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NEW QUESTION # 92
Which condition is most likely the cause of claudication experienced two weeks after this image was obtained?
- A. Neuropathy
- B. Infected hematoma
- C. Ruptured Baker cyst
- D. Thrombophlebitis
Answer: C
Explanation:
The ultrasound image demonstrates a fluid-filled structure in the posterior knee region, consistent with a Baker cyst (also called a popliteal cyst). A Baker cyst is a synovial fluid-filled sac arising from the posterior medial aspect of the knee joint, typically extending between the medial head of the gastrocnemius and the semimembranosus tendon.
The history of delayed-onset claudication (pain in the calf when walking) two weeks after this image was obtained is strongly suggestive of a ruptured Baker cyst. When a Baker cyst ruptures, synovial fluid may track inferiorly into the calf, producing pain, swelling, and clinical symptoms that mimic deep vein thrombosis (DVT) or arterial insufficiency (e.g., pseudothrombophlebitis syndrome).
Ultrasound findings consistent with a ruptured Baker cyst:
* Complex fluid collection tracking along muscle fascial planes (hypoechoic to anechoic)
* Posterior calf swelling and tenderness
* Absence of thrombus in the deep venous system
* Crescent-shaped fluid may be seen between muscle compartments
Why the other choices are incorrect:
* A. Neuropathy: Would not show fluid-filled structures on ultrasound and would not present with calf swelling.
* B. Infected hematoma: May appear complex, but would require a history of trauma or anticoagulation and systemic signs (fever, redness).
* C. Thrombophlebitis: Involves a thrombosed superficial vein with wall thickening and surrounding inflammation, which is not seen in this image.
References:
American Institute of Ultrasound in Medicine (AIUM). Practice Guidelines for Musculoskeletal Ultrasound Examination, 2020.
Bianchi S., Martinoli C. Ultrasound of the Musculoskeletal System. Springer, 2007. Chapter: Knee Region - Popliteal Fossa and Baker's Cyst, pp. 433-437.
Radiopaedia.org. Ruptured Baker cyst: https://radiopaedia.org/articles/ruptured-bakers-cyst
NEW QUESTION # 93
Which liver neoplasm is associated with use of oral contraceptives and is most often seen in women under the age of 40?
- A. Hepatoblastoma
- B. Adenoma
- C. Cavernous hemangioma
- D. Hepatoma
Answer: B
Explanation:
Hepatic adenomas are benign liver tumors strongly associated with long-term use of oral contraceptives and are most frequently found in women under 40. Hepatoblastoma is seen in children; hepatoma (HCC) is a malignant tumor typically found in cirrhotic livers. Cavernous hemangioma is unrelated to oral contraceptives.
According to Rumack's Diagnostic Ultrasound:
"Hepatic adenomas occur predominantly in young women with a history of oral contraceptive use." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Tumours of the Digestive System, 5th ed., IARC, 2019.
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NEW QUESTION # 94
Which vascular condition is most consistent with patent cutaneous para-umbilical channels and portal hypertension?
- A. Coronary vein varices
- B. Caput medusae
- C. Splenic vein varices
- D. Esophageal varices
Answer: B
Explanation:
Caput medusae refers to dilated paraumbilical veins due to portal hypertension. When portal venous pressure rises, collateral channels may open along the ligamentum teres and recanalized paraumbilical vein, resulting in visible dilated veins radiating from the umbilicus.
* Esophageal varices (B) are gastroesophageal collaterals.
* Coronary vein varices (C) involve gastric veins.
* Splenic vein varices (D) are typically localized to the splenic hilum.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
* Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed. Saunders, 2015.
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NEW QUESTION # 95
Which complication would be associated with retroperitoneal fibrosis?
- A. Venous thrombosis
- B. Aortic stenosis
- C. Portal hypertension
- D. Hydronephrosis
Answer: D
Explanation:
Retroperitoneal fibrosis can encase and compress the ureters, leading to obstructive uropathy and hydronephrosis. It may also involve other retroperitoneal structures but hydronephrosis is the most common significant complication.
According to Rumack's Diagnostic Ultrasound:
"Retroperitoneal fibrosis frequently results in ureteral obstruction, leading to hydronephrosis." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
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NEW QUESTION # 96
Which normal anatomical structure is also known as the accessory pancreatic duct?
- A. Duct of Santorini
- B. Duct of Vater
- C. Duct of Wirsung
- D. Common pancreatic duct
Answer: A
Explanation:
The Duct of Santorini is the accessory pancreatic duct that drains the superior portion of the pancreatic head into the minor duodenal papilla. The main pancreatic duct (Duct of Wirsung) drains into the major papilla, often joining the common bile duct at the Ampulla of Vater.
According to Moore's Clinically Oriented Anatomy:
"The accessory pancreatic duct (Duct of Santorini) may be present and drains into the minor duodenal papilla." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 97
Which condition is demonstrated in this image of the groin?
- A. Indirect hernia
- B. Orchiectomy
- C. Testicular rupture
- D. Hematocele
Answer: A
Explanation:
The ultrasound image demonstrates bowel loops with peristalsis visualized within the inguinal canal, which is diagnostic of an inguinal hernia-more specifically, an indirect inguinal hernia. Indirect hernias pass through the deep inguinal ring and may extend into the scrotum, appearing sonographically as bowel-containing masses adjacent to or within the scrotal sac. Peristaltic motion confirms the presence of viable bowel content.
This finding is typical in indirect inguinal hernias, which are more common in males and often congenital due to a patent processus vaginalis. The herniated bowel can be traced through the inguinal canal, as seen in this image.
Comparison of answer choices:
* A. Hematocele presents as a complex fluid collection surrounding the testis, often due to trauma-no complex fluid or trauma is apparent here.
* B. Testicular rupture shows discontinuity of the tunica albuginea and irregular testicular contour-none of which is seen.
* C. Orchiectomy would show an absent testis-this is not the case here.
* D. Indirect hernia is correct. The presence of bowel with peristalsis in the inguinal canal is diagnostic.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations (2021).
Dogra VS, Gottlieb RH, Rubens DJ, Oka M. Sonography of the scrotum. Radiology. 2003;227(1):18-36
NEW QUESTION # 98
Which structure is indicated by the arrow on this image?
- A. Esophagus
- B. Parathyroid
- C. Paraganglioma
- D. Lymph node
Answer: A
Explanation:
The ultrasound image shows a transverse view of the lower neck region at the thyroid level. The arrow is pointing to a round-to-oval structure located posterior and slightly to the left of the thyroid gland. The structure has a characteristic "target" or "bull's-eye" appearance with a hypoechoic outer ring and echogenic central mucosal interface - this is classic for the esophagus when seen in transverse view.
Key sonographic features of the esophagus:
* It lies posterior to the left lobe of the thyroid.
* It demonstrates a layered wall structure ("target" or "bull's-eye" appearance).
* It may change shape or move during swallowing, and occasionally air bubbles or movement of fluid may be observed.
Comparison of answer choices:
* A. Parathyroid glands are small, homogeneous, hypoechoic, and located posterior to the thyroid - but do not have this layered target appearance.
* B. Lymph nodes have a hypoechoic cortex and echogenic hilum and are typically oval or bean-shaped, without the concentric ring appearance.
* C. Esophagus - Correct. The location, appearance, and structure are consistent with the cervical esophagus.
* D. Paragangliomas are highly vascular and more commonly located in the carotid body or adrenal region, not in this location or with this sonographic pattern.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Grant EG, Tessler FN, Hoang JK, et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR TI- RADS Committee. J Am Coll Radiol. 2015.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
NEW QUESTION # 99
Hepatitis is classified into groups. Which of these four types are transmitted by fecal-oral route?
- A. Hepatitis C
- B. Hepatitis B
- C. Hepatitis D
- D. Hepatitis A
Answer: D
Explanation:
Hepatitis A is primarily transmitted via the fecal-oral route, often through contaminated food or water.
Hepatitis B, C, and D are transmitted through blood and body fluids.
According to CDC and WHO guidelines:
"Hepatitis A virus (HAV) is transmitted primarily by the fecal-oral route via ingestion of contaminated food or water." Reference:
CDC. Viral Hepatitis Surveillance - United States, 2020.
WHO. Hepatitis A Fact Sheet, 2022.
NEW QUESTION # 100
Which structures converge to form the inferior vena cava?
- A. Right, left, and middle hepatic veins
- B. Right and left common iliac veins
- C. Superior mesenteric and splenic veins
- D. Right atrium and superior vena cava
Answer: B
Explanation:
The inferior vena cava (IVC) is formed by the confluence of the right and left common iliac veins at the level of approximately L5. The hepatic veins drain into the IVC superiorly but do not form it. The superior mesenteric and splenic veins join to form the portal vein, not the IVC.
According to Moore's Clinically Oriented Anatomy:
"The IVC begins at the level of L5 by the union of the right and left common iliac veins." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 101
Which structure is located between the fundus of the stomach and the diaphragm?
- A. Left lobe of the liver
- B. Right kidney
- C. Caudate lobe of the liver
- D. Spleen
Answer: D
Explanation:
The spleen lies in the left hypochondrium, superior and lateral to the fundus of the stomach, and directly contacts the diaphragm. It occupies the space between the stomach and diaphragm. The liver and kidneys are located more medially or inferiorly.
According to Gray's Anatomy for Students:
"The spleen lies posterolateral to the fundus of the stomach, separated from the diaphragm by its fibrous capsule." Reference:
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
Moore KL, Clinically Oriented Anatomy, 8th ed.
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NEW QUESTION # 102
Which congenital anomaly is characterized by the failure of the dorsal and ventral pancreatic buds to fuse?
- A. Annular pancreas
- B. Ectopic pancreas
- C. Pancreatic agenesis
- D. Pancreas divisum
Answer: D
Explanation:
Pancreas divisum occurs when the dorsal and ventral pancreatic ducts fail to fuse during embryologic development. This results in most pancreatic secretions draining through the minor papilla via the dorsal duct (duct of Santorini).
According to Rumack's Diagnostic Ultrasound:
"In pancreas divisum, the dorsal and ventral pancreatic ducts fail to fuse, resulting in separate drainage systems." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
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NEW QUESTION # 103
Which condition is a cause of intrahepatic dilatation with a normal common bile duct?
- A. Tumor at the porta hepatis
- B. Choledocholithiasis
- C. Acute pancreatitis
- D. Portal vein thrombus
Answer: A
Explanation:
Intrahepatic biliary dilatation with a normal common bile duct (CBD) is typically caused by obstruction located at or above the level of the hepatic duct confluence. A tumor at the porta hepatis, such as cholangiocarcinoma (Klatskin tumor), is a classic cause of this pattern. The porta hepatis is the site where the right and left hepatic ducts join to form the common hepatic duct. A mass at this location can obstruct the intrahepatic ducts while leaving the distal CBD unaffected and of normal caliber.
By contrast:
* Portal vein thrombus (A) affects vascular flow but does not directly obstruct bile ducts.
* Choledocholithiasis (C) obstructs the CBD, typically resulting in both intrahepatic and extrahepatic duct dilatation.
* Acute pancreatitis (D) may cause distal CBD compression if there is associated inflammation or pseudocyst formation, but typically results in extrahepatic duct dilatation rather than isolated intrahepatic dilation.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
Chapter: Biliary Tract: "Klatskin tumors cause proximal (intrahepatic) biliary dilatation while the distal bile duct remains normal in caliber."
* Gore RM, Levine MS. Textbook of Gastrointestinal Radiology, 4th ed. Saunders, 2015.
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NEW QUESTION # 104
Which congenital disorder is most consistent with the finding identified by the arrow on this image?
- A. Alagille syndrome
- B. Sclerosing cholangitis
- C. Caroli disease
- D. Biliary atresia
Answer: C
Explanation:
The image demonstrates a characteristic "central dot sign" - a hallmark finding of Caroli disease. This is best appreciated on ultrasound as a cystic dilation of the intrahepatic bile ducts with a central echogenic dot or linear structure (which corresponds to the portal vein and fibrous tissue within the dilated duct). The arrow in the image points to one such dilated duct.
Caroli disease is a rare congenital disorder characterized by segmental, saccular dilation of intrahepatic bile ducts. It is often associated with congenital hepatic fibrosis and may predispose to cholangitis, stone formation, and even cholangiocarcinoma.
Key ultrasound features of Caroli disease:
* Cystic or saccular dilations of the intrahepatic bile ducts
* The "central dot sign" - echogenic focus in the center of the dilated ducts (representing portal vein radicle or fibrous tissue)
* May show associated hepatosplenomegaly or signs of portal hypertension Differentiation from other options:
* A. Sclerosing cholangitis: Typically causes diffuse or segmental biliary ductal wall thickening and stricturing; does not present with cystic dilations.
* B. Alagille syndrome: A multisystem disorder often characterized by a paucity of intrahepatic bile ducts, not dilation.
* D. Biliary atresia: Presents in infancy with obliteration of extrahepatic bile ducts, echogenic "triangular cord" sign, and absence of a visible gallbladder. It does not cause ductal dilation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Biliary System, pp. 152-155.
Radiopaedia.org. Caroli disease. https://radiopaedia.org/articles/caroli-disease American College of Radiology (ACR). ACR-SPR Practice Parameter for the Performance of Pediatric Abdominal Ultrasound, 2022.
NEW QUESTION # 105
Which hernia characteristic is demonstrated in these images?
- A. Incarcerated
- B. Strangulated
- C. Reducible
- D. Fat only
Answer: C
Explanation:
The ultrasound images show two views of the same groin region - one without compression (left image labeled "W/O COMPRESSION") and one with graded probe compression (right image labeled "W/ COMPRESSION").
In the non-compression image, a hypoechoic mass-like structure is visible protruding through the abdominal wall, consistent with a hernia sac. On the compression image, the herniated content is no longer visible, indicating that the contents have been pushed back into the abdominal cavity. This is the hallmark feature of a reducible hernia.
Key characteristics of a reducible hernia on ultrasound:
* Herniated contents are visible without pressure.
* Contents disappear or reduce back into the abdomen with graded probe compression or Valsalva release.
* Typically includes omental fat or bowel, but reduction confirms lack of incarceration or strangulation.
Comparison of answer choices:
* A. Fat only refers to the hernia content type, not the behavior or reducibility shown here.
* B. Reducible - Correct. The change in hernia appearance between images demonstrates successful reduction with compression.
* C. Incarcerated hernia would remain visible and not compressible or reducible.
* D. Strangulated hernia would show signs of ischemia (bowel wall thickening, absent perfusion, hyperechoic mesentery), and would also not reduce with compression.
References:
Radswiki. Ultrasound evaluation of hernia. Radiopaedia.org
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination for Hernia (2021)
NEW QUESTION # 106
Which renal condition is commonly associated with pyuria and leukocytosis?
- A. Staghorn calculus
- B. Acute pyelonephritis
- C. Renal cell carcinoma
- D. Nephrocalcinosis
Answer: B
Explanation:
Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Classic clinical findings include fever, flank pain, leukocytosis (elevated white blood cells), and pyuria (white blood cells in urine). Ultrasound may demonstrate renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation.
* Nephrocalcinosis (A) involves calcium deposition without infection.
* Staghorn calculus (B) may lead to infection but is primarily characterized by obstructive uropathy.
* Renal cell carcinoma (C) presents with hematuria and mass formation rather than infection symptoms.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Chapter: Kidneys.
* Middleton WD, Kurtz AB, Hertzberg BS.Ultrasound: The Requisites. 3rd ed. Elsevier, 2015.
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NEW QUESTION # 107
What is a major advantage of power Doppler over color flow Doppler?
- A. Decreased sensitivity to motion artifacts
- B. Improved signal-to-noise ratio
- C. Ease of determining flow direction
- D. Doppler angle independent
Answer: B
Explanation:
Power Doppler measures the amplitude (strength) of Doppler signals rather than frequency shift, making it more sensitive to low-velocity and small-vessel blood flow. Its primary advantage is an improved signal-to- noise ratio, allowing for better visualization of slow or weak flow.
* A: Power Doppler is more sensitive to motion artifacts, not less.
* B: It is still angle dependent, though somewhat less so than color Doppler.
* D: Power Doppler does not display flow direction (a limitation).
Reference Extracts:
* Kremkau FW. Sonography Principles and Instruments. 9th ed. Elsevier, 2015.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
NEW QUESTION # 108
Which condition is most likely to develop after splenic trauma?
- A. Target lesion
- B. Splenule
- C. Splenosis
- D. Hamartoma
Answer: C
Explanation:
Splenosis refers to autotransplantation of splenic tissue following splenic trauma or splenectomy. After rupture, splenic fragments may implant throughout the peritoneal cavity and vascularize, forming multiple nodules of functional splenic tissue. Splenosis is typically asymptomatic and discovered incidentally on imaging.
Splenule (A) is a congenital accessory spleen, not related to trauma.
Hamartoma (C) is a benign primary splenic lesion.
Target lesion (D) generally refers to sonographic appearance seen in metastases or infections, not post-trauma.
Reference Extracts:
Mortele KJ, et al. "Multimodality imaging of splenic lesions and the spleen." Radiographics. 2004;24(4):1137-
1163.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 109
Which gray scale artifact is caused by the oscillation of gas bubbles?
- A. Reverberation
- B. Refraction
- C. Mirror image
- D. Ring down
Answer: D
Explanation:
Ring-down artifact occurs when gas bubbles resonate or oscillate, creating continuous echoes distal to the structure that appear as a vertical, echogenic band extending posteriorly. This is distinct from reverberation, which produces multiple discrete reflections.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Ring-down artifact results from resonance of gas bubbles, producing a continuous, echogenic tail distal to the reflecting interface." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
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NEW QUESTION # 110
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