OB/GYN Boards Review Pt 3

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Author:
dorkfork
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288533
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OB/GYN Boards Review Pt 3
Updated:
2014-11-15 11:29:56
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CNS Skeletal Face Neck
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chromosomal associations, CNS, placenta/umbilical cord, face neck and skeletal dysplasia
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  1. Normal brain appearance in 1st trimester
    • Rhombencephalon
    • Ventricle more prominent
    • Choroid plexus more prominent
  2. Top 2 anomalies associated with increased MSAFP
    • #1 Spina bifida
    • #2 anencephaly
  3. AFP and _____ measured in an amniocentesis provides a 97% defection rate for NTDs.
    AChE (acetylcholinesterease)
  4. Normal cisterna magna should measure:
    3-10mm
  5. 2nd most common NTD
    Anencephaly
  6. Anencephaly
    • Defect in closure of the neural tube
    • Complete or partial absence of the forebrain, meninges, skull, and skin
  7. _______ supplement can decrease risk for anencephaly.
    Folic acid
  8. Sonographic appearance of anencephaly 1st trimester
    • Neural tissue present with no skull/calveria (exencephaly)
    • CRL small for ga
  9. Sonographic appearance of anencephaly 2nd trimester
    • Frog face/ mask sign
    • Polyhydramnios 75% of the time due to impaired swallowing
  10. Early anencephaly aka
    • Fetal acrania (exencephaly)
    • Exposed brain with no cranium
  11. Mild microcephaly is defined as
    HC 2-3 SD below mean for ga
  12. Severe microcephaly is defined as
    HS >3 SD below mean for ga
  13. Aneuploidies associated with microcephaly
    • T13
    • T18
    • T22 (NOT T21)
  14. Causes of microcephally
    • Genetics
    • Maternal infections (present with calcifications)
    • PKU
    • Cardiac anomalies
    • Beckwidth-Weidemann syndrome
  15. Failure of the cleavage/ rotation of the procencephalon causes
    Holoprocencephaly
  16. Procencephalon differentiates into
    Telencephalon and diencephalon
  17. Telencephalon differentiates into
    Cerebral hemispheres and caudate nucleus
  18. Diencephalon differentiates into thalamus, hypothalamus, and optic vessels
  19. Holoprocencephalon is most frequently associated with
    T13
  20. Sonographic patterns of holoprocencephalon
    • 1st trimester- absent butterfly sign/ abnormal appearance of choroid plexus
    • 2nd trimester- fused thalami with monoventricle and absent midline structures
  21. Hydranencephaly
    • Partial or complete absence of cerebral hemispheres
    • Associated with: T13(omphalocele and cardiac defects)
    • Sonographic pattern: failure to identify notmal lateral ventricles and choroid plexus, fluid filled supratentorial space,usualy normal head shape and posterior fossa, absent flow in ACA and MCA
  22. Majority of cases of ventriculomegaly are
    Non communicating
  23. Non communicating ventriculomegaly
    Obstruction within the ventricular system
  24. Communicating ventriculomegaly
    • Obstruction external to ventricular system
    • Enlargement of subarachnoid space, then ventricles
  25. __% of mild cases of ventriculomegaly are ideopathic.
    90%
  26. Most frequent cause of congenital ventriclumegaly
    Aqueductal stenosis
  27. Causes of aqueductal stenosis
    • 50% related to TORCH
    • Bickers-Adams syndrome
  28. Bickers-Adams syndrome
    • Aqueductal stenosis
    • Males (X-linked)
    • Adducted thumbs
    • Severe mental retardation
  29. Sonographic pattern of aqueductal stenosis
    • Moderate to sever ventriculomegaly
    • "Dangling" choroid
    • Dilated 3rd ventricle
    • Normal posterior fossa
    • Frontal bossing
    • Compressed flow in MCA
  30. Group of cystic posterior fossa malformations
    Dandy-Walker malformation, complex, or spectrum
  31. Most severe forma of the Dandy-Walker continuum
    Dandy-Walker variant
  32. Least severe form of the Dandy-Walker continuum
    Mega cisterna magna
  33. Cause of the Dandy-Walker malformation
    • Due to abnormalities of the 4th ventricle
    • 50% chromosomal association
    • T13, T18, T21, turners
    • Meckel-Gruber syndrome
  34. Intracerebellar cyst separating lobes of the cerebellum
    Dandy-Walker Continuum
  35. Complete agenesis of the corpus callosum sonographic pattern
    • Mild ventriclulomegaly and absent caum septum pellucidum
    • Superior displacement of the 3rd ventricle
    • Colpocephaly
  36. Colpocephaly
    • Lateral displacement of anterior portion of lateral ventricles
    • Seen with ACC
    • "tear drop sign"
  37. What forms the "roof"/superior boarder of the lateral ventricles?
    Corpus callosum
  38. Choroid plexus cysts usually regress by:
    32 weeks ga
  39. Trisomy 18 has a 50% incidence of this CNS abnormality
    Choroid plexus cyst (particularly bilaterally)
  40. Arachnoid cyst
    • Fluid collection within layers of the arachnoid membrane
    • Can occur anywhere in cranium
    • Most cases are sporadic but some association with t18, and Neurofibromatosis type 1
  41. Anechoic fluid collection that displaces the cerebellum together.
    Arachnoid cyst
  42. Most common congenital vascular malformation of the brain
    Vein of Galen aneurysm
  43. Midline anechoic structure in brian with color flow
    Vein of Galen aneurysm
  44. Intracranial hemorrhage is most frequent in
    Preterm infants
  45. Intraparenchymal hemorrhage is most frequent in
    Term infants
  46. Majority of intracranial hemorrhages are
    Subepengymal
  47. Comnplication of cerebral hemorrhage into parenchyma resulting in necrosis/cystic structure
    Porencephalic cyst
  48. Porencephalic cyst on ultrasound
    • Cyst is anechoic and connected to ventricular system
    • Must demonstrate this connection to narrow differential dx
  49. Most frequent brain tumor in utero
    Intracranial teratoma
  50. Sonographic pattern of intracranial tetatoma
    • Complex possibly hypervascular mass
    • May produce asymmetric ventriculomegaly
  51. Herniation of intracranial structures through skull defect
    Encephalocele aka cephalocele
  52. Cranial meningocele
    • Meninges only
    • Best prognosis
  53. Most common related malformation/syndrome of encephalocele
    Meckle-Gruber syndrome
  54. Sonographic criteria for encephalocele
    • Document skull defect
    • Demonstrate brain tissue contained within meninges (complex pattern)
    • Ventriculomegaly 70-80%
  55. Iniencephaly
    • Extremely rare
    • Calveria defect in skull
    • Absence of lamellea and spines of cervical and thoracic vertebrae
    • Gross hyperextension of head
    • Fusion of occiput to cervical spine
  56. Lissencephaly
    • Cerebral development disorder
    • Gyri in brain do not develop (no dx until late 2nd trimester)
  57. Premature fusion of one or more cranial sutures
    Craniosynostosis
  58. Oxycephaly
    • Bilateral coronoal synostosis
    • "Cone head"
  59. Cloverleaf skull seen with ______ is AKA _______.
    • Thanatophoric dysplasia
    • AKA kleeblattschade
  60. Spina bifida is associated with _______.
    Folate deficiency
  61. Myeloschisis
    • Classification of spina bifida
    • No pouch
    • Tethered nerves exposed to amniotic fluid
  62. Spina bifida occulta
    • Closed spina bifida
    • Thick membrane or skin
    • Tuft of hair, skin dimple, subcutaneous lipoma
  63. Most common location of spina bifida
    Lumbar
  64. Splayed dorsal ossification centers signifies
    Spina bifida
  65. Sonographic patterns of spina bifida
    • Splayed dorsal ossification centers
    • 99% have Arnold Chiari malformation type 1 (banana and lemon sign)
    • 80% have meningocele, myomeningocele
  66. Longitudinal/transverse view of the spine exposes:
    Meningo/mylomeningocele
  67. Coronal view of the spine exposes:
    Spina bifida
  68. Scoliosis
    Lateral spine angulation
  69. Kyphosis
    Anterior spine angulation
  70. Arnold-Chiari type 2
    • 100% association with open NTD
    • Hindbrain herniates through foramen magnum
  71. Arnold-Chiari type 2 sonographic patterns
    • Obliterated cisterna magna less than 3 mm
    • Banana sign (cerebellar shape)
    • Lemon sign (skull shape)
    • Possible ventriculomegaly
  72. Caudal Regression syndrome
    • Distal neural tube distruption
    • Association with poor control of maternal diabetes
  73. Most common tumor in neonates
    Sacrococcygeal teratoma
  74. Sacrococcygeal teratoma
    • Large mass extending from fetal rump
    • 75% benign
    • Solid or complex (solid tumors have worst prognosis)
    • Determine if interior component is present
    • Spine intact

  75. What clinical laboratory test results would correlate with the displayed abnormality?
    Elevated maternal AFP
  76. Sonographic evaluation of a 24 week gestation demonstrates asymmetric limb shortening. This is most likely due to:
    Amniotic Band syndrome

  77. This image of the face most likely demonstrates:
    Cleft lip

  78. Based on the displayed condition, the sonographer should next look for:
    Hydrops fetalis

  79. This fertility patient presents with severe abdominal pain. Based on this image, this most likely represents:
    Hyperstimulation Syndrome

  80. Identify the type of twinning on this first trimester examination:
    Monoamniotic
  81. An obstetric sonogram demonstrates marked polyhydramnios, fetal hypertelorism, narrow chest and symmetric limb shortening. This most likely represents:
    Thanatophoric dysplasia

  82. Based on this image of the fetal pelvis, the most common associated anomaly is:
    Cardiac
  83. The most specific/sensitive criteria for the diagnosis of incompetent cervix is:
    Functional length less than 2.0 cm
  84. The sonographic criteria that confirms dizygotic twins is:
    Identification of different fetal genitalia

  85. Based on this image, this most likely represents:
    Pseudocyst
  86. The typical gestational age for genetic amniocentesis is ____ weeks LNMP.
    16-20

  87. This sonographic examination as part of an infertility work-up most likely demonstrates:
    Asherman Syndrome
  88. All of the following are characteristics of a monozygotic, monochorionic, monoamniotic pregnancy except:
    Produces fraternal twins
  89. What is the most accurate predictor of fetal lung maturity?
    Amniotic L/S ratio
  90. Shortening of the humerus and femur is termed:
    Rhizomelia

  91. Based on this image, the most likely type of twinning is:
    Monoamniotic

  92. This patient presents with a history of labor pains at 25 weeks gestational age. Based on this endovaginal image, this most likely represents:
    Incompetent cervix

  93. This image of the fetal head most likely demonstrates:
    Cystic Hydroma
  94. Vasa previa consists of:
    Umbilical cord prolapse between fetal head and intact membranes

  95. Based on this image of the fetal abdomens, the sonographer should be suspicious of:
    Discordant growth restriction

  96. Identify the type of twinning:
    Dichorionic diamniotic
  97. The most frequent cause of painless vaginal bleeding is:
    Placenta previa
  98. The typical gestational age for chorionic villus sampling is ____ weeks LNMP.
    10-13
  99. Demise of one twin during the second trimester with resultant dehydration/maceration is termed:
    Fetus papyraceous
  100. Which of the following is a risk factor for placenta accreta?
    Previous C-section

  101. Abnormality demonstrated in this image of the fetal arm is most frequently associated with:
    Amniotic band syndrome
  102. What is not associated with an abnormally thick placenta?
    Maternal hypertension

  103. Based on this image, the type of twinning is:
    Dichorionic, diamniotic

  104. The condition depicted in this image is most frequently associated with:
    Turners

  105. Based on this longitudinal image of the fetal abdomen and thorax, the sonographer should evaluate for:
    Thanatophoric dysplasia
  106. The substance that must be present in the alveoli for normal breathing post delivery is:
    Surfactant

  107. This patient presents with painless vaginal bleeding. Based on this image, this most likely represents:
    Placenta previa
  108. A "mature" placenta is considered a normal finding at ______ weeks gestational age.
    36

  109. This image of the fetal lower extremity demonstrates:
    Club foot
  110. Rhizomelia
    • Shortened proximal extremity
    • Humerus or femur
  111. Mesomelia
    • Shortened middle segment/
    • Radius/ulna or tibia/fibia
  112. Acromelia
    • Shortened distal segement
    • Hands or feet
  113. Micromelia
    Entire extremity is shortened
  114. Examples of severe micromelia (all lethal)
    • Thanatophoric dysplasia
    • Osteogenesis imperfecta type 2
    • Achondrogenesis
    • Homozygous Achondroplasia
  115. Examples of mild micromelia
    • Osteogenesis imperfecta type 2
    • Camptomelic dysplasia
  116. Example of rhizomelic dysplasia
    Heterozygous Achondroplasia
  117. Differential for bowing/fractures of extremities
    • Osteogenesis imperfecta type 2
    • Achondrogenesis
    • Thanatophoric dysplasia
    • Camptomelic dysplasia
  118. Most common non lethal skeletal dysplasia
    • Achondroplasia
    • Associated with advanced paternal age
  119. Achondroplasia sonographic features
    • Mildly narrow chest
    • Trident hands
    • Progressive shortening- especially upper extremities
  120. Best imaging clue for Achondrogenesis type 1
    • Generalized poor ossibifation
    • Rib fractures (but not predominant)
    • Flared ribs
  121. Best imaging clue for Achondrogenesis type 2
    • Normal skull ossification
    • No spine ossification
    • "Floating head"
    • Flared ribs
  122. Achondrogenesis
    • Type 1 and 2
    • Lethal skeletal dysplasia due to failure of cartilaginous matrix formation
  123. Telephone receiver femur is seen with
    Thanotophoric dysplasia type 1
  124. Cloverleaf skull/kleeblattschadel is seen with
    Thanotophoric dysplasia type 2
  125. Most severe/most commonly identified by ultrasound form of osteogenesis imperfecta
    Type 2
  126. Talipes
    • Club foot
    • Long axis of foot in same plane as long axis of tibia/fibula
  127. Club foot is associated most commonly with:
    T18
  128. Rockerbottom feet has a high association with
    T13 and T18
  129. Sandal gap foot has a high association with ___ but is most common in normal fetus'.
    T21
  130. Sirenomelia
    • "Mermaid"
    • Partial or complete fusion of lower extremities
    • Lethal
    • Related to VACTERL
  131. Polydactyl is associated with
    • T13
    • Meckle-Gruber syndrome
    • Ellis-van Creveld
    • Carpenter syndrome
  132. Syndactyly
    fusion of 1st and 2nd digits
  133. Risk factors of amniotic band syndrome
    • Amniocentesis
    • Drugs- methadone, LSD

  134. This patient presents at 21 weeks gestational age with elevation of MSAFP. Based on this image, this most likely represents:
    Encphalocele

  135. The sonographic pattern indicated by the arrow in this image of the posterior fossa is most frequently associated with:
    Dandy Walker Malformation

  136. Label the structures:
    • A: atria
    • B: choroid plexus
    • C: wall of lateral ventricle

  137. Label the structures:
    • A: cerebellum
    • B: cisterna magna
    • C: 3rd ventricle
    • D: 4th ventricle
    • E:

  138. Based on this finding, the sonographer should next evaluate for:
    Arnold Chiari Malformation

  139. Based on the abnormality indicated by the arrow, this case of ventriculomegaly is due to:
    Maternal CMV exposure

  140. This patient presents at 22 weeks gestational age with elevation of MSAFP. Based on this image, this most likely
    Meningocele

  141. The sonographic feature indicated by the arrows is most frequently associated with:
    Myelomeningocele

  142. The abnormality indicated by the arrows is most frequently associated with:
    Arnold Chiari Malformation

  143. This image was obtained in a 20 week pregnancy. Based on this pattern, the sonographer should:
    Perform a full anatomy screen

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