Ultrasound — MCQs
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POCUS is related to which imaging modality?
Pulse echo principle is used by which modality?
Which of the following contrast agents is used in USG?
Ultrasonography transducer contains –
Absent cranial vault on ultrasound imaging is characteristic of
Investigation of choice to diagnose hypertrophic pyloric stenosis in infants is
All are important ultrasound findings of amebic liver abscess, EXCEPT:
The "Target sign" ultrasonographically means:
Thyroid malignancies appear on USG as
USG findings of focal anechoic lesion with floating membranes indicate which liver pathology?
Ultrasound Indian Medical PG Practice Questions and MCQs
Question 201: POCUS is related to which imaging modality?
- A. X-ray
- B. MRI
- C. CT
- D. Ultrasound (Correct Answer)
Explanation: ***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.
Question 202: Pulse echo principle is used by which modality?
- A. X-ray
- B. CT
- C. MRI
- D. USG (Correct Answer)
Explanation: ***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.
Question 203: Which of the following contrast agents is used in USG?
- A. Urograffin
- B. Omnipaque
- C. Conray
- D. SonoVue (Correct Answer)
Explanation: ***SonoVue*** - **SonoVue** (also known as Lumason in the US) is the most commonly used **microbubble contrast agent** specifically designed for **ultrasonography (USG)**. - Contains **sulphur hexafluoride gas microbubbles** stabilized by a phospholipid shell. - These microbubbles enhance the echogenicity of blood, improving the visualization of blood flow and tissue perfusion in various organs, particularly in **liver imaging** and **cardiac echocardiography**. - Other USG contrast agents include Definity and Optison. *Urograffin* - **Urograffin** (diatrizoate) is an iodine-based contrast agent primarily used in **X-ray imaging**, particularly for **urography (imaging of the urinary tract)** and **angiography**. - It is not suitable for USG as it does not produce the necessary acoustic impedance difference for ultrasound enhancement. *Omnipaque* - **Omnipaque** (iohexol) is a non-ionic, low-osmolar **iodinated contrast agent** used for various **X-ray and CT procedures**. - Like other iodinated agents, its properties are optimized for X-ray attenuation, not for ultrasound enhancement. *Conray* - **Conray** (iothalamate) is an older generation, high-osmolar, **iodinated contrast agent** used for various **X-ray procedures** like angiography and CT scans. - Similar to Urograffin, it works by X-ray attenuation and is not effective for ultrasound contrast enhancement.
Question 204: Ultrasonography transducer contains –
- A. Lead Zirconate (Correct Answer)
- B. Sodium fluoride
- C. Caesium fluoride
- D. None of the options
Explanation: ***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.
Question 205: Absent cranial vault on ultrasound imaging is characteristic of
- A. Renal anomalies
- B. Congenital rubella syndrome
- C. Anencephaly (Correct Answer)
- D. Trisomy 18
Explanation: ***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
Question 206: Investigation of choice to diagnose hypertrophic pyloric stenosis in infants is
- A. Gastroscopy
- B. CT scan abdomen
- C. Ultrasound abdomen (Correct Answer)
- D. Contrast radiology
Explanation: ***Ultrasound abdomen*** - **Abdominal ultrasound** is the diagnostic procedure of choice due to its **non-invasive nature**, **lack of radiation exposure**, and high accuracy in visualizing the pylorus. - It allows for direct measurement of the **pyloric muscle wall thickness** (typically >3-4 mm) and **pyloric channel length** (typically >14-17 mm), which are characteristic findings of hypertrophic pyloric stenosis. *Gastroscopy* - While gastroscopy can visualize the gastric outlet, it is an **invasive procedure** and not the primary diagnostic tool due to the risk associated with endoscopy in infants. - It is often reserved for cases where the diagnosis is unclear or other upper gastrointestinal pathologies are suspected. *CT scan abdomen* - **CT scans** expose infants to **ionizing radiation**, making it an unsuitable primary diagnostic investigation, especially when a highly accurate non-irradiating alternative exists. - Although it can show pyloric thickening, its disadvantages outweigh its benefits for this diagnosis. *Contrast radiology* - **Barium studies** are less sensitive and specific than ultrasound for diagnosing pyloric stenosis, especially for distinguishing muscle thickening from spasm. - This method also involves **radiation exposure** and poses a risk of aspiration, making it a secondary choice.
Question 207: All are important ultrasound findings of amebic liver abscess, EXCEPT:
- A. Round or oval in shape
- B. Single lesion
- C. Located in the left hepatic lobe (Correct Answer)
- D. Hypoechoic with irregular ill defined margins initially
Explanation: ***Located in the left hepatic lobe*** - While amebic liver abscesses can occur in the left lobe, they are **much more common in the right hepatic lobe** due to the preferential blood flow from the portal vein's superior mesenteric branch. - Therefore, location in the left lobe is not an *expected* or typical finding for an amebic liver abscess. *Round or oval in shape* - **Amebic liver abscesses typically present as round or oval lesions** on ultrasound due to their expanding nature within the liver parenchyma. - This morphology is a common characteristic used for their sonographic identification. *Single lesion* - **Amebic liver abscesses are usually solitary**; multiple abscesses are less common. - This characteristic helps differentiate them from other liver pathologies, such as pyogenic abscesses, which are often multiple. *Hypoechoic with irregular ill defined margins initially* - In their early stages, amebic liver abscesses are **hypoechoic (darker) on ultrasound** because of the initial inflammatory response and presence of necrotic material. - They also tend to have **ill-defined and irregular margins** initially as the infection is spreading through the liver tissue.
Question 208: The "Target sign" ultrasonographically means:
- A. Liver metastasis
- B. Ectopic kidney
- C. Intussusception (Correct Answer)
- D. Ovarian carcinoma
Explanation: ***Intussusception*** - The **"target sign"** (also known as the **"donut sign"** or **"pseudokidney sign"**) on ultrasound is a classic finding for **intussusception**. - It represents concentric layers of bowel telescoping into an adjacent segment, creating a central hyperechoic core surrounded by hypoechoic rings. *Liver metastasis* - Liver metastases often appear as **hypoechoic, hyperechoic, or mixed echogenicity lesions** on ultrasound, and vary widely in appearance. - While some can have a "target-like" appearance with a hyperechoic rim, it's not the primary or most specific sign for liver metastasis and is less distinct than in intussusception. *Ectopic kidney* - An ectopic kidney is an anatomical variant where the kidney is located outside its normal position, most commonly in the **pelvis**. - On ultrasound, it would appear as a normally formed kidney in an atypical location, without the distinct concentric layers seen in the "target sign." *Ovarian carcinoma* - Ovarian carcinomas present with **complex masses** that can be solid, cystic, or mixed, often with septations, papillary projections, and areas of necrosis. - Their ultrasound appearance is highly variable but does not typically manifest as a "target sign" with concentric rings.
Question 209: Thyroid malignancies appear on USG as
- A. Hyperechoic
- B. Isoechoic
- C. Hypoechoic (Correct Answer)
- D. Anechoic
Explanation: ***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.
Question 210: USG findings of focal anechoic lesion with floating membranes indicate which liver pathology?
- A. Hydatid cyst (Correct Answer)
- B. Pyogenic abscess
- C. Hemangioma
- D. Amoebic abscess
Explanation: ***Hydatid cyst*** - A **hydatid cyst** often presents on ultrasound as a **focal anechoic lesion** with characteristic **floating membranes** (water lily sign) due to detachment of the endocyst. - These cysts are caused by tapeworm larvae (*Echinococcus granulosus*) and can have daughter cysts within the main cyst. *Pyogenic abscess* - A **pyogenic abscess** typically appears as an **ill-defined, hypoechoic liver lesion** with internal debris, sometimes showing gas. - While it can be anechoic, the presence of **floating membranes** is not a characteristic feature. *Hemangioma* - A **hemangioma** is usually a **well-defined, hyperechoic lesion** on ultrasound, without any internal fluid or floating membranes. - Its appearance is distinct from cystic lesions and it often shows characteristic peripheral nodular enhancement on contrast-enhanced imaging. *Amoebic abscess* - An **amoebic abscess** typically presents as a **hypoechoic, often round or oval lesion** with fine internal echoes and poorly defined walls, usually without floating membranes. - It is frequently located in the right lobe of the liver and can be difficult to differentiate from a pyogenic abscess based on imaging alone.
Practice by Chapter
Physics of Ultrasound
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Instrumentation and Techniques
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Abdominal Ultrasonography
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Pelvic Ultrasonography
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Obstetric Ultrasonography
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Small Parts Ultrasonography
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Musculoskeletal Ultrasonography
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Vascular Ultrasonography
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Pediatric Ultrasonography
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Contrast-Enhanced Ultrasound
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Ultrasound-Guided Interventions
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Doppler Ultrasound Principles and Applications
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