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What is the ultrasound appearance of retained products of conception?
Echogenic mass within uterine cavity
Blood flow from the myometrium
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What is the definition of varicocele?
Tubular veins that are greater than 2-3 mm
Increase with Valsalva
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What type of thyroid tumor is associated with microcalcifications?
Papillary carcinoma
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What are spermatoceles?
Cystic lesions closely associated with epididymis
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Where does the fluid in the hydrocele reside?
Fluid goes around the tunica vaginalis
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What is the most common neural tube defect?
Anencephaly - absence of brain above orbits
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What are classic findings of chronic pancreatitis?
Pancreatic duct dilatation
Coarse calcifications
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What is the most common post partum cause of fever?
Endometritis
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How does the clinical presentation in patients with retained products of conception differ from patients with endometritis?
Retained products of conception > heavy bleeding
Endometritis > fever and purulent discharge
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What is the most common cancer to metastasize to the gallbladder?
Melanoma
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What are imaging findings of a malignant thyroid nodule?
Taller than wide shape
Microcalcifications
Capsular invasion
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What is the urachus?
Connection between bladder and umbilicus
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What is the blood supply to the ovary?
Ovarian artery
Uterine artery
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What are ultrasound findings of ovarian torsion?
Enlarged ovary
Peripheral cysts (due to central edema)
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What is the best measure of gestational age in a FIRST trimester pregnancy?
Crown rump length
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How does the venous drainage of the caudate lobe of the liver differ from the rest of the liver?
Caudate lobe drains directly into the IVC
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What is a potential hematologic complication of rapidly growing hemangiomas?
Large hemangioma sequestering and destroying platelets
(Kasabach-Merritt syndrome)
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What is the most common ovarian neoplasm in women of reproductive age?
Teratoma
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What is the most common ovarian mass (not neoplasm) seen in pregnancy?
Corpus luteum cyst
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What is Mirizzi syndrome?
Obstruction of the common hepatic duct by an impacted cystic duct stone
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What is the most important parameter to assess renal artery stenosis on ultrasound?
Peak systolic velocity of main renal artery
>200 considered elevated
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What is the most common cause of an enlarged UNILATERAL kidney?
Acute renal vein thrombosis
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What is the most sensitive and specific finding of ectopic pregnancy on ultrasound?
Nonovarian complex adnexal mass
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What are hepatobiliary signs of congestive heart failure?
Gallbladder wall thickening
Pulsatile portal flow
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What vessels are normally present in the umbilical cord?
2 arteries
1 vein
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What is the pathophysiology of lymphoproliferative disorder?
Antigenic stimulation of lymphoid tissue leading to lymphoproliferative response
In patients with autoimmune or immunosuppressed conditions
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What is the definition of placenta accreta?
Abnormal proliferation of placental tissue beyond endometrial lining of uterus
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What is the definition of placenta previa?
Placenta implants in lower uterine segment
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What are characteristic findings of polycystic ovarian syndrome on ultrasound?
Increased central stroma (echogenic)
Peripheral follicles
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What is vasa previa?
Fetal vessels near cervical os
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What is a succenturiate lobe?
Accessory placental lobe
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What are virtually diagnostic findings to rule out endometrial cancer in post menopausal women with bleeding?
Endometrial stripe less than 4 mm virtually excludes endometrial cancer
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What happens to flow in the renal artery when the renal vein is thrombosed?
Outflow (renal vein) is blocked so flow becomes reversed during diastole
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What are signs of portal venous gas on ultrasound?
Small echogenic foci in portal vein
Bi-directional spike like waveform
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What are the most common risk factors for hepatic adenoma?
Oral contraceptives
Glycogen storage disease
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What types of cells in the ovary account for most ovarian neoplasms?
Epithelial cells (~80%)
Germ cells (~20%)
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What are the major types of ovarian epithelial cell neoplasms?
Serous
Mucinous
Endometroid
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What is the natural history of a hemorrhagic cyst?
Regresses within 14-16 weeks typically spontaneously
Hormone therapy can cause regression by 6 weeks
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What syndrome includes benign ovarian tumors combined with excess pleural and peritoneal cavity?
- Meigs syndrome
- 1)Benign tumor (fibroma)
- 2) Pleural effusion
- 3) Ascites
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Homogeneous, low level echoes
Endometrioma
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What genetic abnormality is associated with: choroid plexus cysts, clenched hands, club feet, hyperechogenic kidneys and brachycephaly (strawberry shaped head/early fusion of coronal suture)?
Trisomy 18
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What is the most common cause of fetal abdominal cysts in a female?
Ovarian cysts
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What is the most common benign liver neoplasm?
Hemangioma
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How large can a dominant follicle grow at ovulation?
3 cm
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What is the size of cyst at which mural nodules can be obscured?
7 cm
(Hence above 7 cm, cysts need MR for further evaluation)
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What are imaging findings of hydrosalpinx?
Dilated adnexal tubular structure separate from and leading to ovary
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What are features of an indeterminate ovarian cyst?
Multiple thin septations
Solid nodule without detectable flow
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What is the appropriate workup for an indeterminate ovarian cyst?
Follow up US in 6-12 weeks
Lesion resolves > hemorrhagic cyst
Unchanged > surgical evaluation if lesion is not endometrioma or dermoid
-
Pelvic inflammatory disease
Fluid distended fallopian tube
Hyperemia
-
Hemorrhagic cyst
Fishnet/lacelike pattern - comes from retraction/hemolysis of clot
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What is the most common cause of delayed graft function in a transplant kidney?
Acute tubular necrosis
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What are features that can help to distinguish follicular adenoma versus an adenomatoid nodule?
- Follicular adenoma -
- Hypoechoic halo
- Well defined
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What are the most common types of thyroid cancer?
Papillary (75%)
Follicular (10%)
Medullary (5%)
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What is the difference between the spread of papillary versus follicular thyroid carcinoma?
Papillary spreads via lymph nodes
Follicular has a hematogenous spread
-
Homogeneous echotexture replaced by heterogeneous echotexture
Fibrous strands
Hashimoto's thyroiditis
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What clinical history may be helpful in evaluating an ill defined hypoechoic lesion in the thyroid?
Preceding viral infection
Is the thyroid painful?
-
What are the most common salivary gland neoplasms?
Pleomorphic adenomas
Warthin's tumors
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What are the most common sites for an ectopic parathyroid adenoma?
Behind trachea, medial to carotid
-
What syndrome is medullary thyroid cancer associated with?
20% seen in patients with MEN-IIa and IIb
-
What are signs of TIPS malfunction in the main portal vein and in the shunt?
Main portal vein velocity < 35 cm/sec
Shunt velocity < 90 cm/sec
-
Where do most TIPS occlusions occur?
Hepatic venous side
-
At what Beta-HCG level should you see a gestational sac?
2000
-
At a Beta-HCG level of 10,000 what structure should you see?
Embryo
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If you have a beta HCG level greater than 100,000, what should you suspect?
Molar pregnancy
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What are the top three causes of polyhydramnios?
Idiopathic
Diabetes
Fetal anomalies - structural anomalies that inhibit swallowing or intestinal absorption
-
What are the effects of tamoxifen on the breast versus the uterus?
Breast - acts as antagonist
Uterus - acts as agonist
-
What is the demarcation point for central versus lateral neck?
Carotid artery
-
-
What is the differential for large, hyperechoic kidneys (bilateral) found on obstetric ultrasound and how can one differentiate these causes?
- Autosomal recessive polycystic kidney disease
- Trisomy 13 (multiple additional anomalies)
- Meckel-Gruber syndrome (polydactyly, encephalocele)
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What are doppler findings of fetal anemia?
Elevated peak systolic velocity of the middle cerebral artery
-
How can one distinguish serous cystadenoma of the pancreas from mucinous cystadenoma?
Serous - microcysts, pancreatic head
Mucinous - larger cysts, pancreatic tail
-
What is the ultrasound appearance of acute hepatitis?
Hepatomegaly
Diffusely decreased echogenicity > more prominent portal triads
-
What are characteristic velocities suggestive of carotid artery stenosis on duplex ultrasound?
125 cm/sec - suggests greater than 50% stenosis
230 cm/sec - suggests greater than 70% stenosis.
-
What is the definition of resistive index?
(Peak systolic velocity - Diastolic velocity)/ (Peak systolic velocity)
-
What can elevated resistive indices signify in a transplant kidney?
Rejection
Acute tubular necrosis
-
Mass with lamellated wall in testicle - Epidermoid cyst
-
What are the findings of hepatic arterial thrombosis after transplant?
Biliary leaks/complications (hepatic artery is only blood supply for biliary system after transplant)
Parvus tardus waveform
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What genetic syndrome is associated with holoprosencephaly (~50%), cleft lip/palate, echogenic intracardiac focus, polydactyly, rocker bottom feet?
Trisomy 13
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What genetic syndrome is associated with echogenic intracardiac focus, nuchal thickening, echogenic bowel, cardiac defects and the double bubble sign?
Trisomy 21
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