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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5786_Библиотеки_им_академика_М_И_Перельмана.pdf
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c. vaginal bleeding
d. fetal symmetrical growth restriction and placental Swiss cheese
appearance
e. bilateral ovarian theca-lutein cyst
4. The correct terminology for a placental lesion resulting from bleeding due to
rupture of fetal vessels branching from the cord is:
a. subchorionic cyst
b. membranous cyst
c. thrombotic cyst
d. subchorionic haemorrhage
e. subamniotic haematoma
5. All the following statements concerning the single umbilical artery syndrome
are correct except one.
a. The absence of one umbilical artery is associated with a high incidence of
trisomy 21.
b. The single umbilical artery cord is one of the most common anatomical
Ultrasound in obstetrics and gynaecology
defects in the human fetus.
c. Single umbilical artery is often found in association with major fetal
abnormalities.
d. The single umbilical artery is found almost invariably in cases of the
acardia malformation and sirenomelia or caudal regression syndrome.
e. When isolated, the single umbilical artery is associated with a 15–20%
incidence of poor fetal growth.
358
CHAPTER 8 EXAMINING THE CERVIX BY TRANSVAGINAL
ULTRASOUND
1. The risk of spontaneous early preterm delivery increases with decreasing
cervical length. At a cervical length of 25 mm, the risk is approximately:
a. 25%
b. 15%
c. 10%
d. 1%
2. Cervical funnelling is:
a. the early onset of labour
b. protrusion of membranes into the endocervical canal
c. shortening of the cervix
3. A short cervical length is synonymous with cervical incompetence:
a. correct
b. incorrect
4. Ultrasound measurement of cervical length allows differentiation between
true and false labour:
a. correct
b. incorrect
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5. True cervical incompetence is responsible for which percentage of preterm
labour:
a. 40%
b. 30%
c. <10%
CHAPTER 9 FETAL BIOMETRY, ESTIMATION OF GESTATIONAL
AGE, ASSESSMENT OF FETAL GROWTH
1. What is the aim of CRL measurement?
a. to determine fetal weight
b. to determine true gestational age
c. both
d. other aims
2. The accuracy of pregnancy dating:
a. increases with gestational age
b. decreases with gestational age
c. is independent from gestational age
3. The measurement of biparietal diameter:
a. is used for dating pregnancy in the second trimester
b. is very accurate for dating pregnancy in the third trimester
c. is taken at the same level as the measurement of the cerebellar
diameter
4. The abdominal circumference:
a. is used for fetal dating in the third trimester
b. is used for the evaluation of fetal growth disturbances in the second
trimester
c. is the main factor in fetal weight determination in most of the
mathematical equations
5. For a confident diagnosis of IUGR:
a. the calculated fetal length should be below normal values
b. the calculated fetal weight should be below normal values
c. both AC and fetal weight estimation, made at least 2–3 weeks apart,
should be below normal values
Test yourself – questions and answers
CHAPTER 10 PRENATAL DIAGNOSIS OF FETAL ANOMALIES
1. What is the estimated frequency of congenital anomalies detected by a
clinical examination performed within the first week of life?
a. 1%
b. 2%
c. 6%
d. 10%
e. 15%
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2. What is the proportion of congenital anomalies that are probably identified
by a well-performed ultrasound sonogram at midgestation in a patient who
does not have specific risk factors?
a. 1%
b. 10%
c. 50%
d. 90%
e. virtually all
3. What is the normal measurement of the posterior horn or atria of lateral
ventricles in the midtrimester fetus?
a. <1 mm
b. <5 mm
c. <10 mm
d. <15 mm
e. < 20 mm
4. Which of the following views of the fetal heart should always be obtained at
Ultrasound in obstetrics and gynaecology
midgestation even in a pregnancy without specific risk factors?
a. five-chamber view
b. four-chamber view
c. transverse view of great vessels
d. view of the aortic arch
e. view of the pulmonary artery
5. Which of the following strategies of trisomy 21 screening has the greatest
accuracy?
a. anatomic scan and soft markers evaluation around
midgestation
b. nuchal transluciency measurement at 11–14 weeks
c. nuchal translucency measurement plus biochemistry at 11–14 weeks
d. biochemistry around 16 weeks
e. biochemistry around 16 weeks and ultrasound at midgestation
360
CHAPTER 11 EVALUATION OF FETAL AND UTEROPLACENTAL
BLOOD FLOW
1. For the assessment of true flow velocities, the angle of insonation should be
close to:
a. 90°
b. 60°
c. 25°
d. 0°
2. The gestational age-related decrease in impedance to flow in the uterine
arteries during normal pregnancy is determined by:
a. increasing vessel compliance
b. slowing of fetal heart rate
c. trophoblast invasion of the spiral arteries
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3. Uterine artery screening studies are best performed at:
a. 10–14 weeks
b. 15–18 weeks
c. 20–24 weeks
d. 25–30 weeks
4. A moderate reduction in umbilical artery end-diastolic blood flow velocity
requires:
a. additional Doppler information from systemic vessels (fetal middle
cerebral artery and ductus venosus)
b. hospital admission and close fetal heart rate monitoring
c. emergency caesarean section
5. Increased end-diastolic flow velocity in the fetal middle cerebral artery indicates:
a. fetal infection
b. imminent delivery
c. fetal growth restriction/fetal hypoxaemia
d. fetal anaemia
e. c+d
6. Abnormal flow velocities in the fetal ductus venosus associated with fetal
growth restriction/fetal hypoxaemia are characterized by:
a. a reduction in the systolic flow component
b. a reduction in the early diastolic flow component
c. an increase in the late diastolic flow component
d. a reduction in the late diastolic flow component
Test yourself – questions and answers
CHAPTER 12 INVASIVE PROCEDURES IN OBSTETRICS
1. Chorion villus sampling is preferably performed:
a. before 10 weeks
b. at 11–14 weeks
c. at 15–20 weeks
2. Amniocentesis is performed using a:
a. 14 gauge needle
b. 16 gauge needle
c. 20 gauge needle
d. 24 gauge needle
3. Main diagnostic indications for amniocentesis are:
a. fetal karyotyping
b. vaginal bleeding
c. oligohydramnios
4. When blood sampling the umbilical vein, the needle should puncture the
vessel at an angle of:
a. 5–10°
b. 20–30°
c. 50–60°
d. 80–90°
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CHAPTER 13 MULTIPLE PREGNANCIES
1. Early assessment of chorionicity and amnionicity in multiple pregnancies is
of particular importance since:
a. fetal surveillance should be undertaken in appropiate intervals regardless
of zygocity
b. in monochorionic twins the rates of mortality and morbidity are markedly
higher and clinical counselling, management and surveillance differ
according to chorionicity and amnionicity
c. one-third of monozygotic twins are dichorionic and diamniotic if splitting
occurs after day 4 postconception
d. risk of twin–twin transfusion syndrome in dichorionic twins can be
assessed early
2. Sonographic features of monochorionic twinning are:
a. presence of the lambda sign, easily identifiable intertwin membrane and
different gender
Ultrasound in obstetrics and gynaecology
362
b. absent lambda sign, very thin or absent intertwin membrane, same gender
c. present lambda sign, lack of intertwin membrane, unique yolk sac
d. absent lambda sign, discordant gender, unique yolk sac
3. When assessing the risk for chromosomal abnormalities in multiple
pregnancies:
a. in dizygotic twins the risk that at least one fetus is affected is obtained by
doubling the age-related risk; in monozygotic twins it is equal to the risk of a
singleton pregnancy, both fetuses being affected if the karyotype is abnormal
b. an increased NT can indicate the early onset of a twin–twin
transfusion syndrome in dichorionic twins, and therefore falsely
increase the risk
c. squaring the singleton risk for chromosomal abnormalities in monozygotic
twins derives the risk that both fetuses are affected
d. regardless of chorionicity, the risk calculation based on NT measurement
and maternal age can be transferred from singleton to twin pregnancies
4. Regarding placental vascular anastomoses in monochorionic twinning, it is
FALSE to say that:
a. due to their existence, death of one fetus may affect the co-twin due to an
acute hypotensive and anaemic episode leading to death or neurological
damage
b. they are the underlying cause of the twin–twin transfusion syndrome,
where a net imbalance in intertwin blood flow may ensue as early as the
17th week and in a rapid fashion for 1 or 2 weeks
c. anastomoses are always present in dichorionic placentae and a continuous
blood exchange between both fetuses takes place
d. in early pregnancy the presence of one arterio-arterial and one venovenous
anastomosis between both cord insertions may result in the reversed
perfusion of one of the fetuses, with its consequent transformation into an
acardiac twin
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5. Regarding monoamniotic twins, the following is FALSE:
a. the finding of close proximity and synchronous movements of the fetuses,
without separation during a period of observation time, is sonographically
typical for them
b. cord entanglement has been responsible for the demise of one or both
fetuses in the majority of cases
c. absence of intertwin membrane, single yolk sac, placental cord insertions
close to each other and unusual fetal proximity to each other are their
sonographic criteria
d. monoamniotic twins occur in 5% of monochorionic twins, representing
1% of all twins and showing a significantly increased risk for structural
anomalies and poor perinatal outcome
CHAPTER 14 THREE-DIMENSIONAL AND FOUR-DIMENSIONAL
ULTRASOUND APPLICATION IN PRENATAL DIAGNOSIS
1. The advantage of 3D ultrasound is that it can:
a. demonstrate the face of the baby
b. provide a reliable diagnosis of the fetal gender
c. be combined with colour Doppler
d. be used to acquire a volume data set with different ways of image display
2. A volume data set:
a. can be acquired with manual moving of the transducer over the region of
interest
b. can be acquired with 3D, 4D or with spatial or temporal image correlation
(STIC)
c. is a result of an offline analysis of cine loops acquired separately
d. can only be acquired with the newest matrix transducers
3. Tomography imaging can be performed:
a. on every 3D volume
b. only when a volume data set was acquired with colour Doppler
c. only when a manual acquisition was achieved by a parallel shift of the
transducer
d. only with a volume data set acquired from a transvaginal transducer
4. The fetal skeleton is best demonstrated with:
a. minimum mode
b. maximum mode
c. STIC
d. inversion mode
5. STIC is the technique of choice for:
a. the fetal brain
b. early pregnancy (nuchal translucency, nasal bone)
c. the fetal heart
d. analysing fetal breathing movements
Test yourself – questions and answers
363
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CHAPTER 15 FETAL MOVEMENT PATTERNS
AND BEHAVIOURAL STATES
1. In cases of fetal brain anomalies, changes in fetal movements are usually:
a. qualitative in nature
b. quantitative
2. Shaking of the maternal abdomen during quiet sleep (i.e. during a flat FHR
pattern):
a. results in a change from quiet sleep to REM sleep
b. has no effect on fetal behaviour
3. Fetal micturition usually occurs:
a. during quiet sleep
b. at the transition from quiet sleep to REM sleep
c. during REM sleep
4. Which association is the strongest?
a. Absence of fetal breathing movements is strongly associated with
Ultrasound in obstetrics and gynaecology
imminent preterm delivery.
b. Presence of fetal breathing movements is strongly related to imminent
preterm delivery.
c. Absence of fetal breathing movements indicates that imminent preterm
delivery is unlikely.
d. Presence of fetal breathing movements indicates that imminent preterm
delivery is unlikely.
5. Betametasone administration to the mother results in a temporary:
a. reduction of fetal breathing movements
b. reduction of fetal body movements
c. reduction of fetal heart rate variation
d. all three answers are correct
364
CHAPTER 16 NORMAL GYNAECOLOGICAL ANATOMY (UTERUS,
TUBES, OVARIES)
1. Endometrial thickness should be measured:
a. from a transverse view of the uterus where the endometrium appears to
be at its thickest
b. from a transverse view of the uterus where the endometrium appears to
be at its thinnest
c. from a sagittal section through the uterus where it appears to be at its
thickest
d. from a sagittal section through the uterus where the endometrium appears
to be at its thinnest
e. any of the above
2. The gold standard for assessing tubal patency is:
a. laparoscopy with dye
b. hysterosalpingography
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c. hystero-contrast salpingosonography
d. all of the above
e. there is no gold standard
3. In the late proliferative phase of the menstrual cycle the endometrium has
the following appearance at ultrasound examiantion.
a. ‘triple layer’, thick
b. hyperechogenic, thick
c. hyperechogenic with echo enhancement
d. pencil-line
e. none of the above
4. In the luteal phase of the menstrual cycle:
a. blood flow velocities in the uterine arteries are lower and pulsatility index
values are higher than in the follicular phase
b. blood flow velocities in the uterine arteries are lower and pulsatility index
values are lower than in the follicular phase
c. blood flow velocities in the uterine arteries are higher and pulsatility index
values are higher than in the follicular phase
d. blood flow velocities in the uterine arteries are higher and pulsatility index
values are lower than in the follicular phase
e. none of the above is true
5. At ultrasound examination the corpus luteum is:
a. an anechoic cystic structure
b. an echogenic cystic structure with smooth walls
c. an echogenic cystic structure with crenellated walls
d. a cystic structure whose content has the same ultrasound morphology as
clotted blood
e. any of the above
Test yourself – questions and answers
CHAPTER 17 GYNAECOLOGICAL PATHOLOGY: THE UTERUS
1. The ultrasound appearance of uterine fibroids most commonly is:
a. echo-dense
b. anechoic
2. In premenopausal women, endometrial polyps are best visualized by
ultrasound:
a. in the follicular phase of the menstrual cycle
b. at the beginning of the luteal phase of the menstrual cycle
c. just before the onset of the menstrual period
3. In the peri- and postmenopause, the following endometrial thickness is
highly unlikely to harbour significant pathology and chance of
malignancy:
a. 8 mm or less
b. 6 mm or less
c. 4 mm or less
365
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CHAPTER 18 GYNAECOLOGICAL PATHOLOGY: TUBES
AND OVARIES
(Note: more than one answer can be correct)
1. Which of the following sonographic signs serve as the most important
feature(s) to estimate the risk of ovarian malignancy?
a. tumour size
b. tumour structure (complexity)
c. a+b
d. cyst wall thickness
e. a+d
f. echo-dense foci
2. Endometriosis is sonographically characterized by:
a. complete lack of internal echoes
b. irregular echoes with solid components
c. homogeneous internal echoes of medium density
3. Pyosalpinx is sonographically characterized by:
Ultrasound in obstetrics and gynaecology
a. a normal image
b. a swollen tortuous tube without any internal echoes
c. a swollen tortuous tube with internal echoes.
CHAPTER 19 DOPPLER ULTRASONOGRAPHY IN GYNAECOLOGY
1. Which cut-off level has been suggested for the resistance index (RI) in
tumour vessels as a sign of potential malignancy?
a. 0.9–1.0
b. 0.8–0.9
c. 0.6–0.7
d. 0.45–0.5
2. 3D power Doppler imaging has replaced 2D Doppler imaging in detecting
potential ovarian malignancy.
a. correct
b. incorrect
CHAPTER 20 MEDICO-LEGAL IMPLICATIONS OF ULTRASOUND
IMAGING IN OBSTETRICS AND GYNAECOLOGY
(Note: more than one answer can be correct)
1. Defending a claim is facilitated if:
a. no images were recorded
b. a contemporaneous written protocol is available
c. the scan was performed in a research institution
d. several years elapsed before the claim is initiated
366
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2. Most patients initiating a claim:
a. win a substantial financial settlement
b. do not go to court
c. regret initiating the claim
d. do not need an expert witness
3. Phocomelia can be excluded:
a. by a competent 20-week anomaly scan
b. only after 30 weeks of pregnancy
c. if both hands and feet are confidently seen
d. none of the above
4. Ultrasound should always achieve a correct preoperative diagnosis of:
a. uterine fibroid (myoma)
b. benign ovarian cyst
c. dysgerminoma
d. none of the above
5. The recent increase in medical litigation is attributable to:
a. a decline in the quality of medical practice
b. increasing patient expectations
c. changes in the law
d. poor advice from lawyers
Test yourself – questions and answers
CHAPTER 21 ETHICS AND PATIENT INFORMATION
1. Informed consent is most closely related to which ethical principle?
a. beneficence
b. non-maleficence
c. justice
d. respect for autonomy
e. confidentiality
2. The ethical principle of beneficence is most closely associated with:
a. primum non nocere
b. greater balance of goods over harms for the patient
c. justice
d. non-maleficence
e. confidentiality
3. For which of the following anomalies diagnosed at 20 weeks should the
sonologist give directive counselling for abortion?
a. anencephaly
b. hydrocephalus
c. Down syndrome
d. all of the above
e. none of the above
367