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180 Cards in this Set
- Front
- Back
Distinguishing characteristics between AMLs and hyperechoic RCCs? |
AMLs tend to have acoustic shadowing. Hyperechoic RCCs may have cystic elements, calcifications, or hypoechoic halo.
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Caudate lobe drains into what vein?
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IVC via small veins separate from hepatic veins. Caudate veins function as collaterals in Budd-Chiari syndrome.
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Distinguishing ultrasound features of peritoneal fluid collections versus simple ascites?
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Fluid collections displace and distort adjacent structures. Ascites conforms to adjacent structures.
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Causes of fatty liver infiltration?
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Obesity. Alcohol abuse. TPN. Diabetes. Malnutrition. Steroid use. Hepatic toxins. Chemotherapy.
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Usefull clue in located parathyroid adenomas and lymph nodes?
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Parathyroid adenomas are medial to carotid arteries. Lymph nodes are usually lateral to carotids.
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Baker's cyst, most characteristic diagnostic feature at Ultrasound?
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Neck that extends between medial head of gastrocnemius and semimembranosus tendon.
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Syndrome caused by hepatic hemangioma that sequesters platelets?
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Kasaback-Merritt syndrome.
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What markers are elevated in a pancreatic pseudocyst aspirate compared to a pancreatic cystic neoplasm aspirate?
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Pseudocyst aspirate elevated amylase. Neoplastic aspirate elevated carcinoembryonic antigen.
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Funiculocele, what is it?
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Spermatic cord hydrocele.
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Difference between a replaced and an accessory artery?
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Replaced: Artery arises from an anomalous source (1 anomalous artery). Accessory: one of atleast two arteries arises from an anomalous source (2 arteries present, 1 artery anomalous).
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Which gallstones can float?
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Cholesterol stones can float in high specific gravity bile.
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What patient's benefit from an carotid endarterectomy?
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Symptomatic patients with stenosis >70%.
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Best study to identify a splenule?
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Sulfur colloid scan or heat-damaged tagged RBC scan.
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Reversed flow in the internal mammary veins indicates?
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Central venous obstruction
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Solid renal neoplasms?
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RCC. TCC. Renal medullary carcinoma. Renal sarcoma. Metastases. Lymphoma.
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Sickle cell trait and solid renal neoplasm?
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Renal medullary carcinoma.
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When do hematomas and lymphoceles appear in renal transplant patients?
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Hematoma: Immediately after transplant Lymphocele: 1 to 2 months posttransplant
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Most common cause of calcified liver tumor?
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Metastases.
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Morton neuroma?
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Benign mass of plantar digital nerves of the foot.
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Which side is subclavian steal more common on?
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Left.
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What is normal portal vein velocity?
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20 cm/s.
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Pancreatic neoplasm almost exclusively seen in women?
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Macrocystic neoplasm.
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RCC stage when tumor invades renal vein or IVC?
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At least IIIa
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2 common liver locations for focal fatty infiltration?
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Preportal. Anterior left lobe adjacent to ligamentum teres.
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Resistive index (RI) formula?
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RI = (S-D)/S
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Parenchymal organ normal resistive index (RI)?
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<0.7
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Midline prostate cysts?
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Utricle cyst. Mullerian cyst.
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What replaced artery can be seen coursing through the ligamentum venosum?
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Replaced left hepatic artery.
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Mucinous macrocystic pancreatic neoplasm, common locations?
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Body and tail of pancreas.
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Distinguish between classic and limited microlithiasis of testis?
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Classic: > 5 microliths on 1 view. Limited: less than 5 on 1 view.
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Multilocular cystic nephroma, population?
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Young boys (3 months - 4 years). Adult women (>30 years old).
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2 most common masses in the hand?
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Ganglion cyst. Giant cell tumor.
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Does a giant cell tumor move with the associated tendon?
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No, it arrised from the tendon sheath not the tendon.
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TCC, most common anatomy involved?
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Bladder > renal pelvis > ureter.
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Pheochromocytoma's 10% rule?
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10% malignant. 10% extra-adrenal. 10% bilateral. 10% associated with MEN.
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Vascular pattern of FNH at ultrasound?
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Spokewheel pattern.
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Most definitive means of diagnosing FNH?
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Sulfur colloid scanning.
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Chronic calcific pancreatitis is caused by?
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Alcoholic abuse, not gallstones.
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Focal fatty sparing within the liver commonly occurs where?
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Around the gallbladder. At portal bifurcation.
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What is Page kidney?
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Renal subcapsular hematoma causing hypertension.
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Effect of renal vein thrombosis on resistive index (RI) of renal artery?
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Normal to increased RI.
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Horseshoe kidney predispositions?
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Urinary obstruction. Stone formation. Rrenal trauma. Questionable increase risk of Wilm's tumor.
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Upper limit of normal renal artery velocity?
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180-200 cm/s.
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Bile duct blood supply?
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Hepatic artery. In liver transplant hepatic artery thrombosis bile ducts may form strictures due to ischemia.
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Common factors that render pancreatic cancers nonresectable?
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Lver metastases. Peripancreatic vessel invasion. Peritoneal spread.
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Ultrasound signs of complete tendon rupture?
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Blunt tendon tip (longitudinal view). Mass (transverse view). Refractive shadowing. Nonvisualization. Loss of fibrillar architecture. Fluid collection.
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Sonographic signs of full-thickness rotator cuff tear?
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Anechoic or hypoechoic defect. Focal superficial contour abnormality. Compressibility. Nonvisualization.
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Characteristics of pseudoaneurysms on ultrasound?
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Complex fluid collection. Single of multiple loculations. Visible pulsations on gray-scale imaging. Internal luminal flow on color Doppler. To and fro flow in the neck.
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Characteristics of iatrogenic arteriovenous fistulas at ultrasound?
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Usually located below femoral artery bifurcation. Perivascular tissue vibration. Low-resistance flow in supplying artery near fistula. High-velocity flow at site of communication. Turbulent and/or arterialized flow in draining vein near fistula.
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Extremity artery waveform?
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High-resistance flow. Typically triphasic waveform: Antegrade systole, retrograde early diastole, antegrade in mid diastole, absent flow in end diastole.
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Extremity venous waveform?
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Respiratory phasicity. Variable cardiac related pulsatility.
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Factors that decrease chance of scrotal malignancy?
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Extratesticular. Nonpalpable. Simple cystic appearance. No detectable vascularity.
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Factors that increase chance of scrotal malignancy?
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Intratesticular. Palpable. Solid or complex cyst. Detectable internal vascularity.
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Germ cell tumor list?
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Seminoma. Embryonal cell carcinoma. Teratoma. Choriocarcinoma. Yolk sac. Mixed germ cell.
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Stromal testicular tumors?
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Leydig cell tumor. Sertoli cell tumor.
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Other non-germ cell and non-stromal testicular neoplasms?
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Lymphyoma/leukemia. Metastases. Epidermoid cyst.
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Testicular lesions mimicking tumors?
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Focal orchitis. Focal atrophy/fibrosis. Infarcts. Abscess. Hematoma. Contusion. Sarcoid. Tuberculosis. Adrenal rest tissue.
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Causes of enlarged hypoechoic testis?
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Orchitis. Torsion. Lymphoma. Seminoma.
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Of the four causes of enlarged hypoechoic testes, which have increased/decreased blood flow?
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Increased flow: Orchitis. Lymphoma. Seminoma. Decreased (torsion).
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Primary neoplasms of the bladder?
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TCC. Adenocarcinoma. SCC. Pheochromocytoma.
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Causes of bladder wall lesions from adjacent neoplasms?
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Rectum. Prostate. Cervix. Uterus.
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Causes of bladder wall lesions from inflammation from adjacent organs?
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Diverticulitis. Crohn's disease. PID. Appendicitis.
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Other bladder wall lesions?
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Ureteroceles. Urachal cyst. Cystitis cystica. Endometriomas. Fistulas. Malakoplakia. Leukoplakia. Tuberculosis. Shistosomiasis.
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Frequency of prostate cancer per anatomical zone?
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Peripheral zone 75%. Transitional zone 20%. Central zone 5%
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Percentage of prostate cancers that are hypoechoic?
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Hypoechoic 70%. Hyperechoic/mixed 30%.
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Sonographic characteristics of seminoma?
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Homogeneous and hypoechoic.
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Most common scrotal mass?
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Spermatocele.
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Causes of hydroceles?
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Idiopathic (most common). Tumors. Torsion. Inflammatory disorders. Trauma.
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Varicocele percentage on the left?
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Left-sided 85%. Right-sided 15%.
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Scrotal mass with peripheral calcification and/or onion peel appearance?
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Epidermoid cyst.
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Testicular microlithiasis and germ cell tumor relevance?
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Isolated microlithiasis increases risk of germ cell cancer. Annual physical exam recommended.
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Besides absent blood flow, other signs of testicular torsion?
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Enlarged hypoechoic testis. Torsion knot. Reactive hydrocele. Scrotal wall thickening.
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Distinguishing characteristic of blood clot from bladder cancer on ultrasound?
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Blood clot is mobile.
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After injection of vasoactive substance, normal penile Doppler should have a deep cavernosal velocity that exceeds?
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35 m/s
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Plaque formation in the tunica albuginea of the corpora cavernosa?
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Peyronie's disease.
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Sonographic signs of acute pancreatitis?
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Decreased or heterogeneous pancreatic echogenicity. Pancreatic enlargement. Peripancreatic fluid collection. Perivascular fluid collection. Periduodenal fluid collection. Perirenal fluid collection.
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Complications of Pancreatitis?
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Pseudocyst formation. Bile duct obstruction. Pancreatic abscess. Venous thrombosis. Pseudoaneurysm.
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Causes of solid hypoechoic pancreatic masses?
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Carcinoma. Focal Pancreatitis. Lymphoma. Metastases. Islet cell tumors. Thrombosed aneurysm.
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Pancreatic cystic lesions?
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Pseudocyst. Macrocystic (mucinous) tumor. Microcystic (serous) tumor. Intraductal papillary mucinous tumor. Solid and papillary epithelial neoplasm. Autosomal dominant polycystic kidney disease. von Hippel-Lindau disease. Cystic fibrosis. Aneurysm/pseudoaneurysm.
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Normal pancreatic duct should mearsure?
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Less than or equal to 3 mm, but can enlarge with age.
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Sonographic signs of chronic pancreatitis?
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Pancreatic calcification. Ductal dilation. Ductal irregularity. Parenchymal atrophy.
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Pancreatic and islet cell tumors are generally hypoechoic. T/F?
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TRUE
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Pancreatic neoplasm that contains serous fluid, consists of multiple small cystic elements, and is benign?
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Microcystic adenoma.
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Pancreatic neoplasm that contains mucinous fluid, large cystic elelements, thick septations, solid elements, and can be malignant or benign?
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Macrocystic tumors.
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Solid spleen lesions?
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Hemangiomas. Hamartomas. Lymphomas. Metastases. Infarcts. Abscesses. Sarcoidosis. Granulomas. Extramedullary hematopoiesis.
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Causes of splenomegaly?
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Heart failure. Portal hypertension. Leukemia. Lymphoma. Hepatitis. Mononucleosis. Generalized infections. Hemolytic anemias. Glycogen storage disease. Malaria. Myelofibrosis.
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Lymphoma and leukemia sonographic appearance in the spleen?
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Focal. Multifocal. Diffuse. Almost always hypoechoic.
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Multiple small calcifications within the spleen?
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Granulomatous disease. Histoplasmosis. Tuberculosis.
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The age of pregnancy definition?
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1st day of LMP/
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When is the earliest, on TV US, that gestational sac, yolk sac, and embryo can be seen?
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Gestational sac 5 wks. Yolk sac 5.5 wks. Embryo 6 wks.
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What structure, if seen, can confirm a IUP even before the embryo is identified?
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Yolk sac.
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What is better at estimating gestational age than LMP?
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1st trimester CRL (crown rump length). 2nd trimester biparietal diameter (+/- 1 wk) LMP (+/- 2 wks)
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Normal gestational sac characteristics on US?
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Correct positioning within uterus. Double decidual sac DDS. Continuous hyperechoic rim > 2mm. Spherical or ovoid shape. Growth of > 1.2 mm/day.
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2 hyperechoic lines surrounding a hypoechoic closed endometrial canal?
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DDS, Double decidual sign
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How does seeing a DDS help in 1st trimester US?
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Its absence is more suggestive of miscarriage or ectopic pregnancy. Does not exclude IUP.
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At what CRL is heart activity expected?
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5 mm.
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By 5 wks the embryonic heart rate should be?
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> 120.
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After 3 wks the embryonic heart rate should be?
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120 - 180
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At what Beta-hCG level should an intra-uterine gestation sack be seen on TV US?
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2000 IU/L
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In early pregnancy the Beta-hCG level should double how often?
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Every 2 days.
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Differential diagnosis of positive pregnancy test?
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IUP. Miscarriage. Ectopic pregnancy.
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Risk factors for ectopic pregnancy?
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Abnormal fallopian tubes. Previous ectopic pregnancy. IUD. Fertility medication. In-vitro fertilization.
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Beta-hCG level in an ectopic pregnancy patients increases slower or faster than an IUP?
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Slower.
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Where can an ectopic pregnancy occur within the uterus?
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Cornua. Cervix.
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Define an heterotopic pregnancy?
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Concomitant intrauterine and extrauterine pregnancy.
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What is a pseudogestational sac?
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Collection of fluid or decidual cast within endometrial canal or thickened endometrium in an ectopic pregnancy.
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With a positive pregnancy test, give 5 findings that have positive predictive value for ectopic pregnancy?
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Gestation sac in ectopic position Adnexal mass with yolk sac or embryo. Tubal ring appearing as an empty gestation sac. Complex or solid adnexal mass. Moderate amount of intraperitoneal fluid.
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Common causes of bowel wall thickening?
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Inflammation. Infection. Neoplasm. Ischemia. Edema. Hemorrhage.
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Sonographic signs of appendicitis?
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Diameter greater than 6 mm. Lack of compressibility. Inflamed, echogenic periappendiceal fat. Hyperemia. Appendicolith. Adjacent fluid collection.
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Causes of peritoneal masses?
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Metastases. Tuberculosis. Mesothelioma. Pseudomyxoma peritonei. Omental infarct.
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Causes of abdominal wall masses?
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Metastases. Lipoma. Hernia. Hematoma. Abscess. Seroma. Desmoid. Endometriosis. Sarcoma. Lymphoma.
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Features of Abdominal Aortic Aneurysms?
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95% infrarenal. Majority are fusiform. Mural thrombus common with large aneurysm. Surgery considered when >5 cm. AP diameter measured on sagittal images. Transverse diameter measured on coronal images.
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Common causes of adrenal masses?
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Adenoma. Metastases. Pheochromocytomas. Primary carcinoma. Lymphoma. Myelolipoma. Hemorrhage.
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Pseudokidney sign?
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Extensive mesenteric adenopathy.
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Distinguishing feature of tumor thrombus from blood clot?
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Tumor thrombus has internal vascularity.
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Ultrasound is not good at characterizing most adrenal masses, except for?
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Myelolipomas.
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Benign characteristics of thyroid nodules?
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Cystic elements. Hyper or isoechoic. Eggshell calcification. Inspissated colloid.
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Malignant characteristics of thyroid nodules?
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Entirely solid. Hypoechoic. Microcalcifications. Associated cervical adenopathy.
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Characteristics of parathyroid adenomas on ultrasound?
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Solid. Hypoechoic. Oval shape. Hypervascular. Posterior to thyroid. Medial to carotid.
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Locations of ectopic parathyroid adenomas?
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Low neck. Mediastinum. Retrotracheal/retroesophageal. Carotid sheath. Intrathryoidal.
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Characteristics of Neoplastic Neck Lymph Nodes?
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Obliteration of echogenic hilum. Long-axis to short-axis ration less than 1.5. Cystic changes. Microcalcifications.
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Differences between ICA and ECA?
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ICA: Larger. Posterolateral location. No branches. Low resistance wavefore. Negative temporal tap. ECA: Smaller. Anteriomedial location. Branches. High resistance waveform. Positive temoral tap.
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ICA peak systolic velocities and associated stenoses?
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Normal less than 125cm/s. 50-69% stenosis 125-230 cm/s. >70% stenosis >230 cm/s. Near occlusion variable. Complete occlusion no flow.
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Midline complex lesions that are usually intimately associated with the hyoid bone?
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Thyroglossal duct cyst.
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Most common cause of hyperparathyroidism?
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Parathyroid adenoma.
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Carotid artery flow velocities and ratios start to increase at what stenotic level?
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>50% stenosis.
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Sonographic characteristics of unstable carotid artery plaques?
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Heterogenous plaques with focal hypoechoic regions.
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Causes of polyhydramnios?
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Idiopathic. Maternal (diabetes). Fetal (Anomalies, Hydrops).
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Findings in anencephaly
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Absence of normal calvarium and brain above orbits. Residual dysmorphic brain may be seen, called angiomatous stroma.
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Moderate to marked polyhydramnios is often associated with what fetal anomalies?
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CNS. GI. Fetal hydrops.
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Fetal head measurements (BPD and HC) are accurate for gestational age until when?
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Within 1.2 weeks up to 24 weeks. Accuracy decreases in third trimester.
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Fetal lateral ventrical evaluation and measurement?
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Measured at atria. Less than or equal to 10 mm. Choroid plexus occupying 60%. Small or dangling choroid plexus may indicate ventriculomegaly.
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Regardless of hydrocephaly severity there is always a…
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Thin cortical mantle. Hydrancephaly may mimic this but instead is destroyed brain.
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Holoprosencephaly
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Midline developmental anomaly, three forms (alobar, semilobar, lobar).
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Relatively common anterior cephalocele
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Ethmoidal sinus region.
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Banana shaped cerebellum?
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Neural tube defect with downward displacement of cerebellum.
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Enlarged cisterna magna with splaying of cerebellar hemispheres and a vermian defect?
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Dandy-Walker abnormality.
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A nuchal fold measurement above _____ is a marker for trisomy 21?
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6 mm.
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Choroid plexus cyst possibilities?
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Normal or other chromosomal abnormalities such as trisomy 18.
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Secondary abnormalities of the skull that occur with spinal defects?
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Lemon sign (least specific). Banana sign. Hydrocephalus.
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Large aorta in fetal ultrasound?
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Tetralogy of Fallot. Truncus arteriosus.
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Small aorta in fetal ultrasound?
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Coarctation. Hypoplastic left heart.
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Small pulmonary artery in fetal ultrasound?
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Hypoplastic right heart. Ebstein's anomaly with pulmonary hypoplasia.
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Fetal hydrops generalities
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Immune and nonimmune causes. Excessive fetal body water. Fluid in serous cavities, skin thickening, placental enlargement, polyhydramnios.
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Fetal pericardial effusions are normal if isolated and measure less than ____?
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2 mm in thickness.
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Fetal cystic thoracic masses
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Bochdalek congenital diaphragmatic hernias. Type I and II cystic adenomatoid malformations. Bronchogenic cysts. Duplication cysts. Pulmonary sequestration.
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Fetal solid thoracic masses
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Morgagni and some Bochdalek congenital diaphragmatic hernias. type III CAMs. Bronchopulmonary sequestration.
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Most common fetal intrathoracic, extracardiac abnormality
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CDH, Left-sided posterolateral hernia (Bochdalek).
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Enlarged hyperechoic fetal lungs, a finding for this rare entity
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Laryngeal atresia.
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Most common cause of enlarged fetal liver?
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Hydrops and infections.
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Most common cause of small fetal liver?
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Growth restriction
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Fetal pseudoascites?
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Hypoechoic band in upper abdomen
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Umbilical vein varix implications?
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Normal outcome or fetal hydrops. Structural abnormalities. Aneuploidy. Intrauterine demise.
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Fetal meconium ileus?
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Impaction of thick meconium within terminal ileum. Proximal bowel dilation may not occur until 3rd trimester. Causes: Mechanical intestinal obstruction. Cystic fibrosis.
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Fetal meconium peritonitis findings
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Intraperitoneal calcifications. Meconium pseudocysts. Bowel dilation. Ascites. Polydyramnios.
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Hyperechoic fetal bowel
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If equal to or greater than bone brightness it may be abnormal. Associations: Cystic fibrosis. Chromosomal abnormalities. Growth restriction. Swallowed blood. Perinatal death.
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Most common fetal anterior wall defects
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Omphalocele. Gastroschisis. Elevated alpha-fetoprotein.
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Fetal omphaloceles
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Defects of mid abdomen. Covered by thin amnioperitoneal membrane. Large type contains liver, usually stomach and bowel. Small type contains only bowel located at the base of umbilical cord. Associations: Structural abnormalities and chromosomal abnormalities.
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Fetal gastroschisis
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Paraumbilical, usually right lower quadrant. No covering membrane. Protruding bowel floats freely in amniotic fluid. No associated anomalies or abnormal karyotype.
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Fetal cystic abdominal masses
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Mesenteric cyst. Duplication cyst. Urachal cysts. Ovarian (female).
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Common third trimester cause of oligohydramnios
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Spontaneous rupture of membranes.
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Common second trimester causes of oligohydramnios
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Bilateral renal abnormalit. Urinary bladder obstruction (posterior urethral valves).
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Keyhole fetal bladder configuration
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Dilated bladder and proximal urethra due to posterior urethral valves.
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Enlarged hyperechoic fetal kidneys with oligohydramnios?
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Infantile polycystic kidney disease (ARPKD).
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Bilateral fetal renal abnormalities?
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Urethral obstruction (posterior urethral valves). Renal agenesis. Infantile polycystic kidney disease. Bilateral UPJ obstruction.
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Distinguishes dilated fetal ureter from bowel and blood vessel?
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Doppler distinguishes from blood vessel. Real time imaging distinguishes bowel (peristalsis).
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Fetal renal dysplasia findings
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Increased renal cortex echogenicity (greater than liver). Subcortical cysts
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Common fetal unilateral renal anomalies?
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Multicystic dysplastic kidney. Reflux. UPJ obstruction.
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If obstruction is identified in upper but not lower pole of kidney, what should be considered?
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Duplicated kidney with ectopic uretrerocele from upper pole moiety.
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Four major fetal skeletal anomalies, which account for 2/3 or all dysplasias?
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Heterozygous achondroplasia. Osteogenesis imperfecta. Achondrogenesis. Thanatophoric dysplasia
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Heterozygous achondroplasia fetal US findings?
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Femur length falls below 10th percentile before 28 weeks' gestation.
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Osteogenesis imperfecta fetal US findings?
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Skeletal deformities (fractures and abnormal bowing) or demineralization.
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Achondrogenesis fetal US major finding?
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Severe shortening of limbs (micromelic pattern). Varying degrees of demineralization and chest narrowing.
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Thanatophoric dysplasia fetal US findings?
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Normal bone brightness. Severe limb shortening and chest narrowing. Pronounced polyhydramnios.
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Amniotic band syndrome at fetal US?
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Skeletal deformities are asymmetric and atypical in appearance compared to skeletal dysplasias.
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Subchorionic versus retroplacental hemorrhages, prognosis?
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Uncomplicated subchorionic hemorrhages are usually benign. Retroplacental hemorrhages can cause considerable fetal and, infrequently, maternal problems.
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Placenta previa classification?
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Low-lying (near). Marginal (touching). Complete (covering cervical os).
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Vasa previa?
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Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord insertions or with succenturiate lobes).
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Cervical incompetence US findings?
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Shortening of endocervical length to less than 2.5 cm, with or without cervical funneling.
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Complete (classic) hydatidiform mole features?
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Noninvasive (85%). Locally invasive (13%). Metastatic (choriocarcinoma 2%). Enlarged uterus filled with hyperechoic tissue (multiple cysts). No fetus present. |