OB Gyn CTL Physics & Instrumentation 8%

When evaluating a patient with suspected pelvic congestion, the patient should be scanned in the:

reverse trendeleburg

What is the first step in obtaining a 3D image?

optimize the 2D image

When attempting to image the fundus of an anteverted uterus with transvaginal US, the transducer should be angled so the handle is:

closer to the bed

Which of the following console controls should be increased to attempt to differentiate debris from artifactual echoes in an ovarian cyst?

output power

Which of the following Sonographic techniques is most sensitive to detecting ovarian blood flow in cases of suspected torsion?

Power Doppler

When evaluating a small embryo for cardiac activity, it is important to:

Reduce the size of the field of view and increase frame rate

In order to properly evaluate arterial inflow to the ovaries,

the date of the last menstrual period must be documented

There is a cystic mass present within the ovary that contains septations and internal nodularity. What is the best way to evaluate the malignant potential of the mass?

evaluate internal nodules with PW Doppler

Which of the following requires a Doppler cursor angle of 60 degrees or less for accurate reporting of numerical values?

peak systolic velocity

If serum bhCG levels are inconclusive, what Doppler waveforms should be used to assist in confirming the presence of an early intrauterine pregnancy?

uterine artery at the level of the cervix

Which of the following describes correct positioning of a single focal zone?

at or just deep to the structure of interest

On the region of interest on a 3d system, the X-axis represents the __________________ and the Y-axis represents the __________________.

width of the box, height of the box

Which of the following correctly lists how to estimate the volume of a structure on 2D imaging?

length x width x height x 0.523

3D ultrasound can be used to assess adnexal pathology. Which of the following rendering models is most useful for demonstration of hydrosalpinx?

inversion mode

Applying color Doppler to a transverse view of the fetus at the level of the fetal bladder will help to demonstrate:

You are performing a PW Doppler evaluation of the umbilical artery and the venous flow signal is also demonstrated on the tracing. What system adjustment can be made to remove the venous signal while maintaining the proper arterial signal on the tracing?

reduce the sample size

Spectral Doppler evaluation of a uterine AV malformation will demonstrate:

increased flow velocity and reduced resistance in the uterine artery and high velocity pulsatile flow in the uterine vein

Which of the following will demonstrate the highest resistance flow pattern on Doppler evaluation?

partial ovarian torsion

What is the best way to differentiate an umbilical cord cyst from an umbilical varix?

apply color Doppler

Which of the following statements is true regarding blood flow evaluation of the ovaries?

In patients undergoing infertility treatment, PW Doppler should not be used to evaluate ovarian blood flow due to increased beam intensity with PW Doppler techniques.

A patient presents for a follow up scan at 28wks due to suspected IUGR. A scan was performed at 24wks and the umbilical artery Doppler demonstrated an S/D ratio of 2.8. The umbilical artery Dppler performed today demonstrates and S/D ratio of 3.3. Which of the following statements is true regarding the change in the umbilical Doppler

S/D ratio is moderately increased indicating the presence of IUGR

The Doppler tracing of the MCA demonstrating diastolic flow reversal is typically seen in a fetus with what condition?

IUGR

Which acoustic artifact causes decreased visualization of the cerebral hemisphere closest to the transducer face?

reverberation

You are performing a Doppler evaluation of the fetal abdominal aorta in a 30 week gestation. The waveform is monophasic with no flow in diastole. Which of the following correctly describes the findings?

The waveform is abnormal and can be related to IUGR

Which of the following describes the PW Doppler tracing obtained from the tissues surrounding the dominant follicle?

higher velocity, low resistance flow

Which of the following will improve color display in the ovaries?

increasing the color threshold

According to the AIUM guidelines, which of the following structures can be safely evaluated with PW Doppler on a routine first trimester ultrasound exam?

uterine arteries

Which of the following will usually exhibit posterior enhancement?

hemorrhagic cyst

Assuming proper fetal position, which transducer provides the most accurate measurement of the femur length on a 28 week fetus?

linear array

What direction is the blood moving on the image?

from the right ventricle to the left ventricle

Which of the following techniques is described as a graphic representation of the motion of a structure over time?

M-mode

Smaller volume angle settings are preferred for 3D evaluation of:

the fetal heart

An increase in the peak systolic velocity of the middle cerebral artery of a fetus on serial exams is most suggestive of:

Fetal anemia

_______________________is a process used to obtain a consistent coronal view of the endometrium on all patients.

The Z-technique

You are evaluating the left ovary with color Doppler. As you manipulate the probe to improve the color display, the image appears to drag as you move the probe. There is a delay between when you move and the response of the image display. How can you reduce this drag effect and improve color display?

make the color box smaller

Pelvic congestion syndrome is suspected when periuterine veins measure:

>5mm in diameter

How can a uterine arteriovenous malformation be differentiate from retained products of conception?

evaluate serum bhCG levels

Which of the following is correct regarding Doppler evaluation of the umbilical artery?

the Doppler cursor angle is relatively unimportant when evaluating the umbilical artery flow

3D reconstruction cannot provide an accurate assessment of the volume of:

the amniotic fluid

If m-mode cannot successfully document the fetal heart rate, the AIUM recommends using ________________as the alternative.

a 2D cine clip

Which of the following statements is true regarding the Doppler waveforms obtained from the normal ovary with a corpus luteal cyst?

low resistance, prominent diastolic flow

Which of the following is preferred for 3D evaluation of the fetal face?

Slower sweep and smaller AP distance for the region of interest

IUGR can be assessed by Doppler evaluation of which of the following structures?

Umbilical cord and middle cerebral artery

Glass-body rendering mode would be most useful in the 3D evaluation of suspected:

knot in the umbilical cord

All of the following are true regarding Doppler evaluation of the middle cerebral artery, except:

The MCA normally demonstrates a lower resistance flow pattern than the umbilical artery

Fetal Doppler evaluation was performed and produced the information below. What is the cerebroplacental ratio? MCA PSV 40cm/s MCA PI 3.5 uterine artery PSV 70cms uterine artery PI 7 umbilical artery PSV 30cm/s umbilical artery PI 1.75

2.0

Which of the following best describes the Doppler waveforms obtained from the uterine artery of a gravid uterus?

low resistance, average velocity

Anemia will ________________ blood flow velocities detected on Doppler evaluation.

increase

Use of the Virtual Organ Computer Aided Analysis feature of a 3D system is recommended for evaluating a fetus with suspected:

lung defects

When performing diagnostic ultrasound, the mechanical index should always be _______________________ and the thermal index should always be __________________.

1.0 or less, 0.7 or less

When evaluating a 30wk fetus with IUGR, the umbilical artery will demonstrate which of the following flow patterns?

minimal to absent diastolic flow

Low resistance flow identified from ovarian tissues during the early follicular phase is most suggestive of:

neovascularization

3D/4D imaging techniques are most commonly used to evaluate which of the following uterine abnormalities?

polyps

Which feature of a 3D ultrasound system is system is used to assist in the evaluation of the ovarian reserve in an IVF patient?

Virtual Organ Computer Aided Analysis

You are evaluating the umbilical artery with PW Doppler and then move the cursor to evaluate the umbilical vein. Which of the following console adjustments will need to be made for proper display of the new signal?

decrease the velocity scale

When evaluating the ductus venosus with PW Doppler, samples should be taken:

at the origin from the umbilical vein and at the junction with the IVC

The most common cause of pelvic congestion is:

An incompetent left ovarian vein

A congenital anomaly described as a vascular plexus of arteries and veins without a capillary network in between is called:

arteriovenous malformation

The Doppler tracing of the Ductus Venosus is:

abnormal, displays flow reversal indicated by flow peak at "a"

When evaluating a patient with suspected ovarian torsion, which of the following system adjustments should be made?

decrease color Doppler velocity scale

If the S/D ratio of the umbilical artery exceeds a minimum level of _________ IUGR is suspected

3.0

When attempting to image the fundus of an retroverted uterus with transvaginal US, the transducer should be angles so the handle is:

father from the bed

What artifact is obscuring the anterior border of the ovary?

reverberation

What acoustic artifact is associated with endometritis and air in the endocervical canal?

Reverberation

The optimum obtainable Doppler angle used for evaluation of the uterine arteries is?

60 degree

Which of the following is a disadvantage of transvaginal sonography over transabdominal pelvic sonography?

depth of the field of view

Which of the following statements is correct regarding the performance of OB GYN ultrasound exams?

An increase of 2 degrees Celsius or more in the womb can have adverse effects on the pregnancy

Which of the following correctly describes how to use 3D imaging to differentiate a septate uterus and an arcuate uterus?

Obtain a coronal image and use the calipers to create a line between the top edges of the endometrial horns. Measure from the center of the line to the edge of the enometrium

The S/D ratio in the umbilical artery ___________________ throughout normal pregnancy.

gradually decreases

What 3D plane is preferred for evaluation of congenital uterine anomalies, endometrial characteristics and IUD position?

coronal

The Doppler tracing from the umbilical artery of a 28wk fetus indicates:

IUGR

When evaluating suspected endometrial polyp formation with 3D imaging, it is recommended:

for patient with an endometrial thickness greater than 5mm

At the end of a 2nd trimester fetal scan you notice the overall gain was set to the maximum level during the exam. Which of the following statements is true?

No additional action needed because gain settings do not affect patient exposure

The Doppler tracing would be considered normal if it was obtained from which of the following?

2nd trimester middle cerebral artery

When performing 2D imaging activating which of the following ultrasound functions will cause the largest increase in beam intensity?

PW Doppler

Which of the following is true regarding the Doppler tracing provided?

Flow in the MCA is abnormal with flow reversal in diastole

3D systems offer multiple image rendering options. _______________________ mode is used to evaluate skeletal structure and _________________ model is used to evaluate cystic structure.

Maximum, minimum

The optimum time for 3D facial evaluation is between:

23-30 weeks

What acoustic artifact is demonstrated on both sides of the uterus from the cervix to the fundus, in a transverse view?

edge shadowing

Pulsatile flow in the umbilical vein of a 34 week gestation indicates:

possible congestive heart failure in the fetus

As a non-gravid patient ages, the resistive index for the uterine artery moves closer to:

1.0

Why is a 3.5MHZ curvilinear phased array preferred over a 3.5MHZ sector phased array for imaging a 30 week gestation?

the curvilinear array has a wider near field

The blue arrow indicates _______________________, which is caused by ___________________________.

ring down artifact, gas-tissue interface

What can be done to reduce/eliminate shadowing artifacts on coronal 3D images of an IUD?

move the reference dot on image A and B to the endometrial tissue

Which if the following is preferred for assessment of perfusion of the uterus and ovaries?

Power Doppler

Flow in which of the following is typically unaffected by fetal anemia?

umbilical artery

Which of the following techniques can be used to enhance a 2D image of the fetal kidneys by accentuating certain shades in the image to assist in detecting subtle differences?

B-color

Which of the following correctly describes how to assess the middle cerebral artery(MCA) with PW Doppler?

Sample the vessel as close to the origin from the ICA as possible

Which of the following Doppler information is necessary to calculate the pulsatility index?

peak systolic velocity only

Which of the following is displayed with spectral Doppler, but not with Color Doppler?

Peak flow velocity

The thermal index for ___________ should be monitored for pregnancies less than 10 weeks and the thermal index for _________ should be monitored for pregnancies more than 10 weeks.

soft tissue, bone

Which of the following will maintain compliance with the ALARA principle?

reducing the number of images taken in standard protocol

Which of the following is the preferred method of evaluation of a suspected septate uterus?

3D/4D ultrasound, coronal view of the uterus

When evaluating a fetus for suspected IUGR, the umbilical artery is sampled with PW Doppler. The peak systolic velocity of flow us 25cm/s and the end diastolic velocity is 5cm/s. Which of the following calculations is preferred for demonstrating the vascular resistance in fetal tissues?

S/D ratio

Which of the following congenital uterine defects cannot be accurately identified using 2D imaging, and is best evaluated using 3D imaging?

septate uterus

When resistance in the distal vascular bed decreases, what happens to the resistive index(RI)?

decreases

Posterior enhancement can be helpful in the evaluation/diagnosis of:

Corpus Luteal cyst

Which of the following is the best technique for the assessment of fetal heart rate in a 12wk gestation?

Transabdominal approach, M-mode

What is the primary purpose of performing serial Doppler evaluations of the umbilical artery?

to asses for signs of placental insufficiency

Which of the following best describes the difference between 3D ultrasound imaging and 4D ultrasound imagining?

4D imaging provides real time display of 3D images