Diploma of Diagnostic Ultrasound (DDU) Past Examination Papers

Transcription

1 ASUM is the Peak Body for Medical Ultrasound in Australia and New Zealand Diploma of Diagnostic Ultrasound (DDU) Past Examination Papers Contents Page Introduction: Changes to the DDU Examination 2 PART 1 (MODULE 1): Foundations of Ultrasound Practice 2 PART 2 2 Part 1 (Module 1): Foundations of Ultrasound Practice Example Questions 3 DDU Part 2 Written Examination: Past Papers 4 DDU Past Exams V3

2 Introduction CHANGES TO THE DDU EXAMINATION PART 1 (MODULE 1): Foundations of Ultrasound Practice The DDU Part I (Module 1) Examination consists of 120 Multiple Choice Questions (MCQs). From 2011 onwards there will be no negative marking of the DDU Part I (Module 1) Examination. From 2012 onwards the Part 1 (Module) will comprise of three(3) parts; Physics and instrumentation (70% of available marks) Principles of image/data collection and optimisation (15% of available marks) Professional, ethical and legal issues (15% available marks) Please refer to the DDU Syllabus for details. PART 2: From 2012 there will be a separate examination for each specialty. From 2012 there will be no compulsory physics question in the DDU Part 2 written examination. From 2012 the Part 2 written examination will comprise of 10 compulsory Short Answer Questions (SAQs) to be answered in 2.5 hours (plus 10 minutes reading time). 2

3 Part 1 (Module 1): Foundations of Ultrasound Practice Only the following example MCQs are available to candidates. 1. The matching layer between the crystal and tissue is designed to: a. Insulate the patient from the hot crystal b. Reduce the vibration of the transducer c. Reduce the acoustic impedance mismatch between crystal and tissue * d. Protect the crystal from electromagnetic interface 2. If the field of view is expanded while maintaining the same scanning depth, what must accompany this change so lateral resolution is not degraded? a. Increase the digitisation bit depth b. Increase the number of scan lines * c. Decrease the number of pixels in the image matrix d. Focus the beam to be more narrow 3. Aliasing is a potential problem in PW Doppler because of: a. High -frequency transducers b. Intermittent sampling * c. Dynamic focusing d. Motion of the interface perpendicular to ultrasound wave propagation 4. The computer parameter that limits the number of brightness levels available for display of the image matrix is the: a. Memory capacity in megabytes b. Bit depth * c. Clock speed in megahertz d. Number of pixels in the matrix * = correct answer 3

4 DDU Part 2 Written Examination: Past Papers Diploma of Diagnostic Ultrasound (DDU) Part II Written Examination NOTE: From 2012 onwards the DDU Part 2 written examination will consist of 10 compulsory short Answer Questions INSTRUCTIONS: Three questions should be attempted, one from each section. There are three sections (Section A, B and C), please ensure you have all sections. Start each question in a new book and label it with your candidate number. Please allocate your time according to marks required. 15 th May 2010 DDU Part 2 Written Examination (a) A number of artifacts appear in ultrasonic images. Briefly explain with the aid of diagrams the physical causes and the effect on images of three common artifacts. (b) Explain with the aid of diagrams why lateral resolution of the image should improve when a higher frequency probe is selected. (c) Thermal bio-effects need to be considered in ultrasound examinations. Explain why and in what way the thermal index may be different in each of grey-scale imaging, spectral Doppler and colour Doppler. 2. (a) Describe how you would perform (i) a treadmill stress echocardiographic study (ii) a pharmacological stress echocardiographic study When would you perform such studies compared to a simple stress ECG? How would you analyse the images? Include diagrams showing the various left ventricular segments and their corresponding coronary arterial territories. Contrast the features found in myocardial ischaemia and infarction to those found normally. (b) How would you perform a myocardial viability study? (c) Discuss the role of stress echocardiography in non-ischaemic cardiac conditions. 3. A 26 year old male presents with short distance claudication. Discuss the use of ultrasound for investigation. 4. Discuss the ultrasound techniques used for the evaluation of the fetal palate. 4

5 5. A patient presents with a parotid mass. Discuss the relevant anatomy, common benign causes and their ultrasound findings. 6. A haemodymanically decompensating patient requires assessment of his intravascular fluid status. Describe what Doppler echocardiographic methods can assist, outlining supporting evidence for their use, in addition to any obvious limitations in their application. 7. Ultrasound is the preferred method over Computerised Tomography for evaluating the acute female pelvis. Discuss this statement. 8. Discuss the use and value of echocardiography in evaluating pericardial disease of various types. 9. Describe normal and abnormal waveforms which may be found in the extracranial carotid and vertebral arteries. Include discussion of likely velocities. 10. Discuss the clinical application of 3D ultrasound in obstetrics and Gynaecology. 11. A 35 year old woman present with RUQ pain. An echogenic liver lesion is found. Discuss the likely possibilities and further assessment. 12. Discuss the options available for image archiving and their respective benefits vs drawbacks for an ultrasound imaging practice. 13. A 44 year old woman presents to the Emergency Department with fevers for 2 days, lassitude and increasing dyspnoea. Her heartrate is 120 bpm, regular and blood pressure 95/45 mm Hg (systolic/mean/diastolic) and continues to fall further over the next hour. An urgent transthoracic echocardiogram is requested. What underlying pathologies should be considered in the differential diagnosis and what are the associated echocardiographic features? 14. A 42 year old woman presents with abnormal uterine Bleeding for investigation. How would you approach this problem and use ultrasound to assist in diagnosis and treatment. 5

6 18 th May 2009 DDU Part 2 Written Examination (a) Give the definition of TI and MI as used on the Output Display Standard. Quote the suggested safe limit for each as given by the World Federation for Ultrasound in Medicine and Biology. (b) Describe, with the help of diagrams, the physical principles of harmonic imaging in medical ultrasound. (c) Explain the value of harmonic imaging in your area of clinical practice. 2. Discuss the use of echocardiography for assessment of mitral regurgitation. Include methods for determining the mechanism and severity of regurgitation and their pitfalls in addition to discussing the use of intra-operative echocardiography. 3. Discuss the use of ultrasound in the management of patients undergoing endovascular aortic aneurysm repair. 4. A soft tissue mass is noted at the fetal abdominal cord insertion site at 11 weeks gestation. Discuss your approach to sonographic diagnosis and management. 5. What is the role of ultrasound in screening and diagnosis of endometrial pathology? 6. Discuss the value of sonography in the investigation of persistent vomiting in a young infant. 7. Discuss the use of ultrasound in the assessment of acute abdominal pain in an adult patient. 8. Describe the application of ultrasound in the assessment of patients requiring arteriovenous fistula formation for vascular access and renal dialysis. 9. (a) Discuss how you would assess left ventricular diastolic function by echocardiography in everyday practice. How would you determine if left ventricular filling pressure is elevated? (b) Are there measurements which have been reported in the literature for assessing left ventricular diastolic function which you do not use ordinarily in everyday practice? What are their strengths and weaknesses? 6

7 10. A 30 year-old nulliparous women, who is trying to conceive presents with acute onset of lower pain for investigation. Her LMP was 5 weeks ago. Describe your approach to his ultrasound examination. 11. An antenatal ultrasound at 24 weeks shows the head and abdominal circumferences on the 30th centile and the femur length below the 5th centile. (a) Describe what other information you would require to complete the report. (b) List your differential diagnosis and further suggestions for ultrasound review. 12. Discuss the technique and role of ultrasound in the assessment of a new born infant with a sacral dimple. 13. Discuss congenital abnormalities of the kidneys related to both ureteral bud development and renal ascent with particular attention to clinical presentation, ultrasound findings and their clinical relevance. 17 th May 2008 DDU Part 2 Written Examination Explain, using physical principles of ultrasound, why transmitted pulses of different length and different ultrasound frequency are used in Doppler to those used in imaging. 35 Marks 2. Describe the application of ultrasound in the diagnosis, management and follow-up of patients with carotid artery stenosis. 3. Describe the typical and atypical morphologic features of hypertrophic cardiomyopathy. Describe how you would comprehensively evaluate the relevant aspects of cardiac function in this condition. Use diagrams where it is appropriate. 4. Discuss the clinical application of 3D ultrasound in Obstetrics and Gynaecology. 5. Describe the spectrum of possible ultrasonic findings in a patient with chronic pelvic pain. 6. A 50 year old male presents with a painless mass in the scrotum. Discuss your approach to ultrasound of this and the likely causes. 7

8 7. Discuss the use of ultrasound in the diagnosis and management of venous thromboembolism (VTE). 8. Discuss briefly the epidemiology, natural history and genetic implications of bicuspid aortic valve disease. Describe the M-Mode and 2-D appearances of this valve condition, and how you would measure bicuspid aortic valve function with Doppler techniques. Comment on the non-cardiac abnormalities associated with this Condition, how you would assess them, and what implications they have on management. 9. Discuss the Role of ultrasound in the investigation and management of female Infertility. 10. Discuss the role of ultrasound of the renal tracts in the early post-natal period with an antenatal diagnosis of an abnormal finding. Include a discussion of common pathologies encountered. 11. Discuss the role of ultrasound in investigation and management of thyroid disease. Include its role in monitoring progression and treatment response. 14 th May 2007 DDU Part 2 Written Examination (a) (b) (c) How has recent technology reduced slice thickness artifacts? What methods and precautions should you use in order to accurately measure a liquid filled structure in an image? Explain the effect of 'aliasing' in spectral Doppler and colour Doppler displayed information. 2. Discuss the use of ultrasound in the follow-up of endovascular arterial interventions. Describe the benefits and technical limitations, and compare with those of other imaging modalities. 3. a) Describe, with the aid of diagrams, the various mechanisms which may produce aortic regurgitation in native and prosthetic valves. b) Discuss the echocardiographic methods that have been proposed for evaluating the severity of aortic regurgitation, highlighting their strengths and weaknesses. 8

9 4. Discuss the significance of echogenic foci identified in these anatomical locations: a) Fetal Heart. b) Ovaries. c) Testes. 5. Some ultrasound practices offer 3D scanning and DVD recording during pregnancy when there is no medical indication for testing. Discuss this statement. 6. a) Discuss the role of Doppler Ultrasound in the assessment of the small for gestational age fetus. b) Discuss the role of Doppler Ultrasound in the assessment of a high risk pregnancy. 7. A 65 year old male with peripheral arterial disease requires intervention but the use of contrast is contra-indicated because of chronic renal impairment. Describe in detail how you might use ultrasound as the sole imaging modality in the management of this patient. 8. Discuss the Echocardiographic assessment of an adult patient with severe pulmonary hypertension. 9. Discuss the role of ultrasound in imaging a child with abdominal pain. In particular, the techniques used in scanning and conditions which may present. 10. Describe the different forms of abnormally adherent placentae and their ultrasound appearances. Discuss the role of other imaging modalities in the diagnosis. 11. Discuss the current role of ultrasound in the investigation of Primary Infertility. 12. Discuss the role of ultrasound in the investigation and management of Breast Disease. Make reference to the role of ultrasound screening. 15 th May 2006 DDU Part 2 Written Examination (a) Describe the principles of harmonic imaging in medical ultrasound. (b) Explain the benefits of harmonic imaging in your practice. (c) Why does the use of harmonic imaging have an effect on the TI and MI output display? 9

10 2. Discuss the place of ultrasound in the diagnosis of a 12 year old girl presenting to the emergency department with RIF pain of one day s duration. 3. Outline the role of ultrasound in the assessment of the small for gestational age (SGA) foetus. 4. Discuss the role of ultrasound in the investigation of recent post-menopausal bleeding. 5. (a) Outline the use of ultrasound in the assessment of veins of the lower limb. (b) Describe 10 of the pitfalls which may be associated with these techniques. 6. Discuss the role of echocardiography including transoesophageal echo in the diagnosis and management of a patient with infective endocarditis (include both native and prosthetic valves). 7. Discuss the role and limitations of the mid trimester scan in the diagnosis of foetal malformation. 8. An ultrasound at 28 weeks gestation reveals a foetus with non-immune hydrops and polyhydramnios. Discuss your approach to the management. 9. Discuss the role of ultrasound in the diagnosis of non-gynaecological pelvic pathology. 10. (a) Describe the use of ultrasound in the assessment of arteriovenous fistulae. (b) Describe how the ultrasound derived information is useful in assessing the haemodynamics of arteriovenous fistulae. 11. (a) Discuss the echcardiographic findings in a patient with cardiac aymyloid. (b) Discuss the typical echocardiographic findings in the various types of cardiac tumor. 12. Discuss the use of ultrasound in the assessment of acute abdominal pain in an adult patient. 10

11 15 th May 2005 DDU Part 2 Written Examination a) How does the use of contrast agents assist in improving diagnoses when used in ultrasonic examinations? b) Explain the expected differences in thermal bio-effects between B-Mode imaging, Spectral Doppler, and Colour Doppler? 2. Discuss the use of Echocardiography/Doppler in the assessment of complications of acute myocardial infarction. 3. Thyroid nodules are common. What is their clinical relevance, what is the role of ultrasound in their investigation and follow up? What features should be included in an adequate scan? 4. Describe the different methods of antenatal assessment for fetal chromosome abnormality. 5. Discuss the benefits and limitations of Doppler assessment of the fetal circulation. 6. Discuss the use of ultrasound in the assessment of lower limb arterial supply. 7. Discuss the role of Echocardiography/Doppler in evaluating a patient who has had an unexplained cerebrovascular event. 8. Discuss the use of ultrasound in the diagnosis and management of Gestational Trophoblastic Disease. 9. An ultrasound at 24 weeks reveals a foetus with head and abdomen circumference measurement on the 30th centile and femur length just below the 5th percentile. Describe your approach to the management. 10. Ultrasound is useful in the pre-operative assessment of varicose veins in the leg. Give an account of the relevant anatomy and pathophysiology, explain the rationale of the study, and indicate points important in a comprehensive clinical report. 11. Describe the fetal lung lesions diagnosable on ultrasound examination and characterize their ultrasound features. 11

12 12. Review current modalities of ultrasound assessment of extracranial vascular disease and treatment. Include descriptions of the utility of different ultrasound modalities in the assessment of quantitation and characterization of disease states. Highlight ten (10) artefacts or errors of technique which can impair these methods of ultrasound assessment. 17 th May 2004 DDU Part 2 Written Examination (a) Intracavity ultrasound used for transoesophageal, intravascular or transvaginal scanning usually produces higher quality images than transcutaneous ultrasound. Explain with the aid of diagrams the technical reasons for this statement. (b) What is meant by the slice thickness of an ultrasound image and what effect does it have on the anatomical information displayed. (c) Describe techniques used in the transducer and system design to minimise slice thickness. 2. a) Outline technical issues that affect the reliability of colour flow duplex ultrasound assessment of extracranial carotid arteries. b) Outline methods to reduce the impact of these issues. 3. Discuss the management of choroid plexus cyst and echogenic intra-cardiac focus in women at low risk for chromosomal abnormality. 4. A 25 year old woman presents to her Gynaecologist with primary infertility. She is referred to you for investigation using Ultrasound. List the ultrasound procedures available to you to asses her pelvis and to avoid a laparoscopy. Include possible information that may be obtained from each of the procedures. List also any contraindications for each procedure. 5. Discuss the role of ultrasound in the assessment of thyroid disease. Include its role in monitoring the progression of disease and its response to treatment. 6. a) Describe the echocardiography and Doppler assessment of the various types of Atrial septal defect including patent foramen ovale. Include a discussion of the quantification of shunt size and role of echocardiography in percutaneous closure. b) A 45 year old male presents with sudden onset of severe acute central chest and back pain suggestive of aortic dissection. Discuss the role of transthoracic and transoesophageal echo-cardiography in the initial assessment and ongoing management. 12

13 7. Discuss the current role of ultrasound in assessment of lower limb venous disease. Include comments on its role in monitoring treatment. 8. Discuss the role of ultrasound in the evaluation of multiple pregnancy. 9. In which clinical situations might the ovaries be difficult to visualise, despite both abdominal and vaginal scans? List these and the scanning techniques that may help to identify the ovary in difficult cases. 10. Describe the relevant features when determining zygosity in multiple pregnancies and how conclusive are they? 11. Discus the role of ultrasound in assessing and monitoring the new born with a clicky hip. 12. Discuss the role of stress echocardiography in the assessment of patients with possible myocardial ischaemia. Include a discussion of the methods employed, interpretation, complications, limitations and newer techniques to improve sensitivity. 19 th May 2003 DDU Part 2 Written Examination (a) (b) (c) Describe the principles of harmonic imaging in medical ultrasound. Explain the benefits of harmonic imaging in your practice. Why does the use of harmonic imaging have an effect on the TI and MI output display? 2. Discuss ultrasound assessment in the management of lower limb venous disease. 3. Discuss the evaluation of a complex pelvic mass found in a 45 year old parous female with recent menstrual disturbance. 4. Discuss the role of echocardiography/doppler in the assessment of the of the role of transoesophageal mechanism and severity of mitral valve regurgitation in native and prosthetic valves. Include a discussion echocardiography and intraoperative TOE in this condition. 13

14 5. A 38 year old is referred to you for an ultrasound examination. The referral reads: Now 38 weeks pregnant clinically small for gestational age. Please assess. Discuss your approach to the examination and possible findings. 6. A 24 year old female presents with a 24 hour history of acute right iliac fossa pain. Discuss your approach to the ultrasound examination and possible findings. 7. A 50 year old patient has been referred with syncope, particularly when hanging clothes. (a) Outline the possible findings and the technical issues that affect the reliability of colour flow duplex ultrasound in this case. (b) Outline methods to reduce the impact of these issues. 8. Discuss the use of Doppler in Obstetrics and Gynaecology by giving an example in three areas of clinical use. Discuss the methods of assessing Doppler flow in these areas, their pitfalls and their clinical relevance. 9. (a) Discuss the role of echocardiography/doppler in the diagnosis and management of hypertrophic cardiomyopathy. (b) Discuss the technique and role of contrast echocardiography. 10. Describe how serial ultrasound examinations can be helpful in the management of a foetus at risk for anaemia. 11. A 20 year old man has presented with unilateral groin pain. Describe the ultrasound features to be expected in the event of: (a) Testicular torsion (b) Epididymo-orchitis (c) Strangulated inguinal hernia. 20 th May 2002 DDU Part 2 Written Examination (a) (b) Discuss potential bio-effect mechanisms, other than heating, in diagnostic ultrasound. How would you avoid these effects in your area of clinical practice? Calculate the number of lines of sight in an ultrasound image when the frame rate is 20 frames /second and the imaging depth is 14 cm. 14

15 (c) Discuss how these parameters would change if the imaging system was being used to image a thyroid nodule. 2. Discuss the haemodynamic alterations of an arteriovenous fistula and describe how ultrasound imaging is used in the assessment of arteriovenous fistulae. 3. Discuss the role of cranial sonography in the investigation of a young infant presenting with a big head. 4. Discuss the various echocardiographic parameters used in the assessment of left ventricular diastolic function, elaborating on their strengths and limitations. 5. You are performing an ultrasound examination at 19 weeks gestation and suspect the fetus has a bony dysplasia. Describe the algorithm you would use to help you towards making a specific diagnosis. 6. The place of ultrasound in the evaluation of chronic liver disease in a middle aged adult. 7. Discuss the use of Ultrasound in the assessment of a patient with suspected arterial disease of the leg. 8. Discuss the technique and role of sonography in the investigation of young infant presenting with two documented episodes of urinary tract infection. 9. Discuss the use of echocardiography/doppler in the assessment and management of pericardial diseases. Include a discussion of the differentiation of pericardial constriction from restrictive cardiomyopathy. 10. Lives are saved and costs are cut through ovarian cancer screening. Discuss this statement, emphasising the role of diagnostic ultrasound. 11. Discuss the current place of 3D ultrasound, compared to B-mode imaging, in the assessment of gynaecological abnormalities. 15