OB/GYN Flashcards
Implantation of the fertilized egg occurs day ______ of the pregnancy
20-23
_____ MSD should always demonstrate a fetal pole on TV U/S
> 16 mm
_____ MSD should always demonstrate a fetal pole with TA U/S
> 25 mm
With TV U/S, you should always see a gestational sac at _____ weeks
@ 4 weeks
With TV U/S, you should always see a yolk sac at ____ weeks
@ 5.5 weeks
With TV U/S, you should always see a heart at ____ weeks
@ 6 weeks
With TV US, a yolk sac should always be visualized in any gestational sac greater than _____ mm in size
8 mm
Using TA US, a yolk sac should always be identified in any gestational sac greater than ______ MSD
20 mm
If fertilization occurs, ______ will stop the regression of corpus luteum cyst so that it can produce progesterone to stimulate the decidual reaction
bhCG
The number of yolk sacs can be used to determine the ______ of a multifetal pregnancy
Amniocity
Regarding a twin pregnancy, if the zygote occurs BEFORE day 4 of gestation, this will result in ___/___ twins
Dichorionic/Diamniotic
If the division of zygote occurs between day 4 & 8 of gestation, this will result in ___/___ twins
Monochorionic/Diamniotic
If division of zygote occurs between day 8 & 13 of gestation, this will result in
___/___ twins
Monochromic/Monoamniotic
If the division of the zygote is not complete by day 13, this will result in ____ twins
Conjoined
Cardiac activity can first be identified in an embryo with a CRL of ____ @ 6 weeks gestation
5 mm
A yolk sac greater than _____ usually indicates a blighted ovum or fetal abnormalities of the fetal pole is detected
6 mm
______ & ______ produce progesterone
Corpus lute all cyst & placenta
The CSP is located ______ to the thalamus lobes
Anterior
Where is the 3rd ventricle located?
Between the 2 thalamus loves
________ refers to when the yolk sac persists into adulthood as a diverticulum in the ileum portion of bowel
Meckel’s Diverticulitis
Oxygenated blood flow path
- umbilical vein
- left portal vein (ductus venosus)
- IVC
- right atrium
The highest concentration of oxygenated blood in the heart is located in the _______
Right atrium
The fetal stomach should be routinely visualized by week _____
14
Up until 16 weeks, the ______ produce amniotic fluid until the baby takes over
Chorion, amnion & placenta
The vessels in the 3 vessels view
Pulmonary artery, aorta & SVC
Fetal heart chamber located most anterior
Right ventricle
How early can the fetal kidneys be identified?
12 weeks
The fetal bladder can be seen as early as ____?
10 weeks
Blood entering the fetus in the umbilical vein is divided between _______?
Ductus venosus & portal vein
The fetal umbilical arteries branch from the fetal ______
Internal iliac arteries
The normal corpus luteum cyst usually seems to regress by _________ & is often resolved by week 16
Week 14
_______ stimulates the cervix to produce mucous just prior to ovulation
Estrogen
The PROXIMAL femoral epiphyseal on US by week _______
35
The DISTAL femoral epiphyseal can be seen on US by week _____
33
At 26 weeks, the spinal cord tip can be seen at what level?
S1
Late in the 3rd trimester, the spinal cord tip can be seen at what level?
L3
The aqueduct of Sylvia’s connects the ?
3rd & 4th ventricles
What best describes the Doppler waveforms obtained from uterine artery of a gravid uterus ?
Low resistance, average velocity
I’m a normal pregnancy, the placenta should be equal to ?
Weeks of gestation + 10mm
Butt down with legs straight in front of abdomen
Frank breech
Butt down, legs folded, knees bent, ankles crossed
Complete breech
Feet down with baby feet on cervix
Footling breech
_____ refers to normal finding of sebum & epithelial cells that cause white free floating within amniotic fluid late in pregnancy
Vernix
Blood from the SVC & IVC enters the ?
Right atrium
The fetal kidneys begin producing fluid by week 12 & completely take over by week ____
16
Uterine wall layer composed of muscle & is involved in delivery
Myometrium
UT & CX displaced to the left
Levoposition
Cx is ML while uterine body is flexed to the left
Levoflexion
UT & CX displaced to the right
Dextroposition
CX is ML while uterine body is flexed to the right
Dextroflexion
AKA intramural part of Fallopian tube
MOST DANGEROUS SPOT FOR ECTOPIC!!!!
Interstitial
Widest & longest portion of tube.
Egg fertilization normally occurs
here. Most ectopics occurs here
Ampulla
Part of tube that contains fimbria
Trumpet shaped end opens up into pelvic peritoneal cavity
Infundibulum
Portion of the peritoneum connecting anterior ovary to posterior broad ligament
Broad ligament
Fibromuscular bands extending from interns to labia majora and helps maintain normal uterine position
Cardinal ligament
Free margin of broad ligament where Fallopian tubes travel
Mesosalpinx
Muscles of the greater pelvis
- rectus abdominus
- transverse abdominus
- psoas major
- iliopsoas
______ is responsible for stimulating contraction of Fallopian tubes to propel egg toward uterine cavity
Estrogen
The suspensory ligament & broad ligament are composed of _____
Peritoneum
The ovary is normally found in the fossa of _____
Waldeyer
________ can sometimes be mistaken for the ovaries
Normal piriformis & iliopsoas muscles
If fertilization does not occur after ovulation, the corpus luteum becomes ?
Corpus albicans
Which hormone causes the endometrium to thicken during the proliferative phase?
Estrogen
______ produce progesterone & bhCG in early pregnancy. These cells develop into chorionic villi of placenta
Trophoblastic cells
Rigid structure that firmly holds the uterus in position in the pelvic cavity
Broad ligament
A surge of _____ causes ovulation
Luteinizing hormone
_______ of the brain produce hormones that influence the ovaries
Pituitary gland & hypothalamus
Oral contraceptives suppress the production of _______ to prevent follicular maturation
FSH
Doppler waveforms from a normal ovary
Low resistance, low velocity
Which pelvis muscles form the lateral pelvic walls
Obturator internus
Average size of a nulliparous uterus
8 x 5 x 3 cm
Normal ovary measurement
3 x 2 x 1 cm with a volume of 6-13 cc
? Refers to a woman who has had 5 or more infants who achieved 24 weeks or more
Grand multiparity
Woman who are grand multiparity have an increased risk for ?
- placenta previa or accreta
- hemorrhage
- uterine rupture
- dysfunctional labor
______ muscles form the pelvis floor
Levator ani & coccygeus
Greater pelvis is AKA
False pelvis
Flat muscle extending laterally on both sides of vaginal cuff
Levator ani
Non-dominant follicles do no usually exceed ?
11 mm
Gonadatropin Releasing Hormone (GRH) is produced by the ?
Hypothalamus
A dominant follicle will usually reach a diameter of ______ just prior to ovulation
2.5 cm
? stimulates the endometrial proliferation in the secretory phase, after ovulation occurs.
Progesterone
Most commonly a unilateral finding of a hypoechoic mass in a postmenopausal woman.
It is benign & produces estrogen
Granulosa cell tumor
AKA theca cell tumor
Most common type of Müllerian duct anomaly
Separate uterus
U/S findings associated with ovarian hyperstimulation syndrome
- ascites
- pleural effusion
- bilateral ovarian enlargement (>5 cm)
Adhesions of the endometrial lining due to uterine trauma
Asherman syndrome
Commons symptoms associated with Asherman Syndrome
- amenorrhea
- hypomenorrhea
- recurrent miscarriage
- infertility
Rupture of a ________ can lead to bleeding from the uterine arteries that can be life threatening to the patient
Interstitial ectopic
another term used to describe the dermoid plug
Rokitansky nodule
Rokitansky nodule is often seen with what type of pelvic mass ?
Cystic teratoma
When the cephalon part of the neural tube fails to close, ___ occurs
Anencephaly
When the distal end of the neural tube fails to close, _____ occurs
Spina bifida
A blighted ovum is diagnosed when a mean GSD greater than ___ without a fetal pole is seen on TA & TV
- an enlarged yolk sac is commonly present
TV- 16 mm
TA- 25 mm
Pseudomyoxoma peritonei is a complication of which type of tumor?
Mucinous cystadenocarcinoma
Normal endometrial thickness in the secretory phase
9-18 mm
An ectopic pregnancy will almost always been on the ?
Same side as the corpus luteum
Benign unillcular cysts usually do no exceed _____
5 cm
An embryo is most sensitive to teratogenic effects when ?
Between 3 & 8 weeks gestation
Absence of menarchy after age 15
Primary amenorrhea
_______ often forms due to mets, most commit from GI tract primary
Krukenberg tumor
Dot-dash pattern refers to sonographic appearance of ?
Dermoid mesh
Premenopausal woman are more susceptible to ?
Mucinous cystadenoma
Postmenopausal women are susceptible to ?
Mucinous cystadenocarcinoma
_____ refers to air in the circulatory system of the fetal abdomen that occurs with fetal demise
Robert’s sign
Most common cause for postmenopausal bleeding
Endometrial atrophy
Most common NTD’s
Anencephaly & spina bifida
Most common GYN cancer
Endometrial carcinoma
Benign ovarian neoplasms that secrete estrogen
Thecomas & granulosa cell tumors
Most commonly occurring germ cell tumor of ovary
Benign cystic teratoma
Most common cause of pelvic congestion
Incompetent left ovarian vein
Bleeding more than 1 week, cramping, PROM, & cervical shortening are consistent with ?
Inevitable AB
Most common adnexal mass
Ovarian cyst
Metritis is often associated with ?
Leukocytosis
Flow in normal ovaries with a corpus luteum cyst will be low resistance with a RI value between ?
0.4 - 0.6
Most common in premenopausal females
- cystic teratoma
- serous cystadenoma
- mucinous cystadenoma
- sertili-leyding cell tumor
Most common in postmenopausal women
- granulosa cell tumor
(theca-lutein cell tumor) - thecoma
- fibroma
Cystic mass between the wall of the abdomen and the anterior wall of the bladder is called _____
Urachal cyst
Anasarca is commonly seen with ?
Fetal hydrops
Which trisomies exhibit the defects associated with Pentalogy of Cantrell ?
13 & 18
When evaluating a fetus with IUGR, the umbilical artery will demonstrate which type of flow pattern ?
Minimal to absent diastolic flow
Defects caused by neuralation during fetal development include ?
- spina bifida
- anencephaly
- encephaloceles
- myelomeningoceles
Most common fetal intracardiac mass seen
appears as an echogenic mass
Rhabdomyoma
Maternal abnormality that can be caused by a large fibroid uterus
Hydronephrosis
What is present is the heart & stomach are seen on the same transverse view ?
A diaphragmatic hernia
_____ is an austosomal recessive disorder that is most common in Amish communities
- mesomelia
- short ribs
- narrow thorax
- polydactyl
- ASD
Ellis van Crevald syndrome
A normal cerebellum vermis can be seen with ?
* not DWM
Megacisterna magna
Most common cause of hydrocephalus
Aqueductal stenosis
____ are facial anomalies caused by low fluid
Potter facies
Most severe form of TTTS
Acardia
AKA Edwards syndrome
Trisomy 18
Increase in peak systolic velocity of the middle cerebral artery of a fetal on serial exams often indicates ______
Fetal anemia
Most common characteristic of cleindocranial dysplasia is ?
Clavicular aplasia & hypoplasia
In patients with agenesis of the corpus callosum, the lateral central horns are displaced ______ & have a _______ appearance
Displaced laterally with a teardrop appearance
AKA Patau syndrome
Trisomy 13
Trisomy 13 is associated with ?
- IUGR
- holoprosencephaly
- microcephaly
- ml facial clefting
- ocular abnormalities
- polydactyl
- echogenic kidneys
Absence of nasal bone & a shortened ML pharynx of 5th digit are characteristics of ?
Trisomy 21
Increased resistance & decreased diastolic flow is indicative of a fetus with ?
IUGR
Shortening of most distal portion (hand,foot) of an extremity
Acromelia
Refers to smooth brain tissue with absence of sulcri & gyri indentations
- best evaluated with MRI
Lissencephaly
______ causes a low platelet count & increased LFT’s
Preeclampsia
_____ is commonly associated with DORV
Hypoplastic left heart
_______ are related to single or multiple calcifications in the fetal liver
- if these are ruled out then the prognosis is good
- intrauterine infection
- meconium peritonitis
- chromosomal abnormalities
___________ leads to an AV malformation in the brain. This causes an increased amount of flow within the venous system causing fluid accumulation, CHF, & hydrops.
Vein of Galen aneurysm
Skin webbing between fingers
Syndactyly
Arching of the 4th & 5th digits toward thumb
Clinidactyly
Most common causes of CSF production obstruction & ventriculomegaly
Aqueductal stenosis
Combination of ostium primum ASD & inlet VSD
AV canal defect
_________ is more accurate than the lemon sign in predicting spina bifida
Banana sign
The banana sign is seen with ____% of patients with spina bifida
99%
Findings of echogenic bowel, meconium peritonitis, meconium ileus, & absent gallbladder indicate the fetus most likely has ______
Cystic fibrosis
Blood within Fallopian tube
Hematosalpinx
Cyst that contains blood
Hemorrhagic cyst
Hormone produced by trophoblastic cells; may be used as a tumor marker in nongravid patients & males
hCG
Fluid in Fallopian tube
Hydrosalpinx
Excessive vomiting
Hyperemesis
Radiographic procedure that uses dye instilled into endometrial cavity & Fallopian tubes to check for abnormalities
Hysterosalpingography
Distal segment of tube
Infundibulum
Segment of tube that lies within uterine horn (curnu)
Interstitial
Segment of tube located between interstitial & ampulla
Isthmus
Malignant tumor that metastasizes. Most likely from GI tract
Krukenberg tumor
Destruction or breaking down
-lysis
Developing into cancer
Malignant degeneration
Ascites & pleural effusion in lresence of benign ovarian tumor
Meigs syndrome
Abnormally heavy & prolonged period
Menorrhagia
Germ cell layer of embryo that develops into circulatory system, muscles, reproductive system & other structures
Mesoderm
Pelvic pain at time of ovulation
Mittleschmerz
Creation of ovum
Oogenesis
Release of a mature egg from ovary
Ovulation
Small protrusion of tissue
Papillary projection
Contraction that moves in a wave-like pattern to propel a substance
Peristalsis
Intraperitoneal extension of mucin-secreting cells that result from the rupture it a malignant mucinous ovarian tumor or possibly a malignant tumor of appendix
Pseudomyoxoma peritonei
Pus within the Fallopian tube
Pyosalpinx
Oily substance secreted by sebaceous glands
Sebum
Malignant sex cord strongly ovarian neoplasm associated with virilization
Sertoli-Leydig cell tumor
Tumor marker elevated in presence of an ovarian dysgerminoma & other abdominal abnormalities
Serum lactate dehydrogenase
Ovarian tumors that arise from gonadal ridges
Sex cord stromal tumors
Ovarian cyst found with presence of elevated levels of hCG
Theca lutein cyst
Benign ovarian sex cord stromal tumor that produces estrogen in older woman
Thecoma
Indicator of torsed ovarian pedicle adjacent to ovary, appear as round mass with concentric hypoechoic & hyperechoic rings that demonstrate swirling color Doppler
“Whirlpool” sign
Malignant germ cell tumor of ovary
Yolk sac tumor
After the Graafian follicle has ruptured, its structure is converted into the _____
Corpus luteum
Finger-like extensions of tube
Fimbria
Hair-like projections within the tube
Cilia
Inner layer of the wall of the Fallopian tube
Mucosal layer
_______ if associated with the “whirlpool” sign
Ovarian torsion
Stage at which conceptus implants within the decidualized endometrium
Blastocyst
Ovarian mass associated with molar pregnancy & elevated hCG
Theca lutein cyst
Is a dysgerminoma benign or malignant?
Malignant
- usual adnexal location
- asymptomatic
- AKA chocolate cyst
Endometrioma
Adnexal pathology associated with Meigs syndrome, ascites, & hydrothorax is in conjunction with _________
Ovarian fibroma
Remaining structure of corpus luteum after its deterioration
Corpus albicans
Lack of muscle in the dome of diaphragm
Eventration of diaphragm
US findings associated with _________
- indistinct endomyometrial interface
- focal & diffuse bulkiness of posterior
uterine wall - focal cystic areas within myometrium
- hetero uterine texture
Adenomyosis
Ovarian tumor accompanied with pelvic ascites usually suggests malignancy. An exception to this rule would be _____ ?
Ovarian fibroma
Which hormone maintains thickness of endometrium after ovulation?
Progesterone
Least severe form of holoprosencephaly
Lobar holoprosencephaly
“Smooth brain”
Condition with little to no gyri or sulci within cerebral cortex
Lissencephaly
Hemorrhage located within ventricles of the brain
Intraventricular hemorrhage
Hemorrhage within cranium
Intracranial hemorrhage
Mass of tissues located within 3rd ventricle within the ML of brain
- connects 2 loves of thalamus
(massa intermedia)
Interthalmic adhesion
Groove within the ML of brain that divides the 2 cerebral hemispheres
Interhemispheric fissure
Shortage or decreased oxygen in blood
Hypoxia
Things associated with nonimmune hydrops
- anasarca
- ascites
- polyhydramnios
- pleural effusion
Reduced distance between orbits
Hypotelorism
Incomplete growth of a structure or organ
Hypoplasia
Abnormal accumulation of fluid in atleast 2 cavities
Hydrops
Dilation of ventricular system caused by increased volume of CSF, resulting in increased intraventricular pressure
Hydrocephalus
Fatal condition in which the entire cerebrum is replaced by a large sac containing CSF
Hydranencephaly
Group of brain abnormalities consisting of various degrees of fusion of lateral ventricles & associated fetal anomalies
Holoprosencephaly
Folds in cerebral cortex
Gyri
Largest part of choroid
Glomus
Classic clinical triad of an EUP
- pain
- vaginal bleeding
- palpable adnexal mass
Most common location for an EUP
Ampulla portion of tube
Compression maneuver is used to ?
- compress fat
- determine tissue response
- elicit tissue response
- displace bowel
Are cystadenoma painless?
Yes
In Sag on TV, the bladder will fill which corner?
Left upper
_________ is associated with…..
- chorioadenoma destruens
- molar pregnancy
- multiple gestational
- fertility assistance
Hypermemesis gravidarium
Body position for a TV exam
Child birth position
Lithotomy
Best way to relieve supine hypotension syndrome
Rolling only left side
If you should suspect pelvic ascites, you should also check _____ ?
Morrison’s pouch
A patient taking birth control pills greater than 5 years is at an increased risk for developing ____ ?
Hepatic adenoma
Androblastomas (ex: sertoli-leydig) cause _____ ?
Hirsutism
Androgenic tumors are AKA
Androblastomas
Amdrogenic tumors do what ?
- secrete testosterone
- cause masculinization
Dr’s office based exam to see direct visualization of cx
Colposcopy
Most common site for extrauterine adnexal mass
Ovary
A teratoma contains fissures from _____
- ectoderm
- endoderm
- mesoderm
A benign & estrogenic tumor describes ?
Granulosa cell tumor
Stein-leventhal syndrome is characterized by _____
- obesity
- hirsutism
- infertility
If a suspicious adnexal mass is seen, you would scan _____
Lymph nodes
DES was prescribed to women from 1940’s to 1060’s to ______
Later banned in 1971
Inhibit spontaneous AB
What is a krukenberg tumor?
Aka Carcinoma muccocellulare
Mets tumor from GI tract
_______ is true for diagnosis of club foot
Metatarsals & toes like in the same plane as tibia & fibula
Condition associated with bilateral agenesis oligohydramnios & fusion of lower extremities
Sirenomelia
Fusion of digits
Syndactyly
Clover leaf skull & hydrocephalus is seen with ______ ?
Thanatophoric dysplasia
On US, if you see a mass extending from the distal spine, this could possibly be _____ ?
- sacrococcygeal teratoma
- teratoma
- myelomeningocele
Absence of radius
Radial day defect
Sirenomelia is commonly called _____?
Mermaid syndrome
Associated with amniotic band syndrome
- amputation
- anencephaly
- facial clefting
Signs of Arnold Chiara II malformation
- banana & lemon sign
- colpocephaly
Bell shaped chest & multiple fetal fractures are indicative of ______
Osteogenesis imperfect
If you not when pressure is applied to skull that it can be easily be distorted, this is evidence of ______
Osteogenesis imperfecta
Characteristic US findings of achrondrogensis
- Micromelia
- absent mineralization of pelvis
- polyhydramnios
Absent long bones, with hands & feet arising from shoulders & hips
Phocomelia
Absent sacrum & coccyx
Caudal regression syndrome
Rhizomelia denotes ?
Shortening of PROXIMAL segment of limb
Thalamus tissue located within the 3rd ventricle of brain that can become enlarged with Chiari II
Massa intermedia
Limitation of limbs as a result is joint contractures
Arythrogryposis
Achondroplasia is associated with ?
- frontal bossing
- flattened nasal bone
- trident hand
Most common non lethal skeletal dysplasia
Achondroplasia
In VACTERL, “L” stands for ?
Limb
Group of fetal head & brain abnormalities that often coexist with spina bifida
Arnold Chiari II malformation
______ could increase the likelihood of fetus developing sirenomelia & caudal regression syndrome
Pre-existing maternal diabetes
Disorder resulting in abnormal bone growth & dwarfism
Achondroplasia
Clinical or US findings associated with LBWC
- ventral walll defect
- marked scoliosis
- shortened umbilical cord
Group of nuclei within brain that function in several ways, including information processing & emotional response
Basal ganglia
Most common benign tumor of uterus
Leiomyoma
Bicornuate uterus is a congenital malformation resulting from incomplete fusion of ______
Müllerian ducts
Typical ovarian flow is said to be high resistance during which phases?
- early follicular
- late luteal
Ovarian flow is said to be low resistance during which phases?
- late follicular
- early luteal
Most common benign ovarian tumor
Ovarian cystic teratoma
Dermoid cyst
AKA trisomy 13
Patau syndrome
Most accurate method to determine gestational age
CRL
Trophoblasts of blastocysts become ?
Chorion
______ can be associated with low hCG levels
- wrong dates
- embryonic demise
- missed AB
Foramen ovale permits blood to pass from the ______ to the ______
From right atrium to left atrium
Where is the yolk sac located?
Between the amnion & chorion
Dominant hormone in the luteal phase
Progesterone
The Michael fold shouldn’t exceed _____ in a normal pregnancy prior to 21 weeks
6 mm
Least accurate measurement for determining gestation age
AC
Ratio of BPD to OFD determines ?
Cephalic Index
Days 6-13 are in which ovarian phase ?
Follicular
Lateral ventricle atrial width is abnormal if it measures greater than ____
10 mm
Cisterna magna shouldn’t measure greater than ___
1 cm
Hormone primarily responsible for ovulation
LH
Inner cell mass of blastocyst develops into ?
- embryonic disc
- amnion
- yolk sac
Yolk sac actually seen with US
Secondary yolk sac
Embryo seen without FHT
Missed AB
A fetus coexisting with a hydatiform mole
Partial mole
AKA hypogastric artery
Internal iliac artery
Optimal period to see fetal heart
18-24 weeks
Chorioamniotic separation is normal until _____
16 weeks
A pt who has never had a period
Primary amenorrhea
If a mucinous ovarian malignancy ruptures, it could lead to ____
Pseudomyoxoma peritonei
Cystic mass between fetal anterior abdominal wall & bladder most likely represents
Urachal cyst
When is BPD most accurate?
12-33 weeks
US findings with esophageal atresia
- absent stomach
- polyhydramnios
- IUGR
Ovarian cyst that forms as a result of failure of Graafian follicle to ovulate
Follicular cyst
Disease associated with abnormal proliferation of trophoblastic cells during pregnancy
- molar pregnancy
Gestational trophoblastic disease
Dominant follicle prior to ovulation
Graafian follicle
With low AFP, you should check for _____
Trisomy 21
After delivery
Puerperium
Hypotelorism & nose with a single nostril
Cebocephaly
Round skull shape
Brachycephaly
Growth disorder syndrome associated with enlargement of several organs including the skull, tongue & liver
Beck with-wiedemann syndrome
Fetal weight greater than 90th percentile it 4500 g
Macrosomnia
How often does anencephaly occur ?
Approximately 1 in 1000 live births
Twin Reversed Arterial Perfusion results in ?
Acardiac twin
How often does acardiac twins occur ?
1 in 30,000
Fetal blood transfusion is rarely successful before _____
18 weeks
_____ is packed into the umbilical vein during intrauterine blood transfusion
Red blood cells
Twins conjoined at anterior abdominal wall
Omphalopagus
Approximately 20% of fetuses with trisomy 21 are found in women whose _____ level is low ?
MSAFP
Symmetric IUGR May be associated with what Doppler finding ?
Low resistance middle cerebral artery
Most complications with twins relate to ?
Chorionicity
Amniocity refers to ?
of amniotic sacs
Chorionicity refers to ?
of placentas
_____ is a complication that can occur when 1 twin dies in utero & shares a placenta with surviving twin
Twin Embolization Syndrome (TES)
How often does TTTS occur in monochorionic twins?
15-30%
During pregnancy, tenderness over kidneys could suggest ____
Pyelonephritis
Diethylstilbestrol (DES) is known to increase a patients risk for ?
- preterm labor
- ectopics
- uterus malformations
- cervical cancer
Dermoid cysts contain tissue originating from ?
- endoderm
- ectoderm
- mesoderm
In origin, most adnexal masses are ?
Cystic & ovarian
Characteristics of spina bifida
- banana/lemon sign
- enlarged massa intermedia
- closed defect
- sacral dimple
- hemangioma
Ovarian cancer can cause ______ which is thickening on anterior abdomen wall with ascites
“Omental cake”
Fitz-Hugh-Curtis syndrome consists of _______
RUQ pain & PID
Cells that produce hCG
Trophoblastic cells
Form of acrania in which entire cerebrum is located outside of skull
Exencephaly
Lining of ventricles within brain
Ependyma
Elongated, barrow head shape
AKA scaphocephaly
Dolicocephaly
Spectrum of posterior fossa abnormalities that involve cystic dilation of cisterna magna & 4th ventricle
Dandy-walker complex
Fusion of orbits
Cyclopia
Premature closure of cranial sutures with subsequent fusion of cranial bones
Craniosynostosis
Thick white band of white matter that provides communication between right & left halves of brain
Corpus callosum
Abnormal lateral ventricle shape where there is a small frontal horn & enlarged occipital horn
Colpocephaly
Paired structures located anterior to cerebral aqueduct
Cerebral peduncles
Duct that connects 3rd & 4th ventricle
AKA aqueduct of Sylvius
Cerebral aqueduct
Estrogen producing ovarian tumor
Thecoma
If a it presents with elevated serum AFP, what is likely?
Yolk sac tumor
Ovarian cyst that appears with gestational trophoblastic disease
Theca lutein cyst
Most common malignancy of ovary
Serous cystadenocarcinoma
Short & narrow segment of tube, distal to interstitial segment
Isthmus
Modular structure located along the falx cerebri that reabsorb CSF into the venous system
Arachnoid granulations
Abnormal lateral curvature of spine
Scoliosis
Benign cysts within brain that don’t communicate with ventricular system
Arachnoid cyst
Abnormal narrowing of cerebral aqueduct
Aqueductal stenosis
Cerebral aqueduct is AKA
Aqueduct of Sylvius
Opening in a structure
Aperture
Genetic disorder that includes craniosynostosis, ML facial hypoplasia, & cerebral hemispheres
Alert syndrome
Absence of eyes
Anophthalmia
Most severe form of holoprosencephaly
Alobar
Coverings of brain & spinal cord
Meninges
In VACTERL, “C” stands for ?
Cardiac
Enlarged cisterna magna, measuring greater than 10 mm
Mega cisterna magna
Subdivision within middle of lip
Median cleft lip
Fetal syndrome associated with
- microcephaly
- occipital encephalocele
- polydactyl
- PCKD
Meckel-Gruber syndrome
Enlarged HC
Microcephaly
Doppler waveforms in a 2nd trimester from artery supplying trophoblastic tissue will demonstrate _____
High amplitude, low resistance
If a pelvic mass during pregnancy requires surgery, the best time would be _____
16-20 weeks
Dilation of bladder & posterior urethra
“Keyhole” sign
Tumor ectopic endometrial tissue
Endomatrioma
Ovarian mass associated with virilization
Sertoli-leydig cell tumor
With ________ ovarian tumor is Meigs syndrome most likely associated with
Fibroma
Which could most likely be confused with a pedunculated fibroid tumor because of its solid appearing structure
Fibroma
Most common benign ovarian tumor
Cystic teratoma
Ovarian cysts most often bilateral, associated with markedly elevated levels of hCG
Theca lutein cysts
Cystic mass commonly noted with pregnancy
Corpus luteum
US appearance of an ovarian dermoid tumor in which only the anterior element of mass can be seen ?
Tip of iceberg sign
Dominant ovarian follicle prior to ovulation
Graafian follicle
Correct formula for calculating ovarian volume
L x W x H x 0.5233
Normal ovarian flow is said to be ?
High resistance during cycle
Low resistance @ time of ovulation
What predisposed condition could increase the risk for suffering from ovarian torsion ?
Ovarian mass
Malignant ovarian tumor with a GI origin
Krukenberg tumor
Malignant ovarian mass associated with pseudomyoxoma peritonei is _______
Mucinous cystadenocarcinoma
All of these adnexal masses may appear on US similar to a uterine leiomyoma
- thecoma
- fibroma
- granulosa cell tumor
Ovarian tumor associated with serum lactate dehydrogenase
Dysgerminoma
Protein produced by developing placenta
- hCG
- estriol
- PAPP-A
Fusion of thalami & monoventricle are consistent with _____
Trisomy 13
Widened pelvic angles & duodenal atresia are most consistent with US markets for ?
Down syndrome
Another name for most common chromosomal abnormality
Triploidy
Macroglossia is often associated with ?
Trisomy 21
Nonimmune hydrops & ovarian dysgenesis are found in fetuses affected by ?
Turner syndrome
Bilateral choroid plexus cysts, micrognathia, & rocket hottim feet are US findings of a 27 weekend with omphalocele.
This is most consistent with ?
Trisomy 18
Absent nasal bones & increased nuchal fold are consistent with ?
Trisomy 21
Structural abnormality that results from abnormal development
Malformation
Condition in which the heart is located partially or completely outside chest
Ectopic cordis
Malformation it malpositioning of tricuspid valve that causes multiple heart defects
Ebstein anomaly
Fetal shunt that connects the umbilical vein to IVC
Ductus venosus
Fetal shunt that connects pulmonary artery to aortic arch
Ductus arteriosus
Genetic disorder characterized by absent or hypoplastic thymus, which ultimately leads to impairment of immune system & succeptibility to infection, as well as cognitive disorders, congenital heart defects, palate defects, & hormonal abnormalities
Digeorge syndrome
Normal HR @ 6 weeks
100-110 bpm
_______ are stimulated by estrogen & can experience rapid growth during pregnancy
Fibroids
Most common fetal presentation
Cephalic
Fetal presentation when babies butt is closest to cx
Frank Breech
Dilation of renal collecting system secondary to obstruction of normal urine flow
Hydronephrosis
Ovarian cyst that develops after ovulation
Corpus luteum cyst
Narrowing of aortic arch
Coarction of aorta
Tendons within the heart that attach to the tricuspid valve in right ventricle & mitral valve in left ventricle to their respective papillary muscle
Chordae tendinae
Herbiation of abdomen contents into chest cavity because of an opening in left posterilateral portion of diaphragm
Bochladek hernia
US appearance of fetal unilateral pleural effusion
Bat wing sign
Artifact produced when beam of barely attenuated thru fluid containing structure
Posterior shadowing
Endometriomas are AKA
Chocolate cyst
Krukenberg Timor’s tend to have a _______ appearance
Moth- eaten
_______ is the most common malignant tumor germ cell tumor of ovarynnovarian equivalent to testicular seminoma
Dysgerminoma
Tumor marker for yolk sac tumor
AFP
Ovarian torsion typically occurs on which side ?
Right
Longest, most torturous segment of tube. Significant part of tube because of its location of fertilization & area where ectopic pregnancies often embed
Ampulla
Abnormal development of central portion of heart
AKA endocardium cushion defect
Atrioventricular defect
Most common fetal anomaly detected by US
Hydronephrosis
Splaying if laminae would show ____
V- shaped spine
Abnormal heart shift, NTDs, compression of lungs, failure of diaphragm to form properly, pulmonary hypoplasia, would all suggest ?
Congenital diaphragmatic hernia
Caudal regression syndrome is associated with ?
- sirenomelia
- diabetes
- lumbosacral dysplasia
You can best distinguish between omphalocele & gastroschidis by seeing _____
Cord insert
What would cause dangling choroid sign?
Hydrocephalus
Clinidactyly refers to ?
Permanent curvature of a digit
Thickened nuchal fold would suggest ?
Trisomy 21
Double outlet right ventricle is almost always associated with ?
VSD
Syndrome associated with an entire extra set of chromosomes
Triploidy
- moderate posterior position of frontal bone
- abnormal shaped mandible
Micrognathia
Strawberry head shape is associated with ?
Trisomy 18
Head shape associated with thanatophoric dysplasia
Cloverleaf
Flat nose profile, duodenal atresia, mild ventriculomegaly, & echogenic bowel would all suggest ?
Trisomy 21
Holoprosencephaly is often associated with ?
Trisomy 13
Appearance of a femur fracture can be a result of ?
Osteogenesis imperfecta
Talipes is AKA
Clubfoot
Double bubble sign refers to ?
Dilated duodenum next to the stomach
Where do ‘VACTERL’ problems arise from ?
Embryonic mesoderm
What does VACTERL stand for ?
Vertebral defects Anal atresia Cardiac defects Tracheoesophageal fistula Renal abnormalities Limb abnormalities
Most common NTD that is ALWAYS lethal
Anencephaly
Cystic hygroma is often associated with ?
Turner syndrome
Congenital absence of bilateral kidneys & sever oligohydramnios suggests ?
Classic Potter sequence
_____ is characterized by bilateral clefts in cerebellum & has a poor prognosis
Hydranencephaly
Doppler waveforms obtained from an artery supplying an intracranial AVM may exhibit _____
Low pulsatility index
Enzyme found within blood that can be used to monitor renal function. Can also be used as a tumor marker for some ovarian tumors
Lactate dehydrogenase
Painful or difficult urination
Dysuria
Painful sex
Dyspareunia
Difficult or painful periods
Dysmenorrhea
Birth defect in which external genitalia appear neither male or female
Ambiguous genetalia
Typically with anencephaly, MSAFP levels will be ?
Elevated
Typically with gastroschisis, MSAFP levels will be ?
Elevated
In TPAL, the L refers to ?
Live births
Clinical signs of hypotensive syndrome include ?
- tachycardia
- nausea
- pallor
Painless 2nd trimester bleeding is mostly associated with ?
Placenta previa
What would be decreased with presence of Edwards syndrome ?
- estriol
- hCG
- AFP
Things produced by placenta
- hCG
- Papp-a
- inhibin a
Myelomeningocele is associated with ?
Spina bifida
Most common mass associated with pregnancy
Corpus luteum
NT is optimally measured between 11 & 13 weeks & 6 days, when CRL measures between ?
45-84 mm
Vitelline duct is AKA ?
Omphomesentric duct
1 vein, 1 artery
By adding 30 to MSD, you get an estimate for ?
Gestational age in days
Normal hCG levels double every ____ in 1st trimester
48 hours
What are hCG levels like with a complete molar pregnancy
Noticeably increased
HCG level with twins will be ?
Increased
HCG level with a miscarriage
Decreased
HCG level with a blighted ovum
Decreased
HCG level with an ectopic
Decreased
A gestational sac should usually be seen between ____ & ____ mIu per ml with TV US
1000 & 2000
In the 1st trimester, _____ maintains the corpus luteum of ovary so it can continue to produce progesterone
HCG
Most dependent recess in the body
Pouch of Douglas
Ovarian mass that does not secrete hormones
Theca lutein cyst
Fetal lung maturity can be detected via amniocentesis by presence of ?
Phoephatidyl-glycerol
Elevated serum estrogen levels clinically can be associated with ?
- thickened endometrium
- ovarian mass
- multiple follicles
Most common location for a encephalocele
Occipital
Presence of asymmetric encephalocele raises suspicion for ?
Limb body wall complex
Failure of fusion of Müllerian ducts can lead to ?
- bicornuate uterus
- uterus didelphys
- arcuate uterus
Ligaments that attach to ovary to lateral pelvic wall & transits ovarian vessels
Infundibulopelvic ligament
Best scan plane to see spina bifida
Transverse
True knots in the umbilical cord are most likely seen with ?
Monoamniotic twins
Most dangerous location for an ectopic
Cornual
Skeletal anomalies are suspected when long bones measure more than _____ below mean
1 SD
Hormone responsible for proliferation of endometrium
Estrogen
Recipient twin with TTTS often exhibits ?
Hydrops
US visualization of separating membrane is evidence of ____
Diamniotic gestation
Tricuspid valve inserts _____ to the mitral valve
Inferior
Non-functioning mass of lung tissue with its own blood supply from the aorta
Pulmonary sequestration
Most common congenital heart defect
VSD
Pelvic muscle routinely seen with US
Levator ani
Most common cause of hydrocephalus I’m utero
Aqueductal stenosis
Structure created by union of sperm & egg
Zygote
With holoprosencephaly,
there will be a ____- shapes monoventricle, & the lobes of the ______ may be fused & _____ in appearance
- horseshoe
- thalamus
- echogenic
Trisomy 13 is present in 50-70% of fetuses diagnosed with ?
Holoprosencephaly
If cerebellar vermis is absent & 4th ventricle is enlarged, then what is suspected?
Dandy Walker malformation
A normal IUP is seen, as well as a cystic structure with thick & hyperechoic rim
Corpus luteum cyst
With agenesis of corpus callosum, the sulci tend to have more of a perpendicular or radial arrangement & often appear to have a ______ pattern
“Spoke wheel”
Associated with development of fluid filled clefts within the cerebrum
Schizencephaly
Choroid plexus cysts often regress, although there is a slight association with ?
Trisomy 18
US appearance of anencephaly
- ‘frog like’ face
- bulging eyes
- absent cranial vault
Typical complaints of a woman with adenomyosis
- dysmenorrhea
- dyspareunia
- menometrorrhagia
Surgical removal of a fibroid
Myomectomy
Clinical findings associated with leiomyoma
- infertility
- palpable mass
- menorrhagia
Uterine position in which the corpus tilts forward & comes in contact with cx
Antelflexion
Most common uterine anomaly
Septate uterus
Outer layer of endometrium
Basal layer
Extracorpeal approaches to US
- transthoracic
- transvesicular
- TA
- transperineal
Most likely cause if bilateral, enlarged, echogenic kidneys & oligohydramnios
ARPKD
Failure of kidneys to form
Renal agenesis
Most likely associated with polyhydramnios
Duodenal atresia
Most common type of colon atresia
Anorectal atresia
Associated with duodenal atresia
- trisomy 21
- esophageal atresia
- VACTERL
Omphalocele can contain ?
- liver
- ascites
- colon
Things often associated with omphalocele
- multiple chromosomal abnormalities
- elevated MSAFP
- periumbilical mass
Fetal stool is ?
Meconium
Demise of a twin can lead to development of neurologic complication in living twin as a result of ?
Twin embolization syndrome
Least common form of twins
Monochorionic/Monoamniotic
Acardiac twinning results from ?
Abnormal links between placenta vessels
Possible complications associated with twins ?
- preterm delivery
- maternal anemia
- preeclampsia
Most common form of monozygotic twins
Monochorionic/Diamniotic
Fraternal twins result from ?
Dizygotic twinning
The abnormal twin in acardiac twinning is called ?
Parasitic twin
What can occur as a result of dizygotic twinning?
Dichorionic/Diamniotic twins
Shunting if blood from 1 twin to the other
TTTS
Treatment that separates abnormal placental vascular connections between twins suffering from TTTS
Endoscopic-guided laser photocoagulation
Demise of a twin during the 2nd & 3rd trimester can lead to ?
TES
Monozygotic twins results from ?
A single zygote that splits
A triangular extension of placenta @ base of a membrane is indicative of ?
Dichorionic/Diamniotic twins
Presence of 2 separate amniotic sacs
Diamniotic
Factors that could increase likelihood of multiples
- maternal age > 40
- maternal family history of twins
Outer membrane of gestation
Chorion
Twins resulting from 2 separate ova
Dizygotic
What would a newborn most likely suffer from born prior to 32 weeks as result of twin complication ?
Pulmonary hypoplasia
US signs of a Di/Di twins
- twin peak sign
- lambda sign
- delta sign
IUGR is defined as ?
Fetus < 10th percentile
US findings associated with intrauterine infection
- calcs around ventricles
- ventriculomegaly
Appearance of collapsed overriding of cranial bones associated with fetal demise
Spaulding sign
Duels sign is AKA
Halo sign
Condition that includes genitourinary anomalies, heart defects, ear/eye problems & growth restriction
CHARGE
Acetylcholinesterase (ACHE) is specific for ?
Spina bifida
Abnormal nuchal fold thicken is greater than _____
5-6 mm
How is cvs sample usually taken ?
Transcervically
A method of collecting a sample of placental tissue to perform karyotype mapping in order to determine chromosomal & genetic disorders
CVS
Where is the CVS sample usually taken ?
Chorion frondosum
______ is associated with elevated MSAFP
- maternal renal abnormality
- fetal demise
- multiple gestation
- abdomen wall defects
______ is associated with decreased MSAFP
- hydatidiform mole
- underestimation if gestational age
- fetal death
- Down syndrome
@ what level is nuchal fold thickness measured ?
@ level of cerebellum
@ what gestational ago is nuchal fold thickness measured
15-20 weeks
True hermaphrodites have both ?
Female & male gonadal tissue
If a pt presents externally as a female but chromosome analysis reveals 46XY chromosome
Testicular ferminization
Major component of prenatal genetic testing include ?
- amniocentesis
- CVS
- anatomy scan
Hormone that maintains corpus luteum during pregnancy
hCG
Common cause of DUB
PCOS
Structure noted within Graafian follicle containing developing ovum is ?
Cumulus oophorus
Which structure remains after corpus luteum has regressed ?
Corpus albicans
Hormone of pituitary gland that stimulates follicular development of ovary
FSH
Structure that produces hormones that directly acts upon the endometrium to produce varying thickness & US appearances
Ovary
1st phase of ovarian cycle
Follicular
Hormone produced by hypothalamus that controls release of hormones for memstration by anterior pituitary gland
GnRH
Hormone that surges at ovulation
LH
1st phase of endometrial cycle
Proliferative
Hormone released by ovary during proliferative phase stimulates endometrial thickening
Estrogen
Periovulatory phase is AKA
Late proliferative
Corpus luteum primarily releases ?
Progesterone
Intermenstrual bleeding
Metrorrhagia
