Ultrasound applications

44 Gulf Prometric Radiographer (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Ultrasound applications, part of Ultrasound. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   In a carotid scan, the internal carotid artery has a peak systolic velocity of 180 cm/s and an end-diastolic velocity of 70 cm/s, with visible plaque. Using the consensus criteria, the stenosis is:

   1. ANear occlusion
   2. B50 to 69%
   3. CUnder 50%
   4. D70% or more

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   Answer: B · 50 to 69%

   A peak systolic velocity of 125 to 230 cm/s with visible plaque corresponds to a 50 to 69% stenosis. The end-diastolic velocity of 70 cm/s lies in the range of 40 to 100 cm/s, which agrees with the same category. Both velocities place the lesion in the middle band.

   • A: Near occlusion shows a highly variable and often low velocity with a very narrow lumen.
   • C: Under 50% would give a PSV under 125 cm/s and an EDV under 40 cm/s.
   • D: 70% or more needs a PSV above 230 cm/s and an EDV above 100 cm/s.

   Remember this

   PSV 125 to 230 cm/s with plaque means 50 to 69% stenosis.

2. Question 2 · Medium

   Systolic pressure measured at the right ankle is 90 mmHg and the highest brachial systolic pressure is 120 mmHg. The ankle-brachial index is:

   1. A1.00, which is the normal value in a healthy leg
   2. B0.75, which indicates peripheral arterial disease
   3. C1.33, which indicates normal arteries in the leg
   4. D0.30, which indicates critical limb ischaemia

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   Answer: B · 0.75, which indicates peripheral arterial disease

   The ankle-brachial index is the ankle systolic pressure divided by the higher brachial systolic pressure, which is 90 / 120 = 0.75. A value under 0.9 indicates peripheral arterial disease. Values of 1.0 to 1.4 are normal.

   • A: An ABI of 1.00 would need an ankle pressure of 120 mmHg.
   • C: 1.33 comes from dividing the wrong way round.
   • D: 0.30 would need an ankle pressure of only 36 mmHg.

   Remember this

   ABI under 0.9 means arterial disease.

3. Question 3 · Easy

   A full bladder is requested for a transabdominal pelvic scan because the filled bladder:

   1. AIncreases the gain of the transducer so that the image is brighter
   2. BActs as an acoustic window and moves gas-filled bowel out of the way
   3. CProduces posterior shadowing that outlines the uterus and ovaries
   4. DLowers the frequency that is needed to reach the uterus and the ovaries

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   Answer: B · Acts as an acoustic window and moves gas-filled bowel out of the way

   Urine transmits sound well, so the distended bladder works as an acoustic window to the uterus and ovaries, and it lifts gas-filled bowel loops out of the path of the beam.

   • A: Gain is a machine setting and is not changed by bladder volume.
   • C: Fluid causes enhancement behind it, not shadowing.
   • D: The frequency is chosen by the operator and is not changed by the bladder.

   Remember this

   the full bladder is a sound window, not a way to change machine settings.

4. Question 4 · Medium

   At the 22-week anatomy scan, the cervical length measured transvaginally is 18 mm. This finding means:

   1. AA normal cervical length for this stage of pregnancy
   2. BA cervix that is too long and needs no action at all
   3. CA finding that matters only after 36 weeks of pregnancy
   4. DIncreased risk of preterm birth, so inform the clinician

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   Answer: D · Increased risk of preterm birth, so inform the clinician

   A cervical length under 25 mm at 18 to 24 weeks is considered short and is associated with a higher risk of preterm delivery. The measurement, taken with an empty bladder and without pressure, should be reported to the clinician for management such as progesterone or cerclage.

   • A: The normal cervical length at mid-pregnancy is about 35 to 45 mm.
   • B: A longer cervix is not a problem, but 18 mm is short.
   • C: The risk applies at mid-pregnancy, when treatment can still be offered.

   Remember this

   a cervix under 25 mm at mid-pregnancy is short.

5. Question 5 · Hard

   A patient has fever, right upper quadrant pain and a positive sonographic Murphy sign. The scan shows stones in the gallbladder, a 5 mm wall and a thin layer of fluid around it. Which diagnosis fits best?

   1. AChronic cholecystitis with a contracted gallbladder
   2. BAcute calculous cholecystitis
   3. CAdenomyomatosis
   4. DSimple ascites

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   Answer: B · Acute calculous cholecystitis

   The combination of stones, a thickened wall above 3 mm, pericholecystic fluid and a pain response under the probe over the gallbladder is the typical picture of acute calculous cholecystitis. Wall thickening alone has many causes, such as ascites, hepatitis and heart failure, so the stones and the Murphy sign are the key.

   • A: Chronic cholecystitis gives a small contracted gallbladder, not pericholecystic fluid and acute tenderness.
   • C: Adenomyomatosis gives wall thickening with comet-tail artefacts but not fever and tenderness.
   • D: Ascites would show free fluid elsewhere and a thickened wall without a Murphy sign.

   Remember this

   stones, a thick wall, fluid and a sonographic Murphy sign mean acute cholecystitis.

6. Question 6 · Medium

   A sonographer finds a blind-ending, non-compressible tube arising from the caecum with an outer diameter of 9 mm and echogenic fat around it. The finding indicates:

   1. AAcute appendicitis
   2. BA normal terminal ileum
   3. CA simple ovarian cyst
   4. DA normal appendix

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   A carotid Doppler study shows an internal carotid artery peak systolic velocity of 260 cm/s. According to the commonly used consensus criteria, this indicates a stenosis of:

   1. A50 to 69%
   2. BLess than 50%
   3. CTotal occlusion
   4. D70% or more

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   Which ultrasound findings suggest cirrhosis of the liver?

   1. AA uniformly enlarged, bright liver with a normal surface and well-visualised vessels
   2. BNodular surface, coarse echotexture and an enlarged caudate lobe
   3. CA single well-defined anechoic lesion
   4. DSmooth surface with a very fine uniform echotexture

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   Which measurement gives the most accurate estimate of gestational age in the first trimester?

   1. AAbdominal circumference
   2. BCrown-rump length
   3. CFemur length
   4. DEstimated fetal weight

   Answer and explanation in LearnFree account

10. Question 10 · Hard

    At 33 weeks, a fetus has an abdominal circumference below the 5th percentile and an amniotic fluid index of 3 cm. Umbilical artery Doppler shows absent end-diastolic flow. What does the Doppler finding indicate?

    1. ABrain sparing, from raised resistance in the fetal brain
    2. BA normal umbilical artery pattern at this gestation
    3. CFetal anaemia, assessed by umbilical artery peak velocity
    4. DSeverely raised placental resistance needing urgent review

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    At 34 weeks, the largest vertical pocket of amniotic fluid measures 1.5 cm and the amniotic fluid index is 4 cm. The appropriate report is:

    1. AOligohydramnios
    2. BPolyhydramnios
    3. CNormal fluid volume
    4. DBorderline normal fluid

    Answer and explanation in LearnFree account

12. Question 12 · Easy

    Which set of features defines a simple cyst on ultrasound?

    1. AInternal echoes, thick wall and posterior shadowing present
    2. BAnechoic with a thick septum and internal blood flow seen
    3. CAnechoic, thin smooth wall, posterior enhancement
    4. DHyperechoic, irregular wall and no through-transmission

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13. Question 13 · Medium

    In a patient with cirrhosis, colour Doppler of the main portal vein shows flow running away from the liver. What does this finding mean?

    1. AHepatopetal flow, the normal direction in the portal vein
    2. BNormal flow, displayed in reverse by the colour map
    3. CPortal vein thrombosis with complete occlusion
    4. DHepatofugal flow, a sign of severe portal hypertension

    Answer and explanation in LearnFree account

14. Question 14 · Medium

    At a transvaginal scan at about 7 weeks by dates, a normal intrauterine sac contains an embryo with a crown-rump length of 4 mm and no cardiac activity. What is the best next step?

    1. AReport it and advise a repeat scan in 7 to 10 days
    2. BReport a confirmed ectopic pregnancy to the clinician
    3. CReport a confirmed missed miscarriage at once without delay
    4. DReport a molar pregnancy with a vesicular uterine mass

    Answer and explanation in LearnFree account

15. Question 15 · Hard

    A woman requests a nuchal translucency scan. The crown-rump length measures 91 mm. Which statement is correct?

    1. AThe scan should be repeated at 6 weeks of gestation instead
    2. BA CRL of 91 mm corresponds to a gestational age of 8 weeks
    3. CThe measurement is valid because a larger fetus is easier to scan
    4. DBeyond the usual window, so the measurement is not valid

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    A biophysical profile scores two points each for fetal breathing, gross movement, tone and amniotic fluid volume. Breathing is absent over 30 minutes, and the other three are normal. The total score is:

    1. A8 out of 8
    2. B4 out of 8
    3. C6 out of 8
    4. D2 out of 8

    Answer and explanation in LearnFree account

17. Question 17 · Easy

    The normal length of an adult kidney on ultrasound is about:

    1. A10 to 12 cm
    2. B6 to 8 cm
    3. C3 to 5 cm
    4. D14 to 16 cm

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18. Question 18 · Medium

    Which biometric parameter is the most sensitive for detecting fetal growth restriction in the third trimester?

    1. ABiparietal diameter of the head
    2. BFemur length of the thigh bone
    3. CAbdominal circumference
    4. DTransverse cerebellar diameter

    Answer and explanation in LearnFree account

19. Question 19 · Easy

    The nuchal translucency measurement is made at which gestational age?

    1. A6 weeks to 8 weeks of gestation
    2. B18 weeks to 22 weeks of gestation
    3. C11 weeks to 13 weeks 6 days
    4. D28 weeks to 32 weeks of gestation

    Answer and explanation in LearnFree account

20. Question 20 · Easy

    Which transducer is normally chosen for routine transabdominal imaging of the liver, gallbladder and kidneys in an adult?

    1. AEndocavitary, about 6 to 9 MHz
    2. BIntraoperative hockey-stick, about 12 to 18 MHz
    3. CCurvilinear, about 2 to 5 MHz
    4. DLinear, about 10 to 15 MHz

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21. Question 21 · Easy

    In an adult, an abdominal aortic aneurysm is generally defined as an aortic diameter of at least:

    1. A3.0 cm
    2. B1.5 cm
    3. C2.0 cm
    4. D5.5 cm

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22. Question 22 · Medium

    In a thyroid nodule, which ultrasound feature is most worrying for malignancy?

    1. AA spongiform nodule made of many tiny cystic spaces
    2. BA well-defined isoechoic nodule with a thin halo around it
    3. CPunctate microcalcifications in a solid hypoechoic nodule
    4. DA purely cystic nodule with thin walls and no solid part

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23. Question 23 · Easy

    How long should an adult usually fast before an ultrasound examination of the gallbladder?

    1. A24 hours, with no fluids
    2. B6 to 8 hours
    3. CNo fasting is needed
    4. D1 hour, with water allowed

    Answer and explanation in LearnFree account

24. Question 24 · Hard

    A hypotensive trauma patient has a negative FAST examination in all four views. Which conclusion is correct?

    1. AThe patient has no intra-abdominal injury and can be observed
    2. BRetroperitoneal bleeding is excluded by the four views
    3. CA negative FAST does not exclude injury, so repeat or reassess
    4. DNo further imaging or monitoring is needed for this patient

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25. Question 25 · Medium

    During a carotid scan, the sonographer must tell the internal from the external carotid artery. Which finding identifies the external carotid?

    1. AA larger size and a posterolateral position
    2. BBranches in the neck and a high-resistance waveform
    3. CNo branches in the neck and a low-resistance waveform
    4. DContinuous forward flow throughout diastole

    Answer and explanation in LearnFree account