ARDMS Abdomen Review (Based off of URR Review Course) Questions And Answers 2024, Exams of Advanced Education

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ARDMS Abdomen Review (Based off of

URR Review Course) Questions And

Answers 2024

What does an increased RI mean - Correct Answer-increased resistance in vascular bed What does an increased pulsatility index mean - Correct Answer-increased resistance in vascular bed Normal PI for vessels supplying organs such as kidneys - Correct Answer-< 0. Hydrostatic pressure: when supine at ankle when standing above heart when standing - Correct Answer-0 mmHg 100 mmHg -30 mmHg What vessel is the most posterior abdominal vessel - Correct Answer-aorta

Paired branches of the aorta (5) - Correct Answer-suprarenal arteries (adrenal glands) renal arteries (kidneys) gonadal arteries (ovaries/testicles) lumbar arteries common iliac arteries Unpaired branches of the aorta (4) - Correct Answer-celiac axis (common hepatic, splenic, left gastric arteries) SMA IMA median sacral artery What level common iliac arteries bifurcate - Correct Answer- L3- Decreased hematocrit may indicate what - Correct Answer- bleed in body

What happens to the aorta as you follow it distally (2) - Correct Answer-gets smaller becomes more anterior Aortic Ectasia - Correct Answer-lack of tapering of aorta as you move distally (can be precursor to aneurysm) AAA What vessel walls are involved - Correct Answer-focal dilation of aorta >3cm or >50% diameter between two adjacent segments all three Most common cause of AAA - Correct Answer-atherosclerotic disease Risk factors for AAA (4) - Correct Answer-1. male

2. family history
3. smoking
4. chronic hypertension

Saccular aneurysm - Correct Answer-localized round out pouching, may have small stalk Fusiform aneurysm - Correct Answer-vessel wall stretched in circumferential manner (most common) Mycotic aneurysm - Correct Answer-infected aneurysm, seen with syphilis Most common location of fusiform aneurysms - Correct Answer-infrarenal At what diameter is surgical intervention done on an AAA - Correct Answer->5.5cm Complications of AAA (5) - Correct Answer-1. rupture

2. decreased blood to lower extremities
3. thrombus accumulation and embolization (blue toe syndrome)
4. affects renal circulation and systemic blood pressure (if suprarenal)
5. compress IVC

Yin Yang Sign - Correct Answer-sonographic sign with AAA swirling of blood in body of aneurysm on color doppler Splanchnic artery aneurysm most commonly occurs in What gender is this more common in - Correct Answer-splenic artery women Aneurysm in the hepatic artery most commonly occurs in what segment - Correct Answer-extra hepatic With endovascular aortic repair, what happens to the native aortic sac over time What plane should it be measured in - Correct Answer- decreased in size transverse If aortic sac expands more than _____ between exams, a leak should be suspected - Correct Answer-0.6 cm

Type I dissection Type II dissection Type III dissection - Correct Answer-ascending and descending aorta ascending aorta, associated with Marfan syndrome descending aorta Marfan syndrome - Correct Answer-genetic disorder affecting connective tissue of heart, vessels, bones Aortic rupture symptoms - Correct Answer-back pain hypotension Leriche syndrome (3) - Correct Answer-aortoiliac occlusive disease occlusion of abdominal aorta just above CIA bif causes bilateral lower extremity ischemia symptoms Retroperitoneal fibrosis other name, most common location - Correct Answer-Ormond disease most commonly at aortic bifurcation and inferiorly in pelvis

Retroperitoneal fibrosis sonographically (4) - Correct Answer- soft tissue mass surrounding great vessels hypoechoic smooth borders possible hydronephrosis (due to ureteral obstruction) Abnormal dilation of the abdominal segment of the IVC measures - Correct Answer-> 2.5 cm Normal Doppler flow of the IVC is - Correct Answer-triphasic Most common variation of IVC anatomy - Correct Answer- duplicated IVC infrarenal segment duplicated with left IVC entering left renal vein (suprarenal IVC normal) Transposed IVC - Correct Answer-IVC on left side of abdomen (instead of right) Interrupted IVC (3) - Correct Answer-IVC doesn't go to right atrium

enters azygos/hemiazygos veins to reach SVC no intrahepatic segment Causes of IVC dilation (5) - Correct Answer-1. right heart failure (most common)

2. congestive heart failure
3. pulmonary hypertension
4. mass effect
5. pregnancy Greenfield Filter (3) - Correct Answer-prevents emboli from reaching lungs infrarenal echogenic "umbrella" Most common malignancy to invade renal vein and IVC - Correct Answer-RCC (renal cell carcinoma) Liver is encapsulated by _____ capsule - Correct Answer- glisson

Portal triad includes - Correct Answer-portal vein hepatic artery bile duct In pediatric patients, the liver shouldn't extend more than _____ below the costal margin - Correct Answer-1cm below The right hepatic vein (in right intersegmental fissure) divides the right lobe of the liver into what segments The left hepatic vein (in left intersegmental fissure) divides the left lobe of the liver into what segments - Correct Answer- anterior and posterior segments medial and lateral segments Triangular ligament attaches the superior liver - Correct Answer-to the diaphragm Falciform ligemant attaches the anterior surface of the liver - Correct Answer-to the abdominal wall Ligamentum teres is what

What is it also called - Correct Answer-remnant of umbilical vein round ligament Ligamentum venosum is - Correct Answer-remnant of ductus venosum from fetal circulation (umbilical vein-left portal vein-ductus venosus-IVC-right atrium) Hepatoduodenal ligament contains (3) - Correct Answer-MPV hepatic artery CBD Branches of MPV - Correct Answer-RPPV RAPV LMPV LLPV MPV carries _____% of all blood entering liver, hepatic artery carries _____% - Correct Answer- 20

Normal portal vein diameter - Correct Answer-<13mm What is the most common variation in hepatic vein anatomy - Correct Answer-accessory right hepatic vein Caroli disease - Correct Answer-congenital defect of bile ducts, numerous cysts in biliary tree Caroli disease sonographically (3) - Correct Answer-1. focal cystic areas

2. connecting to biliary tree
3. resembles polycystic disease Cyst criteria (5) - Correct Answer-1. smooth borders
4. regular walls
5. no internal echoes
6. through transmission
7. posterior enhancement

Hemorrhagic cyst sonographically (5) - Correct Answer-1. septations with fluid levels

2. smooth borders
3. regular walls
4. through transmission
5. posterior enhancement Polycystic Liver disease What age does it present - Correct Answer-autosomal dominant presents 30-40 years Polycystic liver disease sonographically (4) - Correct Answer-1. focal cystic areas
6. varying sizes
7. thin septations
8. may have cysts in pancreas, kidneys, spleen Biliary Hamartomas (Von Meyenburg Complexes) - Correct Answer-dilated intrahepatic ducts with dense stroma

Biliary Hamartomas (Von Meyenburg Complexes) sonographically (3) - Correct Answer-1. small echogenic nodules

2. heterogeneous liver
3. <1cm Causes of fatty infiltration of liver (5) - Correct Answer- diabetes alcohol abuse obesity starvation cystic fibrosis Diffuse fatty infiltration sonographically (5) - Correct Answer- mild: slight increase in fine echoes, normal visualization of diaphragm and vessel borders moderate: moderate increase in fine echoes, impaired visualization of diaphragm and vessel borders severe: marked increase in fine echoes, poor or non- visualization of diaphragm and vessel borders hepatomegaly possible narrowing of hepatic veins

Focal fatty infiltration sonographically (5) - Correct Answer- focal increased echogenicity possible irregular borders usually adjacent to portal structures similar to hemangioma no displacement of surrounding structures Focal fatty sparing sonographically (5) - Correct Answer-focal decreased echogenicity (remaining liver tissue increased echogenicity) possible irregular borders usually adjacent to gallbladder fossa similar to malignancy no displacement of surrounding structures Amyloid disease (2) - Correct Answer-deposit of amyloid protein in vessel walls of various organs commonly involving liver

Glycogen storage disease, most common type - Correct Answer-autosomal recessive von Gierke disease Glycogen storage disease with excessive storage of glycogen sonographically (2) - Correct Answer-hepatomegaly increased echogenicity Glycogen storage disease with reduced storage of glycogen sonographically (3) - Correct Answer-hypo echoic parenchyma prominent portal walls "starry sky" (similar to hepatitis) What is hemochromatosis What is it inherited from Sonographic appearance - Correct Answer-abnormal iron deposition inherited or due to anemia sonographically includes features of fibrosis and cirrhosis

Wilson disease (2) - Correct Answer-autosomal recessive disease excessive deposition of copper in liver Wilson disease symptoms (5) - Correct Answer-jaundice hematemesis portal hypertension ascites rusty/brown-colored ring around iris of eye (Kayser-Fleischer rings) Wilson disease sonographically (3) - Correct Answer-echogenic fatty liver fibrotic periportal thickening nodular cirrhotic changes Cirrhosis symptoms (5) - Correct Answer-increased abdominal girth (ascites) jaundice liver atrophy splenomegaly

weight loss Causes of cirrhosis (9) - Correct Answer-hep C alcohol abuse chronic liver disease biliary obstruction hep B glycogen storage disease hemochromatosis wilson disease Budd Chiari syndrome Cirrhosis sonographically (6) - Correct Answer-nodular surface hepatomegaly or right lobe atrophy with compensatory hypertrophy of left lobe portal hypertension splenomegaly thickened gallbladder wall ascites

Symptoms of hepatitis (6) - Correct Answer-jaundice hepatomegaly nausea fever/chills malaise dark urine Acute hepatitis sonographically (4) - Correct Answer-"starry sky" appearance (normal liver texture or portal vein borders may be more prominent) increased echogenicity hepatosplenomegaly gallbladder wall thickening Chronic hepatitis sonographically (4) - Correct Answer-coarse echo texture decreased brightness of portal triads normal size increased liver echogenicity (due to fibrosis)

Echinococcal cysts sonographically (3) - Correct Answer-large cyst with "daughter cysts" within honeycomb appearance, water lily sign most commonly found in right lobe What is schistosomiasis - Correct Answer-parasitic infection (most common in humans) Schistosomiasis sonographically (4) - Correct Answer-thick, echogenic portal vein walls debris/occlusion in intrahepatic portal venous system decreased liver size portal hypertension Pneumocystis jirovecci (pneumocystis carinii) cause and what patients is it most common in - Correct Answer-yeast-like fungus AIDS patients Pneumocystis jirovecci (pneumocystis carinii) sonographically (1) - Correct Answer-multiple non-shadowing echogenic foci

Granulomatous infections sonographically (1) - Correct Answer-multiple echogenic foci (granulomas) in spleen and liver Three types of hepatic abscess - Correct Answer-pyogenic amoebic fungal Hepatic abscess symptoms (6) - Correct Answer-fever nausea diarrhea RUQ pain hepatomegaly leukocytosis Pyogenic hepatic abscess sonographically (2) - Correct Answer- solitary or multiple complex lesions fluid collections in: morison's pouch, subdiaphragmatic, subphrenic space

Amebic hepatic abscess sonographically (3) - Correct Answer- complex lesion typically in right lobe history of travel Most common benign lesion of the liver What gender is it more common in What lobe is it usually found in Usual symptoms What can cause it to enlarge - Correct Answer-hemangioma women right asymptomatic pregnancy, estrogen therapy Hepatic hemangioma sonographically (3) - Correct Answer- homogenous hyper echoic well-defined Most common benign vascular tumor in infancy

Most common symptom When does it spontaneously regress by - Correct Answer- infantile hemangioendothelioma cardiac failure age 2 Second most common benign liver mass What gender and age group is it more common in Most common symptom - Correct Answer-focal nodular hyperplasia women of child bearing years asymptomatic Focal nodular hyperplasia sonographically (2) - Correct Answer-well-defined lesion hyper echoic to isoechoic What gender is liver cell adenoma more common in What medication is it associated with What disease is it commonly associated with - Correct Answer-women

oral contraceptives glycogen storage disease Liver cell adenoma sonographically (3) - Correct Answer-well- defined lesion central hyper echoic area surrounded by halo What is the most common primary malignancy of the liver What is the most common risk factor What gender is it more common in - Correct Answer- hepatocellular carcinoma cirrhosis males Hepatocellular carcinoma symptoms (5) - Correct Answer- fever hepatomegaly palpable mass ascites weight loss

Hepatocellular carcinoma sonographically (4) - Correct Answer-solitary massive tumor multiple nodules throughout liver diffuse infiltrative masses variable Most common pediatric primary liver malignancy What age does it occur before What lab value is associated with it - Correct Answer- hepatoblastoma age 2 elevated alpha-fetoprotein Hepatoblastoma is associated with (2) - Correct Answer- Beckwith-wiedemann syndrome familial adenomatous polyposis Hepatoblastoma symptoms (3) - Correct Answer-abdominal enlargement hepatomegaly

palpable mass Hepatoblastoma sonographically (4) - Correct Answer-solid echogenic mass may have cystic portions/septations may contain calcification may invade hepatic and portal veins Most common primary sites of liver mets (4) - Correct Answer- gallbladder (1) colon stomach pancreas Liver mets sonographically (3) - Correct Answer-multi-locular well-defined hypoechoic What is kaposi sarcoma, most common liver malignancy seen with - Correct Answer-malignancy of connective tissue HIV/AIDS