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. Which of the following is not an indication for breast ultrasound?

(A) guidance for a breast biopsy

(B) a patient had a breast sonogram last year and prefers it over a mammogram

(C) an abnormality is palpated by the patient’s physician

(D) an abnormality is palpated by the patient

2. Which of the following statements is true regarding focal zone setting in breast sonography?

(A) the focal zone should be set above the level of the lesion being imaged

(B) the focal zone should be set at the level of the lesion being imaged

(C) there should only be one focal zone used for maximum image optimization

(D) the focal zone placement is not critical in sonographic breast imaging

3. What breast lesion is an acoustic standoff pad most helpful?

(A) deep within the breast tissue

(B) axillary in location

(C) superficially positioned within the breast

(D) mobile upon palpation

4. Each breast lesion should be measured in which of the following scan planes?

(A) radial, antiradial

(B) radial, transverse

(C) sagittal, transverse

(D) longitudinal, antiradial

5. A sonographic exam demonstrating a 2 cm anechoic, circumscribed mass at the 4 o’clock position in the left breast is compared to the patient’s mammogram which suggested a 2 cm spiculated mass at the 9 o’clock position. Which of the following should the sonographer do?

(A) tell the patient she has a cyst and there is nothing to worry about

(B) tell the patient that the mammogram was a false positive and she should be followed up with sonography for future evaluation of the mass

(C) take images of all abnormalities and tell the patient she may leave and return next year for her follow-up mammogram

(D) discuss the differences in location and characteristics of the masses seen on the mammogram and sonogram with the interpreting physician.

6. Which of the following best describes the thickness of normal skin overlying the breast?

(A) 2–3 cm

(B) 1–2 cm

(C) 5–10 mm

(D) 2–3 mm

7. While preparing to perform a sonographic exam on a patient who was referred for evaluation of a palpable abnormality, the patient states she cannot feel the area reliably while lying down. Which of the following should the sonographer do?

(A) ask the patient to try and find the lesion lying down because this is the best position for the sonographic exam

(B) ask the patient to find it sitting up because it is usually the easiest position

(C) ask the patient to find the lesion in whatever position necessary and attempt to image it from this position

(D) examine the entire breast without attempting to localize the palpable abnormality

8. Which of the following sonographic features suggests malignancy?

(A) round

(B) posterior acoustic enhancement

(C) spiculated

(D) circumscribed

9. What minimum center frequency in MHz is required for transducers used in breast sonography

(A) 6

(B) 7

(C) 8

(D) 9

(E) 10

10. In order for a breast mass to be characterized as anechoic it must:

(A) not contain any internal echoes

(B) demonstrate reverberation artifacts at the near-field edge

(C) produce refraction artifacts on the lateral borders

(D) demonstrate reduced echogenicity deep to the mass

11. What is the approximate chance of a woman developing invasive breast cancer in her lifetime?

(A) 1 in 8

(B) 1 in 15

(C) 1 in 40

(D) 1 in 100

12. Positioning to reduce the breast thickness of the upper outer quadrant can be achieved by placing the patient in which of the following positions?

(A) place the ipsilateral hand behind the head and roll the patient into an ipsilateral posterior oblique position

(B) place the contralateral hand behind the head and roll the patient into an ipsilateral posterior oblique position

(C) place the ipsilateral hand behind the head and roll the patient into a contralateral posterior oblique position

(D) place the contralateral hand behind the head and roll the patient into a contralateral oblique position

13. Which of the following information is not required documentation for diagnostic sonograms?

(A) laterality (right or left breast)

(B) clock face notation

(C) distance from the nipple

(D) scan plane orientation

(E) patient’s last name only

14. Using the length of the transducer’s footprint may provide a means to determine what sonographic feature of breast abnormalities?

(A) depth of the lesion

(B) distance of the lesion from the nipple

(C) the transverse diameter of the lesion

(D) the depth at which to place the focal zone for best optimization

15. The utilization of the radial/antiradial scan planes provides the best demonstration of what breast anatomy?

(A) the lobes of the glandular tissue

(B) Cooper’s ligaments

(C) the ductal anatomy of the breast

(D) the terminal ductal lobular units

16. Which two characteristics are most helpful to establish concordance between a lesion seen on ultrasound and mammography?

(A) margins and density

(B) echogenicity and distance from the nipple

(C) margins and echogenicity

(D) size and location

17. The mass in Fig. 10–20 can best be described as:

(A) irregular

(B) circumscribed

(C) macrolobulated

(D) spiculated


FIGURE 10–20.

18. The mass in Fig. 10–21 is best described as:

(A) round

(B) circumscribed

(C) posteriorly enhancing

(D) spiculated


FIGURE 10–21.

19. In Fig. 10–21, what structure is the arrow pointing to?

(A) Cooper’s ligaments

(B) pectoralis muscle

(C) fibroglandular tissue

(D) skin

20. This image in Fig. 10–22 demonstrates:

(A) dilated ductal anatomy

(B) a simple cyst with breast implant rupture

(C) multiple, irregular cysts

(D) a single cyst with dilated ductal anatomy


FIGURE 10–22.

21. What abnormal finding is not demonstrated in Fig. 10–23?

(A) architectural distortion

(B) posterior acoustic attenuation

(C) angular margins

(D) calcifications


FIGURE 10–23.

22. An asymptomatic patient receives a breast sonogram as additional workup. The exam reveals a mass with multiple internal punctuate echogenic foci. What do these foci most likely represent?

(A) calcifications

(B) gas

(C) artifact

(D) fat

23. Sonography is the recommended initial imaging modality for the evaluation of an area of palpable interest in patients younger than what age?

(A) 30

(B) 40

(C) 50

(D) 60

24. Which of the following terms is not an appropriate descriptor of breast lesion shape?

(A) oblong

(B) round

(C) oval

(D) irregular

25. If sonographic scanning in the upper outer quadrant of the breast demonstrates findings suspicious for a tubular structure, which of the following techniques should be used to further evaluate it?

(A) imaging in an orthogonal plane

(B) use of Doppler

(C) adjusting the gray scale

(D) adjusting the focal zone

26. What type transducer should be used for breast sonography?

(A) curved

(B) linear

(C) vector

(D) curvilinear

27. Echogenicity of a mass is assessed relative to which of the following structures?

(A) Cooper’s ligaments

(B) skin

(C) fat

(D) muscle

28. The appearance of hazy, echogenic material with posterior acoustic shadowing seen in an augmented breast should raise the suspicion for which of the following?

(A) malignancy

(B) scar

(C) fibrocystic disease

(D) implant rupture

29. An image from a sonogram performed on a patient referred for evaluation of a palpable abnormality reveals an oval, circumscribed hypoechoic mass-like area with mixed internal echogenicity seen deep to the pectoralis muscle. What does these findings mostlikely represent?

(A) fibroadenoma

(B) cyst

(C) invasive malignancy

(D) lymph node

(E) rib

30. Which of the following statements is true regarding a biopsy performed with a vacuum-assisted device?

(A) pre-fire and post-fire images should be obtained.

(B) pre-fire images only should be obtained.

(C) post-fire images only should be obtained.

(D) images demonstrating the needle in or adjacent to the mass should be obtained.

31. Which of the following statements is true regarding a breast cyst post-aspiration?

(A) there is no need to acquire a post-aspiration image.

(B) a post-aspiration image should only be obtained if a small amount of fluid remains.

(C) a post-aspiration image should only be obtained if there is question if a solid component is present.

(D) a post-aspiration image should be obtained routinely.

32. During imaging of an area of concern, there is evidence of interruption of the Cooper’s ligaments. An irregular hypoechoic region with angular margins and posterior acoustic shadowing is seen, but no mass is visualized. Which of the following is the most appropriate descriptor for this appearance?

(A) spiculation

(B) architectural distortion

(C) dirty shadowing

(D) normal parenchyma

33. The finding discussed in question 32 is most likely to be seen in which of the following scenarios?

(A) benign lesions

(B) post-surgical change

(C) young, asymptomatic patients

(D) pregnant patients with a palpable mass