Lange Review Ultrasonography Examination, 4th Edition

Answers and Explanations

1. (B) Breast sonography is an adjunct to mammography in the detection of breast disorders. It is not an examination that is used in place of mammography, but rather in addition and is not used alone as a screening tool. A, C and D are all indications for breast sonography. (Study Guide)

2. (B) Placement of the focal zone at the level of the lesion or region of interest optimizes visualization of the lesion characteristics. (Study Guide)

3. (C) The use of an standoff pad improves visualization of superficial lesions within the near field, which is sometimes referred to as the sonographic ‘blind spot’. (Study Guide)

4. (A) Radial and antiradial are the preferred scan planes for imaging the breast anatomy primarily based on the ductal anatomy of the breast as it converges toward the nipple. The annotation of the clock face orientation for imaging denotes transducer placement for radial/antiradial scan planes. (Study Guide)

5. (D) All sonographic findings should be discussed with the interpreting physician. (Study Guide)

6. (D) Skin thickness is normally no more than 2–3 mm. (Study Guide)

7. (C) Localizing a palpable lesion is paramount to the performance of an adequate exam. It is also important to stabilize the lesion so that it may be adequately examined. This is often best achieved by scanning the patient in the position in which the lesion is best felt. (Study Guide)

8. (C) Spiculated borders of a breast mass are considered abnormal and concerning for malignancy. (Study Guide)

9. (B) A minimum center frequency of 7 MHz is required for breast sonography, although higher frequencies should be employed when possible. Superficial lesions or smaller breast mass would not require as much penetration and a higher frequency would be appropriate. (Study Guide)

10. (A) The term anechoic indicates ‘without echoes’ and therefore, for a lesion to be deemed such, it should not produce any echoes within. Cysts may produce reverberation artifacts in the near-field edge, but this is not a requirement to be deemed anechoic. (Study Guide)

11. (A) The chance of developing breast cancer in a woman’s life is approximately 1 in 8. (Study Guide)

12. (C) This position permits placement of the breast tissue on a level surface and reduces breast thickness in the upper outer quadrant. (Study Guide)

13. (E) All images are considered part of a patient’s medical record and should document the patient’s full name. (Study Guide)

14. (B) The distance of a lesion from the nipple should be documented with as much accuracy as possible. By knowing the length of the transducer’s footprint that distance can be assessed by placing the edge of the transducer at the nipple and evaluating the relationship of the lesion’s position to the transducer edge in terms of a ratio of the transducer length. (Study Guide)

15. (C) The ductal anatomy of the breast converges toward the nipple. The implementation of the radial and antiradial scan planes provides longitudinal and transverse orientation with respect to breast anatomy. (Study Guide)

16. (D) In order to compare sonographic findings with mammography, it is important to verify that location and the lesion size are consistent in order to prevent errors of discordance. (Study Guide)

17. (A) The lesion is not circumscribed. Macrolobulation is typically benign descriptor that is best reserved for an oval benign-appearing mass such as a suspected fibroadenoma. A spiculated appearance is typically seen with more hypoechoic masses, posterior acoustic shadowing and architectural distortion, similar to that seen with postsurgical scarring. (Study Guide)

18. (B) The lesion is oval and circumscribed, typical for a fibroadenoma. (Study Guide)

19. (B) The pectoralis muscle is demonstrated posterior to the breast tissue and is recognized by internal echogenic striations. (Study Guide)

20. (D) This image demonstrates a well-circumscribed anechoic lesion with posterior enhancement suggesting a breast cyst. In close proximity to the cyst, there are tubular hypoechoic structures suggesting dilated ducts are present. (Study Guide)

21. (D) There are no calcifications suggested in this image, although there is distortion of the normal breast tissue with angular margins and some posterior acoustic shadowing/attenuation. (Study Guide)

22. (A) Artifactual internal echogenicity and fat are rarely punctuate in appearance. Additionally, gas would be unlikely in an asymptomatic patient. (Study Guide)

23. (A) Younger patients typically have dense glandular breast tissue, which prevents mammography from clearly identifying abnormalities even if palpable. The use of sonography can not only evaluate the area of interest, but also correlate any findings with palpation while reducing the patient’s exposure to ionizing radiation. (Study Guide)

24. (A) Oblong is not an accepted descriptor of lesion shape. (Study Guide)

25. (B) Imaging in the orthogonal plane is necessary for any evaluation in breast sonography, normal or abnormal. The use of Doppler will help determine if this finding is a vessel or a duct. (Study Guide)

26. (B) Linear array transducers provide the best resolution and are particularly useful in superficial structures, such as the breast, when a wide field of view is not essential. (Study Guide)

27. (C) Fat is hypoechoic relative to the mammary/glandular tissue. The gray scale and gain settings should be set to demonstrate fat as the medium level echo and compare all other tissue/findings to its echogenicity (Study Guide)

28. (D) Free silicone has the appearance of ‘dirty shadowing’, which is described in this question. (Study Guide)

29. (E) The ribs and chest wall are the only structures which are typically identified deep to the pectoralis muscle. Lymph nodes in this region are not commonly identified by ultrasound. (Study Guide)

30. (D) Vacuum-assisted devices do not ‘fire’ when obtaining the specimen. (Study Guide)

31. (D) This protocol is important to determine and document the completeness of the aspiration. (Study Guide)

32. (B) Spiculation is used to describe the margins of a mass when the tissue surrounding the mass is altered and has angular characteristics. Architectural distortion is best used when a mass is not appreciated, but the tissue is similarly altered. (Study Guide)

33. (B) Architectural distortion is usually seen post-surgically or in association with a malignancy. (Study Guide)