Ultrasound Practice Questions

Q: A 45-year-old female presents with a 2 cm thyroid nodule. Which TIRADS category has >95% risk of malignancy?

TIRADS 5. ***TIRADS 5*** - A **TIRADS 5** classification indicates a **highly suspicious** nodule with features strongly suggestive of **malignancy**. - This category corresponds to a **>95% risk of malignancy**, necessitating further investigation such as fine-needle aspiration (FNA). *TIRADS 4* - **TIRADS 4** nodules are classified as **moderately suspicious** for malignancy, with a risk ranging from **5% to 50%**. - While requiring follow-up and often FNA, the risk is significantly lower than for TIRADS 5. *TIRADS 2* - **TIRADS 2** nodules are considered **benign**, with a **0% risk of malignancy** (or extremely low). - These nodules typically have features like **spongiform appearance** or purely cystic composition. *TIRADS 3* - **TIRADS 3** nodules are classified as **mildly suspicious**, with a malignancy risk between **0% and 5%**. - They often have some indeterminate features but are predominantly considered to be low risk.

Q: Characteristic of venous blood flow of lower limb in duplex Doppler is?

Biphasic. ***Biphasic*** - Normal venous blood flow in the **major lower limb veins** (femoral, popliteal) on duplex Doppler is characteristically **biphasic**, showing variations with respiration. - This biphasic pattern reflects the influence of the **thoracoabdominal pump**, where inspiration decreases intrathoracic pressure and increases intra-abdominal pressure, thus impeding venous return, and expiration reverses this action. - The two phases correspond to **acceleration during expiration** and **deceleration during inspiration**. *Non phasic* - **Non-phasic** (continuous) flow usually indicates a **proximal obstruction** such as deep vein thrombosis (DVT). - This pattern means the respiratory variations are absent due to the blockage preventing normal pressure changes from affecting venous return. - Loss of phasicity is an important sign of venous pathology. *Monophasic* - **Monophasic** flow shows only one phase (forward flow) without clear respiratory variation. - While monophasic flow can be **normal in smaller peripheral veins** (e.g., calf veins), in major lower limb veins it may suggest **partial obstruction** or poor respiratory effort. - It lacks the distinct respiratory modulation seen with biphasic flow. *Triphasic* - **Triphasic** flow is characteristic of **arterial waveforms** in peripheral arteries, showing rapid antegrade flow, brief reversal during early diastole, and slower forward flow during late diastole. - This is not a normal finding for venous blood flow and represents arterial rather than venous physiology.

Q: Which of the following diagnostic tests is most useful in confirming the presence of ascites?

Ultrasound. ***Ultrasound*** - **Ultrasound** is highly sensitive and specific for detecting even small amounts of **ascitic fluid** and can differentiate it from other abdominal masses or fluid collections. - It also allows for assessment of underlying organ pathology (e.g., **liver cirrhosis**) that may be causing the ascites and can guide **paracentesis**. *CT scan* - While a **CT scan** can detect ascites, it exposes the patient to **ionizing radiation** and is generally more expensive than an ultrasound. - It is often reserved for complex cases or when additional information about solid organ pathology is needed, beyond what ultrasound can provide. *Liver function tests* - **Liver function tests (LFTs)** assess liver function and can indicate the presence of **liver disease**, which is a common cause of ascites. - However, LFTs do not directly confirm the presence of **ascitic fluid** in the abdominal cavity but rather point to an underlying cause. *Abdominal X-ray* - An **abdominal X-ray** is very insensitive for detecting small to moderate amounts of **ascites** and is not typically used for this purpose. - It may show a **ground-glass appearance** or flank bulging in cases of massive ascites, but it lacks the detail and specificity of ultrasound or CT.

Q: What does the sign depicted in the image represent?

Mickey Mouse sign. ***Mickey Mouse sign*** - The image displays the common femoral artery (CFA) as the 'head', and the common femoral vein (CFV) and the saphenofemoral junction (SFJ) as the 'ears' of Mickey Mouse. - This **ultrasound sign** is used to identify the structures in the **femoral triangle** at the level of the saphenofemoral junction. *String sign* - The **string sign** is a radiographic finding, typically seen in barium studies of the bowel, where a severely narrowed segment of intestine resembles a thin string. - It is often associated with conditions like **Crohn's disease** or pyloric stenosis. *Tillaux sign* - **Tillaux sign** is a clinical finding associated with an ankle fracture, specifically a **Salter-Harris type III or IV fracture** of the distal tibia. - It refers to localized pain and tenderness over the anterolateral aspect of the distal tibia at the insertion of the anterior inferior tibiofibular ligament. *Stemmer's sign* - **Stemmer's sign** is a clinical test for **lymphedema**, especially in the toes or fingers. - A positive sign indicates the inability to pinch and lift a fold of skin at the base of the second toe (or finger), due to tissue induration caused by fluid accumulation.

Q: In which fetal anomalies are the 'banana sign' and 'lemon sign' observed?

Neural tube defects. ***Neural tube defects*** - The **'banana sign'** describes the cerebellum appearing flattened and curved around the brainstem due to **posterior fossa effacement** in **Chiari II malformation**. - The **'lemon sign'** refers to the frontal bones of the fetal skull appearing indented, creating a **lemon-like shape**, also often associated with **Chiari II malformation**. *Hydrops fetalis* - This condition involves **excess fluid accumulation** in two or more fetal compartments (e.g., ascites, pleural effusion, skin edema) and is not characterized by the described cranial deformities. - It is often caused by various underlying conditions such as **anemia**, **chromosomal abnormalities**, or **infections**, but not primarily by changes in skull shape. *Multiple gestation* - Refers to the presence of **more than one fetus** in the uterus and is not directly associated with specific cranial ultrasound signs like the banana or lemon sign. - While anomalies can occur in multiple gestations, these signs are specific to certain brain abnormalities. *Intrauterine death* - The primary ultrasound findings for intrauterine death include the **absence of fetal heart activity**, as well as other signs such as **scalp edema**, **overlapping skull bones (Spalding sign)**, and fetal maceration. - It does not present with the characteristic banana and lemon signs, which indicate structural brain malformations.

Q: What is the sonographic appearance of a hydatid cyst?

Hypoechoic lesion with septations. ***Hypoechoic lesion with septations*** - Hydatid cysts typically appear as **hypoechoic or anechoic lesions** on ultrasound, meaning they are fluid-filled and transmit sound well. - The presence of **septations** (daughter cysts or internal membranes) is a classic sonographic feature, often described as a "water lily sign" or "rosette sign." *Hypoechoic lesion without septations* - While hydatid cysts are usually **hypoechoic**, the absence of **septations** would be atypical, especially in a mature cyst. - A simple fluid-filled cyst without septations would be more indicative of other conditions, such as a **simple liver cyst**. *Hyperechoic lesion with septations* - A **hyperechoic lesion** indicates a solid or calcified structure that reflects sound strongly, which is not characteristic of the fluid-filled nature of a hydatid cyst. - While septations can be present, the overall echogenicity would rule out a typical hydatid cyst. *Hyperechoic lesion without septations* - This description suggests a **solid mass** or **calcified lesion** that strongly reflects ultrasound waves, which is inconsistent with the fluid-filled characteristic of a hydatid cyst. - The absence of septations further differentiates it from the typical appearance of a hydatid cyst.

Q: Which of the following is a soft tissue marker of Down syndrome on USG?

Increased NT. ***Increased NT*** - An **increased nuchal translucency (NT)** thickness, measured via ultrasound between 11 and 14 weeks of gestation, is a well-established **soft tissue marker** for **Down syndrome**. - NT represents **fluid accumulation in the subcutaneous tissue** at the nape of the fetal neck and is associated with a higher risk of chromosomal abnormalities, including **trisomy 21**. - As a true soft tissue finding (fluid in soft tissue), increased NT is one of the most important first-trimester screening markers. *Absent nasal bone* - An **absent or hypoplastic nasal bone** is an important marker for **Down syndrome**, but it is classified as a **skeletal/osseous marker**, NOT a soft tissue marker. - The nasal bone is a **bony structure**, and its assessment involves evaluation of ossification, not soft tissue or fluid characteristics. - While highly significant for Down syndrome screening, it does not fit the definition of a soft tissue marker as asked in the question. *Exomphalos* - **Exomphalos** (omphalocele) is an abdominal wall defect where abdominal organs protrude into the base of the umbilical cord, covered by a membrane. - While it can be associated with chromosomal abnormalities, including **Down syndrome**, it is classified as a **major structural anomaly** rather than a soft tissue marker. - Soft tissue markers are subtle findings used in aneuploidy screening, whereas exomphalos is a significant structural defect. *Normal fetal anatomy* - **Normal fetal anatomy** is not a marker but rather the absence of abnormal findings. - If all fetal anatomy appears normal, the likelihood of Down syndrome is reduced, but it does not completely rule out the condition as some affected fetuses may have no obvious ultrasound abnormalities.

Q: First line investigation for deep venous thrombosis is -

Ultrasonography. ***Ultrasonography*** - **Duplex ultrasonography** is the preferred first-line investigation due to its **non-invasiveness**, widespread availability, and high accuracy for diagnosing DVT, especially in the proximal veins [1][2]. - It visualizes the vein and assesses compressibility, flow, and presence of thrombus, making it effective for **confirming or excluding DVT** [1][2]. *Venography* - **Venography** is an invasive procedure involving injection of contrast dye and X-rays, carrying risks of allergic reactions and kidney injury. - While considered the **gold standard** for detailed anatomical visualization, its invasiveness and risks make it a second-line or confirmatory test rather than a first-line diagnostic. *MRI* - **Magnetic Resonance Imaging (MRI)** is highly sensitive and specific for DVT, particularly for pelvic or atypical thrombi. - However, its **high cost**, limited availability, and longer acquisition time usually reserve it for cases where ultrasound is inconclusive or technically difficult. *Nuclear imaging* - **Nuclear imaging**, such as scintigraphy, is primarily used for diagnosing **pulmonary embolism (PE)** with Ventilation-Perfusion (V/Q) scans [2]. - It is **not a standard or primary diagnostic tool** for evaluating DVT directly, as it does not visualize thrombi in the venous system.

Q: Which of the following structures cannot be effectively visualized using ultrasonography (USG)?

Bones and dense structures. ***Bones and dense structures*** - **Ultrasound waves** cannot effectively penetrate through **bones or other dense structures** due to their high acoustic impedance, leading to significant reflection and scattering of the waves. - This limitation means that structures located behind bone are poorly visualized, resulting in an acoustic shadow. *Fluid-filled structures* - **Ultrasonography excels** at visualizing **fluid-filled structures** because fluid allows for excellent transmission of sound waves with minimal attenuation. - This results in well-defined anechoic (black) areas on the ultrasound image, making structures like cysts or the urinary bladder easily discernible. *Gallbladder and bile ducts* - The **gallbladder and bile ducts** are routinely and effectively visualized by USG, as they are typically fluid-filled (with bile) and surrounded by soft tissues. - USG is the primary imaging modality for detecting gallstones, cholecystitis, and evaluating biliary obstruction. *Blood vessels and blood flow* - **Doppler ultrasonography** is specifically designed to visualize **blood vessels and assess blood flow** characteristics. - It uses the Doppler effect to detect changes in frequency caused by moving red blood cells, allowing for evaluation of vessel patency, flow direction, and velocity.

Q: Which piezoelectric crystal is most widely used in ultrasonography probes?

Lead zirconate titanate. ***Lead zirconate titanate*** - **Lead zirconate titanate (PZT)** is the most widely used choice due to its superior **piezoelectric properties**, allowing efficient conversion of electrical energy into mechanical vibrations and vice versa. - It offers a good balance of **sensitivity**, **bandwidth**, and **coupling coefficient**, making it ideal for generating and detecting ultrasound waves in medical imaging. *Quartz* - While quartz exhibits **piezoelectric properties**, its electromechanical coupling coefficient is relatively low compared to PZT. - Its use is more common in **high-frequency applications** like crystal oscillators rather than medical ultrasound transducers, which require efficient energy conversion. *Molybdenum* - **Molybdenum** is a metal known for its strength and high melting point, but it does not possess **piezoelectric properties**. - It is often used in **X-ray tube anodes** and other high-temperature applications, not in ultrasonic transducers. *Titanium* - **Titanium** is a strong, corrosion-resistant metal commonly used in medical implants and aerospace applications due to its biocompatibility. - It is not a **piezoelectric material** and therefore cannot be used to generate or detect ultrasound waves in the same way as PZT.

Question 1

A 45-year-old female presents with a 2 cm thyroid nodule. Which TIRADS category has >95% risk of malignancy?

Accepted Answer

TIRADS 5

Answer

TIRADS 4

Answer

TIRADS 2

Answer

TIRADS 3

Question 2

Characteristic of venous blood flow of lower limb in duplex Doppler is?

Accepted Answer

Biphasic

Answer

Non phasic

Answer

Monophasic

Answer

Triphasic

Question 3

Which of the following diagnostic tests is most useful in confirming the presence of ascites?

Accepted Answer

Ultrasound

Answer

CT scan

Answer

Liver function tests

Answer

Abdominal X-ray

Question 4

What does the sign depicted in the image represent?

Accepted Answer

Mickey Mouse sign

Answer

String sign

Answer

Tillaux sign

Answer

Stemmer's sign

Question 5

In which fetal anomalies are the 'banana sign' and 'lemon sign' observed?

Accepted Answer

Neural tube defects

Answer

Hydrops fetalis

Answer

Multiple gestation

Answer

Intrauterine death

Question 6

What is the sonographic appearance of a hydatid cyst?

Accepted Answer

Hypoechoic lesion with septations

Answer

Hypoechoic lesion without septations

Answer

Hyperechoic lesion with septations

Answer

Hyperechoic lesion without septations

Question 7

Which of the following is a soft tissue marker of Down syndrome on USG?

Accepted Answer

Increased NT

Answer

Absent nasal bone

Answer

Exomphalos

Answer

Normal fetal anatomy

Question 8

First line investigation for deep venous thrombosis is -

Accepted Answer

Ultrasonography

Answer

Venography

Answer

MRI

Answer

Nuclear imaging

Question 9

Which of the following structures cannot be effectively visualized using ultrasonography (USG)?

Accepted Answer

Bones and dense structures

Answer

Fluid-filled structures

Answer

Gallbladder and bile ducts

Answer

Blood vessels and blood flow

Question 10

Which piezoelectric crystal is most widely used in ultrasonography probes?

Accepted Answer

Lead zirconate titanate

Answer

Quartz

Answer

Molybdenum

Answer

Titanium

Ultrasound — MCQs

Ultrasound — MCQs

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