Pelvic Ultrasonography — MCQs

10 questions

Most common uterine tumor is:-

A 30-year-old woman presents with a history of pelvic pain and infertility. A transvaginal ultrasound is performed, and the image provided shows a tubular, fluid-filled structure with thin walls. There is no evidence of solid components or internal septations. What is the most likely diagnosis?

Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

A mother brings her daughter with short stature, webbed neck, and other physical features. What is the most likely finding on ultrasound?

Transrectal ultrasonography in carcinoma prostate is most useful for –

All are signs / features of ectopic pregnancy on USG except –

A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

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

Q10

Investigation of choice for vascular ring around airway:

Pelvic Ultrasonography Indian Medical PG Practice Questions and MCQs

Question 1: Most common uterine tumor is:-

A. Adenomyoma
B. Endometrial cancer
C. Leiomyosarcoma
D. Leiomyoma (Correct Answer)

Explanation: ***Leiomyoma*** - **Leiomyomas**, also known as **fibroids**, are the most **common benign tumors of the uterus**. - They are composed of **smooth muscle cells** and can vary in size and location within the uterus. *Adenomyoma* - An **adenomyoma** is a benign uterine tumor characterized by the presence of **endometrial glands and stroma** within the myometrium. - While it is a uterine tumor, it is significantly **less common** than leiomyomas. *Endometrial cancer* - **Endometrial cancer** is a **malignant tumor** arising from the endometrium and is the most common gynecologic malignancy. - However, malignant tumors are generally **less common** than benign tumors like leiomyomas. *Leiomyosarcoma* - **Leiomyosarcoma** is a **rare and aggressive malignant tumor** of the smooth muscle tissue of the uterus. - It accounts for a very small percentage of uterine masses and is much less common than benign leiomyomas.

Question 2: A 30-year-old woman presents with a history of pelvic pain and infertility. A transvaginal ultrasound is performed, and the image provided shows a tubular, fluid-filled structure with thin walls. There is no evidence of solid components or internal septations. What is the most likely diagnosis?

A. Ovarian cyst
B. Ectopic pregnancy
C. Hydrosalpinx (Correct Answer)
D. Endometrioma
E. Tubo-ovarian abscess

Explanation: ***Hydrosalpinx*** - The ultrasound finding of a **tubular, fluid-filled structure with thin walls** and no solid components or septations is highly characteristic of a **hydrosalpinx**, which is a blocked, fluid-filled fallopian tube. - **Pelvic pain** and **infertility** in a young woman are classic clinical presentations associated with hydrosalpinx, often resulting from previous pelvic inflammatory disease. *Ovarian cyst* - While ovarian cysts are fluid-filled, they typically appear as **rounded or oval structures within or adjacent to the ovary**, not distinctively tubular. - They can cause pain but are not typically associated with a "tubular" morphology on ultrasound. *Ectopic pregnancy* - An ectopic pregnancy would typically present with a **gestational sac** (with or without a fetal pole or yolk sac) outside the uterus, often in the fallopian tube. - While it can be tubular, it usually shows more complex internal echoes representing pregnancy components, and the clinical picture would involve a **positive pregnancy test** and often acute, unilateral pain. *Endometrioma* - An endometrioma is a type of ovarian cyst filled with **endometrial tissue**, often appearing on ultrasound as a **"ground glass" or "chocolate cyst"** with internal echoes due to old blood. - It would not typically present as a thin-walled, anechoic (purely fluid-filled) tubular structure. *Tubo-ovarian abscess* - A tubo-ovarian abscess (TOA) is a **complex inflammatory mass** that typically appears on ultrasound as a **thick-walled, complex structure with internal echoes, septations, or debris**. - TOA patients usually present with **acute symptoms including fever, elevated white blood cell count**, and severe pelvic pain, rather than the chronic presentation described here. - The ultrasound description of thin walls and no solid components makes TOA unlikely.

Question 3: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

A. Cyclophosphamide
B. Methotrexate
C. Cisplatin (Correct Answer)
D. Dacarbazine

Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.

Question 4: A mother brings her daughter with short stature, webbed neck, and other physical features. What is the most likely finding on ultrasound?

A. Hepatomegaly with altered echotexture
B. Echo showing tricuspid stenosis
C. Streak ovaries with small uterus (Correct Answer)
D. Single kidney

Explanation: ***Streak ovaries with small uterus*** - The constellation of **short stature** and **webbed neck** is highly suggestive of **Turner syndrome (45,X0)**. - A characteristic feature of Turner syndrome is **gonadal dysgenesis**, which manifests as **streak ovaries** and a **small uterus** due to the absence of normal ovarian development. *Hepatomegaly with altered echotexture* - This finding is more indicative of **liver disease** or metabolic disorders, which are not primary features of Turner syndrome. - While Turner syndrome can be associated with various health issues, **hepatomegaly** is not a common or defining ultrasonographic finding. *Echo showing tricuspid stenosis* - **Cardiac abnormalities** are common in Turner syndrome, but the most frequent ones are **bicuspid aortic valve** and **coarctation of the aorta**, not typically **tricuspid stenosis**. - **Tricuspid stenosis** is a rare congenital heart defect and not specifically associated with Turner syndrome. *Single kidney* - **Renal anomalies**, such as a **horseshoe kidney** or **renal agenesis**, can occur in Turner syndrome. - However, the description of **single kidney** is less specific than **streak ovaries** in identifying the most likely finding given the presented clinical features of short stature and webbed neck.

Question 5: Transrectal ultrasonography in carcinoma prostate is most useful for –

A. To detect hypoechoic area
B. Seminal vesicle involvement
C. Measurement of prostatic volume
D. Guided prostatic biopsies (Correct Answer)

Explanation: ***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.

Question 6: All are signs / features of ectopic pregnancy on USG except –

A. Hyperechoic rim
B. Echogenic mass with multicystic spaces within endometrial cavity (Correct Answer)
C. Adnexal mass
D. Pseudo sac

Explanation: **Echogenic mass with multicystic spaces within endometrial cavity** - This description is characteristic of a **hydatidiform mole**, a form of gestational trophoblastic disease, not an ectopic pregnancy. - A **hydatidiform mole** typically presents with an enlarged uterus and an echogenic, multicystic mass (often described as a "snowstorm" appearance) within the **endometrial cavity**. *Hyperechoic rim* - A **hyperechoic rim (or decidual reaction)** around an adnexal mass can be a sign of an ectopic pregnancy, representing the decidualized tissue surrounding the gestational sac. - This is part of the "ring of fire" sign on Doppler ultrasound, indicating increased vascularity around the ectopic gestational sac. *Adenexal mass* - The presence of an **adnexal mass** separate from the ovary, especially if it contains a gestational sac or yolk sac, is a primary ultrasonographic feature of an **ectopic pregnancy**. - This mass represents the ectopic implantation site, most commonly in the **fallopian tube**. *Pseudo sac* - A **pseudo sac (or pseudo gestational sac)** is a collection of intrauterine fluid that can mimic a gestational sac but lacks an embryo or yolk sac. - It is a common finding in **ectopic pregnancies** and results from decidual reactions within the uterus in response to elevated hCG levels from the ectopic pregnancy.

Question 7: A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

A. Colposcopy
B. Diagnostic laparoscopy
C. Transvaginal USG (Correct Answer)
D. Transabdominal pelvic ultrasound

Explanation: ***Transvaginal USG*** - This is the **first-line investigation** for evaluating pelvic pain, dyspareunia, dysmenorrhea, and adnexal tenderness due to its ability to provide **high-resolution images** of the uterus, ovaries, and surrounding structures to identify potential pathology like **endometriomas** or other adnexal masses. - It allows for detailed assessment of **ovarian cysts**, fibroids, and other pelvic abnormalities, which can explain the patient's symptoms. *Colposcopy* - This procedure is primarily used to closely examine the **cervix, vagina, and vulva** for abnormal cells, often following an abnormal Pap test. - It is not the initial step for investigating generalized pelvic pain, dyspareunia, or adnexal tenderness. *Diagnostic laparoscopy* - While a **diagnostic laparoscopy** can provide a definitive diagnosis for conditions like **endometriosis**, it is an **invasive surgical procedure** and typically reserved for cases where non-invasive imaging, such as transvaginal ultrasound, has not yielded a clear diagnosis or when conservative management has failed. - It is not considered the first-step investigation due to its **invasive nature** and associated risks. *Transabdominal pelvic ultrasound* - A **transabdominal pelvic ultrasound** provides a broader view of the pelvic organs but often has **lower resolution** and is less accurate for detailed assessment of the uterus, ovaries, and adnexa compared to transvaginal ultrasound, especially in obese patients. - It is often used if a transvaginal ultrasound is not feasible or for assessing larger pelvic masses, but the **transvaginal approach** is superior for detailed evaluation of the female reproductive organs.

Question 8: Foetal anaemia can be detected non-invasively by Doppler ultrasonography on the basis of an increase in the

A. SD ratio in the anterior cerebral artery
B. Peak systolic velocity of the anterior cerebral artery
C. Peak systolic velocity of the middle cerebral artery (Correct Answer)
D. SD ratio in the umbilical artery

Explanation: ***Peak systolic velocity of the middle cerebral artery*** - **Foetal anaemia** causes increased **cardiac output** and redistribution of blood flow to vital organs, leading to an increase in **peak systolic velocity (PSV)** in the **middle cerebral artery (MCA)**. - This increased velocity indicates **cerebral vasodilation**, a compensatory mechanism to maintain oxygen delivery to the foetal brain in situations of hypoxia due to anaemia. *SD ratio in the anterior cerebral artery* - The **SD ratio (systolic/diastolic ratio)** is more commonly used in umbilical artery flow. A higher SD ratio in cerebral arteries typically suggests increased downstream resistance, which is not characteristic of foetal anaemia. - In foetal anaemia, the cerebral arteries would typically show **decreased resistance**, leading to a lower, not higher, SD ratio. *SD ratio in the umbilical artery* - An increased **SD ratio in the umbilical artery** often indicates **placental insufficiency** or **foetal growth restriction**, not necessarily **foetal anaemia**. - While placental insufficiency can lead to foetal anaemia, the direct Doppler marker for anaemia is the MCA PSV, reflecting the foetal response to hypoxia. *Peak systolic velocity of the anterior cerebral artery* - While both anterior and middle cerebral arteries are part of the cerebral circulation, the **middle cerebral artery (MCA)** is the most widely validated and sensitive vessel for detecting changes in **foetal blood flow** due to **anaemia**. - Changes in the anterior cerebral artery's PSV are not as reliably linked to the diagnosis of foetal anaemia as those in the MCA.

Question 9: A 45-year-old female presents with a 2 cm thyroid nodule. Which TIRADS category has >95% risk of malignancy?

A. TIRADS 4
B. TIRADS 2
C. TIRADS 5 (Correct Answer)
D. TIRADS 3

Explanation: ***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.

Question 10: Investigation of choice for vascular ring around airway:

A. PET
B. Catheter directed angiography
C. MRI
D. CT (Correct Answer)

Explanation: ***CT*** - **CT angiography (CTA)** is the **investigation of choice** for diagnosing vascular rings due to its ability to provide detailed anatomical visualization of the great vessels and their relationship to the trachea and esophagus. - It offers high spatial resolution, allowing precise identification of the type of vascular anomaly, the degree of **airway and esophageal compression**, and guiding surgical planning. *PET* - **PET scans** are primarily used for assessing **metabolic activity**, particularly in oncology or to evaluate organ function, and do not provide sufficient anatomical detail for vascular rings. - While it can detect metabolically active lesions, it is **not suitable** for visualizing the structural abnormalities of blood vessels and their compressive effects on the airway. *Catheter directed angiography* - **Catheter-directed angiography** is an **invasive procedure** involving radiation and contrast, primarily used for assessing blood flow dynamics, identifying stenosis, or guiding interventions. - While it can visualize vessels, CTA is **less invasive**, provides comparable or superior anatomical detail for vascular rings, and is generally preferred for initial diagnosis. *MRI* - **MRI** can provide good soft tissue contrast and visualize vascular structures without radiation, but it is often **less readily available** and can be more challenging for pediatric patients due to the need for sedation and longer scan times. - For comprehensive anatomical detail including bone and calcifications, and in patients who might struggle with breath-holding, **CT angiography** often offers clearer and more consistent images of complex vascular anatomy.

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