Abdomen Final
prostate is best seen
-BEST SEEN TRANSRECTAL-ENDORECTAL
ASPIRATIONS
-FNA OF CELLS... NOT TISSUE
TWO METHODS FOR PERFORMING ULTRASOUND GUIDED PROCEDURES
-FREE HAND OR NEEDLE GUIDES... MACHINES DECIDES
PROSTATE ANATOMY -4 ZONES
-PERIPHERAL ZONE -CENTRAL -TRANSITIONAL -PERIURETHRAL GLANDULAR ZONE
CORE BIOPSY
-TAKES A CHUNK SAMPLE OF THE TISSUE- SPRING LOADED GUN FOR HISTOLOGIC ANALYSIS
DISADVANTAGES
-TECH RELATED -COMFORT EXPERIENCE -FREE HAND ANGLES -FIXED ANGLES
WHICH ZONE IS PREVALENT TO HAVE PATHOLOGY?
-TRANSITIONAL
MSK- TENDONS
-USE 7 TO 10 MHZ SOFT TISSUE LINEAR ARRAY TRANSDUCER
The beta angle is measured between lines
1 and 3
A dimple may indicate a spinal abnormality if it is more than _____ from the anus.
2.5 cm
What needle guide is typically used in a fine- need aspiration?
20 - 25
The sonographer should take at least how many images of the pediatric hip with the alpha and beta angles?
3
LESS THAN 4.0 PSA NORMAL
4 TO 10 NORMAL LAB VALUES PSA CANCER PRESENCE OF DISEASE
How many lumbar vertebrae are there?
5
Normal AP meas at mid section of Achilles
5 to 6 mm.
Seminal vesicles secrete a viscous fluid rich in fructose; constitutes about -- % volume of semen
60
Vertebral column consists of 33 vertebrae:
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal fused bones
50% of all men have an enlarged prostate by age 60
80% of men have an enlarged prostate by age 80
Prostate gland -- grams is considered enlarged?
>40 g
Patients with carpal tunnel syndrome typically have a positive _______ sign. A) Phalen's B) Homen C) Thompson D) Murphy
A) Phalen's
The posterior glenoid labrum is a good landmark to help locate with on the following structures? A) biceps tendon B) infraspinatus tendon C) supraspinatus tendon D) deltoid muscle
A) biceps tendon B) infraspinatus tendon had this, seen A somewhere else ??
Tendinitis is seen more often in the shoulder, wrist, and ______. A) elbow B) knee C) hip D) fingers
A) elbow
A bursa provides which one of the following functions? A) fluid protection to areas that are subject to friction B) support to muscles C) support to tendons D) nerve bundles to the ligaments
A) fluid protection to areas that are subject to friction
When compared with muscle, a normal nerve is ______. A) hyperechoic B) isoechoic C) hypoechoic D) unable to be visualized on ultrasound
A) hyperechoic
Acute rotator cuff tear may be caused by all of the following except: A) years of playing tennis B) biceps tendon rupture C) falls D) shoulder dislocation
A) years of playing tennis
The largest tendon of the body is the? A) biceps B) Achilles C) supraspinatus D) trapezius
B) Achilles
Indications for wrist sonography include all of the following except: A) pain and swelling B) Thompson sign C) trauma D) Tinel's sign
B) Thompson sign
Which one of the following structures is a band like flat tendon connecting muscle to bone. A) ligament B) aponeurosis C) synovial sheath D) pinnate
B) aponeurosis
Th easiest tendon to image in the adult shoulder is the? A) supraspinatus B) biceps C) infrasoinarus D) supcapsularis
B) biceps
A complete tear of a muscle with a straightforward appearance of a retracted hyperechoic muscle surrounded by a hematoma is known as the ______ sign. A) McBurney's B) clapper-in-the-bell C) gastrocnemius D) sandwich
B) clapper-in-the-bell
Which one of the following types of tendinitis causes pain over the lateral wrist? A) tenosynovitis B) de Quervain tendinitis C) synovial tendinitis D) carpal tunnel syndrome
B) de Quervain tendinitis
❑Is a common problem in older men ❑ ❑Characterized by: enlargement or hypertrophy of the prostate ❑ ❑Enlargement may cause urinary obstruction (urethra passes through the central part of the prostate)
Benign prostatic hyperplasia( Enlargement)
The tendon responsible for dorsal and plantar flexibility of the foot is the ______ tendon. A) biceps B) patellar C) Achilles D) semimembraneous
C) Achilles
Sonographic appearance of the normal muscle appears? A) hyperechoic B) complex C) homogeneous D) heterogeneous
C) homogeneous
The Achilles' tendon is at increased risk for injury because of _____. A) it's vulnerable location B) no surrounding muscle C) its limited blood supply D) it's large size
C) its limited blood supply
Important artifacts in musculoskeletal ultrasound include all of the following except: A) reverberation B) refractile shadowing C) mirror image D) anisotropy
C) mirror image
A hypoechoic halo around a tendon represents which one of the following? A) partial tear B) tendonitis C) normal synovial sheath D) abnormal synovial sheath
C) normal synovial sheath
The proximal portion of the muscle is considered the ______. A) insertion B) anastomosis C) origin D) bifurcation
C) origin
Which one of the following imaging artifacts bends the sound beam to an oblique path? A) reverberation B) anistrophy C) refractile shadowing D) time of flight
C) refractile shadowing
ADVANTAGES OF OUR ROLE OF ULTRASOUND GUIDANCE
CONTINUOUS REAL TIME OF THE NEEDLE ALLOWS ADJUSTMENTS OF THE NEEDLE
SMALL FLUID COLLECTIONS 20-25 GAUGE NEEDLE WITH CUTTING TIP-
CYSTOLOGIC ASPIRATION
A baker's cyst is an example of:
Communicating bursa
Develops between 8th and 18th week of gestation, beginning ventrally and extending dorsal
Corpus Callosum
Infringement of the median nerve in the wrist results in: A) arthritis B) bursitis C) impingement syndrome D) carpal tunnel syndrome
D) carpal tunnel syndrome
The most common site of an Achilles tear is? A) proximal B) medial C) lateral D) distal
D) distal
Support and strength of a joint result, in part, from which one of the following structures? A) muscle B) bursa C) cartilage D) ligament
D) ligament
Image of prostate
Endo rectal prostate
BENEFITS OF NEEDLE GUIDES
FASTER LEARNING CURVE- FASTER PLACEMENT OF THE NEEDLE ABILITY TO KEEP NEEDLE THROUGH THE EXACT SAME PATH BETTER FOR ASPIRATIONS FOR FLUID SAMPLING
--- PORTION OF THE PROSTATE IS NOT A ZONE
FIBROSTROMAL
---(bending forward) and --- (bending backward):
Flexion Extension
While scanning the hips and spines of pediatric patients, what may be used to facilitate stillness and positioning?
Graf cradle
--- seem to have high association with tethered spinal cord.
Hemangiomas
area in which falx cerebri sits and separates two cerebral hemispheres
Interhemispheric fissure
PICTURE OF NEONATE BRAIN
LATERAL VENTRICLES CHOROID PLEXUS
NORMAL MEASUREMENTS FOR LATERAL VENTRICLES
MEASURE LESS THAN 10 <10MM LESS THAN 1 CM ...NOT EXCEED 10 MM... OVER IS DILATED
An open cystic lesion is noted on the posterior aspect of the spine on a newly born infant during physical examination. Meningomyelocele is suspected. What is the most appropriate investigation?
MRI of the spine
---- abnormalities over lower back most common reason for neonatal spinal sonography requests
Midline cutaneous
-- --- BONE INSERTION FOR ACHILLES
POSTERIOR CALCANEUS
❑The surgical removal of all part of the gland is known as
Prostatectomy
NAME OF POSTERIOR FISSURE-
QUADRAGERMINAL
Myelomeningocele
Spinal canal does not close before birth.
Diagnostic triad for early detection of prostate cancer
TRUS DRE PSA
-- -- view is crucial for assessing acetabular (cup shape socket) development
The coronal
Hip scans
The reason we asses is risk factors -breech babies -females -first born -unilateral -left hip most affected
is posterior. Doppler should be performed to make sure it is fissure and not an enlarged vein of Galen.
Vein of Galen
Ultrasound examination of the hip of a 6 month old boy shows a correctly located and stable femoral head. The alpha angle is 65 degrees, the beta 52 degrees, and the femoral head coverage 56%. The acetabulum has a bony roof and sharp ossified rim. The labrum has a long and narrow cartilage roof and extends far over the femoral head. These findings indicate;
a normal mature hip
Ultrasound of the neonate brain is possible due to;
a soft anterior fontanelle that has not yet fused
Image of endoprostate with small hypoechoic structure
adenocarcinoma
More than 95% of prostatic neoplasm's are ------, and most occur in the periphery of the prostate.
adenocarcinomas
Which is the most severe form of holoprosencephaly?
alobar
Cerebrospinal fluid normally appears;
anechoic, surrounding the spinal cord
Which of the following artifacts depends on the angle of incidence?
anisotropy
Which approach is best for scanning the hip of older children?
anterior
In ---- prostatitis, sexual transmission of bacteria is common
bacterial
In a neonate, the most distal aspect of the vertebra column is usually not ossified yet. This part of the spine is known as the;
coccyx
What artifact is a type of reverberation caused by a number of small, highly reflective interfaces such as a needle gauge?
comet tail artifact
The common indication for a biopsy is to
confirm malignancy in a mass
Structure at the L1 and L2
conus medullaris
The caudal end of the spinal cord is called the __________
conus medullaris
The single most important determination is usually the level of the tip of the tapered
conus medullaris.
Largest and densest bundle of white matter is the
corpus callosum
An extension of the internal obliques muscle that descends to the testis with the spermatic cord
cremasteric muscle
Contradictions for a biopsy include all of the following except:
dehydration
is tail of choroid plexus and a major site for bleeding.
glomus
The spinal cord is -- with slightly echogenic borders and an echogenic line extending longitudinally along its midline.
hypoechoic
The alpha angle is measured between
line 1 and 2
Sonographer of the neonatal hip is performed with which transducer;
linear array
common benign tumor composed of fat cells
lipoma
fatty masses that have connection with spinal cord (common benign tumor composed of fat cells).
lipoma
choroid plexus
mass of special cells located in atrium of lateral ventricles
A neonate is referred for ultrasound after a cystic mass is noted on the posterior aspect of the spine on physical examination. This shows an anechoic lesion that communicates with the spinal cord. Most likely diagnosis;
meningocele
Ultrasound may be contraindicated in patients with:
meningocele
Advantages of using ultrasound guidance include all of the following except
multiple angels when using needle guides
When the spinal cord and nerve roots are exposed due to failure of the neural tube to fold and fuse in the midline results in
myelomeningocele
Midline hair patches, fatty lumps, skin tags, pigmented nevi, lumbar dimples, aplasia cutis, and hemangiomas over back should prompt search for
occult tethered spinal cord.
The national patient safety standards mandate that a "time out" be performed before the beginning of any procedure, which means all of the following except:
patients name is recited by a team member
formation of the hip bones by the ilium, ischium, and pubis
pelvic girdle
Which of the following would be the most likely location of prostate cancer?
peripheral zone
Before the posterior arch of the spine in young infants starts to ossify, it can be used as an acoustic window. This acoustic window decreases as ossification progresses. To increase the acoustic window the sonographer should;
place the child in spinal flexion
For younger men, the most common prostate problem is ------.For older men, it's an enlarged prostate.
prostatitis
Cysts of seminal vesicle are .
rare
Which if the following imaging artifacts bends the sound beam to an oblique path?
refractile shadowing
Indications for sonography of the neonate head include all of the following except:
sacral dimple
Clinical signs that there is a spinal problem in an infant include all of the following except
shortened femur
Limitations of ultrasound guidance include all EXCEPT which of the following?
shorter procedure times
The crass position is used to evaluate which one of the following structures?
shoulder
This occurs when the femoral head moves posteriorly and remains in contact with the posterior aspect of the acetabulum;
subluxation
For hip imaging of older children, the following patient potion is best;
supine
located along lateral most aspect of brain; area where middle cerebral artery is located
sylvian fissure
Occult tethered cord
tension on cord
A misplaced testicle is known as a;
testicular ectopic
Patients with cryptorchidism have an increased risk for
testicular malignancy
While scanning the hip of a 2 month old boy, the sonographer notes that the femoral head is hypoechoic, while the ischium and femoral shaft are hyperechoic. This indicates:
that the femoral head is still cartilaginous at this age
In the Barlow test;
the hip is placed in flexion and abduction
The measure the beta angle of the hip, the sonographer needs to determine the inclination line. This line connects;
the lateral aspect of the bony acetabular rim with the lateral aspect of the cartilaginous acetabular labrum
primigravida uterus
the uterus in a woman first pregnancy
filum terminale refers to
thin extension of the nerve fibers to the level of S2
A pavilk harness is often used to treat developmental dysplasia of the hip. When scanning the hips of an infant in a pavlik harness the appropriate procedure is;
to leave the harness on unless advised otherwise by pediatrician
Which of the following would be the most likely location of a benign prostatic hyperplasia?
transitional zone
Ultrasound is the gold standard modality used for paracentesis for procedure guidance T or F
true
Which of the following is associated with an elevation of alpha-fetoprotein
yolk sac tumor
prostatitis
•BENIGN INFLAMMATION OF THE PROSTATE MAY INCLUDE: • ACUTE • • CHRONIC
