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WorksheetsThe role of sonography in OB
Total questions: 91
Worksheet time: 1hrs 11mins
1. To confirm the presence of an intrauterine pregnancy
2. To evaluate a suspected ectopic pregnancy
3. To define the cause of vaginal bleeding
4. To evaluate pelvic pain
5. To estimate gestational (menstrual) age
(a)
6. To diagnose or evaluate multiple pregnancy
7. To confirm cardiac activity
8. As an adjunct to chorionic villous sampling, embryo transfer, or
localization and removal of an intrauterine device
9. To assess for certain fetal anomalies, such as anencephaly, in
patients at high risk
(a)
10. To evaluate maternal pelvic or adnexal masses or uterine
abnormalities
11. To screen for fetal aneuploidy
12. To evaluate suspected hydatidiform mole
(a)
In which trimester would you evaluate for fetal aneuploidy?
1st
2nd
3rd
In which trimester would you evaluate suspected hydatiform mole?
1
2
3
all
Can scanning in the first trimester be performed transabdominally AND transvaginally?
Yes
No
Use of Doppler ultrasound during the first trimester is (a) recommended; it must be used only when there is medical indication and the benefits outweigh the risks
In the first trimester, what is the MOST ACCURATE means for sonographic dating of pregnancy?
Femur to foot length
Crown-rump measurement
BP
APD
1. Evaluation of gestational age
2. Evaluation of fetal growth
3. Evaluation of vaginal bleeding
4. Evaluation of cervical insufficiency
5. Evaluation of abdominal and pelvic pain
(a)
6. Determination of fetal presentation
7. Evaluation of suspected multiple gestation
8. Adjunct to amniocentesis or other procedure
9. Significant discrepancy between uterine size and clinical dates
10. Evaluation of pelvic mass
(a)
11. Examination of suspected hydatidiform mole
12. Adjunct to cervical cerclage placement
13. Evaluation of suspected ectopic pregnancy (rare)
(a)
14. Evaluation of suspected fetal death
15. Evaluation of suspected uterine abnormality
16. Evaluation of fetal well-being
17. Evaluation of suspected amniotic fluid abnormalities
18. Evaluation of suspected placental abruption
19. Adjunct to external cephalic version
(a)
20. Evaluation for premature rupture of membranes and/or premature labor
21. Evaluation for abnormal biochemical markers
22. Follow-up evaluation of a fetal anomaly
23. Follow-up evaluation of placental location for suspected placenta previa
24. Evaluation of those with a history of previous congenital anomaly
(a)
25. Evaluation of fetal condition in late registrants for prenatal care
26. Assessment of findings that may increase the risk of aneuploidy
27. Screening for fetal anomalies
(a)
Which of the following is NOT one of the parameters used to determine gestational age?
Biparietal diameter - BPD
Head circumference – HC
Crown rump length - CRL
Abdominal circumference – AC
Femoral (diaphysis) length = Femur
length -FL
BPD stands for
(a)
HC stands for
(a)
AC stands for
(a)
Femur length (FL)
(a)
Do you measure the epiphysis in the femur length measurement?
yes
No
Measuring fetal growth by sonography at ___ to ___-week intervals permits assessment of the impact of a complicating condition of the fetus and guides pregnancy management.
3-6
10-12
2-4
4-7
When the patient has an identified cause for uteroplacental insufficiency, such as severe preeclampsia, chronic hypertension, chronic renal disease, or severe diabetes mellitus, or for other medical complications of pregnancy in which fetal malnutrition, What should be suspected?
Intrauterine growth restriction (IUGR)
Extrauterine growth restriction (EUGR)
Macrosomia
Microsomia
Determination of the source of bleeding and the status of the fetus
(a)
Pregnant women with increased risk or recurrent preterm birth or primary preterm birth
(a)
Ectopic pregnancy, abrupt placentae, or maternal appendicitis, renal calculi, pelvic mass, or other conditions
(a)
Accurate knowledge of presentation guides management of delivery
(a)
More than one fetal heartbeat pattern, fundal height larger than expected for dates, or prior use of fertilitilty drugs
(a)
Sonography permits guidance of the needle to avoid the placenta and fetus, to increase the chance of obtaining amniotic fluid, and to decrease the chance of pregnancy loss
(a)
suspected on the basis of clinical signs of hypertension,
proteinuria, or the presence of ovarian cysts felt on pelvic examination or
failure to detect fetal heart tones with a Doppler ultrasound device after 12
weeks. US permits accurate diagnosis and differentiation of this neoplasm from
fetal death
(a)
US aids in timing and proper
placement of the cerclage for patients with incompetent cervix
(a)
Tubal pregnancies generally rupture between which weeks?
6-10
4-12
3-9
5-11
Biophysical evaluation for fetal well-being
after (a) weeks of gestation may include assessment of amniotic fluid, fetal
tone, body movements, breathing movements, and heart rate patterns
Elevated maternal serum alpha-fetoprotein (MSAFP) increases the risk for open defects
such as neural tube defects. Other biochemical markers may indicate increased
risk for certain obstetric or fetal conditions
TRUE
FALSE
What examination is performed at 13 weeks and 6 days of GA?
First trimester risk assessment
First trimester examination
First trimester nuchal transluceny
Standard obstetric examination
In which examination would you examine Uterus, the cervix, and the
maternal adnexa, as well as the gestational sac and embryo?
First trimester examination
Second trimester examination
Limited OB examination
Standard OB exam
In the (a) examination you check for GA (CRL, GS), fetal heart activity, uterine anomalies, pelvic masses, chronicity/amniocity of multiple gestations
AKA Nuchal translucency examination, this is performed between weeks 11-14
(a)
Which condition must be met to warrant a first trimetster nuchal translucency exam?
When women choose first trimester screening for BP
When women choose first trimester screening for aneuploidy
When women choose first trimester heartbeat scans
All of the above
Includes measurement of fetal crown- rump length and measurement of nuchal translucency using standard criteria
(a)
Which OB examination is performed during the 2nd trimester around week 18?
Specialty OB examination
Limited OB sonography examination
Repeat OB sonography examination
Standard OB sonography examination
This exam includes:
Evaluation of GA (by fetal biometry), fetal number, placental position, cardiac activity, amniotic volume, fetal anatomic survey
(a)
This exam is similar to standard OB exams, Performed when a previous standard
obstetric examination has been recorded and the second examination is ordered for the same indication
(a)
This examination includes:
Biometry to evaluate fetal growth
Reevaluation of anatomy that may or may not have been visualized during standard exam
(a)
This examination is only done when a previous standard OB exam has been reported, and is used to answer a specific clinical question
(a)
This exam is used to answer:
Presentation of fetus
Placental location
Cervical length
Amniotic fluid volume
Verification of fetal heart motion
(a)
AKA Detailed fetal anatomical sonogram
(a)
Performed when an anomaly is suspected based on maternal history, biochemistry, or results of a previous OB sonogram when there is a known fetal growth disorder, or when there is an increased risk for a fetal condition
(a)
Includes all components of the standard examination plus a more in-depth view of fetal anatomy (additional views of the fetal heart and may include color Doppler views of the heart)
(a)
It is important to document the clinical date reported by the patient and the date determined by the earliest sonographic examination
True
False
Number of pregnancies, INCLUDING the present one
(a)
IS a numeric system that describes all pregnancy outcomes
(a)
In TPAL, T stands for:
Full term deliveries
Premature births and stillborns
Early pregnancy loss or termination
Living children
In TPAL, P stands for
Full term deliveries
Premature births and stillbirths
Early pregnancy loss and stillborns
Living children
In TPAL, A stands for
Full term deliveries
Premature births and stillborns
Early pregnancy loss or termination
Living children
In TPAL, L stands for
Full term deliveries
Premature births and stillborns
Early pregnancy loss or termination
Living children
What is the standard way to date pregnancy in the USA?
Last date of ovulation
First date of last normal menstrual period
Last date of bleeding
If conception on day 14 from LMP pregnancy duration is:
365 days or 52 weeks
280 days or 40 weeks
266 days or 38 weeks
The duration of human pregnancy is 266 days, give or take 10 days
true
false
How many weeks is each trimester?
15
12
16
13
13 weeks and 6 days of GA describes the (a) trimester
14-26 weeks of GA describes the (a) trimester
This trimester begins last 27 weeks and last until term
(a)
GA’s by US during 1st and 2nd Trimesters take
precedence over menstrual dates when
discrepancy > 7 days (1st trimester) or >10 days
(2nd trimester)
True
False
Should GA's be dated using ultrasound measurements in the 3rd term?
Yes
No
Measurement of GA is often precise
true
false
Month 1 corresponds to which weeks?
1-4
5-8
9-13
14-17
Month 2 corresponds to which weeks?
1-4
5-8
14-17
9-13
Month 3 corresponds to which weeks?
1-4
5-8
9-13
14-18
Month 4 corresponds to which weeks?
1-4
5-8
9-13
14-17
Month 5 corresponds to which weeks?
18-21
22-26
27-30
31-35
Month 6 corresponds to which weeks?
1-4
22-26
27-30
31-35
Month 7 corresponds to which weeks?
22-26
27-30
31-35
36-40
Month 8 corresponds to which weeks?
22-26
27-30
31-35
36-40
Month 9 corresponds roughly to which weeks?
22-26
27-30
31-35
36-40
EDD = 1st day of LNMP + 1 year − 3 months + 7 days
OR
EDD = 1st day of LNMP + 9 months +7 days
(a)
Factors that may affect the risk of producing. a fetus with congenital abnormalities include:
Increased maternal age
1st or 2nd trimester maternal serum biochemistry values
1st trimester increased nuchal translucent, maternal disease
1st or 2nd trimester abnormal CRL
Pregnant uterine cavity that is too small or too large for dates
•a previous child born with a chromosomal disorder
•exposure to a known teratogenic drug or infectious agent
known to cause birth defects
(a)
The sonographer should ONLY perform the ultrasound evaluation when there are CLEAR clinical indications
True
False
The (a) possible ultrasonic exposure settings should be used to gain the necessary diagnostic information
A definitive diagnosis of intrauterine pregnancy can be made when the following is present:
An intrauterine gestational sac
A yolk sac
Embryo/Fetus
Cardiac activity
Movement of baby
No independently confirmed adverse
effects caused by exposure from present diagnostic ultrasound instruments
have been reported in human patients in the absence of contrast agents
True
False
Doppler imaging produces (a) levels of energy
Sonographers have a responsibility to be knowledgeable regarding
ultrasound bioeffects and to use the least amount of energy necessary
to obtain the clinical information needed
True
False
Which type of doppler is used in the fetus?
Continuous wave
Color doppler
Power doppler
Pulsed wave doppler
Doppler is NOT used to detect flow in the maternal vessels, the fetal vessels
(umbilical artery and vein, aorta and inferior vena cava, renal arteries,
and cerebral vessels), the fetal ductus venosus, the fetal heart, and the
placenta
True
False
1. Uterus and adnexa should be evaluated for the presence of a gestational sac.
2. Presence or absence of cardiac activity should be reported.
3. Fetal number should be documented.
4. Evaluation of the uterus, adnexal structures, and cul-de-sac should be performed.
(a)
5. During late 1st trimester (11 to 14 weeks) a
nuchal translucency measurement may be
performed according to standard criteria for
women desiring to assess their individual risk for
fetal aneuploidy
(a)
1. Biometric and anatomic survey of the fetus
2. A qualitative or semi quantitative estimate of the volume of amniotic fluid
(a)
3. Placental localization, appearance, and relationship to the internal cervical os should be recorded. Umbilical cord , number of vessels
4. Gestational (menstrual) age should be assessed by sonographic biometry
(a)
5. Evaluation of maternal anatomy
6. Fetal anatomy
(a)
(a) may be estimated by using the AC measurement in
mathematical formulations along with other sonographic parameters
