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Exam
Question 1. Which Couinaud segment of the liver contains the hepatic vein that drains directly into the inferior vena cava? A) Segment I B) Segment IVb C) Segment VII D) Segment II Answer: A Explanation: Segment I (the caudate lobe) drains directly into the IVC via the caudate hepatic veins, bypassing the main hepatic veins. Question 2. The normal wall thickness of the gallbladder on ultrasound is: A) ≤2 mm when distended B) ≤5 mm when contracted C) ≤1 mm regardless of distention D) ≤3 mm only in fasting state Answer: A Explanation: A normal gallbladder wall is ≤2 mm when the lumen is distended; thicker walls suggest inflammation or edema. Question 3. The pancreatic uncinate process is best visualized in which scanning plane? A) Transverse through the epigastrium B) Sagittal through the left flank C) Oblique coronal through the epigastrium D) Axial through the right upper quadrant Answer: C Explanation: An oblique coronal (or longitudinal) plane aligns with the uncinate process, allowing separation from the superior mesenteric vessels.
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Question 4. Which of the following describes the normal appearance of renal cortical thickness on a longitudinal scan? A) 5–7 mm in adults B) 10–12 mm in children C) 2–3 mm in all ages D) 8–10 mm in obese patients only Answer: A Explanation: Normal adult renal cortex measures 5–7 mm; thinning suggests chronic disease. Question 5. In a normal bladder ultrasound, the post‑void residual volume should be: A) <50 mL B) 50–100 mL C) 100–150 mL D) >150 mL Answer: A Explanation: A residual <50 mL indicates adequate emptying; higher volumes suggest obstruction or neurogenic bladder. Question 6. The typical size limit for a normal spleen in the adult is: A) Length ≤12 cm B) Length ≤15 cm C) Width ≤8 cm D) Thickness ≤5 cm Answer: A Explanation: A spleen longer than 12 cm is considered enlarged in most adults. Question 7. Which arterial branch arises directly from the abdominal aorta at the level of T12? A) Celiac trunk
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D) Focal nodular hyperplasia nodules Answer: B Explanation: In hepatitis, inflamed portal tracts become more echogenic, creating a starry‑sky pattern against relatively hypoechoic hepatocytes. Question 11. The most common benign focal liver lesion seen on ultrasound is: A) Hemangioma B) Focal nodular hyperplasia C) Hepatocellular carcinoma D) Metastasis Answer: A Explanation: Hepatic hemangiomas are the most frequent benign focal lesions, typically hyperechoic and well‑circumscribed. Question 12. A “central scar” on ultrasound is most characteristic of which liver lesion? A) Focal nodular hyperplasia B) Hepatocellular carcinoma C) Metastasis D) Hemangioma Answer: A Explanation: FNH often contains a central fibrous scar that appears hypoechoic relative to the surrounding hyper‑ or isoechoic tissue. Question 13. In chronic pancreatitis, the typical ultrasound finding is: A) Diffuse pancreatic enlargement with uniform echogenicity B) Hypoechoic focal mass with central necrosis C) Heterogeneous echotexture with calcifications D) Completely anechoic pancreas Answer: C
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Explanation: Chronic pancreatitis shows a heterogeneous gland with hyperechoic calcifications and possible ductal dilation. Question 14. Which Doppler artifact is most useful for confirming the presence of a renal calculus? A) Alias-ing B) Twinkle artifact C) Mirror image D) Posterior enhancement Answer: B Explanation: Twinkle artifact appears as a rapidly alternating color signal behind strongly reflecting surfaces such as stones, aiding detection. Question 15. The normal common bile duct (CBD) diameter in adults after fasting is: A) ≤4 mm B) ≤6 mm C) ≤8 mm D) ≤10 mm Answer: A Explanation: A CBD ≤4 mm is considered normal; larger diameters may indicate obstruction or post‑cholecystectomy changes. Question 16. A Phrygian cap is best described as: A) A focal gallbladder wall thickening B) A fold of the gallbladder fundus that resembles a cap C) A calcified gallstone in the cystic duct D) An accessory gallbladder Answer: B Explanation: The Phrygian cap is a normal anatomic variant where the fundus folds over itself.
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A) Homogeneous hyperechoic lesion with posterior shadowing B) Wedge‑shaped, hypoechoic area extending to the capsule C) Central cystic cavity with internal septations D) Diffuse splenomegaly with coarse echotexture Answer: B Explanation: Splenic infarcts appear as peripheral, wedge‑shaped, hypoechoic lesions that abut the capsule. Question 21. The “twinkling” artifact is most commonly produced by: A) Air bubbles in a cyst B) Highly reflective metallic objects C) Calculi composed of calcium oxalate D) Simple fluid collections Answer: C Explanation: Twinkling is generated by rough, highly reflective surfaces such as calcium‑containing stones. Question 22. Which of the following best describes the location of the adrenal glands on a transverse abdominal scan? A) Posterior to the pancreas, superior to the kidneys B) Anterolateral to the aorta, between the liver and spleen C) Directly inferior to the diaphragm, lateral to the IVC D) Within the splenic hilum Answer: A Explanation: The adrenal glands lie atop the kidneys, posterior to the pancreas, and are positioned superior to the renal poles. Question 23. The normal maximum diameter of the abdominal aorta in an adult male is: A) ≤2 cm
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B) ≤3 cm C) ≤4 cm D) ≤5 cm Answer: B Explanation: An aortic diameter ≤3 cm is considered normal; larger measurements suggest aneurysm. Question 24. In renal artery stenosis, which Doppler criterion is most reliable? A) Peak systolic velocity >200 cm/s B) Continuous monophasic waveform C) Decreased RI (<0.45) D) Increased diastolic flow reversal Answer: A Explanation: A peak systolic velocity >200 cm/s across the stenotic segment is a strong indicator of significant renal artery stenosis. Question 25. A “target sign” on ultrasound of the appendix is indicative of: A) Acute appendicitis B) Normal appendix C) Appendiceal mucocele D) Crohn’s disease Answer: B Explanation: The normal appendix shows a layered “target” or “gut signature” appearance with alternating echogenic and hypoechoic layers. Question 26. Which of the following ultrasound findings is most specific for acute cholecystitis? A) Gallbladder wall thickness >3 mm with pericholecystic fluid B) Presence of a single gallstone C) Gallbladder sludge only
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Answer: B Explanation: Adenomyomatosis creates small intramural cholesterol crystals that generate comet‑tail reverberation artifacts. Question 30. During a renal Doppler study, an angle correction greater than 60° will most likely result in: A) Overestimation of velocity B) Underestimation of velocity C) No effect on velocity measurement D) Complete loss of signal Answer: B Explanation: Angles >60° cause cosine values to decrease sharply, leading to underestimation of true blood‑flow velocity. Question 31. Which of the following is the best sonographic sign of a hepatic hemangioma? A) Peripheral nodular enhancement on contrast‑enhanced US B) Central necrosis with irregular margins C) Homogeneous hypoechoic mass with posterior shadowing D) Isoechoic mass with calcifications Answer: A Explanation: Hemangiomas demonstrate peripheral, nodular, discontinuous enhancement that fills centripetally on contrast‑enhanced ultrasound. Question 32. In a patient with suspected pancreatic pseudocyst, the most reliable ultrasound characteristic is: A) Solid hyperechoic mass with internal vascularity B) Anechoic or low‑level echoic lesion with thin wall, located adjacent to the pancreas C) Multiple calcifications within the lesion D) Hypervascular solid component on Doppler
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Answer: B Explanation: Pseudocysts appear as well‑defined, anechoic or low‑level fluid collections with thin walls, often adjacent to the pancreas. Question 33. Which of the following is a normal finding on a post‑void bladder scan? A) Residual volume of 80 mL B) Uniform bladder wall thickness of 4 mm C) Presence of ureteral jets on both sides D) Echoic debris within the lumen Answer: C Explanation: Bilateral ureteral jets indicate normal ureteral peristalsis and drainage after voiding. Question 34. The most appropriate patient preparation for a detailed gallbladder ultrasound is: A) Full bladder and supine position B) NPO for at least 6 hours to ensure gallbladder distention C) Administration of IV contrast prior to scanning D) Immediate scanning after a fatty meal Answer: B Explanation: Fasting for 6–8 hours allows the gallbladder to fill, improving visualization of stones and wall pathology. Question 35. In an ultrasound‑guided liver biopsy, which needle visualization technique is recommended? A) In‑plane approach only B) Out‑of‑plane approach only C) Both in‑plane and out‑of‑plane as needed, with continuous real‑time tracking of the needle tip D) No visualization required if the lesion is >2 cm Answer: C
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Explanation: An accessory spleen mirrors the normal spleen’s echotexture and is often located near the splenic hilum or pancreatic tail. Question 39. In a patient with suspected portal vein thrombosis, which Doppler finding is most diagnostic? A) Normal hepatopetal flow with increased velocity B. Absence of flow or echogenic material within the portal vein lumen C) Reversed (hepatofugal) flow in the portal vein D) Triphasic hepatic vein waveform Answer: B Explanation: Thrombus appears as echogenic material within the portal vein, often with absent or very low‑velocity flow on Doppler. Question 40. Which ultrasound artifact is most useful in confirming the presence of a gallstone? A) Posterior acoustic enhancement B) Reverberation artifact C) Acoustic shadowing D) Mirror image artifact Answer: C Explanation: Gallstones produce a clean, distal acoustic shadow due to high acoustic impedance. Question 41. A “double‑track” sign on renal ultrasound is most commonly associated with: A) Acute pyelonephritis B) Obstructive uropathy C) Medullary sponge kidney D) Polycystic kidney disease Answer: C Explanation: Medullary sponge kidney shows multiple echogenic linear tracks (dilated collecting ducts) often described as a double‑track sign.
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Question 42. The optimal angle for Doppler interrogation of the hepatic artery is: A) 0–15° B) 30–45° C) 60–75° D) 80–90° Answer: B Explanation: An angle of 30–45° balances accurate velocity measurement with sufficient Doppler signal. Question 43. Which of the following is the most appropriate frequency for a high‑resolution thyroid ultrasound? A) 2–4 MHz B) 5–7 MHz C) 8–12 MHz D) 13–15 MHz Answer: C Explanation: Linear high‑frequency probes (8– 12 MHz) provide the resolution needed for superficial structures like the thyroid. Question 44. In a patient with acute appendicitis, the typical ultrasound findings include: A) Non‑compressible, >6 mm diameter tubular structure with peri‑appendiceal fluid B) Compressible, <4 mm tubular structure with normal peristalsis C) Large cystic mass with internal septations D) Normal appendix visualized with “target sign” only Answer: A Explanation: Acute appendicitis shows a non‑compressible, enlarged (>6 mm) appendix often with surrounding fluid or hyperemia. Question 45. Which of the following is a common sonographic sign of chronic kidney disease?
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B) A swirling “yin‑yang” color pattern with a narrow neck connecting to an artery C) A solid hyperechoic mass with high‑velocity flow D) A simple anechoic area without color flow Answer: B Explanation: Pseudo‑aneurysms exhibit a characteristic swirling “yin‑yang” color flow pattern with a narrow neck communicating with the parent artery. Question 49. The appropriate technique to reduce acoustic shadowing from a rib during liver scanning is: A) Increase gain dramatically B) Use a sector transducer with a higher frequency C) Change the scanning window to intercostal and angle the probe to avoid the rib shadow D. Apply gel directly over the rib bone Answer: C Explanation: Adjusting the intercostal window and angling the probe can bypass rib shadowing. Question 50. In a patient with suspected adrenal adenoma, the key ultrasound characteristic is: A) Hyperechoic lesion with posterior acoustic enhancement B) Hypoechoic lesion with central necrosis C) Isoechoic to surrounding tissue with well‑defined margins and lack of internal vascularity on Doppler D) Large cystic mass with septations Answer: C Explanation: Adenomas are often isoechoic, well‑circumscribed, and show minimal internal flow on Doppler. Question 51. Which of the following statements about the “triphasic” hepatic vein waveform is correct? A) It is seen only in patients with cirrhosis. B) It reflects normal cardiac‑related phasic changes: forward flow, reverse flow, and a brief pause.
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C) It is caused by portal hypertension. D) It disappears after liver transplantation. Answer: B Explanation: The normal triphasic waveform mirrors atrial contraction, ventricular systole, and diastole. Question 52. During a focused renal ultrasound, the presence of bilateral ureteral jets on color Doppler indicates: A) Obstructive uropathy B) Normal ureteral peristalsis and no obstruction C) Vesicoureteral reflux D) Renal artery stenosis Answer: B Explanation: Bilateral jets demonstrate that urine is flowing freely from the kidneys to the bladder. Question 53. The most common cause of an anechoic, thin‑walled cystic structure in the spleen is: A) Splenic abscess B) Simple splenic cyst (congenital) C) Hemangioma D) Lymphoma Answer: B Explanation: Simple congenital splenic cysts appear anechoic with thin walls and no internal septations. Question 54. In a postpartum patient with suspected uterine subinvolution, ultrasound would most likely show: A) Thickened endometrium >15 mm with retained clots B) Small, involuted uterus with no fluid C) Large anechoic pelvic collection representing a hematoma D) Normal uterine size with increased vascularity on Doppler
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Answer: C Explanation: A depth of 12–16 cm generally encompasses the liver, kidneys, spleen, and aorta in most adults. Question 58. In a patient with a known IVC filter, which ultrasound finding would suggest filter migration? A) Filter located within the hepatic veins B) Filter visualized in the right atrium C) Absence of filter in the expected infrarenal position with new echogenic focus elsewhere along the IVC D) Normal flow in the IVC with no visualized filter Answer: C Explanation: Migration is identified when the filter is no longer in its intended infrarenal location and is seen elsewhere along the venous course. Question 59. Which of the following is NOT a standard component of a quality assurance (QA) program for abdominal ultrasound? A) Daily phantom testing for resolution and depth gain B) Weekly review of image archives for diagnostic accuracy C) Calibration of the transducer’s mechanical index before each exam D) Documentation of scanning parameters for each study Answer: C Explanation: Mechanical index is relevant for contrast or high‑power applications; routine QA focuses on resolution, image quality, and documentation rather than daily MI calibration. Question 60. The “saw‑tooth” pattern on spectral Doppler of the renal artery is most likely due to: A) Turbulent flow from a stenosis B) Normal phasic renal flow C) Aliasing from a low PRF setting D) Artifact from patient movement
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Answer: A Explanation: Turbulent flow across a stenosis creates a jagged “saw‑tooth” waveform. Question 61. In a patient with acute pancreatitis, the pancreas typically appears: A) Uniformly hyperechoic with sharp margins B) Enlarged, heterogeneous, and hypoechoic with peripancreatic fluid C) Small and atrophic with calcifications D) Completely anechoic Answer: B Explanation: Acute inflammation leads to swelling, heterogeneous echotexture, and often surrounding fluid collections. Question 62. Which of the following is the most accurate description of the “cortical rim” sign in renal ultrasound? A) A thin, hyperechoic peripheral rim representing fibrosis in chronic pyelonephritis B) A hypoechoic band at the cortex‑medulla interface in acute tubular necrosis C) An anechoic halo around a renal cyst D) A bright cortical line seen in normal kidneys due to reverberation Answer: A Explanation: The cortical rim sign is a peripheral hyperechoic band indicating chronic scarring or fibrosis. Question 63. The best ultrasound approach to evaluate for a suspected abdominal aortic aneurysm (AAA) is: A) Transverse scan only at the level of the renal arteries B) Longitudinal scan from the diaphragm to the iliac bifurcation, measuring maximal diameter in both planes C) Oblique coronal scan through the celiac trunk only D) Use of a high‑frequency linear probe for better resolution Answer: B
