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489 Cards in this Set
- Front
- Back
In transverse imaging plane, it is the top of the screen.
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Anterior
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In transverse imaging plane, it is the bottom of the screen.
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Posterior
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In transverse imaging plane, it is the left side of the screen
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patient’s right
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In transverse imaging plane, it is the right side of the screen
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patient's left
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In the longitudinal (sagittal) imaging plane, it is the top of the screen
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Anterior
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In the longitudinal imaging plane (sagittal), it is the bottom of the screen
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Posterior
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In the longitudinal imaging plane (sagittal), it is the left side of the screen
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Superior/cephalic
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In the longitudinal imaging plane (sagittal), it is the right side of the screen
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Inferior/caudal
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In the coronal imaging plane, it is the top of the screen
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lateral
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In the coronal imaging plane, it is the bottom of the screen
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medial
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FREQUENCY is indirectly proportional to ________.
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penetration
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Higher frequency = ______ penetration.
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lower
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Lower frequency = ______ penetration
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higher
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FREQUENCY is directly proportional to _______.
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resolution
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Higher freq = ________ resolution
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higher
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Lower frequency = _______ resolution
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lower
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Two types of aortic aneurysm
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Fusiform
Saccular |
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An aortic aneurysm is when it is over ______ cm's or larger in any dimension.
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3
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Leaking aneurysms patients have _______ pain.
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back
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_____ cm or larger aneurysms are indicated for repair
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5
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These result from the separation of the intima layer from the aorta
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Dissections
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Seagull sign
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coming off of aorta at the hepatic artery and splenic artery origins
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Organs we can live without
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Spleen
Gallbladder Appendix Uterus Ovaries Scrotum Prostate One kidney Thyroid Breasts Some nodes Some vessels Portion of the liver |
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SMA feeds blood to these two
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prox colon
small intestine |
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IMA feeds blood to these 4
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left transverse colon, descending colon,
sigmoid and rectum |
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Aorta sits to the ______; IVC sits to the ______.
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right
left |
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T/F The aorta is sometimes posterior
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True
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The Aorta is a _____; The IVC is a _____.
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artery
vein |
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Aorta has a ________ waveform.
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pulsatile
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IVC has a ________ waveform.
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phasic
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T/F Aorta is rigid
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TRUE
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T/F IVC is collapsible
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TRUE
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SMV + Splenic vein
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Portosplenic confluence
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What is the landmark for the pancreas?
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Portosplenic confluence
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Which renal artery is the longest and posterior to the IVC
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Right
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4 Characteristics of the left renal vein
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longer
Anterior to aorta Posterior to SMA Lt. gonadal vein drains into the lt. renal vein |
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Characteristics of a hematoma
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When immediately formed is anechoic - then becomes hypoechoic (still acute) - later becomes hyperechoic over time - degenerates and becomes hypoechoic again
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___________ is peritoneal fluid.
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Ascites
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Ascites is most commonly seen in the ________ gutters and ______ pouch.
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pericolic
Morison's |
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located superior, between
inferior aspect of the diaphragm and superior border of the liver, on the right, and spleen on the left. |
subphrenic space
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The chest sonogram is done to look for _______ effusion.
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pleural
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found in positive appendices
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Appendicolith
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These two merge to form the Common Hepatic Duct
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Right hepatic duct
Left hepatic duct |
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These two merge to form CBD
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Common Hepatic Duct
Cystic Duct |
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The CBD and Wirsung's duct come together to form the _______.
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Ampulla of Vater
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This accessory duct is not seen on ultrasound. Enters duodenum just above the ampulla of Vater.
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Santorini’s duct
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Painless jaundice-caused from pancreatic tumor
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Courvoisier gallbladder
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WES
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wall-echo-shadow
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The gallbladder can become completely filled with stones causing a clean, echo free shadow with distinct edges in the location of the gallbladder fossa. This is called the ________ or WES sign.
This is called the double arc or “WES” sign (wall-echo-shadow). |
double arc
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Most common area of biliary obstruction is the
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Cystic Duct
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positive pain over the gallbladder when scanning
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Murphy's sign
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What is this sign? portal vein, hepatic artery, bile duct @ porta hepatis
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Mickey Mouse sign
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hilum of the liver, portal vein, hepatic artery, bile duct @ porta hepatis comprise this area
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Porta hepatis
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Obstruction at the junction of right and left hepatic ducts. Only the intrahepatic ducts are dilated.
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Klatskin tumor
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Fold in fundus of gallbladder
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Phrygian cap
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Fetal remnant of the ductus venosus
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Ligamentum venosum
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Fetal remnant of the umbilical vein
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Ligamentum teres
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Liver cirrhosis causes an increased risk of __________ carcinoma.
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hepatocellular
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Islands of increased
density or echogenicity surrounded by normal liver tissue. (normally at porta hepatis) |
Focal fatty infiltration
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Liver is ________-level echogenicity.
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medium
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Renal transplants are usually placed in the ______ in the retroperitoneum
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pelvis
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Sonographically we will see these 5 items with renal transplant rejection
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Enlarged transplant
Decreased cortical echogenicity Indistinct corticomedullary boundaries Prominent Hypoechoic medullary pyramids Peritransplant fluid collections |
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Which two lab values delienate renal function?
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BUN
Creatinine |
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Three normal variants of renals
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dromedary hump
column of bertin junctional defect |
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_________ kidneys are normal but just in an “ectopic” location.
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Pelvic
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This is where the kidney ascends to the opposite side .You will see two kidneys on one side and none on the other.
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Crossed renal ectopia
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The kidneys fuse in the pelvis and one kidney ascends carrying the other one with it across the midline. This is where there is a flap of mucosa that has a slit like opening in the area of the prostatic urethra. This is the
most common cause of urinary obstruction in the male infant and second most common cause of hydronephrosis in the neonate. |
Crossed fused renal ectopia
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4 causes of hydronephrosis
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Obstruction
Stone-most common Extrinsic obstruction- tumor, etc. Overdistended urinary bladder-must do post void the patient to see if hydronephrosis resolves Pregnancy UTI’s |
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Patient will present with periumbilical pain, leukocytosis,fever, and rebound tenderness (hurts more when you let go than when you press).
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Acute appendicitis
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T/F? Normal appendices are usually identified on ultrasound
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FALSE
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if the following 4 features are seen sonographically, then there is a good chance that
appendicitis has developed. |
Non-compressible appendix
6mm or greater in diameter appendicolith- (calicified fecal matter that is echogenic with varied amounts of shadowing) *May also be hypervascular |
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Rectal bleeding
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Intussusception
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Characteristics of Pyloric Stenosis
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Pyloric muscle thickness greater than 3 or 4 mm
Pyloric channel length of at least 1.2 cm Cross-section of the entire pyloric muscle of > or = 1.5cm |
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The liver is suspended from the diaphragm and anterior abdominal wall by the
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falciform ligament
the falciform ligament extends from the umbilicus to the diaphragm |
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The play boy bunny or reindeer sign refers to what?
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hepatic veins and IVC
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You have detected a mass anterior and to the left (patient's left) of the ligamentum venosum. This mass is located in what lobe of the liver?
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left lobe
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In patients who develop portal hypertension, the portal blood flow becomes __________ instead of __________.
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hepatofugal
hepatopedal |
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A cyst within a cyst (daughter cysts) is a classic example of which of the following liver masses?
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echinococcal (hydatid) cyst
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Budd-Chiari syndrome is a rare disorder caused by obstruction of the:
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hepatic veins
causes thrombosis of the hepatic veins or IVC |
|
All of the following are ways to tell the difference between the portal and hepatic veins EXCEPT: portal veins have echogenic walls, hepatic veins do not
portal veins are medial in the liver, hepatic veins are lateral portal veins carry blood towards the liver, hepatic veins take blood away portal veins dump into the IVC and hepatic veins do not |
portal veins dump into the IVC and hepatic veins do not
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The most common benign tumor of the liver is:
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cavernous hemangioma
|
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Focal fatty liver is most commonly found in which location?
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porta hepatis
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The common bile duct and hepatic artery enter the liver where?
|
Porta Hepatis
|
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Patients who have hepatocellular carcinoma are likely to have had:
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cirrhosis
hepatocellular carcinoma may develop from cirrhotic livers. |
|
You have identified a single homogenous HYPERechoic lesion measuring 2.4 cm in the posterior aspect of the right lobe of the liver. What is the most common etiology of a mass fitting this description?
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cavernous hemangioma
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The most common form of neoplastic involvement of the liver is:
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metastases
Most common neoplastic involvment in the liver is metastasis. The most common primary, malignant tumor is a hepatoma/hepatocellular carcinoma. |
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You are performing a sonogram on a slender female and notice a long, thin extension of
the inferior aspect of the right lobe of the liver. This most likely represents: |
reidel's lobe
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What two landmarks can be used to divide the right and left lobes of the liver?
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main lobar fissure and middle hepatic vein
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The fossae of the right portal vein (RPV) and gallbladder are found in the:
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Main lobar fissure
the main lobar fissure is a hyperechoic line extending from the RPV to the neck of the gallbladder. It is used as a landmark leading t othe gallbladder fossa. |
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Which of the following should be done to image the near field (anterior) of the liver?
change the transducer from 5.0 to 7.5 mHz change from a linear to a sector transducer change from a sector to a mechanical transducer increase the near gain |
change the transducer from 5.0 to 7.5 mHz
|
|
You have been asked to perform a liver sonogram on a patient with AIDS. Which of the
following tumors is most commonly associated with this history? |
kaposi's sarcoma
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During ultrasound evaluation of the liver, a bull's eye or target lesion is identified in the anterior right lobe. The most likely etiology of this mass is:
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liver metastasis from lung cancer
|
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Hepatocellular disease can be defined as a process that affects the:
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hepatocytes and interferes with liver function
hepatocellular disease can be defined as a process that affects the hepatocytes and interferes with liver function. |
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A recannalized paraumbilical vein may be seen as a result of which of the following?
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portal hypertension
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A patient is referred for abdominal ultrasound with a high FEVER and right upper quadrant pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the right lobe of the liver, adjacent to the capsule and shows increased through transmission. This most likely represents:
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abscess
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What three structures comprise the portal triad?
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portal vein, bile duct, hepatic artery
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The hepatic artery is __________ to the main portal vein.
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anterior
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The ligamentum venosum forms the anterior border of what lobe of the liver?
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caudate lobe
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You are scanning a patient with a single, anechoic, smooth round structure that has posterior acoustic enhancement in the liver. The most likely candidate for this lesion is:
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liver cyst
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The normal echogenicity of the liver should be_______________.
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medium level grays (homogeneous)
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Amebic abscess may reach the liver through the:
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portal vein
The infection is primarily a disease of the colon. The parasites reach the liver via the portal vein. |
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What benign liver tumor is located near the free edge of the liver, is solitary, well circumscribed, and is a nonencapsulated multinodular mass?
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focal nodular hyperplasia
FNH apprears as well-defined hypoechoic patterns compared to the normal liver parenchyma. Internal echoes may be seen if multiple nodules occur together. |
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You are scanning a patient with liver cirrhosis and suspected portal hypertension. In
this study, assessment of the size of which of the following is most important? |
spleen
|
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The blood flow in the hepatic veins flows _______________ the liver.
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away
|
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You are holding your ultrasound probe in the sagittal (long) plane, what would the right side of the screen (your left when looking at the screen) correspond with?
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superior
|
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Where does the main portal vein enter the liver?
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porta hepatis
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The blood flow in the main portal vein flows ___________ the liver.
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towards
|
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What ligament divides the left lobe of the liver into medial and lateral segments?
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ligamentum teres
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If you were holding your ultrasound probe transverse on the abdominal midline, what would the top of the monitor screen correlate with?
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anterior surface
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Which lobe is the largest?
Caudate right anterior left inferior |
right anterior
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Thickening of the gallbladder wall may be caused by what 3 factors?
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hepatitis
pancreatitis ascites |
|
A 20-year old male presents in the ER for an abdominal ultrasound. You scan his gallbladder and see echogenic, horizontal, non-shadowing lines in the neck of the gallbladder. You can assume that these lines are what 3 structures?
|
polyps
valves of Heister junctional parenchymal folds Valves of Heister would be the best bet in this area although multiple polyps or folds could be remote possibilities. |
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If a patient has chronic choledocholithiasis, all of the following structures are dilated EXCEPT the:
distal duct proximal duct pancreatic duct common hepatic duct |
pancreatic duct
|
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What does the right part of the screen (your left when facing the screen) correspond with on a sagittal image?
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superior
|
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T/F? The intrahepatic ductal system includes the CBD.
|
False
The CBD is an extrahepatic duct. |
|
What cause of chronic cholecystitis is NOT associated with stone obstruction?
Milk of calcium bile Mucocele Porcelain gallbladder Courvoisier's |
Courvoisier's
|
|
If there is an obstructive stone in the CBD and you ask the patient to eat a fatty meal and come back in 45 minutes, the diameter of the CBD (proximal to the stone, towards the liver) would:
|
increase in size
it gets larger because it can't let the bile out. The duct is stopped-up. Better call roto-rooter! |
|
The neck is _____________ to the uncinate process.
|
superficial
|
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The head of the pancreas is inferior to the:
|
caudate lobe of liver
|
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____________ duct should measure 2mm or less.
|
The Wirsung's
|
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If the celiac axis is well visualized, the sonographer should move the transducer in which direction to image the pancreas?
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inferior
|
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Classic symptoms of gallbladder disease include all BUT:
|
hematuria
|
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The splenic vein runs along the _________ margin of the pancreas.
|
inferior
|
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Adenomyomatosis causes what sonographic artifact?
|
comet tail
|
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In a 60-year-old adult, the normal common bile duct should not measure more than:
|
6 mm
|
|
The most common group of people suffering from a choledochal cyst are:
|
from asian descent
|
|
What type of tumor occurs mostly in the pancreatic body and tail?
|
islet cell
|
|
A phrygian cap of the gallbladder is:
|
A phrygian cap of the gallbladder is:
|
|
The common bile duct is joined by the main pancreatic duct. Together they open through the ______ into the duodenal wall.
|
ampulla of Vater
|
|
The common hepatic duct (hepatic duct) is joined by the _______ to form the ______.
|
cystic duct; common bile duct
|
|
The superior mesenteric artery arises 1 cm below the celiac trunk and runs:
|
posterior to the pancreas and anterior to the uncinate process
|
|
An extrahepatic mass compressing the common bile duct can produce an enlarged gallbladder. This sign is:
|
Courvoisier's sign
|
|
T/F The pancreas is a retroperitoneal gland.
|
TRUE
|
|
_________ is the primary pancreatic duct.
|
Wirsung's duct
|
|
The most common sign for carcinoma of the gallbladder is:
|
mass will not change with position change
|
|
What part of the liver is the portal triad located when scanning transverse?
|
medial
|
|
Generally speaking, the normal pancreas is shown to be:
|
more echogenic than the liver
|
|
The pancreas is both an exocrine and endocrine gland. The exocrine function is to produce:
|
lipase and amylase
|
|
The enzyme that is the most sensitive in the laboratory tests for the diagnosis of acute pancreatitis is:
|
lipase
|
|
T/F The common bile duct may be found anterior and lateral to the portal vein.
|
TRUE
|
|
The head of the pancreas is _________________ to the CBD and ____________ to the GDA.
|
anteromedial; posteromedial
|
|
Dilatation of the right, left and intra hepatic ducts are noted on an abdominal sonogram. What possible pathologies should be considered here?
Biliary atresia Klatskin tumor Caroli's disease don't know. need more information. All of the above |
All of the above
|
|
NON-shadowing, low-amplitude echoes in a gravity DEPENDENT gallbladder is most characteristic of:
|
sludge
|
|
A 55-year-old robust female presents in your sonography department for an abdominal scan. She has a "positive" Murphy's sign when scanned. What does that mean?
|
she has a pain over her gallbladder
|
|
Gallstones are present in 40% to 60% of patients with:
|
acute pancreatitis
Gallstones are present in 40% to 60% in patients with acute pancreatitis. Five percent of patients with gallstones present with acute pancreatitis. |
|
A gallbladder packed with stones could potentially cast a distinct ___________ ultrasound sign.
|
wall echo shadow
|
|
The pancreas is both an exocrine and endocrine gland. The endocrine function is to produce:
|
insulin
|
|
Clinical signs of acute pancreatitis include all BUT:
persistant abdominal pain diarrhea erythema leukocytosis |
diarrhea and erythema
|
|
The physiologic effect of a fatty meal includes all of the following EXCEPT:
stimulation of cholecystokinin (CCK) contraction of the gallbladder decrease of bile flow to the liver relaxation of the sphincter of Oddi |
decrease of bile flow to the liver
After a fatty meal, CCK stimulation causes the contraction of the gallbladder; the sphincter of Oddi relaxes with the outpouring of bile into the duodenum |
|
T/F?
Insulinomas and gastrinomas are always malignant tumors in the pancreas. |
False
Each tumor can be benign or malignant. |
|
Splenules are synonymous with what other term?
|
accessory spleen
|
|
When scanning a patient for lymphadenopathy, one should check the:
|
pelvis
porta hepatis retroperitoneum perirenal space around the major vessels and their tributaries |
|
A fluid collection located between the diaphragm and the spleen may represent:
|
a subphrenic abscess
|
|
Persistent fever, swelling, and tenderness are indicative of:
|
infection
|
|
A potential space located between the liver edge and right kidney is:
|
Morison's pouch
|
|
Gerota's fascia refers to:
|
the area that separates the kidney and adrenal glands
|
|
T/F
The diaphragmatic crus can be seen on ultrasound. |
TRUE
|
|
Benign ascites is associated with:
|
floating bowel loops
|
|
Splenomegaly is NOT caused by the following:
lymphoma portal hypertension pancreatitis mononucleosis |
Pancreatitis is unrelated to the spleen.
|
|
Retroperitonal fluid collections may be:
hemorrhage abscess Ascites lymphoceles all of the above |
all of the above
All of these collections could be considered retroperitoneal. |
|
A 55-year-old patient presents to the ultrasound department with abdominal pain. He states that he has had abdominal surgery in the past year. During the abdominal sonogram you notice hypoechoic midline mass. What could this structure be?
|
retroperitoneal fibrosis
|
|
Which of the following is retroperitoneal?
spleen gallbladder lung psoas muscle |
psoas muscle
|
|
Chronic adrenal hypofunction usually causes what condition?
|
Addison's syndrome
|
|
The abdomen is divided into what two cavities?
|
peritoneum and retroperitoneum
|
|
The spleen is located in which quadrant of the body?
|
LUQ
|
|
What is the most common neonatal adrenal mass?
|
adrenal hemorrhage
Most common NEONATE adrenal mass. |
|
Which of the following is anatomically correct?
the lesser sac is anterior and superior to the pancreas the greater sac is anterior and inferior to the pancreas the lesser sac is anterior and inferior to the pancreas all of the above |
all of the above
|
|
The muscle groups of the anterior abdominal wall include all of the following EXCEPT:
the internal oblique the diaphragm the external oblique the transversus abdominus the rectus abdominus |
the diaphragm
|
|
Retroperitoneal fluid collections may be:
hemorrhage abscess ascites lymphoceles all of the above |
all of the above
|
|
Which of the following is NOT retroperitoneal?
Aorta inferior vena cava kidneys spleen adrenal glands |
spleen
|
|
The typical position for scanning the spleen is:
|
right lateral decubitus
|
|
A patient feel on the ice and hit his back on the edge of a step. He was bruised but did not have pain unless he was walking or climbing stairs, in which case he had pain in his right lower back. He was febrile, but his urinalysis and white blood count were normal. He was referred for an ultrasound study, which revealed a__________
|
hematoma in the iliopsoas muscle
|
|
A subcapsular hematoma may appear:
|
hypoechoic and curvilinear
|
|
Enlarged lymph nodes may do all of the following EXCEPT:
compress the ureter compress the aorta compress the IVC Displace the superior mesenteric artery displace bowel |
compress the aorta
|
|
Horeshoe kidneys may be confused sonographically with which of the following entities?
carcinoma of the head of the pancreas lymphadenopathy hypernephroma Wilms' tumor |
lymphadenopathy
|
|
What two vessels converge at the ampulla of Vater?
|
CBD, Wirsung's
|
|
T or F. A scanning protocol for the liver includes 7 strict images.
|
False
There are many possible images that can be taken of the liver. The most important thing is to SCAN through the entire organ, not just take images. |
|
Oxygenated blood is supplied to the liver via the:
|
portal vein and hepatic artery
|
|
Ureteral jets are visualized when scanning the bladder. This is used to see:
|
urine draining into bladder
|
|
The thin capsule surrounding the liver is known as:
|
glisson's capsule
|
|
T/F?
The adrenal glands are demonstrated more easily in neonates than in the adult. |
True
|
|
Name the 3 structures that surround the tail of the pancreas:
|
stomach, splenic artery, and hilum of the spleen
|
|
Which of the following syndromes are associated with an adrenal mass?
|
Cushing's syndrome
|
|
Metastatic lymphadenopathy disease can occur by lymphatic or hematogeneous spread. It may be secondary to carcinoma of the: (there are 3)
|
breast, lung, or testis
|
|
T/F?
Ascities will displace the bladder inferiorly but not posteriorly |
False
|
|
When scanning a liver you notice a hypoechoic structure on the anterior surface of the liver. What machine control can you adjust to help determine if the structure is cystic or solid?
|
optimize focal zone
|
|
T/F? A renal carbuncal is an abscess that forms outside the renal parenchyma.
|
FALSE
|
|
What is the portal triad composed of?
|
portal vein, common duct, hepatic artery
|
|
Dilatation of the intrahepatic biliary tree without dilatation of the extrahepatic duct includes all of the following EXCEPT:
Klatskin tumor enlarged portal lymph nodes cholangiocarcinoma pancreatic carcinoma |
pancreatic carcinoma
|
|
_____ are on the right side of the liver form the subphrenic and subhepatic spaces.
|
ligaments
|
|
A BENIGN fatty tumor of the kidney is:
|
angiomyolipoma
This will appear echogenic. |
|
A congenital abnormality in which both kidneys are united at their lower poles is termed:
|
horseshoe kidney
|
|
With renal genetic abnormalities, what other organ(s) will you most commonly see defects also?
|
reproductive
|
|
Adult polycystic renal disease appears on a sonogram as:
|
multiple cysts of varying sizes
|
|
Most renal cysts are located where?
|
cortex
|
|
An enlarged Column of Bertin leads to a frequent misdiagnosis of:
|
tumor
|
|
A typical frequency used to scan an adult abdomen is:
|
3 mHz
|
|
T/F?
The hepatic veins carry blood from the IVC to the liver. |
FALSE
|
|
What is ultrasound's role in evaluating acute renal failure?
|
determination of presence of hydronephrosis
|
|
Hydration of the patient may result in:
|
prominent renal pyramids
|
|
Hypernephromas commonly invade the IVC via the:
|
renal vein
|
|
In acute renal disease, kidney size is
|
generally enlarged
|
|
What is the most involved technique used to visualize the kidney, spleen and pancreas?
|
filling stomach with water
|
|
Which structure divides the left and right lobes of the liver?
|
middle hepatic vein
|
|
Name the vessel that lies posterior to the IVC.
|
right renal artery
|
|
The kidney is seen with color blood flow. Which arteries are see in the cortex?
|
arcuate
|
|
Of the following renal tumors, which is NOT a benign lesion?
hamartoma angiomyolipoma hypernephroma column of Bertin |
hypernephroma
|
|
Pyonephrosis refers to the:
|
presence of pus in a dilated collected system
|
|
Renal arteries arise from the:
|
anterolateral aortic wall
|
|
T/F?
The adrenal glands are peritoneal structures. |
False
The adrenals are retroperitonal structures. |
|
Renal sonography is not helpful in evaluating which of the following:
obstructive uropathy cyst formation renal function angiomyolipoma |
renal function
|
|
Which of the following should be done to image the near field (anterior) of the liver?
|
change the transducer from 5.0 to 7.5 mHz
|
|
The kidney lies on what group of muscles?
|
psoas, quadratus lumborum
|
|
What organ is the Heister's valves located?
|
gallbladder
|
|
The retroperitoneal space is the area between the:
|
posterior portion of the parietal peritoneum and the posterior abdominal wall muscles
|
|
The body of the pancreas is bound on its posterior surface by:
|
aorta
|
|
T/F?
Sinus lipomatosis is clinically significant. |
FALSE
|
|
The left kidney is in contact with the:
|
spleen, pancreas, colon, and jejunum
|
|
The routine gallbladder is scanned and an echogenic line called posterior acoustic enhancement is seen posterior. There also seems to be a shadow on the either side of the gallbladder running down posterior, parallel to the enhancement. What are these shadows caused by?
|
edge shadow artifact
|
|
The left renal vein courses:
|
anterior to the aorta
|
|
Urine passes, in the order given, through which of the following structures?
|
renal pelvis, ureter, bladder, urethra
|
|
You are asked to scan an adult patient for a positive Murphy's sign. What does that mean?
|
the patient has pain over the gallbladder/RUQ
|
|
The process of disposing of metabolic wastes from the blood is called:
|
excretion
|
|
T/F?
The renal artery is superior to the renal veins. |
TRUE
|
|
The renal pyramids are also called the:
|
medulla
|
|
T/F?
The pancreas is located anterior to the aorta, SMA and splenic vein. |
TRUE
|
|
To fulfill the criteria of a cyst, one must demonstrate sonographically:
an anechoic structure distal acoustic enhancement smooth walls all of the above |
all of the above
|
|
T/F
The term anechoic is synonymous with the term hypoechoic. |
FALSE
|
|
A pelvic kidney has a _____ appearance in a ______ location:
|
normal appearance in an abnormal location
It looks like a normal kidney just located in the pelvis. It still functions like it were in the correct location. |
|
A column of Bertin is most commonly seen where?
|
right kidney
|
|
A 3-year-old boy presents with hematuria and a palpable left flank mass. Sonography depicts a solid renal mass. This finding would most likely represent:
|
Wilm's tumor
|
|
Ectopic ureterocele is associated with which complication?
|
upper pole hydronephrosis
The ureterocele blocks the ureter and doesn't allow urine to pass through to the bladder (or very little passes). This causes the upper pole of the kidney to become obstructed. |
|
What is the most common NEONATAL adrenal mass?
|
adrenal hemorrhage
|
|
The most common sign for carcinoma of the gallbladder is:
|
a mass that will not move with position change
|
|
The pancreatic head lies:
|
superior to the portal vein and medial to the SMV
superior to the portal vein and anterior to the IVC |
|
A patient presents in your department with left upper quadrant pain after falling down some stairs. You see the spleen with a large hypoechoic area superiorly but outside the organ. What do you think is going on here?
|
perisplenic hematoma
|
|
The main registry review courses offered nationally are as follows:
|
pegasus lectures (www. pegasus.com), edelman (www.esp-inc.com) and gulf coast (www.gcus.com)
You, as a Washburn student, receive a 50% discount on registration to a pegasus lectures seminar. This includes physics and one specialty. You also receive a discount on their products. |
|
All of the following describe the inferior vena cava EXCEPT that:
valsalva maneuver results in a change in the diameter of the inferior vena cava it lies immediately anterior to the surface of the spine, to the right of the aorta the caliber of the inferior vena cava increases as it courses cephalad it passes through the caval hiatus of the diaphragm to enter the LEFT atrium The inferior vena cava passes through the caval hiatus of the diaphragm to enter the RIGHT atrium. |
it passes through the caval hiatus of the diaphragm to enter the LEFT atrium
The inferior vena cava passes through the caval hiatus of the diaphragm to enter the RIGHT atrium. |
|
Elevation of the following laboratory data may indicate renal failure EXCEPT for:
blood urea nitrogen (BUN) alkaline phosphatase creatinine protein |
alkaline phosphatase
Laboratory data that may indicate renal failure consists of an elevated blood urea nitrogen, creatinine, and increased protein in the urine. Alkaline phosphatase is elevated in hepatobiliary disease. |
|
In a fasting state (pre-prandial), the superior mesenteric artery has:
a low-resistive waveform a high-resistive waveform reversed diastolic flow no resistance |
a high-resistive waveform
In a normal patient, doppler signals wil change from high resistive to low resistive when the patient goes form fasting to a post-prandial state. |
|
Elevated serum amylase may be secondary to all of the following EXCEPT:
Pancreatic duct obstruction acute pancreatitis liver disease obstruction of the ampulla of vater |
liver disease
|
|
If a leaking aneurysm is suspected one should:
|
check the retroperitoneum
|
|
Serum glutamic pyruvic transminase (SGPT) is also referred to as:
|
alanine aminotransferase (ALT)
|
|
In a dissecting aortic aneurysm, the dissection is through:
|
the media and intima
|
|
The best way of delineating a dissecting aneurysm on sonography is to:
|
show an intimal flap vibration with the flow of blood
Sonographically, the best way of delineating a dissecting aneurysm is by showing the intimal flap waving along with the pulsations of blood through the aorta. |
|
The celiac trunk originates within the first 2 cm from the diaphragm and immediately branches into all of the following EXCEPT:
common hepatic artery left gastric artery splenic artery renal artery |
renal artery
|
|
The left gonadal vein typically drains into the:
|
left renal vein
|
|
Which of the following IS a branch of the celiac axis?
proper hepatic artery gastroduodenal artery right gastric artery left gastric artery |
left gastric artery
|
|
Sonographically, the gastroesophageal juction can be visualized where:
|
anterior to the aorta and posterior to the left lobe of the liver
|
|
T/F?
The normal appendix is always seen on ultrasound. |
FALSE
|
|
Hypertrophic pyloric stenosis is characterized by all of the following EXCEPT which 2?
presents as a palpable abdominal mass more common in females a cross-section diameter of > or = 1.5 cm pyloric muscle thickness > 4 mm pyloric channel length > or = 1.2 cm |
more common in females
pyloric channel length > or = 1.2 cm |
|
High levels of serum amylase may be a result of all of the following EXCEPT:
liver disease acute pancreatitis blockage of the pancreatic duct by a stone |
liver disease
High levels of serum amylase can be due to pancreatitis. One of the most common causes of pancreatitis is cholelithiasis. |
|
A 4 month old presents with abdominal pain, rectal bleeding, and a palpable abdominal mass. What is the most likely pathology?
|
intussusception
These are the signs and symptoms of intussusception |
|
The substance that is secreted by the kidney when the renal artery is stenosed causing an increase in the patient's blood pressure is called:
|
renin
|
|
The gastroduodenal artery is a branch of the:
|
common hepatic artery
|
|
The superior mesenteric vein and the splenic vein join to form the:
|
main portal vein
|
|
Which of the following statements about infantile hypertrophic pyloric stenosis are true?
causes projectile vomiting predominately a disorder of male infants the hypertrophied pyloric muscle measures less than 3 mm it appears sonographically as a target-shaped lesion |
the hypertrophied pyloric muscle measures less than 3 mm
The normal pyloric measures less than 15 mm in diameter and its muscular periphery less than 5 mm in thickness. In the presence of pyloric stenosis, the muscle increases in size and measures more than 5 mm in thickness |
|
The substance that is released when fat is present in the bowl and contracts the gallbladder is:
|
cholecystokinin
|
|
Which of the following causes infertility in men?
spermatoceles hydroceles hematoceles varicoceles epididymal cysts |
varicoceles
|
|
A palpable "olive" sign is one of the common criteria used by clinicians to request which of the following ultrasound examinations?
renal sonogram on a patient with a history of adult polycystic kidney disease sonogram of the pancreas on a patient with an elevated amylase sonogram of the groin after femoral catherization and subsequent swelling (pseudo-aneurysm) sonogram of the aorta on an elderly patient with epigastric pain sonogram of the stomach on an infant with persistent projectile vomiting |
sonogram of the stomach on an infant with persistent projectile vomiting
|
|
Density of tissue times the speed of sound in tissue.
|
Acoustic Impedance
|
|
The speed of sound waves in body tissue is relatively constant at approx ________ meters per second
|
1,540
|
|
Strength or height of the wave, measured in decibels
|
Amplitude
|
|
Progressive weakening of the sound beam as it travels through body tissue, caused by scater, absorption, and reflection.
|
Attenuation
|
|
Directed acoustic field produced by a transducer
|
Beam
|
|
Substance within the transducer that converts electrical impulses into sound waves and vice versa.
|
Crystal
|
|
Per-second freq at which teh crystal vibrates. The number of cycles per second determines frequency.
|
Cycle
|
|
A unit used to express the intensity of amplitude of sound waves; does not specify voltage.
|
Decibel (dB)
|
|
The depth of the sound beam where resolution is highest
|
Focal Zone
|
|
Helps to increase the intensity and narrow the width of the beam at a chosen depth.
|
Focusing
|
|
Area where transmitted beam begins to diverge
|
Fraunhofer Zone (Far Field).
|
|
Number of times the wave is repeated per second as measured in hertz.
|
Frequency
|
|
Usable frequencies, except in the eye where higher freq can be used, lie between ____ and _____ million per second.
|
2.5
13 |
|
Area close to the transducer where the beam form is uneven.
|
Fresnel Zone (Near Field)
|
|
Standard unit of freq; equal to one cycle per second
|
Hertz (Hz)
|
|
Occurs whenever two tissues of different acoustic impedance are in contact.
|
Interface
|
|
1,000,000 Hz.
|
Megahertz (MHz)
|
|
Effect caused by crystals (such as zirconate and titanate) changing shape when in an electrical field or when mechanically stressed, so that an electrical impulse can generate a sound wave or vice versa.
|
Piezoelectric Effect
|
|
Quantity of energy generated by the transducer, expressed in watts.
|
Power (Acoustic)
|
|
The number of times per second that a transmit-receive cycle occurs.
|
Pulse Repetition Rate
|
|
Ability to distinguish between two adjacent structures (interfaces).
|
Resolution
|
|
Reflection from a smooth surface at right angles to the sound beam
|
Specular Reflector
|
|
A device capable of converting energy from one form to another. The term is used to refer to the crystal and the surrounding housing.
|
Transducer (Probe).
|
|
Speed of the wave, depending on tissue density.
|
Velocity
|
|
The speed of sound in soft tissues is between _____ and _____ meters per second.
|
1500
1600 |
|
Velocity is standardized at ________ meters per second on all current systems.
|
1540
|
|
Distance a wave travels in a single cycle. As frequency becomes higher, wavelengths become smaller
|
Wavelength
|
|
Ultrasound uses sound waves between ____ and ____ MHz.
|
1
30 |
|
The closer the molecules are, the faster the sound wave moves through a medium so _____ conduct sound exceedingly well.
|
bone
|
|
T/F
Air-filled lungs and bowel containing air conduct sound so poorly that they cannot be imaged with ultrasound in struments. |
TRUE
|
|
A ________ serves as a window for the uterus. Without one, the uterus cannot be seen.
|
distended urinary bladder
|
|
According to this principle, the electrical pulse strikes the crystal and produces a sound beam which propagates through the tissues.
|
Pulse-echo principle
|
|
When the sound beam is perpendicular to the organ interface, ______ echoes are produced.
|
specular
|
|
When teh sound beam is not perpendicular to the organ interface, _______ is seen.
|
scatter
|
|
In acute hepatitis, overall echogenicity is _______ so that the porttal vein's borders stand out more brightly.
|
lowered
|
|
The strength of the returning echo is related to the ______ at which the beam strikes the acoustic interface.
|
angle
|
|
The more nearly _______ the beam is, the stronger the returning echo will be.
|
perpendicular
|
|
To demonstrate the borders of a body structure, the transducer must be placed so that the beam strikes the borders at a more-or-less ______ angle.
|
right
|
|
Acoustic impedance related to tissue ________.
|
density
|
|
The greater the difference in density between two trustures is, the _______ the returning interface echoes.
|
stronger
|
|
The bright interface at the diaphragm is due largely to differences in acoustic ________ compared w/ the liver.
|
impedance
|
|
Transducers come in many different frequencies but typically these five -
|
2.5
3.5 5 7 10 |
|
What happens to the sound beam beyond the focal zone?
|
It widens
|
|
A one-dimensional image displaying the amplitude strength of the returning echo signals along the vertical axis and teh time (and, thererfore, the distance from the transducer) along the horizontal axis.
|
A-Mode (Amplitude Modulation)
|
|
A type of phased array transducer utilizing several concentric ring-shaped elements. Not commonly used in modern equipment.
|
Annular Array
|
|
Depth axis. Resolution along the axis of hte ultrasound beam. Represents the smallest spacing required between two reflectors to be resolved as independent reflectors.
|
Axial
|
|
A method of displaying the intensity (amplitude) of an echo by varying the brightness of a dot to correspond to echo strength. Real0time scanners are baseed on B-mode.
|
B-Mode (Brightness Modulation).
|
|
The ability to steer the beam of a linear transducer to the left or right in two-dimenionssal (2D) (grayscale) imaging.
|
Beam Steering
|
|
The system memory stores the most recent sequence of image frames before the freeze button is pressed. The operator can then review teh sequence of images frame by frame or in real time.
|
Cine Loop
|
|
The term used to describe the monitor on which thh image is displayed
|
Cathode Ray Tube (CRT)
|
|
Linear array transducers with a curved scan head. Focusing is electronically controlled. Useful in abdominal and obstetric/gynecologic imaging.
|
Curved Linear Transducer (Curved Array)
|
|
Material attached to the back of the transducer crystal to decrease ring time (continued vibration of the crystal after the internal responses).
|
Damping Material
|
|
Term used to describe the capture and storage of a cine loop of images. Allows review a real-time clip after the exam is ended.
|
Dynamic Clip
|
|
The ability to select focal zones at different depths throughout the image. As the number of focal zones increases, the frame rate decreases.
|
Dynamic Focusing
|
|
The range of signals that a system's components can process. Relates echo amplitude to the assigned grayscale value. Unit of measure is decibels (dB).
|
Dynamic Range
|
|
Each element, or group of elements, within a transducer is pulsed seeparately to focus the beam at a particular area of interest. Used in array technology of all types.
|
Electronic Focusing
|
|
High-frequency transducer that is designed to be used for endorectal as well as endovaginal imaging.
|
Endocavity Transducer
|
|
High-frequency transducer that is placed into the rectum to evaluate the prostate and rectal wall. Some probes have both longitudinal and transverse transducers mounted on the same probe head (biplane transducers).
|
Endorectal Transducer
|
|
A high-frequency probe, which is introduced into the vagina for evaluating the pelvic organs.
|
Endovaginal Transducer
|
|
The act of narrowing the ultrasound beam to a small width (slice thickness). Image detail increases within the narrowed region.
|
Focusing
|
|
Term used to describe the portion of the transducer that is in contact with the patient.
|
Footprint
|
|
Rate at which the image is refreshed in a real-time system display. Frame rate varies with system settings such as focal zones, depth of the image display, preprocessing settings, and image width.
|
Frame Rate (Image Rate).
|
|
Control that stops a moving realtime image for photography or prolonged evaluation.
|
Freeze frame
|
|
A transducer with many small electronically coordinated elements oriented slide by side, producing a rectangular image. Useful in small parts, intraoperative, and vascular imaging between the ribs, making abdominal imaging difficult.
|
Linnear Array
|
|
Minimizes the difference in acoustic impedance between the transducer crystal and skin.
|
Matching Layer
|
|
The physical movement of the element or mirror that causes the sound beam to sweep through the tissue, providing a real-time image.
|
Mechanically Steered Transducer
|
|
Term used for the TV display
|
Monitor
|
|
Utilize multiple rows of transducer elements fired in sequence to improve imaging slice thickness
|
Multi-D Array Transducer
|
|
The ability to cycle between two or more sending frequencies within a given transducer
|
MultiHertz
|
|
The TV display screen. Not used in modern equipment. May be found on dedicated A-mode machines.
|
Oscilloscope
|
|
Electronically steered system in which many small elements are electronically coordinated to produce a focused wavefront. Used in curved linear, linear, sector, and phased-array transducers.
|
Phased Array
|
|
Type of imaging in which many frames are run together to create a cinematic view of the tissue.
|
Real-Time (Dynamic) Imaging
|
|
Length of time that a transducer crystal vibrates after it has been activated.
|
Ring-time
|
|
A device that gathers all of the signals and organizes them on the basis of their location to give a 2D display.
|
Scan Converter
|
|
Transducer with a small head that produces a pie-shaped image. May be a mechanical or phased array.
|
Sector Scanner
|
|
Small footprint transducer that utilizes the entire transducer face to form the image. Produces a trapezoid image with a larger field of view than the traditional sector.
|
Vector Array
|
|
Allows a linear transducer to be displayed as a trapezoidal image format. Increases the field of view of a linear transducer for easier measurements and display of larger regions of interest.
|
Virtual Format Imaging
|
|
The most basic form of diagnostic ultrasound in which a single beam of ultrasound is analyzed. Almost obsolete now.
|
A-mode
|
|
Because sound traveling through a fluid-filled structure is barely attenuated, the structures distal to a cystic lesion appear to have more echoes than neighborhing areas. Also referred to as through transmission.
|
Acoustic Enhancement
|
|
Without internal echoes. Not necessarily cystic unless there is distal echo enhancement.
|
Anechoic
|
|
A structure that has both fluid-filled (echo-free) and solid (echogenic) areas.
|
Complex
|
|
On the other side of the body
|
Contralateral
|
|
Spherical, fluid-filled structure with well-defined walls that contains few or no internal echoes and exhibits good acoustic enhancement.
|
Cyst
|
|
In ultrasonography, the word cystic does not necessarily refer to a cyst. The term is used inaccurately by some to describe any fluid-filled structure (e.g., urine-filled bladder or bile-filled gallbladder).
|
Cystic
|
|
The extremity (limb) end of a body structure.
|
Distal
|
|
Describes a structure that produces echoes. Usually a relative term. The pancreas is slightly more than the liver.
|
Echogenic
|
|
Term usfed by some to describe an ultrasonic exam, especially in cardiac work; an echocardiogram is frequently referred to as an "echo."
|
Echogram
|
|
Without internal echoes; not necessarily cystic.
|
Echolucent
|
|
A few echoes within a structure; less echogenic. The normal kidney is echopenic relative to the liver.
|
Echopenic
|
|
Interface between two fluids w/ different acoustic characteristics. This interface has a horizontal level that varies w/ patient position.
|
Fluid-fluid level
|
|
Descriptive term for the amount of transducer face in contact with the patient (a small-head transducer has a small footprint).
|
Footprint
|
|
The strength of the echoes throughout the image can be varied by changing the power output from the system.
|
Gain
|
|
Of uniform composition. The normal texture of several parenchymal organs is homogeneous (liver, thyroid, and pancreas).
|
Homogeneous
|
|
Strong echoes that delineate the boundary of organs and that are caused by the diference between the acoustic impedance of two adjacent structures. An interface is usually more pronounced when the transducer is perpendicular to it.
|
Interface
|
|
On the same side of the body
|
Ipsilateral
|
|
Of the same echogenicity as a neighboring area, but not necessarily of hte same texture
|
Isoechoic
|
|
Artifactual echoes resulting from too much gain rather than from true anatomic structures.
|
Noise
|
|
The trunk end of a limb or organ
|
Proximal
|
|
An artifact that results from a strong echo returning from a large acoustic interface to the transducer. This echo returns to the tissues again, causing additional echoes parallel to the first.
|
Reverberation
|
|
Extreme form of reverberation artifact that occurs when a long series of echoes caused by a very strong acoustic interface and consequent reverberations are seen.
|
Ring down
|
|
Failure of the sound beam to pass through an object. This blockage is caused by reflection or absorption of the sound and may be partial or complete. For example, air bubbles in the duodenum allow poor transmission of the sound beam because most of the sound is reflected. A calcified gallstone does not allow any sound to pass through, and shadowing is pronounced.
|
Shadowing
|
|
A mass or organ that contains uniform low-level echoes because the cellular tissues are acoustically very similar.
|
Solid (Homogeneous)
|
|
A structure that transmits sound poorly. A dense structure can attenuate sound to greatly that the back wall is poorly defined.
|
Sonodense
|
|
Handsome ultrasound image, such as a good example of vascular anatomy
|
Sonogenic
|
|
A physician who specializes in ultrasonography and has appropriate training
|
Sonologist
|
|
Without echoes. Not necessarily cystic unless there is good through transmission.
|
Sonolucent (Anechoic)
|
|
Structure that creates a strong echo because it interfaces at right angles to the sound beam and has significantly different acoustic impedance from a neighborhing structure (e.g., diaphragm/liver or posterior bladder wall/bladder).
|
Specular reflector
|
|
Not real time. B-scans produced with a fixed-arm system. Obsolete technique.
|
Static Scan
|
|
The echo pattern within an organ; could be homogeneous or irregular.
|
Texture
|
|
The amount of sound passing through a structure. Same as acoustic enhancement.
|
Through Transmission
|
|
Term used to indicate the amount of sound passing through a mass or cyst, usually qualified as good or poor. Same as acoustic enhancement.
|
Transonicity
|
|
A position in which a recumbent patient is tilted so that the feet are higher than the head
|
Trendelenburg
|
|
Structure lying toward the front of the patient
|
Anterior or Ventral
|
|
Awy from the origin
|
Distal
|
|
Terms denoting a structure closer tothe patient's feet
|
Inferior or Caudal
|
|
Structure lying away from the midline
|
Lateral
|
|
Structure lying toward the midline
|
Medial or Mesial
|
|
Structure lying toward the back of the patient
|
Posterior or Dorsal
|
|
The patient lies on his or her stomach
|
Prone
|
|
Nearer to the center of the body
|
Proximal
|
|
The abdomen is divided into four quarters, each known as a __________.
|
quadrant
|
|
Interchangeable terms denoting a structure closer to the patient's head
|
Superior, Cranial, or Cephalad
|
|
The patient lies on his or her back.
|
Supine
|
|
When the image is taken from the patient's side, whether he or she is decubitus or supine, if you are scanning the abdomen.
|
Coronal
|
|
The beam should be as _________ as possible to the structure as possible.
|
perpendicular
|
|
Two advantages of shape-sector or small footprint scanner
|
Useful for areas of small access: between ribs, through a urinary bladder, through a fontanelle.
Good for angling up under or for wedging in between tight spots. |
|
One disadvantage of shape-sector or small footpring scanner
|
The wedge-shaped image gives you a limited near field of view
|
|
Three advantages of curved linear array
|
Much bigger field of view, good for large structures and overviews.
Near field is wider than sector Useful for second- and third-trimester obstetric patients, anywhere in abdomen that it will fit |
|
Three disadvantages of curved linear array
|
Larger transducer face than sector, may not fit in acoustic window
May acquire artifacts along sides of image due to poor contact Near field is still more limited than linear array, but not by much, so it is the most popular transducer design. |
|
Two advantages of Linear Array
|
"Block" shape of image allows for large field of view in superficial areas; excellent for small parts, renal transplants, subfacial hematomas, etc.
Possible to hook up two images to form one very large field of view in cases when it is important not to extrapolate measurements. |
|
Two disadvantages of Linear Array
|
Can only be used when there is a large window, such as in the midline or in a pregnant uterus. Cannot get between ribs.
Even where there are no ribs, the flat surface of the transducer makes it difficult to angle around pockets of gas or small windows. |
|
Five advantages of using Endovaginal transducer
|
No full bladder needed
Better resolution because decreased distance allows higher frequency Good way to assess cervix w/o distortion caused by full bladder Can see anatomy and fetal heart motion sooner than transabdominally Using the transducer as a palpating tool allows recognition of the source of pain |
|
Two disadvantages of using Endovaginal transducer
|
Limited field of view (difficult to visualize a fibroid or large ovarian mass).
More invasive; |
|
If a tumor doesn't "light up" with color, it may still be a vascular tumor with _____-velocity flow.
|
low
|
|
If you can't duplicate a "lesion", maybe it was a(n) _______ in the first place.
|
artifact
|
|
Contrast media are not readily available except in this field of sonography.
|
Echocardiography
|
|
The bladder should be __________ to provide an acoustic window to the pelvic structures in patients undergoing a transabdominal pelvic scan. Outpatients should be instructed to drink enough fluid - at least _____ ozs - to make their bladder slighlty uncomfortable at the time of the exam.
|
distended
16 |
|
Inpatients instructed to ingest nothing by mouth require alternative arrangements: an indwelling ______ catheter can be clamped ahead of time.
|
Foley
|
|
For ________ transabdominal obstetric scans, the bladder should be distended enough to visualize the lower uterine segments.
|
early
|
|
After _______ weeks, the bladder should be empty to properly evalaute the cervix and its relationship to the placenta.
|
20
|
|
Ao
|
Aorta
|
|
Azv
|
Azygous vein (ascending lumbar vein)
|
|
Ca
|
Celiac artery
|
|
CBD
|
Common bile duct
|
|
CHa
|
Common hepatic artery
|
|
CHD
|
Common hepatic duct
|
|
Cla
|
Common Iliac artery
|
|
Cr
|
Crus of the diaphragm
|
|
Du
|
Duodenum
|
|
GBI
|
Gallbladder
|
|
Gda
|
Gastroduodenal artery
|
|
Hea
|
Hepatic artery
|
|
Hev
|
Hepatic Vein
|
|
IMa
|
Inferior mesenteric artery
|
|
IMv
|
Inferior mesenteric vein
|
|
K
|
Kidney
|
|
L
|
Liver
|
|
LGa
|
Left gastric artery
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LGv
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Left gastric vein
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LHev
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Left hepatic vein
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LPv
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Left portal vein
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LRa
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Left renal artery
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LRv
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Left renal vein
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MHev
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Middle hepatic vein
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P
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Pancreas
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PHa
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Proper hepatic artery
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Ps
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Psoas muscles
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Pv
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Portal vein
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QL
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Quadratus lumborum
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RA
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Rectus abdominis
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RGv
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Right gastric vein
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RHev
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Right Hepatic vein
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RPv
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Right portal vein
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RRa
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Right renal artery
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RRv
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Right renal vein
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S
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Spine
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SGv
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Splenogastric vein
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SMA
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Superior mesenteric artery
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SMV
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Superior mesenteric vein
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Spa
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Splenic artery
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Spv
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Splenic vein
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St
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Stomach
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Main trunk of the arterial system.
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Aorta
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The aorta lies ________ to the spine and bifurcates into the right and left _____ _____ arteries at the level of the umbilicus.
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anterior
common iliac |
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Arises just below the liver from the anterior aorta and is usually only 2 to 3 cm in length.
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Celiac Artery (axis, trunk)
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The Celiac Artery almost immediately divides into these 3 arteries.
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splenic
left gastric common hepatic |
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Seen in the inguinal region, these arteries arise from the iliac arteries and extend into the upper thigh.A branch - the profunda femoris - originates just below the inguinal ligament.
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Common Femoral Arteries
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These originate from the aorta at the level of the umbilicus and extend toward the groin. Less than 15mm in diameter at their origin is normal.
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Common Iliac Arteries
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The vessel arising from the aorta, closest to the diaphragm is the _______ artery.
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Celiac
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The celiac artery is a 1- to 2-cm trunk that bifurcates into these two arteries.
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splenic
common hepatic |
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The common hepatic artery bifurcates into these two arteries:
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proper hepatic
gastroduodenal |
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The SMA arises from the _______ surface of the aorta at a level just inferior to the celiac artery.
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anterior
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The less-frequently visualized left gastric artery originates from the ________ artery.
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celiac
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Originates from the common hepatic trunk and supplies the stomach and duodenum. It is a landmark delineating the anterolateral aspect of the head of the pancreas
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Gastroduodenal artery
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Originates from the celiac trunk and courses toward the liver. It branches into the proper hepatic artery and the gastroduodenal artery. Supplies the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
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Hepatic Artery (Common).
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A branch of the common hepatic artery that supplies the liver and gallbladder. It runs medial to the cbd and anterior to the portal vein into the liver within the porta hepatis.
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Hepatic Artery (Proper)
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Originates from the abdominal aorta close to the umbilicus. Supplies the left portion of the transverse colon, the descending and sigmoid colon, and part of the rectum. It is not usually visualized by ultrasound except at its origin.
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Inferior Mesenteric Artery
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Arises from the superior margin of the celiac axis and can be seen by ultrasound for only 1 or 2 cm; supplies the stomach
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Left Gastric Artery
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Originate from the abdominal aorta just below the level of the SMA. They supply teh kidneys, adrenals, as well as the ureters, and are often best seen when the patient is in the appropriate decubitus position. The left renal artery arises from the posterolateral wall of the aorta and enters the left renal hilum. The right arises from the posterolateral wall of the aorta, runs posterior to the IVC, and enters the right renal hilum
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Renal arteries, left and right
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The _______ artery outlines the anterolateral margin of the head of the pancreas, whereas the ______ marks the posterolateral margin.
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gastroduodenal artery
CBD |
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A normal variatn in which the right hepatic artery arises from the SMA, rather than the proper hepatic artery and celiac axis.
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Replaced Right Hepatic Artery
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Originates from the celiac trunk and courses superior to the body and tail of the pancreas. It primarily supplies the spleen.
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Splenic Artery
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Originates from the anterior abdominal aorta, just below the celiac axis and runs parallel to the aorta. It lies posterior to the body of the pancreas. Supplies the small bowel, cecum, ascending colon, and part of the transverse colon.
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SMA
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Lies posterior to the IVC and is not usually seen unless enlarged secondary to congestive heart failure or portal hypertension.
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Azygous Vein
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Accessory vessels that develop when portal vein pressure is increased (e.g., portal hypertension).These can be seen in the region of the pancreas, around the esophagogastric junction (anterior to the upper portion of the aorta), in the porta hepatis, and in the splenic hilum.
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Collaterals
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The junction of the superior mesenteric vein and splenic vein, which forms the main portal vein.
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Confluence
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Lie medial to the femoral arteries in the groin and upper thigh. They are normally larger than the arteries. These veins normally compress easily and do not pulsate.
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Femoral veins
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Drain the liver and empty into the IVC just below the diaphragm.
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Hepatic Veins
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Divides the liver into right anterior and right posterior segments
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Right hepatic vein
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Divides the left medial and left lateral segments of the liver.
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Left hepatic vein
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Divides the right and left lobes of the liver
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Middle hepatic vein
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The left, middle, and right hepatic veins can be imaged as they empty into the IVC just beneath the _______ _________.
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right diaphragm
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The main branch of the portal vein is seen in its extrahepatic location just ________ to the head of the pancreas.
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superior
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The right renal artery is visualized posterior to the ___
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IVC
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Courses to the left of the SMV to join the Splenic vein. It is usually too small to visualize by ultrasound. Drains the left third and upper portion of the colon.
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Inferior Mesenteric Vein
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Returns blood from teh lower half of the body and enters the right atrium of the heart. It is formed by the union of the iliac veins. A marked change in caliber can be appreciated with respirations.
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IVC
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Drains the left kidney. Runs anterior to the aorta and posterior to the superior mesenteric artery to enter the lateral wall of the IVC. The left renal vein is much longer than the right renal vein.
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Left Renal Vein
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The splenic vein and superior mesenteric vein join (at the confluence) to form the ______.
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main portal vein
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When the portal vein branches into the liver, it forms these two veins:
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left portal vein
right portal vein |
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Venous structures should dilate at the end of deep inspiration or _______. This maneuver can help confirm the venous nature of the vessels and enlarge the vessels to make it easier to image.
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Valsalva
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Drains blood from teh digestive tract and empties into the liver.
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Main Portal Vein
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The Main portal vein divides into the _______, which supplies blood to the left lobe of the liver and the _______, which supplies the right lobe of the liver.
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left portal vein
right portal vein |
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Portal veins characteristically run in triads with the ______ and _________ and branch away from the porta hepatis. They can be identified by their echogenic walls that occur due to acoustic reflection arising from the fibrous tissue that surrounds these triads.
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hepatic arteries
bile ducts |
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Courses along the falciform ligament. Connects the left portal vein to other collateral vessels near the umbilicus. This vein is only seen in the setting of portal hypertension.
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Paraumbilical Vein
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Drains the right kidney and enters the lateral wall of the IVC
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Right Renal Vein
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Drains the spleen. It runs posterior to the pancreas and joins the smv, thereby forming the main portal vein.
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Splenic Vein
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Drains the cecum, transverse and sigmoid colon, and small bowel. Courses anterior to the IVC to join the splenic vein just next to the confluence behind the head of the pancreas.
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SMV
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The portal vein branches into these two veins.
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left and right portal veins
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The gallbladder is ______ to the duodenum.
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lateral
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