DMS 211 Final Exam

The renal cortex should measure as least

1cm

An abdominal aortic aneurysm is present when the diameter of the abdominal aorta exceeds

3cm

Thickness of the gallbladder wall in a normal fasting patient should not exceed

3mm

An adult kidney measures what from from superior to inferior margins?

9-12 cm

You are scanning a patient with suspected liver cirrhosis. All of the following are sonographic features of cirrhosis EXCEPT: A - shrunken caudate lobe B - altered echotexture C - ascites D - regenerative nodules E - surface nodularity

A

Infantile polycystic disease may also be referred to as:

ARPKD

SGOT (serum glutamic-oxaloacetic transaminase) is now referred to as:

AST (aspartate aminotransferase)

Structure NOT seen in RUQ Liver Appendix Right kidney Gallbladder

Appendix

Which of the following is NOT a remnant of the fetal circulation? A - falciform ligament B - coronary ligament C - ligamentum teres D - ligamentum venosum

B

Which of the following is NOT true about the abdominal aorta? A - The aorta has a thicker tunica media than the IVC. B - The proximal aorta is situated more anterior than the distal aorta. C - The abdominal aorta bifurcates into the common iliac arteries. D - The 3rd major branch of the abdominal aorta are the renal arteries.

B

all of the following would be considered common among solid renal masses EXCEPT? A - mural nodules B - smooth walls C - internal echoes D - septations

B

Obstruction of one or more hepatic vein in referred to as:

Budd-Chiari disease

The spiral valves of Heister are located in which structure?

Cystic duct

A 50-year-old woman with a long history of alcoholism presents with increased abdominal girth. Which of the following is the most probably finding on ultrasound of the abdomen? A - liver metastases B - hepatoma C - gallstones with a mass in the lumen of the gallbladder D - massive ascites with a small echogenic liver E - dilated intrahepatic biliary ducts

D

Which of the following is associated with development of cysts in the pancreas? A - Zollinger-Ellison syndrom B - autosomal recessive polycystic disease C - endoscopic retrograde cholangiopancreatography D - Von Hipple-Lindau disease

D

Accessory pancreatic duct

Duct of Santorini

Main pancreatic duct

Duct of Wirsung

Fold in the parietal peritoneum that extends from the umbilicus to the diaphragm and contains the ligamentum teres.

Falciform ligament

Fibroeslastic connective tissue layer that surrounds the liver

Glisson's capsule

Macrophages that are part of the reticuloendothelial system, help break down red blood cells.

Kupffer cells

Pain in the area of the gallbladder

Murphy's sign

In what anatomic variant is the fungus of the gallbladder folded over the body?

Phrygian cap

Anatomic variant in which right lobe is enlarged and extends inferiorly.

Reidel's lobe

The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:

Sphincter of oddi

Patients present with fever and elevated white blood count

abscess

Which cells carry out the exocrine function of the pancreas?

acinar cells

Performs exocrine functions, secreting digestive enzymes

acini cells

A patient presents with a sudden onset of abdominal pain and extreme tenderness over the gallbladder fossa. Localized gallbladder wall thickening is visualized on ultrasound. This most likely represents:

acute cholecystitis

What is the most common primary carcinoma of the pancreas?

adenocarcinoma

Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with:

adenomyomatosis

Laboratory test that evaluates liver function

alkaline phosphatase

Performs endocrine function, secretes glucogon

alpha cells

The common bile duct enters the duodenum at the

ampulla of vader

Enzymes that digests carbohydrates

amylase

Which laboratory finding elevates first in the presence of acute pancreatitis?

amylase

A structure lacking echoes can be referred to as

anechoic

Describes a portion of an image that is echo free

anechoic

A rare malignant tumor of the spleen that consists of blood vessels is an

angiosarcoma

Towards the front of the body

anterior

The right portal vein divides into

anterior and posterior branches

List 4 ways to differentiate between the great vessels (Aorta is/has)

anterior branches, on the left side of the body, nothing posterior, courses posterior to the diaphragm

List the 4 vessels that run long in the body

aorta, IVC, SMA, SMV

An outpatient with a history of back pain and hypertension presents to the ultrasound department for an abdominal aortic ultrasound. Sonographically, you visualize a 6cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis?

aortic dissection

Tendons that attach to muscles

aponeuroses

What is the most common clinical finding of a simple renal cyst?

asymptomatic

What is the most likely clinical finding of a patient who has a splenic hemangioma?

asymptomatic

Non-shadowing, low-amplitude echoes located in the dependent portion of the gallbladder best describes:

biliary sludge

What liver function test is produced from the breakdown of hemoglobin?

bilirubin

What hepatic function continues after birth?

bilirubin production

The most common type of choleductal cyst involves:

both CBD and CHD

What form of hepatic abnormality are immunocompromised patients more prone to develop?

candidiasis

What is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa?

candidiasis

Based on couinad segments of the liver, segment 1 is

caudate lobe

The most common benign hepatic neoplasm

cavernous hemangioma

Surgical removal of the gallbladder

cholecystectomy

Which hormone stimulates gallbladder contraction and the secretion of pancreatic enzymes?

cholecystokinin

Intermittent obstruction of the cystic duct by a gallstone results in

chronic cholecystitis

Demarcates the posterolateral border of the pancreas head

common bile duct

A structure that contains both solid and cystic areas

complex

Plane that divides the body into anterior and posterior portions

coronal

Which ligament serves as a barrier between the subphrenic space and Morison's pouch?

coronary

The spleen removes irregular cells from the bloodstream and retains them through a process called:

culling

What do Klatskin tumors cause

dilation of the intrahepatic ducts

Away from the trunk of the body

distal

Another term for posterior

dorsal

The portion of the bowel that encompasses the head of the panc is the

duodenum

Skin discoloration caused by blood leakage into subcutaneous tissues

ecchymosis

Describes an organ or tissue that is capable of producing echoes by reflecting the acoustic beam

echogenic

Describes a structure that is less echogenic or has few internal echoes

echopenic

Secreting into blood and tissue

endocrine

Pneumobilia is most likely seen after what procedure?

endoscopic retrograde cholangiopancreatography (ERCP)

What is hydros of the gallbladder?

enlarged gallbladder

Redness of the skin due to inflammation

erythema

The process of making blood cells is termed

erythropoiesis

Secreting into a duct

exocrine

Renal cysts that project out away from the kidney are termed:

exophytic

A collection of abdominal fluid within the peritoneal cavity often associated with cancer is

exudate ascites

Fatty infiltration is often patchy or focal. When a region of the liver is less affected it is called

fat sparring

Classic clinical features of acute pancreatitis

fever, back pain, leukocytosis

Opening between the lesser and greater sacs

foramen of winslow

An aortic aneurysm described as "dilatation with a gradual transition between the normal and abnormal segment".

fusiform

The most common shape of an aneurysm is

fusiform

A nonmobile, nonshadowing foci is seen within the gallbladder lumen. This most likely represents a:

gallbladder polyp

Demarcates anterolateral border of pancreas head

gastroduodenal artery

The arterial blood supply to the head of the pancreas is via the

gastroduodenal artery

What is a major branch of the common hepatic artery?

gastroduodenal artery

Which part of the pancreas is located right lateral to superior mesenteric vein, anterior to the IVC, and inferior to the portal vein?

head

A patient who had blunt trauma to the abdomen earlier in the day presents with LUQ pain and a decrease in hematocrit. An echogenic mass is seen in the spleen. What is this consistent with?

hematoma

A tumor that consists of a focal collection of blood best describes the

hematoma

A patient is referred with RUQ tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color doppler reveals hypervascularity of the mass. What is the most likely scenario?

hepatic adenoma

What 3 structures make up the portal triad?

hepatic artery, portal vein, bile duct

Vessels that branch off of celiac axis

hepatic artery, splenic artery, left gastric artery

Hepatoma is also known as

hepatic cellular carcinoma

A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?

hepatocellular carcinoma

The basic functional unit of the liver

hepatocyte

Enlarged liver

hepatomegaly

Which potential space is commonly referred to as Morison's pouch?

hepatorenal space

An out pouching of peritoneum, muscle, and at times bowel is called

hernia

A solid mass that contains a variety of echogenicities could best be described by this term

heterogeneous

Describes tissues or organ structures that have several different echo characteristics

heterogeneous

In a patient with suspected lymphoma, the presence of Reed-Sternberg cells indicates:

hodgkin lymphoma

Describes structures of equal echo intensity

homogeneous

A complex cyst that results from the parasitic infestation of the spleen by a tapeworm is the:

hydatid cyst

What is associated with infestation by a parasite and is most prevalent in sheep and cattle-raising countries?

hydatid disease

Describes portions of the image that are brighter than surrounding tissues or brighter than normal

hyperechoic

Describes portions of an image that are not as bright as surrounding tissues or are less bright than normal

hypoechoic

You are scanning an obese patient to rule out fatty liver. How would you describe a common sonographic appearance of this condition?

increased echogenicity of the liver compared to the normal kidney

Where would a subhepatic abscess be located?

inferior to the liver and anterior to the right kidney

Away from the head

inferior, caudal

Which of the following is not a ventral hernia? Umbilical Inguinal Epigastric Hypogastric

inguinal

Which hormone released by the pancreas that encourages the body's use of glucagon?

insulin

Endocrine portion of the pancreas made up of alpha and beta cells produce insulin and glucagon

islets of langerhans

Refers to imaged echoes of equal intensity

isoechoic

What is a ureterovesical junction?

junction between the distal ureter and the base of the bladder

Away from the midline

lateral

Based on couinad segments of the liver, segment 4a and 4b is

left medial lobe

The vessel located anterior to the abdominal aorta and posterior to the SMA is the

left renal vein

What vessel travels posterior to the superior mesenteric artery and anterior to the abdominal aorta?

left renal vein

The space located behind the liver and stomach, and posterior to the pancreas is the

lesser sac

Elevated WBC count, usually due to infection

leukocytosis

The ligament that anchors the left kidney to the posterior abdominal wall is the

lienorenal

The ligament that anchors the left kidney to the posterior abdominal wall is the

lienorenal ligament

A remnant of the fetal umbilical vein

ligament of teres

Ligament that divides the liver into left lateral and left medial segments

ligament teres

Where can a patent umbilical vein be found?

ligament teres

This ligament separates the caudate lobe from the left lobe of the liver:

ligament vinosum

Fat digesting enzyme

lipase

Most common benign tumor of the abdominal wall

lipoma

Which of these organs is an intraperitoneal organ? Liver IVC Aorta Left Kidney

liver

If you are having trouble visualizing the posterior portion of the liver in a patient with fatty infiltration, what may help?

lowering the frequency

A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is

marfan syndrome

Toward the midline

medial

The anatomic quadrate lobe is what segmental division of the liver?

medial segment of the left lobe

Structure that anchors intestines to the posterior wall of the abdominal cavity and forms ligaments

mesentery

Plane that divides the body into EQUAL anterior and posterior portions

midcoronal

One of the structures that divides the liver into right and left lobes

middle hepatic vein

Which structures separate the left lobe of the liver from the right lobe?

middle hepatic vein, main lobar fissure

Vertical plane that divides the body into EQUAL right and left sections

midsaggital

Cysts that contain calcium carbonate crystals

milk of calcium cysts

Urine in the renal pyramids next passes into the

minor calices

Condition caused by ureteral obstruction in utero

multi cystic dysplastic kidney

An aneurysm associated with infection is termed

mycotic

The ___ of the gallbladder lies most posteriorly in the body.

neck

Occurs due to excessive calcium levels, deposits found in renal cortex and medulla

nephrocalcinosis

Functional unit of the kidney

nephron

Islet cell tumors of the pancreas are likely to be located:

never in the head frequently in the body or tail

Which of the following is not an intraperitoneal organ? Liver Pancreas Spleen Gallbladder

pancreas

What part of the pancreas is located anterior to the portal confluence?

pancreas neck

What results in a shortened main pancreatic duct that works to drain only the pancreatic head and not the entire pancreas?

pancreatic divisum

These potential spaces extend alongside the ascending and descending colon on both sides of the abdomen

paracolic gutters

Cyst that originates from the renal parenchyma and protrudes into the renal sinus

parapelvic cyst

True renal sinus cyst; found in the renal pelvis

peripelvic cyst

The kidneys are located in the ____ space.

perirenal

Rhythmic contractions of the GI tract that propels food through it

peristalsis

Fluid collection in the pleural cavity

pleural effusion

Air in the bile ducts

pneumobilia

What is calcification of the gallbladder wall called:

porcelain gallbladder

Fissure where the Portal Vein and Hepatic Artery enter the liver and Common Hepatic Duct exits.

porta hepatis

What is a reanalyzed paraumbilical vein typically the result of?

portal hypertension

What is the most common cause of splenomegaly?

portal hypertension

The majority of the blood supply to the liver is provided from the:

portal vein

The majority of the blood supply to the liver. is provided from the

portal vein

You are performing an ultrasound on a patient with transjugular intrahepatic portosystemic shunt (TIPS). What two vessels are connected with the TIPS stent?

portal vein and hepatic vein

Towards the back of the body

posterior

Which of the following is not a retroperitoneal compartment? perirenal space anterior pararenal space posterior pararenal space posterior parietal space

posterior parietal space

Patient lying flat on their abdomen

prone

The common hepatic artery divides into what 2 branches?

proper hepatic artery and gastroduodenal artery

Towards the trunk of the body

proximal

An abnormal cavity resembling a true cyst but not lined with epithelium

pseudocyst

The muscle that has a direct relationship with the upper poles of the kidneys

psoas

This muscle has a direct relationship with the upper poles of the kidneys

psoas

Which of the following muscles is not part of the anterolateral abdominal wall? Pyramidallis muscle Rectus abdominis Psoas muscle External oblique

psoas muscle

A patient presents with empyema of the gallbladder. What should the sonographer expect to find?

pus in the gallbladder

Which of the following muscles is not a paired muscle? External oblique Transverse abdominis Pyramidalis muscle Rectus abdominis

pyramidalis muscle

The type of tissue within the spleen that is responsible for its phagocytic function is the:

red pulp

List echogenicities from hypo echoic to hyperechoic: liver, spleen, renal cortex, renal sinus, pancreas

renal cortex, spleen, liver, pancreas, renal sinus

The ureteropelvic junction is located between

renal pelvis and the proximal portion of the ureter

Staghorn calculus refers to a large stone within

renal pelvis of the kidney

Based on couinad segments of the liver, segment 8 is

right anterosuperior segment

The IVC empties blood into the

right atrium

The right lobe of the liver is divided into anterior and posterior segments by the

right hepatic vein

The anatomic division divides the liver into four lobes:

right lobe, left lobe, caudate lobe, quadrate lobe

The right lobe of the liver is divided into anterior and posterior segments by the :

right portal vein

Based on couinad segments of the liver, segment 6 is

right posteroinferior segment

Which vessel courses posterior to the IVC?

right renal artery

The potential space that lies between the liver and the diaphragm is

right subphrenic space

Vertical plane that divides the body into right and left sections

saggital

A lack of echoes posterior to a highly attenuating structure such as a stone is referred to

shadowing

Artifact most commonly encountered posterior to a gallstone is

shadowing

While performing an abdominal ultrasound for RUQ pain, you notice a single, well-circumscribed anechoic lesion in the right lobe of the liver. The lesion exhibits posterior enhancement. The remainder of the examination is normal. What is the most likely diagnosis?

simple liver cyst

A patient in the late stages of sickle cell anemia will have a spleen that is:

small and echogenice

Which enzyme released by the pancreas that neutralizes stomach acid?

sodium bicarbonate

An area within the spleen that has become necrotic because of a lack of oxygen is referred to as a

splenic infarct

The main portal vein is created by the union of the

splenic vein and SMV

An abscess located inferior to the liver and anterior to the right kidney is a ___ (space) abscess.

subhepatic

Space located superior to the liver and inferior to the diaphragm

subphrenic space

The splenic artery marks what aspect of the pancreas?

superior aspect of the pancreatic body and tail

Which artery supplies the small intestines, right colon, and most of the transverse colon?

superior mesenteric

Toward the head

superior, cranial, cephalic

Patient lying flat on their back

supine

Current ultrasound contrast agents go to which located when injected?

the vascular system

How are current ultrasound agents expelled from the body?

through the respiratory system

Plane that divides the body into superior and inferior portions

transverse

T or F? The abdominal aorta normally tapers in diameter from its cranial to its caudal extent.

true

T or F? The lesser sac does not contain any organs.

true

In a dissecting aneurysm, the dissection is through which of the layers of the aorta.

tunica intima

The inner wall of layer of a vessel, closest to the passing blood, is the

tunica intima

Layers of vessels, inner to outer

tunica intima, tunica media, tunica adventitia

Identify the part of the pancreas that lies anterior to the IVC and posterior to the superior mesenteric vein?

uncinate process

Another term for anterior

ventral

Peritoneum that surrounds the abdominal organs is referred to as

visceral peritoneum

The type of tissue within the spleen that is responsible for its lymphatic function is the:

white pulp