Chapter 1: Before, During, and After the Ultrasound Examination Curry/Prince: Sonography, 5th Edition TRUE/FALSE 1. The sonographer should always review available patient information. ANS: T
A sonographer is responsible for acquiring patient information pertinent to the ultrasound study before the examination procedure. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 2. The sonographer should write technical observations of the ultrasound examination in the
patient’s chart. ANS: F
The sonographer’s technical observations serve as a reference for the interpreting physician. Written documentation of any type almost always becomes part of the patient’s medical record. Final interpretation of the ultrasound images and technical observations is always the responsibility of the interpreting physician. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 3. The sonographer should always review the ultrasound request form. ANS: T
The process of reviewing available patient information begins with the sonographer reviewing the ultrasound request form. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 4. The sonographer should always provide the interpretive report. ANS: F
An interpretive report is a formal, legal report of the ultrasound findings by a sonologist, radiologist, or other interpreting physician. A sonographer should never provide diagnoses, because this would be unjustified and potentially legally compromising. OBJ: Contrast technical observation and interpretive report. TOP: How to Describe Ultrasound Findings 5. Procedural consent forms are found in the patient’s chart. ANS: T
Consent forms for routine examinations, treatment, surgical procedures, medical procedures, and anesthesia are found in the patient’s chart. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 6. Laboratory values are part of the patient’s clinical history. ANS: T
Laboratory values are part of the patient’s clinical history and usually are found in the patient’s chart. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Clinical History 7. A living will can be found in the patient’s chart. ANS: T
If the patient has a living will, it is kept in the patient’s chart. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 8. Test results are found in the patient’s chart. ANS: T
Reports from correlating modality studies are found in the patient’s chart. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 9. The ultrasound request form contains the patient’s identification number. ANS: T
The ultrasound request form should include the patient’s identification data, the clinical symptoms, the type of examination requested, and the reason for the examination. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 10. The ultrasound request form contains the patient’s Social Security number. ANS: F
The patient’s Social Security number is not included on the ultrasound request form. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 11. The ultrasound request form indicates whether the examination is a regularly scheduled
exam or a “stat” exam. ANS: T
Generally, the ordering physician checks a box on the ultrasound request for stat or portable sonograms. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 12. The ultrasound request form contains the patient history. ANS: T
The ultrasound request form should include the patient’s identification data, the clinical symptoms, the type of examination requested, and the reason for the examination. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 13. The ultrasound request form contains the type of examination. ANS: T
An ultrasound request form should include the patient’s identification data, the clinical symptoms, the type of examination requested, and the reason for the examination. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Before the Ultrasound Examination 14. Sources of infection for HBV and HIV include saliva. ANS: T
HBV and HIV can be transmitted in body fluids, such as blood, saliva, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, synovial fluid, and pericardial fluid. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 15. Sources of infection for HBV and HIV include amniotic fluid. ANS: T
HBV and HIV can be transmitted in body fluids such as blood, saliva, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, synovial fluid, and pericardial fluid. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 16. Sources of infection for HBV and HIV include blood. ANS: T
HBV and HIV can be transmitted in body fluids, such as blood, saliva, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, synovial fluid, and pericardial fluid. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 17. Sources of infection for HBV/HIV include pericardial fluid.
ANS: T
HBV and HIV can be transmitted in body fluids, such as blood, saliva, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, synovial fluid, and pericardial fluid. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 18. Using self-sheathing needles is a strategy for reducing exposure to blood-borne pathogens. ANS: T
Strategies for reducing exposure to blood-borne pathogens include using sterilization techniques, self-sheathing needles, and proper disposal methods; wearing protective gear (e.g., gloves, face shields, and gowns); and frequent hand washing. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Understanding Standard Precautions 19. Performing frequent hand washing is a strategy for reducing exposure to blood-borne
pathogens. ANS: T
Strategies for reducing exposure to blood-borne pathogens include using sterilization techniques, self-sheathing needles, and proper disposal methods; wearing protective gear (e.g., gloves, face shields, and gowns); and frequent hand washing. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Understanding Standard Precautions 20. Wearing gloves when handling body fluids is a strategy for reducing exposure to
blood-borne pathogens. ANS: T
Strategies for reducing exposure to blood-borne pathogens include using sterilization techniques, self-sheathing needles, and proper disposal methods; wearing protective gear (e.g., gloves, face shields, and gowns); and frequent hand washing. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 21. Sagittal and coronal scanning plane images show only longitudinal sections of structures. ANS: F
A structure’s appearance in any image, sagittal or otherwise, depends on how it lies (or is situated or oriented) in the body. For example, a sagittal scanning plane image at the mid epigastrium shows longitudinal sections of some structures (aorta, superior mesenteric artery, for example) and axial sections of other structures (pancreas body, splenic vein, for example). OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Ultrasound Scanning Planes
22. Transverse scanning plane images show only axial or short axis sections of structures. ANS: F
A structure’s appearance in any image, transverse or otherwise, depends on how it lies (or is situated or oriented) in the body. For example, a transverse scanning plane image at the mid epigastrium shows longitudinal sections of some structures (pancreas, splenic vein, left renal vein, for example) and axial sections of other structures (aorta, inferior vena cava, superior mesenteric artery, for example). OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Ultrasound Scanning Planes 23. Long axis measurements are taken in either the sagittal or coronal scanning plane. ANS: F
Long axis measurements of a structure are taken in the scanning plane that depicts the length of the structure; this is determined by how the structure lies (or is situated or oriented) in the body. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Ultrasound Scanning Planes 24. Sterilization is required for all endocavitary probes. ANS: F High level disinfection procedures are required for all endocavitary probes and probes contaminated with blood or infectious body fluids. Dirty probes should be initially cleaned with an enzymatic cleanser and then carried in covered containers to a high-level disinfectant processor for timed disinfection. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Understanding Standard Precautions 25. The sonographer should have the patient verbally say their name and date of birth prior to beginning the exam. ANS: T It is important to take time out to verify patient identifiers such as a verbal recitation to verify the patient name and/or date of birth. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Before the Ultrasound Examination 26. With regard to echo texture characteristics, a disease can be described as diffuse and localized. ANS: T With regard to the echo texture of affected tissue, a disease can be characterized as diffuse (infiltrative) or localized (a mass or multiple masses circumscribed to a specific area). OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings
27. HBV and HIV can be transmitted through accidental injuries caused by contaminated sharp objects. ANS: T Diseases can be transmitted in many ways. Accidental injuries from contaminated sharp objects (e.g., needles, scalpels, broken glass, and exposed dental wires) are the most common means of transmission. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 28. A person can become infected with HBV or HIV by touching contaminated surfaces and transferring contaminants to the eyes, nose or mouth. ANS: T Touching contaminated surfaces and transferring the infectious material to the mouth, nose, or eyes is a more indirect means of transmission. OBJ: Describe the importance of reviewing the patient's chart/EMR (electronic medical record) prior to the examination. TOP: Understanding Standard Precautions 29. There is a specific patient position that is best for visualization of each organ. ANS: F The best patient position is determined by what will produce optimal views of areas of interest. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: During the Ultrasound Examination MULTIPLE CHOICE 1. Structures are accurately identified on ultrasound images by a. scanning plane interpretation. b. two-dimensional cross-sections. c. their location. d. their sonographic appearance. ANS: C
Body structures are accurately identified on ultrasound images by their location, not by their sonographic appearance, which may be altered by a pathologic condition or other factors. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 2. Documented areas of interest a. are represented in a single scanning plane. b. cover approximately every 2 cm of a structure. c. must be represented in at least two scanning planes. d. must include survey images. ANS: C
Documented areas of interest or required images must be represented in at least two scanning planes perpendicular to each other for a more dimensional and therefore accurate representation. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 3. Organ parenchyma is described in terms of a. echo texture. b. location. c. focal zone. d. refraction. ANS: A
As sonographers become practiced at recognizing the echo patterns of normal anatomy, they can more easily identify changes in the normal appearance that may suggest the presence of an abnormality. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 4. Sonographically, the lumen of the gastrointestinal tract a. resembles a “bull’s eye.” b. has an appearance that depends on the lumen’s contents. c. is hypoechoic relative to its walls. d. is highly reflective. ANS: B
The sonographic appearance of the gastrointestinal tract is dependent on its contents. A fluid-filled lumen appears anechoic or echo free. A gas- or air-filled lumen will appear bright, highly echogenic, and generally hyperechoic relative to adjacent structures. The lumen can also have a complex or mixed appearance, displaying anechoic portions from fluid, along with echogenic portions that vary in brightness depending on their composition (partially digested food, indigestible material, gas, air). All or individual sections of the GI tract may cast a posterior shadow where air or gas is present in the lumen because air/gas attenuates the sound beam. Empty, collapsed bowel has a distinctive “bull's eye” appearance due to the contrast between the very bright collapsed lumen and dark/black walls. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 5. When an organ is described as hypoechoic to another organ, this means that a. one organ is diseased relative to the other. b. one organ is less echogenic relative to the other. c. one organ is visualized inferior to the other. d. one organ is visualized posterior to the other. ANS: B
A structure that is hypoechoic has decreased echogenicity relative to adjacent structure(s). OBJ: Contrast technical observation against the interpretive report.
TOP: How to Describe Ultrasound Findings 6. Structures that cast an acoustic shadow a. attenuates the sound beam. b. are nonattenuating. c. are always directly in front of another structure. d. show acoustic enhancement. ANS: A
Structures that cast a shadow (e.g., calculi) reflect and impede (attenuate) sound waves. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 7. The term through transmission is synonymous with a. sound attenuation. b. posterior enhancement. c. acoustic shadowing. d. infiltrative process. ANS: B
The terms through transmission, posterior through transmission, posterior enhancement, and acoustic enhancement describe the bright, highly echogenic appearance of the unimpeded sound beam posterior to fluid-filled structures. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 8. Pathologic findings that are in a specific area or localized are referred to as a. focal. b. diffuse. c. enhanced. d. regional. ANS: A
Localized (focal) disease represents a circumscribed mass or multiple masses. Diffuse disease parenchymal texture appears heterogeneous with varying degrees of echogenicity. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 9. A characteristic of an intraorgan mass is a. discontinuity of the organ capsule. b. obstruction of other organs and structures. c. disruption of the normal internal architecture. d. internal invagination of organ capsules. ANS: C
Features of an intraorgan mass include disruption of the normal internal architecture, external bulging of organ capsules, and displacement or shifting of adjacent structures. OBJ: Contrast technical observation against the interpretive report.
TOP: How to Describe Ultrasound Findings 10. Which of the following terms would NOT be used to describe a true cyst? a. Anechoic b. Irregular margins c. Posterior enhancement d. Refractive shadows ANS: B
The criteria for describing a true cyst are anechoic; posterior acoustic enhancement; smooth, thin wall margins; and in some cases refractive shadowing. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 11. Which term refers to decreased echogenicity as compared with other body structures? a. Anechoic b. Isoechoic c. Hyperechoic d. Hypoechoic ANS: D
Hypoechoic is a comparative term used to describe an area on a sonogram where the echoes are decreased or not as bright compared to surrounding structures. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 12. Which of the following occurs during an initial scanning survey? a. Measurements of abnormal anatomy are obtained. b. No images are taken during an initial scanning survey. c. Images required by the institution’s protocol are obtained. d. Sagittal and transverse scanning plane images of pertinent anatomy are obtained. ANS: B
During the survey portion of an ultrasound examination no images are taken; areas of interest are evaluated in at least two scanning planes, abnormalities are ruled out, and technique and scanning approach(es) are determined. OBJ: Contrast technical observation against the interpretive report. TOP: During the Ultrasound Examination 13. Which anatomic area is NOT demonstrated in a sagittal scanning plane image? a. Lateral b. Inferior c. Anterior d. Posterior ANS: A
A sagittal scanning plane image demonstrates anterior, posterior, superior, and inferior anatomic areas.
OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 14. Which anatomic area is NOT demonstrated in a transverse scanning plane image? a. Medial b. Anterior c. Posterior d. Superior ANS: D
A transverse scanning plane image demonstrates anterior, posterior, medial, and lateral anatomic areas. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 15. Which anatomic area is NOT demonstrated in a coronal scanning plane image? a. Medial b. Lateral c. Anterior d. Inferior ANS: C
A coronal scanning plane image demonstrates medial, lateral, superior, and inferior scanning planes. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 16. Sonographers must a. have excellent handwriting. b. be licensed by the state. c. present images to the interpreting physician. d. diagnose disease. ANS: C Sonographers primary work involves using ultrasound imaging equipment to produce cross-section images of anatomy and diagnostic data. Specific responsibilities include the following: excellent communication skills; strong computer skills; ability to obtain and record patient data pertinent to the ultrasound study; proper use of ultrasound systems; provide quality patient care; acquire, analyze, modify, and select images to store and present to the interpreting physician for diagnosis; use ultrasound terminology to document the technical summary of the ultrasound findings, which are presented or sent to the interpreting physician. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Image Documentation Criteria 17. Which of the following is an example of professional and clinical standards? a. Wearing an identification badge b. Discussing the sonographic findings with the patient c. Using slang words, so patients feel more comfortable d. Not inquiring about the patient’s illness, so they do not get upset ANS: A
Whether in a classroom or clinical setting, certain professional and clinical standards should be followed: conversations with patients should be proper and professional; never discuss the sonographic findings or offer your opinion of the study results with a patient; inquire about the patient's symptoms and history of illness or surgeries. OBJ: Explain the roles of the sonographer and sonologist/radiologist. TOP: Clinical Criteria 18. Coronal planes divide the body into unequal a. medial and lateral sections. b. anterior and posterior sections. c. superior and inferior sections. ANS: B The coronal plane is any plane parallel to the long axis of the body and perpendicular to sagittal scanning planes. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 19. Transverse planes divide the body into unequal a. right and left sections. b. anterior and posterior sections. c. superior and inferior sections. ANS: C A transverse scanning plane image demonstrates the anatomy visualized in an anterior-to-posterior (or posterior-to-anterior) dimension and right-to-left dimension or a lateral-to-medial dimension and anterior-to-posterior dimension. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 20. Sagittal planes divide the body into unequal a. right and left sections. b. anterior and posterior sections. c. superior and inferior sections. ANS: A A sagittal scanning plane image demonstrates the anatomy visualized in an anterior-to-posterior (or posterior-to-anterior) dimension and superior-to-inferior dimension. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 21. Which planes are parallel to the long axis of the body? a. Transverse and coronal b. Sagittal and transverse c. Sagittal and coronal ANS: C The sagittal and coronal planes are parallel to the long axis of the body. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes
22. Longitudinal views show a structure’s depth and a. height. b. volume. c. width. d. length. ANS: D Longitudinal (long axis) views demonstrate the depth and length of a structure. Measurement calipers are used to obtain length, width, and anteroposterior measurements to provide the dimensions or total volume of a structure of interest. OBJ: Contrast technical observation against the interpretive report. TOP: Ultrasound Scanning Planes 23. The normal echotexture appearance of soft tissues is characterized as a. homogeneous. b. heterogenous. c. isoechoic. d. complex. ANS: A Normal organ parenchyma (soft tissue) is demonstrated on a sonogram as homogeneous, or uniform in texture. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 24. With regard to composition, a mass is classified as a. high gain or low gain. b. cystic, complex or solid. c. big, medium, or small. d. single or many. ANS: B A mass may be described as solid, cystic, or complex, depending on its composition. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 25. A “circumscribed disease process” describes a. diffuse disease. b. intraorgan features. c. extraorgan features. d. a mass. ANS: D A mass is a circumscribed disease process. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 26. An accumulation of serous fluid in the abdominopelvic cavity is called a. ascites. b. pleural effusion.
c. infiltrative disease. d. complex. ANS: A Ascites is an accumulation of serous fluid anywhere in the abdominopelvic cavity. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 27. “Homogenous liver texture” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: B Technical observations should be confined to descriptions of the ultrasound findings based on echo pattern and size. OBJ: Contrast technical observation against the interpretive report. TOP: How to Describe Ultrasound Findings 28. “Fever and chills x 3 days” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: A “Fever and chills 3 days” describes clinical symptoms (clinical history). OBJ: Contrast technical observation against the interpretive report. TOP: The Sonographer's Technical Observation and Comments 29. “Right lower quadrant pain” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: A Right lower quadrant pain is a clinical symptom and part of the patient’s clinical history. OBJ: Contrast technical observation against the interpretive report. TOP: The Sonographer's Technical Observation and Comments 30. “Splenomegaly” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: B Technical observations should be confined to descriptions of the ultrasound findings based on echo pattern and size. OBJ: Contrast technical observation against the interpretive report. TOP: The Sonographer's Technical Observation and Comments
31. “Inflammed appendix” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: C An interpretive report (final report) includes a detailed description of the ultrasound findings and a diagnosis (or diagnoses) derived from them. OBJ: Contrast technical observation against the interpretive report. TOP: The Sonographer's Technical Observation and Comments 32. “Chronic pancreatitis” is an example of a. clinical history. b. technical observation. c. interpretive report. ANS: C An interpretive report (final report) includes a detailed description of the ultrasound findings and a diagnosis (or diagnoses) derived from them. OBJ: Contrast technical observation against the interpretive report. TOP: The Sonographer's Technical Observation and Comments
Chapter 2: Ultrasound Instrumentation: “Knobology,” Imaging Processing, and Storage Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The alphanumeric keyboard is used to a. enter new patient information. b. perform the initial configuration at installation of the ultrasound unit. c. indicate which patient will be examined next. d. house the sonologist workstation. ANS: A
The alphanumeric keyboard controls allow the sonographer to enter the patient’s name, ID number, and full screen annotation. The keyboard also may include specific function keys. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 2. Annotation On/Off a. erases the last character to the left of the cursor. b. erases all user-entered annotations, starting at the cursor’s location. c. clears the patient’s ID number and stored images. d. allows comments to be entered on the screen. ANS: D
When turned on, Annotation On/Off (also called Comments On/Off) allows annotation, or comments, to be entered on the screen. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 3. The HELP menu provides quick access to the a. on/off switch. b. primary imaging controls. c. reference manual. d. clinical application specialist. ANS: C
Some systems employ a HELP menu to access and provide a quick reference manual to the system usage. This is often accessed through a HELP key located directly on the keyboard or is a function key located on the top row of the keyboard. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 4. The frequency control ensures that a. imaging depth is appropriate. b. tissue resolution is adequate. c. the right focal zone is used. d. the image freezes.
ANS: B
The frequency control allows the sonographer to select the imaging frequency best suited to the patient’s anatomy and the type of examination. Better tissue resolution of superficial structures is attained with higher frequencies. A lower imaging frequency is used for deeper structures, but image definition is lost for more superficial structures. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 5. The TGC control can strengthen echoes that are a. returning from deep tissues. b. emitted from the transducer to deep tissues. c. returning from superficial tissues. d. emitted from the transducer to superficial tissues. ANS: A
The TGC control equalizes the differences in received echo amplitudes due to reflector depth. Returning echoes from deep in the body are amplified so that information on deeper structures can be received. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 6. When the focal zone indicator is set too deep for the organ being examined a. the echogenicity is too bright. b. the resolution is suboptimal. c. the light output is inadequate. d. the organ needs to be repositioned. ANS: B
The focal zone should be set at the level of the area of interest. It provides the correct scan depth, ensuring optimal visualization of the target organ. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 7. The posterior border of the gallbladder cannot be seen on sagittal view; it appears to be cut
off. Which control is most likely to correct this? a. Depth b. Frequency c. TGC d. Cine loop ANS: A
The depth control places the area of interest in the center of the screen. The organ should appear large enough to fill a good portion of the image, yet the surrounding anatomy should be easily visualized. If the posterior portion of the organ is off the screen, the depth has been improperly set. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology
8. The sonologist has requested a side-by-side comparison view. Which control should be
used? a. Focal zone position b. Focal zone number c. Left/right key d. Imaging preset ANS: C
The dual image (i.e., left/right) key is used to produce a side-by-side view. In this view, measurements from two different images can be compared. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 9. The trace function a. places cursors for distance measurement. b. erases cursors, outlines, and measurement results. c. places cursors for distance and transverse measurements. d. outlines circumference measurements. ANS: D
The trace function is a measurement key that outlines a circumference for measurements. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 10. The body pattern control a. displays the body pattern to indicate patient positioning. b. adjusts automatically when the patient is turned to another position. c. allows pulsed wave and M-mode images to overlie the body pattern. d. adjusts the detail for images. ANS: A
The body pattern control displays the body pattern to indicate patient positioning. The pattern appears on the monitor screen. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 11. Doppler can be added to the image by which control? a. M mode b. Brightness and contrast c. Power Doppler d. Trackball ANS: C
The Doppler function can be activated by the color Doppler or power Doppler controls. OBJ: Demonstrate the steps to operate the ultrasound system.
TOP: Knobology
12. Which is the proper order for operating the ultrasound system?
a. Adjust the TGC, focal zones, and image size; enter the patient’s name and ID
number; and select the transducer. b. Adjust the focal zones, image size, and TGC; select the transducer; and enter the
patient’s name and ID number. c. Enter the patient’s name and ID number; adjust the focal zones, image size, and
TGC; and select the transducer. d. Enter the patient’s name and ID number; select the transducer; and adjust the TGC,
focal zones, and image size. ANS: D
The recommended order for operating the ultrasound system is enter the patient’s name and ID number; select the appropriate transducer; place the transducer on the patient with a generous amount of coupling gel; and then adjust the TGC, focal zones, and image size. OBJ: Demonstrate the steps to operate the ultrasound system.
TOP: Knobology
13. The Worklist electronic program allows sonographers to a. connect the Hospital Information System, Radiology Information System, and
Picture Archiving and Communication System in one database. b. order the patient examinations for the day. c. query for patient demographic information from the ultrasound system. d. engage the preset function of the system. ANS: C
Many hospitals and imaging centers now use the Worklist program, which transfers patient information electronically to the ultrasound system. Sonographers “query” Worklist from the ultrasound system through a dedicated computer network. Detailed, pertinent patient information (e.g., the patient’s full name and date of birth, the referring physician’s name, the patient’s medical record number, and the type of study to be done) then is populated into a patient information page on the ultrasound system. OBJ: Discuss the functions of the Worklist program. TOP: Image Processing and Storage 14. There is a mass in the anterior portion of the left lobe of the liver, but the borders are not well resolved. Which control should the sonographer adjust? a. Depth b. Overall gain c. TGC d. Frequency ANS: D Better tissue resolution is obtained with higher frequencies. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 15. Which of the following controls allows you to position the measurement cursors? a. Trackball b. Cine Loop c. Freeze key d. Preset
ANS: A The trackball guides the cursor on the screen. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology TRUE/FALSE 1. The advantages of the Radiology Information System include appointment scheduling and
the use of work lists. ANS: T
The Radiology Information System (RIS) can be integrated with other hospital information systems, allowing patient scheduling, the use of work lists, and digital dictation. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage 2. The advantages of the Picture Archiving and Communication System include a capability
for remote radiologic consultation. ANS: T
The Picture Archiving and Communication System at external hospitals allows for remote radiologic consultation through electronic imaging. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage 3. An advantage of the Hospital Information System is electronic storage of patients’
demographics and chart information. ANS: T
The Hospital Information System electronically stores patients’ demographics and chart information. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage 4. Teleradiology involves radiologic consultations done within the imaging center where an
examination was performed. ANS: F
Teleradiology involves remote radiologic consultations done through the use of PACS at the sending and receiving institutions. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage 5. Sonographers must learn to use a wide range of technologic tools to ensure optimum
imaging and to facilitate sonologist reporting.
ANS: T
Sonographers have a wide range of technologic support at their disposal, such as ever-advancing ultrasound systems and electronically connected patient data and physician workstations. Therefore, it is important that sonographers develop superb technologic skills to ensure proper handling of the ultrasound system and additional electronic data systems at their disposal. Well-educated sonographers advance patient care and the ultrasound profession through the proper use of technology and their assistance to sonologists. OBJ: Compare and contrast the functions of the keyboard controls: primary imaging controls, calculation controls, and additional controls. TOP: Knobology 6. PACS is a computer technology system that automatically selects the correct frequency, depth, and focal zone controls. ANS: F Most hospitals and imaging centers currently run filmless by using a computer technology system called PACS, an acronym for Picture Archiving and Communication System. This computer technology allows for improved image resolution as images are stored in a digital format and are software controlled. Ultrasound images are acquired digitally and are viewed and stored on a computer and/or network server. This system can be dedicated to the ultrasound department or used on a larger scale throughout the entire radiology division and hospital. PACS can communicate with outside hospitals and imaging centers located anywhere in the world that are also equipped with PACS capabilities. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage 7. PACS is a computer technology system that unites the HIS and RIS and stores digital images. ANS: T Most hospitals and imaging centers currently run filmless by using a computer technology system called PACS, an acronym for Picture Archiving and Communication System. This computer technology allows for improved image resolution as images are stored in a digital format and are software controlled. Ultrasound images are acquired digitally and are viewed and stored on a computer and/or network server. This system can be dedicated to the ultrasound department or used on a larger scale throughout the entire radiology division and hospital. PACS can communicate with outside hospitals and imaging centers located anywhere in the world that are also equipped with PACS capabilities. OBJ: Describe the differences between PACS, HIS, and RIS. TOP: Image Processing and Storage
Chapter 3: General Patient Care Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. What action conveys a sense of genuine interest in the patient? a. Making small talk b. Adjusting the tone and expression of your voice c. Obtaining a medical history d. Discussing your opinion of the ultrasound findings ANS: B
Conversation should be respectful, warm, and professional. Sonographers should adjust the tone and expression of their voice to convey a sense of genuine interest in the patient. OBJ: Describe effective interpersonal skills.
TOP: Interpersonal Skills
2. A signed informed consent form is required from patients for a. all ultrasound studies. b. endocavital studies. c. invasive procedures. d. ultrasound-guided biopsies and aspirations. ANS: C
For invasive procedures, such as ultrasound-guided biopsies or endocavital studies, patients must be informed of the details of the procedure and then must sign an informed consent form before the procedure can take place. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 3. During an ultrasound examination, it is acceptable for a sonographer to a. show the patient any abnormal findings. b. discuss his or her opinion of the ultrasound findings. c. provide a diagnosis. d. briefly point out one or more structures. ANS: D
Sonographers may briefly point out a structure or structures. However, they may not point out abnormal echo patterns or findings or give a patient their opinion of the findings. OBJ: Describe effective interpersonal skills.
TOP: Interpersonal Skills
4. The best types of questions to present to a patient to obtain a thorough patient history are a. those that require a “yes” or “no” answer. b. multiple choice questions that give them options to choose as an answer. c. true or false questions. d. open-ended questions that can provide accurate and specific details. ANS: D
When obtaining a patient history, sonographers should avoid using medical terms that a patient may not understand and asking questions that require a yes or no answer. Questions should be open-ended to obtain more accurate and specific details. OBJ: Describe effective interpersonal skills.
TOP: Interpersonal Skills
5. A practice to protect patients from infection due to germs is referred to as a(an) a. aseptic technique. b. valsalva maneuver. c. Fowler’s technique. d. invasive procedure. ANS: A
Aseptic technique is the procedure and practices used in any clinical setting to protect patients from infection due to germs. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 6. In order to ensure you have the correct patient, the sonographer should a. call the patient’s name and when someone responds, that is the correct patient. b. use two patient identifiers, having the patient repeat their name and date of birth while checking the identification bracelet. c. ask the clerk in the lobby to identify the patient. d. check all the identification bracelets of the patients in the lobby until the sonographer finds the name they are looking for. ANS: B
Prior to an exam, sonographers must make sure they have the correct patient. Patients have been known to answer to the wrong name. The sonographer should check the patient’s identification bracelet or number against the patient chart and request form; they should ask outpatients to repeat back their names. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 7. If a patient wanders too far off the subject during the medical history, the sonographer
should a. explain that the questions they are being asked are important and direct them to stay on topic. b. let the patient talk about any topic of interest before interrupting. c. gently lead the person back to the reason for the question. d. explain to the patient that there is a limited time to complete the exam. ANS: C
The sonographer must learn to be a good listener and pay close attention to the patient’s answers. If the patient wanders too far off the subject, the sonographer should gently lead the person back to the reason for the question without appearing disinterested in those other concerns. OBJ: Describe effective interpersonal skills.
TOP: Interpersonal Skills
8. In order to properly assist shorter patients on and off the exam table, the sonographer should a. lift the patient on and off the table. b. explain that if the patient cannot get on the table unassisted the sonographer cannot perform the exam. c. provide a chair for them to step on to get on the exam table. d. provide a step stool with handles. ANS: D
Sonographers should always have a handled step stool available for shorter patients or those who require a little more assistance. OBJ: Describe a “patient-ready” ultrasound examination room. TOP: Ultrasound Examination Room 9. When assisting a wheelchair patient, the sonographer should a. verbally direct the patient when they are ready for them to get in or out of the
chair. b. make certain that both brakes are locked and the leg- and footrests have been
pushed out of the way. c. lock at least one brake on the wheelchair. d. push the footrests out of the way. ANS: B
When helping a patient into or out of a wheelchair, the sonographer must make sure both brakes are locked and the leg- and footrests have been pushed out of the way. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 10. What is the appropriate procedure for leaving a confused or uncooperative patient in the examination room unattended? a. If the patient will only be alone for 5 minutes, it is acceptable to provide blankets and pillows as necessary. b. Make sure to leave the stretcher side rails up. c. The brakes must be locked on the stretcher. d. Patients who are confused or uncooperative should never be left unattended. ANS: D
Patients who are confused, upset, or uncooperative should never be left unattended in the examination room. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 11. If patients ask about the ultrasound findings, the sonographer should a. point out and explain the abnormal echo patterns on the screen. b. give the patient their opinion of the ultrasound findings. c. explain that they do not make diagnoses but will provide the images to the
interpreting. d. physician who will provide a report to the patient’s physician not respond. ANS: C
Patients should be told that sonographers do not provide a diagnosis; rather, they provide the sonographic images to an interpreting physician, who sends an interpretive report to the patient’s referring physician. Sonographers work under the delegated authority of the interpreting physician and are not trained or legally qualified to provide a diagnosis. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 12. To maintain a sterile field, all a. areas below the level of the sterile drapes are considered sterile. b. items that enter the sterile field must be sterile. c. packages containing sterile items are opened simultaneously. d. sterile drapes are placed prior to cleaning the site. ANS: B
A sterile field is created by placing prepackaged sterile drapes around the cleaned site. All packages containing sterile items should be opened in such a way that the contents do not touch nonsterile surfaces or items. Areas below the level of the sterile drapes are outside the field and are not sterile. To maintain a sterile field, all items that enter the sterile field must be sterile. OBJ: Describe specific practices comprising aseptic technique. TOP: Aseptic Technique 13. If a patient is incapacitated and unable to communicate, the sonographer should obtain
permission to perform an invasive procedure from a. a patient representative. b. the nurse. c. the reading physician. d. no one, consent is not needed. ANS: A If a patient is incapacitated and cannot speak or sign, a patient representative, such as a family member or the referring physician can grant permission for an invasive procedure to be performed. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 14. The interests of the patient and sonographer can best be protected during endocavitary
procedures by having a. the patient’s family member present during the procedure. b. another healthcare professional witness the procedure. c. a witness designated by the patient. d. verbal consent by the patient. ANS: B
In an effort to protect the interests of the sonographer and patient, it is recommended that endocavital procedures be witnessed by another health care professional. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination
TRUE/FALSE 1. A sonographer’s dress is irrelevant to the quality of care a patient receives. ANS: F
When patients feel comfortable, they become more focused and receptive. A sonographer’s dress should be professional and include a visible, easy-to-read source of personal identification. OBJ: Describe effective interpersonal skills.
TOP: Interpersonal Skills
2. If a patient requests a drink of water following an abdominal ultrasound examination, it is
recommended that the sonographer immediately provide it. ANS: F
If a patient requests something to eat or drink, the sonographer should first check the patient’s chart or ultrasound request to ensure that the patient is not scheduled for another examination that requires him or her to be fluid or food-restricted. It is essential to check all available patient information and/or contact the referring physician, floor nurses, or the outpatient’s physician’s office to be sure prior to allowing the patient to eat or drink. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 3. All patients are susceptible to infection, but those with burns or immune disorders are at
greater risk. ANS: T
All patients are susceptible to infection, particularly those with excessive burns or immune disorders that disturb the body’s natural defenses. OBJ: Describe specific practices comprising aseptic technique. TOP: Aseptic Technique 4. It is a sonographer’s responsibility to be aware of the institution’s policies on universal
precautions, isolation, and “Code” procedures. ANS: T
To provide patients with the best possible care, a sonographer should be aware of the institution’s universal precautions and isolation policies and “Code” procedures for incidences of heart failure. OBJ: Describe the sonographer’s responsibilities regarding patient care. TOP: Patient Care During the Examination 5. Since it is the physician who performs interventional procedures, it is not necessary for the
sonographer to be able to perform asepsis techniques. ANS: F
Ultrasound is routinely used for invasive percutaneous needle-guided biopsies, aspiration and drainage procedures, as well as interventional and intraoperative procedures. To adequately assist the physician in an ultrasound-guided percutaneous procedure and to protect the patient from obtaining an infection during the procedure, a sonographer must be adept at implementing asepsis technique. OBJ: Describe specific practices comprising aseptic technique. TOP: Aseptic Technique
Chapter 4: Introduction to Ergonomics and Sonographer Safety Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The science or study of work is referred to as a. interaction. b. an occupation. c. presbyopia. d. ergonomics. ANS: D
The science or study of work is ergonomics. The application of ergonomics is important for improving work performance and the well-being of workers. OBJ: Define ergonomics and discuss the history of ergonomics as it relates to sonography and the Occupational Safety and Health Act’s (OSHA) involvement. TOP: Ergonomics Defined 2. The significance of evaluating ergonomics in the workplace is to a. improve worker morale. b. reduce employee spending. c. improve performance and quality, reduce injuries, and reduce absenteeism and
turnover. d. improve patient satisfaction. ANS: C
The use of ergonomics is important in the workplace to improve performance and quality, reduce injuries, and reduce absenteeism and turnover. OBJ: Define ergonomics and discuss the history of ergonomics as it relates to sonography and the Occupational Safety and Health Act’s (OSHA) involvement. TOP: Ergonomics Defined 3. When ultrasound equipment was transitioned from static scanners with an articulated arm
to real-time scanning with heavy cables attached to the transducers, sonographers began experiencing muscle strain in the a. ankle, knee, and elbow. b. thumb, wrist, and shoulder. c. knee, elbow, and shoulder. d. fingers, toes, and wrist. ANS: B
As the industry moved to new technology, the transducer was no longer fixed to an articulated arm but connected to a long and heavy cable. By the mid-1990s, sonographers began to complain of muscle strain in the wrist, base of the thumb, shoulder, neck, and back. OBJ: Define ergonomics and discuss the history of ergonomics as it relates to sonography and the Occupational Safety and Health Act’s (OSHA) involvement. TOP: Ergonomics Defined 4. Industry Standards for the Prevention of WRMSD injuries in sonography were first
introduced by the
a. b. c. d.
Occupational Safety and Health Act (OSHA). American Institute of Ultrasound in Medicine (AIUM). Society of Diagnostic Medical Sonographers (SDMS). Joint Review Committee – Diagnostic Medical Sonographers (JRC-DMS).
ANS: C
The Society of Diagnostic Medical Sonographers introduced industry standards for the prevention of WRMSD injuries in sonography in May 2003. OBJ: Learn how the industry has changed over the years to counteract injury and describe the various practice changes made. TOP: Creating a Safe Environment 5. A specific type of tendonitis that is due to repeated and intense gripping of the transducer
is a. b. c. d.
carpal tunnel syndrome. rotator cuff injury. plantar fasciitis. de Quervain’s disease.
ANS: D
De Quervain’s disease is a specific type of tendonitis that involves the thumb and is thought to be caused by repeated gripping of the transducer. OBJ: List the types of injuries most likely to occur while scanning. TOP: Types of Injuries 6. Inflammation on the sole of the foot is referred to as a. carpal tunnel syndrome. b. rotator cuff injury. c. plantar fasciitis. d. de Quervain’s disease. ANS: C
Plantar fasciitis is inflammation of the fascia on the sole or plantar surface of the foot. OBJ: List the types of injuries most likely to occur while scanning. TOP: Types of Injuries 7. Entrapment of the median nerve defines what condition? a. Carpal tunnel syndrome b. Rotator cuff injury c. Bursitis d. de Quervain’s disease ANS: A
Carpal tunnel syndrome is entrapment of the median nerve as it runs through the carpal bones of the wrist. OBJ: List the types of injuries most likely to occur while scanning. TOP: Types of Injuries
8. A leader in the field of sonography who has dedicated her career to awareness and
prevention of workplace injuries is a. Marie Curie. b. Joan Baker. c. Inge Edler. d. Elizabeth Kelly. ANS: B
Through the pioneering work of Joan Baker and other sonography leaders, strategies to prevent WRMSDs and improve sonographer workplace safety remain an important focus in scanning laboratories. OBJ: Learn how the industry has changed over the years to counteract injury and describe the various practice changes made. TOP: Creating a Safe Environment 9. The group that is most instrumental in making changes in the industry to prevent
workplace injuries is a. sonographers. b. sonologists. c. employers. d. equipment manufacturers. ANS: D
The most significant changes in the industry have been made by equipment manufacturers. They continue to develop ergonomically designed ultrasound systems that decrease twisting and turning and have designed lighter transducers and transducer cables. OBJ: Learn how the industry has changed over the years to counteract injury and describe the various practice changes made. TOP: Creating a Safe Environment 10. The highest average number of scans per day is performed in the specialty area of a. OB/GYN. b. abdomen. c. adult cardiac. d. vascular. ANS: C
The highest average number of scans per day is in the adult cardiac specialty followed by OB/GYN. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 11. Extension of the shoulder and arm away from the body is referred to as a. abduction. b. awkward postures. c. ergonomics. d. force. ANS: A
Movements such as twisting and bending of the neck and torso, abduction (extension) of the shoulder, and applying pressure to the transducer contribute to musculoskeletal pain and discomfort. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders. TOP: Types of Injuries 12. Signs and symptoms that indicate a WRMSD may be developing include cramping of the
hand/wrist, loss of grip, tingling, and a. forceful strain. b. decreased movement. c. numbness. d. swelling. ANS: D
WRMSDs are injuries that result in restricted work. The following are important signs and symptoms of developing a work-related injury: cramping or pain of the hand/wrist, loss of grip, stiffness, tingling, swelling, and spinal degeneration. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders. TOP: Types of Injuries 13. Spinal degeneration is caused from awkward and static postures, bending, and a. twisting. b. gripping the transducer too tight. c. repetitive motion. d. swelling. ANS: A
Intervertebral disc degeneration results from awkward and static postures, bending, and twisting while scanning. OBJ: List the types of injuries most likely to occur while scanning. TOP: Types of Injuries TRUE/FALSE 1. Sonographers are not at fault for ergonomic injuries when they are required to work in a
stressful environment. ANS: F
Sonographers should take responsibility for their own actions and behaviors by taking mini-rest breaks, especially when performing portable exams. Sonographer awareness of stress and possible coping mechanisms are keys to maintaining a healthy and stress-free workplace. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries
2. Possessing a positive attitude is a contributing factor toward preventing workplace
injuries. ANS: T
Possessing a positive attitude, not taking yourself too seriously, getting a restful night’s sleep, and exercising can benefit the sonographer immensely in the reduction of workplace stress. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 3. It is acceptable for a sonographer to rearrange furniture in a patient’s room during a
portable examination to position the ultrasound machine close to the bed. ANS: T
Sonographers and supervisors should work with other health care members to move furniture and equipment out of the way to make room for the sonographer to work as safely as possible. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 4. Behavioral modification techniques are useful in the prevention of presbyopia. ANS: T
Eyestrain is a concern for the sonographer. Over time, a focusing issue known as presbyopia can develop. Resting between patients or following the 20-20-20 rule can help to reduce fatigue. The rule states that for every 20 minutes of scanning, the sonographer should look 20 feet away for 20 seconds. This may sound simple, but it is difficult to manage without behavioral modification techniques and practice. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 5. It is the sole responsibility of the employer to ensure that sonographers do not experience
work-related injuries. ANS: F
Ergonomics create a safe scanning environment for the sonographer and sonologist, but the prevention of injury in the workplace must center around manufacturer, sonographer, and employer awareness. OBJ: Describe what comprises a stress-free and safe, injury-free scanning environment and how that environment is managed. TOP: Creating a Safe Environment 6. Degeneration of the intervertebral discs is not related to sonographic scanning. ANS: F
Spinal degeneration is a deterioration of the intervertebral discs and is a common injury or disorder among sonographers. OBJ: List the types of injuries most likely to occur while scanning. TOP: Types of Injuries 7. Good eating habits are a contributing factor in the prevention of work-related injuries. ANS: T
Actions to reduce the risk for injury include adopting good posture, taking brief rest breaks during scan times, stretching throughout the day to control stiffness, getting proper rest, exercising, and maintaining good eating habits. OBJ: Describe what comprises a stress-free and safe, injury-free scanning environment and how that environment is managed. TOP: Creating a Safe Environment 8. Stress does not generally contribute to work-related injuries in sonography. ANS: F
Stress for sonographers in the workplace takes many forms, including overload of patient schedules, communication issues, ethical and legal conflicts, and not enough available resources to do the job properly. As a result of these common stressors, the sonographer can develop physical and/or psychosocial stress-related symptoms that may increase the susceptibility to illness or injury. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 9. Psychosocial symptoms such as low self-esteem and a feeling of failure may be
contributing factors of workplace injuries. ANS: T
Psychosocial stress-related symptoms such as withdrawal, low self-esteem, feeling of failure, and frustration increase the susceptibility of illness or injury. Continuation of these stressors without positive or compassionate intervention can lead to burnout, a result of chronic work-related stress. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Causes and Risk Factors of Workplace Injuries 10. The incorporation of voice recognition on ultrasound machines is a tool for reducing
work-related injuries. ANS: T
Manufacturers design state-of-the-art and ergonomically designed ultrasound systems with adjustable monitors and keyboards. Another creative tool that allows hand-free scanning is voice recognition. OBJ: Describe what comprises a stress-free and safe, injury-free scanning environment and how
that environment is managed.
TOP:
Creating a Safe Environment
11. OSHA classifies occupational injuries as repetitive motion injury, repetitive strain injury,
musculoskeletal strain injury. ANS: T
According to OSHA, an occupational injury can be classified under the categories of repetitive motion injury (RMI), repetitive strain injury (RSI), and musculoskeletal strain injury (MSI). OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Types of Injuries 12. The area of the body that sustain the highest percentage of injury is the back. ANS: F
The upper extremities and neck appear to be the areas with the highest percentage of injury. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders. TOP: Types of Injuries 13. The group or party that has the greatest responsibility to provide working conditions that
reduce and eliminate a sonographer’s chance of work-related injury is the employer. ANS: T
It remains the employer’s responsibility to provide working conditions that reduce and eliminate the chance of injury from WRMSD. OBJ: Describe what comprises a stress-free and safe, injury-free scanning environment and how that environment is managed. TOP: Creating a Safe Environment 14. Cluttered or crowded scanning rooms are factors that contribute to stressful conditions in
the workplace. ANS: T
Factors contributing to stressful conditions in the workplace are environmental stress such as physical working conditions, vision problems such as eyestrain and eye fatigue, cluttered or crowded scanning rooms, and generalized stress whether self-imposed or otherwise. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Creating a Safe Environment 15. An ultrasound room that is too cold is a factor that contributes to workplace stress. ANS: T
Environmental stress factors include air quality, lighting, and scanning room design. A room that is too hot or cold or lacks good air exchange can lead to sonographer ailments or dissatisfaction with working conditions. A room that is too bright without light-dimming capabilities can cause eyestrain. OBJ: Explain the causes and risk factors that influence work-related musculoskeletal disorders (WRMSD) and musculoskeletal injuries (MSI). TOP: Creating a Safe Environment 16. Retraining staff and hiring temporary staff are considerations examined by employers
when trying to develop solutions for managing risk for injury. ANS: T
Employers must increase their awareness of WRMSDs and understand the costs of employee occupational injury. Worker’s compensation, hiring temporary staff, retraining staff, loss of productivity, and quality issues all must be examined and considered in developing solutions and managing risk for injury. OBJ: Describe what comprises a stress-free and safe, injury-free scanning environment and how that environment is managed. TOP: Creating a Safe Environment 17. Ninety percent of sonographers suffer from some form of WRMSD and of those, 30% will
experience a career-ending injury. ANS: F
Valuable information has been obtained from surveys of sonographers and sonologists regarding the number of occurrences of musculoskeletal symptoms, including pain, with up to 90% of sonographers suffering from some form of WRMSD. Of those, 20% will experience a career-ending injury. OBJ: Learn the importance of ergonomic training which is helpful in limiting injury. TOP: Creating a Safe Environment
Chapter 5: Interdependent Body Systems Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Ovulation is the a. mature ova. b. immature ova. c. encasement of immature ova. d. discharge of a mature ovum from its follicle. ANS: D
The release of a mature ovum from the ovarian follicle is called ovulation. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Reproductive System 2. Which organ has two sets of capillary beds? a. Liver b. Kidney c. Pancreas d. Spleen ANS: B
The kidney is unique in that it has two sets of capillary beds, rather than a single set, as do all other areas of the body. The additional capillary bed enables the kidneys to assist the cardiovascular system, if necessary, by maintaining a state of blood pressure equilibrium even when the systematic pressure changes. OBJ: Explain how the body systems maintain homeostasis.
TOP: Urinary System
3. Which organ allows free mixing of oxygenated and deoxygenated blood within the
sinusoids? a. Liver b. Kidneys c. Pancreas d. Spleen ANS: A
In the liver, simultaneous free mixing of portal venous blood (deoxygenated) and hepatic arterial blood (oxygenated) takes place. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Cardiovascular System 4. Venous flow in the lower extremities is accomplished primarily by means of a. subatmospheric pressure. b. cardiac systolic contractions. c. skeletal muscle contractions. d. cardiac diastolic contractions.
ANS: C
Blood in the legs would stagnate were it not for the presence of valves in the veins and the skeletal muscle contractions that help move the venous blood up through the veins against the effects of gravity. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Cardiovascular System 5. The pleural sac is associated with the a. heart. b. lungs. c. kidneys. d. spleen. ANS: B
The pleural sac enables the lungs to expand and contract without adhering to the chest walls. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Respiratory System 6. Fertilization typically occurs in the a. uterus. b. ovary. c. fallopian tube. d. cervix. ANS: C
Fertilization usually takes place within 1 day of ovulation in the ampulla portion of the fallopian tube. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Reproductive System 7. Which of the following directs and monitors endocrine functions? a. Kidneys b. Pancreas c. Hypothalamus d. Parathyroid glands ANS: C
The endocrine system often is referred to as the neuroendocrine system, because the hypothalamus, in the brain, directs and monitors endocrine functions. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Endocrine System 8. Which hormone can be detected in blood or urine, indicating a pregnancy? a. Follicle-stimulating hormone (FSH) b. Growth hormone (GH) c. Adrenocorticotropin (ACTH) d. Human chorionic gonadotropin (BhCG)
ANS: D
Detection of the hormone BhCG (human chorionic gonadotropin) in the blood or urine indicates a pregnancy. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Reproductive System 9. Which is the “master” endocrine gland? a. Pineal gland b. Brain c. Pancreas d. Pituitary gland ANS: D
The pituitary gland is also known as the “master gland” of the endocrine system. OBJ: Describe the interrelationship of the various hormone-producing organs. TOP: Endocrine System 10. Which body system does nothing directly to contribute to the survival of the human body? a. Central nervous system b. Endocrine system c. Reproductive system d. Digestive system ANS: C
The reproductive system differs from other body systems in that it does nothing directly to contribute to the survival of the human body. However, it does contribute to the survival of the human race. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Reproductive System 11. Which of the following is an accessory organ to the digestive system? a. Liver b. Kidney c. Spleen d. Trachea ANS: A
The liver, gallbladder, and pancreas perform functions that aid the digestive system. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Digestive System TRUE/FALSE 1. Systems that share the same function can replace each other if one system’s performance
fails. ANS: T
Although each body system has a unique primary function, the function may also relate in kind to another body system with the exact same function. Systems that share the same function can replace each other if one system’s performance fails. OBJ: Explain how the body systems maintain homeostasis.
TOP: Anatomy and Physiology
2. A body system’s function may serve as an accessory function to another body system. ANS: T
Each body system has a unique primary function, which in turn may act as an accessory function to another body system. OBJ: Explain how the body systems maintain homeostasis.
TOP: Anatomy and Physiology
3. The hypothalamus directly communicates with the pituitary gland. ANS: T
The hypothalamus communicates directly and exclusively with the pituitary gland. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Endocrine System 4. The peripheral nervous system connects the central nervous system with muscles, glands,
and sensory organs. ANS: T
The peripheral nervous system (PNS) is composed of thousands of nerves, which connect the central nervous system (CNS) with the rest of the body (muscles, glands, and sensory organs). OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Nervous System 5. If body systems are affiliated, they can share pathologic conditions. ANS: T
Affiliated body systems can share pathologic conditions. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Anatomy and Physiology 6. Endocrine glands release hormones directly into the bloodstream. ANS: F
The endocrine system is a collection of glands that secrete hormones directly into the bloodstream. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Endocrine System 7. The nervous system uses long-term coordination of responses to stimuli to help maintain
homeostasis.
ANS: F
The endocrine system uses long-term coordination of chemical signals to help maintain homeostasis by regulating body functions such as reproduction, growth and development, metabolism, blood sugar levels, stress response, and ovulation. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Nervous System 8. Gametes are the primary reproductive organs. ANS: F
Gametes are sexual reproductive cells produced by the male and female gonads. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Reproductive System 9. Hormones cause a chemical breakdown of bone when minerals are needed throughout the
body. ANS: T
When various parts of the body need certain minerals to maintain homeostasis, hormones are released that cause a chemical breakdown of bone; this allows calcium, sodium, and potassium to pass into the bloodstream, which transports the minerals to the necessary sites. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Endocrine System 10. Tendons connect bones to bones. ANS: F
Tendons are bands of tough, fibrous, flexible tissue that connect muscles to bones. Ligaments are long, elastic connections between the bones of freely movable joints. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Musculoskeletal System 11. Hormones transfer information from one set of cells to another. ANS: T
Chemical “messengers” transfer instructions from one set of cells to another. OBJ: Explain how the body systems maintain homeostasis.
TOP: Endocrine System
12. Neurons have the unique ability to send and receive electrical signals, which allows them
to communicate with each other and with other parts of the body. ANS: T
The billions of neurons (nerve cells) that make up the nervous system have the unique ability to send and receive electrical signals; this allows them to communicate with each other and with other parts of the body.
OBJ: Explain how the body systems maintain homeostasis.
TOP: Nervous System
13. The respiratory system delivers oxygen, nutrients, and white blood cells to body structures
and removes toxins. ANS: F
The cardiovascular system, not the respiratory system, delivers oxygen, nutrients, and white blood cells to body structures and removes toxins. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Respiratory System 14. If the bone marrow in the musculoskeletal system cannot replace dying red blood cells, the
urinary system steps in and produces new red blood cells. ANS: T
When the bone marrow is unable to replace dying blood cells, death would be certain if the urinary system did not provide an accessory function to the musculoskeletal system by assisting with the production of blood cells. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Musculoskeletal System 15. The reproductive system is not assisted by the endocrine system. ANS: F
The endocrine system assists the reproductive system when the pituitary gland releases luteinizing hormones, which stimulate the release of testosterone in males and initiate ovulation in females. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Reproductive System 16. All body systems are assisted by the endocrine system either directly or indirectly. ANS: T
Body systems work independently and together to maintain homeostasis. OBJ: Describe the interrelationship of the various hormone-producing organs. TOP: Anatomy and Physiology 17. The nervous system assists the endocrine system through the hypothalamus, which
controls the pineal gland; the pineal gland in turn controls the other endocrine glands. ANS: F
The hypothalamus communicates directly with the pituitary gland, which controls the other endocrine glands. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Endocrine System
18. The endocrine system secretes hormones directly into the bloodstream to regulate
reproduction, growth and development, metabolism, blood sugar levels, stress response, and ovulation. ANS: T
The endocrine system is a collection of glands that secrete hormones directly into the bloodstream. The endocrine system regulates reproduction, growth and development, metabolism, blood sugar levels, stress response, and ovulation. OBJ: Explain the interrelationship of the various hormone-producing organs. TOP: Endocrine System 19. The musculoskeletal system controls most functions throughout the body through
voluntary and involuntary muscle signaling. ANS: F
The nervous system, not the musculoskeletal system, controls most functions throughout the body through voluntary and involuntary muscle signaling. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Musculoskeletal System 20. The parasympathetic division of the autonomic nervous system responds to stress or
impending danger; it is known as the “fight or flight” system. ANS: F
The sympathetic division, not the parasympathetic division, of the autonomic nervous system responds to stress or impending danger and is known as the “fight or flight” system. The parasympathetic division restores the body to a normal state after sympathetic episodes. OBJ: Explain how the body systems maintain homeostasis.
TOP: Nervous System
21. The pumping (contracting) phase of the heart is called diastole. ANS: F
The term for the contraction phase of the heartbeat is systole. The heart is relaxed in the filling phase, or diastole. OBJ: Explain how the body systems maintain homeostasis.
TOP: Cardiovascular System
22. In a relaxed state, the normal heart rate is 70 to 90 beats a minute. ANS: T
In a relaxed state, the normal heart rate is 70 to 90 beats a minute. OBJ: Explain how the body systems maintain homeostasis.
TOP: Cardiovascular System
23. Metabolism is defined as the chemical reactions that occur in the body to maintain life. ANS: T
Metabolism is defined as the chemical reactions that occur to maintain life. OBJ: Explain how the body systems maintain homeostasis.
TOP: Anatomy and Physiology
24. Vermiform is a wormlike motion that moves contents along the large bowel. ANS: F
Peristalsis is a wormlike motion that moves contents along the large bowel. The vermiform appendix is a small appendage of the cecum that can fill with indigestible material and become inflamed; this condition, commonly known as appendicitis, in many cases is demonstrable with ultrasound. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Digestive System 25. The urinary system regulates blood volume and composition by filtering waste from the
blood that passes through the kidneys, which form urine. ANS: T
The main functions of the urinary system are to regulate blood volume and composition, regulate blood pressure, and produce red blood cells. OBJ: Explain how the body systems maintain homeostasis.
TOP: Urinary System
26. The paired lungs enclose the branching bronchial tree and alveoli. ANS: T
Contained within the thoracic cavity, the paired lungs enclose the branching bronchial tree and alveoli. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Respiratory System 27. The thoracic and abdominal cavities are separated by a muscular partition called the
visceral pleura. ANS: F
The diaphragm, not the visceral pleura, is the muscular separation between the thoracic and abdominal cavities. OBJ: Describe the interdependence of body systems and why it is significant to sonographers. TOP: Respiratory System 28. The nervous system monitors and controls almost every organ in the body. ANS: T
The nervous system monitors and controls almost every organ in the body. OBJ: Explain how the body systems maintain homeostasis.
TOP: Nervous System
29. Homeostasis is defined as chemical messengers that transfer instructions from one set of cells to another.
ANS: F Hormones are defined as chemical messengers that transfer instructions from one set of cells to another. The equilibrium of the body’s normal physiologic condition is called homeostasis. OBJ: Explain how the body systems maintain homeostasis.
TOP: Anatomy and Physiology
Chapter 6: Anatomy Layering and Sectional Anatomy Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which structure is retroperitoneal? a. Gallbladder b. Pancreas c. Liver d. Spleen ANS: B
The pancreas is located in the retroperitoneum. The gallbladder, liver, and spleen are intraperitoneal organs. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Body Divisions 2. Which structure is intraperitoneal? a. Gallbladder b. Pancreas c. Urinary bladder d. Abdominal aorta ANS: A
The gallbladder is an intraperitoneal structure. The pancreas, urinary bladder, and abdominal aorta are located in the retroperitoneum. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Body Divisions 3. Which structure is oriented horizontally in the body? a. Abdominal aorta b. Superior mesenteric vein c. Right renal artery d. Superior mesenteric artery ANS: C
The right renal artery is oriented horizontally in the body. The abdominal aorta and the superior mesenteric artery and vein all are oriented vertically. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: The Body Layers 4. Which structure is oriented vertically in the body? a. Renal artery b. Splenic vein c. Cystic duct d. Thyroid isthmus ANS: C
The cystic duct lies in a vertical oblique position in the body. The renal arteries and veins, splenic vein, and thyroid isthmus are oriented horizontally. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: The Body Layers 5. Which anatomic area is NOT seen on a sagittal scanning plane image? a. Posterior b. Inferior c. Anterior d. Medial ANS: D
In a sagittal scanning plane, the targeted area of interest is always related to a structure immediately anterior, posterior, superior, and inferior to it. OBJ: Explain the importance of using two different scanning planes. TOP: Body Structure Relationships 6. Which anatomic area is NOT seen on a coronal scanning plane image? a. Medial b. Lateral c. Anterior d. Superior ANS: C
In a coronal scanning plane, the targeted area of interest is always related to a structure immediately right or left lateral, medial, superior, and inferior to it. OBJ: Explain the importance of using two different scanning planes. TOP: Body Structure Relationships 7. Which anatomic area is NOT seen on a transverse scanning plane image? a. Superior b. Right lateral c. Anterior d. Medial ANS: A
In a transverse scanning plane, the targeted area of interest is always related to a structure immediately anterior, posterior, medial, lateral, right, and left of it. OBJ: Explain the importance of using two different scanning planes. TOP: Body Structure Relationships 8. The scanning planes used in sonography are the same as anatomic body planes, but their
interpretations depend on the a. size of the transducer. b. shape of the transducer and how it is held. c. body habitus. d. location of the transducer and sound wave approach.
ANS: D
Scanning planes used in sonography are the same as anatomic body planes; however, their interpretations depend on the location of the transducer and angle approach to the body. OBJ: Explain the importance of using two different scanning planes. TOP: Directional Terminology and Sectional Planes 9. In gross anatomy, the tail of the pancreas is located a. medial b. left lateral c. inferior d. anterior
to the splenic artery.
ANS: C
The tail of the pancreas is typically located inferior to the splenic artery OBJ: Define the layering concept.
TOP: The Body Layers
10. In gross anatomy, the abdominal aorta is located a. medial b. lateral c. inferior d. anterior
to the left kidney.
ANS: A
The abdominal aorta is medial to the left kidney. OBJ: Define the layering concept.
TOP: The Body Layers
11. In gross anatomy, the splenic vein is oriented
and courses
to the
body of the pancreas. a. vertically, medial b. horizontally, posterior c. vertically oblique, posterior d. horizontal oblique, anterior ANS: B
The splenic vein is oriented horizontally in the body and courses posterior to the body and neck of the pancreas. OBJ: Define the layering concept.
TOP: The Body Layers
12. Which group of structures is intraperitoneal in location? a. Ureters, adrenal glands, and prostate gland b. Gallbladder, stomach, and ovaries c. Adrenal glands, pancreas, and ovaries d. Uterus, abdominal lymph nodes, and somatic nerves ANS: B
Intraperitoneal structures include the stomach, ovaries, gallbladder, spleen (except the hilum), liver (except the bare area), and most of the intestines.
OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 13. Which group of structures is located in the retroperitoneum? a. Liver (except the bare area), gallbladder, and spleen b. Liver (except the bare area), spleen, and stomach c. Ovaries and most of the intestines d. Uterus, ascending colon, and descending colon ANS: D
Structures located in the retroperitoneum include the kidneys, urinary bladder, ureters, pancreas, adrenal glands, uterus, prostate glands, inferior vena cava, abdominal aorta, lymph nodes, somatic nerves, most of the duodenum, and the ascending and descending colon. OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 14. The greater sac a. extends from the diaphragm to the pelvis and covers the width of the abdomen. b. is the omental bursa. c. is a double layer of peritoneum that extends from the stomach to adjacent
abdominal organs. d. is a diverticulum of the mesentery located posterior to the stomach. ANS: A
The greater sac extends from the diaphragm to the pelvis, covering the width of the abdomen. OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 15. The lesser sac a. extends from the diaphragm to the pelvis and covers the width of the abdomen. b. is a diverticulum of the greater sac located posterior to the stomach. c. is a double layer of peritoneum that extends from the stomach to adjacent
abdominal organs. d. attaches to the anterior surface of the transverse colon. ANS: B
The lesser sac is a diverticulum of the greater sac located posterior to the stomach. OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 16. Intraperitoneal structures are connected to the cavity wall by the a. omentum. b. greater sac. c. lesser sac. d. mesentery. ANS: D
Double folds of peritoneum (mesentery) connect intraperitoneal body structures to the cavity wall. OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 17. The crura of the diaphragm are a. folds of peritoneum that insert into the diaphragm. b. visceral tissue layers that insert into the diaphragm. c. muscular bands arising from the diaphragm that attach to the abdominal aorta and
inferior vena cava. d. muscular bands that arise from the lumbar vertebrae and insert into the diaphragm. ANS: D
The crura of the diaphragm are muscular bands that rise from the lumbar vertebrae and insert into the diaphragm. OBJ: Define how body structure relationships apply to sonography. TOP: Body Divisions 18. The renal arteries are located a. inferior b. posterior c. anterior d. lateral
to the renal veins.
ANS: B
The right and left renal arteries course posterior to their corresponding renal vein. OBJ: Define the layering concept.
TOP: The Body Layers
19. The quadratus lumborum muscle is a bilateral muscle tissue that is
to the psoas
major muscle. a. medial b. lateral c. anterior d. posterior ANS: B
The quadratus lumborum muscle courses upward, lateral to the psoas major muscle until it reaches the twelfth rib. OBJ: Define the layering concept.
TOP: The Body Layers
20. What is the orientation of the gallbladder in this sagittal scanning plane image just to the right
of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, common hepatic duct, gallbladder, and liver are demonstrated in their longitudinal plane. The portal vein is seen in a cross-sectional (axial) plane. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 21. What is the orientation of the IVC in this sagittal scanning plane image just to the right of the
midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, common hepatic duct, gallbladder, and liver are demonstrated in their longitudinal plane. The portal vein is seen in a cross-sectional (axial) plane. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 22. What is the orientation of the portal vein in this sagittal scanning plane image just to the right
of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: B
The IVC, common hepatic duct, gallbladder, and liver are demonstrated in their longitudinal plane. The portal vein is seen in a cross-sectional (axial) plane. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 23. What is the orientation of the liver in this sagittal scanning plane image just to the right of the
midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, common hepatic duct, gallbladder, and liver are demonstrated in their longitudinal plane. The portal vein is seen in a cross-sectional (axial) plane. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 24. . What is the orientation of the IVC in this transverse scanning plane image just to the right of
the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: B
The IVC, AO, GB, CBD, GDA, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The head of the pancreas lies in a vertical oblique orientation. A transverse imaging plane would demonstrate the length (longitudinal) of the pancreatic head. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 25. What is the orientation of the GDA in this transverse scanning plane image just to the right of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: B The IVC, AO, GB, CBD, GDA, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The head of the pancreas lies in a vertical oblique orientation. A transverse imaging plane would demonstrate the length (longitudinal) of the pancreatic head. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation
26. What is the orientation of the pancreatic head in this transverse scanning plane image just to the right of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A The IVC, AO, GB, CBD, GDA, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The head of the pancreas lies in a vertical oblique orientation. A transverse imaging plane would demonstrate the length (longitudinal) of the pancreatic head. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 27. What is the orientation of the aorta in this transverse scanning plane image of the upper
epigastrium?
a. Longitudinal b. Axial c. Neither ANS: B
The IVC, AO, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The celiac, splenic, and hepatic arteries are situated in a vertical orientation. A transverse imaging plane would demonstrate the length of these arteries.
OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 28. What is the orientation of the celiac axis in this transverse scanning plane image of the upper
epigastrium?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, AO, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The celiac, splenic, and hepatic arteries are situated in a vertical orientation. A transverse imaging plane would demonstrate the length of these arteries. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 29. What is the orientation of the liver in this transverse scanning plane image of the upper
epigastrium?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, AO, and liver are horizontally oriented (sagittal). A transverse imaging plane would demonstrate the axial plane of these structures. The celiac, splenic, and hepatic arteries are situated in a vertical orientation. A transverse imaging plane would demonstrate the length of these arteries. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 30. What is the orientation of the proper hepatic artery in this sagittal scanning plane image of
the right upper quadrant?
a. Longitudinal b. Axial c. Neither ANS: B
The IVC, this portion of the main portal vein, the common bile duct, and the liver are horizontally oriented. A sagittal image would demonstrate the length of these structures (longitudinal). The proper hepatic artery and head of the pancreas are vertically oriented. A sagittal image would demonstrate the axial plane of these structures. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 31. What is the orientation of the liver in this sagittal scanning plane image of the right upper
quadrant?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, this portion of the main portal vein, the common bile duct, and the liver are horizontally oriented. A sagittal image would demonstrate the length of these structures (longitudinal). The proper hepatic artery and head of the pancreas are vertically oriented. A sagittal image would demonstrate the axial plane of these structures. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 32. What is the orientation of the right kidney in this transverse scanning plane image of the
right upper quadrant?
a. Longitudinal b. Axial c. Neither ANS: B
The IVC, AO, right kidney, and liver are vertically oriented. A transverse image would demonstrate the axial plane of these structures. The length (longitudinal) of the left and right portal veins is demonstrated in this image.
OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 33. What is the orientation of the right portal vein in this transverse scanning plane image of
the right upper quadrant?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, AO, right kidney, and liver are vertically oriented. A transverse image would demonstrate the axial plane of these structures. The length (longitudinal) of the left and right portal veins is demonstrated in this image. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 34. What is the orientation of the superior mesenteric vein in this sagittal scanning plane
image just to the right of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, superior mesenteric vein, and liver are horizontally oriented. A sagittal image of these structures would demonstrate their length (longitudinal). The neck of the pancreas and uncinate process are vertically oriented and would demonstrate their axial plane in a sagittal image.
OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 35. What is the orientation of the inferior vena cava in this sagittal scanning plane image just
to the right of the midline of the body?
a. Longitudinal b. Axial c. Neither ANS: A
The IVC, superior mesenteric vein, and liver are horizontally oriented. A sagittal image of these structures would demonstrate their length (longitudinal). The neck of the pancreas and uncinate process are vertically oriented and would demonstrate their axial plane in a sagittal image. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 36. What is the orientation of the right lobe of the thyroid in this transverse scanning plane
image just to the right of the midline of the neck?
a. Longitudinal b. Axial c. Neither ANS: B
The right thyroid lobe, common carotid artery, jugular vein, longus colli muscle, sternothyroid muscle, sternohyoid muscle, sternocleidomastoid muscle, and trachea are horizontally oriented. A transverse image would demonstrate the axial plane of these structures. The thyroid isthmus is vertically oriented. A transverse imaging plane would demonstrate the length of the isthmus (longitudinal).
OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 37. What is the orientation of the isthmus in this transverse scanning plane image just to the
right of the midline of the neck?
a. Longitudinal b. Axial c. Neither ANS: A
The right thyroid lobe, common carotid artery, jugular vein, longus colli muscle, sternothyroid muscle, sternohyoid muscle, sternocleidomastoid muscle, and trachea are horizontally oriented. A transverse image would demonstrate the axial plane of these structures. The thyroid isthmus is vertically oriented. A transverse imaging plane would demonstrate the length of the isthmus (longitudinal). OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 38. What is the orientation of the uterus, vagina, and bladder in this sagittal scanning plane
image at the midline of the pelvis?
a. Longitudinal b. Axial
c. Neither ANS: A
This sagittal image of the female pelvis demonstrates the length (longitudinal) of the uterus, vagina, and urinary bladder. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 39. Using the image below, the portal vein is
proper hepatic artery, and
a. b. c. d.
to the IVC, to the gallbladder.
to the
superior, anterior, medial anterior, medial, superior anterior, posterior, superior inferior, posterior, superior
ANS: C
The portal vein is lying anterior to the IVC, posterior to the CHD, and superior to the gallbladder in this sagittal image of the right upper quadrant. The portal vein is located closer to the anterior surface of the abdomen compared to the IVC. The portal vein is located under the common hepatic duct (posterior). The portal vein is located closer to the patient’s head (superior) compared to the gallbladder. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 40. Using the image below, the inferior vena cava is _
pancreatic head,
to the gallbladder, and to the abdominal aorta.
to the CBD, GDA, and
a. b. c. d.
anterior, lateral, medial posterior, medial, left lateral anterior, medial, lateral posterior, medial, right lateral
ANS: D
The IVC is located anterior to the spine; posterior to the CBD, GDA, and head of the pancreas; medial to the GB; and right lateral to the abdominal aorta. The IVC is located above (anterior to) the spine; below (posterior to) the CBD, GDA, and head of the pancreas; below (posterior) and closer to the center (medial) compared to the GB; and right lateral to the abdominal aorta. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 41.
Using the image below, the head of the pancreas lies
to the gallbladder, and
to the IVC, to the left lobe of the liver.
a. b. c. d.
anterior, medial, posterior superior, medial, posterior anterior, lateral, posterior anterior, medial, posterior
ANS: A OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 42. Using the image below, the hepatic artery is
lobe of the liver, and
a. b. c. d.
superior, inferior, medial superior, inferior, lateral anterior, posterior, medial posterior, anterior, medial
ANS: C
to the portal vein.
to the AO,
to the left
The hepatic artery is anterior to the AO, posterior to the left lobe of the liver, and medial to the portal vein. The hepatic artery lies above (anterior to) the aorta, below (posterior to) the left lobe of the liver, and closer to the center (medial) compared to the portal vein. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 43. Using the image below, the head of the pancreas is
to the gallbladder, and
a. b. c. d.
to the IVC and CBD, to the portal vein and proper hepatic artery.
medial, inferior, posterior anterior, posterior, inferior anterior, inferior, posterior lateral, posterior, inferior
ANS: B
The head of the pancreas is anterior to the IVC and CBD, posterior to the gallbladder, and inferior to the portal vein and proper hepatic artery. The head of the pancreas lies above (anterior to) the IVC and CBD, below (posterior to) the gallbladder, and closer to the feet (inferior) compared to the portal vein and proper hepatic artery. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 44. Using the image below, the common bile duct (CBD) is
vein and
to the gallbladder and liver.
to the IVC and portal
a. b. c. d.
anterior, posterior posterior, anterior medial, lateral superior, inferior
ANS: A
The common bile duct (CBD) is anterior to the IVC and portal vein and posterior to the gallbladder and liver. The CBD lies above (anterior to) the IVC and portal vein (PV) and below (posterior to) the gallbladder and liver. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 45. Using the image below, the IVC is
the portal vein, and
a. anterior, inferior, medial b. anterior, posterior, lateral
to the spine, to the right kidney.
to the liver and
c. superior, posterior, medial d. anterior, posterior, medial ANS: D
The IVC is anterior to the spine, posterior to the liver and the portal vein, and medial to the right kidney. The IVC lies above (anterior to) the spine, below (posterior to) the liver and demonstrated portal vein, and closer to the center (medial) compared to the right kidney. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 46. Using the image below, the superior mesenteric vein (SMV) lies
process of the pancreas, portal vein.
a. b. c. d.
to the neck of the pancreas, and
to the uncinate to the
anterior, posterior, inferior inferior, posterior, medial anterior, posterior, medial inferior, posterior, lateral
ANS: A
The superior mesenteric vein (SMV) lies anterior to the uncinate process of the pancreas, posterior to the neck of the pancreas, and inferior to the portal vein. The SMV lies above (anterior to) the uncinate process of the pancreas, below (posterior to) the neck of the pancreas, and closer to the feet (inferior) compared to the portal vein. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 47. Using the image below, the right common carotid artery (CCA) is
longus colli muscle, gland.
to the to the sternothyroid muscle, lateral to the right thyroid
a. b. c. d.
superior, posterior, lateral superior lateral, superior anterior, posterior, lateral anterior, posterior, medial
ANS: C
The right common carotid artery (CCA) is anterior to the longus colli muscle, posterior to the sternothyroid muscle, lateral to the right thyroid gland, and medial to the right internal jugular vein. The right CCA lies above (anterior to) the longus colli muscle, below (posterior to) the sternothyroid muscle, farther from center (lateral) compared to the right thyroid gland, and closer to the center (medial) compared to the right internal jugular vein. OBJ: Describe structure orientation and its significance in cross sections of the anatomy. TOP: Structure orientation 48. Using the image below, the vagina is
bladder, and
a. b. c. d.
to the uterine cervix.
superior, inferior, medial anterior, posterior, medial inferior, superior, medial anterior, posterior, inferior
ANS: D
to the rectum,
to the urinary
The vagina is anterior to the rectum, posterior to the urinary bladder, and inferior to the uterine cervix. The vagina lies above (anterior to) the rectum, below (posterior to) the urinary bladder, and closer to the feet (inferior) compared to the uterine cervix. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation 49. Using the image below, the uterus is
bladder, and
a. b. c. d.
to the bowel, to the vagina and uterine cervix.
to the urinary
superior, inferior, anterior anterior, posterior, superior superior, medial, inferior anterior, superior, posterior
ANS: B
The uterus is anterior to the bowel, posterior to the urinary bladder, and superior to the vagina and uterine cervix. The uterus lies above (anterior to) the bowel, below (posterior to) the urinary bladder, and closer to the head (superior) compared to the vagina and uterine cervix. OBJ: Define how body structure relationships apply to sonography. TOP: Structure orientation
Chapter 7: Embryology Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The hepatic section of the IVC is derived from the a. subcardinal/supracardinal vein. b. proximal vitelline vein. c. subcardinal vein. d. supracardinal veins. ANS: B
The hepatic section of the IVC originates from the proximal vitelline vein. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
2. The prerenal section of the IVC is derived from the a. subcardinal and supracardinal veins. b. proximal vitelline vein. c. subcardinal vein. d. supracardinal vein. ANS: C
The prerenal section of the IVC originates from the subcardinal vein. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
3. The renal section of the IVC is derived from the a. subcardinal and supracardinal veins. b. proximal vitelline vein. c. subcardinal vein. d. supracardinal vein. ANS: A
The renal section of the IVC originates from the subcardinal and supracardinal veins. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
4. The postrenal section of the IVC is derived from the a. subcardinal and supracardinal veins. b. proximal vitelline vein. c. subcardinal vein. d. supracardinal vein. ANS: D
The postrenal section of the IVC originates from the supracardinal vein. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
5. The foregut forms a. the distal duodenum, small bowel, and proximal part of the colon.
b. the distal part of the colon. c. part of the mouth, as well as the pharynx, esophagus, stomach, and proximal part
of the duodenum. ANS: C
A portion of the mouth and all of the pharynx, esophagus, stomach, and proximal duodenum originate from the foregut and are supplied with blood by the celiac artery. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Embryology 6. The midgut forms a. the distal duodenum, small bowel, and proximal part of the colon. b. the distal part of the colon. c. part of the mouth, as well as the pharynx, esophagus, stomach, and proximal part
of the duodenum. ANS: A
The distal portion of the duodenum, the small bowel, and the colon as far as the middle and left thirds of the transverse colon originate from the midgut. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Embryology 7. The hindgut forms a. the distal duodenum, small bowel, and proximal part of the colon. b. the distal part of the colon. c. part of the mouth, as well as the pharynx, esophagus, stomach, and proximal part
of the duodenum. ANS: B
The hindgut gives rise to the distal part of the colon, which is supplied with blood by the inferior mesenteric artery. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Embryology 8. The anal canal opens at a. 12 weeks. b. 11 weeks. c. 7 weeks. d. 20 weeks. ANS: C
The anal cavity opens during week 7, when a membrane that separates the rectum from the exterior ruptures. OBJ: List the embryologic age at initial organ formation. 9. Peristalsis begins at a. 12 weeks. b. 11 weeks.
TOP: Embryology
c. 7 weeks. d. 20 weeks. ANS: B
Peristalsis occurs by week 11. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Fetal Development 10. Swallowing begins at a. 12 weeks. b. 11 weeks. c. 7 weeks. d. 20 weeks. ANS: A
Swallowing begins at week 12. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Fetal Development 11. Normal formation of the GI tract is complete at a. 12 weeks. b. 11 weeks. c. 7 weeks. d. 20 weeks. ANS: D
By week 20, the GI tract has reached its normal configuration and relative size. OBJ: Compare and contrast the development of the GI tract and accessory organs. TOP: Fetal Development 12. The telencephalon gives rise to the a. pineal gland, pituitary gland, olfactory bulbs, and optic tracts. b. cerebral hemispheres and lateral ventricles. c. thalamus and hypothalamus. ANS: B
The telencephalon gives rise to the large cerebral hemispheres, the basal ganglia, and the lateral ventricles. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
13. The diencephalon gives rise to the a. pineal gland, pituitary gland, olfactory bulbs, and optic tracts. b. cerebral hemispheres and lateral ventricles. c. thalamus and hypothalamus. ANS: C
The diencephalon forms the thalamus and hypothalamus. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
14. The prosencephalon gives rise to the a. pineal gland, pituitary gland, olfactory bulbs, and optic tracts. b. cerebral hemispheres and lateral ventricles. c. thalamus and hypothalamus. ANS: A
The olfactory bulbs, optic tracts, pineal gland, and pituitary gland arise from the prosencephalon. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
TRUE/FALSE 1. Three dorsal aortas fuse into one during embryologic week 3. ANS: F
During week 3, the embryo has two dorsal aortas, which are extensions of the two pericardial heart tubes. The aortas quickly fuse into a single vessel after this period. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
2. The embryologic heart begins beating at approximately embryologic week 3. ANS: T
The embryonic heart is formed at the same time as the aorta and begins beating at approximately 22 days of actual embryonic age. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
3. The celiac axis and superior and inferior mesenteric arteries are derived from the vitelline
artery complex. ANS: T
The vitelline artery complex branches anteriorly from the aorta and extends into the yolk sac. The celiac artery and superior and inferior mesenteric arteries develop from this complex. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
4. Deoxygenated blood that passes from the fetus to the placenta is carried by the umbilical
vein. ANS: F
The umbilical vein carries oxygenated blood from the placenta to the fetus. OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Embryology 5. The IVC is formed in week 3 of gestation.
ANS: F
The IVC and its tributaries form in weeks 6 to 8 of embryologic development. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
6. The portal vein is formed in embryologic week 6. ANS: F
The portal vein develops during approximately embryologic week 8. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
7. The liver is formed from the foregut. ANS: T
The liver develops from the foregut. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
8. The primitive gut forms during embryologic week 4 and is composed of a foregut, a
midgut, and a hindgut. ANS: T
The primitive gut is formed during embryologic week 4 and is composed of a foregut, a midgut, and a hindgut. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
9. The umbilical vein carries oxygenated blood to the embryo. ANS: T
The umbilical vein carries oxygenated blood from the embryo portion of the placenta to the embryonic heart. OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Fetal Circulation 10. The vitelline veins carry oxygenated blood from the embryo to the placenta. ANS: F
The vitelline veins carry blood from the yolk sac to the developing embryo. OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Fetal Circulation 11. The umbilical veins degenerate into one umbilical vein, which carries deoxygenated blood
from the fetus to the placenta. ANS: F
The right umbilical vein and part of the left umbilical vein degenerate. The remaining portion of the left umbilical vein carries oxygenated blood from the placenta to the fetus.
OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Fetal Circulation 12. The ductus venosus shunts blood from the umbilical vein to the IVC. ANS: T
The ductus venosus develops a large shunt that passes through the liver, connecting the umbilical vein to the inferior vena cava and thus allowing some blood to flow directly from the placenta to the heart. OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Fetal Circulation 13. After birth, the umbilical vein becomes the ligamentum venosum, and the ductus venosus
becomes the ligamentum teres. ANS: F
Postnatally the umbilical vein becomes the ligamentum teres, and the ductus venosus becomes the ligamentum venosum. OBJ: Compare and contrast the function of the umbilical arteries and the umbilical vein. TOP: Fetal Circulation 14. The septum transversum in the embryo eventually becomes the connective tissue for the
liver. ANS: T
The septum transversum is an embryonic structure that becomes the connective tissue for the liver. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
15. Hematopoiesis begins in embryologic week 6 in the liver. ANS: T
Hematopoiesis is the formation and development of blood cells, which begins in embryonic week 6 and is primarily responsible for the large size of the liver. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
16. Ventral and dorsal diverticula of the primitive hindgut rotate to form the pancreas. ANS: T
The pancreas is formed from the ventral and dorsal diverticula of the primitive foregut. The diverticula rotate and fuse, with the ventral portion forming most of the head of the pancreas and the dorsal portion forming the entire body and tail. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
17. The three developmental stages of the kidneys are the pronephros, mesonephros, and
metanephros.
ANS: T
Embryonically, the kidneys pass through three developmental stages. The pronephros and mesonephros, which appear in weeks 4 to 5 of gestation, are the precursors of the metanephros. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
18. Embryonic kidneys function by the end of week 5. ANS: F
The permanent kidney is not functional until the end of week 8. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
19. The kidneys lie initially in the pelvis and then move up into the abdomen. ANS: T
The kidneys initially lie in the pelvic cavity. As the embryo grows, they move up into the abdomen. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
20. The spleen develops at 8 weeks of embryologic age. ANS: F
Development of the spleen begins at about week 5 of gestation. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
21. The embryonic/fetal spleen produces red and white blood cells. ANS: T
During embryonic/fetal life, the spleen is important for producing red and white blood cells. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
22. After birth, fetal RBC formation ceases and the reticuloendothelial function begins. ANS: T
Reticuloendothelial function develops after birth, when primary fetal blood cell formation ceases. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
23. The gastrointestinal tract begins to form at 4 weeks of embryologic age. ANS: T
The primitive gut develops from the posterior portion of the yolk sac during week 4 of embryonic development. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
24. The foregut herniates from the abdomen, rotates, and then returns to the abdominal cavity. ANS: F
The midgut herniates from the abdominal cavity, rotates, and then returns to the cavity to its permanent position. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
25. The external genitalia are similar in male and female embryos until 8 weeks of gestation,
when the genital tubercle turns into visible labia. ANS: F
The external genitalia of male and female embryos remain undifferentiated until week 8 of gestation, when the genital tubercle turns into a visible penis. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
26. Wolffian and müllerian ducts are located near the mesonephros, the second-stage structure
of renal formation, and develop into male and female genital tracts. ANS: T
Wolffian and müllerian ducts are paramesonephros structures that develop into male and female genital tracts, respectively. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
27. At 4 months of gestation, the testes descend to the level of the urinary bladder; at 7
months, they descend into the scrotum. ANS: T
In month 4, the testes descend to the level of the urinary bladder, where they remain until approximately month 7; they then descend through the inguinal canal into the scrotum. OBJ: Describe the difference between the embryo and the fetus. TOP: Fetal Development 28. A bicornuate uterus is the least common congenital anomaly of the female genital tract. ANS: F
A bicornuate uterus is the most common congenital malformation of the female genital tract. OBJ: Describe the difference between the embryo and the fetus. TOP: Fetal Development 29. Bicornuate uterus may best be detected in the long axis. ANS: F
A bicornuate uterus is best appreciated in short axis sections. OBJ: Describe the difference between the embryo and the fetus.
TOP: Fetal Development 30. Mammary ridges, which eventually become breasts, develop at 6 weeks. ANS: T
Breast formation from the mammary ridges occurs at 6 weeks of gestation. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
31. Thyroid gland development begins during embryologic week 3. ANS: T
The thyroid gland arises from a median, saclike, entodermal diverticulum, which begins to thicken during week 3 of embryologic development. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
32. Thyroid follicle formation begins by week 5. ANS: F
Thyroid follicles begin to form by week 8 of embryologic development. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
33. About 50% of ectopic thyroids are lingual in nature. ANS: F
About 90% of ectopic thyroids are lingual in nature. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
34. Neural tube formation begins at 3 to 4 weeks of embryologic age. ANS: T
The peak occurrence of neural tube formation is seen at 3 to 4 weeks of embryologic development. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
35. Neural development continues postnatally. ANS: T
Major organizational events occur from approximately month 6 of gestation to several years after birth. These events establish the elaborate circuitry that distinguishes the human brain. OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
36. Most organogenesis takes place during the fetal stage. ANS: F
Almost all organogenesis takes place during embryologic weeks 3 to 8.
OBJ: List the embryologic age at initial organ formation.
TOP: Embryology
Chapter 8: Introduction to Laboratory Values Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The enzyme that metabolizes carbohydrates is a. lipase. b. amylase. c. glucose. d. lactate dehydrogenase. ANS: B
Carbohydrates are digested by amylase, which is produced in the salivary glands and the pancreas. Pancreatic disease can cause a release of amylase in to the blood. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 2. Thyroid-stimulating hormone is produced by the a. liver. b. gallbladder. c. thyroid. d. pituitary gland. ANS: D
Thyroid-stimulating hormone (TSH) is produced by the pituitary gland. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 3. A measurement of inflammation in the body is a. erythrocyte sedimentation rate. b. prothrombin time. c. partial prothrombin time. d. platelet count. ANS: A
Erythrocyte sedimentation rate (ESR) is a measurement of body inflammation. This test is performed by venipuncture when a patient presents with unexplained fevers, muscle symptoms, specific arthritis, and other vague symptoms. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 4. The agency responsible for ensuring that medical laboratory testing is regulated is the a. Center for Clinical Standards and Quality. b. Clinical Laboratory Improvement Amendments. c. US Health Care Financing Administration. d. International Organization for Standardization. ANS: C
It is the duty of the US Health Care Financing Administration to ensure that medical laboratory testing is regulated, to ensure quality control. OBJ: Describe the importance of quality control in laboratory testing. TOP: Agency oversight of laboratory testing 5. Universal computational rules designed to determine if analytical runs are within control
limits are a. Clinical Laboratory Improvement Amendments (CLIA). b. quality control standards. c. accreditation guidelines. d. Westgard Rules. ANS: D
Westgard Rules are universal computational rules designed to determine if analytical runs are within control limits. This helps to determine if samples are viable in their current conditions (samples may need to be diluted, re-obtained, etc.). OBJ: Describe the purpose of Westgard Rules. TOP: Quality control of laboratory values 6. A component of estrogen that varies in amount based on the menstrual cycle is a. estriol. b. estrone. c. estradiol. d. unconjugated estriol. ANS: C
There are three components of estrogen that may be measured in an estrogen test: E1 (estrone), E2 (estradiol), and E3 (estriol). E2 levels may vary during the menstrual cycle. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 7. A laboratory value not normally present in the urine is a. glucose. b. creatinine. c. hCG. d. bilirubin. ANS: A
A glucose test can be performed by venipuncture or urine, however, glucose is not normally found in the urine. Urine glucose tests are performed often during pregnancy as an indicator of gestational diabetes. OBJ: List methods used to obtain lab samples.
TOP: Laboratory values
8. The ratio of packed red blood cell volume in a centrifuged blood sample is referred to as a a. complete blood count. b. red blood count. c. hemoglobin per red blood count. d. hematocrit value.
ANS: D
A hematocrit value is the ratio of the packed red blood cell volume in a centrifuged blood sample and is expressed as percentage. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 9. A test performed in conjunction with prothrombin time and used to measure the ability of
clotting proteins is a. erythrocyte sedimentation rate. b. partial thromboplastin time. c. hemoglobin concentration per red blood cell. d. platelet count. ANS: B
Partial thromboplastin time (PTT) is a test used to measure the ability of clotting proteins or factors and is normally performed in conjunction with prothrombin time (PT). OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 10. When is a quadruple screen blood test administered during pregnancy? a. 8-12 weeks b. 12-14 weeks c. 13-20 weeks d. 15-22 weeks ANS: D
Quad screening is a blood test that includes: AFP, hCG, uE3, and inhibin A (placenta-released hormone) administered between 15 and 22 weeks of pregnancy. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 11. Which of the following elevate due to alcoholic liver disease? a. ALT, AST b. LDH c. BUN, Creatinine d. Amylase, Lipase ANS: A
High levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may indicate the patient is alcoholic and may be the cause of liver damage. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 12. Human chorionic gonadotropin can be determined by blood or urine tests as early as
days post conception. a. 10 b. 12 c. 15
d. 48 ANS: A Human chorionic gonadotropin (hCG) is used to determine pregnancy and can be determined by a blood or urine test as early as 10 days after conception. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 13. A lab value produced in the fetal liver and yolk sac that is used to screen for birth defects is a. uE3. b. AFP. c. inhibin A. d. hCG. ANS: B
AFP is produced in the fetal yolk sac and liver of a developing fetus. AFP is used in a quadruple screen test (quad screen) for fetal birth defects. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 14.
is a soft, waxy substance found in all body parts and is needed for proper bodily function. a. Cholesterol b. Total protein c. Albumin d. Bile pigment ANS: A
Cholesterol is a soft, waxy substance found in all body parts and is needed for proper bodily function. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 15. When cells of the body are damaged or destroyed, they release
into the blood. a. b. c. d.
AST BUN LD CPK
ANS: C
lactic dehydrogenase (LD) When cells are damaged or destroyed, they release lactic dehydrogenase (LD) into the blood. LD is an indicator of tissue damage and certain diseases. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values TRUE/FALSE
1. Anorexia is an implication of decreased estrogen. ANS: T
Anorexia causes a decreased estrogen level in females. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 2. Testicular cancer can cause elevated hCG levels. ANS: T
Testicular cancer is an implication of high values of hCG. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 3. Hypothyroidism causes an elevation in T4. ANS: F
Hypothyroidism causes a decrease in T4. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 4. The College of American Pathologists Laboratory Accreditation Program is a voluntary
accreditation program used to ensure labs meet or exceed laboratory quality requirements. ANS: T
The College of American Pathologists Laboratory Accreditation Program (CAP-LAP) is a voluntary accreditation program used to ensure labs meet or exceed laboratory quality requirements. OBJ: Describe the importance of quality control in laboratory testing. TOP: Agency oversight of laboratory testing 5. Obstruction of a salivary gland may cause a decrease in amylase and lipase. ANS: F
Salivary gland obstruction causes an increase in amylase and lipase levels. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 6. The office responsible for implementation of Clinical Laboratory Improvement
Amendments, policies, quality, clinical, medical sciences issues, surveys and certification of programs is the Commissions of Office Laboratory Accreditation (COLA). ANS: F
The Center for Clinical Standards and Quality (CCSQ) is the office within the CMS responsible for implementation of CLIA, policies, quality, clinical, medical sciences issues, surveys, and certification of programs.
OBJ: Describe the importance of quality control in laboratory testing. TOP: Agency oversight of laboratory testing 7. LDL is responsible for carrying lipids to the liver. ANS: F
HDL carries lipids to the liver. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 8. High levels of LDL are linked to cardiovascular disease. ANS: T
High levels of LDL are linked to cardiovascular disease. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 9. High levels of bilirubin have been linked to neurological defects in the newborn. ANS: T
High levels of bilirubin have been linked to neurological defects in the newborn. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 10. A routine diet of high fat meals can cause elevated ALP. ANS: T
High fatty meals are a contributing factor of elevated ALP. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 11. Chronic smoking is a cause of elevated hematocrit. ANS: T
Chronic smoking is an implication of a high value of hematocrit. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 12. Some foods may affect prothrombin time in patients who are taking warfarin. ANS: T
Food complications can be a cause of an abnormal PT in patients who are taking warfarin. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values
13. PSA levels are not affected by a urinary tract infection. ANS: F
A urinary tract infection may cause an elevated PSA level. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 14. Delayed puberty in males may be attributed to elevated estrogen. ANS: T
Delayed puberty is an implication of an elevated estrogen level in males. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 15. LD levels in the blood are examined to determine abnormalities in the function of the
pancreas. ANS: F
LD is examined in the blood to determine abnormalities in the function of the heart. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 16. hCG levels should triple every 48 hours of early pregnancy. ANS: F
hCG levels rapidly rise in the first trimester of pregnancy and then slowly decline. HCG levels should double every 48 hours of early pregnancy. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 17. Hematocrit levels are unaffected by gender and age in adults. ANS: F Hematocrit levels change with age and differ for gender in adults. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 18. PSA screening normally occurs between the ages of 40-45 in men with no risk factors for
prostate cancer. ANS: F
PSA screening normally occurs between the ages of 50 and 75 in men with no risk factors for prostate cancer. For men with a family history or of African-American ethnicity, PSA screening starts between the ages of 40 and 45. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values
19. A patient should fast eight hours prior to venipuncture to evaluate the lipase level. ANS: T
Measurements of lipase can be performed by blood draw from the vein. A patient normally fasts 8 hours before this test. OBJ: Explain the role of laboratory tests and normal range of values. TOP: Laboratory values 20. A rise of alanine aminotransferase in the blood serves as an indicator of specific liver
damage. ANS: T
ALT is normally present in large concentrations in the liver, however, when ALT levels rise in the blood, it serves as an indicator of specific liver damage. OBJ: Contrast patient’s values to normal, high, and low lab values. TOP: Laboratory values 21. Blood samples to evaluate lactate dehydrogenase may be drawn from either a vein or from
body fluid such as a spinal tap. ANS: T
LD levels from a blood test can help determine anemia, acute or chronic tissue damage, determine or monitor cancers, and detect severe infections. Body fluid (cerebrospinal or pleural) LD can distinguish meningitis and help determine injury or inflammation, or imbalance from blood pressure or protein in the blood. OBJ: List methods used to obtain lab samples.
TOP: Laboratory values
Chapter 9: The Abdominal Aorta Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The aorta is referred to as the abdominal aorta a. when it leaves the left ventricular outflow tract. b. when it follows a candy cane-shaped loop down into the thoracic cavity. c. before it reaches the aortic hiatus on the diaphragm. d. after it reaches the aortic hiatus on the diaphragm. ANS: D
After the aorta passes posterior to the diaphragm at the aortic hiatus on the posterosuperior portion of the diaphragm, it is called the abdominal aorta. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 2. The celiac axis bifurcates into which branches? a. Main pancreatic artery, left gastric artery, and splenic artery b. Left gastric artery, right gastric artery, and common hepatic artery c. Left gastric artery, common hepatic artery, and splenic artery d. Common hepatic artery, main pancreatic artery, and splenic artery ANS: C
The celiac artery branches into the left gastric, common hepatic, and splenic arteries. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 3. The left gastric artery supplies the a. left side of the lesser curvature of the stomach. b. right side of the lesser curvature of the stomach. c. left side of the greater curvature of the stomach. d. right side of the greater curvature of the stomach. ANS: A
The left gastric artery courses superiorly and supplies the left side of the lesser curvature of the stomach. It eventually anastomoses with the right gastric artery. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 4. The splenic artery supplies the a. spleen, left kidney, and pancreas. b. spleen, pancreas, and stomach. c. spleen, pancreas, and left adrenal gland. d. spleen, pancreas, and left lobe of the liver. ANS: B
The splenic artery supplies the spleen, pancreas, and left side of the greater curvature of the stomach. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 5. The common hepatic artery branches into the a. celiac and gastroduodenal arteries. b. celiac and splenic arteries. c. gastroduodenal and proper hepatic arteries. d. proper hepatic and celiac arteries. ANS: C
The common hepatic artery branches into the gastroduodenal and proper hepatic arteries. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 6. The adrenal (or suprarenal) arteries branch off the aorta a. superior to the level of the celiac artery. b. between the renal and superior mesenteric arteries. c. between the gonadal and renal arteries. d. between the celiac and superior mesenteric arteries. ANS: D
The suprarenal arteries commonly originate between the celiac and superior mesenteric arteries. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 7. The inferoposterior pancreatic duodenal artery feeds the pancreatic head and duodenal area
and is a branch of the a. celiac artery. b. superior mesenteric artery. c. pancreatic artery. d. suprarenal arteries. ANS: B
The inferoposterior pancreatic duodenal artery arises from the superior mesenteric artery and feeds the pancreatic head and duodenal area. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 8. The gonadal arteries arise from the aorta superior to the a. superior mesenteric artery. b. renal artery. c. adrenal arteries. d. inferior mesenteric artery. ANS: D
The gonadal arteries arise superior to the inferior mesenteric artery and inferior to the superior mesenteric and renal arteries. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 9. The median sacral artery is superior to the a. renal arteries. b. adrenal arteries. c. gonadal arteries. d. common iliac arteries. ANS: D
The median sacral artery is the most inferior branch of the abdominal aorta. It arises just superior to the bifurcation into the common iliac arteries. OBJ: Describe the location of the aortic branches and the organs supplied by those branches. TOP: Location 10. The average anteroposterior diameter of the adult abdominal aorta is a. 1 cm. b. 1.5 cm. c. 2 cm. d. 3 cm. ANS: C
The size of the normal abdominal aorta varies, depending on body habitus. The average anteroposterior diameter is 2 cm at the most superior portion of the adult abdomen. Coursing inferiorly, the aorta decreases in size. The average measurement at its bifurcation into the common iliac arteries is 1.5 cm. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 11. Which aortic wall layer(s) is/are responsible for contraction and recoil? a. Tunica media b. Tunica intima c. Tunica adventitia d. Tunica intima and adventitia ANS: A
Arteries often have a thicker tunica media to allow for greater elasticity. OBJ: Describe the layers (gross anatomy) of an artery. 12. Angiotensin II is a hormone that causes a. the release of renin. b. vasodilatation. c. vasoconstriction. d. bleeding. ANS: C
TOP: Gross Anatomy
Angiotensin II is a hormone that is released in the event of bleeding to initiate vasoconstriction and to help maintain blood pressure. OBJ: Describe the function of the aorta.
TOP: Physiology
13. Sonographically, in a longitudinal section, the abdominal aorta appears as a a. pulsatile, tubular, anechoic lumen with bright, echogenic walls. b. pulsatile, axial, anechoic lumen with bright, echogenic walls. c. non-pulsatile axial, anechoic lumen with anechoic walls. d. None are correct ANS: A
The arterial vasculature normally displays an anechoic lumen with bright, echogenic walls that clearly delineate it from adjacent structures. Larger vessels often display significant pulsatility. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 14. Which is not a diagnostic test to evaluate the arterial system? a. Segmental blood pressures b. Plethysmography c. Densitometry d. Arteriography ANS: C
Diagnostic tests to evaluate the arterial system include duplex Doppler sonography, color-flow Doppler, plethysmography, segmental blood pressures, arteriography, computed tomography, and magnetic resonance imaging. OBJ: Describe the associated laboratory values and diagnostic tests. TOP: Reference Charts 15. A low-resistance waveform should normally be present in all of these areas except the a. external carotid artery. b. kidneys. c. abdominal organs. d. brain. ANS: A
A low-resistance waveform should be present in arteries that feed low-resistance beds such as the brain, kidneys, and abdominal organs. High-resistance waveforms will be seen in the external carotid artery, extremities, and preprandial SMA. OBJ: Describe the associated laboratory values and diagnostic tests. TOP: Reference Charts 16. The aorta is a. anterior b. posterior c. medial d. lateral
to the body of the pancreas.
ANS: A
The aorta lies posterior to the body of the pancreas. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 17. The aorta is left lateral to the spine and a. anterior b. posterior c. medial d. lateral
to the left kidney.
ANS: C
The aorta lies medial to the left kidney. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 18. The left lobe of the liver is a. anterior b. posterior c. superior d. inferior
to the aorta.
ANS: A
The aorta lies posterior to the left lobe of the liver. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 19. The left renal vein courses a. anterior b. posterior c. superior d. inferior
to the aorta.
ANS: A
The aorta courses posterior to the left renal vein. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 20. The aorta is left lateral to the spine and is a. anterior b. posterior c. left lateral d. right lateral
to the psoas major muscle.
ANS: A
The aorta lies anterior to the psoas major muscle. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location
TRUE/FALSE 1. The celiac artery (CA) can be seen with reasonable consistency on ultrasound. ANS: T
The celiac artery is demonstrated with reasonable consistency on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 2. The superior mesenteric artery (SMA) can be seen with reasonable consistency on
ultrasound. ANS: T
The superior mesenteric artery is demonstrated with reasonable consistency on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 3. The renal arteries (RA) can be seen with reasonable consistency on ultrasound. ANS: T
The renal arteries are demonstrated with reasonable consistency on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 4. The inferior mesenteric artery (IMA) can be seen with reasonable consistency on
ultrasound. ANS: F
The IMA is not consistently demonstrated on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 5. The gonadal arteries can be seen with reasonable consistency on ultrasound. ANS: F
The gonadal arteries are not typically demonstrated on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 6. The splenic artery (SPA) can be seen with reasonable consistency on ultrasound. ANS: T
The longitudinal sections of the SPA and the CHA represent the wings of the bird, and the short tubular section of the CA represents the body. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance
7. The common hepatic artery (CHA) can be seen with reasonable consistency on ultrasound. ANS: T
The common hepatic artery is demonstrated with reasonable consistency on ultrasound. The longitudinal sections of the SPA and the CHA represent the wings of the bird, and the short tubular section of the CA represents the body. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 8. The common iliac arteries can be seen with reasonable consistency on ultrasound. ANS: T
The common iliac arteries are demonstrated with reasonable consistency on ultrasound. OBJ: Describe the sonographic appearance of the aorta and its branches. TOP: Sonographic Appearance 9. The aorta has multiple branches that carry oxygen-rich blood back to the heart. ANS: F
Along its course, the aorta gives off multiple branches that supply body structures with oxygen-rich blood. OBJ: Discuss the function of the aorta.
TOP: Physiology
10. The arterial system contains valves that allow it to maintain blood pressure. ANS: F
The venous system is capable of maintaining blood pressure through its valves; however, valves are not present in the arterial system. OBJ: Discuss the function of the aorta.
TOP: Physiology
11. The aorta lies posterior to the pylorus of the stomach. ANS: T
The aorta is posterior to th left renal vein, SMA, splenic vein, pancreas body/tail, celiac artery, splenic artery, CHA, left gastric artery, inferior duodenum, stomach, peritoneum, liver, and diaphragm (proximal abdominal aorta). OBJ: Describe the normal location, course, and size of the aorta. TOP: Location 12. The aorta courses medial to the left crus of the diaphragm. ANS: T
The aorta is medial to the splenic artery, left renal artery, left kidney, left ureter, left adrenal gland, pancreas tail, ascending duodenum, and left crus of the diaphragm. OBJ: Describe the normal location, course, and size of the aorta.
TOP: Location 13. The aorta courses right lateral to the right adrenal gland. ANS: F
The aorta courses left lateral to the right adrenal gland. OBJ: Describe the normal location, course, and size of the aorta. TOP: Location
Chapter 10: The Inferior Vena Cava Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The IVC can be divided into the following sections: a. Suprahepatic, infrahepatic, and midhepatic b. Hepatic, prerenal, renal, and postrenal c. Hepatic, lumbar, renal, and gonadal d. All of the these ANS: B
The IVC is considered to have four sections, from superior to inferior: hepatic, prerenal, renal, and postrenal. OBJ: Discuss the normal location and course of the IVC.
TOP: Location
2. From inferior to superior, identify the veins that converge into the IVC. a. Common iliac veins, lumbar veins, renal veins, and left and right suprarenal veins b. Common iliac veins, lumbar veins, renal veins, right gonadal vein, and hepatic
veins c. Hepatic veins, renal veins, left and right gonadal veins, and left and right
suprarenal veins d. External iliac veins, left suprarenal vein, right gonadal vein, renal veins, and
hepatic veins ANS: B
Inferiorly, the IVC is formed by the common iliac veins. Moving superiorly, the lumbar veins empty into the IVC, followed by the renal veins, right gonadal vein, and hepatic veins. The left gonadal vein and left suprarenal vein frequently empty directly into the left renal vein, not the IVC. The right gonadal vein is slightly superior to the right renal vein and most often empties directly into the IVC as well. OBJ: Discuss the major tributaries that feed into the IVC, along with the organs emptied by these tributaries. TOP: Location 3. The inferior phrenic veins are located a. at the same level as the hepatic veins. b. superior to the hepatic veins. c. inferior to the hepatic veins. d. inferior to the middle hepatic vein only. ANS: B
The inferior phrenic veins, the most superior branches of the IVC, drain the diaphragm. OBJ: Discuss the major tributaries that feed into the IVC, along with the organs emptied by these tributaries. TOP: Location 4. The diameter of the normal adult IVC is approximately a. 1 cm. b. 1.5 cm.
c. 2.5 cm. d. 3 cm. ANS: C
The normal adult IVC is 2.5 cm in diameter. The diameter increases with the Valsalva maneuver or inspiration and commonly decreases during expiration. OBJ: Discuss the normal location and course of the IVC.
TOP: Location
5. Blood is moved forward through the veins by a. gravity. b. the force of the aorta. c. valves, which close to prevent antegrade flow. d. a decrease in thoracic pressure, which pulls the blood to the right atrium. ANS: D
The venous circulatory system is a low pressure system compared to the arterial system. The momentum of the blood during systole forces the venous valves to open as the blood is pushed forward. Also, blood is pulled toward the right atrium by a decrease in thoracic pressure. OBJ: Discuss the function of the IVC.
TOP: Physiology
6. In a transverse scanning plane image, the left renal vein can be seen as a(n) a. straight structure posterior to the SMA. b. axial structure near the left kidney. c. longitudinal, curvilinear structure anterior to the aorta. d. oval structure that empties into the medial IVC. ANS: C
In a transverse scanning plane, the left renal vein is seen as a longitudinal, curvilinear structure that courses anterior to the aorta and posterior to the SMA and empties into the IVC. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 7. Where should the transducer be placed to visualize the common iliac veins? a. On the right and left groin areas b. Near the umbilicus c. At the symphysis pubis d. None of these ANS: B
The common iliac veins are most easily visualized in the transverse scanning plane at approximately the level of the umbilicus, before they converge to form the IVC. OBJ: Discuss the normal location and course of the IVC. 8. The IVC is a. medial b. lateral
to the right kidney.
TOP: Location
c. anterior d. posterior ANS: A
The IVC is medial to the right kidney. OBJ: Discuss the normal location and course of the IVC. 9. The IVC is a. anterior b. posterior c. right lateral d. left lateral
TOP: Location
to the aorta.
ANS: C
The IVC courses to the right of the aorta (right lateral). OBJ: Discuss the normal location and course of the IVC. 10. The IVC is a. anterior b. posterior c. superior d. inferior
TOP: Location
to the hepatic veins.
ANS: B
The IVC courses posterior to the hepatic veins. OBJ: Discuss the normal location and course of the IVC.
TOP: Location
TRUE/FALSE 1. The walls of the hepatic veins are brightly echogenic. ANS: F
The hepatic veins demonstrate appear as anechoic linear structures, whose walls are not obvious. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 2. The hepatic veins are anechoic. ANS: T
The hepatic veins often can be seen in the most superior portion of the liver as anechoic, linear structures with nondescript walls. They originate in the liver and empty into the IVC. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 3. Echoes thought to be associated with blood flow sometimes can be seen in the IVC.
ANS: T
Small moving echoes often are visualized in the lumen of the IVC. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 4. The hepatic veins can best be seen in the superior section of the liver. ANS: T
The hepatic veins often can be seen in the most superior portion of the liver as anechoic, linear structures with nondescript walls. They originate in the liver and empty into the IVC. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 5. The gonadal veins are easily seen on ultrasound. ANS: F
The gonadal veins are not consistently imaged with ultrasound. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 6. The right renal vein is easily seen on ultrasound. ANS: T
The renal veins are consistently recognized with ultrasound. The right renal vein can be seen as a longitudinal, curvilinear structure emptying into the lateral aspect of the IVC. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 7. The lumbar veins are easily seen on ultrasound. ANS: F
The lumbar veins are not consistently imaged with ultrasound. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 8. The left hepatic vein is routinely seen on ultrasound. ANS: T
The hepatic veins are routinely visualized with ultrasound. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 9. The left common iliac vein is easily seen on ultrasound. ANS: T
The common iliac veins are most easily visualized with ultrasound. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 10. The right hepatic vein is easily seen on ultrasound. ANS: T
The hepatic veins are routinely visualized with ultrasound. OBJ: Discuss the sonographic appearance of the IVC and commonly visualized tributaries. TOP: Sonographic Appearance 11. The IVC is posterior to the intestines. ANS: T
The IVC is posterior to the pancreas head/uncinate process, transverse duodenum, portal vein, CBD, posterior surface of liver, and hepatic veins. OBJ: Discuss the normal location and course of the IVC.
TOP: Location
12. The IVC is anterior to the body of the liver. ANS: F The IVC is posterior to the body of the liver. OBJ: Discuss the normal location and course of the IVC.
TOP: Location
Chapter 11: The Portal Venous System Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Tributaries of the portal vein include which vessels? a. Right and left gastric veins and pancreaticoduodenal veins b. Splenic and superior and inferior mesenteric veins c. Gastroepiploic and right and left gastric veins d. All of the these ANS: D
Portal vein tributaries include the splenic, superior mesenteric, cystic, pyloric, left and right gastric, pancreaticoduodenal, gastroepiploic, and inferior mesenteric veins. OBJ: Discuss the normal location of the portal vein tributaries.
TOP: Location
2. Where does the portal vein form in the body? a. At the tail of the pancreas b. At the left lobe of the liver c. Near the head of the pancreas d. Where it first enters the liver ANS: C
The portal vein is located at the level of the second lumbar vertebra, directly posterior to the neck of the pancreas and anterior to the IVC. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 3. After the main portal vein forms, the vessel courses a. superiorly for 5 to 6 cm and then bifurcates into the right and left branches. b. laterally for 7 to 8 cm and then bifurcates into the medial and lateral branches. c. medially for 3 to 4 cm and then bifurcates into the anterior and posterior branches. d. inferiorly for 5 to 6 cm and then bifurcates into the anterior and posterior branches. ANS: A
The main portal vein courses approximately 5 to 6 cm posterior and superior to the second portion of the duodenum, where it divides into the right and left portal veins. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 4. The normal main portal vein measures up to a. 5 cm in diameter and 3 to 4 cm long. b. 5 cm in diameter and 5 to 6 cm long. c. 13 mm in diameter and 5 to 6 cm long. d. 10 cm in diameter and 3 to 4 cm long. ANS: C
The main portal vein normally measures up to 13 mm in diameter and approximately 5 to 6 cm in length before it divides into the right and left portal veins. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 5. What happens to the right and left portal vein branches? a. The right branches into medial and lateral segments, and the left branches into
anterior and posterior segments. b. The right branches into superior and inferior segments, and the left branches into
anterior and posterior segments. c. The right branches into anterior and posterior segments, and the left branches into
medial and lateral segments. d. The right branches into anterior and posterior segments, and the left branches into
superior and inferior segments. ANS: C
The right portal vein divides into anterior and posterior segments, and the left portal vein divides into medial and lateral segments. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 6. The portal vein a. supplies blood for detoxification. b. supplies blood for splenic function. c. removes blood from the liver. d. drains into the inferior vena cava. ANS: A
The portal system is unique, because it carries blood and nutrients from the bowel and abdominal organs to the liver for metabolism and detoxification. OBJ: Describe the function of the portal venous system.
TOP: Physiology
7. The portal triad is located a. throughout the liver. b. in several places in the liver. c. in the right lobe of the liver. d. high-level echoes. ANS: A
The portal triad is made up of hepatic arteries, bile ducts, and portal veins. It spreads throughout the lobes and segments of the liver. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 8. The echogenicity of the portal venous walls can be described as a. anechoic. b. low-level echoes. c. medium-level echoes.
d. high-level echoes. ANS: D
The walls of the portal veins appear hyperechoic on ultrasound. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 9. The echogenicity of the superior mesenteric vein lumen can be described as a. anechoic. b. low-level echoes. c. medium-level echoes. d. high-level echoes. ANS: A
The lumen of the superior mesenteric vein appears anechoic on ultrasound. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 10. Which of the following physicians interpret various imaging tests used to diagnose
diseases? a. Surgeon b. Internist c. Radiologist d. All of these ANS: C
A radiologist performs and interprets the various imaging tests used to diagnose diseases related to the portal venous system. OBJ: Discuss associated diagnostic tests.
TOP: Reference Charts
11. Which is most often used as primary diagnostic tool in evaluating the portal venous
system? a. Computed axial tomography b. Magnetic resonance imaging c. Portal venography d. Sonography ANS: D
Sonography can easily verify the intraluminal contents and direction of flow of the portal vein so it often used as a primary diagnostic tool in evaluating the portal venous system. OBJ: Discuss associated diagnostic tests.
TOP: Reference Charts
TRUE/FALSE 1. The medial branch of the left portal vein is easier to visualize than the lateral branch. ANS: F
The left lateral branch is more commonly visualized than the left medial branch.
OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 2. The bifurcation of the right portal vein is best seen in a sagittal scanning plane. ANS: F
The right portal vein is best visualized in the transverse plane. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 3. In a transverse scanning plane, the main portal vein initially appears in an axial section as
an oval, anechoic structure. ANS: T
The main portal vein initially courses in a horizontal orientation and is best visualized in the transverse plane. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 4. The bifurcation of the left portal vein is best seen in a sagittal scanning plane. ANS: F
The bifurcation of the left portal vein is demonstrated in the transverse scanning plane. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 5. The union of the superior mesenteric vein and splenic vein is best appreciated in a
transverse scanning plane. ANS: T
In a transverse scanning plane, at the mid-epigastrium, the origin of the portal vein or portal splenic confluence appears as an oval or round structure where the splenic vein and superior mesenteric vein unite, directly posterior to the neck of the pancreas. OBJ: Describe the sonographic appearance of the portal vein and its tributaries. TOP: Sonographic Appearance 6. The portal triad is made up of hepatic arteries, bile ducts, and superior mesenteric veins. ANS: F Portal triads are composed of an hepatic artery and a bile duct that run alongside a portal vein surrounded by a sheath of connective tissue. OBJ: Discuss the normal location, course, and size of the portal vein. TOP: Location 7. The most common reason for examination of the portal vein is to evaluate for portal
hypertension.
ANS: T OBJ: Describe the function of the portal venous system. TOP: Sonographic Applications 8. Portal venography can detect the direction and magnitude of flow within a portal vein. ANS: F OBJ: Discuss associated diagnostic tests. TOP: Reference Charts
Chapter 12: The Liver Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which is a function of the liver? a. Serving as a reservoir of blood b. Synthesizing blood proteins and heparin c. Storing minerals and vitamins d. All of these ANS: D
The functions of the liver include its usefulness as a reservoir for blood that is released as the liver regulates blood volume and blood flow through the body. Detoxification of poisonous and harmful substances absorbed by the intestine is a protective function of the liver. Additional metabolic functions of the liver include the storage of minerals and vitamins, formation of vitamin A, metabolism of steroid hormones, and degradation and detoxification of drugs such as alcohol and barbiturates. The synthesis of blood plasma proteins, which include albumin and various globulins, is a formative function of the liver. Prothrombin and fibrinogen are blood-clotting factors. The synthesis of heparin, an anticoagulant, also takes place in the liver. OBJ: Identify the principal functions of the liver.
TOP: Physiology
2. Each is a blood plasma protein or clotting factor except a. fibrinogen. b. prothrombin. c. albumin. d. arginine. ANS: D
The synthesis of blood plasma proteins, which include albumin and various globulins, is a formative function of the liver. Prothrombin and fibrinogen are blood-clotting factors. Arginine is an amino acid. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values related to the liver. TOP: Reference Charts 3. The left portal vein serves as a. an intralobar boundary b. intralobar drainage c. an intersegmental boundary d. intersegmental drainage
between the medial and lateral left lobe.
ANS: C
Although the hepatic veins usually divide the liver segments, the left portal vein serves as an intersegmental boundary between the medial and lateral segments of the left lobe on caudal transverse scans of the left hepatic lobe.
OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
4. Kupffer cells are specialized liver cells that play a major role in the body’s a. defense. b. nutrition. c. storage capacity. d. fat emulsification. ANS: A
Kupffer cells protect the hepatocytes by engulfing toxic or harmful substances, including ethanol from alcohol ingestion. The importance of this cell function is still being studied. One research study reports that the activation of Kupffer cells may reduce liver damage from hepatocarcinoma, ethanol ingestion, or other toxic agents. OBJ: Identify the principal functions of the liver. 5. The a. superior b. inferior c. anterior d. posterior
TOP: Physiology
surface of the liver normally rests on the abdominal organs.
ANS: B
The inferior (or visceral) surface of the liver rests on the upper abdominal organs. OBJ: Describe the location of the liver.
TOP: Location
6. The right and left lobes of the liver are related to the a. anterior surface b. superior surface c. posterior surface d. undersurface
of the diaphragm.
ANS: D
The right lobe of the liver is related to the right lateral undersurface of the diaphragm, along the right midaxillary line from the seventh to the eleventh ribs. The left lobe of the liver is closely related to the undersurface of the diaphragm. OBJ: Describe the location of the liver.
TOP: Location
7. Which is NOT related to the caudate lobe of the liver? a. Splenic vein b. Left portal vein c. Inferior vena cava d. Ligamentum venosum ANS: A
The anterior boundary of the caudate lobe is marked by the posterior surface of the left portal vein. The posterior boundary is the IVC. The ligamentum venosum separates the caudate lobe from the left lobe of the liver. OBJ: Identify the ligaments, segments, and fissures of the liver.
TOP: Gross Anatomy 8. The boundaries of the bare area of the liver include a. left coronary ligament, transverse colon, and stomach antrum. b. lesser sac, hepatoduodenal ligament, and right kidney. c. inferior vena cava, main portal vein, and middle hepatic vein. d. falciform, coronary, and triangular ligaments. ANS: D
The boundaries of the bare area include the falciform ligament, right anterior inferior and right posterior superior coronary ligaments, right triangular ligament, gastrohepatic ligament, left anterior and left posterior coronary ligaments, and left triangular ligament. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 9. The liver occupies a major portion of the a. umbilical b. right hypochondriac c. hypogastric d. epigastric
region.
ANS: B
The liver occupies a major portion of the right hypochondrium. Normally, it extends inferiorly into the epigastrium and laterally into the left hypochondrium. OBJ: Describe the location of the liver.
TOP: Location
10. The quadrate lobe of the liver is also referred to as a. the papillary projection. b. the main lobar fissure. c. the medial portion of the left lobe. d. Glisson’s capsule. ANS: C
The anterior midportion of the inferior surface is the medial portion of the left lobe of the liver. This portion is also referred to as the quadrate lobe of the liver. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 11. A normal left hepatic lobe is a. variable b. never larger than the right c. fixed d. independent of the quadrate lobe
in size and shape.
ANS: A
A normal hepatic lobe varies in size and shape. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Location
12. The liver metabolizes a. complex sugars. b. fats, carbohydrates, and proteins. c. blood proteins. d. All of these ANS: B
The liver metabolizes fats, carbohydrates, and proteins and forms bile and urea. Additional metabolic functions of the liver include the storage of minerals and vitamins, formation of vitamin A, metabolism of steroid hormones, and degradation and detoxification of drugs, such as alcohol and barbiturates. OBJ: Identify the principal functions of the liver. 13. The liver is composed of a. three b. four c. six d. two
TOP: Physiology
lobes.
ANS: A
The liver is divided into three lobes: a right lobe, a left lobe, and a caudate lobe. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 14. The left hepatic vein and the left hepatic lobe are separated from the caudate lobe by the a. intrasegmental fissure. b. intersegmental fissure. c. fissure for the ligamentum venosum. d. bare area of the liver. ANS: C
The caudate lobe is separated from the left hepatic lobe by the proximal portion of the left hepatic vein and the fissure for the ligamentum venosum. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 15. The portal system supplies a. 25% b. 30% c. 50% d. 75%
of the total blood flow to the liver.
ANS: D
The portal system supplies 75% of the total blood flow to the liver. OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
16. The three main tributaries to the portal confluence are the inferior mesenteric vein, the
superior mesenteric vein, and the a. left gastric vein. b. splenic vein. c. portal vein. d. gastroduodenal vein. ANS: B
The portal system supplies 75% of total blood flow to the liver and provides three main tributaries to the portal confluence: the splenic vein, the superior mesenteric vein, and the inferior mesenteric vein. OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
17. In patients with severe portal hypertension, the left portal vein may communicate with the a. umbilical vein. b. right portal vein. c. left hepatic vein. d. splenic vein. ANS: A
In patients with severe portal hypertension, the left portal vein enters the falciform ligament and communicates with the recanalized ligamentum teres, which had been the postnatally obliterated umbilical vein. OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
18. Blood flow to the caudate lobe is supplied by the a. hepatic artery. b. right portal vein. c. left portal vein. d. right and left portal veins. ANS: D
The caudate lobe is supplied with blood by the right and left portal veins. OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
19. The portal veins and hepatic arteries enter the liver and the hepatic ducts exit through the a. foramen of Winslow. b. porta hepatis. c. pouch of Morrison. d. lesser sac. ANS: B
The porta hepatis is the opening in the liver through which the portal veins and hepatic arteries enter and the hepatic ducts exit. OBJ: Describe and identify the vasculature of the liver. 20. The hepatic artery and common bile duct course _
level of the porta hepatis.
TOP: Gross Anatomy
to the portal veins at the
a. b. c. d.
lateral medial anterior posterior
ANS: C
The common bile duct and hepatic artery course anterior to the portal vein in the portal triad at the level of the porta hepatis. OBJ: Describe and identify the vasculature of the liver.
TOP: Gross Anatomy
21. The normal sonographic appearance of the liver is a. homogeneous. b. heterogeneous. c. decreased in echogenicity relative to the kidney. d. isoechoic compared to the kidney. ANS: A
The liver should be homogeneous and moderately echogenic throughout. OBJ: Describe the sonographic appearance of the liver.
TOP: Sonographic Appearance
22. The main lobar fissure represents a a. marker identifying the falciform ligament. b. boundary between the right and left lobes. c. division between the medial and lateral portions of the left lobe. d. landmark fissure of the caudate lobe. ANS: B
A boundary between the left and right hepatic lobes can be imagined along a line coursing posteriorly from the gallbladder fossa to the groove for the IVC. This line is the main lobar fissure. OBJ: Describe the sonographic appearance of the liver. 23. Proximal to the
TOP: Sonographic Appearance
, the left portal vein takes a C-shaped, superior course
in the liver. a. ligamentum venosum b. left hepatic vein c. coronary ligament d. falciform ligament ANS: D
The left portal vein may be visualized on its C-shaped, superior course proximal to the falciform ligament. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 24. Which of the following may be identified as a fibrous cord that was patent before birth and
extends upward from the diaphragm to the anterior wall? a. Hepatoduodenal ligament
b. Main lobar fissure c. Round ligament d. Cardinal ligament ANS: A
The round ligament (ligamentum teres) is the obliterated umbilical vein, a fibrous cord that extends upward from the diaphragm to the anterior abdominal wall. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Gross Anatomy 25. Which description of the location of the liver is correct? a. Inferior to the dome of the diaphragm b. Superior to the bony lumbar region of the posterior abdominal wall c. Anterior to the right costal margin d. Posterior to the esophagogastric junction ANS: A
The anterosuperior surface of the liver fits snugly inferior to the dome of the diaphragm. OBJ: Describe the location of the liver.
TOP: Location
26. “A tongue-like extension of the right lobe of the liver” describes a(n) a. quadrate lobe. b. Riedel’s lobe. c. accessory liver. d. direct papillary process. ANS: B
Riedel’s lobe is a tongue-like, inferior extension of the right lobe as far caudally as the iliac crest. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Normal Variants 27. The visceral surface of the liver is superior and anterior to which of the following? a. Gallbladder b. Lungs c. Left third of the transverse colon. d. Sigmoid colon ANS: A
The inferior (visceral) surface of the liver is marked by indentations from organs in contact with its surface, including the gallbladder, pylorus, duodenum, right colon, right hepatic flexure of the colon, right third of the transverse colon, right adrenal gland, and right kidney. OBJ: Describe the location of the liver.
TOP: Location
28. Tumor invasion of the portal vein may be observed in association with cancerous lesions
of the liver or with metastases. Color Doppler scanning demonstrates tumor vascularity within the portal vein lesion by the presentation of
a. b. c. d.
low-resistance venous signals. low-resistance arterial signals. high-resistance venous signals. high-resistance arterial signals.
ANS: B
To differentiate tumor invasion from portal vein thrombosis, color Doppler imaging can be used to demonstrate tumor vascularity presenting with low-resistance arterial signals within the portal vein lesion. OBJ: Describe the sonographic appearance of the liver.
TOP: Sonographic Appearance
29. Prominent pulsatility of the Doppler waveform in the portal vein is a. normal. b. abnormal. ANS: B
Abnormally prominent pulsatility may be observed in patients with right heart failure, tricuspid regurgitation, portal hypertension, or a fistula between a hepatic and a portal vein. OBJ: Describe the sonographic appearance of the liver.
TOP: Sonographic Appearance
30. Which of the following is a major component of the bile secreted by the liver? a. Cholesterol b. Bilirubin c. Lecithin d. All of these ANS: D
Cholesterol, a major component of the bile secreted by the liver, emulsifies fats. The presence of cholesterol in the bile is a result of cholesterol’s solubility in the presence of bile salts and the phospholipid lecithin. These substances, along with the bile pigments bilirubin (reddish) and biliverdin (greenish), are the primary components of bile. OBJ: Identify the principal functions of the liver.
TOP: Physiology
31. Cholesterol is most commonly is associated with a. fat b. protein c. carbohydrate d. enzyme
metabolism.
ANS: A
Fat metabolism results in the formation of cholesterol and phospholipids. Phospholipids are structural components of cell membranes that protect the cell’s contents from its environment. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology 32. Amino acids are most commonly is associated with
metabolism.
a. b. c. d.
fat protein carbohydrate Lipid
ANS: B
Protein metabolism results in the synthesis of amino acids into proteins. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology TRUE/FALSE 1. The free inferior margin of the left lobe lies adjacent to the hepatic flexure. ANS: F
The free inferior margin of the left lobe is closely related to the gastric body and antrum of the stomach. It frequently lies anterior to the body of the pancreas, the splenic vein, and the splenic artery. OBJ: Describe the location of the liver.
TOP: Location
2. The inferior surface of the liver is marked by indentations from the pancreas. ANS: F The inferior (visceral) surface of the liver is marked by indentations from organs in contact with its surface, including the gallbladder, pylorus, duodenum, right colon, right hepatic flexure of the colon, right third of the transverse colon, right adrenal gland, and right kidney. OBJ: Identify the ligaments, segments, and fissures of the liver. TOP: Location 3. Cell membranes are most commonly is associated with protein metabolism. ANS: F
Fat metabolism results in the formation of cholesterol and phospholipids. Phospholipids are structural components of cell membranes that protect the cell’s contents from its environment. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology 4. Ketones are most commonly is associated with fat metabolism. ANS: T
Fat is absorbed from fatty acids and desaturated in the liver. Ketones are intermediary products formed during this process. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology 5. Glycogenesis is most commonly is associated with carbohydrate metabolism.
ANS: T
Carbohydrate metabolism in the liver involves the process of glycogenesis. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology 6. Diabetes is most commonly is associated with protein metabolism. ANS: F
Diabetes mellitus is a commonly identified disease characterized by high levels of glucose in the blood. OBJ: Differentiate between carbohydrate, protein, and fat metabolism in the liver. TOP: Physiology
Chapter 13: The Biliary System Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. At the midepigastrium, in the transverse view, the order of structures, from midline to right,
is a. b. c. d.
portal vein, head of the pancreas, duodenum, liver, and gallbladder. portal vein, duodenum, superior mesenteric vein, right kidney, and gallbladder. portal vein, head of the pancreas, gallbladder, right kidney, and liver. splenic vein, superior mesenteric vein, duodenum, gallbladder, and portal vein.
ANS: A
In the transverse view, the order of structures from midline to right is: the portal vein, formed by the superior mesenteric vein and splenic vein at the neck of the pancreas; the head of the pancreas; and a portion of the duodenum, liver, and gallbladder. Continuing right, more liver tissue is seen. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 2. The relationship of the gallbladder and the right kidney can be stated as a. the right kidney is anterior to the gallbladder. b. the right kidney is superior to the gallbladder. c. the right kidney is posterior to the gallbladder. d. the right kidney is inferior to the gallbladder. ANS: C
The right kidney lies posterior to the gallbladder. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
3. The left and right hepatic ducts form the a. cystic duct. b. common duct. c. common bile duct. d. portal triad. ANS: B
The left and right hepatic ducts join to form the biliary duct or common duct. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
4. The relationship of the portal vein, common bile duct, and hepatic artery can be stated as a. the common bile duct lies medial to the portal vein, and the hepatic artery is
located lateral to the portal vein. b. the portal vein lies medial to the common bile duct and the hepatic artery. c. the portal vein lies lateral to the common bile duct and the hepatic artery. d. the common bile duct is located lateral to the portal vein, and the hepatic artery lies
medial to the portal vein.
ANS: D
The portal vein, common bile duct, and hepatic artery form a portal triad, known as the “Mickey’s” sign in the transverse view. The portal vein is the face, the hepatic artery forms the left ear (medial to the portal vein), and the common bile duct forms the right ear (lateral to the portal vein). OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
5. The route of bile secretion directly from the liver to the gallbladder is via the a. common bile duct. b. cystic duct. c. right hepatic duct. d. left hepatic duct. ANS: B
Bile is excreted from the liver and eventually collected by the right and left hepatic ducts. It then is routed to the cystic duct, which conveys the bile directly to the gallbladder. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
6. The gastroduodenal artery is a branch of the a. celiac artery. b. proper hepatic artery. c. splenic artery. d. common hepatic artery. ANS: D
The gastroduodenal artery is a branch of the common hepatic artery, which also gives off the proper hepatic artery. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
7. The diameter of the cystic duct is a. 1 to 7 mm. b. 8 to 11.5 cm. c. 3 mm. d. 1 to 3.5 cm. ANS: C
The cystic duct measures 3 mm in diameter. OBJ: Describe the gross anatomy of the biliary system. 8. The length of the cystic duct is a. 1 to 7 mm. b. 8 to 11.5 cm. c. 3 mm. d. 1 to 3.5 cm. ANS: D
The cystic duct measures 1 to 3.5 cm in length.
TOP: Size
OBJ: Describe the gross anatomy of the biliary system.
TOP: Size
9. The length of the common hepatic duct is a. 0.5 to 2.5 cm. b. 3 to 5 cm. c. 2 to 6.5 mm. d. 8 to 11.5 cm. ANS: C
The common hepatic duct measures 3 to 5 cm in length. OBJ: Describe the gross anatomy of the biliary system.
TOP: Size
10. The length of the right and left hepatic ducts is a. 0.5 to 2.5 cm. b. 3 to 5 cm. c. 1 to 7 mm. d. 8 to 11.5 cm. ANS: A
The right and left hepatic ducts measure 0.5 to 2.5 cm in length. The left hepatic duct generally is longer than the right hepatic duct. OBJ: Describe the gross anatomy of the biliary system.
TOP: Size
11. The diameter of the common bile duct is a. 0.5 to 2.5 cm. b. 3 to 5 cm. c. 1 to 7 mm. d. 8 to 11.5 cm. ANS: C
The common bile duct measures 1 to 7 mm in diameter. OBJ: Describe the gross anatomy of the biliary system.
TOP: Size
12. The length of the common bile duct is a. 0.5 to 2.5 cm. b. 3 to 5 cm. c. 1 to 7 mm. d. 8 to 11.5 cm. ANS: D
The common bile ducts measures 8 to 11.5 cm in length. OBJ: Describe the gross anatomy of the biliary system. 13. The common sections of the gallbladder are a. fundus, body, and neck. b. neck and bottom. c. fundus and neck. d. neck. body, and rugae.
TOP: Size
ANS: A The gallbladder may be descriptively divided into three major sections: fundus, body, and neck. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
TRUE/FALSE 1. The gallbladder fossa can be identified close to the main lobar fissure. ANS: T
The main lobar fissure is a sonographic landmark used to identify the gallbladder fossa. OBJ: Describe the gross anatomy of the biliary system.
TOP: Location
2. Following the main portal vein, the gallbladder is seen just superior to the right portal vein. ANS: F
The gallbladder is located inferior to the right portal vein. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
3. The gallbladder remains stationary despite changes in the patient’s position. ANS: F
The position of the gallbladder can vary considerably and changes as the patient is moved. If the patient is turned into a left lateral decubitus position, the gallbladder shifts closer to the midline. OBJ: Describe the gross anatomy of the biliary system.
TOP: Location
4. The common bile duct is formed by the union of the common hepatic duct and the cystic
duct. ANS: T
The common bile duct (CBD) is formed by the union of the common hepatic and cystic ducts. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
5. The common bile duct can be found medial and posterior to the main portal vein. ANS: F
The CBD is located lateral and anterior to the main portal vein. OBJ: Describe the gross anatomy of the biliary system.
TOP: Location
6. The hepatic artery is found slightly medial and anterior to the main portal vein. ANS: T
The hepatic artery is located slightly medial and anterior to the main portal vein.
OBJ: Describe the gross anatomy of the biliary system.
TOP: Location
7. The most inferior portion of the common bile duct is called the infraduodenal portion. ANS: F
The most inferior portion of the common bile duct is within the duodenum and is called the intraduodenal portion. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
8. The cystic artery passes posterior to the common hepatic duct and anterior to the common
duct. ANS: F
The cystic artery passes posterior to the common hepatic duct and anterior to the cystic duct. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
9. Normally, the gallbladder wall is less than 5 mm thick. ANS: F
The thickness of the gallbladder wall normally does not exceed 3 mm. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Size 10. A normal gallbladder appears round on the longitudinal view. ANS: F
The gallbladder appears round on the transverse view and elongated on the longitudinal view. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 11. The common bile duct enters the duodenum through the hepatopancreatic ampulla. ANS: T
The common bile duct enters the duodenum through the ampulla of Vater, also known as the hepatopancreatic ampulla. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
12. The length of the gallbladder is highly variable. ANS: T
The length of the gallbladder is highly variable, depending on the amount of bile within and any existing normal variant. OBJ: Describe the gross anatomy of the biliary system.
TOP: Size
13. Cholecystokinin (CCK) is a peptide hormone that stimulates the gallbladder to contract. ANS: T
Cholecystokinin stimulates the gallbladder to contract, the sphincter of Oddi to relax, and the liver to increase bile production. OBJ: Describe the basic function of the biliary system.
TOP: Physiology
14. CCK is a peptide hormone that stimulates the sphincter of Oddi to contract. ANS: F
CCK stimulates the sphincter of Oddi to relax, not contract. OBJ: Describe the basic function of the biliary system.
TOP: Physiology
15. CCK is a peptide hormone that increases hepatic production of bile. ANS: T
CCK increases hepatic production of bile. OBJ: Describe the basic function of the biliary system.
TOP: Physiology
16. The landmarks that help identify the gallbladder on longitudinal section are the portal vein,
main lobar fissure, and right kidney. ANS: T
The portal vein, main lobar fissure, and right kidney are landmarks that help identify the gallbladder fossa. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 17. The gallbladder is routinely identified with ultrasound. ANS: T
The gallbladder is commonly identified with ultrasound. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 18. The common hepatic duct is routinely seen on ultrasound. ANS: T
The common hepatic duct is easily visualized in the porta hepatis. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 19. The common bile duct is routinely seen on ultrasound. ANS: T
The common bile duct is easily visualized with ultrasound.
OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 20. The right hepatic duct is routinely seen on ultrasound. ANS: F
It is especially common for the gallbladder, CHD, and CBD to be imaged. In the absence of disease, the other portions of the biliary system may prove difficult to appreciate because they are so small. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 21. The left hepatic duct is routinely seen on ultrasound. ANS: F
It is especially common for the gallbladder, CHD, and CBD to be imaged. In the absence of disease, the other portions of the biliary system may prove difficult to appreciate because they are so small. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 22. The cystic duct is routinely seen on ultrasound. ANS: F
It is especially common for the gallbladder, CHD, and CBD to be imaged. In the absence of disease, the other portions of the biliary system may prove difficult to appreciate because they are so small. OBJ: Describe the ultrasound appearance of the biliary system. TOP: Sonographic Appearance 23. The gallbladder wall has two distinct layers and inner folds that aid in concentrating bile. ANS: F There are three distinct layers to the gallbladder wall: the inner mucosa; the middle fibromuscular layer; and the outer serous layer. Inside the gallbladder are many minute, inward folds or rugae. These folds aid in concentrating the bile through absorption of water and secretion of mucus. OBJ: Describe the gross anatomy of the biliary system.
TOP: Gross Anatomy
Chapter 14: The Pancreas Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. A small part of the a. tail b. body c. neck d. head
of the pancreas is enclosed in peritoneum.
ANS: D
Most of the pancreas is retroperitoneal; however, a small portion of the head is surrounded by peritoneum. OBJ: List the gross anatomy of the pancreas.
TOP: Gross Anatomy
2. The portal vein is formed a. posterior to the neck of the pancreas. b. anterior to the neck of the pancreas. c. posterior to the head of the pancreas. d. anterior to the head of the pancreas. ANS: A
The portal vein is formed by the union of the splenic and superior mesenteric veins posterior to the neck of the pancreas. OBJ: Draw the epigastric vessels that surround the pancreas.
TOP: Gross Anatomy
3. The length of the pancreas is a. 3 to 5 cm. b. 8 to 10 cm. c. 12 to 18 cm. d. 15 to 20 cm. ANS: C
The length of the pancreas ranges from 12 to 18 cm. OBJ: List the gross anatomy of the pancreas.
TOP: Size
4. Which statement best describes the anteroposterior dimensions of the pancreas? a. The head is 1 to 2 cm; the neck is 0.5 to 1 cm; the body is 2 to 3 cm; and the tail is
1 to 2 cm. b. The head is 2 to 3 cm; the neck is 0.5 to 1 cm; the body is 3 to 3.5 cm; and the tail
is 3 to 4 cm. c. The head is 2 to 3 cm; the neck is 0.5 to 1 cm; the body is 2 to 3 cm; and the tail is
1 to 2 cm. d. The head is 2 to 3 cm; the neck is 1.5 to 2.5 cm; the body is 2 to 3 cm; and the tail
is 1 to 2 cm. ANS: D
The anteroposterior measurements of the head, neck, body, and tail of the pancreas vary widely. The size ranges are: head, 2 to 3 cm; neck, 1.5 to 2.5 cm; body, 2 to 3 cm; and tail, 1 to 2 cm. OBJ: List the gross anatomy of the pancreas.
TOP: Size
5. The head of the pancreas lies a. to the right of the SMV, in the C-loop of the duodenum, and anterior to the IVC. b. to the right of the SMV, in the C-loop of the duodenum, and posterior to the IVC. c. to the left of the SMV, outside the C-loop of the duodenum, and anterior to the
IVC. d. to the left of the SMV, in the C-loop of the duodenum, and anterior to the IVC. ANS: A
The head of the pancreas lies to the right of the superior mesenteric vein, cradled in the C-loop of the duodenum, and anterior to the IVC. OBJ: List the gross anatomy of the pancreas.
TOP: Location
6. Which statement describes the structures closely related to the head of the pancreas? a. The common bile duct (CBD) is posterolateral, and the gastroduodenal artery
(GDA) is posterolateral. b. The common bile duct is anterolateral, and the gastroduodenal artery is posterolateral. c. The common bile duct is posterolateral, and the gastroduodenal artery is anterolateral. d. The common bile duct is anterolateral, and the gastroduodenal artery is anterolateral. ANS: C
The CBD is in the posterolateral portion, and the GDA is more anterolateral. In addition, the CBD courses inferomedially, running behind the first part of the duodenum on its way to the head of the pancreas, where it meets the main pancreatic duct. OBJ: List the gross anatomy of the pancreas.
TOP: Location
7. The gastroduodenal artery divides into a. lateral and medial superior pancreaticoduodenal branches. b. proper and common hepatic arteries. c. anterior and posterior superior pancreaticoduodenal branches. d. anterior and posterior portasplenic arteries. ANS: C
The GDA is the first branch of the CHA, which originates from the celiac axis. It courses along the anterior aspect of the head just to the right of the neck, where it divides into the anterior and posterior superior pancreaticoduodenal branches, supplying blood to the head of the pancreas and the duodenum. OBJ: Draw the blood supply to the pancreas.
TOP: Gross Anatomy
8. Which statement best describes the locations of the neck, body, and tail of the pancreas? a. The neck lies posterior to the porta splenic confluence; the body lies anterior to the
SMA; and the tail lies just to the left of the aorta. b. The neck lies anterior to the porta-splenic confluence; the body lies anterior to the SMA; and the tail lies just to the left of the aorta. c. The neck lies posterior to the porta-splenic confluence; the body lies posterior to the SMA; and the tail lies just to the right of the aorta. d. The neck lies anterior to the porta-splenic confluence; the body lies posterior to the SMA; and the tail lies just to the left of the aorta. ANS: B
The neck of the pancreas lies anterior to the porta-splenic confluence; the body lies anterior to the SMA and SV; and the tail lies left lateral to the pancreas body and aorta. OBJ: List the gross anatomy of the pancreas.
TOP: Gross Anatomy
9. The tail of the pancreas a. lies between the stomach anteriorly and left kidney posteriorly and extends to the
splenic hilum. b. lies between the stomach posteriorly and left kidney anteriorly and extends to the
lateral aspect of the spleen. c. lies with the stomach and left kidney posterior and extends to the lateral aspect of
the spleen. d. lies with the stomach and left kidney anterior and extends to the hilum of the
spleen. ANS: A
The tail of the pancreas generally begins just to the left of the spine and extends to the hilum of the spleen. It lies between the stomach anteriorly and the left kidney posteriorly. The SV courses along its posterior superior surface. Usually the tail lies even with the body, but in some cases it may be at a lower or even higher level. OBJ: List the gross anatomy of the pancreas.
TOP: Gross Anatomy
10. Arterial flow to the head, body, and tail of the pancreas is through the a. suprapancreatic, pancreatic, and prepancreatic arteries. b. suprapancreatic, pancreatic, and caudal pancreatic arteries. c. prepancreatic, pancreatic, and prehilar arteries. d. pancreaticoduodenal and splenic arteries. ANS: D
The arterial supply of the pancreas includes blood from the pancreaticoduodenal arteries (branches of the gastroduodenal artery and superior mesenteric artery) and branches of the splenic artery. The superior and inferior pancreaticoduodenal arteries supply a portion of the duodenum and along with the pancreatic arcades—the vascular connections between the hepatic, splenic, and superior mesenteric arteries—supply the head of the pancreas. The pancreatic branches of the splenic artery supply the body and tail of the pancreas with blood. OBJ: Draw the blood supply to the pancreas. TRUE/FALSE
TOP: Gross Anatomy
1. The pancreas is mostly an endocrine gland. ANS: F
The pancreas is mostly an exocrine (digestive) gland; only 2% of the gland’s weight is endocrine (hormonal) tissue. OBJ: Explain the function of the pancreas.
TOP: Physiology
2. The exocrine function of the pancreas is carried out by the beta cells. ANS: F
The exocrine function of the pancreas is carried out by the acini cells. OBJ: Explain the function of the pancreas.
TOP: Physiology
3. Pancreatic juice is comprised of nucleic acids and also enzymes that help digest fats,
proteins, and carbohydrates. ANS: T
Pancreatic juice is comprised of nucleic acids and also enzymes that help digest fats, proteins, and carbohydrates. OBJ: Explain the function of the pancreas.
TOP: Physiology
4. Pancreatic juice reaches the duodenum via the common bile duct. ANS: F
Pancreatic juice moves into the duodenum through the main pancreatic duct (Wirsung’s duct). OBJ: Explain the function of the pancreas.
TOP: Physiology
5. The acini cells produce the hormones insulin, glucagon, and somastatin. ANS: F
Alpha cells produce glucagon, which causes cells to release glucose; beta cells produce insulin, which causes cells to store glucose and stimulates glycogen formation; delta cells produce somatostatin, which inhibits the production of insulin and glucagon. OBJ: Explain the function of the pancreas.
TOP: Physiology
6. Hormones that stimulate the formation of pancreatic juice are triggered by chyme. ANS: T
Chyme in the duodenum stimulates the release of hormones, which in turn act on pancreatic juice formation. OBJ: Explain the function of the pancreas. 7. Sonographically, the pancreas appears isoechoic to the liver. ANS: F
TOP: Physiology
Echo texture of the normal pancreas varies and can appear homogeneous to heterogeneous depending on the amount of interlobular fat that is present. Generally the pancreas appears more echo-dense or hyperechoic compared to the appearance of the normal liver. OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in axial views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 8. The main pancreatic duct can be seen in the body of the pancreas. ANS: T
The main pancreatic duct generally is seen as two short, reflective lines running the entire length of the pancreas. OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in axial views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 9. The CBD and GDA appear circular in the long axis (transverse view) of the pancreas. ANS: T
On transverse views showing the longitudinal axis of the pancreas, two small, circular, anechoic structures can be seen in the head of the pancreas: the posterolateral CBD and the anterolateral GDA. OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in axial views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 10. Sagittal scanning plane images of the pancreas show the gland in transverse sections. ANS: T
Axial sections of the pancreas are demonstrated in the sagittal scanning plane. OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in longitudinal views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 11. The contour of the pancreas cannot be observed on ultrasound. ANS: F
When the pancreas is evaluated sonographically, the parenchymal texture, contour, echo pattern, and size are commonly visualized. OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in axial views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 12. In poorly prepped patients, shadows from the stomach and duodenum obscure the pancreas
and make it difficult to visualize. ANS: T
The pancreas is in close relationship to the portions of the small and large intestine and their contents may affect sound beam transmission and obscure pancreatic structures. This is especially true for patients who have been poorly prepped. Despite these obstacles, sonography has become useful for the evaluation and early detection of diseases of the pancreas.
OBJ: Describe the scanning plane used and the sonographic appearance of the pancreas in axial views, using vascular landmarks and adjacent anatomy. TOP: Sonographic Appearance 13. A water-filled stomach makes the pancreas more difficult to visualize. ANS: F
Having the patient drink water can help the examiner identify parts of the pancreas, especially the pancreatic head in the C-loop of the duodenum. OBJ: Describe the relationship of the pancreas, duodenum, and biliary system. TOP: Sonographic Appearance
Chapter 15: The Urinary and Adrenal System Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The length, depth, and diameter of a normal adult kidney are a. 9 to 12 cm, 2.5 to 4 cm, and 4 to 6 cm, respectively. b. 8 to 10 cm, 1.5 to 3 cm, and 2 to 4 cm, respectively. c. 9 to 12 cm, 4 to 6 cm, and 2.5 to 4 cm, respectively. d. None of these ANS: A
The normal adult kidney is approximately 9 to 12 cm long, 2.5 to 4 cm in depth, and 4 to 6 cm in diameter. OBJ: Describe the size of the kidneys, ureters, bladder, urethra, and adrenal glands. TOP: Size 2. The length, depth, and diameter of a normal neonatal kidney are a. 2 to 3 cm, 1.5 to 2.5 cm, and 3.3 to 5 cm, respectively. b. 4 to 6 cm, 2 to 2.5 cm, and 2 to 3 cm, respectively. c. 3.5 to 5 cm, 1.5 to 2.5 cm, and 2 to 3 cm, respectively. d. 0.5 to 1 cm, 1.5 to 2.5 cm, and 2 to 3 cm, respectively. ANS: C
The neonatal kidney is 3.5 to 5 cm long, 1.5 to 2.5 cm in depth, and 2 to 3 cm in diameter. The pediatric kidney is proportionately larger than the adult kidney and may extend inferiorly to the iliac crest. OBJ: Describe the size of the kidneys, ureters, bladder, urethra, and adrenal glands. TOP: Size 3. The adult male and female urethras measure, respectively, a. 10 cm and 2.5 cm. b. 20 cm and 4 cm. c. 15 cm and 2.5 cm. d. 20 cm and 5.5 cm. ANS: B
The male urethra is 20 cm long; the female urethra is considerably shorter, approximately 3.5 cm in length. OBJ: Describe the size of the kidneys, ureters, bladder, urethra, and adrenal glands. TOP: Size 4. The adult ureter is a. 10 to 15 b. 15 to 20 c. 20 to 25 d. 28 to 34
cm long.
ANS: D
The ureters are hollow, narrow tubes that range in length from 28 to 34 cm. The diameter is 6 mm. OBJ: Describe the size of the kidneys, ureters, bladder, urethra, and adrenal glands. TOP: Size 5. The kidneys are composed mainly of two distinct areas: the a. corpuscle and proximal and distal convoluted tubules. b. parenchyma and sinus. c. renal loops and medulla. d. medullary and renal pyramids. ANS: B
The kidney is composed of two distinct areas; the peripheral parenchyma and central sinus. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
6. The process of nephron function, in correct order, is a. filtration, tubular secretion, and tubular reabsorption. b. filtration, tubular reabsorption, and tubular secretion. c. tubular reabsorption, filtration, and tubular secretion. d. tubular secretion, filtration, and tubular reabsorption. ANS: B
Filtration takes place in the glomerulus and is the first step in urine formation. Tubular reabsorption is the process by which substances in the plasma solute that are useful to the body are reabsorbed into the bloodstream. Tubular secretion is the process through which waste substances, including ammonia, drugs, hydrogen, and potassium, are secreted in the distal convoluted tubules. OBJ: Explain the function of the nephron.
TOP: Physiology
7. Where is ADH produced? a. Adrenal cortex b. Kidney c. Juxtaglomerular apparatus d. Posterior pituitary gland ANS: D
ADH, which increases blood volume, is produced in the posterior pituitary gland. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 8. Where is aldosterone produced? a. Adrenal cortex b. Kidney c. Juxtaglomerular apparatus d. Posterior pituitary gland
ANS: A
Aldosterone, which increases blood volume, is produced in the adrenal cortex. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 9. Where is erythropoietin produced? a. Adrenal cortex b. Kidney c. Juxtaglomerular apparatus d. Posterior pituitary gland ANS: B
Erythropoietin, which increases the production of red blood cells, is produced by the kidney. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 10. Where is renin produced? a. Adrenal cortex b. Kidney c. Juxtaglomerular apparatus d. Posterior pituitary gland ANS: C
Renin, which increases the systemic blood pressure, is produced by the juxtaglomerular apparatus. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 11. What is the echogenicity of the renal capsule? a. High level echoes b. Medium level echoes c. Low level echoes ANS: A
The renal capsule appears as a thin, highly reflective line visualized along the periphery of the kidney; it is hyperechohic relative to adjacent renal cortex. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 12. What is the echogenicity of the renal cortex? a. High level echoes b. Medium level echoes c. Low level echoes ANS: B
The renal cortex demonstrates a medium- to low-level echo texture. OBJ: Describe the sonographic appearance of the urinary and adrenal systems.
TOP: Sonographic Appearance 13. What is the echogenicity of the renal pyramids? a. High level echoes b. Medium level echoes c. Low level echoes ANS: C
Anechoic pyramids have a distinctive and readily identifiable appearance; their echo-free presentation is in sharp contrast to the highly echogenic sinus and medium-gray cortex. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 14. What is the echogenicity of the renal sinus? a. High level echoes b. Medium level echoes c. Low level echoes ANS: A
The sinus is markedly echogenic due to the dense fat and fibrous tissue it contains. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 15. What is the echogenicity of the urinary bladder wall? a. High level echoes b. Medium level echoes c. Low level echoes ANS: A
The distended bladder wall appears as a smooth, bright outline that is hyperechoic relative to the anechoic, urine-filled lumen. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 16. Which of the following structures are anterior to the right kidney? a. Psoas major muscle b. Diaphragm c. Right lobe of the liver d. Pancreas tail ANS: C
Structures anterior to the right kidney are the right adrenal gland, right lobe of the liver, second part of the duodenum, hepatic flexure of the colon, and jejunum of the small bowel. OBJ: Describe the location of the kidneys, ureters, urinary bladder, urethra, and adrenal glands. TOP: Location 17. Which of the following structures are anterior to the left kidney? a. Psoas major muscle
b. 11th and 12th ribs c. Diaphragm d. Spleen ANS: D
Structures anterior to the left kidney are the tail of the pancreas, left adrenal gland, spleen, jejunum, stomach, and splenic flexure of the colon. OBJ: Describe the location of the kidneys, ureters, urinary bladder, urethra, and adrenal glands. TOP: Location 18. Which of the following structures are posterior to the kidneys? a. Diaphragm b. Psoas muscle c. Quadratus lumborum muscle d. All of these ANS: D
Posterior to both kidneys are the diaphragm, psoas muscle, transversus muscle, and quadratus lumborum muscle. OBJ: Describe the location of the kidneys, ureters, urinary bladder, urethra, and adrenal glands. TOP: Location 19. Which of the following is the correct order of the arterial blood supply to the kidney? a. Renal artery, segmental artery, interlobar artery, arcuate artery, interlobular artery b. Renal artery, interlobar artery, segmental artery, arcuate artery, interlobular artery c. Renal artery, segmental artery, interlobular artery, arcuate artery, interlobar artery d. Renal artery, interlobular artery, segmental artery, arcuate artery, interlobar artery ANS: A
Blood reaches the nephron by entering the kidney through the renal artery, a branch of the aorta. The renal artery branches into five segments to supply each one of the apical, superior, middle, inferior and posterior renal segments. The segmental arteries then branch into one lobar artery for each renal pyramid and these form interlobar arteries, which travel between the renal pyramids. The interlobar arteries branch into arcuate arteries, located at the base of the renal pyramids. From the arcuate arteries, the interlobular arteries travel into the renal cortex. OBJ: Explain the blood supply of the kidneys and adrenal glands. TOP: Gross Anatomy 20. Which of the following laboratory values measure how well the kidneys remove waste and
excess fluid from the blood? a. Blood urea nitrogen b. Creatinine c. Glomerular filtration rate d. Specific gravity ANS: C
Glomerular filtration rate measures how well the kidneys remove waste and excess fluid from the blood. Normal GFR is 90 mL/min; lower values may indicate disease.
OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Reference Charts 21. Elevation of this laboratory may indicate renal disease. a. Creatinine b. Glomerlular filtration rate c. Aldosterone d. Serum cortisol ANS: A
Creatinine is used to assess renal function and measure the kidney’s ability to get rid of waste. Normal creatinine is 1.1 mg/dL and elevation of this value may indicate renal disease. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Reference Charts TRUE/FALSE 1. The adrenal gland is easily visualized sonographically in adults. ANS: F
The adrenal gland is one-third the size of the kidney in the newborn, and 1/13 the size of the adult kidney. This makes it fairly easy to visualize in the newborn but more difficult to see in the adult. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 2. At birth, the adrenal glands are as large as the kidneys but then rapidly shrink. ANS: F
The adrenal gland is one-third the size of the kidney in the newborn. OBJ: Describe the sonographic appearance of the urinary and adrenal systems. TOP: Sonographic Appearance 3. The adrenal cortex produces steroid hormones. ANS: T
The adrenal cortex has three zones, each of which produces steroid hormones, called corticoids. The outermost zone, the zona glomerulosa, produces mineralocorticoids, of which the most important is aldosterone. The next zone, the zona fasciculata, produces glucocorticoids. The innermost zone, the zona reticularis, supplements sex hormones produced by the ovaries and testes. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 4. The adrenal medulla is the source of the hormones that produce the “flight or fight”
response.
ANS: T
The adrenal medulla secretes the hormones epinephrine and norepinephrine, which are responsible for the “flight or fight” response. OBJ: List the hormones and laboratory values associated with the kidneys and adrenal glands, and explain the function of each. TOP: Physiology 5. The apex of the medullary pyramid sits within a major calyx. ANS: F
The apex of the medullary pyramid sits within a minor calyx in the renal sinus. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
6. The base of the medullary pyramid comes in contact with the renal cortex. ANS: T
The base of the medullary pyramid comes in contact with the renal cortex. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
7. The medullary pyramids are separated from each other by bands of cortical tissue called
loops of Henle. ANS: F
Medullary pyramids are separated from each other by bands of cortical tissue called columns of Bertin. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
8. There are three components to each renal lobe. ANS: T
The renal lobes are the portions of the kidney that consist of a single pyramid, which is bordered on both sides by interlobar arteries and interlobar veins and which has cortical tissue at its base. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
9. The infundibulum is composed of both minor and major calyces. ANS: T The infundibulum is composed of the minor and major calyces. The 8 to 18 renal pyramids convey urine to an equal number of minor calyces, which form the peripheral border of the renal sinus (see Figure 15.7). There are usually 2 to 3 major calyces that receive urine from the minor calyces. OBJ: Describe the function of the urinary and adrenal system.
TOP: Gross Anatomy
Chapter 16: Abdominal Vasculature Flow Dynamics Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which statement describes the celiac artery? a. The celiac artery feeds organs that have low vascular resistance. b. The celiac artery has three branches: the common hepatic, superior mesenteric, and
left gastric arteries. c. The celiac artery originates from the posterior wall of the aorta. d. The celiac artery averages 1.5 cm in diameter. ANS: A
The celiac axis supplies low-resistance end organs through its branch vessels—the hepatic, left gastric, and splenic arteries. The celiac artery, like the superior mesenteric artery, originates from the anterior wall of the aorta. It averages 0.7 cm in diameter. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 2. Which structure does NOT border the abdominal aorta anteriorly? a. Portal vein b. Superior mesenteric artery c. Celiac axis d. Stomach ANS: A
The abdominal aorta is bordered anteriorly by the stomach, pancreas, celiac axis, splenic vein, and superior mesenteric artery and vein. The portal vein is located posterior to the neck and head of the pancreas. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 3. Which are characteristics of a Doppler spectral waveform from a normal infrarenal
abdominal aorta? a. Rapid systolic upstroke, delayed deceleration, and low diastolic flow b. Rapid systolic upstroke and rapid deceleration with constant forward diastolic flow c. Rapid systolic upstroke and rapid deceleration with flow reversal in late systole d. Rapid systolic upstroke, reversed late systolic flow, and constant forward diastolic flow ANS: C
Flow in the infrarenal segment of the aorta is to the high resistance peripheral arterial system of the lower extremities and lumbar arteries. Therefore, the Doppler spectral waveform shows a reverse flow component. The suprarenal segment of the aorta supplies blood to the low resistance vascular beds of the liver, spleen, and kidneys. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: The Abdominal Arterial System
4. The blood flow pattern in the normal renal artery can be characterized as a. high resistance with high diastolic flow. b. low resistance with high diastolic flow. c. high resistance with low diastolic flow. d. low resistance with low diastolic flow. ANS: B
The kidneys are low resistance organs that demand constant blood flow to moderate metabolic activity. As such, the normal renal artery Doppler spectral pattern shows high forward diastolic flow. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 5. Which describes the blood flow pattern in the superior mesenteric artery after ingestion of
a meal? a. Increased peak systolic velocities with low diastolic flow and systolic flow reversal b. Decreased peak systolic velocities with low diastolic flow c. Increased peak systolic velocities with high diastolic flow d. Systolic flow reversal, and high diastolic forward flow ANS: C
After ingestion of a meal (post-prandial), remarkable changes occur in the flow patterns in the SMA, reflecting the metabolic demands imposed by the digestive process. Therefore, the blood flow pattern in the SMA shows increased velocity with high diastolic flow, a classic low resistance waveform pattern. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 6. High resistance Doppler spectral waveforms recorded throughout the renal medulla and
cortex suggest a. proximal renal artery stenosis. b. flow-limiting disease in the distal renal artery. c. intrinsic medical renal disease. d. the presence of accessory renal arteries. ANS: C
With increased renovascular resistance caused by intrinsic renal pathology, the end-diastolic flow component decreases throughout the vascular tree of the kidney, and the velocity waveform becomes markedly pulsatile. OBJ: Define the role of duplex scanning and color-flow imaging for evaluation of abdominal vascular disease. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 7. Which is NOT a tributary of the inferior vena cava? a. Hepatic vein b. Portal vein c. Renal vein d. Right suprarenal vein ANS: B
The hepatic, renal, and right suprarenal veins are all tributaries of the IVC. The portal vein is an intraabdominal vein. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 8. Which statement describes the portal vein? a. It supplies approximately 70% of the oxygenated blood flow to the liver. b. It is an intraabdominal vein formed by the confluence of the splenic and superior
mesenteric veins. c. Blood flow in the portal vein normally is hepatopetal in direction. d. All of these ANS: C
The portal vein and its branches are intraabdominal vessels that are responsible for approximately 70% of the oxygenated blood supply of the liver. The portal vein is formed by the confluence of the superior mesenteric and splenic veins. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 9. The hepatic artery enters the porta hepatis along with the a. right hepatic and splenic veins. b. main portal vein and common bile duct. c. right hepatic vein and common bile duct. d. left portal vein and right branch of the hepatic artery. ANS: B
From its origin, the hepatic artery courses superiorly and right laterally to enter the porta hepatis with the portal vein and common bile duct. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 10. Blood flow in the right, middle, and left hepatic veins is characterized by a. four phases of flow: two away from the heart and two toward the heart. b. three phases of flow: two toward the heart and a phase of systolic flow reversal. c. three phases of flow: one toward the heart and then two away from the heart. d. four phases of flow: two toward the heart followed by two away from the heart. ANS: B
The hepatic veins demonstrate three phases of flow. The first two are toward the heart and represent reflections of right atrial and ventricular diastole. The third phase is represented by systolic flow reversal and is caused by contraction of the right atrium. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 11. Normally, flow patterns in the portal vein and its branches are characterized by a. continuous, minimally phasic, disordered flow with high mean velocities. b. pulsatile, biphasic, disordered flow with low mean velocities. c. minimally phasic disordered flow with low peak and mean velocities.
d. phasic flow with low peak and mean velocities. ANS: C
Normally the high-volume portal venous flow pattern is characterized by minimally phasic, slightly disordered flow with low peak and mean velocities (20-30 cm/sec) in the supine, fasting patient. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 12. Which does NOT affect portal venous flow? a. Posture b. Dietary state c. Hematocrit d. Exercise ANS: C
Portal venous flow is affected by posture, exercise, and dietary state. With a change in posture or after exercise, portal venous flow normally decreases. In contrast, portal flow normally increases after ingestion of a meal, because of splanchnic vasodilatation and hyperemia, which are required to meet the metabolic demands of digestion. An increase or decrease in the number of red blood cells, reflected by the hematocrit, does not significantly influence the blood flow patterns in the portal vein. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 13. Which statement is NOT true about the renal arteries? a. The left renal artery lies superior to the left renal vein. b. The proximal renal arteries follow the crus of the diaphragm. c. The right renal artery courses posterior to the inferior vena cava. d. The renal arteries originate from the lateral wall of the abdominal aorta. ANS: A
The left renal artery lies directly behind or posterior to the left renal vein. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 14. The left renal vein serves as a valuable landmark for locating the renal arteries. It courses a. anterior to the abdominal aorta and posterior to the superior mesenteric artery. b. posterior to the abdominal aorta and anterior to the left renal artery. c. posterior to the inferior vena cava and anterior to the abdominal aorta. d. anterior to the inferior vena cava and anterior to the abdominal aorta. ANS: A
The left renal vein, which is longer than the right renal vein, courses anterior to the aorta to lie between the aortic wall and the superior mesenteric artery. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System
15. Which statement is correct? a. The inferior mesenteric artery lies anterolateral to the abdominal aorta, superior to
the aortic bifurcation. b. The suprarenal abdominal aortic Doppler velocity waveform is triphasic because
of the high resistance vascular bed of the fasting superior mesenteric artery. c. The kidneys and liver are high resistance end organs. d. A Doppler spectral waveform from the postprandial superior mesenteric artery
demonstrates low diastolic flow because of the change in the vascular resistance of the stomach and small intestine that occurs with digestion. ANS: A
The Doppler spectral waveform in the suprarenal aorta normally demonstrates constant forward flow throughout diastole to supply the low resistance vascular beds of the liver, spleen, and kidneys. The flow pattern in the SMA in the fasting state shows low diastolic flow, because this artery supplies the high resistance vascular bed of the stomach, small intestine, and colon. After ingestion of a meal, the metabolic demands of these tissues change; the level of vascular resistance must decrease for the tissues to receive increased oxygenated blood to remove the metabolic byproducts associated with digestion. For this reason, the Doppler spectral wave from the postprandial SMA shows high diastolic flow, characteristic of a low resistance vessel. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 16. The Doppler spectral waveform from the normal renal artery demonstrates a. constant forward diastolic flow. b. intermittent forward diastolic flow. c. constant flow reversal during diastole. d. intermittent flow reversal during diastole. ANS: A
Vessels feeding low resistance organs, like the normal renal artery, demand constant blood flow and demonstrate high diastolic flow. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 17. Which statement describes the blood flow to the kidney? a. The Doppler velocity signal from the interlobar arteries demonstrates significant
forward diastolic flow. b. Because of the high metabolic demands of the kidney, flow is forward during
diastole. c. The spectral waveform from the arcuate vessels of the kidney of a patient in
chronic renal failure show decreased diastolic flow. d. Because of the low metabolic demands of the kidney, flow is forward during
systole. ANS: B
Blood flow to the normal kidney should demonstrate high diastolic flow. With intrinsic renal pathology the end-diastolic flow component decreases, and the waveform becomes markedly pulsatile.
OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 18. The normal diameter of the portal vein is a. 2.5 cm. b. 7 cm. c. 1.3 cm. d. 1.0 cm. ANS: C Normally, the diameter of the main portal vein is less than 1.3 cm in the segment just anterior to the IVC. The diameter increases during expiration and decreases during inspiration as a result of variation in the volume of blood entering the visceral arterial system and the volume outflow through the systemic venous channels. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 19. Which of the following terms describes a uniform systolic velocity? a. High resistive b. Low resistive c. Laminar d. Spectral broadening ANS: C Laminar flow pattern is characterized by a uniform systolic velocity, an area absent of Doppler shifts, under the systolic component and a very narrow Doppler velocity spectrum. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 20. What becomes evident in a waveform when the sample volume is increased or placed near the vessel wall? a. Appears higher resistant b. Appears lower resistant c. Laminar flow is evident d. Spectral broadening ANS: D Spectral broadening can also occur if the sample volume is placed near the vessel wall, increased in size, or it can be an indication of vessel disease. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 21. The parameters that determine the impact flow including pressure gradient, radius and length of a tube, and the fluid viscosity are a. Poiseuille’s Law. b. Bernoulli’s Principle. c. Ohm’s Law. d. Law of conservation of energy. ANS: A
Poiseuille’s Law predicts the volume of flow in moving fluids. It does this by evaluating several variables and how they impact volume of flow. The parameters that Poiseuille determined that impact flow include a pressure gradient, radius and length of a tube, and the viscosity of the fluid. OBJ: Relate the theories of fluid dynamics and flow to hemodynamics and circulation. TOP: Hemodynamic Principles 22. During diastole a. blood is forced out of the heart into the vessels. b. the diameter of the blood vessels increases. c. pressure stored in the artery walls propels the blood forward. d. cardiac output is increased. ANS: C Systole forces blood out of the heart and into the conducting vessels of the circulatory system. As the pressure created by the heart on the vessels (pressure gradient) increases, the diameter of the blood vessels increases, which leads to a decrease in resistance and an increase in volume flow. The pressure that is stored in the artery walls propels the blood forward in diastole. OBJ: Relate the theories of fluid dynamics and flow to hemodynamics and circulation. TOP: Hemodynamic Principles TRUE/FALSE 1. The renal veins empty into the IVC immediately inferior to the level of the renal arteries. ANS: F
The renal veins empty into the IVC immediately superior to the level of the renal arteries. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: The Abdominal Arterial System 2. The diameter of the hepatic veins increases in the region of the caval confluence. ANS: T
The diameter of the hepatic veins may appear small within the parenchyma of the liver, but it increases in the region of the caval confluence. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: Sonographic Appearance 3. The diameter of the portal vein increases during inspiration and decreases during
expiration. ANS: F
The diameter of the main portal vein increases during expiration and decreases during inspiration as a result of variation in the volume of blood entering the visceral arterial system and the volume outflow through the systemic venous channels. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: Sonographic Appearance
4. Normal flow in the hepatic veins is hepatopetal. ANS: F
Normal flow direction in the hepatic veins is hepatofugal, or away from the liver. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 5. When flow in the portal vein is compromised, the velocity of flow in the hepatic artery
increases. ANS: T
When portal venous flow is compromised, velocity most often increases in the hepatic artery as a result of collateral compensatory mechanisms. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 6. Peak systolic velocity in the common hepatic and splenic arteries is normally slightly
higher than it is in the celiac artery. ANS: F
Peak systolic velocity in the celiac artery normally ranges from 98 to 105 cm/sec, whereas the common hepatic and splenic arteries demonstrate velocity ranges that are slightly lower. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 7. The diameter of the IVC increases in the presence of congestive heart failure. ANS: T
Dilation of the IVC can occur in the presence of congestive heart failure, tricuspid regurgitation, or any condition that results in increased right atrial pressure. OBJ: Review abdominal arterial and venous anatomy and sonographic appearance. TOP: Sonographic Appearance 8. Low resistant vessels are arteries supplying organs that do not need a constant supply of
blood flow. ANS: F
Low resistance vessels are arteries that supply organs that demand constant forward blood flow or perfusion. OBJ: Define the hemodynamic patterns and spectral waveforms found in the normal abdominal vasculature. TOP: Hemodynamic Patterns and Spectral Doppler Waveform 9. The radius of a blood vessel has the most impact on blood flow. ANS: T
Pouiseuille’s Law demonstrates that the greater the pressure gradient the greater the flow. All other parameters in the above equation impact resistance to flow; changes to the radius of a tube having the most impact as it is taken to the 4th power. OBJ: Relate the theories of fluid dynamics and flow to hemodynamics and circulation. TOP: Hemodynamic Principles 10. If blood viscosity increases, resistances increases. ANS: T According to Pouiseuille’s Law, there is a direct relationship between resistance and conduit length and viscosity of the fluid, and an inverse relationship between resistance and tube radius. OBJ: Relate the theories of fluid dynamics and flow to hemodynamics and circulation. TOP: Hemodynamic Principles 11. The volume and velocity of blood flow is impacted by stroke volume and cardiac output. ANS: T Heart function such as stroke volume and cardiac output; impact the volume and velocity of blood flow through the body. OBJ: Relate the theories of fluid dynamics and flow to hemodynamics and circulation. TOP: Hemodynamic Principles
Chapter 17: The Spleen Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The splenic artery arises from the a. superior mesenteric artery. b. common hepatic artery. c. celiac artery. d. proper hepatic artery. ANS: C
The splenic artery (SPA) is one of three vessels that arise from the celiac artery (CA) (the other two branches are the left gastric artery and the common hepatic artery). The diameter of the SPA as it arises from the CA has been estimated to be 5.6 mm. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Location
2. Which artery is a branch of the splenic artery? a. Left gastric artery b. Short gastric artery c. Right gastroepiploic artery d. Inferior mesenteric artery ANS: B
The short gastric artery arises from the splenic artery and supplies the superior portion of the greater curvature of the stomach. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Gross Anatomy
3. At the hilum, the splenic artery branches into a. two to four lobular arteries. b. four to six lobular arteries. c. two to four lobar arteries. d. four to six lobar arteries. ANS: C
The splenic artery branches into two to four lobar arteries after entering the splenic hilum; these splenic artery branches further divide into lobular arteries. OBJ: Describe the gross anatomy of the normal spleen. 4. The primary component of the white pulp is a. Malpighian corpuscles. b. epithelial cells. c. red and pink pulp. d. splenic cords. ANS: A
TOP: Gross Anatomy
The spleen is composed of red and white pulp. The white pulp consists of lymphatic tissue that surrounds and follows the smaller splenic arteries. The primary components of this portion of the spleen are the Malpighian corpuscles. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Gross Anatomy
5. The average volume of the adult spleen is about a. 50 mL. b. 200 mL. c. 400 mL. d. 600 mL. ANS: B
The average splenic volume in an adult is approximately 200 mL. Volumes as low as 60 mL and as high as 350 mL have been reported in normal adults. OBJ: Define the size relationships of the normal spleen.
TOP: Size
6. The normal splenic index is approximately a. 51 to 153 cm3. b. 155 to 450 cm3. c. 450 to 750 cm3. d. 107 to 314 cm3. ANS: D
The normal splenic index is 107 to 314 cm3. OBJ: Define the size relationships of the normal spleen.
TOP: Size
7. The removal of nuclei from old red blood cells without damage to the cells is called a. culling. b. sampling. c. pitting. d. pulping. ANS: C
Pitting is the removal of nuclei from old red blood cells without damaging the cells. OBJ: Describe the function of the spleen.
TOP: Physiology
8. The most abundant pigment released by the spleen during red blood cell removal is a. hemosiderin. b. hemoglobin. c. heme. d. bilirubin. ANS: A
The most abundant pigment released is hemosiderin. OBJ: Describe the function of the spleen.
TOP: Physiology
9. The component of the spleen that is responsible for immune functions is
a. b. c. d.
red pulp. white pulp. hilum. Kupffer cells.
ANS: B
In the white pulp, lymphocytes and monocytes are continually produced and are active in ingesting and digesting harmful pathogens that enter the bloodstream. OBJ: Describe the function of the spleen.
TOP: Physiology
10. The oxygen-carrying and iron-containing pigment of red blood cells is a. red pulp. b. hemosiderin. c. hemoglobin. d. heme. ANS: C
Hemoglobin is the oxygen-carrying and iron-containing pigment of red blood cells. OBJ: Describe the function of the spleen.
TOP: Physiology
11. The echogenicity of the spleen can be described as a. anechoic. b. low-level echoes. c. medium-level echoes. d. high-level echoes. ANS: C
The normal spleen demonstrates a medium-level echo pattern similar to or slightly more echogenic that of the normal liver parenchyma. OBJ: Describe the sonographic appearance and scanning technique of the normal spleen. TOP: Sonographic Appearance 12. The removal of abnormal red blood cells is called a. culling. b. sampling. c. pitting. d. pulping. ANS: A Pitting, the removal of nuclei from old red blood cells without damaging the cells, and culling, the removal of abnormal red blood cells, occur. OBJ: Describe the function of the spleen. 13. The echogenicity of the liver can be described as a. anechoic. b. low-level echoes. c. medium-level echoes. d. high-level echoes.
TOP: Physiology
ANS: C
The normal liver parenchyma demonstrates a medium-level echo pattern. OBJ: Describe the sonographic appearance and scanning technique of the normal spleen. TOP: Sonographic Appearance 14. Which of the following breathing technique would be used to move the spleen inferiorly away from the bony thorax alleviating rib shadows? a. Deep inspiration b. Expiration c. Shallow inspiration d. Varied breathing technique with each patient ANS: A Deep inspirations depress the diaphragm and moves the spleen inferiorly away from the bony thorax, alleviating shadows from the ribs and bowel gas. OBJ: Describe the sonographic appearance and scanning technique of the normal spleen. TOP: Sonographic Appearance 15. The echogenicity of the splenic calcifications can be described as a. anechoic. b. low-level echoes. c. medium-level echoes. d. high-level echoes. ANS: D
Bright reflections may be seen throughout the spleen that represent calcifications of small arterial walls or calcified granulomatous inclusions. OBJ: Describe the sonographic appearance and scanning technique of the normal spleen. TOP: Sonographic Appearance 16. The percentage of red blood cells per volume of blood is termed a. bacteremia. b. leukocytosis. c. hemoglobin. d. hematocrit. ANS: D
The hematocrit reading indicates the percentage of red blood cells per volume of blood. Normal values for men are 40% to 54%; for women, 37% to 47%. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values relevant to the normal spleen. TOP: Reference Charts 17. Which of the following is indicative of an infection in the blood? a. Bacteremia b. Leukocytosis c. Leukopenia d. Hematocrit ANS: B
OBJ: Describe the associated physicians, diagnostic tests, and laboratory values relevant to the normal spleen. TOP: Reference Charts 18. An abnormal decrease in the number of circulating platelets is termed a. bacteremia. b. leukocytosis. c. leukopenia. d. thrombocytopenia. ANS: D
Thrombocytopenia is an abnormal decrease in the number of circulating platelets. The normal range is 150,000 to 350,000 per mm3. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values relevant to the normal spleen. TOP: Reference Charts 19. Which of the following diagnostic imaging modalities involves intravenous injection of
radionuclides to “tag” specific cells? a. Ultrasound b. Nuclear medicine c. Computed axial tomography d. Magnetic resonance imaging ANS: B
Nuclear medicine involves intravenous injection of radionuclides to create diagnostic images. The radionuclides “tag” specific cells, so that the resulting image is specific to the area of interest. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values relevant to the normal spleen. TOP: Reference Charts TRUE/FALSE 1. The spleen is a retroperitoneal organ. ANS: F
The spleen is an intraperitoneal organ. OBJ: Describe the location of the spleen.
TOP: Location
2. In an adult, the spleen is composed primarily of red blood cells. ANS: F
In an adult, the spleen is composed primarily of lymph tissue. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Gross Anatomy
3. The spleen takes damaged cells out of circulation. ANS: T
Part of the spleen’s function is phagocytosis, the removal of damaged or old cells.
OBJ: Describe the function of the spleen.
TOP: Physiology
4. The spleen lies in the epigastrium. ANS: F
The spleen is an intraperitoneal organ, located in the left hypochondrium. OBJ: Describe the location of the spleen.
TOP: Location
5. The longest axis of the spleen is along the eighth rib. ANS: F
The spleen’s longest axis is along the tenth rib. OBJ: Describe the location of the spleen.
TOP: Location
6. The spleen is anterior to the diaphragm and stomach. ANS: F
The spleen is posterolateral to the body and fundus of the stomach and the tail of the pancreas and posterior to the left colic flexure. The spleen is anterior to the diaphragm. OBJ: Describe the location of the spleen.
TOP: Location
7. The spleen is posterolateral to the pancreatic tail and part of the large intestine. ANS: T
The spleen is posterolateral to the body and fundus of the stomach, the tail of the pancreas, and posterior to the left colic flexure. OBJ: Describe the location of the spleen.
TOP: Location
8. The hilar area of the spleen is not covered by peritoneum. ANS: T
The spleen is covered by peritoneum, with the exception of the medially located splenic hilum, where the vasculature structures and lymph nodes are located. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Gross Anatomy
9. Due to the spleen’s location, it is easily palpated. ANS: F The spleen is usually not palpable unless it is pathologically enlarged. OBJ: Describe the location of the spleen.
TOP: Location
10. Accessory spleens are most often found in the splenic hilum. ANS: T Accessory spleens, islands of tissue are usually less than 1 cm in diameter, are most often present near the splenic hilum or attached to the tail of the pancreas.
OBJ: Discuss sonographic applications and normal variants of the spleen. TOP: Normal Variants 11. The spleen is highly vascular. ANS: T
The spleen is composed of a highly vascular mass of lymphoid tissue. OBJ: Describe the gross anatomy of the normal spleen.
TOP: Gross Anatomy
12. A coronal scan plane is used when imaging the superior long axis of the spleen to include the adjacent pleural space. ANS: T
Using a left lateral approach, the coronal plane produces a superior longitudinal image of the spleen including the adjacent pleural space. OBJ: Describe the sonographic appearance and scanning technique of the normal spleen. TOP: Sonographic Appearance
Chapter 18: The Gastrointestinal System Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Digestion and absorption of major food products occur in which portion of the GI tract? a. Transverse colon b. Small bowel c. Stomach d. Mouth ANS: B
Most of the digestive processes take place in the small bowel. OBJ: Describe the functions of the gastrointestinal tract components. TOP: Physiology 2. Which substance is digested and absorbed in the GI tract? a. Fats b. Water c. Carbohydrates d. All of these ANS: D
Carbohydrates, proteins, fats, vitamins, and some fluids, including water and electrolytes, are digested and absorbed in the small bowel. OBJ: Describe the functions of the gastrointestinal tract components. TOP: Physiology 3. The esophagus is continuous with the pharynx superiorly and distally connects with the
region of the stomach. a. b. c. d.
antrum cardiac fundus pylorus
ANS: B
The terminal part of the esophagus lies in a groove on the posterior aspect of the left lobe of the liver. It connects with the cardiac region of the stomach. The entrance of the esophagus into the stomach occurs at the cardiac (esophageal) orifice. OBJ: Differentiate the structures of the gastrointestinal tract. 4. In which region is the stomach likely to be found? a. Epigastric region b. Left upper quadrant c. Left hypochondrium d. All of these ANS: D
TOP: Location
The stomach lies in the left upper quadrant, in the left hypochondrium and epigastric regions. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 5. Which structure is located between the apex of the heart and the stomach? a. Cardiac orifice b. Falciform ligament c. Hemidiaphragm d. Left lobe of the liver ANS: C
The left hemidiaphragm separates the stomach from the pleura of the left lung and the apex of the heart. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 6. Which surface is related to the posterior surface of the stomach? a. Diaphragm b. Anterior surface of the pancreas c. Gastric surface of the spleen d. All of these ANS: D
The posterior surface of the stomach is related to the diaphragm, the gastric surface of the spleen, the left adrenal gland, the superior portion of the left kidney, the anterior surface of the pancreas, the splenic flexure of the colon, and the ascending layer of the transverse mesocolon. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 7. The bulb of the duodenum is found a. posterior b. medial c. lateral d. anterior
to the common bile duct.
ANS: D
The duodenal bulb (first, or superior, portion) is peritoneal, supported by the hepatoduodenal ligament, and passes anterior to the common bile duct and the gastroduodenal artery, the common hepatic artery, the hepatic portal vein, and the head of the pancreas. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 8. The duodenum receives the common bile duct via the ampulla of Vater in which of these
segments? a. Second (descending) segment
b. Fourth (ascending) segment c. Third (transverse) segment d. First (superior) segment ANS: A
The common bile duct enters the second (descending) portion of the duodenum via the ampulla of Vater. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 9. The first portion of the large intestine would be visualized in the a. right inguinal b. left hypogastric c. right hypochondrium d. umbilical
region.
ANS: A
The large intestine begins in the right inguinal region and extends from the end of the ileum to the anus. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 10. The bend of the ascending colon is referred to as the a. duodenojejunal flexure. b. sigmoid flexure. c. splenic flexure. d. hepatic flexure. ANS: D
The bend of the ascending colon is referred to as the right colic or hepatic flexure. OBJ: Differentiate the structures of the gastrointestinal tract. 11. The widest, most a. flexible and longest b. convoluted c. fixed and smallest d. detached
TOP: Location
portion of the small intestine is the duodenum.
ANS: C
The duodenum; the smallest, widest, and most fixed portion of the small intestines, is approximately 25 cm long. OBJ: Describe the size of the gastrointestinal tract structures.
TOP: Size
12. The pylorus of the stomach is subdivided into three regions, which include all of the
following: a. Antrum, canal, sphincter. b. Antrum, body, sphincter. c. Fundus, body, canal.
d. Antrum, corpus, sphincter. ANS: B
The pylorus is subdivided into the antrum, the pyloric canal, and the pyloric sphincter. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
13. Which of the following are parts of the large intestine? a. Appendix, cecum, rectum b. Ileum, jejunem, cecum c. Appendix, ileum, cecum d. Jejunem, rectum, anus ANS: A
The large intestine contains the vermiform appendix; the cecum; the ascending, transverse, descending, and sigmoid colons; the right and left colic flexures; the rectum; the anal canal; and the anus. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
14. The colon is comprised of segments called a. rugae. b. alveoli. c. valvulae conniventes (valves of Kerckring). d. haustra. ANS: D
The colon is divided into segments called haustra. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
15. The hormone that is released by the presence of fat in the intestine and that regulates
gallbladder contraction and gastric emptying is a. gastrin. b. secretin. c. cholecystokinin. d. lipase. ANS: C
Cholecystokinin, which is released by the presence of fat in the intestine, regulates gallbladder contraction and gastric emptying. OBJ: Describe the functions of the gastrointestinal tract components. TOP: Physiology 16. After the major food products have been mixed with digestive secretions and enzymes,
carbohydrates are reduced to monosaccharides and disaccharides, proteins to amino acids and peptides, and fats to monoglycerides and fatty acids. These nutrients are then a. absorbed through intestinal mucosa into the bloodstream. b. propelled into the duodenum for digestion. c. released into the large bowel for elimination. d. transported into the portal system via intestinal lymphatics.
ANS: A
The digestion and absorption of all major food products take place in the small bowel. After the products mix with digestive secretions and enzymes, carbohydrates are reduced to monosaccharides and disaccharides, proteins to peptides and amino acids, and fats to monoglycerides and fatty acids. These nutrients are then absorbed through the intestinal mucosa into the bloodstream. They enter the general circulation via the capillaries (into the portal system) or the lacteals (into the intestinal lymphatics). The remaining contents are moved to the large bowel for elimination. OBJ: Describe the functions of the gastrointestinal tract components. TOP: Physiology 17. Sonographic visualization of the bowel is impeded by a. fluid. b. air. c. bone. d. None of these ANS: B
Visualization of the bowel is impeded by the presence of air or gas in the lumen. The air or gas reflects the sound, preventing transmission of the sound beam. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 18. The layers of the bowel wall create a characteristic sonographic appearance called a “gut
signature.” Up to a. three b. four c. five d. six
layers usually can be visualized.
ANS: C
Five layers of the bowel wall can typically be visualized with ultrasound. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 19. Most of the bowel wall layers recognizable on sonographic images are a. anechoic. b. echogenic. c. hypoechoic. d. isoechoic. ANS: B
The first, third, and fifth layers are echogenic, and the second and fourth layers are hypoechoic. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance
20. Concentric, focal thickening of the gut walls may present sonographically as the
“pseudokidney” or “doughnut” sign in which of the following abnormalities? a. lymphoma. b. neoplasm. c. intussusception. d. All of these ANS: D
Concentric, focal thickening of the gut walls, which presents sonographically as a hypoechoic rim, a homogeneous thickness, and a central echogenic area that is tubular shaped longitudinally (“pseudokidney sign”) and doughnut shaped (“doughnut sign”) on transverse views, may be observed with inflammation, lymphoma, edema, neoplasm, and intussusception. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 21. The ascending colon is anterolateral to the a. tail of the pancreas. b. neck of the gallbladder. c. left iliac crest. d. lower pole of the right kidney. ANS: D
The ascending colon is anterolateral to the lower pole of the right kidney. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 22. The splenic flexure refers to a. the inferior border of the stomach as it empties into the pylorus, anterior to the
body of the pancreas. b. the curvature of the transverse colon as it crosses the abdomen anterior to the
duodenum, below the transpyloric plane. c. that portion of the ascending colon in the epigastric region that courses toward the right side of the body from the region of the splenic hilum. d. the transverse colon bending to descend on the left, inferior to the spleen and coursing caudally into the left iliac fossa. ANS: D
Inferior to the spleen, the colon bends (splenic flexure) to descend on the left side of the abdomen into the left iliac fossa. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
23. Which of the following muscles does the rectum penetrate as it travels inferiorly to
become the anal canal? a. Levator ani b. Iliacus c. Piriformis d. Obturator internus
ANS: A
The rectum penetrates the levator ani muscle to become the anal canal. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
24. Which of the following statements is incorrect in regards to the parts of the stomach? a. The stomach has three parts: the fundus, body, and pylorus. b. The stomach has four parts: the fundus, neck, body, and pylorus. c. The stomach has three parts: the fundus, body, and corpus. d. The stomach has four parts: the fundus, corpus, canal, and omentum. ANS: A
The stomach has three parts: the fundus, the body, and the pylorus. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
25. The esophagus begins at the level of the a. cricoid cartilage of the neck. b. sixth cervical vertebra. c. Both of these d. Neither of these ANS: C
The esophagus begins at the level of the cricoid cartilage of the neck, which is the level of the sixth cervical vertebra. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
26. The juncture of the greater and lesser curvatures of the stomach occurs at the a. cardiac orifice. b. esophageal orifice. c. entrance of the esophagus into the stomach. d. All of these ANS: D
The entrance of the esophagus into the stomach occurs at the cardiac (esophageal) orifice. This orifice marks the juncture of the greater and lesser curvatures of the stomach. The orifice is anterior to and slightly to the left of the abdominal aorta. OBJ: Differentiate the structures of the gastrointestinal tract. 27. The lesser curvature of the stomach marks the a. right b. left c. anterior d. posterior
TOP: Gross Anatomy
border of the organ.
ANS: A
The lesser curvature of the stomach marks the right border of the organ, extending between the esophageal (cardiac) and pyloric orifices. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
28. The greater curvature of the stomach marks the a. right b. left c. anterior d. posterior
border of the organ.
ANS: B
The greater curvature marks the left border of the organ, descending in front of the left crus of the diaphragm along the left side of the eleventh and twelfth thoracic vertebrae. This curvature crosses the first lumbar vertebra as it courses to the right and ascends to the pylorus. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
29. The middle third of the descending duodenum is crossed anteriorly by the
portion of the colon. a. ascending b. descending c. transverse d. sigmoid ANS: C
The transverse colon crosses anterior to the middle third of the descending duodenum and is connected by a small amount of connective tissue. OBJ: Describe the location of the gastrointestinal tract components. TOP: Gross Anatomy 30. The esophageal wall normally measures a. 2 cm b. 3 mm c. 5 mm d. 10 mm
at the esophagogastric (EG) junction.
ANS: C
The normal esophageal wall measures 5 mm. OBJ: Describe the size of the gastrointestinal tract structures.
TOP: Gross Anatomy
31. On transverse scans of the thyroid gland, the esophagus normally is visualized as a. a hypoechoic density with posterior acoustic enhancement, medial to the
sternocleidomastoid muscle. b. a high echogenic mass proximal to the superior parathyroid gland on the left. c. a target lesion inferior to the lower pole of the right lobe. d. posterior to the gland on the left, with a bull’s eye appearance. ANS: D
In the neck, the esophagus may be seen posterior to the thyroid gland on the left. It usually is recognized by its bull’s-eye appearance. OBJ: Recognize the sonographic appearance of the gastrointestinal tract.
TOP: Sonographic Appearance 32. The sonographic appearance of an appendicitis are a. non-compressible, blind-ending tubular structure. b. greater than 6 mm outer wall to outer wall diameter. c. absence of peristalsis. d. All of these ANS: D Ultrasound findings of a non-compressible, blind-ending tubular structure that measures greater than 6 mm in outer wall to outer wall diameter and lacks peristalsis in the long axis and demonstrates the target appearance in cross-section are suggestive of appendicitis, particularly when hyperemia or increased blood flow often termed “ring of fire” is suggested in the structural wall using color Doppler. OBJ: List the ultrasound findings suggestive of appendicitis.
TOP: Sonographic Appearance
33. A bowel abnormality that occurs when a proximal bowel segment invaginates into the lumen of a distal bowel segment is termed a. intussusception. b. Meckel’s diverticulum. c. ulceration. d. serosal inflammation. ANS: A A bowel abnormality that occurs when a proximal bowel segment, called the intussusceptum, invaginates into the lumen of a distal bowel segment, called the intussuscipiens. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 34. Which of the following are retroperitoneal organs? a. Stomach, appendix, fallopian tubes, pancreas b. Pancreas, kidneys, adrenal glands, aorta, prostate c. Transverse colon, sigmoid colon, liver, spleen d. Ovaries, uterine cervix, urinary bladder, prostate ANS: B Retroperitoneal organs include the following: 2nd and 3rd parts of duodenum, ascending colon, pancreas, kidneys, descending colon, middle 3rd of rectum, adrenal glands, proximal ureters, gonadal blood vessels, renal vessels, inferior vena cava, aorta, uterine cervix, prostate, and urinary bladder. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 35. A fluoroscopic and radiographic contrast examination used to evaluate the GI tract from the esophagus to the small bowel is termed a. abdominal plain film. b. single contrast esophogram. c. upper GI. d. barium swallow. ANS: D
The upper GI series or barium swallow is a set of fluoroscopic and radiographic examinations used to evaluate the GI tract from the esophagus to the small bowel. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values related to the gastrointestinal tract. TOP: Reference Charts 36. A fluoroscopic and radiographic contrast examination used to evaluate the colon is termed a. barium enema. b. single contrast esophogram. c. upper GI. d. barium swallow. ANS: A A barium enema involves the study of the colon. Single- or double-contrast media are used in the fluoroscopic procedure. Barium sulfate is infused into the cleaned rectum and x-ray studies are performed OBJ: Describe the associated physicians, diagnostic tests, and laboratory values related to the gastrointestinal tract. TOP: Reference Charts TRUE/FALSE 1. The stomach is a retroperitoneal structure. ANS: F
The stomach is suspended within the peritoneal cavity. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 2. The duodenum is located within the peritoneal cavity. ANS: F
The duodenal bulb (first, or superior, portion) is peritoneal, supported by the hepatoduodenal ligament, and passes anterior to the common bile duct and the gastroduodenal artery, the common hepatic artery, the hepatic portal vein, and the head of the pancreas. The descending duodenum is retroperitoneal and runs posteriorly, parallel and to the right of the spine. OBJ: Describe the location of the gastrointestinal tract components. TOP: Location 3. Abnormal bowel loops demonstrate peristalsis and are compressible; normal loops are
noncompressible. ANS: F
Normal bowel loops demonstrate peristalsis and are compressible. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance
4. The small bowel is divided into four segments: the duodenum, the jejunum, cecum, and
the ileum. ANS: F
The small bowel is divided into three segments: the duodenum, the jejunum, and the ileum. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
5. The visceral peritoneum lines the wall of the abdominal and pelvis cavities. ANS: F Parietal peritoneum lines the walls of the abdominal and pelvic cavities, whereas the visceral layer covers the organs. OBJ: Differentiate the structures of the gastrointestinal tract.
TOP: Gross Anatomy
6. Fasting for six hours tends to decrease bowel motility. ANS: T Fasting for up to six hours tends to decrease bowel motility. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 7. An ileus causes bowel obstruction due to the paralysis of bowel loops. ANS: T
Ileus causes paralysis of bowel loops. OBJ: Recognize the sonographic appearance of the gastrointestinal tract. TOP: Sonographic Appearance 8. An EDG is used therapeutically in children with non-strangulated intussusception. ANS: F A barium enema is a procedure is that is used therapeutically in children with non-strangulated intussusception. A radiologist performs and interprets the examination. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values related to the gastrointestinal tract. TOP: Reference Charts
Chapter 19: The Male Pelvis: Prostate Gland and Seminal Vesicles Sonography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which statement is incorrect about the seminal vesicles? a. They are paired glands. b. They are posterior to the urinary bladder and inferior to the prostate. c. Each gland empties into the distal ductus (vas) deferens. d. They help form the ejaculatory duct. ANS: B
The seminal vesicles are paired glands that lie posterior to the urinary bladder and superior to the prostate. Each gland joins with the distal portion of the corresponding ductus (vas) deferens to form two ejaculatory ducts. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 2. Denonvilliers’ fascia a. is an interior covering for the prostate gland. b. is the external coating for the seminal vesicles. c. lies between the prostate and the rectum. d. lines the external wall of the urinary bladder. ANS: C
The prostate lies behind the symphysis pubis and is separated posteriorly from the rectum by two layers of Denonvilliers’ fascia. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 3. The prostate is supported by a. Denonvilliers’ fascia. b. the seminal vesicles and ejaculatory ducts. c. the symphysis pubis. d. the obturator internus and levator ani muscles. ANS: D
Laterally, the prostate is supported by the obturator internus and levator ani muscles. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 4. The prostate weighs about a. 5 g. b. 10 g. c. 20 g. d. 40 g. ANS: C
The prostate weighs about 20 g and measures approximately 4 cm transversely, 3 cm in AP dimensions, and 3.8 cm in the cephalocaudal dimension. OBJ: Describe the size of the prostate gland and seminal vesicles. TOP: Size 5. The area close to the center of the prostate is called the a. anterior fibromuscular region. b. verumontanum. c. central zone. d. regional stroma. ANS: B
The area close to the center of the prostate is called the verumontanum, which lies on either side of periurethral glandular tissue or zone. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 6. When imaging or describing the glandular prostate, the best technique to describe the
prostate is to use a. regions. b. zones. c. anterior and posterior terminology. d. medial and lateral terminology. ANS: B
Dividing the glandular prostate into zones is probably the most useful representation for imaging the organ. OBJ: Describe the sonographic appearance of the prostate gland and seminal vesicles. TOP: Sonographic Appearance 7. The largest portion of the glandular prostate is the a. central zone. b. transition zone. c. periurethral zone. d. peripheral zone. ANS: D
The peripheral zone comprises 70% of the glandular prostate. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 8. Which areas are posterior to the periurethral zone? a. Central zone, anterior fibromuscular region, and transition zone b. Central zone, transition zone, and verumontanum c. Central zone, peripheral zone, and verumontanum d. Central zone, peripheral zone, and seminal vesicles ANS: D
The central zone, peripheral zone, and seminal vesicles lie posterior to the periurethral zone. The transition zone, anterior fibromuscular region, and verumontanum lie posterior and anterior to the periurethral zone. OBJ: Describe the location of the prostate gland and seminal vesicles. TOP: Location 9. The anterior fibromuscular region, or stroma, a. is anterior to most of the zonal anatomy. b. is more clinically significant than the posterior glandular prostate. c. accounts for most of the weight of the prostate. d. lies adjacent to the seminal vesicles. ANS: A
The anterior fibromuscular region is anterior to the prostatic zones and the seminal vesicles. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 10. The peripheral zone comprises what percentage of the glandular prostate? a. 20% b. 5% c. 30% d. 70% ANS: D
The peripheral zone comprises 70% of the glandular prostate; the central zone, 20%; and the transition zone about 5%. OBJ: Describe the size of the prostate gland and seminal vesicles. TOP: Size 11. Semen is composed of a. 60% alkaline fructose, 13% to 33% alkaline fluid, and sperm. b. 13% to 33% alkaline fructose, 70% alkaline fluid, and sperm. c. 70% alkaline fructose, 13% to 33% sperm, and acidic fluids. d. 60% sperm, 13% to 33% alkaline fluid, and fructose. ANS: A
Semen is composed of 60% alkaline fructose, a viscous fluid rich in fructose; 13% to 33% alkaline fluid; and sperm. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 12. On a sonogram of the prostate and seminal vesicles, the prostate normally appears a. hypoechoic to the seminal vesicles. b. isoechoic to the seminal vesicles. c. hyperechoic to the seminal vesicles. d. anechoic to the seminal vesicles.
ANS: C
The prostate has medium-level echoes, which make it more hyperechoic than the seminal vesicles, which have low-level echoes. OBJ: Describe the sonographic appearance of the prostate gland and seminal vesicles. TOP: Sonographic Appearance 13. When zones are compared on ultrasound, the peripheral zone may appear more echogenic
than which structure(s)? a. Central zone b. Transition zone c. Periurethral tissues d. All of these ANS: D
The peripheral zone normally is homogeneous and slightly more echogenic than the periurethral, transition, and central zones. OBJ: Describe the sonographic appearance of the prostate gland and seminal vesicles. TOP: Sonographic Appearance 14. The part of the prostate that provides an exit for the urethra is a. the base. b. the apex. c. the verumontanum. d. Denonvilliers’ fascia. ANS: B
The tip of the cone, or apex, is the inferior margin of the prostate and provides an exit for the urethra. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 15. The part of the prostate that is in contact with the bladder is the a. apex. b. base. c. cone. d. posterior surface. ANS: B
The base of the gland is the superior aspect, which is in contact with the urinary bladder. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy TRUE/FALSE 1. Alkaline, viscous fructose is produced by the prostate gland. ANS: F
Alkaline, viscous fructose is produced by the seminal vesicles. Alkaline fluid is produced by the prostate gland, which does not produce sperm. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 2. Only alkaline fluid is produced by the seminal vesicles. ANS: F
Alkaline, viscous fructose is produced by the seminal vesicles. Alkaline fluid is produced by the prostate gland, which does not produce sperm. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 3. The seminal vesicles join with the ductus deferens to form the ejaculatory ducts. ANS: T
The seminal vesicles join with the ductus deferens to form the ejaculatory ducts. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 4. The periurethral tissues can easily be differentiated from the anterior fibromuscular
stroma. ANS: F
The periurethral tissues are hypoechoic, and the anterior fibromuscular stroma also can appear hypoechoic; thus the two structures may not be easily differentiated. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 5. The transition zone lines the proximal prostatic urethra. ANS: F
The tissue that lines the proximal prostatic urethra forms the periurethral glandular zone. The transition zone has two lobes situated on the lateral aspects of the proximal prostatic urethra. OBJ: Identify the gross anatomy of the prostate gland and seminal vesicles. TOP: Gross Anatomy 6. Normal serum prostatic specific antigen is less than 4. ANS: T Normal serum PSA is less than 4.0. Elevated serum PSA may indicate presence of disease but is not specific for carcinoma. OBJ: Identify the associated physicians, related diagnostic tests, and laboratory values. TOP: Reference Charts
7. The prostate atrophies due to benign changes and infection. ANS: F Unlike most other organs that atrophy with age, the prostate sometimes enlarges because of benign changes, infection, malignant tumors, or other causes. OBJ: Describe the size of the prostate gland and seminal vesicles. TOP: Size 8. The transabdominal approach is superior for scanning the seminal vesicles and prostate compared to the transrectal approach. ANS: F The transrectal approach is superior for scanning the seminal vesicles and prostate because of the close proximity of the transducer to the area of interest. OBJ: Describe the sonographic appearance of the prostate gland and seminal vesicles. TOP: Sonographic Appearance
Chapter 20: The Female Pelvis Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which statement most accurately describes the anatomic relationships of the ovary, the
ureter, and the internal iliac vessels? a. The ureter is posterior to the ovary, and the internal iliac vessels are anterior to the ovary. b. The ureter is anterior to the ovary, and the internal iliac vessels are posterior to the ovary. c. The ureter and internal iliac vessels both lie posterior to the ovary. d. The ureter and internal iliac vessels both lie anterior to the ovary. ANS: C
The ureter and internal iliac vessels both lie posterior to the ovary. OBJ: Describe the location of the female pelvic anatomy with relation to adjacent structures. TOP: Location 2. Which of the following is used to divide the pelvic cavity into the pelvis major (false
pelvis) and the pelvis minor (true pelvis)? a. Pubic symphysis b. Linea alba c. Linea terminalis d. Iliac crests ANS: C
The linea terminalis is an imaginary arcuate line drawn along the inner surface of the pelvic bone from the pubis symphysis anteriorly to the sacral promontory posteriorly. It marks the planes separating the false pelvis from the true pelvis. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 3. Which muscles do NOT lie within the true pelvis? a. Iliacus muscles b. Piriformis muscles c. Levator ani muscles d. Obturator internus muscles ANS: A
The psoas major muscles join the iliacus muscles at the level of the iliac crests to form the iliopsoas bundles of the false pelvis. OBJ: Describe the muscles of the pelvis and their sonographic presentations. TOP: Gross Anatomy 4. Which of the following produces the hormones estrogen and progesterone in females? a. Anterior pituitary gland b. Ovarian medulla
c. Ovarian follicles d. Uterine endometrium ANS: C
The latter half of the menstrual cycle corresponds to the luteal phase of the ovary, during which the corpus luteum produces estrogen and progesterone. OBJ: Describe the physiology of the female reproductive organs. TOP: Physiology 5. The fibrous tissue mass that remains in the ovarian cortex after ovulation and regression of
the corpus luteum is called the a. corpus albicans. b. graafian follicle. c. linea alba. d. granulosa luteal cells. ANS: A
The corpus luteum eventually regresses as a result of lack of LH stimulation, and only a fibrous tissue mass, called the corpus albicans, remains in the ovary. OBJ: Describe the physiology of the female reproductive organs. TOP: Physiology 6. The arteries in the uterus that penetrate the myometrium are the a. spiral arteries. b. arcuate arteries. c. straight arteries. d. radial arteries. ANS: D
The radial arteries, which are branches of the arcuate arteries, penetrate the myometrium and give rise to the straight arteries. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 7. The region of the uterus where the fallopian tube passes through the uterine wall and
communicates with the uterine cavity is called the a. corpus. b. cornua. c. fundus. d. infundibulum. ANS: B
The fallopian tubes are coiled, muscular tubes that emerge from the cone-shaped cornua of the uterus. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 8. Which of the following is the outermost layer of the ovary?
a. b. c. d.
Tunica externa Tunica albuginea Visceral peritoneum Germinal epithelium
ANS: D
The germinal epithelium is a single layer of epithelial cells lining the outer surface of the ovary. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 9. Which support structure anchors the ovary loosely to the uterine cornu? a. Mesovarium b. Ovarian ligament c. Round ligament d. Cardinal ligament ANS: B
The ovarian ligament supports the medial aspect of the ovary and anchors the ovary loosely to the uterine cornu. OBJ: Describe the muscles of the pelvis and their sonographic presentations. TOP: Gross Anatomy 10. Which support structure extends from the uterine cornu, passes over the pelvic brim,
through the inguinal canal, and is secured at the labia majora? a. Round ligament b. Broad ligament c. Cardinal ligament d. Uterosacral ligament ANS: A
The round ligament originates at the uterine cornu and courses within the broad ligament to the anterolateral pelvic wall. The round ligament passes over the pelvic brim and through the inguinal canal and is secured to the labia majora. OBJ: Describe the muscles of the pelvis and their sonographic presentations. TOP: Gross Anatomy 11. The most echogenic layer of the vagina is the a. vaginal mucosa. b. muscular wall. c. vaginal canal. d. vaginal serosa. ANS: A
The central mucosal lining of the normally collapsed vaginal canal walls appears thin, linear, and highly echogenic. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance
12. A bicornuate uterus is a congenital malformation caused by incomplete fusion of which
structures during embryogenesis? a. Wolffian ducts b. Müllerian ducts c. Urogenital sinuses d. Mesonephros ANS: B
A bicornuate uterus is the most common congenital malformation of the female genital tract. It is the result of incomplete fusion of the müllerian ducts. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 13. On ultrasound, the skeletal muscles of the abdomen and pelvis appear
compared
to their surrounding structures. a. hyperechoic b. hypoechoic c. isoechoic d. anechoic ANS: B
The pelvic muscles typically appear hypoechoic to the pelvic organs. OBJ: Describe the muscles of the pelvis and their sonographic presentations. TOP: Sonographic Appearance 14. The space between the pubic symphysis and the anterior wall of the urinary bladder is
called the a. anterior cul de sac. b. vesicouterine pouch. c. uterovesical junction. d. space of Retzius. ANS: D
The space of Retzius separates the anterior bladder wall from the symphysis pubis. It is filled with extraperitoneal fat. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 15. Name the gonadotropin responsible for maintaining the corpus luteum. a. Follicle-stimulating hormone (FSH) b. Estrogen c. Progesterone d. Luteinizing hormone (LH) ANS: D
The corpus luteum depends on stimulation by luteinizing hormone (LH). If this stimulation is lacking, the corpus luteum eventually regresses.
OBJ: Describe the physiology of the female reproductive organs. TOP: Physiology 16. When the uterine body and fundus are tilted posteriorly, uterine position is described as a. anteflexed. b. retroflexed. c. retroverted. d. anteverted. ANS: C
In a retroverted position, the corpus and fundus are tipped posteriorly and the angle of the cervix and vagina increases, making them more linearly oriented. OBJ: Describe the variable positions of the uterus and their sonographic appearance. TOP: Gross Anatomy 17. When the uterine body and fundus are situated posteriorly adjacent to the cervix, the
uterine position is described as a. anteflexed. b. retroflexed. c. retroverted. d. anteverted. ANS: B
If the corpus and fundus are bent at a greater posterior angle until the fundus is pointing inferiorly adjacent to the cervix, the uterine position is described as retroflexed. OBJ: Describe the variable positions of the uterus and their sonographic appearance. TOP: Gross Anatomy 18. When the urinary bladder is empty, the uterine position is described as a. anteflexed. b. retroflexed. c. retroverted. d. anteverted. ANS: D
When the urinary bladder is empty, the uterus is in an anteverted position, in which the vagina and cervix form a 90-degree angle. OBJ: Describe the variable positions of the uterus and their sonographic appearance. TOP: Gross Anatomy 19. When the corpus and fundus are bent anteriorly until the fundus is resting on the cervix,
the uterine position is described as a. anteflexed. b. retroflexed. c. retroverted. d. anteverted. ANS: A
When the corpus and fundus are bent at a greater anterior angle, until the fundus is pointing inferiorly and resting on the cervix, the uterine position is described anteflexed. OBJ: Describe the variable positions of the uterus and their sonographic appearance. TOP: Gross Anatomy 20. The portions of the large intestine contained within the true pelvis are the a. ascending colon and rectum. b. transverse colon and rectum. c. ascending and descending colon. d. sigmoid colon and rectum. ANS: D
The portions of the colon contained within the pelvis are the sigmoid colon and rectum. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 21. The vagina can be identified in the a. b. c. d.
portion of the pelvis between the (posteriorly).
(anteriorly) and the posterior; urinary bladder; rectum anterior; anterior cul-de-sac; urinary bladder inferior; urinary bladder; rectum superior; urinary bladder; posterior cul-de-sac
ANS: C
The vagina can be identified in the inferior portion of the pelvis between the urinary bladder (anteriorly) and the rectum (posteriorly). OBJ: Describe the location of the female pelvic anatomy with relation to adjacent structures. TOP: Location 22. “A thin, reflective, midline stripe in the uterus” describes the sonographic appearance of
the a. b. c. d.
endometrial canal. basal layer of the endometrium. inner layer of the myometrium. functional zone of the endometrium.
ANS: A
The central, linear, opposing surfaces of the endometrium that form the endometrial canal present on ultrasound as a bright, reflective, thin, midline stripe called the endometrial stripe. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance 23. Anechoic areas seen between the outer and intermediate layers of the myometrium
represent a. spiral arteries. b. arcuate vessels. c. areas of placental abruption.
d. the “sonographic halo.” ANS: B
The outer layer of the myometrium is separated from the intermediate layer by the anechoic arcuate vessels. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance 24. The a. luteal b. proliferative c. secretory d. follicular
phase is the best time to observe blood flow within the ovary.
ANS: A
The luteal phase is the best time to observe blood flow within the ovary using power and color Doppler. OBJ: Describe the physiology of the female reproductive organs. TOP: Sonographic Appearance 25. The muscles of the pelvic diaphragm and any fluid in the posterior cul-de-sac are
visualized a. abutting the anterior cul-de-sac. b. posterior to the vagina. c. abutting the posterior bladder wall. d. posterior to the rectum. ANS: B
The muscles of the pelvis and fluid in the posterior cul-de-sac (pouch of Douglas) lie posterior to the urinary bladder and anterior to the rectum. OBJ: Describe the muscles of the pelvis and their sonographic presentations. TOP: Sonographic Appearance 26. The three descriptive regions of the pelvis are the a. true pelvis, false pelvis, and pelvic inlet. b. right iliac, hypochondrium, and left iliac. c. pelvic inlet, pelvic outlet, and hypogastric. d. right iliac, hypogastric, and left iliac. ANS: D
The three descriptive regions of the pelvis are the right iliac, hypogastric, and left iliac regions. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 27. The congenital malformation recognized sonographically by the presence of two
endometrial canals is known as a. bicornuate uterus.
b. uterus didelphys. c. uterus unicornis. d. uterus subseptus. ANS: A
The congenital malformation recognized sonographically by the presence of two endometrial canals is known as a bicornuate uterus. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 28. The two descriptive compartments of the pelvis are the a. true pelvis and false pelvis. b. pelvis inlet and pelvic outlet. c. right iliac, left iliac. d. sacral promontory and linea terminalis. ANS: A
The two descriptive compartments of the pelvis are the true pelvis and false pelvis. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 29. The peritoneal cavity space posterior to the broad ligaments is the a. space of Retzius. b. pouch of Douglas. c. adnexa. d. pubovesical. ANS: C
The peritoneal cavity space posterior to the broad ligaments is the adnexa. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 30. The congenital malformation recognized sonographically by a midline myometrial septum within the endometrial canal is known as a. bicornuate uterus. b. uterus didelphys. c. uterus unicornis. d. uterus subseptus. ANS: D
Uterus subseptus is a milder anomaly marked by a midline myometrial septum within the endometrial canal. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 31. Which of the following ligaments are not true ligaments and only provide minimal
support? a. Broad ligaments b. Round ligaments
c. Cardinal ligaments d. Ovarian ligaments ANS: A
The broad ligaments are not true ligaments, and they provide minimal support. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 32. Which of the following ligaments maintain the forward bend of the uterus? a. Broad ligaments b. Round ligaments c. Cardinal ligaments d. Ovarian ligaments ANS: B
The round ligaments maintain the forward bend of the uterus. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 33. The space where fluid may occasionally be visible in a shallow space located between the
urinary bladder and the anterior wall of the uterus is termed a. space of Retzius. b. posterior cul-de-sac or pouch of Douglas. c. anterior cul-de-sac or vesicouterine pouch. d. pubococcygeus pouch. ANS: C
The area between the uterus and pubic bone is formed by peritoneum, which expands over the urinary bladder and covers the anterior wall of the uterus. This peritoneal reflection creates a shallow space within the peritoneal cavity, which is known as the anterior cul-de-sac or vesicouterine pouch. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 34. The ligament extends from the lateral aspect of the ovary to the lateral pelvic wall on each
side is termed a. infundibulopelvic ligaments. b. round ligaments. c. uterosacral ligaments. d. ovarian ligaments. ANS: A
The infundibulopelvic ligament extends from the infundibulum and the lateral aspect of the ovary to the lateral pelvic wall. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 35. Which of the following ligaments anchors the urinary bladder to the pelvis?
a. b. c. d.
Infundibulopelvic ligaments Pubovesical ligaments Uterosacral ligaments Ovarian ligaments
ANS: B
The urinary bladder is anchored to the pelvis by pubovesical and lateral ligaments. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Location 36. The layer of the uterine wall that is the muscle layer and forms the bulk of the uterus is
termed a. endometrium. b. myometrium. c. serosa. ANS: B
The myometrium, or muscle layer, forms the bulk of the uterus. It is composed of 3 distinct layers of different muscle fibers: outer longitudinal fibers, intermediate spiral bands, and inner circular and longitudinal fibers. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 37. The endometrium consists of which two layers? a. Functional and basal b. Muscle and serosa c. Internal os and external os d. Muscle and longitudinal ANS: A
The endometrium consists of 2 layers: superficial (functional) and deep (basal). The superficial layer is referred to as the functional layer or functional zone because it increases in size during the menstrual cycle and partially sloughs off at the time of menses. The deep, or basal, layer of the endometrium is composed of dense cellular stroma and mucosal glands; it is not significantly influenced by the menstrual cycle. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 38. Which of the following terms means multiple viable births? a. Nulliparous b. Multiparous c. Parity d. Gravida ANS: B
Multiparous means multiple viable births. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy
39. The term for the number of viable offspring is a. parity. b. births. c. gravida. d. menarche. ANS: A
Parity is the number of viable offspring. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Gross Anatomy 40. The phases of the menstrual cycle in chronological order from day 1 to day 28 are as
follows: a. proliferation, ovulation, secretory, menses. b. menses, ovulation, proliferation, secretory. c. secretory, proliferation, menses, ovulation. d. menses, proliferation, ovulation, secretory. ANS: D
The order of the menstrual cycle is menses, proliferation, ovulation, and the secretory phase. OBJ: Describe the physiology of the female reproductive organs. TOP: Physiology 41. Which of the following statements about an IUD is incorrect? a. Progestrin in an IUD thickens cervical mucus and makes implantation of a
fertilized egg difficult. b. IUDs are affective birth control and depending on the type may last up to 10 years. c. IUDs are highly reflective on ultrasound. d. IUDs are implanted under the skin of the upper arm. ANS: D
The effect of progestrin in the IUD is to thicken mucus in the cervix and make it inhospitable to sperm. It also works as an irritant to a fertilized egg, making implantation difficult. Hormonal IUDS may be effective from three to five years, while nonhormonal IUDs may remain effective for ten years. IUDs appear highly reflective on ultrasound images with varying degrees of posterior acoustic shadowing. OBJ: Describe the location of the female pelvic anatomy with relation to adjacent structures. TOP: Location TRUE/FALSE 1. The advantage of transabdominal (TA) pelvic sonography versus transvaginal (TV)
sonography is that TA provides better anatomic detail. ANS: F
When imaging the female pelvis, the urine-filled bladder serves as a “sonic window” because the urine does not obstruct passage of the sound waves. This provides a large field of view, especially when compared with TV imaging. TV sonography provides better anatomic detail than TA imaging because the high-frequency transducer is placed inside the vagina and thus closer to pelvic anatomy. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance 2. Short axis sections of the vagina have a flattened, oval shape in transabdominal, transverse
scanning plane images. ANS: T
In transabdominal, transverse scanning plane images, short axis sections of the vagina have a flattened, oval shape. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance 3. The dominant follicle measures less than 16 mm. ANS: F
A mature graafian or dominant follicle presents as anechoic, with smooth bright walls, and measures approximately 20 mm (within a range of 16 to 28 mm) OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance 4. Graded compression is a scanning technique when swift pressure is applied to a bowel
segment that is filled with gas. ANS: F
Graded compression means to slowly and steadily compress the bowel between the anterior and posterior abdominal walls. OBJ: Describe the localization of bowel segments within the female pelvis. TOP: Sonographic Appearance 5. The role of ultrasound in pelvis imaging is to determine the whether a mass is benign or
malignant. ANS: F
Ruling out the presence of a mass: if a mass is found, sonography can provide the site of origin, size, and composition. Sonography is limited, however, in providing definitive diagnoses of the benignity or malignancy of such masses. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Applications 6. A hystersalpingography is an endoscopic procedure that allows visualization of the interior
of the uterine walls.
ANS: F
A hysteroscopy/salpingoscopy is an endoscopic procedure in which a telescopic instrument is inserted through the vagina and into the uterus. This test allows visualization of the interior uterine walls. OBJ: Describe associated physicians, diagnostic tests, and laboratory values for female pelvis. TOP: Reference Charts 7. Fertilization most often occurs in the interstitial segment of the uterine tube. ANS: F
Fertilization most often occurs in the ampulla. The mucosal lining of the ampulla folds into complex matrices, filling much of the tubular lumen. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Physiology 8. The uterine tubes are not identifiable sonographically unless there tubal pathology. ANS: T
Unless there is free fluid in the lateral pelvic recesses or tubal pathology, the infundibulum, ampulla, and isthmus cannot be identified sonographically. OBJ: Describe the anatomy of the female pelvis and its sonographic appearance. TOP: Sonographic Appearance
Chapter 21: First Trimester Obstetrics (0 to 12 Weeks) Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Progesterone is produced by the a. uterus. b. pituitary gland. c. corpus luteum. d. thyroid. ANS: C
The corpus luteum produces progesterone and a small amount of estrogen to prepare the uterus for implantation. OBJ: Describe the role of the female reproductive system in creating and supporting a developing embryo. TOP: Maternal Physiology and Embryo Development 2. Human chorionic gonadotropin (HCG) is secreted by the developing a. ovary. b. oviduct. c. zygote. d. placenta. ANS: D
HCG is secreted by the developing placenta to communicate to the rest of the body that a gestation is present. OBJ: Identify related tests performed during the first trimester. TOP: Maternal Physiology and Embryo Development 3. Lacunae are structures in the a. ovary. b. fetal brain. c. amnion. d. placenta. ANS: D
The chorion frondosum villi are surrounded by maternal tissue called the lacunar network. OBJ: Describe the sonographic appearance of the placenta during the first trimester. TOP: Development of the Placenta 4. The most accurate method of dating gestation is the a. sac size. b. crown-rump length (CRL). c. biparietal diameter. d. femur length. ANS: B
The CRL is commonly accepted as the most accurate assessment of gestational age.
OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Appearance of First Trimester Anatomy 5. The secondary yolk sac is a. outside both the chorion and the amnion. b. inside both the chorion and the amnion. c. outside the amnion but inside the chorion. d. outside the chorion but inside the amnion. ANS: C
The primary yolk sac regresses as the secondary yolk sac forms between the amnion (innermost membrane of the embryo) and the chorion (outermost tissues of the embryo). OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy 6. The embryonic primitive heart starts to beat at the beginning of which gestational week? a. Week 4 b. Week 6 c. Week 8 d. Week 10 ANS: B
The primitive heart starts to beat at the beginning of the sixth gestational week. OBJ: Describe the sonographic appearance of embryologic development. TOP: Maternal Physiology and Embryo Development 7. Separation of chorion and amnion membranes at 14 weeks is a. within normal limits. b. a sign of twins. c. due to a large yolk sac. d. a sign of fetal death. ANS: A
The amnion completely fuses with the chorion at 12 to 16 weeks of gestation. OBJ: Describe the appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 8. Which is NOT a common indication for a first trimester ultrasound examination? a. Vaginal bleeding b. Size bigger than dates c. Size smaller than dates d. Lack of sensation of fetal movement ANS: D
Absence of fetal movement is not an indication for a first trimester ultrasound examination. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Appearance of First Trimester Anatomy
9. The secondary yolk sac can a. be used as a landmark to localize the embryonic disk. b. be cystic in appearance. c. be visualized before the embryo. d. All of these ANS: D
The secondary yolk sac appears cystic on ultrasound. It can serve as a landmark for localizing the embryonic disk and cardiac activity and is routinely visualized before the embryo. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 10. The chorionic frondosum eventually becomes the a. amniotic cavity. b. chorionic cavity. c. yolk sac. d. placenta. ANS: D
The chorionic frondosum eventually becomes the placenta. OBJ: Describe the role of the female reproductive system in creating and supporting a developing embryo. TOP: Development of the Placenta 11. The term gestational sac describes the a. endometrial cavity. b. pseudo sac. c. yolk sac. d. chorionic cavity. ANS: D
The term gestational sac describes the chorionic cavity. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 12. The amniotic fluid volume (AFV) normally is reduced by a. fetal regurgitation. b. maternal urination. c. fetal swallowing. d. fetal urination. ANS: C
Structures involved in the reduction of amniotic fluid are the gastrointestinal tract and the amniotic-chorionic interface. Fetal swallowing removes about half of the daily urine produced. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Development of Amniotic Fluid
13. Myometrial contractions are distinguished from a myoma by their a. outward bulge. b. echogenicity. c. inward bulge. d. location. ANS: C
Myometrial contractions are distinguished from a myoma by their inward bulge without disturbing uterine contour and their temporary nature. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Normal Variants 14. What is the first structure identified within the gestational sac? a. Amniotic membrane b. Yolk sac c. Double bleb sign d. Synechia ANS: B
The secondary yolk sac is the first structure identified within the gestational sac, followed by the embryo. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy 15. The embryo is sonographically visible with transvaginal scanning a. as early as 3 to 4 weeks of gestational age. b. when it retreats from the amnion. c. at 5 to 6 weeks gestational age. d. after obliteration of the chorionic cavity. ANS: C
At 5 to 6 weeks gestational age (GA), the embryo is evident on transvaginal scanning. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 16. The embryo’s sonographic appearance is a. echogenic. b. anechoic. c. heterogeneous. d. complex. ANS: A
The embryo appears echogenic and is surrounded by anechoic chorionic fluid. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 17. On a short axis view, the umbilical cord presents as
a. a single large, round, anechoic vessel flanked by two small, round, anechoic
vessels encircled by thick, bright walls. b. a single small, round, anechoic vessel interposed between two large, round,
hypoechoic vessels. c. two linear, anechoic vessels with bright walls that join the fetal portal vein and a
single linear, anechoic vessel with hyperechoic walls that joins the urinary bladder. d. a single large, anechoic vessel flanked by two linear, anechoic vessels. ANS: A
On a short axis view, the umbilical cord presents as a single large, round anechoic vessel (vein) flanked by two small, round, anechoic vessels (arteries) encircled by thick, bright walls. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy 18. The embryonic gut herniates a. into the small bowel. b. at 5 to 6 weeks’ GA. c. into the base of the umbilical cord. d. into the amnion. ANS: C
The embryonic gut herniates into the base of the umbilical cord and returns to the fetal abdomen by gestational week 12. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy 19. An anechoic area identified sonographically in the embryonic skull at 8 weeks is a. abnormal. b. the vitelline duct. c. the hindbrain. d. the midbrain. ANS: C
The normal hindbrain in a developing embryo appears anechoic on ultrasound. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy 20. A sonographic marker of the chorionic cavity is a. echogenic. b. anechoic. c. hyperechoic. d. a triple line. ANS: B
A sonographic marker of the chorionic cavity is the distinctive chorionic fluid, which is very slightly hyperechoic relative to the appearance of amniotic fluid. OBJ: Describe the sonographic appearance of the gestational sac and early embryo.
TOP: Sonographic Appearance of First Trimester Anatomy 21. Gestational age determined by the size of the gestational sac uses a. two right angle measurements in a longitudinal section. b. the mean sac diameter (MSD). c. addition of the number 30 to the sac depth. d. addition of the number 30 to the CRL. ANS: B
The mean sac diameter determines gestational age before visualization of the embryo. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Determination of Gestational Age 22. The gestational age in days is calculated by a. dividing the mean sac diameter by 30. b. dividing the largest sac dimension by 30. c. volume measurement of the gestational sac. d. adding 30 to the mean sac diameter. ANS: D
The gestational age in days is calculated by adding 30 to the mean sac diameter. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Determination of Gestational Age 23. Membranes formed from scarring or adhesions secondary to surgery or infection are called a. succenturiate. b. uterine synechia. c. amniotic bands. d. amnion-chorion separation. ANS: B
Uterine synechia (amniotic sheets) are membranes formed from scarring or adhesions secondary to surgery or infection. They extend from the uterus with amnion and chorion growing around them. OBJ: Describe the role of the female reproductive system in creating and supporting a developing embryo. TOP: Normal Variants 24. What is the corpus luteum? a. The outermost tissues of the developing embryo b. The part of early development that surrounds the amniotic cavity c. The trophoblast layer of the blastocyst d. What remains of the ovarian follicle after ovulation ANS: D
Corpus luteum is the term used to describe what remains of the ovarian follicle after ovulation. The corpus luteum produces the hormones progesterone and a small amount of estrogen to prepare the uterus for pregnancy. OBJ: Describe the role of the female reproductive system in creating and supporting a developing
embryo.
TOP: Maternal Physiology and Embryo Development
25. The corpus luteum a. may become enlarged and cystic. b. is an abnormality. c. contains the yolk sac. d. is eventually obliterated by the amniotic cavity. ANS: A
The corpus luteum may become enlarged and fluid-filled during pregnancy and thereafter gradually diminish without complication. OBJ: Describe the role of the female reproductive system in creating and supporting a developing embryo. TOP: Maternal Physiology and Embryo Development 26. The chorionic villi a. may become enlarged and cystic. b. contain the yolk sac. c. are eventually obliterated by the amniotic cavity. d. are fingerlike projections of the trophoblast layer that extend into the deciduate
endometrium. ANS: D
The chorionic villi are the fetal portions of the placenta that are fingerlike projections of the trophoblast layer (outer cell layer of the blastocyst) that extend into the deciduate endometrium. They are surrounded by lacunae, which are pools of maternal blood. The contact between the villi of the embryonic circulatory system and the maternal lacunae facilitates the exchange of oxygen, metabolites, carbon dioxide, and waste products. OBJ: Describe the sonographic appearance of embryologic development. TOP: Maternal Physiology and Embryo Development 27. The fluid-filled a. b. c. d.
cavity appears slightly hyperechoic to the anechoic cavity because of low-level echoes produced by protein and albumin. blastocyst; amniotic amniotic; chorionic blastocyst; chorionic chorionic; amniotic
ANS: D
A sonographic marker of the chorionic cavity is the distinctive chorionic fluid, which is slightly hyperechoic relative to the anechoic appearance of amniotic fluid. Experts believe that the low-level echoes in chorionic fluid are the result of increased concentrations of protein and albumin in the chorionic cavity. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Development of Amniotic Fluid 28. The double bleb sign a. describes the early blastocyst. b. is the sonographic appearance of the embryo disk lying between the secondary
yolk sac and developing amniotic cavity.
c. distinguishes a pseudo sac from a gestational sac. d. is eventually obliterated by the amniotic cavity. ANS: B
The double bleb sign is the term used to describe the distinctive sonographic appearance of the embryonic disk situated between the newly developed amniotic cavity and secondary yolk sac within the chorionic cavity at 4 to 5 weeks of gestational age. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 29. The double sac sign a. describes the early blastocyst. b. distinguishes a pseudo sac from a gestational sac. c. is eventually obliterated by the amniotic cavity. d. describes the sonographic appearance of the trilaminar embryonic disk. ANS: B
The double sac sign is the term used to describe the sonographic appearance of the decidua capsularis, decidua parietalis, and decidua basalis, which comprise the gestational sac. Confirmation of the double sac sign is used to differentiate a gestational sac from a “pseudo sac,” an abnormality associated with ectopic pregnancies. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 30. It is not unusual to see free-floating particles in the amniotic fluid. These particles are
believed to be a. protein. b. albumin. c. red blood cells. d. flakes of skin. ANS: D
Amniotic fluid appears anechoic; however, it is not unusual to view free-floating particles in the fluid. The particles are believed to be fetal vernix (flakes of skin) with no pathologic significance. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Appearance of First Trimester Anatomy 31. Which of the following describes the correct caliper placement when measuring the
gestational sac? a. Measurement calipers are placed at the fluid-tissue interface, excluding the wall. b. Measurement calipers are placed at the fluid-tissue interface, including the wall. c. Measurement calipers are placed from wall to wall of the bright choriodecidual reaction. d. The gestational sac is not routinely measured. ANS: A
To accurately obtain the mean internal diameter of the gestational sac, measurement calipers are placed at the fluid-tissue interface; the wall (the bright choriodecidual reaction) is not included in the measurement. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Determination of Gestational Age 32. The gestational sac is visible transvaginally as early as a. 2 to 4 weeks gestation. b. 3 to 5 weeks gestation. c. 4 to 6 weeks gestation. d. 5 to 7 weeks gestation. ANS: B
Transvaginal transducers can visualize the gestational sac as early as 3 to 5 weeks. OBJ: Describe the sonographic appearance of the gestational sac and early embryo. TOP: Sonographic Determination of Gestational Age 33. Identification of the placental cord insertion during an ultrasound is important for which
procedure? a. Amniocentesis b. Chorionic villi sampling c. Fetal blood sampling d. Cesarean delivery ANS: C
Ultrasound identification of the cord insertion into the placenta is important for certain invasive obstetric procedures, such as fetal blood sampling. The area is considered optimal because the cord is fixed at this location, making the needle approach more accurate. OBJ: Identify related tests performed during the first trimester. TOP: Sonographic Appearance of First Trimester Anatomy 34. If an incorrect menstrual history is suspected, the most common clinical indication in a
first trimester pregnancy would be a. gestational age/dating scan. b. large for dates. c. small for dates. d. All of these ANS: D
Ultrasound can be used to confirm or rule out a variety of things during the 1st trimester. An incorrect menstrual history is a common indication to confirm/determine GA, patient to measure large for dates or small for dates. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Applications 35.
Which is a function of the amniotic fluid? a. Permits symmetric growth of the fetus b. Allows the fetus to breathe
c. Provides oxygen to the fetus d. All of these ANS: A
Amniotic fluid has several important functions: permits symmetric growth of the embryo/fetus, prevents adhesions from forming in the fetal membranes, cushions the embryo/fetus and acts as a shock absorber, helps to maintain proper temperature of the embryo, allows normal development of the respiratory, gastrointestinal, and musculoskeletal systems, helps to prevent infection, and possibly serves as a source of nutrients for the developing embryo. OBJ: Describe the sonographic appearance of embryologic development. TOP: Development of Amniotic Fluid 36. When does the gestational sac measurement become inaccurate? a. 6 weeks gestation b. 7 weeks gestation c. 8 weeks gestation d. 9 weeks gestation ANS: C
The mean sac diameter is typically considered as an accurate measurement after the first 8 weeks of gestation. OBJ: Describe how gestational age is determined sonographically during the first trimester. TOP: Sonographic Determination of Gestational Age 37. Fetal swallowing begins at a. week 6. b. weeks 7 to 8. c. week 8. d. weeks 11 to 12. ANS: D
Fetal intestinal activity begins the eleventh week of development; fetal swallowing usually starts in week 12. OBJ: Describe the sonographic appearance of embryologic development. TOP: Maternal Physiology and Embryo Development 38. When should fetal limb buds be visible? a. Week 8 b. Week 9 c. Week 10 d. Week 11 ANS: A
Fetal limb buds should start to be visible by 8 weeks as the embryo develops a C-shaped configuration OBJ: Describe the sonographic appearance of embryologic development. TOP: Maternal Physiology and Embryo Development
39. Which of following would be visualized at 5.5 weeks gestation? a. Gestational sac but no yolk sac, no embryo or heartbeat b. Gestational sac with yolk sac but no embryo or heartbeat c. Gestational sac with yolk sac and living embryo d. Ability to measure the crown rump length ANS: B
Measurement guidelines for dating pregnancy during the 1st trimester are: Gestational sac (no yolk sac, embryo, or heartbeat) at 5 weeks; Gestational sac with yolk sac (no embryo, no heartbeat) at 5.5 weeks; Gestational sac with yolk sac (living embryo too small to measure) at 6 weeks; Crown rump length (CRL) measurement of the embryo from 6 weeks + days to 12 weeks. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Determination of Gestational Age 40. At which gestational age is it possible to distinguish the crown from the rump? a. 6 weeks b. 6 to 7 weeks c. 8 to 12 weeks d. 13 weeks ANS: C
The head extends, making true crown rump long axis at 8 to 12 gestational weeks. OBJ: Describe the sonographic appearance of embryologic development. TOP: Sonographic Appearance of First Trimester Anatomy
Chapter 22: Second and Third Trimester Obstetrics (13 to 42 Weeks) Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. In more than 90% of pregnancies, the fetal urinary bladder is visualized by a. 10 weeks. b. 12 weeks. c. 15 weeks. d. 20 weeks. ANS: C
In more than 90% of pregnancies, the fetal urinary bladder is visualized by gestational week 15. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 2. Cerebrospinal fluid is produced in the fetus by the a. cerebellum. b. choroid plexus. c. spine and brain. d. meninges. ANS: B
The choroid plexus secretes cerebrospinal fluid (CSF). OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 3. The fetal lungs are capable of functioning as early as sometime after a. 15 weeks. b. 20 weeks. c. 25 weeks. d. 35 weeks. ANS: C
The primitive lungs mature and become capable of functioning sometime after 25 weeks’ gestation. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 4. The umbilical cord has a. one vessel. b. two vessels. c. three vessels. d. four vessels. ANS: C
The umbilical cord has one vein and two arteries; a total of three vessels.
OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 5. A grade III placenta may have a. anechoic areas. b. calcifications. c. indentations in the chorionic plate. d. All of these ANS: D
A grade III placenta contains indentations in the chorionic plate that extend as far as the basal layer, dividing the placenta into segments. The placenta may contain highly echogenic and anechoic areas and large calcifications, which may demonstrate posterior shadowing. OBJ: Describe the sonographic appearance of the placenta and its role in supporting gestation. TOP: The Placenta 6. A grade I placenta may have a. anechoic areas. b. calcifications. c. individual segments. d. calcified basal layer. ANS: B
A grade I placenta may demonstrate small calcifications and subtle indentations of the chorionic plate. OBJ: Describe the sonographic appearance of the placenta and its role in supporting gestation. TOP: The Placenta 7. What vessels comprise the umbilical cord? a. Portal vein and umbilical artery b. Two umbilical arteries and one umbilical vein c. One umbilical artery and two umbilical veins d. Umbilical artery and right and left portal veins ANS: B
The umbilical cord contains three vessels: one umbilical vein and two umbilical arteries. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 8. Anechoic, tubular structures on the uterine surface of the placenta are called a. lacunae. b. maternal marginal veins. c. fetal marginal veins. d. venous lakes. ANS: B
Maternal marginal veins are anechoic, tubular structures normally seen on the uterine surface of the placenta. OBJ: Describe the sonographic appearance of the placenta and its role in supporting gestation. TOP: The Placenta 9. Placenta previa occurs a. from accelerated calcifications. b. with a grade III placenta. c. when a portion of the placenta covers the internal os of the cervix. d. when a portion of the placenta covers a portion of the external os of the cervix. ANS: C
Placenta previa occurs when a portion of the placenta covers the internal os of the cervix. OBJ: Describe the significance of the location of the placenta in relation to the internal cervical os. TOP: The Placenta 10. An accurate biparietal diameter (BPD) measurement can be obtained through any plane of
section that intersects the a. thalami, third ventricle, and cavum septum pellucidum. b. thalami and cavum septum pellucidum. c. thalami, cavum septum pellucidum, and cerebellum. d. thalami and third ventricle. ANS: D
The BPD can be obtained through any plane of section intersecting the thalami and third ventricle. OBJ: Describe the sonographic markers used to properly orient the transducer planes for the biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). TOP: Determination of Gestational Age During the Second and Third Trimesters 11. The cisterna magna is a(n) a. moderately echogenic portion of the brain stem. b. anechoic medullary pyramid. c. anechoic subarachnoid space. d. highly reflective brain fissure. ANS: C
The cisterna magnum appears as an anechoic subarachnoid space. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 12. The atrial septal opening is the a. ductus venosus. b. mitral valve. c. foramen ovale. d. ductus arteriosus. ANS: C
The foramen ovale is the atrial septal opening. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 13. The thalami are a. centrally located in the brain and appear anechoic. b. centrally located in the brain and appear homogeneous. c. the highly echogenic lines seen dividing the cerebrum. d. the bright, drumstick-shaped portions of the lateral ventricles. ANS: B
The thalamus is a diamond-shaped area visualized in the center of an axial section taken through the temporal lobe of the brain; it appears homogeneous with medium- to low-level echoes and is divided into two equal sections by the third ventricle, a bright line, which extends upward into the space between the two halves. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Determination of Gestational Age During the Second and Third Trimesters 14. Collapsed, the fetal colon typically a. appears hyperechoic compared with adjacent structures. b. presents with anechoic, thick walls and a hyperechoic lumen. c. appears hypoechoic compared with adjacent structures. d. indicates a gastrointestinal abnormality. ANS: C
The fetal colon typically appears hypoechoic to adjacent structures. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 15. Sonographic identification of the fetal
is necessary to establish
renal function. a. urinary bladder b. kidneys c. renal sinus d. urine-filled medullary pyramids ANS: A
Sonographic identification of the fetal urinary bladder is necessary to establish renal function. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 16. The fetal adrenal glands appear a. hyperechoic b. hypoechoic c. anechoic d. anterolateral
_ to the liver, spleen, and renal cortex.
ANS: B
The fetal adrenal glands appear hypoechoic to the liver, spleen, and renal cortex. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 17. The of bone(s) a. mineralization; determines the width of b. density; causes posterior enhancement of c. attenuation; passes d. density; attenuates
sound waves.
ANS: D
Bone density attenuates sound waves. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 18. Muscles usually appear a. hyperechoic b. dense c. hypoechoic d. echodense
compared with adjacent structures.
ANS: C
Normal fetal muscles appear very low-gray on ultrasound. In fact, some muscles may appear anechoic, especially in the abdominal wall where they can mimic the appearance of ascites (abnormal fluid). OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 19. Head circumference (HC) is best obtained through (a)
plane(s) of section
perpendicular to the . a. single; thalami, cavum septum pellucidum, and tentorium b. multiple; thalami, cavum septum pellucidum, and tentorium c. single; thalami, third ventricle, cavum septum pellucidum, and tentorium d. multiple; thalami, third ventricle, cavum septum pellucidum, and tentorium ANS: C
HC is obtained through a single plane of section perpendicular to the thalami, third ventricle, cavum septum pellucidum, and tentorium. OBJ: Describe the sonographic markers used to properly orient the transducer planes for the biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). TOP: Determination of Gestational Age During the Second and Third Trimesters 20. Abdominal circumference (AC) is measured through a
plane(s) of section where the are continuous with one another. a. single; right and left portal veins b. multiple; right and left portal veins c. single; right and left hepatic ducts
d. multiple; right and left hepatic ducts ANS: A
The AC is best obtained at the short axis level of the abdomen where the right and left portal veins are continuous with one another. OBJ: Describe the sonographic markers used to properly orient the transducer planes for the biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). TOP: Determination of Gestational Age During the Second and Third Trimesters 21. While measurement of the placenta is not standard practice, most experts agree that it
should not exceed a. 10 mm. b. 2 cm. c. 4 cm. d. 6 cm. ANS: C
Measurement of the placenta is not standard practice, but most experts agree that it should not exceed 4.0 cm. OBJ: Describe how the placenta functions as an organ of respiration for the fetus. TOP: The Placenta 22. The three causes of placenta previa are a. low-lying placenta in a normal uterus, a low-lying placenta as the result of the
presence of a benign fibroid tumor, and a vascular malformation that causes placental formation only in the lower portion of the uterus. b. history of placenta previa, history of cesarean section, and increased maternal age. c. increased parity, enlarged placenta, and maternal history of smoking. d. the stretched lower uterine segment moves as a result of growing fetus, placenta’s edge lies within 5 cm from the internal os, and low-lying placenta in normal uterus ANS: A
The three causes of placenta previa are (1) a low-lying placenta in a normal uterus; (2) a low-lying placenta as the result of the presence of a benign fibroid tumor; and (3) a vascular malformation that causes placental formation only in the lower portion of the uterus. OBJ: Describe the significance of the location of the placenta in relation to the internal cervical os. TOP: The Placenta 23. Which of the following statements is correct in describing a marginal placenta previa? a. Occurs when a portion of the cervical os is obstructed by overlying placenta. b. Occurs when the entire cervical os is obstructed by an overlying placenta. c. Occurs when the placenta's lower edge lies within 0.5 to 5 cm from the internal
cervical os. d. Exists when the placenta extends up to, but not above, the internal cervical os. ANS: D
A marginal placenta previa exists when the placenta extends up to, but not above, the internal cervical os. OBJ: Describe the significance of the location of the placenta in relation to the internal cervical os. TOP: The Placenta 24. The axis of the heart should be tilted approximately a. b. c. d.
degrees to the axis of the fetal thorax and pointed to the 45; anteroposterior; left 45; anteroposterior; right 60; anteroposterior; left 60; anteroposterior; right
.
ANS: A
The axis of the heart should be tilted approximately 45 degrees to the anteroposterior axis of the fetal thorax and pointed to the left. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 25. The pulmonary artery and the aorta are connected by the a. foramen ovale. b. superior vena cava. c. ductus arteriosus. d. ductus venosum. ANS: C The pulmonary artery and the aorta are connected by the ductus arteriosus. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 26. Which of the following closes shortly before birth and becomes the fibrous ligamentum
venosum? a. Ductus venosus b. Ductus arteriosus c. Foramen ovale d. Ligamentum teres ANS: A
Shortly before birth, the ductus venosus closes and becomes the fibrous ligamentum venosum. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 27. When does the appendicular skeleton form and the upper and lower limbs first appear as
small buds on the lateral body wall? a. 6th menstrual week b. 10th menstrual week c. 12th menstrual week
d. 16th menstrual week ANS: A
The appendicular skeleton begins to form during the 6th menstrual week when the upper and lower limbs first appear as small buds on the lateral body wall. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 28. At what time is the accepted time to make the transition from using the crown rump length
to predict gestational age versus using the BPD, HC, AC, FL? a. 10 to 11 weeks b. 12 to 13 weeks c. 14 to 16 weeks d. 16 to 18 weeks ANS: B
The transition between first and second trimesters (12 to 13 weeks) is the accepted time to make the transition from crown rump length (CRL) measurements to biparietal diameter (BPD), head circumference (HC) and abdominal circumference (AC), and femur length (FL) measurements to predict gestational age. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Determination of Gestational Age During the Second and Third Trimesters 29. Small for dates is a clinical indication for an ultrasound to confirm or rule out a. fetal presentation. b. fetal death. c. multiple gestation. d. fetal anomaly. ANS: B
Ultrasound can be used to confirm or rule out a variety of things during the second and third trimesters. Small for dates: rule out fetal death, fetal anomaly, or incorrect menstrual history. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Sonographic Applications 30. Which of the following may simulate a dilated third ventricle or arachnoid cyst? a. Lemon sign b. Prominent cisterna magna c. Choroid plexus cyst d. Cavum vergae ANS: D
The cavum vergae is a normal prominent posterior continuation of the cavum septum pellucidi, which may simulate a dilated third ventricle or arachnoid cyst. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Normal Variants
TRUE/FALSE 1. The bright reflection of the fetal skeleton is an indication of the degree of mineralization
within the developing bones. ANS: T
The bright reflection of the fetal skeleton is an indication of the degree of mineralization that has taken place within the developing bones. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 2. The anechoic areas between the bright subcutaneous and peritoneal fat are the transversus abdominis muscle and the internal and external oblique muscles. ANS: T
The anechoic areas between the bright subcutaneous and peritoneal fat are the transversus abdominis muscle and the internal and external oblique muscles. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 3. Identification of the great arteries and their outflow tracts in their usual position confirms
the presence of normal atrioventricular connections. ANS: F
Identification of the great arteries and their outflow tracts in their usual position confirms the presence of normal ventriculoarterial connections. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 4. There is a distinct relationship between the age of the gestation and the grade of the
placenta. ANS: T
There is a distinct relationship between the age of the gestation and the grade of the placenta. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: The Placenta 5. Assignment of gender by the sonographer is generally made on the basis of the presence or
absence of a fetal penis. ANS: F
Determination of fetal gender depends on the visualization of either the male scrotum or the female labia. Assignment of gender should not be made on the basis of the presence or absence of a fetal penis.
OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 6. The fourth ventricle is found in the midline of the brain and is located centrally in the
thalamus. ANS: F
The third ventricle is found in the midline of the brain and is located centrally in the thalamus. The fourth ventricle is also found in the midline in a more posterior location. The third and fourth ventricles are connected by a long tubular structure known as the aqueduct of Sylvius, and the fourth ventricle is also connected to the central canal of the spinal cord by two lateral ducts, the foramina of Luschka, and a single medial duct, the foramen of Magendie. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Fetal Organ Systems 7. To accurately measure the BPD, calipers should be placed on the outer edge of the
calvairal wall to the outer edge or the opposing calvaria wall. ANS: F
To accurately measure the BPD, the calvaria (cranium) must be symmetric with smooth contours, and measurement cursors may be positioned in 1 of 2 ways: (1) outer edge of calvarial wall to inner edge of calvarial wall, or (2) middle of near calvarial wall to middle of far calvarial wall. Most institutions use the first method. OBJ: Describe the sonographic markers used to properly orient the transducer planes for the biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). TOP: Determination of Gestational Age During the Second and Third Trimesters 8. Accurate measurement of the femoral length does not include the hypoechoic cartilaginous
ends. ANS: T
Measurement cursors for the fetal femurs are placed at the bone-cartilage interface, which are the ossified portions of the metaphysis and diaphysis. The low-gray cartilaginous ends of the femur are not included in the measurement. OBJ: Describe the sonographic markers used to properly orient the transducer planes for the biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). TOP: Determination of Gestational Age During the Second and Third Trimesters 9. Incompetent cervix requires an ultrasound to rule our cervical shortening. ANS: T
Incompetent cervix is to rule out cervical shortening. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Sonographic Applications
10. Nuchal translucency and nuchal fold are two terms to describe the same measurement of
the fetal nuchal fold. ANS: F
The nuchal fold measurement is performed during the second trimester and should not be confused with the nuchal translucency, which is measured in the first trimester. OBJ: Describe the sonographic appearance of the development of the fetus from the second to third trimester. TOP: Sonographic Applications 11. Both a Beta hCG and pregnancy test are used to determine pregnancy but the difference is that a Beta hCG test can help determine the gestational age of the pregnancy. ANS: T
In the Beta hCG test, blood is tested to quantitate the serum level of hCG to estimate gestational age. OBJ: Be familiar with related tests performed during the second and third trimester. TOP: Reference Charts
Chapter 23: High Risk Obstetrics Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The lecithin-sphingomyelin (L-S) ratio is used to a. determine lung maturity. b. rule out uterine infections. c. determine cardiac activity. d. determine fetal abnormalities. ANS: A
The L-S ratio is used to determine the lung maturity of the fetus. OBJ: Describe the indications for a biophysical profile.
TOP: High-Risk Pregnancies
2. Which procedure is done earliest in a pregnancy? a. Chorionic villus sampling b. Amniocentesis for the L-S ratio c. Amniocentesis for genetic analysis d. Umbilical cord transfusions ANS: A
Chorionic villus sampling can be performed as early as gestational weeks 10 to 12. It offers a great advantage to a woman at high risk of giving birth to an abnormal fetus. OBJ: Describe chorionic villus sampling and its purpose.
TOP: High-Risk Pregnancies
3. Amniocentesis is associated with which risk(s)? a. Infection b. Injury to the fetus c. Premature delivery d. All of these ANS: D
Complications associated with amniocentesis include infection, injury to the fetus from the needle, fetal death, premature rupture of membranes, premature labor, and premature separation of the placenta. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures 4. Which component of amniotic fluid increases beyond normal limits when certain fetal
defects are present? a. Progesterone b. Human chorionic gonadotropin (hCG) c. Alpha-fetoprotein (AFP) d. Luteinizing hormone (LH) ANS: C
AFP is the component of amniotic fluid that increases beyond normal limits when certain fetal defects are present. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures 5. Scores lower than 8 on a biophysical profile are a. usually followed up with additional testing or induced labor. b. associated with a good perinatal outcome. c. followed up with a fetal intravascular transfusion. d. considered questionable and followed up with another profile in 6 weeks. ANS: A
Scores lower than 8 on a biophysical profile usually are followed up with additional testing or induction of labor. OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile 6. In a twin gestation, division of the zygote before day 4 post fertilization results in a a. monochorionic-monoamniotic gestation. b. monochorionic-diamniotic gestation. c. dichorionic-monoamniotic gestation. d. dichorionic-diamniotic gestation. ANS: D
A twin gestation is dichorionic-diamniotic when division of the zygote occurs before day 4 after fertilization. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 7. If division occurs in the embryonic disk more than 13 days after fertilization, the result is a. the demise of one twin. b. a dichorionic-monoamniotic gestation. c. conjoined twins. d. a dichorionic-diamniotic gestation. ANS: C
Conjoined twins are the result of division of the embryonic disk more than 13 days after fertilization. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 8. In multifetal gestations, identifying chorionicity (placentae) is most accurate a. during the third trimester. b. at exactly 12 gestational weeks. c. from gestational weeks 6 through 10. d. from gestational weeks 14 through 16. ANS: C
From 6 to 10 weeks of gestation, sonographic identification of the number of gestational sacs is an accurate method for predicting chorionicity. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 9. If twin fetuses are of opposite gender, they are always a. monochorionic and monoamniotic. b. monochorionic and diamniotic. c. dichorionic and monoamniotic. d. dichorionic and diamniotic. ANS: D
Twin fetuses of opposite gender are always dichorionic-diamniotic. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 10. The interfetal membrane is a. a congenital malformation found with multifetal gestations. b. identifiable in a diamniotic twin gestation. c. only associated with same-gender twin gestations. d. predominantly part of the cord. ANS: B
In a diamniotic twin gestation, whether placentas are shared or not, a membrane should be seen sonographically, separating the fetuses. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 11. When it must be determined whether a fetus is in distress, a(an)
may be
performed. a. amniocentesis b. ultrasound exam c. chorionic villus sampling d. biophysical profile ANS: D
When it must be determined whether a fetus is in distress, a biophysical profile may be performed. The biophysical profile is a test that measures fetal well-being. Several fetal biophysical variables are observed to predict the perinatal outcome. OBJ: Describe the indications for a biophysical profile. TOP: Fetal Sonographic Biophysical Profile 12.
was developed as an early first trimester means of collecting tissue for genetic analysis using placental tissue buds. a. Amniocentesis b. Ultrasound exam c. Chorionic villus sampling d. Biophysical profile
ANS: C
Chorionic villus sampling was developed as an early first trimester means of collecting tissue for genetic analysis using placental tissue buds. Transabdominal or transcervical penetration of the uterus and amniotic sac is performed to collect a sample of the chorion covered by villi. This sample is used to obtain pertinent genetic information about the embryo/fetus. OBJ: Describe chorionic villus sampling and its purpose. 13.
TOP: High-Risk Pregnancies
was developed as a second trimester means of collecting a sample of amniotic fluid, which is used for a variety of metabolic assays or for DNA extraction. a. Amniocentesis b. Ultrasound exam c. Chorionic villus sampling d. Biophysical profile ANS: A
Amniocentesis was developed as a second trimester means of collecting a sample of amniotic fluid, which is used for a variety of metabolic assays or for DNA extraction. Transabdominal or transcervical penetration of the uterus and amniotic sac is performed for aspiration of a sample of amniotic fluid. This sample is used to obtain pertinent genetic information about the fetus. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures 14. Fetal intravascular transfusion is recommended in fetuses with a. severe hydrops. b. polyhydramnios. c. oligohydramnios. d. chromosomal abnormalities. ANS: A
Therapy by intrauterine transfusion of red cells into the umbilical vein is recommended in fetuses with severe hydrops and anemia. A transfusion of thrombocytes may be considered in fetuses with severe thrombocytopenia. OBJ: Describe the indications for fetal blood sampling. TOP: Ultrasound-Guided Procedures 15. Which of the following is NOT a variable observed during a biophysical profile
examination? a. Fetal breathing b. Fetal heart rate c. Fetal urination d. Amniotic fluid volume ANS: C
Fetal biophysical variables observed to predict perinatal outcome include the fetal heart rate, fetal body movement, fetal tone, fetal breathing movements, amniotic fluid volume, and placental grading.
OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile 16. The ideal site to access for fetal blood sampling and fetal intravascular transfusion is a. the fetal cord insertion site. b. the placental cord insertion site. c. a free-floating loop of cord. d. the fetal brachial vein. ANS: B
Prior to the procedure, the area of the umbilical cord insertion into the placenta is established with ultrasound. This area is considered optimal because the cord is fixed at this location. In some cases, a free loop of cord may be used; however, this approach is more difficult because of cord movement. OBJ: Describe the indications for fetal blood sampling. TOP: Ultrasound-Guided Procedures 17. The observation of venous pulsations in late pregnancy is an indication of a. congestive heart failure. b. intrauterine growth restriction. c. a chromosomal anomaly. d. premature labor. ANS: A
Doppler investigation of the umbilical vein is another gauge of fetal well-being. Extraabdominal umbilical venous flow displays regular pulsations up to 15 weeks of gestation; beyond that, the venous pulsations gradually disappear. Occurrence of venous pulsations later in pregnancy is an ominous sign that indicates congestive heart failure in compromised fetuses. OBJ: Describe the indications for a biophysical profile. TOP: Fetal Sonographic Biophysical Profile 18. Which of the following, when elevated in amniotic fluid, indicate fetal abnormalities or
defects? a. AFP b. PAPP c. hCG d. uE3 ANS: A
When certain defects are found during a pregnancy, high concentrations of AFP are found in amniotic fluid samples. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures 19. At six weeks gestation, the amnionicity in a twin gestation can be established by a. the number of placentas. b. the number of embryos.
c. the number of yolk sacs. d. thickness of the membrane. ANS: C
Amnionicity can also be established by identifying the number of yolk sacs. Sonographically, the yolk sac is identified approximately 2 weeks earlier than the amnion. Therefore in a monochorionic twin gestation, identification of two yolk sacs is an accurate method for confirming diamnionicity in the first trimester before visualization of the amniotic membrane. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 20. What is the earliest the amnion can be visualized utilizing transvaginal sonography? a. 5 to 6 weeks gestation b. 7 to 8 weeks gestation c. 9 to 10 weeks gestation d. 11 to 12 weeks gestation ANS: B
Utilizing transvaginal sonography, the amnion is visible by 7 or 8 weeks of gestation, when the crown rump length is 8 to 12 mm. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 21. What biophysical profile score for gross movement would a fetus receive for two separate
body movements in a 30 minute examination? a. 0 b. 1 c. 2 d. 3 ANS: A
The criteria for scoring biophysical profiles may vary among institutions, but generally the normal fetal biophysical profiles are based on the following observations within 30 minutes: (1) the presence of two or more fetal heart rate accelerations of at least 15 beats per minute in amplitude and at least 15 seconds in duration associated with fetal movement in a 20-minute period and (2) fetal body movement consisting of three or more discrete body movements that may include arching of the back or neck or twisting of the trunk. Fetal tone consists of at least one incident of limb motion from a position of flexion to extension and rapid return to flexion. Fetal breathing movement is noted in the presence of at least one 30-second episode during a 30-minute period of observation. Amniotic fluid volume consists of a measure of a pocket of amniotic fluid at least 2 cm or more in vertical diameter and 1 cm in width with no visible fetal parts or umbilical cord or amniotic fluid total of 5 cm in four-quadrant analysis combined. OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile 22. Which of the following would result in a score of 8 on a biophysical profile examination? a. Four-quadrant amniotic fluid total of 5 cm, 30-second episode of fetal breathing,
one episode of twisting of the trunk, one incident of limb motion from flexion to extension without rapid return to flexion b. Four-quadrant amniotic fluid total of 7 cm, 30-second episode of fetal breathing, four episodes of fetus arching back and twisting of the trunk, one incident of limb motion from flexion to extension with rapid return to flexion c. Four-quadrant amniotic fluid total of 4 cm, 20-second episode of fetal breathing, one episode of clenching and unclenching of fetal hand, three separate body movements d. Four-quadrant amniotic fluid total of 2 cm, 20-second episode of fetal breathing, one episode of bending and straightening of the trunk, three separate body movements ANS: B
The criteria for scoring biophysical profiles may vary among institutions, but generally the normal fetal biophysical profiles are based on the following observations within 30 minutes: (1) the presence of two or more fetal heart rate accelerations of at least 15 beats per minute in amplitude and at least 15 seconds in duration associated with fetal movement in a 20-minute period and (2) fetal body movement consisting of three or more discrete body movements that may include arching of the back or neck or twisting of the trunk. Fetal tone consists of at least one incident of limb motion from a position of flexion to extension and rapid return to flexion. Fetal breathing movement is noted in the presence of at least one 30-second episode during a 30-minute period of observation. Amniotic fluid volume consists of a measure of a pocket of amniotic fluid at least 2 cm or more in vertical diameter and 1 cm in width with no visible fetal parts or umbilical cord or amniotic fluid total of 5 cm in four-quadrant analysis combined. OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile TRUE/FALSE 1. Ultrasound is used during in utero procedures to confirm that the needle is in the correct
position and that the fetus is not in the needle’s path. ANS: T
Ultrasound is used during in utero procedures to confirm that the needle is in the correct position and that the fetus in not in the needle’s path. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures 2. Chorionic villus sampling measures the degree of fetal lung development. ANS: F
The ratio of lecithin to sphingomyelin (L-S ratio) measures the degree of fetal lung development. OBJ: Describe an amniocentesis and its purpose. TOP: Ultrasound-Guided Procedures
3. The most common indications for the sampling of fetal blood are the need for rapid
chromosomal diagnosis. ANS: T
The most common indications for the sampling of fetal blood are the confirmation of abnormal findings found on amniocentesis or chorionic villus sampling and the need for rapid chromosomal diagnosis. OBJ: Describe the indications for fetal blood sampling. TOP: Ultrasound-Guided Procedures 4. Twin gestations only result from fertilization of single ovum. ANS: F
Twin gestations result from fertilization of either two separate ova or a single ovum. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations 5. At least 30 seconds of fetal breathing movements in a 60 minute examination would result in a score of 2 for respirations during a biophysical profile exam. ANS: F The criteria for scoring biophysical profiles may vary among institutions, but generally the normal fetal biophysical profiles are based on the following observations within 30 minutes: (1) the presence of two or more fetal heart rate accelerations of at least 15 beats per minute in amplitude and at least 15 seconds in duration associated with fetal movement in a 20-minute period and (2) fetal body movement consisting of three or more discrete body movements that may include arching of the back or neck or twisting of the trunk. Fetal tone consists of at least one incident of limb motion from a position of flexion to extension and rapid return to flexion. Fetal breathing movement is noted in the presence of at least one 30-second episode during a 30 minute period of observation. Amniotic fluid volume consists of a measure of a pocket of amniotic fluid at least 2 cm or more in vertical diameter and 1 cm in width with no visible fetal parts or umbilical cord or amniotic fluid total of 5 cm in four quadrant analysis combined. OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile 6. Fetal parts or umbilical cord cannot be included in the amniotic fluid measurement for a biophysical profile. ANS: T The four-quadrant analysis is a measurement is based on the division of the gravid uterus into four equal quadrants using the umbilicus as the horizontal axis and linea nigra as the vertical axis. The anteroposterior diameter of the deepest amniotic fluid pocket in each quadrant with no fetal parts or umbilical cord is measured. OBJ: Describe how biophysical profiles are scored. TOP: Fetal Sonographic Biophysical Profile 7. The umbilical artery Doppler measurement should be taken at the fetal cord insertion to
increase reproducibility.
ANS: T
The umbilical artery doppler (UA) measurement should always be taken at the fetal cord insertion to increase reproducibility. OBJ: Describe the indications for a biophysical profile. TOP: Fetal Sonographic Biophysical Profile 8. The borders of the placentas can move close to each other and fuse late in pregnancy. ANS: T
Quite often, later in pregnancy, the borders of the placentas will move close to each other and may finally fuse, making differentiation between a monochorionic or dichorionic pregnancy difficult, if not impossible. OBJ: Describe the difference between dizygotic and monozygotic twin gestations. TOP: Multiple Gestations
Chapter 24: Fetal Echocardiography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The pulmonary artery comes off the a. right atrium. b. right ventricle. c. left atrium. d. left ventricle. ANS: B The pulmonary artery comes off the most anterior chamber, the right ventricle. OBJ: Identify normal heart anatomy.
TOP: Fetal Cardiovascular Circulation
2. A landmark frequently used to identify the right ventricle is the a. atrioventricular bundle. b. flap of the fossa ovalis. c. foramen ovale. d. moderator band. ANS: D The moderator band is often used to identify the morphologic right ventricle in prenatal ultrasound. OBJ: Identify normal heart anatomy.
TOP: Four-Chamber View
3. At twenty weeks’ gestation, the fetal heart is about the size of a a. penny. b. nickel. c. dime. d. quarter. ANS: D The fetal heart is about the size of a quarter at twenty weeks’ gestational age. OBJ: Describe the location and size of the heart in the fetus.
TOP: Location
4. Screening of the fetal heart typically occurs a. during the first trimester. b. during the second trimester. c. during the early third trimester. d. during the late third trimester. ANS: B Screening of fetal anatomy is typically performed after 18 weeks gestation and sonography imaging specific to the fetal heart is often performed between 18 to 22 weeks gestation.
OBJ: Understand the screening of the fetal heart and the appropriate timing of this test. TOP: Sonographic Appearance 5. In the second trimester, the normal heart rate ranges between a. 70 and 90 bpm. b. 90 and 110 bpm. c. 120 and 160 bpm. d. 160 and 180 bpm. ANS: C In the second trimester, the normal rate ranges between 120 and 160 beats per minute (bpm). OBJ: Discuss the timing and purpose of fetal heart imaging. TOP: Four-Chamber View 6. At the entrance of the liver, the umbilical vein branches into the a. ligamentum venosum. b. ductus venosus. c. ductus arteriosus. d. eustachian valve. ANS: B At the entrance of the liver, the umbilical vein branches into the ductus venosus, which is the first shunt in the fetal circulation. OBJ: Distinguish the three fetal vascular shunts. TOP: Fetal Cardiovascular Circulation 7. The main pulmonary artery is connected to the descending aorta by the a. ligamentum venosum. b. ductus venosus. c. ductus arteriosus. d. eustachian valve. ANS: C The ductus arteriosus connects the main pulmonary artery to the proximal descending aorta. OBJ: Distinguish the three fetal vascular shunts. TOP: Fetal Cardiovascular Circulation 8. Oxygen-rich blood is directed through the right atrium into the left atrium and away from the right ventricle by the a. pulmonary artery. b. ductus venosus. c. ductus arteriosus. d. eustachian valve. ANS: D
In fetal life, the eustachian valve helps direct the flow of oxygen-rich blood through the right atrium into the left atrium and away from the right ventricle. OBJ: Distinguish the three fetal vascular shunts. TOP: Fetal Cardiovascular Circulation 9. Normal arrangement of the abdominal and thoracic organs is referred to as a. situs solitus. b. situs inversus. c. hypoplastic heart. d. septum primum. ANS: A Situs solitus is the normal arrangement of the abdominal and thoracic organs. This means that the organs, which should develop on the right, did so. OBJ: Explain the five views necessary for imaging during fetal heart screening. TOP: Sonographic Appearance 10. The correct cardiac position is the heart lying anterior in the chest with the heart axis tipped to the a. right. b. left. c. posterior surface. d. anterior surface. ANS: B The fetal heart is normally positioned in the anterior half of the chest with the base of the heart, the atria, in the middle of the chest and the apex of the heart, the tip of the ventricles, to the left of the midline. OBJ: Explain the five views necessary for imaging during fetal heart screening. TOP: Sonographic Appearance 11. The structure normally positioned to the left of the main pulmonary artery is the a. superior vena cava. b. inferior vena cava. c. ascending aorta. d. descending aorta. ANS: C In the RVOT short axis (basal) view, the anechoic right and left pulmonary arteries can be seen bifurcating from the main pulmonary artery. The branches are seen encircling a cross section rounded or oval view of the ascending aorta with the right pulmonary artery lying closest to the aorta. OBJ: Identify normal heart anatomy.
TOP: Four-Chamber View
12. The sound beam insonates the apex of the heart first in the a. basal four-chamber view.
b. apical four-chamber view. c. subcostal four-chamber view. d. long axis four-chamber view. ANS: B In the apical four-chamber view, the beam insonates the apex of the heart first. OBJ: Differentiate four-chamber heart views. TOP: Sonographic Appearance 13. Further investigation of the heart is warranted when the heart rate persistently exceeds a. 160 bpm. b. 170 bpm. c. 180 bpm. d. 190 bpm. ANS: C Persistent tachycardia of greater than 180 bpm requires further investigation. OBJ: Discuss the timing and purpose of fetal heart imaging. TOP: Sonographic Applications 14. A structure commonly visualized anterior to the great vessels and superior vena cava is the a. thymus gland. b. apex. c. moderator band. d. trachea. ANS: A With high frequency imaging, it is not uncommon to visualize the thymus gland anterior to the great vessels and SVC. OBJ: Identify normal heart anatomy.
TOP: Sonographic Appearance
15. When evaluating the ascending aorta superior to the LVOT view, the first branch coming off the aortic arch is the a. main pulmonary artery. b. left common carotid artery. c. left subclavian artery. d. brachiocephalic artery. ANS: D Superior to the LVOT view, the ascending aorta is seen to course toward the fetal right shoulder before beginning a tight arch posteriorly and back towards the left. This is called the aortic arch. The brachiocephalic artery is the first branch coming off this arch, followed by the left common carotid artery and the left subclavian artery. OBJ: Identify normal heart anatomy.
TOP: Sonographic Appearance
16. With increasing gestational age, what percentage larger can the right ventricle normally be compared to the left ventricle? a. 10% b. 20% c. 30% d. 40% ANS: B With increasing gestational age, the right ventricle normally may be up to 20 percent larger than the left ventricle. OBJ: Describe the location and size of the heart in the fetus.
TOP: Size
17. Where does the beam insonate first in the basal four-chamber view of the heart? a. Apex b. Septum c. AV valves d. Base ANS: D In the basal four-chamber view of the heart, the beam insonates the base of the heart (the atria) first. OBJ: Differentiate four-chamber heart views. TOP: Sonographic Appearance 18. How much of the thoracic area should the heart occupy? a. ¼ b. 1/3 c. ½ d. 2/3 ANS: B The heart should occupy about 1/3 of the thoracic area. OBJ: Describe the location and size of the heart in the fetus.
TOP: Size
19. What can be given to the neonate after birth to allow the ductus arteriosus to remain patent until surgery can be performed? a. Prostaglandin E b. Oxygen c. Epinephrine d. Oral steroids ANS: A If flow-restricting abnormalities are found prenatally, measures can be taken to assure that the shunts remain open until surgical intervention can be performed. A drug, prostaglandin E, can be given to the neonate to allow the ductus arteriosus to remain patent. OBJ: Identify normal heart anatomy.
TOP: Affecting Chemicals
20. Another name for the moderator band is the a. interatrial septum. b. eustachian valve. c. foramen ovale. d. septomarginal trabecula. ANS: D The septomarginal trabecula is also known as the moderator band. OBJ: Identify normal heart anatomy.
TOP: Gross Anatomy
21. What controls the controls the opening between the right atrium and ventricle? a. Tricuspid valve b. Mitral valve c. Bicuspid valve d. Eustachian valve ANS: A The triscuspid valve controls the opening between the right atrium and ventricle and the mitral (bicuspid) valve controls the opening between the left atrium and ventricle. OBJ: Identify normal heart anatomy.
TOP: Fetal Cardiovascular Circulation
TRUE/FALSE 1. The diameter of the main pulmonary artery, before it gives off branches, should equal to or slightly larger than the diameter of the ascending aorta. ANS: T The diameter of the main pulmonary artery, before it gives off branches, should be equal to or slightly larger than the diameter of the ascending aorta. OBJ: Describe the location and size of the heart in the fetus.
TOP: Size
2. The two great veins normally connected to the right atrium are the superior vena cava and the inferior vena cava. ANS: T The superior vena cava is one of two great veins normally connected to the right atrium. The other is the inferior vena cava. OBJ: Identify normal heart anatomy.
TOP: Gross Anatomy
3. Oxygenation of fetal blood happens within the lungs. ANS: F The maternal placenta serves as a transfer site of oxygen, carbon dioxide and nutrition to and from the fetus through the umbilical cord.
OBJ: Identify normal heart anatomy.
TOP: Fetal Cardiovascular Circulation
4. In the basal four-chamber view, the beam insonates the interventricular septum in a perpendicular fashion. ANS: F In the subcostal or long axis four-chamber view, the beam insonates the interventricular septum in a perpendicular fashion providing the best resolution to interrogate it. OBJ: Differentiate four-chamber heart views. TOP: Four-Chamber View 5. Abnormalities which may have a normal appearing four-chamber view, such as complete transposition of the great arteries, tetralogy of Fallot and pulmonary atresia with a ventricular septal defect, will have an abnormal RVOT view. ANS: T Abnormalities which may have a normal appearing four-chamber view, such as complete transposition of the great arteries, tetralogy of Fallot and pulmonary atresia with a ventricular septal defect, will have an abnormal RVOT view. OBJ: Identify normal heart anatomy.
TOP: Sonographic Appearance
6. The normal axis of the heart is 45 degrees to the left of midline. ANS: T The normal axis of the heart is 45 degrees to the left of midline. OBJ: Describe the location and size of the heart in the fetus.
TOP: Location
7. The aorta normally arises from the right ventricle. ANS: F The aorta normally arises from the left ventricle. OBJ: Identify normal heart anatomy.
TOP: Fetal Cardiovascular Circulation
8. The mitral valve controls the opening between the left atrium and ventricle. ANS: T The triscuspid valve controls the opening between the right atrium and ventricle and the mitral (bicuspid) valve controls the opening between the left atrium and ventricle. OBJ: Identify normal heart anatomy.
TOP: Fetal Cardiovascular Circulation
9. A cause of a disproportionally larger right ventricle than the left ventricle is coarctation of the aorta.
ANS: T If the right ventricle is disproportionally larger than the left ventricle, likely causes include evolving hypoplastic left heart syndrome or coarctation of the aorta. OBJ: Describe the location and size of the heart in the fetus. TOP: Sonographic Applications
Chapter 25: The Neonatal Brain Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The lateral fissure, or sylvian fissure, separates the a. temporal lobes from the parietal lobes. b. temporal lobes from the frontal lobes. c. parietal lobes from the occipital lobes. d. cerebrum from the cerebellum. ANS: B The sylvian fissure separates the frontal and temporal lobes. OBJ: Identify the major structures in the neonatal brain.
TOP: Physiology
2. The transverse fissure separates the a. temporal lobes from the parietal lobes. b. temporal lobes from the frontal lobes. c. parietal lobes from the occipital lobes. d. cerebrum from the cerebellum. ANS: D The transverse fissure separates the cerebrum and cerebellum. OBJ: Identify the major structures in the neonatal brain.
TOP: Location
3. The central fissure separates the a. temporal lobes from the parietal lobes. b. temporal lobes from the frontal lobes. c. parietal and frontal lobes. d. cerebrum from the cerebellum. ANS: C The central fissure separates the parietal and frontal lobes. OBJ: Identify the major structures in the neonatal brain. 4. The diencephalon rests superior to the brain stem. It consists of a. the thalamus, hypothalamus, and epithalamus. b. the pons, midbrain, and medulla oblongata. c. None of these d. All of these ANS: A
TOP: Location
The diencephalon is composed of three distinct structures: the thalamus, hypothalamus, and epithalamus. The thalamus serves as a relay station for upward-moving sensory impulses. As a result, we can experience a crude recognition of both pleasant and unpleasant sensations. The hypothalamus, lying under the thalamus, plays a role in regulating body temperature, fluid balance, and metabolism. Additionally, it functions as the center for such drives as thirst, appetite, and sex. The epithalamus lies midline and behind the third ventricle; it contains the pineal gland, which synthesizes enzymes related to daylight sensitivity. OBJ: Identify the major structures in the neonatal brain.
TOP: Physiology
5. The structures of the brain stem are a. the thalamus, hypothalamus, and epithalamus. b. the pons, midbrain, and medulla oblongata. c. None of these d. All of these ANS: B The brain stem consists of the midbrain, pons, and medulla oblongata, which provide a pathway for ascending and descending fiber tracts and control activities such as swallowing, blood pressure, breathing, and heart rate. OBJ: Identify the major structures in the neonatal brain.
TOP: Physiology
6. The fourth ventricle is connected to the third ventricle by the a. interventricular foramina of Monro. b. aqueduct of Sylvius. c. aperture of Magendie. d. aperture of Luschka. ANS: B The third ventricle communicates with the fourth ventricle via the aqueduct of Sylvius. OBJ: Identify the major structures in the neonatal brain.
TOP: Physiology
7. The lateral ventricles communicate with the third ventricle through the a. interventricular foramina of Monro. b. aqueduct of Sylvius. c. aperture of Magendie. d. aperture of Luschka. ANS: A The lateral ventricles communicate with the third ventricle via the right and left interventricular foramen of Monro. OBJ: Identify the major structures in the neonatal brain. 8. What is the echogenicity of the bones of the cranial vault? a. Echogenic b. Moderately echogenic
TOP: Physiology
c. Low-level echoes d. Hypoechoic ANS: A The cranial bones are highly echogenic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 9. What is the echogenicity of the cerebral parenchyma? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Anechoic ANS: C The cerebral parenchyma demonstrates a low-level echo pattern. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 10. What is the echogenicity of the sulci and fissures? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A The sulci and fissures are highly echogenic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 11. What is the echogenicity of the corpus callosum? a. Anechoic b. Hypoechoic c. Echogenic d. Moderately echogenic ANS: B The corpus callosum appears hypoechoic to surrounding structures. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 12. What is the echogenicity of the cavum septum pellucidum? a. Moderately echogenic b. Low-level echoes c. Anechoic d. Echogenic
ANS: C The cavum septum pellucidum appears anechoic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 13. What is the echogenicity of the caudate nucleus? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: B The caudate nucleus appears moderately echogenic to surrounding structures. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 14. What is the echogenicity of the lateral ventricle? a. Hypoechoic b. Anechoic c. Echogenic d. Low-level echoes ANS: B The normal lateral, third, and fourth ventricles appear anechoic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 15. What is the echogenicity of the choroid plexus? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A The choroid plexus appears echogenic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 16. What is the echogenicity of the posterior periventricular white matter? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A The level posterior and cephalad to the trigones reveals the symmetric, echogenic “blush” of the posterior periventricular white matter.
OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 17. What is the echogenicity of the caudothalamic groove? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A The caudothalamic groove appears as a thin, bright arc located between the head of the caudate nucleus and the thalamus. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 18. What is the echogenicity of the sylvian fissure? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A The sylvian fissure is the echogenic and divide the frontal and temporal lobes of the cerebral cortex. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 19. What is the echogenicity of the fourth and third ventricles? a. Moderately echogenic b. Anechoic c. Hypoechoic d. Low-level echoes ANS: B The normal lateral, third, and fourth ventricles appear anechoic on ultrasound. OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 20. What is the echogenicity of the quadrigeminal plate cistern? a. Echogenic b. Moderately echogenic c. Low-level echoes d. Hypoechoic ANS: A Echogenic structures of the neonatal brain include the caudothalamic groove, choroid plexus, and quadrigeminal plate cistern.
OBJ: Describe the sonographic appearance of the neonatal brain in the coronal and sagittal scanning planes. TOP: Sonographic Appearance 21. Which of the following is the second largest portion of the brain? a. Cerebellum b. Cerebral hemispheres c. Pons d. Medulla ANS: A The cerebellum constitutes the second largest portion of the brain. OBJ: Identify the major structures in the neonatal brain. Anatomy 22. Visual impulses are interpreted by the lobe. a. anterior; frontal b. posterior; frontal c. anterior; occipital d. posterior; occipital
TOP: Gross
part of the
ANS: D The posterior part of the occipital lobe interprets visual impulses. OBJ: Describe basic brain function and identify its location in the brain. TOP: Physiology 23. The hypothalamus communicates directly with the a. pineal gland. b. pituitary gland. c. falx cerebri. d. epithalamus. ANS: B The hypothalamus communicates directly with the pituitary gland. OBJ: Describe basic brain function and identify its location in the brain. TOP: Gross Anatomy 24. The largest cistern in the brain is the a. lumbar cistern. b. cisterna magna. c. third ventricle. d. fourth ventricle. ANS: B Cisterns are found in various locations within the brain. The largest of these cisterns is the cisterna magna, which is located at the base of the cerebellum in a posterior portion of the brain.
OBJ: Identify the major structures in the neonatal brain. Anatomy
TOP: Gross
25. Which of the following is a network of blood vessels and neural tissue in the brain and is highly susceptible to hemorrhage in the premature infant? a. Circle of Willis b. Corpus callosum c. Germinal matrix d. Tentorium ANS: C The germinal matrix is composed of a fine network of blood vessels and neural tissue. It is highly susceptible to hemorrhage in the premature infant. OBJ: Identify the major structures in the neonatal brain. TOP: Sonographic Appearance 26. Which cranial bone forms part of the orbits and the cranium base and is shaped like butterfly wings? a. Frontal b. Occipital c. Ethmoid d. Sphenoid ANS: D The sphenoid bone forms part of the orbits and the base of the cranium and is shaped like butterfly wings. OBJ: Identify the major structures in the neonatal brain. Anatomy
TOP: Gross
TRUE/FALSE 1. Asymmetry in the size of the lateral ventricles is a common normal variant. ANS: T Asymmetry in the size of the lateral ventricles is a common normal variant. Approximately 40% of premature infants and less than 20% of term infants reveal some asymmetry. The left lateral ventricle is generally larger than the right. OBJ: Describe normal structural variants seen sonographically. TOP: Normal Variants 2. The recognition of pleasant and unpleasant sensations is controlled by the hypothalamus. ANS: F The thalamus serves as a relay station for upward-moving sensory impulses. As a result, we can experience a crude recognition of both pleasant and unpleasant sensations.
OBJ: Describe basic brain function and identify its location in the brain. TOP: Physiology 3. Balance and equilibrium of the body are controlled by the cerebellum. ANS: T The cerebellum functions to provide balance and equilibrium to the body by adjusting the timing of skeletal muscle activity. As a result, body movements are coordinated and smooth. OBJ: Describe basic brain function and identify its location in the brain. TOP: Physiology 4. Blood is supplied to the brain by the internal carotid and vertebral arteries. ANS: T The internal carotid and vertebral arteries supply blood to the brain. OBJ: Describe the arterial supply and venous drainage of the brain. TOP: Vasculature 5. Drainage of the brain occurs through large veins called sinuses which are located in the brain’s tough covering. ANS: T Large veins, called sinuses, located in the brain’s tough covering (i.e., dura mater), drain the brain. OBJ: Describe the arterial supply and venous drainage of the brain. TOP: Vasculature 6. Cerebrospinal fluid serves as a shock absorber against injury and distributes nutrients. ANS: T Cerebrospinal fluid (CSF) circulates around the brain and spinal cord to serve as a shock absorber against injury and a distributor of nutrients. OBJ: Identify the major structures in the neonatal brain. Anatomy
TOP: Gross
7. Gyri are grooves or indentations in the brain cortex. ANS: F The outermost surface of the cerebral hemispheres, the cerebral cortex, or “gray matter,” would appear convoluted with raised ridges called gyri that are separated from each other by sulci (grooves or indentations in the cortex). OBJ: Identify the major structures in the neonatal brain.
TOP: Gross
Anatomy 8. The normal measurement of lateral ventricular depth is 4 mm. ANS: T In a coronal plane at the level of the foramen of Monro, the bodies of the lateral ventricles are measured from wall to wall. This measurement is the widest line perpendicular to the longest axis of the ventricles. Normal measurement is 4 mm or less. OBJ: Identify the major structures in the neonatal brain.
TOP: Size
Chapter 26: The Thyroid and Parathyroid Glands Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The thyroid is an endocrine gland that secretes three hormones, which are a. triiodothyronine (T4), thyroxine (T5), and calcitonin. b. triiodothyronine (T3), thyroxine (T4), and calcium oxide. c. thyroxine (T4), triiodothyronine (T3), and calcitonin. d. triiodothyronine (T3), thyroxine (T7), and iron. ANS: C The thyroid plays a major role in growth and development. It also regulates basal metabolism through the synthesis, storage, and secretion of the thyroid hormones, which are triiodothyronine (T3), thyroxine (T4), and calcitonin. OBJ: Describe the physiology of the thyroid and parathyroid glands. TOP: Thyroid: Physiology 2. Which of the following statements is incorrect about the thyroid gland? a. It lies anterior to the trachea. b. It is composed of right and left lobes only. c. A pyramidal lobe is present in approximately 10% to 40% of the population. d. It is composed of right and left lobes connected across the midline by the isthmus. ANS: B The thyroid gland is composed of right and left lobes connected across the midline by the isthmus. It lies anterior to the trachea, and a pyramidal lobe is present in approximately 15% to 40% of the population. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Gross Anatomy 3. The average weight of the thyroid gland is approximately a. 25 g. b. 40 g. c. 15 g. d. 10 g. ANS: A The thyroid gland weighs approximately 25 g. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Size
4. Which of the following statements is incorrect about the thyroid gland? a. It measures approximately 4 to 6 cm in length, 1.3 to 1.8 cm in anteroposterior (AP) and transverse diameter b. In cross section, it is outlined anteriorly by the longus colli muscle and the internal jugular vein. c. The isthmus measures approximately 4 to 5 mm in AP diameter. d. It plays a major role in growth and development and regulates basal metabolism through the synthesis, storage, and secretion of thyroid hormones. ANS: B The longus colli muscle lies posterior and the internal jugular vein lies lateral to the thyroid lobes. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Location 5. Which of the following neck muscles located posterior to the thyroid gland? a. Sternothyroid (ST) and sternohyoid (SH) b. Sternocleidomastoid muscle (SCM) c. Longus colli muscle (LCM) d. Omohyoid (OH) ANS: C The longus colli muscle, esophagus, and minor neurovascular bundle, consisting of the inferior thyroid artery and recurrent laryngeal nerve, mark the posterior border of the thyroid. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Location 6. The sonographic appearance of the normal thyroid gland is uniformly a. echogenic with medium-level echoes, similar to the testes and liver. b. heterogeneous with medium- to high-level echoes. c. hyperechoic with high-level echoes. d. hypoechoic with medium-level echoes. ANS: A The sonographic appearance of the normal thyroid gland is uniformly echogenic with medium- to high-level echoes, similar to the testes and liver. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Sonographic Appearance
7. The mathematical method for calculating thyroid volume is based on the ellipsoid formula with a correction factor, which is a. (length width thickness 0.729) for each lobe. b. (length width thickness 0.629) for each lobe. c. (length width circumference 0.529) for each lobe. d. (length width thickness 0.529) for each lobe. ANS: D The mean thyroid volume is 18.6 ± 4.5 mL (±SD). This converts to a gland weighing 18.6 g. The mathematical method for calculating thyroid volume is based on the ellipsoid formula with a correction factor (i.e., length width thickness 0.529 for each lobe). OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Volume 8. Which of the following statements is incorrect about the sonographic appearance of the neck muscles and the esophagus? a. The esophagus appears hypoechoic with an echogenic center representing mucosa. b. The infrahyoid muscles, or strap muscles, are hypoechoic relative to the thyroid gland. c. The sternocleidomastoid muscle is hypoechoic compared with the thyroid gland. d. The longus colli muscle is hyperechoic compared with the thyroid gland. ANS: D The neck muscles (infrahyoid, sternocleidomastoid, and longus colli) are hypoechoic relative to the thyroid gland. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Sonographic Appearance 9. The secretion of triiodothyronine (T3), thyroxine (T4), and calcitonin is regulated by the a. pituitary gland only. b. hypothalamus only. c. hypothalamus and pituitary gland. d. parafollicular cells (C cells). ANS: C The secretion of triiodothyronine (T3), thyroxine (T4), and calcitonin is regulated by the hypothalamus and the pituitary gland. OBJ: Describe the physiology of the thyroid and parathyroid glands. TOP: Thyroid: Physiology 10. The thyroid gland is composed of follicles filled with a substance called a. thyrotropin.
b. parafollicular cells (C cells). c. colloid. d. None of these ANS: C Thyroid parenchyma is composed of follicles (glandular epithelium and colloid), connective tissue, stroma, blood vessels, nerves, and lymphatics. Calcitonin is secreted by the parafollicular cells (C cells) of the normal thyroid. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Physiology 11. Which of the following statements is incorrect about the parathyroid glands? a. Most people have four parathyroid glands located in a symmetric position contiguous with the thyroid gland. b. The parathyroid glands generally are situated anterior to the thyroid gland. c. The parathyroid glands may be imbedded within the thyroid tissue. d. Approximately 10% of parathyroid glands are ectopic. ANS: B The parathyroid glands typically are located posterior to the thyroid gland and anterior to the longus colli muscle. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Parathyroid: Location 12. The superior thyroid artery is a branch of the a. common carotid artery. b. internal carotid artery. c. external carotid artery. d. vertebral artery. ANS: C The superior thyroid artery is a branch of the external carotid artery. OBJ: Describe the vascular supply of the thyroid and parathyroid glands. TOP: Thyroid: Physiology 13. Which of the following statements is incorrect about the parathyroid glands? a. They generally have a multilobulated shape. b. Ectopic locations include the carotid bulb and retroesophageal, thymus, and intrathyroidal locations. c. Normal parathyroid glands measure approximately 5 to 7 mm in length, 3 to 4 mm in width, and 1 to 2 mm in thickness. d. Approximately 10% of parathyroid glands are ectopic. ANS: A
The shape of the parathyroid glands varies. They generally are oval, bean shaped, or spherical (83%), or elongated (11%), bilobulated (5%), or multilobulated (1%). OBJ: Describe the various shapes of normal parathyroid glands. TOP: Parathyroid: Gross Anatomy 14. The sonographic appearance of the normal parathyroid glands generally is a. hyperechoic compared with the thyroid gland. b. mixed echogenicity with calcifications. c. anechoic with through transmission. d. hypoechoic compared with the thyroid gland. ANS: D The parathyroid glands generally appear as flat, hypoechoic structures posterior to the thyroid gland and anterior to the longus colli muscle. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Parathyroid: Sonographic Appearance 15. Which of the following statements is incorrect about the parathyroid glands? a. Normal adult parathyroid glands generally are not seen with sonography unless they are abnormal. b. The parathyroid glands are situated posterior to the thyroid gland and anterior to the longus colli muscle. c. Normal parathyroid glands are easy to visualize in young patients. d. A prominent longus colli muscle may be mistaken for a parathyroid adenoma. ANS: C Normal parathyroid glands are small and similar in echogenicity to the thyroid and surrounding tissues, making them difficult to visualize. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Parathyroid: Sonographic Appearance 16. Which of the following statements is incorrect about parathyroid gland physiology? a. When serum calcium levels are low, PTH raises serum calcium by releasing calcium from the bone and decreasing calcium absorption in the liver. b. The parathyroid glands maintain homeostasis of blood calcium by promoting calcium absorption into the blood and preventing hypocalcemia. c. The parathyroid glands secrete parathyroid hormone, also called PTH or parathormone. d. Hypercalcemia (calcium levels greater than 10.5 mg/dL in adults) is an indication for localizing abnormal parathyroid glands. ANS: A
When serum calcium levels are low, parathyroid hormone (PTH) raises serum calcium by releasing calcium from the bone, increasing calcium absorption in the gut, and decreasing renal calcium by decreasing renal phosphate excretion. OBJ: Describe the physiology of the thyroid and parathyroid glands. TOP: Parathyroid: Physiology 17. When ultrasound fails to identify abnormal parathyroid glands preoperatively, and in patients considered for repeat surgery, which test(s) is/are commonly used? a. Selective venous sampling b. Arteriography and magnetic resonance imaging (MRI) c. Computed tomography only d. Scintigraphy, CT, and MRI ANS: D The accuracy of ultrasound in detecting parathyroid disease is approximately 74-94%. Acoustic penetration is limited when evaluating the retrotrachea and substernal regions because acoustic walls or air-containing structures such as the trachea and lung preclude sound through transmission. For this reason, the combined use of either scintigraphy, MRI, or CT increases the diagnostic efficacy. OBJ: Describe the clinical laboratory tests, related diagnostic tests, normal laboratory values, and physicians associated with the workup of the thyroid and parathyroid glands. TOP: Reference Charts 18. The high-resolution sonography recommended for evaluation of parathyroid adenomas is a. 3.5- to 5-MHz. b. 5 MHz. c. 4.5 MHz. d. 12- to 18-MHz. ANS: D A 12- to 18-MHz linear transducer is most commonly used for the initial evaluation of the thyroid and parathyroid glands. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Reference Charts 19. The superior and inferior parathyroid glands are supplied by the a. superior thyroid artery and vein. b. inferior thyroid artery only. c. venous plexus only. d. separate small branches of the superior and inferior thyroid arteries and by branches from the longitudinal anastomoses between these vessels. ANS: D
The superior and inferior parathyroid glands are supplied by separate small branches of the superior and inferior thyroid arteries and by branches from the longitudinal anastomoses between these vessels. Venous drainage is into the thyroid plexus of the veins. The lymphatic channels drain with those from the thyroid gland. OBJ: Describe the vascular supply of the thyroid and parathyroid glands. TOP: Parathyroid: Gross Anatomy 20. Which statement is incorrect about the thyroid gland? a. Thyroid volumes increase with age and body weight, as well as in patients with acute hepatitis and those living in regions deficient in iodine. b. It is an endocrine gland that secretes triiodothyronine (T3), thyroxine (T4), and calcitonin. c. It is an exocrine gland that secretes triiodothyronine (T3), thyroxine (T4), and iron. d. The normal mean thyroid volume is 18.6 ± 4.5 mL (±SD), which converts to a 18.6 g gland. ANS: C The thyroid is an endocrine gland that secretes T3, T4, and calcitonin. The normal mean thyroid volume is 18.6 g. A number of factors can increase thyroid volume, including age, body weight, acute hepatitis, and iodine deficiency. OBJ: Describe the physiology of the thyroid and parathyroid glands. TOP: Thyroid: Physiology 21. Which of the following statements is incorrect about the thyroid gland? a. It is connected across the midline by the isthmus. b. It is composed of right and left lobes. c. It lies anterior to the trachea. d. In cross section, it is outlined posterolaterally by the common carotid artery (CCA) and internal jugular vein (IJV), and anteriorly by the longus colli muscle. ANS: D In cross section, the thyroid gland is outlined posterolaterally by the CCA and the IJV and posteriorly by the LCM. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Gross Anatomy 22. Which of the following statements is incorrect about the size and shape of the thyroid gland? a. The right lobe often is slightly larger than the left lobe. b. Shorter, obese patients tend to have oval lateral lobes measuring less than 3.5 cm. c. Tall, thin patients have elongated lateral lobes that can measure up to 7 to 8 cm in the longitudinal plane. d. Thyroid gland measurements have a wide range of variability. ANS: B
Shorter, obese patients tend to have oval lateral lobes measuring less than 5 cm. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Size 23. Which of the following statements is incorrect about the adult thyroid gland? a. It plays a major role in growth and development and regulates basal metabolism through the synthesis, storage, and secretion of thyroid hormones. b. In cross section, it is outlined posterolaterally by the CCA and the IJV. c. The isthmus measures approximately 2 to 6 mm in AP diameter. d. The thyroid parenchyma is composed of connective tissue and masses of chief cells. ANS: D The thyroid parenchyma is composed of follicles, connective tissue, stroma, blood vessels, nerves, and lymphatics. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Gross Anatomy 24. Which neck muscle(s) is/are located posterior to the thyroid gland? a. Longus colli muscle b. Omohyoid and thyrohyoid muscles c. Sternocleidomastoid muscle d. Sternothyroid and sternohyoid muscles ANS: A The longus colli muscle lies posterior to the thyroid gland. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Location 25. Which of the following statements is incorrect about the sonographic appearance of the normal thyroid gland? a. It is more echogenic than contiguous muscles and vascular structures. b. It is uniformly echogenic with medium-level echoes, similar to the liver and testes. c. Anechoic, 1- to 2-mm tubular structures represent the thyroid arteries and veins. d. It is more uniformly hypoechoic than contiguous muscles and vascular structures. ANS: D The normal thyroid gland appears more echogenic than surrounding muscles and vascular structures. It is uniformly echogenic with medium-level echoes, similar to the liver and testes. Anechoic, 1- to 2-mm tubular structures with bright, thin walls represent the thyroid arteries and veins.
OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Sonographic Appearance 26. Which of the following statements is incorrect about the parathyroid glands? a. The typical sonographic appearance of a parathyroid adenoma is an oval, hyperechoic, structure without through transmission. b. Primary hyperparathyroidism is caused by a solitary parathyroid adenoma in 80% to 90% of cases. c. Most people have four parathyroid glands located posterior to the thyroid lobe and anterior to the longus colli muscle. d. The most common indication for parathyroid imaging is hypercalcemia. ANS: A A parathyroid adenoma generally appears on ultrasound as a hypoechoic to anechoic, oval or bean-shaped, homogeneous mass that does not demonstrate through transmission. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Parathyroid: Sonographic Appearance 27. Which of the following statements is incorrect about the parathyroid glands and parathyroid adenomas? a. Approximately 35% of parathyroid glands are ectopic. b. Ectopic locations for parathyroid glands include the carotid bulb, as well as retroesophageal space, the thymus and perithymic tissues, and within the thyroid gland. c. Color flow imaging of parathyroid adenomas demonstrates intraparenchymal hypervascularization. d. Normal cervical structures, such as the longus colli muscle, esophagus, and small extrathyroidal arteries and veins, can mimic parathyroid adenomas. ANS: A Approximately 10% of parathyroid glands are ectopic. They frequently are found within the thymus or perithymic tissues (10%). Other aberrant locations include the carotid bulb and sheath (1%), the retroesophageal space (1% to 3%), and within the thyroid (1%). OBJ: Describe the sonographic indications for thyroid and parathyroid gland studies. TOP: Parathyroid: Sonographic Indications 28. Which of the following statements is incorrect about imaging of the parathyroid glands? a. High-resolution (12- to 18-MHz) linear transducers are routinely used to image abnormal parathyroid glands. b. In a patient with a thick neck, a lower frequency (e.g., a 5- to 8-MHz convex transducer) may be required to enhance acoustic visualization. c. With parathyroid enlargement, lobulation and heterogenous echotexture are
appreciated sonographically. d. Sonography routinely is performed on patients with normal calcium levels. ANS: D The most common clinical indication for parathyroid imaging is hypercalcemia. OBJ: Describe the sonographic indications for thyroid and parathyroid gland studies. TOP: Reference Charts 29. The largest branch of the thyrocervical trunk is the a. subclavian artery. b. superior thyroid artery. c. inferior thyroid artery. d. external carotid artery. ANS: C The inferior thyroid artery supplies the lower half of the thyroid and is the largest branch of the thyrocervical trunk, which comes off the subclavian artery. OBJ: Describe the vascular supply of the thyroid and parathyroid glands. TOP: Thyroid: Gross Anatomy TRUE/FALSE 1. The presence of an extrathyroidal artery leading to an abnormal parathyroid gland aids the detection of an otherwise inconspicuous parathyroid adenoma. ANS: T The presence of an extrathyroidal artery leading to an abnormal parathyroid gland aids the detection of an otherwise inconspicuous parathyroid adenoma. OBJ: Describe the vascular supply of the thyroid and parathyroid glands. TOP: Parathyroid: Sonographic Appearance 2. Patients with secondary hyperparathyroidism develop hypercalcemia. ANS: T Both primary and secondary hyperparathyroidism result in hypercalcemia. OBJ: Describe the sonographic indications for thyroid and parathyroid gland studies. TOP: Thyroid: Sonographic Indications 3. The major neurovascular bundle is located posterolateral to the thyroid gland and consists of the common carotid artery, internal jugular vein, and vagus nerve. ANS: T
The major neurovascular bundle is located posterolateral to the thyroid gland and consists of the common carotid artery, internal jugular vein, and vagus nerve. It is encased by the carotid sheath, which consists of areolar tissue. The vagus nerve is visualized posterolateral to the thyroid lobes between the CCA and IJV. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Location 4. Most parathyroid adenomas appear in the area of an anatomic “triangle” formed by the thyroid gland, longus colli muscle, common carotid artery, and internal jugular vein. ANS: T Most parathyroid adenomas appear in the area of an anatomic “triangle” formed by the thyroid gland, longus colli muscle, common carotid artery, and internal jugular vein. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Thyroid: Location 5. The superior parathyroid glands are more variable in location than the inferior glands. ANS: F Because of their greater caudal migration, inferior parathyroid glands are more variable in location. OBJ: Describe the anatomy and sonographic appearance of the normal thyroid, parathyroid gland (locations), and relevant adjacent anatomic structures in the neck. TOP: Parathyroid: Location
Chapter 27: Breast Sonography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which of the following is a stromal element of the breast? a. Lobes b. Ducts c. Fat d. Lobules ANS: C Anatomically, the breast is composed of parenchymal and stromal elements. The parenchymal elements include the lobes, lobules, ducts, and acini. The stromal elements include fat and connective tissue. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
2. Which of the following is not contained in the mammary layer of the breast? a. Connective tissue b. Lobes c. Ducts d. Fat ANS: D The mammary layer contains the glandular tissues, ducts, and connective tissues. The retromammary layer contains the retromammary fat, muscle, and deep connective tissues. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
3. What is the sonographic appearance of glandular tissue? a. Hypoechoic b. Bright linear echoes c. Low to medium level echoes d. Anechoic tubular structures ANS: C The glandular or parenchymal tissues tend to appear homogeneous in texture and demonstrate a low- to medium-level echo pattern. OBJ: Describe the sonographic appearance of normal breast anatomy. TOP: Sonographic Appearance 4. What is the sonographic appearance of Cooper’s ligaments? a. Hypoechoic b. Bright linear echoes
c. Low- to medium-level echoes d. Anechoic tubular structures ANS: B Cooper’s ligaments demonstrate as increased echogenicity and are seen as bright linear echoes. OBJ: Describe the sonographic appearance of normal breast anatomy. TOP: Sonographic Appearance 5. What is the sonographic appearance of breast ducts? a. Hypoechoic b. Bright linear echoes c. Low- to medium-level echoes d. Anechoic tubular structures ANS: D Breast ducts and ductules appear as anechoic tubular structures on ultrasound. OBJ: Describe the sonographic appearance of normal breast anatomy. TOP: Sonographic Appearance 6. What is the sonographic appearance of breast fat? a. Hypoechoic b. Bright linear echoes c. Low- to medium-level echoes d. Anechoic tubular structures ANS: A Breast fat appears hypoechoic to the surrounding breast parenchyma or glandular tissue. OBJ: Describe the sonographic appearance of normal breast anatomy. TOP: Sonographic Appearance 7. Prolactin-inhibiting factor a. aids breast development. b. prevents milk production. c. acts on the breast during pregnancy to prepare for nursing. d. stimulates the release of milk during nursing. ANS: D Prolactin-inhibiting factor prevents the release of prolactin until milk production becomes necessary after childbirth. OBJ: Describe the function of the breast. TOP: Physiology 8. Oxytocin a. aids breast development. b. stimulates the breast’s secretory system after childbirth. c. acts on the breast during pregnancy to prepare for nursing. d. stimulates the release of milk during nursing.
ANS: B Oxytocin stimulates the breast’s secretory system after childbirth. OBJ: Describe the function of the breast. TOP: Physiology 9. Prolactin a. aids breast development. b. stimulates the breast’s secretory system after childbirth. c. acts on the breast during pregnancy to prepare for nursing. d. stimulates the release of milk during nursing. ANS: D Prolactin allows the production of milk. OBJ: Describe the function of the breast. TOP: Physiology 10. Estrogen a. aids in breast development. b. stimulates the breast’s secretory system after childbirth. c. acts on the breast during pregnancy to prepare for nursing. d. stimulates the release of milk during nursing. ANS: A Estrogen stimulates breast tissue development during puberty, childbearing years, and pregnancy. OBJ: Describe the function of the breast. TOP: Physiology 11. Progesterone a. aids breast development. b. stimulates the breast’s secretory system after childbirth. c. acts on the breast during pregnancy to prepare for nursing. d. stimulates the release of milk during nursing. ANS: C Progesterone prepares the breast during pregnancy for nursing. OBJ: Describe the function of the breast. TOP: Physiology 12. Prolactin-inhibiting factor is produced in the a. anterior pituitary gland. b. hypothalamus. c. posterior pituitary gland. d. thyroid gland. ANS: B The hypothalamus produces prolactin-inhibiting factor, which prevents the release of prolactin until milk production becomes necessary after childbirth. OBJ: Describe the function of the breast. TOP: Physiology
13.
Oxytocin is produced in the a. anterior pituitary gland. b. hypothalamus. c. posterior pituitary gland. d. thyroid gland. ANS: C The infant’s suckling stimulates the secretion of oxytocin from the posterior pituitary gland. This causes contraction of the lactiferous ducts, and lactation begins. OBJ: Describe the function of the breast. TOP: Physiology
14.
Prolactin is produced in the a. anterior pituitary gland. b. hypothalamus. c. posterior pituitary gland. d. thyroid gland. ANS: A The anterior pituitary gland secretes prolactin, which stimulates the development of the secretory system of the breast. OBJ: Describe the function of the breast. TOP: Physiology 15. Small clusters of calcification seen in the breast tissue on mammography are a. expected. b. normal. c. an early indication of cancer. d. usually an indication of cyst formation. ANS: C Mammography is a compression x-ray examination used to visualize breast tissue. It easily demonstrates the small clusters of calcification that often indicate early breast cancer. OBJ: Describe the physicians, diagnostic tests, and related laboratory values related to breast sonography. TOP: Reference Charts 16. Which of the following physicians analyzes tissues obtained after a biopsy or surgical procedure? a. Surgeon b. Pathologist c. Internist d. Radiologist ANS: B A pathologist determines the presence of pathology through typing tissue obtained at biopsy or other surgical procedures, by means of microscopic cellular analysis. OBJ: Describe the associated physicians, diagnostic tests, and laboratory values related
to breast sonography. TOP: Reference Charts TRUE/FALSE 1. Each breast has 10 to 15 lobes. ANS: F The normal breast is composed of 15 to 20 lobes separated by adipose tissue. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
2. Lobules are subunits of lobes. ANS: T The lobes in each breast are divided into lobules, each of which contains glandular tissue elements. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
3. Glandular breast tissue actually is found in the lobules. ANS: T Lobules contain glandular tissue elements. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
4. Suspensory ligaments for the breast traverse all three breast layers. ANS: T Support of the breast tissue is provided by the suspensory ligament of Cooper (Cooper’s ligaments), which run between each two lobules from the deep muscle fascia to the skin surface. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
5. The breast contains very little fat. ANS: F The breast contains subcutaneous fat and retromammary fat layers, as well as the fat that separates the lobes. OBJ: Define the location of anatomy related to the breast. Anatomy 6. Alveoli are located within Cooper’s ligaments and secrete milk.
TOP: Gross
ANS: F The function of the alveoli is to secrete milk into the secondary tubules. All secondary tubules from each lobe converge to form a lactiferous duct. OBJ: Define the location of anatomy related to the breast. Anatomy
TOP: Gross
7. Montgomery’s glands and areolar glands are similar in that both are located near the nipple area. ANS: T Each lactiferous duct has an ampulla, or expanded region, called Montgomery’s glands. This region is near the nipple, where milk can be stored until released during suckling. Secretions from the areolar glands keep the nipple area pliant. OBJ: Define the location of anatomy related to the breast.
TOP: Physiology
8. The glandular layer of the breast atrophies after menopause. ANS: T As a woman ages, the breast parenchyma is replaced by fatty tissue. As a result, the anterior subcutaneous layer becomes more prominent as the mammary layer atrophies and accounts for a smaller percentage of overall breast size. OBJ: Define the location of anatomy related to the breast.
TOP: Size
9. The breast has the largest amount of fatty tissue during the reproductive years. ANS: F The younger breast has a higher percentage of parenchyma than fat. OBJ: Define the location of anatomy related to the breast.
TOP: Size
10. Mammography is preferred to sonography for examining dense breast tissue. ANS: F Dense parenchyma is difficult to visualize with mammography; therefore, younger patients presenting with a possible breast mass often are first evaluated with ultrasound. OBJ: Describe the physicians, diagnostic tests, and related laboratory values related to breast sonography. TOP: Reference Charts 11. The retromammary layer is bordered posteriorly by the pectoralis major muscle. ANS: T The retromammary layer is bordered posteriorly by the pectoralis major muscle. OBJ: Define the location of anatomy related to the breast.
TOP: Gross
Anatomy 12. 3D and 4D images of the breast are difficult to obtain. ANS: F 3D/4D sonography provides multiplanar imaging. 3D provides images in three planes, the third plane being the C-plane (coronal), and 4D provides real-time 3D imaging. The C-plane provides diagnostic information that is not usually visualized in traditional 2D imaging. OBJ: Describe the sonographic appearance of normal breast anatomy. TOP: Advanced Techniques in Breast Imaging 13. Elastography is a technique that improves sonographic visualization of tissues in fibrous breasts. ANS: T Fibrous breasts have increased amounts of connective tissue and therefore increased echogenicity. Compression sonography is most helpful for assessing fibrous breasts, because it eliminates some of the posterior shadowing caused by the increased dense connective tissues. Incorporating palpation and compression, this technique has evolved into elasticity imaging, also known as strain imaging or elastography. OBJ: Describe the physicians, diagnostic tests, and related laboratory values related to breast ultrasound. TOP: Advanced Techniques in Breast Imaging 14. There are no laboratory values that can be used to indicate or monitor breast cancer. ANS: F The carcinoembryonic antigen (CEA) level is used following breast cancer. It is secreted by the liver and may be elevated in cancer removal to rule out tumor recurrence. A decrease in the antigen level represents tumor removal. Antigen levels are then monitored to detect an increase in baseline levels, which would indicate tumor recurrence. Alkaline phosphatase is an enzyme that may help rule out tumor metastasis in patients with identified breast cancer. It is secreted by the liver and may be elevated in liver diseases, as well as in bone, lung, and pancreatic carcinomas. OBJ: Describe the physicians, diagnostic tests, and related laboratory values related to breast ultrasound. TOP: Reference Charts 15. Lactiferous ducts decrease in size in nursing mothers. ANS: F Lactiferous ducts in nonpregnant women measure 2 mm while in nursing women they measure 8 mm. OBJ: Describe the size relationships of normal breast anatomy. TOP: Anatomy and Physiology
Chapter 28: Scrotal and Penile Sonography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The testes are classified as a. endocrine and seminal glands. b. exocrine and seminal glands. c. exocrine and endocrine glands. d. None of these ANS: C The testes are endocrine glands, producing testosterone, and exocrine glands, producing spermatozoa. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Physiology 2. In an adult, testicular weight is a. 2 to 3 g. b. 4 to 5 g. c. 8 to 10 g. d. 12.5 to 19 g. ANS: D Each testis weighs approximately 12.5 to 19 g. The testicle gradually decreases in size with advancing age. OBJ: Describe the normal anatomy of the scrotum, testis, testicular appendages, epididymis, spermatic cord, ductus (vas) deferens, and penis. TOP: Size 3. The epididymis empties into the a. urinary bladder. b. ductus deferens. c. testis. d. seminal vesicles. ANS: B The epididymis empties into the ductus deferens. The ductus (vas) deferens is the continuation of the tail of the epididymis. It runs in the spermatic cord through the scrotum and inguinal canal. Then it enters the abdomen where it unites with the seminal vesicle behind the urinary bladder to form the ejaculatory duct. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 4. The epididymal head is connected to which portion of the testis?
a. b. c. d.
Superior Inferior Medial Lateral
ANS: A The head of the epididymis or globus major, is located superolateral to the testis, the body of the epididymis lies adjacent to the posterolateral margin of the testis, the tail of the epididymis lies inferolateral to the testis. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Location 5. The median raphe divides the a. testicle into 200 to 300 lobules. b. tunica vaginalis from the tunica albuginea. c. tunica dartos from the cremaster muscle. d. scrotum into two testicles. ANS: D Externally, the scrotum is divided into two testicles laterally by the median ridge, called the median raphe. Internally, the scrotum is divided into sacs by a septum called the tunica dartos. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 6. Convoluted seminiferous tubules connect to straight tubules, which empty into the a. mediastinum testis. b. tunica albuginea. c. spermatogenesis. d. rete testis. ANS: D The seminiferous tubules produce sperm through the process of spermatogenesis. The tubules empty the sperm into straight tubules, which then empty the sperm into the network of ducts called the rete testis. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 7. Spermatozoa exit the testis through the a. tail of the epididymis. b. efferent ducts. c. body of the epididymis. d. head of the epididymis. ANS: B
The spermatozoa are transported out of the testes through the efferent ducts into the ductus epididymis, where the final maturation of the sperm occurs. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 8. The scrotum consists of the a. testicles. b. testicles and epididymis. c. testicles, epididymis, and distal vas deferens. d. testicles, epididymis, and proximal vas deferens. ANS: D The scrotum is a pouch of skin that contains the testicles, epididymis, and proximal portion of the vas deferens and spermatic cord. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 9. The penis is composed of a. two corpora spongiosa midventrally and one corpus cavernosum dorsolaterally. b. two corpora spongiosa dorsolaterally and one corpus cavernosum midventrally. c. two corpora cavernosa dorsolaterally and one corpus spongiosum midventrally. d. two corpora cavernosa midventrally and one corpus spongiosum dorsolaterally. ANS: C The penis is composed of three cylindric masses of tissue: the two corpora cavernosa, located dorsolaterally, and the single corpus spongiosum, in the midventral region. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 10. The main arterial blood supply of the penis includes the a. deep artery of the penis, bulbourethral artery, dorsal artery, and pampiniform plexus arteries. b. superficial dorsal artery, deep dorsal artery, and deep artery of the penis. c. deep artery of the penis, bulbourethral artery, and dorsal artery. d. deep artery of the penis, dorsal artery, and deep dorsal artery. ANS: C The arterial blood supply of the penis is the deep artery of the penis, which supplies the corpora cavernosa, and the dorsal and bulbourethral arteries, which supply the corpus spongiosum, glans penis, and urethra. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy
11. About 60% of semen is composed of a. spermatozoa produced by the testes. b. alkaline fluid rich in fructose, produced by the seminal vesicles. c. acidic fluid rich in fructose, produced by the seminal vesicles. d. alkaline fluid rich in fructose, produced by the testes. ANS: B The seminal vesicles produce an alkaline, fructose-rich fluid that comprises approximately 60% of the semen. The prostate produces an alkaline fluid that makes up 13% to 33% of the semen volume. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Physiology 12. Testicular parenchyma on ultrasound is a. homogeneous. b. heterogeneous. c. anechoic. d. mixed solid appearance. ANS: A The testicular parenchyma is homogeneous, containing medium-level echoes similar in echogenicity to the thyroid gland. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 13. What is the echogenicity of the corpora cavernosa? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. They cannot be identified on ultrasound. ANS: B The corpora cavernosa, two of three cylindric masses of erectile tissues that comprise the penis, demonstrate a medium-level echo pattern. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 14. What is the echogenicity of the corpus spongiosum? a. Low-level echoes b. Medium-level echoes c. High echogenicity
d. It cannot be identified on ultrasound. ANS: B The corpus spongiosum, one of three cylindric masses of erectile tissue that make up the penis, demonstrates a medium-level echo pattern. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 15. What is the echogenicity of the tunica albuginea? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. It cannot be identified on ultrasound. ANS: C The tunica albuginea is a dense, hyperechoic fibrous tissue that covers each testis and forms the mediastinum testis and interlobar septa. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 16. What is the echogenicity of the septum penis? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. It cannot be identified on ultrasound. ANS: C The septum penis demonstrates a highly echogenic structure. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 17. What is the echogenicity of the cavernosal arterial walls? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. They cannot be identified on ultrasound. ANS: C Vessel walls generally demonstrate as a hyperechoic linear structure. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and
penis. TOP: Sonographic Appearance 18. What is the echogenicity of the mediastinum testis? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. It cannot be identified on ultrasound. ANS: C The mediastinum testis is seen as a hyperechoic band running in a cephalocaudal orientation within the testis in the longitudinal plane. In the transverse plane, it is seen as an ovoid hyperechoic structure in the 3 or 9 o’clock position OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 19. What is the echogenicity of the epididymis? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. It cannot be identified on ultrasound. ANS: B The echogenicity of the epididymis is equal to or slightly less than that of the normal testicle. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 20. What is the echogenicity of the spermatic cord? a. Low-level echoes b. Medium-level echoes c. High echogenicity d. It cannot be identified on ultrasound. ANS: A The echogenicity of the normal spermatic cord in longitudinal plane are numerous anechoic slightly tortuous linear structures with echogenic borders representing vascular structures and connecting tissue. In the transverse plane, numerous anechoic ovoid structures with echogenic borders represent vascular structures, nerves, lymphatics and connective tissue OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis.
TOP: Sonographic Appearance 21. Which of the following is a branch of the testicular artery that courses between the septa and supplies the testicular parenchyma? a. Centripetal artery b. Capsular artery c. Cremasteric artery d. Deferential artery ANS: B The centripetal artery branches off the capsular artery that course between the septa, supplying the testicular parenchyma. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 22. The temperature of the testes is regulated by the a. mediastinum testis. b. rete testis. c. median raphe. d. pampiniform plexus. ANS: D The pampiniform plexus helps regulate the temperature of the testes by acting as a heat exchange mechanism to cool down the blood. OBJ: Illustrate the normal gross, sectional, and vascular anatomy of the scrotum, testis, testicular appendages, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Gross Anatomy 23. The normal AP diameter of the epididymal head is a. 5 to 12 mm. b. 10 to 12 mm. c. 2 to 4 mm. d. 2 to 5 mm. ANS: B The normal epididymis measures: Head (5-12 mm) Length, (10-12 mm) AP Diameter, Body (2-4 mm) AP Diameter, Tail ( 2-5 mm) AP Diameter. OBJ: Describe the normal anatomy of the scrotum, testis, testicular appendages, epididymis, spermatic cord, ductus (vas) deferens, and penis. TOP: Size 24. Excess fluid between the two layers of the tunica vaginalis is termed a. convoluted serous fluid. b. alkaline fluid. c. hydrocele. d. testicular cyst. ANS: C
OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance 25. Normal intratesticular arterial flow should exhibit a. high-resistance waveform. b. low-resistance waveform. c. continuous waveform. d. variable waveform depending on sample location. ANS: B Longitudinal scanning plane image with color and spectral doppler of intratesticular arterial flow demonstrating a low resistance waveform. OBJ: Describe the normal sonographic appearance of the scrotum, testis, testicular appendages, scrotal ligament, epididymis, ductus (vas) deferens, spermatic cord, and penis. TOP: Sonographic Appearance
Chapter 29: Pediatric Echocardiography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. What structural differences of the right ventricle help distinguish it from the left ventricle? a. Infundibular muscle band (true outflow tract) b. Moderator band c. Heavily trabeculated endocardium d. All of these ANS: D The right ventricle has a tricuspid valve with a more apical insertion point than the left ventricle. The right ventricle is triangular and has a more heavily trabeculated endocardial surface, a moderator band, and an infundibular muscle band. The left ventricle has a bicuspid valve and a thicker myocardium. The left ventricle is ellipsoidal in shape and demonstrates a smooth endocardial surface. OBJ: Name the chambers, great veins, and great arteries of the heart. TOP: Gross Anatomy 2. In the normal infant heart, blood from the right atrium travels a. across the foramen ovale into the left atrium, through the mitral valve and into the left ventricle. b. through the tricuspid valve into the right ventricle, then continues through the pulmonary valve crossing into the pulmonary artery to the lungs. c. across the foramen ovale into the left atrium, through the pulmonary veins to the lungs. d. through the tricuspid valve into the right ventricle, across the aortic valve into the aorta. ANS: B In the normal infant heart, blood from the right atrium travels through the tricuspid valve into the right ventricle and then continues through the pulmonary valve crossing into the pulmonary artery and lungs. OBJ: Describe the flow of blood through the heart of a normal neonate after closure of the fetal shunts. TOP: Gross Anatomy 3. Functions of the heart and vessels include the a. distribution of medications throughout the body. b. distribution of antibodies and white blood cells to areas of infection. c. disposal of waste products. d. All of these ANS: D
By providing the force that propels blood through all the vessels of the body, the heart distributes medications throughout the body, moves antibodies and white blood cells to areas of infection, disposes of waste products, and distributes oxygen and nutrients to tissues. OBJ: Describe the function of the heart.
TOP: The Pediatric Heart
4. On the electrocardiogram, which wave signals the onset of ventricular contraction? a. P wave b. T wave c. QRS wave d. E wave ANS: C The QRS wave signals the onset of ventricular contraction. OBJ: Describe the associated diagnostic tests. Anatomy
TOP: Gross
5. Subxiphoid imaging is best used to help a. interrogate the interatrial septum. b. determine situs. c. check for pericardial effusion. d. All of these ANS: D Subcostal views provide a wealth of information. The subcostal four-chamber view is used mainly to interrogate the interatrial septum. In this view the septum is perpendicular to the plane of sound, giving the best possible image of the structure. The entire heart and surrounding area can be seen very well in this view, making it excellent for determining situs and optimum for detecting pericardial effusions. OBJ: Describe the pediatric echocardiographic views. TOP: Pediatric Echocardiographic Views 6. The best view to image the coronary artery ostia is the a. parasternal short axis view, aortic valve level (base). b. apical four-chamber view. c. parasternal long axis view. d. parasternal short axis view, papillary muscle level. ANS: A In the parasternal short axis view at the base (aortic valve level), the sinuses are well visualized. With very slight angulations, both right and left coronary ostia can be seen. In many cases, the right coronary artery is visualized for a few millimeters, as well as the left coronary artery to the bifurcation of the left anterior descending and left circumflex and beyond. Use color flow to verify flow into the coronaries from the aorta. OBJ: Describe the pediatric echocardiographic views. TOP: Pediatric Echocardiographic Views
7. In the long axis of the aortic arch (suprasternal notch view), using blood direction, in what sequence will you encounter the normal head/neck vessels? a. Left common carotid, left subclavian, innominate artery b. Innominate, left common carotid, left subclavian artery c. Right subclavian, right common carotid, innominate artery d. Innominate, left subclavian, left common carotid artery ANS: B The innominate artery, left common carotid artery, and left subclavian artery are visualized leaving the arch. The right pulmonary artery is cut in cross section and is seen as a circular structure in the inner curvature of the arch. OBJ: Describe the flow of blood through the heart of a normal neonate after closure of the fetal shunts. TOP: Pediatric Echocardiographic Views 8. Which of the following is the best view for PW or CW Doppler of the aortic valve? a. Apical long axis view b. Apical two-chamber view c. Parasternal short axis view, aortic valve level d. Parasternal long axis view ANS: A The apical long axis view puts the aortic valve in an excellent position for Doppler study. OBJ: Describe the pediatric echocardiographic views. TOP: Pediatric Echocardiographic Views 9. Which of the following would not be detected with echocardiography? a. Ventricular septal defect b. Tetralogy of Fallot c. Abdominal aortic aneurysm d. Transposition of the great arteries ANS: C Echocardiography does not aid in diagnosing abdominal aortic aneurysm. OBJ: Describe the associated diagnostic tests. TOP: Sonographic Applications 10. When the apex of the heart points to the left chest it is termed a. situs solitus. b. levocardia. c. dextrocardia. d. mesocardiac. ANS: B Levocardia is when the apex of the heart is pointing to the left chest. OBJ: Describe the size and position of the heart in the normal child.
TOP: Physiology 11. When there is a midline liver, stomach, and gallbladder it is termed a. situs solitus. b. situs inversus totalis. c. situs ambiguous. d. situs. ANS: C With situs ambiguous, the aorta and IVC and side by side (juxtaposed). There is a midline liver, stomach, and GB. This visceral orientation has a higher incidence of congenital heart disease. OBJ: Describe the size and position of the heart in the normal child. TOP: Physiology 12. When the left ventricle is connected to the aorta and the right ventricle is connected to the pulmonary artery, it is termed a. atrioventricular concordance. b. ventriculoarterial concordance. c. atrioventricular discordance. d. ventriculoarterial discordance. ANS: B Ventriculoarterial concordance is when the left ventricle is connected to the aorta and the right ventricle is connected to the pulmonary artery. OBJ: Name the chambers, great veins, and great arteries of the heart. TOP: Gross Anatomy TRUE/FALSE 1. In the normal heart, the right and left innominate veins come together, connecting them to the superior vena cava. ANS: T Blood from the head and neck are drained by the right and left innominate veins into the SVC. OBJ: Name the chambers, great veins, and great arteries of the heart. TOP: Gross Anatomy 2. The pulmonary veins carry deoxygenated blood and return it to the left atrium. ANS: F The pulmonary veins carry oxygenated blood and return it to the left atrium. OBJ: Describe the flow of blood through the heart of a normal neonate after closure of the fetal shunts. TOP: Prenatal Development
3. The heart is the primary organ that provides the force that propels blood through the veins as well as the arteries. ANS: T The heart is the muscular pump of the body’s cardiovascular system, providing the force that propels blood through all the vessels. OBJ: Describe the flow of blood through the heart of a normal neonate after closure of the fetal shunts. TOP: Prenatal Development 4. On 2D, the heart has a soft, homogeneous, even-textured appearance ranging from medium to low intensity. ANS: T On the two-dimensional image, the heart muscle (myocardium) has a soft homogeneous, even-textured echogenicity. The appearance ranges from medium to low intensity. OBJ: Describe the pediatric echocardiographic views. TOP: Pediatric Echocardiographic Views 5. The cardiologist specializes in the diagnosis and treatment while the thoracic surgeon specializes in structural modification of the heart. ANS: T Cardiologists specialize in the diagnosis and treatment of the heart. Cardiologists, during certain procedures, make changes in existing structures, such as opening stenotic vessels or closing shunts. Only the surgeon can actually open the chest wall and cut into the heart for structural rearrangement to cure or palliate the diseased heart. OBJ: Describe the associated physicians. Charts
TOP: Reference
6. The oxygen content in the pulmonary circuit is higher than in the systemic circuit. ANS: F The oxygen content in the pulmonary circuit is lower than in the systemic circuit. OBJ: Describe function of the heart.
TOP: Reference Charts
7. The apical four-chamber view is good to visualize color flow, PW and CW Doppler of the mitral valve. ANS: T The mitral valve in this view enables the cursor to be aligned parallel to flow for color and pulse wave Doppler. OBJ: Describe the instrumentation to perform a pediatric echocardiogram. TOP: Pediatric Echocardiographic Views
8. In fetal development, if the bulboventricular looping is to the right, the result is dextrocardia. ANS: F Normal looping is to the right and results in levocardia, the normal orientation of the heart in the chest. Looping to the left causes dextrocardia. OBJ: Describe the size and position of the heart in the normal child. TOP: Prenatal Development 9. The oxygen content and intracardiac pressures are higher on the right side of the heart than on the left. ANS: F The blood on the right side has been returned to the heart after releasing oxygen to the tissues; therefore it has lower oxygen content than the left side, which receives oxygenated blood from the lungs for delivery to the tissues. OBJ: Describe the flow of blood through the heart of a normal neonate after closure of the fetal shunts. TOP: Gross Anatomy 10. The ductus venosus bypasses the liver and enables oxygenated blood from the mother to pass almost directly into the fetal heart. ANS: T The ductus venosus, last of the three fetal shunts, enables oxygenated blood from the mother to pass almost directly into the fetal heart, bypassing the liver. OBJ: Describe the flow of blood through the heart of a fully developed fetus, including the fetal shunts and their purpose. TOP: Prenatal Development 11. The sympathetic fibers of the autonomic nervous system cause the heart rate to slow down. ANS: F The sympathetic fibers of the ANS cause an increase in the heart rate. The parasympathetic division, specifically the vagus nerve, or tenth cranial nerve, causes the heart rate to slow down. OBJ: Describe the function of the heart.
TOP: Gross Anatomy
12. Concerns of the echocardiographer when performing pediatric echocardiography exams is that the patient size leaves them vulnerable to probe pressure and they lack the ability to thermoregulate. ANS: T
Pediatric echocardiography differs from adult echocardiography as there is no assumption that anatomy is normal. For that reason, a systematic anatomic assessment is needed. In addition, there are special considerations when scanning premature infants. Their small size leaves them vulnerable to increased probe pressure, excessive length of scan time, and they lack the ability to thermoregulate. OBJ: Describe the instrumentation to perform a pediatric echocardiogram. TOP: Physiology 13. Echocardiogram measurements for pediatric patients are based on calculations by body surface area therefore making it necessary to know the patient’s height, weight, and blood pressure. ANS: T Blood pressure, height and weight must be recorded on all pediatric echocardiograms as measurements are calculated by body surface area. OBJ: Describe the instrumentation to perform a pediatric echocardiogram. TOP: Physiology
Chapter 30: Adult Echocardiography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. A transesophageal echocardiogram (TEE) is the examination of choice for a a. patient with mitral valve prolapse and regurgitation seen on TTE. b. patient with an ASD seen on TTE. c. patient with a cardiac source of embolus. d. patient with an episode of CHF. ANS: C
In most labs the most common indication for TEE is evaluation for a cardiac source of embolus. OBJ: Discuss the indications for transesophageal echocardiography (TEE). TOP: Sonographic Appearance 2. Which statement is false about the evaluation of prosthetic valves? a. TTE is better suited to evaluate prosthetic mitral valve dysfunction than TEE. b. TEE is more sensitive than TTE for detecting paravalvular leaks. c. TTE may be better suited to evaluate Doppler information than TEE. d. TEE is more sensitive than TTE in detecting prosthetic valve endocarditis. ANS: A
Because of significant shadowing related to the mitral valve, prosthesis TTE would not approach the sensitivity of TEE. OBJ: Discuss the indications for transesophageal echocardiography (TEE). TOP: Sonographic Appearance 3. Suspected aortic root dissection may be diagnosed with confidence with a. TTE. b. a chest radiograph. c. a fast CT scan. d. TEE. ANS: D
In most labs the most common indication for TEE is evaluation for a cardiac source of embolus. Other common indications include evaluation of prosthetic valves and native valvular disease, infective endocarditis, aortic pathology including aortic dissection, intracardiac masses, and congenital heart disease. OBJ: Identify the most common reasons for obtaining a TEE.
TOP: Sonographic Appearance
4. M-mode echocardiography a. is no longer needed, having been replaced by TEE, TTE, and 3D
echocardiography. b. provides measurements of cardiac structures for quantitative assessment. c. performs the same function as Doppler assessment. d. None of these
ANS: B
M-mode is an important supplement to the cardiac examination and provides information on subtle changes or rapid movements of the heart that may not be seen on real-time examination. M-mode is a measure of distance over time. Distance is presented on the x-axis and is calibrated by a series of dots 1 cm apart. OBJ: Describe the phases of the cardiac cycle and relate them to intracardiac events. TOP: Sonographic Appearance 5.
A contrast imaging examination is indicated for a patient with hypertrophic cardiomyopathy. a patient with a left ventricular thrombus. a patient with indeterminate left ventricular aneurysm versus pseudoaneurysm. All of these
a. b. c. d.
ANS: D
According to the ASE the major abnormalities that contrast can aide in a more complete evaluation of are as follows: Hypertrophic Cardiomyopathy (Apical Variant), LV Noncompaction, LV Thrombus and Intracardiac Mass Evaluation, LV Aneurysm versus Pseudoanuerysm, and not to forget LV Ejection Fraction and Regional Wall Motion Abnormalities. OBJ: Describe the sonographic appearance of the heart.
TOP: Sonographic Appearance
6. This fetal functional valve, a remnant in the adult, can be seen in the right atrium near the
entrance of the IVC. a. Eustachian valve b. Moderator band c. Tricupsid valve d. Mitral valve ANS: A
The Eustachian valve can be seen in the right atrium near the entrance of the inferior vena cava. In the fetus, it was a functional valve covering the entrance to the IVC. Only a remnant of the valve is now seen. It is best visualized in the right ventricular inflow view OBJ: Describe the sonographic appearance of the heart.
TOP: Sonographic Appearance
7. Best visualized in the apical views, these thin fibrous strands extend from one ventricular
wall to another. a. Chiari network b. Ectopic chordae c. Eustachian valve d. Moderator band ANS: B
Ectopic chordae are thin, fibrous strands that extend from one ventricular wall to another. They can be found in either ventricle and are best visualized in the apical views OBJ: Describe the sonographic appearance of the heart.
TOP: Sonographic Appearance
8. Which of the following may decrease heart rate and contraction strength because it
interferes with calcium participation in muscular contraction? a. Epinephrine b. Potassium c. Sodium d. Calcium ANS: C
Sodium may decrease heart rate and contraction strength because it tends to interfere with calcium participation in muscular contraction. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Reference Charts
9. Which of the following is produced by the adrenal gland and increases the excitability of
the SA node? a. Epinephrine b. Potassium c. Sodium d. Calcium ANS: A
Epinephrine is produced by the adrenal medulla. It increases the excitability of the SA node, thereby increasing the heart rate and the strength of the contractions. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Reference Charts
10. The normal Doppler velocities for the tricuspid valve is a. 0.6 to 1.3 m/sec. b. 1.0 to 1.7 m/sec. c. 0.3 to 0.7 m/sec. d. 0.6 to 0.9 m/sec. ANS: C
The normal Doppler velocities in the tricuspid valve is 0.3 to 0.7 m/sec. OBJ: Learn the normal values for heart chamber sizes, wall thickness, and Doppler flow velocities. TOP: Reference Charts 11. Which view is optimal for imaging the right ventricular wall thickness? a. Subcostal view b. Suprasternal view c. Apical view d. Parasternal long axis ANS: A
Subcostal imaging allows a view across the right ventricle from the area of the subxiphoid and liver. This view facilitates the inspection of the right atrium and right ventricular thickness, pericardial effusion, assessment of inferior vena cava for estimation of right atrial pressure, hepatic vein flow assessment, as well as tricuspid valve morphology and further interrogation of the interatrial septum.
OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Sonographic Appearance
TRUE/FALSE 1. The thickest layer of the heart is the myocardium. ANS: T
The myocardium, the thickest layer of the heart, consists of contractile muscle. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Gross Anatomy
2. Epicardium is another name for pericardium. ANS: F
The epicardium is the thin outer layer of the heart. The pericardium is the sac in which the heart sits. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Gross Anatomy
3. The moderator band cannot be seen on ultrasound. ANS: F
The moderator band is one of four prominent muscular bands in the right ventricle of the heart. The moderator band can be best visualized in the apical four-chamber view on ultrasound. OBJ: Describe the sonographic appearance of the heart.
TOP: Sonographic Appearance
4. Atrioventricular valves are not the same as semilunar valves. ANS: T
The atrioventricular valvules are valves between the atria and ventricles (tricuspid on the right and bicuspid on the left). The semilunar valves are between the ventricles and the great vessels (pulmonary artery and aorta). The semilunar valves are the aortic valve on the left, between the left ventricle and aorta, and the pulmonic valve on the right, between the right ventricle and the pulmonary artery. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Gross Anatomy
5. Blood with a low oxygen content entering the heart comes from the inferior and superior
vena cava. ANS: T
The right atrium receives deoxygenated blood from all parts of the body, including itself. The blood returning from the peripheral tissues enters the heart via the inferior and superior venae cavae. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Gross Anatomy
6. Blood with a high oxygen content entering the heart comes from the pulmonary veins.
ANS: T
Freshly oxygenated blood is returned from the lungs to the left atrium through the four pulmonary veins. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Gross Anatomy
7. Blood with a low oxygen content entering the heart comes from the coronary arteries. ANS: F
Blood from the inferior and superior vena cava has a low oxygen content and enters through the right atrium to receive oxygen from the lungs. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Gross Anatomy
8. The SA node is the “pacemaker” of the heart. ANS: T
The SA node is the primary pacemaker of the heart. It sets the heart rate at 60 to 100 beats per minute. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Physiology
9. The AV node can provide pacing for the heart in the event of SA node failure. ANS: T
In the event of SA node failure, the AV node is the backup pacemaker for the heart. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Physiology
10. The bundle of His and the Purkinje fibers cannot function as pacemakers. ANS: F
In the event of AV node failure, the bundle of His can pace the heart at 30 to 40 beats per minute. The Purkinje fibers can pace the heart at 20 beats per minute in the event of total pacemaker failure. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Physiology
11. Diastole and systole are the left ventricular relaxation and filling phase of the cardiac
cycle. ANS: F
Diastole is the left ventricular relaxation and filling phase of the cardiac cycle. Systole is the ventricular ejection phase of the cardiac cycle. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Physiology
12. The parasternal long axis view shows the right ventricle anteriorly. ANS: F
The parasternal long axis views transect the heart from the base to the apex, and anteriorly, the right ventricle is visualized. The interventricular septum (IVS) also is visualized in this view. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Sonographic Appearance
13. In the parasternal short axis view, the great vessels cannot be identified. ANS: F
The parasternal short axis is at the level of the aortic valve. The pulmonary artery and aorta can be visualized in this view. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Sonographic Appearance
14. The apical four-chamber view displays the ventricles at the top of the screen and the atria
at the bottom of the 2D sector image. ANS: T
The apical four-chamber view displays the ventricles at the top of the screen and the atria at the bottom of the 2D sector image. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Sonographic Appearance
15. The suprasternal view orientation can visualize the ascending and descending aorta and
aortic arch. ANS: T
The suprasternal view visualizes the ascending and descending aorta and the aortic arch. OBJ: Identify cardiac anatomy in the various imaging planes.
TOP: Sonographic Appearance
16. Blood moving toward the transducer will be represented below the baseline on the Doppler strip. ANS: F Blood moving toward the transducer will be represented above the baseline on the Doppler strip, and flow moving away from the transducer will fall below the baseline. OBJ: Identify normal Doppler flow patterns.
TOP: Sonographic Appearance
17. The Dobutamine stress echocardiogram is a stress test that caters to patients who are not
able to walk on a treadmill. ANS: T
The Dobutamine stress echocardiogram (DSE) is a type of stress test is completed for many of the same processes and similar protocols should be utilized as mentioned previously. However, this exam caters to patients who are unable to walk on a treadmill or operate a bicycle. OBJ: Recognize appropriate use criteria for Exercise and Dobutmine Stress Echocardiogram. TOP: Reference Charts 18. LDH peaks at 72 hours when there is a myocardial infarction.
ANS: F
LDH is also found throughout the body, and a certain percentage is used to assess myocardial infarction. LDH usually peaks within 24 to 48 hours and when elevated indicates the presence of an infarct. OBJ: Describe cardiac hemodynamics and physiology.
TOP: Reference Charts
Chapter 31: Vascular Technology Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. What is the first branch of the aortic arch? a. Right brachiocephalic artery b. Right vertebral artery c. Left common carotid artery d. Left subclavian ANS: A The most common configuration of the vessels originating from the aortic arch are the innominate (brachiocephalic), left CCA and left subclavian. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 2. Which vessel is NOT part of the cerebrovascular system? a. Common carotid artery b. Vertebral artery c. Internal carotid artery d. Internal iliac artery ANS: D
The internal iliac artery is a component of the inflow (aortoiliac) segment of the lower extremity arterial system. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Extracranial Cerebrovascular System 3. Which of the following is not characteristic of the Doppler spectral waveform from the
normal common carotid artery? a. Rapid systolic deceleration b. Systolic window c. Spectral broadening d. Constant forward diastolic flow ANS: C
Spectral broadening is a feature of disordered flow commonly associated with a vascular pathological condition. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 4. Color Doppler is used for which of the following? a. To document areas of narrowing associated with stenosis b. To determine and document vessel occlusion c. Identify trickle flow d. All of the these
ANS: D
Normal color Doppler images will demonstrate a uniform color limited to the interior vessel lumen. Color Doppler images should be used to document areas of narrowing or flow disturbances associated with stenosis, vessel occlusion or trickle flow. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 5. Which of the following statements is false? a. Reproducibility and accuracy of velocity measurements is dependent upon sample
volume size and placement. b. Velocity measurements should be obtained from the areas proximal and distal to
the stenosis. c. The sample volume size should be ½ of the vessel diameter and place within the fastest blood flow jet. d. The angle correction cursor should be parallel to the vessel wall with a 60 degree or less angle of insonation. ANS: C
The size of the sample volume should be approximately one third of the vessel diameter being evaluated and placed midstream or within the fastest blood flow jet. OBJ: Describe the sonographic appearance of the extracranial arteries. TOP: Extracranial Cerebrovascular System 6. Which of the following conditions can affect the spectral waveform during a carotid
ultrasound exam? a. Anemia b. Abnormal blood pressure c. Low cardiac output d. All of these ANS: D
Systemic conditions such as anemia and arterial blood pressure can alter the spectral waveform envelope. Cardiac abnormalities that can impact the spectral Doppler waveforms of the cerebrovascular system include cardiomyopathy, aortic valve stenosis or insufficiency, and arrhythmias. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 7. What is the normal peak systolic velocity in the internal carotid artery? a. >100 cm/sec b. Half that of the common carotid artery c. >125 cm/sec d. Double that of the common carotid artery ANS: C
The peak systolic velocity of the ICA is normally less than 125 cm/sec or less than twice the velocity in the CCA.
OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 8. Which of the following incorrectly describes the external carotid artery waveform? a. High flow, low resistance b. Forward flow in systole, low flow in diastole c. Sharp systolic upstroke with rapid deceleration d. A reverse flow component may be present in early diastole ANS: A
The flow pattern for the ECA is characterized by forward flow in systole, and a low or reverse diastolic flow component in diastole. The Doppler velocity waveform exhibits a sharp systolic upstroke, rapid deceleration, and low diastolic flow. A reverse flow component may be present in early diastole. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 9. The vertebral artery flow patterns will be most similar to those of the a. common carotid artery. b. internal carotid artery. c. external carotid artery. d. subclavian artery. ANS: B
The vertebral arteries supply blood flow, by way of the basilar artery, to the posterior cerebral hemispheres. Therefore, their flow patterns will be similar to those seen in the ICA with constant forward diastolic flow. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 10. How often should you compress the veins when evaluating for the presence of thrombus? a. 1 to 2 cm b. 2 to 3 cm c. 3 to 4 cm d. Dependent on the patient’s body habitus ANS: A
The basic ultrasound examination of either the upper or lower extremity veins involves compression of the veins of interest every 1 to 2 cm in the transverse plane imaging with gray-scale ultrasound followed by color and spectral Doppler ultrasound evaluations to further substantiate findings. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries
11. Which of the following describe Virchow’s triad? a. High blood pressure, anemia, low cardiac output b. Smoking, high cholesterol, family history of atherosclerosis c. Post-surgical thrombus, swelling, leg pain d. Hypercoagulability, venous stasis, endothelial trauma ANS: D
In the upper extremity, thrombus formation is more likely to occur due to an indwelling catheter, unlike in the lower extremity where the Virchow triad, a combination of hypercoagulability, venous stasis and endothelial trauma is the more likely cause of a thrombus formation. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: The Lower Extremity Venous System 12. Which is NOT part of the deep venous system of the lower extremities? a. Perforator vein b. Profunda femoris vein c. Femoral vein d. Anterior tibial vein ANS: A
The profunda femoris, femoral, and anterior tibial veins are part of the deep venous system of the lower extremity. The perforating veins connect the superficial and deep venous systems. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System 13. Which statement is incorrect? a. Venous flow from the legs is under the control of the calf muscle pump. b. When the calf muscles are relaxed, the distal perforator valves close to prevent
blood flow in the deep and superficial system. c. The direction of venous flow normally is from the superficial venous system to the
deep venous system. d. Veins can withstand tremendous volume change with little change in transmural
pressure. ANS: B
When the calf muscles are relaxed, the proximal valves are closed due to hydrostatic pressure, and the distal and perforator valves open to allow blood flow into the lower pressure deep venous system from the high-pressure superficial venous system. OBJ: Summarize the components of venous hemodynamics that are responsible for venous blood return to the heart. TOP: Extracranial Cerebrovascular System 14. Which of the following is NOT a branch of the internal carotid artery? a. Middle cerebral artery b. Posterior cerebral artery c. Anterior cerebral artery d. Ophthalmic artery
ANS: B
The posterior cerebral artery is a branch of the basilar artery, a component of the posterior cerebral circulation. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 15. Which statement is NOT true about the vertebral arteries? a. They arise as the first branch of the subclavian arteries. b. They course toward the brain by passing through the upper four cervical vertebrae. c. They pass superior to the atlas, wind around the lateral mass of the atlas, and enter
the vertebral canal superior to the spinal cord. d. They enter the skull through the foramen magnum to form the basilar artery, which
supplies the structures in the posterior fossa. ANS: B
Beyond their origin as the first branch of the subclavian arteries, the vertebral arteries on both sides pass cranially through the foramina of the transverse processes of the upper six cervical vertebrae. They wind around the lateral mass of the atlas and enter the vertebral canal anterior to the spinal cord. They then enter the skull through the foramen magnum and join to form the basilar artery. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 16. The common carotid artery supplies approximately
of the blood flow to the internal
carotid artery. a. 50% b. 80% c. 60% d. 40% ANS: B
Approximately 80% of the blood flow from the common carotid artery enters the internal carotid artery to supply the circulation of the brain and eye. The external carotid artery receives approximately 20% of the flow from the common carotid artery to supply the muscles of the face, forehead, and scalp. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 17. The Doppler spectral waveform from the low-resistance internal carotid artery can be
characterized by a. high peak systolic velocity and low diastolic flow. b. rapid systolic upstroke and rapid deceleration to low diastolic flow. c. slow systolic rise time, rapid deceleration, flow reversal in late systole, and low diastolic flow. d. cephalad flow throughout the cardiac cycle. ANS: D
The Doppler spectral waveform from the normal ICA is characterized by rapid systolic upstroke, a blunted systolic peak, and forward diastolic flow. Flow is toward the brain (cephalad) throughout the cardiac cycle. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 18. Which statement best describes boundary layer separation in the carotid bulb? a. Flow moves forward on the wall opposite the flow divide between the internal and
external carotid arteries. b. Both forward and reverse flow patterns are present as a result of dilatation of the carotid bulb and the presence of a pressure-flow gradient on the posterolateral wall of the bulb. c. Forward flow is seen on the wall opposite the flow divide, whereas reverse flow is seen on the anterolateral wall of the bulb. d. Disordered flow patterns are seen in the carotid bulb as a result of thickening of the arterial intima. ANS: B
The normal increased diameter of the carotid bulb compared to the CCA results in a pressure-flow gradient on the posterolateral wall of the bulb (wall opposite the flow divide). Because blood will normally flow from high- to low-pressure regions, the flow stream within the bulb separates into forward flow entering the ICA and flow reversal near the posterolateral wall. This is known as boundary layer separation and characterizes the normal blood flow patterns in the carotid bulb. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 19. Which is NOT considered a normal Doppler spectral flow pattern found in the peripheral
venous system? a. Spontaneous flow b. Phasicity c. Antegrade flow d. Pulsatile flow in the lower extremities ANS: D
In the lower extremity the venous signal should not demonstrate pulsatility; in other words it does not change with the cardiac cycle. However, in the upper extremity it is normal to observe pulsatility superimposed on respiratory phasicity in the more central veins including the subclavian vein due to their proximal location to the right atrium of the heart. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: The Lower Extremity Venous System 20. Duplication commonly is associated with all these veins except the a. popliteal vein. b. common iliac vein. c. greater saphenous vein.
d. femoral vein. ANS: B
Above the inguinal ligament, duplication of the veins is uncommon. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System 21. Which statement is false about the peripheral veins? a. They can undergo remarkable volume changes with little change in transmural
pressure. b. The percentage of smooth muscle found in the walls of veins varies with their
location. c. The venous wall is only half as thick as the arterial wall and is composed primarily
of elastin fibers. d. The venous pressure in the feet of an exercising adult usually is less than 25 mm
Hg. ANS: C
The vein wall structure has the same layers as the artery, however the composition of each of those layers differs. Overall veins are less muscular than arteries with thinner walls and have more elastic and collagen fibers. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System 22. The common iliacs converge to form the a. inferior vena cava. b. external iliacs. c. greater saphenous vein. d. femoral veins. ANS: A
The common iliac veins converge to form the inferior vena cava. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System 23. The small saphenous vein empties into the a. popliteal vein. b. femoral vein. c. greater saphenous vein. d. All of these ANS: D
The small saphenous vein may empty into the popliteal vein, the femoral vein, or the inferior gluteal vein, or it may not have a confluence at all with the deep venous system, but rather drain into the great saphenous vein in the thigh or at the level of the knee. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System
24. Hydrostatic pressure increases a. the distance below the reference point increases. b. the distance above the reference point increase. c. if the limb is elevated. d. when the patient is supine. ANS: A
Hydrostatic pressure is a physical characteristic of blood; it is related to the height of the column, the density of the fluid, and the gravitational force as it relates to the reference point of the right atrium. In a supine position hydrostatic pressure is negligible at 0-2 mmHg at this reference point. In the standing position hydrostatic pressure increases due to the increase in the weight of the column of blood within the vessel. The greater the distance below the reference point, the higher the hydrostatic pressure. Conversely, at a point above the reference point, such as elevating a limb, hydrostatic pressure will decrease. OBJ: Summarize the components of venous hemodynamics that are responsible for venous blood return to the heart. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 25. What happens during inspiration? a. The diaphragm ascends, intra-thoracic pressure increases b. The diaphragm ascends, intra-thoracic pressure decreases c. The diaphragm descends, intra-abdominal pressure decreases d. The diaphragm descends, intra-abdominal pressure increases ANS: D
During inspiration, the diaphragm descends, which increases the intra-abdominal pressure and collapses the IVC. OBJ: Summarize the components of venous hemodynamics that are responsible for venous blood return to the heart. TOP: Lower and Upper Extremity Venous Systems 26. Compression of the veins should be performed in which plane? a. Sagittal b. Transverse c. Coronal ANS: B
The transverse plane is utilized to perform intermittent compressions along the length of the vessels within the venous systems. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Lower and Upper Extremity Venous Systems 27. Which maneuver is used to test for valve incompetence? a. Sniff technique b. External compression c. Augmentation above the transducer d. Augmentation below the transducer ANS: C
To evaluate the competency of the valves in a specific vein, external compression is applied proximal to the transducer placement. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Lower and Upper Extremity Venous Systems 28. Which of the following should be visualized with competent valves? a. Venous flow halts b. No observable retrograde flow c. After augmentation the flow remains antegrade for 0.5 s d. All of these ANS: D
The flow may remain antegrade or above the baseline for 0.5 s and still be considered normal. To evaluate the competency of the valves in a specific vein, external compression is applied proximal to the transducer placement. If the valves are competent venous flow should halt; there should be no observable retrograde flow in the vein. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Lower and Upper Extremity Venous Systems 29. When would using a smaller footprint transducer be helpful? a. At the confluence of the subclavian and internal jugular vein b. At the confluence of the greater saphenous vein and femoral vein c. At the tibioperoneal trunk d. Small footprint transducer are not used for vascular ultrasound ANS: A
The confluence of the subclavian and IJV is the brachiocephalic vein. Evaluating this junction is challenging with a linear array transducer due to the location posterior to the sternum; therefore switching to a smaller footprint transducer would be beneficial. OBJ: Describe sonographic appearance of the upper and lower extremity peripheral venous vasculature. TOP: Lower and Upper Extremity Venous Systems TRUE/FALSE 1. The external carotid artery supplies the high-resistance vascular beds of the brain and eye. ANS: F
The vascular beds of the brain and eye are comprised of low-resistance tissues that demand blood flow throughout the cardiac cycle. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 2. The vertebral arteries originate from the subclavian arteries on each side respectively. ANS: T
The innominate artery bifurcates into the right CCA and subclavian arteries. The vertebral arteries originate from the subclavian arteries. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 3. The carotid bulb is a defined dilation of the artery and can be identified in every patient. ANS: F
The location of the bulb is variable, with the most frequent location at the origin of the ICA, however it could be located in the distal CCA, proximal ECA, or sometimes a defined dilation of the artery may not be apparent. OBJ: Describe the anatomy of the cerebrovascular system. TOP: Extracranial Cerebrovascular System 4. The ascending pharyngeal artery is the most common branch of the ECA seen during
routine imaging of the carotid arteries. ANS: F
The ECA has eight branches that supply blood flow to the neck, face, and scalp. In ascending order the branches are: superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, superficial temporal, and maxillary arteries. The superior thyroid artery branch is the most common vessel identified during routine imaging. OBJ: Describe the sonographic appearance of the extracranial arteries. TOP: Extracranial Cerebrovascular System 5. A laminar flow pattern demonstrates a wide Doppler velocity spectrum with a uniform
systolic velocity. ANS: F
Spectral Doppler waveform characterization of a laminar flow pattern demonstrates a very narrow Doppler velocity spectrum with a uniform systolic velocity. OBJ: Define the hemodynamic patterns and Doppler spectral waveforms found in the normal extracranial carotid and vertebral vessels. TOP: Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries 6. The venous system is a blood reservoir that can contain two thirds of the total blood
volume. ANS: T
Veins are the capacitive side of the circulatory system holding two thirds of the total blood volume in the body. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: Lower and Upper Extremity Venous Systems 7. The superficial veins do not have a companion artery like the veins in the deep system. ANS: T
The major superficial veins of the lower limb are the great saphenous and the small saphenous veins. These veins lie in subcutaneous tissue in the sapheneous compartment and do not have a companion artery. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: Lower and Upper Extremity Venous Systems 8. The superficial vessels in the upper extremity are larger than the deep vessels in the
forearm. ANS: T
The superficial vessels in the arm, specifically in comparison to the deep vessels of the forearm, are larger in size. This is significant when a thrombus is identified in a superficial arm vessel because it may require treatment. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: Lower and Upper Extremity Venous Systems 9. The ulnar side of the venous network drains into the cephalic vein and the radial side
drains into the basilic vein. ANS: F
The ulnar side of the network drains into the basilic vein and the radial side drains into the cephalic vein. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: Lower and Upper Extremity Venous Systems 10. Valves in the deep veins prevent blood from flowing toward the feet. ANS: T
Valves in the deep veins prevent the flow of blood toward the feet, and the valves in the perforating veins prevent blood from flowing from the deep to the superficial system. OBJ: Describe the anatomy of the upper and lower peripheral venous system. TOP: The Lower Extremity Venous System
Chapter 32: 3D/4D/5D Sonography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Applications for three-dimensional (3D) ultrasound include which of the following? a. Gynecologic procedures b. Musculoskeletal procedures c. Obstetric sonography d. All of these ANS: D
Applications for 3D ultrasound include obstetric, gynecologic, abdominal, prostate, neonatal, musculoskeletal, urologic, pediatric, and invasive procedures, as well as procedures involving small body parts. New applications for 3D sonography are continuously being identified OBJ: Define three-dimensional (3D) sonography.
TOP: Methods
2. 4D imaging can be done only with a. existing ultrasound systems with a 3D option. b. 3D systems that use electromagnetic positioning sensors. c. dedicated 3D transducers. d. offline systems that attach to the ultrasound transducer. ANS: C
4D sonography is simply “real-time” 3D (time being the fourth dimension). It is available only with the automatic acquisition technique in which the elements within the probe continuously acquire, process, and display the 4D image in real time. OBJ: Define four-dimensional (4D) sonography.
TOP: Methods
3. The acquisition of patient anatomy using 3D/4D is called acquiring a. a volume data set. b. a flat screen image. c. algorithms. d. measurements. ANS: A
Acquiring the volume data set is also called volume acquisition. OBJ: Describe 3D/4D/5D acquisition and display techniques. 4. For a multiplanar format, data must be achieved from a. the original acquisition plane. b. three orthogonal planes. c. a fourth acquisition plane. d. None of these ANS: B
TOP: Methods
With a multiplanar format the original acquisition plane plus the two orthogonal planes (planes that are at right angles [90 degrees] to each other; usually sagittal, transverse, and coronal) are displayed simultaneously on the screen. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods 5. 3D and 4D sonography consists of which three steps? a. Measurements, volume data set, and minimum mode b. Measurements, flat screen image, and algorithms c. Volume acquisition, measurements, and 3D rendering d. Volume acquisition, volume manipulations, and enhanced display features ANS: D
Volume acquisition, volume manipulations, and enhanced display features are essential to 3D/4D ultrasound imaging. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods 6. Volume acquisition can be performed by a. automatic and orthogonal acquisitions. b. orthogonal and 4D acquisitions. c. automatic or manual acquisitions. d. None of these ANS: C
Volume acquisition can be performed by either manual or by automatic acquisitions. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods 7. With automatic acquisition on older technology systems, the “Region of Interest” box
requires the sonographer to a. move the transducer across the area of interest. b. keep the transducer stationary over the anatomy of interest. c. turn the patient so that the area of interest is closest to the transducer. d. perform an algorithm. ANS: B
With automatic acquisition on older technology systems, the “Region of Interest”’ box is used with dedicated 3D transducers in which the elements move while the sonographer holds the transducer stationary. OBJ: Select the appropriate technology to demonstrate the anatomy of interest. TOP: Methods 8. Render techniques use algorithms to enhance a. exam time. b. sonographer comfort. c. displayed anatomy. d. None of these
ANS: C
Render techniques use algorithms to enhance displayed anatomy. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods 9. The 4 in 4D sonography refers to a. a special algorithm. b. space. c. time. d. velocity. ANS: C
The fourth dimension is time. The 3 in 3D refers to the three orthogonal views from which data are acquired. OBJ: Define four-dimensional (4D) sonography.
TOP: Methods
10. The most important step in acquiring 3D/4D sonographic images is a. volume acquisition. b. reconstruction. c. rendering. d. movement of the transducer. ANS: A
If the initial 3D/4D volume dataset is acquired suboptimally, the resultant volume dataset and any reconstructions will also be suboptimal and therefore will be of minimal use. OBJ: Describe 3D/4D/5D acquisition and display techniques.
TOP: Methods
11. Spatiotemporal image correlation (STIC) is most useful for evaluating the a. neonatal brain. b. gravid uterus. c. prostate. d. fetal heart. ANS: D
STIC is used to evaluate the fetal heart. STIC uses 4D technology to create a single moving, beating, continuous heart cycle that is able to be manipulated in all orthogonal planes. OBJ: Become familiar with some of the advanced 3D/4D/5D features and technologies. TOP: Advanced Features 12. The inversion mode a. is a type of rendering. b. shows hypoechoic structures as solids. c. Both of these d. None of these ANS: C
The inversion mode is a type of rendering that shows hypoechoic or anechoic structures as solids, giving the appearance of a cast or a mold of the structure. OBJ: Become familiar with some of the advanced 3D/4D/5D features and technologies. TOP: Advanced Features 13. The most important benefit of the new matrix array transducers is the reduction in a. resolution. b. post-processing time. c. scan time. d. exam cost. ANS: B
The latest advancements in 3D/4D volume transducers are the matrix array transducers. Visualizing the live 4D imaging orthogonal planes during the scanning process and the ability to make optimization adjustments during the live acquisition are invaluable tools for the sonographer. The reduction in post-processing time alone makes this feature desirable. OBJ: Become familiar with some of the advanced 3D/4D/5D features and technologies. TOP: Advanced Features 14. The foreign object shown in this figure is a(n)
a. b. c. d.
heart valve. IUD. saline infusion. uterine polyp.
ANS: B
An IUD is shown in the coronal plane of the uterus. OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Methods 15. The main anatomy shown on this image is a(n)
a. b. c. d.
uterus. fetus. adult kidney. thyroid.
ANS: C
The image demonstrates an adult kidney on 3D ultrasound. OBJ: Identify examples of normal 3D or 4D anatomy.
TOP: Methods
16. The main anatomy shown on this image is a(n)
a. b. c. d.
soft tissue lipoma. breast lesion. uterus. scar tissue.
ANS: B
The image demonstrates a breast lesion on 3D ultrasound. OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Methods
17. The main anatomy shown on this image is a(n)
a. b. c. d.
breast lesion. neonatal head. fetal heart. ovarian follicle.
ANS: D
The image demonstrates an ovarian follicle using 3D sonography. OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Advanced Features 18. The mode used for this image of the liver is the
a. inversion mode. b. maximum mode. c. minimum mode. ANS: C
This image demonstrates the adult liver vasculature using the minimal mode and 3D imaging. This mode is best used to show tissue and vascularity. OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Methods 19. Identify the original acquisition plane for this image of the fetal nasal bone.
a. Upper right plane b. Upper left plane c. Lower left plane ANS: B
The original acquisition plane is the upper left plane. The upper right plane is 90 degrees to that (transverse) plane, and the lower left plane is a coronal image. Three planes are shown for one image. The original acquisition plane, the upper left plane, shows a longitudinal image of a face. The upper right plane is 90 degrees to that (transverse) plane. The lower left plane is the coronal image. OBJ: Select the appropriate technology to demonstrate the anatomy of interest. TOP: Methods 20. What does the upper right plane represent?
a. 90 degrees (transverse) to upper left plane b. Original acquisition plane c. Coronal image ANS: A
The original acquisition plane is the upper left plane. The upper right plane is 90 degrees to that (transverse) plane, and the lower left plane is a coronal image. Three planes are shown for one image. The original acquisition plane, the upper left plane, shows a longitudinal image of a face. The upper right plane is 90 degrees to that (transverse) plane. The lower left plane is the coronal image. OBJ: Select the appropriate technology to demonstrate the anatomy of interest. TOP: Methods 21. What happens with rotation of the X-axis? a. The selected plane will roll clockwise or counterclockwise b. The selected plane will roll vertically to the right or left c. The selected plane will roll horizontally forward and backward ANS: C
The X-axis rotation will roll the selected plane horizontally forward and backward. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods 22. Which of the following display options averages multiple slices together rather than
displaying a single slice? a. Tomographic b. Maximum mode c. Minimum mode d. Thick slice imaging ANS: D
Another common display option is using a thick slice imaging technique. Rather than displaying a single slice from the volumetric planes, the system averages multiple slices together to gain a thicker slice and enhanced contrast resolution. OBJ: Explain how to manipulate the volume data for simplified anatomical viewing. TOP: Methods TRUE/FALSE 1. Matrix array transducers contain hundreds of imaging elements. ANS: F
Matrix transducers contain thousands of imaging elements. OBJ: Become familiar with some of the advanced 3D/4D/5D features and technologies. TOP: Advanced Features 2. Matrix array transducers represent advances in volume transducers. ANS: T
Matrix transducers have been used in echocardiography, and additional clinical applications are sure to evolve.
OBJ: Become familiar with some of the advanced 3D/4D/5D features and technologies. TOP: Advanced Features 3. For manual acquisition of a volume data set, the sonographer must hold the transducer
stationary and allow the patient to breathe. ANS: F
The manual acquisition method requires the sonographer to physically move the transducer across the region of interest. OBJ: Describe 3D/4D/5D acquisition and display techniques.
TOP: Methods
4. In these images, the anatomy depicted is a uterus with saline infusion from a hysterogram.
ANS: F
The images show the uterus with saline infusion from a hysterosalpingogram. OBJ: Identify examples of normal 3D or 4D anatomy. 5. The main anatomy shown on this image is the fetal brain.
ANS: F
TOP: Methods
The image demonstrates the neonatal brain on 3D ultrasound. OBJ: Identify examples of normal 3D or 4D anatomy.
TOP: Methods
6. The main anatomy shown on this image is the fetal heart.
ANS: T
The image demonstrates a fetal heart on 3D ultrasound. OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Methods 7. This image was obtained with a transabdominal probe.
ANS: F
The image was not obtained transabdominally. It shows a high level of detail that could not have been obtained if the fetus had been scanned transabdominally.
The image shows a 10-week-old fetus that was scanned with a 3D transvaginal transducer. The high level of detail would not have been possible if the fetus had been scanned transabdominally. OBJ: Identify examples of normal 3D or 4D anatomy. Applications
TOP: Sonographic
8. Nine standard fetal cardiac views are generated from one 4-chamber heart volume. ANS: T
From a 4-chamber heart volume, nine standard fetal cardiac views are generated: Three Vessels and Trachea View, Four-Chamber View, Five-Chamber View, Left Ventricular Outflow Tract (LVOT), Short Axis View of Great Vessels / Right Ventricular Outflow Tract (RVOT), Abdomen View (Stomach), Ductal Arch, Aortic Arch, and Vena Cava (Superior and Inferior) OBJ: Describe the clinical applications of 3D, 4D, and 5D sonography. TOP: Advanced Features 9. The 5th dimension refers to the technology that semi-automatically manipulates the
datasets to display, label, and measure anatomy. ANS: T
The 5th dimension is simply technology that semi-automatically manipulates the volume datasets to display, label and measure anatomy. OBJ: Define five-dimensional (5D) sonography.
TOP: Advanced Features
Chapter 33: Interventional and Intraoperative Ultrasound Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. The term percutaneous means a. to pour over or through, especially the passage of a fluid through the vessels of a
specific organ. b. to sample. c. to perform through the skin. d. to suture. ANS: C
The term percutaneous means “through the skin.” OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 2. Ultrasound-guided biopsies assist needle placement for a. fluid sampling. b. small organ or stone extraction. c. amniocentesis. d. tissue sampling. ANS: D
Ultrasound-guided biopsies assist needle placement for tissue sampling. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 3. Ultrasound-guided aspirations assist needle placement for a. fluid sampling. b. small organ or stone extraction. c. nephrostomies. d. tissue sampling. ANS: A
Ultrasound-guided aspirations assist needle placement for fluid sampling. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 4. During intraoperative ultrasound procedures, sterile gel is a. not used. b. used as a scanning couplant. c. used as a couplant between the transducer and the probe cover. d. used in place of sterile sheaths. ANS: C
During intraoperative ultrasound procedures, sterile gel is used as a couplant between the transducer and the probe cover. The natural moisture on the surface of organs serves as the couplant between the organ and the transducer. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 5. During intraoperative ultrasound procedures, the transducer is a. placed on a sterile water path. b. in direct contact with the skin surface. c. in direct contact with organs and vessels. d. only used laproscopically. ANS: C
During intraoperative ultrasound procedures, the transducer is in direct contact with organs and vessels. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 6. Nephrostomy is the process of ultrasound-guided a. chorionic villus sampling. b. percutaneous tube placement. c. percutaneous biopsy. d. percutaneous stone extraction. ANS: B
Nephrostomy is the process of ultrasound-guided percutaneous tube placement. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 7. A percutaneous cholangiogram is an ultrasound-guided procedure for a. bile drainage. b. evaluation of the gallbladder. c. gallbladder biopsy. d. evaluation of the liver. ANS: A
A percutaneous cholangiogram is an ultrasound-guided bile drainage procedure. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 8. Endoluminal ultrasound is a. used for percutaneous tube placement. b. used to evaluate vessels and grafts during surgery. c. not currently practiced. d. limited to neurosurgical procedures. ANS: B
Endoluminal ultrasound is used to evaluate vessels and grafts during surgery.
OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 9. Chorionic villus sampling is a. a percutaneous biopsy. b. collected during amniocentesis. c. limited to intraoperative surgical procedures. d. collected during a nephrostomy. ANS: A
Chorionic villus sampling is a percutaneous biopsy. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 10. The advantages of interventional ultrasound include a. easy localization of the biopsy site. b. needle tracking. c. visualization of needle placement. d. All of these ANS: D
Ultrasound is routinely used to assist certain interventional radiology cases and a number of various Intraoperative Ultrasound. Ultrasound-assisted interventional radiology cases generally include percutaneous needle-guided biopsies, aspirations, and drainage procedures. Ultrasound is used under these circumstances because the biopsy site can be easily located and the biopsy needle can be well visualized and tracked. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 11. Which of the following is used to detect retained biliary calculi in patients undergoing
laparoscopic cholecystectomy, and assist thorascopic procedures? a. Laparoscopic ultrasound b. Ultrasound-guided percutaneous biopsy c. Ultrasound-guided percutaneous aspiration d. Interventional radiology ANS: A
Laparoscopic ultrasound is used to identify and stage tumors, detect retained biliary calculi in patients undergoing laparoscopic cholecystectomy, and assist thorascopic procedures. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 12. A biopsy site is scanned before the biopsy to determine the best
shortest and the a. Best point of entry b. Shortest distance c. Least angle d. All of these
angle.
with the
ANS: D
A biopsy site is scanned before the biopsy to determine the best point of entry with the shortest distance and the least angle. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 13. Any change in shape or size of a fluid-filled structure can be visualized with a. laparoscopic ultrasound. b. ultrasound-guided percutaneous biopsy. c. ultrasound-guided percutaneous aspiration. d. interventional radiology. ANS: C OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 14. The optimal transducer to use during intraoperative ultrasound when the near field is the
area of interest is a a. linear array probe. b. sector probe. c. curvilinear array probe. d. vector probe. ANS: A
Linear array probes have a small field of view with the best near-field definition. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 15. The transducer frequency for ultrasound-assisted laparoscopic surgery ranges from a. 2.0 to 3.5 MHz. b. 5.0 to 7.5 MHz. c. 7.5 to 10 MHz . d. 11.0 to 15 MHz. ANS: B
Unlike conventional intraoperative sonography, laparoscopic surgery assisted by ultrasound is performed using a flexible tip laparoscopic 5.0- to 7.5-MHz transducer. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound TRUE/FALSE 1. Intraoperative ultrasound is not limited by overlying soft tissue, bone or air. ANS: T
Intraoperative ultrasound is not limited by overlying soft tissue, bone, or air. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound.
TOP: Intraoperative Ultrasound 2. Laparoscopic ultrasound is used to identify and stage tumors. ANS: T
Laparoscopic ultrasound is used to identify and stage tumors, detect retained biliary calculi in patients undergoing laparoscopic cholecystectomy, and assist thorascopic procedures. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 3. Contamination is caused by bubbles between the transducer tip and the sterile sheath
covering separated by a coupling agent. ANS: F
Image artifacts are caused by bubbles between the transducer tip and the sterile sheath covering separated by a coupling agent. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 4. In percutaneous drainage procedures, ultrasound is used to determine the entry site and
monitors the placement of the needle and catheter. ANS: T
Ultrasound-guided percutaneous drainages assist with needle and catheter placement for procedures that include abscess drainage, biliary drainage, and nephrostomy tube placement. Ultrasound is used to determine the entry site and monitors the placement of the needle and catheter. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Ultrasound-Guided Intervention 5. An alternative to using transducer covers for intraoperative ultrasound is to sterilize the
transducer with ethylene oxide gas. ANS: T
Because of contamination if cover sheaths tear, ethylene oxide gas can be used to sterilize the transducer, but this approach takes 24 hours, which limits the use of the transducer to once a day. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound. TOP: Intraoperative Ultrasound 6. Intraoperative ultrasound can be used for evaluation of breast tumors, renal tumors, and
vascular disorders. ANS: T
Intraoperative ultrasound can be used for a variety of surgical applications including breast tumors, renal tumors, and vascular disorders. OBJ: Understand ultrasound-assisted interventional and intraoperative ultrasound.
TOP: Intraoperative Ultrasound
Chapter 34: Musculoskeletal Sonography Curry/Prince: Sonography, 5th Edition MULTIPLE CHOICE 1. Which of the following describes smooth muscle? a. Muscles that surround blood vessels b. Muscles controlled by the autonomic nervous system c. Cardiac muscle d. All of these ANS: D
Smooth muscle is non-striated and not within our control under ANS control. Examples of smooth muscle would be internal organs and muscle surrounding the blood vessels. Cardiac muscle is a smooth muscle that pertains to the heart, also an involuntary muscle. OBJ: Define the anatomy of the musculoskeletal system.
TOP: Gross Anatomy
2. Tendons connect a. bones to bones. b. muscles to muscles. c. muscles to bones. d. ligaments to muscles. ANS: C
Tendons are connective tissues that attach muscles to bones. OBJ: Describe the gross anatomy of musculoskeletal system. 3.
TOP: Gross Anatomy
Ligaments connect a. bones to bones. b. muscles to muscles. c. muscles to bones. d. tissues to muscles. ANS: A
Ligaments are connective tissues that connect bones to other bones. OBJ: Describe the gross anatomy of musculoskeletal system.
TOP: Gross Anatomy
4. Elastic cartilage is a pliable cartilage that can be found in the a. meniscus of the knee. b. intervertebral disc spaces. c. temporal mandibular joint. d. epiglottis. ANS: D
Elastic cartilage is the most pliable type of cartilage and is found in the epiglottis and external ear flaps. OBJ: Describe the gross anatomy of musculoskeletal system.
TOP: Gross Anatomy
5. Which of the following divides the muscular tissue into bundles of muscle fibers? a. Epimysium b. Perimysium c. Endomysium d. Epitenon ANS: B
The perimysium divides the muscular tissue into bundles of muscle fibers. OBJ: Describe the gross anatomy of musculoskeletal system.
TOP: Gross Anatomy
6. Which of the following is a thick connective tissue aiding in muscle protection by
reducing friction and provides separation between muscles and surrounding tissues? a. Epimysium b. Perimysium c. Endomysium d. Endotenon ANS: A
Muscle tissue is covered by the epimysium which is a rather thick connective tissue which aids in the protection of the muscle, helps to reduce friction, and separates the muscles from surrounding tissues and organs. OBJ: Describe the gross anatomy of musculoskeletal system.
TOP: Gross Anatomy
7. The end of each bone that is slightly wider than the shaft is termed a. diaphysis. b. epiphysis. c. periosteum. d. enthesis. ANS: B
The diaphysis is the long tubular section of the bone while the epiphysis is at the end of each bone and slightly wider than the shaft. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Gross Anatomy 8. Which of the following tendons is typically visualized during a shoulder ultrasound? a. Subscapularis b. Supraspinatus c. Infraspinatus d. All of the these ANS: D
Shoulder evaluation with ultrasound typically centers on the rotator cuff tendons, which include the subscapularis, supraspinatus, infraspinatus and teres minor. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications
9. Which of the following statements most accurately describes the anatomical relationships
of the biceps tendon? a. The biceps tendon courses inferiorly between the subscapularis and the infraspinatus tendons. b. The biceps tendon attaches to the lesser tuberosity of the humeral head anteriorly. c. The biceps tendon attaches to the greater tuberosity of the humeral head laterally and courses posterior to the acromion. d. The biceps tendon courses superiorly between the subscapularis and supraspinatus tendon. ANS: D
The biceps tendon will course superiorly between the subscapularis and supraspinatus tendon, and the location of this tendon anatomy aids in localizing the other tendons in the cuff. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications 10. In which plane is the biceps tendon best visualized in the groove between the greater and
lesser tuberosities? a. Sagittal b. Transverse c. Coronal ANS: B
In the transverse plane, the biceps tendon is best seen in the groove between the greater and lesser tuberosities, called the bicipital groove on the anterior shoulder just inferior to the humeral head. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications 11. In which plane will the biceps tendon elongate and have a fibrillar appearance? a. Sagittal b. Transverse c. Coronal ANS: A
Turning the transducer into a sagittal plane, the biceps tendon will elongate and have a fibrillar appearance and should not measure more than 5 mm. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications 12. When moving medially and superiorly from just below the anterior humeral head, which
tendon is visualized in long axis when the patient’s arm is externally rotated and the transducer is oriented in a transverse position? a. Biceps tendon
b. Supraspinatus tendon c. Subscapularis tendon d. Infraspinatus ANS: C
With the transducer returned to the transverse position over the biceps tendon, the patient should externally rotate the arm. In the transverse plane, with the external rotation and very slight movement medially and superiorly, the long axis of the subscapularis tendon can be visualized. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications 13. Which of the following statements is accurate? a. The supraspinatus tendon attaches to the greater tuberosity of the humeral head
laterally and courses posterior to the acromion. b. The supraspinatus tendon attaches to the lesser tuberosity of the humeral head anteriorly. c. The supraspinatus tendon spans the space anterior to the biceps tendon. d. The supraspinatus tendon is a posterior shoulder tendon part of the rotator cuff attaching to the greater tuberosity of the humeral head. ANS: A
The supraspinatus tendon attaches to the greater tuberosity of the humeral head laterally and courses posterior to the acromion. OBJ: Describe the gross anatomy of musculoskeletal system.
TOP: Gross Anatomy
14. In the modified Crass position, the patient a. externally rotates their arm. b. internally rotates their arm. c. places the palm of their hand on their back pocket. d. raises their arm and places the back of their hand in front of their face. ANS: C
In order to move the greater tuberosity more anteriorly and better visualize the supraspinatus, the patient is should be placed into the modified Crass position, where the patient will place the palm of their hand on their back pocket. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 15. The thickness of the supraspinatus tendon should be no more than a. 3 mm. b. 5 mm. c. 6 mm. d. 10 mm. ANS: C
The thickness of the supraspinatus tendon should be no more than 6 mm.
OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 16. Visualization of the infraspinatus tendon attaching to the greater tuberosity requires the
sonographer to scan on the lateral shoulder and have the patient a. in the modified Crass position. b. abduct their arm and bend their elbow 90 degrees. c. adduct their arm and stretch it across their abdomen as if holding their opposite side. d. have their arm in a neutral position with their palm up. ANS: C
The infraspinatus tendon attaches to the greater tuberosity and is seen with a scan of the lateral shoulder with the patient in an adduct position with the arm stretched across the abdomen as if they were holding their opposite side. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Appearance 17. In order to image the infraspinatus tendon, which bony landmarks will help you locate the
tendon attaching to the greater tuberosity? a. Acromion b. Humeral head c. Acromion and humeral head d. Clavicle ANS: C
The infraspinatus tendon attaches to the greater tuberosity and is seen with a scan of the lateral shoulder with the patient in an adduct position with the arm stretched across the abdomen as if they were holding their opposite side. Begin with the transducer in a sagittal plane with reference end pointing to the patient’s face. Slide the transducer down the lateral shoulder until the acromion is the bony landmark far medially and the humeral head is directly posterior to the infraspinatus. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 18. Which direction should you move to image the teres minor tendon attaching to the greater
tuberosity if you are at the infraspinatus tendon? a. Laterally b. Superiorly c. Posteriorly d. Inferiorly ANS: D
Moving inferiorly from the infraspinatus, the teres minor tendon can be seen attaching to the greater tuberosity, and lying just anterior to the humeral head, and just posterior to the deltoid muscle. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications
19. The acromio-clavicular joint should not measure greater than a. 2 mm. b. 3 mm. c. 4 mm. d. 5 mm. ANS: B
The acromio-clavicular joint may contain fibrocartilage, is wider in the anterior portion, and should not measure more than 3 mm. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 20. Which position should you place the patient’s arm in for evaluation of the
acromio-clavicular joint? a. Neutral b. Modified Crass c. Abducted with elbow bent 90 degrees d. Adduct their arm and stretch it across their abdomen as if holding their opposite side ANS: A
With the patient sitting with ipsilateral hand in a neutral position the transducer should be placed along the distal and posterior end of the clavicle, aligned with the long axis of the bone. The acromion and clavicle will serve as the posterior bony landmarks. The acromio-clavicular ligament can often be seen coursing between the two bones anteriorly OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 21. What are the bony landmarks at the carpal tunnel? a. Scaphoid b. Pisiform c. Scaphoid and pisiform d. Navicular and lunate ANS: C
The scaphoid and pisiform form the medial and lateral bony landmarks at the tunnel and the ulnar and radial artery and vein are visible in their respective locations. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 22. In which plane does the median nerve have an oval shape with a honeycomb appearance? a. Sagittal b. Transverse c. Coronal ANS: B
In the transverse plane, the median nerve will have an oval honeycomb appearance representing the fascicles within the nerve surrounded by the hypoechoic connective tissue. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Appearance 23. Which of the following is a common cause of carpal tunnel syndrome? a. Ganglion cysts b. Arthritis c. Thyroid disease d. All of these ANS: D
Carpal tunnel syndrome is one of the most common upper extremity nerve abnormalities. Causes are variable from overuse syndrome to lesions such as ganglion cysts or masses. Disease processes such as arthritis or thyroid disease or even pregnancy can bring about carpal tunnel syndrome. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 24. The normal median nerve is less than a. 6 mm squared. b. 8 mm squared. c. 10 mm squared. d. 12 mm squared. ANS: C
The median nerve is said to be normal if the cross-sectional area is less than 10 mm squared. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 25. The median nerve is measured at the wrist crease and again a. 10 cm from the crease. b. 12 cm from the crease. c. At the distal end. d. Varies among individuals but should be at the largest diameter visualized. ANS: B
At approximately 12 cm from the wrist crease, the median nerve should be measured again. The nerve will be positioned between the flexor digitorum muscle anteriorly and the flexor digitorum profundus muscle posteriorly, and at this point the radius will be the bony landmark visualized most posteriorly. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 26. When scanning the knee, it is important to
a. b. c. d.
use transducer pressure to compress the bursa. use as little gel as possible. understand that any amount of joint fluid is considered abnormal. support the patient’s knee with a cushion to provide stability.
ANS: D
Patient position for anterior knee evaluation should be supine with a slight bend in the knee, supported by a cushion under the knee for stability. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 27. In a sagittal scan of the knee, what is helpful to identifying the attachment of the
quadriceps tendon to the patella? a. Fibrillar pattern of the quadriceps tendon itself b. Hyperechoic suprapatellar bursa above the quadriceps tendon c. Using transducer pressure to compress the bursa d. The bony landmark of the patella in the superior portion of the image ANS: A
In a sagittal scan plane just superior to the patella, the posterior bony landmarks will be the femur most posterior, and the patella rising anterior in the distal portion of the image. The fibrillar pattern of the quadriceps tendon will help to identify the attachment to the patella. The suprapatellar bursa will appear more hypoechoic just below the tendon and a fat pad will round out the layers just above the bone. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 28. Which plane is best for assessing the collateral ligaments and menisci? a. Sagittal b. Transverse c. Coronal ANS: A
Both collateral ligaments and menisci are best seen in the longitudinal scan plane with no need for transverse views. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Appearance 29. Which patient position is required when imaging the Achilles tendon? a. Supine with toes pointed b. Decubitus with foot flexed c. Prone with foot hanging off the table d. Supine with knee bent and foot flat on the table ANS: C
For examination of the Achilles tendon the patient should be placed in a prone position with the foot hanging off the end of the exam table.
OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 30. The Achilles tendon should not measure greater than a. 2 mm. b. 4 mm. c. 6 mm. d. 10 mm. ANS: C
The Achilles tendon is the largest tendon in the body but should not measure more than 6 mm at any point. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Applications 31. In which plane will the tendon fibers appear more bristle like? a. Sagittal b. Transverse c. Coronal ANS: B
In a transverse plane the tendon fibers appear more bristle like and when covered by a sheath may contain a small amount of fluid that will help with visualization. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Appearance 32. In which plane are nerves best visualized? a. Sagittal b. Transverse c. Coronal ANS: B
Nerves are best visualized initially in the transverse plane. Here they will appear as what has been described as a honeycomb appearance because of the hypoechoic fascicles while the perineurium around the fascicle has a hyperechoic appearance. The nerve should have a distinct echogenic border from the epineurium encasing the entire nerve. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Appearance 33. Anisotropy is an artifact a. that occurs when the beam is parallel to a linear structure. b. that has little effect on imaging and diagnosis of musculoskeletal ultrasound
exams. c. that falsely displays a defect in the anatomy. d. that can be corrected by adding focal zones. ANS: C
One artifact unique to MSK sonography is anisotropy. When the ultrasound beam is not perpendicular to a linear structure, such as a tendon or ligament, echoes are not transmitted to form the entire image of the anatomy. Because of the linear nature of much musculoskeletal anatomy, anisotropy can largely affect a diagnosis if one is not aware of how to manipulate the sound beam to image the entire structure. This artifact will appear as if there is a defect in the anatomy because of the lack of beam transmission. To prevent misdiagnosis, the sonographer must learn to use probe manipulation to align completely perpendicular to the anatomy. OBJ: Recognize normal structure of specific musculoskeletal anatomy. TOP: Sonographic Appearance TRUE/FALSE 1. Static positions are critical when performing musculoskeletal ultrasound. ANS: F
Patient position and dynamic movement are crucial to musculoskeletal ultrasound diagnosis. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 2. The distal attachment of the tendon is termed the origin while the proximal attachment is
the called insertion. ANS: F
Tendons are connective tissues that attach muscles to bones. The proximal attachment of the tendon is the origin and the distal attachment is the insertion. OBJ: Define the anatomy of the musculoskeletal system.
TOP: Gross Anatomy
3. The smallest tendon is the rotator cuff is the teres minor tendon. ANS: T
The teres minor tendon is the posterior shoulder tendon which part of the rotator cuff attaching to the greater tuberosity of the humeral head. It is the smallest tendon in the rotator cuff. OBJ: Define the anatomy of the musculoskeletal system.
TOP: Gross Anatomy
4. The parathyroid regulates the level of calcium released from the bones. ANS: T
The majority of calcium is stored in the bone and is released as needed with regulation by the parathyroid. OBJ: Explain the function of the musculoskeletal system.
TOP: Gross Anatomy
5. The deltoid muscle is the most anterior structure in the image regardless if you are in the
sagittal or transverse plane.
ANS: T
In both planes the deltoid muscle is the most anterior structure in the image. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 6. Using a standoff pad is advisable when imaging the wrist. ANS: T
Structures are small and superficial in the hand and wrist, so a high frequency transducer, standoff pads and plentiful gel is advisable. OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 7. The scaphoid is the bony landmark on the ulnar side. ANS: F
The bony landmarks of the scaphoid on the radial side and the pisiform on the ulnar side serve as the lateral and medial borders. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 8. The median nerve is more echogenic at the level of the carpal tunnel in comparison to the
tendons adjacent to it. ANS: F
The median nerve will be more hypoechoic in appearance at the level of the carpal tunnel in comparison to the more echogenic tendons adjacent to it OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 9. Patellar tendon attachment integrity is best visualized in the transverse plane. ANS: F
Patellar tendon attachment integrity is best visualized in the longitudinal scan plane. OBJ: Describe the scanning plane and pertinent ultrasound appearance anatomy of the rotator cuff and shoulder, the median nerve and wrist, the anterior, and medial and lateral knee and the Achilles tendon. TOP: Sonographic Applications 10. When evaluating the medial collateral ligament and medial meniscus the patient should
rotate their leg in and keep their leg as straight as possible. ANS: F
To evaluate the medial collateral ligament and medial meniscus have the patient externally rotate their leg, keeping a slight bend in the knee, and have a cushion under the knee for support.
OBJ: Explain proper ultrasound protocol evaluation for the shoulder, median nerve, anterior knee and Achilles tendon. TOP: Sonographic Applications 11. The most common site for Achilles tendon tears is the insertion site. ANS: F
The Achilles tendon is the largest tendon in the body but should not measure more than 6 mm at any point. Most tears do not actually occur at the insertion, but 2 to 6 cm proximally. At the level of the attachment to the calcaneal bone are two bursae, the subcutaneous and retrocalcaneal bursa. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 12. Deep to the Achilles tendon and retrocalcaneal bursa is Hoffa’s fat pad. ANS: F
The retrocalcaneal bursa will lie just posterior to the tendon along the edge of the bony surface. Deep to the tendon and bursa is Kager’s fat pad OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Applications 13. Bones are useful in musculoskeletal ultrasound and sonographically have a smooth
echogenic surface with posterior shadowing. ANS: T
Sonographers often dismiss bony structures as not ultrasound friendly and somewhat useless in our diagnostic process, but this should not be the case. Not only can abnormalities in bony structures, such as fractures and arthritic changes be identified, but the bones are landmarks for other types of musculoskeletal structures. Bone should have a smooth echogenic surface and posterior shadowing. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Appearance 14. Nerves should have a distinct echogenic border. ANS: T
The nerve should have a distinct echogenic border from the epineurium encasing the entire nerve. OBJ: Describe the sonographic appearance of musculoskeletal anatomy. TOP: Sonographic Appearance 15. Ligaments are easily identified due to the amount of cartilage they contain. ANS: F
Ligaments have a fibrillar appearance and are not as easily seen as tendons because they contain less cartilage. OBJ: Describe the sonographic appearance of musculoskeletal anatomy.
TOP: Sonographic Appearance
Chapter 35: Pediatric Sonography Curry/Price: Sonography, 5th Edition MULTIPLE CHOICE 1. Which is a term for the part of the liver that is not covered by the peritoneum? a. Quadrate lobe b. Caudate lobe c. Bare area d. Right hepatic lobe ANS: C
The superior-posterior aspect of the liver, which is not covered by the peritoneum, is called the bare area. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Liver 2. In which direction should blood flow in the normal hepatic veins? a. Hepatopetal b. Hepatofugal c. Same direction as portal venous flow d. Towards the liver ANS: B
Hepatic venous flow is normally hepatofugal (directed away from the liver). OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Liver 3. What organ synthesizes bile for digestive purposes? a. Gallbladder b. Pancreas c. Liver d. Spleen ANS: C
Bile is manufactured in the hepatocytes of the liver. Bile salts help convert of vitamin D into a form required for calcium utilization. Emulsification breaks down large lipid (fat) globules. Bile salts and phospholipids act as emulsifying agents in the small intestine and aid in fat digestion. Most bile produced in the liver is stored in the gallbladder until its release is signaled by the ingestion of fatty foods. OBJ: Describe physiology of the developing organs. 4. What is the primary indication for neonatal liver transplants? a. Trauma b. Cystic liver fibrosis c. Idiopathic hepatitis d. Hemochromatosis
TOP: Liver
ANS: D
Acute liver failure in neonates from hemochromatosis with a diagnosis of giant cell hepatitis is the primary indication for liver transplants in the neonate. OBJ: Describe the applications for sonography for pediatric patients. TOP: Liver 5. What is the normal echogenicity of the neonatal liver to the adjacent renal cortex? a. Isoechoic b. Hyperechoic c. Anechoic d. A & B ANS: D
After the first few days of life, the echotexture of the liver appears isoechoic or hyperechoic to the adjacent renal cortex. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Liver 6. The liver in a child eight years old should not exceed a. 10 cm. b. 6.5 cm. c. 13 cm. d. 16 cm. ANS: C
The size and shape of the liver in a child depends on the child’s age, sex, height, weight, and body mass. Children 1 to 10 years old range from 6.5 to 13 cm. OBJ: Relate normal measurements for organs according to pediatric development guidelines. TOP: Liver 7. The bile ducts are visualized a. anterior b. posterior c. medial d. lateral
to the portal vein.
ANS: A
The bile ducts are seen anterior to the portal vein and can be differentiated from blood vessels with color Doppler. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Biliary Tree 8. How much does the resistive index of the hepatic artery increase in a post-prandial patient
with a diseased liver? a. 10 - 12% b. 15 - 20% c. 22 - 30% d. 40%
ANS: A
The normal hepatic artery should display a low resistance, continuous antegrade flow throughout the ventricular diastolic cycle with a normal resistive index (RI) of 0.7 in fasting patients. After eating, the RI increases 40% in the healthy liver but in a diseased liver, the RI increases less than 10 - 12%. OBJ: Relate normal measurements for organs according to pediatric development guidelines. TOP: Liver 9. Which vessel supplies the gallbladder? a. Right gastric artery b. Proper hepatic artery c. Cystic artery d. Gastroduodenal arteries ANS: C
The cystic artery supplies blood to the gallbladder. The right gastric, proper hepatic, gastroduodenal, and pancreaticoduodenal arteries supply the bile ducts. OBJ: Describe physiology of the developing organs.
TOP: Biliary Tree
10. Which of these is the typical clinical indication for a physician to order a gallbladder
ultrasound on a child? a. Right upper quadrant pain b. Nausea and vomiting c. Jaundice and fever d. All of these ANS: D
Indications for ultrasound evaluations of the gallbladder in children are typically symptoms suggestive of gallstones and acute cholecystitis. These include right upper quadrant pain and/or tenderness, nausea and vomiting, jaundice and fever. OBJ: Describe the applications for sonography for pediatric patients. TOP: Biliary Tree 11. How long should an infant fast prior to a gallbladder ultrasound? a. Two hours b. Four hours c. Six hours d. Eight hours ANS: B
In an infant, four hours of fasting will distend the gallbladder while 6 to 8 hours of fasting is needed for older children. OBJ: Describe physiology of the developing organs.
TOP: Biliary Tree
12. The diameter of the CBD, regardless of a child’s age, should not exceed a. 0.8 mm. b. 1.8 mm.
c. 2.8 mm. d. 3.3 mm. ANS: D
The diameter of the CBD should be less than or equal to 3.3 mm. OBJ: Relate normal measurements for organs according to pediatric development guidelines. TOP: Biliary Tree 13. When trying to locate the gallbladder while scanning, a valuable landmark is the a. main lobar fissure. b. main portal vein. c. ligamentum venosum. d. IVC. ANS: A
The gallbladder should be identified in the main lobar fissure to the right of the ligamentum teres, posterior to the inferior margin of the liver and anterior to the right kidney. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Biliary Tree 14. Which of the following is the correct sequence for bile to travel from the liver to the
duodenum in a patient with a gallbladder? a. Bile canaliculi, right and left hepatic ducts, common hepatic duct, cystic duct, gallbladder, cystic duct, common bile duct, duodenum b. Right and left hepatic ducts, common hepatic duct, cystic duct, gallbladder, common bile duct, duodenum, bile canaliculi c. Gallbladder, cystic duct, common hepatic duct, common bile duct, bile canaliculi, duodenum d. Bile canaliculi, right and left hepatic dusts, cystic duct, common hepatic duct, common bile duct, gallbladder, cystic duct, duodenum ANS: A
Bile canaliculi transport the bile through collectively larger right and left sided hepatic ducts, which join to form a common hepatic duct. This common hepatic duct joins the cystic duct from the gallbladder and sends bile into the gallbladder. The common bile duct is that segment of bile duct that carries concentrated bile away from the gallbladder also through the cystic duct toward the duodenum to aid the process of food digestion by contributing emulsifying agents. OBJ: Describe physiology of the developing organs.
TOP: Biliary Tree
15. Agenesis of the gallbladder results from a. underdevelopment of the gallbladder. b. a gallbladder attached to surrounding structures by the cystic duct. c. failure of the gallbladder to develop. d. a septation between the body and fundus. ANS: C
Agenesis is failure of the gallbladder to develop.
OBJ: Describe physiology of the developing organs.
TOP: Biliary Tree
16. The most common congenital variation of the gallbladder is a. hypoplasia. b. phrygian cap. c. duplication. d. septation. ANS: B
A phrygian cap is when the fundus folds partially onto itself. This is the most common variation. OBJ: Describe physiology of the developing organs.
TOP: Biliary Tree
17. In a fasting patient, the gallbladder wall should not exceed a. 2 mm. b. 3 mm. c. 4 mm. d. 5 mm. ANS: B
The upper limit of normal for the gallbladder wall with a fasting patient is 3 mm. OBJ: Relate normal measurements for organs according to pediatric development guidelines. TOP: Biliary Tree 18. Which of the following describes the sonographic characteristics of a normal gallbladder? a. Thin, echogenic wall b. Anechoic lumen c. Pear-shaped in the longitudinal plane d. All of these ANS: D
The normal gallbladder appears as a pear-shaped structure in the longitudinal plane or a round or oval structure in the transverse plane with a thin, echogenic wall, an anechoic lumen, and a posterior enhancement of the sound beam. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Biliary Tree 19. A hypoplastic gallbladder is defined as a. internal divisions of the gallbladder into intercommunicating compartments. b. underdevelopment of the gallbladder. c. an hourglass-shaped gallbladder. d. a gallbladder attached to surrounding structures by the cystic duct. ANS: B
Hypoplasia is underdevelopment of the gallbladder. OBJ: List normal variants and congenital anomalies of organs in the pediatric patient. TOP: Biliary Tree
20. Which organ serves as an endocrine as well as an exocrine gland? a. Spleen b. Gallbladder c. Duodenum d. Pancreas ANS: D
As an endocrine gland, the pancreas secretes the hormones insulin and glucagon. As an exocrine gland, the pancreas secretes pancreatic juice and digestive enzymes into ducts. OBJ: Describe physiology of the developing organs.
TOP: Pancreas
21. Which of the following is the most common inherited pancreatic disease of childhood? a. Cystic fibrosis b. Shwachman-Dimond syndrome c. Pancreatic carcinoma d. Gallstones ANS: A
Cystic fibrosis (CF) is one of the most common inherited pancreatic diseases of childhood. In the patient with CF, ducts which carry digestive enzymes in the pancreas become obstructed with mucus and protein. OBJ: List normal variants and congenital anomalies of organs in the pediatric patient. TOP: Pancreas 22. Which approach is used to scan the pancreas? a. Sagittal b. Transverse c. Coronal d. All of these ANS: D
Transverse, sagittal and coronal approaches are used to scan the pancreas with patients supine. The entire gland should be scanned using the cephalad-to-caudad approach. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pancreas 23. Where should the transducer be placed to best image the pancreatic neck and body? a. Position the transducer slightly to the right side of midline and angle obliquely b. Position the transducer just below the xiphoid process c. Position the transducer slightly to the left of midline and rotate toward the left
shoulder d. Position the transducer over the left kidney using it as a window ANS: B
The head and the uncinate process may be best seen by positioning the transducer slightly to the right side of the midline and angling obliquely. Transverse transducer placement right below the xiphoid process is best for imaging the neck and body of the pancreas. The tail is best visualized by placing the transducer in a transverse plane slightly left of the midline and rotating it to be parallel with the tail or by using the left kidney as a window in the coronal plane. In children, it is common to see the tail as slightly larger than the head or neck. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pancreas 24. What is the normal echogenicity of the neonatal kidneys compared to that of the liver
while performing renal ultrasound? a. Hyperechoic b. Hypoechoic c. Isoechoic d. Anechoic ANS: A
Neonatal kidneys usually appear hyperechoic compared to the liver, particularly in premature infants, because the immature renal cortex contains increased density of the glomeruli, thereby creating more interface reflectors. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Urinary System 25. Which of the following transducers are used in pediatric renal evaluation? a. Curvilinear b. Vector c. Linear d. All of these ANS: D
The curvilinear, vector or linear transducers with the highest possible frequency are used to perform pediatric renal scans. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Urinary System 26. Which of the following positions is used to evaluate the kidneys? a. Supine b. Decubitus c. Prone d. All of these ANS: D
Images of the kidneys can be obtained in supine, decubitus or prone positions. The right kidney is generally best seen with patients in the supine or left lateral decubitus positions using the liver as an acoustic window. Images of the left kidney are obtained with the patient in either the supine or right lateral decubitus positions using the spleen as an acoustic window. Prone images may be taken for accurate measures of the length of either kidney.
OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Urinary System 27. Which hormone does the medulla portion of the suprarenal glands secrete? a. Hormones that affect fluid and electrolyte homeostasis b. Hormones that affect metabolism c. Hormones that affect the normal development of bone and reproductive organs d. Hormones that control the fight-or-flight response ANS: D
The adrenal medulla secretes epinephrine (adrenaline) and norepinephrine (noradrenaline). The physiologic response to stress, the fight-or-flight response, is primarily controlled by these two hormones. OBJ: Describe physiology of the developing organs.
TOP: Urinary System
28. Which of the following is an intraperitoneal organ? a. Pancreas b. Kidneys c. Adrenals d. Spleen ANS: D
The spleen is a major intraperitoneal, lymphatic organ in the human body. It is situated in the upper left quadrant between the fundus of the stomach and the left hemidiaphragm and is protected by the rib cage. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Spleen 29. Hemopoiesis is defined as a. the formation and development of blood cells in the bone marrow. b. the destruction of old blood cells and platelets. c. the physiologic response to stress. d. early onset of puberty in girls and boys. ANS: A
Hemopoiesis is the formation and development of blood cells in the bone marrow. OBJ: Describe physiology of the developing organs.
TOP: Spleen
30. Which of the following is a clinical indication for an ultrasound of the spleen? a. Sickle cell disease b. Congenital anomalies c. Splenomegaly d. All of these ANS: D
Sonographic application of the spleen in the pediatric setting includes evaluations for congenital anomalies, sickle cell disease, and splenomegaly as well as the size, shape and location of the spleen.
OBJ: Describe the applications for sonography for pediatric patients. TOP: Spleen 31. Which of the following conditions would require Doppler interrogation of the splenic
vasculature? a. Splenic rupture b. Suspected necrosis c. Rule out a hematoma d. All splenic ultrasound requires Doppler interrogation ANS: B
Doppler interrogation of the splenic vasculature is necessary in the assessment of suspected necrosis, vascular tumors, and malignancies. OBJ: Describe the applications for sonography for pediatric patients. TOP: Spleen 32. The normal echogenicity of the spleen compared to the liver is a. isoechoic. b. hyperechoic. c. isoechoic or hyperechoic. d. isoechoic or hypoechoic. ANS: C
The normal spleen has a uniform, homogeneous appearance with an echogenicity similar to or hyperechoic to liver parenchyma and more echogenic than normal renal cortex. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Spleen 33. In which plane should the splenic length be taken? a. Sagittal b. Transverse c. Coronal ANS: C
The length measurement using the coronal plane at the level of the splenic hilum is a standard in the pediatric clinical group. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Spleen 34. What edge of the spleen are splenic clefts seen? a. Lateral edge b. Medial edge c. Superior edge d. Inferior edge ANS: A
Splenic clefts are variations in the lateral edge of the spleen. OBJ: Describe sonographic appearance of organs in the pediatric patient.
TOP: Spleen 35. In which of the following conditions would a small spleen be seen? a. Polysplenia b. Asplenia c. Splenosis d. Sickle cell anemia ANS: D
Acquired anomalies include a small spleen seen in patients with sickle cell disorder. OBJ: Describe the applications for sonography for pediatric patients. TOP: Spleen 36. What is located between the stomach and the duodenum? a. Spleen b. Pancreas c. Gallbladder d. Pylorus ANS: D
The pylorus is a circular muscle between the stomach and the first part of the duodenum. It is a funnel-shaped structure at the end of the distal stomach and connects to the duodenum at the duodenal pyloric constriction. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 37. Which scanning plane is the most useful when trying to locate the pylorus? a. Sagittal b. Transverse c. Coronal ANS: B
The pylorus is best found scanning in the transverse plane, through the liver, just to the right of midline and medial to the gallbladder. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 38. The pylorus is located a. to the left of midline, lateral to the gallbladder. b. to the right of midline, medial to the gallbladder. c. to the left of midline, medial to the gallbladder. d. to the right of midline, lateral to the gallbladder. ANS: B
The pylorus is best found scanning in the transverse plane, through the liver, just to the right of midline and medial to the gallbladder. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus
39. Which of the following is defined as a notch in the serosal surface of the stomach wall
marking the beginning of the pyloric antrum? a. Incisura angularis b. Duodenal pyloric constriction c. Duodenal junction d. Lesser curvature ANS: A
The incisura angularis is a notch in the serosal surface of the stomach wall that marks the beginning of the pyloric antrum. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 40. Hypertrophic pyloric stenosis is diagnosed with which of the following measurements? a. Wall thickness > 2 mm, channel length 15 mm b. Wall thickness > 2 mm, channel length 16 mm c. Wall thickness > 3 mm, channel length 17 mm d. Wall thickness > 4 mm, channel length 18 mm ANS: C
A wall thickness measurement greater than 3 mm and a pyloric channel length >17 mm is diagnostic for hypertrophic pyloric stenosis OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 41. A pyloric wall measurement between 2 to 3 mm may be seen in which of the following? a. Normal pylorus b. Gastritis c. Pylorospasm d. All of these ANS: D
A normal pyloric muscle wall thickness is less than 2 mm although a range between 2 and 3 mm many be seen with a normal pylorus, gastritis, and pylorospasm. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 42. A sonographic sign of hypertrophic pyloric stenosis is a. mucosal beaking. b. elbow sign. c. pseudokidney sign. d. stomach contents moving through the pyloric channel. ANS: A
Sonographic signs of hypertrophic pyloric stenosis include mucosal beaking or the shoulder sign resulting from the circular pyloric mucosa projecting back into the stomach antrum; the donut or target sign of the hypertrophied hypoechoic pylorus muscle surrounding echogenic mucosa in cross section and the failure to see the stomach contents moving through the pyloric channel in real time imaging.
OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Pylorus 43. The term that defines the complete obstruction of the pylorus is a. hypertrophic pyloric stenosis. b. pyloric hypoplasia. c. pyloric atresia. d. apylorus. ANS: C
Pyloric atresia, a congenital anomaly, is the complete obstruction of the pylorus. OBJ: Describe the applications for sonography for pediatric patients. TOP: Pylorus 44. Which of the following describes the location of the appendix? a. Right lower quadrant, inferior to the cecum, posterolateral to the terminal ileum b. Left lower quadrant, inferior to the cecum, posterolateral to the terminal ileum c. Right lower quadrant, superior to the cecum, posterolateral to the terminal ileum d. Left lower quadrant, superior to the cecum, posterolateral to the terminal ileum ANS: A
The appendix lies in the right lower quadrant, situated inferior to the cecum and posterolateral to the terminal ileum. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Appendix 45. Which of the following are signs of appendicitis? a. Non-compressible appendix b. Free fluid in the right lower quadrant c. Echogenic mesenteric fat d. All of these ANS: D
The normal appendix is easily compressible. A four-quadrant fluid check is recommended in routine practice for appendicitis and cases of a perforated appendix. Free fluid in the RLQ is an important secondary sign of appendicitis. Echogenic mesenteric fat is another secondary sign of appendicitis. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Appendix 46. Which of the uterine layer’s sheds during the menstrual cycle? a. Perimetrium b. Myometrium c. Endometrium ANS: C
The endometrium is the inner layer which thickens and then sheds during the menstrual cycle.
OBJ: Describe physiology of the developing organs.
TOP: Female Pelvis
47. Which of the following is a muscular canal connecting the uterus to the vulva? a. Vagina b. Cervix c. Uterine corpus d. Uterine fundus ANS: A
The vagina is an elastic, muscular canal, which connects the uterus to the vulva. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Female Pelvis 48. Which of the following hormones does a mature ovarian follicle secrete to help regulate
the menstrual cycle? a. Pituitary hormones b. Follicular stimulating hormones c. Estrogen and progesterone d. Progesterone ANS: C
A mature follicle of the ovary secretes the hormones estrogen and progesterone, which regulate the menstrual cycle. OBJ: Describe physiology of the developing organs.
TOP: Female Pelvis
49. Which of the following terms means early onset of puberty? a. Premenarcheal b. Postmenarcheal c. Thelarche d. Precocious ANS: D
Precocious puberty is an early onset of puberty in girls and boys. OBJ: Describe physiology of the developing organs.
TOP: Female Pelvis
50. The diameter of the neonatal cervix will be a. equal to or larger than the uterine fundus. b. equal to or small than the uterine fundus. c. equal to the uterine fundus but not larger. d. varies based on hormonal effects. ANS: A
The neonatal uterus appears larger and either pear shaped or cylindrical with prominent endometrium due to the influence of maternal hormones. The hypoechoic halo surrounding the echogenic endometrial lining represents the inner myometrium. The diameter of the cervix may be seen either equal to or larger than the fundus of the uterus. OBJ: Describe sonographic appearance of organs in the pediatric patient.
TOP: Female Pelvis 51. The resistive index of the ovaries during the middle phase of the menstrual cycle will be a. 0.5 to 0.6 with increased diastolic flow. b. 0.5 to 0.6 with decreased systolic flow. c. 1.0 with little or no diastolic flow. d. 1.0 with increased systolic flow. ANS: A
During the middle phase (days 8-17) of the menstrual cycle, the ovarian RI remains relatively low near 0.5-0.6 and diastolic flow also increases. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Female Pelvis 52. The body of the thyroid lies a. on the superior aspect of the Adam’s apple. b. at the level of the cricoid cartilage. c. posterior to the trachea. d. anterior to the esophagus. ANS: B
The thyroid cartilage, known as the Adam’s apple, lies on the superior aspect of the upper margin of the lobes. The body of the thyroid lies at the level of the cricoid cartilage, and the inferior margins lie at the fifth and sixth tracheal rings. The trachea lies posterior to the isthmus. The thyroid gland is bound posterolateral by the common carotid artery and the internal jugular vein. The esophagus is seen on the left side posterior to the thyroid gland and lateral to the trachea. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Thyroid 53. Which of the following muscles lie posterolateral to each thyroid lobe? a. Sternocleidomastoid b. Strap c. Longus colli d. Sternocleidomastoid and strap ANS: C
The sternocleidomastoid and strap muscles lie anterolaterally to each thyroid lobe, and the longus colli muscle lies posterolateral to each thyroid lobe. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Thyroid 54. Which is the preferred transducer for pediatric thyroid imaging? a. Curvilinear b. Linear c. Sector d. Vector ANS: B
The high frequency linear transducer is preferred to image pediatric thyroid glands by ultrasound. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Thyroid 55. What echogenicity will the normal pediatric thyroid appear compared to the surrounding
tissues and muscles? a. Hypoechoic b. Hyperechoic c. Anechoic ANS: B
Normal glands appear more hyperechoic than surrounding tissues and muscles. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Thyroid 56. Clinical indications for pediatric breast ultrasound include a. infection. b. focal lumps. c. gynecomastia. d. All of these ANS: D
Sonographic application of the pediatric breast generally includes to identify congenital conditions, infections, masses, focal lumps or to evaluate for gynecomastia or unilateral breast development. OBJ: Describe the applications for sonography for pediatric patients. TOP: Breast 57. At what age does breast development in females typically occur? a. 8 – 13 b. 10 – 12 c. 12 – 14 d. > 14 ANS: A
Thelarche, the appearance of breast development in girls, usually occurs between the ages 8-13 years as the result of estrogen and progesterone hormone levels increasing. OBJ: Describe physiology of the developing organs.
TOP: Breast
58. Which of the following is the echogenic covering of the testicle? a. Mediastinum testis b. Tunica albuginea c. Epididymis d. Scrotum ANS: B
The thin (bi-layered) echogenic covering of tunica albuginea around the testicles can be appreciated with the grayscale ultrasound. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Scrotum 59. Where should you move when trying to locate and image the epididymal head in the
longitudinal plane? a. Posterior to the testicle b. Anterior to the testicle c. Superior to the testicle d. Inferior to the testicle ANS: C
The epididymal head is located on the superior aspect of the testis while scanning longitudinally. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Scrotum 60. What is the echogenicity of the epididymal head compared to the testicle? a. Hypoechoic b. Hyperechoic c. Anechoic ANS: A
The epididymal head has a triangular shape and appears iso or hypoechoic compare to the testicle. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Scrotum 61. How many pairs of the spinal nerves are in the human body? a. 25 b. 28 c. 31 d. 35 ANS: C
There are 31 pairs of spinal nerves. OBJ: Describe physiology of the developing organs.
TOP: Spine and Spinal Cord
62. What is typically the maximum age for spinal ultrasound? a. 4 months b. 6 months c. 12 months d. 18 months ANS: A
Ultrasound is the screening method of choice to evaluate any spinal deformity in infants up to 4 months, particularly in the cases like basic sacral dimple and spinal skin lesions.
OBJ: Describe the applications for sonography for pediatric patients. TOP: Spine and Spinal Cord 63. Which of the following is helpful when imaging the pediatric spine? a. Decubitus position b. Prone position lying as flat as possible c. Placing a pillow underneath the patient’s chest and abdomen d. Having the parent hold the child upright while scanning ANS: C
A pillow or folded sheet is placed underneath patient’s chest and abdomen to reduce curvature of the spine. OBJ: Outline the challenges related to pediatric ultrasound.
TOP: Spine and Spinal Cord
64. At what region does the spinal canal appear rounder? a. Cervical b. Thoracic c. Lumbar d. Sacral ANS: B
The anechoic cisterna magna can be seen inferior to the cerebellum in the longitudinal plane in the cervical region. Also, in this region, the shape of the canal appears oval to triangular shaped in the transverse plane. In the thoracic region, the transverse plane canal is rounder and narrowest. OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Spine and Spinal Cord 65. The tip of the conus medullaris ends between a. L1-L2 b. L2-L3 c. L3-L4 d. L4-L5 ANS: A
In the lumber region, the tip of the conus ends between levels L1-L2 vertebrae in the normal scan OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Spine and Spinal Cord 66. The acetabulum is comprised of which bones? a. Ilium and ischium b. Ischium and pubis c. Labrum, ilium, and ischium d. Ilium, ischium, and pubis ANS: D
The acetabulum is made of the ilium, the ischium, and the pubis bones.
OBJ: Describe sonographic appearance of organs in the pediatric patient. TOP: Hips 67. Which of the following describes subluxation? a. Failure of the fusion process of the acetabulum b. Head of femur completely out of acetabulum c. Femur head is loose but is located in the joint d. Failure of triradiate cartilage to fuse ANS: C
With subluxation, the femur head is loose but will not dislocate from the joint. OBJ: Describe the applications for sonography for pediatric patients. TOP: Hips