(Test Bank) Ultrasound Abdomen And Obstetrics Gynecology

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Test Bank for Ultrasound Abdomen And Obstetrics Gynecology, The downloadable file consists of 418 pages, and the total size of the file is 11.7 MB. Purchase now only for highly discounted price.

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EXAMINATION REVIEW FOR ULTRASOUND ABDOMEN & OBSTETRICS AND GYNECOLOGY Steven M. Penny, B.S., RT(R), RDMS Johnston Community College Smithfield, North Carolina Acquisitions Editor: Peter Sabatini Product Director: Eric Branger Managing Editor: Karen Ruppert Marketing Manager: Allison Noplock Compositor: MPS Limited, A Macmillan Company Printed in China Copyright © 2011 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, Maryland 21201 -2436 USA 227 East Washington Square Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care, which should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages and precautions. Library of Congress Cataloging -in-Publication Data Penny, Steven M. Examination review for ultrasound: abdomen & obstetrics and gynecology / Steven M. Penny. p. ; cm. Includes bibliographical references and index. ISBN 978 -0-7817 -7978 -4 (alk. paper) 1. Abdomen —Ultrasonic imaging —Examinations, questions, etc. 2. Ultrasonics in obstetrics —Examinations, questions, etc. 3. Generative organs, Female —Ultrasonic imaging —Examinations, questions, etc. I. Title. [DNLM: 1. Abdomen —ultrasonography —Examination Questions. 2. Pelvis —ultrasonography —Examination Questions. 3. Ultrasonography, Prenatal —methods —Examination Questions. WI 18.2 P426e 2011] RC944.P46 2011 618.2'07543076 — dc22 2009047208 The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638 -3030 or fax orders to (301) 824 -7390 . International customers should call (301) 714 -2324 . D E D I C A T I O N To Lisa, Devin, and Reagan: Lisa, This book would not be possible without your faith in my abilities as a writer and the sacrifices that you have made for me over the past few years. Thank you for all of the things you do for me and our kids. You are the perfect wife, mother, role model, and friend. I simply don’t deserve you, but I thank God every day that you are mine. I love you. Devin, You are the smartest little boy. I am so proud of you. Thank you for letting Daddy work on his book when you wanted to play sometimes. I know that you have sacrificed as well. I pray that you continually seek the will of God in your life. I love you. Reagan, You are a little miracle and the prettiest, sweetest, and most cooperative little Penny ever. You have been such a blessing to all of us. When you were born, you stole my heart. I pray you keep it safe and close to yours. I love you. iii OBJECTIVE ORGANIZATION P R E F A C E Recognizing the educator within the sonography profes - sion is straightforward; we are all educators. Whether our interaction with students is in the classroom or clinical setting, we have all actively been involved with educating individuals who may someday perform a sonographic examination on us. Therefore, as well - trained healthcare professionals, we must appreciate the significance of obtaining and maintaining national certification. Our responsibility in advancing the diagnostic signifi - cance of sonography is obvious, but more importantly, we must be capable of providing consistent high -quality patient care. Standardized testing through credential granting organizations such as the American Registry for Diagnostic Medical Sonography and American Reg - istry of Radiologic Technologist affords our profession a means of necessitating competency, a c ompetency that all patients not only expect but deserve. Accordingly, the objective of Examination Review for Ultrasound: Abdomen & Obstetrics and Gynecology is to provide a comprehensive review in sonography of the abdomen, nongravid female pelvis, and obstetric patient, and the foundation for its content is based on the examinations offered by the above -mentioned organizations. The challenge of constructing a universally functional certification review book lies not only in the presenting of vital information in a comprehensible and yet basic format, but also in providing the user with a tool for knowledge assessment as he or she prepares for the examinations. Each chapter of this bo ok offers opportu - nity for individual evaluation. A list of key terms is provided at the beginning of each chapter, which should allow for a rapid assess - ment of one’s familiarity with the associated material. In the back of the book the student will find a glossary of all the key terms mentioned throughout the book for easy reference. The combination of basic tables, easy - to-read narrative, and high -quality images offers the reader the opportunity to evaluate notable, uncompli - cated details of each topic discussed. Basic review questions are provided at the end of each chapter to help the reader determine if additional studying is needed before progressing further. An answer key for all the review questions is provided in the back of the book. In general, the book is divided into three sections: Section 1, Abdominal Sonography Review; Section 2, Gynecologic Sonography Review; and Section 3, Obstet - ric Sonography Review. The overall configuration of each section and enclosed chapters are unlike compet - ing texts in several ways. In the abdominal section, the initial information of each chapter focuses on normal anatomic and sono - graphic anatomy. Only the most imperative anatomic facts of each structu re are offered, with the intention of not overwhelming the reviewer with an immense amount of information. Next, abdominal pathology is presented in a logical manner, again providing only the most crucial information. After the narrative summary, a concise synopsis of clinical findings and sonographic findings is listed. Furthermore, the reader will find that the abdominal section contains broader chapters on major abdominal organs, such as the liver and kidneys, while supplementary, smaller, and y et thorough chap - ters on the bile ducts (Chapter 4) and the adrenal glands (Chapter 8) are also included. Section 2, the gynecologic section, contains a de- tailed review of the female pelvis and pathology that can be either revealed or further evaluated with the use of sonography. The format is much like the abdominal sec - tion, with both clinical and sonographic findings offered. Unique chapters to this text include an entire chapter (Chapter 19) dedicated to und erstanding the menstrual cycle, an essential element of physiology that must be appreciated in order to do well on the examinations, and chapters solely dedicated to under - standing the significance of postmenopausal sonography (Chapter 20) and female infertility (Chapter 21). iv ADDITIONAL RESOURCES P R E F AC E v Throughout the pages of the obstetric section, Section 3, the reader will find accommodating narrative as well. The focus of the obstetric section is placed more on the visual sonographic findings of fetal abnor - malities. Since the clinical manifestations of many fetal disorders are not always obvious, vital sonographic images and diagrams are offered. Distinctive topics can be found within the obstetric chapters as well. For ex - ample, in Chapter 24, the significance of understanding and recognizing neural tube defects and the brain is discussed. Also, under “Fetal Spine Abnormalities” in Chapter 26, a description of the rela tionship between spina bifida, alpha -fetoprotein, and folic acid supplements can be found. The registry review does not end with the conclusion of this book. Because computer -based testing has be- come the principal device for administering certification examinations, we have supplied the student with an op- portunity to take a computer -based mock exam: registry review examinations in all three subjects are provided online to those who purchase this book. By accessing at thepoint.lww.com/Penny_AbObGyn1e, the reader will have the opportunity to take computer -based examinations with more intense “registry -like” questions. Other instructor and student resources and review materials also can be found online: the faculty resource center includes an image bank, chapter outlines, Power - Point presentations, and the mock exams. The student resource center includes the mock exams and an image bank. The material contained is deliberately not exhaustive so that the review isn’t hindered by an overwhelming amount of statistics and superfluous information. Therefore, there are several uses for this book that are inhere nt in its arrangement. It is certainly suitable for implementation in the classroom environment. Instruc - tors offering registry review classes would significantly benefit by adopting this text. The structure will provide the educator with the opportunity to assign a review of one topic at a time, while affording the recognition and correction of subject matter weaknesses. It should also be helpful to individuals who have completed a formal educational program and who need a realistic gauge of material mastery before attempting the examinations. Lastly, in the clinical setting, this text could be em- ployed as a tool for sonographers, whose complicated daily tasks include correlating clinical presentations with sonographic findings quickly. The expectation of this book is for it to assist those of you who plan on attempting these difficult examina - tions that often are used to define our proficiency as sonographers. Whether you use its information to re - fresh or reinforce your understanding of this material, may the knowledge that you acquire from its pages not only be maintained through the examination period but may it also be exploited in your daily practice as a regis - tered sonographer. Steven M. Penny FINAL NOTE R E V I E W E R S RENATO AGUSTIN, MD Program Director Diagnostic Medical Sonography Department Sanford -Brown Institute Middleburg Heights, OH SHARLET TE ANDERSON, BS, RDMS, RVT, RDCS Program Director Sonography Department American Institute of Medical Technology Tulsa, OK PATTY BRAGA, BSRT, RDMS, RVT, RDC Program Director Sonography Department Palm Beach Community College Palm Beach Gardens, FL MARCIA COOPER Associate Professor Imaging Science Department Morehead State University Morehead, KY MICHELLE M. GAGNON, RDCS, RVT Associate Professor/Program Director Medical Imaging Program Bunker Hill Community College Boston, MA DWIGHT GUNTER, BS, RDMS Program Chair Ultrasound Department Sanford -Brown Institute Atlanta, GA JOANN LAMB, RDMS, RVT, RT DMS Cuyahoga Community College Parma, OH JOANN MCGIVERN, RDMS, RVT Program Director Diagnostic Medical Sonography Sonography Department Carl Sandburg College Galesburg, IL NANDKUMAR RAWOOL, MD, RDMS Associate Professor, Program Director Radiologic Sciences Department Thomas Jefferson University Philadelphia, PA CATHERINE E. RIENZO, MS, RT(R), RDMS Assistant Professor, Program Director Sonography Department Northampton Community College Bethlehem, PA CHERYL ZELINSKY, MM, RT(R), CRT (R,F), RDMS Associate Professor & Diagnostic Medical Sonography Program Director Medical Imaging Department Oregon Institute of Technology Klamath Falls, OR vi A C K N O W L E D G M E N T S This book would not have been possible without the contributions, guidance, or encouragement from the following people: • My loving father and mother, Ted and Linda Penny • My extraordinarily wise brother Jeffrey Penny and his family (Tammy, Nicholas, and Mackenzie) • Don, Teresa, and Laura Katherine Smith • My director, adviser, and friend Cathy Godwin • My great editorial team at LWW —Peter Sabatini, Eric Branger, and Karen Ruppert • All of my students (both past and present) • All of my coworkers at Johnston Community College in Smithfield, North Carolina • Linda Smith, Chair of Health Sciences at Johnston Community College • Diagnostic Medical Sonographers: • Amanda Capps • Ashley Williams • Ashley Woodard • Brandy Holzshu • Catherine Rominski • Julie Malone • Latrell Davis • Lindee Todd • Sabreina Johnson vii viii C O N T E N T S Dedication iii Preface iv Reviewers vi Acknowledgments vii Contents viii SECTION 1 Abdominal Sonography Review 01 CHAPTER 1 Abdominal Sonography Overview 01 CHAPTER 2 The Liver 09 CHAPTER 3 The Gallbladder 28 CHAPTER 4 The Bile Ducts 38 CHAPTER 5 The Pancreas 46 CHAPTER 6 The Spleen 56 CHAPTER 7 The Urinary Tract 63 CHAPTER 8 The Adrenal Glands 90 CHAPTER 9 Abdominal Vasculature 97 CHAPTER 10 The Gastrointestinal Tract 109 CHAPTER 11 Noncardiac Chest and Retroperitoneum 119 CHAPTER 12 The Neck 124 CHAPTER 13 The Male Pelvis 132 CHAPTER 14 Musculoskeletal Imaging and Superficial Structure 147 SECTION 2 Gynecologic Sonography Review 153 CHAPTER 15 Gynecologic Sonography Overview 153 CHAPTER 16 Anatomy of the Female Pelvis 162 CHAPTER 17 The Uterus and Vagina 170 CHAPTER 18 The Ovaries and Fallopian Tubes 183 CHAPTER 19 The Menstrual Cycle 200 CHAPTER 20 Postmenopausal Sonography and Sonohysterography 208 CHAPTER 21 Pelvic Inflammatory Disease and Infertility 216 viii C O N T E N T S ix SECTION 3 Obstetric Sonography Review 228 CHAPTER 22 Obstetric Sonography Overview 228 CHAPTER 23 The First Trimester 237 CHAPTER 24 The Fetal Head and Brain 254 CHAPTER 25 The Fetal Face and Neck 272 CHAPTER 26 The Fetal Spine and Musculoskeletal System 279 CHAPTER 27 The Fetal Heart and Chest 293 CHAPTER 28 The Fetal Gastrointestinal System 305 CHAPTER 29 The Fetal Genitourinary System 312 CHAPTER 30 Chromosomal Abnormalities 325 CHAPTER 31 Multiple Gestations 338 CHAPTER 32 Fetal Environment and Maternal Complications 349 Answer Key 365 Index 370 Glossary: a full glossary of all key terms can be downloaded from thepoint/lww.com/Penny_AbObGyn1e 1 S E C T I O N 1 | Abdominal Sonography Review C H A P T E R Abdominal Sonography Overview INTRODUCTION A synopsis of abdominal sonography practice is provided in this chapter. A brief summary of the importance of obtaining and recognizing important clinical findings, relevant laboratory results, frequently identified artifacts, and common abdominal masses should provide the analytical groundwork for a thorough preparation for the abdome n registry provided by the American Registry for Diagnostic Medical Sonography and the abdominal portion of the registry offered by the American Registry of Radiologic Technologist. The outlines for each examination can be found at www.ardms.org and www.arrt.org, respectively. The most current outlines are not provided in this chapter, as they are modified periodically. KEY TERMS ascites –a collection of abdominal fluid within the peri- toneal cavity chromaffin cells–the cells in the adrenal medulla that se- crete epinephrine and norepinephrine endoscopy –a means of looking inside of the human body by utilizing an endoscope exudate ascites –a collection of abdominal fluid within the peritoneal cavity may be associated with cancer hematocrit –the laboratory value that indicates the amount of red blood cells in blood leukocytosis –an elevated white blood cell count nuclear medicine –a diagnostic imaging modality that utilizes the administration of radionuclides into the human body for an analysis of the function of organs, or for the treatment of various abnormalities oncocytes –large cells of glandular origin paracen tesis– a procedure that uses a needle to drain fluid from the abdominal cavity for diagnostic or therapeutic reasons parietal peritoneum –the portion of the peritoneum that lines the abdominal and pelvic cavity radiography –a diagnostic imaging modality that uses ionizing radiation for imaging bones, organs, and some soft tissue structures thoracentesis –a procedure that uses a needle to drain fluid from the pleural cavity for either diagnostic or therapeutic reasons transudate ascites –a collection of abdominal fluid within the peritoneal cavity often associated with cirrhosis visceral peritoneum –the portion of the peritoneum that is closely applied to each organ 1 2 S E C T I O N 1 A B D O M I N A L S O N O G R A P H Y R E V I E W | GATHERING A CLINICAL HISTORY LABORATORY FINDINGS RELEVANT TO ABDOMINAL SONOGRAPHY Abdominal sonograms may be requested for various reasons. The American Institute of Ultrasound in Medicine (AIUM) publishes the practice guidelines for an abdominal sonogram on their website at www.aium .org (Table 1-1). Patients, who are having an abdominal sonogram, and par- ticularly those with intact gallbladders, need to fast for at least 4 hours, although a period of 8 hours is optimal. This preparation can also eliminate the presence of bowel gas that can inhibit the likelihood of obtaining a detailed diag - nostic sonographic study. Most often, renal sonograms re- quire no preparation, although some facilities recommend that the patient be well hydrated. This is true especially if the urinary bladder needs to be assessed for intraluminal masses. Diabetic patients need to be scheduled early in the morning to prevent hypoglycemic incidents. Also, ab- dominal sonography should be performed before radio - graphic testing that utilizes barium contrast agents. Patient preparation for invasive procedures varies among clinical facilities. However, informed consent from the patient and laboratory findings are universally obtained. Sterile field preparation is performed prior t o the procedure as well. Some invasive procedures that are commonly performed in the sonography department include thoracentesis , paracentesis , organ biopsies, mass biopsies, and abscess drainages. Biopsies can be performed using a freehand technique or under ultra - sound guidance using a needle guide that attaches to the transducer. A review of prior examinations should be performed by the sonographer before any contact with the patient. This review includes reports from previous sonograms, CT scans, MRI studies, nuclear medicine examinations, radiography procedures, endoscopy examinations, and any additional related diagnostic reports available. Moreover, sonographers must be capable of analyzing the clinical history and complaints of their patients. This practice will not only aid in clinical practice but also assist in answering complex certification examina - tion questions. By correlating clinical findings with sonographic findings, the sonographer can directly im - pact the patient’s outcome by providing the most tar - geted examination possible. Furthermore, when faced with a complicated, in -depth registry question, the test taker should be capable of eliminating information that is not applicable, to answer the question appropriately. There is an extensive list of laboratory findings that may be relevant for abdominal sonographic imaging. Applica - ble laboratory findings are found in each specific organ/system chapter. However, it is important to T A B L E 1 - 1 AIUM Practice Guidelines for a Sonogram of the Abdomen and/or Retroperitoneum Abdominal, flank, and/or back pain Signs or symptoms that may be referred from the abdominal and/or retroperitoneal regions, such as jaundice or hematuria Palpable abnormalities, such as an abdominal mass or organomegaly Abnormal laboratory values or abnormal findings on other imaging examinations sugges - tive of abdominal and/or retroperitoneal pathology Follow -up of known or suspected abnormalities in the abdomen and/or retroperitoneum Search for metastatic disease or an occult primary neoplasm Evaluation of suspected congenital abnormalities Abdominal trauma Pre- and posttransplantation evaluation Planning and guidance for an invasive procedure Search for the presence of free or loculated peritoneal and/or retroperitoneal fluid PATIENT PREPARATION FOR AN ABDOMINAL SONOGRAM AND INVASIVE PROCEDURES CLINICAL INDICATIONS FOR AN ABDOMINAL SONOGRAM C H A P T E R 1 | A B D O M I N A L S O N O G R A P H Y O VER V IEW 3 ARTIFACTS IN ABDOMINAL IMAGING ABDOMINAL CAVITY remember two significant laboratory findings that may be mentioned in clinical history questions. First, leukocyto - sis, or an elevation in white blood cell count, always indi - cates the presence of infection. Patients who have some form of “itis” (such as cholecystitis or pancreatitis), or possibly even an abscess, may have an abnormal white blood cell count with existing infection. Second, a de - crease in hematocrit indicates some type of bleeding. Patients who have suffered recent trauma or have an active hemorrhage will have a decreased hematocrit level. Keep these two laboratory findings in mind as you study. Abdominal sonography involves careful analysis of vital structures. Often, artifacts will be observed during an abdominal sonogram. It is important to know that arti - facts exist and why they occur (Table 1-2). The double lining of the abdominal cavity is the peri - toneum. The peritoneum consists of a parietal and vis - ceral layer. The parietal peritoneum forms a closed sac, T A B L E 1 - 3 The List of Intraperitoneal Organs Gallbladder Liver (except for bare area) Ovaries Spleen (except for the splenic hilum) Stomach except for two openings in the female pelvis, which per - mits passage of the fallopian tubes from the uterus to the ovaries. Furthermore, each organ is covered by a layer of visceral peritoneum , which is essentially its serosal layer. Some abdominal organs are considered intraperi - toneal and others retroperitoneal (Tables 1 -3 and 1 -4). The retroperitoneal structures are only covered anteri - orly with peritoneum. The abdominal parietal peri - toneum can be divided into two sections: the greater sac and the lesser sac. The greater sac extends from the di - aphragm to the pelvis, while the lesser sac is located pos- terior to the stomach. Potential spaces, which are essentially outpouching in the peritoneum, exist between the organs (Table 1-5). T A B L E 1 - 2 Artifacts Commonly Observed During an Abdominal Sonogram Artifact Description Comet tail artifact A type of reverberation artifact caused by several small, highly reflective interfaces Seen with adenomyomatosis of the gallbladder Mirror image Produced by a strong reflector and results in a copy of the anatomy being placed deeper than the correct location Seen posterior to the liver and diaphragm Poster ior (acoustic) enhancement Produced when the sound beam is barely attenu - ated through a fluid or a fluid-containing structure Seen posterior to cystic structures such as the gallbladder and renal cysts, and with ascites Reverberation artifact Caused by a large acoustic interface and subse - quent production of false echoes Seen as an echogenic region in the anterior aspect of the gallbladder or other cystic structures Ring-down artifact A type of reverberation artifact that appears as a solid streak or a chain of parallel bands radiating away from a structure Seen emanating from gas within the abdomen Shadowing Caused by attenuation of the sound beam Seen posterior to calculi and bone