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Abdominal Ultrasound
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Which vessel courses within the main lobar fissure


Middle hepatic Vein


Oxygenated blood is supplied to the liver via the


Portal vein & Hepatic artery


You are performing a sonogram on a slender female and notice a long thin extension of the inferior aspect of the rt lobe of the liver. This most likely represents:


Reidel's lobe


What forms the caudal border of the lt portal vein?


Ligamentum teres


What ligament divides the lt lobe of the liver into the medial and lateral segments?


Ligamentum teres


You are asked to perform a Doppler study on the hepatic veins of the liver. What differentiates the hepatic veins from the portal veins?


The portal veins are accompanied by branches of the biliary tree and hepatic artery.


You have detected a mass anterior and to the lt of the ligamentum venosum. This mass is located in what lobe of the liver?


Lt lobe


The thin capsule surrounding the liver is known as:


Glisson's Capsule


What vessels follow an interlobar and inersegmental course within the liver? 


Hepatic Veins


You are performing an ultrasound exam of the liver on a small pt with a 5 MHZ curved linear array. Although you have increased the overall gain to its maximum setting, the posterior border of the liver and diaphragm are not visualized. What should you do?


Rescan the liver with a lower frequency transducer.


What is the probe placement and imaging plane you would use to demonstrate the 3 hepatic veins and IVC in one veiw?


Subcostal oblique approach with the probe angled superiorly and to the pt's Rt.


You are performing a f/u sonogram on a pt in which a 5mm cyst was previously identified at the anterior border of the Lt lobe of the liver.  Although you are using a 3.5 MHZ curved linear array probe,you do not see the cyst. What would be helpful in improving visibility of this cyst?


Rescan the Lt lobe with a higher frequency transducer.


You are imaging a pt with a high liver. Subcostal images do not clearly demonstrate the liver tissue. What should you do?


Scan the pt in deep inspiration


A pt is referred for u/s evaluation of a questionable mass in the dome of the liver seen on CT scan. Which method would improve visualization in this area of the liver?


Perform a subcostal scan with the probe angled superior and the pt in deep inspiration.


A pt is referred for a liver u/s with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?


Hepatocellular carcinoma


You are reviewing labwork prior to performing an abd ultrasound exam. Elevated lab values include Gamma-glutamyl transpeptidase(GGT) & alkaline phosphatase. What does this mean?


Elevation of both GGT & alkaline phosphatase indicates the source of the elevated phosphatase is the liver.


Lipase is a lab test used to evaluate what?


Acute Pancreatitis


Elevation of what lab test indicates biliary obstruction,which may be intrahepatic(due to hepatitis or cirrhosis) or extrahepatic(due to gallstones,gb or pancreatic cancer)?


Direct bilirubin


Elevation of what labwork would indicate hepatocellular dysfunction such as hepatitis?


Indirect bilirubin


A pt is referred with RUQ tenderness & a hisory of oral contraceptive use. A solid hypoechoic mass is identified in the rt lobe of the liver. color doppler reveals hypervascularity of the mass. This most likely represents what?


hepatic adenoma


A liver u/s on a 49y/o obese male demonstrates diffuse increased echogenicity with a focal hypoechoic area anterior to the portal vein. This most likely represents what?


fatty metamorphosis of the liver with focal sparing


A 52y/o male with known liver cirrhosis presents for an abd u/s. Why would you carefully evaluate the liver to rule out the presence of any focal mass?


pts with liver cirrhosis are at increased for hepatocellular carcinoma


You are scanning a pt with suspected liver cirrhosis. What are some of the sonographic features of cirrhosis?


surfac nodularity
enlarged caudate lobe
altered echotexture
ascites
regenerative nodules



An ultrasound evaluation of liver cirrhosis should include a search for which associated complication?


portal hypertension


U/S findings of an abd study on a 51y/o f include enlargement of the hepatic veins & ivc in an otherwise normal appearing liver. These findings are most consistent with what?


Rt-sided heart failure


Focal fatty liver is most commonly found in which location?


Anterior to the portal vein at the portal hepatis


You have performed an u/s on a pt with an enlarged caudate lobe,shrunken rt lobe & splenomegaly. The hepatic veins could not be identified. No other abnormalities were discovered. what should you do?


Evaluate the hepatic veins & ivc with color doppler to confirm patency


A pt is referred to r/o hepatomegaly. List a sonographic indicator.


1.Long measurement of the rt     lobe  exceeding 15.5cm
2.Rounding of the inferior border of the liver
3.Extension of the rt lobe inferior to the lower lobe of the rt kidney
4. increased AP measurement of the rt lobe



You have identified a single homogenous hyperechoic lesion measuring 2.4cm in the posterior aspect of the rt lobe of the liver. What is the most common etiology of a mass fitting this description?


Cavernous hemangioma


A pt is referred for an u/s of the liver to rule out metastatic disease. What is the sonographic appearance of liver metastasis?


any of these
single hypoechoic mass
multiple hypoechoic masses
masses of mixed echogenicity
cystic masses



List features of a hepatic cyst.


thin walled
posterior acoustic enhancement
anechoic
increased through transmission



A single large,well-defined mass with smooth walls & homogemous low level echoes is seen within the anterior rt lobe of the liver in a 48y/o female. No doppler signals could be obtained w/i the mass. What is the most likely etiology of this mass?


Hemorrhagic cyst


You are scanning a pt with a hx of fever, abnormal lfts,  & ruq tenderness. The liver is enlarged with decreased echogenicity,the gb wall is thickened & thick echogenic bands are noted surrounding the portal veins. What is the most likely condition?


Hepatitis


You are eveluating suspicious lesion to look for gas bubbles to confirm the presence of liver abscess in a pt with fever and increased white blood cell count. What is the sonographic appearance of gas bubbles?


Brightly echogenic foci associated with echogenic ringdown artifact


What condition is associated with infestation by a parasite & is most prevalent in sheep & cattle-raising countries?


Hydatid disease


You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with what abnormality?


Cirrhosis


What liver condition fits the folllowing descriptions: its reversible, may be caused by obesity,may be diffuse or focal,may show rapid change in appearance with time, commonly causes increased attenuation of the sound beam.


Fatty liver


You are scanning through the liver & notice luminal narrowing of the hepatic veins. Color & spectral doppler reveal high velocities through the strictures. These findings are most commonly associated with what?


Cirrhosis


The most common benign tumor in the liver is?


cavernous hemangioma


What condition is most commonly associated with invasion of the portal vein?


Hepatocellular carcinoma


You have been asked to perform a liver u/s on a pt with AIDS. What tumor is most commonly associated with this history?


Kaposi's sarcoma


You are scanning a 53y/o female with a hx of recent wt loss and vague abd pain. The liver is markedly heterogenous & contains numerous calcified lesions. This most likely represents metastatic disease from what primary?


Adenocarcinoma of the colon


During a liver u/s, a bull's eye or target lesion is identified in the anterior rt lobe. What's the most likely etiology of this mass?


Liver metastasis from lung cancer


You are performing an u/s exam on a young female and notice a well-defined solitary mass with a central scar measuring 4cm in diameter. Color doppler reveals prominent blood vessels coursing w/i the scar. What does this represent?


Focal nodular hyperplasia


You are performing a liver u/s on a young female with RUQ pain,sudden onset ascites & hepatomgaly. You have obtained trans & sagital images of the liver,cbd, & gb according to protocol. What else should you do?


Use color & spectral doppler to determine patency of the portal and hepatic venous system


What significant complication following liver transplantation is not detectable with u/s?


Rejection


Biliary sludge,acute cholecystitis,portal vein stenosis,hepatic artery thrombosis,liver malignancy could be complications seen on a liver transplant pt. Which complication listed is not associated with a liver transplant?


Acute cholecystitis


2.25 ,3.5, 7, 10, & 12mhz are tranducers available to provide imaging during liver surgery. Which transducer is better suited for this purpose?


7mhz because the sterile transducer will be placed directly on the liver. For this reason you want to use a transducer with a higher than nml frequency.


You are scanning through the rt lobe of the liver and notice that although you have maximazed the far field TGC, the parenchyma in the far field and diaphragm are not clearly  visualized. What should you do?


Decrease the transmit frequency


Hepatofugal flow in the portal vein is a sign of what?


portal hypertension


A pt is referred for an abd u/s with a high fever & ruq pain. You document the presence of a large,rounded homogenous mass  c low level internal echoes and poorly defined borders.The mass is located in the rt lobe of the liver adjacent to the capsule and shows increased through transmission.This most likely represents what?                           


abscess


The most common form of malignant disease of the liver is:


metastatic disease


You are scanning a pt with known liver cirrhosis and notice a focal mass w/i the posterior rt lobe. What lab test would be most helpful in determining if this mass is hepatocellular carcinoma?


serum alpha-fetoprotein


You have been asked to perform an u/s to r/o the prescence of Budd -Chiari syndrome.You will taylor your exam to include what?


doppler analysis of the hepatic venous


You are performing an u/s on a pt with a transjugular intrahepatic portosystemic shunt(TIPS). What 2 vessels are connected with the TIPS stent?


portal vein & hepatic vein


The majority of blood supply to the liver is provided from the:


Portal vein


Following a liver transplant,what anatomic locations have an anastomotic connection that should be evaluated with u/s?


IVC, portal vein,hepatic artery, bile duct


You are scanning a pt with liver cirrhosis & suspected portal hypertension. In this study, assessment of the size of what is most important?


Spleen & portal vein diameter


A recannalized paraumbilical vein may be seen as a result of what?


Portal hypertension


The best sonographic window to view a recannalized paraumbilical vein is?


Saggital subcostal view through the lt lobe of the liver at the level of the ligamentum teres


The portal triad consists of what 3 structures ?


Portal vein
bile duct
hepatic artery



The ligamentum venosum forms the anterior border or what lobe of the liver?


Caudate lobe


You are scanning a pt with portal hypertension. Enlargement of what structure is diagnostic of this condition?


coronary vein(lt gastric vein)


What measurement is the diagnostic cutoff for portal vein enlargement?


13mm or 1.3cm


Regenerating nodules are a feature associated with:


Cirrhosis


You are performing an u/s on a pt with a hx of alcoholic cirrhosis. You have documented the presence of splenomegaly & dilated veins in the splenic hilum.Considering the pt's hx & findings, what else should you look for


search for the presence of portosystemic collaterals


What's the best view for u/s demonstration of the coronary vein?


a saggital view of the splenic vein near the midline


You are performing a f/u study on a pt with a hx of cavernous transformation. Where should you look to evaluate this condition?


porta hepatis


You are scanning a pt with an enlarged caudate lobe & shrunken rt lobe. What diffuse liver process


cirrhosis


You are scanning an obese pt to r/o fatty liver. What would be the sonographic appearance of this condition?


increased echogenicity of the liver compared to the nml kidney


You are having difficulty locating the gb in a pt w ruq pain. what anatomic landmark will help you identify the gb fossa?


interlobar hepatic fissure


In what anatomic variant is the fundus of the gb folded over the body?


Phrygian cap


A pt is referred from the E.R. to rule out acute cholecystitis.You think the gb wall may be thickened.What is the nml diameter of the gb wall?


<3mm


You are scanning the gb and notice some smudgy echoes within it.You suspect the echoes are due to artifact.What is a common cause of artifactual echoes w/i the gb?


reverbration
side lobes
slice thickness artifact



You have a pt scheduled for a gb sonogram.What preparation is required?


the pt should be fasting 8-12hrs prior to the study


You have been requested to perform a GB u/s to r/o cholelithiasis. What is cholelithiasis?


Gallstones


You are scanning the GB and notice that the wall is abnormally thick. Which of the following choices IS NOT a cause for gb wall thickening?
1)inflammation
2)hepatic dysfunction
3)congestive heart failure
4)malignant ascites
5)gb wall varices



malignant ascites


A referring physician has asked you about the accuracy of gb sonography. The diagnostic accuracy of gb sonography is?


>90 %


During GB sonography, you notice echogenic foci w/i the gb but do not detect acoustic shadowing.What changes will improve the detectability of stone shadowing?


increase transducer frequency & increase transducer focusing


You are scanning a pt with a porcelain gb. What does this term
mean?



the gb wall contains varying amounts of calcium


Describe the location of the distal cbd.


Posterior and slightly lateral to the pancreatic head


The pt you are scanning has eaten breakfast prior to your study.What is the appearance of the GB in the postprandial state?


contraction of the GB with diffuse wall thickening


A pt presents to the US dept for a sonogram to r/o biliary obstruction. Which lab test would best indicate the presence of bile duct obstruction? 


Serum Direct Bilirubin


What is the most common cause of acute choleycystitis?


calculus obstruction of the gb neck or cystic duct


Tenderness over the GB with probe(transducer) pressure is termed what?


Murphy's sign


You are performing an abd u/s and detect a dilated, nontender Gb. What should you look for?


A mass in the head of the pancreas


Name a sympton associated with acute choleycystitis.


nausea
vomiting
epigastric pain
RUQ pain



You are performing an u/s exam on a pt with acute choleycystitis. Which of the listed complications of acute choleycystitis should you not look for?  Pancreatitis, Pancreatic Carcinoma, GB Perforation, Gangrenous choleycystitis, Emphyasematous choleycystitis


Pancreatic carcinoma


You have been asked to rule out the presence of choledocholithiasis. What are you looking for?


Stones within the CBD


Identification of what anatomic structure would most help a sonographer locate a contracted GB?


Main lobar fissure


The transverse measurements of the GB in a fasting pt measure 5.3cm. This measurement is:


Consistent with a hydropic GB


You are scanning a pt in ICU and notice low-level echoes w/i the GB consistent w/ sludge. The GB wall is not thickened. Which statement is true?
1.pt most likely has acute acalculus choleycystitis
2.findings represent Gb perforation
3.pt has sludge most likely due to bile stasis
4.pt has a porcelain GB
5.pt has a pancreatic abnormality



Pt has sludge most likely due to bile stasis


U/S images obtained on a 48y/o male show a comet tail or V-shaped reverberation artifact originating from the anterior wall of the GB. This artifact most likely results from:


adenomyomatosis


You are performing an u/s study to r/o cholelithiasis. A small echogenic foci is seen in the posterior aspect of the gb fundus. How can you determine if this foci represents a polyp or stone?


Shadowing is not present with polyps but is present with stones


What is the sonographic appearance of tumefactive sludge w/i the gb?


an avascular mass w low level echoes


You are scanning a 34y multiparous woman w/ symptons of severe ruq pain, nausea & vomiting. The gb is thick-walled w/ stones and an adjacent complex fluid coleection seen. These findings most likely represents:


Acute choleycystitis complicated by gb perforation


You are scanning a 44y/o man w diabetes. He complains of severe epigastric pain radiating to the back,vomiting,chills and fever. U/S findings include a large gb w/ nondependent hyperechoic foci associated w/ ringdown artifacts. These findings are most consistent with:


Emphysematous cholecystitis


Hypervascularity associated with acute choleycystitis is best evaluated with doppler interrogation of what artery?


Cystic artery


Which of the following are not signs of acalculous choleycystitis?

A) gb wall thickening
B) sonographic murphy's sign
C) cholelithiasis
D) pericholecystic fluid
E) gb wall edema



cholelithiasis


You are scanning a gb and notce posterior acoustic shadowing. You are unsure if the shadowing is due to bowel gas or gallstones. What will hep determine your decison?


Roll the pt into the LLD position


You are imaging the gb intransverse orientation and  notice a long shadow at both edges. What is the etiology of this shadow?


Refraction artifact


An u/s image obtained from the gb shows an irregular mass w/i the lumen which demonstrates hypervascularity by color doppler imaging. Multiple stones are also seen w/i the gb lumen. These findings are most consistent with what?


Gb carcinoma


Rokitansky-Aschkoff sinuses are associated with what condition?


Adenomyomatosis


The best way to identify the intrahepatic biliary system is to image which structure?


Intrahepatic portal veins


A pt is referred for a f/u abd u/s. The previous report indicates that pneumobilia was present. What is pneumobilia?


Air in the bile ducts


You suspect intrahepatic bile duct dilatation in a pt w/ ruq pain and tenderness. How can you differentiate the dilated bile ducts from intrahepatic veins?


Dilated bile demonstrate irregular tortuous walls
bile ducts will not demonstrate flow with doppler



What  forms the common bile duct?


the junction of the cystic duct and common hepatic duct


During u/s evaluation of the gb system,you notice thickening  of the bile duct walls. This finding may be related to what?


Sclerosing cholangitis
pancreatitis
choledocholithiasis
cholangiocarcinoma



You have been asked to perform an u/s to evaluate for biliary obstruction in a pt with a hx of wt loss & midepigastric pain. You find both intrahepatic & extrahepatic biliary dilatation. The gb is hydropic. Which of the following conditions causing ductal dilatation should you look for?

a)choledocholithiasis
b)pancreatic carcinoma
c)chronic pancreatitis w/stricture
   formation
d) a & b only
e) all the above
  




e) all the above


Cystic dilatation of the cbd is:


choledochal cyst


A 51y/o male is referred for abd u/s with abnormal liver function tests and jaundice. Which lab work will aid in differentiation of an intrahepatic vs extrahepatic cause of jaundice?


serum bilirubin


You are scanning at the area of the porta hepatis in a pt w/ alcoholic liver cirrhosis. 2 large tubular structures are identified. How can you identify which structure is the duct and which is the hepatic artery?


Doppler signals can be elicited from the artery but not the bile duct


A pt presents for abd u/s with a hx of jaundice,wt loss, & nausea. You detect dilatation of the cbd at the level of the porta hepatis but are unable to see the distal cbd due to overlying bowel gas. What position would be most helpful in improving visualization of the cbd?


roll the pt into a rt posterior oblique position or rt decubitus position


The most common anatomic variant of the gb is:


gb folds


What is the most accurate test for acute choleycystitis?


cholescintigraphy


You are scanning a pt w a porcelain gb. You must carefully evaluate the gb because these pts are at increased risk for:


GB carcinoma


A pt is referred for a gb u/s w a hx of RUQ pain & nausea. You suspect the presence of a stone in the region of the gb neck, but are not sure. What would be helpful in confirming the presence of a stone?


Roll the pt into a left lateral decubitus position


You have been asked to administer cholecystokin to a pt. What do you expect to happen if the study is normal?


The GB will contract


You are attempting to locate the common hepatic duct at the porta hepatis. What is the most common anatomic relationship of the portal triad at this location?


The common duct is anterior to the hepatic artery & portal vein


A pt is referred for u/s with jaundice,pain,nausea, and vomiting and a hx of cholecystectomy. What is the most likely finding?


choledocholithiasis


You have detected a stone impacted in the distal cbd in a pt with jaundice and abd pain. You will tailor your exam to evaluate what complication of this condition?


Pancreatitis


You are requested to perform an u/s evaluation of the GB and biliary tree on an elderly, small-framed female.  Which of the listed transducers is most suited to this task?
a) 2.5mhz phased array
b) 5.0mhz curved linear array
c) 3.5mhz linear array
d)10mhz curved linear array
e)13mhz linear array



b) 5.0mhz curved linear array


A pt is referred for an abd u/s. You notice a yellow discoloration of the eyes and skin. This condition is called:


Jaundice


You are asked to perform an u/s study on a pt with suspected cholangiocarcinoma. What associated findings should you look for?


Dilatation of the biliary tree


You are scanning a pt in the E.R. with severe nausea & abd pain. When you press with the transducer over the gb, the pt has increased pain. What did you do?


Elicited a sonographic Murphy's sign


You are scanning a pt with sickle cell anemia and note the presence of gallstones & gb wall thickening. What else should you do to determine if acute cholecystitis is present?


1) Press with the u/s probe over the gb to determine if it is painful
2) Look to see if a gallstone is  lodged in the gb neck
3) check for the presence of pericholeycystic fluid



What is the purpose of obtaining images in the lt lateral decubitus position during ultrasonography of the gb?


evaluate mobility of gallstones


You are scanning a pt with symptons of cholelithiasis. Although you cannot clearly identify a gb, you detect bright band of echoes w/ posterior shadowing in the RUQ. How can you determine if this represents a contracted gb filled with stones?


1)connection of the shadowing echoes to the interlobar fissure confirms identification of the gb

2)the wall-echo shadow(WES) sign confirms identification of the gb

3)dirty shadowing from bowel gas can be differentiated from "clean" shadowing from stones by the presence of ringdown artifact in the bowel gas shadow



A tumor that may be located in an intrahepatic or extrahepatic bile duct is known as:


cholangiosarcoma


Ultrasound images you obtained on an 81y/o man with acute ruq pain show gallstones & bright echoes in the gb wall w/ ringdown artifacts. This most likely represents what?


emphysematous gb


You are attempting to image the head of the pancreas in a pt referred for abd sonography. how should you align the probe on the body to obtain a a long-axis veiw of the head & body of the pancreas?


Obtain a midline transverse scan plane with the lt side of the probe slightly caudad compared to th rt side of the probe


Your dept protocol requires you to measure the main pancreatic duct whenever it is visible by u/s. What is the name of the duct you are measuring?


Duct of Wirsung


The accessory pancreatic duct, which is sometimes visible sonographically, is known as:


Duct of Santorini


What is the anatomic relationship of the cbd to the pancreas?


the cbd is posterior to the head of the pancreas


You are reviewing a CT report on a pt referred for abd sonography. The report states that pancreatic divisum is present. What does this mean? 


the two pancreatic ducts have not fused


What structure can you use to identify the anterior aspect of the head of the pancreas?


Gastroduodenal artery


What structure can be used to identify the posterior aspect of the head of the pancreas?


common bile duct


What structure can be seen coursing transversely at the level of the upper pancreatic head?


Lt renal vein


A thin pt has been referred for u/s evaluation of the pancreas. Which of the following transducers would be best for this exam?
a) 2.25mhz phased linear array
b) 3.5mhz curved linear array
c) 5.0mhz curved linear array
d) 7.5mhz small footprint phased 
    array
e) 12mhz linear array



c) 5.0mhz curved linear array


You are performing an u/s exam on a pt with a history of repeated bouts of pancreatitis. What would you most likely use color doppler for in this study?


Improve detectibility of possible pseudoaneurysms


During insonation of the pancreas, you notice a prominent vessel just posterior to the pancreatic neck. What vessel are you imaging?


Portal-splenic confluence


You are having difficulty imaging the entire pancreas in a pt referred for abd u/s. Which part of the pancreas is least commonly visualized by u/s?


Tail


What frequency transducer would most commonly be used for endoscopic u/s of the pancreas?

a) 2.25MHZ
b) 3.5 MHZ
c) 5.0 MHZ
d) 10.0MHZ
e) 25MHZ



d) 10MHZ


You are performing an u/s exam to r/o the presence of a pancreatic tumor. What is the most commonly occurring malignant tumor of the pancreas?


Adenocarcinoma


Which of the following is a risk factor for the development of pancreatic cancer?

a) smoking
b) high fat diet
c) diabetes
d) chronic pancreatitis
e) all the above



All the above


You are scanning a 52y/0 male with a hx of alcohol abuse. U/s findings include a hyperechoic mass in the head of the pancreas, dilatation of the pancreatic and cbd, and diffuse calcification within the pancreas. What condition is most likely present?


Chronic pancreatitis


You have a pt who is scheduled for pancreatic surgery following u/s and CT evaluation. What is the surgical procedure of choice for pancreatic cancer?


Whipple procedure


You have been asked to aid in staging of pancreatic cancer.  What procedure is most accurate in staging pancreatic adenocarcinoma?


CT


A pt has been referred to u/s to r/o the presence of pancreatic cancer. The cancer is most likely to be located in which part of the pancreas?


Head


What is the most common u/s appearance of pancreatic adenocarcinoma?


Hypoechoic mass


Which of the following is an endocrine tumor?

a) Adenocarcinoma
b)Islet cell tumor
c) cyst adenocarcinoma
d) lymphangioma
e) pancreaticoblastoma



Islet cell tumor


You are requested to perform an abdominal u/s on a pt to evauate for complications of pancreatitis. What should you look for?


pseudoaneurysm
pseudocyst
phlegmon
abscess



What lab values would be of greatest benefit to you in evaluation of a pt with acute pancreatitis?


Serum amylase


You have just discovered a pancreatic mass suspicious for adenocarcinoma in a pt with wt loss & abdominal pain. What associated findings should you look for?


lymphadenopathy & liver metastasis


You are scanning a pt with increased pancreatic enzymes & white blood cell count. What condition is most commonly associated with these lab findings?


acute pancreatitis


You are scanning a pt with a hx of alcohol abuse and liver cirrhosis. The pancreatic tissue is heterogenous. Calcifications and dilatation of the pancreatic duct is present. What condition is most likely considering this hx and findings?


chronic pancreatitis


You have been asked to perform an u/s on a pt with a pancreatic transplant. What chronic condition does this pt likely have?


Type 1 diabetes mellitus


Where should you look for the pancreas in a pt with a pancreatic transplant?


Iliac fossa


Which of the following would be an indicator of pancreatic transplant rejection:

a)high-resistance doppler signals
b) low-resistance doppler signals
c) heterogenous parenchyma



High-resistance doppler signals &
heterogenous parenchyma



A non-encapsulated collection of necrotic & edematous peripancreatic tissues is termed?


Phlegmon


What is the most common cause of acute pancreatitis?


Obstruction of  the pancreatic duct by biliary caculi


Surgery has requested u/s guidance to excise an insulinoma.Which transducer would be best for this application?

a) 2.25mhz curved array
B 3.5mhz curved array
c) 5.0mhz curved array
d) 7.0mhz curved array
e) 10mhz linear array



10mhz linear array


You have documented the presence of a pseudocyst adjacent to the pancreatic head in a 56y male. Pseudocysts may be associated with which of the following?


Acute pancreatits
Chronic pancreatitis
Pancreatic cancer



What is the relationship of the superior mesentric artery (sma) to the pancreas?


posterior to the neck


You have been asked to r/o pseudocyst formation in a pt with acute pancreatitis. What is the u/s appearance of a pancreatic pseudocyst?


1) Cyst w/0 internal echoes

2) Cyst with low level echoes

3) Cyst with internal septations

4) Well-defined wall 



You are performing an u/s on an obese pt and notice a small hypoechoic tumor located int tail of the pancreas.  This most likely represents:


insulinoma


Which part of the pancreas does the duodenum encircle?


head


What is the relationship of the splenic vein to the pancreas?


posterior and caudal


Which vessel is located at the superior border of the pancreas?


celiac trunk


When imaging the pancreas, which vessel do you routinely visualize at a the posterior border of the pancreatic head?


Inferior Vena Cava (IVC)


During insonation of the pancreas, you routinely image a vessel coursing anterior to the uncinate process. What is this vessel?


Superior messenteric vein


You have obtained a sagittal image of the pancreatic head & detect a small tubular structure coursing cephalocaudad anterior to the pancreas. What is this structure?


gastroduodenal artery


Which part of the pancreas generally has the largest dimensions?


Head


Part of your routine protocol for pancreatic imaging is to comment on the echogenicity of the organ. What is the normal echogenicity of the nml pancreas?


Either isoechoic or hyperechoic compared to the liver


The tail of the pancreas is in contact with what structures?


Spleen
Lt Kidney
Splenic flexure of the colon



You are scanning a pt and notice that the rt & lt kidneys are attached at their lower poles. What anomaly is present?


Horseshoe kidney


During a routine renal u/s, you are suspicious of increased echogenicity of the kidneys. Describe the normal echogenicity of the renal cortex?


the normal kidney echogenicity is frequently isoechoic to the liver & spleen


Which of the following renal masses would most likely cause a speed propagation artifact?

a) angiomyolipoma

b) renal cell carcinoma

c) renal pseudoaneurysm

d) transitional cell carcinoma

e) adenoma



angiomyolipoma


You are performing a sonogram on a pt with bilaterally small kidneys. What is the normal range in size of the kidneys?


9 - 14cm


During a renal sonogram, you notice a 1.5cm thickening of the lt lateral renal cortex. This most likely represents:


Dromedary hump


You have detected compensatory hypertrophy of the rt kidney in 35y/o male. This finding is associated with which of the following?
a) Nephrectomy
b) Renal agenesis
c) Renal hypoplasia
d) Renal atrophy
e) all the above



all the above


True or False

The tail of the pancreas is in contact with the dorsal aspect of the lt kidney.



False


True or False

The superomedial aspect of the rt kidney is in contact with the adrenal gland.



True


True or False

The rt kidney is located slightly inferior compared to lt kidney.



True


True or false

The superior pole of each kidney is slightly medial compared to the lower pole. 



True


True or false

The kidneys are retoperitoneal in location.



True


What is the normal appearance of the central sinus of the kidney?


Highly echogenic compared to the cortex


You are performing an u/s on a pt with suspected renal failure. What labwork is elevated with renal failure?


Serum creatinine


A pt is referred from x-ray with a questionable lt renal cyst. What are the sonographic criteria of a simple cyst?


Anechoic, acoustic enhancement,  sharply defined smooth far wall, round or ovoid shape


You are performing a renal u/s and identify hydronephrosis in th rt kidney.  Which of the listed conditions is NOT a potential cause of hydronephrosis?

a) ureteral stone
b) Large uterine fibroid
c)  Ureteropelvic junction   
     obstruction
d) Acute pyelonephritis
e) Ovarian mass



Acute pyelonephritis


A questionable mass is seen between the renal pyramids on the rt kidney.  You suspect this is a Column of Bertin "pseudomass". Which of the following sonograhic  features helps distinguish this from a true pathologic mass?
a) Isoechogenicity with the rest
    of the renal cortex
b) Continuity with the renal
     cortex
c) lack of mass effect or splaying
    of central renal sinus fat
d) Normal vascularity by color
     doppler
e) All the above



All the Above


You have been asked to perform an u/s evaluation on a child with multicystic dyplastic kidney(MCDK). Which of the following is NOT a sign of this condition?
a) multiple variably sized cysts
b) nomedial location of the 
     largest cyst
c) dilated ureter
d) no identifiable renal sinus
e) brightly echogenic tissue
     interfaces between cysts 



c) dilated ureter


You are performing an u/s exam on a pt with crossed renal ectopia. Describe your findings:



Both kidneys are on the same side of the abdomen


Which malignant tumor is most common in children aged 2-5?


Wilm's tumor


What part of the kidney contains fat,calyces,infundibuli of the collecting system, and vessels?


sinus


During routine surveilance of the urinary bladder, you detect the presence of periodic ureteral "jets". This is a sign of:


normality


What preparation should you require of your pts scheduled for renal sonograms?


moderate hydration with no other specific preparation


You are scanning a 31y/o pt with hypertension and impaired renal function. You detect enlarged kidneys with cysts that are too numerous to count. What condition is most likely?


Polycystic kidney disease


You have detected a solid mass in the rt kidney of a 47y/o male. You should taylor your exam to evaluate which of the following?

a) extension of the tumor into the
    renal vein
b) search for liver metastasis
c) search for retroperitoneal
     adenopathy
d) A & B only
e) all the above



all the above


An u/s exam reveals a solid, hyperechoic mass in a 46y/o pt with tuberous sclerosis. This most likely represents:

a) Renal cell carcinoma
b) Wilm's Tumor
c) Renal Harmartoma
d) Angiomyolipoma
e) Renal lymphoma



Angiomyolipoma


You are performing an ultrasound on a pt with known horseshoe kidneys.  Where is the isthmus of a horseshoe kidney located?


Anterior to the abdominal aorta


What is the ultrasound appearance of ureteropelvic junction obstruction?


Pelviectasis to the level of the junction of the renal pelvis & ureter


A pt has been referred to your dept with a history of pyelonephritis. What is the most common ultrasound appearance of this condition?


Normal appearance


A renal mass that is highly echogenic due to its high-fat content is:


angiomyolipoma


A pt has been referred to your lab for a doppler study of the kidneys. What type of wave form do you expect to see in the normal main renal artery? 


low resistance with forward flow throughout the cardiac cycle


You are scanning a pt with a known bladder outlet obstruction and note thickening of the urinary bladder wall. What is the most likely eitiology of the wall thickening?


muscular hypertrophy


A pt with a history of chronic medical renal disease has been referred for an abdominal u/s. What renal appearance would you expect to see?


small hyperechoic kidneys


A pt has been referred from CT with a history of nephrocalcinosis. What is the u/s appearance of this condition?


highly echogenic renal pyramids w or without posterior acoustic shadowing


You suspect hydronephrosis in a 42y/o female who complains of vague abdominal discomfort. Which of the following is a cause of false positive determination of hydronephrosis: a) overdistention of the urinary bladder b) parapelvic cysts c) prominent hilar vessels d) large extrarenal pelvis e) all the above      


all the above


During a routine abdomen & pelvic u/s, you detect a small round,cystic structure projecting into the urinary bladder. This most likely represents:


ureterocele


You are scanning a 69y/o m with hematuria. Your u/s findings include rt sided hydronephrosis and a mass within the urinary. What tumor most commonly occurs within the urinary bladder?


Transitional cell carcinoma


During u/s evaluation of a 2w/o
renal transplnt, you detect a fluid collection with septations and internal debris adjacent to that  the kidney. This most likely represents? 



lymphocele


Which intrarenal arteries course alongside the  renal pyramids? 


interlobar


Describe the normal course of the left renal vein.


Between the superior mesenteric artery(sma) & the aorta


Describe the normal course oth rt renal artery.


Posterior to the IVC


You are scanning a pt with a history of renal infections. You suspect thinning of the renal cortex. What is the normal diameter of the renal cortex?


>10mm


Ultrasound imaging reveals lt-sided hydronephrosis in a 38y/o woman with vague abdominal pain.You should tailor your exam to rule out which of the following?
a) ureteral calculi
b) pelvic mass
c) aortic aneurysm
d) all the above



all the above


What is the purpose of scanning the bladder to identify ureteral "jets"?


To determine if a ureter is obstructed


You are scanning a pt with suspected lymphoma of the kidney. What u/s appearance is associated with renal lymphoma?


Multiple,bilateral, hypoechoic masses in enlarged kidneys


What arteries course on top of the renal pyramids and give rise to the tiny intralobular arteries? 


Arcuate


You detect a discrete echogenic focus without shadowing in the lt kidney & suspect the presence of a renal calculus. Which of the following is most helpful in improving visualization of posterior acoustic shadowing?

a) higher frequency transducer
b) lower frequency transducer
c) smaller aperture transducer
d) increased frame rate
e) increased dynamic range



Higher frequency transducer


You detect the presence of free fluid in the space between the liver and rt kidney. what is the name for this anatomic location?


Morrison's pouch


What is the indication for a doppler renal study to r/o renal artery stenosis?


Uncontrolled hypertension


You are performing a doppler evaluation to r/o renal artery stenosis. You will compute a ratio comparing the velocity in the renal artery to what vessel?


Abdominal aorta


You are performing a followup u/s on a pt with a large lt renal cyst. Which of the following most accurately describes the prevalence of renal cysts?
a) <1% people over age 50
b) 15% of people over age 50
c) 30% of people over age 50
d) 50% of people over age 50
e) 100% of people over age 50



50% of people over age 50


You are scanning a pt with autosomal dominant polycystic kidney disease. Which of the following statements is NOT true regarding this disease?
a) liver cysts may be present in up
    to 30% of pts
b) high blood pressure is common
c) cysts may be complicated by
     bleeding or infection
d) frequently only 1 kidney is
     involved
e) progressive renal failure is 
     common 



d) frequently only 1 kidney is 
     involved



Which of the following is usually diagnosed in early childhood or in utero?

a) autosomal dominant polycystic 
     kidney disease
b) multicystic dyplastic kidney
c) acquired cystic kidney disease
d) parapelvic cysts
e) A and B



b) multicystic dyplastic kidney


Doppler analysis of intrarenal waveforms performed during renal sonography reveal a resistive index of 1.0. This finding is consistent with:
a) normality
b) chronic medical renal disease
c) renal vein thrombosis
d) renal obstruction
e) B, C, and D



e) chronic medical renal disease
     renal vein thrombosis
     renal obstruction



During performance of a renal sonogram, you identify only 1 kidney. What should you do? 


scan in the pelvic area to r/o the presence of a pelvic kidney


What is the most helpful way to delineate ureteral jets?


Examine the urinary bladder with doppler


You are scanning a pt post biopsy and discover a cystic mass in the kidney. What should you do?


Evaluate the cyst with color doppler


Which of the following results from an ascending urinary tract infection?

a) horseshoe kidney
b) acute tubular necrosis
c) glomerulonephritis
d) pyelonephritis
e) nephrocalcinosis



pyelonephritis


You are having difficulty identifying renal arteries in a pt referred for questionable renal artery stenosis. Which vessel listed below is most helpful as a landmark for the location of the renal arteries?
a) Celiac trunk
b) Superior Mesenteric artery
c) Splenic vein
d) Inferior mesenteric artery
e) Common Hepatic artery



Superior mesenteric Artery


You are scanning a pt with rt flank pain and known polycystic kidney disease. You suspect the presence of hemorrhage within one of the renal  cysts. What is the sonographic appearance of this finding?


Low level echoes within the cyst


A pt has been referred to your lab for evaluation of a new renal transplant. Where should you look?


Right lower quadrant


U/S findings in a pt with hypertension include a lt kidney measuring 6.8cm and a rt kidney measuring 11.7cm. Which of the following is most consistent with these findings?
a) acute pyelonephritis in the lt
    kidney
b) acute glomerulonephritis in the
    rt kidney
c) Occlusion of the lt main renal
     artery
d)  Amyloidosis of the rt kidney
e) none of the above



Occlusion of the lt main renal artery


What doppler parameter should you measure to look for rejection in a renal transplant?


Resistivity index


You detect irregular thickening of the bladder wall in a 53y/o male with hydronephrosis and a dilated ureter. Which of the following would you suspect?
a) renal cell carcinoma
b) ureterocele
c) bladder outlet obstruction
d) transitional cell carcinoma
e) endometriosis



Transitional cell carcinoma


Which statement below would help you in identification of the rt renal vein?

a) the rt renal vein lies inferior &
    posterior to the renal artery
b) the rt renal vein course
     underneath the IVC
c) the rt renal vein courses
    anterior to the abd aorta
d) the rt renal vein divides into a
     circumaortic ring before
     draining into the IVC
e) the rt renal vein lies anterior to
     the renal artery



e) rt renal artery lies anterior to the renal artery


You have been asked to identify the "ureteral jets". Where are the
ureteral orifices in the urinary bladder?



base of the trigone along the posterior aspect


A pt has been referred for doppler interrogation of the kidney. Which view provides the best color doppler evaluation of the intrarenal vasculature?
a) pt supine, anterior view 
    through liver
b) pt supine, coronal view
     through liver
c) pt prone, oblique view through
     back musculature
d) pt in posterior oblique position,
     coronal view through posterior
     axillary line
e) pt upright, anterior view
    through liver



d) pt in posterior oblique postion,
     coronal view through posterior
     axillary line



During color doppler evaluation of the kidney, you observe inadequate fill of the intrarenal
vasculature. Which doppler parameter will you adjust to improve sensitivity to flow?
a) decrease pulse repetition
     frequency
b) increase wall filter
c)  decrease packet size
d) decrease color gain
e) decrease color resolution
     setting



a) decrease pulse repetition
     frequency



You are scanning the urinary bladder and notice multiple artifactual bands in the near field at the anterior bladder wall. What is the source of these echoes?


reverberation artifact


You have been asked to evaluate an atypical  renal cyst seen on CT. What feature below is indicative of an atypical cyst?
a) internal septations
b) Wall calcification
c) internal echoes
d) irregular walls
e) all the above



all the above


What is the accepted treatment for a simple renal cyst?


no further evaluation is needed


You are performing an u/s exam on a pt who has been on dialysis for 4yrs. Which of the following describes the typical appearance of the kidney in these cases?

a) bilateral renal enlargement with
     increased echogenicity
b) bilaterally small, echoenic
     kidneys with multiple cysts of
    varying sizes
c) bilaterl small,hypoechoic
    kidneys with increased
    corticomedullary distinction
d) normal appearing kidneys
     bilaterally
e) all the above sonographic
     appearances are common in 
     this senario



b) bilaterally small, echogenic kidneys with multiple cysts of
varying sizes



A pt is referrred for u/s evaluation to r/o the presence of renal malignancy. What is the most common solid renal mass in the adult?


renal cell carcinoma


You are performing a f/u study on a pt diagnosed with emphysematous pyelonephritis.
Which of the following best describes the sonographic appearance of this condition?

a) multiple echogenic foci within
   the renal sinus or parenchyma 
   with "dirty" posterior acoustic
   shadows
b) multiple distinct hyperechoic
     foci with discreet, well-defined
    posterior acoustic shadows
c) Multiple indistinct, hazy foci
    within the renal sinus w
    posterior acoustic enhancement
d) large area of posterior acoustic
    shadowing which is not
    associated with any defined
     echoes
e) focal, wedge-shaped 
     hypoechoic masses with
     posterior acoustic
     enhancement throughout the
     kidney



multiple echogenic foci within
the renal sinus or parechyma with
"dirty" posterior acoustic shadows



Which of the following is NOT a part of the urinary tract?

a) kidneys
b) ureters
c) uterus
d) urinary bladder
e) urethra



uterus


What is the normal waveform of the main renal artery?


low resistance


The renal arteries arise from the aorta closest to the origin of which artery?


Superior mesenteric artery


The lt renal artery is normally located immediately posterior to which of the following?

a) lt renal vein
b) portal vein
c) Common hepatic artery
d) splenic artery
e) none of the above



lt renal vein


Which of the following renal tumors is more common?

a) transitional cell carcinoma
b) renal cell carcinoma
c) Oncocytoma
d) primary renal lymphoma
e) Angiomyolipoma



renal cell carcinoma


A pt has been referred to the u/s dept with a history of medullary
nephrocalcinosis. What do you expect to see?



Calcified pyramids


A pt has been referred for u/s
evaluation of the lt kidney following an automobile accident. What is the sonographic appearance of a subcapsuler hematoma?



perirenal fluid collection that flattens the underlying renal contour


What is the most common cause of acute renal failure?


Acute tubular necrosis(ATN)


You are performing a follow-up study on a pt with a renal transplant. Which of the folowing changes normally occurs in renal transplants compared to the immediate postoperatrive study?
a) hypertrophy 
b) increased echogenicity
c) hydronephrosis
d) shrinkage
e) calcified pyramids



hypertrophy



You are performing a Doppler study of a renal transplant to r/o stenosis of the renal artery. The renal artery is usually anastomosed to which artery?


external illiac artery


The mediastinum testis is identified sonographically as:


Prominent echogenic linear echo in the midline of the testis


Which of the following conditions would show hyperemic flow on color doppler?
a)testicular torsion
b) spermatocele
c) orchitis
d) hydrocele
e) infarction



orchitis


A large complex hydrocele is most commonly associated with which of the following?
a) seminoma
b) epididymal cyst
c) varicocele
d) orchitis
e) infarction



orchitis


The most common germ cell testicular tumor is:


seminomas


You are performing an u/s of a pt with a known "bell clapper" deformity. This deformity is associated with which condition?


torsion


The capsular artery of the testis is a branch of what artery?


testicular


The testicular artery is a branch of what artery?


Abdominal aorta


You are performing a doppler evaluation of the testis. Describe the waveform you will see within an artery of the testicular parenchyma if the artery is normal.


low resistance


You are performing doppler analysis of the spermatic cord. Which of the following arteries or structures is found within the spermatic cord?
a) vas deferens
b) testicular artery
c) cremasteric artery
d) deferential artery
e) all the above



all the above


The intratesticular arteries that arise from the capsular artery are known as:
a) deferential arteries
b) cremasteric arteries
c) vas deferens
d) centripetal arteries
e) pampiniform plexus



centripetal arteries


The left testicular vein drains into what?


Lt renal vein


You are performing an u/s exam on an adolescent male to rule out testicular torsion. How should you adjust the system color doppler parameters to achieve the greatest sensitivity to slow flow?


low PRF, low filter,high gain, high packet size


You are performing an u/s study on a 27y/o male with scrotal pain to r/o epididymo-orchitis vs torsion. Which finding below is most consistent with epidymitis?
a) absence of flow by color
   doppler
b) increased flow by color
     doppler
c) small cyst in the epididymal
    head
d) small calcification in the
    epididymal head
e) multiple tiny calcifications
    throughout the testis



Increased color flow by doppler


A 33y/o m has been referred for a scrotal u/s as part of an infertility workup. You will taylor your exam to include an evaluation for which of the following ?
a) epididymal cyst
b) torsion of the appendix testis
c) varicocele
d) testicular artery aneurysm
e) testicular cyst



varicocele


You have identified a hydrocele during a scrotal u/s. Hydroceles form in what potential space?


between two layers of the tunica vaginalis


The rete teste is located in the ?


mediastinum teste


Which of the following arteries shows a low-resistance waveform?
a) testicular artery
b) deferential artery
c) cremasteric artery
d) external iliac artery
e) all the above



testicular artery


Which of the following arteries courses within the testicular parenchyma?
a) testicular artery
b) deferential artery
c) cremasteric artery
d) centripetal artery
e) all the above



centripetal artery


You detect a mass within the left testis on a 43y/o male. Which of the following is a sign indicative of  malignancy?
a) irregular shape of testis
b) intratesticular location of mass
c) presence of a large hydrocele
d) all the above
e) A & B only



A & B only


In performing scrotal sonography, you should taylor your exam to include color Doppler analysis in which of the following conditions?

a) epididymitis
b) torsion
c) testicular microlithiasis
d) A & B only
e) all the above



A & B only
(epididymitis & torsion)



You have detected an intratesticular mass on a pt with mild scrotal swelling. Which of the following is an u/s feature of seminoma should you look for?
a) hyperechoic intratesticular lesions
b) ill-defined tumor borders
c) large hydrocele
d) all the above
e) none of the above



none of the above


The most common germ cell tumor of the testis is:


seminoma


You are imaging a pt presenting with trauma, pain, and scrotal swelling. You detect a large hydrocele with prominent internal echoes. This most likely represents:
a)pyocele
b) simple hydrocele
c) varicocele
d) hematocele
e) hernia



hematocele


You have detected a transtesticular artery during scrotal sonography. Which of the following is TRUE regarding this finding?
a) it is a common anatomic variant
b) it courses in the opposite direction of the centripetal arteries
c) it enters the testicular parenchyma at the mediastinum testis
d) a large vein frequently accompanies it
e) all the above



all the above


You are performing a scrotal u/s on a 38y/o male with acute scrotal pain to r/o orchitis. Which listed finding is NOT associated with orchitis?
a) hypoechoic testis
b) hyperemic testicular flow
c) enlargement of testis
d) thickened scrotal wall
e) microlithiasis



microlithiasis


You are performing a scrotal u/s on a 21y/o male with acute scrotal pain. You do not detect flow with color doppler in the painful testis. This finding is most consistent with? 


torsion


Which structure would you image posterior to the prostate gland?

a) urinary bladder
b) pubic bones
c) levator ani muscles
d) rectum
e) urethra



rectum


You are performing a prostate u/s to evaluate a pt with known prostate cancer. Which anatomic zone is most likely involved with the cancer?

a) peripheral zone
b) central zone
c) transitional zone
d) periurethral glandular area
e) prostate cancer occurs equally
     between the peripheral zone
     and the central zone



peripheral zone


You are imaging a pt with suspected benign prostatic hypertrophy (BPH). Which zone is most commonly involved?


transition zone


You have been asked to identify the seminal vessels. What is their anatomic location to the prostate gland?


posterior and superior


Which of the following describes the most common pt positioning for performance of a transrectal prostate ultrasound?

a) supine
b) lt lateral decubitus
c) rt oblique
d) supine in a reversed trendelenburg position
e) standing



lt lateral decubitus


What lab test is most helpful in screening pts for prostate cancer?


PSA (prostate specific antigen)


A pt has been referred for transrectal sonography due to symptoms of prostatism. What are the most common pt symptoms of prostatism?


difficult initiation of voiding, nocturia, and small stream


A referring physician has asked if your dept uses color doppler during transrectal prostate sonography. What is the role of color doppler in this procedure?


color doppler allows improved perception of pathologic vessels associated with cancer


What is the sonographic appearance of prostate cancer?

a) hypoechoic lesions
b) isoechoic lesions
c) hyperechoic lesions
d) only A & B
e) all the above



all the above


You are aiding a physician in a transrectal biopsy of the prostate. What pt preparation is required?


a cleansing enema is performed immediately prior to the procedure

antibiotics are administered prior to and following the procedure



Which anatomic classification is most commonly used to describe the prostate during sonographic evalution?


zonal anatomy


The prostaticovesical arteries that supply the prostate are branches from which artery?


Internal iliac


Which of the following describes the most widely used conventional display of the prostate using transrectal sonography?

a) the anterior abd wall is shown
    at the bottom of the screen
b) the rectum is shown at the
     bottom of the screen
c) the rectum is shown to the rt of the screen in a sagittal view
d) the lt side of the pt is shown 
    on the lt side  of the image in 
    a transverse plane
e) head of the pt is on the rt side
     of the image in a saggital plane
 



the rectum is shown at the bottom of the screen


You are performing a transrectal prostate u/s in a saggital plane. The most lateral images of the gland show which tissue?


peripheral zone


You have been asked to perform a transrectal prostate u/s exam. What frequency transducer is best suited for this study?


7 - 8 MHz


Which of the following describes the most common appearance of the seminal vesicles by transrectal prostate sonography?

a) hyperechoic, symmetrical, irregularly shaped structures
b) hyoechoic, symmetrical, irregularly shaped structures
c) hyperechoic, asymmetrical, smooth structures
d) hyperechoic, asymmetrical, irregularly shaped structures
e) hypoechoic, asymmetrical, smooth structures



hypoechoic, symmetrical, irregularly shaped structures


You have been requested to perform a transrectal prostate u/s in a pt with suspected benign prostatic hyperplaysia (BHP). What is the u/s appearance of this condition?


enlarged prostate gland which may be diffuse or focal


You are performing a prostate u/s in a pt having an infertility work-up. Which of the listed cysts may be associated with infertility?

a) mullerian duct cysts
b) prostatic utricle cysts
c) retention cysts
d) ejaculatory duct cysts
e) seminal vesicle cysts



ejaculatory duct cysts


You are performing a transrectal u/s in a pt with acute prostatitis. An anechoic mass is seen within the prostate. This most likely represents:
a) prostate utricle cyst
b) abscess
c) hematoma
d) lymphocele
e) seroma



abscess


You have been asked to perform a transrectal u/s of the prostate in a pt with metastasis of unknown origin. What are you looking for?

a) BPH
b) ejaculatory duct cyst
c) prostatic abscess
d) prostate cancer
e) prostatitis 



prostate cancer


You are performing an abdominal u/s and have difficuly identifying the spleen. What structure is in contact with the spleen?
a) lt hemidiaphragm
b) stomach
c) pancreas
d) splenic flexure of the colon
e) all the above



all the above


You are examining the spleen during routine sonography. What view provides the best long axis image of the spleen?


intercostal veiw with the pt supine


You are scanning a pt with moderate splenomegaly. Which of the following is a cause of mild to moderate splenomegaly?

a) portal hypertension
b) infection
c) AIDS
d) Lymphoma
e) A,B, & C only



Portal hypertension, infection, AIDS


During routine sonographic evaluation of the spleen, you detect a small, rounded mass at the splenic hilum that is homogenous & isoechoic with the spleen. You have most likely detected:


accessory spleen


You are imaging the spleen of a 27y/o male with AIDS. What is the most common finding in the spleen in pts with AIDS?


moderate splenomegaly


You are performing abd u/s scan and detect a hypoechoic, wedge -shaped lesion within the spleen.  This is the typical appearance of which of the following entities?

a) splenic hemangioma
b) splenic infarction
c) splenic metastasis
d) granulomatous disease of the
      spleen
e) splenic abscess



Splenic infarction


You detect a wedge-shaped hypoechoic lesion within the spleen. Which of the following would increase diagnostic confidence the most?


evaluate the lesion with color doppler


During splenic sonography you detect moderate splenomegaly and dilated , tortuous vessels at the hilum. What condition do you suspect?


portal hypertension


You have detected moderate splenomegaly and dilated, tortous vessels at the splenic hilum. In light of these findings, you should also:


Evaluate the liver and portal vein


Which structure will you detect at the splenic hilum?

a) diaphragm
b) splenic vein
c)  left kidney
d) doudenum
e) lt lobe of the liver



splenic vein


You have been asked to evaluate the tail of the pancreas. What is the relationship of the pancreatic tail to the spleen?


inferomedial


What term can be used to describe the normal sonographic appearance of the splenic parenchyma?


homogenous with mid-low level echogenicity


An average sized male pt has been referred for u/s evaluation of splenomegaly. What transducer would provide the highest resolution images of the spleen?

a) 2.25MHz linear array
b) 3.5MHz phased array
c) 5.0MHz curved linear array
d) 3.5MHz curved linear array
e) 2.25MHz phased array



5.0MHz curved linear array


Which of the following statements is NOT true regarding the spleen?

a) the spleen is located in the LUQ
b) the spleen is a retroperitoneal
     structure
c) the spleen lies between the
     fundus of the stomach and the
     diaphragm
d) the average adult spleen
     measures 12cm in length
e) the normal spleen decreases in
    size and weight with advancing
    age



The spleen is a retroperitoneal structure( it's actually located intraperitoneally)


Which of the following is a pitfall you might encounter in u/s when scanning the spleen?

a) intercostal scanning may produce rib shadows obscuring the splenic parenchyma
b) in hepatomegaly, the lt lobe of the liver may be mistaken for the spleen
c) a mass in the tail of the pancreas may be confused with a splenic mass
d) an accessory spleen may be confused with an  enlarged lymph
 node
e) all the above



all the above


You are performing an abd u/s on a pt with histoplasmosis. What findings of the spleen are commonly seen with this condition?


multiple, focal, bright echogenic granulomatous lesions throughout the spleen


The splenic vein drains into what vein?


portal vein


You are performing an u/s on a pt with a history of recent blunt lt sided trauma in a motor vehicle accident. Which finding is NOT associated with this history?

a) splenic laceration
b) subcapsular hematoma of the spleen
c) free fluid
d) perisplenic hematoma
e) calcified splenic cyst



calcified splenic cyst


You are performing an u/s study on a pt with malignant melanoma. Your findings reveal multiple hyperechoic masses within the spleen. This most likely represents: 


metastasis


During abd sonography of a pt with portal hypertension and splenomegaly , you detect a calcified ring at the splenic hilum. What should you do?


evaluate the area with color doppler


Which of the following is NOT a feature you would detect in a splenic cyst?

a) smooth border
b) posterior acoustic enhancement
c) anechoic
d) increased attenuation
e) rounded shape



increased attenuation


Which of the following structures is NOT retroperitoneal in location?

a) spleen
b) kidney
c) pancreas
d) aorta
e) psoas muscles



spleen


You are performing an abd u/s and detect a striated,hypoechoic structure immediately posterior to the rt kidney. A similar structure is seen posterior to the lt kidney. What are you imaging?

a) psoas muscle
b) quadratus lumborum muscle
c) adrenal gland
d) diaphragmatic crura
e) gerota's fascia



quadratus lumbrorum muscle


The kidneys lie in what retroperitoneal space?

a) posterior pararenal space
b) perirenal space
c) retrofascial space
d) anterior pararenal space
e) the kidneys are not retroperitoneal in location



perirenal space


During sonographic evaluation of the periaortic area, you detect several hypoechoic structures each measuring slightly greater than 2.0cm, adjacent to the celiac trunk & superior messenteric artery. What is the most likely etiologyof these structures?


para-aortic lymph nodes


A pt has been referred for abd sonography with abd pain and increased serum amylase. You detect a fluid pocket in the lt pararenal space. Given these u/s findings & pt history, what is the most likely etiology of this mass?

a) exophytic renal cyst
b) pancreatic pseudocyst
c) retroperitoneal hemorrhage
d) lymphocele
e) urinoma  



pancreatic pseudocyst


A pt has been referred for u/s evaluation with suspicion of retroperitoneal fibrosis. What structure will you image to identify this abnormality?


abdominal aorta


During a routine abd sonogram,you detect several small lymph nodes adjacent to the abd aorta. Your exam should include which of the following:
a) spetral analysis of each lymph 
     node
b) diameter measurements of each lymph node
c) graded compression of each 
   lymph node
d) evaluation of the pelvis
e) examination with the pt in a 
     prone posistion  



diameter measurements of each
lymph node



You are performing an abd u/s on a pt with a history of pheochromocytoma. Sonographic evaluation of what structure will be most beneficial in identification of this abnormality?


adrenal glands


You are performing an abd sonogram on a pt with a history of lung cancer. what retroperitoneal structure is a common site for metastasis from the lung?

a) pancreas
b) kidneys
c) psoas muscle
d) doudenum
e) adrenal glands



adrenal glands


You are asked to identify the rt adrenal gland. Which of the following correctly describes its location?
a) medial to the IVC
b) superolateral to the upper pole
    of the rt kidney
c) between the IVC & abd aorta
d) posterior to the IVC
e) medial to the crus of the diaphragm



posterior to the IVC


You are performing an abd u/s to search for lymphadenopathy. Where should you look?

a) splenic hilum
b)  porta hepatis
c) renal hilum
d) para-aortic area
e) all of the above



all the above


During ultrasound eval of the kidney, you detect a striated structure located posteromedial in relation to the kidney. What muscle are you imaging?


psoas


Abdominal sonography of a 42y/o male reveals a solid mass located at the upper pole of the kidney. Which of the following would be most helpful in differentiating between a renal & an adrenal mass?

a) scan the pt in both deep inspiration & expiration
b) evaluate the mass with color
     doppler
c) have the pt drink 32oz of h2o
    and rescan
d) give the pt fatty meal and rescan in 20min
e) perform spectral doppler resistive indices from vessels w/i the  mass



scan the pt in both deep inspiration & expiration


You are performing an abd u/s and suspect a lt adrenal mass. Which of the following conditions may simulate an adrenal mass?

a) thickened diaphragmatic crus
b) accessory spleen
c) gastric diverticulum
d) retroperitoneal lymphadenopathy
e) all the above



all the above


You have been asked to identify the lt adrenal gland. Which describes the correct anatomic relationship of this gland?

a)superolateral to the lt kidney
b) anterior to the pancreatic tail
c) lat tothe abd aorta & diaphragmatic crus
d) inferior to quadratus lumborum
     muscle
e) inferior & lateral to the splenic
     hilum



lateral to the abd aorta & diaphragmatic crus


Which describes the anatomic location of the rt diaphragmatic crus?

a) anterior tothe IVC & superior
    to the rt renal artery
b) posterior to the IVC & RK
c) medial to the RK & posterior
    to the abd aorta
d) anterior to the abd aorta and
     inferior to the pancreas
e) lat to the pancreatic head and 
     anterior to the IVC



posterior to the IVC & rt renal artery


What is the most useful criterion for assessment of nodal disease?


only lymph nodes measuring greater than 1.0cm are considered to be abnormal


You are performing an abd u/s on a pt with a palpable mass following kidney transplantation. Your imaging reveals an anechoic mass with multiple septations located lateral to the midline and 2cm below the abdominal wall. Which of the following is most likely?

a) lymphocele
b) varices
c) pancreatic pseudocyst
d) hematoma
e) exophytic renal cyst



Lymphocele


Which retroperitoneal compartment contains no solid organs?

a) anterior pararenal space
b) perirenal space
c) posterior pararenal space
d) retrofascial space
e) C & D



C & D
posterior pararenal space
retrofascial space



Which retroperitoneal compartment contains the psoas & quadratus lumboram muscles?


retrofascial space


You are performing an u/s on a pt with acute pancreatitis to rule the presence of a pseudocyst. Which retoperitoneal compartment is most frequently involved with pseudocyst?


anterior pararenal space


You have been asked to perform an u/s on a pt to r/o a leaking aortic aneurysm. Which retroperitoneal compartment contains the aorta?


Anterior pararenal space


You have been asked to perform an abd u/s on a pt with abnormal blood urea nitrogen(BUN) levels. All other labwork is normal. Considering this history, what is the study area of interest? 


The Kidneys


You have been asked to perform an abd u/s on a pt with abnormal liapase levels. All other lab work is normal. Considering this history, what is the specific area of interest?


pancreas


While performing an abd u/s, you detect multiple hypoechoic nodules surrounding the abd aorta and separating the mesenteric vessels. You are most likely imaging:


Lymphadnopathy


A pt is referred to r/o the presence of portal vein thrombus. You must evaluate the portal vein & other pertinent veins. What vessels form the portal veins?


Superior mesenteric vein & splenic vein


Which 3 structures compose the portal triad?


Hepatic artery, portal vein & bile duct


Which of the following arteries are branches of the celiac trunk?


splenic, lt gastric, & common hepatic


What vessel is anterior to the uncinate process & posterior to the neck of the pancreas?


confluence of the portal and splenic vein


What is the relationship of the lt renal vein to the aorta and SMA?


anterior to the aorta and posterior to the SMA


You are performing a doppler study of the hepatic venous system and cannot obtain a color doppler signal from the main portal vein. What should you do?


Decrease the system pulse repetition frequency (PRF)


True or false

The aorta normally tapers in diameter from its cranial to its caudal extent.



True


True or  False

The aorta divides into the paired internal iliac arteries.



False



True or false

The widest portion of the abd aorta is just proximal to its bifurcation.



False


Which of the following is NOT a direct branch of the abd aorta?

a) celiac trunk
b) Superior Mesenteric Artery
c) External Iliac Artery
d) Inferior Mesenteric Artery
e) Renal Artery



external iliac artery


A 57y/o woman has been referred for an abd u/s with a history of an abd bruit. What pathology are you searching for?

a)choleycystitis
b) para-aortic lymphadnopathy
c) retroperitoneal fibrosis
d) vascular compromise involving
    the aorta or its branches
e) varices 



Vascular compromise involving the aorta or its branches


You are performing a doppler study on a pt with median arcuate ligament syndrome. What vessel are you studying? 


celiac trunk


A 54y/o man has been referred for an abd doppler u/s with a history of  uncontrollable high blood pressure. What pathology are you searching for? 


Renal artery stenosis


You are performing a doppler study of the mesenteric arteries in a fasting pt. Which of the following describes the waveform you expect to see in a normal study?

a) low resistance
b) retrograde
c) continuous
d) high resistance
e) monophasic 



High resistance


While performing a doppler evaluation of the abd vessels, you detect a stenosis in the rt renal artery. Which of the following is NOT asign of stenosis with spectral analysis?

a) spetral broadening distal to the stenosis
b) increased peak systolic velocity
    at the stenosis
c) increased peak diastolic velocity
    proximal to the stenosis
d) increased pulsatility proximal to
     the stenosis
e) dampening of the waveform
     distal to the stenosis



increased peak diastolic velocity proximal to the stenosis


You are performing an u/s exam on a pt with a history of chronic pancreatitis & abd bruit. What vascular abnormality is associated with this history?

a) abd aortic aneurysm
b) renal artery stenosis
c) IMA occlusion
d) retroaortic renal vein
e) pseudoaneurysm of the hepatic
    or splenic artery



Pseudoaneurysm of the hepatic or splenic artery


The IVC empties blood into which of the following?

a) abdominal aorta
b) rt atrium
c) lt atrium
d) rt ventricle
e) lt ventricle 



Rt atrium


Which of the following does NOT drain directly into the IVC ?

a) renal vein
b) rt hepatic vein
c) common iliac vein
d) splenic vein
e) middle hepatic vein



splenic vein


You are imaging the common hepatic artery & detect its division into two branches. What are these 2 branches?


Proper hepatic artery & gastroduodenal artery


You are imaging a pt with an anatomic variant called "replaced" hepatic artery. In this anatomic variant, the rt hepatic artery  originates from what artery?


Superior Mesenteric artery


You are imaging the pancreas and detect a vessel posteriorly, coursing between the superior mesenteric artery and the aorta. What vessel are you imaging? 


Lt renal vein


Describe the anatomic course of the gastroduodenal artery(GDA)? 


the GDA has a caudal course, anterior to the pancreatic head


Which artery supplies the small intestine, rt colon and most of the transverse colon?


Superior mesenteric artery


A pt has been referred for a doppler study with symptons of chronic mesenteric ischemia. What are the symptons of this disease?


postprandial abd pain & wt loss.


What vessels will you study in a pt who has been referred for a doppler study with symptons of chronic mesenteric ischemia


celiac trunk, SMA and IMA


What vessels will you study in a pt who has been referred for a doppler study with symptoms of chronic mesenteric ischemia?
a) portal, superior mesenteric, &
    splenic veins
b) aorta, renal, common iliac
     arteries
c) main renal & intrarenal vessels
d) distal aorta, common iliac, ext.
     iliac, & common femorals 
     arteries
e) celiac trunk, superior
     messenteric, & inferior
     messenteric arteries



e) celiac trunk, superior & inferior
     messenteric arteries



A 38y/o female has been referred for a doppler study of the liver with a history of ETOH abuse and cirrhosis. What vascular condition is associated with this history?

a) mesenteric ischemia
b) portal hypertension
c) hepatic artery fibromuscular
     displasia
d) splenic artery pseudoaneurysm
e) Budd-Chiari syndrome



b) portal hypertension


The hepatic veins drain into what vessel?

a) main portal vein
b) Splenic vein
c) IVC
d) hepatic artery
e) caudate vein



IVC


You have been asked to perform a doppler analysis of the portal venous system. Which of the following describes the waveform you will see in the portal vein in a normal study?

a) Bidirectional
b) Triphasic
c) Mildly undulating
d) Highly pulsatile
e) Continuous 



Mildly undulating








You are performing an u/s to r/o the presence of aortic aneurysm(AAA). What is the most common location of AAA?

a) suprarenal
b) Infrarenal
c) Thoracic
d) Aortic arch
e) suprarenal & infrarenal aortic
    aneurysms occur with equal
    frequency



b) infrarenal


Which of the following is the biggest risk factor for rupture of an AAA?

a) aneurysm location
b) aneurysm size
c) pt age
d) flow velocity through the
     aneurysm
e) presence of laminar thrombus
     within the aneurysm



b) aneurysm size


You are performing a f/u u/s exam in a pt with a known AAA. You cannot obtain a clear image of the aorta in a midline sagittal view due to overlying bowel gas. What should you do?

a) have the pt return after fasting 
     overnight
b) have the pt perform a valsalva 
     maneuver while scanning the
     same area
c)  roll the pt into either decubitus
     position and image the aorta
     from a coronal plane
d) scan the pt in a reversed
     Trendelenburg position
e) scan the aorta from a prone
     position



c) roll the pt into either decubitus
    position & image the aorta from
     a coronal plane



You have detected an abdominal
aneurysm. Considering this finding, you should taylor your exam to include which of the following?

a) evaluation of the common iliacs
b) measurement of the trv and
    ap diameter
c) assessment of intraluminal
     thrombus
d) location of the aneurysm in
     relation to the renal arteries
e) all the above



All the above


You are scanning a pt with Marfan's syndrome. U/s findings reveal a linear band throughout the length of the abd aorta that is
mobile in relation to the cardiac cycle. What pathology is most likely present?

a) aortic pseudoaneurysm
b) aortic dissection
c) micotic aortic aneurysm
d) inflammatory aortic aneurysm
e) fibromuscular dysplasia of the
     abd aorta



b) aortic dissection


A pt is referred for an abd doppler u/s to r/o the presence of Budd - Chiari syndrome. What vessels will you evaluate?

a) pv, splenic vein, renal veins
b) hep artery, splenic artery,
     celiac trunk, superior
    mesenteric artery
c) renal veins & renal arteries
d) all three hepatic veins, IVC, PV
e) distal aorta & iliac arteries



d) all 3 hepatic veins, IVC,
     PV



Which of the following describes the normal flow pattern in the hepatic veins?

a) biphasic
b) triphasic
c) monophasic
d) continuous
e) it is normal to see any of the
    above listed waveforms in the
    hepatic veins



b) triphasic


Which vessel listed provides the greatest amount of oxygenated flow to the liver?

a) portal vein
b) hepatic vein
c) gastroduodenal artery
d) hepatic artery
e) superior mesenteric artery



a) portal vein


What is the most significant clinical consequence of portal hypertension?

a) respiratory compromise
b) ascites
c) variceal hemorrhage
d) liver ischemia
e) vascular thrombosis



c)variceal hemorrhage


You have been asked to perform a doppler study on a pt with a new Transjugular Intrahepatic Portosystemic Shunt (TIPS). This  shunt connects what two vessels?

a) pv & hep artery
b) hepatic artery & hep vein
c) hep vein & splenic vein
d) hep vein & IVC
e) pv & hep vein



e) pv & hep vein


You are performing a doppler study on a pt with aTIPS stent. What is the greatest doppler angle of incidence you should use to get accurate velocity measurements in this exam?

a) o degrees
b) 45 degrees
c) 60 degrees
d) 70 degrees
e) 90 degrees



c) 60 degrees


You are performing an abd doppler study & suspect the presence of median arcuate ligament syndrome. To r/o this condition, you should:

a) obtain baseline doppler values,
   give the pt a fatty meal, & 
  rescan at 10, 20, & 30 min
  following the meal
b) obtain doppler readings 
    during both inspiration &
  expiration and in both the  supine & upright positions
c) obtain doppler readings at an 
   angle of 45 degrees & then repeat at an angle of 60 & 90
 degrees
d) obtain baseline doppler
  readings & have the pt return in
  approx. 2 wks for a comparison
  study
e) obtain doppler readings from the proximal, mid, & distal aspect of the artery
 
 



b) obtain doppler readings during both inspiration & expiration & in both supine & upright positions


A pt is referred for u/s evaluation of possible cavernous transformation of the pv. Which of the following describes this condition?
a) retrograde portal venous flow
b) portal vein thrombosis
c) tumor invasion of the portal vein
d) network of vessels replacing
    obliterated portal vein
e) portal vein aneurysm



d) network of vessels replacing
    obliterated portal vein



A 49y/o male is referred for abd doppler with a hx of cirrhosis & portal hypertension. U/s findings related to portal hypertension include all of the following except:

a) splenomegaly
b) portosystemic varices & 
    collaterals
c) hepatofugal flow in the PV
d) hepatic cysts
e) dilated portal vein 



d) hepatic cysts


You are performing a doppler study of the portal vein & detect that the flow direction in the main PV is the same as the hep artery. What does this indicate?
a) a nml flow direction in the PV
b) severe portal hypertension
c) hepatofugal flow
d) reversed hepatic artery flow
e) portal vein/hep artery fistula



a) a normal flow direction in the PV


You are performing an u/s study on a pt with an aortoiliac graft & suspect the presence of a pseudoaneurysm at the graft site. What is the typical waveform in the neck of a pseudoaneurysm?
a) continuous 
b) low velocity, monophasic
c) Tardus parvus
d) high velocity, bidirectional
e) high velocity, low resistance 



d) high velocity, bidirectional


Which visceral artery is most commonly involved with anuerysmal formation?

a) hep artery
b) splenic artery
c) SMA
d) IMA
e) gastroduodenal artery 



b) splenic artery


Which of the following vessels normally follows a retroaortic course ?

a) lt renal vein
b) rt renal vein
c) SMV
d) IMA
e) none of the above 



e) none of the above


Which of the following vessels courses posterior to the inferior IVC?
a) rt hepatic artery
b) lt renal vein
c) rt renal artery
d) lt renal  artery
e) none of the above



c) rt renal artery


You are having difficulty identifying the pancreas in an elderly pt. You can identify the spleenic vein. What is the relationship of the splenic vein to the pancreas?
a) posterior & superior
b) posterior & inferior
c) anterior & superior
d) anterior & inferior
e) splenic vein does not 
    approximate the pancreas 



b) posterior & inferior


You have been asked to include an evaluation of the SMV in a doppler study of the portal system. What vessel does the SMV join?
a) IMV
b) lt renal vein
c) rt renal vein
d) splenic vein
e) hepatic vein 



d) splenic vein


You have been asked to identify the lobes of the liver in a pt with a hepatic mass. Which vessels course intersegmental in the liver?
a) portal veins
b) hepatic veins
c) hepatic arteries
d) both the portal veins & hepatic
     veins
e) both the portal veins & hepatic
    arteries



b) hepatic veins


A pt has been referred for a doppler study to r/o the presence of renal artery stenosis. A thorough knowledge of the renal vasculature is required to perform this study. Which of the following is NOT true regarding the renal vasculature?
a) mult. renal arteries are rare,
    occurring in less than 5% of
    individuals
b) the renal arteries lie posterior
     to the renal veins
c) the renal arteries branch off 
    the aorta immediately below
    the SMA
d) the rt renal vein is shorter than
     the lt renal vein
e) the renal veins drain into the 
     IVC
 



a) mult. renal arteries are rare, occurring in less than 5% of individuals


You are examining the IVC to r/o obstruction. Within the liver, the IVC lies along the posterior surface of what lobe?
a) lt lobe
b) caudate lobe
c) anterior segment rt lobe
d) posterior segment rt lobe
e) quadrate lobe 



b) caudate lobe


You are performing an abd u/s on a pt with mass in the pancreatic head. In order to be sure you are imaging the entire pancreatic head, you must identify the vessel that lies immediately posterior to the pancreatic head. What is this vessel? 
a) abdominal aorta
b) IVC
c) SMV
d) splenic vein
e) portal vein 
 



b) IVC


You are imaging a pt with a fusiform abd aortic aneurysm. Which of the following describes the fusiform aneurysmal shape?
a) bulbous enlargement with a
    sharp junction between the nml
   and abnormal segment
b) dilatation with a gradual
    transition between the nml and
   abnormal segment
c) figure eight appearance to the
     aneurysm
d) intimal flap within the
    aneurysm
e) sharp, sudden sac-like
    protuberance



b) dilatation with a gradual   transition between the nml and abnormal segment


You are performing an u/s on a pt with suspected aortic aneurysm. Which of the following defines an aortic aneurysm?
a) when the length of the dilated
    segment exceeds 3CM
b) a dilatation of the aorta
    exceeding 3cm in any
    dimension
c) a focal dilatation of any
    segment exceeding 4mm
d) when the aorta becomes
     tortuous & dilated with an AP
    diameter greater than 4cm
e) when the diameter of the aorta
    is greater than 2.5cm



b) a dilatation of the aorta
     exceeding 3cm in any
     dimension



You are imaging the gut with a high resolution transducer. How many layers do you expect to see in a good imaging of the gut?
a) 1
b) 2
c) 3
d) 4
e) 5



e) 5


During abd u/s on a 68y/o male, you suspect an exophytic mass arising from the stomach. Which technique will be most useful in analyzing this mass?
a) scan the area while the pt
    performs a valsalva manuever
b) perform compression u/s over
    the suspicious area
c) scan the pt in both inspiration
    & expiration
d) rescan the pt following 
    ingestion of a fatty meal
e) scan the pt in a trendelenburg
     position



b) perform compression u/s over
    the suspicious area



You have been asked to evaluate a suspicious gut mass with color & spectral doppler. What is the role of doppler in the evaluation of gut masses?
a) color doppler is definitive in
    determination if a mass is
    benign or malignant
b) color doppler is used to
    identify regions of peristalsis
c) color doppler is used to identify
    the layers of the gut
d) color doppler aids in differentiation between ischemic & inflammatory gut masses
e) there is no role for color spectral doppler in the evaluation 
 of the GI tract at this time

 



d) color doppler aids in differentiation between ischemic & inflammatory gut masses



What is the most common malignant tumor of the GI tract?
a)adenocarcinoma
b) Mesenchymal tumors
c) lymphoma
d) metastatic tumors
e) cystadenocarcinoma



a) adenocarcinoma


Which of the following describes an abnormal sonographic appearance of the gut?
a) target
b) asymmetric target
c) pseudokidney
d) a & b only
e) all the above



e) all the above


You have detected an exophytic mass attached to the gut and suspect malignancy.  You should taylor your exam to specifically evaluate what related pathology?
a) regional lymph node enlargement
b) liver metastasis
c) pancreatic adenocarcinoma
d) pancreatitis
e) A & B only



e) A & B only


You are performing an abd u/s on a pt with a history of crohn's disease. What part of the GI tract is most commonly involved with this disorder?
a) Terminal ileum & colon
b) colon & antrum of the stomach
c) duodenum
d) Pyloris & lesser curve of
     stomach
e) crohn's disease affects the GI
     tract equally



a) terminal ileum & colon


Which of the following is a classic sonographic feature of crohn's disease?

a) gut wall thickening
b) strictures
c) creeping fat
d) increased vascularity
e) all the above



e) all the above


You have been asked to perform graded compression sonography of the appendix in a young pt with questionable acute appendicitis. Which of the following describes the technique you will employ?
a) perform quick, short 
    compressions in the rt lower 
   quadrant to assess pain & size   of the appendix 
b) quickly push the probe as far 
     as possible into the abd & hold
    long enough to image the
    appendix & surrounding tissue
c) apply gradual & uniform pressure  with the probe over the
 area of interest
d) push slowly & uniformly with
    the hand just superior to the
   probe to push the tissue into
   the field
e) any of the above maneuvers
     can be used



c) apply gradual and uniform pressure with the probe over the area of interest


You are performing an u/s study to r/o the presence of acute appendicitis. Which of the following constitutes an abnormal finding?
a) appendix diameter greater 
     than or = to 6mm
b) noncompressible appendix
c) appendix diameter greater than
    or = to 3mm
d) A & B only
e) B & C only
 



d) A & B only


What is the transducer of choice for evaluation of acute appendicitis?
a) 5.0 MHz linear array with short
     focus
b) 5.o MHz curved linear array
     with long focus
c) 3.5 MHz curved linear array
d) 3.5 MHz pased array
e) 2.25 MHz phased array 



a) 5.0 MHz linear array w/ short focus


You are imaging the abd in a pt with abdominal pain & wt loss. You detect an area that is suspicious for mass, but are considering the possibility that the
mass is a nml loop of bowel. What should you do?
a) have the pt return for a
    comparison study
b) image the area for a short
     duration to see if peristalsis
     occurs
c) scan the pt in a different
    position
d) evaluate the area with color
     doppler
e) all of the above manuevers
     should be attempted if
     diagnostic confidence is not
     attained



e) all of the above manuevers should be attempted if diagnostic confidence is not attained


A pt has been referred for an u/s evaluation to r/o acute appendicitis. What laboratory values are pathognomonic for acute appendicitis?
a) leukocytosis
b) increased alpha-fetoprotein
c) increased alkaline  phosphatase
d) increased serum bilirubin
e) there are no pathognomic 
    laboratory values for acute
    appendicitis



e) there are no pathognomic laboratory values for acute appendicitis


You have performed a study to r/o appendicitis in a young female with RLQ pain. No evidence of appendicitis was detected. What should you do?
a) nothing, the study is complete
b) suggest the pt have a Barium
    enema
c) search for other causes of RLQ
     pain
d) have the pt return in 24-48hrs 
     for a repeat study if symptoms 
     have not subsided
e) both B & D 
 
    



c) search for other causes of RLQ
    pain



The orifice of the appendix opens into which of the following?

a) cecum
b) Descending colon
c) Jejunum
d) ileum
e) Sigmoid



a) Cecum


Which part of the GI tract curves around the pancreatic head?

a) Hepatic flexure of the colon
b) Duodenum
c) Jejunum
d) pyloris
e) Ileum



b) Duodenum


You are imaging the RLQ in a pt with leukocytosis and a low grade fever.  What part of the GI tract will you most likely see in this area?
a) Sigmoid
b) Cecum
c) Descending colon
d) Duodenum
e) Pyloris



b) Cecum


During sonographic evaluation of the appendix, you detect an apendicolith. What is the sonographic appearance of this structure?
a) hyperechoic focus w/ posterior
   shadowing
b) hyperechoic focus with posterior acoustic enhancement
c) Hypoechoic focus w/ posterior
   acoustic enhancement
d) Hypoechoic focus with posterior shadowing
e) punctate focus without shadowing



a) hyperechoic focus w/ posterior shadowing


During abd sonography, you detect a fluid-filled mass in the LUQ. What technique below is most useful in determining if this mass is the stomach or a pathologic structure?
a) Have the pt perform a Valsalva
    manuever
b) Have the pt drink some h2o 
    while imaging the suspicious
    area
c) Scan the pt in both inspiration
    & expiration
d) roll the pt into a LL decub
    position & rescan
e) Evaluate the area w/ color
    doppler



b) have the pt drink some h2o while imaging the suspicious area


You are imaging a pt with abd pain and detect multiple dilated fluid-filled loops of bowel. This is suspicious for which of the following?
a) Obstruction
b) Ileus
c) Lymphoma
d) Appendicitis
e) A & B



e) A & B


You are imaging a 25y/o female w/ a history of chronic diarrhea, wt loss, abd pain, & fever. You detect a segment of concentrically thickened small bowel that is hyperemic by color doppler. This finding is most consistent with which of the following?
a) Adenocarcinoma
b) Crohn's disease
c) Acute appendicitis
d) Acute diverticulitis
e) Lymphoma



b) Crohn's disease


You are imaging a pt with dilated loops of bowels. You detect the presence of the haustra. This is an identifying feature of which part of the GI tract?
a) stomach
b) duodenum
c) small intestine
d) colon
e) all of the above



d) colon


You have detected dilated bowel with multiple concentric rings w/i it in a pt with severe abd pain. This finding is most consistent with which of the following?

a) Crohn's disease
b)  intussusception
c) adenocarcinoma
d) lymphoma
e) acute diverticulitis



b) intussusception


You suspect  gut wall thickening in an elderly pt with abd pain & diarrhea. What is the normal average thickness of the gut wall?

a) 1-2mm
b) 1-2cm
c) 3-5mm
d) 3-5cm
e) 6-7mm



c)3-5mm


You are imaging a thickened loop of bowel in a pt with Crohn's disease & detect a hyperechoic "mass effect" adjacent to the bowel with a "thyroid-like" appearance. This finding is most consistent with which of the following?
a) creeping fat
b) fistula 
c) stricture
d) appendicitis
e) adenocarcinoma 



a) Creeping fat


What is the innermost lining of teh gut?

a) mucosa
b) submucosa
c) Muscularis propria
d) serosa
e) adventitia



a) mucosa


You have been requested to perform a thyroid u/s on a pt with a palpable nodule in the lt neck. Which of the following transducers would provide the most optimal scan?

a) 2.25Mhz curved linear array
b) 3.5Mhz curved linear array
c) 5.0Mhz curved linear array
d) 7.5Mhz curved linear array
e) 10.0Mhz linear array



e) 10.0Mhz linear array


What muscle is seen as thin, hypoechoic bands immediately anterior to each thyroid lobe?
a) sternocleidomastoid
b) longus coli
c) sternohyoid
d) sternothyroid
e) both c & d



e) both c & d


What muscle is located posterior to each lobe of the thyroid?

a) sternocleidomastoid
b) longus coli
c) sternohyoid
d) sternothyroid
e) both C & D



b) longus coli


What is the role of color & spectral doppler in evaluating thyroid nodules?

a) increased color doppler flow 
    w/i a nodule indicates 
    malignancy
b) identification of a vascular 
    halo around a nodule indicates
    a benign condition
c) hyperemia of a heterogenous 
    thyroid by color doppler indicates malignancy
d) A,B, & C
e) neither color nor spectral 
    doppler have been shown to 
    be sensitive in determining if a 
    thyroid nodule is benign or
   malignant 



e) neither color nor spectral doppler have been shown to be
sensitive in determining if a thyroid nodule is benign or malignant



You are performing a thyroid u/s on a pt with a hx of Hashimoto's thyroiditis. What is the sonographic appearance of this condition?
a) multiple large, hypoechoic
    nodules throughout both lobes
b) many small, echogenic nodules
    throughout both lobes
c) small, shrunken thyroid with
   heterogenous echo texture
d) diffuse enlargement of the
    thyroid w/ heterogenous echo
    texture
e) enlarged thyroid with
    homogenous, low-level echo
    texture 



d) diffuse enlargement of the
     thyroid w/ heterogenous echo
      texture



You are performing a thyroid study on a pt with an enlarged
gland. Color Doppler shows markedly increased vascularity of
both lobes. Which of the following is most likely?
a) Grave's Disease
b) Adenomatous goiter
c) Hashimoto's thyroiditis
d) Follicular adenoma
e) Colloid nodule 



a) Grave's disease


A pt has been referred for a thyroid u/s to locate a pararthyroid adenoma. How many parathyroid glands are present in
most people?
a) one
b) two
c) three
d) four
e) six



d) four


You are performing a thyroid u/s on a pt with increased serum calcium levels. What pathology are you searching for?
a) Hashimoto's disease
b) Grave's Disease
c) Adenomatous thyroid nodule
d) Parathyroid adenoma
e) Colloid cyst



d) Pararthyroid adenoma


During sonographic imaging of the thyroid, you detect several cervical lymph nodes. Which of the following statements is NOT true regarding these lymph nodes?
a) U/S cannot detect normal
    lymph nodes
b) visualization of inflammatory
    lymph nodes in the neck is
   common
c) Most normal cervical lymph 
    nodes have an oblong or oval
    shape
d) the greatest dimension in nml
    cervical lymph nodes is the 
   longitudinal axis
e) Most inflammatory lymph 
     nodes exhibit an echogenic 
     hilum 



a) U/S cannot detect normal 
    lymph nodes 



Which of the following is NOT true regarding thyroid nodules?
a) the overwhelming majority of
   thyroid nodules are benign
b) thyroid nodules are very
     common
c) a solitary thyroid nodule is
    usually malignant
d) nodules with significant cystic
     component are usually benign
e) nodules may be hyperechoic or
    hypoechoic to the thyroid



c) a solitary thyroid nodule is
    usually malignant



You have been asked to identify a parathyroid adenoma. What is the typical sonographic appearance of this structure?

a) Hyperechoic, round, solid
    nodule
b) heterogenous, oval, solid
     nodule
c) Round, solid nodule, isoechoic
    to the thyroid
d) Homogenous, hypoechoic,
     solid oval-shaped nodule
e) Hypoechoic nodule with highly
    echogenic hilum



d) Homogenous, hypoechoic solid
     oval-shaped nodule



You are performing an U/S to r/o the presence of parathyroid adenoma. Hyperthyroidism is usually caused by enlargement of how many parathyroid glands?
a) one
b) two
c) three
d) four
e) five  



a) one


You are performing an U/S on a pt with parathyroid hyperplasia. How many glands are usually involved in this condition?
a) one
b) two
c) three
d) four
e) five



d) four


While performing a thyroid U/S, you detect a lymph node suspicious for malignancy. Which of the following sonographic features is consistent with nodal malignancy in the neck?
a) Rounded lymph node
b) heterogenous echo texture
c) intranodal calcification
d) absence of an echogenic hilum
e) all the above 



e) all the above


During transverse imaging of the thyroid, you detect a hypoechoic, round nodule posterior & medial to the thyroid. how can you determine if this is the esophagus or a nodule?
a) image the pt in both inspiration
     and expiration
b) have the pt perform a valsalva
     manuever
c) have the pt swallow while
    scanning the area
d) scan the pt in an upright 
     position
e) all the above



c)  have the pt swallow while
     scanning the area



What vessel is seen to course through the transverse foramina of the cervical spine?
a) Common carotid
b) superior thyroid
c) inferior thyroid
d) thyrocervical 
e) vertebral 



e) vertebral


The superior thyroid artery is a branch of what artery?

a) Common carotid
b) internal carotid
c) External carotid
d) Thyrocervical
e) Inferior thyroid



c) external carotid


You are performing a thyroid U/S on a pt with a nodule suspicious for malignancy. What is the most common form of thyroid cancer?
a) papillary carcinoma
b) follicular carcinoma
c) medullary carcinoma
d) lymphoma
e) metastatic disease



a) papillary carcinoma


During transverse insonation of the thyroid gland, you detect two large vessels just lateral to the thyroid. What is the most medial vessel?

a) Common carotid artery
b) Internal jugular vein
c) Vertebral artery
d) Subclavian artery
e) External jugular vein



a) Common carotid artery


During transverse insonation of the thyroid gland, you detect 2 large vessels just lateral to the thyroid. What is the most lateral vessel?
a) Common Carotid artery
b) Internal jugular vein
c) Vertebral artery
d) Subclavian artery
e) External jugular vein



b) Internal jugular vein


You have identified the thyrocervical trunk in a pt with a hypervascular thyroid nodule. The thyrocervical trunk arises from what artery?
a) Common carotid artery
b) internal carotid artery
c) external carotid artery
d) subclavian artery
e) vertebral artery 



d) subclavian artery


You are performing a thyroid u/s on a young woman with hypothyroidism. You detect a moderately enlarged hypoechoic thyroid with a coarsened parenchymal echo texture. Which of the following conditions is most likely present, considering this history & findings?
a) Graves disease
b) multinodular adenomatous 
     goiter
c) Hashimoto's thyroiditis
d) Papillary carcinoma
e) normal thyroid 



c) Hashimoto's thyroiditis


Which of the following describes the correct pt positioning for sonographic evaluation of the thyroid ?
a) the pt is supine in a reversed
    Trendelenburg position
b) the rt thyroid lobe is examined
    with the pt in lt lateral decub &
    the lt thyroid lobe is examined
    with the pt in rt lat decub
c) the pt is prone with the neck
     extended
d) the pt is supine with the neck
    hyperextended by a pad under
    neath the scapulae
e) the pt is best examined in an
    upright position with the chin
   on the chest



d) the pt is supine with the neck
    hyperextended by a pad under
    neath the scapulae



On the lt side of the neck, the common carotid arises from what artery?
a) Innominate
b) Subclavian
c) Rt Common carotid
d) Internal jugular
e) aortic arch



e) aortic arch


Which transducer will provide the most optimal imaging for ultrasound imaging of the breast?
a) 3.5Mhz curved linear array
b) 5.0 Mhz curved linear array
c) 5.0 Mhz linear array
d) 7.5Mhz linear array
e) 10.0Mhz linear array



e) 10.0Mhz linear array


You have been requested to perform an U/S to rule out the presence of a Baker's cyst. Where will you look?
a) Breast
b) neck
c) mediastinum
d) Popliteal fossae
e) Groin



d) Popliteal fossae


You have been requested to perform an U/S to rule out the presence of a popliteal aneurysm. Where will you look?
a) Groin
b) calf
c) behind the knee
d) elbow
e) shoulder



c) behind the knee


What is the appearance of a normal lymph node in the breast?
a) small, ovoid structure w a
    hypoechoic rim & echogenic
    hilum
b) large, round structure w a
    hyperechoic rim & hypoechoic
    hilum
c) small, rounded nodule with a
    homogenous, hypoechoic echo
    texture
d) small, nodule with
    microlobulations &
     heterogenous echo texture
e) small, ellipsoid nodule
     frequently containing cystic
     areas & microcalcifications



a) small, ovoid structure with a
   hypoechoic rim & echogenic
   hilum



A pt has been referred for an U/S to rule out the presence of a rectus sheath hematoma. Where will you look?
a) Lateral aspect of the affected
    thigh
b) popliteal fossa
c) calf
d) neck
e) mid abdominal wall



e) mid abdominal wall


You have been asked to perform an U/S on the Achilles tendon. Which transducer would provide the most optimal image of this structure?
a) 5.0mhz linear array
b) 5.0mhz curved linear array
c) 7.5mhz curved linear array
d) 10 Mhz curved linear array
e) 12 Mhz linear array



e) 12 Mhz linear array


Which of the following is NOT an accepted indication for breast U/S?
a) differentiation of cysts from
     solid masses
b) evaluation of a palpable mass
    that is not visible in a
    radiographically dense breast
c) screening for malignancy in the
    general population
d) assessment of a mass that is
    inaccessible to mammography
    due to location
e) evaluation of a young pt with 
     a palpable mass
 



c) Screening for malignancy in the
    general population



A pt has been referred for U/S evaluation of a rt lateral breast mass seen on mammography. What is the correct pt posistioning to evaluate this mass?
a) pt supine w/ rt arm adducted
b) pt in lt posterior oblique w/
    rt arm abducted
c) pt supine w/ arms folded
     across chest
d) pt in rt posterior oblique w/
    rt arm adducted
e) lt in lt decubitus position w/ rt
    arm adducted



b) pt in  LPO position w/ rt arm abducted


You have been asked to determine if a mammography detected breast mass is cystic or solid. What is the established accuracy of U/S for distinguishing a simple
cyst from a solid lesion?
a) 10-22%
b) 30-50%
c) 70-80%
d) 87-95%
e) 96-100%



e)96-100%


A pt has been referred for U/S evaluation to r/o the presence of a carotid body tumor. Where's this tumor located?
a) at the origin of the common
   carotid on each side of the neck
b) lat to the carotid bifurcation &
    medial to the sterncleidomastoid muscle
c) at the level of the carotid
    bifurcation between the internal & external carotid arteries
d) superomedial to the submandibular gland on each side of the neck
e) w/I the strenocleidomastoid
    muscle, lateral to the carotid
   bifurcation



c) at the level of the carotid
   bifurcation between the 
   internal & external carotid 
    arteries   
 



Which of the following is suggestive of malignancy of a solid mass seen on U/S?
a) a mass that is taller than it is
     wide
b) spiculation
c) angular margins
d) markedly hypoechoic solid
     lesion
e) all of the above



e) all of the above


What comprises the terminal ductal lobular unit (TDLU) in the breast?
a) lobule with its terminal branches ,short intralobular & longer extralobar duct
b) coopers's ligament,areola & 
    duct
c) lobule, coopers ligament &
    areola
d) Skin, subcutaneous fat &
    glandular tisue
e) fatty loule, retromammary fat
    prepectoral fascia & subcutaneous fat  



a) lobule with its terminal branches, short intralobular & longer extralobar duct


You have been asked to determine if a mass seen on mammography in the lt breast is solid or cystic. What are the characteristics of a
breast cyst by u/s? 
a) smooth walls, sharp anterior &
     posterior borders, no internal
    echoes, posterior enhancement
b) smooth walls, sharp lateral
     borders, refraction shadowing 
    posterior enhancement
c) thin walls, sharp lateral borders, no internal echoes, posterior shadowing
d) increased posterior attenuation
    low level echos, minimal color
     doppler signal
e) sharp borders in all dimensions, compressibility , no internal echoes, posterior attenuation 
 



a) smooth walls, sharp anterior & posterior borders, no internal echoes, posterior enhancement


You have obtained several images of a breast mass in a radial plane & have determined that the mass is solid. You measured the long axis of the mass. What else should you do?
a) nothing, the study is complete
b) obtain resistive & pulsatility 
    indices from arteries w/i the 
    the mass
c) obtain images in a projection 
    90 degrees to the original scan
   plane
d) evaluate the mass with both a
     low & high frequency 
     transducer
e) evaluate the compressibility of
    the mass with probe pressure  



c) obtain images in a projection
    90 degrees to the original scan
    plane



You have been asked to perform an u/s on a pt with recent muscular trauma. Which of the following is true regarding the
normal sonographic findings in a
muscle?
a) on saggital scans,oblique, parallel, echogenic fibers are seen 
against a hypoechoic background

b) color doppler reveals no signals in a normal muscle at rest
c) U/S is extremely useful in 
    identifying strained muscles
d) muscle fibers cannot be 
    recognized sonographically
e) all of the above statements 
     are true   



a) On saggital scans, oblique
    parallel, echogenic fibers are
    seen against a hypoechoic
    background



What is the sonographic appearance of a normal peripheral nerve?
a) markedly echogenic structure
    with scattered bright internal
   foci
b) striated, hypoechoic, linear structure
c) markedly hyperechoic structure with parallel internal linear echoes
d) homogenous, hyperechoic, 
    structure with barbell shape 
e) peripheral nerves cannot be 
    detected sonographically    



c) markedly hyperechoic structure with parallel internal linear echoes


A pt has been referred for U/S evaluation of tendinitis in the wrist. What is the U/S appearance of a tendon?
a) the sonographic appearance of
    a tendon varies greatly by
    location within the body
b) tendons are highly echogenic 
     with a fibrillar echotexture
c) tendons are markedly hypoechoic & homogenous
d) tendons have a heterogenous
    sonographic appearance with
    mixed echodensity
e) tendons cannot be recognized
    sonographically



b)tendons are highly echogenic w/ a fibrillar echotexture


You detect a hypoechoic region within an otherwise normal appearing tendon. What causes false hypoechogenicitywithin a tendon?
a)use of too much scan gel between the skin & transducer
  surface
b) scanning with the beam
    perpendicular to the tendon
    axis
c) oblique incidence of the beam
    to the tendon axis
d) use of a transducer frequency
    greater than 10 Mhz
e) overuse of reciever gain



c) oblique incidence of the beam to the tendon axis


Which of teh following is NOT a sonographic sign of tendinitis?
a) thickening of the tendon
b) absence of vascularity on 
     color doppler imaging
c) decreased echogenicity 
d) blurred margins
e) calcifications in chronic 
     tendinitis  



b) absence of vascularity on color
    doppler imaging



You have detected a cyst in a pt referred for sonographic evaluation of a wrist nodule. Which of the following is a cyst that occurs adjacent to a joint?
a) Ganglion cyst
b) Colloid cyst
c) Branchial
d) Dermoid
e) hydatid



a) ganglion cyst


A pt has been referred for sonographic evaluation of the rotator cuff. What part of the body should you image?
a) Hip
b) elbow
c) wrist
d) shoulder
e) ankle 



d) shoulder


You are imaging a pt with pneumobilia. What artifact is associated with this condition?
a) refraction
b) shadowing
c) side lobes
d) grating lobes
e) ringdown



e) ringdown


You are imaging the GB in a trv
orientation & detect shadowing on each edge of organ. What artifact are you identifying?
a) refraction 
b) ringdown
c) comet tail
d) reverberation
e) partial volume



a) refraction


Which of the following parameters can be tested on a phantom?
a) sensitivity
b) contrast resolution
c) axial resoultion
d) lateral resolution
e) all of the above



e) all of the above


You have been asked to create a test object to detect the measurement accuracy of the U/S unit in your dept. In order for the test object to determine the accuracy of the U/S system, the speed of sound in the test object should be:
a) one-half the speed of sound in
     tissue
b) one-third the speed of sound
     in tissue
C) equal to the speed of sound in
     tissue
d) equal to the speed of sound in
     water
e) twice the speed of sound in
    water



c) equal to the speed of sound in
    tissue



Which of the following transducers does not demonstrate a sector field of view?
a) phased array
b) sequential linear array
c) curved linear array
d) annular array
e) all of these transducers
    produce a sector field



b) sequential linear array


You have been asked to obtain an abd U/S on a 320lb male. Which of the following will help you obtain adequate penetration of the liver in this pt?
a) high-frequency transducer
b) increase the transmit power
c) increase the receiver gain
d) use a small footprint
      transducer
e) all of the above



b) increase the transmit power


You are performing a doppler study of the SMA. The doppler waveform is aliased. What should you do to correct thi problem?
a) decrease the wall filter
b) increase the PRF
c) increase the doppler
    frequency
d) decrease the doppler gain
e) raise the baseline



b) increase the PRF


You have been asked to evaluate various image-recording devices for the U/S dept. Which of the following offers the best spatial resolution?
a) multiformat camera
b) video printer
c) laser camera
d) VHS video cassette recorder
     (VHS)
e) the spatial resolution is equal in
     these devices



c) laser camera


What is the purpose of a quality control program in the U/S dept?
a) evaluate sonographer scan 
   time
b) reduce pt exposure
c) compare exam fees with 
     competitors
d) monitor equipment 
     performance
e) all the above

 



d) monitor equipment
    performance



You are assisting a physician in a thyroid biopsy. Which of the following would result in the best image of the needle?
a) image the needle at near zero 
   degrees incidence
b) image the needle at near
    perpendicular incidence
c) decrease the overall gain so
     that the needle is the only
     bright structure seen
d) use a curved array rather than
    a linear array transducer
e) all of the above 



b) image the needle at near perpendicular incidence


You are having difficulty obtaining an adequate color doppler image of a deep abd vessel. What color Doppler parameter will increase the signal-to-noise(SNR) ratio and result in a stronger signal?
a) Color filter
b) Color pulse repetition 
     frequency
c) color packet size
d) color baseline 
e) color reject 



c) color packet size


You are using color doppler to evaluate for portal vein patency. The frame rate is very slow. What parameter can you adjust to increase the color doppler frame rate?
a) Increase the color filter
b) decrease the color pulse 
     repetition frequency
c) increase the color gain
d) decrease the color field of 
     view 
e) increase the color baseline 



d) decrease the color field of
     view