MIDTERM REVIEW (IR, NECK, SCROTUM, & BREAST)

What is the most common sonographic appearance of a seminoma? a. hyperechoic b. anechoic c. heterogenous with calcifications d. hypoechoic

d. hypoechoic

Which of the following invasive procedures removes a small piece of living tissue for microscopic analysis? a. core biopsy b. paracentesis c. fine-needle biopsy d. cyst aspiration

a. core biopsy

Normally, how many parathyroid glands are found within the adult neck? a. 3 b. 4 c. 6 d. 8

b. 4

A breast lesion that presents with well-defined borders, low-level internal echoes, and good through transmission most likely represents: a. a hemorrhagic cyst b. a simple cyst c. fibroadenoma d. cystosarcoma phyllodes

a. a hemorrhagic cyst

Which of the following best describes the normal appearance of a cervical lymph node? a. a hypoechoic, oblong structure with a distinct echogenic hilum b. a rounded, echogenic structure with small calcifications c. a solid, hypoechoic mass that measures greater than 1 cm d. a solid, echogenic mass that measures less than 1 cm

a. a hypoechoic, oblong structure with a distinct echogenic hilum

A cystic mass noted at the mandibular angle is most likely a: a. branchial cleft cyst b. follicular adenoma c. thyroglossal duct cyst d. parathyroid adenoma

a. branchial cleft cyst

The common indication for a biopsy is to: a. confirm a malignancy in a mass b. define the amount of fluid in a mass c. define the size of the drainage tube needed to drain the mass d. confirm whether the mass is a simple cyst

a. confirm malignancy in a mass

What type of gland is the thyroid gland? a. endocrine b. exocrine c. both A and B d. neither A nor B

a. endocrine

What structure may be confused for a thyroid or parathyroid mass because of its relationship to the trachea and the posterior aspect of the left thyroid gland? a. esophagus b. common carotid artery c. internal jugular vein d. sternothyroid

a. esophagus

All of the following are sonographic findings consistent with the diagnosis of testicular torsion except: a. hyperemic flow within the testis b. hypoehoic testis c. reactive hydrocele d. decreased intratesticular flow (as compared with the asymptomatic side)

a. hyperemic flow within the testis

In a renal parenchymal biopsy, which part of the kidney is typically biopsied? a. lower pole b. mid-lower pole c. mid-upper pole d. upper pole

a. lower pole

All of the following are sonographic findings consistent with torsion of the testicular appendage except: a. no intratesticular flow b. small hyperechoic mass adjacent to the testis c. reactive hydrocele d. scrotal wall thickening

a. no intratesticular flow

The national patient safety standards mandate that a "time-out" be performed before beginning any procedure, which means all of the following except the: a. patient's name is recited by a team member b. patient's name is recited by the patient c. patient's identification number is confirmed d. type and location of the procedure are confirmed

a. patient's name is recited by a team member

Which muscles are located lateral to each thyroid lobe? a. sternocleidomastoid b. longus colli c. sternohyoid d. omohyoid

a. sternocleidomastoid

What needle gauge is typically used in a fine-needle aspiration? a. 14 to 20 b. 20 to 25 c. 16 to 18 d. 10 to 23

b. 20 to 25

All of the following are sonographic findings of an abnormal lymph node except: a. round shape b. echogenic hilum c. calcifications d. enlargement

b. echogenic hilum

All of the following are sonographic findings of malignant thyroid nodules except: a. internal calcifications b. echogenic mass c. cervical node involvement d. solitary mass

b. echogenic mass

The most common solid benign tumor of the breast is a. fibrocystic disease b. fibroadenoma c. papilloma d. lipoma

b. fibroadenoma

Clinical findings of lumpy, painful, tender breasts that vary with monthly cycles usually represent: a. carcinoma b. fibrocystic disease c. cyst d. adenoma

b. fibrocystic disease

The most common malignant neoplasm of the breast in women is a: a. lobular carcinoma in situ b. invasive ductal carcinoma (IDC) c. invasive lobular carcinoma d. ductal carcinoma in situ

b. invasive ductal carcinoma (IDC)

The thyroid gland utilizes which of the following to produce its hormones? a. colloid b. iodine c. iron d. calcium

b. iodine

Which muscles are located posterior to each thyroid lobe? a. sternocleidomastoid b. longus colli c. sternohyoid d. omohyoid

b. longus colli

The breast is sonographically divided into three layers. Which is incorrect? a. skin, nipple, subareolar b. pectoralis major c. subcutaneous region d. parenchyma

b. pectoralis major

The primary advantage of an ultrasound-guided procedure is: a. marks the spot for biopsies or fluid taps b. provides for continuous real-time visualization of the biopsy needle c. drains abscess collections d. places drainage tubes

b. provides for continuous real-time visualization of the biopsy needle

Skin dimpling may be caused by a. old age b. retraction of tissue secondary to tumor infiltration c. enlarged ducts d. thrombosis of arterial vessels

b. retraction of tissue secondary to tumor infiltration

Primary varicoceles are associated with all of the following except: a. left-sided location b. retroperitoneal mass c. infertility d. palpable extratesticular mass

b. retroperitoneal mass

What is the most common malignancy of the testicles? a. embryonal cell carcinoma b. seminoma c. choriocarcinoma d. spermatocele

b. seminoma

Which of the following patient positions is typically used during a thoracentesis? a. prone b. sitting c. decubitus d. trendelenburg

b. sitting

The most common location of a varicocele is a. the right side of the scrotum b. the left side of the scrotum c. the inguinal canal d. within the testis

b. the left side of the scrotum

The most characteristic finding of a fibroadenoma is a. a poorly defined border b. uniform, low-level homogeneous echoes c. increased through transmission d. disruption of architecture

b. uniform, low-level homogeneous echoes

According to the American Cancer Society, all women should begin annual screening mammography and screening breast ultrasound at age a. 20 b. 30 c. 40 d. 50

c. 40

The wait time after discontinuing the use of aspirin is: a. 4 to 6 hours b. 3 to 4 days c. 5 to 7 days d. 1 to 2 days

c. 5 to 7 days

A lack of fixation of the testis to the posterior scrotal wall is referred to as a. Kleinfelter syndrome b. Blue dot sign c. Bell-clapper deformity d. Cryptochidism

c. Bell-clapper deformity

Which of the following best describes a spermatocele? a. the most common malignant neoplasm of the scrotum b. a benign intratesticular cyst c. a simple-appearing cyst, found within the head of the epididymis, that may contain debris d. a dilated group of veins found within the scrotum

c. a simple-appearing cyst, found within the head of the epididymis, that may contain debris

Which one of the following types of biopsy uses an automatic spring-loaded device to provide tissue for analysis? a. fine-needle aspiration b. free-hand biopsy c. core biopsy d. needle-guided biopsy

c. core biopsy

Contraindications for a biopsy needle include all of the following except: a. uncorrectable bleeding disorder b. lack of a safe needle path c. dehydration d. uncooperative patient

c. dehydration

Cooper's ligaments are best characterized as a. low reflectivity in the retromammary layer b. high reflectivity in the retromammary layer c. echogenic line interfaces in the subcutaneous layer d. homogeneous reflections in the parenchyma

c. echogenic line interfaces in the subcutaneous layer

A cystic enlargement of a distal duct filled with milk is called a: a. lactoadenoma b. lactoma c. galactocele d. lactiferoma

c. galactocele

Biopsies of the spleen carry an increased risk for: a. capsule rupture b. pneumothorax c. hemorrhage d. infection

c. hemorrhage

The retromammary layer is sonographically imaged as a. hyperechoic b. dense c. hypoechoic d. high reflectivity

c. hypoechoic

The ________ patient position is most commonly used in a prostate biopsy. a. supine b. prone c. left lateral decubitus d. semi-erect

c. left lateral decubitus

You have been asked to perform a study to rule out cryptorchidism. The term cryptorchidism denotes: a. one or both testicles has malignancy b. the patient lacks the normal fixation of the testis to the posterior scrotal wall c. one or both of the testicles has not descended into the scrotum d. the patient has been kicked in the scrotum

c. one or both of the testicles has not descended into the scrotum

a common cyst most often seen in the head of the epididymis that contains nonviable sperm is the a. epididymal cyst b. tunica albuginea cyst c. spermatocele d. seminoma

c. spermatocele

Characteristic findings of breast carcinoma include all except which of the following? a. attenuation of sound b. irregular margins c. strong posterior margin d. inhomogeneous low-level internal echo pattern with calcifications

c. strong posterior margin

What is the first branch of the ECA? a. internal carotid artery b. optic artery c. superior thyroid artery d. inferior thyroid artery

c. superior thyroid artery

Fat, Cooper's ligaments, connective tissue, blood vessels, nerves, and lymphatics are found in which layer or zone? a. the retromammary region b. the parenchyma c. the subcutaneous layer d. the subareolar area

c. the subcutaneous layer

Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as: a. branchial cleft cysts b. follicular adenomas c. thyroglossal duct cysts d. parathyroid adenomas

c. thyroglossal duct cysts

A thyroid isthmus that measures greater than ________ is indicative of thyroid enlargement. a. 8 mm b. 5 mm c. 12 mm d. 10 mm

d. 10 mm (greater than)

Dilated veins of a varicocele will measure: a. > 8 mm b. > 4 mm c. < 2 mm d. > 2 mm

d. > 2 mm

Parathyroid glands control the release and absorption of which nutrient? a. thyroxine (T4) b. triiodothyronine (T3) c. calcitonin d. calcium

d. calcium

Advantages of using ultrasound guidance include all of the following except: a. lack of radiation b. reduced risk of complications c. variable patient positions d. fixed angles when using needle guides

d. fixed angles when using needle guides

Which of the following is the most common form of thyroid cancer? a. follicular b. anapestic c. lymphoma d. papillary

d. papillary ("popular")

The role of the cytopathology team is to: a. ensure enough diagnostic tissue is obtained b. increase the percentage of successful biopsies c. minimize the number of core samples d. provide all of the above

d. provide all of the above

The superior extension of the thyroid isthmus is referred to as the a. thyroglossal duct b. branchial cleft c. yodeler's lobe d. pyramidal lobe

d. pyramidal lobe

Spermatogenesis occurs within the a. tunica albuginea b. rete testis c. mediastinum testes d. seminiferous tubules

d. seminiferous tubules

Limitations of ultrasound guidance include all of the following except: a. bowel gas b. isoechoic masses c. inexperienced ultrasound personnel d. shorter procedure times

d. shorter procedure times

A higher percentage of positive cells is observed in the ________ of a thyroid mass. a. center b. complex portion c. anechoic portion d. small calcifications

d. small calcifications

The exocrine function of the testicle is to produce: a. testosterone b. human chorionic gonadotropin c. alpha-fetoprotein d. sperm

d. sperm

Which muscles are located anterior to the thyroid gland? a. sternocleidomastoid b. longus colli c. thyrocervical trunk d. strap

d. strap (SOS Muscles)

Acute onset of testicular pain at rest is a common clinical finding with: a. testicular carcinoma b. hydrocele c. testicular trauma d. testicular torsion

d. testicular torsion

What scrotal abnormality is caused by incompetent valves within the pampiniform plexus? a. testicular carcinoma b. testicular microlithiasis c. testicular torsion d. varicocele

d. varicocele

Which of the following statements about ultrasound of the breast is/are true? 1. Ultrasound of the breast is the primary breast imaging modality used for females too young for mammography who present for evaluation of a palpable breast lump 2. Ultrasound of the breast is the primary breast imaging modality used to screen women for clustered micro calcifications, which is one of the main signs of possible breast cancer and usually an indication for breast biopsy. 3. Ultrasound of the breast is used as an adjunctive breast imaging modality for further assessment of smooth mammography masses as cystic or solid 4. ultrasound of the breast must never be used to evaluate a breast abnormality in a pregnant female.

1 and 3

What is the most common cause of hyperthyroidism? a. Graves' disease b. Hashimoto thyroiditis c. Papillary carcinoma d. Parathyroid adenoma

a. Graves' disease

The international normalized ratio (INR) was developed because of the variable results of ________ among laboratories. a. PT b. AFP c. PTT d. PSA

a. PT

Which of the following would more likely be a malignant thyroid nodule? a. cold nodule b. hot nodule

a. cold nodule

In the case of a cancerous mammographic mass, the correlating sonographic mass will likely show which of the following features? a. irregular margin/taller than wide b. anechoic c. irregular margin/wider than tall d. posterior acoustic enhancement

a. irregular margin/taller than wide

Secondary varicoceles are associated with all of the following except: a. left-sided location b. right-sided location c. hepatomegaly d. renal mass

a. left-sided location

Advantages of breast ultrasound over mammography in evaluating the breast include all except which of the following? a. limited radiation exposure to the patient b. differentiation of cystic versus solid smooth masses c. more comfortable examination for the patient d. better visualization of juxtathoracic deep tissues

a. limited radiation exposure to the patient

The endocrine function of the testicles is to produce a. testosterone b. human chorionic gonadotropin c. alpha-fetoprotein d. sperm

a. testosterone

Which of the following is the hormone that is most abundantly produced by the thyroid? a. thyroxine b. iodine c. triiodothyronine d. calcitonin

a. thyroxine

Which of the following sonographic techniques is useful at providing sonographic evidence of a varicocele? a. valsalva maneuver b. sitting position c. pulsed Doppler d. right lateral decubitus position

a. valsalva maneuver

A dilated group of veins found within the scrotum is defined as a. varicocele b. spermatocele c. seminoma d. hydrocele

a. varicocele

What is the most correctable cause of male infertility? a. varicocele b. chlamydia c. hydrocele d. testicular torsion

a. varicocele

In documenting a sonographic breast mass, which one of the following statement(s) apply? 1. The sonographic image recording the mass should be labeled appropriately according to either breast quadrant or breast clock face position. 2. The sonographic image recording the mass should be labeled appropriately according to which breast contains the mass. 3. The sonographic image recording the mass should be labeled appropriately according to transducer orientation (i.e., sagittal, transverse, radial, or anti-radial) 4. The sonographic image should ideally record the size of the mass in all three dimensions.

all

Which one of the following laboratory tests could indicate a liver lesion? a. prothrombin time b. alpha-fetoprotein (AFP) c. partial thromboplastin time d. liver-specific antigen

b. alpha-fetoprotein (AFP)

Sonographically, the breast may be characterized by a. a homogeneous parenchymal pattern b. an inhomogeneous parenchymal pattern c. a highly echogenic parenchymal pattern d. dense internal echoes

b. an inhomogeneous parenchymal pattern

In the case of a smooth mammographic mass that is cystic, the correlating sonographic mass will likely show which of the following features? a. irregular margins b. anechoic/posterior acoustic enhancement c. taller than wide d. echogenic/posterior enhancement

b. anechoic/posterior acoustic enhancement

A simple fluid collection surrounding the testis is referred to as a: a. hematocele b. hydrocele c. varicocele d. spermatocele

b. hydrocele

All fo the following are hormones produced by the thyroid except: a. thyroxine b. iodine c. triiodothyronine d. calcitonin

b. iodine

The best way to recognize the tip of the needle with ultrasound is all of the following except: a. the needle tip appears as an echogenic dot b. the needle tip appears as a hypoechoic area c. the needle tip may be seen as it advances into the area d. the needle tip may be seen with a small amount of saline injection

b. the needle tip appears as a hypoechoic area

A pre-procedural image should document the patient's name and the: a. date, needle path, and sonographer's initials b. time, date, and needle path c. time, date, and examination description d. date, needle depth, and needle position

b. time, date, and needle path

The most common location of a hydrocele is a. superior to the testis b. within the scrotal wall c. between the two layers of the tunica vaginalis d. between the tunica vaginalis and tunica albuginea

c. between the two layers of tunica vaginalis

Which of the following statements is false? a. breast ultrasound is the imaging tool of choice to evaluate a breast mass in a teenage girl b. ultrasound of the breast is the primary imaging tool of choice in evaluating a breast mass in a pregnant woman c. breast ultrasound is the primary imaging tool of choice in screening a 45-year-old woman for any evidence of possible breast cancer d. in the case of a benign fibroadenoma, the sonogarhic features of a smooth sharply circumscribed hypoechoic mass with homogeneous echogenicity and mild posterior acoustic enhancement usually will be seen

c. breast ultrasound is the primary imaging tool of choice in screening a 45-year-old woman for any evidence of possible breast cancer

The fluid produced by the thyroid gland that contains thyroid hormones is referred to as: a. thyroxine b. calcitonin c. colloid d. triiodothyronine

c. colloid

Specific complications of a renal biopsy is: a. infection b. hypertension c. hematuria d. hypotension

c. hematuria

The most common clinical sign of breast carcinoma is: a. skin dimpling b. skin discoloration c. palpable lump d. pain

c. palpable lump

Hypercalcemia is associated with which of the following? a. Grave's disease b. thyroglossal duct cyst c. parathyroid adenoma d. thyroid adenoma

c. parathyroid adenoma

Renal parenchymal biopsies are requested for patients with: a. hypertension b. diabetes mellitus c. proteinuria d. pyelonephritis

c. proteinuria

The most common germ cell tumor of the testis is the a. yolk sac tumor b. embryonal cell carcinoma c. seminoma d. teratoma

c. seminoma

In the presence of Hashimoto thyroiditis, the thyroid produces: a. too many thyroid hormones b. too much calcium c. too few thyroid hormones d. too much iodine

c. too few thyroid hormones

A 23-year-old man presents to the ultrasound department with a history of infertility. Which of the following is associated with male infertility? a. spermatocele b. choriocarcinoma c. varicocele d. hydrocele

c. varicocele

A normal lymph node will not measure greater than: a. 8 mm b. 5 mm c. 12 mm d. 10 mm

d. 10 mm

Signs or symptoms of possible breast cancer include all except which of the following? a. irregular or speculated mammographic mass, solid on ultrasound b. clustered pleomorphic micro calcifications on mammogram, with or without any abnormality on breast ultrasound c. focal distortion on mammogram, showing a correlating area distortion on breast ultrasound d. a smooth low density mammographic mass, solid on breast ultrasound that has not grown or changed in over 3 years

d. a smooth low density mammographic mass, solid on breast ultrasound that has not grown or changed in over 3 years

All of the following are diagnostic findings of benign thyroid nodules except: a. anechoic mass b. eggshell calcification c. hyperechoic mass d. cold nodule

d. cold nodule

The most important signs to look for in determining a cystic lesion of the breast include all except which of the following? a. well-defined borders b. good through transmission c. anechoic d. disruption of architecture

d. disruption of architecture

The characteristic findings of a papilloma of the breast include all except which of the following? a. well-circumscribed solid mass with micro-calcifications b. sonolucent cystic lesions with a medium-level encapsulated component c. single or multiple d. no disruption of architecture

d. no disruption of architecture

Ultrasound of the breast is often performed as an adjunctive imaging tool in all except which of the following situations? a. to assess a smooth mammographic mass as cystic or solid b. to further evaluate a palpable breast lump in a patient with very dense breast tissue and a negative mammogram c. to further evaluate a palpable breast lump in a patient with breast implants d. to further evaluate an asymptomatic patient with large fatty replaced breasts and a negative mammogram

d. to further evaluate an asymptomatic patient with large fatty replaced breasts and a negative mammogram

The blue dot sign is indicative of: a. testicular torsion b. epididymitis c. orchitis d. torsion of the testicular appendage

d. torsion of the testicular appendage

In a renal transplant procedure, which part of the kidney is typically biopsied? a. lower pole b. mid-lower pole c. mid-upper pole d. upper pole

d. upper pole

The test used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process is: a. coumadin b. PTT c. AFP d. PSA

b. PTT

Which of the following statements is/are correct? 1. Key criteria for a simple cyst by ultrasound are only 75% reliable in excluding malignancy. 2. The usual sonographic appearance of a benign fibroadenoma (oval, wider than tall, homogeneous internal echoes, smooth sharp margin) is 100% reliable in excluding the possibility of malignancy. 3. When a teenage girl presents with a palpable breast lump, ultrasound of the breast will usually reveal a rapidly growing soft tissue sarcoma, a malignancy that is not of breast origin. 4. In evaluating a breast mass by ultrasound, signs of suspicion for malignancy include a poorly defined irregular margin, inhomogeneous pattern of internal echoes, taller than wide shape, and posterior shadowing.

4

A 30-year-old patient presents to the sonography department for a thyroid sonogram with a history of weight loss, hair loss, and hyperthyroidism. You note that the patient has bulging eyes. What is the most likely diagnosis? a. Hashimoto's thyroiditis b. Graves' disease c. hyperparathyroidism d. cervical lymphadenopathy

b. Graves' disease

Which abnormality is associated with the sonographic findings of a thyroid inferno? a. Hashimoto thyroiditis b. Graves' disease c. hyperparathyroidism d. cervical lymphadenopathy

b. Graves' disease

What is the most common cause of hypothyroidism? a. Graves' disease b. Hashimoto thyroiditis c. papillary carcinoma d. parathyroid adenoma

b. Hashimoto thyroiditis

Advantages of breast ultrasound over mammography in evaluating the breast include which of the following? a. better visualization of those often obscure signs of breast cancer such as microcalcifications b. better visualization of microcytic adenomas with layering milk of calcium and sclerosis adenomas, variants of benign fibrocystic condition that both contain small calcifications as the principal mammographic finding that can be overlooked easily on routine mammographic images. c. better discrimination of Cooper's ligaments within lumen of the small ducts of the terminal ductal lobular units (TDLUs) d. evaluation of those hard-to-reach places not well seen on mammogram, such as parasternal tissues and axilla

d. evaluation of those hard-to-reach places not well seen on mammogram, such as parasternal tissues and axilla

Postbiopsy compilations may include all of the following except: a. pain or discomfort b. vasovagal reactions c. hematomas d. heart failure

d. heart failure

Which vascular structure is located closest to the thyroid lobes? a. external carotid vein b. external carotid artery c. internal jugular vein d. internal carotid artery

d. internal carotid artery

Ultrasound is often of benefit in guiding breast procedures, except for which of the following? a. cyst aspiration b. fine needle aspiration cytology (FNAC), which is used in many centers for diagnosis of a solid mass c. large core needle biopsy of a solid mass d. large core needle biopsy of microcalcifications not visible on ultrasound

d. large core needle biopsy of microcalcifications not visible on ultrasound

The ________ is mostly glandular tissue, whereas the peripheral part is adipose tissue rimmed by ________. a. central layer, superficial fascia b. outer layer, connective tissue c. peripheral layer, Cooper's ligaments d. retromammary layer, nervers

a. central layer, superficial fascia

Which of the following is/are true statements concerning breast cancer risk? 1. A patient who has already been treated for breast cancer in one breast will not be at increased risk for development of another breast cancer in her opposite breast. 2. Older women are at increased risk for development of breast cancer compared with younger women. 3. Although men may develop a breast mass resulting from a benign condition called gynecomastia, men never develop breast cancer. 4. A significant risk factor for development of breast cancer is a positive family history of breast cancer in first-degree relatives (mother, sister, daughter).

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