Ultrasound Practice Questions

Q: Which of the following is a primary use of this imaging modality? ![img-42.jpeg](img-42.jpeg)

Staging of esophageal cancer. ***Staging of esophageal cancer*** - The image displays an **Endoscopic Ultrasound (EUS)**, which is the most accurate modality for the locoregional staging of esophageal cancer. - EUS provides detailed imaging of the esophageal wall layers, allowing for precise assessment of the **depth of tumor invasion (T stage)** and involvement of **regional lymph nodes (N stage)**, which is critical for treatment planning. *Evaluation of gastroesophageal reflux disease (GERD)* - The diagnosis of GERD is primarily based on clinical symptoms and may be confirmed with **upper endoscopy** to look for esophagitis or **ambulatory pH monitoring**. - EUS is not used for evaluating reflux itself, as it doesn't measure acid exposure or lower esophageal sphincter function. *Identifying the cause of dysphagia* - The initial investigation for dysphagia typically involves a **barium esophagram** or a standard **upper endoscopy** to visualize the esophageal lumen directly. - EUS is a secondary test used to further characterize a mass or stricture already identified by other means, rather than as a primary tool for dysphagia workup. *Assessing cardiac and aortic pathology* - While EUS can visualize adjacent mediastinal structures, including the heart and aorta, it is not the primary imaging modality for their assessment. - **Echocardiography** is the standard for cardiac evaluation, and **CT or MR angiography** is superior for assessing aortic pathology.

Q: Identify the imaging procedure shown in the image.

Saline infusion sonography. ***Saline infusion sonography*** - The image clearly shows the "uterine cavity filled with **saline solution**" seen on an **ultrasound** image, which is the hallmark of saline infusion sonography (SIS). - SIS, also known as **sonohysterography**, is used to evaluate the uterine cavity for abnormalities such as polyps, fibroids, or adhesions by distending the cavity with saline. *Hysterosalpingography* - This procedure uses **X-rays** and an **iodine-based contrast dye** to visualize the uterus and fallopian tubes, not ultrasound and saline. - While it also evaluates the uterine cavity, the imaging modality and contrast agent are different. *Pelvic ultrasound* - A standard pelvic ultrasound does not involve the **infusion of saline** into the uterine cavity. - While it can visualize the uterus, the detailed assessment of the **endometrial lining** and cavity shape is limited without uterine distension. *MRI of pelvis* - Magnetic resonance imaging (MRI) uses **magnetic fields** and radio waves to create detailed cross-sectional images of pelvic organs. - It does not involve the use of **saline infusion** into the uterine cavity for diagnostic purposes as shown in the image.

Q: Identify the type of sonography shown:

Saline infusion sonography. ***Saline infusion sonography*** - The image shows a **fluid-filled uterine cavity** (hypoechoic space) with a visible **echogenic endometrial lining**, which is characteristic of saline infusion sonography. - This technique involves injecting saline into the uterus to distend the cavity, allowing for better visualization of **endometrial abnormalities** like polyps or fibroids. *Doppler sonography* - **Doppler sonography** is used to assess **blood flow** and would show color overlays or spectral patterns indicating flow direction and velocity, which are absent here. - It's often used to evaluate **vascularity of masses** or blood flow in vessels, not to outline the uterine cavity with fluid. *3D sonography* - **3D sonography** generates **multiplanar views** and volumetric images, creating a three-dimensional reconstruction, which is not depicted in this single 2D image. - While it can be used to evaluate uterine anomalies, this particular image does not show the typical output of a 3D reconstruction. *Hysterosalpingography* - **Hysterosalpingography (HSG)** involves injecting **radiopaque contrast** into the uterus and fallopian tubes, followed by X-ray imaging. - It would appear as a series of X-ray images, with contrast visible in the tubes and spilling into the peritoneum, not an ultrasound image of the uterine cavity.

Q: A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Lemon sign. ***Lemon sign*** - The **lemon sign** refers to the shape of the fetal skull on ultrasound, where the frontal bones are indented, making the head appear lemon-shaped. - This sign is often associated with **Chiari II malformation** and spina bifida, where there is downward displacement of the cerebellar vermis and fourth ventricle. *Boomerang sign* - The **boomerang sign** is typically observed in imaging of the knee, referring to a meniscal tear where the displaced fragment resembles a boomerang. - It is not a sign used for fetal cranial abnormalities in ultrasound. *Spring coiled sign* - The **spring coiled sign** is a feature seen in intussusception on ultrasound, where layers of bowel are invaginated within another, resembling a coiled spring. - This sign is related to intestinal pathology, not fetal head anomalies. *Banana sign* - The **banana sign** describes the appearance of the cerebellum on fetal ultrasound when it is displaced or compressed due to Chiari II malformation, making it appear banana-shaped. - While also associated with Chiari II, the image provided shows the **head shape**, not the cerebellum, aligning with the lemon sign.

Q: Which one of the following statements is correct regarding eFAST in trauma? 1. It is a technique to assess free fluid in abdominal cavity, thoracic cavity, and pericardium. 2. It is a technique to assess free fluid in pelvic cavity. 3. It is a technique to assess free fluid in pleural cavity. Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The **eFAST exam (extended Focused Assessment with Sonography for Trauma)** evaluates multiple areas for **free fluid**, including the abdominal cavity, thoracic cavity (pleural effusions), and pericardium (pericardial effusions). - It also includes specific views for the **pelvic cavity** (pouch of Douglas) to detect free fluid, which is highly relevant in trauma settings. *1 and 2 only* - This option misses the crucial component of assessing the **pleural cavity** for free fluid (hemothorax), which is an integral part of the **eFAST protocol**. - While it correctly includes the abdominal and pelvic cavities, the exclusion of the thoracic cavity (pleural) makes it incomplete. *2 and 3 only* - This option incorrectly omits the assessment of the **abdominal cavity**, which is a primary and essential part of any FAST or eFAST exam to identify intra-abdominal hemorrhage. - The abdominal cavity includes views of the **hepatorenal space (Morison's pouch)**, **splenorenal space**, and **suprapubic window**. *1 and 3 only* - This option incorrectly excludes the specific assessment of the **pelvic cavity**, which is routinely included in the eFAST exam, particularly in trauma, to identify dependent pooling of free fluid. - While it correctly includes the abdominal and thoracic cavities, the absence of the pelvic cavity assessment makes it incomplete.

Q: "Mickey Mouse Sign" during B-mode duplex ultrasound imaging comprises :

Popliteal artery, Popliteal vein and Tibial nerve. ***Popliteal artery, Popliteal vein and Tibial nerve*** - The \"Mickey Mouse Sign\" in the **popliteal fossa** visualizes the **popliteal artery** as the \"head\" and the **popliteal vein** and **tibial nerve** as the \"ears.\" - This specific configuration is seen on **transverse B-mode ultrasound** of the popliteal fossa and is crucial for identifying neurovascular structures for **popliteal nerve blocks** and vascular assessments. - The tibial nerve is the largest branch of the sciatic nerve in the popliteal fossa and runs alongside these vessels. *Common femoral vein, Common femoral artery and Great Saphenous vein* - This is the **most commonly referenced \"Mickey Mouse Sign\"** in ultrasound, visualized in the **groin/femoral region**. - The **common femoral artery** forms the \"head\" and the **common femoral vein** and **great saphenous vein** (at its junction) form the \"ears.\" - This sign is important for **central venous access**, **femoral vessel assessment**, and **avoiding complications** during procedures. *Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon* - These structures are located in the **lower leg and foot**, not in a configuration that forms the Mickey Mouse sign. - They are important for assessing **peripheral vascular status** but do not constitute this specific ultrasound landmark. *Brachial artery, Basilic vein and Biceps tendon* - These are structures found in the **upper arm**. - While important for upper extremity vascular imaging, they do not form the \"Mickey Mouse Sign\" pattern on ultrasound.

Q: The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is

aortoiliac segment. ***aortoiliac segment*** - The **aortoiliac segment** is often challenging to visualize due to its deep location within the **pelvis** and the presence of overlying **bowel gas**, which scatters ultrasound waves. - In obese patients, increased **adipose tissue** further attenuates the ultrasound signal, making imaging of this specific segment particularly difficult. *abdominal aorta above renal vessels* - While the **abdominal aorta** can be challenging, particularly the segment above the renal vessels due to the diaphragm and lung bases, it is generally more accessible than the deep pelvic structures. - Visualization can be improved by optimizing patient position and using specific transducer angles. *carotid vessels* - **Carotid vessels** are superficial and easily accessible for duplex scanning, making them one of the easiest vascular beds to image. - There is minimal tissue attenuation, and bowel gas is not a factor. *iliofemoral segment* - The **iliofemoral segment** is more superficial than the aortoiliac segment and is generally well visualized, especially the femoral arteries in the groin. - While obesity can increase the scanning depth, it does not pose the same challenges as the deeper and often gas-obscured pelvic vessels.

Q: The sonographic finding of a cyst containing clear fluid is described as

Anechoic. ***Anechoic*** - **Anechoic** refers to structures that do not produce echoes, appearing **black** on ultrasound. - A simple cyst with clear fluid allows sound waves to pass through without reflection, making it appear anechoic. *Isoechoic* - **Isoechoic** describes structures that have the same echogenicity as surrounding tissues. - This term is typically used for solid tissues rather than fluid-filled cysts. *Hypoechoic* - **Hypoechoic** structures produce fewer echoes than surrounding tissues, appearing darker but not completely black. - This is often seen in solid lesions or complex cysts with internal debris, not clear fluid. *Hyperechoic* - **Hyperechoic** structures produce many echoes, appearing brighter than surrounding tissues. - This can be indicative of calcifications, fat, or certain solid masses, not clear fluid.

Q: Endoluminal probe for transrectal ultrasonography operates at the frequency of:

7.5 MHz. ***7.5 MHz*** * **Transrectal ultrasonography (TRUS)** typically utilizes frequencies between **7 and 10 MHz** to achieve a good balance of penetration depth and resolution in the prostate and surrounding tissues. * A frequency of **7.5 MHz** is commonly employed for detailed imaging of the prostate, allowing for clear visualization of anatomical structures and detection of abnormalities like tumors or inflammation. *5.0 MHz* * A frequency of **5.0 MHz** provides greater penetration depth but offers lower resolution, which is generally not optimal for the detailed imaging required in TRUS of the prostate. * Lower frequencies are more often used for imaging deeper structures or in situations where tissue attenuation is high, which is less of a concern for the relatively superficial prostate. *2.5 MHz* * A frequency of **2.5 MHz** offers significantly higher penetration but at the cost of very low resolution, making it unsuitable for the precise diagnostic imaging of the prostate gland. * This lower frequency range is typically used for general abdominal imaging or structures requiring deep penetration, where fine detail is not the primary concern. *15.0 MHz* * A frequency of **15.0 MHz** provides excellent resolution but has very limited penetration depth, making it less practical for comprehensive transrectal imaging of the entire prostate gland. * While high frequencies can be used for very superficial structures or specific applications requiring extremely fine detail, they often cannot visualize the entire organ effectively due to rapid attenuation.

Q: In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

All of these. ***All of these*** - The presence of the **banana sign**, **lemon sign**, and a **visible vertebral or overlying tissue defect** are all characteristic ultrasound findings in a fetus with spina bifida. - These signs indicate associated structural abnormalities in the **brain** and **spine** due to the neural tube defect. - All three findings are clinically significant and commonly used for prenatal diagnosis. **Banana sign** - This refers to the shape of the **cerebellum** appearing flattened and curved like a banana due to its caudal displacement into the foramen magnum in **Chiari II malformation**, which is frequently associated with spina bifida. - It is an important indicator of **hindbrain herniation**. **Lemon sign** - The lemon sign describes the shape of the fetal skull, where the frontal bones are indented, making the head appear like a **lemon** on axial view. - This sign is often seen in cases of **spina bifida** and is caused by **bifrontal bone scalloping**. **Defect seen in vertebral bodies or tissue overlying it** - This is the **direct visualization** of the open neural tube defect (myelomeningocele or meningocele) in the spine. - It involves a discontinuity in the **vertebral arches** and/or the overlying soft tissues.

Question 1

Which of the following is a primary use of this imaging modality?

![img-42.jpeg](img-42.jpeg)

Accepted Answer

Staging of esophageal cancer

Answer

Evaluation of gastroesophageal reflux disease (GERD)

Answer

Identifying the cause of dysphagia

Answer

Assessing cardiac and aortic pathology

Question 2

Identify the imaging procedure shown in the image.

Accepted Answer

Saline infusion sonography

Answer

Hysterosalpingography

Answer

Pelvic ultrasound

Answer

MRI of pelvis

Question 3

Identify the type of sonography shown:

Accepted Answer

Saline infusion sonography

Answer

Doppler sonography

Answer

3D sonography

Answer

Hysterosalpingography

Question 4

A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Accepted Answer

Lemon sign

Answer

Boomerang sign

Answer

Spring coiled sign

Answer

Banana sign

Question 5

Which one of the following statements is correct regarding eFAST in trauma?

1. It is a technique to assess free fluid in abdominal cavity, thoracic cavity, and pericardium.
2. It is a technique to assess free fluid in pelvic cavity.
3. It is a technique to assess free fluid in pleural cavity.

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 6

"Mickey Mouse Sign" during B-mode duplex ultrasound imaging comprises :

Accepted Answer

Popliteal artery, Popliteal vein and Tibial nerve

Answer

Common femoral vein, Common femoral artery and Great Saphenous vein

Answer

Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon

Answer

Brachial artery, Basilic vein and Biceps tendon

Question 7

The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is

Accepted Answer

aortoiliac segment

Answer

abdominal aorta above renal vessels

Answer

carotid vessels

Answer

iliofemoral segment

Question 8

The sonographic finding of a cyst containing clear fluid is described as

Accepted Answer

Anechoic

Answer

Isoechoic

Answer

Hypoechoic

Answer

Hyperechoic

Question 9

Endoluminal probe for transrectal ultrasonography operates at the frequency of:

Accepted Answer

7.5 MHz

Answer

5.0 MHz

Answer

2.5 MHz

Answer

15.0 MHz

Question 10

In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

Accepted Answer

All of these

Answer

Banana sign

Answer

Lemon sign

Answer

Defect seen in vertebral bodies or tissue overlying it

Ultrasound — MCQs

Ultrasound — MCQs

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