Pediatric Sonography
Chapter Exam Questions
Course Introduction
Pediatric Sonography is a specialized course focusing on the application of ultrasound imaging techniques in the diagnosis and assessment of medical conditions affecting infants, children, and adolescents. The curriculum covers the unique anatomical and physiological considerations in pediatric patients, the proper selection and optimization of sonographic protocols, and the identification of normal and pathological findings across organ systems such as the brain, abdomen, pelvis, and musculoskeletal structures. Emphasis is placed on patient care, communication strategies with children and families, and adapting imaging approaches to accommodate various pediatric age groups and clinical scenarios, preparing students for effective practice in pediatric imaging departments.
Recommended Textbook
Sonography Introduction to Normal Structure and Function 3rd Edition by
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Reva Arnez Curry
Chapter 1: Before and After the Ultrasound Examination
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Q1) Lower right quadrant pain ____
Answer: CH
Right lower quadrant pain is a clinical symptom and part of the patient's clinical history.
Q2) The sonographer should always review available patient information._____
A)True
B)False
Answer: True
Q3) The ultrasound request form contains the type of examination.____
A)True
B)False
Answer: True
Q4) A living will can be found in the patient's chart. ____
A)True
B)False
Answer: True
Q5) The sonographer should always provide the interpretive report. _____
A)True
B)False
Answer: False
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Chapter 2: Ultrasound Instrumentation: Knobology, Imaging Processing, and Storage
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Q1) Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls.
Answer: Primary imaging controls (i.e., transducer selection, imaging preset, frequency, depth, TCG, TCG curve, focal zone position, focal zone number, dual image, image direction, freeze, cine loop, print/store, and trackball) are essential for producing and recording images of diagnostic quality. Calculation controls include the calculations package activated upon imaging preset and measurement functions (i.e., distance, trace, measure, and off). Additional important controls include body pattern and Doppler, color, power Doppler, pulsed wave, and M-mode controls, as well as monitor controls for brightness and contrast.
Q2) The Worklist electronic program allows sonographers to
A) connect the Hospital Information System, Radiology Information System, and Picture Archiving and Communication System in one database.
B) order the patient examinations for the day.
C) query for patient demographic information from the ultrasound system.
D) engage the preset function of the system.
Answer: C
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Chapter 3: General Patient Care
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Q1) If patients ask about the ultrasound findings, they should be told that sonographers _____________________; rather, sonographers _________________________.
Answer: do not provide a diagnosis; provide the ultrasound images to an interpreting physician, who provides an interpretive report to the referring physician Patients should be told that sonographers do not provide a diagnosis; rather, they provide the sonographic images to an interpreting physician, who sends an interpretive report to the patient's referring physician.
Q2) Before a patient gets onto or off of the examination table or stretcher, the sonographer must make sure it is _____________________________________. Answer: stationary and the brakes have been set
Before a patient gets onto or off of the examination table or stretcher, the sonographer must make sure the table or stretcher is stationary and the brakes have been set.
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Chapter 4: First Scanning Experience
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Q1) Which term refers to decreased echogenicity as compared with other body structures?
A) Anechoic
B) Isoechoic
C) Hyperechoic
D) Hypoechoic
Q2) Sonographically, the lumen of the gastrointestinal tract
A) resembles a "bull's eye."
B) has an appearance that depends on the lumen's contents.
C) is hypoechoic relative to its walls.
D) is highly reflective.
Q3) Sagittal planes divide the body into unequal _________ and _________ sections.
Q4) Long axis measurements are taken in either the sagittal or coronal scanning plane.
A)True B)False
Q5) Sagittal and coronal scanning plane images show only longitudinal sections of structures. ____
A)True B)False
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Chapter 5: Interdependent Body Systems
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Q1) The parasympathetic division of the autonomic nervous system responds to stress or impending danger; it is known as the "fight or flight" system. ____
A)True
B)False
Q2) Fertilization typically occurs in the
A) uterus.
B) ovary.
C) fallopian tube.
D) cervix.
Q3) Which of the following directs and monitors endocrine functions?
A) Kidneys
B) Pancreas
C) Hypothalamus
D) Parathyroid glands
Q4) All body systems are assisted by the endocrine system either directly or indirectly. ____
A)True B)False
Q5) Homeostasis is defined as _____________________________________________________.
Q6) The _______________ system monitors and controls almost every organ in the body. Page 7
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Chapter 6: Anatomy Layering and Sectional Anatomy
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Q1) The crura of the diaphragm are
A) folds of peritoneum that insert into the diaphragm.
B) visceral tissue layers that insert into the diaphragm.
C) muscular bands arising from the diaphragm that attach to the abdominal aorta and inferior vena cava.
D) muscular bands that arise from the lumbar vertebrae and insert into the diaphragm.
Q2) The lesser sac
A) extends from the diaphragm to the pelvis and covers the width of the abdomen.
B) is a diverticulum of the greater sac located posterior to the stomach.
C) is a double layer of peritoneum that extends from the stomach to adjacent abdominal organs.
D) attaches to the anterior surface of the transverse colon.
Q3) Intraperitoneal structures are connected to the cavity wall by the A) omentum.
B) greater sac.
C) lesser sac.
D) mesentery.
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Chapter 7: Embryology
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Q1) The foregut herniates from the abdomen, rotates, and then returns to the abdominal cavity. ____
A)True B)False
Q2) The primitive gut forms during embryologic week 4 and is composed of a foregut, a midgut and a hindgut. ____
A)True B)False
Q3) About 50% of ectopic thyroids are lingual in nature. ____
A)True B)False
Q4) Mammary ridges, which eventually become breasts, develop at 6 weeks. ____ A)True B)False
Q5) The umbilical vein carries oxygenated blood to the embryo. ____ A)True B)False
Q6) The kidneys lie initially in the pelvis and then move up into the abdomen. ____ A)True B)False
Page 10
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Chapter 8: The Abdominal Aorta
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Q1) The median sacral artery is superior to the
A) renal arteries.
B) adrenal arteries.
C) gonadal arteries.
D) common iliac arteries.
Q2) Pylorus of the stomach ____
Q3) The celiac axis bifurcates into which branches?
A) Main pancreatic artery, left gastric artery, and splenic artery
B) Left gastric artery, right gastric artery, and common hepatic artery
C) Left gastric artery, common hepatic artery, and splenic artery
D) Common hepatic artery, main pancreatic artery, and splenic artery
Q4) Left renal vein ____
Q5) Body of the pancreas ____
Q6) Sonographically, in a longitudinal section, the abdominal aorta appears as a
A) pulsatile, tubular, anechoic lumen with bright, echogenic walls.
B) pulsatile, axial, anechoic lumen with bright, echogenic walls.
C) non-pulsatile axial, anechoic lumen with anechoic walls.
D) none of the above
Q7) Spine ____
Q8) Psoas major muscle ____
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Chapter 9: The Inferior Vena Cava
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Q1) The walls of the hepatic veins are brightly echogenic. ____
A)True
B)False
Q2) In a sagittal scanning plane, the right renal artery can be seen as a(n)
A) longitudinal, curvilinear structure anterior to the axial IVC.
B) straight structure posterior to the AO.
C) round, short axis structure posterior to the longitudinal IVC.
D) oval structure anterior to the longitudinal IVC.
Q3) The inferior phrenic veins are easily seen on ultrasound. ____
A)True
B)False
Q4) The left hepatic vein is easily seen on ultrasound. ____ A)True
B)False
Q5) Intestines ____
Q6) The right renal vein is easily seen on ultrasound. ____ A)True
B)False
Q7) Right kidney ____
Q8) Aorta ____
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Chapter 10: The Portal Venous System
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Q1) The portal triad is located
A) throughout the liver.
B) in several places in the liver.
C) at the opening of the liver.
D) none of the above
Q2) The union of the superior mesenteric vein and splenic vein is best appreciated in a transverse scanning plane. ____
A)True
B)False
Q3) Superior mesenteric vein walls ____
Q4) The bifurcation of the right portal vein is best seen in a sagittal scanning plane.
A)True B)False
Q5) Portal venous walls ____
Q6) Hepatic artery walls ____
Q7) Normal liver ____
Q8) Head of the pancreas ____
Q9) Inferior vena cava lumen ____
Q10) Superior mesenteric vein lumen ____ Page 13
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Chapter 11: Abdominal Vasculature
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Q1) The left renal vein serves as a valuable landmark for locating the renal arteries. It courses
A) anterior to the abdominal aorta and posterior to the superior mesenteric artery.
B) posterior to the abdominal aorta and anterior to the left renal artery.
C) posterior to the inferior vena cava and anterior to the abdominal aorta.
D) anterior to the inferior vena cava and anterior to the abdominal aorta.
Q2) Blood flow in the right, middle, and left hepatic veins is characterized by
A) four phases of flow: two away from the heart and two toward the heart.
B) three phases of flow: two toward the heart and a phase of systolic flow reversal.
C) three phases of flow: one toward the heart and then two away from the heart.
D) four phases of flow: two toward the heart followed by two away from the heart.
Q3) The blood flow pattern in the normal renal artery can be characterized as
A) high resistance with high diastolic flow.
B) low resistance with high diastolic flow
C) high resistance with high diastolic flow.,
D) low resistance with low diastolic flow..
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Chapter 12: The Liver
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Q1) Tumor invasion of the portal vein may be observed in association with cancerous lesions of the liver or with metastases. Color Doppler scanning demonstrates tumor vascularity within the portal vein lesion by the presentation of: high resistance venous signals.
A) low resistance venous signals
B) low resistance arterial signals
C) high resistance venous signals
D) high resistance arterial signals.
Q2) Prominent pulsatility of the Doppler waveform in the portal vein is
A) normal.
B) abnormal.
Q3) The normal sonographic appearance of the liver is
A) homogeneous.
B) heterogeneous.
C) decreased in echogenicity relative to the kidney.
D) isoechoic compared to the kidney.
Q4) Ketones ______
Q5) Cholesterol ______
Q6) Amino acids ______
Q7) Glycogenesis ______
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Chapter 13: The Biliary System
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Q1) The relationship of the portal vein, common bile duct. and hepatic artery can be stated as:
A) The common bile duct lies medial to the portal vein, and the hepatic artery is located lateral to the portal vein.
B) The portal vein lies medial to the common bile duct and the hepatic artery.
C) The portal vein lies lateral to the common bile duct and the hepatic artery.
D) The common bile duct is located lateral to the portal vein, and the hepatic artery lies medial to the portal vein.
Q2) The left hepatic duct is routinely seen on ultrasound. ____
A)True
B)False
Q3) The celiac artery passes posterior to the common hepatic duct and anterior to the common duct. ____
A)True B)False
Q4) The gallbladder fossa can be identified close to the main lobar fissure. ____
A)True
B)False
Q5) Diameter of the common bile duct ____
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Chapter 14: The Pancreas
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Q1) Sonographically, the pancreas appears isoechoic to the liver. ____
A)True
B)False
Q2) Arterial flow to the head, body, and tail of the pancreas is through the
A) suprapancreatic, pancreatic, and prepancreatic arteries.
B) suprapancreatic, pancreatic, and caudal pancreatic arteries.
C) prepancreatic, pancreatic, and prehilar arteries.
D) anterior and inferior pancreaticoduodenal and splenic arteries.
Q3) The pancreas is mostly an endocrine gland. ____
A)True
B)False
Q4) The thickness of the pancreas is approximately
A) 2 cm.
B) 2.5 cm.
C) 3 cm.
D) 3.5 cm.
Q5) The acini cells produce the hormones insulin, glucagon, and somastatin. ____
A)True
B)False
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Chapter 15: The Urinary System
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Q1) What is the echogenicity of the urinary bladder wall?
A) High level echoes
B) Medium level echoes
C) Low level echoes
Q2) The renal pyramid is one component of the renal lobe. Two other components are the ________ and the ________.
Q3) Where is renin produced?
A) Adrenal cortex
B) Kidney
C) Juxtaglomerular apparatus
D) Posterior pituitary gland
Q4) The structures posterior to the kidneys are the:
Q5) What is the echogenicity of the renal cortex?
A) High level echoes
B) Medium level echoes
C) Low level echoes
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Chapter 16: The Spleen
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Q1) The spleen is a retroperitoneal organ. ____
A)True
B)False
Q2) Left renal cortex ____
Q3) Splenic artery lumen ____
Q4) The spleen takes damaged cells out of circulation. ____
A)True
B)False
Q5) The spleen is posterolateral to the pancreatic tail and part of the large intestine.
A)True
B)False
Q6) The hilar area of the spleen is not covered by peritoneum. ____
A)True
B)False
Q7) In an adult, the spleen is composed primarily of red blood cells. ____
A)True
B)False
Q8) Liver ____
Q9) Spleen ____ Page 20
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Chapter 17: The Gastrointestinal System
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Q1) The juncture of the greater and lesser curvatures of the stomach occurs at the A) cardiac orifice.
B) esophageal orifice.
C) entrance of the esophagus into the stomach.
D) all of the above
Q2) Which of the following is NOT part of the large intestine?
A) Appendix
B) Cecum
C) Rectum
D) Ileum
Q3) Most of the bowel wall layers recognizable on sonographic images are
A) anechoic.
B) echogenic.
C) hypoechoic.
D) isoechoic.
Q4) The first portion of the large intestine would be visualized in the ____ region.
A) right inguinal
B) left hypogastric
C) right hypochondrium
D) umbilical
Page 22
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Chapter 18: The Prostate Gland and Seminal Vesicles
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Q1) When zones are compared on ultrasound, the peripheral zone may appear more echogenic than which structure(s)?
A) Central zone
B) Transition zone
C) Periurethral tissues
D) All of the above
Q2) The prostate is supported by
A) Denonvilliers' fascia.
B) the seminal vesicles and ejaculatory ducts.
C) the symphysis pubis.
D) the obturator internus and levator ani muscles.
Q3) Semen is composed of
A) 60% alkaline fructose, 13% to 33% alkaline fluid, and sperm.
B) 13% to 33% alkaline fructose, 70% alkaline fluid, and sperm.
C) 70% alkaline fructose, 13% to 33% sperm, and acidic fluids.
D) 60% sperm, 13% to 33% alkaline fluid, and fructose.
Q4) Alkaline, viscous fructose is produced by the prostate gland. ____
A)True
B)False
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Chapter 19: The Female Pelvis
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Q1) When the corpus and fundus are bent anteriorly until the fundus is resting on the cervix, the uterine position is described as
A) anteflexed.
B) retroflexed.
C) retroverted.
D) anteverted.
Q2) Which of the following is used to divide the pelvic cavity into the pelvis major (false pelvis) and the pelvis minor (true pelvis)?
A) Pubic symphysis
B) Linea alba
C) Linea terminalis
D) Iliac crests
Q3) The most echogenic layer of the vagina is the
A) vaginal mucosa.
B) muscular wall.
C) vaginal canal.
D) vaginal serosa.
Q4) The three descriptive regions of the pelvis are the ________, ________, and _______ regions.
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Chapter 20: First Trimester Obstetrics 0 to 12 Weeks
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Q1) The amniotic fluid volume (AFV) normally is reduced by A) fetal regurgitation.
B) maternal urination.
C) fetal swallowing.
D) fetal urination.
Q2) The most accurate method of dating gestation is the A) sac size.
B) crown-rump length (CRL).
C) biparietal diameter.
D) femur length.
Q3) The gestational age in days is calculated by
A) dividing the mean sac diameter by 30.
B) dividing the largest sac dimension by 30.
C) volume measurement of the gestational sac.
D) adding 30 to the mean sac diameter.
Q4) A sonographic marker of the chorionic cavity is A) echogenic.
B) anechoic.
C) hyperechoic.
D) triple line.
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Chapter 21: Second and Third Trimester Obstetrics 13 to 42 Weeks
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Q1) The fetal lungs are capable of functioning as early as sometime after A) 15 weeks.
B) 20 weeks.
C) 25 weeks.
D) 35 weeks.
Q2) A grade I placenta may have
A) anechoic areas.
B) calcifications.
C) individual segments.
D) calcified basal layer.
Q3) Cerebrospinal fluid is produced in the fetus by the A) cerebellum.
B) choroid plexus.
C) spine and brain.
D) meninges.
Q4) The bright reflection of the fetal skeleton is an indication of ______________________within the developing bones.
Q5) Identification of the great arteries and outflow tracts in their usual positions confirms normal ___________________ connections.
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Chapter 22: High-Risk Obstetric Sonography
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Q1) In severe cases of intrauterine growth restriction, which fetal artery usually can be detected?
A) Renal artery
B) Hepatic artery
C) Splenic artery
D) Superior mesenteric artery
Q2) Ultrasound is used during in utero procedures to confirm that the needle is in the correct position and that ___________________________.
Q3) Twin gestations result from fertilization of either _______ or a _______.
Q4) __________________________ measures the degree of fetal lung development.
Q5) Abnormal fetal aortic flow velocity waveforms have been associated with A) musculoskeletal abnormalities.
B) genitourinary dysfunctions.
C) neurologic dysfunctions.
D) cardiac dysfunctions.
Q6) When certain defects are found during a pregnancy, high concentrations of _____________________ are found in amniotic fluid samples.
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Chapter 23: The Thyroid and Parathyroid Glands
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Q1) Which statement is NOT true about the parathyroid glands?
A) They generally have a multilobulated shape.
B) Ectopic locations include the carotid bulb and retroesophageal, thymus, and intrathyroidal locations.
C) Normal parathyroid glands measure approximately 5 to 7 mm in length, 3 to 4 mm in width, and 1 to 2 mm in thickness.
D) Approximately 15% to 20% of parathyroid glands are ectopic.
Q2) Which statement is NOT true about the thyroid gland?
A) Thyroid volumes increase with age and body weight, as well as in patients with acute hepatitis and those living in regions deficient in iodine.
B) It is an endocrine gland that secretes triiodothyronine (T3), thyroxine (T4), and calcitonin.
C) It is an exocrine gland that secretes triiodothyronine (T3), thyroxine (T4), and iron.
D) The normal mean thyroid volume is 18.6 ± 4.5 ml (± SD), which converts to a 18.6-g gland.
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Chapter 24: Breast Sonography
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Q1) Prolactin-inhibiting factor is produced in the
A) anterior pituitary gland.
B) hypothalamus.
C) posterior pituitary gland.
D) thyroid gland
Q2) The glandular layer of the breast atrophies after menopause. ____
A)True
B)False
Q3) Prolactin-inhibiting factor
A) aids breast development.
B) prevents milk production
C) acts on the breast during pregnancy to prepare for nursing.
D) stimulates the release of milk during nursing.
Q4) Oxytocin is produced in the
A) anterior pituitary gland.
B) hypothalamus.
C) posterior pituitary gland.
D) thyroid gland
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Chapter 25: Penile and Scrotal Ultrasound
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Q1) The epididymis is connected to which portion of the testis?
A) Superior
B) Inferior
C) Medial
D) Lateral
Q2) The scrotum consists of the
A) testicles
B) testicles and epididymus
C) testicles, epididymis, and distal vas deferens
D) testicles, epididymis, and proximal vas deferens
Q3) What is the echogenicity of the septum penis?
A) Low level echoes
B) Medium level echoes
C) High echogenicity
D) It cannot be identified on ultrasound.
Q4) What is the echogenicity of the spermatic cord?
A) Low level echoes
B) Medium level echoes
C) High echogenicity
D) It cannot be identified on ultrasound.
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Chapter 26: The Neonatal Brain
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Q1) What is the echogenicity of the caudate nucleus?
A) Echogenic
B) Moderately echogenic
C) Low level echoes
D) Hypoechoic
Q2) The fourth ventricle is connected to the third ventricle by the
A) interventricular foramina of Monro.
B) aqueduct of Sylvius.
C) aperture of Magendie.
D) aperture of Luschka.
Q3) The central fissure separates the
A) temporal lobes from the parietal lobes.
B) temporal lobes from the frontal lobes.
C) parietal and frontal lobes.
D) cerebrum from the cerebellum.
Q4) What is the echogenicity of the bones of the cranial vault?
A) Echogenic
B) Moderately echogenic
C) Low level echoes
D) Hypoechoic
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Chapter 27: Pediatric Echocardiography
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Q1) In the normal infant heart, blood from the right atrium travels
A) across the foramen ovale into the left atrium, through the mitral valve and into the left ventricle.
B) through the tricuspid valve into the right ventricle, then continues to and through the pulmonary valve crossing into the pulmonary artery to the lungs.
C) across the foramen ovale into the left atrium, through the pulmonary veins to the lungs.
D) through the tricuspid valve into the right ventricle, across the aortic valve into the aorta.
Q2) In fetal development, if the bulboventricular looping is to the right, the result is dextrocardia. ____
A)True
B)False
Q3) The oxygen content and intracardiac pressures are higher on the right side of the heart than on the left. _____
A)True
B)False
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Chapter 28: Adult Echocardiography
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Q1) Epicardium is another name for pericardium. ____
A)True
B)False
Q2) The SA node is the "pacemaker" of the heart. ____
A)True
B)False
Q3) The thickest layer of the heart is the myocardium. ____
A)True
B)False
Q4) The AV node can provide pacing for the heart in the event of SA node failure. ____
A)True
B)False
Q5) Atrioventricular valves are not the same as semilunar valves. ____
A)True
B)False
Q6) Diastole and systole are the left ventricular relaxation and filling phase of the cardiac cycle. ____
A)True
B)False
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Chapter 29: Vascular Technology
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Sample Questions
Q1) In a normal abdominal aorta, the peak systolic velocity averages ____cm/sec; in the popliteal artery, an average peak systolic velocity of _____cm/sec normally is found.
A) 60/80
B) 80/50
C) 100/50
D) 90/60
Q2) The goal of the vascular diagnostic laboratory is to answer the following questions using an array of indirect and direct noninvasive evaluations: Is vascular disease present? Where is it located? How severe is the disease process? What are the therapeutic options? Has revascularization been successful? ____
A)True
B)False
Q3) The internal carotid artery supplies the high-resistance vascular beds of the brain and eye. ____
A)True
B)False
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Chapter 30: Three-Dimensional Ultrasound
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32 Verified Questions
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Sample Questions
Q1) For a multiplanar format, data must be achieved from the A) original acquisition plane.
B) three orthogonal planes.
C) fourth acquisition plane.
D) none of the above
Q2) Matrix array transducers contain hundreds of imaging elements. ____
A)True
B)False
Q3) The inversion mode
A) is a type of rendering.
B) shows hypoechoic structures as solids.
C) a and b
D) none of the above
Q4) The 4 in 4D ultrasound refers to
A) a special algorithm.
B) space.
C) time.
D) velocity.
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Chapter 31: Interventional and Intraoperative Ultrasound
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Q1) __________ are caused by bubbles between the transducer tip and the sterile sheath covering separated by a coupling agent.
Q2) With ultrasound-guided aspiration, the examiner can __________ any change in shape or size of a fluid-filled structure.
Q3) An option for a sterile transducer sheath during interventional ultrasound is a(n) A) alcohol bath.
B) sterile gel.
C) rubber glove.
D) water path.
Q4) Ultrasound-guided biopsies assist needle placement for A) fluid sampling.
B) small organ or stone extraction.
C) amniocentesis.
D) tissue sampling.
Q5) Laparoscopic ultrasound is used to:
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