CTL Clinical 20% Scrotum, Thyroid, Proc.

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

supine with neck extended

If a varicocele is identified on the left side

The left kidney should be evaluated for mass formation

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

imaging the unaffected side

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

by pulling the far corner of the cover toward you

Air in the gallbladder wall will be demonstrated as areas of hyper echogenicity with posterior dirty shadowing and ring down artifact on sonography. How is this demonstrated on CT exam

The gallbladder will demonstrate black areas within the wall where air present

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

uncooperative patient

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

Measuring the depth of the mass within the liver

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

standing

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

gown, mask, goggles, gloves

Which of the following will cause elevated serum amylase

tumor of the submandibular gland and use of oral contraceptives

Which of the following is not a symptom of hyperthyroidism?

A) weight loss

B) increased heart rate

C) excessive sweating

D) weight gain

Weight gain

Which type of thyroid cancer is associated with elevated calcitonin levels

medullary

Medullary thyroid cancer is a hard, bulky mask that is usually found in the fifth and sixth decade of life. The mass secretes calcitonin. It is associated with MEN syndrome and Sipple syndrome (medullary cancer + parathyroid cancer + pheochromocytoma)

In patients with primary hyperparathyroidism, levels of parathyroid hormone will increase, and

Serum calcium levels will increase

In patients with primary hyperparathyroidism levels of parathyroid hormone will be increased in serum. Calcium levels will be increased. Impatiens with secondary hyperparathyroidism, levels of parathyroid hormone will be increased in the serum Calcium levels will be low.

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

A) nothing to eat, or drink at least eight hours before the procedure

B) begin taking a several day course of antibiotics

C) perform a cleansing enema

D) have lab testing for PT/INR levels

Nothing to eat or drink for at least eight hours before the procedure

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

Serum levels of thyroglobulin

Thyroglobulin and thyroglobulin antibody levels, monitored and post surgical patients with a bilateral thyroidectomy after a cancer diagnosis. If the patient had a complete thyroidectomy, there should be no thyroiglobulin present in the blood. Increasing thyroglobulin levels and thyroglobulin antibodies level in post surgical, patient can indicate reoccurrence

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

Hyperparathyroidism

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

Table height should allow the Sonographer's arm to be slightly abducted with the wrist fully extended

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

varicocele and inguinal hernia

A patient presents with a mild scrotal pain and swelling on the left side that started 2 to 3 days ago. The patient walk this morning with a slight fever and increased swelling. All of the following should be a suspected cause for the symptoms except

A) orchitis

B) epididymitis

C) hydrocele

D) Testicular infract

Testicular infract

Acute pain and swelling, not associated with trauma are usually caused by infection. Scrotal infections can lead to hydrocele formation that will present as swelling. A testicular infarct would not be related to a fever.

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

Turn the neck to a neutral position and document lymph node position relative to the carotid artery

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

Supraclavicular

When cancer is suspected, after biopsy, confirmation of cancer, and after thyroidectomy, the neck should be evaluated for lymphadenopathy. Scan the tissue lateral to the common carotid artery, scan from the clavicle to the acromioclavicular joint, scan above, below, and behind the clavicle.

The blue dot sign is a clinical finding of

Tortion of the testicular appendage

Which of the following would be considered a critical finding on a point of care ultrasound exam

severe pericardial effusion

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

the sonographers hands must be covered by sterile gloves when passing the biopsy device to the physician to start the procedure

When wearing a protective gown and gloves

the open end of the gloves should be pulled over the wrist cuffs of the gown

Which of the following statements is true regarding paracentesis?

paracentesis requires the use of the sterile field technique

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

Seated leaning forward over a table

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

secondary hyperparathyroidism

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

2.25mhz, long focus

The lower the probe frequency, the better penetration of the beam. The longer the focus, the better the resolution of deeper structures.

Which of the following requires healthcare providers, and organizations to develop and follow procedures that ensure the confidentiality and security of protected health information

Health insurance, portability, and accountability act

While performing a thyroid, ultrasound, you notice the area indicated by the blue arrow, which of the following statements is true regarding completing this patient exam

Request that the patient swallow to better evaluate the area

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

Linear 10Mhz

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

Complete the ultrasound exam and guy the patient to the CT department, where they can drink the necessary contrast material

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) discussing exam results with the patients physician

C) discussing exam results with a patient

D) sharing in anonymized image from an exam with your sonography class

Posting patient symptoms and demographics within anonymous ultrasound image on social media

You're performing a parathyroid ultrasound, and cannot locate a known adenoma. Which of the following would be most helpful in locating the mass

Ask the patient to swallow

The superior parathyroid gland is usually located posterior to the mid segment of the thyroid lobe. The inferior parathyroid gland is usually located close to the lower pole of the thyroid lobe. Parathyroid glands may be found below the clavicle's, in the lower neck, or upper mediastinum , because the glands can even be found in the retro tracheal location. It may be helpful to have the patient swallow during real time imaging.

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

Periaortic lymphadenopathy

The first location at a seminoma spreads is to the retroperitoneal lymph nodes. The right gonadal vein connects directly to the IVC so the renal vein would most likely be unaffected by tumor invasion.

30-year-old 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.

The right testicle appears torsed

Note the body marker on the image indicates the right side. There's no colorful present for the right, testicle or epididymis, which indicates no blood flow is present. Note the overall heterogenicity of the testicle and epididymis. As ischemia sets in the tissue will become increasingly heterogeneous, recent, groin trauma can lead to torsion of the testicle within the scrotal sac.

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

A) is spiculated lung mass seen on CT exam of the chest

B) an irregular liver mass that is contiguous with the diaphragm seen on CT exam of the abdomen

C) hot thyroid, nodules seen on nuclear medicine exam

D) cold thyroid nodule seen a nuclear medicine exam

Cold thyroid nodule seen a nuclear medicine exam

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 exam. What are you looking for on the nuclear medicine exam to locate the nodule to be biopsied

White/light areas with absence of accumulation of the radioactive isotope

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

A) patient with Budd-Chiari syndrome

B) patient with allergies to iodinated contrast

C) patient with severe liver atrophy caused by cirrhosis

D) patient with the advanced Alzheimer's disease and hepatitis

Patient with advanced Alzheimer's disease and hepatitis

Patients with new onset of secondary hyperparathyroidism will demonstrate

low serum calcium and vitamin D levels with high PTH levels

Primary hyperparathyroidism - most commonly occurs due to single adenoma in the parathyroid gland.

With hyper parathyroidism PTH secretion is constantly induced which induces parathyroid gland hyperplasia. Increasing PTH increases what levels.

Serum calcium levels

With primary hyperparathyroidism increasing calcitonin reduces serum Calcium levels increase PTH equals reduce calcitonin, which equals ?

Hypercalcemia

With primary hyperparathyroidism increase levels of PTH and calcium in the blood increased PTH reduces vitamin D storage, which causes deficiency. The most common type for secondary hyperparathyroidism is associated with

nephrolithiasis, osteopenia, weakness, Malaise, dyspepsia, constipation, and polyuria

A 65-year-old female presents for a neck ultrasound with a script that states hypophosphatemia in hypercalcemia. What do you expect to find on the exam?

enlarged parathyroid glands

Hypophosphatemia and hypercalcemia are clinical signs of hyper parathyroidism. The excessive PTH production causes reduce calcium excretion (hypercalcemia), and an increase in the excretion of phosphate (hypophosphatemia).

Hypophosphatemia is a Clinical sign of

Hyperparathyroidism

Hyper parathyroidism leads to increased PTH production. This causes increased renal excretion of phosphate and reduce serum. Phosphate levels (hypophosphatemia). Cushing syndrome and hypothyroidism are also associated with hypophosphatemia. Renal failure is a common cause of hyperphosphatemia.

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

Pallor is a sign of vasovagal response, while erythema is a sign of anaphylaxis.

Bradycardia is a sign of vasovagal response. Well tachycardia is a sign of anaphylaxis. Hypotension is a sign of vasovagal response, while hypertension is a sign of anaphylaxis. A feeling of impending doom is a sign of anaphylaxis, while dizziness in near syncope or signs of vasovagal response

Sjogren syndrome is an immune system disorder that commonly affects

salivary glands

It is associated with rheumatoid arthritis and lupus. Primary symptoms are dry eyes and dry mouth. It may cause swelling of the salivary glands.

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

A) recurrent antibiotic treatment

B) current Warfarin use

C) polycystic, kidney disease

D) AIDS

Current warfarin use

Patients who are currently taking a blood thinner cannot have a biopsy unless they stop taking the medication for several days

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

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

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

stand off pad

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

Aspirin

Warfarin, Coumadin, Jan seven, Xarelto, paradoxus, or Lovenox aspirin, ibuprofen, NSAIDs should be stopped at least seven days before a procedure and resumed seven days after the invasive procedure. Hypertension, medication and insulin should not be taken the morning of the procedure, but can be taken immediately after the procedure.

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

an area of absence of contrast material

Patient diagnosed with multinodular goiter will also have

Increased TSH, decreased T3 and T4

In cases of multinodular goiter, the thyroid tissue is abnormal, and it produces an abnormally low level of hormones, T3 and T4. The pituitary will over, produce TSH to try to stimulate the gland to produce more T3 and T4. The gland also tries to produce more thyroid tissue in order to produce more hormones. The new thyroid tissue is also abnormal, and only produces low levels of the hormones. Without treatment, the overproduction of tissue will cause a significant increase in gland size .

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

A) signature line to indicate patient consent

B) description of the procedure

C) possible complications that the patient me experience

D) percentage of patients that have experienced complications after the same procedure at the facility

Percentage of patients that have experienced complications after the same procedure at the facility

When using color Doppler to compare, testicular perfusion, you should always

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

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

A) sterile gloves must be used to open the procedure tray

B) when in doubt about sterility, discard the potential contaminated item, and begin again

C) hands and elbows must be kept above the sterile field of the table

D) sterile individuals must pass each other back to back when moving around the procedure room

Sterile gloves, must be used to open the procedure tray

Which of the following patient would benefit from a FAST exam

Patient with a history of abdominal pain after a fall from a lottery yesterday

FAST evaluation = focused assessment with sonography and trauma; used to evaluate the abdomen for fluid or blood in trauma patients; check the four quadrants, midline, and Morrison pouch

Prehn sign is used to differentiate what two abnormalities

testicular torsion and epididymo-orchitis

Prehn sign is used to differentiate epididymo orchitis from torsion. Lifting the painful scrotum above the level of the symphysis pubis will relieve pain when infection is the cause for symptoms. There is no reduction in pain with torsion.

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

limitations of exam performance

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

A trophied epididymis

Post vasectomy changes seen on ultrasound include epidermal, enlargement, tubular, ectasia of the epididymis, dilated vas deferens, spermatocele and cysts. NO hyper vascularity with the enlarged epididymis. Use color Doppler to differentiate post surgical changes from acute epididymitis.

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

Record a blank image that states "time out" after the consent form is signed, and then another image at the start of the procedure

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

attaching the needle and filling the syringe with the numbing agent

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

10-12 MHz linear

Sialothiasis is the formation of a salivary stone. High frequency linear transducer is preferred for evaluating superficial structures. The submandibular glands are located under the mandible, and the parotid glands are located anterior to the ear. A salivary stone would have an appearance similar to a kidney stone. If the stone is causing obstruction, the duct will be dilated within the gland. The submandibular gland is drained by the Wharton's duct and parotid gland is drained by the stensen duct

A FNA, biopsy of the thyroid nodule is not recommended for nodules

<10mm

Uncomplicated, cysts and fluid collections appear black on ultrasound and _______ on CT scan

Dark gray

What dimension of the mass is being measured in this image

Width

Which of the following is true regarding paracentesis

placing the fluid collection container on the floor next to the pt bed increases the fluid drainage rate

A 30 year old presents with a history of normal clinical exam of the scrotum and infertility. What is the referring doctor expecting to find on the ultrasound exam?

Varicocele

Scrotal varicoceles have been linked to male infertility

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

A) pregnancy

B) hepatocellular carcinoma

C) seminomatous tumor of the testicle

D) yolk, sac tumor of the right testicle

Seminomatous tumor of the testicle

Serum AFP levels increase with certain testicular, tumors, liver cancer in pregnancy. Seminomatous tumors of the testicles. Well normally demonstrate normal AFP levels with elevated bhCG levels

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

Paracentesis

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

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

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

Solid mass with hypoechoic halo

The radioactive tracer used in thyroid scintigraphy is designed to indicate concentrations of iodine. A hot nodule indicates hyperactive thyroid tissue. The majority of hot nodules are benign, and a hyper functioning. Adenoma is common. Adenomas are usually solid with a hypoechoic halo surrounding the mass.

What is a Point of Care ultrasound

Focused evaluation used to answer a specific question

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

To assess the patient's risk for post procedure hemorrhage

Which of the following commonly leads to acute scrotal pain

epididymitis

Epididymitis is a common cause for a cute, scrotal pain. The other choices are chronic disease processes that would not normally lead to acute symptoms.

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

Calcifications

Air = black on CT, dirty, shadowing in ring down, artifact on ultrasound

Fluid = dark gray on CT, black on ultrasound

Soft tissue = very levels of gray on both modalities

Calcifications = bright, white on both modalities

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

Prothrombin time (PTT) and international normalized ratio (INR) values

The greatest advantage of ultrasound, guided, approve percutaneous needle biopsy over biopsy performed with CAT scan guidance is.

Ability to view the biopsy needle passing into the mass in real time

Which measurement of the hydrocele is being assessed on the image

Length

A patient is referred to rule out cryptorchidism. You evaluate the scrotal sac with ultrasound, and demonstrate the presence of a right testicle only. Where would your first look for the left testicle

Left inguinal canal

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

AP

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

Sjogren syndrome

Sjogren syndrome is an immune system disorder that causes a reduction in saliva and tear production. It is associated with rheumatoid arthritis and lupus. Primary symptoms are dry eyes and dry mouth. It may cause swelling of the salivary glands. Usually affects the parotid in submandibular glands. Swelling of the salivary glands with a dry mouth is common finding with Sjogren syndrome

Which of the following Doppler formation is necessary to calculate the resistive index

Peak systolic and end diastolic velocity

The following images of taint on a 12-year-old boy with a non-palpable, right testicle. What should be your next step as a sonographer performing this exam?

Evaluate the right groin for an on the undescended testicle

The testicles form in the lower pelvic region and migrate to the scrotal sac after 36 weeks of gestational age. When the scrotal sac is found to contain only one testicle, the undescended testes is most commonly found along the inguinal canal of the affected side.

Iodine deficiency is a primary cause of

Hypothyroidism

Which of the following is true regarding the difference between the simple obtained from a fine needle aspiration in a core biopsy, taken from the liver

The cytology lab evaluates the sample obtained from the FNA. The histology lab evaluates the sample obtained from the needle.

Which of the following correctly describes proper ergonomic steering is sonography exam

Choose a seat that allows your knees to fall below the level of your hips