Abdomen & Small Parts Final Flashcards
What is the most common form of thyroiditis?
Hashimoto’s disease
Which structure is located to the left of midline and is often mistaken for a thyroid lesion?
esophagus
Name the three strap muscles.
omohyoid, sternohyoid, sternothyroid
What are the categories on the TIRADS scale?
- Composition
- Echogenicity
- Shape
- Margins
- Echogenic foci
- Significant change in size
- Change in features
- Change in ACR risk categories
Which parathyroid pathology is associated with patients who have chronic renal failure?
secondary hyperparathyroidism
Which thyroid disease has a typical clinical symptom of opthalmopathy?
Graves disease
What is the most common type of thyroid cancer?
papillary carcinoma
Which type of thyroid cancer metastasizes to the brain, bones, lungs, and liver?
follicular carcinoma
The parathyroid controls the amount of ______ in the body.
calcium
What hormone is produced by the hypothalamus?
thyrotropin releasing hormone
Where is a Thyroglossal Duct Cyst going to be located?
midline anterior to trachea
What neonatal condition can lead to adult testicular cancer? Why? Be specific.
Cryptorchidism can lead to adult testicular cancer due to the testicles being exposed to too much heat inside of the body.
Which prostate zone is least likely for a malignancy to occur in?
transitional
Which scrotal condition can cause a positive pregnancy result in a male patient?
choriocarcinoma
Which order will spermatozoa travel for expulsion?
Seminiferous tubules, tubuli recti, rete testes, efferent ducutules, ductus epididymis, vas deferens
Which tumors can produce enlarged male breasts?
Sertoli, Leydig, Granulosa
Which structures join to form the ejaculatory duct?
vas deferens and seminal vesicle
During an adominal with dopplers exam, which vessel appears to travel away from the transducer at the porta hepatis?
RPV
An ultrasound guided liver aspiration is scheduled for a patient with elevated LFTs and leukocystosis. What is the likely diagnosis:
pyogenic abscess
The hepatic veins join to enter the _____
IVC
In some cases of portal hypertension, why can some velocities measure within the normal range?
recanalized umbilical vein
A patient presents with elevated alanine transaminase and alkaline phosphatase. What is the likely diagnosis:
cirrhosis
All of the following are sonographic appearances of the liver condition most common in sheep-herding locations except:
Cyst-within-cyst
Water lily
Bulls-eye
Daughter cyst
bullseye
A 3 year old patient presents with a large, palpable mass in the RUQ. Sonographic evaluation demonstrates a large, heterogenous liver mass containing small cysts and areas of calcification. What is the likely diagnosis:
hepatoblastoma
Which of the following statements regarding testicular vascularity is true?
- Right testicular vein drains into the IVC
- The right and left testicular arteries arise from the respective right and left external iliac arteries
- The scrotum is supplied through a pampiniform plexus
- The left testicular vein drains into the left external iliac vein
Right testicular vein drains into IVC
Which liver condition typically displays a “spoke-wheel” sign?
focal nodular hyperplasia
Intrahepatic biliary ducts are only sonographically visualized when
> 4 mm
Orchititis is associated with epididymitis in _________ of cases.
- 15-20%
- 15-30%
- 20-30%
- 30-50%
20-30%
Which abdominal vessel does not normally display a waveform above the baseline?
RPV
Which of the following statements regarding the “starry sky” sign is accurate:
- Result of parenchyma fibrosis due to chronic hepatitis
- Indicative of echogenic portal vein walls in acute hepatitis
- Visualized due to coarse echotexture of late-stage cirrhosis
- Describes the impaired visualization of hepatic vessels with fatty infiltration
Indicative of echogenic portal vein walls in acute hepatitis
Upon evaluation of the porta hepatis, only the PV and HA are visualized. What is the likely diagnosis?
biliary atresia
What is the most likely cause of hepatic jaundice?
cholelithiasis
Which of the following vessels will not normally display respiratory phasicity:
- HA
- MHV
- MPV
- LHV
HA
Metastatic spread of disease to the gallbladder most commonly comes from:
A. Liver cancer
B. Melanoma
C. Lung cancer
D. Breast cancer
B. melanoma
Which of the following testicular malignancies has the best prognosis?
Choriocarcinoma
Teratoma
Seminoma
Embryonal carcinoma
Seminoma
Which thyroid vessel is a branch of the external carotid artery?
superior thyroid artery
A 15 year-old male patient arrives to the ER with severe right sided testicular pain. He states that he has had the sudden onset of pain for 14 hours. Upon sonographic evaluation you notice that there is no documentable vascularity to the testicle but there is increased flow in the peritesticular tissues. What surigcal outcome is most likely?
50% probability of recovering the testicle
What is the most common thyroid malignancy?
papillary carcinoma
How does papillary carcinoma metastasize?
through cervical lymph channels
What is the second MC thyroid malignancy?
follicular carcinoma
How does follicular carcinoma spread?
through bloodstream to bone, brain, lung, liver
NOT to lymph nodes
Who gets follicular carcinoma more often?
older women
What cancer makes up 10% of all thyroid cancers?
medullary carcinoma
What kind of cells does medullary carcinoma arise from? What do they secrete?
parafollicular cells which secrete calcitonin
What is a unique sign of medullary carcinoma?
abnormal serum calcitonin levels
What is the most deadly type of thyroid cancer?
anaplastic carcinoma
Who gets anaplastic carcinoma typically?
people over 50
What percentage of thyroid cancers does lymphoma make up?
4%
What kind of lymphoma is most common in the thyroid?
Non-Hodgkin’s lymphoma
What is the relationship between Hashimoto’s disease and thyroid lymphoma?
greater than 90% of those who develop lymphoma originating within the thyroid have Hashimoto’s disease
What causes primary hyperparathyroidism?
An adenoma, carcinoma, or primary hyperplastic PT gland causes increased amounts of PTH to be produced
What are the S&S of primary hyperparathyroidism?
hypercalcemia, hypercaluria
Who gets primary hyperparathyroidism more commonly?
women, 3x more likely, esp. after menopause
What is the MC cause of primary hyperparathyroidism?
adenoma
How large is a PT adenoma?
less than 3 cm
What causes secondary hyperparathyroidism?
chronic renal failure causes inability to synthesize vitamin D which decreases serum calcium level
What zone does prostate cancer MC occur in?
peripheral zone, 25% in central zone
What demographic is at an increased risk of prostate cancer?
African American males
Prostate cancer is the ____ most common cancer in American men.
second
Where does fluid accumulate with a hydrocele?
Between the visceral and parietal tunica vaginalis
What supplies the testes?
deferential artery, cremasteric artery, testicular artery
What drains the testes?
Pampiniform plexus, R testicular vein into IVC, L testicular vein into L renal vein
What is microlithiasis in the testicles?
benign accumulations of calcium in testicular tissue, link to testicular carcinomas
What is the MC cause of orchitis?
chlamydia
What is most often the cause of spermatic cord torsion?
Bell & Clapper deformity
What is the chance of recovering a testicle after 4-6 hours of torsion? 12? 24?
4-6: 90%
12: 50%
24: 10%
When do spermatoceles most commonly occur?
post vasectomy
What is the MC cause of infertility?
varicoceles
Where do the majority of varicoceles occur?
left testicle due to drainage into L renal vein
What is associated with a large right sided varicocele?
Possible renal or retroperitoneal tumor
What causes abscess in the testicle?
untreated epididymo-orchitis
What is the MC extratesticular tumor?
adenomatoid, benign
What are the 3 non-Germ cell tumors?
Leydig, Sertoli, cystadenoma
What is the MC germ cell tumor? 2nd?
1st: seminoma
2nd: mixed germ cell
Who does seminoma typically occur in?
40-50 yo males
Scrotal
What percentage of germ cell tumors does embryonal carcinoma make up?
2-3%
Who does embryonal carcinoma usually develop in?
20-30 yo males
What kind of cells are teratomas made up of?
Cells from all 3 embryologic germ layers
What is the rarest testicular cancer and highly malignant and aggressive?
choriocarcinoma
Who does choriocarcinoma most commonly affect?
25-30 yo males
Why does choriocarcinoma cause a male to have a positive pregnancy test?
high levels of b-HCG
What is the infantile form (< 2 yo) of embryonal carcinoma?
Yolk Sac tumor
What kind of testicular tumors are typically benign with 10% being malignant?
Leydig cell tumor, Sertoli tumor
Who most commonly gets a Leydig cell tumor?
20-50 yo men
What kind of testicular tumor is rare, making up <1% of all testicular cancers?
Sertoli tumors
What is the difference between a juvenile and adult granulosa tumor?
Juvenile is typically benign, adult typically malignant with mets
What hormone do theca cell tumors produce? Are they MC in ovaries or testes?
androgen, MC in ovaries
Lymphoma in the testes usually affects men over what age?
60
What type of hepatitis is treated with antivirals?
Hep C
What is the difference between early and late cirrhosis?
early: hepatomegaly
late: small liver, coarse, caudate enlargement
What are the differences between acute and chronic hepatitis?
acute: decreased echogenicity, echogenic PV walls
chronic: increased echogenicity, hypoechoic PV walls, cirrhotic appearance
What causes an amebic abscess?
Entamoeba parasite
What disease is not found in the US but is the 2nd MC parasitic disease?
schistosomiasis
You have an immunocompromised patient who presents with an ongoing fever and rising WBC count. What is the likely diagnosis?
(liver condition)
hepatic candidiasis
What is another name for an echinococcal cyst?
Hyatid cyst
Who is cavernous hemangioma more common in?
Females
What is the most common benign neoplasm in the liver?
Cavernous hemangioma
What is a focal nodular hyperplasia composed of?
Kupffer cells, hepatocytes, biliary structures
Where does focal nodular hyperplasia arise from?
Areas of congenital vascular malformation
Who is focal nodular hyperplasia MC in?
Women under 40- hormone driven
What is the MC liver malignancy?
Hepatocellular carcinoma
What is associated with development of HCC?
Chronic liver disease ex. Hep B, C, cirrhosis
Aflatoxin exposure
Hepatocarcinogens
HCC is known as hepatoblastoma up to what age?
4 yo, most cases under 1 yo
What is the 3rd most common malignant tumor in children?
Hepatoblastoma
Mets to the liver usually come from what primary sites?
Colon, breast, lungs
HCC often metastasizes to where?
Pancreas, stomach, esophagus
What are gallstones composed of?
Bilirubinate, cholesterol, and calcium carbonate
What are the five F’s for cholelithiasis?
Fat, female, forty, fertile, fair
What other diseases are associated with development of Cholelithiasis?
- obesity
- diabetes
- pancreatitis
- parasitic disease
- biliary tree infection
What is sludge AKA?
Sand or microlithiasis
What is a sludge ball AKA?
Tumefactive sludge
Who gets Cholecystitis most often?
Women 40-60s
What are the causes of acute Cholecystitis?
90-95% stones
5-10% parasitic/bacterial
What two signs related to acute Cholecystitis indicate an emergent situation?
Positive Murphy’s sign & > 3 mm wall
What is gangrenous cholecystitis?
Intermural hemorrhage and ulceration of mucosal surfaces
Chronic cholecystitis can progress to what?
Carcinoma
What causes hydrops of the GB?
Cystic duct obstruction causes bile to be reabsorbed, GB is filled with secretions from mucosa layer
What is hydrops of GB AKA?
Mucocele
What is Courvoisier’s law?
Enlarged GB of a jaundiced patient is usually caused by obstruction of a biliary duct
Who is porcelain GB MC in?
Females over 60
Porcelain GB increases the risk of what?
GB carcinoma
Who is primary GB carcinoma MC in?
Females 50-80 yo
The MC primary that metastasizes to the GB is?
Melanoma
What measurement of the CHD warrants further evaluation?
6 mm
What is Caroli’s disease AKA?
Communicating cavernous dilation
Who is Caroli’s disease more common in?
People under 30
Who is choledochal cyst MC in?
20 yo Asian women
Where is choledocholithiasis MC?
Distal CBD
What is primary choledocholithiasis? What is secondary?
Primary: stones form within the duct due to stasis
Secondary: stones form within GB then pass through GB via cystic duct
What causes cholangitis?
Stone or interventional procedure
What diseases is cholangitis associated with?
IBS and UC
What is ascariasis AKA?
Roundworm
What causes hemobilia?
Interventional procedures, vascular malformation, cholangitis, cholecystitis, malignancies
What causes pneumobilia?
Procedures, biliary-enteric fistula, cholelithiasis, chronic cholecystitis
What is Adenocarcinoma?
Cancer of mucus secreting glands
What populations most often get cholangiocarcinoma?
Japanese and Thai
Where is a Klatskin tumor located?
Hilar region (where L & R hepatic ducts join and form CHD)
How does CF affect the pancreas?
- can lead to acute pancreatitis
- panc undergoes fatty replacement
What are the 5 B’s related to acute pancreatitis development?
Booze, blood, bile, bug, birth
What is phlegmon?
Noninfected solid mass of panc tissue
What 3 permanent complications does chronic pancreatitis lead to?
- Poor absorption of food=weight loss
- Pain
- Diabetes from damaged islets of Langerhans
What is a Cystadenoma? What is it also called?
Rare benign lesion, AKA microcystic or serous adenoma
Who typically gets Cystadenoma?
Women ~70s
What condition is associated with Cystadenoma?
Von Hippel-Landau syndrome (can cause panc cysts with thick fluid & calcs)
What is Cystadenocarcinoma?
Pre malig or malig, slow growing tumor, arises from panc ducts as a cystic neoplasm
Who most often gets Cystadenocarcinoma?
Women in 50s
What is adenocarcinoma AKA? (Pancreas)
Mucinous or colloid carcinoma
What is the MC panc neoplasm?
Adenocarcinoma
Who is Adenocarcinoma MC in?
Men
What signs indicate eligibility for a whipple procedure?
Adenocarcinoma located at panc head with hydrops, compressed IVC, and biliary dilation
What percentage of Islet Cell tumors are malignant?
90%
What is the difference between nonfunctional and functional Islet Cell tumors?
Nonfunctional: no symptoms, typically malig
Functional: produce hormone response
What are insulinoma, gastrinoma and glucagonoma?
Insulinoma: MC, causes hypoglycemia
Gastrinoma: causes diarrhea & peptic ulcers
Glucagonoma: causes rash
The pituitary tumor that causes elevated ACTH and results in excessive cortisol is called what?
Cushing’s disease
The disease that causes excessive aldosterone production is known as?
Conn’s disease
What is Addison’s disease?
Abnormally low cortisol and aldosterone production
What is neuroblastoma?
Pediatric sarcoma arising from adrenal medulla
What is the MC childhood malignancy?
Neuroblastoma
How is tuberculosis related to the adrenal glands?
Adrenals are the MC involved organ, resulting from adrenal insufficiency (Addison’s disease)
When do the adrenal glands develop?
6 weeks gestation
What are the layers of the adrenal cortex?
Zona glomerulosa, zona fasciculata, zona reticularis (inner)
What shape are the adrenal glands?
V or Y
What happens to the adrenal glands in the first 10 days of life?
They decrease rapidly in size
What does the adrenal cortex secrete?
- steroids
- mineralcorticoids
- glucocorticoids
- gonadal hormones
What does the adrenal medulla secrete?
- catecholamines: epinephrine/norepinephrine
- endocrine hormones
What does aldosterone do?
Steroid that regulates salt and water = blood pressure
What is cortisol?
Steroid that increases neurologic use of glucose, fight or flight
What is ACTH?
Adrenocorticotropic hormone, regulates cortisol production
What are metanephrines?
Metabolic byproduct of catecholamines, excreted in urine and blood
What is VMA?
vanillylmandeic acid, metabolic byproduct of epi/norepinephrine, used to detect neuroblastomas
How is histoplasmosis related to adrenal glands?
Inhalation of fungal spores resulting in adrenal insufficiency
How does cytomegalovirus affect the adrenals?
Causes adrenal insufficiency and adrenitis
How commonly does accessory spleen occur?
In 30% of population
What is splenic atrophy also called?
Autosplenectomy
What is Gaucher’s disease?
Metabolic disorder causing accumulation of lipid cells in organs, mostly spleen and liver
Who gets Gaucher’s disease?
50% under 8 yo, 17% under 1 yo
What is Neimann-Pick disease?
Disorder causing inability to metabolize lipid cells and leads to apoptosis (cell death)
What is hemolytic anemia?
RBCs are destroyed at a higher rate than bone marrow can compensate for
What is polycythemia vera? How does it affect the spleen?
Excess RBCs, causes splenomegaly and splenic infarction
What is a FAST exam?
Focused Assessment with Sonography for Trauma
What causes splenic infarction?
Occlusion of splenic artery or branches, results from embolus from the heart
Who most commonly gets splenic infarction?
Those with
- pancreatitis
- leukemia
- lymph disorders
- sickle cell anemia
What is the MC benign splenic tumor?
Hemangioma
What is hemangiosarcoma?
Rare malignancy arising from vascular endothelium of the spleen
What is the benign tumor made up of an abnormal mixture of cells and tissues (mainly lymphoid tissues) known as?
- commonly occurs in the spleen
Hamartoma
What is a lymphangioma?
Malformation of the lymphatics consisting of cystic spaces of varying size, benign
spleen
What is the MC involved organ with lymphoma?
Spleen
What is the 10th most common site of mets?
Spleen
What is an ectactic aneurysm?
Diffuse enlargement of entire aorta
Where is AAA typically located?
Infrarenal
A pseudoaneurysm is a defect in what layer of the aorta wall?
Adventitia
What is a tear in the intimal wall allowing blood flow between the intima and media called?
Aortic dissection
What section of bowel does Crohn’s disease most commonly affect?
Terminal ileum
The diameter of an appendix with appendicitis is over what?
6 mm
What is the MC location of Adenocarcinoma in the abdomen?
Colon, rectum, rectosigmoid
What does intussusception resemble on ultrasound?
Transverse kidney
What is volvulus?
Torsion of bowel loop
What is an incarcerated hernia?
Hernia that centrally protrudes and cannot return to normal position
What is the most common cause of rectus sheath hematoma?
C-section
What is a desmoid? (Abdomen)
Benign fibrous tumor arising from muscle sheath and connective structure
What is transudative ascites?
Caused by high serum albumin, anechoic, free bloating bowel, fluid conforms to structure and pt position
What is exudative ascites?
Response to malignancy or inflammation, thickened and matted bowel, echogenic debris and septations
What is loculated ascites?
Doesn’t conform to structures or pt position
How does pseudomyxoma peritonei spread malignant cells?
It fills the peritoneal cavity with mucinous/gelatinous ascites, tumor implants on peritoneal surfaces
What are common locations for abdominal lymphadenopathy?
- para-aortic
- mesenteric & celiac
- hypogastric
- intraperitoneal: splenic, parapancreatic, hepatic hilum
What is transitional cell carcinoma?
Primary malignant tumor originating in urinary collecting system
What is the MC renal fusion anomaly?
Horseshoe kidney
What is the MC congenital renal anomaly?
Extrarenal pelvis
When does kidney ascent happen?
12-15 weeks gestation
Who does unilateral multicystic dysplastic kidney occur in?
Children, non hereditary
What is the MC form of cystic disease in neonates?
Unilateral multicystic dysplastic kidney
Who is medullary sponge kidney MC in?
Children
Who does medullary cystic disease affect most often?
Young adults
What are the four types of infantile Polycystic kidney disease?
Perinatal, neonatal, infantile, juvenile
What happens to people with adult Polycystic kidney disease by about 60?
End stage kidney disease
Is UMDK hereditary?
No
Are medullary sponge kidney or medullary cystic disease hereditary?
Medullary sponge- no
Medullary cystic- autosomal recessive
What is the difference between medullary sponge kidney and medullary cystic disease?
Medullary sponge: non hereditary, small cysts on tubules or collecting ducts
Medullary cystic: autosomal recessive, small cysts result in fibrosis/scarring of parenchyma & tubules
What is the difference between infantile Polycystic kidney disease and adult polycystic kidney disease?
Infantile: dilation of collecting tubules, autosomal recessive
Adult: cysts in cortex & medulla, autosomal dominant
What causes acute glomerulonephritis? What is it?
Accumulation of inflammatory elements, necrosis of glomeruli
What is angiomyolipoma also called?
Renal hamartoma
At what measurement is there a chance of hemorrhage from an angiomyolipoma?
> 4 cm
What is an oncocytoma? Who does it occur more often in?
Benign tumor made up of oncocytes & epithelial cells, MC in older men
What is a mesoblastic nephroma? Who does it affect?
Tumor composed of mesoderm tissue, children
What is renal cell carcinoma also known as?
Hypernephroma
What is Nephroblastoma AKA?
Wilm’s tumor
What is the difference between mesoblastic nephroma and nephroblastoma?
MN: pedi benign tumor
Nephroblastoma: pedi malignant tumor
What congenital anomaly is Nephroblastoma associated with?
Horseshoe kidney
What are the 3 causes of Hydronephrosis?
Congenital: anatomic variants
Intrinsic: stones, tumors
Extrinsic: trauma, infections
How is Hydronephrosis categorized?
Grade I-IV
Renal calculi is more common in?
Males
What is an increased calcium level in blood and/or urine that leaves deposits in the kidney parenchyma called?
Nephrocalcinosis
Who is Nephrocalcinosis common in?
Infants
What are possible results of trauma to the kidney(s)?
- rupture of kidney & capsule
- subcapsular hematoma
- parenchymal laceration
- urinoma
What is the difference in appearance of acute renal infarction and chronic renal infarction?
Acute: Hypoechoic
Chronic: Hyperechoic, small size, capsular retraction or scarring
What renal condition has hypertension as its only symptom?
Renal artery stenosis
How does kidney size change during and after the acute phase of renal vein thrombosis?
During: increased size
After: decreased size
What are extensions of the intimal layer within veins called?
Bicuspid valves
What percentage of blood volume does the deep venous system carry?
85%
What liver pathology causes elevated ALP and bilirubin?
Fatty infiltration
What pathology causes elevated ALT, AST, and bilirubin?
Acute and chronic hepatitis
What pathology causes elevated ALT, ALP, AST, and bilirubin?
Cirrhosis
What pathology causes increased lactic acid dehydrogenase?
Glycogen storage disease
What is the most likely cause of hepatic jaundice?
Cholelithiasis
Which of the following is most common in post menopausal women?
A. Grave’s Disease
B. Secondary hyperparathyroidism
C. Primary hyperparathyroidism
D. Hypothyroidism
C
Which biliary condition does not belong?
A. Tumefactive sludge
B. Polyp
C. Cholelithiasis
D. Adenoma
Cholelithiasis
Which liver condition would result in the formation of collateral vessel pathways?
A. Fatty infiltration
B. Glycogen storage disease
C. Portal hypertension
D. Budd-Chiari syndrome
C
What is the most common TIPS connection?
A. MPV to MHV
B. LPV to RHV
C. RPV to RHV
D. MPV to RHV
C
Which pancreatic malignancy is more likely to occur in males than females?
Adenocarcinoma
Where does the lymphatic system join with the vascular system?
Capillary beds
A 57 year old woman with a history of Type I diabetes presents with a palpable abdominal mass. What is the likely diagnosis?
Cystadenocarcinoma
A benign angiomyolipoma can easily be mistaken for
Metastatic tumor
It is important to fully sweep through the kidney to rule out a possible _____ mass/cyst
Exophytic
What is the difference between afferent and efferent lymph vessels?
Afferent: bring lymph into nodes
Efferent: drain processed lymph from node into lymph vessels
What percent of blood volume becomes lymph?
10%
Where are the largest lymph nodes in the body located?
Axilla, inguinal region, submandibular
What is the maximum cortical thickness of a normal lymph node?
3 mm, must be measured on anterior side
What midline vessel requires paracentesis access to be in the lateral abdomen?
Inferior epigastric artery, deep circumflex iliac artery (inferior)
What are the veins stretched across the distended abdomen called?
Caput medusa
Select the correct pathway:
Tubuli recti > rete testis > efferent ductules > ductus epididymis > vas deferens > seminal vesicle > ejaculatory duct > urinary duct > urethra
Seminiferous tubules > mediastinum testes > tubuli recti > ductus epididymis > efferent ductules > seminal vesicle > vas deferens > ejaculatory duct > urethra
Tubuli recti > efferent ductules > rete testis > ductus epididymis > vas deferens > seminal vesicle > urinary duct > ejaculatory duct > urethra
Seminiferous tubules > mediastinum testis > rete testis > ductus epididymis > efferent ductules > vas deferens > seminal vesicle > ejaculatory duct > urethra
Tubuli recti > rete testis > efferent ductules > ductus epididymis > vas deferens > seminal vesicle > ejaculatory duct > urinary duct > urethra