ABD: Mock Registry Exam D22

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Put the following in order in decreasing echogenicity:

Renal sinus, pancreas, liver, spleen, renal parenchyma

What describes the best way to image the patellar tendon with ultrasound?

Evaluate the patellar attachments from an anterior approach

What is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver?

Early echinococcal infection

What statement is true regarding retroperitoneal lymph nodes?

Abnormal lymph nodes exhibit posterior enhancement

The image demonstrates the Doppler evaluation of a transplant kidney. The findings on the image are most suggestive of:

Renal vein thrombosis

A 30yr old 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?

Varicocele

The major branches of the Celiac axis are:

Left gastric, splenic, common hepatic artery

What has the lowest risk of developing renal cell carcinoma (RCC)?

Patients with autosomal recessive PCKD

Billroth cords in the red pulp of the spleen are responsible for _______________ destruction. Malpighian corpuscles in the white pulp of the spleen are responsible for _____________ production.

RBC, lymphocyte

What type of transducer produced this image?

Sector phased array

A 30yr old patient presents with an order for a renal ultrasound due to suspected multicystic kidney disease (MCKD). What are the expected findings on the ultrasound exam if the abnormality is present?

Unilateral formation of multiple renal cysts consuming the renal parenchyma

What best describes the areas indicated by the yellow arrows?

PE element damage

What will improve the color Doppler visualization of flow in the arcuate arteries?

Increased transducer frequency

What acoustic properties causes the echogenic appearance of the diaphragm related to the surrounding structures?

Specular reflection

What sonographic technique can be used to evaluate a possible inguinal hernia?

color Doppler

What describes the ultrasound appearance of an abnormal small bowel segment?

Intraluminal and extraluminal fluid

What are commonly associated findings with horseshoe kidneys?

Calculi and hydronephrosis

A patient presents for an abdominal sonogram due to a history of hepatic congestion. What structure(s) should be closely evaluated for related findings?

Portal system

What describes the correct method used to measure the wall thickness of the gallbladder?

With the ultrasound beam as perpendicular to the GB wall as possible, measure the AP thickness of the anterior wall

A 6 month old Asian female presents with jaundice and fever. While scanning the liver, you note a 1cm anechoic, round dilatation of the extrahepatic CBD at the porta hepatis. Color Doppler does not demonstrate flow within the structure. What is the most likely diagnosis?

Choledochal cyst

The _____________ are called intersegmental vessels of the liver.

Hepatic veins

A patient presents for an abdominal US to verify findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that do not communicate with the biliary tree or the vascular system. What best describes the expected US findings?

Polycystic disease

Which of the following is a contraindication for a liver transplant in a patient with hepatocellular carcinoma (HCC)?

A single primary tumor >5cm

3 multiple choice options

In a patient with a complete situs inversus, the liver will be:

Located in the LUQ

If a peripheral, wedge-shaped, hypoechoic lesion is identified in the spleen, what should be the first diagnosis considered?

Infarction

The classic appearance of a splenic infarction is a peripheral, wedge-shaped, hypoechoic lesion. Hamartoma is a benign mass that is typically round or oval. TB and lymphoma commonly cause di!use changes in the spleen tissue.

Oncocytoma, renal cell carcinoma (RCC), and focal nodular hyperplasia (FNH) share what sonographic characteristics?

Central scar

A patient presents for an abdominal ultrasound with a history of increased LFTs and obesity. The referring doctor would like to rule out hepatomegaly. What findings will indicate hepatomegaly is present?

When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged.

Power Doppler:

Display is not dependent on incident beam angle

A patient presents for a post-transplant evaluation of the pancreas. Where is the most common location for the allograft?

Right iliac fossa

A patient presents for an abdominal ultrasound due to abdominal pain and bloating. The script for their exam reads "R/O cholangiocarcinoma." What structure should you closely evaluate to answer the question?

Biliary tree

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

Aspirin

3 multiple choice options

A patient presents with a history of Cushing syndrome and an adrenal tumor. What lab results are expected in the clinical findings?

Elevated cortisol levels in the urine

A 56yr old male presents with acute onset of epigastric pain that has persisted for about 2 days. His lab tests demonstrate elevated amylase and lipase. Multiple mobile echogenic foci are present in the gallbladder with a wall thickness of 2.4mm. The CBD measures 6mm and appears patent. The pancreas is mildly enlarged with posterior enhancement. What best describes these findings?

Acute pancreatitis with cholelithiasis

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

Imaging the unaffected side

The findings on the image are a common complication of:

Marfan syndrome

What is a common cause of exudate pleural effusion?

Malignancy

What is indicated by the yellow arrow?

Esophagus

A benign thyroid adenoma is associated with ______________ calcification(s), while malignant adenoma is associated with _______________ calcification(s).

Eggshell, punctate

What lymph node chains should be evaluated for related metastasis with thyroid cancer?

Supraclavicular

The IVC is located posterior to the pancreatic ___________.

Head

What will cause an increase in alpha-fetoprotein (AFP) values?

Hepatocellular carcinoma (HCC)

What imaging plane can produce a longitudinal image of the IVC and the aorta on the same image?

Coronal only

In most patients, the proper hepatic artery bifurcates into the right and left hepatic arteries. In about 10% of patients, the right hepatic artery originates from the ________ and the left hepatic artery originates from the __________.

SMA, left gastric artery

Which type of thyroid cancer is most lethal?

Anaplastic

A 4yr old patient is referred for an abdominal ultrasound due to a palpable mass in the RUQ and jaundice. The image most likely represents what finding?

Hepatoblastoma

Which of the following foreign body type is better visualized on sonography than with radiology?

Rose thorn

3 multiple choice options

A 4 month old presents for an abdominal ultrasound following a recent Kasai procedure. What ultrasound findings would indicate the procedure was a success?

Normal liver echotexture with normal biliary duct diameter

What statement best describes the location of the ligamentum venosum?

It forms the anterior border of the caudate lobe

Accessory renal arteries:

Must be documented prior to renal resection or transplantation

What are most common primary carcinomas to metastasize to the thyroid?

Breast and lung

You are scanning the gallbladder and there appears to be sludge within the lumen. What will aid in differentiating the sludge from artifact?

Increase the transducer frequency

Splenosis is a complication of:

Splenic trauma

Hypovolemic shock is a common symptom of:

Aortic rupture

The US exam of a patient's liver demonstrates a patent umbilical vein. The most common cause for this recanalization is:

Portal HTN

A patient presents with a history of neurologic bladder and recent onset of mild hematuria. What statement is true regarding the findings on the image?

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

Overgaining on an US exam can cause _____________.

Overestimation of Doppler velocity

In the porta hepatis, what structure is anterior to the portal vein and lateral to the proper hepatic artery?

Common hepatic duct

The white arrow on the image indicates:

Urethra

The arrow on the attached image demonstrates:

Ascites in the paracolic gutter

What statement is true regarding the abnormality on the image?

It can be caused by Nutcracker syndrome.

What two bladder abnormalities are most commonly associated with a duplicated collecting system?

Ureterocele and vesicoureteral reflux

Bacterial infection, internal bleeding, and viral infection typically share what ultrasound finding?

Ascites with debris/septations

Sonographic signs of chronic renal failure include a/an ________ in size and a/an __________ in echogenicity.

Decrease, increase

What is the most common cause of a hepatic abscess in the US?

Cholangitis and cholecystitis

___________ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood.

Anemia

The renal arteries branch from the aorta just below the origin of the __________.

Superior mesenteric artery (SMA)

A female patient presents with 8 days of abdominal pain, fever, and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, alkaline phosphatase, and WBC's. These clinical findings are most suggestive of:

Cholangitis

Leydig cell tumors of the testicle will demonstrate high serum levels of _____________ which can lead to __________.

Testosterone, precocious puberty

What is demonstrated by the same colon on an ultrasound image as on a CT image?

Calcifications

3 multiple choice options

The purple arrow on the image indicates:

A normal variant in renal formation usually related to a duplicated collecting system

Which of the following is a symptom of Addison disease?

Hyperkalemia

3 multiple choice options

A patient presents with a history of renal calculi. The image displayed is from the area of pain in the LLQ. What is indicated by the green arrow?

Iliac artery

What correctly describes the findings on the image?

Lymphadenopathy

If a patient forgets to take their hypertension medication before a renal duplex exam, what effect can this have on the findings?

Overestimation of renal artery stenosis

What is an acquired abnormality of the biliary system?

Sclerosing cholangitis

3 multiple choice options

What correctly describes how to aid in differentiation of a thyroid adenoma in the lower pole from a parathyroid adenoma?

Thyroid adenomas are hypovascular and parathyroid adenomas are hypervascular

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

Linear 10MHz

The most common site for a renal artery stenosis is:

At the origin of the renal artery

Diffuse or focal GB wall thickening may be seen with all of the following, except:

Courvoisier GB

Splenic vein thrombosis and splenic artery pseudoaneurysm formation are vascular complications seen with:

Pancreatitis

On a scrotal ultrasound exam, how do you differentiate acute epididymitis from post-vasectomy enlargement of the epididymis?

Use color Doppler

The inguinal ligament extends:

From the anterior superior iliac spine to the pubic tubercle

What describes the sonographic appearance of hepatic candidiasis?

Mass formation is described as a wheel within a wheel pattern

Bilateral ureteral obstruction can be caused by?

Retroperitoneal fibrosis

Which muscle group is located posterior to the thyroid gland?

Longus colli muscle

What is a complication of cystic fibrosis?

Meconium ileus

In cases of acute pancreatitis, which enzyme level increases first?

Amylase

Which portion of the GI tract contains numerous valvulae conniventes that cause a feathery appearance of the structure on ultrasound?

Jejunum

A patient presents with intermittent RUQ pain and nausea. No lab information was available at the time of the ultrasound exam. The findings on the image are most suggestive of:

Gallbladder metastasis

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

Increases the RI in the parenchymal arteries

A patient presents for an abdominal ultrasound due to suspected displacement of the Greenfield filter. Where should you look to find the filter in the normal position?

In the IVC just below the level of the renal veins

Which type of pancreatic mass has a strong risk of malignant conversion?

Macrocystic cystadenoma

Epididymitis most commonly results from ___________ in males 14-35yrs and ______________ in men over 35yrs.

Sexually transmitted disease, bladder infection

A TIPS shunt is placed into the liver circulation to alleviate portal HTN. What two vessels are usually connected?

Right portal vein connects to the right hepatic vein

What statement best describes the findings on the image?

The arrows indicate a remnant of the Mullerian duct and a scrotal calcification.

A 50yr old male presents with RLQ pain, watery diarrhea, and a low grade fever. The ultrasound exam demonstrates a prominent lymph node in the area of pain and this image was also obtained at the area of pain. These findings are most consistent with?

Colitis

What correctly describes the difference between the normal waveform in the renal artery and the external iliac artery?

The renal artery flow is monophasic and the external iliac artery demonstrates triphasic flow.

The most common extra-testicular neoplasm is:

Adenomatoid tumor

What is the most common cause of cholangitis?

Choledocholithiasis