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NEW QUESTION # 55
Which abnormality is depicted in this image of a patient who presents with a fever following a liver biopsy?
Answer: C
Explanation:
The sonographic image shows a complex fluid collection within the liver parenchyma, with internal echoes and possibly septations, consistent with an abscess. In the clinical context of post-procedural fever following a liver biopsy, a liver abscess is the most likely diagnosis.
A liver abscess appears on ultrasound as a hypoechoic or complex fluid collection that may contain internal debris, septations, or gas (which may produce reverberation artifacts). These features distinguish it from other post-procedural complications.
* A cyst (Option A) typically appears as an anechoic, well-defined lesion with posterior acoustic enhancement and no internal debris-this does not match the image or clinical setting.
* A biloma (Option B) is a bile collection that can appear similar to a cyst or fluid collection but typically occurs due to bile leak; however, fever and internal complexity on ultrasound more strongly suggest abscess.
* A hematoma (Option D) may also appear complex but usually presents with pain and not fever unless secondarily infected. Over time, hematomas evolve in appearance but lack septations and gas unless superinfected.
Reference:
Rumack, Carol M., et al. Diagnostic Ultrasound.5th ed., Elsevier, 2018. Chapter: Hepatobiliary System, pp.
107-111.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.
NEW QUESTION # 56
Which diagnosis is most consistent with this image from a patient with acute scrotal pain?
Answer: A
Explanation:
The grayscale ultrasound image demonstrates a uniformly enlarged, hypoechoic (dark), and heterogeneous testis without signs of surrounding scrotal wall thickening or a discrete fluid collection. This pattern is highly suggestive of testicular torsion in the setting of acute scrotal pain.
Sonographic features of testicular torsion on grayscale imaging:
* Enlarged testis
* Diffusely hypoechoic parenchyma
* Loss of normal homogeneity
* Absence of internal vascular flow on Doppler imaging (not shown here but critical in confirming diagnosis) Testicular torsion occurs due to twisting of the spermatic cord, leading to vascular compromise and eventual infarction if not promptly corrected. It is a surgical emergency and typically presents in adolescent males with sudden-onset, severe unilateral testicular pain.
Comparison of answer choices:
* A. Scrotal abscess appears as a complex fluid collection with irregular margins and posterior enhancement.
* B. Testicular rupture would show discontinuity of the tunica albuginea, heterogeneous texture, and often a hematocele.
* C. Testicular torsion - Correct. The enlarged, hypoechoic, heterogeneous testis is characteristic, particularly in the acute phase.
* D. Epididymitis typically shows an enlarged, hypervascular epididymis and may extend to the testis (epididymo-orchitis), but vascularity is usually increased rather than absent.
References:
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Scrotal Ultrasound Examination (2021).
NEW QUESTION # 57
Which pancreatic condition is commonly associated with complete or partial atresia of the duodenum?
Answer: A
Explanation:
Annular pancreas is a congenital anomaly in which pancreatic tissue encircles the second part of the duodenum, potentially causing partial or complete duodenal obstruction (atresia). It is due to abnormal migration of the ventral pancreatic bud.
According to Rumack's Diagnostic Ultrasound:
"Annular pancreas results from failure of the ventral pancreatic bud to rotate properly, leading to encirclement of the duodenum." 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 # 58
Which description is associated with the normal sonographic appearance of a tendon?
Answer: D
Explanation:
On ultrasound, tendons appear as cord-like hyperechoic structures with linear fibrillar echotexture when imaged in long axis. The fibrils are highly reflective, creating the typical hyperechoic appearance. Posterior shadowing is not typical unless there is calcification.
According to Rumack's Diagnostic Ultrasound:
"Tendons have a highly organized hyperechoic linear fibrillar pattern when examined along their long axis." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Musculoskeletal Ultrasound, 2020.
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NEW QUESTION # 59
Which syndrome is characterized by right upper quadrant pain, ascites, and hepatocellular dysfunction?
Answer: C
Explanation:
Budd-Chiari syndrome is caused by hepatic venous outflow obstruction, resulting in hepatomegaly, ascites, right upper quadrant pain, and liver dysfunction. It may be due to thrombosis or compression of the hepatic veins or IVC.
According to Rumack's Diagnostic Ultrasound:
"Budd-Chiari syndrome results from hepatic venous outflow obstruction and presents with hepatomegaly, ascites, and right upper quadrant pain." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Liver Ultrasound, 2020.
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NEW QUESTION # 60
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