Sonography Exam Review: Physics, Abdomen, Obstetrics and Gynecology E-Book: Sonography Exam Review: Physics, Abdomen, Obstetrics and Gynecology E-Book

Ensure you can correctly answer any and all questions on their registry exams. Sonography Exam Review: Physics, Abdomen, Obstetrics and Gynecology, 3 rd Edition provides the exact review materials you need to pass the three main sonography exams: physics, abdomen, and OB/GYN. Each chapter is arranged in table and outline format with 50 review questions at the end of the chapter and a mock exam at the end of each section. New and revised chapters in this 3 rd edition include additional information on salivary glands, musculoskeletal, and male pelvis sonography. Updated information on patient care, imaging techniques, and protocols is also included, and much more! Complete preparation for the three main ARDMS exams: physics, abdomen, and ob/gyn covers the three subject areas required for general ultrasound practice. More than 1,900 questions in registry format — 1,910 in the text and 700 online — allow you to thoroughly prepare for the registry exams using multiple methods of learning. Content review in outline and tabular format offers a quick, concise review of key terms, anatomy, functions, scanning technique, lab values, and pathology for each registry subject. Rationales for answers to mock exam questions are provided to help you understand why an answer is correct and incorrect. More than 350 ultrasound scans are included in the abdominal and ob/gyn sections. Color insert of Doppler images of anatomy and pathology prepares you to answer questions related to Doppler imaging. NEW! Updated coverage of the neck to include salivary glands NEW! Revised section on the male pelvis to include penile sonography NEW! Additional coverage on imaging techniques and protocols Front cover Front matter Sonography exam review: Physics, abdomen, obstetrics and gynecology 2nd edition Copyright page About the author Dedication Reviewers Preface Content and organization Features Registry-level questions Images and illustrations Evolve How to use Acknowledgments Table of contents I: Physics 1 Clinical safety Key terms Occupational safety and health act (osha) Ergonomics Work-related musculoskeletal disorders (wrmsd) Causes of WRMSD in sonography Types of injuries Prevention of injury Bioeffects and alara principle Safety ALARA principle Intensity of ultrasound Spatial peak (SP) Spatial average (SA) Temporal peak (TP) Temporal average (TA) Pulse average (PA) Intensity values (lowest to highest) Spatial average–temporal average (SATA) Spatial peak–temporal average (SPTA) Spatial average–pulse average (SAPA) Spatial peak–pulse average (SPPA) Spatial average–temporal peak (SATP) Spatial peak–temporal peak (SPTP) Instrument output Biological effects Cavitation Stable cavitation Transient cavitation Acoustic output labeling standards System maintenance Bioeffects and safety review 2 Physics principles Key terms Sound categories Infrasound Audible sound Ultrasound Sound waves Pulse ultrasound Propagation of ultrasound Incident beam = reflected beam + transmitted beam Perpendicular incidence Oblique incidence Reflection of ultrasound Specular reflections Scatter Rayleigh’s scatter Harmonic frequencies Transmission of ultrasound Refraction of ultrasound Decibel (dB) Attenuation Attenuation coefficient Half value layer Range equation Physics principles review 3 Ultrasound transducers Key terms Diagnostic ultrasound transducers Piezoelectricity (piezoelectric effect) Types of transducers Continuous wave Pulse wave Unfocused sound beam (figs. 3-1 and 3-2) Focusing of the sound beam (fig. 3-3) Types of focusing Acoustic mirrors Dynamic receive focusing Electronic External Internal Steering of the sound beam (fig. 3-4) Resolution Transducer care Transducer review 4 Pulse-echo instrumentation Key terms Display modes A-mode B-mode M-mode Volumetric scanning Real-time imaging Advantages Limitations Pulse-echo instrumentation Functions Power Transducer Channels Master synchronizer Pulser (transmitter) Digital beam former Pulse delays Transmit and receiver switch (t/r switch) Signal processing Receiver Amplification Time gain compensation (fig. 4-1) Compression Demodulation Rejection (threshold, suppression) Image storage Scan converter Analog scan converter Digital scan converter Analog-to-digital converter Digital memory Digital-to-analog converter Memory Functions Random-access memory (RAM) Read-only memory (ROM) Bit Binary numbers Preprocessing Persistence Region of interest/expansion Write zoom Postprocessing (contrast variation) B-color 3-D presentation Read zoom Image display Matrix Pixel Pixel density Voxel Cathode ray tube (CRT) Computer monitor Liquid-crystal display (LCD) Recording techniques Hard copy imaging X-ray film Thermal processors Laser imaging Digital recording device Videotape player Archive storage Magnetic-optical disk Picture archiving and communication system (PACS) Standards for archiving medical files American college of radiology (ACR) Digital imaging and communications in medicine (DICOM) National electrical manufacturers association (nema) Artifacts of ultrasound Caused by Assumptions in the design of ultrasound systems Pulse-echo instrumentation review 5 Doppler instrumentation and hemodynamics Key terms Hemodynamics Cardiac circulation Volumetric flow rate Continuity rule Types of blood flow Venous hemodynamics Doppler shift Doppler equation Doppler effect Detection of doppler shift Factors influencing the doppler shift Spectral ratios Pulsatility index Resistant index (pourcelot index) Hemodynamics and doppler review 6 Quality assurance, protocols, and new technologies Key terms Quality assurance (QA) Methods of evaluation Operation testing Acoustic output testing Record keeping Statistical indices Protocols New technologies Contrast agents Contrast harmonic imaging Elastography Quality assurance review Physics Mock Exam II: Abdomen 7 Liver Key terms Physiology Functions of the liver Anatomy (figs. 7-1 and 7-2) Liver divisions Left lobe Right lobe Caudate lobe Liver ligaments Coronary Falciform Gastrohepatic Hepatoduodenal Teres Triangular Venosum Liver spaces Morison pouch (hepatorenal pouch) Subhepatic space Subphrenic space Vascular anatomy Hepatic arteries Hepatic veins Portal veins Location Left lobe Right lobe Caudate lobe Sonographic appearance Liver Bile ducts Hepatic vein Portal vein Hepatic artery Technique Preparation Examination technique and image optimization Indications for examination Laboratory values Alkaline phosphatase Alpha-fetoprotein Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Bilirubin Prothrombin time Serum albumin Hepatic transplant Preoperative protocol Postoperative complications Liver review 8 Biliary system Key terms Biliary system Functions of the biliary system Biliary anatomy (fig. 8-1) Bile ducts Common hepatic duct Cystic duct Common bile duct Size of the normal bile duct Sonographic appearance Normal intrahepatic bile ducts Normal extrahepatic bile ducts Longitudinal plane Transverse plane Abnormal intrahepatic and extrahepatic ducts Gallbladder physiology and anatomy Functions of the gallbladder Gallbladder divisions Layers of the gallbladder wall Gallbladder location Gallbladder anatomical variants Congenital anomalies Gallbladder size Sonographic appearance Normal fasting gallbladder Abnormal fasting gallbladder Reasons for nonvisualization of the gallbladder Noninflammatory causes of gallbladder wall thickening Technique Preparation Examination technique and image optimization Indications for ultrasound examination Laboratory values Alkaline phosphatase Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Bilirubin Biliary review 9 Pancreas Key terms Pancreas physiology Functions of the pancreas Exocrine Endocrine Pancreas anatomy (fig. 9-1) Pancreas divisions and location Tail Body Neck Head Uncinate process Ducts of the pancreas Duct of wirsung Duct of santorini Congenital anomalies Pancreatic divisum Annular pancreas Ectopic pancreatic tissue Cystic fibrosis Sonographic appearance Normal pancreas Abnormal pancreas Normal pancreatic duct Abnormal pancreatic duct Technique Preparation Examination technique and image optimization Indications for ultrasound examination Laboratory values Serum amylase Urine amylase Serum lipase Glucose Pancreatoduodenectomy (whipple procedure) (fig. 9-2) Preoperative criteria Basic procedure Pancreas review 10 Urinary system Key terms Physiology Functions of the urinary system Anatomy Ureter anatomy Arterial supply to the ureter Location Each kidney is located Size Adult Child Infant Technique Preparation Examination technique and imaging optimization Indications for examination Laboratory values Creatinine Blood urea nitrogen Hematuria Proteinuria Concentration–dilution urinalysis Renal dialysis Renal transplant Normal sonographic appearance of the renal transplant Abnormal sonographic appearance of the renal transplant Normal doppler appearance of the renal transplant Abnormal doppler appearance of the renal transplant Urinary bladder anatomy Apex Neck Trigone Normal sonographic appearance Urinary system review 11 Spleen Key terms Physiology Function of the spleen Anatomy (fig. 11-1) Splenic vasculature Location Normal sonographic appearance Technique Preparation Examination technique and image optimization Indications for examination Laboratory values Erythrocyte Leukocyte Hematocrit Hemoglobin Spleen review 12 Retroperitoneum Key terms Physiology Adrenal glands (fig. 12-1) Function of the adrenal glands Epinephrine (adrenaline) Norepinephrine Glucocorticoids Gonadal hormones Mineral corticoids Anatomy Location Size Vascular anatomy Normal sonographic appearance Technique Preparation Examination technique and image optimization Indications for examination Laboratory values Adrenocorticotrophic hormone (ACTH) Aldosterone Potassium Sodium Retroperitoneum Borders of the retroperitoneum Spaces in the retroperitoneum Anterior pararenal Posterior pararenal Perirenal Lymph nodes Functions of lymph nodes Divisions of lymph nodes Parietal nodes Visceral nodes Sonographic appearance of the normal lymph node Sonographic appearance of the abnormal lymph node Sonographic appearance of retroperitoneal masses Retroperitoneum review 13 Abdominal vasculature Key terms Physiology and anatomy Functions of the vascular system Vessel wall layers Tunica adventitia Tunica media Tunica intima Arterial anatomy (fig. 13-1) Abdominal aorta Main visceral branches of the abdominal aorta Celiac axis (CA) Superior mesenteric artery (SMA) Middle suprarenal arteries Main renal arteries Gonadal arteries Inferior mesenteric artery Main parietal branches of the abdominal aorta Inferior phrenic artery Lumbar arteries Median sacral artery Additional abdominal arteries Gastroduodenal artery (GDA) Hepatic artery Left gastric artery Splenic artery Venous anatomy (fig. 13-2) Inferior vena cava (IVC) Main venous tributaries Common iliac veins Renal veins Hepatic veins Additional abdominal veins Main portal vein Splenic vein Superior mesenteric vein Gonadal veins Lumbar veins Location Abdominal aorta Inferior vena cava Size Abdominal aorta Inferior vena cava Sonographic appearance Technique Preparation Examination technique and image optimization Indications for examination Abdominal vasculature review 14 Gastrointestinal tract Key terms Gastrointestinal (GI) tract (fig. 14-1) Physiology Functions of the gi tract Anatomy Esophagus Stomach Small intestines Duodenum Jejunum Ileum Colon Cecum Appendix Ascending colon Transverse colon Descending colon Sigmoid Rectum Anal canal Location Esophagus Stomach Small intestines Duodenum Jejunum Ileum Colon Size Sonographic appearance Technique Preparation Examination technique and image optimization Indications for examination Gastrointestinal tract review 15 Superficial structures: Breast, abdominal wall, and musculoskeletal sonography Key terms Physiology Function of the breast Function of the anterior abdominal wall Function of the musculoskeletal system The breast Breast anatomy and location (Fig. 15-1) Terminal ductal lobular unit Lobe Lactiferous duct Fibrous planes of the breast Skin Subcutaneous fat layer Cooper ligaments Superficial fascia Mammary zone Retromammary space Deep fascia Pectoralis muscles Pectoralis major muscle Pectoralis minor muscle Breast vasculature Arterial supply Venous system Congenital breast anomalies Sonographic appearance of the breast Technique Preparation Examination technique and image optimization Indications for a breast examination Anterior abdominal wall and musculoskeletal system Anterior abdominal wall anatomy (Fig. 15-2) Linea alba Rectus abdominis muscles External oblique muscles Internal oblique muscles Transversus abdominis muscle Musculoskeletal anatomy Achilles tendon Hip joint Knee joint Shoulder joint Sonographic appearance of the anteriora bdominal wall Sonographic appearance of the musculoskeletal system Technique Preparation Examination technique and image optimization Indications for an anterior abdominal wall examination Indications for a musculoskeletal examination Superficial structures review 16 Scrotum and prostate Key terms Physiology Function of the scrotum Functions of the epididymis Functions of the testis Functions of the prostate gland Anatomy Scrotum (fig. 16-1) Epididymis Testes Tunica albuginea Tunica vaginalis Mediastinum testis Rete testis Spermatic cord Vas deferens Prostate gland (fig. 16-2) Central zone (CZ) Peripheral zone (PZ) Transitional zone (TZ) Periurethral glands Seminal vesicles Surgical capsule Verumontanum Vascular anatomy Scrotum Testicular arteries Centripetal arteries Cremasteric and deferential arteries Testicular veins Spermatic vein Prostate Prostaticovesical arteries Inferior vesical artery Capsular arteries Urethral artery Size Adult Prepuberty Infant Sonographic appearance Scrotum Testes Epididymis Spermatic cord Prostate Technique Scrotum preparation Prostate preparation Examination technique and image optimization Scrotum Prostate Indications for scrotal examination Indications for prostate examination Laboratory values Prostate specific antigen Scrotum and prostate review 17 Neck Key terms Physiology Function of the thyroid glands Function of the parathyroid glands Function of the carotid arteries Function of the jugular veins Anatomy (fig. 17-1) Muscles of the neck Longus colli muscles Platysma muscles Sternocleidomastoid muscles Strap muscles Vasculature of the neck Common carotid arteries External carotid arteries Internal carotid arteries Vertebral arteries Internal jugular veins External jugular veins Vertebral veins Anatomy of the thyroid glands Vasculature of the thyroid glands Anatomy of the parathyroid glands Location Thyroid lobes Thyroid isthmus Parathyroid glands Congenital anomalies Pyramidal lobe Absent isthmus Ectopic parathyroid gland location Size Sonographic appearance Technique Preparation Examination technique and image optimization Indications for examination Laboratory values Thyroid Thyrotropin (TSH) Thyroxine (T4) Triiodothyronine (T3) Calcitonin Parathyroid Parathormone (PTH) Calcium Thyroid pathology Hyperthyroidism Hypothyroidism Thyroid nodules Parathyroid pathology Hypercalcemia Hyperparathyroidism Hypocalcemia Hypoparathyroidism Neck review 18 Peritoneum, noncardiac chest, and invasive procedures Key terms Physiology Functions of the peritoneum Peritoneum anatomy (fig. 18-1) Greater omentum Lesser omentum (gastrohepatic omentum) Organs contained within the peritoneum include: Peritoneal spaces Lesser sac (omental bursa) Morison pouch (hepatorenal pouch) Paracolic gutters Pelvic spaces Subhepatic space Subphrenic spaces Location of the peritoneum Anatomy of the pleura Sonographic appearance Technique Preparation Examination technique and image optimization Indications for peritoneal cavity examination Indications for pleural cavity examination Laboratory values Invasive procedures Types of invasive procedures Biopsy Fine-needle aspiration Paracentesis Thoracentesis Technique Preparation Examination technique Peritoneum, noncardiac chest, and invasive procedures review Abdomen mock exam III: Obstetrics and Gynecology 19 Pelvic anatomy Key terms Pelvic anatomy (fig. 19-1) True pelvis False pelvis Pelvic ligaments Pelvic spaces Female reproductive system (fig. 19-2) Vagina Sonographic appearance of the vagina Uterus Tissue layers of the uterus Perimetrium Myometrium Endometrium Location of the uterus Normal sonographic appearance of the uterus Normal sonographic appearance of the endometrium Measuring the uterus (Fig. 19-3) Measuring the endometrium (Fig. 19-4) Congenital uterine anomalies Ovaries Anatomy of the ovaries Physiology of the ovaries Function Location of the ovaries Normal sonographic appearance of the ovary Measuring of the ovaries (Fig. 19-5) Ovarian size Menarche Ovarian volume Anatomical ovarian variant L-shaped ovary Congenital ovarian anomalies Agenesis Unilateral ovary Fallopian tubes (oviduct) (Fig. 19-6) Physiology of the fallopian tubes Function Location of the fallopian tubes Sonographic appearance of the fallopian tube Size Urinary bladder Anatomy Normal sonographic appearance Radiographic procedures Pelvic anatomy review 20 Physiology of the female pelvis Key terms Normal physiology Laboratory values Estradiol Estrogen Follicle-stimulating hormone (FSH) Follicle-stimulating hormone–releasing factor Luteinizing hormone (LH) Luteinizing hormone-releasing factor (LHRF) Progesterone Endometrium Premenarche Precocious puberty Precocious pseudopuberty Menarche Ovaries Postmenopause With hormone replacement therapy Without hormone replacement therapy Contraception Physiology of the female pelvis review 21 Uterine and ovarian pathology Key terms Uterine pathology Ovarian pathology Uterine and ovarian pathology review 22 Adnexal pathology and infertility Key terms Infertility Methods of assisted reproductive technologies (ART) Ovarian induction therapy In vitro fertilization Gamete intrafollicular transfer Zygote intrafallopian transfer Ultrasound evaluation of the uterus Ultrasound monitoring of the endometrium Ultrasound monitoring of the ovaries Baseline study before therapy During induction therapy Complications of art Ectopic pregnancy Multiple gestations Ovarian hyperstimulation syndrome Adnexal pathology and infertility review 23 Assessment of the first trimester Key terms Early embryology (fig. 23-1) Blastocyst development (fig. 23-2) Anatomy Laboratory values Human chorionic gonadotropin (hCG) First-trimester measurements Mean sac diameter (MSD) Crown–rump length (CRL) Nuchal translucency First-trimester protocol Evaluate and document the following: Indications for sonographic evaluation Assessment of the first-trimester review 24 Assessment of the second trimester Key terms Second trimester biometric measurements Biparietal diameter Head circumference Cephalic index Abdominal circumference Femur length Laboratory values Alpha-fetoprotein Causes of high alpha-fetoprotein Causes of low alpha-fetoprotein Second trimester protocol Assessment of fetal age Fetal anatomy Fetal circulation Assessment of the second trimester review 25 Assessment of the third trimester Key terms Third trimester Third-trimester measurements Fetal growth Decrease in fetal growth Small for gestational age Intrauterine growth restriction Increase in fetal growth Large for gestational age Macrosomia Amniotic fluid Functions of the amniotic fluid Amniotic fluid volume Measuring amniotic fluid volume Fetal well-being Biophysical profile Fetal presentation Cephalic or vertex Transverse Oblique Breech Frank breech Complete breech Incomplete breech Assessment of the third trimester review 26 Fetal abnormalities Key terms Fetal abnormalities review 27 Complications in pregnancy Key terms Chromosomal abnormalities Fetal syndromes Hydrops fetalis Multifetal gestations Sonographic evaluation Complications in pregnancy review 28 Placenta and umbilical cord Key terms Placenta Anatomy (fig. 28-1) Physiology Functions Respiration Nutrition Excretion Protection Storage Hormone production Size Normal sonographic appearance First trimester Second and third trimesters Placental position Placental maturity and grading Grade 0 Grade 1 Grade 2 Grade 3 Placenta previa Umbilical cord Anatomy Umbilical vein Umbilical arteries Size Cervical os Placenta and umbilical cord review 29 Patient care and technique Key terms Patient care Standard precautions and infection control Patient–sonographer interaction Sonographer responsibilities Patient history Transabdominal examination Purpose of bladder distention Optimal bladder distention Underdistention Overdistention Orientation Technique Adult preparation Child preparation Gynecological examination technique Indications Obstetric examination technique Indications Transvaginal examination Orientation Technique Preparation Gynecological examination technique Obstetrical examination technique Translabial examination Orientation Technique Preparation Gynecological and obstetrical examination technique Indications Transducer care Patient care and technique review Obstetrics and gynecology mock exam Physics answers Chapter 1 clinical safety Chapter 2 physics principles Chapter 3 ultrasound transducers Chapter 4 pulse-echo instrumentation Chapter 5 doppler instrumentation and hemodynamics Chapter 6 quality assurance, protocols, and new technologies Physics mock exam Abdomen answers Chapter 7 liver Chapter 8 biliary system Chapter 9 pancreas Chapter 10 urinary system Chapter 11 spleen Chapter 12 retroperitoneum Chapter 13 abdominal vasculature Chapter 14 gastrointestinal tract Chapter 15 superficial structures: breast, abdominal wall, and musculoskeletal sonography Chapter 16 scrotum and prostate Chapter 17 neck Chapter 18 peritoneum, noncardiac chest, and invasive procedures Abdomen mock exam Obstetrics and gynecology answers Chapter 19 pelvic anatomy Chapter 20 physiology of the female pelvis Chapter 21 uterine and ovarian pathology Chapter 22 adnexal pathology and infertility Chapter 23 assessment of the first trimester Chapter 24 assessment of the second trimester Chapter 25 assessment of the third trimester Chapter 26 fetal abnormalities Chapter 27 complications in pregnancy Chapter 28 placenta and umbilical cord Chapter 29 patient care and technique Obstetrics and gynecology mock exam Bibliography Illustration credits Courtesies Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z How to use Be confident that you can answer any and all questions on your registry exams correctly when you prepare with this complete review. Mosby?s Comprehensive Review for General Sonography Examinations provides study resources for all three main exams required for general ultrasound physics, abdomen, and ob/gyn. Each chapter is arranged in table and outline format with 50 review questions at the end of the chapter and a mock exam at the end of each section. Access additional mock exams for each subject area on the companion CD or Evolve site. These exams give you experience with timed test taking in an electronic environment that simulates the actual registry exam experience. With this realistic preview of the exam environment and solid review of the material, you?ll be prepared to ace the exams! "..no doubt that this is a worthwhile text which could provide a useful revision platform for sonography students in the UK." Reviewed by Sue Halson-Brown on behalf of RAD Magazine, February 2015 Be confident that you can answer any and all questions on your registry exams correctly when you prepare with this complete review. Mosby’s Comprehensive Review for General Sonography Examinations provides study resources for all three main exams required for general ultrasound practice: physics, abdomen, and ob/gyn. Each chapter is arranged in table and outline format with 50 review questions at the end of the chapter and a mock exam at the end of each section. Access additional mock exams for each subject area on the companion CD or Evolve site. These exams give you experience with timed test taking in an electronic environment that simulates the actual registry exam experience. With this realistic preview of the exam environment and solid review of the material, you’ll be prepared to ace the exams!