Anatomy Practice #3 Flashcards
The cup-like or funnel shaped extensions of the renal sinus that originate at the papilla and collect urine that is coursing toward the renal pelvis:
pyramids
cortex
minor calyces
major calyces
minor calyces
The splenic artery courses across the ___ surface of the pancreas
anterior inferior
posterior superior
posterior inferior
none of the above
posterior superior
A patient presents with increased red and white blood cell count on urinalysis. These clinical and imaging findings are most suggestive of:
cystitis
TCC
bladder hematoma
neurogenic bladder
cystitis
What vessel is indicated by #4?
splenic artery
SMA
celiac trunk
hepatic artery
hepatic artery
The ___ arteries are the vessels that course between the renal pyramids.
interlobar
segmental
arcuate
lobular
interlobar
When resistance in the distal vascular bed decreases, what happens to the RI?
no change unless collateral vessels present
decreases
increases
no change
decreases
Which of the following structures lies posterior to the diaphragm crura?
IVC
AO
celiac axis
AO and IVC
AO
What renal structure/region is being measured on the image?
renal parenchyma, abnormally thinned
renal parenchyma, normal thickness
renal pyramid bed, normal thickness
renal sinus, normal thickness
renal parenchyma, normal thickness
The LRV courses laterally from the left kidney to the IVC by traveling:
posterior to the RRA
posterior to the AO and RRA
anterior to the AO and posterior to the SMA
anterior to both the AO and SMA
anterior to the AO and posterior to the SMA
The IMV empties into the:
SMV
left gastric vein
splenic vein
MPV
splenic vein
The ___ arteries are the vessels that course perpendicular to the renal capsule within the outer renal parenchyma.
interlobar
segmental
arcuate
interlobular
interlobular
Where is the distal CBD located on this image
What structure/vessel is indicated by #4?
SMA
AO
IVC
SMV
LRV
SMA
What renal structure/region is indicated by #2?
major calyx mid pole
major calyx lower pole
major calyx upper pole
renal pyramid
major calyx upper pole
The celiac axis originates from the ___, ___, to the body of the pancreas.
AO, superior
PV, inferior
AO, inferior
SMA, superior
AO, superior
What is indicated by the X on the image?
psoas muscle
complicated ascites
adrenal gland
rectus abdominis muscle
psoas muscle
Which of the following is not a required part of an ultrasound evaluation for a suspected AAA?
assess location in relationship to the RAs
evaluate the AP and width measurements of the true and false lumen if thrombus is present
evaluate flow in both internal iliac arteries
evaluate the length of the affected segment
evaluate flow in both internal iliac arteries
What structure/vessel is indicated by #10?
LRA
LRV
RRV
RRA
LRV
The image is a TRV view of the midline abdomen. What structure/vessel is indicated by #1?
RRA
AO
RRV
IVC
IVC
Which of the following would be used to describe the normal sonographic appearance of the spleen?
mottled appearance
lobulated borders
prominent internal vascularity
heterogeneous echotexture
prominent internal vascularity
Where is the HA in this image?
This image demonstrates the AO, SMA, and LRV
celiac axis and it’s branches
SMA is anterior to AO
HA is not visualized
What structure/vessel is indicated by #9?
IVC
AO
SMA
spine
IVC
The kidneys release renin to stimulate the release of:
anti-diuretic hormone to counteract low blood pressure
angiotensin to counteract high blood pressure
anti-diuretic hormone to counteract high blood pressure
angiotensin to counteract low blood pressure
angiotensin to counteract low blood pressure
The AO bifurcates:
3-5cm below the umbilicus
at the level of the L4 vertebral body
at the level of the sacrum
3-5cm
below the SMA origin
the AO bifurcates into the RCIA and LCIA at the level of L3-L4 vertebrae
The white arrows on the image indicate
perinephric fat
Morison pouch
subcapsular hematoma
psoas muscle
perinephric fat
(note the medium gray, mottled echogenicity of the fat)
What vessel can be used to differentiate the LRV and splenic vein on the ultrasound exam?
LRA
RRA
SMA
SMV
SMA
LRV is posterior to the SMA
splenic vein is anterior to SMA
Which of the following corresponds with #4 on the image?
splenic vein
IVC
SMV
LRV
splenic vein
The renal arteries branch from the AO just below the origin of the ____.
gonadal arteries
SMA
IMA
celiac axis
SMA
The LCCA is a branch of which artery?
left innominate artery
AO arch
left vertebral artery
left subclavian artery
AO arch
When trying to distinguish free fluid in the abdomen from the IVC, which of the following is true?
the IVC will not demonstrate respiratory changes in diameter, while fluid pocket size/shape will vary respiration
color Doppler is an effective tool in differentiating the IVC from free fluid
the IVC will demonstrate respiratory changes in diameter, while fluid pocket size/shape will not vary respiration
the intrabdominal fluid is most commonly seen on the left side of the abdomen and the IVC is located on the right side of the abdomen
Color Doppler is an effective tool in differentiating the IVC from free fluid
both IVC and fluid pockets vary in size with respiration
Applying color Doppler to the distended urinary bladder identifies two ureteral jets at the trigone of the bladder that are directed toward the opposing sides of the bladder. The color demonstrates the flow from the two ureters as an “X” within the bladder lumen. Which of the following statements best characterizes these findings?
this is a normal finding
bilateral posterior urethral valves are most likely present
the ureters are abnormally inserted into the bladder causing eccentric ureteral jet formation
the patient most likely has cystitis with ureteral inflammation leading to eccentric urine jet formation
this is a normal finding
While imaging the long axis of LRV, you identify an anterior, somewhat parallel vessel that demonstrates flow moving in the same direction. What vessel is this?
IVC
SMV
splenic vein
splenic artery
splenic vein
Which structure is most posterior at the renal hilum?
ureter
vein
artery
vein = anterior
artery = middle
ureter = posterior
The image is a TRV view of the midline abdomen. What structure/vessel is indicated by #3?
LRV
RRA
RRV
LRA
RRA
Where is the LRA in this image?
Which structure is most anterior at the renal hilum?
ureter
vein
artery
vein = anterior
artery = middle
ureter = posterior
What vessel is indicated by #2?
splenic artery
celiac trunk
hepatic artery
SMA
celiac trunk
Which of the following vessels is not directly connected to the IVC?
right suprarenal vein
right gonadal vein
left gonadal vein
RRV
left gonadal vein
On a longitudinal scan, this vessel is seen in cross section posterior to the IVC
RRA
RRV
LRA
LRV
RRA
The spleen produces ___ and their main function is to control antibodies and prevent infection.
amylase
aldosterone
platelets
leukocytes
leukocytes
Billroth cords in the red pulp of the spleen are responsible for ___ destruction. Malpighian corpuscles in the white pulp or the spleen are responsible for ___ production.
lymphocytes, RBC
platelets, lyphocyte
RBC, lymphocyte
lymphocyte, platelet
RBC, lymphocyte
The psoas muscle is ___ to the kidney
anterolateral
posteromedial
posterolateral
anteromedial
posteromedial
The renal medulla contains ___ pyramids in an average adult kidney
12-24
8-18
1-5
3-10
8-18
Which of the following is responsible for extramedullary hematopoiesis?
kidneys
spleen
thyroid
gallbladder
spleen
This vessel arises from the anterior AO and courses inferiorly, parallel to the AO
SMV
common hepatic artery
splenic artery
SMA
SMA
The ___ arteries are the vessels that course parallel to the renal capsule within the parenchyma.
segmental
interlobular
lobular
arcuate
arcuate
____ is being measured by the calipers because ___ is suspected from findings seen on the image.
the diameter of the LRV, Nutcracker syndrome
pyloric channel, pyloric stenosis
the diameter of the LRA, renal artery stenosis
the diameter of the RRA, renal artery stenosis
the diameter of the LRV, Nutcracker syndrome
What vessel is indicated by the red arrow?
LRV
RRA
RRV
LRA
RRA - courses posterior to the IVC to reach the right kidney
Which of the following corresponds with #3 on the image?
SMA
RRV
LRV
AO
LRV
Where is the SMV on this image?
What structure/vessel is indicated by #2?
IVC
celiac axis
mid AO
prox AO
SMA
SMA
Which of the following correctly describes the difference between the normal waveform in the RA and the external iliac artery?
the RA flow is triphasic and the EIA demonstrates monophasic flow
the RA flow is high resistance and the EIA demonstrates low resistance flow
the RA flow is monophasic and the EIA demonstrates triphasic flow
the RA flow is laminar and the EIA demonstrates nonlaminar flow
the RA flow is monophasic and the EIA demonstrates triphasic flow
The SMA originates from the AO approximately ___ below the celiac axis and posterior to the ___.
2-3cm, stomach and duodenum
1-2cm, body of the pancreas
2-3cm, body of the pancreas
2-2cm, stomach and duodenum
1-2cm, body of the pancreas
Which of the following is a part of the renal parenchyma?
minor calyces
pyramids
segmental arteries
major calyces
pyramids
In most patients, the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of patients, the right hepatic artery originates from the ___ and the left hepatic artery originates from the ___.
celiac axis, coronary artery
SMA, left gastric artery
LRA, RRA
splenic artery, common hepatic artery
SMA, left gastric artery
A retrorenal spleen is an important consideration when planning:
the point of entry for a paracentesis
a left renal biopsy
AAA repair
treatment for PHTN
a left renal biopsy
a renal biopsy is usually performed with the patient in prone position, if a portion of the spleen is posterior to the kidney it could be inadvertently hit by the biopsy needle
The left renal vein passes ___ to the AO to enter the medial aspect of the IVC.
posterior
superior
anterior
cephalad
anterior
Where is the GE junction on this image?
Where is the SMA in this image?
The major branches of the celiac axis are:
left gastric, splenic, common hepatic artery
hepatic, gastroduodenal artery, splenic
left gastric, common hepatic artery, gastroduodenal artery
left gastric, SMA, gastroduodenal artery
left gastric, splenic, common hepatic artery
The round anechoic structures in the renal parenchyma indicate:
acquired cystic disease
multicystic kidney disease
ADPKD
normal medullary pyramids
normal medullary pyramids
Autoregulation of the systemic blood pressure refers to:
the release of epinephrine to cause constriction of the convoluted tubules
the renin-angiotensin system that controls the glomerular filtration rate of the kidneys and systemic BP level
the renin-angiotensin system that controls the level of construction of the convoluted tubules
the release of norepinephrine to cause constriction of the convoluted tubules
the renin-angiotensin system that controls the glomerular filtration rate of the kidneys and systemic BP level
The diameter of the normal abdominal AO is greatest at the level of the:
iliac bifurcation
celiac
SMA
renal arteries
celiac
AO diameter is greatest at the level of its origin, the celiac axis is the most superior branch
A 3 year old presents for a renal scan, complaining of left sided pain. No renal abnormality was identified on the exam but a common anatomical variant was identified. What is the term for a single cortical bulge off of the lateral border of the left kidney?
dromedary hump
column of bertin
fetal lobulation
cortical hyperplasia
dromedary hump
The quadratus lumborum muscle is ___ to the kidney.
medial
lateral
posterior
anterior
posterior
The term “splanchnic arteries” describes which of the following vessels?
celiac, SMA, IMA
hepatic, renal, splenic, celiac arteries
renal, suprarenal, splenic, gastric arteries
all arterial branches of the abdominal AO from the diaphragm to the umbilicus
celiac, SMA and IMA
The fibrous capsule surrounding the kidneys, fat, and adrenal glands is referred to as:
Glisson fascia
Gerota fascia
peritoneum
Glisson capsule
Gerota fascia
How is the renal cortex measured correctly?
calipers are placed on the peak of the pyramid to the outer edged of the parenchyma
cortical thickness should be measured in the TRV view of the kidney
cortical thickness is always reported from just the right kidney because it is typically thicker than the left kidney
calipers are placed on the base of the pyramid to the outer edge of the parenchyma
calipers are placed on the base of the pyramid to the outer edge of the parenchyma
should be measured in the longitudinal view
Where is the IVC in this image?
A prior CT report for your current patient states there is possible thrombus in the ovarian vein but does not identify which one. The longitudinal image of the IVC is from the US exam, which ovarian vein is thombosed?
medial
right
left
lateral
right
The renal arteries arise from the lateral walls of the AO ____.
at the level of the SMA origin
1-2cm above the SMA origin
2-3cm below the SMA origin
2-3cm below the IMA origin
2-3cm below the SMA origin
A patient presents with a history of renal calculi. The image displayed is from the area of pain in the LLQ. What is indicated by the green arrow?
iliac vein
iliac artery
inguinal ligament
dilated ureter
iliac artery
The loops of Henle are located in which portion of the kidney:
pyramids
medulla
cortex
sinus
medulla
The renal cortex contains which of the following:
loops of Henle
calyces
pyramids
Bowman capsule
Bowman capsule
The image is a TRV view of the midline abdomen. What structure/vessel is indicated by #4?
RRV
LRA
RRA
LRV
LRV
What vessel is indicated by #1?
celiac trunk
HA
splenic artery
SMA
splenic artery
A thickened area of normal renal parenchyma between 2 pyramids is called:
dromedary hump
duplicated collecting system
fetal lobulation
column of Bertin
column of Bertin
The splenic vein is located:
posterior to the PV
anterior to SMA
anterior to the pancreas
posterior to the SMA
anterior to the SMA
What structure/vessel is indicated by #11?
RRV
RRA
LRA
LRV
RRV
Dehydration can be caused by reduced levels of ___ in the blood.
anti-diuretic hormone
epinephrine
cortisol
bilirubin
anti-diuretic hormone
Measurements of the bladder wall thickness should normally be no more than ___ when fully distended and no more than ___ when nearly empty.
3mm, 5mm
5mm, 3mm
5mm, 8mm
0.5cm, 1.0cm
3mm, 5mm
Which vessel is seen coursing laterally, posterior to the IVC?
IMV
LRA
SMV
RRA
RRA
Which of the following corresponds with #2 on the image?
AO
SMA
spine
IVC
AO
The spleen’s normal echotexture is:
homogenous throughout
homogeneous with portal echoes seen throughout
mildly inhomogeneous
homogenous and hyperechoic compared to the sinus of the left kidney
homogenous throughout
The proximal SMV is normally located ___ the proximal SMA in the abdomen.
to the right of
to the left of
posterior to
superior to
to the right of
Which of the following corresponds with #1 on the image?
LRV
AO
CBD
SMA
SMA
Which of the following lists the branches in the correct order that they originate from the AO arch?
right innominate, left carotid, left innominate
right subclavian, right carotid, left innominate
innominate, left carotid, left subclavian
innominate, right carotid, left subclavian
innominate, left carotid, left subclavian
What structure/region is indicated by #3?
major calyx lower pole
major calyx mid pole
renal pyramid
major calyx upper pole
major calyx lower pole
Which of the following vessels follow a retroaortic course in the abdomen?
portal confluence
RRA
LRA
none of the above
none of the above
Where is the gastroduodenal artery on this image?
The IVC and SVC empty their blood into the ___.
right ventricle
left atrium
right atrium
left ventricle
right atrium
What structure/vessel is indicated by #2?
MPV
common hepatic artery
LHV
IVC
LPV
IVC
Which of the following vessels follow a retrocaval course in the abdomen?
LRA
RRA
SMA
portal confluence
RRA - courses posterior to the IVC to reach the right kidney
What structure/vessel is indicated by #8?
IVC
SMA
AO
spine
AO
All of the following structures are directly medial and anterior to the splenic hilum, EXCEPT:
fundus of the stomach
lesser sac
pancreatic tail
Morison pouch
Morison pouch
Which portion of the bladder is in direct contact with the anterior vaginal wall/prostate?
dome
base
apex
fundus
base
The ___ region is defined by the orifices of the two ureters and the urethral outlet?
trigone
base
fundus
dome
trigone
Where is the RRV on this image?
The largest abdominal tributaries of the IVC are the:
HVs
MPV
gonadal veins
renal veins
HVs
Where is the splenic artery on this image?
the splenic artery is not visible in this image
Hutch diverticula are identified in the:
small bowel
large bowel
gallbladder
urinary bladder
Hutch diverticula are congenital outpouchings of the bladder wall near the ureteral orifice
All of the following are seen posterior to the kidney, EXCEPT:
levator ani muscle
psoas muscle
quadratus lumborum muscle
diaphragm
levator ani muscle - forms the pelvic floor
The renal pyramids are found in the:
calyces
cortex
sinus
medulla
medulla
Which of the following best describes the normal Doppler tracing from the renal arteries?
low resistance waveform with increased diastolic flow reversal
low resistance waveform with increased diastolic flow
triphasic waveform with increased diastolic flow reversal
high resistance flow with increased diastolic flow reversal
low resistance waveform with increased diastolic flow
Accessory spleens are usually seen:
adjacent to the inferior pole of the kidney
at the posterior aspect of spleen
near the porta hepatis
near splenic hilum
near splenic hilum
Which of the following describes the location of lymphocyte production in the spleen?
Malpighian corpuscles
Kupffer cells
red pulp
alpha cells
Malpighian corpuscles
The image is a TRV view of the midline abdomen. What structure/vessel is indicated by #2?
IVC
AO
RRV
RRA
AO
What major branch of the celiac axis is not visible on the image?
HA
left gastric artery
splenic artery
SMA
left gastric artery
The image is a TRV view of the midline abdomen. What structure/vessel is indicated by #5?
SMA
AO
MPV
SMV
SMA
What vessel is indicated by #3?
IVC
HA
AO
SMA
AO
The average measurement of the normal spleen is:
6-10cm
less than 12cm
5-8cm
6-10mm
less than 12cm
Where is the LRV in this image?
