Sonography Canada (Generalist) - 1

A female patient complaining of right lower quadrant pain and vomiting present to the emergency department. Her last menstrual period was two weeks earlier. A pelvic ultrasound might be ordered to rule out all of the following EXCEPT:

a) Appendicitis

b) Pancreatitis

c) Ovarian torsion

d) Hemorrhagic cyst

e) Tubo-ovarian abscess

A: Pancreatitis

The most common complication associated with acute pancreatitis is a(n):

a) Abscess

b) Phlegmon

c) Insulinoma

d) Pseudocyst

e) Bowel obstruction

A: Pseudocyst

In case of renal sinus lipomatosis, sonographic findings may include all of the following EXCEPT:

a) Renal atrophy

b) Hyperechoic renal sinus

c) Ireegular renal contour

d) Hyperechoic renal cortex

e) Decreased cortical thickness

A: irregular renal contour

Focal dilatation of the anterior wall of the abdominal aorta describes a:

a) Berry aneurysm

b) Saccular aneurysm

c) Pseudoaneurysm

d) Fusiform aneurysm

e) Dissecting aneurysm

Saccular aneurysm

Predisposing factors correlating with development of renal vein thrombosis include all of the following EXCEPT:

a) Trauma

b) Renal disease

c) Over hydration

d) Malignant renal neoplasm

e) Post surgical complication

A: over hydration

The arrow is identifying which of the following vascular structures?

a) Celiac axis

b) Splenic artery

c) Hepatic artery

d) Gastroduodenal artery

e) Superior mesenteric artery

A: Celiac axis (splenic, left gastric, and common hepatic arteries)

Which of the following vascular structures is the arrow identifying?

a) Vertebral artery

b) External jugular vein

c) Internal carotid artery

d) Internal jugular vein

e) Common carotid artery

A: Internal jugular vein

The sonographic findings in this transverse image of the distal abdominal aorta, are most suspicious for a(n):

a) A pseudoaneurysm

b) Ectatic aneurysm

c) Myocotic aneurysm

d) Dissecting aneurysm

e) True aortic aneurysm

A: Dissecting aneurysm

Which of the following vascular structures is located directly posterior to the neck of the pancreas?

a) Inferior vena cava

b) Proper hepatic artery

c) Gastroduodenal artery

d) Superior mesenteric vein

e) Superior mesenteric artery

A: Superior mesenteric vein

Presence of a palpable "thrill" over a vascular structure is highly suspicious for a(n):

a) Occlusion

b) Stenosis

c) Perforator

d) Anteriovenous fistula

e) Abdominal aortic aneurysm

A: Anteriovenous fistula

The Gastroduodenal artery arises from which of the following arteries?

a) Gastric artery

b) Splenic artery

c) Hepatic artery

d) Duodenal artery

e) Superior mesenteric artery

A: Hepatic artery (a branch off the celiac axis)

Which of the following accurately describe the portal veins?

a) Portal veins are intralobar in location

b) The walls of the portal veins contain lipids

c) Oxygen-rich blood is transported through the portal veins

d) The majority of the liver's blood supply empties through the portal veins

e) The main portal vein divides into the anterior and posterior portal veins

A: Portal veins are intralobar in location

A true abdominal aortic aneurysm is defined as dilation of the aorta:

a) Inferior to the renal arteries

b) When compared with a previous study

c) With a diameter measuring three centimeters or greater

d) When compared with a proximal segment

e) When compared with a distal segment

A: With a diameter measuring three centimeters or greater

The main portal vein supplies blood to which of the following organs?

a) Liver

b) Spleen

c) Pancreas

d) Gallbladder

e) Gastrointestinal tract

A: Liver

The distance between the abdominal aorta and superior mesenteric artery should not exceed:

a) 3mm

b) 5mm

c) 11mm

d) 15mm

e) 18mm

A: 11mm

Which of the following arteries are termed the hypogastric arteries?

a) Gonadal arteries

b) Suprarenal arteries

c) Common iliac arteries

d) External iliac arteries

e) Internal iliac arteries

A: Internal iliac arteries

Which vascular structures course posterior to the superior mesenteric artery and anterior to the abdominal aorta?

a) Splenic vein

b) Left renal vein

c) Splenic artery

d) Left gastric artery

e) Superior mesenteric vein

A: Left renal vein

The coronary vein enters the venous system near the:

a) Medial border of the main portal vein

b) Inferior border of the right hepatic vein

c) Superior border of the porto-splenic confluence

d) Inferior border of the superior mesenteric vein

e) Lateral border of the porto-splenic confluence

A: Superior border of the porto-splenic confluence

The arrow is identifying which of the following structures.

a) Left renal vein

b) Right renal artery

c) Common bile duct

d) Proper hepatic artery

e) Gastroduodenal artery

A: right renal artery

Which branch of the aorta supplies the ascending colon?

a) Celiac axis

b) Gastroepiploic artery

c) Gastroduodenal artery

d) Inferior mesenteric artery

e) Superior mesenteric artery

A: superior mesenteric artery

Which of the following arteries arises caudal to the inferior mesenteric artery?

a) Lumbar

b) Gonadal

c) Infrarenal

d) Median sacral

e) Inferior phrenic

A: median sacral

Which of the following vessels receives blood from the gallbladder, pancreas, spleen, and gastrointestinal tract?

a) Hepatic veins

b) Main portal vein

c) Inferior vena cava

d) Inferior mesenteric vein

e) Superior mesenteric vein

A: Main portal vein

Which of the following structures is most likely mistaken for the splenic artery?

a) Celiac axis

b) Splenic vein

c) Hepatic artery

d) Pancreatic duct

e) Superior mesenteric artery

A: pancreatic duct

Which of the following vascular structures normal demonstrates this waveform?

a) Portal vein

b) Hepatic vein

c) Splenic vein

d) Hepatic artery

e) Superior mesenteric vein

A: hepatic Vein (pulsatile bidirectional venous flow)

A duplex image of the splenic vein is demonstrating:

a) Stenotic flow

b) Pulsatile flow

c) Turbulent flow

d) Antegrade flow

e) Retrograde flow

A: retrograde flow

How many centimeters below the superior mesenteric artery do the main renal arteries arise?

a) 0.5 - 1.0 cm

b) 1.0 - 1.5 cm

c) 1.5 - 2.0 cm

d) 2.0 - 2.5 cm

e) 2.5 - 3.0 cm

A: 1.0 - 1.5 cm

Which of the following anatomical variants involve the fundus of the gallbladder?

a) Junctional fold

b) Fetal lobulation

c) Phrygians cap

d) Hartmann's pouch

e) Multiseptated gallbladder

A: Phrygians cap

Gallbladder enlargement is suggested once the transverse diameter exceeds:

a) 3 mm

b) 4 cm

c) 5 cm

d) 7 cm

e) 9 cm

A: 5 cm

Which of the following gallbladder abnormalities is not always pathological in origin?

a) Cholecystitis

b) Cholelithiasis

c) Biliary sludge

d) Cholsesterolosis

e) adenomyomatosis

A: biliary sludge

A contracted gallbladder is a common sonographic finding in which of the following conditions:

a) Cholesterolosis

b) Adenomyomatosis

c) Portal hypertension

d) Chronic cholecystitis

e) Metastatic gallbladder disease

A: chronic cholecystitis

Which anatomical variant is present in this sonogram of the gallbladder?

a) Duplication

b) Phyrgian cap

c) Hartmann's pouch

d) Intrahepatic location

e) Junctional fold defect

A: Phyrgian cap

Which of the following pathologies is most consistent with these sonographic findings?

a) Caroli's disease

b) Polycystic disease

c) Biliary obstruction

d) Portal hypertension

e) Budd-Chiari syndrome

A: Biliary obstruction

A patient presents with an occasional history of right upper quadrant pain following a spicy meal. The sonographic findings are most consistent with which of the following abnormalities?

a) Cholangitis

b) Cholecystitis

c) Cholelithiasis

d) Cholesterolosis

e) Adenomyomatosis

A: Cholelithiasis

A patient presents with a history of autoimmune deficiency syndrome, jaundice, and marked elevation in bilirubin and alkaline phosphatase. Based on this clinical history, the sonographic findings are most consistent with:

a) Ascariasis

b) Cholangitis

c) Clonorchiasis

d) Cholangiocarcinoma

e) Choledocholithiasis

A: cholangitis

An asymptomatic patient with a history of Hepatitis B presents for an annual abdominal ultrasound examination. The gallbladder is demonstrating:

a) Pneumobilia

b) Cholesterolosis

c) Floating gallstones

d) Focal Cholecystitis

e) Adenomyomatosis

A: Adenomyomatosis

Progression of which of the following abnormalities flattens the portal veins?

a) Ascariasis

b) Pneumobilia

c) Portal hypertension

d) Biliary obstruction

e) Portal vein thrombosis

A: Biliary obstruction

Which of the following structures aids in locating the gallbladder fossa?

a) Main portal vein

b) Right hepatic vein

c) Main lobar fissure

d) Ligamentum Teres

e) Middle hepatic vein

A: Main lobar fissure

A beaded appearance to the intrahepatic ducts is a sonographic finding in which of the following conditions?

a) Caroli's disease

b) Addison's disease

c) Budd-Chiari syndrome

d) Courvoisier's syndrome

e) Bouvenet's syndrome

A: Caroli's disease

Which of the following laboratory values reflects the balance between production and excretion of bile?

a) Bilirubin

b) Serum albumin

c) Alkaline phosphatase

d) Aspartate aminotransferase (AST)

e) Alanine aminotransferase (ALT)

A: Bilirubin

This sonogram is most likely demonstrating which of the following:

a) Cholelithiasis

b) Junctional fold

c) Tumefactive sludge

d) Hartmann's pouch

e) Gallbladder adenoma

A: gallbladder adenoma

A middle age patient presents with a history of vague right upper quadrant pain. Laboratory values reveal an increase in non-conjugated bilirubin levels. A sagittal image of the gallbladder demonstrates which of the following:

a) Biliary sludge

b) Acute Cholecystitis

c) Gallbladder carcinoma

d) Gallbladder duplication

e) Gangrenous Cholecystitis

A: biliary sludge

A patient presents with a history of right upper quadrant pain and elevated liver function tests. Based on this clinical history, the sonogram is most likely demonstrating:

a) Acute Cholecystitis

b) Choledocholithiasis

c) Gallbladder carcinoma

d) Cholelithiasis with biliary sludge

e) Choledocholithiases with biliary sludge

A: Cholelithiasis with biliary sludge

The abnormality in this sonogram is most consistent with:

a) An adenoma

b) Cholelithiasis

c) Cholesterolosis

d) Adenomyomatosis

e) Gallbladder carcinoma

A: Adenomyomatosis

Based on the sonogram, this patient is at high risk for developing:

a) Cholangitis

b) Adenomyomatosis

c) Acute Cholecystitis

d) Porcelain gallbladder

e) Gangrenous gallbladder

A: acute Cholecystitis

Clinical symptoms associated with this abnormality would most likely include:

a) Positive Murphy sign, elevated bilirubin levels, renal colic

b) Elevated bilirubin levels, severe epigastric pain, leukopenia

c) Severe epigastric pain, elevated alpha feto-protein levels, jaundice

d) Severe right upper quadrant pain, positive Murphy sign, jaundice

e) Leukocytosis, positive Murphy sign, elevated alkaline phosphatase levels

A: Severe right upper quadrant pain, positive Murphy sign, jaundice

The solitary echogenic focus most likely represents a(n):

a) Imaging artifact

b) Benign neoplasm

c) Floating gallstone

d) Malignant neoplasm

e) Tumefactive sludgeball

A: floating gallstone

This sonogram of the right upper quadrant is demonstrating the:

a) Olive sign

b) WES sign

c) Target sign

d) Doughnut sign

e) Bull's eye sign

A: WES sign

This image of the gallbladder is demonstrating:

a) Cholelithiasis

b) Adenomyomatosis

c) Acute Cholecystitis

d) A normal gallbladder

e) Chronic Cholecystitis

A: Cholelithiasis

The gallbladder is demonstrating which of the following abnormalities.

a) Cholelithiasis

b) Acute Cholecystitis

c) Porcelain gallbladder

d) Gangrenous Cholecystitis

e) Emphysematous Cholecystitis

A: porcelain gallbladder

The valves of Heister are unique to the:

a) Cystic duct

b) Portal vein

c) Hepatic vein

d) Common bile duct

e) Inferior vena cava

A: cystic duct

The presence of gallbladder varices raises suspicion for:

a) Acute hepatitis

b) Peliosis hepatitis

c) Acute pancreatitis

d) Choledocholithiasis

e) Portal vein thrombosis

A: portal vein thrombosis

The wall thickness in a normal fasting gallbladder should not exceed:

a) 2 mm

b) 3 mm

c) 5 mm

d) 7 mm

e) 10 mm

A: 3 mm

If Cholelithiasis is discovered on an ultrasound, the sonographer must determine the:

a) Number of stones

b) Size of the stone (s)

c) Contour of the stone (s)

d) Mobility of the stone (s)

e) Composition of the stone (s)

A: Mobility of the gallstones

Which portion of the gallbladder is located most inferior?

a) Neck

b) Body

c) Head

d) Fundus

e) Phrygian cap

A: Fundus

An abrupt increase in alkaline phosphatase levels is suggestive of:

a) Cholelithiasis

b) Acute pancreatitis

c) Acute Cholecystitis

d) Portal hypertension

e) Obstructive jaundice

A: obstructive jaundice

Hyperechoic foci within the intrahepatic ducts most likely represents:

a) Pneumobilia

b) Clonorchiasis

c) Klatskin tumor

d) Choledocholithiasis

e) Cholangiocarcinoma

A: Pneumobilia

Mirrizi syndrome demonstrates a:

a) Hepatic mass

b) Mobile calculus

c) Dilated pancreatic duct

d) Normal common bile duct

e) Normal common hepatic duct

A: Normal common bile duct

Which of the following hormones stimulates contraction of the gallbladder?

a) Pepsin

b) Gastrin

c) Secretin

d) Somostatin

e) Cholecystokinin

A: cholecystokinin

The gallbladder lies posterior and inferior to the:

a) Right kidney

b) Coronary ligament

c) Right hepatic vein

d) Main lobar fissure

e) Inferior vena cava

A: main lobar fissure

Case of gallbladder carcinoma frequently demonstrates co-exists:

a) Cholecystitis

b) Cholelithiasis

c) Pleural effusion

A: Cholelithiasis

Patients with diabetes mellitus have an increase risk for developing:

a) Ascariasis

b) Cholangitis

c) Biliary sludge

d) Adenomyomatosis

e) Gangrenous Cholecystitis

A: gangrenous Cholecystitis

A febrile adolescent patient presents to the emergency room with severe right lower quadrant pain. Based on this clinical history the sonographic findings are most suspicious for a(n):

a) Ileus

b) Mucocele

c) Diverticular abscess

d) Meckel's diverticulum

e) Appendiceal abscess

A: Appendiceal abscess

A patient presents with sudden onset of upper abdominal pain. Ultrasound demonstrates prominence in the stomach rugae. These findings are most suspicious for which of the following conditions?

a) Gastritis

b) Carcinoma

c) Gastric ulcer

d) Crohn's disease

e) Leiomyosarcoma

A: Gastritis

Clinical findings associated with an ileus may include all of the following EXCEPT:

a) Fever

b) Constipation

c) Abdominal pain

d) Nausea and vomiting

e) Hyperactive bowel sounds

A: hyperactive bowel sounds

The arrows in this sonogram are identifying which of the following structures:

a) Ileum

b) Cecum

c) Jejunum

d) Duodenum

e) Sigmoid colon

A: Jejunum

A seven-year-old child presents with severe abdominal pain and abnormal bowel patterns. Based on the clinical history, the sonogram is most likely suspicious for:

a) An ileus

b) A mucocele

c) Diverticulitis

d) Intussusception

e) Crohn's disease

A: Intussusception

A six-week-old infant presents with a history of projective vomiting. A sagittal sonogram of the upper abdomen suggests which of the following:

a) Cholecystitis

b) Appendicitis

c) Cholelithiasis

d) Intussusception

e) Pyloric stenosis

A: Pyloric stenosis

The liver is considered enlarged once the length exceeds:

a) 10 cm

b) 13 cm

c) 15 cm

d) 18 cm

e) 22 cm

A: 18 cm

A hepatic abscess is most likely to develop within the:

a) Left lobe

b) Right lobe

c) Caudate lobe

d) Hepatic hilum

e) Gallbladder fossa

A: right lobe

Which of the following liver pathologies is associated with glycogen storage disease?

a) Hepatitis

b) Adenoma

c) Hepatoma

d) Polycystic disease

e) Cavernous hemangioma

A: Adenoma

Which of the following laboratory values is associated with malignancy in the elderly population?

a) Bilirubin

b) Serum albumin

c) Alpha-fetoprotein

d) Prothrombin time

e) Alkaline phosphatase

A: Alpha-fetoprotein

A patient presents with a history of vague right upper quadrant pain. Laboratory values are within normal limits. The sonogram is most likely demonstrating a(n):

a) Adenoma

b) Hepatoma

c) Metastatic lesion

d) Angiomyolipoma

e) Cavernous hemangioma

A: Cavernous hemangioma

Portal veins appear prominent on ultrasound because the walls contain:

a) Lipids

b) Fibrin

c) Valves

d) Plaque

e) More layers

A: Fibrin

The arrow is identifying which of the following structures.

a) Falciform ligament

b) Coronary ligament

c) Ligamentum venosum

d) Gastrohepatic liegament

e) Hepatoduodenal ligament

A: Falciform ligament

A patient presents with a history of alcohol abuse, abdominal distention, and fatigue. Based on the clinical history the sonogram is most likely demonstrating:

a) Cirrhosis

b) Fatty infiltration

c) Portal hypertension

d) Budd-Chiari syndrome

e) Hepatocellular carcinoma

A: Cirrhosis

An afebrile patient presents to the emergency department with a history of severe abdominal pain. Based on this clinical history, the sonographic findings are most consistent with which of the following pathologies?

a) Cirrhosis

b) Caroli's disease

c) Portal hypertension

d) Budd-Chiari syndrome

e) Portal vein thrombosis

A: Portal Vein thrombosis

A patient with a history of cirrhosis presents for an annual abdominal ultrasound. Hyperechoic tubular structure is present within the liver. This is consistent with which of the following.

a) Hepatic stent

b) Surgical clips

c) Falciform ligament

d) Recanalized hepatic vein

e) Portal vein thrombosis

A: Hepatic stent

Extension of the right lobe of the liver inferior and anterior to the right kidney is termed a(n):

a) Caudate lobe

b) Reidel's lobe

c) Accessory lobe

d) Pyramidal lobe

e) Succenturiate lobe

A: Reidel's lobe

Extended use of oral contraceptives is predisposing factor in developing which o the following hepatic neoplasms?

a) Cyst

b) Adenoma

c) Hepatoma

d) Cystadenoma

e) Cavernous hemangioma

A: Adenoma

Which of the following most accurately describes the location of the common hepatic duct?

a) Medial to the main portal vein and anterior to the proper hepatic artery

b) Anterior to the main portal vein and lateral to the proper hepatic artery

c) Lateral to the main portal vein and medial to the common hepatic artery

d) Anterior to the main portal vein and medial to the proper hepatic artery

e) Anterior to the main portal vein and posterior to the proper hepatic artery

A: anterior to the main portal vein and lateral to the proper hepatic artery

Marked elevation, in which of the following laboratory tests, is associated with obstructive jaundice?

a) Serum albumin

b) Indirect bilirubin

c) Alpha-fetoprotein

d) Alkaline phosphatase

e) Alanine aminotransferase

A: Alkaline phosphatase

Sonographic findings associated with acute hepatitis may include all of the following EXCEPT:

a) Hepatomegaly

b) Splenomegaly

c) Irregular liver contour

d) Prominent portal veins

e) Hypoechoic liver parenchyma

A: Irregular liver contour

The "water lily" sign is associated with which of the following abnormalities?

a) Hydronephrosis

b) Echinococcal cyst

c) Chronic pancreatitis

d) Hepatic cystadenoma

e) Polycystic liver disease

A: echinococcal cyst

Which of the following is an abnormal flow characteristic of the hepatic veins?

a) Pulsatile

b) Hepatopetal

c) Multiphasic

d) Spontaneous

e) Slow flow velocity

A: Mulitphasic

Location of a Klatskin tumor is near which of the following structures?

a) Adrenal gland

b) Hepatic hilum

c) Inferior vena cava

d) Head of the pancreas

e) Gastroesophageal junction

A: Hepatic hilum

Which of the following laboratory tests will most likely elevate in cases of non-obstructive jaundice?

a) Serum albumin

b) Indirect bilirubin

c) Alkaline phosphatase

d) Conjugated bilirubin

e) Aspartate aminotransferase

A: conjugated bilirubin

Which of the following structures divides the left lobe into two segments?

a) Left portal vein and Ligamentum of Teres

b) Middle hepatic vein and main lobar fissure

c) Left hepatic vein and Ligamentum of venosum

d) Left hepatic vein and Ligamentum of Teres

e) Main portal vein and Ligamentum of venosum

A: Left hepatic vein and Ligamentum of Teres

A patient presents with a history of abdominal pain and lower extremity edema. An ultrasound is requested to rule out Budd-Chiari syndrome. The sonographer should thoroughly evaluate which of the following organs?

a) Liver

b) Spleen

c) Kidneys

d) Pancreas

e) Adrenal glands

A: liver

A sagittal sonogram medial to the porta hepatis is demonstrating which of the following abnormalities.

a) Pyloric stenosis

b) Chronic Cholecystitis

c) Portal vein thrombosis

d) Budd-Chiari syndrome

e) Dilated common bile duct

A: dilated common bile duct

In this case, which of the following laboratory values would be of benefit?

a) Hematocrit

b) Indirect bilirubin

c) White blood count

d) Alpha feto-protein

e) Alkaline phosphatase

A: Hematocrit

A patient presents with a history of weight loss and elevation in his liver function tests. The patient is presently afebrile but has been experiencing a low-grade fever off and on for the last month. Based on this clinical history, the sonographic finding is most suspicious for which of the following pathologies.

a) Abscess

b) Adenoma

c) Hepatoma

d) Hematoma

e) Focal nodular hyperplasia

A: Hepatoma

An asymptomatic patient presents with a history of elevated liver function tests. Based on this clinical history, the sonogram most likely demonstrates:

a) Hepatitis

b) Cirrhosis

c) Fatty infiltration

d) Metastatic disease

e) Focal Nodular hyperplasia

A: Fatty infiltration

A patient presents with a history of fatigue and marked elevation in direct bilirubin levels. Based on this clinical history, the sonogram is most likely demonstrating:

a) Hepatitis

b) Cirrhosis

c) Biliary obstruction

d) Metastatic disease

e) Congestive heart failure

A: Hepatitis

A transverse sonogram of the liver is likely demonstrating which of the following:

a) Hepatomegaly resulting from biliary dilation

b) Hepatic vein thrombosis and biliary dilation

c) Prominent portal veins resulting from hepatitis

d) Biliary dilatation secondary to metastatic disease

e) Chronic cirrhosis with associated portal hypertension

A: biliary dilatation secondary to metastatic disease

A patient arrives for an abdominal ultrasound to rule out gallstones. A sonogram of the liver demonstrates which of the following:

a) Hepatic adenoma

b) Metastatic disease

c) Adrenal hemorrhage

d) Cavernous hemangioma

e) Transjugular porto-systemic shunt

A: cavernous hemangioma

Which of the following most accurately describe the sonographic findings?

a) Diffuse hepatic mass

b) Irregular hepatic mass

c) Complex hepatic mass

d) Hyperechoic hepatic mass

e) Homogeneous hepatic mass

A: complex hepatic mass

Which of the following ligaments is present in this image of the liver?

a) Teres

b) Falciform

c) Venosum

d) Coronary

e) Hepatoduodenal

A: Venosum

A patient presents with a history of abdominal pain. A sonogram of the liver is most likely demonstrating:

a) Candidiasis

b) Metastatic lesions

c) Simple hepatic cysts

d) Obstructive jaundice

e) Polycystic liver disease

A: Polycystic liver disease

A twenty five year old female patient presents with a history of mild right upper quadrant pain and normal liver function tests. Based on the sonogram, the sonographer should ask the patient:

a) Are you diabetic?

b) Do you use oral contraceptives?

c) Are you taking medication for hypertension?

d) Have you undergone any abdominal surgery?

e) Is this a follow up examination on a known liver mass

A: Do you use oral contraceptives?

A patient presents with elevated liver function tests and prior history of lung cancer. Based on this clinical history, the sonogram is most likely displaying:

a) Candidiasis

b) Fatty infiltration

c) Metastatic lesions

d) Hepatocellular carcinoma

e) Focal nodular hyperplasia

A: Metastatic lesions