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Practise viva Flashcards

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1
Q

Hydrops

A

At least 2 fetal oedema components
Immune (blood group incompatibility) or non-immune
Non-immune: Turners or trisomy, cardiac disease, infection, twin related, neoplastic (AV shunts), inborn errors of metabolism, anaemia,

Immune now uncommon due to practice of giving mother anti-immunoglobulin when she is Rhesus negative

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2
Q

Endometrial thickening

A

Best measured immediately post-menstrual / early proliferative
Hyperplasia, neoplasia / carcinoma, polyp, tamoxifen (causes polyps, hyperplasia, carcinoma), infection

15mm top normal for secretory. <6mm to exclude thickening. Should not be above 5 post menopause

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3
Q

Cornual ectopic / other ectopics

A

Cornual sometimes used interchangeably with interstitial ectopic, but should be reserved for when there is a rudimentary horn (bicornuate or septate)

Interstitial ectopics have a higher risk of rupture and haemorrhage compared with tubal ectopics. Present later with larger size.

Risk factors for ectopic:
Prior
IVF
Tubal surgery or inflammation
PID
Salpingitis isthmica nodosa (nodular scarring of tubes, controversial aetiology, not post infective)
IUDs
Congenital abnormalities

HCG tends to rise at a slower rate
At <2000 may not see an intrauterine pregnancy anyway

Heterotopic essentially only occurs in IVF

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4
Q

Symmetric v asymmetric growth restriction

A

Symmetric - all measurements <10%
A - classically AC <10%

S: Trisomy, infection, maternal drugs
A: Placental insufficiency. Low or minimal karyotype abnormalities. HC reduced in maternal cocaine

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5
Q

Uterine artery assessment

A

High resistance non-pregnant waveform, drops in resistance during pregnancy. Abnormally high resistance increases risk of pre-eclampsia and IUGR
Notching (trough like between systole and diastole) should not persist throughout pregnancy (22 weeks). Bilateral more concerning, or unilateral on same side as unilateral placenta
Normal RI <0.5

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6
Q

Umbilical artery assessment

A

Surveillance of fetal wellbeing in 3rd trimester
Should be low resistance, PI approximately 1

Normal???

CPR should be greater than one (MCA should be high resistance)

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7
Q

Filling defects on HSG

A

Fibroids, polyps, cancer, adhesions

Ashermans / uterine synechiae is multiple adhesions, associated with infertility, often develops after pregnancy

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8
Q

Breast density

A

Fatty
Scattered fibroglandular
Heterogeneously dense
Dense

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9
Q

Technically adequate mammogram

A

Nipple in profile, and midline on CC
Pectoral shadow down to nipple level or lower
Inframammary fold seen
Symmetric
Posterior nipple line similar, within 1cm, on CC and MLO

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10
Q

Gynaecomastia

A

Usually unilateral / asymmetric

Flame shaped (mammography)
Disc shaped (palpation, ultrasound - hypoechoic, triangular)
CODES
Cirrhosis
Obesity
Digitalis
Estrogen (or androgen deficiency - the imbalance)
Spirinolactone

Testicular tumours - examine testes.
Estrogenic tumours may also cause (adrenal, liver, lung, pituitary)

Senescent change - pseudogynaecomastia - increased fat and decreased muscle. No actual mass

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11
Q

Ovarian torsion

A

Mostly dermoids or paraovarian cysts
Hyperstimulated cystic ovaries at high risk

Enlarged ovary, midline, peripheral follicles, with altered vascularity

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12
Q

ASUM fetal demise

A 
MSD > 25mm no HB
FP >7mm no HB
Both > or =
14 days after GS seen no HB
11 days after GS with yolk sac no HB
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13
Q

Uterine congenital abnormalities

A

Septate most common
Septum can be removed.
Normal external contour, unlike bicornuate
Arcuate is mild indentation at fundus
Didelphys there are two cervixes, vaginas
Can have two cervixes in bicornuate

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14
Q

Cleopatra view

A

Axillary view

An exaggerated CC for if can only see on MLO in axilla

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15
Q

Placental abruption

A

Associated with smoking, cocaine, PROM, thrombophilia, chorioamnionitis, previous abruption
Retroplacental haematoma not commonly seen. Hyperechoic actutely then becomes hypo
Small treated conservatively. Risk of IUGR or demise.

Subchorionic haemorrhage - increased risk of preterm labour and of placental abruption

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16
Q

Molar pregnancy

A

Complete mole Diploid XX, or less commonly XY - All chromosomes from sperm - snowstorm, bunch of grapes, bilateral theca lutein cysts
Partial mole triploid usually XXY (can be XXX or XYY)

Complete may progress to invasive mole, or choriocarcinoma

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17
Q

Major cardiac views on fetal ultrasound

A

.

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18
Q

Bilateral ovarian tumours

A 
Serous tumours are more commonly bilateral than mucinous.
Serous are more common.
Mucinous oftern larger, multiseptated.
Serous tumours more commonly calcify
Most likely mets

Krukenberg tumour is adenocarcinoma met to ovary.
Stomach, colon most common
Breast and lung next most common mets, and oppositve ovary

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19
Q

Inflammatory breast cancer

A

Clinical appearance of breast swelling and skin thickening. Mimics mastitis
Can be any type of invasive carcinoma, but most commonly ductal
Tendency to early metastasis
Poor prognosis
Dilated dermal lymphatics in 80%. Invasion of these pathognomonic

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20
Q

BIRADS 5

A

Highly likely to be malignant
Any 2 of - spiculated or irregular mass
High density
Fine linear or linear branching segmental calcifications

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21
Q

BIRADS 2

A

Lymph nodes
Cysts
Calcified fibroadenomas
Fat containing lesions - hamartomas, oil cysts, lipomas, galactoceles

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22
Q

Ductus venosus

A

Most sensitive to cardiac function

S, D, and A waves

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23
Q

Cervical funnelling

A

Percentage (funnel length / functional cervix + funnel)
Shape (U shaped higher risk of preterm delivery than V shaped)

Cervical length should be at least 30mm

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24
Q

Normal mammary ducts

A

Up to 3mm on ultrasound

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25
Lobular carcinoma
Often difficult to see as don't invoke desmoplasia Still stellate mass is the most common presentation Often bilateral Leptomeningeal spread more common Calc rare 52% sensitivity of mammography Less than 30% well defined
26
DCIS
10% present as mass 10% present as mass with calcs 80% just calcs - pleomorphic, amorphous
27
Breast implants
Saline or silicone Fibrous capsule forms around implant, which may calcify May have herniation through capsule without rupture of implant May have intra or extra capsular implant rupture Linguine sign is of intracapsular implant rupture (silicone) Silicone implants should have uniform density and no valve Silicon will be denser peripherally, and have a valve Snowstorm appearance of extracapsular silicone rupture on ultrasound
28
Single deepest pocket
2-8cm normal
29
True lateral
Calcs - tea cupping Masses - localisation And for biopsy planning
30
Placenta praevia
.
31
Uterus didelphus
With haemotcolpos?
32
Breast conserving surgery
Must be <40mm
33
Molar pregnancy
.
34
Placental abruption
.
35
Fetal echo views
.
36
Endometrial cancer
.
37
SROM
.
38
Krukenberg tumour
Metastatic tumour to ovary Mucinous signet ring cells, most commonly from GI tract Stomach > colon May also be breast, lung, contralateral ovary, pancreatic, cholangio, gallbladder
39
Keyhole bladder
.
40
Fetal demise
.
41
Mucinous v serous ovarian tumour
Serous more common Serous more commonly unilocular Mucinous multiple thin septa Serous more commonly bilateral - 15%
42
Ovarian teratoma
CT: Fat fluid level Rokitansky nodule or dermoid plug (calicum, hair, teeth, sebaceus, fat) Suspect malignant transformation if large (>10cm) or irregular soft tissue borders USS: Dot dash and tip of the iceberg Monitor if large. May surgically remove Risk of torsion Anti NMDA limbic encephalitis
43
Posterior urethral valves
.
44
Renal dilatation
.
45
Renal cystic disease
.
46
Polyhydramnios
.
47
Oligohydramnios
.
48
Omphalocele
.
49
Trisomy 18
. Written case with enlarged cisterna magna, omphalocele, AV canal defect, curved fingers / hands Look these images up and review them - was in the writtens ``` Choroid plexus cysts Mega cisterna magna Associated with spina bifida, talipes, Rocker bottom feet Clenched hands Radial ray Single umbilical artery Horseshoe kidney ```
50
Trisomy 13
.
51
Trisomy 21
.
52
Turners
.
53
Meigs syndrome
. Fibroma / thecoma? This was in the writtens - review the images
54
Endometriosis
.
55
Lemon sign
Concavity of frontal bones, as part of Chiari 2
56
Fetal ventriculomegaly
>10mm. Mild to 12, Moderate to 15, severe above 15 Separation of choroid plexus >3mm (dangling choroid) Mild is a soft marker for chromosomal abnormality ``` Aqueduct stenosis Chiari Neural tube defect Dandy Walker Holoprosencephay Obstructing mass Other ``` Obstructive, dysgenesis, or destructive
57
Choroid plexus cysts
In up to 50% of Tri 18 | Also 21, Klinefelter
58
Mega cisterna magna
Infarction Infection esp CMV Trisomy 18 >10mm
59
Single umbilical artery
Increased incidence in twins and diabetes Increased incidence of IUGR ``` Chromosomal abnormality (21, 18, 13 in that order) - soft sign Persistent left umbilical vein Renal anomalies - agenesis on same side Sirenomelia (mermaid) Velamentous cord insertion ```
60
Clubfoot
Large number of associations: Choromosomal: trisomy 18, 18q deletion Renal: prune belly and agenesis Connective tissue: marfans, ehlers danlos Spinal anomalies: caudal regression, diastrmatomyelia, spina bifida
61
Rockerbottom foot
13, 18, 18q deletion | Spina bifida, arthrogryposis (which itself may be syndromic or non-syndromic)
62
Echogenic bowel
Soft marker for trisomy 21 | Also seen in CF, CMV, demise, IUGR, amniotic haemorrhage
63
Echogenic cardiac focus
Soft marker Trisomy 21, and 13 Dual chamber higher risk
64
Soft signs
``` Echogenic intracardiac focus (21>13) Ventriculomegaly Nuchal fold >6mm (turners,21) Echogenic bowel (21,CMV,CF,demise) Hypoplastic or absent nasal bone (21, rarely fetal warfarin syndrome) Shortened long bones Renal pyelectasis (21) Choroid plexus cysts (18>21,Klinefelter) Aberrant right subclavian artery (21,18) Single umbilical artery (21>18>13) Mega cisterna magna (18,CMV, infarction) Rocker bottom feet (13,18,18qdeletion) Clenched fists (18>13) Sandal gap (21) Strawberry skull (18) ```
65
Sandal gap deformity
Downs
66
Strawberry skull
Aneuploidy, particularly 18
67
Cloverleaf skull, strawberry skull, lemon skull
Lemon - Chiari 2 - concave frontals Strawberry - Tri 18. Flattened occiput, pointed frontal bones with hypoplastic frontal lobes, brachycephaly Cloverleaf - severe multiple craniosynostosis - thanatophoric dysplasia, Aperts, Crouzon
68
Breast calc biopsy
Need >5 in one specimen, or calc in 3 samples
69
Lymph node thickness, axilla
Normal cortex <3mm
70
Fibroadenoma
Popcorn calc Hypoechoic, well circumscribed, macrolobulated mass Associated with cyclosporin use, and Cowden syndrome(AD, GI hamartomas, mucocutaneous lesions, breast disease, increased risk of breast Ca, follicular thyroid ca, Lhermette Duclos) ?Consider excision if >30mm
71
Fetal pericardial effusion
>2mm | Associated with hydrops, aneuploidy, cardiac anomalies
72
Breast lesion benign ultrasound features
Well circumscribed hyperechoic (fat containing lesion - lipoma, hamartoma) Wider than deep Gentle macrolobulation Thin echogenic pseudocapsule (in a wider than deep lesion) (represents normal compressed tissue so therefore not an infiltrative disease)
73
Malignant breast ultraound features
``` Taller than wide Spiculated Microlobulated Thick hyperechoic halo Annular margins Markedly hypoechoic Acoustic shadowing Branching pattern Punctate calcs Duct extension ```

Women's (5 decks)

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