Cross Sectional Anatomy: The Final Battle
The __________________ is located posterior to the isthmus and medial to the thyroid lobes.
trachea
The name of one of the surface lines used for references is:
transtubercular
The "best" plane to assess the carotid vessels is:
transverse
The right renal vein is best seen on a(n) ___________________ image.
transverse
The __________ ____________ consists of endothelial cells that line the inner lumen of the vessel.
tunica intima
The term "bruit" is used to describe:
turbulent flow
In the majority of the population, there is/are _______ main arterie(s) that arise from the aortic arch.
3
Normal abdominal aortic diameter should not exceed:
3 cm
The adult kidney is approximately ________ cm in width.
5
How many tributaries form to unite the main renal veins?
5-6
The following describes the accepted threshold for singular thyroid lobe size:
6 cm x 3 cm x 1.8 cm
The main portal vein carries approximately ___________% of the total blood volume to the liver.
70%
The normal adult kidney length is typically between _____ and _____ cm.
9 and 12
In terms of echogenicity, how should the uterus look under ultrasound?
A medium shade of gray.
When the bladder is full in transverse, it looks like what?
A square.
How does the endometrium look under ultrasound?
A thin, echogenic line central to the uterus.
When the bladder is full in longitudinal, it looks like what?
A triangle.
_______________ BEST describes the hollow elastic tubes which are critical in maintaining blood flow
Arteries
Why is the left renal vein typically bigger than the right renal vein?
Because there are other veins dumping into it, making it bigger, larger.
Three branches arise from the superior border of the aorta to the supply the head neck and upper extremities in the majority of the population. They are the:
Bracheocephalic, left common carotid and left subclavian
_______________ are located within the ascending aorta to prevent the backflow of blood into the heart.
Cusps
The _____________ demonstrates a rapid decline in diastole on the spectral waveform analysis.
ECA
Atrial fibrillation or A-fib is defined as:
an abnormal heartbeat
In the female, the peritoneum covers the __________ and body of the _________ and extends over the posterior __________ and the wall of the _____________.
fundus, uterus, fornix, vagina
What vessel lies in the anterolateral portion of the pancreatic head?
gastroduodenal artery
Numbness or weakness of either arm or leg especially on one side of the body is known as:
hemiparesis
The PSV demonstrates the _________________ flow velocity through a vessel.
highest
The _______________ veins course transversely and perpendicular to the ultrasound beam which contributes to their increased wall reflectivity
portal
T/F: The ascending duodenum lies anteriorly to the renal hilum of the right kidney.
False
T/F: The greater sac lies immediately and directly anterior to the left kidney and the tail of the pancreas.
False
The left adrenal vein enters directly into the IVC.
False
True or False: The celiac axis arises from the lateral abdominal aorta 1.5 - 2.0 cm below the diaphragm.
False
True or False: The coronal plane divides the body into cephalad and caudad.
False
True or False: The descending abdominal aorta courses to the right of the IVC.
False
True or False: The hepatic veins decrease in caliper as they approach the IVC.
False
True or False: The left gonadal vein enters the IVC directly.
False
True or False: The portal branches become larger as they move away from the porta hepatis.
False
True or False: The thoracic aorta descends anterolaterally to the heart through the thoracic cavity.
False
Extends from the lateral border of the sacrum out laterally. Attaches to the greater trochanter of the femur.
Piriformis Muscle
Rectouterine Pouch (Pouch of Douglas or Posterior Cul de Sac)
Pouch between the posterior wall of the uterus and the anterior wall of the rectum.
What is the number one place in the female pelvis where fluid will accumulate first?
Rectouterine Pouch (Pouch of Douglas or Posterior Cul de Sac)
(The) _____________ lobe is a normal anatomical variant and is seen as an extension of the right lobe of the liver.
Reidel's
_________ and _________ enter IVC directly.
Right suprarenal and right gonadal veins.
The uterus is more ________ in the transverse plane.
Rounded
The ___________ drains the head, neck, thoracic cavity and upper extremities.
SVC
The ________ and the ________ form the boundary between the false pelvis and the true pelvis to delineate the boundary of the abdominal and pelvic cavities.
Sacral Promontory, Iliopectineal Line
Which of the following is released by the pituitary gland to stimulate hormone production?
TSH
What are the two venous systems?
The Hepatic Venous System and Portal Venous System.
The false pelvis is bounded laterally by what?
The Iliac Fossa and Iliacus Muscles
The pelvic diaphragm is formed by which muscles?
The Levatores and Coccygeus Muscles
The false pelvis is bounded anteriorly by what?
The Lower Anterior Abdominal Wall
In the transverse plane, on either side of the uterus, what are the structures that are oval in shape?
The Ovaries
What is posterior to the bladder and prostate?
The Rectum
How do you know the bladder is fully distended?
The bladder is taking up the whole top of the image.
Endometrium
The inner lining of the uterus.
Which three anterior tributaries are part of the Hepatic Venous System?
The right, left and middle hepatic veins.
The muscles that are anterior and/or lateral to the thyroid are
strap muscles and sternocleidomastoid muscles
The following body locations/plane(s) may be utilized to image the kidneys.
subcostal, intercostal, coronal
The jugular or suprasternal notch is located ___________________ to the xiphoid process.
superior
The transverse aortic arch lies in the __________________ mediastinum.
superior
The following statements about the kidney are typically true except:
the collecting system of the kidney is seen in the non-obstructive state
The renal veins are ______________ to the renal arteries on either side of the abdomen.
anterior
The spleen lies ___________ to the left kidney.
anterior
All of the following describe the thyroid gland location except:
anterior to the hyoid bone
The ECA is typically more _______________ and _______________ than the ICA.
anterior, medial
The true pelvis is divided into ________ and _________ compartments.
anterior, posterior
The anatomical directions seen on the sagittal plane are:
anterior-posterior
The ______________ arises from the LV outflow tract
aortic root
The peri-renal fascia is located _______________ the perinephric fat.
around
Pulmonary ________ carry ______ blood from the heart to the lungs for oxygenation.
arteries, deoxygenated
The thyroid begins to develop:
at the base of the tongue
The loss of full body movements is medically termed:
ataxia
Which of the following is the medical term used when the thyroid fails to develop:
athyreosis
In early diastole, blood rapidly enters the ventricles through __________ valves.
atrioventricular
The plane that divides the body into superior and inferior portions is the ____________________ plane.
axial
The __________ ___________ is the superior portion of the liver that rests against the diaphragm.
bare area
The anatomical landmarks in locating the parathyroid glands on sonography are:
between the carotid artery laterally and the longus colli muscle posteriorly
The kidneys are ____________ organs.
bilateral
The anterior compartments contain the ________ and _________.
bladder, reproductive organs
The ______________ artery is also known as the innominate artery.
brachiocephalic
Which of the following is not directly associated with hyperthyroidism?
bradycardia
The vessels that supply the thyroid are:
branches from the ECA supply the upper pole, and branches from the subclavian artery supply the inferior thyroid pole.
The #1 distinguishing characteristic that differentiates the ICA from the ECA on a carotid doppler study is the:
branches of the ECA
___________________ is secreted by the thyroid gland and assists in lowering calcium concentration within the blood.
calcitonin
Nutrients and waste products are exchanged at the ________________ level.
capillary
The ______________ arterie(s) supply the brain with oxygenated blood:
carotid
The ______________ lobe is located on the posterior superior surface of the liver.
caudate
The superior mesenteric vein courses _________________ along the posterior abdominal wall.
cephalad
Which portion of the ICA is evaluated during a carotid doppler assessment:
cervical
All valves are _______ in isovolumetric contraction.
closed
A muscular sling consisting of the __________ and __________ forms the inferior boundary of the true pelvis and separates it from the perineum.
coccygeus, levator ani muscles
The ______________________ branches into the proper hepatic and gastroduodenal arteries.
common hepatic artery
Persons who have unilateral numbness or weakness often demonstrate _____________ carotid disease with these symptoms.
contralateral
Sonography of the thyroid is useful in differentiating which of the following:
cystic from solid lesions
When serum calcium ________________, the parathyroid gland is stimulated to release ____________________.
decreases, PTH
The hepatic veins return _________________ blood from the liver to the IVC.
deoxygenated
The portal venous system directs blood to the liver from the following structures except:
diaphragm
The phalanges or fingers are _______ to the wrist.
distal
Difficult or unclear articulation of speech is medically termed:
dysarthria
The pancreas is more _____________ than the adjacent liver parenchyma in most cases under normal conditions.
echogenic
Normal production of the thyroid hormones is termed _______________________.
euthyroid
The __________ __________fissure separates the right and left lobes of the liver.
main lobar
The _______________ is utilized to locate the gall-bladder and houses a portion of the middle hepatic vein.
main lobar fissure
The lesser sac is __________________ to the spleen.
medial
The left lobe of the liver is divided into __________ and __________ segments.
medial, lateral
Think carefully about this question. The anatomical directions seen on the transverse plane are:
medial-lateral, anterior-posterior, right-left
The anatomical directions seen in the coronal plane are:
medial/lateral, cephalad/caudad
The plane that divides the body right down the middle into two equal halves is the:
mid-sagittal and median planes
The ____________hepatic vein separates the left lobe of the liver from the right lobe of the liver.
middle
All of the following are true regarding stroke except:
most are classified as hemorrhagic
If you are scanning in the right coronal plane, then your transducer is:
on the right lateral side of the body
The main portal vein is carrying __________________ blood to the liver.
oxygenated
The three fossa contained in the right lobe of the liver are all of the following except:
pancreatic
The ______________ arteries arise laterally and supply the undersurface of the diaphragm.
phrenic
The union of the SMV and the splenic vein is called the ______________ ______________.
portal confluence
The __________________ system has highly reflective walls on ultrasound.
portal venous
The IVC courses _______________ to the liver
posterior
The left renal vein lies ____________ to the splenic vein.
posterior
The spleen is ___________ to the stomach.
posterior
The superior mesenteric vein courses ____________ to the pancreatic neck.
posterior
The body of the pancreas lies __________ to the left lobe of the liver.
posterior and inferior
The IVC lies ___________ of the aorta.
posterior and to the right
The location of the 4 parathyroid glands are on the:
posterior side of the thyroid on the upper and lower portions of the gland
The esophagus is seen under ultrasound as a target mass:
posterior to the thyroid gland
The left renal vein lies _____________ to the SMA and ____________ to the aorta.
posterior, anterior
The left renal veins lies _____________ to the SMA and ____________ to the aorta.
posterior, anterior
The ICA is USUALLY more _____________ and _____________ compared to the ECA.
posterior, lateral
The stomach lies ___________ and more _____________ to the left lobe of the liver.
posterior, lateral
The esophagus is typically seen on ultrasound located _____________ to the _______ CCA.
posterior, left
For the true pelvis, the anterior and lateral margins are formed by the ________, the ________ and the small portion of the __________.
pubis, ischium, ilium
Which of the following represents a persistent portion of the thyroglossal duct seen in 15- 30% of the population?
pyramidal lobe
The carotid sheath includes the following except the
recurrent laryngeal nerve
The most outer portion of the kidney that is covered by the renal capsule is known as the:
renal cortex
The medial surface of the kidney has an indentation where vessels enter/exit called the:
renal hilum
The inner portion of the kidney from the base of the renal pyramids to the apex of the renal pyramids is known as the:
renal medulla
The inner echogenic portion of the kidney that houses the calyces is called the:
renal sinus
The lateral tributaries(s) of the IVC include
renal veins
The renal hilum provides access to the kidneys for the following structures:
renal veins, arteries, and ureters
The renals lie within the ________________ cavity.
retroperitoneal
What do pulmonary veins do?
return oxygenated blood to the left atrium
The IVC enters the ______________ of the heart.
right atrium
The right lobe of the liver occupies the:
right hypochondriac region
If you are scanning on the anterior surface of the right upper quadrant and wanted to avoid bowel gas to visualize the right kidney, then you would move the transducer:
right laterally
The main portal vein divides into the _______________ and _____________
right portal vein, left portal vein
If you wanted to scan the right lobe of the liver, the area in which you be scanning would be the:
right upper quadrant
What is visible in the apical 4 chamber view of the heart?
right ventricle, left ventricle, right atrium, left atrium
The paramedian plane:
runs lateral alongside the median plane
The pelvic cavity also has a small outpocket called the _________ which houses the __________.
scrotal cavity, testes
In ventricular ejection, the _________ valves _________.
semilunar(aortic and pulmonic), open
The internal carotid artery is divided into segments which include all of the following except:
sphenoid
One of the following structures will remain the same shape no matter which plane you are scanning in. Which of the following shapes is it?
sphere
The ______________ artery is typically the largest vessel in the celiac trunk and supplies the blood to the fundus of the stomach and spleen.
splenic
The _______________ courses directly posterior to the pancreatic body and tail and delineates the pancreatic body and tail on a transverse image.
splenic vein
The main portal vein is formed by the following structures:
splenic vein and superior mesenteric vein
The ______________ _______________ attaches the spleen to the kidney.
splenorenal ligament
The pancreatic ________________ lies anterior to the portal confluence.
tail
The gonadal veins include:
testicular and ovarian veins
In most patients, the bifurcation of the carotid artery is located at the level of:
the angle of the mandible
The superior mesenteric artery has multiple branches. The 5 main branches are:
the colic, ileocolic, intestinal, duodenal and inferior pancreatic arteries
All of the following are true about the parathyroid except:
they are usually > 5 mm in size
How does fluid accumulate posterior to the uterus?
to the uterus? When one of the follicles becomes mature and goes unfertilized, that follicle will rupture. The fluid will go posterior to the uterus or the Rectouterine Pouch (Pouch of Douglas or Posterior Cul de Sac).
In all cases, the scanning surface is assigned to the:
top of the image
The patient is lying with his left side down on the table and the transducer is placed on the anterior surface of his body with the transducer in the transverse plane. On the imaging screen, anterior is directed or oriented at the:
top of the screen
The term rostral refers to:
towards the nose
The portal veins course _____________________ throughout the liver.
transversely
T/F: The protocol of the renals includes assessment in both the transverse and longitudinal planes.
true
The prep for performing an abdominal aorta ultrasound includes fasting.
true
True or False: In longitudinal, the LRV is seen as a circular structure between the SMA and aorta.
true
True or False: The superior mesenteric artery includes the inferior pancreatic artery as a branch.
true
If long axis of a tubular structure was positioned in the body in the cephalad-caudad direction, then in the sagittal plane it's shape will be a/an:
tube
The ____________ ______________ is the external loose connective tissue layer which also contains muscle and elastic properties.
tunica adventitia
________________ are typically larger in total diameter because they transport a higher volume of blood.
veins
The left adrenal gland lies superior and _________ to the left kidney.
anterior
The liver lies ____________ to the right kidney.
anterior
The main portal vein lies _____________ to the IVC.
anterior
Which vein drains the caudate lobe of the liver?
inferior vena cava
The true pelvis has an ________ and ________ cavity.
inlet, outlet
The brain's main source of oxygenated blood is fed by the vertebral arteries and the:
internal carotid arteries
The hepatic veins run _____________________ through the liver.
intersegmentally
The spleen is a(n) __________________ organ covered by peritoneum except at the hilum.
intraperitoneal
Approximately eighty percent of strokes are:
ischemic
The psoas major muscle is typically ____________ compared to the adjacent renal cortex.
isoechoic
The right lobe of the thyroid is bound laterally by the ipsilateral carotid. This would mean:
it is bound laterally by the right carotid
The carotid arteries are ________________ to the right and left thyroid lobes.
lateral
In reference to the surface lines of the chest, the para sternal line is:
lateral to the lateral sternal line and medial to the mid-clavicular line
When presenting the sonographic anatomy on the imaging screen the rule states that wherever the transducer indicator is pointing, then that is the ________________ side of the imaging screen.
left
The ___________________ artery is anterior and to the left of the esophagus and courses along the lesser curvature of the stomach to supply blood to these structures.
left gastric
What portion of the liver does the left hepatic artery supply?
left lobe and caudate lobes of liver
The left suprarenal vein drains into the:
left renal vein
The left kidney is positioned in the _________ quadrant.
left upper
If you wanted to image the spleen, you would place your transducer in the:
left upper quadrant
The ascending aorta arises from the:
left ventricle
The ____________ hepatic vein divides the left liver lobe into _________ and ____________ segments
left, medial, lateral
The __________ kidney lies more superior than the _____________ kidney.
left, right
The falciform ligament contains the ____________ _____________.
ligamentum teres
In the sagittal view, the _____________ _____________ is seen as an echogenic horizontal line between the left lobe of the liver and the caudate lobe of the liver.
ligamentum venosum
The preferred transducer used to examine the thyroid is:
linear array 7-15 MHz
The hepatic veins course __________________ throughout the liver.
longitudinally
The ____________ may be mistaken for the parathyroid gland.
longus colli muscle
The internal carotid artery demonstrates a(n) ___________ resistant waveform on spectral doppler.
low
The splenic vein drains blood from all of the following except:
GI Tract
Perinephric fascia is known as ______________ fascia.
Gerota's
Of the following, which is more often of larger caliper if measured?
ICA
Proximal dilatation of the _______________ is commonly seen during a carotid doppler examination.
ICA
The hepatic veins are tributaries to the:
IVC
What separates the false pelvis from the true pelvis? (or the major pelvis from the minor)?
Iliopectineal Line
Under ultrasound, which muscles could be confused for ovaries?
Iliopsoas Muscles
The Major (false or greater) Pelvis contains what?
Intestinal content. Most of the small bowel, parts of the colon, and the common iliac vessels.
The bifurcation of the aorta into the common iliac arteries typically occurs at the level of ____________.
L4
A patient lying pone with the right knee bent, right arm bent with the right shoulder off of the table would indicate he/she is in the ________________________ position.
LAO
List the organs located in the pelvic cavity.
Large intestine, rectum, urinary bladder and the reproductive organs.
The lower portion of the abdominopelvic cavity can be divided into what?
Major (false pelvis or greater pelvis) and minor (true pelvis or lesser pelvis)
The space between the right lobe of the liver and the right kidney where fluid may accumulate is called:
Morison's Pouch
Muscle that lines the lateral pelvic wall.
Obturator Internus
How are follicles seen under ultrasound?
On the ovaries of a menstruating female. Little anechoic, circular areas.
Functions of the thyroid gland include the following except:
PTH production
_____________ _____________ is composed of tiny arteries and veins that supply the walls of the blood vessels.
The vasa vasorum
T/F: A portion of the lesser sac is located between the stomach and spleen.
True
T/F: The gallbladder comes in contact with the anterior abdominal wall at the level of the 9th costal cartilage.
True
T/F: The left lobe of the liver occupies the epigastric and left hypochondriac regions.
True
T/F: The liver is completely surrounded by connective tissue called Glisson's capsule.
True
True or False: Both the coronal and the sagittal plane follow the long axis of the human body.
True
True or False: In viewing anatomy in the transverse plane with the patient in the prone position, the left side of the patient is seen on the left side of the imaging screen.
True
True or False: The external iliac artery courses medially along the rectus abdominis muscle.
True
True or False: The gonadal veins are retroperitoneal and course along the psoas muscle.
True
True or False: The greater sac surrounds the anterior and lateral aspects of the liver.
True
True or False: The right and left coronary arteries arise from the right and left coronary cusps.
True
True or False: The right renal artery lies posterior to the IVC.
True
True or False: The union of the right and left common iliac veins occurs near the level of the umbilicus.
True
True or False: Veins are more easily compressed or collapsible relative to arteries.
True
True/False: The terms peri-renal and perinephric have the same meaning.
True
Ultrasound protocol of the aorta typically requires interrogation of the proximal, mid, distal aorta.
True
The Minor (true or lesser) Pelvis contains what?
Urinary bladder, rectum and reproductive organs.
What are the two triangles of the perineum?
Urogenital Triangle (anterior to the line) and Anal Triangle (posterior to the line).
_____________ are located in the veins to prevent the backflow of blood.
Valves
Pouch between the uterus and the urinary bladder where fluid accumulates. Anterior the uterus and posterior to the bladder.
Vesicouterine Pouch
Indications for an ultrasound evaluation of the aorta include:
abdominal bruit, palpable pulsatile mass, family history of abdnominal aortic aneurysm
In the female, the peritoneum descends from the anterior ____________ to the level of the _________ onto the superior surface of the __________.
abdominal wall, pubic bone, bladder
Changeable risk factors for stroke include all of the following except:
age
Transient blindness is medically termed:
amaurosis fugax
Hemorrhagic stroke occurs when there is:
an aneurysm of an intracranial vessel that ruptures
The urinary bladder under normal conditions when distended appears __________________________ under ultrasound.
anechoic
The jejunum lies ______________ to the left kidney.
anterior
FAST stroke signs are described as the following:
face, arm, speech, time
The liver is suspended from the diaphragm and the anterior abdominal wall by the _____________ ligament.
falciform
T/F: The left renal is typically easier to image by ultrasound than the right kidney.
false
T/F: The perinephric fat does not surround the posterior portion of the kidneys.
false
T/F: The quadtratus lumborum muscle lies anterior to the right kidney.
false
True or False: The abdominal aorta bifurcates into right and left internal iliac arteries.
false
True or False: The left renal artery lies anterior to the left renal vein.
false
True or False: The main portal vein courses longitudinally through the liver.
false
True or False: The portal vein bifurcates into right, middle and left portal veins.
false
True or False: the thyroid gland produces thyroid stimulating hormone
false
True or false: a plane is 3-dimensional.
false
The walls of the true pelvis are formed by the bones and ligaments which are lined by muscles covered with _______ and ________.
fascia, parietal peritoneum
The coronal plane:
follows the coronal sutures of the skull
The normal spleen is more __________ than the adjacent normal left kidney parenchyma.
hyperechoic
The outer cortex of the kidney is more ____________ than the adjacent renal medulla.
hyperechoic
The thyroid gland under normal conditions is described sonographically when compared to the adjacent strap muscles as:
hyperechoic
The left kidney cortex is more _______________ than the adjacent spleen.
hypoechoic
The left renal cortex is more ______________ than the adjacent pancreas.
hypoechoic
The normal kidney cortex is more ___________ than the adjacent normal liver parenchyma in most cases.
hypoechoic
If you wanted to scan the bladder what region would you scan in?
hypogastric