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(3) Musculoskeletal Imaging > S3_L4 Musculoskeletal Ultrasound > Flashcards

S3_L4 Musculoskeletal Ultrasound Flashcards

1
Q

Echogenicity

  1. Structures that reflect much energy with reference to other structures
  2. Water
  3. Darker resulting images

A. Hyperechoic
B. Hypoechoic
C. Anechoic

A
  1. A
  2. C
  3. B
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2
Q

Echogenicity

  1. Structures that reflect little energy
  2. Cortical bone
  3. Air

A. Hyperechoic
B. Hypoechoic
C. Anechoic

A
  1. B
  2. A
  3. C
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3
Q

Echogenicity

  1. Bright resulting images
  2. Black images
  3. No reflection from the structures being imaged

A. Hyperechoic
B. Hypoechoic
C. Anechoic

A
  1. A
  2. C
  3. C
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4
Q

Normal Imaging Characteristics of MSUS

Thin hypoechoic line, dark inside because it is fluid-filled

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

D. Bursa

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5
Q

Normal Imaging Characteristics of MSUS

Hyperechoic; distinct parallel fiber pattern

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

B. Tendons and ligament

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6
Q

Normal Imaging Characteristics of MSUS

  1. Hyperechoic, relative to muscle
  2. Hyperechoic, smooth, continuous

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A
  1. F
  2. A
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7
Q

Normal Imaging Characteristics of MSUS

Hypoechoic, with parallel fibrous hyperechoic bands

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

C. Muscle

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8
Q

Normal Imaging Characteristics of MSUS

  1. Anechoic, fluid-filled
  2. Hypoechoic layer next to cortex

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A
  1. G
  2. E
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9
Q

Abnormal Imaging Characteristics of MSUS

Flattening; swelling proximal to the area of compression

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

F. Nerve

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10
Q

Abnormal Imaging Characteristics of MSUS

Increased volume, thickened walls; with septations, hypoechoic debris

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

G. Cysts

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11
Q

Abnormal Imaging Characteristics of MSUS

Early changes display as inhomogeneous thickening; later with irregularity and disruption.

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

E. Hyaline cartilage

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12
Q

Abnormal Imaging Characteristics of MSUS

Increased width, and in later stages, hyperechoic thickening (sclerosis) of its walls

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

D. Bursa

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13
Q

Abnormal Imaging Characteristics of MSUS

Break in continuity, uneven surfaces; degenerating cortices due to disease processes

A. Cortical bone
B. Tendons and ligament
C. Muscle
D. Bursa
E. Hyaline cartilage
F. Nerve
G. Cysts

A

A. Cortical bone

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14
Q

Abnormal Imaging Characteristics of MSUS

Disruption of structure, initially filled with hypoechoic hematoma, and separation of ends

A. Tendons and ligament strain
B. Tendons and ligament rupture
C. Muscle strain
D. Muscle rupture

A

B. Tendons and ligament rupture

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15
Q

Abnormal Imaging Characteristics of MSUS

Thickening, of mixed echogenicity (hypoechoic if inflammation or hematoma); disrupted fiber pattern

A. Tendons and ligament strain
B. Tendons and ligament rupture
C. Muscle strain
D. Muscle rupture

A

A. Tendons and ligament strain

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16
Q

Abnormal Imaging Characteristics of MSUS

  1. Retraction of muscle
  2. Disruption of fibrous bands; hypoechoic hematoma in early stages

A. Tendons and ligament strain
B. Tendons and ligament rupture
C. Muscle strain
D. Muscle rupture

A
  1. D. Muscle rupture
  2. C. Muscle strain
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17
Q

Modified TF
A. In a longitudinal sonogram, the transducer is applied across the tendon, resulting in an axial image.
B. For the transverse sonogram, the transducer is applied along the tendon, and the resulting image is a sagittal slice of the tendon.

A

FF

A. In a longitudinal sonogram, the transducer is applied along the tendon, and the resulting image is a sagittal slice of the tendon.
B. For the transverse sonogram, the transducer is applied across the tendon, resulting in an axial image.

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18
Q

Modified TF
A. The color doppler allows the visualization of small vessels and changes in local blood associated with inflammation and/or synovial proliferation.
B. The power doppler demonstrates the presence and direction of blood flow and identifies circulation anomalies.

A

FF

A. The color doppler demonstrates the presence and direction of blood flow and identifies circulation anomalies.
B. The power doppler allows the visualization of small vessels and changes in local blood associated with inflammation and/or synovial proliferation.

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19
Q

Modified TF
A. Blood flowing in low velocities signifies arterial vessels that show up in the color red.
B. Blood flowing in high velocities indicates venous vessels that show up in the color blue.

A

FF

A. Blood flowing in high velocities signifies arterial vessels that show up in the color red.
B. Blood flowing in low velocities indicates venous vessels that show up in the color blue.

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20
Q

Modified TF
A. The color doppler provides an overall view of flow in a region.
B. It is usually employed to see areas of healing based on the presence of small blood vessels.

A

TT

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21
Q

Modified TF
A. Absoprtion is the result of intermolecular friction which converts the electrical energy of ultrasound waves into heat.
B. Scattering results in a less accurate localization of the reflecting surface and of underlying structures.

A

FT

A. Absoprtion is the result of intermolecular friction which converts the mechanical energy of ultrasound waves into heat.

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22
Q

Modified TF
A. The MSK Ultrasound has a linear array and produces a fan-shaped image.
B. The Pelvic and Abdominal Ultrasound has a curved array and produces a square image.

A

FF

A. The MSK Ultrasound has a linear array and produces a square image.
B. The Pelvic and Abdominal Ultrasound has a curved array and produces a fan-shaped image.

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23
Q

Modified TF
A. Therapeutic ultrasound uses the frequency range of 2 to 15 MHz.
B. The pulser in MSUS produces waves of electrical energy in the frequency range 1 to 3 MHz.

A

FF

A. Therapeutic ultrasound uses the frequency range of 1 to 3 MHz.
B. The pulser in MSUS produces waves of electrical energy in the frequency range 2 to 15 MHz.

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24
Q

True about the uses of musculoskeletal ultrasound in PT practice, except
A. Diagnosis of musculoskeletal disorders
B. Use of ultrasound as biofeedback
C. Help visualize the stabilizing musculature of the low back and other muscles
D. Evaluating muscle and soft tissue morphology and function during activities
E. None

A

E. None

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25
Q

Converts the electricity from the pulser into sound energy, delivers the sound to the tissues, receives the reflected waves, and converts those waves back to electrical signals.

A. Pulser
B. Ultrasound transducer
C. Scan convertor and monitor

A

B. Ultrasound transducer

NOTE: Electrical signals go back to the machine for processing for the viewers to see the image formed on the screen.

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26
Q

A computer that changes the incoming signal from an analog signal to a digital matrix. It projects whatever the transducer finds on the body to the screen.

A. Pulser
B. Ultrasound transducer
C. Scan convertor and monitor

A

C. Scan convertor and monitor

27
Q

It delivers bursts of waves at this base frequency, between bursts, there is silence.
A. Pulser
B. Ultrasound transducer
C. Scan convertor and monitor

A

A. Pulser

NOTE: Silence is essential for the machine to receive sound waves produced.

28
Q

Modified TF
A. The scan convertor amplifies the signal received.
B. Most MSUS monitors have 265 shades of gray.

A

TF

B. Most MSUS monitors have 256 shades of gray.

29
Q

TRUE OR FALSE: Doppler imaging employs color monitors.

A

True

30
Q

TRUE OR FALSE: Using a curved array transducer widens the field of view as the distance from the transducer increases, where deeper structures are imaged disproportionally larger than superficial structures.

A

True

31
Q

TRUE OR FALSE: Reflection is most responsible for the attenuation of ultrasound.

A

False, correct answer is absorption

32
Q

Modified TF
A. Obese patients are not imaged well on MSUS due to loss of acoustic energy and difficulty obtaining focal length.
B. The MSUS can penetrate bone, so structures deep to bone such as intra-articular ligaments are well-visualized.

A

TF

B. The MSUS does not penetrate bone, so structures deep to bone such as intra-articular ligaments are not visualized.

33
Q

Modified TF
A. The MSUS is operator dependent.
B. Ultrasound waves do not cross air interfaces, presenting difficulty when assessing structures obscured by the lungs or by gases in the intestine.

A

TT

34
Q

TRUE OR FALSE: The power doppler is used by a rheumatologist to determine the extent of inflammation in pts with RA.

A

True

35
Q

TRUE OR FALSE: The more the angle of reflection is deivated from the perpendicular, the less energy is reflected to the transducer.

A

True

36
Q

It is a cross imaging method based on sound waves reflected off tissue interfaces with origins in sonar energy.

A

Ultrasound

37
Q

Modified TF
A. Ultrasound started in the 1940s to 1950s and was used to check breast tissue for lumps.
B. In the 1980s, US gained widespread acceptance for the evaluation of the musculoskeletal system.

A

TT

38
Q

True of the advantages of US, except
A. Low cost, cost effective, and portability
B. Continuous modification of imaging on findings
C. Ability to visualize structures not limited by orthogonal planes
D. Higher resolution
E. None

A

E. None

39
Q

True of the advantages of US, except
A. No known hazards
B. Can be used to image tissue with the presence of orthopedic hardware
C. Ready comparison with the opposite side
D. Diagnostic sensitivity and specificity comparable to MRI
E. None

A

E. None

40
Q

TRUE OR FALSE: The biggest advantage of MSUS over MRI is its low cost and portability.

A

True

41
Q

True of the advantages of US, except
A. The ability to perform palpation, stress, testing, and application of resistance while imaging
B. No contraindications
C. Ability to follow a structure such as a peripheral nerve, tendon, or muscle belly
D. None

A

D. None

42
Q

TRUE OR FALSE: The MSUS monitor displays the signal returned from tissues in terms of different levels of brightness, depending on the echogenicity of the tissues.

A

True

43
Q

Advantage or Disadvantage of MSUS vs MRI

  1. For bones: it can show the cortical outline of bone
  2. For ligaments: it has the ability to stress test while imaging
A
  1. D
  2. A
44
Q

Advantage or Disadvantage of MSUS vs MRI

  1. For cysts and bursae: it can show septations and debris
  2. For scanning across lung fields: it does not cross air/tissue interfaces
A
  1. A
  2. D
45
Q

Advantage or Disadvantage of MSUS vs MRI

For muscles: it shows the muscle architecture, and imaging can be done while testing with resistance

A

Advantage

46
Q

Advantage or Disadvantage of MSUS vs MRI

  1. For joints and intra-articular structures: it has a limited ability to show these
  2. For tendons: it can show degenerative changes, longitudinal tears, and the fiber structure
A
  1. D
  2. A
47
Q

The amount of reflection is determined by the ff, except
A. Angle of Reflection
B. Smoothness of the reflective surfaces
C. Difference between acoustic impedance of the tissues forming the interface
D. Echogenicity
E. None

A

E. None

48
Q

Modified TF
A. Sound waves are emitted from the pulser for approximately 10% of the time.
B. The transducer acts as a receiver for the reflected sound waves 90% of the time.

A

FF

A. Sound waves are emitted from the pulser for approximately 1% of the time.
B. The transducer acts as a receiver for the reflected sound waves 99% of the time.

49
Q

TRUE OR FALSE: Acoustic impendance is when sound is transmitted from one type to another type that has a different resistance to the passage of sound waves, so some sound waves get reflected at the interface between 2 tissues.

A

True

50
Q

Modified TF
A. Refraction occurs when waves transmitted across an interface undergo a change in direction.
B. Refraction affects image quality because of the loss of reflected energy and image distortion.

A

TT

51
Q

Modified TF
A. Ultrasound transducers contain an array of crystals.
B. The linear array is used during fetal imaging in pregnant women.

A

TF

B. The curved array is used during fetal imaging in pregnant women.

52
Q

TRUE OR FALSE: Scattering occurs when the reflecting surface is uneven, so less energy is returned.

A

True

53
Q

TRUE OR FALSE: Pressure applied during MSUS should be carefully monitored as it may displace structures and deplete the blood within veins.

A

True

NOTE
Too much pressure = squished structures
Too little pressure = low quality visualization

54
Q

Modified TF
A. Musculoskeletal structures are often located by palpation in US imaging.
B. The US transducer is also applied directly to skin with an intervening layer of gel.

A

TT

55
Q

Modified TF
A. Doppler US may be used for the diagnosis of arterial stenosis or vessel constriction.
B. Doppler US can also be used to identify and avoid vessels during procedures such as ultrasound-guided injections and dry needling.

A

TT

NOTE: US in dry needling is only used for deep muscles to avoid puncture of vessels.

56
Q

Modified TF
A. Blood cells arriving towards the transducer arrive at a higher rate than corresponds to the frequency of the emitted waves.
B. Blood cells moving away from the transducer will return at a slower rate.

A

TT

57
Q

TRUE OR FALSE: Doppler ultrasound can be used to measure blood flow in an artery or vein.

A

True

58
Q

The use of US during PT examination techniques includes the ff, except
A. Palpating for tenderness to guide transducer placement
B. Placing the affected joint in a symptom provoking position (special tests)
C. Using resisted muscle contractions or passive stretching
D. Stress testing tendons
E. Applying traction or compression

A

D. Stress testing tendons

Correct answer: D. Stress testing ligaments

NOTE: Performing US during PT examination greatly adds to the value of the examination.

59
Q

Modified TF
A. In US imaging, scanning for images takes place in real time.
B. The examiner can also perform various tests while the scanning is taking place.

A

TT

60
Q

Modified TF
A. The amount of refraction varies depending on the difference in acoustic impedance between tissue types and the angle of incidence.
B. For the angle of incidence, the farther from the perpendicular, the greater the refraction.

A

TT

61
Q

TRUE OR FALSE: Musculoskeletal ultrasound can be used in conjunction with PT examination and evaluation procedures for a better assessment.

A

True

62
Q

TRUE OR FALSE: Musculoskeletal ultrasound is used as biofeedback and for evaluating muscle and soft tissue.

A

True

63
Q

TRUE OR FALSE: The pulser of the ultrasound produces waves of electrical energy with a frequency range of 5 - 20 MHz.

A

False, 2-15 MHz

64
Q

TRUE OR FALSE: Ultrasound can visualize structures but are limited by orthogonal planes.

A

False

(3) Musculoskeletal Imaging (25 decks)

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