DMS 211 Final Exam
The renal cortex should measure as least
1cm
An abdominal aortic aneurysm is present when the diameter of the abdominal aorta exceeds
3cm
Thickness of the gallbladder wall in a normal fasting patient should not exceed
3mm
An adult kidney measures what from from superior to inferior margins?
9-12 cm
You are scanning a patient with suspected liver cirrhosis. All of the following are sonographic features of cirrhosis EXCEPT: A - shrunken caudate lobe B - altered echotexture C - ascites D - regenerative nodules E - surface nodularity
A
Infantile polycystic disease may also be referred to as:
ARPKD
SGOT (serum glutamic-oxaloacetic transaminase) is now referred to as:
AST (aspartate aminotransferase)
Structure NOT seen in RUQ Liver Appendix Right kidney Gallbladder
Appendix
Which of the following is NOT a remnant of the fetal circulation? A - falciform ligament B - coronary ligament C - ligamentum teres D - ligamentum venosum
B
Which of the following is NOT true about the abdominal aorta? A - The aorta has a thicker tunica media than the IVC. B - The proximal aorta is situated more anterior than the distal aorta. C - The abdominal aorta bifurcates into the common iliac arteries. D - The 3rd major branch of the abdominal aorta are the renal arteries.
B
all of the following would be considered common among solid renal masses EXCEPT? A - mural nodules B - smooth walls C - internal echoes D - septations
B
Obstruction of one or more hepatic vein in referred to as:
Budd-Chiari disease
The spiral valves of Heister are located in which structure?
Cystic duct
A 50-year-old woman with a long history of alcoholism presents with increased abdominal girth. Which of the following is the most probably finding on ultrasound of the abdomen? A - liver metastases B - hepatoma C - gallstones with a mass in the lumen of the gallbladder D - massive ascites with a small echogenic liver E - dilated intrahepatic biliary ducts
D
Which of the following is associated with development of cysts in the pancreas? A - Zollinger-Ellison syndrom B - autosomal recessive polycystic disease C - endoscopic retrograde cholangiopancreatography D - Von Hipple-Lindau disease
D
Accessory pancreatic duct
Duct of Santorini
Main pancreatic duct
Duct of Wirsung
Fold in the parietal peritoneum that extends from the umbilicus to the diaphragm and contains the ligamentum teres.
Falciform ligament
Fibroeslastic connective tissue layer that surrounds the liver
Glisson's capsule
Macrophages that are part of the reticuloendothelial system, help break down red blood cells.
Kupffer cells
Pain in the area of the gallbladder
Murphy's sign
In what anatomic variant is the fungus of the gallbladder folded over the body?
Phrygian cap
Anatomic variant in which right lobe is enlarged and extends inferiorly.
Reidel's lobe
The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:
Sphincter of oddi
Patients present with fever and elevated white blood count
abscess
Which cells carry out the exocrine function of the pancreas?
acinar cells
Performs exocrine functions, secreting digestive enzymes
acini cells
A patient presents with a sudden onset of abdominal pain and extreme tenderness over the gallbladder fossa. Localized gallbladder wall thickening is visualized on ultrasound. This most likely represents:
acute cholecystitis
What is the most common primary carcinoma of the pancreas?
adenocarcinoma
Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with:
adenomyomatosis
Laboratory test that evaluates liver function
alkaline phosphatase
Performs endocrine function, secretes glucogon
alpha cells
The common bile duct enters the duodenum at the
ampulla of vader
Enzymes that digests carbohydrates
amylase
Which laboratory finding elevates first in the presence of acute pancreatitis?
amylase
A structure lacking echoes can be referred to as
anechoic
Describes a portion of an image that is echo free
anechoic
A rare malignant tumor of the spleen that consists of blood vessels is an
angiosarcoma
Towards the front of the body
anterior
The right portal vein divides into
anterior and posterior branches
List 4 ways to differentiate between the great vessels (Aorta is/has)
anterior branches, on the left side of the body, nothing posterior, courses posterior to the diaphragm
List the 4 vessels that run long in the body
aorta, IVC, SMA, SMV
An outpatient with a history of back pain and hypertension presents to the ultrasound department for an abdominal aortic ultrasound. Sonographically, you visualize a 6cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis?
aortic dissection
Tendons that attach to muscles
aponeuroses
What is the most common clinical finding of a simple renal cyst?
asymptomatic
What is the most likely clinical finding of a patient who has a splenic hemangioma?
asymptomatic
Non-shadowing, low-amplitude echoes located in the dependent portion of the gallbladder best describes:
biliary sludge
What liver function test is produced from the breakdown of hemoglobin?
bilirubin
What hepatic function continues after birth?
bilirubin production
The most common type of choleductal cyst involves:
both CBD and CHD
What form of hepatic abnormality are immunocompromised patients more prone to develop?
candidiasis
What is typically transmitted through contaminated water found in places such as Mexico, Central America, South America, Asia, India, and Africa?
candidiasis
Based on couinad segments of the liver, segment 1 is
caudate lobe
The most common benign hepatic neoplasm
cavernous hemangioma
Surgical removal of the gallbladder
cholecystectomy
Which hormone stimulates gallbladder contraction and the secretion of pancreatic enzymes?
cholecystokinin
Intermittent obstruction of the cystic duct by a gallstone results in
chronic cholecystitis
Demarcates the posterolateral border of the pancreas head
common bile duct
A structure that contains both solid and cystic areas
complex
Plane that divides the body into anterior and posterior portions
coronal
Which ligament serves as a barrier between the subphrenic space and Morison's pouch?
coronary
The spleen removes irregular cells from the bloodstream and retains them through a process called:
culling
What do Klatskin tumors cause
dilation of the intrahepatic ducts
Away from the trunk of the body
distal
Another term for posterior
dorsal
The portion of the bowel that encompasses the head of the panc is the
duodenum
Skin discoloration caused by blood leakage into subcutaneous tissues
ecchymosis
Describes an organ or tissue that is capable of producing echoes by reflecting the acoustic beam
echogenic
Describes a structure that is less echogenic or has few internal echoes
echopenic
Secreting into blood and tissue
endocrine
Pneumobilia is most likely seen after what procedure?
endoscopic retrograde cholangiopancreatography (ERCP)
What is hydros of the gallbladder?
enlarged gallbladder
Redness of the skin due to inflammation
erythema
The process of making blood cells is termed
erythropoiesis
Secreting into a duct
exocrine
Renal cysts that project out away from the kidney are termed:
exophytic
A collection of abdominal fluid within the peritoneal cavity often associated with cancer is
exudate ascites
Fatty infiltration is often patchy or focal. When a region of the liver is less affected it is called
fat sparring
Classic clinical features of acute pancreatitis
fever, back pain, leukocytosis
Opening between the lesser and greater sacs
foramen of winslow
An aortic aneurysm described as "dilatation with a gradual transition between the normal and abnormal segment".
fusiform
The most common shape of an aneurysm is
fusiform
A nonmobile, nonshadowing foci is seen within the gallbladder lumen. This most likely represents a:
gallbladder polyp
Demarcates anterolateral border of pancreas head
gastroduodenal artery
The arterial blood supply to the head of the pancreas is via the
gastroduodenal artery
What is a major branch of the common hepatic artery?
gastroduodenal artery
Which part of the pancreas is located right lateral to superior mesenteric vein, anterior to the IVC, and inferior to the portal vein?
head
A patient who had blunt trauma to the abdomen earlier in the day presents with LUQ pain and a decrease in hematocrit. An echogenic mass is seen in the spleen. What is this consistent with?
hematoma
A tumor that consists of a focal collection of blood best describes the
hematoma
A patient is referred with RUQ tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color doppler reveals hypervascularity of the mass. What is the most likely scenario?
hepatic adenoma
What 3 structures make up the portal triad?
hepatic artery, portal vein, bile duct
Vessels that branch off of celiac axis
hepatic artery, splenic artery, left gastric artery
Hepatoma is also known as
hepatic cellular carcinoma
A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?
hepatocellular carcinoma
The basic functional unit of the liver
hepatocyte
Enlarged liver
hepatomegaly
Which potential space is commonly referred to as Morison's pouch?
hepatorenal space
An out pouching of peritoneum, muscle, and at times bowel is called
hernia
A solid mass that contains a variety of echogenicities could best be described by this term
heterogeneous
Describes tissues or organ structures that have several different echo characteristics
heterogeneous
In a patient with suspected lymphoma, the presence of Reed-Sternberg cells indicates:
hodgkin lymphoma
Describes structures of equal echo intensity
homogeneous
A complex cyst that results from the parasitic infestation of the spleen by a tapeworm is the:
hydatid cyst
What is associated with infestation by a parasite and is most prevalent in sheep and cattle-raising countries?
hydatid disease
Describes portions of the image that are brighter than surrounding tissues or brighter than normal
hyperechoic
Describes portions of an image that are not as bright as surrounding tissues or are less bright than normal
hypoechoic
You are scanning an obese patient to rule out fatty liver. How would you describe a common sonographic appearance of this condition?
increased echogenicity of the liver compared to the normal kidney
Where would a subhepatic abscess be located?
inferior to the liver and anterior to the right kidney
Away from the head
inferior, caudal
Which of the following is not a ventral hernia? Umbilical Inguinal Epigastric Hypogastric
inguinal
Which hormone released by the pancreas that encourages the body's use of glucagon?
insulin
Endocrine portion of the pancreas made up of alpha and beta cells produce insulin and glucagon
islets of langerhans
Refers to imaged echoes of equal intensity
isoechoic
What is a ureterovesical junction?
junction between the distal ureter and the base of the bladder
Away from the midline
lateral
Based on couinad segments of the liver, segment 4a and 4b is
left medial lobe
The vessel located anterior to the abdominal aorta and posterior to the SMA is the
left renal vein
What vessel travels posterior to the superior mesenteric artery and anterior to the abdominal aorta?
left renal vein
The space located behind the liver and stomach, and posterior to the pancreas is the
lesser sac
Elevated WBC count, usually due to infection
leukocytosis
The ligament that anchors the left kidney to the posterior abdominal wall is the
lienorenal
The ligament that anchors the left kidney to the posterior abdominal wall is the
lienorenal ligament
A remnant of the fetal umbilical vein
ligament of teres
Ligament that divides the liver into left lateral and left medial segments
ligament teres
Where can a patent umbilical vein be found?
ligament teres
This ligament separates the caudate lobe from the left lobe of the liver:
ligament vinosum
Fat digesting enzyme
lipase
Most common benign tumor of the abdominal wall
lipoma
Which of these organs is an intraperitoneal organ? Liver IVC Aorta Left Kidney
liver
If you are having trouble visualizing the posterior portion of the liver in a patient with fatty infiltration, what may help?
lowering the frequency
A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is
marfan syndrome
Toward the midline
medial
The anatomic quadrate lobe is what segmental division of the liver?
medial segment of the left lobe
Structure that anchors intestines to the posterior wall of the abdominal cavity and forms ligaments
mesentery
Plane that divides the body into EQUAL anterior and posterior portions
midcoronal
One of the structures that divides the liver into right and left lobes
middle hepatic vein
Which structures separate the left lobe of the liver from the right lobe?
middle hepatic vein, main lobar fissure
Vertical plane that divides the body into EQUAL right and left sections
midsaggital
Cysts that contain calcium carbonate crystals
milk of calcium cysts
Urine in the renal pyramids next passes into the
minor calices
Condition caused by ureteral obstruction in utero
multi cystic dysplastic kidney
An aneurysm associated with infection is termed
mycotic
The ___ of the gallbladder lies most posteriorly in the body.
neck
Occurs due to excessive calcium levels, deposits found in renal cortex and medulla
nephrocalcinosis
Functional unit of the kidney
nephron
Islet cell tumors of the pancreas are likely to be located:
never in the head frequently in the body or tail
Which of the following is not an intraperitoneal organ? Liver Pancreas Spleen Gallbladder
pancreas
What part of the pancreas is located anterior to the portal confluence?
pancreas neck
What results in a shortened main pancreatic duct that works to drain only the pancreatic head and not the entire pancreas?
pancreatic divisum
These potential spaces extend alongside the ascending and descending colon on both sides of the abdomen
paracolic gutters
Cyst that originates from the renal parenchyma and protrudes into the renal sinus
parapelvic cyst
True renal sinus cyst; found in the renal pelvis
peripelvic cyst
The kidneys are located in the ____ space.
perirenal
Rhythmic contractions of the GI tract that propels food through it
peristalsis
Fluid collection in the pleural cavity
pleural effusion
Air in the bile ducts
pneumobilia
What is calcification of the gallbladder wall called:
porcelain gallbladder
Fissure where the Portal Vein and Hepatic Artery enter the liver and Common Hepatic Duct exits.
porta hepatis
What is a reanalyzed paraumbilical vein typically the result of?
portal hypertension
What is the most common cause of splenomegaly?
portal hypertension
The majority of the blood supply to the liver is provided from the:
portal vein
The majority of the blood supply to the liver. is provided from the
portal vein
You are performing an ultrasound on a patient with transjugular intrahepatic portosystemic shunt (TIPS). What two vessels are connected with the TIPS stent?
portal vein and hepatic vein
Towards the back of the body
posterior
Which of the following is not a retroperitoneal compartment? perirenal space anterior pararenal space posterior pararenal space posterior parietal space
posterior parietal space
Patient lying flat on their abdomen
prone
The common hepatic artery divides into what 2 branches?
proper hepatic artery and gastroduodenal artery
Towards the trunk of the body
proximal
An abnormal cavity resembling a true cyst but not lined with epithelium
pseudocyst
The muscle that has a direct relationship with the upper poles of the kidneys
psoas
This muscle has a direct relationship with the upper poles of the kidneys
psoas
Which of the following muscles is not part of the anterolateral abdominal wall? Pyramidallis muscle Rectus abdominis Psoas muscle External oblique
psoas muscle
A patient presents with empyema of the gallbladder. What should the sonographer expect to find?
pus in the gallbladder
Which of the following muscles is not a paired muscle? External oblique Transverse abdominis Pyramidalis muscle Rectus abdominis
pyramidalis muscle
The type of tissue within the spleen that is responsible for its phagocytic function is the:
red pulp
List echogenicities from hypo echoic to hyperechoic: liver, spleen, renal cortex, renal sinus, pancreas
renal cortex, spleen, liver, pancreas, renal sinus
The ureteropelvic junction is located between
renal pelvis and the proximal portion of the ureter
Staghorn calculus refers to a large stone within
renal pelvis of the kidney
Based on couinad segments of the liver, segment 8 is
right anterosuperior segment
The IVC empties blood into the
right atrium
The right lobe of the liver is divided into anterior and posterior segments by the
right hepatic vein
The anatomic division divides the liver into four lobes:
right lobe, left lobe, caudate lobe, quadrate lobe
The right lobe of the liver is divided into anterior and posterior segments by the :
right portal vein
Based on couinad segments of the liver, segment 6 is
right posteroinferior segment
Which vessel courses posterior to the IVC?
right renal artery
The potential space that lies between the liver and the diaphragm is
right subphrenic space
Vertical plane that divides the body into right and left sections
saggital
A lack of echoes posterior to a highly attenuating structure such as a stone is referred to
shadowing
Artifact most commonly encountered posterior to a gallstone is
shadowing
While performing an abdominal ultrasound for RUQ pain, you notice a single, well-circumscribed anechoic lesion in the right lobe of the liver. The lesion exhibits posterior enhancement. The remainder of the examination is normal. What is the most likely diagnosis?
simple liver cyst
A patient in the late stages of sickle cell anemia will have a spleen that is:
small and echogenice
Which enzyme released by the pancreas that neutralizes stomach acid?
sodium bicarbonate
An area within the spleen that has become necrotic because of a lack of oxygen is referred to as a
splenic infarct
The main portal vein is created by the union of the
splenic vein and SMV
An abscess located inferior to the liver and anterior to the right kidney is a ___ (space) abscess.
subhepatic
Space located superior to the liver and inferior to the diaphragm
subphrenic space
The splenic artery marks what aspect of the pancreas?
superior aspect of the pancreatic body and tail
Which artery supplies the small intestines, right colon, and most of the transverse colon?
superior mesenteric
Toward the head
superior, cranial, cephalic
Patient lying flat on their back
supine
Current ultrasound contrast agents go to which located when injected?
the vascular system
How are current ultrasound agents expelled from the body?
through the respiratory system
Plane that divides the body into superior and inferior portions
transverse
T or F? The abdominal aorta normally tapers in diameter from its cranial to its caudal extent.
true
T or F? The lesser sac does not contain any organs.
true
In a dissecting aneurysm, the dissection is through which of the layers of the aorta.
tunica intima
The inner wall of layer of a vessel, closest to the passing blood, is the
tunica intima
Layers of vessels, inner to outer
tunica intima, tunica media, tunica adventitia
Identify the part of the pancreas that lies anterior to the IVC and posterior to the superior mesenteric vein?
uncinate process
Another term for anterior
ventral
Peritoneum that surrounds the abdominal organs is referred to as
visceral peritoneum
The type of tissue within the spleen that is responsible for its lymphatic function is the:
white pulp
