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Abdominal Ultrasound > Practice Questions > Flashcards

Practice Questions Flashcards

1
Q

Name two abdominal organs that can be affected by polycystic disease

A

Liver, spleen, pancreas, kidneys

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2
Q
  • Scarred gb wall
  • Smaller gb in fully fasted pt
  • No/min pericholecystic fluid
  • Cholelithiasis/calculi/echogenic foci
A

Chronic cholecystitis

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3
Q
  • Hyperechoic parenchyma
  • Hypoechoic & oedematous parenchyma
  • Homogenous parenchyma
  • Enlarged pancreas
  • Peripancreatic fluid
  • Irregular pancreatic outline
A

Acute pancreatitis

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4
Q

A 46 yr old woman presents for an abdominal ultrasound with the following clinical indications:

Prev. cholecystectomy 13 years ago, RUQ pain last 2/12; ↑ALT, AST, LDL; ↓HDL; nil ETOH; no fever

a) What is the most likely pathological condition?

b) What sonographic appearances do you expect to see when scanning this patient?

A

a) Non-alcoholic fatty liver disease

b)
- Enlarged/well rounded liver
- Highly echogenic/hyperechoic
- Very attenuating

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5
Q

Within parenchyma of kidney
May infiltrate into pelvis of kidney
Varies in echogenicity (mostly iso or hyper/echogenic)
Can spread via veins, to renal vein & IVC
Can extend from IVC into contralateral renal vein
Solid mass
Irregular borders

A

RCC

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6
Q
  • Within the collecting system of the kidney
  • Does not infiltrate into parenchyma
  • Compresses adjacent parenchyma
  • Can spread from kidney into ureter
  • Can spread from ureter to UB
  • Finger-like projections into bladder
  • Usually hypoechoic, heterogenous
  • Solid lesion/mass
  • Irregular borders
  • Possible hydronephrosis
  • Originates within renal pelvis or calyx
A

TCC

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7
Q

List the pathology process and effects on the liver in a patient with portal hypertension liver portal hypertension, including sonographic appearances

A

Small cirrhotic liver, nodular surface, fibrosis
OR
Large liver (post-hepatic cause), abnormal texture

MPV dilated >15mm, hepatofugal flow, cavernous transformation

Varices near porta hepatis, hepatopetal flow

Paraumbilical vein, patent, branching from left portal vein

Ascites, anechoic fluid around liver

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8
Q

A patient presented for an upper abdominal ultrasound with the following information on her referral:

Mr Tony Martin
DOB 31/8/1975
Generalised fatigue FI

Document:
- Patient details,
- Clinical information
- Ultrasound measurement
- Sonographic characteristics
- PDx

A
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9
Q

A patient presented for an abdominal aorta ultrasound with the following information on her referral:

Joan Venning
DOB 28/9/1945
Patient feels pain in abdomen.
Palp mass lower abdomen FI

Document:
- Patient details
- Clinical Information
- Measurements

Under “additional comments”:
- PDx

A
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10
Q

What does AML stand for when used in terms of abdominal ultrasound?

A

Angiomyolipoma

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11
Q
  • Well defined
  • Hyperechoic mass
  • Homogenous
  • Possible acoustic shadowing
  • Located cortex of kidney most commonly, liver second most commonly
A

Angiomyolipoma

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12
Q

How can liver steatosis cause RUQ pain

A

Cause of pain:
- Liver enlargement, inflammation
- Puts pressure on surrounding structures

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13
Q

List the abdominal organs that can develop fatty infiltration

A
  • Liver
  • Pancreas
  • Kidneys
  • Spleen
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14
Q

List the THREE sonographic characteristics that are common to all organs that can have fatty infiltration disorder

A
  • Increased echogenicity
  • Ill-defined borders
  • Enlargement
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15
Q
  • Thickened odeamatous wall (>3mm)
  • Calculi/sludge/fluid/pericholecystic fluid
  • Distended / irregular lumen
  • Murphy’s sign
A

Acute cholecystitis

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16
Q

List the THREE main sonographic characteristics that are used to identify chronic pancreatitis.

A

Chronic pancreatitis

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17
Q

When scanning the common bile duct, you notice a solid area within the lumen that has a homogenous texture and mid-level echoes with no posterior shadowing. Provide TWO differential diagnoses.

A
  • Biliary sludge
  • Cholangiocarcinoma
  • Bile duct obstruction
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18
Q

When scanning the urinary bladder, you notice a highly echogenic focus with posterior shadowing, that moves freely around the bladder. After thoroughly assessing and imaging the bladder, where else would you need to check for similar foci in this patient?

A
  • Kidneys
  • Ureters
  • Prostate
  • Urethra
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19
Q

Name the TWO most commonly occurring primary renal malignancies.

A
  • Renal cell carcinoma
  • Transitional cell carcinoma
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20
Q

Name the two most common metastatic sites for TCC and RCC

A
  • Lungs
  • Bones
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21
Q

List the TWO most common abdominal organs that can be affected by portal hypertension.

A
  • Liver
  • Spleen
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22
Q
  • Hyperechoic/increased echogenicity
  • smooth / normal size
  • Heterogenous echotexture
A

Focal steatosis of liver

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23
Q

Increased echogenicity
Hepatorenal contrast loss
Normal/smooth margins
Liver enlargement
Posterior attenuation

A

Diffuse steatosis of liver

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24
Q

What sonographic features are present with an inflammatory AAA that are not present in a normal AAA?

A
  • Sonolucent halo
  • Aneurysmal dilatation, thickened adventitia
  • Hypoechoic surrounding fibrosis
  • Sparing of posterior wall
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25
Q

Name the pathology

A

Abdominal aortic aneurysm (fusiform)

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26
Q

Name the pathology

A

Abdominal aortic aneurysm

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27
Q

Name the pathology

A

Abdominal aortic aneurysm

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28
Q

Name the pathology

A

Acute acalculous cholecystitis

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29
Q
  • Thickened gb wall
  • increased vasc
  • pericholecystic fluid
  • Calculus in Hartmann’s pouch or cystic duct
A

Acute cholecystitis

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30
Q
  • Hepatomegaly
  • Smooth, homogenous
  • Increased portal venous flow
A

Acute hepatitis

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31
Q

Name the pathology

A

Acute pancreatitis

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32
Q
  • Enlarged pancreas
  • Heterogenous
  • Peripancreatic fluid collections
A

Acute pancreatitis

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33
Q
  • Hepatomegaly
  • Decreased echogenicity
  • Smooth liver surface
  • Splenomegaly (possible)
  • Enlarged LNs
A

Acute viral hepatitis

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34
Q
  • Single/multiple
  • Comet tail artefact
  • Focal or diffuse thickening of GB wall
A

GB Adenomyomatosis

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35
Q

Name the pathology

A

Chronic cholecystitis

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36
Q

Name the pathology

A

Chronic hepatitis C

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37
Q

Name the pathology

A

Chronic pancreatitis

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38
Q
A

Chronic pancreatitis

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39
Q
A

Cirrhosis

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40
Q
A

Cirrhosis

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41
Q
A

Hepatic cystadenoma

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42
Q

Inflamed bladder wall

Symp:
Frequency, burning pain
Strong-smelling urine
Lower abdo pain
Haematuria/cloudy urine

A

Bladder cystitis

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43
Q
A

Dissection aneurysm

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44
Q
A

Emphysematous cystitis (bladder)

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45
Q
  • Intraluminal gas (bright echoes along ant. wall)
  • WES sign
  • posterior shadowing
A

Emphysematous cholecystitis

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46
Q
  • Intraluminal gas (bright echoes along ant. wall)
  • WES sign
  • posterior shadowing
A

Emphysematous cholecystitis

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47
Q
A

Fatty panc

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48
Q
A

Focal nodular hyperplasia

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49
Q
A

Focal nodular hyperplasia

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50
Q
  • Thickened gb wall
  • odematous ulcerations
  • gallstones/fine gravel
A

Gangrenous cholecystitis

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51
Q
  • Focal thickening, irregular wall (nodular or diffuse)
  • Possible invasion into surrounding tissue
  • Increased vascularity
  • Hypoechoic mass in gb
A

GB adenocarcinoma

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52
Q
  • Focal thickening, irregular wall (nodular or diffuse)
  • Possible invasion into surrounding tissue
  • Increased vascularity
  • Hypoechoic mass in gb
A

GB adenocarcinoma

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53
Q
  • Focal thickening, irregular wall (nodular or diffuse)
  • Possible invasion into surrounding tissue
  • Increased vascularity
  • Hypoechoic mass in gb
A

GB adenocarcinoma

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54
Q
A

GB polyp

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55
Q

Inflammation of glomeruli
Can be acute or chronic
Usually bilateral
Caused by staphylococal infection or immunologic illness

Sono app:
Hyperechoic, enlarged kidneys
Cortical thinning
Heterogenous

A

Glomerulonephritis

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56
Q
A

Hepatic haemangioma

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57
Q
A

Hepatic haemangioma

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58
Q
A

Hepatocelluar carcinoma

59
Q
A

Hepatocellular carcinoma

60
Q
A

Hepatic abscess

61
Q
A

Hepatic adenoma

62
Q
A

Hepatic angiomyolipoma

63
Q
A

Hepatic angiomyolipoma

64
Q
A

Hepatic lymphoma

65
Q
A

Hepatic lymphoma

66
Q
A

Hepatoblastoma

67
Q
A

Hydatid cyst

68
Q
A

Hydatid cyst

69
Q
A

Hydronephrosis (and grades)

70
Q
A

Inflammatory aortic aneurysm

71
Q
A

Inflammatory aortic aneurysm

72
Q
A

Multicystic dysplastic kidney disease

73
Q
A

Nephroblastoma (Wilm’s tumour)

74
Q
A

Pancreatic adenocarcinoma

75
Q
A

Pancreatic adenocarcinoma

76
Q
A

Pancreatic neuroendocrine tumour

77
Q
A

Pancreatic pseudocyst

78
Q
A

Polycystic kidney disease

79
Q
A

Polycystic liver cysts

80
Q
A

Porcelain gb

81
Q
  • Bright echogenic echoes around region of gb
  • sharp posterior shadowing
A

Porcelain gb

82
Q
A

Portal vein hypertension

83
Q
A

Pseudoaneurysm

84
Q
A

Pseudoaneurysm

85
Q

Sono appearance:
- Unilateral or bilateral
- focal or diffuse
- Echogenic wedge defect (partial)
- Loss of blood flow
- Enlarged, hypoechoic kidney
- Perinephric fluid collection
- Hypoechoic areas

Symptoms:
- Fever, nausea, frequency
- Pain in back/side/groin

A

Pyelonephritis

86
Q

Sono appearance:
- Unilateral or bilateral
- focal or diffuse
- Echogenic wedge defect (partial)
- Loss of blood flow
- Enlarged, hypoechoic kidney
- Perinephric fluid collection
- Hypoechoic areas

Symptoms:
- Fever, nausea, frequency
- Pain in back/side/groin

A

Pyelonephritis

87
Q

Sono app:
Echoes seen within pelvicalyceal system
Can sometimes look solid
Pus, debris, haemorrhage seen within dilated pelvicalyceal system

A

Pyeonephrosis

88
Q
A

Pyeonephrosis

89
Q
A

RA stenosis

90
Q
A

RCC

91
Q
A

RCC

92
Q
A

Saccular aortic aneurysm

93
Q
A

Simple cyst liver

94
Q
A

Simple cyst panc

95
Q

Well-defined echogenic lesion
Most common benign neoplasm of the spleen
Consists of vascular channels

A

Splenic haemangioma

96
Q
A

Splenic infarct

97
Q
A

TCC

98
Q
A

TCC

99
Q
A

Urachal cyst

100
Q
A

Ureterocele

101
Q
A

Vesicoureteric reflux

102
Q
A
103
Q
A

Bladder polyps

104
Q
A

Bladder calculi

105
Q
A

Squamous cell carcinoma

106
Q
A

Splenunculus

107
Q
A

Transitional cell carcinoma

108
Q

Symp:
Haematuria

Sono app (inverted):
Macroscopic haematuria
Dysuria

A

Urinary bladder papilloma

109
Q

Which liver segments

A

Segments 2 & 3 (left to right)

110
Q

Which liver segments

A

Segments 7, 8 & 4a

111
Q

Which liver segments

A

Lig ven separates seg 1 from lt lobe

112
Q

Which liver segments

A

6, 7 & 8
Hepatic vein between 6 & 7
Hepatic vein between 7 & 8

113
Q

Which liver segments

A

5 & 8

114
Q

Which liver segments

A

4a, 4b, 2 & 3

115
Q

Which liver segments

A

Centrally left PV,
seg 2 adjacent & 3 anteriorly
Lig ven post. to seg 2, separates segment 1
Seg. 4b lateral to left PV

116
Q

Which liver segments

A

MHV & LHV centrally
Seg 8, 4a, 2

117
Q

Which liver segments

A

RPV & LPV centrally
7, 8, 4a anteriorly
6, 5, 4b posteriorly

118
Q

The extension of the pancreas that lies posterior to the superior mesenteric vein is the

A

Uncinate process

119
Q

List the neoplasms that appear as finger like growths into the bladder (5)

A
  • Transitional cell carcinoma
  • Bladder polyps
  • Papilloma
  • Inverted papilloma
  • Adenocarcinoma
120
Q

Describe two ways you would differentiate a clot in the bladder from a neoplasm

A

Colour doppler:
- neoplasms = vascular
- Clot = avascular

Echogenicity/structure:
- Neoplasms = irregular, hetero, echogenic
Clot = homo, echogenic, uniform texture

121
Q

The adult liver is considered to be enlarged after the AP diameter exceeds what measurement?

A

> 15 cm AP

122
Q

Name the two (2) types of ascites.

A

Transudative ascites
Exudative ascites

123
Q

A decrease in haematocrit is consistent with the developement of what abdominal wall pathology?

A

Abdominal wall haematoma

124
Q

A 46 year old female patient presents to the ultrasound department, complaining of right flank pain and dysuria. Upon ultrasound investigation a generalised swelling of the kidney is demonstrated and the medullary pyramids appear well defined. This is most suspicious of which pathology?

A

Acute pyelonephritis

125
Q

What is the most common location for a splenunculus?

A

Near the hilum of the spleen, peritoneal cavity or near pancreatic tail

126
Q

What seperates the intrahepatic right lobe from the left lobe?

A

Porta hepatis

127
Q

Is severe sound attenuation associated with cholangitis or chronic cirrhosis?

A

Chronic cirrhosis

128
Q

What is the name given to the sensitivity test of the gallbladder where probe pressure is applied and causes a pain response?

A

Murphy’s sign

129
Q

Define Mirizzi syndrome.

A

Condition caused by obstruction of CBD or CHD by impacted gallstone(s)

130
Q

Define the term Lipoma.

A

Benign tumour of fatty tissue

131
Q

Sono apperance:
- Calculi (large or small)
- Posterior shadowing
- Distended gallbladder

Symptoms:
- pain with fatty meal
- + murphy sign

A

Cholelithiasis

132
Q
  • IHD dilation
  • Normal CBD dize
  • Large stone in neck of gb or cystic duct
A

Mirizzi syndrome

133
Q

Sono app:
- Dilated bile ducts
- Intraluminal debris
- Thickened walls of bile ducts
- Hyperechoic sludge/debris in bile ducts

A

Cholangitis

134
Q
  • Irregular thickening of bile ducts
  • Presences of mass within/adjacent to bile duct
A

Cholangiocarcinoma

135
Q
  • Saccular/fusiofrm
  • Normal liver tissue between cysts
  • Cystic dilatations of intrahepatic bile ducts
A

Caroli’s disease

136
Q

Which BOSNIAK Grading:
- Simple
- Thin walls, anechoic
- Post. enhancement
- Avascular
- No septae
- Round

A

Grade 1, approx 0% malignancy

137
Q
  • Thick wall
  • thick vascular septations
  • solid vascular nodule
  • posterior enhancement
A

Grade 3, approx 50% malig.

138
Q
  • Multiple thick septa
  • macrocalcifications
A

Grade 2F, approx 5% malig.

139
Q
  • Solid mass w/cystic spaces
  • hypervascular
  • irregular border
  • invasive
A

Grade 4, approx 100% malig.

140
Q
  • Thin septae
  • possibly microcalcifications
A

Grade 2, approx 0% malig.

141
Q

Panc bio markers:

Elevated levels of this indicate acute pancreatitis or pancreatic pseudocyst

A

Serum amylase

142
Q

Panc bio markes:

Increased levels indicative of pancreatitis, obstruction of panc duct, panc carincoma

A

Serum lipase

143
Q

Panc bio markers:

  • Increased levels indicate severe diabetes mellitus, NIDDM, overactivity of several endocrine glands.
  • Decreased levels indicates tumours of islets of Langerhans in the pancreas
A

Glucose

144
Q

Increased for longer period of time indicative of acute pancreatitis

A

Urine amylase

Abdominal Ultrasound (4 decks)

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