URR 32 Flashcards by Billie Harney

When evaluating the venous outflow of a liver transplant patient, it is most important to check the surgical history to find ____ before scanning.
a. the patient’s current LFT levels and prothrombin time
b. what segment of the portal vein was attached to the hepatic veins
c. what segment of the portal vein was attached to the IVC
d. the type of surgical anastamosis

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What lab test is used to evaluate the endocrine function of a pancreas transplant?
a. amylase levels
b. anodal trypsinogen levels
c. glucose levels
d. hematocrit levels

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Applying compression using a curvilinear transducer with a large footprint is the key method used to best evaluate:
a. the scrotal wall thickness
b. the body of the pancreas
c. neonatal hips
d. a suspected thyroglossal duct

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Which of the following will consistently cause an increase in values on liver function tests?
a. focal nodular hyperplasia
b. hepatitis
c. polycystic liver disease
d. adenoma

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Before performing a liver transplant evaluation, the sonographer must review the surgical history to determine:
a. if the transplant was full or partial
b. the location of all sites of vascular anastamosis
c. if the transplant has a piggyback or interposition anastamosis
d. more than one of the above

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Which probe position is used to demonstrate a longitudinal view of the main portal vein entering the liver?
a. sagittal subcostal position just to the right of the midline
b. oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch
c. sagittal subcostal position just to the left of midline
d. oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more inferiorly than the side of the probe without the notch

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The Charcot triad is used to describe the classic clinical presentation of:
a. pyloric stenosis
b. Hashimoto thyroiditis
c. acute cholangitis
d. abdominal aortic aneurysm

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Which of the following correctly describes the method used to measure the wall thickness of the gallbladder?
a. with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall
b. with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the posterior wall
c. with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the anterior wall
d. with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the posterior wall

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What lab values increases with gallbladder cancer, cholecystitis or prolonged biliary obstruction?
a. LDH
b. CA-125
c. AFP
d. PT time

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You are trying to scan the liver from a midline window, but there is excessive gas in the GI tract. Which of the following techniques can aid in better visualization of the liver?
a. give the patient ginger ale and rescan
b. reposition the patient in a prone position
c. use graded compression to displace bowel gas
d. give the patient cholecystokinin

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Which of the following is required when performing liver elastography?
a. the ROI box should be placed on the liver tissue within 2 cm of the skin surface
b. the ROI box should be placed on the liver tissue within 2 cm of the diaphragm
c. patient should perform the Valsalva maneuver for a few seconds when recording measurements
d. patient should perform a neutral breath hold for a few seconds when recording measurements

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In cases of acute pancreatitis, which enzyme level increases first?
a. trypsin
b. alkaline phosphatase
c. lipase
d. amylase

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Which of the following blood tests will aid in diagnosis of a hydatid cyst in the liver?
a. albumin/protein ratio and aldosterone assay
b. ratio of conjugated bilirubin to unconjugated bilirubin
c. serum lipase and amylase
d. indirect hemagglutination test and the enzyme linked immunosorbent assay (ELISA)

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Elevated GGTP and ALP indicates ____.
Elevated GGTP and ALT indicates ____.
a. biliary obstruction, hepatocellular disease
b. hepatocellular disease, biliary obstruction
c. cirrhosis, hepatitis
d. hepatic carcinoma, hepatic adenoma

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When scanning the pancreas, which of the following techniques will assist in reducing the gas artifact around the pancreas?
a. deep inspiration or drink water
b. ultrasound contrast injection
c. ask patient to perform Valsalva maneuver
d. scanning the patient while they are prone

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A patient presents for a pre-surgical evaluation of a known pancreatic mass. What is the most important information you need to document for the surgeon?
a. the volume of the pancreatic mass
b. if any vessels around the pancreas demonstrate tumor invasion
c. the number and location of abnormal lymph nodes in or around the porta hepatis
d. the volume of normal pancreatic tissue present

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Which of the following are contraindications for a liver transplant?
a. cholangiocarcinoma and current alcohol or drug abuse
b. autosomal recessive polycystic disease and biliary hamartomas
c. hepatocellular carcinoma and hepatitis
d. hepatitis C and cirrhosis

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What is an absolute contraindication for ethanol ablastion of a liver nodule?
a. diabetes mellitus
b. nodule location in center of liver
c. patient allergy to injectate
d. nodule location in the periphery of the liver

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Which of the following Doppler parameters is most commonly used when evaluation the common hepatic artery in patient with a liver transplant?
a. resistive index
b. pulsatility index
c. S/D ratio
d. peak systolic velocity

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Which of the following lab values is usually unaffected by an isolated acute biliary duct obstruction?
a. gamma glutamyl transpeptidase
b. total bilirubin
c. aspartate aminotransferase
d. alkaline phosphatase

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Decreased serum albumin levels are associated with the development of ____.
a. ascites
b. kidney stones
c. thyroid adenomas
d. epididymitis

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What liver abnormality results in low blood sugar levels?
a. glycogen storage disease
b. wilson disease
c. focal nodular hyperplasia
d. hemangioma

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Serum amylase will be increased with all of the following, except:
a. tumor of the submandibular gland
b. acute pancreatitis
c. parathyroid adenoma
d. use of oral contraceptives

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Which of the following describes AFP?
a. normal lab testing should show no amount of AFP in the blood
b. AFP levels are elevated with a fungal infection in the body
c. liver metastasis causes the most significant increase in AFP levels
d. Increased AFP levels are associated with primary liver cancer in adults and children

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A patient presents for an abdominal ultrasound due to elevated LDH and a low grade fever. Which of the following is the most likely finding on the exam? a. steatosis b. choledocholithiasis c. hepatitis d. Wilson disease

What is the proper caliper placement for assessing the portal vein diameter? a. inner wall to inner wall at the point the portal vein crosses the IVC b. inner wall to inner wall at the junction of the splenic vein and portal vein c. outer wall to outer wall at the point the portal vein crosses the IVC d. outer wall to outer wall at the junction of the splenic vein and portal vein

What lab test is used to evaluate the exocrine function of a pancreas transplant? a. hematocrit levels b. glucose levels c. glomerular filtration rate d. amylase levels

Alcoholic cirrhosis demonstrates a severe increase in ____, while viral hepatitis demonstrates a severe increase in _____. a. AFP, ALP b. AST, ALT c. ALT, AST d. ALP, AFP

A low albumin/globulin ratio usually indicates: a. cirrhosis b. impacted stone at gb neck c. partial obstruction of Ampulla of Vater d. primary carcinoma of gb

Which of the following is associated with persistent hypoglycemia? a. oncocytoma b. islet cell tumor c. diabetes mellitus d. mucinous cystadenoma

Sulfur colloid imaging is: a. used to evaluate ADPKD b. type of contrast used in CT imaging c. used to evaluate suspected FNH d. type of contrast used in MR imaging

While scanning in the transverse plane of the abdomen, you notice a small round anechoic structure just anterior to the pancreatic head. Which of the following should be the next step in evaluating this finding? a. evaluate the kidneys for cysts b. apply color doppler c. have the patient drink water d. scan patient in decubitius position

Which probe position is used to demonstrate all three hepatic veins entering the IVC? a. sagittal subcostal position just to left of ml b. sagittal subcostal position just to right of ml c. oblique subcostal approach angled superior toward right shoulder d. oblique intercostal approach angled superior toward left shoulder

A ____ abscess will result in leukopenia, while a ____ abscess will result in leukocytosis. a. amebic, pyogenic b. pyogenic, amebic c. echinococcal, fungal d. fungal, pyogenic

A 28 year old male presents for an abdominal ultrasound exam. The chart states he has elevated urine copper levels and Kayser=Fleisher rings noted on physical exam. What organ should be closely evaluated for findings related to the clinical findings? a. bladder b. gallbladder c. kidneys d. liver

Hypersplenism and anemia are common findings in cases of: a. asplenia b. inflammatory bowel disease c. celiac disease d. cirrhosis

Acetic acid injection, ethanol injection, and radiofrequency ablation are techniques used to treat? a. portal hypertension b. varicosities c. polycystic liver disease d. hepatocellular carcinoma

Alpha-fetoprotein values will be increased with: a. viral and alcoholic hepatitis b. glycogen storage disease and Wilson disease c. biliary obstruction d. malignancy and pregnancy

While scanning the liver, you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. The CBD measures 5mm in diameter and the gallbladder appears normal. The liver demonstrates mild fatty infiltration and the pancreas and kidneys appear within normal limits. Which of the following correctly describes the laboratory findings that correlate with these findings? a. increased indirect bilirubin, increased LFTs b. increased LFTs, normal direct bilirubin c. increased direct bilirubin, normal LFTs d. increased LFTs, increased bilirubin

Alkaline phosphatase is normally produced in what organ? a. kidney b. liver c. thyroid d. pancreas

Alanine aminotransferase levels are: a. used to evaluate the degree of jaundice and monitor hepatitis and cirrhosis b. the most sensitive indicator for alcoholism c. decreased with hepatitis, cirrhosis, liver tumors, biliary obstruction, and Reye Syndrome d. the primary indicator for hepatocellular carcinoma

The most important structure to evaluate with a new liver transplant is: a. hepatic artery b. biliary anastamosis c. hepatic vein d. portal vein

A female patient presents with 8 days of abdominal pain, fever, and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, alkaline phosphatase, and WBCs. Alpha fetoprotein levels are normal. These clinical findings are most suggestive of: a. pneumobilia b. primary GB carcinoma c. cholangitis d. hemolytic anemia

A patient presents with mildly increased levels of ALT and significantly increased levels of AST. Which of the following is the most likely finding on the ultrasound exam? a. acute viral hepatitis b. cirrhosis c. Mirizzi syndrome d. choledocholithiasis

Posterior shadowing can be helpful in the diagnosis of all of the following, except: a. GB calculi b. steatosis c. choledocholithiasis d. nephrocalcinosis

____ may be a cause for liver echoes distal to the GB to appear brighter than the surrounding parenchyma. a. posterior enhancement b. decreased gain settings c. portal venous reflections d. posterior shadowing

A mass that demonstrates propagation speed artifact may lead to a positive diagnosis of: a. lipoma b. staghorn calculus c. renal cyst d. renal cell carcinoma

A contrast agent that consists of a cellulose suspension is administered to a patient to better visualize: a. an aorta aneursym b. functioning thyroid nodules c. non-functioning adrenal adenomas d. the pancreatic tail

If the entire image is too bright, what console adjustment should you make first? a. adjust the near field TGC b. adjust the far field TGC c. decrease the output power d. decrease the overall gain

Potential bioeffects of ultrasound can be minimized by which of the following? a. using a lower frequency transducer b. reduce exam time c. increase PRF d. decrease overall gain

B-color can be helpful in the evaluation of: a. anechoic fluid/cysts b. subtle differences in tissues c. high velocity blood flow d. low velocity blood flow

All of the following can cause artifactual debris within a simple cyst, except: a. improper gain settings b. superficial location of the cyst c. small size of the cyst d. increased rejection settings

___ occurs posterior to highly attenuation structures. a. refraction b. speckle c. enhancement d. shadowing

What acoustic artifact is commonly seen with a bacterial liver abscess, adenomyomatosis of the GB, and emphysematous cholecystitis? a. propagation speed artifact b. mirror image artifact c. posterior reverberation artifact d. posterior enhancement

Increasing the size of the field of view will ____ the frame rate. a. have no effect on b. increase c. cause a 50% decrease d. decrease

Propagation speed artifact, reverberation artifact, and the bayonet artifact are acoustic artifacts seen with: a. abscess formation b. abdominal aortic aneurysms c. needles d. pneumothorax

Which of the following correctly describes why the arcuate arteries are not easily or accurately evaluated by PW doppler? a. because the blood flows perpendicular to the Doppler sound beam b. the renal capsule attenuates the Doppler signal so only limited information is reflected to the probe c. because the blood flows parallel to the Doppler sound beam d. because the flow is very low resistance

When evaluating a liver transplant, you must use angle correction during Doppler evaluation of: a. portal veins only b. hepatic arteries and veins c. hepatic arteries and portal veins d. hepatic arteries only

Which acoustic artifact will commonly be identified with hydrocele formation? a. edge shadowing b. posterior enhancement c. comet tail artifact d. posterior shadowing

The artifact that is produced when the incident beam hits a curved surface and produces an acoustic shadow is referred to as: a. lobe artifact b. comet tail artifact c. posterior shadowing d. refractive shadowing

Which acoustic artifact is a common sonographic sign of emphysematous pyelonephritis? a. propagation speed error b. misregistration c. side lobe d. resonance artifact

Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient? a. transverse only b. coronal and transverse c. coronal only d. mid sagittal only

All of the following techniques will aid in the visualization of a small renal calculi with questionable shadowing, except: a. using multiple scanning planes to evaluate the kidney b. decreasing transducer frequency c. rescanning the patient in the decubitus position d. reducing the dynamic range

Color Doppler demonstrates the: a. direction of flow only b. peak velocity of flow only c. average velocity and direction of flow d. peak velocity and direction of flow

A patient presents with a palpable lump adjacent to the umbilicus. Which of the following transducers would be best to use for this exam? a. 10 MHz linear array b. 3.5 MHz curvilinear array c. 8 MHz sector array d. 3.5 MHz linear array

Which of the following would be associated with posterior enhancement artifact in the liver tissues? a. fatty infiltration b. dilated intrahepatic ducts c. lymphoma d. large lipoma

What is the name of the universally accepted image file type that is used by a PACS system to store and view images? a. AVI b. MPEG c. JPEG d. DICOM

Acoustic Radiation Forced Impulse evaluation of the liver: a. is helpful in cases of suspected abscess formation b. should be performed in the right lobe c. should be performed with the patient in the prone position d. is performed with a subcostal midline window

On a scrotal ultrasound exam, how do you differentiate acute epididymitis from post-vasectomy enlargement of the epididymis? a. use color Doppler b. use PW Doppler c. use dual screen imaging d. use a stand off pad

Which type of transducer would be used to evaluate a patient with increased LFTs and height 5'3" and weight 275 pounds? a. 3 MHz curvilinear phased array b. 5 MHz sector phased array c. 10 MHz vector array d. 5 MHz linear phased array

What changes in system controls can reduce the appearance of color displayed over vessel walls? a. increasing color threshold b. decreasing color priority c. decreasing color PRF d. increasing persistence

Which imaging plane is most commonly used to obtain the length of the spleen during an abdominal ultrasound? a. coronal b. sagittal c. transverse d. axial

If the entire image is too dark, what console adjustment should you make first? a. adjust the near field TGC b. increase the overall gain c. increase the output power d. adjust the far field TGC

Which acoustic property causes the echogenic appearance of the diaphragm related to surrounding structures? a. refraction b. non-specular reflection c. specular reflection d. attenuation

All of the following controls affect the amount of color fill in a vessel evaluated with Color Doppler, except? a. sample size b. color doppler baseline c. sample angle d. color doppler scale settings

Which of the following will increase the amount of color displayed in the abdominal aorta? a. increase frame rate b. increase wall filter c. decrease color gain d. decrease color priority

The use of multiple focal zone will improve ___ but degrade ___. a. lateral, temporal b. axial, lateral c. lateral, axial d. temporal, lateral

When performing a doppler evaluation of the renal arteries the cursor angle should be set at ___ degrees or less for the main renal arteries and ___ degrees or less for the intraparenchymal arteries. a. 20, 0 b. 45,60 c. 60,45 d. 60,20

Which of the following best describes the probe position used to evaluate the long axis of the pancreas? a. transverse oblique probe position at the midline with notch side of the probe rotated slightly inferior to the side of the probe without the notch b. sagittal probe position just the left of midline with notch rotated slightly to the right side of the patient c. sagittal probe position just to the left of midline with notch rotated slightly to the left side of the patient d. transverse oblique position at the midline with notch side of the probe rotated slightly superior to the side of the probe without the notch

Which of the following exams does not require angle corrected Doppler evaluation? a. TIPS evaluation b. IVC duplex c. renal artery duplex d. aorta duplex

Which imaging plane can produce a longitudinal image of the IVC and aorta on the same image? a. mid sagittal only b. transverse only c. coronal and transverse d. coronal only

Which of the following renal abnormalities is commonly associated with propagation speed artifact? a. staghorn calculus b. hypernephroma c. mycetoma d. 4cm renal angiomyolipoma

The primary factor that determines transducer selection for a biopsy is: a. thickness of the sterile cover b. physician preference c. composition of the mass d. depth of the mass

Put the following in order in decreasing echogenicity: a. pancreas, spleen, liver, renal sinus, renal parenchyma b. renal sinus, pancreas, spleen, liver, renal parenchyma c. renal parenchyma, spleen, liver, pancreas, renal sinus d. renal sinus, renal parenchyma, liver, spleen, pancreas

Which transducer would be best suited to rule out appendicitis in an average sized patient? a. 3MHz curvilinear b. 5 MHz curvilinear c. 12 MHz linear d. 5 MHz linear

Power Doppler: a. display is not dependent on the incident beam angle b. is preferred for evaluation of blood flow in a TIPS shunt c. is preferred for evaluation of blood flow in a patient with suspected portal HTN d. is less sensitive than color Doppler when evaluation renal transplant perfusion

What system control should be turned off when trying to differentiate a small stone in the gb from a sludge ball? a. harmonic imaging b. compound imaging c. focal zone d. time gain compensation

Which type of transducer would be used to evaluate a palpable lump in the neck? a. 12 MHz sector phased array b. 3 MHz curvilinear sequential array c. 12 MHz curvilinear phased array d. 12 MHz linear phased array

You are evaluating an obese patient with a known AAA. While using color Doppler to assess flow within the aneurysm, minimal flow is detected in the anechoic lumen. You decrease the color scale and increase the color gain but there is no improvement. Which of the following adjustments will most improve the color display on this exam? a. increase color sample size b. switch from a 4 MHz curved array to a 4 MHz linear array c. increase the color threshold d. decrease the color threshold

No flow is detected while performing a Color Doppler evaluation of a normal splenic vein. What will improve the color display? a. increase the color velocity scale b. increase the sample size c. increasing angle of insonation d. increase the color packet size

AFRI is typically used to assess the ___ for signs of ____. a. liver, chronic disease b. aorta, stenosis c. kidneys, obstructive disease d. abdominal wall, hernia formation

Which of the following will improve the color Doppler visualization of flow in the arcuate arteries? a. reduced color gain b. increased transducer frequency c. larger color sample size d. smaller packet size

What can be used to alter the displayed brightness of the image after is have been stored in the memory? a. compression b. rejection c. pre-processing d. post-processing

When performing contrast enhanced ultrasound evaluation of the liver, when is the timer started for the procedure? a. when the contrast is first visualized in the areas of interest b. at the start of the contrast injection c. after the saline flush d. at the start of the saline flush

Which of the following would cause artifactual debris within a simple cyst? a. reduced gain settings b. short distance from the transducer c. activation of spatial compounding d. increased rejection settings

Which of the following techniques will lead to degraded lateral resolution? a. increased probe frequency b. trapezoidal FOV on linear array c. none of the above d. increase in number of focal zones

What determines the transducer frequency used for the evaluation of a foreign body? a. age of the foreign body b. composition of the foreign body c. the radiologist reading the exam d. depth of the foreign body

Which of the following probe frequencies should be used when trying to evaluate the pancreas in an obese patient? a. 5 MHz vector b. 5 MHz curvilinear c. 3 MHz curvilinear d. 3 MHz linear

How are the gain settings adjusted to the proper level for evaluation of abdominal structures? a. liver echogenicity should be set to a medium grey level at start of exam b. spleen echogenicity should be set to a medium grey level at start of exam c. anterior abdominal fat should appear as medium grey level throughout the exam d. normal gb or IVC should look anechoic throughout exam

Increasing wall filter setting could reduce the display of all of the following, except: a. cross talk artifact b. clutter artifact c. beam width artifact d. aliasing artifact