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 specified.

1. Which of the following sonographic features is not used to diagnose renal artery occlusion?

(A) absence of a visible main renal artery

(B) low-amplitude, low-velocity signals in the kidney

(C) kidney size >9 cm

(D) no flow detected by optimized spectral, color, or power Doppler

2. Which of the following terms describes an aorta that is diffusely dilated?

(A) saccular

(B) fusiform

(C) spindle-shaped

(D) ectatic

3. What is the first major branch of the abdominal aorta?

(A) lumbar artery

(B) renal artery

(C) celiac artery

(D) superior mesenteric artery

4. Which of the following terms is used to describe concentric, spindle-shaped dilation of the abdominal aorta?

(A) ectatic

(B) fusiform

(C) saccular

(D) dissecting

5. The branches of which of the following arteries form a “seagull” appearance on a sonographic image?

(A) inferior mesenteric artery

(B) renal artery

(C) superior mesenteric artery

(D) celiac artery

6. What are the branches of the celiac artery?

(A) proper hepatic, superior mesenteric, and left gastric arteries

(B) splenic, left gastric and common hepatic arteries

(C) right gastric, splenic, and inferior mesenteric arteries

(D) left gastric, superior mesenteric, and splenic arteries

7. Abdominal pain that increases in severity with an upright position is symptomatic of which of the following conditions?

(A) aortic dissection

(B) pancreatitis

(C) ruptured aortic aneurysm

(D) acute mesenteric ischemia

8. Where are abdominal aortic aneurysms most often located?

(A) in the juxtarenal aorta

(B) in the suprarenal aorta

(C) in the infrarenal aorta

(D) at the aortic bifurcation

9. The splanchnic circulation does not include which of the following arteries?

(A) renal, superior, and inferior mesenteric arteries

(B) gastric, celiac, and superior mesenteric arteries

(C) celiac, superior, and inferior mesenteric arteries

(D) superior mesenteric, celiac, and gastroduodenal arteries

10. A 50–74% diameter-reducing stenosis of the abdominal aorta is characterized by which of the following findings?

(A) a 20% increase in peak systolic velocity compared to the proximal normal arterial segment

(B) a twofold increase in peak systolic velocity compared to the proximal normal arterial segment

(C) a fourfold increase in peak systolic velocity compared to the proximal normal arterial segment

(D) a 50% increase in peak systolic velocity compared to the proximal normal arterial segment

11. When an aortic stent graft is used to repair an abdominal aortic aneurysm, which of the following statements about the aneurysm is true?

(A) It is allowed to remain.

(B) It is resected.

(C) It is wrapped around the aortic graft.

(D) It is ligated and bypassed.

12. Which of the following findings is not usually associated with aortic dissection?

(A) pregnancy

(B) Marfan’s syndrome

(C) hypertension

(D) advanced age

13. Real-time images demonstrating the echogenic intima separated from the aortic wall are suggestive of which of the following diagnoses?

(A) abdominal aortic aneurysm

(B) arterial dissection

(C) false aneurysm

(D) mycotic aneurysm

14. The common hepatic artery gives rise to which of the following arteries?

(A) gastroduodenal artery and right gastric artery

(B) coronary artery and celiac artery

(C) proper hepatic artery and left gastric artery

(D) gastroduodenal artery and right hepatic artery

15. The splenic artery does not supply blood to which of the following structures?

(A) spleen

(B) gallbladder

(C) pancreas

(D) stomach

16. Which of the following arteries is the largest branch of the celiac artery?

(A) gastroduodenal artery

(B) left gastric artery

(C) hepatic artery

(D) splenic artery

17. The left gastric artery is most often visualized in real-time

(A) longitudinally

(B) arising from the superior mesenteric artery

(C) inferior to the celiac artery

(D) along the greater curvature of the stomach

18. The Doppler spectral waveform from the normal celiac artery is characterized by all of the following except.

(A) constant forward diastolic flow

(B) peak systolic velocity <200 cm/sec

(C) end-diastolic velocity >75 cm/sec

(D) rapid systolic upstroke

19. The accompanying Doppler spectral waveform is from a fasting superior mesenteric artery. This waveform is characteristic of

(A) a normal superior mesenteric artery (SMA)

(B) more than 70% diameter-reducing SMA stenosis

(C) a post-stenotic signal

(D) SMA stenosis that is not hemodynamically significant

Image

20. Anatomically, the SMA courses

(A) anterior to the left renal vein

(B) posterior to the duodenum

(C) perpendicular to the aorta

(D) anterior to the pancreas

21. Which of the following is not a classic symptom associated with chronic mesenteric ischemia?

(A) post-prandial pain

(B) “fear of food” syndrome

(C) weight loss

(D) acute, severe abdominal ischemia

22. The Doppler spectral waveform associated with flow- reducing SMA stenosis is not characterized which one of the following findings?

(A) turbulence

(B) an SMA-aortic ratio >3.5

(C) peak systolic velocity >275 cm/sec

(D) end-diastolic velocity >45 cm/sec

23. A high-velocity celiac artery Doppler signal that normalizes with deep inspiration is suggestive of which of the following diagnoses?

(A) flow-reducing celiac artery stenosis

(B) portal hypertension

(C) median arcuate ligament compression

(D) mesenteric ischemia

24. A collateral pathway to compensate for occlusion of the celiac and/or superior mesenteric artery does not include which of the following?

(A) the arc of Riolan

(B) the pancreaticoduodenal arcade

(C) the marginal artery of Drummond

(D) the inferior epigastric artery

25. Which of the following imaging procedures is historically used for confirmation of visceral artery stenosis or occlusion and demonstration of the extent of collateralization?

(A) standard contrast arteriography with selective lateral views

(B) computed tomography

(C) magnetic resonance imaging

(D) contrast-enhanced sonography

26. The left renal vein courses

(A) posterior to the inferior vena cava (IVC)

(B) posterior to the aorta

(C) between the aorta and the SMA

(D) parallel to the superior mesenteric vein

27. The arcuate arteries of the kidney

(A) subdivide into the intersegmental arteries

(B) curve around the bases of the pyramids

(C) lie within the renal hilum

(D) demonstrate a high-resistance Doppler spectral waveform

28. Renal artery flow-reducing stenosis is indicated if which of the following findings is seen?

(A) The renal-aortic ratio is <3.0 and the peak systolic velocity is >180 cm/sec.

(B) The peak systolic renal artery velocity is <180 cm/sec and a post-stenotic signal is found.

(C) The end-diastolic renal artery velocity is >20 cm/sec and the acceleration time is >1.0.

(D) The renal-aortic ratio is >3.5 and a post-stenotic signal is found.

29. The renal-aortic velocity ratio can be used to diagnose renal artery stenosis if the aortic velocity is

(A) <30 cm/sec

(B) between 40 cm/sec and 100 cm/sec

(C) >120 cm/sec

(D) between 30 cm/sec and 80 cm/sec

30. As renal vascular resistance increases, what happens to diastolic flow initially?

(A) decreases

(B) reverses

(C) becomes quasi-steady

(D) increases

31. The renal resistive index (RI) would not usually be increased in patients with which of the following conditions?

(A) intrinsic renal parenchymal disease

(B) perinephric or subcapsular hematoma

(C) decreased heart rate

(D) mild acute tubular necrosis

32. A Doppler spectral waveform demonstrating high resistance features would normally be found in which of the following arteries?

(A) hepatic artery

(B) inferior mesenteric artery

(C) renal artery

(D) splenic artery

33. What is the second most common cause of renovascular hypertension?

(A) ostial atherosclerotic plaque

(B) anastomotic stenosis

(C) fibromuscular dysplasia

(D) renal artery aneurysm

34. Tardus parvus Doppler spectral waveforms within the renal parenchyma indicate which of the following findings?

(A) renal artery stenosis or occlusion

(B) medical renal disease

(C) hydronephrosis

(D) pyelonephritis

35. Renal artery occlusion is not indicated by

(A) a kidney pole-to-pole length <8 cm

(B) low-amplitude, low-velocity cortical signals

(C) a difference in kidney length <2 cm

(D) absence of color Doppler in imaged renal artery

36. An end-diastolic to systolic velocity ratio of <0.20 from a renal intersegmental artery indicates which of the following diagnoses?

(A) medical renal disease

(B) renal artery stenosis

(C) renal artery occlusion

(D) fibromuscular dysplasia

37. The common iliac veins come together to form the inferior vena cava at the level of the

(A) second lumbar vertebra

(B) fourth lumbar vertebra

(C) ileocecal valve

(D) inguinal ligament

38. What is the most common vascular problem affecting the inferior vena cava?

(A) tumor extension

(B) thrombosis

(C) extrinsic compression

(D) transposition

39. Carcinomas of the kidney, adrenal gland, and liver frequently involve which of the following vessels?

(A) abdominal aorta

(B) hepatic veins

(C) renal arteries

(D) inferior vena cava

40. Which of the following is not likely to cause inferior vena cava thrombosis?

(A) stasis

(B) sepsis

(C) abdominal surgery

(D) pregnancy

41. In a normal adult, the renal artery resistive index should not be greater than

(A) 0.03

(B) 0.35

(C) 0.70

(D) 1.05

42. If the inferior vena cava is partially obstructed, the Doppler spectral waveforms will be

(A) phasic

(B) pulsatile

(C) continuous

(D) absent

43. Which of the following would not be used for confirmation of inferior vena cava thrombosis?

(A) venocavography

(B) contrast angiography

(C) magnetic resonance imaging

(D) computed tomographic scan

44. The liver is divided into right and left lobes by which of the following veins?

(A) right hepatic vein

(B) middle hepatic vein

(C) portal vein

(D) left hepatic vein

45. The “Playboy bunny” sign refers to the

(A) hepatic artery

(B) portal veins

(C) common bile duct

(D) hepatic veins

46. Which vessel receives drainage from the hepatic veins?

(A) inferior vena cava

(B) portal vein

(C) splenic vein

(D) superior mesenteric vein

47. The Doppler spectral waveform from the hepatic veins is normally

(A) non-phasic

(B) pulsatile

(C) quasi-steady

(D) continuous

48. Which of the following vessels supplies the majority of oxygenated blood to the liver?

(A) aorta

(B) hepatic artery

(C) superior mesenteric artery

(D) portal vein

49. The portal vein is formed by the confluence of which of the following veins?

(A) hepatic and splenic veins

(B) superior mesenteric and splenic veins

(C) hepatic and superior mesenteric veins

(D) inferior and superior mesenteric veins

50. Where does the main portal vein lie?

(A) inferior to the superior mesenteric vein

(B) inferior to the head of the pancreas

(C) cephalad to the caudate lobe

(D) anterior to the inferior vena cava

51. Which three vessels form the portal triad?

(A) portal vein, superior mesenteric vein, splenic vein

(B) portal vein, common bile duct, hepatic artery

(C) portal vein, hepatic artery, superior mesenteric artery

(D) portal vein, common bile duct, middle hepatic vein

52. Which of the following is true regarding hepatic veins?

(A) are boundary formers and course horizontally toward the inferior vena cava

(B) are not boundary formers and are oriented toward the porta hepatis

(C) are not boundary formers and course longitudinally toward the porta hepatis

(D) are boundary formers and course longitudinally toward the inferior vena cava

53. Doppler spectral waveforms from the portal veins do not normally demonstrate which of the following?

(A) pulsatility

(B) minimal phasicity

(C) hepatopetal flow

(D) velocity ranging from 20–30 cm/sec

54. Which of the following terms is used to describe obstruction of the hepatic veins?

(A) fibromuscular dysplasia

(B) cavernous transformation

(C) Budd–Chiari syndrome

(D) hemangioma

55. Which of the following statements describes hepatic veins?

(A) They can be compressed with a Valsalva maneuver.

(B) They have thick, echogenic walls.

(C) They course horizontally within the liver parenchyma.

(D) They divide the liver into segments.

56. In the Western countries, portal hypertension is most often caused by which of the following?

(A) hepatitis

(B) sclerosing cholangitis

(C) cirrhosis

(D) hepatocellular carcinoma

57. Cavernous transformation is found in association with

(A) hepatic vein thrombosis

(B) portal vein thrombosis

(C) superior mesenteric vein thrombosis

(D) inferior vena cava thrombosis

58. What is the normal blood pressure within the liver?

(A) 5–10 mm Hg

(B) 20–30 mm Hg

(C) 0–5 mm Hg

(D) more than 30 mm Hg

59. What is the most common type of portal hypertension?

(A) suprahepatic

(B) extrahepatic

(C) intrahepatic

(D) posthepatic

60. Which of the following signs is not consistent with portal hypertension?

(A) portal vein diameter >13 mm

(B) portal vein velocity <12 cm/sec

(C) respiratory variation in portal vein signals

(D) hepatofugal portal venous flow

61. Which of the following causes mycotic aneurysms?

(A) Marfan’s syndrome

(B) trauma

(C) penetrating injuries

(D) infection

62. The paraumbilical vein is a branch of which of the following veins?

(A) coronary vein

(B) left gastric vein

(C) left portal vein

(D) middle hepatic vein

63. Which of the following veins assumes a “bull’s eye” appearance in the transverse image plane in the region of the falciform ligament and after exiting the liver may form the caput medusa in the region of the umbilicus in patients with portal hypertension?

(A) paraumbilical vein

(B) coronary vein

(C) left hepatic vein

(D) right gastric vein

64. A TIPS is placed in the liver to shunt blood from which of the following veins?

(A) right hepatic artery to left hepatic vein

(B) left portal vein to right hepatic artery

(C) main portal vein to right hepatic vein

(D) right portal vein to left hepatic vein

65. The color-flow image and Doppler spectral waveforms below are suggestive of which of the following findings?

(A) TIPS stenosis

(B) obstruction in the hepatic outflow vein

(C) inferior vena cava thrombosis

(D) portal vein thrombosis

Image

66. Following placement of a functioning TIPS, flow in the hepatic veins should be

(A) hepatopetal

(B) phasic

(C) hepatofugal

(D) continuous

67. The B-Mode image below demonstrates

(A) a TIPS within the liver

(B) hepatocellular carcinoma

(C) hemangioma

(D) stenosis of the right hepatic vein

Image

68. Following placement of a TIPS, velocity within the shunt is 180 cm/sec, flow in the portal vein is 110 cm/sec, flow in the main portal vein is hepatopetal, flow in the left portal and hepatic veins is hepatofugal. What are these findings most consistent with?

(A) occlusion of the TIPS

(B) TIPS stenosis

(C) normally functioning TIPS

(D) hepatic outflow obstruction

69. Following placement of a TIPS, velocity within the shunt is 55 cm/sec, flow in the portal vein is 58 cm/sec, flow in the main portal vein is hepatopetal, flow in the left portal and hepatic veins is hepatopetal. What are these findings most consistent with?

(A) occlusion of the TIPS

(B) TIPS stenosis

(C) normally functioning TIPS

(D) hepatic outflow obstruction

70. The Doppler spectral waveform pattern that suggests renal vein thrombosis is characterized by which of the following findings?

(A) rapid systolic upstroke, rapid deceleration, and low diastolic flow

(B) delayed systolic upstroke, rapid deceleration, and high diastolic flow

(C) rapid systolic upstroke, rapid deceleration, and reversed, blunted diastolic flow

(D) delayed systolic upstroke, rapid deceleration, and high, blunted diastolic flow

71. Which of the following symptoms is not associated with renal vein thrombosis?

(A) hematuria

(B) pulmonary embolism

(C) epigastric pain

(D) fever

72. The Doppler spectral waveforms shown below illustrate

(A) flow-reducing celiac artery stenosis

(B) flow-reducing renal artery stenosis

(C) normal flow in the celiac artery

(D) normal flow in the renal artery

Image

73. The Doppler spectral waveforms shown below are diagnostic of

(A) atherosclerotic stenosis of the celiac artery

(B) median arcuate ligament compression of the celiac artery

(C) postprandial celiac artery flow

(D) collateral compensatory flow in the celiac artery

Image

Image

74. If the urethra is obstructed, which of the following is true?

(A) Hydronephrosis will not occur.

(B) Hydronephrosis will be unilateral.

(C) Hydronephrosis will be bilateral.

(D) Renal calculi are the cause.

75. Acute renal vein thrombosis is suggested if which of the following is true?

(A) The renal sinus become hyperechogenic.

(B) The corticomedullary junction is indistinct.

(C) The Doppler spectral waveform demonstrates pulsatility.

(D) The kidney is smaller than normal.

76. The kidney exhibits a hypoechoic, cystic-appearing area within the echogenic renal sinus. What is this finding most consistent with?

(A) renal calculus

(B) hydronephrosis

(C) renal infarction

(D) renal artery occlusion

Image

77. With obstructive hydronephrosis, the resistive index is

(A) less than 0.50

(B) more than 1.2

(C) more than 3.5

(D) more than 0.70

78. Which of the following terms is used to describe a cadaveric liver transplant?

(A) orthotopic

(B) heterogeneous

(C) heterotopic

(D) homogeneous

79. The arterial and venous anastomoses for a cadaveric liver transplant include the

(A) extrahepatic portal vein, hepatic artery, right hepatic vein, suprahepatic and infrahepatic IVC

(B) the left portal vein, hepatic artery, right hepatic vein, and IVC

(C) extrahepatic portal vein, hepatic artery, suprahepatic and infrahepatic IVC

(D) right portal vein, splenic vein, suprahepatic and infrahepatic IVC

80. Which of the following is not a valued tool for confirmation of liver transplant rejection?

(A) sonography

(B) standard contrast arteriography

(C) radionuclide scintigraphy

(D) computed tomography

81. Which of the following is considered a critical complication following liver transplantation?

(A) hepatic artery stenosis

(B) hepatic vein thrombosis

(C) IVC stenosis

(D) hepatic artery thrombosis

82. Post-liver transplantation, the hepatic artery Doppler spectral waveforms demonstrate a peak systolic velocity >180 cm/sec, systolic acceleration time >0.8 sec, and RI <0.5. What are these findings most consistent with?

(A) normal hepatic artery

(B) hepatic artery stenosis

(C) hepatic artery thrombosis

(D) portal vein obstruction

83. Pseudoaneurysms are associated with

(A) an intimal tear

(B) low-resistance Doppler spectral waveforms

(C) to- and fro-flow patterns

(D) a post-stenotic signal

84. The diameter of the portal vein is measured as it crosses anterior to the IVC in a patient lying supine. The diameter should not exceed

(A) 5 mm

(B) 10 mm

(C) 13 mm

(D) 15 mm

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

(A) celiac artery

(B) hepatic artery

(C) splenic artery

(D) gastric artery

86. Which of the following is not a significant cause of renal transplant failure?

(A) acute rejection

(B) acute tubular necrosis

(C) renal artery stenosis

(D) fibromuscular dysplasia

87. In adults, the transplant renal artery is most often anastomosed to which of the following arteries?

(A) aorta

(B) common iliac artery

(C) external iliac artery

(D) hepatic artery

88. Real-time imaging characteristics of renal transplant rejection include

(A) decreased renal volume, decreased cortical echogenicity, thickening of the renal pelvis

(B) decreased renal volume, increased cortical echogenicity, thickening of the renal pelvis

(C) decreased renal sinus fat, increased cortical echogenicity, thickening of the renal pelvis

(D) increased renal volume, increased cortical echogenicity, thickening of the renal pelvis

89. The Doppler spectral waveform pattern associated with acute renal transplant rejection demonstrates

(A) rapid systolic upstroke, rapid deceleration, low or absent diastolic flow

(B) rapid systolic upstroke, delayed deceleration, forward diastolic flow

(C) delayed systolic upstroke, rapid deceleration, low or absent diastolic flow

(D) delayed systolic upstroke, delayed deceleration, forward diastolic flow

90. Moderate ATN is associated with a Doppler spectral pattern demonstrating

(A) rapid systolic upstroke, rapid deceleration, absent diastolic flow

(B) rapid systolic upstroke, rapid deceleration, increased pulsatility

(C) delayed systolic upstroke, delayed deceleration, low or absent diastolic flow

(D) delayed systolic upstroke, delayed deceleration, acceleration index >3.78

91. Flow-reducing transplant renal artery stenosis is suggested by

(A) a renal-aortic velocity ratio >3.5

(B) a peak systolic renal artery velocity >180 cm/sec

(C) a renal-iliac velocity ratio >3.0

(D) an end-diastolic to peak systolic velocity ratio >0.2

92. Which of the following does not apply to the right renal artery?

(A) courses posterior to the IVC

(B) arises from the aortic wall at the level of the first or second lumbar vertebrae

(C) demonstrates a spectral waveform with constant forward diastolic flow

(D) gives rise to branches that supply the adrenal, pancreas and ureter

93. Doppler spectral waveforms from a renal transplant arteriovenous fistula are characterized by

(A) low velocity, low-amplitude arterial signals and pulsatile venous flow

(B) high-velocity, turbulent arterial signals and low amplitude, continuous venous flow

(C) high-velocity, turbulent arterial signals and pulsatile venous flow

(D) low-velocity, low-amplitude arterial signals and continuous venous flow

94. What is the most serious complication of pancreas transplantation?

(A) superior mesenteric artery stenosis

(B) hepatic artery thrombosis

(C) splenic vein thrombosis

(D) celiac artery stenosis

95. Normally, portal venous flow is

(A) pulsatile

(B) hepatopetal

(C) hepatofugal

(D) bidirectional

96. Severe portal hypertension may be accompanied by all of the following except

(A) a patent paraumbilical vein

(B) a patent coronary vein

(C) increased portal venous flow volume

(D) a caput medusa

97. TIPSs are used to

(A) treat recurrent gastrointestinal bleeding and refractory ascites

(B) treat hepatocellular carcinoma

(C) shunt blood from the splenic vein to the renal vein

(D) shunt blood from the jugular vein to the IVC

98. Renal artery occlusion is suggested by all of the following EXCEPT

(A) absence of flow in the renal artery using optimized power Doppler imaging

(B) low-amplitude, low-velocity Doppler spectral waveforms throughout the renal parenchyma

(C) a side-to-side difference in renal length of 1.5 cm

(D) a kidney length <8 cm

99. The renal artery acceleration index is defined as

(A) the time interval from the onset of systole to the early systolic peak

(B) the time interval from the onset of systole to peak systole divided by Doppler frequency

(C) the change in distance between the onset of systolic flow and the early systolic peak

(D) the change in distance between the onset of systolic flow and the peak systolic velocity divided by the acceleration time

100. The term “flow-reducing stenosis” signifies arterial narrowing of

(A) 20–30%

(B) 30–40%

(C) 50–60%

(D) 100%

101. The postprandial Doppler spectral waveform from the normal SMA will exhibit

(A) rapid systolic upstroke, rapid deceleration, reversed diastolic flow

(B) rapid systolic upstroke, rapid deceleration, forward diastolic flow

(C) rapid systolic upstroke, delayed deceleration, low diastolic flow

(D) rapid systolic upstroke, blunt systolic peak, delayed run-off

102. The best image of the celiac, common hepatic, and splenic arteries is obtained from the

(A) transverse plane at the level of the left renal vein

(B) sagittal plane to the right of midline

(C) transverse plane at the level of the SMA

(D) sagittal plane at the level of the SMV

103. A perivascular color artifact is noted in the region of a transplant renal artery anastomosis. What is this most likely associated with?

(A) a bruit

(B) an arteriovenous fistula

(C) transplant renal artery occlusion

(D) a pseudoaneurysm

104. A “to- and-fro” Doppler spectral waveform is associated with

(A) saccular aneurysm

(B) dissecting aneurysm

(C) pseudoaneurysm

(D) fusiform aneurysm

105Acute occlusion of a renal artery would likely result in

(A) low-amplitude, low-velocity Doppler waveforms throughout the kidney

(B) increased flow in the contralateral renal artery

(C) Doppler waveforms with absent diastolic flow in the cortical vessels

(D) no evidence of collateral flow

106. An abdominal aortic aneurysm >6 cm in anteroposterior diameter should be

(A) followed with sonograms at 6-month intervals

(B) followed with CT scan at yearly intervals

(C) treated emergently to prevent risk of rupture

(D) treated with ultrasound probe compression

107. What is the second most common cause of renovascular hypertension?

(A) fibromuscular dysplasia

(B) atherosclerotic renal artery stenosis

(C) renal artery occlusion

(D) chronic renal failure

108. The longitudinal image of the aorta seen below illustrates

(A) saccular aneurysm

(B) fusiform aneurysm

(C) mycotic aneurysm

(D) aortic dissection

Image

109. The transverse image ol the aorta seen below illustrates

(A) saccular aneurysm

(B) fusiform aneurysm

(C) mycotic aneurysm

(D) aortic dissection

Image

110. Which artery is not routinely evaluated during a mesenteric duplex study?

(A) superior mesenteric

(B) splenic

(C) left gastric

(D) celiac

111. In the figure below, the Doppler spectral waveform from the SMA indicates

(A) collateralization

(B) fasting state

(C) postprandial state

(D) flow-limiting stenosis

Image

112. A rapid decrease in velocity and turbulent flow distal to arterial stenosis is the result of

(A) a pressure-flow gradient

(B) narrowing of the diameter of the vessel

(C) an increase in kinetic energy at the distal end of the stenosis

(D) tandem lesions

113. What is the best image plane to use for visualization of the left renal vein?

(A) transverse

(B) coronal

(C) oblique

(D) longitudinal

114. The color-flow image seen below illustrates

(A) normal renal artery

(B) multiple renal arteries

(C) renal artery occlusion

(D) retroaortic left renal vein

Image

115. The transducer is placed in the right intercostal space directed toward the porta hepatis. The color bar indicates flow toward the transducer is red and flow away is blue. Using this scan plane and color setting, flow in the normal portal vein will be

(A) blue

(B) red

(C) bidirectional

(D) absent

116. Power Doppler imaging demonstrates all of the following except

(A) power spectrum

(B) perfusion

(C) intensity

(D) direction

117. Distal to an 80% stenosis in the proximal renal artery, the Doppler spectral waveform will exhibit

(A) rapid systolic upstroke

(B) early systolic peak

(C) tardus parvus morphology

(D) absence of diastolic flow

118. Heterotopic partial transplantation is

(A) frequently used with pancreas transplantation

(B) frequently used for patients with renal failure

(C) the most common type of liver transplantation

(D) used with cadaveric livers

119. The abdominal aorta is considered aneurysmal if its diameter exceeds

(A) 1 cm

(B) 2 cm

(C) 3 cm

(D) 1 times the diameter of the proximal normal segment

120. Which vessel is not interrogated during routine evaluation of a renal transplant?

(A) external iliac artery

(B) external iliac vein

(C) intersegmental artery

(D) inferior vena cava

121. Which vessel is not routinely interrogated during evaluation of a pancreas transplant?

(A) hepatic artery

(B) splenic vein

(C) superior mesenteric artery

(D) portal vein

122. Clinically, patients with portal hypertension may have

(A) bleeding from gastroesophageal varices

(B) ascites

(C) hepatomegaly

(D) all of the above

123. Increased velocity due to stenosis can be differentiated from collateral compensatory flow by noting that the

(A) post-stenotic signal is present with a flow-reducing stenosis but not with collateral flow

(B) high velocity will be seen throughout the visualized length of the artery in both cases

(C) A but not B

(D) both A and B

124. Which of the following is a complication associated with aortic stent grafts that may require lifelong follow-up?

(A) risk of kinking

(B) crossed limbs

(C) endoleaks

(D) stenosis

125. Which of the following is not associated with aortic endoleaks?

(A) flow within the residual aneurysm sac

(B) increased risk for rupture

(C) graft and endoleaks waveforms differ

(D) turbulent chaotic flow pattern

126. The right renal artery can be imaged from

(A) transverse approach at the level of the left renal vein

(B) longitudinal image of the IVC from a right paramedian scan plane

(C) transverse view of the kidney through an intercostal approach

(D) all of the above

127. The left portal vein divides into

(A) the paraumbilical and coronary veins

(B) medial and lateral branches

(C) left gastric and coronary veins

(D) anterior and posterior branches

128. The coronary vein enters which of the following veins near the confluence of the superior mesenteric and portal veins?

(A) inferior mesenteric

(B) renal

(C) portal

(D) left gastric

129. The Doppler spectral waveform from the normal portal vein is

(A) pulsatile

(B) minimally phasic

(C) continuous and non-phasic

(D) high resistant

130. In patients with portal hypertension, it is common to find spontaneous venous shunting between the

(A) IVC and hepatic artery

(B) coronary vein and the paraumbilical vein

(C) splenic vein and renal vein

(D) superior mesenteric vein and portal vein

131. Velocity parameters diagnostic of flow-reducing SMA stenosis are

(A) peak systolic velocity <250 cm/sec; end-diastolic velocity <45 cm/sec

(B) peak systolic velocity >275 cm/sec; end-diastolic velocity >55 cm/sec

(C) peak systolic velocity <250 cm/sec; end-diastolic velocity <45 cm/sec and a post-stenotic signal

(D) peak systolic velocity >275 cm/sec; end-diastolic velocity >45 cm/sec and a post-stenotic signal

132. The caput medusa associated with portal hypertension is identified

(A) in the region of the portal confluence

(B) as periportal collaterals in the porta hepatis

(C) as superficial collaterals surrounding the umbilicus

(D) as varices in the splenic hilum

133. Which of the following arteries is not part of the renal arterial system?

(A) segmental arteries

(B) arcuate arteries

(C) cruciate arteries

(D) interlobar arteries

134. The adult kidney is normally

(A) 8–10 cm in length, 2–4 cm in width, and 4–5 cm in anteroposterior thickness

(B) 10–14 cm in length, 3–5 cm in width, and 2–3 cm in anteroposterior thickness

(C) 12–15 cm in length, 2–4 cm in width, and 4–5 cm in anteroposterior thickness

(D) 11–13 cm in length, 5–7 cm in width, and 2–3 cm in anteroposterior thickness

135. The peak systolic velocity in the adult aorta is normally

(A) 30–70 cm/sec

(B) 40–100 cm/sec

(C) 70–140 cm/sec

(D) 140–160 cm/sec

136. Elevated resistive index in a renal transplant can be associated with

(A) acute rejection

(B) acute tubular necrosis

(C) increased transducer pressure over the transplant

(D) all of the above

137. The Doppler spectral waveform from the suprarenal aorta may be

(A) triphasic

(B) biphasic

(C) A but not B

(D) both A and B

138. The Doppler spectral waveform pattern for severe acute tubular necrosis is indistinguishable from the pattern associated with severe acute rejection. Both patterns demonstrate

(A) rapid systolic upstroke, rapid deceleration, constant forward diastolic flow

(B) rapid systolic upstroke, rapid deceleration, low diastolic flow

(C) delayed systolic upstroke, rapid deceleration, constant forward diastolic flow

(D) delayed systolic upstroke, delayed deceleration, low diastolic flow

139. Which type of aneurysm forms an “outpouching” from the aortic wall?

(A) mycotic aneurysm

(B) pseudoaneurysm

(C) saccular aneurysm

(D) fusiform aneurysm

140. An epigastric bruit that is present during normal respiration but disappears with deep inspiration is most likely due to

(A) median arcuate ligament compression of the celiac artery

(B) atherosclerotic aortic stenosis

(C) superior mesenteric artery Nutcracker syndrome

(D) renal artery stenosis

141. The renal-aortic velocity ratio should not be used when the aortic peak systolic velocity is

(A) 50–60 cm/sec

(B) 90 cm/sec

(C) less than 30 cm/sec

(D) 100 cm/sec

142. The inferior mesenteric vein drains into the splenic vein

(A) to the left of the confluence of the portal and splenic veins

(B) to the right of the confluence of the portal and splenic veins

(C) inferior to the confluence of the portal and splenic veins

(D) superior to the confluence of the portal and splenic veins

143. Which vessel is not usually visualized sonographically?

(A) inferior mesenteric artery

(B) cystic vein

(C) paraumbilical vein

(D) inferior right hepatic vein

144. Pulsatility of the portal venous Doppler waveform indicates

(A) right heart failure

(B) tricuspid regurgitation

(C) portal hypertension

(D) all of the above

145. When measured in the cranio-caudad plane, the spleen is considered to be enlarged when its length exceeds

(A) 8 cm

(B) 10 cm

(C) 13 cm

(D) 15 cm

146. In patients with portal hypertension, the most common portosystemic collateral is the

(A) paraumbilical vein

(B) coronary vein

(C) splenic vein

(D) cystic vein

147. The coronary vein is considered to be enlarged when its diameter exceeds

(A) 2 mm

(B) 4 mm

(C) 6 mm

(D) 8 mm

148. The normal flow direction in the coronary vein is

(A) toward the splenic and portal vein

(B) away from the splenic and portal vein

(C) hepatofugal

(D) toward the inferior vena cava

149. The portal vein travels throughout the liver with the

(A) middle hepatic vein and left hepatic artery

(B) hepatic vein and common bile duct

(C) paraumbilical vein and hepatic artery

(D) hepatic artery and common bile duct

150. To obtain the correct dimensions of an abdominal aortic aneurysm it is important to scan

(A) following the axis of the spine

(B) following the axis of the aorta

(C) following the axis of the IVC

(D) all of the above