ABD: Mock Registry Exam D24

A patient presents with an enlarged left scrotum and palpable mass. The US demonstrates an intratesticular mass that is hypoechoic and heterogeneous with multiple coarse calcifications. There is also an irregular central cystic area. These findings are most suggestive of:

a. teratoma only

b. seminoma only

c. embryonal cell tumor or teratoma

d. seminoma, embryonal cell tumor, or teratoma

c

What is the key anatomic landmark in differentiating direct, indirect, and spigelian hernias?

a. rectus abdominis muscle

b. inferior epigastric artery

c. linea alba

d. internal iliac artery

b

Budd Chiari syndrome, portal thrombosis, and splenomegaly are complications of:

a. increased prothrombin time

b. anemia

c. steatosis

d. polycythemia vera

d

A patient presents with fever, flank pain, dehydration, electrolyte imbalance, and positive serum and urine bacterial cultures for E. coli. These clinical findings are most suggestive of:

a. renal artery stenosis

b. acute renal failure

c. urinary tuberculosis

d. emphysematous pyelonephritis

d

Pseudoaneurysm formation, biliary obstruction, and phlegmon are complications typically seen with:

a. insulinomas

b. alcoholic cirrhosis

c. pancreatitis

d. non-alcoholic steatosis

c

In patients with cirrhosis, what effect will deep inspiration have on the portal vein?

a. the PV diameter will increased by 50%

b. there will be minimal change in the PV diameter

c. the PV diameter will double in size

d. the PV will collapse at the deepest point of inspiration

b

A 45 y/o female patient presents with nausea and vomiting, fever, RUQ pain, and increased WBC. The GB is enlarged and filled with echogenic material that does not shadow or demonstrate fluid levels. These findings are most consistent with:

a. emphysematous cholecystitis

b. porcelain GB

c. empyema of the GB

d. adenomyomatosis

c

Which of the following is most likely to cause anterior displacement of the abdominal aorta?

a. lymphadenopathy

b. mass in the LT diaphragm crura

c. pleural effusion

d. ascites

a

A pregnant female presents with lateral LUQ pain and a bruit in the same area. What is the most likely finding on the abdominal ultrasound exam?

a. IVC congestion due to uterine compression

b. pancreatic pseudocyst

c. splenic artery aneurysm

d. splenic varices

c

A new liver mass in a patient with sclerosing cholangitis should cause suspicion of:

a. development of schistosomiasis

b. a peribiliary leak

c. portal HTN

d. the development of cholangiocarcinoma

d

What is the cause of the vertical acoustic shadow seen on the images?

a. element damage

b. air in the trachea

c. patient motion

d. electrical interference

a

Oncocytoma, RCC, and FNH share what sonographic characteristic?

a. central scar

b. posterior enhancement

c. thick septations within the mass

d. invasion of vasculature

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

The main lobar fissure:

a. separates anterior right lobe and median left lobe

b. separates the anterior and posterior right lobes

c. separates the medial and lateral left lobes

d. separates the IVC and medial left lobe

a

Which of the following correctly describes a mechanical bowel obstruction?

a. functional obstruction is much more common than mechanical obstruction

b. adhesions are the most common cause of mechanical obstruction in adults

c. best evaluated by US after the patient drinks at least 32 oz of water

d. paralysis of the wall muscles inhibits peristalsis and the progression of the luminal contents

b

Acoustic Radiation Forced Impulse (AFRI) evaluation of the liver:

a. is performed with a subcostal midline window

b. should be performed with the patient in the prone position

c. should be performed on the right lobe

d. is helpful in cases of suspected abscess formation

c

Which exam would be improved by the administration of simethicone prior to the ultrasound evaluation?

a. thyroid ultrasound

b. breast ultrasound

c. carotid duplex

d. renal artery duplex

d

Which of the following vessels will be abnormally dilated with significant portal HTN?

a. MPV only

b. HVs only

c. MPV and left gastric vein

d. HVs, MPV, and left gastric vein

c

A patient presents with a history of neurogenic bladder and recent onset hematuria. Which of the following statements is true regarding the findings on the image?

a. it is necessary to change the patient position while scanning to determine mass mobility

b. the mass appears to be a remnant of the catheter balloon that was thought to be removed one week ago

c. the hypoechoic mass is most likely malignant due to significant infiltration of the bladder wall

d. if the hypoechoic mass is mobile, it is most likely calculus

a

Anemia is a complication of cirrhosis due to associated abnormality of which of the following?

a. esophagus

b. aorta

c. diaphragm

d. kidney

a

Splenic calcifications are commonly seen with what type of infection?

a. parasitic

b. echinococcal

c. granulomatous

d. AIDS

c

A patient presents for a renal ultrasound due to high serum levels of anti-diurectic hormone, low urine output, and a recent pulmonary embolism. These clinical findings are most suggestive of:

a. abscess formation in the renal pelvis

b. renal vein thrombosis

c. formation of a renal carbuncle

d. obstructive bladder calculi

b

Which of the following describes a technique that can be used to locate a collapsed GB in a patient with chronic cholecystitis?

a. have the patient perform the Valsalva maneuver to force bile into the GB for improved visualization

b. use color doppler to identify the associated hypervascularity seen with wall inflammation

c. locate the RPV and main lobar fissure, trace the fissure to the GB neck

d. locate the umbilical vein and trace it to the ligamentum teres to locate the GB neck just medial to the proximal ligamentum

c

A patient presents with RUQ pain and nausea 1 week post-cholecystectomy. These findings on the image are most suggestive of:

a. biliary stricture

b. abscess formation in GB fossa

c. biloma formation in GB fossa

d. porcelain GB

b

If the entire image is too dark, what console adjustment should you make first?

a. adjust the far field TGC

b. increase the output power

c. increase the overall gain

d. adjust the near field TGC

c

Which of the following sonographic characteristics is most suggestive of acute renal vein thrombosis?

a. diastolic flow reversal in the renal arteries

b. atrophied kidney with mottled echogenicity

c. hyperarterial flow within the kidney

d. increased corticomedullary definition

a

The ________ zone is the prostate zone most commonly affected by BPH.

a. transitional

b. paraprostatic

c. central

d. peripheral

a

What lab test is used to evaluate the endocrine function of a pancreas transplant?

a. anodal trypsinogen levels

b. amylase levels

c. hematocrit levels

d. glucose levels

d

Sonographic signs of chronic renal failure include a/an _____ in size and a/an _______ in echogenicity.

a. decrease, increase

b. decrease, decrease

c. increase, increase

d. increase, decrease

a

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

Which is the most common cause of splenomegaly?

a. AIDS

b. polycythemia vera

c. portal hypertension

d. mononucleosis

c

The IVC and SVC empty their blood into the ______.

a. right atrium

b. right ventricle

c. left atrium

d. left ventricle

a

A patient is referred for an abdominal ultrasound due to an abnormal CT scan. The report is not yet available but the study is in the PACS system. Based on this single CT image, where will you scan to evaluate an abnormality identified on the CT exam?

a. right renal hilum

b. anterolateral right kidney

c. lateral spleen

d. right lower quadrant

b

Which of the following is located between the transversalis fascia and the posterior parietal peritoneum?

a. stomach

b. spleen

c. pancreas

d. linea alba

c

Which of the following are contraindications for a liver transplant?

a. HCC and hepatitis

b. hepatitis C and cirrhosis

c. cholangiocarcinoma and current alcohol/drug abuse

d. autosomal recessive polycystic disease and biliary hamartomas

c

The image demonstrates a transverse view of the right and left side of the abdominal wall, about 5 cm lateral to the umbilicus. Which of the following statements is true regarding the findings on the image?

a. there is a heterogeneous rounded mass located within the muscle layers and posterior to the peritoneal lining on the left side

b. there is a heterogeneous rounded mass located within the left rectus sheath, within the muscle layers and anterior to the peritoneal lining

c. there is a homogeneous rounded mass within the left rectus sheath, anterior to the muscle layers and peritoneal lining

d. the image demonstrates the normal appearance of the muscle structures of the anterior abdominal wall bilaterally

b

The most common benign breast mass is _________ and the most common malignant mass is ______.

a. fibroadenoma, invasive ductal carcinoma

b. acute mastitis, chronic mastitis

c. ductal carcinoma in situ, invasive ductal carcinoma

d. lipoma, invasive lobular carcinoma

a

Steatosis refers to:

a. chronic hepatitis infection

b. fatty liver disease

c. glycogen storage disease of the liver

d. pneumocystis carinii

b

The ______ sign is a clinical finding with pyloric stenosis, while the _______ sign is a sonographic sign of pyloric stenosis.

a. olive, donut

b. Murphy, Homan’s

c. bird, snowman

d. pseudokidney, yin yang

a

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

Unilateral renal agenesis is associated with what anomaly in women and in men?

a. ovarian agenesis, agenesis of the seminal vesicles

b. ovarian agenesis, testicular agenesis

c. uterine agenesis, testicular agenesis

d. bicornuate uterus, agenesis of the seminal vesicles

d

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

What condition is associated with prominent portal walls?

a. hemangioma

b. cirrhosis

c. fatty infiltration

d. acute viral hepatitis

d

What change in system controls can reduce the appearance of color displayed over vessel walls?

a. decreasing color PRF

b. decreasing color threshold

c. increasing persistence

d. decreasing color priority

d

Which of the following is preferred to better evaluate the anomaly on the image?

a. KUB x-ray

b. core needle biopsy

c. serum BUN and creatinine levels

d. intravenous pyelogram

d

Which of the following is not an expected finding with adrenal myelolipoma?

a. comet tail artifacts

b. increased echogenicity compared to adrenal and renal cortical tissue

c. attenuation artifacts

d. propagation speed artifacts

a

Use your mouse to place your cursor on the lipoma and mark the mass.

_______ transplant rejection appears as swollen kidney, loss of corticomedullary definition, enlarged renal pyramids, compression of the renal sinus, and decreased blood flow with increased RI value.

a. chronic

b. acute

c. chronic or acute, stages of rejection are not able to be differentiated with sonography

d. rejection of a renal allograft is not usually evaluated by sonography

b

The renal cortex contains which of the following:

a. calyces

b. Loops of Henle

c. Bowman capsule

d. pyramids

c

Which of the following has the lowest risk of developing RCC?

a. patients with tuberous sclerosis

b. patients with acquired cystic disease

c. patients with ARPKD

d. patients on long term dialysis

c

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

How does significant hydronephrosis affect the blood flow in the renal cortex?

a. increased systolic flow

b. decreases the RI in the parenchyma arteries

c. increases diastolic flow

d. increases the RI in the parenchymal arteries

d

Aneurysms of the iliac and popliteal arteries are commonly associated with:

a. aortic aneurysm

b. renal failure

c. pancreatic pseudocysts

d. prostate carcinoma

a

Which doppler artifact is demonstrated on the image?

a. reverberation

b. side lobes

c. cross talk

d. aliasing

c

A 66 y/o female presents for an abdominal US due to bloating and pain following a recent cholecystectomy. The bile ducts demonstrate varied levels of increased echogenicity with dirty shadowing and ring-down artifact posterior to several segments. These findings are consistent with?

a. choledocholithiasis

b. sclerosing cholangitis

c. cholangiocarcinoma

d. pneumobilia

d

GB polyps measuring greater than _________ in diameter are highly suspicious for malignancy.

a. 5 mm

b. 10 mm

c. 15 mm

d. 20 mm

b

A patient presents with LUQ and a history of MVA 3 days, a cystic structure is seen in the spleen with layered debris within it. This most likely represents:

a. hematoma

b. hydatid cyst

c. hemangioma

d. carcinoma

a

A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of:

a. FFS

b. HCC

c. hepatic adenoma

d. cavernous hemangioma

d

Which liver pathology is most commonly associated with the GB pathology demonstrated on the image?

a. hepatitis

b. fatty infiltration

c. hepatoma

d. FNH

a

A 16 y/o male presents with acute onset of significant scrotal pain. The US exam reveals a 1 cm hypoechoic, heterogeneous mass located between the head of the epididymis and the testicle. The mass demonstrates no vascularity. Normal flow is demonstrated in the epididymis and testicle. These findings are most suggestive of:

a. adenomatoid tumor

b. sarcoidosis

c. seminoma

d. torsion of appendix testis

d

On an ultrasound exam, the normal adrenal cortex appears:

a. isoechoic to the medulla

b. as a hyperechoic ring around the hypoechoic medulle

c. as an anechoic ring around the echogenic medulla

d. as a hypoechoic ring around the echogenic medulla

d

Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient?

a. transverse only

b. mid sag only

c. coronal only

d. coronal and trv

d

The _____ is a connective sheath that is connected to the small intestine that provides structure and support, along with encasing/protecting blood vessels.

a. lesser omentum

b. mesocolon

c. mesentery

d. greater omentum

c

Which of the following are commonly associated with retroperitoneal fibrosis?

a. hydronephrosis and ureterocele formation

b. scrotal swelling and pedal edema

c. scrotal calcifications and cryptorchidism

d. pedal edema and portal HTN

b

Splenic torsion is most commonly associated with:

a. ectopic spleen

b. asplenia

c. Gaucher disease

d. accessory spleen

a

Which of the following are commonly associated findings with horseshoe kidneys?

a. emphysematous pyelonephritis and ureterocele

b. bilateral renal atrophy and echogenic cortex

c. calculi and hydronephrosis

d. RCC and oncocytoma

c

Harmonic imaging:

a. degrades spatial resolution but improves temporal resolution

b. uses information from reflections created by the non-linear behavior of sound waves to form the image

c. is not recommended for use on fetal exams due to increased beam intensity

d. improves spatial resolution but causes degradation of contrast resolution

b

While scanning the liver, you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. The CBD measures 5 mm in diameter and the GB appears normal. The liver demonstrates mild fatty infiltration and the pancreas and kidneys appear within normal limits. Which of the following correctly describes the laboratory findings that correlate with these findings?

a. increased LFTs, increased bilirubin

b. increased LFTs, normal direct bilirubin

c. increased direct bilirubin, normal LFTs

d. increased indirect bilirubin, increased LFTs

b

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

Which of the following is not true regarding milk of calcium bile?

a. layering of bile/calcium with change of patient position

b. also called limy bile

c. related to hyperfunction of the GB

d. lumen filled with highly echogenic material with shadowing

c

A patient is scheduled for abdominal US every six months due to their history of cirrhosis. What is the primary reason for these serial exams?

a. increased risk of tumor invasion of the PV from metastatic lesion

b. evaluate for the development of an abscess

c. evaluate for pleural effusion

d. increased risk for portal thrombosis

d

A patient has a history of adenomyomatosis of the GB. What acoustic artifact is expected to be present on the US images of the GB?

a. volume averaging

b. comet tail

c. side lobe

d. mirror image

b

Which of the following statements is true regarding the image displayed?

a. a staghorn calculus is seen in the central pelvis of the kidney causing hydronephrosis

b. the BUN and creatinine serum levels will be decreased due to decreased renal function

c. the patient will present with a fever and increased WBC count

d. the renal cortex is thinned and increased in echogenicity

c

What congenital renal anomaly is commonly associated with ureterocele formation?

a. duplicated collecting system

b. dromedary hump

c. horseshoe kidney

d. renal agenesis

a

Excessive androgen production is commonly associated with adrenal hyperplasia, adrenal cortical cancer, and polycystic ovarian disease. How will these increased androgen levels present as a clinical finding?

a. pedal edema

b. hirsutism

c. excessive nausea and vomiting

d. alopecia

b

Chronic steroid use is the most common cause of:

a. Cushing disease

b. Addison disease

c. Cushing syndrome

d. Conn disease

c

Regarding the evaluation of a patient with suspected abdominal aortic aneurysm:

Identifying the _______ guarantees a complete evaluation of the proximal segment while identifying the ______ guarantees a complete evaluation of the infrarenal segment.

a. SMA origin, IMA origin

b. aortic connection to the heart, aortic bifurcation

c. celiac axis, renal artery origins

d. celiac axis, aortic bifurcation

d

An ERCP is commonly performed to evaluate:

a. the Ampulla of Vater

b. the left renal vein

c. the right renal vein

d. pyloric stenosis

a

A patient with multiple gastrinomas will usually present with what other GI tract issue?

a. mesenteric ischemia

b. peptic ulcer formation

c. intussusception

d. esophageal and gastric varices

b

The ________ can be identified anterolateral to the pancreas tail.

a. hepatic flexure of the colon

b. stomach

c. left kidney

d. superior mesenteric artery

b

Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction?

a. cavernosal

b. urethral

c. dorsal

d. ventral

a

The hormone changes with pregnancy have been associated with the enlargement of what type of liver mass?

a. granuloma

b. schistosomiasis

c. hemangioma

d. hepatoma

c

Schistosomiasis and chronic cystitis are commonly associated with what sonographic findings in the urinary bladder?

a. diffuse bladder wall calcification

b. the bladder lumen is filled with numerous non-shadowing stones

c. bladder wall atrophy due to reduced arterial supply

d. ureterocele formation

a

A contrast enhanced ultrasound examination is performed on a patient with suspected HCC. What are the expected findings if the exam is positive for HCC?

a. hyperechoic lesions that demonstrate sustained levels of contrast uptake throughout the arterial and venous phases of circulation

b. hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

c. hypoechoic lesions during the arterial phase and hyperechoic lesions during the portal venous phase

d. hypoechoic lesions that demonstrates absence of contrast uptake throughout the arterial and venous phases of circulation

b

A 70 y/o male presents for transrectal ultrasound due to PSA levels of 7 ng/ml, urinary frequency, and hematuria. The US exam demonstrates a 40 cc prostate volume with heterogeneity and calcifications centrally. The peripheral zone appears normal. These findings are most consistent with:

a. benign prostatic hypertrophy

b. prostatitis

c. carcinoma of the prostate

d. normal prostate

a

What is indicated by the X on the image?

a. complicated ascites

b. psoas muscle

c. rectus abdominis muscle

d. adrenal gland

b

In a patient with cirrhosis, the _______ lobe of the liver can enlarge to nearly half the size of the RT lobe.

a. left

b. caudate

c. quadrate

d. none of the above, the entire liver shrinks in size with cirrhosis

b

Which of the following is a common complication of a Leydig cell tumor?

a. varicocele

b. metastasis

c. gynecomastia

d. cellulitis

c

Which of the following statements is true regarding pancreatic masses?

a. the location of a mass in the tail of the pancreas usually indicates a malignant process

b. the location of a mass in the head of the pancreas usually indicates a malignant process

c. a round mass with smooth borders is usually a malignant process

d. a pancreatic tail mass is commonly mistaken for a mass in the caudate lobe

b

The pancreas is found in what retroperitoneal space?

a. anterior pararenal

b. retrofascial

c. perirenal

d. posterior pararenal

a

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

Which of the following statements regarding the image is true?

a. the mass on the image is most likely a non-seminomatous germ cell tumor because of the characteristic heterogeneous texture with areas of cystic degeneration

b. the mass on the image is most likely a seminoma because of the characteristic heterogeneous texture with areas of cystic degeneration

c. the image demonstrates the most common type of testicular malignancy

d. this type of malignancy is treatable with radiation only, no surgical intervention is required

a

Sulfur colloid imaging is:

a. used to evaluate autosomal polycystic liver disease

b. a type of contrast used in CT imaging

c. used to evaluate suspected FNH

d. a type of contrast used in MR imaging

a

Which of the following is most likely to be affected by a mumps infection?

a. renal vein

b. thyroid vein

c. parotid gland

d. prostate

c

Regarding the aorta, fusiform aneurysm formation usually occurs in the _______ while dissecting aneurysm usually occur in the ______.

a. aortic arch, distal abdominal aorta

b. proximal abdominal aorta, thoracic aorta

c. distal abdominal aorta, thoracic aorta

d. distal abdominal aorta, aortic arch

d

A right spigelian hernia is suspected in this patient. Where will you look? Use your mouse to place the cursor over the area and mark it.

No flow is detected while performing color doppler evaluation of a normal splenic vein. What will improve the color display?

a. increase sample size

b. increase color packet size

c. increase the color velocity scale

d. increasing the angle of insonation

b

________ may be a cause for liver echoes distal to the GB to appear brighter than the surrounding parenchyma.

a. portal venous reflections

b. posterior shadowing

c. posterior enhancement

d. decreased gain settings

c

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

The image demonstrates the most common form of pancreatic endocrine tumor (PET) of the pancreas. What type of PET is displayed?

a. pseudocyst

b. adenoma

c. insulinoma

d. fibroma

c