This paper presents a real-time capable graphics processing unit (GPU)-based ultrasound simulator suitable for medical education. The main focus of the simulator is to synthesize realistic looking ultrasound images in real-time including artifacts, which are essential for the interpretation of this data. The simulation is based on a convolution-enhanced ray-tracing approach and uses a deformable mesh model. Deformations of the mesh model are calculated using the PhysX engine. Our method advances the state of the art for real-time capable ultrasound simulators by following the path of the ultrasound pulse, which enables better simulation of ultrasound-specific artifacts. An evaluation of our proposed method in comparison with recent generative slicing-based strategies as well as real ultrasound images is performed. Hereby, a gelatin ultrasound phantom containing syringes filled with different media is scanned with a real transducer. The obtained images are then compared to images which are simulated using a slicing-based technique and our proposed method. The particular benefit of our method is the accurate simulation of ultrasound-specific artifacts, like range distortion, refraction and acoustic shadowing. Several test scenarios are evaluated regarding simulation time, to show the performance and the bottleneck of our method. While being computationally more intensive than slicing techniques, our simulator is able to produce high-quality images in real-time, tracing over 5000 rays through mesh models with more than 2 000 000 triangles of which up to 200 000 may be deformed each frame.