Abdomen ARDMS _ MOCK exam

Fifty percent of neuroblastomas appear prior to what age? A. 6 months to 1 year B. 1 to 2 years C. 2 to 3 years D. 5 years or less

1 - 2 years Fifty percent of neuroblastomas occur prior to 1 to 2 years of age. A nephroblastoma (Wilms' tumor) occurs at 5 years of age or less.

How many centimeters below the superior mesenteric artery do the main renal arteries arise? A. 0.5 to 1.0 cm B. 1.0 to 1.5 cm C. 1.5 to 2.0 cm D. 2.0 to 2.5 cm

1.0 to 1.5 cm The main renal arteries are located 1.0 to 1.5 cm inferior to the superior mesenteric artery. Knowing this is useful when determining whether an abdominal aortic aneurysm includes the renal arteries.

The wall thickness in a normal fasting gallbladder should not exceed

3 mm

To obtain an optimal evaluation of the gallbladder, the adult patient should fast for A. 2 to 4 hours. B. 4 to 6 hours. C. 6 to 8 hours. D. 8 to 10 hours

6 to 8 hours To obtain an optimal evaluation of the gallbladder, the adult patient should fast for 6 to 8 hours prior to the examination.

A transplanted kidney is commonly placed in the A. right flank. B. left iliac fossa. C. right iliac fossa. D. paraumbilical region

A renal transplant is commonly placed in the anterior right iliac fossa.

A patient with a history of cirrhosis presents with a history of a painful supraumbilical mass. Based on this clinical history, the sonogram is most suspicious for which of the following abnormalities? A. Abdominal wall hematoma B. Meckel diverticulum C. Abdominal wall hernia D. Recanalized paraumbilical vein

Abdominal wall hernia A small defect is demonstrated in the anterior abdominal wall with extension of the omentum through the defect.

Paralytic ileus is associated with which of the following conditions? A. Cirrhosis B. Acute pancreatitis C. Acute cholecystitis D. Chronic pancreatitis

Acute pancreatitis In cases of acute pancreatitis, amylase and lipase levels are generally elevated. Patients complain of an abrupt onset of epigastric pain. Other symptoms include paralytic ileus and nausea/vomiting.

Extended use of oral contraceptives is a predisposing factor in developing which of the following hepatic neoplasms?

Adenoma Extended use of oral contraceptives is linked to development of liver adenomas. Cavernous hemangiomas and cystadenomas have a female prevalence but are not related to the use of oral contraceptives.

Which complication is most likely associated with an annular pancreas? A. Hepatitis B. Pancreatitis C. Bowel obstruction D. Urinary tract obstruction

Bowel obstruction Annular pancreas is a rare congenital anomaly where the head of the pancreas surrounds the duodenum. This anomaly may result in obstruction of the duodenum or biliary tree.

When assessing for mesenteric ischemia, which of the following arteries should be evaluated?

Celiac, superior, and inferior mesenteric arteries Duplex imaging of the celiac, superior mesenteric, and inferior mesenteric arteries should be evaluated when assessing for mesenteric ischemia.

Which benign liver neoplasm is composed of large, blood-filled cystic spaces?

Cavernous hemangioma The cavernous hemangioma is composed of large, blood-filled cystic spaces and is the most common benign hepatic neoplasm.

Which of the following conditions is most likely to result in acute pancreatitis? A. Cirrhosis B. Diverticulitis C. Cholelithiasis D. Portal hypertension

Cholelithiasis Biliary disease is the most common cause of acute pancreatitis followed by alcohol abuse.

The sonographic findings are most consistent with which of the following abnormalities?

Cholelithiasis Multiple small echogenic foci layer in the dependent portion of the gallbladder. Attenuation of sound by these foci produces posterior acoustic shadowing.

The sonographic findings are most consistent with which of the following abnormalities? A. Cholangitis B. Cholecystitis C. Cholelithiasis D. Adenomyomatosis

Cholelithiasis Multiple small echogenic foci layer in the dependent portion of the gallbladder. Attenuation of sound by these foci produces posterior acoustic shadowing.

The arrow is identifying which of the following structures?

Falciform ligament A hyperechoic linear structure extends anterior to the left lobe of the liver consistent with the falciform ligament. The falciform attaches the liver to the anterior abdominal wall and separates the subphrenic space into right and left compartments.

Which of the following structures separates the subphrenic space into two compartments?

Falciform ligament The falciform ligament divides the subphrenic space into right and left compartments. The left coronary ligament suspends the left lobe of the liver from the diaphragm.

Which of the following structures separates the subphrenic space into two compartments? A. Falciform ligament B. Left coronary ligament C. Gastroesophageal junction D. Hepatoduodenal ligament

Falciform ligament The falciform ligament divides the subphrenic space into right and left compartments. The left coronary ligament suspends the left lobe of the liver from the diaphragm.

Which of the following abnormalities is demonstrated in this color Doppler image?

Fatty infiltration with focal fat sparing The liver parenchyma demonstrates a diffuse increase in echogenicity (fatty infiltration). Hypoechoic areas are identified anterior and posterior to a hepatic vessel (fat sparing). Incidentally the right renal cortex has a scalloped appearance typical of fetal lobulation.

Portal veins appear prominent on ultrasound because the walls contain A. lipids. B. fibrin. C. calcium. D. plaque.

Fibrin Portal walls contain fibrin, resulting in a prominent hyperechoic appearance on ultrasound.

This sonogram is most likely demonstrating which of the following?

Gallbladder adenoma An immobile (decubitus position), nonshadowing, echogenic intraluminal focus is most consistent with a gallbladder adenoma (polyp).

A patient presents with a history of a painful lump on her posterior wrist. Based on this clinical history, the sonogram is most likely demonstrating which of the following abnormalities?

Ganglion cyst An anechoic smooth walled mass is identified in the area of concern. This most likely represents a ganglion cyst. A Baker cyst is located in the posterior medial portion of the knee joint.

A patient presents with sudden onset of upper abdominal pain. Ultrasound demonstrates prominence in the stomach rugae. These findings are most suspicious for which of the following conditions?

Gastritis Prominence of the stomach rugae in a patient with upper abdominal pain is most suspicious for gastritis. Hypervascular, thick gastric walls are sonographic findings associated with gastric ulcers.

Glisson's capsule surrounds which of the following organs? A. Liver B. Spleen C. Kidney D. Pancreas

Glisson's capsule surrounds the liver and Gerota's fascia surrounds the kidneys.

Proteinuria is a common clinical finding in which of the following conditions? A. Hydronephrosis B. Glomerulonephritis C. Nephrocalcinosis D. Medullary sponge disease

Glomerulonephritis Proteinuria is a finding in cases of glomerulonephritis, nephrolithiasis, renal carcinoma, polycystic disease, hypertension, and diabetes mellitus.

In this case which of the following laboratory values would be of benefit?

Hematocrit A fluid-fluid level is demonstrated within the liver parenchyma most suspicious for a hematoma. Hematocrit levels would aid in determining internal bleeding.

The gastroduodenal artery arises from which of the following arteries?

Hepatic artery The gastroduodenal artery arises from the common hepatic artery. The common hepatic artery is a branch of the celiac axis.

The gastroduodenal artery arises from which of the following arteries? A. Gastric artery B. Splenic artery C. Hepatic artery D. Superior mesenteric artery

Hepatic artery The gastroduodenal artery arises from the common hepatic artery. The common hepatic artery is a branch of the celiac axis.

A Klatskin tumor is located near which of the following structures?

Hepatic hilum A Klatskin tumor is a malignant neoplasm located at the junction of the right and left hepatic ducts near the hepatic hilum.

The anechoic structure is most likely arising from which of the following structures?

Kidney The cyst is most likely arising from the renal parenchyma. Possible differential considerations include hepatic or adrenal cyst.

Development of which of the following is associated with recurrent urinary tract infections? A. Angiomyolipoma B. Renal cell carcinoma C. Staghorn calculus D. Multicystic dysplasia

Staghorn calculus Development of staghorn calculus is associated with chronic urinary tract infections and chronic history of kidney stones.

Which of the following abnormalities is demonstrated in this transverse sonogram?

Stones in the duct of Wirsung Multiple stones are located in main pancreatic duct (duct of Wirsung).

Sialolithiasis most commonly occurs in which of the following salivary glands? A. Parotid B. Sublingual C. Submandibular D. Sublingual and submandibular

Submandibular 60 - 90% of cases of sialolithiasis occur in the submandibular salivary glands with 10 to 20 percent occurring in the parotid salivary glands.

Which of the following structures is located posterior to the superior mesenteric vein and anterior to the aorta? A. Splenic vein B. Uncinate process C. Body of the pancreas D. Caudate lobe of the liver

Uncinate process The uncinate process lies directly posterior to the superior mesenteric vein and anterior to the aorta and inferior vena cava. The splenic vein courses posterior to the pancreatic body and anterior to the aorta.

The hyperechoic structure in this sonogram represents

a hepatic stent The hyperechoic structure in the right portal vein is most consistent with a hepatic stent. Patients with cirrhosis may require a hepatic stent or shunt to decrease pressure within the portosplenic venous system. Recanalization demonstrates as an echogenic thickening to the intraluminal hepatic walls.

A normal lymph node will likely demonstrate

a hyperechoic fatty center The normal lymph node demonstrates a smooth, hypoechoic, oval shape and a hyperechoic fatty center on ultrasound.

This sagittal image of the left kidney is most likely demonstrating

a normal neonatal kidney. A 5.0 cm kidney (using sidebar measurements) inferior to the spleen demonstrates an echogenic renal cortex, anechoic medullary pyramids, and a discrete renal sinus. This is most consistent with a normal neonatal kidney.

Renal dialysis patients have an increased risk of developing a renal

carcinoma Renal dialysis patients have an increased risk of developing a renal carcinoma, cyst, or adenoma.

Renal dialysis patients have an increased risk of developing a renal A. abscess. B. calculus. C. infection. D. carcinoma

carcinoma Renal dialysis patients have an increased risk of developing a renal carcinoma, cyst, or adenoma.

A patient presents with a history of vague right upper quadrant pain. Laboratory values are within normal limits. The sonogram is most likely demonstrating a(n) A. hepatoma. B. metastatic lesion. C. angiomyolipoma. D. cavernous hemangioma

cavernous hemangioma. A well-defined hyperechoic mass is present in a patient with normal laboratory values. This is most consistent with a cavernous hemangioma.

The sonographic finding in this sonogram of the common bile duct is most consistent with A. ascariasis. B. cholangitis. C. clonorchiasis. D. cholangiocarcinoma

cholangitis The common duct demonstrates hypoechoic wall thickening. This is most consistent with cholangitis. Cholangitis is a common complication in patients with autoimmune deficiency syndrome.

Cases of gallbladder carcinoma frequently demonstrate coexisting

cholelithiasis In approximately 90 percent of cases, cholelithiasis coexists with gallbladder carcinoma

Which of the following conditions is associated with secondary subacute thyroiditis? A. Grave's disease B. Mirizzi syndrome C. Hashimoto disease D. de Quervain syndrome

de Quervain syndrome de Quervain syndrome is associated with subacute thyroiditis secondary to a viral infection. Hashimoto disease is a progressive autoimmune inflammatory disorder of the thyroid gland.

Which of the following conditions is associated with secondary subacute thyroiditis? A. Grave's disease B. Mirizzi syndrome C. Hashimoto disease D. de Quervain syndrome

de Quervain syndrome is associated with subacute thyroiditis secondary to a viral infection. Hashimoto disease is a progressive autoimmune inflammatory disorder of the thyroid gland.

This sonogram of the right kidney is most likely demonstrating

junctional parenchymal defect. A triangular, echogenic cortical defect present in the anterior wall of the right kidney most likely represents a junctional parenchymal defect. An angiomyolipoma is a differential consideration but is not as likely the diagnosis.

Regulation of serum electrolytes is a function of the

kidneys The urinary system regulates serum electrolytes.

Regulation of serum electrolytes is a function of the A. liver. B. kidneys. C. adrenal glands. D. thyroid glands

kidneys The urinary system regulates serum electrolytes.

Bile pigments are produced by the

liver The liver breaks down red blood cells, producing bile pigments.

Enlarged lymph nodes demonstrating smooth wall margins are most consistent with an underlying A. infection. B. obstruction. C. malignancy. D. hemorrhage

infection Lymphadenopathy demonstrating a normal oval shape with smooth wall margins is most consistent with an underlying infection. Irregular wall margins or decreases in the fatty hilum are findings suspicious for an underlying malignancy.

Enlarged lymph nodes demonstrating smooth wall margins are most consistent with an underlying A. infection. B. obstruction. C. malignancy. D. hemorrhage

infection Lymphadenopathy demonstrating a normal oval shape with smooth wall margins is most consistent with an underlying infection. Irregular wall margins or decreases in the fatty hilum are findings suspicious for an underlying malignancy.

Sonographic findings associated with pyelonephritis include

well-defined renal pyramids. Generalized or focal swelling of the kidney demonstrating well-defined renal pyramids is the typical sonographic finding associated with pyelonephritis.

A true abdominal aortic aneurysm is defined as dilatation of the aorta A. inferior to the renal arteries. B. when compared with a previous study. C. with a diameter measuring 3 cm or greater. D. when compared with a proximal segment

with a diameter measuring 3 cm or greater A true abdominal aortic aneurysm (AAA) measures 3 cm or greater in diameter. The majority of AAA are located inferior to the renal arteries.

A positive Phalen's sign is associated with an abnormality of which of the following joints? A. Knee B. Ankle C. Wrist D. Shoulder

A positive Phalen's and/or Tinel's sign is associated with carpal tunnel syndrome (wrist).

Extended use of oral contraceptives is a predisposing factor in developing which of the following hepatic neoplasms? A. Adenoma B. Hepatoma C. Cystadenoma D. Cavernous hemangioma

Adenoma Extended use of oral contraceptives is linked to development of liver adenomas. Cavernous hemangiomas and cystadenomas have a female prevalence but are not related to the use of oral contraceptives.

Which of the following liver pathologies is associated with glycogen storage disease?

Adenoma Glycogen storage disease is an autosomal recessive disorder resulting in excessive deposition of glycogen in the liver, kidneys, and gastrointestinal tract. It is associated with development of a hepatic adenoma, focal nodular hyperplasia, and nephromegaly.

Which of the following liver pathologies is associated with glycogen storage disease? A. Hepatitis B. Adenoma C. Hepatoma D. Cavernous hemangioma

Adenoma Glycogen storage disease is an autosomal recessive disorder resulting in excessive deposition of glycogen in the liver, kidneys, and gastrointestinal tract. It is associated with development of a hepatic adenoma, focal nodular hyperplasia, and nephromegaly.

Which of the following abnormalities is present in this sagittal sonogram?

Adenomyomatosis Immobile hyperechoic foci demonstrating a "comet-tail" reverberation artifact are characteristic findings of adenomyomatosis.

In which of the following laboratory tests is marked elevation associated with obstructive jaundice?

Alkaline phosphatase Marked elevation in alkaline phosphatase is associated with obstructive jaundice. Elevation of direct or conjugated bilirubin is associated with biliary obstruction.

In which of the following laboratory tests is marked elevation associated with obstructive jaundice? A. Indirect bilirubin B. Alpha-fetoprotein C. Alkaline phosphatase D. Alanine aminotransferase

Alkaline phosphatase Marked elevation in alkaline phosphatase is associated with obstructive jaundice. Elevation of direct or conjugated bilirubin is associated with biliary obstruction.

Which of the following laboratory values is associated with malignancy in the elderly population?

Alpha-fetoprotein Alpha-fetoprotein is an abnormal finding associated with an underlying malignancy in nonpregnant patients.

Which of the following laboratory values is associated with malignancy in the elderly population? A. Bilirubin B. Serum albumin C. Alpha-fetoprotein D. Alkaline phosphatase

Alpha-fetoprotein is an abnormal finding associated with an underlying malignancy in nonpregnant patients.

Which of the following most accurately describes the location of the common hepatic duct?

Anterior to the main portal vein and lateral to the proper hepatic artery The common hepatic duct lies anterior to the main portal vein and lateral to the proper hepatic artery.

Which of the following demonstrates diffuse enlargement of the abdominal aorta without distal tapering?

Arteriomegaly Arteriomegaly (aortic ectasia) demonstrates as a diffuse enlargement of the abdominal aorta without distal tapering on ultrasound.

Which of the following demonstrates diffuse enlargement of the abdominal aorta without distal tapering? A. Pseudoaneurysm B. Mycotic aneurysm C. Ectatic aneurysm D. Arteriomegaly

Arteriomegaly (aortic ectasia) demonstrates as a diffuse enlargement of the abdominal aorta without distal tapering on ultrasound.

Which laboratory value reveals cell injury or damage?

Aspartate aminotransferase Aspartate aminotransferase (AST) is an enzyme present in many kinds of tissues releasing when cells are injured or damaged. Levels are proportional to the amount of damage and the time between cell injury and testing

Which laboratory value reveals cell injury or damage? A. Bilirubin B. Alkaline phosphatase C. Aspartate aminotransferase D. Alanine aminotransferase

Aspartate aminotransferase Aspartate aminotransferase (AST) is an enzyme present in many kinds of tissues releasing when cells are injured or damaged. Levels are proportional to the amount of damage and the time between cell injury and testing.

When empty, bladder wall thickness should not exceed A. 2 mm. B. 3 mm. C. 5 mm. D. 7 mm.

Bladder wall thickness should not exceed 5 mm when empty or 3 mm when distended.

Acute tubular necrosis demonstrates on ultrasound as A. a unilateral small hypoechoic kidney. B. bilateral renal enlargement with hypoechoic renal pyramids. C. unilateral renal enlargement with absent renal pyramids. D. bilateral renal enlargement with hyperechoic renal pyramids

Bilateral renal enlargement with hyperechoic renal pyramids is the classic sonographic finding associated with acute tubular necrosis.

A transverse sonogram of the liver is likely demonstrating which of the following? A. Hepatomegaly resulting from biliary dilatation B. Hepatic vein thrombosis and biliary dilatation C. Prominent portal veins resulting from hepatitis D. Biliary dilatation secondary to metastatic disease

Biliary dilatation secondary to metastatic disease The most likely diagnosis of this sonogram is biliary dilatation resulting from metastatic disease. Multiple discrete masses are present in the liver parenchyma.

Progression of which of the following abnormalities flattens the portal veins?

Biliary obstruction

Progression of which of the following abnormalities flattens the portal veins? A. Ascariasis B. Portal vein thrombosis C. Portal hypertension D. Biliary obstruction

Biliary obstruction Progression of biliary obstruction will inadvertently flatten the portal venous system.

Which of the following gallbladder abnormalities is not always pathological in origin?

Biliary sludge Biliary sludge may develop in cases of prolonged fasting or biliary disease.

Which of the following laboratory values reflects the balance between production and excretion of bile? A. Bilirubin B. Alkaline phosphatase C. Alanine aminotransferase (ALT) D. Aspartate aminotransferase (AST)

Bilirubin Bilirubin reflects the balance between production and excretion of bile. Serum albumin evaluates protein synthesis.

Which of the following laboratory values reflects the balance between production and excretion of bile? A. Bilirubin B. Alkaline phosphatase C. Alanine aminotransferase (ALT) D. Aspartate aminotransferase (AST)

Bilirubin Bilirubin reflects the balance between production and excretion of bile. Serum albumin evaluates protein synthesis.

A patient presents with a history of hematuria. The findings in this duplex image are most suspicious for which of the following pathologies?

Carcinoma A vascular echogenic mass is identified protruding from the posterior wall of the urinary bladder. Bladder carcinoma commonly presents with a history of painless hematuria. Based on the clinical history, the sonographic findings are suspicious for a malignant mass.

A beaded appearance to the intrahepatic ducts is a sonographic finding in which of the following conditions?

Caroli disease Caroli disease demonstrates a segmental, saccular, or beaded appearance to the intrahepatic biliary ducts.

A beaded appearance to the intrahepatic ducts is a sonographic finding in which of the following conditions? A. Caroli disease B. Bouveret syndrome C. Budd-Chiari syndrome D. Courvoisier syndrome

Caroli disease demonstrates a segmental, saccular, or beaded appearance to the intrahepatic biliary ducts.

A contracted gallbladder is a common sonographic finding in which of the following conditions?

Chronic cholecystitis A small or contracted gallbladder is a common sonographic finding in cases of chronic cholecystitis. Cholesterolosis, adenomyomatosis, and metastatic gallbladder disease demonstrate as intraluminal masses

A contracted gallbladder is a common sonographic finding in which of the following conditions? A. Cholesterolosis B. Metastatic gallbladder disease C. Portal hypertension D. Chronic cholecystitis

Chronic cholecystitis A small or contracted gallbladder is a common sonographic finding in cases of chronic cholecystitis. Cholesterolosis, adenomyomatosis, and metastatic gallbladder disease demonstrate as intraluminal masses

A small hyperechoic pancreas is most suspicious for which of the following abnormalities?

Chronic pancreatitis Chronic pancreatitis is associated with atrophy of the pancreas and demonstrates a hyperechoic parenchyma. Fatty infiltration generally does not affect the size of the pancreas.

Which of the following should be included in a kidney ultrasound protocol when hydronephrosis is encountered? A. Color Doppler imaging of the renal artery and vein B. Pre and post void bladder volumes C. Color Doppler imaging of the ureteral jet(s) D. Gray-scale images of the liver and spleen

Color Doppler imaging of the ureteral jet(s) When hydronephrosis is encountered, color Doppler imaging of the ureteral jets should be included in the examination protocol.

The arrow is identifying which of the following vascular structures?

Common hepatic artery The arrow identifies a structure branching from the celiac axis and coursing toward the liver. This is most consistent with the common hepatic artery. The common hepatic artery becomes the proper hepatic artery after the origin of the gastroduodenal artery.

A metabolic disorder resulting from excessive production of cortisol describes A. Conn syndrome. B. Addison disease. C. Marfan syndrome. D. Cushing syndrome

Cushing syndrome The cortex of the adrenal gland secretes cortisol. Cushing disease is associated with an excessive production of cortisol. Partial or complete failure of the adrenocortical function is associated with Addison disease. Conn syndrome is associated with elevated aldosterone levels.

A sagittal sonogram medial to the porta hepatis is demonstrating which of the following abnormalities?

Dilated common bile duct A hypoechoic mass identified by the calipers is obstructing the common bile duct resulting in dilatation. The mass is most likely a malignancy in the head of the pancreas.

A 25-year-old female patient presents with a history of mild right upper quadrant pain and normal liver function tests. Based on the sonogram, the sonographer should ask the patient

Do you use oral contraceptives? A 25-year-old female demonstrating a hypoechoic liver mass and a peripheral hypoechoic halo is suspicious for a hepatic adenoma. The sonographer should inquire whether the patient is taking oral contraceptives.

A 25-year-old female patient presents with a history of mild right upper quadrant pain and normal liver function tests. Based on the sonogram, the sonographer should ask the patient: A. Are you diabetic? B. Do you use oral contraceptives? C. Are you taking medication for hypertension? D. Have you undergone any abdominal surgery

Do you use oral contraceptives? A 25-year-old female demonstrating a hypoechoic liver mass and a peripheral hypoechoic halo is suspicious for a hepatic adenoma. The sonographer should inquire whether the patient is taking oral contraceptives.

Which of the following is a complication of acute pancreatitis?

Duodenal obstruction Complications of acute pancreatitis may include abscess formation, duodenal obstruction, hemorrhage, phlegmon, and pseudocyst formation. Cholecystitis is a possible etiology of acute pancreatitis.

Which of the following is a complication of acute pancreatitis? A. Cholecystitis B. Hepatomegaly C. Splenomegaly D. Duodenal obstruction

Duodenal obstruction Complications of acute pancreatitis may include abscess formation, duodenal obstruction, hemorrhage, phlegmon, and pseudocyst formation. Cholecystitis is a possible etiology of acute pancreatitis.

The "water lily" sign is associated with which of the following abnormalities?

Echinococcal cyst The "water lily" sign describes a collapsed cyst within a cyst, characteristic of an echinococcal cyst.

The "water lily" sign is associated with which of the following abnormalities? A. Hydronephrosis B. Echinococcal cyst C. Hepatic cystadenoma D. Polycystic liver disease

Echinococcal cyst The "water lily" sign describes a collapsed cyst within a cyst, characteristic of an echinococcal cyst.

Which of the following is the optimal technique for evaluating the kidneys? A. Harmonic imaging B. Patient lying supine C. Empty urinary bladder D. Phased array linear transducer

Empty urinary bladder Utilizing an empty urinary bladder is optimal when assessing the kidneys. Optimal patient position depends on several different factors. Prone imaging is great for pediatric cases. Adult exams typically utilize a coronal scanning plane.

A Klatskin tumor is located near which of the following structures? A. Adrenal gland B. Hepatic hilum C. Head of the pancreas D. Gastroesophageal junction

Hepatic hilum A Klatskin tumor is a malignant neoplasm located at the junction of the right and left hepatic ducts near the hepatic hilum.

Which of the following vascular structures normally demonstrates this waveform? A. Portal vein B. Hepatic vein C. Splenic vein D. Superior mesenteric vein

Hepatic vein Pulsatile bidirectional venous flow is characteristic of a normal hepatic vein.

An ultrasound is requested to rule out Budd-Chiari syndrome. The sonographer should thoroughly evaluate which of the following abdominal veins?

Hepatic veins Budd-Chiari syndrome is a life-threatening condition associated with thrombosis of the hepatic veins. The sonographer should thoroughly evaluate the liver vasculature.

Which of the following pathologies is most likely demonstrated in this sonogram?

Hepatitis An increase in echogenicity in the walls of the portal veins is a sonographic finding associated with hepatitis (star effect). Biliary obstruction demonstrates parallel channeling and flattening of the portal veins.

Prominence of the portal veins is a sonographic characteristic of which of the following abnormalities?

Hepatitis The contour of the liver is generally unaffected in cases of acute hepatitis. Acute hepatitis may demonstrate a hypoechoic liver parenchyma, hepatomegaly, associated splenomegaly, and prominence of the portal veins (star effect).

Prominence of the portal veins is a sonographic characteristic of which of the following abnormalities? A. Hepatitis B. Candidiasis C. Hepatic steatosis D. Biliary obstruction

Hepatitis The contour of the liver is generally unaffected in cases of acute hepatitis. Acute hepatitis may demonstrate a hypoechoic liver parenchyma, hepatomegaly, associated splenomegaly, and prominence of the portal veins (star effect).

Which of the following ligaments forms the anterior border of the epiploic foramen?

Hepatoduodenal ligament The hepatoduodenal ligament surrounds the portal triad just proximal to the porta hepatis and forms the anterior border of the epiploic foramen.

Which of the following ligaments forms the anterior border of the epiploic foramen? A. Falciform ligament B. Coronary ligament C. Gastrohepatic ligament D. Hepatoduodenal ligament

Hepatoduodenal ligament The hepatoduodenal ligament surrounds the portal triad just proximal to the porta hepatis and forms the anterior border of the epiploic foramen.

Which of the following pathologies is most likely identified in this sonogram of the liver? A. Abscess B. Adenoma C. Hepatoma D. Cavernous hemangioma

Hepatoma A solitary, smooth walled, hypoechoic mass is identified in the left lobe of the liver most suspicious for a hepatoma. The mass does not demonstrate a hypoechoic halo characteristic of a hepatic adenoma or irregular wall margins characteristic of an abscess.

Which of the following is an abnormal flow characteristic of the hepatic veins?

Hepatopetal Hepatic veins course away from the liver toward the inferior vena cava. This is termed hepatofugal flow. Hepatic veins demonstrate spontaneous multiphasic (pulsatile) flow.

A patient presents with a history of a palpable neck mass. Which of the following terms best describes the sonographic findings?

Heterogeneous thyroid gland The sonographer's technical report should describe the right thyroid lobe as demonstrating an irregular and heterogeneous echo texture.

Which of the following congenital anomalies demonstrates a "dipping effect" to inferior poles of the kidneys? A. Cake kidney B. Renal ptosis C. Renal duplication D. Horseshoe kidney

Horseshoe kidney Demonstration of bilateral "dipping" of the inferior poles should raise suspicion of a horseshoe anomaly. Crossed fused ectopia demonstrates one single large kidney within the same quadrant.

Which of the following is the most common form of renal fusion? A. Renal duplication B. Cake kidney C. Cross-fused ectopia D. Horseshoe kidney

Horseshoe kidney The horseshoe kidney is the most common form of renal fusion

Which of the following abnormalities are demonstrated in this sonogram?

Hydrocele and complex epididymal cyst An anechoic fluid collection is identified in the right scrotal sac. The scrotal wall appears thin. This is most consistent with a hydrocele. A complex cyst is also identified in the head of the epididymis.

Visceral lymph nodes are located in which of the following regions? A. Around the aorta B. In the peritoneum C. Near the adrenal glands D. Along the prevertebral vessels

In the peritoneum Visceral lymph nodes are located in the peritoneum. They follow the course of the vessels supplying the major organs. Parietal lymph nodes are located in the retroperitoneum and course along the prevertebral vessels.

Which of the following vascular landmarks is used to differentiate an indirect from a direct inguinal hernia? A. Internal iliac artery B. Superior epigastric artery C. Inferior epigastric artery D. External iliac artery

Inferior epigastric artery The inferior epigastric artery is the vascular landmark used to differentiate an indirect from a direct inguinal hernia.

Which of the following arteries are termed the hypogastric arteries?

Internal iliac arteries The internal iliac arteries are also known as the hypogastric arteries.

Which of the following vascular structures is the arrow identifying?

Internal jugular vein The anechoic structure is located lateral to the thyroid lobe and anterior to the common carotid artery. This is most consistent with the internal jugular vein. The external jugular vein is located in the lateral neck.

This transverse sonogram of the right testicle is most likely demonstrating which of the following abnormalities?

Intratesticular calcifications Multiple small hyperechoic foci (microcalcifications) are demonstrated in the right testis. Intratesticular calcifications may be idiopathic or associated with chronic orchitis.

Which of the following neoplasms is commonly located in the tail of the pancreas?

Islet cell tumor Islet cell tumors are most commonly located in the body and tail of the pancreas. Adenocarcinoma involving the pancreas commonly develops in the head of the pancreas.

Which of the following neoplasms is commonly located in the tail of the pancreas? A. Cyst B. Adenoma C. Islet cell tumor D. Adenocarcinoma

Islet cell tumors are most commonly located in the body and tail of the pancreas. Adenocarcinoma involving the pancreas commonly develops in the head of the pancreas.

Which of the following structures divides the left lobe into two segments?

Left hepatic vein and ligamentum of Teres The left hepatic vein and ligamentum of Teres divide the left lobe of the liver into left and right segments. The left lobe is separated from the right lobe by the middle hepatic vein and the main lobar fissure.

Which vascular structure courses posterior to the superior mesenteric artery and anterior to the abdominal aorta?

Left renal vein The left renal vein courses posterior to the superior mesenteric artery and anterior to the abdominal aorta.

Which vascular structure courses posterior to the superior mesenteric artery and anterior to the abdominal aorta? A. Splenic vein B. Left renal vein C. Left gastric artery D. Superior mesenteric vein

Left renal vein The left renal vein courses posterior to the superior mesenteric artery and anterior to the abdominal aorta.

A palpable buttock mass identified is most consistent with which of the following?

Lipoma A well circumscribed mass that does not demonstrate posterior acoustic enhancement is most consistent with a lipoma.

Glisson's capsule surrounds which of the following organs?

Liver Glisson's capsule surrounds the liver and Gerota's fascia surrounds the kidneys.

Prothrombin is an enzyme produced by the A. heart. B. liver. C. spleen. D. pancreas

Liver The liver produces prothrombin. Elevation is associated with cirrhosis, malignancy, malabsorption of vitamin K, and clotting failure.

Which of the following structures are included in an ultrasound protocol of the pancreas? A. Liver and spleen B. Liver and biliary system C. Inferior vena cava and abdominal aorta D. Liver and right kidney

Liver and biliary system Due to the association of the liver and biliary tree with the pancreas, sagital and transverse images of these structures should be included in an ultrasound protocol of the pancreas.

Inferiorly, the right hepatic lobe is separated from the left lobe by the A. right portal vein. B. left hepatic vein. C. main lobar fissure. D. middle hepatic vein

Main Lobar Fissure The right hepatic lobe is separated from the left lobe by the main lobar fissure inferiorly and the middle hepatic vein superiorly.

Which of the following structures aids in locating the gallbladder fossa?

Main lobar fissure The main lobar fissure is a sonographic landmark used in locating the gallbladder fossa. The right hepatic vein divides the right lobe of the liver into anterior and posterior segments.

Cryptorchism is a predisposing risk factor for developing which of the following abnormalities?

Malignancy Undescended testis (cryptorchism) is a risk factor for developing testicular torsion, malignancy, and infertility.

A 20-year-old patient presents with a palpable left scrotal mass. The sonographic findings are most suspicious for which of the following pathologies?

Malignant neoplasm A malignant neoplasm is the most likely diagnosis in a young adult demonstrating a hypoechoic intratesticular mass. The patient is afebrile excluding a testicular abscess from the differential considerations.

In a renal transplant patient, a lymphocele is generally located A. medial. B. lateral. C. anterior. D. posterior

Medial Lymphoceles are usually found medial to a renal transplant and will frequently contain debris.

Which of the following most accurately describes the location of the adrenal glands?

Medial to the kidneys The adrenal glands are located anterior, medial, and superior to each kidney and lateral to the crura of the diaphragm.

Which of the following most accurately describes the location of the adrenal glands? A. Medial to the kidneys B. Inferior to the kidneys C. Anterior to the pancreas D. Medial to the diaphragmatic crura

Medial to the kidneys The adrenal glands are located anterior, medial, and superior to each kidney and lateral to the crura of the diaphragm.

Which of the following is a clinical symptom of hypothyroidism?

Muscle cramps Muscles cramping is a symptom of hypothyroidism. Other symptoms may include weight gain, mental and physical lethargy, arthritis, skin dryness, feeling cold, slow metabolic rate, and decreased heart rate. Symptoms commonly associated with hyperthyroidism include weight loss, palpitations, nervousness, exophthalmos, constant hunger, tremors, increased heart rate, and intolerance to heat.

A toddler presents to the ultrasound department with a history of a left upper quadrant mass. Based on this clinical history, the coronal sonogram is most suspicious for which of the following abnormalities? A. Splenomegaly B. Adrenal adenoma C. Nephroblastoma D. Intussusception

Nephroblastoma A complex solid mass is identified inferior to the spleen. A normal left kidney is not identified. In a toddler the most likely diagnosis would be nephroblastoma. Differential consideration may include neuroblastoma if a normal left kidney is identified. An adrenal adenoma appears as a hypoechoic homogeneous mass.

Hyperparathyroidism may lead to which of the following renal pathologies? A. Multicystic dysplasia B. Pyelonephritis C. Nephrolithiasis D. Acute tubular necrosis

Nephrolithiasis Excessive function of the parathyroid glands may lead to osteoporosis and nephrolithiasis.

Which of the following structures is most likely mistaken for the splenic artery?

Pancreatic duct The pancreatic duct and the splenic artery are most likely to be confused with each other. Color Doppler imaging is a quick method of verifying a vascular structure.

Stenson's duct is located in which of the following glands? A. Thyroid gland B. Parotid salivary gland C. Sublingual salivary gland D. Submandibular salivary gland

Parotid salivary gland The parotid salivary gland contains Stenson's duct. Submandibular salivary gland contains Wharton duct.

Stenson's duct is located in which of the following glands? A. Thyroid gland B. Parotid salivary gland C. Sublingual salivary gland D. Submandibular salivary gland

Parotid salivary gland The parotid salivary gland contains Stenson's duct. Submandibular salivary gland contains Wharton duct.

This color Doppler sonogram is most likely demonstrating which of the following abnormalities?

Patent umbilical vein The sonogram is demonstrating a patent paraumbilical vein. Note the liver parenchyma of the left lobe superior to the patent umbilical vein. Gastric varices are generally located to the left of midline.

A cake kidney is generally located in which of the following regions? A. Pelvis B. Left flank C. Paraumbilical D. Right flank

Pelvic A cake kidney is a variant of a horseshoe kidney. The entire medial aspects of the kidneys are fused. A cake kidney is typically located in the pelvis.

A cake kidney is generally located in which of the following regions?

Pelvis A cake kidney is a variant of a horseshoe kidney. The entire medial aspects of the kidneys are fused. A cake kidney is typically located in the pelvis.

An obese patient presents with a history of elevated liver function tests. The arrows are identifying which of the following structures?

Perinephric fat Increase in perinephric and peritoneal fat are common sonographic findings in obese patients. The arrows are identifying a thick amount of perinephric fat.

Which anatomic variant is present in this sonogram of the gallbladder? A. Duplication B. Phrygian cap C. Hartmann pouch D. Intrahepatic location

Phrygian cap A fold in the gallbladder fundus is consistent with a phrygian cap. Hartmann pouch or a junctional fold is anatomic variants located near the gallbladder neck.

Which of the following anatomic variants involves the fundus of the gallbladder?

Phrygian cap Folding of the gallbladder fundus describes a phrygian cap. Hartmann pouch and junctional fold are anatomic variants in the region of the gallbladder neck. A multiseptated gallbladder is a congenital anomaly and fetal lobulation involves the kidney.

Which of the following anatomic variants involves the fundus of the gallbladder? A. Junctional fold B. Phrygian cap C. Hartmann pouch D. Multiseptated gallbladder

Phrygian cap Folding of the gallbladder fundus describes a phrygian cap. Hartmann pouch and junctional fold are anatomic variants in the region of the gallbladder neck. A multiseptated gallbladder is a congenital anomaly and fetal lobulation involves the kidney.

Splenomegaly is a consistent finding in which of the following pathologies? A. Hepatic steatosis B. Biliary obstruction C. Portal hypertension D. Portal vein thrombosis

Portal hypertension Splenomegaly is a consistent finding in cases of portal hypertension

Splenomegaly is a consistent finding in which of the following pathologies?

Portal hypertension Splenomegaly is a consistent finding in cases of portal hypertension.

Which of the following pathologies is most consistent with these sonographic findings?

Portal vein thrombosis Altered blood flow within the portal vein, in conjunction with a hypoechoic intraluminal mass, is most suspicious for portal vein thrombosis. Severe abdominal pain and loss of appetite are common clinical symptoms connected with thrombosis of the portal venous system.

Which of the following pathologies is more commonly associated with severe abdominal pain?

Portal vein thrombosis Severe abdominal pain is more commonly associated with portal vein thrombosis.

Which of the following pathologies is more commonly associated with severe abdominal pain? A. Portal hypertension B. Cirrhosis C. Hepatoma D. Portal vein thrombosis

Portal vein thrombosis Severe abdominal pain is more commonly associated with portal vein thrombosis.

Which of the following accurately describes the portal veins?

Portal veins are intralobar in location Portal veins are intralobar or intrasegmental in location. The portal veins supply approximately 70 to 75 percent of the liver's total blood volume. The main portal vein divides into the right and left portal veins. The walls of the portal veins contain fibrin.

Production of prothrombin depends on the amount of vitamin Vitamin D. Vitamin A. Vitamin K. Vitamin B.

Production of prothrombin depends on the amount of vitamin K in the circulatory system.

Which of the following is NOT a sonographic finding associated with Achilles' tendonitis? A. Irregular margins B. Hypervascular tendon C. Thickness exceeding 7 mm D. Prominent hyperechoic areas interspersed within the tendon

Prominent hyperechoic areas interspersed within the tendon Tendonitis of the Achilles' tendon demonstrates hypoechoic areas interspersed between the fibrous tissues of the tendon. Additional sonographic findings may include hypervascular tendon, irregular margins, and a thickness exceeding 7 mm.

This color Doppler sonogram is most likely demonstrating which of the following abnormalities?

Pseudoaneurysm This color Doppler image demonstrates turbulent swirling blood flow within a fluid collection, classic sonographic findings of a common femoral artery pseudoaneurysm.

The pathology in this sonogram is most likely a/an

Pseudocyst A complex fluid collection is identified posterior to the tail of the pancreas. This is most likely a pancreatic pseudocyst. Phlegmons and islet cell tumors appear as hypoechoic masses on ultrasound. A pancreatic hemorrhage is a differential consideration but not the most likely pathology.

The sonographic findings in this infant kidney are most consistent with which of the following anomalies?

Renal duplication Two individual renal sinuses are present. The lower sinus demonstrates pelviectasis (Grade 1 hydronephrosis). This is most suspicious for renal duplication. Hypertrophied column of Bertin is a common anatomic variants.

Which of the following enzymes will most likely affect blood pressure? A. Renin B. Trypsin C. Somatostatin D. Aldosterone

Renin Renin, also known as angiotensinogenase, is an enzyme secreted by the kidneys to help regulate blood pressure.

Extension of the right lobe of the liver inferior and anterior to the right kidney is termed a(n) A. accessory lobe. B. Riedel's lobe. C. succenturiate lobe. D. pyramidal lobe

Riedel's lobe Extension of the right lobe of the liver anterior and inferior to the kidney is termed a Riedel's lobe. This is a common finding in the female population.

Extension of the right lobe of the liver inferior and anterior to the right kidney is termed a(n) A. accessory lobe. B. Riedel's lobe. C. succenturiate lobe. D. pyramidal lobe.

Riedel's lobe. Extension of the right lobe of the liver anterior and inferior to the kidney is termed a Riedel's lobe. This is a common finding in the female population.

A transjugular intrahepatic portosystemic shunt (TIPS) generally connects which of the following? A. Right portal vein and the inferior vena cava B. Right hepatic vein and right portal vein C. Middle hepatic vein and the left portal vein D. Left hepatic vein and left portal vein

Right hepatic vein and right portal vein TIPS generally connects the right hepatic vein and right portal vein.

A transjugular intrahepatic portosystemic shunt (TIPS) generally connects which of the following? A. Right portal vein and the inferior vena cava B. Right hepatic vein and right portal vein C. Middle hepatic vein and the left portal vein D. Left hepatic vein and left portal vein

Right hepatic vein and right portal vein TIPS generally connects the right hepatic vein and right portal vein.

The arrow is identifying which of the following structures?

Right renal artery The right renal artery coursing posterior to the inferior vena cava is a common sonographic landmark.

The inferior mesenteric artery is best visualized in which of the following body planes? A. Transverse B. Sagittal C. Coronal D. Sagittal oblique

Sagittal oblique That's correct! The inferior mesenteric artery is best visualized in the sagittal oblique plane, to the left of midline, approximately 1 cm superior to the abdominal aortic bifurcation.

Which of the following laboratory values increases in Addison disease?

Serum potassium Laboratory values associated with Addison disease demonstrate an elevation in serum potassium and a decrease in serum sodium and glucose.

Which of the following laboratory values increases in Addison disease? A. Cortisol B. Serum sodium C. Aldosterone D. Serum potassium

Serum potassium Laboratory values associated with Addison disease demonstrate an elevation in serum potassium and a decrease in serum sodium and glucose.

Which of the following vascular structures is located directly posterior to the neck of the pancreas? A. Inferior vena cava B. Gastroduodenal artery C. Superior mesenteric vein D. Superior mesenteric artery

Superior mesenteric vein The superior mesenteric vein and portosplenic confluence lie directly posterior to the neck of the pancreas.

The color Doppler image is most suspicious for which of the following abnormalities? A. Epididymitis B. Testicular torsion C. Testicular abscess D. Testicular carcinoma

Testicular torsion The color Doppler image demonstrates an absence of testicular flow in the right testicle and the presence of blood flow within the left testicle. This is most suspicious for testicular torsion.

The subhepatic space communicates with the lesser sac through the foramen of A. Ovale. B. Monro. C. Winslow. D. Santorini

The foramen of Winslow allows communication between the subhepatic space and lesser sac

Which of the following arteries are termed the hypogastric arteries? A. Suprarenal arteries B. Common iliac arteries C. External iliac arteries D. Internal iliac arteries

The internal iliac arteries are also known as the hypogastric arteries.

Bile pigments are produced by the A. liver. B. pancreas. C. gallbladder. D. biliary ducts

The liver breaks down red blood cells, producing bile pigments.

Which of the following vessels receives blood from the gallbladder, pancreas, spleen, and gastrointestinal tract? A. Hepatic veins B. Main portal vein C. Inferior vena cava D. Superior mesenteric vein

The main portal vein receives blood from the gastrointestinal tract, gallbladder, pancreas, and spleen.

How many centimeters below the superior mesenteric artery do the main renal arteries arise? A. 0.5 to 1.0 cm B. 1.0 to 1.5 cm C. 1.5 to 2.0 cm D. 2.0 to 2.5 cm

The main renal arteries are located 1.0 to 1.5 cm inferior to the superior mesenteric artery. Knowing this is useful when determining whether an abdominal aortic aneurysm includes the renal arteries.

The wall thickness in a normal fasting gallbladder should not exceed A. 2 mm. B. 3 mm. C. 5 mm. D. 7 mm

The normal fasting gallbladder demonstrates smooth hyperechoic walls measuring 3 mm or less.

The protective connective tissue surrounding each kidney is termed A. renal fascia. B. renal capsule. C. Gerota's fascia. D. perinephric fat

The renal capsule is a protective connective tissue surrounding each kidney. Gerota's or renal fascia is the fibrous covering of tissue surrounding each kidney.

Which of the following terms describes the sections of the epididymis? A. Head, body, and tail B. Right, left, and posterior C. Superior, midline, and inferior D. Medial, posterior, and lateral

The sections of the epididymis include the head (posterior and superior portion), body (posterior portion), and tail (posterior and inferior portion).

Which of the following accurately describes the spleen? A. The spleen is a retroperitoneal organ. B. The peritoneum completely covers the spleen. C. The spleen is located medial to the pancreas. D. The spleen lies posterior and lateral to the stomach

The spleen lies posterior and lateral to the stomach within the peritoneum. Peritoneum covers the spleen except at the hilum.

To obtain an optimal evaluation of the gallbladder, the adult patient should fast for A. 2 to 4 hours. B. 4 to 6 hours. C. 6 to 8 hours. D. 8 to 10 hours

To obtain an optimal evaluation of the gallbladder, the adult patient should fast for 6 to 8 hours prior to the examination.

A transverse image of the urinary bladder is demonstrating which of the following?

Ureteroceles Bilateral hyperechoic septations within the posterior bladder wall are most consistent with ureteroceles. Ureteroceles are focal dilatations of the distal ureter expanding as urine enters the bladder.

The sonogram is most suspicious for which of the following abnormalities?

Varicocele Multiple anechoic tubular structures are identified posterior to the left testicle, most suspicious for a varicocele. Duplex imaging of these tubular structures should be included in this examination.

Which of the following ligaments is present in this image of the liver?

Venosum The sonogram demonstrates the left and caudate lobes of the liver separated by the hyperechoic ligament of venosum.

A "time out" is best described as A. verifying the proper equipment and medication are available for a specific invasive procedure. B. time set aside for the patient to ask questions about the invasive procedure being performed. C. time after the procedure is performed to evaluate the patient and document the area of needle path for any evidence of post procedural bleeding. D. verifying with the patient the correct invasive procedure is being performed, on the correct patient and at the correct site.

Verifying with the patient the correct invasive procedure is being performed, on the correct patient and at the correct site. "time out" is performed before beginning the invasive procedure to verify with the patient the site of procedure, the correct invasive procedure is being performed, and the patient's name and birthdate

Production of prothrombin depends on the amount of vitamin: D, A, K, B ?

Vitamin K Production of prothrombin depends on the amount of vitamin K in the circulatory system.

What is the first step in a sterile procedure technique?

Wash your hands thoroughly The first step in a sterile procedure technique is to wash your hands thoroughly, followed by placing a sterile wrapped package on a clean and stable surface.

The subhepatic space communicates with the lesser sac through the foramen of

Winslow The foramen of Winslow allows communication between the subhepatic space and lesser sac.

A positive Phalen's sign is associated with an abnormality of which of the following joints?

Wrist A positive Phalen's and/or Tinel's sign is associated with carpal tunnel syndrome (wrist).

A postsurgical patient presents with abdominal tenderness and leukocytosis. A sonogram demonstrates a superficial, ill-defined mass beneath the surgical incision. Based on the clinical history, the sonographic findings are most suspicious for

abscess An ill-defined superficial mass beneath a recent surgical incision in a patient with leukocytosis most likely represents a postsurgical abscess.

A postsurgical patient presents with abdominal tenderness and leukocytosis. A sonogram demonstrates a superficial, ill-defined mass beneath the surgical incision. Based on the clinical history, the sonographic findings are most suspicious for A. seroma. B. abscess. C. hematoma. D. lymphocele

abscess An ill-defined superficial mass beneath a recent surgical incision in a patient with leukocytosis most likely represents a postsurgical abscess.

A patient presents with abdominal pain and fever following an appendectomy. Based on this clinical history, the sonographic findings are most suspicious for a(n)

abscess An irregular bordered, complex hepatic mass is present in a febrile post appendectomy patient most likely representing a hepatic abscess.

A patient presents with a history of severe upper abdominal pain increasing in intensity over the last 12 hours. Based on this clinical history, the sonogram is most likely demonstrating

acute pancreatitis. An enlarged hypoechoic pancreas in a patient with severe upper abdominal pain is most consistent with acute pancreatitis. Laboratory values will likely demonstrate elevation in serum amylase and lipase levels.

The sonographic findings are most suspicious for a(n)

angiomyolipoma A well-defined hyperechoic mass is present in the anterior cortex. Angiomyolipomas are common incidental findings.

The renal cortex is bound by the renal capsule and A. major calyces. B. perinephric fat. C. arcuate vessels. D. column of Bertin

arcuate vessels The renal cortex is bound by the renal capsule and the arcuate vessels.

Presence of a palpable ''thrill'' over a vascular structure is highly suggestive of a(n) A. occlusion. B. stenosis. C. arteriovenous fistula. D. abdominal aortic aneurysm

arteriovenous fistula The presence of a ''thrill'' over a vascular structure is highly suspicious and characteristic of an arteriovenous fistula.

Cases of gallbladder carcinoma frequently demonstrate coexisting A. cholecystitis. B. cholelithiasis. C. pleural effusion. D. adenomyomatosis.

cholelithiasis In approximately 90 percent of cases, cholelithiasis coexists with gallbladder carcinoma.

A decrease in serum amylase levels can be associated with A. cirrhosis. B. pancreatic carcinoma. C. biliary obstruction. D. peptic ulcer disease

cirrhosis Decreases in serum amylase may occur in cases of cirrhosis or hepatitis. Elevation in serum amylase is associated with acute pancreatitis and peptic ulcer disease.

Hemochromatosis is a rare disorder that may lead to

cirrhosis Hemochromatosis is characterized by excessive iron deposits throughout the body and may cause cirrhosis.

Hemochromatosis is a rare disorder that may lead to A. hepatitis. B. cirrhosis. C. cholangitis. D. schistosomiasis.

cirrhosis Hemochromatosis is characterized by excessive iron deposits throughout the body and may cause cirrhosis.

An inward extension of the renal cortex describes a A. medullary pyramid. B. fetal lobulation. C. dromedary hump. D. column of Bertin

column of Bertin An inward extension of the renal cortex between the medullary pyramids describes a column of Bertin. Dromedary hump describes an outward cortical bulge.

An inward extension of the renal cortex describes a A. medullary pyramid. B. fetal lobulation. C. dromedary hump. D. column of Bertin

column of Bertin. An inward extension of the renal cortex between the medullary pyramids describes a column of Bertin. Dromedary hump describes an outward cortical bulge.

A patient presents with a history of a Whipple procedure. The sonographer should expect to visualize A. splenomegaly. B. a small gallbladder. C. pancreatic tissue attached to the liver. D. common bile duct attached to the duodenum

common bile duct attached to the duodenum A Whipple procedure is a surgical resection of the pancreatic head or periampullary area to relieve obstruction of the biliary tree often due to a malignant tumor. The remaining normal pancreatic tissue is anastomosed to the duodenum. The common bile duct is attached to the duodenum distal to the pancreas and stomach.

The expected sonographic appearance of a subacute hematoma is described as a(n) A. anechoic mass. B. complex mass. C. hypoechoic mass. D. hyperechoic mass

complex mass. A subacute hematoma is composed of both hypoechoic blood and a hyperechoic clot appearing as a complex mass on ultrasound. A hypoechoic mass is more commonly associated with acute cases and an anechoic appearance in chronic cases.

A patient presents with a history of cirrhosis. The arrows are identifying the

coronary ligament A hyperechoic linear structure is identified dividing the right subphrenic space from the subhepatic space. This is consistent with the right coronary ligament. The right coronary ligament serves as a barrier between these two peritoneal spaces.

A 6-week-old female infant presents with a history of left hip clicking. Based on this clinical history, the sonogram is most likely demonstrating a

dysplastic hip. The Graf alpha angle is abnormal. To be considered within normal limits the alpha angle should be 60 degrees or greater. The alpha angle in this case measures 46 degrees. The beta angle is normal measuring under 55 degrees ( 48 degrees). This is consistent with developmental dysplasia of the hip. In addition the femoral head is too lateral but still partially lies within the acetabulum consistent with subluxation.

A patient presents with a history of right upper quadrant pain since returning from an overseas vacation. Based on this clinical history, the sonogram is mostly likely displaying a(n) A. hepatic abscess. B. hemorrhagic cyst. C. echinococcal cyst. D. hepatocellular carcinoma.

echinococcal cyst A cystic structure within a cystic structure (honeycomb appearance) in a patient recently returning from an overseas vacation is characteristic of an echinococcal cyst. A hepatic abscess demonstrates as a heterogeneous complex mass.

An asymptomatic patient presents with a history of elevated liver function tests. Based on this clinical history, the sonogram most likely demonstrates

fatty infiltration Fatty infiltration is the most likely diagnosis in an asymptomatic patient demonstrating diffusely echogenic liver parenchyma. In addition, the portal veins are still clearly visible, consistent with fatty infiltration.

An asymptomatic patient presents with a history of elevated liver function tests. Based on this clinical history, the sonogram most likely demonstrates A. hepatitis. B. cirrhosis. C. fatty infiltration. D. focal nodular hyperplasia

fatty infiltration Fatty infiltration is the most likely diagnosis in an asymptomatic patient demonstrating diffusely echogenic liver parenchyma. In addition, the portal veins are still clearly visible, consistent with fatty infiltration.

The solitary echogenic focus most likely represents a(n)

floating gallstone Multiple small stones are present in the dependent portion of the gallbladder. The solitary focus most likely represents a floating gallstone.

All of the following structures attach to the liver by a ligament EXCEPT A. stomach. B. diaphragm. C. gallbladder. D. anterior abdominal wall.

gallbladder Ligaments attach the diaphragm, stomach, retroperitoneum, and anterior abdominal wall to the liver. The gallbladder lies within a hepatic fossa.

All of the following structures attach to the liver by a ligament EXCEPT A. stomach. B. diaphragm. C. gallbladder. D. anterior abdominal wall.

gallbladder Ligaments attach the diaphragm, stomach, retroperitoneum, and anterior abdominal wall to the liver. The gallbladder lies within a hepatic fossa.

The main lobar fissure is a sonographic landmark used for locating the

gallbladder fossa The main lobar fissure is a sonographic landmark used to locate the gallbladder fossa.

Patients with diabetes mellitus have an increased risk for developing A. ascariasis. B. cholangitis. C. gangrenous cholecystitis. D. adenomyomatosis

gangrenous cholecystitis Patients with diabetes mellitus have an increased risk for developing cholelithiasis, gangrenous cholecystitis, gallbladder enlargement, and perforation.

A patient with a history of splenomegaly demonstrates multiple tubular structures posterior to the left lobe of the liver. These tubular structures are most suspicious for

gastric varices. Splenomegaly is associated with portal hypertension. Multiple anechoic tubular structures in the epigastric region are most suspicious for gastric varices.

An endocrine function of the pancreas includes secretion of

glucagon Endocrine functions of the pancreas include secretion of glucagon, insulin, and somatostatin. Exocrine functions include secretion of amylase, lipase, and trypsin.

An endocrine function of the pancreas includes secretion of A. lipase. B. pepsin. C. glucagon. D. amylase.

glucagon Endocrine functions of the pancreas include secretion of glucagon, insulin, and somatostatin. Exocrine functions include secretion of amylase, lipase, and trypsin.

Spectral analysis of the suprarenal portion of the abdominal aorta should demonstrate a

high resistance waveform with a low diastolic component The abdominal aorta demonstrates a high resistance waveform with a low diastolic component proximal to the renal arteries. A triphasic waveform is found distal to the renal arteries.

Clinical findings associated with an ileus may include all of the following EXCEPT A. fever. B. constipation. C. nausea and vomiting. D. hyperactive bowel sounds

hyperactive bowel sounds Clinical findings in cases of ileus or bowel obstruction may include absent or hypoechoic bowel sounds, fever, constipation, abdominal pain, nausea, and vomiting

Clinical findings associated with an ileus may include all of the following EXCEPT

hyperactive bowel sounds Clinical findings in cases of ileus or bowel obstruction may include absent or hypoechoic bowel sounds, fever, constipation, abdominal pain, nausea, and vomiting.

The most common sonographic appearance of the mediastinum testis is described as a(n) A. complex linear structure. B. anechoic tortuous structure. C. hyperechoic linear structure. D. hyperechoic tubular structure.

hyperechoic linear structure A hyperechoic linear structure in the posterior medial aspect of the testis is the most common sonographic appearance of the mediastinum testis.

The most common sonographic appearance of the mediastinum testis is described as a(n) A. complex linear structure. B. anechoic tortuous structure. C. hyperechoic linear structure. D. hyperechoic tubular structure.

hyperechoic linear structure A hyperechoic linear structure in the posterior medial aspect of the testis is the most common sonographic appearance of the mediastinum testis.

Pelvic lymph nodes course along the A. psoas muscles. B. iliac vessels. C. inguinal canal. D. broad ligament

iliac vessels The pelvic lymph nodes course along the iliac vessels.

Retroperitoneal fibrosis is most commonly located near large blood vessels in the region of the A. pancreas. B. stomach. C. lumbar spine. D. urinary bladder.

lumbar spine Retroperitoneal fibrosis is a chronic inflammatory process wherein fibrotic tissue surrounds large blood vessels in the lumbar area. Fibrotic tissue rarely extends above the second lumbar vertebra.

The gallbladder lies posterior and inferior to the A. inferior vena cava. B. coronary ligament. C. right hepatic vein. D. main lobar fissure

main lobar fissure The gallbladder lies posterior and inferior to the main lobar fissure, lateral to the inferior vena cava, and anterior medial to the right kidney.

Inferiorly, the right hepatic lobe is separated from the left lobe by the A. right portal vein. B. left hepatic vein. C. main lobar fissure. D. middle hepatic vein.

main lobar fissure The right hepatic lobe is separated from the left lobe by the main lobar fissure inferiorly and the middle hepatic vein superiorly.

The gallbladder lies posterior and inferior to the A. inferior vena cava. B. coronary ligament. C. right hepatic vein. D. main lobar fissure

main lobar fissure. The gallbladder lies posterior and inferior to the main lobar fissure, lateral to the inferior vena cava, and anterior medial to the right kidney.

The caudate lobe is located A. medial to the lesser sac. B. anterior to the porta hepatis. C. anterior to the ligamentum venosum. D. medial to the inferior vena cava

medial to the inferior vena cava The caudate lobe lies anterior and medial to the inferior vena cava, posterior to the ligamentum venosum and porta hepatis, and lateral to the lesser sac.

The pathology in this sonogram is most consistent with

metastatic lesions The liver demonstrates a heterogenous parenchyma most suspicious for metastatic lesions.

If cholelithiasis is discovered on an ultrasound, the sonographer must determine the A. size of the stone(s). B. contour of the stone(s). C. composition of the stone(s). D. mobility of the stone(s)

mobility of the stone(s). The mobility of the gallstones must be evaluated. Lodged or immobile stones can change the patient's course of treatment.

An abrupt increase in alkaline phosphatase levels is suggestive of A. acute cholecystitis. B. acute pancreatitis. C. obstructive jaundice. D. portal hypertension

obstructive jaundice. That's correct! Alkaline phosphatase is an enzyme produced primarily by the liver. A marked increase is suggestive of obstructive jaundice.

A round anechoic mass adjacent to the renal pelvis is most likely a(n)

parapelvic cyst A round anechoic mass (cyst) adjacent to the renal pelvis is most likely a parapelvic cyst. An extrarenal pelvis and renal vein demonstrate an oval contour medial to the renal pelvis.

A round anechoic mass adjacent to the renal pelvis is most likely a(n) A. hydroureter. B. renal vein. C. extrarenal pelvis. D. parapelvic cyst

parapelvic cyst. A round anechoic mass (cyst) adjacent to the renal pelvis is most likely a parapelvic cyst. An extrarenal pelvis and renal vein demonstrate an oval contour medial to the renal pelvis.

Secretion of thyroid-stimulating hormone is controlled by the

pituitary gland The anterior pituitary gland controls secretion of thyroid-stimulating hormone.

Secretion of thyroid-stimulating hormone is controlled by the A. cerebellum. B. thyroid gland. C. hypothalamus. D. pituitary gland

pituitary gland The anterior pituitary gland controls secretion of thyroid-stimulating hormone.

A patient presents with a history of abdominal pain. A sonogram of the liver is most likely demonstrating

polycystic liver disease Multiple contiguous hepatic cysts are most suspicious for polycystic liver disease.

Normal sonographic findings of a renal transplant include

prominent renal pyramids. Normal sonographic findings in a renal transplant include prominent renal pyramids, hyperechoic renal sinus, and hypoechoic renal cortex.

The protective connective tissue surrounding each kidney is termed A. renal fascia. B. renal capsule. C. Gerota's fascia. D. perinephric fat

renal capsule The renal capsule is a protective connective tissue surrounding each kidney. Gerota's or renal fascia is the fibrous covering of tissue surrounding each kidney.

Sharp, severe flank pain, radiating to the groin describes A. dysuria. B. renal colic. C. renal failure D. dyspareunia

renal colic Sharp, severe flank pain radiating to the groin describes renal colic. Renal colic is associated with nephrolithiasis. Pain or burning during urination describes dysuria. Abnormal pain during sexual intercourse is termed dyspareunia.

Sharp, severe flank pain, radiating to the groin describes A. dysuria. B. renal colic. C. renal failure. D. dyspareunia

renal colic Sharp, severe flank pain radiating to the groin describes renal colic. Renal colic is associated with nephrolithiasis. Pain or burning during urination describes dysuria. Abnormal pain during sexual intercourse is termed dyspareunia.

Acute tubular necrosis is the most common cause of A. renal failure. B. nephrolithiasis. C. sinus lipomatosis. D. renal cell carcinoma

renal failure Ischemic necrosis of the tubular cells is the most common cause of renal failure.

Elevation in creatinine levels is associated with

renal failure, chronic nephritis, or urinary obstruction Elevation in creatinine levels is associated with renal failure, chronic nephritis, or urinary obstruction.

Dehydration increases the risk for developing

renal vein thrombosis Dehydration increases the risk for developing renal vein thrombosis

A complication generally occurring within days of a renal transplant is

renal vein thrombosis Renal vein thrombosis generally occurs within days of a renal transplant. Renal artery stenosis typically occurs months to years after transplantation.

A complication generally occurring within days of a renal transplant is A. pyelonephritis. B. hydronephrosis. C. renal vein thrombosis. D. renal artery stenosis.

renal vein thrombosis Renal vein thrombosis generally occurs within days of a renal transplant. Renal artery stenosis typically occurs months to years after transplantation.

A duplex image of the splenic vein is demonstrating

retrograde flow. That's correct! The splenic vein normally flows toward the transducer, displaying a waveform above the baseline (antegrade). In this case, the blood is flowing away from the transducer back toward the spleen (retrograde).

A transplanted kidney is commonly placed in the

right iliac fossa A renal transplant is commonly placed in the anterior right iliac fossa.

A hepatic abscess is most likely to develop within the

right lobe Hepatic abscesses form within the right lobe in approximately 80 percent of cases.

Focal dilatation of the anterior wall of the abdominal aorta describes a

saccular aneurysm Focal outpouching of one arterial wall is characteristic of a saccular aneurysm. They are often a result of trauma or infection.

Sonographic findings in cases of mesenteric lymphomatous are described by the A. olive sign. B. doughnut sign. C. sandwich sign. D. keyboard sign.

sandwich sign Sandwich sign describes an anechoic lesion with a hyperechoic center found in mesenteric lymphomatous. This type of lesion is more frequent in non-Hodgkin's lymphoma cases. The jejunum and ileum demonstrate small folds in the wall termed the keyboard sign. The doughnut sign is a sonographic finding associated with intussusception.

Sonographic findings in cases of mesenteric lymphomatous are described by the A. olive sign. B. doughnut sign. C. sandwich sign. D. keyboard sign

sandwich sign Sandwich sign describes an anechoic lesion with a hyperechoic center found in mesenteric lymphomatous. This type of lesion is more frequent in non-Hodgkin's lymphoma cases. The jejunum and ileum demonstrate small folds in the wall termed the keyboard sign. The doughnut sign is a sonographic finding associated with intussusception.

The coronary vein enters the venous system near the

superior border of the portosplenic confluence The coronary vein enters the superior border of the portosplenic confluence and may be a collateral source in cases of portal hypertension. The inferior mesenteric vein enters the inferior border of the portosplenic confluence.

The coronary vein enters the venous system near the A. medial border of the main portal vein. B. inferior border of the right hepatic vein. C. superior border of the portosplenic confluence. D. inferior border of the superior mesenteric vein

superior border of the portosplenic confluence The coronary vein enters the superior border of the portosplenic confluence and may be a collateral source in cases of portal hypertension. The inferior mesenteric vein enters the inferior border of the portosplenic confluence.

The celiac axis is located at

superior to the body of the pancreas The celiac axis is located superior to the body of the pancreas, superior mesenteric artery, and splenic vein; posterior to the left gastric vein; inferior to the gastroesophageal junction.

The celiac axis is located at A. anterior to the left gastric vein. B. inferior to the splenic vein. C. superior to the gastroesophageal junction. D. superior to the body of the pancreas

superior to the body of the pancreas The celiac axis is located superior to the body of the pancreas, superior mesenteric artery, and splenic vein; posterior to the left gastric vein; inferior to the gastroesophageal junction.

An 11-year-old presents with a history a palpable thyroid gland, fatigue, and dysphagia. Based on this clinical history, the color Doppler image of the right thyroid lobe is most likely demonstrating

thyroiditis The duplex sonogram is demonstrating a hypervascular, hypoechoic enlarged thyroid gland, most suspicious for thyroiditis. Clinical symptoms of thyroiditis may include fatigue, fever, leukocytosis, neck pain, dysphagia, and hyperthyroidism followed by hypothyroidism.

The sonographic appearance of candidiasis is described as

uniform hypoechoic masses Candidiasis is a fungal infection associated with immune-suppressed patients. Sonographic findings include uniform hypoechoic masses, hyperechoic masses demonstrating posterior shadowing, or target lesions.

Sonographic findings associated with pyelonephritis include A. hydronephrosis. B. hypoechoic renal sinus. C. ill-defined renal capsule. D. well-defined renal pyramids.

well-defined renal pyramids Generalized or focal swelling of the kidney demonstrating well-defined renal pyramids is the typical sonographic finding associated with pyelonephritis.

A true abdominal aortic aneurysm is defined as dilatation of the aorta A. inferior to the renal arteries. B. when compared with a previous study. C. with a diameter measuring 3 cm or greater. D. when compared with a proximal segment.

with a diameter measuring 3 cm or greater. A true abdominal aortic aneurysm (AAA) measures 3 cm or greater in diameter. The majority of AAA are located inferior to the renal arteries.