Abdomen Review Book Questions

Front 1

What ligament forms the caudal border of the left portal vein? What segments does this ligament divide the liver into?

Back 1

ligamentum teres
-divides the left lobe into medial and lateral segments

Front 2

what should you look for with high levels of AFP? What other abnormalities associated w/ high levels of AFP?

Back 2

hepatocelluar carcinoma
-other abnormalities w/ high AFP include germ cell tumors, Pancreatic CA(ocasionally), stomach CA< or biliary CA.

Hepatitis and Cirrhosis may produce modest serum AFP elevations

Front 3

what location is focal fatty liver most commonly found?

Back 3

-anterior to the portal vein at the porta hepatis

Front 4

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 fiting this discription?

Back 4

-cavernous hemangioma

Front 5

T/F fatty liver is irreversable

Back 5

false

Front 6

why would narrow hepatic vein lumens, and high velocities within the Hepatic veins occur with cirrhosis?

Back 6

-Since the walls are thin, they may be compressed with cirrhosis progression.
-this, in turn causes an increase in the velocities

Front 7

what is the most common benign tumor of the liver?

Back 7

-cavernous hemangiomwa

Front 8

which of the following s most commonly associated with invasion of the portal vein?
-hepatocellular carcimoma
-cavernous hemangioma
-liver mets
-hepatic adenoma
-focal nodular hyperplasia

Back 8

-hepatocellular carcimoma

Front 9

How do you tell the difference btw tumor invasion of the portal vein, and portal vein thrombosis?

Back 9

Tumor:
-low resistant arterial flow in a fine network within veinYou

Thrombus:
-no flow within thrombus.

Front 10

You have been asked to perform a liver sonogram on a patient with AIDS. Which of the followig tumors is most commonly associated with this history?
-HCC
-Kaposi's sarcoma
-Budd Chiari
-Hemaniosacoma
-hepatic adenoma

Back 10

Kaposki's sarcoma

Front 11

A liver mets mass is markedly heterogenous and contains nCumerous calcified lesions. Where is the most likely source of the primary tumor?

Back 11

Calcified mets is most commonly associated with Adenocarcinoma of the colon.

Front 12

What do mets from the colon, breast, lung, lymphatics, and the ovary tend to look like?

Back 12

-Mets from an adenocarcinoma of the colon tends to look calcified and heterogenous.
-Mets from the breast, lung, and lymphoma tend to be hypoechoic.
-Cystic mets may occur from cystadenocarcinoma of the ovary or pancreas.

Front 13

You are scanning a patient with a history of liver transplantation. You should search for all of the following complications of this surgery except:
-biliary sludge
-aructe cholecystitis
-portal vein stenosis
-hepatic artery thrombosis
-liver malignancy

Back 13

Don't bother searching for cholecystitis because they routinely remove the GB with a liver transplant.

Front 14

What LFT is specifically increased with HCC?

Back 14

AFP

Front 15

What patients are more likely to develop HCC?

Back 15

any patient with chronic liver disease(cirrhosis, hepatitis) has a higher chance of developing HCC

Front 16

What 2 vessels does a TIPS shunt connect?

Back 16

portal vein and hepatic vein

Front 17

You are scanning a patient with portal hypertension. Enlargement of which of the following structures is diagnositc of this condition?
-coronary vein
-hepatic vein
-renal vein
-CBD
-ligamentum teres

Back 17

The coronary vein, or left gastric vein normally empties flow from the esphageal veins into the splenic vein. It can become dialated with portal hypertension. Flow direction may become reveresed forming dangerous esophageal varicies.

Front 18

Where, on U/S can we demonstrate the coronary vein?

Back 18

-A sagital veiw of the splenic vein near the midline will usually demonstrate the coronary vein.

Front 19

What anatomic landmark can help to locate the GB fossa?

Back 19

-interlobar hepatic fissure

Front 20

What 3 artifacts do you see in the GB? What do they appear as? How can they be managed?

Back 20

Reverberation:
-anterior GB
-multiple bands of equal spacing
-using an u/s window that includes anterior liver tissue can reduce reverb.

Side lobe:
-can be seen anywhere in GB
-hazy in nearfield, or more lineear in midportion of GB.
-Changing sonographic window, or repositioning focal zones may help

Slice thickness:
-low level echos at the edges of GB lumen
-can be reduced by using a transducer with at thinner beam or by readjusting the scanning plane so the gb falls at the point of mechanical focusing.

Front 21

What is the most frequent cause of sludge? When can it occur?

Back 21

bile stasis; can occur in patients who undergo prolonged fasting or hyperalimentation

Front 22

What is the clinical significance of sludge.

Back 22

-uncertain, but sludge balls have been seen to develop into gallstones

Front 23

What is the most likely cause of echogenic foci within the GB wall that have associated comet tail or v-shaped reverb artifacts?

Back 23

-Ademomyomatosis: it is a form of hyperplastic cholecystosis.
-it usually is asymptomatic and characterized by small mucosal herniations into the muscular layer of the GB wall.

Front 24

what GB pathology are Rokitansky-Aushoff sinuses associated with?

Back 24

-Adenomyomatosis
-can appear as cystic spaces if filled with bile, or if fileld with cholesterol deposits, they will appear as echogenic foci with a v-shaped distal reverb artifact.

Front 25

What lab work would aid in differnetiation of an intrahepatic vs. extrahepatic cause of Jaundce?

Back 25

serum billirubin

Front 26

What is the best position to put a patient in to see the distal CBD? why?

Back 26

Right decubitus because it lessens the interference from bowel gas.
-LLD is helpful in demonstrating the GB, or prox CBD, but to see the pancreatic portion of the duct, a RLD with help.

Front 27

what are patients with a porcelin GB at increased risk for?

Back 27

GB carcinoma

Front 28

Which of the following would be caused by a ston lodged in the distal CBD?:
-aortic anurysm
-portal vein aneurysm
-portal hypertension
-acute pancreatitis
-choledochal cyst

Back 28

acute pancreatitis

Front 29

What is the name of the main pancreatic duct? what is the name of tha accosory pancreatic duct?

Back 29

main=duct of wirsung
accessory=duct of santorini

Front 30

what is pancreatic divism

Back 30

when the two pancreatic ducts have not fused

Front 31

which structure can be seen coursing transveresly at the level of the upper pancreatic head

Back 31

the left renal vein

Front 32

why is color doppler useful to use on a patient whin pancreatitis?

Back 32

-to confirm patency of the splenic, portal, superior mesenteric and hepatic vessels
-improve detectibility of psudoaneurysms

Front 33

what is the surgery of choice for pancreatic cancer?

Back 33

whipple procedure

Front 34

what is the most common appearance of pancreatic adenocarcinoma?

Back 34

-hypoechoic mass in the ehad of the pancreas
-hyperechoic masses may occur in cases with concomitant chronic pancreatitis

Front 35

where should you look for the pancreas after a pancreatic transplant?

Back 35

iliac fossa

Front 36

a nonencapsulated collecction of necrotic and edematous perpancreatic tissues is termed what?

Back 36

phlegmon

Front 37

what is the most common type of istlet cell tumor

Back 37

insulinoma

Front 38

what is the typical presentation and appearnce of insilinoma?

Back 38

-usually benign and occur in the 4th-6th decade of life
-usually a solitary well-defined hypoechoic tumor in the body and tail of the pancreas.

Front 39

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

Back 39

posterior and caudal

Front 40

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

Back 40

celiac trunk

Front 41

when imaging the pancreas, which vessel do you routinely vsualize at the posterior border of the pancreatic head

Back 41

IVC

Front 42

during insonation of the pancrease, you routinely image a vessel coursing aterior the the uncinate process. What is this vessel?

Back 42

SMV

Front 43

you have obtained a sagital image of the pancreatic head and detect a small tubular structure coursing cephalocaudad anterior to the pancreas. What is this structure?

Back 43

gastroduodenal artery

Front 44

you are scanning a 31 yr old patient with hypertension and impared renal function. You detect enlarged kidneys with cysts that are too numberous to count. Which of the following is most likely?
-MDK
-multicystic disease
-Polycystic kidney disease
-parapelvic cysts
-multiple simple cysts

Back 44

APKD
-none of the other entities mentioned with result in enlargement of the kidney

Front 45

any solid mass in the kidney should raise suspician for what?

Back 45

RCC

Front 46

if you see a solid mass in the kidney, where else should you look, and what should you look for?

Back 46

-renal vein and IVC should be evaluated for potential extension of the tumor thrombus
-search for mets which includes evaluating the liver as well as the retroperitoneum

Front 47

An ultrasound exam reveals a solid, hyperechoic mass in a 46 yr. old patient with tuberous sclerosis. this most likely represents what?

Back 47

Angiomyolipoma
-up to 50% of tuberous sclerosis patients will have an angiomyolipoma

Front 48

what is the sonographic appearance of angiomyolipomas in the kidney?

Back 48

-solid, hyperechoic
-may be located within the renal parenchyma or may be exophytic

Front 49

what is the typical appearance of the kidneys of someone with acute pyelonephritis? what are some other features that may be present?

Back 49

-typically have normally appearing kidneys on U/S

May see other features such as:
-renal enlargement
-compression of the renal sinus
-alteration of echotexture
-loss of corticomedulary differentiation
-poorly marginated mass
-gas within renal parychma

Front 50

What is the u/s appearance of nephrocalcinosis?

Back 50

-highly echogenic renal pyramids w/ or w/out posterior acoustic shadowing.

Front 51

what is normal renal cortical thickness?

Back 51

> or equal to 10mm

Front 52

what u/s appearance is associated with renal lymphoma?

Back 52

-multiple, bilateral, hypoechoic masses in enlarged kidneys

Front 53

what is the likelihood of someone over 50 having a renal cyst?

Back 53

50% over the age of 50 have renal cysts

Front 54

which artery is most helpful in locating the renal arteries?WHy?

Back 54

SMA-because it is immediately superior to the origin of the reanl arteries and seres as a conveinient landmark.

Front 55

what is the sonographic appearnace of subcasular hematoma?

Back 55

-perirenal fluid collection that flattens the underlying renal contour.

Front 56

what change normally occurs to the appeance of the kidney immediatly after a renal transplant?

Back 56

hypertrophy

Front 57

what artery is the renal artery usually anastamosed to during a renal transplant?

Back 57

external illiac.

Front 58

A large complex hydrocele is most comonly associated with what?

Back 58

Orchitis. Small hydroceles may present w/ malignancy, but large hydroceles are most commonly associated with inflammation such as orchitis and epididymitis.

Front 59

Will a varicocele or epididymal cyst be associated with hydrocele?

Back 59

no

Front 60

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

Back 60

testicular artery

Front 61

the testicular artery is a branch of what artery?

Back 61

-abdominal aorta

Front 62

Explain the blood supply to the scrotum?

Back 62

Derived from 3 vessels:Testicular, derential, and cremasteric.
-testicular: arises from abdominal aorta just below renals and courses through the spermatic cord to the mediastinum where it branches into capsular arteries.
-Capsular arteries give origin to centripital arteries that course through the testicular parynchma toward the mediastinum.
-Near the mediastinum, centripetal arteries branch into recurrent rami(centrifugal arteries) which travel in the opposite direction.

Front 63

the intratesticular arteries that arise from the capsular artery are known as what?

Back 63

-centripetal arteriesl

Front 64

the left testicular vein drains into what vein?

Back 64

-left renal vein, wheras the right testicular vein drains directly into the IVC.

Front 65

why do varicoceles occur more on the left side than the right?

Back 65

because the left testicular vein drains into the left renal vein, wheras the right testicular vein drains directlhy into the IVC

Front 66

Btw what layers do hydroceles occur?

Back 66

Btw the two layers of the tunica vaginalis.
-the tunica vaginalis is a peritoneal sac that lines the inner walls of the scrotum. It is composed of 2 layers; visceral, and parietal
-The space btw these 2 layers is where hydroceles can form.

Front 67

If you see small particles within a hydrocele, what are they, most likely

Back 67

-probably represent cholesterol crystals; probably no significance.

Front 68

Where are the rete testes located?

Back 68

in the mediastinum testes.
-testes are divied into lobules that contain many tiny seminiferous tubules that converge at the apex of each lobule as the rectu. The rete testis is formed by the anastamosis of these tubules in the mediastinum. It is connected to the head of the piddiymis through the effent ducts.

Front 69

What artery courses within the testicular parynchma?

Back 69

centripedal artery

Front 70

what are the characteristic sonographic appearance of a seminoma?

Back 70

-predominantly hypoechoic
-well definied margins
-sometimes multifocal
-hoogenous echotexture, although large seminomas may show bright areas due to internal hemorrhage.

Front 71

What is the anatomic relationship of the seminal vessicles to the prostate gland?

Back 71

posterior and superior

Front 72

What are the most common patient symotims if oristatusn>

Back 72

difficult initiation of voiding, nocturia, and small stream

Front 73

what is the regular sonographic appearance of seminal vescicles?

Back 73

-hypoechoic, symetrical, irregularly shaped structures.

Front 74

What can happen to the spleen with portal hypertension?

Back 74

-dialated varices are commonly seen
-splenomegaly is almost always present.

Front 75

What findings of the spleen are common on a patient w/ histoplasmosis? What other conditions can a similar appearance of the spleen occur?

Back 75

-multiple focal, bright echogenic granulomatous lesion throughout the spleen
-tuberous sclerosis and sarcoidosis

Front 76

A calcified ring at the splenic hilum in a patient with portal hypertension and splenomegaly is most likely what?

Back 76

-most consistant w/ splenic artery aneurysm.
-the patient may also have varices at the splenic hilum due to portal hypertension.
-color doppler should aid in the distinction btw these.

Front 77

What is contained within the perirenal space?

Back 77

kidney, adrenal land, proximal ureter, and perirenal fat

Front 78

What are the top 4 most common sites of metastatic disease in order?

Back 78

Lung
Liver
Bone
Adrenal gland

Front 79

Describe the locations of the right and left adrenal glands?

Back 79

RT:
-SAM to the rt kidney
-posterior to IVC
-lateral to the crus of the diaphram

Left:
-SAM to left kidney
-posterior to the stomach
-posterior to the pancreatic body

Front 80

What is the anatomic location of the right diaphragmatic crus?

Back 80

posterior to the inferior vena vaca and right renal artery

Front 81

Explain lymphoceles and the songoraphic appearance

Back 81

-commonly seen following surgery
-most appear as anechoic cystic masses
-septations seen 20-50% of the time
-usually seen within 3 cm of the abdominal wall and lateral to the bladder

Front 82

Which retroperitoneal compartement contains no solid organs?

Back 82

posterior pararenal space
retrofascial space

Front 83

which retroperitoneal compartement contains the psoas and quandratus lumborum muscles

Back 83

retrofascial space

Front 84

Which retroperitoneal compartment is most frequenly involved w/ a pseudocyst?

Back 84

anterior pararenal space

Front 85

which retroperitoneal compartment contains the AO?

Back 85

anterior pararenal space

Front 86

What could increased BUN levels indicate? what does BUN stand for?

Back 86

could indicate renal disease, reduced renal blood flow, and urinary tract infection.
-Blood urea nitrogen

Front 87

searching for?

Back 87

Renal artery stenosis; renal artery stenosis of 60% or greater can result in hypertension.

Front 88

What vasculr abnormalitiy is associated with a hys of chronic pancreatitis and abdominal bruit?

Back 88

Psudoanurysms of the splacnic arteries may be caused by repeated bouts of pancreatitis. They occur in approximately 10% of patients w/ chrinc pancreatitis.

Front 89

What does the common hepatic artery divide into?

Back 89

-proper hapatic artery and gastroduodenal artery

Front 90

YOu are imaging someone with an anatomical varient called replaced hepatic artery. In this aatomic varient, the right hepatic artery originates from what artery?

Back 90

-SMA

Front 91

What is the anatomical course of the gastroduodenal artery?

Back 91

-courses caudally and anterior to the pancreatic head.

Front 92

which artery supplies the small intestine, right colon, and most of the transverse colon?

Back 92

superior mesenteric

Front 93

What is the normal waveform of the portal vein?

Back 93

low velocity and mildly undulating

Front 94

A patient is sent for an abdominal doppler ultrasound to rule out the presence of Budd-chiari syndrome. What vessels will you evaluate, and why

Back 94

All 3 hepatic veins, IVC and portal vein.
-Budd chiari is characteriezed by obstruction or severe stenosis of some or all of these vessels.

Front 95

What is the normal flow pattern in the hepatic veins?

Back 95

triphasic

Front 96

You are perfoming an ultrasound study on a patient with an aortoiliac graft and suspect the presence of a pseudoaneurysm at the graft site. What is the typical waveform in the neck of a pseudoaneurysm?

Back 96

High velocity; bidirectional due to changes in pressure btw the native vessel and aneurysm with the cardiac cycle. During systole, flow courses to the pseudoaneurysm, and diastole, it courses towards the native vessel .

Front 97

How many layers of gut will you see with a high resolution transducer? what are these layers? What is the sonographic appearance of each layer?

Back 97

5:
1. interface of superficial mucosa w/ luminal content-echogenic
2. deep mucosa, including muscularis mucosa-hypoechoic
3. submucosa-echogenic
4. muscularis propria-hypoechoic
5. serosa-echogenic

Front 98

What is the most common malignant tumor of the GI tract?

Back 98

-Adenocarcinoma-accounts for nearly 80% of all malignant tumors of the GI tract.

Front 99

What part of the GI tract is most commonly invlolved with chron's disease?

Back 99

-terminal ileum and colon

Front 100

what are the classic sonographic appearances of chron's disease?

Back 100

-gut wall thickening
-strictures
-creeping fat
-increased vascularity
-mesenteric lyhandenopathy

Front 101

Describe how the graded compression technique for the appendix is perfomed?

Back 101

apply gradual and uniform pressure tith the probe over the area of interest

Front 102

What laboratory values are pathognomonic for acute appendicitis? Explain

Back 102

There are no pathognomonic lab tests for acute appendicitis:
-Leukocytsis is common in patients w/ appendicitis, but up to 1/3 of all adult patients with acute appendicits have normal leukocytes.

Front 103

You are imaging a patient with dialated loops of bowl. you detect the presence of haustra. THis is an identifying feature of what part of the GI tract?

Back 103

Colon

Front 104

You have detectedbowel w/ multiple concentric rings within it in a patient w/ severe abdominal pain. Whis finding is most consistant with which of the followig?

Back 104

Intussesception.

Front 105

What are the strap muscles? where are they located?

Back 105

the sternohyoid and sternothyroid muscles are know as the strap muscles. They are located medial to the sternocleidomastoid and anterior to each lobe of the thyroid.

Front 106

You are performing a thyroid study on a patient with an enlarged gland. Color doppler shows markedly increased vascularity of both lobes. Which of the following is most likely?
-graves disease
-adenomatous goiter
-hashimoto's thyroiditis
-follicular ladenoma
-colloid nodule

Back 106

graves disease

Front 107

You are performing a thyroid ultrasound on a patient w/ increased serum calcium levels. What pathology are you searching for?

Back 107

parathyroid adenoma

Front 108

What is the typical sonographic appearance of parathyroid adenoma?

Back 108

homogenous, hypoechoic, solid oval-shaped nodule

Front 109

Hyperparathyroidism is usually caused by the enlargement of how many parathyroid glands?

Back 109

4

Front 110

what is the most common form of thyroid cancer?

Back 110

-papillary carcinoma

Front 111

what artery does the thyrocervical trunk arise from?

Back 111

subclavian artery

Front 112

What is the sonographic appearance of a normal peripheral nerve?

Back 112

-markedly hyperechoic structure w/ parallel internal linear echos

Front 113

you have detected a cyst in a patient referred for sonographic evlauation of a wrist nodule. Which of the following is a cyst that occurs adjacent to a joint?

Back 113

-ganglion cyst

Front 114

When is a comet tail artifact seen? explain it

Back 114

seen w/ metallic objects. It occurs because of multiple sound reflections at a high speed wihtin the metallic object.

Front 115

When is ringdown artifact seen? explain it

Back 115

-associated with gas bubbles in the body.
-air resonates causing a continuous emission of ultrasound.
-this artifact can be helpful in detecting air in abscess, biliary tree, or peroneal cavity.\
-it is also seen w/ bowel gas

Front 116

Which of the following image recording devices offers the best spacial resolution?-multiformat camera
video printer
laser camera
VHS video cassette recorder(VCR)
the spatial resolution is equal in these devices

Back 116

laser camera

Front 117

What color doppler parameter will increase the signal to nois ratio and result in a stronger signal?

Back 117

-color packet size
-the greater the number of pulses, the better the SNR. Frame rate is decreased as the packet size is increased.