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21 Cards in this Set
- Front
- Back
- 3rd side (hint)
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1. Midline facial defects are most likely associated with:
A. Holoprosencephaly B. Septo optic dysplasia C. Chiari II D. Trisomy 21 E. Dandy Walker36 |
A) Holoprosencephaly
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Causes of median facial cleft are 1. median cleft face syndrome 2. Holoprosencephaly 3. Majewski syndrome (short rib, polydactily, facial cleft)
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2. The stuck twin phenomenon is associated with:
a. Diamniotic, dichorionic twins. b. Diamniotic, monochorionic twins. c. Monoamniotic, monochorionic twins. d. Monoamniotic, dichorionic twins. |
Answer: Diamniotic, monochorionic
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4. At what level do you measure the abdominal circumference in a fetal ultrasound?
• Level of the kidneys • Level of the cord insertion • Level of the gallbladder • Level of the umbilical vein • Level of the left portal vein |
Answer: Left portal Vein
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8. What can be done to reduce aliasing artifact on Doppler study?
• increase the pulse repetition frequency • decrease the angle of incidence • alter focal point • increase gain |
Answer: Increase pulse repetition frequency
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To decrease aliasing:
Fd= [2FtVCos0]/C • Increase the PRF • Increase the Doppler angle (decreases Doppler frequency shift, but not too much!) • Decrease transducer frequency (Doppler shift =proportional to tramsmitted frequency) • Change position so that object in closer (allows PRF to be increased) |
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Refraction
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usually occurs at fat-soft tissue or soft tissue-fluid interfaces and results in duplication of deep abdominal and pelvic structures
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Reverberation
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decreased by decreasing power output and gain; minimized by positioning the transducer so that the cystic structure is no longer in the near field.
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Ring down
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bright echoes produced deep to a gas collection
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Tissue vibration
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arises in tissues surrounding an artery due to pulsatility and may produce a detectable Doppler frequency shift, which will be assigned a color.
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9. What is best evaluated on fetal US with a four-chamber view?
• Double outlet right ventricle • Transposition • VSD • ASD • AV canal abnormalities |
AV Canal defects and valvular abn. Also, hypoplastic right or left heart
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10. Prenatal ultrasound demonstrates a normal brain cortex at the level of the lateral ventricle(s). The head circumference is indicated in the graph. What is the most likely diagnosis? (graph with linear plot and head diameter of 15mm at 16 weeks)
• Holoprosencephaly • Chiari II • Hydrancephaly • Normal |
Chiari II
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The ventricles are considered dilated in a fetus when they measure >10 mm at the level of the atrium. Ventricular dilatation is present in 98% of patients, and 90% require a shunt) with a normal cerebral mantle (sort of) and head circumference is a Chiari II malformation.
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15. Regarding schizencephaly, all of the following are true except:
a. Dysplastic grey matter lines the cleft b. Rarely bilateral c. Ventricle “dimple” is suggestive. d. Most commonly found in the posterior fossa |
Answer: Most commonly found in the posterior fossa
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16. Regarding early first trimester of pregnancy, which of the following is a true statement?
A) HCG doubles every 24 hours B) The gestational sac is usually visualized when the HCG is >2000(1st) C) The MSD approximately doubles in size each day D) The HCG and MSD typically increase proportionately until the 5th week |
B) gestational sac is usually visualized when HCG is >2000 (1st)
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18. What predisposes to placenta accreta?
a. prior C-section b. multiple gestations c. PID d. Prior molar pregnancy |
prior c section
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Varies (increases) with number of C-sections, seen in up to 67% of those with a placenta previa and 4 cesarean sections
- Uterine scarring: previous D&C, endometritis, submucous leiomyoma, Asherman’s syndrome, adenomyosis. Accreta: chorionic villi in contact with myometrium (80% of cases) Increta: chorionic villi invade into myometrium (15% of cases) Percreta: chorionic villi invade into serosa (5% of cases). US: loss of the normal hypoechoic rim of myometrial tissue beneath the placenta |
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19. A rounded focus of decreased echogenicity is seen in the upper pole on one of two kidneys on prenatal ultrasound examination. What is the most likely diagnosis?
A) ARPCKD B) ADPCKD C) Medullary cystic disease D) Multicystic dysplastic kidney E) Obstruction of the upper pole moiety |
E) Obstruction of the upper pole moiety
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A duplicated kidney can have an obstructed upper pole (presenting as a “cyst”) and a normal or dilated lower pole. Dilation of lower pole moiety is typically caused by reflux. The upper pole obstruction is caused by ectopic ureter, which inserts lower and more medially toward the base of the bladder. Autosomal recessive (infantile) polycystic kidney disease (ARPCKD) presents as bilateral enlarged hyperechoic kidneys, a finding that usually presents in 3rd trimester. In 2nd trimester, kidneys of fetusus with ARPCKD are usually normal. Autosomal dominant polycystic kidney disease (ADPCKD) is usually diagnosed in adulthood as enlarged kidneys with multiple cysts. It can be seen in utero as hyperechoic kidneys (if cysts are small) or with multiple bilateral cysts. Medullary cystic disease also presents as bilateral cysts. Multicystic dysplastic kidney (MCDK) represents a kidney with multiple noncommunicating cysts. By contrast, in UPJ obstruction, cystic structures are connected.
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20. Choroid plexus cyst is associated with
A) tri 13 B) tri 18 C) tri 21 D) XXY |
tri 18
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35. Nonimmune hydrops is not caused by which of the following?
A. viral infection B. Turner C. congenital heart disease D. chronic disease of the placenta E. erythroblastosis fetalis |
Answer: E - Erythroblastosis fetalis
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What is the optimum gestational age to measure nuchal translucency?
a. 6 – 8 weeks. b. 8 – 11 weeks. c. 11 – 14 weeks. d. 14 – 18 weeks. e. 18 – 20 weeks. |
11-14 wks
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Branches of the left circumflex artery
Obtuse Acute marginal Diagonal |
obtuse
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Circumflex obtuse
Right coronary acute marginal Left anterior descending diagonals |
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What is the most echogenic features on neonatal US
cingulate gyrus corpus callosum vermis massa intermedia caudate |
vermis
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On neonatal cranial sonography, the cingulate gyrus is hypoechoic. The caudate head is more echogenic than the thalamus and adjacent frontal horn of the lateral ventricle. However, the cerebellar vermis is most hyperechoic
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A patient is 2-3 days status post renal transplant, now with rising creatinine and decreased urine output. This is consistent with: a. hyperacute rejection b. accelerated acute rejection c. acute rejection d. chronic rejection
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accelerated acute rejection
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Hyperacute: Minutes to hours. Preformed antidonor antibodies and complement
Accelerated: Days. Reactivation of sensitized Tcells Acute: Days to weeks. Primary activation of T cells Chronic: Months to years. Both immunologic and nonimmunologic factors |
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Artifact on US. Mirror image artifact vs. reverberation artifact. a. At junction of gas and soft tissue b. Occurs at interfaces between tissues due to differences in sound velocities c. Can be corrected by decreasing energy? d. Most common in the right upper quadrant
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junction of gas and soft tissue; also common in RUQ
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Mirror image artifacts: Because of reflection of US waves at acoustic mirrors, (e.g., diaphragm), lesions can be projected into locations in which they are not really present. Typical example is that of a liver lesion near the diaphragm, which can be projected into the lung because the liver-lung boundary acts as an acoustic mirror.
Reverberation artifacts: Returning echoes are partially reflected at an internal boundary (“…between reflective interfaces such as metallic objects or air pocket/partial liquid areas of the anatomy” per Bushberg). This produces misregistration and assigns structures to places they don’t really exist (e.g., a bright line is seen in the bladder). Can be reduced by changing the scanning angle or transducer placement to avoid the parallel interfaces that contribute to the artifact. Also known as ring-down, and comet-tail artifacts. |
