Abdomen Review boards
How is sonography utilized to analyze the bowel?
Compressible bowel is considered normal, non-compressible bowel abnormal.
What is the most common acute vascular complication associated with pancreatic transplants?
Elevated resistive index
What is the sonographic appearance of Addison disease in the acute stage?
Enlarged, hypoechoic adrenal glands bilaterally
What is the recommended preparation for a bile duct scan?
Fasting for a minimum of 4 hours
Which gastrointestinal tract abnormality presents with nonbilious vomiting and transposition of the superior mesenteric vein (SMV) and superior mesenteric artery (SMA)?
Midgut malrotation with volvulus
What is the normal sonographic appearance of a muscle?
Hypoechoic tissue with linear echogenic strands
A sonogram revealed a heterogeneous mass within the scrotum that demonstrates peristalsis. What pathology does this describe?
Inguinal hernia
A 2-year-old male patient presents with intermittent RLQ pain, vomiting, palpable abdominal mass, and red currant jelly stool. What gastrointestinal disorder is most likely?
Intussusception
Which patient population is most likely to demonstrate an adrenal hemorrhage?
Neonates
A patient presents with hypercalcemia. Sonography demonstrated a hypoechoic mass adjacent to the thyroid gland. What is the most likely diagnosis?
Parathyroid adenoma
What feature below is consistent with a malignant adrenal tumor originating from the adrenal cortex?
Invasion of adrenal vein and IVC
What is a common complication of Wilms tumor, renal transitional cell carcinoma, and Budd-Chiari syndrome?
Invasion of the IVC
What normal structure most often demonstrated with sonography in pediatric patients appears as an echogenic solid mass with linear and punctate echogenicities?
Thymus
A patient presents with a history of medically treated migraines, back/flank pain, weight loss, and vomiting. What retroperitoneal pathology should the sonographer consider?
Retroperitoneal fibrosis
Which of the following artifacts can be helpful in identifying air in the biliary tree?
Ring down
When assessing the sonographic appearance of an adult kidney, what echogenicity comparisons are typically used?
The cortex should be hypoechoic or isoechoic to the liver or spleen.
A 3-day-old patient presented with jaundice, an acute drop in hematocrit, and a broken clavicle. What is the most likely diagnosis for a triangular shaped mass in the area of the adrenal gland?
Adrenal hemorrhage
Which of the following renal disorders presents sonographically with echogenic renal pyramids due to accumulation of calcium in dilated collecting ducts? A. Angiomyolipoma B. Renal fungal disease C. Glomerulonephritis D. Medullary sponge kidney
D. Medullary sponge kidney
What are the sonographic features of a pheochromocytoma?
Large hyperechoic mass adjacent to the superior pole of the kidney
A patient presents with fever, leukocytosis, and rebound tenderness. What should the sonographer expect to find on the sonogram?
Noncompressible blind-ended tubular structure in the RLQ measuring >6 mm.
What is the most common cause of splenomegaly?
Portal hypertension
A patient presents with a history of diverticulitis. On ultrasound, small bright reflectors are noted within the portal vein producing ring-down artifact. What condition is most likely?
Portal venous gas
What acute disorder is best described sonographically as a hypoechoic wedge-shaped mass within the spleen?
Splenic infarct
A 90-year-old patient presents with painless bilateral scrotal swelling over a period of 2 years. What findings should the sonographer anticipate?
Thickened scrotal wall with bilateral hydrocele
A patient presents with a palpable enlarged thyroid gland, dysphagia, and intermittent coughing. Sonogram demonstrated an enlarged heterogeneous gland with multiple focal nodules. What is the most likely diagnosis?
Adenomatous goiter
A patient presented with abdominal pain, weight loss, and vomiting. Sonography revealed a 10-cm hypoechoic irregular shaped mass in the LLQ. What is the most likely diagnosis?
Adenocarcinoma
What is the most common primary pancreatic malignancy?
Adenocarcinoma
What does the term cholangitis refer to?
Inflammation of the bile ducts
A patient presents with intense chest and abdominal pain radiating to the lower back. A mildly dilated area of the aorta is identified with demonstration of an intimal flap with color Doppler. What is the most likely diagnosis?
Aortic dissection
When scanning a patient's pelvis, a cystic structure is demonstrated adjacent to the urinary bladder with a small connection to the bladder identified. What is this abnormality consistent with?
Bladder diverticulum
What is the origin of the splenic artery?
Branch of celiac axis
A breast sonogram on a lactating female demonstrated a focal fluid collection with internal echoes and enlarged lymph nodes. What is the most likely diagnosis?
Breast abscess
Where is the gastroesophageal junction demonstrated on a sonogram?
Bull's eye structure between the left lobe of the liver and the proximal aorta in a sagittal plane.
What gallbladder pathology is described as a projection of tissue from the gallbladder wall caused by an accumulation of cholesterol and triglycerides?
Cholesterolosis
How is pelvocaliectasis diagnosed with sonography?
Dilation of the calices and renal pelvis
What is the typical sonographic appearance of an intestinal obstruction?
Distended fluid-filled loops of bowel
What is Charcot triad?
Fever, right upper quadrant pain, and jaundice
How is a subluxed hip demonstrated on a sonogram?
Femoral head rests laterally in the acetabulum.
What symptoms are typically associated with transitional cell carcinoma of the bladder?
Gross hematuria and passing blood clots
Which splenic pathology is often associated with Beckwith-Wiedemann syndrome?
Hamartoma
What are the sonographic findings associated with retroperitoneal fibrosis?
Large, hypoechoic mass surrounding the abdominal aorta
What is the proper method for measuring the common bile duct?
Measure the segment on the extrahepatic side of the cystic duct with an inner-to-inner measurement.
What area of the adrenal gland produces epinephrine and norepinephrine?
Medulla
What hepatic pathology demonstrates the sonographic findings of multiple target lesions within the liver parenchyma?
Metastatic disease from lung or colon cancer
What are the criteria of a simple cyst?
Smooth borders, anechoic, through transmission, and round shape
How does the patient population differ for acalculous cholecystitis?
Typically occurs in children or immunocompromised patients
What is a possible role of sonography in the evaluation of lung masses?
Ultrasound-guided biopsy
Which solid pediatric malignancy occurs in the kidney?
Wilms tumor
What is the Graf technique?
A technique used to measure the relationship of the femoral head and acetabulum to determine if developmental hip dysplasia is present.
What disorder of the scrotum presents with increased levels of adrenocorticotropic hormone in patients with a history of adrenal hyperplasia?
Adrenal rests
What is the most common cause of acute pancreatitis?
Alcohol abuse
What is the purpose of having a patient fast for 8 hours prior to an abdominal ultrasound?
Allows for maximal distension of the gallbladder
What is the cause of a pancreatic pseudocyst?
Encapsulation of digestive enzymes that leak out of the pancreas to form a cystic structure
What is the function of the white pulp in the spleen?
Production of lymphocytes
Why should the gallbladder be imaged in multiple patient positions?
To provide proof of pathology mobility/nonmobility
Sonographic examination demonstrated multiple enlarged cervical lymph nodes. The patient indicated having had fever for over a week. What is the most likely cause for the lymphadenopathy?
Infection
What is a pyramidal lobe?
A superior extension of the thyroid isthmus
In what part of the gastrointestinal tract is the vermiform appendix connected?
Cecum
What are the complications associated with choledochal cyst?
Cholangitis, portal hypertension, pancreatitis, and liver failure
A 1-year-old patient presented with a palpable abdominal mass, jaundice, and fever. A cystic mass is noted in the area of the porta hepatis with sonography. What is the most likely diagnosis?
Choledochal cyst
What is the least common cause of bile duct obstruction?
Cholelithiasis
Which of the following exams would require the sonographer to practice surgical asepsis?
Fine needle aspiration of liver nodule
What is the term used to describe an enlarged spleen?
Splenomegaly
What is the cause of gallbladder sludge?
Stasis of bile in the gallbladder
Which of the following is an example of an endocrine organ? A. Spleen B. Adrenal gland C. Salivary glands D. Breast
B. Adrenal gland
How is an arteriovenous fistula best demonstrated sonographically?
Color Doppler imaging
What organs should be closely interrogated if the common bile duct is dilated?
Complete biliary tree, liver, gallbladder, and pancreas
In which planes should the infant hip be imaged to determine if developmental dislocation of the hip is present?
Coronal and transverse of the hip in both the resting and flexed positions with and without applied stress.
If a patient's lab results indicate increased amylase, increased lipase, and increased bilirubin, which of the following organs is likely diseased?
Gallbladder
In a transverse image of the right lobe of the thyroid gland, what is the most lateral structure typically demonstrated?
Internal jugular vein
What is the classic sonographic appearance of a pancreas demonstrating chronic pancreatitis?
Small, hyperechoic, heterogeneous, atrophic gland with ill-defined borders
What is the most common cause of IVC enlargement?
Right heart failure
A complex cystic mass is demonstrated in the spleen with posterior dirty shadow in a febrile patient. What is the most likely diagnosis?
Splenic abscess
What is the most common complication of a wandering spleen?
Splenic torsion
How is blood supplied to the adrenal glands?
Suprarenal branches of aorta, suprarenal branches of inferior phrenic arteries, and suprarenal branches of main renal artery
Why is a 2- to 5-MHz transducer generally utilized for imaging the liver?
The lower frequencies allow for better penetration because the liver is a large organ.
How is testicular echotexture described?
The testicles are isoechoic to each other and similar to that of the thyroid gland.
If colitis is suspected, what sonographic finding is most consistent?
Thickened hypoechoic colon wall with hyperemia
What term is used to describe enlargement of the abdominal lymph nodes located within the abdomen?
Retroperitoneal lymphadenopathy
What pathology is best described as a small hyperechoic mass usually found in the right lobe of the liver with through transmission with female predominance?
Cavernous hemangioma
What is the main role of sonography post abdominal aortic aneurysm (AAA) repair?
Evaluate for graft patency and leakage at attachment sites.
Which of the following clinical symptoms is a common feature of colitis? A. Watery and/or bloody diarrhea B. Olive sign C. Nausea and vomiting D. Constipation
A. Watery and/or bloody diarrhea
What is the most common complication associated with annular pancreas?
Duodenal obstruction
What is the most common cause of hyperthyroidism?
Graves disease
What thyroid disorder presents with bulging eyes, nervousness, weight loss, and hair loss?
Graves disease
What is the most common renal mass demonstrated on sonography?
Simple renal cyst
What is the measurement used to determine if pyloric stenosis is present?
Single-walled muscle thickness of 3 mm or greater and 17 mm or greater length
What is the most common cause of ureteropelvic junction obstruction?
Urolithiasis
A decreased hematocrit indicates which of the following?
Internal bleeding
What renal disorder presents with decreased renal function in the 3rd to 4th decades of life, and bilaterally enlarged kidneys containing multiple cortical cysts?
Autosomal dominant polycystic kidney disease
Which sonographic feature is not consistent with gallbladder carcinoma?
Avascular mass within gallbladder lumen <1cm
What measurement describes an enlarged lymph node?
> 10 mm
How does the function of the spleen differ in infants/children and adults?
In infants/children, its primary function is defense against infection, whereas in adults, it is production of lymphocytes and monocytes.
Which artery arises from the anterior surface of the abdominal aorta just inferior to the gonadal arteries?
Inferior mesenteric artery
What are the normal measurements for a fasting gallbladder?
8 to 10 cm length, ≤5 cm diameter, ≤3 mm wall thickness
Which abdominal muscle is demonstrated posterior and slightly medial to the kidney on a transverse image?
Psoas muscle
What lung pathology is described as a separate mass of nonfunctioning lung tissue with its own blood supply?
Pulmonary sequestration
Which renal tumor has an asymptomatic presentation in its early stages but over time patients complain of gross hematuria, weight loss, and palpable flank mass?
Renal cell carcinoma
A hemophiliac patient presents with low hematocrit and RT back pain. A complex mass is demonstrated in the muscle between the kidney and the spine. What is the most likely diagnosis?
Retroperitoneal hematoma
How does chronic cholecystitis differ from acute cholecystitis?
Chronic cholecystitis presents with a WES sign but no Murphy's sign.
What term describes a lesion with cystic and solid components?
Complex
Which adrenal disorder presents with hypernatremia, hypertension, excessive thirst, and excessive urination?
Conn syndrome
What is the most common mass found in the spleen?
Hemangioma
What patient position typically allows for best visualization of the spleen?
Right lateral decubitus with deep inspiration
A patient presents with a painless scrotal mass and elevated hCG levels. On sonographic examination, a solid, hypoechoic mass is demonstrated within the testicle. What is the most likely diagnosis?
Seminoma
Why are radial and anti-radial planes preferred for breast imaging?
The lactiferous ducts are arranged in a radial pattern, so will be better demonstrated if scanned along the same planes.
Which hormone is produced in the greatest abundance by the thyroid gland?
Thyroxine
A patient presents with elevated liver function tests and the sonogram reveals diffuse increase in echogenicity, hepatomegaly, and a poorly visualized diaphragm. Which of the following conditions is most likely?
Hepatic steatosis
A patient presents with RUQ pain, weight loss, jaundice, and hepatomegaly. What is the most likely diagnosis in the presence of an asymmetrically thickened gallbladder wall?
Gallbladder carcinoma
A 3-year-old patient presents with Beckwith-Wiedemann syndrome, a palpable right-sided abdominal mass, and elevated alpha-fetoprotein. What it the most likely diagnosis?
Hepatoblastoma
What benign renal mass is described sonographically as a hypervascular, hyperechoic mass with internal echoes producing acoustic shadowing?
Renal adenoma
If a breast mass is annotated as LT 4:00 1 C, what does this tell you about its location?
Left breast, lower outer quadrant, midway from nipple deep to the pectoral muscle
What is the term used to describe a salivary gland that presents sonographically with an echogenic foci within a dilated duct producing shadowing?
Sialolithiasis
What is the typical sonographic pattern demonstrating an intussusception?
Target shaped mass in the transverse plane and pseudokidney sign in the longitudinal plane
What is a possible complication of a thoracentesis?
Pneumothorax
What is the most common cancer found in a patient with cryptorchidism?
Seminoma
What sonographic feature is consistent with a benign mass?
Smooth borders
What other disorder should be investigated for if pancreatic cysts are noted on a sonogram?
Hippel-Lindau disease
What is exudate ascites in the subhepatic space?
Malignant form of ascites found between the liver and the kidney
What layer of the breast tissue contains the ducts and glandular tissue?
Mammary layer
A 45-year-old female patient with a history of chronic dieting presents with acute abdominal pain after fatty meals that radiates to her shoulders. Which of the following sonographic presentations do you expect to find?
Multiple mobile echogenic masses that produce acoustic shadowing
What is a complication of hepatic hematoma?
Arteriovenous fistula
What pathology is diagnosed by the sonographic demonstration of worms in the bile ducts?
Ascariasis
Nuclear medicine demonstrated a hot nodule, what is likely to be demonstrated on thyroid sonography?
Colloid cyst
Which tendon pathology is described as an anechoic or heterogeneous area within a tendon with refractive shadowing?
Complete tendon rupture
What procedure is used to remove fluid from around the lung in order to determine if it has a malignant origin?
Diagnostic thoracentesis
What finding can right-sided enlargement of the heart cause on an abdominal sonogram?
Enlargement of the IVC
What benign pediatric tumor presents clinically with hepatomegaly and skin hemangiomas?
Infantile hemangioendothelioma
What is the path of venous drainage of the LT adrenal gland?
LT suprarenal vein drains into the LT renal vein
What is the endocrine function of the testis?
Production of testosterone
Which disorder of the testicle demonstrates tiny echogenic foci throughout the testicular tissue and is often associated with Klinefelter syndrome?
Microlithiasis
A patient presents with obesity, hirsutism, and a buffalo hump. Sonography identified a mass in the RT adrenal gland. What is the most likely diagnosis?
Cushing syndrome
Which of the following is not a sonographic finding for acute pancreatitis? A. Phlegmon B. Focal enlargement of the pancreatic head C. Normal sonographic appearance D. Atrophic hypoechoic pancreas
D. Atrophic hypoechoic pancreas
A motor vehicle patient from the emergency room presents with LUQ pain and decreased hematocrit. What should the sonographer look for on the abdominal scan?
A complex or hypoechoic mass in the spleen with posterior enhancement and an echogenic line within the spleen demonstrating the laceration
What is a ganglion cyst?
A fluid-filled mass arising from the tendon found most often on the dorsal aspect of the hand or wrist.
Which statement is false with respect to the difference between the wall of an artery and a vein? A. Artery walls have a thicker tunica adventitia layer with greater elasticity. B. Veins are collapsible with mild tissue pressure, arteries are more rigid. C. Veins have valves, arteries do not. D. Veins have a thinner tunica media layer with less smooth muscle.
A. Artery walls have a thicker tunica adventitia layer with greater elasticity.
If the gallbladder wall is demonstrated as symmetrically thickened, what is the most likely pathologic cause?
Chronic cholecystitis
What feature allows the sonographer to distinguish porcelain gallbladder from WES sign?
Identification of the calcified back wall of the gallbladder
Why is it important to demonstrate blood flow in the thyroid lobes?
Inflammatory disorders of the thyroid demonstrate increased vascularity.
A patient presents with jaundice, right upper quadrant pain, an elevated serum bilirubin and a fever. Sonogram demonstrates a common hepatic duct measuring 12 mm. What is the most likely diagnosis?
Mirizzi syndrome
What is the function of the bile ducts?
Provide a conduit for bile to get from the liver to the digestive system
What signals the adrenal gland to release hormones?
Release of adrenocorticotropic hormone by the anterior pituitary gland
If the patient history includes inflammatory bowel disease, fibrotic thickening of the bile ducts, and cholangiocarcinoma, what is the most likely diagnosis?
Sclerosing cholangitis
What is the innermost layer of the bowel identifiable by sonography?
Superficial mucosa
A patient presents with weight loss, jaundice, and epigastric pain. The sonogram demonstrates a hypoechoic mass in the pancreatic head and a dilated CBD. What is the most likely diagnosis?
Adenocarcinoma
Rokitansky-Aschoff sinuses are a mitigating factor in the development of which gallbladder pathology?
Adenomyomatosis
What is the term used to describe a fluid collection around the lung?
Pleural effusion
What is the easiest method for distinguishing the esophagus from a mass?
Have patient swallow, saliva can be visualized passing through the esophagus.
What is a complication of acute cholecystitis if it is not treated?
Gangrenous cholecystitis
Which patient population is most prone to developing hepatic candidiasis?
Immunocompromised patients
Why is it important for the sonographer to be able to identify imaging artifacts?
Tissue composition is often confirmed by the presence of an artifact.
What is the purpose of standard precautions?
To decrease the spread of infection
Which of the following best describes a pyogenic hepatic abscess? A. A solid mass producing dirty shadow is demonstrated in the upper pole of the right kidney. B. A complex cyst with thick walls and internal debris producing dirty shadow is noted in the dome of the liver. C. A hypoechoic solid mass with intense shadowing is demonstrated in the inferior aspect of the left lobe of the liver. D. A simple cystic mass with smooth, well-demarcated borders is demonstrated in the caudate lobe.
B. A complex cyst with thick walls and internal debris producing dirty shadow is noted in the dome of the liver.
Which of the following complications of chronic pyelonephritis demonstrates gas or air within the renal parenchyma with dirty shadowing? A. Glomerulonephritis B. Emphysematous pyelonephritis C. Xanthogranulomatous pyelonephritis D. Perinephric abscess
B. Emphysematous
Which of the following renal cystic diseases presents sonographically as a smooth thick-walled cyst with internal debris? A. Hemorrhagic cyst B. Infected renal cyst C. Milk of calcium cyst D. Renal cell carcinoma
B. Infected renal cyst
Which of the following best describes a splenic granuloma? A. Well-defined hyperechoic mass B. Multiple small echogenic masses with acoustic shadowing C. Hypoechoic mass demonstrating hypervascularity D. Small isoechoic mass demonstrated outside the spleen
B. Multiple small echogenic masses with acoustic shadowing
Which of the following can cause the appearance of false hydronephrosis? A. Urolithiasis B. Prominent renal vein C. Enlarged prostate D. Pregnancy
B. Prominent renal vein
Which of the following is a vascular complication associated with acute pancreatitis? A. Portal vein thrombosis B. Pseudoaneurysm of the splenic artery C. Pancreatic abscess D. Phlegmon
B. Pseudoaneurysm of the splenic artery
Which of the following abdominal arteries have high-resistance flow when a fasting preparation is followed? A. Celiac axis B. Superior mesenteric artery C. Renal artery D. Gonadal artery
B. Superior mesenteric artery
A 3-year-old patient presents with nausea, LUQ pain, and abdominal distension. On sonographic exam, multicystic masses with hypoechoic locules and hyperechoic septations are demonstrated. What is the most likely diagnosis?
Lymphangioma
What term is used to describe dilation of the ureter as it enters the bladder?
Ureterocele
A female hair stylist presented with pain, erythema, and edema in the gluteal cleft. Sonography revealed a complex subcutaneous mass with hyperemia and a hypoechoic tract to the skin surface. What pathology does this represent?
Pilonidal cyst
In what image is the crus of the diaphragm typically demonstrated on sonography?
Transverse image of the kidney
Which of the following is a hyperfunctioning adrenal mass that results in uncontrollable hypertension and excessive perspiration? A. Adrenal adenoma B. Adrenal carcinoma C. Adrenal rest D. Pheochromocytoma
D. Pheochromocytoma
Which type of islet cell tumor causes patients to develop peptic ulcers?
Gastrinoma
Arterial blood supply to the pancreas is supplied by which of the following arteries?
Gastroduodenal artery, splenic artery, and superior mesenteric artery
When imaging the liver, in which image are you likely to note fluid around the lung?
Dome of liver
Which vessel in the liver normally demonstrates a pulsatile low-resistant waveform?
Hepatic artery
What branches make up the celiac axis?
Hepatic artery, LT gastric artery, and splenic artery
Where is the abdominal aorta located?
Inferior to the diaphragm, just anterior to the spine, and slightly to the left of the midline
What is the normal Doppler waveform appearance of the distal aorta?
Triphasic, high-resistant pattern with flow reversal in early diastole
What is the upper limit of normal for a measurement of the common bile duct in an 80-year-old female who has had a cholecystectomy?
10 mm
What congenital anomaly of the pancreas causes a functional obstruction leading to pancreatitis?
Pancreatic divisum
What is the classic sonographic presentation of adenomyomatosis?
Tiny comet tail artifacts projecting from the gallbladder wall into the gallbladder lumen
A 30-year-old female presented with puffy eyes, slight weight gain, increased cold sensitivity, elevated cholesterol, and decreased thyroxine levels. Her sonogram demonstrated a coarse textured thyroid gland with increased vascularity. What is the most likely diagnosis?
Hashimoto thyroiditis
An elevation of albumin, alkaline phosphatase, and aspartate aminotransferase would lead the sonographer to investigate which of the following conditions?
Cirrhosis
What posterior landmark can the sonographer use to aid in delineation of the pancreas?
Superior mesenteric vein and splenic vein
What flow pattern is expected in an endovascular aortic stent graft repair?
Triphasic
Which of the following is not consistent with testicular torsion? A. Acute testicular pain localized to the superior pole of the testis is the main clinical finding for testicular torsion. B. Patients who demonstrate the bell-clapper deformity have a predisposition for torsion. C. Torsion is most common between the ages of 12 and 18. D. Sonography will demonstrate an enlarged hypoechoic testicle with no identifiable blood flow.
A. Acute testicular pain localized to the superior pole of the testis is the main clinical finding for testicular torsion.
What releases thyroid-stimulating hormone into the bloodstream?
Anterior pituitary
On a transverse sonogram of the mid abdominal aorta, what vessels make up the seagull sign?
Common hepatic artery makes up left wing, splenic artery makes up right wing, and celiac axis makes up body.
Which of the following best describes a simple splenic cyst? A. Asymptomatic, round, smooth-walled mass with posterior enhancement B. Painful, irregularly shaped hypoechoic mass with through transmission C. Painful, smooth-walled, fluid-filled mass with internal septations and debris D. Asymptomatic, anechoic mass with thick wall and posterior shadowing
A. Asymptomatic, round, smooth-walled mass with posterior enhancement
Which of the following falsely describes an accessory spleen? A. Polysplenia B. Splenule C. Splenunculus D. Supernumerary spleen
A. Polysplenia
Which of the following disorders is caused by abdominal trauma? A. Diverticulitis B. Gastric carcinoma C. Rectus sheath hematoma D. Endometriosis of abdominal wall
C. Rectus sheath hematoma
Which organs should be interrogated if the patient is diagnosed with Budd-Chiari syndrome?
Liver and IVC
A 50-year-old patient presents with an acute episode of choledocholithiasis and thickening of the bile duct walls. If the patient is presented with Charcot triad clinically, what is the most likely diagnosis?
Acute bacterial cholangitis
A patient presents with hypotension, weakness, hyperkalemia, and hyperpigmentation. Which adrenal disorder is most likely?
Addison disease
Which statement below is true with respect to the liver ligaments? A. Recanalization of the paraumbilical vein in the ligamentum venosum can occur with portal hypertension. B. The ligamentum venosum divides the left lobe from the caudate lobe. C. The right branch of the umbilical vein becomes the ligamentum teres after birth. D. The left branch of the umbilical vein becomes the ligamentum venosum after birth.
B. The ligamentum venosum divides the left lobe from the caudate lobe.
How do you measure the true lumen of an AAA?
Outer to outer including wall thrombus
What is the cause of Conn syndrome?
Overproduction of aldosterone by a functional adrenal tumor
Which of the following is a differential diagnosis for porcelain gallbladder? A. Emphysematous cholecystitis B. Hydropic gallbladder C. Gallbladder carcinoma D. Courvoisier gallbladder
A. Emphysematous cholecystitis
How is splenomegaly diagnosed from ultrasound?
Spleen extends beyond inferior pole of left kidney and measures >13 cm length or >6 cm thickness.
What is a tumor marker?
Substances produced by cancer cells or organs when cancer is present
How is arterial blood supplied to the thyroid gland?
Superior thyroid artery and inferior thyroid artery
Which of the following is a lung mass primarily found in pediatric patients? A. Congenital cystic adenomatoid malformation B. Lymphoma C. Thymoma D. Wilms tumor
A. Congenital cystic adenomatoid malformation
What does the sonographic "sandwich sign" describe?
Enlarged abdominal nodes surrounding the aorta and the IVC
Which of the following best describes a superficial hypoechoic mass that demonstrates blood flow when interrogated? A. Baker cyst B. Ganglion C. Hemangioma D. Lipoma
C. Hemangioma
What is the most common scrotal mass?
Spermatocele
Which lab results will be elevated when gallbladder disease is present?
ALT, ALP, GGT, and white blood cells
What is the Thompson test used to help diagnose?
Achilles tendon rupture
What are the symptoms of a nonfunctioning adrenal adenoma?
Hypertension
What part of the testicle produces sperm?
Seminiferous tubules
What is the term used to describe the inner layer of the aorta wall?
Tunica intima
When urolithiasis is suspected with sonography but difficult to visualize, what can the sonographer do to better define it?
Turn on color Doppler
Which portion of the pancreas lies in the C-loop of the duodenum?
Pancreatic head
What disorder is characterized by neonatal jaundice, cirrhosis, portal hypertension, and the triangular cord sign?
Biliary atresia
Which sonographic sign is associated with Caroli disease?
Central dot sign
A patient presents with epilepsy and skin lesions. The sonogram demonstrated bilateral renal cysts and angiomyolipoma. What is the most likely diagnosis?
Tuberous sclerosis
A diagnosis of chronic cirrhosis is consistent with which of the following sonographic findings?
Shrunken echogenic right lobe, nodular contour, hepatofugal flow in the portal veins, and ascites
Where is the most common location for a retroperitoneal hematoma to occur?
Psoas muscle
Which of the following artifacts causes a laterally displaced duplication of the real structure?
Refraction
What is a subluxated hip?
Partial dislocation of the hip
What is the most common benign solid tumor of the adrenal gland?
Adrenal adenoma
What is the normal diameter of the proximal abdominal aorta?
2.5 cm or less
How does blood drain from the testicles?
The pampiniform plexus empties into the RT and LT testicular veins; then the RT testicular vein drains into the IVC and the LT drains into the LT renal vein.
Which of the following bowel disorders presents with a bowel wall thickness greater than 5 mm and hyperemic bowel wall? A. Diverticulitis B. Intussusception C. Crohn disease D. Bowel obstruction
C. Crohn disease
Which of the following would be the least likely sonographic finding of hepatitis? A. Thickened gallbladder wall B. Enlarged, hypoechoic liver C. Enlarged coronary vein D. Starry sky appearance with periportal cuffing
C. Enlarged coronary vein
Which of the following are often associated with congenital adrenal hyperplasia and Cushing syndrome? A. Pheochromocytoma B. Adrenal rests C. Adrenal cysts D. Agenesis of the adrenal glands
B. Adrenal rests
What is the most significant lab result indicating acute pancreatitis?
Elevated lipase
What is a common cause of pneumobilia?
Emphysematous cholecystitis
How is an aortic rupture diagnosed?
Presence of an AAA with adjacent hematoma.
How does acute renal failure differ from chronic renal failure?
The most common cause of chronic renal failure is diabetes mellitus and it presents as small kidneys with cortical thinning on sonography whereas acute renal failure is most commonly caused by acute tubular necrosis and presents as normal appearing kidneys.
What is the function of the parathyroid glands?
Regulation of calcium levels
What is the most common cause of acute testicular pain in adults?
Epididymitis
What is the most inferior structure in the male pelvis?
Bladder
What sonographic feature gives an adrenal cyst concern for malignancy?
Calcified cyst wall
Which patient population is most susceptible to emphysematous cholecystitis?
Diabetic patients
What technique can be used to help define an abdominal wall hernia?
Valsalva maneuver
A 2-year-old male presents with a palpable abdominal mass with abdominal and back pain. A 10-cm heterogeneous ill-defined mass with calcifications is identified in the RT abdomen. Mets were identified in the liver. What is the most likely diagnosis?
Neuroblastoma
Which disorder of the gallbladder is associated with cystic kidney disease?
Caroli disease
Which of the following patient populations is at greater risk of complications from a thoracentesis? A. Elderly B. Immunocompromised C. Smokers D. Hemophiliacs
A. Elderly
Which of the following describes the sonographic appearance of a normal parotid gland? A. Hyperechoic homogenous tissue that is elliptical in long and round in transverse, anechoic duct may be visualized. B. Hypoechoic tissue that is round in both planes, hyperechoic duct may be visualized. C. Heterogeneous tissue that is triangular shaped in both planes, anechoic duct may be visible. D. Hypoechoic ovoid tissue with hilar blood flow and presence of anechoic duct.
A. Hyperechoic homogenous tissue that is elliptical in long and round in transverse, anechoic duct may be visualized.
Which of the following disorders presents clinically with the "olive sign"? A. Hypertrophic pyloric stenosis B. Appendicitis C. Intussusception D. Constipation
A. Hypertrophic pyloric stenosis
Which of the following best describes the location of the spleen? A. Intraperitoneally located in the left upper quadrant (LUQ) B. Intraperitoneally located in the left lower quadrant (LLQ) C. Retroperitoneally located in the LUQ D. Intraperitoneally located in the LLQ
A. Intraperitoneally located in the left upper quadrant (LUQ)
Which of the following best describes the flow of bile? A. Liver - RT or LT hepatic ducts - common hepatic duct (CHD) - cystic duct - gallbladder - common bile duct (CBD) - ampulla of Vater - sphincter of Oddi - duodenum B. Liver - RT or LT hepatic ducts - CHD - cystic duct - gallbladder - CBD - sphincter of Oddi - ampulla of Vater - duodenum C. Liver - RT or LT hepatic ducts - CBD - cystic duct - gallbladder - CHD - ampulla of Vater - sphincter of Oddi - duodenum D. Liver - RT or LT hepatic ducts - CBD - cystic duct - gallbladder - CHD - sphincter of Oddi - ampulla of Vater - duodenum
A. Liver - RT or LT hepatic ducts - common hepatic duct (CHD) - cystic duct - gallbladder - common bile duct (CBD) - ampulla of Vater - sphincter of Oddi - duodenum
Which of the following correctly describes acute cholecystitis? A. Nausea and vomiting, positive sonographic Murphy's sign, symmetric gallbladder wall thickening, and gallstones B. Sudden onset of colicky right upper quadrant (RUQ) pain with asymmetric wall thickening, sludge, and gallbladder atrophy C. Left lower quadrant pain, leukocytosis, thickened edematous gallbladder wall with pericholecystic fluid D. Elevation of bilirubin, tachycardia, gallbladder enlargement with fluid-fluid level
A. Nausea and vomiting, positive sonographic Murphy's sign, symmetric gallbladder wall thickening, and gallstones
Which of the following best describes the adult kidney? A. Retroperitoneal location with cortex responsible for blood filtration and medulla responsible for absorption B. Intraperitoneal location with right kidney typically measuring up to 2 cm larger than left responsible for homeostasis C. Retroperitoneal location covered by Gerota fascia with the main function being the regulation of blood pressure by producing renin D. Intraperitoneal location typically down in the pelvis responsible for detoxification and filtration of the blood
A. Retroperitoneal location with cortex responsible for blood filtration and medulla responsible for absorption
Which of the following best describes the location of the left adrenal gland? A. Retroperitoneal, located medial to the superior pole of the LT kidney B. Intraperitoneal, posterior to the lesser sac C. Retroperitoneal, medial to the right lobe of the liver D. Intraperitoneal, lateral to the crus of the diaphragm
A. Retroperitoneal, located medial to the superior pole of the LT kidney
Which of the following correctly identifies the path sperm take from origin to the seminal vesicles? A. Seminiferous tubules > straight tubule > efferent duct > epididymis > ductus deferens > seminal vesicle B. Seminiferous tubules > efferent duct > epididymis > straight tubule > ductus deferens > seminal vesicle C. Seminiferous tubules > ductus deferens > straight tubule > efferent duct > epididymis > seminal vesicle D. Seminiferous tubules > efferent duct > epididymis > ductus deferens > straight tubule > seminal vesicle
A. Seminiferous tubules > straight tubule > efferent duct > epididymis > ductus deferens > seminal vesicle
Which of the following best describes a chronic condition that results in fibrotic replacement and atrophy of the spleen? A. Sickle cell anemia B. Granulomatous disease C. Lymphoma D. Lymphangioma
A. Sickle cell anemia
Which of the following is an indication for completing a bowel sonogram? A. Suspected intussusception B. Constipation C. Diarrhea D. Enteritis
A. Suspected intussusception
Which of the following terms describes an anechoic, smooth-walled cyst located inferior to the hyoid bone but superior to the thyroid isthmus? A. Thyroglossal duct cyst B. Brachial cleft cyst C. Fibromatosis colli D. Submandibular gland
A. Thyroglossal duct cyst
Which of the following correctly orders the normal organs from least echogenic to most echogenic? A. Renal sinus, spleen, gallbladder B. Pancreas, liver, gallbladder C. Gallbladder, renal cortex, pancreas D. Renal pyramids, pancreas, liver
C. Gallbladder, renal cortex, pancreas
A male athlete presented with pain between the heel and the calf. The area was warm to the touch. Sonogram demonstrated a focal thickened hypoechoic area within the tendon with hyperemic flow. What is the most likely diagnosis?
Achilles tendonitis
Which of the following presents as a tender, palpable retroareolar mass in a male patient? A. Galactocele B. Mastitis C. Gynecomastia D. Mastoma
C. Gynecomastia
Which of the following is a false statement about the renal arteries? A. The right renal artery (RRA) courses posterior to the IVC prior to entering the renal hilum. B. The LT renal artery is longer than the RT. C. The left renal artery (LRA) comes off the aorta at approximately the 4:00 position. D. Normal renal arteries demonstrate low resistance flow.
B. The LT renal artery is longer than the RT.
Which of the following is most accurate when describing Klatskin tumors? A. Alcoholic cirrhosis is the most common risk factor for Klatskin tumors. B. Tumors are generally located at the junction of the RT and LT hepatic ducts. C. Prognosis is generally good as they are symptomatic at an early stage. D. Sonography usually demonstrates normal hepatic ducts, dilated CHD and CBD.
B. Tumors are generally located at the junction of the RT and LT hepatic ducts.
An infant patient presents with a history of a breech birth, asymmetric skinfolds on the legs, and a difference in length between both lower limbs. What tests should be conducted as an initial assessment of developmental dislocation of the hip?
Barlow and Ortolani test
Which of the following best describes sonographic appearance of an abnormal lymph node? A. Small hypoechoic mass with echogenic hilum and irregular wall B. Enlarged, hyperechoic mass with echogenic hilum and smooth wall C. Enlarged, hypoechoic mass with absence of echogenic hilum and irregular wall contour D. Small, hyperechoic mass with smooth wall
C. Enlarged, hypoechoic mass with absence of echogenic hilum and irregular wall contour
Which of the following best describes the sonographic appearance of an enlarged lymph node that is likely benign? A. Irregularly shaped node that is taller than wide with increased vascularity B. Enlarged round node with increased echogenicity C. Enlarged oval node with decreased echogenicity D. Hyperechoic irregularly shaped node with increased vascularity
C. Enlarged oval node with decreased echogenicity
Which statement below is true with respect to the normal liver? A. Retroperitoneal organ located in right flank responsible for carbohydrate metabolism B. Large parenchymal organ located in the epigastric area responsible for hemolysis C. Intraperitoneal organ located in right upper quadrant (RUQ) responsible for bile synthesis D. Covered by Glisson capsule, located in RUQ, responsible for drug activation
C. Intraperitoneal organ located in right upper quadrant (RUQ) responsible for bile synthesis
Which of the following statements is false with respect to transjugular intrahepatic portosystemic shunt (TIPS) procedures? A. The main function of TIPS is to prevent the rupture of gastroesophageal varices. B. The procedure makes a connection between the right portal vein and the right hepatic vein to bypass the liver parenchyma. C. It is considered an abnormal finding post stent placement for the flow to reverse within the right and left portal veins. D. Failure of a TIPS shunt is indicated by clot within the shunt, reversal of intrahepatic flow, and a drop in flow velocity on serial examinations.
C. It is considered an abnormal finding post stent placement for the flow to reverse within the right and left portal veins.
Which of the following statements is false with respect to abdominal aortic aneurysm (AAA)? A. AAA is diagnosed by an aorta diameter of 3.0 cm or greater. B. A saccular aneurysm is often spherical and protrudes off only on one side of the aorta. C. Marfan syndrome is considered the most common cause of AAA. D. Most AAA occurs in the infrarenal segment of the abdominal aorta.
C. Marfan syndrome is considered the most common cause of AAA.
Which of the following best describes a mucinous cystadenocarcinoma? A. Large benign cystic mass in the pancreatic head with CBD dilation B. Small cystic mass in the tail of the pancreas C. Multilocular cystic mass with mural nodules and internal echoes with dilation of the duct of Wirsung D. Microscopic cystic mass in the head of the pancreas with dilation of the pancreatic duct
C. Multilocular cystic mass with mural nodules and internal echoes with dilation of the duct of Wirsung
Which of the following statements is false with respect to developmental dysplasia of the infant hip (DDH)? A. The Barlow test is used to determine if the hip dislocates whereas the Ortolani test is used to realign a dislocated hip. B. DDH is linked with spina bifida and arthrogryposis. C. The cause of DDH is thought to be degeneration of the acetabulum caused by maternal hormones. D. DDH is more common in female infants.
C. The cause of DDH is thought to be degeneration of the acetabulum caused by maternal hormones.
Which of the following best describes the sonographic appearance of the IVC? A. In transverse, the IVC will lie to the left of the aorta and have an oval shape. B. Slightly tapered diameter as it approaches the heart, triphasic waveform at origin, and phasic pattern at heart. C. Variable diameter that changes with respiration, pulsatile waveform close to the heart with a phasic waveform at its origin. D. Diameter that is largest in expiration and smallest in inspiration, phasic waveform proximal and distal.
C. Variable diameter that changes with respiration, pulsatile waveform close to the heart with a phasic waveform at its origin.
Which statement below is false with respect to the normal gallbladder? A. The gallbladder is located posterior to the medial aspect of the right lobe of the liver. B. The gallbladder neck is connected to the common hepatic duct by the cystic duct. C. When a patient fasts, the duodenum secretes cholecystokinin which causes contraction of the gallbladder. D. A normal variant of the gallbladder is a fold at the junction of the neck of the gallbladder.
C. When a patient fasts, the duodenum secretes cholecystokinin which causes contraction of the gallbladder.
A patient presents with a history of chronic alcohol abuse and hyperparathyroidism. The sonogram demonstrates a small pancreas with a complex cystic mass demonstrated along the border of the pancreatic tail. What is the most likely diagnosis?
Chronic pancreatitis
A patient presents with diarrhea, fever, nausea, and vomiting with crampy LLQ pain. Sonogram demonstrated a segment of thickened bowel with an inflamed outpouching of the intestine. What is the most likely diagnosis?
Diverticulitis
Which of the following typically presents in a patient whose history includes chronic bladder UTI and sonographic appearance of diffusely thickened bladder wall with septations and internal debris? A. Neurogenic bladder B. Cystitis C. Bladder lithiasis D. Bladder diverticulum
D. Bladder diverticulum
Which of the following is most likely a malignant tumor? A. Hamartoma B. Pheochromocytoma C. Adenomyomatosis D. Choriocarcinoma
D. Choriocarcinoma
Which of the following is false with respect to the pancreas? A. The pancreas produces insulin and glucagon that are involved in maintaining blood sugar levels. B. Cholecystokinin causes both contraction of the gallbladder and relaxation of the sphincter of Oddi. C. Pancreatic enzymes drain into the duct of Wirsung then collect at the ampulla of Vater before mixing with bile and then entering the duodenum via the sphincter of Oddi. D. Exocrine function of the pancreas is performed by the islets of Langerhans.
D. Exocrine function of the pancreas is performed by the islets of Langerhans.
Which of the following disorders presents with congenital muscular torticollis and a palpable mass in the sternocleidomastoid muscle that contains calcifications? A. Retroperitoneal fibrosis B. Thyroglossal duct cyst C. Brachial cleft cyst D. Fibromatosis colli
D. Fibromatosis colli
Which of the following should the sonographer carefully examine in the urinary bladder of a patient who has undergone a pancreatic transplant? A. Pancreatic abscess commonly extends to the urinary bladder in cases of rejection. B. Ascites is commonly demonstrated around the urinary bladder if there is a failed anastomosis. C. Acute pancreatic rejection can cause ureteral obstruction leading to bladder atrophy. D. Formation of an urinoma secondary to a bladder anastomosis.
D. Formation of an urinoma secondary to a bladder anastomosis.
Sonographic features of gallbladder sludge include which of the following? A. Nonmobile hyperechoic nodular echoes within the gallbladder B. Septations and internal debris C. WES sign D. Hepatization of the gallbladder
D. Hepatization of the gallbladder
Which of the following is a benign mass found in the liver parenchyma found in patients taking oral contraceptives? A. Hepatic lipoma B. Hepatic hematoma C. Hepatocellular carcinoma D. Hepatocellular adenoma
D. Hepatocellular adenoma
Which of the following findings are consistent with a diagnosis of hydatid liver cyst? A. Asymptomatic patient with smooth bordered anechoic mass in the liver demonstrating posterior enhancement B. Asymptomatic patient with increased liver echogenicity C. Low grade fever, RUQ pain, and demonstration of echogenic solid liver nodule D. Leukocytosis, obstructive jaundice, and anechoic liver mass described as mother cyst with daughter cyst
D. Leukocytosis, obstructive jaundice, and anechoic liver mass described as mother cyst with daughter cyst
Which of the following best describes malignant disease of the spleen? A. Leukemia is the most common malignancy of the spleen presenting with splenomegaly. B. Metastatic disease to the spleen is the most common malignancy presenting as multiple bull's eye masses throughout the spleen. C. Angiosarcoma is the most common tumor of the spleen presenting as a solitary complex mainly solid mass in the spleen. D. Lymphoma is the most common malignancy of the spleen presenting as multiple hypoechoic masses throughout the spleen.
D. Lymphoma is the most common malignancy of the spleen presenting as multiple hypoechoic masses throughout the spleen.
Which of the following is a false statement about sonography of the penis? A. Sonography can be used to diagnose strictures of the penile urethra. B. Squamous cell carcinoma of the penis can be demonstrated as a penile mass. C. Ultrasound can be used to diagnose vascular impotence. D. Peyronie disease can be diagnosed when thickening of the tunica albuginea is filled with anechoic fluid.
D. Peyronie disease can be diagnosed when thickening of the tunica albuginea is filled with anechoic fluid.
Which of the following is false with respect to how sonography can be used to demonstrate a foreign body? A. It may demonstrate the distance to the skin surface. B. It may demonstrate ring-down or comet tail allowing for determination of the foreign body composition. C. Hyperemia can be demonstrated using color Doppler outlining the foreign body. D. The vibration of the sound waves will help to dislodge the foreign body.
D. The vibration of the sound waves will help to dislodge the foreign body.
A 65-year-old male patient presents with nocturia, increased urinary frequency, constant feeling of bladder fullness, and elevated PSA. What is most likely demonstrated on ultrasound?
Enlarged diffusely heterogeneous gland with calcifications and cystic changes
A male patient presents with a history of chronic hepatitis and Wilson disease. Sonography reveals a heterogeneous mass in the right lobe that appears to invade the IVC and the hepatic veins appear to be narrowed. What is the most likely diagnosis?
Hepatoma with Budd-Chiari syndrome
A 3-week-old infant presented with projectile vomiting, dehydration, weight loss, and insatiable appetite. Sonography demonstrated a cervix sign in the long axis. What is the most likely diagnosis?
Hypertrophic pyloric stenosis
A male patient presents with history of acute scrotal trauma. Bloodwork revealed a decreased hematocrit. What should the sonographer expect to find on the scan?
Ill-defined margins of the testicle with a complex fluid collection in the scrotum
A patient presents with pulmonary edema. On sonography, an area of lung has the same echotexture as the liver but with areas of linear pattern echogenicities. What is the most likely diagnosis?
Lung consolidation
A 60-year-old male patient presents with elevated prostate-specific antigen (PSA), macroscopic hematuria, and a decrease in the amount of ejaculated fluid. Sonogram demonstrates a hypervascular enlarged prostate gland. What is the most likely diagnosis?
Prostate cancer
If a patient presents with elevated blood urea nitrogen (BUN) and elevated creatinine, what disease process is most likely?
Renal failure
A 6-year-old female patient presents with low-grade fever, mild leukocytosis, complains of right hip pain, and a reluctance to walk. Sonography demonstrated a hypoechoic fluid collection in the right hip joint that measured 7 mm in width. What is the most likely diagnosis?
Transient synovitis
A 35-year-old male patient presents with infertility and a palpable extratesticular mass on the LT side. Sonogram demonstrates multiple anechoic tubular structures in the LT adjacent to the testicle. What can the sonographer suggest to help solidify the diagnosis?
Valsalva maneuver will cause the veins to fill with blood and become more dilated with increased blood flow.
