Mock Exam B

A. Both kidneys are located on the same side of the body and fused together at varied locations. *If both kidneys are on one side of the body, one renal fossa will be empty.

A patient is referred for a renal ultrasound due to suspected cross fused renal ectopia. What is the expected ultrasound finding for this condition? A. Both kidneys are located on the same side of the body and fused together at varied locations. B. There is a single kidney located in the midline pelvic region. C. The kidneys are in their normal position but the upper poles of the kidneys are joined across the midline, usually anterior to the mid aorta. D. The kidneys are in their normal position but the lower poles of the kidneys are joined across the midline, usually anterior to the mid aorta.

A. Renal vein thrombosis *Increased levels of ADH and low urine output indicate the patient is dehydrated. The recent PE indicates there is potential thrombus formation in the IVC or its branches.

A patient presents for a renal ultrasound due to high serum levels of anti-diuretic hormone, low urine output and a recent pulmonary embolism. What is the referring doctor most likely looking for on the exam? A. Renal vein thrombosis B. Abscess formation in the renal pelvis C. Formation of a renal carbuncle D. Obstructive bladder calculi

C. Aorta *Aortic aneurysm and dissection are associated with Marfan syndrome.

A patient presents for an abdominal sonogram due to a history of Marfan syndrome. What structure(s) should be closely evaluated for related findings? A. Liver B. Portal system C. Aorta D. Kidneys E. Pancreas

A. Lymphoma *A splenic hamartoma is a rare, benign vascular proliferation that is often found incidentally. A hemangioma is another type of benign vascular malformation. A Granuloma forms after an infection such as toxoplasmosis. Lymphoma is a primary malignancy of the spleen related to the lymphatic tissues.

All of the following are benign splenic neoplasms, EXCEPT: A. Lymphoma B. Granuloma C. Hemangioma D. Hamartoma

D. Splenomegaly *Splenomegaly is an acquired condition. Common causes include infection and portal HTN. Agenesis is a congenital absence of the spleen. An ectopic spleen forms in a different location that in the LUQ adjacent to the left kidney. A splenunculi is an accessory spleen or mass of normal splenic tissue not attached to the main gland.

All of the following are congenital anomalies of the spleen, except: A. Splenunculi B. Ectopic spleen C. Agenesis D. Splenomegaly

D. Insulin *Insulin is a hormone produced by the pancreas and released into the blood stream (endocrine). The other choices are digestive enzymes produced by the pancreas and distributed by a ductal system (exocrine).

All of the following are produced by the exocrine function of the pancreas, except: A. Trypsin B. Lipase C. Amylase D. Insulin

B. Switch to a 5MHz linear probe *The linear probe would provide the largest near field. A 12MHz may be too high of a frequency to penetrate the abdominal wall into the liver. Note the amount of skin/fatty tissue on the current image. The best choice is a 5MHz linear transducer.

You are currently using a curved probe with a 3.5MHz frequency to evaluate a patient's liver. What can be done to better visualize the area indicated by the arrow? A. Switch from a curved array to a vector array of the same frequency B. Switch to a 5MHz linear probe C. Switch to a 2.5MHz curved probe D. Switch to a 12MHz linear probe

A. the presence of red blood cells in urine *Hematuria is defined as red blood cells in the urine. Leukocytosis would indicate an increase in WBC in the blood. To assess renal filtration function, the urea (and nitrogen) levels are measured in the blood and listed as the BUN level.

Hematuria is defined as: A. the presence of red blood cells in urine B. the presence of red blood cells in blood C. the presence of white blood cells in urine D. the presence of urea in blood

C. urinary bladder *Hutch diverticula are congenital outpouchings of the bladder wall near the ureteral orifice.

Hutch diverticula are identified in the: A. small bowel B. large bowel C. urinary bladder D. gallbladder

D. Portal HTN *Increased pressure in the liver and portal system causes them to engorge with blood. In some cases, this pressure is great enough to recanalize the umbilical vein outward to the umbilicus, as blood backs up in the system. The umbilical vein is a remnant of fetal circulation that used to connect to the portal system of the liver from the placenta.

The US exam of a patient's liver demonstrates a patent umbilical vein. The most common cause for this recanalization is: A. Abscess B. Ascites C. Hepatitis D. Portal HTN

D. anterior fibromuscular region *The prostate gland contains four glandular zones and a fibromuscular region. The peripheral zone is the largest glandular segment. Most prostate cancer occurs in the peripheral zone and is also the most common site of chronic prostatitis. The transitional zone, the site of benign prostatic hyperplasia (BPH), surrounds the urethra. The central zone holds most of the remaining glandular tissue. The glandular tissue that surrounds the proximal prostatic urethra is called the periurethral glandular zone. The anterior fibromuscular region is mostly smooth muscle and occupies about one-third of the prostate.

The ____________ is the portion of the prostate that is mostly composed of smooth muscle cells and makes up approximately 1/3 of the gland. A. transitional zone B. peripheral zone C. central zone D. anterior fibromuscular region

C. ejaculatory duct *The ejaculatory duct is formed at the junction of the vas deferens and seminal vesicles.

The _________________ is formed at the junction of the vas deferens and seminal vesicles. A. rete testes B. efferent ducts C. ejaculatory duct D. afferent ducts

A. melanoma *The most common primary malignancy to metastasize to the spleen is melanoma.

The most common primary malignancy to metastasize to the spleen is _______________________. A. melanoma B. renal cancer C. breast cancer D. lung cancer

B. Liver *The liver filters blood from many abdominal organs, such as the stomach and the colon. This function of the liver makes it more susceptible to metastasis.

The most frequently involved organ in metastatic disease is the: A. GI tract B. Liver C. Pancreas D. Spleen

B. Left gastric, Splenic, Common Hepatic Artery *The major branches of the Celiac Axis are the Left gastric, Splenic, Common Hepatic Arteries.

The major branches of the Celiac Axis are: A. Left gastric, SMA, Gastroduodenal Artery B. Left gastric, Splenic, Common Hepatic Artery C. Left gastric, Common Hepatic Artery, Gastroduodenal Artery D. Hepatic, Gastroduodenal Artery, Splenic

D. Most aggressive testicular malignancy *Embryonal Cell Carcinoma usually affects men age 25-35yrs. It is the most aggressive testicular cancer. Alpha fetoprotein and beta hCG elevated in most cases. Sonographic Appearance: More heterogeneous than seminoma; Can have solid and cystic portions along with coarse calcifications; Distortion of the organ contour with tumor invasion

The mass on the image is a confirmed embryonal cell tumor. Which statement is true regarding this type of neoplasm? A. Usually presents with normal b-hCG levels B. Normally affects men in their late 50's, early 60's C. Usually presents with normal AFP levels. D. Most aggressive testicular malignancy

A. biliary atresia *The lack of opening in the biliary tree will cause the persistence of jaundice after birth.

What biliary anomaly is suspected if jaundice persists more than 14 days after birth? A. biliary atresia B. ectopic GB C. agenesis of the GB D. choledochal cyst

A. post-processing *Post-processing is the only control that will adjust the brightness of the image AFTER the data is stored in the digital memory (when the image is frozen).

What can be used to alter the displayed brightness of the image after it has been stored in the memory? A. post-processing B. pre-processing C. compression D. rejection

C. right atrial contraction and relaxation *The flow in the hepatic veins is normally triphasic due to right atrial contraction and relaxation.

What causes the hepatic vein flow to have a triphasic waveform? A. hepatic congestion B. portal HTN C. right atrial contraction and relaxation D. congestive heart failure

C. ruptured gastroesophageal varices *Cavernous transformation causes the formation of varices that can rupture and cause significant hemorrhage, even death.

What is a potentially life threatening complication of portal HTN? A. ascites formation B. portal embolism C. ruptured gastroesophageal varices D. pulmonary embolism

C. Cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation *Cholangitis leads to diffuse thickening of the walls of the biliary tree which leads to diffuse dilatation of the entire biliary tree. Cholangiocarcinoma leads to a focal area of mass formation within the wall biliary tree that invades surrounding liver tissues. This causes focal areas of intrahepatic ductal wall thickening and dilatation.

Which of the following correctly describes how to differentiate cholangitis from cholangiocarcinoma? A. Cholangitis leads to dilated extrahepatic ducts while cholangiocarcinoma leads to dilated intrahepatic ducts B. Cholangitis is a focal disease process while cholangiocarcinoma causes diffuse mass formation C. Cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation D. Cholangitis leads to dilated intrahepatic ducts while cholangiocarcinoma leads to dilated extrahepatic ducts

D. mesenteric vein thrombosis *Congestive heart failure refers to reduced cardiac output and volume overload which can lead to pooling of blood in the legs. Retroperitoneal fibrosis can constrict IVC causing decreased venous outflow from the legs. A large AAA can compress the IVC and prevent flow from exiting the legs. Thrombosis of the mesenteric veins would not affect IVC circulation because they are part of the portal system.

Which of the following is the least likely cause for bilateral pedal edema? A. congestive heart failure B. 5cm AAA C. retroperitoneal fibrosis D. mesenteric vein thrombosis

D. Courvoisier gallbladder *Courvoisier gallbladder refers to an enlarged, non-tender GB caused by a distal obstruction.

. A patient presents for an abdominal US to evaluate a potential cystadenocarcinoma of the pancreatic head that was identified on a recent CT scan. The ultrasound demonstrates a complex mass in the pancreatic head. Also demonstrated is a 12cm gallbladder with no stones or wall thickening and the CBD is patent measuring 10mm. The patient has a negative Murphy's sign. Which term below can be used to describe the findings? A. Mirizzi syndrome B. Caroli's disease C. Secondary biliary metastasis D. Courvoisier gallbladder

B. amebic, fungal *Amebic abscesses are most commonly found in countries outside the US. Fungal abscesses are most commonly seen in immunosuppressed patients (AIDS, Cancer, Organ transplant).

. ____________ abscesses are most commonly found in countries outside the US. _______________ abscesses are most commonly seen in immunosuppressed patients. A. pyogenic, amebic B. amebic, fungal C. fungal, pyogenic D. fungal, amebic

A. prominent focal area of concentric rings of bowel *An intussusception refers to a segment of bowel that involutes into itself. You will see a focal area of concentric rings of bowel that do not persitalse or change shape.

A 2yr old presents with a swollen abdomen and pain for 3 days. The doctor suspects an intussusception is present. How will this appear on the exam? A. prominent focal area of concentric rings of bowel B. thickened pylorus muscle C. fluid filled colon with inflamed walls D. fluid filled colon with multiple intramural masses

C. Pheochromocytoma *Pheochromocytoma cause increased secretion of dopamine, epinephrine and norepinephrine. This leads to symptoms that include HTN, anxiety, headache, nausea, vomiting, sweating, tachycardia. Tumors originate in medulla tissue and grow to an average size of 5-6cm.

A 40yr old male presents for an Abdominal US exam with a history of anxiety, headaches and excessive sweating. His current BP is 175/90mmHg with a pulse of 102bpm. You identify a 4cm solid mass superior medial to the left kidney. The mass is highly vascular. Which of the following describes the findings? A. Renal Cell Carcinoma B. Hepatoma C. Pheochromocytoma D. Retroperitoneal Metastasis

D. Acute postrenal failure is present and the radiologist should review the case immediately. *Bilateral hydronephrosis and hydroureter with increased serum levels of BUN and creatinine and an EMPTY bladder most likely indicates acute renal failure. Acute renal failure caused by a bilateral ureteral obstruction can be treated by removing the obstructions. The parenchyma can be saved if the patient gets immediate treatment. A neurogenic bladder will not empty properly causing increased bladder volumes pre- and post-void. Antibiotics are used to treat infections not obstructions.

A 45yr old patient presents with increased serum BUN and creatinine, a recent history of oliguria and bilateral flank pain. The US exam demonstrates bilateral hydronephrosis and hydroureter but the bladder is nearly empty. Which of the following statements is true regarding this patient and the findings? A. The patient will most likely return in 7-10 days after antibiotic treatment. B. The patient has a neurogenic bladder and the radiologist should review the case immediately. C. Acute intrinsic renal failure is present that is most likely due to acute tubular necrosis. D. Acute postrenal failure is present and the radiologist should review the case immediately.

B. choledochal cyst *Choledochal cysts are more commonly found in the Asian population. Ultrasound usually demonstrates a focal dilatation of the biliary tree. The dilatation can be cystic or fusiform.

A 46yr old Asian female presents with intermittent mild RUQ pain and normal labs. While scanning the liver, you note a 1cm anechoic, round structure attached to the CBD at the porta hepatis. Color Doppler does not demonstrate flow within the structure. Which of the following is the most likely diagnosis? A. pneumobilia B. choledochal cyst C. pseudoaneurysm of the hepatic artery D. cholangitis

D. Schistosomiasis *Schistosomiasis appears as thickened intrahepatic portal walls with possible occlusion, decreased liver size, portal HTN and splenomegaly.

A 5ft 8in, 140lb female patient presents for an ultrasound after a recent trip to Africa. She complains of nausea, vomiting and RUQ pain for about a month. The liver measures 11.2cm in length and the walls of the right and left portal veins appear thickened with narrowed lumens. Doppler evaluation demonstrates occlusion of the right portal branches. The main portal vein is patent with 15mm diameter. The spleen length is recorded at 13cm. Which of the following most likely describes the cause for these findings? A. Echinococcal infection B. Amoebic abscess C. Biliary ascaris D. Schistosomiasis

C. splenic atrophy *Sickle cell anemia causes the spleen to enlarge early in life and then atrophy and shrink later in childhood.

A 60yr old presents with a history of sickle cell anemia. What do you expect to find on the US evaluation of the spleen? A. splenomegaly B. splenic artery aneurysm C. splenic atrophy D. agenesis of the spleen

C. Courvoisier's sign *Painless jaundice, distended GB and an obstruction at the Ampulla of Vater are the three characteristics of Courvoisier syndrome or sign. Mirizzi's syndrome is when a stone in the cystic duct causes extrinsic compression of the CBD, very painful.

A 64yr old patient presents with painless jaundice. The GB is over-distended with an obstruction at the Ampulla of Vater. Which of the following best describes this condition? A. Choledochal cyst B. Hydropic GB C. Courvoisier's sign D. Mirizzi's syndrome

D. Hydatid cyst or Echinococcal cyst *Echinococcal cysts are also called hydatid cysts and demonstrate a cyst with another cyst inside (daughter cyst). They form due to parasitic infection of the liver. A fungal abscess is described as having a wheel within a wheel appearance. A pyogenic abscess is an irregular mass with gas shadowing and comet tail artifacts. Polycystic liver disease cause the formation of multiple cysts throughout the liver.

A cyst within a cyst (daughter cyst) is a classic sign of: A. Polycystic liver disease B. Hydatid cyst or fungal abscess C. Echinococcal cyst or pyogenic abscess D. Hydatid cyst or Echinococcal cyst

A. cholangitis *The fever and increased levels of WBCs indicate an infection. Cholangitis is common in Asian countries.

A female patient presents with 8 days of abdominal pain, fever and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, alkaline phosphatase and WBCs. Which of the following biliary abnormalities will most likely be identified on the exam? A. cholangitis B. Klatskin's tumor C. primary GB carcinoma D. pneumobilia

A. Subphrenic abscess *A pleural effusion will be located above the diaphragm. A subcapsular hematoma will be located between the splenic tissue and the splenic capsule. A pericardial effusion refers to fluid in the pericardial sac around the heart. Sub- means under and -phrenic means diaphragm. The subphrenic abscess will be located under the diaphragm adjacent to the splenic capsule.

A fluid collection between the diaphragm and splenic capsule may represent: A. Subphrenic abscess B. Subcapsular hematoma C. Pericardial effusion D. Pleural effusion

D. Seminomatous tumor *Seminomas are composed of seminomatous cells. Non-seminomatous tumors are composed of a variety of types of cells. Mixed germ cell tumors contain two or more types of seminomatous or non-seminomatous cells.

A histology report indicates that a testicular tumor contains only seminomatous cells. Which of the following best describes the tumor? A. Metastatic tumor B. Mixed germ cell tumor C. Mature teratoma D. Seminomatous tumor

C. posterior displacement of the IVC *Intrahepatic masses can lead to the posterior displacement of the IVC, inferior displacement of the GB and right kidney and abnormal bulging of the liver capsule

A large intrahepatic mass can cause ____________________. A. anterior displacement of the aorta B. anterior displacement of the IVC C. posterior displacement of the IVC D. anterior displacement of the left kidney

A. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged. *Hepatomegaly is diagnosed when the length of the liver exceeds 15.5cm. The AP diameter will also increase as the liver enlarges but the length measurement is the most accurate measurement for diagnosis of hepatomegaly. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is also considered enlarged.

A patient presents for an abdominal ultrasound with a history of increased LFTs and obesity. The referring doctor would like to rule out hepatomegaly. Which of the following statements regarding hepatomegaly is true? A. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged. B. When the right lobe is rounded inferiorly and extends past the upper pole of the right kidney, the liver is considered enlarged. C. The liver is considered enlarged when the AP measurement exceeds 15.5cm. D. Hepatomegaly causes rounding of the superior liver segments

B. pancreas *The main duct of the pancreas is the Duct of Wirsung.

A patient presents for an ultrasound due to a dilated duct of Wirsung identified on CT. What organ will you evaluate to assess the duct of Wirsung? A. gallbladder B. pancreas C. liver D. spleen

C. myocardial infarction *Increased levels of AST with normal levels of ALT is associated with myocardial infarction, CHF, CNS disease and other non-hepatic disorders. Some patients that experience a myocardial infarction describe the radiating pain as heartburn or intense indigestion.

A patient presents with a history of a recent single episode of significant indigestion, increased levels of AST and normal levels of ALT, alkaline phosphatase and bilirubin. Which of the following is a possible explanation of these symptoms? A. chronic hepatitis C B. schistosomiasis C. myocardial infarction D. biliary stasis with a partial ductal obstruction due to Klatskin's tumor

C. Demonstrate a longitudinal view of the main portal vein and look for the CBD anterior to it. *The CBD usually courses anterior to the main portal vein when it exits the liver.

A patient presents with a history of choledocholithiasis. How will you assess the common bile duct for the presence of a stone? A. Locate the main portal vein and look for the CBD posterior to it. B. Demonstrate a long axis gall bladder image and look for the CBD superior to it. C. Demonstrate a longitudinal view of the main portal vein and look for the CBD anterior to it. D. Demonstrate a transverse view of the pancreatic head and look for the CBD entering the anterior aspect.

A. 7 MHz Linear Array *High frequency linear arrays are preferred for superficial imaging.

A patient presents with a palpable lump adjacent to the umbilicus. Which of the following transducers would be best to use for this exam? A. 7 MHz Linear Array B. 3.5MHz Linear Array C. 7MHz Phased Array D. 3.5 MHz Curvilinear Array

B. Elongated left lobe of the liver adjacent to spleen *The left lobe of the liver can sometimes be elongated and extend to the spleen on the left side, Note the vessels and echogenic walls of small portal branches in the liver tissue. Reidel's lobe refers to the elongation of the right lobe inferiorly, past the lower pole of the kidney. The pain has been present for several months. A hematoma would be an acute complication that, if present at the time of the trauma, would be resolved over a few months.

A patient presents with intermittent RUQ pain for several months. A complete abdominal exam is performed with an image displayed from the spleen evaluation. What is the most likely finding displayed by the blue arrows? A. Fractured spleen due to unknown trauma B. Elongated left lobe of the liver adjacent to spleen C. Reidel's lobe D. Loculated ascites

C. There is a hematoma formation within Morrison's pouch, adjacent to the right kidney. *With a history of a recent sporting event and the decrease in hematocrit levels, a traumatic bleed should be considered. The complex fluid collection within Morrison's pouch demonstrates the appearance of a hematoma. With an intracapsular renal hematoma, the collection of blood beneath the renal capsule would distort the appearance of the renal cortex. An extracapsular renal hematoma will demonstrate extrinsic compression of the cortex., without distortion of the tissues.

A patient presents with persistent flank pain for 3 days following his weekly flag football game. Lab testing demonstrated a small decrease in hematocrit levels. Which statement below best describes the abnormality on the US image? A. There is a hematoma formation within Glisson's pouch, adjacent to the right kidney. B. The right kidney demonstrates an edematous cortex consistent with glomerulonephritis. C. There is a hematoma formation within Morrison's pouch, adjacent to the right kidney. D. The image demonstrates a complex mass adjacent to the right kidney, which is most likely renal cell carcinoma.

A. The simple cyst has become hemorrhagic due internal hemorrhage caused by growth. *Decreased hematocrit accompanied by the new onset of pain can indicate acute hemorrhage. The increased size of the cyst and presence of internal echoes most likely indicates internal hemorrhage within the cyst.

A patient with a history of a 2cm simple cyst in the right lobe of the liver presents for a new scan. He complains of a recent onset of pain and bloating. Lab values are normal, except a mild decrease in hematocrit Today there is a single 4cm round, well defined structure filled with varied low level internal echoes in the mid right lobe. Which of the following statements regarding the findings is true? A. The simple cyst has become hemorrhagic due internal hemorrhage caused by growth. B. The simple cyst has become infected and evolved into an abscess. C. A liver biopsy will most likely be recommended to confirm the diagnosis of malignancy. D. The simple cyst demonstrates either hemorrhage or infection and aspiration should be performed. E. The echoes are probably artifact and you should document the cyst as unchanged.

B. cholelithiasis *Polycythemia Vera refers to the overproduction of red blood cells that causes hypercoagulability of blood. This leads to decreased PT and INR values = fast clotting, abnormal clotting. The condition causes splenomegaly and is associated with splenic infarcts, renal vein thrombosis, portal vein thrombosis, and Budd Chiari syndrome.

A patient with polycythemia vera has an increased risk of developing all of the following, except: A. splenomegaly B. cholelithiasis C. Budd Chiari syndrome D. portal thrombosis

D. primary carcinoma *A porcelain GB causes an increase in the patient's risk for primary GB carcinoma

A porcelain GB causes an increase in the patient's risk for ____________________. A. adenomyomatosis B. sclerosing cholangitis C. choledocholithiasis D. primary carcinoma

A. splenic artery aneurysm *Splenic artery aneurysms are the most common type of abdominal branch aneurysm. They are seen more in females than males and are associated with pregnancy. The risk of rupture makes it a critical finding requiring immediate intervention. Splenic varices would demonstrate low velocity flow that would not normally lead to a bruit.

A pregnant female presents with lateral LUQ pain and a bruit in the same area. What will be the most likely finding? A. splenic artery aneurysm B. splenic varices C. pancreatic pseudocyst D. IVC congestion due to uterine compression

C. medially *A right renal mass will cause medial displacement of the IVC.

A right renal mass will displace the IVC: A. inferiorly B. superiorly C. medially D. laterally

C. absence of early systolic peak and prolonged acceleration time *Tardus Parvus waveform - absence of early systolic peak and prolonged acceleration time. If identified in in the native arcuate arteries, significant renal artery stenosis is present.

A tardus parvus waveform is described as? A. pronounced of early systolic peak and prolonged acceleration time B. Resistive index of 1.0 or greater C. absence of early systolic peak and prolonged acceleration time D. reduced systolic velocity with diastolic flow reversal

A. on the midline neck, superior to the thyroid gland *A thyroglossal duct cyst is identified on the midline neck superior to the thyroid gland. A branchial cleft cyst is located near the angle of the mandible.

A thyroglossal duct cyst is most commonly found: A. on the midline neck, superior to the thyroid gland B. within the isthmus of the thyroid gland C. near the angle of the mandible D. posterior to the ear at the level of the thyroid gland

D. >3mm *Acute cholecystitis is associated with wall thickening >3mm.

Acute cholecystitis is associated with wall thickening ______________. A. <3mm B. >6mm C. >2mm D. >3mm

B. family history of hypercalcemia *Risk factors for thyroid cancer include personal history of radiation treatment of the head and neck, personal history of previous papillary cancer, and diagnosis of multiple endocrine neoplasm (MEN) syndrome. Patients with these risk factors should have an annual screening exam to look for malignancy.

All of the following are risk factors for thyroid cancer, except: A. diagnosis of multiple endocrine neoplasm (MEN) syndrome B. family history of hypercalcemia C. personal history of previous papillary cancer D. personal history of radiation treatment of a cerebral malignancy

D. Keep the exam room door open and the lights on during the exam in case you need to get help quickly *There is no need to compromise patient privacy and exam performance due to patient condition. Always consult the patient's nurse or family member for any special considerations needed when performing the exam.

All of the following are techniques that can be used to assist an Alzheimer's patient during an ultrasound exam, except: A. Have the patient's nurse alert you to helpful techniques used with this patient B. Allow a family member to accompany them during their exam C. Bring something that is usually familiar to the patient into the exam room D. Keep the exam room door open and the lights on during the exam in case you need to get help quickly

D. right and left lobes are divided by the branches of the main hepatic vein *Couinaud's Liver Segments: Method for liver lesion localization Previous methods divided liver based on anatomy, this method divides liver into 8 functional segments Each of the 8 segments has its own portal vein, hepatic vein and bile duct 3 main lobes: Right, left and caudate lobes Right and left lobes are divided by the branches of the main portal vein; right portal = right lobe, left portal = left lobe Lobes are further divided according to portal branches Right lobe is segmented into 2 anterior and 2 posterior lobes Left lobe is segmented into 2 medial and 2 lateral segments Allows for liver resection/surgery without negatively affecting other segments 1. Caudate 2. Left Lateral Superior Segment 3. Left Lateral Inferior Segment 4a. Left Medial Superior Segment 4b. Left Medial Inferior Segment 5. Right Anterior Inferior Segment 6. Right Posterior Inferior Segment 7. Right Posterior Superior Segment 8. Right Anterior Superior Segment

All of the following are true regarding Couinaud's liver segmentation except: A. divides liver into 8 functional segments B. allows for liver resection/surgery without negatively affecting other segments C. each of the 8 segments has its own branch of the portal vein, hepatic vein and bile duct D. right and left lobes are divided by the branches of the main hepatic vein

D. post-procedure chest x-ray *A pre- and post-procedure chest x-ray are normally performed for a thoracentesis

All of the following are usually a part of the normal paracentesis procedure, except? A. puncture usually made lateral to the mammary line B. only a small amount of fluid is removed for a diagnostic procedure C. removal of up to 6 liters of fluid in one day D. post-procedure chest x-ray

C. Hepatoma *Focal nodular hyperplasia is a benign liver tumor. An adenoma is a benign liver tumor commonly associated with oral contraceptives. A hemangioma is an abnormal accumulation of vascular tissues that forms as a benign liver mass. A hepatoma is a primary malignant tumor of the liver.

All of the following are usually benign liver neoplasms, except: A. Focal Nodular Hyperplasia B. Hemangioma C. Hepatoma D. Adenoma

C. Easily distinguished from focal nodular hyperplasia due to hypervascularity *FNH and liver adenomas have a similar sonographic appearance and biopsy is usually required to determine the mass origin

All of the following correctly describe liver adenomas, except: A. Associated with glycogen storage disease B. Surgical intervention is usually recommended because of risk of internal hemorrhage C. Easily distinguished from focal nodular hyperplasia due to hypervascularity D. Encapsulated mass that is more common in women

E. Alpha fetoprotein *ALT, AST, bilirubin and alkaline phosphatase levels will all increase with cirrhosis. Alpha-fetoprotein levels increase with malignancy and pregnancy. If hepatocellular carcinoma develops with the cirrhosis, then AFP levels will rise.

All of the following lab values will be increased with cirrhosis, except: A. ALT B. Bilirubin C. AST D. Alkaline phosphatase E. Alpha fetoprotein

C. Amylase *Amylase is an enzyme created by the pancreas. PT refers to prothrombin time which is the ability of the blood to clot. Prothrombin is a protein produced by a normally functioning liver. Aspartate Aminotransferase is a liver enzyme. Bilirubin is produced and conjugated by the liver.

All of the following laboratory tests are used to evaluate the liver, EXCEPT: A. Bilirubin B. Aspartate aminotransferase C. Amylase D. Prothrombin time

A. The valsalva maneuver was used to demonstrate the increased vascular flow within the testicle. *The image demonstrates increased testicular vascularity related to orchitis. The valsalva maneuver is used to demonstrate the increased vascular flow within a varicocele that forms outside the testicle.

All of the following statements are true regarding the image displayed, except: A. The valsalva maneuver was used to demonstrate the increased vascular flow within the testicle. B. Epididymitis is commonly associated with this finding. C. There is increased vascularity in the testicle. D. The patient suffers from a fever and increased leukocytosis.

B. Decreasing transducer frequency *Increased transducer frequency will improve resolution of smaller objects.

All of the following techniques will aid in the visualization of a small renal calculi with questionable shadowing, except? A. Rescanning the patient in the decubitus position B. Decreasing transducer frequency C. Using multiple scanning planes to evaluate the kidney D. Decreasing the dynamic range

A. Polyp *A GB polyp demonstrates a non-shadowing, non-mobile, echogenic foci within the GB on ultrasound.

An US demonstrates a non-shadowing, non-mobile, echogenic foci within the GB that most likely represents: A. Polyp B. Calculus C. Sludge ball D. Porcelain GBV

C. Cholangitis *The suffix -itis refers to an infection. EX: Hepatitis, Cholecystitis etc. HIV is an infection and cholangitis is a common complication. The other items listed are related to mass formation, ductal obstruction and air in the biliary tree. None of these items are infection related.

An inflammation of the biliary tree common in HIV patients is called: A. Klatskin's tumor B. Mirizzi's syndrome C. Cholangitis D. Pneumobilia

B. There is a possible bladder rupture and the radiologist should review the exam immediately. *The presence of free fluid in the pelvis and an irregular mass of tissue in the lower pelvis are indicators for possible bladder rupture. This is a critical finding and the case should be reviewed by a radiologist immediately. A Sonographer should not offer exam results to the ER physician. Attempting to fill the bladder could assist in a pelvic examination but the physician must write an order for Foley catheter insertion. If bladder rupture is suspected, it is highly unlikely a Foley would be inserted. A rectus sheath hematoma would demonstrate fluid collection within the abdominal wall, not the cavity.

An unconscious patient is referred for an abdominal ultrasound through the ER after a car accident. All abdominal organs appear normal in structure and echogenicity. There is free fluid in the right and left paracolic gutters with a complex mass of irregular tissue in the inferior midline pelvic cavity and no discernible bladder can be identified. What should you do when the exam is complete? A. There is a potential bladder rupture and you should notify the referring ER physician immediately. B. There is a possible bladder rupture and the radiologist should review the exam immediately. C. There is a rectus sheath hematoma present which is a non-critical finding. D. You should ask the nurse to insert a Foley catheter and attempt to fill the bladder with saline solution.

B. the renin-angiotensin system that controls the glomerular filtration rate of the kidneys and systemic BP level *When the blood pressure drops, the GFR drops. The kidneys release renin to prompt the release of angiotensin which constricts flow in the arterioles. This increases BP and GFR

Autoregulation of the systemic blood pressure refers to: A. the release of epinephrine to cause constriction of the convoluted tubules B. the renin-angiotensin system that controls the glomerular filtration rate of the kidneys and systemic BP level C. the renin-angiotensin system that controls the level of constriction of the convoluted tubules D. the release of aldosterone to cause vasoconstriction of the efferent arterioles

A. Thyroid parafollicular *Calcitonin is produced in the thyroid in the parafollicular cells. These cells are located in the tissues between the thyroid follicles.

Calcitonin is produced by which of the following types of cells? A. Thyroid parafollicular B. Parathyroid parafollicular C. Parathyroid follicular D. Thyroid follicular

A. anti-diuretic hormone *Antidiuretic hormone (ADH) is secreted by the pituitary gland and helps to regulate fluid levels through changes in water permeability. Increased ADH levels will increase the resorption of water in the distal convoluted tubule. Higher serum levels seen with dehydration.

Dehydration will lead to increased levels of _____________________ in the blood. A. anti-diuretic hormone B. cortisol C. epinephrine D. bilirubin

A. gastroduodenal artery *During an abdominal ultrasound, the gastroduodenal artery is demonstrated as a small circular anechoic structure at the anterior portion of the pancreas head.

During an abdominal ultrasound, a small circular anechoic structure is identified at the anterior portion of the pancreas head. Color flow is identified in the structure. What is it? A. gastroduodenal artery B. inferior mesenteric artery C. celiac axis D. common bile duct

D. biliary obstruction, hepatocellular disease *GGTP - Gamma-glutamyl transpeptidase is normally found in liver cells and biliary epithelium. It is the most sensitive indicator for alcoholism. A marked increase is seen with liver disease and post hepatic biliary obstruction. A moderate increase seen with liver damage due to alcohol, drugs, and chemotherapy. Increased GGTP + ALP = Biliary obstruction Increased GGTP + ALT = Hepatocellular disease

Elevated GGTP and ALP indicates ______________. Elevated GGTP and ALT indicates ______________. A. hepatic carcinoma, hepatic adenoma B. hepatocellular disease, biliary obstruction C. cirrhosis, hepatitis D. biliary obstruction, hepatocellular disease

B. uses information from reflections created by the non-linear behavior of sound waves to form the image *Harmonic imaging does not affect the beam intensity so there is no restriction of its use. The process is performed by the machine processing more reflections to improve the spatial and contrast resolution on the image.

Harmonic Imaging: A. improves spatial resolution but degrades temporal resolution. B. uses information from reflections created by the non-linear behavior of sound waves to form the image C. is not recommended for use on fetal exams due to increased beam intensity. D. improves spatial resolution but degrades contrast resolution.

A. contracted GB and dilated intrahepatic ducts *Amount of biliary tree dilatation varies with the location of the obstruction Obstructed right hepatic duct will cause dilated intrahepatic ducts in the right lobe (left ductal stone dilates ducts in left lobe) Obstructed CHD will cause dilatation of the intrahepatic ducts and a contracted GB because no bile is reaching the cystic duct to fill the gallbladder Distal CBD is the most common location for obstruction and causes dilated intrahepatic/extrahepatic ducts and GB

If the common hepatic duct is obstructed, how will this affect the other biliary structures? A. contracted GB and dilated intrahepatic ducts B. dilated extrahepatic ducts C. contracted GB and dilated extrahepatic and intrahepatic ducts D. dilated GB and dilated intrahepatic ducts

D. 1.0 *The resistive index is calculated using the peak and end diastolic velocities measured on a Doppler tracing. PSV - EDV / PSV Example: PSV 50cm/s, EDV 0cm/s; 50 - 0 / 50 = 1.0

If there is no diastolic flow demonstrated on a Doppler tracing of the arcuate artery of the upper pole of the right kidney, what will the resistive index be? A. 0 B. 0.5 C. unable to calculate the RI, not enough information given D. 1.0

B. 100 mg/100ml *In a normal fasting adult, blood sugar levels should not exceed 100 mg/100ml of blood.

In a normal fasting adult, blood sugar levels should not exceed __________ of blood. A. 50 mg/100ml B. 100 mg/100ml C. 150 mg/100ml D. 200 mg/100ml

C. SMA, left gastric artery *In most patients, the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of patients, the right hepatic artery originates from the SMA and the left hepatic artery originates from the left gastric artery. If you identify an arterial branch coursing from the SMA, posterior to the pancreas toward the porta hepatis, it is most likely the right hepatic artery.

In most patients, the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of patients, the right hepatic artery originates from the ___________________ and the left hepatic artery originates from the ________________. A. left renal artery, right renal artery B. splenic artery, common hepatic artery C. SMA, left gastric artery D. celiac axis, coronary artery

C. increased resistive index (RI) *Post-prandially, the normal hepatic artery will demonstrate an increased resistive index (RI) due to increased portal venous inflow to the liver with digestion. Increased RI = increased PSV and decreased EDV. A patient with cirrhosis will demonstrate a diminished change in RI values after eating.

In the normal liver, which of the following correctly describes the changes in flow in the hepatic artery after eating? A. increased end diastolic flow velocities B. decreased peak and end diastolic flow velocities C. increased resistive index (RI) D. no change occurs in the hepatic artery after eating

E. caudate *Note the ligamentum venosum along the anterior aspect of the mass and that the mass is contiguous with the caudate lobe tissue.

In what lobe of the liver is the mass located? A. The mass is within the IVC not the liver. B. left C. right D. quadrate E. caudate

B. reduce exam time *Reducing overall exam time will reduce patient exposure. Adhering to the ALARA principle will also reduce exposure by limiting power output increases and using TGC controls instead.

Potential bioeffects of ultrasound can be minimized by which of the following? A. increase PRF B. reduce exam time C. decrease overall gain D. using a lower frequency transducer

D. unilateral, bilateral *Primary testicular carcinoma is usually unilateral and secondary testicular malignancy is usually bilateral.

Primary testicular carcinoma is usually _____________ and secondary testicular malignancy is usually _________________. A. heterogeneous, isoechoic B. hypoechoic, isoechoic C. bilateral, unilateral D. unilateral, bilateral E. hypervascular, hypovascular

B. Renal sinus, pancreas, liver, spleen, renal parenchyma *The order of echogenicities in the abdomen from most echogenic to least echogenic. S P L S P = renal Sinus > Pancreas > Liver > or = Spleen > renal Parenchyma

Put the following in order in decreasing echogenicity: A. Renal parenchyma, spleen, liver, pancreas, renal sinus B. Renal sinus, pancreas, liver, spleen, renal parenchyma C. Pancreas, spleen, liver, renal sinus, renal parenchyma D. Renal sinus, renal parenchyma, liver, spleen, pancreas

D. distal abdominal aorta, aortic arch *Regarding the aorta, fusiform aneurysm formation usually occurs in the distal abdominal aorta while dissecting aneurysms usually occur in the aortic arch

Regarding the aorta, fusiform aneurysm formation usually occurs in the ________________ while dissecting aneurysms usually occur in the __________________. A. distal abdominal aorta, thoracic aorta B. proximal abdominal aorta, thoracic aorta C. aortic arch, distal abdominal aorta D. distal abdominal aorta, aortic arch

A. decrease, increase\ *As a kidney decreases in function, the organ atrophies. The cortex thins and becomes more dense leading to an increase in cortical echogenicity.

Sonographic signs of chronic renal failure include a/an ___________ in size and a/an ____________ in echogenicity. A. decrease, increase B. decrease, decrease C. increase, increase D. increase, decrease

A. main lobar fissure *The main lobar fissure courses through the right lobe between the neck of the GB and the IVC fossa. Sonographically, the main lobar fissure, appears to connect the GB neck and junction of right and left portal veins. Ligamentum teres courses through the left lobe and contains the collapsed umbilical vein. Ligamentum venosum separates the left lobe from the caudate lobe. The right and left segmental fissures separate the right and left lobes into two portions.

Sonographically, ______________ appears to connect the GB neck and junction of right and left portal veins. A. main lobar fissure B. ligamentum teres C. ligamentum venosum D. intersegmental fissure

D. right atrium *The IVC and SVC empty their blood into the right atrium.

The IVC and SVC empty their blood into the __________________________. A. right ventricle B. left ventricle C. left atrium D. right atrium

C. hepatic veins *The hepatic veins course between the liver segments (intersegmental). The portal veins and hepatic arteries course into the mid portion of each segment and branch toward the edge (intrasegmental).

The _________________________ are called intersegmental vessels of the liver. A. portal veins B. hepatic arteries C. hepatic veins D. hepatic arteries and veins

B. 5 x 3 x 1mm *The average normal size of the parathyroid gland is 5 x 3 x 1mm

The average normal size of the parathyroid gland is __________ A. <2mm in all dimensions B. 5 x 3 x 1mm C. 3 x 2 x 1cm D. 3 x 8 x 5mm

B. Posterior superior *The caudate lobe occupies much of the posterior superior surface of the liver.

The caudate lobe occupies much of the ___________ surface of the liver. A. Posterior inferior B. Posterior superior C. Anterior superior D. Anterior inferior

A. Celiac *The aorta tapers in size as it courses inferiorly through the abdomen. The celiac axis is the most superior branch of the aorta, therefore the aorta diameter is greatest at the level of its origin.

The diameter of the normal aorta is greatest at the level of the: A. Celiac B. Renal arteries C. Superior mesenteric artery D. Iliac bifurcation

D. 6cm hepatoma *A liver mass would not cause severe hydronephrosis in the left kidney. Retroperitoneal fibrosis and a AAA could compress the ureter causing hydronephrosis. Posterior urethral valves cause bladder outlet obstruction and bilateral hydronephrosis.

The findings on the renal ultrasound image displayed are least likely to be caused by? A. posterior urethral valves B. 6cm aortic aneurysm C. retroperitoneal fibrosis D. 6cm hepatoma

C. There is a heterogeneous, rounded mass located within the left rectus sheath, within the muscle layers and anterior to the peritoneal lining. *The image demonstrates a large hematoma within the rectus sheath of the abdominal wall.

The image demonstrates a transverse view of the right and left side of the abdominal wall, about 5cm lateral to the umbilicus. Which of the following statements is true regarding the findings on the image? A. There is a heterogeneous, rounded mass located within the muscle layers and posterior to the peritoneal lining on the left side. B. There is a homogeneous, rounded mass located within the left rectus sheath, anterior to the muscle layers and the peritoneal lining. C. There is a heterogeneous, rounded mass located within the left rectus sheath, within the muscle layers and anterior to the peritoneal lining. D. The image demonstrates the normal appearance of the muscle structures of the anterior abdominal wall bilaterally.

A. insulinoma *There are 3 types of PET; formerly known as Islet Cell Tumors; insulinoma (#1), gastrinoma, glucagonoma.

The image demonstrates the most common form of Pancreatic Endocrine Tumor (PET) of the pancreas. What type of PET is displayed? A. insulinoma B. pseudocyst C. fibroma D. adenoma

B. seminoma *Seminoma is the most common primary malignancy of the testicle. Mixed germ cell is the second most common primary malignancy in younger men age 20-30yrs.

The image demonstrates the most common malignant testicular neoplasm that occurs in men age 40-50yrs. This neoplasm is: A. mixed germ cell tumor B. seminoma C. teratoma D. embryonal cell tumor

B. IVC *1. IVC 2. aorta 3. right renal artery 4. left renal vein 5. SMA The IVC is dilated in this patient which can cause confusion with the aorta. By identifying the other structures on the image, you can determine that the rounded vessel is actually the IVC.

The image is a close up transverse view of the midline abdomen. What structure/vessel is indicated by #1? A. Aorta B. IVC C. right renal artery D. right renal vein

B. drains blood from the distal colon. *The IMV drains the blood from the distal colon. The SMV drains the blood from the proximal color and some small bowel portions. The IMV meets the splenic vein near the portal confluence.

The inferior mesenteric vein (IMV) __________________________. A. courses from the mesentery to the join the SMV near the portal confluence. B. drains blood from the distal colon. C. drains blood from the proximal colon. D. drains blood from the small bowel. E. All of the above

A. superior mesenteric artery *The renal arteries branch from the aorta just below the origin of the superior mesenteric artery.

The renal arteries branch from the aorta just below the origin of the ____________________. A. superior mesenteric artery B. celiac axis C. gonadal arteries D. inferior mesenteric artery

E. Leukocytes *Leukocytes are white blood cells. They are produced in the splenic tissue.

The spleen produces ____________________ and their main function is to control antibodies and prevent infection. A. Amylase B. Aldosterone C. Mitochondria D. Platelets E. Leukocytes

A. Breast *Breast cancer is the most common primary carcinoma to metastasize to the thyroid.

What is the most common primary carcinoma to metastasize to the thyroid? A. Breast B. Lungs C. Liver D. Stomach

C. thrombus in the portal vein *The IVC is the flattened blue structure posterior to the thrombus in the portal vein. It appears patent with decreased flow volume with patient supine and obstructed portal flow. There is color flow in the vessel around the hypoechoic rounded mass = not the CBD. There is no flow within the hypoechoic mass but flow is present around it which indicates an avascular thrombus within a vessel. Lymphadenopathy would demonstrate enlarged nodes with increased internal vascularity.

What is the yellow arrow pointing to? A. mass in the CBD B. retroperitoneal lymphadenopathy C. thrombus in the portal vein D. IVC tumor extension

C. unconjugated bilirubin *There is an extrahepatic ductal obstruction because the common duct and intrahepatic ducts are dilated. The bilirubin will be conjugated by the liver but unable to be excreted through the obstructed ductal system. ALP, GGTP, PT and conjugated bilirubin are increased with extrahepatic obstruction.

What lab values would NOT be elevated in this patient? A. conjugated bilirubin B. alkaline phosphatase C. unconjugated bilirubin D. prothrombin time

E. anterior right lobe *The branches of the right portal vein enter the segments of the right lobe. The posterior right portal branch (green arrow) enters the posterior right lobe. The anterior right portal branch (yellow arrow) enters the anterior right lobe.

What lobe of the liver is indicated by #2? A. caudate lobe B. posterior right lobe C. medial left lobe D. lateral left lobe E. anterior right lobe

B. CT scan *CT can detect the high fat composition of the mass.

What modality is commonly used in the characterization of a renal angiomyolipoma? A. Angiography B. CT scan C. Nuclear medicine D. X-ray

C. renal cortex *1. renal cortex 2. upper pole major calyx 3. lower pole major calyx 4. mid pole major calyx 5. renal pelvis 6. renal sinus

What renal structure/region is indicated by #1? A. Morrison's pouch B. major calyx C. renal cortex D. renal sinus

D. Normal sized prostate with a corpora amylacea. *The normal prostate usually demonstrates a somewhat homogeneous, hypoechoic appearance. The image demonstrates a hyperechoic focus in the center of the gland (calcification). Corpora amylacea refers to benign calcification formation in the prostate gland.

What structure is being measured by the calipers on the male pelvis ultrasound image? A. Enlarged seminal vesicle B. Normal seminal vesicle C. Normal sized prostate with echogenic appearance of the central sinus related to the hypoechoic outer cortex D. Normal sized prostate with a corpora amylacea.

E. CBD *The CBD is significantly dilated. The CBD and hepatic artery are usually located anterior to the portal vein. 1. CBD 2. hepatic artery 3. portal vein 4. GB

What structure is indicated by #1? A. IVC B. Splenic Vein C. Hepatic artery D. MPV E. CBD

C. Proper hepatic artery *The cross section of the portal triad is seen within the liver therefore the common hepatic duct, PROPER hepatic artery and main portal vein. The proper hepatic artery is formed when the GDA branches from the common hepatic artery.

What structure is indicated by the red arrow? A. Main portal vein B. CBD C. Proper hepatic artery D. common hepatic artery

A. Gastroduodenal artery\ *1. left lobe of liver 2. pancreas head 3. gastroduodenal artery 4. pancreas body 5. pancreas tail 6. SMA 7. splenic vein 8. aorta 9. OVC 10. left renal vein 11. right renal vein 12. spine

What structure/vessel is indicated by #3? A. Gastroduodenal artery B. Superior mesenteric artery C. Celiac D. CBD

C. Celiac Axis *1. Proximal Aorta 2. SMA 3. Celiac axis 4. Mid Aorta 5. Lt Lobe of Liver 6. EG junction 7. SMV 8. Pancreas

What structure/vessel is indicated by #3? A. Mid Aorta B. SMA C. Celiac Axis D. IVC E. Proximal Aorta

D. medial left lobe *1. medial branch of LPV 2. LPV 3. lateral branch of LPV 4. medial part of left lobe 5. lateral part of left lobe

What structure/vessel is indicated by #4? A. lateral left lobe B. right lobe C. caudate lobe D. medial left lobe

E. medial left lobe *1. Left portal vein 2. IVC 3. Aorta 4. SMA 5. Lateral left lobe 6. Caudate lobe 7. Ligamentum venosum 8. Medial left lobe 9. Spine

What structure/vessel is indicated by #8? A. lateral left lobe B. ligamentum venosum C. ligamentum teres D. caudate lobe E. medial left lobe

B. aorta *1. left lobe of liver 2. pancreas head 3. gastroduodenal artery 4. pancreas body 5. pancreas tail 6. SMA 7. splenic vein 8. aorta 9. OVC 10. left renal vein 11. right renal vein 12. spine

What structure/vessel is indicated by #8? A. spine B. aorta C. superior mesenteric artery D. IVC

D. decreasing color priority *Color Priority: Adjusts the threshold setting; Determines if a pixel is displayed as shade of gray, black or white or as a color; Lower threshold settings reduce the display of color (lower color priority); Higher threshold settings display more color (higher color priority); Necessary to minimize color ghosting and improper placement of color on vessel walls

What system control can reduce the appearance of color ghosting? A. increasing persistence B. decreasing PRF C. increasing color threshold D. decreasing color priority

C. Hepatization *Hepatization of the GB refers to a GB filled with sludge that is isoechoic to the liver. This makes the GB tough to identify on ultrasound. Try to identify GB wall in these cases.

What term describes a gallbladder that is filled with bile that is isoechoic to the liver and is difficult to identify on ultrasound? A. Courvoisier gallbladder B. Charcot's triad C. Hepatization D. Mirizzi syndrome

D. hepatic artery *1. Splenic artery 2. Celiac trunk 3. Aorta 4. Hepatic artery

What vessel is indicated by #4? A. SMA B. splenic artery C. celiac trunk D. hepatic artery E. aorta

A. centripetal *Centripetal arteries course through the parenchyma to deliver oxygenated blood to the testicular tissues. These arteries are sampled with Doppler in a standard ultrasound evaluation.

When evaluating intratesticular flow, which vessel is sampled by Doppler? A. centripetal B. deferential C. gonadal D. cremasteric

A. Scan the patient in the decubitus position *The decubitus position allows for transducer placement closer to the kidney than from an anterior approach. Coronal and posterior probe placement can aid in better visualization of the kidneys, especially in obese patients.

When scanning a large habitus patient, a possible renal cyst is identified. Which of the following is a technique that would most likely be used to better visualize the finding? A. Scan the patient in the decubitus position B. Drink water and rescan in 20-30 minutes C. Use a standoff pad D. Switch to a higher frequency probe

B. ask patient to perform the valsalva maneuver *The valsalva maneuver will not usually affect the evaluation of the pancreas.

When scanning the pancreas, which of the following techniques will not assist in reducing the gas artifact around the pancreas? A. deep inspiration B. ask patient to perform the valsalva maneuver C. water ingestion D. NPO 8-12 hrs prior to exam

C. Phrygian cap *A phrygian cap is a type of French hat. The top is "puffed up" and folded over toward the front. When the GB fundus is folded over the body of the GB, it resembles this style of hat/cap.

When the GB fundus is folded over on itself, this is referred to as: A. Hartman's pouch B. Roland Ashkoff sinus C. Phrygian cap D. Junctional fold

B. at the level of the aortic bifurcation *Retroperitoneal Fibrosis (Ormond's disease) usually occurs at the level of the aortic bifurcation. It refers to idiopathic(usually) overgrowth of fibrous tissue. It can be related to drugs, infection, malignancy or cancer therapy. The overgrowth of tissue may lead to ureteral obstruction causing hydronephrosis.

Where is the most common location for the occurrence of retroperitoneal fibrosis? A. at the lateral borders of the kidneys B. at the level of the aortic bifurcation C. at the level of the renal arteries D. adjacent to the diaphragm surrounding aorta

B. left internal jugular vein *The internal jugular vein is located lateral to the left lobe of the thyroid and demonstrates an anechoic ovoid shape in a transverse view of the mid thyroid. The carotid artery is also lateral to the thyroid lobes but it should be a circular structure.

Which blood vessel is located lateral to the left lobe of the thyroid and demonstrates an anechoic ovoid shape in a transverse view of the mid thyroid? A. left common carotid artery B. left internal jugular vein C. superior vena cava D. left external carotid artery

C. coronal and transverse *A transverse view can demonstrate a transverse image of both great vessels on the same image. To obtain a longitudinal view of the aorta and IVC on the same image, position the patient in a decubitus position. Use a coronal approach to angle through the abdomen to visualize the aorta and IVC simultaneously. A right coronal approach will demonstrate the aorta as the posterior vessel. A left coronal approach will demonstrate the IVC as the posterior vessel.

Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient? A. coronal only B. mid sagittal only C. coronal and transverse D. transverse only

A. The technologist uses ultrasound to guide the probe placement during compression therapy applied in 10 minute intervals. *Treatment of a pseudoaneurysm is performed by applying compression over the stalk. Compression is performed in 10 minute intervals with a re-evaluation of flow within the pseudo after each compression interval. Thrombin can be injected into the body of the pseudoaneurysm under ultrasound guidance. Lovenox is used to treat DVT.

Which of the following correctly describes how ultrasound is used to guide treatment of a pseudoaneurysm of the external iliac artery? A. The technologist uses ultrasound to guide the probe placement during compression therapy applied in 10 minute intervals. B. The technologist uses ultrasound to guide the probe placement during compression therapy applied in 30 minute intervals. C. The physician uses ultrasound guidance during the injection of Lovenox into the stalk of the pseudoaneurysm. D. The physician uses ultrasound guidance during the injection of Lovenox into the body of the pseudoaneurysm.

D. With the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall\ *With the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall. Be sure that you are not slicing obliquely through the organ when assessing wall thickness.

Which of the following correctly describes the method used to measure the wall thickness of the gallbladder? A. With the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the anterior wall B. With the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the posterior wall C. With the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the posterior wall D. With the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall

A. It is normally isoechoic to the liver *The pancreas is isoechoic to the liver as a child and increases in echogenicity as the patient reaches adulthood. Cystic fibrosis causes an increase in echogenicity of the gland.

Which of the following correctly describes the pediatric pancreas? A. It is normally isoechoic to the liver B. The ducts are dilated at >2mm at birth and decrease in size throughout the first year C. Cystic fibrosis leads to the production of mucus and the gland is reduced in echogenicity D. It normally decreases in echogenicity as the patient reaches adulthood

D. prone with a pillow under the abdomen to accentuate the normal curvature of the spine *The preferred position for the patient undergoing a renal biopsy is prone with a pillow under the abdomen to accentuate the normal curvature of the spine. This approach allows the needle to travel the shortest distance through other tissues before reaching the kidney. It also prevents puncture of bowel and other organs. An anterior biopsy approach is least preferable due to the bowel, liver, spleen and vessels that could be punctured in the procedure.

Which of the following correctly describes the preferred patient position for a renal biopsy? A. decubitus position with knees drawn to chest B. posterior oblique with ipsilateral arm extended over the head C. supine with a pillow under the back to accentuate the normal curvature of the spine D. prone with a pillow under the abdomen to accentuate the normal curvature of the spine

C. portal vein, proper hepatic artery and bile duct *The portal triad contains the portal vein, proper hepatic artery and common hepatic duct.

Which of the following correctly lists the structures found in a portal triad? A. common hepatic artery, hepatic vein and portal vein B. hepatic vein, proper hepatic artery and bile duct C. portal vein, proper hepatic artery and bile duct D. portal vein, hepatic vein and bile duct

B. decreased size and increased overall echogenicity *As the pancreas continues to produce the mucous substance, the gland becomes fibrotic. These changes lead to an increase in echogenicity and decrease in size.

Which of the following describes the sonographic appearance of the pancreas with chronic cystic fibrosis? A. increased size with mottled echogenicity, no definite nodules B. decreased size and increased overall echogenicity C. increased size with nodule and calcification formation D. decreased size with hypoechoic nodularity throughout the gland

B. Patient with active Alzheimer's disease and hepatitis *A patient with Alzheimer's disease cannot sign the informed consent for the procedure and may be uncooperative. Contraindications for Sonography Guided Procedures: 1. Coagulopathy - use of blood thinners; if permitted by their physician, the patient can discontinue their blood thinner medication until their PT and INR values return to normal levels and then proceed with the invasive procedure 2. Unsafe biopsy route - must avoid large vessels, bowel, trachea and adjacent organs 3. Uncooperative patient - uncontrolled movement during the procedure can result in laceration or hemorrhage

Which of the following is a contraindication for a liver biopsy? A. Patient with allergies to iodinated contrast B. Patient with active Alzheimer's disease and hepatitis C. Patient with Budd Chiari syndrome D. Patient with severe liver atrophy caused by cirrhosis

D. current Warfarin use *Patients who are currently taking a blood thinner cannot have a biopsy unless they can stop the medication for several days.

Which of the following is a contraindication for a renal biopsy? A. AIDS B. Polycystic kidney disease C. current antibiotic treatment D. current Warfarin use

C. When finished, remove the gloves first, and then untie the bottom strings, followed by the top strings *When finished, remove the gloves first, and then untie the bottom strings, followed by the top strings. Do not touch the part of the mask that will touch your face. Tie the upper strings over the ears and towards the top of the back of your head. Discard the mask properly and wash your hands.

Which of the following is a correct statement describing the guidelines for wearing a mask? A. It is OK to touch the part of mask that will touch your face B. Tie the upper strings across the top of your head and the lower strings around your neck C. When finished, remove the gloves first, and then untie the bottom strings, followed by the top strings D. Remove gloves, wash hands and then remove mask

B. Dampen soft cloth to cleanse probe with mild liquid soap *You need to remove probe cover and use running water to remove any debris or gel. Dry probe with soft cloth or paper towel.

Which of the following is correct referring to cleaning a transducer as part of a high level disinfection procedure? A. Dry probe with toilet paper B. Dampen soft cloth to cleanse probe with mild liquid soap C. Rinse probe with alcohol D. Use just running water to remove any debris or gel

A. Sterile gel is used between the sterile sheath on the transducer and the organ being scanned *Gel is not used as a coupling agent when scanning intraoperatively. Surface moisture is usually enough to allow sound transmission into the body but sterile saline may also be used.

Which of the following is incorrect regarding intraoperative ultrasound? A. Sterile gel is used between the sterile sheath on the transducer and the organ being scanned B. Soaking the transducer in alcohol for 30 minutes prior to the procedure is sufficient sterilization before surgery C. Ethylene Oxide gas can be used to sterilize the transducer

C. have the patient fill their bladder and evaluate the scrotal sac for pocket of urine *Peristalsis of a bowel segment inside the scrotal sac is a definitive sign of a hernia. Color Doppler can be used to assess blood flow in the bowel segment. The strain and release from the Valsalva maneuver can stimulate peristalsis and accentuate the protrusion of bowel in the sac.

Which of the following is least likely to assist in diagnosing an inguinal hernia? A. record bowel peristalsis on a cine clip B. use dual screen imaging ,with and without Valsalva, over the suspected location of the hernia C. have the patient fill their bladder and evaluate the scrotal sac for pocket of urine D. apply color Doppler to the suspected bowel protrusion into the scrotal sac

B. extrinsic compression of the celiac artery *Retroperitoneal Fibrosis is also called Ormond's disease and refers to idiopathic(usually) overgrowth of fibrous tissue around an atherosclerotic aorta. It most commonly occurs at the level of the aortic bifurcation and extends inferiorly in pelvis. Rarely will it extend superiorly in the abdomen. Complications include IVC compression, pedal edema, gonadal vein compression, and ureteral obstruction. May lead to ureteral obstruction causing hydronephrosis. Sonographic characteristics include a hypoechoic, soft tissue mass with smooth borders.

Which of the following is least likely to be identified in a patient with Ormond's disease? A. pedal edema B. extrinsic compression of the celiac artery C. bilateral ureteral obstruction D. scrotal swelling

B. Sclerosing cholangitis *Sclerosing cholangitis is an acquired inflammatory disorder of the biliary tree.

Which of the following is not a congenital anomaly/disorder? A. Biliary atresia B. Sclerosing cholangitis C. Caroli's disease D. Choledochal cyst

B. Exposure to sunlight *The factors to consider when choosing a high level disinfectant are: transducer compatibility, ventilation requirements, disinfection time, rinsing requirements, temperature, re-use period, cycle cost, neutralization requirements

Which of the following is not a factor to consider when choosing a high level disinfectant for the transducer? A. Temperature B. Exposure to sunlight C. Ventilation requirements D. Disinfection time

A. solid hypoechoic mass *Prostatitis is usually a diffuse process that affects the entire gland.

Which of the following is not a sonographic characteristic of prostatitis? A. solid hypoechoic mass B. increased gland size C. increased vascularity seen with color Doppler D. heterogeneous gland

D. acute tubular necrosis *Acute tubular necrosis is the most common cause of acute renal failure in an allograft.

Which of the following is the most common cause of acute renal failure in an allograft? A. multicystic kidney disease B. renal artery stenosis C. polycystic disease D. acute tubular necrosis

C. seminoma *Seminomas make up 40-50% of all germ cell tumors identified in the testicle.

Which of the following is the most commonly occurring germ cell tumor of the testicle? A. embryonal cell tumor B. choriocarcinoma C. seminoma D. teratoma

C. The cytology lab evaluates the sample obtained from the FNA. The histology lab evaluates the sample obtained from the needle biopsy. *The needle used for the FNA is usually much smaller than the biopsy needle. Core needle biopsies are more commonly performed to assess parenchymal liver disease than for liver mass evaluation. FNA procedures are less traumatic to the tissues than needle biopsy procedures

Which of the following is true regarding the difference between the sample obtained from a fine needle aspiration and a core biopsy sample taken from the liver? A. Core needle biopsies are more commonly performed for liver masses than to assess parenchymal liver disease. B. The needle used for the FNA is usually much larger than the biopsy needle. C. The cytology lab evaluates the sample obtained from the FNA. The histology lab evaluates the sample obtained from the needle biopsy. D. FNA procedures are more traumatic to the tissues than needle biopsy procedures

B. The pylorus is thickened and the stomach is demonstrated medially. *Note the excessive thickness of the pyloric walls. The stomach is distended with fluid and food material.

Which of the following is true regarding the image of the RUQ of a neonate? A. The pylorus is thickened with an adjacent solid mass. B. The pylorus is thickened and the stomach is demonstrated medially. C. The pylorus and the stomach are both demonstrated normally on the image. D. The pylorus is not thickened but there is a fluid collection seen in the stomach.

D. ligamentum teres *The left intersegmental fissure divides the left lobe into medial and lateral lobes. The falciform ligament, ligamentum teres and left hepatic vein course within this fissure.

Which of the following ligaments separates the medial and lateral left lobes of the liver? A. broad ligament B. ligamentum venosum C. coronary ligament D. ligamentum teres

D. hepatic adenoma and Budd Chiari syndrome *Both hepatic adenoma and Budd Chiari syndrome have been associated with oral contraceptive use.

Which of the following liver abnormalities can be related to the use of oral contraceptives? A. hydatid disease and schistosomiasis B. Budd Chiari syndrome and hydatid disease C. focal nodular hyperplasia and hepatic adenoma D. hepatic adenoma and Budd Chiari syndrome

C. hemochromatosis *Amyloidosis - increased levels of amyloid deposited in liver Hemochromatosis - increased levels of iron deposited in the liver Wilson disease - increased levels of copper stored in the liver

Which of the following liver disorders will result in increased levels of iron stored in the liver? A. glycogen storage disease B. Wilson disease C. hemochromatosis D. amyloid disease

B. output *The output control will increase/decrease the voltage applied to the transducer which affects the intensity of the beam accordingly. Harmonic imaging is a frequency compounding technique used to improve image resolution of the displayed information. The TGC and overall gain controls are used to amplify the reflected signal.

Which of the following operator controls adjusts the beam intensity? A. overall gain B. output C. TGC D. dynamic range

B. autosomal recessive polycystic kidney disease *Lack of fetal urine production in utero is the first sign that infantile PCKD is present.

Which of the following renal disorders is usually detected in utero due to oligohydramnios? A. multicystic dysplastic kidney disease B. autosomal recessive polycystic kidney disease C. horseshoe kidney D. duplicated collecting system

B. perirenal space *Perirenal space holds kidney, perirenal fat, proximal ureter, adrenal gland. Renal infection can lead to fluid, abscess or gas within the space which will distort renal fascia.

Which of the following retroperitoneal spaces contains the adrenal gland? A. posterior pararenal space B. perirenal space C. anterior pararenal space D. retrofascial space E. Glisson's capsule

D. efferent ducts *The seminiferous tubules empty into the efferent ductules that connect to the epididymis.

Which of the following scrotal structures carries the seminal fluid from the rete testis to the epididymis? A. seminiferous tubules B. mediastinum testis C. vas deferens D. efferent ducts

D. The location of a mass in the head of the pancreas usually indicates a benign process. *Most tumors with round smooth borders are benign. Most pancreatic tumors located in the head of the organ are usually malignant. Masses found in the pancreatic tail are usually benign. Because of the proximity of the pancreatic tail to the splenic hilum, tail masses can look like splenic pathology.

Which of the following statements is false regarding pancreatic masses? A. A mass with round smooth borders is usually a benign process. B. A pancreatic tail mass can be confused with splenic hilar pathology. C. The location of a mass in the head of the pancreas usually indicates a malignant process D. The location of a mass in the head of the pancreas usually indicates a benign process.

D. The scrotum and testicles are normal with mild bilateral hydroceles. *Chronic infection, radiation therapy, CHF and liver failure can all be associated with scrotal wall thickening. Normal scrotal wall thickness is <8mm.

Which of the following statements is false regarding the findings on the image? A. Radiation treatment of the prostate can lead to these findings. B. CHF can be associated with the findings on the image. C. The image demonstrates normal testicles with bilateral hydroceles and significant scrotal wall thickening. D. The scrotum and testicles are normal with mild bilateral hydroceles.

A. The images most likely display Non Hodgkin's lymphoma. *Hodgkin's lymphoma is the most common type seen in the spleen so the images most likely represent this type of lymphoma..

Which of the following statements is false regarding the images of splenic lymphoma? A. The images most likely display Non Hodgkin's lymphoma. B. The masses are well circumscribed and hypoechoic to the splenic parenchyma. C. These tumors of the spleen are rare. D. They form due to abnormal cell growth in the lymphatic system of the spleen.

B. The hepatic artery is hepatopetal and the portal vein is hepatofugal. *Hepatopetal = flow toward the liver; Hepatofugal = flow away from the liver; The hepatic artery and portal vein are both normally hepatopetal but the image displays abnormal flow direction in the portal vein.

Which of the following statements is true regarding the Doppler evaluation of the liver vasculature displayed? A. The hepatic artery and portal vein are demonstrated with normal flow directions. B. The hepatic artery is hepatopetal and the portal vein is hepatofugal. C. The hepatic artery is hepatofugal and the portal vein is hepatopetal. D. The portal vein flow is normal but the hepatic artery demonstrates increased resistance

D. The gallbladder contains a stone and a wall mass indicating primary GB carcinoma. *The image demonstrates a large stone with posterior shadowing at the neck of the GB. A solid mass is attached to the mid portion of the body of the GB. Primary GB carcinoma is usually identified as a solid mass within the GB with coexisting stone(s). Metastasis to the GB is most commonly identified as a solid mass within the GB lumen and no coexisting stones.

Which of the following statements is true regarding the image displayed? A. The gallbladder contains a stone and a wall mass indicating secondary GB carcinoma. B. The gall bladder contains a cholesterol polyp at the neck. C. The gallbladder contains a stone indicating cholelithiasis. D. The gallbladder contains a stone and a wall mass indicating primary GB carcinoma.

A. Middle Hep V *1. left hepatic vein 2. middle hepatic vein 3. IVC 4. right hepatic vein 5. lateral left lobe 6. medial left lube 7. anterior right lobe 8. posterior right lobe

Which of the following structures is labeled #2? A. Middle Hep V B. Left Hep V C. IVC D. Left Portal V

A. Internal jugular vein *1. Right lobe of the thyroid 2. Right carotid artery 3. Right internal jugular vein 4. Sternocleidomastoid muscle 5. Strap muscles 6. Longus colli muscle

Which of the following structures is labeled #3? A. Internal jugular vein B. Sternocleidomastoid muscle C. Strap muscle D. Common carotid artery

A. portal confluence *1. liver 2. gastroduodenal artery 3. common bile duct 4. portal confluence 5. superior mesenteric artery 6. aorta

Which of the following structures is labeled #4? A. portal confluence B. splenic vein C. superior mesenteric vein D. IVC

B. Longus Colli muscle *1. Right lobe of the thyroid 2. Right carotid artery 3. Right internal jugular vein 4. Sternocleidomastoid muscle 5. Strap muscles 6. Longus colli muscle

Which of the following structures is labeled #6? A. Strap muscle B. Longus Colli muscle C. Sternocleidomastoid muscle D. Esophagus

D. posterior right lobe *1. left hepatic vein 2. middle hepatic vein 3. IVC 4. right hepatic vein 5. lateral left lobe 6. medial left lube 7. anterior right lobe 8. posterior right lobe

Which of the following structures is labeled #8? A. medial left lobe B. lateral left lobe C. anterior right lobe D. posterior right lobe

E. hepatoblastoma *Alpha-fetoprotein levels will increase with malignancy and pregnancy.

Which of the following will cause an increase in alpha fetoprotein values? A. adenoma B. biloma C. glycogen storage disease D. focal nodular hyperplasia E. hepatoblastoma

A. increase frame rate *Increased frame rate will improve temporal resolution and may reduce any visible delay in displayed information. Smaller sample sizes will increase frame rates. Color threshold determines the limit of when color is displayed over the 2D image. Increasing the threshold allows for more color to be displayed.

Which of the following will improve the color display in the abdominal aorta? A. increase frame rate B. decrease color threshold C. decrease color gain D. increase sample size

D. Oncocytoma *Oncocytoma would normally present as a hypoechoic renal mass. Acute pyelonephritis does not cause mass formation but will present as loss of corticomedullary definition. The other choices will appear as a hyperechoic mass.

Which of the following would normally present as a hypoechoic renal mass? A. Angiomyolipoma B. Mycetoma C. Acute Pyelonephritis D. Oncocytoma

B. mucocele of the GB *A mucocele of the GB is caused by a long standing obstruction of the cystic duct. The remainder of the biliary system is normal and jaundice would not occur.

Which of the following would not be associated with jaundice? A. sphincter of Oddi dysfunction B. mucocele of the GB C. hepatitis D. a stone at the Ampulla of Vater

D. body and fundus *A phrygian cap forms when the fundus of the GB folds over on the body of the GB.

Which portions of the gallbladder and/ or biliary tree are involved in the formation of a phrygian cap? A. cystic duct and common bile duct B. neck and body C. neck and cystic duct D. body and fundus

D. curved array imaging *The curved array can be used to provide a larger footprint and near field size. A vector array would have a very small near field with a pie shaped sector. This is helpful for the assessment of superficial structures of significant size. Harmonic imaging is helpful to evaluate the fluid for debris but is not helpful in evaluating the size of the mass

Which supplemental technique, used to better visualize the size of a large scrotal mass, is demonstrated on the image? A. harmonic imaging B. vector array imaging C. extended field of view D. curved array imaging

A. Deep mucosa, muscularis propia *The Gut Signature (Sonographically): Superficial Mucosa - epithelial lining (and lumen); echogenic Deep Mucosa-- Consists of loose connective tissue and muscularis mucosa; hypoechoic Submucosa - echogenic Muscularis propia-- inner circular fibers and outer longitudinal fibers; hypoechoic Serosa or Adventitia - echogenic

Which two gut layers are normally hypoechoic on the ultrasound image? A. Deep mucosa, muscularis propia B. Submucosa, muscularis propia C. Serosa, muscularis propia D. Serosa, superficial mucosa

D. Emphysematous Pyelonephritis *Emphysematous Pyelonephritis is considered a critical finding on a renal ultrasound exam. If not treated early, it may lead to fulminant sepsis and carries a high mortality.

Which type of kidney infection is considered a critical finding? A. Acute Pyelonephritis B. Chronic Pyelonephritis C. Glomerulonephritis D. Emphysematous Pyelonephritis

B. 3MHz curvilinear phased array *Deep abdominal imaging is best performed with low frequency, curvilinear phased array transducers. The larger footprint and near field provide improved imaging FOV for abdominal structures. Lower frequencies also provide the best penetration.

Which type of transducer would be used to evaluate a patient with increased LFTs and height 5'3" and weight 275lbs? A. 5MHz linear phased array B. 3MHz curvilinear phased array C. 5MHz sector phased array D. 10MHz vector array

B. prothrombin time *Vitamin K is used to convert prothrombin to thrombin in the liver. Thrombin functions as a clotting agent in the blood. Reduced vitamin K will increase the prothrombin conversion time. Longer prothrombin times indicate a risk of hemorrhage. Increasing vitamin K intake will increase the amount of thrombin created in the liver and reduce the prothrombin time (and risk of hemorrhage).

While discussing the medical history with a patient, he tells you that the doctor recommended that he increase his intake of vitamin K due to some recent abnormal lab results. Which of the following lab values was abnormal? A. alkaline phosphatase B. prothrombin time C. Alpha feto-protein D. red blood cell count

D. Immediately wash the hand with soap and water *Immediately wash the affected area with soap and water. Notify your supervisor and immediately report to occupational health to file an exposure report.

While you are performing an exam, the patient's nurse comes in to try to draw blood. The nurse dropped the blood tube and the you got a splash of blood on your arm. What should you do next? A. Report the clumsy actions of the nurse to her supervisor B. Use alcohol based sanitizer to disinfect hand C. Report to occupational health so they can test the blood on your hand for disease D. Immediately wash the hand with soap and water

D. Increase the color threshold *Color threshold (aka priority) determines the limit of when color will be displayed over the gray scale image. Decreasing the threshold would reduce the amount of color displayed in slow flowing vessels. Increasing the color threshold will increase the amount of color displayed. Smaller sample sizes produce better color display.

You are evaluating an obese patient with a known AAA. While using color Doppler to assess flow within the aneurysm, minimal flow is detected in the anechoic lumen. You decrease the color scale and increase the color gain but there is no improvement. Which of the following adjustments will most improve the color display on this exam? A. Increase color sample size B. Decrease the color threshold C. Switch from a 4MHz curved array to a 4MHz linear array D. Increase the color threshold

C. 5MHz linear *In order to balance resolution and penetration a 5-7MHz transducer should work best for liver surface evaluation in an average sized patient. The linear array works best due to its large near field and rectangular field of view.

You are scanning the liver of an average sized patient with known cirrhosis. You complete the exam using a 3.5MHz curvilinear transducer but the doctor would like a better evaluation of liver surface nodularity. Which of the following transducers would provide the best evaluation of the liver surface? A. 12MHz linear B. 8MHz curvilinear C. 5MHz linear D. 3.5MHz linear

D. a thyroid mass *Esophageal Diverticulum refers to an outpouching of a weak spot in the esophageal wall. Killian-Jamieson diverticulum - protrudes from anterolateral wall of the cervical esophagus Zenker's diverticulum - located at the back of the throat, protrudes posterior or midline They can be mistaken for a thyroid mass.

Zenker's diverticulum can be mistaken for: A. a bowel obstruction B. the appendix C. a dilated bile duct D. a thyroid mass