ab boards 1

Normally there are _________ parathyroid glands in the adult neck. A. 4 B. 8 C. 6 D. 2

4

A top normal thyroid isthmus measurement would be: A. 4cm B. 4mm C. 6cm D. 6mm

6

Which portion of the bladder is in direct contact with the anterior vaginal wall/prostate? A. Fundus B. Base C. Dome D. Apex

B. base

Massive splenomegaly is defined as a spleen that exceeds ____________ in length. A. 23cm B. 15cm C. 18cm D. 13cm

C. 18cm

The pancreatic duct should normally be less than _______ in diameter in children and young adults. A. 0.5mm B. 1mm C. 2mm D. 4mm

C. 2mm

Pyloric stenosis is diagnosed when the muscle wall thickness exceeds: A. 2mm B. 6mm C. 4mm D. 8mm

C. 4mm

. Normal wall thickness of the bowel is: A. <5cm B. <3mm C. <5mm D. <3cm

C. <5mm

Which of the following can lead to a false positive diagnosis of stones in the biliary system? A. Rejection setting too high B. Improperly decreased TGC settings C. Decreased color Doppler gain D. Shadowing from surgical clip in porta hepatis

D. Shadowing from surgical clip in porta hepatis

B. Nephrocalcinosis

The attached image demonstrates which abnormality, commonly associated with medullary sponge kidneys? A. Nephrolithiasis B. Nephrocalcinosis C. Pyelonephritis D. Granuloma formation

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. prothrombin time B. alkaline phosphatase C. conjugated bilirubin D. unconjugated bilirubin

Which of the following correctly describes why the arcuate arteries are not easily or accurately evaluated by PW Doppler? A. because the blood flows parallel to the Doppler sound beam B. because the flow is very low resistance C. because the blood flows perpendicular to the Doppler sound beam D. The renal capsule attenuates the Doppler signal so only limited information is reflected to the probe.

because the blood flows perpendicular to the Doppler sound beam

All of the following are common symptoms of colitis, except: A. bloody diarrhea B. watery diarrhea C. hemoptysis D. low grade fever

hemoptysis Hemoptysis refers to coughing up bloody sputum from the lungs. Colitis is associated with a low grade fever, pain, cramping, and watery diarrhea. Bloody diarrhea and rectal bleeding occur with ulcerative colitis.

match the primary carcinoma with the most common sonographic appearance of liver mets: Cystic lesions mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

lung or colon

match the primary carcinoma with the most common sonographic appearance of liver mets: Bulls eye lesions choices:mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

lymphom, lung or breast primary

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

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.

match the primary carcinoma with the most common sonographic appearance of liver mets: Calcified Lesions choices:mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

mucinous adenocarcinoma

When resistance in the distal vascular bed decreases, what happens to the resistive index(RI)? A. decreases B. increases C. no change unless collateral vessels present D. no change

A. decreases

Analgesic abuse is the most common cause of what renal abnormality? A. papillary necrosis B. glomerulonephritis C. acute renal failure D. nephrocalcinosis

A. papillary necrosis

A 3cm hypoechoic mass is identified in the right testicle. The radiologist requests that you perform an abdominal US. What are you looking for? A. periaortic lymphadenopathy B. renal vein tumor invasion C. other manifestations of MENS syndrome D. associated Crohn's disease

A. periaortic lymphadenopathy The first location that a seminoma spreads to is the retroperitoneal lymph nodes. The right gonadal vein connects directly to the IVC so the renal vein would most likely be unaffected by tumor invasion.

Biliary atresia and congenital absence of the gall bladder are associated with which complex congenital defect? A. polysplenia B. annular pancreas C. asplenia D. pancreas divisum

A. polysplenia

Which of the following is true regarding the anatomic position of the right adrenal gland? A. posterior to the IVC B. lateral to the right lobe of liver C. lateral to the left diaphragm crura D. anterior to the aorta and SMA E. adjacent to the pancreas tail

A. posterior to the IVC

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

A. right atrium

Doppler evaluation of the parenchymal arteries is required in patients with: A. significant hydronephrosis B. acute pancreatitis C. angiomyolipoma D. splenic infarction

A. significant hydronephrosis

A hematoma of the rectus abdominis muscle that occurs below the arcuate line can extend into: A. space of Retzius B. Morrison's pouch C. the umbilicus D. pouch of Douglas

A. space of Retzius

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

A. subphrenic abscess

The hepatic veins divide the liver longitudinally into: A. superior right and left lobe segments B. posterior right and left lobe segments C. inferior right and left lobe segments D. anterior right and left lobe segments

A. superior right and left lobe segments

Increased androgen production can lead to hirsutism. This is commonly associated with all of the following, except: A. polycystic ovarian disease B. adrenal hyperplasia C. pheochromocytoma D. adrenal cortical cancer

C. pheochromocytoma

Which of the following is a contraindication to placement of a TIPS shunt? A. cirrhosis B. hepatocellular carcinoma C. portal thrombosis D. hepatic artery aneurysm

C. portal thrombosis

A patient presents for their annual screening ultrasound after a complete thyroidectomy with to papillary carcinoma. You identify a 1cm uniformly hypoechoic mass lateral to the trachea. The mass is painful with transducer pressure and pain radiates to the head and chest. These finding are most suggestive of: A. abnormal lymph node B. parathyroid adenoma C. post-traumatic neuroma D. parathyroid carcinoma

C. post-traumatic neuroma

The quadratus lumborum muscle is __________________ to the kidney. A. lateral B. medial C. posterior D. anterior

C. posterior

On a longitudinal scan, this vessel is seen in cross section, posterior to the IVC: A. Left renal vein B. Right renal vein C. Right renal artery D. Left renal artery

C. right renal artery

. _____________________ occurs posterior to highly attenuating structures. A. speckle B. enhancement C. shadowing D. refraction

C. shadowing

Gamna-Gandy bodies result in: A. aneurysm formation in the splenic artery B. hypothyroidism C. splenic calcifications D. aneurysm formation in the aorta

C. splenic calcifications

The length measurements of the adult kidneys should be within _______ of each other. A. 1cm B. 2cm C. 3cm D. 4cm

2cm

When performing a Doppler evaluation of the renal arteries the cursor angle should be set at ___________ degrees or less for the main renal arteries and ____________ degrees or less for the intraparenchymal arteries. A. 60, 20 B. 60, 45 C. 20, 0 D. 45, 60

A. 60, 20

Acute cholecystitis is associated with gallbladder wall thickening ______________. Cholangitis is associated with ductal wall thickening ___________. A. >3mm, >2mm B. >2mm, >3mm C. >3mm, >5mm D. >6mm, >3mm

A. >3mm, >2mm

Which of the following correctly describes peritoneal dialysis? A. A cleansing fluid flows is injected through an intraperitoneal catheter B. Requires regular visits to a dialysis center for the treatment C. Blood is removed from the body, cleaned and returned D. Requires the creation of an arteriovenous fistula

A. A cleansing fluid flows is injected through an intraperitoneal catheter

While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings? A. A dilated coronary vein is present which is a common complication of cirrhosis. B. A dilated umbilical vein is present which is a common complication of cirrhosis. C. A dilated SMV is present with flow reversal which is a common complication of cirrhosis. D. The ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis.

A. A dilated coronary vein is present which is a common complication of cirrhosis.

Which of the following is true regarding a liver hemangioma? A. A hemangioma is composed of an abnormal concentration of vascular tissues within the liver. B. Most hemangiomas demonstrate some level of posterior shadowing. C. Fluid and debris levels are commonly present in a hemangioma. D. Color Doppler is a valuable tool in evaluating this highly vascular mass.

A. A hemangioma is composed of an abnormal concentration of vascular tissues within the liver.

All of the following correctly describe transitional cell carcinoma, except? A. Most commonly presents as diffuse bladder wall thickening with multiple masses within the wall B. Most common bladder mass C. Can cause unilateral or bilateral hydronephrosis D. Painless hematuria is the most common symptom

A. Most commonly presents as diffuse bladder wall thickening with multiple masses within the wall

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

A. Phrygian cap

Which of the following describes the best technique to differentiate a polyp in the gallbladder wall from a stone within the lumen? A. Roll the patient into the left lateral decubitus position. B. Apply color Doppler. C. Have the patient drink water and rescan the GB. D. Ask the patient to perform the Valsalva maneuver.

A. Roll the patient into the left lateral decubitus position.

Which of the following describes the proper technique for visualization of the bicep tendon? A. Scanning with the US beam as perpendicular to the tendon as possible to improve visualization. B. Longitudinal probe position on the posterior upper arm, just proximal to the elbow joint C. Oblique probe position with the notch turned 60 degrees medially; placed on the anterior upper arm, just proximal to the elbow joint D. Oblique probe position with the notch turned 30 degrees medially; placed on the posterior upper arm, just proximal to the elbow joint

A. Scanning with the US beam as perpendicular to the tendon as possible to improve visualization.

Increased renal fat in the renal sinus with a thinned cortex indicates: A. Sinus lipomatosis B. Acute tubular necrosis C. Angiomyolipomatosis D. Chronic renal failure

A. Sinus lipomatosis

Primary sclerosing cholangitis is usually seen in patients with: A. ulcerative colitis B. biliary ascariasis C. pancreatic head mass D. HIV infection

A. ulcerative colitis

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

A. Thyroid parafollicular

decreased albumin/globulin ratio usually indicates: A. cirrhosis B. impacted stone at the gall bladder neck C. pancreatitis D. partial obstruction of the ampulla of Vater

A.Cirrhosis Due to decreased liver function with cirrhosis, the albumin/globulin ratio decreases. Also associated with ascites formation and other fluid collections A low ratio can also be related to kidney disease and autoimmune disease.

Which of the following is the most likely cause for renal vein thrombosis? A. Dehydration B. Ascending urinary tract infection C. Decreased serum BUN and creatinine D. Pulmonary embolism

A.Dehyradtion

A patient presents with a history of Addison disease. Which of the following hormone levels will be increased? A. Cortisol B. Aldosterone C. Adrenocorticotropic Hormone D. Epinephrine

Adrenocorticotropic Hormone

A. hematuria

All of the following are signs and symptoms related to the abnormality seen on the images, except? A. hematuria B. leukocytosis C. rebound tenderness in RLQ D. nausea and vomiting

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

B. 1.0

How much of the body's total blood volume can be stored in the spleen? A. 1/3 B. 1/6 C. 1/4 D. 1/2

B. 1/6

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

B. 100 mg/100ml

A 28yr old presents for a testicular sonogram due to a palpable lump. The lab work in the chart indicates high levels of alpha fetoprotein and b-hCG. A mostly solid intratesticular mass is identified in the right testicle that disrupts the smooth contour of the teste. There is a small cystic area centrally. Which of the following most likely describes the findings? A. Yolk Sac Tumor B. Embryonal Cell Carcinoma C. Lymphoma D. Seminoma

B. Embryonal Cell Carcinoma

The best way to differentiate hepatic jaundice from obstructive jaundice is: A. Measure levels of total bilirubin in the blood B. Evaluate the diameter of the biliary duct C. Evaluate the liver for tumor formation D. Measure levels of alpha-fetoprotein

B. Evaluate the diameter of the biliary duct

Which of the following statements is true regarding focal nodular hyperplasia? A. FNH causes an increase in liver function tests. B. FNH usually presents as a solitary mass within the liver parenchyma. C. The use of oral contraceptives has been linked to focal nodular hyperplasia of the liver. D. FNH can be differentiated from a liver adenoma due to the posterior shadowing seen with the adenoma.

B. FNH usually presents as a solitary mass within the liver parenchyma.

The first branch of the common hepatic artery is the: A. Pancreatic artery B. Gastroduodenal artery C. Duodenal artery D. Cystic artery

B. Gastroduodenal artery

Which of the following ultrasound exams requires the patient to be NPO, even if they are ordered STAT? A. RUQ ultrasound for possible hepatoma B. RUQ ultrasound for possible cholecystitis C. Abdominal ultrasound for possible rectus sheath hematoma D. Abdominal ultrasound for possible Crohn's disease

B. RUQ ultrasound for possible cholecystitis

Which of the following vessels can be identified as a circular structure immediately posterior to the body of the pancreas? A. IVC B. superior mesenteric artery C. celiac axis D. splenic vein

B. SMA

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. splenic artery, common hepatic artery B. SMA, left gastric artery C. left renal artery, right renal artery D. celiac axis, coronary artery

B. SMA, left gastric artery

You are attempting to scan the spleen with the patient in the right lateral decubitus position and using a coronal view. The spleen is obscured by the left lung. What can you do to obtain a better view of the spleen? A. Scan the patient at full inspiration B. Scan the patient at full expiration C. Turn the patient to the left lateral decubitus position D. Have the patient drink water and repeat the image from the same patient and probe position

B. Scan the patient at full expiration

Which scrotal artery supplies the epididymis? A. cremasteric B. deferential C. capsular D. centripetal

B. deferential

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

B. splenic atrophy

Which of the following vessels can be used to help locate the left adrenal gland? A. distal SMA B. splenic vein C. celiac axis D. right renal vein

B. splenic vein

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

B. superior mesenteric artery

If you are trying to evaluate the cystic duct for a possible obstruction, where will you look? A. inferior to the neck of the gallbladder B. superior to the neck of the gall bladder C. At the junction of the right and left hepatic ducts, just inside the liver D. anterior to the main portal vein, adjacent to the CBD

B. superior to the neck of the gall bladder

Leydig cell tumors of the testicle will demonstrate high serum levels of ________________ which can lead to _____________. A. hematocrit, thrombus formation B. testosterone, precocious puberty C. AFP, cancer D. bhCG, cancer

B. testosterone, precocious puberty

A patient presents with an order for an abdomen ultrasound to rule out UPJ obstruction of the left kidney. What are the expected findings if the exam is positive? A. The left renal calyces, renal pelvis and ureter will be dilated when the bladder is distended. B. The left renal calyces, renal pelvis and ureter will be dilated with or without the bladder distended. C. A normal ureter will be identified but the left renal calyces and renal pelvis will be chronically dilated, with or without the bladder distended. D. The renal calyces and renal pelvis will be normal but the ureter will be dilated anytime the bladder is distended.

C. A normal ureter will be identified but the left renal calyces and renal pelvis will be chronically dilated, with or without the bladder distended. The UPJ obstruction is a narrowing or obstruction of the junction of the renal pelvis and ureter. The calyces and pelvis will be chronically dilated due to the constant obstruction of urine excretion into the ureter. The bladder distension will not affect the presentation of this abnormality.

Which of the following statements is true regarding retroperitoneal lymph nodes? A. Both normal and abnormal lymph nodes exhibit mild posterior shadowing. B. Normal lymph nodes exhibit posterior enhancement. C. Abnormal lymph nodes exhibit posterior enhancement. D. A lymph node is considered abnormally enlarged once it reaches a maximum dimension of 3cm.

C. Abnormal lymph nodes exhibit posterior enhancement.

Hyperpigmentation of the skin that results in brownish discoloration is a clinical sign of: A. Conn disease B. Cushing syndrome C. Addison disease D. Adrenal hemorrhage

C. Addison disease Hyperpigmentation of the skin is a sign of Addison disease. Purple stretch marks (striae) on the lower and lateral abdomen are a signs of Cushing syndrome.

Which of the following is not a responsibility of a Sonographer who is assisting with a liver biopsy? A. Discuss breathing instructions for during the procedure with the patient B. Recommend a possible point of insertion and path for the biopsy needle C. Have patient sign informed consent form prior to the arrival of the radiologist D. Open the sterile tray and biopsy device

C. Have patient sign informed consent form prior to the arrival of the radiologist

A patient presents for a liver ultrasound. A 5cm mass is identified at the porta hepatis of the liver. How will this affect the IVC position in the abdomen? A. IVC will be displaced anteriorly B. IVC will be displaced inferiorly C. IVC will be displaced posteriorly D. A 6cm mass is not large enough to displace the IVC in most patients

C. IVC will be displaced posteriorly

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. Decrease the color threshold B. Switch from a 4MHz curved array to a 4MHz linear array C. Increase the color threshold D. Increase color sample size

C. Increase the color threshold

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

C. Insulin

A 28yr old male presents for an abdominal ultrasound exam. The chart states he has elevated urine copper levels and Kayser-Fleischer rings noted on physical exam. What organ should be closely evaluated for findings related to the indications given? A. kidneys B. bladder C. liver D. gallbladder

C. Liver

All of the following are signs of pyloric stenosis, except: A. olive B. doughnut C. Mcburney D. cervix

C. Mcburney

The renal pyramids are found in the: A. Sinus B. Calyces C. Medulla D. Cortex

C. Medulla

Which of the following is a stress maneuver performed when evaluating infant hips? A. Baker maneuver B. Graf maneuver C. Ortolani maneuver D. Allis maneuver

C. Ortolani maneuver

The renal collecting system is dilated and contains mildly echogenic material with dirty shadowing posteriorly. This most likely represents: A. Hydronephrosis B. Pyonephrosis C. Pyelonephritis D. Staghorn calculus

C. Pyonephrosis

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

C. Sclerosing cholangitis

Which of the following correctly describes how to differentiate a large gallstone (>3cm) from a porcelain gallbladder? A. A large gallstone and porcelain gallbladder are not easily differentiated sonographically B. The gallstone can be located in any part of the gallbladder while porcelain calcification only affects the gallbladder fundus. C. The posterior wall of the gallbladder can be evaluated in patients with porcelain gallbladder but not in patients with a large stone. D. A gallstone will demonstrate significant posterior shadowing but there is no shadowing associated with the wall calcification seen with a porcelain gallbladder

C. The posterior wall of the gallbladder can be evaluated in patients with porcelain gallbladder but not in patients with a large stone.

A patient presents with a recent diagnosis of lymphoma. Which of the following statements regarding the sonographic appearance of splenic lymphoma is false? A. Multiple solid tumors are present causing marked increase in size. B. The splenic hilum should be evaluated for lymphadenopathy. C. The spleen is mildly enlarged due to fluid accumulation. D. The porta hepatis and para-aortic areas should be evaluated for lymphadenopathy

C. The spleen is mildly enlarged due to fluid accumulation.

What liver mass is associated with glycogen storage disease? A. hepatoma B. hamartoma C. adenoma D. lipoma

C. adenoma

A patient presents for a thyroid biopsy with a script that states "US guided biopsy, cold nodule". The patient does not have the report with them but they do have a copy of the nuclear medicine (NM) exam. What are you looking for on the NM exam to locate the nodule to be biopsied? A. darker areas of increased accumulation of the radioactive isotope B. green areas with absence of accumulation of the radioactive isotope C. white/light areas with absence of accumulation of the radioactive isotope D. bright red areas of increased accumulation of the radioactive isotope

C. white/light areas with absence of accumulation of the radioactive isotope

The superior mesenteric artery originates from the aorta approximately __________ below the celiac axis and posterior to the ___________________. A. 2-3cm, body of the pancreas B. 1-2cm, stomach and duodenum C. 2-3cm, stomach and duodenum D. 1-2cm, body of the pancreas

D. 1-2cm, body of the pancreas

A patient presents for a renal ultrasound due to a recent diagnosis of staphylococcus aureus infection, right flank pain and microscopic hematuria. The chart states the referring physician suspects a renal carbuncle has formed. How will this abnormality be identified Sonographically? A. A single large calculus obstructing the renal pelvis with severe hydronephrosis B. 1.5cm complex mass located within the renal pelvis that is causing renal vein thrombosis C. A hyperechoic mass of fibrous tissue replaces the tissues of the renal sinus causing significant outflow obstruction D. 1.5cm complex mass with gassy shadowing located within the renal parenchyma

D. 1.5cm complex mass with gassy shadowing located within the renal parenchyma

Which of the following correctly describes hemodialysis? A. Contraindications include abdominal wall scarring, hernia, inflammatory bowel disease or diverticulitis B. Can be performed by the patient at home C. A cleansing fluid flows is injected through an intraperitoneal catheter D. An arteriovenous fistula is created by connecting an artery and a vein, usually in the arm

D. An arteriovenous fistula is created by connecting an artery and a vein, usually in the arm

___________________ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood. A. Kaposi's sarcoma B. Budd Chiari syndrome C. Acute hepatitis D. Anemia

D. Anemia

The splenic vein is located: A. Posterior to the superior mesenteric artery B. Anterior to superior mesenteric artery C. Posterior to the portal vein D. Anterior to the pancreas

D. Anterior to the SMA

The _________________ arteries are the vessels that course parallel to the renal capsule within the parenchyma. A. Segmental B. Interlobular C. Lobular D. Arcuate

D. Arcuate

Which of the following is a stress maneuver performed when evaluating infant hips? A. Graf maneuver B. Baker maneuver C. Allis maneuver D. Barlow maneuver

D. Barlow maneuver

The renal cortex contains which of the following: A. Calyces B. Pyramids C. Loops of Henle D. Bowman's capsule

D. Bowman's capsule The pyramids and loops of Henle are located in the medulla portion of the parenchyma of the kidney. The calyces are a part of the collecting system in the renal sinus. Bowman's capsules are located in the cortex portion of the parenchyma and are responsible for blood filtration.

A vascular condition of the liver frequently seen in women who take oral contraceptives is: A. Hereditary telangiectasia B. Liver adenoma C. Portal aneurysm D. Budd Chiari Syndrome

D. Budd Chiari Syndrome

Diffuse or focal GB wall thickening may be seen with all of the following, except: A. Carcinoma of the GB B. Adenomyomatosis C. Acute Cholecystitis D. Courvoisier GB

D. Courvoisier GB

Which of the following is least likely to be associated with splenomegaly in and adult male? A. Circulation problems B. Infections C. Neoplasms D. Heterozygous sickle cell anemia

D. Heterozygous sickle cell anemia

Which of the following best describes the ultrasound appearance of nephrocalcinosis? A. Multiple linear calcifications within the renal parenchyma B. Three or more renal calculi identified in each pole of the kidney C. A large calculus within the renal pelvis causing hydronephrosis D. Hyperechoic renal pyramids that may shadow

D. Hyperechoic renal pyramids that may shadow

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

D. Increase frame rate

Patients diagnosed with a multinodular goiter will also have: A. Increased T3 and T4, Normal TSH B. Increased TSH, Normal T3 and T4 C. Decreased T3 and T4, Normal TSH D. Increased TSH, Decreased T3 and T4

D. Increased TSH, Decreased T3 and T4

Which of the following statements regarding the dome of the liver is false? A. Deep inspiration is required to evaluate this portion of the liver. B. The dome of the liver is in contact with the diaphragm. C. The hepatic veins increase in size as they near the dome of the liver. D. Intercostal scanning is the preferred scanning approach to evaluate the dome of the liver.

D. Intercostal scanning is the preferred scanning approach to evaluate the dome of the liver.

The _________________ arteries are the vessels that course perpendicular to the renal capsule within the outer renal parenchyma. A. Arcuate B. Segmental C. Interlobar D. Interlobular

D. Interlobular

Which of the following produces insulin? A. Pituitary gland B. Kupffer cells in the liver C. Acini glands of the pancreas D. Islets of Langerhans

D. Islets of Langerhans

On a renal sonogram, thin walled structures are identified covering ureterovesicular junctions inside the bladder. These structures most likely represent: A. Bladder Polyps B. Urethroceles C. Posterior urethral valves D. Ureteroceles

D. Ureteroceles

Acalculus cholecystitis is least likely to be seen in a patient with: A. AIDS B. sepsis C. a history of recent abdominal surgery D. a history of a prolonged low fat diet

D. a history of a prolonged low fat diet

A splenic ________________ is a cartilaginous tumor. A. hamartoma B. osteoma C. fibroma D. chondroma

D. chondroma

The cystic artery originates at the _____________________ and the cystic vein empties into the __________________________. A. common hepatic artery, main portal vein B. right hepatic artery, right hepatic vein C. left hepatic artery, left portal vein D. right hepatic artery, right portal vein

D. right hepatic artery, right portal vein

A pyogenic abscess in the liver has been associated with all of the following, except: A. osteomyelitis B. diverticulitis C. cholangitis D. sickle cell anemia

D. sickle cell anemia

A patient with a recent diagnosis of pancreatitis presents for an abdominal ultrasound. Which of the following would be an associated finding with this diagnosis? A. Formation of a pseudocyst B. Splenic artery pseudoaneurysm C. Abscess adjacent to the splenic hilum D. A and C E. All of the above

E. All of the above

Which of the following will lead to an increase in the direct bilirubin levels in the blood? A. CBD obstruction B. hepatitis C. mass in the duodenum D. A and C E. All of the above

E. All of the above

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

E. Alpha fetoprotein

All of the following will demonstrate normal values on liver function tests, except: A. Focal nodular hyperplasia B. Glycogen storage disease C. Polycystic disease of the liver D. Adenoma E. Fungal abscess

E. Fungal abscess

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

E. Leukocytes

All of the following lab values will increase with mucinous cystadenocarcinoma of the pancreas, except: A. amylase B. bilirubin C. alkaline phosphatase D. carcinoembryonic antigen E. alpha fetoprotein

E. alpha fetoprotein

match the primary carcinoma with the most common sonographic appearance of liver mets: Hyperechoic lesions choices:mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

GI tract

D. evaluate the organs for carcinoma

This image is the first sagittal image of an abdominal US exam you are performing. What should you be sure to do during the rest of the exam for this patient? A. evaluate the abdomen for fluid collections and/or active bleeding B. evaluate the aorta for thrombus accumulation and source of embolus C. evaluate the organs for parasitic infection D. evaluate the organs for carcinoma

Which of the following best describes the probe position used to evaluate the long axis of the pancreas? A. Transverse oblique probe position at the midline with notch side of the probe rotated slightly superior to the side of the probe without the notch. B. Sagittal probe position just to the left of midline with notch rotated slightly to the left side of the patient. C. Transverse oblique probe position at the midline with notch side of the probe rotated slightly inferior to the side of the probe without the notch. D. Sagittal probe position just to the left of midline with notch rotated slightly to the right side of the patient.

Transverse oblique probe position at the midline with notch side of the probe rotated slightly inferior to the side of the probe without the notch.

Which of the following is incorrect regarding the evaluation of a patient with a suspected abdominal aortic aneurysm? A. Right lateral oblique position can be especially helpful for evaluating the distal aorta bifurcation into the common iliac arteries B. Identifying the aortic bifurcation guarantees a complete evaluation of the infrarenal segment C. Transverse views are preferred for the most accurate diameter measurement D. Identifying the celiac axis guarantees a complete evaluation of the proximal segment

Transverse views are preferred for the most accurate diameter measurement

B. increased serum creatinine

Which of the following would be associated with the findings on the image? A. decreased serum creatinine B. increased serum creatinine C. increased serum alkaline phosphatase D. increased serum alpha fetoprotein

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 perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall D. With the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the posterior wall

With the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall

B. Pyonephrosis

A patient presents with a history of a chronic UTI for over three weeks with little resolve from antibiotic treatment. He also suffers from visible hematuria and a low grade fever. The most likely diagnosis made from the images displayed would be: A. Pyelonephritis B. Pyonephrosis C. Hydronephrosis - Mild to Moderate D. Hydronephrosis - Moderate to Severe

extrahepatic ductal obstruction

A patient presents with increased bilirubin, normal blood cell counts and recent onset of jaundice. What is identified on the images from their US exam? A. portal thrombosis with dilated portal branches in the liver B. extrahepatic ductal obstruction C. adenocarcinoma of the gallbladder D. cholangitis

An average sized patient presents with a fever, acute RLQ pain and vomiting. The ER physician wants to rule out appendicitis in this patient. Which transducer would best be suited for the exam? A. 5MHz linear B. 3MHz curvilinear C. 12MHz linear D. 5MHz curvilinear

A. 5MHz linear

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

A. ARPKD

A patient presents with a history of Conn syndrome. Which of the following hormone levels will be increased? A. Aldosterone B. Adrenocorticotropic Hormone C. Cortisol D. Epinephrine

A. Aldosterone Cortisol and ACTH levels are increased with Cushing disease. Cortisol decreases with Addison disease. Aldosterone increases with Conn syndrome.

An abdominal US is ordered for a patient with bilateral pedal edema. The abdomen demonstrates mild ascites but otherwise normal organs. The IVC appears prominent with a constant diameter of 2.8cm. A continuous venous waveform is demonstrated on Doppler evaluation. Which of the following is the most likely cause for the US exam findings? A. congestive heart failure B. portal HTN C. malignant HTN D. all of the above

A. CHF

The common bile duct is formed by: A. Common hepatic duct + the cystic duct B. Cystic duct + the duct of Wirsung C. Right and left hepatic ducts + the cystic duct D. Varies per patient

A. Common hepatic duct + the cystic duct

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

A. Deep mucosa, muscularis propia

A 10 yr old presents for an abdominal ultrasound with a palpable RUQ mass. He has no history of liver disease and alpha-fetoprotein levels are normal. You identify a 9cm mass in the right lobe that demonstrates punctate calcifications and a central scar. These findings are most suggestive of? A. Fibrolamellar Carcinoma B. Hepatoma C. Hepatoblastoma D. Metastasis

A. Fibrolamellar Carcinoma

A patient presents for an abdominal ultrasound due to elevated Lactic Dehydrogenase and a low grade fever. Which of the following is the most likely finding on the exam? A. Hepatitis B. Steatosis C. Wilson's disease D. Choledocholithiasis

A. Hepatitis

Which of the following describes the table placement for performing an ultrasound exam? A. Table height should allow the Sonographer's arm to be slightly abducted with the wrist fully extended. B. The table should be placed in the trendelenburg position to assist in moving blood flow into the cerebral vessels. C. The table should be placed in the reverse trendelenburg position to assist in moving blood flow into the cerebral vessels. D. Table height should allow the Sonographer's arm to be slightly adducted with the wrist fully flexed toward the side being examined.

A. Table height should allow the Sonographer's arm to be slightly abducted with the wrist fully extended.

All of the following are sonographic signs of a normal bowel segment, except? A. Three distinct wall layers are noted in the transverse plane B. Compressibility noted with mild probe pressure C. Color Doppler demonstrated with peristalsis D. Bull's eye appearance identified in a cross sectional view

A. Three distinct wall layers are noted in the transverse plane

A patient presents with an acute onset of left scrotal pain this morning. The US exam demonstrates small hydrocele and an enlarged body and tail of the epididymis. There is very minimal flow demonstrated in the body and tail but the head appears normal. What most likely describes the findings? A. Torsion of the epididymal body B. Sperm granuloma C. Focal epididymitis of the head D. Focal epididymitis of the body and tail

A. Torsion of the epididymal body

All of the following correctly describe biliary hamartomas, except: A. Usually demonstrates a single hyperechoic mass >3cm B. Focal developmental lesions of the liver C. Associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma D. AKA von Meyenburg Complexes

A. Usually demonstrates a single hyperechoic mass >3cm

Increased serum levels of ____________________ will reduce urine output and increase blood volume in the body. A. aldosterone B. bilirubin C. alkaline phosphatase D. thyroxine

A. aldosterone

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

A. amebic, fungal

Jaundice is related to ___________________ in the amount of conjugated bilirubin found during urinalysis. A. an increase B. a decrease C. no change

A. an increase Conjugated bilirubin is normally excreted in the urine and levels can be used to assess levels of bilirubin in the body. Jaundice is related to an increase in serum bilirubin, therefore more bilirubin will be excreted in the urine.

The kidneys release renin to stimulate the release of: A. angiotensin to counteract low blood pressure B. anti-diuretic hormone to counteract high blood pressure C. anti-diuretic hormone to counteract low blood pressure D. angiotensin to counteract high blood pressure

A. angiotensin to counteract low blood pressure

All of the following would be symptoms of Cushing syndrome, except: A. anorexia B. hypertension C. amenorrhea D. hyperglycemia

A. anorexia

The fibromuscular stroma of the prostate is called the ____________ zone. A. anterior B. transitional C. peripheral D. central

A. anterior

The pancreas is found in what retroperitoneal space? A. anterior pararenal B. perirenal C. retrofascial D. left subhepatic E. posterior pararenal

A. anterior pararenal

A pseudocyst most commonly forms in which retroperitoneal space? A. anterior pararenal space B. omental bursa C. perinephric space D. posterior pararenal space

A. anterior pararenal space

You are performing a parathyroid ultrasound and cannot locate a known adenoma. Which of the following would be most helpful in locating the mass? A. ask the patient to swallow B. use IV contrast to locate the blood supply of the mass C. give the patient oral contrast to outline the trachea D. more than one of the above

A. ask the patient to swallow

All of the following are expected findings in a patient that had a vasectomy 4 years ago, except: A. atrophied epididymis B. dilated vas deferens C. tubular ectasia of the epididymis D. spermatoceles

A. atrophied epididymis Postvasectomy changes seen on ultrasound include epididymal enlargement, tubular ectasia of the epididymis, dilated vas deferens, spermatoceles and cysts.

Which of the following lists the most common ultrasound findings with acute glomerulonephritis? A. bilateral renal enlargement with increased cortical echogenicity B. unilateral renal enlargement with decreased cortical echogenicity C. small, smooth echogenic kidneys D. bilateral microcyst formation that causes increased cortical echogenicity

A. bilateral renal enlargement with increased cortical echogenicity

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

A. 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

Which of the following is a potential collateral pathway formed in patients with cirrhosis? A. blood moves from the superior rectal vein to middle rectal vein B. blood moves from the gastric vein to the splenic vein C. blood moves from the splenic vein to the coronary vein D. blood moves from the emmissary veins to the umbilical vein

A. blood moves from the superior rectal vein to middle rectal vein

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

A. body and fundus

When a pancreas transplant has enteric drainage: A. bowel should be evaluated for obstruction B. the urinary bladder should be evaluated for abnormalities C. the allograft will be located in the chest D. it is common for the stomach to be dilated with pancreatic juices

A. bowel should be evaluated for obstruction

The liver is divided in the transverse plane by the : A. branching of the portal veins B. branching of the hepatic veins C. course of the fissures through the tissue D. course of the biliary vessels through the tissue

A. branching of the portal veins

The term "splanchnic arteries" describes which of the following vessels? A. celiac, SMA and IMA B. hepatic, renal, splenic and celiac arteries C. renal, suprarenal, splenic and gastric arteries D. All arterial branches of the abdominal aorta from the diaphragm to the umbilicus

A. celiac, SMA and IMA

A patient presents with a history of high fever, HTN, nausea and vomiting. Lab results indicate the presence of white blood cells, pus and bacteria in the urine. A small, shrunken, misshapen left kidney and a normal right kidney are documented on the ultrasound exam. What are these findings most suggestive of? A. chronic pyelonephritis B. acute glomerulonephritis C. acute renal failure D. emphysematous pyelonephritis

A. chronic pyelonephritis

Which of the following is a common cause of transudate pleural effusion? A. congestive heart failure B. tuberculosis C. malignancy D. pneumonia

A. congestive heart failure

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

A. current Warfarin use

A patient presents with a history of AIDS and recent pneumocystis carinii infection. What changes to the liver do you expect to see on the ultrasound exam? A. diffuse echogenic foci throughout the liver tissue B. gas-producing abscess near the porta hepatis C. diffuse increase in liver tissue echogenicity with ascites D. formation of multiple abscesses within the liver tissue

A. diffuse echogenic foci throughout the liver tissue

The most common location for a urinary obstruction caused by a renal calculus is in the ___________________. A. distal ureter B. proximal ureter C. distal urethra D. trigone of the bladder

A. distal ureter

Which of the following is a common cause of a splenic abscess? A. endocarditis B. cholecystitis C. portal HTN D. Gaucher disease

A. endocarditis

Which of the following is most likely to be confused with a breast carcinoma? A. fat necrosis after breast surgery B. sebaceous cyst C. single 5 cm fibroadenoma in the breast D. multiple fibroadenomas in both breast

A. fat necrosis after breast surgery

A patient presents with right groin pain. You identify a hernia sac medial to the common femoral vein. What type of hernia is present? A. femoral B. spigelian C. direct inguinal D. umbilical

A. femoral

How can you differentiate a ganglion cyst from a giant cell tumor of the hand? A. ganglion cyst will demonstrate posterior enhancement, giant cell tumor will not demonstrate enhancement B. giant cell tumors will move along with the adjacent tendon, ganglion cyst will not move with the adjacent tendon C. ganglion cyst will demonstrate posterior enhancement, giant cell tumor will demonstrate posterior shadowing D. giant cell tumor will demonstrate posterior enhancement, ganglion cyst will not demonstrate enhancement

A. ganglion cyst will demonstrate posterior enhancement, giant cell tumor will not demonstrate enhancement

The gallbladder wall is asymmetrically thickened with hypervascularity and perfusion defects noted on color Doppler evaluation. Intraluminal membranes and sludge are also present. What is the most likely cause for these findings? A. gangrenous cholecystitis B. chronic cholecystitis C. cholesterolosis D. adenomyomatosis

A. gangrenous cholecystitis

Which of the following is the most common cause for intrahepatic cholestasis? A. hepatitis B. pancreatic head mass C. fatty infiltration of the liver D. stone in the distal CBD

A. hepatitis

Which of the following tumors is least likely to demonstrate a central scar? A. hepatoblastoma B. renal cell carcinoma C. focal nodular hyperplasia D. oncocytoma

A. hepatoblastoma

Which of the following Sonographic characteristics is least likely to be identified in a patient with papillary carcinoma of the thyroid? A. hyperechoic mass B. internal flow in the nodule C. absent halo sign D. microcalcifications

A. hyperechoic mass

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

A. increased RI

Which of the following sonographic characteristics is least likely to be identified in a patient with renal vein thrombosis? A. increased diastolic flow in the renal arteries B. enlarged kidney with mottled echogenicity C. lack of venous flow within the kidney D. decreased corticomedullary definition

A. increased diastolic flow in the renal arteries

A right sided pheochromocytoma will displace the ipsilateral kidney _______________. A. inferiorly B. anteriorly C. medially D. superiorly

A. inferiorly

Schistosomiasis is an _______________ cause of portal HTN. Budd Chiari syndrome is an __________________ cause of portal HTN. A. intrahepatic presinusoidal, intrahepatic postsinusoidal B. intrahepatic presinusoidal, extrahepatic postsinusoidal C. intrahepatic presinusoidal, extrahepatic presinusoidal D. extrahepatic presinusoidal, intrahepatic postsinusoidal

A. intrahepatic presinusoidal, intrahepatic postsinusoidal

A 6 month old female is referred for an abdominal ultrasound due to suspected Kasabach-Merritt syndrome. What are you looking for on the exam? A. liver or spleen hemangioma formation B. ascites, pleural effusion and abscess formation in the abdominal wall C. pancreatic divisum D. absence of the biliary tree

A. liver or spleen hemangioma formation

The hepatoduodenal ligament contains which of the following structures? A. main portal vein, proper hepatic artery and common bile duct B. right portal vein, right hepatic artery and cystic duct C. the emissary veins D. the umbilical arteries and vein

A. main portal vein, proper hepatic artery and common bile duct

The ________________________ is a connective sheath that is connected to the small intestine that provides structure and support, along with encasing/protecting blood vessels. A. mesentery B. greater omentum C. mesocolon D. lesser omentum

A. mesentery

The ________________________ is a connective sheath that is connected to the large intestine that provides structure and support, along with encasing/protecting blood vessels. A. mesocolon B. lesser omentum C. mesentery D. greater omentum

A. mesocolon

Which liver vessel courses within the main lobar fissure? A. middle hepatic vein B. right hepatic vein C. common hepatic artery D. main portal vein

A. middle hepatic vein

Air in the gallbladder wall will be demonstrated as areas of hyperechogenicity with posterior dirty shadowing and ring down artifact on sonography. How is this demonstrated on a CT exam? A. the gallbladder will demonstrate black areas within the wall where air is present B. the gallbladder will demonstrate bright white areas within the wall where air is present C. the gallbladder will demonstrate linear spokes of shadowing from the pockets of air in the wall D. the gallbladder will demonstrate no discernible changes on a CT scan with the presence of air in the wall

A. the gallbladder will demonstrate black areas within the wall where air is present Air does not attenuate radiation. Air is demonstrated as black on a CT scan because the full beam of radiation reaches the sensor.

When evaluating the venous outflow of a liver transplant patient, it is most important to check the surgical history to find _____________________________ before scanning. A. the type of surgical anastomosis B. the patient's current LFT levels and prothrombin time C. what segment of the portal vein was attached to the hepatic veins D. what segment of the portal vein was attached to the IVC

A. the type of surgical anastomosis When evaluating the venous outflow of a liver transplant patient, it is important to check the surgical history to find the type of surgical anastomosis before scanning. There are two common types piggyback versus interposition. Piggyback - hepatic confluence of transplant liver attached to native IVC. Interposition - athe liver and hepatic veins are left attached to an IVC segment and it replaces a segment of the native IVC. Because anastomosis sites are the common sites of obstruction, it is important to know where all surgical connections are located prior to starting to scan

Wolman's disease is least likely to be associated with: A. thyromegaly B. hepatomegaly C. splenomegaly D. massive adrenal gland enlargement

A. thyromegaly

The proximal superior mesenteric vein is normally located ___________ the proximal superior mesenteric artery in the abdomen. A. to the right of B. posterior to C. to the left of D. superior to

A. to the right of

Spontaneous splenic rupture is associated with all of the following, except: A. trauma B. HIV C. splenosis D. mononucleosis

A. trauma

Normal retroperitoneal lymph nodes usually measure less than ___ in length. A. 0.5cm B. 1cm C. 1.5cm D. 2cm

B. 1cm

In a normal adult patient, the common hepatic duct lumen measures less than or equal to ________. A. 2mm B. 4mm C. 2cm D. 6mm

B. 4mm

The thyroid gland is considered normal in size if the: A. length measurement is < 4cm B. AP measurement is <2cm C. width measurement is <3cm D. volume is <30mL

B. AP measurement is <2cm

A patient presents with increasing RUQ pain and vomiting after a recent liver biopsy. An irregular mass with internal debris and an overall heterogeneous appearance is noted in the right lobe. The mass also demonstrates several echogenic foci with ringdown artifact. What is the most likely diagnosis of this finding? A. Hematoma B. Abscess C. Pseudoaneurysm D. Seroma E. Lymphocele

B. Abscess

Which of the following is false regarding hydrocele formation? A. Most hydroceles are congenital B. Accumulation of serous fluid between the two layers of the tunica albuginea C. Usually contains serous fluid but may see minimal cellular debris D. Most common cause of painless swelling

B. Accumulation of serous fluid between the two layers of the tunica albuginea

______________ transplant rejection appears as swollen kidney, loss of corticomedullary definition, enlarged renal pyramids, compression of the renal sinus, and decreased blood flow with increased RI value. A. Chronic B. Acute C. Chronic or acute, stages of rejection are not able to be differentiated with sonography D. Rejection of a renal allograft is not usually evaluated by sonography

B. Acute

Which of the following statements is true regarding the non-seminomatous germ cell tumor? A. They are the second most common secondary malignancy of the testicles. B. The tumors are more common in men age 20-30yrs. C. These tumors are less aggressive than a seminoma tumor. D. Seminomatous tumors usually contain cystic areas and calcifications that assist in differentiating them from non-seminomatous tumors.

B. The tumors are more common in men age 20-30yrs.

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 for a follow up exam in 7-10 days after anticoagulant treatment. B. Acute postrenal failure is present and the radiologist should review the case immediately. C. The patient has a neurogenic bladder and the radiologist should review the case immediately. D. Acute intrinsic renal failure is present that is most likely due to acute tubular necrosis.

B. Acute postrenal failure is present and the radiologist should review the case immediately.

________________________ is the most common malignant neoplasm found in the prostate. A. Metastasis B. Adenocarcinoma C. Transitional zone sarcoma D. Central zone sarcoma

B. Adenocarcinoma

_______________ is the most common cause for micronodular cirrhosis and _____________________ is the most common cause of macronodular cirrhosis. A. Alcohol consumption, analgesic consumption B. Alcohol consumption, chronic viral hepatitis C. Chronic viral hepatitis, alcohol consumption D. Analgesic consumption, alcohol consumption

B. Alcohol consumption, chronic viral hepatitis

All of the following statements are true regarding equipment preparation for beginning an ultrasound exam, except? A. In order to reduce exam time, the proper exam preset must be used for each exam. B. Always place the cord around your neck or shoulder to avoid dragging the cord across open sores, wounds or ulcers during the exam. C. A medical record number must be used to identify the patient on the ultrasound system. D. Adjust the height of the chair to allow your wrist to be fully extended while scanning.

B. Always place the cord around your neck or shoulder to avoid dragging the cord across open sores, wounds or ulcers during the exam.

. The splenic artery courses across the ______________ surface of the pancreas. A. Anterior inferior B. Anterior superior C. Posterior inferior D. None of the above

B. Anterior superior

Which of the following structures is not included in the spermatic cord? A. Vas deferens B. Centripetal artery C. Cremasteric artery D. Gonadal artery

B. Centripetal artery

Which of the following is the least likely cause of shadowing from the area of the GB fossa? A. Gas in duodenum B. Choledochal cyst C. Valves of Heister D. Pneumobilia

B. Choledochal cyst

Which testicular tumor will cause b-hCG levels to rise but AFP levels will be normal? A. Epidermoid Cyst B. Choriocarcinoma C. Yolk Sac Tumor D. Embryonal Cell Carcinoma

B. Choriocarcinoma

A patient presents with epigastric pain and nausea. Lab values demonstrate increased levels of amylase, direct bilirubin, alkaline phosphatase and LFTs. A cystic mass with thickened walls is identified in the head of the pancreas. No Color flow is identified in the mass. Two small hypoechoic masses are identified in the area of the pancreatic head near the porta hepatis. Which of the following best describes the findings? A. Choledochal cyst B. Cystadenocarcinoma C. Adenocarcinoma D. Biliary ascariasis

B. Cystadenocarcinoma

Schistosomiasis and chronic cystitis are commonly associated with what Sonographic findings in the urinary bladder? A. The bladder lumen is filled with numerous non-shadowing stones B. Diffuse bladder wall calcification C. Ureterocele formation D. Bladder wall atrophy due to reduced arterial supply

B. Diffuse bladder wall calcification

Primary GB carcinoma most commonly presents as: A. Enlarged GB surrounded by fluid B. Diffusely thickened GB wall with stones C. Focal wall mass without stones D. Small GB with thickened walls

B. Diffusely thickened GB wall with stones

_________________________ is one of the most common surgical procedure in the US and most patients are males, less than 1yr old. A. Nephrectomy B. Herniorrhaphy C. Appendectomy D. Cholecystectomy

B. Herniorrhaphy

Which of the following describes the Doppler appearance of liver transplant rejection? A. Mottled appearance of the liver parenchyma with ascites B. High resistance flow in the hepatic artery C. Nodular formations within the liver parenchyma D. Low resistance flow in the portal vein

B. High resistance flow in the hepatic artery

All of the following medications should be stopped at least 7 days before a renal biopsy, except? A. Lovenox B. Hypertension medication C. Ibuprofen D. Aspirin

B. Hypertension medication

Which of the following is the least likely potential complication of pancreatitis? A. biliary obstruction B. IVC thrombosis C. pseudoaneurysm D. phlegmon

B. IVC thrombosis

A patient presents with a 2cm palpable reddened lump on the bottom of her foot. The patient states she accidentally stepped on a piece of broken glass. The doctor suspects there may be some glass remaining in her foot. Which of the following statements is true regarding the evaluation of a this patient's foot? A. Most foreign bodies are echogenic with significant posterior enhancement. B. Inflammation usually leads to a hypoechoic ring surrounding the foreign body. C. Improved visualization of the foreign body occurs as the US beam becomes more parallel to the structure. D. The radiologist should be consulted because MRI is preferred over Sonography for foreign body detection.

B. Inflammation usually leads to a hypoechoic ring surrounding the foreign body.

Which of the following statements is false regarding hepatocellular carcinoma? A. Tumor invasion of the portal system can lead to portal vein thrombosis. B. It is the most common liver malignancy. C. Can be focal, multifocal or diffuse D. Most cases demonstrate increased levels of serum alpha-fetoprotein.

B. It is the most common liver malignancy.

The most common secondary malignancy of the testicles is: A. Leukemia B. Lymphoma C. Myeloma D. Hypernephroma

B. Lymphoma

What is the most common bilateral malignancy of the testicles? A. Metastasis B. Lymphoma C. Leukemia D. Seminoma

B. Lymphoma

The cup-like or funnel shaped extensions of the renal sinus that originate at the papilla and collect urine that is coursing toward the renal pelvis are: A. Cortex B. Major calyces C. Pyramids D. Minor calyces

B. Minor calyces

All of the following are correct regarding renal angiomyolipoma, except: A. CT used to confirm diagnosis B. Most commonly presents in the left kidney C. Large masses can cause propagation speed artifact D. Benign renal tumor

B. Most commonly presents in the left kidney

It may be difficult to differentiate a ________________ from a splenic disease process at the hilum. A. Liver mass in the caudate lobe B. Pancreatic pseudocyst C. Duodenal tumor D. All of the above

B. Pancreatic pseudocyst

When an AAA ruptures, which retroperitoneal space will fill with blood first? A. Posterior Pararenal B. Perirenal C. Omental Bursa D. Anterior Pararenal

B. Perirenal

About 50% of all primary tumors that metastasize to the liver are drained through the: A. Aorta B. Portal vein C. IVC D. Hepatic vein

B. Portal vein

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

B. Posterior superior

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. Use a standoff pad B. Scan the patient in the decubitus position C. Switch to a higher frequency probe D. Drink water and rescan in 20-30 minutes

B. Scan the patient in the decubitus position

Which of the following statements is true regarding the Sonographer assisting the radiologist with a renal biopsy? A. The Sonographer should wear sterile gloves when disposing of the needles and devices used for the biopsy. B. The Sonographer's hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure. C. The Sonographer is responsible for creating the point of entry on the patient for the biopsy device. D. The Sonographer's hands must be sterile when opening needles and biopsy device packaging.

B. The Sonographer's hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure.

Which of the following describes how to differentiate adenomyomatosis of the GB from cholesterolosis of the GB? A. Adenomyomatosis is usually focal process and cholesterolosis is a diffuse process. B. The polyps in cholesterolosis do not exhibit the comet tail artifact but polyps with adenomyomatosis do demonstrate the artifact. C. Adenomyomatosis is usually a diffuse process and cholesterolosis is a focal process. D. The polyps in adenomyomatosis do not exhibit the comet tail artifact but polyps with cholesterolosis do demonstrate the artifact.

B. The polyps in cholesterolosis do not exhibit the comet tail artifact but polyps with adenomyomatosis do demonstrate the artifact.

All of the following are associated with an increased risk of thyroid malignancy, except: A. intranodular flow patterns B. wider than tall mass orientation C. psammoma bodies D. absence of the halo sign

B. wider than tall mass orientation

How does a junctional parenchymal defect appear on ultrasound examination? A. Narrowing or obstruction of the junction of the renal pelvis and ureter B. Triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney C. Thicker cortex on the lateral aspect of the left kidney D. Prominent renal cortical parenchyma located between 2 medullary pyramids

B. Triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney

. All of the following correctly describe hepatocellular carcinoma, except: A. Cirrhosis is the most common pre-existing condition B. Usually presents as multiple complex masses throughout the liver C. AST, ALT and alpha-fetoprotein levels are elevated D. Commonly invades venous vasculature, usually the portal vein

B. Usually presents as multiple complex masses throughout the liver

Which of the following is not a symptom of hyperthyroidism? A. Increased heart rate B. Weight gain C. Excessive sweating D. Weight loss

B. Weight gain Hyperthyroidism leads to symptoms similar to anxiety. Increased heart rate, weight loss, and sweating are all related symptoms. Weight gain is a possible symptom of hypothyroidism.

The most common use of chest sonography is to evaluate: A. suspected atelectasis B. a complete or partial radiopaque hemithorax C. suspected lung cancer D. a known pulmonary embolism

B. a complete or partial radiopaque hemithorax

The Achilles' tendon most commonly ruptures: A. mid-tendon B. about 4 cm from the distal insertion point C. at the proximal insertion point D. at the distal insertion point

B. about 4 cm from the distal insertion point

The most common cause of acute scrotal pain in postpubertal men is: A. Orchitis B. Acute epididymitis C. Torsion D. Hydrocele

B. acute epididymitis

Sudden onset of hematuria, azotemia, and proteinuria is an indication of: A. chronic renal failure B. acute glomerulonephritis C. tuberous sclerosis D. oncocytoma

B. acute glomerulonephritis

Which of the following is least likely to demonstrate an increased resistive index in the renal parenchymal arteries? A. acute tubular necrosis B. acute renal artery occlusion C. renal vein thrombosis D. acute renal failure

B. acute renal artery occlusion

Which of the following correctly describes angiosarcoma of the spleen? A. usually presents as a homogeneous hyperechoic mass near the periphery of the spleen B. arises from the vascular endothelium and demonstrates increased vascularity C. most common primary malignancy of the spleen D. very responsive to chemotherapy with good prognosis

B. arises from the vascular endothelium and demonstrates increased vascularity

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

B. at the level of the aortic bifurcation

Why does the spleen have an increased risk of infarction compared to the other abdominal organs? A. because it is non-encapsulated B. because the intrasplenic arteries do not have communicating branches C. because there is only one intrasplenic artery D. because of the small size of the splenic vein and increased risk of stasis thrombosis

B. because the intrasplenic arteries do not have communicating branches

A 70yr old male presents for transrectal ultrasound due to PSA level of 7ng/ml, urinary frequency and hematuria. The US exam demonstrates a 40cc prostate volume with heterogeneity and calcifications centrally. The peripheral zone appears normal. What is the most likely diagnosis of these findings? A. normal prostate B. benign prostatic hypertrophy C. prostatitis D. carcinoma of the prostate

B. benign prostatic hypertrophy

Which of the following correctly describes the sonographic appearance of renal lymphoma? A. unilateral renal enlargement B. bilateral renal enlargement C. unilateral renal atrophy D. bilateral renal atrophy with renal failure

B. bilateral renal enlargement

Which of the following is demonstrated by the same color on an ultrasound image as on a CT image? A. cysts B. calcifications C. uncomplicated pleural effusion D. more than one of the above

B. calcifications Air = black on CT, dirty shadowing and ring down artifact on ultrasound Fluid = dark grey on CT, black on ultrasound Soft Tissue - varied levels of grey on both modalities Calcifications - bright white on both modalities

Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction? A. ventral B. cavernosal C. urethral D. dorsal

B. cavernosal

What is the most common cause of cholangitis? A. AIDS B. choledocholithiasis C. adenomyomatosis D. Klatskin's tumor

B. choledocholithiasis

What biliary abnormality is a common finding in patients with hemolytic anemia? A. adenomyomatosis B. cholelithiasis C. cholecystitis D. gangrenous cholecystitis

B. cholelithiasis

Which of the following is least likely to lead to extrinsic compression of the IVC? A. Budd Chiari syndrome B. congestive heart failure C. 8cm hepatoma in the right lobe of the liver D. 6cm AAA at the level of the renal arteries

B. congestive heart failure

Which of the following is normally identified in the urine? A. glucose B. conjugated bilirubin C. minimal amount of red blood cells D. protein

B. conjugated bilirubin Substances NOT normally found in urine: sugar(glucose), red/white blood cells, protein and acid ketones. Conjugated bilirubin is absorbed in digestion and filtered from the blood by the kidneys.

What changes occur on the US image when scanning breast tissue affected by acute mastitis? A. dilated ductal system within normal breast tissues B. decreased penetration due to tissue edema C. posterior enhancement due to tissue edema D. improved visualization of the ductal system due to tissue edema

B. decreased penetration due to tissue edema

While scanning the liver, you notice a small dilated tubular structure with stellate branches coursing anterior to the right portal vein. Which of the following best describes the findings? A. duplicated right portal vein B. dilated right hepatic duct C. Budd Chiari Malformation D. dilated cystic duct

B. dilated right hepatic duct

A small rounded prominence on the anteroinferior aspect of the normal caudate lobe is called A. elongated left lobe B. distal papillary process C. Reidel's lobe D. quadrate lobe

B. distal papillary process

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

B. drains blood from the distal colon.

A 4yr old presents for a renal ultrasound with a suspected mass on the lateral aspect of the left kidney seen on a KUB x-ray. The ultrasound reveals a focal outward thickening of the normal renal cortex near the mid pole of the kidney. Which of the following best describes the finding? A. Wilm's tumor B. dromedary hump C. column of Bertin D. duplicated collecting system

B. dromedary hump

Which of the following is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver? A. chronic hydatid infection B. early echinococcal infection C. early schistosomiasis infection D. chronic focal nodular hyperplasia

B. early echinococcal infection

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

B. efferent ducts

A renal transplant patient is referred for an ultrasound due to the presence of an abdominal bruit. A pseudoaneurysm is identified in the renal artery just distal to the arterial anastomosis site. What native vessel is most likely feeding the transplant artery and pseudoaneurysm? A. internal iliac B. external iliac C. aorta D. inferior mesenteric artery

B. external iliac

What causes pseudopancreatitis? A. polycystic liver disease B. fatty liver C. cholecystitis D. hepatitis

B. fatty liver

Histoplasmosis and tuberculosis are the most common cause of ___________ formation in the liver and spleen. A. abscess B. granuloma C. hemangioma D. hematoma

B. granuloma

Where is the Dartos muscle layer? A. in the cystic duct B. in the scrotal sac C. in the abdominal wall D. in the urinary bladder

B. in the scrotal sac

While scanning the liver, you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. The CBD measures 5mm in diameter and the gallbladder appears normal. The liver demonstrates mild fatty infiltration and the pancreas and kidneys appear within normal limits. Which of the following correctly describes the laboratory findings that correlate with these findings? A. increased direct bilirubin, normal LFTs B. increased LFTs, normal direct bilirubin C. Increased indirect bilirubin, increased LFTs D. increased LFTs, increased bilirubin

B. increased LFTs, normal direct bilirubin If there is only a partial blockage of the biliary tree, bilirubin levels will remain normal. Fatty infiltration will cause an increase on the LFTs.

Which of the following will improve the color Doppler visualization of flow in the arcuate arteries? A. increased wall filter settings B. increased transducer frequency C. reduced color gain D. smaller packet size

B. increased transducer frequency

What clinical symptoms are common with adrenal hemorrhage? A. hyperkalemia and dysuria B. jaundice and low hematocrit C. nausea and vomiting D. weight loss and edema

B. jaundice and low hematocrit

Hepatic fibrosis and portal HTN are seen with which of the following? A. multicystic dysplastic kidney disease B. juvenile autosomal recessive polycystic kidney disease C. perinatal autosomal recessive polycystic kidney disease D. autosomal dominant polycystic kidney disease

B. juvenile autosomal recessive polycystic kidney disease

Which of the following organ transplants are best evaluated for rejection using 2D and Doppler sonography? A. kidney and liver B. kidney C. liver D. pancreas and liver

B. kidney

Which liver segment is located immediately lateral to the ligamentum teres? A. caudate lobe B. lateral left lobe C. anterior right lobe D. medial left lobe

B. lateral left lobe

Which of the following correctly lists the equation for the splenic volume index? A. (length X width X height)2= SVI B. length X width X height / 27 = SVI C. length X width X height X 2 = SVI D. length X width X height X 3.14 = SVI

B. length X width X height / 27 = SVI

A 55yr old male patient presents with a script that states "pelvic ultrasound; post biopsy, Gleason score of 8". What are you most likely looking for on the exam? A. lymphadenopathy and metastasis related to transitional cell bladder cancer B. lymphadenopathy and metastasis related to prostate cancer C. bladder puncture caused by recent biopsy of the seminal vesicle D. inguinal hernia caused by recent bladder wall biopsy

B. lymphadenopathy and metastasis related to prostate cancer Gleason score is used to classify prostate cancer; 1-10 with 10 as most aggressive. A score of 8 indicates a moderately aggressive prostate tumor. The pelvis should be evaluated for lymphadenopathy and metastasis related to prostate cancer.

Which of the following is the most likely symptom of renal transplant rejection? A. urinary frequency and urgency B. oliguria C. hyperbilirubinemia D. reduced serum levels of BUN and creatinine

B. oliguria

The ____________________________ gland is located under the mandible and is drained by the __________________________. A. submandibular, Stensen duct B. submandibular, Wharton duct C. parotid, Stensen duct D. sublingual, Wharton duct

B.submandibular, Wharton duct

What is the proper caliper placement for assessing the portal vein diameter? A. inner wall to inner wall at the point the portal vein crosses the IVC B. outer wall to outer wall at the point the portal vein crosses the IVC C. outer wall to outer wall at the junction of the splenic vein and portal vein D. inner wall to inner wall at the junction of the splenic vein and portal vein

B. outer wall to outer wall at the point the portal vein crosses the IVC

If a patient forgets to take their hypertension medication before a renal duplex exam, what effect can this have on the findings? A. overestimation of renal parenchymal thickness B. overestimation of renal artery stenosis C. underestimation of renal artery stenosis D. underestimation of peak renal artery velocity

B. overestimation of renal artery stenosis

A patient with multiple gastrinomas will usually present with what other GI tract issue? A. mesenteric ischemia B. peptic ulcer formation C. intussusception D. esophageal and gastric varices

B. peptic ulcer formation

All of the following would be identified on an ultrasound of a patient in the earlier stages of Budd Chiari syndrome, EXCEPT: A. hypertrophy of the caudate lobe B. pericardial effusion C. ascites D. splenomegaly

B. pericardial effusion

A 40yr old female patient presents with nausea, vomiting and increasing abdominal pain following a recent procedure. The patient has a history of a mass in the head of the pancreas and an ERCP was performed to evaluate the ductal involvement. The ERCP report states the ductal system at the head of the pancreas was within normal limits. Which of the following is most likely be identified on the US exam as a cause for the acute symptoms? A. CBD over 8mm B. pneumobilia C. liver metastasis D. biloma

B. pneumobilia

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

B. posterior displacement of the IVC

The psoas muscle is __________________ to the kidney. A. anteromedial B. posteromedial C. posterolateral D. anterolateral

B. posteromedial

Which of the following is the least likely complication associated with chronic hydronephrosis? A. systemic HTN B. pulmonary embolism C. renal failure D. sepsis

B. pulmonary embolism

A _____________ abscess is caused by bacteria and most commonly forms within the right lobe of the liver. A _______________ abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm. A. parasitic, fungal B. pyogenic, amebic C. amebic, pyogenic D. fungal, pyogenic

B. pyogenic, amebic

Billroth cords in the red pulp of the spleen are responsible for _______________ destruction. Malpighian corpuscles in the white pulp of the spleen are responsible for _____________ production. A. lymphocyte, platelet B. red blood cell, lymphocyte C. lymphocyte, red blood cell D. platelet, lymphocyte

B. red blood cell, lymphocyte

Which of the following is not true regarding milk of calcium bile? A. lumen filled with highly echogenic material with shadowing B. related to hyperfunction of the gallbladder C. also called limey bile D. layering of bile/calcium with change of patient position

B. related to hyperfunction of the gallbladder

All of the following are causes for increased serum levels of alpha-fetoprotein, except? A. yolk sac tumor of the right testicle B. seminoma tumor of the left testicle C. hepatocellular carcinoma D. twin pregnancy

B. seminoma tumor of the left testicle Serum AFP levels increase with certain testicular tumors, liver cancer and pregnancy. Seminomas of the testicles will normally demonstrate normal AFP levels with elevated bhCG levels.

The ligamentum venosum travels between: A. the right portal vein and the IVC B. the left portal vein and the IVC C. caudate lobe and the right lobe D. the main portal vein and the IVC

B. the left portal vein and the IVC

A contrast agent that consists of a cellulose suspension is administered to a patient to better visualize: A. non-functioning adrenal adenomas B. the pancreatic tail C. functioning thyroid nodules D. an aortic aneurysm

B. the pancreatic tail

Which of the following are vascular complications seen with pancreatitis? A. progression of Budd Chiari syndrome and the development of congestive heart failure B. thrombosis of the splenic vein or pseudoaneurysm of the splenic artery C. cholecystitis and phlegmon formation D. portal hypertension and biliary strictures

B. thrombosis of the splenic vein or pseudoaneurysm of the splenic artery

Which of the following structures can be used as an acoustic window when evaluating the pediatric mediastinum? A. diaphragm B. thymus C. lung pleura D. thyroid

B. thymus

Anemia is least likely to be related to abnormalities of which of the following organs? A. aorta B. thyroid C. spleen D. esophagus

B. thyroid

Which of the following is an important part of a transrectal ultrasound performed prior to brachytherapy? A. to obtain a PW Doppler signal from the base and apex of the gland B. to determine prostate size and volume C. to locate the main arterial branch that is feeding the carcinoma D. to measure the distance from the prostate to the anterior abdominal wall

B. to determine prostate size and volume

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

B. urinary bladder

Sulfur colloid imaging is: A. a type of contrast used in CT imaging B. used to evaluate suspected focal nodular hyperplasia C. a type of contrast used in MR imaging D. used to evaluate autosomal polycystic liver disease

B. used to evaluate suspected focal nodular hyperplasia Sulfur Colloid Imaging is a nuclear medicine exam used to detect FNH. In most patients, the FNH mass will absorb the sulfur colloid at the same rate as the normal liver tissue which helps to differentiate it from malignancy.

Tumor invasion into the urinary bladder is most commonly caused by _______________ in females and by _________________ in males. A. ovarian cancer, testicular cancer B. uterine cancer, prostate cancer C. uterine cancer, colon cancer D. colon cancer, prostate cancer

B. uterine cancer, prostate cancer

Pancreatic malignancy is the _________ leading cause of death due to cancer. A. 2nd B. 3rd C. 4th D. 6th

C. 4th

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

C. 5 x 3 x 1mm

The renal medulla contains ____________ pyramids in an average adult kidney. A. 3-10 B. 12-24 C. 8-18 D. 1-5

C. 8-18

A 60yr old male presents for an abdominal ultrasound for recurrent epigastric pain. The patient tells you this is the fourth time he has been hospitalized for pancreatitis and the medications are just not working. What is the expected appearance of his pancreas on ultrasound? A. Increased size with decreased echogenicity B. Enlarged and edematous with a hyperechoic appearance C. Atrophied with calcifications in the parenchyma D. Atrophied with multiple cysts and calcifications consuming the parenchyma

C. Atrophied with calcifications in the parenchyma

Placing the patient in an oblique position and using a lateral transducer position on the lower abdomen would best demonstrate what vessels? A. Common femoral veins B. Suprarenal arteries C. Common Iliac arteries D. Hepatic Artery

C. CIA

Which of the following is true regarding a liver hemangioma? A. Fluid and debris levels are commonly present in a hemangioma. B. A hemangioma is composed of an abnormal concentration of smooth muscle and Kupffer cells within the liver. C. Color Doppler is not usually helpful in evaluating this highly vascular mass. D. Most hemangiomas demonstrate some level of posterior shadowing.

C. Color Doppler is not usually helpful in evaluating this highly vascular mass.

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. Hydropic GB B. Choledochal cyst C. Courvoisier's sign D. Mirizzi's syndrome

C. Courvoisier's sign

Obstruction of the CBD by a pancreatic head mass will lead to: A. Contracted, small GB with dilated biliary tree B. Contracted, small GB with normal biliary tree C. Dilated GB and biliary tree D. All of the above are potential findings

C. Dilated GB and biliary tree

Jaundice is usually associated with all of the following, except: A. Ductal obstruction B. Red blood cell destruction C. Fatty infiltration D. Hepatocellular disease

C. Fatty infiltration

Which of the following sonographic techniques can be used to evaluate a possible inguinal hernia? A. valsalva maneuver B. PW Doppler C. color Doppler D. tissue Doppler

C. color Doppler

A patient presents for a post biopsy scan of the right kidney. A lymphocele is suspected. What will be the appearance of this abnormality on the image? A. Heterogeneous mass within the renal parenchyma B. Cystic formation with debris levels found within the renal sinus C. Fluid collection with debris and septations located adjacent to the kidney D. Anechoic free fluid beneath the renal capsule that distorts the contour of the parenchyma

C. Fluid collection with debris and septations located adjacent to the kidney A lymphocele is a collection of lymphatic fluid that is usually associated with trauma or surgery. The fluid commonly contains debris and septations. A hematoma will form quickly after the procedure due to the constant blood flow from the heart, while a lymphocele or seroma will usually present after several days or even weeks post biopsy.

All of the following correctly describe proper behavior related to a sterile field, except: A. Hands and elbows must be kept above the level of the table B. Sterile individuals must pass each other back to back when moving around the procedure room C. Sterile gloves must be used to open the procedure tray D. When in doubt about sterility, discard the potentially contaminated item and begin again

C. Sterile gloves must be used to open the procedure tray

What does McBurney's point refer to? A. An ectopic ridge of thyroid tissue in the chest. B. An ectopic mass of endometriosis on the right kidney. C. The most common location of the appendix D. The point of greatest tenderness in the RUQ in a patient with cholecystitis.

C. The most common location of the appendix

Causes of hydronephrosis include all of the following, except: A. Mass effect B. Pregnancy C. Vascular calcification D. Stone formation

C. Vascular calcification

Serum amylase will be increased with all of the following, except: A. tumor of the submandibular gland B. acute pancreatitis C. parathyroid adenoma D. use of oral contraceptives

C. parathyroid adenoma The pancreas and salivary glands excrete amylase. Pancreatitis and a salivary gland tumor will cause an increase in amylase levels. OCP usage can also lead to elevated levels of serum amylase.

A choledochocele is: A. a collection of bile that forms around a perforated gallbladder B. a type of cyst that forms at the terminal ducts in the biliary tree C. a cyst of the intraduodenal portion of the duct D. an intrahepatic collection of bile that forms around a major branch of the biliary tree

C. a cyst of the intraduodenal portion of the duct

On ultrasound, a mycetoma appears as: A. a hypoechoic mass that causes propagation artifact B. a hyperechoic mass with posterior enhancement C. a hyperechoic mass without posterior shadowing D. a hypoechoic mass that forms in the renal pelvis with a bacterial infection

C. a hyperechoic mass without posterior shadowing

Which of the following chest masses would be most easily be evaluated with ultrasound? A. a mass located in the central portion of the lung B. a mass located in the posterior lobes C. a mass located between the pleura and the chest wall D. a mass located between the bronchial tubes

C. a mass located between the pleura and the chest wall

Which of the following frequently occurs as a late complication of pharyngitis (throat infection)? A. renal artery stenosis B. cholecystitis C. acute glomerulonephritis D. adrenal hemorrhage

C. acute glomerulonephritis Acute Glomerulonephritis refers to inflammation of glomeruli. It frequently occurs as a late complication of pharyngitis (throat infection). Also caused by other types of infection, autoimmune response, medications, toxins. Symptoms include the sudden onset hematuria, azotemia, proteinuria; foggy urine, fever, sore throat, joint pain, peripheral edema, oliguria, anemia, HTN.

Splenic vein thrombosis and splenic artery pseudoaneurysm formation are vascular complications seen with: A. cirrhosis B. renal artery stenosis C. acute pancreatitis D. Zollinger Ellison syndrome

C. acute pancreatitis

The most common cause of acute renal failure is ____________________ and the most common cause of chronic renal failure is _____________________. A. acute tubular necrosis, renal artery stenosis B. trauma, renal vein thrombosis C. acute tubular necrosis, diabetes mellitus D. renal artery stenosis, renal vein thrombosis

C. acute tubular necrosis, diabetes mellitus

Which of the following is the most common cancer of the GI tract? A. Kaposi's sarcoma B. Krukenberg tumor C. Adenocarcinoma D. Gastric sarcoma

C. adenocarcinoma

Which of the following will not cause an increase in values on liver function tests? A. fatty liver B. pyogenic abscess C. adenoma D. hepatocellular carcinoma E. hepatoblastoma

C. adenoma

Increasing the wall filter setting could reduce the display of all of the following, except: A. cross talk artifact B. beam width artifact C. aliasing artifact D. clutter artifact

C. aliasing artifact

Which type of liver abscess is caused by a parasite? A. pyogenic B. fungal C. amebic D. viral

C. amebic

The kidneys release renin to stimulate the release of: A. angiotensin to counteract high blood pressure B. anti-diuretic hormone to counteract low blood pressure C. angiotensin to counteract low blood pressure D. anti-diuretic hormone to counteract high blood pressure

C. angiotensin to counteract low blood pressure

The _______________________ lobe of the liver is located between the right and middle hepatic vein. A. lateral left B. caudate C. anterior right D. medial left

C. anterior right

Aneurysms of the iliac and popliteal arteries are commonly associated with: A. pancreatic pseudocysts B. renal failure C. aortic aneurysm D. prostate carcinoma

C. aortic aneurysm

Which of the following correctly describes penile cancer? A. usually found on the proximal shaft in circumcised men B. most commonly demonstrates a complex cystic mass C. associated with inguinal lymphadenopathy D. most common type of penile cancer is transitional cell carcinoma

C. associated with inguinal lymphadenopathy

Which of the following correctly describes the ducts of Luschka? A. associated with porcelain GB and GB carcinoma B. only visible in obese patients C. bile thickening occurs within them D. located within the 3rd segment of the duodenum

C. bile thickening occurs within them

A patient presents for an abdominal ultrasound due to abdominal pain and bloating. The script for their exam reads "R/O cholangiocarcinoma". What structure should you closely evaluate to answer the question? A. spleen B. gallbladder C. biliary tree D. adrenals E. aorta

C. biliary tree

Which scrotal artery encircles the testicular periphery? A. deferential B. centripetal C. capsular D. cremasteric

C. capsular

All of the following will lead to an increase in the direct bilirubin levels in the blood, except: A. CBD obstruction B. cystic duct obstruction C. cirrhosis D. hepatitis E. biliary atresia

C. cirrhosis

A patient presents with mildly increased levels of ALT and significantly increased levels of AST. Which of the following is an expected finding on the ultrasound exam? A. choledocholithiasis B. Mirizzi's syndrome C. cirrhosis D. acute viral hepatitis

C. cirrhosis Comparison of the AST and ALT levels is used to diagnose the associated liver abnormality. Significant increases in AST with mild increases in ALT indicate cirrhosis or metastatic disease is present. Both AST and ALT are significantly increased with acute viral hepatitis. ALT is increased with biliary obstruction, while AST levels are usually normal.

Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate: A. contrast enhancement during portal venous phase of imaging B. contrast enhancement during the arterial and portal venous phases of imaging C. contrast enhancement during the arterial phase of imaging D. no contrast enhancement

C. contrast enhancement during the arterial phase of imaging

Purple stretch marks (striae) on the lateral and lower abdomen can be a clinical sign of: A. Adrenal hemorrhage B. Conn disease C. Cushing syndrome D. Addison disease

C. cushing syndrome

All of the following are potential malignant features of a pancreatic cyst, except? A. increase in cyst size on serial examinations B. internal nodule C. cyst size <3cm D. thickened septations

C. cyst size <3cm

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

C. decreasing color priority

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. distal abdominal aorta, aortic arch D. aortic arch, distal abdominal aorta

C. distal abdominal aorta, aortic arch

The IVC is located posterior to the pancreatic __________________. A. body B. neck C. head D. tail

C. head

Which type of liver neoplasm can be stimulated to grow in a pregnant patient? A. granuloma B. hepatoma C. hemangioma D. schistosomiasis

C. hemangioma

All of the following are contraindications for a liver transplant, except: A. extrahepatic malignancy B. cholangiocarcinoma C. hepatitis C D. current alcohol abuse

C. hepatitis C

Which of the following is the most likely cause for an increase in alpha-fetoprotein levels in a 7month old boy? A. nephroblastoma B. pheochromocytoma C. hepatoblastoma D. neuroblastoma

C. hepatoblastoma

A normal evaluation of a patient with transjugular intrahepatic shunt would include all of the following, EXCEPT: A. continuous flow pattern within the shunt B. diminished flow in the right and left portal branches C. hepatofugal flow in the main portal vein D. spleen length <12cm in average patient

C. hepatofugal flow in the main portal vein

A patient presents for an abdominal ultrasound due to suspected displacement of the Greenfield filter. Where should you look to find the filter in the normal position? A. in the IVC just below the level of the hepatic veins B. in the renal vein at the renal hilum C. in the IVC just below the level of the renal veins D. in the renal artery at the renal hilum

C. in the IVC just below the level of the renal veins

All of the following are characteristics of acute tubular necrosis, except: A. prominent renal pyramids B. enlarged kidney C. increased diastolic flow in the arcuate arteries D. reversible in the early stages

C. increased diastolic flow in the arcuate arteries

All of the following are associated with celiac artery occlusion, except? A. flow reversal in the splenic artery B. flow reversal in the hepatic artery C. increased systolic velocity of flow in celiac artery D. all of the above are characteristics of a celiac artery occlusion

C. increased systolic velocity of flow in celiac artery

Which of the following machine adjustments will produce a more black and white 2D image? A. reducing monitor contrast B. increasing dynamic range C. increasing log compression D. reducing overall gain

C. increasing log compression

What is the key anatomic landmark in differentiating direct, indirect and spigelian hernias? A. internal iliac artery B. linea alba C. inferior epigastric artery D. rectus abdominis muscles

C. inferior epigastric artery

Which renal arterial branches are used to assess parenchymal resistance? A. segmental or interlobar arteries B. segmental or arcuate arteries C. interlobar or arcuate arteries D. intralobular or segmental arteries

C. interlobar or arcuate arteries

The ___________________ is located within the inferior margin of the falciform ligament. A. middle hepatic vein B. ligamentum venosum C. ligamentum teres D. left hepatic vein

C. ligamentum teres

Tumefactive sludge would demonstrate a sonographic appearance similar to all of the following, except: A. primary GB carcinoma B. secondary GB carcinoma C. membranous gangrenous cholecystitis D. benign polyp

C. membranous gangrenous cholecystitis

A 4 month old presents for an abdominal ultrasound following a recent Kasai procedure. Which of the following ultrasound findings would indicate the procedure was a success? A. echogenic mesh in the abdominal wall used to close an inguinal hernia B. echogenic mesh in the abdominal wall used to close an umbilical hernia C. normal liver echotexture with normal biliary duct diameter D. echogenic graft connecting the hepatic and portal venous systems in the liver with flow velocity greater than 40cm/s

C. normal liver echotexture with normal biliary duct diameter

All of the following would be symptoms related to Conn syndrome, except: A. hypokalemia B. excessive thirst C. oliguria D. hypernatremia

C. oliguria Symptoms of Conn syndrome include salt retention, HTN, thirst, increased urination, weakness, EKG abnormalities. Lab Testing: elevated serum levels of sodium(hypernatremia), decreased serum levels of potassium (hypokalemia)

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

C. oncocytoma

Alkaline phosphatase is normally produced by all of the following, except: A. liver tissue B. placenta C. pancreas tissue D. growing bones

C. pancreas tissue

What is the most common abdominal lesion seen with Von Hippel Landau syndrome? A. fatty liver sparing B. liver adenoma C. pancreatic cysts D. renal cell carcinoma

C. pancreatic cysts

Internal rotation of the arm is preferred for evaluation of the _____________ tendon, while external rotation of the arm is preferred for evaluation of _______________tendon. A. long bicep, short bicep B. subscapularis, supraspinatus C. supraspinatus, subscapularis D. flexor, biceps

C. supraspinatus, subscapularis

Which of the following correctly describes a pneumothorax? A. fluid accumulation between the visceral and parietal pleura B. there are two types of pneumothorax, transudate and exudate C. the lung-gliding sign is not present with free air in the chest D. ultrasound is not able to demonstrate a pneumothorax

C. the lung-gliding sign is not present with free air in the chest

The medial segment of the left lobe lies between: A. the right hepatic vein and middle hepatic vein B. the ligamentum teres and the spleen C. the middle hepatic vein and the ligamentum teres D. the ligamentum venosum and IVC

C. the middle hepatic vein and the ligamentum teres

Chest sonography is a valuable tool that can be used to evaluate all the following, except? A. pleural effusion B. pneumothorax C. the number of lobes in each lung D. pulmonary sequestration

C. the number of lobes in each lung

In patients with cirrhosis, what effect will deep inspiration have on the portal vein? A. the portal vein diameter will increase by 50% B. the portal vein diameter will double in size C. there will be minimal change in the portal vein diameter D. the portal vein will collapse at the deepest point of inspiration

C. there will be minimal change in the portal vein diameter

Which of the following correctly describes how to aid in differentiation of a thyroid adenoma in the lower pole from a parathyroid adenoma? A. thyroid adenomas are hyperechoic and parathyroid adenomas are hypoechoic B. thyroid adenomas are hypoechoic and parathyroid adenomas are hyperechoic C. thyroid adenomas are hypovascular and parathyroid adenomas are hypervascular D. thyroid adenomas are homogeneous and parathyroid adenomas are heterogeneous

C. thyroid adenomas are hypovascular and parathyroid adenomas are hypervascular

A patient is referred for an abdominal ultrasound to rule out a post-transplant fluid collection. Which of the following is least likely to be a complication of a liver transplant? A. seroma B. hematoma C. urinoma D. abscess E. biloma

C. urinoma

What transducer would be preferred for the evaluation of sialolithiasis on an average sized patient? A. 3-5 MHz curvilinear B. 5-7 MHz linear C. 3-5 MHz sector D. 10-12 MHz linear

D. 10-12 MHz linear

Which of the following patients would most likely demonstrate a 10cm spleen with homogeneous echotexture? A. 30yr old female with lymphoma B. 65yr old female with mononucleosis C. 5'10" 250lb male born with homozygous sickle cell anemia D. 50yr old with a splenic artery aneurysm

D. 50yr old with a splenic artery aneurysm

The inferior mesenteric vein (IMV) __________________________. A. courses to the left of the IMA. B. drains blood from the distal colon. C. courses to the right of the IMA. D. A and B E. B and C

D. A and B

Hypernatremia and hypokalemia are clinical signs of A. Adrenal myelolipoma B. Addison disease C. Adrenal hemorrhage D. Conn syndrome

D. Conn syndrome Conn syndrome demonstrates low levels of potassium (hypokalemia) and high levels of sodium (hypernatremia). This causes excessive thirst and urination. High levels of potassium (hyperkalemia) and low sodium levels (hyponatremia) are seen with Addison disease.

Which of the following statement is true regarding rectus sheath hematomas? A. Arcuate line stops the blood from extending across the midline B. An acute hematoma will appear hyperechoic compared to surrounding tissues C. Linea alba stops the blood from spreading into the pelvis D. Coumadin therapy is a common cause for hematoma formation

D. Coumadin therapy is a common cause for hematoma formation

All of the following are patient positioning techniques used to better visualize the pancreas, except A. Upright position B. Semi-erect position C. Decub positions D. Drink water

D. Drink water

A benign thyroid adenoma is associated with __________________ calcification(s), while malignant adenomas are associated with ______________________ calcification(s). A. Punctate, Fine B. Punctate, Coarse C. Large, Coarse D. Eggshell, Punctate

D. Eggshell, Punctate

Which of the following describes the placement for the second line for measurement of the alpha angle during an infant hip evaluation? A. Aligned with iliac bone and extends through the center of the femoral head B. Extends from the bony edge of the acetabulum to the lateral aspect of the femoral head C. Extends from the iliac bone, along the labrum, and the lateral aspect of the femoral head D. Extends from the iliac bone, along the labrum, and the medial aspect of the femoral head

D. Extends from the iliac bone, along the labrum, and the medial aspect of the femoral head

Which liver function level is the most sensitive indicator for alcoholism? A. ALT B. AFP C. AST D. GGTP

D. GGTP

Which of the following will cause an increase in values on liver function tests? A. Adenoma B. Focal nodular hyperplasia C. Glycogen storage disease D. Hepatitis E. All of the above

D. Hepatitis

______________ is the most common malignancy of the liver seen in a patient with AIDS. _____________ is the most common infection of the liver seen in a patient with AIDS. A. metastasis, schistosomiasis B. hepatoblastoma, candidiasis C. hepatocellular carcinoma, hepatitis D. Kaposi's sarcoma, pneumocystis carinii

D. Kaposi's sarcoma, pneumocystis carinii

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

D. Left gastric, Splenic, Common Hepatic Artery

A patient presents with a history of Gaucher disease. What do you expect to see on the abdominal ultrasound exam? A. Numerous cysts within the mesentery B. Significant atherosclerosis in the aorta C. Bilateral atrophied kidneys with increased echogenicity D. Massive splenomegaly

D. Massive splenomegaly

An infant hip evaluation is performed to evaluate suspected: A. subluxation B. dislocation C. ossification D. More than one of the above

D. More than one of the above

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

D. Most aggressive testicular malignancy

Which of the following is least likely to be associated with gallbladder sludge? A. fasting B. cystic duct obstruction C. alcoholism D. elevated cholecystokinin levels

D. elevated cholecystokinin levels

Which of the following correctly describes Non-Hodgkin's lymphoma? A. Average patient age 20yrs B. More commonly affects lymph nodes in the arms, upper chest and neck C. Usually affects the retroaortic and pelvic lymph nodes first D. Much less responsive to treatment than Hodgkin's type

D. Much less responsive to treatment than Hodgkin's type

Which probe position is used to demonstrate all three hepatic veins entering the IVC? A. Sagittal subcostal position just to the left of midline B. Oblique intercostal approach angled superior toward the left shoulder C. Sagittal subcostal position just to the right of midline D. Oblique subcostal approach angled superior toward the right shoulder

D. Oblique subcostal approach angled superior toward the right shoulder

Which of the following is located between the transversalis fascia and the posterior parietal peritoneum? A. spleen B. stomach C. linea alba D. pancreas

D. Pancreas

Splenic atrophy in adults is often associated with: A. Typhoid fever B. Tuberculosis C. Splenitis D. Sickle cell anemia

D. Sickle cell anemia

The thyroid normally produces the most of which of the following hormones? A. T3 B. TSH C. Thyrotropin D. T4

D. T4

An 85yr old patient presents with a history of epigastric pain. Lab values are normal. The exam demonstrates normal intrahepatic ducts and a 10mm CBD that appears patent. The pancreas appears normal. Which of the following correctly explains the most likely reason for the 10mm CBD? A. The patient most likely has portal HTN which can cause ductal dilatation. B. The obstruction in the CBD must be due to biliary stricture which is hard to visualize sonographically. C. Cholangitis usually only affects the CBD and can lead to a focal extrahepatic dilatation. D. The CBD normally dilates with age.

D. The CBD normally dilates with age.

Which of the following can be used to differentiate Reidel's lobe from hepatomegaly? A. The ligamentum venosum is not visible in cases of Reidel's lobe but well seen in hepatomegaly B. The ligamentum teres is not visible in cases of Reidel's lobe but well seen in hepatomegaly C. The right lobe is normal in size in Reidel's lobe but enlarged with hepatomegaly D. The left lobe is normal in size with Reidel's lobe but enlarged with hepatomegaly

D. The left lobe is normal in size with Reidel's lobe but enlarged with hepatomegaly

A patient is referred for a renal ultrasound due to suspected horseshoe kidney. What is the expected ultrasound finding for this condition? A. Displacement of the kidney to the pelvic area. B. The hilums of the kidneys are joined across the midline by a bridge of renal parenchyma. C. Both kidneys are abnormally shaped like two horseshoes. The upper pole of the kidney is "bent" toward the lower pole. D. The lower poles of the kidneys are joined across the midline, usually anterior to the mid aorta.

D. The lower poles of the kidneys are joined across the midline, usually anterior to the mid aorta. Horseshoe kidneys and cross fused renal ectopia are congenital malformations that involve malpositioning of the kidneys. A horseshoe kidney leads to kidneys that are tilted medially and fused across the midline of the body. Cross fused renal ectopia is indicated when both kidneys are fused and identified on the same side of the body. These abnormalities occur during the formation and migration of the kidneys in utero. The overall renal function is usually not affected.

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. Hepatomegaly causes rounding of the superior liver segments. 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. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged.

D. When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged.

Which of the following is a contraindication for a liver transplant in a patient with hepatocellular carcinoma? A. the presence of a tumor in the caudate lobe B. more than 2 HCC tumors C. more than 1 HCC tumor D. a single primary tumor >5cm

D. a single primary tumor >5cm

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

D. a thyroid mass

The greatest advantage of ultrasound guided percutaneous needle biopsy over biopsy performed with cat scan guidance is the: A. decreased cost to the patient B. ability to take multiple samples during one procedure C. lack of radiation exposure D. ability to view the biopsy needle passing into the mass in real time

D. ability to view the biopsy needle passing into the mass in real time

Which of the following holds the psoas muscle? A. perirenal space B. anterior pararenal space C. posterior pararenal space D. retrofascial space E. none of the above

D. retrofascial space

A 55yrd old female presents with a fever, leukocytosis and LLQ pain. She states she suffers from Crohn's disease. The exam demonstrates a 2.7cm ill-defined hypoechoic mass in the LLQ that is surrounded by a small amount of ascites. There is no flow within the mass and no movement with peristalsis. What is the most likely diagnosis for these findings? A. Intussusception B. Retroperitoneal lymphadenopathy C. Appendicitis D. Abscess

D. abscess

Which of the following pancreatic abnormalities are associated with an increase in amylase and lipase levels in the blood? A. pseudocyst, acute pancreatitis and chronic pancreatitis B. chronic pancreatitis and pseudocyst C. pseudocyst and adenoma D. acute pancreatitis and pseudocyst

D. acute pancreatitis and pseudocyst

Which of the following abnormalities would benefit the most from the administration of a water enema during the ultrasound evaluation? A. gastric sarcoma B. pancreatic adenocarcinoma (head) C. distal abdominal aorta D. adenocarcinoma of the descending colon

D. adenocarcinoma of the descending colon

All of the following excrete amylase, except? A. kidneys B. salivary glands C. pancreas D. adrenal glands

D. adrenal glands

Any mass or focal thickening of the bladder wall demonstrated on a sonography exam should raise suspicion of what bladder abnormality(s)? A. Renal Cell CA metastasis B. Transitional cell CA C. Squamous cell CA D. All of the above

D. all of the above

Multicystic dysplastic kidneys are usually the result of: A. autosomal recessive genetic disorder B. chronic urinary tract infections as a child C. autosomal dominant genetic disorder D. an obstruction of the ureteropelvic junction in utero

D. an obstruction of the ureteropelvic junction in utero

What congenital anomaly of the pancreas results in duodenal obstruction? A. pancreatic sequestration B. pancreas divisum C. aberrant pancreatic tissue D. annular pancreas

D. annular pancreas

The celiac axis originates from the _____________, _____________ to the body of the pancreas. A. portal vein, inferior B. superior mesenteric artery, superior C. aorta, inferior D. aorta, superior

D. aorta, superior

Chronic moderate congestive heart failure can cause this tributary of the IVC to be visualized sonographically due to the formation of a collateral pathway. A. portal vein B. umbilical vein C. coronary vein D. azygous vein

D. azygous vein

Which of the following is incorrect when referring to the patellar tendon? A. injury associated with sports that involve jumping B. patient is unable to fully extend their leg C. injury usually causes detachment from the distal patella D. best imaged from the posterior approach

D. best imaged from the posterior approach

Which of the following is a fungal infection that can affect the kidney? A. E. coli infection B. salmonella infection C. streptococcus aureus infection D. candidiasis infection

D. candidiasis infection Candidiasis infection is caused by a fungus called candida albicans. It can cause the formation of fungal balls (mycetoma) or abscesses in the kidney. The liver can also demonstrate associated abscess formation. The other choices are types of bacteria.

Which of the following prostate abnormalities most significantly elevates the amount of serum prostate specific antigen in lab testing? A. abscess B. benign prostatic hypertrophy C. prostatitis D. carcinoma

D. carcinoma

Retrograde flow in the splenic artery would most likely indicate: A. left gastric artery occlusion B. chronic systemic HTN C. mild portal HTN D. celiac axis occlusion

D. celiac axis occlusion

Which of the following exam results is most likely to end up with an ultrasound guided biopsy of the area of interest? A. an irregular liver mass that is contiguous with the diaphragm seen on CT exam of the abdomen B. hot thyroid nodule seen on nuclear medicine exam C. a spiculated lung mass seen on a CT exam of the chest D. cold thyroid nodule seen on nuclear medicine exam

D. cold thyroid nodule seen on nuclear medicine exam

Malignant ascites is described as: A. hyperechoic fluid with septations B. anechoic fluid with free-floating bowel loops C. anechoic fluid with free-floating bowel loops and septations D. complex fluid collection with matted bowel loops

D. complex fluid collection with matted bowel loops

What penile structure is usually fractured with penile trauma? A. pampiniform plexus B. corpus spongiosum C. glans penis D. corpus cavernosum

D. corpus cavernosum

A patient presents with a history of Cushing syndrome and an adrenal tumor. Which of the following hormones will be increased? A. Aldosterone B. Cortisol and ACTH C. Epinephrine D. Cortisol

D. cortisol

Which of the following correctly describes the location of the right hepatic vein? A. courses inferiorly through the right intersegmental fissure B. courses superiorly through the main lobar fissure C. courses inferiorly through the falciform ligament D. courses superiorly through the right intersegmental fissure

D. courses superiorly through the right intersegmental fissure

The most common finding with choledochal cysts is: A. cyst formation on the fundus of the gallbladder B. cystic dilatation of multiple intrahepatic ducts C. cyst formation at the ampulla of Vater D. cystic dilatation of the common bile duct

D. cystic dilatation of the common bile duct

A. is less sensitive than color Doppler when evaluating renal transplant perfusion B. is preferred for evaluation of blood flow in a TIPS shunt C. is preferred for evaluation of blood flow in a patient with suspected portal HTN D. display is not dependent on incident beam angle

D. display is not dependent on incident beam angle

Which of the following describes a giant cell tumor of the hand? A. hypoechoic structure that demonstrates posterior enhancement B. moves with the adjacent tendon with flexion and extension C. anechoic structure that demonstrates posterior shadowing D. does not move with the adjacent tendon with flexion and extension

D. does not move with the adjacent tendon with flexion and extension

Bacterial cholangitis is nearly always seen with: A. biliary ascariasis B. HIV cholangitis C. ulcerative colitis D. ductal obstruction by a stone or tumor

D. ductal obstruction by a stone or tumor

A patient presents with an enlarged left scrotum and palpable mass. The US demonstrates an intratesticular mass that is hypoechoic and heterogeneous with multiple coarse calcifications. There is also an irregular central cystic area. Which of the following can be used to describe the findings? A. embryonal cell tumor only B. teratoma only C. seminoma only D. embryonal cell tumor or teratoma E. seminoma, embryonal cell tumor or teratoma

D. embryonal cell tumor or teratoma

Which of the following should be performed on a patient with suspected acute renal failure? A. evaluate the kidneys for suspected unilateral hydronephrosis B. evaluate the patient for signs of cortical thinning C. evaluate the S/D ratio of the interlobar arteries D. evaluate the bladder volume

D. evaluate the bladder volume

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

D. extrinsic compression of the celiac artery

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

D. fibromuscular region

Which of the following usually affects the pancreatic head? A. adenocarcinoma and cystadenoma B. cystadenoma and islet cell tumors C. pseudocyst and focal pancreatitis D. focal pancreatitis and adenocarcinoma

D. focal pancreatitis and adenocarcinoma

A 30yr old male presents with pelvic discomfort. He has a 2 year history of HIV infection and is an insulin dependent diabetic. When evaluating the urinary bladder, you identify a mobile, round, hyperechoic solid mass with no posterior shadowing. What is the most likely diagnosis for these findings? A. squamous cell carcinoma B. bladder stone C. transitional cell carcinoma D. fungal ball

D. fungal ball

All of the following are accessory glands of the GI tract, EXCEPT: A. pancreas B. liver C. submandibular gland D. gallbladder

D. gallbladder

What is the most common primary cancer to metastasize to the liver? A. colon B. ovary C. lung D. gallbladder

D. gallbladder

A 56yr old male presents with epigastric pain, nausea and a chronic history of alcoholism. Lab values demonstrate increased levels of amylase and lipase. Hematocrit levels are below normal values. The US exam demonstrates a hypoechoic, enlarged pancreas with periglandular fluid. Which of the following best describes the findings? A. acute pancreatitis B. chronic pancreatitis C. phlegmon D. hemorrhagic pancreatitis

D. hemorrhagic pancreatitis

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

D. hepatic adenoma and Budd Chiari syndrome

Periportal cuffing is a sign of: A. extrahepatic biliary tree obstruction B. Caroli's disease C. intrahepatic biliary tree obstruction D. hepatitis

D. hepatitis

A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of the liver. Which of the following best describes the findings on the exam? A. schistosomiasis B. candidiasis C. histoplasmosis infection D. hydatid disease

D. hydatid disease

Dark urine and pale stool are indications of: A. diverticulitis B. ulcerative colitis C. renal cell carcinoma D. hyperbilirubinemia

D. hyperbilirubinemia Increased serum levels of bilirubin leads to increased levels of bilirubin in other products excreted from the body. The urine will have a darker color and stool will be pale in color.

A contrast enhanced ultrasound examination is performed on a patient with suspected hepatocellular carcinoma. What are the expected findings if the exam is positive for HCC? A. hypoechoic lesions during the arterial phase and hyperechoic lesions during the portal venous phase B. hypoechoic lesions that demonstrate absence of contrast uptake throughout the arterial and venous phases of circulation C. hyperechoic lesions that demonstrate sustained levels of contrast uptake throughout the arterial and venous phases of circulation D. hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

D. hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

Which of the following is a symptom of Addison disease? A. hypernatremia B. weight gain C. hypertension D. hyperkalemia

D. hyperkalemia Addison Disease is referred to as adrenal insufficiency and results in low aldosterone and cortisol production. It is most commonly associated with autoimmune disorders and is caused by hypersecretion of adrenocortical hormones from the pituitary gland (high ACTH levels). Symptoms include fever, fatigue, hypotension, GI tract distress, weight loss, high levels of potassium (hyperkalemia) and low sodium levels (hyponatremia).

Which of the following is a symptom of Addison disease? A. weight gain B. hypokalemia C. hypertension D. hyponatremia

D. hyponatremia Addison Disease is referred to as adrenal insufficiency and results in low aldosterone and cortisol production. It is most commonly associated with autoimmune disorders and is caused by hypersecretion of adrenocortical hormones from the pituitary gland (high ACTH levels). Symptoms include fever, fatigue, hypotension, GI tract distress, weight loss, high levels of potassium (hyperkalemia) and low sodium levels (hyponatremia).

Hashimoto disease is the most common type of ______________ and leads to _________________. A. hyperthyroidism, goiter formation B. hyperthyroidism, diffuse enlargement of the gland C. hypothyroidism, nodule formation D. hypothyroidism, diffuse enlargement of the gland

D. hypothyroidism, diffuse enlargement of the gland

A normal portal vein will: A. increase in diameter by placing patient in the upright position B. increase in diameter after exercise C. decrease in diameter after eating D. increase in diameter by more than 20% with deep inspiration

D. increase in diameter by more than 20% with deep inspiration

Which of the following blood tests will aid in diagnosis of a hydatid cyst in the liver? A. serum lipase and amylase B. ratio of conjugated bilirubin to unconjugated bilirubin C. albumin / protein ratio and aldosterone assay D. indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA)

D. indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA) Hydatid disease of the liver can be diagnosed with simple blood testing using the indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA). A Casoni test (similar to PPD test) can also be administered to assess for hydatid disease.

Which of the following vessels are a common source for a Type II endoleak? A. celiac axis and superior mesenteric artery B. common iliac artery and gonadal arteries C. left gastric artery and right hepatic artery D. inferior mesenteric artery and lumbar arteries

D. inferior mesenteric artery and lumbar arteries

A hernia with a narrow neck: A. can be closed with compression therapy instead of surgery B. should not be evaluated with the Valsalva maneuver C. is usually completely reducible with compression D. is at an increased risk for incarceration and strangulation

D. is at an increased risk for incarceration and strangulation

Which of the following is associated with hypoglycemia? A. adenoma B. oncocytoma C. mucinous cystadenoma D. islet cell tumor E. diabetes mellitus

D. islet cell tumor Hyperinsulinism causes hypoglycemia. Diabetes is related to increased blood sugar levels. An insulinoma is a type of islet cell tumor that causes overproduction of insulin. Islet cell tumors are referred to as pancreatic endocrine tumors.

Patients with new onset of secondary hyperparathyroidism will demonstrate: A. increased vitamin K and D levels B. increased vitamin D levels, normal calcium and PTH levels C. increased serum calcium levels, vitamin D and PTH D. low serum calcium levels and vitamin D with high PTH levels

D. low serum calcium levels and vitamin D with high PTH levels

Which type of pancreatic mass has a strong risk of malignant conversion? A. insulinoma B. microcystic cystadenoma C. gastrinoma D. macrocystic cystadenoma

D. macrocystic cystadenoma

Which of the following vessels will be abnormally dilated with significant portal HTN? A. main portal vein only B. hepatic veins only C. left gastric vein only D. main portal vein and left gastric vein E. hepatic veins, main portal vein and left gastric vein

D. main portal vein and left gastric vein

Which of the following is a common cause of exudate pleural effusion? A. congestive heart failure B. kidney failure C. cirrhosis D. malignancy

D. malignancy

A. untreated kidney infection B. metastatic disease C. significant cardiac disease D. marked increase in serum creatinine

D. marked increase in serum creatinine

Which of the following is least likely to cause anterior displacement of the aorta? A. spinal mass B. lymphadenopathy C. retroperitoneal fibrosis D. mass in the left diaphragm crura

D. mass in the left diaphragm crura

While scanning the abdomen, you note the gallbladder is moderately overdistended. Which of the following is the most likely cause for the finding? A. right hepatic duct stone B. portal HTN C. gastric mass D. mass of the ampulla of Vater

D. mass of the ampulla of Vater

A patient presents for an abdominal ultrasound due to a history of elevated amylase. She was diagnosed 5 years ago with Von Hippel Lindau syndrome. You identify a round, lobulated hyperechoic mass in the body of the pancreas. Mild posterior enhancement is present. Which of the following is the most likely diagnosis for the abnormality displayed? A. pseudocyst B. adenocarcinoma C. Sphincter of Oddi carcinoma D. microcystic cystadenoma

D. microcystic cystadenoma

A patient presents for an ultrasound of the RUQ due to a recent diagnosis of duodenal cancer. If liver metastasis is present, what are the expected sonographic findings? A. large solitary hypoechoic lesion B. multiple target lesions C. multiple complex cystic lesions D. multiple hyperechoic lesions

D. multiple hyperechoic lesions

The splenic vein distributes blood to the ____________________________. A. stomach B. pancreas C. spleen D. none of the above

D. none of the above

What is the name of the calcium based hormone produced by the parathyroid? A. Calcitonin B. PTH C. TSH D. None of the above

D. none of the above

Which of the following vessels follow a retroaortic course in the abdomen? A. right renal artery B. left renal artery C. portal confluence D. None of the above

D. none of the above

Appendiceal perforation is least likely to be associated with: A. loculated fluid collection B. abscess formation C. phlegmon formation D. nonvisualization of the pericecal fat

D. nonvisualization of the pericecal fat

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

D. on the midline neck, superior to the thyroid gland

Ascites is usually associated with all of the following, except: A. hepatoma B. renal failure C. congestive heart failure D. oncocytoma

D. oncocytoma

All of the following have been associated with peliosis hepatis, except: A. anabolic steroids B. renal transplant C. HIV D. pregnancy

D. pregnancy

In infants and children, the superior vena cava, aorta, and _________________, are well visualized using the thymus as an acoustic window A. inferior vena cava B. distal carotid arteries C. renal arteries D. pulmonary artery

D. pulmonary artery

Harmonic imaging leads to: A. increased image noise B. reduced signal to noise ratio C. improved axial but degraded lateral resolution D. reduced appearance of lobe artifact

D. reduced appearance of lobe artifact

Which of the following renal pathologies will appear the same sonographically as focal acute pyelonephritis? A. angiomyolipoma B. renal adenoma C. pyonephritis D. renal infarct

D. renal infarct

Which of the following are commonly associated with retroperitoneal fibrosis? A. pedal edema and portal HTN B. hydronephrosis and ureterocele formation C. scrotal calcifications and cryptorchidism D. scrotal swelling and pedal edema

D. scrotal swelling and pedal edema Retroperitoneal fibrosis refers to the formation of fibrous tissues in the retroperitoneum. This tissue formation can cause stenosis or obstruction of blood vessels and ureters due to extrinsic compression. If the IVC is compressed, pedal edema and scrotal swelling can occur. Fibrosis in the area of the ureter can lead to hydronephrosis.

Which of the following statements is false regarding pancreatic divisum? A. abnormal drainage of the pancreatic enzymes B. commonly associated with pancreatitis C. most common congenital pancreatic anomaly D. sonographically demonstrates a classic V-shaped organ with increased vascularity

D. sonographically demonstrates a classic V-shaped organ with increased vascularity

Which acoustic property causes the echogenic appearance of the diaphragm related to surrounding structures? A. attenuation B. non-specular reflection C. refraction D. specular reflection

D. specular reflection

Prehn's sign is used to differentiate what two abnormalities? A. renal cell carcinoma and oncocytoma B. seminoma and yolk sac tumor C. fungal liver abscess and amoebic liver abscess D. testicular torsion and epididymo-orchitis

D. testicular torsion and epididymo-orchitis

The double duct sign refers to the dilatation of: A. the main pancreatic duct and accessory pancreatic duct B. the common bile duct and cystic duct C. right and left hepatic ducts D. the common bile duct and the duct of Wirsung

D. the common bile duct and the duct of Wirsung

A patient presents with mild testicular pain that has increased over the last few months. The US exam demonstrates a normal right testicle. The left testicle demonstrates many tiny cysts clustered centrally along the mediastinum. No color flow is identified within the cystic structures. Which of the following best describes the findings? A. cystadenoma B. spermatocele C. varicocele D. tubular ectasia

D. tubular ectasia

Normal hepatic venous flow will demonstrate: A. two large antegrade diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction B. two large retrograde diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction C. two large retrograde diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction D. two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction

D. two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction

A patient with a seminoma of the left testicle will usually be treated by ___________, while a patient with a non-seminomatous tumor of the left testicle will usually be treated by _____________. A. bilateral orchiectomy, unilateral orchiectomy B. chemotherapy, radiation therapy C. unilateral orchiectomy, radiation therapy and unilateral orchiectomy D. unilateral orchiectomy and chemotherapy, unilateral orchiectomy

D. unilateral orchiectomy and chemotherapy, unilateral orchiectomy

All of the following correctly describe adrenal gland hemorrhage, except: A. in adults, it can be related to thrombocytopenia B. most commonly seen in newborns C. associated with decreased hematocrit levels D. very rare because the adrenal glands are hypovascular fatty organs

D. very rare because the adrenal glands are hypovascular fatty organs

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 leads to dilated intrahepatic ducts while cholangiocarcinoma leads to dilated extrahepatic ducts D. Cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation

D.Cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation

A 2 week post op liver transplant patient is referred for an abdominal ultrasound due to the presence of an abdominal bruit. Hepatic artery stenosis is suspected. Which of the following Doppler characteristics of the hepatic artery will be seen in this patient if flow is normal? A. increased resistive index B. increased systolic velocity of flow C. mosaic color pattern D. loss of spectral window E. absence of diastolic flow reversal

E. absence of diastolic flow reversal

adrenal cortical carcinoma. Which of the following statements is true regarding this pathology? A. Associated with Cushing syndrome B. Associated with increased cortisol levels C. Very aggressive malignancy that can grow to be very large D. More than one but not all E. All of the above

E. all of the above

A patient presents for an abdominal sonogram due to a history of acute onset of malignant HTN. What structure(s) should be closely evaluated? A. celiac axis B. distal aorta C. mesenteric arteries D. aortic arch E. renal arteries

E. renal arteries Malignant HTN refers to a significant increase in systemic BP that is unaffected by medications. Stenosis in the renal arteries causes decreased flow to the kidneys. Once the kidneys detect the decrease in blood flow, they activate the renin-angiotensin system in the body. The systemic BP will increase to push more blood to the kidneys to increase perfusion. The stenosis will still block any increase in flow which causes the BP to continue to increase to sometimes dangerous levels.

A patient presents with mild scrotal pain and swelling on the left side that started 2-3 days ago. The patient awoke this morning with a slight fever and increased swelling. All of the following should be a suspected cause for the symptoms, except: A. orchitis B. epididymitis C. hydrocele D. intratesticular abscess E. testicular infarct

E. testicular infarct Acute pain and swelling, not associated with trauma, are usually caused by infection. Scrotal infections can lead to hydrocele formation that will present as swelling. A testicular infarct would not be related to a fever.

The pancreas is encapsulated by: A. greater omentum B. Gerota's fascia C. Glisson's capsule D. peritoneum E. none of the above

E.none of the above

match the primary carcinoma with the most common sonographic appearance of liver mets: Hyperechoic lesions with hypervascularity choices:mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

renal cell carcinoma

The ------- courses posterior to the IVC to reach the right kidney.

right renal artery

match the primary carcinoma with the most common sonographic appearance of liver mets: Hypoechoic choices:mucinous adenocarcinoma,GI tract,lymphoma, lung or breast primary,sarcoma, renal cell carcinoma, and lung or colon

sarcoma