Pathology 18-35

A transverse image of the fetal thorax shows a cystic structure adjacent to malposition fetal heart. A normally placed stomach is not visualized in the fetal abdomen. This is most suggestive of which of the following anomalies

CDH

The fetal thoracic circumference should be closely evaluated and compared with the abdominal circumference in the event of a suspected

Chromosomal abnormality

When serial sonographic examination demonstrate the progression of significant IUGR, the clinician needs to try to determine the cause of the problem. A fetal cause that can lead to IUGR is

Chromosome abnormalities

A fetus is diagnosed with TOF. On which of the following does the prognosis depend

Degree of pulmonary stenosis

What test results is available in 24 hours for anomalies of chromosomes 13, 18, 21, X, and Y

FISH

Which anatomic structure would aid in the differentiation of alobar holoprosencephaly from hydranencephaly

Falx

Sonograohic evaluation of fetal head reveals hypotelorism with a midline facial cleft. Severe microcephaly is present, preventing adequate visualization of fetal head anatomy. On the basis of the findings that are evident what is the most likely diagnosis

Holoprosencephaly

A 22 year old woman is seen for ob at 16 gestational age by lmp for increased uterine size and absent heart tones. The sonogram shows a large heterogenous mass within the uterus. No identifiable fetus or amniotic fluid can be detected. What is the most likely diagnosis

Hydatidiform mole

What would you expect to see in the donor twin affected by twin to twin transfusion syndrome

IUGR

Commonly seen in men older than 50 years of age symptoms of BPH include

Leaking or dribbling of urine Weak or hesitant urine stream Increased urine frequency Nocturia

A 50 year old woman palpated a compressible mobile mass in her left breast. Sonograohically the mass although palpable is indistinguishablefrom the surrounding breast tissue. What would be the most likely diagnosis

Lipoma

Failure of the sulci and the gyri to develop in a term infant is associated with which cranial anomaly

Lissencephaly

Which organ produces alpha fetoprotein

Liver

A 29 year old presents for ob ultrasound at 35 weeks she has a history of gestational diabetes in two prior pregnancies sonograms at 11 and 23 weeks have confirmed gestational age and have been otherswise unremarkable the current exam reveals an average age of 38 weeks 4 days the placenta appears generous in size measuring 6.2cm what is the most likely diagnosis

Macrosomia

An elderly man with a painless palpable thyroid nodule is referred for thyroid sonography. Previous imaging studies have reported s thyroid nodule with calcification. These images are not available for review. A second sonogram is performed and reveals a 2cmx3cm solid hypoechoic nodule with a hypoechoic halo and disruption of peripheral eggshell calcification.

Malignant nodule

A 19 year old woman gravitate 2 para 1 presents to the emergency department at 11 weeks gestation with vaginal bleeding. Lab test results reveal a beta hCG of 219,000. A sonogram is ordered to confirm what?

Molar pregnancy

Which of the following sonographic finding is associated with twin to twin transfusion syndrome

Monochorionicity with unequal distribution of AFV

Routine annual follow up examination of popliteal artery stent reveals an echo freelumen by grayscale. Color Doppler shows aliasing within the stent and spectral Doppler confirms the mildly elevated velocities. Flow distal to the stent becomes triohasic and demonstrates normal velocities. What is most likely diagnosis

Normal finding in a stent

A 24 year old women with a history of reduced fetal movement presents for ob. There is no indication of bleeding pain or other complications based on previous unremarkable sonography is the first trimester the pregnancy should currently measure 37 week the patient is 5ft 11 and the father is 6ft 7 the average age by sonography is 40 weeks gestational age the remainder of the examination is unremarkable. What is the most likely diagnosis

Normal growth from tall parents

L-TGA is best described as

Normal visceral situs, L-looped ventricles and TGA

A sonographic evaluation reveals a fetus with short bowed limbs with multiple fractures and a compressible skull . This would be most suggestive of which of the following

OI type II

A patient presents with a 15 week pregnancy with oligohydraminos. The patient complains that she has had significant bleeding and has lost multiple pregnancies before 20 weeks. The fetus was noted to have a bladder and no other significant abnormalities were identified. The most likely cause of oligohydraminos is

Obtain blood work to determine if the patient is a cystic fibrosis carrier

Suspected abnormal growth or development of the spinal cord and adjacent structures is known as

Occult spinal dysraphism

A detailed sonogram was obtained of a 23 week fetus whose gestational age was confirmed by a sonogram previous at 13 weeks. The sonogram demonstrates a 19 week fetus with a two vessel cord, echogenic kidneys oligohydraminos and a probable heart defect. The next step should be to

Offer genetic counseling and Karyotyping

A 30 year old woman with a history of breast reduction is sent to sonography department for imaging of palpable masses along the surgical scar. A sonogram reveals three round smooth anechoic masses. The finding are most consistent with which of the following

Oil cyst

A 66 year old woman comes for her annual physical and mentions she has been experiencing pain in her legs during exercise. She states it is worse in the left calf but notes mild achiness in the right calf too. She can walk about 5 minutes then needs to stop for 1 minute before continuing. Her physician orders an ABI. During the test biphasic waveforms are noted throughout the right leg and the left common and femoral artery but the left leg demonstrates monopshsic signals in the popliteal posterior tibial and dorsalis pedias. Before the exercise portion of the test the abi values were 1.0 on the right and 0.76 on the left. After exercise left foot pallor is noted and the abi value are 0.80 on the right and 0.35 on the left. What is the most likely cause of her leg pain

Old disease in the right leg and severe arterial occlusive disease in the left leg

A 36 year old woman is seen for a sonogram for an elevated alpha fetoprotein vale at 17 weeks gestation. A large protrusion of abdominal contents is identified contained within a membrane what is the most likely explanation

Omphalocele

A 55 year old woman undergoes a sonogram that reveals a retroareolar solid mass within dilated ducts. She has evidence of skin edema and complains of unilateral pink nipple discharge. What would be the most likely diagnosis

Papillary carcinoma

A 19 year old man with no significant medical history is seen with a palpable nodule in the region of the right inferior lobe of the thyroid. On sonographic evaluation the corresponding nodule is found to be slightly less echogenic than the surrounding thyroid parenchyma. There is a wide irregular halo surrounding the nodule and fine punctuate internal calcification throughout the nodule.

Papillary thyroid cancer

HLHS involves which structures

The left ventricle mitral valve and aorta

In which of the following views does the normal hip display a U shape

Transverse/flexion

Which of the following would meet the criteria of the minimum standard examination

Transverse/flexion view with stress maneuvers coronal/neutral view

Which chromosome abnormality is a lethal condition and is rarely reported in live births

Triploidy

A 23 year old women had increased nuchal translucency on her first trimester scan. She chose not to proceed with CVS or early amniocentesis. At the time of her targeted sonogram polydactyl microcephaly and a renal abnormality were identified. What chromosome abnormality is most likely to be seen in this case

Trisomy 13

Clenched hands are identified in a fetus that has a heart defect. Which of the following is most likely

Trisomy 18

Echogenic bowel has an association with all of the following except for which one

Trisomy 18

Which of the following is the most common chromosome abnormality to have a SUA

Trisomy 18

A 61 year old man is seen with intermittent pain and swelling of the right scrotum radiating to the right inguinal canal. A sonogram is ordered because a scrotal hernia is suspected. Which of the following somogroahic finding is suggestive of scrotal hernia

Tubular structures that demonstrate peristalsis within the scrotum

Which of the folllowing is a somographic feature of advance prostate cancer

Tumor extension to the periproststic lymph nodes

A 35 year old present for ultrasound dating and is found to have a fetus with severe abnormalities findings included scalp edema generalized skin edema ascites plural effusion and a large cystic structure st the occipital area. What is the most likely diagnosis

Turners syndrome

A cystic hygroma May be seen in association with many chromosomal abnormalities however it is most often associated with which syndrome

Turners syndrome

When scanning to determine the presence of tethered cord the vertbral level is determined by counting down from __________and confirmed by counting up from ______

Twelfth rib ; L5-S1 junction

Which of the following complication related to the death of one twin results in the most danger to the other twin

Twin embolization syndrome

A 29 year old women is seen for an obstetric sonogram for an increased fundal height at 27 weeks gestation by LMP the sonographic examination reveals two fetuses sharing a single placenta. Fetus a measures 28 weeks fetus b measures 25 weeks and shows moderate oligohydraminos. What is the most likely diagnosis

Twin to twin transfusion syndrome

Which Graf classification describes an immature hip with an alpha angle of 50 to 60 degrees

Type II

A large key hole bladder is noted in a female fetus. A large distended fluid filled abdomen is also seen, along with oligohydraminos. The likely prognosis for this 35 week fetus is poor. The likely cause is

Urethral atresia

Symptoms of prostatitis include all of the following except

Urinary urgency or frequency

In the development of a normal al intrauterine pregnancy the yolk sac should be demonstrated transvaginally in a gestational sac with what minimum measurement

8mm

Following are the PSV for a patient carotid sonogram. What is the right ICA/CCA ratio Right CCA prox 98 Right ICA prox 145/ Right CCA distal 88 Right ICA distal 160

1.82

Evidence of developing intrauterine pregnancy should be recognized endovaginally with a serum beta hCG of

1000 to 2000

In the early first trimester of pregnancy the gestational sac is expected to grow a rate of

1mm a day

Sonographic finding of a carotid sonogram reveals moderate heterogenous plaque in the left CCA. Spectral Doppler revealed a PSV of 224 cm/s and EDV of 85 cm/s. Which of the following accurately describes the sonographic finding

50 to 79% stenosis

A secondary yolk sac measuring greater than what measurement is considered abnormal and suspicious for abnormal pregnancy development

6mm

Which of the following is the percentage of stenosis of the RCCA on a transverse image with a true diameter of 10mm and a residual diameter of 2mm

80%

Which of the following would be the most worrisome sonographic finding

A 4 cm smooth oval mass with cystic areas in the breast of a 55 year old woman

A fetus is diagnosed with a complete atrioventriuclar heart block. Which of the following statements regarding the infants prognosis or treatment or both is true

AVSD are more complex to repair and are frequently associated with other cardiac defects

Sonographic evalauation at 19 weeks gestation reveals an appropriately infant with unilateral talipes. Which of the following conditions may be associated with this finding

ABS

Radial arrangement of the sulci superior to the third ventricle is a sonographic finding associated with which anomaly

ACC (agenesis of corpus callosum)

A 78 year old man visits his physician with a chief complaint of an inability to walk long distances anymore. He complains of severe pain in his calves on both sides. This pain also occurs while sitting for long periods of time. The physician orders a lower extremity venous and arterial and ABI. The lower extremity venous study demonstrates fully collapsed vessels and wall to wall color with color Doppler. The lower extremity arterial sonogram demonstrates minimal plaque formation and no evidence for high grade stenosis although the average peak systolic velocity 70cm/s . One section in the above the knee popliteal artery demonstrates 112cm/s . The abi is 1.1 on the right and 1.2 on the left . What is most likely cause of the pain

ASO

A young woman in the upper Midwest presents to her physicians office with very painful toes, that turn white, blue, and finally red during cold winter weather this occurs in a few of her fingers as well . She mentions this happens even in the summer when quizzed further she notes this happens in the summer only when she is in an air conditioned building. An arterial lower vascular lab study is performed. Common femoral profunda superficial femoral popliteal posterior tibial and dorsalis pedias arteries are triphasic/biphasic with normal blood pressures. Her digital pressure indices all are less than0.79 her digital temperature are about 21 C and her fingers are noticeably discolored. After heating her fingers her pressures and temperature improve and her fingertips are bright red. What is the most likely diagnosis

ASO

Which of the following genetic markers is considered as sensitive as a thickened NF in screening for Down syndrome

Absent nasal bone

A 31 year old women is seen for a sonogram for an anatomy scan at 30 weeks gestation for size greater than dates. The examination shows approximately 31 week gestation based on fetal head measurement. The femoral measurements are consistent with 18 weeks gestation and the humeral lengths are consistent with 19 weeks geststion. The fetal spine is almost translucent without any shadowing, the brain is extremely well visualized and the thorax is extremely small compared with the abdominal circumference. Polyhydraminos is also noted. This would be most consistent with which of the following

Achondrogenesis

A 62 year old man presents to the emergency department with chest pain and sudden onset of shortness of breath. Findings of a bilateral lower extremity Doppler reveals noncompressible veins from the CFV to the popliteal vein. Intraluminal echogenic matter is very difficult to visualize. Doppler signals are lacking as well. What is the most likely diagnosis

Acute DVT

A patient describes loss of vision in the left eye as someone pulling the shade down. What term describes this transient monocular Blindness

Amaurosis fugax

As an infant grows a tethered cord causes increasing tension leading to

Ambulation problems

A 23 year old man arrived by ambulance to the er from a motorcycle accident 4 days ago. Portable left LEVD revealed dilated proximal femoral vein with slow moving flow seen. Intraluminal hypoechoic matter was located in the left popliteal vein extending down to the distal posterior tibial vein. What is most likely the treatment

Anticoagulant

A22 year old man with an extensive history of DVT with pulmonary emboli presents to his primary care physician to follow up a hospital stay because of DVT. What is the most likely treatment the physician will prescribe in an attempt to prevent future DVT

Anticoagulant

An 84 year old woman presents for s bilateral LEVD for pain posterior to the right knee for 6 months the patient has bilateral ankle edema she denies any chest pain or shortness of breath. Each vein appears compressible with no intraluminal echogenic matter seen. Color Doppler appears adequate. Pulsed wave Doppler reveals pulsatile veins bilaterally. A complex area was noted in the popliteal fossa the measured 5.4cmx3.7cmx4.0cm. What is the most likely diagnosis

Baker cyst with CHF

Which maneuver is performed to solicit subluxation

Barlow maneuver

A 30 year old woman with gestational age by LMP of 30 weeks is referred for gestational dating and fetal assment the sonogram showed the fetal age by HC and femur length to be 31 weeks and the ac 35 weeks. The liver kidneys and other visceral appeared large and the fetal face has macroglossia . What is the diagnosis

Beck with Wiedemann syndromes

Incidental bilateral thyroid nodules are noted on a 75 year old man who is undergoing carotid artery evaluation. Because the patients wife recently died of breast cancer the patient is concerned about cancer and has asked that these nodules be investigated. The nodule in the right lobe is noted to be mostly cystic but contains debris. The nodule in the left lobe contains multiple microcystic spaces separated by thin septa.

Bilateral benign thyroid nodules

A 42 year old man presents to the er with ulceration on his toes and fingers. He has a known history of extremely heavy tobacco use. A lower extremity Doppler imaging study demonstrates flow in the common femoral, profunda, superficial femoral, and popliteal.doppler evaluation also shows marked velocity decrease in the posterior tibial artery and flow could not be detected in the dorsalis pedias. What is the diagnosis

Buergers disease

A 10 year old boy is referred for scrotal sonography because of clinical examination only one of his testicles was palpable within the scrotal sac. A homogenous ovoid mass is identified within the left inguinal canal. Surgical repair is recommended because of this condition is associated with an increased risk for which of the following

Cancer

A boy born at 32 weeks gestational age is diagnosed with hydranencephaly. Which cranial structure would be absent

Cerebrum

What is the first sign of subclavian artery stenosis

Change in the vertebral artery waveform

A 51 year old man with ankle pain for the last 4 years presents for an outpatient left LEVD. The patient does not appear to have any edema, stasis dermatitis or varicose veins. He states that his ankle has been hurting since a fall from a ladder 4 years ago. The patient is still very active despite the pain . Sonographic findings include a fully compressible CFV proximal GSV and femoral vein. Colormdoppler reveals adequate blood flow with normal pw signals. The sonographer is trying to compress the popliteal vein but cannot. No intraluminal echogenic matter can be seen within the popliteal vein and Doppler reveals normal signals. What should the sonographer do next

Change the sonographic window

The sonographic bat wing sign is associated with which cranial anomaly

Chiari II malformation

A 30 year old man with gynecomastia elevated hCG and no palpable scrotal mass presents for s sonogram. The most significant finding includes a 1.5 cm heterogenous mass within the right testicle. After orchiectomy the prognosis remains poor because this type of cancer does not respond well to radiation and chemotherapy.

Choriocarinoma

A young woman presents with painless diffusely enlarged thyroid gland on physical examination. The sonographic appearance confirms diffuse enlargement with micronodular pattern and increased vascualrity.

Chronic thyroiditis

A 32 yea old women is seen for an obstretic sonogram with an abnormal triple screen. hCG, uE3, and afp all were decreased. Which abnormality is most likely to be seen on the sonogram

Clenched hands

A sonographic evaluation of a 29 week gestation reveals that the lateral ventricle has a tear drop shape with asymmetric enlargement of the occipital horn, and the fetal head measurement is consistent with established due date. The remainder of the examination is unremarkable.this is consistent with which of the following

Colpocephaly

A 35 year old multifarious woman is seen for an ob ultrasound with bleeding at 32 weeks gestation. Endovaginal ultrasound reveals a placenta on the anterior uterine wall crossing the internal cervical os and extending 2 cm on the posterior uterine wall. This is consistent with

Complete Previa

The key to the diagnosis of tethered cord is sonograohically visualization of the level of the

Conus medullaris

Which if the following views are combined with stress maneuvers for evaluation of hip stability

Coronal/ flexion, transverse /flexion

Which of the following views is taken at the lateral aspect of the infant with the transducer orientated parallel to the long axis of the body with the hip at 90 degree angle

Coronal/flexion view

A cranial sonogram is performed because of an abnormal prenatal scan. Routine coronal and Sagittal views are performed through the anterior fontanelle. Additional scanning through the mastoid fontanelle reveals hypoplasia of the cerebellar Vermis and communication between the fourth ventricle and posterior fossa. These finding would be consistent with

Dandy walker variant

The occipitofrontal diameter y be measured in the second or third trimester of pregnancy. This measurement in conjunction with BPD is best used to

Determine fetal head shape

An incomplete or complete longitudinal split or cleft through the spinal cord is the definition of

Diastematomyelia

Dizygotic twins are always which type of placentation

Dichorionic diamniotic

Monozygotic embryonic division between 0 and 3 day after conception results in which type of placentation

Dichorionic diamniotic

Which term describes the type of hip abnormality which the femoral head sits outside the confines of the acetabulum

Dislocation

A 28 year old women presents for sonogram at 28 weeks gestational age with a history of no prenatal care and a recent fall. The sonographic examination demonstrates an atrioventricular canal defect, BPD/NBL ratio of 12.2 and polyhydraminos. What is the most likely diagnosis

Down syndrome

A 35 year old woman is seen for an obstetric sonogram late prenatal care and an uncertain last menstrual period. The sonogram establishes a gestational age of 27 weeks4 days. Polyhydraminos and the presence of two stomachs in the fetal abdomen are identified. This is suggestive of which of the following anomalies ?

Duodenal atresia

In normal patient the cauda equina nerve branches are the nerve fibers arising from the distal end of the spinal cord and appear sonographically as

Echogenic and oscillate with respiration

A 24 year old woman with a positive pregnancy test result and pelvic pain is seen for an ultrasound. She has a history of PID. The ultrasound reveals a uterus containing an anechoic sac that lack a double deck dual sac sign with a moderate amount of cul-de-sac fluid. This is most suspicious for which of the following

Ectopic pregnancy

A28 year old man undergoes clinical examination for a palpable mass in the left testicle. A sonogram reveals a solid mostly hypoechoic mass including a shadowing calcification within the left testicle.

Embryonal cell carcinoma

The most common reason for elevated PSA is

Enlarged prostatectomy gland

After experiencing a ruptured Achilles' tendon injury 34 year old man complains of severe leg pain and swelling. Spectral Doppler of the veins reveals normal phasicity and complete compressibility from thigh to just below the knee. Because of the extreme pain the sonographer is unable to compress the calf or document augment flow within the veins.the sonographer notes arterial signals seem weak. An arterial spectral tracing in posterior tibial and perineal arteries confirms diminished flow and shows that flow disappears entirely in distal calf. A large hematoma between the gastrocnemius and soles muscles is incidentally noted. What is the diagnosis

Entrapment syndromes

A 35 year old women is seen for sonographic evaluation for advance maternal age. The examination reveals polyhydraminos and absence of the stomach. This is most suggestive of which of the following anomalies

Esophageal atresia

A woman with a 35 week pregnancy is found to have normal appearing fetus and AFI of 3cm. She states she has not felt any more fluid leaking since last week. She has also noticed the baby is not moving like it usually does and she has had a fever for 2 days. The fetus is at increased risk for what.

Fetal demise

A 28 week gestational age fetus is noted to have severe IUGR. The umbilical artery Doppler waveform shows reversed diastolic flow, and the ductus venosus shows flow reversal of the a wave. What is the significance of these Doppler findings?

Fetal distress

An AFI measurement was obtained on a 38 week gestational pregnancy. The AFI was considered within normal limits. A fetal bladder was never demonstrated on imaging. What could be the likely explanation?

Fetus emptied bladder

A 40 year old woman presents to the er with uncontrolled hypertension and abnormal lab values. Bilateral carotid bruit is noted on cervical auscultation. Renal angiogram results reveal multiple bulbous luminal irregularities in the renal arteries bilaterally. What is the most likely cause of this patients carotid bruit

Fibromuscular dysplasia

A normal variant that has no known clinical signficance when it occurs alone is

Filar cyst

A 32 year old man undergoes evaluation for infertility and his physician orders a sonogram. The examination shows a collection of vessels measuring 2 to 2.5 mm in the left hemiscrotum. What Doppler finding within this collection of vessels would suggest a primary varicocele

Further dilation and increased blood flow during valsalva maneuver

A 25 year old women is seen for an alpha fetoprotein level of 5.7 MoMat 16 weeks gestation. Sonogrsphic evaluation reveals free floating bowel anterior to the abdomen. What is the most likely diagnosis

Gastroschisis

A 16 year old girl presents to the sonography department with breast mass that has been palpable for 6 months. Sonographically a 7 cm smooth oval gently lobulated mass is seen. The findings are most consistent with which of the following

Giant fibroadenomas

A premature infant born at 28 weeks gestational age is scanned to rule out intracranial hemorrhage. The sonogram demonstrates echogenic material within normal sized ventricles. This finding would be consistent with which pathology

Grade II hemorrhage

A35 year old man presents with symptoms consistent with hyperthyroidism. He is referred for a neck sonogram. The thyroid appears diffusely hypoechoic with a lobulated contour. No discrete nodules are seen. Color Doppler shows dramatic increase in flow throughout the gland. What is the most likely cause for these findings

Graves' disease

The sonogrpahic measurement of what fetal biometric parameter is least influenced by shape

HC

A 31 year old woman is referred for a sonogram after bilateral neck fullness is noted during a routine physical examination. The sonographic appearance of the thyroid gland is diffuse hypoechoic enlargement of both lobes and the isthmus and coarse parenchyma . The sonographic features of the mass along with the patients gender are suspicious for

Hashimoto thyroiditis

A patient presents with pain and spotting at 7 weeks gestation. Ultrasound confirms a viable IUP consistent with patients LMP. An adnexal ring sign is imaged in the left adnexal region adjacent to the left ovary. The sonographic finding describes which of the following diagnosis most accurately

Heterotopic pregnancy

The risk factors for DDH include which of the following

High birth weight spina bifida cold season

How can theICA Doppler flow be best described

High flow and low resistance signal

A gravitational 1 para 0 patient comes in at 32 weeks of pregnancy for a sonogram because of decreased fetal movement. Fetal biometery reveals an estimated fetal weight in the 5th percentile. A past sonogram performed at 20 weeks of gestation was normal. At her last monthly visit the patients look pressure was normal and the funds height measurement was appropriate. At this visit her ankles are swollen and her blood pressure is 150/90mmHg. What is the most likely diagnosis?

IUGR secondary to preeclampsia

An 18 year old pregnant woman presents to the er with bilateral lower extremity pain for the last 2 days. Sonographic findings include fully compressible veins with adequate color Doppler signals. Proximal compressions halts blood flow, whereas the distal compression demonstrates adequate augmentation. Pulsed wave Doppler reveals monophasic waveforms down the entire lower extremity bilaterally. What is the most likely diagnosis

IVC obstruction

The goal of PSA testing is to

Identify early stage prostate cancer

The bony acetabulum consists of which of the following

Ilium Ischium Pubis

Sonographically prostate cancers are often visualized as focal hypoechoic nodules most often found in

In the peripheral zone

Benign enlargement of the prostate gland occurs almost exclusively

In the transition zone

A 29 year old woman has an alpha fetoprotein value of 4.2 MoM at 18.5 weeks gestation. Sonogrpahic evaluation reveals a24.5 week viable gestation with normal anatomy. What is the most likely diagnosis

Inaccurate dating

Which of the following is not considered a mass of breast tissue

Inclusion cyst

A 10 year old girl presents with a very tender high midline neck mass. Her parents report feeling a small lump in this location since sh was a baby, but it has enlarged and is now painful. The sonogram reveals an oval 1.0cmx1.5 cm cystic mass with a thin wall and some internal debris. It is located 3cm superior to the thyroid isthmus.

Infected thyroglossal duct cyst

The most common site for VSD is

Infracristal

Which of the following is a reason for the increased incidence of multiple gestation

Later life pregnancy

A 38 year old pregnant woman presents to the sonography department with a rapidly enlarging retroareolar palpable mass. Sonographically a microlobulated mass with internal blood flow is identified. The finding are most consistent with which of the following

Invasive ductal carcinoma

A65 year old man presents to the sonography department with a palpable right upper outer quadrant breast mass. Sonographically a solid mass with posterior shadowing is seen at 10 o'clock 3 CMFN. These finding are most consistent with which of the following

Invasive ductal carcinoma

A 53 year old woman is sent for a breast sonogram because of an abnormality seen only on one view of her recent mammogram. The sonogram reveals an area of distortion with thickened coopers ligaments and lymphadenopathy but does not show a discrete mass. The findings are most consistent with which of the following

Invasive lobular carcinoma

When performing a duplex carotid examination a vessel is encountered demonstrating a continuous low velocity signal with irregular and varying shape. This most likely represents what vessel

Jugular vein

Which of the following is an acceptable termination point of the conus medullaris in a normal patient

L1

A 34 year old woman who is 4 hours postpartum complains of sudden onset of left lower extremity pain . Clinical history reveals she has experienced left lower extremity pain for the past 7 years. Left LEVD reveals fully compressible veins and no intraluminal echogenic matter with an adequate color Doppler signal. On pulsed wave Doppler proximal compressions haunt blood flow and distal compression demonstrates a good augment. However Doppler reveals a dampened waveform down the entire left lower extremity. What is most likely diagnosis

May Thurner syndrome

Anatomically the prostate can be divided into four zones. These include each of the following except

Medial zone

A young man is referred to the ultrasound department for evaluation of a lateral neck mass that is nontender. The sonogram reveals a solitary thyroid nodule and multiple rounded masses that follow the carotid jugular areas. Both the intrathyroidal and extrathyroidal masses contain microcalcifications

Metastatic thyroid cancer

A 63 year old man in apparent good health is seeking a second opinion for a thyroid nodule that was diagnosed elsewhere. He was told that nodule contained psammoma bodies. This finding refers to

Microcalcifications in a nodule

Which of the following describes the decreased length of the entire extremity

Micromelia

An 18 year old woman is seen by her gyn with a 1 week history of spotting. She report that she had a positive pregnancy test after her missed period 7 weeks ago. Sonographic. Evaluation reveals an intrauterine sac with embryo, without a heartbeat measuring 6 weeks gestation. This is consistent with which of the following

Missed abortion

A fetal echo demonstrates a small left ventricular cavity. Which of the following abnormalities is associated with this finding

Mitral atresia

A 25 year old woman has a sonogram at an outpatient imaging center that reveals lateral ventricles measuring 14.2mm and is referred to a maternal fetal center. The patient declined alpha fetoprotein testing. Sonographic evaluation may reveal which of the following

Open neural tube defect

All of the following are indications for neonatal spine sonography except

Osteosarcoma

A cystic lesion is identified in the fetal abdomen adjacent to the bladder. No other anomalies are identified. A normal stomach and gallbladder are seen, the gender is female this is most suggestive of which of the following

Ovarian cyst

A 23 year old women with a morbid increase in body habits complains of left lower extremity pain with swelling and edema. During examination she becomes short of breath with hemoptysis. Sonographic findings inc,use dilated femoral vein with wall that do not coapt on extrinsic transducer pressure. The lumen of the vessel demonstrates echogenic matter that is difficult to visualize. Doppler signals are absent. What is the most likely diagnosis

PCD

A detailed sonogram shows large keyhole bladder in the fetus and oligohydraminos. The fetal kidneys are not well visualized, but large tubular structures are seen arising from the bladder. What is the most likely diagnosis?

PUV

A premature infant born at 26 weeks gestational age undergoes scanning at 4 weeks of age for routine follow up to prematurity. The sonogram reveals symmetric regions of increased echogenicity in the watershed area.

PVL

A 52 year old man is diagnosed with epididymorchitis after a sonographic evaluation. His clinical signs and symptoms most likely include

Painful enlargement of the scrotum

A postmenopausal patient with hypercalcemia and hypophosphatasia is referred for sonography of the neck. An oval shaped hypoechoic mass is seen posterior to the mid lower right lobe of the thyroid. The clinical findings of hypercalcemia and hypophophatasia along with the shape and location of this mass are most suggestive for

Parathyroid adenoma

A 41 year old women is seen by her ob with vaginal bleeding and hypermesis. Clinical examination reveals a uterus consistent with a 12 week gestation which is inconsistent with her predicted 10 weeks gestation by LMP. An ultrasound is performed and reveals a fetus without heart motion and CRL consistent with an 8 week gestation. An enlarged placenta is identified containing numerous small cystic lesions. This is most suggestive of

Partial hydatidiform mole

Severe IUGR is noted on a 30 week fetus. The patient denies having diabetes or lupus and the fetus appears otherwise normal. What other factor could play a role in the growth of this fetus

Patient has hypertension

An 81 year old man comes to the er with a blue right toe. His history is positive for long term tobacco use. On clinicical examination the patient has a right ABI of 0.4 and a left ABI of 0.70. On lower extremity Doppler imaging the common femoral artery through the popliteal arteries are patent, however severe irregular plaque is noted. The perineal artery is occluded at its origin but the posterior tibial and anterior finial arteries are patent, modest plaque buildup is noted. What is the most likely diagnosis

Peripheral artery disease and arterial thromboemboli causing acute ischemia

A sonographic evaluation at 10 weeks gestation reveals a small anterior abdominal wall defect. What is the most likely diagnosis at this gestational age

Physiologic gut herniation

A 39 year old woman bra ICA 4 para 3 is seen for on ob at 33 weeks gestation got late prenatal care. The sonographer identifies placenta Previa and observes a cesarean section scar which is confirmed by the patient. The sonographer should also look for signs suggesting which additional abnormality

Placenta accreta

A 28 year old pregnant woman presents to the emergency department at 30 weeks gestation with knifelike abdominal pain following a motor vehicle accident. Her abdomen is tense and hard on palpation. Ultrasound reveals a large hypoechoic collection of fluid in the retroplacental region. This is consistent with which of the following

Placental abruption

Which of the following statement describe why monochorionic multiple gestation have the highest fetal mortality

Placental intertwin vascular anastomoses play a key role in complication associated with monochorionic gestational

A 31 year old women with a quadruple screen analyte pattern of decreased maternal serum AFP and uE3and elevated hCG and DIA is referred for a genetic sonogram at 19 weeks. You would expect to see all of the following markers except for which one

Polydactyl

A 21 year women is seen for an ob exam with a indication of large for gestational age at 28 weeks by first trimester sonography the sonogram shows a fetus measuring 28 weeks the AFI 25cm. What is the most likely diagnosis

Polyhydraminos

A man presents to his physician with a large no painful mass in the posterior knee fossa. Doppler and grayscale imaging reveals a patent popliteal artery with normal biphasic signal. Outer to outer wall diameters in the proximal mid and distal areas are 0.8cm 0.9cm 0.7cm there is a 3.0cmX 4.2cm X3.0cm anechoic mass located on medial to the popliteal artery. No color or spectral Doppler is demonstrated in the mass. What is the most likely diagnosis ?

Popliteal cyst

A coronal image of the neonatal head demonstrates the lateral ventricles at the level of the third ventricle and foramen of monro. The transducer should be angled in which direction to visualize the glomus of the choroid plexus

Posterior

Which of the following is common maternal complication in pregnancies with multiple gestation

Preeclampsia

Cervical length of less than 2.5 cm and evidence of funneling are associated with which of the following

Preterm delivery

Which of the following represents the most common complication in a pregnancy with multiple gestation

Preterm labor

The PSA density result in an symptomatic 65 year old African American man 0.2 and DRE reveals a nodule.

Prostate. Cancer

The absence of thick echogenic rim surrounding the early gestational sac within the endometrial cavity is suspicious for

Pseudo gestational sac of ectopic pregnancy

A 58 year old patient is noted to have swelling and discoloration in the groin after balloon angioplasty of the common iliac artery. Grey scale imaging demonstrates a cystic mass located adjacent to the CFA. Color and spectral Doppler show turbulent flow within the mass and a to and fro waveform in the neck connecting the mass to the artery . What is the diagnosis

Pseudoaneursym

A 61 year old man presents to the emergency department for severe leg pain and generalized erythema or redness. Silvery scaly skin that is severely flaking is noted bilaterally from the lower abdomen to the toes. Patient history revealed that he is currently undergoing chemotherapy treatments. LEVD appeared negative for any echogenic matter. What is the most likely diagnosis

Psoriasis

A patient is seen with heavy bleeding 7 days after delivery of a 36 week infant. Ultrasound reveals an enlarged postpartum uterus containing an echogenic mass. This suggest

Retained products of conception

A32 year old woman is seen for an elevation of the alpha fetoprotein level at 2.8 MoM. The sonographic evaluation reveals a fetal age consistent with LMP without any anomalies. The placenta has a subchorionic hypoechoic area. What is the most likely explanation for the elevated alpha fetoprotein

Retroplacental clot

A neurologic deficit that last longer than 24 hours but completely resolves is a

Reversible ischemic neurologic deficit

A patient presents with left arm paralysis which artery is most likely the cause

Right ICA

A 36 year old woman is seen for a routine obstretic examination at28 weeks gestation and the fetus is noted to have an arrhythmia. An echocardiogram is ordered to assess fetal cardiac rhythm adequately an M mode tracing should be performed simultaneously through which cardiac structures

Right atrium , left ventricle

A 50 year old woman with augmented breasts presents to the sonography department complaining of newly occurring asymmetry of breast size, right smaller than left. Sonographically the right breast has long echogenic lines within the internal portion of the implant. Shadowing resembling bowel gas is also seen along the external periphery of the implant. The finding are most consistent with which of the following

Right breast step ladder and snow storm signs

A 6 week old infant with a history of a click on clinical examination is seen for a hip sonogram. The alpha angle measure 60 degrees on the right and 55 on the left. This is consistent with which of the following

Right hip type II left hip type III

A 22 year old pregnant woman is seen in the sonography department with heavy bleeding and cramping. She had a sonogram 1 week prior because of episode of spotting which revealed a 6 week embryo. The current sonogram reveals a uterus without evidence of an embryo or gestational sac. This is most consistent with

SAB

The nuchal translucency thickness used for genetic screening in the first trimester of pregnancy must be obtained in

Sagittal plane

While performing a fetal echocardiogram the sonographer cannot identify the foramen ovale flap and notes the foramen ovale opening is larger than normal. The ventricular septum is intact. What abnormality is most likely presented

Secundum ASD

A 30 year old man undergoes sonographic examination for a painless mass in the right hemiscrotum. The sonogram reveals multiple punctuate hyperechoic nonshadowing Foci and a hypoechoic mass within the right testis. What is most likely diagnosis

Seminole makes with microlithiasis

A patient is seen for evaluation at 16 weeks gestation for an alpha fetoprotein of 4.2 MoM which of the following sonographic finding would suggest a recalculation of the alpha fetoprotein

Sonographic dating of 19 weeks

A 43 year old man is seen with mobile painless mass at the upper pole of his right testis. Sonographic examination reveals a 1.5 cm round anechoic lesion that demonstrates acoustic enhancement. No other abnormalities are apparent. This probably represents

Spermatocele

Which of the following is not associated with Arnold chiari malformation

Spina bifida occulta

A routine 6 month follow up exam of femoropopliteal bypass vein graft reveals a new modestly echogenic regions protruding into the linen near prox anastomosis color Doppler shows aliasing and flow disturbance whereas spectral tracing demonstrate very high velocities and marked spectral broadening. What is the most likely diagnosis

Stenosis is secondary to Intimal hyperplasia

Which of the following defines a grade III hemorrhage

Subpendymal hemorrhage with extension. Into the ventricle with ventriculomegaly

Transverse imaging of the prostate gland in a 70 year old man with history of urinary obstruction demonstrates an anechoic defectinto the base of the prostate. This finding most likely represents which of the following

Surgical defect from TURP

On the modified long axis view the sonographer was unable to view the normal crisscross pattern when evaluating the outflow tracts. The great vessels appear to arise from the ventricle in parallel. This finding is associated with which cardiac abnormality

TGA

A 15 year old boy is seen in the emergency department after falling and straddling a bicycle cross bar. He has pain and swelling of the scrotum. The sonogram demonstrates heterogeneity of the right testicle and hypervascularity on color Doppler. An area of echogenic material is seen just outside the upper margin of the right testicle. What is the most likely diagnosis

Testicular rupture

A 25 year old man has a sudden onset of scrotal pain during a soccer game. During examination in the er the right hemiscrotum is still painful. A sonogram reveals slight enlargement of the right testified and on color Doppler examination no blood flow can be detected.

Testicular torision

A pathologic fixation of the spinal cord in an abnormal caudal location is the definition of

Tethered cord

A 25 year old women is referred for sonogrpahic dating with unknown lmp no prior studies and a fundal height measuring approximately 35 weeks the average of four fetal parameters measured calculate to 32 weeks. AFI measures 17 cm what is the most likely diagnosis

The fetus is most likely normal with mild polyhydraminos

A routine obstetric sonogram was performed in a patient with reported LMP of 20 weeks the estimated age by femur was 19 weeks and the ac was calculated to 22 weeks liver and spleen were normal the HC indicated a gestational age of 20 weeks. What is the most likely explanation of this age assessment?

The fetus is normal with slightly short femurs and fat abdomen

A women is referred to the sonography lab for gestational dating. Reported lmp was 10 weeks earlier than the current examination date and lighter than normal. The average age of multiple fetal parameters was 13 weeks and all parameters ages were within 1 week of that age. What is the most likely explanation of fetal age discrepancy?

The reported lmp was most likely implantation breakthrough bleeding and the true lmp was 13 weeks earlier

A 54 year old man presents to the er with a large weepy ulcer on his right lower extremity. The clinician ogives stasis dermatitis with pitting edema in the right gaiter zone. The patient denies any chest pain or shortness of breath. Sonographic finding include fully compressible veins demonstrating adequate color Doppler flow, proximal compression cannot halt blood flow, but distal compression yields augmentation. What is the most likely diagnosis

Venous insufficiency

Which of time following statements regarding fetal cardiac rhythm is false

Ventricular contraction. Precedes electrical activation

The cystic space within the embryonic head visualized at approximately 8 weeks gestational age is the developing:

rhombencephalon