Abdomen Review

All of the following may be present in a patient with autosomal dominant (adult) polycystic kidney disease EXCEPT: Small, shrunken kidneys Multiple irregularly shaped cysts Renal failure Distortion of the central sinus echoes Liver cysts

Small, shrunken kidneys

In the pediatric patient, if a Wilms' tumor is suspected the sonographer should look for related abnormalities in all of the following EXCEPT: Opposite kidney The pancreas IVC Aorta Liver

The pancreas

A 16-year-old boy was being scanned for right upper quadrant pain. There was no evidence of stones in the intrahepatic ducts or gallbladder, but the common duct was 6.5 mm at the level of the right portal vein. Soon after the sonographer was called away to assist with an emergency, the bored and hungry patient ate a Snickers bar. When the common bile duct was scanned 40 minutes later, it measured 8.5 mm at the same level. What is the most likely explanation for the increased measurement? a. a gallstone was recently passed b. there is a stone in the distal CBD that is at least partially abstructing the biliary system c. the fat in the candy bar decreased the release of cholecystokinin d. there is obstruction caused by hepatocellular disease e. this is the normal response to the ingestion of a candy bar

There is a stone in the distal common duct that is at least partially obstructing the biliary system.

All of the following are characteristics of the hepatic veins EXCEPT: They branch away from the diaphragm They have echogenic walls They originate close to the diaphragm They can be traced into the IVC All three are best seen on a transverse scan

They have echogenic walls

Typical locations of lymph nodes include all of the following EXCEPT: Surrounding or adjacent to the aorta In the inguinal region In the renal hilum Surrounding or adjacent to the pancreas Under the diaphragm

Under the diaphragm

On an otherwise routine abdominal survey, a vessel is seen arising from the superiour mesenteric artery and heading toward the porta hepatis. Colour flow Doppler demonstrates hepatopetal flow. The vessel is most likely: a. a portosystemic collateral b. the coronary artery c. a replaced right hepatic artery d. the gastric artery e. the GDA

a replaced right hepatic artery (a variant in 20% of the population)

Extrinsic causes of hydronephrosis include all of the following EXCEPT: a. A calculus b. Uterine fibroids c. Trauma d. Pregnancy e. Ovarian neoplasms

a. A calculus

Fusion anomalies of the kidneys include all of the following EXCEPT: a. Ectopic kidneys b. Pancake kidneys c. Crossed renal ectopia d. Horseshoe kidney e. Duplicated kidneys

a. Ectopic kidneys

Common conditions in which the gallbladder wall is thickened include all of the following EXCEPT: a. Fatty infiltration of the liver b. Acute cholecystitis c. AIDS d. Ascites e. Hypoalbuminemia

a. Fatty infiltration of the liver

Which of the following is NOT an acoustic window to demonstrate the pancreas? a. Intercostal approach through the liver, at the lower pole of the right kidney b. Left lobe of the liver c. Spleen d. Fluid-filled stomach e. Fluid-filled duodenum

a. Intercostal approach through the liver, at the lower pole of the right kidney

A congenital disease of the aorta is: a. Marfan's syndrome b. Morison's pouch c. atherosclerosis d. dissecting aortic aneursym e. aortic thrombosis

a. Marfan's syndrome

A sonogram on a patient referred for right upper quadrant pain shows an enlarged gallbladder and dilated peripheral ducts with no evidence of calculi. The extrahepatic common bile duct is normal in caliber; the only evidence of a stone is just proximal to Hartmann's pouch, complete with shadowing, but it does not change position on a left lateral decubitus view. This condition is most likely: a. Mirizzi syndrome b. ascaris lumbricoides c. caroli's disease d. sclerosing cholangitis e. klatskin tumor

a. Mirizzi syndrome

Sonographic depiction of acute renal vein thrombosis includes all of the following EXCEPT: a. Renal vein dilation distal to the occlusion b. Enlarged hypoechoic kidney c. Low-level echoes in the renal vein d. Absent or reversed diastolic flow in the infrarenal arteries e. Decreased or no Doppler flow

a. Renal vein dilation distal to the occlusion

The C-loop of the duodenum is bordered by all of the following EXCEPT: a. The main lobar fissure b. Sphincter of Oddi c. Gallbladder d. Pacreatic head e. Renal artery

a. The main lobar fissure

A 6-year-old patient with a history of a recent streptococcus throat infection treated with a 10-day course of antibiotics is referred for a neck sonogram to evaluate a large, tender, palpable mass. Which of the following is the sonographer MOST likely to find?: a. a hypoechoic, homogeneous mass with an echogenic center lateral to the internal jugular vein b. a solid, echogenic mass in the thyroid gland surrounded by an echopenic halo c. a diffusely enlarged thyroid gland d. an echogenic mass lateral to the carotid artery e. a well-circumscribed, echo-free structure adjacent to the thyroid gland

a. a hypoechoic, homogeneous mass with an echogenic center lateral to the internal jugular vein

All of the following techniques are useful in distinguishing between floating gallstones and gallbladder polyps EXCEPT: a. a lower frequency transducer b. decubitus views of the gallbladder c. prone views of the gallbladder d. checking the chart to see if the patient has had any oral cholecystographic agents e. erect views of the gallbladder

a. a lower frequency transducer

In a patient with cryptorchidism, which of the following is MOST likely to occur?: a. a seminoma b. torsion c. epididymitis d. a hydrocele e. a spermatocele

a. a seminoma

A round, echo-free mass seen high in the midline of the neck, above the thyroid, is MOST likely: a. a thyroglossal duct cyst b. a brachial cleft cyst c. a lymph node d. a normal parathyroid gland e. an adenoma

a. a thyroglossal duct cyst

A benign, highly echogenic, vascular tumor found on a renal sonogram is MOST likely: a. an angiomyolipoma b. a wilms tumor c. staghorn calculus d. a renal lymphoma e. an adenoma

a. an angiomyolipoma

The majority of extratesticular masses are: a. benign b. malignant c. echogenic d. cystic e. complex

a. benign

Which of the following describes the sonographic features of autosomal recessive (infantile) polycystic kidney disease? a. bilateral, enlarged, echogenic kidneys b. bilateral hydronephrosis c. small echogenic kidneys d. multiple large, irregular cysts throughout kidney e. multiple cysts of varying size throughout the kidney

a. bilateral, enlarged, echogenic kidneys

A shrunken, echogenic pancreas is usually indicative of: a. chronic pancreatitis b. acute pancreatitis c. cirrhosis d. a pancreatic pseudocyst e. no pathology, this is a normal finding

a. chronic pancreatitis

The GDA is a branch of the: a. common hepatic artery b. common bile duct c. aorta d. splenic artery e. gastric artery

a. common hepatic artery

With hepatopetal flow, the blood in the portal vein and the blood in the hepatic artery: a. flows in the same direction b. flows in opposite directions c. cannot be detected with doppler d. flows away from the liver e. is turbulent

a. flows in the same direction

The distal CBD is BEST visualized sonographically using which of the following for an acoustic window? a. head of the pancreas b. water filled second portion of the duodenum c. gallbladder on a decubitus view d. liver on suspended inspiration e. liver on a decubitus view

a. head of the pancreas

A patient fell on the ice and his his back on the edge of a step. He was bruised but did not have pain unless he was walking or climbing stairs, in which case he had pain in his right lower back. He was febrile, but his urinalysis and white blood cell count were normal. He was referred for an ultrasound study, which revealed a: a. hematoma in the iliopsoas muscle b. fracture in the kidney c. retroperitoneal abscess d. ruptured spleeen

a. hematoma in the iliopsoas muscle

A patient is sent to ultrasound to rule out Budd-Chiari syndrome. Which of the following vessels require careful interrogation? a. hepatic veins b. portal vein and hepatic artery c. aorta and ivc d. lower extremity veins e. anterior and middle cerebral arteries

a. hepatic veins

Choppy, triphasic flow patterns are seen in the: a. hepatic veins b. portal veins c. hepatic arteries d. superior mesenteric artery e. iliac veins

a. hepatic veins

Which of the following is a rare malignant tumor, most commonly found in infants and children, that causes abdominal distention and hepatomegaly?: a. hepatoblastoma b. hepatocellular carcinoma c. focal nodular hyperplasia d. hematoma e. rhabdomyosarcoma

a. hepatoblastoma

A subcapsular hematoma may appear: a. hypoechoic and curvilinear b. anechoic and circular c. echogenic and square d. hypoechoic and rectangular e. echogenic and straight

a. hypoechoic and curvilinear

A condition seen mostly in children in which there is telescoping and subsequent obstruction of the bowel is called: a. intussusception b. pyloric stenosis c. biliary atresia d. crohn's disease e. obstructive bowel disease

a. intussusception

Which of the following cells are responsible for the endocrine function of the pancreas?: a. islet cells b. T cells c. Islets of Langerhans d. acinar cells e. red blood cells

a. islet cells

The vessel that is responsible for supplying the liver with the most nutrients is the: a. main portal vein b. hepatic artery c. common bile duct d. celiac artery e. hepatic vein

a. main portal vein

Which of the following is a true cyst?: a. parenchymal renal cyst b. biloma c. parapelic cyst d. pancreatic pseudocyst e. seroma

a. parenchymal renal cyst

MOST prostate cancers occur in the: a. peripheral zone b. central zone c. transitional zone d. seminal vesicles e. ejaculatory ducts

a. peripheral zone

Which of the following abnormalities most often complicates intercostal percutaneous liver biopsy? a. pneumothorax b. retroperitoneal bleeding c. pancreatitis d. bowel perforation e. liver abscess

a. pneumothorax

Which of the following is a normal finding when scanning the urinary tract of the infant? a. prominent renal pyramids b. dilation of the proximal portions of the ureters c. decreased echogenicity of the cortices of the kidneys d. increased echogenicity of the sinus echoes e. echoes in the bladder

a. prominent renal pyramids

A 30-year-old hemophiliac with a decrease in hematocrit presents for an abdominal sonogram. Where is the sonographer MOST likely to find an explanation for the abdominal hematocrit value?: a. psoas muscle b. spleen c. beneath the diaphragm d. liver e. posterior cul-de-sac

a. psoas muscle

Most of the central echogenic area in the normal kidney represents: a. renal sinus fat b. the renal pyramids c. the renal cortex d. the renal capsule e. the medulla

a. renal sinus fat

In certain geographical areas, a widespread disease caused by an infection from parasites that involves the bladder is: a. schistosomiasis b. glycogen storage disease c. malaria d. hydatid disease e. ascaris infection

a. schistosomiasis

Chronic inflammation of the bile ducts resulting in scarring and destruction is known as: a. sclerosing cholangitis b. pneumobilia c. mirizzi syndrom d. choledocholithiasis e. klatskin tumor

a. sclerosing cholangitis

An 82 year old man with a 10 year history of alcohol abuse is admitted with abdominal pain. his amylase and lipase levels are normal, as is the configuration of his pancreas. However, an abdominal sonogram shows that his pancreas is markedly less echogenic than his liver and is difficult to see. Which of the following transducers would provide the best image of this patient's right hemidiaphragm a. sector transducer (2MHz) b. curved array transducer (3.5MHz) c. Vector (3.5MHz) d. annular array transducer e. linear array (5MHz)

a. sector transducer (2MHz)

The most sensitive laboratory test for determining renal dysfunction is: a. serum creatinine b. blood urea nitrogen c. 24 hour urine collection d. specific gravity e. urinalysis

a. serum creatinine

The portal confluence is composed of the: a. smv, splenic vein and portal b. right, middle and left hepatic veins c. ivc, right renal vein and portal d. smv, imv, and splenic vein e. right portal vein, splenic vein and imv

a. smv, splenic vein and portal

When scanning transversely over the pancreas, which of the following is a tortuous vessel that will be seen coursing superior to the body and tail of the pancreas? a. splenic artery b. pancreatic artery c. splenic vein d. right renal artery e. superior mesenteric vein

a. splenic artery

An elderly man falls on a wooden chair and strikes his left side. He catches the fall with both hands, but has to struggle to get back to a standing position. Although in pain, he does not report his injury. One day later he falls again and is unable to sit up. Paramedics arrive to find the patient pale and clammy with a blood pressure of 60/40. At the hospital, a sonogram is ordered. The sonographer should be careful to search for: a. splenic rupture b. prostate obstruction c. gallbladder rupture d. an abscess e. a renal artery aneurysm

a. splenic rupture

A sagittal view oat the level of the common duct reveals multiple bright, linear echoes scattered throughout the liver. The echoes exhibit "dirty" shadowing and, in one area, a ring down artifact. Which of the following situations could not be responsible for the bright echoes disseminated in the liver? a. surgical clips from a cholecystectomy b. a choledochojejunostomy c. a sphincterotomy d. gallbladder ileus

a. surgical clips from a cholecystectomy

A patient with an abdominal aortic aneurysm of 3.1 cm has a follow-up scan done, which reveals an increase in diameter to 5.0 cm. However, surgical intervention shows no change in diameter. What could be a reasonable explanation for this discrepancy in size? a. the last quality assurance was performed 5 years ago b. it is variable aneurysm c. the patient position was different on the follow up scan d. a different transducer was used for the follow up scan e. the patient ate immediately before the follow up scan

a. the last quality assurance was performed 5 years ago

A 35-year-old woman with a palpable neck mass presents for a thyroid sonogram. Two solid, echogenic masses, each surrounded by a halo of hypoechoic tissue, are seen in the thyroid gland. The MOST likely diagnosis is: a. thyroid adenomas b. Grave's disease c. thyroid cancer d. Hashimoto's disease e. thyroid cysts

a. thyroid adenomas

A hypoechoic mass is seen in the renal pelvis of the kidney. Which of the following is the MOST likely diagnosis?: a. transitional cell carcinoma b. angiomyolipoma c. adenoma d. hypernephroma e. renal lymphoma

a. transitional cell carcinoma

Which of the following decreases in hepatocellular disease?: a. vitamin K b. alkaline phosphatase c. alanine aminotransferase d. aspartate aminotransferase e. indirect bilirubin

a. vitamin K

All of the following are indications for US evaluation of the retroperitoneum EXCEPT: a.To rule out splenic abscess b. To follow up a hematoma in the quadratus lumborum muscles c. An unexplained decrease in hematocrit d. To rule out a hematoma in Gerota's fascia e. Following a renal transplant

a.To rule out splenic abscess

In a patient with a highly echogenic liver, all of the following laboratory values can help distinguish between cirrhosis and an normal liver EXCEPT: a. acetylcholinesterase b. aspartate aminotransferase (AST) c. gamma-glutamyltransferase (GGT) d. alanine aminotransferase (ALT) e. liver function tests (LFTs)

acetylcholinesterase (in amniotic fluid)

All of the following are typical of long-standing cirrhosis EXCEPT: a. Small liver b. An enlarged liver c. Nodular outline to the liver d. Increased echogenicity e. Hepatofugal flow in portal veins

b. An enlarged liver

All of the following are sonographic indications of rejection in a transplanted kidney EXCEPT: a. Increased parenchymal echogenicity b. Bladder distention c. High-resistance Doppler pattern d. Abnormal decrease in renal size e. Presence of hydronephrosis

b. Bladder distention

The typical symptoms of gallbladder disease include all of the following EXCEPT: a. Nausea and vomiting b. Melena c. Right shoulder pain d. Right upper quadrant pain e. Chest pain

b. Melena (black tarry stools)

Which of the following is NOT normally found in renal metabolic waste material? a. Water b. Red blood cells c. Carbon dioxide d. Nitrogen waste e. Protein

b. Red blood cells

All of the following will help to distinguish the hepatic artery from the CBD EXCEPT: a. The hepatic artery is pulsatile b. The CBD is always anterior to the hepatic artery c. The hepatic artery can be traced back to the celiac axis d. The use of color flow or duplex Doppler imaging will show flow in the hepatic artery e. The hepatic artery has more echogenic walls than the CBD

b. The CBD is always anterior to the hepatic artery

The muscle groups of the anterior abdominal wall include all of the following EXCEPT: a. Internal oblique b. The diaphragm c. External oblique d. Transverse abdominus e. Rectus abdominus

b. The diaphragm

All of the following may be features of benign prostatic hypertrophy EXCEPT: a. Renal failure b. Unexplained fever c. Frequent urination d. Poor urinary stream e. Abnormal serum creatinine levels

b. Unexplained fever

Which of the following is necessary in order to perform a diagnostic transabdominal sonogram of the bladder? a. a catheter placed in the bladder b. a distended bladder c. NPO for 8 to 12 hours before the examination d. patient in a left lateral decub position e. the bladder cannot be examined transabdominally

b. a distended bladder

A 37-year-old woman is referred for a breast sonogram after a mass is seen on a mammogram. This mass appears small and homogeneous with smooth borders and contains low-level internal echoes. The MOST likely diagnosis is: a. a cyst b. a fibroadenoma c. cystosarcoma phyllodes d. ductal carcinoma e. a galactocele

b. a fibroadenoma

In a fasting state, the SMA has: a. a low-resistance waveform b. a high-resistance waveform c. reversed diastolic flow d. no resistance e. a high dicrotic notch

b. a high-resistance waveform

An 8-year-old patient presents with midabdominal pain and an elevated serum amylase level after blunt trauma to her abdomen. The abdominal sonogram demonstrates a cystic mass in the lesser sac. This MOST likely represents: a. a lymphoma deposit b. a pancreatic pseudocyst c. an aortic aneurysm d. fluid filled bowel e. an ovarian cyst

b. a pancreatic pseudocyst

An elderly patient is referred for an ultrasound study by her surgeon. The sonographer spends most of the scanning time imaging the renal and superiour mesenteric and celiac axis. The patient had surgery the following week for her: a. osteoporosis b. abdominal aortic aneurysm c. hydronephrosis d. hlomerulonephritis e. renal calculi

b. abdominal aortic aneurysm

Which of the following Doppler measurements is MOST sensitive in assessing renal artery stenosis? a. RI b. acceleration time c. peak-systolic/end-diastolic ratio d. flow velocity e. pulsatility index

b. acceleration time

Two days after a renal transplant, the most common cause of acute renal failure is: a. cyclosporine toxicity b. acute tubular necrosis c. renal obstruction d. acute pyelonephritis e. acute rejection

b. acute tubular necrosis

A fatal tumor that involves the exocrine portion of the pancreas and predominately occurs in elderly male smokers is: a. an islet cell tumor b. adenocarcinoma c. cystadenocarcinoma d. a pseudocyst e. phlegmon

b. adenocarcinoma

Serum glutamic pyruvic transaminase (SGPT) is also referred to as: a. bilirubin b. alanine aminotransferase (ALT) c. serum protein d. alkaline phosphatase e. alpha-fetoprotein (AFP)

b. alanine aminotransferase (ALT)

A known drug user presents with a high fever and right flank pain. The sonogram reveals a complex mass with low-level echoes, debris, and bright echoes with ring down artifacts. These findings MOST likely represent: a. hypernephroma b. an abscess c. a complex cyst d. a hematoma e. transitional cell carcinoma

b. an abscess

Which area of the prostate gland has the most peripheral zone tissue? a. base b. apex c. periurethral area d. anterior aspect e. superior aspect

b. apex

A young male patient with rebound tenderness, an elevated white blood cell counts, a fever, and periumbilical and RLQ pain MOST likely has: a. gallstones b. appendicitis c. pancreatitis d. renal colic e. ulcerative colitis

b. appendicitis

Which of the following is a condition in neonates in which the ducts of the biliary tree are very small and jaundice is present? a. choledochal cyst b. biliary atresia c. intussusception d. budd chiari syndrome e. cirrhosis

b. biliary atresia

A child with known medullary sponge kidney presents with hematuria and is sent to ultrasound to look for nephrocalcinosis. The sonographer sees rounded, echo-free structures in the liver with good acoustic enhancement. The structures vary in size and some appear to be connected by thinner tubular structures. What is the first differential diagnosis? a. autosomal recessive polycystic disease b. caroli's disease c. autosomal dominant polycystic disease d. Meckel Gruber syndrome e. biliary duct dilation

b. caroli's disease

Renal sinus lipomatosis: a. is another term for renal cyst b. causes an increase in echogenicity and size of the renal sinus c. is a term for anechoic areas secondary to obesity d. results in increased cortical echoes e. is a form of angiomyolipoma

b. causes an increase in echogenicity and size of the renal sinus

The cells of the intestinal mucosa secrete a hormone that causes the gallbladder to contract and release bile. This hormone is: a. lecithin b. cholecystokinin c. cholesterol d. bilirubin e. renin

b. cholecystokinin

Dilation of the IVC may be seen in: a. portal hypertension b. congestive heart failure c. uremia d. hypertension e. mitral valve prolapse

b. congestive heart failure

A highly vascular, benign tumor in the liver is referred to as a: a. hepatoma b. hemangioma c. lymphoma d. hepatic adenoma e. focal nodular hyperplasia

b. hemangioma

The vessel that typically runs between the portal vein and the common bile duct is the: a. porata hepatis b. hepatic artery c. ivc d. gda e. middle hepatic vein

b. hepatic artery

The vessel(s) in the liver that is(are) important in defining lobar anatomy for hepatic resection is(are) the: a. inferior vena cava b. hepatic veins c. portal artery d. hepatic arteries e. umbilical vein

b. hepatic veins

A casual reading of an abdominal sonogram in a patient with a Riedel's lobe could result in which of the following misdiagnoses? a. a mass in the head of the pancreas b. hepatomegaly c. a mass in the spleen d. hypernephroma e. heatoma

b. hepatomegaly

Complete blockage of the cystic duct can result in: a. a dilated distal common bile duct b. hydrops of the gallbladder c. Mirizzi syndrome d. gallbladder polyps e. jaundice

b. hydrops of the gallbladder

The MOST sensitive indicator of the presence of prostate cancer is: a. an abnormal digital rectal examination b. increased prostate-specific antigen (PSA) c. a hypoechoic nodule on a sonogram d. decreased PSA e. a hyperechoic nodule on a sonogram

b. increased prostate-specific antigen (PSA)

In a patient recently diagnosed with lymphoma, the sonographer discovered a 5-cm mass in the porta hepatis on the initial abdominal survey. The mass was probably enlarged lymph nodes. For what indication was the patient most likely referred to ultrasound? a. epigastric pain b. jaundice c. weight loss d. flank pain e. fever

b. jaundice

A patient with end-stage cirrhosis exhibits hepatofugal portal flow, making the presence of collateral vessels likely. A close look at which of the following will most easily demonstrate collateral flow? a. gallbladder region b. ligamentum teres c. spleen d. ligamentum venosum e. renal hilum

b. ligamentum teres (recanalized umbilical vein)

A remnant of the fetal ductus venosus that divides the caudate lobe of the liver from the left lobe of the liver is: a. main lobar fissure b. ligamentum venosum c. falciform ligament d. ligamentum teres e. hepatoduodenal ligament

b. ligamentum venosum

The majority of intratesticular masses are: a. benign b. malignant c. echogenic d. cystic e. complex

b. malignant

A 23-year-old college student is referred by the university health clinic because of diffuse abdominal and right upper quadrant pain. There is some free fluid in her abdomen and an encapsulated mass in her liver that is solid but contains complex cystic components. The sonologist, quite correctly, makes hepatic adenoma the first differential diagnosis for all of the following reasons EXCEPT: a. Upon question, the patient reported having been on oral contraceptives since her freshman year b. metastatic lesions in her liver would have a "bull's eye" appearance c. the cyctic areas are compatible with bleeding inside the mass, as hepatic adenomas are prone to do d. while ultrasound features are variable, hepatic adenomas often appear encapsulated

b. metastatic lesions in her liver would have a "bull's eye" appearance

An aneurysm caused by a bacterial infection is called a: a. pseudoaneurysm b. mycotic aneurysm c. berry aneurysm d. saccular aneurysm e. fusiform aneurysm

b. mycotic aneurysm

To exclude a false-positive diagnosis of hydronephrosis, the sonographer should: a. change to a lower frequency transducer b. perform prevoid and postvoid images of the kidneys c. defer to CT scan d. repeat the scan in 24-48 hours e. defer to MRI

b. perform prevoid and postvoid images of the kidneys

What structure surrounds the kidney?: a. tunica albuginea b. perirenal fat c. Glisson's capsule d. renal capsule e. renal cortex

b. perirenal fat

Multiple, sizable areas of splenic tissue in the splenic fossa are referred to as: a. accessory spleen b. polysplenia c. ectopic spleen d. agenesis of the spleen e. wandering spleen

b. polysplenia

Which of the following vessels is associated with waveforms that do NOT vary with respiration in a normal patient?: a. hepatic vein b. portal vein c. jugular vein d. femoral vein e. inferior vena cava

b. portal vein

Which of the following conditions affects male children and is characterized by bilateral hydronephrosis, an overly distended bladder, and dilated ureters? a. vesicoureteral reflux b. posterior urethral valves c. cryptorhidism d. ureteropelvic junction obstruction e. multicystic dysplastic kidney disease

b. posterior urethral valves

A 24-year-old man was referred for a CT scan after experiencing penetrating trauma to his abdomen. The CT scan showed a hematoma in the right psoas muscle. Two weeks later he was referred to US for an abdominal sonogram to follow up the initial CT scan. Which of the following techniques would afford the BEST view of the area of the bleed?: a. supine, scanning intercostally b. prone oblique decubitus, using the kidney as an acoustic window c. supine, scanning through the distended bladder d. supine, after administering a water enema e. none; this area cannont be imaged sonographically

b. prone oblique decubitus, using the kidney as an acoustic window

The presence of hydronephrosis and a renal pelvis filled with low-level echoes may be indicative of: a. the gain turned down too low b. pyonephrsis c. staghorn calculus d. medullary nephrocalcinosis e. peripelvic cysts

b. pyonephrsis

Small outpouchings of the mucosa of the gallbladder that extend into the underlying gallbladder wall are called: a. morisons pouch b. rokitansky-aschoff sinuses c. maxillary sinuses d. pouch of douglas e. hartmann's pouch

b. rokitansky-aschoff sinuses

Which of the following is the BEST acoustic window to demonstrate the pancreatic tail? a. right lobe of the liver b. spleen and left kidney c. right kidney d. fluid filled duodenum e. caudate lobe of the liver

b. spleen and left kidney

A normal structure that encircles the pancreatic head and may mimic a pancreatic mass is: a. the stomach b. the duodenum c. a pancreatic pseudocyst d. the uncinate process e. the gda

b. the duodenum

In a normal patient, where are the gallbladder and duodenum located in relation to the pancreatic head? a. superior b. to the right c. to the left d. posterior e. anterior

b. to the right

A 17-year-old boy presents in the ER with scrotal pain. The sonogram reveals an enlarged testicle, decreased echogenicity, thickening of the scrotal wall, a hydrocele, an no arterial flow. These findings are consistent with: a. cryptorchidism b. torsion c. acute orchitis d. epididymitis e. a spermatocele

b. torsion

On which of the following views are all three hepatic veins BEST seen? a. transverse, midliver b. transverse, close to the diaphragm c. transverse, adjacent to the gallbladder d. long, midline e. long, adjacent to the aorta

b. transverse, close to the diaphragm

Which of the following is a common cause of infertility in men? a. spermatocele b. varicoceles c. epididymal cysts d. hydroceles e. hamatoceles

b. varicoceles

Which of the following is the BEST transducer to use when imaging the thyroid gland?: a. 3.5MHz sector b. 5.0MHz curved linear array c. 7.5MHz electronically focused d. 7.5MHz mechanical sector e. 10MHz sector

c. 7.5MHz electronically focused

Which of the following is NOT true concerning the parathyroid glands? a. They may be located posterior to the thyroid gland b. They may be located in the thyroid gland c. A normal parathyroid gland is 1cm d. A parathyroid mass is not often palpable e. A typical patient has four parathyroid glands

c. A normal parathyroid gland is 1cm Truths: They may be located posterior to the thyroid gland, They may be located in the thyroid gland, A parathyroid mass is not often palpable, A typical patient has four parathyroid gland

A patient is sent to US to follow up a CT scan that showed an ill-defined mass in the isthmus of the thyroid. The sonographer is unable to visualize the mass on the initial sonogram. All of the following may be helpful in demonstrating the pathology EXCEPT: a. A standoff pad b. A higher frequency transducer c. A slight increase in pressure d. Color flow Doppler e. More acoustic gel

c. A slight increase in pressure

A 35-year-old man has irregularly thickened mucosa in dilated bile ducts. This finding is indicative of: a. primary biliary cirrhosis b. a choledochal cyst c. AIDS cholangitis d. biliary atresia e. heister's biliary hypertrophy

c. AIDS cholangitis

Chronic inflammatory disease of the thyroid is known as: a. multinodular goiter b. endemic goiter c. Hashimoto's disease d. follicular adenoma e. follicular adenocarcinoma

c. Hashimoto's disease

All of the following findings are consistent with Crohn's disease EXCEPT: a. An increased white blood cell counts b. Bloody stools c. Lack of color flow Doppler signals in the bowel wall d. A thickened bowel wall e. Lack of peristalsis

c. Lack of color flow Doppler signals in the bowel wall

The principle function of the urinary system include all of the following EXCEPT: a. Excretion of waste products b. Formation of urine c. Regulation of body temperature d. Regulation of blood pressure e. Control of fluid balance

c. Regulation of body temperature

All of the following will help to distinguish the aorta from the IVC EXCEPT: a. The aorta lies more midline b. Color flow or duplex Doppler imaging will show respiratory changes in the IVC c. The IVC is normally to the left of the aorta d. The IVC is normally compressible while the aorta is not e. The aorta has branches arising anteriorly

c. The IVC is normally to the left of the aorta

A bile duct neoplasm that carries a poor prognosis and is located at the hepatic duct bifurcation is MOST likely to be: a. Budd-Chiari syndrome b. Arnold-Chiari malformation c. a Klatskin tumor d. cystadenocarcinoma e. intraductal metastasis

c. a Klatskin tumor

To assess the degree of echogenicity of the renal cortex, a comparison with the liver would be inaccurate in which of the following instances? a. hydronephrosis b. the presence of two liver cysts c. a cirrhotic liver d. renal stones e. a discrepancy in renal length

c. a cirrhotic liver

A branching tubular structure in the liver is either an intrahepatic portal vein or a dilated bile duct. All of the following criteria would identify it as a bile duct EXCEPT: a. through transmission b. a tortuous course c. a monophasic Doppler signal d. being adjacent to a larger portal vein e. echogenic walls

c. a monophasic Doppler signal

A 13-year-old girl was referred for a pelvic ultrasound 2 days after she underwent surgery for a ruptured appendix. She was febrile and had leukocytosis. The surgeon was looking for a postoperative abscess. Trying to scan around a gas pocket without disturbing the incision, the sonographer asked the patient to turn toward her right side. The patient camplained that her right shoulder hurt too much to turn. Given that all of the patient's history is relevant, what did the sonogram show? a. an abcess in the right paracolic gutter b. a hematoma in the right shoulder c. a right subphrenic abscess d. enlarged lymph nodes e. an ovarian cyst

c. a right subphrenic abscess

The three layers that compose the aortic wall are: a. adventitia, visceral, peritoneal b. aneurysmal, intima, peritoneal c. adventitia, media, intima d. ventral, media, intima e. pia, arachnoid, dura

c. adventitia, media, intima

What renal disease is associated with berry aneurysms?: a. renal cell carcinoma b. autosomal recessive polycystic kidney disease c. autosomal dominant polycystic kidney disease d. multicystic dysplastic kidney disease e. transitional cell carcinoma

c. autosomal dominant polycystic kidney disease

The liver is an intraperitoneal organ surrounded by peritoneum. Which portion, if any, is NOT covered by peritoneum?: a. right lobe b. caudate lobe c. bare area d. left lobe e. it is all covered

c. bare area

In patients with Budd-Chiari syndrome, which lobe of the liver is spared? a. right b. left c. caudate d. quadrate e. medial

c. caudate

The first sonographically detectable branch to leave the abdominal aorta is the: a. common hepatic artery b. superior mesenteric artery c. celiac axis d. portal vein e. proper hepatic artery

c. celiac axis

Most gallstones are composed of: a. sludge b. xanthine c. cholesterol d. uric acid e. cysteine

c. cholesterol

Which of the following is a rare, highly malignant testicular tumor in which levels of circulating human chorionic gonadotropin are high: a. teratoma b. seminoma c. choriocarcinoma d. adenoma of the tunica albuginea e. fibroadenoma

c. choriocarcinoma

Echogenic foci with acoustic shadowing in the pancreas and a dilated pancreatic duct are consistent with which of the following? a. gallstones b. pancreatic pseudocyst c. chronic pancreatitis d. pancreatic cancer e. polycystic disease

c. chronic pancreatitis

A patient is sent to ultrasound for an "abdominal survey" with no history. Questioning the patient produces vague, unsatisfactory answers. The sonographer looks in the patient's chart and decides to focus the study on the liver and biliary system. What laboratory result did the sonographer most likely find in the patient's chart? a. decreased AFP b. low hematocrit c. elevated alk phos d. elevated amylase e. eleveated creatinine

c. elevated alk phos

Which of the following structures can be seen entering the pancreatic head? a. splenic vein b. common hepatic artery c. gda d. smv e. sma

c. gda

Which of the following is a way to avoid mistaking the duodenum for a pancreatic head mass? a. give the patient cholecystokinin b. look for bile duct dilation c. give the patient fluid by mouth d. apply firm pressure to the midabdominal region e. place the patinet in the trendelenburg position

c. give the patient fluid by mouth

An obstruction at the junction of the ureter and bladder will MOST likely cause: a. dilation of the bladder only b. hydronephrosis only c. hydronephrosis and hydroureter d. increased echogenicity of the renal cortex

c. hydronephrosis and hydroureter

An echo-free gallbladder that is 12cm in length is: a. a biloma b. a papilloma c. hydropic d. megacystic e. consistent with acalculous cholecystitis

c. hydropic

A 1 week old patient presents with left flank pain associated with a mass in the same area. Lab tests indicate hematuria and proteinuria. The patient is afebrile. Sonography depicts an enlarged kidney. Which of the following is the most likely diagnosis? a. renal cyst b. multicystic kidney c. left renal vein thrombosis d. pyonephrosis e. neuroblastoma

c. left renal vein thrombosis

Wirsung's duct is another name for the a. common bile duct b. cystic duct c. main pancreatic duct d. hepatic duct e. donald duct

c. main pancreatic duct

The normal Doppler waveform of the portal vein is: a. triphasic b. away from the liver c. monophasic d. biphasic

c. monophasic

When measuring gallbladder wall thickness in suspected acute cholecystitis, the wall should be measured: a. on the posterior surface b. on the lateral surface c. on the anterior surface d. on any surface e. at the fundus

c. on the anterior surface

A scrotal hernia occurs when bowel protrudes through the inguinal canal into the scrotal sac. The presence of which of the following confirms the diagnosis? a. fluid filled mass b. solid mass c. peristalsis d. cystic mass e. hydrocele

c. peristalsis

Six days after a cesarean section, a patient develops a fever and has a drop in her hemoglobin level. She is referred to ultrasound for a careful examination of all of the following EXCEPT: a. anterior to the rectus muscles b. posterior to the rectus muscles c. posterior to the rectum d. posterior to the bladder e. the uterine wall

c. posterior to the rectum

Thermal effects can be caused by a change in the: a. near field b. far field c. power d. gain e. transducer frequency

c. power

When performing an US evaluation of the thyroid, color flow Doppler may be helpful when: a. determining whether a mass is malignant or benign b. looking for calcifications in the lesion c. proving that a mass is real and not an artifact d. a mass is echogenic e. a mass is in the near field

c. proving that a mass is real and not an artifact

The presence of pus in a dilated collecting system is referred to as: a. acute pyelonephritis b. a renal abscess c. pyonephrosis d. focal pyelonephritis e. focal nephronia

c. pyonephrosis

A 75-year-old man presents with abdominal pain, hematuria, and a palpable upper abdominal mass. The sonographer performs an abdominal scan. When scanning the kidney, a solid mass with calcifications is noted. Further investigation reveals tumor involvement in the IVC. Which of the following is the MOST likely diagnosis?: a. Wilm's tumor b. transitional cell carcinoma c. renal cell carcinoma d. multicystic dysplastic kidney disease e. hemanigoma

c. renal cell carcinoma

On a longitudinal view, which of the following may be visualized posterior to the IVC? a. left renal vein b. right renal vein c. right renal artery d. left renal artery e. aorta

c. right renal artery

A 22-year-old man presents with an elevated human chorionic gonadotropin (hCG) level. The sonographer should scan the: a. breast b. pancreas c. scrotum d. thyroid e. prostate

c. scrotum

A complex cystic area is seen in the liver. Which of the following patients, whose occupations are listed, is MOST at risk to contract this condition?: a. asbestos worker b. coal miner c. shephard d. glass blower e. carpenter

c. shephard

On a transverse image of the abdomen, at the level of the hepatic veins, a fluid collection was found posterior but no superior to the liver, extending from the lateral margin of the trunk to the spine. a decision was made to culture the fluid. how should the patient be position for the puncture? a. LLD with wedges or pillows to stabilize the patient b. supine position to keep the patient steady and allow the needle to be inserted perpendicular to the table c. sitting position d. prone position with a pillow under the abdomen to spread the ribs e. trendeleburg position

c. sitting position

Which of the following is the BEST approach when scanning the right kidney in a normal patient? a. supine, scanning intercostally b. right lateral decub, using the spleen as an acoustic window c. supine, using the liver as an acoustic window d. prone, scanning posteriorly e. supine, using a subxiphoid approach

c. supine, using the liver as an acoustic window

A common site for fluid collections in the pelvis is: a. Morison's Pouch b. Hartmann's Pouch c. the Pouch of Douglas d. the sacral pouch e. the Chiari pouch

c. the Pouch of Douglas

In the postmenopausal breast: a. the amount of fatty tissue decreases while the amount of normal breast tissue increases b. the amount of fatty tissue increases while the amount of normal breast tissue increases c. the amount of fatty tissue increases while the amount of normal breast tissue decreases c. the amount of fatty tissue decreases while the amount of normal breast tissue decreases e. there are no changes

c. the amount of fatty tissue increases while the amount of normal breast tissue decreases

An asymptomatic, 80-year-old woman is having her abdominal aortic aneurysm scanned to follow the size. The alert sonographer finds a gallstone and a 7-mm common bile duct in the porta hepatis. What is true? a. the patient needs surgery to prevent possible obstructive jaundice b. the patient recently passed a gallstone c. the gallstone is incidental; the duct is normal in size for her age d. the patient is asymptomatic because the duct is obstructed from her aneurysm e. the patient has a positive murphy's sign

c. the gallstone is incidental; the duct is normal in size for her age

The extension of the pancreas that lies posterior to the SMV is the: a. caudate lobe b. tail c. uncinate process d. body e. head

c. uncinate process

In a pediatric patient, the renal pelvis is dilated but the ureter is normal. Which of the following is the MOST likely diagnosis? a. multicystic dysplastic kidney b. ureterovesical junction obstruction c. ureteropelvic junction obstruction d. pelvic kidney e. urethral obstruction

c. upj obstruction

Infarction of the spleen is associated with all of the following EXCEPT: a. Splenic artery thrombosis b. Bacterial endocarditis c. Sickle cell anemia d. A splenic cyst

d. A splenic cyst

All of the following are indications for US evaluation of the neck EXCEPT: a. A cold nodule on a nuclear medicine study b. Difficulty swallowing c. A palpable neck mass d. Abnormally low serum calcium levels e. A history of tongue carcinoma

d. Abnormally low serum calcium levels should be high levels

Arteriovenous fistulas may be caused by all of the following EXCEPT: a. Surgery b. Trauma c. Aneurysm d. Atherosclerosis e. Congenital factors

d. Atherosclerosis

A 25-year-old man with a myelomeningocele has a sonogram of the urinary bladder. All of the following conditions might be found EXCEPT: a. Renal calculi b. A dilated ureter c. Large bladder with trabeculation d. BPH e. Dilated renal pelvis

d. BPH

A patient had laboratory data and clinical symptoms suggesting stones in the gallbladder or biliary tree. The sonographer felt he had ruled out these diagnoses by demonstrating a normal gallbladder, a 4-mm common duct anteriour to the right portal vein, and no peripheral duct dilation. The sonologist sent him back for additional views of the: a. main lobar fissure b. ligamentum teres c. pancreas and right kidney d. CBD in the head of the pancreas e. portal vein

d. CBD in the head of the pancreas

All of the following are common symptoms of pancreatic disease EXCEPT: a. Weight loss b. Chronic severe abdominal pain c. An epigastric mass d. Dysuria e. Vomiting

d. Dysuria

Fatty infiltration of the liver is associated with all of the following EXCEPT: a. Diabetes mellitus b. Ethanol abuse c. Obesity d. Intravenous antibiotics e. Oral contraceptives

d. Intravenous antibiotics

The gallbladder is divided into all of the following regions EXCEPT: a. Neck b. Body c. Fundus d. Isthmus e. Hartmann's pouch

d. Isthmus

A health care worker contracted hepatitis B from an accidental needle stick. Which of the following is NOT likely to be seen on her abdominal sonogram? a. Prominent portal vessels b. Thickened GB wall c. Splenomegaly d. Lobular outline of the liver e. Hypoechoic liver

d. Lobular outline of the liver

A 25-year-old man with scrotal swelling is referred for a scrotal sonogram. A large cystic space is found surrounding the normal testicle. All of the following could be appropriate descriptions for the findings EXCEPT: a. Congenital b. Acquired c. Traumatic d. Malignant e. Infective

d. Malignant

All of the following can be surgically removed without need of replacement EXCEPT: a. GB b. Appendix c. Uterus d. Pancreas e. Spleen

d. Pancreas

Which of the following is a liver function test related to a blood clotting mechanism?: a. Bilirubin level b. Aspartate aminotransferase (AST) level c. Alanine aminotransferase (ALT) level d. Prothrombin time e. Lactic acid dehydrogenase level

d. Prothrombin time

When scanning the appendix for appendicitis, the differential diagnosis typically includes all of the following EXCEPT: a. Tubo-ovarian abscess b. Torsed ovarian cyst c. Ruptured ectopic pregnancy d. Rectal polyps e. Crohn's disease

d. Rectal polyps

All of the following vessels arise from the aortic arch EXCEPT: a. Left CCA b. Right innominate artery c. Left subclavian artery d. Right common carotid artery e. Brachiocephalic artery

d. Right common carotid artery

All of the following are causes of splenomegaly EXCEPT: a. Infectious mononucleosis b. Thalassemia c. Portal vein thrombosis d. Splenic infarct e. Cirrhosis

d. Splenic infarct

Five patients from a renal transplant ward are sent to US for postoperative sonograms. The following is a list of the indications for their postoperative examinations. Based on these indications, which patient was NOT sent to a machine equipped with Doppler? a. Renal artery stenosis b. Renal vein thrombosis c. Rejection d. Urinoma formation e. Acute tubular necrosis

d. Urinoma formation

A heterogeneous malignant tumor found in a newborn in the region of the kidney most likely represents: a. a teratoma b. an infantile polycystic kidney c. adrenal hemorrhage d. a neuroblastoma e. wilms tumor

d. a neuroblastoma

Which of the following statements is true? a. fibroadenomas and medullary cell carcinomas have cery different sonographic appearances b. lactating breasts are easy to examine with ultrasound because of milk filled ducts c. a breast hematoma is usually the result of an obstructed duct d. a simple cyst demonstrates smooth walls no internal echoes, and good through transmission e. breast malignancies are always well circumscribed and demonstrate posterior enhancement

d. a simple cyst demonstrates smooth walls no internal echoes, and good through transmission

Which of the following is a characteristic of a horseshoe kidney? a. two normal kidneys plus a pelvic kidney b. bilateral, malrotated kidneys c. two kidneys on the same side of the body d. a single kidney, in the shape of a horseshoe, with a single collecting system e. bilateral kidneys fused together by isthmus of tissue

d. a single kidney, in the shape of a horseshoe, with a single collecting system

When scanning a pediatric patient, a cystic structure is seen in the posterior portion of the bladder and hydronephrosis is present. The structure in the bladder is MOST likely: a. a phabdomyosarcoma b. a bladder diverticulum c. a pelvic kidney d. a ureterocele e. an ovarian cyst

d. a ureterocele

Although there are many variations in normal anatomy, the usual site for bifurcation of the common hepatic duct into the right and left hepatic ducts takes place: a. posterior and medial to the hepatic artery b. anterior to the portal vein bifurcation c. in the lateral portion of the head of the pancreas d. anterior and superior to the right hepatic artery

d. anterior and superior to the right hepatic artery

Time gain compensation (TGC), depth gain compensation (DGC), or swept gain compensates for sound: a. reflection b. refraction c. focusing d. attenuation e. propagation speed

d. attenuation

Which of the following increases the blood urea nitrogen level?: a. decreased protein intake b. pregnancy c. liver failure d. dehydration e. excessive fluid intake

d. dehydration

One year after surgery, a patient presents complaining of tenderness deep to the incision. The 3-cm long incision is directly below the umbilicus and has healed nicely. The patient has a slight fever and a mildly elevated white blood count. His hematocrit is normal. On ultrasound, a dense, linear echo with well-defined shadowing is seen in the midline, posteriour to the incision within the mesentery. The diagnosis is confirmed with a CT scan. Most likely differential diagnosis? a. lymphocele b. calculus c. hematoma d. gossyphiboma e. postoperative air

d. gossyphiboma - surgical gauze left behind after surgery

A patient presents with severe abdominal pain, nausea, vomiting, abdominal distention, increased lipase levels, and decreased hematocrit. What should the sonographer suspect?: a. hepatitis b. duodenitis c. cholecystitis d. hemorrhagic pancreatitis e. cholelithiasis

d. hemorrhagic pancreatitis

A 30-year-old man is referred to ultrasound for generalized right upper quadrant tenderness and early signs of jaundice. His gallbladder appears normal, but there are bright focal areas without shadowing scattered throughout his liver. On close inspection, these areas are seen to be the walls of the portal vein branches. What is first in the list of differential diagnoses? a. choledocholithiasis b. multiple focal abscesses c. metastatic lesions d. hepatitis e. pneumobilia

d. hepatitis

The most common malignant breast tumor in the USA is: a. medullary carcinoma b. fibroadenoma c. lobular carcinoma d. infiltrating ductal carcinoma e. Paget's disease

d. infiltrating ductal carcinoma

A preoperative ultrasound study reveals a solitary liver mass displacing two structures in the liver. The surgeon is told he can confine his operation to the medial segment of the left lobe. Which two structures are being displace? a. ligamentum teres and gallbladder b. fissure for the ligamentum venosum and left portal vein c. main portal vein and hepatic duct d. left hepatic vein and middle hepatic vein

d. left hepatic vein and middle hepatic vein

Which of the following correctly describes the placement of structures in the neck from medial to lateral?: a. left lobe of thyroid, internal jugular vein, common carotid artery b. right lobe of thyroid, internal carotid artery, internal jugular vein c. internal carotid artery, right lobe of thyroid, internal jugular vein d. left lobe of thyroid, common carotid artery, internal jugular vein e. right lobe of thyroid, internal carotid artery, external carotid artery

d. left lobe of thyroid, common carotid artery, internal jugular vein

On a transverse view of the mid abdomen, which of the following can be seen coursing between the aorta and the SMA? a. body of the pancreas b. inferior vena cava c. right renal vein d. left renal vein e. superior meseteric vein

d. left renal vein

An inexperienced sonography student was unable to visualize a patient's gallbladder. The patient had no incisions and assured the sonographer that she had fasted as instructed. Knowing that the clinician suspected gallstones, the sonographer decided to take enough images so as not to miss the gallbladder. Without realizing it, the sonographer demonstrated the gallbladder filled with stones on which of the views? a. transverse view, including the long axis of the right portal vein b. longitudinal view at the level of the duodenum c. LLD view at the level of the pancreas d. long view, including the right portal vein and the main lobar fissure e. long view throught the liver and right kidney

d. long view, including the right portal vein and the main lobar fissure

Which of the following is a condition in which small stones are present in the renal pyramids? a. staghorn calculus b. cystitis c. pyelonephritis d. nephrocalcinosis e. pyonephrosis

d. nephrocalcinosis

Pneumothorax is routinely ruled out after a pleurocentesis by: a. auscultating the lungs b. injecting contrast before the needle is removed c. obtaining a posteroanterior chest xray taken on inspiration d. obtaining a posteroanterior chest xray taken on expiration e. looking for pneuothorax with us

d. obtaining a posteroanterior chest xray taken on expiration

A patient presents with a dilated CBD and an ill-defined pancreatic head mass with poor through transmission. Which of the following is the MOST likely diagnosis? a. gallstone pancreatitis b. common bile duct calcification c. pancreatic pseudocyst d. pancreatic cancer e. hepatoma

d. pancreatic cancer

Which of the following techniques is the MOST satisfactory for recording and maintaining an accurate representation of the image seen on the US screen?: a. thermal paper b. radiographic film c. polaroid film d. picture-archiving systems (PACS) e. VHS videotape

d. picture-archiving systems (PACS)

The artery(ies) that carries(y) 15-30% of the total cardiac output is(are) the: a. left gastric artery b. left common carotid artery c. superior mesenteric artery d. renal arteries e. common iliac arteries

d. renal arteries

Which of the following is the MOST common germ cell tumor of the testicles? a. testicular metastases b. teraltoma c. dermoid d. seminoma e. embryonal cell carcinoma

d. seminoma

Which of the following structures is NOT retroperitoneal?: a. aorta b. inferior vena cava c. kidneys d. spleen e. adrenal glands

d. spleen

A cirrhotic liver is hyperechoic which means a. there are no flectors b. there are few echoes c. there are high impedance interfaces d. there are many reflectors e. there is decreased echgenicity

d. there are many reflectors

Cirrhosis of the liver can be caused by all of the following EXCEPT: a. ETOH abuse b. Obstruction by cholelithiasis c. Hepatitis B d. Chemical toxicity e. Diabetes mellitus

e. Diabetes mellitus

Which of the following is NOT a transrectal US diagnosis? a. Infertility b. A seminal vesicle cyst c. Prostatic calculi d. Congenital vas deferens absence e. Peyronie's disease

e. Peyronie's disease (crooked penis)

Which of the following is NOT an indication for renal artery Doppler imaging? a. Possible renal artery stenosis b. Hypertension c. Abdominal bruit d. Unilateral small kidneys e. Renal calculi

e. Renal calculi

All of the following are characteristics of pyloric stenosis EXCEPT: a. Abnormally thickened pyloric wall b. Projectile vomiting c. Presence of an epigastric mass d. A persistent fluid-filled stomach e. Shortened pyloric length

e. Shortened pyloric length

A 39-year-old renal transplant patient arrives in the US department. The patient is referred for all of the following EXCEPT: a. Rule out hydronephrosis b. Rule out fluid collections around kidney c. Doppler imaging of the arcuate artery to rule out rejection d. Doppler imaging of the renal vein to rule out kinked vein e. To rule out cyclosporine toxicity

e. To rule out cyclosporine toxicity

All of the following increase in hepatocellular disease EXCEPT: a. alanine aminotransferase (ALT) b. aspartate aminotransferase (AST) c. prothrombin time (PT) d. bilirubin e. acid phosphatase

e. acid phosphatase

A 42-year-old man is found to have a 14mm parathyroid gland on US evaluation. Based on this finding, the sonographer should look: a. at the abdomen for a primary neoplasm b. at the juglar vein for tumor invasion c. at the esophagus to rule out obstruction d. along the major vessels for adenopathy e. at the kidneys for calcifications

e. at the kidneys for calcifications

Extrahepatic collections of extravasated bile from abdominal trauma, biliary surgery, or gallbladder disease are known as: a. hematomas b. choledochal cysts c. lymphoceles d. urinomas e. bilomas

e. bilomas

A focal mass that does not appear to be a regenerating nodule is seen on ultrasound in a patient with end-stage cirrhosis. The mass should be considered malignant until proved otherwise. This statement is TRUE because: a. there is no completely solid hepatic tumor that is benign b. the histology of a mass cannot be proved until a biopsy is performed c. malignant tumors in cirrhosis are always vascular, which can always be proved with color flow doppler d. it is unusual to see regenerating nodules in cirrhosis e. cirrhosis is strongly associated with hepatocellular carcinoma

e. cirrhosis is strongly associated with hepatocellular carcinoma

The ampulla of Vater is another name for the: a. accessory pancreatic duct b. entrance of the gda and the cbd into the pancreatic head c. junction of the splenic vein, smv and portal vein d. outlet of the stomache e. entrance of the cbd and pancreatic duct into the duodenum

e. entrance of the cbd and pancreatic duct into the duodenum

A gallbladder contains gallstones and one wall shows localized, severe thickening/ Which of the following is the MOST likely diagnosis?: a. empyema b. cholecystitis c. adenomyomatosis d. hemobilia e. gallbladder cancer

e. gallbladder cancer

The vessel normally seen lying posterior to the head of the pancreas is the: a. aorta b. pancreatic artery c. clenic artery d. hepatic artery e. ivc

e. ivc

A transducer with small rectangular elements lined up side by side and firing in a straight line is a: a. curved linear (curved array) transducer b. phased array transducer c. mechanical sector transducer d. intracavitary transducer e. linear array transducer

e. linear array transducer

Which of the following statements concerning metastatic lesions to the liver is TRUE? a. Metastases in the GB are from melanoma b. Metastases from the colon invariably appear as "bulls eye lesions" c. Color flow Doppler demonstrates if a tumor or metastatic lesion is vascular d. lymphoma causes hypoechoic lesions in the liver e. one can never make a tissue-specific diagnosis form the sonographic appearance of a lesion

e. one can never make a tissue-specific diagnosis form the sonographic appearance of a lesion

Which of the following conditions causes leukocytosis?: a. benign prostatic hypertrophy b. AIDS c. anemia d. goiter e. pyelonephritis

e. pyelonephritis

Put the following normal renal structures in order from least to greatest echogenicity. a. pyramids, sinus fat, cortex b. sinus fat, pyramids, cortex c. sinus fat, cortex, pyramids d. cortex, sinus fat, pyramids e. pyramids, cortex, sinus fat

e. pyramids, cortex, sinus fat

Absence or failure of formation of the kidneys is: a. renal noesis b. renal dysgenesis c. renal dysamyomenosis d. arenaluria e. renal agenesis

e. renal agenesis

The typical position for scanning the spleen is: a. reverse Trendelenburg b. prone c. erect d. left lateral decubitus e. right lateral decubitus

e. right lateral decubitus

Which of the following blood tests is helpful in diagnosing acute pancreatitis? a. bilirubin b. LDH c. alk phos d. creatinine e. serum amylase

e. serum amylase

A palpable "olive" sign is one of the common criteria used by clinicians to request which ultrasound examination? a. renal sonogram on a patient with a history of adult polycystic kidney disease b. sonogram of the pancreas on a patient with an elevated amylase c. sonogram of the groin after femoral catheterization and subsequent swelling d. sonogram of the aorta on an elderly patient with epigastric pain e. sonogram of the stomach on an infant with persistent projectile vomiting

e. sonogram of the stomach on an infant with persistent projectile vomiting

Which of the following laboratory values will MOST likely be abnormal in a patient with a multinodular goiter?: a. serum calcium b. potassium c. triiodothyronine and thyroxine d. white blood cells e. thyroid-stimulating hormone

e. thyroid-stimulating hormone

After cholecystectomy, the CBD measures 8mm in a patient experiencing RUQ and back pain. Which of the following may NOT be true? a. The "duct" is actually a large hepatic artery b. There is a stone lodged in the CBD or ampulla of Vater c. This may be a normal finding in an elderly patient d. This may be a normal finding in a postcholecystectomy patient e.This is a normal response to food in a 25-year-old patient

e.This is a normal response to food in a 25-year-old patient

A patient recently diagnosed with AIDS is sent for a baseline sonogram. All of the following are related to AIDS and could be found on an abdominal ultrasound study EXCEPT: a. multiple abscesses in the liver or spleen b. flukes in the gallbladder c. a thick walled gallbladder d. lymphadenopathy e. enlarged, echogenic kidneys

flukes in the gallbladder

An inability to detect blood flow in the portal vein may be caused by all of the following EXCEPT: a clot in the portal vein low flow velocity in the portal vein high flow velocity in the portal vein a transducer angle perpendicular to the portal vein an obscuring mass

high flow velocity in the portal vein

The right and left lobes of the liver are separated by all of the following EXCEPT: a. the falciform ligament b. the gallbladder c. the interlobar fissure d. the middle hepatic vein

the falciform ligament

The porta hepatis contains all of the following EXCEPT: the sphincter of Oddi the portal vein Glisson's capsule the hepatic artery the common bile duct

the sphincter of Oddi

All of the following are procedures used to relieve apparent or genuine hydronephrosis EXCEPT: Nephrostomy tube Having the patient urinate A renal vein stent Inserting a catheter into the bladder Prostatectomy

A renal vein stent

All of the following are typical characteristics of multicystic dysplastic kidney disease EXCEPT: Bilateral, evenly echogenic kidneys Multiple cysts that don't communicate Little or no renal parenchyma present Fatal if bilateral Cysts of varying size and shape

Bilateral, evenly echogenic kidneys

Hepatofugal flow may be indicative of all of the following EXCEPT: CBD obstruction A poor Doppler angle Portal hypertension A cirrhotic liver Portal vein thrombosis

CBD obstruction

Enlarged lymph nodes may do all of the following EXCEPT: Compress the ureter Compress the aorta Compress the IVC Displace the SMA Displace bowel

Compress the aorta

A 50-year-old woman is referred for a breast sonogram. All of the following aspects of her history are important to know EXCEPT: Pain and tenderness Nipple discharge Family history of breast cancer Localized mass Family history of gynecomastia

Family history of gynecomastia

All of the following are normal variants in the adult kidney EXCEPT: Dromedary hump Multiple renal arteries Oblique position in the patient A column of Bertin Greater echogenicity of the renal parenchyma compared to the normal liver

Greater echogenicity of the renal parenchyma compared to the normal liver

All of the following are features of portal hypertension EXCEPT: Collaterals Splenomegaly Ascites Hepatic artery thrombosis Recanalization of the paraumbilical veins

Hepatic artery thrombosis

Common causes for acute pancreatitis include all the following EXCEPT: a. Hypertension b. Alcoholism c. Pancreatic duct calculus d. Blunt midabdominal trauma e. Gallstones

Hypertension

Having the patient drink water during a pancreatic sonogram may be useful in all of the following ways EXCEPT: a. Using the fluid-filled duodenum to image the pancreatic head b. Distinguishing the stomach from a pancreatic pseudocyst c. Increasing the gas in the abdomen, thereby pushing the pancreas into a better position for scanning d. Imaging the pancreatic tail through the fundus of the stomach e. Distinguishing the duodenum from a pancreatic mass

Increasing the gas in the abdomen, thereby pushing the pancreas into a better position for scanning

Findings in a patient with acute pancreatitis of recent onset may include all of the following EXCEPT: Gallstones A normal sonographic appearance of the pancreas A pancreatic pseudocyst Low urine amylase Pain

Low urine amylase (should be increased)

All of the following are possible causes of hyperbilirubinemia EXCEPT: Increased red blood cell destruction Congenital disease Common duct stone Presbyductia Severe cirrhosis

Presbyductia

All of the following are characteristics of an infant with prune-belly syndrome EXCEPT: Hydronephrosis Renal agenesis Enlarged bladder Dilated posterior urethra Hydroureter

Renal agenesis

Which of the following is NOT a cause of gross hematuria? Bladder calculi Benign prostatic hypertrophy Renal stones A bladder tumor Renal sinus lipomatosis

Renal sinus lipomatosis