Samplex Through the Years

Question 1

Based on the 5th edition of BI-RADS, breast density is described using the quartile system in mammography. (Ikeda 36)

Answer 1

False

Breast density is an important feature of the mammogram that describes how much of the breast volume is filled with white glandular tissue. Breast fibroglandular tissue is white on the mammogram, and fat is black on the mammogram.

The natural progression of the mammogram is mostly white (dense) at a young age when the breasts are filled with glandular tissue and it becomes progressively darker (fatty) as the woman ages. As women age, their fibroglandu- lar tissue involutes into fat, which is black.

Generally as women age there are greater amounts of fat and less dense glandular tissue, which usually remains in the upper outer quad- rants of the breast

Question 2

FALSE about diagnostic mammography (Ikeda 55)
a. Used for women with findings on screening mammography
b. Radiologist is on-site
c. Used for symptomatic women
d. None of the choices

Answer 2

d. None of the choices

Question 3

FALSE about screening mammography (Ikeda 55)
a. Used for asymptomatic women
b. NO radiologist on-site
c. Two standard views: CC and L
d. None of the choices

Answer 3

c. Two standard views: CC and L

Question 4

Additional mammographic view to evaluate the outer breast (Ikeda 56 - 57)
a. From-below
b. Cleopatra view
c. Cleavage view
d. None of the choices

Answer 4

b. Cleopatra view

Question 5

Factor resulting in nondetection of cancer on mammography (Ikeda 59)
a. Experience of radiologist
b. Mammographic technique
c. Morphology of the breast tumor
d. All of the choices

Answer 5

d. All of the choices

Page 73, Table 2.9 Ikeda

Question 6

Typically benign calcifications on mammography EXCEPT (Ikeda 83)
a. Round
b. Dystrophic
c. Coarse heterogeneous
d. Skin
e. None of the choices

Answer 6

c. Coarse heterogeneous

Question 7

Calcifications with suspicious morphology EXCEPT (Ikeda 83)
a. Amorphous
b. Coarse heterogeneous
c. Fine pleomorphic
d. Fine linear or fine-linear branching
e. None of the choices

Answer 7

e. None of the choices

Question 8

Ultrasound features of a BENIGN breast mass EXCEPT (Ikeda 141)
a. Intense hyperechogenicity
b. Parallel orientation
c. Oval shape
d. Very hypoechoic
e. None of the choices

Answer 8

d. Very hypoechoic

Question 9

Ultrasound features of a MALIGNANT breast mass EXCEPT (Ikeda 141)
a. Irregular shape
b. Not-parallel
c. Not-circumscribed
d. Acoustic shadowing
e. None of the choices

Answer 9

e. None of the choices

Question 10

Differential diagnosis for spiculated masses EXCEPT (Ikeda 142)
a. Postbiopsy scar
b. Radial scar
c. Proliferative fibrocystic change
d. Tubular cancer
e. None of the choices

Answer 10

e. None of the choices

Question 11

Only malignant masses cause architectural distortion (Ikeda 132)
a. True
b. False

Answer 11

b. False

Question 12

TRUE about fibroadenomas. (Ikeda 147)
a. Arises from the terminal ductal lobular unit
b. Equal-density mass on mammography
c. Can be single or multiple
d. Hypoechoic on ultrasound
e. Most common solid benign tumor in young women
f. All of the choices

Answer 12

f. All of the choices

Fibroadenoma is the most common solid benign tumor in young women. It is thought to arise from the terminal ductal lobular unit via localized hypertrophy.

Question 13

The “round” invasive ductal carcinoma is a common form of the most
common cancer, invasive ductal carcinoma. (Ikeda 150)

Answer 13

False

UNCOMMON

Question 14

What is NOT TRUE about breast MRI? (Ikeda, p. 240)
a. Benign conditions enhance usually gradually and continuously.
b. Lesion morphology helps distinguish cancer from benign conditions.
c. Contrast-enhanced MRI of the breast is highly dependent on radiographic
breast density.
d. Most cancers initially enhance rapidly.

Answer 14

c. Contrast-enhanced MRI of the breast is highly dependent on radiographic
breast density.

Question 15

When is the best time to perform breast MRI? (Ikeda, p. 240)
a. On the 7th to 14th day after the onset of menses
b. Right before the first day of menses
c. On the 3rd to 5th day after the onset of menses
d. None of the above

Answer 15

a. On the 7th to 14th day after the onset of menses

Question 16

The following are MRI features of malignant breast lesions EXCEPT?
(Ikeda, p. 273)
a. Oriented along Cooper ligaments
b. Bright enhancement
c. Rim enhancement
d. Heterogeneous enhancement

Answer 16

a. Oriented along Cooper ligaments

Question 17

TRUE OR FALSE: Most breast cancers are dark on T2-weighted,
noncontrast, fat suppressed MRI (Ikeda, p. 241).

Answer 17

True

Question 18

Which of the following patterns is suggestive of a benign lesion on
dynamic contrast enhanced MRI? (Ikeda, p. 253)
a. Periphery enhances first
b. Center enhances first
c. Washout
d. Rapidly initial enhancement

Answer 18

b. Center enhances first

Question 19

What are the possible appearances of dilated milk ducts on breast
MRI? (Ikeda, p. 260)
a. Ducts may demonstrate high signal on unenhanced T1-weighted images
b. Ducts may demonstrate variable signal on T2-weighted images
c. Linear high signal on fat-suppressed T2-weighted imaging
d. All of the above

Answer 19

d. All of the above

Question 20

In breast MRI, this type of enhancement is especially worrisome for
DCIS. It represents enhancement tumor following the duct, simulating a
string of pearls or cobblestone appearance. It occurs due to cancer
growing and expanding the ductal system without penetrating the duct
basement membrane: (Ikeda, p. 265)
a. Creeping enhancement
b. Clumped enhancement
c. Branched enhancement
d. Tumoral enhancement

Answer 20

b. Clumped enhancement

Question 21

Under the category of DIAGNOSIS, which is NOT an accepted
indication for contrast-enhanced breast MRI? (Ikeda, p. 270)
a. Suspicious lesions seen on only one x-ray mammography view, not found by sonography
b. Radiation to the chest between age 10 and 30
c. Bloody nipple discharge with negative or failed galactogram
d. Indeterminate palpable findings with negative mammogram and ultrasound

Answer 21

b. Radiation to the chest between age 10 and 30

Question 22

This type of implant rupture is defined by implant rupture with silicone
gel still contained within an intact fibrous capsule: (Ikeda, p. 346)
a. Gel bleed
b. Extracapsular rupture
c. Intracapsular rupture
d. None of the above

Answer 22

c. Intacapsular rupture

Question 23

On ultrasound, snowstorm or echodense noise can be observed in
what types of implant rupture? (Ikeda, p. 349)
a. In both intracapsular rupture and gel bleed
b. In both extracapsular rupture and gel bleed
c. Only in extracapsular rupture
d. In both intracapsular rupture and extracapsular rupture

Answer 23

b. In both extracapsular rupture and gel bleed

Question 24

Which of the following is FALSE regarding pregnancy-associated
breast cancer? (Ikeda, p. 376)
a. It is cancer diagnosed during pregnancy or within 1 year postpartum
b. Mammography is contraindicated
c. Stage for stage, same prognosis as in nonpregnant patients
d. Radiation therapy absolutely contraindicated

Answer 24

b. Mammography is contraindicated

Question 25

Which is TRUE about lactational mastitis? (Ikeda, p. 378) a. It is a rare complication of breastfeeding. b. A cracked nipple may be the port of entry. c. Breastfeeding must be stopped during antibiotic therapy. d. Streptococcus is the most common causative agent.

Answer 25

b. A cracked nipple may be the port of entry.

Question 26

What is NOT a cause of false-negative breast lesions on PET/CT? (Ikeda, p. 416) a. Carcinoma in situ b. Lobular carcinoma c. Small lesion size (<1 cm) d. None of the above. They are all causes of false-negatives.

Answer 26

d. None of the above. They are all causes of false-negatives.

Question 27

How is the biparietal diameter measured? (Callen p. 11) It is measured at the level of the thalami and the cavum septi pellucidi. a. Measured from the inner edge of the proximal skull to the outer edge of the distal skull b. Measured from the inner edge of the proximal skull to the inner edge of the distal skull c. Measured from the outer edge of the proximal skull to the outer edge of the distal skull d. Measured from the outer edge of the proximal skull to the inner edge of the distal skull

Answer 27

d. Measured from the outer edge of the proximal skull to the inner edge of the distal skull

Question 28

What is the most reliable method of measuring gestational age in utero? (Callen p. 13) a. head circumference b. abdominal circumference c. crown-rump length d. femoral length

Answer 28

c. crown-rump length

Question 29

Which statement correctly describes Frank breech presentation? (Callen p. 16) a. thighs are flexed at the hips with legs and knees extended b. one or both hips and knees are extended c. thighs are flexed at the hips with the knees flexed as well d. None of the above

Answer 29

a. thighs are flexed at the hips with legs and knees extended

Question 30

What is the most common non-lethal skeletal dysplasia? (Callen p.424)

Answer 30

Achondroplasia

Question 31

Which error of morphogenesis is being described? Abnormalities of form, shape or position caused by mechanical forces such as intrauterine molding or constraint. (Callen p. 27) a. Malformation b. Sequence c. Deformation d. Disruption

Answer 31

c. Deformation ## Footnote ERRORS OF MORPHOGENESIS A. Malformations are defects in the structure of an organ resulting from a specific primary abnormality of development B. Deformation: normal development > mechanical force > abnormal form, shape or position 1. Extrinsic: e.g., oligohydramnios owing to ruptured membranes 2. Intrinsic: oligohydramnios owing to renal agenesis C. Disruption: breakdown of previously normal tissue SEQUENCE versus SYNDROME Both: Pattern of multiple abnormalities Sequence: From a single primary anomaly or mechanical factor Example: Potter sequence, in which oligohydramnios from any cause leads to similar features of fetal compression: characteristic facial features and abnormal positioning of the hands and feet. Syndrome: Have a common, specific cause Example: Down syndome which is caused by the presence of an extra copy of chromosome 21

Question 32

Increased nuchal translucency, low PAPP-A (pregnancy-associated plasma protein A), and low free B-hCG are associated with which condition? (Callen p. 60) a. Pregnancy loss <24 weeks b. Trisomy 18 c. Trisomy 21 d. Congenital heart defect

Answer 32

b. Trisomy 18

Question 33

Prenatal sonography reveals strawberry-shaped skull, horseshoe kidney, radial aplasia, overlapping digits and rocker-bottom feet. Which condition are you considering? (Callen p. 72) a. Trisomy 13 b. Trisomy 18 c. Turner syndrome d. Trisomy 21

Answer 33

b. Trisomy 18

Question 34

What is the first definitive sonographic finding to suggest early pregnancy? (Callen p. 189) a. gestational sac b. embryo c. cardiac activity d. yolk sac

Answer 34

a. gestational sac

Question 35

The embryo is always present when... (Brant p. 911) a. MSD >= 8 mm on transvaginal US b. MSD >=25 mm on transvaginal US c. MSD >= 16 mm on transvaginal US d. MSD >= 20 mm on transabdominal US

Answer 35

c. MSD >= 16 mm on transvaginal US

Question 36

# ``` Cardiac activity should be detected routinely when... (Callen p. 194) a. Using a transabdominal approach, detected at 8 weeks GA with MSD of 25 mm b. The embryo attains a length of 4 to 5 mm c. Gestational age of 6.0 to 6.5 weeks with mean sac diameter of 13 to 18 mm d. All of the above e. None of the above

Answer 36

d. All of the above

Question 37

Which is not a feature of Twin-to-Twin Transfusion Syndrome? (Callen p. 281) a. Velamentous cord insertion b. Dichorionic placentation c. Enlarged bladder in recipient twin and no bladder in donor twin d. Oligohydramnios around one twin and polyhydramnios around the other

Answer 37

b. Dichorionic placentation

Question 38

On sonography, you note a poorly-defined, ovoid focus centrally located within the endometrial cavity with single decidual layer. Findings are suggestive of? (Callen p. 1035) a. Early intrauterine pregnancy b. Pseudogestational sac

Question 38

Which is indicative of a dichorionic pregnancy? (Callen p. 273) a. Twins with differing sexes b. Two distinct placentas c. Both conditions d. Neither are indicative of dichorionic pregnancy

Answer 38

c. Both conditions

Question 39

The following are criteria for diagnosis of ectopic pregnancy EXCEPT? (Callen p. 1034) a. Complex adnexal mass separate from ovary b. Decidual reaction c. Adnexal ring d. Extrauterine gestational sac with yolk sac or embryo e. Free fluid

Answer 39

b. Decidual reaction

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