Clinical #3 Flashcards
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?
usually the sonographer opens multiple sizes of core biopsy needles and place them on the sterile procedure tray in case they are needed
using color Doppler to locate surrounding vascularity
measuring the depth of the mass within the liver
measuring the width of the mass in the liver
measuring the depth of the mass within the liver
Which of the following should always be included on the technologist worksheet that is given to the radiologist with the images?
limitations of exam performance
differential diagnoses for abnormal findings
follow up recommendations
thermal index setting during the exam
limitations of exam performance
An area of plaque or thrombus in an artery will be demonstrated as ___ on angiography.
an area of increased concentration of contrast material
a dark black area within the vessel
a highly reflective area within the vessel
an area of absence of contrast material
an area of absence of contrast material
Why is it necessary to obtain the PT and INR lab values prior to a liver biopsy?
to assess that patient’s risk for post procedure infection
to assess the patient’s risk for post procedure thrombosis of the PV
to assess the patient’s risk for post procedure hemorrhage
to asses the extent of cirrhosis within the liver
to assess the patient’s risk for post procedure hemorrhage
What is a Point of Care Ultrasound?
follow up exam on a known abnormality
ultrasound exam performed on the same day as the clinical evaluation
ultrasound exam performed at the office of the referring physician
focused evaluation used to answer a specific question
focused evaluation used to answer a specific question
When evaluating a suspected testicular varicocele, what patient position will be better demonstrate the abnormality?
decubitus right
supine
standing
decubitus left
standing
the increase in hydrostatic pressure will cause the vessels of the varicocele to dilate
The blue dot sign is a clinical finding of:
torsion of the testicular appendage
testicular varicocele
bladder calculi
thyroid adenoma
torsion of the testicular appendage
Which of the following indicates the proper order for putting on PPE?
mask, goggles, gloves, gown
goggles, gown, mask, gloves
gloves, gown, mask, goggles
gown, mask, goggles, gloves
gown, mask, goggles, gloves
Which of the following is a violation of HIPAA policies?
posting patient symptoms and demographics with an anonymous ultrasound image on social media
sharing an anonymized image from an exam with your sonography class
discussing exam results with a patient
discussing exam results with the patient’s physician
posting patient symptoms and demographics with an anonymous ultrasound image on social media
A patient presents for a thyroid biopsy with a script that states “US guided biopsy, cold nodule.” The patient does not have the report with them but they do have a copy of the nuclear medicine exam. What are you looking for on the NM exam to locate the nodule to be biopsied?
green areas with absence of accumulation of the radioactive isotope
bright red areas of increased accumulation of the radioactive isotope
white/light areas with absence of accumulation of the radioactive isotope
darker areas of increased accumulation of the radioactive isotope
white/light areas with absence of accumulation of the radioactive isotope
Which of the following statements is true regarding paracentesis?
because the diagnostic paracentesis is performed with a long thin needle instead of a catheter, a sterile field in not required for the procedure
the preferred entry point for fluid removal is on the right side at the level of Morrison pouch
paracentesis requires the use of the sterile field technique
an informed consent form is not required when a diagnostic paracentesis is performed - the form is only required for a therapeutic paracentesis
paracentesis requires the use of the sterile field technique
Which of the following is a contraindication for a renal biopsy?
AIDS
current antibiotic treatment
current Warfarin use
polycystic kidney diseasse
current Warfarin use
The following image is obtained on a 12 year old boy with a non-palpable right testicle. What should be your next step as the sonographer performing this exam?
evaluate the left groin for an undescended testicle
evaluate the right groin for an undescended testicle
evaluate the paraumbilical area for an undescended testicle
evaluate the perineal area for an undescended testicle
evaluate the right groin for an undescended testicle
Which of the following commonly leads to acute scrotal pain?
seminoma
microlithiasis
tubular ectasia
epididymitis
epididymitis
Which of the following would be an unexpected finding in a patient that had a vasectomy 4 years ago?
atrophied epididymis
tubular ectasia of the epididymis
spermatoceles
dilated vas deferns
atrophied epididymitis
A 30 year old male presents with a softball injury to the groin area. The scrotum is abnormally swollen and extremely painful for the patient. Which of the following statements is true regarding the findings on the image?
the right testicle has ruptured and increased flow is seen within the testicular tissue
the right testicle demonstrates orchitis with increased vascularity
the right testicle appears torsed
the left testicle appears torsed
the right testicle is torsed
Which of the following is a contraindication for a liver biopsy?
patient with allergies to iodinated contrast
patient with severe liver atrophy caused by cirrhosis
patient with advanced Alzheimer and hepatitis
patient with Budd Chiari
patient with advanced Alzheimer and hepatitis
cannot sign informed consent and may be uncooperative
Hypophosphatemia is a clinical sign of:
hyperparathyroidism
hyperthyroidism
renal failure
internal hemorrhage
hyperparathyroidism
Which of the following exam results is most likely to end up with an ultrasound guided biopsy of the area of interest?
a spiculated lung mass seen on a CT exam of the chest
hot thyroid nodule seen on nuclear medicine exam
an irregular liver mass that is contiguous with the diaphragm seen on CT exam of the abdomen
cold thyroid nodule seen on nuclear medicine exam
cold thyroid nodule seen on nuclear medicine exam
Which of the following will have no effect on serum levels of AFP?
seminomatous tumor of the testicle
HCC
pregnancy
yolk sac tumor of the right testicle
seminomatous tumors of the testicles will normally demonstrate normal AFP levels with elevated bhCG levels
Which of the following lymph node chains should be evaluated for related metastasis with thyroid cancer?
internal mammary
pectoral
axillary
supraclavicular
supraclavicular
Which type of thyroid cancer is associated with elevated calcitonin levels?
anaplastic
medullary
papillary
follicular
medullary
When evaluating a patient with a complete thyroidectomy, what is the best way to differentiate level VI nodes from level III/IV nodes?
hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the hyoid bone
turn the neck to a neutral position and document lymph node position relative to the carotid artery
hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the carotid artery
turn the neck to a neutral position and document lymph node position relative to the angle of mandible
turn the neck to a neutral position and document lymph node position relative to the carotid artery
Which of the following Doppler information is necessary to calculate the RI?
PSV only
PSV and EDV
PSV, average flow velocity, and EDV
PSV and PDV
PSV and EDV
Prehn sign is used to differentiate what two abnormalities?
seminoma and yolk sac tumor
fungal liver abscess and amoebic liver abscess
RCC and oncocytoma
testicular torsion and epididymo-orchitis
testicular torsion and epididymo-orchitis
HTN, nephrolithiasis, osteopenia, weakness, and malaise are common symptoms of:
hypoparapthyroidism
hyperparathyroidism
hyperthyroidism
hypothyroidism
hyperparathyroidism
Which of the following is relative to renal failure and vitamin D deficiency?
nephrocalcinosis
pulmonary HTN
hyperthyroidism
secondary hyperparathyroidism
secondary hyperparathyroidism
When wearing a protective gown and gloves:
the open end of the gloves should not be touching the wrist cuffs of the gown
the open end of the gloves should be pulled over the wrist cuffs of the gown
the open end of the gloves should be fitted under the wrist cuff of the gown
two pairs of gloves should be worn
the open end of the gloves should be pulled over the wrist cuffs of the gown
A 65 year old female presents for a neck ultrasound with a script that states hypophosphatemia and hypercalcemia. What do you expect to find on the exam?
atrophied thyroid gland
papillary thyroid cancer
enlarged parathyroid glands
medullary thyroid cancer
enlarged parathyroid glands
When using color Doppler to complete testicular perfusion, you should always:
use the dual screen function to demonstrate an image of both testicles
document flow during the Valsalva strain
document flow after the Valsalva release
document normal flow in one testicle and then adjust color scale and wall filter settings to demonstrate the same amount of flow i the other testicle
use the dual screen function to demonstrate an image of both testicles
Sjogren syndrome is an immune system disorder that commonly affects:
thyroid
bile ducts
adrenal glands
salivary glands
salivary glands
A patient presents for an abdominal ultrasound exam due to recent general pain in the abdomen. While reviewing the patient chart, you note that they have a CT of the abdomen with contrast that is scheduled immediately after the ultrasound appointment. How should you proceed?
complete the ultrasound exam and guide the patient to the CT department where they can drink the necessary contrast material
contact the CT department to ask the to do their exam first
ask the patient to finish drinking the CT contrast material before you start the ultrasound exam
call the referring doctor to let them know that the two exams will image the same anatomy and one should be cancelled
complete the ultrasound exam and guide the patient to the CT department where they can drink the necessary contrast material
Which of the following scrotal abnormalities would be better displayed if the patient performed the Valsalva maneuver?
varicocele only
inguinal hernia only
testicular torsion and inguinal hernia
varicocele and inguinal hernia
varicocele and inguinal hernia
A 30 year old presents with a history of a normal clinical exam of the scrotum and infertility. What is the referring doctor expecting to find on the US exam?
seminoma
varicocele
torsion
acute epididymitis
varicocele
Which of the following is true regarding paracentesis?
placing the fluid collection container on the floor next to the patient bed increases the fluid drainage rate
normally only performed for diagnostic reasons
normally the patent is seated and leaning over a table to allow posterior lateral access for the catheter
placing the patient in the supine position will improve the rate of fluid drainage
placing the fluid collection container on the floor next to the patient bed increases the fluid drainage rate
Which measurement of the hydrocele is being assessed on the image?
AP
length
width
length
Which of the following describes the best patient position for a thyroid ultrasound?
posterior oblique with neck extended
semi-erect with chin angled toward the side not being scanned
supine with neck extended
prone with the neck extended
supine with the neck extended
A patient is scheduled for a liver biopsy with the radiologist in the morning. What lab values will the doctor want to see before the procedure is performed?
PT and INR
RBC and platelet count
BUN and creatinine
WBC count
PT and INR
While performing a thyroid ultrasound, you notice the area indicated by the blue arrow. Which of the following statements is true regarding completing this patient’s exam?
color Doppler must be applied to assess the tumor vascularity
request that the patient swallow to better evaluate the area
the radiologist will need all lab values related to the parathyroid hormones and calcium levels in the blood to aid in confirming the diagnosis of the mass
the arrow indicates that normal longus colli muscle
request that the patient swallow to better evaluate the area
Which of the following correctly describes the preferred patient position for a renal biopsy?
posterior oblique with ipsilateral arm extended over the head
supine with a pillow under the back to accentuate the normal curvature of the spine
decubitus position with knees drawn to chest
prone with a pillow under the abdomen to accentuate the normal curvature of the spine
prone with a pillow under the abdomen to accentuate the normal curvature of the spine
Which of the following is not a symptom of hyperthyroidism?
weight loss
weight gain
excessive sweating
increased heart rate
weight gain
Which of the following will cause elevated serum amylase?
tumor of the submandibular gland and use of oral contraceptives
parathyroid adenoma and RCC
acute pancreatitis and pyelonephritis
use of anabolic steroids and parathyroid adenoma
tumor of the submandibular gland and use of oral contraceptives
Which of the following is an absolute contraindication to an ultrasound guided biopsy?
daily aspirin use
uncooperative patient
current antibiotic use
history of DM
uncooperative patient
A 3cm hypoechoic mass is identified in the right testicle. The radiologist requests that you perform an abdominal US. What are you looking for?
other manifestations of MENS syndrome
renal vein tumor invasion
periaortic lymphadenopathy
Crohn disease
periaortic lymphadenopathy
What dimension of the mass is being measured on the image?
width
AP
length
AP
Which of the following would improve the visualization of the thyroid isthmus?
transducer with a deep focus
curvilinear transducer
stand-off pad
color Doppler
stand-off pad
Which of the following is true regarding the difference between the sample obtained from the fine needle aspiration and a core biopsy sample taken from the liver?
the needle used for then FNA is usually much larger than the biopsy needle
the cytology lab evaluates the sample obtained from the FNA. the histology lab evaluates the sample obtained from the needle biopsy
FNA procedures are more traumatic to the tissues than needle biopsy procedures
core needle biopsies are more commonly performed for liver masses than to asses parenchymal liver disease
the cytology lab evaluates the sample obtained from the FNA. the histology lab evaluates the sample obtained from the needle biopsy
You are performing a parathyroid ultrasound and cannot locate a know adenoma. Which of the following would be most helpful in locating the mass?
use IV contrast to locate the blood supply of the mass
give the patient oral contrast to outline the trachea
ask the patient to swallow
more than one of the above
ask the patient to swallow
Which of the following patients would benefit from a FAST examination?
patient with abdominal bruit, weight loss and post prandial pain
patient with history of RUQ pain after eating
patient with history of abdominal pain after a fall from a ladder yesterday
patient with suspected prostate cancer
patient with history of abdominal pain after a fall from a ladder yesterday
A patient presents for a thyroid ultrasound due to an incidental finding on a nuclear medicine exam. The report states there is a 2cm hot nodule in the upper left lobe. Which of the following is the most likely finding on the ultrasound exam?
solid mass with hypoechoic halo
solid mass with microcalcifications and irregular margins
cystic mass
complex cyst with peripheral hypervascularity
solid mass with hypoechoic halo
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:
sjogren syndrome
meolytic anemia
Hashimoto thyroiditis
Graves’ disease
sjogren syndrome
What dimension of the mass is being measured on the image?
AP
width
length
width
Which of the following should be avoided for at last 7 days before a renal biopsy?
insulin
multivitamin
aspirin
HTN medication
aspirin
A patient has a history of thyroid cancer and bilateral thyroidectomy 3 years ago. What lab values should be reviewed before starting the annual post-surgical neck ultrasound?
serum levels of CEA 123
serum levels of T3
serum levels of thyroglobulin
serum levels of calcium
serum levels of thyroglobulin
Which of the following correctly describes a way to tell the difference between a vasovagal response and anaphylaxis caused by contrast injection?
HTN is a sign of vasovagal response, while hypotension is a sign of anaphylaxis
a feeling of impending doom is a sign of vasovagal response, while dizziness and near syncope are sign of anaphylaxis
pallor is a sign of vasovagal response, while erythema is a sign of anaphylaxis
tachycardia is a sign of vasovagal response, while bradycardia is a sign of anaphlyaxis
pallor is a sign of vasovagal response, while erythema is a sign of anaphylaxis
When a patient presents with acute scrotal pain, the sonographer should always begin the scrotal ultrasound by:
imaging the groin area
imaging the unaffected side
imaginag the epididymis on the affected side
imaging the testicle on the affected side
imaging the unaffected side
If a varicocele is identified on the left side:
the left kidney should be evaluated for mass formation
the IVC should be evaluated for a Greenfield filter
the left kidney should be evaluated for renal artery stenosis
the porta hepatis should be evaluated for cavernous transformation
the left kidney should be evaluated for mass formation
Which of the following statements is false regarding the abnormality on the image?
it is more commonly seen on the left side due to the relationship of the gonadal vascular anatomy to surrounding structures
it can be caused by Nutcracker syndrome
it has been related to incompetent venous valves
placing the patient in the supine position best demonstrates this abnormality
placing the patient in the supine position best
The radiologist asks you to set up the US room for a thyroid biopsy. Which probe should be covered with a sterile probe cover?
curvilinear 8MHz
linear 5MHz
vector 10MHz
linear 10MHz
linear 10MHz
A patient scheduled for a transrectal prostate biopsy must perform all of the following prior to the exam, EXCEPT:
begin taking a several day course of antibiotics
nothing to eat or drink at least 8 hours prior
perform a cleansing enema
have lab testing for PT/INR levels
nothing to eat or drink at least 8 hours prior
An obese patient has a known hepatoma in the posterior aspect of the right lobe of the liver. Which probe would you use to assist the radiologist in the performing a biopsy?
2.25MHz, long focus
3.5MHz, long focus
5MHz, short focus
2.25MHz, short focus
2.25MHZ, long focus
A patient is referred to rule out cryptorchidism. You evaluate the scrotal sac with US and demonstrate that presence of a right testicle only. Where will you look first for the left testicle?
right paracolic gutter
left paracolic gutter
left inguinal canal
right inguinal canal
left inguinal canal
Which of the following requires health care providers and organizations to develop and follow procedures that ensure the confidentiality and security of protected health information?
informed consent
stark law
HIPAA
ALARA principle
HIPAA
When setting up for a liver biopsy, which of the following must be performed by a sterile person?
attaching the needle and filling the syringe with the numbing agent
opening the biopsy needle packaging
verifying the expiration date of the numbing agent
opening the bottle of the numbing agent
attaching the needle and filling the syringe with the numbing agent
What ultrasound guided procedure is performed using the area lateral to the rectus abdominis muscle in the left lower abdomen as the most common puncture site?
thoracentesis
ethanol ablation
lovenox injection
paracentesis
paracentesis
Patients with new onset of secondary hyperparathyroidism will demonstrate:
increased vitamin K and D levels
increased vitamin D levels,normal calcium and PTH levels
low serum calcium and vitamin D levels with high PTH levels
increased serum calcium, vitamin D and PTH
low serum calcium and vitamin D levels with high PTH levels
What transducer would be preferred for the evaluation of sialolithiasis on an average sized patient?
5-7MHz linear
10-12MHz linear
3-5MHz sector
3-5MHz curvilinear
10-12MHz linear
Uncomplicated cysts and fluid collections will appear black on ultrasound and ___ on CT scan.
light gray
black
white
dark gray
dark gray
A FNA biopsy of a thyroid nodule is not recommended for nodules ___.
< 20mm
< 10mm
> 50mm
< 1mm
< 10mm
Which of the following describes the best patient position for a thoracentesis?
LLD
RLD
seated leaning forward over a table
semi-erect with knees raised toward the chest
seated leaning forward over a table
Iodine deficiency is a primary cause of:
renal calculi
cirrhosis
hypothyroidism
sialolithiasis
hypothyroidism
The greatest advantage of ultrasound guided percutaneous needle biopsy over biopsy performed with cat scan guidance is the:
decreased cost to the patient
lack of radiation exposure
ability to take multiple samples during one procedure
ability to view the biopsy needling passing into the mass in real time
ability to view the biopsy needling passing into the mass in real time
The informed consent form is required to include all of the following, EXCEPT:
percentage of patients that have experienced complications after the same procedure at the facility
possible complications that the patient may eperience
signature line to indicate patient consent
description of the procedure
percentage of patients that have experienced complications after the same procedure at the facility
Which of the following lists an advantage of fine needle capillary technique over a FNA technique?
FNC does not require local anesthetic and FNA does
FNC collects a tissue core while FNA collects a small amount of cells
FNC is less traumatic to the tissues than FNA
FNC aspirates a smaller but more concentrated sample of cells than FNA
FNC aspirates a smaller but more concentrated sample of cells than FNA
When preparing the sterile tray for a liver biopsy, the cover on the tray should be opened:
while wearing sterile gloves
no more than 2hrs before the procedure
by pulling the far corner of the cover toward you
by the radiologist
by pulling the far corner of the cover toward you
Which of the following statements is true regarding the sonographer assisting the radiologist with a renal biopsy?
the sonographer’s hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure
the sonographer should wear sterile gloves when disposing of the needles and devices used for the biopsy
the sonographer is responsible for creating the point of entry on the patient for the biopsy device
the sonographer’s hands must be sterile when opening needles and biopsy device packaging
the sonographer’s hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure
The National Patient Safety Standards recommend a “time out” period prior to the start of an invasive procedure. How will you comply with this recommendation during a renal biopsy?
record an image that says “time out” when the radiologist is adjusting the needle
allow the patient to take a 15-20min walk/break before they are set up for the procedure
record a blank image that says “time out” after the consent form is signed and then another image at the start of the procedure
allow the patient to take a break between biopsy samples and record the downtime in the patient shart
record a blank image that says “time out” after the consent form is signed and then another image at the start of the procedure
Which of the following would be considered a critical finding on a Point of Care Ultrasound exam?
pneumothorax
4cm abdominal aortic aneurysm
severe pericardial effusion
nonobstructive renal calculi
severe pericardial effusion
In patients with primary hyperparathyroidism, levels of parathyroid hormone will increase and:
T4 levels will increase
serum calcium levels will increase
serum calcium levels will decrease
T3 levels will increase
serum calcium levels will increase
All of the following correctly describe proper behavior related to a sterile field EXCEPT:
when in doubt about sterility, discard the potentially contaminated item and begin again
hands and elbows must be kept above the level of the table
sterile individuals must pass each other back to back when moving around the procedure room
sterile gloves must be used to open the procedure tray
sterile gloves must be used to open the procedure tray
Patients diagnosed with multinodular goiter will also have:
increased T3 and T4, normal TSH
increased TSH, normal T3 and T4
descreased T3 and T4, normal TSH
increased TSH, decreased T3 and T4
increased TSH, decreased T3 and T4
Which of the following is demonstrated by the same color on an ultrasound image as on a CT image?
cysts
calcifications
uncomplicated pleural effusion
more than one of the above
calcifications
A patient presents with mild scrotal pain and swelling on the left side that started 2-3 days ago. The patient awoke this morning with a slight fever and increased swelling. All of the following should be suspected cause for the symptoms EXCEPT:
orchitis
epididymitis
hydrocele
testicular infarct
testicular infarct
Which of the following describes the table placement for performing an ultrasound exam?
the table be placed in the trendelenburg position to assist in moving blood flow into the cerebral vessels.
table height should allow the sonographer’s arm to be slightly abducted with the wrist fully extended
the table should be placed in the reverse trendelenburg position to assist in moving blood flow into the cerebral vessels
table height should allow the sonographer’s arm to be slightly adducted with the wrist fully flexed toward the side being examined
table height should allow the sonographer’s arm to be slightly abducted with the wrist fully extended
Air in the gallbladder wall will be demonstrated as areas of hyperechogenicity with posterior dirty shadowing and ring down artifact on sonography. How is this demonstrated on a CT exam?
the GB will demonstrate linear spokes of shadowing from the pockets of air in the wall
the GB will demonstrate bright white areas within the wall where air is present
the GB will demonstrate black areas within the wall where air is present
the GB will demonstrate no discernible changes on a CT scan with the presence of air in the wall
the GB will demonstrate black areas within the wall where air is present
