WBR0333

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Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Physiology
Sub Category SubCategory::Reproductive
Prompt [[Prompt::A pregnant 28-year-old female presents to her gynecologist's office for a routine pregnancy visit. In the office, the gynecologist performs a pregnancy ultrasound. He informs the patient that she has twins. Then he explains to the patient that the cleavage of the fertilized egg likely occurred between day 4 and day 8 post-fertilization. Which of the following ultrasound findings is most likely present in this patient?]]
Answer A AnswerA::Dichorionic diamniotic twin pregnancy
Answer A Explanation AnswerAExp::Dichorionic diamniotic twin pregnancy occurs when cleavage takes place between 0-4 days post-fertilization.
Answer B AnswerB::Monochorionic diamniotic twin pregnancy
Answer B Explanation AnswerBExp::Monochorionic diamniotic twin pregnancy occurs when cleavage takes place between 4-8 days post-fertilization.
Answer C AnswerC::Dichorionic monoamniotic twin pregnancy
Answer C Explanation AnswerCExp::Dichorionic monoamniotic twin pregnancy is not possible.
Answer D AnswerD::Monochorionic monoamniotic twin pregnancy
Answer D Explanation AnswerDExp::Monochorionic monoamniotic twin pregnancy occurs when cleavage takes place between 8-12 days post-fertilization
Answer E AnswerE::Monochorionic monoamniotic conjoined twin pregnancy
Answer E Explanation [[AnswerEExp::Monochorionic monoamniotic conjoined twin pregnancy occurs when cleavage takes place > 13 days post-fertilization.]]
Right Answer RightAnswer::B
Explanation [[Explanation::While dizygotic twins always form from 2 separately fertilized eggs, monozygotic twins form from 1 fertilized egg that later splits into 2 zygotes during early pregnancy. The time post-fertilization by which the fertilized egg cleaves is important for determining the number of chorions and amnions.


0-4 days: Dichorionic diamniotic twin pregnancy
4-8 days: Monochorionic diamniotic twin pregnancy
8-12 days: Monochorionic monoamniotic twin pregnancy
> 13 days: Monochorionic monoamniotic conjoined twin pregnancy
Educational Objective: Monochorionic diamniotic twin pregnancy occurs when the fertilized egg cleaves at 4-8 days post-fertilization.
References: First Aid 2014 page 555]]

Approved Approved::Yes
Keyword WBRKeyword::monochorionic, WBRKeyword::dichorionic, WBRKeyword::monoamniotic, WBRKeyword::diamniotic, WBRKeyword::pregnancy, WBRKeyword::conjoined twins, WBRKeyword::fertilization, WBRKeyword::cleavage, WBRKeyword::fertilized, WBRKeyword::post-fertilization, WBRKeyword::post, WBRKeyword::zygote, WBRKeyword::monozygote, WBRKeyword::monozygotic
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