Q1: Which of the following statements is/are correct (more than one answer is possible)
a) GIRADS classifies adnexal masses into 5 risk groups of malignancy
b) GIRADS uses pattern recognition and 7 ultrasound features of malignancy to estimate malignancy risk
c) GIRADS has been prospectively validated
d) O-RADS classifies adnexal masses into 6 groups
e) O-RADS uses pattern recognition and combinations of ultrasound features of to assign a malignancy risk to adnexal masses
f) O-RADS has been prospectively validated

Q2: Which of the following statements is/are correct (more than one answer is possible)
a) ADNEX calculates the risk of malignancy in adnexal masses using 3 clinical and 6 ultrasound variables
b) ADNEX calculates the likelihood of a benign tumor and that of four malignant subtypes of tumor
c) ADNEX has not been prospectively validated
d) The risk of malignancy calculated by ADNEX agrees well with the true observed malignancy rate

Q3: Which of the following statements is/are correct (more than one answer is possible)
a) To use the ADNEX model the serum level of CA125 must me known
b) ADNEX includes one color Doppler variable, i.e) the color content of the tumor scan (color score)
c) To use ADNEX one must use the IOTA definitions of the ultrasound variables
d) An ADNEX calculator is available for free

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Q1: Which of the following findings was not found to be helpful in the diagnosis of retained products of conception?
a) echogenic mass
b) positive color doppler flow
c) endometrial fluid
d) vaginal bleeding

Q2: Enhanced myometrial vascularity is diagnosed if doppler peak systolic velocity is which of the following?
a) ≥20 cm/s
b) ≥40 cm/s
c) ≥60 cm/s
d) no established minimum peak systolic velocity

Q3: Enhanced myometrial vascularity is associated with which of the folllowing?
a) retained products of conception
b) an increased risk of complications
c) endometrial synechia

Q1: Which of the following pathologies is most likely explain the scan findings
a) Pelvic Abscess
b) Ovarian Fibroma
c) Pedunculated Fibroid
d) Ovarian Dermoid
e) Sex cord Stromal or Germ Cell Tumour
f) Gastrointestinal Stromal Tumour
g) Torsion

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Q2: Which of the following pathologies most likely explain the scan findings
a) Left pelvic side wall abscess
b) Left tubo-ovarian endometriotic Collection
c) Sex Cord Stromal or Germ Cell tumour
d) Left lateral Pedunculated Fibroid
e) Primary Ovarian Carcinoma
f) Retroperitoneal Mass
g) Pre Sacral Neuroma
h) Metastatic Ovarian lesion
i) Left lateral Pedunculated Fibroid

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Q1: How many diagnostic signs need to be present to diagnose adenomyosis?
a) At least two diagnostic signs need to be present.
b) If only indirect signs are seen, at least three signs need to be present.
c) If direct signs are present, one sign is always enough.
d) There is no defined number

Q2: Which of the following statements are true?
     1. MRI can help secure the diagnosis of adenomyosis as it has a higher diagnostic accuracy than ultrasound.
     2. Doppler evaluation can help to discriminate myometrial cysts from vessels.
     3. Doppler evaluation can help to discriminate adenomyoma from fibroids.
     4. The junctional zone can only be evaluated with 3D ultrasound.
a) Only 1 and 2 are true.
b) Only 2 and 3 are true.
c) Only 1 and 3 are true.
d) Only 2, 3 and 4 are true.

Q3: Which statement regarding diagnostic signs of adenomyosis is wrong?
a) Direct signs always need to be present to secure the diagnosis.
b) Myometrial cysts can be small or large.
c) Indirect signs are caused by muscular hypertrophy.
d) Uterine contractions can mimic a thickened, asymmetric wall.

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Q1: Select one of the following statements which is false or incorrect:
a) Small polyps in asymptomatic pre-menopusal patients may be managed conservatively in the knowledge that with observation up to 29% resolve spontaneously
b) Risk factors for malignant change within endometrial polyps include: Size . Patients age ,vaginal bleeding and polycystic ovarian syndrome.
c) The majority of polyps will be composed of the endometrium that differs from the surrounding endometrium and does not respond to cyclic hormonal changes
d) Both Hormone replacement therapy and Tamoxifen Therapy are associated with the formation of endometrial polyps. In the case of tamoxifen approximately 20-30% taking this form of therapy develop polyps .
e) The location of the polyp, number, and diameter correlates with patients presenting symptoms ( most often bleeding)
f) Medical management with hormonal therapy has limited support in the literature and cannot be recommended.

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Q2: Which of the following pathologies most likely explain the scan findings
a) Enhanced Myometrial Vascularity
b) Retained Products of conception
c) Arterio –Venous Malformation
d) Cystic Fibroid
e) Uterine Sarcom

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Q1: What is the most common site of deep endometriosis?
a) Bowel
b) Rectovaginal septum
c) Uterosacral ligaments
d) Bladder
e) Posterior vaginal fornix

Q2: Ultrasound can negate the need for a diagnostic laparoscopy.
a) True
b) False

Q3: Ultrasound can be used in which of the following endometriosis staging systems?
a) Ultrasound-based endometriosis staging system (UBESS)
b) American Society of Reproductive Medicine (ASRM) classification of endometriosis
c) Enzian classification
d) Endometriosis Fertility Index
e) All of the above

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Q1: In the triage of women with a PUL, which statement would be correct?
a) 30-80% of cases will have a final pregnancy outcome of an intrauterine pregnancy or failed PUL
b) 60-90% of cases will have a final pregnancy outcome of an intrauterine pregnancy or failed PUL
c) 30-80% of cases will have a final pregnancy outcome of an intrauterine pregnancy or persistent PUL
d) 60-90% of cases will have a final pregnancy outcome of an ectopic pregnancy or failed PUL

Q2: The M6 model is based on the following variables:
a) Initial serum hCG and 48 hour serum hCG levels
b) Initial serum hCG, 48 hour serum hCG levels and pain score
c) Initial serum progesterone, initial serum hCG and 48 hour serum hCG levels
d) Initial serum progesterone, initial serum hCG and 48 hour serum progesterone levels

Q3: When using the two-step protocol incorporating the M6 model, which statement would be correct?
a) In step 1, if the patients’ serum progesterone level is 10 nmol/l, they should be discharged and advised to perform a urine pregnancy test in two weeks
b) In step 1, if the patients’ serum progesterone level is 2 nmol/l, the protocol recommends a follow up scan in one week
c) In step 2, if the patient is felt to ‘high risk’, the protocol recommends a follow up scan in one week
d) In step 2, if the patient is felt to ‘low risk, likely failed PUL’, the protocol recommends a urine pregnancy test in two weeks

Q1: In what planes should a niche be evaluated?
a) Sagittal plane
b) Transversal plane
c) Coronal plane
d) Sagittal and Transversal plane

Q2: A CSP that is embedded for < 50% in the myometrium is classified as a
a) Type 1 CSP
b) Type 2a CSP
c) Type 2b CSP
d) None of the above answers

Q3: If I want to evaluate a niche in the non pregnant women:
a) Sonohysterography is preferred over normal US in all women with a niche
b) Sonohysterography is preferred over normal US only if the uterine cavity is not filled with fluid
c) Sonohystergraphy is not needed
d) 3D US is preferred

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Q1: Placenta Accreta Spectrum is the only frequently used nomenclature which encompasses abnormally adherent and invasive placenta.
a) True
b) False

Q2: Retained tissue on ultrasound scan in a woman with a risk factor for PAS is sufficient to make the diagnosis of accreta.
a) True
b) False

Q3: Different grades of PAS can co-exist in the same placenta leading to discrepancies between the clinical and histopathological findings
a) True
b) False

Q1: What treatment option would you consider most appropriate in this situation:
a) Expectant Management
b) Ultrasound guided Injection of Methotrexate
c) Systemic Methotrexate
d) Surgical Removal
e) Vascular embolization

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Q2: Which of the following most likely explain the scan findings
a) Fallopian Tube Cancer
b) Peritoneal malignant deposits with Ascites
c) Ruptured Appendix
d) Mucocele of the appendix
e) Normal Fallopian Tube
f) Appendices Epiploicae

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Q1: Clinical indications for pelvic floor ultrasound include:
a) Anterior vaginal prolapse
b) Vaginal masses and cysts
c) Anal incontinence
d) All of the above

Q2: The basic structures relevant to pelvic floor ultrasound all except:
a) The urethra
b) The ovaries
c) The bladder
d) The uterus

Q3: Which of the following is false:
a) A 2D PFUS examination can be performed with a simple B mode transducer
b) A 3D/4D capable system is capable of examining the anal sphincter complex
c) A sagittal view is required to visualize the levator ani muscles
d) An endoanal ultrasound is the only method or imaging the anal sphincter complex

Q1: Which ovarian feature has the highest predictive power for PCOS and is therefore, the preferred metric for defining polycystic ovaries?
a) Ovarian Volume
b) Follicle Number Per Ovary
c) Stromal Area
d) Peripheral Follicle Distribution Pattern

Q2: In adolescents, what is the threshold to define polycystic ovarian morphology on ultrasonography?
a) Follicle Number Per Ovary (FNPO) ≥ 20
b) Ovarian Volume ≥ 12 mL
c) Follicle Number Per Single Cross-Section (FNPS) ≥ 9
d) There are no criteria to define polycystic ovaries in adolescents

Q3: Which of the following contributes to controversy in defining diagnostic thresholds for polycystic ovaries?
a) Few data are available on ovarian morphology in unbiased populations
b) It is difficult harmonize data on sonographic endpoints across existing studies.
c) Thresholds based on diagnostic test studies are not consistent with methods that define the other cardinal features of PCOS.
d) All of the above

Q1: Normal fallopian tubes are always invisible on transvaginal sonography.
a) True
b) False

Q2: On static images, which are the best positive discriminators of hydrosalpinx from other cystic adnexal masses?
a) Tubular structure, waist sign and cogwheel (small rounded) projections
b) Acute angles, thin septations, adjacency to ovary
c) Tubular structure, peristalsis
d) Smooth walls, low level homogeneous echoes

Q3: Small tubal ectopic pregnancies typical present as:
a) Hypoechoic intraovarian complex cysts with peripheral blood flow
b) Echogenic rounded intraovarian nodules
c) Echogenic rounded or bagel-shaped extraovarian masses
d) Echogenic enlargement of the symptomatic ovary

Q1: In a study on the quality of ultrasound for fibroid evaluation in Canada, what proportion of scans met quality criteria?
a) <25%
b) 25-50%
c) 50-75%
d) >75%

Q2: At present, which gynecologic pathology is the most underappreciated using ultrasound before a gynecologist performs surgery, resulting in intraoperative surprises?
a) Fibroids
b) Endometriosis
c) Ovarian cancer
d) Ectopic pregnancy
e) Endometrial cancer

Q3: How can we improve the overall standard of quality for gynecologic in North America?
a) Build awareness
b) Education programs
c) Clinical practice guidelines
d) Research
e) All of the above

Q1: Which of the following most likely explain the scan findings
a) Intrauterine Pseudo Sac with Ruptured Fallopian tube
b) Multiple peritoneal Inclusion Cysts
c) Large unilateral hydrosalpinx
d) Ovarian Carcinoma with pelvic ascites
e) Bilateral Hydrosalpinges
f) Haematosalpinx

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Q2: Which of the following most likely explain the scan findings
a) A peritoneal inclusion Cyst
b) An Ovarian Dermoid cyst
c) A Fimbrial Cyst
d) Stage I Ovarian cancer
e) Ovarian Cystadenofibroma
f) Ovarian Fibroma

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