Question 1

The practitioner is evaluating a woman who is at high risk for an ectopic pregnancy. The β-hCG level is far above the level expected for an intrauterine pregnancy and there is no intrauterine sac seen on ultrasound. Which is the appropriate interpretation of the information?

A) An ectopic pregnancy should be of high concern.
B) The findings could indicate a psuedogestational sac.
C) An intrauterine pregnancy is possible and likely to be very early.
D) The findings are insignificant and further testing needs completed.

A

Accepted Answer

The high β-hCG level without an intrauterine sac on ultrasound is concerning for an ectopic pregnancy, especially in a high-risk individual.

Question 2

The practitioner is conducting a transvaginal ultrasound to confirm the presence of an intrauterine pregnancy. The practitioner notes a small fetal pole with cardiac activity. What is the approximate gestational age?

A) 4 weeks gestation
B) 5 weeks gestation
C) 6 weeks gestation
D) 7 weeks gestation

C

Accepted Answer

A fetal pole with cardiac activity is typically visible on a transvaginal ultrasound around 6 weeks of gestation.

Question 3

The ultrasound examination reveals a yolk-sac of 8 mm at 8 weeks gestation. Which is the best interpretation of these results?&#10;A) The results suggest an abnormal pregnancy that requires more testing.&#10;B) The woman should prepare for a spontaneous abortion within a day.&#10;C) The pregnancy is demonstrating normal progression and embryo growth.&#10;D) The practitioner should complete a transabdominal exam to confirm results.

Accepted Answer

A yolk sac measuring greater than 7 mm is considered abnormal and may indicate a potential miscarriage or other complications, thus requiring further evaluation.

Question 4

The pregnant woman has had several ultrasound examinations. She asks &#34;Which due date should I use? I've gotten different dates with each ultrasound.&#34; Which is the best response to her question?&#10;A) &#34;The earliest ultrasound is the most accurate and should be used.&#34;&#10;B) &#34;We will use the midpoint of all the dates acquired as your due date.&#34;&#10;C) &#34;The later ultrasound is more accurate than earlier ones and will be used.&#34;&#10;D) &#34;Your last menstrual period will still give you the best estimation of date.&#34;

Accepted Answer

The earliest ultrasound is generally considered the most accurate for dating a pregnancy, especially in the first trimester, as it provides the best estimate of gestational age.

Question 5

Which measurements does advanced biometry in the first trimester pregnancy provide? Select all that apply?&#10;A) The presence of a multiple gestational pregnancy.&#10;B) The ability to recognize fetal abnormalities earlier.&#10;C) The presence of varied fetal features related to race.&#10;D) Indication of placenta previa and similar conditions.&#10;E) A more reliable pregnancy dating than later measures.

Accepted Answer

Advanced biometry in the first trimester can detect multiple gestations (A), identify fetal abnormalities earlier (B), and provide more accurate pregnancy dating compared to later trimesters (E).

Question 6

The practitioner is attempting to locate cardiac activity in the fetus during an ultrasound examination at approximately 5 &#189; weeks gestation. Which is the recommended practice for the practitioner?&#10;A) Use M-mode to document the cardiac activity.&#10;B) Use B-mode to document the cardiac activity.&#10;C) Use spectral Doppler to record the cardiac activity.&#10;D) Use the hand-held Doppler to record the cardiac activity.

Accepted Answer

M-mode is recommended for documenting fetal cardiac activity as it provides a safe and effective way to assess heart motion without exposing the fetus to unnecessary Doppler ultrasound energy.

Question 7

At 12-weeks' gestation, increased nuchal translucency is noted by ultrasound examination of the fetus. Which is the best interpretation of this finding?&#10;A) This is a common, normal variation noted in the early weeks.&#10;B) This demonstrates an increased risk of chromosomal abnormalities.&#10;C) This is a sign indicating possible multiple gestations are present in utero.&#10;D) This indicates a major aneuploidy condition is likely present in the fetus.

Accepted Answer

Increased nuchal translucency at 12-weeks' gestation is associated with an increased risk of chromosomal abnormalities, such as Down syndrome, but it is not definitive for any specific condition.

Question 8

During an ultrasound examination, the practitioner notes a subchorionic hemorrhage (SCH). The fetal heart rate remains detectable at rates greater than 100 beats per minute. Which is the most appropriate interpretation of the findings?

A) The SCH indicates a missed abortion.
B) The woman is likely going to experience fetal loss.
C) The SCH is likely an insignificant finding.
D) The woman is likely experiencing an ectopic pregnancy.

Accepted Answer

A subchorionic hemorrhage is a common finding in early pregnancy and often resolves on its own without affecting the pregnancy outcome. The presence of a detectable fetal heart rate greater than 100 beats per minute is reassuring and suggests that the pregnancy is currently viable.

Question 9

During the ultrasound examination in the early weeks of pregnancy, the practitioner notes several cystic areas within the uterus. Which is the most appropriate interpretation of this finding?&#10;A) The woman has a pregnancy with multiple gestations.&#10;B) The practitioner should refer the woman to a neonatologist for care.&#10;C) The practitioner needs to prepare the woman for preterm delivery.&#10;D) The woman is likely experiencing a molar pregnancy.

Accepted Answer

Cystic areas within the uterus during early pregnancy are often indicative of a molar pregnancy, which is characterized by abnormal growth of trophoblastic tissue.

Question 10

The woman's examination reveals a positive β-hCG with levels consistent with pregnancy. Her ultrasound findings demonstrate a thickened endometrium and an empty uterus. Which is the best interpretation of these findings?

A) The woman likely has an adherent placenta.
B) The woman likely has an ectopic pregnancy.
C) The woman has no signs of extrauterine pregnancy (EP).
D) The woman has a definite intrauterine pregnancy (IUP).

Accepted Answer

The combination of a positive β-hCG, a thickened endometrium, and an empty uterus on ultrasound is suggestive of an ectopic pregnancy, where the embryo implants outside the uterine cavity.

Deck 4: Ultrasound in the First Trimester