Lange Review Ultrasonography Examination, 4th Edition


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

1. The 3D sonogram in Fig. 8–38 is shown as which of the following?

(A) surface-rendered image

(B) multiplanar image

(C) “see-through” or transparent mode image

(D) has too many artifacts to be considered of diagnostic quality


FIGURE 8–38. 3D sonogram of a 12-week fetus.

2. Which of the following statements is true concerning Fig. 8–38?

(A) Cleft lip and palate are seen.

(B) A large cranial structure defect is seen.

(C) Numerous fetal limb abnormalities are seen.

(D) None of the above

3. Which of the following statements is also true regarding Fig. 8–38?

(A) There is a large diaphragmatic hernia.

(B) There is a large abdominal wall hernia.

(C) There is absence of an umbilical cord.

(D) None of the above

4. Which of the following is a false statement concerning the image in Fig. 8–38?

(A) There is an amniotic band.

(B) There is anencephaly

(C) A and B

(D) None of the above

5. Which of the following is true concerning the 3D image in Fig. 8–39?

(A) surface rendered

(B) volume rendered

(C) misleading

(D) obtained through a lateral ventricle


FIGURE 8–39. Long axis (1); short axis (2); and (3) coronal planes and 3D volume of the fetal brain in midline.

6. The upside down U-shaped structure in the center of the 3D image in Fig. 8–39 is which of the following?

(A) The corpus callosum

(B) A large intraventricular clot

(C) The choroid plexus

(D) None of the above

7. Which of the following is shown in the 3D sonogram in Fig. 8–39?

(A) marked ventricular dilation

(B) agenesis of the corpus callosum

(C) a vein of Galen aneurysm

(D) none of the above

8. Which of the following statements is true concerning Fig. 8–39?

(A) The fetus is brow down.

(B) The fetus is in breech position.

(C) The position of the fetus cannot be determined.

(D) The fetus is anencephalic.

9. In Fig. 8–40, image number 2 is taken through which of the following scan planes?

(A) long-axis

(B) short-axis

(C) coronal

(D) cannot be determined


FIGURE 8–40. 3D sonogram of the kidneys of a second-trimester fetus.

10. In Fig. 8–40, which of the following best describes the appearance of the kidneys?

(A) normal

(B) polycystic

(C) atrophic

(D) cannot tell

11. Which of the following is usually shown in 3D sonography of infantile polycystic kidneys?

(A) multiple tiny cysts

(B) echogenic kidney

(C) enlarged kidney

(D) both B and C

12. Which of the following is true about the ureters on a second-trimester fetus on 3D sonography?

(A) cannot be seen in their entirety

(B) can be imaged in their long axis

(C) have fluid (urine) in there

(D) none of the above

13. In Fig. 8–41 what is the most common abnormal facial finding?

(A) bilateral cleft lip

(B) bilateral cleft palate

(C) both A and B

(D) neither A nor B


FIGURE 8–41. 3D sonogram of the fetal face.

14. Short-axis images through the fetal hard palate may show which of the following characteristics?

(A) teeth buds

(B) cleft palate

(C) cleft lip

(D) all of the above

15. Which of the following is usually true concerning cleft lip?

(A) an isolated anomaly

(B) life threatening

(C) associated with brain anomaly

(D) surgically treatable in utero

16. Which of the following can be said about transparency mode?

(A) may help delineation of the extent of the osseous abnormality

(B) cannot be done since only surface rendition was done

(C) reverses background colors

(D) requires additional sweeps

17. What does the 3D sonogram in Fig. 8–42 show?

(A) two umbilical arteries and one umbilical vein

(B) abnormally loose coiling

(C) abnormally tight coiling

(D) none of the above


FIGURE 8–42. 3D sonogram of an umbilical cord.

18. Which of the following conditions is associated with a single umbilical artery?

(A) genitourinary abnormalities

(B) central nervous system abnormalities

(C) gastrointestinal abnormalities

(D) all of the above

19. Which of the following is true regarding the tightness or “pitch” of umbilical cord coiling?

(A) related to rotation of the fetus in utero

(B) varies according to gestational age of the fetus

(C) predictive of whether or not the fetus has “tumbled” in utero

(D) is not predictive of anything

20. 3D of the umbilical cord is helpful in the diagnosis of which of the following?

(A) umbilical cord “knots”

(B) umbilical cord entanglement in twins

(C) determines the number of vessels within the cord

(D) all of the above

21. In Fig. 8–43 what does the image in this sonogram show?

(A) abnormal number of toes

(B) typical “sandal” gap anomaly of the Down’s fetus

(C) both A and B

(D) normal feet and toes


FIGURE 8–43. 3D sonogram of the feet of a near-term fetus.

22. Which of the following can be associated with club feet?

(A) meningomyelocele

(B) many types of karyotypic anomalies

(C) normal fetus

(D) all of the above

23. Rockerbottom feet can be associated with which of the following conditions?

(A) meningomyelocele

(B) many types of karyotypic anomalies

(C) normal fetus

(D) all of the above

24. The relationship of the long bones of the leg to the foot is

(A) best shown on 3D

(B) best shown on 2D

(C) is difficult to show when there is polyhydramnios

(D) none of the above

25. What are the arrows pointing to in Fig. 8–44?

(A) a large retroplacental hematoma

(B) a 3D scanning artifact

(C) a large marginal sinus hemorrhage

(D) none of the above


FIGURE 8–44. 3D placental sonogram.

26. This condition may be associated with which of the following?

(A) severe maternal compromise

(B) severe fetal compromise

(C) both A and B

(D) none of the above

27. Retroplacental hemorrhage is typically seen associated with which of the following conditions?

(A) maternal hypertension (eclampsia)

(B) trauma to abdomen

(C) both A and B

(D) amniocentesis

28. In patients with retroplacental hemorrhage, it is important to determine which parameters?

(A) extent of retroplacental hemorrhage (relative to basal plate surface area)

(B) the area of hemorrhage

(C) both A and B

(D) none of the above

29. What is the diagnosis of the fetus shown in Fig. 8–45?

(A) hydrocephalus

(B) 3D artifact

(C) bilateral cleft palate

(D) none of the above


FIGURE 8–45. 3D sonogram of a second-trimester fetus.

30. Anencephaly is not closely associated with which one of the following findings?

(A) meningomyelocele

(B) agenesis of corpus callosum

(C) decreased maternal serum alpha fetoprotein

(D) maternal diabetes

31. Anencephaly is thought to be the result of which of the following?

(A) failure of the anterior neuropore to close properly

(B) failure of the posterior neuropore to close properly

(C) maternal trauma

(D) maternal hypertension

32. Anencephaly is an example of which of the following?

(A) neural tube defect

(B) normal embryonic stage

(C) an inherited disorder

(D) all of the above

33. What is the diagnosis for the fetus shown in Fig. 8–46?

(A) omphalocele

(B) scrotal mass

(C) gastroschisis

(D) none of the above


FIGURE 8–46. 3D sonogram of a fetus at 29-weeks’ gestation.

34. Omphalocele may be associated with which of the following?

(A) karyotypic anomalies

(B) ectopic heart (cordis)

(C) diaphragmatic hernia

(D) all of the above

35. Gastroschisis is characterized by which of the following?

(A) eccentric herniation of the umbilical cord

(B) higher probability of karyotypic anomaly than omphalocele

(C) bowel covered by membrane

(D) none of the above

36. Omphaloceles may:

(A) contain liver and bowel

(B) be transient and regress

(C) may be both A and B

(D) are neither A nor B

37. What is the sex of the fetus shown in Fig. 8–47?

(A) male

(B) female

(C) ambiguous

(D) cannot be determined


FIGURE 8–47. 3D sonogram of the fetal perineum.

38. Which of the following is true regarding sonographic evaluation of fetal gender?

(A) helpful if karyotypic anomaly is suspected

(B) endorsed by the AIUM as an indication for routine 3D sonography

(C) usually misleading

(D) none of the above

39. Hypospadias may be associated with which of the following?

(A) hydronephrosis

(B) renal anomalies

(C) both A and B

(D) none of the above

40. Which type of 3D processing best depicts external genitalia?

(A) surface rendering

(B) transparency mode

(C) tomographic made

(D) none of the above

41. What is the most likely diagnosis of the finding in Fig. 8–48?

(A) hemorrhagic cyst

(B) ovarian tumor

(C) neither A nor B

(D) mature follicle


FIGURE 8–48. Multiplanar image and 3D surface volume of an ovary.

42. The low-level echoes within the mass probably represent which of the following?

(A) hemorrhage

(B) mucin

(C) sebum

(D) cannot be determined

43. Which of the following does the wall contain?

(A) papillary excrescence

(B) dermal sinus

(C) blood clot

(D) none of the above

44. What is the most common type of tumor that contains a papillary excrescence?

(A) borderline serous cystadenoma

(B) dermoid cyst

(C) follicular cyst

(D) hemorrhagic cyst

45. What is the most likely diagnosis of the finding in Fig. 8–49?

(A) polyp

(B) pedunculated submucosal fibroid

(C) uterine septum

(D) none of the above


FIGURE 8–49. 3D uterine sonogram obtained in the coronal plane.

46. Polyps may be associated with which of the following?

(A) infertility

(B) pain and bleeding

(C) carcinoma

(D) all of the above

47. Which of the following is the most appropriate treatment of a polyp?

(A) wire-loop resection

(B) dilation and curettage

(C) don’t ask me; I’m just a sonographer

(D) hysteroscopic removal with polyp forceps

48. What is the best way to distinguish fibroids from polyps?

(A) They are more echogenic than polyps

(B) polyps may contain tiny cystic spaces

(C) blood supply

(D) none of the above

49. What abnormality is seen in Fig. 8–50?

(A) endometrial polyp

(B) submucosal fibroid

(C) adhesion

(D) cannot be determined


FIGURE 8–50. 3D sonogram obtained during sonohysterography.

50. What is the relative chance that a polyp is cancerous?

(A) low

(B) high

(C) cannot be determined based on 3D

(D) none of the above

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