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ARDMS OBSTETRICS /ARDMS OB/GYN ACTUAL EXAM AND PRACTICE EXAM
NEWEST 202 5 COMPLETE 300 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
Are subchorionic lesions and cyst a significant finding in terms of the placenta? - ANSWER-No they are insignificant. Sonographic findings of subchorionic thrombotic lesions - ANSWER-Echogenic focus beneath the chorionic plate Sonographic findings of subchorionic cystic lesions - ANSWER-Well circumscribed, anechoic areas beneath the chorionic plate Most hypoechoic or cystic areas in the mid placenta are due to - ANSWER-Intervillous thrombus in the space between the fetal and the maternal sides of the placenta. Early in the placenta hemorrhagic process, flow may be observed within these spaces as hypoechoic areas mid placenta and may be termed - ANSWER-Maternal lakes Septal cyst placenta - ANSWER-Is a rare mid placental cystic structure; it is a cyst that forms between cotyledons of the placenta. Sonographic signs of mid placental lesions are - ANSWER-Maternal lakes and intervillous thrombosis Itervellous thrombosis - ANSWER- A circumvallate placenta can only be demonstrated during what portion of pregnancy? - ANSWER-Mid second trimester Early in pregnancy, the entire surface of the gestational sack is covered with the ViLLI, as the pregnancy progresses, the VEILLi usually regress over most of the surface of the sac, and that remains becomes the
placenta. If this regression does not occur, the placenta may cover the entire surface of the sack, if it is patchy, there may be two or more separate areas of placenta formation. And either case, this is called what? - ANSWER-Placenta membranacea Placenta membranacea - ANSWER-Fetal membranes covered by chorionic villi due to failure of chorion differentiation into the chorion laeve and chorion frondosum Succenturiate lobe - ANSWER-Accessory lobe of placenta located away from the main placenta body. It is connected to the main placenta via large blood vessels That course through the membranes that accompany it Bipartite lobe - ANSWER-Is one that is divided into two approximately equal size lives in is sometimes called but I bilobed placenta Annular placenta - ANSWER-A ring shaped placenta that attaches circumferentially to the myometrium. Between succentruriateblobes, bipartite placenta, and annular placenta which types of placentas are seen on ultrasound and which are not? - ANSWER-Succenturiateblobes and bipartite placentas are seen on ultrasound. And annular placenta is not seen on ultrasound. Sonographic findings of succenturiateblobes and bipartite placentas - ANSWER--two masses of placenta tissue that appear unconnected. - Color Doppler imaging will show robust flow in the blood vessels that vascularize the accessory lobe. - when the lines are of equal size, the primary lobe can be identified by the presence of the umbilical cord insertion on its chorionic surface. After 33 weeks, more that 50% of placentas contain some degree of calcification. - ANSWER-Calicifation is a normal part of placental aging ( fact card) Where are calcifications usually found on the placenta? - ANSWER-At the base of the placenta, in the septa, and in the subchorionic and perivillous spaces. Calcification of the placenta is more common in women with what? - ANSWER--low parity-smoke cigarettes-mothers who have thrombotic disorders and are on anticoagulants such as heparin or aspirin therapy. Coumadin crosses placenta discontinued first trimester due to fetal abnormalities correlation
The umbilical cord vessels are the extension of what? - ANSWER-Of the fetal internal iliac arteries and course along the inferolateral aspect of the fetal urinary bladder, exiting the anterior abdominal wall at the level of the dome of the bladder. The umbilical arteries carry ________. - ANSWER-They carry deoxygenated blood from the heart of the fetus to the woman. Is formed by myriad anastomoses game subchorionic tributaries moving oxygenated and nutrient rich blood from the surface of the placenta to the fetus. - ANSWER-Umbilical vein Wharton's jelly - ANSWER-A gelatinous tissue that remains when the embryonic body stalk blends with the yolk sac within the umbilical cord. Umbilical cord is first seen at how many weeks - ANSWER-8 weeks Cord diameter - ANSWER-Less than 2 cm Most common vascular abnormality of the umbilical cord is - ANSWER-Single umbilical artery also known as the 2vessel cord Causes of single umbilical artery - ANSWER--primary agenesis of one of the arteries, secondary atrophy of presviously present artery, and persistent of the original single embryonic artery. The most common cause of single umbilical artery is - ANSWER-Secondary atrophy of a previously normal vessel Conditions associated with a 2 vessel cord/ single umbilical artery include - ANSWER--chromosomal abnormalities-multiple gestational- maternal diabetes - persistent right umbilical vein - congenital renal anomalies Vascular cord abnormalities - ANSWER-Are those related to the two umbilical arteries and the single umbilical vein present in a normal cord
Umbilical vein thrombosis is most frequently seen - ANSWER-With diabetic mothers and in fetuses with no immune hydrops Conditions associated with umbilical vein thrombosis include - ANSWER--long umbilical cord- velamentous insertion of the cord- cord knots Characteristic signs of umbilical vein thrombosis - ANSWER--increased echogenic it's in the lumina of umbilical vessels- absence of Doppler signals within an umbilical vessel- absence of color flow within an umbilical vessel Structure abnormalities of the umbilical cord - ANSWER-Are those that pertain to variations, size, shape, and configuration of the umbilical cord. What does can twin to twin transfusion do to the umbilical cord of the recipient twin? - ANSWER-Diffuse enlargement of the cord bc of the increased flow through the vessels and superimposed edema of Whartons jelly Enlarged umbilical cords have been reported with - ANSWER-Diabetes, hydros, diffuse hematoma What are abnormally long umbilical cords subseptable to? - ANSWER-Knotted, entangled, or prolapsed What are issues that arise with short umbilical cords? - ANSWER-May restrict fetal movement and normal hemodynamic exchange in uterine and present problems at delivery A _______________ can occur as a primary phenomenon due to failure of embryonic infolding. - ANSWER-Short cord A __________________ May cause a predisposition toward inadequate fetal descent during labor, fetal heart rate abnormalities related to cord compression, and placental abruption. - ANSWER-Short umbilical cord
trophotropism - ANSWER-As the placenta develops; it tends to grow more freely in areas where myometrial perfusion is robust and less freely in areas where perfusion is weaker. As a result the cord may insert eccentrically on the placentas. This process is called Most common cord insertion abnormalities - ANSWER-Battledore placenta and velamentous insertion battledore placenta - ANSWER-Placenta with the umbilical cord inserted into the border Velamentous insertion - ANSWER-Blood vessels in the umbilical cord separate and leave the cord prior to insertion into the surface of the placenta. Occurs 1% of the time. Dangerous, rupture of membranes may also rupture a fetal blood vessel. Vessels are also liable to compression which would cause fetal anoxia. Is one in which the cord inserts along the margin of the placenta - ANSWER-Battledore placenta aka marginal insertion of the cord Sonographic identity of battledore placenta - ANSWER-Insertion of the umbilical cord is at the periphery of the placenta, Color Doppler imaging is useful in confirmation in confirmation of the vascular insertion site. Attaches beyond the placental edge and into the free membranes of the placenta - ANSWER- Velamentously inserted cord Why in velamentous insertion may be complicated by by ruptured or thrombosis of the umbilical vessels
- ANSWER-Bc they are not protected by whartons jelly A rare form of velamentous insertion, where the umbilical vessels lie across the internal cervical is is called - ANSWER-Vasa previa Conditions associated with a velamentously inserted cord include - ANSWER-Bilobed placenta,twin pregnancy, uterine anomalies, intrauterine conceptiondevice, single umbilical artery Masses close to the placental end are more commonly - ANSWER-Allantoic cyst
Masses close to the fetal end are more commonly - ANSWER-Omphalomesenteric cyst Cyst of the umbilical cord detected in the first trimester is more likely reprenting - ANSWER-Normal variant The most common tumor of the umbilical cord - ANSWER-Is a benign and rare vascular tumor called hemangioma Cord hemangiomas are associated with - ANSWER-Increased risk of AFP levels, polyhydramnois, some congenital abnormalities, and increased perinatal mortality Sonographic sign of hemangioma - ANSWER-Is an echogenic or multicystic mass located near the placental insertion of the cord Biometric measurements during the first trimester - ANSWER-Crown rump length & mean sac diameter 2nd and 3rd trimester biometric measurements - ANSWER-Biparietal diameter bpd, head circumference (hc) abdominal circumference (ac) femur length (fl) Gestational sac measurements - ANSWER-Cursors places on the inner edge of the chorionic villi and the measurements is to the outer edge of the chorionic fluid Earliest measure of sonographically obtainable gestational age - ANSWER-Mean diameter of a gestational sac Practical use of mean sac diameter for gestational dating is limited to - ANSWER-6weeks or less General rule of thumb at 5 weeks MSD (mean sac diameter) = - ANSWER-5mm Sac size increases approximately how much per day - ANSWER-1mm
When is the bilateral diameter (BPD) be measured to be most accurate? - ANSWER-Between 14 & 24 weeks biparietal diameter (BPD) - ANSWER-fetal transverse cranial diameter at the level of the thalamus and cavum septum pellucidum What structures should be seen when measuring the BPD - ANSWER-Thalami and Calvin septi pellecidi Rules for measuring the biparietal diameter include - ANSWER-- true axial section. 90% at the level of the 3rd ventricle and thalami. - the Calabria should appear smooth and symmetric- cursors should be placed leading edge to leading edge (outer to inner) 1=lateral ventricle-fetal horn 2=Cancun septi pellucidi 3=third ventricle 4=thalamus 5=lateral ventricle 6=cerebellum 7=choroid plexus 8=Sylvia's fissue - ANSWER- Proper measurements of BPD - ANSWER-Cursers leading edge to leading edge (outer to inner) In BPd measurements the width of the parietal skull should be no greater that whAt? - ANSWER-5mm Is obtained from an axial section of the head at the same level as that used for BPD - ANSWER-Head circumference An atomic land marks for head circumference measurements - ANSWER-Cavil septum pellucidi, thalmic nuclei, fall cerebrum, Chris plexus OFD stands for - ANSWER-Occipital frontal diameter Formula for head circumference - ANSWER-HC=(BPD+OFD)x1. Head Circumference Measurement - ANSWER-
Formula for Cephalic index - ANSWER-BPD/OFD x 100=CI When does the first trimester begin? - ANSWER-Begins with the first day of the woman's last menstrual period (lmp) and ends 10 weeks later. Marks the point when all organ systems have been differentiated and are in place and the embryo has become a fetus. - ANSWER-The end of the first trimester Occurs 14 days after the first day of menstrual period. - ANSWER-Ovulation Determines the beginning of pregnancy in clinical obstetrics. - ANSWER-The first day of the last period Embryologic tests are based on what? - ANSWER-Conceptual age Gracie uterus - ANSWER-Name for uterus during pregnancy Chadwick's sign - ANSWER-Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. Goodell's sign - ANSWER-softening of the vaginal portion of the cervix Hegar's sign - ANSWER-softening of the lower uterine segment (uterine isthmus) Hyper pigmentation of the lines alba - ANSWER-The fibrous structure that runs down the the abdominal midline Labratory hormones that can determine early pregnancy - ANSWER-Progesterone, early pregnancy factor, HCG beta-hCG stands for? - ANSWER-Beta subunit of human chorionic honadotropin in maternal serum
What test excludes the diagnosis of a live pregnancy anywhere in the body. - ANSWER-A negative beta hcg blood test Descrinatory levels of serum beta hcg - ANSWER- Early pregnancy timeline - ANSWER- When does fertilization occur? - ANSWER- 24 - 36 hours after ovulation. Fertilization of the ovum occurs how many days after the beginning of the last mentrual period? - ANSWER- 15 - 16 days after Conceptual age is how much less than menstrual age? - ANSWER-2 weeks less Mentrual age - ANSWER-In clinical obstetrics the exact date of ovulation is unknown. Calculated by lmp Occurs 14 days after LMP - ANSWER-Ovulation Occurs 15-16 days after lmp - ANSWER-Fertilization Occurs 18-19 days after lmp - ANSWER-Conceptus enters uterine cavity Occurs 21-22 days after lmp - ANSWER-Implantation Occurs 29-30 days after lmp - ANSWER-Gastrulation Occurs 35 days after lmp - ANSWER-Neurulation starts
Occurs 42 days after lmp - ANSWER-Neurulation ends Occurs 43 days after lmp - ANSWER-Heart separation starts Nearly all permanent internal and external structures are formed by how many weeks? - ANSWER- 6 - 10 weeks What week of pregnancy does unidirectional blood flow begin? - ANSWER-Week 6 Formation of the heart is complete by what week? - ANSWER-Week 8 Formation of the peripheral vascular system is complete by what week? - ANSWER-Week 10 Formation of the primitive gut is complete? - ANSWER-Week 6 The rectum separates from the urogenital sinus at what week? - ANSWER-Week 8 The midgut herniated into the umbilical cord and then returns to the abdomen at what week? - ANSWER-Weeks 8- 12 The anal membrane perforated at what week? - ANSWER-Week 10 The primitive kidneys (metanephrol) begin to form and descend into the abdomen at what week? - ANSWER-Week 8 Kidneys are in the adult position; external genitalia are visually similar in males and females at what week? - ANSWER-Week 11 Differentiation of external male and female genitalia is complete at what week? - ANSWER-Week 14
Gestational sac can be visually seen on trans abdominal scan at what week? - ANSWER-6 weeks Characteristic signs of a normal intrauterine gestational sac - ANSWER-1. Round, oval, well defined borders
- Echogenic, intact borders 3.positioned in fundus or mid uterus
- Growth =1mm/day
- Yolk sac present when mean sac diameter is >or= 13mm 6.intradecidual sign
- Double bleh sign Intradecidual sign - ANSWER-Sonographic presence of a small gestational sac within the decides at approx 4-4.5weeks. How to distinguish a true intradecidual sign from a deco dual cyst? - ANSWER-Sonographer must be sure that the gestational sac is directly adjacent to the endometrial canal. Double bleb sign - ANSWER-At 5.5 menstrual weeks, the developing amniotic sac measures about 2mm in diameter and becomes visible to the adjacent to the yolk sac. Double sac appearance is the double bleb sign. During the double bleb sign where does the bilaminar embryonic disc lie? - ANSWER-Between the yolk sac and the amnion. The double bleb sign is no longer viable by what week? - ANSWER-Week 7 Sonographic image of double bleb sign - ANSWER-1=decides Vera 2=decide capsularis 3=decidua basal is 4=yolk sac 5= amniotic sac Sonographic image of double decidual sign. - ANSWER-Echogenic ring formed by two decidual layers surrounding the gestational sac. 1. Decidua Vera 2. Decidua capsularis 3. Decidua basalis 4. Yolk sac
The echogenic ring formed by the decidua Vera and decidua capsularis is called the - ANSWER-Double decidual sac sign Future placenta - ANSWER-Decidua basalis May be visualized as an area of echogenic thickening on one portion of the sac. - ANSWER-Decidua basalis # When can the double decidual sac sign be seen at what weeks? - ANSWER-5.5-6 weeks What is the earliest embryonic structure identified sonographically and is reliably demonstrated by 5 weeks in a normal gestation? - ANSWER-Yolk sac Initially produces red blood cells needed by the primitive circulatory system - ANSWER-Yolk sac Yolk sac ultrasound image - ANSWER-Yolk sac between the amnion and chorion The yolk sac sits between what two structures? - ANSWER-Amnion and chorion What type of transducer is required to consistently visualize yolk sacs in 8mm GS or when beta hcg levels have reached discriminatory level consistent with failed pregnancy? - ANSWER-High frequency (7- 10mhz) transvaginal Characteristics sonographic signs of a normal yolk sac? - ANSWER-1. Sepherical in shape, w/a sonolucent center and a clearly defined echogenic wall
- May be visualized when the mean sac diameter is >or = 5mm (5mentrusl weeks)
- Always visualized when the mean sac diameter is >or=8mm (@5.5 mentrual weeks) Embryonic cardiac activity may be visualized when the crown rump length is approximately - ANSWER- 2 - 4mm
If prominent rhombencephalon are seen in the second trimester this sonographic finding suggests a - ANSWER-Dandy walker malformation Dandy walker malformation - ANSWER-Cystic dilation of the fourth ventricle, hypoplasia or complete absence of the vermis, an enlarged posterior fossa, and hydrocephalus The hindbrain structures, can appear prominent, a normal finding during the first and second trimester - ANSWER-Prominent rhombencephalon Abnormal nuchal translucency - ANSWER- Is a collection of lymphatic fluid found in the posterior neck region of the embryo that is normal during the first trimester? - ANSWER-Nuchal translucency Nuchal translucency is a useful indicator of possible genetic abnormalities, notably trisomy 21 and is best measured between what weeks? - ANSWER-11 and 14 weeks nuchal translucency - ANSWER-It is a useful indicator of possible genetic abnormalities notably trisomy 21 Between what weeks does the amniotic sac grow to fill the chorionic cavities? - ANSWER-Week 12 to 16 Implantation bleeding - ANSWER-a bleed that occurs at the time in which the conceptus implants into the decidualized endometrium Intrauterine gestational sac >or = 8mm without evidence of embryo. - ANSWER-Anembryonic pregnancy/blatant of them Small demised embryo relative to gestational sac sizeYolk sac arrow occupying more than 30% of toast total gestational sack volume - ANSWER-
Poorly marginated and insisting borders surround an irregularly shaped gestational age. - ANSWER- Sonographic sign of an abnormal early pregnancy Sagittarius endovaginal image demonstrating a large well circumscribed gestational sac implanted in the lower uterine segment. - ANSWER-Sonographic sign of an abnormal early pregnancy Yolk sac occupying more than 30% of total gestational sac volume - ANSWER-Sonographic sign of an abnormal early pregnancy incomplete abortion - ANSWER-Sagittarius endovaginal image demonstrating an irregularly shaped gestational sac containing complex, echogenic material consistent with products of conception and clot Is the physiologic termination of pregnancy prior to 20 weeks gestation - ANSWER-Spontaneous abortion What percentage of spontaneous abortions occur before the 16th week of pregnancy? - ANSWER-75% risk factors of spontaneous abortion - ANSWER--endocrine factors
- failure of the corpus outrun
- maternal muller Ian outrun
- interruption of embryonic development
- chromosomal causes
- diabetes mellitus
- polycystic ovary syndrome
- cigarette smoking Occurs when some of the products of conception remain in there maybe organization of a blood clot surrounding the conceptus - ANSWER-Incomplete abortion Occurs when some of the products of conception remain in there maybe organization of blood clot surrounding the conception - ANSWER-Incomplete abortion
