URR 35 Flashcards
1
Q
increased levels of platelets
A
thrombocytosis
2
Q
Thrombocytosis can indicate ___, ___, ____, or ____
A
anemia
hemorrhage
myocardial infarction
history of splenectomy
3
Q
determines the number/percentage of red blood cells in blood
A
hematocrit
4
Q
Elevated hematocrit levels are associated with ___ and ____
A
dehydration
polycythemia vera
5
Q
Lower hematocrit levels are associated with ___, ____, and ____
A
anemia
bleeding (ulcers, colon cancer, leaking aneurysms)
some medications
6
Q
a protein in the red blood cells that carries oxygen
A
hemoglobin
7
Q
More red blood cells = ____ hematocrit = ____ hemoglobin
A
increased
increased
8
Q
Normal hematocrit levels in men
A
41%-50%
9
Q
Normal hematocrit levels in women
A
36%-48%
10
Q
Normal hemoglobin levels men
A
13-18g/dL
11
Q
Normal hemoglobin levels women
A
12-16g/dL
12
Q
Indications for spleen ultrasound
A
LUQ pain
splenomegaly
anemia
traumatic disorders
congenital anomalies
focal defects
hematogenic and lymphogenic disorders
liver disease
metastases
13
Q
You should use a __MHz to ___ MHz probe for a spleen ultrasound in adults
A
2.5
6.5
14
Q
You should use a __MHz-__MHz probe for a pediatric spleen ultrasound
A
4
8
15
Q
A probe with a ___ footprint is recommended for a spleen ultrasound
A
smaller
16
Q
NPO spleen
A
8-12 hours
17
Q
___ views are preferred for evaluation of spleen
A
coronal
18
Q
____ position may be helpful for obtaining an accurate length measurement of spleen
A
RLD
19
Q
A good window for the spleen is usually between the ___ and __ ribs
A
10
11
20
Q
If lung tissue is obscuring the spleen, ask the patient to:
A
take a deep breath, blow it all the way out and hold it
21
Q
Measured as the greatest dimension in the longitudinal view
A
splenic length
22
Q
measured from the hilum to outer capsule on transverse view
A
splenic thickness
23
Q
generally considered the greatest dimension on the transverse view
A
splenic width
24
Q
Splenic size is most accurately measured by __ or __
A
CT
MRI
25
The normal spleen has a ____ echotexture
homogeneous
26
Normal splenic echogenicity
same as or slightly above the normal liver echogenicity
27
The spleen has ___, ____ borders
smooth
well-defined
28
____ or ____ view that includes the hilum provides the best view to obtain length
intercostal coronal
coronal oblique
29
average length of spleen
11-13cm
30
The spleen usually ____ in size with age
decreases
31
The spleen is usually __/__ the size of the liver
2/3
32
____ and ____ are usually necessary to evaluate the entire spleen
deep inspiration and expiration
33
The long axis of the spleen run parallel to the:
a. left kidney
b. 10th rib
c. sternum
d. hepatic flexure of the colon
b
34
Which of the following lies just medial to the splenic hilum?
a. pancreatic tail
b. stomach
c. lesser omentum
d. all the above
d
35
It is important to identify a retrorenal spleen when:
a. planning a left renal biopsy
b. planning a portal shunt placement
c. planning a renal allograft placement
d. planning a pancreatic allograft placement
a
36
The splenic artery courses through the ___ to supply blood to the spleen, pancreas, and fundus of the stomach
a. diaphragm
b. transversalis fascia
c. splenorenal ligament
d. main lobar fissure
c
37
What makes the splenic circulation so unique?
a. the intrasplenic arterial branches do not connect to the capillary system
b. the intrasplenic arterial branches do not connect or communicate with each other
c. the intrasplenic arterial branches do not carry oxygenated blood
d. the intrasplenic arterial branches connect directly to the venous system as a natural AV fistula
b
38
The unique circulation of the spleen puts it a higher risk of ____ than other organs
a. tissue death
b. infection
c. trauma
d. rupture
a
39
Normally, the splenic vein diameter ____ with a held deep inspiration, but if the change in diameter is less than 20% ____ should be expected.
a. decreases, portal HTN
b. decreases, systemic HTN
c. increases, portal HTN
d. increases, systemic HTN
c
40
Extramedullary hematopoeisis is defined as:
a. blood cell production that occurs after birth
b. blood cell production that occurs outside the bone marrow
c. blood cell production that occurs in the bone marrow
d. blood cell production that occurs after age 50 years
b
41
Hypersplenism causes:
a. increased risk of infection
b. anemia
c. splenomegaly
d. all the above
d
42
Hemoglobin released from red blood cell destruction is sent to the ___ for ___ production.
a. kidneys, urine
b. pancreas, bile
c. liver, bile
d. stomach, hormone
c
43
High levels of white blood cells noted on lab testing usually indicate ___ and low levels of red blood cells usually indicate ___
a. infection, anemia
b. anemia, polycythemia vera
c. anemia, infection
d. infection, polycythmia vera
a
44
Elevated hematocrit levels are associated with ____, while lower hematocrit levels are associated with ____
a. dehydration, internal bleeding
b. anemia, polycythemia vera
c. polycythemia vera, dehydration
d. internal bleeding, anemia
a
45
All of the following are preferred for an ultrasound evaluation of the spleen, except?
a. a probe with a smaller footprint
b. emptying all the air out of the lungs
c. left lateral decubitus position
d. coronal view that includes the hilum to obtain length
c
46
Which of the following terms can be used to describe a normal spleen?
a. mottled
b. hypovascular
c. hypoechoic to liver
d. homogeneous
d
47
Which of the following is most commonly found in the pancreatic body or tail and secretes hormones?
a. microcystic cystadenoma
b. macrocystic cystadenoma
c. islet cell tumor
d. pseudocyst
c
48
3 types of PET; formerly known as islet cell tumors
insulinoma
gastrinoma
glucagonoma
49
Gastrinomas are the most common islet cell tumor seen with:
a. MEN syndrome
b. Epstein Barr Syndrome
c. cystic fibrosis
d. Kasabach-Merritt Syndrome
a
50
Retrograde flow in the splenic artery would most likely indicate:
a. celiac axis occlusion
b. chronic systemic HTN
c. left gastric artery occlusion
d. mild portal HTN
a
51
Spontaneous splenic rupture is associated with all of the following, except:
a. HIV
b. mononucleosis
c. trauma
d. splenosis
c
52
Which of the following statements is true regarding pancreatic masses?
a. the location of a mass in the head of the pancreas usually indicates a malignant process
b. a pancreatic tail mass is commonly mistaken for a mass in the caudate lobe
c. a round mass with smooth borders is usually a malignant process
d. the location of a mass in the tail of the pancreas usually indicates a malignant process
a
53
A patient tells you that they have undergone the Whipple procedure. What did they have done?
a. partial removal of the pancreas
b. renal transplant
c. liver resection
d. thyroidectomy
a
54
A patient presents with a recent diagnosis of lymphoma. Which of the following is an expected finding on the ultrasound?
a. solitary hyperechoic mass with peripheral hypervascularity
b. multiple solid tumors are present causing marked increase in spleen size
c. mildly enlarged spleen due to fluid accumulation
d. multiple splenic varices at the hilum
b
55
Congestive splenomegaly is an expected finding in patients with:
a. multicystic kidney disease
b. autosomal dominant polycystic kidney disease
c. lymphoma and leukemia
d. congestive heart failure and splenic thrombosis
d
56
The splenic vein measures 5mm in diameter. If the diameter remains constant with deep inspiration:
a. duodenal obstruction should be suspected
b. the response is normal
c. the celiac axis should be evaluated for obstruction
d. portal HTN should be suspected
d
57
A splenic ___ is a cartilaginous tumor.
a. hamartoma
b. osteoma
c. fibroma
d. chondroma
d
58
Splenic calcifications are commonly seen with what type of infection?
a. parasitic
b. echinococcal
c. granulomatous
d. AIDS
c
59
A patient presents for an abdominal ultrasound with a history of renal and pancreatic transplant. What chronic medical condition is the primary reason for the double transplant?
a. pancreatic adenocarcinoma
b. type I diabetes
c. hypertension
d. chronic pancreatitis
b
60
All of the following are potential malignant features of a pancreatic cyst, except?
a. cyst size <3cm
b. internal nodule
c. increase in cyst size on serial exams
d. thickened septations
a
61
Which of the following patients would most likely demonstrate a 10 cm spleen with homogeneous echotexture?
a. 65 year old female with mononucleosis
b. 5'10" 250 lb male born with homozygous sickle cell anemia
c. 30 year old female with lymphoma
d. 50 year old with a splenic artery aneurysm
d
62
If a peripheral, wedge-shaped, hypoechoic lesion is identified in the spleen, what should be the first diagnosis considered?
a. hamartoma
b. Hodgkin lymphoma
c. infarction
d. tuberculosis
c
63
Which of the following usually affects the pancreatic head?
a. focal pancreatitis and adenocarcinoma
b. adenocarcinoma and cystadenoma
c. cystadenoma and islet cell tumors
d. pseudocyst and focal pancreatitis
a
64
Which of the following is a malignant splenic neoplasm?
a. granuloma
b. hamartoma
c. hemangioma
d. lymphoma
d
65
Which of the following results from embryonic failure of fusion of the pancreas tissues?
a. annular pancreas
b. pancreas divisum
c. whipple pancreas
d. ectopic pancreas tissue
b
66
Which of the following splenic tumors is associated with tuberous sclerosis or Wiskott-Aldrich syndrome?
a. cystic lymphangioma
b. chondroma
c. hamartoma
d. hemangioma
c
67
The splenic vein measures 5mm in diameter. If the diameter increases to 10 mm with deep inspiration:
a. the celiac axis should be evaluated for obstruction
b. portal HTN should be suspected
c. duodenal obstruction should be suspected
d. the response is normal
d
68
Asplenia is associated with all of the following, except:
a. aorta on the right side of the body
b. absence of the spleen
c. congenital heart defects
d. liver on the right, gallbladder on the left
d
69
Which of the following is a common cause of a splenic abscess?
a. Gaucher disease
b. cholecystitis
c. portal HTN
d. endocarditis
d
70
A 56 year old male presents with acute onset of epigastric pain that has persisted for about 2 days. His lab tests demonstrate elevated amylase and lipase. Multiple mobile echogenic foci are present in the gallbladder with a wall thickness of 2.4 mm. The CBD measures 6mm and appears patent. The pancreas is mildly enlarged with posterior enhancement. Which of the following best describes these findings?
a. acute pancreatitis with cholelithiasis
b. adenomyomatosis with cholelithiasis and cholecystitis
c. cystic fibrosis with cholelithiasis
d. chronic pancreatitis with cholelithiasis
a
71
What causes pseudopancreatitis?
a. polycystic liver disease
b. cholecystitis
c. fatty liver
d. hepatitis
c
72
Splenic vein thrombosis is a common finding in patients with:
a. splenic hemangioma
b. pancreatic divisum
c. chronic pancreatitis
d. splenic infarct
c
73
Gamna-Gandy bodies result in:
a. aneurysm formation in the splenic artery
b. aneurysm formation in the aorta
c. splenic calcifications
d. hypothyroidism
c
74
Splenic vein thrombosis can lead to what life threatening condition?
a. congestive heart failure
b. splenic artery stenosis
c. GI bleed from gastric varices
d. splenic artery pseudoaneurysm
c
75
Why does the spleen have an increased risk of infarction compared to other abdominal organs?
a. because of the small size of the splenic vein and increased risk of stasis thrombosis
b. because its non-encapsulated
c. because the intrasplenic arteries do not have communicating branches
d. because there is only one intrasplenic artery
c
76
The most common cause of splenomegaly is:
a. mononucleosis infection
b. AIDS
c. portal HTN
d. malignant HTN
c
77
What congenital anomaly of the pancreas is most associated with duodenal obstruction?
a. pancreatic sequestration
b. pancreas divisum
c. aberrant pancreatic tissue
d. annular pancreas
d
78
Which of the following is an expected finding with asplenia?
a. second IVC on left side of body
b. presence of multiple spleens
c. aorta on the left side of the body
d. liver on the right, gallbladder on the left
a
79
The double duct sign refers to the dilatation of:
a. CBD and cystic duct
b. main pancreatic duct and accessory pancreatic duct
c. CBD and duct of Wirsung
d. right and left hepatic ducts
c
80
What is the most common abdominal lesion seen with Von Hippel Lindau syndrome?
a. renal cell carcinoma
b. liver adenoma
c. pancreatic cysts
d. fatty liver sparing
c
81
Splenic vein thrombosis and splenic artery pseudoaneurysm formation are vascular complications seen with:
a. Zollinger Ellison syndrome
b. cirrhosis
c. pancreatitis
d. renal artery stenosis
c
82
A patient presents for a post-transplant evaluation of the pancreas. Where is the most common location for the allograft?
a. epigastric area
b. periumbilical area
c. right iliac fossa
d. left lower quadrant
c
83
A patient presents with LUQ pain and no lab findings. He had a splenectomy 4 years ago after a car accident. There are 2 homogeneous masses with smooth borders measuring <3cm located lateral and anterior to the pancreas tail. Internal vascularity is identified. These findings are most suggestive of:
a. abscess formation
b. splenosis
c. lymphatic adenopathy
d. circumscribed hematomas
b
84
A patient presents for an abdominal ultrasound due to a history of elevated amylase. She was diagnosed 5 years ago with Von Hippel Lindau syndrome. You identify a round, lobulated mass with numberous small cysts in the body of the pancreas. Mild posterior enhancement is present. These findings are most suggestive of:
a. adenocarcinoma
b. Sphincter of Oddi
c. microcystic cystadenoma
d. pseudocyst
c
85
Tuberculosis and ___ will demonstrate similar ultrasound findings in the spleen.
a. infarction
b. sarcoidosis
c. hamartoma
d. hemangioma
b
86
Which of the following describes the sonographic appearance of the pancreas with chronic cystic fibrosis?
a. decreased size with hypoechoic nodularity throughout the gland
b. decreased size and increased overall echogenicity
c. increased size with nodule and calcification formation
d. increased size with mottled echogenicity, no definite nodules
b
87
Which of the following is an acquired abnormality of the spleen?
a. splenunculi
b. agenesis
c. splenomegaly
d. ectopic spleen
c
88
A patient presents with a history of fever and vomiting with increased serum levels of amylase and lipase. While scanning the abdomen you note a complicated cyst in the anterior pararenal space on the left side. These findings are most consistent with:
a. splenic aneurysm
b. splenic varices
c. pancreatic pseudocyst
d. GI tract mass
c
89
Alcohol abuse is the most common cause for:
a. renal failure
b. chronic pancreatitis
c. acute pancreatitis
d. cholecystitis
b
90
A fluid collection between the diaphragm and splenic capsule may represent:
a. subphrenic abscess
b. subcapsular hematoma
c. pericardial effusion
d. pleural effusion
a
91
A patient presents with a recent history of a histoplasmosis infection. The referring doctor would like to evaluate the abdomen for residual effects from the infection. Which sonographic findings in the abdomen would be consistent with this type of infection?
a. mild to moderate ascites and splenomegaly
b. multiple echogenic foci in the liver or splenic parenchyma
c. dilated ductal system of the liver with inflammation (cholangitis)
d. significant amount of loculated ascites in the bilateral paracolic gutters
b
92
What congenital anomaly of the pancreas results in two separate ductal systems that drain the pancreas?
a. pancreas divisum
b. annular pancreas
c. pancreatic sequestration
d. aberrant pancreatic tissue
a
93
Which of the following is considered a direct sign of pancreatic adenocarcinoma?
a. biliary ductal dilatation
b. hypoechoic mass in the pancreatic head
c. liver metastasis
d. palpable gallbladder
b
94
The bright band sign is a characteristic of:
a. rectus abdominis hematoma
b. splenic infarction
c. hepatitis
d. biliary tree dilatation
b
95
Massive splenomegaly is defined as a spleen that exceeds ___ in length.
a. 15cm
b. 20cm
c. 13cm
d. 23cm
b
96
A patient presents with a recent diagnosis of AIDS. Which of the following statements is true regarding the sonographic appearance of spleen in this patient?
a. the spleen will be severely enlarged with numerous punctate calcifications
b. the spleen will be mild-moderately enlarged with a homogeneous texture
c. the splenic hilum should be evaluated for varices
d. multiple hypoechoic tumors will be present causing marked increase in size
b
97
Which of the following are vascular complications seen with pancreatitis?
a. portal hypertension and biliary strictures
b. thrombosis of the splenic vein or pseudoaneurysm of the splenic artery
c. cholecystitis and phlegmon formation
d. progression of Budd Chiari syndrome and the development of congestive heart failure
b
98
Biliary atresia and congenital absence of the gallbladder are associated with which complex congenital defect?
a. pancreas divisum
b. annular pancreas
c. polysplenia
d. asplenia
c
99
Which of the following is a common complication of cystic fibrosis?
a. renal calculi
b. meconium ileus
c. AAA
d. systemic HTN
b
100
What effect does polycythemia vera have on the sonographic appearance of the spleen?
a. multiple hypoechoic masses less than 1cm in diameter
b. diffuse increase in echogenicity and hypervascularity
c. multiple echogenic foci in an atrophied spleen
d. marked splenomegaly with normal echogenicity
d
