Retroperitoneum Review

What does it mean if an organ is retroperitoneal?

Organs are retroperitoneal if they have peritoneum on their anterior side only. Structures that are not suspended by mesentery in the abdominal cavity and that lie between the parietal peritoneum and abdominal wall are classified as retroperitoneal.

The right suprarenal vein drains directly into the: a. IVC b. abdominal aorta c. celiac trunk d. left renal vein

a. IVC

Which hormones below play a part in the development of male characteristics? a. androgens b. cortisol c. aldosterone d. hematocrit

a. androgens

You are performing an ultrasound on a patient with acute pancreatitis to rule out the presence of a pseudocyst. Which retroperitoneal compartment is most frequently involved with a pseudocyst? a. anterior pararenal space b. perirenal space c. posterior pararenal space d. retrofascial space e. b and c

a. anterior pararenal space

You have been asked to perform an ultrasound on a patient to rule out a leaking abdominal aortic aneurysm. Which retroperitoneal compartments contains the aorta? a. anterior pararenal space b. perirenal space c. posterior pararenal space d. retrofascial space e. the aorta is not retroperitoneal in location

a. anterior pararenal space

All of the following are clinical findings of a pheochromocytoma except: a. bradycardia b. uncontrollable hypertension c. excessive sweating d. tremors

a. bradycardia

Which types of glands release their hormones directly into the bloodstream? a. endocrine glands b. exocrine glands

a. endocrine glands

Which of the following hormones are responsible for the flight or fight response? a. epinephrine and norepinephrine b. cortisol and androgens c. cortisol and aldosterone d. adrenocorticotrophic hormone and aldosterone

a. epinephrine and norepinephrine

When internal bleeding is suspected, what laboratory value is useful for a sonographer to evaluate? a. hematocrit b. blood urea nitrogen c. androgenic hormone d. alkaline phosphatase

a. hematocrit

Bilateral adrenal hyperplasia is associated with: a. hyperaldosteronism b. Addison disease c. Conn syndrome d. Bouveret syndrome e. Cushing disease

a. hyperaldosteronism

The most common sonographic appearance of a pheochromocytoma is a/an: a. hyperechoic mass b. hypoechoic mass c. anechoic mass d. complex mass

a. hyperechoic mass

The most common neoplasm to develop in the retroperitoneum is a: a. liposarcoma b. myxoma c. fibrosarcoma d. mesothelioma e. rhabdomyosarcoma

a. liposarcoma

You are performing an abdominal ultrasound on a patient with a palpable mass following kidney transplantation. Your imaging reveals an anechoic mass with multiple septations located lateral to the midline and 2 cm below the abdominal wall. Which of the following is most likely? a. lymphocele b. varices c. pancreatic pseudocyst d. hematoma e. exophytic renal cyst

a. lymphocele

You have been requested to perform an abdominal ultrasound on a patient with abnormal lipase levels. All other lab work is normal. Considering this history, what is the specific area of interest? a. pancreas b. liver c. adrenal d. kidney e. aorta

a. pancreas

Which of the following is considered a function of the adrenal glands? a. produce hormones b. release secretin hormones c. regulate serum electrolytes d. release glycogen as glucose e. maintain homeostasis of blood calcium concentrations

a. produce hormones

An adrenal cyst is considered a: a. rare finding b. bilateral condition c. functioning neoplasm d. life-threatening neoplasm e. proliferation of adrenal cells

a. rare finding

Abdominal sonography of a 42-year-old male reveals a solid mass located at the upper pole of the kidney. Which of the following would be most helpful in differentiation between an adrenal mass and a renal mass? a. scan the patient in both deep inspiration and expiration b. evaluate the mass with color Doppler c. have the patient drink 32 oz. of water and rescan d. give the patient a fatty meal and rescan in 20 minutes e. perform spectal Doppler resistive indices from vessels within the mass

a. scan the patient in both deep inspiration and expiration

Which of the following components is a major factor in determining blood volume? a. sodium b. vitamin K c. potassium d. calcium e. barium sulfate

a. sodium

Which of the following structures is not retroperitoneal in location? a. spleen b. kidney c. pancreas d. aorta e. psoas muscles

a. spleen

During a routine abdominal sonogram, you detect several small lymph nodes adjacent to the abdominal aorta. Your exam should include which of the following? a. spectral Doppler analysis of each lymph node b. diameter measurements of each lymph node c. graded compression of each lymph node d. evaluation of the pelvis e. examination with the patient in a prone position

b. diameter measurements of each lymph node

Which of the following hormones is secreted by the adrenal medulla? a. cortisol b. epinephrine c. estrogen d. aldosterone e. secretin

b. epinephrine

A localized collection of blood describes a: a. hemangioma b. hematoma c. hypertoma d. hydrocele

b. hematoma

The sonographic appearance of a liposarcoma is most likely described as: a. hypoechoic mass with thin wall margins b. hyperechoic mass with thick wall margins c. complex mass with irregular wall margins d. hypoechoic mass with irregular wall margins e. hyperechoic mass with thin wall margins

b. hyperechoic mass with thick wall margins

Which of the following adrenal neoplasms is most likely to infiltrate surrounding structures? a. teratoma b. liposarcoma c. myxoma d. mesothelioma e. leiomyosarcoma

b. liposarcoma

All of the following are benign adrenal masses except: a. adrenal adenoma b. neuroblastoma c. pheochromocytoma d. adrenal hematoma

b. neuroblastoma

The right suprarenal vein empties into which of the following vascular structures? a. splenic vein b. left renal vein c. IVC d. right gonadal vein e. superior mesenteric vein

c. IVC

Obesity is most likely a predisposing factor in developing which of the following adrenal neoplasms? a. cyst b. hemorrhage c. adenoma d. neuroblastoma e. pheochyromocytoma

c. adenoma

Which hormone listed below is responsible for regulating blood pressure by controlling the amounts of sodium and water in the body? a. epinephrine b. cortisol c. aldosterone d. adrenocorticotrophic hormone

c. aldosterone

Which of the following conditions is a predisposing factor for development of an adrenal adenoma? a. anorexia b. hypotension c. diabetes d. congestive heart failure e. polycythemia vera

c. diabetes

The adrenal glands are surrounded by a connective tissue capsule called: a. glisson capsule b. adrenocortical fascia c. gerota fascia d. glisson fascia

c. gerota fascia

Which of the following abnormalities is the most likely complication of retroperitoneal fibrosis? a. pancreatitis b. cholecystitis c. hydronephrosis d. portal hypertension e. abdominal aortic aneurysm

c. hydronephrosis

An enlarged lymph node demonstrating an oval shape and smooth wall margins is most consistent with an underlying: a. malignancy b. hemorrhage c. infection d. infarction e. obstruction

c. infection

You have been asked to identify the left adrenal gland. Which describes the correct anatomic relationship of this gland? a. superolateral to the left kidney b. anterior to the pancreatic tail c. lateral to the abdominal aorta and diaphragmatic crus d. inferior to the quadratus lumborum muscle e. inferior and lateral to the splenic hilum

c. lateral to the abdominal aorta and diaphragmatic crus

Which of the following malignant neoplasms contain cells of smooth muscle? a. fibrosarcoma b. liposarcoma c. leiomyosarcoma d. rhabdomyosarcoma e. mesothelioma

c. leiomyosarcoma

While performing an abdominal ultrasound, you detect multiple hypoechoic nodules surrounding the abdominal aorta and separating the mesenteric vessels. You are most likely imaging: a. pancreatic pseudocysts b. retroperitoneal fibrosis c. lymphadenopathy d. urinomas e. lymphoceles

c. lymphadenopathy

Which of the following is produced by the adrenal medulla? a. cortisol b. aldosterone c. norepinephrine d. androgens

c. norepinephrine

During sonographic evaluation of the periaortic area, you detect several hypoechoic structures each measuring slightly greater than 2.0 cm, adjacent to the celiac trunk and superior mesenteric artery. What is the most likely etiology of these structures? a. diaphragmatic crus b. retroperitoneal fibrosis c. para-aortic lymph nodes d. mesenteric aneurysms e. lymphoceles

c. para-aortic lymph nodes

A urinoma is most likely to develop in which of the following regions? a. lesser sac b. paracolic gutter c. perinephric space d. subhepatic space e. pouch of Douglas

c. perinephric space

Which of the following best describes the location of the right adrenal gland? a. posterior and lateral to the pancreas b. medial to the lower pole of the right kidney c. posterior and lateral to the IVC d. medial to the crus of the diaphragm

c. posterior and lateral to the IVC

Which of the following structures form the anterior border of the retroperitoneum? a. diaphragm b. pelvic rim c. posterior parietal peritoneum d. transversalis fascia e. posterior abdominal wall muscles

c. posterior parietal peritoneum

During ultrasound evaluation of the kidney, you detect a striated structure located posteromedial in relation to the kidney. What muscle are you imaging? a. quadratus lumborum b. rectus sheath c. psoas d. iliacus e. piriformis

c. psoas

The arterial blood supply to the adrenal glands is accomplished by the means of the: a. celiac trunk b. subphrenic arteries c. suprarenal arteries d. superior mesenteric arteries

c. suprarenal arteries

The adrenal glands are also known as the: a. cortisol glands b. adrenaline glands c. suprarenal glands d. retroperitoneal glands e. stress glands

c. suprarenal glands

The neuroblastoma typically presents before the age of: a. 1 year b. 2 years c. 4 years d. 5 years

d. 5 years

All of the following structures are located within the anterior pararenal space except: a. pancreas b. ascending colon c. superior mesenteric artery d. IVC e. descending colon

d. IVC

A patient has been referred for ultrasound evaluation with suspicion of retroperioneal fibrosis. What structure will you image to identify this abnormality? a. pancreas b. kidneys c. adrenal glands d. abdominal aorta e. psoas muscle

d. abdominal aorta

Hyperfunctioning adrenal adenomas are associated with all of the following except: a. cushing syndrome b. conn syndrome c. hypoechoic mass in the area of the adrenal gland d. acute drop in hematocrit

d. acute drop in hematocrit

Upon sonographic examination of the right upper quadrant in a 32-year-old female patient complaining of generalized abdominal pain, you visualize an anechoic mass with posterior enhancement superior and medial upper pole of the right kidney. This most likely represents a/an: a. adrenal metastatic lesion b. pheochromocytoma c. neuroblastoma d. adrenal cyst

d. adrenal cyst

the adrenal cortex produces all of the following except: a. cortisol b. androgens c. aldosterone d. adrenaline

d. adrenaline

A 45-year-old obese woman with thin arms and legs, hypertension, and severe fatigue presents to the ultrasound department for an abdominal sonogram. Bases on these clinical findings, you should evaluate the adrenal glands closely for signs of: a. primary adrenal carcinoma b. adrenal hemorrhage c. adrenal adenoma d. both a and c

d. both a and c

Which of the following hormones increases during times of excitement or stress? a. renin b. cortisol c. aldosterone d. epinephrine e. norephinephrine

d. epinephrine

Which of the following is considered a function of the lymph node? a. modify the body's response to inflammation b. aid in controlling the amount of water in the body c. maintain the water and sodium balance d. form antibodies to fight infection e. maintain normal blood circulation

d. form antibodies to fight infection

Which of the following hormones modifies the body's response to inflammation? a. androgens b. aldosterone c. norephinephrine d. glucocoticoids e. epinephrine

d. glucocoticoids

The most common sonographic appearance of a neuroblastoma is: a. hyperechoic mass b. heterogenous mass with calcifications c. anechoic mass d. hypoechoic mass

d. hypoechoic mass

Visceral lymph nodes are located: a. around the aorta b. in the perineum c. along the prevertebral vessels d. in the peritoneum e. near the adrenal glands

d. in the peritoneum

You have been requested to perform an abdominal ultrasound on a patient with abnormal BUN levels. All other lab work is normal. Considering this history, what is the study area of interest? a. pancreas b. liver c. adrenal d. kidney e. aorta

d. kidney

The left suprarenal vein drains directly into the: a. IVC b. abdominal aorta c. celiac trunk d. left renal vein

d. left renal vein

The inner portion of the adrenal gland is termed the: a. hilum b. cortex c. intima d. medulla e. sinus

d. medulla

The most common, extracranial, malignant mass in children is the: a. hepatoblastoma b. hypernephroma c. pheochromocytoma d. neuroblastoma

d. neuroblastoma

Young children has a predisposing factor for developing which of the following adrenal neoplasms? a. nephroblastoma b. pheochromocytoma c. wilms tumor d. neuroblastoma e. liposarcoma

d. neuroblastoma

The adrenal mass often associated with uncontrollable hypertension, tachycardia, and tremors is the: a. neuoblastoma b. adrenal hematoma c. oncocytoma d. pheochromocytoma

d. pheochromocytoma

You have been asked to identify the right adrenal gland. Which of the following correctly describes its location? a. medial to the IVC b. superolateral to the upper pole of the right kidney c. between the IVC and the abdominal aorta d. posterior to the IVC e. medial to the crus of the diaphragm

d. posterior to the IVC

The location of the left adrenal gland most accurately correlates to which of the following regions? a. lateral to the kidney b. medial to the aorta c. inferior to the kidney d. posterior to the splenic artery e. posterior to the IVC

d. posterior to the splenic artery

All of the following structures are located within the perirenal space except: a. kidneys b. aorta c. lymph nodes d. psoas muscles e. adrenal glands

d. psoas muscles

Indications for a sonogram of the adrenal glands include all of the following except: a. tachycardia b. severe anxiety c. hypertension d. renal insufficiency e. weight loss

d. renal insufficiency

Which retroperitoneal compartment contains the psoas and quadratus lumborum muscles? a. anterior pararenal space b. perirenal space c. posterior pararenal space d. retrofascial space e. none of the above

d. retrofascial space

A malignant neoplasm derived from striated muscle describes a: a. myxoma b. mesothelioma c. leiomyosarcoma d. rhabdomyosarcoma e. pheochromocytoma

d. rhabdomyosarcoma

Elevation in which of the following laboratory tests is a clinical finding in Addison disease? a. cortisol b. aldosterone c. serum sodium d. serum potassium e. adrenocorticotrophic hormone

d. serum potassium

The adrenal glands receive a portion of their blood supply from all of the following except the: a. suprarenal branches of inferior phrenic arteries b. suprarenal branches of the aorta c. suprarenal branches of the renal arteries d. suprarenal branches of the celiac trunk

d. suprarenal branches of the celiac trunk

The floating aorta sign is caused by lymphadenopathy in which of the following regions? a. lesser sac b. perinephric space c. anterior to the aorta d. surrounding the aorta e. posterior to the aorta

d. surrounding the aorta

All of the following are associated with Con syndrome except: a. adrenal adenoma b. hypertension c. excessive thirst d. thinning arms and legs

d. thinning arms and legs

Which of the following fluid collections is most likely to demonstrate a rapid increase in size following renal transplant surgery? a. seroma b. abscess c. hematoma d. urinoma e. lymphocele

d. urinoma

The outer portion of the adrenal gland comprises: a. 10% of the gland b. 25% of the gland c. 50% of the gland d. 75% of the gland e. 90% of the gland

e. 90% of the gland

Hemorrhage within the retroperitoneum may be caused by all the following conditions except: a. trauma b. neoplasm c. infarction d. ruptured aneurysm e. abscess formation

e. abscess formation

You are performing an abdominal ultrasound on a patient with a history of lung cancer. What retroperitoneal structure is a common site for metastasis from the lung? a. pancreas b. kidneys c. psoas muscles d. duodenum e. adrenal glands

e. adrenal glands

You are performing an abdominal ultrasound on a patient with a history of pheochromocytoma. Sonographic evaluation of what structure will be most beneficial in identification of this abnormality? a. pancreas b. kidneys c. psoas muscle d. abdominal aorta e. adrenal glands

e. adrenal glands

Which of the following hormones is produced by the pituitary gland? a. trypsin b. insulin c. epinephrine d. aldosterone e. adrenocorticotrophic hormone

e. adrenocorticotrophic hormone

You are performing an abdominal ultrasound and suspect a left adrenal mass. Which of the following may simulate an adrenal mass? a. thickened diaphragmatic crus b. accessory spleen c. gastric diverticulum d. retroperitoneal lymphadenopathy e. all of the above

e. all of the above

You are performing an abdominal ultrasound to search for lymphadenopathy. Where should you look? a. splenic hilum b. porta hepatis c. renal hilum d. para-aortic area e. all of the above

e. all of the above

Which retroperitoneal compartment contains no solid organs? a. anterior pararenal space b. perirenal space c. posterior pararenal space d. retrofascial space e. c and d

e. c and d

An abnormal growth of epithelial cells is demonstrated in which of the following neoplasms? a. myxoma b. teratoma c. lipoma d. leiomyosarcoma e. mesothelioma

e. mesothelioma

A rare vascular tumor of the adrenal gland defines a(n): a. adenoma b. teratoma c. neuroblastoma d. rhabdomyosarcoma e. pheochromocytoma

e. pheochromocytoma

Which of the following statements correctly describes the adrenal glands? a. the medulla comprises 25% of the gland b. the right suprarenal vein drains into the right renal vein c. gonadal hormones are secreted by the medulla d. norephinephrine is secreted by the cortex e. the suprarenal arteries arise from the aorta, renal, and inferior phrenic arteries

e. the suprarenal arteries arise from the aorta, renal, and inferior phrenic arteries

What are the retroperitoneal organs?

kidneys ascending colon descending colon duodenum pancreas

What are the intraperitoneal organs?

The intraperitoneal organs are the stomach, spleen, liver, bulb of the duodenum, jejunum, ileum, transverse colon, and sigmoid colon.

A condition caused by complete or partial failure of the adrenocortical function describes: a. conn syndrome b. addison disease c. budd-chiari syndrome d. cushing disease e. graves disease

b. addison disease

Which hormone, secreted by the anterior pituitary gland, controls the release of hormones by the adrenal glands? a. epinephrine b. cortisol c. aldosterone d. adrenocorticotrophic hormone

b. cortisol

A syndrome associated with hypertension, hypercalcemia, obesity, and an adrenal mass is: a. edwards syndrome b. cushing syndrome c. juliet syndrome d. hirshsprung syndrome

b. cushing syndrome

With active internal hemorrhage, the patient's hematocrit will: a. increase b. decrease c. become stable d. not change

b. decrease

What is the most useful criterion for assessment of nodal disease? a. since ultrasound cannot detect normal abdominal lymph nodes, whenever they are visualized, it means they are abnormal b. only lymph nodes measuring greater than 1.0 cm are considered to be abnormal c. whenever the hilum of the lymph node is echogenic, it is considered to be abnormal d. only abdominal lymph nodes which have an oval shape are considered to be abnormal e. only abdominal lymph nodes which show increased vascularity by color Doppler are considered to be abnormal

b. only lymph nodes measuring greater than 1.0 cm are considered to be abnormal

A patient has been referred for abdominal sonography with abdominal pain and increased serum amylase. You detect a fluid pocket in the left pararenal space. Given these ultrasound findings and patient history, what is the most likely etiology of this mass? a. exophytic renal cyst b. pancreatic pseudocyst c. retroperitoneal hemorrhage d. lymphocele e. urinoma

b. pancreatic pseudocyst

The kidneys lie in which retroperitoneal space? a. posterior pararenal space b. perirenal space c. retrofascial space d. anterior pararenal space e. the kidneys are not retroperitoneal in location

b. perirenal space

Benign adrenal pathology associated with hypertension, tachycardia, and palpitations is most consistent with which of the following pathologies? a. hyperplasia b. pheochromocytoma c. hemorrhage d. adenoma e. polycystic disease

b. pheochromocytoma

Cushing disease is most commonly caused by which of the following pathologies? a. adrenal hyperplasia b. pituitary mass c. adrenal mass d. polycystic ovarian disease e. adrenal insufficiency

b. pituitary mass

The anterior pararenal space is most accurately defined as the area between the: a. perirenal space and the posterior pararenal space b. posterior peritoneum and Gerota fascia c. anterior abdominal wall and psoas muscle d. posterior retroperitoneum and the perirenal space e. anterior peritoneum and Gerota fascia

b. posterior peritoneum and Gerota fascia

The location of the right adrenal gland most accurately correlates to which of the following regions? a. lateral to the right kidney b. posterior to the IVC c. medial to the diaphragmatic crura d. inferior to the right kidney e. medial to the IVC

b. posterior to the IVC

Which of the following describes the anatomic location of the right diaphragmatic crus? a. anterior to the IVC and superior to the right renal artery b. posterior to the IVC and right renal artery c. medial to the right kidney and posterior to the abdominal aorta d. anterior to the abdominal aorta and inferior to the pancreas e. lateral to the pancreatic head and anterior to the IVC

b. posterior to the IVC and right renal artery

You are performing an abdominal sonogram and detect a striated, hypoechoic structure immediately posterior to the right kidney. A similar structure is seen posterior to the left kidney. What are you imaging? a. psoas muscle b. quadratus lumborum muscles c. adrenal gland d. diaphragmatic crura e. Gerota's fascia

b. quadratus lumborum muscles

Symptoms associated with adrenocortical carcinoma include all of the following except: a. hypertension b. severe anxiety c. muscle weakness d. weight loss e. abdominal pain

b. severe anxiety

All of the following are true statements about the adrenal glands except: a. the adrenal glands are easily identified in the fetus b. the adrenal glands are exocrine glands c. the adrenal glands are composed of a medulla and cortex d. the adrenal glands may also be referred to as suprarenal glands

b. the adrenal glands are exocrine glands