Clinical 20% Miscellaneous
B. Unintended weight loss is a common symptom in patients with cancer. Patients with ascites, hyperglycemia and hypothyroidism experience weight gain.
Unintended weight loss is a common symptom in patients with: A. Hypothyroidism B. Carcinoma C. Hyperglycemia D. Ascites
B. Adrenal Hemorrhage usually presents as jaundice and anemia. It most commonly occurs in newborns and is caused by birthing process. In adults, it is related to trauma and hematologic disorders such as thrombocytopenia. Adrenal glands are highly vascular organs and hemorrhage results in decreased hematocrit (indicates internal bleeding). Sonographic Appearance: Mass with varied echogenicity with age of thrombus
What clinical symptoms are common with adrenal hemorrhage? A. Nausea and vomiting B. Jaundice and low hematocrit C. Hyperkalemia and dysuria D. Weight loss and edema
C. McBurney point: lies one-third of the distance laterally on a line drawn from the umbilicus to the right anterior superior iliac spine. This point is the most common location of the appendix in the RLQ. It relates to the point of greatest tenderness in a patient with appendicitis.
What does McBurney point refer to? A. An ectopic mass of endometriosis on the right kidney B. An ectopic ridge of thyroid tissue in the chest C. The most common location of the appendix D. The point of greatest tenderness in the RUQ in a patient with cholecytitis.
C. The best time to evaluate infant hips for developmental dysplasia is between 4-6 weeks of age. The supporting structures should have strengthened after birth but the ossification of the femoral head is not yet complete.
What patient age is preferred for performing ultrasound of the infant hips? A. 4 - 6 months B. > 6 months C. 4 - 6 weeks D. 1 - 2 weeks
B. To evaluate the Achillies' tendon, place the patient in the prone position with their feet dangling off the end of the table. Measure the tendon thickness and obtain comparison views of the unaffected leg.
What patient position is used to evaluate the Achilles' tendon with ultrasound? A. Seated, knee and ankle flexed B. Prone, feet dangling C. Standing D. Seated, knee flexed and ankle extended
D. When evaluating an infant for pyloric stenosis, the infant should be placed in the right lateral decubitus position for better visualization of the pylorus.
When evaluating an infant for pyloric stenosis, the infant should be placed in the ______________ position for better visualization of the pylorus. A. Left lateral decubitus B. Prone C. Semi-erect D. Right lateral decubitus
C. When evaluating an infant hip, the transducer is placed on the lateral hip, but for a pediatric hip evaluation the transducer is placed on the anterior hip. Infant hip evaluation is for hip dysplasia and pediatric hip evaluation is for inflammation and effusion.
When evaluating an infant hip, the transducer is placed ____________, but for a pediatric hip evaluation the transducer is placed _____________. A. On the lateral hip, on the posterior hip B. On the anterior hip, on the posterior hip C. On the lateral hip, on the anterior hip D. On the anterior hip, on the lateral hip
A. The thickness of the Achilles tendon should be measured in the transverse plane. Normal thickness is 5-7 mm.
When evaluating the Achilles tendon, the thickness of the tendon should be obtained in what imaging plane? A. Transverse B. Oblique C. Sagittal D. Coronal
C. When removing a protective gown, remove your gloves, untie the strings, pull the gown forward from the shoulders using the neck strings, grab the inside shoulder seams pull it off the arms and turn it inside out as it is removed, wash your hands.
When removing a protective gown: A. Untie the strings, pull the gown forward from the shoulders using the neck strings to turn it inside out as it is removed, remove your gloves, wash your hands B. untie the strings, roll the gown upward from the bottom edge to turn it inside out, pull it from the shoulders and off the arms, remove your gloves, wash your hands C. Remove your gloves, untie the strings, pull the grown forward from the shoulders using the neck strings, grab the inside shoulder seams to pull it off the arms and turn it inside out as it is removed, wash your hands D: remove your gloves, untie the strings, pull the gown forward from the center of the front of the gown to remove it with the exposed side out, roll it into a ball, wash your hands
D. An enlarged prostate can cause urine retention in the bladder and associated hydronephrosis.
When the prostate is enlarged, what other structures should be evaluated for related findings? A. Renal arteries for thrombosis B. Renal veins for Nutcracker syndrome C. Portal vein for thrombosis D. Kidneys for hydronephrosis
B. A water enema can be helpful to evaluate lumen characteristics of the colon. It may assist in identitying an intraluminal detect or tumor formation.
Which of the following abnormalities would benefit the most from the administration of a water enema during the ultrasound evaluation? A. Pancreatic adenocarcinoma (head) B. Adenocarcinoma of the descending colon C. Distal abdominal aorta D. Gastric sarcoma
D. A pheochromocytoma causes symptoms similar to chronic anxiety. Weight loss, increased adrenaline, tachycardia and palpitations are common symptoms. Bradycardia refers to a slow heart rate.
Which of the following are clinical findings related to a pheochromocytoma? A. Hirsutism and bilateral pedal edema B. Palpitations and skin discoloration C. Bradycardia and fatigue D. Increased adrenaline and anxiety
D. Cushing syndrome is characterized by truncal obesity, hirsutism, amenorrhea, HT, fatigue, hyperglycemia. It is usually caused by excessive cortisol secretion from an adrenal mass.
Which of the following are common symptoms of Cushing syndrome? A. Hypotension and fever B. Anorexia and vomiting C. Cholecystitis and ascites D. Hyperglycemia and Hirsutism
A. A penile duplex exam can be performed to evaluate a vascular cause of erectile dysfunction. The cavernosal artery diameters and velocities are evaluated before and after an injection of vasoactive substance. The dorsal vein is also evaluated.
Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction? A. Cavernosal B. Dorsal C. Urethral D. Ventral
B. Pheochromocytoma cause increased secretion of dopamine, epinephrine and norepinephrine. This leads to symptoms that include HT, anxiety, headache, nausea, vomiting, sweating, tachycardia and palpitations. Tumors originate in medulla tissue and grow to an average size of 5-6cm.
A 40 yr old male presents for an abdominal US exam with a history of anxiety, headaches and excessive sweating. HIs current BP is 174/90 mmHg with a pulse of 102 bpm. What is the referring doctor expecting to find? A. Budd Chiari syndrome B. Pheochromocytoma C. Adenomyosis D. Aortic aneurysm
B. Gleason score is used to classify prostate cancer; 1-10 with 10 as most aggressive. A score of 8 indicates a moderately aggressive prostate tumor. The pelvis should be evaluated for lymphadenopathy and metastasis related to prostate cancer.
A 55 yr old male patient presents with a script that states "pelvic ultrasound; post biopsy, Gleason score of 8". What should you expect to find on the exam? A. Bladder puncture caused by recent biopsy of the seminal vesicle B. Lymphadenopathy and metastasis related to prostate cancer C. Inguinal hernia caused by recent bladder wall biopsy D. Lymphadenopathy and metastasis related to transitional cell bladder cancer
A. Bezoars are intraluminal masses of undigested material Concretions - inorganic substances; medications, bubble gum Trichobezoar - hairball Phytobezoar - undigestible plant or vegetable materials (cellulose) Lactobezoar - milk materials; seen in infants
A mother presents with her 3 mo old infant due to excessive vomiting and crying for 3 days. The referring physican suspects a lactobezoar may be the problem. Where will you look for this abnormality? A. Anywhere along the digestive tract B. Urinate bladder C. The appendix D. Gallbladder
C. Puerperal mastitis is associated with lactation and is caused by bacteria invading the nipple through cracks in the skin. The ducal system dilates and debris may be identified within the ducts.
A mother who is currently breast feeding presents with a painful and reddened area on the UOQ of the right breast. She states that she first notified it two days ago. What is the most likely finding on her exam? A. Paget disease B. Cyst C. Puerperal mastitis D. Inflammatory carcinoma
B. 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. Swelling of the salivary glands with a dry mouth is a common finding with Sjogren syndrome.
A patient presents for a neck ultrasound due to swelling under the angle of the jaw and anterior to the ear. She also complains of a dry mouth, dry cough, and dry eyes. These clinical findings are most suggestive of: A. Hashimoto thyroiditis B. Sjogren syndrome C. Graves' disease D. Hemolytic anemia
D. Rocking the transducer will ensure the transducer face is perpendicular to the tendon and anisotropy artifact is eliminated. Comparison views are always helpful in MSK evaluations. Inflammation of the tendon can demonstrate increased vascularity on color Doppler evaluation. Power Doppler offers increased sensitivity for hypervascularity. Variation in the arm position is helpful in tendon evaluation but the use of weights is not part of the protocol and could further strain a damaged tendon.
A patient presents for an extremity ultrasound to evaluate the bicep tendon for tendinitis. The following image was obtained on the symptomatic left arm. All of the following would improve the tendon evaluation, except? A. Rock the transducer back and forth to ensure the transducer face is perpendicular to the tendon B. The right bicep tendon should be evaluated to provide comparison views. C. Power Doppler should be applied to assess any increased vascularity associated with inflammation. D. Ask the patient to hold a 5 lb weight and reassess the thickness of the tendon
A. Aldosterone and cortisol will be low due to the hypofunction of the adrenal cortex. The pituitary gland will respond by producing higher levels of ACTH.
A patient presents with a history of Addison disease. Which of the following hormone levels will be increased? A. Adrenocorticotropic Hormone B. Cortisol C. Aldosterone D. Epinephrine
B. Cortisol and ACTH levels are increased with Cushing disease. Cortisol decreases with Addison disease. Aldosterone increases with Conn syndrome.
A patient presents with a history of Conn syndrome Which of the following hormone levels will be increased? A. Cortisol B. Aldosterone C. Epinephrine D. Adrenocorticotropic Hormone
C. Cushing Syndrome caused by Cushing disease = elevated serum ACTH and cortisol in urinalysis. Pituitary tumor causes over production of ACTH which causes overproduction of cortisol by the adrenal glands. Cushing Syndrome caused by steroid use or adrenal tumor = elevated cortisol on urinalysis; no pituitary gland involvement, normal serum ACTH levels
A patient presents with a history of Cushing syndrome and an adrenal tumor. What lab results are expected in the clinical findings? A. Elevated serum levels of aldosterone B. Elevated serum levels of cortisol and ACTH C. Elevated cortisol levels in the urine D. Elevated epinephrine levels in the urine
C. Cushing disease can be caused by a pituitary tumor. It leads to excessive production of adrenocorticotropic hormone (ACTH) by the pituitary gland. This will cause the adrenal gland to produce excessive cortisol. An adrenal tumor or chronic steroid use can also cause excessive cortisol production by the adrenal glands. Normal ACTH levels with high cortisol levels indicates Cushing syndrome. Chronic elevation of cortisol results in a group of clinical findings that include obesity, purple stretch marks on the sides and lower abdomen (striae) hirsutism, amenorrhea and hyperglycemia. These clinical findings related to high cortisol levels is called Cushing syndrome.
A pituitary tumor that is causing Cushing syndrome will cause what lab value(s) to be increased? A. Cortisol only B. Aldosterone only C. Adrenocorticotropic hormone and cortisol D. Adrenocorticotropic hormone only
A. The Tinel sign is the tingling or prickling sensation elicited by the percussion of an injured nerve. A positive Tinel sign indicates carpal tunnel syndrome is present at the wrist
A positive Tinel sign indicates: A. Carpal tunnel syndrome B. Patellar tendinitis C. Pyloric stenosis D. Ruptured Archilles' tendon
B. A common clinical indication for hip ultrasound is a palpable "clunk" or clicking sound with manipulation. A positive Allis or Galeazzi sign refers to visual shortening of the femur(s) when the hip(s) and knee(s) are flexed. Asymmetric folds of the skin around the thigh at the hip area may be noted. The Barlow and Ortolani maneuvers are used to assess the hip during the exam.
All of the following are clinical signs of congenital hip dysplasia, except: A. Allis sign B. Barlow sign C. Palpable clunking sound on physical exam D. Asymmetric skin folds of the hip and thigh
B. Hemoptysis refers to coughing up bloody sputum from the lungs. Colitis is associated with a low grade fever, pain, cramping, and watery diarrhea. Bloody diarrhea and rectal bleeding occur with ulcerative colitis.
All of the following are common symptoms of colitis, except: A. Bloody diarrhea B. Hemoptysis C. Low grade fever D. Watery diarrhea
B. The image demonstrates an abnormal appendix in the RLQ. Appendicitis is associated with rebound tenderness, increased white blood cell count, nausea and vomiting.
All of the following are sign and symptoms related to the abnormality seen on the images, except? A. Rebound tenderness in RLQ B. Hematuria C. Leukocytosis D. Nausea and vomiting
A. Graded compression should demonstrate pliable loops of bowel with normal peristalsis. Rebound pain should not be present when the compression of a normal bowel segment is released.
An average sized patient presents with a fever, acute RLQ pain and vomiting. The ER physician wants to rule out appendicitis in the patient. Which of the following techniques would be used in the US exam? A. Apply graded transducer compression to the area of interest B. Use a stand-off pad to better visualize the superficial bowel loops C. Ask the patient to drink 32 oz of water and fill the bladder prior to the exam D. Ask the patient to perform the Valsalva maneuver while scanning.
A. Chest ultrasound is very helpful in evaluating pneumothorax, pleural effusion and empyema. It is also used to evaluate pneumonia, atelectasis, sequestration, chest/mediastinal masses and congenital airway malformations. Diaphragm paralysis, hernia or rupture can also be assessed with Sonography. US guidance can be used for thoracentesis and biopsy. Unfortunately ultrasound cannot effectively evaluate normal lung anatomy and assessment of the number of lobes would not be possible.
Chest sonography is a valuable tool that can be used to evaluate all the following, except? A. The number of lobes in each lung B. Pulmonary sequestration C. Pneumothorax D. Pleural effusion
C. Cushing Disease is caused by excessive secretion of ACTH by the pituitary gland. It is related to a pituitary tumor. Lab Testing: hypersecretion of ACTH by pituitary gland causes increased cortisol production by the adrenal gland; excess cortisol causes increased glucose production (hyperglycemia) Cushing syndrome is associated with excess cortisol, no matter what the cause. Steroid use is the most common cause of Cushing syndrome, but adrenal tumors can also be related. Cushing syndrome is characterized by truncal obesity, hirsutism, amenorrhea, HTN, fatigue, hyperglycemia. It is usually caused by excessive cortisol secretion from an adrenal mass.
Chronic steroid use is the most common cause of: A. Conn disease B. Addison disease C. Crushing syndrome D. Crushing disease
A. Cullen sign is hemorrhagic discoloration of the umbilical area caused by intraperitoneal hemorrhage. Grey Turner sign is hemorrhagic discoloration of the left flank caused by acute hemorrhagic pancreatitis.
Cullen sign is hemorrhagic discoloration of the umbilical area caused by ________________. Grey Turner sign is hemorrhagic discoloration of the left flank caused by _________________. A. Intraperitoneal hemorrhage, hemorrhagic pancreatitis B. Cavernous transformation, gastric varices C. Recuts sheath hematoma, subcapsular renal hematoma D. Umbilical vein recanalization, gastric varices
C. Increased hematocrit means the percentage of red blood cells is above the upper limits of normal. Causes include dehydration, living at a high altitude, COPD, and polycythemia vera. A low hematocrit means the percentage of red blood cells is below the lower limits of normal. Causes include internal bleeding (varices), red blood cell destruction (anemia), kidney failure, and malnutrition.
Decreased hematocrit is associated with which of the following? A. Polycythemia Vera B. Living at high altitude C. Hemorrhagic cyst of the kidney D. Dehydration
D. Adrenal hyperplasia, adrenal cortical cancer and polycystic ovarian disease are associated with excessive androgen production. The excessive hormones can cause hirsutism which refers to male pattern hair growth.
Excessive androgen production is commonly associated with adrenal hyperplasia, adrenal cortical cancer, and Polycystic ovarian disease. How will these increased androgen levels Preston as a clinical finding? A. Alopecia B. Pedal edema C. Excessive nausea and vomiting D. Hirsutism
B. Conn syndrome demonstrates low levels of potassium (hypokalemia) and high levels of sodium (hypernatremia). This causes excessive thirst and urination. High levels of potassium (hyperkalemia) and low sodium levels (hyponatremia) are seen with Addison disease.
Hypernatremia and hypokalemia are clinical signs of A. Addison disease B. Conn syndrome C. Adrenal hemorrhage D. Adrenal myelolipoma
A. Hyperpigmentation of the skin is a sign of Addison disease. Purple stretch marks (striae) on the lower and lateral abdomen are a signs of Cushing syndrome.
Hyperpigmentation of the skin that results in brownish discoloration is a clinical sign of: A. Addison disease B. Adrenal hemorrhage C. Conn disease D. Cushing syndrome
D. Thompson Test - patient placed in the prone position and the calf muscle is squeezed. If the foot flexes in response to the squeeze of the tendon is not completely torn. If the foot is non-reactive to the squeeze, the tendon is completely torn.
If a patient has a non-reactive Thompson Test, what problem do they have? A. Baker cyst in the popliteal fossa B. Hydatid cyst of the liver C. Fungal abscess of the liver D. Complete tear of the Achilles tendon
C. you unable to locate the prostate on transrectal ultrasound, have the patient drink water and fill their bladder. The bladder is used as a landmark to locate the prostate between the bladder and the rectum.
If you are unable to locate the prostate on transrectal ultrasound: A. Ask the patient to perform the Valsalva maneuver B. Use firm pressure to insert the transducer 2-3 inches further into the rectum C. Have the patient drink water and partially fill their bladder D. Introduce 30-50cc of air into the probe cover
A. Internal rotation of the arm is preferred for evaluation of the supraspinatus tendon, while external rotation of the arm is preferred for evaluation of subscapularis tendon.
Internal rotation of the arm is preferred for evaluation of the ____________ tendon, while external rotation of the arm is preferred for evaluation of ______________ tendon. A. Supraspinatus, subcapularis B. Subcapularis, supraspinatus C. Long bicep, short bicep D. Flexor, biceps
D. Prostatic Acid Phosphatase (PAP) serum levels are increased with prostate carcinoma.
Prostatic Acid Phosphatase (PAP) levels are increased with: A. BPH B. Prostate calcifications C. Prostatitis D. Prostate carcinoma
D. Hyperpigmentation of the skin is a sign of Addison disease. Purple stretch marks (striae) on the lower and lateral abdomen are a signs of Cushing syndrome.
Purple stretch marks (striae) on the lateral and lower abdomen can be a clinical sign of: A. Addison disease B. Adrenal hemorrhage C. Conn disease D. Crushing syndrome
A. Red currant jelly stool - stool contains a mixture of blood and mucus. This a classic clinical finding of Intussusception.
Red Currant jelly stool is a common clinical findings associated with: A. Intussusception B. Pyloric stenosis C. Mesenteric ischemia D. Appendicitis
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.
Sjogren syndrome is an immune system disorder that commonly affects: A. The salivary glands B. Bile ducts C. Adrenal glands D. Thyroid
D. The Graf classification requires the measurement of alpha and beta angles to determine the presence of abnormal findings on the ultrasound exam. Graf classification is based on the position of the femoral head related to the acetabulum. Alpha angle less than 60 degrees suggests abnormal findings. Alpha angle <43 degrees indicates dislocation.
The Graf classification requires the measurement of __________________ to determine the presence of abnormal findings on the ultrasound exam. A. End diastolic velocity B. Vessel diameter C. Resistive index D. Alpha and beta angles
D. The olive sign is a clinical finding with pyloric stenosis, while the doughnut sign is a Sonographic sign of pyloric stenosis. The olive sign refers to the palpation of the thickened pylorus muscle on the clinical exam. It feels like an olive in size and shape. The doughnut sign refers to the cross section appearance of the pyloric canal.
The ______________ sign is a clinical finding with pyloric stenosis, while the __________________ sign is a sonographic sign of pyloric stenosis. A. Pseudokidney, Yin Yang B. Murphy, Homan's C. Bird, Snowman D. Olive, Doughnut
B. Alpha angle is measured between line 1 (vellow) and 2 (red). It refers to the angle that is formed by the acetabular roof to the vertical cortex of the iliac bone. The normal value is greater than or equal to 60 degrees. Less than 60 degrees suggests dysplasia, subluxation or dislocation
The image displayed is an infant hip ultrasound with measurements added. Which letter indicated where the alpha angle is measured? A. B B. C C. D D. None of the above
D. Beta angle is measured between line 1 (yellow and 3 (blue). It refers to the angle formed between the vertical cortex of the iliac bone and the triangular labral fibrocartilage (echogenic triangle). It is not universally used to assess dysplasia.
The image displayed is an infant hip ultrasound with measurements added. Which letter indicated where the beta angle is measured? A. A B. B C. C D. D
C. The most common use of chest sonography to evaluate a complete or partial radiopaque hemithorax. Ultrasound distinguishes pleural effusion from pulmonary causes of pacification.
The most common use of chest sonography is to evaluate: A. Suspected lung cancer B. A known pulmonary embolism C. A complete or partial radiopaque hemithorax D. Suspected atelectasis
C. A lung mass that is located between the chest wall and the pleura can usually be seen with ultrasound because there is no air to obscure the image. If there is air between the transducer face and the mass, it will not be visualized in most cases due to scatter.
Which of the following chest masses would be most easily be evaluated with ultrasound? A. A mass located in the central portion of the lung B. A mass located between the bronchial tubes C. A mass located between the pleura and the chest wall D. A mass located in the posterior lobes
D. Transracial ultrasound or the prostate is performed with the patient in the left lateral decubitus or lithotomy position.
Which of the following describes the patient position for a trans recital prostate ultrasound? A. Lithotomy or prone B. Prone or Fowler C. Trendelenburg or supine D. Left lateral decubitus or lithotomy position
D. Infant Hip Alpha/Beta Angle Assessment Line 1 - Aligned with iliac bone extends through femoral head Line 2- Extends from the iliac bone along the labrum on the medial aspect of the femoral head Line 3 - Extends from the bony edge of the acetabulum to the lateral aspect of the femoral head
Which of the following describes the placement for the first line for measurement of the alpha angle during an infant hip evaluation? A. Extends from the bony edge of the acetabulum to the lateral aspect of the femoral head B. Extends from the iliac bone along the labrum C. Extends from the bony edge of the acetabulum to the medial aspect of the femoral head D. Aligned with iliac bone and extends through femoral head
D. Infant Hip Alpha/Beta Angle Assessment Line 1 - Aligned with iliac bone extends through femoral head Line 2- Extends from the iliac bone along the labrum on the medial aspect of the femoral head Line 3 - Extends from the bony edge of the acetabulum to the lateral aspect of the femoral head
Which of the following describes the placement for the second line for measurement of the alpha angle during an infant hip evaluation? A. Aligned with iliac bone and extends through the center of the femoral head B. Extends from the iliac bone, along the labrum, and the lateral aspect of the femoral head C. Extends from the bony edge of the acetabulum to the lateral aspect of the femoral head D. Extends from the iliac bone, along the labrum and the medial aspect of the femoral head.
A. Use linear probe in an oblique plane on the anterior hip (parallel to the femoral neck); Normal hip capsule 2-5mm thick; should be symmetric between hips; Both hips should have should be evaluated for capsule comparison Transient Arthritis - Common cause of hip pain in children; May present with a history of recent respiratory infection, no fever at the onset of the hip pain; Treated with anti-inflammatory meds Septic Arthritis - Bacterial infection causes inflammation; Patient presents with fever, increased WBC count and hip pain; CONSIDERED A MEDICAL EMERGENCY to prevent long term joint damage; Requires US guided arthrocentesis for fluid evaluation; treated with IV antibiotics
Which of the following describes the proper technique for the evaluation of a pediatric hip for suspected transient arthritis? A. Comparison views of the unaffected hip should always be obtained B. The normal hip capsule thickness is less than 1 cm C. The curved array is used for the best evaluation of the curved structures in the boney hip. D. Transient arthritis requires an immediate arthrocentesis for fluid evaluation
B. Dynamic imaging is also helpful to assess tendons. Scanning with the US beam as perpendicular to the tendon as possible to improve visualization and eliminate anisotropy artifact.
Which of the following describes the proper technique for visualization of the bicep tendon? A. Oblique probe position with the notch turned 30 degrees medically; placed on the posterior upper arm, just proximal to the elbow joint B. Scanning with the US beam as perpendicular to the tendon as possible to improve visualization. C. Oblique probe position with the notch turned 60 degrees medically; placed on the anterior upper arm, just proximal to the elbow joint D. Longitudinal probe position on the posterior upper arm, just proximal to the elbow joint
B. Contraindications of TRUS - significant rectal abnormalities that prevent tolerable probe insertion: fissures, neoplasms, hemorrhoids, or prostatitis
Which of the following is a contraindication for transrectal ultrasound? A. Crohn disease B. Significant Prostatitis C. Hepatitis D. Lesions of the ileocecal valve
C. Hip Stressing Maneuvers: Barlow Maneuver - attempt to push the femoral head out of the hip socket posteriorly; attempt to see if the hip can be dislocated Ortolani Maneuver - attempt to reduce an acutely dislocated hip Palpable "clunk" sound with manipulation indicates a positive clinical exam
Which of the following is a stress maneuver performed when evaluating infant hips? A. Baker maneuver B. Graft maneuver C. Ortolani maneuver D. Allis maneuver
C. Hip Stressing Maneuvers: Barlow Maneuver - attempt to push the femoral head out of the hip socket posteriorly; attempt to see if the hip can be dislocated Ortolani Maneuver - attempt to reduce an acutely dislocated hip Palpable "clunk" sound with manipulation indicates a positive clinical exam
Which of the following is a stress maneuver performed when evaluating infant hips? A. Graf maneuver B. Allis maneuver C. Barlow maneuver D. Baker maneuver
D. Addison Disease is referred to as adrenal insufficiency and results in low aldosterone and cortisol production. It is most commonly associated with autoimmune disorders and is caused by hypersecretion of adrenocortical hormones from the pituitary gland (high ACTH levels). Symptoms include fever, fatigue, hypotension, Gl tract distress, weight loss, high levels of potassium (hyperkalemia) and low sodium levels (hyponatremia).
Which of the following is a symptom of Addison disease? A. Weight gain B. Hypernatremia C. Hypertension D. Hyperkalemia
D. Addison Disease is referred to as adrenal insufficiency and results in low aldosterone and cortisol production. It is most commonly associated with autoimmune disorders and is caused by hypersecretion of adrenocortical hormones from the pituitary gland (high ACTH levels). Symptoms include fever, fatigue, hypotension, Gl tract distress, weight loss, high levels of potassium (hyperkalemia) and low sodium levels (hyponatremia).
Which of the following is a symptom of Addison disease? A. Weight gain B. Hypokalemia C. Hypertension D. Hyponatremia
D. Prior to performing brachytherapy, a sequential scan of the prostate is performed to obtain the volume and shape of the prostate. This information determines the number of seeds needed and seed distribution. The pre-procedure scan also aids in identifying any pubic arch interference that limits access to the gland for the procedure.
Which of the following is an important part of a transrectal ultrasound performed prior to brachytherapy? A. To obtain a PW Doppler signal from the base and apex of the gland B. To measure the distance from the prostate to the anterior abdominal wall C. To locate the main arterial branch that is feeding the carcinoma D. To determine prostate size and volume
D. The thymus is a gland that atrophies after puberty. It can be evaluated in children and makes a great acoustic window to see the great vessels. PICC line insertion is a common procedure that can involve the veins of the neck and chest (subclavian vein, brachiocephalic vein and/or the internal jugular vein.). US guidance is used during the procedure. Superficial chest masses and pneumothorax are common indications for chest sonography.
Which of the following is not a common indication for a chest ultrasound in adults? A. Evaluate PICC line placement B. Evaluate a superficial mass seen on chest CT C. Suspected pneumothorax D. Suspected mass in the thymus
A. The image demonstrates an opening in the muscular fascia of the abdominal wall with a "mushroom cloud" of intestine extending anteriorly through the herniation. The Valsalva maneuver is helpful in evaluating the presence/absence of bowel protruding through a herniation in the abdominal wall. The increase in intra-abdominal pressure should force the bowel through the opening and peristalsis should occur upon release.
Which of the following maneuvers is utilized to assist in the diagnosis of the abnormality displayed? A. Valsalva B. Homan C. Murphy D. Glisson
A. An informed consent form must be signed by patients in normal mental health and who has a full understanding of the procedure with related risks. Alzheimer disease affects a patient's cognitive function. A blind patient would need to have the form read to them before they could be guided to sign. A translator would assist the non-English speaking patient in giving their consent. Parkinson disease affects muscular ability but does not normally affect mental faculties.
Which of the following patients would need a guardian to sign an informed consent form for a liver nodule ablation? A. A patient with Alzheimer disease B. A patient that does not speak English C. A blind patient D. A patient with Parkinson disease
A. BPH causes increased levels of PSA in the blood. Carcinoma also causes increased PSA (>10ng/ml) but usually much more significantly than BPH.
Which of the following prostate abnormalities most significantly elevates the amount of serum prostate specific antigen in lab testing? A. Carcinoma B. Prostatitis C. Abscess D. Benign prostatic hypertrophy
D. Peristalsis of a bowel segment inside the scrotal sac is a definitive sign of a hernia. Color Doppler can be used to assess blood flow in the bowel segment. The strain and release from the Valsalva maneuver can stimulate peristalsis and accentuate the protrusion of bowel in the sac.
Which of the following should be performed when evaluating a suspected inguinal hernia? A. Record bowel peristalsis on a cine clip B. Use dual screen imaging, with and without Valsalva, over the suspected location of the hernia C. Have the patient fill their bladder and evaluate the scrotal sac for pocket of urine D. More than one of the above
A. Color Doppler can be used to evaluate the flow within the herniated bowel segment and assess for incarceration. The Valsalva maneuver is not a sonographic technique but a patient action used to stimulate peristalsis and better visualize the contents of the hernia.
Which of the following sonographic techniques can be used to evaluate a possible inguinal hernia? A. Color Doppler B. PW Doppler C. Tissue Doppler D. Valsalva Maneuver
B. The thymus is a gland that is part of the endocrine system. Initially it produces thymosin that helps boost the immunity system. After puberty, the gland shrinks and goes through fatty replacement. It is located behind the sternum and between the lungs. It is anterior to the great vessels and it extends inferiorly to a position just superior to the heart. In infants and children, the SVC, aorta, and pulmonary artery, are well visualized using the thymus as an acoustic window
Which of the following structures can be used as an acoustic window when evaluating the pediatric mediastinum? A. Thyroid B. Thymus C. Lung pleura D. Diaphragm