Ultrasound markers and anomaly screening — MCQs

A 39-year-old pregnant woman at 16 weeks gestation recently underwent a quad-screen which revealed elevated beta-hCG, elevated inhibin A, decreased alpha-fetoprotein, and decreased estradiol. An ultrasound was performed which found increased nuchal translucency. Which of the following is recommended for diagnosis?

A 27-year-old female in her 20th week of pregnancy presents for a routine fetal ultrasound screening. An abnormality of the right fetal kidney is detected. It is determined that the right ureteropelvic junction has failed to recanalize. Which of the following findings is most likely to be seen on fetal ultrasound:

A 37-year-old woman comes for a follow-up prenatal visit at 18 weeks' gestation. At 12 weeks' gestation, ultrasonography showed increased nuchal translucency and pregnancy-associated plasma protein A (PAPP-A) was decreased by 2 standard deviations. Chorionic villus sampling showed a 47, XX, +21 karyotype. During this visit, ultrasonography shows a hypoplastic nasal bone, shortened femur length, shortened middle phalanges of the fifth digits with clinodactyly. A quadruple marker test would most likely show which of the following sets of findings? $$$ α-Fetoprotein (AFP) %%% Estriol %%% β-Human chorionic gonadotropin (HCG) %%% Inhibin A $$$

A 34-year-old gravida 2 para 1 woman at 16 weeks gestation presents for prenatal care. Her prenatal course has been uncomplicated. She takes no medications besides her prenatal vitamin which she takes every day, and she has been compliant with routine prenatal care. She has a 7-year-old daughter who is healthy. The results of her recent quadruple screen are listed below: AFP: Low hCG: Low Estriol: Low Inhibin-A: Normal Which of the following is the most appropriate next step to confirm the diagnosis?

A 28-year-old G2P1 female is concerned that she may give birth to another child with Down syndrome. She states that she may not be able to take care of another child with this disorder. Which of the following tests can confirm the diagnosis of Down syndrome in utero?

A 19-year-old woman presents for a sports physical. She says she feels healthy and has no concerns. Past medical history is significant for depression and seasonal allergies. Current medications are fluoxetine and oral estrogen/progesterone contraceptive pills. Family history is significant for a sister with polycystic ovarian syndrome (PCOS). The patient denies current or past use of alcohol, recreational drugs, or smoking. She reports that she has been on oral birth control pills since age 14 and uses condoms inconsistently. No history of STDs. She is sexually active with her current boyfriend, who was treated for chlamydia 2 years ago. She received and completed the HPV vaccination series starting at age 11. Her vital signs include: temperature 36.8°C (98.2°F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. Physical examination is unremarkable. Which of the following are the recommended guidelines for cervical cancer screening for this patient at this time?

A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best step?

The following set of instruments are used for which procedure?

A 25-year-old pregnant woman, at 18 weeks of gestation, undergoes a routine ultrasound scan. The ultrasound images provided show below. Based on the imaging findings, what is the most likely diagnosis?

A home drug screening test kit is currently being developed. The cut-off level is initially set at 4 mg/uL, which is associated with a sensitivity of 92% and a specificity of 97%. How might the sensitivity and specificity of the test change if the cut-off level is changed to 2 mg/uL?