Lange Review Ultrasonography Examination, 4th Edition

Questions

GENERAL INSTRUCTIONS: For each question, select the best answer. Select only one answer for each question unless otherwise instructed.

1. What three structures comprise the portal triad?

(A) portal vein, portal artery and common bile duct

(B) hepatic artery, portal vein and bile duct

(C) hepatic vein, portal artery and cystic duct

(D) hepatic artery, portal artery and bile duct

(E) hepatic duct, hepatic vein and common bile duct

2. A 4-year-old boy presents with high blood pressure, hematuria, and a palpable left flank mass. An ultrasound examination is performed, and a solid renal mass is identified. This finding is most characteristic of which of the following?

(A) hypernephroma

(B) infantile polycystic kidney disease

(C) neuroblastoma

(D) nephroblastoma

(E) acute lymphoblastic leukemia

3. A patient presents with ampulla of Vater obstruction, distention of the gallbladder, and painless jaundice. Which of the following is this presentation associated with?

(A) hydropic gallbladder

(B) choledochal cyst

(C) Courvoisier’s sign

(D) Mirizzi’s syndrome

(E) Caroli’s disease

4. Which of the following will long-standing cystic duct obstruction give rise to?

(A) porcelain gallbladder

(B) hydropic gallbladder

(C) septated gallbladder

(D) gallbladder septations

(E) gallbladder contraction

5. While performing an ultrasound examination, the sonographer finds that both kidneys measure 5 cm in length. They are very echogenic. One should consider the possibility of all of the following except

(A) chronic glomerulonephritis

(B) chronic pyelonephritis

(C) renal vascular disease

(D) renal vein thrombosis

(E) renal hypoplasia

6. Staghorn calculus refers to a large stone within which of the following?

(A) pancreas

(B) urinary bladder

(C) renal pelvis of the kidney

(D) neck of the gallbladder

(E) hepatic duct

7. What gastrointestinal peptide hormone stimulates gallbladder contraction?

(A) gastrin

(B) cholecalciferol

(C) cholestyramine

(D) cholecystokinin

(E) cholestasis

8. What is the name of the portion of the liver that is not covered by the peritoneum?

(A) quadrate lobe

(B) intraperitoneal

(C) Riedel’s lobe

(D) bare area

(E) hepatopetal

9. What is the normal thickness of the gallbladder wall?

(A) 15 mm

(B) 10 mm

(C) 3 cm

(D) 5 mm

(E) 3 mm

10. Where does the pancreatic head lie?

(A) caudad to the portal vein and medial to the superior mesenteric vein

(B) cephalad to the portal vein and medial to the superior mesenteric vein

(C) caudad to the portal vein and anterior to the inferior vena cava

(D) cephalad to the portal vein and anterior to the inferior vena cava

11. Identify the sonographic pattern that best describes hydronephrosis.

(A) distortion of the reniform shape

(B) multiple cystic space masses throughout the kidneys

(C) fluid-filled pelvocaliceal collecting system

(D) fluid-filled pararenal space

(E) echogenic renal cortex

12. A patient presents with a dilated interhepatic duct, dilated gallbladder, and a dilated common bile duct. This is most characteristic of which one of the following levels of obstruction?

(A) proximal common bile duct

(B) distal common bile duct

(C) distal common hepatic duct

(D) cystic duct

(E) neck of the gallbladder

13. What is the most common location of pancreatic pseudocyst?

(A) lesser sac

(B) porta hepatis area

(C) groin

(D) splenic hilum

(E) mediastinum

14. Which of the following is true about the extrahepatic portion of the falciform ligament?

(A) courses between the inferior vena cava and the gallbladder

(B) is visualized when massive ascites is present

(C) connects the liver to the lesser sac

(D) is visualized when peritonitis is present

(E) is visualized when there is recanalization of the umbilical vein

15. The superior mesenteric artery arises 1 cm below the celiac trunk and courses

(A) 1 cm before it bifurcates

(B) inferiorly and lateral to the head of the pancreas

(C) anterior and parallel to the aorta

(D) transversely and caudad

(E) posterior to the inferior vena cava

16. The division by using Couinaud’s sections into right and left lobes of the liver is

(A) main lobar fissure

(B) ligamentum venosum

(C) falciform ligament

(D) hepatoduodenal ligament

(E) hepatic arteries

17. Which of the following is the portion of the pancreas that lies posterior to the superior mesenteric artery and vein?

(A) head

(B) neck

(C) uncinate process

(D) body

(E) tail

18. Which vessel courses along the posterior surface of the body and tail of the pancreas?

(A) superior mesenteric artery

(B) left renal vein

(C) aorta

(D) splenic artery

(E) splenic vein

19. Sonographically, where can the gastroesophageal junction be visualized?

(A) anterior to the inferior vena cava and posterior to the right lobe of the liver

(B) anterior to the aorta and posterior to the left lobe of the liver

(C) lateral to the head of the pancreas

(D) anterior to the stomach and medial to the spleen

(E) posterior to the left lobe of the liver and medial to the stomach

20. Which of the following describes adenomyomatosis of the gallbladder?

(A) a congenital anomaly that presents itself in the fourth or fifth decade

(B) an inflammation of the gallbladder and biliary ducts

(C) associated with chronic hepatitis

(D) proliferation of the mucosal layer, which extends into the muscle layer

(E) a malignant process that involves the gallbladder wall and lumen

21. What is the most common cause of acute pyelonephritis?

(A) hypertension

(B) Escherichia coli

(C) Klebsiella

(D) hydronephrosis

(E) enterococcus faecalis

22. A renal sonogram is performed and an echogenic well-defined mass is identified in the renal cortex. This is characteristic of which of the following?

(A) angiomyolipoma

(B) column of Bertin

(C) adenocarcinoma

(D) pyonephrosis

(E) renal stone

23. The gastroduodenal artery is a branch of which of the following?

(A) aorta

(B) celiac axis

(C) common hepatic artery

(D) left gastric artery

(E) duodenal artery

24. Identify the vessel that is seen anterior to the aorta and posterior to the superior mesenteric artery.

(A) splenic vein

(B) common hepatic artery

(C) gonadal artery

(D) left renal artery

(E) left renal vein

25. The liver is covered by a thick membrane of collagenous fibers intermixed with elastic elements. What is this membrane called?

(A) Glisson’s capsule

(B) Gerota’s fascia

(C) Bowman’s capsule

(D) adipose capsule

(E) membrane capsule

26. Which of the following can cause anterior displacement of the splenic vein?

(A) pancreatitis

(B) pseudocysts

(C) left adrenal hyperplasia

(D) aneurysm

(E) inferior vena cava thrombi

27. Which one of the following vessels originates from the celiac axis and is very tortuous?

(A) splenic artery

(B) hepatic artery

(C) right gastric artery

(D) gastroduodenal artery

(E) coiled artery

28. When accessory spleens are present, where are they usually located?

(A) at the superior margin of the spleen

(B) on the posterior aspect of the spleen

(C) near the kidney

(D) near the splenic hilum

(E) near the left diaphragm

29. What is a fold at the fundal portion of the gallbladder usually called?

(A) Hartmann’s pouch

(B) junctional fold

(C) valves of Heister

(D) Phrygian cap

(E) pouch of Douglas

30. The inferior vena cava forms at the confluence of which of the following vessels?

(A) right and left carotid veins

(B) right and left common iliac veins

(C) right and left lumbar veins

(D) right and left renal veins

(E) right and left common iliac arteries

31. Diffuse thickening of the gallbladder wall can be seen sonographically in all of the following except

(A) acute cholecystitis

(B) hepatitis

(C) congestive heart failure

(D) ascites

(E) portal hypertension

32. A gallbladder sonographic examination is performed, and a small gallbladder with intrahepatic dilatation is seen. This may indicate that the level of obstruction is at the level of which of the following?

(A) neck of the gallbladder

(B) common bile duct

(C) cystic duct

(D) common hepatic duct

(E) none of the above

33. What is the maximum inner diameter of the main pancreatic duct in young adults?

(A) 10 mm

(B) 5 mm

(C) 2 cm

(D) 3 cm

(E) 2 mm

34. Which of the following is produced by the endocrine function of the pancreas?

(A) insulin

(B) lipase

(C) amylase

(D) trypsin

(E) chymotrypsin

35. Which laboratory test is used to assess renal function?

(A) serum creatinine

(B) serum bilirubin

(C) aspartate aminotransferase (AST)

(D) alkaline phosphatase

(E) serum amylase

36. Adult polycystic disease may be characterized by all of the following except

(A) it is autosomal dominant disease

(B) it may be associated with cysts in the liver, pancreas, and spleen

(C) bilateral small and echogenic kidneys

(D) usually does not produce any symptoms until the third or fourth decade of life

(E) the kidneys lose their reniform shape

37. What is the best sonographic window to image the left hemidiaphragm?

(A) liver

(B) spleen

(C) stomach

(D) left kidney

(E) urinary bladder

38. A patient in the late stages of sickle cell anemia will have a spleen that is which of the following?

(A) enlarged and lobulated

(B) enlarged and echogenic

(C) small and hypoechoic

(D) small and echogenic

(E) atrophic and isoechoic

39. Bilateral hydronephrosis frequently occurs in all of the following except

(A) urinoma

(B) posterior urethral valve (PUV)

(C) late pregnancy

(D) fibroid uterus

(E) benign prostate hypertrophy (BPH)

40. In a patient with acute hepatitis, what is the appearance of the liver parenchyma sonographically?

(A) hypoechoic

(B) echogenic

(C) complex

(D) normal

(E) anechoic

41. What is a hypertrophied column of Bertin?

(A) benign tumor of the kidney

(B) malignant tumor of the lower urinary tract

(C) renal variant

(D) a common cause of hydronephrosis

(E) complication of a renal transplant

42. What is a ureterovesical junction?

(A) junction between the renal pelvis joins the proximal ureter

(B) junction between the distal ureter and the base of the bladder

(C) junction between the renal pyramids and the distal calyces

(D) junction between the ejaculatory ducts and urethra

43. What is the landmark for the posterolateral border of the thyroid?

(A) trachea

(B) esophagus

(C) strap muscle

(D) common carotid artery

(E) superior thyroid artery

44. Which of the following is not a clinical sign of renal disease?

(A) oliguria

(B) palpable flank mass

(C) generalized edema

(D) hypertension

(E) jaundice

45. Acute hydroceles may be caused by all of the following except

(A) infarction

(B) tumor

(C) testicular torsion

(D) trauma

(E) infection of the testis or epididymis

46. What is the most common malignancy of the adrenal gland in children?

(A) adrenal adenoma

(B) neuroblastoma

(C) nephroblastoma

(D) pheochromocytoma

(E) lymphoma

47. If a mass in the area of the pancreatic head is found, what other structure should be examined sonographically?

(A) the liver

(B) the inferior vena cava

(C) the spleen

(D) the kidney

(E) the bowel

48. What is the most common primary carcinoma of the pancreas?

(A) insulinoma

(B) cystadenocarcinoma

(C) adenocarcinoma

(D) pancreatic pseudocyst

(E) lymphoma

49. The ligament of venosum separates which two lobes of the liver?

(A) right and left lobes

(B) medial portion of the left lobe and the lateral portion of the left lobe

(C) caudate lobe and left lobe of the liver

(D) anterior portion of the right lobe and the posterior portion of the right lobe

(E) quadrate lobe and the left lobe of the liver

50. What is the most common benign neoplasm of the liver?

(A) hemangioma

(B) angiomyolipoma

(C) focal nodular hyperplasia

(D) abscess

(E) Wilms’ tumor

51. Which of the following may develop in patients with right-sided heart failure and elevated systemic venous pressure?

(A) fatty liver

(B) portal-systemic anastomoses

(C) focal liver lesions

(D) dilatation of the intrahepatic veins

(E) hematomas

52. Which of the following separates the right and left lobes of the liver?

(A) coronary ligament

(B) main lobar fissure

(C) falciform ligament

(D) ligament of venosum

(E) interhemispheric fissure

53. Which of the following is not a retroperitoneal structure?

(A) kidney

(B) pancreas

(C) aorta

(D) spleen

(E) psoas muscle

54. Which of the following statements is true about the portal vein?

(A) It is formed by the union of the common hepatic duct and the cystic duct.

(B) It is only imaged sonographically when there is liver pathology.

(C) It is formed by the union of the splenic vein and superior mesenteric vein.

(D) It is very pulsatile.

(E) It is commonplace for stones to form.

55. The common bile duct is joined by the pancreatic duct as they enter the

(A) first portion of the duodenum

(B) second portion of the duodenum

(C) third portion of the duodenum

(D) fourth portion of the duodenum

(E) pylorus of the stomach

56. A patient presents with empyema of the gallbladder. What should the sonographer expect to find?

(A) pus within the gallbladder

(B) common bile duct obstruction

(C) stones within the gallbladder

(D) abscess surrounding the gallbladder

(E) duplication of the gallbladder

57. Identify the laboratory value that is specific for a hepatoma of the liver.

(A) alkaline phosphatase

(B) alpha-fetoprotein

(C) serum amylase

(D) bilirubin

(E) serum albumin

58. If the prostate is found to be enlarged, which of the following should the sonographer also check?

(A) spleen for enlargement

(B) scrotum for hydroceles

(C) kidneys for hydronephrosis

(D) liver for metastases

(E) gallbladder for stones

59. The body of the pancreas is bound on its anterior surface by which of the following?

(A) atrium of stomach

(B) greater sac

(C) splenic vein

(D) common bile duct

(E) duodenum

60. On a transverse scan, the portal vein is seen as a circular anechoic structure

(A) anterior to the inferior vena cava

(B) posterior to the aorta

(C) medial to the head of the pancreas

(D) inferior to the head of the pancreas

(E) anterior to the common bile duct

61. Hyperthyroidism associated with a diffuse goiter is associated with which of the following?

(A) papillary carcinoma

(B) Graves’ disease

(C) Hashimoto’s thyroiditis

(D) adenoma

62. Identify the part of the pancreas that lies anterior to the inferior vena cava and posterior to the superior mesenteric vein.

(A) head

(B) neck

(C) body

(D) uncinate process

(E) tail

63. In a dissecting aneurysm, the dissection is through which of the following?

(A) the adventitia

(B) the media

(C) the intima

(D) all three layers

(E) lumen

64. The adrenal gland can be divided into which of the following parts?

(A) pelvis and sinus

(B) cortex and medulla

(C) major and minor calices

(D) head and tail

(E) fundus and body

65. Where can a patent umbilical vein be found?

(A) ligamentum venosum

(B) main lobar fissure

(C) ligamentum teres

(D) intersegmental ligament

(E) gallbladder fossa

66. All of the following are characteristic for dilated intrahepatic bile ducts except

(A) the parallel channel sign

(B) irregular borders to dilated bile ducts

(C) echo enhancement behind dilated ducts

(D) decreasing size as they course toward the porta hepatis

(E) they do not fill with color

67. A retroperitoneal abscess may be found within in all of the following except

(A) the rectus abdominis muscle

(B) the psoas muscle

(C) the iliacus muscle

(D) the quadratus lumborum muscle

68. Dilatation of the intrahepatic biliary ducts without dilatation of the extrahepatic ducts may be caused by all of the following except

(A) a Klatskin tumor

(B) enlarged portal lymph nodes

(C) a cholangiocarcinoma

(D) a pancreatic carcinoma

69. A 42-year-old woman presents postcholecystectomy with right-upper-quadrant pain, elevated serum bilirubin (mainly conjugated), and bilirubin in her urine. Which of the following is this best characteristic of?

(A) hepatitis

(B) stone, tumor, or stricture causing obstruction of the bile duct

(C) small common duct stone <5 mm in diameter

(D) alkaline phosphatase will be normal

(E) pancreatic pseudocyst

70. What is a cause of a small gallbladder?

(A) prolonged fasting

(B) insulin-dependent diabetes

(C) chronic cholecystitis

(D) hydrops

(E) ascites

71. Identify the vessel that is located superior to the pancreas.

(A) inferior vena cava

(B) superior mesenteric artery

(C) splenic vein

(D) celiac axis

(E) left renal vein

72. A tumor in the retroperitoneal space will displace surrounding organs in what position?

(A) anterior

(B) posterior

(C) medial

(D) lateral

(E) inferior

73. Which of the following can cause anterior displacement of the abdominal aorta?

(A) enlarged adrenal gland

(B) kidney mass

(C) aortic aneurysm

(D) enlarged lymph nodes

(E) inferior vena cava thrombus

74. Sonographically, how do enlarged lymph nodes most commonly appear?

(A) as solid masses

(B) as complex masses

(C) as cystic masses with increased through transmission

(D) as hypoechoic masses with no increased through transmission

(E) as irregular-shaped masses with small focal areas of calcification

75. Which of the following best describes hepatofugal blood flow?

(A) blood flows away from the liver

(B) turbulent blood flow

(C) intermittent blood flow

(D) blood flows toward the liver

(E) blood fungi in the hepatic veins

76. What anatomic landmarks can be used to sonographically locate the left adrenal gland?

(A) aorta, stomach, and spleen

(B) aorta, spleen, and left kidney

(C) inferior vena cava, spleen, and left kidney

(D) inferior vena cava, stomach, and left kidney

(E) stomach, pancreas, and left kidney

77. Which of the following most likely appears as nonshadowing, nonmobile, echogenic foci imaged within the gallbladder lumen?

(A) polyps

(B) calculi

(C) biliary gravel

(D) sludge balls

(E) thin bile

78. What is hydrops of the gallbladder?

(A) a small contracted gallbladder

(B) a gallbladder with a thickened wall

(C) a thick walled gallbladder filled with stones

(D) congenital duplication of the gallbladder

(E) an enlarged gallbladder

79. Which of the following most likely causes jaundice in a pediatric patient?

(A) hepatitis

(B) fatty infiltration

(C) biliary atresia

(D) cirrhosis

(E) portal hypertension

80. The majority of primary retroperitoneal tumors are malignant. Which of the following is an example of a primary retroperitoneal tumor?

(A) hepatoma

(B) hypernephroma

(C) leiomyosarcoma

(D) adenocarcinoma

(E) hematoma

81. Compare the echogenicities of the following structures and place them in increasing echogenic order.

(A) renal sinus < pancreas < liver < spleen < renal parenchyma

(B) renal sinus < liver < spleen < pancreas < renal parenchyma

(C) pancreas < liver < spleen < renal sinus < renal parenchyma

(D) renal parenchyma < liver < spleen < pancreas < renal sinus

(E) renal parenchyma < pancreas < renal sinus < spleen < liver

82. In comparison to the normal echotexture in adults, the pancreas in children will be relatively

(A) more echogenic

(B) less echogenic

(C) the same echogenicity

(D) larger and less echogenic

(E) complex

83. The kidneys, the perinephric fat, and the adrenal glands are all covered by which of the following?

(A) a true capsule

(B) Gerota’s fascia

(C) peritoneum

(D) Glisson’s capsule

(E) quadratus lumborum muscle

84. What is the largest major visceral branch of the inferior vena cava?

(A) portal vein

(B) hepatic veins

(C) renal veins

(D) inferior mesenteric vein

(E) gonadal veins

85. The spleen is variable in size, but it is considered to be which of the following?

(A) concave superiorly and inferiorly

(B) convex superiorly and concave inferiorly

(C) concave superiorly and convex inferiorly

(D) convex superiorly and inferiorly

86. A malignant solid renal mass can be all of the following except

(A) renal cell carcinoma

(B) adenocarcinoma of the kidney

(C) oncocytoma

(D) transitional cell carcinoma

87. Which one of the following statements correctly describes the anatomic location of structures adjacent to the spleen?

(A) the diaphragm is superior, lateral, and inferior to the spleen.

(B) the fundus of the stomach and lesser sac are medial and posterior to the splenic helium.

(C) the left kidney lies inferior and medial to the spleen.

(D) the pancreas lies anterior and medial to the spleen.

(E) the adrenal gland is anterior, superior, and lateral to the spleen.

88. Which of the following sonographic findings are associated with hematoceles?

(A) a cyst along the course of the vas deferens

(B) a blood-filled sac that surrounds the testicle, secondary to trauma or surgery

(C) dilated veins caused by obstruction of the venous return

(D) a condition in which the testicles have not descended

(E) a solid mass outside the testes

89. When scanning a 22-year-old patient to rule out cholelithiasis, a single echogenic lesion is seen within the liver. What is this most characteristic of?

(A) a cavernous hemangioma

(B) a hematoma

(C) a hepatic cyst

(D) an abscess

(E) lipoma

90. What are normal measurements of the thyroid gland?

(A) 3–4 cm in anteroposterior and length dimensions

(B) 2–3 cm in anteroposterior dimensions and 4–6 cm in length

(C) 1–2 cm in anteroposterior dimensions and 4–6 cm in length

(D) 3–5 cm in anteroposterior dimensions and 6–8 cm in length

(E) 4–6 cm in anteroposterior dimensions and 8–10 cm in length

91. Ascites can be caused by all of the following except

(A) malignancy

(B) nephritic syndrome

(C) congestive heart failure

(D) tuberculosis

(E) adenomyomatosis

92. What is the best way to delineate a dissecting aneurysm on sonography?

(A) begin scanning in the transverse section and document serial scans.

(B) show an intimal flap pulsating with the flow of blood.

(C) scan the patient in a decubitus position to document the aorta and inferior vena cave simultaneously.

(D) document the renal arteries.

(E) have the patient perform a Valsalva maneuver to dilate the aorta.

93. Obstructive jaundice may be diagnosed sonographically by demonstrating which of the following?

(A) a mass in the head of the pancreas with a dilated common bile duct

(B) an enlarged liver

(C) a fibrotic and atrophic liver

(D) cholangitis

(E) portal hypertension

94. Where would a subhepatic abscess be located?

(A) superior to the liver

(B) inferior to the liver, anterior to the right kidney

(C) inferior to the liver, posterior to the right kidney

(D) adjacent to the porta hepatis

(E) inferior to the pleura and superior to the liver

95. Which of the following is not a remnant of the fetal circulation?

(A) ligamentum teres

(B) ligamentum venosum

(C) falciform ligament

(D) coronary ligament

96. Which of the following is a major branch of the common hepatic artery?

(A) gastroduodenal artery

(B) coronary artery

(C) esophageal artery

(D) left gastric artery

(E) duodenal artery

97. A 44-year-old patient presents with painless jaundice and a palpable right-upper-quadrant mass, which is most characteristic of which of the following?

(A) acute hepatitis

(B) cirrhosis

(C) porcelain gallbladder

(D) Courvoisier’s gallbladder

(E) Klatskin tumor

98. A common anatomical variant is a bulge of the lateral border of the left kidney. What is this called?

(A) junctional parenchymal defect

(B) Phrygian cap

(C) column of Bertin

(D) Bowman’s capsule

(E) dromedary hump

99. Which of the following cannot be imaged in a case of end-stage liver disease?

(A) ascites

(B) small atrophied liver

(C) biliary dilatation

(D) portal hypertension

(E) echogenic nodular liver

100. The head of the pancreas is located anterior to which of the following vessels?

(A) inferior vena cava

(B) aorta

(C) superior mesenteric artery

(D) splenic vein

(E) portal vein

101. What is the lesser sac located between?

(A) pancreas and the inferior vena cava

(B) stomach and pancreas

(C) abdominal wall and stomach

(D) liver and right kidney

(E) stomach and spleen

102. Where are the renal pyramids found?

(A) cortex

(B) medulla

(C) renal pelvis

(D) renal sinus

(E) loop of Henle

103. Which of the following is chronic renal disease associated with?

(A) an enlarged kidney with a small contralateral kidney

(B) unilateral hydronephrosis

(C) small echogenic kidneys

(D) renal carbuncle

(E) an ectopic kidney

104. A 50-year-old woman with a long history of alcoholism presents with increased abdominal girth. Which of the following is the most probable finding on a sonogram of the abdomen?

(A) liver metastases

(B) massive ascites with a small echogenic liver

(C) hepatoma

(D) gallstones with a mass in the lumen of the gallbladder

(E) dilated intrahepatic biliary ducts

105. Chronic active hepatitis is a progressive destructive liver disease that eventually leads to which of the following?

(A) liver cysts

(B) hepatoma

(C) cirrhosis

(D) pancreatitis

(E) liver metastases

106. A 6-year-old child presents with recurrent fever, right-upper-quadrant pain, and jaundice. An abdominal sonogram is performed. The liver and gallbladder appear normal, but a 2-cm cyst is seen communicating with the common bile duct. What does this cystic structure most likely represent?

(A) a choledochal cyst

(B) a pseudocyst

(C) an aortic aneurysm

(D) a mucocele

(E) hydatid cyst

107. A 35-year-old woman presents with a tender neck, and on physical exam, an enlarged thyroid is found. An enlarged inhomogeneous thyroid with irregular borders is seen on the sonogram. What is this most characteristic of?

(A) a malignant lesion

(B) Graves’ disease

(C) cyst

(D) adenomatous hyperplasia

(E) Hashimoto’s thyroiditis

108. What is calcification of the gallbladder wall called?

(A) cholesterolosis

(B) Courvoisier’s gallbladder

(C) hydropic gallbladder

(D) porcelain gallbladder

109. A 60-year-old man presents with an abdominal pulsatile mass and high blood pressure. What is this most characteristic of?

(A) an aneurysm

(B) a mesenteric cyst

(C) gallstones

(D) Budd–Chiari syndrome

(E) portal hypertension

110. Identify the vessel that may be imaged posterior to the inferior vena cava.

(A) right renal vein

(B) right renal artery

(C) left renal vein

(D) left renal artery

(E) no vessels course posterior to the inferior vena cava

111. The retroperitoneal space is defined as the area between which of the following?

(A) posterior portion of the parietal peritoneum and the posterior abdominal wall muscles

(B) anterior portion of the parietal peritoneum and the posterior abdominal wall muscles

(C) anterior portion of the parietal peritoneum and the posterior portion of the parietal peritoneum

(D) anterior abdominal wall and the posterior parietal peritoneum

(E) posterior to the great vessels and anterior to the lumbar spine

112. An abdominal sonogram is performed, and there is a suggestion of a mass in the head of the pancreas. Identify the other structures that should be evaluated.

(A) the biliary system and gallbladder to evaluate biliary obstruction

(B) the hepatic artery and splenic artery to document dilatation

(C) the kidney to evaluate renal obstruction

(D) liver to evaluate focal masses

(E) spleen to document size

113. Identify the laboratory values that are most consistent for a patient with acute pancreatitis.

(A) creatinine and BUN will both rise, but creatinine remains higher for a longer period of time.

(B) amylase and alkaline phosphatase will both rise, but amylase remains higher for a longer period of time.

(C) amylase and lipase rise at the same rate, but lipase remains higher for a longer period of time.

(D) insulin and glucose will both rise, but glucose will remain higher for a longer period of time.

(E) epinephrine and norepinephrine will both rise and stay elevated for the same period of time.

114. When hypertrophic pyloric stenosis is imaged in the short axis, what is the least measurement of the muscle wall?

(A) 2 mm

(B) 4 mm

(C) 6 mm

(D) 8 mm

(E) 12 mm

115. What is a malignant tumor of the adrenal gland found in children called?

(A) nephroblastoma

(B) neuroblastoma

(C) hepatoma

(D) lymphoma

(E) sarcoma

116. Lymph nodes may be confused sonographically with all of the following except

(A) an abdominal aortic aneurysm

(B) chronic pancreatitis

(C) the crus of the diaphragm

(D) the bowel

117. An abdominal sonogram is performed on a 35-year-old man with a history of primary cancer of the liver who now presents with abdominal pain and increasing abdominal girth. What is this most consistent with?

(A) cholecystitis

(B) pancreatitis

(C) portal hypertension

(D) Budd–Chiari syndrome

(E) renal failure

118. During an abdominal sonogram, recanalization of the umbilical vein is identified. What could this be associated with?

(A) ascites

(B) an abscess

(C) a hematoma

(D) hepatoma

(E) portal hypertension

119. Which of the following is characteristic of a pelvic kidney?

(A) an abnormal appearance in a normal location

(B) a normal appearance in an abnormal location

(C) a normal appearance in a normal location

(D) an irregular shape

(E) twice the renal volume

120. The ureteropelvic junction is located between which of the following?

(A) renal pelvis and the proximal portion of the ureter

(B) distal ureter and base of the bladder

(C) urethra and the bladder

(D) medulla and the cortex

(E) apex and the base of the bladder

121. One method to diagnosis renal obstruction is to document a resistive index (RI) of greater than

(A) 0.07

(B) 0.09

(C) 0.30

(D) 0.50

(E) 0.70

122. Identify the syndrome that is associated with an adrenal mass.

(A) Murphy’s syndrome

(B) Budd–Chiari syndrome

(C) Cushing’s syndrome

(D) Frohlich’s syndrome

(E) Graves’ syndrome

123. Islet cell tumors of the pancreas are most likely to be located in which portion of the pancreas?

(A) head and neck

(B) neck and tail

(C) uncinate process

(D) body and tail

(E) head and body

124. What do the celiac axis branches consist of?

(A) common hepatic, splenic, and right gastric arteries

(B) common hepatic, gastroduodenal, and left gastric arteries

(C) common hepatic, left gastric, and splenic arteries

(D) common hepatic, coronary, and phrenic arteries

(E) common hepatic, right, and left gastric arteries

125. What is the most common benign mass of the spleen?

(A) cavernous hemangioma

(B) angiosarcoma

(C) congenital cyst

(D) lymphoma

(E) hematoma

126. Which of the following is the membrane that lines the abdominal cavity?

(A) visceral peritoneum

(B) parietal peritoneum

(C) pleura

(D) endometrial lining

(E) serosal lining

127. A normal functioning transplanted kidney will appear sonographically as which of the following?

(A) more echogenic than a normal kidney

(B) with a thin renal cortex and prominent medullary pyramids

(C) the same as a normal kidney

(D) twice the size of a normal kidney

(E) with the renal sinus and renal cortex being isoechoic

128. When performing a gallbladder examination, why is the patient asked to be NPO (nothing by mouth) for approximately 6 hours before the examination?

(A) to eliminate any overlying bowel gas

(B) to make the patient more cooperative

(C) to bring about dehydration, which will make the patient easier to scan

(D) causes bile to collect in the gallbladder

(E) causes the bile ducts to dilate

129. Where are transplanted kidneys usually placed?

(A) within the renal fossa

(B) in the pelvis along the iliopsoas margin

(C) in the pelvis anterior to the bladder

(D) within the abdominal rectus sheath

(E) in Morrison’s pouch

130. What do Klatskin tumors cause?

(A) dilatation of intrahepatic ducts

(B) dilatation of extrahepatic ducts

(C) gallstones

(D) pancreatitis

(E) porcelain gallbladder

131. Which of the following is not located in the peritoneal cavity?

(A) gallbladder

(B) liver

(C) spleen

(D) pancreas

(E) hepatic veins

132. The splenic artery

(A) originates from the anterior abdominal aorta

(B) lies posterior to the inferior vena cava

(C) is tortuous, and courses along the superior aspect of the body and tail of the pancreas

(D) is the first branch of the abdominal aorta

(E) courses along the posterior aspect of the body and tail of the pancreas

133. Artifactual echoes may occur within cysts owing to each of the following except

(A) slice thickness artifacts

(B) side-lobe artifacts

(C) edge artifacts

(D) reverberation artifacts

134. In which of the following ways does ascites sonographically affect the liver?

(A) there will be no effect.

(B) the liver will appear more echogenic.

(C) the ascites will attenuate the liver, resulting in decreased echoes.

(D) the ascites will cause the liver to appear inhomogeneous.

135. If the ultrasound beam passes through a fatty tumor within the liver, and we know that the speed of sound in fat is lower than in soft tissue, where will this fatty tumor be placed?

(A) farther away than it really is

(B) closer than it really is

(C) its true position

(D) smaller is size than it really is

(E) can be any of the above, depending on the frequency of the transducer

136. Which of the following is representative of a post-trauma fluid collection located between the diaphragm and the spleen?

(A) ascites

(B) a pleural effusion

(C) a subcapsular hematoma

(D) a subphrenic abscess

(E) retroperitoneal fibrosis

137. Which of the following can be displaced by a retroperitoneal sarcoma?

(A) kidney posteriorly

(B) spleen anteriorly

(C) pancreas posteriorly

(D) diaphragm inferiorly

(E) aorta posteriorly

138. Splenomegaly may be caused by all of the following except which one?

(A) an inflammatory process

(B) portal vein thrombus

(C) a left subphrenic abscess

(D) polycythemia vera

(E) chronic leukemia and lymphoma

139. The causes of a large gallbladder include all of the following except

(A) adenomyomatosis

(B) pancreatic carcinoma

(C) diabetes mellitus

(D) a fasting patient

(E) common duct obstruction

140. Where are the quadratus lumborum muscles located?

(A) medial to the lumbar spine

(B) in the anterior abdominal wall

(C) between the kidneys and the adrenal glands

(D) posterior to the kidneys

(E) perirenal

141. All of the following are associated with cirrhosis except

(A) ascites

(B) splenomegaly

(C) jaundice

(D) hepatomegaly

(E) collateral vessel development

142. Which of the following is absence of a ureteral jet consistent with?

(A) pyelonephrosis

(B) parapelvic renal cyst

(C) obstructive hydronephrosis

(D) posterior urethral values

(E) renal cell carcinoma

143. A cystic mass that extends from the renal pelvis to outside the renal capsule is

(A) a parapelvic cyst

(B) an extrarenal pelvis

(C) a renal artery aneurysm

(D) a grade II hydronephrosis

(E) duplex collecting system

144Fig. 4–9 is a longitudinal scan to the left of midline. The long narrow arrow points to which of the following structures?

(A) diaphragm

(B) ascites

(C) inferior vena cava

(D) left pleural effusion

(E) heart

Image

FIGURE 4–9. Longitudinal sonogram of the upper abdomen.

145. Which of the following is the wide short arrow in Fig. 4–9 pointing to?

(A) an abdominal aneurysm

(B) an esophagus

(C) the inferior vena cava

(D) an hepatic vein

(E) the aorta

146Fig. 4–10 is a transverse view of the upper abdomen. What is the arrow pointing to?

(A) the aorta

(B) the inferior vena cava

(C) the portal vein

(D) the spine

(E) an enlarged lymph node

Image

FIGURE 4–10. Transverse sonogram of the upper abdomen.

147. A patient with normal renal function test results presents for a sonogram of the kidneys. Fig. 4–11 is a longitudinal image of the left kidney. What does this image most likely represent?

(A) polycystic kidneys

(B) infected cysts

(C) hydronephrosis

(D) parapelvic renal cysts

(E) two simple cysts

Image

FIGURE 4–11. Longitudinal view of the left kidney.

148. A 35-year-old man with a history of diabetes presents with an increase of ALT and AST and vague abdominal pain. What do the longitudinal and transverse images shown in Fig. 4–12 most likely represent?

(A) fatty liver

(B) severe hepatitis

(C) cirrhosis

(D) metastases

(E) Budd–Chiari syndrome

Image

FIGURE 4–12. (A) Longitudinal sonogram through the liver. (B) Transverse sonogram through the liver.

149. The arrow in Fig. 4–13 points to

(A) aorta

(B) superior mesenteric artery

(C) portal vein

(D) enlarged lymph node

(E) inferior vena cava

Image

FIGURE 4–13. Transverse sonogram of the upper abdomen.

150. A 35-year-old woman presents with right-upper-quadrant pain, nausea, and vomiting. The findings in Fig. 4–14 are most consistent with which of the following?

(A) acute cholecystitis

(B) chronic cholecystitis

(C) adenomyosis

(D) a gallbladder of a patient who has just eaten

(E) a normal gallbladder

151. What is the arrowhead in Fig. 4–14 pointing to?

(A) pericholecystic fluid collection

(B) loop of bowel

(C) cystic artery

(D) gastroduodenal artery

(E) portal vein

Image

FIGURE 4–14. A longitudinal sonogram at the level of the gallbladder.

152. What is the finding in Fig. 4–15A and B characteristic of?

(A) pleural effusion

(B) pleural abscess

(C) ascites

(D) dissecting aneurysm

(E) fatty liver

Image

FIGURE 4–15. (A) Longitudinal sonogram through the upper abdomen. (B) Transverse sonogram through the upper abdomen.

153Fig. 4–16 is a transverse scan at the level of the liver and right kidney. What is this liver abnormality most consistent with?

(A) a hydatid cyst

(B) a hematoma

(C) metastatic lesions

(D) a cavernous hemangioma

(E) infected cysts

Image

FIGURE 4–16. A transverse view of the right kidney.

154. What are the arrows in Fig. 4–17 pointing to?

(A) main portal veins

(B) hepatic veins

(C) right and left portal vein

(D) phrenic veins

(E) hepatic ducts

Image

FIGURE 4–17. Transverse scan of the upper abdomen.

155. What is the arrow in Fig. 4–18 pointing to?

(A) the right crus of the diaphragm

(B) the right renal artery

(C) the right adrenal gland

(D) the right renal vein

(E) the right portal vein

Image

FIGURE 4–18. Transverse scan of the abdomen.

156. What is the arrow in Fig. 4–19 pointing to?

(A) levator ani muscle

(B) quadratus lumborum muscle

(C) psoas muscle

(D) internal oblique muscle

(E) rectus abdominis muscle

Image

FIGURE 4–19. Longitudinal scan through the right kidney.

157. The patient in Fig. 4–20 presented with massive ascites. What is the arrow pointing to?

(A) ligamentum teres

(B) ligamentum venosum

(C) falciform ligament

(D) coronary ligament

(E) splenorenal ligament

Image

FIGURE 4–20. Transverse scan through the liver.

158. A 1-week-old male infant presents with a left flank mass. An IVP demonstrates a normal right kidney, but there is no visualization of the left kidney. A sonogram is performed and numerous noncommunicating round cystic structures are demonstrated in the left renal fossa, the largest of which is located laterally. No renal parenchyma is identified. The right kidney is normal. This most probably represents which of the following?

(A) severe hydronephrosis

(B) polycystic kidneys

(C) a multicystic kidney

(D) nephroblastoma

(E) unilateral renal agenesis

159. Which of the following is an echogenic linear line extending from the portal vein to the neck of the gallbladder?

(A) cystic duct

(B) right hepatic vein

(C) left portal vein

(D) main lobar fissure

(E) round ligament

160. What is the most common primary neoplasm of the pancreas?

(A) an adenocarcinoma

(B) an insulinoma

(C) a pseudocyst

(D) a cystadenoma

(E) a congenital cyst

161. A patient presents with epigastric tenderness, fever, and an increase in serum amylase and lipase. What is the arrowhead in Fig. 4–21 pointing to?

(A) superior mesenteric artery

(B) splenic vein

(C) portal vein

(D) hepatic artery

(E) pancreatic duct

Image

FIGURE 4–21. Transverse scan through the pancreas.

162. Which of the following is the most likely diagnosis of the patient in Fig. 4–21?

(A) acute pancreatitis

(B) phlegmonous pancreatitis

(C) hemorrhagic pancreatitis

(D) chronic pancreatitis

(E) normal pancreas

163. A 65-year-old patient presents with a history of hypertension and a palpable pulsatile mass on physical examination. What is the most likely finding in Fig. 4–22A-D?

(A) cholecystitis with a gallstone

(B) a hematoma

(C) an aortic aneurysm

(D) an abscess

(E) a hemorrhagic pseudocyst

Image

Image

FIGURE 4–22. (A) Longitudinal scan through the aorta. (B) Transverse scan through the aorta. (C) Transverse sonogram through midabdomen aorta. (D) Longitudinal sonogram through the proximal section of the aorta.

164. What is the arrow in Fig. 4–23 pointing to?

(A) splenic vein

(B) superior mesenteric artery

(C) celiac artery

(D) splenic artery

(E) superior mesenteric vein

Image

FIGURE 4–23. Longitudinal scan through the midline of the abdomen.

165. What do the findings in Fig. 4–24 represent?

(A) acute pancreatitis

(B) a pancreatic pseudocyst

(C) chronic pancreatitis

(D) adenocarcinoma of the pancreas

(E) a normal pancreas

Image

FIGURE 4–24. Transverse sonogram through the pancreas.

166. What does the arrow in Fig. 4–25 point to?

(A) a medullary pyramid

(B) a renal cyst

(C) diverticula of the calyce

(D) a parapelvic cyst

(E) a renal artery aneurysm

Image

FIGURE 4–25. Sagittal sonogram through the right upper abdomen.

167. What is the arrow in Fig. 4–26 pointing to?

(A) a sludge ball in the gallbladder

(B) a polyp in the gallbladder neck

(C) calculi

(D) a surgical clip with distal acoustic shadow

(E) a normal gallbladder

Image

FIGURE 4–26. Longitudinal sonogram through the gallbladder.

168. What is the artifact on Fig. 4–26 called?

(A) reverberation

(B) a comet-tail artifact

(C) scattering

(D) acoustic shadowing

(E) posterior acoustic enhancement

169. What linear anechoic structure is being measured by the calipers in Fig. 4–27?

(A) left portal vein

(B) main portal vein

(C) middle hepatic vein

(D) patient umbilical vein

(E) common bile duct

Image

FIGURE 4–27. Transverse view through the right upper quadrant.

170. What can be said about the structure being measured by the caliper in Fig. 4–27?

(A) normal in caliber

(B) small in caliber

(C) large in caliber

(D) unable to determine

Image

FIGURE 4–28. Transverse sonogram through the upper abdomen.

171. What are the findings in Fig. 4–28 characteristic of?

(A) intrahepatic dilatation

(B) pneumobilia

(C) acute hepatitis

(D) chronic hepatitis

(E) hepatocellular carcinoma

172. Which of the following abnormal findings is shown in Fig. 4–29?

(A) hydrated disease

(B) fatty liver

(C) cavernous hemangioma

(D) multiple abscesses

(E) liver metastasis

Image

FIGURE 4–29. Transverse scan through the liver.

173. Which of the following sonographic findings is shown in Fig. 4–30?

(A) splenomegaly

(B) a subphrenic abscess

(C) subcapsular hematoma

(D) normal appearing spleen

(E) metastasis within the spleen

Image

FIGURE 4–30. Coronal image through the left upper quadrant.

174. The common bile duct is formed by which of the following?

(A) right and left hepatic ducts joining the cystic duct

(B) cystic duct joining the right hepatic duct

(C) common duct joining the cystic duct

(D) common duct joining the neck of the gallbladder

(E) common duct joining the pancreatic duct

175. Which of the following is usually the cause of an aneurysm?

(A) degenerative joint disease

(B) atherosclerosis

(C) hypertension

(D) diabetes

(E) cystic fibrosis

176. What is the arrow in Fig. 4–31 pointing to?

(A) common hepatic duct

(B) hepatic artery

(C) common bile duct

(D) portal vein

(E) hepatic vein

Image

FIGURE 4–31. Magnified sagittal sonogram of the porta hepatis area.

177. What are the sonographic findings shown in Fig. 4–32 consistent with?

(A) column of Bertin

(B) prominent renal pyramid

(C) junctional parenchymal defect

(D) duplex collecting system

(E) sinus lipomatosis

Image

FIGURE 4–32. Long-axis view of the left kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

178. What is the arrowhead in Fig. 4–33 pointing to?

(A) calculi in the common bile duct

(B) calculi in the neck of the gallbladder

(C) air in the bile system

(D) a Klatskin tumor

(E) sludge

Image

FIGURE 4–33. Magnified oblique sonogram of the porta hepatis area.

179. A renal ultrasound is performed on a 30-year-old patient with right flank pain, elevated BUN, and creatinine. The findings in Fig. 4–34 are consistent with all of the following except

(A) a stone in the ureter

(B) an enlarged prostate

(C) gallstones

(D) the posterior urethra valve (PUV)

(E) a bladder mass

Image

FIGURE 4–34. Long-axis scan through the left kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

180. Sonographers are sometimes asked to assist in sonographic-guided needle thoracentesis. What is the recommended position for the patient?

(A) Trendelenburg position

(B) sitting upright

(C) Sims position

(D) recumbent position

(E) supine position

181. Patients with hyperthyroidism caused by Graves’ disease is most likely to have which of the following biochemical markers?

(A) increased T3 and T4

(B) decreased T3 and T4

(C) high TSH

(D) no changes in T3 and T4

(E) hyponatremia

182. What is the sonographic characteristic of Hashimoto’s thyroiditis?

(A) atrophic thyroid tissue with homogeneous echotexture

(B) multiple hypoechoic micronodules

(C) bilateral enlargements of the thyroid with multiple small cyst

(D) hypertrophy of the thyroid gland with homogeneous echo-texture

(E) hyperplasia with fluid levels

183. Which of the following is associated with an increase with the biochemical marker CEA?

(A) postradioimmunotherapy

(B) bowel decompression surgery

(C) follicular cyst of the ovaries

(D) relapse of colorectal cancer

(E) colostomy

184. A 35-year-old man was found to have an abdominal mass, and a sonographically guided fine needle aspiration biopsy is required. What kind of anesthesia is normally used for this type of procedure?

(A) topical

(B) regional

(C) general

(D) local

(E) spinal

185. Pneumobilia is most likely seen after which of the following procedures?

(A) cholecystectomy

(B) barium enema

(C) gallstone lithotripsy

(D) endoscopic retrograde cholangiopancreatography (ERCP)

(E) radiographic oral contrast cholecystogram

186. Which of the following anatomical structures is not seen anterior to the inferior vena cava in the abdomen?

(A) main lobar fissure

(B) main portal vein

(C) left hepatic vein

(D) caudate lobe

(E) right renal artery

187. Hashimoto’s disease is a chronic disease of which of the following glands?

(A) pancreas

(B) thyroid

(C) adrenal

(D) prostate

(E) thymus

188. What is the most common cause for acute pancreatitis in the United States?

(A) smoking and alcohol abuse

(B) cocaine and marijuana

(C) cholelithiasis and pancreatic tumor

(D) cholelithiasis and alcoholism

(E) peptic ulcer and abdominal trauma

189Fig. 4–35 suggests that the patient has which of the following?

(A) horseshoe kidney

(B) unilateral renal agenesis

(C) three kidneys

(D) pelvic kidney

(E) cross ectopic kidney

Image

FIGURE 4–35. Sagittal sonogram through the pelvis.

190. A patient presents with a history of epigastric pain and elevated lipase. What does the arrows in Fig. 4–36 point to?

(A) lymph nodes

(B) mesenteric cysts

(C) pseudocyst

(D) abscesses

(E) normal vessels

Image

FIGURE 4–36. Transverse sonogram through the pancreatic region.

191. What is the arrow in Fig. 4–37 pointing to?

(A) a pseudocyst

(B) perirenal fluid

(C) a dromedary hump

(D) pleural effusion

(E) a renal cyst

Image

FIGURE 4–37. Longitudinal sonogram through the kidney.

192. What are the findings in Fig. 4–38 most consistent with?

(A) patient who has just eaten

(B) porcelain gallbladder with gallstones

(C) gallbladder carcinoma

(D) adenomyomatosis

(E) acute cholecystitis with gallstones

Image

FIGURE 4–38. Left decubitus scan through the upper abdomen.

193. Identify the artifact shown in Fig. 4–39 (arrow).

(A) comet tail

(B) noise

(C) distal acoustic shadow

(D) refraction

(E) side lobes

Image

FIGURE 4–39. Left decubitus scan through the upper abdomen.

194. What is the arrowhead in Fig. 4–40 pointing to?

(A) the gallbladder

(B) an upper pole hydronephrosis

(C) a renal cyst

(D) an aneurysm

(E) a dilated ureter

Image

FIGURE 4–40. Long-axis view through a kidney.

195. The patient in Fig. 4–40 will most likely present with which of the following?

(A) flank pain

(B) fever

(C) nausea and vomiting

(D) no symptoms

(E) jaundice

196. What are the calipers in Fig. 4–41 measuring?

(A) antrum of stomach

(B) lymph node

(C) pancreatic pseudocyst

(D) body of pancreas

(E) aorta filled with thrombus

Image

FIGURE 4–41. Transverse sonogram of the upper abdomen. (Courtesy of Shpetim Telegrafi, MD, New York University.)

197. A 35-year-old man presents with right-upper-quadrant pain and recurrent attacks of pancreatitis. His laboratory results would be expected to indicate which of the following?

(A) increased blood urea nitrogen (BUN)

(B) decreased serum amylase

(C) increased lipase

(D) increased indirect bilirubin

(E) increased alkaline phosphatase

198. Sonographically, one can recognize fatty infiltration of the liver by all of the following except

(A) hepatomegaly

(B) parenchymal echoes are echogenic

(C) decreased vascular structure

(D) decreased through transmission

(E) a focal mass

199. Obstruction of the common bile duct by a mass in the head of the pancreas will lead to which of the following?

(A) a dilated gallbladder with dilated biliary radicles

(B) a contracted gallbladder with dilated biliary radicles

(C) dilated biliary radicles with normal or shrunken gallbladder

(D) portal hypertension

(E) cirrhosis

200. A 41-year-old man presents with epigastric pain and a history of alcoholism. The findings in Fig. 4–42 include which of the following?

(A) fatty pancreas

(B) adenocarcinoma

(C) metastatic disease to the pancreas

(D) chronic pancreatitis

(E) normal results

Image

FIGURE 4–42. Transverse sonogram of the upper abdomen.

201. A 50-year-old woman presents with painless hematuria. A longitudinal view of the left kidney is imaged in Fig. 4–43. What are the findings most consistent with?

(A) transitional cell carcinoma

(B) renal cell carcinoma

(C) adenoma

(D) angiolipoma

(E) oncocytoma

Image

FIGURE 4–43. A longitudinal sonogram of the left kidney.

202. What is the most common medical disease that causes acute renal failure?

(A) acute tubular necrosis

(B) renal infarction

(C) diabetes

(D) hypertension

(E) nephrocalcinosis

203. What is Fig. 4–44 consistent with?

(A) adult polycystic kidneys

(B) hydronephrosis

(C) medullary sponge kidney

(D) medullary cystic disease

(E) acquired cystic disease found in dialysis

Image

FIGURE 4–44. Longitudinal sonogram of the kidney.

204. A pelvic sonogram is performed. What is Fig. 4–45 consistent with?

(A) an enlarged prostate

(B) a Foley catheter balloon

(C) a ureterocele

(D) a bladder cyst

(E) diverticula

Image

FIGURE 4–45. Left sagittal sonogram of the pelvis.

205. What are the arrows in Fig. 4–46 pointing to?

(A) thrombus

(B) polyp

(C) bowel

(D) calculi

(E) parapelvic cyst

Image

FIGURE 4–46. Longitudinal scan of the left kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

206Fig. 4–47 is a midline longitudinal scan of the abdomen. What is the abnormality?

(A) an ectopic gallbladder

(B) aneurysmal dilatation of the distal abdominal aorta

(C) occlusion of abdominal aorta by thrombus

(D) a dissecting aneurysm

(E) an enlarged psoas muscle

Image

FIGURE 4–47. Midline longitudinal scan of the abdomen.

207. What term is used to describe onset of pain while scanning over the gallbladder?

(A) Kehr’s sign

(B) candle sign

(C) Murphy’s sign

(D) Chandelier’s sign

(E) Courvoisier’s gallbladder

208. What is the most likely diagnosis that can be made by the findings shown in Fig. 4–48?

(A) biliary obstruction caused by cholelithiasis

(B) biliary obstruction caused by pancreatitis

(C) distended portal vein caused by portal hypertension

(D) distended hepatic vein caused by chronic congestive heart failure

(E) obstruction of the distal common duct caused by a pancreatic tumor

Image

FIGURE 4–48. Transverse sonogram of the liver.

209. Which one of the following statements concerning the sonographic patterns of periaortic lymph nodes is not correct?

(A) they may drape or mantle the great vessels anteriorly.

(B) they may displace the superior mesenteric artery posteriorly.

(C) they may displace the great vessels anteriorly.

(D) they may have lobar, smooth, or scalloped appearance.

(E) as mesenteric involvement occurs, the adenopathy may fill most of the abdomen in an irregular complex pattern.

210. Which of the following findings is not represented in Fig. 4–49?

(A) diabetes

(B) hepatitis

(C) malignancy

(D) chronic pancreatitis

(E) portal caval shunts

Image

FIGURE 4–49. Longitudinal sonogram of the portal vein.

211. What is the blood flow in Fig. 4–50 consistent with?

(A) right-sided heart failure

(B) cirrhosis

(C) Budd–Chiari syndrome

(D) cavernous transformation of the portal vein

(E) normal blood flow in the hepatic and portal veins

Image

FIGURE 4–50. Transverse sonogram of the upper liver.

212. What is the arrow in Fig. 4–51 pointing to?

(A) a mass in the head of the pancreas

(B) c-loop of duodenum

(C) bowel mass

(D) calculi

(E) loculated fluid with debris

Image

FIGURE 4–51. Oblique sonogram of the liver.

213. What are the calipers in Fig. 4–51 measuring?

(A) common hepatic duct

(B) common bile duct

(C) main portal vein

(D) hepatic vein

(E) inferior vena cava

214. What are the findings in Fig. 4–51 most consistent with?

(A) mass in the head of the pancreas

(B) intrahepatic obstruction

(C) choledocholithiasis

(D) liver trauma

(E) liver cell carcinoma

215Fig. 4–52 is a transverse sonogram through the right lobe of the thyroid. What are the findings consistent with?

(A) Graves’ disease

(B) thyroiditis

(C) papillary carcinoma

(D) primary hyperplasia

(E) adenoma

Image

FIGURE 4–52. Transverse sonogram through the thyroid.

216. Which of the following findings is least likely to be associated with the disorder shown in Fig. 4–53?

(A) leukocytosis

(B) afebrile

(C) Murphy’s sign

(D) elevation of serum total bilirubin

(E) nausea and vomiting

Image

FIGURE 4–53. Sonogram of the right upper abdomen.

217Fig. 4–54 is a transverse sonogram of the left lobe of the liver. What do the arrows point to?

(A) hepatic vessels

(B) hypoechoic lesions

(C) portal sinuses

(D) biliary radicles

(E) none of the above

Image

FIGURE 4–54. Transverse sonogram of the left lobe of the liver.

218. Diagnostic possibilities in the findings in Fig. 4–54 include which one of the following?

(A) metastases

(B) hemangiomas

(C) infectious foci

(D) abscesses

219. What is the arrow in Fig. 4–55 pointing to?

(A) coronary ligament

(B) ligamentum of Teres

(C) gallstone

(D) lesser omentum

(E) main lobar fissure

Image

FIGURE 4–55. Transverse scan of the liver.

220. The findings in Fig. 4–56 are associated with all of the following except

(A) increase in alpha-fetoprotein level

(B) increase in direct bilirubin

(C) increase in alkaline phosphatase

(D) jaundice

(E) none of the above

Image

FIGURE 4–56. (A) Longitudinal (B) Transverse scans of the right lobe of the liver.

221. What are the findings in Fig. 4–56 consistent with?

(A) Budd–Chiari syndrome

(B) portal hypertension

(C) right-sided heart failure

(D) hepatic hydatid cysts

(E) hemangioma

Image

FIGURE 4–57. Longitudinal magnified sonogram of the gallbladder.

222. The findings in Fig. 4–57 are associated with all of the following except

(A) hypoproteinemia

(B) congestive heart failure

(C) acute hepatitis

(D) cholecystitis

(E) choledocholithiasis

223. What are the findings in Fig. 4–58 suggestive of?

(A) acute hepatitis

(B) fatty liver

(C) metastatic disease of the liver

(D) multiple hematomas

(E) cirrhosis

Image

FIGURE 4–58. Longitudinal sonogram of the right lobe of the liver.

224. The laboratory findings of renal failure include which of the following?

(A) creatinine and alkaline phosphatase

(B) creatinine and blood urea nitrogen

(C) serum amylase and lipase

(D) serum amylase and creatinine

(E) alkaline phosphatase and alpha-fetoprotein

225. The head of the pancreas is located to the right of which of the following?

(A) celiac axis

(B) inferior vena cava

(C) gastroduodenal artery

(D) common bile duct

(E) portal splenic confluence

226. What is Crohn’s disease?

(A) a mass in the stomach

(B) a parasitic condition

(C) an inflammation of the bowel

(D) loculated fluid in the peritoneal cavity

(E) a mass relating to the pancreas and biliary system

227. A resistive index (RI) >0.70 in a kidney is consistent with early

(A) obstructive jaundice

(B) obstructive hydronephrosis

(C) renal cell carcinoma

(D) benign renal cyst

(E) polycystic renal disease

228. A postrenal transplant perirenal fluid collection can be all of the following except

(A) parapelvic cyst

(B) urinoma

(C) lymphoma

(D) hematoma

(E) abscess

229. Which of the following describes the Doppler characteristic of the venous blood flow in a varicocele?

(A) increased blood flow

(B) irregular waveform

(C) triphasic flow

(D) no change in flow

(E) no blood flow

230. A 40-year-old patient presents with epigastric pain and jaundice. Fig. 4–59 is a transverse scan through the mid-abdomen. The crossbars delineate the area of interest. This is consistent with which of the following?

(A) bowel mass

(B) liver mass

(C) omental mass

(D) pancreatic mass

(E) normal finding

Image

FIGURE 4–59. Transverse sonogram at the level of the pancreas.

231. A 60-year-old man presents for a pelvic ultrasound. What are the findings in Fig. 4–60A and B consistent with?

(A) Foley catheter

(B) cystitis

(C) bladder carcinoma

(D) polyp

(E) enlarged prostate

Image

FIGURE 4–60 (A) Longitudinal transabdominal scan at the level of the bladder. (B) Transverse transabdominal scan of the bladder.

232. What is the arrow in Fig. 4–61 pointing to?

(A) ascites

(B) pleural effusion

(C) an abscess

(D) a hematoma

(E) a cyst

Image

FIGURE 4–61. Sagittal sonogram obtained through the right upper abdomen.

233. Fatty infiltration of the liver can be assessed sonographically by visualizing which of the following?

(A) echogenic vessel walls seen throughout the liver

(B) hypoechoic diaphragm

(C) increased liver echogenicity

(D) multiple echogenic focal masses

(E) small nodular liver

234. What is the most likely diagnosis of the patient shown in Fig. 4–62?

(A) hematoma

(B) metastases

(C) abscess

(D) hemangioma

(E) hydrated cysts

Image

FIGURE 4–62. Transverse sonogram throughout the right hepatic lobe. (Courtesy of Dunstan Abraham, MPH, PA-C, RDMS.)

235. A patient who has blunt trauma to the abdomen earlier in the day presents with left-upper-quadrant pain and a decrease in hematocrit. An echogenic mass is seen in the spleen. What is this consistent with?

(A) abscess

(B) lymphoma

(C) infection

(D) hematoma

(E) leukemia

236. Which of the following tests can be used to diagnose hemangiomas?

(A) needle biopsy

(B) a tagged red blood cell liver scan

(C) a computed tomographic (CT) scan

(D) a magnetic resonance imaging (MRI) scan

(E) all of the above

237. What is the most likely diagnosis of the patient in Fig. 4–63?

(A) cirrhosis

(B) pyonephritis

(C) acute glomerulonephritis

(D) chronic renal disease

(E) renal agenesis

Image

FIGURE 4–63. Sagittal sonogram obtained through the right upper quadrant.

238. The findings in Fig. 4–64 are consistent with which of the following?

(A) gallbladder carcinoma

(B) adenomyomatosis

(C) cholecystitis

(D) gallbladder polyp

(E) metastasizes to the gallbladder

Image

FIGURE 4–64. Longitudinal scan of the gallbladder.

239. Which of the following may a jaundiced male child with a hemolytic disorder be found to have?

(A) increase in direct bilirubin

(B) increase in indirect bilirubin

(C) increase in alpha-fetoprotein

(D) increase in prothrombin time

(E) normal liver function test results

240. Which of the following statements are true?

(A) Bowman’s capsule is the fibrous capsule around the kidney.

(B) a glomerulus, Bowman’s capsule, and renal tubules together constitute a nephron.

(C) nephrons are the only structures, in which active transport of substances through cell membrane does not occur.

(D) the renal cortex secretes hormones called corticoids.

(E) nephrons are not an important part of the production of urine.

241Fig. 4–65 is a longitudinal scan through the abdomen. Which linear longitudinal vessel is being imaged?

(A) aorta

(B) inferior vena cava

(C) main portal vein

(D) none of the above

Image

FIGURE 4–65. Longitudinal scan of the upper abdomen.

242. The arrow in Fig. 4–65 is pointing to which of the following?

(A) psoas muscle

(B) left renal vein

(C) superior mesenteric artery

(D) right renal artery

(E) phrenic artery

243Fig. 4–66 is a transverse sonogram obtained through the urinary bladder. This image is consistent with which of the following conditions?

(A) a thickening of the posterior bladder wall

(B) bladder calculi

(C) cholelithiasis

(D) ureterocele

(E) urinary bladder diverticula

Image

FIGURE 4–66. Transverse sonogram obtained through the urinary bladder.

244. Which of the following is the most likely diagnosis in the patient in Fig. 4–66?

(A) bladder tumor

(B) overdistended bladder

(C) cystitis

(D) ureterocele

(E) Foley catheter

245. A longitudinal scan is performed on the right side of the abdomen. The arrow in Fig. 4–67 is pointing to a small fluid collection in which of the following structures?

(A) pleural cavity

(B) lesser sac

(C) right paracolic gutter

(D) subhepatic space

(E) right subphrenic space

Image

FIGURE 4–67. Longitudinal scan through the right upper abdomen.

246. A transverse scan of the upper abdomen is performed. What is the arrow in Fig. 4–68 pointing to?

(A) the heart

(B) pleural effusion

(C) pericardial effusion

(D) hemangioma

(E) hydatid cyst

Image

FIGURE 4–68. Transverse scan through the upper abdomen.

247. The liver in Fig. 4–68 is consistent with which one of the following findings?

(A) fatty infiltrations

(B) hepatitis

(C) hepatocellular carcinoma

(D) diabetes mellitus

(E) normal finding

248. Which of the following terms describes a normal variant of the liver in which the right lobe of the liver extends below the lower pole of the right kidney?

(A) Murphy’s lobe

(B) caudate lobe

(C) duplication of the right lobe

(D) Riedel’s lobe

(E) extra lobe

249Fig. 4–69 is a longitudinal scan through the right lower quadrant. This image is consistent with which one of the following diagnoses?

(A) appendicitis

(B) bowel obstruction

(C) Crohn’s disease

(D) intussusception

(E) volvulus

Image

FIGURE 4–69. Longitudinal sonogram of the right lower quadrant.

250Fig. 4–70 is a long-axis view of the gallbladder that shows which of the following abnormalities?

(A) a distended gallbladder with thickened walls

(B) a positive wall-echo-shadow (WES) sign

(C) multiple floating, low-level echoes

(D) an hydropic gallbladder

(E) porcelain gallbladder

Image

FIGURE 4–70. Long-axis image of the gallbladder.

251. What is the most likely diagnosis of the patient in Fig. 4–70?

(A) obstruction of the cystic duct

(B) Klatskin tumor

(C) acalculous cholecystitis

(D) gallbladder carcinoma

(E) adenoma of the gallbladder

252. Hydrops of the gallbladder may be secondary to all of the following except which one?

(A) sludge

(B) mass in the head of the pancreas

(C) obstruction of the distal common bile duct by a mass of the ampulla of Vater

(D) stones in Hartmann’s pouch

(E) surgery

253Fig. 4–71 is a longitudinal view of the gallbladder in a patient with a history of gallbladder disease. This image is most consistent with which of the following?

(A) chronic cholecystitis

(B) hepatitis

(C) metastasizes to the gallbladder

(D) gallbladder carcinoma

(E) a patient who just ate a fatty meat

Image

FIGURE 4–71. Longitudinal magnified sonogram through the right upper quadrant.

254Fig. 4–72 is a sonogram of the urinary bladder. What is the round anechoic structure in the bladder?

(A) a Foley catheter

(B) a bladder cyst

(C) an ureterocele

(D) a bladder stone

(E) an ureteral jet

Image

FIGURE 4–72. Sonogram of urinary bladder

255. A longitudinal scan of the right lobe of the liver is performed in a postoperative patient. What is the most likely diagnosis in the patient in Fig. 4–73?

(A) subphrenic collection

(B) subcapsular collection

(C) subhepatic collection

(D) loculated ascites

(E) perigastric collection

Image

FIGURE 4–73. A longitudinal scan of the right lobe of the liver.

256. The patient in Fig. 4–73 has a fever and a low hematocrit. The patient was placed in a decubitus position and the low-level echoes within the collection did not move. This is most diagnostic of which of the following?

(A) abscess

(B) hematoma

(C) infected cyst

(D) hemorrhagic cyst

(E) malignant fluid

257Fig. 4–74 is a transverse scan at the level of the pancreas. What structure are the arrows pointing to?

(A) bowel

(B) stomach

(C) lesser sac

(D) duodenum

(E) pancreas

Image

FIGURE 4–74. A transverse scan at the level of the pancreas.

258. The patient in Fig. 4–74 presents with normal laboratory values and persistent epigastric pain. Which of the following pathologies is this image most consistent with?

(A) chronic pancreatitis

(B) acute pancreatitis

(C) complicated pancreatic pseudocyst

(D) bowel mass

(E) insulinoma

259Fig. 4–75 is a coronal image through the left upper quadrant of the abdomen. What is the arrow pointing to?

(A) left kidney

(B) the normal left adrenal gland

(C) stomach

(D) the left crus of the diaphragm

(E) the splenic flexure

Image

FIGURE 4–75. Coronal image through the left upper quadrant.

260. What is the longitudinal anechoic structure shown in Fig. 4–75?

(A) right renal vein

(B) left renal artery

(C) aorta

(D) inferior vena cava

(E) artifact

261. Which of the following conditions may affect the adrenal gland?

(A) neonatal hypotension

(B) severe fulminant tuberculosis infection

(C) malignant lung carcinoma

(D) breast carcinoma

(E) all of the above

262Fig. 4–76 is a transverse scan obtained through the abdomen of a child with a palpable mass that is what?

(A) a complex mass with areas of septations and debris

(B) a cystic mass that appears to displace bowel and mesentery

(C) free-fluid within the abdomen

(D) loculated fluid collection

Image

FIGURE 4–76. Transverse scan obtained through the abdomen of a child with a palpable mass.

263. What is the most likely diagnosis of the patient in Fig. 4–76?

(A) mesenteric cyst

(B) complicated ascites

(C) ovarian carcinoma

(D) abscess

264Fig. 4–77A and B are long- and short-axis sonograms through the gastric antrum of a child. Which of the following best describes the image?

(A) atrophy of the antrum wall

(B) mass of the antrum wall

(C) thickened antrum wall and increase length

(D) shorten pyloric canal and shorten length

(E) normal

Image

Image

FIGURE 4–77 (A) Longitudinal image through the gastric antrum of a child. (B) Transverse scan through the gastric antrum of a child.

265. What is the most likely diagnosis of the patient in Fig. 4–77A and B?

(A) normal stomach

(B) hypertrophic pyloric stenosis

(C) duodenal tumor

(D) mass in the lesser sac

(E) infected lymph nodes

266Fig. 4–78 is a transverse sonogram through the upper abdomen. This image is most consistent with which of the following diagnoses?

(A) chronic pancreatitis

(B) gastric outlet obstruction

(C) insulinoma

(D) portal hypertension

(E) normal pancreas

Image

FIGURE 4–78. Transverse image obtained in the upper abdomen.

267. What portion of the pancreas is anterior to the formation of the portal vein?

(A) head

(B) neck

(C) isthmus

(D) body

(E) tail

268. What is the most common islet cell tumor?

(A) adenocarcinoma

(B) pseudocyst

(C) true cyst

(D) insulinoma

(E) gastrinoma

269Fig. 4–79 is a longitudinal image of the liver. What is the distal acoustic shadow in this image?

(A) rib shadow

(B) comet tail artifact

(C) calculi

(D) bowel shadow

(E) shadow from falciform ligament of the liver

Image

FIGURE 4–79. Longitudinal scan of the liver.

270. What is the arrow in Fig. 4–80 pointing to?

(A) major lobar fissure

(B) ligamentum of Teres

(C) ligamentum of venosum

(D) air in bile duct

(E) cholecystectomy clip

Image

FIGURE 4–80. Longitudinal scan of the right upper quadrant.

271. The findings in Fig. 4–81 are associated with all of the following except

(A) an increase alkaline phosphatase

(B) an increase serum glutamic-oxaloacetic transaminase

(C) sickle cell disease

(D) an increase alpha-fetoprotein

(E) jaundice

Image

FIGURE 4–81. Longitudinal scan of the gallbladder.

272. The findings in Fig. 4–82 are consistent with which of the following diagnoses?

(A) Budd–Chiari syndrome

(B) hepatitis

(C) dilated biliary radicles

(D) gallstones

(E) fatty infiltrations

Image

FIGURE 4–82. Longitudinal scan of the liver.

273. The findings in Fig. 4–83 are consistent with which of the following diagnoses?

(A) portal hypertension

(B) congestive heart failure

(C) fatty liver disease

(D) cirrhosis

(E) a normal scan

Image

FIGURE 4–83. Transverse scan of the liver.

274. Which of the following ligaments are visualized in Fig. 4–84?

(A) middle lobar ligament

(B) ligament venosum

(C) coronary ligament

(D) round ligament

(E) gastroduodenal ligament

Image

FIGURE 4–84. Transverse scan of the liver.

275Fig. 4–85 is an upright coronal image of the lower left hemithorax of a 12-year-old child with a fever. Which of the following abnormalities can be seen?

(A) loculated pleural effusion

(B) nonloculated pleural effusion

(C) hydronephrotic kidney

(D) herniated bowel

Image

FIGURE 4–85. An upright coronal image of the lower left hemithorax of a 12-year-old child with a cough and fever.

276. Which of the following is the most likely diagnosis of the patient in Fig. 4–85?

(A) simple effusion

(B) cystic lung mass

(C) obstructed bowel

(D) empyema

(E) obstructed kidney

277. A patient presents with right-upper-quadrant pain, fever, nausea, and leukocytosis. The findings in Fig. 4–86 are most consistent with which of the following diagnoses?

(A) gallbladder carcinoma

(B) chronic cholecystitis

(C) adenomyomatosis

(D) acute cholecystitis

(E) postprandial gallbladder contraction

Image

FIGURE 4–86. (A) Transverse image of the gallbladder. (B) Long-axis image of the gallbladder.

278. The findings shown in Fig. 4–87 are consistent with which of the following diagnoses?

(A) chronic cholecystitis with cholelithiasis

(B) adenomatosis

(C) postprandial gallbladder contraction

(D) duodenal bulb

(E) postcholecystectomy clip

Image

FIGURE 4–87. Longitudinal scan of the right upper quadrant.

279. A patient presents with an increase in direct bilirubin, alanine aminotransferase (ALT), and alkaline phosphatase. What are the findings in Fig. 4–88 suggestive of?

(A) liver metastases

(B) hepatoma

(C) cirrhosis

(D) fatty infiltrations

(E) hematomas

Image

FIGURE 4–88. Longitudinal scan of the liver.

280. A patient presents with vague right-upper-quadrant pain and normal liver function laboratory test results. The echogenic mass in Fig. 4–89 is suggestive of a liver

(A) abscess

(B) hematoma

(C) hepatoma

(D) echinococcal cyst

(E) hemangioma

Image

FIGURE 4–89. Transverse scan of the liver.

281. Where is the echogenic mass shown in Fig. 4–89 located?

(A) posterior segment of the right lobe

(B) anterior segment of the right lobe

(C) anterior segment of the left lobe

(D) medial segment of the right lobe

(E) medial segment of the left lobe

282. Which of the following terms describes the malformation variant in the gallbladder that involves an acutely angulated pouch of the fundus?

(A) Phrygian cap

(B) duplication of the gallbladder

(C) Hartmann’s pouch

(D) junctional fold

(E) Murphy’s cap

283. Identify the vessels being imaged in Fig. 4–90 in the order in which they appear (anterior to posterior).

(A) inferior vena cava, portal vein, left renal vein, right renal vein

(B) inferior vena cava, aorta, right hepatic artery, splenic artery

(C) inferior vena cava, aorta, left renal vein, right renal vein

(D) inferior vena cava, aorta, right renal artery, left renal artery

(E) inferior vena cava, portal vein, right hepatic vein, left hepatic vein

Image

FIGURE 4–90. Coronal scan of the midabdomen.

284. Which of the following statements does not differentiate the portal veins from the hepatic veins?

(A) portal veins become larger as they approach the diaphragm.

(B) portal veins have echogenic borders.

(C) portal veins bifurcate into the right and left branches.

(D) the main portal vein is part of the portal triad.

285Horseshoe kidney may be confused sonographically with which of the following?

(A) carcinoma of the head of the pancreas

(B) lymphadenopathy

(C) hypernephroma

(D) gastric mass

(E) aortic aneurysm

286. A 53-year-old man with a history of liver cirrhosis presents with increased abdominal girth. Fig. 4–91 demonstrates a thickened gallbladder wall, which is most often associated with which of the following?

(A) calculous cholecystitis

(B) pancreatitis

(C) portal hypertension

(D) adjacent ascites

(E) loss of appetite

Image

FIGURE 4–91. Longitudinal scan of the liver and gallbladder.

287. What is the arrow in Fig. 4–92 pointing to?

(A) inferior vena cava

(B) superior mesenteric artery

(C) celiac

(D) right crus of the diaphragm

(E) psoas muscle

Image

FIGURE 4–92. Longitudinal scan of the aorta.

288. The left crus of the diaphragm may be confused with which of the following?

(A) left adrenal gland

(B) aorta

(C) splenic vein

(D) superior mesenteric artery

(E) accessory spleen

289. What is the long arrow in Fig. 4–93 pointing to?

(A) inferior vena cava

(B) psoas muscle

(C) lumbar artery

(D) right crus of diaphragm

(E) right adrenal gland

Image

FIGURE 4–93. Longitudinal scan of the inferior vena cava.

290. What is the short arrow in Fig.4-93 pointing to?

(A) right renal vein

(B) right renal artery

(C) left renal vein

(D) left renal artery

(E) celiac axis

291. What is the arrow in Fig. 4–94 pointing to?

(A) hepatic artery

(B) common duct

(C) hepatic vein

(D) portal vein

(E) inferior vena cava

Image

FIGURE 4–94. Longitudinal scan of the gallbladder.

292. What is the lumen seen anterior and parallel to the arrow in Fig. 4–94?

(A) celiac axis

(B) cystic duct

(C) left renal vein

(D) hepatic vein

(E) common duct

293. There appear to be two echogenic masses in Fig. 4–95. One is anterior to the diaphragm (indicated by the calipers), and the other one is posterior to the diaphragm (indicated by the arrow). Which of the following usually causes this phenomenon?

(A) slice-thickness artifact

(B) reflection

(C) mirror-image artifact

(D) refraction

(E) side lobe artifact

Image

FIGURE 4–95. Longitudinal scan of the right upper quadrant.

294. A 38-year-old man, who is an intravenous drug abuser, with a known mediastinal mass is seen in Fig. 4–96A and B. What does Fig. 4–96A show?

(A) a mass near the head of the pancreas

(B) periportal lymphadenopathy

(C) chronic cholecystitis

(D) Klatskin tumor

(E) liver mass

Image

FIGURE 4–96. (A) Sagittal scan of the right upper quadrant. (B) Sagittal scan through the right kidney.

295Which of the following is demonstrated in Fig. 4–96B?

(A) a normal kidney

(B) a kidney consistent with acute renal insufficiency

(C) a kidney consistent with chronic renal insufficiency

(D) renal cell carcinoma

(E) an adrenal gland in the renal fossa

296. A sonogram is performed on a 32-year-old woman with a history of pancreatic carcinoma. Which of the following diagnoses is most likely represented in the scan in Fig. 4–97?

(A) celiac nodes

(B) an aortic aneurysm

(C) horseshoe kidney

(D) gastric lesion

(E) lesser sac mass

Image

FIGURE 4–97. Transverse scan of the abdomen.

297. What type of aneurysm is demonstrated in Fig. 4–98?

(A) fusiform

(B) saccular

(C) cylindrical

(D) berry

(E) dissecting

Image

FIGURE 4–98. Longitudinal scan through the abdominal aorta.

298. What is the arrow in Fig. 4–99 pointing to?

(A) right renal artery

(B) right renal vein

(C) left renal artery

(D) left renal vein

(E) gastroesophageal junction

Image

FIGURE 4–99. Longitudinal scan through the abdominal aorta.

299. What is the arrow in Fig. 4–100 pointing to?

(A) head of the pancreas

(B) body of the pancreas

(C) caudate lobe of the liver

(D) medial aspect of the left lobe

(E) right lobe of the liver

Image

FIGURE 4–100. Sagittal scan through the right upper quadrant.

300. What is the thin black arrow in Fig. 4–101 pointing to?

(A) celiac artery

(B) superior mesenteric artery

(C) portal vein

(D) left gastric artery

(E) hepatic artery

Image

FIGURE 4–101. Sagittal scan through the right upper quadrant.

301What is the white arrowhead in Fig. 4–101 pointing to?

(A) celiac artery

(B) superior mesenteric artery

(C) portal vein

(D) left gastric artery

(E) hepatic artery

302. What is the name of the vessel that lies posterior to the pancreas in Fig. 4–101?

(A) splenic vein

(B) aorta

(C) portal vein

(D) left renal vein

(E) hepatic vein

303. What is the arrow in Fig. 4–102 pointing to?

(A) stomach

(B) pancreas

(C) C-loop of the duodenum

(D) gastroduodenal artery

(E) spleen

Image

FIGURE 4–102. Transverse scan through the pancreas.

304. What is the arrow in Fig. 4–103 pointing to?

(A) normal head of pancreas

(B) normal stomach

(C) pancreatic duct

(D) superior mesenteric artery (SMA)

(E) normal tail of the pancreas

Image

FIGURE 4–103. Transverse sonogram through the pancreas.

305. What is the arrow in Fig. 4–104 pointing to?

(A) gastroduodenal artery

(B) common bile duct

(C) portal vein

(D) superior mesenteric vein

(E) hepatic artery

Image

FIGURE 4–104. Transverse sonogram through the pancreas.

306. Which of the following structures defines the anterolateral aspect of the head of the pancreas?

(A) superior mesenteric artery

(B) inferior vena cava

(C) splenic vein

(D) common bile duct

(E) gastroduodenal artery

307. What are the arrows in Fig. 4–105 pointing to?

(A) peripelvic cysts

(B) extrapelvic cysts

(C) parapelvic cysts

(D) renal pyramids

(E) dilated calyces

Image

FIGURE 4–105. Long-axis image of the right kidney.

308. What is demonstrated in this color Doppler image of the bladder in Fig. 4–106?

(A) acute obstructive uropathy

(B) ureteral dilatation

(C) diverticular jet effect

(D) color Doppler flow

Image

FIGURE 4–106. Short-axis sonogram through the urinary bladder.

309. What is the finding seen within the urinary bladder of the patient imaged in Fig. 4–106?

(A) ureteral jet

(B) thickened Foley catheter

(C) bladder aneurysm

(D) ureteral venous flow

(E) intraluminal arterial bladder flow

310. Ureteral jets will not be seen in which of the following?

(A) extrapelvic cyst

(B) obstructive hydronephrosis

(C) renal artery aneurysm

(D) parapelvic cyst

(E) transient diuresis

311. A 30-year-old patient with a history of biliary disease presents with fever, pain, and leukocytosis. An abdominal sonogram is performed. The areas labeled “A” in Fig. 4–107 are consistent with which of the following diagnoses?

(A) hematomas

(B) complicated cysts

(C) abscesses

(D) echinococcal disease

(E) metastatic lesions

Image

FIGURE 4–107. Sonogram of the urinary bladder.

312. A patient presents with polycystic liver disease. What other organ should also be evaluated by sonogram?

(A) spleen

(B) pancreas

(C) gallbladder

(D) adrenal glands

(E) kidneys

313. Identify the vessel with a postprandial low-resistive blood flow.

(A) celiac artery

(B) hepatic artery

(C) splenic artery

(D) superior mesenteric artery

(E) aorta

314. What are the arrows in Fig. 4–108 pointing to?

(A) ascites

(B) perinephric fluid

(C) pleura effusion

(D) fluid in Morrison’s pouch

(E) normal renal cortex

Image

FIGURE 4–108. Longitudinal sonogram of the left kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

315Fig. 4–109 is a transverse view of the bladder. What is the arrow pointing to?

(A) bladder stone

(B) bladder diverticula

(C) bladder mass

(D) Foley catheter

(E) ureteral jet

Image

FIGURE 4–109. Transverse scan of the urinary bladder.

316. What is the arrow in Fig. 4–110 pointing to?

(A) antrum of the stomach

(B) head of the pancreas

(C) caudate lobe of the liver

(D) body of the pancreas

(E) adrenal gland

Image

FIGURE 4–110. Longitudinal scan of the inferior vena cava.

317Fig. 4–111 is consistent with which of the following findings?

(A) chronic pancreatitis

(B) acute pancreatitis

(C) adenocarcinoma

(D) islet cell tumor

(E) normal scan

Image

FIGURE 4–111. Transverse sonogram through the pancreas.

318. A 37-year-old man with a history of repeated episodes of pancreatitis due to alcoholism presents with an epigastric mass. What does Fig. 4–112 suggest?

(A) negative study

(B) adenocarcinoma

(C) pancreatic pseudocyst

(D) acute pancreatitis

(E) chronic pancreatitis

Image

FIGURE 4–112. Transverse sonogram through the pancreas.

319. What is the most common complication of a pancreatic pseudocyst?

(A) infection

(B) reabsorption

(C) calcification

(D) hemorrhage

(E) rupture

320. A sonogram of the abdominis rectus muscle is ordered. Which of the following is the most appropriate transducer to use to obtain optimal images?

(A) 2.5 MHz curve linear

(B) 5 MHz curve linear

(C) 3.5 MHz mechanical sector

(D) 5 MHz linear

(E) 3.5 MHz vector array

321. What is the name of the area anterior to the right kidney and posterior to the right lobe of the liver?

(A) pouch of Douglas

(B) Morison’s pouch

(C) Hartmann’s pouch

(D) lesser sac

(E) greater sac

322. A 34-year-old man presents with flank pain. The ureteral jets are normal. What finding does the image in Fig. 4–113 suggest?

(A) renal cell carcinoma

(B) pyonephrosis

(C) pyelocaliectasis

(D) pyelonephrosis

(E) renal transplant

Image

FIGURE 4–113. a longitudinal sonogram through the left kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

323. The renal transplant patient shown in Fig. 4–114 was referred for a sonogram. The perirenal fluid collection may be associated with all of the following except

(A) abscess

(B) hematoma

(C) ascites

(D) urinoma

(E) lymphocele

Image

FIGURE 4–114. Longitudinal scan though the kidney.

324. A post-renal-transplant patient presents with fever, flank pain, localized tenderness, and leukocytosis. A renal sonogram is performed, and a perinephric fluid collection is documented. This finding is most consistent with which of the following?

(A) abscess

(B) hematoma

(C) lymphocele

(D) renal cyst

(E) urinoma

325. In Fig. 4–115, what are the anechoic structures visualized within the liver?

(A) normal bile ducts

(B) dilated bile ducts

(C) hepatic arteries

(D) hepatic veins

(E) portal veins

Image

FIGURE 4–115. A magnified view through the liver.

326. In Fig. 4–116, the organ that the arrow is pointing to is consistent with which of the following diagnoses?

(A) normal pancreas

(B) acute pancreatitis

(C) chronic pancreatitis

(D) adenocarcinoma

(E) islet cell tumor

Image

FIGURE 4–116. Transverse scan through the pancreas.

327. A 38-year-old man with a history of enuresis presents for a pelvic sonogram. Fig. 4–117 is most consistent with which of the following diagnoses?

(A) a normal pelvic sac

(B) an enlarged prostate

(C) diffuse bladder wall thickening

(D) bladder outlet obstruction

(E) endometriosis of the bladder wall

Image

FIGURE 4–117. Longitudinal scan of a male pelvis.

328Fig. 4–118 is most consistent with which of the following diagnoses?

(A) hepatitis

(B) cirrhosis

(C) pyelonephritis

(D) pyelocaliectasis

(E) chronic renal failure

Image

FIGURE 4–118. Longitudinal scan of the right kidney.

329. Identify the laboratory values that would most likely be elevated in the patient in Fig. 4–118.

(A) alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

(B) alkaline phosphatase and bilirubin

(C) amylase and lipase

(D) creatinine and blood urea nitrogen (BUN)

(E) acid phosphatase and white blood cell (WBC) cell

330. Internal echoes inside the renal cyst shown in Fig. 4–119 may be due to all of the following except

(A) reverberation

(B) beam width artifact

(C) refraction

(D) attenuation

(E) side lobe artifact

Image

FIGURE 4–119. Longitudinal scan of the right kidney.

331. The findings in the transverse scan in Fig. 4–120 of the right kidney is most consistent with which of the following diagnoses?

(A) parapelvic cyst

(B) ureteropelvic junction (UPJ) obstruction

(C) nonobstructive hydronephrosis

(D) adult polycystic kidney disease

(E) infantile polycystic kidney disease

Image

FIGURE 4–120. Transverse scan of the right kidney.

332. The neonate in Fig. 4–121 presented with a palpable abdominal mass. What is the sonogram most suggestive of?

(A) multicystic dysplastic kidney

(B) pyonephrosis

(C) infantile polycystic disease

(D) peripelvic cysts

(E) extrapelvic cysts

Image

FIGURE 4–121. Transverse scan of the left kidney of a newborn.

333Fig. 4–122 suggests that this patient may have all of the following except

(A) a normal kidney

(B) benign prostate hyperplasia

(C) prostatitis

(D) calculi

(E) retroperitoneal fibrosis

Image

FIGURE 4–122. Longitudinal scan of the right kidney.

334. The longitudinal scan of the right kidney in Fig. 4–123 is consistent with which of the following diagnoses?

(A) acute pyelonephritis

(B) acute tubular necrosis

(C) tubular sclerosis

(D) acute focal bacteria nephritis

(E) duplex collecting system

Image

FIGURE 4–123. Coronal scan of the right kidney.

335. A transverse scan of the upper abdomen is shown in Fig. 4–124. What is the arrow pointing to?

(A) hepatic vein

(B) splenic artery

(C) celiac axis

(D) hepatic artery

(E) portal confluence

Image

FIGURE 4–124. Transverse scan of the upper abdomen.

336Fig. 4–125 is an abdominal longitudinal scan of a 14-day-old male infant born 2 weeks prematurely. What is the arrow pointing to?

(A) normal adrenal gland

(B) perirenal hemorrhage

(C) retroperitoneal fat

(D) neuroblastoma

(E) pheochromocytoma

Image

FIGURE 4–125. Longitudinal sonogram of a neonate through the area of the right kidney.

337. The coronal scan of the left kidney shown in Fig. 4–126 is suggestive of which of the following diagnoses?

(A) an extrapelvic cyst

(B) hydronephrosis

(C) pyonephrosis

(D) urinoma

(E) renal infarct

Image

FIGURE 4–126. Coronal scan of the kidney.

338. A longitudinal scan of the right kidney is performed. What is the thin black arrow in Fig. 4–127 pointing to?

(A) the renal sinus

(B) arcuate arteries

(C) renal medullary pyramids

(D) simple renal cysts

(E) renal stone

Image

FIGURE 4–127. Longitudinal scan of the right kidney.

339. What is the open arrowhead in Fig. 4–127 pointing to?

(A) the renal sinus

(B) arcuate arteries

(C) renal medullary pyramids

(D) simple renal cyst

(E) renal stones

340. What is the white arrow in Fig. 4–127 pointing to?

(A) renal column of Bertin

(B) an angiomyolipoma

(C) dromedary hump

(D) bifid collecting system

(E) the renal pelvis

341. A patient presents with vague abdominal pain and elevated bilirubin level and liver function test results. The finding in Fig. 4–128 may be initiated by all of the following except

(A) stone in the common bile duct

(B) mass in the head of the pancreas

(C) mass in the ampulla of Vater

(D) diffuse metastatic disease of the liver

(E) cirrhosis

Image

FIGURE 4–128. Longitudinal scan of the liver.

342. A patient presents with a spleen that is palpable on physical examination. Fig. 4–129 is a longitudinal image of the spleen. Which of the following is not associated with splenomegaly?

(A) lymphoma

(B) portal hypertension

(C) infectious disease

(D) myeloproliferation

(E) neuroblastoma

Image

FIGURE 4–129. Longitudinal scan of the spleen.

343. A 25-year-old woman presents for an abdominal sonogram. A longitudinal scan of the liver is performed. What is the most likely diagnosis for the two cystic structures in Fig. 4–130?

(A) liver metastases

(B) hydatid cysts

(C) simple benign cysts

(D) lymphoma

(E) polycystic liver disease

Image

FIGURE 4–130. Longitudinal scan through the right upper quadrant.

344Fig. 4–131A–C is a scan of a 70-year-old man with a history of weight loss, abdominal pain, and anorexia. What does the scan suggest?

(A) negative study

(B) pancreatic pseudocyst

(C) acute pancreatitis

(D) chronic pancreatitis

(E) pancreatic adenocarcinoma

Image

Image

FIGURE 4–131. (A) Sagittal scan through the head of the pancreas. (B) Sagittal scan through the liver. (C) Sagittal scan through the gallbladder.

345Fig. 4–132 is most consistent with which of the following diagnosis?

(A) acute pyelonephritis

(B) acute tubular necrosis

(C) tubular sclerosis

(D) chronic glomerulonephritis

(E) medullary nephrocalcinosis

Image

FIGURE 4–132. Longitudinal scan through the right kidney.

346Fig. 4–133 is a transverse sonogram of the liver. What is the white arrow pointing to?

(A) pancreas

(B) spleen

(C) abdominal aortic aneurysm

(D) stomach

(E) heart

Image

FIGURE 4–133. Transverse image of the upper abdomen.

347. Hashimoto’s disease is a type of chronic

(A) gastroenteritis

(B) thyroiditis

(C) orchitis

(D) prostatitis

(E) hepatitis

348. Which of the following is a type of a malignant adrenal mass?

(A) adenoma

(B) myelolipoma

(C) cyst

(D) pheochromocytoma

(E) neuroblastoma

349. An enlarged right adrenal gland will displace the inferior vena cava in which of the following directions?

(A) anteriorly

(B) posteriorly

(C) medially

(D) laterally

(E) no displacement

350. The findings in Fig. 4–134 is most-likely

(A) normal liver parenchyma

(B) dilated portal veins

(C) dilated common bile ducts

(D) dilated hepatic veins

(E) dilated intrahepatic ducts

Image

FIGURE 4–134. Longitudinal view of the liver.

351. Which of the following conditions is not associated with pneumobilia

(A) emphysematous cholecystitis

(B) cholecysto-enteric fistula

(C) choledochojejunostomy

(D) pancreatic carcinoma

(E) prolonged acute cholecystitis

352. Which of the following structures is most likely being measured in Fig. 4–135?

(A) hypernephroma

(B) peliosis hepatis

(C) fungal infection of the liver

(D) hemangioma

(E) hydatid cyst

Image

FIGURE 4–135. Longitudinal view of the liver.

353. Which of the following will not increase the chance of documenting shadowing posterior to a small renal stone?

(A) decreasing gain

(B) focal zone set at the level of the calculi

(C) increasing the transducer frequency

(D) using a linear probe

(E) use of tissue harmonics

354Fig. 4–136 of the kidney is consistent with which of the following diagnoses?

(A) hydronephrosis

(B) hydroureter

(C) pyonephrosis

(D) vesicoureteral obstruction

(E) normal findings

Image

FIGURE 4–136. Longitudinal view of the liver and right kidney.

355Fig. 4–137 is a longitudinal scan of the right upper quadrant. What abnormality is seen?

(A) a hypoechoic texture of the renal parenchyma

(B) an echogenic liver texture

(C) atrophy of the kidney

(D) metastases

(E) none—inappropriate technical settings

Image

FIGURE 4–137. Longitudinal scan of the right upper quadrant.

356Fig. 4–137 is not consistent with which of the following diagnoses?

(A) glycogen storage disease

(B) fatty metamorphosis

(C) echinococcal disease

(D) severe hepatitis

(E) hemochromatosis

357. To optimize a sonogram, all of the following must be taken into consideration except

(A) change overall gain

(B) time-gain compensation (TGC)

(C) depth and focus

(D) transducer frequency and type

(E) speed of sound

358Fig. 4–138 is a duplex color Doppler sonogram of the right kidney. Which of the following diagnoses is consistent with the Doppler findings?

(A) normal kidney

(B) obstructive uropathy

(C) pelviectasis

(D) renal artery stenosis

(E) hypertension

Image

FIGURE 4–138. Long-axis view of the right kidney. (Courtesy of Shpetim Telegrafi, MD, New York University.)

359. Splenomegaly is diagnosed when the spleen is greater than how many centimeters?

(A) 8 cm

(B) 11 cm

(C) 13 cm

(D) 15 cm

(E) 18 cm

360Fig. 4–139 is a long-axis sonogram of the right upper quadrant of the abdomen. Which of the following best describes the image?

(A) contracted gallbladder filled with stones

(B) contracted gallbladder without stones

(C) postcholecystectomy

(D) heterogeneous liver

(E) echogenic focal mass

Image

FIGURE 4–139. Long-axis sonogram of the upper abdomen.

361. Which of the following is the most likely diagnosis of the patient in Fig. 4–139?

(A) cholecystectomy

(B) gastric mass

(C) acalculous cholecystitis

(D) calculous cholecystitis

(E) normal abdomen

362. The laboratory finding in the patient in Fig. 4–139 would most likely be consistent with which of the following?

(A) increase in amylase

(B) increase in creatinine

(C) decrease in prothrombin time

(D) decrease in indirect bilirubin

(E) increase in alkaline phosphatase

363. The findings in Fig. 4–140 are most likely due to which of the following diagnoses?

(A) medullary sponge kidney

(B) renal parenchymal disease

(C) renal cell carcinoma

(D) medullary nephrocalcinosis

(E) renal sinus lipomatosis

Image

FIGURE 4–140. Longitudinal scan of the kidney.

364. What is the most common congenital cause of urinary track obstruction in males?

(A) ureteropelvic junction obstruction (UPJ)

(B) posterior urethral valve (PUV)

(C) infantile polycystic kidney disease

(D) undescended testes

(E) duplex collecting system

365. Where are the spiral values of Heister located?

(A) ampulla of Vater

(B) junction of the cystic duct and common duct

(C) junction of the right and left common hepatic duct

(D) proximal portion of the cystic duct

(E) fundus of the gallbladder

366. Identify the pre-existing condition that occurs in patients with hepatomas.

(A) hematomas

(B) abscesses

(C) gallstones

(D) developmental cysts

(E) cirrhosis

367. A 3-year-old child with a clinical history of intermittent pain, jaundice, and a palpable mass presents for an abdominal sonogram. A cystic dilatation of the common bile duct is seen in the liver. This is most characteristic of which of the following diagnoses?

(A) biliary atresia

(B) hepatitis

(C) choledochal cyst

(D) hypertrophy pyloric stenosis

(E) normal liver finding

368. Which of the following describes how carcinoma of the gallbladder would most likely appear?

(A) thin-walled gallbladder

(B) small gallbladder with thickened walls

(C) large gallbladder with a halo surrounding it

(D) diffusely thickened gallbladder with gallstones

(E) echogenic mass with no distinguishing features of a gallbladder

369. Where is a Baker’s cyst usually located?

(A) adjacent to the thyroid

(B) behind the nipple in a breast

(C) within the liver parenchyma

(D) posterior to the uterus

(E) behind the knee

370. What is Riedel’s lobe?

(A) elongation of the left lobe

(B) a duplication of the caudate lobe

(C) tongue-like extension of the right lobe

(D) a small right lobe

(E) transposition of the liver lobes