Lange Review Ultrasonography Examination, 4th Edition

Case Studies

CASE 1

History: 65-year-old with bilateral a testicular mass. Sagittal gray scale (A) and transverse (B) sonograms of right testicle.

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1-1. Which of the following statements is true concerning this scrotal sonogram?

A. There are bilateral masses in the mediastinum of both testes.

B. There is dilatation of the rete testes of the right testicle.

C. There is dilatation of both epididymides.

D. There is a bilateral testicular torsion.

1-2. What is the most likely diagnosis?

A. a normal variant

B. bilateral testicular tumor

C. chronic torsion

D. none of the above

1-3. What is the proper thing for sonographers to do if the patient states that he has a palpable scrotal mass?

A. Ignore anything a patient has to say about his scrotum.

B. Try to scan over the area of palpable abnormality to confirm presence of a mass.

C. Perform a scrotal sonogram while the patient performs a Valsalva maneuver.

D. Explain to the patient that most palpable scrotal masses are benign and you are sure his is.

CASE 2

History: 28-year-old man with acute right testicular pain. (A) Sagittal scan of right testicle (B) Sagittal gray scale and color Doppler scan of the right testicle.

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2-1. Which of the following can be included in the findings?

A. hypoechoic area in upper pole

B. hypovascular area in upper pole

C. diffuse abnormal texture

D. A and B

2-2. What is the most likely diagnosis?

A. testicular infarction

B. epididymitis

C. seminoma

D. none of the above

2-3. Why was power color Doppler used?

A. It is more sensitive to flow through frequency-based color Doppler sonography (CDS).

B. It has less exposure.

C. There is a possibility to hear the area and restore flow.

D. None of the above.

CASE 3

History: Sagittal images (A and B) at level III of the right side of the neck.

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3-1. Which of the following are true statements regarding this patient?

A. There are multiple thyroid nodules.

B. The lymph nodes are normal.

C. There is enlargement of the lymph nodes.

D. The lymph nodes have an abnormal morphology.

E. Both C and D are true.

3-2. Which of the following is a sonographic feature of normal cervical lymph nodes?

A. a central, echogenic hilum

B. oblong shape

C. <6 mm height

D. all of the above

3-3. If a sonographer finds a suspicious thyroid nodule, what is the most appropriate next step?

A. The cervical lymph nodes should be imaged.

B. A biopsy of the lesion must be performed.

C. A fine needle aspiration may be indicated.

D. Both A and C should be performed.

CASE 4

History: Sagittal gray scale (A) and transverse color Doppler (B) sonogram taken of the left lobe of thyroid.

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4-1. Which of the following statements is true concerning the role of color Doppler sonography (CDS) of thyroid nodules?

A. CDS is highly specific for thyroid cancers.

B. CDS should be performed when a thyroid nodule is seen on gray scale sonography.

C. Spectral tracings are needed to differentiate benign nodules from cancer.

D. CDS is of no clinical use for thyroid nodules.

4-2. What is the most likely diagnosis in this patient?

A. papillary thyroid cancer

B. benign nodule

C. hyperplastic nodule

D. metastatic lesion from colonic tumor

4-3. Sonographically guided fine needle aspiration (FNA) of this lesion:

A. would be contraindicated because of all the vessels

B. could be performed safely

C. most likely would result in extensive hemorrhage

D. This lesion requires biopsy, not FNA.

CASE 5

History: Sagittal (A) and color Doppler sonography (CDS) (B) of right thyroid lobe.

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5-1. Which of the following statements is true concerning this patient’s thyroid sonogram?

A. There is a large, hypoechoic nodule in the upper pole.

B. There is a hypoechoic, ill-defined nodule in the upper pole.

C. There is a hypervascular nodule in the upper pole.

D. There is a hypervascular nodule in the lower pole.

5-2. Which of the following statements is true concerning color Doppler sonogram of thyroid nodules?

A. Their relative vascularity reflects their functions.

B. Tumors have central vessels.

C. Benign lesions tend to have peripheral flow.

D. All of the above.

5-3. Which of the following statements are true regarding the sonographic findings in thyroiditis?

A. Focal hypoechoic areas may represent normal thyroid tumors.

B. Multiple hypoechoic punctate areas can be seen representing lymphocytic infiltrate.

C. Fine needle aspiration (FNA) is rarely indicated.

D. FNA is always indicated.

CASE 6

History: Sagittal gray scale (A) and color Doppler sonogram (B) obtained through left thyroid lobe.

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6-1. Which of the following statements are true concerning this patient’s thyroid sonogram?

A. There is an enlarged lymph node obstructing the lower aspect of the lower pole.

B. There is a hypoechoic thyroid nodule within the lower pole.

C. There is an enlarged left parathyroid mass.

D. This is a normal thyroid sonogram.

6-2. Which of the following is true regarding the sonographic appearance of normal parathyroid glands?

A. They are typically posterior to thyroid.

B. They are seen in area of longus colli muscle.

C. They are approximately 3 × 5 mm.

D. All of the above.

6-3. What is the most likely diagnosis?

A. parathyroid adenoma

B. thyroid cancer

C. papillary thyroid cancer

D. follicular adenoma

CASE 7

History: A midline sagittal gray scale neck sonogram.

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7-1. Which of the following statements is false concerning this scan?

A. There is enhanced through transmission suggesting a cystic internal consistency.

B. This mass has all the sonographic features of a thyroid tumor.

C. Since this mass is midline, it is possible to be a thyroglossal duct cyst.

D. Fine needle aspiration is required in this patient.

7-2. What is the most likely diagnosis?

A. thyroid neoplasm

B. multinodular cyst

C. thyroglossal duct cyst

D. enlarged lymph nodes

7-3. Which of the following statements is true regarding thyroglossal duct cysts?

A. They are typically midline.

B. They need to be aspirated.

C. They are malignant.

D. They should be biopsied to confirm the diagnosis.

CASE 8

History: Sagittal gray scale (A) and color Doppler sonogram (CDS) (B) of right thyroid lobe.

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8-1. In this case, which of the following statements is true?

A. CDS was helpful to confirm whether the nodule is benign.

B. CDS was helpful to confirm whether the nodule is malignant.

C. CDS was not helpful.

8-2. Which of the following should be included in the diagnostic considerations?

A. benign adenoma

B. follicular cancer

C. metastatic nodule

D. all of the above

8-3. Which of the following is true concerning metastases to the thyroid?

A. never occurs

B. rarely occurs

C. not uncommonly occurs

D. frequently occurs