Ultrasound 2

Question 1

What is the imaging modality of choice for testicular pain?

Answer 1

testicular ultrasound

Question 2

On testicular u/s you notice an increase in the size of the affected testis and an absence of blood flow what are you concerned for?

Answer 2

testicular torsion

Question 3

What is the imaging modality of choice for pelvic complaints in female?

Answer 3

pelvic ultrasound

Question 4

What is the difference between transabdominal u/s and transvaginal u/s?

Answer 4

• TAUS = utilizes the curvilinear probe and uterus better visualized with a full bladder
• TVUS = utilizes the endocavitary probe and uterus better visualized with an empty bladder

Question 5

On a pelvic ultrasound what female structure is not normally seen unless there is associated pathology?

Answer 5

• fallopian tubes

Question 6

What finding on pelvic u/s is consistent with endometrial cancer?

Answer 6

> 5 mm thickness post-menopause

Question 7

How do fibroids (leiomyoma) appear on u/s?

Answer 7

• typically hypo or isoechoic masses within the myometrium

Question 8

How can you tell the difference between simple cysts and hemorrhagic cysts?

Answer 8

• hemorrhagic cysts have a lace-like echoes within it = “fish-net appearance”

Question 9

How can you distinguish a benign ovarian cyst from ovarian malignancy?

Answer 9

• features of malignancy that diff from benign include:
  1. thick, irregular walls
  2. solid components
  3. increase blood flow
  3. papillary structures

Question 10

Ovarian cysts that are how big can be indicative of ovarian torsion?

Answer 10

5-10 cm in size

Question 11

What is the relationship between blood flow and ovarian torsion?

Answer 11

• no blood flow is specific for torsion but torsion can not be ruled out if there is blood flow

Question 12

What imaging test is used to confirm intrauterine pregnancy (IUP) in the first trimester?

Answer 12

• ultrasound

Question 13

What is the first sign of pregnancy on ultrasound?

Answer 13

Gestational sac

Question 14

At what serum HCG level do you expect to see a gestational sac?

Answer 14

1500 mIU/mL

Question 15

In which order are the following structures able to be seen under ultrasound during the first trimester?

gestational sac, fetal pole, yolk sac

Answer 15

1. gestational sac
2. yolk sac
3. fetal pole

Question 16

What can be used to estimate the gestational age of the fetus during the first trimester?

Answer 16

• crown rump length (CRL)

* length from top of its head to bottom of torso*

Question 17

T/F: You cannot reliably determine sex in first trimester with U/S.

Answer 17

True

Question 18

How is fetal heart rate calculated?

Answer 18

using M-mode on u/s

normal = 120-160 bpm

Question 19

What sign on ultrasound is indicative of Trisomy 21?

Answer 19

nuchal translucency at 11-14 weeks

Question 20

Where is the common location of an ectopic pregnancy?

Answer 20

fallopian tube (95-96%)

Question 21

How can you distinguish an ectopic pregnancy vs a cyst or mass?

Answer 21

• applying gentle pressure during real time imaging will separate ectopic pregnancy but NOT cysts or masses

Question 22

When comparing the serum HCG and ultrasound findings, what correlation is concerning for ectopic pregnancy?

Answer 22

• serum HCG >1500-2000 without visible IUP

Question 23

What sign is indicative of a ruptured ectopic pregnancy until proven otherwise?

Answer 23

• sudden onset abdominal pain and hypotension in a pregnant patient

Question 24

delete

Answer 24

• free fluid

Question 25

ultrasound is the test of choice to evaluate for all of the following except: a. ejection fraction b. valvular disease c. endocarditis d. cardiomyopathy e. pericardial effusion f. coronary artery disease

Answer 25

f. coronary artery disease

Question 26

How is the ejection fraction measured under u/s?

Answer 26

- change in volume at end diastole and end systole | * normal = 55-70%*

Question 27

what u/s findings are consistent with stenosis?

Answer 27

- abnormal valve anatomy - hyperechoic leaflefts d/t calcification - elevated outflow velocity

Question 28

what u/s finding is consistent with regurgitation?

Answer 28

- retrograde flow on color doppler

Question 29

when is an agitated saline echo used? "bubble study"

Answer 29

- to examine for a defect in the walls of the heart (e.g. PFO)

Question 30

what sonographic findings are consistent with HOCM?

Answer 30

- increases LV wall thickness > 15mm + outflow obstruction?

Question 31

Cardiac tamponade correlates with what?

Answer 31

time rather than size

Question 32

What is the criteria for a small, moderate, and large pericardial effusion? For each, what do they correspond to in terms of fluid amount?

Answer 32

- small = < 10mm = 100 cc fluid - mod = 10-20mm = 100-500 cc fluid - large = > 20mm = >500 cc fluid

Question 33

What is Beck's triad?

Answer 33

-clinical signs that correlate to cardiac tamponade 1. Hypotension 2. distended neck veins 3. muffled heart sounds

Question 34

What u/s findings are consistent with cardiac tamponade?

Answer 34

- pericardial effusion - right atrial systolic collapse - right ventricular diastolic collapse - dilated IVC

Question 35

In which population are you especially concerned for endocarditis?

Answer 35

IVDU

Question 36

Using the modified Duke criteria, what sonographic findings are consistent with endocarditis?

Answer 36

- presence of vegetation - presence of abscess - presence of a new dehiscence of a valvular prothesis - new valve regurgitation

Question 37

Which of the following is more sensitive TTE or TEE?

Answer 37

TEE