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SON-225 Case Studies > Final > Flashcards

Final Flashcards

1
Q
  1. What might a person with long standing hepatitis C have abdominal distention?
A

Cirrhosis causing ascites

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2
Q

What affect can ascites have on the gallbladder?

A

Edematous gallbladder wall

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3
Q

What is the upper limit of the pancreatic duct?

A

2mm

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4
Q

What is the most common malignant tumor of the pancreas?

A

Adenocarcinoma

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5
Q

Renal carcinoma can likely invade other parts of the body. Where else might you look when you suspect a mass?

A

RV, IVC, contralateral

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6
Q

What is the most common bladder tumor in America?

A

Transitional Cell Carcinoma

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7
Q

What tumor is associated with cholangiocarcinoma?

A

Klatskin’s tumor

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8
Q

What is the most common pelvic tumor

A

Fibroids

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9
Q

What is the upper limit of the MPV diameter?

A

13mm

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10
Q

Name 2 cancers that might metastasize to the liver.

A

Breast, colon, GB, pancreas, stomach

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11
Q

What pediatric pathology is the stricture or obliteration of the bile ducts?

A

Biliary atresia

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12
Q

What is the name of hypoechoic areas of regenerating liver parenchyma?

A

Focal sparing

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13
Q

Name 2 causes of obstruction in the kidney.

A

Stone, mass, enlarged prostate, pregnancy

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14
Q

Showing jets on ultrasound rules out obstruction. True or False.

A

False

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15
Q

A fibroid located in the endometrium is which type?

A

Submucosal

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16
Q

What condition is consistent with the cystic dilation of the biliary tree?

A

Choledochal cyst

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17
Q

What is the most common primary liver tumor in children?

A

Hepatoblastoma

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18
Q

What are the upper limits of endometrial measurement for a postmenopausal woman who is not on HRT?

A

4-5mm

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19
Q

Which typically benign liver mass is associated with prominent vascularity, a stellate scar, and also discovered when vascularity is disturbed?

A

FNH (adenoma has a central scar and vasculature is around the periphery)

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20
Q

What is the most common location of Klatskin’s tumor?

A

Hilum of liver at the junction of right and left hepatic ducts

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21
Q

List 2 causes of pancreatitis.

A

Alcoholism and biliary disease

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22
Q

What is a common effect of acute and chronic pancreatitis?

A

Pseudocyst

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23
Q

Pyelonephritis is seen as a diffuse disease on sonography. True or False

A

True (look for areas of masses; infectious process that is encased, look at the entire organ)

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24
Q

What type of pediatric tumor can appear along the sympathetic nervous system, mostly in the adrenals.

A

Neuroblastoma

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25
Q

One sonographic feature of an endometrioma.

A

Low-level echoes, punctate hypoechoic areas along the borders, well-defined, thin walls, internal echoes.

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26
Q

How would you distinguish between adrenal hemorrhage and neuroblastoma at adrenals?

A

Vascularity within neuroblastoma

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27
Q

What is the most common benign neoplasm of liver?

A

Cavernous hemangioma

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28
Q

What pancreatic lab value will increase first?

A

Amylase

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29
Q

Unilateral pediatric kidney cyst will indicate what disease?

A

Multicystic kidney disease

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30
Q

What is the upper limits of intrahepatic ducts?

A

3mm

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31
Q

What are the 3 most significant, important signs of acute cholecystitis?

A

Pericholecystic fluid, thick wall, echogenic foci

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32
Q

If you had a patient who has a long history of urinary obstruction with echogenic debris in the collecting system, what could it be?

A

Pyonephritis

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33
Q

How might the size of the ovary change within the first 24-36 hours of ovarian torsion?

A

Enlarges

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34
Q

Name 2 possible sonographic appearances of acute pancreatitis.

A

Normal or enlarged, hypoechoic

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35
Q

What is the most common renal tumor in children?

A

Wilm’s Tumor

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36
Q

Name 2 collateral pathways that can form with portal HTN.

A

Cavernous transformation and patent umbilical vein.

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37
Q

Which adult liver mass is most likely to increase AFP?

A

HCC

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38
Q

What pelvic pathology could be seen with diffused heterogeneous uterus with myometrial cyst?

A

Adenomyosis (mostly when you can’t measure something discretely)

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39
Q

A pancreatic head mass may have what affect on the bile ducts and where?

A

Can cause dilated ducts (intrahepatic or extraheptic or pancreatic ducts) and increased gallbladder size

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40
Q

An uterine pathology that is often caused by unopposed estrogen.

A

Fibroid, hyperplasia of endometrium, endometrial carcinoma

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41
Q

What is the most common cause of hydronephrosis in peds?

A

UPJ obstruction

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42
Q

What vessel takes over the blood flow in liver when PV is thombosed?

A

Hepatic artery

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43
Q

What are the sonographic findings with acute kidney injury?

A

Enlarged, hyperechoic

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44
Q

Your patient has an increased WBC and fever, you find dilated ducts.

A

Cholangitis

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45
Q

What pediatric tumor is the most common in the first year of life?

A

Neuroblastoma

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46
Q

What is the pathology that is described with inflamed parenchyma and debris in the collecting system with no hydronephritis.

A

Pyelonephritis

47
Q 
Diffuse wall thickening of the gallbladder can be significant in all the following except:
Select one:
a. Hepatitis
b. Portal hypertension
c. Acute cholecystitis
d. Ascites
A

d. Ascites

48
Q 
All of the following are sonographic findings of acute cholecystitis except:
Select one:
a. Cholethiasis
b. Pericholecystic fluid
c. Ductal dilatation
d. Gallbladder wall thickening
A

c. Ductal dilatation

49
Q 
Of the following sonographic characteristics which is the most consistent with chronic cholecystitis?
Select one:
a. Pericholecystic fluid
b. Free fluid
c. WES sign
d. Wall thickening
A

c. WES sign

50
Q 
A patient presents with ampulla of Vater obstruction, distension of the gallbladder and painless jaundice.  This is associated with:
Select one:
a. Courvoisier's sign
b. Hartmann's Pouch
c. Kehr's sign
d. Choledochal cyst
A

a. Courvoisier’s sign

51
Q

Which of the following describes adenomyomatosis of the gallbladder?
Select one:
a. Associated with chronic hepatitis
b. Inflammation of the gallbladder and biliary ducts
c. A congenital anomaly that presents itself in the 4th and 5th decade of life
d. A proliferation of the mucosal layer, which extends into the muscle layer

A

d. A proliferation of the mucosal layer, which extends into the muscle layer

52
Q 
What is the most common benign liver neoplasm?
Select one:
 a. Angiomyolipoma
 b. Focal Nodular Hyperplasia
 c. Abscess
 d. Cavernous Hemangioma
A

d. Cavernous Hemangioma

53
Q 
Identify the lab value which is specific for a malignant hepatoma of the liver.
Select one:
 a. Serum amylase
 b. Alpha fetoprotein
 c. Bilirubin
 d. Alkaline phosphate
A

b. Alpha fetoprotein

54
Q 
One could expect to image all of the following in a case of end stage liver disease except:
Select one:
 a. Biliary dilatation
 b. Portal hypertension
 c. Ascites
 d. Echogenic nodular liver
 e. Small atrophied liver
A

a. Biliary dilatation

55
Q

All of the following are true of fatty infiltration of the liver except:
Select one:
a. Chronic cirrhosis patients typically have severe fatty infiltration
b. Focal sparing can be seen anywhere in the liver
c. NASH can cause fatty infiltration
d. Sound waves have a hard time penetrating tissue affected by fatty infiltration

A

c. NASH can cause fatty infiltration

56
Q 
In a patient with acute hepatitis, the liver parenchyma sonographically typically appears as
Select one:
a. Echogenic
b. Normal
c. Hypoechoic
d. Complex
A

b. Normal

57
Q 
Chronic active hepatitis C is a progressive destructive liver disease that eventually leads to:
Select one:
a. Liver mets
b. Pancreatitis
c. Liver cysts
d. Cirrhosis
A

d. Cirrhosis

58
Q 
What term is used to describe collaterals that form in the area of the porta hepatis when thrombus is present in the portal system?
Select one:
a. Patent paraumbilical vein
b. Duplicate portal system
c. Hepatosplenomegaly
d. Cavernous transformation
e. Varices
A

d. Cavernous transformation

59
Q 
Fatty infiltration of the liver can be assessed sonographically by visualizing:
Select one:
a. Small nodular liver
b. Echogenic vessel walls
c. Increased liver echogenicty
d. Hypoechoic diaphragm
e. Multiple echogenic focal masses
A

c. Increased liver echogenicty

60
Q 
A 50 year old female with a long history of alcoholism presents with increased abdominal girth.  A sonogram of the abdomen is performed and the most probable finding is:
Select one:
a. Ascites with an enlarged liver
b. Ascites with a small echogenic liver
c. Hepatoma
d. Liver mets
A

b. Ascites with a small echogenic liver

61
Q 
All of the following are associated with chronic cirrhosis except
Select one:
a. Jaundice
b. Ascites
c. Collateral vessel development
d. Hepatomegaly
e. Splenomegaly
A

e. Splenomegaly

62
Q 
This type of liver lesion is characterized by often being isoechoic to the liver, prompted by female hormones, and displaces normal liver vasculature.
Select one:
a. Hemangioma
b. Focal Nodular Hyperplasia
c. Liver adenocarcinoma
d. Lipoma
A

b. Focal Nodular Hyperplasia

63
Q 
A patient presents with increase in direct bilirubin, ALT and Alkaline Phosphate.  The sonogram shows multiple bulls eye lesions throughout the liver.  The most likely diagnosis is:
Select one:
a. Hematoma
b. Cirrhosis
c. Multiple hemangioma
d. Fatty infiltration
e. Liver mets
A

e. Liver mets

64
Q 
All of the following increase the risk of hepatocellular carcinoma except:
Select one:
a. Gallbladder Cancer
b. Hepatitis B
c. Hepatits C
d. Cirrhosis
A

a. Gallbladder Cancer

65
Q 
Which of the following properly describes the typical appearance of islet cell tumors?
Select one:
 a. Small and hypoechoic
 b. Small and hyperechoic
 c. Large and hypoechoic
 d. Large and hyperechoic
A

a. Small and hypoechoic

66
Q 
What is the most common location of a pancreatic pseudocyst?
Select one:
 a. Pancreatic head
 b. Lesser sac
 c. Splenic hilum
 d. Porta hepatis area
A

b. Lesser sac

67
Q 
Which of the following pancreatic neoplasms occurs more frequently in the body and tail and is associated with a suspicion for malignant conversion?
Select one:
 a. Van Hippel-Lindau disease
 b. Macrocystic cystadenoma
 c. Islet cell tumor
 d. Microcystic cystadenoma
A

b. Macrocystic cystadenoma

68
Q 
The normal size of the pancreatic duct is less than
Select one:
a. 3 mm
b. 6 mm
c. 4 mm
d. 2 mm
A

d. 2 mm

69
Q

Clinical sign and symptoms in acute pancreatitis include all of the following except:
Select one:
a. Severe abdominal pain radiating to the back
b. Nausea and vomiting
c. Elevated amylase
d. Severe abdominal pain radiating to the shoulder

A

d. Severe abdominal pain radiating to the shoulder

70
Q 
An elderly man with a history of alcoholism recently was diagnosed with acute pancreatitis.  He now presents with decreased hematocrit and hypotension.  Your differential includes:
Select one:
a. Pseudocyst
b. Chronic pancreatitis
c. Pancreatic hemorrhage
d. Cholecystitis
A

a. Pseudocyst

71
Q 
What is the most common primary carcinoma of the pancreas?
Select one:
a. Lymphoma
b. Adenocarcinoma
c. Cystadenocarcinoma
d. Insulinoma
A

b. Adenocarcinoma

72
Q

Abnormal accumulation of intraperitoneal fluid that becomes trapped in adhesions in a patient with a history of previous surgery is most likely to cause what to form?

a. Follicular cyst
b. Peritoneal inclusion cyst
c. Dermoid cyst
d. Ovarian torsion

A

b. Peritoneal inclusion cyst

73
Q

A 25 year old woman has a pelvic ultrasound for LLQ pain and has a negative pregnancy test. The ultrasound shows a 2.0 cm essentially circular cystic area adjacent to the ovary? Which of the following statements is the most accurate with concern to the findings?

a. Most likely an ectopic pregnancy beside the ovary
b. Most likely a teratoma and will need follow up
c. Most likely a paraovarian cyst
d. Most likely a corpus luteum

A

c. Most likely a paraovarian cyst

74
Q

A simple cyst may exhibit all of the following except:

a. Distal acoustic shadow
b. Anechoic interior
c. Posterior enhancement
d. Thin walls

A

a. Distal acoustic shadow

75
Q

Which of the following is least likely to be true of dermoid tumors?

a. Encountered in more women over 40
b. May cast an acoustic shadow
c. Also called benign cystic teratoma
d. Most common benign germ cell tumor in females

A

a. Encountered in more women over 40

76
Q

Ovarian torsion can present all of the following sonographic findings except:

a. Hypervascularity
b. Fluid in the cul de sac
c. Large ovary
d. Mass on the ovary

A

a. Hypervascularity

77
Q

Which ovarian mass is more likely to have low level echoes internally?

a. Mucinous cystadenoma
b. Serous cystadenoma
c. Corpus luteum
d. Benign cystic teratoma

A

a. Mucinous cystadenoma

78
Q

Which of the following is not a true characteristic of serous cystadenoma?

a. Usually are large with thin walls
b. Most common benign ovarian neoplasm
c. Interior of mass is mostly anechoic
d. Thick septations

A

d. Thick septations

79
Q

An adnexal mass is palpated in a 34 year old female with symptoms of pelvic pressure. A pelvic ultrasound shows a 4 cm solid adnexal mass with a normal appearing ovary adjacent to it. What is the most likely diagnosis?

a. Intramural fibroid
b. Pedunculated fibroid
c. Submucosal fibroid
d. Ovarian Cancer

A

b. Pedunculated fibroid

80
Q

Which uterine abnormality consists of a duplicated uterus with or without duplication of the cervix?

a. Arcuate uterus
b. Septate uterus
c. Bicornuate uterus
d. Uterus didelphys

A

c. Bicornuate uterus

81
Q

This 29 year old patient presents with a history of chronic pelvic pain especially during menses, back pain and dyspareunia. What is the most likely diagnosis?

a. Endometrioma
b. Cystadenoma
c. Brenner’s tumor
d. Thecoma

A

a. Endometrioma

82
Q

All of the following would be important when scanning a possible case of pyosalpinx except:

a. Using color Doppler to show increased flow in the pelvic structures due to infection
b. Differentiating tube from surrounding structure
c. Filling the bladder to distinguish it from the dilated tube
d. Proving the difference between bowel and tube through peristalsis

A

c. Filling the bladder to distinguish it from the dilated tube

83
Q

All of the following are structural reasons for AUB except:

a. Polycystic ovarian disease
b. Retained products of conception
c. Endometrial hyperplasia
d. Fibroids

A

a. Polycystic ovarian disease

84
Q

A 19 year old woman is referred for a pelvic ultrasound after her physician palpated a right adnexal mass. The sonographer could not identify a right ovary but noticed a discrete area with hyperechoic dots and lines, including a rounded echogenic area that produced shadowing. Bowel was ruled out due to the fact that the area did not peristalsis. What is the most likely diagnosis?

a. Dermoid
b. Tuboovarian Abscess
c. Mucinous cystadenoma
d. Hemorrhagic cyst

A

a. Dermoid

85
Q

All of the following are characteristics of an endometriosis except:

a. Sonographic findings are low level echoes, thin wall, small echogenic foci and septations
b. Can be located any where in the body
c. Symptoms are pelvic pain, AUB and dysmenorrhea
d. Most common in women between 40 and 50

A

d. Most common in women between 40 and 50

86
Q

A 26 year female patient has extreme RLQ pain. On ultrasound a large ovary with almost no blood flow is seen with fluid in the cul de sac. The most likely diagnosis is:

a. Tuboovarian abscess
b. Endometroid tumor
c. Ovarian torsion
d. Dermoid

A

c. Ovarian torsion

87
Q

Adenomyosis is:

a. Benign penetration and growth of endometrial glands and stroma into the myometrium
b. Inflammation of the endometrium
c. Malignant penetration and growth of endometrial glands and stroma into the myometrium
d. Endometrial stroma and glands located outside of the uterus

A

a. Benign penetration and growth of endometrial glands and stroma into the myometrium

88
Q 
Question 21
Congenital anomalies of the uterus result from the improper fusion of which of the following structures?
a. Mesonephric ducts
b. Gartner's ducts
c. Paramesonephric ducts
d. Mullerian Ducts
A

d. Mullerian Ducts

89
Q

Which of the following cancers would be the most likely to metastasize to the ovaries?

a. Lung cancer
b. Endometrial cancer
c. Breast cancer
d. Pancreatic cancer

A

c. Breast cancer

90
Q

A 26 year old woman presents to her family physician with a one month history of intermittent pelvic pain, intermittent fevers, and an unusual vaginal discharge. She has no pregnancies and no pelvic surgeries. She has an IUD and her periods have been regular but she is unsure of her last period. Based on this information and the following image what is the most likely diagnosis?

a. Endometrioma
b. Ovarian Torsion
c. Hydrosalpinx
d. Pyosalpinx

A

d. Pyosalpinx

91
Q

Pelvic mass sonographic evaluation would include all of the following except:

a. Evaluation of overall internal echotexture
b. Evaluation for papillary projections
c. Comparison of contralateral ovary
d. Evaluation for septations and their thickness
e. Extensive search for mural nodules and blood flow within

A

c. Comparison of contralateral ovary

92
Q

Which uterine abnormality will present with two separate endometriums and often has no effect on the contour of the uterus?

a. Uterus didelphys
b. Septate uterus
c. Bicornuate uterus
d. Arcuate uterus

A

b. Septate uterus

93
Q

What is the sonographic sign for Polycystic Ovarian Syndrome?

a. Small atrophic ovaries
b. Tip of the iceberg
c. Dilated tube with echogenic debris
d. String of pearls

A

d. String of pearls

94
Q

A 25 year old is referred for a pelvic ultrasound due to multiple miscarriages. The ultrasound shows a subtle fundal indentation on the uterus with a slightly concave uterine cavity. These findings would be consistent with what uterine abnormality?

a. Bicornuate uterus
b. Uterine Didelphys
c. Septate uterus
d. Arcuate uterus

A

d. Arcuate uterus

95
Q

Which of the following is true of serous cystadenocarcinoma?

a. Occurs more frequently in women between the ages of 40 -50
b. Displays the sonographic feature called tip of the iceberg
c. Occurs in women who are peri menopausal and post menopausal
d. Composed of germ layers, ectoderm, mesoderm, and endoderm

A

c. Occurs in women who are peri menopausal and post menopausal

96
Q

All of the following are sonographic features of adenomyosis except:

a. Myometrial cysts
b. Discrete lesions seen in the uterus
c. Diffusely large uterus
d. Disruption of the borders of the endometrium

A

d. Disruption of the borders of the endometrium

97
Q

If an appendix is visualized with ultrasound it is considered enlarged and abnormal. True or False?
True
False

A

False

98
Q

All of the following are clinical signs of appendicitis except:

a. Lethargy
b. Fever
c. Loss of appetite
d. Projectile vomiting

A

d. Projectile vomiting

99
Q

A newborn with traumatic birth is coming for a suspected RUQ mass. Upon examination a swollen and bluish discolored scrotum is noted. Labs show the infant is anemic. The ultrasound showed a crescent shaped slightly hyperechoic right supra renal mass with no blood flow What is the most likely diagnosis?

a. Multicystic dysplastic kidney
b. Neuroblastoma
c. Wilm’s tumor
d. Adrenal hemorrhage

A

d. Adrenal hemorrhage

100
Q 
Which landmark is essential to the location of the appendix and typically sits posterior to the appendix?
Select one:
a. Umbilicus
b. Iliac vessels
c. Bladder
d. Right kidney
A

b. Iliac vessels

101
Q

Which pathology could present sonographically with a triangular cord sign and what is the normal location?
Select one:
a. Pyloric stenosis, anterior to portal vein
b. Biliary atresia, posterior to portal vein
c. Biliary atresia, anterior to portal vein
d. Intussusception, anterior to portal vein
e. Pyloric stenosis, posterior to portal vein

A

c. Biliary atresia, anterior to portal vein

102
Q 
What predominately pediatric abnormality can be confused with a normal appearing gallbladder?
Select one:
a. Biliary atresia
b. Mesoblasitc nephroma
c. Choledochal cyst
d. Pyloric stenosis
A

c. Choledochal cyst

103
Q

Which of the following would be normal wall measurement for the appendix?

a. 4 mm
b. 5 mm
c. 2 mm
d. 3 mm

A

c. 2 mm

104
Q

What is the most common location of an intussusception?

a. Inferior and to right of stomach
b. RLQ
c. Ileocolic region
d. LUQ

A

c. Ileocolic region

105
Q

What is the most common reason for pediatric hydronephrosis?

A

UPJ obstruction

106
Q

A two year old boy presents with hematuria and a palpable right flank mass. The ultrasound showed a solid renal mass, What is the most likely diagnosis?

a. Neuroblastoma
b. Renal infarction
c. Hypernephroma
d. Wilm’s tumor
e. Infantile polycystic disease

A

d. Wilm’s tumor

107
Q

What is the upper limits of normal measurement for the diameter of the appendix?

a. 4 mm
b. 5 mm
c. 6 mm
d. 7 mm

A

c. 6 mm

108
Q

Which of the following accurately describes rebound pain?

a. Pain experienced the compression of one finger
b. Pain experienced upon the release of compression
c. Pain experienced upon compression
d. Pain experienced during a graded compression technique

A

b. Pain experienced upon the release of compression

109
Q

A one year boy who was delivered prematurely due to fetal alcohol syndrome presents for abdominal ultrasound. He has hepatomegaly and an elevated AFP. The sonographer finds a 9 cm hepatic mass with calcifications with invasion into the portal system. What is the most likely diagnosis?

a. Hepatoblastoma
b. Wilm’s Tumor
c. Neuroblastoma
d. Infantile Hemangioendothelioma

A

d. Infantile Hemangioendothelioma

110
Q

All of the following can be sonographic findings of intussusception except:

a. Hypoechoic and hyperechoic outer rings
b. Lack of fluid moving through the bowel
c. Bulls eye target sign
d. Free fluid

A

b. Lack of fluid moving through the bowel

111
Q

Anatomical landmarks for location of the pylorus are:

a. Scan inferiorly form the xiphoid between the gallbladder and kidney
b. Scan inferiorly from the xiphoid between the gallbladder and CBD
c. Scan inferiorly from the xiphoid between the kidney and IVC
d. Scan inferiorly between the pancreas and stomach

A

d. Scan inferiorly between the pancreas and stomach

112
Q

Which of the following would be a normal wall AP wall measurement for the pylorus?

a. 3 cm
b. 2 mm
c. 17 mm
d. 4 mm

A

b. 2 mm

113
Q

What is the measurement criteria for the length of the pylorus?

a. 3 - 4 mm
b. 3 - 4 cm
c. 14 - 17 mm
d. 14 - 17 cm

A

c. 14 - 17 mm

114
Q

All of the following are clinical symptoms of pyloric stenosis except:

a. Dehydration
b. Bloody stools
c. Projectile vomiting
d. Olive shape palpable mass
e. Weight loss

A

b. Bloody stools

SON-225 Case Studies (2 decks)

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