Lung Ultrasound — MCQs
Which is not echogenic while doing ultrasonography:
Which is NOT a feature of pleural effusion?
Most sensitive method of monitoring cardiovascular ischemia in the perioperative period is -
A patient of RTA with injury over chest and limbs has low SpO2. M-mode ultrasound of right upper chest shows stratosphere sign. What is the diagnosis?
A chest CT shows 'comet tail' sign in lung bases. Which additional finding would best support rounded atelectasis?
You are in the operating room and notice the tracing in yellow colour on this device. What does it indicate?
A woman has been using oral contraceptive pills (OCP) for 5 months and has had amenorrhea for the last 6 weeks. What is the best method to calculate the gestational age in this case?
What is the gold standard diagnostic procedure for assessing placental location during the second trimester?
Which of the following statements about deep venous thrombosis (DVT) is incorrect?
Diagnostic criteria for PCOS are: 1. Oligo/amenorrhea 2. Hyperandrogenism 3. Polycystic ovaries on ultrasound Which of the above are correct?
Lung Ultrasound Indian Medical PG Practice Questions and MCQs
Question 1: Which is not echogenic while doing ultrasonography:
- A. Bile (Correct Answer)
- B. Bone
- C. Gas
- D. Gall stones
Explanation: ***Bile*** - Bile is largely composed of **water**, which allows ultrasound waves to pass through it with minimal reflection, appearing **anechoic** (black) on ultrasound. - This property makes the gallbladder lumen, when filled with bile, appear anechoic, which is crucial for identifying structures like gallstones. *Bone* - **Bone** is highly dense and reflects a significant portion of ultrasound waves, making it appear very **echogenic** (bright) on ultrasonography. - Due to its high reflectivity, bone often produces a strong **acoustic shadow** behind it, obscuring deeper structures. *Gas* - **Gas** (air) is a strong reflector of ultrasound waves and appears brightly echogenic, often with a characteristic **dirty shadowing** or **reverberation artifact**. - The presence of gas can significantly hinder visualization of underlying tissues due to its strong reflection and scatter of the ultrasound beam. *Gall stones* - **Gallstones** are solid concretions that are highly reflective of ultrasound waves, appearing as bright, **echogenic foci** within the gallbladder lumen. - A classic ultrasound sign of gallstones is an echogenic structure with strong **posterior acoustic shadowing**.
Question 2: Which is NOT a feature of pleural effusion?
- A. Horizontal fluid level
- B. Low lung volume
- C. Muffled heart sound (Correct Answer)
- D. Decreased chest movements
Explanation: ***Muffled heart sound*** - This is **NOT a feature of pleural effusion** and is the correct answer to this negation question. - Muffled heart sounds are characteristic of **pericardial effusion** or **cardiac tamponade**, where fluid accumulates in the pericardial sac around the heart itself. - Pleural effusion involves fluid in the pleural space surrounding the lungs, not the heart. - While massive pleural effusions can displace mediastinal structures, they do not typically cause muffled heart sounds. *Horizontal fluid level* - This **IS a feature** when air is also present in the pleural space (**hydropneumothorax**). - In **simple pleural effusion** (fluid only), the fluid typically forms a **meniscus-shaped curve** with blunting of the costophrenic angles on upright chest X-ray, not a horizontal level. - However, when both air and fluid are present, a distinct horizontal air-fluid level is visible on upright imaging. - Since the question asks about pleural effusion broadly, and effusions can be associated with air (empyema with gas-forming organisms, post-thoracentesis), this can be considered a radiological feature in certain contexts. *Low lung volume* - This **IS a feature** of pleural effusion. - The accumulating pleural fluid causes **compression atelectasis** of the adjacent lung parenchyma. - This results in **reduced functional lung volume** on the affected side, visible on chest imaging. *Decreased chest movements* - This **IS a feature** of pleural effusion. - Fluid in the pleural space restricts normal lung expansion and chest wall movement. - On physical examination, there are **diminished respiratory excursions** on the affected side. - This is one of the classic clinical signs of pleural effusion.
Question 3: Most sensitive method of monitoring cardiovascular ischemia in the perioperative period is -
- A. NIBP
- B. ECG
- C. Pulse oximeter
- D. TEE (Correct Answer)
Explanation: ***TEE*** - **Transesophageal echocardiography (TEE)** is the most sensitive method for detecting perioperative myocardial ischemia because it can visualize **regional wall motion abnormalities** and changes in **ventricular function** much earlier than ECG. - **Ischemia** directly impairs the contractility of the affected myocardium, leading to subtle changes in wall motion that TEE can identify. *NIBP* - **Non-invasive blood pressure (NIBP)** monitoring can detect **hemodynamic changes** (like hypotension or hypertension) that may precede or accompany ischemia. - However, these changes are **non-specific** and occur relatively late, making NIBP a less sensitive indicator of early ischemia. *ECG* - **Electrocardiography (ECG)** monitors the electrical activity of the heart and can detect **ST-segment changes** indicative of ischemia. - While useful, ECG changes may appear later than wall motion abnormalities, and **silent ischemia** can be missed if the leads are not optimally placed or if the ischemia does not produce significant electrical changes. *Pulse oximeter* - A **pulse oximeter** measures **oxygen saturation** in the peripheral blood. - It is primarily used to assess **respiratory function** and tissue oxygenation, and it does not directly monitor myocardial ischemia or cardiac function.
Question 4: A patient of RTA with injury over chest and limbs has low SpO2. M-mode ultrasound of right upper chest shows stratosphere sign. What is the diagnosis?
- A. Cardiac tamponade
- B. Hemothorax
- C. Pulmonary embolism
- D. Pneumothorax (Correct Answer)
Explanation: ***Pneumothorax*** - A **stratosphere sign** (also known as a barcode sign) on M-mode ultrasound indicates the absence of lung sliding, which is a key diagnostic feature of **pneumothorax**. - In a patient with chest injury and low SpO2, the presence of a **collapsed lung** due to air in the pleural space explains respiratory distress. *Cardiac tamponade* - Characterized by **fluid accumulation in the pericardial sac**, leading to impaired cardiac filling and shock. - While it can cause low SpO2 and be associated with chest trauma, the **stratosphere sign** is not a diagnostic feature of cardiac tamponade. *Hemothorax* - Involves the **accumulation of blood in the pleural space**, often following trauma, leading to respiratory compromise. - Ultrasound in hemothorax would show **anechoic or complex fluid collections** but not the stratosphere sign. *Pulmonary embolism* - A condition where a **blood clot blocks blood flow to the lungs**, causing sudden onset dyspnea and hypoxemia. - Although it causes low SpO2, pulmonary embolism is not diagnosed by chest ultrasound revealing a **stratosphere sign**.
Question 5: A chest CT shows 'comet tail' sign in lung bases. Which additional finding would best support rounded atelectasis?
- A. Pleural thickening (Correct Answer)
- B. Ground glass opacities
- C. Tree-in-bud pattern
- D. Honeycomb changes
Explanation: ***Pleural thickening*** - The 'comet tail' sign refers to **curved bronchi and vessels** leading into a rounded opaque lesion, which is highly characteristic of **rounded atelectasis**. - **Pleural thickening** is an almost universal finding in rounded atelectasis, as it commonly develops in areas of localized pleural inflammation and fibrosis. *Ground glass opacities* - **Ground glass opacities** indicate partial filling of airspaces or thickening of interstitial structures, but they do not specifically point to rounded atelectasis. - This finding is nonspecific and can be seen in various lung conditions, including infection, inflammation, or early fibrosis. *Tree-in-bud pattern* - A **tree-in-bud pattern** on CT suggests infection or inflammation of the small airways (**bronchioles**), commonly seen in conditions like **bronchiolitis**, tuberculosis, or aspiration. - It does not directly correlate with the development or features of rounded atelectasis. *Honeycomb changes* - **Honeycomb changes** are a hallmark of **end-stage pulmonary fibrosis**, representing clustered cystic airspaces with thickened walls. - While rounded atelectasis involves fibrosis, honeycomb changes represent a distinct and more severe pattern of lung damage.
Question 6: You are in the operating room and notice the tracing in yellow colour on this device. What does it indicate?
- A. O2 pressure in exhaled air
- B. Capnography (Correct Answer)
- C. O2 pressure in inhaled air
- D. Airway pressure
Explanation: ***Capnography*** - The yellow tracing displays a waveform that is characteristic of a **capnogram**, which measures the concentration of **carbon dioxide (CO2)** in the expired breath over time. - The rectangular shape with a sudden rise, plateau, and rapid fall is typical of the **CO2 waveform** during a respiratory cycle. *O2 pressure in exhaled air* - While oxygen levels can be monitored, the characteristic waveform shown with its distinct plateau phase is specific to **carbon dioxide** measurement. - Oxygen monitoring provides different types of waveforms or numerical values, such as **pulsus oximetry**, which shows oxygen saturation. *O2 pressure in inhaled air* - Monitoring devices typically display **inspired oxygen concentration (FiO2)** as a numerical value rather than a waveform. - The waveform shown is indicative of gas exchange dynamics during **exhalation**, not inhalation. *Airway pressure* - Airway pressure tracings typically show a waveform that correlates with the **inspiratory and expiratory phases** of breathing, indicating the pressure within the airway. - However, the specific shape and plateau of the waveform in yellow are distinct from typical **airway pressure** curves and are characteristic of CO2.
Question 7: A woman has been using oral contraceptive pills (OCP) for 5 months and has had amenorrhea for the last 6 weeks. What is the best method to calculate the gestational age in this case?
- A. Abdominal girth
- B. 280 days from Last Menstrual Period (LMP)
- C. Crown-Rump Length (CRL) by Ultrasound (USG) (Correct Answer)
- D. 256 days from Last Menstrual Period (LMP)
Explanation: ***Crown-Rump Length (CRL) by Ultrasound (USG)*** - For women with **irregular menstrual cycles**, unknown last menstrual period, or those on **hormonal contraceptives**, **early ultrasound measurement of CRL** is the most accurate method for gestational age determination. - CRL is most accurate between **6 and 14 weeks of gestation**, providing a precise estimate within 3-5 days. *Abdominal girth* - **Abdominal girth** is an unreliable and highly variable measure that is not used for accurate gestational age determination. - It is influenced by maternal body habitus, uterine fibroids, and amniotic fluid volume, making it imprecise. *280 days from Last Menstrual Period (LMP)* - This method (Naegele's rule) assumes a **regular 28-day menstrual cycle** and ovulation on day 14, which is not applicable for a woman on **oral contraceptive pills (OCP)** where ovulation is suppressed. - The use of OCPs alters the hormonal profile, generally causing **amenorrhea or withdrawal bleeding** that does not reflect a true ovulatory cycle. *256 days from Last Menstrual Period (LMP)* - This calculation is not a standard or recognized method for determining **estimated date of delivery (EDD)**. - The standard calculation from LMP uses **280 days (40 weeks)** for a full-term pregnancy.
Question 8: What is the gold standard diagnostic procedure for assessing placental location during the second trimester?
- A. Transabdominal ultrasound imaging
- B. Transvaginal ultrasound imaging (Correct Answer)
- C. Computed Tomography (CT) scan
- D. Magnetic Resonance Imaging (MRI)
Explanation: ***Transvaginal ultrasound imaging*** - The **gold standard for accurate assessment** of placental location, particularly for determining the exact distance between the placental edge and the internal cervical os. - Provides **superior resolution and clarity** of the cervix and lower uterine segment compared to transabdominal approach, with sensitivity approaching **95-100%** for placenta previa diagnosis. - Particularly valuable when the placenta is **posterior**, in **obese patients**, or when transabdominal findings are equivocal. - **Safe procedure** with no increased risk of bleeding, contrary to historical concerns. *Transabdominal ultrasound imaging* - The standard **initial screening tool** for placental localization in routine second-trimester anatomy scans. - May provide **suboptimal visualization** of the lower uterine segment, especially with a posterior placenta, full bladder distortion, or maternal obesity. - Can **overestimate** the distance between placental edge and cervical os due to bladder compression effects, potentially leading to false-positive diagnoses of placenta previa that resolve on transvaginal imaging. *Computed Tomography (CT) scan* - Involves **ionizing radiation** exposure to the fetus, which is contraindicated in pregnancy except for emergent maternal indications. - Provides **poor soft tissue contrast** for placental assessment compared to ultrasound. - Not used for routine obstetric imaging. *Magnetic Resonance Imaging (MRI)* - Excellent soft tissue contrast but **more expensive**, time-consuming, and less readily available than ultrasound. - Reserved for **complex scenarios** such as suspected placenta accreta spectrum disorders, morbidly adherent placenta, or when ultrasound findings are inconclusive. - Not the primary modality for routine placental localization in the second trimester.
Question 9: Which of the following statements about deep venous thrombosis (DVT) is incorrect?
- A. Mostly bilateral (Correct Answer)
- B. Most common clinically presents as pain and tenderness in calf
- C. Some cases may directly present as pulmonary thromboembolism
- D. Clinical assessment highly reliable
Explanation: ***Mostly bilateral*** - DVT is typically **unilateral**, affecting one limb [2]. Bilateral DVT is less common, making this statement incorrect [2]. - The symptoms of **pain, swelling, and tenderness** are usually localized to one leg [1]. *Most common clinically presents as pain and tenderness in calf* - **Calf pain and tenderness** are common clinical presentations of DVT, especially in the lower extremities [1]. - Other common signs include **swelling, warmth, and redness** in the affected leg [1]. *Some cases may directly present as pulmonary thromboembolism* - A significant concern with DVT is that a **clot can dislodge** and travel to the lungs, causing a **pulmonary embolism (PE)**, which can be the initial presentation [1]. - PE is a potentially life-threatening complication and may present with **dyspnea, chest pain, and hemoptysis**. *Clinical assessment highly reliable* - **Clinical assessment alone is not highly reliable** for diagnosing DVT due to its variable and often non-specific presentation [2]. - A definitive diagnosis usually requires objective diagnostic tests such as **compression ultrasonography** or **D-dimer assay** [3].
Question 10: Diagnostic criteria for PCOS are: 1. Oligo/amenorrhea 2. Hyperandrogenism 3. Polycystic ovaries on ultrasound Which of the above are correct?
- A. 1, 2 and 3 (Correct Answer)
- B. 2 and 3 only
- C. 1 and 3 only
- D. 1 and 2 only
Explanation: ***1, 2 and 3*** - All three listed features are the **Rotterdam criteria** for diagnosing PCOS, which is the most widely used diagnostic system. - The Rotterdam criteria require **at least 2 out of 3** of the following: **(1) oligo-ovulation/anovulation** (clinically presenting as oligo/amenorrhea), **(2) clinical or biochemical hyperandrogenism**, and **(3) polycystic ovaries on ultrasound**. - Since all three listed features are valid diagnostic criteria, the correct answer includes all of them (1, 2, and 3). - Note: Diagnosis requires meeting 2 out of 3 criteria, but all 3 are recognized valid criteria. *2 and 3 only* - This option incorrectly excludes **oligo/amenorrhea** (oligo-ovulation/anovulation). - Oligo/amenorrhea is a core criterion in the Rotterdam criteria and represents the ovulatory dysfunction that is central to PCOS. - Excluding this criterion makes the option incomplete. *1 and 3 only* - This option incorrectly excludes **hyperandrogenism**. - Hyperandrogenism (clinical signs like hirsutism, acne, or biochemical elevation of androgens) is a fundamental criterion in the Rotterdam criteria. - It reflects the hormonal dysregulation that characterizes PCOS and cannot be excluded as a valid diagnostic criterion. *1 and 2 only* - This option incorrectly excludes **polycystic ovaries on ultrasound**. - The ultrasound finding of polycystic ovarian morphology (≥12 follicles measuring 2-9 mm or ovarian volume >10 mL) is an essential criterion in the Rotterdam criteria. - Excluding this morphological feature makes the option incomplete.
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