Ch. 10-12 Urinary System, Spleen, Retroperitoneum

Rejection of a renal transplant is suggested after the resistive index reaches:

0.9

Mesoblastic nephromas are more likely to occur in patients under:

1 year of age

The normal renal cortex measures a minimum of:

1.0 cm

The normal adult spleen measures approximately:

11 cm in length, 7 cm in width, and 4 cm in thickness

In a 40-year-old patient, splenomegaly is suggested after the length of the spleen exceeds:

13 cm

Renal artery stenosis is suggested after the peak systolic velocity exceeds:

180 cm/s

Aneurysms involving the renal artery are at an increased risk of rupturing after the diameter exceeds:

2.0 cm

Normal hemoglobin levels should not exceed:

20 g/dL

Normal postvoid residual urine volume should not exceed:

20 mL

The outer portion of the adrenal gland comprises:

90% of the gland

A condition caused by complete or partial failure of the adrenocortical function describes:

Addison disease

When encountering this type of pathology, which of the following questions in most important for the sonographer to ask the patient?

Have you noticed any blood in your urine?

Which of the following statements correctly describes the adrenal glands?

The suprarenal arteries arise from the aorta, renal, and inferior phrenic arteries

A hyperechoic focus located in the anterior renal cortex in an asymptomatic patient most likely represents:

a junctional parenchymal defect

Leukocytosis is defined as a white blood cell count:

above 20,000

Which of the following splenic abnormalities is most commonly linked to infective

abscess

A patient presents with a history of liver function tests showing elevated levels. Based on this clinical history, the sonogram is most likely demonstrating a(n):

accessory spleen

Obesity is most likely a predisposing factor in developing which of the following adrenal neoplasms?

adenoma

Which of the following is the most common cause of Conn syndrome?

adrenal adenoma

A 35-year-old man presents with a history of a sudden onset of hypertension. An anechoic area is identified in the right upper quadrant. On the basis of the clinical history, the anechoic area in this sonogram is most suspicious for a(n):

adrenal cyst

Which of the following hormones is produced by the pituitary gland?

adrenocorticotrophic hormone[

Which of the following terms describes the typical sonographic appearance of the medullary pyramids in the neonate?

anechoic

The most common clinical finding associated with a hemangiosarcoma is:

anemia

A benign tumor composed of fat, blood vessels, and muscle describes a(n):

angiomyolipoma

Duplex imaging of the lower pole of the left kidney most likely demonstrates which of the following?

arcuate vessels

Patients with a history of portal hypertension have an increased risk of developing a splenic:

artery aneurysm

A patient presents with a history of increased abdominal girth and liver function tests showing elevated levels. Which of the following findings is most likely demonstrated in this sonogram of the left upper quadrant?

ascites

Leukopenia is defined as a white blood cell count:

below 4000

A patient arrives at the emergency department following a motor vehicle accident. An abdominal ultrasound is most likely ordered to evaluate for which of the following conditions?

biliary obstruction

A 45-year-old female patient arrives for a pelvic ultrasound complaining of urinary frequency. An anechoic structure is identified contiguous with the urinary bladder. The pathology identified is most suspicious for a(n):

bladder diverticulum

Fusion of the entire medial aspect of both kidneys is a congenital anomaly termed:

cake kidney

Which of the following splenic pathologies is associated with granulomatosis?

calcifications

Multiple splenic infection is a predisposing factor for which of the following conditions?

candidiasis

Which of the following pathologies is associated with a "wheel within a wheel" appearance on ultrasound?

candidiasis

A 78-year-old patient presents to the ultrasound department to rule out an abdominal aortic aneurysm. An incidental mass was discovered in the urinary bladder. Blood flow was demonstrated within the mass using color Doppler imaging. This incidental finding is most suspicious for a bladder:

carcinoma

A catheterized paraplegic patient is scheduled for a retroperitoneum ultrasound. An anechoic structure is identified in the region of the urinary bladder. This structure most likely represents a(n):

catheter balloon

An asymptomatic middle-aged patient presents with a history of liver function tests showing elevated levels on an annual physical examination. An abdominal ultrasound is ordered to rule out liver disease. A sonogram of the left upper quadrant demonstrates a hyperechoic mass in the splenic parenchyma. Based on this history, the mass identified most likely represents a(n):

cavernous hemangioma

The most common benign neoplasm of the spleen is a(n):

cavernous hemangioma

The splenic artery is a branch of which of the following vascular structures?

celiac axis

Which of the following scanning planes is most likely demonstrated in this sonogram?

coronal

A hematoma located below the splenic capsule most commonly appears on ultrasound as a:

crescent-shaped fluid collection inferior to the diaphragm

An asymptomatic patient presents to the ultrasound department with a history of hepatitis B. An incidental finding is identified in the superior portion of the spleen. This finding is most consistent with a(n):

cyst

Which of the following conditions is a predisposing factor for development of an adrenal adenoma?

diabetes mellitus

A patient presents with a history of portal hypertension. The spleen is expected to demonstrate:

enlargement

Which of the following hormones increases during times of excitement or stress?

epinephrine

Which of the following hormones is secreted by the adrenal medulla?

epinephrine

The complete inability of the kidneys to excrete waste, concentrate urine, and converse electrolytes is termed renal:

failure

Which of the following is an indication for an ultrasound of the spleen?

fatigue

Which of the following is considered a function of the lymph node?

form antibodies to fight infection

A patient hospitalized with malaria presents with a history of proteinuria. An enlarged hyperechoic kidney is demonstrated on ultrasound. Based on this clinical history, the sonogram is most suspicious for which of the following conditions?

glomerulonephritis

Which of the following renal structures is composed of blood vessels or nerve fibers?

glomerulus

Which of the following hormones modifies the body's response to inflammation?

glucocorticoids

Which of the following benign neoplasms is composed of lymphoid tissue?

hamartoma

Splenic infarction is most commonly associated with an embolism originating from which of the following structures?

heart

An afebrile 13-year-old female patient presents to the ultrasound department complaining of vague left upper quadrant pain. She admits to "wrestling" with her brother a week earlier. She denies blunt force trauma. Laboratory tests are pending. Based on this clinical history, the sonographic findings are most suspicious for which of the following conditions?

hematoma

Which of the following structures carries carbon dioxide back to the lungs?

hemoglobin

Which of the following structures is recycled into iron by the spleen?

hemoglobin

A patient arrives at the emergency department following a motor vehicle accident. An abdominal ultrasound is most likely ordered to evaluate for which of the following conditions

hemoperitoneum

A neonate presents with a history of decreasing hematocrit levels. A sonogram of the right upper quadrant demonstrates a complex mass in the right adrenal gland. On the basis of the clinical history, the mass is most suspicious for a(n):

hemorrhage

A 25-year-old woman presents to the emergency department complaining of severe left flank pain. A sonogram of the kidney most likely demonstrates which of the following conditions?

hydronephrosis

Which of the following abnormalities is the most likely complication of retroperitoneal fibrosis?

hydronephrosis

Bilateral adrenal hyperplasia is associated with:

hyperaldosteronism

The sonographic appearance of a liposarcoma is most likely described as a:

hyperechoic mass with thick wall margins

A hemanigosarcoma located in the spleen on ultrasound would appear as a(n):

hyperechoic or complex mass

A 54-year-old woman presents to the ultrasound department complaining of right upper quadrant pain. Which of the following anatomical variants is most likely identified in this sonogram?

hypertrophied column of Bertin

Which of the following conditions is most likely to mimic a duplicated urinary system?

hypertrophied column of Bertin

Visceral lymph nodes are located:

in the peritoneum

Based on the clinical history, these sonographic findings are most likely considered:

incidental findings

An enlarged lymph node demonstrating an oval shape and smooth wall margins is most consistent with an underlying:

infection

Which of the following conditions is most likely to demonstrate an elevated hematocrit?

infection

Which of the following splenic regions is identified by arrow C?

inferior portion

The right suprarenal vein empties into which of the following vascular structures?

inferior vena cava

Gain settings should be placed to demonstrate the normal spleen as:

isoechoic to the normal liver

A renal ultrasound is ordered on an older patient with elevated creatinine levels. Based on this clinical history the sonogram is most likely demonstrating:

junctional parenchymal defect

The renal arteries arise from which aspect of the abdominal aorta?

lateral

The location of the spleen is best described as:

lateral to the stomach

The spleen is predominantly located in which of the following quadrants?

left hypochodrium

Which of the following malignant neoplasms contains cells of smooth muscle?

leiomyosarcoma

The most common neoplasm to develop in the retroperitoneum is a:

liposarcoma

Which of the following adrenal neoplasms is most likely to infiltrate surrounding structures?

liposarcoma

Hemangiosarcoma involving the spleen frequently metastasizes to which of the following organs?

liver

Which of the following conditions is associated with a decrease in blood urea nitrogen (BUN)?

liver failure

A 70-year-old patient presents with a palpable mass in the left groin following a recent invasive procedure. A sonogram of the left groin demonstrates an oval-shaped mass in the superficial tissues of the thigh. This mass is most likely a:

lymph node

A 45-year-old woman presents with a history of weight loss, severe back pain, and elevated alkaline phosphatase. A sonogram of the great vessels identifies multiple masses anterior to the inferior vena cava and abdominal aorta. These masses are most suspicious for

lymphadenopathy

Which of the following structures are contained in the renal sinus?

lymphatics, peripelvic fat, major calyces

Gastrohepatic lymphadenopathy is associated with:

lymphoma

Which of the following conditions is most likely associated with a decrease in leukocytes?

lymphoma

Fibromuscular hyperplasia is most commonly associated with stenosis in which of the following renal arteries?

main renal artery

An enlarged irregular lymph node demonstrating a round appearance is most consistent with an underlying:

malignancy

The inner portion of the adrenal gland is termed the:

medulla

Metastasis to the spleen most commonly originates from which of the following malignancies?

melanoma

An abnormal growth of epithelial cells is demonstrated in which of the following neoplasms?

mesothelioma

A 51-year-old man complaining of right upper quadrant pain presents to the ultrasound department with a history of gallstones. This sonogram is most likely identifying which of the following conditions?

nephrocalcinosis

Which of the following conditions is frequently associated with urinary stasis?

nephrolithiasis

Which of the following structures is considered the basic functional unit of the kidney?

nephron

A 15-month-old toddler presents with a history of a palpable abdominal mass, poor weight gain, and fatigue. A hypervascular complex mass is identified superior and medial to the right kidney. On the basis of the clinical history, the sonogram is most suspicious for which of the following pathologies?

neuroblastoma

Young children have a predisposing factor for developing which of the following adrenal neoplasms?

neuroblastoma

A clinical finding associated with splenic infarction may include:

no symptoms

A patient with an accessory spleen will most likely present with which of the following symptoms?

no symptoms

A 2-day-old neonate presents with a history of decreased urinary output. A sagittal image demonstrates a hyperechoic focus within the right adrenal gland. This finding is most suspicious for a(n):

normal medulla

A 5-week-old infant presents to the ultrasound department with a history of a single urinary tract infection. The sonogram of the kidney most likely demonstrates:

normal medullary pyramids

Which of the following structures is located in the anterior pararenal space?

pancreas

An asymptomatic patient presents to the ultrasound department with a clinical history of microscopic hematuria. The anechoic area demonstrated in the sonogram is MOST consistent with a(n):

parapelvic cyst

A morbidly obese patient presents to the ultrasound department with a history of elevated liver function tests. He denies abdominal or flank pain. The arrow in this sonogram most likely identifies:

perinephric fat

A urinoma is most likely to develop in which of the following regions?

perinephric space

A rare vascular tumor of the adrenal gland defines a:

pheochromocytoma

Benign adrenal pathology associated with hypertension, tachycardia, and palpitations is most consistent with which of the following pathologies?

pheochromocytoma

Cushing disease is most commonly caused by which of the following pathologies?

pituitary mass

A 40-year-old patient presents with a history of elevated creatinine levels. A sagittal image of the right kidney demonstrates multiple masses. Based on the clinical and sonographic findings, the masses are most suspicious for:

polycystic kidney disease

A congenital anomaly of the spleen associated with gastrointestinal, cardiovascular, and biliary anomalies is most consistent with:

polysplenia syndrome

Based on this history and sonogram, the sonographer should also evaluate for which of the following pathologies?

portal hypertension

The splenic vein joins the superior mesenteric vein to form the:

portal vein

The quadratus lumborum is a muscle located in the:

posterior abdominal wall

Which of the following structures form the anterior border of the retroperitoneum?

posterior parietal peritoneum

The anterior pararenal space is most accurately defined as the area between the:

posterior peritoneum and Gerota's fascia

The location of the right adrenal gland most accurately correlates to which of the following regions?

posterior to the inferior vena cava

The location of the left adrenal gland most accurately correlates to which of the following regions?

posterior to the splenic artery

An afebrile patient with a history of leukemia presents to the ultrasound department complaining of left upper quadrant pain. A sonogram of the spleen demonstrates hypoechoic nodules within the splenic parenchyma. These nodules most likely represent:

primary malignant tumors

Which of the following is considered a function of the adrenal glands?

produce hormones

Which of the following patient positions is typically used for renal biopsy procedures?

prone

A 43-year-old female patient presents to the ultrasound department complaining of right flank pain and dysuria. A generalized swelling of the kidney is demonstrated. The medullary pyramids appear well defined. This is most suspicious for:

pyelonephritis

An adrenal cyst is considered a:

rare finding

The pathology identified in this sonogram is considered a(n):

rare finding

Hematocrit is defined as the percentage of:

red blood cells in the blood

Patients with adult polycystic renal disease have an increased incidence of developing:

renal calculi

A 70-year-old patient presents with a history of painless hematuria, uncontrolled hypertension, and vague right upper quadrant pain. A mass is identified that demonstrates internal blood flow. Based on this history, the mass identified in the sonogram is most suspicious for a(n):

renal carcinoma

Dialysis patients are at increased risk for developing:

renal carcinoma

Which of the following conditions is most likely associated with painless hematuria?

renal cell carcinoma

A patient complaining of sharp, severe flank pain radiating to the groin is describing:

renal colic

A malignant neoplasm derived from striated muscle describes a:

rhabdomyosarcoma

Elevation in which of the following laboratory tests is a clinical finding in Addison disease?

serum potassium

A middle-aged patient presents with a history of elevated creatinine levels. The left kidney is not identified in the left flank. A sonogram of the right flank is documented. Which of the following congenital anomalies is most likely demonstrated in this sonogram?

sigmoid kidney

Fusion of the superior pole of one kidney to the inferior pole of the contralateral kidney is most consistent with which of the following congenital anomalies?

sigmoid kidney

The most common renal neoplasm identified in patients over the age of 55 years is a(n):

simple cyst

Which of the following components is a major factor in determining blood volume?

sodium

A retroperitoneal ultrasound is ordered on an older patient with a history of elevated creatinine levels. Hyperechoic foci are identified in the splenic parenchyma. These foci are most suspicious for:

splenic calcifications

The most common location of an accessory spleen is near the:

splenic hilum

Which of the following splenic regions is identified by arrow B?

splenic hilum

A 50-year-old patient with a long history of alcohol abuse presents to the ultrasound department complaining of left upper quadrant pain. This sonogram of the left upper quadrant is most consistent with which of the following conditions?

splenomegaly

Which of the following splenic regions is identified by arrow A?

superior portion

The adrenal glands are also known as the:

suprarenal glands

The "floating aorta" sign is caused by lymphadenopathy in which of the following regions?

surrounding the aorta

Which of the following muscles is located lateral to each kidney?

transversus abdominis

A patient presents with a history of intermittent umbilical discharge. The patient denies a history of abdominal trauma, pain, or fever. A sonogram of the pelvic midline shows a tubular mass between the urinary bladder and umbilicus. Based on the clinical history, the sonogram is most likely demonstrating which of the following conditions?

urachal sinus

This image of the urinary bladder is most likely demonstrating which of the following?

ureteral jet

Small echogenic protuberances identified on the posterior wall of the urinary bladder most likely represent:

ureteric orifices

During a screening obstetrical examination, an intermittent bladder abnormality is identified. This incidental finding is most consistent with a(n):

ureterocele

The most common etiology for this pathology is:

urinary tract obstruction

Which of the following fluid collections is most likely to demonstrate a rapid increase in size following renal transplant surgery?

urinoma

Which of the following is a symptom associated with adrenocortical carcinoma?

weight loss