ARR 2: Test A16

In a normal adult patient, the common HEPATIC duct measures less than or equal to:

4mm

An average sized patient presents with fever, acute RLQ pain and vomiting. The ER physician want to rule out appendicitis. Which transducer would be best?

5MHz

What is a Greenfield filter?

An IVC filter used to prevent emboli from reaching the lungs (does NOT prevent thrombus formation) Sonographically appears as an echogenic "umbrella" in lumen of IVC

The renal cortex contains what?

Bowman's capsule (responsible for blood filtration)

Patients with SECONDARY hyperparathyroidism will demonstrate:

DECREASED serum calcium levels

A mass is identified in the left testicle, rounded with well-defined borders. Internal rings of hyperechoic & hypoechoic demonstrated within the mass. What most likely describes this finding?

Epidermoid cyst (fibrous walls that may calcify, onion-like appearance, contains thick keratin and are Avascular)

What is true regarding Milk of Calcium bile (limey bile)?

GB is filled with calcium carbonate in a thick pasty form, associated with GB stasis, sonographic appearance is lumen filled with highly echogenic material with SHADOWING, layering of bile/calcium may be noted with change of patient position

The patient presents for abdominal U/S due to suspected displacement of the Greenfield filter. Where should you look to find it in the normal position?

In the IVC just below the renal veins

The aorta bifurcates at the level of:

L4

Medullary carcinoma of the thyroid is a common occurrence with:

MEN syndrome (multiple endocrine neoplasia)

Branches of which vessels supply the pancreas with blood?

SMA & gastroduodenal artery

Which imaging plane is most commonly used to obtain the length of the spleen during an abdominal U/S?

coronal

Asplenia is associated with:

absence of the spleen, congenital heart defects, right-sided aorta, left-sided IVC, midline liver and GB, & horseshoe kidneys

A patient presents with RUQ pain, increased serum levels of direct or conjugated bilirubin & amylase. These are all potential findings associated with:

acute pancreatitis, cystadenocarcinoma, in pancreatic head, krukenberg tumor of ampulla of Vater.

The most common cause of small bowel obstruction in an adult:

adhesions

A patient presents with a history of Addison's disease. Which hormone will be increased?

adrenocorticotropic hormone

Increased serum levels of which hormone will reduce urine output and increase blood volume in the body?

aldosterone

The fibromuscular stroma of the prostate is called:

anterior zone

On an ultrasound exam, the normal adrenal cortex appears:

as a hypoechoic ring around the echogenic medulla

What sonographic characteristic is associated with Budd Chiari Syndrome?

atrophied hepatic veins

Ascites may appear complex & contain debris/septations if there is associated:

bacterial/viral infection, internal bleeding or carcinoma

Which scrotal arteries penetrate the testicular parenchyma to supply oxygenated blood?

centripetal (a branch of the capsular artery)

Most common cause of cholangitis?

choledocolithiasis

If a patient has a non-reactive Thompson Test, what problem do they have?

complete tear of the Achilles tendon

Which imaging plane can produce a longitudinal image of the IVC and aorta on the same image?

coronal

If the entire image is too bright, what console adjustment should you make first?

decrease output power

Acute pain the LLQ is commonly associated with:

diverticulitis

An abnormal enlarged GB demonstrates thickened walls at 1.2cm, floating debris & echogenic foci which exhibit comet tail artifact. Which condition is this?

emphysematous cholecystitis

Postvasectomy changes seen on ultrasound include:

epididymal ENLARGEMENT, tubular ectasia of the epididymis, dilated vas deferens, spermatoceles and cysts

Which type of obstruction causes the extrahepatic and intrahepatic ducts to be dilated?

extrahepatic ductal obstruction

The most important structure to evaluate with a liver transplant is:

hepatic artery

A 4mo. old presents for abdominal U/S following a recent Kasai procedure. Which U/S findings would indicate the procedure was a success?

normal liver echotexture with normal biliary duct diameter (Kasai procedure treats biliary atresia)

The "Eiffel tower" sign on ultrasound refers to:

normal prostate

Which sonographic characteristics are likely identified with renal vein thrombosis?

increased renal size, hypoechoic renal cortex, decreased corticomedullary differentiation, mottled echogenicity, dilated renal vein with no intrarenal venous flow, & increased resistance in the renal artery

Increased thyroid volume is associated with:

increasing age, iodine deficiency, increased body weight, ACUTE hepatits and CHRONIC RENAL failure

Which of the following machine adjustments would create a more black and white 2D image?

increasing log compression (decreases dynamic range which decreases shades of gray)

Which is true regarding left adrenal gland position?

lateral to left diaphragm crura, medial to spleen, posterior to pancreas tail and stomach, lateral to aorta

The gastroesophageal junction is best seen in which plane?

longitudinal (anterior to aorta, posterior to LLL)

Most malignant tumors will demonstrate which type of flow on Doppler evaluation?

low resistance

A 75yr old male patient presents with a script that states, "pelvic U/S, post biopsy, Gleason score of 8." What are you most likely looking for on the exam?

lymphadenopathy & metastasis related to prostate cancer (Gleason score is used to classify prostate cancer, 8 is moderately aggressive, 10 is most aggressive)

The most common SECONDARY malignancy of the testicles:

lymphoma

What is the connective tissue sheath that is connected to the large intestine to provide structure and support, along with encasing/protecting blood vessels?

mesocolon

If the SMA is identified to the right of the SMV in a patient with acute abdomen symptoms, what does this suggest?

midgut malrotation (variation in the normal rotation & fixation of GI tract during development)

Epstein Barr is associated with which type of infection?

mononucleosis (causes significant splenomegaly)

What is true regarding renal oncocytoma?

most common benign tumor that occurs later in life, they can NOT be distinguished from renal cell carcinoma without biopsy, can demonstrate a central scar like RCC

What describes the appearance of the liver in a patient in the later stages of cirrhosis?

multiple nodules usually 1-5cm in size(micronodular- multiple nodules <1cm: alcoholism; macronodular- 1-5cm: chronic viral hepatitis)

Which organs are included in the endocrine system?

pancreas, pituitary gland, hypothalamus gland, pineal gland, thyroid, parathyroid, adrenal glands, ovaries and testes

Amylase is excreted by which structures?

pancreas, salivary glands & small intestine

What is associated with echogenic debris/calcifications in renal pyramids?

papillary necrosis

A 40yr old male patient presents for an abdominal U/S exam with history of anxiety, headaches & excessive sweating. His current BP is 175/90 mmHg with a pulse of 102 bpm. What is the referring doctor expecting to find?

pheochromocytoma

The most common cause of splenomegaly is

portal HTN

On a longitudinal scan, this vessel is seen in cross section, posterior to the IVC

right renal artery

What can lead to a false positive diagnosis of stones in the biliary system?

shadowing from a surgical clip in the porta hepatis

Anemia is likely to be related to abnormality of which organs?

spleen, aorta, esophagus

A 6yr old presents with a history of sickle cell anemia. What do you expect to find on the spleen U/S?

splenomegaly

What is true of sterile technique?

sterile packages should be opened just before they are used, gowns are only sterile on the front when dry, all items and persons in the sterile field must be sterile, moist areas are not sterile, personnel with colds should avoid working while ill or double mask

The splenic artery distributes blood to the:

stomach, pancreas & spleen

A 6yr old is referred for an abdominal ultrasound due to history of Epstein Barr infection. What organ should be closely evaluated?

the spleen

What are characteristics of normal lymph node?

thin hypoechoic rim with hyperechoic central hilum

Which pathology is commonly associated with PAINLESS hematuria?

transitional cell carcinoma of the bladder

Which zone of the prostate has the highest risk for BPH?

transitional zone