ABD: CTL Clinical 20% - Scrotum, Thyroid, Proc

Which of the following would improve the visualization of the thyroid isthmus?

a. color doppler

b. transducer with a deep focus

c. stand-off pad

d. curvilinear transducer

c

Which of the following should always be included on the technologist worksheet that is given to the radiologist with the images?

a. limitations of exam performance

b. differential diagnoses for abnormal findings

c. follow up recommendations

d. thermal index setting during the exam

a

Which of the following will cause elevated serum amylase?

a. use of anabolic steroids and parathyroid adenoma

b. chronic pancreatitis and pyelonephritis

c. parathyroid adenoma and RCC

d. tumor of the submandibular gland and use of oral contraceptives

d

When evaluating a suspected testicular varicocele, what patient position will better demonstrate the abnormality?

a. decubitus left

b. supine

c. decubitus right

d. standing

d

Which of the following requires health care providers and organizations to develop and follow procedures that ensure the safety and confidentiality and security of protected health information?

a. ALARA principle

b. Stark Law

c. health insurance portability and accountability act

d. informed consent

c

Which of the following would be considered a critical finding on a POCUS exam?

a. pneumothorax

b. 4 cm AAA

c. severe pericardial effusion

d. nonobstructive renal calculi

c

A patient presents for a thyroid ultrasound due to an incidental finding on a nuclear medicine exam. The report states there is a 2 cm hot nodule in the upper left lobe. Which of the following is the most likely finding on the ultrasound exam?

a. solid mass with microcalcifications and irregular margins

b. complex cyst with peripheral hypervascularity

c. solid mass with hypoechoic halo

d. cystic mass

c

A patient presents for an abdominal ultrasound exam due to recent general pain in the abdomen. While reviewing the patient chart, you note that they have a CT of the abdomen with contrast that is scheduled immediately after the ultrasound appointment. How should you proceed?

a. contact the CT department to ask them to do their exam first

b. ask the patient to finish drinking the CT contrast material before you start the ultrasound exam

c. complete the ultrasound exam and guide the patient to the CT department where they can drink the necessary contrast material

d. call the referring doctor to let them know that the two exams will image the same anatomy and one should be cancelled

c

Hypophosphatemia is a clinical finding that is most suggestive of:

a. internal hemorrhage

b. hyperthyroidism

c. hyperparathyroidism

d. renal failure

c

Which of the following commonly leads to acute scrotal pain?

a. tubular ectasia

b. microlithiasis

c. seminoma

d. epididymitis

d

Which of the following is not a symptom of hyperthyroidism?

a. weight loss

b. increased heart rate

c. excessive sweating

d. weight gain

d

A patient scheduled for a transrectal prostate biopsy must perform all the following prior to the exam, except:

a. perform a cleansing enema

b. have lab testing for PT/INR levels

c. nothing to eat or drink at least 8 hrs before the procedure

d. begin taking a several day course of antibiotics

c

Iodine deficiency is a primary cause of:

a. renal calculi

b. cirrhosis

c. sialolithiasis

d. hypothyroidism

d

What dimension of the mass is being measured on the image?

a. length

b. width

c. AP

c

Which of the following scrotal abnormalities would be better displayed if the patient performed the Valsalva maneuver?

a. varicocele and scrotoliths

b. inguinal hernia and adenomatoid tumors

c. testicular torsion and inguinal hernia

d. varicocele and inguinal hernia

d

When setting up a liver biopsy, which of the following must be performed by a sterile person?

a. opening the bottle of numbing agent

b. verifying the expiration date of the numbing agent

c. opening the biopsy needle packaging

d. attaching the needle and filling the syringe with the numbing agent

d

Which of the following describes the best patient position for a thoracentesis?

a. LLD

b. semi-erect with knees raised toward the chest

c. seated leaning forward over a table

d. RLD

c

What transducer would be preferred for the evaluation of sialolithiasis on an average sized patient?

a. 3-5 MHz sector

b. 3-5 MHz curvilinear

c. 5-7 MHz linear

d. 10-12 MHz linear

d

Sjogren syndrome is an immune system disorder that commonly affects the:

a. adrenal glands

b. thyroid

c. bile ducts

d. salivary glands

d

The blue dot sign is a clinical finding of:

a. torsion of the testicular appendage

b. bladder calculi

c. testicular varicocele

d. thyroid adenoma

a

What dimension of the mass is being measured on the image?

a. width

b. length

c. AP

a

Patients with new onset of secondary hyperparathyroidism will demonstrate:

a. increased vitamin K and D levels

b. increased vitamin D levels, normal calcium and PTH levels

c. low serum calcium and vitamin D levels with high PTH levels

d. increased serum calcium, vitamin D, and PTH

c

The following image is obtained on a 12 y/o boy with a non-palpable right testicle. What should be your next step as the sonographer performing this exam?

a. evaluate the left groin for an undescended testicle

b. evaluate the right groin for an undescended testicle

c. evaluate the paraumbilical area for an undescended testicle

d. evaluate the perineal area for an undescended testicle

b

Which of the following patients would benefit from a FAST examination?

a. patient with abdominal bruit, weight loss, and post prandial pain

b. patient with history of abdominal pain after a fall from a ladder

c. patient with history of RUQ pain after eating

d. patient with suspected prostate cancer

b

A 65 y/o female presents for a neck ultrasound with a script that states hypophosphatemia and hypercalcemia. What do you expect to find on the exam?

a. enlarged parathyroid glands

b. atrophied thyroid gland

c. papillary thyroid cancer

d. medullary thyroid cancer

a

Air in the GB wall will be demonstrated as areas of hyperechogenicity with posterior dirty shadowing and ring down artifact on sonography. How is this demonstrated on a CT exam?

a. the GB will demonstrate no discernible changes on a CT scan with the presence of air in the wall

b. the GB will demonstrate black areas within the wall where air is present

c. the GB will demonstrate linear spokes of shadowing from the pockets of air in the wall

d. the GB will demonstrate bright white areas within the wall where air is present

b

Which of the following should be avoided for at least 7 days before a renal biopsy?

a. insulin

b. multivitamin

c. hypertension medication

d. aspirin

d

All the following correctly describe proper behavior related to a sterile field, except:

a. sterile individuals must pass each other back to back when moving around the procedure room

b. hands and elbows must be kept above the level of the table

c. when in doubt about sterility, discard the potentially contaminated item and begin again

d. sterile gloves must be used to open the procedure tray

d

Which type of thyroid cancer is most associated with calcitonin levels?

a. papillary

b. follicular

c. anaplastic

d. medullary

d

Which of the following is a contraindication for a liver biopsy?

a. patient with allergies to iodinated contrast

b. patient with Budd Chiari syndrome

c. patient with severe liver atrophy caused by cirrhosis

d. patient with advanced Alzheimer disease and hepatitis

d

A patient is scheduled for a liver biopsy with the radiologist in the morning. What lab values will the doctor want to see before the procedure is performed?

a. RBC and platelet count

b. WBC count

c. prothrombin time and INR

d. BUN and creatinine

c

A FNA biopsy of a thyroid nodule is NOT recommended for nodules _______.

a. >50 mm

b. <10 mm

c. <1 mm

d. <20 mm

b

Patients diagnosed with multinodular goiter will also have:

a. increased T3 and T4, normal TSH

b. increased TSH, normal T3 and T4

c. decreased T3 and T4, normal TSH

d. increased TSH, decreased T3 and T4

d

A 3 cm hypoechoic mass is identified in the right testicle. The radiologist requests that you perform an abdominal US. What are you looking for?

a. associated Crohn disease

b. renal vein tumor invasion

c. other manifestations of acute tubular necrosis

d. periaortic lymphadenopathy

d

What ultrasound guided procedure is performed using the area lateral to the rectus abdominis muscle in the left lower abdomen as the most common puncture site?

a. ethanol ablation

b. thoracentesis

c. paracentesis

d. Lovenox injection

c

When preparing the sterile tray for a liver biopsy, the cover on the tray should be opened:

a. while wearing sterile gloves

b. by pulling the far corner of the cover toward you

c. by the radiologist

d. no more than 2 hrs before the procedure begins

b

Which of the following lists an advantage of fine needle capillary technique over a fine needle aspiration technique?

a. FNC does not require local anesthetic and FNA does

b. FNC aspirates a smaller but more concentrated sample of cells than FNA

c. FNC is less traumatic to the tissues than FNA

d. FNC collects a tissue core while FNA collects a small amount of cells

b

The radiologist asks you to set up the US room for a thyroid biopsy. Which probe should be covered with a sterile probe cover?

a. linear 5 MHz

b. curvilinear 8 MHz

c. vector 10 MHz

d. linear 10 MHz

d

When using color doppler to compare testicular perfusion, you should always:

a. document the flow after the Valsalva release

b. use the dual screen function to demonstrate an image of both testicles

c. document normal flow in one testicle and then adjust color scale and wall filter settings to demonstrate the same amount of flow in the other testicle

d. document flow during the Valsalva strain

b

The greatest advantage of ultrasound guided percutaneous needle biopsy over biopsy performed with a cat scan guidance is:

a. lack of radiation exposure

b. decreased cost to patient

c. ability to view the biopsy needle passing into the mass in real time

d. ability to take multiple samples during one procedure

c

You are performing a parathyroid ultrasound and cannot locate a known adenoma. Which of the following would be helpful in locating the mass?

a. use IV contrast to locate the blood supply to the mass

b. ask the patient to swallow

c. give the patient oral contrast to outline the trachea

d. report the mass as unidentifiable so that a CT scan can be performed instead

b

Which of the following doppler information is necessary to calculate the resistive index?

a. peak systolic velocity and peak diastolic velocity

b. peak systolic velocity and end diastolic velocity

c. peak systolic velocity, average flow velocity, and end diastolic velocity

d. peak systolic velocity only

b

Which of the following exam results is most likely to end up with an ultrasound guided biopsy of the area of interest?

a. an irregular liver mass that is contiguous with the diaphragm as seen on CT exam of the abdomen

b. a spiculated lung mass seen on a CT exam of the chest

c. cold thyroid nodule seen on nuclear medicine exam

d. hot thyroid nodule seen on nuclear medicine exam

c

Which of the following will have no effect on serum levels of alpha fetoprotein?

a. pregnancy

b. HCC

c. seminomatous tumor of the testicle

d. yolk sac tumor of the RT testicle

c

What is a point of care ultrasound?

a. ultrasound exam performed at the office of the referring physician

b. focused evaluation used to answer a specific question

c. ultrasound exam performed on the same day as the clinical evaluation

d. follow up exam on a known abnormality

b

Which measurement of the hydrocele is being assessed on the image?

a. width

b. AP

c. length

c

Which of the following will help the radiologist select the correct biopsy needle size/length for the biopsy of a mass on the posterior right liver?

a. usually the sonographer opens multiple sizes of core biopsy needles and places them on the sterile procedure tray in case they are needed

b. measuring the depth of the mass within the liver

c. using color doppler to locate surrounding vascularity

d. measuring the width of the mass in the liver

b

Which of the following correctly describes the preferred patient position for a renal biopsy?

a. decubitus position with knees drawn to chest

b. prone with a pillow under the abdomen to accentuate the normal curvature of the spine

c. supine with a pillow under the back to accentuate the normal curvature of the spine

d. posterior oblique with ipsilateral arm extended over the head

b

Which of the following correctly describes proper ergonomics during a sonography exam?

a. adjust the table height to maintain a minimum of 90 degree angle of the elbow joint

b. place the transducer cord around your neck to provide support for the weight of the probe

c. position your wrist to allow for full flexion during imaging

d. choose a seat that allows your knees to fall below the level of your hips

d

A patient is referred to rule out cryptorchidism. You evaluate the scrotal sac with US and demonstrate the presence of the RT testicle only. Where will you look first for the LT testicle?

a. left inguinal canal

b. left paracolic gutter

c. right inguinal canal

d. right paracolic gutter

a

If a varicocele is identified on the left side:

a. the LT kidney should be evaluated for mass formation

b. the LT kidney should be evaluated for renal artery stenosis

c. the IVC should be evaluated for a Greenfield filter

d. the porta hepatis should be evaluated for cavernous transformation

a

Uncomplicated cysts and fluid collections will appear black on ultrasound and ________ on CT scan.

a. dark gray

b. white

c. light gray

d. black

a

A 30 y/o presents with history of a normal clinical exam of the scrotum and infertility. What is the referring doctor expecting to find on the US exam?

a. acute epididymitis

b. seminoma

c. varicocele

d. torsion

c

When a patient presents with acute scrotal pain, the sonographer should always being the scrotal ultrasound by:

a. imaging the unaffected side

b. imaging the groin area

c. imaging the epididymis on the affected side

d. imaging the testicle on the affected side

a

Which of the following describes the best patient position for a thyroid ultrasound?

a. prone with neck extended

b. posterior oblique with neck extended

c. supine with neck extended

d. semi-erect with chin angled toward the side not being scanned

c

Which of the following indicates the proper order for putting on personal protective equipment?

a. gloves, gown, mask, goggles

b. gown, mask, goggles, gloves

c. goggles, gown, mask, gloves

d. mask, goggles, gloves, gown

b

Which of the following is a violation of HIPAA policies?

a. posting patient symptoms and demographics with an anonymous ultrasound image on social media

b. sharing an anonymized image from an exam with your sonography class

c. discussing exam results with the patient’s physician

d. discussing exam results with a patient

a

Which of the following is true regarding the difference between the sample obtained from a fine needle aspiration and a core biopsy sample taken from the liver?

a. FNA procedures are more traumatic to the tissues than needle biopsy procedures

b. the needle used for FNA is usually much larger than the biopsy needle

c. core needle biopsies are more commonly performed for liver masses than to assess parenchymal liver disease

d. the cytology lab evaluates the sample obtained from the FNA. the histology lab evaluates the sample obtained from the needle biopsy

d

An area of plaque or thrombus in an artery will be demonstrated as ________ on angiography.

a. a highly reflective area within the vessel

b. an area of increased concentration of contrast material

c. a dark black area within the vessel

d. an area of absence of contrast material

d

A patient has a history of thyroid cancer and bilateral thyroidectomy 3 years ago. What lab values should be reviewed before starting the annual post-surgical neck ultrasound?

a. serum levels of CEA 123

b. serum levels of thyroglobulin

c. serum levels of T4

d. serum levels of T3

b

When evaluating a patient with a complete thyroidectomy, what is the best way to differentiate between level VI nodes from level III/IV nodes?

a. hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the hyoid bone

b. turn the neck to a neutral position and docment lymph node position relative to the carotid artery

c. hyperextend the neck and rotate until the chin touches the contralateral shoulder to document lymph node position relative to the carotid artery

d. turn the neck to a neutral position and document lymph node position relative to the angle of the mandible

b

A patient presents for a thyroid biopsy with a script that states “US guided biopsy, cold nodule.” The patient does not have the report with them but they do have a copy of the nuclear medicine (NM) exam. What are you looking for on the NM exam to locate the nodule to be biopsied?

a. darker areas of increased accumulation of radioactive isotope

b. green areas of absence of accumulation of the radioactive isotope

c. bright red areas of increased accumulation of the radioactive isotope

d. white/light areas with absence of accumulation of the radioactive isotope

d

Which of the following statements is true regarding the sonographer assisting the radiologist with a renal biopsy?

a. the sonographer is responsible for creating the point of entry on the patient for the biopsy device

b. the sonographer should wear sterile gloves when disposing the needles and devices used for the biopsy

c. the sonographer’s hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure

d. the sonographer’s hands must be sterile when opening needles and biopsy device packaging

c

The informed consent form is required to include all of the following, except:

a. possible complications that the patient may experience

b. signature line to indicate patient consent

c. description of the procedure

d. percentage of patients that have experienced complications after the same procedure at the facility

d

Hypertension, nephrolithiasis, osteopenia, weakness, and malaise are common symptoms of:

a. hyperparathyroidism

b. hypoparathyroidism

c. hyperthyroidism

d. hypothyroidism

a

Why is it necessary to obtain the PT and INR lab values prior to liver biopsy?

a. to assess the patient’s risk for post procedure infection

b. to assess the extent of cirrhosis within the liver

c. to assess the patient’s risk for post procedure thrombosis of the portal vein

d. to assess the patient’s risk for post procedure hemorrhage

d

Prehn sign is used to differentiate what two abnormalities?

a. fungal liver abscess and amoebic liver abscess

b. seminoma and yolk sac tumor

c. RCC and oncocytoma

d. testicular torsion and epididymo-orchitis

d

Which of the following is related to renal failure and vitamin D deficiency?

a. secondary hyperparathyroidism

b. nephrocalcinosis

c. hyperthyroidism

d. pulmonary HTN

a

In patients with primary hyperparathyroidism, levels of PTH will increase and:

a. T3 levels will increase

b. T4 levels will increase

c. serum calcium levels will increase

d. serum calcium levels will decrease

c

Which of the following correctly describes a way to tell the difference between a vasovagal response and anaphylaxis caused by contrast injection?

a. hypertension is a sign of vasovagal response, while hypotension is a sign of anaphylaxis

b. tachycardia is a sign of vasovagal response, while bradycardia is a sign of anaphylaxis

c. pallor is a sign of vasovagal response, while erythema is a sign of anaphylaxis

d. a feeling of impending doom is a sign of vasovagal response, while dizziness and near syncope are signs of anaphylaxis

c

The National Patient Safety Standards recommend a “time out” period prior to the start of an invasive procedure. How will you comply with this recommendation during a renal biopsy?

a. record an image that says “time out” when the radiologist is adjusting the needle

b. record a blank image that says “time out” after the consent form is signed and another image at the start of the procedure

c. allow the patinet to take a 15-20 minute walk/break before they are set up for the procedure

d. allow the patient to take a break between biopsy samples and record the downtime in the patient chart

b

A patient presents with mild scrotal pain and swelling on the left side that started 2-3 days ago. The patient awoke this morning with a slight fever and increased swelling. All the following should be suspected causes for the symptoms, except:

a. orchitis

b. epididymitis

c. hydrocele

d. testicular infarct

d

Which of the following is true regarding paracentesis?

a. normally performed only for diagnostic reasons

b. normally the patient is seated and leaning over a table to allow posterior lateral access for the catheter

c. placing the patient in the supine position will improve rate of fluid drainage

d. placing the fluid collection container on the floor next to the patient bed increases the fluid drainage rate

d

Which of the following is demonstrated by the same color on an ultrasound image as on a CT image?

a. calcifications

b. cysts

c. uncomplicated pleural effusion

d. more than one of the above

a

Which of the following statements is true regarding paracentesis?

a. an informed consent form is not required when a diagnostic paracentesis is performed, only for therapeutic paracentesis

b. paracentesis requires the use of the sterile field technique

c. the preferred entry point for fluid removal is on the right side at the level of Morrison pouch

d. because the diagnostic paracentesis is performed with a long needle instead of a catheter, a sterile field is not required for the procedure

b

Which of the following would be an unexpected finding in a patient that had a vasectomy 4 years ago?

a. atrophied epididymis

b. tubular ectasia of the epididymis

c. dilated vas deferens

d. spermatoceles

a

An obese patient has a known hepatoma in the posterior aspect of the RT liver lobe. Which probe would you use to assist the radiologist in performing a biopsy?

a. 5 MHz, short focus

b. 2.25 MHz, short foxus

c. 2.25 MHz, long focus

d. 3.5 MHz, long focus

c

A patient presents for a neck ultrasound due to swelling under the angle of the jaw and anterior to the ear. She also complains of a dry mouth, dry cough, and dry eyes. These clinical findings are most suggestive of:

a. Hashimoto thyroiditis

b. Graves’ disease

c. Sjogren syndrome

d. hemolytic anemia

c

While performing a thyroid ultrasound, you notice the area indicated by the blue arrow. Which of the following statements is true regarding completing the patient’s exam?

a. color doppler must be applied to assess the tumor’s vascularity

b. request the patient swallow to better evaluate the area

c. the radiologist will need all lab values related to the parathyroid hormones and calcium levels in the blood to aid in confirming the diagnosis of the mass

d. the arrow indicates the normal longus colli muscle

b

Which of the following describes the table placement for performing an ultrasound exam?

a. table height should allow the sonographer’s arm to be slightly adducted with the wrist fully flexed toward the side being examed

b. the table should be placed in reverse Trendelenburg position to assist in moving blood flow into the cerebral vessels

c. the table should be placed in the trendelenburg position to assist in moving blood flow into the cerebral vessels

d. table height should allow the sonographer’s arm to be slightly abducted with the wrist fully extended

d

When wearing a protective gown and gloves:

a. two pairs of gloves should be worn

b. the open end of the gloves should be fitted under the wrist cuffs of the gown

c. the open end of the glows should be pulled over the wrist cuffs of the gown

d. the open end of the gloves should not be touching the wrist cuffs of the gown

c

Which of the following is a contraindication for a renal biopsy?

a. polycystic kidney disease

b. current Warfarin use

c. current antibiotic treatment

d. AIDS

b

Which of the following lymph node chains should be evaluated for related metastasis with thyroid cancer?

a. supraclavicular

b. axillary

c. pectoral

d. internal mammary

a

A 30 y/o male presents with a softball injury to the groin area. The scrotum is abnormally swollen and extremely painful for the patient. Which of the following statements is true regarding the findings on the image?

a. the RT testicle has ruptured and increased flow is seen within the testicular tissue

b. the RT testicle demonstrates orchitis with increased vascularity

c. the RT testicle appears tosed

d. the LT testicle appears torsed

c

Which of the following is an absolute contraindication to an ultrasound guided biopsy?

a. uncooperative patient

b. history of diabetes mellitus

c. current antibiotic use

d. daily aspirin use

a