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Question 1
Incorrect
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The transvaginal ultrasound of a 37 year old woman reveals a left ovarian mass. The mass is a unilocular cyst with diffuse homogenous ground glass echoes as a result of hemorrhagic debris. Which of the following is the most likely diagnosis?
Your Answer: Physiological cyst
Correct Answer: Endometrioma
Explanation:An endometrioma, also known as a chocolate cyst is a benign ovarian cyst that occurs as a result of the trapping of endometriosis tissue inside the ovary. The findings on transvaginal ultrasound are often a unilocular cyst, with ground glass echogenicity due to haemorrhage. Other benign masses that can be evaluated using transvaginal ultrasound are functional cysts, serous and mucinous cystadenomas and mature teratomas.
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This question is part of the following fields:
- Data Interpretation
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Question 2
Correct
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Molar Pregnancy
Explanation:This is typical appearance of molar pregnancy. This used to be referred to as ‘snowstorm sign’ as with older poorer resolution ultrasound the anechoic species looked like a snowstorm.
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This question is part of the following fields:
- Data Interpretation
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Question 3
Incorrect
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Question 4
Correct
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A 47 year old women has a transvaginal ultrasound that shows a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer: Mature teratoma
Explanation:These are the most common ovarian tumours in young women. The most common form is the mature dermoid cyst (cystic teratoma). It can consist of a combination of all the type of tissues (mesenchymal, stromal and epithelial). Any mature tissue type can be present such as muscle, cartilage, bone, teeth and often hair. Treatment is cystectomy.
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This question is part of the following fields:
- Data Interpretation
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Question 5
Correct
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You are called to see a 24 year old patient who is currently in labour but is failing to progress. A fetal blood sample is sent for analysis. pH is 7.22. Which of the following is the appropriate course of action?
Your Answer: Consider delivery
Explanation:A normal pH value is above 7.25. A pH below 7.20 is confirmation of fetal compromise. Values between 7.20 and 7.25 are ‘borderline’.
The base deficit can also be useful in interpretation of the fetal scalp pH. A base excess of more than -10 demonstrates a significant metabolic acidosis, with increasing risk of fetal neurological injury beyond this level. Delivery should be considered.
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This question is part of the following fields:
- Data Interpretation
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Question 6
Correct
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You are asked to review the early pregnancy ultrasound scan of a 27 year old lady. The transvaginal ultrasound results show a gestational sac of 26mm with no fetal pole and no fetal heartbeat. Which of the following is the most likely diagnosis?
Your Answer: Miscarriage
Explanation:Ultrasound findings in early pregnancy can help determine the viability of an intrauterine pregnancy. In the absence of a fetal heartbeat and no visible fetal pole, the mean gestational sac diameter should be measured. A sac diameter of less than 25mm on a transvaginal ultrasound scan is likely an indication of a miscarriage. In the presence of a fetal heartbeat, the crown-rump length should be less than 7mm according to NICE guidelines. Further scans are indicated 14 days later to confirm the diagnosis. The diagnosis of ‘pregnancy of uncertain viability’ is given in situations where there is inadequate ultrasound evidence to diagnose a miscarriage, such as a developing sac but no visualisation of a foetus with a heartbeat.
Ultrasound findings for partial molar pregnancy are an enlarged placenta with multiple diffuse anechogenic patches, while findings in a complete molar pregnancy include an enlarged uterus with multiple small anechogenic spaces (snowstorm appearance), or the bunch of grapes sign representing hydropic trophoblastic villi. -
This question is part of the following fields:
- Data Interpretation
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Question 7
Correct
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Question 8
Incorrect
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You are called to a delivery as the midwife is concerned about CTG changes. She suggests a fetal blood sample (FBS). You inspect the cervix. At what dilatation would you NOT perform FBS?
Your Answer: Less than 4cm
Correct Answer: Less than 3cm
Explanation:Indications for FBS:
1. Pathological CTG in labour (cervix dilated >3 cm)
2. Suspected acidosis in labour (cervix dilated >3 cm)
Contraindications to FBS:
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromise -
This question is part of the following fields:
- Data Interpretation
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Question 9
Correct
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Molar Pregnancy
Explanation:Gestational trophoblastic disorder is characterized by an abnormal trophoblastic proliferation and include a complete and partial mole. It is characterized by persistently elevated BHCG levels after pregnancy and on ultrasound a snow storm appearance. These appear as anechoic areas on ultrasound.
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This question is part of the following fields:
- Data Interpretation
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Question 10
Correct
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Regarding CTG (cardiotocography) analysis what is the normal range for variability?
Your Answer: 5-25 bpm
Explanation:Fetal hypoxia may cause absent, increased or decreased variability. Other causes of decreased variability include: normal fetal sleep-wake pattern, prematurity and following maternal administration of certain drugs including opioids.
Variability Range:
Normal – 5 bpm – 25bpm
Increased – >25 bpm
Decreased – <5 bpm
Absent – <2 bpm -
This question is part of the following fields:
- Data Interpretation
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SESSION STATS - PERFORMANCE PER SPECIALTY
