Lange Review Ultrasonography Examination, 4th Edition


GENERAL INSTRUCTIONS: For each question, select the best answer. Select only one answer for each question unless otherwise specified.

1. Which of the following choices best describes the fibromuscular stroma?

(A) covers the anterior surface of the prostate

(B) is the major site of benign prostatic hypertrophy

(C) is a nonglandular region

(D) A and C

2. Which of the following is not an indication for endorectal prostate sonography?

(A) a prostatic abscess

(B) biopsy guidance of a palpable prostate nodule

(C) an elevated prostatic-specific antigen

(D) differentiation of a benign from a malignant nodule by imaging

3. Patients having endorectal prostate sonography are commonly examined in which of the following positions?

(A) left lateral decubitus position

(B) the erect position

(C) the Trendelenburg position

(D) Fowler’s position

4. Which of the following statements about the transitional zone is false?

(A) it is located centrally around the urethra.

(B) it represents about 5% of the gland.

(C) it is the primary site of benign prostatic hyperplasia.

(D) it is the primary site of adenocarcinoma.

5. Which one of the following statements is false?

(A) the central zone constitutes approximately 25% of the glandular tissue.

(B) the central zone is located at the apex of the prostate.

(C) the vas deferens joins the seminal vesicles in the central zone.

(D) the central zone surrounds the ejaculatory ducts.

6. The peripheral zone accounts for what percentage of the prostatic glandular tissue?

(A) 50%

(B) 10%

(C) 70%

(D) 1%

7. Which of the following statements about the prostate is false?

(A) its apex is located superiorly.

(B) its base abuts the urinary bladder.

(C) it has three zones.

(D) the urethra runs through the gland.

8. Which of the following is a function of the prostate?

(A) hormonal secretions

(B) testosterone production

(C) secretion of seminal fluid

(D) spermatozoa production

9. The seminal vesicles join which of the following to form the ejaculatory duct?

(A) the Denonvilliers’ duct

(B) the vas deferens

(C) the verumontanum

(D) the urethra

10. The ejaculatory duct joins which of the following structures at the verumontanum?

(A) vas deferens

(B) efferent ducts

(C) epididymis

(D) urethra

11. The seminal vesicles are located on which surface of the prostate?

(A) the anterior-inferior surface

(B) the posterior-inferior surface

(C) the posterior-superior surface

(D) the inferior-lateral surface

12. Which of the following statements about prostatic cancer is not true?

(A) it originates mainly in the central zone.

(B) it is commonly a hypoechoic lesion.

(C) its associated factors include genetic and hormonal influence.

(D) clinical presentation may include urinary obstruction.

13. Which of the following is commonly included in the sonographic features of acute prostatitis?

(A) a hypoechoic gland with anechoic areas

(B) a hypoechoic nodule on the peripheral zone

(C) unilateral enlargement of the seminal vesicle

(D) a midline anechoic mass

14. Benign prostatic hyperplasia originates in which of the following areas of the prostate?

(A) the fibromuscular stroma

(B) the peripheral zone

(C) the ejaculatory ducts

(D) the transitional zone

15. Which of the following statements is true about corpora amylacea?

(A) they are part of the anterior fibromuscular capsule.

(B) they are calcified deposits in the prostate.

(C) they appear hypoechoic on endorectal ultrasound.

(D) they are never seen on endorectal ultrasound.

16. Which of the following is not a common sonographic characteristic of prostatic cancer?

(A) a hypoechoic nodule in the peripheral zone

(B) distortion of the capsule

(C) obliteration of the “nipple”

(D) marked compression of the prostatic urethra

17. An endorectal examination of the prostate should begin with which of the following?

(A) transverse scanning

(B) longitudinal scanning

(C) views of the seminal vesicles

(D) a digital rectal examination

18. Which of the following best describes prostate cancer?

(A) echogenic

(B) anechoic

(C) hypoechoic

(D) sonographically variable

19. Which of the following best describes the verumontanum?

(A) a midpoint region between the base and apex of the prostate

(B) a congenital abnormality of the prostate

(C) part of the peripheral zone

(D) part of the seminal vesicle

20. An elevated prostatic-specific antigen may commonly indicate all of the following except

(A) prostatic inflammation

(B) prostatic cancer

(C) benign prostatic hyperplasia

(D) obstruction of the seminal vesicle

21. Which of the following narrows to an apex at the verumontanum?

(A) the central zone

(B) the peripheral zone

(C) the transitional zone

(D) the fibromuscular stroma

22. What does the normal adult prostate weigh?

(A) 10 g

(B) 20 g

(C) 30 g

(D) 40 g

23. Which of the following statements about the seminal vesicles is incorrect?

(A) their absence does not usually affect fertility.

(B) they are joined by the vas deferens.

(C) they are normally less echoic than the prostate.

(D) their sizes varies.

24. Fig. 63 represents a longitudinal scan taken to the right of midline. Which of the following structures is indicated by the arrow?

(A) the proximal urethra

(B) a seminal vesicle

(C) the verumontanum

(D) the ejaculatory duct


FIGURE 6–3. Longitudinal scan to the right of midline.

25. Fig. 64 represents a transverse scan. Which of the following structures are the arrows pointing to?

(A) a tumor in the peripheral zone

(B) prostatitis involving the periurethral areas

(C) central gland calcification

(D) distortion of the prostatic capsule


FIGURE 6–4. Transverse scan of the prostate.

26. Fig. 65 represents a longitudinal scan of a 60-year-old patient presenting with urinary frequency. He was referred for an endorectal prostate sonography examination. What area is outlined by the white arrow?

(A) obliteration of the “prostate-seminal vesicle angle”

(B) a hypoechoic mass in the central zone

(C) a tumor in the peripheral zone

(D) bulging of the prostatic capsule


FIGURE 6–5. Longitudinal scan of the prostate.

27. Fig. 66 represents a longitudinal scan. What region is indicated by the white arrow?

(A) the fibromuscular stroma

(B) the seminal vesicle

(C) the peripheral zone

(D) the central zone


FIGURE 6–6. Longitudinal scan of the prostate.

28. Fig. 66 represents a longitudinal scan. What region is indicated by the black arrow?

(A) the peripheral zone

(B) the central zone

(C) the prostatic capsule

(D) the vas deferens

29. Fig. 67 represents a longitudinal scan taken from a patient presenting with a history of infertility. The white arrow most likely indicates which of the following findings?

(A) benign prostatic hypertrophy

(B) a cyst in the ejaculatory duct

(C) extension of a tumor into the nipple region

(D) central gland disease


FIGURE 6–7. Longitudinal scan of the prostate.