, Question 1
A pediatric sonographer is evaluating a neonate with suspected
hypoxic-ischemic injury. Which sonographic finding, when present within the
first 24 hours, most strongly correlates with severe long-term
neurodevelopmental impairment?
A. Increased echogenicity of the periventricular white matter on coronal
views
B. Loss of the normal gyral/sulcal pattern with a smooth cortical surface
C. Reversed diastolic flow in the anterior cerebral artery on Doppler
D. Mild asymmetry of the lateral ventricles without midline shift
Correct Answer: C - Reversed diastolic flow in the anterior
cerebral artery on Doppler
RATIONALE
Reversed diastolic flow in the anterior cerebral artery indicates
severely elevated intracranial pressure or profound cerebral edema,
both markers of severe hypoxic-ischemic injury and poor
neurodevelopmental outcome. Increased periventricular echogenicity
can be transient and nonspecific, a smooth cortical surface may be
normal in extreme prematurity, and mild ventricular asymmetry is
often a normal variant.
Question 2
During a hip ultrasound for developmental dysplasia, the alpha angle is
measured at 48 degrees with a rounded lateral acetabular roof and a femoral
head that is well seated but slightly subluxable under stress. According to the
Graf classification, which category does this represent?
A. Type I - mature hip
B. Type IIa - physiologically immature
C. Type IIb - delayed ossification
D. Type III - dislocated hip
Page 2
,Correct Answer: C - Type IIb - delayed ossification
RATIONALE
A Graf Type IIb hip has an alpha angle between 43 and 49 degrees, a
rounded acetabular roof, and delayed ossification; it is considered
pathologic and requires treatment. Type IIa is similar but occurs in
infants younger than 3 months and is considered physiologic
immaturity; Type I has an alpha angle >60 degrees; Type III shows
frank dislocation.
Question 3
A child with sickle cell disease presents with acute right upper quadrant pain.
Sonography demonstrates gallstones and a thickened gallbladder wall with
pericholecystic fluid. Which additional Doppler finding would most
specifically support the diagnosis of acute cholecystitis rather than
uncomplicated cholelithiasis?
A. Increased flow in the hepatic artery
B. Hyperemic flow in the gallbladder wall on power Doppler
C. Reversed flow in the portal vein
D. Elevated resistive index in the common hepatic artery
Correct Answer: B - Hyperemic flow in the gallbladder wall on
power Doppler
RATIONALE
Hyperemia of the gallbladder wall on power Doppler reflects active
inflammation and is a specific sign of acute cholecystitis,
distinguishing it from simple cholelithiasis. Hepatic artery flow
changes are nonspecific, portal vein reversal suggests portal
hypertension, and elevated hepatic artery resistive index is not a
primary marker of cholecystitis.
Page 3
, Question 4
Which sonographic parameter is most critical to monitor when performing
cranial ultrasound in a preterm neonate to minimize the risk of thermal injury
to the developing brain?
A. Mechanical index (MI)
B. Thermal index for soft tissue (TIS)
C. Thermal index for bone (TIB)
D. Frame rate
Correct Answer: C - Thermal index for bone (TIB)
RATIONALE
The thermal index for bone (TIB) is most relevant when bone is in the
beam path, as in transcranial imaging, because it estimates
temperature rise at the bone-soft tissue interface. TIS underestimates
risk when bone is present, MI relates to cavitation not heating, and
frame rate affects temporal resolution but not thermal risk.
Question 5
A pediatric patient with known congenital heart disease undergoes abdominal
sonography for hepatomegaly. The inferior vena cava is dilated and shows loss
of normal phasic variation, and hepatic veins are also dilated. Which
hemodynamic state is most likely?
A. Constrictive pericarditis
B. Tricuspid regurgitation
C. Fontan circulation
D. Restrictive cardiomyopathy
Correct Answer: C - Fontan circulation
Page 4
A pediatric sonographer is evaluating a neonate with suspected
hypoxic-ischemic injury. Which sonographic finding, when present within the
first 24 hours, most strongly correlates with severe long-term
neurodevelopmental impairment?
A. Increased echogenicity of the periventricular white matter on coronal
views
B. Loss of the normal gyral/sulcal pattern with a smooth cortical surface
C. Reversed diastolic flow in the anterior cerebral artery on Doppler
D. Mild asymmetry of the lateral ventricles without midline shift
Correct Answer: C - Reversed diastolic flow in the anterior
cerebral artery on Doppler
RATIONALE
Reversed diastolic flow in the anterior cerebral artery indicates
severely elevated intracranial pressure or profound cerebral edema,
both markers of severe hypoxic-ischemic injury and poor
neurodevelopmental outcome. Increased periventricular echogenicity
can be transient and nonspecific, a smooth cortical surface may be
normal in extreme prematurity, and mild ventricular asymmetry is
often a normal variant.
Question 2
During a hip ultrasound for developmental dysplasia, the alpha angle is
measured at 48 degrees with a rounded lateral acetabular roof and a femoral
head that is well seated but slightly subluxable under stress. According to the
Graf classification, which category does this represent?
A. Type I - mature hip
B. Type IIa - physiologically immature
C. Type IIb - delayed ossification
D. Type III - dislocated hip
Page 2
,Correct Answer: C - Type IIb - delayed ossification
RATIONALE
A Graf Type IIb hip has an alpha angle between 43 and 49 degrees, a
rounded acetabular roof, and delayed ossification; it is considered
pathologic and requires treatment. Type IIa is similar but occurs in
infants younger than 3 months and is considered physiologic
immaturity; Type I has an alpha angle >60 degrees; Type III shows
frank dislocation.
Question 3
A child with sickle cell disease presents with acute right upper quadrant pain.
Sonography demonstrates gallstones and a thickened gallbladder wall with
pericholecystic fluid. Which additional Doppler finding would most
specifically support the diagnosis of acute cholecystitis rather than
uncomplicated cholelithiasis?
A. Increased flow in the hepatic artery
B. Hyperemic flow in the gallbladder wall on power Doppler
C. Reversed flow in the portal vein
D. Elevated resistive index in the common hepatic artery
Correct Answer: B - Hyperemic flow in the gallbladder wall on
power Doppler
RATIONALE
Hyperemia of the gallbladder wall on power Doppler reflects active
inflammation and is a specific sign of acute cholecystitis,
distinguishing it from simple cholelithiasis. Hepatic artery flow
changes are nonspecific, portal vein reversal suggests portal
hypertension, and elevated hepatic artery resistive index is not a
primary marker of cholecystitis.
Page 3
, Question 4
Which sonographic parameter is most critical to monitor when performing
cranial ultrasound in a preterm neonate to minimize the risk of thermal injury
to the developing brain?
A. Mechanical index (MI)
B. Thermal index for soft tissue (TIS)
C. Thermal index for bone (TIB)
D. Frame rate
Correct Answer: C - Thermal index for bone (TIB)
RATIONALE
The thermal index for bone (TIB) is most relevant when bone is in the
beam path, as in transcranial imaging, because it estimates
temperature rise at the bone-soft tissue interface. TIS underestimates
risk when bone is present, MI relates to cavitation not heating, and
frame rate affects temporal resolution but not thermal risk.
Question 5
A pediatric patient with known congenital heart disease undergoes abdominal
sonography for hepatomegaly. The inferior vena cava is dilated and shows loss
of normal phasic variation, and hepatic veins are also dilated. Which
hemodynamic state is most likely?
A. Constrictive pericarditis
B. Tricuspid regurgitation
C. Fontan circulation
D. Restrictive cardiomyopathy
Correct Answer: C - Fontan circulation
Page 4
