OBGYN Final

Section 1A: (16 questions)

Q: What are the different uterine positions?

A: Anteversion, retroversion, anteflexion, retroflexion.

Q: What is the normal size of the uterus in multiparous women?

A: 4 cm by 6 cm by 10 cm.

Q: What are some congenital uterine abnormalities?

A: Didelphys, bicornuate, septate, arcuate, DES.

Q: What is the function of the myometrium?

A: The myometrium is the thickest layer of the uterus, made of smooth muscle, and surrounds the uterus.

Q: What are the layers of the endometrium and their characteristics?
A: Functionalis layer: Compact and spongy, shed during menstruation. Basalis layer: Thin, contains arteries supplying the functionalis, and always remains intact.

Q: During which phase is the endometrium thickest and thinnest?
A: Thickest during the secretory phase. Thinnest during the proliferative phase.

Q: What is the normal endometrial thickness for symptomatic women and those on HRT?
A: Symptomatic: 5 mm Asymptomatic and HRT: 8 mm

Q: What are the functions of the cervix and vaginal canal?
A: The cervix connects the lower uterine segment with the vaginal canal. The vaginal canal is a tubular structure, and the fornices are extensions where the cervix meets the vaginal wall.

Q: What is the normal size of ovaries in reproductive women?

A: 3 cm by 2 cm by 1 cm.

Q: What is the tunica albuginea and where is it located?

A: The tunica albuginea is the outer fibrous capsule of the ovaries.

Q: What are the parts of the fallopian tube from the connection to the ovary to the uterus?

A: Interstitial → isthmus → ampulla → infundibulum.

Q: What is the importance of imaging the anterior and posterior cul de sacs?

A: Imaging these areas helps detect free fluid, which could indicate various pathologies.

Q: What is the location of the anterior and posterior cul de sacs?
A: Anterior cul de sac: Between the bladder and uterus. Posterior cul de sac: Between the uterus and rectum.

Q: What are the characteristics of the uterus and ovaries in premenarchal patients?
A: Uterus: ⅓ UT, ⅔ CX    Ovaries: 1 cm by 1 cm by 1 cm

Q: What are the characteristics of the uterus and ovaries in reproductive women?
A: Uterus: ⅔ UT, ⅓ CX    Ovaries: 3 cm by 2 cm by 1 cm

Q: What are the characteristics of the uterus and ovaries in postmenopausal women?
A: Uterus: ⅓ UT, ⅓ CX    Ovaries: 2 cm by 1 cm by 1 cm

Section 1B: (22 questions)

Q: What are the different types of abnormal fluid collections?
A:

• Hydro: Fluid.

• Hemato: Blood.

• Pyo: Pus.

• Colpos: Vagina.

• Metra: Endometrial.

• Salpinx: Fallopian tubes.

Q: What are uterine leiomyomas and their types?
A:

• Benign muscle neoplasm of the uterus, also called myoma or fibroid.

• Types:

  • Submucosal: Displace/distort the endometrium.

  • Intramural/Interstitial: Within the myometrium.

  • Subserosal: Arise from the myometrium and project exophytically.

Q: How do uterine leiomyomas appear on imaging?

A: They appear as a whorled pattern or pseudocapsule. They can be monitored for malignancy through time and growth.

Q: What is the difference between adenomyosis and endometriosis?
A:

• Adenomyosis: Ectopic endometrial tissue within the uterus, symptoms include pelvic cramping, tenderness, uterine enlargement. Imaging shows a venetian blinds or swiss cheese appearance.

• Endometriosis: Diffuse spread of endometrial tissue, symptoms include dysmenorrhea and dyspareunia. Imaging may show chocolate cysts, sliding sign, and kissing ovaries sign.

Q: What is the appearance of endometrial hyperplasia?

A: Thickened endometrial canal, usually hyperechoic due to cystic or secretory changes or blood accumulation.

Q: What is the appearance of endometrial polyps?

A: Variable appearance, but generally shows diffuse or focal endometrial thickening, more pronounced in the proliferative phase.

Q: How is endometrial carcinoma diagnosed?

A: Diagnosis requires a biopsy. Symptoms include postmenopausal bleeding (PMB), and it may show myometrial invasion, endometrial adhesions, and synechiae/Asherman syndrome.

Q: What is the appearance of cervical polyps?

A: Benign hyperplasia of cervical tissue, characterized by a stalk with blood flow. Symptoms may include menorrhagia and postmenopausal bleeding.

Q: What is the appearance of Nabothian cysts?

A: Benign cervical retention cysts that usually appear cystic and are typically asymptomatic.

Q: What are the symptoms and appearance of cervical carcinoma?

A: Symptoms include vaginal discharge, bleeding, and rectal or bladder dysfunction. It typically shows an enlarged, bulky cervix with cervical stenosis.

Q: What does a C-section scar indicate?

A: A hyperechoic scar in the uterus, more likely to have associated conditions such as endometriosis, placenta previa, or accreta.

Q: What is a leiomyosarcoma?

A: A malignant tumor that arises from a fibroid or myoma. Symptoms can include uterine bleeding and pelvic pain, and it shows rapid growth with local invasion or metastases.

Q: What is a follicular cyst?

A: A functional benign ovarian mass caused by the dominant follicle failing to rupture and ovulate. It appears as a round, anechoic, thin-walled cyst.

Q: What is a corpus luteum cyst?

A: A functional benign ovarian mass that forms after ovulation. It appears as a unilateral cyst with a "ring of fire" and supports early pregnancy.

Q: What are theca lutein cysts?

A: Benign cysts usually caused by ovarian hyperstimulation syndrome. They appear as bilateral, multilocular cysts and are associated with high hCG.

Q: What is the appearance of fibromas and thecomas?
A:

• Fibroma: Hypoechoic solid mass that rarely produces estrogen.

• Thecoma: Estrogen-producing, unilateral, hypoechoic mass with acoustic shadowing.

Q: What is a cystic teratoma (dermoid)?

A: A benign tumor made up of multiple germ layers, may have fat-fluid levels, calcifications, and hair. It can sometimes be malignant.

Q: How does a serous cystadenocarcinoma appear on imaging?

A: It looks similar to a cystadenoma but may show metastasis, ascites, septations, thickened walls, and calcifications.

Q: What is Krukenberg's tumor?

A: A secondary ovarian carcinoma, usually from the GI tract or breast. It typically appears as a unilateral mass on the right side and has increased CA125.

Q: What is polycystic ovarian syndrome (PCOS)?

A: A hormonal disorder causing enlarged ovaries with small cysts, leading to symptoms like hirsutism, acne, and infertility. It shows a "string of pearls" appearance on ultrasound.’

Q: What are the symptoms and imaging findings of pelvic inflammatory disease (PID)?

A: Symptoms include pelvic pain, fever, and creamy vaginal discharge. Imaging may show salpingitis, pyosalpinx, and tubo-ovarian abscess (TOA) with a butterfly appearance.

Q: What is the proper positioning of an intrauterine contraceptive device (IUCD)?

A: The IUCD should be properly positioned in the fundal endometrial canal, and abnormal positioning would be considered eccentric.

Section 2A (16 questions)

Q: What is the earliest sign of pregnancy visible on ultrasound?

A: The gestational sac.

Q: What are the characteristics of the gestational sac on ultrasound?

A: It is round or oval, anechoic, and surrounded by a thin hypoechoic lining.

Q: How fast does the gestational sac grow per day?

A: Approximately 1.1 mm per day.

Q: What is the typical size of the gestational sac at 5 weeks?

A: It is usually 2-3 mm.

Q: What is the function of the yolk sac?

A: It provides early nutrition to the embryo before the placenta becomes functional.

Q: What is the normal size range of the yolk sac?

A: It typically measures between 2-6 mm.

Q: What is the embryo, and at what stage is it present?

A: The embryo is the developing organism from fertilization to the 8th week of gestation.

Q: What is the function of the amnion?

A: It is a clear, thin membrane that surrounds the embryo and is filled with amniotic fluid.

Q: What is the expected crown-rump length (CRL) at 6 weeks?

A: Approximately 2-4 mm.

Q: At what gestational age is fetal heart activity first detected, and what is the normal heart rate range?

A: The fetal heart can be detected as early as 6 weeks, with a heart rate of 120-160 bpm.

Q: What is the expected crown-rump length (CRL) at 12 weeks?

A: It typically ranges from 50-60 mm.

Q: What is the fetal pole, and when does it become more defined?

A: The fetal pole is the early developing fetus, first seen at about 6 weeks, becoming more defined between 10-14 weeks.

Q: Which brain structures can be identified during the first-trimester ultrasound?

A: Cerebral hemispheres, ventricles, cerebellum, choroid plexus, falx cerebri, and lateral ventricles.

Q: What is the expected measurement of the cerebellum at 12-14 weeks?

A: It typically measures 12-15 mm.

Q: What does the umbilical cord insertion site represent in fetal ultrasound?

A: It is the location where the umbilical cord attaches to the fetus.

Q: What is the difference between monochorionic and dichorionic twins?

A: Monochorionic twins share one placenta, while dichorionic twins each have their own placenta.

Section 2B (16 questions)

Q: What is a hydatidiform mole, and what are its characteristics?

A: A non-invasive form of gestational trophoblastic disease characterized by cystic structures.

Q: What distinguishes an invasive mole from a hydatidiform mole?

A: An invasive mole penetrates the uterine wall and has a high risk of malignancy.

Q: What is choriocarcinoma, and how does it develop?

A: A malignant tumor of trophoblastic tissue that grows rapidly and often follows a miscarriage, ectopic pregnancy, or molar pregnancy.

Q: What is the sonographic appearance of a hydatidiform mole?

A: A "snowstorm" pattern with multiple cysts in the uterine cavity.

Q: What is the most common site of ectopic pregnancy?

A: The fallopian tube.

Q: What are the possible implantation sites for an ectopic pregnancy?

A: Fallopian tube, ovary, cervix, and abdominal cavity (intestines, omentum, bowel).

Q: How does a heterotopic pregnancy appear on ultrasound?

A: Two gestational sacs: one inside the uterus and one outside the uterus.

Q: What are the common symptoms of ectopic pregnancy?

A: Abdominal pain and vaginal bleeding.

Q: What are the ultrasound findings for embryonic or fetal demise?

A: Absence of fetal heartbeat, lack of fetal movement, and disappearance of fetal structures.

Q: What is an empty gestational sac, and what does it indicate?

A: A gestational sac without a fetal pole, seen in embryonic demise.

Q: What is a blighted ovum?

A: A gestational sac without an embryo, indicating a failed pregnancy.

Q: What are common symptoms of anembryonic pregnancy?

A: Spotting, bleeding, cramping, and disappearance of pregnancy symptoms like morning sickness.

Q: What does an abnormally small yolk sac (<3mm) suggest?

A: Early pregnancy, miscarriage, or fetal demise.

Q: What are the risks associated with an abnormally large yolk sac (>5mm)?

A: Chromosomal abnormalities, miscarriage, or early embryonic death.

Q: What are common ultrasound markers for Trisomy 21 (Down Syndrome)?

A: Thickened nuchal translucency, absent nasal bone, heart defects, short femur length, and echogenic bowel.

Q: What is a common sonographic feature of Turner Syndrome?

A: Cystic hygroma, hydrops, coarctation of the aorta, and structural kidney abnormalities.

Section 3A (28 questions)

Q: What is the normal thickness of the placenta?

A: Answer: 3-5 cm

Q: What conditions are associated with placentamegaly (enlarged placenta)?

A: Answer: Maternal diabetes, Isoimmunization, Hemorrhage, Infection, Non-immune hydrops, Chromosomal or uterine anomalies, Twin-to-twin transfusion syndrome, Congenital neoplasm

Q: What placental grade is normal in the first and second trimesters?

A: Grade 0-1

Q: What is a concern if a Grade 3 placenta is seen before the third trimester?

A: It may indicate placental insufficiency or preterm placental aging.

Q: What is the normal length of the umbilical cord?

A: 55 cm

Q: What is the function of Wharton's Jelly?

A: It protects the umbilical cord from compression and twisting and contributes to the production of amniotic fluid.

Q: What are the normal vessel structures of the umbilical cord?

A: One umbilical vein and two umbilical arteries.

Q: What does the presence of a single umbilical artery indicate?

A: It can be associated with congenital anomalies or fetal growth restriction.

Q: What is the normal range for amniotic fluid index (AFI)?

A: 5-25 cm

Q: What is oligohydramnios, and what conditions can cause it?

A: Oligohydramnios is a low amniotic fluid volume and can be caused by fetal renal anomalies, placental insufficiency, and post-term pregnancy.

Q: What is the difference between longitudinal and transverse fetal lie?

A: Longitudinal lie means the fetal spine is aligned with the maternal spine, while transverse lie means the fetal spine is perpendicular to the maternal spine.

Q: What are the three types of breech presentations?

A: Frank breech (buttocks first, legs extended), Complete breech (buttocks and feet presenting), Footling breech (one or both feet presenting).

Q: What is the normal measurement of the lateral ventricles in the fetal brain?

A: Less than 10mm

Q: What structures are visible in a four-chamber view of the fetal heart?

A: Two atria and two ventricles.

Q: What does the lung-to-heart ratio (LHR) help evaluate?

A: It helps assess lung development and predicts potential respiratory issues after birth.

Q: What is the keyhole sign, and what condition is it associated with?

A: The keyhole sign refers to dilation of the bladder and proximal urethra, commonly associated with posterior urethral valves (PUV).

 Q: What conditions are associated with a small placenta (<3 cm, <400 g)?

A: Intrauterine growth restriction (IUGR), placental infarction, chromosomal anomalies, infection, polyhydramnios, membranous placenta, preeclampsia/eclampsia.

Q:  What is the significance of coiling in the umbilical cord?

A: Coiling indicates normal fetal movement and development; absence of coiling may be associated with poor fetal outcomes.

Q:  What is the normal umbilical artery Doppler waveform pattern?

A: A "sawtooth" pattern with a peak systolic to end-diastolic (PS/ED) ratio of approximately 3.0.

Q:  What is the normal range for a single deepest pocket (SDP) measurement of amniotic fluid?

A: 2-8 cm.

Q:  What is situs inversus, and why is it important to identify?

A: Situs inversus is a condition where fetal organs are mirrored (heart on the right, liver on the left). It is important to identify for potential congenital abnormalities and complications during delivery.

Q:  What could an enlarged choroid plexus indicate?

A: It may be associated with hydrocephalus or chromosomal abnormalities such as trisomy 18.

Q: What does an increased nuchal translucency (NT) measurement indicate?

A: It may be associated with chromosomal abnormalities such as Down syndrome (trisomy 21) or structural defects like congenital heart disease.

Q: Why is an absent or hypoplastic nasal bone significant in a first-trimester ultrasound?

A: It can be an early indicator of chromosomal abnormalities, particularly trisomy 21 (Down syndrome).

Q:  What are two common abnormalities in fetal limb development?

A: Polydactyly (extra fingers or toes) and syndactyly (fusion of fingers or toes).

Q: What is the difference between gastroschisis and omphalocele?

A: Gastroschisis is bowel herniation through a small defect in the abdominal wall without a covering membrane, while omphalocele is a herniation of abdominal contents into the base of the umbilical cord with a covering membrane.

Q: What is posterior urethral valves (PUV), and how does it appear on ultrasound?

A: PUV is an obstruction in the male urethra causing urinary retention, often seen as a "keyhole" sign on ultrasound.

Q: Where should the fetal heart be located within the thoracic cavity?

A: On the left side of the chest.

Section 3B

Q: What is the process of determining zygosity, chorionicity, and amnionicity in multiple gestations?

A:

• Zygosity: Number of fertilized ova.

• Chorionicity: Number of placentas.

• Amnionicity: Number of amniotic sacs.

Q: What defines monozygotic (identical) twins?

A: One zygote divides into two embryos.

Q: What defines dizygotic (fraternal/non-identical) twins?

A: Two separate amniotic and chorionic cavities (placentas).

Q: What is the classification of twins based on the timing of division?

A:

• Dichorionic, Diamniotic: Division within 0-4 days.

• Monochorionic, Diamniotic: Division within 4-8 days.

• Monochorionic, Monoamniotic: Division after 8 days.

Q: What is the mortality rate for monochorionic, monoamniotic twins?

A: 50% mortality rate.

Q: What is the most common complication of multiple gestations?

A: Increased risk of anomalies, including CNS, respiratory, cardiovascular, and GI issues.

Q: What are the signs of Twin Anemia Polycythemia Syndrome (TAPS)?

A: One twin is anemic, and the other is polycythemic, resulting in discordant growth and Doppler abnormalities.

Q: What is Twin Reverse Arterial Perfusion (TRAP)?

A: One twin lacks a heart and receives blood through arterial anastomosis from the other twin.

Q: What is Twin-Twin Transfusion Syndrome (TTTS)?

A: It results from imbalanced vascular supply to monozygotic, monochorionic, monoamniotic twins, leading to fetal death in severe cases.

Q: What causes conjoined twins?

A: Division of the zygote after day 13, resulting in monoamniotic twins.

Q: What is the "Vanishing Twin" phenomenon?

A: The reduction of one twin in the early stages of pregnancy, often leading to fetal remnants being detected on scans.

Q: What is fetal papyraceous?

A: A flattened, mummified remnant of a nonviable fetus, often seen as calcified between membranes.

Q: When is cord entanglement most problematic?

A: When it leads to a cord knot with arterial compromise, especially in monochorionic, monoamniotic twins.

Q: What are soft markers for aneuploidy?

A:

• Thickened nuchal fold

• Echogenic bowel

• Short femur/humerus

• Absent or hypoplastic nasal bone

• Single uterine artery (SUA)

Q: What anomalies are specific to Trisomy 21 (Down Syndrome)?

A:

• Mild ventriculomegaly

• Pyelectasis

• Echogenic intracardiac foci

• Sandal gap deformity

• Duodenal atresia

• Hyperechoic bowel

Q: What markers are associated with Trisomy 18 (Edwards Syndrome)?

A:

• Strawberry-shaped skull

• Club feet

• Choroid plexus cysts

• Micrognathia

• Clenched hands/wrists

Q: What are the characteristics of Trisomy 13 (Patau Syndrome)?

A:

• Omphalocele

• Bladder exstrophy

• Holoprosencephaly

• Polydactyl

• Rocker-bottom feet

Q: What is the Biophysical Profile (BPP)?

A: A scoring system to assess fetal health, including heart rate, breathing, body movement, tone, amniotic fluid, and placental grading.

Q: What defines polyhydramnios?

A: Excessive amniotic fluid, with an AFI > 25 cm or >2000 cc, associated with maternal gestational diabetes.

Q: What defines oligohydramnios?

A: Low amniotic fluid, with an AFI < 5 cm or single pocket < 2 cm, associated with IUGR, renal anomalies, and limb contracture.

Q: What is the main risk of asymmetric intrauterine growth restriction (IUGR)?

A: Disproportionate growth where the abdominal circumference is below the 10th percentile, often with a high HC:AC ratio.

Q: What are the characteristics of symmetric IUGR?

A: Equal reduction in all biometric parameters, commonly associated with infections, maternal factors, and genetic/chromosomal anomalies.

Q: What is the definition of fetal macrosomia?

A: Fetal weight > 4500 grams (~10 lbs), associated with diabetes, obesity, and certain congenital syndromes.

Q: What is Spalding's sign?

A: A sign of fetal demise, where the skull bones overlap due to fetal death.

Q: What are neural tube defects (NTDs)?

A: Birth defects related to the brain or spine, such as spina bifida, cephalocele, and myelomeningocele.

Q: What is microcephaly?

A: An abnormally small head and brain size, often associated with developmental delays and genetic conditions.

Q: What is Dandy-Walker Syndrome?

A: A malformation of the brain where the fourth ventricle is dilated and cystic, associated with developmental delays.

Q: What is holoprosencephaly?

A: A forebrain malformation where the brain fails to divide into two hemispheres, leading to facial anomalies.

Q: What is nuchal translucency?

A: A measurement of fluid at the back of the neck, used to assess risk for trisomies, especially during weeks 11-13 of pregnancy.

Q: What is cystic hygroma?

A: An abnormal lymphatic system defect often seen as a septated cystic structure, associated with Turner's syndrome, trisomies, and other defects.

Q: What is a cleft lip?

A: A facial abnormality where the upper lip does not fully form, commonly seen with trisomies, Roberts syndrome, and cardiac anomalies.

Q: What is hydrops fetalis?

A: Excessive fluid accumulation in the fetus, which can be due to immune (isoimmunization) or non-immune causes (fetal cardiac insufficiency, trisomies, maternal diabetes).

Q: What is micrognathia?

A: A condition where the mandible is abnormally small, associated with several syndromes, including Trisomy 21 and 13.

Q: What is the cause of hypertelorism?

A: Abnormally wide-set eyes, often associated with Trisomy 18, Triploidy, and Roberts syndrome.

Q: What is anophthalmia?

A: The absence or underdevelopment of one or both eyes, associated with conditions like Trisomy 13 and 18.

Q: What are the two types of abnormal fetal heart rhythms?

A: Tachycardia (usually self-limiting and associated with infection) and bradycardia (risk for fetal demise).

Q: What is the most common cardiac anomaly in fetuses?

A: Ventricular Septal Defect (VSD).

Q: What is Transposition of Great Arteries (TGA)?

A: A condition where the pulmonary artery and aorta are switched in position, incompatible with life unless septal defects or PDA/PFO are present.

Q: What anomaly is associated with maternal lithium ingestion?

A: Ebstein’s anomaly (apical displacement of the right atrium and a small right ventricle with a dysplastic tricuspid valve).

Q: What does Tetralogy of Fallot consist of?

A: Ventricular septal defect, aortic override, pulmonary stenosis, and right ventricular hypertrophy.

Q: What is the characteristic feature of Aortic Coarctation?

A: Narrowing of the aortic lumen, most commonly between the left subclavian and ductus arteriosus.

Q: What is Double Outlet Right Ventricle (DORV)?

A: A condition where both the aorta and pulmonary trunk arise from the right ventricle, often with a ventricular septal defect.

Q: What is Truncus Arteriosus (TA)?

A: A condition where a single arterial trunk supplies both coronary, pulmonary, and systemic circulations, often associated with a ventricular septal defect.

Q: What is the most common fetal cardiac tumor?

A: Cardiac Rhabdomyoma, which is usually benign and echogenic.

Q: What is the primary issue in Hypoplasia of Ventricles?

A: Underdevelopment or nonfunctioning ventricles, with left-sided hypoplasia being most common and fatal without a patent foramen ovale (PFO) or atrial septal defect (ASD).

Q: What is Cardiomyopathy in fetuses?

A: Poor muscular development of the heart, often with hypertrophy and increased cardiothoracic ratio.

Q: What does Heterotaxy involve?

A: Situs ambiguous or inversus, where left-right asymmetry is reversed. Left and right isomerisms are identified based on the fetus' anatomy.

Q: What is the most common type of congenital diaphragmatic hernia?

A: Bochdalek hernia, located on the left side of the diaphragm.

Q: What is Pentalogy of Cantrell?

A: A congenital anomaly consisting of diaphragmatic defect, omphalocele, ectopia cordis, cardiac anomaly, and pericardial/sternal defect.

Q: What is Achondrogenesis?

A: A skeletal dysplasia with extreme deficiency in bone and cartilage development, including micromelic limbs and poorly ossified spine.

Q: What is Thanatophoric Dysplasia?

A: The most common lethal skeletal dysplasia, characterized by a cloverleaf skull, hypertelorism, narrow thorax, and platyspondyly.

Q: What is Campomelic Dysplasia?

A: A skeletal dysplasia that affects bone, genital, and facial formation, characterized by bowing of long bones, bell-shaped thorax, and IUGR.

Q: What is Osteogenesis Imperfecta?

A: A condition of hypo-mineralization and brittle bones, with multiple fractures and beaded healing, often fatal in Type 2.

Q: What is Pulmonary Hypoplasia?

A: Underdeveloped fetal lungs, often due to low amniotic fluid index (AFI), small thorax, or a mass in the thorax.

Q: What is Hydrothorax?

A: A pleural effusion or chylothorax, often resulting in pulmonary hypoplasia, with a "batwing" appearance of the lungs.

Q: What is Bronchopulmonary Sequestration?

A: Accessory lung tissue with no connection to the tracheobronchial tree, often located on the left posterior aspect and fed by a vessel from the aorta.

Q: What is Congenital Cystic Adenomatoid Malformation (CCAM)?

A: A benign cystic proliferation in the lung, often resulting in pulmonary hypoplasia, and usually affecting a single lung lobe.

Q: What is a common characteristic of Congenital Diaphragmatic Hernia?

A: Abdominal contents protruding into the thorax through defects in the diaphragm, commonly on the left side.

Q: What is Gastroschisis?

A: A lateral defect of the abdominal wall (most commonly on the right), allowing bowel loops and/or solid organs to be seen within the amniotic fluid. It is often an isolated finding with elevated AFP.

Q: What is Omphalocele?

A: A midline herniation of abdominal contents into the umbilical cord, surrounded by a membrane. It is associated with elevated AFP and many pathologies.

Q: What is Pentalogy of Cantrell?

A: A congenital anomaly consisting of diaphragmatic defect, omphalocele, ectopia cordis, cardiac anomaly, and pericardial/sternal defect. It results from failure of lateral folding in the 1st trimester and has a poor prognosis.

Q: What is Bladder Exstrophy?

A: A midline defect of the anterior abdominal wall causing herniation of the urinary bladder through the abdominal wall with the absence of the anterior bladder wall, often surrounded by umbilical arteries. It is associated with elevated AFP.

Q: What is Cloacal Exstrophy?

A: A complex anomaly involving omphalocele, bladder exstrophy, imperforate anus, and lumbar/sacral spinal defects (OEIS). Elevated AFP is present.

Q: What is Prune Belly Syndrome?

A: A condition characterized by renal dysplasia, ureteral dilation, an enlarged bladder with a thin wall, potential patent urachus, underdevelopment of the abdominal wall, and cryptorchidism.

Q: What is Meconium Ileus?

A: An obstruction of the distal ileum caused by thick meconium, leading to dilated bowel with echogenic material contained within it.

Q: What is Meconium Peritonitis?

A: Inflammation of the peritoneum due to meconium escaping into the peritoneal cavity, leading to a "snowstorm" appearance, ascites, polyhydramnios, and calcifications.

Q: What is Duodenal Atresia?

A: A form of small bowel atresia from failure of recanalization of the bowel lumen, characterized by the "double bubble" sign and polyhydramnios, often associated with trisomy 21.

Q: What is Limb Body Wall Complex?

A: A condition involving ventral body fusion failure, leading to abdominal and thoracic defects, lower limb anomalies, scoliosis, and exencephaly, associated with cocaine use. Elevated AFP is present.

Q: What is Distal Bowel Atresia?

A: A narrowing or absence of loops of bowel, often in the jejunum, ileum, or large colon, with prominent, non-peristalsing loops of meconium-filled bowel.

Q: What is Hirschsprung Disease?

A: The most common cause of neonatal obstruction, caused by a lack of ganglion cells in the colon, leading to lack of peristalsis, dilated loops of the colon, and polyhydramnios.

Q: What is Esophageal Atresia?

A: Underdevelopment of the esophagus, often diagnosed by the absence of the stomach, polyhydramnios, and intrauterine growth restriction. The esophagus is often atretic.

Q: What is Obstructive Cystic Dysplasia?

A: A condition in which bladder or urethral outlet obstruction leads to small scattered renal cysts.

Q: What is Autosomal Recessive Polycystic Kidney Disease (ARPKD)?

A: A condition characterized by bilateral microcystic replacement of renal tubules, enlarged echogenic kidneys, poor renal function, and oligohydramnios.

Q: What is Multi Cystic Kidney Disease (MCKD)?

A: A condition where multiple varying-sized cysts replace normal renal tissue. If bilateral, it leads to poor renal function.

Q: What is Renal Agenesis?

A: The congenital absence of one or both kidneys. Bilateral renal agenesis is historically incompatible with life and results in oligohydramnios, pulmonary hypoplasia, and Potter’s facies.

Q: What is Fetal Hydronephrosis?

A: A condition where the renal pelvis and calyces are dilated. The size criteria for diagnosis are: >4 mm in the 1st trimester, >8 mm in the 2nd trimester, and >10 mm in the 3rd trimester.

Q: What is Posterior Urethral Valves (PUV)?

A: A condition that only affects males, characterized by a "keyhole" sign of an enlarged bladder and urethra, and may be associated with hydramnios or oligohydramnios.

Q: What is Testicular Hydrocele?

A: The accumulation of fluid in the layers of the tunica vaginalis, seen as the "owl sign" and common in 3rd trimester male fetuses.

Q: What is an Ovarian Cyst?

A: The most common intra-abdominal cyst in females, often functional due to maternal hormones. It may develop daughter cysts, septa, or torsion.

Q: What is Hypospadias?

A: A congenital condition where the urethral meatus is abnormally positioned, typically along the underside of the penis. It is often associated with cryptorchidism.

Q: What is a Horseshoe Kidney?

A: A condition where the lower poles of the kidneys are fused. It is more common in males and associated with conditions like Trisomy 18 and Turner's syndrome.

Q: What is Abnormal Genitalia?

A: A condition where there is sexual ambiguity or congenital anomalies of the genitalia, often associated with conditions like Klinefelter syndrome, Turner's syndrome, and congenital adrenal hyperplasia.

Q: What is Amniotic Band Syndrome?

A: A condition characterized by the foreshortening or amputation of extremities and other unusual defects due to ruptured amnion disrupting fetal growth.

Q: What is Osteogenesis Imperfecta?

A: A disorder of hypo-mineralization and brittle bones, resulting in multiple bone fractures. Type 1 is the most common and least severe, while Type 2 is lethal.

Q: What is Campomelic Dysplasia?

A: A skeletal dysplasia affecting bones, genitalia, and facial structures. It causes bowing of long bones, intrauterine growth restriction, and is fatal by age 1.

Q: What is Talipes Equinovarus?

A: A deformity where the foot is turned inward and downward, involving adduction of the forefoot, inversion of the heel, and plantar flexion of the ankle. It is most common bilaterally in males.

Q: What is Thanatophoric Dysplasia?

A: The most common lethal skeletal dysplasia, characterized by a cloverleaf skull, frontal bossing, hypertelorism, and narrow thorax. It results from a chondrocyte defect.

Q: What is Cleidocranial Dysostosis?

A: A condition characterized by absent or malformed skeletal structures, including hypoplastic bones, cloverleaf skull, hypoplastic clavicles, extra ribs, and hemivertebrae.

Q: What is Clinodactyly?

A: A condition where the digits deviate or override, most often affecting the fifth digit. It is strongly associated with Trisomy 21 and Turner's syndrome.

Q: What is Achondrogenesis?

A: A severe skeletal dysplasia with extreme deficiency in bone and cartilage development, resulting in micromelic limbs, poorly ossified spine, and a large head.

Q: What is Achondroplasia?

A: The most common skeletal dysplasia, characterized by rhizomelic dwarfism, short bowed femurs, frontal bossing, and knee deformities. It is fatal in the homozygous form but compatible with life in the heterozygous form.

Q: What is Polydactyly?

A: The condition of having more than five fingers or toes, either fully formed or rudimentary. It is associated with Meckel Gruber syndrome and Trisomies 13 and 21.

Q: What is Syndactyly?

A: A condition where two or more digits are fused together. It is often associated with Smith-Lemli-Opitz syndrome.

Q: What is Mesomelia?

A: Shortening of the middle segments of limbs, affecting structures like the tibia, fibula, radius, and ulna.

Q: What is Rhizomelia?

A: Shortening of the proximal limbs, affecting the humerus and femur.

Q: What is Acromelia?

A: Shortening of the distal limbs, affecting the hands and feet.

Q: What is Micromelia?

A: Shortening of both the distal and proximal portions of the bones equally.

Q: What is Amelia?

A: The complete absence of a limb.

Q: What is Platyspondyly?

A: Flattening of the vertebral bodies.

Section 3C

Q: What is placenta previa?

A: Placenta previa is when the placenta implants over a portion of the internal cervical os within the lower uterine segment.

Q: What is the main symptom of placenta previa?

A: The main symptom is painless vaginal bleeding.

Q: What are the different types of placenta previa?

A: Types include:

• Complete/Grade 4: Placenta centrally covers the os

• Partial/Grade 3: Placenta partially covers the internal os

• Marginal/Grade 2: Placenta is at the margin of the os (<10mm)

• Low lying/Grade 1: Placenta within 2 cm of the os

Q: What is placental abruption?

A: Placental abruption is the premature separation of the placenta from the uterine wall, which can lead to bleeding and fetal distress.

Q: What are the types of placental abruption?

A: Types include:

• Preplacental: Subamniotic or chorionic location, less poor prognosis

• Retroplacental: High pressure bleed, affecting spiral arteries

• Marginal: Low pressure bleed at edges of placenta

Q: How does placental abruption appear sonographically?

A: Retroplacental abruption appears as a thickened placenta with possible clot visualization, and marginal abruption appears as an anechoic or hypoechoic subchorionic area.

Q: What is placental infarction?

A: Placental infarction is a wedge-shaped hypoechoic region due to interrupted vascular supply, typically affecting less than 10% of the placenta. Larger infarctions can cause complications like hypertension and intrauterine growth restriction.

Q: What is placental hematoma and its types?

A: Placental hematoma is a blood collection within the placenta. Types include:

• Retroplacental (due to abruption)

• Marginal (subchorionic)

• Intraplacental (intervillous thrombosis)

Q: What is postpartum hemorrhage?

A: Postpartum hemorrhage is the loss of 500 mL or more of blood from the genital tract within 24 hours after childbirth, often due to uterine atony or cretas.

Q: What is placenta creta?

A: Placenta creta is when the placenta attaches abnormally to the uterus, with elevated AFP and hCG levels. Types include:

• Accreta: Villi penetrate the basalis but not into the myometrium

• Increta: Villi penetrate the myometrium but not the serosa

• Percreta: Villi invade the serosa and possibly adjacent structures

Q: What are membranous placental abnormalities?

A: Types include:

• Placenta diffusa: Diffuse thinning of placenta

• Circumvallate placenta: Tethered chorionic and basal membranes, associated with marginal infarction

• Circummarginate placenta: Basal plate extends beyond the chorionic plate with a flat interface

• Succenturiate placenta: Accessory lobes with vascular connection, associated with hemorrhage

Q: What is a chorioangioma?

A: A chorioangioma is a common benign vascular tumor of the placenta, often found near the cord insertion and associated with increased MSAFP.

Q: What are abnormal umbilical cord insertions?

A: Types include:

• Eccentric (normal): Lateral insertion > 2 cm from the edge

• Marginal: Insertion less than 2 cm from the edge

• Velamentous: Cord inserts into membranes outside the placental margin, associated with previa

Q: What is a single umbilical artery (SUA)?

A: SUA is the absence of one umbilical artery, associated with IUGR, premature delivery, and is a soft marker for conditions like trisomies.

Q: What is vasa previa?

A: Vasa previa is when fetal vessels cross the cervical internal os within the membranes, without support from the placenta or Wharton’s Jelly. It is a high-risk condition, especially with polyhydramnios or twin pregnancies.

Q: What is short umbilical cord syndrome?

A: Short umbilical cord syndrome occurs when the cord is 40 cm or less, associated with abdominal, chest, and neural anomalies, and elevated MSAFP. It is often linked to maternal cocaine use.

Q: What is a long umbilical cord associated with?

A: A long umbilical cord (greater than 80 cm) is often associated with polyhydramnios, LGA, thick placenta, and extra loops or hypercoiling.

Q: What are umbilical cord knots?

A: A true umbilical cord knot is formed due to fetal twisting, which can risk vessel compression but usually does not compromise fetal well-being. A false knot results from a longer umbilical vein.

Q: What is abnormal coiling of the umbilical cord?

A: Types include:

• Hypocoiled cord: Fewer than 1 coil per 5 cm, associated with hypertension and oligohydramnios

• Hypercoiled cord: More than 1 coil per 5 cm, linked to maternal diabetes, polyhydramnios, and neonatal distress

Q: What are the types of umbilical cord cysts?

A: Types include:

• Allantoic cyst: Epithelial-lined cyst near the fetal end

• Omphalomesenteric cyst: Epithelial-lined cyst near the fetal end, associated with yolk stalk remnants

• Pseudocyst: Collection of liquified Wharton’s jelly, not lined with epithelial tissue

Q: What are some causes of umbilical cord constriction or occlusion?

A: Causes include intrinsic factors like deficient Wharton’s jelly, and extrinsic factors such as amniotic bands, nuchal cord, knots, fetal grasping, and cord prolapse.

Q: What is umbilical cord prolapse?

A: Umbilical cord prolapse is when the cord slips past the presenting fetal part and enters the cervix or vagina, which can be frank, funic, or occult.

Section 3D

Q: What is cervical incompetence?

A: Cervical incompetence is when the cervix opens prematurely, often leading to miscarriage or preterm birth. It is characterized by an open internal os and a cervix measuring less than 2-3 cm.

Q: What is the hourglass appearance in cervical incompetence?

A: The hourglass appearance refers to bulging fetal membranes, fetal parts, or cords into the widened cervical os.

Q: What are the treatments for cervical incompetence?

A: The treatments for cervical incompetence include cerclage, bed rest, and progesterone.

Q: What is the first step in evaluating maternal pelvic pathology?

A: The first step is to follow any identified mass and assess whether it is consistent and located peripherally (not in the lower uterine segment).

Q: What should be done if a mass is larger than 6 cm or threatens the fetus during pregnancy?

A: Surgery should be performed during the second trimester, as the effects on the fetus are more predictable at this stage.

Q: What should a sonographer do if a mass is identified during an ultrasound scan?

A: The sonographer should obtain displaced bladder images and roll the patient into different positions to assess the fixed nature of the mass.

Q: What are the clinical symptoms of maternal pelvic pathology?

A: Clinical symptoms include palpable mass and pain.

Q: What are common types of masses found in maternal pelvic pathology?

A: Common masses include fibroids/myomas, corpus luteum mass, dermoid cyst, serous cystadenoma/adenocarcinoma, mucinous cystadenoma/adenocarcinoma, theca lutein cysts, PID, intra-abdominal abscess, ectopic organs, contractions, and hydronephrosis.

Section 4A

Section 4B

Section 4C

Section 4D

Part 5: Physics and Instrumentation:

Section 5A (23 questions) Accessing pelvic vasculature, AV malformations using doppler 

Q: Where is the uterine artery located?

A: Within the lateral aspect of the myometrium.

Q: What happens to uterine artery diastolic flow as pregnancy progresses?

A: It increases due to decreased vascular resistance.

Q: How does blood flow resistance change in the uterine artery during pregnancy?

A: It gradually decreases as pregnancy progresses.

Q: What conditions could be associated with high resistance flow throughout pregnancy?
A: Pre-eclampsia and IUGR (Intrauterine Growth Restriction).

Q: What could reversal of diastolic flow throughout pregnancy indicate?

A: Severe complications, potentially threatening fetal well-being.

Q: What is the expected Doppler pattern of the uterine artery in a healthy pregnancy?

A: Progressively increasing diastolic flow with decreasing resistance.

Q: What Doppler finding in the uterine artery is an early sign of vascular complications in pregnancy?

A: Persistently high-resistance flow or absent/reversed diastolic flow.

Q: What is an arteriovenous malformation (AVM)?

A: An abnormal connection between arteries and veins that bypasses the capillary system.

Q: How does AVM affect blood flow?

A: It creates irregular, abnormal, and turbulent flow.

Q: What does Doppler ultrasound detect in an AVM?

A: Abnormal flow and flow in areas where it should not be present.

Q: What is turbulent flow in AVMs?
A: Chaotic or disordered blood flow due to abnormal vessel connections.

Q: What is a key feature of AVMs seen with Color Doppler?

A: Visualization of abnormal blood vessels with rapid flow.

Q: What vessels are involved in an AVM?

A: Feeding arteries (bringing blood in) and draining veins (removing blood).

Q: What abnormal Doppler findings suggest an AVM?

A: High-velocity, low-resistance arterial flow and pulsatile venous flow.

Q: What does spectral Doppler show in an AVM?

A: Increased velocity, low resistance, and turbulent waveforms.

Q: How can AVMs cause clinical complications?

A: They may lead to hemorrhage, ischemia, or high-output cardiac failure.

Q: What is a uterine arteriovenous malformation (AVM)?

A: An abnormal connection between arteries and veins in the uterus, bypassing the capillary system.

Q: What can cause an acquired uterine AVM?

A: Trauma, surgery, infection, or previous pregnancy complications.

Q: What is a pelvic AVM?

A: An abnormal vascular connection in the pelvic region affecting blood flow and function.

Q: How do congenital and acquired AVMs differ?

A: Congenital AVMs are present at birth, while acquired AVMs develop later due to injury, infection, or surgery.

Q: What are common symptoms of a uterine AVM?
A: Heavy vaginal bleeding, pelvic pain, and abnormal Doppler flow patterns.

Q: Why is it important to differentiate AVMs from retained products of conception (RPOC)?

A: Both can cause abnormal bleeding, but treatment approaches are different.

Q: What are the treatment options for uterine AVMs?

A: Uterine artery embolization, surgical removal, or conservative management depending on severity.

Section 5B (33 questions)  Accessing Fetal Heart Rate (m-mode), MCA, Ductus Venosus, and Umbilical Cord Vessels using Doppler

Q: When can fetal heart rate first be detected using transvaginal ultrasound?

A: As early as 5 weeks gestation.

Q: When can fetal heart rate typically be detected using transabdominal ultrasound?

A: Around 6 weeks gestation.

Q: What mean sac diameter (MSD) should be present before expecting to see fetal heart activity?
A: Greater than 25mm.

Q: What is the normal fetal heart rate range?
A: 120–160 beats per minute (bpm).

Q: What imaging modes should be used if no fetal heart rate is detected?
A: M-mode, cine clip, color Doppler, power Doppler, and pulse wave Doppler.

Q: Why is M-mode preferred over Doppler in early pregnancy?

A: M-mode has lower acoustic exposure, making it safer for the developing embryo.

Q: What does the Left Ventricular Outflow Tract (LVOT) view assess?

A: The aorta and its connection to the left ventricle.

Q: What does the Right Ventricular Outflow Tract (RVOT) view assess?

A: The pulmonary artery and its connection to the right ventricle.

Q: What is assessed in the Three Vessels and Trachea View?

A: The alignment of major vessels with the trachea, ensuring normal vascular anatomy.

Q: What condition might be suspected if there is an absence of normal fetal heart tones?

A: Embryonic demise or early pregnancy failure.

Q: Why is it important to document cine clips in fetal heart evaluation?

A: To provide real-time motion analysis of cardiac activity.

Q: What should be done if an abnormal fetal heart rate is detected?

A: Further assessment using M-mode and Doppler studies to evaluate rhythm and function.

Q: Where is the middle cerebral artery (MCA) located?

A: Within the Sylvian fissure.

Q: In which plane should the MCA be sampled using Doppler?

A: Axial plane at the biparietal diameter (BPD) level.

Q: What is the normal Doppler waveform pattern of the MCA?

A: Sharp systolic upstroke with rapid diastolic deceleration that stays above baseline.

Q: How does the systolic/diastolic (S/D) ratio of the MCA compare to the umbilical artery?

A: The MCA S/D ratio should be higher than the umbilical artery S/D ratio.

Q: What does slower diastolic deceleration below the baseline indicate?

A: Brain-sparing effect, which may suggest fetal distress or hypoxia.

Q: What is the clinical significance of MCA Doppler in fetal assessment?

A: It helps detect fetal anemia, hypoxia, and brain-sparing physiology.

Q: What happens to MCA resistance in cases of fetal hypoxia?

A: MCA resistance decreases, allowing more blood to flow to the brain.

Q: What is the function of the ductus venosus?

A: It brings oxygenated blood from the umbilical vein to the IVC, bypassing the liver.

Q: What Doppler waveform pattern is expected in the ductus venosus?

A: The "Flying W" sign or a triphasic waveform with forward flow.

Q: What does the S wave in the ductus venosus waveform correspond to?

A: Fetal ventricular systolic contraction (the highest peak).

Q: What does the D wave in the ductus venosus waveform correspond to?

A: Fetal early ventricular diastole (the second highest peak).

Q: What does the A wave in the ductus venosus waveform correspond to?

A: Fetal atrial contraction, which is the lowest point in the waveform but should still show forward flow.

Q: Why is it important that the A wave maintains forward flow?

A: Reversed or absent A wave could indicate fetal cardiac compromise or increased central venous pressure.

Q: What does a reversed A wave in the ductus venosus suggest?

A: Severe fetal distress, possibly leading to fetal heart failure.

Q: What images are required for assessing umbilical cord vessels with Doppler?
A:

1. Transverse (TRV) segment of free-floating umbilical cord

2. Two umbilical arteries adjacent to the fetal bladder

3. Abdominal cord insertion (ACI)

4. Placental cord insertion (PCI)

Q: What is the normal Doppler flow pattern of the umbilical vein?

A: Monophasic, continuous forward flow, ensuring oxygenated blood enters the fetus.

Q: What is the characteristic Doppler waveform of the umbilical artery?

A: “Sawtooth pattern” – sharp systolic upstroke, curved peak, and slow diastolic downstroke.

Q: Where should Doppler samples be taken from the umbilical cord?
A: At three locations:

1. Placental cord insertion (PCI)

2. Abdominal cord insertion (ACI)

3. Free-floating cord

Q: What is the normal Systolic/Diastolic (S/D) ratio of the umbilical artery?

A: Less than 3.0.

Q: What does absent or reversed end-diastolic flow in the umbilical artery indicate?

A: Placental insufficiency and possible fetal distress.

Q: Why is umbilical artery Doppler assessment important in high-risk pregnancies?

A: It helps detect placental dysfunction, fetal hypoxia, and risk of adverse outcomes.

Section 5C (16 questions) M-Mode, Doppler, 3D Imaging & ALARA Principle

Q: What is M-mode used for in fetal imaging?

A: To evaluate normal or abnormal fetal heart rhythms.

Q: How is M-mode acquired?

A: By using a single line that transmits and receives in the same direction over time.

Q: Why is M-mode preferred for fetal imaging?

A: It requires less power, making it safer for the fetus.

Q: How do you measure fetal heart rate using M-mode?

A: Measure from two consecutive peaks, representing one full cardiac cycle.

Q: What is the normal fetal heart rate range?

A: 120–160 bpm.

Q: What is considered fetal bradycardia and tachycardia?
A:

• Bradycardia: < 110 bpm

• Tachycardia: > 160 bpm

Q: How should Doppler tracings of blood flow be obtained?

A: The transducer should be parallel to the four-chamber view, and the cursor should be placed at the level of the annulus, then moved toward the apex and ventricular cavity.

Q: What does Doppler allow for in terms of fetal heart evaluation?

A: Visualization of atrial size, forward flow patterns, and the absence of regurgitation.

Q: What is the characteristic flow pattern of the atrioventricular (AV) valves?
A: A double-peak pattern:

• E wave (first peak, passive filling phase)

• A wave (second peak, active atrial phase)

Q: What is the purpose of 3D sonography in fetal imaging?

A: It increases sensitivity to detect anomalies such as monoamniotic twins, cardiac defects, cranial and spinal defects, and limb abnormalities.

Q: What abnormalities can 3D sonography help evaluate in greater detail?

A: Conditions like talipes (clubfoot), cleft lip/palate, spina bifida, and anencephaly.

Q: What does the ALARA principle stand for?

A: As Low As Reasonably Achievable, emphasizing minimizing ultrasound exposure.

Q: What does the ALARA principle recommend for transducer contact with the patient?

A: Minimize the amount of time the transducer is in contact with the patient.

Q: What is the safe thermal index (TI) for ultrasound?

A: A TI less than 2.0 is considered likely safe, and there is no time limit if TI remains below 0.7.

Q: What temperature increase is required to cause fetal abnormalities?

A: A 2.5°C temperature increase sustained for 2 hours can potentially cause fetal abnormalities.

Q: What is the safe mechanical index (MI) for ultrasound?

A: An MI less than 1.9 without gas bodies, or 0.4 with gas bodies, is considered safe.

Section 4: Protocols and Procedures (66)

Section 4A: Clinical standards and guidelines (13) 

Q: What should be verified before performing an ultrasound?  

A: Verify the accuracy of the physician’s order and obtain pertinent clinical history. Confirm exam type, review pre-procedure instructions, and verify patient details such as name, age, date of birth, and medical conditions.

Q: What types of ultrasound exams need to be confirmed?  

A: Transvaginal and transabdominal.

Q: What pre-procedure instructions should be reviewed with the patient?  

A: Full bladder, fasting, and scanning specific areas/anatomy.

Q: What clinical history should be obtained from the patient?  

A: Symptoms (abdominal pain, vaginal bleeding, cramping, etc.), obstetric and gynecological history (GPA, complications, conditions like endometriosis, fibroids, ovarian cysts), medications, and family history of genetic disorders.

Q: What symptoms should be assessed during the clinical history review?  

A: Abdominal pain, vaginal bleeding, spotting, cramping, lack of fetal movement, and leaking fluid.

Q: What obstetric history should be reviewed?  

A: GPA (Gravida, Para, Abortus) and any pregnancy complications.

Q: How should ultrasound findings be correlated?  

A: Compare ultrasound findings with clinical presentation, previous imaging, physical examination, lab results (e.g., hCG levels, CBC, thyroid function tests), and other imaging modalities like MRI or CT scans.

Q: What types of previous imaging should be compared with current ultrasound findings?  

A: Historical ultrasound, gestational sac, fetal growth, placental positioning, fetal heartbeat, embryonic development, and anatomical changes.

Q: What scanning techniques should be used during an ultrasound exam?  

A: Transabdominal ultrasound (requires full bladder), transvaginal ultrasound (for early pregnancy or better visualization), Doppler ultrasound (for blood flow), and 3D/4D ultrasound (for detailed imaging scenarios).

Q: What patient positions should be used during an ultrasound?  

A: Supine, slightly tilted to the left or right for patient comfort.

Q: What ultrasound findings require immediate action?  

A: Ectopic pregnancy, fetal demise, severe placental abruption, massive hemorrhage, hydrops fetalis, abnormal fetal anatomy, and severe pre-eclampsia or eclampsia signs.

Q: What is the role of Doppler ultrasound?  

A: It is used to assess blood flow, including fetal heart rate, placental blood flow, and maternal arteries.

Q: What conditions are assessed with 3D/4D ultrasound?  

A: Detailed imaging scenarios such as abnormal fetal anatomy or complex cases requiring further examination.

Section 4B: measurement techniques - gynecology (9)

Q: What is the role of the endometrium in the uterus?  

A: The endometrium is the lining of the uterus that thickens in preparation for pregnancy and is essential for the implantation of a fertilized embryo.

Q: What are the indications for measuring endometrial thickness?  

A: Early pregnancy evaluation, infertility investigations, postmenopausal bleeding, endometrial pathologies, and monitoring after IVF.

Q: What is the normal endometrial thickness during different phases of the menstrual cycle?  

A:  

- Pre-ovulation (follicular phase): 4-7 mm  

- Post-ovulation (luteal phase): 7-14 mm  

- During menstruation: 1-4 mm  

- Postmenopausal: <5 mm

Q: What is the normal size of the uterus?  

A:  

- Length: 7-9 cm  

- Width: 4-6 cm  

- Depth: 2-4 cm  

- Shape: Pear-shaped with a smooth outline

Q: What are the indications for measuring the uterus?  

A: Routine obstetric exams, menstrual cycle disorders, abnormal bleeding, postpartum evaluation.

Q: What are common uterine abnormalities?  

A: Fibroids (leiomyomas), adenomyosis, and congenital anomalies (e.g., bicornuate, septate, unicornuate uterus).

Q: What is the normal size of ovaries?  

A:  

- Length: 2-5 cm  

- Width: 1-3 cm

Q: What are the indications for measuring ovaries?  

A: Ovarian cysts, ovarian tumors, polycystic ovary syndrome (PCOS), monitoring ovulation, pain, and abnormal bleeding.

Q: What are common ovarian abnormalities?  

A: Ovarian cysts (simple and complex), polycystic ovary syndrome (PCOS), ovarian tumors, and ovarian torsion.

Section 4C: Measurement techniques - obstetric (30)

Q: What first trimester structures should be measured?  

A: Yolk sac (or placenta), CRL (crown-rump length), and MSD (mean sac diameter).

Q: What is the normal measurement for nuchal translucency?  

A: The normal nuchal fold measurement is <6 mm and is typically done between weeks 18-22.

Q: How is nuchal translucency measured?  

A: Measure from the outer edge of the skin to the outer edge of the occipital bone.

Q: How is biparietal diameter (BPD) measured?  

A: Measured at the axial section of the fetal head at the level of falx cerebri, cavum septi pellucidi, choroid plexus, and other landmarks. Measure from the inner or leading edge to the leading edge.

Q: When is BPD most accurate?  

A: BPD is most accurate between weeks 14-20.

Q: How is head circumference measured?  

A: By mapping or using an ellipse around the outer perimeter of the calvarium or by measuring the shortest and longest axes (D1+D2) and multiplying by 1.57. Alternatively, frontal occipital diameter can be used if the skull shape is abnormal.

Q: What is the normal range for cisterna magna?  

A: Normal range is 5-6 mm, and if it is enlarged, it is >11 mm.

Q: How is the cisterna magna measured?  

A: Measure from the vermis to the inner occipital bone.

Q: How is transverse cerebellar diameter measured?  

A: Measure in the axial plane at the widest portion of the cerebellum.

Q: What is the normal range for transverse cerebellar diameter?  

A: It ranges with age:  

- 1.5 mm at 10 weeks  

- 2 cm at 20 weeks

Q: What is an indication of cerebellar hypoplasia?  

A: A smaller-than-normal transverse cerebellar diameter.

Q: How is lateral cerebral ventricle measured?  

A: Measure the atrial portion in the far field from inner to inner, and it should be equidistant from the interhemispheric fissure.

Q: What is the normal measurement for lateral cerebral ventricles?  

A: Normal is 6.5 mm, and enlarged is greater than 10 mm.

Q: What does the cephalic index evaluate?  

A: It evaluates head shape for the reliability of BPD or in the presence of abnormal head shapes (dolichocephaly or brachycephaly).

Q: How is the cephalic index (CI) calculated?  

A: CI% = BPD/OFD × 100. The normal range is 75-86%.

Q: When should nuchal fold measurement be taken?  

A: Between 15-20 weeks' gestation.

Q: What is the normal range for abdominal circumference?  

A: Abdominal circumference should be measured at a 90-degree transverse view of the spine, with the stomach in the left fetal abdomen, ribs symmetric, and the junction of the left and right portal veins visible.

Q: How is abdominal circumference measured?  

A: Trace or ellipse the perimeter of the skin, including the outer edge all the way around.

Q: How is femur length (FL) measured?  

A: Measure the femoral diaphysis with the transducer perpendicular to the long axis of the bone, most accurate between weeks 14-20.

Q: When is the distal femoral epiphysis visualized?  

A: At 32 weeks.

Q: What is the normal measurement for renal pelves?  

A: The renal pelvis should have a normal AP measurement of <5-10 mm.

Q: When can kidneys be seen in a fetus, and what do they look like?  

A: Kidneys can be seen as early as week 13 and are hypoechoic with indistinct borders. In the second and third trimesters, they show echogenic sinus, pyramids, and perirenal fat.

Q: What are the methods for assessing amniotic fluid?  

A:

- Single pocket method: Measure the maximum vertical pocket.  

- 4-quadrant method: Ensure pockets are ≥2 cm.

Q: What is the normal range for amniotic fluid?  

A: Normal is 10-20 cm (4-quadrant method).  

- Oligohydramnios: <5 cm (4-quadrant), <2 cm (single pocket).  

- Polyhydramnios: >2 cm (4-quadrant), >8 cm (single pocket).

Q: What are the functions of amniotic fluid?  

A: It cushions and protects the fetus, allows for movement, prevents adherence of the amnion to the embryo, regulates temperature, serves as a reservoir for metabolites, and helps with fluid regulation.

Q: What is a biophysical profile (BPP)?  

A: A BPP evaluates 5 parameters (heart reactivity, breathing, body movement, tone, and amniotic fluid) within 30 minutes or less.

Q: What score indicates fetal well-being in a BPP?  

A: A score of 8+ indicates fetal well-being.

Q: What does a BPP score of <6 indicate?  

A: Fetal distress.

Q: What is the normal measurement for maternal cervix?  

A: The normal cervical length is 3-5 cm.

Q: What is important to note regarding the placenta's relationship to the cervix?  

A: It is important to note whether the placenta is eccentric or low-lying as it can indicate a risk for placenta previa.

Section 4D: Sonographer Role in Procedures (14)

Q: What is the purpose of sonohysterography in ultrasound assistance?  

A: Sonohysterography involves injecting saline through the cervix into the cervical canal to visualize structures that are normally not seen. It helps detect polyps, fibroids, and uterine scarring.

Q: What should be evaluated before performing an amniocentesis after 15 weeks’ gestation?  

A: Evaluate fetal age, number of pregnancies, fetal position and viability, any anomalies, placental location, and the fluid pocket.

Q: What is the role of ultrasound during the amniocentesis procedure?  

A: Ultrasound provides guidance for fluid localization, ensures sterile technique, and visualizes the needle during the procedure.

Q: What should be assessed post-amniocentesis?  

A: Post-procedure, ultrasound demonstrates fetal wellness and heart rate, checks for post-biopsy complications, and provides potential follow-up to rule out complications. If the mother is Rh-negative, she may receive 300 mg of anti-D IgG.

Q: What is the optimal biopsy site for chorionic villus sampling (CVS)?  

A:The optimal biopsy site is the portion of the placenta adjacent to the cord insertion.

Q: What is the preferred approach for performing CVS?  

A: 90% of CVS are performed transcervically in the lithotomy position with a full bladder. The transabdominal approach is used for fundal or high anterior placentas, maternal herpes simplex virus, and severe flexion.

Q: Why is a transabdominal approach for CVS useful?  

A: It increases the success rate and decreases the complication rate, especially for certain placenta locations and maternal conditions.

Q: What should be assessed during ultrasound assistance for intrauterine contraceptive device (IUD) placement?  

A: Check for proper positioning in the fundal endometrial canal, look for the "lost strings" sign, and check for symptoms of pelvic inflammatory disease (PID).

Q: Why is it important to check for pregnancy before IUD placement?  

A: Checking for pregnancy is crucial because removing an IUD while pregnant can pose a risk for spontaneous abortion.

Q: What should be assessed during infertility examinations and procedures using ultrasound?  

A: Assess the cause of infertility, presence, number, and maturation of follicles, and monitor the development of the endometrium.

Q: When are baseline studies for infertility performed?  

A: Baseline studies are typically performed on day 2 or 3 of the menstrual cycle.

Q: What is the minimum size of follicles that must be present for retrieval?  

A: Follicles must be greater than 16-20 mm in size for retrieval.

Q: What should be monitored during infertility procedures to avoid complications?  

A: Monitor for ovarian torsion and ovarian hyperstimulation syndrome, characterized by enlarged ovaries and increased vascular permeability.

Q: What is the role of ultrasound in ovum retrieval and embryo transfer during infertility procedures?  

A: Ultrasound guides the aspiration of ova during retrieval and assists with embryo transfer.