RD7.{1,6} | Imaging in Obstetrics, Gynecology and Breast Care — Practice Quiz — RD7.{1,6} | Imaging in Obstetrics, Gynecology and Breast Care

Q1 RD7.1 1 pt

A 22-year-old woman with oligomenorrhoea and clinical hyperandrogenism undergoes transvaginal ultrasound. The radiologist reports each ovary contains 24 small peripherally arranged follicles measuring 2–9 mm, with an ovarian volume of 9 mL, using a modern high-frequency transducer. Which single statement best integrates these findings into her diagnosis?

A The follicle number alone confirms polycystic ovary syndrome regardless of other features

B Using a modern high-frequency transducer the threshold for polycystic ovarian morphology is ≥20 follicles per ovary, so this scan meets the morphological criterion which is one of the three Rotterdam criteria ✓

C An ovarian volume of 9 mL excludes polycystic ovarian morphology because the volume must exceed 10 mL

D The scan is normal because follicles measuring 2–9 mm are physiological antral follicles

E MRI of the ovaries is now required to confirm the diagnosis

Correct. With modern high-frequency transducers the follicle-number threshold for polycystic ovarian morphology has been revised upward to ≥20 follicles (2–9 mm) per ovary; ovarian volume >10 mL is an alternative, not a mandatory, criterion. Either suffices for the morphological component, which is only ONE of the three Rotterdam criteria.

Modern high-frequency transducer threshold for PCOM is ≥20 follicles per ovary (older/Rotterdam 2003 used ≥12); ovarian volume >10 mL is an alternative criterion. Morphology is one of three Rotterdam criteria.

Polycystic ovarian morphology is met by ≥20 follicles (2–9 mm) per ovary on a modern transducer OR ovarian volume >10 mL; morphology is just one of three Rotterdam criteria and does not by itself confirm PCOS.

Click to reveal answer

Q2 RD7.1 1 pt

A regularly menstruating, asymptomatic 25-year-old has a pelvic ultrasound for an unrelated reason that incidentally shows 22 follicles in one ovary. She has no hyperandrogenism. How should this finding be integrated into her care?

A She should be diagnosed with PCOS and started on treatment

B Polycystic ovarian morphology in a woman with regular cycles and no hyperandrogenism does not meet Rotterdam criteria (needs any two of three); no diagnosis or treatment is warranted on imaging alone ✓

C She requires an urgent HSG to assess tubal patency

D A polycystic-appearing ovary is always pathological and mandates endocrine suppression

E She should undergo CT of the abdomen to stage the ovaries

Correct. Rotterdam requires any TWO of three criteria (oligo/anovulation, hyperandrogenism, polycystic ovarian morphology). A polycystic-appearing ovary in a woman with regular cycles and no hyperandrogenism is an isolated finding, not a diagnosis.

Rotterdam = any 2 of 3 (oligo/anovulation, hyperandrogenism, PCOM). Imaging is supportive, never standalone diagnostic.

The scan does not diagnose PCOS by itself; Rotterdam needs any two of three criteria. An isolated polycystic morphology in an asymptomatic, regularly cycling woman is not PCOS.

Click to reveal answer

Q3 RD7.1 1 pt

A 28-year-old woman with a positive pregnancy test, 6 weeks amenorrhoea, and right iliac fossa pain has a transvaginal ultrasound showing an empty uterus. Her serum beta-hCG is 3200 IU/L. Which interpretation best integrates these findings?

A The empty uterus is reassuring and she can be discharged

B An empty uterus with a beta-hCG above the discriminatory zone (~1500–2000 IU/L) is an ectopic pregnancy until proven otherwise and mandates active assessment ✓

C The pregnancy is too early to see and she should simply repeat the scan in three weeks

D A normal intrauterine pregnancy is confirmed because the uterus is empty

E An abdominal X-ray should be performed to localise the pregnancy

Correct. With beta-hCG of 3200 IU/L (above the ~1500–2000 IU/L discriminatory zone) an intrauterine gestational sac should be visible. An empty uterus at this level is an ectopic until proven otherwise.

Empty uterus + beta-hCG above discriminatory zone (~1500–2000 IU/L) = ectopic until proven otherwise. Avoid ionising imaging in pregnancy; TVS is first-line.

Read the TVS against the beta-hCG. An empty uterus with hCG ABOVE the discriminatory zone (~1500–2000 IU/L) is an ectopic until proven otherwise — not reassuring.

Click to reveal answer

Q4 RD7.1 1 pt

During evaluation of suspected ectopic pregnancy, the sonographer reports a small fluid collection within the endometrial cavity. Which feature most reliably distinguishes a true gestational sac from a pseudosac?

A A pseudosac is eccentrically placed within the endometrium and shows a double decidual or yolk-sac/fetal-pole, whereas a true sac is central and featureless

B A true gestational sac is eccentrically located within the endometrium and may show a double decidual sign, yolk sac or fetal pole, whereas a pseudosac is a centrally placed fluid collection conforming to the cavity without these features ✓

C Only colour Doppler can ever distinguish the two and morphology is irrelevant

D A pseudosac always contains a yolk sac

E There is no reliable way to distinguish them and CT is required

Correct. A true intrauterine gestational sac is eccentrically embedded in the decidua (double decidual sign) and may contain a yolk sac or fetal pole. A pseudosac is a central cavity fluid collection that follows the cavity shape and lacks these features.

True sac: eccentric, double decidual sign, may contain yolk sac/fetal pole. Pseudosac: central cavity collection, no yolk sac — do not call it an intrauterine pregnancy.

A true sac is eccentric within the decidua with a double decidual sign / yolk sac / fetal pole; a pseudosac is a central, featureless cavity collection. Mistaking a pseudosac for a true sac is a classic trap.

Click to reveal answer

Q5 RD7.1 1 pt

A subfertile couple is being investigated. The female partner needs assessment of tubal patency and wishes to avoid ionising radiation. Which imaging approach best matches the factor being tested?

A Transvaginal ultrasound alone, because it directly demonstrates tubal patency

B HyCoSy (hysterosalpingo-contrast-sonography), a radiation-free ultrasound-based alternative to HSG for assessing tubal patency ✓

C Mammography, because it images the reproductive tract

D CT urogram, because it shows the fallopian tubes

E Plain abdominal radiograph in the follicular phase

Correct. HyCoSy assesses tubal patency using ultrasound contrast and avoids ionising radiation, making it the radiation-free alternative to HSG. TVS assesses ovarian reserve, ovulation and the cavity but not tubal patency directly.

Tubal patency: HSG (follicular phase, day 6–10) or radiation-free HyCoSy. TVS assesses ovarian reserve/ovulation/uterine cavity.

Match the test to the factor. Tubal patency = HSG or its radiation-free alternative HyCoSy. TVS assesses ovarian reserve/ovulation/cavity, not patency.

Click to reveal answer

Q6 RD7.1 1 pt

An HSG is planned for a woman being investigated for infertility. To maximise diagnostic value and safety, when in the menstrual cycle should the study be performed?

A During menstruation (day 1–3) to flush the tubes

B In the follicular phase, typically day 6–10, after menstruation has stopped and before ovulation to avoid irradiating an early pregnancy ✓

C In the luteal phase (day 21–24) to coincide with implantation

D At any time, because cycle timing does not affect HSG

E Only after a positive pregnancy test is confirmed

Correct. HSG is performed in the follicular phase (about day 6–10), after bleeding has stopped and before ovulation, so that an early pregnancy is not inadvertently exposed to ionising radiation.

HSG timing: follicular phase, day 6–10 — post-menstrual and pre-ovulatory to avoid radiation to an early pregnancy.

HSG is a follicular-phase study (day 6–10): after menses, before ovulation, to avoid irradiating a possible early pregnancy.

Click to reveal answer

Q7 RD7.6 1 pt

A 32-year-old woman presents with a palpable breast lump. Her breasts are clinically dense and she is concerned about radiation. Which imaging modality is the appropriate first-line investigation of the lump?

A Screening mammography, as it is first-line for all breast lumps

B Ultrasound, which is first-line for a lump in a young woman with dense breasts and avoids ionising radiation ✓

C Contrast-enhanced CT of the chest

D PET-CT of the whole body

E No imaging is needed; reassure and discharge

Correct. Ultrasound characterises focal lumps and is first-line in young women and in dense breasts, where mammographic sensitivity falls; it also uses no ionising radiation. Mammography screens asymptomatic and older breasts.

Lump in young/dense breast → ultrasound first-line (radiation-free, better in dense tissue). Mammography is the screening tool for asymptomatic/older breasts.

Mammography screens; ultrasound characterises and is first-line for a lump in a young woman with dense breasts. It is also radiation-free.

Click to reveal answer

Q8 RD7.6 1 pt

A screening mammogram in a 52-year-old woman is reported as BI-RADS 4 with a cluster of pleomorphic microcalcifications. How should this category be integrated into her management?

A BI-RADS 4 indicates a benign finding requiring no action

B BI-RADS 4 denotes a suspicious finding, so tissue biopsy is indicated to complete the triple assessment (clinical examination, imaging, pathology) ✓

C BI-RADS 4 means biopsy-proven malignancy and definitive surgery should proceed without histology

D BI-RADS 4 requires only routine recall in two years

E BI-RADS 0 and BI-RADS 4 are equivalent and both mean the study is incomplete

Correct. BI-RADS 4 is a suspicious category warranting tissue diagnosis. Imaging is one limb of the triple assessment (clinical examination + imaging + pathology); a suspicious image must be confirmed by biopsy, not treated as proven cancer.

BI-RADS scale 0–6: 0=incomplete, 1=negative, 2=benign, 3=probably benign (short interval follow-up), 4=suspicious (biopsy), 5=highly suggestive of malignancy (biopsy), 6=known cancer. Triple assessment = exam + imaging + pathology.

BI-RADS 4 = suspicious → biopsy. It is not benign (2), not proven malignancy (6), and not incomplete (0). Triple assessment integrates clinical exam, imaging and pathology.

Click to reveal answer