Ultrasound Practice Questions

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.

Q: Which one of the following is NOT the strength of ultrasound as a diagnostic modality?

Short learning curve. ***Short learning curve*** - While ultrasound is widely used, developing proficiency requires **extensive training** and **experience**, especially for complex evaluations. - The interpretation of ultrasound images is highly **operator-dependent**, and mastering proper technique and recognizing subtle findings demands a significant learning investment. *No radiation* - Ultrasound uses **sound waves** to generate images, meaning it does not expose patients to **ionizing radiation**. - This makes it a safer option for repeated studies, pregnant patients, and pediatric populations compared to modalities like X-rays or CT scans. *Inexpensive* - Ultrasound machines are generally **less expensive** to purchase and maintain compared to MRI or CT scanners. - The procedure itself is also typically **less costly** than other advanced imaging techniques, making it more accessible. *Allows dynamic studies to be done* - Ultrasound can capture images in **real-time**, allowing clinicians to observe organ movement, blood flow, and tissue changes during various maneuvers. - This capability is crucial for assessing joint stability, vascular patency, and the mobility of masses or fluid collections.

Q: Banana sign is seen in which of the following conditions?

Spina bifida. ***Spina bifida*** - The **"banana sign"** is a distinctive ultrasound finding associated with **Chiari II malformation**, which is frequently seen in cases of **spina bifida**. - It refers to the characteristic **flattening and anterior bowing of the cerebellar hemispheres**, compressing them against the skull and giving them a banana-like appearance. *NCC* - **Neurocysticercosis (NCC)** is caused by tapeworm larvae in the central nervous system and is characterized by **cysts** or calcifications on imaging, not a "banana sign." - Imaging findings in NCC typically include **cystic lesions**, **edema**, and calcifications, unrelated to cerebellar shape. *Omphalocele* - **Omphalocele** is an abdominal wall defect where abdominal organs protrude through the navel, covered by a membrane. - The ultrasound findings for omphalocele involve visualization of abdominal contents outside the abdominal cavity, which is distinct from intracranial findings like the "banana sign." *Anencephaly* - **Anencephaly** is a severe birth defect where a baby is born without parts of the brain and skull, typically presenting with an **absent cranial vault** and cerebral hemispheres. - While a severe neural tube defect, anencephaly features agenesis of the brain and skull, rather than the cerebellar distortion seen as a "banana sign."

Q: Identify the imaging modality given below.

USG. ***USG*** - The image displays characteristic **gray-scale imaging** with an **echogenic appearance** of tissues, typical of an ultrasound. - Presence of annotations like "10 MHz G 64%" for **frequency and gain**, and "PRC" suggest ultrasound parameters. *Fluoroscopy* - Fluoroscopy provides **real-time X-ray images** and often involves the use of contrast agents, appearing as a dynamic, darker image with high contrast. - The image lacks the distinct bone and air contrast and dynamic motion typical of fluoroscopy. *X-Ray* - X-ray images depict a **static shadowgram** of dense structures like bones as white, and air as black, with sharp delineation. - The image shows a **granular texture** and fluid-filled structures that are characteristic of soft tissue imaging through ultrasound, not X-ray. *MRI* - MRI produces **cross-sectional images** with high soft tissue contrast in multiple planes (axial, sagittal, coronal). - The image shows real-time B-mode ultrasound characteristics with **probe frequency notation**, not the slice-based imaging of MRI.

Q: Which of the following is best assessed by FAST USG?

Pericardium. ***Pericardium*** - FAST USG is **most clinically significant** for detecting **pericardial effusions** and **cardiac tamponade** in trauma patients. - The **subxiphoid view** provides **excellent direct visualization** of the heart and pericardial space with minimal interference. - **Small volumes** of pericardial fluid (as little as 50-100 mL) are **clinically significant** and potentially life-threatening, requiring immediate intervention. - Cardiac tamponade is an **immediately reversible cause of shock** that demands urgent diagnosis and pericardiocentesis. - **Sensitivity >90%** for clinically significant pericardial effusions in the trauma setting. *Liver* - FAST assesses the **hepatorenal space (Morison's pouch)** for free fluid, not the liver parenchyma itself. - Requires **larger volumes of free fluid** (>200-500 mL) to be reliably detected in the peritoneal cavity. - Detailed assessment of actual liver injury requires **contrast-enhanced CT imaging**. *Spleen* - FAST evaluates the **splenorenal recess** for free fluid surrounding the spleen, not splenic parenchymal injury. - Detection depends on adequate volume of free fluid being present. - **CT scanning** is superior for defining splenic lacerations, hematomas, and grading injury severity. *Pleural cavity* - While Extended FAST (eFAST) can assess **pleural spaces** for effusion or pneumothorax, this is an **extension** of the standard 4-view FAST protocol. - Standard FAST focuses on the **four primary windows**: pericardial, perihepatic, perisplenic, and pelvic. - **Chest X-ray** and **CT** remain primary modalities for comprehensive thoracic assessment.

Q: Red Color on color doppler suggests?

Flow towards the transducer. ***Flow towards the transducer*** - In **color Doppler ultrasound**, the standard convention is that **red color** represents blood flow moving **towards** the transducer. - This is based on the **Doppler effect**, where frequency shift occurs as blood cells move closer to the transducer, which the ultrasound machine translates into a red hue. - This convention helps sonographers quickly interpret the direction of blood flow within vessels or cardiac chambers. *Flow Away from the transducer* - Flow moving **away** from the transducer is depicted in **blue** on color Doppler imaging. - This is the opposite of red, creating an intuitive visual distinction for flow direction assessment. *Arterial Blood* - Color Doppler displays the **direction of flow** relative to the transducer, not whether blood is arterial or venous. - While arteries carry oxygenated blood and veins carry deoxygenated blood, the color shown (red or blue) **only indicates movement direction**, not the blood's oxygenation status or vessel type. - Both arterial and venous blood can appear red or blue depending on their flow direction relative to the transducer position. *Venous Blood* - Similar to arterial blood, venous blood can appear as either red or blue on color Doppler depending solely on flow direction. - The color assignment is **independent of vessel type** and only reflects whether flow is toward (red) or away (blue) from the transducer.

Q: Transrectal ultrasonography in carcinoma prostate is most useful for –

Guided prostatic biopsies. ***Guided prostatic biopsies*** - **Transrectal ultrasonography (TRUS)** provides real-time visualization of the prostate, allowing for precise guidance during **prostatic biopsies**. - This guidance ensures that tissue samples are taken from suspicious areas, increasing the diagnostic yield for **prostate cancer**. *To detect hypoechoic area* - While TRUS can identify **hypoechoic areas** in the prostate, which may suggest malignancy, these are **not specific** to cancer and can be caused by other conditions like inflammation. - The primary utility of TRUS in prostate cancer is not merely detection of these areas, but rather using this information for targeted sampling. *Seminal vesicle involvement* - TRUS can visualize the seminal vesicles, but its accuracy in definitively determining **seminal vesicle invasion** is limited compared to more advanced imaging like **MRI**. - **MRI** is generally preferred for assessing extraprostatic extension and seminal vesicle involvement due to its superior soft tissue contrast. *Measurement of prostatic volume* - TRUS is used to measure **prostatic volume**, which is important for calculating **PSA density** and for treatment planning in benign prostatic hyperplasia (BPH). - However, in the context of prostate cancer, while volume measurement is possible, guided biopsy is its most crucial role for diagnosis.

Q: FAST USG focuses on all of the following areas except-

Pleura. ***Pleura*** - While pleural assessment is included in **extended FAST (E-FAST)** for detecting pneumothorax and hemothorax, the **traditional FAST protocol** focuses specifically on detecting **free fluid** in the **peritoneal** and **pericardial** spaces in trauma patients. - The pleura is not one of the standard **four views** of traditional FAST USG, though it is assessed in the expanded E-FAST protocol. *Splenic* - The **splenorenal recess** (left upper quadrant space between the spleen and left kidney) is one of the four key regions in FAST USG to detect **free fluid**. - Fluid accumulation in this area can indicate injury to the spleen or other abdominal organs. *Hepatic* - The **hepatorenal recess (Morison's pouch)** between the liver and right kidney is a critical view in FAST USG for identifying **free fluid**. - This is often the first place fluid collects in the peritoneum in supine patients and is the most sensitive area for detecting intraperitoneal fluid. *Pelvic* - The **pouch of Douglas** (rectovesical in males or rectouterine in females) is a standard view in FAST USG to detect **free fluid** in the pelvis. - Fluid here can indicate significant abdominal or pelvic injury.

Q: Best method to diagnose hydrocephalus in a fetus at 24 weeks gestation is:

Ultrasound. ***Ultrasound*** - **Fetal ultrasound** is the primary and most effective imaging modality for diagnosing hydrocephalus in a 6-month-old fetus due to its **safety**, accessibility, and ability to visualize the developing brain. - It allows for the measurement of **ventricular size** and observation of characteristic features of hydrocephalus, such as **ventriculomegaly** and **dangling choroid plexus**. *X-ray* - **X-rays** use ionizing radiation, which is generally avoided in pregnant women due to potential risks to the developing fetus. - They provide limited detail of **soft tissues** like the brain and would not be effective in diagnosing hydrocephalus. *CT scan* - **CT scans** also involve significant **radiation exposure**, posing risks to the fetus and limiting their use in prenatal diagnosis. - While capable of visualizing brain structures, the benefits do not outweigh the **radiation risk** when safer and equally effective alternatives like ultrasound are available. *MRI* - **Fetal MRI** can provide detailed imaging of the fetal brain but is typically reserved for **further characterization** of anomalies identified by ultrasound or when ultrasound findings are inconclusive. - It is more expensive and less readily available than ultrasound, making it a **secondary imaging tool** rather than the primary diagnostic method for initial screening.

Q: A 40-year-old female was sent to the Radiology department for thyroid USG scan. Which probe will you use for thyroid scan?

Linear. ***Linear*** - A **linear probe** is ideal for scanning superficial structures like the thyroid gland due to its high-frequency transducers, which provide excellent **spatial resolution** for structures close to the skin surface. - This probe type yields a **rectangular field of view**, allowing for detailed imaging of the thyroid's fine anatomy and any subtle nodules or abnormalities. *Curvilinear* - A **curvilinear probe** uses a lower frequency, which offers better **penetration depth** but at the cost of spatial resolution, making it suitable for deeper abdominal or pelvic organs. - Its **curved footprint** produces a wider, sector-shaped field of view, which is less optimal for the detailed assessment of a superficial organ like the thyroid. *Endocavitary* - An **endocavitary probe** is specifically designed for intracavitary examinations, such as transvaginal or transrectal ultrasound, providing high-resolution images of internal structures not accessible externally. - Its specialized shape and frequency are entirely unsuitable for surface scanning of the thyroid gland. *Phase array* - A **phase array probe** is characterized by a small footprint and the ability to electronically steer the ultrasound beam, making it ideal for cardiac imaging or transcranial doppler studies where a small acoustic window is present. - While it can achieve good depth penetration, its primary application and image quality profile are not optimized for superficial, high-resolution imaging of organs like the thyroid.

Question 1

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

Question 2

Which one of the following is NOT the strength of ultrasound as a diagnostic modality?

Accepted Answer

Short learning curve

Answer

No radiation

Answer

Inexpensive

Answer

Allows dynamic studies to be done

Question 3

Banana sign is seen in which of the following conditions?

Accepted Answer

Spina bifida

Answer

NCC

Answer

Omphalocele

Answer

Anencephaly

Question 4

Identify the imaging modality given below.

Accepted Answer

USG

Answer

Fluoroscopy

Answer

X-Ray

Answer

MRI

Question 5

Which of the following is best assessed by FAST USG?

Accepted Answer

Pericardium

Answer

Liver

Answer

Spleen

Answer

Pleural cavity

Question 6

Red Color on color doppler suggests?

Accepted Answer

Flow towards the transducer

Answer

Flow Away from the transducer

Answer

Arterial Blood

Answer

Venous Blood

Question 7

Transrectal ultrasonography in carcinoma prostate is most useful for –

Accepted Answer

Guided prostatic biopsies

Answer

To detect hypoechoic area

Answer

Seminal vesicle involvement

Answer

Measurement of prostatic volume

Question 8

FAST USG focuses on all of the following areas except-

Accepted Answer

Pleura

Answer

Splenic

Answer

Hepatic

Answer

Pelvic

Question 9

Best method to diagnose hydrocephalus in a fetus at 24 weeks gestation is:

Accepted Answer

Ultrasound

Answer

X-ray

Answer

CT scan

Answer

MRI

Question 10

A 40-year-old female was sent to the Radiology department for thyroid USG scan. Which probe will you use for thyroid scan?

Accepted Answer

Linear

Answer

Curvilinear

Answer

Endocavitary

Answer

Phase array

Ultrasound — MCQs

Ultrasound — MCQs

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