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What is the concept behind the FAST exam or eFAST exam?
A. A comprehensive examination is rapidly
B. Sonography evaluation is easy to learn.
C. Life-threatening injuries cause bleeding.
D. A complete diagnosis is obtained quickly and
What acoustic window is the most commonly used to visualize the cardiac structures?
C. Parasternal short axis
D. Parasternal long axis
What procedure is used to remove ascites?
A. Abscess drainage
D. Transhepatic windowing
Why is a fine-needle aspiration of a thyroid nodule less than 10 mm discouraged?
A. Higher false-positive results
B. Microcalcification prevents clean aspiration
C. Nodule aspiration of a solid component is
D. The microcarcinomas infrequently metastasize
What is the range of needle gauges used for a fine-needle aspiration?
A. 8 gauge to 13 gauge
B. 14 gauge to 19 gauge
C. 20 gauge to 27 gauge
D. 28 gauge to 32 gauge
When used for thyroid biopsy, what is an advantage of fine-needle capillary technique?
A. Minimal trauma
B. Larger cellular sample
C. Maximum capillary action
D. Less concentrated sample
What is a limitation of a FAST exam?
A. Difficulty examining obese patients
B. The imaging equipment lack portability
C. The imaging equipment is expensive and
difficult to find
D. Inability to differentiate fluids from soft tissue
What patient position increases the sensitivity of the FAST exam, especially in the detection of free fluid in the hepatorenal and perisplenic spaces?
What is a major benefit of FAST or eFAST?
A. Uses low doses of ionizing radiation
B. Children do not need heavy sedation
C. Examination is comprehensive
D. Noninvasive bedside examination
What procedure is used to remove pleural fluid?
A. Pericardial drainage
B. Abscess drainage
What term describes air located outside of the lung but within the pleural cavity?
What is a sign of cardiac tamponade?
A. Symmetrical ventricular contraction
B. Loss of respiratory variation in the inferior
C. Bowing of the interventricular septum into the
D. Collapse of all chambers during systole
B. Loss of respiratory variation in
the inferior vena cava
When evaluating for a deep vein thrombosis, what observation suggests a clot?
B. The vein is respirophasic
C. Veins will not compress
D. Positive Valsalva response
What is a contraindication to a needle biopsy?
A. Uncorrectable coagulopathy
B. Patient is obese
C. Mass is deeply located
D. Mass is solid
Using one of the eFAST methods, what is indicated if there is an absence of the sliding sign?
A. Pleural effusion
C. Pericardial effusion
What is the relationship between the needles bore size and its gauge?
A. Directly proportional
B. Dimensionally proportional
C. Exponentially proportional
D. Inversely related
What is the advantage of using color flow Doppler imaging when performing sonography-guided biopsy procedures?
A. Increases interpretation accuracy of the sample
B. Decreases scanning artifacts
C. Helps clinician avoid vascular structures
D. Reduces procedural time
Which type of needle will have a larger reflectivity surface?
A. Larger caliber needle
B. Small bore caliber needle
C. Larger gauge needle
D. Out-of-plane positioned needle
What is the likely diagnosis of an anechoic or hypoechoic fluid collection localized to the costophrenic angle after blunt or penetrating chest injury superior to an intact diaphragm?
B. Pleural effusion
What laboratory test is used to evaluate for blood clotting abnormalities?
A. International normalized ratio
B. Prothrombin time
C. Plasma frozen time
D. Specific antigen test
What is characteristic about the apex that explains why most prostate cancers involve the apex?
Has the greatest portion of peripheral glandular tissue
What is one common entity involving the prostate gland?
What is one of the most common causes of endogenous calculi?
What pathology is most likely demonstrated on a 64-year-old man with a slightly elevated prostate-specific antigen level and the endorectal sonogram documenting an 8.9 mm hypoechoic mass in the right peripheral zone?
What pathology is most likely demonstrated on a patient with a painfully swollen prostate gland, an elevated prostate-specific antigen level, and the endorectal sonogram documenting several irregular, hypoechoic areas in the periurethral area?
Where is the near field located on the sonographic image that was obtained using an endorectal technique?
Where is the prostate gland located?
Between the bladder and the pelvic floor
Which area is primarily affected as benign prostatic hypertrophy progresses?
Which of the following is the best indicating marker for diagnosing prostate cancer?
Which prostate zone is most often the primary site of carcinoma?
While scanning the prostate gland, what is the most likely explanation for visualizing while scanning an irregular echo pattern of the internal and external zones?
Capsular invasion has occured because of the carcinoma
Crohn's disease primarily affects young adults and affects what anatomic region?
Gastric carcinoma arises from what layer of the stomach?
In cases of gastritis, thinning of the mucosa is considered a precursor of what pathology?
In what region does inflammation usually start with ulcerative colitis that is an inflammatory disease confined to the colonic mucosa and submucosa?
What carcinoma affects more men and elderly with about equal frequency in the middle and lower third of the esophagus?
Squamous cell carcinoma
What is the deepest, innermost, mucosal esophageal surface that can be visualized on both endoscopic and transabdominal imaging?
What is the most common primary neoplastic lesion of the small bowel?
Smooth muscle tumors
What portion of the GI tract have walls that are thicker and can nearly always be visualized sonographically in the normal patient using a transabdominal scanning approach?
What portion of the duodenum bends and courses inferiorly to the right of the pancreatic head?
What portion of the duodenum includes the duodenal bulb?
Where is the body and antrum of the stomach located relative to the gallbladder and porta hepatis?
Where is the body and antrum of the stomach located relative to the left hepatic lobe?
Posterior and Inferior
What is the second leading cause of malpractice lawsuits against emergency medicine physicians?
Missed foreign bodies
What term refers to a biological process that occurs within a living organism or natural setting?
With a retained foreign body, what acoustic property can be identified distal to the echogenic object?
Distal ring down artifacts
What condition results when the patient is unable to synthesize erythropoietin?
What term is used when describing on a radiograph an object that attenuates or blocks radiation?
What is an early sonographic appearance of renal transplant rejection?
What does it mean to triangulate location?
Acquire images in two perpendicular projections
If a foreign body is composed of organic material, what does it refer to?
Biological plant material and animal products
What condition results when the patient is unable to clear nitrogren-containing wastes from the body?
What is the most common cause if acute posttransplant renal failure?
Renal tubule damage
What can be a complication if immunosuppressive medication dosage is too low?
What term describes the reduction in echo amplitude caused by the attenuating properties of an object?
What is a disadvantage of using tissue harmonics imaging or transmit beam-steering?
Shadow artifacts are reduced
What is the expected echogenic pattern of a foreign body in the acute phase?
Hyperechoic object with shadowing
What is an advantage of using color or power Doppler for evaluating the renal transplant?
Assesses global renal artery perfusion
What term describes a left kidney transplanted in the right iliac fossa?
External Iliac Vein
What is the normal flow pattern for a pancreatic allograft?
Monophasic venous flow
What is suspected if there is a drop in the timed urine amylase output?
Pancreatic allograft rejection
During what age of the foreign body does the hypoechoic ring around an object appear most pronounced?
Why do females have a great potential for carpal tunnel syndrome?
The carpal tunnel is smaller in females
Which ligament tear generally occurs from the joint space superiorly?
Medial collateral ligament
What term is used to describe common flexor osteotendinopathy?
What term describes a change in the properties of a structure when measured or evaluated in different directions such as changing the insonating angle?
What statement best describes a ligament?
Attaches bone to bone
What statement best describes a bursa?
Highly specialized synovial lined pouches
What is the most superficial muscle visualized when scanning the posterior knee?
What is the most common injury of the ankle?
What is the echogenicity on a long axis plane of large muscle fibers?
What is a common finding in rotator cuff pathology?
Pain in the lateral deltoid area
In transverse sections through the shoulder, what is the superficial muscle on the lateral side of the humerus?
In rupture of the Achilles tendon, what may be seen injecting posterior into the area of disrupted fibers?
Kager's fat pad
What are the three transducer design parameters for a single-focus transducer to image the breast?
For single-focus transducers, only three transducer design parameters control range, lateral resolution, and depth of field: 1. the diameter; 2. the focal length; and 3. the frequency.
Describe the ultrasound anatomy of the breast.
The parenchymal elements include the lactiferous ducts and alveoli of the breast as well as the intralobular connective tissue, and the stromal or supporting tissues can be divided into fat and dense connective tissue.
In a normal premenstrual breast, the following areas are clearly demonstrated: subcutaneous fat, fibroglandular tissue, lactiferous ducts, retromammary space, muscle layers, and ribs.
How do fatty lobules appear in the breast?
Fat/dense connective tissue is strongly echogenic as compared with the fat/parenchymal interfaces or dense connective tissue/parenchymal interfaces.
Ultrasonography demonstrates that fatty tissue has relatively low acoustic impedance and sparse low-level echoes in contrast to the high-level intensity echoes of fibrous tissue, which has relatively high acoustic impedance. The proportions of parenchymal and stromal elements vary considerably within the breast; therefore, for a careful interpretation of the images one must consider this aspect of anatomy.
Describe the sonographic appearance of subcutaneous fat.
1. The subcutaneous fat lies deep in relation to the skin. Usually in the young woman there is little or no subcutaneous fat; the amount normally increases with age and parity. Multiple distinct fat lobules are often identified, separated by highly echogenic connective tissue ligaments (Cooper’s ligaments).
The orderly orientation of fat lobules is often best seen when scanning is being performed in the longitudinal plane (generally because of the line of fat lobules and connective tissue ligaments). Sometimes these dense supporting ligaments cause attenuation shadowing, making it difficult to image the posterior structures with ultrasonography. Moving the transducer with a slight angulation usually allows one to avoid the shadowing and image the structures beyond this ligament.
Describe the fibroglandular layer of the breast.
1. The fibroglandular (parenchymal) layer lies below the subcutaneous fatty layer. Separating these two layers is the highly echogenic band of tissue that represents the superficial fascia. The parenchymal layer consists of the ducts and alveoli, including the intralobular connective tissue. Some of the dense intralobular connective tissue, which is part of the stromal tissue component, may be difficult to differentiate from the remainder of the parenchyma because of similar imaging characteristics. The deep fascia is located deep to the fibroglandular tissue. The deep fascia has an appearance similar to that of the superficial fascia.
What is the significance of imaging the retromammary layer and pectoralis muscles of the breast?
1. The retromammary layer lies between the deep connective tissue plane and the fascia of the underlying muscle. This layer predominantly contains fat lobules that are smaller than those found in the subcutaneous layer. Connective tissue ligaments are not usually seen in this layer because they are thinner than in the subcutaneous layer.The pectoralis major and minor muscles are easily demonstrated usually, depending on the area of the breast being scanned. They are imaged as structures of relatively low echogenicity running deep in the breast above the ribs and parallel to the skin. The structures are more prominent in small-breasted women and may be quite large in athletic individuals. The muscles are best imaged in the transverse plane.
How can the lactiferous ducts be identified on ultrasonography?
1. The lactiferous ducts are easily seen on most scans, especially when they are dilated. A typical breast is composed of 15 to 20 lobules that are drained by a network of ducts. These ducts are branched in the peripheral parts of the breast and join in the subareolar region to form approximately 15 to 20 ducts that drain onto the surface of the nipple. Therefore, the diameter of the ducts is slightly larger in the subareolar region than in the periphery of the breast.
The lactiferous ducts usually are collapsed in the nonlactating breast; at the sinus level in the subareolar region the ducts may have a potential diameter of 8 mm. In the periphery of the breast, a diameter of 2 to 4 mm is normal in the lactating breast. Surrounding the subareolar ducts are varying amounts of fibrosis, which accentuate the degree of nipple shadowing observed.
Describe the breast parenchymal patterns as seen on ultrasound examination.
1. In the young, nonlactating breast, the tissue is primarily composed of fibroglandular tissue with little or no subcutaneous fat. With increasing age and parity, fat is deposited in both the subcutaneous and retromammary layers.
During pregnancy there is a substantial increase in glandular tissue in the breast. The resultant image on ultrasound examination demonstrates a finely granular echo pattern with little subcutaneous fat. The subcutaneous and retromammary fat layers are compressed by the glandular tissue and are decreased in size. Late in pregnancy and during lactation, the lactiferous ducts increase in size and number, with resultant duct dilation throughout most of the breast tissue.
Cyclic breast changes may occur with each menstrual cycle. Ultrasonography may image mild duct dilation during the period between ovulation and menstruation. In most normal women, no significant changes are noted.The postmenopausal breast demonstrates varying amounts of fibrous tissue interspersed among predominantly fatty tissue. With increasing age there is normal regression of the glandular tissue, with subsequent replacement by fat.
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