UTC Clinical Procedures & Protocols 3 — Questions and Answers
Question 1: A patient with a pacemaker is referred for cardiac echo. Which ultrasound mode requires special caution documentation in this scenario?
- B-mode (2D grayscale)
- M-mode
- Pulsed-wave Doppler (Correct answer)
- Continuous-wave Doppler
Correct answer: Pulsed-wave Doppler
While ultrasound does not affect pacemakers the way MRI does, pulsed-wave Doppler produces focused energy bursts; careful documentation ensures the ordering physician is aware of device presence for complete clinical context.
Question 2: During a thyroid ultrasound, a nodule is identified with microcalcifications and taller-than-wide shape. Per ACR TI-RADS guidelines, this most likely corresponds to which category?
- TR1 – Benign
- TR3 – Mildly suspicious
- TR5 – Highly suspicious (Correct answer)
- TR2 – Not suspicious
Correct answer: TR5 – Highly suspicious
Microcalcifications and a taller-than-wide shape are high-suspicion features in ACR TI-RADS, placing the nodule in the TR5 category.
Question 3: What is the purpose of using harmonic imaging during an abdominal ultrasound?
- It increases penetration depth at lower frequencies
- It reduces side-lobe and reverberation artifacts, improving contrast resolution (Correct answer)
- It eliminates the need for acoustic gel
- It measures tissue stiffness
Correct answer: It reduces side-lobe and reverberation artifacts, improving contrast resolution
Tissue harmonic imaging uses second-harmonic frequencies generated within tissue, which have fewer artifacts from side lobes and reverberation than fundamental frequencies.
Question 4: A pregnant patient at 28 weeks is scanned and the placenta is found to cover the internal os. The appropriate next step in documentation is:
- Perform transvaginal ultrasound immediately to confirm
- Document as placenta previa and note the relationship to the internal os (Correct answer)
- Disregard the finding since it may resolve before term
- Apply color Doppler to the os only
Correct answer: Document as placenta previa and note the relationship to the internal os
A placenta covering the internal os at 28 weeks must be documented as placenta previa with precise description of coverage; further follow-up imaging is determined by the clinical team.
Question 5: Which scanning plane is used to measure the nuchal translucency (NT) during first-trimester screening?
- Coronal plane of the fetal head
- Mid-sagittal plane with the fetal neck in a neutral position (Correct answer)
- Transverse plane at the level of the fetal abdomen
- Oblique plane through the fetal spine
Correct answer: Mid-sagittal plane with the fetal neck in a neutral position
NT measurement requires a strict mid-sagittal view with the fetal neck neither hyperflexed nor hyperextended to obtain an accurate measurement.
Question 6: When performing an endovaginal ultrasound, which of the following represents the correct infection-control protocol?
- Use a single-use probe cover and apply gel inside and outside the cover (Correct answer)
- Wipe the transducer with alcohol only between patients
- Soak the transducer in cidex for 10 minutes after every exam
- Use a sterile surgical glove without gel
Correct answer: Use a single-use probe cover and apply gel inside and outside the cover
Standard protocol requires a single-use transducer cover (condom or probe cover) with coupling gel placed inside and outside to ensure acoustic contact and patient safety.
Question 7: A sonographer is evaluating testicular blood flow with color Doppler and finds absent flow on one side in a teenager with acute scrotal pain. The most likely diagnosis is:
- Epididymo-orchitis
- Varicocele
- Testicular torsion (Correct answer)
- Hydrocele
Correct answer: Testicular torsion
Absent intratesticular blood flow on color Doppler in the setting of acute scrotal pain in a young male is the hallmark finding of testicular torsion, a surgical emergency.
UTC Clinical Procedures & Protocols 3
A patient with a pacemaker is referred for cardiac echo.
Which ultrasound mode requires special caution documentation in this scenario?