Review Questions Flashcards
Which organ is most likely to be affected in adult polycystic kidney disease?
Liver
Bilateral echogenic kidneys in newborns most likely represent?
Wilms’ tumors and autosomal recessive polycystic kidney disease
the most common cause of acute renal failure is
Acute tubular necrosis
A hypernephroma is a solid renal mass. it is known as
- von grawitz tumor
-renal cell carcinoma
-adenocarcinoma of the kidney
What laboratory values may be elevated in renal failure
-protein
-creatinine
-BUN
elevated serum amylase may be secondary to all of the following except;
a. pancreatic duct obstruction
b. acute pancreatitis
c. liver disease
d. obstruction of the ampulla of Vater
Liver Disease
which laboratory value is associated with prostate carcinoma
Acid phosphatase
PAP Prostatic acid phosphatase aka PSAP prostatic specific acid phosphatase will be increase
Which laboratory values are elevated with liver metastases?
alpha-fetoprotein
which lab value is the most sensitive indicator of hepatocellular disease?
ALT (alanine aminotransferase)
Which laboratory value is specific for obstructive jaundice
Direct bilirubin
all of the following increase with hepatocellular disease except:
a. AST
b. SGOT
c. SGPT
d. PSA
e. ALT
PSA
alkaline phosphatase increased without elevation of alt maybe seen in
- Mirizzi syndrome
- Pancreatic carcinoma
- Choledocholithiasis
Choledocholithiasis may result in
Increased direct bilirubin
Increased indirect bilirubin
Hemolytic disorders may result in
predominant increase in indirect bilirubin
What is the most common adrenal mass in a neonatal?
Adrenal Hemorrhage
What is the most common childhood adrenal mass
Wilm’s Tumor and Nueroblastoma
What is the most common primary carcinoma associated with adrenal metastases?
Lung
An adrenal mass which causes a propagation speed artifact is a
Myelolipoma
The adrenal glands and kidneys lie with in the
Perirenal space
Which vessels is interlobar and which is intrasegnmental
Hepatic Vein is interlobar ; Portal vein is intrasegmental
Addison’s disease is a syndrome that results from
Chronic Hypofunction
What structure lies directly medial to both adrenal glands?
Crus of the diaphragm
The IVC and Aorta are located in which retroperitoneum space?
Anterior pararenal space
Which of the following syndromes are associated with an adrenal mass
Cushing’s syndrome
Which of the following is not retroperitoneal?
Kidney
Prostate
Aorta
Colon
Spleen
Spleen
The retroperitoneal space is defined as the area between the
Posterior parietal peritoneum and the posterior abdominal wall muscles
Which is spread through a fecal -oral route?
Hepatitis A
if retroperitoneal fibrosis is suspected, what is the most common secondary finding?
Hydronephrosis due to bilateral ureteral obstruction.
the inferior mesenteric vein drains into the
Splenic Vein
Which vessel is imaged between the SMA and the Aorta
Left Renal Vein
The azygous vein
Connects the proximal abdominal IVC to the superior vena cava
Which vessel does not drain directly into the IVC
Left Gonadal Vein
Which of the following is a branch of the celiac axis?
Left gastric artery
Which of the following is not a correct anatomic landmark in relation to the thyroid
Sternocleidomastoid - anteriolateral
Longus colli muscle - posterior
Internal jugular vein - lateral
Trachea - medial
Minor neurovascular bundle – lateral
Minor neurovascular bundle – lateral
all of the following a para mimic a parathyroid adenoma
-minor nuerovascular bundle
-esophagus
-intrathyroidal adenoma
The halo sign is defined as a sonolucent rim surrounding a throid mass, it is commonly seen in
Adenomas
graves disease is associated with all of the following except
-Hypothyroidism
-Audible bruit
-Diffusely enlarged thyroid
-prominent eye (exophthalmos)
-Cardiovascular symptoms
Hypothyroidism
parathyroid adenomas may be associated with
Hypercalcemia
What is the most common primary thyroid cancer
papillary carcinoma
Peripheral or eggshell like calcification are indicative of a
Benign nodule
which of the following lab values would reflect a pt with graves?
decreased TSH, Increased T3 and T4
Hashimoto’s thyroiditis is characterized by all of the following
Glandular enlargement
coarse echotexture
hypothyroidism
Thyroglossal duct cysts are usually located
Anterior to the trachea
Strap muscle is ______ to thyroid
Anterior
sternocleidomastoid is ___________ to the thyroid
anterolateral
common carotid A, Internal Jugular V. are _________ to thyroid
lateral
Minor neurvascular bundle, Longus Colli Muscle parathyroid are ____________ to the thyroid
Posterior
The most common testicular tumor is a
Seminoma
to better image flow in a testicle for evaluation a torsion, you should
Decrease PRF
Anechoic lesions associated with the epididymis are
Epididymal cysts and spermatoceles
The spermatic cord consists of the
-Vas Deferens
- Creamasteric, deferential, testicular arteries
- Pampiniform plexus of veins
- Lymphatics
The most common cause of an acute scrotum in postpubertal males is
Epididymitis
A complication of cryptorchidism/orchioplexy is
Increased risk of malignancy
Hydroceles can be defined as serous fluid accumulated between the
Two layers of the tunica vaginalis
Most intratesticular masses are. . . Benign or Malignant?
Malignant
Most extratesticular masses are . . . Benign or Malignant?
Benign
Varicoceles are more common in the left or right of the scrotum?
Left
Which is the correct pathway of sperm from the testicle
ST,TR,RT,ED,DE,VD
Seminiferous Tubules, Tubuli recti, Rete Testes, Efferent ductules, Epididymis, Vas Deferens
Hypertrophic pyloric stenosis is characterized as
Increase in pyloric channel length, cross-sectional diameter, pyloric muscle thickness
Acute diverticulitis is characterized by
LLQ Pain, fever, Leukocytosis, Thickened bowel
Sonographically, the Gastroesophageal Junction can be visualized
Anterior to the Aorta and Posterior to the left lobe
Name the space of that is a recess of the peritoneum located between the uterus and the rectum
Pouch of Douglas
A 4 Month old infant presents with abdominal pain, rectal bleeding, and a palpable abdominal mass. What is the most likely pathology?
Intussusception
Which of the following is a component oof coagulation?
Vitamin K
What is the most likely dx in a pt with an elevation of CEA, Alkaline phosphatase, and GGT?
Liver Metastasis
Elevation of both GGT and ALP would most likely repersent
Biliary obstruction
A right adrenal mass will displace the superior pole of the kidney
Laterally
SGPT is the same laboratory value as
Alanine aminotransferase
Calcifications of the prostate are termed
Corpora amylacea
The largest percentage of cancers originate from which area of the prostate?
Peripheral Zone
The most common location for a pseudocyst is
Lesser sac
What is the classical sonographic appearance of prostate cancer?
Peripherally located and hypoechoic lesion.
PSA Levels Increase due to
prostate volume and age increase
What will increase PSA levels higher than that of BPH
Prostate cancer
Benign prostatic hyperplasia originates from the
transition zone
The Caudad portion of the gland is the
Prostatic Apex
What zone does the ejaculatory ducts pass through
Central zone of the prostate
What is the dcision between the inner gland and the peripheral zone
the surgical capsule
The fibromuscular stroma is a
Non-glandular anterior portion of the prostate
What structure marks the mid-point of the prostatic urethra by a small elevation of the urethral crest
Verumontanum
The seminal vesicles are located on which surface of the prostate?
Posterior/Superior surface
What is the most likely diagnosis in a pt with elevated AST and ALT
Hepatitis
Which of the following mist accurately describes the location of the caudate lobe
posterior to porta hepatis
Which of the following ligaments attaches the live to the anterior abdominal wall
Falciform
on spectral doppler, the hepatic veins are characterized by which of the following flow types
Multiphasic
Enlargement of the caudate lobe is most commonly associated with which of the following pathologies?
Cirrhosis
Which of the following spaces is located superior to the liver and inferior to the diaphragm?
Subphrenic Space
Which of the following conditions describes a congenital extension of the liver anterior and inferior to the right kidney?
Reidel lobe
The umbilical vein courses from the umbilicus to the
Left portal vein
A transjugular intra hepatic portosystemic shunt (TIPS) is most commonly placed between the
RHV & RPV, (right hepatic vein and right portal vein)
Prominence of the portal veins (starry night sign or periportal cuffing) is most commonly associated with which of the following pathologies?
Acute hepatitis
Von Gierke disease is most commonly associated with:
Glycogen storage disease
Which of the following liver pathologies is associated with immune-suppressed pts?
Candidiasis
Which of the following hepatic structures is interlobar in locations
Hepatic Veins
Pts with history of Hepatitis B have a predisposing risk factor for developing a (an)
Hepatoma
The right lobe of the liver is divided into anterior and posterior segments by the
Right hepatic Vein (RHV)
The left lobe of the liver is separated from the right lobe by which of the following structures
Middle Hepatic Vein and Main Lobar Fissure (MHV & MLF)
The ductus venosum drains into the
IVC
A Cavernous Hemangioma most commonly appears on ultrasound as a
Homogeneous hyperechoic mass
Organs associated with polycystic disease include:
Adrenal Gland
Which of the following landmarks are used to divide the liver into right and left lobes
GB Fossa, Main Lobar Fissure, Middle Hepatic Vein, Inferior vena cava
Which of the following describes diffuse foci within the liver with or without shadowing, most often associated with acquired immunodeficiency syndrome?
Pneumocystis (carinii) jiroveci
Which of the following are associated with an increase in incidence in renal cell carcinoma?
Multiple sclerosis
Which of the following more commonly invades the Inferior Vena Cava?
Renal Cell Carcinoma
Which of the following is a type of Hamartoma?
Angiomyolipoma
What is the common cause of a hepatic abscess?
Biliary tract disease
What is the most common location of a hepatic pyogenic abscess?
Right lobe
A “Daughter Cyst” is associated with which of the following pathologies?
Hydatid Cyst
Marked elevation in which of the following laboratory test is associated with obstructive jaundice?
Alkaline Phosphatase
Which is the location of a Klatskin tumor?
Porta Hepatis
what is the most common form of glycogen storage disease?
Von Gierke’s disease
Which of the following is considered a “stealth lesion”?
Focal nodular hyperplasia
Which of the following pharmacologic agents has been postulated to promote cavernous hemangioma growth?
Estrogen
Which What is associated with pneumobilia?
-Sphincter of Odi Incompetency
-Emphysematous cholecystitis
-ERCP
Choledochal cysts are more commonly associated with which ethnic group?
Japanese
What portion of the pancreas is perpendicular to the sound beam?
Body
what are the tributary of the main portal vein
-Right gastric vein
-Coronary vein
-Cystic Vein
What is the most common cause of a hyperechoic pancreas is a child
Cystic Fibrosis
Which of the following is a branch of the proper hepatic artery?
Right Gastric Artery
What is the single most common cause of acute pancreatitis
Gallstones
Alcohol abuse is 2nd
What is the single most common cause of chronic pancreatitis
Alcohol abuse
What is the most common cause of a pseudocyst in a child
Abdominal trauma
Which vessel may demonstrate retrograde flow with anterior nutcracker syndrome
Gonadal Vein
What condition is suggested by intrahepatic ductal dilatation and the absence of the common hepatic duct in the neonate?
Biliary atresia
What is the most likely diagnosis of a round anechoic mass located on the midline of the neck?
Thyroglossal duct cyst
Which would be most diagnostically useful when hydronephrosis is discovered
Check Bladder for Ureteral jets
What is the term for a color doppler artifact seen posterior to a strong reflector
Twinkle
Which medicine may be discontinued before performing an ultrasound-guided biopsy
Heparin
Describes a fact the caudate lobe
It receives its blood supply from the right and left portal vein
Where is the superior mesenteric artery in relation to the pacreas
Posterior
Ascites in the upper abdomen of a supine PT will accumulate between which structure
Liver and the right kidney
Where are the spiral valves of heister located?
Cystic duct
What is the term for hyperplasia of the thyroid?
Goiter
The ligamentum venosum appears as a echogenic band that divides which two structures
Left lobe of the liver and the caudate lobe
An ultrasound examination of a PT who has a cholangiocarcinoma at the level of the common hepatic duct is most likely to reveal which finding?
Dilated intrahepatic bile ducts
What velocity info do the pixels of a color doppler image provide?
Mean Velocity
What waveform characteristic produces power or energy imaging?
Amplitude
The parallel channel sign is most often associated with which disease process
Cholangiocarcinoma
What is the most likely clinical sign in a PT with elevated indirect bilirubin
Jaundice
Which laboratory value decreases in the hepatocellular disease?
Albumin
Which term defines hospital acquired infections?
Nosocomial
Which portion of the penis contains the urethra
Corpus spongiosum
In a PT with normal portal pressures, the left (coronary) gastric vein drains into the
Main Portal Vein
if testicular torsion occurs in a neonate, it is most likely a (an)
Extravaginal torsion
Peyronies disease is a demonstration of calcifications along what portion of the penis?
Dorsal
Which portion of the penis contains the urethra?
corpus spongiosum
When scanning the penis in the anatomic position, what structure is in the near field?
Corpus spongiosum
The superior extension of the thyroid isthmus is referred to as the
Pyramidal lobe
why is paracentesis performed prior to TIPS placement in PTs with ascites?
creates a more favorable angle between the hepatic veins and IVC for the procedure
Which of the following is a prehepatic cause for jaundice?
Gilbert’s syndrome
Which of the following is an intra-hepatic cause for jaundice?
Primary sclerosing cholangitis
Which of the following is a post-hepatic cause for jaundice?
Pancreatic adenocarcinoma
when preforming shear wave elastography, what is the recommended number of sampling
10
Which METAVIR stage is indicative of cirrhosis?
F4
Which METAVIR stage is indicative of normal liver parenchyma
F0
When performing hepatic elastography, the region of intrest is
2 cm below Glisson’s capsule in the right lobe of the liver
Which sonoelastography technique is used to determine hepatic fibrosis
shear wave
An Ectopic ureterocele is associated with which complication?
Upper pole hydronephrosis
Which of the following represents the most commonly reported cause of a palpable abdominal mass in the newborn
multicystic dysplastic kidney
Anechoic masses that occur around a renal transplant included
-Urinoma
-Lymphocele
-Hematoma
-Corpus luteal cyst
Which statement about the kidney is false?
Kidneys rest on the psoas laterally and quadratus lumborum medially
a 3 year old boy present with hematuria and a palpable left flank mass. sonography depicts a solid renal mass. This finding would most likely represent
Wilms’ tumor
While preforming an ultrasound exam, the sonographer finds that both kidneys measure 5 cm in length. they are very echogenic. What or possible DX?
-Chronic glomerulonephritis
-Chronic pyelonephritis
-Bilateral renal artery disease
What is the most common newborn abdominal mass associated with a decrease in hematocrit?
Adrenal Hemorrhage
Which of the following is not a cause of splenomegaly?
Pancreatitis
Which of the following is not associated with splenic trauma
Perinephric fluid collection
A Wedge-shaped lesion within the spleen is associated with
splenic infarct
the most common cause of splenomegaly is
portal hypertension
The congenital absence of the spleen is associated with
visceral heterotaxy
Which of the following diseases would result in splenic atrophy (autosplenectomy)
sickle-cell anemia
which of the following are associated with splenomegaly?
polycythemia vera
lymphoma
portal vein thrombosis
schistosomiasis
What is the correct path of a red blood cell returning to the heart
Splenic vein, Portal vein, Right portal vein, emissary veins, IVC, right atrium
Which o the following will displace the the superior mesenteric artery anteriorly?
left renal vein thrombosis
Which of the following is correct?
The lesser sac is located anterior and superior to the pancreas
Which of the following will displace the superior mesenteric artery anteriorly?
left renal vein thrombosis.
Which of the following is correct?
the lesser sac is located anterior and superior to the pancreas
The CBD is joined with the pancreatic duct before entering the
second portion of the duodenum
the gastroduodenal artery
-is the first branch of the common hepatic artery
-proceeds caudally along the anterolateral margin of the pancreatic head
-is seen in the transverse views directly anterior to the common bile duct
-is the point where the common hepatic artery becomes the hepatic artery proper
islet cell tumors of the pancreas are most likely to be located
frequently in the body and tail, rarely in the head
Chronic pancreatitis may be associated with which of the following sonographic patterns?
-Increased echogenicity
-decrease in pancreas size
-calcifications
-dilated pancreatic duct
Occasionally a puesdocysts may have internal echoes and be confused with an abscess. to distinguish the two, one should look for
Gas
The pancreas is located in the
Retroperitoneum
The portion of the pancreas that lies posterior to the superior mesenteric artery and vein is the
uncinate process
the most common primary neoplasm of the pancreas is adenocarcinoma
-usually found in the head of the pancreas
-accompanies by weight loss and painless jaundice
-accompanied by dilated gallbladder
-causes dilatation of the CBD
Throughout its course, the splenic vein is located on the
posterior surface of the pancreatic body and tail
Courvoisier sign is associated with all of the following except
hepatocellular carcinoma
Throughout it’s course, the splenic vein is located on the
posterior surface of the pancreatic body and tail.
Courvoisiers sign is associated with all the following
-Pancreatic carcinoma
-Dilated GB
-Biliary duct dilatation
-painless jaundice
Courvoisiers sign is associated with all the following:
-Pancreatic carcinoma
-Dilated GB
-Hepatocellular Carcinoma
-Biliary duct dilatation
-painless jaundice
-Hepatocellular carcinoma
G B wall thickening may be due to all of the following
-Ascites
-Hypoproteinemia
-right-sided congestive failure
-acute cholecystitis
Which of the following is associated with Caroli’s disease
dilated intrahepatic bile ducts
The causes of a large GB include all of the following
-Cystic duct obstruction
-Pancreatic Carcinoma
-Diabetes Mellitus
-A fasting PT
-Common duct obstruction
A Phrygian cap is
A fold at the GB Fundus
increased levels of alkaline phosphatase are expected with
-Biliary obstruction
-Children
-Hepatocellular disease
-Pregnancy
A 48 year old female presents post cholecystectomy with RUQ pain, Elevated serum bilirubin (manly conjugated) and bilirubin in her urine. It is true that
she probably has a stone tumor or stricture obstructing the bile duct
Dilatational of the intrahepatic biliary tree without dilatation of the extrahepatic duct includes all of the following except
-Klatskin tumor
-Enlarged portal lymph nodes at the porta hepatis
-Cholangiocarcinoma
if on US exam, one finds a PT with intrahepatic dilated ducts and a small GB, this may indicated that the level of obstruction
Above the cystic duct
A parasitic, disease of the liver that causes portal hypertension and occlusion of the portal veins is
Schistosomiasis
All of the following mass lesions are benign
-Hematoma
-Hamartoma
-Hepatic adenoma
-Hemangioma
Which part of the liver is least affected by Budd Chiari?
Caudate
Caudate lobe venous drainage is primarily through
The emissary veins
Budd Chiari is occlusion of the
Hepatic Veins
Which is in decreasing order of echogenicity
Renal sinus > Pancreas > Liver > Renal Parenchyma
Cystic Lesions with in the liver included all of the following except
-Congenital cysts
-Polycystic liver disease
-Caroli’s disease
-Hemangiomas
Hemangiomas
The ligamentum teres
-Resides in the left intersegmental fissure
-A remnant of the umbilical vein
-Recanalized in servere cirrhosis
-An echogenic spot on transverse liver images
The caudate lobe is located on the
posterosuperior surface of the liver
the ligamentum venosum is all of the following except
A remnant of the umbilical vein
Which fetal circulation pathway connects the left portal vein to the IVC
Ductus Venosus
All of the following are associated with echinococcal cysts except
Ascites
Right liver lobe is supplied by what vessel
right portal vein
Left liver lobe is supplied by what vessel
left portal vein
Caudate lobe is supplied by what vessel
Right and Left vein
Where does the caudate lobe lie
posterior-superior surface between the IVC and medial left lobe
What vessels drain the caudate lobe
Emissary veins drain directly into the IVC
Caudate lobe is specifically located
-Posterior to the Ligamentum venosum & Porta Hepatis
-Anterior and Medial to IVC
-Lateral to Lesser Sac
IVC maybe compressed if what part of the level is enlarged
Caudate Lobe
What segments are in the right posterior
Segments VI (6) & VII (7)
What segments are in the right anterior
Segments V (5) & VIII (8)
What segments are in the left medial
Segments IVa (4a) & IVb (4b)
