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NEW QUESTION # 83
Which condition is most consistent with the findings in the image below?
- A. Porcelain gallbladder
- B. Emphysematous cholecystitis
- C. Adenomyomatosis
- D. Gangrenous cholecystitis
Answer: B
Explanation:
The ultrasound image shows echogenic foci with dirty shadowing and reverberation artifacts within the gallbladder wall and lumen. These features are characteristic of emphysematous cholecystitis, a severe, life- threatening variant of acute cholecystitis caused by gas-forming organisms (e.g., Clostridium or E. coli) infecting the gallbladder wall.
Sonographic features of emphysematous cholecystitis:
* Echogenic gas within the gallbladder wall or lumen
* Reverberation or "dirty" shadowing artifacts
* May show intramural gas bubbles or "ring-down" artifact
* Often seen in diabetic or immunocompromised patients
* No gallstones may be present ("acalculous cholecystitis")
Clinical context:
* More common in elderly men and diabetics
* Presents with right upper quadrant pain, fever, and leukocytosis
* Surgical emergency due to risk of perforation and sepsis
Differentiation from other options:
* A. Adenomyomatosis: Involves gallbladder wall thickening with "comet tail" artifacts due to Rokitansky-Aschoff sinuses, not intramural gas.
* B. Porcelain gallbladder: Shows curvilinear calcification of the gallbladder wall - dense echogenic rim with posterior shadowing.
* C. Gangrenous cholecystitis: May show wall irregularity, intraluminal membranes, and absence of Doppler flow but lacks intramural gas.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gallbladder and Biliary System, pp. 155-160.
American College of Radiology (ACR). Appropriateness Criteria for Right Upper Quadrant Pain, 2022.
Radiopaedia.org. Emphysematous cholecystitis: https://radiopaedia.org/articles/emphysematous-cholecystitis
NEW QUESTION # 84
Which condition is most consistent with the findings in this image?
- A. Fungal balls
- B. Renal cell carcinoma
- C. Medullary sponge kidney
- D. Acute pyelonephritis
Answer: C
Explanation:
The ultrasound image demonstrates a longitudinal view of the right kidney. Within the renal pyramids, there are multiple echogenic foci, some showing posterior acoustic shadowing-findings characteristic of medullary nephrocalcinosis. This sonographic appearance is strongly associated with medullary sponge kidney (MSK).
Medullary sponge kidney is a congenital disorder of the renal tubules that results in ectatic (dilated) collecting ducts in the renal medulla. The dilated ducts frequently become calcified, leading to the "paintbrush" or
"bouquet of flowers" appearance seen in the renal pyramids on ultrasound. These calcifications are most often bilateral and symmetrical, further aiding the diagnosis.
Comparison of answer choices:
* A. Fungal balls (mycetomas) typically appear as mobile, non-shadowing echogenic masses within the collecting system, often in immunocompromised patients.
* B. Renal cell carcinoma usually presents as a solid mass with irregular borders and variable echogenicity-this image does not show a mass.
* C. Acute pyelonephritis may show renal enlargement, decreased echogenicity, or loss of corticomedullary differentiation-but not calcification of the pyramids.
* D. Medullary sponge kidney is correct due to the punctate echogenic foci within the medullary pyramids, consistent with nephrocalcinosis.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
Babcock DS. Sonographic findings in medullary sponge kidney. AJR Am J Roentgenol. 1981;137(6):1239-
1243.
NEW QUESTION # 85
Which best describes the Doppler waveform findings in this image?
- A. Tardus parvus
- B. Increased resistance
- C. Triphasic
- D. Normal
Answer: D
Explanation:
The Doppler spectral waveform shown in this image of the right testis demonstrates low-resistance, forward- flowing arterial waveforms with continuous diastolic flow - this is characteristic of normal testicular perfusion. The presence of both color Doppler flow and a resistive index (RI) of 0.66 further supports normal testicular arterial circulation.
Key Doppler features of a normal testicular waveform:
* Low-resistance waveform (RI typically 0.5-0.75)
* Continuous diastolic flow
* No reversal of flow or spectral broadening
* Color Doppler confirms uniform intratesticular vascularity
Clinical context:
* Normal testicular flow on Doppler imaging excludes testicular torsion, infarction, or significant inflammation.
* Testicular torsion would show either absent or very high-resistance (reduced or absent diastolic flow) waveform.
* Epididymo-orchitis may show hyperemia with low resistance but often presents with other gray-scale findings like heterogeneous echotexture or scrotal wall thickening.
Differentiation from other options:
* B. Increased resistance: RI >0.75 and reduced or reversed diastolic flow; may indicate impending torsion or ischemia.
* C. Tardus parvus: A slow systolic upstroke and diminished amplitude; indicates proximal arterial stenosis.
* D. Triphasic: Normal waveform in peripheral arteries, such as extremities, not seen in testicular circulation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Male Pelvis - Testis and Scrotum, pp. 793-800.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations, 2020.
Radiopaedia.org. Testicular Doppler assessment: https://radiopaedia.org/articles/testicular-doppler-assessment
NEW QUESTION # 86
Which finding is most likely demonstrated in this abdominal wall image of a patient with a history of atrial fibrillation?
- A. Hernia
- B. Abscess
- C. Lipoma
- D. Hematoma
Answer: D
Explanation:
The ultrasound image demonstrates a complex, heterogeneous hypoechoic collection within the abdominal wall, with mixed echogenicity and ill-defined margins. The lesion appears to contain internal debris but lacks definitive signs of vascularity or air (which would be seen in an abscess). There is no peristalsis, herniated bowel, or fat to suggest hernia.
Given the history of atrial fibrillation - a condition commonly treated with anticoagulation therapy (e.g., warfarin, apixaban) - this clinical background raises high suspicion for a rectus sheath or abdominal wall hematoma.
Key ultrasound features of hematomas:
* Early (acute): hyperechoic or heterogeneous
* Chronic/resolving: complex or cystic with fluid-debris levels
* No internal vascularity on Doppler
* May be confined to muscle or fascial planes
This is consistent with a hematoma, particularly in patients on anticoagulation therapy.
Comparison of answer choices:
* A. Hernia - typically shows bowel or fat with movement/peristalsis passing through a fascial defect.
* B. Lipoma - usually homogeneous and echogenic, not complex or fluid-filled.
* C. Abscess - often presents as a complex fluid collection with peripheral hyperemia and possibly air, plus systemic signs of infection.
* D. Hematoma - Correct. The image and clinical history (anticoagulation due to atrial fibrillation) strongly support this diagnosis.
References:
Berman L, et al. Sonographic appearance and evolution of rectus sheath hematomas. AJR Am J Roentgenol.
1996.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Diagnostic Ultrasound Examinations of the Abdomen and Retroperitoneum (2020).
NEW QUESTION # 87
Which congenital anomaly is characterized by the failure of the dorsal and ventral pancreatic buds to fuse?
- A. Ectopic pancreas
- B. Pancreas divisum
- C. Pancreatic agenesis
- D. Annular pancreas
Answer: B
Explanation:
Pancreas divisum occurs when the dorsal and ventral pancreatic ducts fail to fuse during embryologic development. This results in most pancreatic secretions draining through the minor papilla via the dorsal duct (duct of Santorini).
According to Rumack's Diagnostic Ultrasound:
"In pancreas divisum, the dorsal and ventral pancreatic ducts fail to fuse, resulting in separate drainage systems." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
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NEW QUESTION # 88
Which finding is expected in the contralateral kidney given the pathology depicted in this image?
- A. Polycystic kidney
- B. Duplicated collecting system
- C. Parapelvic cysts
- D. Atrophic kidney
Answer: A
Explanation:
The ultrasound image shows a sagittal view of the right kidney with multiple anechoic (black), non- communicating cysts of varying sizes distributed throughout the renal parenchyma, consistent with autosomal dominant polycystic kidney disease (ADPKD).
ADPKD is a hereditary disorder characterized by the progressive development of multiple bilateral renal cysts, which leads to renal enlargement and eventual loss of function. This condition typically affects both kidneys, making bilateral polycystic involvement expected. Therefore, the same cystic appearance is anticipated in the contralateral (left) kidney as well.
Comparison of answer choices:
* A. Duplicated collecting system: This is a congenital anomaly but does not result in diffusely cystic kidneys.
* B. Polycystic kidney: Correct. Bilateral renal involvement is the hallmark of ADPKD.
* C. Parapelvic cysts: These are simple cysts located in the renal sinus and do not exhibit the diffuse pattern seen here.
* D. Atrophic kidney: Not typical in the contralateral side in ADPKD; the disease affects both kidneys symmetrically.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet. 2007;369(9569):
1287-1301.
NEW QUESTION # 89
Which common congenital anomaly is typically seen as a cystic midline anterior neck structure?
- A. Cystic follicular adenoma
- B. Cystic hygroma
- C. Thyroglossal duct cyst
- D. Branchial cleft cyst
Answer: C
Explanation:
A thyroglossal duct cyst is the most common congenital cystic anomaly in the anterior midline neck. It arises from persistent remnants of the thyroglossal duct, typically located inferior to the hyoid bone.
According to Rumack's Diagnostic Ultrasound:
"Thyroglossal duct cysts are located in the midline anterior neck and are the most common congenital cystic neck lesions." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
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NEW QUESTION # 90
Which vessel is most likely to display hepatofugal flow in the presence of portal hypertension?
- A. Coronary vein
- B. Inferior vena cava
- C. Inferior epigastric vein
- D. Splenic vein
Answer: A
Explanation:
The coronary vein (left gastric vein) is a common collateral pathway in portal hypertension. It often becomes dilated and may demonstrate hepatofugal (reversed) flow as blood diverts from the high-pressure portal system into systemic collaterals.
According to Zwiebel's Introduction to Vascular Ultrasound:
"The left gastric (coronary) vein is a frequent site of hepatofugal flow in portal hypertension, reflecting collateral development." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Portal Venous Doppler Ultrasound, 2020.
NEW QUESTION # 91
Which sonographic finding is most consistent with scrotal inflammation?
- A. Abscess
- B. Hydrocele
- C. Hyperemia
- D. Granuloma
Answer: C
Explanation:
Scrotal inflammation, such as epididymitis or orchitis, typically presents with increased blood flow (hyperemia) on color Doppler sonography. This finding reflects the inflammatory process and vascular dilation. Abscesses, granulomas, or hydroceles may be present but are not as consistent or specific for inflammation.
According to AIUM Practice Parameters and Rumack's Diagnostic Ultrasound:
"In acute inflammation, color Doppler ultrasound demonstrates prominent hyperemia of the epididymis or testis." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Scrotal Ultrasound, 2020.
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NEW QUESTION # 92
Which vessel is located directly proximal to the origination of the renal arteries?
- A. Hepatic artery
- B. Splenic vein
- C. Superior mesenteric artery
- D. Left portal vein
Answer: C
Explanation:
The renal arteries originate from the abdominal aorta just inferior to the superior mesenteric artery (SMA).
The SMA arises anteriorly from the abdominal aorta at the level of L1, and just below it, the renal arteries branch laterally. The splenic vein, portal vein, and hepatic artery are located more superiorly in relation to the renal arteries.
According to Moore's Clinically Oriented Anatomy:
"The superior mesenteric artery arises from the anterior surface of the abdominal aorta just above the renal arteries." (Moore KL et al., Clinically Oriented Anatomy, 8th ed.) Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
NEW QUESTION # 93
Which technique best differentiates a bladder mass from a hematoma?
- A. Fill the bladder
- B. Obtain post-void image
- C. Change patient position
- D. Use harmonic imaging
Answer: C
Explanation:
Changing the patient's position allows evaluation of lesion mobility. Blood clots and hematomas are often mobile, while true bladder wall masses remain fixed. This technique helps differentiate between solid masses and non-adherent debris.
According to Rumack's Diagnostic Ultrasound:
"Changing patient position may distinguish between mobile blood clots and fixed bladder wall masses." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
NEW QUESTION # 94
Which abnormality is the most common adult adrenal tumor?
- A. Pheochromocytoma
- B. Adenoma
- C. Neuroblastoma
- D. Adrenal cortical carcinoma
Answer: B
Explanation:
Adrenal adenomas are the most common adrenal tumors in adults. They are often discovered incidentally (adrenal incidentalomas) and are usually nonfunctioning, though some may secrete cortisol or aldosterone.
Neuroblastoma is common in children, pheochromocytomas are rarer catecholamine-producing tumors, and adrenal cortical carcinoma is malignant but much less common than adenomas.
According to Rumack's Diagnostic Ultrasound:
"Adrenal adenomas are the most common adrenal masses in adults, frequently identified incidentally on imaging studies." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
ACR Incidental Findings Committee Guidelines for Adrenal Masses, 2017.
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NEW QUESTION # 95
Which condition is demonstrated in this image?
- A. Cryptorchidism
- B. Bell clapper deformity
- C. Inguinal hernia
- D. Pyocele
Answer: A
Explanation:
The ultrasound image shows an ovoid, homogeneously hypoechoic soft tissue structure located in the inguinal canal, surrounded by echogenic fat and soft tissue. This is consistent with an undescended testis, also known as cryptorchidism.
Cryptorchidism refers to the failure of one or both testes to descend into the scrotal sac. On ultrasound, the undescended testis typically appears:
* Ovoid in shape
* Homogeneous and hypoechoic compared to scrotal testis
* Located in the inguinal canal or, less commonly, within the abdomen
* Smaller in size than a normally descended testis
Comparison of answer choices:
* A. Bell clapper deformity refers to an anatomic predisposition for testicular torsion where the tunica vaginalis surrounds the entire testis and epididymis-usually a clinical rather than directly sonographic diagnosis.
* B. Inguinal hernia appears as bowel or omentum within the inguinal canal or scrotum with peristalsis or fat-no bowel loops are seen here.
* C. Pyocele is a complex fluid collection around the testis (usually with septations and internal echoes)- not evident in this image.
* D. Cryptorchidism - Correct. The findings match those of an undescended testis in the inguinal canal.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Dogra VS, Gottlieb RH, Rubens DJ, Oka M. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations (2021).
NEW QUESTION # 96
Which finding is indicated by the arrow in this image of the right upper quadrant?
- A. Retroperitoneal hemorrhage
- B. Mirror image
- C. Pleural effusion
- D. Ascites
Answer: C
Explanation:
The image provided is a right upper quadrant (RUQ) ultrasound-typically performed during a FAST (Focused Assessment with Sonography in Trauma) exam or for abdominal assessment. The arrow points to an anechoic (black) fluid collection seen above the diaphragm and posterior to the liver.
This fluid collection lies within the thoracic cavity, confirming the diagnosis of a pleural effusion. Pleural effusions are seen sonographically as an anechoic or hypoechoic area superior to the diaphragm in the thoracic cavity and often appear triangular or crescent-shaped. The diaphragm is visualized as a curvilinear echogenic structure separating the liver (or spleen) below from the lung space above.
Comparison of answer choices:
* A. Retroperitoneal hemorrhage would be seen in the posterior abdomen, not above the diaphragm.
* B. Pleural effusion is correct-anechoic fluid above the diaphragm is classic for this condition.
* C. Mirror image artifact occurs when liver echoes are mirrored across the diaphragm and lung-this is not a mirror artifact.
* D. Ascites collects inferior to the diaphragm and around the abdominal organs, not in the thoracic cavity.
References:
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound, 3rd ed. McGraw-Hill; 2014.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-757.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
NEW QUESTION # 97
Which thyroid condition is most likely caused by a viral infection?
- A. Hashimoto
- B. Graves
- C. Abscess
- D. De Quervain
Answer: D
Explanation:
De Quervain thyroiditis (subacute granulomatous thyroiditis) is often triggered by a viral infection. Patients may present with painful thyroid enlargement, elevated inflammatory markers, and transient hyperthyroidism.
Hashimoto's and Graves' diseases are autoimmune in nature.
According to Braverman's The Thyroid:
"Subacute (De Quervain) thyroiditis typically follows a viral upper respiratory tract infection and is characterized by thyroid pain and transient thyrotoxicosis." Reference:
Braverman LE, Cooper DS. The Thyroid: A Fundamental and Clinical Text. 11th ed. Wolters Kluwer, 2021.
American Thyroid Association Guidelines, 2016.
NEW QUESTION # 98
Which artifact is seen within the gallbladder in this image?
- A. Attenuation
- B. Banding
- C. Shadowing
- D. Reverberation
Answer: D
Explanation:
The ultrasound image demonstrates multiple parallel echogenic lines within the gallbladder lumen, extending distally and diminishing in intensity. These equidistant lines are classic for a reverberation artifact.
Reverberation occurs when the ultrasound beam reflects multiple times between two strong reflectors (such as the anterior gallbladder wall and the transducer), creating repeating echoes that appear as equally spaced lines.
This is frequently seen in:
* The gallbladder (especially when collapsed or near the wall)
* Near air-filled structures
* With metallic objects or surgical clips
Reverberation does not represent a true anatomical structure and should be distinguished from real pathology.
Comparison of answer choices:
* A. Banding refers to speed displacement or slice-thickness artifacts and typically does not appear as repetitive lines.
* B. Shadowing is a dark band posterior to highly attenuating structures like gallstones or bone, not present here.
* C. Attenuation is a general term for the reduction in sound energy as it travels-posterior acoustic shadowing is one type.
* D. Reverberation - Correct. The characteristic bright, parallel lines within the gallbladder lumen confirm this artifact.
References:
Kremkau FW. Sonography Principles and Instruments, 9th ed. Elsevier; 2015.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
NEW QUESTION # 99
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