Clinical #2 Flashcards
Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction?
dorsal
cavernosal
urethral
ventral
cavernosal
A patient presents for an extremity ultrasound to evaluate the bicep tendon for tendonitis. The following image was obtained on the symptomatic left arm. All of the following would improve the tendon evaluation, EXCEPT:
rock the transducer back and forth to ensure the transducer face is perpendicular to the tendon
the right bicep tendon should be evaluated to provide comparison views
power Doppler should be applied to assess any increased vascularity associated with inflammation
ask the patient to hold a 5lb weight and reassess the thickness of the tendon
ask the patient to hold a 5lb weight and reassess the thickness of the tendon
A patient presents with a history of Addison disease. Which of the following hormone levels will be increased?
cortisol
aldosterone
ACTH
epinephrine
ACTH
When removing a protective gown:
untie the strings, pull the gown forward from the shoulders using the neck strings to turn it inside out as it is removed, remove your gloves, wash your hands
remove your glove, untie the strings, pull the gown forward from the center of the front of the gown to remove it with the exposed side out, roll it into a ball, wash your hands
remove your gloves, untie the strings, pull the gown forward from the shoulder using the neck strings, grab the inside shoulder seams to pull it off the arms and turn it inside out as it is removed, wash your hands
untie the strings, roll the gown from the bottom edge to turn it inside out, pull it from the shoulder and off the arms, remove your gloves, wash your hands
remove your gloves, untie the strings, pull the gown forward from the shoulder using the neck strings, grab the inside shoulder seams to pull it off the arms and turn it inside out as it is removed, wash your hands
When the prostate is enlarged, what other structures should be evaluated for related findings?
PV for thrombosis
RVs for Nutcracker syndrome
kidneys for hydronephrosis
RAs for thrombosis
kidneys for hydronephrosis
Chest sonography is a valuable tool that can be used to evaluate all of the following EXCEPT:
pleural effusion
pneumothorax
pulmonary sequestration
the number of lobes in each lung
the number of lobes in each lung
A patient presents with a history of Conn syndrome. Which of the following hormone levels will be increased?
epinephrine
aldosterone
ACTH
cortisol
aldosterone
A patient presents for a neck ultrasound due to swelling under the angle of the jaw and anterior to the ear. She also complains of a dry mouth, dry cough, and dry eyes. These clinical findings are most suggestive of:
Hashimoto thyroiditis
Graves’ disease
sjogren syndrome
hemolytic anemia
sjogren syndrome
A 40 year old male presents for an abdominal ultrasound exam with a history of anxiety, headaches, and excessive sweating. His current BP is 175/90mmHg with a pulse of 102bpm. What is the referring doctor expecting to find?
pheochromocytoma
adenoma
aortic aneurysm
Budd Chiari
pheochromocytoma
A pituitary tumor that is causing Cushing syndrome will cause what lab value(s) to be increased?
aldosterone only
ACTH only
ACTH and cortisol
cortisol only
ACTH and cortisol
Which of the following prostate abnormalities most significantly elevates the amount of serum prostate specific antigen in lab testing?
carcinoma
prostatitis
abscess
BPH
carcinoma
causes increased PSA levels usually much more significantly than BPH
Prostatic Acid Phosphatase (PAP) levels are increased with:
prostate carcinoma
BPH
prostate calcifications
prostatitis
prostate carcinoma
Which of the following is a symptom of Addison disease?
hypernatremia
weight gain
hyperkalemia
hypertension
hyperkalemia
The image displayed is an infant hip ultrasound with measurements added. Which letter indicates where the alpha angle is measure?
B
C
D
none of the above
C
measured between the yellow and red lines
formed by the acetabular roof to the vertical cortex of the iliac bone
normal = greater or equal to 60 degrees
less than 60 degrees = dysplasia, subluxation, dislocation
A patient presents with a history of Cushing syndrome and an adrenal tumor. What lab results are expected in the clinical findings?
elevated cortisol levels in the urine
elevated epinephrine levels in the urine
elevated serum levels of cortisol and ACTH
elevated serum levels of aldosterone
elevated cortisol levels in the urine
no pituitary gland involvement = normal ACTH
A positive Tinel sign indicates:
pyloric stenosis
ruptured Achilles’ tendon
carpal tunnel syndrome
patellar tendonosis
carpal tunnel syndrome
Internal rotation of the arm is preferred for evaluation of the ___ tendon, while external rotation of the arm is preferred for evaluation of ___ tendon.
long bicep, short bicep
flexor, biceps
supraspinatus, subscapularis
subscapularis, supraspinatus
supraspinatus, subscapularis
Which of the following is not a common indication for a chest ultrasound in adults?
evaluate a superficial mass seen on chest CT
evaluate PICC line placement
suspected mass in the thymus
suspected pneumothorax
suspected mass in the thymus
All of the following are common symptoms of colitis, EXCEPT:
bloody diarrhea
hemoptysis
watery diarrhea
low grade fever
hemoptysis = coughing up bloody septum from the lungs
Which of the following structures can be used as an acoustic window when evaluating the pediatric mediastinum?
thymus
lung pleura
thyroid
diaphragm
thymus
Which of the following chest masses would be most easily be evaluated with ultrasound?
a mass located between the bronchial tubes
a mass located in the posterior lobes
a mass located between the pleura and chest wall
a mass located in the central portion of the lung
a mass located between the pleura and chest wall
no air to obscure the image
Which of the following describes the proper technique for visualization of the bicep tendon?
oblique probe position with the notch turned 30 degrees medially; placed on the posterior upper arm, just proximal to the elbow joint
scanning with the US beam as perpendicular to the tendon as possible to improve visualization
oblique probe position with the notch turned 60 degrees medially; placed on the anterior upper arm, just proximal to the elbow joint
longitudinal probe position on the posterior upper arm, just proximal to the elbow joint
scanning with the US beam as perpendicular to the tendon as possible to improve visualization
You are providing instructions for a patient that needs a core needle biopsy. Which of the following medications should be taken as initially prescribed until the day of the procedure?
aspirin
hypertension medication
ibuprofen
lovenox
hypertension medication
What clinical symptoms are common with adrenal hemorrhage?
nausea and vomiting
jaundice and low hematocrit
hyperkalemia and dysuria
weight loss and edema
jaundice and low hematocrit
Which of the following are clinical findings related to a pheochromocytoma?
hirsutism and bilateral pedal edema
palpitations and skin discoloration
bradycardia and fatigue
increased adrenaline and anxiety
increased adrenaline and anxiety
Excessive androgen production is commonly associated with adrenal hyperplasia, adrenal cortical cancer, and polycystic ovarian disease. How will these increased androgen levels present as a clinical finding?
pedal edema
hirsutism
excessive nausea and vomiting
alopecia
hirsutism
A mother presents with her 3 month infant due to excessive vomiting and crying for 3 days. The referring physician suspects a lactobezoar may be the problem. Where will you look for this abnormality?
anywhere along the digestive tract
appendix
gallbladder
urinary bladder
anywhere along the digestive tract
Red currant jelly stool is a common clinical finding associated with:
appendicitis
pyloric stenosis
intussusception
mesenteric ischemia
intussusception
The Graf classification requires the measurement of ____ to determine the presence of abnormal findings on the ultrasound exam.
vessel diameter
end diastolic velocity
resistive index
alpha and beta angles
alpha and beta angles
alpha angles < 60 degrees = abnormal
alpha angles <43 degrees = dislocation
Which of the following maneuvers is utilized to assist in the diagnosis of the abnormality displayed?
Murphy
Valsalva
Glisson
Homan
Valsalva
Which of the following is an important part of a transrectal ultrasound performed prior to brachytherapy?
to determine prostate size and volume
to locate the main arterial branch that is feeding the carcinoma
to obtain a PW Doppler signal from the base and apex of the gland
to measure the distance from the prostate to the anterior abdominal wall
to determine the prostate size and volue
determines the number of seeds needed and seed distribution
All of the following are clinical signs of congenital hip dysplasia, EXCEPT:
palpable clunking sound on physical exam
Allis sign
asymmetric skin folds of the hip and thigh
Barlow sign
Barlow sign - maneuver used to assess the hip during the exam
Hypernatremia and hypokalemia are clinical signs of:
Conn syndrome
Addison disease
adrenal hemorrhage
adrenal myelolipoma
Conn syndrome
Hyperpigmentation of the skin that results in brownish discoloration is a clinical sign of:
Conn disease
adrenal hemorrhage
Cushing syndrome
Addison disease
Addison disease
What does McBurney point refer to?
an ectopic ridge of thyroid tissue in the chest
as ectopic mass of endometriosis on the right kidney
the most common location of the appendix
the point of greatest tenderness in the RUQ in a patient with cholecystitis
the most common location of the appendix
Which of the following describes the placement for the first line for measurement of the alpha angle during an infant hip evaluation?
extends from the iliac bone along the labrum
extends from the bony edge of the acetabulum to the medial aspect of the femoral head
extends from the bony edge of the acetabulum to the lateral aspect of the femoral head
aligned with the iliac bone and extends through femoral head
Line 1 = aligned with the iliac bone and extends through the femoral head
Line 2 = extends from the iliac bone along the labrum on the MEDIAL aspect of the femoral head
Line 3 = extends from the bony edge of the acetabulum to the LATERAL aspect of the femoral head
Which of the following patients would need a guardian to sign an informed consent form for a liver nodule ablation?
a patient that does not speak English
a patient with Parkinson disease
a patient with Alzheimer disease
a blind patient
a patient with Alzheimer disease
Which of the following is a contraindication for transrectal ultrasound?
Crohn disease
significant prostatitis
hepatitis
lesion of the ileocecal valve
significant prostatitis
significant rectal abnormalities that prevent tolerable probe insertion: fissures, neoplasms, hemorrhoids, prostatitis
Sjogren syndrome is an immune system disorder that commonly affects:
thyroid
adrenal glands
bile ducts
salivary glands
salivary glands
When evaluating an infant for pyloric stenosis, the infant should be placed in the ___ position for better visualization of the pylorus.
semi-erect
LLD
prone
RLD
RLD
Which of the following are common symptoms of Cushing syndrome?
hypotension and fever
cholecystitis and ascites
anorexia and vomiting
hyperglycemia and hirsutism
hyperglycemia and hirsutism
A 55 year old male patient presents with a script that states “pelvic ultrasound; post biopsy, Gleason score of 8.” What should you expect to find on the exam?
inguinal hernia caused by recent bladder wall biopsy
lymphadenopathy and metastasis related to prostate cancer
lymphadenopthy and metastasis related to bladder TCC
bladder puncture caused by recent biopsy of the seminal vesicle
lymphadenopathy and metastasis related to prostate cancer
When evaluating an infant hip, the transducer is placed ___, but for a pediatric hip evaluation the transducer is placed ___.
on the lateral hip, on the posterior hip
on the anterior hip, on the posterior hip
on the lateral hip, on the anterior hip
on the anterior hip, on the lateral hip
on the lateral hip, on the anterior hip
Which of the following abnormalities would benefit the most from the administration of a water enema during the ultrasound evaluation?
gastric sarcoma
distal abdominal AO
adenocarcinoma of the descending colon
pancreatic adenocarcinoma (head)
adenocarcinoma of the descending colon
Which of the following describes the proper technique for the evaluation of a pediatric hip suspected transient arthritis?
comparison views of the unaffected hip should always be obtained
the curved array is used for the best evaluation of the curved structures in the boney hip
the normal hip capsule thickness is less than 1cm
transient arthritis requires an immediate arthrocentesis for fluid evaluation
comparison views of the unaffected hip should always be obtained
What patient age is preferred for performing ultrasound of the infant hips?
4-6 weeks
1-2 weeks
>6 months
4-6 months
4-6 weeks
Which of the following is a symptom of Addison disease?
hypokalemia
hypertension
hyponatremia
weight gain
hyponatremia
The ___ sign is a clinical finding with pyloric stenosis, while ___ sign is a sonographic sign of pyloric stenosis.
bird, snowman
pseudokidney, yin yang
olive, doughnut
murphy, homan’s
olive, doughnut
Which of the following should be performed when evaluating a suspected inguinal hernia?
use dual screen imaging, with and without valsalva, over the suspected location of the hernia
record bowel peristalsis on a cine clip
have the patient fill their bladder and evaluate the scrotal sac for pocket of urine
more than one of the above
more than one of the above
All of the following are signs and symptoms related to the abnormality seen on the images, EXCEPT
hematuria
leukocytosis
rebound tenderness in RLQ
nausea and vomiting
hematuria
appendicitis is associated with rebound tenderness, leukocytosis, nausea and vomiting
Unintended wight loss is a common symptom in patients with:
ascites
hypothyroidism
hyperglycemia
carcinoma
carcinoma
When an epigastric hernia is suspected in this patient, where will you look?
What patient position is used to evaluate the Achilles’ tendon with ultrasound?
prone, feet dangling
seated, knee and ankle flexed
seated, knee flexed and ankle extended
standing
prone, feet dangling
Cullen sign is hemorrhagic discoloration of the umbilical area caused by ___. Grey Turner sign is hemorrhagic discoloration of the left flank caused by ___.
cavernous transformation, gastric varices
rectus sheath hematoma, subcapsular renal hematoma
intraperitoneal hemorrhage, hemorrhagic pancreatitis
umbilical vein recanalization, gastric varices
intraperitoneal hemorrhage, hemorrhagic pancreatitis
Which of the following is a stress maneuver performed when evaluating infant hips?
Allis maneuver
Ortolani maneuver
Baker maneuver
Graf maneuver
Ortolani maeuver
If a patient has a non-reactive Thompson Test, what problem do they have?
hydatid cyst of the liver
complete tear of the Achilles tendon
fungal abscess of the liver
Baker cyst in the popliteal fossa
complete tear of the Achilles tendon
Which of the following sonographic techniques can be used to evaluate a possible inguinal hernia?
Valsalva maneuver
tissue Doppler
color Doppler
PW Doppler
color Doppler
A mother who is currently breast feeding presents with a painful and reddened area on the UOQ of the right breast. She states that she first noticed it two days ago. What is the most likely finding on her exam?
cyst
puerperal mastitis
inflammatory carcinoma
Paget disease
puerperal mastitis
Decreased hematocrit is associated with which of the following?
dehydration
polycythemia vera
living at high altitude
hemorrhagic cyst of the kidney
hemorrhagic cyst of the kidney
When evaluating the Achilles tendon, the thickness of the tendon should be obtained in what imaging plane?
coronal
transverse
oblique
sagittal
transverse
When a right spigelian hernia is suspected in the this patient, where will you look?
The image displayed is an infant hip ultrasound with measurements added. Which letter indicates where the beta angle is measured?
A
B
C
D
D
angle formed between the vertical cortex of the iliac bone and the triangular labral fibrocartilage
Which of the following is a stress maneuver performed when evaluating infant hips?
Graf maneuver
Baker maneuver
Allis maneuver
Barlow maneuver
Barlow maneuver
Chronic steroid use is the most common cause of:
Conn disease
Cushing disease
Cushing syndrome
Addison disease
Cushing syndrome
Which of the following describes the placement for the second line for measurement of the alpha angle during an infant hip evaluation?
extends from the iliac bone, along the labrum, and the lateral aspect of the femoral head
extends from the iliac bone, along the labrum, and the medial aspect of the femoral head
aligned with iliac bone and extends through the center of the femoral head
extends from the bony edge of the acetabulum to the lateral aspect of the femoral head
extends from the iliac bone, along the labrum, and the medial aspect of the femoral head
If you are unable to locate the prostate on transrectal ultrasound:
ask the patient to perform the Valsalva maneuver
use firm pressure to insert the transducer 2-3 inches further into the rectum
have the patient drink water and partially fill their bladder
introduce 30-50cc of air into the probe cover
have the patient drink water and partially fill their bladder
An average sized patient presents with a fever, acute RLQ pain and vomiting. The ER physician wants to rule out appendicitis in this patient. Which of the following techniques would be used in the US exam?
use a stand off pad to better visualize the superior bowel loops
ask the patient to drink 32oz of water and fill the bladder prior to the exam
apply graded transducer compression to the area of interest
ask the patient to perform the Valsalva maneuver while scanning
apply graded transducer compression to the area of interest
Which of the following describes the patient position for transrectal prostate ultrasound?
prone or fowler
trendelenburg or supine
LLD or lithotomy position
lithotomy or prone
LLD or lithotomy position
The most common use of chest sonography is to evaluate:
a complete or partial radiopaque hemithorax
suspected atelectasis
a known pulmonary embolism
suspected lung cancer
a complete or partial radiopaque hemithorax
Purple stretch marks (striae) on the lateral and lower abdomen can be a clinical sign of:
Addison disease
Conn disease
adrenal hemorrhage
Cushing syndrome
Cushing syndrome
