Lange Review Ultrasonography Examination, 4th Edition

Answers and Explanations

At the end of each explained answer, there is a number combination in parentheses. The first number identifies the reference source; the second number or set of numbers indicates the page or pages on which the relevant information can be found.

1. (D) Both A and C. The fibromuscular stroma is a nonglandular region that covers the anterior surface of the prostate. Therefore, both A and C are correct. (1:396)

2. (D) Differentiation of a benign from a malignant nodule by imaging. Ultrasound cannot make a specific diagnosis of prostatic diseases. Biopsy is required to establish the diagnosis. (1:411)

3. (A) The left lateral decubitus. Patients who are having endorectal prostate sonography are usually examined in the left lateral decubitus position. (1:402)

4. (D) It is the primary site of adenocarcinoma. The transitional zone is located on both sides of the proximal urethra and represents 5% of the gland. It also is the primary site of benign prostatic hyperplasia. (1:397)

5. (B) The central zone is located at the apex of the prostate. The central zone is a triangular structure located at the base of the prostate with its apex at the verumontanum. (1:397)

6. (C) 70%. The peripheral zone constitutes more than two-thirds of prostatic glandular tissue. (1:396)

7. (A) Its apex is located inferiorly and the base of the prostate is located superiorly. (See Fig. 6–1B in the Study Guide.)

8. (C) Secretion of seminal fluid. The prostate discharges this fluid into the urethra to enhance the motility of sperm. (2:2)

9. (B) The vas deferens. The seminal vesicles join the vas deferens to form the ejaculatory duct, which passes through the central zone. (See Fig. 6–1B in the Study Guide.)

10. (D) Urethra. The ejaculatory duct empties into the urethra at the verumontanum. (See Fig. 6–1B in the Study Guide.)

11. (C) The posterior-superior surface. (See Fig. 6–1B in the Study Guide.)

12. (A) It originates mainly in the central zone. Seventy percent of prostatic cancers originate de novo in the peripheral zone. (1:411)

13. (A) A hypoechoic gland with anechoic areas. (1:403)

14. (D) The transitional zone. (1:403)

15. (B) They are calcified deposits in the prostate. (1:402)

16. (D) Marked compression of the prostatic urethra. Early prostatic cancer can present as hypoechoic lesions on the peripheral zone. They can break through the prostatic capsule causing distortion, or they can invade the seminal vesicles. (1:412)

17. (D) A digital rectal examination. This examination should be done before the probe is inserted to exclude obstructing lesions and to correlate the imaging study with the digital rectal exam. (1:402)

18. (D) Sonographically variable. Prostate cancer can be hypoechoic, hyperechoic, or isoechoic. (1:412)

19. (A) A midpoint region between the base and apex of the prostate. (See Fig. 6–1B in the Study Guide.)

20. (D) Obstruction of the seminal vesicle. An elevated prostatic-specific antigen (PSA) may be indicated in prostate cancer, prostatitis, or benign prostatic hyperplasia (BPH). (1:410)

21. (A) The central zone. (See Fig. 6–1B in the Study Guide.)

22. (B) The normal postpubescent prostate weighs approximately 20 g. (Study Guide:349)

23. (A) Their absence does not usually affect fertility. In rare cases, infertility can be caused by absence of the seminal vesicles or by an obstruction in the ejaculatory ducts. (1:405)

24. (B) A seminal vesicle. The structure demonstrated in Fig. 6–1B is the right seminal vesicle, that joins the vas deferens (not shown) to form the ejaculatory duct. (Study Guide: Fig. 6–1B)

25. (C) Central gland calcification. Fig. 64 shows bright echoes representing prostatic calcification, which can be solitary or can occur in clusters. (Study Guide:351)

26. (C) A tumor in the peripheral zone. The hypoechoic mass seen on the peripheral zone in Fig. 64 is characteristic of prostatic cancer. (Study Guide:351)

27. (D) The central zone. The zone (white arrow) in Fig. 66 is clearly demarcated from the peripheral zone (black arrow) by a curved band of echoes. (Study Guide:350)

28. (A) The peripheral zone. (Study Guide:350)

29. (B) A cyst in the ejaculatory duct. The cystic structure shown in Fig. 67 is clearly located within the ejaculatory duct. (Study Guide:350)


1. Toi A, Bree R. The prostate. In: Rumack C, Wilson S, Charboneau W, et al. Diagnostic Ultrasound. 3rd ed., vol. 1. St. Louis, MO: Mosby; 2005.

2. Paulson D. Diseases of the prostate. Clin Symposia. 1989; 41.