulation induction of IVF

Question 47

______ is the most dangerous type of ectopic pregnancy

Answer 47

cornual and interstitual

Question 48

Why is interstitial ectopic pregnancy so dangerous

Answer 48

tremendous blood supply and potential for hemorrhage upon rupture

Question 49

Define cervical pregnancy

Answer 49

gestational sac implants in cervix

Question 50

If the fetal heart rate in the 1st trimester is less than 90 bpm, the prognosis is poor

Answer 50

true

Question 51

If the MSD is _____ less than the CRL, oligohydramnios may be suspected

Answer 51

4mm

Question 52

Embryos with 1st trimester oligohydramnios always die

Answer 52

true

Question 53

Diagnosis of _____ requires serial sonograms

Answer 53

embryonic growth retardation

Question 54

Describe the sonographic appearance of complete abortion

Answer 54

reveals empty uterus with normal endo with no adnexal mass or free fluid

Question 55

Describe the sonographic appearance of incomplete abortion

Answer 55

thickened or irregular endometrial echos, may see fluid in endo, no heart tones

Question 56

What is another term for imcomplete abortion

Answer 56

missed abortion

Question 57

Define anembryonic pregnancy

Answer 57

blighted ovum, gest sac is present but no embryo develops

Question 58

Molar pregnancy is easily diagnosed in the 1st trimester

Answer 58

false

Question 59

The snowstorm or bunches of grapes appearance of molar pregnancy appears to be specific to the ____ trimester

Answer 59

2nd

Question 60

With molar pregnancy, HCG levels are ____ than expected

Answer 60

higher

Question 61

Why are serial HCG levels done after evacuation of a molar pregnancy

Answer 61

to ensure tropho tissue has been removed

Question 62

_____ refers to a group of tumors that arise from the chorionic villi of the placenta

Answer 62

gestational trophoblastic disease

Question 63

Abnormal proliferation of the trophoblast leads to

Answer 63

molar pregnancy

Question 64

_____ is the most common form of trophoblastic disease and is benign

Answer 64

hyatidiform mole

Question 65

Increased maternal age leads to a ____ risk for molar pregnancy

Answer 65

increased

Question 66

Previous history of molar pregnancy leads to a _____ risk for molar pregnancy

Answer 66

increased

Question 67

______ has only trophoblastic material and no fetal parts

Answer 67

complete molar pregnancy

Question 68

_____ occurs when a sperm fertilizes an ovum that contains no chromosomes

Answer 68

complete molar pregnancy

Question 69

______ are locally invasive but do not metastasize

Answer 69

invasive molar pregnancies

Question 70

______ is both locally invasive and will develop distant mets

Answer 70

choriocarcinoma

Question 71

What characteristics help the sonographer distinguish between hydropic degeneration of the placenta and molar pregnancy

Answer 71

HCG levels and presence of normal fetus