For those who are writing the SPI- Ultrasound physics exam. I have notes for sale it is about 1500 multiple choices sets for ARDMS -spi exam = 50 USA DOLLARS. I study those notes and passed my exam 670/700 . If you want to buy i can copy the notes and send them to you in e mail or by mail you can reach me atdrsteveramsey@gmail.com . I will also include some of the ideas about the 12 simulation questions. The payment with PayPal to drsteveramsey@gmail.com , fetal gender , Saad Ismail
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These 50 ABD US question of abdominal us anatomy for ardms starter.
also must read these guide lines for the abd us ardms test; log to this site
https://books.google.ca/books?id=1sgzJozepOsC&pg=PR17&lpg=PR17&dq=www.abdominal+ultrasound+exam+free+quiz+questions&source=bl&ots=F1g3u5lJtv&sig=ys5P9w0EMrWHk4Y2pe52-W-sWMw&hl=en&sa=X&ved=0ahUKEwjEhJ2As4nKAhUDkx4KHY6gAJIQ6AEISTAJ#v=onepage&q&f=false
These are some of the mc questions to check yourself for abdominal us.
Schistosomiasis
-One of the most common parasitic infections in humans & major cause of portal hypertension in endemic areas
– eggs react liver via portal vn inciting granulomatous resulting in peri portal fibrosis
-U/S: occluded intrahepatic portal vn, thickening and increased echogenicity of portal
Acute Hepatitis
-this form of hepatitis is known as “starry night”
-hypoechoic enlarged liver
-can cause elevated ALT,AST, conjugated and unconjugated bilirubin
Chronic Hepatitis
This form of hepatitis causes liver to become hyperechoic and small with decreased echogenicity of portal walls
Sonographic findings related to AIDS
What DZ is associated with: Pneumocystis carinii, fatty liver infiltration, hepatomegaly, hepatitis, Non-hodgkin’s Lymphoma, Candidiasis, Cholangitis, Acalculous Cholecystitis, and Kaposi’s Sarcoma?
Pneumocystis carinii and it causes diffuse, non-shadowing, hyperechoic foci.
What is the most common organism causing infection in AIDS patients and what effect does it have on the liver?
Fatty Infiltration
this is the accumulation of triglycerides within hepatocytes.
Glycogen Storage Dz
genetically aquired disorder that results in excessive deposition of glycogen in the liver. It is associated with fatty infiltration and hepatic adenomas.
Focal fatty infiltration, cavernous hemangiomas, echogenic metastasis, or hepatic lipoma.
What could be a differential diagnosis of hyperechoic masses within the liver include?
Cirrhosis
What is a diffuse process of fibrosis and distortion of normal liver architecture. With this Dz there is initially liver enlargement then with repeated insult, liver atrophy occurs along with portal hypertension an hepatic encephalopathy.
Hepatitis C
What is the leading cause nation wide
>13mm
What portal diameter is suggestive of portal hypertension?
True
T/F ? Does cirrhosis patients have a high incidence of HCC?
Caput Medusa
What are tortuous collaterals seen around the umbilicus called?
Hepatofugal
What direction is normal for the RPV and LPV to travel in a patient with a TIPS?
Biliary atresia
What would be an indication/reason for a child to need a liver transplant?
Cavernous transformation of PV
What are seen as numerous worm-like venous collaterals that are parallel to a thrombosed portal vein called?
Budd-Chiari Syndrome
What is a disorder that is typically seen in young females on BCP, that causes hepatic vein obstruction by thrombus or tumor invasion called?
Portal Vein Gas
What condition is associated with Ischemic bowel Dz, where air is noted within the intrahepatic portal vein?
Necreotizing entercolitis
What is intrahepatic portal vein gas in infants due to?
Liver cysts
What is a fluid-filled space lined by biliary epithelium found in liver called? (anechoic, thined walled, and acoustic enhancement)
Kidneys (autosomal dominant poly cystic kidney dz)
What should be evaluated if liver cysts are found in someone younger than 50?
Hemangioma
What most common benign tumor of the liver?
Cavernous hemangioma
What is the most common benign tumor of the liver?
Hemangioma
What is made up of multiple vascular channels that appear as a hyperechoic mass with posterior enhancement?
Focal Nodular Hyperplasia
Benign solid liver mass with central scar, that is a hyper plastic lesion related to an area of congenital vascular malformation? Is more common in women than men.
Hepatic adenoma
Associated with BCP and gylcogen storaged dz and can cause pain due to tumor hemorrhage. Also has potential for malignant transformation.
Hepatic Lipoma
What is a rare fatty tumor that is hyperechoic mass with a propagation speed artifact.
HCC
What is the most common primary malignancy of the liver?
Gastrointestinal tract
Hyperechoic mets source is?
Lymphoma
Hypoechoic mets source is?
Lung
Bull’s eye or Target mets source is?
Mutinous adenocarcinoma
Calcified mets source is?
Sarcoma
Cystic metastases source is?
Hepatoblastoma
What is the third most common intr-abdominal childhood malignancy after adrenal neurolastoma and Wilm’s disease?
Duct of Wirsung
What is the main pancreatic duct that the CBD drains into called?
Posterior
How does the CBD travel in reference to the 1 part of the duodenum and pancreatic head?
>3mm
Gallbladder wall thickness greater than what is considered abnormal?
Tumefactive sludge
What is organized sludge balls called?
Hemolysis (RBC breakdown)- sickle cell anemia or spherocytosis
What are some pre-hepatic causes of jaundice (Hemolytic Jaundice)?
Hepatitis, biliary cirrhosis, Gilbert’s syndrome () , or Crigler-Najjar syndrome()
What are some hepatic causes of jaundice that reduces the livers ability to metabolize bilirubin?
Choledocholithiasis, Pancreatic Ca, bile duct stricture, biliary atresia, cholangiocarcinoma, Mirizzi syndrome
What are some post-hepatic causes of jaundice ( obstructive jaundice) ?
Cholesterol, calcium bilirubinate, or calcium carbonate
What can gallstones be made up of?
True
T/F Does the CBD travel slightly lateral and anterior to the MPV?
Sphincter of Oddi
What regulates bile flow into the duodenum at the Ampulla of Vater?
Cholecystokinin
What is released from duodenal mucosa after a fatty meal that stimulates the Gb to contract and sphincter of Oddi to relax?
Biliary atresia
What is the progressive obliteration of extra & intra hepatic ducts as well as the GB within the first 2 weeks of life called?
Choledochocele
This forms when a section of CBD has entered the duodenum and enlarges. (ureterocele)
Courvoisier GB
This type of Gb dz is characterized by an enlarged, palpable Gb resulting from distal obstruction of CBD 2nd to pancreatic head mass?
Klatskins Tumor
This is a type of cholangiocarcinoma, and adenocarcinoma of the CHD birfurcation.
Hydrops of Gb
What Gb pathology is also known as a mucocele, which is a round, non inflamed Gb due to cystic duct obstruction that leads to bile reabsorbtion and a Gb filled with anchovy secretions?
>5cm
What trv diameter measurement of Gb is suggestive of Gb Hydrops?
Cholesterolosis
What Gb pathology is known to deposit lipids in the Gb walls? Also known as “strawberry Gb”.
Adenomyomatosis
This causes by plastic changes in Gb wall causing overgrowth of muscosa, thickening of wall, and diverticula.
RAS- Rokitansky-Aschoff sinuses
What are diverticula within Gb wall that can accumulate stones and sludge called?
Endoscopic retrograde cholangiopancreatogram-ERCP
What does the test ERCP stand for, which is used to evaluate Gb function?
Mirizzi Syndrome
What causes extra hepatic biliary obstruction due to an impacted stone in the cystic duct cashiering compression of the CHD called?
Emphysematous cholecystitis
What pathology is found more commonly in diabetic men, where gas is found In the wall of the Gb,the Gb lumen or biliary tree?
Empyema of Gb
What is it called when purulent material is found within Gb due to bacteria-containing bile associated with acute cholecystitis?
Choangitis
What is it called when a bacterial infection is superimposed on an obstruction of the biliary tree?
Pneumobilia
What is air in the biliary Tract called?
Choledochal cysts
Congential bile duct anomaly consisting of cystic dilatation of intra and extra hepatic ducts?
Caroli’s disease
What is a congenital anomaly of the biliary tract that has mulifocal segmental dilatation of INTRAHEPATIC bile ducts?
Primary sclerosing choleangitis
What is an inflammation and fibrosis of the intrahepatic and extra hepatic bile ducts, which leads to liver failure and transplant
Primary biliary cirrhosis
What is a chronic and progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end-stage liver disease?
Exocrine
What function of the pancreas is to secrete trypsin, lipase, and amylase through the ducal system?
Endocrine ( non-ductal)
What function of the pancreas is to secrete insulin via the islets of Langerhans?
Anterior
Head of pancreas is where in relation to the IVC?
Medial
Head of pancreas is where in relation to the duodenum?
Anterior and medial
Tail of pancreas is where in relation to the splenic hilum?
Posterior and lateral
CBD is located where on pancreatic head?
Anterior and lateral
GDA is located where on pancreatic head?
Posterior to the pancreatic neck and anterior to the uncinate process
The SMV and SMA are located where in relation to the pancreatic neck? Uncinate process?
Posterior
Aorta is located where to the body of the pancreas?
Superior
Celiac axis arises from aorta at what border of the pancreas?
Inferior
SMA arises from aorta at what border of the pancreas?
Left gastric artery, splenic artery, and common hepatic artery
What are the branches of the celiac axis?
Superior border of body and tail
What path does the splenic artery follow in relation to the pancrea?
Proper hepatic Artery and GDA
What does the common hepatic artery branch into?
Anterior to MPV and to the left of the CBD
Proper hepatic artery travels where in relation to the portal vein? CBD?
Phlegmon
What is a spreading inflammatory reaction to an infection which forms a suppurating lesion called?, a spreading inflammatory reaction to infection that can form multiple pus pockets
Acute- enlarge & hypo / chronic – small & echogenic
What sonographer findings differentiaite acute vs chronic pancreatitis?
Von Hippel-Lindau syndrome
This is a rare genetic disease that causes rumors or cysts to form in the body, which may be malignnant or benign.
Multiple Endocrine neoplasia (MEN-1)
This is and inherited endocrine disorder that is categorized into type 1 (Wermer syn) and type 2 (Sipple’s syn), with the most common sites of involvement being: parathyroids, pancreatic islets cells, pituitary gland, adrenal glands, and thyroid.
Insulinoma
This is the most common islet cell tumor which is usually benign and causes hypoglycemia.
Gastrinoma
This is the second most common islet cell tumor that causes gastric acid hyper secretion and gastric and duodenal ulcerations
MRA–Segmental–Interlobar–Arcuate–Interlobular
What is the branching of the renal blood supply starting at the hilum with the MRA?
Pelvic/Ectopic kidney
What is it called when the kidneys fail to ascend into the abdomen?
Horseshoe kidneys
What’s the most common fusion anomaly in which the lower poles of the kidneys typically connect across midline anterior of the aorta?
Crossed fused ectopic kidney
This occurs when the developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carrying the other kidney with it across midline.
Dromedary Hump
What is a common variant of cortical thickening on the lateral aspect of the left kidney referred to as?
Junctional parenchymal defect (aka fetal lobulation)
This is a triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney.
Duplex kidney
This is a duplication of the renal collecting system.
Posterior Uretheral Valve
This is a common urinary obstruction in the male neonate. this is due to obstruction of the prostatic urethra
Multicystic dysplastic kidney
What is the most common cause of an abdominal mass in newborns?
Multicystic dysplastic kidney
This is a non-functioning kidney that consists of non-communicating cysts that is a result of atresia of the uropelvic junction.
Medullary sponge kidney
Congenital dysplasic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia.
Von Hippel-Lindau Disease
Inherited disease which usually presents in people’s 20s or 30s with serious visual impairment.
Angiomyolipoma
This is a benign fatty renal tumor that’s hyperechoic and is 80% of the time found in the right kidney.
Tuberous Sclerosis
This is a multi-system disease that causes seizures, mental retardation, and facial angiofibromas. Patients with this are at an increase incidence for renal cysts and bilateral angiomyolipomas.
Renal cell carcinoma
This is the most common solid renal mass in the adult that is a hypoechoic, unilateral encapsulated mass. Tumor extension into renal veins and IVC are common.
Wilm’s Tumor
This is the most common childhood renal tumor with a mean age of diagnosis at 3.5 years.
Leukemia (35%)
What type of pediatric cancer has the highest incidence?
Acute pyelonephritis
What is a renal infection that is caused by gram (-) bacilli from intestines called? It causes renal enlargement, hypo parenchyma, and. Absence of sinus echoes.
Acute focal bacterial nephritis or lobar nephonia
What is it called when acute pyelonephritis is focal causing a focal wedge-shaped hypoechoic area in kidney?
Emphysematous pyelonephritis
This is a bacterial infection associated with renal ischemia that more commonly affects diabetics and immunocompromised patients.
Xanthogranulomatous Pyelonephritis
Type of chronic pyelonephritis resulting from chronic infection due to a lone term obstruction. Usually associated with a staghorn calculus.
Mycetoma (fungal balls)
This is a renal fungal infection that results from hematogenous seeding or ascending from the bladder and forming hyperechoic non-shadowing masses in kidney.
Pyonephrosis
Purulent material in the collecting system of kidney associated with an infection secondary to renal obstruction. Look for hyperechoic debris in pelvis or fluid-fluid level.
Changes in serum creatinine which reflects changes in glomerular filtration rate
What is the most accurate method of determining ARF?
Acute Renal Failure (ARF)
What causes an abrupt decrease in renal filtration marked by an increase in serum creatinine and BUN (azotemia)?
Acute tubular necrosis
What is the most common cause of medical renal disease?
Uretrovesical junction
What is the most common area of obstruction by a stone of the kidneys to be found?
Nephrocalcinosis
Disorder of calcium metabolism (hypercalcemia or hypercalciuria) that results in the formation of calcium stones and deposition of calcium salts internal parenchyma.
Papillary Necrosis
Ischemia of the medullary pyramids which results in sloughing papilla found in urine.
Renal sinus lipomatosis
Increased renal sinus fat that replaces the normal renal parenchyma.
Steve Ramsey.PhD, Calgary- Canada.