Lange Review Flashcards
Name the largest artery in the body
Aorta
The abdominal aorta bifurcates at what level
L4
Name the 2 arteries the aorta bifurcates into
Right and left common iliac arteries
Name the first visceral branch of the abdominal aorta
Celiac axis
What are the 3 branches of the celiac axis
1) common hepatic artery
2) left gastric artery
3) splenic artery
What artery follows a tortuous horizontal course along the posterosuperior margin of the pancreatic body
Splenic artery
What artery arises from the anterior border of the abdominal aorta about 1 cm inferior to the celiac trunk
SMA
The SMA is _____ to the body of the pancreas
Posterior
The right renal artery courses______ to the IVC
Posteriorly
These arteries are small vessels that arise off the anterior border of the aorta and inferior to the renal arteries
Gonadal arteries
What artery is a small artery that arises off the anterior aspect of the abdominal aorta and is slightly left of midline
IMA
Name the arterial disease in which the vessel wall loses its elasticity and becomes hardened
Arteriosclerosis
What is the most common cause of aneurysms
Arteriosclerosis
How is the aorta measured
Outer border to outer border
Name the 3 types of aneurysms
1) true
2) dissecting
3) pseudo (false)
Which aneurysm has dilation of all 3 layers of the vessel wall
True
Name the 3 types of true aneurysms
1) fusiform
2) saccular
3) berry
What type of true aneurysm is the most common type and is characterized by an elongated spindle shaped dilatation of the artery
Fusiform
What type of true aneurysm is characterized by a focal outpouching of the vessel wall primarily caused by trauma or infection
Saccular
What type of aneurysm occurs when there is a tear of the intima layer of the vessel wall causing blood to collect between the intima layer and the media layer
Dissecting aneurysm
What type of aneurysm results from a tear in the vessel wall that permits blood to escape into the surrounding tissue
Pseudo aneurysm
The IVC carries deoxygenated blood into the ______ atrium of the heart
A) right
B) left
A) right
The right renal vein is located where in relation to the right renal artery
Anterior
What vein courses anterior to the aorta and posterior to the SMA
Left renal vein
Where does the right gonadal vein empty directly into
IVC
Where does the left gonadal vein empty and drain into
Empties unit left renal vein and drains into the IVC
What is the most common tumor that involves the IVC
Renal cell carcinoma
What is the sequence of echogenicity of abdominal structures from hyperechoic to hypoechoic
1) renal sinus
2) pancreas
3) liver
4) spleen
5) renal cortex
Which portion of the liver receives both right and left portal branches
Caudate lobe also drains directly into the IVC via the emissary veins
What vein divides the liver into right and left lobes
Middle hepatic vein
What vein divides the right lobe of the liver into anterior and posterior segments
Right hepatic vein
What vein divides the left of the liver into medial and lateral segments
Left hepatic vein
The ______ ______ is a remnant of the fetal ductus venosus
Ligamentum venosum
What divides the caudate lobe from the left lobe
Ligamentum venosum
This is a remnant of the fetal umbilical vein
Ligamentum teres
This courses within the left intersegmental fissure dividing the left lobe into medial and lateral segments
Ligamentum teres
Sonographically this is seen as a round hyperechoic area in the left lobe of the liver
Falciform ligament
This separates the right and left lobes of the liver . Seen as an echogenic linear line extending from the portal vein to the neck of the GB
Main lobar fissure
The majority of the total blood supplied to the liver is from what
The main portal vein
This drains deoxygenated blood into the IVC
Hepatic veins
What are nonpulsatile increase in size and course superiorly toward the IVC
Hepatic veins
What vein is formed posterior to the pancreatic neck by confluence of the splenic vein and SMV
Portal vein
What 3 things does the portal triad contain
1) portal vein
2) hepatic artery
3) bile duct
What is the CBD formed by
Formed by the confluence of the common hepatic duct and the cystic duct
AST is formerly known as
SGOT
What liver function test is increased with hepatocellular disease and is useful in detecting acute hepatitis
AST
ALT is formerly known as
SGPT
What liver function test is increased with hepatocellular disease and is used to assess jaundice
ALT
What liver function test is normally found in serum and it’s level rises in liver and biliary tract disorders while bile excretion is impaired
ALP
Which liver function test is produced by the fetal liver and yolk sac, GI tract, scrotal and heptocellular germ cell neoplasms and other cancers in adults
AFP
This is elevated when there is an obstruction of the biliary system
Direct bilirubin (conjugated)
Excessive destruction of red blood cells/hemolysis associated with anemias and liver disease
Indirect bilirubin (unconjugated)
Obstructive jaundice is an example of
A) direct bilirubin
B) indirect bilirubin
A) direct bilirubin
An enlarged left and caudate lobe, increased liver echogenicity with decrease through transmission and decrease visualization of vessel walls describes
Fatty liver
Hypoechoic liver parenchyma, increased echogenicity if portal vein walls and thickened GB wall describes
Acute viral hepatitis
What is the most common type of glycogen storage disease
Von Gierke disease
What is the most common cause of cirrhosis
Alcohol abuse
-Formation of collateral venous channels
-splenomegaly
-GI tract bleeding
-Ascites
Are all clinical findings of what
Portal hypertension
-dilation of portal vein
-dilation of SMV
- formation of collaterals
-varies
-reversed blood flow
-splenomegaly
-recanalization of the umbilical vein
Are all sonographic findings of
Portal hypertension
Thrombosis, invasion of the portal vein by a tumor describes
Portal vein obstruction
-nonvisualization of the portal vein
-echoes within the portal vein
-dilation of the splenic and SMV
Are all sonographic findings of
Portal vein obstruction
Obstruction of the hepatic veins caused by thrombosis or compression of a liver mass describes
Budd-Chiari Syndrome
-reduced or no visualization of the hepatic veins
-hepatic vein proximal to the obstruction may be dilated
-large and hypoechoic caudate lobe
-ascites
-abnormal Doppler blood flow
All are sono findings of
Budd-Chiari syndrome
What is another name for echinococcal cyst
Hydatid cyst
Solitary cysts which may have thick or calcified walls, mother daughter cysts,honeycomb appearance or solid in appearance describes
Echinococcal cysts
This is usually found in the right lobe, solitary, variable in size, anechoic to echogenic or complex may have calcifications or shadowing from gas describes
Abscess or pyogenic cyst
Hepatomegaly, fatty infiltrations, focal lesions. Wheel within a wheel becomes more hypoechoic describes
Fungal infection- candidiasis
Varies depending on age- mostly cystic (fresh blood) echogenic, mixed appearance, irregular shape describes
Hematoma
What is the most common benign solid tumor in the liver
Cavernous hemangioma
This is usually asymptomatic, more prevalent in women
-normal LFTs
-usually small, round in the right lobe, homogenous with increased through transmission
Cavernous hemangioma
Usually asymptomatic, increased incidence in women on oral contraceptives
-normal LFTS
-usually echogenic, found in the right lobe, similar in appearance as adenomas or hepatomas
Focal nodular hyperplasia
Usually asymptomatic, or as a palpable mass, increased incidence in women on oral contraceptives or men on steroids
-normal LFTs
-most often found in the right lobe, hyperechoic may have areas of hemorrhage
Liver cell adenoma
What malignant liver tumor is usually found during infancy or childhood
Heptoblastoma
-abdominal enlargement, hepatomegaly, weight loss, nausea, vomiting, precocious puberty
-abnormal LFTs and elevated AFP
All describe what malignant liver tumor
Hepatoblastoma
What are the 3 primary sites for metastatic lesions
1) GI tract
2) Breast
3) Lungs
-LFTs usually abnormal, increase in total bilirubin, ALP
-hyperechoic, hypoechoic, complex, target lesions, anechoic
Metastatic lesions
The neck of the gallbladder tapers to form
The cystic duct
Where is the spiral valves of Heister located
In the cystic duct
The right and left hepatic ducts join to form the
Common hepatic duct
What is the function of the common hepatic duct
Transport bile to the gallbladder
The cystic duct unites with the ______ to transport concentrated bile to the second portion of the duodenum
CBD
What are the 3 main functions of the gallbladder
1) concentrate bile
2) store the concentrated bile
3) transport bile to the duodenum
What is the most common variant of the GB
Junctional fold
A fold or kinking located on the posterior GB wall between the body and neck describes
Junctional fold
A fold located in the fundal portion of the GB is called
Phrygian cap
A small sac located between the junctional fold and the neck of the GB describes
Harrimanns pouch
-prolonged fasting
-intravenous hyperalimentation
-cystic obstruction
-obstruction of the common bile duct
All are causes of
Large GB (hydrops)
A large GB caused by obstruction at the distal portion of the CBD is called
Courvoisier GB
-intrahepatic biliary obstruction, chronic cholecystitis, liver disease, and congenital hypoplasia are all causes of
Small GB
Low level non shadowing echoes in the dependent portion of the GB that moved with a change in patient position is
Sludge
-gas in the duodenum
-surgical clips from post-cholecystectomy
-valves of Heister and folds in the GB are structures that can mimic
Gallstones
These are not gravity dependent and do not move with changing patient position
Polyps
Hyperplastic changes in the GB wall describe
Adenomyomatosis
What refers to a common hepatic duct obstruction caused by a stone in the cystic duct with a normal CBD
Mirizzi Syndrome
Inflammation of the GB wall with decreased GB function caused by an obstruction at the level of the cystic duct, bacterial infection in the biliary system, or pancreatic enzyme reflux all describe
Acute cholecystitis
- diffuse wall thickening
-gallstones - halo sign
-cystic artery along the anterior GB wall - sludge
-pericholecystic fluid
Are all sonographic findings of
Acute cholecystitis
Pus in the GB is called
Empyema
Rare occurrence caused by a gas forming bacteria in the wall of the GB describes
Emphysematous Cholecystitis
Patients with cholecystitis that do not have gallstones describes
Acalculous cholecystitis
What is the most common cause of symptomatic GB disease and is associated with gallstones in 90% of cases
Chronic cholecystitis
Sono appearance of a small or normal sized GB, gallstones, sludge, and thickened echogenic GB wall with elevated AST, ALT, ALP and direct serum bilirubin describes
Chronic cholecystitis
Intramural calcification of the gallbladder wall which occurs in association with chronic cholecystitis is known as
Porcelain gallbladder
What is the most common benign gallbladder tumor
Adenoma
Small echo-densities attached to the gallbladder wall by a stalk that do not shadow or move to the dependent portion of the gallbladder describes
A polyp
What type of cancer is the most common malignant cause to obstruct the biliary tree
Pancreatic
What is the most common cause of acute pyelonephritis
A) hypertension
B) E. coli
C) Klebsiella
D) hydro
E) enterococcus faecalis
B) E. coli
The GDA is a branch of which of the following
A) aorta
B) celiac axis
C) common hepatic artery
D) left gastric artery
E) duodenal artery
C) common hepatic artery
Which of the following can cause anterior displacement of the splenic vein
A) pancreatitis
B) pseudocysts
C) left adrenal hyperplasia
D) aneurysm
E) IVC thrombi
C) left adrenal hyperplasia
When accessory spleens are present, where are they usually located
A) at the superior margin of the spleen
B) on the posterior aspect of the spleen
C) near the kidney
D) near the splenic hilum
E) near the left diaphragm
D) near the hilum of the spleen
The IVC forms at the confluence of which of the following vessels
A) right and left carotid veins
B) right and left common iliac veins
C) right and left lumbar veins
D) right and left renal veins
E) right and left common iliac arteries
B) right and left common iliac veins
The right and left hepatic ducts unite to form the
Common hepatic duct
What is the most common fatal liver disorder in children in the United States
Biliary atresia
A genetic trait characterized by a segmental saccular dilatation of the intrahepatic ducts describes
Caroli disease
What is characterized as a cystic dilatation and out-pouching of the common duct wall
Choledochal cyst
Sonographically what presents as a solid mass at the junction of the right and left hepatic ducts and there is intrahepatic duct dilatation without extrahepatic duct dilatation
Klatskin tumor
A GB sonographic exam is performed and a small GB with intrahepatic dilatation is seen. This maybe indicate that the level of obstruction is at the left of which of the following
A) neck of the GB
B) CBD
C) cystic duct
D) common hepatic duct
E) none of the above
D) common hepatic duct
What is the max inner diameter of the main pancreatic duct in young adults
A) 10 mm
B) 5 mm
C) 2 cm
D) 3 mm
E) 2 mm
E) 2 mm
A patient in the late stages of sickle cell anemia will have a spleen that is which of the following
A) enlarged and lobulated
B) enlarged and echogenic
C) small and hypoechoic
D) small and echogenic
E) atrophic and isoechoic
D) small and echogenic
In a patient with acute hepatitis, what is the appearance of the liver parenchyma Sonographically
A) hypoechoic
B) echogenic
C) complex
D) normal
E) anechoic
D) normal
What portion of the pancreas is located anterior to the IVC and right renal vein
Head
What vein is imaged posterior to the SMA and anterior to the aorta
Left renal vein
Another name for the main pancreatic duct is
Wirsungs duct
Another name for the accessory duct is the
Santorini duct
The exocrine function of the pancreas is to secrete
1) amylase
2) lipase
3) trypsin
What is the most common complication associated with acute pancreatitis
Pancreatic pseudocyst
What is the most common malignant tumor of the pancreas
Adenocarcinoma
What malignant tumor of the pancreas is visualized Sonographically as an irregular cystic lobulated mass with thick walls and is more commonly seen in the body or tail
Cystadenocarcinoma
The spleen is located in what region
Left hypochondriac
What organ in the body is the main component of the reticuloendothelial system
Spleen
The spleen is crescent shaped with a _____ superior lateral border and ______ medially
Convex, concave
Where is a wandering spleen usually located
In the pelvis
What is the landmark for the posterolateral border of the thyroid
A) trachea
B) esophagus
C) strap muscle
D) common carotid artery
E) super thyroid artery
D) common carotid artery
Acute hydroceles may be caused by all of the following except
A) infarction
B) tumor
C) testicular torsion
D) trauma
E) infection of the testis or epididymis
C) testicular torsion
If a mass in the area of the pancreatic head is found, what other structure should be examined sonographically
A) liver
B) IVC
C) spleen
D) kidney
E) bowel
A) Liver
The ligament of venosum separates which 2 lobes of the liver
A) right and left lobes
B) medial portion of the left lone and the lateral portion of the left lobe
C) caudate lobe and left lobe of liver
D) anterior portion of the right lobe and posterior portion of the right lobe
E) quadrate love and left lobe of the liver
C) caudate lobe and left lobe of liver
Which of the following is not a retroperutoneal structure
A) kidney
B) pancreas
C) aorta
D) spleen
E) psoas muscle
D) spleen
Which of the following statements is true about the portal vein
A) it is formed formed by the union of the common hepatic duct and cystic duct
B) it is only imaged sonographically when there is liver pathology
C) it is formed by the union of the splenic vein and superior mesenteric vein
D) is it very pulsatile
E) it is common place for stones to form
C) it is formed by the union of the splenic vein and SMV
Identify the lab value that is specific for a hepatoma of the liver
A) ALP
B) AFP
C) serum amylase
D) bilirubin
E) serum albumin
B) AFP
Identify the part of the pancreas that lies anterior to the IVC and posterior to the SMV
A) head
B) neck
C) body
D) uncinate process
E) tail
D) uncinate process
In a dissecting aneurysm, the dissection is through which of the following
A) adventitia
B) media
C) intima
D) all 3 layers
E) lumen
C) intima
What part of the kidney contains fat, calyces, infundibula, renal pelvis, connective tissue, renal vessels, and lymphatics
Renal sinus
What portion of the kidney is where blood vessels, nerves, lymphatic vessels, and the ureter enter or exit the renal sinus
Renal hilum
What lab value is elevated with renal dysfunction
Serum creatinine
What lab value is elevated when there is acute or chronic renal disease or urinary obstruction.
BUN
What occurs when the kidney fails to ascend out of the pelvis
Pelvic kidney
What kidney disease presents as bilateral echogenic enlarged kidneys with cysts
Infantile polycystic kidney disease
What are 2 other names for infantile polycystic kidney disease
1) autosomal recessive polycystic disease
2) potter type 1
What is another name for adult polycystic kidney disease
Potter type 2
What kidney disease presents as bilateral large kidneys with randomly distributed cortical cysts of various sizes
Adult polycystic kidney disease
An RI of less than _____ will diagnosis renal obstruction
0.70
The “twinkle sign” is a color artifact that has been seen with
Urinary stones
What is the most common cause of acute renal failure
Acute tubular necrosis
Where is a transplanted kidney placed
Within the iliac fossa
What is the most serious sign of transplant rejection
Renal failure
A kidney that appears as an enlarged kidney with increased cortical echogenicity, decreased renal sinus echogenicity, irregular sonolucent areas in the cortex, enlarged and decreased echogenicity of the pyramids, distortion of the renal outline, and indistinct corticomedullary junction describes
Acute renal rejection
What is another name for prune belly syndrome
Eagle Barrett syndrome
A cystic dilatation of the distal portion of the ureter with narrowing of the ureteric orifice describes
Ureterocele
Adrenalcortical hyper function is another name for
Cushing syndrome
Hyperalrosteronism is another name for
Conns syndrome
Adrenocortical hypofunction is another name for
Addisons disease
An increase in aldosterone producing sodium retention describes
Conns syndrome
Decreased hormonal production causing hypotension, malaise, weight loss, changes in skin pigmentation, loss of body hair describes
Addison disease
Right adrenal pathology will displace the IVC
A) anterior
B) posterior
A) anterior
Right adrenal pathology will displace the right renal vein
A) anterior
B) posterior
A) anterior
Right adrenal pathology will displace the right kidney
A) anterior
B) posterior
B) posterior
Left adrenal pathology will displace the splenic vein
A) anterior
B) posterior
A) anterior
Left adrenal pathology will displace the left kidney
A) anterior
B) posterior
B) posterior
What produces steroid hormones
Adrenal cortex
The adrenal cortical hormones are regulated by what
ACTH
Name 2 things the adrenal medulla produces
1) epinephrine (adrenaline)
2) norepinephrine
______ dilates the coronary vessels and constricts the skin and kidney vessels
Epinephrine
______ constricts all arterial vessels except the coronary arteries (which dilate)
Norepinephrine
The narrowest portion of th colon is
The sigmoid
The _______ space is between the liver (or spleen) and the diaphragm and is a common site for abscess
Subphrenic
The ______ crus can be visualized anterior to the aorta above the level of the celiac artery
Left
The _____ crus is visualized posterior to the caudate lobe and IVC
Right
Where can a patent umbilical vein be found
A) ligamentum venosum
B) main lobar fissure
C) ligamentum teres
D) intersegmental ligament
E) gallbladder fossa
C) ligamentum teres
Dilatation of the intrahepatic biliary ducts without dilatation of the extrahepatic ducts may be caused by all of the following except
A) klatskin tumor
B) enlarged portal lymph nodes
C) cholangiocarcinoma
D) pancreatic carcinoma
D) pancreatic carcinoma
What is a cause of a small gallbladder
A) prolonged fasting
B) insulin dependent diabetes
C) hydrops
D) ascites
E) chronic cholecystitis
E) chronic cholecystitis
What is hydrops of the gallbladder
A) small contracted gallbladder
B) gallbladder with a thickened wall
C) thick walled gallbladder filled with stones
D) congenital duplication of the gallbladder
E) enlarged gallbladder
E) an enlarged gallbladder
The majority of primary retroperitoneal tumors are malignant. Which of the following is an example of a primary retroperitoneal tumor
A) hepatoma
B) hypernephroma
C) leiomyosarcoma
D) adenocarcinoma
E) hematoma
C) leiomyosarcoma
In comparison to the normal echotexture in adults, the pancreas in children will be relatively
A) more echogenic
B) less echogenic
C) the same
D) larger and less echogenic
E) complex
D) larger and less echogenic
What is the largest major visceral branch of the IVC
A) portal vein
B) hepatic veins
C) renal veins
D) IMV
E) gonadal veins
B) hepatic veins
What are the normal measurements of the thyroid gland
A) 3-4 cm in AP and length dimensions
B) 2-3 cm in AP and 4-6 cm in length
C) 1-2 cm in AP and 4-6 in length
D) 3-5 cm in AP and 6-8 cm in length
E) 4-6 cm in AP and 8-10 cm in length
C) 1-2 cm in AP and 4-6 in length
Ascites can be caused by all of the following except
A) malignancy
B) nephritic syndrome
C) congestive heart failure
D) tuberculosis
E) adenomyomatosis
E) Adenomyomatosis
What is the best way to delineate a dissecting aneurysm on sonography
A) begin scanning in the transverse section and document serial scans
B) show an intimal flap pulsating with the flow of blood
C) scan the patient in a decubitus position to document the aorta and IVC simultaneously
D) document the renal arteries
E) have the patient perform a Valsalva maneuver to dilate the aorta
B) show an intimal flap pulsating with the flow of blood
Which of the following is not a remnant of the fetal circulation
A) ligamentum teres
B) ligamentum venosum
C) Falciform ligament
D) coronary ligament
D) coronary ligament
A 44 year old patient presents with painless jaundice and a palpable RUQ mass which is most characteristic of which of the following
A) acute hepatitis
B) cirrhosis
C) porcelain GB
D) courvoisiers GB
E) Klatskin tumor
D) courvoisiers GB
What is the lesser sac located between
A) pancreas and IVC
B) stomach and pancreas
C) abdominal wall and stomach
D) liver and right kidney
E) stomach and spleen
B) stomach and pancreas
Abscesses are most often associated with
Cholangitis
Subhepatic abscess are associated with
Cholecystectomy
What type of abscess is associated with bacterial spill into the peritoneum during surgical procedure, bowel rupture, peptic ulcer perforation, and trauma
Subphrenic
A variable, complex, solid cystic lesion with septa, debris, and scattered echoes describes an
Abscess
What type of abscess is located within the liver parenchyma
Intrahepatic
What type of abscess is located inferior to the liver, fluid collection anterior to the right kidney, and gallbladder fossa
Subhepatic
What type of abscess is located superior to the liver and inferior to the diaphragm
Subphrenic
What does the anterior perirenal space contain
Retroperitoneal portion of the intestines and pancreas
Name 6 things the perineal space contains
1) kidneys
2) ureters
3) adrenal glands
4) aorta
5) IVC
6) retroperitoneal nodes
Name 3 things the posterior perirenal space contains
1) posterior abdominal wall
2) iliopsoas muscle
3) quadratic muscle
Name the 6 primary retroperitoneal tumors
1) liposarcoma
2) fibrosarcoma
3) rhabdomyosarcoma
4) leiomyosarcoma
5) teratoma
6) neurogenic tumors
Para-aortic nodes may displace the celiac axis and SMA _____
Anteriorly
What is calcification of the gallbladder wall called
A) cholesterolosis
B) courvoisiers gallbladder
C) hydronic gallbladder
D) porcelain gallbladder
D) porcelain gallbladder
A 60 year old man presents with an abdominal pulsatile mass and high blood pressure. What is this most characteristic of
A) an aneurysm
B) mesenteric cysts
C) gallstones
D) budd chiari syndrome
E) portal hypertension
A) aneurysm
Identify the vessel that may be imaged posterior to the IVC
A) right renal vein
B) right renal artery
C) left renal vein
D) left renal artery
E) no vessels course posterior to the IVC
B) right renal artery
The retroperitoneal space is defined as the area between which of the following
A) posterior portion of the parietal peritoneum and the posterior abdominal wall muscles
B) anterior portion of the parietal peritoneum and the posterior abdominal wall muscles
C) anterior portion of the parietal peritoneum and the posterior portion of the parietal peritoneum
D) anterior abdominal wall and the posterior parietal peritoneum
A) posterior portion of the parietal peritoneum and the posterior abdominal wall muscles
An abdominal sonogram is performed and there is a suggestion of a mass in the head of the pancreas. Identify the other structures that should be evaluated
A) the biliary system and GB to evaluate biliary obstruction
B) the hepatic artery and splenic artery to document dilatation
C) the kidney to evaluate renal obstruction
D) liver to evaluate focal masses
E) spleen to document size
A) the biliary system and GB to evaluate biliary obstruction
Lymph nodes may be confused sonographically with all of the following except
A) abdominal aortic aneurysm
B) chronic pancreatitis
C) crus of the diaphragm
D) bowel
B) chronic pancreatitis
An abdominal sonogram is performed on a 35 year old man with a history of primary cancer of the liver who now presents with abdominal pain and increasing abdominal girth. What is this most consistent with
A) cholecystitis
B) pancreatitis
C) portal hypertension
D) budd chiari syndrome
E) renal failure
D) budd chiari syndrome
During an abdominal sonogram, recanalization of the umbilical vein is identified. What could this be associated with
A) ascites
B) an abscess
C) a hematoma
D) hepatoma
E) portal hypertension
E) portal hypertension
Islet cell tumors of the pancreas are most likely to be located in which portion of the pancreas
A) head and neck
B) neck and tail
C) uncinate process
D) body and tail
E) head and body
D) body and tail
A normal functioning transplanted kidney will appear sonographically as which of the following
A) more echogenic than a normal kidney
B) with a thin renal cortex and prominent medullary pyramids
C) the same as a normal kidney
D) twice the size of a normal kidney
E) with the renal sinus and renal cortex being isoechoic
C) the same as a normal kidney
When performing a gallbladder exam, why is the patient asked to be NPO for approx 6 hours before the exam
A) to eliminate any overlying bowel gas
B) to make the patient more cooperative
C) to bring out dehydration which will make the patient easier to scan
D) causes bile to collect in the gallbladder
E) causes the bile ducts to dilate
D) causes bile to collect in the gallbladder
What do Klatskin tumors cause
A) dilatation of the intrahepatic ducts
B) dilatation of the extrahepatic ducts
C) gallstones
D) pancreatitis
E) porcelain gallbladder
A) dilatation of the intrahepatic ducts
Which if the following is not located in the peritoneal cavity
A) gallbladder
B) liver
C) spleen
D) pancreas
E) hepatic veins
D) pancreas
Artifactual echoes may occur within cysts owing to each of the following except
A) slice thickness
B) side lobe
C) edge
D) reverb
C) edge
In which of the following ways does ascites sonographically affect the liver
A) there will be no effect
B) the liver will appear more echogenic
C) the assured will attenuate the liver resulting in decreased echoes
D) the ascites will cause the liver to appear inhomogenous
B) the liver will appear more echogenic
Which of the following is a representative of a post trauma fluid collection located between the diaphragm and the spleen
A) ascites
B) pleural effusion
C) a subcapsular hematoma
D) a Subphrenic abscess
E) retroperitoneal fibrosis
D) a Subphrenic abscess
Which of the following can be displaced by a retroperitoneal sarcoma
A) kidney posterior
B) spleen anterior
C) pancreas posterior
D) diaphragm inferior
E) aorta posterior
B) spleen anterior
The causes of a large gallbladder include all of the following except
A) Adenomyomatosis
B) pancreatic carcinoma
C) diabetes mellitus
D) fasting patient
Eh common duct obstruction
A) Adenomyomatosis
All of the following are associated with cirrhosis except
A) ascites
B) splenomegaly
C) jaundice
D) hepatomegaly
E) collateral vessel development
D) hepatomegaly
What lies posterior to the IVC
Right renal artery
The _____ is a central branch of the aorta
SMA
The common bile duct is formed by which of the following
A) right and left hepatic ducts joining the cystic duct
B) cystic duct joining the right hepatic duct
C) common duct joining the cystic duct
D) common duct joining the neck of the gallbladder
E) common duct joining the pancreatic duct
C) common duct joining the cystic duct
The livers covering is called glissons capsule. What’s another term for this covering
Visceral peritoneum
Name the lining of the abdominal cavity
Parietal peritoneum
What is segment 1 of the liver called
Caudate lobe
What is segment 2 of the liver called
Left lateral posterior
What is segment 3 of the liver called
Left lateral anterior
What is segment 4A and 4B of the liver called
4A- left medial superior
4B- left medial inferior
What is segment 5 of the liver called
Right anterior inferior
What is segment 6 of the liver called
Right posterior inferior
What is segment 7 of the liver called
Right posterior superior
What is segment 8 of the liver called
Right anterior superior
Name 3 vessels that form the portal triad
1) portal vein
2) hepatic artery
3) bile duct
Describe the location of the main lobar fissures
Imaginary line from GB fossa to IVC
Separates right and left lobes of liver
Middle hepatic vein= landmark
Which 2 segments of the liver does the main lobar fissure separate
Separates the right anterior segment of the right lobe from the left medial segment of the left lobe
Describe the location of the right intersegmental fissure
The right intersegmental fissure is a coronal division of the right lobe of the liver. Divides the right lobe into anterior and posterior segments. Right hepatic vein is a landmark
Describe the location of the left intersegmental fissure
The left intersegmental fissure is a sagittal division of the left lobe of the liver. Divides left lobe into medial and lateral sections. Left hepatic vein, ligamentum teres, Falciform ligament, and ascending segment of left portal vein are landmarks
What is the ligamentum venosum
Remnant of the ductus venosum. Conducts blood from the left portal vein to IVC. Separates the medial segment of the left lobe from the caudate lobe
Name the 4 borders of the caudate lobe
1) posteriorly by IVC
2) anterioinferiorly by prox left portal vein
3) anterolaterally by ligamentum venosum
4) inferior by the main portal vein
Which of the following is usually the cause of an aneurysm
A) degenerative joint disease
B) atherosclerosis
C) hypertension
D) diabetes
E) cystic fibrosis
B) atherosclerosis
What is the sonographic characteristic of Hasimotos thyroiditis
A) atrophic thyroid tissue with homogenous echotexture
B) multiple hypoechoic micronodules
C) bilateral enlargements of the thyroid with multiple small cyst
D) hypertrophy of the thyroid gland with homogenous echotexture
E) hyperplasia with fluid levels
B) multiple hypoechoic micronodues
Which of the following is associated with an increase with the biochemical marker CEA
A) postradioummunotherapy
B) bowel decompression surgery
C) follicular cyst of the ovaries
D) relapse of colorectal cancer
E) colostomy
D) relapse of colorectal cancer
A _______ is a saccular outpouching of the distal ureter into the urinary bladder
Ureterocele
A_____ _____ is an outpouching of the bladder mucosa through the muscular layer
Bladder diverticula
Which one of the following statements concerning the sonographic patterns of periaortic lymph nodes is not correct
A) they may drape or mantle the great vessels anteriorly
B) they may displace the SMA posteriorly
C) they may displace the great vessels anteriorly
D) they may have lobar, smooth, or scalloped appearance
E) as mesenteric involvement occurs, the adenopathy may fill most of the abdomen in an irregular complex pattern
B) they may displace the SMA posteriorly
Cholecystitis, right sided heart failure, and hypoproteinemia are some causes of a
Thickened gallbladder wall
The lab findings of renal failure include which of the following
A) creatinine and alkaline phosphatase
B) creatinine and BUN
C) serum amylase and lipase
D) serum amylase and creatinine
E) alkaline phosphatase and alpha-fetoprotein
B) creatinine and BUN
A resistive index of >0.70 in a kidney is consistent with early
A) obstructive jaundice
B) obstructive hydro
C) renal cell carcinoma
D) benign renal cyst
E) polycystic renal disease
B) obstructive hydro
What is the bare area
Posterior crescent shaped portion of the liver not covered by peritoneum
Describe how pyogenic abscesses develop in the liver
They are solitary and occur in the right lobe of the liver caused by bacteria which enter the liver via the bile ducts, portal veins and hepatic artery
What is the sonographic appearance of pyogenic abscesses
Appear as hypoechoic, round, fluid filled masses with variable degrees of internal echoes or debris
Describe the sonographic appearance of acute hepatitis
-hypoechoic liver parenchyma
-liver enlargement
-hyperechoic portal vein walls
What is the sonographic appearance of a fungal abscess
1) wheel within a wheel
2) bulls eye
3) hypoechoic mass
4) echogenic mass
Describe the sonographic appearance of an amoebic abscess within the liver
1) a round or oval shaped hypoechoic mass
2) absence of a prominent wall
3) fine low level internal echoes
4) distal enhancement
5) continguous with diaphragm
Portal vein occlusion due to schistosomiasis leads to what 4 things
1) portal hypertension
2) splenomegaly
3) varies
4) ascites
Describe the sonographic appearance of schistosomiasis
Distended, echogenic debris filled intrahepatic portal vein
What is the most common organism causing infections in AIDS and other immune compromised patients
Pneumocystis Carinni
How does pneumocystis carinni appear sonographically
Appears as non shadowing echogenic foci
Fatty infiltration of the liver can be assessed sonographically by visualizing which of the following
A) echogenic vessel walls seen throughout the liver
B) hypoechoic diaphgram
C) increased liver echogenicity
D) multiple echogenic focal masses
E) small nodular liver
B) hypoechoic liver echogenicity
A patient who has blunt trauma to the abdomen earlier in the day presents with LUQ pain and a decrease in hematocrit. An echogenic mass is seen in the spleen. What is this consistent with
A) abscess
B) lymphoma
C) infection
D) hematoma
E) leukemia
D) hematoma
Which of the following conditions may affect the adrenal gland
A) neonatal hypotension
B) severe fulminant tuberculosis infection
C)malignant lung carcinoma
D) breast carcinoma
E) all of the above
E) all the above
What portion of the pancreas is anterior to the formation of the portal vein
A) head
B) neck
C) isthmus
D) body
E) tail
B) neck
Name the 3 most common causes of general dilation of the IVC
1) congestive heart failure
2) hypertension
Describe the appearance of focal fatty infiltration
Regions of increased echogenicity present within a background of normal liver parenchyma
Describe the appearance of focal fatty sparing
Islands of normal liver parenchyma which appear as hypoechoic masses within a dense fatty infiltrated liver. Commonly seen adjacent to the GB
What liver mass is associated with glycogen storage disease
Hepatic adenoma. Linked the the usage of oral contraceptives
What is the clinical presentation of a patient with cirrhosis
1) hepatomegaly
2) jaundice
3) ascites
What are the clinical signs of portal hypertension
1) ascites
2) splenomegaly
3) varies
What are the sonographic findings of portal vein thrombosis
1) intraluminal thrombus
2) increased vein diameter
3) cavernous transformation
What are the sonographic findings associated with Budd chiari syndrome
1) hepatic vein thrombosis
2) ascites
3) hepatomegaly
4) caudate lobe enlargement
5) portal hypertension
What is the sonographic appearance of a focal nodular hyperplasia
Solitary mass less than 5 cm that may have a central scar. Also described as a stealth lesion
Name 4 well defined hyperechoic liver masses
1) hemangiomas
2) hepatic lipomas
3) echogenic mets
4) focal fatty infiltrations
Name the most common primary malignant tumor of the liver
Hepatocellular carcinoma
Etiologic factors include alcoholic cirrhosis, chronic hep B and C
Seen as a hypoechoic mass
Name 5 portosystemic shunts
1) portocaval shunt
2) prox splenorenal shunt
3) dst splenorenal (warren) shunt
4) mesocaval shunt
5) TIPS
How is shunt patency confirmed sonographically
1) demonstration of flow within the shunt
2) presence of heptofugal portal vein flow
-Warren shunt and TIPS will have hepatopetal portal vein flow
Low velocity continuous flow toward the liver with mild undulations that is physic and affected by respirations describes flow of the
Portal vein
_____ veins are typically triphasic reflecting right atrial filling, contraction, and relaxation
Hepatic veins
What artery runs parallel to the main portal vein
Hepatic artery
Doppler waveforms demonstrating flow throughout diastole, indicating a low resistance system describes what artery
Hepatic artery
______ is a non obstructive hepatocellular cause of jaundice
Hepatitis
Which of the following statements does not differentiate the portal veins from the hepatic veins
A) portal veins become larger as they approach the diaphragm
B) portal veins have echogenic borders
C) portal veins bifurcate into right and left branches
D) the main portal vein is part of the portal triad
A) portal veins become larger as they approach the diaphragm
The left crus of diaphragm may be confused with which of the following
A) left adrenal gland
B) aorta
C) splenic vein
D) SMA
E) accessory spleen
A) left adrenal gland
A) spleen
B) pancreas
C) gallbladder
D) adrenal glands
E) kidneys
E) kidneys
Identify the vessel with a postprandial low-resistive blood flow
A) celiac artery
B) hepatic artery
C) splenic artery
D) SMA
E) aorta
D) SMA
What is the purpose of administering a fatty meal to a patient
A fatty meal is helpful in assessing biliary obstruction. An obstructed bile duct should increase in size following administration of a fatty meal.
What does a significant level of conjugated bilirubin levels indicate
1) obstructive jaundice
2) intrahepatic cholestasis
3) biliary tree obstruction
What are the 8 causes for gallbladder wall thickening
1)cholecystitis
2) ascites
3) hypoalbuminea
4) hepatitis
5) CHF
6) renal disease
7) AIDS
8) sepsis
Describe acute cholecystitis
A stone obstructing the cystic duct
What are the symptoms of acute cholecystitis
1) RUQ pain
2) fever
3) chills
4) leukocytosis
Name the 5 sonographic criteria that define acute cholecystitis
1) gallstones
2) Murphy sign
3) diffuse wall thickening
4) GB dilatation
5) sludge
What is emphysematous cholecystitis
Infection associated with gas forming bacteria within the wall of the gallbladder.
Describe the mechanism of hydrops of the gallbladder
Distended non inflamed GB due to total obstruction of the cystic duct.
-enlarged non tender gallbladder r
What is the most common complication of a pancreatic pseudocyst
A) infection
B) reabsorption
C) calcification
D) hemorrhage
E) rupture
E) rupture
Which of the following is a type of a malignant adrenal mass
A) adenoma
B) myelolipoma
C) cyst
D) pheochromocytoma
E) neuroblastoma
E) neuroblastoma
An enlarged right adrenal gland will displace the IVC in which of the following directions
A) anterior
B) posterior
C) medial
D) lateral
E) no displacement
A) anterior
Where are the spiral values of Heister located
A) ampulla of Vater
B) junction of the cystic duct and common duct
C) junction of the right and left common hepatic duct
D) proximal portion of the cystic duct
E) fundus of the gallbladder
D) proximal portion of the cystic duct
Identify the pre-existing condition that occurs in patients with hepatomas
A) hematomas
B) abscesses
C) gallstones
D) developmental cysts
E) cirrhosis
E) cirrhosis
Which of the following describes how carcinoma of the gallbladder would most likely appear
A) thin walled gallbladder
B) small gallbladder with thickened walls
C) large gallbladder with a halo surrounding it
D) diffusely thickened gallbladder with gallstones
E) echogenic mass with no distinguishing features of a gallbladder
D) diffusely thickened gallbladder with gallstones
What are Rokitansky-Aschoff sinuses
Diverticula within the wall of the GB
- sludge and stones accumulate within the sinuses and present as focal wall thickening
What is the sonographic presentation of gallbladder carcinoma
Intraluminal mass, asymmetric wall thickening or a mass filled GB
What 3 other findings should be investigated to confirm the diagnosis of GB carcinoma
1) liver Mets
2) lymphadenopathy
3) bile duct dilatation
What are the 2 most common causes of biliary tract obstruction
1) gallstones
2) carcinoma of the pancreas
What 3 lab values are most likely to be elevated due to biliary tract obstruction.
1) ALP
2) conjugated (direct) bilirubin
3) GGT
What is Mirizzi syndrome
Extrahepatic bile duct obstruction due to a stone within the cystic duct
-the stone causes extrinsic mechanical compression of the common hepatic duct
Describe the 3 sonographic findings associated with Mirizzi syndrome
1) intrahepatic bile duct dilatation
2) normal sized CBD
3) large stone in cystic duct
Name 3 extrahepatic biliary ducts
1) common hepatic duct
2) cystic duct
3) CBD
A Klatskin tumor is a specific type of
Cholangiocarcinoma
Where is a Klatskin tumor located
Located at the hepatic hilum at the junction of the right and left hepatic ducts
Where is pneumobilia commonly seen
In the hilum of the liver
What are the sonographic features associated with a choledochal cyst
1) 2 cyst like structures in the RUQ ( gallbladder and dilated CBD)
2) dilated intrahepatic biliary tree
What is the sonographic appearance of Caroli disease
Saccular, communicating intrahepatic bile duct dilatation
What other genetically acquired conditions are associated with Caroli disease
1) infantile PKD
2) congenital hepatic fibrosis
3) choledochal cysts
Name 5 predisposing conditions associated with cholangiocarcinoma
1) ulcerative colitis
2) sclerosing cholangitis
3) Caroli disease
4) choledochal cysts
5) parasitic infestations
The SMA and SMV are ______ to the neck of the pancreas
Posterior
The uncinate process is ______ to the SMA and SMV
Posterior
The celiac axis arises from the aorta ______ to the pancreas
Superior
The GDA and CBD run________ to the first portion of the duodenum
Posterior
The SMA and SMV are ______ to the third portion of the duodenum.
Anterior
What are the 2 most common causes of pancreatitis
1) alcohol abuse
2) biliary calculi
What is the sonographic appearance of acute pancreatitis
May demonstrate a normal pancreas with increasing severity, decreased echogenicity and increased gland size
What are the sonographic signs of chronic pancreatitis
Irreversible destruction of the pancreas
1) small echogenic gland
2) calcifications
3) pancreatic duct dilatation
4) pseudocyst formation
What 6 findings are associated with pancreatic adenocarcinoma
1) dilated biliary system
2) dilated pancreatic duct
3) liver Mets
4) ascites
5) lymphadenopathy
6) pseudocyst formation
What are the branches of the common hepatic artery
1) proper hepatic
2) GDA
What are Islet cell tumors
Well circumscribed masses found in the tail of the pancreas
Name the 2 most common Islet cell tunes and describe the symptoms of each
1) Insulinoma- characterized by hyperinsulinism and hypoglycemia
2) gastrinomas- associated with gastric hypersecretions and peptic ulcer disease
Where is a TIPS shunt typically placed
Placed by using a jugular access between the right hepatic vein and right portal vein
If a liver cyst is seen what organ should be evaluated next
Kidneys looking for autosomal dominant polycystic kidney disease
This is a solid liver mass associated with the use of oral contraceptive agents
Hepatic adenoma
What is another name for hepatocellular carcinoma
Hepatoma
What are pancreatic pseudocyst
Collections of pancreatic fluid encapsulated by fibrous tissue
What are the 4 functions of the spleen
1) breakdown of hemoglobin
2) formation of bile pigment
3) formation of antibodies
4) reservoir for blood
Name 5 structures that appear as cystic splenic masses
1) cystic degeneration of infarcts or hematomas
2) cysts associated with adult PKD
3) parasitic cyst of spleen
4) epidermoid cyst of spleen
5) pancreatic pseudocyst
What type of hematoma is the result of splenic trauma in which the splenic capsule remains intact
Intraparenchymal or subcapsular hematoma
What type of hematoma is the result of splenic trauma in which the splenic capsule ruptures
Perisplenic or intraperitoneal hematoma
Multiple pancreatic cysts are associated with what 2 syndromes
1) autosomal dominant PKD
2) Von Hippel-Lindau syndrome
When severely affected, what is the sonographic appearance of the pancreas in a patient with cystic fibrosis
Increased echogenicity of the pancreatic parenchyma
Name 4 sonographic indications of portal vein thrombosis
1) echogenic thrombus within vessel lumen
2) an increase in portal vein diameter
3) portosystemic collateral circulation
4) cavernous transformation
What is the most common malignant liver tumor in early childhood
Hepatoblastoma
________ is a spiral fold which controls bile flow in the cystic duct
Valve of Heisters
________ is an abnormal sacculation of then neck of the gallbladder
Hartmanns pouch
What’s another name for the main pancreatic duct
Duct of Wirsung
What is another name for hydrops of the gallbladder
Mucocele
Trace the branches of the renal artery
1) main renal artery branches from aorta
2) entering hilum of kidney it divides unit 5 segmental arteries which divide into interlobar arteries
3) interlobar arteries are seen between medullary pyramids
4) at base of med pyramids the arcuates branch perpendicular from interlobar arteries
5) arcuates are seen running parallel to the renal capsule
6) interlobar arteries branch off arcuates and run perpendicular to the renal capsule
What is associated with unilateral renal agenesis
1) uterine duplication in females
2) seminal vesicle agenesis in males
Describe the development and appearance of crosses renal ectopia
Kidney ascends to the contra lateral side. Ureter of kidney ascends to the contra lateral side crosses the midline. Seen as 2 kidneys on 1 side of the abdomen
Describe the development and sono appearance of crossed fused renal ectopia
Developing kidneys fuse in the pelvis. 1 kidney ascends to normal position and carries the other across the midline. Appears as 2 kidneys fused at the upper and lower poles on 1 side of the abdomen
A prolapse of the distal ureter into the bladder with cystic dilatation describes
Ureterocele
A frequent complication of ectopic ureter is a
Ureterocele
Describe the appearance of column of Bertin
Hypertrophy of renal cortical parenchyma located between 2 medullary pyramids
Describe the appearance of an extra renal pelvis
Renal pelvis protrudes outside the renal hilum. Seen as a cystic collection medial to the renal hilum
What is the most common cause of extrahepatic obstructive jaundice
Choledocholithiasis
What type of choledochal cyst is the most common
A) type 1
B) type 2
C) type 3
D) type 4
E) type 5
Type 1
Type 5 choledochal cyst is also called
Caroli disease
The central dot sign is an ultrasound finding of what
Caroli disease
The most common cause of malignant neoplasm obstructing the biliary tree is
Pancreatic adenocarcinoma
______ is an enzyme found in bone, liver and placenta
ALP
ALP increases with what 5 things
1) biliary obstruction
2) liver disease
3) bone growth and diseases
4) hyperparathyroidism
5) pregnancy
True or false
The pancreas’s should be more echogenic than the liver
True
The GDA supplies what portion of the pancreas
The head
The splenic artery and the SMA supply what 2 portions of the pancreas
Body and tail
The CBD and duct of Wirsung join to become the
Ampulla of Vater
What is another name for the duct of Wirsung
Main pancreatic duct
The normal panc duct is considered abnormal if it is > _____ mm
2.0 mm
In children the most common reason for a pancreatic pseudocyst is
Abdominal trauma
Failure of the dorsal and ventral pancreatic duct to fuse during embryonic development is called
Pancreatic divisum
An uncommon congenital anomaly where a ring of normal pancreatic tissue encircles the duodenum is called
Annular pancreas
The 2 most common cystic neoplasms of the pancreas are
1) serous cystadenoma
2) mucinous cystic neoplasm
What’s another name for serous cystadenoma
Microcystic cystadenoma
What is another name for mucinous cystic neoplasm
Macrocystic neoplasm
What is the 2nd most common islet cell tumor
Gastrinoma
______ is a digestive enzyme for carbohydrate
Amylase
_______ is produced by the pancreas and salivary glands
Amylase
What lab value rises later and persists longer
Lipase
Describe the sonographic appearance of infantile polycystic kidney disease
Bilaterally enlarged echogenic kidneys with loss of cortical medullary boundary
What 3 other anomalies are associated with infantile PKD
1) lung hypoplasia
2) periportal hepatic fibrosis
3) oligohydraminos
What is medullary sponge kidney
Dysplastic cystic dilatation of the collecting tubules of the medullary pyramids
Describe the sono appearance of medullary sponge kidney
Equally spaced hyperechoic medullary pyramids
List 4 sonographic features of multicystic dysplastic kidney disease
1) cysts of varying shape and size
2) absence of communication between cysts
3) absence of renal sinus
4) absence of renal parenchyma
What contralateral renal abnormalities are found when multicystic kidney disease is unilateral
1) Ureteropelvic junction obstruction
2) renal agenesis or hypoplasia
3) pelvocalectasis
What would a sonographer look for in a patient with a history of tuberous sclerosis
Renal cyst formation and multiple renal angiomyolipomas
In relation to the right kidney where is the adrenal gland located
Superomedial
The ______ arteries are the smallest renal arteries that branch off the arcuates running perpendicular to the renal capsule
Interlobular arteries
What vein sits between the SMA and aorta
Left renal vein
What is the 2nd most common renal fusion anomaly
Crossed fused renal ectopia
What is another name for junctional parenchyma defect
Fetal lobulation
Cysts located in the periphery of the kidney are termed
Cortical or parenchyma cysts
Cysts located in the center of the kidney are termed
Peripelvic cysts
What is the most common genetic determined childhood cystic disease of the kidneys
Austosomal recessive infantile polycystic kidney disease
Where is the most common cause of an abdominal mass in a newborn
Multicystic dysplastic kidney
What is another name for angiomyolipoma
Renal hamartoma
What organ is the main focus of an abdominal sono eval in a patient with tuberous sclerosis
Kidneys
What is the most common solid renal mass in the adult
Renal cell carcinoma
What are 3 other names for renal cell carcinoma
1) renal adenocarcinoma
2) hypernephroma
3) Grawitz tumor
In a normal adult patient, the common hepatic duct lumen measures less than or equal to
A) 2 cm
B) 2 mm
C) 6 mm
D) 4 mm
D) 4 mm
All of the following are true regarding the ligamentum teres except
A) recanalizes with cirrhosis
B) is a remnant of the umbilical vein
C) located in the left interetmental fissure
D) round, hyperechoic foci near the porta hepatis
D) round, hyperechoic foci near the porta hepatis
Renal cell carcinoma is associated with what 4 renal diseases
1) Adult PKD
2) Acquired cystic disease
3) Von Hippel
4) Tuberous Sclerosis
What additional areas should be evaluated whenever a solid renal mass is detected
1) ipsilateral renal vein and IVC for tumor invasion
2) contralateral kidney and renal vein
3) retroperitonem for lymphadenopathy
4) liver for mets
What is the most common solid tumor in children diagnosed by ultrasound
Wilms tumor (nephroblastoma)
What are the 3 ultrasound findings associated with significant acute pyelonephritis
1) renal enlargement
2) hypoechoic parenchyma
3) absence of sinus echoes
What are the 3 sonographic features of pyonephrosis
1) dependent echoes within a dilated pelvocaliceal system
2) shifting urine debris level
3) gas shadowing from infection
What are the 2 most common explanations for bilateral renal masses
1) malignant lymphoma/hodgkins
2) Mets
What is the sonographic appearance of a renal mycetoma
Aka fungal ball
Appears as hyperechoic nonshadowing masses
What 7 tumors commonly imaged with US are associated with Von Hippel
1) renal cell carcinoma
2) hemangioma
3) pheochromocytoma
4) pancreatic cystadenoma
5) adenoma
6) Islet cell tumor
7) cysts associated with a variety of organs
What is the most common renal fungal disease
Candidiasis
Name 6 types of hyperechoic renal masses
1) mycetoma
2) angiomyolipomas
3) blood clots
4) pyogenic debris
5) sloughed papilla
6) nonshadowing renal stones
What is the most common cause of acute intrinsic renal failure
Acute tubular necrosis
An inflammatory response resulting in glomerular damage caused by an autoimmune reaction, infection or exposure to toxins describes
Acute glomerulonephritis
Ischemia of the medullary pyramids describes
Papillary necrosis
Identify 5 causes of renal vein thrombosis
1) IVC or renal vein compression
2) nephrotic syndrome
3) renal tumors
4) renal allografts
5) trauma
List 4 sonographic indications for acute renal vein thrombosis
1) dilated thromboses renal vein
2) absence of flow within kidney
3) enlarged hypoechoic kidney
4) high resistive renal artery waveform
Describe the waveform characteristics of the arterial side of an AVF
Abnormally low resistive arterial flow pattern. This means a waveform with increased and sustained diastolic flow
Describe the waveform characteristics of the venous side of an AVF
Increased velocity, pulsatility and with spectral broadening due to turbulence
List 4 sonographic criteria for determining renal artery stenosis
1) kidney size less than 9 cm
2) peak main renal artery velocity >180
3) renal artery/aorta ratio >3.5
4) intrarenal parvus tardus waveform
Describe the sonographic appearance of a ureterocele
Round cystic structure that projects into the bladder lumen at the ureterovesical junction.
Normal bladder wall thickness is
_______ mm in a non distended bladder
______ mm in a distended bladder
<5 mm in a nondistended
<3 mm in a distended
What is the most common clinical presentation of transitional cell carcinoma
Hematuria
The normal ______ _______ demonstrates continuous forward flow during diastole typical of low resistance perfusion
Renal artery
What is the most correctable form of hypertension
Renal artery stenosis
What is the most common cause of renal disease leading to kidney transplantation
Diabetes
A transplanted kidney arterial anastomosis will involve what artery
External iliac artery or the hypo gastric (internal iliac ) artery
An echogenic linear band extending long within the testis is called
Mediastinum testis
What carry’s the seminal fluid from the rete testis to the epididymis
Efferent ductules
The ______ ________ a remnant of the Müllerian duct, is a small ovoid structure located beneath the head of the epididymis
Appendix testis
The ______ _______, representing a detached efferent duct, is a small stalk projecting off the epididymis
Appendix epididymis
The testicular artery divides into _______ and _______ branches
Capsular and centripetal
The ______ arteries course along the septula converging on the mediastinum testis
Centripetal
What is the most common germ cell tumor in adults
Seminomas
When an intratesticular mass is discovered what region should be evaluated for lymph nodes
Paraaortic
Name 8 disorders associated with AIDS
1) fatty liver
2) hepatomegaly
3) hepatitis
4) non-Hodgkin lymphoma
5) candidiasis
6) cholangitis
7) cholecystitis
8) Kaposi sarcoma
What are the sonographic findings associated with acute rejection of a renal transplant
1) enlarged transplant
2) decreased cortical echogenicity
3) Indistinct cortiocomedullay boundary
4) prominent hypoechoic med pyramids
5) peritransplant fluid collection
Name 3 abdominal masses associated with the elevation of AFP
1) hepatocellular carcinoma
2) metastatic liver disease
3) Hepatoblastoma
What is the most common prepubertal testicular tumor
Yolk sac tumor
Increased levels of _______ is seen with yolk sac tumors
ALP
Choriocarcinoma is associated with an increase in
Beta HCG
_______ and _______ are the most common malignancies to affect the testis secondarily
Leukemia and lymphoma
What type of testicular cyst is well defined solid hypoechoic mass with an echogenic capsule or onion ring pattern formed by multiple layers of keratin
Epidermoid cyst
What is the most common cause of painless scrotal swelling
Hydrocele
What is the most common correctable cause of male infertility
Varicoceles
The left testicular vein drains into the
Left renal vein
The right testicle drains into the
IVC
Where do spermatoceles usually occur at
Epididymal head
What is the most common condition that causes acute scrotal pain
Acute epididymitis
What is the most common cause of scrotal pain in adolescents
Testicular torsion
_____ and ______ are complications of cryptorchidism
Infertility and cancer
The most common location of the cryptorchoid testis is in the
Inguinal canal
What is the most common primary cancer to metastasize to the liver
A) melanoma
B) lung
C) ovary
D) GI tract
D) GI tract
The most common parasitic infection in humans is
A) hydatid disease
B) schistosomiasis
C) pneumocystis carinnii
D) hepatitis
B) schistosomiasis
Describe the anatomical relationship between the crus of diaphragm, aorta, celiac axis, IVC, and adrenal glands
Crus of diaphragm lies:
1) anterior to AO
2) superior to celiac
3) posterior to IVC
4) medial and posterior to the adrenal glands
What 3 arteries supply the adrenal glands bilaterally
1) suprarenal branch of the inferior phrenic artery
2) suprarenal branch of the aorta
3) suprarenal branch of the renal artery
Into which vessel does the right suprarenal vein drain
What about the left suprarenal vein
Right- Directly into the IVC
Left- left renal vein
In what locations can pheochromocytoma be found
1) adrenal medulla
2) organ of Zuckerlandi
3) paravertebral sympathetic ganglia
What 4 criteria define a nonfunctioning cortical adenoma
1) unilateral mass
2) no history of malignancy
3) no biochemical evidence of adrenal hyper-functioning
4) adrenal mass < 3 cm
What 2 tumors originate from the adrenal medulla
1) pheochromocytoma
2) neuroblastoma
Name 11 structures that are retroperitoneal
1) kidneys and ureters
2) IVC
3) pancreas
4) ascending and descending colon
5) lymph nodes
6) bladder
7) adrenal glands
8) aorta
9) portions of duodenum
10) prostate
11) uterus
What zone of the prostate contains 70% of tissue and is the source of most prostate cancer
Peripheral zone
What zone of the prostate is the site of origins of BPH
Transitional zone
What is the largest lymphoid organ
The spleen
_________ and ________ are the most common causes of granulomas
Histoplasmosis and tuberculosis
_________ is defined as bilateral left sidedness
Polysplenia
_______ is defined as bilateral right sidedness
Asplenia
-absent spleen
- midline liver and GB
-intestinal malrotation
- reversed positions of AO and IVC
-cardiac defects describe
Asplenia
Which of the following is a symptom of Addison disease
A) hypertension
B) hypokalemia
C) weight gain
D) hyponatremia
D) hyponatremia
What is the definition of a true aortic aneurysm
Dilatation that involves all 3 layers of the aorta
What is the definition of a false aneurysm
Aka pseudo- results from injury to the vessel wall where blood extravasates from the vessel
What is a dissecting aneurysm
Describe the appearance of a dissecting aneurysm
Dissection of the intima away from the aortic wall
Seen as a septation dividing the aorta into a true lumen and a false lumen
What is the thoracic continuation of ascending lumbar veins
Ascending lumbar veins parallel the spine and lie posterior to the psoas muscle
Superior to the diaphragm the right ascending lumbar continues as the azygos and the left ascending continues as the hemiazygos. Both drain into the IVC
Refine retroperitoneal fibrosis
Describe the sono appearance
Dense fibrous tissue proliferation that is confined to the paravertebral and central abdominal region
Presents as a smooth marginated hypoechoic mass encasing the IVC and AO
What is the presentation of papillary carcinoma
Hypoechoic thyroid mass and adjacent to enlarged cervical nodes
The ______ sac is the space that is situated between the liver pancreas and stomach
Lesser
The kidneys and adrenal glands lie in what space
Perirenal space
What vessel branches do for the aorta 1 cm inferior to the celiac
SMA
What arises from the lateral walls of the aorta just below the origin of the SMA
Renal arteries
Which artery passes posterior to the IVC
Right renal artery
What is the most common tumor to involve the IVC
Renal cell carcinoma
A right renal artery aneurysm moves the IVC where
Anterior
Lymphadenopathy displaces the IVC
Anterior
A tortuous aorta displaces the IVC to the
Right
A right renal/ adrenal mass displaces the IVC
Lateral
A retroperitoneal tumor displaces the IVC
Anterior
Which of the following is a malignant neoplasm
A) hamartoma
B) lymphoma
C) granuloma
D) hemangioma
B) lymphoma
What causes pseudopancreatitis
A) cholecystitis
B) polycystic liver disease
C) hepatitis
D) fatty liver
D) fatty liver
What is the tunica albuginea
Fibrous capsule that surrounds the testicle
What is the tunica vaginalis
Extension of the peritoneum into the scrotal chamber.
Inner or visceral layer covers the testis and epididymis
Outer or parietal layer lines the wall of the scrotal chamber
What are the 2 most common causes of acute scrotal pain
1) torsion of the spermatic cord
2) epididymo-orchitis
Describe the sono findings associated with torsion of the spermatic cord
Testicle becomes enlarged, inhomgeneous and hypoechoic when compared to the contralateral normal testis
Enlarged epi, skin thickening, and reactive hydrocele
Describe the sono findings associated with acute epididymitis
Enlarged epididymis with decreased echogenicity and inhomogenous echo texture.
How does acute appendicitis develop
What are the sono signs of an inflamed appendix
Develops from the obstruction of the appendiceal lumen
Appendix greater than 6 mm or an appendicolith
What are the sono signs of acute diverticulitis
What is a target or pseudo kidney sign
Thickened bowel or abscess formation in the LLQ
Abnormal bowel wall thickening. Appears as a hypoechoic external rim representing the thickened intestinal wall and an echogenic center
_______ veins drain into the IVC
Hepatic
Which renal vein drains directly into the IVC
Right renal vein
Which renal vein passes between the SMA and aorta and travels from the left kidney to the IVC
Left renal vein
What are 2 other names for retroperitoneal fibrosis
1) Ordmonds disease
2) inflammatory aneurysm
The adrenal glands and kidneys are located in what space
Perirenal space
This is excessive cortical secretion associated with adrenal adenomas
Cushing syndrome
This is excessive cortical secretion due to increase in ACTH from a pituitary adenoma
Cushing disease
This is excessive aldosterone secretion associated with adrenal adenoma
Conn disease
Pheochromocytomas are assisted with what 2 things
1) MEN
2) Von-Hippel
This is a malignant tumor that typically presented as a palpable abdominal mass in children
Adrenal neuroblastoma
Benign nonfunctioning adrenal masses that contain fat and bone elements describes
Myelolipomas
Which lymphoma is the most common cell type
Non-Hodgkin disease
What is the most common symptom of renal cell carcinoma
Hematuria
What are the symptoms of hypertrophic pyloric stenosis
Hypertrophy of the circular pyloric muscle resulting in elongation and constriction of the intestines between the stomach and first portion of the duodenum. Neonates present with projectile vomiting and palpable olive like abdominal mass
What are the sonographic criteria for HPS
Pyloric muscle > 4mm
Pyloric channel length > 1.2 cm
Pyloric cross section >1.5 cm
What are the symptoms of an intussusception
Crampy intermittent abdominal pain, vomiting and passage of blood through the rectum
What is the sonographic appearance of an intussusception
Oval pseudo kidney mass with central echoes on long imaging and a sonolucent doughnut or target configuration
Define BPH
Enlargement of the inner gland which is hypoechoic relative to the peripheral zone.
Describe the sono appearance of an abscess
Complex collections containing cystic and solid components. Debris, septations and gas are seen within the abscess. Borders are irregular and thick with posterior enhancement
Iliac and popliteal aneurysms are commonly associated with
Aortic aneurysms
What is the most common cause of a false aortic aneurysm
Trauma
Celiac axis compression syndrome is also known as
Arcuate ligament compression syndrome
Another name for duodenal atresia is
Double bubble sign
What is the most common cause of obstruction in infants
Intussusception
The diameter of the normal abdominal aorta is greatest at the level of the
Celiac
The largest abdominal tributaries of the IVC are the
Hepatic veins
The largest tributaries of the IVC are the
Common iliac veins
The loops of Henle are located in which portion of the kidney
Medulla
What is the normal Doppler tracing from the renal arteries
Low resistance waveform with increased diastolic flow
The renal cortex contains which of the following
A) loops of henle
B) calyces
C) bowman’s capsule
D) pyramids
C) bowman’s capsule
The renal pyramids are found in the
A) calyces
B) sinus
C) medulla
D) Cortex
C) medulla
On a long scan, this vessel is seen in cross section posterior to the IVC
A) right renal artery
B) left renal vein
C) right renal vein
D) left renal artery
A) right renal artery
The IMV empties into the
Splenic vein
The ______arteries are the vessels that course perpendicular to the renal capsule within the outer renal parenchyma
Interlobular
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 are
Minor calyces
What artery courses posterior to the IVC to reach the right kidney
Right renal artery
The renal arteries branch from the aorta just below the origin of the
SMA
Which of the following vessels follow a retrocaval course in the abdomen
Right renal artery
Describe the sono appearance of a hematoma
Depends on the age of the collection. Seen as echogenic collection because of rapid fibrin invasion
What is pseudomyxoma peritonei
Filling of the peritoneal cavity with mucinous material and gelatinous ascites
What does the presence of portal venous gas indicate
What is the sono appearance
Indicates bowel infarction as seen in ulcerative colitis or necrotizing entercolitis
Linear echogenic branches in the periphery of the liver
What are the symptoms of Graves’ disease
Describe the sono features
1) exophthalmos
2) palpable lymph nodes
3) muscle atrophy
4) localized myxedema
5) weight loss
6) temors
7) nervousness
Diffusely enlarged thyroid that’s hyper functioning. Color flow shows increased vascularity
Name and describe 2 cystic masses associated with the pancreas in patients without a history of adult PKD
1) pseudocysts- encapsulated collections of panc enzymes
2) cystadenomas- fluid collection that arise from the epithelium of the pancreatic duct. Primarily cystic with separations and thick walls
Name 5 techniques to access a renal artery stenosis
1) main renal artery peak systolic velocity
2) RAR
3) pulsus parvus et Tardus
4) absent early systolic peak
5) acceleration
Define acceleration time
Define acceleration index
Acceleration time- interval of time from the beginning of systole to the initial peak velocity
Acceleration index- dividing acceleration slope by frequency
Define the term tardus
Define the term parvus
Tardus- prolonged or delayed early systolic acceleration
Parvus- decreased amplitude and rounding of the systolic peak
Name 6 causes of GB wall thickening
1) ascites
2) cholecystitis
3) Adenomyomatosis
4) hypoalbuminea
5) CHF
6) acute hepatitis
Name 5 reasons for an enlarged GB
1) prolonged fasting
2) hydrops
3) choledocholithiasis
4) Courvoisier GB
5) diabetes
Name and describe 3 causes of jaundice
1) hepatocellular disease- destruction of the hepatocytes that interfere with the excretion of bilirubin
2) hemolytic disease- hepaocytes can’t conjugate bilirubin fast enough
3) surgical jaundice- mechanical obstruction of the biliary tree
Describe the location of the 4 parts of the duodenum and their anatomical relationship
First portion- transverse oriented segment which originates from the pylorus. CBD and GDA run posterior
2nd portion- longitudinal oriented segment. Directly lateral to head of the pancreas. CBD and panc duct combine to form ampulla of Vater which terminates 2nd portion
3rd portion- transversely oriented segment located between SMA and AO
4th portion- longitudinally oriented to the left of the AO and terminates jejunum
What is the typical sono appearance of lymph nodes
Anechoic or hypoechoic masses with acoustic enhancement
What is the most common type of thyroiditis
Chronic lymphocytic hashimotos
Name 2 structures posterior to the IVC
1) right renal artery
2) right adrenal gland
What is a cold nodule
What mass commonly appears as a cold nodule in a nuc med thyroid scintigram
Cold nodule- indicates an areas of hypofunctioning
Benign thyroid nodules like adenomas
What clinical condition is milk of calcium bile associated with
Chronic cholecystitis due to gallstones or obstruction of the cystic duct
What are 2 other name for Graves’ disease
1) hyperthyroidism
2) diffuse toxic goiter
What is the most common cause of hyperparathyroidism
Parathyroid adenoma
An increase is PTH that is increased with serum calcium confirms the diagnosis of
Primary hyperparathyroidism
Hyperparathyroidism is the most common manifestation of
MEN syndrome
The inability to synthesize vitamin D depresses the serum calcium level which stimulates
Parathyroid gland hyperplasia
What 2 arteries originate from the aortic arch
1) left CCA
2) subclavian
Name the 3 vessels of the aortic arch
1) innominate artery
2) left CCA
3) left subclavian
The ICA is ______ and ______ and the ECA is ______ and ______ in location
ICA= lateral and posterior
ECA= medial and anterior
The ICA has a ____ resistance waveform while the ECA has a _____ resistance waveform
ICA= low
ECA= high
The first branch of the ICA is
The ophthalmic artery
What is the first branch of the ECA
Superior thyroid artery
Calcitonin is produced by which of the following cell types
A) pararthyroid parafollicular
B) thyroid follicular
C) parathyroid follicular
D) thyroid parafollicular
D) thyroid parafollicular
Which of the following structures is not included in the spermatic cord
A) centripetal artery
B) gonadal artery
C) vas deferens
D) cremasteric artery
A) centripetal artery
Aside from the pancreas what other organ produces amylase
A) adrenal glands
B) pituitary glands
C) liver
D) salivary glands
D) salivary glands
