Ultrasound Practice Questions

Q: According to endoscopic ultrasound (EUS) criteria for chronic pancreatitis, the main pancreatic duct is considered dilated when its diameter is:

>3 mm. A main pancreatic duct diameter **greater than 3 mm** is a significant endoscopic ultrasound (EUS) criterion for the diagnosis of **chronic pancreatitis**. This dilation indicates advanced disease and is often accompanied by other EUS features like **lobularity**, **hyperechoic foci/stranding**, and cysts. While a dilated pancreatic duct is indicative of chronic pancreatitis, a diameter of **>1 mm** is generally too small to be considered a definitive EUS criterion for significant disease. A main pancreatic duct diameter greater than 2 mm is often considered abnormal [1], but it's **not the established threshold** used in EUS criteria for chronic pancreatitis. A diameter of 1.5 mm is usually considered within the **normal range** for the main pancreatic duct in many clinical contexts.

Q: Ultrasound is the best initial investigation of choice for:

Blunt abdominal trauma. ***Blunt abdominal trauma*** - **Focused Assessment with Sonography for Trauma (FAST) exam** is the initial imaging modality of choice for rapidly detecting **intra-abdominal free fluid** (hemoperitoneum) in hemodynamically unstable patients with blunt abdominal trauma due to its speed, portability, and non-invasiveness. - It helps guide the need for further imaging or surgical intervention, making it critical in the acute setting. *Urethral stricture* - The gold standard for diagnosing urethral strictures is **urethrography** (retrograde urethrogram), which directly visualizes the stricture and its extent. - While ultrasound can sometimes be used to assess the urethra, it is less effective than urethrography for defining the length and severity of a stricture. *Intraductal Pancreatic calculi* - Often best visualized with **Endoscopic Retrograde Cholangiopancreatography (ERCP)** or **Magnetic Resonance Cholangiopancreatography (MRCP)**, which provide detailed imaging of the pancreatic and bile ducts. - While transabdominal ultrasound can sometimes detect dilated ducts or large calculi, **Endoscopic Ultrasound (EUS)** is more sensitive and specific for intraductal pathologies, making routine transabdominal ultrasound not the primary choice. *Somatostatinoma* - Diagnosed primarily through biochemical tests (elevated **somatostatin levels**) and imaging like **CT, MRI, or somatostatin receptor scintigraphy (SRS)**, which are superior for localizing these rare neuroendocrine tumors. - Although ultrasound can sometimes detect pancreatic masses, it is not the **investigation of choice** for definitive diagnosis or staging of somatostatinomas.

Q: Best advantage of doing transcranial Doppler ultrasound?

Detect vasospasm. ***Detect vasospasm*** - **Transcranial Doppler (TCD) ultrasound** is highly effective for monitoring and detecting **cerebral vasospasm**, particularly after a **subarachnoid hemorrhage**. - It allows for non-invasive, continuous, and dynamic assessment of **blood flow velocities** in the **intracranial arteries**, which increase significantly during vasospasm. *Detect brain blood vessels stenosis* - While TCD can indicate increased flow velocities suggestive of **stenosis**, it is less accurate for precise anatomical localization and quantification compared to **CTA** or **MRA**. - Its ability to directly visualize the vessel lumen and the degree of stenosis is limited by its reliance on **flow dynamics**. *Detect AV malformation* - TCD can sometimes detect altered flow patterns associated with **arteriovenous malformations (AVMs)**, but it lacks the spatial resolution to definitively diagnose or characterize these complex vascular structures. - **Cerebral angiography** or **MRA** are the gold standards for diagnosing and mapping **AVMs**. *Detect emboli* - TCD can detect **microembolic signals (MES)**, which are transient high-intensity signals indicating the passage of emboli through the cerebral circulation. - However, while it can detect emboli, it is not its *best* or primary advantage compared to its utility in monitoring **vasospasm**, which directly impacts patient management and prognosis in certain acute conditions.

Q: POCUS is related to which imaging modality?

Ultrasound. ***Ultrasound*** - **POCUS** stands for **Point-of-Care Ultrasound**, indicating that it is a direct application of ultrasound technology. - It involves using a portable **ultrasound machine** at the patient's bedside for rapid diagnostic and therapeutic guidance. *X-ray* - **X-ray** imaging uses ionizing radiation to create images of bones and some soft tissues, which is fundamentally different from ultrasound's sound wave technology. - It is not typically performed at the bedside as commonly as POCUS, and it provides static images rather than real-time dynamic views. *MRI* - **MRI** (Magnetic Resonance Imaging) uses strong magnetic fields and radio waves to produce detailed images of organs and soft tissues. - This modality requires specialized, large equipment and is not suitable for point-of-care use due to its size, cost, and complexity. *CT* - **CT scans** (Computed Tomography) utilize X-rays from multiple angles to create cross-sectional images of the body, providing detailed anatomical information. - Like MRI, CT scanners are large, expensive, and require a dedicated imaging suite, making them unsuitable for point-of-care applications.

Q: Pulse echo principle is used by which modality?

USG. ***USG*** - **Ultrasound (USG)** imaging relies on the **pulse echo principle**, where high-frequency sound waves are emitted and their reflections (echoes) are detected to create images. - The transducer sends out a short **ultrasound pulse** and then listens for the echoes returning from structures within the body. *X-ray* - **X-ray** imaging uses **ionizing radiation** to produce images, where X-rays pass through the body and are absorbed differently by various tissues. - It does not involve emitting pulses or detecting echoes; instead, it measures the **attenuation of X-rays**. *CT* - **Computed Tomography (CT)** also uses **X-rays** but in a cross-sectional manner, rotating an X-ray source and detector around the patient. - It reconstructs detailed 3D images based on varying **X-ray absorption** and does not use sound waves or the pulse echo principle. *MRI* - **Magnetic Resonance Imaging (MRI)** utilizes strong **magnetic fields** and **radio waves** to produce detailed anatomical images. - It measures the signals emitted by **protons in water molecules** after they are excited by radiofrequency pulses, which is distinct from sound wave echoes.

Q: Ultrasonography transducer contains –

Lead Zirconate. ***Lead Zirconate*** - **Lead Zirconate Titanate (PZT)** is a widely used **piezoelectric ceramic** material in ultrasound transducers due to its strong piezoelectric properties. - This material converts electrical energy into mechanical vibrations (sound waves) and vice-versa, which is crucial for generating and detecting **ultrasound images**. *Sodium fluoride* - **Sodium fluoride** is not a **piezoelectric material** and therefore cannot be used to generate or detect ultrasound waves. - It is primarily known for its use in **dental care** for strengthening tooth enamel. *Caesium fluoride* - **Caesium fluoride** is an **ionic compound** and does not possess the **piezoelectric properties** required for ultrasound transducer functionality. - It is used in various chemical applications but not in medical imaging transducers. *None of the options* - This option is incorrect because **Lead Zirconate** (specifically as PZT) is a fundamental component of most modern ultrasound transducers.

Q: Absent cranial vault on ultrasound imaging is characteristic of

Anencephaly. ***Anencephaly*** - **Anencephaly** is a severe neural tube defect resulting in the absence of a major portion of the brain, skull, and scalp - On ultrasound, it presents with **absent cranial vault** (acrania) with no brain tissue visible above the orbits - The **"frog-eye" or "Mickey Mouse" appearance** is pathognomonic due to prominent orbits without overlying cranial structures - This is a **lethal malformation** incompatible with life, typically diagnosed in the first or second trimester *Renal anomalies* - Renal anomalies such as bilateral renal agenesis or multicystic dysplastic kidney can be detected on ultrasound - They present with findings like **absent or abnormal kidney visualization**, **oligohydramnios**, and **"Potter sequence"** - However, they do not cause absent cranial vault; the skull and brain development are typically normal *Congenital rubella syndrome* - **Congenital rubella syndrome** causes various fetal abnormalities including cardiac defects, cataracts, hearing loss, and growth restriction - Ultrasound may show **symmetric IUGR**, cardiac anomalies, or microcephaly - The cranial vault remains intact; this condition does not cause acrania or absent skull bones *Trisomy 18* - **Trisomy 18** (Edwards syndrome) presents with multiple anomalies including **strawberry-shaped skull**, clenched fists, rocker-bottom feet, and cardiac defects - Ultrasound shows **symmetric IUGR** and structural malformations - While the skull shape may be abnormal, the cranial vault is present, unlike in anencephaly

Q: Thyroid malignancies appear on USG as

Hypoechoic. ***Hypoechoic*** - The majority of **malignant thyroid nodules** appear **hypoechoic** on ultrasound, meaning they reflect fewer sound waves than the surrounding tissues, making them appear darker. - This characteristic often correlates with increased cellularity and decreased colloid content within the tumor. *Hyperechoic* - **Hyperechoic** nodules are brighter than the surrounding parenchyma, which is more commonly associated with **benign conditions** like colloid cysts or hyperplastic nodules, although some rare malignancies can be hyperechoic. - This appearance suggests a higher density of reflections from, for example, colloid or calcifications. *Isoechoic* - **Isoechoic** nodules have similar echogenicity to the adjacent thyroid tissue, making them difficult to distinguish. - While some malignancies can be isoechoic, this feature is more often seen in **benign nodules** or early changes, making it a less specific indicator for malignancy. *Anechoic* - **Anechoic** lesions appear completely black on ultrasound, indicating no internal echoes, which is characteristic of **fluid-filled structures** like simple cysts. - Malignancies are typically solid or predominantly solid and therefore are rarely anechoic.

Q: 'Triphasic waveform' on colour Doppler is of

Hepatic vein. ***Hepatic vein*** - A normal hepatic vein Doppler waveform is **triphasic**, showing two antegrade (towards the heart) waves corresponding to **ventricular systole (S wave)** and **diastole (D wave)**, and one small retrograde (away from the heart) wave corresponding to **atrial contraction (a wave)**. - This triphasic pattern reflects the cyclic pressure changes in the right atrium and is crucial for assessing **right heart function** and conditions affecting hepatic venous outflow. *Portal vein* - The portal vein typically exhibits a **monophasic waveform** with continuous, low-velocity, hepatopetal (towards the liver) flow, often with slight undulations due to respiration. - The absence of a triphasic pattern differentiates it from the hepatic veins, as its flow is driven by pressure differences from the mesenteric circulation, not directly by cardiac cycles. *Hepatic artery* - The hepatic artery demonstrates a **high-resistive, biphasic waveform** with a sharp systolic peak and continuous diastolic flow, reflecting its essential role in supplying oxygenated blood to the liver parenchyma. - It does not show a triphasic pattern, which is characteristic of venous structures influenced by right atrial pressures. *All of the options* - This option is incorrect because only the **hepatic veins** typically display a triphasic waveform; the portal vein and hepatic artery have distinct, different waveform patterns. - Each vessel's unique flow pattern is indicative of its specific physiological role and anatomical connection to the cardiac cycle.

Question 1

According to endoscopic ultrasound (EUS) criteria for chronic pancreatitis, the main pancreatic duct is considered dilated when its diameter is:

Accepted Answer

>3 mm

Answer

>1 mm

Answer

>2 mm

Answer

1.5 mm

Question 2

The four points of probe placement in focused abdominal sonogram for trauma (FAST) in thoracoabdominal trauma are

Accepted Answer

Subxiphoid, (R) upper quadrant, (L) upper quadrant, suprapubic

Answer

Hypogastrium, (R) and (L) lumbar region, (R) lower chest

Answer

Epigastrium, (R) and (L) lumbar region, (R) lower chest

Answer

Epigastrium, (R) and (L) hypochondria, (R) iliac fossa

Question 3

Ultrasound is the best initial investigation of choice for:

Accepted Answer

Blunt abdominal trauma

Answer

Somatostatinoma

Answer

Intraductal Pancreatic calculi

Answer

Urethral stricture

Question 4

Best advantage of doing transcranial Doppler ultrasound?

Accepted Answer

Detect vasospasm

Answer

Detect brain blood vessels stenosis

Answer

Detect AV malformation

Answer

Detect emboli

Question 5

POCUS is related to which imaging modality?

Accepted Answer

Ultrasound

Answer

X-ray

Answer

MRI

Answer

CT

Question 6

Pulse echo principle is used by which modality?

Accepted Answer

USG

Answer

X-ray

Answer

CT

Answer

MRI

Question 7

Ultrasonography transducer contains –

Accepted Answer

Lead Zirconate

Answer

Sodium fluoride

Answer

Caesium fluoride

Answer

None of the options

Question 8

Absent cranial vault on ultrasound imaging is characteristic of

Accepted Answer

Anencephaly

Answer

Renal anomalies

Answer

Congenital rubella syndrome

Answer

Trisomy 18

Question 9

Thyroid malignancies appear on USG as

Accepted Answer

Hypoechoic

Answer

Hyperechoic

Answer

Isoechoic

Answer

Anechoic

Question 10

'Triphasic waveform' on colour Doppler is of

Accepted Answer

Hepatic vein

Answer

Portal vein

Answer

Hepatic artery

Answer

All of the options

Ultrasound — MCQs

Ultrasound — MCQs

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