Abdomen ARDMS mock exam Flashcards
Which of the following is not a factor when choosing a high level disinfectant?
a. exposure to sunlight
b. temperature
c. disinfection time
d. ventilation requirements
A
The factors to consider when choosing a high level disinfectant are: transducer compatibility, ventilation requirements, disinfection time, rinsing requirements, temperature, re-use period, cycle cost, neutralization requirements.
Which type of kidney infection is considered a critical finding?
a. acute pyelonephritis
b. glomerulonephritis
c. emphysematous pyelonephritis
d. chronic pyelonephritis
C
Emphysematous Pyelonephritis is considered a critical finding on a renal US. If not treated early, it may lead to fulminant sepsis and carries a high mortality.
All of the following are techniques that can be used to assist an Alzheimer’s patient during an US exam, except:
a. allow a family member to accompany them during their exam.
b. keep the exam room door open and the lights on during the exam in case you need to get help quickly.
c. have the patient’s nurse alert you to helpful techniques used with this patient.
d. bring something that is usually familiar to the patient into the exam room.
B
There is no need to compromise patient privacy and exam performance due to patient condition. Always consult the patient’s nurse or family member for any special considerations needed while performing the exam.
Put the following in order in decreasing echogenicity:
a. pancreas, spleen, liver, renal sinus, renal parenchyma
b. renal parenchyma, spleen, liver, pancreas, renal sinus
c. renal sinus, pancreas, liver, spleen, renal parenchyma
d. renal sinus, renal parenchyma, liver, spleen, pancreas
C
The order of echogenicities in the abdomen from most echogenic to least; A P L S P = renal sinus > pancreas > liver > or = spleen > renal parenchyma.
Which of the following is a contraindication for a renal biopsy?
a. current Warfarin use
b. current antibiotic treatment
c. AIDS
d. Polycystic kidney disease
A
Patients who are currently taking a blood thinner’s cannot have a biopsy unless they can stop the meds for several days.
All of the following are usually part of the normal paracentesis procedure, except?
a. post-procedure chest x-ray
b. puncture usually made lateral to the mammary line
c. only a small amount of fluid is removed for a diagnostic procedure
d. removal of up to 6 liters of fluid in one day
A
A pre- and post-procedure x-ray are normally performed for a Thoracentesis.
Which blood vessel is located lateral to the left lobe of the thyroid and demonstrates an anechoic ovoid shape in a transverse view of the mid thyroid?
a. left external carotid artery
b. left internal jugular vein
c. left CCA
d. superior vena cava
B
The internal jugular vein is located lateral to the left lobe of the thyroid and demonstrates an anechoic ovoid shape in a transverse view of the mid thyroid. The carotid artery is also lateral to the thyroid but it should be a circular structure.
Which of the following is the least likely sonographic characteristic of the papillary carcinoma of the thyroid?
a. hypervascularity
b. multiple cystic areas within the mass
c. cervical lymphadenopathy
d. microcalcifications
B
Sonographic characteristics of Papillary Cancer of the thyroid include heterogeneous, hypo echoic solid mass with microcalcifications. The mass is hypervascular in most cases. It is commonly associated with enlarged cervical lymph nodes due to metastasis. Cystic degeneration of the mass is very rare.
Which of the following vessels can be identified as a circular structure immediately posterior to the neck of the pancreas?
a. splenic vein
b. celiac axis
c. SMA
d. IVC
C
The splenic vein would be identified as a tubular structure that courses posterior to the neck of the pancreas. The IVC is posterior to the head. The celiac axis is superior to the head of the pancreas.
Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma?
a. cirrhosis
b. acute hepatitis
c. chronic hepatitis
d. hydatid disease
B
Acute hepatitis demonstrated the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parechyma (starry night).
You are evaluating an obese patient with a known AAA. While using color doppler to assess flow within the aneurysm, minimal flow is detected in the anechoic lumen. You decrease the color scale and increase the color gain but there is no improvement. Which of the following adjustments will most improve the color display on this exam?
a. switch from a 4MHz curved array to a 4MHz linear array
b. increase color sample size
c. decrease the color threshold
d. increase the color threshold
D Color threshold (AKA priority) determines the limit of when color will be displayed over the gray scale image. Decreasing the threshold would reduce the amount of color displayed in slow flowing vessels. Increasing the color threshold will increase the amount of color displayed. Smaller sample sizes produce a better color display.
Which of the following is correct referring to cleaning a transducer as part of a high level disinfection procedure?
a. dampen soft cloth to cleanse probe with mild liquid soap
b. use just running water to remove any debris or gel
c. rinse probe with alcohol
d. dry probe with toilet paper
A or B? needs research
You need to remove probe cover and use running water to remove any debris or gel. Dry probe with a soft cloth or paper towel.
Which of the following is a correct statement describing the guidelines for wearing a mask?
a. remove gloves, wash hands and then remove mask
b. it is okay to touch the parts of the mask that will touch your face
c. tie upper strings across the top of your head and the lower stings around your neck
d. when finished, remove the gloves first, and then untie the bottom strings, followed by the top strings.
D
When finished, remove gloves first, and then untie the bottom strings, followed by the top strings. Do not touch the part of the mask that will touch your face. Tie the upper strings over the ears and towards the back of your head. Discard the mask properly and wash your hands.
Which portions of the GB and/or biliary tree are involved in the formation of a Phrygian cap?
a. cystic duct and CBD
b. neck and body
c. neck and cystic duct
d. body and fundus
D
A Phrygian cap is when the fundus of the GB folds over the body of the GB.
A pregnant woman presents with lateral LUQ pain and a bruit in the same area. What will be the most likely finding?
a. splenic aneurysm
b. splenic varices
c. pancreatic pseudocyst
d. IVC congestion due to uterine compression
A
Splenic artery aneurysms are the most common type of abdominal aneurysm. They are seen more in females than males and are associated with pregnancy. The risk of rupture makes it a critical finding requiring immediate intervention. Splenic varices would demonstrate low velocity flow that would not normally lead to a bruit.
Which of the following liver disorders will result in increased levels of iron stored in the liver?
a. amyloid disease
b. hemochromatosis
c. glycogen storage disease
d. Wilson disease
B
Amyloidosis- increased levels of amyloid deposited in the liver.
Hemochromatosis- increased levels of iron deposited in the liver.
Wilson disease- increased levels of copper stored in the liver.
__________ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood.
a. Kaposi’s sarcoma
b. acute hepatitis
c. Budd Chiari syndrome
d. Anemia
D
Hemolytic anemia refers to the abnormal destruction and reformation of RBC’s. This causes excessive amounts of RBC’s to be destroyed which releases the hemoglobin they should be carrying. The hemoglobin is then converted into bilirubin. The more RBC’s destroyed. the more bilirubin in the blood stream.
When scanning a large habitus patient, a possible renal cyst is identified. Which of the following is a technique that would most likely be used to better visualize the finding?
a. switch to a higher frequency probe
b. drink water and rescan in 20-30 minutes
c. scan the patient in the decubitus position
d. use a standoff pad
C
The decubitus position allows for transducer placement closer to the kidney than from an anterior approach. Coronal and posterior probe placement can aid in better visualization of the kidney’s, especially in obese patients.
If a liver mass is located between the middle hepatic vein and the right portal vein, in what lobe of the liver is the mass located?
a. anterior right lobe
b. medial left lobe
c. caudate lobe
d. posterior right lobe
A
The middle hepatic vein separates the right and left lobes. The right portal vein enters the center of the right lobe. A mass between the two structures would be located in the anterior right lobe.
An unconscious patient is referred for an abdominal ultrasound through ER after a car accident. All abdominal organs appear normal in structure and echogenicity. There is free fluid in the right and left paracolic gutters with a complex mass of irregular tissue in the inferior midline pelvic cavity and no discernible bladder can be identified. What should you do when the exam is complete?
a. there is a rectus sheath hematoma present which is a non-critical finding
b. you should ask the nurse to insert a foley catheter and attempt to fill the bladder with saline solution
c. there is a possible bladder rupture and the radiologist should review the exam immediately
d. there is a potential bladder rupture and you should notify the referring physician immediately
C
The presence of free fluid in the pelvis and an irregular mass of tissue in the lower pelvis are indicators for possible bladder rupture. This is a critical finding and the case should be reviewed by a radiologist immediately. A sonographer should not offer exam results to the ER physician. Attempting to fill the bladder could assist in a pelvic exam but the physician must write an order for foley catheter insertion. If bladder rupture is suspected, it is highly unlikely a foley would be inserted. A rectus sheath hematoma would demonstrate fluid collection within the abdominal wall, not the cavity.
A 60 year old presents with a history of sickle cell anemia. What do you expect to find of the US evaluation of the spleen?
a. agenesis of the spleen
b. splenic atrophy
c. splenomegaly
d. splenic artery aneurysm
B
Sickle cell anemia causes the spleen to enlarge early in life and then atrophy and shrink later in life.
Elevated GGTP and ALP indicates _______. Elevated GGTP and ALT indicates _______.
a. hepatocellular disease, biliary obstruction
b. biliary obstruction, hepatocellular disease
c. hepatic carcinoma, hepatic adenoma
d. cirrhosis, hepatitis
B
GGTP: gamma-glutamyl transpeptidase is normally found in liver cells and biliary epithelium. It is the most sensitive indicator for alcoholism. A marked increase is seen with liver disease and post hepatic biliary obstruction. A moderate increase is seen with liver damage due to alcohol, drugs and chemotherapy.
Increased GGTP + ALP = biliary obstruction
Increased GGTP + ALT = hepatocellular disease
A patient presents with a palpable lump adjacent to the umbilicus. Which of the following transducers would be best to use for this exam?
a. 3.5MHz linear array
b. 7MHz phased array
c. 7MHz linear array
d. 3.5MHz curvilinear array
C
High frequency linear arrays are preferred for superficial imaging. 7MHz linear array.
All of the following techniques will aid in the visualization of a small renal calculi with questionable shadowing, except?
a. decreasing the dynamic range
b. using multiple scanning planes
c. decreasing the transducer frequency
d. rescanning the patient in the decubitus position
C
Increased transducer frequency will improve resolution of smaller objects.
Which of the following correctly describes the preferred patient position for a renal biopsy?
a. decubitus with knees drawn to chest
b. supine with a pillow under the back to accentuate the normal curvature of the spine
c. prone with a pillow under the abdomen to accentuate the normal curvature of the spine
d. posterior oblique with ipsilateral arm extended over the head
C
The preferred position for the patient undergoing a renal biopsy is prone with a pillow under the abdomen to accentuate the normal curvature of the spine. This approach allows the needle to travel the shortest distance through other tissues before reaching the kidney. It also prevents puncture of bowel and other organs. An anterior approach is least preferable due to the bowel, liver, spleen and vessels that could be punctured in the procedure.
A 45 year old patient presents with increased serum BUN and creatinine, a recent history of oliguria and bilateral flank pain. The US exam demonstrates bilateral hydronephrosis and hydroureter but the bladder is nearly empty. Which of the following statements is true regarding the patient and the findings?
a. acute intrinsic renal failure is present that is most likely due to acute tubular necrosis
b. acute post renal failure is present and the radiologist should review the exam immediately
c. the patient has a neurogenic bladder and the radiologist should review the exam immediately
d. the patient will most likely return in 7-10 days after antibiotic treatment
B
Bilateral hydronephrosis and hydroureter with increased serum levels of BUN and creatinine and an empty bladder most likely indicates acute renal failure. Acute renal failure caused by a bilateral ureteral obstruction can be treated by removing the obstructions. They parenchyma can be saved if the patient gets immediate treatment. A neurogenic bladder will not empty properly, causing increased bladder volumes pre- and post-void. Antibiotics are used to treat infections, not obstructions.
Which of the following operator controls adjusts the beam intensity?
a. dynamic range
b. output
c. overall gain
d. TGC
B
The output control will increase/decrease the voltage applied to the transducer which affects the intensity of the beam accordingly. Harmonic imaging is a frequency compounding technique used to improve image resolution of the displayed information. The TGC and overall gain controls are used to amplify the reflected signal.
When scanning the pancreas, which of the following techniques will not assist in reducing the gas artifact around the pancreas?
a. NPO 8-12 hours prior to exam
b. ask patient to perform the Valsalva maneuver
c. water ingestion
d. deep inspiration
B
The Valsalva maneuver will not usually affect the evaluation of the pancreas.
A 50 year old patient presents with acute RUQ pain and elevated alkaline phosphatase and bilirubin. The GB appears normal and the CBD measures 11mm at the porta heptatis. What should be evaluated next for this patient’s exam?
a. pancreas for a mass in the head
b. pancreas for a mass in the tail
c. spleen for varices
d. liver metastasis
A
11mm CBD is too large and abnormal. The pancreas head should be evaluated for a reason that the CBD is dilated if the duct is clear.
Which of the following is true regarding the difference between the sample obtained from a fine needle aspiration and a core biopsy sample taken from the liver?
a. FNA procedures are more traumatic to the tissues than needle biopsy procedures
b. The needle used for the FNA is usually much larger than the biopsy needle
c. The cytology lab evaluates the sample obtained from the FNA. The histology lab evaluates the sample obtained from the needle biopsy
d. Core needle biopsies are more commonly performed for liver masses than to assess parenchymal liver disease
C
The needle used for the FNA is usually much smaller than the biopsy needle. Core needle biopsies are more commonly performed to assess parenchymal disease than for liver mass evaluation. FNA procedures are less traumatic to the tissues than needle biopsy procedures.
Which of the following is a contraindication for a liver biopsy?
a. patient with Budd-Chiari syndrome
b. patient with severe liver atrophy caused by cirrhosis
c. patient with severe allergies to iodinated contrast
d. patient with active Alzheimer’s disease and hepatitis
D
A patient with Alzheimer’s disease cannot sign the informed consent for the procedure and may be uncooperative.
Contraindications for sonography guided procedures:
1. coagulopathy- use of blood thinners
2. unsafe biopsy route- must avoid large vessels, bowel, trachea and adjacent organs.
3. Uncooperative patient- uncontrolled movement during the procedure can result in laceration or hemorrhage.
Which scrotal artery encircles the testicular periphery?
a. cremasteric
b. deferential
c. capsular
d. centripetal
C
Capsular artery courses along the testicle periphery and produces branches called centripetal arteries which course through the parenchyma. The deferential artery supplies the vas deferens and epididymis with blood. The cremasteric supplies the scrotal sac with blood.
A patient presents with a recent single episode of significant indigestion, increased levels of AST and normal levels of ALT, alkaline phosphatase and bilirubin. Which of the following is a possible explanation of these symptoms?
a. myocardial infarction
b. chronic hepatitis C
c. Schistosomiasis
d. biliary stasis with a partial ductal obstruction due to Klatskin’s tumor
A
Increased levels of AST with normal ALT is associated with myocardial infarction, CHF, CNS disease and other non-hepatic disorders. Some patients that experience a myocardial infarction describe the radiating pain as heart burn or intense indigestion.
A right renal mass will displace the IVC:
a. Inferiorly
b. Laterally
c. Superiorly
d. Medially
D
A right renal mass will cause medial displacement of the IVC.
Potential bioeffects of US can be minimized by which of the following?
a. reduce exam time
b. using a lower frequency transducer
c. decrease overall gain
d. increase PRF
A
Reducing overall exam time will reduce patient exposure. Adhering to ALARA principle will also reduce exposure by limiting power output increases and using TGC contrast controls instead.
While you are performing an echo, the patients nurse comes in to try to draw blood. The nurse dropped the tube and you get a splash of blood on your hand. What should you do?
a. Immediately wash hands with soap and water
b. use alcohol based sanitizer to disinfect hand
c. report to occupational health so they can test the blood on your hand for disease
d. report the clumsy actions of the nurse to her supervisor
A
Immediately wash the affected area with soap and water. Notify your supervisor and immediately report to occupational health to file an exposure report.
Harmonic imaging:
a. is not recommended for use on fetal exams due to increased beam intensity
b. uses information from reflections created by the non-linear behavior of sound waves to form the image
c. improves spatial resolution but causes a reduction in temporal resolution
d. improves spatial resolution but causes a reduction in contrast resolution
B
Harmonic imaging does not affect the beam intensity so there is no restriction of its use. The process is performed by the machine processing more reflections to improve contrast resolution.
What modality is commonly used in the characterization of a renal angiomyolipoma?
a. CT scan
b. angiography
c. x-ray
d. nuclear medicine
A
CT scan can detect the high fat composition of the mass.
What is a potentially life threatening complication of portal HTN?
a. ascites formation
b. ruptured gastroesophageal varices
c. portal embolism
d. pulmonary embolism
B
Cavernous transformation causes the formation of varices that can rupture and cause significant hemorrhage, even death.
Which of the following is incorrect regarding intraoperative US?
a. soaking the transducer in alcohol for 30 minutes prior to the procedure is sufficient sterilization before surgery
b. sterile gel is used between the transducer and sterile sheath
c. sterile gel is used between the sterile sheath on the transducer and the organ being scanned
d. ethylene oxide gas can be used to sterilize the transducer
C
Gel is not used as a coupling agent when scanning intraoperatively. Surface moisture is usually enough to allow sound transmission into the body but sterile saline can be used.
A patient presents for a renal US due to high serum levels of anti-diuretic hormone, low urine output and a recent pulmonary embolism. What is the referring doctor most likely looking for on the exam?
a. renal vein thrombosis
b. formation of renal carbuncle
c. obstructive bladder calculi
d. abscess formation in the renal pelvis
A
Increased levels of ADH and low urine output indicates the patient is dehydrated. The recent PE indicates there is potential thrombus formation in the IVC or its branches.
In cases of acute pancreatitis, which of the enzyme levels increases first?
a. Alkaline Phosphatase
b. Trypsin
c. Amylase
d. Lipase
C
Amylase usually increases within the first 3-6 hours of the onset while lipase usually increases within 48 hours of the onset of acute pancreatitis.
Retrograde flow in the splenic artery would most likely indicate:
a. left gastric artery occlusion
b. chronic systemic HTN
c. mild portal HTN
d. celiac axis occlusion
D
If the celiac artery is occluded, the splenic artery will receive no blood because it is distal to the celiac origin. The lack of blood to the celiac artery will cause a significantly low pressure within the vessel that will allow collateral flow to occur. As the blood enters the empty splenic artery from a point distal to its origin from the celiac, it will flow back to the origin to the point of obstruction. Severe portal HTN could cause increased resistance and flow reversal in the splenic artery but mild portal HTN will have little effect on the splenic artery flow.
In the normal fasting adult, blood sugar levels should not exceed _______ of blood.
a. 50mg/100ml
b. 100mg/100ml
c. 150mg/100ml
d. 200mg/100ml
B
In a normal fasting adult, blood sugar should not exceed 100mg/100ml of blood.
Which of the following is not a sonographic characteristic of prostatitis?
a. heterogenous gland
b. increased gland size
c. increased vascularity seen with color doppler
d. solid hypoechoic mass
D
Prostatitis is usually a diffuse process that affects the entire gland.
Which of the following will improve the color display in the abdominal aorta?
a. increased frame rate
b. increased sample size
c. decrease color threshold
d. decrease color gain
A
Increased frame rate will increase temporal resolution that may reduce any visible delay in displayed information. Smaller sample sizes will increase frame rates. Color threshold determines the limit of when color is displayed over the 2D image. Increasing the threshold allows for more color to be displayed.
Which 2 gut layers are normally hypoechoic on the US image?
a. submucosa, muscularis propria
b. serosa, superficial mucosa
c. deep mucosa, muscularis propia
d. serosa, muscularis propia
C
The gut signature (sonographically):
superficial mucosa- epithelial lining (and lumen); echogenic
deep mucosa- consists of loose connective tissue and muscularis mucosa; hypoechoic
submucosa- echogenic
muscularis propria- inner circular fibers and outer longitudinal fibers; hypoechoic
serosa or adventitia- echogenic
What can be used to alter the displayed brightness of the image after it has been stored in the memory?
a. compression
b. rejection
c. pre-processing
d. post-processing
D
Post-processing is the only control that will adjust the brightness of the image AFTER the data is stored in the digital memory.
The major branches of the celiac axis are:
a. left gastric, splenic, common hepatic artery
b. left gastric, SMA, GDA
c. hepatic, GDA, splenic
d. left gastric, common hepatic, GDA
A
The major branches of the celiac axis are the left gastric, splenic, common hepatic arteries.
The US exam of a patient’s liver demonstrates a patent umbilical vein. The most common cause for this recanalization is:
a. hepatitis
b. abscess
c. portal HTN
d. ascites
C
Increased pressure in the liver and portal system causes them to engorge with blood. In some cases, this pressure is great enough to recanalize the umbilical vein outward to the umbilicus, as blood backs up in the system. The umbilical vein is a remnant of fetal circulation that used to connect the portal system of the liver to the placenta.
You are scanning the liver of an average sized patient with known cirrhosis. You complete the exam using a 3.5MHz curvilinear transducer but the doctor would like a better evaluation of the liver surface nodularity. Which of the following transducers would provide the best evaluation of the liver surface?
a. 3.5MHz linear
b. 8MHz curvilinear
c. 12MHz linear
d. 5MHz linear
D
In order to balance resolution and penetration a 5-7MHz transducer should work best for liver surface evaluation in an average size patient. The linear array works best due to its large near field and rectangular field of view.
A female patient presents with 8 days of abdominal pain, fever and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, alkaline phosphatase and WBC’s. Which of the following biliary abnormalities will most likely be identified on the exam?
a. cholangitis
b. primary GB carcinoma
c. Klatskin’s tumor
d. Pneumobilia
A
The fever and increased WBC’s indicate an infection. Cholangitis is common in Asian countries.
When evaluating intratesticular flow, which vessel is sampled by doppler?
a. cremasteric
b. gonadal
c. deferential
d. centripetal
D
Centripetal arteries course through the parenchyma to deliver blood to the testicular tissues. These arteries sampled with doppler in a standard US evaluation.
A patient presents for a post-biopsy scan of the right kidney. A lymphocele is suspected. What will be the appearance of this abnormality on the image?
a. fluid collection with debris and septations located adjacent to the kidney
b. cystic formation with debris levels found within the renal sinus
c. anechoic free fluid beneath the renal capsule that distorts the contour of the parenchyma
d. heterogeneous mass within the renal parenchyma
A
A lymphocele is a collection of lymphatic fluid that is usually associated with trauma or surgery. The fluid commonly contains debris and septations. A hematoma will form quickly after the procedure due to the constant blood flow from the heart, while a lymphocele or seroma will usually present after several days, or even weeks, post-biopsy.
Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient?
a. coronal only
b. transverse only
c. mid sagittal only
d. coronal and transverse
D
A transverse view can demonstrate a transverse image of both great vessels on the same image. A coronal view can demonstrate a sagittal view of both great vessels on the same image.
Which of the following liver abnormalities can be related to the use of oral contraceptives?
a. hydatid disease and schistosomiasis
b. focal nodular hyperplasia and hepatic adenoma
c. hepatic adenoma and Budd Chiari syndrome
d. Budd Chiari syndrome and hydatid disease
C
Both hepatic adenoma and Budd Chiari syndrome have been associated with oral contraceptive use.
Which type of transducer would be used evaluate a patient with increased LFT’s and height 5’3” and weight of 275lbs?
a. 3MHz curvilinear phased array
b. 10MHz vector array
c. 5MHz linear
d. 5MHz sector phased array
A
Deep abdominal imaging is best performed with a low frequency, curvilinear phased array transducer.
A patient presents with an order for a renal US due to increased BUN and creatinine levels in the blood and bilateral decreased renal size seen on CT. What will be the expected findings on the US exam?
a. nephrocalcinosis
b. medical renal disease
c. multicystic kidney disease
d. medullary sponge kidney
B
MCKD is a congenital malformation of the kidney with formation of multiple cysts and decreased function. In most cases it causes the unilateral formation of multiple large cysts that consume the parenchyma. Medullary sponge kidney and nephrocalcinosis lead to enlarged kidneys. Medical renal disease leads to decreased renal function and size bilaterally.
What system control can reduce the appearance of color ghosting?
a. increasing persistence
b. increasing color threshold
c. decreasing color priority
d. decreasing PRF
C
Color priority- adjusts the threshold setting; determines if a pixel is displayed as a shade of gray, black or white, or as a color; lower threshold settings reduce the display of color (lower color priority); higher threshold settings display more color (higher color priority); necessary to minimize color ghosting and improper placement of color on vessel walls.
All of the following are true regarding Couinad’s liver segmentation except:
a. Allows for liver resection/surgery without negatively affecting other segments
b. right and left lobes are divided by the branches of the main hepatic vein
c. each of the 8 segments has its own branch of the hepatic vein, portal vein and bile duct
d. divides liver into 8 functional segments
B
Mucocele of the GB most commonly occurs due to:
a. a stone in the ampulla of Vater
b. hepatitis
c. a stone blocking the cystic duct
d. cirrhosis
C
If the GB is the only part of the biliary system that is dilated, the blockage must be isolated to the cystic duct.
Which of the following statements is false regarding HCC?
a. multiple tumors form throughout the parenchyma on most cases
b. is is the most common liver malignancy
c. tumor invasion of the portal system can lead to the portal vein thrombosis
d. most cases demonstrate increased levels of serum alpha-fetaprotein
B
Liver metastasis is the most common liver malignancy.
Which of the following describes the sonographic appearance of the pancreas with chronic cystic fibrosis?
a. Increased size with mottled echogenicity, no definite nodules
b. Decreased size and increased overall echogenicity
c. Increased size with nodule calcification formation
d. Decreased size with hypoechoic nodularity throughout the gland
B
As the pancreas begins to produce the mucous substance, the gland becomes fibrotic. These changes lead to an increase in echogenicity and decrease in size.
If there is no diastolic flow demonstrated on a Doppler tracing of the arcuate artery of the upper pole of the right kidney, what will the resistive index be?
a. 0
b. 1.0
c. 0.5
d. Unable to calculate RI, not enough information given
B
The RI is calculated using the peak and end diastolic velocities measured on a Doppler tracing. PSV-EDV/PSV.
Which of the following ligaments separates the medial and lateral left lobes of the liver?
a. Ligamentum teres
b. Coronary ligament
c. Ligamentum venosum
d. Broad ligament
A
The left intersegmental fissure divides the left lobe into medial and lateral lobes. The falciform ligament, ligamentum teres and left hepatic vein course within this fissure.
Which of the following would normally present as a hypoechoic renal mass?
a. Acute pyelonephritis
b. Angiomyolipoma
c. Mycetoma
d. Oncocytoma
D
Oncocytoma would normally present as a hypoechoic renal mass, acute pyelonephritis does not cause mass formation but will present as loss of corticomedullary definition. The other choices will appear as a hyperechoic mass.
The loops of Henle are located in which portion of the kidney?
a. Pyramids
b. Medulla
c. Cortex
d. Sinus
B
The nephrons are located within the parenchyma. Bowmann’s capsule and the vascular supply of the nephron are located in the cortex layer. The nephron tubules to and from the capsule dive between the pyramids within the medulla area of the parenchyma to connect to the loop of Henle.
Which of the following is the most commonly occurring germ call tumor of the testicle?
a. Seminoma
b. Choriocarcinoma
c. Embryonal cell tumor
d. Teratoma
A
Seminomas make up to 40-50% of all germ cell tumors identified in the testicle.
What causes hepatic flow to have a triphasic waveform?
a. Hepatic congestion
b. Congestive heart failure
c. Portal HTN
d. Right atrial contraction and relaxation
D
The flow in the hepatic veins is normally triphasic due to right atrial contraction and relaxation.
The IVC and SVC empty in the ____________.
a. Left ventricle
b. Left atrium
c. Right ventricle
d. Right atrium
D
The IVC and SVC empty their blood into the right atrium
The most frequently involved organ in metastatic disease is the:
a. Pancreas
b. Spleen
c. GI tract
d. Liver
D
The liver filters blood from many abdominal organs, such as the stomach and the colon. This function of the liver makes if more susceptible to metastasis.
What type of pancreatic cells compose an adenoma?
a. Alpha only
b. Beta only
c. Islets of Langherhans and alpha
d. Alpha and beta
B
A pancreatic adenoma is composed of beta cells.
An inflammation of the biliary tree common in HIV pts is called:
a. Mirizzi’s syndrome
b. Pneumobilia
c. Cholangitis
d. Klatskin tumor
C
The suffix -itis refers to an infection. A, B and D refer to tumor formation.
Which of the following statements is false regarding pancreatic divisum?
a. Sonographically demonstrates a classic V-shaped organ with increased vascularity
b. Abnormal drainage of the pancreatic enzymes
c. Most common congenital pancreatic anomaly
d. Commonly associated with pancreatitis
A
Pancreatic divisum is difficult to detect sonographically.
Sonographically ____________ appears to connect the GB neck and the junction of the right and left portal veins.
a. Ligamentum venosum
b. Main lobar fissure
c. Intersegmental fissure
d. Ligamentum teres
B
The main lobar fissure courses through the right lobe between the neck of the GB and the IVC fossa. Sonographically, the main lobar fissure appears to connect the GB neck and junction of the right and left portal veins. Ligamentum teres courses through the left lobe and contains the collapsed umbilical vein. Ligamentum venosum separates the left lobe from the caudate lobe. The right and left segmental fissures separates the left and right lobes in 2 portions.
The IMV:
a. Courses from the mesentery to join the SMV near the porta hepatis
b. Drains blood from the distal colon
c. Drains blood from the proximal colon
d. All of the above
B
The IMV drains blood from the distal colon. The SMV drains the blood from the proximal colon and some small bowel portions. The IMV meets the splenic vein near the portal confluence.
All of the following are correct regarding acute pyelonephritis, except:
a. Critical finding that requires immediate nephrectomy to prevent sepsis
b. Most commonly caused by an ascending UTI
c. Focal involvement will demonstrate a hypoechoic wedge shaped segment of parenchyma
d. Diffuse involvement will demonstrate loss of distinction of the renal sinus in affected kidney/segment
A
Acute pyelonephritis is most commonly diagnosed clinically with lab testing and is treated with antibiotics.
Which of the following retroperitoneal spaces contains the adrenal gland?
a. Posterior pararenal space
b. Retrofascial space
c. Anterior pararenal space
d. Perirenal space
e. Glisson’s capsule
D
Perirenal space holds kidneys, perinephric fat, prox ureter, adrenal glands. Renal infection can lead to fluid, abscess or gas within the space which will distort renal fascia.
Which of the following is least likely to lead to extrinsic compression of the IVC?
a. Congestive heart failure
b. 8cm mass in the right lobe of the liver
c. 6cm AAA at the level of the renal arteries
d. Budd Chiari syndrome
A
CHF indicates poor cardiac function. There will be a back log if blood tries to enter the heart from the IVC causing it to dilate. Bilateral pedal edema is a common sign of CHF.
Which of the following correctly lists the structures found in the portal triad?
a. Common hepatic artery, hepatic vein, portal vein
b. Portal vein. Proper hepatic artery and bile duct
c. Hepatic vein, proper hepatic artery and bile duct
d. Portal vein, hepatic vein and bile duct
B
The portal triad contains the portal vein, proper hepatic artery and CBD(/CHD?)
A pt presents with a history of choledocholithiasis. How will you assess the common bile duct for the presence of a stone?
a. Demonstrate a longitudinal view of the main portal vein and look for the CBD anterior to it
b. Locate the main portal vein and look for the CBD posterior to it
c. Demonstrate a long axis GB image and look for the CBD superior to it
d. Demonstrate a transverse view of the pancreatic head and look for the CBD entering the anterior aspect
A
The CBD usually courses anterior to the main portal vein when it exits the liver.
The diameter of the normal aorta is greatest at the level of the:
a. Renal arteries
b. Iliac bifurcation
c. SMA
d. Celiac axis
D
The aorta tapers in size as it courses inferiorly through the abdomen. The celiac axis is the most superior branch of the aorta therefore the aorta diameter is greatest at the level of its origin.
The most common primary malignancy to metastasize to the spleen is ________________________.
a. Lung cancer
b. Melanoma
c. Renal cancer
d. Breast cancer
B
The most common primary malignancy to metastasize to the spleen is melanoma.
All of the following are usually benign liver neoplasms, except:
a. Focal nodular hyperplasia
b. Hemangioma
c. Hepatoma
d. Adenoma
C
Focal nodular hyperplasia is a benign liver tumor. An adenoma is a benign liver tumor commonly associated with oral contraceptives. A hemangioma is an abnormal accumulation of vascular tissues that forms as a benign liver mass. A hepatoma is a primary malignant tumor of the liver.
A thyroglossal duct cyst is most commonly found:
a. On the midline neck, superior to the thyroid gland
b. Posterior to the ear at the level of the thyroid gland
c. Near the angle of the mandible
d. Within the isthmus of the thyroid gland
A
A thyroglossal duct cyst is identified on the midline neck, superior to the thyroid gland. A brachial cleft cyst is located near the angle of the mandible.
A pt presents for an abdominal US to evaluate a potential cystadenocarcinoma of the pancreatic head that was identified on a recent CT scan. The US demonstrates a complex mass in the pancreatic head. Also, demonstrated is a 12cm GB with no stones or wall thickening and the CBD is patent measuring 10mm. the pt has a negative murphy’s sign. Which term below can be used to describe the findings?
a. Secondary biliary metastasis
b. Courvoisier GB
c. Mirizzi syndrome
d. Caroli’s disease
B
Courvesier GB refers to an enlarged, non-tender GB caused by a distal obstruction.
The renal arteries branch from the aorta just below the origin of the __________.
a. IMA
b. Gonadal arteries
c. SMA
d. Celiac axis
C
The renal arteries branch just below the SMA.
Autoregulation of the systemic blood pressure refers to:
a. The release of epinephrine to cause constriction of the convoluted tubules
b. The renin-angiotensin system that controls the level of constriction of the convoluted tubules
c. The release of aldosterone to cause vasoconstriction of the efferent arterioles
d. The renin-angiotensin system that controls the glomerular filtration rate of the kidneys and systemic BP level
D
When the BP drops, the GFR drops. The kidneys release renin to prompt the release of angiotensin which constricts flow in the arterioles. This increases BP and GFR.
All of the following are congenital anomalies of the spleen, except:
a. Splenunculi
b. Agenesis
c. Splenomegaly
d. Ectopic spleen
C
Splenomegaly is an acquired condition. Common causes include infection and portal HTN. Agenesis is a congenital absence of the spleen. An ectopic spleen forms in a different location than in the LUQ adjacent to the left kidney. A splecunculi is an accessory spleen or mass of normal splenic tissue not attached to the main gland.
All the following lab values will be increased with cirrhosis, except:
a. AST
b. ALT
c. Alkaline phosphatase
d. bilirubin
e. alpha fetoprotein
E
ALT, AST, bilirubin and alkaline phosphatase levels will all increase with cirrhosis. Alpha fetoprotein levels increase with malignancy and pregnancy. If HCC develops with cirrhosis, then AFP levels will rise.
What term describes a GB that is filled with bile that is isoechoic to the liver and is difficult to identify on US?
a. Mirizzi syndrome
b. Charcot’s triad
c. Courvoisier GB
d. Hepatization
D
Hepatization of the GB refers to a GB filled with sludge that is isoechoic to the liver. This makes the GB difficult to identify on US. Try to identify the GB wall in these cases.
A cyst within a cyst (daughter cyst) is a classic sign of:
a. Polycystic liver disease
b. Hydatid disease
c. Echinococcal cyst or pyogenic abscess
d. Hydatid cyst or Echinicoccal cyst
D
Echinococcal cysts are also called hydatid cysts and demonstrate a cyst with another cyst inside. They form due to parasitic infection of the liver.
Which of the following vessels does not drain into the IVC?
a. Right gonadal vein
b. Right renal vein
c. Left hepatic vein
d. Splenic vein
e. Internal iliac vein
D
The splenic vein is a part of the portal venous system. It joins with the SMV at the portal confluence.
Which of the following is false regarding pancreatic masses?
a. The location of the mass in the head of the pancreas usually indicates a benign process
b. The location of the mass in the head of the pancreas usually indicates a malignant process
c. A pancreatic tail mass can be confused with splenic hilar pathology
d. A mass with round smooth borders is usually a benign process
A
Most tumors with round smooth borders are benign. Most pancreatic tumors located in the head are malignant. Masses found in the tail are usually benign. Because of the proximity of the pancreatic tail to the splenic hilum, tail masses can look like splenic pathology.
The __________ is formed at the junction of the vas deferens and the seminal vessicals.
a. Rete testes
b. Ejaculatory duct
c. Afferent ducts
d. Efferent ducts
C
The ejaculatory duct is formed at the junction of the vas deferens and seminal vesicles.
During an abdominal US, a small circular anechoic structure is identified at the anterior portion of the pancreatic head. Color flow is identified in the structure. What is it?
a. Celiac axis
b. CBD
c. GDA
d. IMA
C
The GDA is demonstrated as a small circular anechoic structure at the anterior portion of the pancreas head.
All of the following correctly describes liver adenomas, except:
a. Encapsulated mass that is more common in women
b. Surgical intervention is usually recommended because of risk of internal hemorrhage
c. Easily distinguished from a focal nodular hyperplasia due to hypervascularity
d. Associated with glycogen storage disease
C
FNH and liver adenomas have a similar sonographic appearance and biopsy is usually required to determine the mass origin.
A fluid collection between the diaphragm and splenic capsule may represent:
a. Subphrenic abscess
b. Subcapsular hematoma
c. Pericardial effusion
d. Pleural effusion
A
A pleural effusion will be located above the diaphragm. A subcapsular hematoma will be located between the splenic tissue and the splenic capsule. A pericardial effusion refers to fluid in the pericardial sac around the heart. Sub- means under and -phrenic means diaphragm. The subphrenic abscess will be located under the diaphragm adjacent to the splenic capsule.
The _____________ is the portion of the prostate that is usually composed of smooth muscle cells and make up approximately 1/3 of the gland.
a. Peripheral zone
b. Central zone
c. Transitional zone
d. Anterior fibromuscular zone
D
The anterior fibromuscular zone is composed of mostly smooth muscle and occupies 1/3 of the gland.
The spleen produces _________ and their main function is to control antibodies and prevent infection.
a. Amylase
b. Aldosterone
c. Mitochondria
d. Platelets
e. Leukocytes
E
Leukocytes are WBCs. They are produced in the splenic tissue.
Where is the most common location for the occurrence of retroperitoneal fibrosis?
a. Adjacent to the diaphragm surrounding aorta
b. At the lateral borders of the kidneys
c. At the level of the renal arteries
d. At the level of the aortic bifurcation
D
Retroperitoneal fibrosis usually occurs at the level of the aortic bifurcation. It refers to idiopathic overgrowth of fibrous tissue. It can be related to drugs, infection, malignancy or cancer therapy. The overgrowth of tissue may lead to ureteral obstruction, causing hydronephrosis.
__________ is the most common malignant neoplasm of the prostate.
a. Metastasis
b. Central zone sarcoma
c. Transitional zone sarcoma
d. Adenocarcinoma
D
Adenocarcinoma is the most common malignant neoplasm found in the prostate.
The __________ are called intersegmental vessels of the liver.
a. Portal veins
b. Hepatic arteries
c. Hepatic veins
d. Hepatic arteries and veins
C
The hepatic veins course between the liver segments (intersegmental). The portal veins and hepatic arteries course into the mid portion of each segment and branch toward the edge (intrasegmental).
Acute cholecystitis is associated with wall thickening _________.
a. >3mm
b. >2mm
c. >6mm
d. <3mm
A
Acute cholecystitis is associated with GB wall thickening >3mm.
The renal pyramids are found in the:
a. Medulla
b. Calyces
c. Sinus
d. Cortex
A
The renal pyramids are wedge-shaped spaces located in the medulla portion of the renal parenchyma. The base of the triangle is adjacent to the cortex of the parenchyma. The urine is funneled to the papilla, or tip of the wedge, that is connected to the calyce of the renal sinus.
All of the following structures are directly medial and anterior to the splenic hilum, except:
a. Fundus of the stomach
b. Morrison’s pouch
c. Lesser sac
d. Pancreatic tail
B
Morrison’s pouch is located between the liver and the right kidney. The pancreatic tail, fundus of the stomach and lesser sac are anterior/medial to the spleen
Calcitonin is produced by which of the following types of cells?
a. Parathyroid parafollicular
b. Parathyroid follicular
c. Thyroid parafollicular
d. Thyroid follicular
C
Calcitonin is produced by in the thyroid in the parafollicular cells. These cells are located in the tissues between the thyroid follicles.
All of the following correctly describe papillary thyroid cancer, except:
a. Is highly curable
b. 5% of all thyroid cancers
c. Associated with enlarged cervical lymph nodes
d. Most commonly presents as a hypoechoic mass with calcifications
B
Papillary carcinoma is the most common type of thyroid cancer. It is commonly associated with enlarged cervical lymph nodes but is highly curable. Sonographic characteristics include a hypoechoic mass with calcifications.
Which of the following correctly describes the pediatric pancreas?
a. It normally increases in echogenicity as the pt reaches adulthood
b. The ducts are dilated at >2mm at birth and decrease in size throughout the first year
c. It is normally isoechoic to the liver
d. Cystic fibrosis leads to the production of mucus and the gland is reduced in echogenicity
C
The pancreas is isoechoic as a child and increases in echogenicity as the pt reaches adulthood. Cystic fibrosis causes an increase in echogenicity of the gland.
Which of the following is not a congenital anomaly/disorder?
a. Biliary atresia
b. Choledochal cyst
c. Sclerosing cholangitis
d. Caroli’s disease
C
Sclerosing cholangitis is an acquired inflammatory disorder of the biliary tree
In most pts, the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of pts, the right hepatic artery originates from the ___________ and the left hepatic artery originates from the ___________.
a. SMA, left gastric
b. Splenic artery, common hepatic
c. Left renal, right renal
d. Celiac, coronary
A
In most pts the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of pts the right hepatic artery originates from the SMA and the left originates from the left gastric artery.
Which of the following statements are false regarding liver hemangiomas?
a. This type of liver mass is commonly identified as an incidental finding
b. The mass is composed of a high concentration of vascular tissues
c. This type of mass is rarely malignant
d. This type of liver mass is usually hyperechoic to normal liver tissue
e. Increasing diffuse fatty replacement will cause the mass to increase in echogenicity
E
Increasing diffuse fatty replacement will cause the liver tissues to increase in echogenicity and the mass will become more isoechoic or even hypoechoic to the liver tissues
Which of the following scrotal structures carries the seminal fluid from the rete testis to the epididymis?
a. Efferent ducts
b. Mediastinum
c. Vas deferens
d. Seminiferous tubules
A
The seminiferous tubules empty into the efferent ductules that connect to the epi.
What fetal syndrome is associated with hepatoblastoma?
a. Down syndrome
b. Beckwith-Weidemann syndrome
c. Trisomy
d. Budd Chiari syndrome
B
Beckwith-Weidemann syndrome is associated with hepatoblastoma
Sonographic signs of chronic renal failure include a/an _________ in size and a/an ________ in echogenicity.
a. Decrease, increase
b. Decrease, decrease
c. Increase, increase
d. Increase, decrease
A
As kidney function decreases the organ atrophies. The cortex thins and becomes increasingly dense leading to an increase in cortical echogenicity
Which of the following Doppler criteria is used to evaluate the parenchymal flow in a renal allograft?
a. Resistive index
b. SD ratio
c. Peak systolic velocity
d. Renal aorta ratio
A
The resistive index should normally be below 0.7 in a renal allograft. If the RI reaches 0.8-1.0 transplant failure is suspected.
All of the following are produced by the exocrine function of the pancreas, except:
a. Trypsin
b. Lipase
c. Insulin
d. Amylase
C
Insulin is a hormone produced by the pancreas (endocrine).
A histology report indicates that a testicular tumor contains only seminomatous cells. Which of the following best describes the tumor?
a. Mature teratoma
b. Mixed germ cell tumor
c. Metastatic tumor
d. Seminomatous tumor
D
Seminomatous tumors are comprised of seminomatous cells.
Corpora amylacea is a benign condition of what organ?
a. Prostate
b. Liver
c. Spleen
d. Kidneys
A
Corpora amylacea refers to calcifications commonly seen in the inner gland.
A pt presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:
a. Cavernous transformation
b. Dilated extrahepatic biliary system
c. Duplicated hepatic artery
d. Portal aneurysm
A
Cavernous transformation of the vessels at the porta hepatis refers to the formation of varices from the increased portal pressure with portal HTN. Accessory veins dilate at the porta hepatis due to the backlog of blood flow. These vessels are small and tortuous. Splenomegaly is another sign of portal HTN and a backlog of blood flow in the porta hepatis.
Regarding the aorta, fusiform aneurysm formation usually occurs in the _________ while dissecting aneurysms usually occur in the __________.
a. Aortic arch, distal abdominal aorta
b. Prox abdominal aorta, thoracic aorta
c. Distal abdominal aorta, aortic arch
d. Distal abdominal aorta, thoracic aortic
C
Fusiform aneurysms usually occur in the distal abdominal aorta while dissecting aneurysms usually occur in the aortic arch.
Hutch diverticula are identified in the:
a. GB
b. Large bowel
c. Urinary bladder
d. Small bowel
C
Hutch diverticula are congenital outpouchings of the bladder wall near the urethral opening.
Zenker’s diverticulum can be mistaken for:
a. A thyroid mass
b. A bowel obstruction
c. Dilated CBD
d. The appendix
A
Esophageal diverticulum refers to the outpouching of a weak spot in the esophageal wall.
Killian-Jameison diverticulum- protrudes from anterolateral wall of the cervical esophagus.
Zenker’s diverticulum- located at the back of the throat, protrudes posterior or midline.
They can be mistaken for a thyroid mass.
Which of the following is least likely to demonstrate an increased RI in the arcuate arteries?
a. Acute renal artery occlusion
b. Renal vein thrombosis
c. Acute renal failure
d. Acute tubular necrosis
A
No intrarenal arterial flow will be detected in the kidney with an acute renal arterial occlusion. Acute tubular necrosis, acute renal failure and renal vein thrombosis reflect the kidneys that cannot properly filter blood and cortical tissue resistance is increased.
A tardus parvus waveform is described as:
a. Pronounced early systolic pressure and prolonged acceleration time
b. Reduced systolic velocity with diastolic flow reversal
c. Absence of early systolic peak and prolonged acceleration time
d. RI of 1.0 or greater
C
Tardus parvus waveform- absence of early systolic peak and prolonged acceleration time. If identified in the native arcuate arteries, significant stenosis is present.
All of the following are benign splenic neoplasms, except:
a. Hamartoma
b. Granuloma
c. Hemangioma
d. Lymphoma
D
A splenic hamartoma is a rare, benign vascular proliferation that is often found incidentally. A hemangioma is another type of benign vascular malformation. A granuloma forms after infection. Lymphoma is a primary malignancy of the spleen related to the lymphatic tissues.
What biliary anomaly is suspected if jaundice persists more than 14 days after birth?
a. Agenesis of the GB
b. Choledochal cyst
c. Biliary atresia
d. Ectopic GB
C
The lack of opening of the biliary tree will cause persistent jaundice after birth.
What is the most common bilateral malignancy of the testicle?
a. Seminoma
b. Leukemia
c. Metastasis
d. Lymphoma
D
The most common BILATERAL malignancy of the testes is lymphoma.
Primary testicular carcinoma is usually __________ and secondary testicular malignancy is usually __________.
a. Heterogeneous, isoechoic
b. Hypoechoic, isoechoic
c. Bilateral, unilateral
d. Unilateral, bilateral
e. Hypervascular, hypovascular
D
Unilateral, bilateral
Which of the following describes carpal tunnel syndrome?
a. Compression of the median nerve by the carpal sheath causing numbness, weakness and pain
b. Compression of the blood vessels as they enter/exit the wrist causing thrombus formation and emboli
c. Damage to the median nerve by chronic compression between the metacarpal bones of the palm
d. Damage to the cartilage between the carpal bones of the wrist causing swelling and pain with motion
A
Carpal tunnel syndrome refers to compression of the median nerve by the carpal sheath causing numbness, weakness and pain in the wrist/hand.
Which of the following biliary abnormalities is associated with chronic cholecystitis?
a. Empyema
b. Porcelain GB
c. Strawberry GB
d. Biloma
B
Chronic cholecystitis can lead to calcium formation within the wall of the GB.
_________ abscesses are most commonly found in countries outside the U.S. _________ abscesses are most commonly seen in immunosuppressed pts.
a. Fungal, amebic
b. Amebic, fungal
c. Fungal, pyogenic
d. Pyogenic, amebic
B
A pt presents for an abdominal US with a history of increased LFT’s and obesity. The referring doctor would like to rule out hepatomegaly. Which of the following statements regarding hepatomegaly is true?
a. When the right lobe is rounded inferiorly and extends past the upper pole of the right kidney
b. Rounding of the superior liver segments
c. AP measurement exceeds 15.5cm
d. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney
D
Hepatomegaly is diagnosed when the length of the liver exceeds 15.5cm. the AP measurement will also increase but the length is most accurate.
Which of the following pts would benefit from a FAST exam?
a. Pt with abnormal bruit, weight loss and post prandial pain
b. Pt with suspected prostate cancer
c. Pt with a history of abdominal pain after falling from a ladder yesterday
d. Pt with a history of RUQ pain after eating
C
FAST evaluation- Focused Assessment with Sonography in Trauma; used to evaluate the abdomen for fluid or blood in trauma pts; check the 4 quadrants, midline and Morrison’s pouch
How many layers are identified in the normal gut?
a. 5
b. 3
c. 8
d. 2
e. 6
A
Serosa, muscularis, submucosa, deep mucosa, superficial mucosa/lumen.
Increased thyroid volume is associated with all of the following, except:
a. Iodine deficiency
b. Chronic hepatitis
c. Increasing age
d. Chronic renal failure
B
Thyroid volume increases normally with age and body weight. Iodine deficiency, acute hepatitis and chronic renal failure can also cause increased gland volume. Chronic hepatitis, thyroxine treatment and radioactive iodine treatment can cause decreased gland volume.
Which of the following is least likely to be used to treat a liver mass formed due to HCC?
a. Acetic acid injection
b. Thrombin injection
c. Radiofrequency ablation
d. Ethanol injection
B
Percutaneous ethanol injection is used to cause tumor necrosis in thyroid adenomas and cysts, parathyroid adenomas, HCC and liver metastasis. Acetic acid is another type of injectable used for liver tumor treatment. Radiofrequency ablation of liver tumors induces thermal injury to the target tissues. Thrombin is used in the treatment of pseudoaneurysms.
A FNA biopsy of a thyroid nodule is not recommended for nodules ________.
a. <20mm
b. >50mm
c. <1mm
d. <10mm
D
Which of the following is incorrect in reference to sterile technique?
a. Sterile fields or packages are opened as close as possible to time of actual use
b. Personnel with colds should avoid working while ill or apply a double mask
c. Gowns are considered sterile only in the front
d. The only person who must be sterile within the sterile field is the physician performing the procedure
D
Sterile field:
All items and personnel in a sterile field must be sterile
Sterile packages or fields are opened or created as close as possible to the time of actual use.
Moist areas are not considered sterile.
Contaminated items must be removed immediately from the sterile field.
Gowns are considered sterile only in the front, from chest to waste and from the hands to slightly above the elbow.
Personnel with colds should avoid working while ill or apply a double mask.
Edges of sterile areas are not considered sterile.
Which of the following describes the best pt position for a thoracentesis?
a. Left lateral decubitus
b. Seated leaning forward over a table
c. Semi-erect with the knees raised toward the chest
d. Right lateral decubitus
B
Thoracentesis is performed for removal of fluid from the pleural space in the thoracic cavity. It is performed for diagnostic or therapeutic purposes. A chest x-ray is performed before and after the procedure to evaluate fluid removal and for the presence of a potential pneumothorax caused by the procedure. Most pts are placed in the semi-erect position and leaning forward over a table.
Which lab value is associated with jaundice?
a. Bilirubin
b. WBC
c. PT
d. INR
A
Jaundice is caused by an increase in bilirubin in the blood. This can be due to ductal obstruction or liver malfunction.
Which of the following will help the radiologist select the correct biopsy needle size/length for the biopsy of a mass in the posterior right liver?
a. Measuring the depth of the mass within the liver
b. Measuring the width of the mass
c. Using color Doppler to locate the surrounding vascularity
d. Usually the sonographer opens multiple sizes of core biopsy needle and places them on the sterile procedure tray in case they are needed
A
The depth of the mass can affect the length of needle required for the procedure. Normally only one biopsy device is opened and used for the procedure.
A pt presents for a liver US with contrast to evaluate a tumor. Which of the following lists the correct machine settings needed for the exam?
a. Low mechanical index, harmonics on, focal zone placed at the area of interest
b. Mechanical index over 1.5, harmonics off, focal zone at the chest wall
c. Highest output power settings available, harmonics on, at least 3 focal zones surrounding the area of interest
d. Low mechanical index, harmonics off, focal zone at the chest wall
A
The mechanical index should be low, 1.0 or less, to decrease cavitation and decrease the potential to burst the microbubbles. Harmonics will assist in visualizing the contrast in the microvascularity. The focal zone should always be placed at or just below the area of interest.
Which type of transducer would be used to evaluate a palpable lump in the neck?
a. 3MHz curvilinear sequential array
b. 12MHz sector phased array
c. 12MHz linear phased array
d. 12MHz curvilinear phased array
C
Superficial imaging is best performed with linear transducers. The large near field and rectangular FOV provide improved imaging of superficial structures. Higher frequencies also provide the best resolution.
All the following are pt positioning techniques that can assist in viewing the GB, except:
a. Prone
b. Supine
c. LLD
d. Erect
A
Due to the anatomic position of the GB anf the limited imaging windows from the pt’s back, the prone position will not provide additional imaging views of the GB.
When the prostate is enlarged, what other structures should be evaluated for related findings?
a. Renal arteries for thrombosis
b. Kidneys for hydronephrosis
c. Portal vein for thrombosis
d. Renal veins for nutcracker syndrome
B
An enlarged prostate can cause urine retention in the bladder and associated hydronephrosis.
Overgaining on an US exam can cause _________.
a. Overestimation of Doppler velocity
b. Blood to appear anechoic
c. Increased posterior shadowing
d. Underestimation of arterial stenosis
A
Which of the following machine adjustments will produce a more black and white 2D image?
a. Decreased overall gain
b. Increased dynamic range
c. Decreased monitor contrast
d. Increased log compression
D
As log compression increases, the dynamic range decreases. The lower the dynamic range, the smaller number of shades of gray that are displayed on the image. Overall gain would adjust the brightness of all shades on the screen and will not affect contrast.
What type of precautions are required for a pt with MRSA?
a. Reverse protective isolation
b. Contact precautions
c. Enteric precautions
d. Strict isolation
B
Wound-skin precautions- AKA contact precautions; used to protect others from germs in pt’s wounds or any other heavily contaminated areas; require gown and gloves for any type of pt contact; MRSA, scabies, VRE, Impetigo.
What is the twinkle artifact?
a. Varied brightness of vascular calcifications causes a twinkling effect on 2D
b. Thin line of reverberation artifact that is caused by calcium deposits in the renal parenchyma
c. Mosaic color pattern displayed in a linear pattern posterior to a dense object, such as a renal stone
d. Describes the color display seen as urine is entering the bladder during real-time imaging
C
Which image plane can produce a longitudinal image of the IVC and the aorta on the same image?
a. Coronal only
b. Coronal and transverse
c. Mid sagittal only
d. Transverse only
A
A pt presents for a post biopsy scan of the right kidney. An extracapsular hematoma is suspected. What will be the appearance of this abnormality on the image?
a. Free fluid with debris levels found within Morrison’s pouch
b. Free fluid beneath the renal capsule that distorts the contour of the parenchyma
c. Free fluid with debris levels found within Murphy’s pouch
d. Cystic formation with debris levels found within the renal sinus
A
Blood that collects between the renal capsule and the cortex is an intracapsular hemorrhage. Blood that collects outside the capsule. Between the capsule and the liver tissue is an extracapsular hemorrhage. An intracapsular hemorrhage will distort the renal cortex while an extra capsular hemorrhage will not.
A pt presents after a recent MVA. He complains of several new palpable masses on the anterior abdomen. Sonographically they appear as rounded complex masses with some through transmission. These findings most likely represent:
a. Rectus sheath hematoma
b. Peritoneal fibrosis
c. Lipomas
d. Sebaceous cysts in the rectus sheath abdominus muscles
A
The recent history of an MVA and acute presentation of the complex masses should lead to a diagnosis of a hematoma. Fibrosis would appear as dense formations within the muscular tissues. A sebaceous cyst would present in a much more superficial location as they are related to the oil glands of the skin. Lipomas are composed of fatty tissue and usually present as a round or oval homogeneous, hyperechoic mass related to the surrounding muscle tissue.
Which of the following is NOT accurate when describing standard precautions?
a. Gowns are worn if soiling of clothing is likely from blood or body fluid
b. When using cloth sheets, each one can be used twice as long as it is flipped over to the clean side after the first pt
c. Hands should be washed after removing gloves
d. Standard precautions should apply to all body fluids from all pts
B
The _______ region is defined by the orifices of the two ureters and the urethral outlet.
a. Trigone
b. Fundus
c. Dome
d. Base
A
The right lobe of the liver is divided into ______ segments, while the left lobe is divided into _______ segments.
a. Anterior and posterior, medial and lateral
b. Caudate and anterior, quadrate and posterior
c. Medial and lateral, anterior and posterior
d. Caudate and posterior, quadrate and anterior
A
Which of the following probe frequencies should be used when trying to evaluate the pancreas in an obese pt?
a. 3MHz linear
b. 5MHz phased
c. 3MHz curvilinear
d. 5MHz curvilinear
C
