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NEW QUESTION # 75
Which vessel is indicated by the arrow on this image?
Answer: C
Explanation:
The ultrasound image demonstrates a transverse view of the abdominal vasculature, where the arrow is pointing to a circular vascular structure anterior to the aorta and posterior to the body of the pancreas - consistent with the superior mesenteric artery (SMA).
The SMA originates from the anterior aspect of the abdominal aorta just below the level of the celiac trunk and courses anterior to the left renal vein and uncinate process of the pancreas. On transverse ultrasound, it is often seen in cross-section as a round, pulsatile structure with echogenic walls, situated just anterior to the aorta. This appearance is known as the "target sign" or "bull's-eye" appearance.
Vessel Position Landmarks (transverse plane):
* Aorta: Posterior and central
* SMA: Just anterior to the aorta
* Left renal vein: Passes between the aorta and SMA (nutcracker location)
* Right renal artery: Courses posterior to the IVC toward the right kidney Differentiation from other options:
* A. Proper hepatic artery: Typically visualized within the liver hilum (portal triad), not in this anatomic location.
* C. Left renal vein: Seen in transverse as a longer, oval structure crossing anterior to the aorta and posterior to the SMA.
* D. Right renal artery: Arises laterally from the aorta and courses posterior to the IVC - not visualized in this axial midline location.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Vascular Anatomy and Abdominal Vessels, pp. 471-475.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.
Radiopaedia.org. Superior mesenteric artery: https://radiopaedia.org/articles/superior-mesenteric-artery
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NEW QUESTION # 76
Which type of choledochal cyst is the most common?
Answer: D
Explanation:
Type I choledochal cyst, characterized by fusiform dilatation of the common bile duct, is the most common form, accounting for 80-90% of cases. Other types are much less frequent.
According to Rumack's Diagnostic Ultrasound:
"Type I fusiform dilatation of the extrahepatic bile duct is the most common type of choledochal cyst." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Hepatobiliary Ultrasound, 2020.
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NEW QUESTION # 77
Which portion of the renal arterial vasculature is indicated by the arrow in this image?
Answer: D
Explanation:
The arrow in this Doppler ultrasound image of the kidney is pointing to vessels located at the corticomedullary junction, arching over the bases of the medullary pyramids. This vascular pattern is characteristic of the arcuate arteries.
Renal arterial anatomy follows a specific branching hierarchy:
* Segmental arteries branch off the main renal artery.
* Interlobar arteries travel between renal pyramids.
* Arcuate arteries arch over the base of the pyramids at the corticomedullary junction.
* Interlobular arteries extend into the cortex from the arcuate arteries.
Key characteristics of arcuate arteries on ultrasound:
* Located at the corticomedullary junction (between the medullary pyramids and renal cortex).
* Run perpendicular to the long axis of the kidney, often forming an arching or curving pattern.
* Commonly targeted in Doppler studies to assess resistive index (RI) in renal perfusion studies.
Comparison of answer choices:
* A. Interlobular arteries are smaller vessels that extend perpendicularly from the arcuate arteries into the cortex-not visible at this level.
* B. Arcuate - Correct. The arrow is indicating these vessels arching over the medullary pyramids.
* C. Segmental arteries are larger and deeper, branching off the renal artery near the hilum.
* D. Interlobar arteries course between the pyramids but do not arch along their base.
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.
AIUM Practice Parameter for the Performance of a Renal Artery Duplex Sonogram (2020).
NEW QUESTION # 78
Which laboratory value stays elevated longest and is considered the most reliable in diagnosing pancreatitis?
Answer: B
Explanation:
Lipase is the most sensitive and specific laboratory marker for diagnosing acute pancreatitis. It rises earlier, remains elevated longer (up to 14 days), and is more pancreas-specific than amylase. Amylase may normalize within 48-72 hours and may also be elevated in non-pancreatic conditions.
According to ACG (American College of Gastroenterology) Guidelines:
"Serum lipase is preferred over amylase due to its higher sensitivity, specificity, and prolonged elevation in pancreatitis." Reference:
American College of Gastroenterology (ACG) Clinical Guideline: Management of Acute Pancreatitis, 2013.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 79
Identify the region where Doppler sampling should be performed in a young woman with severe postprandial pain.
Answer:
Explanation:
Explanation:
A ultrasound image of a person's body AI-generated content may be incorrect.
The origin of the superior mesenteric artery (SMA)
The image provided is a color Doppler ultrasound scan of the abdominal aorta and its major branches. In the center of the image, just anterior to the aorta, we see the superior mesenteric artery (SMA) arising in the sagittal plane. This is the critical area for Doppler sampling in a patient with symptoms suggestive of mesenteric ischemia.
Severe postprandial pain in a young woman may be a manifestation of median arcuate ligament syndrome (MALS) or chronic mesenteric ischemia. Both of these conditions are assessed via Doppler sampling of mesenteric vessels, specifically:
* The origin and proximal segment of the SMA
* The celiac artery (especially for MALS)
Doppler waveform analysis should assess:
* Peak systolic velocity (PSV): >275 cm/s suggests #70% SMA stenosis
* Angle correction should be aligned properly
* Sampling must be performed at the narrowest origin point (as shown in the image) This type of Doppler interrogation is typically done in both fasting and postprandial states to evaluate changes in flow and symptom correlation.
Why this area?
* The SMA is anterior to the aorta and travels inferiorly into the mesentery.
* The site shown in the image is ideal for measuring PSV and evaluating for stenosis or extrinsic compression.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Moneta GL, et al. Duplex ultrasound criteria for diagnosis of mesenteric artery stenosis. J Vasc Surg. 1991.
AIUM Practice Parameter for the Performance of a Mesenteric Artery Duplex Ultrasound Examination (2020).
NEW QUESTION # 80
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