URR 72

Question 1

Relative contraindications for a renal biopsy

Answer 1

uncooperative patient
small kidneys or single kidney

Question 2

most common reason for an adrenal biopsy

Answer 2

confirm metastatic disease in a patient with a known primary and an adrenal mass

Question 3

The ____ adrenal gland is easier to visualize and biopsy because the liver can be used as a window.

Answer 3

right

Question 4

If a ____ is being biopsied, the patient may need to take alpha-adrenergic blockers to prevent a hypertensive crisis.

Answer 4

pheochromocytoma

Question 5

A prostate biopsy is performed to:

Answer 5

confirm malignancy

Question 6

Indications for a prostate biopsy

Answer 6

elevated PSA levels
abnormal digital or manual rectal exams

Question 7

Prep for prostate biopsy

Answer 7

cleansing enema

Question 8

A prostate biopsy is most commonly performed with the patient in the _____ position, ___ position can also be used.

Answer 8

left lateral decubitus
lithotomy

Question 9

The ___ side of the gland poses an increased risk for puncture of the urethra during the prostate biopsy

Answer 9

left

Question 10

____ should be administered to the patient before and after a prostate biopsy

Answer 10

antibiotics

Question 11

Complications of a prostate biopsy

Answer 11

vasovagal response
rectal bleeding
hematuria

Question 12

Relative contraindications for prostrate biopsy

Answer 12

untreatable/unmanageable coagulopathy
uncooperative patient

Question 13

A thyroid biopsy uses ___ or ___ sampling techniques to collect sample.

Answer 13

fine needle aspiration
fine needle capillary

Question 14

A thyroid biopsy is not recommended for nodules less than ___ mm

Answer 14

10

Question 15

thyroid biopsy recommended for nodule >10mm

Answer 15

with microcalcifications

Question 16

thyroid biopsy recommended for nodule >15mm

Answer 16

solid

Question 17

thyroid biopsy recommended for nodule >20mm

Answer 17

cystic or complex

Question 18

patient positioning thyroid biopsy

Answer 18

supine with neck extended; may use pillow or towel under patient’s shoulders to increase neck extension

Question 19

injection of ethanol into thyroid cysts, benign thyroid nodules, enlarged parathyroid glands, and cervical nodal metasasis from papillary carcinoma

Answer 19

percutaneous ethanol injection

Question 20

Percutaneous ethanol injection of the thyroid causes __, __, and __

Answer 20

necrosis/fibrosis
vessel thrombosis
infarction

Question 21

Percutaneous ethanol injections of the thyroid usually require __-__ sessions for thyroid nodules/cysts

Answer 21

4
8

Question 22

____ adenomas also require multiple percutaneous ethanol injections that are repeated daily or every other day until the serum calcium returns to normal levels.

Answer 22

parathyroid

Question 23

pocket of blood contained in tissues outside of an artery that has been punctured

Answer 23

pseudoaneurysm

Question 24

Pseudoaneurysms are commonly associated with:

Answer 24

interventional cardiology procedures

Question 25

Least invasive form of treatment of pseudoaneurysms

Answer 25

sonography guided compression

Question 26

Sonography guided compression is not effective for pseudoaneurysms larger than __-__ cm

Answer 26

3 4

Question 27

Process of sonography guided compression for pseudoaneurysms

Answer 27

compression performed in 10 intervals of one minute each

Question 28

Success rate of percutaneous thrombin injection for pseudoaneurysm

Answer 28

97%

Question 29

Low-dose thrombin injected into body of the pseudoaneurysm to cause clotting to occur and occlude the stalk/neck

Answer 29

percutaneous thrombin injection

Question 30

Potential complication of percutaneous thrombin injection

Answer 30

migration of the thrombin downstream

Question 31

Percutaneous thrombin injection is not recommended in patients with:

Answer 31

larger diameter pseudoaneurysms >5cm and wide necks >1 cm

Question 32

____ are often used when peripheral IV access is not an option, or when large volumes of fluid or medications are required

Answer 32

central venous catheters

Question 33

Central venous catheters are commonly referred to __ or __

Answer 33

`peripherally inserted central catheters of PICC lines

Question 34

Three primary sites for PICC line placement

Answer 34

internal jugular vein subclavian vein femoral vein

Question 35

For PICC line placement, the needle is placed at about a __ degree angle to the skin prior to insertion

Answer 35

45

Question 36

PICC line transverse view

Answer 36

round or oval anechoic vein with echogenic foci indicating needle tip (target sign)

Question 37

PICC line longitudinal view

Answer 37

tubular anechoic vein with linear echogenicity indicating the long axis of the needle

Question 38

A catheter is demonstrated as _____ echogenicities

Answer 38

parallel linear

Question 39

____ may be injected to confirm patency and accuracy of catheter location

Answer 39

agitated saline

Question 40

Surgical procedures require:

Answer 40

sterile field

Question 41

Transducers should be soaked in alcohol for ___ minutes prior to an intraoperative procedure

Answer 41

30

Question 42

Abdominal applications of intraoperative ultrasound

Answer 42

used primarily to assist with pancreatic, biliary, and liver procedures biopsies, aspirations, drainages, tumor ablation vascular disorders

Question 43

____ is the most common major complication of biopsy of a solid abdominal organ

Answer 43

hemorrhage

Question 44

Renal biopsy is most commonly performed to evaluate:

Answer 44

parenchymal disease

Question 45

The ___ is the most common biopsy site of the kidney due to the lowest rick of great vessel puncture

Answer 45

lower pole

Question 46

Liver biopsy is most commonly performed to evaluate ___/___

Answer 46

liver disease/damage

Question 47

A prostate biopsy is most commonly performed with the patient in the ____ position

Answer 47

left lateral decubitus

Question 48

A pseudoaneurysm is commonly associated with ____

Answer 48

interventional cardiology procedures

Question 49

What lab values must be reviewed prior to any invasive procedure? a. BUN and creatinine b. PT and INR c. blood sugar and white blood cell count d. bilirubin and albumin

Answer 49

b

Question 50

Which of the following should be stopped 7 days prior to an invasive procedure? a. blood thinners b. ibuprofen c. NSAIDS d. all the above

Answer 50

d

Question 51

All of the following correctly describe proper behavior related to a sterile field, except: a. sterile individuals must pass each other back to back when moving around the procedure room b. when in doubt about sterility, discard the potentially contaminated item and begin again c. sterile gloves must be used to open the procedure tray d. hands and elbows must be kept above the level of the table

Answer 51

c

Question 52

When setting up for a liver biopsy, which of the following must be performed by a sterile person? a. attaching the needle and filling the syringe with the numbing agent b. opening the biopsy needle packaging c. verifying the expiration date of the numbing agent d. opening the bottle of numbing agent

Answer 52

a

Question 53

The informed consent form is required to including all of the following EXCEPT: a. signature line to indicate patient consent b. description of the procedure c. percentage of patients that have experienced complications aft the same procedure at the facility d. possible complications that the patient may experience

Answer 53

c

Question 54

The National Patient Safety Standards recommend a "time out" period prior to the start of an invasive procedure. How will you comply with this recommendation during a renal biopsy? a. allow the patient to take a 15 to 20 minute walk/break before they are set up for the procedure b. record a blank image that says "time out" after the consent form is signed and then another image at the start of the procedure c. allow the patient to take a break between biopsy samples and record the downtime in the chart d. record an image that says "time out" when the radiologist is adjusting the needle

Answer 54

b

Question 55

Which of the following will help the radiologist select the correct biopsy needle size/length for the biopsy of a mass in the posterior right liver? a. using color Doppler to locate surrounding vascularity b. usually the sonographer opens multiple sizes of core biopsy needles and places them on the sterile procedure tray in case they are needed c. measuring the width of the mass in the liver d. measuring the depth of the mass within the liver

Answer 55

d

Question 56

What is the #1 advantage of using ultrasound guidance for biopsies? a. real time visualization of the needle passing through the area of interest b. use on contrast is not necessary c. US guided biopsies are noninvasive d. less painful than biopsies guided by other modalities

Answer 56

a

Question 57

What is an absolute contraindication? a. a condition that makes a procedure absolutely inadvisable b. a modifiable condition that can be corrected to reschedule the procedure c. a condition that potentially makes a procedure inadvisable d. a modifiable condition that requires a second preprocedural assessment after modification

Answer 57

a

Question 58

__ refers to when a tissue sample is removed, tumoral cells can be released into the blood or lymphatic system causing the formation of satellite tumors and/or metastasis a. tumor extension b. needle track seeding c. tumor expansion d. nodule explosion factor

Answer 58

b

Question 59

Which of the following correcting describes an ultrasound guided invasive procedure? a. sterile gloves must be used to put the sterile sheath on the probe b. if the sonographer is scanning during the procedure, they must be wearing sterile gloves and gown c. a sonographer who is not sterile must be making machine adjustments d. all the above

Answer 59

d

Question 60

What two artifacts are commonly seen posterior to the needle of an ultrasound image? a. reverberation artifact and/or posterior shadowing b. mirror image artifact and/or posterior enhancement c. refraction artifact and/or posterior shadowing d. reverberation artifact and/or side lobe artifact

Answer 60

a

Question 61

Where is the preferred location for catheter insertion for a paracentesis? a. lower than the ninth rib b. 3 cm lateral to the umbilicus c. left paracolic gutter d. right paracolic gutter

Answer 61

c

Question 62

Which of the following procedures requires a chest Xray before and after the procedure? a. renal biopsy b. thoracentesis c. paracentesis d. prostate biopsy

Answer 62

b

Question 63

Where is the preferred location for catheter insertion for a thoracentesis? a. lower than the ninth rib b. 3 cm lateral to the sternum c. left paracolic gutter d. right paracolic gutter

Answer 63

a

Question 64

Which of the following describes a liver biopsy? a. patient must be able to follow breathing instructions b. subcostal approach used for left lobe biopsies c. right lobe biopsies use an intercostal approach with the patient in the left posterior oblique position d. all the above

Answer 64

d

Question 65

Percutaneous ethanol injection and radiofrequency ablation are commonly used to treat tumors formed by: a. prostate adenocarcinoma b. parotid gland carcinoma c. hepatocellular carcinoma d. cavernous transformation

Answer 65

c

Question 66

Native kidneys are biopsied with the patient in the ___ position, while renal allografts are biopsied with the patient in the ___ position. a. decubitus, prone b. decubitus, supine c. prone, supine d. supine, decubitus

Answer 66

c

Question 67

Why is the lower pole of the kidney the most common site of parenchymal biopsy? a. because there are no ribs covering the lower pole b. because there is least risk of great vessel puncture c. because the lower pole is usually affected first by parenchymal disease d. because the lower pole is usually affected last by parenchymal disease

Answer 67

b

Question 68

Color Doppler is used: a. to confirm there is no hilar blood flow in a lymph node after percutaneous ethanal injection b. to differentiate a pseudoaneurysm from a urinoma c. to evaluate the potential needle path for any vessels that are in its path d. all the above

Answer 68

d

Question 69

What are the proper guidelines for compression therapy for a pseudoaneurysm? a. use color Doppler in real time while compressing the pseudoaneurysm at 15 minute intervals b. compress the pseudoaneurysm with 10 one-minute intervals and apply color Doppler after each interval to assess closure progress c. use color Doppler in real time while compressing the pseudoaneurysm at 10 minute intervals d. compress the pseudoaneurysm with 10 ten-minute intervals and apply color Doppler after each interval to assess closure progress

Answer 69

b

Question 70

The normal sonographic appearance of a longitudinal view of an intravenous catheter is: a. a single linear echogenicity within a vein b. parallel linear echogenicities c. a single echogenic foci d. a focal area of posterior shadowing that extends from inside the vein lumen

Answer 70

b

Question 71

Which of the following is true regarding the anatomic position of the right adrenal gland? a. posterior to the IVC b. lateral to the right lobe of the liver c. lateral to the left diaphragm crura d. anterior to the aorta and SMA

Answer 71

a

Question 72

The paracolic gutters: a. trap fluid in the pelvic area b. allow fluid to move between the abdomen and pelvis c. trap fluid in the lateral abdomen d. are divided by the linea alba

Answer 72

b

Question 73

Which blood vessel is located lateral to the right lobe of the thyroid and demonstrates an anechoic circular shape in a transverse view of the mid thyroid? a. right common carotid artery b. superior vena cava c. right internal jugular vein d. left common carotid artery

Answer 73

a

Question 74

Increased serum levels of ___ will reduce urine output and increase blood volume in the body. a. alkaline phosphatase b. thyroxine c. aldosterone d. bilirubin

Answer 74

c

Question 75

The gastroesophageal junction is best seen in the ___ plane, anterior to the aorta and posterior to the left lobe of the liver. a. longitudinal b. transverse c. coronal d. radial

Answer 75

a

Question 76

Aside from the pancreas, what other organs produces amylase? a. adrenal glands b. salivary glands c. liver d. pituitary gland

Answer 76

b

Question 77

The Eiffel tower sign on ultrasound refers to: a. normal prostate b. lymphadenopathy c. duplex kidney d. portal HTN

Answer 77

a

Question 78

The cremasteric artery and deferential artery supply blood to the: a. stomach b. adrenal glands c. thyroid d. testicles

Answer 78

d

Question 79

Which of the following lines the inside of the scrotal sac? a. tunica albuginea b. rete testis c. parietal tunica vaginalis d. visceral tunica vaginalis

Answer 79

c

Question 80

On an ultrasound exam, the normal adrenal cortex appears: a. as an anechoic ring around the echogenic medulla b. as a hypoechoic ring around the echogenic medulla c. isoechoic to the medulla d. as a hyperechoic ring around the hypoechoic medulla

Answer 80

b

Question 81

A patient presents with a palpable round lump on the midline anterior neck about 2cm below the jaw. The structure appears anechoic with thin, smooth walls on ultrasound. Which of the following is the most likely explanation for the findings? a. ectopic thyroid cyst b. nasopharyngeal cyst c. thyroglossal duct cyst d. pharyngeal pouch cyst

Answer 81

c

Question 82

Normal wall thickness of distended small bowel is: a. <7mm b. <3cm c. <3mm d. <1 cm

Answer 82

c

Question 83

Normal retroperitoneal lymph nodes usually measure less than ___ in length. a. 0.5 cm b. 1 cm c. 1.5 cm d. 2 cm

Answer 83

b

Question 84

What is the term for a cone-like mass of normal thyroid tissue protruding superiorly from isthmus? a. hyperthyroidism b. pyramidal lobe c. early Graves' disease d. thyroglossal lobe

Answer 84

b

Question 85

The inguinal ligament extends: a. from the distal right oblique muscle to the distal left oblique muscle b. from the anterior superior iliac spine to the pubic tubercle c. from the linea alba to the anterior superior iliac spine d. from the tip of coccyx to the pubic tubercle

Answer 85

b

Question 86

Which blood vessel is located lateral to the left lobe of the thyroid and demonstrates an anechoic ovoid shape in a transverse view of the mid thyroid? a. left internal jugular vein b. left common carotid artery c. left external carotid artery d. superior vena cava

Answer 86

a

Question 87

The cardiac orifice is: a. the opening in the diaphragm that allows the IVC to pass through b. the bare area of the liver that allows the hepatic veins to pass through c. the opening by which the esophagus communicates with the stomach d. the opening in the diaphragm that allows the aorta to pass through

Answer 87

c

Question 88

The thyroid gland is considered normal in size if the: a. AP measurement is <2 cm b. width measurement is <3cm c. volume is <30 mL d. length measurement is <4cm

Answer 88

a

Question 89

The appendix is normally identified: a. anterior to the terminal ileum and lateral to the iliac vessels b. only in patients less than 150 lbs c. originating from the sigmoid colon at the level of the inguinal ligament d. posterior to the terminal ileum and anterior to the iliac vessels

Answer 89

d

Question 90

While scanning the thyroid, you identify a 0.6 cm ovoid structure outside the thyroid, lateral to the left carotid artery. The structure has a thin hypoechoic rim surrounding a hypoechoic center. These findings are most suggestive of: a. thyroglossal duct cyst b. normal lymph node c. normal esophagus d. parathyroid carcinoma

Answer 90

b

Question 91

Which muscle group is located anteromedial to the lobes of the thyroid gland? a. tracheal muscles b. strap muscles c. sternocleidomastoid d. longus colli muscle

Answer 91

b

Question 92

The functional unit of the thyroid gland is called ___. a. lobule b. nodule c. lobe d. follicle

Answer 92

d

Question 93

The __ is a connective sheath that is connected to the small intestines that provides structure and support, along with encasing/protecting blood vessels. a. lesser omentum b. mesocolon c. greater omentum d. mesentery

Answer 93

d

Question 94

The testicles normal descend into the scrotum: a. at the onset of puberty b. in utero c. 7 days after birth d. by 1 year old

Answer 94

b

Question 95

The __ gland is located anterior to the ear and is drained by the __. a. submandibular, Stensen duct b. submandibular, Wharton duct c. sublingual, Wharton duct d. parotid, Stensen duct

Answer 95

d

Question 96

Which of the following structures is not included in the spermatic cord? a. Gonadal artery b. Vas deferens c. centripetal artery d. cremasteric artery

Answer 96

c

Question 97

What is the primary function of lymph nodes? a. release endorphins that aid in blood filtration b. filter lymphatic fluid and protect the body from infection c. filter blood and protect the body from infection d. release enzymes that fight infection in the body

Answer 97

b

Question 98

Which of the following retroperitoneal spaces contains the adrenal gland? a. anterior pararenal space b. perirenal space c. retrofascial space d. Glisson capsul

Answer 98

b

Question 99

The __ zone is the largest zone in the prostate. a. central b. paraprostatic c. peripheral d. transitional

Answer 99

c

Question 100

How many layers are identified in the normal sonographic "gut signature"? a. 6 b. 3 c. 8 d. 5

Answer 100

d