ARDMS Abdomen Review (Based off of URR Review Course) Exam 581 Questions with Verified Answers,100% CORRECT

ARDMS Abdomen Review (Based off of URR Review Course) Exam 581 Questions with Verified Answers What does an increased RI mean - CORRECT ANSWER increased resistance in vascular bed What does an increased pulsatility index mean - CORRECT ANSWER increased resistance in vascular bed Normal PI for vessels supplying organs such as kidneys - CORRECT ANSWER 0.75 Hydrostatic pressure: when supine at ankle when standing above heart when standing - CORRECT ANSWER 0 mmHg 100 mmHg -30 mmHg What vessel is the most posterior abdominal vessel - CORRECT ANSWER aorta Paired branches of the aorta (5) - CORRECT ANSWER suprarenal arteries (adrenal glands) renal arteries (kidneys) gonadal arteries (ovaries/testicles) lumbar arteries common iliac arteries Unpaired branches of the aorta (4) - CORRECT ANSWER celiac axis (common hepatic, splenic, left gastric arteries) SMA IMA median sacral artery What level common iliac arteries bifurcate - CORRECT ANSWER L3-4 Decreased hematocrit may indicate what - CORRECT ANSWER bleed in body What happens to the aorta as you follow it distally (2) - CORRECT ANSWER gets smaller becomes more anterior Aortic Ectasia - CORRECT ANSWER lack of tapering of aorta as you move distally (can be precursor to aneurysm) AAA What vessel walls are involved - CORRECT ANSWER focal dilation of aorta 3cm or 50% diameter between two adjacent segments all three Most common cause of AAA - CORRECT ANSWER atherosclerotic disease Risk factors for AAA (4) - CORRECT ANSWER 1. male 2. family history 3. smoking 4. chronic hypertension Saccular aneurysm - CORRECT ANSWER localized round out pouching, may have small stalk Fusiform aneurysm - CORRECT ANSWER vessel wall stretched in circumferential manner (most common) Mycotic aneurysm - CORRECT ANSWER infected aneurysm, seen with syphilis Most common location of fusiform aneurysms - CORRECT ANSWER infrarenal At what diameter is surgical intervention done on an AAA - CORRECT ANSWER 5.5cm Complications of AAA (5) - CORRECT ANSWER 1. rupture 2. decreased blood to lower extremities 3. thrombus accumulation and embolization (blue toe syndrome) 4. affects renal circulation and systemic blood pressure (if suprarenal) 5. compress IVC Yin Yang Sign - CORRECT ANSWER sonographic sign with AAA swirling of blood in body of aneurysm on color doppler Splanchnic artery aneurysm most commonly occurs in What gender is this more common in - CORRECT ANSWER splenic artery women Aneurysm in the hepatic artery most commonly occurs in what segment - CORRECT ANSWER extra hepatic With endovascular aortic repair, what happens to the native aortic sac over time What plane should it be measured in - CORRECT ANSWER decreased in size transverse If aortic sac expands more than _____ between exams, a leak should be suspected - CORRECT ANSWER 0.6 cm Type I dissection Type II dissection Type III dissection - CORRECT ANSWER ascending and descending aorta ascending aorta, associated with Marfan syndrome descending aorta Marfan syndrome - CORRECT ANSWER genetic disorder affecting connective tissue of heart, vessels, bones Aortic rupture symptoms - CORRECT ANSWER back pain hypotension Leriche syndrome (3) - CORRECT ANSWER aortoiliac occlusive disease occlusion of abdominal aorta just above CIA bif causes bilateral lower extremity ischemia symptoms Retroperitoneal fibrosis other name, most common location - CORRECT ANSWER Ormond disease most commonly at aortic bifurcation and inferiorly in pelvis Retroperitoneal fibrosis sonographically (4) - CORRECT ANSWER soft tissue mass surrounding great vessels hypoechoic smooth borders possible hydronephrosis (due to ureteral obstruction) Abnormal dilation of the abdominal segment of the IVC measures - CORRECT ANSWER 2.5 cm Normal Doppler flow of the IVC is - CORRECT ANSWER triphasic Most common variation of IVC anatomy - CORRECT ANSWER duplicated IVC infrarenal segment duplicated with left IVC entering left renal vein (suprarenal IVC normal) Transposed IVC - CORRECT ANSWER IVC on left side of abdomen (instead of right) Interrupted IVC (3) - CORRECT ANSWER IVC doesn't go to right atrium enters azygos/hemiazygos veins to reach SVC no intrahepatic segment Causes of IVC dilation (5) - CORRECT ANSWER 1. right heart failure (most common) 2. congestive heart failure 3. pulmonary hypertension 4. mass effect 5. pregnancy Greenfield Filter (3) - CORRECT ANSWER prevents emboli from reaching lungs infrarenal echogenic "umbrella" Most common malignancy to invade renal vein and IVC - CORRECT ANSWER RCC (renal cell carcinoma) Liver is encapsulated by _____ capsule - CORRECT ANSWER glisson Portal triad includes - CORRECT ANSWER portal vein hepatic artery bile duct In pediatric patients, the liver shouldn't extend more than _____ below the costal margin - CORRECT ANSWER 1cm below The right hepatic vein (in right intersegmental fissure) divides the right lobe of the liver into what segments The left hepatic vein (in left intersegmental fissure) divides the left lobe of the liver into what segments - CORRECT ANSWER anterior and posterior segments medial and lateral segments Triangular ligament attaches the superior liver - CORRECT ANSWER to the diaphragm Falciform ligemant attaches the anterior surface of the liver - CORRECT ANSWER to the abdominal wall Ligamentum teres is what What is it also called - CORRECT ANSWER remnant of umbilical vein round ligament Ligamentum venosum is - CORRECT ANSWER remnant of ductus venosum from fetal circulation (umbilical vein-left portal vein-ductus venosus-IVC-right atrium) Hepatoduodenal ligament contains (3) - CORRECT ANSWER MPV hepatic artery CBD Branches of MPV - CORRECT ANSWER RPPV RAPV LMPV LLPV MPV carries _____% of all blood entering liver, hepatic artery carries _____% - CORRECT ANSWER 80 20 Normal portal vein diameter - CORRECT ANSWER 13mm What is the most common variation in hepatic vein anatomy - CORRECT ANSWER accessory right hepatic vein Caroli disease - CORRECT ANSWER congenital defect of bile ducts, numerous cysts in biliary tree Caroli disease sonographically (3) - CORRECT ANSWER 1. focal cystic areas 2. connecting to biliary tree 3. resembles polycystic disease Cyst criteria (5) - CORRECT ANSWER 1. smooth borders 2. regular walls 3. no internal echoes 4. through transmission 5. posterior enhancement Hemorrhagic cyst sonographically (5) - CORRECT ANSWER 1. septations with fluid levels 2. smooth borders 3. regular walls 4. through transmission 5. posterior enhancement Polycystic Liver disease What age does it present - CORRECT ANSWER autosomal dominant presents 30-40 years Polycystic liver disease sonographically (4) - CORRECT ANSWER 1. focal cystic areas 2. varying sizes 3. thin septations 4. may have cysts in pancreas, kidneys, spleen Biliary Hamartomas (Von Meyenburg Complexes) - CORRECT ANSWER dilated intrahepatic ducts with dense stroma Biliary Hamartomas (Von Meyenburg Complexes) sonographically (3) - CORRECT ANSWER 1. small echogenic nodules 2. heterogeneous liver 3. 1cm Causes of fatty infiltration of liver (5) - CORRECT ANSWER diabetes alcohol abuse obesity starvation cystic fibrosis Diffuse fatty infiltration sonographically (5) - CORRECT ANSWER mild: slight increase in fine echoes, normal visualization of diaphragm and vessel borders moderate: moderate increase in fine echoes, impaired visualization of diaphragm and vessel borders severe: marked increase in fine echoes, poor or non-visualization of diaphragm and vessel borders hepatomegaly possible narrowing of hepatic veins Focal fatty infiltration sonographically (5) - CORRECT ANSWER focal increased echogenicity possible irregular borders usually adjacent to portal structures similar to hemangioma no displacement of surrounding structures Focal fatty sparing sonographically (5) - CORRECT ANSWER focal decreased echogenicity (remaining liver tissue increased echogenicity) possible irregular borders usually adjacent to gallbladder fossa similar to malignancy no displacement of surrounding structures Amyloid disease (2) - CORRECT ANSWER deposit of amyloid protein in vessel walls of various organs commonly involving liver Glycogen storage disease, most common type - CORRECT ANSWER autosomal recessive von Gierke disease Glycogen storage disease with excessive storage of glycogen sonographically (2) - CORRECT ANSWER hepatomegaly increased echogenicity Glycogen storage disease with reduced storage of glycogen sonographically (3) - CORRECT ANSWER hypo echoic parenchyma prominent portal walls "starry sky" (similar to hepatitis) What is hemochromatosis What is it inherited from Sonographic appearance - CORRECT ANSWER abnormal iron deposition inherited or due to anemia sonographically includes features of fibrosis and cirrhosis Wilson disease (2) - CORRECT ANSWER autosomal recessive disease excessive deposition of copper in liver Wilson disease symptoms (5) - CORRECT ANSWER jaundice hematemesis portal hypertension ascites rusty/brown-colored ring around iris of eye (Kayser-Fleischer rings) Wilson disease sonographically (3) - CORRECT ANSWER echogenic fatty liver fibrotic periportal thickening nodular cirrhotic changes Cirrhosis symptoms (5) - CORRECT ANSWER increased abdominal girth (ascites) jaundice liver atrophy splenomegaly weight loss Causes of cirrhosis (9) - CORRECT ANSWER hep C alcohol abuse chronic liver disease biliary obstruction hep B glycogen storage disease hemochromatosis wilson disease Budd Chiari syndrome Cirrhosis sonographically (6) - CORRECT ANSWER nodular surface hepatomegaly or right lobe atrophy with compensatory hypertrophy of left lobe portal hypertension splenomegaly thickened gallbladder wall ascites Symptoms of hepatitis (6) - CORRECT ANSWER jaundice hepatomegaly nausea fever/chills malaise dark urine Acute hepatitis sonographically (4) - CORRECT ANSWER "starry sky" appearance (normal liver texture or portal vein borders may be more prominent) increased echogenicity hepatosplenomegaly gallbladder wall thickening Chronic hepatitis sonographically (4) - CORRECT ANSWER coarse echo texture decreased brightness of portal triads normal size increased liver echogenicity (due to fibrosis) Echinococcal cysts sonographically (3) - CORRECT ANSWER large cyst with "daughter cysts" within honeycomb appearance, water lily sign most commonly found in right lobe What is schistosomiasis - CORRECT ANSWER parasitic infection (most common in humans) Schistosomiasis sonographically (4) - CORRECT ANSWER thick, echogenic portal vein walls debris/occlusion in intrahepatic portal venous system decreased liver size portal hypertension Pneumocystis jirovecci (pneumocystis carinii) cause and what patients is it most common in - CORRECT ANSWER yeast-like fungus AIDS patients Pneumocystis jirovecci (pneumocystis carinii) sonographically (1) - CORRECT ANSWER multiple non-shadowing echogenic foci Granulomatous infections sonographically (1) - CORRECT ANSWER multiple echogenic foci (granulomas) in spleen and liver Three types of hepatic abscess - CORRECT ANSWER pyogenic amoebic fungal Hepatic abscess symptoms (6) - CORRECT ANSWER fever nausea diarrhea RUQ pain hepatomegaly leukocytosis Pyogenic hepatic abscess sonographically (2) - CORRECT ANSWER solitary or multiple complex lesions fluid collections in: morison's pouch, subdiaphragmatic, subphrenic space Amebic hepatic abscess sonographically (3) - CORRECT ANSWER complex lesion typically in right lobe history of travel Most common benign lesion of the liver What gender is it more common in What lobe is it usually found in Usual symptoms What can cause it to enlarge - CORRECT ANSWER hemangioma women right asymptomatic pregnancy, estrogen therapy Hepatic hemangioma sonographically (3) - CORRECT ANSWER homogenous hyper echoic well-defined Most common benign vascular tumor in infancy Most common symptom When does it spontaneously regress by - CORRECT ANSWER infantile hemangioendothelioma cardiac failure age 2 Second most common benign liver mass What gender and age group is it more common in Most common symptom - CORRECT ANSWER focal nodular hyperplasia women of child bearing years asymptomatic Focal nodular hyperplasia sonographically (2) - CORRECT ANSWER well-defined lesion hyper echoic to isoechoic What gender is liver cell adenoma more common in What medication is it associated with What disease is it commonly associated with - CORRECT ANSWER women oral contraceptives glycogen storage disease Liver cell adenoma sonographically (3) - CORRECT ANSWER well-defined lesion central hyper echoic area surrounded by halo What is the most common primary malignancy of the liver What is the most common risk factor What gender is it more common in - CORRECT ANSWER hepatocellular carcinoma cirrhosis males Hepatocellular carcinoma symptoms (5) - CORRECT ANSWER fever hepatomegaly palpable mass ascites weight loss Hepatocellular carcinoma sonographically (4) - CORRECT ANSWER solitary massive tumor multiple nodules throughout liver diffuse infiltrative masses variable Most common pediatric primary liver malignancy What age does it occur before What lab value is associated with it - CORRECT ANSWER hepatoblastoma age 2 elevated alpha-fetoprotein Hepatoblastoma is associated with (2) - CORRECT ANSWER Beckwith-wiedemann syndrome familial adenomatous polyposis Hepatoblastoma symptoms (3) - CORRECT ANSWER abdominal enlargement hepatomegaly palpable mass Hepatoblastoma sonographically (4) - CORRECT ANSWER solid echogenic mass may have cystic portions/septations may contain calcification may invade hepatic and portal veins Most common primary sites of liver mets (4) - CORRECT ANSWER gallbladder (1) colon stomach pancreas Liver mets sonographically (3) - CORRECT ANSWER multi-locular well-defined hypoechoic What is kaposi sarcoma, most common liver malignancy seen with - CORRECT ANSWER malignancy of connective tissue HIV/AIDS What is lymphoma, what is it commonly associated with - CORRECT ANSWER malignancy of lymphatic system HIV/AIDS Lymphoma sonographically (3) - CORRECT ANSWER solid tumor single or multiple hypoechoic and/or complex Budd-Chiari Syndrome - CORRECT ANSWER obstruction of hepatic veins by thrombus or tumor Budd-Chiari sonographically (8) - CORRECT ANSWER variable thick hepatic vein walls hepatomegaly or atrophy IVC compression ascites splenomegaly slow/reversed portal vein flow absent/reversed/turbulent/continuous hepatic vein flow Air in hepatic veins cause, sonographic appearance - CORRECT ANSWER bacterial infection releasing air into bloodstream mobile echogenic foci with dirty shadowing and/or ring down artifact Hepatic infarct sonographically (1) - CORRECT ANSWER wedge-shaped hypoechoic area with no flow What is hepatic congestion associated with (2) - CORRECT ANSWER congestive heart failure reduced cardiac function Hepatic congestion sonographically (5) - CORRECT ANSWER hepatomegaly dilated hepatic veins enlarged IVC ascites biphasic waveform in hepatic veins Most common cause of portal hypertension - CORRECT ANSWER cirrhosis from alcoholism Portal hypertension sonographically (7) - CORRECT ANSWER portal vein 13mm dilated splenic and SMV hepatofugal flow varices abnormal portal vein flow ascites splenomegaly Abnormal portal vein flow (5) - CORRECT ANSWER pulsatile biphasic slow (16) reversed absent Collateral pathways with portal hypertension (3) - CORRECT ANSWER splenorenal esophageal recanalized umbilical vein Transjugular intrahepatic portosystemic shunt (TIPS) - CORRECT ANSWER hepatic vein connected to portal vein Linton shunt - CORRECT ANSWER proximal splenic vein connected to renal vein Warren shunt - CORRECT ANSWER distal splenic vein connected to renal vein Mesocaval shunt - CORRECT ANSWER SMV connected to IVC Normal portosystemic or portal-caval shunt sonographically (4) - CORRECT ANSWER flow from portal to hepatic system MPV hepatopedal flow intrahepatic branches hepatofugal peak velocity between 50-200 cm/s Most common reason for liver transplant in adults and children - CORRECT ANSWER hepatitis C biliary atresia What artery supplies the gallbladder What artery does it originate from What vein drains the gallbladder - CORRECT ANSWER cystic artery right hepatic artery cystic vein Gallbladder wall layers from inner to outer - CORRECT ANSWER mucosa muscle serosa Where are the ducts of luschka located What is their function - CORRECT ANSWER within gallbladder wall bile thickening Cystic duct carries bile to and from what What regulates the flow in the cystic duct - CORRECT ANSWER gallbladder spiral valves of heister CBD _____ considered dilated with gb present CBD _____ considered dilated in patients without gb - CORRECT ANSWER 8 mm 12 mm Which wall of the gallbladder should be measured Normal wall measurement - CORRECT ANSWER anterior wall 3 mm How does cholecystokinin affect the gallbladder - CORRECT ANSWER causes contraction Second most common congenital anomaly of the gallbladder - CORRECT ANSWER phrygian cap Most common congenital gallbladder anomaly - CORRECT ANSWER junctional fold What gender and ethnicity are choledochal cysts more common in - CORRECT ANSWER women Asian Five types of choledochal cysts - CORRECT ANSWER I: fusiform dilation of CBD (most common) II: diverticulum of CBD III: dilation of intraduodenal portion IV: dilation of intrahepatic and extra hepatic ducts V: dilation of intrahepatic ducts (Caroli disease) Biliary atresia sonographically (2) - CORRECT ANSWER triangular cord sign small/absent gb in fasting patient Calculous cholecystitis cause, what gender is it more common in Acalculous cholecystitis cause, what gender is it more common in - CORRECT ANSWER gallstones females bile stasis men Acute cholecystitis sonographically (4) - CORRECT ANSWER positive murphy sign increased color doppler flow pericholecystic fluid thick wall Chronic cholecystitis sonographically (4) - CORRECT ANSWER small, contracted gallbladder thick wall usually stones layering sludge levels Emphysematous cholecystitis sonographically (4) - CORRECT ANSWER thickened wall enlarged gallbladder bright echo with ring down artifact dirty shadowing (packed bag or WES sign) Gangrenous cholecystitis sonographically (4) - CORRECT ANSWER echogenic debris non shadowing not gravity dependent no layering effect What is porcelain gallbladder What is it associated with - CORRECT ANSWER calcification of part of all of gallbladder wall increased risk of gallbladder carcinoma Porcelain gallbladder sonographically (3) - CORRECT ANSWER echogenic wall posterior shadowing (no WES sign) possible stones Symptoms of cholangitis (3) - CORRECT ANSWER fever RUQ pain jaundice Cholangitis sonographically (2) - CORRECT ANSWER dilated bile ducts thick walls ( 2 mm) Most common cause of biliary obstruction Most common disease of the gallbladder - CORRECT ANSWER gallstones gallstones Risk factors of cholelithiasis (5) - CORRECT ANSWER fat female fertile forty fair skinned Cholelithiasis symptoms (3) - CORRECT ANSWER radiating RUQ pain (to shoulder) nausea vomiting Cholelithiasis sonographically (4) - CORRECT ANSWER one or more echogenic foci posterior acoustic shadow mobile WES sign What is Mirizzi syndrome - CORRECT ANSWER stone in cystic duct causes compression on common hepatic duct Mirizzi syndrome sonographically (2) - CORRECT ANSWER normal CBD gb, common hepatic, and intrahepatic ducts dilated Normal gallbladder length and transverse diameter - CORRECT ANSWER 8-12cm long 5cm transverse diameter Polyp measuring _____ indicates strong suspicion for malignant mass formation - CORRECT ANSWER 10mm What is cholesterolosis What is it also called What gender is it more common in - CORRECT ANSWER type of hyperplastic cholecystitis strawberry gallbladder women Cholesterolosis sonographically (3) - CORRECT ANSWER normal wall thickness multiple non shadowing masses attached to gallbladder wall What is adenomyomatosis Most common symptom - CORRECT ANSWER type of hyper plastic cholecystitis asymptomatic Adenomyomatosis sonographically (2) - CORRECT ANSWER wall thickening comet tail artifact What is pneumobilia What is it a complication of - CORRECT ANSWER air in biliary tree recent biliary intervention Pneumobilia sonographically (2) - CORRECT ANSWER echogenic foci in bile ducts dirty shadowing and ring down artifact Another name for gallbladder carcinoma What age group and gender is it more common in - CORRECT ANSWER adenocarcinoma women over 60 Gallbladder carcinoma (adenocarcinoma) sonographically (3) - CORRECT ANSWER variable focal or diffuse wall thickening solid mass replacing gallbladder Cholangiocarcinoma sonographically (3) - CORRECT ANSWER dilated intrahepatic and extra hepatic ducts adjacent to or within ducts irregular isoechoic mass What is the most common type of cholangiocarcinoma What is another name for it Where is it found - CORRECT ANSWER klatskin tumor hilar cholangiocarcinoma liver hilum Klatskin tumor sonographically (2) - CORRECT ANSWER dilated intrahepatic ducts non union of right and left ducts Primary sites of metastases to gallbladder (4) - CORRECT ANSWER melanoma (1) pancreas ducts liver Gallbladder metastasis sonographically (3) - CORRECT ANSWER solid mass without shadowing focal gallbladder wall thickening vascular flow in mass Is the pancreas an encapsulated organ Is it a retroperitoneal organ Average length, width, AP measurements List the five parts Is the pancreas an exocrine or endocrine gland - CORRECT ANSWER no yes, except small portion of head 12-18cm length 1-1.5 cm width 2.5 cm AP head neck body tail uncinate process exocrine and endocrine gland What is the name of the main pancreatic duct What other duct does it join What structure does this joining form Normal diameter - CORRECT ANSWER Duct of Wirsung common bile duct ampulla of vater (at 2nd portion of duodenum) 2mm What is the name of the secondary pancreatic duct What portion of the pancreas does it drain - CORRECT ANSWER duct of santorini the head What artery feeds the head of the pancreas What arteries feed the body and tail of the pancreas What veins drain the pancreas (2) - CORRECT ANSWER pancreatoduodenal artery branches of splenic artery SMV and splenic veins Function of: insulin glucagon - CORRECT ANSWER convert glucose to glycogen convert glycogen to glucose List enzymes of pancreatic juice (4) - CORRECT ANSWER lipase (lipids) amylase (carbs) trypsin (proteins) nucleases (DNA) What stimulates pancreatic juice production What stimulates secretion of pancreatic juices - CORRECT ANSWER cholecystokinin GI tract hormones Functions relating to digestion of food are from what portion of the pancreas - CORRECT ANSWER exocrine What do each of these cells produce: alpha beta delta - CORRECT ANSWER glucagon insulin somatostatin Pancreas echogenicity in children What happens to echogenicity of the pancreas as age increases Pancreas echogenicity in normal adult - CORRECT ANSWER hypoechoic to isoechoic to liver increases isoechoic or hyper echoic to liver What is the most common congenital pancreatic anomaly - CORRECT ANSWER pancreas divisium What is aberrant pancreatic tissue - CORRECT ANSWER ectopic pancreatic tissue What is annular pancreas - CORRECT ANSWER head of pancreas surrounds second portion of duodenum What is cystic fibrosis How does it affect the pancreas What function of the pancreas does it inhibit How does it affect the pancreas echogenicity, regardless of age - CORRECT ANSWER autosomal recessive disorder causes it to secrete thick mucous exocrine function (decreased lipase) increased echogenicity Symptoms of acute pancreatitis (5) - CORRECT ANSWER abdomen/back pain nausea vomiting weight loss fever Most common cause of acute pancreatitis Second most common cause of acute pancreatitis - CORRECT ANSWER biliary tract disease alcohol abuse With pancreatitis, what lab value elevates first - CORRECT ANSWER amylase (then lipase) Complications of pancreatitis (5) - CORRECT ANSWER fluid collections (ascites) pseudocysts hemorrhage phlegmon abscess Acute pancreatitis sonographically (4) - CORRECT ANSWER enlarged, edematous gland hypoechoic heterogeneous may be associated with thrombosis or gallstones What causes hemorrhagic pancreatitis - CORRECT ANSWER rupture of pancreatic vessels and subsequent hemorrhage Is acute pancreatitis reversible Is chronic pancreatitis reversible - CORRECT ANSWER yes no Most common cause of chronic pancreatitis What gender is it more common in - CORRECT ANSWER alcohol abuse males Chronic pancreatitis sonographically (4) - CORRECT ANSWER echogenic foci throughout gland enlarged pancreatic duct atrophic size may be associated with thrombosis or gallstones What is a phlegmon - CORRECT ANSWER an inflammatory process that spreads along fascial pathways Pancreatic abscess sonographically (4) - CORRECT ANSWER complex cystic mass thick, irregular walls debris ring down artifact from air produced by bacterial infection Are pancreatic cysts unilocular or multilocular Are they congenital or acquired Where are they most commonly found (2) What conditions are they associated with (2) - CORRECT ANSWER unilocular or multilocular congenital or acquired head body autosomal dominant polycystic disease (ADPKD) von hippel lindau syndrome What is a pancreatic pseudocyst - CORRECT ANSWER attempt of the body to wall off pancreatic juices Pancreatic pseudocyst sonographically (5) - CORRECT ANSWER smooth walls through transmission thick walls debris wall calcifications What is the most common benign tumor of the pancreas What lab values are associated with it (2) What age of patients is it more common in - CORRECT ANSWER islet cell tumors increased amylase increased associated hormones with tumor type 40-60 years What is the most common functioning islet cell tumor What does it result in What is it associated with - CORRECT ANSWER insulinoma hyperinsulinism = hypoglycemia von hippel landau syndrome What is the second most common islet cell tumor What hormone does it secrete What are gastrinomas associated with (3) - CORRECT ANSWER gastrinoma gastrin (overproduction of gastric acid) peptic ulcer MEN syndrome Zollinger Ellison syndrome Islet cell tumor sonographically (4) - CORRECT ANSWER solid, hypo echoic mass well-circumscribed may have cystic areas 3cm MEN 1 is characterized by lesions in the triad of - CORRECT ANSWER parathyroid pituitary pancreas What is zollinger-ellison syndrome What do these tumors secrete What does the secretion cause - CORRECT ANSWER one or more gastrinomas of duodenum amounts of gastrin (acid production in stomach) peptic ulcers What is a pancreatic adenoma composed of What lab values increase with it (2) - CORRECT ANSWER beta cells amylase lipase Pancreatic adenoma sonographically (3) - CORRECT ANSWER solid mass posterior enhancement varying echogenicity What is a serous cystadenoma What portions of the pancreas does it usually affect (2) Microcystic includes cysts of what size Macrocystic includes cysts of what size What gender is in more common in What lab value is it associated with What syndrome is it associated with - CORRECT ANSWER serous cystic neoplasm body tail 2 cm 2 cm women elevated amylase von hippel lindau syndrome What does a mucinous cystadenoma contain What is more likely to occur to a mucinous cystadenoma - CORRECT ANSWER mucinous material malignant transformation Pancreatic cancer is usually seen in patients of what age What portion of the pancreas does it normally occur in - CORRECT ANSWER 60 years head What is the most common primary malignancy of the pancreas What decade of life does it usually present What procedure may be attempted - CORRECT ANSWER adenocarcinoma 5th whipple procedure Risk factors of adenocarcinoma (4) - CORRECT ANSWER high fat diet smoking chronic pancreatitis family history Most common clinical findings of adenocarcinoma (2) - CORRECT ANSWER palpable gallbladder obstructive jaundice Adenocarcinoma sonographically (4) - CORRECT ANSWER hypoechoic mass dilated pancreatic duct dilated CBD variable Mucinous cystadenocarcinoma symptoms (4) - CORRECT ANSWER abdominal mass jaundice weight loss courvoisier sign Mucinous cystadenocarcinoma sonographically (2) - CORRECT ANSWER cystic mass with septations and mural nodules thick, mucinous fluid What is 4X more common than primary pancreatic cancer Most common primaries (4) What does the mass usually have - CORRECT ANSWER metastasis melanoma breast GI lung hypervascularity Another name for whipple procedure What is it most commonly performed to treat - CORRECT ANSWER pancreaticoduodenectomy pancreatic cancer What is the most common reason for a pancreas transplant What is the most common location for the allograft - CORRECT ANSWER insulin dependent diabetic with renal failure right iliac fossa Is the spleen an intraperitoneal organ Is it encapsulated The gastrosplenic ligament connects the spleen to what curvature of the stomach Length Width Thickness How does size change with age - CORRECT ANSWER yes yes greater 12cm length 8cm width 4cm thick decreases What is a retrorenal spleen (2) - CORRECT ANSWER anatomical variant inferior portion of spleen posteriolateral to upper pole of left kidney What is the largest branch of the celiac axis What ligament does it course through - CORRECT ANSWER splenic artery splenorenal ligament List the structures supplied and drained by the splenic artery and vein (3) - CORRECT ANSWER stomach spleen pancreas What is the largest organ of the reticuloendothelial system It plays a role in fetal _____ and adult _____ - CORRECT ANSWER spleen hematopoiesis lymphopoiesis What is red pulp of the spleen What does red pulp do to hemoglobin What is white pulp of the spleen - CORRECT ANSWER venous sinuses filled with blood break down lymphatic tissue that produce lymphocytes What does the spleen store (3) - CORRECT ANSWER iron blood other metabolites Leukocytosis Leukopenia Anemia Polycythemia Thrombocytopenia Thrombocytosis - CORRECT ANSWER increased WBC decreased WBC decreased RBC increased RBC decreased platelet levels increased platelet levels Situs solitus Situs inversus Situs ambiguous - CORRECT ANSWER normal organs reversed disorganized rearrangement (AKA heterotaxia) Asplenia What is it (2) Occurs with what other conditions (3) - CORRECT ANSWER absence of spleen type of heterotaxia double right-sidedness complex cardiac malformations right sided aorta midline liver Polysplenia What is it (2) Associated with (4) - CORRECT ANSWER multiple spleens double left-sidedness type of heterotaxia absence of liver biliary atresia interrupted IVC intestinal malrotation Most common congenital anomaly of spleen Where is it usually found - CORRECT ANSWER accessory spleen (splenule) pancreas tail/splenic hilum area Another name for ectopic spleen - CORRECT ANSWER wandering spleen (weak ligaments lead to torsion) With hereditary hemolytic anemia, what happens to the spleen early in life What occurs later in life How may the spleen appear Eventually, what happens to the spleen - CORRECT ANSWER enlarged atrophies and shrinks bright with calcifications autosplenectomy What is acquired hemolytic anemia What is a common sign of it What type of patients is it commonly seen in - CORRECT ANSWER acquired disorder caused by infection or medication increased indirect bilirubin AIDS What does the breakdown of red blood cells create - CORRECT ANSWER bilirubin What is gaucher disease What is being abnormally accumulated Common symptom - CORRECT ANSWER autosomal recessive disorder lipids hepatosplenomegaly Gaucher disease sonographically (3) - CORRECT ANSWER multiple hypoechoic nodules heterogeneous spleen splenomegaly Subcapsular hematoma is when the capsule is Where does it appear - CORRECT ANSWER intact outer boarders of spleen A perisplenic hematoma is intraperitoneal or retroperitoneal When does it occur - CORRECT ANSWER intraperitoneal when splenic capsule ruptures What is an intraparenchymal hematoma Is the capsule intact - CORRECT ANSWER blood collection within splenic parenchyma yes Symptoms of splenic rupture (3) - CORRECT ANSWER LUQ pain decreased hematocrit hypotension Splenic infarct sonographically (2) - CORRECT ANSWER acute: hypoechoic, wedge shape chronic: hyper echoic wedge shape (triangular point toward hilum) Reversal of main portal vein flow causes what to occur to the spleen Splenic vein or SMV measurement of what indicates portal hypertension What plane is splenic vein measured What plane is SMV measured - CORRECT ANSWER congestive splenomegaly 1 cm transverse sagittal What is polycythemia vera How does it affect clotting What does it cause to occur to the spleen - CORRECT ANSWER overproduction of RBC increased clotting, fast clotting splenomegaly What is the most frequent LUQ mass What is the most common splenic abnormality What is it most commonly caused by (2) - CORRECT ANSWER splenomegaly splenomegaly portal hypertension cirrhosis Three criteria of splenomegaly - CORRECT ANSWER 13 cm upper border of spleen extends across anterior aorta 2cm in supine patient in transverse plane (Asher sign) spleen extending past lower pole of left kidney What is sarcoidosis What does it form in the spleen - CORRECT ANSWER inflammatory disease causing cell clumping in some organs splenic nodules called granulomas Sarcoidosis sonographically (3) - CORRECT ANSWER multiple hypoechoic nodules throughout spleen multiple echogenic foci when healed some may cause shadowing What infection causes significant increase in spleen size What other infection is it associated with - CORRECT ANSWER mononucleosis Ebstein Barr infection AIDS sonographically (1) - CORRECT ANSWER hepatosplenomegaly What is granulomatous infections What is it associated with What are the two most common causes - CORRECT ANSWER systemic fungal respiratory disease (caused by bird, bat, or other animal droppings) splenomegaly histoplasmosis tuberculosis Granulomatous infections sonographically (3) - CORRECT ANSWER multiple hypoechoic nodules throughout spleen multiple echogenic foci when healed some may cause shadowing and twinkle artifact How common are splenic abscesses What are they associated with (3) - CORRECT ANSWER rare splenectomy septicemia trauma Splenic abscess sonographically (4) - CORRECT ANSWER complex fluid lesion with internal echoes irregular borders possible septations and pleural effusion dirty shadowing What is the most common benign tumor of the spleen - CORRECT ANSWER cavernous hemangioma Splenic hamartoma sonographically (6) - CORRECT ANSWER solitary or multiple well-defined not encapsulated hyper vascular hypoechoic homogenous Osteoma is from A fibroma is A chondroma is a A cystic lymphangioma is a Granulomas are - CORRECT ANSWER bone disease fibrous tissues cartilaginous tumor congenital defect in lymphatic vessels calcifications What is the most common splenic malignancy What is the most common type - CORRECT ANSWER lymphoma non-Hodgkin lymphoma What age group does Hodgkin lymphoma usually effect Lab values - CORRECT ANSWER 15-24 and over 60 malignant B cells (Reed-Sternberg cells) What age group does non-Hodgkin lymphoma usually effect Lab values - CORRECT ANSWER 60 years lactate dehydrogenase Lymphoma sonographically (6) - CORRECT ANSWER diffuse involvement multiple small nodular lesions multiple large nodular lesions single bulky mass hypoechoic splenomegaly Leukemia symptoms (5) - CORRECT ANSWER night sweats fatigue unintentional weight loss painless, swollen lymph nodes liver and/or spleen enlargement Most common leukemia What is it What is lymphocytic leukemia - CORRECT ANSWER myelogeneous leukemia cancer of myeloid cells (immature blood cells) cancer of lymphocytes Lab values with leukemia (4) - CORRECT ANSWER elevated ALP low RBC high WBC low sedimentation rate Angiosarcoma has a high incidence of what - CORRECT ANSWER splenic rupture Angiosarcoma sonographically (4) - CORRECT ANSWER splenomegaly heterogeneous complex mass with cystic components increased vascularity Most common primary sites of splenic metastasis (3) - CORRECT ANSWER melanoma lymphoma leukemia Splenic metastasis sonographically (3) - CORRECT ANSWER hypoechoic "bulls-eye" can be cystic or hyper echoic Are the kidneys retroperitoneal or intraperitoneal Are the kidneys encapsulated What also surrounds the kidneys What surrounds the kidneys, adrenals, and perirenal fat What structure is most anterior at the hilum What structure is most posterior at the hilum Length Width AP What two types of tissue are the kidneys composed of - CORRECT ANSWER retroperitoneal yes perirenal fat gerota fascia renal vein renal pelvis/ureter 9-12cm length 4-5 cm width 3-4 cm AP renal parenchyma renal sinus What does the renal cortex contain (3) How thick is the renal cortex - CORRECT ANSWER renal corpuscles proximal convoluted tubules distal convoluted tubules 1cm How many pyramids does the renal medulla contain What does the renal medulla contain (2) What occurs in the renal medulla - CORRECT ANSWER 8-18 loop of henle collecting duct reabsorption What drains each of the medullary pyramids What connects the medullary pyramids - CORRECT ANSWER minor calyces (one for each pyramid) major calyces What is the functional unit of the kidney What does the juxtaglomerular apparatus secrete What is the function of that - CORRECT ANSWER nephron renin regulate sodium, water retention, and blood pressure 30% of patients have what What do the renal arteries supply (3) - CORRECT ANSWER duplicated renal arteries (smaller artery called accessory) kidneys adrenals ureters Abnormal RI in renal artery What does it indicate (2) - CORRECT ANSWER 0.7 renal dysfunction ischemia How many main renal arteries are there for one kidney How many segmental arteries Where do the interlobar arteries course What do the arcuate artery separate - CORRECT ANSWER one five between pyramids medulla from cortex Functions of kidneys - CORRECT ANSWER maintaining acid base balance maintaining water balance electrolyte balance toxin removal blood pressure control making erythropoietin vitamin d metabolism Three steps in urine formation - CORRECT ANSWER glomerular fultration tubular resorption tubular secretion What is BUN produced by What is BUN excreted by - CORRECT ANSWER liver kidney Substances not normally found in urine (4) - CORRECT ANSWER sugar (glucose) red/white blood cells protein acid ketones Risk factors for renal disease (4) - CORRECT ANSWER over 40 smoking hx UTI hx exposure to toxic chemicals/dyes Normal renal artery doppler findings Where is the most common site of renal artery stenosis - CORRECT ANSWER low resistive flow, increased diastolic flow at origin (branch points and bifurcations) What is potter syndrome caused by - CORRECT ANSWER oligohydramnios Another name for fused pelvic kidney (2) What is it - CORRECT ANSWER pancake kidney discoid kidney kidneys fuse in pelvis Crossed fused renal ectopic sonographically (2) - CORRECT ANSWER two kidneys on one side of body empty fossa on contralateral side What is the most common fusion anomaly of the kidneys - CORRECT ANSWER horseshoe kidney Horseshoe kidney sonographically (3) - CORRECT ANSWER kidneys fused across midline isthmus crosses anterior great vessels hydronephrosis commonly What is dromedary hump - CORRECT ANSWER bulge of cortical tissue on lateral surface of kidney What is fetal lobulation - CORRECT ANSWER indented kidney surface between calyces, giving kidneys lobulated appearance What is junctional parenchymal defect What kidney is it more common in - CORRECT ANSWER triangular echogenic area location anteriorly and superiorly right What is column of bertin - CORRECT ANSWER prominent invaginations of cortex located at varying depths within into the medulla of kidneys What is the most common congenital urinary anomaly What is a common finding of it What is a common complication (2) - CORRECT ANSWER duplicated collecting system hydronephrosis of upper pole (can happen in lower pole) ureterocele reflux What is tuberous sclerosis What can it lead to What is it associated with - CORRECT ANSWER autosomal dominant genetic disorder renal cysts multiple bilateral angiomyolipomas Cortical cysts Pyelogenic cysts Parapelvic cysts Peripelvic cysts - CORRECT ANSWER originates in cortex bulging calyx that appears as cyst cyst bulging into central sinus lymphatic cysts in central sinus of kidney Bosniak Classifications - CORRECT ANSWER I-simple cyst II-cystic lesions IIF-benign complex cyst III-benign and malignant characteristics IV-high risk for malignancy Malignant cyst characteristics (3) - CORRECT ANSWER thick/irregular septations multiple septains calcifications in septations What causes milk of calcium cyst Sonographic appearance (3) - CORRECT ANSWER urinary stasis echogenic material gravity dependent material may have posterior shadowing (not always) What age does autosomal dominant polycystic kidney disease (ADPKD) present - CORRECT ANSWER 30-40 years (when HTN presents) ADPKD sonographically (3) - CORRECT ANSWER bilateral multiple cystic lesions in varying size replacing renal cortex enlarged kidneys Four types of autosomal recessive polycystic kidney disease (depending on pt age when onset) - CORRECT ANSWER perinatal neonatal infantile juvenile ARPKD sonographically (3) - CORRECT ANSWER bilateral enlarged kidneys echogenic kidneys decreased corticomedullary differentiation Most common cause of abdominal mass in newborns Most common cystic disease in infants Related to (2) - CORRECT ANSWER multi cystic dysplastic kidney multicystic dysplastic kidney maternal cocaine use anti-seizure medication Multicystic dysplastic kidney sonographically (2) - CORRECT ANSWER multiple cysts enlarged kidney (decreases over time) What does acquired cystic disease usually occur after What is there an increased risk of - CORRECT ANSWER 3-4 years of dialysis renal cell carcinoma Acquired cystic disease sonographically (2) - CORRECT ANSWER renal atrophy multiple cysts What is medullary cystic disease (medullary sponge kidney) Cause - CORRECT ANSWER autosomal recessive defect urinary stasis from dilated collecting tubules Medullary cystic disease (medullary sponge kidney) sonographically (2) - CORRECT ANSWER echogenic renal pyramids thinning cortex What is nephrocalcinosis Lab values with nephrocalcinosis - CORRECT ANSWER calcium deposits in renal parenchyma (most commonly medulla/pyramids) elevated serum calcium levels (occurs secondary to renal transplant rejection) Nephrocalcinosis sonographically (3) - CORRECT ANSWER bilateral cortical: echogenic cortex medullary: echogenic renal pyramids What is acute glomerulonephritis Symptoms (3) - CORRECT ANSWER infection of glomeruli facial puffiness hematuria anuria Acute glomerulonephritis sonographically (2) - CORRECT ANSWER renal enlargement increased parenchymal echogenicity What is acute pyelonephritis What is it caused by - CORRECT ANSWER inflammation of renal collecting system bacteria from ascending UTI Symptoms of pyelonephritis (3) - CORRECT ANSWER fever elevated WBC flank pain Acute pyelonephritis sonographically (5) - CORRECT ANSWER variable loss of cortiocomedullary differentiation diminished sinus echoes enlarged kidney Focal: hypoechoic wedge Chronic pyelonephritis sonographically (3) - CORRECT ANSWER small kidney irregular contour increased echogenicity What is emphysematous pyelonephritis commonly caused by What gender is it more common in What type of patients is it common in (2) - CORRECT ANSWER e coli women diabetic immunocompromised patients Emphysematous pyelonephritis sonographically (2) - CORRECT ANSWER enlarged, hypoechoic kidney echogenic foci with dirty shadow What is malakoplakia Sonographically (2) - CORRECT ANSWER chronic e coli infection unilateral enlarged kidney multiple poorly defined cortical masses What is xanthogranulomatous pyelonephritis What gender is it more common in What is it associated with How is it treated, why - CORRECT ANSWER replacement with lipid-laden foamy macrophages women diabetics nephrectomy, tends to invade adjacent organs Xanthogranulomatous pyelonephritis sonographically (3) - CORRECT ANSWER renal enlargement cystic replacement of renal parenchyma possible presence of stag horn calculus What is the most common fungal infection in kidneys What is it associated with What type of patients is it commonly seen in (2) - CORRECT ANSWER mycetoma (fungal ball) candidiasis diabetics immunocompromised patients Mycetoma (fungal ball) sonographically (3) - CORRECT ANSWER hyperechoic non-shadowing mass in collecting system can be mobile AIDS sonographically (2) - CORRECT ANSWER normal or hypertrophic renal size increased cortical echogenicity Cause of renal abscess What is a renal carbuncle - CORRECT ANSWER ascending spread of bacteria in the urinary tract renal abscess in the parenchyma What is a urinoma caused by (2) - CORRECT ANSWER leaking urine from UPJ/UVJ post-op complication What is a lymphocele What is it a complication of Sonographically (1) - CORRECT ANSWER encapsulated collection of lymph operations cystic structure between kidney and bladder Hydronephrosis sonographically (4) - CORRECT ANSWER grade: 1: small, fluid-filled separation of renal pelvis 2: dilation of some but not calyces, renal sinus orientation still concave 3: complete pelvocaliectasis, calyx presentation convex 4: prominent dilation of collecting system, thinning renal parenchyma What is pyonephrosis What is it caused by Sonographically (1) - CORRECT ANSWER pus in collecting system infection secondary to obstruction dilated collecting system with complex fluid/debris within What is the most common cause of intrinsic acute renal failure Causes (2) - CORRECT ANSWER acute tubular necrosis ischemia drug toxicity Acute tubular necrosis sonographically (3) - CORRECT ANSWER bilateral renal hypertrophy hyper echoic renal pyramids nephrocalcinosis Acute renal failure sonographically (3) - CORRECT ANSWER enlarged kidney possible hydronephosis (indicates post renal failure) hypoechoic parenchyma Chronic renal failure sonographically (3) - CORRECT ANSWER small kidney increased echogenicity thinning cortex What is created with hemodialysis - CORRECT ANSWER AV fistula (connecting artery and vein) (usually in arm) Peritoneal dialysis What is commonly seen in these patients - CORRECT ANSWER cleansing fluid injected through catheter and filters waste products from blood ascites What gender are kidney stones most common in Most common site for obstruction by stones - CORRECT ANSWER men ureterovesical junction Kidney stones sonographically (4) - CORRECT ANSWER echogenic foci shadowing twinkle doppler artifact anechoic dilation of renal pelvis or ureter proximal to stone (staghorn calculus fills renal collecting system) Renal vascular calcifications sonographically (2) - CORRECT ANSWER echogenic foci in cortex may or may not shadow What is an angiomyolipoma What gender and age group is it commonly seen in Which kidney is it more common in - CORRECT ANSWER benign fatty tumor females 40-60 years right Renal angiomyolipoma sonographically (3) - CORRECT ANSWER may simulate RCC avascular hyper echoic What is papillary necrosis Most common cause What gender and type of patients is it more common in - CORRECT ANSWER ischemia of cells at apex of renal pyramids analgesic abuse women diabetics Papillary necrosis symptoms (5) - CORRECT ANSWER fever flank pain hypertension hematuria dysuria Papillary necrosis sonographically (2) - CORRECT ANSWER one or more fluid spaces at pyramidal side of corticomedullary junction increased visualization of arcuate vessels Renal adenoma sonographically (4) - CORRECT ANSWER solid hyper echoic to hypoechoic hypo vascular similar to RCC What gender and age group are oncocytomas most common in Most common symptom - CORRECT ANSWER men 70-80 years asymptomatic Oncocytoma sonographically (3) - CORRECT ANSWER usually hypoechoic may see central scar very similar to RCC Most common renal mass identified in neonatal period Sonographically (3) - CORRECT ANSWER mesoblastic nephroma large, solid, homogenous mass replacing kidney polyhydramnios Other names for renal cell carcinoma (2) Most common solid renal mass in adults What gender is it more common in - CORRECT ANSWER hypernephroma Grawitz tumor renal cell carcinoma men Symptoms of renal cell carcinoma (3) - CORRECT ANSWER hematuria flank pain palpable mass Renal cell carcinoma sonographically (6) - CORRECT ANSWER solid isoechoic mass variable hemorrhage and necrosis with central scar intratumoral calciications hypoechoic rim IVC or renal vein invasion/thrombus Where is transitional cell carcinoma found - CORRECT ANSWER in urinary collecting system (most commonly in bladder) Transitional cell carcinoma sonographically (4) - CORRECT ANSWER hypoechoic mass low vascularity calcifications rare may invade adjacent renal parenchyma, usually preserves renal contour How does lymphoma get to the kidneys (2) Is it usually unilateral or bilateral - CORRECT ANSWER blood retroperitoneal lymphatic channels bilateral Most common primaries of metastasis to the kidneys (3) - CORRECT ANSWER lung breast RCC of contralateral kidney Most common renal tumor identified in pediatric patients Other name What age does it present - CORRECT ANSWER nephroblastoma wilms tumor 3-5 years Nephroblastoma symptoms (4) - CORRECT ANSWER abdominal/flank mass hematuria fever anorexia Nephroblastoma sonographically (3) - CORRECT ANSWER hypoechoic to echogenic renal vein/IVC thrombosis disrupts renal contour What is the most common cause of renal artery stenosis What is the second most common cause - CORRECT ANSWER atherosclerosis fibromuscular dysplasia Indirect evaluation of renal artery stenosis uses what arteries (2) What angle is used - CORRECT ANSWER interlobar arcuate 20 or less Renal artery doppler criteria 60% stenosis PSV renal/aortic ratio RI - CORRECT ANSWER 1.8 m/s 3.5 0.75 Most common reason for renal transplant How long does a cadaveric allograft last How long does a living donor allograft last Where is donor renal artery connected Where is donor renal vein connected Which kidney is usually harvested Why - CORRECT ANSWER end stage renal disease caused by diabetes 7-10 years 15-20 years recipient external iliac artery recipient external iliac vein left kidney longer renal vein RI equation - CORRECT ANSWER PSV - EDV / PSV Most common cause of renal vein thrombosis - CORRECT ANSWER primary renal disease Renal vein thrombosis sonographically (5) - CORRECT ANSWER increased kidney size hypoechoic cortex decreased corticomedullary differentiation dilated renal vein with no flow increased resistance in renal arteries List the layers of the bladder wall from innermost layer to outermost layer What arteries supply the bladder Wall thickness when distended and nearly empty Normal post-void volume - CORRECT ANSWER mucosa submucosa muscularis serosa superior, middle, inferior vesicle arteries 3mm 5mm 100ml What is neurogenic bladder - CORRECT ANSWER incontinence secondary to brain, spinal, or nervous pathology Bladder diverticula sonographically (2) - CORRECT ANSWER cystic lobulations extending from bladder wall no vascular flow Ureterocele sonographically (2) - CORRECT ANSWER well-circumscribed cystic out pouching at posterior bladder wall What is the most common cause of urinary obstruction in newborn males What is it - CORRECT ANSWER posterior urethral valve connective tissue forming valve-like structure in urethra Posterior urethral valve sonographically (2) - CORRECT ANSWER dilated bladder, ureters, and collecting system bilateral What is the most common bladder pathology What is it most commonly caused by - CORRECT ANSWER cystitis e coli Cystitis sonographically (2) - CORRECT ANSWER irregular thickened wall debris within bladder What is the most common bladder neoplasm What is the most common symptom What gender is it more common in - CORRECT ANSWER transitional cell carcinoma macroscopic hematuria males What is the second most common urothelial malignancy Where is it usually identified Sonographically - CORRECT ANSWER squamous cell carcinoma renal pelvis large mass in renal pelvis Most common primary malignancy to metastasize to bladder Extravesicular tumor invasion most commonly occurs with which cancer in females and which cancer in males - CORRECT ANSWER melanoma uterine prostate Normal length of teste Width AP What do the seminiferous tubules form What do those form Where does that carry the fluid to - CORRECT ANSWER 3-5 cm 2-4 cm 3 cm efferent ducts rete testis from testicle to epididymis List the two layers of the tunica vaginalis and what they cover What is normally between these layers - CORRECT ANSWER visceral layer-testes and epididymis parietal layer-scrotal wall small amount of fluid (assists in movement) What does the tunica albuginea have direct contact with What structure does it form What enters and exits the testicle at the mediastinum (2) - CORRECT ANSWER testicular tissue mediastinum blood vessels ductules Where does the epididymis lie in comparison to the testicle Usual length Usual width of head List the different parts - CORRECT ANSWER posterolateral 6-7cm 10-12mm head body tail What is the appendix testis What is it a remnant of - CORRECT ANSWER small protuberance from head of epididymis mullerian duct What does the spermatic cord hold (6) - CORRECT ANSWER vas deferens testicular arteries venous pampiniform plexus lymphatics nerves cremasteric muscle List layers of scrotal wall from inner layer to outermost layer - CORRECT ANSWER tunica vaginalis dartos skin What do the capsular arteries give rise to Where do these arteries course through What arteries are sampled to assess perfusion Where does the deferential artery originate from What does it feed (2) Where does the cremasteric artery originate What does it feed (1) - CORRECT ANSWER centripetal arteries testicular parenchyma centripetal arteries internal iliac artery epididymis vas deferens external iliac artery peritesticular tissues Where does the right testicular vein drain into Where does the left testicular vein drain into - CORRECT ANSWER IVC left renal vein Exocrine function of testicles Endocrine function of testicles - CORRECT ANSWER sperm production testosterone secretion What is polyorchidism - CORRECT ANSWER three or more testicles present Common complications of cryptorchidism (2) - CORRECT ANSWER infertility cancer Cryptorchidism sonographically (3) - CORRECT ANSWER smaller and less echogenic than normal usually oval with homogenous texture empty scrotal sac Is tubular ectasia of the rete testis usually unilateral or bilateral What is it commonly seen with Sonographically (1) - CORRECT ANSWER bilateral spermatocele multiple tiny cystic areas in mediastinum What is an epidermoid cysts Sonographically (4) - CORRECT ANSWER benign teratoma hypoechoic thick calcified wall "onion/target" appearance avascular What do epididymal cysts contain What are they caused by - CORRECT ANSWER serous fluid dilation of epididymal tubules What is the most common scrotal mass What are they caused by Where are they usually found What do they contain What type of patients are they commonly seen in - CORRECT ANSWER spermatocele dilation of epididymal tubules epididymal head spermatozoa post vasectomy patients Another name for extrascrotal calcifications Where do they arise Are they mobile - CORRECT ANSWER scrotal pearls between layers of tunica vaginalis yes Most common cause of acute scrotal pain in adults Most common cause in men under 35 Most common cause in men over 35 - CORRECT ANSWER acute epididymitis STD lower UTI Acute epididymitis sonographically (4) - CORRECT ANSWER enlarged, hypo echoic gland heterogeneous increased flow hydrocele What can acute orchitis result from What is the Prehn sign (2) - CORRECT ANSWER lower UTI differentiate orchitis from torsion lifting scrotum above pubic symphysis should relieve pain (no reduction in pain with torsion) Acute orchitis sonographically (2) - CORRECT ANSWER increased vascularity hypoechoic What is a common complication of epididymitis/orchitis - CORRECT ANSWER abscess What type of patients is fournier gangrene usually seen in What does it cause - CORRECT ANSWER diabetics air in scrotum Most common cause of painless scrotal swelling What is primary hydrocele - CORRECT ANSWER hydrocele congenital, communication between scrotal sac and peritoneum Most common malignancy in men 15-35 years Most intratesticular masses are Most extratesticular masses are - CORRECT ANSWER testicular cancer malignant benign Most common germ cell tumor of testes What race and age is it more common in What lab value is associated with it What patents is it more common in - CORRECT ANSWER seminoma white 40-50 years elevated hCG cryptorchidism Seminoma sonographically (3) - CORRECT ANSWER homogenous hypoechoic without calcification What is the most aggressive testicular malignancy What ages does it affect What labs is it associated with (2) - CORRECT ANSWER embryonal cell carcinoma 25-35 years elevated alpha-fetoprotein elevated hCG Embryonal cell carcinoma sonographically (3) - CORRECT ANSWER heterogeneous solid and cystic components distorted organ contour Second most common primary malignancy of testicles What is it What is it composed of - CORRECT ANSWER mixed germ cell tumors non-seminomatous germ cell tumor two or more types of germ cell tumor tissue Most common testicular tumor in patients 2 years Associated lab Sonographically (1) - CORRECT ANSWER yolk sac tumor elevated alpha fetoprotein cystic areas and echogenic foci due to hemorrhage and necrosis Second most common testicular tumor in infants and young children Are they usually benign or malignant - CORRECT ANSWER teratoma benign Testicular teratoma sonographically (2) - CORRECT ANSWER large heterogeneous complex mass calcifications and cystic components Rarest type of germ cell tumor Ages Lab value What can it cause - CORRECT ANSWER choriocarcinoma 20-30 increase hCG gynecomastia Leydig cell tumors are usually benign or malignant Ages Symptom Hormones (2) - CORRECT ANSWER benign 5-10 or 30-60 painless, palpable mass testosterone and sometimes estrogen Sertoli cell tumors usually benign or malignant Usual symptom Can be associated with Usually bilateral or unilateral - CORRECT ANSWER malignant or benign painless mass gynecomastia bilateral Testicular metastasis most commonly comes from (2) - CORRECT ANSWER prostate lung Most common bilateral testicular tumor Most common secondary malignancy of testes Ages - CORRECT ANSWER lymphoma lymphoma 60-70 years Testicular lymphoma sonographically (3) - CORRECT ANSWER homogenous hypoechoic increased vascularity Second most common metastatic neoplasm of testicles Sonographically (3) - CORRECT ANSWER leukemia hypoechoic, enlarged testicle hypervascularity similar to lymphoma How does sarcoidosis present Sonographically presents as (1) - CORRECT ANSWER recurrent epididymitis solid hypoechoic nodules Normal scrotal veins diameter Idiopathic varicocele Secondary varicocele Why is it more common on the left Nutcracker syndrome - CORRECT ANSWER 1.5mm incompetent valves due to hydronephrosis or abdominal mass left gonadal vein enters into left renal vein instead of IVC SMA compresses left renal vein What age is testicular torsion most common Salvage rate 6 hours 6-12 hours 12 hours Blue dot sign - CORRECT ANSWER before age 30 excellent declining poor with appendix epididymis torsion, blue dot under skin surface of scrotum With ruptured testicle, 90% can be saved if treated within _____ hours - CORRECT ANSWER 72 Ruptured testicle sonographically (3) - CORRECT ANSWER hematocele interrupted tunica albuginea irregular testicular contour and parenchyma What is sperm granuloma Sonographically (2) - CORRECT ANSWER extravasation of spermatozoa solid hypoechoic, heterogeneous mass may contain calcification (commonly seen hx vasectomy) Scrotal wall considered thickened with measurement - CORRECT ANSWER 8mm Muscles anterior to thyroid (2) - CORRECT ANSWER strap muscles sternocleidomastoid Muscle posterior to thyroid (1) - CORRECT ANSWER longus colli muscle Structures lateral to thyroid (3) - CORRECT ANSWER carotid artery jugular vein vagus nerve Structure posterior to thyroid (1) - CORRECT ANSWER esophagus Length of thyroid Width of thyroid AP of thyroid AP measurement indicative of enlargement - CORRECT ANSWER 4-6cm 2cm 1.3-1.8cm 2cm Arteries supplying thyroid (2) Where do they arise from (2) What do they supply (2) - CORRECT ANSWER 2 superior thyroid arteries external carotid arteries upper poles 2 inferior thyroid arteries thyrocervical trunk of subclavian artery lower poles (veins named same thing drain thyroid) Functions of thyroid (6) - CORRECT ANSWER growth metabolism development storage (of thyroid hormones) synthesis (of thyroid hormones) secretion (of thyroid hormones) How does thyroid produce thyroid hormones Thyroid hormones (3) What stimulates the thyroid to produce more hormones - CORRECT ANSWER traps iodine from the blood and (through chemical reactions) produces thyroid hormones Triiodothyronine (T3) Thyroxine (T4) Calcitonin thyroid stimulating hormone Symptoms of hyperthyroidism (9) - CORRECT ANSWER Increased metabolism Weight loss Increase appetite Nervous energy Tremor Excessive sweating Heat intolerance Palpitations Exophthalmos Symptoms of hypothyroidism (9) - CORRECT ANSWER Myxedema Hair loss Weight gain Increased subcutaneous tissue around eyes Lethargy Intellectual and motor slowing Cold intolerance Constipation Deep husky voice Most common location of ectopic thyroid tissue in neck Most common location of ectopic thyroid tissue outside neck - CORRECT ANSWER sublingual area mediastinum Most common congenital neck cyst - CORRECT ANSWER thyroglossal duct cyst What are branchial cleft cysts formed from - CORRECT ANSWER remnant of 2nd branchial cleft Malignant thyroid lesion characteristics (5) - CORRECT ANSWER irregular margins taller than wide micro calcifications thick peripheral halo internal hypervascularity Most common solid lesion of thyroid What gender is it more common in - CORRECT ANSWER adenoma women Thyroid adenoma sonographically (3) - CORRECT ANSWER Anechoic to hyperechoic Echogenic peripheral halo Increased color flow around and/or within lesion Another name for goiter What gender is it more common in Most common cause Labs (2) Most common symptom - CORRECT ANSWER multi nodular goiter women low iodine low thyroid hormones high thyroid stimulating hormones thyroid enlargement (usually palpable) Goiter sonographically (3) - CORRECT ANSWER heterogeneous multiple nodules areas of necrosis Most common symptom of diffuse thyroiditis Most common causes (2) - CORRECT ANSWER tender, palpable gland Graves' disease hashimoto's thyroiditis Cause of subacute thyroiditis (de quervain) Symptoms (3) - CORRECT ANSWER Viral infection of thyroid Pai