Clinical 20% Scrotum, Thyroid, Proc

B. 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.

A 3 cm hypoechoic mass is identified in the right testicle. The radiologist requests that you perform an abdominal US. What are you looking for? A. Associated Crohn disease B. Periarotic lymphadenopathy C. Other manifestations of MENS syndrome D. Renal vein tumor invasion

C. Note the body marker on the image indicates the right side. There is no color flow present for the right testicle or epididymis which indicates no blood flow is present. Note the overall heterogeneity of the testicle and epididymis. As ischemia sets in the tissues will become increasingly heterogeneous. Recent groin trauma can lead to torsion of the testicle within the scrotal sac. Orchitis would lead to increased blood flow to the testicle that would easily be demonstrated with color Doppler. There is no flow demonstrated in this testicle.

A 30 yr old male presents with a softball injury to the groin area. The scrotum is abnormally swollen and extremely painful for the patient. Which of the following statements is true regarding the findings on the image? A. The right testicle has ruptured and increased flow is seen within the testicular tissue B. The right testicle demonstrates orchitis with increased vascularity C. The right testicle appears tossed D. The left testicle appears torsed

B. Scrotal varicoceles have been linked to male infertility

A 30 yr old presents with history of a normal clinical exam of the scrotum and infertility. What is the referring doctor expecting to find on the US exam? A. Acute epididymitis B. Varicocele C. Torsion D. Seminoma

D. Sterile packages can be opened with non-sterile gloves but if any items inside the tray will be touched, sterile gloves must be used. Sterile gloves must be used to remove items for the tray to prepare them (needle, syringe, biopsy instrument).

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. When in doubt about sterility, discard the potentially contaminated item and begun again D. Sterile gloves must be used to open the procedure tray

D. lodinated contrast material is injected into a vessel to highlight the lumen characteristics. The contrast media causes opacity of the patent portions of the vessels. The color of the contrast on the image can be bright white or dark gray, depending on the angiography system settings. Areas that are obstructed with thrombus or plaque will not fill with the contrast media.

An area of plaque or thrombus in an artery will be demonstrated as _________________ on angiography. A. A highly reflective area within vessel B. An area of increased concentration of contrast material C. A dark black area within the vessel D. An area of absence of contrast material

D. The lower the probe frequency, the better the penetration of the beam. The longer the focus, the better the resolution of deeper structures.

An obese patient has a known hepatoma in the posterior aspect of the right lobe of the liver. Which probe would you use to assist the radiologist in performing a biopsy? A. 2.25 MHz, short focus B. 3.5 MHz, long focus C. 5 MHz, short focus D. 2.25 MHz, long focus

D. Hypophosphatemia and hypercalcemia are clinical signs of hyperparathyroidism. The excess PTH production causes reduced calcium excretion (hypercalcemia) and an increase in the excretion of phosphate (hypophosphatemia).

A 65 yr old female presents for a neck ultrasound with a script that states hypophosphatemia and hypercalcemia. What do you expect to find on the exam? A. Atrophied thyroid gland B. Medullary thyroid cancer C. Papillary thyroid cancer D. Enlarged parathyroid glands

D. A FNA biopsy of a thyroid nodule is not recommended for nodules <10mm.

A FNA biopsy of a thyroid nodule is not recommended for nodules __________________. A. < 1 mm B. > 50 mm C. < 20 mm D. < 10 mm

C. Thyroglobulin and thyroglobulin antibody levels monitored in post-surgical patients with a bilateral thyroidectomy after a cancer diagnosis. If the patient had a complete thyroidectomy, there should be no thyroglobulin present in the blood. Increasing thyroglobulin levels and thyroglobulin antibody levels in a post-surgical patient can indicate recurrence.

A patient has a history of thyroid cancer and bilateral thyroidectomy 3 years ago. What lab values should be reviewed before starting the annual post-surgical neck ultrasound? A. Serum levels of T4 B. Serum levels of T3 C. Serum levels of thyroglobulin D. Serum levels of CEA 123

C. Cryptorchidism refers to an undescended testicle. The testicles originate in the pelvis and normally descend along the inguinal canal into the scrotum.

A patient is referred to rule out cryptorchidism. You evaluate the scrotal sac with US and demonstrate the presence of a right testicle only. Where will you look first for the left testicle. A. Left paracolic gutter B. Right inguinal canal C. Left inguinal canal D. Right paracolic gutter

B. Prothrombin time (PT) and International Normalized Ratio (INR) values are required before the procedure to evaluate clotting ability of blood.

A patient is scheduled for a liver biopsy with the radiologist in the morning. What lab values will the doctor want to see before the procedure is performed ? A. WBC count B. Prothrombin time and INR C. RBC and platelet count D. BUN and creatinine

A. The radioactive tracer used in thyroid scintigraphy is designed to indicate concentrations of iodine. A hot nodule indicates hyperactive thyroid tissue. The majority of hot nodules are benign and a hyperfunctioning adenoma is common. Adenomas are usually solid with a hypochoic halo surrounding the mass

A patient present for a thyroid ultrasound due to an incidental finding on a nuclear medicine exam. The report states there is a 2 cm hot nodule int eh upper left lobe. Which of the following is the most likely findings on the ultrasound exam? A. Solid mass with hypoechoic halo B. Cystic mass C. Complex cyst with peripheral hypervascularity D. Solid mass with microcalcifications and irregular margins

D. Sjogren syndrome is an immune system disorder that causes a reduction in saliva and tear production. It is associated with rheumatoid arthritis and lupus. Primary symptoms are dry eyes and dry mouth. It may cause swelling of the salivary glands. Usually affects the parotid and submandibular glands. Swelling of the salivary glands with a dry mouth is a common finding with Sjogren syndrome.

A patient presents for a neck ultrasound due to swelling under the angle of the jaw and anterior to the ear. She also complains of a dry mouth, dry cough and dry eyes. These clinical findings are most suggestive of: A. Graves' disease B. Hashimoto thyroiditis C. Hemolytic anemia D. Sjogren syndrome

C. NM exams use a radioactive isotope injection and the area of interest is evaluated for areas of increased uptake of the isotope. Different isotopes are used for different exams. NM can be used to evaluate gallbladder function, gastric emptying, cardiac wall perfusion, lung perfusion, bone and brain tumors or infection. The exam is commonly used to evaluate thyroid function and suspected thyroid malignancy. Hot Thyroid Nodule: Functional adenoma or thyroiditis; A nodule that is overproducing thyroid hormone which attracts more of the isotope than the surrounding normal tissue. The nodule appears as darker area over the mass than the normal tissue. These nodules are rarely malignant. Cold Thyroid Nodule: Nonfunctional nodule that does not demonstrate isotope uptake; It looks like a hole in the gland with white area in the area of interest. 20% of cold nodules are malignant and these nodules usually require biopsy.

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. Oral contrast for CT can inhibit or degrade the ultrasound evaluation of the same areas. The contrast should be ingested after the ultrasound exam. The contrast is used to highlight the digestive tract and both the CT and ultrasound exam would be beneficial to the patient because of their generalized symptoms. A Sonographer should never attempt to advise a physician or patient regarding the necessity of an exam. Consult your reading physician with any questions about exams.

A patient presents for an abdominal ultrasound exam due to recent general pain in the abdomen. While reviewing the patient chart, you note that they have a CT of the abdomen with contrast that is scheduled immediately after the ultrasound appointment. How should you proceed? A. Call the referring doctor to let them know that the two exams will image the same anatomy and one should be cancelled B. Contact the CT department to ask them to do their exam first C. Complete the ultrasound exam and guide the patient to the CT department where they can drink the necessary contrast material D: Ask the patient to finish drinking the CT contrast material before you start the ultrasound exam

D. 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.

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 causes for the symptoms, except: A. Orchitis B. Epididymitis C. Hydrocele D. Testicular infarct

D. A prostate biopsy requires the patient to perform a cleansing enema before the procedure. The radiologist will want the PT/INR values to assess the risk of hemorrhage from the procedure. Antibiotic therapy is required before and after the exam to prevent infection. The patient is not required to be NPO before the procedure.

A patient scheduled for a trans recital prostate biopsy must perform all of the following prior to the exam, except: A. Have lab resting for PT/INR levels B. Begin taking a several day course of antibiotics C. Perform a cleansing enema D. Nothing to eat or drink at least 8 hours before the procedure

A. Air does not attenuate radiation. Air is demonstrated as black on a CT scan because the full beam of radiation reaches the sensor.

Air in the gallbladder wall will be demonstrates 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.

D. Hypertension, nephrolithiasis, osteopenia, weakness, and malaise are common symptoms of hyperparathyroidism. The parathyroid glands control calcium levels in the blood. Kidney stones and brittle bones are signs of hypercalcemia.

Hypertension, nephrolithiasis, osteopenia, weakness, and malaise are common symptoms of: A. Hypoparathyroidism B. Hypothyroidism C. Hyperthyroidism D. Hyperparathyroidism

C. Hyperparathyroidism leads to increased PTH production. This causes increased renal excretion of phosphate and reduced serum phosphate levels (hypophosphatemia). Cushing syndrome and hypothyroidism are also associated with hypophosphatemia. Renal failure is a common cause of hyperphosphatemia.

Hypophosphatemia is a clinical sign of: A. Renal failure B. Internal hemorrhage C. Hyperparathyroidism D. Hyperthyroidism

B. The left kidney should be scanned when a varicocele is found on the left side. The upper abdomen should be evaluated for the presence of a mass when a varicocele is found on the right side.

If a varicocele is identified on the left side: A. the IVC should be evaluated for a Greenfield filter B. The left kidney should be evaluated for mass formation C. The left kidney should be evaluated for renal artery stenosis D. The porta hepatis should be evaluated for cavernous transformation

B. In patients with primary hyperparathyroidism, levels of parathyroid hormone will be increased and serum calcium levels will be increased. In patients with secondary hyperparathyroidism, levels of parathyroid hormone will be increased and serum calcium levels will be low.

In patients with primary hyperparathyroidism, levels of parathyroid hormone will increase and: A. T4 levels will increase B. Serum calcium levels will increase C. Serum calcium levels will decrease D. T3 levels will increase

A. lodine deficiency is a primary cause of hypothyroidism. The body needs iodine to produce thyroid hormones. If there is too little iodine in the blood, a goiter can form.

Iodine deficiency is a primary cause of: A. Hypothyroidism B. Renal calculi C. Sialolithiasis D. Cirrhosis

D. In cases of a multinodular goiter, the thyroid tissue is abnormal and it produces an abnormally low level of hormones, T3 and T4. The pituitary will over produce TSH to try to stimulate the gland to produce more T3 and T4. The gland also tries to produce more thyroid tissue in order to produce more hormones. The new thyroid tissue is also abnormal and only produces low levels of the hormones. Without treatment, the overproduction of tissue can cause a significant increase in gland size.

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

B. Secondary Hyperparathyroidism: All 4 glands hyperfunctioning for unknown reason Usually caused by renal failure, also vitamin D deficiency, malabsorption syndromes Failing kidneys cannot remove phosphorus from the blood which causes calcium levels to drop PTH production is increased as the body tries unsuccessfully to raise calcium levels Low calcium with high PTH levels seen early in the disease progression Primary Hyperparathyroidism: Most commonly occurs due to single adenoma in one parathyroid gland PTH secretion is constantly induced which induces parathyroid gland hyperplasia Increasing PTH increases serum calcium levels Increasing calcitonin reduces serum calcium levels Increased PTH = Reduced calcitonin = Hypercalcemia Increased levels of PTH and calcium in the blood Increased PTH reduces vitamin D storage, causes deficiency Most common type Associated with nephrolithiasis, osteopenia, weakness, malaise, dyspepsia, constipation, polyuria

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

B. Prehn Sign is used to differentiate epididymo-orchitis from torsion. Lifting the painful scrotum above the level of the symphysis pubis will relieve pain when infection is the cause for symptoms. There is no reduction in pain with torsion.

Preen sign is used to differentiate what two abnormalities? A. Renal cell carcinoma and oncocytoma B. Testicular torsion and epididymo-orchitis C. Fungal liver abscess and amoebic liver abscess D. Seminoma and yolk sac tumor

B. Sjogren syndrome is an immune system disorder that causes a reduction in saliva and tear production. It is associated with rheumatoid arthritis and lupus. Primary symptoms are dry eyes and dry mouth. It may cause swelling of the salivary glands.

Sjogren syndrome is an immune system disorder that commonly affects: A. Bile ducts B. The salivary glands C. Adrenal glands D. Thyroid

D. The National Patient Safety Standards recommend a "time out" period prior to the start of an invasive procedure. Record a blank image that says "time out" after the consent form is signed and then another image at the start of the procedure.

The National Patient Safety Standards recommend a "time out" period prior to the start of an invasive procedure. How will you comply with this recommendation during a renal biopsy? A. Allow the patient to take a break between biopsy samples and record the downtime in the patient chart. B. Allow the patient to take a 15 to 20 minute walk/break before they are set up for the procedure. C. Record an image that says" time out" when the radiologist is adjusting the needle D. Record a blank image that says "time out" after the consent form is signed and then another image at the start of the procedure.

D. Blue Dot Sign - clinical finding with torsion of the testicular appendage. The blue dot just under the skin surface of the scrotum is the ischemic appendage.

The blue dot sign is a clinical finding of: A. Testicular varicocele B. Bladder calculi C. Thyroid adenoma D. Torsion of the testicular appendage

B. The testicles form in the lower pelvic region and migrate to the scrotal sac after 36 weeks of gestational age. When the scrotal sac is found to contain only one testicle, the undescended teste is most commonly found along the inguinal canal of the affected side.

The following image is obtained on a 12 yr old boy with a non-palpable right testicle. What should be your next step as the Sonographer performing this exam? A. Evaluate the left groin for an undescended testicle B. Evaluate the right groin for an undescended testicle C. Evaluate the paraumbilical area for an undescended testicle D. Evaluate the perineal area for an undescended testicle

A. Advantages of Sonography Guided Biopsy: #1 advantage is real time visualization of the needle passing through the area of interest to confirm an accurate sample is taken Accurate diagnosis in 95% cases If you can see it on US, you can biopsy it by US guidance Minimally invasive No radiation Cost effective Prevents surgical removal of tissue for analysis Allows for multiple patient positions and approaches Portable

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

C. The informed consent must include a description of the procedure and list the possible complications that the patient may experience. The patient must be of sound mind when giving consent by signature.

The informed consent form is required to include all of the following, except: A. Possible complications that the patient may experience B. Description of the procedure C. Percentage of patients that have experienced complications after the same procedure at the facility D. Signature line to indicate patient consent

A. High frequency linear transducers are preferred for superficial imaging and used for thyroid and breast biopsies.

The radiologist asks you to set up the US room for a thyroid biopsy. Which probe should be covered with a sterile probe cover? A. Linear 10 MHz B. Linear 5 MHz C. Vector 10 MHz D. Curvilinear 8 MHz

D. Fluid does not attenuate sound and does not produce any reflections. The greater number and intensity of the reflections, the brighter the pixels on the display. An area of fluid will be have no reflections and will be black on an ultrasound image. Fluid wil cause mild attenuation of radiation. An area of fluid will be a darker gray color on CT scan because some of the radiation did not penetrate the fluid to reach the sensor.

Uncomplicated cysts and fluid collections will appear black on ultrasound and _______________ on CT scan. A. White B. Light gray C. Black D. Dark gray

A. In both the transverse and longitudinal views, the top of the image is anterior and the bottom of the image is posterior. In the longitudinal view, the left side of the image is the head and the right side of the image is the feet of the patient. In the transverse view the left side of the image is the right side of the patient and the right side of the image is the left side of the patient.

What dimension of the mass is being measured on the image? A. AP B. Width C. Length

B. In both the transverse and longitudinal views, the top of the image is anterior and the bottom of the image is posterior. In the longitudinal view, the left side of the image is the head and the right side of the image is the feet of the patient. In the transverse view the left side of the image is the right side of the patient and the right side of the image is the left side of the patient.

What dimensions of the mass is being measured on the image? A. AP B. Width C. Length

A. POCUS is a focused evaluation used to answer a specific question. Examples include FAST exam, limited cardiac, thorax, vascular, kidney, and biliary exams. Ultrasound evaluation is used to enhance patient care during a specific encounter or procedure.

What is a Point of Care ultrasound? A. Focused evaluation used to answer a specific question B. Ultrasound exam performed on the same day as the clinical evaluation C. Ultrasound exam performed at the office of the referring physician D. Follow up exam on a known abnormality

D. Sialolithiasis is the formation of a salivary stone. A high frequency linear transducer is preferred for evaluating superficial structures. The submandibular glands are located under the mandible and the parotid glands are located anterior to the ear. A salivary stone would have an appearance similar to a kidney stone. If the stone is causing obstruction, the duct will be dilated within the gland. The submandibular gland is drained by the Wharton duct and the parotid gland is drained by the Stensen duct.

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

B. Paracentesis can be performed for diagnostic or therapeutic reasons. When performed for therapeutic reasons, up to 6 liters of fluid can be removed each day as needed. When performed for diagnostic purposes, a small amount of fluid is removed to be evaluated by the lab. The preferred puncture site for the procedure is in a location that is lateral to the rectus abdominis muscle in the left lower abdomen.

What ultrasound guided procedure is performed using the area lateral to the recuts abdominis muscle in the left lower abdomen as the most common puncture site? A. Thoracentesis B. Paracentesis C. Lovenox injection D. Ethanol ablation

D. When a patient presents with acute scrotal pain, the Sonographer should always begin the scrotal ultrasound by imaging the unaffected side. The 2D image should be optimized using the normal testicle and then maintain those settings when evaluating the affected side. Comparison views should also be taken with equipment settings optimized for the unaffected side.

When a patient presents with acute scrotal pain, the Sonographer should always begin the scrotal ultrasound by: A. Imaging the groin area B. Imagining the testicle on the affected side C. Imaging the epididymis on the affected side D. Imaging the unaffected side

A. When differentiating level VI nodes from level III/IV nodes, turn the neck to a neutral position and document lymph node position relative to the carotid artery. Level Ill and IV nodes are lateral to the carotid artery, while the level VI nodes are medial to the carotid artery.

When evaluating a patient with a complete thyroidectomy, what is the best way to differentiate level VI nodes from level III/IV nodes? A. turn the neck to a neutral position and document lymph node position relative to the carotid artery B. hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the hyoid bone C. turn the neck to a neutral position and document lymph node position relative to the angle of the mandible D. hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the carotid artery

B. If the patients stands while being scanned, the increase in hydrostatic pressure will cause the vessels of the varicocele to dilate.

When evaluating a suspected testicular varicocele, what patient position will better demonstrate the abnormality? A. Decubitus left B. Standing C. Supine D. Decubitus right

B. The Sonographer should prepare the supplies for the biopsy. The tray should not be opened until just before the procedure begins. The cover can be opened without wearing gloves, but the far corner of the top should be pulled toward you to expose the products facing away from you. This prevents your arm from hovering over the supplies and prevents you from breathing on the supplies. Sterile gloves must be used to remove items from the tray to prepare them (lidocaine, needle and syringe).

When preparing the sterile tray for a liver biopsy, the cover on the tray should be opened: A. While wearing sterile gloves B. By pulling the far corner of the cover toward you C. No more than 2 hours before the procedure begins D. By the radiologist

D. The wrapper of the sterile tray and the biopsy needle should be opened by a nonsterile person. If you are setting up the sterile filed or touching the actual biopsy needle, you must be sterile. The bottles of numbing agent are not sterile but the syringe and needle filled with the agent must be sterile. A nonsterile person should verify the expiration date and name of the agent and share this info with the sterile person who is assisting. The top of the bottle should be wiped with alcohol before the syringe is filled.The nonsterile person holds the numbing agent bottle, while the sterile person manipulates the sterile syringe and needle to fill it.

When setting up for a liver biopsy, which of the following must be performed by a sterile person? A. Opening the bottle of numbing agent B. Opening the biopsy needle packaging C. Verifying the expiration date of the numbing agent D. Attaching the needle and filling the syringe with the numbing agent

B. When putting on PPE, always put the mask on first after washing your hands. Then put the gown on, followed by the gloves.

Which of the following indicates the proper order for putting on personal protective equipment? A. Gown, mask, gloves B. Mask, gown, gloves C. Gloves, gown mask D. Mask, gloves, gown

C. When using color Doppler to evaluate testicular perfusion, it is important to compare flow between the two testicles. Side by side images that are taken using the SAME Doppler settings should be documented. Differences in testicular flow can indicate abnormalities like orchitis or torsion. Doppler evaluation is required on all patients with acute scrotal pain. The Valsalva maneuver is helpful in varicocele evaluation but is unrelated to abnormalities in arterial perfusion.

When using color Doppler to compare testicular perfusion, you should always: A. Document normal flow in one testicle and then adjust color scale and wall filter settings to demonstrate the same amount of flow in the other testicle B. Document flow during the Valsalva strain C. Use the dual screen function to demonstrate an image of both testicles D. Document flow after the Valsalva release

D. When wearing a protective gown and then putting on gloves the open end of the gloves should be pulled over the wrist cuffs of the gown. The hands and arms are then fully protected

When wearing a protective gown and then putting on gloves: A. The open end of the gloves should not be touching the wrist cuffs of the gown. B. The open end of the gloves should be fitted under the wrist cuffs of the gown C. Two pairs of gloves should be worn D. The open end of the globes should be pulled over the wrist cuffs of the gown

B. The image is a sagittal view which means the calipers are measuring the superior to inferior dimension AKA length.

Which measurement of the hydrocele is being assessed on the image? A. Width B. Length C. AP

C. The resistive index = PSV - EDV / PSV

Which of the following Doppler information is necessary to calculate the resistive index? A. Peak systolic velocity, average flow velocity and end diastolic velocity B. Peak systolic velocity and peak diastolic velocity C. Peak systolic velocity and end diastolic velocity D> peak systolic velocity only

D. Epididymitis is a common cause of acute scrotal pain. The other choices are chronic disease processes that would not normally lead to acute symptoms.

Which of the following commonly leads to acute scrotal pain? A. Microlithiasis B. Seminoma C. Tubular ectasia D. Epididymitis

A. Pallor is a sign of vasovagal response, while erythema is a sign of anaphylaxis. Bradycardia is a sign of vasovagal response, while tachycardia is a sign of anaphylaxis. Hypotension is a sign of vasovagal response, while hypertension is a sign of anaphylaxis. A feeling of impending doom is a sign of anaphylaxis, while dizziness and near syncope are signs of vasovagal response.

Which of the following correctly describes a way to tell the difference between a vasovagal response and anaphylaxis caused by contrast injection? A. Pillor is a sign of vasovagal response, while erythema is a sign of anaphylaxis B. A feeling of impending doom is a sign of vasovagal response, while dizziness and near syncope are signs of anaphylaxis C. Hypertension is a sign of vasovagal response, while hypotension is a sign of anaphylaxis D. Tachycardia is a sign of vasovagal response, while bradycardia is a sign of anaphylaxis

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

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

C. Thoracentesis is performed for removal of fluid from the pleural space in the thoracic cavity. It is performed for diagnostic or therapeutic purposes. A chest x-ray is performed before and after the procedure to evaluate fluid removal and for the presence of a potential pneumothorax caused by the procedure. It is important to keep the patient in the same position during pre-procedure images as during the procedure. Most patients are placed in the semi-erect position and leaning forward over a table. The puncture site should always be lower than the ninth rib to avoid puncturing the diaphragm.

Which of the following describes the best patient position for a thoracentesis? A. Right lateral decubitus B. Left lateral decubitus C. Seated leaning forward over a table D. Semi-erect with the knees raised toward the chest

B. Some patients lying supine may require a pillow to be placed under their shoulders to hyperextend the neck for proper thyroid evaluation.

Which of the following describes the best patient position for a thyroid ultrasound? A. Posterior oblique with neck extended B. Supine with neck extended C. Prone with the neck D. Semi-erect with chin angled toward the side not being scanned

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

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. Table height should allow the Sonographer's arm to be slightly addicted with the wrist fully flexed toward the side being examined C. The table should be placed in the reverse trendelenburg position to assist in moving blood flow into the cerebral vessels. D. The table should be placed in the trendelenburg position to assist in moving blood flow into he cerebral vessels.

C. Cold Thyroid Nodule: Nonfunctional nodule that does not demonstrate isotope uptake; It looks like a hole in the gland with white area in the area of interest. 20% of cold nodules are malignant and these nodules usually require biopsy. Hot Thyroid Nodule: Functional adenoma or thyroiditis; A nodule that is overproducing thyroid hormone which attracts more of the isotope than the surrounding normal tissue. The nodule appears as darker area over the mass than the normal tissue. These nodules are rarely malignant. In most cases, lung masses are better evaluated with CT or MRI. A biopsy may be contraindicated in patients where the mass is too close to other structures, like the diaphragm and large vessels.

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

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

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

A. Patients who are currently taking a blood thinner cannot have a biopsy unless they can stop the medication for several days.

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

C. Most facilities prohibit posting of exam images on social media, even without any identifying information. Always research your employer's policy on social media before posting anything. HIPAA allows the discussion of results with the patient and their physician, but NOT with anyone else unless the patient supplies written permission. Anonymous images are permitted for use in research and educational settings.

Which of the following is a violation of HIPAA policies? A. Sharing an anonymized image from an exam with you sonography class B. Discussing exam results with a patient C. Posting patient symptoms and demographics with an anonymous ultrasound image on social media D. Discussing exam results with the patient's physician

C. An absolute contraindication is situation which makes a particular treatment or procedure absolutely inadvisable. These include a known allergy to the injected material (ablation, steroid injection), lack of appropriate equipment or skill to complete the procedure, uncooperative patient (uncontrolled movement during the procedure can result in laceration or hemorrhage) A relative contraindication is a condition which makes a particular treatment or procedure possibly inadvisable. Changes can be made to make the procedure safer or easier to perform. These include coagulopathy and the use of blood thinners, aspirin or antibiotics. If permitted by their physician, the patient can discontinue their blood thinner medication until their PT and INR values return to normal levels and then proceed with the invasive procedure. Warfarin, Coumadin, Jantoven, Xarelto, Pradaxa or Lovenox, Aspirin, Ibuprofen, NSAIDs should be stopped at least 7 days before a procedure and resumed 7 days after the procedure. Other relative contraindications include: Unsafe biopsy route - must avoid large vessels, bowel, trachea and adjacent organs When corticosteroids must be injected, it can raise blood sugar levels; can be a contraindication for patients with diabetes mellitus but insulin levels can be adjusted to accommodate elevated sugar levels Local infection, rash, or skin breakdown

Which of the following is an absolute contraindication to an ultrasound guided biopsy? A. Daily aspirin use B. Current antibiotic use C. Uncooperative patient D. History of diabetes mellitus

A. 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 is demonstrated by the same color on an ultrasound image as on a CT image? A. Calcifications B. Uncomplicated pleural effusion C. Cysts D. More than one of the above

C. 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.

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

A. Secondary hyperparathyroidism is caused by vitamin D deficiency renal failure and malabsorption syndromes.

Which of the following is related to renal failure and vitamin D deficiency? A. Secondary hyperparathyroidism B. Pulmonary HTN C. Nephrocalcinosis D. Hyperthyroidism

D. Paracentesis is performed for diagnostic and therapeutic reasons. The preferred puncture site is lateral to the rectus abdominis muscle in the lower abdomen. The patient is seated semi erect in the bed. If you place the specimen container on the floor, gravity will assist in draining the fluid.

Which of the following is true regarding paracentesis? A. Normally only performed for diagnostic reasons B. Normally the patient is seated and leaning over a table to allow posterior lateral access for the catheter C. Placing the patient in the supine position will improve the rate of fluid drainage D. Placing the fluid collection container on the floor next to the patient bed increases the fluid drainage rate

A. The needle used for the FNA is usually much smaller than the biopsy needle, therefore, FNA procedures are less traumatic to the tissues than needle biopsy procedures Core needle biopsies are more commonly performed to assess parenchymal liver disease than for liver mass evaluation.

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

B. FNC aspirates a smaller but more concentrated sample of cells than FNA. Both procedures use local anesthetic to numb the area around the puncture site. FNC and FNA procedures are used to collect cells from a mass.

Which of the following lists an advantage of fine needle capillary technique over a fine needle aspiration technique? A. FNC is less traumatic to the tissues than FNA B. FNC aspirates a smaller but more concentrated sample of cell than FNA C. FNC does not require local anesthetic and FNA does D. FNC collects a tissue core while FNA collects a small amount of cells

D. When cancer is suspected, after biopsy confirmation of cancer, and after thyroidectomy, the neck should be evaluated for lymphadenopathy. Scan the tissue lateral to the common carotid artery Scan from the clavicle to the acromioclavicular joint Scan above, below and behind the clavicle

Which of the following lymph node chains should be evaluate for related metastasis with thyroid cancer? A. Axillary B. Internal mammary C. Pectoral D. Supraclavicular

B. FAST evaluation = Focused Assessment with Sonography in Trauma; used to evaluate the abdomen for fluid or blood in trauma patients; check the four quadrants, midline and Morrison pouch

Which of the following patients would benefit from a FAST examination? A. Patient with suspected prostate cancer B. Patient with history of abdominal pain after a fall from a ladder yesterday C. Patient with history of RUQ pain after eating D. Patient with abdominal bruit, weight loss and post par dial pain

D. HIPAA Compliance: Health insurance portability and accountabilitv act Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs Reduces health care fraud and abuse Mandates industry-wide standards for health care information on electronic billing and other processes Requires the protection and confidential handling of protected health information Health care providers and organizations must develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared Applies to all forms of PHI, including paper, oral, and electronic, etc. Only the minimum health information necessary to conduct business is to be used or shared

Which of the following requires health care providers and organizations to develop and follow procedures that ensure the confidentiality and security of protected health information? A. Informed consent B. Stark Law C. ALARA principle D. Health insurance portability and accountability act

D. The Valsalva maneuver is used to demonstrate the increased vascular flow within a varicocele that forms outside the testicle. A hernia will demonstrate motion of tissues through the opening with the strain portion of the maneuver.

Which of the following scrotal abnormalities would be better displayed if the patient performed the Valsalva maneuver? A. Varicocele only B. Inguinal hernia only C. Testicular torsion and inguinal hernia D. Varicocele and inguinal hernia

A. Any limitations of exam performance should be reported to the physician. These limitations include the patient's ability to cooperate with positioning and breathing instructions, obesity, excessive bowel gas, restricted transducer placement with bandages or open wounds.

Which of the following should always be included on the technologist worksheet that is given to the radiologist with the image? A. Limitations of exam performance B. Differential diagnoses for abnormal findings C. Follow up recommendations D. Thermal index setting during the exam

D. Warfarin, Coumadin, Jantoven, Xarelto, Pradaxa or Lovenox, Aspirin, Ibuprofen, NSAIDs should be stopped at least 7 days before a procedure and resumed 7 days after the invasive procedure. Hypertension medication and insulin should not be taken the morning of the procedure but can be taken immediately after the procedure

Which of the following should be avoided for at least 7 days before a renal biopsy? A. Insulin B. Multivitamin C. Hypertension medication D. Aspirin

D. A varicocele is demonstrated on the image. The vessels will dilate and be easier to see if the patient is scanned while standing or using the Valsalva maneuver to increase intra abdominal pressure.

Which of the following statements is false regarding the abnormality on the image? A. It can be caused by Nutcracker syndrome B. It is more commonly seen on the left side due to the relationship of the gonadal vascular anatomy to surrounding structure. C. It has been related to incompetent venous valves D. Placing the patient in the supine position best demonstrate this abnormality

A. Paracentesis is the aspiration of fluid from the peritoneal cavity. It can be performed for diagnostic or therapeutic reasons. The procedure requires an informed consent form and use of sterile technique. Prothrombin time (PT) and International Normalized Ratio (INR) values are required before the procedure to evaluate clotting ability of blood. US guidance is commonly used to insert needle or catheter for drainage in the area of the left paracolic gutter.

Which of the following statements is true regarding paracentesis? A. Paracentesis requires the use of the sterile field technique B. Because the diagnostic paracentesis is performed with a long thin needle instead of a catheter, a sterile field is not required for the procedure. C. An informed consent form is not required when a diagnostic paracentesis is performed. The form is only required for a therapeutic paracentesis. D. The preferred entry point for fluid removals is on the right side at the level of Morrison pouch

A. Anytime you touch a sterile item, your hands must also be sterile. The physician is responsible for creating the point of entry for the biopsy. If you are only opening the packaging of the sterile items, your hands do not need to be sterile. After the procedure, Sonographers can wear non-sterile gloves to clean up the used items after a biopsy.

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

D. The pancreas and salivary glands excrete amylase. Pancreatitis or a salivary gland tumor will cause an increase in amylase levels. OP usage can also lead to elevated levels of serum amylase.

Which of the following will cause elevated serum amylase? A. Parathyroid adenoma and renal cell carcinoma B. Use of anabolic steroids and parathyroid adenoma C. Acute pancreatitis and pyelonephritis D. Tumor of the submandibular gland and use of oral contraceptives

D. Serum AFP levels increase with certain testicular tumors, liver cancer and pregnancy. Seminomatous tumors of the testicles will normally demonstrate normal AFP levels with elevated bhCG levels.

Which of the following will have no effect on serum levels of alpha-fetoprotein? A. Yolk sac tumor of the right testicle B. Pregnancy C. Hepatocellular carcinoma D. Seminomatous tumor of the testicle

A. The depth of the mass can affect the length of needle required for the procedure. Color Doppler is an important part of the pre-procedure evaluation but does not aid in needle selection. Normally only one biopsy device is opened and used for the procedure.

Which of the following will help the radiologist select the correct biopsy needle size/length for the biopsy needle size/length for the biopsy of a mass in the posterior right liver? A. Measuring the depth of the mass within the liver B. Using color Doppler to locate surrounding vascularity C. Measuring the width of the mass in the liver D> usually the Sonographer opens multiple sizes core biopsy needles and places them on the sterile procedure tray in case they are needed.

A. Postvasectomy changes seen on ultrasound include epididymal enlargement, tubular ectasia of the epididymis, dilated vas deferens, spermatoceles and cysts. NO hypervascularity with the enlarged epididymis. Use color Doppler to differentiate postsurgical changes from acute epididymitis.

Which of the following would be an unexpected finding in a patient that has a vasectomy 4 years ago? A. Atrophied epididymis B. Tubular ectasia of the epididymis C. Dilated vas deferens D. Spermatoceles

B. Severe pericardial effusion can put significant external pressure on the cardiac chambers causing collapse of the right heart chambers. Cardiac tamponade physiology can be fatal and the fluid needs to be drained immediately. The other options are abnormal findings that should be evaluated by a physician as soon as reasonably possible.

Which of the following would be considered a critical finding on a Point of Care ultrasound exam? A. Nonobstructive renal calculi B. Severe pericardial effusion C. Pneumothorax D. 4 cm abdominal aortic aneurysm

C. A stand-off pad eliminates the dead zone on the image. This is helpful for very superficial structures like the thyroid isthmus.

Which of the following would improve the visualization of the thyroid isthmus? A. Curvilinear transducer B. Color Doppler C. Stand-off Pad D. Transducer with a deep focus

C. Medullary thyroid cancer is a hard bulky mass that is usually found in 5th and 6th decades of life. The mass secretes calcitonin. It is associated with MEN syndrome and Sipple Syndrome (medullary cancer + parathyroid cancer + pheochromocytoma)

Which type of thyroid cancer is associated with elevated calcitonin levels? A. Anaplastic B. Follicular C. Medullary D. Papillary

B. The esophagus is demonstrated posterior to the left thyroid lobe.

While performing a thyroid ultrasound, you notice the area indicated by the blue arrow. Which of the following statements is true regarding completing this patient's exam? A. Color Doppler must be applied to assess the tumor vascularity B. Request that the patient swallow to better evaluate the area C. The radiologist will need all lab values related to the parathyroid hormones and calcium levels in the blood to aid in confirming the diagnosis of the mass. D. The arrow indicates the normal longs colli muscle

C. If the PT and INR levels are too high, the risk of hemorrhage may be too great to perform the procedure safely.

Why is it necessary to obtain the PT and INR lab values prior to a liver biopsy? A. To assess the patient's risk for post procedure infection B. To assess the patient's risk for post procedure thrombosis of the portal vein C. To assess the patient's risk for post procedure hemorrhage D. To assess the extent of cirrhosis within the liver

B. To locate the parathyroid glands scan the area extending from the carotid artery bifurcation superiorly to the thoracic inlet inferiorly. The superior parathyroid gland is usually located posterior to the midsegment of the thyroid lobe. The inferior parathyroid gland is usually located close to the lower pole of the thyroid lobe. Parathyroid glands may be found below the clavicles, in the lower neck, or upper mediastinum Because the glands can even be found in a retrotracheal in location, it may be helpful to have the patient swallow during real-time imaging.

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. Give the patient oral contrast to outline the trachea B. Ask the patient to swallow C. Use IV contrast to locate the blood supply of the mass D. More than one of the above