Ob/Gyn Flashcards
(414 cards)
1
Q
Sonographic findings with Trisomy 18 include all of the following except (A) IUGR (B) clenched hands (C) holoprosencephaly (D) cystic hygroma
A
(D) Cystic hygroma is associated with Turner syndrome, not trisomy 18.
2
Q
Paternally derived triploidy has the following sonographic markers
(A) complete mole
(B) severe asymmetrical IUGR
(C) large placenta with multiple cystic areas
(D) oligohydramnios
(E) A and D
(F) B and D
A
(C) Paternally derived triploidy is associated with a relatively well-grown fetus that has a proportionate head size. The placenta is large with multiple cystic spaces resembling a molar pregnancy. This accounts for 90% of triploidy.
3
Q
Maternally derived triploidy has the following sonographic markers
(A) complete mole
(B) severe assymetrical IUGR
(C) large placenta with multiple cystic areas
(D) oligohydramnios
(E) AandD
(F) BandD
A
(F) Maternally derived triploidy is associated with a small placenta. The fetus has severe asymmetric growth restriction and oligohydramnios.
4
Q
Amniotic fluid is withdrawn from the gestational sac. Performed after 14 weeks with a low loss rate. It has a 0.3% risk of miscarriage.
A
Amniocentesis
5
Q
Performed 10–12 weeks. Cannot rule out spina bifida. Can test for karyotype only. AFP is a fetal protein that may be tested for by concentration levels in the amniotic fluid or in maternal serum.
A
Chorionic villi sampling (CVS)
6
Q
Performed 11–14 weeks. Increased loss rate and associated with talipes equinovarus. Early loss rate is thought to be associated with the unfused chorion and amnion. They are difficult to penetrate and often require multiple sticks.
A
Early amniocentesis
7
Q
“Tags” chromosomes 13,18,21, X and Y for quick preliminary results It is considered experimental and requires amniocentesis follow-up. Fluorescent chromosomal markers are introduced into the amniotic fluid that “tag” or attach to certain chromosomes. These markers and chromosomes fluorescence allow for early preliminary detection of chromosomal abnormalities.
A
Fluorescence in Situ Hybridization (FISH).
8
Q
Technically difficult procedure that tests fetal blood. It involves an insertion of a needle into the fetal umbilical cord and the withdrawal of fetal blood. It may be used in cases of anhydramnios, testing for isoimmunization, fetal blood typing, hemophilias, and other disorders.
A
Percutaneous umbilical blood sampling (PUBS)
9
Q
The most common twin zygocity is (A) conjoined twins (B) monochorionic/diamniotic (C) dichorionic/diamniotic (D) monochorionic/monoamniotic
A
(C) Seventy-five percent of twins are dizygotic.
10
Q
The “twin peak” sign is
(A) also known as the beta sign
(B) a triangular projection of chorion into the dividing membrane
(C) a sonographic predictor for dizygotic twins
(D) B and C
(E) all of the above
A
(D) The twin peak is formed when the placental tissue migrates between the chorionic layers. This is 94–100% predictive of dizygotic twins.
11
Q
Which of the following statements about conjoined twins is not true?
(A) 60% are born alive
(B) 56% of conjoined twins are fused on the ventral wall
(C) polyhydramnios is commonly present
(D) the largest risk of fetal demise is because of cord entanglement
A
(D) Forty percent of conjoined twins are born stillborn. Fifty-six percent of conjoined twins are thoracoomphalopagus, thoracopagus, and omphalopagus. Polyhydramnios is present 50% of the time. Commonly, there is one umbilical cord that may have an abnormal number of vessels and is shared by the conjoined fetuses.
12
Q
Shortening of the proximal limb. Shortening of the humerus and femur.
A
rhizomelia
13
Q
Shortening of the middle portion of the limb (forearms and lower leg bones). Shortening of the radius/ulna and tibia/fibula.
A
mesomelia
14
Q
Shortening of all portions of a limb. Shortening of the entire limb, but can also refer to shortening of a limb without specific reference.
A
micromelia
15
Q
Shortening of the hand and foot bones.
A
acromelia
16
Q
The most common short limb syndrome is (A) achondrogenesis (B) thanatophoric dysplasia (C) osteogenesis imperfecta (D) jeune thoracic dystrophy
A
B) The occurrence rate for thanatophoric dysplasia is 1/6000–1/17,000 births. Sonographic findings are polyhydramnios, severe rhizomelia, and micromelia with bowing. The thorax is bell-shaped, and the cranium is cloverleaf-shaped with hydrocephaly and frontal bossing.
17
Q
What sonographic findings would be identified in a fetus with heterozygous achondroplasia? (A) hydrocephaly (B) frontal bossing (C) “bell shaped” thorax (D) “trident hand” (E) A and C (F) B and D (G) all of the above
A
(F) Heterozygous achondroplasia accounts for 80% of achondroplasias. It is the most common form of genetic skeletal dysplasia. It is often not identified before 26–27 weeks
18
Q
What is the most common congenital facial anomaly? (A) proboscis (B) hypotelorism (C) isolated cleft lip/palate (D) low set ears
A
(C) It has a variable prevalence, with Native American being the highest at 3.6/1000 births.
19
Q
3-D surface rendering is used to (A) obtain volume measurements (B) obtain technically difficult images (C) image fetal spine (D) image fetal face
A
(D) Three-dimensional imaging of the internal organs is termed volume imaging. Three-dimensional images of surface structures, such as the fetal face, is surface rendering.
20
Q
The earliest age at which a gestational sac may be visualized by transvaginal sonography is (A) 4 weeks (B) 6 weeks (C)8 weeks (D)10 weeks
A
(A) A gestational sac can be visualized by transvaginal scanning as early as 4 weeks.
21
Q
The optimal time for imaging cardiac structures is (A) 14–18 weeks (B) 18–24 weeks (C) 24–28 weeks (D) 28–32 weeks
A
(B) Cardiac imaging can be done earlier than 18 weeks, but is dependent on maternal habitus. After 24 weeks, the fetal bones become denser and more cal- cified and begin to limit the sonographic windows that allow visualization of the cardiac structures.
22
Q
3D volumetric reconstructions are used to show all of the following except (A) fetal face (B) fetal limbs (C) organs (D) digits
A
(A) Three-dimensional imaging of surface structures, such as the fetal face, is termed surface rendering.
23
Q
By 12 weeks gestational age, the sonographer can identify what abnormalities? (A) conjoined twins (B) anencephaly (C) duodenal atresia (D) A and B (E) all of the above
A
(C) Although duodenal atresia has been detected in the first trimester, the classic “double bubble” sign is not usually present until the late second and early third trimesters.
24
Q
An unexplained increased MSAFP3 can cause what third trimester complications? (A) premature rupture of membranes (B) placental abruption (C) preterm labor (D) A and B (E) all of the above
A
(E) When the increased AFP is unexplained, it is thought to be because of an increased placental transfer of AFP. The placental dysfunction can occur with various placental abnormalities that may cause third trimester complications.
25
```
A markedly increased MSAFP would be associated with
(A) amniotic sheets
(B) cloacal exstrophy
(C) congenital diaphragmatic hernia
(D) Smith-Lemli-Opitz syndrome
```
(B) Cloacal exstrophy is characterized by an abdominal wall defect inferior to the umbilical cord insertion with exstrophy of a cloacal sac and a neural tube defect. It is associated with a markedly increased MSAFP. Amniotic sheets and congenital diaphragmatic hernia do not increase MSAFP. Smith-Lemli-Opitz syndrome is associated with a low level of maternal uE3 and normal MSAFP.
26
If the triple marker screen shows a decreased AFP,
a decreased estriol, and a decreased hCG, the fetus
is at risk for
(A) trisomy 21
(B) Smith-Lemli-Opitz syndrome
(C) trisomy 18
(D) trisomy 13
(C) If AFP (<0.6 MoM), uE3 (<0.5 MoM), and hCG
(<0.3 MoM) are all decreased, the triple screen will
show an increased risk for trisomy 18.
27
```
Which is not a direct sonographic finding of posterior urethral valve obstruction?
(A) "keyhole" bladder
(B) anhydramnios
(C) hydronephrosis
(D) pulmonary hypoplasia
```
(D) Pulmonary hypoplasia can be assumed by the
small thoracic circumference and anhydramnios,
but underdeveloped fetal lungs are not visible by
sonography.
28
```
What cranial finding can cause congestive heart failure and hydrops?
(A) vein of Galen aneurysm
(B) periventricular leukomalacia
(C) Dandy-Walker malformation
(D) iniencephaly
```
(A) Vein of Galen aneurysm is an AV malformation located posterior to the third ventricle in the midline of the brain.
29
What is the name of the cardiac abnormality with
one outflow tract giving rise to both the pulmonary
and aortic branches and associated with a ventricular septal defect?
(A) truncus arteriosis
(B) double outlet right ventricle
(C) tetralogy of Fallot
(D) transposition of the great vessels
(A) Truncus arteriosis consists of one outflow tract overriding a VSD. The right ventricular outflow tract
is absent. Differential diagnosis includes tetralogy of
Fallot with pulmonary atresia. Identifying the pulmonary arteries branching from the main trunk would differentiate the defect.
30
```
The cardiac abnormality consisting of a VSD, an over-riding aorta, a small or atretic pulmonary trunk, and
right ventricular hypertrophy describes
(A) double outlet right ventricle
(B) hypoplastic left heart syndrome
(C) transposition of the great vessels
(D) tetralogy of Fallot
```
(D) The most predictive sonographic findings is the
overriding aorta and VSD. If the VSD is perimem-branous, it will not appear on the four chamber view.
The right ventricle may appear larger than the left,
but this is not a consistent finding and is dependent
of the degree of pulmonary stenosis. Differential diag-
nosis would include truncus arteriosis.
31
Which of the following describes congenital cystic
adenomatoid malformation?
(A) may spontaneously regress
(B) poor survival rate
(C) divided into two subsets, solid and cystic
(D) none of the above
(A) Congenital cystic adenomatoid malformation
(CCAM) is divided into three subsets; macro, medium,
and microcystic. Survival rate combines all types and
sizes and is 75-80%. Studies have shown that CCAM
regresses 55-69% of the time.
32
```
Which of the following statements regarding congenital diaphragmatic hernia are true?
(A) more commonly right sided than left sided
(B) carries a poor prognosis
(C) may be associated with chromosomal
abnormalities
(D) all of the above
(E) A and C
(F) B and C
```
(F) Congenital diaphragmatic hernia is left sided
75-90% of the time. Prognosis is poor, particularly if
the liver is herniated into the chest. Five to fifteen percent of congenital diaphragmatic hernias are associated with chromosomal abnormalities, commonly trisomy 18.
33
Esophageal atresia is
(A) diagnosed by ultrasound 90% of the time
(B) associated with oligohydramnios
(C) is a component ofthe VACTERL complex
(D) can be diagnosed in the first trimester
(D) Ninety percent of esophageal atresias have a
tracheoesophageal fistula. This allows amniotic
fluid to reach the stomach, but at a slower rate. The
stomach will be visualized, but may be smaller than
usual. Polyhydramnios occurs in the mid to late second trimester. The VACTERL complex is: vertebral
anomalies, anal atresia, cardiac abnormalities,
tracheoesophageal atresia, renal anomalies, and
limb anomalies. At least three of the anomalies
listed must be present to diagnosis the VACTERL
condition.
34
```
An increased MSAFP is associated with all of the
following except
(A) trisomy 21
(B) neural tube defect
(C) maternal preeclampsia
(D) gastroschisis
```
(A) Trisomy 21 is associated with a decreased MSAFP and an increased hCG.
35
```
The uterine ligament responsible for uterine orientation is
(A) transversal ligament
(B) broad ligament
(C) uterosacral ligament
(D) round ligament
```
(C) The uterosacral ligament is the distal portion of
the cardinal ligament. It anchors the cervix and is
responsible for uterine orientation.
36
```
Which two ligaments are not true ligaments?
(A) uterosacral and broad ligament
(B) suspensory and broad ligament
(C) uterosacral and round ligament
(D) cardinal and suspensory ligament
```
(B) Both the suspensory and broad ligaments are folds of peritoneum.
37
```
The most commonly visualized pelvic muscle often
mistaken for an ovary is
(A) piriformis muscle
(B) levator ani muscle
(C) coccygeus muscle
(D) iliopsoas muscle
```
(D) The iliopsoas muscle runs laterally to the uterus, near the iliac vessels. In transverse, it is ovoid and hypoechoic and may be mistaken for an ovary.
38
```
The most dependent portion of the peritoneum is called
(A) pouch of Douglas
(B) vesicouterine pouch
(C) retropubic space
(D) none of the above
```
(A) The most dependent portion is the pouch of Douglas, or the posterior cul-de-sac. It is located posterior to the cervix and anterior to the rectum.
39
```
The three peritoneal spaces in the pelvic cavity are:
(A) PCDS, ACDS, and vesicouterine
(B) PCDS, pouch of Douglas, ACDS
(C) PCDS, ACDS, and prevesical
(D) PCDS, ACDS, and interstitial
```
(C) The posterior cul-de-sac (pouch of Douglas) is located posterior to the uterus. The anterior cul-de-sac (vesicouterine pouch) is located anterior to the uterus. The prevesical space (retropubic space) is anterior to the bladder. They form the peritoneal spaces of the pelvic cavity.
40
```
AIUM guidelines for cleaning a transvaginal probe
are
(A) clean with soap and water
(B) immerse in disinfecting solution
(C) clean with moist towelette
(D) AandB
(E) A and C
(F) all of the above
```
(D) Transvaginal probes need to be cleaned with soap and water as well as soaked in a disinfecting solution. Transabdominal probes may be cleaned with a moist towelette.
41
```
An invasive mole is also known as
(A) hydatidiform mole
(B) triploid molar pregnancy
(C) endometrioma
(D) chorioadenoma destruens
```
(D) An invasive mole and a hydatidiform mole are excessive trophoblastic proliferation. Unlike the hyda-
tidiform mole, chorioadenoma destruens is malignant
and invades into the myometrium.
42
Which of the following is true regarding a hydatidiform mole and coexistent fetus?
(A) consistent with maternally derived trisomy 13
(B) consistent with paternally derived trisomy 13
(C) can progress to choriocarcinoma
(D) A and C
(E) Band C
(E) Paternally derived trisomy 13 presents with a large placenta sometimes termed a partial mole. Less commonly, a dizygotic pregnancy may occur. One fetus results from normal fertilization of one egg and a complete molar pregnancy results from the fertilization of the other egg. In those cases, it is possible for the hydatidiform mole to advance to choriocarcinoma.
43
```
In what portion of the fallopian tube does fertilization usually occur?
(A) interstitial
(B) isthmus
(C) ampulla
(D) infundibulum
```
(C) The ovum enters the fallopian tube at the fimbriated ends. It courses to the ampulla where fertilization occurs 24-36 hours after ovulation.
44
The sonographic appearance of an ectopic gestation
includes all of the following except
(A) increased endometrial lining
(B) irregular adnexal mass or ovarian mass with ring of color flow Doppler
(C) fluid in the cul-de-sac
(D) absence of sac within the uterus
(D) The decidual reaction may resemble an early intrauterine sac. A yolk sac or embryonic pole will confirm an intrauterine pregnancy.
45
Rank the following ectopic pregnancy implantation
sites from the most common to the least common.
(1) ampullary
(2) ovarian
(3) isthmus
(4) cervical
(A) 1,2,3,4
(B) 4,2,3,1
(C) 1,3,2,4
(D) 3,1,4,2
```
(C) The occurrence rates for ectopic locations are:
ampullary-most common (75-80%)
isthmus-second most common (10-15%)
ovarian (0.5%)
cervical (0.1%)
```
46
Fetal demise is the detection of an absent heart beat
after 16 weeks.
(A) True
(B) False
(B) Fetal demise is defined as an absence of fetal heart tones after 20 weeks.
47
Which of the following is not true of dysgerminoma?
(A) It is a solid malignant germ cell tumor of the ovary.
(B) It is a counterpart of seminoma of the testis.
(C) It is a relatively uncommon tumor accounting for about 2% of all ovarian cancers.
(D) 90% are unilateral.
(E) It is a solid benign tumor.
(E) Dysgerminoma is a malignant tumor.
48
Which of the following is not true of dermoid tumors?
(A) may cast an acoustic shadow
(B) encountered more in women over 40 years
(C) also called benign cystic teratoma
(D) most common benign germ cell tumor in the female
(E) unilateral in about 80% of cases
(F) The tumor has elements such as hair, tooth, bone, endoderm, ectoderm, mesoderm, and thyroid glandular tissue.
(G) may be echogenic because of fat content and
sonographically produce "tip of the iceberg" effect
(B) Dermoid cysts are more common in younger women.
49
```
The normal adult ovaries measure
(A) 3 x 2 x 2 em
(B) 2 x2 x4 em
(C) 3 x 3 x 2 cm
(D) 3 x 2 x 1 em
```
(A) Normal adult ovarian size is 3 x 2 x 2 cm.
50
```
The first definitive sonographic sign of an intrauterine pregnancy is
(A) gestational sac
(B) yolk sac
(C) fetal pole
(D) double decidua sign
```
(B) The first finding is a gestational sac, however ectopic pregnancies may also present with a pseudosac. A yolk sac is the earliest definitive sonographic sign of an intrauterine pregnancy.
51
```
What percentage of cardiac defects can be detected
from the four-chamber view?
(A) 50
(B) 65
(C) 80
(D) 85
```
(B) The detection rate is 65%, but may vary among patients depending on the maternal habitus, fetal position, AFV, ultrasound machine, and expertise of the sonographer and physician.
52
What percentage of cardiac defects can be detected
from the four-chamber view and outflow tracts?
(A) 50
(B) 65
(C) 80
(D) 85
(D) The detection rate is 85%, but may vary among
patients depending on the maternal habitus, fetal
position, AFV, ultrasound machine, and expertise of
the sonographer and physician.
53
```
A simple cyst may exhibit all of the following except
(A) anechoic interior
(B) posterior enhancement
(C) thin walled
(D) distal acoustic shadows
```
(D) Distal acoustic shadowing is associated with a solid mass.
54
The cyst commonly associated with hydatidiform mole is
(A) follicular
(B) paraovarian
(C) Theca lutein cysts are present in 18-37% of hydatidiform moles.
55
```
The most accurate method for establishing EDC is
(A) first trimester ultrasound
(B) second trimester ultrasound
(C) LMP
(D) Nagele's rule
```
(A) The CRL is the most accurate because fetal growth is very uniform and is rarely affected by pathological disorders. The choices C and D are based on
maternal LMP, which assumes ovulation on day 14.
56
```
The accuracy of gestational age in the first trimester is
(A) 3-5 days
(B) ± 10 days
(C) ± 14 days
(D) ± 21 days
```
(A) Fetal growth in the first trimester is very uniform, thus allowing for accurate dating.
57
```
The accuracy of gestational age from 13-20 weeks is
(A) 3-5 days
(B) ± 10 days
(C) ± 14 days
(D) ± 21 days
```
(B) Fetal growth is starting to show variation and multiple parameters are used to calculate the EDC.
Both of these factors allow for an increased range of
error.
58
```
The accuracy of gestational age from 20-30 weeks is
(A) 3-5 days
(B) ± 10 days
(C) ± 14 days
(D) ± 21 days
```
(C) Fetal growth is showing a moderate amount of variation, which allows for an increasing range of error.
59
```
The accuracy of gestational age in the third trimester is
(A) 3--4 days
(B) ± 10 days
(C) ± 14 days
(D) ± 21 days
```
(D) Fetal growth has a large amount of variation in the third trimester and obtaining the images for
60
```
The normal rise of hCG in a viable pregnancy should
(A) double in 24 hours
(B) double in 48 hours
(C) double in 72 hours
(D) double in 1 week
```
(B) The hCG doubles in approximately 48 hours until 6 weeks.
61
```
Conditions associated with a poorly rising or decreasing hCG include all of the following except
(A) twin pregnancy
(B) ectopic pregnancy
(C) anembryonic demise
(D) incorrect dates
```
(A) Twin pregnancy is associated with an elevated hCG.
62
```
An ovarian mass identified on sonogram is complex, predominately hypoechoic with septations. The patient complains of severe pain during menses. The most likely diagnosis is
(A) corpus luteal cyst
(B) granulosa cell
(C) thecoma
(D) endometrioma
```
(D) The internal component of an endometrioma is typically blood from bleeding ectopic endometrial tissue during menstruation. Differential diagnosis may include a dermoid tumor; however, most women tend to be asymptomatic with dermoids.
63
```
If a patient's LMP is 6/15/2001, by Nagele's rule, the EDC should be
(A) 2/22/2002
(B) 2/30/2002
(C) 3/22/2002
(D) 3/30/2002
```
(C) Nagele's rule is: (1) identify the LMP, (2) add 7 days, (3) subtract 3 months, and (4) add one year.
64
```
The differential diagnosis for a thick-walled ovarian cyst with blood flow surrounding the periphery is
(A) follicular cyst
(B) oocyte
(C) corpus luteal cyst
(D) all of the above
```
(C) A corpus luteal cyst and ectopic pregnancy may
| mimic each other, and the sonogram should be cor-related with clinical findings.
65
```
The following are true characteristics of a mucinous
cystadenoma except
(A) the largest abdominal tumor
(B) thick septations
(C) benign
(D) may have debris layering within cyst
```
(A) A mucinous cystadenoma is the largest ovarian tumor.
66
```
Another name for polycystic ovarian syndrome is
(A) Stein-Leventhal syndrome
(B) Seroli-Leydig cell
(C) Brenner's tumor
(D) Chocolate cyst
```
(A) Seroli-Leydig cell tumor is an androblastoma and Brenner's cell tumor is a transitional cell tumor. Chocolate cyst is another name for endometrioma.
67
The etiology of hydatidiform mole is
(A) trophoblastic changes in a blighted ovum
(B) hydatid swelling of the retained placenta in a missed abortion
(C) fertilization of an ovum without any active chromosomal material
(D) A and B
(C) The etiology of hydatidiform mole is fertilization of an ovum without any active chromosomal material.
68
All of the following characteristics of color Doppler energy are false except
(A) CDE can determine the direction of blood flow
(B) CDE can determine the velocity of blood flow
(C) the different colors represent flow toward or away from the transducer
(D) CDE is based on the amplitude of the soundwave
(D) Blood flow direction and velocity are characteristics of color Doppler imaging.
69
The term trophoblast denotes
(A) the extra-embryonic peripheral cells of the blastocyst
(B) a rigid state of the flagellate microorganism
(C) the gestation sac
(D) the characteristics of a disease
(A) The extra-embryonic peripheral cells of the blastocyst. The trophoblast forms these cells, which form the wall of the blastocyst.
70
```
The mean diameter of a dominant follicular cyst at the time of ovulation is
(A) 10mm
(B) 15 mm
(C) 20 mm
(D) 25 mm
```
(C) By approximately day 14 of the menstrual cycle, one or more dominant follicles will reach a mean diameter of 20 mm with a hypoechoic rim.
71
```
The most common uterine tumor is
(A) leiomyoma
(B) adenomyosis
(C) leiomyosarcoma
(D) endometrial hyperplasia
```
(A) Leiomyomas are present in 25% of the female
population with a higher percentage in African American women and becoming more prevalent in
the fourth generation of life.
72
```
A complex adnexal mass is identified in a patient with tenderness and elevated temperature. The most likely diagnosis is
(A) tubo-ovarian abscess
(B) corpus luteal cyst
(C) serous cystadenoma
(D) Brenner's tumor
```
(A) The majority of tubo-ovarian abscesses are bacterial in origin. Symptoms are similar to other bacterial infections including pain, fever, and increased white blood cell count.
73
```
The endometrium can appear echogenic (1) in the secretory phase, (2) in patients with pelvic inflammatory disease, (3) after dilation and curettage, (4) in patients with endometritis, (5) after removal of an intrauterine contraceptive device
(A) 1 and 3 only
(B) 4 only
(C) 1,2,3, and 5
(D) all of the above
```
(D) All of the above. Decidual proliferation in ectopic
pregnancy and endometrial carcinoma can also cause
the endometrium to appear echogenic.
74
```
The endometrial lining in postmenopausal women not on hormone replacement therapy should be less than
(A) 10mm
(B) 8mm
(C) 6 mm
(D) 2mm
```
(C) Normal endometrial lining in postmenopausal
women not on hormone replacement therapy is
<5-6 mm.
75
```
The endometrial lining in postmenopausal women on hormone replacement therapy should be less than
(A) 10 mm
(B) 8mm
(C) 6mm
(D) 2mm
```
(B) Normal endometrial lining in postmenopausal
| women on hormone replacement therapy is <8 mm.
76
```
The best time to visualize a polyp is during what stage of the menstrual cycle?
(A) menstruation phase
(B) follicular phase
(C) proliferative phase
(D) secretory phase
```
(C) In the proliferative phase, the lining is thick, but the internal component is hypoechoic. This allows for the echogenic polyp to be seen. In the secretory phase, the entire endometrial lining is echogenic and will mask a polyp.
77
The date of the last menstrual period indicates
(A) the date when fertilization occurred
(B) the date when menstrual bleeding ended
(C) the date when ovulation occurred
(D) the date when menstrual bleeding began
(D) LMP refers to the first day of the last cycle.
78
```
Which of the following diagnoses does not mimic the sonographic characteristic of hydatidiform mole?
(A) endometriosis
(B) hematoma
(C) uterine leiomyoma
(D) anembryonic demise
```
(A) The differential diagnoses that may mimic hyda-tidiform moles are missed abortions, leiomyomas, and hematomas. Endometriosis is endometrial tissue outside of the endometrial lining.
79
```
What percentage of patients diagnosed with hyda-tidiform mole will usually follow a benign course?
(A) 20
(B) 10
(C) 50
(D) 80
```
(D) 80
80
```
The uterus can be divided into regions. List them from inferior to superior.
(A) cervix, isthmus, corpus, fundus
(B) serosal, myometrial, endometrial
(C) fundus, isthmus, corpus, cervix
(D) cervix, corpus, isthmus, fundus
```
(A) The cervix is the most inferior portion of the uterus and invaginates into the vagina. Moving superiorly, the next section is the isthmus beginning at the internal os. The body, or corpus, of the uterus is the largest section of the uterus. The most superior portion is the fundus.
81
```
The uterine layers are
(A) cervix, isthmus, corpus, fundus
(B) serosal, myometrial, endometrial
(C) fundus, isthmus, corpus, cervix
(D) peritoneum, serosal, and myometrial
```
(B) The outer layer is the serosal, or peritoneal layer. The large muscular middle layer is the myometrium, and the inner layer is the endometrium.
82
Prepubertal uterus
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(C) The cervix is larger than the body of the uterus in prepuberty.
83
Adult nulliparous woman
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(B) If the woman has not delivered a child before, the cervix and corpus are equal in size.
84
Adult multiparous woman
(A) corpus twice the length of cervix
(B) corpus and cervix equal in length
(C) corpus half the length of the cervix
(A) After a full term pregnancy, the corpus is twice as long as the cervix.
85
```
The normal size of a multiparous uterus is
(A) 5x4x3 cm
(B) 7x5 x4 cm
(C) 10x6x5 cm
(D) 6x4x3 cm
```
(C) A nulliparous uterus is 8x5x4 cm. A post-menopausal uterus is 7x4x3 cm.
86
In postmenopausal women, the uterus will not atrophy as much in multi gravid women as nulligravid women
(A) true
(B) false
(B) False. The uterus atrophies equally in both multi-gravid and nulligravid women.
87
```
Congenital abnormalities of the uterus result from improper fusion of the
(A) mesonephric ducts
(B) paramesonephric ducts
(C) Gartner's duct
(D) Wolffian ducts
```
(B) Congenital abnormalities result from improper fusion of the mullerian, or paramesonephric ducts.
88
During the early proliferative phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mrn
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(A) The proliferative phase is day 5-9 postmenstruation.
89
During the periovulatory phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mm
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(C) The periovulatory, or late proliferative phase is day 10-14 postmenstruation.
90
During the secretory phase, the endometrium appears
(A) thin, echogenic line, 4-8 mm
(B) thin, hypoechoic line, 4-8 mm
(C) thickened and hypoechoic medially with an echogenic basal layer
(D) thickened and echogenic throughout
(D) The secretory phase is day 15-28 postmenstruation. The echogenicity is a result of edema of the
functional zone of the endometrium.
91
```
Women with endometriosis may have
(A) dyspareunia
(B) metromennorhagia
(C) dysmenorrhea
(D) all of the above
```
(D) Symptoms of endometriosis caused by adhesions
include dysmenorrhea, low back pain, dyspareunia
(painful sexual intercourse), irregular bleeding and
infertility.
92
```
Endometriosis is
(A) ectopic endometrial tissue
(B) benign invasion of endometrial tissue into the myometrium
(C) endomyosarcoma with chocolate tissue
(D) inflammation of the endometrium
```
(A) The most common locations for endometriosis
are: ovaries, uterine ligaments, rectovaginal septums,
posterior cul-de-sac, and pelvic peritoneum.
93
```
The most common location for a dermoid cyst is
(A) posterior cul-de-sac
(B) right adnexa
(C) left adnexa
(D) superior to the uterine fundus
```
(D) Dermoid tumors are most commonly located superior to the uterine fundus.
94
```
Macrosomia is
(A) fetus weighing >4,000 g
(B) fetus >90% for gestational age
(C) fetus with a shoulder thickness >10 mm
(D) LGA fetus
```
(A) A fetus greater than the 90th percentile for esti-
mated fetal weight is termed large for gestational age
(LGA). A fetus greater than 4000 g is macrosomic.
95
```
LGA is a term referring to
(A) a fetus weighing >4,000 g
(B) fetus >90% for gestational age
(C) a clinical assessment of an increased fundal height
(D) polyhydramnios
```
(B) LGA refers to a fetus measuring greater than
| the 90th percentile for gestational age.
96
```
A macrosomic fetus is at risk for
(A) shoulder dystocia
(B) increased perinatal morality
(C) prolonged labor
(D) all of the above
```
(D) All of the above. Identification of a macrosomic fetus can alert the obstetrician to watch for complications of macrosomia during delivery.
97
```
Macrosomia may be associated with
(A) IDDM
(B) GDM
(C) HTN
(D) Rh isoimmunization
(E) AandB
```
(E) Insulin-dependent diabetes mellitus (IDDM) and
gestational diabetes mellitus (GDM) may both cause
macrosomia. If the IDDM involves vascular disease,
the fetus may actually be at risk for intrauterine
growth retardation.
98
```
An increased fundal height may be caused by
(A) macrosomic fetus
(B) polyhydramnios
(C) twins
(D) all of the above
```
(D) Other causes for an increased fundal height include fibroids, incorrect dates, and molar pregnancy.
99
```
IUGR is
(A) EFW <10%
(B) decreased AFV
(C) increased umbilical cord dopplers
(D) abnormal growth ratios
```
(A) Although the other features, such as oligo-hydramnios, do often coexist and interact with IUGR,
the diagnosis of IUGR is a fetus <10% for gestational
age.
100
```
An increased HC/AC is a suggestion of
(A) late onset ofIUGR
(B) brain sparing effort
(C) placental insufficiency
(D) all of the above
```
(B) An increased HC/AC ratio is the result of redistribution of fetal blood away from the bowel and directed to the fetal head.
101
```
Causes of IUGR include
(A) fetal infection
(B) chromosomal abnormality
(C) placental insufficiency
(D) all of the above
```
(D) All of the above. IUGR may be found in chromosomal abnormalities, infection early in pregnancy, and placental insufficiency.
102
```
IUGR can be caused by all except
(A) diabetes
(B) maternal hypertension
(C) chromosomal abnormalities
(D) spina bifida
```
(D) Spina bifida is not associated with IUGR. Diabetes with vasculopathy, maternal HTN, and chromosomal abnormalities may all be associated with IUGR.
103
```
Doppler testing of vessels that may aid in the diagnosis of IUGR are
(A) umbilical cord
(B) straight sinus
(C) celiac axis
(D) jugular vein
(E) A and C
(F) all of the above
```
(A) An increase in systolic/diastolic ratio has been shown to have a correlation with placental insufficiency.
104
```
Doppler sampling of the maternal uterine artery <26 weeks shows a diastolic notch. This notch is indicative of
(A) IUGR
(B) maternal HTN
(C) normal
(D) A and B
```
(C) The diastolic notch is normal before 26 weeks and is related to trophoblastic invasion.
105
```
Rank the following in order of their neurologic development, earliest to latest.
(A) Body motion
(B) Fetal tone
(C) Breathing
(D) Fetal heart rate acceleration
```
(B) The central nervous center that regulates fetal tone functions first at 7.5-8.5 weeks.
(A) The central nervous center that regulates body movements starts functioning at 9 weeks.
(C) The central nervous center that regulates fetal breathing starts at 21 weeks.160.
(D) The central nervous center for fetal heart rate
reactivity functions by the end of the second trimester
or beginning of the third trimester.
106
Placental grading is an important component of BPP.
(A) true
(B) false
(B) Components of a BPP include flexion/extension, gross body movement, breathing, amniotic fluid, and NST.
107
The components of BPP are
(A) fetal breathing, Doppler, NST, gross body movement, and AFV
(B) placental grade, NST, gross body movement, and AFV
(C) NST, Doppler, gross body movement, AFV, and fetal flexion/extension
(D) AFV, gross body movement, fetal flexion/extension, fetal breathing, and NST
(D) If the component (i.e., movement) is present, it is given a score of two. If it is absent, it is given a zero with the total score being 10.
108
```
Fetal breathing must last how long to be counted in the BPP?
(A) 20 seconds
(B) 30 seconds
(C) 1 minute
(D) 2 minutes
```
(B) Fetal breathing must last at least 30 seconds in a 30-minute time period in order to score a 2 in the BPP.
109
```
In a normal fetus, if the middle cerebral artery is sampled, one would expect to find
(A) an increased S/D ratio
(B) a decreased S/D ratio
(C) retrograde flow
(D) absent flow
```
(A) In response to hypoxia, the fetus reroutes blood to
the brain in a brain-sparing effort. The middle cerebral artery is normally of higher resistance, but it will decrease to compensate for the increased blood flow
and brain-sparing effort.
110
The only purpose of amniotic fluid is to allow the fetal lungs to develop and to allow for fetal movement.
(A) true
(B) false
(B) Amniotic fluid also controls temperature, protects
| the fetus, allows growth, and prevents infection.
111
```
The amniotic fluid production is performed primarily by the fetus after what gestational age in pregnancy?
(A) 8 weeks
(B) 10 weeks
(C) 16 weeks
(D) 25 weeks
```
(C) Although the kidneys produce some urine prior to 16 weeks, they do not take over the majority of urine production until after 16 weeks.
112
```
When does the amniotic fluid volume peak in preg-nancy?
(A) 20 weeks
(B) 24weeks
(C) 33 weeks
(D) 38 weeks
```
(C) The maximum amniotic fluid volume peaks at
| approximately 33 weeks, and then begins to decline.
113
An exact volume of amniotic fluid can be determined
by measuring the four quadrants of the maternal abdomen.
(A) true
(B) false
(B) The exact uterine volume cannot be determined by the sonogram.
114
In the single pocket method, when is the diagnosis
of oligohydramnios made?
(A) a single pocket of 2 mm cannot be measured
(B) a single pocket of 1 cm cannot be measured
(C) a single pocket of 2 cm cannot be measured
(D) a single pocket of 4 cm cannot be measured
(B) This method is not as accurate as the amniotic fluid index.
115
In the amniotic fluid index method of measuring four quadrants, the diagnosis of oligohydramnios is made
(A) when the amniotic volume is less than 300 mL
(B) when the amniotic volume is less than 200 mL
(C) when the amniotic fluid index is less than the
10th percentile
(D) when the amniotic fluid index is less than the
2.5th percentile
(D) All four quadrants are added and compared to
an expected amniotic fluid volume for that fetus' ges-
tational age. The normal range extends from 2.5% to
97.5%.
116
The nonspecific signs of fetal death are which of the
following: (1) echoes in the amniotic fluid, (2) the
absence of the falx cerebri, (3) a decrease in the bi-
parietal diameter (BPD) measurements, (4) a double
contour ofthe fetal head (sonographic halo sign).
(A) 3 and 4
(B) 4 only
(C) all of the above
(D) none of the above
(C) All of the above. Nonspecific signs of fetal death
are double contour of the fetal head caused by scalp
edema, absence of the falx cerebri because of lique-
faction of the brain, echoes in the amniotic fluid
because of fragmentation of the fetal skin, and a
decrease in biparietal diameter measurements
because of collapse of the cranial sutures after
death.
117
```
How long after fetal death can scalp edema be seen?
(A) 2-3 days
(B) 5-10 days
(C) 10-20 days
(D) 20-30 days
```
(A) Scalp edema can be seen 2-3 days, or 24-72 hours, after fetal death.
118
The term decidua denotes the transformed endo-metrium of pregnancy. The different regions of the
decidua are divided into
(A) two regions called decidua basalis and chorionic villi
(B) one region called decidual reaction
(C) three regions called decidua basalis, decidua
parietalis, and decidua capsularis
(D) three regions called endoderm, mesoderm, and
ectoderm
(C) The decidua of early intrauterine pregnancy is divided into decidua basalis, decidua parietalis (vera), and decidua capsularis. This marked hypertrophic
change in the endometrium occurs no matter where
the pregnancy is located. The uterine mucosa responds by a decidual reaction caused by hormonal stimuli. However, when an ectopic pregnancy occurs, the uterine decidua responds by a cast off-decidual cast. This should not be confused with the normal decidua in an early pregnancy.
119
```
Cystic masses in the vagina could include all of the following except
(A) Gartner's duct cyst
(B) Nabothian cyst
(C) hematocolpos
(D) vaginal agenesis
```
(D ) Vaginal agenesis is the absence of a vagina. Gartner's duct cyst, Nabothian cyst, and hematocolpos will appear as a cystic mass in the vagina.
120
The functions of the secondary yolk sac are which of the following
(A) nutrients for the embryo
(B) hematopoiesis
(C) contributing to the development of the reproductive system
(D) all of the above
(D) All of the above. The functions of the yolk sac are: nutrition-transfer of nutrients to the embryo; hemopoiesis-blood cell development; and development of sex cells that later become spermatogonia or oogonia.
121
```
In about 2% of adults, the yolk sac persists as a diverticulum of the ileum. This is known as
(A) Michael's diverticulum
(B) Meckel's diverticulum
(C) Turner's diverticulum
(D) Smith's diverticulum
```
(B) The yolk sac reduces in size as pregnancy advances. However, it may persist throughout preg-
nancy and continue to persist into adulthood. In
about 2 of adults, the proximal intra-abdominal
part of the yolk sac is presented as a diverticulum of
the ilium, called Meckel's diverticulum.
122
The location of the yolk sac is
(A) inside the umbilical cord
(B) inside the amniotic cavity
(C) in the chorionic cavity between the amnion and the chorion
(D) outside the chorionic cavity between the chorion and the endometrial wall
(C) The yolk sac is located adjacent to the embryonic plate in early pregnancy and is located within the chorion.
123
```
On transvaginal sonography, when is the yolk sac visible?
(A) 4 weeks
(B) 5.5 weeks
(C) 6 weeks
(D) 7 weeks
```
(B) The yolk sac may be visible as early as 5 weeks, but is virtually always seen by 5.5 weeks.
124
Arrange in sequence in the embryologic stages following fertilization: (A) morula, (B) cleavage, (C) zygote, (D) blastocyst
(C) Zygote
(B) Cleavage
(A) Morula
(D) Blastocyst
125
```
All of the following are complications of oligohydram-
nios except
(A) clubfeet
(B) hand posturing
(C) urethral stenosis
(D) pulmonary hypoplasia
```
(C) Oligohydramnios can cause restrictive deformities such as clubfoot, hand posturing, and scoliosis due to restricted fetal movement. Oligohydramnios may also cause pulmonary hypoplasia. It will not cause urethral stenosis.
126
The umbilical cord S/D ratio normally
(A) increases throughout the pregnancy
(B) decreases throughout the pregnancy
(C) remains the same throughout pregnancy
(D) is controlled by the fetal cerebellum
(B) As the pregnancy advances, the placenta becomes
less resistive. This allows for more blood and oxygen
to reach the growing fetus.
127
Placental insufficiency is indirectly monitored by
(A) an increasing umbilical cord S/D ratio
(B) a decreasing umbilical cord S/D ratio
(C) Doppler of placental intervillous spaces
(D) Doppler of maternal arcuate arteries
An increasing S/D ratio of the umbilical cord is a sign of vascular resistance within the placenta, which ultimately leads to a decrease in oxygen to the
fetus.
128
```
The terminology vasa previa describes
(A) placenta near the internal os
(B) placenta touching the internal os
(C) placenta crossing the internal os
(D) placenta vessels crossing the internal os
```
(D) Vasa previa may also be described as a succenturiate placenta with vessels crossing the internal os.
129
```
The primary cause of third trimester bleeding is
(A) placenta previa
(B) preterm labor
(C) cervical bleeding
(D) abruption
```
(A) The incidence of placenta previa at term is 0.5-1% , with 90% of previas bleeding before 38 weeks.
130
An ectopic pregnancy will usually be on the same
side as the corpus luteal cyst.
(A) true
(B) false
(A) The ovum is usually found on the side of the corpus luteum from which it was released. It is possible for the ovum to contralaterally implant one-third of the time.
131
Which of the following statements is NOT TRUE concerning the yolk sac?
(A) The yolk sac should be included in measurements of CRL.
(B) The yolk sac shrinks as pregnancy advances.
(C) The yolk sac plays a role in blood development and transfer of nutrients.
(D) The yolk sac is attached to the body stalk and
is located between the amnion and chorion.
(A) The yolk sac lies in the chorionic cavity between
the amnion and chorionic sac. It measures 5 mm to
1 cm. The yolk sac shrinks as pregnancy advances.
It should not be measured in the CRL.
132
The vessels of the normal umbilical cord consist of
(A) two arteries, one vein
(B) two veins, one artery
(C) one artery, one iliac vein, and the iliac artery
(D) one artery, one vein
(A) The umbilical cord normally consists of two arteries and one vein.
133
```
The term "neural tube defect" refers to
(A) spinal defect
(B) open tube defect
(C) anencephaly
(D) cephalocele
(E) all of the above
```
(E) Open tube defect, anencephaly, and cephalocele are part of the neural tube defect spectrum.
134
```
Myelomeningocele refers to the herniation of
(A) meninges
(B) meninges and neural tissue
(e) meninges at the lumbar level
(D) meninges and neural tissue below L5
```
(B) Herniation of meninges alone is termed a meningo-cele.
135
The most accurate way to diagnosis a spinal defect is
(A) in the longitudinal plane of the spine
(B) in the coronal plane of the spine
(C) in the sagittal plane of the spine
(D) the "lemon and banana" signs of the fetal cranium
(D) Cranial signs are present 99% of the time with spinal defects. The second most accurate technique would be visualizing the spine in the transverse plane of view, looking for vertebral splaying and a break in the skin line.
136
The ''lemon" sign of the fetal cranium in diagnosing
spina bifida refers to
(A) the narrowing of the vertebral process at the area of the defect
(B) the overall appearance of the fetal spine in the presence of a defect
(C) the appearance of the cerebellum in the presence of a spinal defect
(D) the appearance of the fetal skull in the presence of a spinal defect
(D) The "lemon" refers to the narrowing of the parietal bones giving the appearance of a lemon-shaped cranium in the axial view.
137
The "banana" sign of the fetal cranium in diagnosing spina bifida refers to
(A) the narrowing of the vertebral process at the area of the defect
(B) the overall appearance of the fetal spine in the presence of a defect
(C) the appearance of the cerebellum in the presence of a spinal defect
(D) the appearance of the fetal skull in the presence of a spinal defect
(C) The ''banana" refers to the displacement of the cerebellum inferiorly into the upper cervical canal. On transverse view, the cerebellum is small and resembles a banana.
138
```
The ''banana'' sign is present with spinal defects
(A) 50% of the time
(B) 75% of the time
(C) 85% of the time
(D) 99% of the time
```
(D) 99% of the time.
139
Which of the following is true about the "lemon" sign
and neural tube defects?
(A) The "lemon" sign is not as accurate as the ''banana'' sign.
(B) The "lemon" sign may be present in the normal fetus in the third trimester.
(C) The ''lemon'' sign can be artificially produced at the level of the ventricles.
(D) The "lemon" sign is a predictor for spina bifida.
(E) all of the above
(E) The lemon sign is found in 1-2% of normal fetuses.
140
The diagnosis of placenta previa is most accurately made
(A) transabdominally with a full maternal bladder
(B) transabdominally with an empty maternal bladder
(C) transrectally
(D) transvaginally
(D) There is no contraindication to scanning a placenta previa transvaginally, and it provides the most accurate diagnosis. Transabdominal scanning may give a false-positive caused by a full maternal bladder compressing the internal os or an inadequate view of the internal os.
141
The definition of "low lying placenta" in the third trimester is
(A) placental edge >3 cm from internal os
(B) placental edge <2 cm from internal os
(C) placental edge <3 cm from internal os
(D) placental edge in lower uterine segment
(B) If the placenta is greater than 2 cm from the internal os, a vaginal delivery is considered safe.
142
The rotation of the heart in the fetal chest should be
(A) 45° with apex pointed to the right
(B) 45° with apex pointed to the left
(C) 60° with apex pointed to the right
(D) the heart should not be rotated in fetal chest
(B) The normally positioned heart should be rotated
| approximately 45° with the apex pointed to the left.
143
```
The fetal heart is horizontal in the chest because of
(A) large spleen
(B) flat diaphragm
(C) large liver
(D) large thorax
```
(C) The horizontal position of the fetal heart is largely due to a large liver size.
144
The majority of cephaloceles are parietal.
(A) true
(B) false
(B) 75% of cephaloceles are occipital.
145
```
What percentage of cephaloceles are occipital?
(A) 50
(B) 60
(C) 75
(D) 99
```
(C) 75% of cephaloceles are occipital.
146
The diagnosis of ventriculomegaly may be made
when the ventricle measures
(A) greater than 10 mm in the posterior horn
(B) greater than 15 mm in the posterior horn
(C) when the third ventricle may be visualized
(D) when the choroid does not touch the medial
wall of the lateral ventricle
(A) In the absence of a spinal defect, if the lateral ventricles measure greater than 10 mm, it is commonly associated with an obstruction of the ventricular system.
147
```
The most common type of obstruction causing ven-triculomegaly is
(A) Dandy-Walker malformation
(B) communicating hydrocephalus
(C) aqueductal stenosis
(D) congenital hydrocephaly
```
(C) The order of occurrence of obstruction from
most common to least common is: aqueductal steno-
sis, communicating hydrocephaly, Dandy-Walker
malformation, congenital hydrocephaly.
148
Congenital hydrocephalus is
(A) genetically linked affecting both male and females
(B) able to be detected in both male and females by DNA testing
(C) expressed in males only
(D) A and C
(E) B and C
(F) all of the above
(E) Congenital hydrocephaly is an X-linked abnormality, with the expression in males and the females being carriers. It is able to be detected through DNA testing.
149
```
Mild ventriculomegaly is described as
(A) posterior horn measuring > 15 mm
(B) posterior horn measuring >5 mm
(C) choroid is separated from the medial wall of the ventricle >5 mm
(D) visualization of the third ventricle
```
(C) Mild ventriculomegaly may be described as a separation of choroid from the medial ventricular
wall >5 mm (but not dangling) or a measurement of
the ventricular atrium between 10 and 15 mm.
150
```
Mild ventriculomegaly may be associated with
(A) agenesis of the corpus callosum
(B) trisomy 21
(C) normal
(D) all of the above
```
(D) Agenesis of the corpus callosum has mild ventri-culomegaly, but the ventricle is also shaped like a
"teardrop" in most cases. Mild ventriculomegaly has
been associated with trisomy 21, but may also a normal variant.
151
```
Other findings associated with a spinal defect are
(A) clubfeet
(B) ventriculomegaly
(C) single umbilical artery
(D) A and B
(E) all of the above
```
(D) Clubfeet and ventriculomegaly have a strong associ-ation with spinal defects.
152
The severity of impairment in a child with hydrocephaly may be predicted by the severity of their fetal hydro-cephaly.
(A) true
(B) false
(B) The prognosis of hydrocephaly remains unclear from the prenatal imaging.
153
In the case of spina bifida, the fetal sonogram is able to accurately predict the child's impairment.
(A) true
(B) false
(B) The site and extension of the lesion may aid in a very general prognosis, but it is impossible to accu-rately and clearly predict an individual fetus' prognosis by in utero findings.
154
The cisterna magna is considered increased when
(A) the measurement is >5 mm
(B) the cerebellum may be seen outlined by fluid
(C) the cerebellar vermis is splayed
(D) the measurement is >10 mm
(D) The cisterna magna is enlarged if the measurement is greater than 10 mm.
155
```
Findings on ultrasound include an increased cisterna magna, agenesis of the cerebellar vermis with communication to the fourth ventricle and ventricu-lomegaly. The most likely diagnosis would be
(A) Dandy-Walker malformation
(B) Dandy-Walker malformation variant
(C) arachnoid cyst
(D) communicating hydrocephaly
```
(A) A true Dandy-Walker malformation must have
agenesis of the cerebellar vermis with communica-
tion to the fourth ventricle. A Dandy-Walker mal-formation variant is described as having some degree
of cerebellar vermis agenesis, but not complete agen-
esis. An arachnoid cyst will push the cerebellum
superiorly without splaying the cerebellum.
156
Findings on ultrasound include hydrocephaly, an enlarged cisterna magna, and an intact cerebellar
vermis elevated by a cyst in the posterior fossa. The
most likely diagnosis would be
(A) Dandy-Walker malformation
(B) Dandy-Walker malformation variant
(C) arachnoid cyst
(D) communicating hydrocephaly
(C) An arachnoid cyst will not cause splaying of the
| cerebellum and the cerebellar vermis will be intact.
157
```
Other findings associated with Dandy-Walker malfor-mation include
(A) holoprosencephaly
(B) facial clefting
(C) cardiac defects
(D) all of the above
```
(A) Dandy-Walker malformation is associated with other midline defects including agenesis of the corpus callosum and cephaloceles, as well as holoprosen-
cephaly, clefting and cardiac defects. Dandy-Walker
malformation has a 50-70% risk of associated abnor-
malities.
158
```
Associated findings occur with Dandy-Walker malfor-mation
(A) rarely
(B) 10-25% of the time
(C) 50-70% of the time
(D) always
```
(C) Dandy-Walker malformation may occur as part of the mendelian disorder (abnormalities in multiple different organ systems) and is associated with chromosomal abnormalities.
159
```
Complications associated with Dandy-Walker mal-formation include
(A) chromosomal abnormalities
(B) subnormal intelligence after birth
(C) increased neonatal death
(D) A and B only
(E) all of the above
```
(E) Subnormalintelligence is reported in 40-70% of
cases. Morbidity rates are 24%, but are improving
with increased anesthesia and surgical techniques.
160
```
The most common cause of hypotelorism is
(A) Dandy-Walker malformation
(B) Arnold-Chiari type II
(C) Goldenhar syndrome
(D) holoprosencephaly
```
(D) The most common cause of hypotelorism is holoprosencephaly. Hypotelorism is found in many
different syndromes and chromosomal abnormalities and is strongly associated with abnormalities of the brain.
161
```
Cyclopia, hypotelorism, proboscis, cebocephaly, and
cleft lip/palate are
(A) abnormal intracranial findings
(B) abnormal facial findings
(C) associated with hydrocephaly
(D) all of the above
```
(B) Cyclopia-absent nose with protrusion of tissue
at level of eye sockets; hypotelorism-close set
orbits; cebocephaly-single nostril nose; and cleft
lip/palate are all abnormal facial findings strongly
associated with holoprosencephaly.
162
```
The most common chromosomal abnormality associated with holoprosencephaly is
(A) trisomy 21
(B) trisomy 18
(C) trisomy 13
(D) Turner syndrome
```
(C) 30-50% of fetuses with holoprosencephaly have chromosomal abnormalities, the most common being trisomy 13.
163
```
The most common cause of hypertelorism is
(A) anterior cephalocele
(B) holoprosencephaly
(C) hydranencephaly
(D) craniosynostosis
```
(A) The most common cause of hypertelorism is a
defect that prevents the migration of the eyes to
their normal position. An anterior cephalocele is the
most common blockage of that migration.
164
```
Teratomas in pregnancy are located in
(A) the sacrococcygeal region
(B) intracranial
(C) cervical
(D) all of the above
```
(D) Teratomas can occur in many different locations.
The most common region is sacrococcygeal accounting
for 50% of fetal teratomas. The second most common
location is orofacial (including intracranial) and cervical, accounting for 5% of fetal teratomas.
165
```
Maternal Grave's disease and Hashimoto thyroiditis may cause what finding in the fetus?
(A) fetal ascites
(B) fetal goiter
(C) oligohydramnios
(D) there is no effect on the fetus
```
(B) Maternal Graves disease and Hashimoto thyroiditis produce antibodies that cross the placenta and may affect fetal thyroid production.
166
```
The most common cause of macroglossia is
(A) micrognathia
(B) trisomy 18
(C) Beckwith-Wiedemann syndrome
(D) obstruction ofthe fetal airway
```
(C) Macroglossia is present in 97.5% of Beckwith-Weidemann syndrome.
167
Macroglossia may cause polyhydramnios.
(A) true
(B) false
(A) Macroglossia may prevent effective fetal swallowing causing polyhydramnios.
168
```
Macroglossia is present how often in Beckwith-
Wiedemann syndrome?
(A) 15% of the time
(B) 25% of the time
(C) 50% ofthe time
(D) 97% of the time
```
(D) Other findings of Beckwith-Wiedemann syndrome include omphalocele, organomegaly, hemi-hypertrophy, and hypoglycemia.
169
```
The most common type of isolated cleft lip/palate is
(A) unilateral cleft lip
(B) unilateral cleft lip and palate
(C) bilateral cleft lip
(D) bilateral cleft lip and palate
```
(B) Of the isolated cleft lip and palate cases, 40% are
unilateral cleft lip and palate, 29% are unilateral
cleft lip, 27% are bilateral cleft lip and palate, and 5%
are bilateral cleft lip.
170
The most common associated anatomic abnormalities of cleft lip are
(A) genitourinary
(B) gastrointestinal
(C) cardiac
(D) there are no associated abnormalities
(C) The risk of significant abnormalities seems to
increase with the severity of the cleft. A wide variety of abnormalities are associated with clefts, but cardiac abnormalities are the most prevalent.
171
```
A medial cleft lip has a strong association with what abnormality?
(A) hydrocephaly
(B) Turner syndrome
(C) holoprosencephaly
(D) hydranencephaly
```
(C) Medial cleft lip is associated with a spectrum of midline defects, the most common being holopros-encephaly.
172
```
Micrognathia may be associated with which of the
following syndromes?
(A) Pierre Robin syndrome
(B) trisomy 18
(C) campomelic dysplasia
(D) all of the above
```
(D) Pierre Robin syndrome, trisomy 18, and campomelic dysplasia are all associated with micrognathia and polyhydramnios. Micrognathia commonly causes difficulty swallowing resulting in polyhydramnios.
173
```
In the presence of micrognathia, polyhydramnios is
present how often?
(A) 15% of the time
(B) 25% of the time
(C) 50% of the time
(D) 70% of the time
```
(D) Due to the small mandible and normal sized tongue, normal swallowing is inhibited.
174
```
If a fetal nose is not visualized, one should look for
(A) cebocephaly
(B) cyclopia
(C) proboscis
(D) all of the above
```
(C) If the nose is not visualized, the sonographer
should look superiorly on the fetal face for a proboscis. The orbits should also be identified, looking for hypotelorism or cyclopia.
175
All cases of alobar holoprosencephaly will demonstrate facial anomalies.
(A) true
(B) false
(B) It is possible to have a normal face with holopros-encephaly, although the majority of cases will not have facial anomalies.
176
```
Agenesis ofthe corpus callosum cannot be diagnosed
by ultrasound before
(A) 10 weeks
(B) 14 weeks
(C) 18 weeks
(D) 28 weeks
```
(C) Development of the corpus callosum occurs between 12-18 weeks; therefore, visualization is not possible less than 18 weeks.
177
In 90% of cases with agenesis of the corpus callosum,
what other sonographic finding is present?
(A) polyhydramnios
(B) omphalocele
(C) polydactyly
(D) teardrop ventricles
(D) The "teardrop" appearance (enlargement of the
atria and occipital horns and lateral displacement of
the anterior horns) is present 90% of the time.
178
```
Absent cerebral cortex is found in what cranial
abnormality?
(A) holoprosencephaly
(B) hydrocephaly
(C) hydranencephaly
(D) agenesis of the corpus callosum
```
(C) Hydranencephaly exists when the cerebral hemi-spheres are replaced by fluid. The brain stem is usually spared. Causes are thought to be infection or obstruction of the internal carotid artery.
179
Microcephaly is defined as
| (A) HC
(D) Microcephaly has been described as an HC between -2 and -3 standard deviations (SD) of the mean.
180
A fetus presents with an anechoic midline lesion in
the brain, fetal hydrops, and congestive heart failure.
The most likely diagnosis for the lesion is
(A) agenesis ofthe corpus callosum
(B) dilation of the third ventricle
(C) arachnoid cyst
(D) AV malformation
(D) A Vein of Galen aneurysm is a type of AV malfor-mation. Agenesis of the corpus callosum, third ven-tricular dilation, and an arachnoid cyst are cystic midline lesions, but they will not have the high, turbulent blood flow of an AV malformation.
181
```
Choroid plexus cysts, when found with other associated abnormalities, have a strong association with
(A) Noonan's syndrome
(B) trisomy 18
(C) trisomy 13
(D) X-linked hydrocephaly
```
(B) Isolated choroid plexus cyst has a small risk for trisomy 18. If other abnormalities are identified along with the choroid plexus cyst, the risk for trisomy 18 increases.
182
The risk of aneuploidy is increased in cases where the choroid plexus cysts are multiple, bilateral, and/or large.
(A) true
(B) false
(B) The data do not support an increased risk attributable to size or number of choroid plexus cysts.
183
The nuchal skin fold in the second trimester should
be measured at what level?
(A) the level of the BPD
(B) the same image as the OOD
(C) the level of the TCD in the axial plane
(D) the level of the ventricles
(C) The image should also show the cavum septum
pellucidum. The measurement is taken from the outer
edge of the cranium to the outer edge of the skin.
184
When measuring the lateral ventricle, the anterior
portion of the ventricle should always be measured.
(A) true
(B) false
(B) The lateral ventricle should be measured at the
widest portion of the atrium from the medial to the
lateral wall. It should not exceed 10 mm.
185
The TCD may be measured in either the axial or coronal view.
(A) true
(B) false
(B) The data for transverse cerebellar diameter is based on imaging in the axial plane of view.
186
```
If the cephalic index is >85, it is an indication for what condition?
(A) brachycephaly
(B) dolicocephaly
(C) microcephaly
(D) macrocephaly
```
(A) A cephalic index >85 describes an increased BPD when compared to a shorter OFD. The head has a rounded appearance on ultrasound.
187
```
If the cephalic index is <75, it is an indication for what condition?
(A) brachycephaly
(B) dolicocephaly
(C) microcephaly
(D) macrocephaly
```
(B) Dolicocephaly is a long, narrow head with a small BPD when compared with a longer OFD.
188
Dolicocephaly will demonstrate
(A) a large BPD and shorter OFD for gestational age
(B) a small BPD and longer OFD for gestational age
(C) an HC <3SD of mean for GA
(D) an HC >2SD of mean for GA
(B) Dolicocephaly appears as a long, narrow head.
189
Brachycephaly will demonstrate
(A) a large BPD and shorter OFD for gestational age
(B) a small BPD and longer OFD for gestational age
(C) an HC <3SD of mean for GA
(D) an HC >2SD of mean for GA
(A) Brachycephaly appears as a short, rounded head.
190
```
Dolicocephaly is often associated with what conditions?
(A) breech fetus
(B) oligohydramnios
(C) LGA fetus
(D) A and B
(E) A and C
(F) all of the above
```
(D) Dolicocephaly is associated with breech fetuses and oligohydramnios.
191
```
Brachycephaly is associated with what conditions?
(A) trisomy 21
(B) normal variant
(C) myelomeningocele
(D) A and B
(E) A and C
(F) all of the above
```
(F) Brachycephaly with a flat occiput is a feature of trisomy 21. Brachycephaly may also be present with a spina bifida due to ventricular enlargement. Most commonly, brachycephaly is a normal variant.
192
The ratio of head circumference to body circumference normally changes as pregnancy progresses. Match the weeks of gestation in Column A with the head and body ratio in Column B.
COLUMN A COLUMN B
12-24 weeks (A) abdomen larger than head
32-36 weeks (B) head and body are equal
36-40 weeks (C) head larger than abdomen
12-24 weeks (C) head is larger than the abdomen
32-36 weeks (B) head and body are about the same size
36-40 weeks (A) after 36 weeks, the abdomen is larger than the head
193
If performing a BPD measurement and the midline
echo is continuous and unbroken, this would indicate that the scanning plane is
(A) normal
(B) too high
(C) through the fetal neck
(D) correct
(B) The scanning plane is too high. When performing a biparietal diameter measurement (BPD), the fetal head should be ovoid and the measurement obtained at the level of the thalami and cavum septum pellucidum.
194
```
The fluid within a cystic hygroma is
(A) serous fluid
(B) amniotic fluid
(C) ascites
(D) lymphatic fluid
```
(D) The fluid within a cystic hygroma is lymphatic fluid from an obstructed lymph system.
195
Cystic hygromas are caused by
(A) obstruction ofthe lymph system at the level of the jugular veins
(B) obstruction of the lymph system at the level of the iliac veins
(C) obstruction of the venous system at the level of the jugular veins
(D) carotid artery obstruction
(A) A cystic hygroma occurs when the jugular lymph sacs fail to communicate with the venous system. The obstructed lymphatic fluid fills the sacs and forms the cystic hygroma.
196
Cystic hygromas differ from cervical masses because
(A) a cystic hygroma is hypoechoic with internal septations
(B) a cystic hygroma is a cystic mass separated by a midline septum
(C) a cystic hygroma appears as two completely separate sacs
(D) cystic hygromas may not be differentiated from other cervical masses
(B) The midline septum represents the medial walls of the two obstructed lymph sacs.
197
```
Eighty percent of cystic hygromas occur in what region?
(A) the axilla
(B) the mediastinum
(C) the cervical region
(D) none of the above
```
(C) The cervical region
198
```
Cystic hygromas are associated with
(A) Potter's syndrome
(B) Beckwith-Weidemann syndrome
(C) elevated levels of AFP
(D) Turner syndrome
(E) C and D
(F) B andD
(G) all of the above
```
(E) C and D. Cystic hygromas are associated with elevated MSAFP and Turner syndrome.
199
Cystic hygromas are always associated with a
chromosomal abnormality.
(A) true
(B) false
(B) Seventy-five percent of cystic hygromas are associated chromosomal abnormalities. If the cystic
hygroma is isolated, the outcome for the fetus is typically good.
200
```
The fetal shunt between the left and right atria is
(A) ductus venosum
(B) ductus arteriosis
(C) foramen ovale
(D) pulmonary ductus
```
(C) The foramen ovale allows for oxygenated blood to pass from the right atrium to the left atrium.
201
```
The fetal shunt connecting the transverse aortic trunk and the main pulmonary trunk is
(A) ductus venosum
(B) ductus arteriosis
(C) foramen ovale
(D) pulmonary ductus
```
(B) The ductus arteriosis allows for approximately 70% of the blood to bypass the nonfunctioning lungs.
202
Hydranencephaly is thought to result from
(A) chromosomal abnormalities
(B) a vascular accident of the jugular veins
(C) a vascular accident of the internal carotid arteries
(D) none of the above
(C) It is a destructive process that obliterates the cerebral cortex. The brain stem is usually spared.
Other causes include infection and intrauterine
strangulation.
203
```
The differential diagnosis for hydranencephaly may be
(A) semilobar holoprosencephaly
(B) alobar holoprosencephaly
(C) severe hydrocephaly
(D) A and C
(E) Band C
(F) all ofthe above
```
(E) Alobar holoprosencephaly and severe hydrocephaly may sonographically present similar to hydranenceph-aly. Lobar holoprosencephaly sonographically presents with a interhemispheric fissure anterior and posterior, thus being excluded in the differential.
204
Hemivertebrae may be identified on sonogram
(A) as a narrowing of the individual vertebrae in the coronal plane of view
(B) as a narrowing of the individual vertebrae in the sagittal plane of view
(C) as a narrowing ofthe individual vertebrae in the axial plane of view
(D) all of the above
(D) Hemivertebrae is easiest to view in the sagittal
plane of view because the other vertebrae may be
used as a reference of normal. It is visible in the other
planes of view also, but requires more meticulous
scanning.
205
The downward displacement of the cerebellar vermis,
the fourth ventricle, and medulla oblongata through
the foramen magna is termed
(A) "lemon" sign
(B) Dandy-Walker malformation
(C) arachnoid cyst
(D) Arnold-Chiari malformation
(D) Arnold-Chiari malformation is most commonly associated with myelomeningocele and hydrocephaly.
206
```
Large encephaloceles may be associated with
(A) hydranencephaly
(B) hypotelorism
(C) microcephaly
(D) all of the above
```
(C) Microcephaly is a result of a large portion of the brain tissue being herniated out of the cranium.
207
A patient presents for an anatomy scan. The fetal
head shows a single ventricle, single choroid, two
cerebellar hemispheres, and fused thalamus. The
abnormality is most likely
(A) semilobar holoprosencephaly
(B) alobar holoprosencephaly
(C) hydranencephaly
(D) hydrocephaly
(A) Semilobar holoprosencephaly is a single anterior ventricle with partial separation of the posterior cerebellar hemispheres.
208
A patient presents for an anatomy scan. The fetal
head shows a single large cystic cavity with a rim of
cerebral cortex. A fused thalamus is also identified.
The most likely diagnosis is
(A) alobar holoprosencephaly
(B) semilobar holoprosencephaly
(C) hydranencephaly
(D) hydrocephaly
(A) The most likely diagnosis would be alobar holopros-encephaly. Differential diagnosis would include hydran-encephaly and hydrocephaly. Hydranencephaly would not show any cerebral cortex and only brain stem would be spared. Hydrocephaly would show a bi-lobed thalamus with a dilated third ventricle.
209
```
A patient presents for an anatomy scan. The fetal head shows the cranium filled with anechoic fluid, and no cerebral cortex is identified. The brain stem is identified. The most likely diagnosis is
(A) semilobar holoprosencephaly
(B) alobar holoprosencephaly
(C) hydranencephaly
(D) hydrocephaly
```
(C) Hydranencephaly will present with no visible cerebral cortex. The differential includes alobar holoprosenceph-aly (fused thalamus) and severe hydrocephaly (bi-lobed thalamus with dilated third ventricle).
210
```
How early can anencephaly be detected on ultrasound?
(A) 10 weeks
(B) 14 weeks
(e) 16 weeks
(D) 20 weeks
```
(B) It may be possible to diagnose anencephaly as early as 12 weeks, but it should be definitely diagnosed by 14 weeks.
211
Acrania is described as
(A) abnormal brain tissue with absent calvarium
(B) the first stage of anencephaly before
prolonged exposure to amniotic fluid
(C) normal brain tissue with abnormal facies
(D) A and B
(E) all of the above
(D) Acrania is theorized to be the first trimester finding of anencephaly. With prolonged exposure to the amniotic fluid, the abnormal brain tissue is eroded, and the second trimester finding of anencephaly is appreciated.
212
```
Which numbers in the term "parity G7P3214" correspond to the following?
The number of living children
The number of preterm infants
The number of pregnancies total
The number of abortions
The number of full term pregnancies
```
(4) The last number stands for the number of living children.
(2) The number of preterm births is the second number after parity.
(7) G refers to the gravida or number of pregnancies.
(1) The third number after parity represents the
number of abortions (spontaneous and elective).
(3) The first number after parity represents the number of full term pregnancies.
213
A patient has had six pregnancies: three full term,
one preterm delivery of twins, one spontaneous
abortion, one fetal loss at 22 wks. This would be
listed as
(A) G6P3215
(B) G6P3124
(C) G7P5411
(D) G7P2135
(A) The number of pregnancies is listed after gravida
(G). The first number after parity (P) is the number of
full term pregnancies (3), the second number is the
number of preterm pregnancies (1 set of twins, single
pregnancy and 1 preterm fetal death >20 weeks = 2),
the third number is the number of abortions (1), and
the final number is the number of living children (5).
214
Spina bifida occulta may be diagnosed on ultrasound
by the lemon and banana sign.
(A) true
(B) false
(B) Spina bifida occulta is a mild form of spina bifida
that does cause a break in the skin. Because the
spinal cord does not herniate out of the spinal canal,
it does not cause a lemon or banana sign.
215
```
An increased MSAFP may be associated with
(A) anencephaly
(B) spina bifida occulta
(C) skin covered spina bifida
(D) A and C
```
(A) AFP is produced by the fetus. An abnormal concen-tration occurs whenever there is an abnormal opening in the fetus allowing an increased amount of the protein in the amniotic fluid.
216
A gestational sac is identified within the uterus. The
CRL measures 3 mm. What is the approximate age
of the embryo?
(A) <4 weeks
(B) 5 weeks
(C) 6 weeks
(D) 8 weeks
(B) 5 weeks.
217
```
CRL is the appropriate dating measurement until what gestational age?
(A) 8 weeks
(B) 10 weeks
(C) 13 weeks
(D) 15 weeks
```
(C) After 13 weeks, the fetus is larger and it is technically more difficult to obtain the correct view to measure a CRL.
218
In a fetus without abnormalities in the second and
early third trimester, the best parameters to use for
EFW are
(A) CRL
(B) FL/AC
(C) BPD, HC, AC, FL
(D) BPD/FL
(C) Multiple parameters help to increase the accuracy of estimated fetal weight.
219
When measuring the femur, the calipers should be placed at
(A) the outermost edge of the bone
(B) include epiphyseal plate
(e) the diaphysis of the shaft of the femur
(D) the edges of the entire bone, including the head and neck of the femur
(B) Only the shaft of the femur should be measured in femur length, excluding the femoral neck and other epiphyseal calcification centers.
220
```
Polyhydramnios is most commonly associated with
what finding?
(A) insulin-dependent diabetes mellitus
(B) duodenal atresia
(C) idiopathic
(D) micrognathia
```
(C) Of the cases with polyhydramnios, 60% are idiopathic, 20% are structural, and 20% are maternal insulin depen-dent diabetes mellitus.
221
```
Polyhydramnios may be associated with which of the following?
(A) osteogenesis imperfecta
(B) cleft lip
(e) maternal diabetes
(D) twin-twin transfusion
(E) A and B
(F) all of the above
```
(F) Polyhydramnios has many causes that may include increased urine production or decreased fetal swallow-ing.
222
```
At what gestational age should the amnion and chorion be fused?
(A) 8 weeks
(B) 10 weeks
(C) 16 weeks
(D) 20 weeks
```
(C) Amnion begins to fuse with the chorion at 12 weeks and is routinely complete by 14-16 weeks.
223
```
The placenta is responsible for all of the following except
(A) exchange of nutrients
(B) hematopoiesis
(C) oxygen exchange
(D) barrier to some medications
```
(B) Hematopoiesis, or red blood cell production, is done by the fetus. The placenta is responsible for the exchange of nutrients, oxygen, and waste. The placenta also acts as a barrier although some medication can cross through the placenta.
224
Placental abruption is primarily diagnosed by ultra-sound.
(A) true
(B) false
(B) The diagnosis is determined by the history and
| physical findings. Most commonly, the patient presents with vaginal bleeding and abdominal or back pain.
225
Placental abruption is
(A) the premature separation of placenta before 20 weeks
(B) the premature separation of placenta after 20 weeks (C) the premature separation of placenta at any gesta-tional age
(D) the same as a retrochorionic clot
(C) Placental abruption usually occurs in the third trimester, although it is possible at any point in the
pregnancy.
226
```
Sonographic signs of placental abruption include
(A) retroplacental veins >2 cm
(B) echogenic periplacental hematomas
(C) hypoechoic periplacental hematomas
(D) A and C
(E) all of the above
```
(D) The hypoechoic region behind the placenta should measure 1-2 cm in thickness. Any increase in thickness of this area should alert the sonographer to a possible hematoma.
227
```
Placental abruption is associated with
(A) drug abuse
(B) fibroids
(C) maternal vascular disease
(D) A and C
(E) all of the above
```
(E) Other risk factors include: abdominal trauma, smoking, sudden decompression of the uterus (i.e. delivery of a twin or PROM), prolonged PROM, uterine anomaly, high pariety, and prior abruption.
228
```
Risks for placenta accreta include
(A) maternal hypertension
(B) isoimmunization
(C) previous cesarean section
(D) infertility
```
(C) Implantation sites at risk for placenta accreta are uterine scars, submucosal fibroids, lower uterine segment, rudimentary horn, and uterine cornua.
229
```
"Swiss cheese" appearance retroplacentally is asso-ciated with what abnormality?
(A) placenta previa
(B) placental abruption
(C) placenta accreta
(D) placental chorioangioma
```
(C) The "swiss cheese" appearance is referring to large anechoic spaces in and behind the placenta and increased placental vascularity.
230
Placenta percreta refers to
(A) invasion of placental tissue through the uterus into bladder
(B) invasion of placental tissue into myometrium
(C) invasion of placenta up to the serosal layer
(D) placental attachment to the myometrium without invasion
(A) Placenta accreta may be divided into:
(1) placenta accreta vera-placental attachment to the myometrium without invasion,
(2) placenta increta-invasion of placenta into the myometrium and
(3) placenta percreta-invasion of placenta through
the uterus and into other organs.
231
```
Name the placental vascular malformation that appears as a hypoechoic mass near the cord insertion.
(A) fetal vascular anastomosis
(B) placental lake
(C) placental aneurysm
(D) chorioangioma
```
(D) Chorioangioma is a vascular mass arising from chorionic tissue and is similar to a hemangioma.
232
The fetal umbilical vein carries deoxygenated blood.
(A) true
(B) false
(B) The umbilical vein carries oxygenated blood.
233
```
The vessels in the umbilical cord are protected by.
(A) Wharton's jelly
(B) amniotic fluid
(C) serosal fluid
(D) myometrium
```
(A) Wharton's jelly is a mucoid connective tissue that surrounds the umbilical vein and artery.
234
```
A cyst in the umbilical cord is called?
(A) allantoic cyst
(B) yolk sac cyst
(C) Meckel's cyst
(D) ectodermal cyst
```
(A) A true cord cyst is attributable to allantoic duct remnants and is thought to be more common in the
first trimester.
235
```
The umbilical cord inserting in the membranes and
coursing to the placenta is termed
(A) normal cord insertion
(B) succenturiate cord insertion
(C) eccentric cord insertion
(D) velamentous cord insertion
```
(D) A velamentous cord insertion is associated with IUGR, particularly in monochorionic twins.
236
```
The umbilical cord inserting into the edge of the pla-
centa is called?
(A) normal cord insertion
(B) marginal cord insertion
(C) eccentric cord insertion
(D) velamentous cord insertion
```
(C) An eccentric cord insertion is considered a normal variant and is of no clinical significance.
237
```
The most common cardiac defect is
(A) hypoplastic left heart syndrome
(B) atrial/ventricular septal defect
(C) tetralogy of Fallot
(D) none of the above
```
(B) Atrial and ventricular septal defects are the most
common defects accounting for 26% of the cardiac
abnormalities.
238
```
The left side of the heart is responsible for perfusing
(A) cranial aspects of the fetus
(B) systemic aspects of the fetus
(C) placenta
(D) none of the above
```
(A) Generally, the left side of the heart perfuses the fetal cranium.
239
```
The right side of the heart is responsible for perfusing
(A) cranial aspects of the fetus
(B) systemic aspects ofthe fetus
(C) placenta
(D) none of the above
```
(B) Generally, the right side of the heart perfuses the systemic circulation of the fetus.
240
```
The heart should occupy what percentage of the fetal thorax?
(A) 25
(B) 30
(C) 60
(D) 75
```
(B) The ratio of the heart circumference to the thoracic circumference should be 30-50%.
241
```
If the axis of the heart is pointed to the right, the sonographer should look for
(A) an interrupted IVC
(B) other heart abnormalities
(C) abdominal organ orientation
(D) all of the above
```
(D) This condition is called situs inversus (partial or total), dextrocardia and heterotaxy syndrome. Along with dextrocardia, there may be significant intracardiac anomalies, anomalies of the great vessels, an interrupted IVC, an anomalous venous return system, asplenia or polysplenia, and possible heterotaxy of the abdominal organs depending on whether it is complete or partial.
242
```
The most common cardiac defect associated with trisomy 21 is
(A) atrial/ventricular septal defect
(B) hypoplastic left heart syndrome
(C) AV canal defect
(D) transposition of the great vessels
```
(C) 50 of trisomy 21 cases have a cardiac defect, the majority being AV canal defects.
243
From the four-chamber view, the transducer is tilted
toward the fetal left shoulder. This will obtain what
cardiac view?
(A) five-chamber view
(B) short axis view
(C) long axis view
(D) aortic arch
(C) This view allows for visualization of the right ventricular outflow tract, the left ventricular outflow tract and the crossing of the outflow tracts.
244
What anatomy should be evaluated in the four-chamber view?
(A) junction of the AV valves with the atrial and ventricular septum intact
(B) equally sized ventricular chambers
(C) contractility of the heart
(D) A and B
(E) all of the above
(E) Other structures to evaluate include atrial sizes, foramen ovale, coronary vessels, thickness of the ventricular walls, cardiac orientation and size.
245
All ventricular septal defects can be detected in the four-chamber view.
(A) true
(B) false
(B) Ventricular septal defects can be divided into
the muscular and membranous regions. A muscular
VSD is within the muscular portion of the septum
and may be detected from a four-chamber view. A
membranous VSD is just below the aortic valve and
is confirmed in the long axis view of the heart.
246
Hypoplastic left heart syndrome is easily apparent at 18 weeks.
(A) true
(B) false
(B) In most cases, hypoplastic left heart syndrome
(HLHS) is easily visualized by 18 weeks. It is possible for HLHS to evolve through the pregnancy due
to aortic coarctation.
247
```
Which of the following heart abnormalities are difficult or unable to be identified on fetal echo-cardiography?
(A) coarctation of the aorta
(B) Ebstein's anomaly
(C) double outlet right ventricle
(D) none of the above
```
(A) Coarctation of the aorta is a narrowing of the aorta, usually near the ductus arteriosis. It may be very difficult to image depending on the degree of stenosis. Often diagnosis relies on the ventricular discrepancy indicating that a stenosis is present.
248
```
The majority of congenital diaphragmatic hernias are
(A) left sided
(B) right sided
(C) bilateral
(D) midline
```
(A) Of the diaphragmatic hernias, 75-90% are left sided, 10% are right and <5% are bilateral.
249
On sonogram, the fetal heart is deviated to the right
with apex pointed to the left. The sonographer should
consider what possible abnormalities?
(A) congenital diaphragmatic hernia
(B) congenital cystic adenomatoid malformation
(C) teratoma
(D) A and B
(E) all of the above
(E) Whenever the heart is deviated with the correct apex orientation, the sonographer should consider a
thoracic mass.
250
```
In the identification of congenital diaphragmatic hernia, the sonographer should also assess
(A) the location of the fetal liver
(B) fetal kidneys
(C) fetal bladder
(D) all of the above
```
(A) It is important to identify the location of the fetal liver. If the liver is intrathoracic, the prognosis for survival is 43. If the liver is intrabdominal the prognosis is 80 survival.
251
The significant perinatal mortality of fetuses with
congenital diaphragmatic hernia is caused by
(A) chromosomal abnormalities
(B) oligohydramnios
(C) associated cardiac defects
(D) pulmonary hypoplasia
(D) Although chromosomal abnormalities and associated anomalies are prevalent in congenital diaphragmatic hernia, the significant factor in mortality is pulmonary hypoplasia.
252
Congenital diaphragmatic hernia has a poorer prog-nosis if
(A) it is a left-sided defect
(B) the stomach is located on the left and anterior
(C) if bowel is identified in the chest
(D) if liver is identified in the chest
(D) If the liver is intrathoracic, the survival rate is 43%, if the liver is intrabdominal, the survival rate is 80%.
253
The most frequently identified chest mass is
(A) right-sided diaphragmatic hernia
(B) left-sided diaphragmatic hernia
(C) congenital cystic adenomatoid malformation
(D) pulmonary sequestration
(C) CCAM accounts for 75-80% of congenital lung
| malformations with over 95% of those being unilateral.
254
```
Congenital cystic adenomatoid malformation is divided into three types. Type I is
(A) microcystic
(B) medium-sized cysts
(C) macrocystic
(D) mixed-size cysts
```
(C) Macrocystic is defined as multiple large cyst measuring 2-10 cm.
255
```
Type II congenital cystic adenomatoid malformation is
(A) microcystic
(B) medium-sized cysts
(C) macrocystic
(D) mixed-size cysts
```
(B) Type II cysts are <2 cm, but still visible.
256
```
Type III congenital cystic adenomatoid malformation is
(A) microcystic
(B) medium-sized cysts
(C) macrocystic
(D) mixed-size cysts
```
(A) Sonographically, these appear as a solid, homo-genous, echogenic lung mass.
257
Pulmonary sequestrations may be found in the fetal
abdomen.
(A) true
(B) false
(A) Approximately 10-15 of pulmonary sequestrations are found within or below the diaphragm, typically on the left side.
258
```
The majority of pulmonary sequestrations are found
(A) inferior to the diaphragm
(B) in the lower left lung base
(e) in the lower right lung base
(D) in the upper left pulmonary lobe
```
(B) The most common appearance detected prenatally is a well-circumscribed echogenic mass in the left lower lung base.
259
Esophageal atresia is routinely diagnosed by ultra-
sound because of an absent or small stomach bubble.
(A) true
(B) false
(B) Ninety percent of esophageal atresias have a TE fistula that communicates with the stomach. Polyhydramnios may not develop until the third
trimester, making a second trimester diagnosis difficult.
260
```
What percentage of esophageal atresias have a tracheoesophageal fistula?
(A) 25
(B) 50
(C) 75
(D) 90
```
(D) There are five types of TE fistulas. They comprise 90% of the cases of esophageal atresia.
261
Eighty percent of fetuses with esophageal atresia
have what associated condition in the third trimester?
(A) intrauterine growth retardation
(B) macrosomia
(C) polyhydramnios
(D) decreased abdominal circumference
(C) Regardless of the presence of a TE fistula, 80%
| of fetuses derive polyhydramnios by the third trimester.
262
```
Esophageal atresia has a strong association with what chromosomal abnormality?
(A) trisomy 21
(B) trisomy 18
(C) trisomy 13
(D) translocation
```
(B) Esophageal atresia is a very strong marker for trisomy 18.
263
```
The "double bubble" sign refers to
(A) two-vessel umbilical cord
(B) duodenal atresia
(C) ureterocele
(D) hypotelorism
```
(B) Amniotic fluid fills the stomach and duodenum
proximal to the site of obstruction. The ultrasound
appearance resembles a "double bubble."
264
```
Fifty percent of fetuses with duodenal atresia also have which of the following abnormalities?
(A) spinal defects
(B) cardiac defects
(C) macrosomia
(D) A and B
(E) all of the above
```
(D) Thirty-three percent will have spinal defects, 36% will have cardiac defects.
265
```
Duodenal atresia has a strong association with what
chromosomal abnormality?
(A) trisomy 21
(B) trisomy 18
(C) trisomy 13
(D) unbalanced translocation
```
(A) Thirty percent of fetuses with duodenal atresia have trisomy 21.
266
```
The physiological herniation of bowel into the umbilical cord is complete by what gestational age?
(A) 8 weeks
(B) 9 weeks
(C) 11 weeks
(D) 13 weeks
```
(C) The bowel begins to herniate at 8 weeks and
becomes most visible at 9-10 weeks on ultrasound,
because of the rotation of the bowel. The bowel then
returns to the abdomen by the end of the 11th week.
267
Gastroschisis has more associated defects and chromosomal abnormalities than omphaloceles.
(A) true
(B) false
(B) Chromosomal and associated defects (non-gastrointestinal) with gastroschisis are very rare.
268
MSAFP is elevated more with omphaloceles than with gastroschisis.
(A) true
(B) false
(B) Gastroschisis is a defect in the abdominal wall in which the bowel herniates into the amniotic fluid. This allows the AFP to enter the amniotic fluid directly from the abdominal wall defect, cross the placenta, and enter the maternal blood stream. The mean AFP value for gastroschisis is 7 MoM versus 4.1 MoM for omphaloceles.
269
Which of the following about gastroschisis is true?
(A) more common with advanced maternal age
(B) often associated with other abnormalities
(C) has a very good prognosis with 80-90% survival rate
(D) has an autosomal recessive inheritance
(C) Gastroschisis is rarely associated with chromosomal or nongastrointestinal disorders and has an excellent survival rate.
270
```
Sonographic signs of bowel perforation include all of
the following except
(A) thickened bowel loops
(B) abdominal calcifications
(C) meconium cysts
(D) oligohydramnios
```
(D) When the bowel perforates, meconium enters the
peritoneal space. A membrane forms that seals off the
intestine at the site of the perforation. The meconium
that entered the peritoneum may cause calcium
deposits. Other findings are polyhydramnios, ascites
with echogenic debris, and bowel dilation.
271
```
Intrauterine complications of gastroschisis include all of the following except
(A) IUGR
(B) edematous bowel wall
(C) intestinal obstruction
(D) dilated fetal stomach
(E) none of the above
```
(E) All of the above. They may all cause a complication in gastroschisis and should be monitored with ultrasound throughout the pregnancy.
272
Gastroschisis is a break in the abdominal wall at the
level of the umbilical cord. Where does this typically
occur?
(A) right side of the umbilical cord
(B) left side of the umbilical cord
(C) at the umbilical cord insertion with cord attaching to the gastroschisis
(D) medially and inferior to the umbilical cord
(A) Although left-sided gastroschisis have been reported, it is typically to the right of the umbilical cord.
273
Physiological herniation <12 weeks may also include
bowel and liver.
(A) true
(B) false
(B) The physiological hernia is the outpouching of the intestines as they rotate around the SMA and then return to the abdomen.
274
Large omphaloceles have a worse prognosis than small omphaloceles.
(A) true
(B) false
(B) The presence of bowel without liver in the smaller
omphaloceles has a stronger association to abnormal
karyotypes and perinatal mortality.
275
A midline defect in the anterior abdominal wall with
herniation of abdominal contents into the base of the
umbilical cord is called
(A) gastroschisis
(B) omphalocele
(C) cloacal exstrophy
(D) pentalogy of Cantrell
(B) Small omphaloceles may be mistaken for a cord hematoma. If the defect at the base of the cord insertion is >7 mm it is most likely an omphalocele.
276
```
Omphaloceles are associated with all of the following except
(A) advanced maternal age
(B) chromosomal abnormalities
(C) maternal smoking
(D) cardiac abnormalities
```
(C) Omphaloceles are not associated with teratogens, such as maternal smoking.
277
The terminology for a midline defect of the chest with
the heart herniated to the outside of the chest is
(A) rachyschisis
(B) ectopia cordis
(C) cloacal extrophy
(D) limb-body wall complex
(B) Ectopia cordis results from underdevelopment or
agenesis of the fetal sternum. It is rarely isolated and
is most commonly part of the pentalogy of Cantrell.
278
```
An omphalocele and ectopia cordis are identified on
sonogram. What condition should be included in the
differential?
(A) pentalogy of Cantrell
(B) trisomy 18
(C) Beckwith-Wiedemann syndrome
(D) A and B
(E) all of the above
```
(D) Pentalogy of Cantrell involves defects of the lower sternum, diaphragm, diaphragmatic pericardium,
abdominal wall, and intracardiac defects. It is associated with trisomy 13 and trisomy 18.
279
```
Beckwith-Wiedemann syndrome is a group of which of the following disorders?
(A) omphalocele
(B) shortening of limbs unilaterally
(C) macroglossia
(D) polyhydramnios
(E) A and C
(F) all of the above
```
(F) Beckwith-Wiedemann syndrome is due to a dysfunction of the placenta excreting increased levels of growth hormone. This causes organomegaly, macroglossia, omphalocele, hemi hypertrophy, and
cardiac abnormalities.
280
```
If the bladder is herniated through the ventral wall and a spinal defect is identified, what condition should be considered?
(A) bladder exstrophy
(B) cloacal exstrophy
(C) pentalogy of Cantrell
(D) limb-body wall complex
```
(B) Cloacal exstrophy is believed to arise from irregular development of the cloacal membrane. Neural tube defects are present 50 of the time.
281
```
A condition in which no umbilical cord may be iden-tified, along with ventral wall defects, and scoliosis
is most likely
(A) cloacal exstrophy
(B) amniotic synechia
(C) limb-body wall complex
(D) complete ventral wall defect
```
(C) Limb-body wall complex (LBWC) is the most severe abdominal wall defect with the entire ventral wall disrupted. If the umbilical cord is visualized at all, it is very short and severe scoliosis is present.
282
Amniotic bands differ from amniotic sheets because
(A) amniotic bands are attached to the uterus at both ends
(B) amniotic sheets often cause disruption in the first trimester
(C) amniotic bands can cause amputation or limb deformities
(D) there is no difference between amniotic bands and sheets
(C) Amniotic band syndrome is a rupture of the amnion early in pregnancy. That rupture allows bands of amniotic tissue to float freely in the amniotic fluid. If these bands come in contact with the fetus, they can cause strictures, amputations, and adhesions to the band itself. Amniotic sheets, also known as uterine synechia, are caused by scars or adhesions in the uterus. The amnion and chorion grow around the synechia and form a thick membrane with two layers of amnion and chorion on either side of the membrane. It is attached to the uterus at both ends and does not impede the fetus in any way.
283
```
Rh isoimmunization results from which of the following combinations?
(A) mother Rh- and father Rh-
(B) mother Rh- and father Rh-
(C) mother Rh+ and fetus Rh-
(D) mother Rh- and fetus Rh+
```
(D) If a mother is Rh-, she will produce antibodies against an Rh+ fetus. The mother's antibodies will
perceive the fetal blood as foreign and attack the
fetal red blood cells resulting in erythroblastosis
fetalis.
284
The Rh immune globulin is effective against the anti-D antibody; therefore, immune hydrops no longer exists in anyone able to receive rhogam.
(A) true
(B) false
(B) There are many other antibodies in addition to the anti-D antibody that can cause immune hydrops.
285
```
The hemolytic process of destruction of fetal red blood cells by the maternal antibodies is termed
(A) hypercoagulation
(B) erythroblastosis fetalis
(C) thrombocytopenia
(D) nonimmune hydrops
```
(B) This condition will cause immune hydrops in the fetus
286
Immune and nonimmune hydrops may be differentiated by their sonographic appearances.
(A) true
(B) false
(B) Both immune and nonimmune hydrops present the same sonographically.
287
```
Signs of congestive heart failure in the fetus are
(A) serous effusions
(B) enlarged fetal liver
(C) fetal ascites
(D) all of the above
```
(D) Other signs of heart failure include pericardial effusions, decreased contractility, increased ventricular thickness, abnormal umbilical cord, and middle cerebral artery Doppler.
288
How is the diagnosis of fetal hydrops made by sonog-raphy?
(A) two fetal sites of fluid accumulation
(B) fetal ascites and one site of accumulated fluid
(C) one site of fluid accumulation and oligohydramnios
(D) A and B
(E) A and C
(F) all of the above
(D) Fetal hydrops is defined as two sites of fluid accumulation or one site of fluid accumulation and fetal ascites.
289
```
In cases of fetal distress in diabetic mothers, the fetal heart may
(A) have thickened ventricular walls
(B) have decreased contractility
(C) have increased cardiac output
(D) A and B
(E) all of the above
```
(D) The cardiac ventricular walls will thicken and contractility decreases. This causes the cardiac output to decrease. This may lead to acidosis, increased hematocrit, and increased neonatal morbidity.
290
```
The main causes for nonimmune hydrops include
(A) fetal abnormalities
(B) parvovirus
(C) anti-Kell antibodies
(D) A and B
(E) A and C
(F) all of the above
```
(D) The list of causes for nonimmune hydrops fetalis (NIHF) is more than 120 conditions, some of which are rare. Major causes are: cardiac arrhythmias and tumors, abnormal chromosomes, cardiac failure, anemia, AV shunts, mediastinal compression, metabolic disease, fetal infection, fetal tumors, congenital fetal defects, and placental defects.
291
A quick way to check for organ orientation is to
assure that the heart and stomach are on the same
side of the fetus.
(A) true
(B) false
(B) A complete situs inversus will appear with the heart and normally positioned left-sided abdominal organs on the right side. A complete situs inversus has a minimally increased risk of abnormalities and is not as significant as a partial situs inversus.
292
Partial situs inversus is associated with more significant abnormalities than complete situs inversus.
(A) true
(B) false
(A) Partial situs inversus, divided into asplenia and polysplenia, has a 40 incidence of anomalies. They
include complex heart disease, absent gallbladder,
interrupted IVC with an azygous venous return, and
splenic abnormalities.
293
```
In cases of partial situs inversus, the sonographer
should consider
(A) cardiac defects
(B) polysplenia
(C) asplenia
(D) interrupted IVC
(E) B and C
(F) all of the above
```
(F) Partial situs inversus, divided into asplenia and
polysplenia, has a 40 incidence of anomalies. They
include complex heart disease, absent gallbladder,
interrupted IVC with an azygous venous return and
splenic abnormalities.
294
```
On a sonogram, the fetus has unilateral hydronephrosis, nonvisualized ureters, normal bladder, and normal AFV. This most likely represents
(A) unilateral UVJ obstruction
(B) unilateral UPJ obstruction
(C) PUV
(D) none of the above
```
(B) A ureteropelvic junction (UPJ) obstruction is an
obstruction at the junction of the ureter and renal pelvis. Therefore, the fetal urine is obstructed within
the kidney causing hydronephrosis, but not hydro-ureter. As long as the contralateral kidney is functioning normally, the amniotic fluid should remain normal.
295
```
A UVJ obstruction is associated with what other findings?
(A) ureterocele
(B) unilateral hydronephrosis
(C) pelvic kidney
(D) A and C
```
(A) A ureterovesicle junction (UV J) obstruction is an obstruction at the junction of the ureter and fetal bladder. It is associated with ureter anomalies, such
as duplication and abnormal insertion sites. There is often an ureterocele caused by the abnormal insertion of the ureter. Hydroureter and mild hydronephrosis are commonly present.
296
A hydroureter will appear differently than dilated bowel on sonogram because
(A) ureters are predominately lateral structures in the fetal abdomen
(B) ureters will appear predominately anechoic
(C) bowel will appear predominately anechoic
(D) dilated large bowel mainly found in the midline of the fetus
(B) Ureters will typically appear anechoic and tortuous on sonogram. Bowel is typically hypoechoic with peristalsis.
297
The trigone refers to is
(A) the point at which the ureter enters the kidney
(B) the region where the urethra exits the body
(C) the region of the bladder containing the orifices of the ureters and urethra
(D) the region ofthe bladder containing the orifice of the urethra
(C) The trigone is located at the inferior portion of the posterior bladder wall.
298
Posterior urethral valve obstruction is found only in males.
(A) true
(B) false
(B) Although it is overwhelmingly found in males, it may rarely be found in females. In females, it is usually caused by a cloacal malformation or urethral atresia.
299
```
Complete posterior urethral valve obstruction has all of the following ultrasound characteristics except
(A) hydramnios
(B) hydronephrosis
(C) hydroureter
(D) ''keyhole'' bladder
(E) lax abdominal wall
```
(A) Complete PUV obstruction does not allow for any fetal urination, therefore severe oligohydramnios occurs.
300
Potter's facies refers to
(A) flattened facial features caused by the lack of amniotic fluid in PUV syndrome
(B) abnormal development of the abdominal muscles caused by the overdistended bladder in PUV syndrome
(C) the appearance of the fetal bladder in PUV syndrome
(D) other name for urinary ascites
(A) Potter's facies also includes low set ears, clubfoot, and hip dislocation.
301
```
The primary cause of death in posterior urethral valve outlet syndrome is
(A) renal failure
(B) sepsis
(C) cardiac overload
(D) pulmonary hypoplasia
```
(D) The primary cause of neonatal death in PUV syndrome is pulmonary hypoplasia, although the other entities are also serious complications.
302
Sonographic features of renal agenesis include all except
(A) inability to demonstrate blood flow in renal arteries
(B) elongated adrenal glands in the renal fossa
(C) low amniotic fluid
(D) unable to visualize fetal bladder
(C) In cases of renal agenesis, particularly after 16 weeks, anhydramnios is present.
303
```
How often does the fetal bladder fill?
(A) every 10 minutes
(B) every 30 minutes
(C) every hour
(D) every 2 hours
```
(B) A normal fetal bladder should empty every 30-45 minutes.
304
During organogenesis, the kidneys migrate from
(A) the thorax, moving inferiorly to the renal fossa
(B) the anterior midgut to the posterior renal fossa
(C) the pelvis, moving superiorly to the renal fossa
(D) the kidneys do not migrate
(C) Kidneys begin to develop at 7 weeks. Between 7 and 11 weeks, the kidneys migrate cephalically into the renal pelvis.
305
```
In the early stages of organogenesis, how many kidneys form?
(A) 2
(B) 3
(C) 4
(D) 6
```
(D) Three pairs of kidneys form in successive stages:
pronephros, mesonephros, and metanephros with
metanephros remaining as the functioning kidney.
306
```
What other organ system has a strong correlation with renal abnormalities?
(A) cardiac
(B) uterine
(C) ovarian
(D) muscular
```
(D) The urinary system develops closely with the uterine development. Twenty to thirty percent of patients with uterine anomalies also have renal ectopia or agenesis.
307
All of the following about multicystic dysplastic kidney disease is true except
(A) caused by a first trimester obstruction
(B) caused by a second trimester obstruction
(C) multiple, varying sized cysts in the parenchyma
(D) echogenic parenchyma
(B) Multicystic dysplastic kidney disease is caused by a first trimester obstruction. The kidney is nonfunctioning with ureteral atresia.
308
```
In the case of unilateral, multi cystic, dysplastic kidney disease, the contralateral kidney will often
(A) enlarge
(B) become obstructed
(C) have decreased function
(D) remain the same
```
(A) In cases of a unilateral nonfunctioning kidney, the contralateral kidney will often enlarge to compensate. The unilateral kidney usually provides enough function to be sufficient for the individual.
309
```
If one parent has autosomal dominant polycystic kidney disease, the risk for the fetus having the same disease is
(A) 25%
(B) 50%
(C) 75%
(D) 100%
```
(B) The risk to the fetus in an autosomal dominant disease with one parent affected is 50%.
310
A 26-week fetus presents with large echogenic kidneys that contain some small cysts. The amniotic fluid volume is normal. Differential diagnosis includes
(A) autosomal recessive polycystic kidney disease
(B) autosomal dominant polycystic kidney disease
(C) Meckel's syndrome
(D) A and C
(E) all of the above
(B) Autosomal dominant polycystic kidney disease does not typically cause renal disease prenatally therefore the amniotic fluid is normal. The kidneys may appear large and echogenic. Autosomal recessive polycystic kidney disease does affect renal function and is associated with oligohydramnios. Meckel's syndrome is associated with encephaloceles and postaxial polydactyly.
311
```
The kidneys should occupy how much of the fetal abdomen in an axial plane of view?
(A) 1/4
(B) 1/3
(C) 1/2
(D) 2/3
```
(B) Although kidneys grow throughout gestation, the ratio of kidneys to abdomen remains constant at 0.27-0.30.
312
Anechoic cysts that surround the periphery of the kidney in a "string of pearls" appearance most likely
represent
(A) multicystic dysplastic kidney disease
(B) autosomal dominant polycystic kidney disease
(C) normal renal pyramids
(D) early-stage obstructed renal pyramids
(C) Unless the kidney is echogenic or obstructed, the anechoic cysts in the periphery represent normal renal pyramids.
313
```
The fetus begins to produce urine at what gestational age?
(A) 10 weeks
(B) 13 weeks
(C) 17 weeks
(D) 20 weeks
```
(B) Fetal urine production begins at 12 weeks, but the fetal kidneys do not produce the majority of the fetal urine until 16 weeks.
314
It is possible for the fetal bladder to rupture in utero.
(A) true
(B) false
(A) In PUV cases, the fetal bladder may rupture creating urine ascites.
315
```
In the second trimester, the normal renal pelvis size is
(A) less than 20 mm
(B) less than 15 mm
(C) less than 8 mm
(D) less than 6 mm
```
(D) Although this is somewhat debated, many sources quote a number from 4-6 mm as the upper limit of normal in the second trimester.
316
Renal Grade 0
no dilation
317
Renal Grade I
renal pelvic dilation with or without infundibula visible
318
Renal Grade II
renal pelvic dilation with calices visible
319
Renal Grade III
renal pelvis and calices dilated
320
Renal Grade IV
renal pelvis and calices dilated with parenchymal thinning
321
```
A rare renal tumor that is large, solid, and highly vascular is
(A) neuroblastoma
(B) renal teratoma
(C) congenital mesoblastic nephroma
(D) none of the above
```
(C) Because of its vascularity, the fetus may experience heart failure and polyhydramnios. On ultrasound, a congenital mesoblastic nephroma will resemble a Wilm's tumor.
322
```
A malignant adrenal gland tumor that appears as an echogenic, heterogenous mass is
(A) neuroblastoma
(B) teratoma
(C) Wilm's tumor
(D) none of the above
```
(A) A neuroblastoma appears as a suprarenal mass and should be considered when a mass is identified superior to the kidney.
323
```
A congenital mesoblastic nephroma is also known as a
(A) neuroblastoma
(B) teratoma
(C) Wilm's tumor
(D) William's tumor
```
(C) Nephroblastoma, also known as Wilm's tumor, is a malignant renal tumor that sonographically appears similar to a mesoblastic nephroma.
324
```
The degree to which the head shapes may affect biparietal diameter (BPD) can be estimated by which of the following formulas?
(A) HC = BPD2 + OFD
(B) V = 7(pi/6(bpd/OFD)
(C) CI = BPD/OFD x 100
(D) BPD = BPD x OFD/1.256
```
(C) A change in head shape, such as brachycephaly
or dolicocephaly, affects accurate measurement in
predicting gestational age. The degree to which fetal
head shape affects BPD can be estimated with the
formula:
CI = BPD/OFD x 100
325
```
The most common cause for ovarian torsion is
(A) ovarian tumors
(B) hyperstimulation of the ovary
(C) adhesions
(D) hypervascularity to the ovary
```
(A) Ovarian tumors account for 50-81% of torsion.
326
Causes for ovarian hyperstimulation may include
(A) oral contraceptives
(B) hyperstimulation of the ovaries by infertility medications
(C) hydatidiform mole
(D) all of the above
(B) Risks for ovarian hyperstimulation syndrome include: advanced maternal age, polycystic ovarian disease, oral contraceptives, and obesity.
327
```
Ovaries that have been overstimulated by infertility
medication are at risk for
(A) producing grossly enlarged cysts
(B) torsion
(C) endometriosis
(D) A and B
(E) all of the above
```
(D) Hyperstimulated ovaries produce large cysts that may torse, as well as cause fullness and nausea to the patient. Rarely, more severe complications can occur because of the shift in fluid resulting in ascites and effusions.
328
```
The sonographic characteristics of ovarian torsion are
(A) enlarged ovaries
(B) edematous ovarian walls
(C) decreased intraovarian blood flow
(D) all of the above
```
(D) Torsed ovaries will appear edematous with a change in blood flow patterns. First is the loss of
venous flow, followed by the lack of arterial flow in a
complete ovarian torsion.
329
Fibroids are estrogen-stimulated tumors.
(A) true
(B) false
(A) Fibroids are estrogen dependent and will increase with pregnancy and decrease postmenopausally.
330
A rapidly growing fibroid in the first trimester of
pregnancy is not as worrisome as a rapidly growing
fibroid in a postmenopausal woman because
(A) of the rapid rise of progesterone in the first trimester
(B) of the decrease of estrogen in postmenopausal
women
(C) rapid fibroid growth is not worrisome
(D) both cases are cause for concern
(B) Fibroids are estrogen dependent and commonly increase in pregnancy and decrease postmenopausally. The only sonographic difference between a leiomyoma and a leiomyosarcoma is a rapid increase in growth.
331
A rapidly growing fibroid in a postmenopausal woman
not on hormone replacement therapy could indicate
(A) leiomyosarcoma
(B) fibrous degeneration
(C) hemorrhagic infiltration
(D) calcific changes
(A) On ultrasound, a leiomyoma and a leiomyosarcoma appear the same. Clinically, the only difference is a rapid increase in growth in postmenopausal women.
332
In the first and second trimesters, the fetal lung is
(A) of greater echogenicity than the fetal liver
(B) of decreased echogenicity compared to the fetal liver
(C) isoechoic to the fetal liver
(D) variable in appearance
(C) The fetal lung is isoechoic to the fetal liver in the second trimester.
333
In the third trimester, the fetal lung is
(A) of greater echogenicity than the fetal liver
(B) of decreased echogenicity compared to the fetal liver
(C) isoechoic to the fetal liver
(D) variable in appearance
(A) Although the lung increases in echogenicity throughout the pregnancy, researchers have not been
able to correlate the increase with lung maturity.
334
```
The femoral epiphyseal plates are visualized on sono-
gram after
(A) 13 weeks
(B) 20 weeks
(C) 24 weeks
(D) 32 weeks
```
(D) Visualization of the femoral epiphyseal plate is seen on fetuses with a gestational age greater than 33 weeks with 95% accuracy.
335
Postaxial polydactyl is
(A) an extra digit on the ulnar aspect of the fetal hand
(B) an extra digit on the radial aspect of the fetal hand
(C) curvature of the last digit on the ulnar aspect
(D) an extra digit on the fetal foot
(A) Polydactyly may be isolated or occur as part of a syndrome. The extra digit may have a bone or be soft tissue only. Postaxial refers to the ulnar aspect of the hand.
336
Preaxial polydactyl is
(A) an extra digit on the ulnar aspect of the fetal hand
(B) an extra digit on the radial aspect of the fetal hand
(C) curvature of the last digit on the ulnar aspect
(D) an extra digit on the fetal foot
(B) Polydactyly may be isolated or occur as part of a syndrome. The extra digit may have a bone or be soft tissue only. Preaxial refers to the radial aspect of the hand.
337
Concordant growth in twins refers to
(A) <10 difference in EFW between the twins
(B) <20 difference in EFW between the twins
(C) both fetus within normal range on a normal growth curve
(D) fetus remaining at the same EFW percentile from exam to exam
(B) Discordance in dichorionic/diamniotic twins is more acceptable because of their different genetic makeup, provided that the smaller twin is not less than the 10th percentile in EFW. In monochorionic twins, EFW should be concordant and not differ by more than 20.
338
Concordant twin growth is more important in dichorionic twins than monochorionic twins.
(A) true
(B) false
(B) Discordance in dichorionic/diamniotic twins is more acceptable because of their different genetic makeup, provided that the smaller twin is not less than the 10th percentile in EFW. In monochorionic twins, EFW should be concordant and not differ by more than 20%.
339
The formula for determining EFW discordance is?
(A) smallest EFW + largest EFW/smallest EFW
(B) smallest EFW x 2 -largest EFW/largest EFW
(C) largest EFW - smallest EFW /largest EFW x 100
(D) largest EFW x 100 - smallest EFW/largest EFW
(C) Twin fetal discordance is determined by subtracting the largest twin from the smallest twin and dividing by the largest twin. This number is multiplied by 100 to determine the percentage.
340
What is frank breech?
(A) when both feet are prolapsed into the lower uterine segment
(B) when one foot is prolapsed into the vagina
(C) when the fetal head is to the maternal right and the buttocks are to the maternal left
(D) when the buttocks descend first, the thighs and legs are extended upward along the anterior fetal trunk
(D) Frank breech is described as the buttocks descending first with the thighs and legs extending upward along the anterior fetal trunk.
341
What is complete breech?
(A) when both feet are prolapsed into the lower uterine segment
(B) when both feet are prolapsed into the vagina
(C) when the buttocks descend first, the knees are flexed, baby sitting cross-legged
(D) when the thighs and legs are extended upward along the anterior fetal trunk
(C) Complete breech is described as the buttocks descending first with the knees flexed, and the fetus
sitting cross-legged.
342
What is footling breech?
(A) when one or both feet are prolapsed into the lower uterine segment
(B) when one foot is prolapsed into the fundus
(C) when the buttocks descend first, the knees are flexed, fetus sitting cross-legged
(D) when the thighs and legs are extended upward along the anterior fetal trunk
(A) A footling breech is when one or both feet are prolapsed into the lower uterine segment.
343
```
A fetal karyotype is 46 XY. This fetus is
(A) affected with Down syndrome
(B) affected with Turner syndrome
(C) a boy
(D) a girl
```
(C) XY karyotype indicates a male fetus. XX karyotype indicates a female fetus. Down syndrome is labeled 47, +21, and Turner syndrome is labeled 45X.
344
```
A fetal karyotype is 47X.. This fetus is
(A) affected with Down syndrome
(B) affected with Turner syndrome
(C) a boy
(D) a girl
```
(B) XY karyotype indicates a male fetus. XX karyotype indicates a female fetus. Down syndrome is labeled 47, +21, and Turner syndrome in labeled 45X.
345
In a twin pregnancy with only one placenta, a dividing membrane is the only structure that needs to be identified to determine zygocity.
(A) true
(B) false
(B) A membrane may be present with a dichorionic/
| diamniotic or monochorionic/diamniotic pregnancy. A zygocity indicator would be fetal genders (if different).
346
When labeling twins, fetus A should be
(A) the first fetus identified
(B) the fetus closest to the fundus
(C) the fetus closest to the internal os
(D) any of the above methods is appropriate
(C) The fetus (regardless of the body part), as well as
| the sac, closest to the internal os is labeled fetus A.
347
```
The fetus is vertex with the spine on the maternal right. The fetal left side should be
(A) anterior
(B) posterior
(C) inferior
(D) superior
```
(A) The fetus would be lying on its right side, with left side closest to the maternal abdominal wall.
348
```
The fetus is transverse with head on the maternal left. The fetal spine is inferior. The fetal left side should be
(A) anterior
(B) posterior
(C) inferior
(D) superior
```
(A) The fetus would be lying on its right side, with the left side closest to the maternal abdominal wall.
349
```
The fetus is breech with the spine on the maternal left. The fetal left side should be
(A) anterior
(B) posterior
(C) inferior
(D) superior
```
(A) The fetus would be lying on its right side, with
| the left side closest to the maternal abdominal wall.
350
```
Subchorionic placental lakes are
(A) associated with IUGR
(B) associated with oligohydramnios
(C) also known as subchorionic fibrin deposition
(D) all of the above
```
(C) Placental lakes are areas of fibrin under the chorion, on the fetal side of the placenta. They carry no clinical significance.
351
```
Early placental maturation may be associated with
(A) hypertension
(B) gestational diabetes mellitus
(C) maternal smoking
(D) A and C
(E) all of the above
```
(D) Hypertension and maternal smoking can cause the placenta to undergo early maturation. Smoking can cause an increase in calcifications in the placenta. Unfortunately, placenta maturation has not proved to be a reliable tool in assessing placental function or fetal well-being.
352
```
A thin placenta (<1.5 cm) may be associated with all of the following except
(A) preeclampsia
(B) IUGR
(C) insulin dependent diabetes mellitus
(D) triploidy
```
(D) Triploidy from the paternal component, presents with a large cystic placenta.
353
```
A thick placenta (>5 cm) may be associated with all of the following except
(A) gestational diabetes mellitus
(B) infection
(C) multiple gestations
(D) hypertension
```
(D) Maternal hypertension can cause a restrictive flow in the uterine vessels, which in turn, may decrease the placental perfusion.
354
```
Maternal causes of IUGR may include all of the following except
(A) maternal infection
(B) diabetic mothers with vasculopathy
(C) maternal smoking
(D) gestational diabetes mellitus
```
(D) Gestational diabetes mellitus is a cause for macrosomia because of the increased maternal blood
sugars.
355
If an insulin-dependent mother is in good diabetic control in the first trimester, the risk of structural abnormalities is decreased.
(A) true
(B) false
(A) Studies have shown a 22% rate of congenital
abnormalities if hemoglobin (a reflection of blood
sugar control) was >8.5% before 14 weeks. A 3% rate
of congenital abnormalities was reported if hemoglobin was <8.5%.
356
```
Caudal regression syndrome is associated with
(A) insulin-dependent diabetes mellitus
(B) chromosomal abnormalities
(C) Noonan's syndrome
(D) hypertension
```
(A) Caudal regression syndrome is associated with
insulin-dependent diabetes mellitus in up to 16% of
the cases. It is thought to occur with poor glucose
control in the first trimester. Findings include sacral
agenesis, spinal, and lower limb abnormalities,
femoral hypoplasia, GI and GU abnormalities.
357
```
Ultrasound findings in caudal regression syndrome include all of the following except
(A) agenesis of the sacrum
(B) hypoplasia of the lower extremities
(C) agenesis of the coccyx
(D) exstrophy of the bladder
```
(D) Other findings of caudal regression syndrome may include renal, gastrointestinal, facial, and spinal abnormalities.
358
A definitive diagnosis of trisomy 18 can be made by
ultrasound if the fetus has multiple structural abnormalities.
(A) true
(B) false
(B) The only definitive test for any chromosomal abnormality is karyotyping of fetal cells.
359
```
Turner syndrome affects males and females
(A) equally
(B) males more than females
(C) females more than males
(D) males only
(E) females only
```
(E) The phenotype for Turner syndrome is 45X, indicating only one single X, or female, chromosomes.
360
The fetus of an insulin-dependent diabetic mother may suffer from IUGR.
(A) true
(B) false
(A) If the diabetic mother has significant vascular disease as a component of her diabetes, it may cause
intrauterine growth retardation in the fetus.
361
```
Fetal complications caused by maternal diabetes may include
(A) caudal regression syndrome
(B) cardiac defects
(C) shoulder dystocia
(D) A and B
(E) all of the above
```
(E) Caudal regression syndrome and cardiac defects are first trimester insults and a risk of occurrence increases with increasing blood sugar levels in the first trimester. Shoulder dystocia can occur with delivery of macrosomic fetuses.
362
```
Lung maturity amniocentesis is used in what cases?
(A) IUGR fetus with decreasing EFW
(B) insulin-dependent diabetes mellitus
(C) complete PROM
(D) A and B
(E) all of the above
```
(D) Depending on the fetal gestational age, lung maturity amniocentesis may be performed to assure
lung maturation before delivery. In cases of complete PROM, often there is not an adequate sample of amniotic fluid available for maturity testing.
363
Sonographic markers that may be used to assess
macrosomia include all of the following except
(A) humeral shoulder thickness
(B) cheek-to-cheek diameter
(C) HC/AC ratio
(D) AFV
(D) Although an increased AFV is associated with macrosomia, it is not a direct assessment of macrosomia.
364
```
In the case of anhydramnios, how can karyotype be obtained?
(A) PUBS
(B) CVS
(C) cystocentesis
(D) all of the above
```
(D) CVS and PUBS may be performed provided the placenta or umbilical cord are accessible. If the fetal
bladder is full, as in cases of PUV syndrome, fetal urine may be tested for karyotype.
365
```
Amniocentesis may be used to test for
(A) fetal infection
(B) fetal bilirubin
(C) specific short limb syndromes
(D) A and B
(E) all of the above
```
(E) Amniocentesis can be used to test the level of fetal bilirubin, infection, and for a limited amount of short limb syndromes.
366
```
Maternal hypertension may have what effect on pregnancy?
(A) fetal abnormalities
(B) chromosomal abnormalities
(C) IUGR
(D) delayed lung maturation
```
(C) Hypertension can affect the vascular bed of the placenta resulting in intrauterine growth retardation.
367
```
An excessively accelerated calcific placenta in the second trimester is associated with
(A) excessive maternal smoking
(B) chromosomal abnormality
(C) precursor to third trimester IUGR
(D) all of the above
```
(A) Excessive maternal smoking has been linked to
accelerated maturation of the placenta. It is not predictive, however, in actual placenta perfusion to the
fetus.
368
```
The abbreviation BBOW refers to
(A) baby below outer water
(B) brachycephalic baby on way
(C) bulging bag of water
(D) baby below occipital wing
```
(C) BBOW, bulging bag of water, refers to the amniotic membrane bulging into the vagina.
369
```
The abbreviation PROM refers to
(A) partially ruptured outer membrane
(B) previous rip of mucus plug
(C) partial range of motion
(D) premature rupture of membranes
```
(D) PROM, premature rupture of membranes, is the rupture of membranes before 37 weeks.
370
Overdistension of the urinary bladder may cause
(A) anterior placenta to appear previa
(B) closure of an incompetent cervix
(C) distortion or closure of the gestational sac
(D) obscured visualization of the internal iliac vein
(E) A and B only
(F) all ofthe above
(E) All of the above. Overdistension of the urinary bladder can result in serious diagnostic error. Over-
distension of the urinary bladder may result in closure
of an incompetent cervix due to bladder compression
on the cervix; placenta previa caused by bladder com-
pression on the lower uterine segment; closure of the
gestational sac caused by bladder compression that
causes both sides of the sac walls to meet resulting in
a loss of the anechoic center or a change in sac shape
(distortion); nonvisualization of the internal iliac vein
because of displacement.
371
Ovulation occurs approximately
(A) always after intercourse
(B) on the 7th day ofthe menstrual cycle
(C) on the 14th day of the menstrual cycle
(D) on the 2nd day of the menstrual cycle
(C) Ovulation occurs approximately 14 days after the first day of the last menstrual period.
372
Gravida
Gravida is a woman who is pregnant.
373
Multipara
Multipara is a woman who has given birth two or more times.
374
Nullipara
Nullipara is a woman who has never given birth to a viable infant.
375
Primipara
Primipara is woman who has given birth one
time to a viable infant, regardless of whether the
child was living at birth and regardless of whether
the birth was single or multiple.
376
Nulligravida
Nulligravida is a woman who has never been pregnant.
377
Primigravida
Primigravida is a woman who is pregnant for the first time.
378
Multigravida
Multigravida is a woman who has been pregnant several times.
379
Para
(G) Para is the number of pregnancies that have continued to viability.
380
Trimester
Trimester is a 3-month period during gestation.
381
```
Puerperium refers to the period
(A) surrounding conception time
(B) after death
(C) 6-8 weeks before delivery
(D) beginning with the expulsion of the placenta
```
(D) The puerperium period begins with the expulsion of the placenta and continues until maternal physiology and anatomy return to a prepregnancy level, approximately 6-8 weeks.
382
A postpartum gynecologic sonogram may be needed for
(A) assessing maternal hydronephrosis
(B) examining the uterus for retained placenta
(C) checking for maternal bowel obstruction
(D) all of the above
(B) Sonographic assessment of the maternal kidneys and bowel would not be considered a gynecological sonogram.
383
It is not possible to get pregnant while lactating.
(A) true
(B) false
(B) It is possible to ovulate during lactation. The risk of ovulation in the first 6 months while breast feeding is 1-5%.
384
```
Which of the following structures is most likely not
seen in a postpartum pelvic sonogram?
(A) uterus
(B) endometrial echo
(C) vagina
(D) ovaries
```
(D) The ovaries are least likely to be seen on a post-partum pelvic sonogram. This may be because of
extrapelvic position of the ovaries caused by the large uterus.
385
```
A sonogram approximately 1 week after delivery would visualize the uterus
(A) above the umbilicus
(B) 38 cm from the symphysis pubis
(C) 30 cm from the symphysis pubis
(D) below the umbilicus
```
(D) The uterus has a dramatic decrease in size and returns to a position between the symphysis pubis
and umbilicus.
386
In a nongravid uterus, a previous cesarean section scar may be visualized on sonogram.
(A) true
(B) false
A) A cesarean section scar will appear at the cervico-corpus junction on the anterior myometrial wall.
387
```
The most common complication during the postpartum period is?
(A) hemorrhage
(B) thromboembolism
(C) infection
(D) A and B
(E) all of the above
```
(E) Hemorrhage, thromboembolism, and infection are the most common complications during the postpartum period. Placenta previa is an antepartum complication.
388
```
What percentage of fetuses are breech at term?
(A) 25%
(B) 7%
(C) 4%
(D) 1%
```
(C) 25 of fetuses are breech at 28 weeks, 7 at 32 weeks, and 3-4 at term.
389
Term breech fetuses are more likely to have abnor-malities than vertex fetuses.
(A) true
(B) false
(A) The incidence of abnormalities in a breech fetus is 6.3% versus 2.4% in a vertex fetus.
390
```
The abbreviation VBAC refers to
(A) vaginal blockage and closure
(B) vaginal blockage after cesarean
(C) vaginal birth after cesarean
(D) none of the above
```
(C) VBAC is a commonly used abbreviation for vaginal birth after cesarean section.
391
What sonographic findings may help determine mothers that are not VBAC candidates?
(A) decreased cervical length
(B) large amount of maternal abdominal scarring from previous cesarean section
(C) uterine wall <5 mm in the lower uterine segment
(D) sonogram cannot aid in determining VBAC candidates
(C) Although adhesions cannot be seen on ultrasound, occasionally changes related to previous cesarean sections may be appreciated. These changes are found in the lower uterine segment and may include thinning, ballooning, and wedge defects. A thin uterine wall is felt to be at increased risk for uterine rupture.
392
placenta previa
Placenta previa is the implantation of the placenta in the lower uterine segment.
393
placenta accreta
Placenta accreta is the abnormal adherence of part or all of the placenta to the uterine wall.
394
placenta succenturiata
Placenta succenturiata is an accessory lobe of placenta.
395
abruptio placentae
Abruptio placentae is the premature separation of the placenta after 20 weeks of gestation.
396
placenta increta
Placenta increta is the abnormal adherence of part or all of the placenta in which the chorionic villi invade the myometrium.
397
placenta percreta
Placenta percreta is the abnormal adherence of part or all of the placenta in which the chorionic villi invade the uterine wall.
398
```
The chorion frondosum progressively develops to
become
(A) fetal component of the placenta
(B) maternal component of the placenta
(C) the amniotic cavity
(D) the yolk sac and stalk
```
(A) The fetal component of the placenta.
399
```
The decidua basalis progressively develops to become
(A) fetal component of the placenta
(B) maternal component of the placenta
(C) the amniotic cavity
(D) the yolk sac and stalk
```
(B) The maternal component of the placenta.
400
The following information about HELLP syndrome is true except
(A) abbreviation for hemolysis, elevated liver enzymes, and low platelets
(B) abbreviation for hemivertebrae, elevated liver enzymes, and low lying placenta
(C) treated similar to severe preeclampsia
(D) Doppler may help in assessing HELLP syndrome
(A) Sonographic fetal HELLP findings include IUGR,
oligohydramnios, and possible signs of fetal distress
(poor BPP, abnormal UC Dopplers for example).
401
```
Infections that may affect the fetus include all of the
following except
(A) parvovirus
(B) cytomegalovirus
(C) HIV
(D) none of the above
```
(D) Parvovirus, CMV, and HIV are all infections that may be transmitted across the placenta.
402
```
Varicella-zoster virus is also known as
(A) 5ths disease
(B) chicken pox
(C) "slapped cheek" disease
(D) herpes simplex
```
(B) Varicella-zoster is also known as chicken pox.
403
```
The most common intrauterine viral infection is
(A) toxoplasmosis
(B) HIV
(C) parvovirus
(D) cytomegalovirus
```
(D) With a maternal CMV infection, the risk of trans-mission to the fetus is 40-50, regardless of gestational age.
404
Ultrasound is not able to differentiate between different infections.
(A) true
(B) false
(A) Infections, regardless of the type, present in the fetus with the same spectrum of sonographic findings.
These may be IUGR, oligohydramnios, ventriculo-megaly, microcephaly, and nonimmune hydrops fetalis.
405
```
Parvovirus is also described as
(A) 5th's disease
(B) chicken pox
(C) "slapped cheek" disease
(D) A and C
(E) B and C
```
(D) Parvovirus have also be referred to as 5th's disease and "slapped cheek" disease
406
```
Sampling of the middle cerebral artery is helpful in
determining
(A) IUGR and related complications
(B) prediction of'fetal anemia
(C) the need for a fetal transfusion
(D) all of the above
```
(D) In the case of IUGR, the fetus will direct more blood flow to the brain. This will lower the PI and SID ratio of the middle cerebral artery (MCA). More recently, multiple studies have been conducted showing that the peak velocity of the MCA is a good predictor of fetal anemia. The peak velocity is measured and plotted of a curve to determine whether the fetus is in need of a fetal blood transfusion because of fetal anemia.
407
```
Ovarian tumors that appear similar to a fibroma include all of the following except
(A) androblastoma
(B) endometroid
(C) thecoma
(D) all of the above
```
(B) Androblastoma, fibroma, thecoma, and granulosa cell are all sex cord-stromal tumors, with fibromas being the most common.
408
```
A 24-year-old patient presents for an ultrasound. The sonogram shows a solid hypoechoic ovarian mass. The differential is most likely
(A) granulosa cell
(B) thecoma
(C) dysgerminoma
(D) fibroma
```
(C) Dysgerminoma is one of the most common malignant tumors of pregnancy. Granulosa cell and thecoma tumors typically occur postmenopausally, and fibromas usually occur in the 5-6th decade.
409
All of the following about stromal tumors is correct except
(A) All have a similar sonographic appearance and can't be differentiated from one another.
(B) solid, hypoechoic ovarian tumors
(C) Types include: fibromas, thecomas, Sertoli-Leydig cell tumors.
(D) Types include: fibromas, thecomas, Brenner tumors.
(D) Sex cord-stromal tumors are: fibroma, thecoma, granulosa cell, and androblastoma (Seroli-Leydig cell). They appear hypoechoic to echogenic with a mixed heterogeneous pattern and appear similar to each other on ultrasound.
410
```
Endometrioma may appear similar to
(A) benign cystic teratoma
(B) mucinous cystadenoma
(C) thecoma
(D) serous cystadenoma
```
(A) An endometrioma may have a variety of appear-ances, but primarily appears as a cystic to hypoechoic
mass with internal echoes or debris layering consistent with blood. Teratomas also have a variety of appearances, but can be hypoechoic with internal
echoes and a layering of debris.
411
Hydrosalpinx may be differentiated from a multicystic ovarian mass on sonogram by
(A) following the cystic spaces to ensure that they all communicate
(B) using color Doppler to follow the ovarian artery to the ovary
(C) having the patient roll to lengthen out the fallopian tube
(D) the two cannot be differentiated
(A) A hydrosalpinx may initially look like a cystic mass with septations. On closer examination, the septations are not complete. The sonographer is able to follow the connection of the cystic spaces. This assumes that the structure is tubular and communicates as with hydrosalpinx.
412
```
An anechoic, smooth-walled cyst is identified in a patient who has had a hysterectomy/oophorectomy. The differ-ential diagnosis should include
(A) paraovarian cyst
(B) ovarian cyst
(C) mesonephric cyst
(D) all of the above
```
(D) A paraovarian, or mesonephric cyst originates from the mesonephric duct. A paraovarian cyst may form, regardless of uterine or ovarian status. Ovarian tissue does occasionally remain after an oophorectomy, especially if adhesions were present. The remaining ovarian tissue can still function and produce a cyst. It is called ovarian remnant syndrome and should be considered with any cystic mass identified in a postoophorectomy patient.
413
The hydatid of Morgagni is
(A) a complex ovarian mass
(B) a section of sigmoid colon visible on transvaginal ultrasound
(C) paramesonephric cyst
(D) another name for ovarian remnant syndrome
(C) Hydatid of Morgagni is the most common parameso-nephric cyst. It measures 2-10 mm and appears similar to ovarian cysts.
414
```
The formula for determining ovarian volume is
(A) d1 x d2 x d3 x .523
(B) d1 + d2 + d3 x 3.14
(C) d1 x d2 x d3 x 3.14
(D) d1 x d2/d1 + d2 + d3
```
(A) d1 x d2 x d3 x .523
