Veterinary Radiology (3Rd Year) - Spring 2011 - Set #3 (Final)

Front 1

Which of these joints communicates?

-Antebrachiocarpal joint
-Middle carpal joint

Back 1

Middle carpal joint - communicates with the carpometacarpal joint

Front 2

On a flexed lateral view of the carpus, which carpal bone is "highest" in the proximal row? Which one drops?

Back 2

Intermediate carpal bone is high (remember, "I" is high or Intermediate Carpal bone moves Up - ICU).

The radial carpal bone drops

Front 3

Which carpal bone on the distal row drops down on a flexed lateral view?

Back 3

3rd carpal bone

Front 4

Which side is the accessory carpal bone on on a dorsopalmar view?

Back 4

On the lateral side.

Front 5

Starting at the accessory carpal bone, name the carpal bones next to it going from lateral to medial.

Back 5

Accessory, Ulnar, Intermediate, Radial carpal bone

Front 6

What features on a DLPMO view of the carpus tells you that you are looking at a DLPMO and not a DMPLO?

Back 6

L can be drawn on the splint bones and the distal row of carpal bones.

A DMPLO doesn't have an 'L' and the 2nd carpal bone is on top of the splints.

Front 7

On a skyline view of the distal row of carpal bones, which bone is the biggest (it is often in the middle)?

Back 7

The 3rd carpal bone. The 2nd carpal bone is medial, the 4th carpal bone is lateral.

Front 8

What two things happen to the 3rd carpal bone?

Back 8

Fractures
Sclerosis

Front 9

List the angle at which the machine is held when shooting the following carpal skyline films:
-Skyline of distal row
-Skyline of proximal row
-Skyline of distal radius

Back 9

-Skyline of distal row: 35 degrees
-Skyline of proximal row: 55 degrees
-Skyline of distal radius: 85 degrees

Front 10

T/F The craniodistal radius (of the carpus) gets kissing lesions on the medial side caused by overextension injuries.

Back 10

True.

Front 11

What is the difference between an osteophyte and an enthesiophyte?

Back 11

Osteophyte: DJD associated with bones at the level of the joint

Enthesiophytes: DJD associated with ligament or soft tissue attachments

Front 12

**Where are the two most common places that chip fractures occur in the carpus?**

Back 12

-Dorsomedial aspect of the radial carpal bone
-Proximal aspect of the intermediate carpal bone

-May need flexed lateral or skyline of proximal row to distinguish

Front 13

What is a slab fracture?

**Where is the most common place to get a slab fracture in the carpus?

Back 13

Slab fracture involves the proximal and distal articular surfaces

**Dorsal aspect of the third carpal bone**

Front 14

T/F The proximal intertarsal joint communicates with the talocrural joint.

Back 14

True.

Front 15

T/F The Tarsometatarsal joint communicates with the DIJ <25% of the time.

Back 15

True.

Front 16

T/F The 1st and 2nd tarsal bones are fused.

Back 16

True.

Front 17

(1) How can you tell a tarsus DMPLO from a tarsus DLPMO besides the marker?

(2) **Which view is better for viewing DIRT lesions?

Back 17

(1) -The lateral trochlear ridge of the tarsus (LARRY'S NOSE) is seen on the DMPLO.
-The sustentaculum tali is seen on the DMPLO

-No LARRY'S NOSE on the DLPMO view

(2) DMPLO is best for DIRT lesions (distal intermediate ridge of the tibia)

Front 18

What two joints are most commonly affected by bone spavin?

Back 18

Distal intertarsal joint or tarsometatarsal joint

Front 19

What should you write on the exam if you suspect a DIRT lesion on the tibia?

Back 19

Subchondral bony defect on the distal intermediate ridge of the tibia
-include how many fragments, size, etc

Front 20

**What structures attach to the calcaneus?

Back 20

Gastrocneumius and soleus tendons insert onto the calcaneus

Front 21

T/F Tarsal bone collapse in young horses is caused by incomplete cuboidal bone ossification.

Back 21

True.

Front 22

**What are the next most common places that OCD of the tarsus occurs (other than DIRT lesions)?

Back 22

-Lateral trocheal ridge of talus
-Medial trochlear ridge of talus (less common)
-Medial malleolus (less common) of tibia

Front 23

T/F The femoropatellar joint and medial femorotibial joint don't usually communicate.

Back 23

False. They do usually communicate.

Front 24

**Where does OCD occur in the stifle?

Back 24

Lateral trochlear ridge of the femur
-take a lateral view and/or caudal- lateral-cranial medial oblique.

Front 25

What two types of horses does lateral patella luxation occur in?

Back 25

Foals
Miniature horses

Front 26

T/F Upward fixation of the patella is NOT usually a radiographic diagnosis.

Back 26

True. Is a clinical diagnosis.

Front 27

**Where do horses get calcinosis circupscripta?

Back 27

Lateral aspect of the stifle, adjacent to the tibia. These horses will have a visible enlargement of the region. Can remove it surgically.

Front 28

**Cows get _______ septic arthritis and _____________.

Back 28

Cows get DIJ (distal interphylangeal joint) septic arthritis and sequestrums.

Front 29

**T/F Bone islands are of no clinical significance.

Back 29

True.

Front 30

List 5 strengths of ultrasonography.

Back 30

(1) Determining origin of abd. mass
(2) Evaluation of organ parenchyma
(3) Fetal viability
(4) Real time scanning - see movement/motion
(5) Aid with fine needle aspiration or biopsy

Front 31

T/F Ultrasound can't penetrate bone but can penetrate gas.

Back 31

False. Cannot penetrate either.

Front 32

T/F Probes transmit 1% of the time and receive 99% of the time.

Back 32

True.

Front 33

What is the acoustic impedance of most soft tissues? Bone?

Back 33

1400-1600m/sec for ST
4080 for bone
330 for air

Front 34

**(1) As frequency ___________, resolution improves

**(2) As frequency ___________, depth of penetration decreases

Back 34

(1) As frequency INCREASES, resolution improves

(2) As frequency INCREASES, depth of penetration decreases

Front 35

What shape of beam does a sector scanner produce?

Back 35

Fan shaped beam - small surface required for contact

Front 36

What shape of beam does a linear scanner produce?

Back 36

Rectangular beam - large contact area required

Front 37

T/F Gain on the ultrasound machine is the amplification of returning echoes and determines the overall brightness of the picture.

Back 37

True.

Front 38

T/F It is better to have a low MHz scanner to see structures deep within the abdomen of a horse.

Back 38

True.

Front 39

T/F 12MHz would be a good choice for scanning horse tendons.

Back 39

True. Don't have to penetrate very far and has high resolution.

Front 40

Which mode of ultrasound is used most often?

Back 40

B mode (brightness)

Front 41

What is A mode ultrasound used for?

Back 41

Ophtho

Front 42

What is M mode ultrasound used for?

Back 42

Motion - cardiology mainly

Front 43

Name a classic example of a reverberation artifact in the GI tract.

Back 43

Internal echoes created by superficially located gas-filled bowel segments and the contact artifact created by interposition of highly reflective (air) between the probe and the patient.

Front 44

Where does the mirror image artifact commonly occur?

Back 44

Liver, diaphragm, gall bladder. When echoes bounce back and forth between two interfaces, the return to the transducer time is extended and a second image of the structure is placed deeper than it really is.

Front 45

What does a comet tail artifact look like?

Back 45

Multiple bright streaks/bands deep to the reflective structure. An example is a gas bubble.

Front 46

What is acoustic shadowing?

Back 46

Failure of the US beam to pass through an object because of reflection and or absorption of the beam. Will see acoustic shadowing when scanning near cystic calculi, lung, or bone.

Front 47

T/F On ultrasound, gas will have a "clean shadow" and bone will have a "dirty shadow."

Back 47

False. Gas has a "dirty shadow" due to more beam reflected and bone has a "clean shadow" due to more beam abdorbed. Shadow is due to reflection, reverberation, or both.

Front 48

T/F Acoustic enhancement occurs distal (ventral) to objects with very low attenuation such as fluid filled cavities.

Back 48

True. Hyperintense signal areas relative to the adjacent tissues not under the cavities occurs.

Front 49

What is a "side-lobe" artifact?

Back 49

Lateral displacement of structures not aligned with the sound beam. Produced by minor beams traveling in different directions from the primary beam (side lobes).

Front 50

What is a slice thickness artifact?

Back 50

A variant of the side-lobe artifact which mimics the presence of sediment in the gallbladder or bladder, also called pseudosludge. The surface of the pseudosludge is curved whereas true sediment has a flat interface.

Front 51

_____________ is a structure which is of low echogenicity, it will appear blacker.

Back 51

Hypoechoic

Front 52

_____________ is a structure which is of equal echogenicity to a second structure.

Back 52

Isoechoic

Front 53

___________ is a structure which is of higher echogenicity (appears whiter) than a comparable structure.

Back 53

Hyperechoic

Front 54

T/F The spleen is of a higher echogenicity to the liver.

Back 54

True.

Front 55

The dot should point to the _______ when taking a transverse image of an organ and should point to the ________ when taking a saggital image.

Back 55

Dot to the right - transverse
Dot to the head - saggital

Front 56

T/F Normal abdominal ultrasound imaging indicates that the organs are normal.

Back 56

False!!! May just not detect change even though change is present. Do an FNA if suspect disease.

Front 57

What two structures does Dr. Pack never aspirate?

Back 57

Adrenals
Gall bladder

Front 58

What 3 structures does Dr. Pack occasionally aspirate?

Back 58

Kidneys
Pancreas
Urinary bladder masses

Front 59

Portal veins of the liver have ________ walls. Hepatic veins appear as ______ _______.

Back 59

Portal veins of the liver have ECHOGENIC walls. Hepatic veins appear as BLACK TUBES (have no walls).

Front 60

What might you suspect is going on if you saw very large hepatic veins on ultrasound (big black tubes)?

Back 60

Right heart failure

Front 61

T/F Hepatic arteries are routinely seen on ultrasound.

Back 61

False. Are NOT seen.

Front 62

Echogenicity:
Dog - ______ > liver > _______
Cat - _______ = ______ > ______

Back 62

Dog: spleen>liver>kidney
Cat: spleen = liver>kidney

Front 63

Where in the liver are hepatic veins best visualized on US?

Back 63

Cranially, near the diaphragm (emptying into the vena cava).

Front 64

Why are portal veins more visable than hepatic veins on ultrasound?

Back 64

Surrounded by fibro-fatty tissue.

Front 65

T/F The spleen won't often show you that something is obviously wrong with it on ultrasound.**

Back 65

False. The liver will often NOT show you something is wrong with it, the spleen WILL show you.

Front 66

What are 3 examples of diffuse hyperechoic changes of the liver on US?

Back 66

Hepatic lipidosis
Chronic hepatitis
Fibrosis/cirrhosis
Steroid hepatopathy

Front 67

T/F Liver cysts have thin, well-defined walls, no internal echos, and sharp distinct borders.

Back 67

True. Also have acoustic enhancement.

Front 68

T/F Liver hematomas have mixed echogenicity.

Back 68

True. The echogenicity changes with age. Acute = echogenic, then anechoic or hypoechoic until clot occurs.

Front 69

T/F You can diagnose liver nodular hyperplasia with US alone.

Back 69

False. Can't differentiate using U/S alone, biopsies are indicated.

Front 70

**The halo sign of the gall bladder is associated with what?

Back 70

Gall bladder wall edema

Front 71

Large dogs get _____________ shunts and small dogs get ____________ shunts.

Back 71

Large dogs - intrahepatic
Small dogs - extrahepatic

Front 72

**If you saw a kiwi-shaped extension in the gall bladder with US, what would suspect it is?

Back 72

Gallbladder mucocele - Dr. Pack loves to diagnose these and testicular lesions the best on US

Front 73

**What breed of dogs get gall bladder mucoceles?

Back 73

Cocker spaniels

Front 74

If you see a spaceship-looking spleen on US what might you suspect?

Back 74

Splenic mass

Front 75

T/F The normal size of the spleen is variable, even on ultrasound.

Back 75

True.

Front 76

**What is the whale tail sign of the spleen?

Back 76

Splenic hilus

Front 77

Besides the capsule and parenchyma of the spleen, what other structure is normally visualized?

Back 77

Splenic veins

Front 78

What are 5 examples of diffuse decrease in echogenicity of the spleen on US?

Back 78

(1) Congestion
(2) Extra-medullary hematopoesis
(3) Lymphosarcoma
(4) Inflammation/septicemia
(5) Torsion

Front 79

T/F Normal echogenicity of the spleen can occur with lymphoma and mast cell tumors.

Back 79

True.

Front 80

If you saw a spleen on US that was hypoechoic, coarse and "lace-like" in appearance, what would you consider as a diagnosis?

Back 80

Splenic torsion
-although lymphoma can appear similar

Front 81

T/F You can differentiate between hematoma, hemangioma, and hemangiosarcoma on US but not on radiographs.

Back 81

False. Cannot differentiate, need surgery or biopsy to determine which of the three it is.

Front 82

T/F Lymphoma in the spleen looks more cavitated in appearance with fluid pockets when compared to hemangiosarcoma.

Back 82

False. Lymphoma looks like measles in the spleen (multiple hypoechoic pattern). Hemangiosarcoma is more cavitated in appearance.

Front 83

T/F Biopsy of the spleen is commonly performed.

Back 83

False. Not a good idea. Fine needle aspirate may be useful for mast cell tumors and lymphoma because they tend to exfoliate sometimes.

Front 84

T/F Hemangiosarcomas often cause splenic rupture but you cannot rule out hematomas.

Back 84

True.

Front 85

What type of transducer (ie what range of frequency) should you use to scan the urinary bladder?

Back 85

High resolution transducer (7-12MHz)

Front 86

**What commonly occurs (disease processes) in the following parts of the bladder:

Apex -
Body -
Trigone -

Back 86

Apex - cystitis
Body - calculi
Trigone - masses (TCC)

Front 87

**What is the bladder wall thickness normally in a dog? Cat?

Back 87

Dog - 1.6mm
Cat - 1.7mm

Front 88

T/F Transitional cells of the bladder can change shape based on whether or not the bladder is empty.

Back 88

True. Cuboidal when empty makes bladder wall look thicker than it really is.

Front 89

If you suspect emphysematous cystitis if occurring in a patient, what underlying disease should you investigate for?

Back 89

Diabetes - BOARDS

Front 90

If you are concerned that you are not seeing a mass in the trigone region of the bladder of a dog that has just peed, what can you do?

Back 90

Give lasix, wait 30min and scan again. It is best to see these at moderate distention.

Front 91

What do urinary bladder polyps look like on US?

Back 91

Stalked mass arising from the bladder wall, like a mushroom.

Front 92

T/F The length of the kidney of a dog in a saggital plane (US) is subjective and depends on the size and weight of the dog.

Back 92

True.

Front 93

What is the normal length of a kidney of a cat in a saggital plane on US?

Back 93

2.8-4.2 cm (roughly 3-4cm)

Front 94

For echogenicity of the kidney on US, what is the order from blackest to brightest for the following structures:

-Cortex
-Pelvis
-Medulla

Back 94

Medulla>cortex>pelvis (brightest)

Front 95

Which view (transverse or saggital) is best for viewing the renal pelvis?

Back 95

Transverse view

Front 96

**What are two possible causes of increased kidney size?

Back 96

Acute inflammation
Infiltrative disease (amyloidosis, lymphoma)

Front 97

**What is 1 possible cause of decreased kidney size?

Back 97

Chronic renal failure (nodular and irregular)

Front 98

What two breeds of cats get renal cysts?

Back 98

Persians
Himalayans

Front 99

What are three possible causes of diffuse hypoechoic changes in the kidney on US?

Back 99

(1) Lymphoma
(2) Edema
(3) inflammation

Front 100

What are 6 possible causes of diffuse hyperechoic changes to the kidney on US?

Back 100

(1) Lymphoma
(2) Interstitial nephritis
(3) Amyloidosis
(4) Fibrosis
(5) Nephrocalcinosis
(6) Ethylene glycol toxicity

Front 101

What type of neoplasia is usually responsible for a large focal mass of the kidney causing capsular distention?

Back 101

Adenocarcinoma