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Diagnostic Medical Sonography > Superficial Strucutures > Flashcards

Superficial Strucutures Flashcards

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USMLE® Step 1 flashcards
1
Q

Muscles appearance ?

A

Hypoechoic with linear echogenic strands

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2
Q

Tendons appearance ?

A

Echogenic fibrous structures connecting muscle to bones

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3
Q

Ligaments appearance ?

A

Echogenic
Connects bone to bone

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4
Q

Tendinitis ?

A

Inflammation of a tendon, termed tendonitis
diffuse or focal
May be caused by overuse or strain
Hyperemic flow may be noted within the tendon as well
Patients will present with pain, swelling, and possibly warm to the touch in the area affected

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5
Q

focal tendinitis appearance ?

A

localized, enlarged hypochoic area within the tendon.
Hyperemic flow may be noted

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6
Q

diffuse tendinitis appearance ?

A

Whole tendon will appear more thick, hypoechoic and enlarged
Hyperemia may be present

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7
Q

Indicative sign tenosynovitis is present ?

A

Fluid within the synovial sheath

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8
Q

Tendon rupture/ tear ?

A

Partial / complete types
Usually caused by some form of recreational sport
Patient will suffer from edema and significant pain in the wounded region

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9
Q

Partial tendon tear appearance ?

A

Hypoechoic focal area within the tendon

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10
Q

Complete tendon tear appearance ?

A

Anechoic or heterogenous appearing region within the tendon surrounded by edematous tissue (often indicative of hematoma)
The partition of the tendon causes refractive shadowing from the body’s attempt to repair the damage with fat, hematoma, or granulomatous material filling in the “gap”

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11
Q

Achilles tendon location?

A

Along the posterior ankle
Connecting the calf muscle and surface of the heel/ calcaneus

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12
Q

Achilles tendon tear test ?

A

Thompson test
Patient is prone with feet hanging over edge of bed
Calf is squeezed and the foot should PLANTARFLEX in a patient who has an intact tendon

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13
Q

Most commonly injured ankle tendon ?

A

Achilles

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14
Q

Achilles tendon can be assessed with sonography for ?

A

Tendonitis
Rupture

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15
Q

Achilles tendon rupture/ tear ?

A

Patients suffer from ankle and leg pain, patients may hear an audible snap when the tear occurs

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16
Q

Developmental Dysplasia of the infant Hip ? (DDH)

A

Congenital anomaly defined as shallow hip socket
Thought to be caused by abnormal fetal limb development within the hip that is intensified by the excessive levels of
circulating maternal estrogen
Commonly seen in FEMALE - LEFT side

Infants should be assessed between 4 to 6
weeks after birth

Asymmetric leg skinfolds, discrepancy between leg lengths, and have limited limb abduction

BARLOW/ ORTOLANI tests /
GRAF technique

Coaverage of the femoral head by the acetabulum of greater > 55% considered normal

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17
Q

Increased risks and links associated with DDH?

A

Breech fetal position
Oligohydramnios

Linked;
Spina Bifida
Arthrogryposis
And a familial link as well

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18
Q

Barlow test ?

A

Used to evaluate for hip dislocation

Hip is flexed and abducted
Knees are pushed posteriorly and superiorly

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19
Q

Ortolani test ?

A

Evaluates for the reduction or relocation of a dislocated hip

Performed by abducting and lifting the thigh,
Relocating the hip back into the acetabulum

Audible click may be heard and a palpable click felt as the head to the femur passes over the acetabulum

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20
Q

Sonographic infant hip techniques ?

A

Should be evaluated while the hip is examined in both flexion and at rest

The femoral head and its relationship to the acetabulum should be examined in both stressed and relaxed state as well

Normal / subluxation/ or dislocated hip

The hip is examined in both a neutral or resting coronal view and a transverse view of the flexed hip

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21
Q

Subluxation ?

A

Partial dislocation of the infant hip
Will rest more laterally, although it’s partially covered by the acetabulum

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22
Q

Femoral head sonographic appearance ?

A

Hypoechoic round structure that contains echogenic stripes throughout

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23
Q

Ilium appearance ?

A

Seen extending from the femoral head as an echogenic linearly structure producing shadowing

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24
Q

Graf Technique ?

A

Used to measure the relationship of the femoral head and acetabulum by evaluating alpha and beta angles created by the relationships of these structures

Smaller the alpha angle < larger the beta angle more likely the infant is suffering from DDH

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25
Q

Nonsurgical treatment of DDH?

A

Casting or by means of a Pavlik harness

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26
Q

Hip joint effusion ?

A

Buildup of fluid within the hip secondary to inflammation
Typically occurs in children between age 5 to 10 years,

Most likely the result of transient synovitis

Ultrasound guided hip aspiration can be done to relieve the pain and to differentiate the disorder from the more worrisome diagnosis of septic arthritis

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27
Q

Most common cause of a painful hip and joint effusion in children?

A

Transient synovitis

28
Q

Hip joint effusion appearance ?

A

Appears as hypoechoic fluid that elevates the anterior capsule of the joint
Width exceeding > 5 mm

29
Q

Transient synovitis ?

A

Most common cause of painful hip and joint effusion in children

Cause is unknown, although viral causes, infection, allergic reaction have been suspected

Leg and knee pain, reluctance to walk, irritability, low grade fever, mild leukocytosis

30
Q

Three layers of breast tissue (superficial to deepest layer)?

A

Subcutaneous
Mammary
Retromammary

31
Q

Subcutaneous layer ?

A

Superficial layer of breast
Typically appears hypoechoic and composed mostly of fat

32
Q

Subcutaneous layer of the breast?

A

Hypoechoic most superficial layer
Composed mostly of fat

33
Q

Mammary layer of breast?

A

Typically hyperechoic and contains the ducts and glandular tissue
Functional layer
Can vary sonographically based on age and other factors

34
Q

Retromammary layer of the breast ?

A

Deepest layer
Typically hypoechoic and contains fat as well

35
Q

Mastitis ?

A

Breast infection
Most often associated with lactation
Caused by the staphylococcus or streptococcus organisms

Suffer from ;
Pain, swelling, and warmth and redness in the area
Also may suffer from leukocytosis and fever

Appear as ill defined areas of echogenicity with diffuse edema and hypoechoic fluid within the subcutaneous tissue that may outline the fat lobules
Affective skin may be thickened greater than > 2 mm
Reactive enlarged lymph nodes may be seen as well

36
Q

Breast abscess ?

A

Focal area of pus
Patient suffer from diffuse pain, may have a palpable painful lump,
Typically appearing as focal, complex fluid collection that can contain debris
Enlargement of lymph nodes may be seen

37
Q

Puerperal mastitis?

A

Mastitis associate with lactation

38
Q

Galactocele ?

A

Associated with lactating patients may present to the emergency department with a palpable mass that may be painful

Milk filled cyst that can develop after an abrupt termination to breast feeding or result from an obstruction of lactiferous duct/ducts

Typically palpable, painful and located near the areola

Appear as a round mass with good borders, can be seen as complex or also have fluid- fluid level present

39
Q

Gynecomastia ?

A

Benign enlargement of the male breast

Seen anytime during life, but most commonly seen just after birth, during puberty, and during mid - late life stages (50 to 80 years old)

Can be bilateral and can be associated with high levels of HCG
(Testicular tumors, high levels of estrogen, adrenal tumors, hepatoblastoma, Klinefelter syndrome, drugs (weed and steroids))

Most often presents as tender palpable retroareolar breast mass
Firm to touch
Appearing as a triangular hypoechoic mass posterior to the areola

40
Q

Skin layers ?

A

Epidermis
Dermis
Appears as a indistinguishable collective hyperechoic linear structure

41
Q

Subcutaneous layer appearance ?

A

Hypoechoic with interspersed hyperechoic linear echoes representing connective tissue septa

42
Q

Fascia appearance ?

A

Hyperechoic layer of varying thickness

43
Q

Superficial epidermal cyst ?

A

Sebaceous cyst
Uncommon
Most likely found in the scalp, face, neck, trunk, or back
Can be congenital or result from trauma, or potentially the result of an obstructed hair follicle
Varying sonographic appearance including anechoic / hypoechoic / hyperechoic/ complex appearing - pseudotestis appearance
Patient will have a palpable mass that raises the skin and most likely asymptomatic
Infection can result in pain and oozing of fluid however

44
Q

Ganglion cyst ?

A

Bible bumps

Noncompressible anechoic mass with posterior enhancement that may contain debris or septations

Common mass found along the dorsal aspect of the hand, wrist, can arise from a
joint and even the ankle and foot as well

May be hard to touch and painful

Often treated with corticosteroid injection and surgical removal

45
Q

Superficial lipoma ?

A

Benign fatty tumor
Typically oval shaped and can appear hypoechoic or hyperechoic
Usually compressible and may be observable
Typically asymptomatic but may complain of unsightly bulging of the skin in the area of the mass

46
Q

Superficial hemangioma ?

A

Benign mass comprised of vascular channels
typically asymptomatic
Appear as a raised red or reddish - purple mass on the skin
Blood flow may be detectable with color doppler
Typically appear sonographically as hypoechoic mass

47
Q

Baker cyst ?

A

Popliteal cyst located in the popliteal fossa
Common and a result of an accumulation of synovial fluid from weakening in the joint capsule of the knee
Seen in conditions such as RA / rheumatoid arthritis or osteoarthritis
Channel may be seen connecting the cyst to the joint space
May be asymptomatic, but
May present with focal tenderness secondary to hemorrhage, rupture, or impingement on adjacent structures.
Clinical findings may mimic those of a deep venous thrombosis.

48
Q

Accumulation of synovial fluid from a weakening in the joint capsule of the knee is associated with ?

A

Bakers cyst
Osteoarthritis
Rheumatoid Arthritis

49
Q

Complex appearance of bakers cysts ?

A

Bakers cysts containing echogenic fluid, debris, pannus, or septations

50
Q

Sonographic appearance of Bakers Cyst ?

A

Anechoic mass with posterior enhancement

51
Q

Pilondial cyst?

A

“Nest of hair”
Most often found within the natal / gluteal cleft, but can be seen between the fingers/ toes
Asymptomatic and associated with long extended amount of time sitting, hairdressers and “jeep disease”

52
Q

Pilondial cyst appearance ?

A

Complex mass with a hypoechoic tract may be noted extending from the cyst to the external surface of the skin

53
Q

Cellulitis ?

A

Infection and subsequent inflammation of the skin and subcutaneous tissue
Most commonly caused by staphylococcus and streptococcus
Often the skin is red, tender and warm
May be evidence of leukocytosis present, especially if an abscess is present
Appearing as hypoechoic edematous strands within the soft tissue - cobblestone appearance

54
Q

Cobblestone appearance sign indicative of ?

A

Cellulitis

55
Q

Abscess sonographic findings ?

A

Hyperemia around the periphery
Complex appearing mass
Focal fluid collections present

56
Q

hidden abscess ?

A

Occult abscess

57
Q

Melanoma ?

A

Most likely primary tumor to metastasize to the subcutaneous fat
Hypervascularity and will be solid and a hypoechoic mass

58
Q

Metallic foreign object produce what type of artifact ?

A

Ring down or comet tail artifact

59
Q

Inflammation around a foreign body will appear as ?

A

Hypoechoic area adjacent to the foreign structure

60
Q

Which of the following at the site of a foreign body may produce bright echoes and therefore cause some ambiguity about the correct orientation of the object?

A

Air

61
Q

A patient presents to the sonography department with a history of cellulitis on his abdomen. The patient has fever, edema, and complains of focal tenderness in a specific region affected by the cellulitis.
Sonographically, you identify a localized complex collection of fluid.
What is the most likely diagnosis?

A

Superficial abscess

62
Q

Inflammation of the tendon and synovial tendon sheath is referred to as ?

A

Tendosynovitis

63
Q

What is the most likely cause of a hip joint effusion in infants?

A

Transient Synovitis

64
Q

A 6-year-old female patient presents to the sonography department for a hip sonogram with irritability, unwillingness to walk, and low-grade fever. Sonographically, you visualize a hypochoic fluid collection that elevates the joint capsule. What is the most likely diagnosis?

A

Joint effusion

65
Q

transducer must be placed _____________ to the tendon for it to be appropriately imaged with sonography, occasionally altering the angle of insonation can help differentiate the tendon from adjacent fat

A

Perpendicular

66
Q

Anisotropy ?

A

Occurs when the sound beam strikes a structure in a nonperpendicular manner, resulting in a loss of the true echogenicity of the structure.

Diagnostic Medical Sonography (15 decks)

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