Lange Review Ultrasonography Examination, 4th Edition

Questions

GENERAL INSTRUCTIONS: For each question, select the best answer. Select only one answer for each question unless otherwise specified.

1. The sonographic finding in Fig. 7–48 is

(A) normal fetal face

(B) cleft lip

(C) anencephaly

(D) hypertelorism

(E) epignathus

Image

FIGURE 7–48.

2. Fig. 7–49 demonstrates

(A) omphalocele

(B) encephalocele

(C) cystic hygroma

(D) craniosynostosis

(E) arachnoid cyst

Image

FIGURE 7–49.

3. The sonographic finding in Fig. 7–50 include

(A) equinovarus

(B) normal foot posture

(C) an association with spina bifida

(D) both A and C

(E) all of the above

Image

FIGURE 7–50.

4. Fig. 7–51 demonstrates

(A) cystic hygroma

(B) spina bifida

(C) encephalocele

(D) non-immune hydrops

(E) scalp edema

Image

FIGURE 7–51.

5Fig. 7–51 is a sonographic marker for

(A) Turner’s syndrome

(B) Down’s syndrome

(C) trisomy 18

(D) fetal infection

(E) Potter’s syndrome

6. The most likely diagnosis for Fig. 7–52 includes

(A) spalding’s sign

(B) Down’s syndrome

(C) “lemon”-shaped skull

(D) microcephaly

(E) both A and D

(F) both C and D

Image

FIGURE 7–52.

7. The sonographic finding in Fig. 7–53 is

(A) fetal abdominal ascites

(B) meconium peritonitis

(C) Spalding’s sign

(D) non-immune hydrops

(E) scalp edema

Image

FIGURE 7–53.

8. Fig. 7–54 demonstrates

(A) bilateral pleural effusions and edema

(B) cystic hygroma and scalp edema

(C) increased nuchal sonolucency and fetal ascites

(D) encephalocele

(E) normal findings

Image

FIGURE 7–54

9Fig. 7–55 is an example of

(A) sonographic artifact

(B) severe ventriculomegaly

(C) holoprosencephaly

(D) scalp edema

(E) none of the above

Image

FIGURE 7–55.

10. Which of the following sonographic findings is not associated with trisomy 18?

(A) intrauterine growth retardation

(B) clenched hands

(C) holoprosencephaly

(D) cystic hygroma

11. Paternally derived triploidy has the following sonographic markers

(A) complete mole

(B) severe asymmetrical intrauterine growth retardation

(C) large placenta with multiple cystic areas

(D) oligohydramnios

(E) both A and D

(F) both B and D

12. Which of the following sonographic findings are seen in maternally derived triploidy?

(A) complete mole

(B) severe asymmetrical intrauterine growth retardation

(C) large placenta with multiple cystic areas

(D) oligohydramnios

(E) both A and D

(F) both B and D

13. Oligohydramnios is most likely associated with which one of the following?

(A) Potter’s syndrome

(B) duodenal atresia

(C) hydrocephalus

(D) maternal diabetes

(E) fetal hydrops

14. Which one of the following is within the normal range of the fetal heart rate when documented on M-mode at 6 weeks gestation?

(A) 40–80 beats per minutes

(B) 80–100 beats per minutes

(C) 112–136 beats per minutes

(D) 136–200 beats per minutes

(E) 200–250 beats per minutes

15. A 60-year-old woman with primary adenocarcinoma of the stomach now presents with a large complex right ovarian mass and ascites. What is the most likely diagnosis?

(A) neurofibromatosis

(B) Sertoli-Leydig tumor

(C) Krukenberg’s tumor

(D) Meigs’ syndrome

(E) cystadenofibroma

16. A 25-year-old patient presents for ultrasound with a history of hyperemesis gravidarum and preeclampsia. Fig. 7–56 is a sonogram of the uterus that demonstrates which of the following?

(A) blighted ovum

(B) leiomyosarcoma

(C) missed abortion

(D) hydatidiform mole

(E) theca lutein cyst

Image

FIGURE 7–56.

17. When the sole of the foot is visualized in the same anatomical plane as the tibia and fibula, what is this findings most likely to be?

(A) talipes

(B) dwarfism

(C) polydactyly

(D) osteogenesis imperfecta

(E) achondrogenesis

18. What is the most common twin zygosity?

(A) conjoined twins

(B) monochorionic/diamniotic

(C) dichorionic/diamniotic

(D) monochorionic/monoamniotic

19. Which of the following best describes the “twin peak” sign?

(A) also known as the beta sign

(B) a triangular projection of chorion into the dividing membrane

(C) a sonographic predictor for dizygotic twins

(D) both B and C

(E) all of the above

20. Which of the following statements about conjoined twins is not true?

(A) Sixty percent are born alive.

(B) Fifty-six percent of conjoined twins are fused on the ventral wall.

(C) Polyhydramnios is commonly present.

(D) The largest risk of fetal demise is because of cord entanglement.

21. Which of the following best describes the uterine position shown in Fig. 7–57?

(A) retroverted

(B) retroflexed

(C) anteverted

(D) anteflexed

Image

FIGURE 7–57.

22. What is the most reliable indicator for fetal demise in the second and third trimester?

(A) oligohydramnios

(B) polyhydramnios

(C) mother stating she has not detected any fetal movement

(D) the sonographic presence of fetal scalp edema, ascites and hydrops

(E) absence of cardiac motion

23. Fluid in the endometrial cavity in a post-menopausal patient may be associated with which of the following?

(A) increased in estrogen

(B) vaginal atrophy

(C) endometriosis

(D) ectopic pregnancy

(E) cervical stenosis

24. Which one of the following signs/symptoms is usually not associated with placenta abruption?

(A) bloody amniotic fluid

(B) painless bright red blood

(C) sudden onset of pain and increase uterine tone

(D) fetal distress

(E) maternal shock

25. Which of the following is not a midline structure?

(A) cavum septum pellucidum

(B) third ventricle

(C) foramen of Monro

(D) pituitary gland

(E) hippocampus

26. Which of the following is the most common short limb syndrome?

(A) achondrogenesis

(B) thanatophoric dysplasia

(C) osteogenesis imperfecta

(D) Jeune thoracic dystrophy

(E) none of the above

27. What sonographic findings would be identified in a fetus with heterozygous achondroplasia?

(A) hydrocephaly

(B) frontal bossing

(C) “bell-shaped” thorax

(D) “trident hand”

(E) both A and C

(F) both B and D

(G) all of the above

28. Fig. 7–58 is a transverse plane of view through the uterus. What do the two-echogenic lines represent?

(A) the interstitial portion of the fallopian tube

(B) two endometrial linings of a septate uterus

(C) single endometrial lining

(D) two endometrial linings of a bicornuate uterus

(E) none of the above

Image

FIGURE 7–58.

29. Fig. 7–59 demonstrates what fetal anomaly?

(A) sacral agenesis

(B) meningocele

(C) myelomeningocele

(D) sacrococcygeal teratoma

(E) pelvic cyst

Image

FIGURE 7–59.

30Fig. 7–60 is a sonographic example of which of the following?

(A) placenta accreta

(B) placental abruption

(C) marginal placenta previa

(D) placenta vasa previa

(E) normal findings

Image

FIGURE 7–60.

31. Fig. 7–61 is a transverse plane of view in the fetal nuchal region. Which of the following is the sonographic finding?

(A) cystic hygroma

(B) increased nuchal skin fold

(C) fetal scalp edema

(D) increased nuchal translucency

(E) nuchal cord

Image

FIGURE 7–61.

32. Fig. 7–62 is a longitudinal plane of view through the midline of the uterus. The echogenic foci represent which of the following?

(A) endometrial polyp

(B) IUD in situ

(C) endometrial hyperplasia

(D) endometrial cancer

(E) eccentric IUD

Image

FIGURE 7–62.

33. Fig. 7–63 demonstrates what ovarian abnormality?

(A) hemorrhagic corpus luteum cyst

(B) tubo-ovarian abscess

(C) benign cystic teratoma

(D) septated ovarian cyst

(E) polycystic ovaries

Image

FIGURE 7–63.

34Fig. 7–64 demonstrates which of the following findings?

(A) left ectopic pregnancy

(B) corpus luteal cyst

(C) polycystic ovarian disease

(D) left hydrosalpinx posterior to the left ovary

(E) normal ovary with iliac vessels

Image

FIGURE 7–64.

35. Fig. 7–65 is an image of a fetus at 8 weeks gestational age. What is the cystic structure within the fetus?

(A) rhombencephalon

(B) cystic hygroma

(C) increased nuchal translucency

(D) hydrocephalus

(E) Dandy-Walker malformation

Image

FIGURE 7–65.

36. Fig. 7–66 shows transverse scans of the uterus. What is the mass measured in this figure?

(A) intramural fibroid

(B) calcified fibroid

(C) submucosal fibroid

(D) pedunculated fibroid

(E) subserosal fibroid

Image

FIGURE 7–66.

37. A 27-year-old female G5P4 with complaints of menorrhagia and pelvic pain. The serum β-hCG was 4,500 mIU/mL, no intrauterine pregnancy (IUP) was seen on the first sonogram, and a dilation and curettage (D&C) was performed. The serum β-hCG was repeated 48 hours after the D&C with findings of 4,900 mIU/mL. Fig. 7–67 is a longitudinal sonogram repeated after the D&C. What is the most likely diagnosis?

(A) complete abortion

(B) hydatidiform mole

(C) missed abortion

(D) incomplete abortion

(E) ectopic pregnancy

Image

FIGURE 7–67.

38. What is the most likely diagnosis for the image of the adnexa Fig. 7–68?

(A) serous cystadenoma

(B) dermoid

(C) septated ovarian cyst

(D) tubo-ovarian abscess

(E) paratubal cyst

(F) all of the above

Image

FIGURE 7–68.

39. What is the abnormality in Fig. 7–69?

(A) abdominal ascites

(B) encephalocele

(C) anasarca with cystic hygroma

(D) prune-belly syndrome

(E) two fetuses next to each other

Image

FIGURE 7–69.

40. Fig. 7–70 demonstrates which one of the following sonographic abnormalities?

(A) hemivertebra

(B) rachischisis

(C) sacral agenesis

(D) none of the above

Image

FIGURE 7–70.

41. The sonographic image in Fig. 7–71 is consistent with what findings?

(A) 60% positive predictive value for trisomy 21

(B) increased nuchal translucency

(C) 80% positive predictive value for trisomy 21

(D) both A and B

(E) both B and C

Image

FIGURE 7–71.

42. The findings in Fig. 7–71 are associated with which of the following?

(A) cardiac defects

(B) skeletal dysplasia

(C) Down syndrome

(D) both A and C

(E) all of the above

43. Fig. 7–72 demonstrates what fetal bladder abnormality?

(A) ureterocele

(B) posterior urethral valve obstruction

(C) cloacal exstrophy

(D) normal full bladder

Image

FIGURE 7–72

44. Fig. 7–73 is a sonographic image of what cardiac defect?

(A) ventricular septal defect

(B) overriding aorta

(C) tetralogy of Fallot

(D) both A and C

(E) all of the above

Image

FIGURE 7–73

45. Which of the following is demonstrated in the sonographic image of Fig. 7–74?

(A) normal fetal thorax and heart

(B) congenital cystic adenomatoid malformation of the lung, type III

(C) pulmonary sequestration

(D) congenital left diaphragmatic hernia

(E) none of the above

Image

FIGURE 7–74

46. Fig. 7–75 demonstrates what sonographic finding?

(A) Dandy–Walker malformation

(B) normal cerebellum

(C) arachnoid cyst

(D) Arnold–Chiari malformation

(E) holoprosencephaly

Image

FIGURE 7–75.

47. Fig. 7–76 is a sonographic example of which of the following?

(A) gastroschisis

(B) omphalocele

(C) normal physiological herniation of midgut

(D) duodenal atresia

(E) encephalocele

Image

FIGURE 7–76.

48. Fig. 7–77 demonstrates what sonographic finding?

(A) normal kidneys

(B) dysplastic kidneys

(C) infantile polycystic kidney disease

(D) enlarged kidneys

(E) agenesis of the fetal kidneys

Image

FIGURE 7–77.

49. Fig. 7–78 demonstrates what fetal abnormality?

(A) micrognathia

(B) macroglossia

(C) frontal bossing

(D) normal fetal profile

(E) none of the above

Image

FIGURE 7–78.

50. What is the most likely diagnosis if Figs. 776777, and 7–78 are found in the same fetus?

(A) trisomy 18

(B) trisomy 13

(C) Beckwith–Wiedemann syndrome

(D) Finnish nephrosis

(E) fetal alcohol syndrome

51. Fig. 7–79 is a sonographic example of which of the following?

(A) multicystic dysplastic kidney disease

(B) infantile polycystic kidney disease

(C) UPJ obstruction

(D) both A and B

(E) both B and C

Image

FIGURE 7–79.

52. What is the most common congenital facial anomaly?

(A) proboscis

(B) hypotelorism

(C) isolated cleft lip/palate

(D) low set ears

(E) midface hypoplasia

53. Three-dimensional surface rendering is used to do which of the following?

(A) obtain volume measurements

(B) obtain technically difficult images

(C) image fetal spine

(D) image fetal face

(E) exclusion of artifact

54. What is the earliest age at which a gestational sac may be visualized by transvaginal sonography?

(A) 2 weeks

(B) 4 weeks

(C) 6 weeks

(D) 8 weeks

(E) 10 weeks

55. What is the optimal time for performing a fetal echocardiogram?

(A) 14–18 weeks

(B) 18–24 weeks

(C) 24–28 weeks

(D) 28–32 weeks

(E) 38–40 weeks

56. Three-dimensional volumetric reconstructions are used to show all of the following except

(A) fetal face

(B) fetal limbs

(C) kidneys

(D) digits

(E) heart

57. By 12 weeks of gestational age, the sonographer can identify what abnormalities?

(A) conjoined twins

(B) anencephaly

(C) duodenal atresia

(D) both A and B

(E) all of the above

58. An unexplained increased in maternal serum triple screen (MSAFP3) can cause what third-trimester complications?

(A) premature rupture of membranes

(B) placental abruption

(C) preterm labor

(D) both A and B

(E) all of the above

59. A markedly increased maternal serum alpha-fetoprotein (MSAFP) would be associated with which of the following findings?

(A) amniotic sheets

(B) cloacal exstrophy

(C) congenital diaphragmatic hernia

(D) Smith–Lemli–Opitz syndrome

(E) Down’s syndrome

60. If the triple screen marker shows a decreased alpha-fetoprotein, a decreased estriol, and a decreased hCG, the fetus is at risk for which of the following?

(A) trisomy 21

(B) Smith–Lemli–Opitz syndrome

(C) trisomy 18

(D) trisomy 13

(E) trisomy 9

61. Which of the following is not a direct sonographic finding of posterior urethral valve obstruction?

(A) “keyhole” sign

(B) oligohydramnios

(C) hydronephrosis

(D) pulmonary hypoplasia

(E) bilateral hydroureter

62. What cranial finding can cause congestive heart failure and hydrops?

(A) vein of Galen aneurysm

(B) periventricular leukomalacia

(C) Dandy–Walker malformation

(D) iniencephaly

(E) corpus callosum

63. What is the name of the cardiac abnormality with one outflow tract giving rise to both the pulmonary and aortic branches and associated with a ventricular septal defect?

(A) truncus arteriosus

(B) double outlet right ventricle

(C) tetralogy of Fallot

(D) transposition of the great vessels

(E) Ebstein’s anomaly

64. The cardiac abnormality consisting of a ventricular septal defect (VSD), an overriding aorta, a small or atretic pulmonary trunk, and right ventricular hypertrophy describes

(A) double outlet right ventricle

(B) hypoplastic left heart syndrome

(C) transposition of the great vessels

(D) tetralogy of Fallot

(E) Ebstein’s anomaly

65. All of the following are associated with infantile polycystic kidney disease except

(A) autosomal-recessive disorder

(B) bilateral enlarged kidneys

(C) oligohydramnios

(D) echogenic kidneys

(E) visible cysts greater than 20 mm in diameter are often seen on the kidneys

66. Which of the following statements regarding congenital diaphragmatic hernia are true?

(A) more commonly right sided than left sided

(B) carries a poor prognosis

(C) may be associated with chromosomal abnormalities

(D) all of the above

(E) both A and C

(F) both B and C

67. Esophageal atresia is

(A) diagnosed by ultrasound 90% of the time

(B) associated with oligohydramnios

(C) a component of the VACTERL complex

(D) easily diagnosed in the second and third trimester

(E) all of the above

68. An increased MSAFP is associated with all of the following except

(A) trisomy 21

(B) neural tube defect

(C) maternal preeclampsia

(D) gastroschisis

(E) incorrect dating

69. Which uterine ligament is responsible for uterine orientation?

(A) transversali ligament

(B) broad ligament

(C) uterosacral ligament

(D) round ligament

(E) ovarian ligament

70. Which two ligaments are not true ligaments?

(A) uterosacral and broad ligaments

(B) suspensory and broad ligaments

(C) uterosacral and round ligaments

(D) cardinal and suspensory ligaments

(E) ovarian and round ligaments

71. What is the most commonly visualized pelvic muscle that is often mistaken for an ovary?

(A) piriformis muscle

(B) levator ani muscle

(C) coccygeus muscle

(D) iliopsoas muscle

(E) gluteus maximus muscle

72. What is the most dependent portion of the peritoneum called?

(A) pouch of Douglas

(B) vesicouterine pouch

(C) retropubic space

(D) Morrison’s pouch

(E) none of the above

73. What are the three peritoneal spaces in the pelvic cavity?

(A) posterior cul-de-sac, anterior cul-de-sac, and vesico-uterine pouch

(B) posterior cul-de-sac, pouch of Douglas, and anterior cul-de-sac

(C) posterior cul-de-sac, anterior cul-de-sac, and prevesical space

(D) posterior cul-de-sac, anterior cul-de-sac, and interstitial space

(E) Morrison’s, retropubic space, and sac of Douglas

74. What are the AIUM guidelines for cleaning and preparing a transvaginal probe?

(A) pre-clean with mild non-abrasive liquid soap and water

(B) immerse in high-level disinfecting solution

(C) clean with moist novelettes at the end of the day

(D) disposable probe covers

(E) lubricated or medicated condoms

(F) all of the above

(G) A, B, and D

75. An invasive mole is also known as

(A) hydatidiform mole

(B) triploid molar pregnancy

(C) endometrioma

(D) chorioadenoma destruens

(E) lipomyosarcoma

76. Which of the following is true regarding a hydatidiform mole and coexistent fetus?

(A) consistent with maternally derived trisomy 13

(B) consistent with paternally derived trisomy 13

(C) 2% will have a fetus

(D) both A and C

(E) both B and C

77. In what portion of the fallopian tube does fertilization usually occur?

(A) interstitial

(B) isthmus

(C) ampulla

(D) infundibulum

(E) fimbria

78. A patient informs you before her sonogram that she was previously diagnosed with an extrauterine pregnancy 10 days ago and was given the drug methotrexate. This indicates that previously she most likely had which of the following?

(A) ruptured ectopic pregnancy

(B) unruptured ectopic pregnancy

(C) intrauterine pregnancy greater than 12 weeks with no fetal heart motion

(D) β-hCG greater than 10,000 mIU/mL

(E) a ruptured ovarian cyst

79. A patient informs you, before her sonogram that she fainted several times just prior to her being diagnosed with an ectopic pregnancy. She had a salpingectomy. This indicates that she most likely had which of the following?

(A) unruptured ectopic pregnancy

(B) early intrauterine pregnancy (IUP) with a ruptured cyst

(C) voluntary termination of pregnancy

(D) missed abortion or spontaneous abortion

(E) ruptured ectopic pregnancy

80. Which of the following best defines intrauterine fetal demise?

(A) blighted ovum

(B) absent fetal heart tone after 20 weeks of gestation

(C) no fetal movement

(D) missed abortion

(E) all of the above

81. Which of the following is not true of dysgerminoma?

(A) It is a solid malignant germ cell tumor of the ovary.

(B) It is a counterpart of seminoma of the testis.

(C) It is a relatively uncommon tumor accounting for about 2% of all ovarian cancers.

(D) It is predominantly echogenic.

(E) It is a solid benign tumor.

82. Which of the following is least likely to be true of dermoid tumors?

(A) may cast an acoustic shadow

(B) encountered more in women over 40 years

(C) also called benign cystic teratoma

(D) most common benign germ cell tumor in the female

(E) unilateral in about 80% of cases

83. What is the measurement of the normal adult ovaries?

(A) 3 × 2 × 2 cm

(B) 3 × 2 × 2 mm

(C) 4 × 4 × 2 cm

(D) 4 × 2 × 2 mm

(E) 7 × 4 × 3 mm

84. What is the first definitive sonographic sign of an intrauterine pregnancy?

(A) gestational sac

(B) yolk sac

(C) fetal pole

(D) double decidua sign

(E) thickened endometrium

85. What percentage of cardiac defects can be detected from the four-chamber view?

(A) 50

(B) 65

(C) 80

(D) 85

(E) 95

86. What percentage of cardiac defects can be detected from the four-chamber view and outflow tracts?

(A) 50

(B) 65

(C) 80

(D) 85

(E) none of the above

87. A simple cyst may exhibit all of the following except

(A) anechoic interior

(B) posterior enhancement

(C) thin walled

(D) distal acoustic shadows

(E) sonolucent

88. Which of the following types of ovarian cyst is commonly associated with hydatidiform mole?

(A) dermoid

(B) paraovarian

(C) theca lutein

(D) corpus luteal

(E) hydropic villi

89. What is the most accurate method for establishing estimated date of confinement (EDC)?

(A) first-trimester ultrasound

(B) second-trimester ultrasound

(C) last menstrual period (LMP)

(D) Angele’s rule

(E) fundal height

90. What is the accuracy of crown rump length (CRL) in the first trimester?

(A) 3–5 days

(B) ± 10 days

(C) ± 14 days

(D) ± 21 days

(E) has never been predicted

91. What is the accuracy of gestational age from 13 to 20 weeks?

(A) 3–5 days

(B) ± 10 days

(C) ± 14 days

(D) ± 21 days

(E) has never been predicted

92. What is the accuracy of gestational age from 20 to 30 weeks?

(A) 3–5 days

(B) ± 10 days

(C) ± 14 days

(D) ± 21 days

(E) has never been predicted

93. What is the accuracy of gestational age in the third trimester?

(A) 3–4 days

(B) ± 10 days

(C) ± 14 days

(D) ± 21 days

(E) has never been predicted

94. The normal rise of hCG in a viable pregnancy should

(A) double in 24 hours

(B) double in 48 hours

(C) double in 72 hours

(D) double in 1 week

(E) decrease in 2 days

95. Conditions associated with a poorly rising or decreasing hCG include all of the following except

(A) twin pregnancy

(B) ectopic pregnancy

(C) anembryonic demise

(D) incorrect dates

(E) missed abortion

96. An ovarian mass identified on sonogram is complex, predominately hypoechoic with septations. The patient complains of severe pain during menses. What is the most likely diagnosis?

(A) corpus luteal cyst

(B) granulosa cell

(C) thecoma

(D) endometrioma

(E) follicular cyst

97. If a patient’s last menstrual period is 8/10/2011, by Nagele’s rule, what is the estimated date of confinement?

(A) 8/10/2012

(B) 4/30/2012

(C) 5/17/2012

(D) 6/30/2012

(E) 5/2/2012

98. Which of the following best describes Krukenberg tumors?

(A) secondary metastatic ovarian neoplasms

(B) usually of gastric or colonic primary origin

(C) usually bilateral solid masses

(D) all of the above

99. Which of the following is not a true characteristic of a serous cystadenoma?

(A) usually large, thin-walled

(B) thick septations

(C) papillary projections are seen occasionally

(D) most common benign ovarian neoplasm

(E) peak incidence is in the fourth and fifth decade

100. What is another name for polycystic ovarian syndrome?

(A) Stein–Leventhal syndrome

(B) Sertoli–Leydig cell

(C) Brenner’s tumor

(D) chocolate cyst

(E) Mittelschmerz

101. What is the etiology of complete hydatidiform mole?

(A) trophoblastic changes in a blighted ovum

(B) hydatid swelling of the retained placenta in a missed abortion

(C) fertilization of an empty ovum with normal diploid karyotype and no embryo

(D) both A and B

(E) all of the above

102. Which of the following characteristics of color Doppler energy (CDE) is true?

(A) CDE can determine the direction of blood flow.

(B) CDE can determine the velocity of blood flow.

(C) the different colors represent flow toward or away from the transducer.

(D) CDE is based on the amplitude of the sound wave.

103. Which of the following does the term trophoblast denote?

(A) the extra-embryonic peripheral cells of the blastocyst

(B) a rigid state of the flagellate microorganism

(C) the gestation sac

(D) the characteristics of a disease

(E) multiplication of similar tissue

104. What is the mean diameter of a dominant follicular cyst at the time of ovulation?

(A) 5 mm

(B) 10 mm

(C) 15 mm

(D) 25 mm

(E) 25 cm

105. What is the most common neoplasm of the uterus?

(A) leiomyoma

(B) adenomyosis

(C) leiomyosarcoma

(D) endometrial hyperplasia

(E) endometrioma

106. A complex adnexal mass is identified in a patient with tenderness and elevated temperature and white blood cell count (cbc). What is the most likely diagnosis?

(A) tubo-ovarian abscess

(B) corpus luteal cyst

(C) serous cystadenoma

(D) Brenner’s tumor

(E) endometritis

107. Which of the following is true of mucinous cystadenocarcinoma?

(A) composed of germ layers, ectoderm, mesoderm, and endoderm

(B) when ruptured can result in pseudomyxoma peritonei

(C) occurs more frequently in women 40 to 70 years old

(D) contains fatty, sebaceous material, bone, teeth, and hair

(E) gives a sonographic appearance called “tip–of-the-iceberg”

108. The endometrial lining in postmenopausal women not on hormone replacement therapy should be less than

(A) 10 mm

(B) 8 mm

(C) 3 mm

(D) 2 mm

(E) 3 cm

109. The endometrial lining in postmenopausal women on hormone replacement therapy (HRT) should less than

(A) vary, depending on the type and dosing of hormone replacement therapy used

(B) 5 mm

(C) 5 cm

(D) 3 cm

(E) 3 mm

110. In what stage of the menstrual cycle would be an ideal time to evaluate the endometrium for a polyp?

(A) menstruation phase

(B) follicular phase

(C) proliferative phase

(D) secretory phase

(E) all of the above

111. The date of the last menstrual period is counted from

(A) the date when fertilization occurred

(B) the date when menstrual bleeding ended

(C) the date when ovulation occurred

(D) the date when menstrual bleeding began

(E) 48 hours after the menstrual bleeding began

112. Which of the following diagnoses does not mimic the sonographic characteristic of hydatidiform mole?

(A) endometriosis

(B) incomplete abortion

(C) degenerative uterine leiomyoma

(D) trophoblastic changes in a blighted ovum

(E) missed abortion

113. What percentage of patients diagnosed with hydatidiform mole will usually follow a benign course?

(A) 20%

(B) 10%

(C) 50%

(D) 80%

(E) 2%

114. The uterus can be divided into regions. Which of the following choices lists them from inferior to superior?

(A) cervix, isthmus, corpus, fundus

(B) serosal, myometrial, endometrial

(C) fundus, isthmus, corpus, cervix

(D) cervix, corpus, isthmus, fundus

(E) vagina, cervix, body, fundus

115. What are the uterine layers?

(A) vagina, endometrium, endocervical

(B) serosal, myometrial, endometrial

(C) fundus, isthmus, corpus, cervix

(D) peritoneum, serosal, and myometrial

(E) vagina, uterus, tubes, ovaries

Questions 116–118. Match the structures numbered in Fig. 7–80 with the list of terms in Column B.

Image

FIGURE 7–80.

COLUMN A

116. Arrow number 1:_______

117. Arrow number 2:_______

118. Arrow number 3:_______

COLUMN B

(A) internal iliac vein

(B) ovary

(C) internal iliac artery

(D) ureter

119. What is the normal size of a multiparous uterus,

(A) 5 × 4 × 3 cm

(B) 7 × 5 × 4 cm

(C) 9 × 6 × 5 cm

(D) 6 × 4 × 3 cm

120. What is the name of the anatomic opening between the third and fourth ventricle?

(A) aqueduct of Sylvius (cerebral aqueduct)

(B) interventricular foramina (foramen of Monro)

(C) Magendie’s foramen (foramen of Magendie)

(D) foramen of Luschka

(E) choroid plexus

121. Congenital abnormalities of the uterus result from improper fusion of which of the following structures?

(A) mesonephric ducts

(B) paramesonephric ducts

(C) Gartner’s duct

(D) Wolffian ducts

(E) Bartholin duct

122. During the early proliferative phase, the endometrium appears

(A) thin, echogenic line, 4–8 mm

(B) thin, hypoechoic line, 4–8 mm

(C) thickened and hypoechoic medially with an echogenic basal layer

(D) thickened and echogenic throughout

(E) thin, echogenic line, 4–8 cm

123. During the periovulatory phase, the endometrium appears

(A) thin, echogenic line, 4–8 mm

(B) thin, hypoechoic line, 4–8 mm

(C) thickened and hypoechoic medially with an echogenic basal layer

(D) thickened and echogenic throughout

(E) less than 2 mm

124. During the secretory phase, the endometrium appears

(A) thin, echogenic line, 4–8 mm

(B) thin, hypoechoic line, 4–8 mm

(C) thickened and hypoechoic medially with an echogenic basal layer

(D) thickened and echogenic

(E) less than 2 mm

125. Women with endometriosis may have

(A) dyspareunia

(B) metromenorrhagia

(C) dysmenorrhea

(D) all of the above

(E) both D and C

126. Which of the following best describes endometriosis?

(A) functional endometrial tissue outside the uterine cavity

(B) benign invasion of endometrial tissue into the myometrium

(C) endomyosarcoma with chocolate tissue

(D) inflammation of the endometrium

(E) a malignant invasion of endometrial tissue into the myometrium

127. What is the most common anatomical location for a dermoid cyst?

(A) posterior cul-de-sac

(B) right adnexa

(C) left adnexa

(D) superior to the uterine fundus

(E) right upper quadrant

128. Macrosomia is

(A) fetus weighing > 4,000 g

(B) fetus > 90% for gestational age

(C) fetus with a shoulder thickness > 10 mm

(D) large-for-gestational-age (LGA) fetus

(E) a fetus with a head size larger than 10 cm

129. What does the term LGA refer to?

(A) a fetus weighing > 4,000 g

(B) fetus > 90%

(C) a clinical assessment of an increased fundal height

(D) polyhydramnios

(E) an increase in head size

130. A macrosomic fetus is at risk for which of the following?

(A) shoulder dystocia

(B) increased perinatal morality

(C) prolonged labor

(D) all of the above

(E) none of the above

131. Which of the following is usually not a cause of oligohydramnios?

(A) cystic hygroma

(B) posterior urethral valve obstruction

(C) intrauterine growth retardation (IUGR)

(D) post maturity

(E) premature rupture of the membranes (PROM)

132. An increased fundal height may be caused by which of the following?

(A) macrosomic fetus

(B) polyhydramnios

(C) twins

(D) pregnancy with fundal fibroids

(E) all of the above

133. Intrauterine growth restriction (IUGR) is

(A) estimated fetal weight (EFW) below 10% for a given gestational age

(B) decreased AFV

(C) increased umbilical cord size

(D) abnormal growth ratios

(E) fetal weight at or below 3% for a given gestational age

134. An increased HC/AC is a suggestion of

(A) late onset of IUGR

(B) brain sparing effort

(C) placental insufficiency

(D) anasarca

(E) all of the above

135. Causes of asymmetric IUGR include

(A) fetal infection

(B) chromosomal abnormality

(C) placental insufficiency

(D) all of the above

(E) none of the above

136. Which of the following is the most sensitive indicator for assessment of IUGR

(A) BPD to OFD ratio

(B) FL to AC ratio

(C) HC to AC ratio

(D) AC

(E) none of the above

137. Doppler testing of vessels that may aid in the diagnosis of IUGR is

(A) umbilical cord

(B) straight sinus

(C) celiac axis

(D) jugular vein

(E) both A and C

(F) all of the above

138. Doppler sampling of the maternal uterine artery < 26 weeks shows a diastolic notch. This notch is indicative of

(A) IUGR

(B) maternal hypertension

(C) normal

(D) both A and B

(E) none of the above

139. In Fig. 7–81, what is the most likely diagnosis?

(A) hydrometra

(B) hematometra

(C) partial mole

(D) myoma

(E) hematometrocolpos

Image

FIGURE 7–81

140. When a patient being treated for infertility demonstrated bilaterally enlarged multicystic ovaries and ascites, the diagnosis of ovarian hyperstimulation syndrome (OHSS) was made. Patients who are at risk of developing OHSS are

(A) patients on Clomid or Pergonal

(B) patients with Stein–Leventhal syndrome

(C) patients with a history of OHSS

(D) all of the above

141. In Fig. 7–82, the endovaginal image was taken at the level of the uterine corpus. The patient is a 55-year-old woman on hormone replacement therapy (HRT). Which of the following should not be included in the differential diagnosis?

(A) endometrial hyperplasia

(B) endometrial carcinoma

(C) endometriosis

(D) endometrial polyp

(E) hydatidiform mole

Image

FIGURE 7–82

142. In Fig. 7–83, what is the arrow pointing to?

(A) iliopsoas muscle

(B) right ovary

(C) bowel mass

(D) piriformis muscle

Image

FIGURE 7–83

143. A pseudo-gestational sac will normally demonstrate

(A) a secondary yolk sac within the pseudo-gestational sac

(B) high-amplitude chorio-decidua

(C) anechoic center with a thin ring

(D) one mm increase in size each day

(E) a small embryo

144. In Fig. 7–84, the endovaginal image of a 32-year-old woman with abnormal vaginal bleeding is most suggestive of which of the diagnoses?

(A) endometrioma

(B) adenoma

(C) endometrial polyp

(D) myoma

(E) leiomyoma sarcoma

Image

FIGURE 7–84

145. In Fig. 7–85, this 29-year-old patient presents with a history of chronic pelvic pain especially during menses, back pain, and dyspareunia. What is the most likely diagnosis?

(A) Brenner’s tumor

(B) fibroma

(C) thecoma

(D) endometrioma

(E) cystadenocarcinoma

Image

FIGURE 7–85.

146. Fig. 7–86 is of a 38-year-old black female patient who presented with an enlarged palpated uterus, pain, and abnormal vaginal bleeding. What is the most likely diagnosis?

(A) intramural myoma

(B) subserosal myoma

(C) submucosal myoma

(D) leiomyosarcoma

(E) pedunculated fibroid

Image

FIGURE 7–86

147. Fig. 7–87 is an endovaginal sonogram of the right adnexa of a 24-year-old patient that presented with an acute onset of pelvic pain. What does this most likely represent?

(A) hemorrhagic cyst

(B) hyperstimulated ovarian syndrome

(C) endometrioma

(D) serous cystadenocarcinoma

(F) follicular cyst

Image

FIGURE 7–87

148. Fig. 7–88 is suggestive of which of the following diagnoses?

(A) hyperstimulated ovary

(B) corpus luteal cyst

(C) cystadenoma

(D) polycystic ovary

(E) normal appearing ovary

Image

FIGURE 7–88

149. The patient described in the previous question may present with any of the following except

(A) ovarian agenesis

(B) amenorrhea

(C) infertility

(D) hirsutism

(E) obesity

150. A 35-year-old patient presented with vaginal discharge and pelvic tenderness. The clinical information together with the endovaginal sonogram in Fig. 7–89 is most suggestive of which of the following diagnoses?

(A) hydrosalpinx

(B) endometrioma

(C) ascites

(D) ectopic pregnancy

(E) dermoid

Image

FIGURE 7–89

151. A 29-year-old patient presented with menorrhagia and dysmenorrhea. On physical examination an enlarged uterus was palpated. The sonogram Fig. 7–90 is suggestive of which of the following diagnoses?

(A) a myomatous uterus

(B) adenomyosis

(C) endometriosis

(D) intrauterine contraceptive device (IUCD)

(E) hematometra

Image

FIGURE 7–90

152. In Fig. 7–91, the endovaginal sonogram of a post-menopausal female being treated with tamoxifen for breast cancer is suggestive of which of the following diagnoses?

(A) endometrial hyperplasia

(B) normal endometrium

(C) poor quality image and cannot make a diagnosis

(D) endometriosis

(E) none of the above

Image

FIGURE 7–91

153. In Fig. 7–92, which of the following should be noted while performing the sonogram?

(A) Gartner’s duct cyst

(B) Nabothian cyst

(C) Bartholin’s cyst

(D) cervical myoma

(E) intrauterine gestational sac

Image

FIGURE 7–92

154. The endovaginal sonogram in Fig. 7–93 of a 28-year-old patient with a history of chlamydia, pelvic pain, and fever. Serum β-hCG is negative. This sonogram is suggestive of which of the following diagnoses?

(A) bilaterally enlarged ovaries

(B) right corpus luteal cyst

(C) bilateral dermoids

(D) tubo-ovarian abscesses

(E) bilateral ectopic pregnancy

Image

FIGURE 7–93

155. The uterus in Fig. 7–94 is poorly visualized. What can be done to improve the visualization of the uterus?

(A) increase the near gain

(B) increase the far gain

(C) change transabdominal transducers

(D) distend the urinary bladder more

(E) have the patient post void

Image

FIGURE 7–94

156. In Fig. 7–95, the echoes on the anterior aspect of the urinary bladder are an example of which artifact normally seen?

(A) edge

(B) comet tail

(C) attenuation

(D) reverberation

(E) distal acoustic enhancement

Image

FIGURE 7–95

Questions 157–160: Rank the following in order of their neurologic development, earliest to latest.

COLUMN A

157. _______

158. _______

159. _______

160. _______

COLUMN B

(A) body motion

(B) fetal tone

(C) breathing

(D) fetal heart rate acceleration

161. The pathological condition characterized by a solid ovarian tumor, right pleural effusions, and ascites is

(A) Meigs syndrome

(B) dysgerminoma

(C) Stein–Leventhal syndrome

(D) mucinous cystadenoma

(E) leiomyoma sarcoma

162. The components of biophysical profile (BPP) are

(A) fetal breathing, Doppler, non-stress test (NST), gross body movement, and amniotic fluid volume (AFV)

(B) placental grading, non-stress test (NST), gross body movement, and amniotic fluid volume (AFV)

(C) non-stress test (NST), Doppler, gross body movement, amniotic fluid volume (AFV), and fetal flexion/extension

(D) amniotic fluid volume (AFV), gross body movement, fetal flexion/extension, fetal breathing, and non-stress test (NST)

(E) BPD, AC, FL, and non-stress test (NST)

163. Fetal breathing must last how long to be counted in the biophysical profile (BPP)?

(A) 20 seconds

(B) 30 seconds

(C) 1 minute

(D) 2 minutes

(E) 5 minutes

164. In a normal fetus, if the middle cerebral artery were sampled, one would expect to find which of the following?

(A) an increased S/D ratio

(B) a decreased S/D ratio

(C) retrograde flow

(D) absent flow

(E) has no change in S/D ratio

165. A 27-year-old female presented to the emergency department complaining of heavy vaginal bleeding and pain in pregnancy. What is the finding in the sonogram in Fig. 7–96?

(A) ruptured ectopic pregnancy

(B) fundal fibroid uterus

(C) unruptured ectopic pregnancy

(D) cervical phase of an impending abortion

(E) none of the above

Image

FIGURE 7–96

166. The fetus starts swallowing the amniotic fluid at what gestational age in pregnancy?

(A) 8 weeks

(B) 12 weeks

(C) 20 weeks

(D) 33 weeks

167. Which of the following is not a cause for pelvic inflammatory disease and its contribution to infertility?

(A) chlamydia

(B) actinomycetes

(C) gonorrhea

(D) genital herpes

(E) mycobacterium tuberculosis

168. Which one of the following is not part of the adnexa?

(A) urinary bladder

(B) fimbria

(C) follicular cyst

(D) broad ligaments

(E) internal iliac arteries

169. Using the single pocket technique for assessment of amniotic fluid, oligohydramnios is suggested when the amniotic fluid is?

(A) a single pocket of 2 cm

(B) a single pocket of 20 cm

(C) a single pocket of 5 cm

(D) a single pocket of 8 cm

170. In the amniotic fluid index method of measuring four quadrants, when is the diagnosis of oligohydramnios made?

(A) when the amniotic volume is < 300 mL

(B) when the amniotic volume is < 200 mL

(C) when the amniotic fluid index is < the 10th percentile

(D) when the amniotic fluid index is < the 2.5th percentile

(E) none of the above

171. Which of the following are nonspecific signs of fetal death: (1) echoes in the amniotic fluid, (2) the absence of the falx cerebri, (3) a decrease in the biparietal diameter (BPD) measurements, (4) a double contour of the fetal head (sonographic halo sign), (5) no fetal heart motion?

(A) both 3 and 4

(B) only 4

(C) only 1, 2, 3, and 4

(D) only 5

(E) 1, 2, 3, 4, and 5

172. How long after fetal death can scalp edema be first seen?

(A) 2–3 days

(B) 5–10 days

(C) 10–20 days

(D) 20–30 days

(E) 2–3 weeks

173. The term decidua denotes the transformed endometrium of pregnancy. What are the different regions of the decidua?

(A) two regions called decidua basalis and chorionic villi

(B) one region called decidual reaction

(C) three regions called decidua basalis, decidua parietalis, and decidua capsularis

(D) three regions called endoderm, mesoderm, and ectoderm

(E) amnion, chorion, and extraembryonic coelom

174. Which of the following cannot be included in the category of cystic masses of the vagina?

(A) Gartner’s duct cyst

(B) Nabothian cyst

(C) hematocolpos

(D) Bartholin cyst

(E) all of the above

175. What are the functions of the secondary yolk sac?

(A) nutrients for the embryo

(B) hematopoiesis

(C) contributing to the development of the reproductive system

(D) give rise to cells that later becomes sex cells

(E) all of the above

176. In about 2% of adults, the yolk sac persists as a diverticulum of the ileum. What is this known as?

(A) Michael’s diverticulum

(B) Meckel’s diverticulum

(C) Turner’s diverticulum

(D) Smith’s diverticulum

(E) diverticular coelom

177. The location of the yolk sac is

(A) inside the umbilical cord

(B) inside the amniotic sac

(C) in the chorionic cavity between the amnion and the chorion

(D) outside the chorionic cavity between the chorion and the endometrial wall

(E) with the stomach of the embryo

178. On transvaginal sonography, the yolk sac is visible as early as how many weeks?

(A) 4 weeks

(B) 5 weeks

(C) 6 weeks

(D) 7 weeks

(E) 8 weeks

Questions 179–182: Arrange in sequence in Column A the embryologic stages following fertilization listed in Column B.

COLUMN A

179. _______

180. ______

181. ______

182. ______

COLUMN B

(A) morula

(B) cleavage

(C) zygote

(D) blastocyst

183. Which of the following is not a complication associated with oligohydramnios?

(A) premature rupture of membranes (PROM)

(B) Intrauterine growth restriction (IUGR)

(C) post date pregnancy (>42 weeks)

(D) urethral stenosis

(E) posterior urethral valve syndrome

184. The umbilical cord S/D ratio normally

(A) increases throughout the pregnancy

(B) decreases throughout the pregnancy

(C) remains the same throughout pregnancy

(D) is controlled by the fetal cerebellum

(E) no change in S/D ratio

185. Placental insufficiency is indirectly monitored by

(A) an increasing umbilical cord S/D ratio

(B) a decreasing umbilical cord S/D ratio

(C) Doppler of placental intervillous spaces

(D) Doppler of maternal arcuate arteries

(E) none of the above

186. The terminology vasa previa best describes

(A) placenta near the internal os

(B) placenta touching the internal os

(C) placenta crossing the internal os

(D) placenta vessels crossing the internal os

(E) premature separation of the placenta

187. What is the primary cause of third-trimester painless vaginal bleeding?

(A) placenta previa

(B) ruptured ovarian cyst

(C) placentomegaly

(D) placenta abruption

(E) malpresentation

188. Which of the following is true concerning pseudogestational sac?

(A) It is located in the ampullary segment of the fallopian tube.

(B) It is located in the uterine cavity.

(C) It has two layers of decidua called double decidual sign.

(D) It has a yolk sac.

(E) Its growth rate is approximately 1mm per day.

189. Which of the following statements is not true concerning the yolk sac?

(A) The yolk sac should be included in measurements of CRL.

(B) The yolk sac shrinks as pregnancy advances.

(C) The yolk sac plays a role in blood development and transfer of nutrients.

(D) The yolk sac is attached to the body stalk and is located between the amnion and chorion.

(E) The yolk sac contains vitelline fluid

190. The vessels of the normal umbilical cord consist of

(A) two arteries, one vein

(B) two veins, one artery

(C) one artery, one iliac vein, and the iliac artery

(D) one artery, one vein

(E) two arteries, two veins

191. The term “neural tube defect” refers to

(A) spinal defect

(B) open tube defect

(C) anencephaly

(D) cephalocele

(E) all of the above

192. Myelomeningocele refers to

(A) neural tube defect characterized by absent of the cerebellum

(B) protrusion of meninges and neural tissue though a defect

(C) fat tumor and meninges at the lumbar region

(D) meninges and brain herniate through a defect in the calvarium

(E) muscle tumor of the fetal spine

193. What is the estimated gestational age for a CRL of 28 mm

(A) 9.3 weeks

(B) 6.5 weeks

(C) 5.5 weeks

(D) 12 weeks

(E) 14 weeks

194. The “lemon” sign of the fetal cranium in diagnosing spina bifida refers to

(A) the narrowing of the vertebral process at the area of the defect

(B) the overall appearance of the fetal spine in the presence of a defect

(C) the appearance of the cerebellum in the presence of a spinal defect

(D) the appearance of the fetal skull in the presence of a spinal defect

(E) lemon shape of the cerebellum

195. The “banana” sign of the fetal cranium in diagnosing spina bifida refers to

(A) the narrowing of the vertebral process at the area of the defect

(B) the overall appearance of the fetal spine in the presence of a defect

(C) the appearance of the cerebellum in the presence of a spinal defect

(D) the appearance of the fetal skull in the presence of a spinal defect

(E) banana shape of the fetal skull bones

196. The “banana” sign is present with spinal defects

(A) 50% of the time

(B) 75% of the time

(C) 85% of the time

(D) 95% of the time

(E) 25% of the time

197. Which of the following is true about the “lemon” sign and neural tube defects?

(A) The “lemon” sign is not as accurate as the “banana” sign.

(B) The “lemon” sign may be present in the normal fetus in the third trimester.

(C) The “lemon” sign can be artificially produced at the level of the ventricles.

(D) The “lemon” sign is a predictor for spina bifida.

(E) All of the above statements are true.

198. The diagnosis of placenta previa is most accurately made

(A) transabdominally with a full maternal bladder

(B) transabdominally with an empty maternal bladder

(C) transrectally

(D) transvaginally

(E) all of the above

199. The definition of “low lying placenta” in the third trimester is

(A) placental edge >3 cm from the internal os

(B) placental edge <2 cm from the internal os

(C) placental edge <3 cm from the internal os

(D) placental edge in lower uterine segment

(E) placenta edge >20 cm from the internal os

200. The rotation of the heart in the fetal chest should be

(A) 45° with apex pointed to the right

(B) 45° with apex pointed to the left

(C) 60° with apex pointed to the right

(D) the heart should not be rotated in fetal chest

(E) parallel with apex pointed to the median plain

201. The fetal heart is horizontal in the chest because of

(A) large spleen

(B) flat diaphragm

(C) large liver

(D) large thorax

(E) large bowel

202. The type of hydrops defined as absence of a detectable circulating antibody against red blood cells in the mother is

(A) immune

(B) non-immune

(C) erythroblastosis fetalis

(D) isoimmunization fetalis

(E) all of the above

203. What percentage of cephaloceles are occipital?

(A) 50

(B) 60

(C) 75

(D) 99

(E) 25

204. The diagnosis of ventriculomegaly may be made when the ventricle measures

(A) greater than 10 mm in the atrium of the occipital horn

(B) greater than 15 mm in the posterior horn

(C) when the third ventricle may be visualized

(D) when the choroid does not touch the medial wall of the lateral ventricle

(E) greater than 10 cm in the posterior horn

205. A patient states she was given a medication called RhoGAM after she had vaginal spotting in pregnancy. This was most likely due to

(A) ectopic pregnancy

(B) abortion

(C) Rh-negative status of the mother

(D) pelvic infection

(E) human immunodeficiency virus

206. Congenital hydrocephalus is

(A) genetically linked affecting both male and females

(B) able to be detected in both male and females by DNA testing

(C) expressed in males only

(D) both A and C

(E) both B and C

(F) all of the above

207. Intracranial calcifications and microcephaly of the fetus are associated with

(A) Dandy–Walker cyst

(B) vein of Galen aneurysm

(C) gestational diabetes

(D) TORCH infections

(E) agenesis of corpus callosum

208. Which of the following is a type of ectopic pregnancy that when ruptured is less likely to have internal hemorrhage?

(A) cervical ectopic

(B) cornual ectopic

(C) abdominal ectopic

(D) ampullary ectopic

(E) ovarian

209. A 29-year-old female presented to the emergency department with painless vaginal bleeding in pregnancy. The serum β-hCG taken was 3,500 mIU/mL. What is the finding in the transvaginal sonograms shown in Fig. 7–97A and B?

(A) cervical scar implantation

(B) pseudo-gestational sac

(C) abdominal pregnancy

(D) tubal pregnancy

(E) complete abortion

Image

FIGURE 7–97

210. What does the arrow in the sonogram shown in Fig. 7–98 point to?

(A) yolk sac

(B) amnion

(C) chorion

(D) vitelline duct

(E) Wharton’s duct

Image

FIGURE 7–98

211. Fig 7–99 is a transvaginal sonogram after placement of an intrauterine device (IUD). What does this image demonstrate?

(A) IUD in situ

(B) IUD in the uterine fundus

(C) IUD in the vagina

(D) none visualization of the IUD

(E) IUD in the cervix

Image

FIGURE 7–99

212. The cisterna magna is considered increased when

(A) The measurement is >5 mm.

(B) The cerebellum may be seen outlined by fluid.

(C) The cerebellar vermis is splayed.

(D) The measurement is >11 mm.

(E) None of the above is true.

213. Findings on ultrasound include an increased cisterna magna, agenesis of the cerebellar vermis with communication to the fourth ventricle and ventriculomegaly. What is the most likely diagnosis?

(A) Dandy–Walker malformation

(B) Dandy–Walker malformation variant

(C) arachnoid cyst

(D) communicating hydrocephaly

(E) agenesis of the corpus callosum

214. Findings on ultrasound include hydrocephaly, an enlarged cisterna magna, and an intact cerebellar vermis elevated by a cyst in the posterior fossa. What is the most likely diagnosis?

(A) Dandy–Walker malformation

(B) Dandy–Walker malformation variant

(C) arachnoid cyst

(D) communicating hydrocephaly

(E) agenesis of the corpus callosum

215. What other findings are associated with Dandy–Walker malformation?

(A) holoprosencephaly

(B) facial clefting

(C) cardiac defects

(D) only B and C

(E) all of the above

216. A patient who presented for pelvic ultrasound informs you that she has secondary infertility and is currently on a medication to stimulate ovulation induction. This drug is most likely

(A) folic acid

(B) clomiphene citrate

(C) methotrexate

(D) lupron

(E) vitamin B12

217. Complications associated with Dandy–Walker malformation include

(A) chromosomal abnormalities

(B) subnormal intelligence after birth

(C) increased neonatal death

(D) only A and B

(E) all of the above

218. The most common cause of hypotelorism is

(A) Dandy–Walker malformation

(B) Arnold–Chiari type II

(C) Goldenhar syndrome

(D) holoprosencephaly

(E) arachnoid cyst

219. Cyclopia, hypotelorism, proboscis, cebocephaly, and cleft lip/palate are

(A) abnormal intracranial findings

(B) abnormal facial findings

(C) associated with hydrocephaly

(D) all of the above

(E) none of the above

220. The most common chromosomal abnormality associated with holoprosencephaly is

(A) trisomy 21

(B) trisomy 18

(C) trisomy 13

(D) Turner’s syndrome

(E) trisomy 9

221. The most common cause of hypertelorism is

(A) anterior cephalocele

(B) holoprosencephaly

(C) hydranencephaly

(D) craniosynostosis

(E) none of the above

222. Teratomas in pregnancy are located in

(A) the sacrococcygeal region

(B) intracranial

(C) cervical

(D) lumbar

(E) all of the above

223. Maternal Graves’ disease and Hashimoto thyroiditis may cause what finding in the fetus?

(A) fetal ascites

(B) fetal goiter

(C) oligohydramnios

(D) there is no effect on the fetus

(E) all of the above

224. The most common cause of macroglossia is

(A) micrognathia

(B) trisomy 18

(C) Beckwith–Wiedemann syndrome

(D) obstruction of the fetal airway

(E) Dandy–Walker malformation

225. The arrow is pointing to what anatomical structure Fig. 7–100.

(A) unilateral cleft lip

(B) unilateral cleft lip and palate

(C) bilateral cleft lip

(D) bilateral cleft lip and palate

(E) none of the above

Image

FIGURE 7–100.

226. Macroglossia is present how often in Beckwith–Wiedemann syndrome?

(A) 15% of the time

(B) 25% of the time

(C) 50% of the time

(D) 97% of the time

(E) 76% of the time

227. What is the most common type of isolated cleft lip/palate?

(A) cerebrum

(B) cerebellum

(C) cisterna magna

(D) cerebral peduncle

(E) cavum septum pellucidum

228. The arrow in Fig. 7–101 is pointing to what anatomic structure?

(A) falx cerebri

(B) choroid plexus

(C) cavum septum pellucidum

(D) third ventricle

(E) cerebellum

Image

FIGURE 7–101.

229. A medial cleft lip has a strong association with what abnormality?

(A) hydrocephaly

(B) Turner’s syndrome

(C) holoprosencephaly

(D) hydranencephaly

(E) all of the above

230. Micrognathia may be associated with which of the following syndromes?

(A) Pierre Robin syndrome

(B) trisomy 18

(C) campomelic dysplasia

(D) all of the above

(E) none of the above

231. A 32-year-old female is complaining of lower abdominal cramping and vaginal bleeding with clots. Her serum β-hCG 2 days ago was 5,200 mIU/mL and a repeated serum β-hCG taken 48 hours after the first β-hCG is now 1,200 mIU/mL. Figs. 7–102A and B are her sonograms. What are the most likely findings?

(A) ruptured ectopic pregnancy

(B) unruptured ectopic pregnancy

(C) hydatidiform mole

(D) complete abortion

(E) incomplete abortion

Image

FIGURE 7–102.

232. If a fetal nasal bone is not visualized, which of the following should one look for?

(A) increase nuchal fold

(B) protruding tongue

(C) cardiac defects

(D) Down’s syndrome

(E) both A and D

(F) all of the above

233. Which of the following is true in reference to focal myometrial contraction?

(A) It is physiologic.

(B) It increases the risk of spontaneous abortion.

(C) It increases the risk of premature labor.

(D) It is pathologic.

(E) It is likely to resolve spontaneously.

(F) Both B and D are true.

(G) Both A and E are true.

234. Agenesis of the corpus callosum cannot be diagnosed by ultrasound before

(A) 10 weeks

(B) 14 weeks

(C) 18 weeks

(D) 28 weeks

(E) 34 weeks

235. In 90% of cases with agenesis of the corpus callosum, what other sonographic finding is present?

(A) polyhydramnios

(B) omphalocele

(C) polydactyly

(D) teardrop ventricles

(E) double bubble sign

236. Absent cerebral cortex is found in what cranial abnormality?

(A) holoprosencephaly

(B) hydrocephaly

(C) hydranencephaly

(D) agenesis of the corpus callosum

(E) Dandy–Walker malformation

237. Microcephaly is defined as

(A) HC ≤ 2 SD of mean

(B) HC ≤ 3 SD of mean

(C) 2-week lag in HC

(D) both A and B

(E) all of the above

238. A fetus presents with an anechoic midline lesion in the brain, fetal hydrops, and congestive heart failure. What is the most likely diagnosis for the lesion?

(A) agenesis of the corpus callosum

(B) dilation of the third ventricle

(C) arachnoid cyst

(D) atrioventricular malformation

(E) hydranencephaly

239. Choroid plexus cysts, when found with other associated abnormalities, have a strong association with which of the following conditions?

(A) Noonan’s syndrome

(B) trisomy 18

(C) trisomy 13

(D) X-linked hydrocephaly

(E) none of the above

240. Which of the following is not a known cause for ectopic pregnancy

(A) cigarette smoking

(B) sterilization by bilateral tubal ligation

(C) chlamydia trachomatis

(D) pelvic inflammatory disease

(E) herpes genitalis

241. The nuchal skin fold in the second trimester should be measured at what level?

(A) the level of the cerebral peduncle

(B) the same image as the circle of Willis, falx cerebri and 4th ventricle

(C) the level of the cavum septi pellucidi, cerebellum and cisterna magna

(D) the level of the ventricles

(E) all of the above

242. Where are the ovaries normally located?

(A) fallopian tubes

(B) pouch of Douglas

(C) Morrison’s pouch

(D) ovarian fossa

(E) sacrouterine ligament

243. Abnormal accumulation of intraperitoneal fluid that becomes trapped by adhesions in a patient with a history of previous surgery is most likely caused by which of the following?

(A) inclusion cyst

(B) ovarian torsion

(C) dermoid cyst

(D) follicular cyst

(E) leiomyosarcoma

244. If the cephalic index is > 85, it is an indication of what condition?

(A) brachycephaly

(B) dolichocephaly

(C) microcephaly

(D) macrocephaly

(E) normal cephalic

245. If the cephalic index is < 75, it is an indication of what condition?

(A) brachycephaly

(B) dolichocephaly

(C) microcephaly

(D) macrocephaly

(E) normal cephalic

246. When a sonographic procedure is to be performed that requires a needle insertion. The sonographer should use which one of the following types of gel?

(A) warm ultrasound gel

(B) sterile gel

(C) hypoallergenic gel

(D) transmission gel only

(E) mineral oil

247. Which one of the following lubricants should not be used on latex probe covers?

(A) K-Y jelly

(B) coupling gel

(C) water-based gel

(D) oil-based products

(E) hypoallergenic gel

248. Dolichocephaly is often associated with what conditions?

(A) breech fetus

(B) oligohydramnios

(C) large-for-gestational-age fetus

(D) both A and B

(E) both A and C

(F) all of the above

249. Brachycephaly is associated with what conditions?

(A) trisomy 21

(B) normal variant

(C) myelomeningocele

(D) both A and B

(E) both A and C

(F) all of the above

Questions 250–252: The ratio of head circumference to body circumference normally changes as pregnancy progresses. Match the weeks of gestation in Column A with the head and body ratio in Column B.

COLUMN A

250. 12–24 ______

251. 32–36 ______

252. 36–40 ______

COLUMN B

(A) abdomen larger than head

(B) head and body are equal

(C) head larger than abdomen

253. If performing a biparietal diameter (BPD) measurement and the midline echo is continuous and unbroken, this would indicate what about the scanning plane?

(A) normal

(B) too high

(C) through the fetal neck

(D) correct

(E) too low

254. Which of the following is true regarding the fluid within a cystic hygroma?

(A) serous fluid

(B) amniotic fluid

(C) ascites

(D) lymphatic fluid

(E) hemorrhagic

255. Cystic hygromas are caused by which of the following?

(A) obstruction of the lymph system at the level of the jugular veins

(B) obstruction of the lymph system at the level of the iliac veins

(C) obstruction of the venous system at the level of the jugular veins

(D) carotid artery obstruction

(E) obstruction of the circle of Willis

256. Which of the following is not true of hydatidiform mole?

(A) preeclampsia before 24 weeks of gestation

(B) may have a clinical symptoms of hyperemesis gravidarum

(C) patient may show signs of toxemia or hyperthyroidism

(D) passing of small swollen villus via vagina

(E) the uterus is frequently smaller for dates

257. Eighty percent of cystic hygromas occur in what region?

(A) the axilla

(B) the mediastinum

(C) the cervical region

(D) the lumbar region

(E) the sacral region

258. Cystic hygromas are associated with which of the following?

(A) Potter’s syndrome

(B) Beckwith–Wiedemann syndrome

(C) elevated levels of alpha-fetoprotein

(D) Turner’s syndrome

(E) both C and D

(F) both B and D

(G) all of the above

259. Which of the following best describes the sonographic appearance of molar pregnancy?

(A) “snowstorm”

(B) vesicular sonographic texture

(C) Swiss cheese appearance

(D) “tip of the iceberg” appearance

(E) all of the above

(F) A, B, and C only

Questions 260–269: Match the structures in Fig. 7–103 with the list of terms in Column B.

COLUMN A

260. ______

261. ______

262. ______

263. ______

264. ______

265. ______

266. ______

267. ______

268. ______

269. ______

COLUMN B

(A) amnion

(B) chorion

(C) decidua parietalis (vera)

(D) decidua capsularis

(E) yolk sac

(F) amniotic cavity

(G) uterine cavity

(H) chorionic cavity

(I) chorionic villi

(J) decidua basalis

Early Pregnancy

Image

FIGURE 7–103.

Questions 270–272: Match the structures in Fig. 7–104 with the list of terms in Column B.

COLUMN A

270. ______

271. ______

272. ______

COLUMN B

(A) submucous

(B) pedunculated

(C) intracavitary

Fibroids

Image

FIGURE 7–104

Questions 273–281: Match the structures in Fig. 7–105 with the list of terms in Column B.

COLUMN A

273. ______

274. ______

275. ______

276. ______

277. ______

278. ______

279. ______

280. ______

281. ______

COLUMN B

(A) third ventricle

(B) atrium

(C) inferior horn

(D) posterior horn

(E) interventricular antrum

(F) cerebral aqueduct

(G) lateral recess

(H) anterior horn

(I) third ventricle

Ventricular System

Image

FIGURE 7–105.

282. The fetal shunt between the left and right atria is

(A) ductus venosum

(B) ductus arteriosus

(C) foramen ovale

(D) pulmonary ductus

(E) all of the above

283. The fetal shunt connecting the transverse aortic trunk and the main pulmonary trunk is

(A) ductus venosum

(B) ductus arteriosus

(C) foramen ovale

(D) pulmonary ductus

(E) all of the above

284. Hydranencephaly is thought to result from

(A) chromosomal abnormalities

(B) a vascular accident of the jugular veins

(C) a vascular accident of the internal carotid arteries

(D) calcification of the circle of Willis

(E) none of the above

285. The differential diagnosis for hydranencephaly may be

(A) semilobar holoprosencephaly

(B) alobar holoprosencephaly

(C) severe hydrocephaly

(D) both A and C

(E) both B and C

(F) all of the above

286. Hemivertebrae may be identified on sonogram

(A) as a narrowing of the individual vertebrae in the coronal plane of view

(B) as a narrowing of the individual vertebrae in the sagittal plane of view

(C) as a narrowing of the individual vertebrae in the axial plane of view

(D) all of the above

(E) none of the above

287. The downward displacement of the cerebellar vermis, the fourth ventricle, and medulla oblongata through the foramen magna is termed

(A) “lemon” sign

(B) Dandy–Walker malformation

(C) arachnoid cyst

(D) Arnold–Chiari malformation

(E) agenesis of the corpus callosum

288. Large encephaloceles may be associated with

(A) hydranencephaly

(B) hypotelorism

(C) microcephaly

(D) macrocephaly

(E) all of the above

289. A patient presents for an anatomy scan. The fetal head shows a single ventricle, single choroid, two cerebellar hemispheres, and fused thalamus. The abnormality is most likely

(A) semilobar holoprosencephaly

(B) alobar holoprosencephaly

(C) hydranencephaly

(D) hydrocephaly

(E) arachnoid cyst

290. A patient presents for an anatomy scan. The fetal head shows a single large cystic cavity with a rim of cerebral cortex. A fused thalamus is also identified. What is the most likely diagnosis?

(A) alobar holoprosencephaly

(B) semilobar holoprosencephaly

(C) hydranencephaly

(D) hydrocephaly

(E) arachnoid cyst

291. A patient presents for an anatomy scan. The fetal head shows the cranium filled with anechoic fluid, and no cerebral cortex is identified. The brainstem is identified. What is the most likely diagnosis?

(A) semilobar holoprosencephaly

(B) alobar holoprosencephaly

(C) hydranencephaly

(D) hydrocephaly

(E) Dandy–Walker malformation

292. How early can anencephaly be detected on ultrasound?

(A) 10 weeks

(B) 14 weeks

(C) 16 weeks

(D) 20 weeks

(E) 24 weeks

293. Which of the following best describes acrania?

(A) abnormal brain tissue with absent calvarium

(B) the first stage of anencephaly before prolonged exposure to amniotic fluid

(C) normal brain tissue with abnormal facies

(D) both A and B

(E) all of the above

For questions 294–298, which numbers in the term “parity G7 P3214” correspond to the following?

294. The number of living children:_______

295. The number of preterm infants:_______

296. The number of pregnancies total:_______

297. The number of abortions:_______

298. The number of full-term pregnancies:_______

299. A patient has had six pregnancies: three full term, one preterm delivery of twins, one spontaneous abortion, one fetal loss at 22 weeks. How would this be listed?

(A) G6P3215

(B) G6P3124

(C) G7P5411

(D) G7P2135

(E) G6P3132

300. Adenomyosis is

(A) benign penetration and growth of endometrial glands and stroma into the myometrium

(B) malignant penetration and growth of endometrial glands and stroma into the myometrium

(C) endometrial stroma and glands located outside of the uterus

(D) inflammation of the endometrium

(E) both B and C

301. An increased MSAFP3 may be associated with which of the following?

(A) anencephaly

(B) spina bifida occulta

(C) skin covered spina bifida

(D) both A and C

(E) none of the above

302. An embryo is identified within a gestational sac with an estimated gestational age of 8 weeks. What is the approximate CRL measurement?

(A) 4 mm

(B) 1.5 cm

(C) 2.7 cm

(D) 80 mm

(E) 0.8 mm

303. CRL is the appropriate dating measurement until what gestational age?

(A) 8 weeks

(B) 10 weeks

(C) 12 weeks

(D) 15 weeks

(E) 40 weeks

304. In a fetus without abnormalities in the second and early third trimester, what are the best parameters to use for estimated fetal weight (EFW)?

(A) CRL

(B) FL/AC

(C) BPD, HC, AC, FL

(D) BPD/FL

(E) orbital measurement and cerebellar measurement

305. When measuring the femur, where should the calipers be placed?

(A) the outermost edge of the bone

(B) include epiphyseal plate

(C) the diaphysis of the shaft of the fetal femur

(D) the edges of the entire bone, including the head and neck of the femur

(E) all of the above

306. Polyhydramnios is most commonly associated with what finding?

(A) insulin-dependent diabetes mellitus

(B) duodenal atresia

(C) idiopathic

(D) micrognathia

(E) fetal demise

307. Polyhydramnios may be associated with which of the following?

(A) osteogenesis imperfecta

(B) cleft lip

(C) maternal diabetes

(D) twin–twin transfusion

(E) both A and B

(F) all of the above

308. At what gestational age should the amnion and chorion be fused?

(A) 8 weeks

(B) 10 weeks

(C) 16 weeks

(D) 20 weeks

309. The placenta is not responsible for which one of the following?

(A) exchange of nutrients

(B) hematopoiesis

(C) oxygen exchange

(D) barrier to some medications

(E) hormone production

310. Which of the following is least likely to cause placental abruption?

(A) maternal hypertension

(B) fibroids

(C) cocaine

(D) auto accident

(E) focal myometrial contraction

311. Which of the following best describes placental abruption?

(A) the premature separation of placenta before 20 weeks of gestation

(B) the premature separation of placenta after 20 weeks of gestation

(C) the premature separation of placenta at any gestational age week

(D) the same as a retrochorionic clot

(E) the implantation of the placenta in the lower uterine segment

312. Sonographic signs of placental abruption include which of the following?

(A) retroplacental veins > 2 cm

(B) intervillous lakes

(C) hypoechoic periplacental hematomas

(D) both A and C

(E) all of the above

313. Risks for placenta accreta include

(A) maternal hypertension

(B) isoimmunization

(C) previous cesarean section

(D) infertility

(E) all of the above

314. Placenta percreta refers to

(A) invasion of placental tissue through the uterus into bladder

(B) invasion of placental tissue into myometrium

(C) invasion of placenta up to the serosal layer

(D) placental attachment to the myometrium without invasion

(E) the premature separation of placenta before 20 weeks of gestation

315. What is the placental vascular malformation that appears as a hypoechoic mass near the cord insertion?

(A) fetal vascular anastomosis

(B) placental lake

(C) placental aneurysm

(D) chorioangioma

(E) allantoic cyst

316. The vessels in the umbilical cord are protected by which of the following?

(A) Wharton’s jelly

(B) amniotic fluid

(C) serosal fluid

(D) myometrium

(E) placenta

317. What is a cyst in the umbilical cord called?

(A) allantoic cyst

(B) yolk sac cyst

(C) Meckel’s cyst

(D) ectodermal cyst

(E) chorioangioma

318. Which of the following terms denotes the umbilical cord inserting in the membranes and coursing to the placenta?

(A) normal cord insertion

(B) succenturiate cord insertion

(C) eccentric cord insertion

(D) velamentous cord insertion

(E) nuchal cord

319. Which of the following terms best describes the umbilical cord inserting into the edge of the placenta?

(A) normal cord insertion

(B) marginal cord insertion

(C) eccentric cord insertion

(D) velamentous cord insertion

(E) nuchal cord

320. Which of the following is the most common cardiac defect?

(A) hypoplastic left heart syndrome

(B) atrial/ventricular septal defect

(C) tetralogy of Fallot

(D) transposition of the great arteries

(E) Ebstein’s abnormally of the tricuspid valve

321. The left side of the heart is responsible for perfusing

(A) cranial aspects of the fetus

(B) systemic aspects of the fetus

(C) placenta

(D) lower limbs of the fetus

(E) none of the above

322. The right side of the heart is responsible for perfusing

(A) cranial aspects of the fetus

(B) systemic aspects of the fetus

(C) placenta

(D) umbilical cord only

(E) none of the above

323. The heart should occupy what percentage of the fetal thorax?

(A) 25%

(B) 30%

(C) 60%

(D) 75%

(E) 90%

324. If the axis of the heart is pointed to the right, which of the following should the sonographer look for?

(A) an interrupted inferior vena cava

(B) other heart abnormalities

(C) abdominal organ orientation

(D) dextrocardia

(E) all of the above

325. What is the most common cardiac defect associated with trisomy 21?

(A) atrial/ventricular septal defect

(B) hypoplastic left heart syndrome

(C) atrioventricular canal defect

(D) transposition of the great vessels

(E) dextrocardia

326. From the four-chamber view, the transducer is tilted toward the fetal left shoulder. This will obtain what cardiac view?

(A) five-chamber view

(B) short-axis view

(C) long-axis view

(D) aortic arch

(E) none of the above

327. What anatomy should be evaluated in the four-chamber view?

(A) junction of the atrioventricular valves with the atrial and ventricular septum intact

(B) equally sized ventricular chambers

(C) contractility of the heart

(D) both A and B

(E) all of the above

328. Which of the following best describes the “banana” sign?

(A) concave formation of the frontal bones

(B) flattening of the cerebellum

(C) dumbbell-shaped cerebellum

(D) dilatation of the third ventricle

(E) absence of the corpus callosum

329. A patient presents for ultrasound and informs you that she had a ruptured ectopic pregnancy one year ago in which she fainted. Which of the following most likely was her treatment for her ectopic pregnancy?

(A) methotrexate

(B) hysterectomy

(C) salpingectomy

(D) dilation and curettage

(E) folic acid

330. Which of the following heart abnormalities is difficult or impossible to identify on fetal echocardiography?

(A) Coarctation of the Aorta

(B) Ebstein’s anomaly

(C) double outlet right ventricle

(D) atrial/ventricular septal defect

(E) none of the above

331. The majority of congenital diaphragmatic hernias are

(A) left sided

(B) right sided

(C) bilateral

(D) midline

(E) none of the above

332. On fetal sonogram, the fetal heart is deviated to the right with apex pointed to the left. The sonographer should consider what possible abnormalities?

(A) congenital diaphragmatic hernia

(B) congenital cystic adenomatoid malformation

(C) teratoma

(D) both A and B

(E) all of the above

333. In the identification of congenital diaphragmatic hernia, which of the following is the most important organ the sonographer should also assess?

(A) the location of the fetal liver

(B) fetal kidneys

(C) fetal bladder

(D) placenta

(E) all of the above

334. The significant perinatal mortality of fetuses with congenital diaphragmatic hernia is caused by

(A) chromosomal abnormalities

(B) oligohydramnios

(C) associated cardiac defects

(D) pulmonary hypoplasia

(E) polyhydramnios

335. Congenital diaphragmatic hernia has a poorer prognosis if

(A) it is a left-sided defect

(B) the stomach is located on the left and anterior

(C) if bowel is identified in the chest

(D) if liver is identified in the chest

(E) none of the above

336. The most frequently identified chest mass is

(A) right-sided diaphragmatic hernia

(B) left-sided diaphragmatic hernia

(C) congenital cystic adenomatoid malformation

(D) pulmonary sequestration

(E) omphalocele

337. Congenital cystic adenomatoid malformation is divided into three types. Type I is

(A) microcystic

(B) medium-sized cysts

(C) macrocystic

(D) mixed-size cysts

(E) megacystis

338. Type II congenital cystic adenomatoid malformation is

(A) microcystic

(B) medium-sized cysts

(C) macrocystic

(D) mixed-size cysts

(E) megacystis

339. Type III congenital cystic adenomatoid malformation is

(A) microcystic

(B) medium-sized cysts

(C) macrocystic

(D) mixed-size cysts

(E) megacystis

340. What type of tumor is most likely to produce hCG and AFP?

(A) dermoid cyst

(B) fibroid uterus

(C) Meigs syndrome

(D) dysgerminoma

(E) endometrioma

341. Where are the majority of pulmonary sequestrations found?

(A) inferior to the diaphragm

(B) in the lower left lung base

(C) in the lower right lung base

(D) in the upper left pulmonary lobe

(E) apex of the lungs

342. Methotrexate usually is not given in which of the following situations?

(A) unruptured ectopic pregnancy is present

(B) if the β-hCGis<l,500U/L

(C) ectopic embryo heart motion not seen

(D) ectopic gestational sac >4 cm

(F) all of the above

343. What percentage of esophageal atresia has a tracheoesophageal fistula?

(A) 25%

(B) 50%

(C) 75%

(D) 90%

(E) 10%

344. Eighty percent of fetuses with esophageal atresia have what associated condition in the third trimester?

(A) intrauterine growth retardation

(B) macrosomia

(C) polyhydramnios

(D) decreased abdominal circumference

(E) oligohydramnios

345. Esophageal atresia has a strong association with what chromosomal abnormality?

(A) trisomy 21

(B) trisomy 18

(C) trisomy 13

(D) translocation

(E) none of the above

346. Which of the following does the “double-bubble” sign refer to?

(A) two-vessel umbilical cord

(B) duodenal atresia

(C) ureterocele

(D) hypotelorism

(E) two air-filled structures

347. Fifty percent of fetuses with duodenal atresia also have which of the following abnormalities?

(A) spinal defects

(B) cardiac defects

(C) macrosomia

(D) both A and B

(E) all of the above

348. Duodenal atresia has a strong association with what chromosomal abnormality?

(A) trisomy 21

(B) trisomy 18

(C) trisomy 13

(D) unbalanced translocation

(E) none of the above

349. The physiological herniation of bowel into the umbilical cord is complete by what gestational age?

(A) 8 weeks

(B) 9 weeks

(C) 10 weeks

(D) 13 weeks

(E) 40 week

350. A pseudogestational sac does not have which one of the following characteristics?

(A) anechoic center

(B) yolk sac

(C) fail to grow from one week to the next

(D) sac-like structure

(E) sloughing decidua

351. Which of the following is a sign/symptoms for ruptured ectopic pregnancy?

(A) unilateral adnexal pain which increase with time

(B) heavy vaginal bleeding with clots

(C) right shoulder pain and fainting

(D) nausea and vomiting

(E) vaginal discharge and urinary frequency

352. Which of the following about gastroschisis is true?

(A) more common with advanced maternal age

(B) often associated with other abnormalities

(C) has a very good prognosis with 80–90% survival rate

(D) has an autosomal recessive inheritance

(E) has herniation covered by a membrane consisting of amnion and peritoneum

353. Sonographic signs of bowel perforation do not include which one of the following?

(A) thickened bowel loops

(B) abdominal calcifications

(C) meconium cysts

(D) oligohydramnios

(E) polyhydramnios

354. Which of the following can cause intrauterine complications of gastroschisis

(A) intrauterine growth retardation

(B) edematous bowel wall

(C) intestinal obstruction

(D) dilated fetal stomach

(E) all of the above

355. Gastroschisis is a break in the anterior abdominal wall at what level

(A) right side of the umbilical cord

(B) left side of the umbilical cord

(C) at the umbilical cord insertion with cord attaching to the gastroschisis

(D) medially and inferior to the umbilical cord

(E) none of the above

356. Physiological herniation of the midgut does not include

(A) small intestines

(B) cecum and variform appendix

(C) liver

(D) superior mesenteric artery

(E) vitelline artery

357. A 24-year-old woman presents with c/o right-lower-quadrant pain, nausea with vomiting, and vaginal bleeding for 2 days, as well as serum β-hCG 1,500 mIU/mL. What is the finding in the sonogram shown in Fig. 7–106?

(A) ectopic pregnancy with free fluid

(B) complete abortion

(C) appendicitis with a ruptured ectopic pregnancy

(D) early intrauterine pregnancy in a retroverted uterus

(E) missed abortion

Image

FIGURE 7–106.

358. A midline defect in the anterior abdominal wall with herniation of abdominal contents into the base of the umbilical cord is called which of the following?

(A) gastroschisis

(B) omphalocele

(C) cloacal exstrophy

(D) pentalogy of Cantrell

(E) double bobble

359. Omphaloceles are not associated with which one of the following?

(A) advanced maternal age

(B) chromosomal abnormalities

(C) maternal smoking

(D) cardiac abnormalities

(E) has herniation covered by a membrane consisting of amnion and peritoneum

360. Which of the following terms best describes a midline defect of the chest with the heart herniated to the outside of the chest?

(A) rachischisis

(B) ectopia cordis

(C) cloacal exstrophy

(D) limb–body wall complex

(E) tetralogy of Fallot

361. An omphalocele and ectopia cordis are identified on sonogram. What condition should be included in the differential?

(A) pentalogy of Cantrell

(B) trisomy 18

(C) Beckwith–Wiedemann syndrome

(D) both A and B

(E) all of the above

362. Beckwith–Wiedemann syndrome is a group of which of the following disorders?

(A) omphalocele

(B) shortening of limbs unilaterally

(C) macroglossia

(D) polyhydramnios

(E) both A and C

(F) all of the above

363. If the bladder is herniated through the ventral wall and a spinal defect is identified, what condition should be considered?

(A) bladder exstrophy

(B) cloacal exstrophy

(C) pentalogy of Cantrell

(D) limb–body wall complex

(E) omphalocele

364. A condition in which no umbilical cord may be identified, along with ventral wall defects, and scoliosis is most likely

(A) cloacal exstrophy

(B) amniotic synechiae

(C) limb–body wall complex

(D) complete ventral wall defect

(E) pentalogy of Cantrell

365. Amniotic bands syndrome differs from amniotic sheets (synechiae) because

(A) amniotic bands are attached to the uterus at both ends

(B) amniotic sheets often cause disruption in the first trimester

(C) amniotic bands can cause amputation or limb deformities

(D) there is no difference between amniotic bands and sheets

(E) none of the above

366. Rh isoimmunization results from which of the following combinations?

(A) mother Rh– and father Rh–

(B) mother Rh+ and father Rh–

(C) mother Rh+ and fetus Rh–

(D) mother Rh– and fetus Rh+

(E) none of the above

367. What is the name of the drug given to Rh-negative mothers to prevent hemolytic disease of the newborn?

(A) folic acid

(B) Clomid

(C) methotrexate

(D) RhoGAM

(E) lupron

368. The hemolytic process of destruction of the fetal red blood cells by the maternal antibodies is termed

(A) hypercoagulation

(B) erythroblastosis fetalis

(C) thrombocytopenia

(D) non-immune hydrops

(E) microcytic-hypochromic anemia

369. Which of the following is not characteristic of a blighted ovum?

(A) gestational sac fails to grow from one week to the next

(B) large empty gestational sac

(C) dead embryo

(D) thin trophoblastic reaction

(E) irregularly shaped gestational sac

370. Signs of congestive heart failure in the fetus are

(A) serous effusions

(B) enlarged fetal liver

(C) fetal ascites

(D) pericardial effusions

(E) all of the above

371. How is the diagnosis of fetal hydrops made by sonography?

(A) two fetal sites of fluid accumulation

(B) fetal ascites and one site of accumulated fluid

(C) one site of fluid accumulation and oligohydramnios

(D) both A and B

(E) both A and C

(F) all of the above

372. In cases of fetal distress in diabetic mothers, the fetal heart may

(A) have thickened ventricular walls

(B) have decreased contractility

(C) have increased cardiac output

(D) both A and B

(E) all of the above

373. The main causes for non-immune hydrops include

(A) fetal abnormalities

(B) parvovirus

(C) anti-Kell antibodies

(D) both A and B

(E) both A and C

(F) all of the above

374. Ultrasound confirmation that an intrauterine device (IUD) is in situ is

(A) highly echogenic linear echo in the endometrial cavity with distal acoustic shadowing

(B) depiction of the IUD string on ultrasound in the endometrial cavity

(C) depiction of the IUD in the myometrium with distal acoustic shadow

(D) demonstration of the endometrial stripe

(E) eccentric position of the IUD with entrance-exit reflections

375. Pain in the right upper quadrant (RUQ) due to adhesions and inflammation between the liver and the diaphragm secondary to ascending pelvic infection is known as

(A) Fitz–Hugh–Curtis syndrome

(B) Mittelschmerz

(C) Stein–Leventhal syndrome

(D) ectopic pregnancy

(E) right-sided salpingitis

376. In cases of partial situs inversus, which of the following should the sonographer consider?

(A) cardiac defects

(B) polysplenia

(C) asplenia

(D) interrupted inferior vena cava

(E) both B and C

(F) all of the above

377. On a sonogram, the fetus has unilateral hydronephrosis, nonvisualized ureters, normal bladder, and normal amniotic fluid volume. What does this most likely represent?

(A) unilateral ureterovesical junction (UVJ) obstruction

(B) unilateral ureteropelvic junction (UPJ) obstruction

(C) posterior urethral valves (PUV)

(D) all of the above

(E) none of the above

378. A ureterovesical junction (UVJ) obstruction is associated with what other findings?

(A) ureterocele

(B) unilateral hydronephrosis

(C) pelvic kidney

(D) both A and C

(E) none of the above

379. What is the sonographic appearance of the fetal ureters on ultrasound

(A) the fetal ureters are dilated on most sonograms due to the fetal bladder

(B) the fetal ureters are dilated on most sonograms due to the fetal kidneys

(C) it is normally seen next to the iliac vessels on ultrasound

(D) only one ureter is dilated due to the position of the fetal liver

(E) the ureters are 1 to 2 mm in diameter and are rarely depicted on ultrasound

380. The trigone refers to

(A) the point at which the ureter enters the kidney

(B) the region where the urethra exits the body

(C) the base of the bladder containing the orifices of the ureters and urethra

(D) the region of the bladder containing the orifice of the urethra

(E) the anterior wall of the bladder near the urethra

381. A 35 year old with complaint of lower abdominal cramping, which comes and goes. She also complains of heavy vaginal bleeding with clots. Beta-hCG done on Monday was 8,200 mIU/mL and a second serum β-hCG done on Wednesday (48 hours later) was 20 mIU/mL. The patient now states the cramping and vaginal bleeding have stop. Transvaginal and transabdominal sonogram done demonstrate no intrauterine pregnancy (IUP), no adnexal mass, and no free fluid. The endometrial thickness is 2 mm. What is the most likely diagnosis?

(A) ruptured ectopic pregnancy

(B) unruptured ectopic pregnancy

(C) abdominal pregnancy

(D) incomplete abortion

(E) complete abortion

382. Which of the following is not an ultrasound characteristic of complete posterior ureteral valve obstruction?

(A) hydramnios

(B) hydronephrosis

(C) hydroureter

(D) “keyhole” urethra

(E) abnormally distended urinary bladder

383. Potter’s facies refers to

(A) flattened facial features caused by the lack of amniotic fluid

(B) abnormal development of the abdominal muscles caused by overdistention of the urinary bladder

(C) cleft lip and palate

(D) bulging orbits with assent of the cranial bones

(E) small mouth with protruding tongue and small ears

384. That is the primary cause of death in posterior urethral valve (PUV) outlet syndrome?

(A) renal failure

(B) sepsis

(C) cardiac overload

(D) pulmonary hypoplasia

(E) polyhydramnios

385. Sonographic features of renal agenesis do not include which one of the following?

(A) inability to demonstrate blood flow in renal arteries

(B) elongated adrenal glands in the renal fossa

(C) polyhydramnios

(D) unable to visualize fetal bladder

(E) low amniotic fluid

386. How often does the fetal urinary bladder empty?

(A) every 5 minutes

(B) every 30 to 45 minutes

(C) every 1 to 2 hours

(D) every 4 hours

(E) every 1 minute

387 Causes for abnormal vaginal bleeding do not include which one of the following?

(A) endometrial carcinoma

(B) polycystic ovarian syndrome

(C) ovarian torsion

(D) submucosal fibroids

(E) hyperthyroidism

388. In the early stages of organogenesis, how many kidneys form?

(A) 2

(B) 3

(C) 4

(D) 6

(E) two pairs

389. What other organ system has a strong correlation with renal abnormalities?

(A) cardiac

(B) uterine

(C) ovarian

(D) muscular

(E) brain

390. Which of the following statements about multicystic dysplastic kidney disease is false?

(A) caused by a first-trimester obstruction

(B) caused by a second-trimester obstruction

(C) multiple, varying sized cysts in the parenchyma

(D) echogenic parenchyma

(E) caused by a third-trimester obstruction

391. In the case of unilateral, multicystic, dysplastic kidney disease, the contralateral kidney will often

(A) enlarge

(B) become obstructed

(C) have decreased function

(D) remain the same

(E) small

392. If one parent has autosomal-dominant polycystic kidney disease, the risk for the fetus having the same disease is

(A) 25%

(B) 50%

(C) 75%

(D) 90%

(E) 100%

393. A 26-week fetus presents with large echogenic kidneys that contain some small cysts. The amniotic fluid volume is normal. Differential diagnosis includes

(A) autosomal-recessive polycystic kidney disease

(B) autosomal-dominant polycystic kidney disease

(C) Meckel’s syndrome

(D) both A and C

(E) all of the above

394. The kidneys should occupy how much of the fetal abdomen in an axial plane of view?

(A) 1/4

(B) 1/3

(C) 1/2

(D) 2/3

(E) 3/4

395. Anechoic cysts that surround the periphery of the kidney in a “string of pearls” appearance most likely represent

(A) multicystic dysplastic kidney disease

(B) autosomal dominant polycystic kidney disease

(C) normal renal pyramids

(D) early stage obstructed renal pyramids

(E) Stein–Leventhal syndrome

396. The fetus begins to produce urine at what gestational age?

(A) 10 weeks

(B) 12 weeks

(C) 17 weeks

(D) 20 weeks

(E) 24 weeks

397. Ectopic pregnancy is defined as

(A) pregnancy in the fallopian tubes

(B) pregnancy in the peritoneal space

(C) pregnancy outside of the uterus

(D) pregnancy in the uterine cavity

(E) pregnancy outside the endometrial cavity

398. In the second trimester, what is the normal renal pelvis size?

(A) less than 20 mm

(B) less than 15 mm

(C) less than 8 mm

(D) less than 6 mm

(E) 4–6 cm

Questions 399–403: Match the renal grading system in Column A to the description in Column B.

COLUMN A

399. Grade 0_______

400. Grade I_______

401. Grade II_______

402. Grade III_______

403. Grade IV_______

COLUMN B

(A) renal pelvis and calices dilated

(B) no dilation

(C) renal pelvic dilation with or without infundibula visible

(D) renal pelvis and calices dilated with parenchymal thinning

(E) renal pelvic dilation with calices visible

404. A rare renal tumor that is large, solid, and highly vascular is

(A) neuroblastoma

(B) renal teratoma

(C) congenital mesoblastic nephroma

(D) none of the above

(E) polycystic kidney

405. A malignant adrenal gland tumor that appears as an echogenic, heterogeneous mass is

(A) neuroblastoma

(B) teratoma

(C) Wilms’ tumor

(D) nephroblastoma

(E) none of the above

406. A congenital mesoblastic nephroma is also known as a

(A) neuroblastoma

(B) teratoma

(C) Wilms’ tumor

(D) William’s tumor

(E) angiomyolipomas

Questions 407–409: Match the structures in Fig. 7–107 with one of the following muscles.

407. Arrow no. 1 is pointing to ______

408. Arrow no. 2 is pointing to _____

409. Arrow no. 3 is pointing to _____

(A) obturator internus

(B) rectus abdominis

(C) piriformis

Image

FIGURE 7–107.

410. In Fig. 7–108, the bilateral hypoechoic regions visualized posterior and lateral to the vagina represent which of the following?

(A) ovaries

(B) obturator internus muscles

(C) bilateral masses

(D) levator ani muscle group

Image

FIGURE 7–108.

411. The degree to which the head shapes may affect biparietal diameter (BPD) can be estimated by which of the following formulas?

(A) HC = BPD2 + OFD

(B) Index = HC/OFD × 1.54

(C) CI = BPD/OFD × l00

(D) BPD = BPD × OFD/1.256

(E) CI = BPD/OFD × 1.54

412. What is the most common cause for ovarian torsion?

(A) ovarian tumors

(B) hyperstimulation of the ovary

(C) adhesions

(D) hypervascularity to the ovary

(E) pelvic inflammatory disease

413. The blood supply to the ovaries comes from which of the following?

(A) ovarian artery

(B) aorta

(C) uterine artery

(D) both A and B

(E) both A and C

414. Ovaries that have been overstimulated by infertility medication are at risk for which of the following?

(A) producing grossly enlarged cysts

(B) torsion

(C) endometriosis

(D) both A and B

(E) all of the above

415. Which of the following is not a characteristic of ovarian torsion in adults?

(A) enlarged ovary with a large dermoid cyst

(B) Whirlpool sign

(C) no venous flow but arterial flow present

(D) variable sonographic appearances

(E) bilateral normal size ovary with follicular cyst and Doppler flow present

(F) bilateral salpingo-oophorectomy

416. Which of the following is an early sign/symptom of endometrial cancer?

(A) postmenopausal vaginal bleeding

(B) abdominal and pelvic pain

(C) ascites seen on ultrasound

(D) massive weight loss

(E) headache

417. A rapidly growing fibroid in the first trimester of pregnancy is not as worrisome as a rapidly growing fibroid in a postmenopausal woman because

(A) of the rapid rise of progesterone in the first trimester

(B) of the decrease of estrogen in postmenopausal women

(C) rapid fibroid growth is not worrisome

(D) both cases are cause for concern

(E) fibroids are not dependent on hormones

418. A rapidly growing fibroid in a postmenopausal woman not on hormone replacement therapy is suggestive of which of the following?

(A) leiomyosarcoma

(B) fibrous degeneration

(C) hemorrhagic infiltration

(D) calcific changes

(E) pregnancy

419. In the first and second trimesters, the fetal lung is

(A) of greater echogenicity than the fetal liver

(B) of decreased echogenicity compared to the fetal liver

(C) isoechoic to the fetal liver

(D) variable in appearance

(E) not visible sonographically

420. In the third trimester, the fetal lung is

(A) of greater echogenicity than the fetal liver

(B) of decreased echogenicity compared to the fetal liver

(C) isoechoic to the fetal liver

(D) variable in appearance

(E) fluid filled

421. The femoral epiphyseal plates are visualized on sonogram after

(A) 8 weeks

(B) 12 weeks

(C) 15 weeks

(D) 24 weeks

(E) 32 weeks

422. Postaxial polydactyly is

(A) an extra digit on the ulnar aspect of the fetal hand

(B) an extra digit on the radial aspect of the fetal hand

(C) curvature of the last digit on the ulnar aspect

(D) an extra digit on the fetal foot

(E) absent of the fetal hand

423. Preaxial polydactyly is

(A) an extra digit on the ulnar aspect of the fetal hand

(B) an extra digit on the radial aspect of the fetal hand

(C) curvature of the last digit on the ulnar aspect

(D) an extra digit on the fetal foot

(E) absence of the foot

424. Concordant growth in twins refers to

(A) <10% difference in estimated fetal weight (EFW) between the twins

(B) <20% difference in estimated fetal weight (EFW) between the twins

(C) both fetus within normal range on a normal growth curve

(D) fetus remaining at the same estimated fetal weight (EFW) percentile from exam to exam

(E) all of the above

425. A 27-year-old woman presented for an anatomy ultrasound at 38 weeks of gestation. After 20 minutes of scanning, the patient complains of nausea, dizziness, and lightheadedness. She became pale and sweaty. What is this most likely due to?

(A) supine hypotensive syndrome

(B) ectopic pregnancy

(C) hyperemesis gravidarum

(D) supine hypertensive syndrome

(E) Fitz–Hugh–Curtis syndrome

426. The formula for determining EFW discordance in twins is?

(A) smallest EFW + largest EFW/smallest EFW

(B) smallest EFW × 2 – largest EFW/largest EFW

(C) largest EFW – smallest EFW/largest EFW × 100

(D) largest EFW × 100 – smallest EFW/largest EFW

(E) none of the above

427. What is frank breech?

(A) when both feet are prolapsed into the lower uterine segment

(B) when one foot is prolapsed into the vagina

(C) when the fetal head is to the maternal right and the buttocks are to the maternal left

(D) when the buttocks descend first, the thighs and legs are extended upward along the anterior fetal trunk

(E) when one foot is prolapsed in the lower uterine segment the other leg is above the head

428. What is complete breech?

(A) when both feet are prolapsed into the lower uterine segment

(B) when both feet are prolapsed into the vagina

(C) when the buttocks descend first, the knees are flexed, baby sitting cross-legged

(D) when the thighs and legs are extended upward along the anterior fetal trunk

(E) when one foot is prolapsed in the lower uterine segment the other leg is above the head

429. What is footling breech?

(A) when one or both feet are prolapsed into the lower uterine segment

(B) when one foot is prolapsed into the fundus

(C) when the buttocks descend first, the knees are flexed, fetus sitting cross-legged

(D) when the thighs and legs are extended upward along the anterior fetal trunk

(E) when the fetal head is toward the maternal left and the feet are toward the right

430. Which site of ectopic pregnancy has the highest maternal morbidity or mortality?

(A) abdominal pregnancy

(B) cornual

(C) ampullary

(D) ovarian

(E) isthmic

431. A fetal karyotype of 47X indicates which of the following about the fetus?

(A) affected with Down’s syndrome

(B) affected with Turner’s syndrome

(C) a boy

(D) a girl

432. When performing sonographic examination, the sonographer is expected to do all of the following except?

(A) explain the procedure that will be performed to the patient

(B) input the patient’s name and medical number in the ultrasound equipment

(C) review any previous imaging

(D) briefly explain the sonographic finding with her/his family members who are observing the procedure in the room

(E) briefly examine the patient’s chart for relevant laboratory values

433. When labeling twins, fetus A should be

(A) the first fetus identified

(B) the fetus closest to the fundus

(C) the fetus closest to the internal os

(D) any of the above methods is appropriate

(E) the fetus seen first on the sonogram

434. The fetus is vertex with the spine on the maternal right. The fetal left side should be

(A) anterior

(B) posterior

(C) inferior

(D) superior

(E) none of the above

435. The fetus is transverse with head on the maternal left. The fetal spine is inferior. The fetal left side should be

(A) anterior

(B) posterior

(C) inferior

(D) superior

(E) none of the above

436. The fetus is breech with the spine on the maternal left. The fetal left side should be

(A) anterior

(B) posterior

(C) inferior

(D) superior

(E) none of the above

437. Subchorionic placental lakes are

(A) associated with intrauterine growth retardation

(B) associated with oligohydramnios

(C) also known as subchorionic fibrin deposition

(D) are sonographic findings of abruptio placenta

(E) all of the above

438. Early placental maturation may be associated with

(A) hypertension

(B) gestational diabetes mellitus

(C) maternal smoking

(D) both A and C

(E) all of the above

439. A thin placenta (<1.5 cm) is not associated with which one of the following?

(A) preeclampsia

(B) intrauterine growth retardation

(C) insulin dependent diabetes mellitus

(D) triploidy

(E) intrauterine infection

440. A thick placenta (>5 cm) is not associated with which one of the following?

(A) gestational diabetes mellitus

(B) infection

(C) multiple gestations

(D) hypertension

(E) hydrops

441. Maternal causes of intrauterine growth retardation do not include which one of the following?

(A) maternal infection

(B) diabetic mothers with vasculopathy

(C) maternal smoking

(D) gestational diabetes mellitus

(E) previous history of fetus with intrauterine growth retardation

442. A patient presents for amniocentesis, which of the following is most imperative before performing the procedure?

(A) briefly examine the patient’s chart for relevant laboratory values

(B) confirm that an informed consent was obtained

(C) input the patient’s name and medical number into the ultrasound equipment

(D) obtain previous imaging

(E) ensure the room and the transducer are clean

443. Caudal regression syndrome is associated with

(A) insulin-dependent diabetes mellitus

(B) chromosomal abnormalities

(C) Noonan’s syndrome

(D) hypertension

(E) all of the above

444. Which organ or tissue has the furthermost concern with respect to biological effects when utilizing ultrasound on humans?

(A) skin

(B) embryo

(C) spleen

(D) bone

(E) adult red blood cells

445. What is the highest amount of output intensity typically utilized in diagnostic ultrasound?

(A) pulse-wave Doppler with real-time imaging

(B) color power Doppler

(C) fetal Doppler monitor

(D) real-time

(E) none of the above

446. Turner’s syndrome affects males and females

(A) equally

(B) males more than females

(C) females more than males

(D) males only

(E) females only

447. In order to reduce the acoustic exposure to the obstetrical patient, which of the following should the sonographer do?

(A) decrease the power output controls and increase the receiver gains

(B) decrease the near gain and increase the far gain and power output

(C) increase the overall receiver gain and the output power at the same time

(D) decrease the scanning time and increase the power output

(E) increase the power output and receiver gains in order to increase attenuation, which will decrease the patient exposure

448. Which of the following might be fetal complications caused by maternal diabetes?

(A) caudal regression syndrome

(B) cardiac defects

(C) shoulder dystocia

(D) both A and B

(E) all of the above

449. Lung maturity amniocentesis is used in what cases?

(A) intrauterine growth retardation fetus with decreasing estimated fetal weight (EFW)

(B) insulin-dependent diabetes mellitus

(C) complete premature rupture of membranes

(D) both A and B

(E) all of the above

450. Which of the following sonographic markers may not be used to assess macrosomia?

(A) humeral shoulder thickness

(B) cheek-to-cheek diameter

(C) HC/AC ratio

(D) amniotic fluid volume

(E) abdominal subcutaneous tissue thickness

451. In the case of anhydramnios, how can karyotype be obtained?

(A) percutaneous umbilical blood sampling

(B) chorionic villus sampling

(C) cystocentesis

(D) all of the above

(E) none of the above

452. Amniocentesis may not be used to test for which one of the following?

(A) sickle cell disease

(B) fetal bilirubin

(C) specific short limb syndromes

(D) cystic fibrosis

(E) cleft palate

453. Maternal hypertension may have what effect on pregnancy?

(A) polyhydramnios

(B) placentomegaly

(C) intrauterine growth retardation

(D) chromosomal abnormalities

(E) macrosomia

454. An excessively accelerated calcific placenta in the second trimester is associated with which of the following risk factors?

(A) excessive maternal smoking

(B) chromosomal abnormality

(C) precursor to third-trimester intrauterine growth retardation

(D) hydrops

(E) all of the above

455. The abbreviation BBOW refers to

(A) baby below outer water

(B) brachycephalic baby on way

(C) bulging bag of water

(D) baby below occipital wing

(E) baby below obstetrical weight

456. The abbreviation PROM refers to

(A) partially ruptured outer membrane

(B) previous rip of mucus plug

(C) partial range of motion

(D) premature rupture of membranes

(E) postpartum removal of membrane

457. Overdistension of the urinary bladder may cause

(A) anterior placenta to appear previa

(B) closure of an incompetent cervix

(C) distortion or closure of the gestational sac

(D) obscured visualization of the internal iliac vein

(E) both A and B

(F) all of the above

458. Ovulation is assume to occurs

(A) during intercourse

(B) on the 7th day of the menstrual cycle

(C) on the 14th day of the menstrual cycle

(D) on the 2nd day of the menstrual cycle

(E) on the first day of menstruation

Questions 459–467: Match the terms in Column A to the correct description in Column B.

COLUMN A

459. Gravida ______

460. Multipara ______

461. Nullipara ______

462. Primipara ______

463. Nulligravida ______

464. Primigravida ______

465. Multigravida ______

466. Para ______

467. Trimester ______

COLUMN B

(A) a woman who has given birth two or more times

(B) one who has never been pregnant

(C) a woman who is pregnant

(D) a woman who has never given birth to a viable infant

(E) pregnant for the first time

(F) one who has been pregnant several times

(G) the number of pregnancies that have continued to viability

(H) a woman who has given birth one time to a viable infant

(I) a 3-month period during gestation

468. Puerperium refers to the period

(A) surrounding conception time

(B) after death

(C) 6–8 weeks before delivery

(D) beginning with the expulsion of the placenta

(E) the area of anatomy between the anus and vagina

469. A postpartum gynecologic sonogram may be needed for which of the following assessments?

(A) assessing maternal hydronephrosis

(B) examining the uterus for retained placenta

(C) checking for maternal bowel obstruction

(D) maternal gallstones

(E) all of the above

470. Which of the following components of the ultrasound system exposes a patient to greater potential risk?

(A) a cracked transducer face

(B) a transducer cable that is wet with ultrasound gel

(C) a hot TV monitor

(D) ultrasound equipment that need calibration

(E) cold transducer gel

471. Which of the following structures is most likely not seen in a postpartum pelvic sonogram?

(A) uterus

(B) endometrial echo

(C) vagina

(D) ovaries

(E) all of the above

472. Approximately what level is the fundus of the gravid uterus at 20 weeks of gestation?

(A) umbilicus

(B) xiphoid process

(C) half way between the umbilicus and the symphysis pubic

(D) at the level of the symphysis pubic

(E) below the symphysis pubic

473. What is the most common complication during the postpartum period?

(A) hemorrhage

(B) thromboembolism

(C) infection

(D) both A and B

(E) all of the above

474. Which of the following is a least likely cause for abdominal and pelvic ascites?

(A) heart failure

(B) nephrotic syndrome

(C) pancreatitis

(D) cancer

(E) fibroid uterus

475. What percentage of fetuses is in the breech presentation at term?

(A) 25%

(B) 50%

(C) 75%

(D) 5%

(E) 1%

476. Which of the following characteristic is most suspicious of malignant ascites?

(A) free intraperitoneal fluid in paracolic gutters and Morison’s pouch

(B) loculated fluid with loops of bowel adherent and fixed to the abdominal wall

(C) free echogenic fluid in the peritoneal cavity with floating bowel loops

(D) anechoic free fluid in the in the gravity-dependent position of the abdomen

(E) homogeneous echogenic free fluid in the paracolic gutters and Morison’s pouch

477. The abbreviation VBAC refers to

(A) vaginal blockage and closure

(B) vaginal blockage after cesarean

(C) vaginal birth after cesarean

(D) none of the above

(E) vaginal bacteria at cesarean

478. Which of the following anatomical sites is where the normal implantation of pregnancy occurs?

(A) ampullary region of the fallopian tube

(B) endometrial cavity

(C) myometrium

(D) abdomen

(E) ovaries

Questions 479–484: Match the terms in Column A to the correct description in Column B.

COLUMN A

479. placenta previa ______

480. placenta accreta ______

481. placenta succenturiata ______

482. abruptio placentae ______

483. placenta increta ______

484. placenta percreta ______

COLUMN B

(A) abnormal adherence of part or all of the placenta to the uterine wall

(B) premature separation of the placenta after 20 weeks of gestation

(C) accessory lobe of placenta

(D) implantation of the placenta in the lower uterine segment

(E) abnormal adherence of part or all of the placenta in which the chorionic villi invade the myometrium

(F) abnormal adherence of part or all of the placenta in which chorionic villi invade the uterine wall

485. The chorion frondosum progressively develops to become

(A) fetal component of the placenta

(B) maternal component of the placenta

(C) the amniotic cavity

(D) the yolk sac and stalk

(E) fetus

486. The decidua basalis progressively develops to become

(A) fetal component of the placenta

(B) maternal component of the placenta

(C) the amniotic cavity

(D) the yolk sac and stalk

(E) embryo

487. Which of the following choices is true about HELLP syndrome?

(A) abbreviation for hemolysis elevated liver enzymes, and low platelets

(B) abbreviation for hemivertebrae elevated liver enzymes, and low-lying placenta

(C) treated similar to severe preeclampsia

(D) Doppler may help in assessing HELLP syndrome

(E) acronym for help evaluation of lungs, liver and preeclampsia

488. A large fibroid uterus is seen on the ultrasound. The sonographer should scan what organ?

(A) kidneys

(B) liver

(C) posterior cul-de-sac

(D) pancreas

(E) spleen

489. What is the primary infection that causes varicella-zoster virus (VZV)?

(A) 5ths disease

(B) chicken pox

(C) human papilloma virus (HPV)

(D) herpes simplex

(E) cytomegalovirus

490. What is the most common congenital intrauterine viral infection?

(A) toxoplasmosis

(B) HIV

(C) parvovirus

(D) cytomegalovirus

(E) rubella

491. Which of the following statements about the secondary yolk sac is false?

(A) located in amniotic cavity

(B) disappears at approximately 12 weeks of gestation

(C) is depicted before the embryo is seen

(D) contains vitelline fluid

(E) is essential in blood development

492. What is the most common cause for hematocolpos?

(A) bicornuate uterus

(B) endometritis

(C) pelvic inflammatory disease

(D) imperforate hymen

(E) ectopic pregnancy

493. Sampling of the middle cerebral artery is helpful in determining

(A) IUGR and related complications

(B) prediction of fetal anemia

(C) the need for a fetal transfusion

(D) all of the above

494. Which of the following statements regarding leiomyoma is false?

(A) calcifies and attenuates the ultrasound beam

(B) may mimic a myometrial contraction

(C) normally increases in size after menopause

(D) distorts the endometrial cavity

(E) derives from the muscle of the uterus

495. A 24-year-old presents for an ultrasound with a markedly elevated serum β-hCG. Her sonogram demonstrates multiple small anechoic spaces about 3–5 mm in the uterine cavity. What is this finding most likely to be?

(A) theca lutein cyst

(B) corpus lutein cyst

(C) follicular cyst

(D) hydropic villi

(E) pseudogestational sac

496. Which of the following statements about stromal tumors is false?

(A) All have a similar sonographic appearance and can’t be differentiated from one another.

(B) solid, hypoechoic ovarian tumors

(C) types include: fibromas, thecomas, Sertoli- Leydig cell tumors.

(D) types include: fibromas, thecomas, and Brenner tumors.

(E) all of the above

497. Endometrioma may appear sonographically similar to

(A) benign cystic teratoma

(B) polycystic ovaries

(C) hemorrhagic cyst

(D) hydrosalpinx

(E) follicular cyst

498. Hydrosalpinx may be differentiated from a multi-cystic ovarian mass on sonogram by

(A) following the cystic spaces to ensure that they all communicate

(B) using color Doppler to follow the ovarian artery to the ovary

(C) having the patient roll to lengthen out the fallopian tube

(D) the two cannot be differentiated

(E) using power Doppler

499. An anechoic, smooth-walled cyst is identified in a patient who has had a hysterectomy/oophorectomy. Which of the following should be included in the differential diagnosis?

(A) paraovarian cyst

(B) ovarian remnant cyst

(C) mesonephric cyst

(D) inclusion cyst

(E) all of the above

500. The hydatid cyst of Morgagni is

(A) a complex ovarian mass

(B) an hydatidiform mole cyst

(C) paramesonephric cyst

(D) another name for ovarian remnant syndrome

(E) an hydatid cyst of the ovaries

501. The formula for determining ovarian volume is

(A) D1 × D2 × D3 × 0.523

(B) D1 + D2 + D3 × 3.14

(C) D1 × D2 × D3 × 3.14

(D) D1 + D2 × 100

(E) D1 + D2 × 1.57

502. The image in Fig. 7–109 represents

(A) arachnoid cyst

(B) communicating hydrocephaly

(C) “banana” sign

(D) Dandy–Walker malformation

(E) choroid plexus cyst

Image

FIGURE 7–109.

503. Fig. 7–110 demonstrates a

(A) normal adult uterus

(B) multiparous uterus

(C) prepubertal uterus

(D) nulliparous uterus

(E) enlarged fibroid uterus

Image

FIGURE 7–110.

504. Fig. 7–111 is of a 25-year-old patient referred for a sonogram because a right adnexal mass was palpated. What is the most likely diagnosis?

(A) cystadenoma

(B) fibroma

(C) cystic teratoma

(D) dysgerminoma

(E) endometrioma

Image

FIGURE 7–111.

505. In Fig. 7–112, what are the arrows pointing to?

(A) ovarian ligament

(B) broad ligament

(C) obturator internus muscle

(D) vagina

(E) cervix

Image

FIGURE 7–112

506. In Fig. 7–113, the markers are placed on the endocervical canal; what do the markers represent?

(A) isthmus to corpus

(B) anterior cul-de-sac and internal os

(C) internal os to external os

(D) the vaginal fornices

(E) vaginal canal

Image

FIGURE 7–113

Questions 507–510. Match the structures numbered in Fig. 7–114 with the list of terms in Column B.

507. Arrow no. 1 is pointing to ______

508. Arrow no. 2 is pointing to _____

509. Arrow no. 3 is pointing to _____

510. Arrow no. 4 is pointing to _____

(A) cervix

(B) fundus

(C) corpus

(D) isthmus

(E) endometrium

Image

FIGURE 7–114

511. In Fig. 7–115, identify the potential space that is marked by the asterisk.

(A) space of Retzius

(B) pouch of Douglas

(C) anterior cul-de-sac

(D) Morrison’s pouch

(E) vesicouterine pouch

Image

FIGURE 7–115.

512. Female infertility may be caused by which of the following?

(A) uterine synechiae

(B) polycystic ovarian syndrome (PCOS)

(C) Asherman’s syndrome

(D) adenomyosis

(E) all of the above may cause infertility

513. In Fig. 7–116, the endometrium is in what phase of the menstrual cycle?

(A) menstrual

(B) secretory

(C) proliferative

(D) luteal

Image

FIGURE 7–116.

514. The anterior pituitary gland is responsible for the production of which of the following?

(A) FSH (follicle-stimulating hormone)

(B) GnRH (gonadotropin releasing hormone)

(C) LH (luteinizing hormone)

(D) oxytocin

(E) both B and D

(F) both A and C

515. When performing a spectral Doppler evaluation of the ovary during the pre-ovulatory phase, which of the following is false?

(A) the waveform has a decreased diastolic flow

(B) decreased resistance index (RI)

(C) increased vasculature of the follicular wall

(D) high amount of flow during diastole

(E) no change in waveform

516. Meigs’ syndrome consists of all of the following except?

(A) pleural effusion

(B) uterine tumor

(C) ascites

(D) fibrous ovarian tumor

517. The onset of menstruation is also referred to as?

(A) parity

(B) menarche

(C) climacteric

(D) Mittelschmerz

(E) puberty

518. Sonographically normal bowel can present as

(A) echogenic

(B) having peristaltic motion

(C) having acoustic shadowing

(D) fluid-filed

(E) all of the above

519. An 18-year-old female presents with amenorrhea. The sonogram demonstrates a cystic dilated uterine and vaginal cavity containing low-level echoes. The diagnosis of hematometrocolpos was made. This may have resulted from all of the following except

(A) obstruction at the vaginal level

(B) secondary to an imperforate hymen

(C) vaginal septum

(D) stenotic or atretic vagina

(E) cervical stenosis

520. The incidence of ovarian carcinoma is relatively low (1.4% lifetime risk, or 1 in 70). Women with at least a 2.0% lifetime risk include all of the following except

(A) infertility patients

(B) perineal talc exposure

(C) high-fat diet

(D) multiparity

(E) family history

521. There are various methods of assisted reproductive technology. Which of the following is not a method of assisted reproductive technology?

(A) in vitro fertilization

(B) GIFT

(C) FIFT

(D) ZIFT

(E) none of the above

522. In Fig. 7–117, the endometrium is in what phase of the menstrual cycle?

(A) menstrual

(B) secretory

(C) proliferative

(D) luteal

(E) none of the above

Image

FIGURE 7–117

523. What is the congenital uterine anomaly that is demonstrated in Fig. 7–118?

(A) didelphys uterus

(B) septate uterus

(C) bicornuate uterus

(D) unicornis

(E) no congenital anomaly is visualized

Image

FIGURE 7–118

524. This patient might present with a history of

(A) spontaneous abortions

(B) vaginal bleeding

(C) pelvic pain

(D) infertility

(E) vaginal discharge

525. Fig. 7–119 is a sagittal midline image of the pelvis demonstrating a mass superior to the fundus of the uterus, which most-likely represents a (an)

(A) endometrioma

(B) ectopic kidney

(C) bowel

(D) thecoma

(E) ovary

Image

FIGURE 7–119.

526. Which of the following muscles is not located within the true pelvis?

(A) obturator internus

(B) levator ani

(C) piriformis

(D) iliopsoas

(E) coccygeus

527. Which of the following ligaments does not provide structural support for the uterus and cervix?

(A) round

(B) cardinal and uterosacral

(C) infundibulopelvic

(D) uterosacral

(E) cardinal

528. What sonographic study requires a catheter inserted into the endometrial cavity with the insertion of normal saline solution as contrast medium for the purpose of demonstrating abnormalities of the uterine cavity?

(A) in vitro fertilization

(B) hysterosalpingogram

(C) computerized tomography

(D) sonohysterography

(E) magnetic resonance imaging

529. In the presence of ascites, Fig. 7–120 is most suggestive of

(A) cystadenoma

(B) serous cystadenocarcinoma

(C) endometriosis

(D) paraovarian cyst

Image

FIGURE 7–120.

530. Which of the following patients will require an informed consent for transvaginal ultrasound?

(A) a comatosed intensive care unit patient on mechanical ventilation with possible small ovarian cyst

(B) a patient with history of bipolar disorder and schizophrenia to r/o ectopic pregnancy

(C) patient with ovarian torsion, who refuses transvaginal sonogram, which is warranted to confirmed the diagnosis

(D) a patient with morphine overdose and other control drugs including alcohol

(E) A, B, and D only

(F) all of the above

531. A sonographer working in a hospital ultrasound department was approach by a 22-year-old hospital employee who is requesting an ultrasound and a DVD of her baby. This is her first pregnancy and she is very excited about her pregnancy. She states that the DVD is to show her husband and family her unborn baby in 3D. What is the most appropriate next step for the sonographer to take?

(A) do the ultrasound in 3D and charge her only for the cost of the DVD

(B) do the ultrasound only

(C) do the ultrasound and give her the DVD for free; DVD is part of her medical records, and therefore, she has a legal right to have it

(D) refuse to do the ultrasound study, but do the 3D ultrasound on DVD for her

(E) none of the above

532. A patient informs you prior to her sonogram that she is 30 weeks pregnant. She had prenatal care in Puerto Rico and came to the United States two weeks ago. She is now complaining of uterine contractions. She came to the hospital via ambulance because she is unable to tolerate the contractions. The sonogram performed today fails to demonstrate any pregnancy. The uterus is small, 6 cm in size. The urine and serum β-hCG test results are negative. What is the most likely finding?

(A) abdominal pregnancy

(B) fetal demise

(C) pseudocyesis

(D) ectopic pregnancy

(E) missed abortion

533. Precocious puberty is

(A) premature development of secondary sexual characteristics before 8 years

(B) infants born with an atypical enlarged genitals with undetermined sex type

(C) a rare and abnormal separation of the symphysis pubis and piriformis muscle

(D) a congenital abnormality of the pubic bone

(E) preventative measure before teenage reproductive years

534. What is the most common cause for requesting pelvic ultrasound in the pediatric age-group?

(A) fibroid uterus

(B) vaginal foreign body

(C) ovarian cancer and ascites

(D) precocious puberty and sexual ambiguity

(E) endometrial polyps

535. The gold standard for predicting fetal lung maturity is

(A) lecithin-sphingomyelin (L/S) ratio

(B) grade III placenta

(C) demonstration of the proximal humeral epiphyses

(D) alpha-fetoprotein (AFP)

(E) ultrasound utilizing all three parameters BPD, AC, and FL

536. An infection acquired via a medical instrument or a medical procedure is called

(A) nosocomial

(B) iatrogenic

(C) mortality

(D) mobility

(E) autoclave

537. A 22-year-old presented to the emergency department complaining of vaginal bleeding and lower abdominal cramping for 7 days after a suction dilatation and curettage for an unwanted pregnancy at 8 weeks. Her serum β-hCG is currently 3,500 mIU/mL. What is the sonographic finding shown in Fig. 7–121?

(A) ectopic pregnancy

(B) abdominal pregnancy

(C) complete abortion

(D) pseudo-gestational sac

(E) retained products

Image

FIGURE 7–121.

538. The fetal head should be in what position for a more precise nuchal translucency measurements

(A) neutral position

(B) brow presentation

(C) occiput transverse

(D) hyperflexion

(E) hyperextended

539. Sonographic measurements taken between the outer edge of the occipital bone to the outer margin of the skin is called

(A) nuchal fold

(B) nuchal translucency

(C) cisterna magna

(D) orbital distance

(E) cerebellar measurement

540. Enlarged nuchal translucency is often associated with all of the following except

(A) aneuploidy

(B) Down’s syndrome and cystic hygroma

(C) Turner’s syndrome

(D) congenital heart disease

(E) rhombencephalon

541. The optimal time to assess measurements for nuchal translucency is

(A) 6–12 weeks

(B) 4–5 weeks

(C) 14–16 weeks

(D) 11–14 weeks

(E) 6–14 weeks

542. The mean measurement for nuchal translucency is

(A) 30 cm

(B) 30 mm

(C) 1 mm

(D) 7 mm

(E) 3 mm

543. Which of the following terms is used in association with cystic hygroma and enlarged nuchal translucency?

(A) nuchal fold

(B) ventriculomegaly

(C) hydrops fetalis

(D) mesenchymal edema

(E) spina bifida