Self study clinical rotation VI

The breast is sonographically divided into three layers. Which is incorrect?

A. skin, nipple, subareolar

Fat, Cooper's ligaments, connective tissue, blood vessels, nerves, and lymphatics are found in which layer or zone?

the subcutaneous layer.

The breast is sonographically divided into three layers. Which is incorrect?

A. skin, nipple, subareolar

Fat, Cooper's ligaments, connective tissue, blood vessels, nerves, and lymphatics are found in which layer or zone?

the subcutaneous layer.

The ___________ is mostly glandular tissue, whereas the peripheral part is adipose tissue rimmed by ___________

parenchyma, retromammary layer.

Sonographically, the breast may be characterized by:

an inhomogeneous parenchymal pattern.

Cooper's ligaments are best characterized as:

echogenic line interfaces in the subcutaneous layer.

The retromammary layer is sonographically imaged as:

hypoechoic.

The most important signs to look for in determining a cystic lesion of the breast include all except which of the following?

disruption of architecture.

Clinical findings of lumpy, painful, tender breasts that vary with monthly cycles usually represent:

fibrocystic disease.

The characteristic findings of a papilloma of the breast include all except which of the following?

well-circumscribed solid mass with microcalcifications.

The most common solid benign tumor of the breast is:

fibroadenoma.

The most characteristic finding of a fibroadenoma is:

uniform, low-level homogeneous echoes.

A cystic enlargement of a distal duct filled with milk is called a:

galactocele.

The most common malignant neoplasm of the breast in women is a:

invasive ductal carcinoma (IDC).

Characteristic findings of breast carcinoma include all except which of the following?

strong posterior margin.

Skin dimpling may be caused by:

retraction of tissue secondary to tumor infiltration.

The most common clinical sign of breast carcinoma is:

palpable lump.

A breast lesion that presents with well-defined borders, low-level internal echoes, and good through transmission most likely represents:

a simple cyst.

Q: Which of the following statements about ultrasound of the breast is/are true? 1. Ultrasound of the breast is the primary breast imaging modality used for females too young for mammography who present for evaluation of a palpable breast lump. 2. Ultrasound of the breast is the primary breast imaging modality used to screen women for clustered microcalcifications, which is one of the main signs of possible breast cancer and usually an indication for breast biopsy. 3. Ultrasound of the breast is used as an adjunctive breast imaging modality for further assessment of smooth mammographic masses as cystic or solid. 4. Ultrasound of the breast must never be used to evaluate a breast abnormality in a pregnant female.

A. 1 and 3.

Q: Which of the following is/are true statements concerning breast cancer risk? 1. A patient who has already been treated for breast cancer in one breast will not be at increased risk for development of another breast cancer in her opposite breast. 2. Older women are at increased risk for development of breast cancer compared with younger women. 3. Although men may develop a breast mass resulting from a benign condition called gynecomastia, men never develop breast cancer. 4. A significant risk factor for development of breast cancer is a positive family history of breast cancer in first-degree relatives (mother, sister, daughter).

Answer: 2 and 4.

2. Older women are at increased risk for development of breast cancer compared with younger women.

4. A significant risk factor for development of breast cancer is a positive family history of breast cancer in first-degree relatives (mother, sister, daughter).

According to the American Cancer Society, all women should begin annual screening mammography and screening breast ultrasound at age

Answer: 40.

Which of the following statements is/are correct?

1. Key criteria for a simple cyst by ultrasound are only 75% reliable in excluding malignancy. 2. The usual sonographic appearance of a benign fibroadenoma (oval, wider than tall, homogeneous internal echoes, smooth sharp margin) is 100% reliable in excluding the possibility of malignancy. 3. When a teenage girl presents with a palpable breast lump, ultrasound of the breast will usually reveal a rapidly growing soft tissue sarcoma, a malignancy that is not of breast origin. 4. In evaluating a breast mass by ultrasound, signs of suspicion for malignancy include a poorly defined irregular margin, inhomogeneous pattern of internal echoes, taller than wide shape, and posterior shadowing

D. 4 only

In evaluating a breast mass by ultrasound, signs of suspicion for malignancy include a poorly defined irregular margin, inhomogeneous pattern of internal echoes, taller than wide shape, and posterior shadowing.

Q: In documenting a sonographic breast mass, which of the following statement(s) apply? 1. The sonographic image recording the mass should be labeled appropriately according to either breast quadrant or breast clock face position. 2. The sonographic image recording the mass should be labeled appropriately according to which breast contains the mass. 3. The sonographic image recording the mass should be labeled appropriately according to transducer orientation (i.e., sagittal, transverse, radial, or antiradial). 4. The sonographic image should ideally record the size of the mass in all three dimensions.

a. 1,2, and 3

1. The sonographic image recording the mass should be labeled appropriately according to either breast quadrant or breast clock face position.

2. The sonographic image recording the mass should be labeled appropriately according to which breast contains the mass.

3. The sonographic image recording the mass should be labeled appropriately according to transducer orientation (i.e., sagittal, transverse, radial, or antiradial).

Signs or Symptoms of Breast Cancer

d.Signs or symptoms of possible breast cancer include all except a smooth low density mammographic mass, solid on breast ultrasound that has not grown or changed in over 3 years.

Ultrasound is often of benefit in guiding breast procedures, except for large core needle biopsy of microcalcifications not visible on ultrasound.

d. large core needle biopsy of microcalcifications not visible on ultrasound

False Statement about Breast Ultrasound

c. Breast ultrasound is the primary imaging tool of choice in screening a 45-year-old woman for any evidence of possible breast cancer.

Q: Ultrasound of the breast is often performed as an adjunctive imaging tool in all except which of the following situations?

d. to further evaluate an asymptomatic patient with large fatty replaced breasts and a negative mammogram

Q: In the case of a cancerous mammographic mass, the correlating sonographic mass will likely show which of the following features?

a. irregular margin/ taller than wide

In the case of a smooth mammographic mass that is cystic, the correlating sonographic mass will likely show which of the following features?

b. anechoic/posterior acoustic enhancement

Advantages of breast ultrasound over mammography in evaluating the breast include all except which of the following?

d. better visualization of juxtathoracic deep tissues

Q: Advantages of breast ultrasound over mammography in evaluating the breast include which of the following?

d. evaluation of those hard-to-reach places not well seen on mammogram, such as parasternal tissues and axilla.

Q: The thyroid is an endocrine gland that regulates metabolic function through the production of all except which of the following hormones?

d. thyrodetonine

The thyroid gland consists of the following number of lobes

c. two

Q: The approximate dimensions of the thyroid gland are:

A. gland are 5 cm length, 2 cm width, 2 cm depth.

The lobes of the thyroid gland are connected by:

the isthmus

Q: All of the following structures form neighboring structures for the thyroid gland except:

b. parotid muscle

Q: Sonographically, the thyroid may be described as having characteristics of all of the following except:

a. inhomogeneous echogenic pattern

Q: Characteristic ultrasound findings of a cyst of the thyroid gland include all except:

a. cysts account for 20% of all cold thyroid nodules

Q: The differential diagnosis for thyroiditis includes all except which of the following?

d. multinodular goiter

Clinical signs of a thyroid goiter

thyroid enlargement

The most common thyroid abnormality

goiter

Best sonographic characteristic for thyroid cancer

A. solid complex mass with heterogeneous echo pattern and irregular margins

Most common feature of a thyroid adenoma

peripheral sonolucent halo

Q: The parathyroid glands produce a hormone that affects:

kidneys, bones, and gastrointestinal tract

Normal parathyroid glands measure less than

5 mm

Location of parathyroid glands lie

A. between the posterior borders of the lateral lobes of the thyroid gland

Q: There are usually ___________ parathyroid glands

four

Q: A patient presents with osteoporosis. A hyperplastic parathyroid gland is seen on ultrasound examination. Your differential diagnosis includes all except which of the following?

thyroid cyst

Most common cause of hyperparathyroidism

parathyroid adenoma

Q: A ___________ presents as a palpable midline mass between the hyoid bone and isthmus of the thyroid.

thyroglossal duct cyst

Q: Which of the following structures lies posterolateral to the thyroid gland?

esophagus

Most common cause of thyroid disorder worldwide

iodine deficiency

Increased vascularity termed 'thyroid inferno'

Graves' disease

Most common cause of thyroid malignancy

papillary carcinoma

Q: An abnormal lymph node demonstrates:

round contour

Cystic formation lateral to the thyroid gland

brachial cleft cyst

Contents of the scrotum

testes, epididymis, and spermatic cord

Q: The testes are covered by a fibrous capsule formed by the:

tunica albuginea

Q: The testes measure:

4 cm length, 3 cm A-P, 3 cm width

Sonographic characteristics of the testes

a homogeneous pattern with medium-level echoes

Q: A linear stripe of variable thickness and echogenicity running through the testis in a craniocaudal direction represents the:

mediastinum testis

Location of the epididymis

posterior and superior to the testis

Q: Which fact about an undescended testis is false?

All undescended testes are found in the inguinal canal

Q: The differential diagnosis for an undescended testis includes all except which of the following?

retroperitoneal neoplasm

Q: Common causes of a secondary hydrocele include all except which of the following?

undescended testes

False statement about varicocele

They are more common on the right side

Q: A spermatocele usually lies:

in the head of the epididymis, superior to the testis

Q: A common problem that is viral in origin that affects some adolescent and middle age men is:

epididymo-orchitis

Q: A problem that may occur secondary to an acute systemic infection is:

orchitis

Clinical findings suggestive of acute scrotal pain and swelling

torsion

Most common neoplasm associated with undescended testes

seminoma

Q: Characteristic sonographic findings of torsion include all except which of the following?

hyperechoic parenchyma

Q: Sonographic patterns of testicular neoplasms include all except which of the following?

anechoic pattern with increased transmission

Q: Sonographic patterns of testicular neoplasms include all except which of the following?

A: d. hemorrhage

Q: A scanning feature that improves contrast resolution and visibility of low-level echoes is:

Harmonics

Q: Microlithiasis of the testis is associated with:

malignancy

follow-up examination of patients with microlithiasis is Recommended

annually

Q: Attached at the superior pole of the testis, between the epididymis and the testis is the:

c. appendix testis

Q: A hydrocele develops between:

c. parietal and visceral layers of the tunica vaginalis

rete testis is located

at the hilum of the testis.

Q: Compared with the testis, the epididymis typically appears:

coarse in texture

Q: A bursa performs what function?

a. It provides fluid protection to areas that are subject to friction.

Q: Normal muscle appears sonographically as:

homogeneous.

Q: A Baker's cyst is an example of:

communicating bursa.

Q: The angle and direction of the reflected beam depends upon the angle of incidence is found in:

b. anisotropy

Q: The best definition of refractile shadowing is:

curved edge of a structure.

Q: The best definition of refractile shadowing is:

a. carpal tunnel syndrome

Q: The tendon responsible for dorsal and plantar flexion of the foot is the:

c. Achilles tendon

Q: What type of tendinitis is found more commonly in the sonographer?

b. De Quervain's tendinitis

Q: A complete tear of a muscle with a straightforward appearance of a retracted hyperechoic muscle surrounded by a hematoma is known as:

b. clapper-in-the-bell sign

Q: What is a bandlike flat tendon connecting muscle to bone?

b. aponeurosis

Q: Support and strength of a joint result in part from the:

d. ligament

Q: When compared with muscle, a normal nerve is

a. hyperechoic

Q: Important artifacts in musculoskeletal ultrasound include all except which of the following?

d. anisotropy

Achilles tendon injury risk

Increased due to limited blood supply.

Q: Indications for wrist sonography include all except which of the following?

Include all except Thompson's sign.

Q: Acute rotator cuff tear may be caused by all except which of the following?

b. biceps tendon rupture

Q: The proximal portion of the muscle is considered the:

c. origin

Q: The cartilage interface sign is the echogenic line on the anterior surface of the cartilage surrounding the:

a. radial head

Q: Tendinitis is seen more often in the shoulder. wrist, and:

a. elbow

Q: The easiest tendon to image in the adult shoulder is:

a. supraspinatus