OB/GYN Boards Review Pt 4

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  1. Blood flows from LV to _____ via the ______ valve.
    Aorta; aortic
  2. _____ atrium is located closest to spine.
  3. Mitral valve is located between ______ atrium and ventricle.
  4. IVC/SVC merge where?
    Right atrium
  5. Tricuspid valve is located between _____ atrium and ventricle.
  6. Where is the pulmonary valve located?
    Between the right ventricle and the pulmonary artery
  7. Pulmonary veins merge into the _____ atrium.
  8. ____ ventricle may be slightly larger than the ____ ventricle as the pregnancy progresses.
    Right; left
  9. _____ valve inserts slightly more towards the apex than the _____ valve.
    Tricuspid; mitral
  10. Apical 4 chamber heart
    • Apex of heart pointed directly towards or away from transducer
    • Not ideal view for septal defects.
    • Excludes up to 95%of all congenital heart defects
  11. Subcostal 4 chamber heart
    Places AV septum perpendicular to sound field
  12. What 4 chamber heart view provides the framework for all other heart views?
    Subcostal 4 chamber heart
  13. Echogenic foci
    • Must be as bright as bone in order to be considered
    • Minor marker for T 21
    • 90% resolve by 3rd trimester
  14. Structure often mistaken for echogenic foci
    • Echogenic chordae tendinea
    • Is less echogenic than bone and has a normal color flow pattern
  15. Fetal blood cirulation
    Umbilical vein > internal umbilical vein (ligamentum teres)> left portal vein > ductus venosum (ligamentum venosum) > IVC > right atrium > left atrium via the foramen Ovale > left ventricle > ascending aorta > small amount to the pulmonary artery and then into the ascending aorta via the patent ductus arteriosis > inferior abdominal aorta > the umbilical arteries
  16. ______ ventricle is closest to the stomach.
  17. Cardiac cirfumference/chest circumference relationship
    Cardiac circum = 1/2 chest circum
  18. Average HR
    120-160 BPM
  19. Epsteins anomaly
    Abnormal inferior insertion of the tricuspid valve
  20. RVO bifurcation
    Ductus arteriosis and the right pulmonary artery
  21. Most frequent heart defect detected by ultrasound
    • VS defect
    • 50% occur at the aortic root
  22. Membranous VSD
    • 80% of all VSDs
    • Located by AV valves
  23. Muscular VSD
    • 20% of all VSDs
    • Located at inlet/tribecular
  24. VSDs
    • 74% closure in utero
    • 50% association with additional cardiac anomalies
    • Best seen in subcostal 4 chamber view
  25. Recurrance risk of VSD
    • 1 child 3%
    • 2 children 10%
    • Maternal VSD- 6-10%
    • Paternal VSD- 2%
  26. AV septal defect
    • AKA endocardial cushion defect
    • Central defect in heart involving atrial and ventricular septa, AV valves and electrical conduction system
    • "hole in the heart"
    • 70% association with additional cardiac anomaly
    • Associated with bradycardia
  27. AV septal defect is associated with which chromosomal anomaly?
    50% association with downs
  28. AV canal defects
    • Septal defect/endocardial cushion defect
    • Tetralogy of Fallot
    • Aortic coarctation
    • Pulmonary stenosis
    • Double outlet right ventricle
  29. Tetralogy of fallot
    • VSD
    • Overriding aorta
    • Right ventricular hypertrophy
    • RVOT obstruction
  30. 3VV presentation in tetralogy of fallot
    • Small pulmonary artery
    • Anterior displacement of aorta
    • SVC
  31. Coarctation of aorta
    • Narrowing of distal aortic arch
    • Pulmonary artery > aorta
  32. Coartation of the AO has a strong association with what chromosomal anomaly?
    Turners syndrome
  33. Most severe congenital anomaly of neonate (list features)
    • Hypoplastic left heart syndrome
    • Asymmetry ventricles on 4 chamber view
    • Small/absent left ventricle (right ventricle looks large)
  34. Ebstein anomaly
    • Apical displacement of septal and posterior tricuspid valve leaflets
    • Produces atrialization of right ventricle
    • Associated with lithium use
  35. Sonographic patterns of Ebsteins anomaly
    • Apical displacement of tricuspid
    • Tricuspid regurgitation
    • Large right atrium
    • Small functional right ventricle
  36. Pulmonary atresia
    • Obstruction of RVO at level of pulmonary valve
    • Rare
  37. Rhabdomyoma
    • Hemartoma
    • Most  frequent in utero finding of tuberous sclerosis
  38. Most common in utero finding of tuberous sclerosis
  39. Pentralogy of Cantrell
    • Rare and lethal
    • Consists of: ectopia cordis (heart outside of body), supra-umbilical wall defect, cleft sternum, pericardial defect, other cardiac anomalies
  40. Normal limit of fluid surrounding heart
  41. Cardiomyopathy is associated with what?
    • Insulin dependent diabetics
    • 10% association with genetic disorders
  42. Image Upload 1
    Based on this image, the sonographer should next check for:
  43. Image Upload 2
    Based on this coronal image at 24 weeks, this most likely represents:
    Autosomal recessive polycystic disease
  44. Image Upload 3
    In this image of the right ventricle, the arrow is indicating:
    Moderator band
  45. Image Upload 4
    Based on this finding, the sonographer should next look for:
  46. Image Upload 5
    This patient had an equivacol nuchal translucency during the first trimester. Based on this image at 18 weeks, the sonographer should look for additional evidence associated with:
    Downs syndrome
  47. Image Upload 6
    Based on this four-chamber view of the heart, this most likely represents:
    AV Septal defect
  48. Image Upload 7
    The abnormal patterns displayed in this image are most frequently associated with:
    Thanatophoric dysplasia
  49. Image Upload 8
    This patient presents at 17 weeks small for gestational age. Based on this coronal power Doppler image, this most likely represents:
    Bilateral renal agenesis
  50. Image Upload 9
    This patient presents at 18 weeks for routine dating. This coronal image most likely displays:
    UPJ obstruction
  51. Image Upload 10
    Based on this color Doppler image of the fetal ventricles, this most likely represents:
    Ventricular septal defect
  52. Image Upload 11
    This patient presented at 19 weeks for routine dating. The right kidney appeared normal. Based on this image of the left kidney, this most likely represents:
  53. Image Upload 12
    The sonographic patterns displayed on these coronal and transverse images of the fetal thorax/abdomen are most frequently associated with:
    Diaphragmatic hernia
  54. Image Upload 13
    In this image of the fetal heart, the arrow is most likely indicating:
    Membraneous VSD
  55. Image Upload 14
    Based on this image at 27 weeks, this most likely represents:
    UPJ obstruction
  56. Image Upload 15
    Based on this image of the fetal bladder at 16 weeks, the most frequent cause is:
  57. Image Upload 16
    The amniotic fluid index is 2 cm at 17 weeks gestational age. The most significant complication for this finding is:
    Pulmonary hypoplasia
  58. Image Upload 17
    The most frequent cause for the abnormality in this image is:
    Hydrops fetalis
  59. Most common cause of bilateral renal obstruction/hydro?
    UPJ obstruction
  60. Potter sequence
    • Occurs with severe early renal failure
    • Squished baby with no room to move and malformed from lack of space/no fluid
  61. Unilateral hydronephrosis
    • Most common site = UPJ
    • Check for cortical cysts>> sign of perminant renal damage
  62. MCKD
    • Not genetic
    • 80% are unilateral no visible parenchyma
  63. PUV
    • Posterior urethral valve outlet obstruction
    • Males only
    • "key hole bladder"
    • Megacystis
    • Oligo as early as 12-14 weeks
  64. Megacystis is strongly associated with what condition
  65. Prune belly syndrome
    • Rare
    • Males only
    • Deficient abdominal wall musculature
    • Megacystis but no key hole sign
  66. Meckel-Gruber syndrome
    • Lethal with 25% recurrance risk
    • Consists of at least 2 of the following: enlarged, hyperechoic kidneys; encephalocele; polydactyl; sever oligohydramnios
  67. Roberts syndrome
    • Autosomal recessive (25% recurrence risk)
    • Enlarged hyperechoic kidneys
    • Cardiac defects
    • Lung deformities
    • Cleft lip/palate
    • Rare association with PCKD
  68. Most freqguent congenital neoplasm
    Mesoblastic nephroma- unilateral solid/complex mass
  69. Most common urachal anomaly
    • Patent urachus
    • Urachal cyst = 2nd most common
  70. Bladder extrophy
    • Failure of colsure of lower abdomen wall
    • Exposure of bladder
  71. Cloacal exstrophy
    Bowel herniation in addition to bladder extophy
  72. Hydrocele
    • Common
    • Usually physiologic and will dissapear
  73. Neuroblastoma
    Raremalignant adrenal neoplasm
  74. Esophageal atresia
    • No stomach demonstrated on sonography
    • 90% are tracheoeshophageal fistulas
  75. Normal small bowel diameter
    Less than 7mm
  76. Most common location of a choledochal cyst
  77. GI anomaly associated with cystic fibrosis
    Meconium ileus- impacted meconium in distal ileum
  78. This image of the fetal chest and abdomen most likely demonstrates:
  79. The most frequent cause of fetal unilateral hydronephrosis is:
    UPJ obstruction
  80. The _______ are located in the right ventricle and should not be misidentified as an intracardiac mass.
    Moderator band
  81. Image Upload 18
    This image of the fetal heart most likely demonstrates:
  82. A mild, persistent presentation of this condition in the early second trimester is associated with:
    T 21
  83. Image Upload 19
    This coronal image of the kidney most likely demonstrates:
  84. Sonographic evaluation of the fetal heart demonstrates apical displacement of the tricuspid septal leaflet. This finding is associated with:
    Epstien's anomaly
  85. The most frequent type of fetal solid renal tumor is the:
    Mesoblastic nephroma
  86. Image Upload 20
    Which of the following has the highest incidence with the condition demonstrated in this image?
  87. The typical sonographic pattern associated with fetal infantile polycystic renal disease is:
    • Bilaterally enlarged, hyperechoic kidneys
    • 50% association with oligohydramios
  88. Which of the following cardiac views places the intraventriclar and interatrial septum perpendicular to the sound field?
    Subcostal 4 chamber heart
  89. Sonographic evaluation of an 18 week fetus reveals severe oligohydramnios and failure to demonstrate the urinary bladder. This most likely represents:
    Bilateral renal agenisis
  90. Image Upload 21
    This transverse image of the fetal kidneys most likely demonstrates:
    Autosomal recessive PCDK
  91. Image Upload 22
    Based on this image, this most likely represents:
  92. Image Upload 23
    To narrow the differential diagnosis, the sonographer should next look for:
    Intact diaphragm
  93. Which of the following connects the pulmonary artery and fetal aorta?
    Ductus arteriosis
  94. Image Upload 24
    This transverse image of the fetal chest most likely demonstrates:
    Diaphragmatic hernia
  95. Image Upload 25
    Based on this condition, the sonographer should next evaluate for:
  96. Image Upload 26
    This abnormality is most frequently associated with:
    T 21
  97. The most life-threatening fetal condition that develops as a result of severe oligohydramnios is:
    Pulmonary hypoplasia

    • This longitudinal image of the urinary bladder demonstrates the sonographic pattern most frequently associated with:
    • PUV
  98. Image Upload 27
    This renal condition has the highest association with which of the following?
  99. Image Upload 28
    The finding indicated by the curved arrow is most frequently associated with:
    Pericardial effusion
  100. By rate of incidence, the most common cardiac anomaly is:
    Membranous VSD
  101. The most frequent fetal adrenal neoplasm is:
  102. The most common location for a ventricular septal defect is:
    Membranous- by the AV valve
  103. Normal cerebrospinal flow
    • 1. lateral ventricles
    • 2. 3rd ventricle
    • 3. 4th ventricle
    • 4. subarachnoid space
    • 5. dural sinus
  104. Midline structure between thalami
    3rd ventricle
  105. Normal measurement of the 3rd ventricle
  106. BPD anatomic landmarks
    • Calveria
    • 3rd ventricle and thalami
    • Tentorium hiatus (posterior)
    • Cavum septum pellucidum
  107. Accuracy of measurements varies as much as +/- _____ in the third trimester
    • +/-3 weeks
    • or
    • +/-15%
  108. Cephalic index
    • BPD/OFD x 100
    • Normal = bewtween 74 and 83
  109. Femur length
    • Measured diaphysis and metaphysis
    • Demonstrate femoral head or greater trochanter in image
  110. After 32 weeks ___ _____ can be prominent  but should NOT be included in the femur length.
    Distal epiphysis
  111. Abdominal circumference landmarks
    • Portal vein (hook)
    • Symmetric lower ribs
  112. Only part of GI tract that contains fluid in 2nd trimester
  113. Peripherally located colon has a hypoechoic pattern due to _____.
  114. Polyhydramnios and causes
    • Excessive amniotic fluid >24cm AFI
    • Causes: 
    • Fetal anomalies that impair swallowing
    • Hydrops
    • Anencephaly
    • Esophageal/duodenal atresia
  115. Fetal skin thickness should measure less than
  116. AP renal pelvis measurement should be less than ___ prior to 20 weeks
  117. Oligohydramnios causes
    • Reduction in fetal urine
    • Chronic amniotic leak
    • Bilateral sever renal dysfunction/obstruction
  118. Most common form of skeletal dysplasia
    Thanatophoric dwarfism
  119. 3 ossification centers should be demonstrated by when?
    2nd trimester
  120. Flaring of posterior ossification centers
    Spina bifida
  121. Atria
    Junction of body of lateral ventricles with occipital and temporal horns
  122. Location of frontal horns
    Most anterior
  123. Location of lateral bodies
    Most superior
  124. Location of temporal horns
    Most lateral
  125. Location of occipital horns
    Most posterior
  126. In a normal pregnancy ____ levels of AFP are found in the fetal serum and  _____ levels in the maternal serum and amniotic fluid.
    • High levels in fetus
    • Low levels in maternal serum and amniotic fluid
  127. Ideal time frame to draw MSAFP
    16-20 weeks
  128. Elevated MSAFP
    • Open neural tube defects 
    • #1 Anencephaly
    • #2 Spina bifida
    • #3 Encephalocele
    • Renal failure
    • Omphalocele/gastroschisis
  129. Amniocentesis measures both AFP and ____ to provide a 97% detection rate of open neural tube defects.
    AChE (acetylcholinesterease)
  130. Low MSAFP
    Minor marker of T21
  131. Triple screen in correlation to detection of downs
    • MSAFP- low
    • hCG- high
    • Estriol- low
    • Detects 58-91% of cases
  132. Quadruple screen
    • Addition of inhibin A to triple screen (MSAPF, hCG, estriol)
    • Inhibin A- increased with T 21
    • Much lower false positive rate than triple screen
Card Set
OB/GYN Boards Review Pt 4
Fetal heart, chest, GU, GI, normal CNS spine and abdomen
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