OB/GYN

Question 1

Which of the following would not be least likely associated with microcephaly?
a) Edwards syndrome
b) Beckwith-Wiedemann syndrome
c) TORCH infections
d) Fetal alcohol syndrome

Answer 1

b) Beckwith-Wiedemann syndrome
Explanation: Beckwith-Wiedemann syndrome is a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver.

Question 2

Within the fetal heart, one should recognize which structure is located between the right ventricle and right atrium?
a) Bicuspid valve
b) Foramen ovale
c) Tricuspid valve
d) Ductus venosus

Answer 2

c) Tricuspid valve
Explanation: Between the right ventricle and right atrium, one should visualize the tricuspid valve, and between the left ventricle and left atrium, the mitral valve (bicuspid valve) should be noted.

Question 3

Which of the following would be least likely associated with dilation of the fallopian tube? a) Endometrial polyp
b) Endometriosis
c) Pelvic inflammatory disease (PID)
d) Hydrosalpinx

Answer 3

a) Endometrial polyp
Explanation: An endometrial polyp, found within the uterine cavity, would be the least likely among this list to lead to obstruction of the fallopian tube with subsequent dilation.

Question 4

What is the sonographic “string of pearls” sign indicative of?
a) PID
b) Polycystic ovary disease
c) Hirsutism
d) Cystic teratoma

Answer 4

b) Polycystic ovary disease
Explanation: With polycystic ovary disease, sonographically, the ovaries are often enlarged and contain multiple, small follicles along the periphery or throughout the ovary, with prominent echogenic stromal elements. The sonographic “string of pearls” sign or “necklace” denotes the presence of 10 or more small cysts measuring 2 to 18 mm along the periphery of the ovary.

Question 5

MCDK is thought to be caused by:
a) Venereal diseases
b) Gestational diabetes
c) Early urinary obstruction
d) Intrauterine infections

Answer 5

c) Early urinary obstruction
Explanation: MCDK is thought to be caused by an early, first-trimester obstruction of the ureter.

Question 6

Upon ultrasound interrogation of the gravid uterus, you discover a fetal cranium obviously filled with anechoic fluid. You suspect hydranencephaly verse severe hydrocephalus. Which of the following would not be sonographic features of hydranencephaly?
a) Presence of the basal ganglia
b) Absence of the falx cerebri
c) Presence of the brainstem
d) Presence of a thin rim of cerebral cortex

Answer 6

d) Presence of a thin rim of cerebral cortex
Explanation: With hydranencephaly, there is typically no identifiable cerebral cortex. The falx cerebri may be partially or completely absent, while the brainstem and basal ganglia are maintained and surrounded by cerebrospinal fluid.

Question 7

A 55-year-old patient, with a history of gastric carcinoma, presents to the ultrasound department for a pelvic sonogram. She states that her gynecologist felt something in her pelvis during her physical examination. Sonographically, you visualize a solid, hypoechoic mass on the left ovary. This mass most likely represents a:
a) Cystic teratoma
b) Serous cystadenoma
c) Androblastoma
d) Krukenberg tumor

Answer 7

d) Krukenberg tumor
Explanation: A Krukenberg tumor is a malignant ovarian tumor that metastasized from the gastrointestinal tract, most frequently the stomach.

Question 8

Which of the following is considered to be the most common female malignancy in women younger than age 50?
a) Endometrial carcinoma
b) Cervical carcinoma
c) Ovarian carcinoma
d) Lung cancer

Answer 8

b) Cervical carcinoma
Explanation: Cervical carcinoma is the most common female malignancy in women younger than age 50.

Question 9

The sonographic analysis of a 22-year-old female pelvis reveals that the uterine body tilts forward and comes in contact with the cervix. This uterine position is referred to as:
a) Anteversion
b) Anteflexion
c) Retroflexion
d) Retroversion

Answer 9

b) Anteflexion
Explanation: Anteflexion is the uterine position in which the uterine body tilts forward and comes in contact with the cervix, forming an acute angle between body and cervix.

Question 10

The condition in which the foot is inverted and rotated medially is referred to as:
a) Talipes equinovarus
b) Rhizomelia
c) Rockerbottom foot
d) Mesomelia

Answer 10

a) Talipes equinovarus
Explanation: Clubfoot, also referred to as talipes or talipes equinovarus, is a malformation of the bones of the foot. The foot is most often inverted and rotated medially.

Question 11

All of the following are true concerning physiologic bowel herniation except:
a) It consistently results in an omphalocele.
b) It typically resolves by 12 weeks.
c) It is migration of the midgut into the base of the umbilical cord.
d) It begins around 8 weeks.

Answer 11

a) It consistently results in an omphalocele.
Explanation: Physiologic bowel herniation is a phenomenon that is developmentally normal. The sonographer should determine the gestational age based on crown rump length and understand that physiologic herniation is normal during this early stage of maturity. Conversely, if physiologic bowel herniation does not resolved by 12 weeks, a follow-up examination is often warranted.

Question 12

What is an expected future complication of the fetus that suffers from ADPKD?
a) It will most likely develop a cloacal anomaly.
b) It will most likely die soon after birth secondary to pulmonary hypoplasia.
c) It will most likely develop renal cysts late in adult life.
d) It will most likely die from congestive heart failure.

Answer 12

c) It will most likely develop renal cysts late in adult life. Explanation: The cysts associated with ADPKD do not typically manifest until approximately the fifth decade of life. The individual may die from end-stage renal failure. Adult renal cystic disease is also associated with the development of cysts within the liver, pancreas, and spleen.

Question 13

If a young lady does not experience menarche before age 16, she is said to have:
a) Pseudoprecocious puberty
b) Primary amenorrhea
c) Precocious puberty
d) Secondary amenorrhea

Answer 13

b) Primary amenorrhea
Explanation: If an individual does not experience menarche before age 16, she is said to have primary amenorrhea. Primary amenorrhea may be caused by congenital abnormalities or congenital obstructions, such as an imperforate hymen.

Question 14

Which of the following is a vitamin that has been shown to significantly reduce the likelihood of neural tube defect?
a) RhoGAM
b) Riboflavin
c) Folate
d) Vitamin C

Answer 14

c) Folate
Explanation: Studies have shown that a supplement of 4 mg of folate (folic acid) in a woman’s diet significantly reduces the likelihood of her fetus developing spina bifida and other neural tube defects.

Question 15

A two-day old female newborn presents to the sonography department with a history of a palpable pelvic mass. Sonographically, the uterus and vagina appear enlarged and both contain simple appearing fluid. This finding is termed:
a) Hydrometrocolpos
b) Asherman syndrome
c) Meigs syndrome
d) Hydrocolpos

Answer 15

a) Hydrometrocolpos
Explanation: Clinically, neonatal patients with vaginal obstructions present with a palpable pelvic or abdominal mass as a result of an excessive buildup of vaginal secretions in utero.

Question 16

The use of an intrauterine device has been linked with an increased risk for all of the following except:
a) PID
b) Endometriosis
c) Spontaneous abortions
d) Ectopic pregnancy

Answer 16

b) Endometriosis
Explanation: The use of an intrauterine device has been linked with PID, ectopic pregnancy, and spontaneous abortions.

Question 17

Which of the following sonographic findings would be the most reliable indicator of a probable poor outcome during the first trimester?
a) Lack of fetal movement
b) Visualization of the amniotic membrane
c) Embryonic bradycardia
d) Subchorionic hemorrhage

Answer 17

c) Embryonic bradycardia
Explanation: Bradycardia is associated with a poor prognosis and is often the first sonographic sign of an eminent embryonic demise.

Question 18

The fingerlike projections that extend from the infundibulum are the:
a) Cilia
b) Fimbria
c) Plicae
d) Infundibili

Answer 18

b) Fimbria
Explanation: The distal portion of the tube is termed the infundibulum, which provides an opening to the peritoneal cavity within the pelvis. The fingerlike projections that extend from the infundibulum are the fimbria. The primary role of the fimbria is to draw the unfertilized egg into the tube.

Question 19

Which of the following would be most likely associated with Trisomy 18?
a) Patau syndrome
b) Heterozygous achondrogenesis
c) Rockerbottom feet
d) Achondroplasia

Answer 19

c) Rockerbottom feet
Explanation: Trisomy 18, or Edwards syndrome, is associated with limb anomalies such as rockerbottom feet.

Question 20

The sonographic investigation of an 18-week fetus reveals malposition of the heart and an anechoic mass noted adjacent to the fetal heart in the four-chamber heart view. Which of the following is the most likely diagnosis?
a) Pulmonary hypoplasia
b) Pleural effusion
c) Ectopic cordis
d) Diaphragmatic hernia

Answer 20

d) Diaphragmatic hernia
Explanation: The sonographic findings of a diaphragmatic hernia include malposition of the heart as a result of the stomach or other abdominal organs being located within the chest.

Question 21

Mothers with pregestational diabetes, as opposed to gestational diabetes, have an increased risk of a fetus with:
a) DES
b) Proteinuria
c) Neural tube defects
d) TORCH

Answer 21

c) Neural tube defects
Explanation: Mothers with pregestational diabetes are more likely to have a fetus with a neural tube defect. The congenital anomalies most often encountered with pregestational diabetes include cardiac defects, neural tube defects, caudal regression syndrome, sirenomelia, and renal anomalies.

Question 22

Which of following statements is true concerning the umbilical arteries?
a) They enter the umbilicus and proceed cephalad to connect to the paired hepatic arteries. b) They bring oxygenated blood from the placenta to the fetus.
c) They bring oxygenated blood to the fetus from the placenta.
d) They return deoxygenated blood from the fetus back to the placenta.

Answer 22

d) They return deoxygenated blood from the fetus back to the placenta.
Explanation: The paired umbilical arteries return the deoxygenated blood from the fetus back to the placenta.

Question 23

Monthly symptoms of menstruation without bleeding describes:
a) Mittelschmerz
b) Cryptomenorrhea
c) Metrorrhagia
d) Menometrorrhagia

Answer 23

b) Cryptomenorrhea
Explanation: Cryptomenorrhea is defined as monthly symptoms of menstruation without bleeding.

Question 24

Which of the following pelvic muscles would be noted within the anterior body wall?
a) Levator ani muscle
b) Rectus abdominis muscle
c) Psoas major muscle
d) Piriformis muscle

Answer 24

b) Rectus abdominis muscle
Explanation: The rectus abdominis muscle extend from the xyphoid process of the sternum to the pelvis in the midline.

Question 25

Which of the following is considered to be the most common chromosomal abnormality? a) Trisomy 13 b) Trisomy 18 c) Turner syndrome d) Trisomy 21

Answer 25

d) Trisomy 21 Explanation: Down syndrome, or trisomy 21, is the most common chromosomal abnormality. It occurs in 1 in 500-800 pregnancies.

Question 26

Because of their sonographic appearance, which of the following masses would be most likely misdiagnosed as a pedunculated uterine leiomyoma? a) Brenner tumor b) Serous cystadenoma c) Paraovarian cyst d) Cystic teratoma

Answer 26

a) Brenner tumor Explanation: The sonographic appearance of a Brenner tumor is that of a solid, hypoechoic mass. This appearance can mimic that of a pedunculated uterine leiomyoma or fibroid. Other ovarian tumors, like the fibroma and thecoma, may also mimic the sonographic appearance of a fibroid.

Question 27

Which of the following statements is true concerning the normal prepubertal uterus? a) The uterus has a pear shape, as seen in the adult. b) The cervix is larger than the uterine fundus. c) The cervix and uterus are the same size and echogenicity. d) The uterus decreases in size before puberty.

Answer 27

b) The cervix is larger than the uterine fundus. Explanation: The normal prepubertal uterus has a cervix to uterus ratio of 2:1.

Question 28

Days 1 through 5 of the menstrual cycle correlate with: a) Ovulation b) Secretory phase of the endometrial cycle c) Luteal phase of the ovarian cycle d) Menses

Answer 28

d) Menses Explanation: Days 1 through 5 of the menstrual cycle correlate with menses, at which time the endometrium is shed.

Question 29

Which of the following would be described as the coverings of the brain and spinal cord? a) Meninges b) Ependymas c) Deciduas d) Aperatures

Answer 29

a) Meninges Explanation: The meninges are the coverings of the brain and spinal cord. They include the dura mater, arachnoid membrane, and pia mater.

Question 30

A 26-year-old patient presents with a history of PID. She complains of right upper quadrant tenderness. What is this finding most indicative of? a) Fitz-Hugh-Curtis syndrome b) Stein-Leventhal syndrome c) Asherman syndrome d) Perihepatic incongruity syndrome

Answer 30

a) Fitz-Hugh-Curtis syndrome Explanation: Patients suffering from salpingitis may present clinically with symptoms resembling cholecystitis. Pelvic infections, such as chlamydia or gonorrhea, can actually lead to a perihepatic infection and the subsequent development of adhesions located between the liver and diaphragm. As a result, the liver capsule can become inflamed, thus leading to a clinical presentation much like gallbladder disease. This event is called Fitz-Hugh-Curtis syndrome. Free fluid may be noted within the hepatorenal space (Morrison pouch) with this condition.

Question 31

Which of the following results from the calcification of the papillary muscle or chordae tendineae? a) Pampiniform calcification b) Rhabdomyoma c) Echogenic intracardiac focus d) CAM

Answer 31

c) Echogenic intracardiac focus Explanation: An echogenic intracardiac focus (EIF) is most often seen within the left ventricle of the heart. This is thought to represent the calcification of the papillary muscle or chordae tendineae.

Question 32

The sensitivity of the associated cranial findings at detecting spina bifida is said to be: a) Less than 5% b) Approximately 77% c) Approximately 25% d) More than 99%

Answer 32

d) More than 99% Explanation: Arnold-Chiari Il malformation, the cranial sonographic findings associated with spina bifida, have a sensitivity at detecting spina bifida that is said to be greater than 99%.

Question 33

Which of the following would not be a clinical finding in a 13-year-old who is suffering from hematometrocolpos? a) Enlarged uterus b) Abdominal pain c) Urinary retention d) Menorrhagia

Answer 33

d) Menorrhagia Explanation: Menorrhagia is described as abnormally heavy and prolonged menstruation. This young lady is probably suffering from an imperforate hymen, in which case, she would be suffering from amenorrhea (no menstrual bleeding).

Question 34

Which of the following would be a cause for hematometrocolpos in a teenage girl? a) Uterine fibroid b) Imperforate hymen c) Adenomyosis d) Vaginal atrophy

Answer 34

b) Imperforate hymen Explanation: Teenage girls may have hematometrocolpos, a condition when both the uterine cavity and vagina are filled with blood. This obstruction is frequently associated with the presence of an imperforate hymen. Clinically, these young girls present with amenorrhea, cyclic abdominal pain, an abdominal mass, enlarged uterus, and possibly urinary retention.

Question 35

Progesterone is produced by the: a) Corpus albicans b) Theca destruens c) Corpus luteum d) Trophoblastic cells

Answer 35

c) Corpus luteum Explanation: During the second half of the menstrual cycle, following ovulation, progesterone is produced by the corpus luteum of the ovary.

Question 36

All of the following are causes of nonimmune hydrops except: a) Diaphragmatic hernia b) Rh isoimmunization c) CAM d) Turner syndrome

Answer 36

b) Rh isoimmunization Explanation: Rh isoimmunization is associated with immune hydrops.

Question 37

Which of the following cranial abnormalities would be most likely associated with an elevation in maternal serum alpha-fetoprotein? a) Lissencephaly b) Holoprosencephaly c) Arnold-Chiari Il malformation d) Dandy-Walker malformation

Answer 37

c) Arnold-Chiari Il malformation Explanation: Arnold-Chiari II or Chiari II malformation is a group of cranial abnormalities associated with the neural tube defect spina bifida. Spina bifida may result in a mass that protrudes from the spine, thus allowing excessive amount of alpha-fetoprotein to exit the fetus and enter the maternal circulation.

Question 38

Dyspareunia denotes: a) Pain during menstruation b) Pain midway between periods at the time of ovulation c) Painful intercourse d) Painful micturition

Answer 38

c) Painful intercourse Explanation: Dysparuenia is defined as painful intercourse.

Question 39

A 42-year-old patient presents to the sonography department with a history of a myomectomy and uterine artery embolization. These two procedures are used to treat: a) Endometrial carcinoma b) Dyspareunia c) Adenomyosis d) Leiomyoma

Answer 39

d) Leiomyoma Explanation: Myomectomy is the surgical removal of a fibroid and may be performed abdominally or laparoscopically. Another alternative treatment for fibroids involves uterine artery embolization, which is used to inhibit blood supply to the mass.

Question 40

The ovarian cycle consists of the: a) Follicular phase and secretory phase b) Luteal phase and menstrual phase c) Proliferative phase and secretory phase d) Follicular phase and luteal phase

Answer 40

d) Follicular phase and luteal phase Explanation: The ovarian cycle consists of two phases: the follicular phase and the luteal phase.

Question 41

Why is determining the level of spina bifida so imperative when the defect is sonographically recognized? a) It determines if hydrocephalus will occur. b) It helps predict the chance of limited leg motion. c) It helps predict renal function. d) It helps predict bowel function.

Answer 41

b) It helps predict the chance of limited leg motion. Explanation: The higher the level of the spinal defect, the more likely the fetus will suffer from limited leg motion at birth.

Question 42

A patient presents to the ultrasound department with a positive pregnancy test and left lower quadrant pain. Sonographically, a single live intrauterine pregnancy is identified. The crown rump length yields a 6-week gestation. A structure is identified that appears to be connecting the developing embryo to the secondary yolk sac. What is this structure called? a) Gastroepipoic duct b) Omphalomesenteric duct c) Duct of Monro d) Duct of Santorini

Answer 42

b) Omphalomesenteric duct Explanation: The yolk sac is connected to the embryo by the vitelline duct, also referred to as the omphalomesenteric duct, which contains one artery and one vein. It is responsible for transporting vital nutrients to the developing embryo.

Question 43

. A bladder flap hematoma may result from: a) Cesarean section b) Fetal hydronephrosis c) Placental abruption d) Bladder trauma

Answer 43

a) Cesarean section Explanation: A bladder flap hematoma may result from a C-section. This mass can appear anechoic, although it most likely will appear as a complex mass greater than 2 cm. It will be located adjacent to the scar between the lower uterine segment and the posterior bladder wall.

Question 44

The proliferative phase of the endometrial cycle coincides with which phase of the ovarian cycle? a) Luteal b) Follicular c) Secretory d) Menstrual

Answer 44

b) Follicular Explanation: Following menses, the ovary is within the follicular phase while the endometrium is within the proliferative phase.

Question 45

Each fetal vertebra consists of: a) Two neural process and two central processes b) One centrum and two neural processes c) One neural process and two articular processes d) One centrum and three vertebral bodies

Answer 45

b) One centrum and two neural processes Explanation: Each fetal vertebra consists of three echogenic ossification centers: one centrum and two neural processes.

Question 46

The endocrinologic ovarian disorder linked with infertility and chronic anovulation is: a) Ovarian hyperstimulation syndrome b) Endometriosis c) Ovarian torsion d) Polycystic ovary disease

Answer 46

d) Polycystic ovary disease Explanation: Polycystic ovarian disease is an endocrinologic ovarian disorder linked with infertility. Patients suffer from chronic anovulation as a result of hormonal imbalances.

Question 47

Which hormone is responsible for the creation of multiple follicles on the ovary during the first half of the menstrual cycle? a) Follicle-stimulating hormone b) Luteinizing hormone c) Estrogen d) Progesterone

Answer 47

a) Follicle-stimulating hormone Explanation: The ovaries are stimulated by follicle-stimulating hormone (FSH), released by the anterior pituitary gland, to develop multiple follicles during the first half of the menstrual cycle (follicular phase).

Question 48

Which of the following would not be associated with endometrial thickening during menopause? a) Endometrial hyperplasia b) Atrophy of the endometrium c) Endometrial polyps d) Endometrial carcinoma

Answer 48

b) Atrophy of the endometrium Explanation: The typical sonographic appearance of endometrial atrophy is that of a thin endometrium.

Question 49

Which of the following would be most likely associated with sirenomelia? a) Large sacrococcygeal teratoma b) Polyhydramnios c) Bilateral renal agenesis d) Radial ray defect

Answer 49

c) Bilateral renal agenesis Explanation: Sirenomelia is also referred to as mermaid syndrome because of the fusion of the lower extremities that occurs with this disorder. Since bilateral renal agenesis often accompanies this condition, it is almost always lethal.