Pathology 42% Scrotum, Thyroid, Vasc.

D. Yolk Sac Tumor is the most common testicular tumor in patients <yrs of age. They produce alpha fetoprotein (AFP). Sonographically they usually have areas of hemorrhage and necrosis in the mass causing a complex appearance.

A 1 yr old presents for a testicular sonogram due to a palpable lump. The lab work in the chart indicates high levels of alpha fetoprotein. A mostly solid intratesticular mass is identified in the right testicle. There is a small area of possible necrosis centrally. These findings are most consistent with: A. Lymphoma B. Epidermoid Cyst C. Seminoma D. Yolk Sac Tumor

D. The acute onset of pain indicates potential torsion. The other choices list tumors that grow over time which would not cause an acute onset of pain. Seminoma and sarcoidosis are intratesticular or intra-epididymal tumors.

A 16 yr old male presents with acute onset of significant left scrotal pain. The US exam reveals a 1 cm hypoechoic, heterogeneous mass located between the head of the epididymis and the testicle. The mass demonstrates no vascularity with color Doppler evaluation. Normal flow is demonstrated in the epididymis and testicle. These findings are most suggestive of: A. Sarcoidosis B. Adenomatoid tumor C. Seminoma D. Torsion of the appendix testis

C. Primary testicular carcinoma is usually unilateral and secondary testicular malignancy is usually bilateral.

Primary testicular carcinoma is usually ____________ and secondary testicular malignancy is usually __________. A. Heterogeneous, isoechoic B. Hypoechoic, isoechoic C. Unilateral, bilateral D. Hypervascular, hypovascular

B. Embryonal Cell Carcinoma is most common in men age 25-35yrs. It is the most aggressive testicular malignancy with invasion of tunica albuginea in most patients. Alpha fetoprotein and beta hG are elevated in most cases These tumors are more heterogeneous than seminoma and can have solid and cystic portions, along with coarse calcifications. Distortion of the organ contour will be seen with tumor invasion

A 28 yr old presents for a testicular sonogram due to a palpable lump. The lab work in the chart indicates high levels of alpha fetoprotein and b-hCG. A mostly solid intratesticular mass is identified in the right testicle that disrupts the smooth contour of the teste. There is a small cystic area centrally. These findings are most suggestive of: A. Yolk sac tumor B. Embryonal cell carcinoma C. Seminoma D. Lymphoma

A. The clinical findings indicate infection. Diastolic flow reversal in cases of epididyo-orchitis can indicate venous infarction. Similar Doppler findings can be seen with partial torsion, but the clinica information indicates infection.

A 30 year old male presents with fever, malaise, and mild to moderate right scrotal pain that began 3 days ago. Lab results indicate leukocytes is is present. The right testicle demonstrates mild diffuse heterogeneity. PW Doppler evaluation of the affected side produces a waveform with peak ante grade systolic flow and diastolic flow reversal. These findings are most suggestive of: A. Acute or hit is with venous infarction B. Partial torsion C. Uncomplicated acute orchitis D. Testicular rupture

A. Most primary testicular cancers are unilateral in formation. Testicular lymphoma, leukemia and metastasis usually occur bilaterally.

A 65 yr old male patient presents with bilateral scrotal swelling and mild pain. The US exam demonstrates bilateral hypoechoic, solid masses within the testicular parenchyma. Which of the following is the most likely diagnosis for the findings? A. Lymphoma B. Choriocarcinoma C. Bilateral orchitis D. Bilateral Seminoma

D. Presence and pattern of calcification of a thyroid adenoma: Peripheral or Eggshell - benign Thickened or Interrupted Peripheral - malignant Large and Coarse - benign Fine and Punctate - malignant

A benign thyroid Adenomyosis is associated with ________ calcification(s), while malignant adenomas are associated with ___________ calcification(s). A. Large, Coarse B. Punctuate, Fine C. Punctuate, Coarse D. Eggshell, Punctate

B. Papillary carcinoma is the most common type of thyroid cancer. Sonographic characteristics of papillary cancer of the thyroid include heterogeneous, hypochoic solid mass with microcalcifications. The mass is hypervascular in most cases. It is commonly associated with enlarged cervical lymph nodes due to metastasis. Cystic degeneration of the mass is very rare.

A heterogeneous, hypervascular mass with microcalcifications is identified in the left upper pole of the thyroid gland. Left side lymphadenopathy is also present. These findings are most suggestive of: A. Parathyroid adenoma B. Papillary carcinoma C. Colloid cyst D. Anaplastic carcinoma

D. Sonographic characteristics of papillary cancer of the thyroid include heterogeneous, hypochoic solid mass with microcalcifications. The mass is hypervascular in most cases. It is commonly associated with enlarged cervical lymph nodes due to metastasis. Cystic degeneration of the mass is very rare.

A hypoechoic thyroid mass with micro calcifications, hypervascularity and no halo sign is most consistent with: A. Goiter B. Neuroma C. Hyper functioning adenoma D. Papillary carcinoma

C. Mixed germ cell tumors contain components of two or more types of germ cell growth.

A lab report demonstrates that a testicular tumor contains Choriocarcinoma cells and Embryonal cell carcinoma. Which of the following best describes the tumor? A. Seminomatous tumor B. Metastatic tumor C. Mixed germ cell tumor D. Mature teratoma

D. Epidermoid cysts have fibrous walls that may calcify. They are described as having an onion-like appearance due to alternating rings of hyperechoic and hypochoic tissues. These cysts contain thick keratin and are avascular.

A mass is identified in the left testicle. It is rounded with well-defined borders. There are internal rings of hyperechoic and hypoechoic tissues giving the appearance of an onion. No color flow is demonstrated within the mass. These findings are most consistent with: A. Sperm granuloma B. Dilated rete testes C. Testicular infarct D. Epidermoid cyst

C. A scrotal pearl refers to an extra testicular calcification.

A patient presents with a small, palpable extratesticular mass on the left side. The US exam demonstrates a mobile, hyperechoic mass with posterior shadowing. Which of the following best describes the findings? A. Adenomatoid tumor B. Microlithiasis C. Scrotal pearl D. Abscess

B. Tumor recurrence is most common in level Ill and IV lymph nodes. The internal jugular chain is located between the carotid artery and sternocleidomastoid muscle. When differentiating level VI nodes from level III/IV nodes, turn the neck to a neutral position and document lymph node position relative to the carotid artery.

A patient presents for a neck ultrasound that has a history of papillary carcinoma and bilateral thyroidectomy. What area of the neck is most commonly involved in recurrence? A. Level VI lymph nodes from the inferior margin of hyoid bone to the manubrium B. Level III and IV lymph nodes between the carotid artery and the sternocleidomastoid muscle C. Level VII lymph nodes infraclavicular and anterior mediastinal D. Level I lymph nodes below mylohyoid muscle to the lower margin of the hyoid bone

A. The prominent veins within the testicle indicate an intratesticular varicocele. There are also a few dilated veins posterior to the testicle. The varicocele could have been related to the hernia or inadvertently caused by the recent repair. Orchitis is usually a diffuse process that involves hypervascularity of the whole testicle. filariasis is a condition that can demonstrate parasitic worm in the scrotum. They are normally hyperechoic, non-vascular structures. Dilated rete testis demonstrates anechoic tubular structures in the mediastinum of the testicle that do not fill with color on Doppler evaluation.

A patient presents for a scrotal ultrasound following a recent herniorrhaphy. The findings on the image are most consistent with: A. Intratesticular varicocele B. Orchitis C. Filariasis D. Dilated rete testis

B. Graves' disease is the most common cause of hyperthyroidism. Symptoms include increased T3 and T4 levels in the blood, weight loss, night sweats and exophthalmos. Sonographically, the gland will enlarge with a heterogeneous echotexture and increased vascularity.

A patient presents for a thyroid US due to increased T3 and T4 levels in the blood. Additional symptoms include weight loss, night sweats and exophthalmos. The thyroid demonstrates an increase in size and a diffuse decrease in echogenicity with a coarse, heterogeneous texture. Which of the following best describes these findings? A. Hashimoto disease B. Graves' disease C. Goiter D. Hurthle cell cancer

A. Post-traumatic neuroma is contraindicated for biopsy: It is seen in the post-operative neck patients. It may be identified as a hypochoic mass lateral to the spine that is in contiguity with its associated nerve. Sonopalpation - Deep palpation of the mass with the transducer may produce focal pain, which may radiate along the nerve pathway. The post-traumatic neuroma should not be sampled by core biopsy as it could cause significant pain. An abnormal lymph node will usually be larger than 1cm and would not be uniformly hypochoic.

A patient presents for their annual screening ultrasound after a complete thyroidectomy due to papillary carcinoma. You identify a 1 cm uniformly hypoechoic mass lateral to the trachea. The mass is painful with transducer pressure and pain radiates to the head and chest. These finding are most suggestive of: A. Post-traumatic neuroma B. Parathyroid adenoma C. Abnormal lymph node D. Parathyroid carcinoma

A. DeQuervain disease is a type of hypothyroidism that is painful in the first 4-6 weeks and usually presents with low TSH and high T3 and T4 levels. Hashimoto thyroiditis is a type of hypothyroidism that is PAINLESS and usually presents with low TSH and high T3 and T4 levels.

A patient presents with a fever, fatigue, hoarseness, and a painful thyroid on clinical examination. The lab test results indicate low levels of thyroid stimulating hormone and high levels of T3 and T4. These findings are most suggestive of: A. De Quervain thyroiditis B. Hashimoto thyroiditis C. Sjrogen disease D. Grave disease

B. The hypochoic mass represents abscess formation due to the infection in the testicle. Hypervascularity is common at the periphery of an abscess.

A patient presents with a fever, scrotal swelling and leukocytosis. Which of the following statements is correct regarding the image? A. The focal hypochoic area represents focal orchitis within the testicle. B. Power Doppler demonstrates an avascular intratesticular mass with increased peripheral vascularity. C. Power Doppler demonstrates normal vascularity of the scrotum testicle with neoplasm formation within the testicle. D. Power Doppler demonstrates no flow within the hypochoic testicle with scrotal inflammation.

C. Leydig cell tumors can cause an endocrine imbalance which can lead to the development of gynecomastia. Any testicular tumor that is associated with elevated beta hG can lead to gynecomastia.

A patient presents with a history of a 5 mm Leydig Cell tumor identified on an exam 6 months ago. What is a common complication of this type of neoplasm? A. Metastasis B. Varicocele C. Gynecomastia D. Cellulitis

B. A varicocele would be located laterally adjacent to the edge of the scrotal sac. Note the lack of an anterior wall of the loculated fluid. The testicular capsule can be seen compressed beneath the fluid which also indicates the formation is extra-testicular. The testicle would present as enlarged with a heterogeneous appearance and no evidence of internal blood flow, if torsion of the cord had occurred. The fluid surrounding the testicle is complicated with debris and septations consistent with pyocele formation due to infection. Note the thickened scrotal wall anteriorly which would help to differentiate the mass from a hematoma.

A patient presents with a new onset of scrotal pain and a low grade fever. Which statement below offers the most accurate summary of findings? A. The spermatic cord is tossed and the scrotal sac is becoming edema to us and inflamed. B. There is a complicated fluid collection compressing the testicle C. The patient has tubular ectasia of the rete testis. D. There is a varicocele present.

C. Note the rings of alternating hyperechoic and hypochoic tissue giving the mass an "onion" appearance. Also note that the mass is avascular. The normal lab values confirm the diagnosis of an epidermoid cyst.

A patient presents with a palpable lump in the right testicle. Lab values are normal and there is no fever. What is the most likely diagnosis for the abnormality on the image? A. Yolk sac tumor B. Dilated rete testis C. Epidermoid cyst D. Seminoma

D. Note the lab results and the internal vascularity of the mass. AFP levels are always normal in cases of seminoma, but bhCG can be elevated. Most seminomatous tumors over 1.6cm demonstrate hypervascularity. Embryonal cell carcinoma usually is associated with increased levels of b-hCG and AFP. A yolk sac tumor is usually associated with increased levels of AFP. An epidermoid cyst would not demonstrate internal vascularity.

A patient presents with a palpable scrotal mass. There is no evidence of fever. AFP levels are normal and beta hCG levels are elevated. These findings are most suggestive of? A. Embryonal cell tumor B. Yolk sac tumor C. Epidermoid cyst D. Seminoma

A. The testicle and epididymis have abnormal echotexture and absence of normal internal flow. These findings are consistent with complete testicular torsion.

A patient presents with acute scrotal pain after a 2 mile run. Which of the following statements best describes the findings on the image? A. The testicle and epididymis have abnormal echotexture and absence of normal internal flow. These findings are consistent with complete testicular torsion. B. The testicle is abnormal with an occluded varicocele and loss of arterial inflow due to testicular congestion. Both testicles are abnormal with no internal flow detected. The C. Both testicles are abnormal with no internal flow detected. The left testicle is severely atrophied. These findings are consistent with bilateral chronic torsion. D. There is a hypochoic avascular mass within the body of the epididymis. The head of the epididymis and testicle appear normal. These findings are consistent with epididymal torsion.

D. The blood flow in the epididymis should be consistent throughout the gland. A difference in flow between two segments can indicate partial or complete torsion in the segment with little to no flow.

A patient presents with an acute onset of left scrotal pain this morning. The US exam demonstrates small hydrocele and an enlarged body and tail of the epididymis. There is very minimal flow demonstrated in the body and tail but the head appears normal. These findings are most suggestive of: A. Focal epididymitis of the body and tail B. Sperm granuloma C. Focal epididymitis of the head D. Torsion of the epididymal body

C. Seminomas normally present as hypochoic, heterogeneous solid tumors. Cystic areas and coarse calcifications are common in embryonal cell tumors and testicular teratomas.

A patient presents with an enlarged left scrotum and palpable mass. The US demonstrates an intratesticular mass that is hypoechoic and heterogeneous with multiple coarse calcifications. There is also an irregular central cystic area. These findings are most suggestive of: A. Teratoma only B. Seminoma only C. Embryonal cell tumor or teratoma D. Seminoma, Embryonal cell tumor or teratoma

D. The images demonstrate a critical finding of an aortic dissection. Note the aorta is separated into two channels by a flap of tissue. Aortic dissection is a common complication of Marfan syndrome.

A patient presents with epigastric pain. The findings on the image are most suggestive of: A. Pseudocyst B. Duplicated Aorta C. Fusiform aortic aneurysm D. Aortic Dissection

D. Tubular ectasia of rete testis refers to dilated testicular mediastinal tubules. This is a benign condition thought to result from partial or complete obliteration of the efferent ducts.

A patient presents with mild testicular pain that has increased over the last few months. The US exam demonstrates a normal right testicle. The left testicle demonstrates many tiny cysts clustered centrally along the mediastinum. No color flow is identified within the cystic structures. Which of the following best describes the findings? A. Spermatocele B. Varicocele C. Cystadenoma D. Tubular ectasia

B. Testicular cancer can be cured when a pure seminomatous tumor is removed and the patient has adjunctive chemotherapy. Non-seminomatous tumors are removed but additional treatments are not performed due to their lack of response to the adiunctive therapies.

A patient with a semi Norma of the left testicle will usually be treated by ___________, while a patient with a non-seminomatous tumor of the left testicle will usually be treated by ____________. A. Bilateral or history, unilateral orchiectomy B. Unilateral orchiectomy and chemotherapy, unilateral orchiectomy C. Unilateral orchiectomy, radiation therapy and unilateral orchiectomy D. Chemotherapy, radiation therapy

C. Testicular infection can lead to increased blood flow to the testicle which causes hyper vascular its identified on color Doppler

A referring doctor requests a scrotal US to rue out orchitis. Which of the following is an expected sonographic finding for this abnormality? A. Hematocele B. Hyperechoic testicle C. Increased intratesticular vascularity D. Multiple small cysts within the testicle

C. The right gland is posterior to the IVC. Tumor formation can displace the IVC more anteriorly.

A right adrenal mass will displace the IVC: A. Inferiorly B. Posteriorly C. Anteriorly D. Superiorly

D. A right renal mass will cause medial displacement of the IVC.

A right renal mass will displace the IVC: A. Laterally B. Superiorly C. Inferiorly D. Medially

B. A scrotal pearl refers to a large extra-testicular calcification.

A scrotal pearl refers to: A. Microlithiasis formation only in the central portion of the teste adjacent to the rete testes. B. A large extra-testicular calcification C. Testicular prosthesis D. A large intra-testicular calcification

A. A significant increase in blood supply/drainage to thyroid will be seen with thyroiditis. This can be demonstrated with Color Doppler and is called the inferno sign.

A significant increase in blood supply/drainage to thyroid will be seen with thyroiditis. This can be demonstrated with ________ Doppler and is called the ___________ sign. A. Color, inferno B. Color, flame C. Color, string of pearls sign D. PW, color flash

C. A small, hypochoic testicular mass with a large calcification in a patient with gynecomastia is most likely a Sertoli cell tumor. Gonadal stromal tumors (Leydig cell, Sertoli cell) should be suspected in a patient with a painless testicular mass and endocrinopathy. Gynecomastia and impotence are signs of abnormal estrogen and testosterone levels in adults. Precocious puberty is a sign of abnormal estrogen and testosterone levels in children.

A small, hypoechoic testicular mass with a large calcification in a patient with Gynecomastia is most likely a: A. Lymphoma B. Embryonal Cell carcinoma C. Sertoli cell tumor D. Seminoma

A. Thyroid malignancies tend to grow across normal tissue planes, while benign neoplasms tend to grow parallel to tissue planes. Tumors that demonstrate a larger AP measurement than transverse measurement are usually malignant (taller than wide). AP / Transverse Ratio > 1 is associated with malignancy. Papillary carcinoma represents 75-90% of thyroid malignancies and anaplastic carcinoma represents <5% of thyroid malignancies, therefore the mass is most likely papillary carcinoma.

A solid nodule in the left lobe of the thyroid that measures 2 cm AP and 1 cm width is most suggestive of: A. Papillary carcinoma B. Adenoma C. Anaplastic carcinoma D. Colloid cyst

B. A thyroglossal duct cyst is identified on the midline neck, anywhere between the base of the tongue and the thyroid isthmus. A branchial cleft cyst is located near the angle of the mandible.

A thyroglossal duct cyst is most commonly found: A. Near the angle of the mandible B. On the midline neck, superior to the thyroid gland C. Posterior to the ear at the level of the thyroid gland D. Within the isthmus of the thyroid gland

A. The pampiniform plexus refers to the venous drainage system of the testicle and scrotum. Normally they are <2mm in diameter. A varicocele is diagnosed when the veins dilate >2mm.

A vein in the pampiniform plexus is considered abnormally dilated when the diameter exceeds: A. 2 mm B. 6 mm C. 4 mm D. 8 mm

D. Debakey Classification: Type I - involves ascending and descending aorta Type II - involves ascending aorta; associated with Marian syndrome; least common Type III - involves the descending aorta; lowest mortality rate

According to the DeBakey Classification system, what type of aortic dissection is most commonly associated with Marfan syndrome? A. Type IV B. Type I C. Type III D. Type II

B. Most malignancies invade the thyroid across tissue planes from posterior to anterior. This produces a taller than wide mass. A benign thyroid mass displaces normal tissues and is usually wider than tall. Absent halo sign, microcalcifications and intranodular flow patterns offer very strong indication of thyroid malignancy. Microcalcifications are also referred to as psammoma bodies (small round calcifications).

All of the following are associated with an increased risk of thyroid malignancy, except: A. A sense of the halo sign B. Wider than tall mass orientation C. Pasammoma bodies D. Intranodular flow patterns

A. Risk factors for thyroid cancer include personal history of radiation treatment of the head and neck, personal history of previous papillary cancer, and diagnosis of multiple endocrine neoplasm (MEN) syndrome. Patients with these risk factors should have an annual screening exam to look for malignancy.

All of the following are risk factors for thyroid cancer, except: A. Family history of hypercalcemia B. Personal history of previous papillary cancer C. Personal history of radiation treatment of a cerebral malignancy D. Diagnosis of multiple endocrine neoplasm (MEN) syndrome

B. The image demonstrates a pyocele formation due to chronic infection. Note the septations and debris within the fluid surrounding the testicle. Pain, Fever, increased WBC, and Swelling are all symptoms of infection.

All of the following symptoms would be associated with the findings on the image, except? A. Leukocytosis B. Palpable area that increases in size with the Valsalva maneuver C. Fever D. Swelling

A. CHF indicates poor cardiac function. Blood flow returns to the heart from the lower extremities via the IVC. If the heart is not ejecting enough blood during systole, the venous return will back log in the IC. The IVC should normally collapse with respiration and demonstrate a triphasic, pulsatile waveform on Doppler evaluation.

An abdominal US is ordered for a patient with bilateral pedal edema. The abdomen demonstrates mild ascites but otherwise normal organs. The IVC appears prominent with a constant diameter of 2.8 cm. These findings are most suggestive of: A. Congestive heart failure B. Malignant HTN C. Portal HTN D. All of the above

B. Aneurysms of the iliac and popliteal arteries are commonly associated with aortic aneurysm. Atherosclerosis is the most common cause of aneurysm formation and it is a diffuse process that can affect all arteries.

Aneurysms of the iliac and popliteal arteries are commonly associated with: A. Pancreatic pseudocysts B. Aortic aneurysm C. Renal failure D. Prostate carcinoma

A. Bacterial orchitis is most commonly caused by sexually transmitted disease. Viral orchitis is most commonly caused by mumps

Bacterial orchitis is most commonly caused by _______________, while viral orchitis is most commonly caused by _____________. A. Sexually transmitted disease, mumps B. Trauma, HIV C. Trauma, recent vasectomy D. Recent vasectomy, sexually transmitted disease

C. Sonographic findings of a thyroid mass that include the combination of an absent halo sign, microcalcifications and intranodular flow patterns offer very strong indication of thyroid malignancy. Sonographic characteristics of papillary cancer of the thyroid include heterogeneous, hypochoic solid mass with microcalcifications. The mass is hypervascular in most cases. It is commonly associated with enlarged cervical lymph nodes due to metastasis. Cystic degeneration of the mass is very rare.

Cervical lymphadenopathy is a common findings with: A. Hyper functioning thyroid adenoma B. Parathyroidism C. Papillary thyroid carcinoma D. Brachial cleft cyst

D. Significant chronic dilatation of the IVC can lead to dilated azygous and hemiazygos veins. These veins connect the upper abdominal IVC to the SVC in the chest so that the blood can reach the right atrium.

Chronic moderate congestive heart failure can cause this tributary of the IVC to be visualized sonographically due to the formation of a collateral pathway. A. Portal vein B. Coronary vein C. Umbilical vein D. Azygous vein

B. Epididymitis most commonly results from sexually transmitted disease in males 14- 35yrs and lower urinary tract infection in men over 35yrs.

Epididymitis most commonly results from ___________ in males 14-35 yrs and ____________ in men over 35 yrs. A. Poor hygiene, torsion B. Sexually transmitted disease, bladder infection C. Torsion, poor hygiene D. Bladder infection, sexually transmitted disease

C. Hepatomegaly caused by Budd Chiari syndrome, a large tumor or AAA can compress the adjacent IVC. CHF indicates poor cardiac function. There will be a back log if blood trying to enter the heart from the IVC causing it to dilate. A pancreatic pseudocyst is found in the LUQ and is not immediately adjacent to the IVC. The diaphragmatic crura are posterior to the IVC.

Extrinsic compression of the IVC is an expected finding with: A. Congestive heart failure or mass in the diaphragmatic crura B. Pancreatic pseudocyst or portal HTN C. Large AAA or larger hepatoma D. Congestive heart failure or large AAA

A. Gonadal stromal tumors (Leydig cell, Sertoli cell) should be suspected in a patient with a painless testicular mass and endocrinopathy. Gynecomastia and impotence are signs of abnormal estrogen and testosterone levels in adults. Precocious puberty is a sign of abnormal estrogen and testosterone levels in children.

Gonadal Stromal Tumors should be suspected in a patient with a painless testicular mass and: A. Gynecomastia B. Elevated AFP level C. Scrotal varicosities D. Hematuria

B. Graves' disease is the most common cause of hyperthyroidism. Sonographically, the gland will enlarge with a heterogeneous echotexture and increased vascularity.

Graves' disease refers to a type of: A. Hypothyroidism B. Hyperthyroidism C. Carcinoma D. Multinodular Goiter

D. Hashimoto disease is a type of "painless" hypothyroidism that leads to diffuse enlargement of the gland. It is the most common cause of hypothyroidism. DeQuervain disease is a type of hypothyroidism that is painful in the first 4-6 weeks and usually presents with a normal sized gland with poorly defined areas of decreased echogenicity.

Hashimoto disease is the most common type of ____________ and leads to ________________. A. Hyperthyroidism, diffuse enlargement of the gland B. Hypothyroidism, nodule formation C. Hyperthyroidism, goiter formation D. Hypothyroidism, diffuse enlargement of the gland

C. Iliac, common femoral and popliteal arteries can have associated aneurysm formation. Common iliac artery diameter > 1.5 cm indicates aneurysm formation. If AAA is identified, the diameters of the common femoral and popliteal arteries should also be measured. CFA and popliteal artery aneurysms are defined as a >50% increase in diameter compared to adjacent segment.

If an abdominal aortic aneurysm is identified, what two other vessels should be evaluated for associated aneurysm formation? A. Celiac axis and superior mesenteric aneurysm B. Inferior and superior vena cava C. Common femoral and popliteal arteries D. Bilateral renal arteries

C. Thyroid volume is calculated by L x W x H x 0.529. The average volume is 19 mL. Thyroid volume increases normally with age and body weight. lodine deficiency, acute hepatitis and chronic renal failure can also cause increased gland volume. Chronic hepatitis, thyroxine treatment and radioactive iodine treatment can cause decreased gland volume.

Increased thyroid volume is associated with: A. Chronic hepatitis B. Thyroxine treatment C. Chronic Renal Failure D. Radioactive Iodine treatment

B. Aortic Ectasia refers to the lack of tapering of the aorta as it travels distally. The size remains constant from proximal to distal portions. It can be a precursor to aneurysm formation.

Lack of tapering of the aorta as it travels dismally, without focal dilation, indicates: A. Retroperitoneal fibrosis B. Ectasia C. Marfan syndrome D> Fusiform aneurysm

C. Leydig cell tumors of the testicle will demonstrate high serum levels of testosterone which can lead to endocrine imbalance, precocious puberty, impotence, or gynecomastia.

Leydig cell tumors of the testicle will demonstrate high serum levels of _____________ which can lead to __________. A. bhCG, Cancer B. AFP, Cancer C. Testosterone, Precocious puberty D. Hematocrit, Thrombus formation

A. The median arcuate ligament connects the right and left crura of the diaphragm across the anterior proximal abdominal aorta. The celiac axis origin is very close to the diaphragm and in some patients the median arcuate ligament crosses anterior to the celiac origin. Median arcuate Ligament syndrome is caused by the ligament compressing the celiac axis with respiration. The aorta and branches move superiorly upon expiration. If the median arcuate ligament is compressing the celiac axis, symptoms will be emphasized upon expiration.

Median accurate pigments syndrome involves compression of which vessel during respiration? A. Celiac axis B. Main portal vein C. Inferior mesenteric artery D. Superior mesenteric artery

C. MEN syndrome refers to multiple endocrine neoplasia syndrome. This syndrome includes tumors of the endocrine organs, such as the thyroid. Medullary carcinoma has been related to MEN syndrome.

Medullary carcinoma of the thyroid is a common occurrence with: A. Zollinger—Ellison B. Von Hippel Lindau syndrome C. MEN syndrome D. Marfan syndrome

D. There is significantly increased risk of seminoma formation in patients with cryptorchidism, even after orchiopexy.

Patients with ____________ have a significantly increased risk of developing a seminoma. A. Hydrocele B. Varicocele C. Diabetes D. Cryptorchidism

C. Regarding the aorta, fusiform aneurysm formation usually occurs in the distal abdominal aorta while dissecting aneurysms usually occur in the aortic arch

Regarding the aorta, fusiform aneurysm formation usually occurs in the ____________ while dissecting aneurysms usually occur in the ____________. A. Proximal abdominal aorta, thoracic aorta B. Aortic arch, distal abdominal aorta C. Distal abdominal aorta, aortic arch D. Distal abdominal aorta, thoracic aorta

C. If the celiac artery is occluded, the splenic and hepatic arteries will receive no blood because they are distal to the celiac origin. The lack of blood in the splenic/hepatic artery will cause a significantly low pressure within the vessel that will allow collateral back filling to occur. As the blood enters the empty end of the splenic/hepatic artery (from the collaterals), it will flow back toward the origin of the vessel to the point of obstruction in the celiac. Mesenteric ischemia requires stenosis/occlusion of at least 2 splanchnic arteries.

Retrograde flow in the common hepatic artery and splenic artery is highly suggestive of:: A. Mesenteric ischemia B. SMA occlusion C. Celiac artery occlusion D. Portal HTN

B. Serpiginous vessels refers to very tortuous vessels. It is typically used to describe veins that are dilated due to an circulatory system abnormality. Cavernous transformation seen with portal HT and varicocele formation demonstrate multiple dilated, tortuous venous structures.

Serpiginous vessels are identities on the examinations of patients with: A. Renal artery and mesenteric artery stenosis B. Portal HTN or testicular varicoceles C. Situs inversus and organ agenesis D. Renal or liver transplants

A. CHF causes a backlog of venous flow causing the IVC to dilate. Severe right heart failure can lead to stasis in the IVC which leads to the spontaneous contrast phenomenon and thrombus formation.

The IVC is dilated and the spontaneous contrast phenomenon is seen in the proximal segment. Which of the following is the most likely cause? A. Congestive heart failure B. Portal HTN C. Dehydration D. Hemophilia

A. A sperm granuloma is a common complication of a vasectomy

The abnormality on the image is a confirmed sperm granuloma. This is a common chronic complication of what procedure? A. Vasectomy B. Testicular biopsy C. Scrotal aspiration D. Hernia repair

B. The bell clapper deformity refers to the tunica vaginalis completely encircling the epididymis, distal spermatic cord, and testis, rather than attaching to posterolateral aspect of testis. It predisposes the patient to intravaginal testicular torsion.

The bell clapper deformity is a predisposing factor for testicular torsion. It is defined as: A. The epididymis floating freely in the scrotal sac B. The tunica vaginalis completely encircles the epididymis, distal spermatic cord, and testis C. The tunica albuginea completely encircles the epididymis, distal spermatic cord, and testis D. The testicles are connected by thick dermal tissue and cannot move separately

C. The images demonstrate a critical finding of an aortic dissection. Note the aorta is separated into two channels by a flap of tissue. Aortic dissection is a common complication of Marfan syndrome.

The findings on the image are a common complication of: A. Leriche syndrome B. Lupus C. Marfan syndrome D. Irritable Bowel Syndrome

C. The IVC and hepatic veins are significantly dilated. The liver also appears enlarged. This indicates an outflow issue in the liver. Congestive heart failure or severe tricuspid regurgitation in the heart can cause a reduction of flow out of the right heart. This causes blood pooling in the IVC and hepatic veins and hepatic congestion.

The findings on the image are most suggestive of: A. Budd Chiari Disease B. Portal HTN C. Right Heart Failure D. Cirrhosis

D. The CT images demonstrate a fluid filled mass on the anterior neck just below the level of the mandible. Note that the cyst is darker gray than all the surrounding soft tissue structures. This is consistent with fluid because it attenuates less radiation than the soft tissue. The ultrasound image demonstrates a cystic structure with internal debris and posterior enhancement. There is no related hypervascularity that is expected with inflammation. Due to the location of the structure and the imaging characteristics, the findings are most suggestive of a thyroglossal cyst.

The findings on the image are most suggestive of: A. Parathyroid adenoma B. Reactive lymph node from infection C. Normal lymph node D. Thyroglossal cyst

B. 60% of thyroid adenomas demonstrates a thin, echolucent rim known as the halo sign.

The halo sign is a sonographic characteristic of what thyroid abnormality? A. Complex cyst B. Adenoma C. Papillary carcinoma D. Germ Cell tumor

B. Seminoma is the most common primary malignancy of the testicle. The average age of patients with seminoma formation is 40yrs. Mixed germ cell is the second most common primary malignancy in younger men age 20-30yrs.

The image demonstrates the most common malignant testicular neoplasm that occurs in men age 30-50 yrs. This neoplasm is: A. Mixed germ cell tumor B. Seminoma C. Teratoma D. Embryonal cell tumor

A. Embryonal Cell Carcinoma usually affects men age 25-35yrs. It is the most aggressive testicular cancer. Alpha fetoprotein and beta hG elevated in most cases. Sonographic Appearance: More heterogeneous than seminoma; Can have solid and cystic portions along with coarse calcifications; Distortion of the organ contour with tumor invasion

The mass on the image is a confirmed Embryonal cell tumor. Which statement is true regarding this type of neoplasm? A. Most aggressive testicular malignancy B. Normally affects men in their late 50's, early 60's C. Usually presents with normal b-hCG levels D. Usually presents with normal AFP levels

B. A cyst and a hematoma are not considered solid masses. A goiter is a diffuse condition. The adenoma is the most common solid, benign thyroid mass.

The most common benign, solid lesions of the thyroid is _________________. A. Cyst B. Adenoma C. Hematoma D. Goiter

C. The most common cause for fluid collection in the perirenal space are renal abnormalities, such as nephritis or renal artery aneurysm rupture. The most common cause for fluid collection in the posterior pararenal space is aortic disease related to leaking grafts or trauma.

The most common cause for fluid collection in the perirenal space is _______________. The most common cause for fluid collection in the posterior paralegal space is ____________. A. Pancreatic disease, renal disease B. Aortic disease, renal abnormalities C. Renal abnormalities, aortic disease D. Small bowel infection, colitis

B. The most common cause of acute scrotal pain in postpubertal men is acute epididymitis.

The most common cause of acute scrotal pain in postpubertal men is: A. Hydrocele B. Acute epididymitis C. Orchitis D. Torsion

B. The most common extra-testicular neoplasm is an adenomatoid tumor.

The most common extra-testicular neoplasm is: A. Hamartoma B. Adenomatoid tumor C. AV malformation D. Lipoma

D. Most aortic aneurysms lie below the level of the renal artery origins (infrarenal). If an aneurysm is at or above the level of the renal arteries, the possible complications are much greater and treatment is more difficult.

The most common location for an aortic aneurysm is: A. Juxtarenal B. Suprarenal C. Aortic arch D. Infrarenal

B. The thyroid forms within the pharyngeal pouches in the neck and migrates inferiorly to its position at the base of the neck. When ectopic tissue is present, it most commonly migrates beyond the base of the neck and is located more inferiorly in the mediastinum area.

The most common location of ectopic thyroid tissue formation outside the neck is in the ___________________. A. Base of the skull B. Chest C. Shoulder D. Groin

A. The most common secondary malignancy of the testicles is lymphoma.

The most common secondary malignancy of the testicle is: A. Lymphoma B. Hypernephroma C. Myeloma D. Leukemia

A. There is a hypochoic ovoid mass posterior to the thyroid. The esophagus is noted medial to the mass and the carotid artery is lateral to the mass. The homogeneous hypochoic appearance is common in parathyroid adenomas.

What is indicated by the arrow? A. Parathyroid adenoma B. Esophagus C. Internal jugular vein D. Longs colli muscle

D. The image is a transverse view. Note the circular aorta. The IVC is demonstrated to the right of the aorta. The shape is rounded due to engorgement of the vessel with echogenic thrombus.

What is the arrow pointing to on the midline view of the abdomen? A. Recanalized umbilical vein B. Lymphadenopathy C. Gastroesophageal junction D. IV thrombosis

D. Identify the echogenic mediastinum testis to distinguish cryptorchid testis from other inguinal masses. The epididymis and spermatic cord cannot be identified in the groin around a cryptorchid testis. Masses and cryptorchid testis will demonstrate internal vascularity.

What is the best way to differentiate an undescended testicle form other inguinal masses? A. Identify the epididymis B. Identify the presence of internal vascularity C. Identify the spermatic cord extending to the scrotal sac D. Identify the mediastinum testis

A. When a performing any type of US guided invasive procedure, it is important the measure the depth to the "target". Most pseudoaneurysms are treated with an injection of Thrombin.

Why did the sonography measure the distance with the first set of calipers? A. To determine the length of the needle for Thrombin injection B. To evaluate the length of the pseudoaneurysm C. To demonstrate the inflamed anterior tissues D. To evaluate the width of the pseudoaneurysm

D. Seminomas are intratesticular neoplasms. Adenomatoid tumors are extratesticular tumors that typically affect the epididymis. Gentle transducer pressure can be used to demonstrate an extratesticular mass can move independently of testis

What technique can be used to differentiate a seminoma and an adenomatoid tumor? A. Scan the patient in the Trendelenburg position B. Scan the patient in standing position C. Ask the patient to perform the Valsalva maneuver D. Apply gentle transducer pressure to the affected testicle

C. The greenfield filter is implanted into the IC to prevent emboli from reaching the lungs from the lower extremities.

What therapeutic device is implanted inside the distal IVC? A. Pacemaker B. Stent C. Greenfield filter D. Catheter

C. Perirenal or perinephric space encloses the kidneys, adrenals, portions of the IC and aorta. The anterior pararenal space holds the CBD, portions of the duodenum, pancreas, ascending and descending colon. The posterior pararenal space contains only fat, no organs. The psoas muscles and quadratus lumborum muscles are medial and posterior to the posterior pararenal space. The transversals fascia courses anterior to these muscles and they lie within the retrofascial space.

When an AAA ruptures, which retroperitoneal space will fill with blood first? A. Posterior pararenal B. Mental Bursa C. Perirenal D. Anterior pararenal

D. An increase in aortic sac diameter of 0.6 cm or greater indicates a possible endoleak.

When evaluating a patient with an aortic endograft, what is the minimum increase in aortic sac size that indicates as a possible endoleak? A. 0.9 cm B. 1.5 cm C. 0.2 cm D. 0.6 cm

B. In cases of acute epididymo-orchitis, hypervascularity will be identified in the area of infection. The affected side will show decreased vascular resistance (= hypervascularity) compared to unaffected side. The resistive index (RI) is a value between 0 and 1. Acute infection is associated with RI values <0.5 in affected teste. Diastolic flow reversal in cases of epididvmo-orchitis can indicate the presence of a complication, venous infarction.

Which of the following Doppler findings is most consistent with uncomplicated epididymo-orchitis? A. High resistance flow; resistive index 1.2 B. Low resistance flow; resistive index 0.4 C. High resistance flow; resistive index 0.2 D. Low resistance flow; resistive index 0.8

D. Partial Torsion may still demonstrate some high resistance flow with absent or reversed diastolic flow in the affected teste. Comparison of the PW Doppler waveforms from both sides can assist in diagnosis. Asymmetry of the resistive indices can indicate partial torsion. High RI values indicate elevated resistance and partial torsion.

Which of the following Doppler findings is most suggestive of partial testicular torsion? A. Antegrade flow throughout the cardiac cycle B. Increased diastolic flow velocities with a very low resistive index on the affected side C. Increased diastolic flow velocities with a very high resistive index on the affected side D. Asymmetric resistive indices on the intratesticular Doppler evaluations

A. Most malignancies invade the thyroid across tissue planes from posterior to anterior. This produces a taller than wide mass. A benign thyroid mass displaces normal tissues and is usually wider than tall. Absent halo sign, microcalcifications and intranodular flow patterns offer very strong indication of thyroid malignancy. Microcalcifications are also referred to as psammoma bodies (small round calcifications).

Which of the following are associated with an increased risk of thyroid malignancy? A. Psammoma bodies and intranodular flow patterns B. Wider than tall mass orientation and intranodular cystic changes C. Prominent halo around mass and intranodular cystic changes D. Prominent halo around mass and intranodular flow patterns

C. Lung, breast and renal cell cancers are the most common primary carcinomas to metastasize to the thyroid.

Which of the following are the most common primary carcinomas to metastasize to the thyroid? A. Stomach and gallbladder B. Lung and bone C. Breast and lung D. Liver and spleen

D. Marfan syndrome is a genetic disorder that affects connective tissue of the heart, vessels and bones. Patients are usually very tall with a thin frame, long extremities and fingers. Abraham Lincoln is believed to have had Marfan syndrome. The aortic root and arch are the most commonly affected blood vessel. Aortic dissection, aneurysm and valve insufficiency are commonly associated with this disorder. Mitral valve prolapse and valve insufficiency are common with this disorder.

Which of the following correctly describes Marfan syndrome ? A. Patients are usually less than 48 inches tall with foreshortened limbs and digits B. Genetic weakness of all arterial walls results in the formation of aneurysms throughout the systemic circulatory system C. Abdominal situs defects are common D. Genetic disorder that affects connective tissues of the heart, vessels, and bones

C. De Quervain thyroiditis and Hashimoto thyroiditis are causes of hypothyroidism. De Quervain thyroiditis is caused by a virus, Hashimoto thyroiditis is caused by bacteria. De Quervain thyroiditis is causes painful thyroiditis, while Hashimoto thyroiditis is typically painless.

Which of the following correctly describes a difference between De Quervain and Hashimoto thyroiditis? A. De Quervain thyroiditis causes hyperthyroidism, Hashimoto thyroiditis causes hypothyroidism B. De Quervain thyroiditis causes hypothyroidism, Hashimoto thyroiditis causes hyperthyroidism C. De Quervain thyroiditis is caused by a virus, Hashimoto thyroiditis is caused by bacteria. D. De Quervain thyroiditis has no effect on TSH levels, Hashimoto thyroiditis causes

C. Both thyroid and parathyroid adenomas are hypochoic. Thyroid adenomas are generally heterogeneous, while parathyroid adenomas are homogeneous. Vascularity differs greatly between the two adenomas. Parathyroid adenomas are highly vascular masses. Use color Doppler to differentiate it from thyroid adenoma (hypovascular). Another characteristic sign is a Vascular Arc, which refers to vascularity surrounds 90 to 270 degrees of the mass. An enlarged extrathyroidal artery may be visualized supplying the mass.

Which of the following correctly describes how to aid in differentiation of a thyroid adenoma in the lower pole from a parathyroid adenoma? A. thyroid adenomas are hypochoic and parathyroid adenomas are hyperechoic B. thyroid adenomas are homogeneous and parathyroid adenomas are heterogeneous C. thyroid adenomas are hypovascular and parathyroid adenomas are hypervascular D. thyroid adenomas are hyperechoic and parathyroid adenomas are hypoechoic

A. Papillary is the most common type of thyroid cancer. It is commonly associated with enlarged cervical lymph nodes but is highly curable. Sonographic characteristics include a hypoechoic mass with calcifications.

Which of the following correctly describes papillary thyroid cancer? A. Most commonly presents as a hypoechoic mass with calcifications B. Associated with colloid cyst formation C. Most masses are complex cysts with thick septations and nodule formation D. Has a very high mortality rate

C. An adenomatoid tumor is an extratesticular, intrascrotal tumor. They typically involve the epididymis. Gentle transducer pressure can be used to demonstrate the mass can move independently of testis. They typically present as a rounded, well circumscribed, hypovascular mass in the tail of the epididymis.

Which of the following describes an adenomatoid tumor? A. A benign intratesticular tumor B Hypervascular testicular tumor C. A benign intrascrotal tumor D. Hypovascular testicular tumor

B. Tubular Ectasia of the Rete Testis is associated with epididymal inflammation or trauma. It is usually bilateral and seen with spermatocele formation. It is a common finding after a vasectomy.

Which of the following describes tubular ectasia of the rete testis? A. Unilateral and associated with infertility B. Bilateral and associated with spermatocele formation C. Bilateral and has a strong association with malignant transformation D. Unilateral and associated with chronic bacterial infection

A. The image demonstrates an intratesticular cyst and extratesticular varicocele. Normal testicular vascularity is present with no signs of inflammation.

Which of the following findings are seen on the image? A. Intratesticular cyst and extratesticular varicocele B. Orchitis and intratesticular cyst C. Intratesticular and extratesticular varicocele D. Orchitis, intratesticular cyst and extratesticular varicocele

C. Hashimoto thyroiditis causes an increased risk of thyroid cancer, breast cancer, lung cancer, Gl tract cancer, urogenital cancer, and blood cancer.

Which of the following has the highest risk of developing thyroid cancer? A. Graves' disease B. Parathyroid adenoma C. Hashimoto thyroiditis D. Cirrhosis

C. Synthroid or Levothyroxine is the most commonly used medication used for treatment of hypothyroidism. Another option for treatment is the use of iodine supplements. Iodine deficiency can sometimes lead to decreased thyroid function. In these cases, iodine supplements may be helpful. In some cases, iron deficiency can cause hypothyroidism. In these cases, iron supplements may be helpful

Which of the following is NOT a medication that can be used to treat patients with hypothyroidism? A. Iodine supplements B. Levothyroxine C. Coumadin D. Iron Supplements

A. Sjogren syndrome is an immune system disorder that causes a reduction in saliva and tear production. It is associated with rheumatoid arthritis and lupus. Primary symptoms are dry eyes and dry mouth. It may cause swelling of the salivary glands. Usually affects the parotid and submandibular glands

Which of the following is an immune system disorder that commonly affects the salivary glands? A. Sjogren syndrome B. Klippel-Trenaunay-Weber syndrome C. Kasabach-Merritt syndrome D. Epstein-Barr syndrome

D. Adrenal Rests are associated with Cushing syndrome and adrenal hyperplasia. They appear as hypochoic, multifocal masses with wheel spoke vascularity.

Which of the following is an intratesticular mass associated with Cushing syndrome and adrenal hyperplasia? A. Mixed germ cell tumor B. Yolk sac tumor C. Epidermoid cyst D. Adrenal rest

D.

Which of the following is commonly associated with the abnormality on the image? A. Down Syndrome B. Tuberculosis C. Radiation Exposure D. All of the above

C. Mumps most commonly affects the parotid glands. They will enlarge and become hypervascular due to inflammatory response.

Which of the following is most likely to be affected by a mumps infection? A. Renal vein B. Thyroid gland C. Parotid gland D. Prostate

B. Enlarged lymph nodes around the aorta, retroperitoneal fibrosis or a spinal mass can cause anterior displacement of the aorta. The left and right crura cross just anterior to the aorta and extend to the spine on both sides of the aorta. A mass in this structure would displace the aorta posteriorly. Ascites in the peritoneal cavity could also displace the aorta posteriorly. A pleural effusion forms in the chest cavity.

Which of the following is most likely to cause anterior displacement of the abdominal aorta? A. Pleural effusion B. Lymphadenopathy C. Ascites D. Mass in the left diaphragm crura

B. Retroperitoneal Fibrosis is also called Ormond disease and refers to idiopathic(usually) overgrowth of fibrous tissue around an atherosclerotic aorta. It most commonly occurs at the level of the aortic bifurcation and extends inferiorly in pelvis. Rarely will it extend superiorly in the abdomen. Complications include IVC compression, pedal edema, gonadal vein compression, and ureteral obstruction. May lead to ureteral obstruction causing hydronephrosis. Sonographic characteristics include a hypoechoic, soft tissue mass with smooth borders.

Which of the following is most suggestive of Ormond disease? A. Extrinsic compression of the celiac artery B. Pedal edema and scrotal swelling C. Bilateral staghorn calculi and posterior urethral valves D. Aortic arch aneurysm formation

C. Embolism can occur as thrombus accumulates within the AAA and then breaks loose to travel distally. Blue Toe Syndrome occurs as an embolism travels to the most distal point (toes) and causes ischemia in the vessel/area where it lodges. As the AAA grows the vessel wall thins and weakens causing a risk of rupture. DVT occurs with thrombus formation in the deep venous system.

Which of the following is the least likely complication of the pathology demonstrated on the ultrasound image? A. Rupture B. Blue Toe syndrome C. Deep vein thrombosis D. Embolism

B. Seminomas make up 40-50% of all germ cell tumors identified in the testicle.

Which of the following is the most commonly occurring germ cell tumor of the testicle? A. Teratoma B. Seminoma C. Choriocarcinoma D. Embryonal cell tumor

B. A hydrocele is the accumulation of serous fluid between the two layers of the tunica vaginalis. They most commonly occur in newborns (congenital), but are also seen in adults associated with infection/inflammation (acquired). The most common cause of acute scrotal pain is epididymitis. Hydroceles usually contains serous fluid but may see minimal cellular debris.

Which of the following is true regarding hydrocele formation? A. Most common cause of acute scrotal pain B. Accumulation of serous fluid between the two layers of the tunica vaginalis C. Usually contains mucinous fluid D. Most hydroceles are due to infection

B. The body of the pseudoaneurysm will demonstrate a low resistance "swirling" of flow on the Doppler tracing. The neck/stalk of the pseudoaneurysm is normally very narrow and will demonstrate a high resistance, biphasic waveform.

Which of the following statements best describes the Doppler tracing found in the stalk of a pseudoaneurysm? A. Phasic forward flow B. High resistance to and fro flow C. Continuous forward flow D. Low resistance to and fro flow

B. The body of the pseudoaneurysm will demonstrate a low resistance "swirling" of flow on the Doppler tracing. The neck/stalk of the pseudoaneurysm will demonstrate a high resistance, biphasic waveform.

Which of the following statements best describes the Doppler tracing found within the body of a pseudoaneurysm? A. High resistance to and fro flow B. Low resistance to and fro flow C. Continuous forward flow D. Phasic forward flow

B. The central portion of the abscess is fluid and debris with no vascularity. The surrounding tissues are inflamed which leads to increased flow and an increase in the color flow displayed.

Which of the following statements best describes the appearance of color Doppler evaluation of a testicular abscess? A. Due to fluid accumulation with inflammation, color Doppler does not usually demonstrate flow around or within an abscess. B. There will be no color flow demonstrated centrally with increased color flow displayed around the periphery of the abscess C. There will be a significant increase in vascularity within the abscess due to inflammation D. There will be focal areas of increased vascularity in the central abscess and limited color flow demonstrated at the periphery of the abscess.

D. The BEST answer lists the hydrocele and appendix testis that are visible on the image.

Which of the following statements best describes the findings on the image? A. The image is a normal scrotal ultrasound with a normal testicle with the appendix testis demonstrated. B. There is a hydrocele present on the image. C. The testicle demonstrates a dilated rete testes. D. There is a hydrocele and appendix testis visible on the image

C. The image demonstrates several cysts in the thyroid. The cysts may contain echogenic foci with the comet tail artifact and debris, if filled with colloid substance.

Which of the following statements best describes the findings on the image? A. There are several colloid cysts present within the thyroid and some demonstrate the propagation speed artifact. B. The findings are should raise significant suspicion for thyroid malignancy. C. There are several colloid cysts present within the thyroid and some demonstrate the comet tail artifact D. There are several milk of calcium cysts with in the thyroid

D. The appendix testis is a remnant of the Mullerian duct. It is located between the epididymal head and the testis.

Which of the following statements best describes the findings on the image? A. There arrows indicate two extratesticular neoplasms, one is solid and the other is calcified B. The arrows indicate two scrotal calcifications, one much older than the other C. Chronic atrophy of the epididymis has led to a very small epididymal head and calf iced tail portion D. The arrows indicate a remnant of the Müllerian duct and a scrotal calcification

D. Testicular prosthetics are most commonly silicone or gel filled which provides no reflection of the sound beam. (anechoic)

Which of the following statements describes the appearance of a testicular prosthetic on the US image? A. Homogenous, hypoechoic structure with sound attenuation posteriorly causing decreased visibility of the posterior borders of the prosthesis B. Solid, round structure with homogenous, hypoechoic texture compared to the native taste. C. Solid, oblong structure with homogenous, hypoechoic texture compared to the native taste. D. Round structure with reflective borders and an anechoic lumen

C. Seminomatous tumors are the most common "pure" germ cell tumor of testes. Most common in white males age 30-50yrs. It has been associated with cryptorchidism, trisomy 21 (Down syndrome), Klinefelter syndrome, smoking. When it metastasizes, it spreads to the retroperitoneal lvmph nodes first. They have the best prognosis of all germ cell tumors because they are very responsive to radiation and chemotherapy.

Which of the following statements is correct regarding testicular seminoma? A. Spreads to liver first with metastasis B. Most common in African American males C. Associated with cryptorchidism, trisomy 21, Klinefelter syndrome, and smoking D. Unresponsive to radiation and chemotherapy

C. A varicocele is demonstrated on the image. The Valsalva maneuver will increase the size of the veins and can cause flow reversal to occur. The abnormality has been linked to infertility in some cases. It is more commonly seen on the left side due to the relationship of the gonadal vascular anatomy to surrounding structures. The left renal vein courses between the SMA and aorta which increases the risk of extrinsic compression causing decreased drainage of the left gonad. (nutcracker syndrome)

Which of the following statements is true regarding the abnormality on the image? A. The Valsalva maneuver will have minimal effect on the already engorged vessels. B. It is more commonly seen on the right side due to the relationship of the gonadal vascular anatomy to surrounding structures. C. It can be caused by Nutcracker syndrome D. The abnormality has no association with male infertility.

B. Chronic infection, radiation therapy near the scrotal area, CHF and liver failure can all be associated with scrotal wall thickening. Normal scrotal wall thickness is <8mm.

Which of the following statements is true regarding the findings on the image? A. Radiation treatment of the breast cancer can lead to these findings. B. CHF can be associated with the findings on the image. C. The groin should be evaluated for serpiginous vessels related to the hydrocele D. Nutcracker syndrome can be associated with the findings on the image.

B. The parathyroid gland produces parathyroid hormones that affect calcitonin production by the thyroid. Calcitonin affects the body's ability to metabolize the calcium in our food into a form that is excreted by our intestines and kidneys. The higher the PTH levels, the lower the calcitonin levels. If the calcitonin levels are low, the calcium levels remain very high in the blood. The constant filtration of excess calcium in the kidneys can lead to stone formation.

Which of the following statements is true regarding the image displayed? A. The thyroid adenoma causes increased calcium filtration in the kidneys leading to the formation of renal calculi. B. The parathyroid adenoma causes reduced calcium excretion by the intestines leading to serum hypercalcemia and potential renal stone formation. C. The parathyroid adenoma causes decreased calcium absorption in the intestines leading to the formation of renal calcull. D. The thyroid adenoma causes decreased calcium absorption in the intestines leading increased calcium concentrations in the blood filtered by the kidneys which may cause the formation of renal calculi.

C. image demonstrates increased testicular vascularity related to orchitis. Acute infection usually results in the inflammatory response with fluid accumulation and hypervascularity. The Valsalva maneuver is used to demonstrate the increased vascular flow within a varicocele that forms outside the testicle.

Which of the following statements is true regarding the image of the left testicle? A. The image demonstrates a normal testicle B. The patient should be re-scanned while standing C. The hypervascularity suggests orchitis D. The Valsalva maneuver was used to demonstrate the increased vascular flow within the testicle

B. Non-Seminomatous tumors usually contain cystic areas and calcifications that assist in differentiating them from seminomatous tumors. These tumors are more aggressive than a seminoma tumor. They are the second most common primary malignancy of the testicles.

Which of the following statements is true regarding the non-Seminomatous germ cell tumor displayed on the image? A. Seminomatous tumors usually contain cystic areas and calcifications that assist in differentiating them from non-seminomatous tumors. B. The tumors are most common in men age 20-30 yrs.

B. Non-Seminomatous tumors usually contain cystic areas and calcifications that assist in differentiating them from seminomatous tumors. These tumors are more aggressive than a seminoma tumor. They are the second most common primary malignancy of the testicles.

Which of the following statements is true regarding the non-seminomatous germ cell tumor displayed on the image? A. Seminomatous tumors usually contain cystic areas and calcifications that assist in differentiating them from non-Seminomatous tumors. B. The tumors are more common secondary malignancy of the testicles C. They are the second most common secondary malignancy of the testicles D. These tumors are less aggressive than a seminoma tumor

A. Seminoma tumors do not normally exhibit cystic degeneration and areas of internal necrosis. Germ cell tumors commonly demonstrate those characteristics.

Which of the following statements regarding the image is true? A. The mass on the image is most likely a non-Seminomatous germ cell tumor because of the characteristic heterogeneous texture with areas of cystic degeneration. B. The mass on the image is most likely a seminoma because of the characteristic heterogeneous texture with areas of cystic degeneration C. The image demonstrates the most common type of testicular malignancy D. This type of malignancy is treatable with radiation only, no surgical intervention required.

A. Type Il endoleak: leak at the branch vessels; will see retrograde flow into the aneurysm sac and increase in AAA diameter; inferior mesenteric artery, internal iliac, lumbar arteries and accessory renal arteries are potential sources for the leak

Which of the following vessels are a common source for a Type II endoleak? A. Inferior mesenteric artery and lumbar arteries B. Common iliac artery and gonadal arteries C. Celiac axis and superior mesenteric artery D. Left gastric artery and right hepatic artery

C. A testicular teratoma is composed of ectodermal tissues such as, bone, cartilage and smooth muscle fibers.

Which testicular tumor is composed of bone, cartilage and smooth muscle fibers? A. Seminoma B. Choriocarcinoma C. Teratoma D. Yolk Sac Tumor

A. Embryonal cell carcinoma usually leads to increased levels of b-hG and AFP. Yolk sac tumors usually cause an increase in AFP. Choriocarcinoma usually leads to an increase in b-hCG.

Which testicular tumor will cause b-hCG levels to rise but AFP levels will be normal? A. Choriocarcinoma B. Epidermoid cyst C. Yolk sac tumor D. Embryonal cell carcinoma

D. Anaplastic CA make up about 10% of thyroid malignancies;. It is very aggressive and the most lethal type of thyroid malignancy. It most commonly presents as a hard, fixed mass with rapid growth and usually invades surrounding neck structures.

Which type of thyroid cancer is most lethal? A. Follicular B. Medullary C. Papillary D. Anaplastic

B. The internal jugular chain runs between the carotid artery and the sternocleidomastoid muscle. The chain extends from the base of the skull to the level of the clavicle. Upper - base of skull to hyoid bone(level Il); Mid - hyoid bone to cricoid cartilage(level III); Lower - from cricoid cartilage to clavicle (level IV)

You are scanning the patient that has a bilateral thyroidectomy 3 years ago. There are 3 round, anechoic lymph nodes identified between the mid common carotid artery and the sternocleidomastoid muscle. How will you report these findings? A. Possible abnormal lymph nodes in level VII B. Possible abnormal lymph nodes in level III C. Possible abnormal lymph nodes in level I D. Possible abnormal lymph nodes in level V

C. Esophageal Diverticulum refers to an outpouching of a weak spot in the esophageal wall. Killian-Jamieson diverticulum - protrudes from anterolateral wall of the cervical esophagus Zenker diverticulum - located at the back of the throat, protrudes posterior or midline They can be mistaken for a thyroid mass.

Zenker diverticulum can be mistaken for: A. The appendix B. A dilated bile duct C. A thyroid mass D. A bowel obstruction

B. Splenic artery aneurysms are the most common splanchnic artery aneurysm. They are associated with pancreatic inflammation, peptic ulcers, patients with more than 2 pregnancies (multigravida) and trauma. They are more common in women and are considered a critical finding due to rupture risk. Hepatic artery aneurysms are the 2nd most common type. They are usually seen in the extrahepatic segment and associated with systemic infection and trauma. SMA aneurysms are the least common type and most are associated with cystic medial necrosis.

_________________ artery aneurysms are commonly associated with pancreatitis and peptic ulcer disease, while ______________ artery aneurysms are usually caused by cystic medial necrosis. A. Hepatic, splenic B. Splenic, superior mesenteric C. Celiac, hepatic D. Celiac, superior mesenteric