Enhances Detection of Microvascular Architecture
Differentiates Benign vs Malignant Ovarian Masses
Useful When MRI is Contraindicated or Inconclusive
Real-Time Perfusion Assessment
Can Guide Biopsy or Intervention in Complex Cases
2. Role of CEUS in Ovarian Imaging 0%
2. Benign Ovarian Lesions on CEUS
Simple Cysts: Anechoic with No Enhancement
Hemorrhagic Cysts: Peripheral or Septal Enhancement
Endometriomas: Typically Avascular or Peripheral Flow
Corpus Luteum: Ring of Peripheral Enhancement (Hypervascular Rim)
Dermoid Cysts: No Enhancement, May Contain Calcification or Fat
3. Malignant Ovarian Lesions on CEUS 0%
Irregular, Solid Components with Early Arterial Enhancement
Septations and Papillary Projections Show Vascularity
Rapid Wash-In and Washout of Contrast
Chaotic, Disorganized Microvascular Flow
Useful in Evaluating Peritoneal Implants and Ascites
4. CEUS vs Conventional Technique 0%
Higher Sensitivity for Vascularized Solid Components
Complements Color Doppler and B-mode
Comparable to MRI in Lesion Characterization
Real-Time Contrast Flow Visualization Advantage
5. Ovarian CEUS Case Studies & Quiz 0%
Case 1: Corpus Luteum with Peripheral Contrast Ring
Case 2: Enhancing Solid Mass Suggestive of Serous Cystadenocarcinoma
Case 3: Avascular Endometrioma vs Enhancing Hemorrhagic Cyst
Quiz: Identify Malignant Pattern Based on CEUS Phases
Interpretation Pitfalls: Mistaking Functional Cysts for Tumors
Scenario Review: CEUS vs Doppler in Borderline Tumor Evaluation
1. Introduction to Menstrual Cycle Evaluation 100%
Role of Ultrasound in Cycle Monitoring
Indications: Infertility, Irregular Cycles, ART Monitoring
Hormonal Regulation of Uterus and Ovaries
TVS as the Primary Modality
2. Anatomy and Hormonal Basics 100%
Uterine and Ovarian Anatomy
Menstrual Hormonal Axis: Hypothalamus → Pituitary → Ovary
Hormone-Dependent Endometrial and Follicular Changes
Relevance to Cycle Phases
3. Ultrasound Protocols and Techniques 100%
Transvaginal Probe Use
Cycle Day-Based Scanning (Day 2, 7, 10, 12, 14, 21)
Endometrial and Ovarian Measurements
Doppler Assessment of Blood Flow and Vascularity
4. Menstrual Phase (Days 1–5) 100%
Thin Endometrium (2–4 mm), Echogenic Shedding
Small Antral Follicles (2–6 mm)
Hypoechoic Endometrial Appearance
Baseline Scan for ART and Cycle Evaluation
Dominant Follicle Rupture and Collapse
Free Fluid in POD (Posterior Cul-de-sac)
Perifollicular Flow (Low Resistance Doppler)
Endometrium: Max Thickness ~10–12 mm
7. Luteal Phase (Days 16–28) 100%
Corpus Luteum Formation: Ring of Fire Doppler
Endometrium Becomes Hyperechoic
Thickness Maintained if Pregnancy
Premature Regression in Luteal Phase Defect
8. Endometrial and Follicular Measurements 100%
Endometrial Thickness Chart by Cycle Day
Dominant Follicle Tracking
AFC (Antral Follicle Count) for Ovarian Reserve
Folliculometry for Ovulation Prediction
9. Clinical Applications and Cycle Abnormalities 90%
Anovulation and PCOS Monitoring
Luteal Phase Defect Diagnosis
Endometrial Insufficiency (Thin Lining)
ART Monitoring: Clomiphene, Letrozole, IVF Cycles
Cycle Assessment in Perimenopause
10. Case Studies and Quiz Section 0%
Follicle vs Corpus Luteum
Endometrial Pattern Interpretation
Ovulation Identification on Serial Scans
Quiz on Day-Based Endometrial and Ovarian Features
Role of Ultrasound in Adnexal Evaluation
Indications: Pain, Mass, Infertility, Menstrual Irregularity
TVS vs TAS Approaches
Advantages, Safety, and Limitations
2. Anatomy of Ovary and Adnexa 00%
Ovarian Location and Relations
Ovarian Ligaments and Blood Supply
Tubal Anatomy and Relationship to Ovary
Surrounding Structures: Uterus, Bladder, Bowel, Pouch of Douglas
3. Normal Ovary on Ultrasound 00%
Normal Size and Volume by Age
Follicular Development: Antral, Dominant, Corpus Luteum
Echotexture and Stromal Echogenicity
Periovulatory Changes
Ovarian Volume and Antral Follicle Count (AFC)
Folliculometry and Ovulation Tracking
Doppler Flow Patterns in Different Cycles
4. Physiological and Functional Lesions 00%
Simple Follicular Cyst
Postmenopausal Pelvic Cyst
Ovarian Functional Cyst
Corpus Luteum Cyst
Theca Lutein Cysts (High hCG States)
Luteoma of Pregnancy
Luteinized Unruptured Follicle
Ovarian Changes in Early Pregnancy
Tubo-Ovarian Abscess (TOA)
Hydrosalpinx and Pyosalpinx
Ectopic Pregnancy (Adnexal Ring Sign)
Paraovarian Cysts
Peritoneal Inclusion Cysts
7. Ovarian Torsion 00%
Enlarged Ovary with Peripheral Follicles
Absent or Reduced Doppler Flow
Whirlpool Sign (Twisted Vascular Pedicle)
Differential with Hemorrhagic Cyst or TOA
div class="subtopics">
Polycystic Ovarian Syndrome (PCOS)
Doppler in Luteal Phase
Ovarian Hyperstimulation Syndrome (OHSS)
9. Interventional and Follow-Up Role 50%
US-Guided Follicular Aspiration
Monitoring IVF and Ovulation Induction
Post-Surgical Monitoring of Cysts
Assessing Response to Hormonal Treatment
10. Case Studies and Quiz Section 0%
Differentiating Hemorrhagic vs Endometrioma
Torsion vs Large Benign Mass
PCOS vs Normal Variant
Interactive Quiz with Annotated Images
Role of Ultrasound in Vaginal Pathology Assessment
Indications: Pain, Bleeding, Discharge, Trauma
Comparison: Transvaginal vs Transperineal Ultrasound
Safety, Patient Preparation, and Consent
2. Anatomy of the Vagina 100%
Vaginal Canal and Fornices
Layers: Mucosa, Muscularis, Adventitia
Relation to Urethra, Bladder, Rectum, Cervix
Pediatric, Premenopausal, and Postmenopausal Differences
3. Scanning Techniques 100%
Transvaginal (Endocavitary) Probe Use
Translabial/Transperineal Approach
Probe Positioning and Orientation
Gel Use, Infection Control, and Imaging Planes
4. Normal Vaginal Appearance 100%
Homogeneous Hypoechoic Wall Layers
Collapsed Vaginal Canal (Thin Echogenic Line)
Recognition of Fornices and Cervical Bulge
Variable Appearance with Hormonal Status
Gartner Duct Cyst
Vaginal Polyps
Vaginal Cancer (Rare – SCC, AdenoCA)
Metastasis or Extension from Cervix or Vulva
Evaluation of Vaginal Wall Thickening
Ultrasound-Guided Drainage of Abscess
Monitoring Cyst Resolution or Recurrence
Evaluation of Postoperative Healing
Guidance for Foreign Body Removal
9. Case Studies and Quiz Section 0%
Differentiating Abscess vs Hematoma
Cyst vs Polyp vs Tumor in Vaginal Canal
Trauma vs Congenital Anomaly Cases
Interpretation Practice with Labeled Scenarios
Upper, Mid, and Lower Thirds of Ureter
Ureteropelvic Junction (UPJ)
Ureterovesical Junction (UVJ)
Relationship with Kidney, Bladder, and Psoas Muscle
Normal Wall Thickness and Lumen Caliber
Challenges in Visualizing Non-Dilated Ureter
2. Ureteric pathology 00%
1. Obstructive Pathologies
Ureteric Calculus – Bright Echogenic Foci with Posterior Acoustic Shadowing
UVJ Calculus – Common Cause of Acute Obstruction
Ureterocele – Anechoic Rounded Bulge within Bladder Wall
Hydroureter – Dilated Tubular Ureteral Segment
Congenital Megaureter – Fusiform Dilatation
Ureteric Strictures – Narrowed, Non-compliant Segments
Vesicoureteral Reflux (VUR) – Indirect Signs in Children
2. Neoplastic and Infiltrative Lesions
Transitional Cell Carcinoma (TCC) of Ureter
Urothelial Masses with Intraluminal Growth
Invasion from Adjacent Malignancy (Cervical, Colorectal)
3. Functional Evaluation
Ureteric Peristalsis – Wave-like Movements on Real-Time Scanning
Use of Color Doppler to Assess Ureteric Jets into Bladder
Absent or Reduced Jet Suggests Obstruction
Comparison of Bilateral Ureteric Jet Frequency
3. Ureter Case Studies and Quiz Section 0%
Clinical Case Review
Image-Based Quiz: Identify Ureteric Calculus
Doppler Flow Quiz: Intermittent vs Absent Ureteric Jet
Pitfalls: Mistaking Bowel Gas for Dilated Ureter
Importance of Bladder Ultrasound in Urology
Common Clinical Indications (UTI, Hematuria, Retention)
Benefits and Limitations
Role in Emergency, Routine, and Post-Surgical Settings
2. Anatomy and Orientation 100%
Bladder Wall Layers and Normal Thickness
Trigone, Dome, and Neck of the Bladder
Ureteric Orifices and Internal Urethral Opening
Male vs Female Pelvic Anatomy Relationships
3. Scanning Technique 100%
Transabdominal Scanning Approach
Probe Selection (Curvilinear or Phased Array)
Patient Prep – Full Bladder Protocol
Longitudinal and Transverse Views
Bladder Volume Estimation (L × W × H × 0.52)
4. Normal Bladder Sonographic Appearance 100%
Anechoic Fluid-Filled Appearance
Smooth Contour and Symmetric Shape
Wall Thickness: Normal < 3 mm (Distended)
Visualization of Ureteric Jets with Color Doppler
Basics of Contrast Agents (e.g., SonoVue, Lumason)
Physics of Microbubbles and Harmonic Imaging
Advantages: Real-Time, Non-Ionizing, Repeatable
Applications in Tumor Imaging and Biopsy Guidance
2. CEUS Phases and Interpretation 100%
Arterial Phase (10–30 sec): Hypervascular Tumor Identification
Portal Phase (30–120 sec): Washout Evaluation
Late Phase (up to 5 min): Persistence or Loss of Enhancement
Enhancement Patterns: Rim, Centripetal, Mosaic, etc.
3. CEUS for Liver Cancer Localization 100%
Hepatocellular Carcinoma (HCC): Arterial Hyperenhancement + Late Washout
Cholangiocarcinoma: Rim Enhancement + Rapid Washout
CEUS LI-RADS Classification
Differentiation from Hemangioma, FNH, Cysts
4. CEUS in Kidney Tumors 100%
Clear Cell RCC: Intense, Early Enhancement
Papillary RCC: Hypovascular
Angiomyolipoma: No Washout
Indeterminate Complex Cysts (Bosniak III/IV)
5. CEUS for Prostate Cancer Localization 10%
Focal Early Enhancement in the Peripheral Zone
Identification of Suspicious Nodules Missed on Grey-Scale TRUS
Enhancement Timing: Tumor Shows Earlier and Stronger Enhancement than Normal Tissue
Microvascular Architecture Visualization: Disordered, Chaotic Vessels in Malignancy
Improved Targeting for TRUS-Guided Biopsy in Lesion-Directed Approach
Useful in Re-Biopsy Cases after Negative Systematic Biopsies
CEUS-mpMRI Fusion: Correlation and Added Sensitivity in Lesion Detection
Assessment of Tumor Volume and Extracapsular Extension (ECE)
CEUS Elastography Combination for Stiffness-Based Detection
Role in Monitoring Focal Therapy Outcomes (e.g., HIFU, Cryoablation)
6. CEUS in Other Organ Cancers 60%
Pancreas
Hypoenhancing Adenocarcinoma vs Hypervascular NETs
Guidance for EUS-FNA in Borderline Lesions
Thyroid
Irregular, Rapid Washout in Malignancy
Distinguishing Benign Nodules with Persistent Enhancement
Breast
Irregular Margins, Central Necrosis Patterns
Use in Dense Breasts and Pre-Biopsy Evaluation
7. CEUS-Guided Interventions 0%
Targeted Biopsy of Enhancing Lesions
Intra-procedural Localization for Ablation
Monitoring Ablation Zone Post-Treatment
Real-Time Adjustment Based on Enhancement Changes
8. Limitations and Pitfalls 0%
User Dependency and Learning Curve
Limited Role in Deep Lesions (Obesity/Gas Interference)
Misinterpretation of Benign Hyperenhancing Lesions
Microbubble Destruction Artifacts
9. Case Studies and Quiz Section 0%
Liver Tumor CEUS Interpretation Quiz
RCC vs AML CEUS Cases
Washout Pattern Analysis Practice
Doppler vs CEUS vs MRI Correlation Scenarios
Definition and Types (Strain vs Shear Wave Elastography)
Basic Physics of Tissue Stiffness Measurement
Advantages in Prostate Imaging
Comparison with Other Modalities (TRUS, MRI)
2. Prostate Anatomy and Zonal Importance 100%
Peripheral Zone (PZ) – High Cancer Incidence
Transition Zone (TZ) – Common for BPH
Central and Anterior Fibromuscular Zones
Importance of Zone-Based Stiffness Mapping
3. Elastography Techniques in the Prostate 100%
Strain Elastography: Manual Compression or Physiologic Pulsations
Shear Wave Elastography (SWE): Quantitative Stiffness Maps
Transrectal vs Transperineal Approaches
Color Maps, Stiffness Units (kPa or m/s), and ROIs
Equipment Settings and Optimization
4. Interpretation of Prostate Elastography 80%
Normal Peripheral Zone: Soft Elasticity (Low kPa)
Prostate Cancer: Focal Areas of Increased Stiffness
BPH: Diffuse Stiffening in TZ
Artifacts: Probe Pressure, Calcifications, Shadowing
Learning Curve and Pitfalls
5. Clinical Applications and Diagnostic Role
1. Prostate Cancer Detection
Suspicious Lesions: Stiff, Irregular, Non-homogeneous
PI-RADS Integration (MRI-US Fusion + SWE)
Increased Sensitivity and Specificity with Elastography
2. Biopsy Guidance
Targeted Biopsy of Hard Lesions
Avoiding Repeat Biopsies in Negative TRUS Cases
Guidance for Focal Therapy or Ablation Planning
3. BPH and Prostatitis
Distinguishing Focal Cancer from Diffuse TZ BPH
Chronic Prostatitis May Mimic Focal Stiffness
Elastography Patterns Over Time
6. Quantitative Metrics and Thresholds 30%
Normal Prostate Stiffness: ~20–40 kPa (Peripheral Zone)
Suspicious Lesions: > 60–80 kPa
Strain Ratios >2.5 Between Lesion and Background
Interpretation Depends on System Calibration
7. Research, Limitations, and Future Scope 0%
Operator Dependence in Strain Elastography
Need for Standardized Cutoffs
Use in Active Surveillance Patients
Integration with AI and Fusion-Guided Biopsy Platforms
8. Case Studies and Quiz Section 0%
Real-Life Cases with Imaging and Biopsy Correlation
SWE vs Strain Map Comparison
Image-Based MCQs on Stiffness Interpretation
Common Mistakes and Diagnostic Pearls
Role of Ultrasound in Evaluating Seminal Vesicles
Clinical Indications: Infertility, Hematospermia, Pain
Relevance in Male Pelvic Anatomy
Comparison with MRI and CT
2. Anatomy and Physiology 100%
Paired Glandular Structures Posterior to Bladder
Relation to Vas Deferens, Prostate, and Rectum
Contribution to Seminal Fluid
Ducts of Seminal Vesicles and Ejaculatory Duct Pathway
3. Scanning Techniques 100%
Transabdominal vs Transrectal (TRUS) Approach
High-Resolution Linear or Endocavitary Probe
Patient Prep: Full Bladder (Transabdominal) or Enema (TRUS)
Axial and Sagittal Views
Size, Symmetry, and Echotexture Assessment
4. Normal Seminal Vesicle Appearance 80%
Symmetrical, Hypoechoic, Elongated Structures
Normal Size: Length ~3 cm, Width ~1.5 cm
Anechoic Central Lumen
No Focal Mass or Wall Thickening
5. Congenital and Developmental Anomalies
1. Aplasia or Hypoplasia
Unilateral or Bilateral Absence
Associated with Vas Deferens or Renal Agenesis
2. Zinner Syndrome
Triad: Unilateral Renal Agenesis + Ipsilateral Seminal Vesicle Cyst + Ejaculatory Duct Obstruction
TRUS and MRI for Confirmation
6. Infections and Inflammation
Seminal Vesiculitis
Thickened, Enlarged Vesicle with Hyperemia
Reactive Changes in Adjacent Structures
Association with Prostatitis or Epididymitis
7. Cystic Lesions 30%
Congenital Seminal Vesicle Cysts
Acquired Retention Cysts
Simple vs Complex Appearance
Differentiation from Mullerian Duct or Ejaculatory Duct Cysts
8. Tumors and Masses 0%
Rare Primary Adenocarcinoma
Secondary Invasion from Prostate or Rectum
Solid, Heterogeneous Masses with Irregular Borders
Further Evaluation by MRI and Biopsy
9. Interventional and Post-Surgical Assessment 0%
TRUS-Guided Aspiration of Cysts
Post-Ejaculatory Duct Stenting Follow-up
Post-Vesiculectomy Changes
Evaluation After Seminal Tract Surgery
10. Case Studies and Quiz Section 0%
Unilateral Cyst Case (Zinner Syndrome)
Vesiculitis vs Cystic Mass Differentiation
Doppler Assessment Practice
Image-Based Multiple Choice Questions
Role of Ultrasound in Penile Evaluation
Indications: Erectile Dysfunction, Priapism, Trauma, Masses, Peyronie’s Disease
Benefits of Real-Time, Dynamic Vascular Imaging
Limitations Compared to MRI
2. Penile Anatomy 100%
Corpora Cavernosa and Corpus Spongiosum
Tunica Albuginea and Buck’s Fascia
Urethra and Glans Penis
Dorsal and Cavernosal Arteries
Veins and Neurovascular Bundle
3. Scanning Techniques 100%
High-Frequency Linear Probe (10–15 MHz)
Transverse and Longitudinal Views
Baseline (Flaccid) and Post-Vasoactive Injection Evaluation
Patient Preparation and Privacy Considerations
Use of Color and Spectral Doppler
4. Normal Penile Ultrasound Appearance 80%
Symmetrical Corpora Cavernosa
Homogeneous Echotexture
Visible Tunica Albuginea and Urethra
Arterial Waveform: Low Resistance in Erection Phase
PSV > 30 cm/s Considered Normal
5. Vascular Evaluation and Erectile Dysfunction
1. Arteriogenic ED
Low Peak Systolic Velocity (PSV < 25 cm/s)
Absent or Poor Rise After Injection
2. Venogenic ED
Normal or High PSV with Persistent Diastolic Flow
Lack of Adequate Rigidity
Squamous Cell Carcinoma
Subcutaneous Cysts or Lipomas
Hemangioma
Inflammatory Lesions (Abscess, Fournier’s)
MRI for Further Evaluation if Indeterminate
8. Interventional and Post-Operative Assessment 0%
Post-Injection Vascular Response Evaluation
Post-Surgical Implants (Prosthesis Integrity)
Post-Urethroplasty or Hypospadias Repair
Assessment After Trauma or Reconstructive Surgery
9. Case Studies and Quiz Section 0%
Penile Fracture Case
Doppler Flow Interpretation in ED
Mass vs Plaque Identification
Interactive Image-Based MCQs
118 Case Study Bone Flap Preservation in a Subcutaneous Abdominal Pocket Bone flap preservation in a subcutaneous abdominal pocket refers to a surgical technique used to temporarily store a removed portion of the skull (bone flap) within a subcutaneous space of the patient's abdominal wall, typically after a craniectomy.
Patient underwent decompressive craniectomy for management of elevated intracranial pressure following traumatic brain injury. The autologous bone flap was preserved in a subcutaneous abdominal pocket for delayed cranioplasty.
Findings
image
📄 Report Sample Line- >Bone flap preservation Shows hyper echogenic structure in the right anterior abdominal wall anterior to the muscles at the site of surgical scar. The patient had undergone Craniectomy bone plate in abdominal wall before 8 months ago. No evidence of surrounding fluid collection, abscess, or abnormal vascularity.
Conclusion
📋 Preserved cranial bone flap in subcutaneous abdominal pocket shows normal post-operative appearance with no evidence of complication
Recommendation:
Bone Flap Preservation in Subcutaneous Abdominal Pocket – Care and Complications
Post-operative Care
• Regular inspection of the abdominal site for signs of infection (redness, swelling, discharge)
• Maintain hygiene – keep the area clean and dry
• Avoid direct trauma or pressure to the abdominal pocket
• Follow-up imaging (ultrasound/CT) to monitor flap status
• Plan cranioplasty typically within 6–12 weeks when safe
Potential Complications
• Infection: Cellulitis or abscess formation at the pocket site
• Bone flap resorption: More common in pediatric patients
• Seroma or hematoma: Fluid accumulation around the flap
• Abdominal wall hernia or dehiscence: Due to poor healing or large bone
• Skin necrosis: Pressure-related ischemia over the flap
• Delayed reimplantation risks: May compromise flap viability
Diagnostic Strategy for Bone Flap Preservation in Subcutaneous Abdominal Pocket
Clinical Evaluation
• Assess for pain, redness, swelling, or discharge at the abdominal site
• Monitor for systemic signs of infection (fever, elevated WBC)
• Document any changes in the pocket contour or skin integrity
Ultrasound Examination
• First-line imaging modality
• Evaluate for bone flap position, contour, and echogenicity
• Identify surrounding fluid (suggestive of seroma, hematoma, or abscess)
• Use color Doppler to assess for hyperemia (suggestive of infection)
Further Imaging (If Indicated)
A-CT Abdomen Wall: Detailed evaluation if ultrasound is inconclusive or deep infection is suspected
Normal Findings
• Bony flap located within the subcutaneous fat plane of the anterior abdominal wall
• Well-corticated bone margins with preserved architecture
• No periosteal reaction or adjacent fat stranding
• No fluid collection or gas formation around the flap
Abnormal Findings
• Patchy or diffuse demineralization → suggests early bone resorption
• Bone fragmentation or cortical disruption → indicative of damage or necrosis
• Surrounding fat stranding or soft tissue swelling → may indicate inflammation or infection
• Subcutaneous fluid collection with or without gas → suggestive of seroma, hematoma, or abscess
• Flap displacement or migration from expected location
X-ray of Flap: Assess for resorption or fracture
Normal Findings
• Radiopaque bone flap visible within the subcutaneous tissues of the anterior abdominal wall
• Well-defined bony margins
• No signs of fragmentation or resorption
• Maintained contour and shape consistent with cranial origin
Abnormal Findings
• Irregular or moth-eaten appearance → suggestive of bone resorption
• Fragmentation or discontinuity → possible bone damage or necrosis
• Periosteal reaction or surrounding soft tissue opacity → possible infection
• Displacement from original location → possible herniation or poor anchoring
• Radiolucent rim around the flap → may indicate fluid collection or early seroma
Cranial CT (Pre-cranioplasty): To assess readiness and match cranial defect with preserved flap
Laboratory Investigations
• CBC for leukocytosis
• CRP/ESR to assess inflammatory activity
• Culture if fluid collection is aspirated
Decision Making
• If normal: Continue monitoring until cranioplasty
• If infection/complication: Consider flap removal, antibiotic therapy, or synthetic replacement
1. What is the primary reason for preserving a bone flap in a subcutaneous abdominal pocket? A. Cosmetic reasons
B. Infection control
C. Temporary storage for future cranioplasty
D. Reduce intracranial pressure
👉 Explanation: The bone flap is stored subcutaneously to preserve it for delayed reimplantation after brain swelling resolves.
2. Which layer is typically used for creating the subcutaneous abdominal pocket? A. Intramuscular
B. Intraperitoneal
C. Subcutaneous tissue
D. Retroperitoneal
👉 Explanation: The bone flap is stored in a subcutaneous space, usually in the lower abdomen, between the skin and abdominal wall musculature.
3. What imaging modality is most commonly used to evaluate the bone flap in the abdominal pocket? A. MRI
B. CT Brain
C. Ultrasound
D. X-ray Abdomen
👉 Explanation: Ultrasound is the first-line tool to assess the subcutaneous bone flap for positioning, integrity, and surrounding fluid.
4. Which of the following is a possible complication of bone flap preservation in the abdomen? A. Pneumothorax
B. Liver injury
C. Abdominal wall hernia
D. Intracranial hemorrhage
👉 Explanation: A rare but recognized complication is herniation or weakening of the abdominal wall at the pocket site.
5. Which of the following signs on ultrasound may indicate infection around the bone flap? A. Anechoic pocket with no vascularity
B. Echogenic bone with sharp borders
C. Fluid collection with peripheral hyperemia
D. Hyperechoic lines without shadowing
👉 Explanation: Peripheral fluid with increased vascularity suggests abscess or cellulitis around the flap.
6. What is the typical time frame for reimplanting the preserved bone flap? A. 1–2 days
B. 1–2 weeks
C. 6–12 weeks
D. 6–12 months
👉 Explanation: Cranioplasty is usually planned after 6–12 weeks, once cerebral swelling or infection has resolved.
7. What is the most common site for subcutaneous bone flap storage? A. Posterior thorax
B. Anterior chest wall
C. Anterior abdominal wall
D. Thigh muscle
👉 Explanation: The anterior abdominal wall provides a safe and accessible site for subcutaneous storage.
8. Which patient group is more prone to bone flap resorption? A. Elderly
B. Pediatric
C. Diabetic
D. Pregnant women
👉 Explanation: Children have higher rates of bone flap resorption due to ongoing bone remodeling.
9. What X-ray feature suggests bone flap resorption? A. Homogenous density
B. Sharp margins
C. Moth-eaten appearance
D. Cortical thickening
👉 Explanation: A moth-eaten or irregular appearance is characteristic of resorption or osteolysis.
10. What is the best imaging modality for evaluating both bone integrity and surrounding soft tissue changes? A. MRI
B. X-ray
C. CT
D. Ultrasound
👉 Explanation: CT offers excellent detail for bone and soft tissues, making it useful for pre-cranioplasty evaluation.
11. Which of the following is a sterile complication that may mimic infection? A. Seroma
B. Abscess
C. Cellulitis
D. Osteomyelitis
👉 Explanation: Seromas are sterile fluid collections that may resemble early infection on imaging.
12. What is the preferred method to monitor flap viability over time? A. MRI scans
B. Repeated X-rays
C. Clinical exam and serial ultrasound
D. PET scan
👉 Explanation: Physical exam and ultrasound are safe and repeatable tools for monitoring the flap.
13. Which condition would contraindicate reimplantation of the bone flap? A. Normal intracranial pressure
B. Healed scalp wound
C. Persistent intracranial infection
D. Absence of neurological deficit
👉 Explanation: Reimplanting an autologous bone flap is contraindicated if an active infection is still present.
14. Which surgical step ensures bone flap viability during subcutaneous storage? A. Irrigation with alcohol
B. Exposure to air
C. Sterile wrapping before placement
D. Drilling holes in the bone
👉 Explanation: Wrapping the flap in sterile gauze helps preserve sterility and viability.
15. What is the most appropriate follow-up period after reimplantation of the bone flap? A. 24 hours
B. 1–2 days
C. 2–4 weeks
D. Regular imaging for 3–6 months
👉 Explanation: Post-cranioplasty patients require close monitoring, typically with clinical and imaging follow-up over 3–6 months to assess for complications.
1. पेट की त्वचा के नीचे हड्डी (Bone Flap) को सुरक्षित रखने का मुख्य उद्देश्य क्या है? A. कॉस्मेटिक कारण
B. संक्रमण नियंत्रण
C. भविष्य की क्रैनियोप्लास्टी के लिए अस्थायी भंडारण
D. मस्तिष्क दाब को कम करना
👉 व्याख्या: हड्डी को भविष्य में फिर से लगाने के लिए पेट की त्वचा के नीचे सुरक्षित रखा जाता है।
2. उपचर्म जेब (subcutaneous pocket) आमतौर पर शरीर के किस भाग में बनाई जाती है? A. मांसपेशियों के बीच
B. पेरिटोनियल गुहा
C. त्वचा और मांसपेशियों के बीच
D. रेट्रोपेरिटोनियम
👉 व्याख्या: हड्डी को आमतौर पर त्वचा और पेट की मांसपेशियों के बीच की उपचर्म परत में सुरक्षित रखा जाता है।
3. उपचर्म में रखी गई बोन फ्लैप का मूल्यांकन करने के लिए कौन सी इमेजिंग सबसे उपयुक्त है? A. एमआरआई
B. सीटी स्कैन मस्तिष्क
C. अल्ट्रासाउंड
D. एक्स-रे पेट
👉 व्याख्या: अल्ट्रासाउंड एक सुरक्षित और आसान तरीका है जिससे फ्लैप की स्थिति और आसपास की स्थिति देखी जा सकती है।
4. नीचे दी गई कौन-सी जटिलता बोन फ्लैप के उपचर्म भंडारण से हो सकती है? A. न्यूमोपोथोरैक्स
B. लिवर की चोट
C. पेट की दीवार में हर्निया
D. मस्तिष्क रक्तस्राव
👉 व्याख्या: फ्लैप के कारण पेट की दीवार में कमजोरी आ सकती है, जिससे हर्निया हो सकता है।
5. अल्ट्रासाउंड में कौन-सा लक्षण संक्रमण की ओर इशारा करता है? A. सादा तरल बिना रक्त संचार
B. स्पष्ट हड्डी की आकृति
C. द्रव के चारों ओर रक्त संचार बढ़ना
D. तीव्र इको
👉 व्याख्या: फ्लैप के आसपास रक्त प्रवाह और तरल संक्रमण की ओर संकेत करता है।
6. बोन फ्लैप को पुनः लगाने का सामान्य समय क्या होता है? A. 1–2 दिन
B. 1–2 सप्ताह
C. 6–12 सप्ताह
D. 6–12 महीने
👉 व्याख्या: आमतौर पर 6 से 12 सप्ताह बाद जब सूजन कम हो जाती है तब पुनः लगाया जाता है।
7. बोन फ्लैप सुरक्षित करने की सबसे आम जगह क्या है? A. पीठ
B. सीना
C. पेट की आगे की दीवार
D. जांघ
👉 व्याख्या: पेट की आगे की दीवार आसानी से सुलभ होती है और फ्लैप के लिए उपयुक्त जगह होती है।
8. बोन फ्लैप के अपघटन (resorption) की संभावना किन मरीजों में अधिक होती है? A. बुज़ुर्ग
B. बच्चों में
C. डायबिटिक
D. गर्भवती महिलाएं
👉 व्याख्या: बच्चों में बोन रिमॉडलिंग अधिक होती है जिससे बोन फ्लैप घुलने की संभावना बढ़ जाती है।
9. एक्स-रे में बोन फ्लैप के घुलने का संकेत क्या है? A. एकसमान घनत्व
B. स्पष्ट किनारे
C. छिद्रों जैसा "मॉथ ईटन" रूप
D. हड्डी मोटी होना
👉 व्याख्या: घुलती हुई हड्डी असमान और छिद्रदार दिखती है।
10. हड्डी और आसपास के ऊतकों का मूल्यांकन करने के लिए सबसे उपयुक्त इमेजिंग क्या है? A. एमआरआई
B. एक्स-रे
C. सीटी स्कैन
D. अल्ट्रासाउंड
👉 व्याख्या: सीटी स्कैन हड्डी और आसपास के ऊतक दोनों को अच्छे से दिखा सकता है।
11. कौन-सी जटिलता संक्रमण जैसी दिख सकती है परंतु स्टेराइल होती है? A. सीरोमा
B. एब्सेस
C. सेल्युलाइटिस
D. ऑस्टियोमाइलाइटिस
👉 व्याख्या: सीरोमा एक तरल संचय है जो बिना संक्रमण के भी हो सकता है।
12. फ्लैप की स्थिति की नियमित निगरानी के लिए सबसे अच्छा तरीका क्या है? A. एमआरआई
B. एक्स-रे
C. क्लिनिकल जांच और अल्ट्रासाउंड
D. पीईटी स्कैन
👉 व्याख्या: नियमित शारीरिक जांच और अल्ट्रासाउंड सुरक्षित और व्यावहारिक तरीका है।
13. किस स्थिति में फ्लैप को दोबारा नहीं लगाया जाना चाहिए? A. सामान्य आईसीपी
B. ठीक हुआ स्कैल्प
C. सक्रिय मस्तिष्क संक्रमण
D. न्यूरोलॉजिकल लक्षण न होना
👉 व्याख्या: यदि मस्तिष्क में संक्रमण हो तो फ्लैप को पुनः नहीं लगाया जाना चाहिए।
14. ऑपरेशन के दौरान फ्लैप को सुरक्षित रखने के लिए कौन-सी प्रक्रिया की जाती है? A. अल्कोहल से धोना
B. हवा में खुला छोड़ना
C. स्टेराइल गौज में लपेटना
D. हड्डी में छेद करना
👉 व्याख्या: स्टेराइल गौज में लपेटने से हड्डी को संक्रमण से बचाया जाता है।
15. फ्लैप को दोबारा लगाने के बाद उचित फॉलो-अप अवधि क्या है? A. 24 घंटे
B. 1–2 दिन
C. 2–4 सप्ताह
D. 3–6 महीने तक निगरानी
👉 व्याख्या: क्रैनियोप्लास्टी के बाद 3 से 6 महीने तक नियमित फॉलो-अप किया जाना चाहिए।
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Role of Scrotal Ultrasound
Clinical Indications: Pain, Swelling, Trauma, Infertility
Advantages of High-Frequency Ultrasound
Use in Emergency and Outpatient Settings
2. Anatomy of the Scrotum and Testes 90%
Testis: Tunica Albuginea and Seminiferous Tubules
Epididymis: Head, Body, Tail
Spermatic Cord Components
Tunica Vaginalis and Hydrocele Space
Blood Supply and Venous Drainage
3. Scanning Technique 100%
Patient Positioning and Privacy
Use of High-Frequency Linear Transducer
Longitudinal and Transverse Views of Both Testes
Side-to-Side Comparison
Color and Spectral Doppler Assessment
4. Normal Appearance 80%
Homogeneous Testicular Echotexture
Symmetric Size and Vascularity
Epididymis: Isoechoic to Slightly Hypoechoic
Minimal Physiological Fluid in Tunica Vaginalis
Principles of Contrast-Enhanced Ultrasound
Microbubble Contrast Agents (e.g., SonoVue, Definity)
Advantages Over CT/MRI in Liver Imaging
Safety Profile and Contraindications
2. CEUS Phases and Timing
Arterial Phase (10–35 sec)
Portal Venous Phase (30–120 sec)
Late Phase (>2 min)
Wash-in and Wash-out Patterns
3. CEUS in Benign Liver Lesions
Hemangioma: Peripheral Nodular Enhancement
Focal Nodular Hyperplasia (FNH): Central Arterial Fill-in
Hepatic Adenoma: Homogeneous Hyperenhancement
Cyst: No Enhancement
4. CEUS in Malignant Liver Lesions
Hepatocellular Carcinoma (HCC): Arterial Hyperenhancement with Late Washout
Cholangiocarcinoma: Rim Enhancement, Delayed Washout
Liver Metastases: Rapid Washout in Portal Phase
Angiosarcoma: Early Hyperenhancement + Irregular Washout
5. Comparison with Other Modalities
CEUS vs CT for HCC Diagnosis
CEUS in Indeterminate Lesions (LR-3, LR-4 in LI-RADS)
Role in Guiding Biopsies or Ablations
6. Limitations and Pitfalls
Isoenhancing Lesions
Deep or Subdiaphragmatic Lesions
Artifacts: Blooming, Motion
Learning Curve for Interpretation
7. Case Examples and Interpretation
CEUS Pattern Recognition (Benign vs Malignant)
CEUS for Follow-up Post-Treatment (RFA, TACE)
Multiple Case Snapshots with Key Features
8. Quiz and Self-Assessment
Phase Identification Challenge
Spot the Pattern: HCC vs Metastasis
CEUS Diagnosis-Based MCQs
Role of Ultrasound in Prostate Evaluation
Clinical Indications (PSA Elevation, Urinary Symptoms, Cancer Screening)
Comparison with MRI and DRE
Contraindications and Patient Counseling
2. Anatomy of the Prostate 80%
Prostate Zones: Peripheral, Central, Transitional, Anterior Fibromuscular Stroma
Seminal Vesicles and Ejaculatory Ducts
Capsule and Neurovascular Bundles
Relationship to Bladder, Rectum, Urethra
3. Scanning Techniques 100%
Transrectal vs Transabdominal Ultrasound
Patient Preparation and Positioning
Probe Types and Frequencies
Volume Calculation and Prostate Measurements
Use of Color Doppler
4. Normal Prostate Ultrasound Appearance 50%
Echotexture and Size in Different Age Groups
Symmetry and Capsule Definition
Normal Seminal Vesicle Appearance
TRUS Volume Formula: L × W × H × 0.52
5. Prostate Pathologies
1. Benign Conditions
Benign Prostatic Hyperplasia (BPH)
Prostatitis (Acute and Chronic)
Prostatic Calcifications
Prostatic Cysts and Abscesses
2. Malignant Lesions
Suspicious Hypoechoic Lesions in Peripheral Zone
Extracapsular Extension
Seminal Vesicle Invasion
TRUS-Guided Biopsy Indications
3. Post-Procedural Imaging
Post-Biopsy Changes
Follow-up of Ablation or Radiotherapy
Prostatectomy Bed Evaluation (if indicated)
6. Advanced Techniques 0%
Contrast-Enhanced Ultrasound (CEUS) for Cancer Detection
Elastography: Strain and Shear Wave Techniques
TRUS-MRI Fusion for Targeted Biopsy
PI-RADS Overview (MRI Reference and Correlation)
7. Interventional Applications 0%
TRUS-Guided Biopsy Techniques (Systematic & Targeted)
TRUS-Guided Prostatic Abscess Drainage
Fusion Biopsy Planning
Role in Brachytherapy and Focal Therapies
8. Case-Based Learning and Quiz Section 0%
Benign vs Malignant Lesion Examples
Real-World Imaging Challenges
Volume Interpretation Practice
Interactive Image-Based MCQs
Role of Ultrasound in Gynecology
Common Indications: AUB, Pain, Infertility, Mass Evaluation
Transabdominal vs Transvaginal Approaches
Advantages and Limitations
2. Uterine Anatomy 100%
Fundus, Body, Isthmus, and Cervix
Endometrial Cavity, Myometrium, Serosa
Junctional Zone (Adenomyosis Marker)
Uterine Arteries and Vascular Supply
Position (Anteverted, Retroverted, Axial)
3. Scanning Techniques 100%
Transvaginal (TVS): High-Resolution, Empty Bladder
Transabdominal (TAS): Full Bladder for Overview
Sagittal and Transverse Planes
Use of Doppler and 3D Ultrasound
Measuring Uterus and Endometrial Thickness
