AB 2 FINAL Flashcards
1
Q
liver is suspended from diaphragm and anterior wall by what ligament
A
Falciform ligament pg. 208
2
Q
fatty infiltration may be observed in all patients ( we pick the one that doesn’t fit )
A
Obesity Excessive alcohol intake Poorly controlled hyperlipidemia (cholesterol) Diabetes mellitus Excess corticosteriods Pregnancy Total parenteral hyperalimentation (nutrition) Severe Hepatitis Glycogen Storage Disease Cystic Fibrosis Pharmaceutical Chronic Illness pg. 235
3
Q
What is Budd Chiari Syndrome?
A
Thrombosis of the hepatic veins or IVC
pg. 246
4
Q
Echinococcal cysts have a higher incidence from where?
A
Sheep-herding areas pg. 255
5
Q
What is the most common benign tumor of liver?
A
Cavernous hemangioma pg. 256
6
Q
What is the benign liver tumor, can be found in patients with glycogen storage disease?
A
Liver Cell Adenoma pg. 258
7
Q
Patients with hepatocellular carcinoma likely to have had ___.
A
Cirrhosis pg. 259
8
Q
What is the most common form of neoplastic involvement in liver?
A
Metastatic Disease pg. 259
9
Q
RPV and GB found in what fissure?
A
Main Lobar Fissure pg. 276
10
Q
In severe hepatocellular destruction, AST and ALT levels are ___.
A
AST: significantly elevated
ALT: moderately elevated
pg. 215
High -quizlet
11
Q
Elevated alk phos is associated with ___.
A
Liver and biliary obstruction pg. 33
12
Q
Diminished vascular structures in the liver parenchyma most likely suggests ___.
A
Fatty infiltration pg. 234
Cirrhosis -quizlet
13
Q
The falciform ligament extends from the umbilicus to the diaphragm. It contains the ___.
A
Ligamentum teres pg. 208
14
Q
Elevation of bilirubin leads to ___.
A
Jaundice pg. 218
15
Q
Patients with an abscess formation may have ___.
A
Fever Tenderness and swelling post-op Chills Weakness Normal LFT's Leukocytosis Sepsis pg. 466
Doesn’t include decreased white blood count -quizlet
16
Q
What tumor consists of large blood filled spaces?
A
Hemangioma pg. 256
17
Q
What cells does hepatocellular disease attack?
A
Liver cells (Hepatocytes) pg. 213
and interferes with liver function -quizlet
18
Q
Glycogen storage disease type 1 is the most common, it is also known as ___.
A
von Gierke’s disease pg. 239
19
Q
What benign liver tumor is located near the free edge of the liver, solitary, well-circumscribed, and a nonencapsulated multinodular mass?
A
Focal Nodular Hyperplasia -quizlet
20
Q
What common malignancies affect the pediatric population?
A
Neuroblastoma Nephroblastoma (Wilm's Tumor) Hepatoblastoma Hepatocellular Carcinoma Leukemia Lymphoma pg. 697-698
21
Q
In cases of choledocholithiasis, stones tend to lodge in ___.
A
the Ampulla of Vater pg. 295
22
Q
The right and left hepatic ducts emerge and unite to form ___.
A
Common hepatic duct pg. 268
23
Q
What is the size of the common hepatic duct?
A
4 mm pg. 268
24
Q
In a 60 year old adult, how big should the common duct be?
A
6 mm pg. 268
25
What is a phyrigian cap of the GB?
Folding of the fundus pg. 273
26
What is the function of the GB?
Reservoir for bile and concentration of bile pg. 273
27
What is a fold in the neck of the GB called?
Hartmann's pouch pg. 273
28
What is a positive Murphy's sign?
Acute RUQ pain when palpating area
pg. 281
Associated with cholecystitis
29
What are classic symptoms of GB disease?
RUQ pain after eating greasy food
Nausea/vomiting
Pain in right shoulder
Jaundice pg. 278-279
Doesn't include Hematuria -quizlet
30
What is inflammation of the GB?
Cholecystitis pg. 281
31
What are the small polypoid masses that arise from the GB wall?
Cholesterolosis pg. 288
| Adenomyomatosis??
32
What is the sonographic criteria for cholelithiasis?
Increased size
Wall thickness
Presence of internal reflections w/in lumen
Posterior acoustic shadowing pg. 284
33
What is a porcelain GB?
Calcium incrustation of the gallbladder wall Appears hyperechoic with posterior shadowing pg. 288
34
What is sludge?
Thickened bile
Low level internal echoes
Nonshadowing pg. 279
35
Where are the valves of Heister located?
In the neck of the GB pg. 273
36
What are ALL of the effects of a fatty meal?
- Stimulation of cholecystokinin
- Contraction of the gallbladder
- Decrease of bile flow into the duodenum
- Relaxation of the sphincter of oddi
pg. 273
37
What cavity does the pancreas lie in?
Retroperitoneal cavity pg. 302
38
What duct is in the pancreatic head?
Duct of Santorini pg. 308
39
What structure is on the anterolateral border of the pancreatic head?
Gastroduodenal Artery pg. 309
40
What is the primary pancreatic duct?
Duct of Wirsung pg. 308
41
An older man with a history of alcoholism is recently diagnosed with acute pancreatitis. His hematocrit and hypotension levels are decreased. Your differential diagnosis includes:
Hemorrhagic pancreatitis
Quizlet
P 318 & 323
42
What veins course sagittal and posterior to the neck of the pancreas?
Superior Mesenteric Vein
Main Portal Vein pg. 309
Confluence
43
A patient with painless jaundice, weight loss, and a decrease in appetite should be evaluated for:
Adenocarcinoma of the pancreas
Quizlet
Sonographic appearance: loss of parenchymal pattern, hypoechoic poorly defined mass, enlargement of pancreas
44
What is the duct of santorini?
Accessory duct located in the head of the pancreas pg. 308
45
What is the normal size of the pancreatic duct?
Less than 2 mm pg. 308
46
When a patient has acute pancreatitis, what lab value will be elevated 2 times the normal limit?
Amylase pg. 311
47
What are the microscopic cells of the pancreas called?
Acini cells- exocrine
| Islets of Langerhans- endocrine pg. 310
48
What is the most common cause for acute pancreatitis?
Biliary tract disease pg. 317
49
What is an annular pancreas?
Rare anomaly in which the head of the pancreas surrounds the second portion of the duodenum pg. 309
50
What is cystic fibrosis?
Heredity disease that causes excessive production of thick mucus by the endocrine glands
Pancreas is replaced with fatty tissue and sometimes calcifications pg. 327
51
In cases of acute pancreatitis, what does it look like sonographically?
```
Enlarged
Hypoechoic
Indistinct, but smooth borders
IVC may be compressed
Parapancreatic fluid collections pg. 319
```
52
What is the most common obstructive congenital obstruction in utero and in infants?
UPJ pg. 713
53
Where are parapelvic cysts located?
Renal hilum or renal sinus
| p 375
54
What is the most common solid renal mass found in childhood?
Nephroblastoma (Wilm's tumor) pg. 387
55
What is fusion of the lower poles of the kidneys?
Horseshoe kidney pg. 371
56
What is the most echogenic portion of the kidney?
Renal sinus pg. 359
57
What is a cystlike enlargement of the lower end of the ureter?
Ureterocele pg. 373
58
What is a cortical bulge at the lateral border of the kidney?
Dromedary hump pg. 366
59
What is a dilated renal pelvis without ureteral involvement?
Ureteropelvic Junction Obstruction pg. 713
60
What is the most likely reason for a renal artery duplex?
Hypertension
61
What could a perinephric fluid collection post transplant be?
Hematoma, abscess, lymphocele, or urinoma p 407
62
The baseline ultrasound after a transplant should be done within ___.
48-72 hours pg. 407
63
What is a common finding in people over 50?
Simple Renal Cyst pg. 379
64
What is dilatation of the renal pelvis without thinning of the renal cortex?
Hydronephrosis pg. 397-398
65
When will ureteral jets not be visualized?
Ureteral Obstruction pg. 713
66
What is the process of disposing metabolic waste?
Excretion pg. 358
67
When a patient has extensive damage to a kidney, what might be found in the urine?
Hemoglobin pg. 359
68
What cavity are kidneys located in?
Retroperitoneum pg. 355
69
What 'stuff' is outside the renal capsule?
Perinephric fat pg. 356
70
What vessel is seen in a sagittal IVC scan that is posterior to it in a transverse plane?
Right renal artery pg. 363
71
Renal sonography is not helpful in evaluating ___.
Function
72
What is the space between the liver edge and the right kidney?
Morison's pouch pg. 356
73
Renal cell carcinoma commonly invades the IVC via the ___.
Renal vein pg. 385
74
What is pyonephrosis referred to as?
Pus found in the collecting renal system Emergent procedure needed
Sonographic: low-level echoes, anechoic dilated system pg. 401
75
What are different reasons why there might be dilatation of the renal pelvis?
```
Hydronephrosis
Reflux
Infection
Extrarenal pelvis
Polyuria
Distended renal bladder
Atrophy after obstruction
Pregnancy pg. 397
```
Except oliguria -quizlet
76
What is a benign vascular fatty tumor of the kidney?
Renal Angiomyolipoma pg. 388
77
What cavity does the spleen lie in?
Intraperitoneal cavity pg. 422 Note that it is in the left hypochondrium as well as being in the reticuloendothelial system
78
What is the size of the spleen?
8-13 cm x 7 cm x 3-4 cm pg. 424
79
Reasons why one might develop splenomegaly?
Mild to moderate: Infection, portal hypertension and AIDS
Moderate: Leukemia, lymphoma, infectious mononucleosis
Massive: Myelofibrosis
Focal Lesions: Lymphomatous involvement, metastatic disorder, hematomas p. 431
80
What are the functions of the spleen?
Production of lymphocytes and plasma cells
Production of antibodies
Storage of iron
Storage of other metabolites
Maturation of the surface of erythrocytes
Reservoir
Culling
Pitting function
Disposal of senescent or abnormal erythrocytes
Functions related to platelet and leukocyte life span p.427
81
Where would an accessory spleen be located?
Near hilum or inferior border pg. 425
82
The splenic vein courses ___ along the pancreas
Posteromedially pg. 424
83
What is the best position to evaluate the spleen on ultrasound?
Steep right decubitus pg. 428
84
What is a spleen that has migrated from its normal location?
Wandering spleen pg. 425
85
What is the major function of the spleen?
To filter the peripheral blood and is active in the body's defense against disease pg. 426
86
What is a measurement of the spleen considered splenomegaly?
Greater than or equal to 13 cm pg.430
87
Why might someone have atrophy of the spleen?
Sickle cell anemia patients Pg 429
88
What are the hormones of the thyroid?
T3 and T4 and Calcitonin pg. 590
89
What is the size of the thyroid?
40-60mm (length) x 20-30mm (AP) x 15-20mm (width) pg. 589
90
What are the neighboring structures around thyroid? (muscles)
Anterior: Strap muscles-Sternothyroid Omohyoid, Sternohyoid (Appear thin, hypoechoic) Sternocleidomastoid (Large, Oval, located anterior and lateral)
Posterior: Longus colli (Hypoechoic, Triangular, located posterior and lateral) pg. 589
91
What is a pyramidal lobe of the thyroid?
The pyramidal lobe arises from the isthmus and tapers superiorly just anterior to the thyroid cartilage. It may be seen in the pediatric population but usually atrophies in the adults. It is found in 15-30% of patients. Pg. 589
92
What is the most common cause for thyroid disorders worldwide?
Iodine deficiency pg. 593
93
What are the common disorders associated with hyperthyroidism?
Common:
Diffuse Toxic Hyperplasia (Grave's disease)
Toxic multi nodular goiter
Toxic adenoma.
Uncommon: Acute or subacute thyroiditis Hyperfunctioning thyroid cancer Choriocarcinoma or hydatidiform mole TSH-secreting pituitary adenoma Neonatal thyrotoxicosis associated with maternal Graves disease pg. 590
94
What is the sonographic criteria for a thyroid adenoma?
Anechoic to hyperechoic
Solid mass
Peripheral halo
Cystic degeneration pg. 596
95
How many parathyroid glands are there?
4 pg. 600
96
What is the position of parathyroid glands?
2 lie posterior to the superior pole of thyroid 2 lie posterior to the inferior pole of thyroid pg. 600
97
If you see a thyroid nodule with a lymphadenopathy of the same side, what is it suspicious for?
Malignancy pg. 596
98
What is the common cause for primary hyperparathyroidism?
Adenoma pg. 601
99
Thyroglossal duct cysts are found ___.
Anteriorly to the trachea pg. 602
100
What disease process is thyroid inferno?
Graves' Disease
| Hyperthyroidism pg. 599
101
What is the most common thyroid malignancy?
Papillary Carcinoma pg. 596
102
What is the shape of an abnormal lymph node?
Round pg. 603
103
What is a cystic formation lateral to the thyroid gland?
Branchial cleft cysts pg. 602
104
What is the fibrous capsule the covers the teste?
Tunica Albuginea pg. 606
105
What is the normal measurement of the testicles?
L= 3-5 cm W= 2-4 cm H= 3 cm pg. 604
106
What is the sonographic criteria of the tecticles?
Smooth Medium gray Fine echo textures pg. 604
107
What is mediastinum testes?
Vertical septum formed from the posterior aspect of tuica albuginea that reflects into the testis pg. 606
108
What is the location of the epididymis?
Begins superior and then courses posteriolateral to the testis pg. 604
109
What is the most common cause of acute scrotal pain in an adolescent?
Torsion pg. 616
110
What are varicoceles?
Abnormal dilation of veins of pampiniform plexus, usually caused by incompetent venous valves within the spermatic vein. More common on the left side, and will measure more than 2 mm in diameter. Color Doppler will be very lite up pg. 618
111
What are spermatoceles?
- Cystic dilations of efferent ductules of the epididymis
- Always located in the epididymal head
- More often seen following vasectomy pg. 618
112
What is the most common cause of acute scrotal pain on adults?
Epididymo-orchitis pg. 615
113
What almost always transpires secondary to epididymitis?
Orchitis, infection of testis pg. 615
114
What is the appearance of a seminoma?
Homogeneous or hypoechoic lesion with smooth, well-defined borders pg. 626
(Most common germ cell tumor)
115
Epididymorchitis most commonly results from ___.
Spread of a lower urinary tract infection via the spermatic cord pg. 615
116
What is the primary source of blood flow to the testicles?
Right and left testicular arteries pg. 606
117
Microlithiasis of the teste is associated with ___.
Testicular malignancy
```
Cryptorchidism
Klinefelter's syndrome
Infertility
Varicoceles
Testicular atrophy
Male pseudohermaphroditism
pg. 625
```
118
What is the appendix teste?
Small protuberance from the head of the epididymis
upper pole of the testis between the testis and the epididymis pg. 605
Isoechoic to the testis p606
119
What layers does a hydrocele form in?
Between the visceral and parietal layers of the tunica vaginalis pg. 620
120
Where is a rete teste located?
At the hilum of the testis where the mediastinum resides pg. 623
121
What are the important lab values for accessing renal function?
BUN
Creatinine
pg. 359
122
AAA's are present when the diameter exceeds ___.
3cm pg. 173
123
What is the most common AAA type?
Fusiform pg. 173
124
What is the innermost layer of the aorta?
Tunica intima pg. 165
125
What are the clinical symptoms of acute appendicitis?
Pain and rebound tenderness over RLQ (McBurney's point),
diarrhea,
fever,
nausea/vomiting pg. 348
126
What would a collection of air or gas in the pleural cavity be?
Pneumothorax
127
What vessels form the portal confluence?
Splenic vein and SMV pg. 302
128
What is the most dependent area in the flanks of the abdomen and pelvis where fluid accumulates?
Gutters pg. 462
129
What are the typical symptoms with an abscess formation?
```
Fever
Tenderness and swelling from post-op procedure
Chills
Weakness
Malaise
Pain
Increased WBC's
Sepsis pg. 466
```
130
What is the most common cause for renal failure?
Diabetes Per handout ATN Per Beth
131
What is an area in an organ that has become necrotic due to lack of oxygen called?
Infarct?
132
What are the potential signs for rejection? (kidneys)
1. enlargement and decreased echogenicity of the pyramids
2. Hyperechoic cortex
3. loss of cortical and medullary boundary
4. Distortion of renal outline
5. increased RI (greater than 0.8 = dysfunction) Per handout
P 411
133
What is ATN?
Acute tubular necrosis pg. 412
| Damage to the tubular cells within the kidneys that result in decreased renal function
134
What is a thoracentesis?
Drainage of fluid in the chest
The patient sits on the side of the bed, leaning on a bedside table with a pillow for comfort. This opens up space between the ribs to be able to get needle in to drain the fluid pg. 523
135
Why is a time out performed?
Patient recites their name
Patient's ID and MRN is confirmed
Type and location of procedure is said
136
What is a lack of normal fixation to the testes called?
bell clapper
137
What technique is used to find evidence of a varicocele?
Valsalva maneuver pg. 620
138
What are the layers of the teste?
Parietal- outer layer
Visceral- inner layer
Which forms to create the tunica vaginalis
139
Skin dimpling may be caused by ___.
Breast cancer pg. 571
140
What is a fibroadenoma?
Most common benign breast tumor which occurs primarily in young women and is stimulated by estrogen pg. 575
141
What is the best needle gage for a thyroid FNA?
25 gauge pg. 498
142
What is the primary advantage of ultrasound guidance?
To have continuous real-time visualization of the biopsy needle, allowing for adjustment of the needle as needed pg. 495
143
What is the functional portion of the breast called?
Mammary (glandular) layer pg. 550
144
What is the sonographic appearance of Cooper's ligaments?
- Echogenic and are dispersed in a linear pattern
| - Best identified when the beam strikes the ligaments at a perpendicular angle pg. 552
145
What is a specific complication of a kidney biopsy?
Perinephric hematoma and Hematuria pg. 519
146
What are polyps of the GB?
Small, well-defined soft tissue projections from the gallbladder wall
p 288
147
What symptoms might a patient experience with polyps?
None
148
Appearance of gallstones
```
Hyperechoic intraluminal echoes with posterior acoustic shadowing
Dilated GB with thick wall
WES sign
Gravity dependent calcifications in GB
p279
```
149
Nonshadowing low level echoing in the gallbladder-what is that called?
Sludge
150
A condition that has increased secretion, abnormal mucus of the exocrine gland
Cystic fibrosis
151
Parathyroid measurement
less than 4 mm
152
Bell clapper deformity
Occurs when the tunica vaginalis completely surrounds the testis, epididymis, and distal spermatic cord, allowing them to move and rotate freely within the scrotum
p 616
153
Layers of the breast
Subcutaneous layer
Mammary layer (glandular)
Retromammary layer
154
Addisons disease
Adrenocortical insufficieny
Affect males and females equally
Atrophy of the adrenal cortex with decreased production of cortisol and sometimes aldosterone
Causes: autoimmune process, tuberculosis, inflammatory process, primary neoplasm, metastases
p 452
155
Cushings syndrome
Caused by excessive secretion of cortisol resulting from adrenal hyperplasia, cortical adenoma, renal carcinoma, anterior pituitary tumor, or elevated ACTH resulting from a pituitary adenoma
Symptoms: truncal obesity, pencil thin extremities, "buffalo hump", "moon face", hypertension, renal stones, irregular menses in females, psychiatric disturbances
P452
156
What in the GB will have a dirty shadow
Adenomyomatosis
157
Another name for a complex mass
Heterogenous
158
Hyperplasia
An increase in the number of cells of a body part that results from an increased rate of cellular division
159
Normal thickness of GB wall
less than 3 mm
| p 279
160
What transducer would you use for scrotal scanning?
High frequency linear-array probe (7.5 MHz)
| p609
161
Limitations for ultrasound guidance
- Not all masses can be visualized with ultrasound because they may be isoechoic to normal tissue
- Bowel gas may move in and obscure the mass before or even during the procedure; overlying bowel may not be able to be displaced
- Needle tip may be difficult to see or may deviate from the projected path because of bending or deflection of the needle
- Inexperience of ultrasound personnel
- Comfort level of the radiologist and or sonologist with other imaging modalities
- Need to use fixed angles when needle guides are used on the transducer
162
Outer diameter in appendicitis should measure
6 mm or greater
163
What percentage of liver tumors in children are benign
40%
P697
164
Where do they place a transplant kidney
right iliac fossa
165
Normal measurement of the renal cortex
greater than 1 cm
166
What term is used for absent urine production
Anuria
167
Metabolic diseases of the liver
Wilsons
| Hemochromatosis
168
Normal flow direction in the portal vein
Hepatopetal
169
what does the nuclear medicine scan show
Thyroid function
| If thyroid nodular are hot or cold
170
Where do the testicular veins drain
Right-IVC
Left joins the left renal vein
p608
171
Most common cause of painless scrotal swelling
Hydrocele
172
Speculations
figure like extenions of malignant tumor
173
Puncture of the peritoneal space is referred to as
Paracentesis
174
Why would you remove fluid from the pleural cavity
Patient has a hard time breathing
175
What are universal precautions
- use of personal protective devices
| - hand washing
176
name three vital signs
- pulse
- blood pressure
- respiration
177
Reasons why fluid accumulates in the abdomen
- cirrhosis
| - cancer
178
A dirty shadow is likely a result of
Bowel gas
179
Best choice for evaluation of blood flow?
Power Doppler
180
Spectral Doppler flow of the testes in normal individuals
Low resistive waveform pattern
181
Describe the normal spectral Doppler waveform for a transplant kidney
Low resistive
