IJCAHPO CDOS Certified Diagnostic Ophthalmic Sonographer

What is the typical operating frequency of a B-scan ophthalmic ultrasound probe?

• A2 MHz
• B5 MHz
• C10 MHz
• D50 MHz

What does the probe marker indicate on the B-scan display?

• AThe 6 o'clock position on the display
• BThe 12 o'clock position on the display
• CThe center of the globe
• DThe optic nerve location

Which scan orientation passes through the visual axis with the probe marker at the 12 o'clock meridian?

• ATransverse scan
• BLongitudinal scan
• CAxial scan
• DTopographic scan

In a longitudinal scan, where is the probe marker oriented?

• AToward the limbus
• BToward the nose
• CToward the brow
• DPerpendicular to the limbus

What does a transverse B-scan evaluate?

• AA single clock-hour meridian
• BThe visual axis only
• CEquatorial structures across multiple clock hours
• DOnly the optic nerve sheath

Which of the following best describes a kinetic B-scan examination?

• AA still image series for documentation
• BReal-time scanning while asking the patient to move the eye to assess membrane mobility
• CAn A-scan combined with a B-scan in tandem
• DA high-frequency ultrasound biomicroscopy of the angle

Why is coupling gel used during a B-scan ophthalmic examination?

• ATo anesthetize the eyelid
• BTo provide acoustic coupling between the probe and the skin or cornea
• CTo sterilize the probe
• DTo improve image color

What is the most common method of probe placement during routine B-scan ophthalmic ultrasound?

• ADirect corneal contact without anesthesia
• BThrough the closed eyelid using coupling gel
• CThrough a water bath only
• DVia transcutaneous orbital approach posteriorly

When direct corneal contact B-scan is performed, what additional preparation is required?

• APupil dilation
• BInstillation of topical anesthetic drops
• CInsertion of a scleral lens
• DSystemic sedation

Which structure forms the outer fibrous coat of the globe?

• AChoroid
• BSclera
• CRetina
• DVitreous

How does normal vitreous appear on a B-scan at moderate gain settings?

• ABright and highly echogenic
• BAnechoic (echo-free, black)
• CFilled with mobile bright echoes
• DCalcified with shadowing

On B-scan, where does a complete (total) retinal detachment characteristically attach?

• AIt attaches to and crosses the optic nerve
• BIt attaches to the optic nerve head but does not cross it
• CIt attaches only to the ora serrata
• DIt floats freely with no attachment

Which feature on B-scan best differentiates a posterior vitreous detachment (PVD) from a retinal detachment (RD)?

• APVD attaches to the optic nerve; RD does not
• BPVD is highly mobile and does not insert into the optic disc; RD is taut and inserts into…
• CPVD shows acoustic shadowing; RD never shadows
• DPVD always contains calcifications

A choroidal melanoma on B-scan classically demonstrates which internal reflectivity pattern?

• AHigh internal reflectivity
• BMedium-to-low internal reflectivity
• CNo reflectivity at all
• DVariable reflectivity that depends only on gain

The classic 'collar-button' or 'mushroom' shape of a choroidal melanoma on B-scan is caused by what?

• ACalcification at the apex
• BTumor breakthrough of Bruch's membrane
• CSubretinal fluid
• DVitreous traction

Which intraocular tumor in children is characterized on B-scan by highly reflective calcifications with acoustic shadowing?

• AChoroidal melanoma
• BChoroidal hemangioma
• CRetinoblastoma
• DChoroidal metastasis

Which gain setting is most appropriate for detecting subtle vitreous hemorrhage?

• AVery low gain (~30 dB)
• BLow gain (50-70 dB)
• CHigh gain (90-100 dB)
• DGain has no effect on detecting subtle echoes

When evaluating a solid intraocular tumor's true reflectivity, which gain range is most appropriate?

• A30-40 dB
• B50-70 dB (low gain)
• C90-100 dB (high gain)
• DAlways use the maximum gain

What is the most important pre-scan consideration if a patient may have an open globe injury?

• AUse maximum probe pressure to obtain a clear image
• BAvoid direct probe pressure; use a sterile cover and the lightest possible touch, or defe…
• CAlways perform corneal contact scanning
• DApply additional firm pressure to stop any bleeding

The optic nerve appears on a B-scan as which feature in the orbit?

• AA bright echogenic round mass
• BA hypoechoic (dark) tubular structure extending posteriorly from the globe
• CA calcified ring
• DA pulsating arterial structure

Widening of the optic nerve sheath beyond approximately 3 mm on B-scan typically suggests what?

• ANormal variation
• BIncreased intracranial pressure (ICP)
• CPhthisis bulbi
• DPosterior staphyloma

Asteroid hyalosis on B-scan is characterized by which feature?

• ABright mobile echoes throughout the vitreous that do not contact the retina
• BA taut funnel-shaped membrane attached to the optic nerve
• CA dome-shaped subretinal mass with shadowing
• DComplete absence of vitreous echoes

A choroidal hemangioma typically demonstrates what internal reflectivity pattern compared to a choroidal melanoma?

• ALower reflectivity than melanoma
• BHigher reflectivity than melanoma
• CIdentical reflectivity to melanoma
• DNo internal echoes at all

Choroidal detachment classically appears on B-scan as what configuration?

• AA taut funnel attached to the optic nerve
• BSmooth dome-shaped elevations that do not extend to the optic nerve
• CA mushroom-shaped mass
• DA calcified ring around the lens

What is the typical sonographic appearance of vitreous hemorrhage?

• AAnechoic black vitreous
• BPunctate or cloud-like mobile echoes throughout the vitreous, intensity varying with seve…
• CA solid dome-shaped mass
• DA calcified plaque

Which two measurements are commonly recorded for an intraocular tumor (e.g., choroidal melanoma) on B-scan?

• AColor and texture
• BBasal diameter and height (apical thickness)
• CPatient age and tumor temperature
• DRefractive index and density

Which structure is the innermost neurosensory layer of the eye?

• ASclera
• BChoroid
• CRetina
• DLens capsule

The choroid lies between which two structures of the globe?

• ACornea and lens
• BSclera and retina
• CVitreous and aqueous
• DOptic nerve and dura

What is the Weiss ring associated with on B-scan?

• AChoroidal melanoma
• BPosterior vitreous detachment
• CPhthisis bulbi
• DEndophthalmitis

An intraocular metallic foreign body characteristically shows what B-scan feature?

• AAnechoic interior
• BHighly reflective echo with reverberation artifact
• CFunnel attachment to optic nerve
• DSmooth dome with no shadowing

Which of the following is a key role of the B-scan sonographer when communicating findings?

• AProvide a definitive medical diagnosis to the patient
• BDescribe sonographic findings accurately and forward images to the ordering physician for…
• CPrescribe treatment based on the scan
• DWithhold images from the physician until all measurements are double-checked offline

Which infection-control practice is most important between B-scan patients?

• AReplace the probe cable
• BDisinfect the probe head per manufacturer instructions and clean the patient's lid area
• CRecalibrate the ultrasound machine
• DChange the gel brand each patient

On a labeled B-scan image, the standard label for an axial scan placed centrally with marker at 12 is:

• AT6
• BAx
• CL9
• DP3

Endophthalmitis on B-scan typically demonstrates which finding?

• AAnechoic vitreous
• BDiffuse low-to-medium reflective vitreous opacities, often with posterior hyaloid thicken…
• CA taut funnel inserting at the optic nerve
• DSingle mushroom-shaped solid mass

A small, disorganized, calcified globe on B-scan is most consistent with which condition?

• APhthisis bulbi
• BPosterior staphyloma
• CAcute retinal detachment
• DPosterior vitreous detachment

Posterior staphyloma is most often associated with which clinical condition?

• AHypermetropia
• BAphakia
• CHigh axial myopia
• DCataract

Optic nerve head drusen on B-scan typically demonstrate which feature?

• AHypoechoic optic nerve head with no shadowing
• BHighly reflective deposits at the optic nerve head with acoustic shadowing, persisting at…
• CA mushroom-shaped mass at the macula
• DA taut funnel-shaped membrane

What is the primary purpose of the freeze frame function on a B-scan unit?

• ATo increase ultrasound output power
• BTo capture and hold a single image for measurement, annotation, and printing
• CTo sterilize the probe
• DTo shift the probe frequency

What does dynamic range refer to on a B-scan ultrasound system?

• AThe number of probe frequencies available
• BThe range of echo amplitudes displayed in shades of gray on the image
• CThe number of patients scanned per hour
• DThe patient's eye motion during scanning

When scanning over a closed eyelid, which patient instruction supports a comfortable, high-quality image?

• AHold breath for the entire exam
• BLook in the direction opposite the area of interest with the eye gently closed
• CSquint as tightly as possible
• DKeep eyes wide open under the eyelid

Which finding is most suggestive of an old, organized vitreous hemorrhage rather than a fresh one?

• AAnechoic vitreous
• BDense membranous echoes with reduced mobility and possible traction
• CSmooth dome-shaped subretinal mass
• DCalcification at the optic nerve

Which lesion most commonly demonstrates 'choroidal excavation' on B-scan?

• AChoroidal hemangioma
• BChoroidal melanoma
• CAsteroid hyalosis
• DVitreous hemorrhage

Acoustic shadowing posterior to a melanoma occurs because:

• AThe tumor reflects sound forward
• BThe tumor absorbs/attenuates sound, creating a hypoechoic region behind it
• CCalcium deposits within all melanomas reflect sound
• DThe vitreous is thicker behind a tumor

Which patient history element is most important to verify before any ophthalmic B-scan exam?

• ARecent meals
• BPossibility of open globe injury
• CFamily history of diabetes
• DCurrent eyeglasses prescription

What sonographic feature helps distinguish a choroidal detachment from a serous retinal detachment?

• AChoroidal detachment extends to the optic nerve
• BChoroidal detachment forms smooth thick domes that stop short of the optic nerve
• CSerous RD shows a calcified surface
• DBoth look identical on B-scan

Which is a critical element of a complete B-scan report?

• APatient's home address
• BIdentification of right vs left eye, scan orientation/position, gain settings, and findin…
• CList of patient's current medications only
• DThe price of the procedure

On B-scan, the lens normally appears as:

• AA bright echogenic curved structure with anechoic interior in clear lens
• BA diffuse cloud of echoes
• CA funnel-shaped membrane
• DA calcified ring near the optic nerve