Radiology Inservice Exam Question Bank

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  • 1/1383 Questions

    What is the MOST LIKELY diagnosis in this 30-year-old woman (Figures 1 and 2)?Figure 1-Transabdominal image of left ovaryFigure 2-Transabdominal image of right ovary

    • Polycystic ovary disease
    • Bilateral serous cystadenomas
    • Endometriosis
    • Ovarian hyperstimulation syndrome
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Radiology Quizzes & Trivia
About This Quiz

The 'Radiology Inservice Exam Question Bank' assesses knowledge in diagnostic imaging through ultrasound, targeting common and complex cases in radiology. It is designed for radiology professionals to evaluate their expertise in interpreting diverse ultrasound scenarios.

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  • 2. 

    You are shown images from a carotid ultrasound (Figures 3 and 4). What is the MOST LIKELY diagnosis? Figure 3-Left common carotid waveform Figure 4-Right common carotid waveform

    • Aortic valve stenosis

    • Intracranial AVM

    • Aortic valve incompetence

    • Distal left internal carotid artery occlusion

    Correct Answer
    A. Aortic valve incompetence
    Explanation
    A: An aortic valve stenosis has the same effect on the waveform as a stenosis anywhere proximal to the area of sampling and would include delayed systolic upstroke and decreased peak systolic velocities. Images demonstrate normal systolic upstroke and peak systolic velocities. B: As with arterial venous malformations located throughout the body sampling proximal to AVM could produce increased peak systolic velocity and diastolic flow rather than the reversal of flow shown on these images. C: Aortic valve incompetence if it is severe enough can result in reversal of diastolic flow and should affect the carotid system bilaterally. D: A distal unilateral internal carotid artery (ICA) occlusion should result in increased velocities of the patent contralateral carotid system including the contralateral common carotid artery. In addition distal left ICA occlusion will result in a waveform that more closely resembles the left external carotid waveform with high resistance waveform but no reversed diastolic flow in the common carotid artery.

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  • 3. 

    You are shown two images (Figures 5 and 6) from a second trimester ultrasound. What is the MOST LIKELY diagnosis? Figure 5-Axial transabdominal image of uterus Figure 6-Longitudinal view of lower uterine segment

    • Ectopic pregnancy

    • Partial molar pregnancy

    • Intrauterine pregnancy in uterus didelphys

    • Intrauterine pregnancy with exophytic fibroid

    Correct Answer
    A. Intrauterine pregnancy in uterus didelphys
    Explanation
    A: Submitted images particularly the lower uterine segment image confirm that the visualized pregnancy is intrauterine in position and is not an ectopic pregnancy. B: Partial molar pregnancy by ultrasound will demonstrate a fetus (which is present) combined with an abnormally thickened and complex placenta. The placenta on these images is unremarkable in its visualized portions. C: There is an intrauterine pregnancy in the right uterine horn with an empty uterine horn on the left. This could represent didelphis or bicornuate uterus based on the images. Physical exam confirmed two cervices consistent with didelphis uterus. D: Intrauterine pregnancy is present with a separate "mass" to the left of the uterus. Although fibroids can be complex in appearance this "mass" contains what appears to be an endometrium which is most consistent with a separate uterine horn.

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  • 4. 

    A 26-year-old woman presents with vaginal spotting (Figures 7 and 8). Which of the following BEST describes the findings? Figure 7-Sagittal endovaginal US of the uterus Figure 8-Coronal endovaginal US of the uterus

    • Intradecidual sac sign

    • Endometriotic cyst

    • Pseudogestational sac

    • Endometrial fluid collection

    Correct Answer
    A. Intradecidual sac sign
    Explanation
    A: The sagittal and coronal ultrasound of the uterus shows a small fluid collection surrounded by an echogenic ring. This echogenic ring confirms that we are dealing with a small gestational sac. This gestational sac is seen separate from the endometrial cavity represented by the echogenic line. The gestational sac is in a subendometrial location within the prominent decidua. This is the earliest manifestation of an intrauterine pregnancy that can be seen on transvaginal ultrasound at 3.5 to 4 weeks menstrual age. B: Endometriotic cysts also known as endometriomas or chocolate cysts form as a result of endometriosis and typically develop on the surface of the ovaries. C: The pseudogestational sac sign refers to a fluid collection within the endometrial collection. There is fluid sometimes complex fluid within the endometrial complex surrounded by a single echogenic ring and the endometrial stripe is not seen separately because the fluid is actually within the endometrial cavity. D: This is not fluid in the endometrium as was discussed above. There is no reason to suspect cervical stenosis in this young woman.

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  • 5. 

    You are shown ultrasound images (Figures 9 and 10) of the right testis in a 41-year-old man. What is the MOST LIKELY diagnosis? Figure 9-Sagittal image of the right testis Figure 10-Transverse image of the right testis

    • Synchronous seminomas

    • Large B cell lymphoma

    • Cystic dilatation of the rete testis

    • Orchitis

    Correct Answer
    A. Cystic dilatation of the rete testis
    Explanation
    A: The sagittal and transverse ultrasound images of the right testis show a cluster of small cysts in the location of the rete testis. Seminomas can occur in this age group in fact the peak incidence is in the 4th and 5th decade of life. Seminomas can be bilateral. However on ultrasound seminomas appear as hypoechoic relatively homogeneous solid intratesticular mass so this answer is not correct. B: Lymphoma is the most common testicular tumor in men over the age of 60 and is usually of the B cell type. It can be bilateral and appear as hypoechoic masses or diffuse heterogeneous enlargement of the testis. The age of the patient as well as the ultrasound appearance do not fit this diagnosis. C: This ultrasound appearance of cluster of small cysts in the location of the rete testis is characteristic of cystic dilatation of the rete testis. This is an 'aunt Minnie' and should be recognized as a normal variant not to be confused with a neoplasm. Cystic dilatation of the rete testis is often but not always bilateral and can be associated with a spermatocele. D: Orchitis is rarely isolated and usually associated with epididymitis. In this condition the testis is enlarged and hypervascular.

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  • 6. 

    You are shown ultrasound images (Figures 11 and 12) of the neck in a 50-year-old woman. Which of the following laboratory tests would be helpful to confirm your diagnosis? Figure 11-Sagittal US of the right neck Figure 12-Transverse US of the right neck

    • Serum parathormone level

    • Serum antithyroglobulin antibodies

    • Serum T3 and T4

    • Urine metanephrine and normetanephrine

    Correct Answer
    A. Serum parathormone level
    Explanation
    A: The sagittal and transverse ultrasound of the right lobe of the thyroid shows a well define hypoechoic mass inferior to the right lobe of the thyroid. There is a tissue plane (echogenic line) between the thyroid and the mass confirming that the mass is separate from the thyroid. This is a classic ultrasound appearance of a parathyroid adenoma. This diagnosis can be confirmed by checking the serum PTH level that will be elevated. The patient may also undergo another imaging test a sestamibi scan that will show retention of radioactive tracer below the right thyroid lobe. B: Serum Anti-thyroglobulin antibodies are elevated in patients with Hashimoto thyroiditis. These patients can have enlarged cervical nodes in level 6 below the thyroid. However the patient's visible thyroid appears homogeneous and normal. In addition reactive cervical nodes often display an echogenic hilum C: Serum T3 and T4 are elevated in case of a hyperfunctioning thyroid either and most commonly Grave's disease where the gland would be enlarged or a hyperfunctioning adenoma that would appear as an intrathyroidal nodule. D: Urine metanephrine and normetanephrine are elevated with other endocrine tumors such as pheochromocytomas.

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  • 7. 

    You are shown two images (Figures 13 and 14) of the left adnexa in a 30-year-old woman with acute pelvic pain. What is the MOST LIKELY diagnosis? Figure 13-Gray scale ultrasound of the left ovary Figure 14-Doppler image of the left ovary

    • Pyosalpinx

    • Cystadenocarcinoma

    • Ovarian torsion

    • Ectopic pregnancy

    Correct Answer
    A. Ovarian torsion
    Explanation
    A: The most specific finding in ovarian torsion is a unilaterally enlarged ovary with peripherally displaced follicles. Other associated findings may include absent or reduced flow within the ovary although the flow may be completely normal in some cases of ovarian torsion. There may be associated free fluid in the cul-de-sac. Pyosalpinx typically appears as a complex tubular thick-walled adnexal structure in close proximity to the ovary but separate from it. B: Cystadenocarcinoma appears as a complex cystic ovarian mass with thick septa and nodules with presence of vascularity. C: The most specific finding in ovarian torsion is a unilaterally enlarged ovary with peripherally displaced follicles. Other associated findings may include absent or reduced flow within the ovary although the flow may be completely normal in some cases of ovarian torsion. There may be associate free fluid in the cul-de-sac. D: The most specific finding in ectopic pregnancy is a non ovarian complex adnexal mass with associated findings such as echogenic free fluid.

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  • 8. 

    You are shown two images (Figures 15 and 16) of the left ovary in a young woman. What is the MOST LIKELY diagnosis? Figure 15-Gray scale ultrasound of the ovary Figure 16-Doppler ultrasound image of the ovary

    • Ectopic pregnancy

    • Chocolate cyst

    • Ovarian torsion

    • Cystadenocarcinoma

    Correct Answer
    A. Chocolate cyst
    Explanation
    A: The most specific finding in ectopic pregnancy is a non ovarian complex adnexal mass. B: Endometriomas within the ovaries gives rise to endometriotic cysts secondary to repeated cyclical hemorrhage. They are referred to as the chocolate cysts because of the cyst contents which comprise of thick dark degenerated blood products. Most common sonographic appearance of an endometrioma is diffuse low level echoes as seen on the given images. C: The most specific finding in ovarian torsion is a unilaterally enlarged ovary with peripherally displaced follicles. Other associated findings may include absent or reduced flow within the ovary although the flow may be completely normal in some cases of ovarian torsion. There may be associate free fluid in the cul-de-sac. D: Cystadenocarcinoma is seen as a complex cystic solid ovarian mass with thick septa or nodules with vascularity.

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  • 9. 

    You are shown two images (Figures 17 and 18) of a patient with right upper quadrant pain. What is the MOST LIKELY diagnosis? Figure 17-Gray scale ultrasound image from right upper quadrant Figure 18-Doppler ultrasound of right upper quadrant

    • Acute cholecystitis

    • Portal vein thrombosis

    • Choledocholithiasis

    • Cholangiocarcinoma

    Correct Answer
    A. Choledocholithiasis
    Explanation
    A: There is a common bile duct stone which appears as an echogenic focus within the duct with posterior acoustic shadowing and proximal duct dilatation. The color Doppler image demonstrates the twinkle artifact posterior to the duct stone. Acute cholecystitis presents as a distended gallbladder with gallstones positive sonographic Murphy sign gallbladder wall thickening and pericholecystic fluid. B: Portal vein thrombosis should show absence of flow within the portal vein C: There is a common bile duct stone which appears as an echogenic focus within the duct with posterior acoustic shadowing and proximal duct dilatation. The color Doppler image demonstrates the twinkle artifact posterior to the duct stone. D: Cholangiocarcinoma of the duct can have a varied appearance and may appear as a duct thickening or an irregular mass.

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  • 10. 

    A 40-year-old man presents with a scrotal mass (Figures 19 and 20). What is the MOST LIKELY diagnosis? Figure 19-Gray scale ultrasound of the scrotum Figure 20-Doppler image of the scrotum

    • Seminoma

    • Lymphoma

    • Epididymo-orchitis

    • Scrotal abscess

    Correct Answer
    A. Scrotal abscess
    Explanation
    A: Seminoma appears as a hypoechoic intratesticular mass with some internal vascularity. B: Lymphoma of the testes can have a variable appearance which includes a diffuse hypoechoic testis or multiple intratesticular masses or a striated apperance with increased vascularity. C: Epididymoorchitis is seen as an enlarged and hypoechoic testis and epididymis with increased vascularity. There may be associated hydrocele. D: Scrotal abscess appears as a complex fluid collection with no internal vascularity but increased peripheral hyperemia. There is no intratesticular mass which excludes seminoma and lymphoma. Epididymoorchitis demonstrates increased vascularity within the testis and epididymis.

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  • 11. 

    Which of the following measurements provides the BEST estimate of gestational age in a normal mid-first-trimester pregnancy?

    • Yolk sac diameter

    • Crown-rump length

    • Mean sac diameter

    • Biparietal diameter

    Correct Answer
    A. Crown-rump length
    Explanation
    A: Yolk sac diameter is not an accepted measure of gestational age B: An embryo is normally visible beginning at 6 weeks' gestation and crown-rump length provides the best estimate of embryonic age C: The mean sac diameter may be used in the early first trimester but is not as accurate as crown-rump length in the mid first trimester once an embryo is visible. D: Biparietal diameter should be used beginning at 12 weeks' gestation but cannot be obtained in a 6-7 week embryo.

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  • 12. 

    Concerning Doppler imaging of the abdominal vasculature which of the following is CORRECT?

    • The portal vein should be hepatopedal and nonpulsatile.

    • The hepatic veins should be hepatopedal and pulsatile.

    • The hepatic artery should be pulsatile with a high resistance waveform.

    • The splenic vein has a waveform most similar to normal hepatic veins.

    Correct Answer
    A. The portal vein should be hepatopedal and nonpulsatile.
    Explanation
    A: Portal vein normally should be hepatopedal (flow toward liver) and nonpulsatile with only gentle undulation with respiration. B: Hepatic veins are normally hepatofugal (flowing away from liver)and pulsatile. The pulsatility is related to proximity to the right atrium. C: Hepatic artery should be pulsatile but with a low resistance waveform rather than a high resistance waveform. D: Splenic vein has waveform most similar to normal portal vein waveform and is part of the portal system with a direct connection to the portal vein.

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  • 13. 

    Regarding Budd-Chiari syndrome which of the following is CORRECT?

    • Ascites is rare.

    • It is secondary to acute portal vein thrombosis.

    • The caudate lobe can be spared.

    • Intrahepatic collaterals most commonly extend from the hepatic veins to the portal venous system.

    Correct Answer
    A. The caudate lobe can be spared.
    Explanation
    A: Ascites is almost always present with Budd-Chiari Syndrome. B: Budd-Chiari Syndrome is a result of occlusion of the hepatic veins with or without involvement of the IVC. C: Caudate lobe is frequently spared due to its venous drainage which is independent of the main hepatic veins. If the IVC at the level of the caudate is involved then the caudate may be affected. D: Although intrahepatic collaterals can extend from hepatic veins to the portal venous system intrahepatic collaterals most commonly extend from the hepatic veins to the systemic circulation frequently at the peripheral hepatic capsule.

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  • 14. 

    Concerning hepatic cavernous hemangioma which of the following statements is TRUE?

    • Regardless of their size cavernous hemangiomas appear as a uniformly echogenic homogeneous hepatic mass.

    • All patients with suspected hepatic hemangioma based on characteristic ultrasound appearance should have a confirmatory CT or MRI scan.

    • There is an association between thrombocytopenia and cavernous hemangioma.

    • A well-recognized sonographic appearance of hemangioma is that of an echogenic center surrounded by a hypoechoic rim.

    Correct Answer
    A. There is an association between thrombocytopenia and cavernous hemangioma.
    Explanation
    A: While small hemangiomas are typically well defined and more echogenic then the surrounding liver parenchyma on ultrasound many atypical appearances have been recognized including a lace like appearance scalloping of the margins and heterogeneous central area. This latter appearance is more common in large lesions with central hypoechoic areas in large hemangiomas corresponding to fibrous collagen scar. B: It is well recognized that hemangiomas are common found in about 4% of the population and are usually found incidentally. If the mass displays the characteristic US appearance of a well defined echogenic mass no more then 2 to 3 cm no further examination is necessary provided the patient has NO risk factor for hepatic malignancy such as a history of primary cancer elsewhere or history of liver disease predisposing that patient to the development of a hepatocellular carcinoma. In this high risk group further evaluation with a dedicated liver CT or MR is warranted. C: The Kasabach-Merritt syndrome refers to the sequestration and destruction of platelets in a large cavernous hemangioma. This rare complication is more common in infants then adults. D: A well recognized appearance of hemangiomas is that of hypoechoic central area with a thick or thin echogenic rim. An echogenic mass with hypoechoic rim would be quite concerning for primary malignant tumor or hepatic metastasis (the so called target lesion)

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  • 15. 

    Which of the following is the MOST common ovarian neoplasm found in pregnancy?

    • Corpus luteum cyst

    • Ovarian tumor of low malignant potential

    • Endometrioma

    • Ovarian cystic teratoma

    Correct Answer
    A. Ovarian cystic teratoma
    Explanation
    A: While a corpus luteum cyst is the most common ovarian mass seen in pregnancy it is not a neoplasm. The corpus luteum is a normal physiologic cyst that secretes progesterone to support the early pregnancy. It usually appears as a simple or sometimes complex cyst in the ovary usually less then 5cm in size but can be larger. B: Ovarian tumors of low malignant potential can be seen in women of reproductive age and although they have histological features of malignancy they are less aggressive then the usual ovarian carcinoma and have a better prognosis. However they are not the most common ovarian tumor seen in pregnant women. C: Endometriomas are caused by focal deposits of functional endometrial tissue on the adnexae. These appear as cystic adnexal masses filled with low level echoes and are often multiloculated. Although endometriosis is associated with an increased incidence of infertility endometriomas are occasionally seen in pregnancy however C is False because endometriomas are not true neoplasms. D: Ovarian cystic teratoma is the most common ovarian neoplasm found in women of reproductive age including pregnant women. In fact about 10% of cystic teratomas are diagnosed during pregnancy.

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  • 16. 

    Concerning Mirizzi syndrome which of the following statements is TRUE?

    • It refers to obstruction of the common hepatic duct by an impacted cystic duct stone.

    • It is a clinical syndrome of painless jaundice in an elderly patient.

    • Ultrasound of the liver shows pneumobilia.

    • It is associated with primary sclerosing cholangitis.

    Correct Answer
    A. It refers to obstruction of the common hepatic duct by an impacted cystic duct stone.
    Explanation
    A: Mirizzi syndrome refers to a clinical syndrome caused by obstruction of the common hepatic duct due to a stone impacted in the cystic duct. It happens when the cystic duct and common hepatic duct run a parallel course and the edema and inflammation surrounding the obstructed cystic duct affect the adjacent common hepatic duct. The gallbladder displays sonographic signs of acute cholecystitis. Recognition of this relatively uncommon complication of acute cholecystitis preoperatively is important as there is potentially increased risk of injury to the bile duct during surgery. B: Mirizzi syndrome is a clinical syndrome with right upper quadrant pain and fever (symptoms of acute cholecystitis) and jaundice (caused by biliary obstruction). Painless jaundice in an elderly patient should prompt investigation for a pancreatic head mass. C: Ultrasound findings associated with Mirizzi syndrome include gallbladder wall thickening focal tenderness and other signs of acute cholecystitis. The gallbladder may be distended orin some cases contracted. An obstructing stone is present in the cystic duct with signs of inflammation such as echogenic fat. The common hepatic duct is dilated and there may be intrahepatic biliary tree dilatation. The common bile duct distal to the cystic duct is normal in caliber. These findings should lead the radiologist to suggest the diagnosis of Mirizzi. Pneumobilia is not typically associated with Mirizzi syndrome. D: Primary sclerosing cholangitis (PSC) is not associated with Mirizzi syndrome. Primary sclerosing cholangitis is a disease of unknown etiology causing fibrosis and inflammation of the biliary ducts. It is often associated with inflammatory bowel disease particularly Ulcerative colitis. Patients with PCS are at risk for developing cholangiocarcinoma.

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  • 17. 

    Which of the following ultrasound imaging features is MOST suspicious for papillary thyroid carcinoma?

    • Ill-defined hyperechoic nodule

    • Nodule with honeycomb pattern of cystic change and thin hypoechoic rim

    • Hypoechoic nodule with microcalcifications

    • Oval nodule with peripheral eggshell calcification

    Correct Answer
    A. Hypoechoic nodule with microcalcifications
    Explanation
    A: Approximately 90% of papillary thyroid carcinomas are hypoechoic rather than hyperechoic. B: Although there can be overlap of many benign and malignant imaging features honeycomb pattern of cystic change and thin hypoechoic rim are both features more typically associated with benign nodules. C: Approximately 90% of papillary thyroid carcinomas are hypoechoic and microcalcifications are an additional finding that has been associated with papillary thyroid carcinomas. Therefore a hypoechoic nodule with microcalcifications would be the most suspicious imaging characteristics for papillary thyroid carcinoma of the submitted choices. D: Peripheral eggshell type calcifications of a thyroid nodule are a feature that is most typically associated with benign thyroid nodules.

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  • 18. 

    Concerning renal vascular pathology and renal arterial Doppler imaging which of the following statements is TRUE?

    • Renal artery stenosis is the underlying cause of hypertension in almost 50% of adult women.

    • Measurement of the peak systolic velocity in the main renal artery is considered the most accurate parameter for the sonographic diagnosis of hemodynamically significant renal artery stenosis.

    • A parvus tardus appearance of the arterial waveform in the intrarenal arterial branches of the kidney is an indication of ipsilateral renal vein thrombosis.

    • For accurate measurements of the peak systolic velocity in the main renal arteries the Doppler angle should be kept above 60 degrees.

    Correct Answer
    A. Measurement of the peak systolic velocity in the main renal artery is considered the most accurate parameter for the sonographic diagnosis of hemodynamically significant renal artery stenosis.
    Explanation
    A: Essential (primary) hypertension is the most common cause of elevated blood pressure in both adult males and females. Renovascular disease is the most common cause of secondary hypertension found in 5% of patients with hypertension and among those patients atherosclerosis of the renal artery is a more common etiology then fibromuscular dysplasia. B: Direct Doppler interrogation of the main renal arteries with measurement of the peak systolic velocity (PSV) is considered more reliable then other Doppler parameters by most experts as was recently confirmed by a large meta analysis study. Other measurements that have been proposed include ratio of renal artery PSV to aorta PSV and evaluation of intrarenal arterial Doppler parameters such as acceleration time. C: A parvus tardus waveform with slow systolic upstroke and prolonged acceleration time has been proposed as an indirect sign of a more proximal (upstream) indicator of a significant renal artery stenosis. D: For accurate measurements of the PSV in any vessel the Doppler angle should be kept at 60 degrees or less because it is the cosine of the Doppler angle and not the angle itself that is factored in the Doppler equation relating the Doppler frequency shift (detected by the transducer) and the PSV displayed on the screen after the angle correction has been factored in. The cosine of the Doppler angle changes rapidly above an angle of 60 degrees and thus any small error in estimating the Doppler angle gets magnified in the calculation of the PSV.

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  • 19. 

    Which of the following is the MOST LIKELY cause for a unilateral enlarged kidney?

    • Chronic pyelonephritis

    • Reflux nephropathy

    • Acute renal vein occlusion

    • Renal artery stenosis

    Correct Answer
    A. Acute renal vein occlusion
    Explanation
    A: The kidney is reduced in size in chronic pyelonephritis. B: Kidney is reduced in size in reflux nephropathy. C: Acute renal vein thrombosis gives rise to diffuse edema of the kidney resulting in a unilaterally enlarged kidney. D: Kidney is reduced in size in renal artery stenosis.

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  • 20. 

    Which of the following is the MOST sensitive and specific ultrasound finding in ectopic pregnancy?

    • Echogenic free fluid in cul-de-sac

    • Nonovarian complex adnexal mass

    • Fluid within the endometrial cavity

    • Ring of fire sign on a color Doppler image

    Correct Answer
    A. Nonovarian complex adnexal mass
    Explanation
    A: Echogenic free fluid in the cul de sac may be seen in ectopic pregnancy however it is not the most sensitive and specific finding. B: Presence of a non-ovarian complex adnexal mass is the most sensitive and specific ultrasound finding in patients suspected of having ectopic pregnancy. It is due to the bleeding and clotting of blood in the wall and lumen of the fallopian tube as the tube distends to accommodate the products of conception. C: A pseudogestational sac may be seen in the uterus in ectopic pregnancy however it is a non specific finding. D: Ring of fire may be seen in ectopic pregnancy but is non specific and may also be seen in a corpus luteal cyst or a dominant follicle.

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  • 21. 

    You are shown a sagittal image of the gallbladder (Figure 1) and a Doppler image of the main portal vein (Figure 2). What is the MOST LIKELY diagnosis?

    • Acute cholecystitis

    • Congestive heart failure

    • Hepatitis

    • Adenomyomatosis

    Correct Answer
    A. Congestive heart failure
    Explanation
    A: Acute cholecystitis is a common cause of gallbladder wall thickening but gallbladder wall thickening is a non-specific sign. B: Congestive heart failure can cause gallbladder wall thickening. The pulsatile portal flow in the Doppler image indicates CHF is present C: Hepatitis can cause gallbladder wall thickening but does not cause a pulsatile portal vein. D: Adenomyomatosis can cause various forms of gallbladder wall thickening but does not cause a pulsatile portal vein. Findings: Concentric gallbladder wall thickening and markedly pulsatile portal venous flow. Transabdominal image right adnexa Endovaginal scan right ovary grayscale Figure 3 Figure 4 Doppler endovaginal image of right ovary Figure 5

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  • 22. 

    You are shown three images of the right adnexa (Figures 3-5). What is the MOST LIKELY diagnosis?

    • Hemorrhagic cyst

    • Dermoid

    • Ovarian carcinoma

    • Ovarian torsion

    Correct Answer
    A. Dermoid
    Explanation
    A: Hemorrhagic cyst can have a fishnet appearance but the linear echoes are not echogenic B: The linear echogenic interfaces or "dermoid mesh" represent hair fibers (Rumack chapter 15 "Gynecologic sonography" p.570) C: Ovarian carcinomas may have septations and mural nodules but these will typically have flow. (Rumack chapter 15). D: A torsed ovary may appear enlarged and avascular but the characteristic grayscale appearance has multiple peripheral follicles not a single large cyst cavity with echogenic linear interfaces. (Rumack chapter 15) Findings: Avascular right adnexal mass with linear echogenic interfaces: the dermoid mesh

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  • 23. 

    You are shown a Doppler image of the left common carotid artery (Figure 6) and of the left internal carotid artery (Figure 7). What is the MOST LIKELY diagnosis?

    • Subclavian steal syndrome

    • Vasculitis

    • Distal internal carotid artery stenosis or occlusion

    • Aortic valve regurgitation

    Correct Answer
    A. Distal internal carotid artery stenosis or occlusion
    Explanation
    A: Subclavian steal syndrome is diagnosed when there is reversal of flow in the vertebral artery. B: Vasculitis produces spectral broadening and thickened vessel walls but not absent diastolic flow C: Absent diastolic flow suggests downstream high resistance as is seen in distal or intracranial stenosis or occlusion. D: Aortic valve regurgitation can cause abnormalities of the carotid Doppler waveforms but not absent diastolic flow Findings: Absent diastolic flow in common and internal carotid arteries / High resistance waveform

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  • 24. 

    You are shown a longitudinal image (Figure 8) of the right lower quadrant in a young man with pain and anorexia. What is the MOST LIKELY diagnosis?

    • Intussusception

    • Small bowel lymphoma

    • Ureterolithiasis

    • Appendicitis

    Correct Answer
    A. Appendicitis
    Explanation
    A: The tubular structure in the image has a bowel signature but not a "bowel-within-bowel" appearance that would indicate intussusceptions. B: Lymphoma can cause bowel wall thickening but not luminal distention. The characteristic appearance of lymphoma on ultrasound is a thickened hypo-echoic wall producing the "pseudo-kidney" sign. C: A distended ureter containing stones will appear tubular and echogenic calculi should be visible but the structure should not be blind-ending. D: This is a characteristic appearance for appendicitis with a tubular blind-ending structure in the right lower quadrant containing echogenic foci (appendicoliths). Findings: Tubular blind-ending appendix with appendicoliths. Transvaginal transverse image of uterus Figure 9 Transvaginal sagittal image of uterus Figure 10

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  • 25. 

    A patient who is 10 weeks pregnant by dates presents to the ER because she is passing blood clots. You are shown two pelvic ultrasound images (Figures 9 and 10). What is the MOST LIKELY diagnosis?

    • Ectopic pregnancy

    • Molar pregnancy

    • Spontaneous abortion

    • Subchorionic hemorrhage

    Correct Answer
    A. Spontaneous abortion
    Explanation
    A: The complexity and amount of material in the endometrial canal is more than expected for pseudogestational sac of ectopic pregnancy. B: Although the presented ultrasound appearance could be seen with molar pregnancy this would not be the most likely diagnosis in view of the history of passing blood clots. C: Although discrete fetal parts or gestational sac are not visualized complex material within the endometrial canal is most consistent with spontaneous abortion in view of the history of passing blood clots. D: Subchorionic hemorrhage can range in size from a small loculated collection to complete separation of the membranes. Hemorrhage can enter the amniotic fluid and distend the endometrial canal. In the first trimester a normal gestational sac is typically seen adjacent to the hematoma. A normal gestational sac is not present on the submitted images. Findings: Tranvaginal images of the uterus demonstrate prominent amount of complex material within the endometrial canal but without a normal intrauterine pregnancy or fetal parts identified. Transverse image of left superior kidney Figure 11 Longitudinal image of left kidney Figure 12

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  • 26. 

    You are shown transverse (Figure 11) and longitudinal (Figure 12) images of the left kidney in a 70-year-old man. Which one of the following statements is CORRECT?

    • A focal parenchymal scar with invagination of perirenal fat is seen.

    • The findings are most suggestive of prominent column of Bertin.

    • Renal cell carcinoma is a significant diagnostic consideration.

    • The findings are pathognomonic for angiomyolipoma.

    Correct Answer
    A. Renal cell carcinoma is a significant diagnostic consideration.
    Explanation
    A: Although a focal cortical insult can result in volume loss/scar which then contains adjacent fat the images show a discrete focal hyperechoic mass. B: The location of the hyperechoic mass at the superior pole of the left kidney is not typical of the location for column of Bertin. Column of Bertin is typically located at the junction of the upper and middle third of the kidney. In addition the degree of increased echogenicity and exophytic component of this mass are not typical of a prominent column of Bertin. C: Renal cell carcinoma can have a variable appearance including partially cystic hypoechoic isoechoic or even hyperechoic as in the above case. D: Although angiomyolipomas typically present as hyperechoic focal renal masses differential considerations for hyperechoic renal mass also include renal cell carcinoma. Findings: Large diffusely hyperechoic mass of the left superior kidney. Transverse image of fetal bladder with Doppler Figure 13 Transverse image of umbilical cord Figure 14

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  • 27. 

    You are shown two images (Figures 13 and 14) from a 2nd trimester obstetric (OB) ultrasound. Which one of the following statements is CORRECT?

    • There is no significant association with other fetal structural anomalies.

    • A strong association with umbilical cord cysts is expected.

    • Prior monozygotic co-twin demise is implied.

    • This anomaly is found in 1% of pregnancies.

    Correct Answer
    A. This anomaly is found in 1% of pregnancies.
    Explanation
    A: Presence of a 2 vessel cord with single umbilical artery has a 30 to 60% increased risk in regards to the presence of other fetal anomalies. Careful anatomic survey should be performed. B: I could find no association between umbilical cord cysts and a 2 vessel cord with single umbilical artery. C: I could find no association between prior monozygotic co-twin demise and a 2 vessel cord with single umbilical artery. D: Two vessel cord with single umbilical artery is an uncommon anomaly found in 1% of pregnancies. Findings: Submitted images demonstrate a 2 vessel cord with single umbilical artery. Transverse doppler image of fetal bladder confirms presence of only one umbilical artery. Transverse Figure 15 Longitudinal Figure 16

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  • 28. 

    You are shown two images of the neck (Figures 15 and 16) from a patient with a palpable neck mass. What is the MOST LIKELY diagnosis?

    • Parathyroid carcinoma

    • Thyroid nodule

    • Parathyroid adenoma

    • Ectopic parathyroid tissue

    Correct Answer
    A. Parathyroid adenoma
    Explanation
    A: Parathyroid carcinomas are usually lobular heterogeneous with a depth to width ration greater than or equal to one B: The mass shown is extrinsic to the thyroid gland. C: Large homogeneous hypoechoic mass in the expected location of a left parathyroid gland. D: The mass is in the expected location of a left parathyroid gland and is also enlarged. Findings: Homogeneous hypoechoic mass extrinsic to the thyroid gland. Sagittal Figure 17 Transverse Figure 18

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  • 29. 

    Based on the sagittal and transverse images (Figures 17 and 18) in a 37-year-old woman what is the MOST LIKELY diagnosis?

    • Multinodular thyroid

    • Hashimoto's thyroiditis

    • Colloid cyst

    • Normal thyroid

    Correct Answer
    A. Hashimoto's thyroiditis
    Explanation
    A: The ultrasound images show a diffusely heterogeneous thyroid. The right lobe is top normal in size. There are however no discrete nodules which would be required for a diagnosis of multinodular thyroid. B: Hashimoto thyroiditis presents as a diffusely heterogeneous appearance of the thyroid. As in this patient diffuse hypoechoic micronodules separated by echogenic septae can be seen. Thyroid size can be increased (in the acute phase) normal or decreased. C: There are no discrete nodules seen. Colloid cysts present as predominantly cystic lesions in the thyroid they may contain scattered echogenic foci associated with comet tail artifact. D: The normal thyroid has a homogeneous ultrasound appearance with medium gray echotexture. Findings: Diffusely heterogeneous thyroid gland. The right lobe is top normal in size. No discrete nodules. Sagittal Figure 19 Duplex Doppler Figure 20

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  • 30. 

    You are shown ultrasound images (Figures 19 and 20) from a patient who had a liver transplant. What is the MOST LIKELY diagnosis?

    • Liver abscesses secondary to hepatic artery stenosis

    • Lymphoproliferative disorder

    • Liver metastases with increased arterial flow to the transplanted liver

    • Incidental liver cysts with normal arterial perfusion of the transplanted liver

    Correct Answer
    A. Liver abscesses secondary to hepatic artery stenosis
    Explanation
    A: The ultrasound images show a complex cystic mass in the liver. In a patient with fever and sepsis the primary concern should be liver abscesses. The Duplex Doppler image of the main hepatic artery at the porta shows a parvus tardus appearance of the waveform with increased diastolic flow with resistive index less then 0.5. This is a key finding indicating more proximal hepatic artery stenosis or thrombosis. Hepatic artery thrombosis or stenosis are the most common vascular complications in patients with liver transplants and can be associated with ichemic cholangiopathy and liver infarcts as well as abscesses. B: Lymphoproliferative disorder (PTLD) is a know complication in patients with solid organ transplants and can certainly present as hypoechoic masses in the liver. However the hepatic artery Doppler waveform should be normal. C: Lymphoproliferative disorder (PTLD) is a know complication in patients with solid organ transplants and can certainly present as hypoechoic masses in the liver. However the hepatic artery Doppler waveform should be normal. D: The gray scale images show a complex cystic fluid collections in the liver. Cysts should not be this complex. Findings: The ultrasound images demonstrate a complex cystic mass in the liver. The duplex Doppler image of the main hepatic artery shows a parvus tardus waveform with increased diastolic flow and a resistive index less than 0.5.

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  • 31. 

    Regarding AIDS cholangitis which of the following statements is TRUE?

    • It is usually due to retroviral therapy.

    • It rarely occurs in patients with CD4 counts of less than 100.

    • Patients are usually asymptomatic.

    • Ultrasound findings may mimic primary sclerosing cholangitis.

    Correct Answer
    A. Ultrasound findings may mimic primary sclerosing cholangitis.
    Explanation
    A: Retroviral therapy does not cause cholangiopathy. AIDS cholangiopathy is usually due to opportunistic infection. B: AIDS cholangiopathy is most often due to opportunistic infection and therefore commonly occurs in patients whose CD4 counts are less than 100. C: Patients usually have right upper quadrant pain and elevated alkaline phosphates. D: This is one of the well-established appearances of AIDS cholangiopathy.

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  • 32. 

    A mirror image artifact is MOST LIKELY in which of the following imaging situations?

    • Extensive fatty moiety in the liver

    • Air pockets in the soft tissues of the lung

    • Echogenic tissues in the vicinity of the diaphragm

    • Rapidly moving blood cells in the vasculature with Doppler acquisition

    Correct Answer
    A. Echogenic tissues in the vicinity of the diaphragm
    Explanation
    A: Incorrect. B: Incorrect. C: Correct. D: Incorrect.

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  • 33. 

    Renal vein thrombosis in a transplanted kidney is suggested by which one of the following findings?

    • Decreased resistive index

    • Prolonged acceleration time

    • Aliasing at the arterial anastomosis

    • Reversed diastolic flow in the main renal artery

    Correct Answer
    A. Reversed diastolic flow in the main renal artery
    Explanation
    A: The resistive index is a commonly used measure of vascular function. However in renal vein thrombosis the resistive index will be increased. B: Prolonged acceleration time may be seen in the intra-renal vessels downstream from renal artery stenosis but not in renal vein thrombosis C: Aliasing at the arterial anastamosis may be seen in renal artery stenosis but not in renal vein thrombosis D: Flow reversal in the main renal artery during diastole occurs because the normal egress of blood from the transplant--the renal vein--is occluded. The renal artery becomes both an inflow and outflow vessel with high resistance to downstream flow.

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  • 34. 

    An ultrasound acquisition mode that helps improve resolution and reduce echogenic clutter proximal to the tissues adjacent to the skin / transducer interface is known as:

    • Time gain compensation imaging.

    • Multi-directional compound imaging.

    • Doppler imaging.

    • Harmonic imaging.

    Correct Answer
    A. Harmonic imaging.
    Explanation
    A: Incorrect. B: Incorrect. C: Incorrect. D: Correct.

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  • 35. 

    Regarding peritoneal inclusion cysts which of the following is MOST CORRECT?

    • Round or oval cyst located separate from the ovary

    • Tubular cystic structure of adnexa adjacent to the ovary

    • Round simple cyst arising from the ovary

    • Fluid collection encasing the ovary with margins following the contour of the adjacent pelvic cavity

    Correct Answer(s)
    A. Round or oval cyst located separate from the ovary
    A. Fluid collection encasing the ovary with margins following the contour of the adjacent pelvic cavity
    Explanation
    The correct answer is "Round or oval cyst located separate from the ovary" and "Fluid collection encasing the ovary with margins following the contour of the adjacent pelvic cavity". This is because peritoneal inclusion cysts can present in two different ways. They can appear as round or oval cysts that are separate from the ovary, or they can manifest as fluid collections that encase the ovary with margins following the contour of the adjacent pelvic cavity.

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  • 36. 

    Concerning interstitial ectopic pregnancy which of the following statements is TRUE?

    • Its mortality rate is half the rate of other types of ectopic pregnancy due to surrounding myometrium.

    • It is the most common location for ectopic pregnancy.

    • It is typically located eccentrically in the fundus of the uterus outside the expected region of the endometrial canal with a thin rim of surrounding myometrium.

    • It occurs most commonly in patients with a bicornuate uterus.

    Correct Answer
    A. It is typically located eccentrically in the fundus of the uterus outside the expected region of the endometrial canal with a thin rim of surrounding myometrium.
    Explanation
    A: Interstitial ectopic pregnancy has higher mortality rate due to later presentation and massive hemorrhage. B: Majority of ectopic pregnancies occur at the ampullary or isthmic portion of the fallopian tube with only 2% to 4% located at the interstitial location. C: Interstitial ectopic pregnancies usually appear to be located eccentrically in fundus of uterus outside expected region of endometrial canal with thin rim of surrounding myometrium. D: I can find no known association between interstitial ectopic pregnancy and bicornuate uterus.

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  • 37. 

    Regarding the succenturiate lobe of the placenta which of the following statements is MOST CORRECT?

    • A potential complication includes vasa previa.

    • It occurs in one third of pregnancies.

    • It appears as a rolled up edge or shelf at the edge of the placenta.

    • It is associated with a high risk of placental abruption.

    Correct Answer
    A. A potential complication includes vasa previa.
    Explanation
    A: Vasa previa is a serious complication associated with a succenturiate lobe in which the vasculature extending to this accessory lobe from the main placenta extends across the cervix and can become entrapted or rupture during labor. B: Succenturiate lobe is only present in 5% of pregnancies. C: A rolled up edge or shelf at the edge of the placenta describes the appearance of a circumvallate placenta. D: A succenturiate lobe does not have a known association with a high risk for abruption.

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  • 38. 

    Which of the following scrotal varicoceles requires evaluation for an underlying neoplasm?

    • Unilateral right-sided varicocele

    • Unilateral left-sided varicocele

    • Decompressible varicocele

    • Any newly diagnosed varicocele

    Correct Answer
    A. Unilateral right-sided varicocele
    Explanation
    A: Idiopathic varicoceles occur on the left side in 98% of the cases and are bilateral in 70% of the cases. Idiopathic varicoceles are secondary to incompetent valves in the internal spermatic vein. It is thought that they occur much more commonly on the left because the venous drainage on the left is into the left renal vein. B: Idiopathic varicoceles are usually left sided because of the venous drainage into the left renal vein. C: A varicocele that is nondecompressible should be evaluated for an underlying neoplasm as the cause of the venous obstruction. D: Newly diagnosed varicoceles in men who are older than 40 years of age should be evaluated for an underlying neoplasm as the source of obstruction of gonadal venous return.

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  • 39. 

    Concerning polycystic ovary syndrome which of the following statements is TRUE?

    • The diagnosis of polycystic ovary can be made with equal accuracy using transabdominal and endovaginal pelvic ultrasound.

    • Visualization of bilateral markedly enlarged ovaries with an ovarian volume greater than 50 cc with multiple cysts greater than 2.5 cm is highly suggestive of the diagnosis of polycystic ovary syndrome.

    • The ovaries in women with polycystic ovary syndrome have increased echogenic ovarian stroma.

    • A finding of increased ovarian vascularity by Doppler ultrasound is an integral part of the diagnosis of polycystic ovary syndrome.

    Correct Answer
    A. The ovaries in women with polycystic ovary syndrome have increased echogenic ovarian stroma.
    Explanation
    A: High frequency transducers used for endovaginal ultrasound afford better resolution then transabdominal transducers and thus endovaginal ultrasound is more accurate for the diagnosis of polycystic ovar syndrome. B: This appearance is usually seen with hyperstimulation syndrome or theca lutein cysts associated with molar pregnancy. The follicles in polycystic ovary syndrome typically measure 2 to 9mm and are peripherally placed. C: The characteristic findings associated with polycystic ovary syndrome include: increase ovarian stroma which is abnormally echogenic and multiple (more then 12) peripherally placed follicles. D: Reports regarding ovarian vascularity in patients with polycystic ovary syndrome have varied and increased vascularity is not part of the diagnostic criteria of polycystic ovary syndrome.

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  • 40. 

    Concerning renal arteriovenous fistulas (AVFs) which of the following statements is TRUE?

    • AVFs are very uncommon in transplanted kidneys.

    • Renal AVFs are usually associated with a systemic vascular disorder such as Rendu-Osler-Weber syndrome.

    • On color Doppler AVFs are associated with a color bruit caused by vibration of the adjacent renal parenchyma.

    • All AVFs in transplanted kidneys should be managed with catheter embolization.

    Correct Answer
    A. On color Doppler AVFs are associated with a color bruit caused by vibration of the adjacent renal parenchyma.
    Explanation
    A: AVF are found in up to 15% of patient following biopsy. As many patients with renal transplant undergo biopsy to diagnose rejection AVF are not uncommon in these patients. B: Most renal AVF whether in native or transplanted kidneys are caused by prior renal biopsy. C: AVF are associated with high velocity low resistance flow diagnosed by demonstration of a low resistance (low resistive index) arterial flow pattern. The turbulent flow is usually also associated with a mosaic of color reverberating over the adjacent renal parenchyma creating a 'color bruit'. D: Many patients with renal AVF are asymptomatic and the AVF is found incidentally. Only patients with large AVF who have associated symptoms such as significant hematuria need embolization.

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  • 41. 

    Regarding evaluation of endometrial abnormalities in postmenopausal women which of the following statements is TRUE?

    • Measurement of endometrial thickness is best performed on a coronal/transverse endovaginal ultrasound image of the midbody of the uterus.

    • Fluid within the endometrial canal is included in the measurement of the endometrium.

    • All patients with postmenopausal vaginal bleeding should undergo histologic sampling regardless of endometrial thickness measurements on ultrasound to exclude endometrial cancer.

    • In a postmenopausal woman with no history of endometrial bleeding an endometrial thickness of 7 mm is considered normal.

    Correct Answer
    A. In a postmenopausal woman with no history of endometrial bleeding an endometrial thickness of 7 mm is considered normal.
    Explanation
    A: Endometrial thickness should be measured on a sagittal endovaginal midline (or near midline) image of the uterus B: If there is fluid present it should be excluded from measurement of endometrial thickness. A very small amount of simple fluid may be a normal finding in asymptomatic patients. Larger amount of endometrial fluid should raise the possibility of cervical stenosis or tumor. C: Although endometrial cancer often presents with post menopausal vaginal bleeding it is in fact not the most common cause of post menopausal vaginal bleeding. Large studies have shown that an endometrial thickness of 4mm or less in patients with post menopausal vaginal bleeding excludes endometrial cancer and these women do not require histologic sampling. D: As mentioned above several large studies comparing endometrial thickness as measured on endovaginal ultrasound and results from endometrial histologic sampling have shown that endometrial thickness of 8mm-9mm or less can be normal in asymptomatic postmenopausal women.

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  • 42. 

    Concerning the ultrasound diagnosis of lower extremity deep vein thrombosis (DVT) which of the following statements is TRUE?

    • Venous compression is best performed in the sagittal plane with the transducer oriented in a sagittal fashion over the longest segment of the vein being examined.

    • Loss of respiratory phasicity in the external iliac vein indicates more central iliac vein occlusion or compression by an adjacent mass.

    • Visualization of a thrombus in the greater saphenous vein is a sonographic finding indicating deep vein thrombosis.

    • Acute venous thrombi are always echogenic.

    Correct Answer
    A. Loss of respiratory phasicity in the external iliac vein indicates more central iliac vein occlusion or compression by an adjacent mass.
    Explanation
    A: Venous compression is a very important part of the sonographic examination of the veins of the lower extremities. It should be performed on gray scale imaging in the transverse plane so the entire cross section of the vein being examined is visualized. The normal vein should compress easily and completely with light pressure applied by the transducer. Lack of compressibility of the vein is the most important finding associated with deep vein thrombosis. B: Loss of the normal respiratory phasicity in the external iliac vein is an important indirect sign of more central venous occlusion by thrombus or compression by adjacent mass such as adenopathy. Lack of the normal response to Valsalva maneuver is another indirect sign of more central DVT. Normally The Valsalva maneuver produces an increase in intra abdominal pressure. During the Valsalva maneuver normally there is a short period of flow reversal followed by no flow. After release of the Valsalva maneuver there is a transient surge in forward venous flow. C: The greater saphenous vein (GSV) is part of the superficial venous system. However the junction of the greater saphenous vein with the common femoral vein should be carefully examined and documented in every lower extremity venous study to exclude extension of a GSV thrombus in the common femoral vein. D: The sonographic appearance of venous thrombi is variable and depends on the age of the thrombus. Acute thrombi may in fact be anechoic.

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  • 43. 

    You are shown two transvaginal pelvic images (Figure 1 and Figure 2) from a woman with a positive beta-human chorionic gonadotropin (beta-HCG). What is the MOST LIKELY diagnosis?

    • Molar pregnancy

    • Lithopedion

    • Dysgerminoma

    • Ectopic pregnancy

    Correct Answer
    A. Ectopic pregnancy
    Explanation
    A: Early IUP is not given as a potential answer which would be considered in a patient without gestation sac and positive B-HCG. Additionally submitted images demonstrate right adnexal ring-like mass which in this setting has a 92% positive predictive value for ectopic.

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  • 44. 

    You are shown two sagittal sonograms (Figures 3 and 4) of the liver and a duplex Doppler image (Figure 5) of the main portal vein in a 75-year-old man. What is the MOST LIKELY diagnosis?

    • Congestive heart failure

    • Cirrhosis and portal hypertension

    • Cavernous transformation of the portal vein

    • Slow flow in the portal vein

    Correct Answer
    A. Congestive heart failure
    Explanation
    A: The sonograms show an enlarged liver extending below the lower pole of the right kidney with smooth borders. Figure 1 also shows a large dilated inferior vena cava and one of the hepatic veins. The duplex Doppler image shows a normal size main portal vein with hepatopedal flow (towards the liver). However the Doppler spectrum is abnormal wuth pulsatile phasic flow rather then the normal monophasic flow. All these findings are caused by right sided heart failure causing passive congestion of the liver. Several studies have shown a correlation between abnormally high portal vein pulsatility and elevated right atrial pressure. Tricuspid regurgitation is the predominant cause of this abnormal flow pattern.

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  • 45. 

    You are shown grayscale (left) and power Doppler (right) ultrasound images (Figure 6) of the groin in a patient who has undergone recent cardiac catheterization. Which of the following would be the BEST method of management for the ultrasound finding?

    • Firm groin compression for 20 minutes or until the flow stops

    • Thrombin injection under ultrasound guidance

    • Surgical repair

    • No treatment needed

    Correct Answer
    A. No treatment needed
    Explanation
    A: This is correct as the ultrasound demonstrates a normal lymph node.

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  • 46. 

    You are shown a color Doppler image (Figure 7) of a transjugular intrahepatic portosystemic shunt (TIPS). What is the MOST LIKELY diagnosis?

    • Focal stenosis in the hepatic vein end of the TIPS

    • Normal flow within the TIPS with expected turbulence

    • A fistula present in the mid-TIPS

    • Migration of the TIPS with a component of the stent seen above the diaphragm

    Correct Answer
    A. Focal stenosis in the hepatic vein end of the TIPS
    Explanation
    A: The most common location for shunt stenosis is in the hepatic vein end of the shunt. Shunt stenosis can be identified by ultrasound by localized high velocity flow and turbulence. This associated with incomplete filling of the hepatic vein end of the shunt with color flow makes this the most likely diagnosis.

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  • 47. 

    You are shown two images (Figure 8 and Figure 9) of the lower uterine segment from a second trimester pregnancy. Which of the following is TRUE?

    • Abruption is present which requires immediate surgical intervention.

    • A postvoid image confirms no placenta previa.

    • The placental position will likely preclude vaginal delivery.

    • Low-lying placenta is present which will likely resolve by the third trimester.

    Correct Answer
    A. The placental position will likely preclude vaginal delivery.
    Explanation
    A: It is highly unlikely that a complete central placental previa will resolve. Therefore placental position will likely preclude vaginal delivery and require cesarean section.

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  • 48. 

    You are shown two images (Figure 10 and Figure 11). What is the MOST LIKELY diagnosis?

    • Subchorionic hemorrhage

    • Demise of co-twin

    • Partial mole

    • Twin pregnancy with complete mole and normal fetus

    Correct Answer
    A. Demise of co-twin
    Explanation
    A: Images demonstrate a large fetus as well as a much smaller second gestation without cardiac activity. This constellation of findings is most suggestive of demise of one of the twin gestations also known as demise of a co-twin.

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  • 49. 

    You are shown a sagittal (Figure 12) and coronal (Figure 13) image of the left ovary/ adnexal region in a 26-year-old woman with lower abdominal pain. Color Doppler (not shown) did not demonstrate any flow within the lesion. What is the MOST LIKELY diagnosis?

    • Pyosalpinx

    • Ovarian cancer

    • Cystic teratoma

    • Hemorrhagic cyst

    Correct Answer
    A. Hemorrhagic cyst
    Explanation
    A: The sonogram shows a well defined complex cystic mass surrounded by ovarian parenchyma. There is good posterior enhancement confirming the cystic nature of the lesion. The internal complex pattern has a reticular appearance combined with the more echogenic retracting clot. The age of the patient and the symptoms of pain makes this diagnosis most likely as well. The absence of doppler flow confirms the diagnosis.

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  • Mar 22, 2023
    Quiz Edited by
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  • Dec 10, 2014
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