Small Parts Ultrasonography — MCQs
Bony erosions are seen in the following except -
Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?
Radiation exposure can lead to which type of thyroid carcinoma?
What is not an advantage of USG over mammography?
A 45-year-old female presents with a 2 cm thyroid nodule. Which TIRADS category has >95% risk of malignancy?
A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is
Which one of the following is a recognized X-ray feature of rheumatoid arthritis?
A 40-year-old female was sent to the Radiology department for thyroid USG scan. Which probe will you use for thyroid scan?
Which of the following is the initial investigation of choice for a patient presenting with a solitary nodule of the thyroid?
Current gold standard to detect ductal carcinoma in situ breast is:
Small Parts Ultrasonography Indian Medical PG Practice Questions and MCQs
Question 1: Bony erosions are seen in the following except -
- A. Psoriasis
- B. Osteoarthritis
- C. Gout
- D. SLE (Correct Answer)
Explanation: ***SLE*** - **Systemic Lupus Erythematosus (SLE)** is primarily a connective tissue disease characterized by inflammation, but it typically causes **non-erosive arthritis** [1]. - While joint pain and inflammation are common, **bony erosions** are a classic feature of inflammatory arthropathies like rheumatoid arthritis or spondyloarthropathies, not SLE [1]. *Psoriasis* - **Psoriatic arthritis**, a form of spondyloarthritis associated with psoriasis, frequently causes **bony erosions**, particularly in the small joints of the hands and feet [1]. - It can also lead to characteristic radiographic changes like the "**pencil-in-cup**" deformity and periostitis [1]. *Osteoarthritis* - **Osteoarthritis** is characterized by cartilage degradation, but it can lead to **subchondral bone erosions** in advanced stages, particularly in severely affected joints. - These erosions are often accompanied by **osteophytes** and **subchondral sclerosis**. *Gout* - **Gout** is caused by the deposition of urate crystals, which can lead to characteristic **bony erosions** known as "punched-out" lesions or **tophi** on radiographs [2]. - These erosions often have an **overhanging edge** appearance, particularly around the affected joints.
Question 2: Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?
- A. Hydrocele
- B. Testicular torsion (Correct Answer)
- C. Testicular atrophy
- D. Varicocele
Explanation: ***Testicular torsion*** - The **bell clapper deformity** describes an abnormally high attachment of the tunica vaginalis, leaving the testis and epididymis free to rotate within the scrotal sac. - This anatomical variation allows the spermatic cord to twist, cutting off blood supply to the testis, which is the mechanism of **testicular torsion**. *Hydrocele* - A **hydrocele** is a collection of fluid in the tunica vaginalis, resulting from an imbalance in fluid production and absorption, or a patent processus vaginalis. - It is not directly caused by abnormal testicular fixation. *Testicular atrophy* - **Testicular atrophy** is a reduction in testicular size, often due to conditions like cryptorchidism, mumps orchitis, or prolonged testicular torsion, but not predisposed by the bell clapper deformity itself unless torsion occurs. - While torsion can lead to atrophy if not promptly treated, the deformity directly predisposes to the torsion event, rather than atrophy itself. *Varicocele* - A **varicocele** is an abnormal dilation of the veins of the pampiniform plexus within the scrotum, usually due to incompetent valves or venous obstruction. - This condition is not associated with testicular fixation abnormalities.
Question 3: Radiation exposure can lead to which type of thyroid carcinoma?
- A. Lymphoma
- B. Papillary carcinoma (Correct Answer)
- C. Medullary carcinoma
- D. Follicular carcinoma
Explanation: ***Papillary carcinoma*** - Papillary thyroid carcinoma is strongly associated with **radiation exposure**, particularly during childhood [1]. - It is the most prevalent type of thyroid cancer and typically has a **good prognosis** [1]. *Lymphoma* - Thyroid lymphoma is rare and generally not linked to **radiation exposure**; it often presents as a **rapidly enlarging goiter**. - It is more commonly associated with **autoimmune thyroiditis**, not primary radiation effects. *Follicular carcinoma* - Follicular carcinoma shows a correlation with **iodine deficiency** rather than radiation exposure [1]. - Its presentation is more subtle, compared to the classical association of **radiation with papillary carcinoma**. *Medullary carcinoma* - Medullary thyroid carcinoma is primarily linked to **familial syndromes** like MEN 2 and not radiation exposure. - It arises from **parafollicular C cells**, making it clinically distinct from radiation-related types. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099.
Question 4: What is not an advantage of USG over mammography?
- A. Can be used for guided biopsy
- B. Superior detection of microcalcifications (Correct Answer)
- C. In young females with dense breasts
- D. Can be used to differentiate solid VS cystic
Explanation: ***Superior detection of microcalcifications*** - **Mammography** is the gold standard for detecting **microcalcifications**, which can be a key indicator of **ductal carcinoma in situ (DCIS)** or early invasive breast cancer. - **Ultrasound (USG)** has limited sensitivity for detecting and characterizing microcalcifications. *Can be used for guided biopsy* - **USG-guided biopsy** is a common and advantageous technique for obtaining tissue samples from suspicious lesions in the breast or other organs. - This allows for **real-time visualization** of the needle, improving accuracy and reducing complications. *Can be used to differentiate solid VS cystic* - **USG** excels at distinguishing between **solid masses and fluid-filled cysts** due to differences in sound wave reflection. - This capability is crucial in characterizing breast lesions and often eliminates the need for further invasive procedures for benign cysts. *In young females with dense breasts* - **Dense breast tissue** in young females can obscure lesions on mammography, making interpretation difficult. - **USG** is particularly valuable in this population because it is not hindered by breast density and can provide a clearer view of underlying pathology.
Question 5: 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 6: A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is
- A. Biopsy
- B. Orchidectomy (Correct Answer)
- C. USG
- D. Wait and Watch
Explanation: ***Radical Inguinal Orchidectomy*** - In a patient who already presents with a **testicular mass** and **elevated AFP** (suggesting non-seminomatous germ cell tumor), the most appropriate next step is **radical inguinal orchidectomy**. - This procedure is both **diagnostic and therapeutic**, providing tissue for histopathological confirmation while removing the primary tumor. - The standard management sequence is: clinical examination → scrotal USG → tumor markers → **orchidectomy** → staging imaging → further treatment based on histology and stage. - Since the mass is already identified and tumor markers are done, proceeding directly to orchidectomy is appropriate. *USG* - Scrotal **ultrasound** is typically the **first imaging modality** when a testicular mass is suspected or palpated. - However, in this scenario, the mass is already clinically identified and tumor markers (AFP) have been measured, suggesting that initial workup including USG has likely been completed. - USG would have been the appropriate answer if the question asked for the "first investigation" before tumor markers were done. *Biopsy* - Direct **biopsy** of a testicular mass is **contraindicated** due to the high risk of tumor cell spillage along the needle tract, which can alter staging and worsen prognosis. - Testicular cancer is diagnosed via **radical inguinal orchidectomy**, not biopsy. *Wait and Watch* - A **wait and watch** approach is inappropriate and dangerous in the presence of a **testicular mass with elevated AFP**, which strongly suggests malignancy (non-seminomatous germ cell tumor). - Delayed treatment can lead to disease progression, metastasis, and poorer outcomes.
Question 7: Which one of the following is a recognized X-ray feature of rheumatoid arthritis?
- A. Bamboo spine
- B. Bone erosions (Correct Answer)
- C. Peri-articular calcification
- D. Juxta-articular osteosclerosis
Explanation: ***Bone erosions*** - **Bone erosions** are a hallmark feature of **rheumatoid arthritis (RA)**, representing irreversible joint damage caused by synovial inflammation and pannus formation. - They typically appear early in the disease course and contribute to functional impairment. *Juxta-articular osteosclerosis* - **Osteosclerosis** (increased bone density) near the joints is more characteristic of **osteoarthritis**, where new bone formation occurs in response to cartilage loss. - In rheumatoid arthritis, **juxta-articular osteopenia** (decreased bone density) due to inflammation and disuse is more common. *Bamboo spine* - **Bamboo spine** is a characteristic radiographic finding in **ankylosing spondylitis**, due to syndesmophyte formation and fusion of vertebral bodies. - It is not associated with rheumatoid arthritis. *Peri-articular calcification* - **Peri-articular calcification** is seen in conditions like **calcium pyrophosphate deposition disease (CPPD)**, also known as pseudogout. - While calcification can occur in some rheumatic conditions, it is not a primary or characteristic feature of rheumatoid arthritis.
Question 8: A 40-year-old female was sent to the Radiology department for thyroid USG scan. Which probe will you use for thyroid scan?
- A. Linear (Correct Answer)
- B. Curvilinear
- C. Endocavitary
- D. Phase array
Explanation: ***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 9: Which of the following is the initial investigation of choice for a patient presenting with a solitary nodule of the thyroid?
- A. Thyroid function test
- B. FNAC (Correct Answer)
- C. Radionuclide scan
- D. MRI
Explanation: ***FNAC*** - **Fine needle aspiration cytology (FNAC)** is the most important initial investigation for a solitary thyroid nodule to determine if it is benign or malignant. [1] - It offers a highly accurate and minimally invasive method for **cytological analysis** to guide further management. *Thyroid function test* - While important for assessing **thyroid hormone levels** and diagnosing hyper or hypothyroidism, it does not directly evaluate the **malignant potential** of a nodule. [1] - Normal thyroid function does **not rule out malignancy** within a nodule. *Radionuclide scan* - A **radionuclide scan** is useful for assessing the **functional status** of a nodule (hot or cold). [1] - However, non-functional (**cold**) nodules are more suspicious for malignancy, but the scan doesn't provide **histological diagnosis**. *MRI* - **MRI** provides detailed anatomical imaging of the thyroid and surrounding structures but is generally not the **initial diagnostic test of choice** for evaluating a solitary nodule. [1] - It is typically reserved for assessing **nodule extension** or **lymph node involvement** once malignancy is suspected or confirmed. [1]
Question 10: Current gold standard to detect ductal carcinoma in situ breast is:
- A. Mammography (Correct Answer)
- B. CT/PET
- C. MRI
- D. USG
Explanation: ***Mammography*** - **Mammography** is the gold standard for detecting **ductal carcinoma in situ (DCIS)**, often visible as microcalcifications. - It plays a crucial role in early detection and has been a cornerstone of breast cancer screening for decades. *CT/PET* - **CT scans** are primarily used for evaluating tumor extent and metastasis, not for initial DCIS detection. - **PET scans** are not routinely used for DCIS due to their lower resolution for subtle changes and higher false-negative rates for small lesions. *MRI* - While **MRI** is highly sensitive for breast cancer, its specificity for **DCIS** is lower, often leading to false positives. - It is typically used as an adjunct to mammography for high-risk screening or for evaluating the extent of known cancer, not as a primary screening tool for DCIS. *USG* - **Ultrasound (USG)** is effective for evaluating palpable masses or specific areas of concern identified on mammography, but it is not sensitive enough to reliably detect **microcalcifications** characteristic of DCIS. - It is often used to differentiate between solid and cystic lesions or guide biopsies, but not as a primary screening tool for DCIS.
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