DMS 250 Superficial Structures
A patient presents with an aching over the right Achilles tendon. A sagittal image of the tendon reveals what finding? (Mosby, fig 15-12)
normal tendon (≤ 5 mm)
You have obtained several images of a breast mass in a radial plane and have determined that the mass is solid. You measured the long axis of the mass. What else should you do?
obtain images in a projection 90 degrees to the original scan plane
A patient has been referred for sonographic evaluation of a right lateral breast mass seen on mammography. What is the correct patient positioning to evaluate this mass?
patient in left posteriour oblique position with right arm abducted
The fascial interface of the anteriour abdominal wall is located directly anteriour to the:
peritoneum
The most common congenital breast anomaly is:
polythelia (accessory nipples)
What is the appearance of a normal lymph node in the breast?
small, ovoid structure with a hypoechoic rim and echogenic hilum
A common malignancy of the breast demonstrating posteriour acoustic shadowing describes what neoplasm?
invasive ductal carcinoma (shadow)
A mass is identified in the upper outer quadrant of the right breast, near the axilla and chest wall. This mass should be annotated as:
10:00 3C (10:00 = R UOQ; 3 = near the axilla; C = near the chest wall)
Thickness of a normal Achilles tendon should not exceed:
7 mm (tendonitis after 7mm
The accumulation of synovial fluid from a weakening in the joint capsule of the knee, as seen in conditions such a rheumatoid arthritis can result in a
Baker Cyst
A common mass found along the dorsal aspect of the hand and wrist is the
Ganglion cyst
Hyperemic flow (increased blood flow) w/in or around a structure is often indicative of
Inflammation
Which of the following would best describe a benign tumor composed of fat?
Lipoma
Acoustic shadowing caused by bending of a sound beam at the edge of a curved reflector is referred to as
Refractive shadowing
When imaging the breast parenchyma, the thickness of the standoff pad should not exceed:
1.0 cm (w/ newer machines, no need for standoff pad)
Which transducer will provide the most optimal imaging for ultrasound imaging of the breast?
10.0 MHz linear array
You have been asked to perform an ultrasound exam of the Achilles tendon. Which transducer would provide the most optimal image of this structure?
12 MHz linear array
The breast parenchyma is composed of approximately:
15 to 20 lobes
The diameter of a normal lactiferous duct should not exceed:
3.0 mm
You have been asked to determine if a mammographically detected breast mass is cystic or solid. What is the established accuracy of ultrasound for distinguishing a simple cyst from a solid lesion?
96 - 100%
The Thompson test is used to check the integrity of the:
Achilles tendon
Which of the following at the site of a foreign body may produce bright echoes & therefore cause some ambiguity about the correct orientation of the object?
Air
Clinical findings of a Baker cyst may mimic those of a
DVT
Tendons appear as
Echogenic, fibrous structures connecting muscles to bone
A partial tear of a tendon typically appears as
Focal hypo echoic area w/in tendon
The Achilles tendon connects the
Heel to the calf muscle (gastrocnemius)
Which transducer would be best suited to assess for a splinter in a pt's hand?
High freq, linear array
Clinical findings of tendonitis does not include:
Itching in the area of the tendon
To better eval the Achilles tendon, the pt should be placed in
Prone
A standoff pad is most useful in imaging
Superficial structures
Fluid w/in the synovial sheath is indicative of
Tendosynovitis
Inflammation of the tendon & synovial tendon sheath is referred as
Tendosynovitis
Which of the following best describes a negative Thompson test
The calf is squeezed & the foot should plantar flex (going down) in a pt who doesn't have a complete tear of the Achilles tendon
Which of the following best describes the Thompson test?
The pt lies prone while the symptomatic calf is squeezed
The hyperechoic linear structure identified by the arrow is most consistent with: (Mosby, fig 15-9)
a Cooper ligament
Which of the following is suggestive of malignancy of a solid mass seen on ultrasound?
a mass that is taller than wider spiculation angular margins markedly hypoechoic solid lesion
A patient has been referred for ultrasound evaluation to rule out the presence of a carotid body tumour. Where is this tumour located?
at the level of the carotid bifurcation between the internal and external carotid arteries
You have been requested to perform an ultrasound exam to rule out the presence of a popliteal aneurysm. Where will you look?
behind the knee
A patient has been referred for an ultrasound study of the parotid gland. Where is this gland located?
between the external auditory canal and the inferiour edge of the mandible
What benign breast neoplasms may undergo malignant transformation?
cystosarcoma phyllodes (may become huge; when diagnose, take out b/c may become malignant)
Painful breast(s) one week prior to the onset of menstruation is a common symptom in what condition?
fibrocystic disease
A patient complains of pain in the forearm following a hiking trip. A soft tissue image over the area of discomfort demonstrates a hyperechoic linear structure outlined by the calibers. This is most suspicious for a: (Mosby, fig 15-11)
foreign body
A retroareolar mass developing shortly after childbirth is most suspicious for a:
galactocele
You have detected a cyst in a patient referred for sonographic evaluation of a wrist nodule. What is a cyst that occurs adjacent to a joint?
ganglion cyst
Abnormal enlargement of the male breast parenchyma is most likely a clinical finding in what pathology?
gynecomastia
A teenager arrives to the emergency department following a skiing injury. A nonvascular hypoechoic mass is identified in the posterior popliteal fossa. This mass most likely represents a:
hematoma
Which of the following would best describe a benign tumor comprised of blood?
hematoma
A defect in the muscles of the abdominal wall is most likely related to a:
hernia
A patient presents to the ultrasound department with a palpable umbilical mass. The finding in this sonogram is most consistent for a: (Mosby, fig 15-6)
hernia (mushroom cloud like)
A complete tear of the Achilles tendon is most commonly located:
in the distal portion of the tendon near the calcaneus
A patient is referred for an ultrasound to evaluate a mass identified on a recent mammogram. A radial image of the right breast demonstrates an abnormality most suspicious for: (Mosby, fig 15-8)
invasive ductal carcinoma
The location of the rectus abdominus muscles is described as lateral to the:
linea alba (dark like on pregnant women)
What comprises the terminal ductal lobular unit (TDLU) in the breast?
lobule with its terminal branches, short intralobular and longer extralobular duct
What is the sonographic appearance of a normal peripheral nerve (spinal cord nerve)?
marked hyperechoic structure with parallel internal linear echoes
A patient has been referred for an ultrasound study to rule out the presence of a rectus sheath hematoma. Where will you look?
mid abdominal wall
Echogenicity of glandular breast tissue when compared to a fatty breast lobule is best described as:
moderately hyperechoic
You detect a hypoechoic region within an otherwise normal appearing tendon. What causes false hypoechogenicity within a tendon?
oblique incidence of the beam to the tendon axis (anisotropy: associated with a false hypoechoic area within the tendon when the ultrasound beam is not perpendicular with a fibrillar tendon)
You have been asked to perform an ultrasound exam on a patient with recent muscular trauma. What is true regarding the normal sonographic findings in a muscle?
on sagittal scans, oblique, parallel, echogenic fibers are seen against a hypoechoic background
You have been requested to perform an ultrasound to rule out the presence of a Baker's cyst. Where will you look?
popliteal fossa
What accurately describes the location of the transversus abdominus muscle?
posteriour to the internal oblique muscle ("bad question")
What muscle extends the entire length of the anteriour abdominal wall?
rectus abdominus
An afebrile elderly patient hospitalized with pheumonia presents with a palpable abdominal wall mass. A mass is identified adjacent to the urinary bladder. This finding is most suspicious for a: (Mosby, fig 15-3)
rectus sheath hematoma (anteriour to bladder)
The deep layer of the superficial fascia is located within the:
retromammary space
What is not an accepted indication for breast ultrasound?
screening for malignancy in the general population
A toddler with a recent upper respiratory infection presents with a history of limping. Asymmetric hip joints are identified on ultrasound. On the basis of the clinical history, the sonographic finding is most suspicious for what condition? (Mosby, fig 15-10)
septic hip
A patient has been referred for sonographic evaluation of the rotator cuff. What part of the body should you image?
shoulder
What joint has the largest range of motion?
shoulder (can go 360 degrees almost)
A 45-year-old female presents with a firm, nontender, palpable breast mass. The finding in this sonogram is most consistent with a: (Mosby, fig 15-5)
simple cyst
The most common benign breast lesion in women between the ages of 35 and 50 is a:
simple cyst
You have been asked to determine if a mass seen on mammography in the left breast is solid or cystic. What are the characteristics of a breast cyst by ultrasound?
smooth walls, sharp anteriour and posteriour borders, no internal echoes, posterior enhancement (star)
The echogenicity of a fatty breast lobule is most commonly described as a:
smooth, moderately hypoechoic mass
All of the following are keys to ID foreign bodies (something stuck inside u) w/ US
they show as hyper echoic
Measurement of the Achilles tendon should be made in the:
transverse plane
What is a sonographic sign of tendinitis?
vascularity on color Doppler imaging
In the breast, the lymph vessels generally course parallel with the:
venous system (true throughout the body, in general)
All of the following correctly describe the venous system of the breast parenchyma:
(deep veins may empty into the subclavian vein and axillary vein; superficial veins lie deep to the superficial fascia; superficial veins from the left and right breast can communicate)
Clinical symptoms associated with mastitis may include all of the following:
(fever, erythema, breast pain, malaise)
Sonographic findings associated with invasive ductal carcinoma may include:
(hypoechoic mass; ill-defined borders; posteriour acoustic shadowing; thick Cooper ligaments)
Possible etiologies of a rectus sheath hematoma may include all of the following:
(trauma, pregnancy, severe coughing, anticoagulant therapy)
True about ganglion cysts:
A ganglion cyst is NOT a common mass found along the ant aspect of the hand & wrist, between the carpals
A cystic mass located w/in the popliteal fossa is a
Baker Cyst
Inflammation & infection of the skin subcutaneous tissue is
Cellulitis
Bullets, shrapnel and other metallic objects may cause
Comet-tail artifact
What structure is considered the "skeletal" framework in the breast?
Cooper ligaments
What structure provides support to the breast parenchyma?
Cooper ligaments
Which of the following is true of a lipoma?
No pain in the area of the mass
A complicated baker cyst may contain a thin flap of tissue referred to as
Pannus
What test can be performed to determine a torn Achilles tendon?
Thompson Test
What is the smallest functional unit in the breast parenchyma?
acini
Complete absence of one or both breasts is termed:
amastia
What artifact is likely to occur when the ultrasound beam is not perpendicular with a fibrillar (fibrous) tendon?
anisotropy (false hypoechoic area within tendon)
The Valsalva maneuver is a common technique used when evaluating the:
anteriour abdominal wall (looking for hernia)
The sinus of a lactiferous duct is located near the:
areola
Estrogen levels most frequently influence what breast lesions?
fibroadenoma
A 25-year-old female presents with a firm, nontender, palpable breast mass. An antiradial image of the right breast demonstrates a hypoechoic mass. On the basis of the clinical history, the sonographic finding is most suspicious for a: (Mosby, fig 15-7)
fibroadenoma (homogeneous, not shadowing)
An elderly patient presents with a history of acute ankle swelling. A sonogram is ordered to rule out deep vein thrombosis. A nonvascular anechoic structure is identified in the popliteal fossa. Based on these sonographic findings the anechoic structure is most suspicious for a: (Mosby, fig 15-4)
synovial cyst (= Baker cyst = popliteal cyst)
Muscle attaches to bone by what structure?
tendon
A patient has been referred for ultrasound evaluation of tendinitis in the wrist. What is the ultrasound appearance of a tendon?
tendons are highly echogenic with fibrillar echotexture
Breast pathology most commonly originates in what structure?
terminal ductal lobular unit
