This document provides information and questions for an assessment on mid-trimester fetal ultrasound. It notes that the assessment contains 7 administrative questions requiring codes from previous sessions, and 30 multiple choice scientific questions. A passing score of 70% is required to receive a certificate of completion if all sessions were also viewed. The assessment then provides sample multiple choice questions covering topics like placenta previa, twin pregnancies, congenital heart defects, and evaluation of fetal brain and other anatomical structures in a mid-trimester ultrasound.

1. Mid-trimester Fetal Ultrasound Certificate Course Assessment -
International Symposium
Please complete this assessment below.
Please note:
 You will have one opportunityto take the assessment.
 Deadline: 17 May 2021.
 There are 7 administrative questions and30 scientific questions.
 During the administrative questions,youwill need the code that
was displayed during eachof the 4 sessions.We will ask you to
enter each code, below. If you do not have these codes, you can
access them by watching the sessions on-demandinthe
Auditorium in the virtual platform.
 The scientific questions are in the form of multiple choice
questions - you must select one correct answer for each
question.
 You will be emailedwith your results after 17 May 2021 and if
you score 70% or above in the scientific questions,andviewed
all the sessions,will receive a certificate ofcompletion.
Question Title
* 8. The genetic sonogram would be most useful to avoid invasive
testing in one of the following patients
40 yr old patient with prior low-risk NIPT
28 yr old patient with increased NT at 12 weeks
39 yr old patient with 1/240 risk after serum screening
37 yr old patient with atrioventricular septal defect
Question Title
* 9. In case of a thickened nuchal fold at 20 weeks, the positive
predictive value for T21
Is between 5 and 10%
Depends on the a priori risk
Is equivalent to the likelihood ratio (10-15)
Is not modified from the baseline risk

2. Question Title
* 10. The most commonsolidliver mass in a fetus is a
Hepatoblastoma
Mesenchymal hamartoma
Metastatic neuroblastoma
Congenital hemangioma
Question Title
* 11. The most commoncystic mass in a female fetus is
Choledochal
Ovarian
Lymphatic
GI duplication
Question Title
* 12. A practical differential diagnosis for a fetal abdominalmass can
be made by determining its
Organ of origin
Vascularity
Both organ of origin and vascularity
Neither organ of origin or vascularity
Question Title
* 13. Autosomaldominant polycystic disease
Can only be detected after 20 years of age
May show subtle signs antenatally with echogenic cortex and normal
amniotic fluid
Shows at 22 weeks scan large renal cysts (>1.5cm) and is only unilateral
Has an inheritance of 25% to siblings
Question Title
* 14. The following diseases are associated withabnormal fetal
kidneys. Which one of these is a ciliopathy?
Meckel-Gruber syndrome
Beckwith-Wiedemann syndrome
Noonan syndrome
Tuberous sclerosis complex
Question Title

3. * 15. Which of the following statements about the HNF1-Beta gene
mutation is true
It is associated with a Joubert-related disorder and of one of the 35 Joubert
genes
It is always detected on karyotype after amniocentesis
It is the gene involved in trisomy 13 related echogenic kidneys
It is responsible for up to 20% of other non-classified echogenic kidneys
Question Title
* 16. What is the best discriminatory value for suspicion of a skeletal
dysplasia
Femur length < the 5th percentile
Femur length > 2 standard deviations below the mean
Femur length > 5mm below 2 standard deviations
Question Title
* 17. Which of the ultrasound findings below is consistent withan
assumption ofa constitutionally smallfetus
Decreased growth velocity of the femur length as gestational age advances
Other biometry in the low or low normal range
Femoral bowing
Femur to foot length of 1.2
Question Title
* 18. What is the most commondiagnosis with severe micromelia
Achondrogenesis
Heterozygous achondroplasia
Osteogenesis Imperfecta type II
Thanatophoric Dysplasia
Question Title
* 19. The most commontheme seen in OB/GYN medico-legalcases is
Communication
Procedural violation
Diagnostic error
Lack of situational awareness
Question Title

4. * 20. The contributing factoranalysis to assess medico-legalcases has
the following categories
Hierarchy, communication, policies
Consent, procedures, just culture
Documentation, delegation, misdiagnosis
Provider factors, Team factors, Systems factors
Question Title
* 21. Medico-legalrisk mitigation strategies related to OB/GYN
ultrasounds include
Reliable systems to receive, review and follow up on reports
Updated hospital policies
Appropriate supervision of residents
Flatten the hierarchy of reporting structures
Question Title
* 22. A 32 year old gravida 1 is seen in your office after a nuchal
transluscency scan. It showed presence of a complete placenta previa.
What will you tell her in relation to this diagnosis?
She will need a cesarean delivery at 37 weeks
At least for now, she needs to be on bed rest
She will most likely be able to deliver vaginally
It is difficult to prognosticate at this time
Question Title
* 23. Your patient with a known placenta previa is seen for a mild
episode of bleeding at 31 weeks. Ultrasound shows a thin placental
edge coming up to the cervical os. Which step is appropriate for her
management?
Book an ultrasound to reassess placental location in 3-4 weeks
Administer a complete series ofantenatal corticosteroids
Place her on bed rest, she may use the bathroom as needed
Schedule a cesarean delivery at 37 weeks of gestation
Question Title
* 24. An ultrasound is done at 35 weeks. It shows a thin placental edge
1.1 cm from cervicalos. How will you plan her delivery?
Cesarean delivery at 37 weeks of gestation
Cesarean delivery at 38 weeks of gestation

5. Induction of labour at 38-39 weeks of gestation
Allow spontaneous onset of labourtill 41 weeks
Question Title
* 25. Which of the following statements is correct regarding the
screening for structural anomalies in twin pregnancies?
In dichorionic twin pregnancies, about 1 in 4 anomalies are detectable in
the first trimester.
In dichorionic twin pregnancies, the 2nd trimester is the best time to
detect an anomaly in one twin.
A dichorionic twin has the same risk of an anomaly as a singleton fetus.
Monochorionic twin pregnancies are monozygotic, so if one twin looks
normal, the other twin will be normal too, and only one twin needs to be
checked.
Question Title
* 26. Twin-twin transfusion syndrome
Is diagnosed by a severe difference in growth, amniotic fluid, and bladder
filling.
Is more common in monoamniotic than in diamniotic monochorionic twin
pregnancies.
Occurs in about 1 in 10 monochorionic diamniotic twin pregnancies,
typically between 16 and 26 weeks.
Is also characterized by a difference in hemoglobin levels between the
twins.
Question Title
* 27. In a monochorionic twinpregnancy, an estimated fetalweight
discordance of >20%
Is usually due to genetic differences.
Is necessary to diagnose twin-twin transfusion syndrome.
Is usually related to an unequally shared placenta with a marginal or
velamentous insertion of the smaller twin’s cord and a more central insertion
of the larger twin’s cord.
Is less common than twin-twin transfusion syndrome but carries a poorer
prognosis.
Question Title
* 28. Which congenitalheart diseases maybe missed ona 4-chamber
view of the heart?

6. Tetralogy of Fallot
Coarctation of the aorta
Transposition of the great arteries
All of the above
Question Title
* 29. In hypoplastic left heart syndrome, on the three vessel view, the
aorta will be
Larger than the pulmonary artery
Larger than the SVC
Smaller than the pulmonary artery
None of the above
Question Title
* 30. The cervical length measurement
1. Might be considered part of the routine mid trimesterscan
2. Should be performed by transvaginalultrasound
3. May reduce the incidence of preterm birth
4. Is used to prevent post-partum haemorrhage
Please select which of the above statement(s) is/are correct:
1 and 3 are correct
2 and 4 are correct
1, 2 and 3 are correct
4 only is correct
Question Title
* 31. The fetal thymus
Should be examined as part of the routine mid trimester scan
May be visible on a 3 vessel view
Is better observed using transvaginal ultrasound
Should be measured routinely
Question Title
* 32. The normal nasal cavity:
Has a central nasal septum and fluid filled nasal cavities on either side
The choanae are bony structures in the posterior nasal space
The presence of fluid in the nares confers patency of the nasal cavities

7. Patency is diagnosed when fluid flow in the posterior nasal space
communicates with the nasopharynx
Question Title
* 33. Bilateral Choanal atresia
Is usually an isolated finding
Is considered an emergency at birth
Is diagnosed by absent flow in both nasal cavities in the second trimester
Is diagnosed by the presence ofbidirectional flow in both nasal cavities
Question Title
* 34. Microform cleft lip
Is often subtle and can be missed if the entire lip is not imaged
Results from incomplete closure of lateral and median palatal shelves
Does not result in postnatal feeding problems as there is no disruption of
the orbicularis oris muscle
Usually involves the alveolar ridge
Question Title
* 35. Abnormalities of the “animal” mnemonic canbe usedto identify
which of the following brain abnormalities?
1. Malformations of corticaldevelopment
2. Agenesis of the corpus callosum
3. Neural tube defects
4. Absent cavum septum pellucidum
1 only is correct
2 and 3 are correct
2 and 4 are correct
4 only is correct
Question Title
* 36. When scanning the anterior complex it is important to:
1. Ensure that the medial wall of the anterior horn approaches the
cavum septum pellucidum
2. Make sure that there are three lines in the region of the
interhemispheric fissure
3. Make sure that the box of the cavum septum pellucidum appears
normal

8. 4. Ensure that the frontal horns of the lateral ventricles are separated
from the midline
1 only is correct
1 and 3 are correct
2 only is correct
3 and 4 are correct
Question Title
* 37. When scanning the anterior complex of the fetal brain in the mid-
trimester, it is important to evaluate the following structures:
Cerebellum, cisterna magna, nuchal fold
Midline Falx, thalami, cerebellar peduncles
The interhemispheric fissure, cavum septum pellucidum, corpus callosum,
anterior horns of the lateral ventricle and the callosal sulcus
Ensure that there is a box-like structure in the anterior complex
DONE