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NEW QUESTION # 28
Which thyroid condition is most likely caused by a viral infection?
Answer: D
Explanation:
De Quervain thyroiditis (subacute granulomatous thyroiditis) is often triggered by a viral infection. Patients may present with painful thyroid enlargement, elevated inflammatory markers, and transient hyperthyroidism.
Hashimoto's and Graves' diseases are autoimmune in nature.
According to Braverman's The Thyroid:
"Subacute (De Quervain) thyroiditis typically follows a viral upper respiratory tract infection and is characterized by thyroid pain and transient thyrotoxicosis." Reference:
Braverman LE, Cooper DS. The Thyroid: A Fundamental and Clinical Text. 11th ed. Wolters Kluwer, 2021.
American Thyroid Association Guidelines, 2016.
NEW QUESTION # 29
Identify the congenital anomaly.
Using your mouse, place the cursor on the appropriate region of the image and then left-click the mouse button to indicate your selection.
Answer:
Explanation:
Explanation:
An ultrasound of a fetus AI-generated content may be incorrect.
The ultrasound image shows a transverse (axial) view of the fetal abdomen. Notably, there is abnormal continuity of renal parenchyma across the midline anterior to the aorta, forming a U- or horseshoe-shaped structure. This is characteristic of a congenital anomaly known as a horseshoe kidney.
Horseshoe kidney is the most common fusion anomaly of the kidneys, occurring in approximately 1 in 400-
600 live births. It results from fusion of the lower poles of both kidneys during fetal development. On prenatal ultrasound, this anomaly can be suspected when the kidneys appear closer to the midline than usual and are connected by an isthmus of renal tissue or fibrous band that crosses anterior to the spine and great vessels.
Typical sonographic findings include:
* Abnormally located kidneys, often lower than expected
* Renal fusion across the midline (usually at the lower poles)
* Possible associated hydronephrosis or malrotation
Comparison to other anomalies:
* This is not consistent with polycystic kidney disease (which would show diffusely echogenic kidneys with poor corticomedullary differentiation).
* Duplex kidney would show duplicated collecting systems but not fusion across the midline.
* Renal agenesis would demonstrate absence of renal tissue.
* Posterior urethral valves would show a distended bladder with bilateral hydronephrosis, not midline fusion.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Callen PW. Ultrasonography in Obstetrics and Gynecology, 6th ed. Elsevier; 2016.
Nyberg DA, McGahan JP, Pretorius DH, Pilu G. Diagnostic Imaging of Fetal Anomalies. Lippincott Williams
& Wilkins; 2003.
NEW QUESTION # 30
Which is the most common pancreatic cancer?
Answer: D
Explanation:
Pancreatic ductal adenocarcinoma is by far the most common pancreatic malignancy, accounting for approximately 85-90% of pancreatic cancers. It typically arises from the exocrine portion of the pancreas, most frequently in the pancreatic head. Islet cell (neuroendocrine) tumors and cystic neoplasms (e.g., mucinous cystadenocarcinoma) are far less common.
According to Rumack's Diagnostic Ultrasound:
"Adenocarcinoma is the most common malignant neoplasm of the pancreas, representing the vast majority of pancreatic cancers." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Digestive System Tumors, 5th ed., IARC, 2019.
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NEW QUESTION # 31
A patient presents with right lower quadrant pain and fever. Which condition is most likely indicated by the arrow on this image?
Answer: C
Explanation:
The ultrasound image demonstrates a tubular, non-compressible, blind-ending structure located in the right lower quadrant (RLQ) with associated echogenic periappendiceal fat and possibly adjacent fluid or phlegmon.
These features are consistent with appendicitis. Given the clinical history of fever and RLQ pain, along with the irregular borders and complex periappendiceal findings, the diagnosis of a ruptured appendix is most likely.
Key sonographic features of ruptured appendicitis include:
* Non-visualization or distortion of the normal appendiceal wall architecture
* Periappendiceal fluid collection or abscess
* Disruption of the echogenic submucosal layer
* Surrounding fat stranding (hyperechoic inflammatory changes)
* Clinical correlation with fever and peritonitis
Comparison of answer choices:
* A. Bowel obstruction typically shows dilated bowel loops with air-fluid levels, not a tubular structure like the appendix.
* B. Intussusception presents with a target or "donut" sign in a transverse view, not a linear tubular structure.
* C. Enlarged lymph nodes are usually round or oval and hypoechoic with a central echogenic hilum, without a tubular appearance.
* D. Ruptured appendix - Correct. The ultrasound features and clinical presentation match.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Jeffrey RB, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology.
1988;167(2):327-329.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of the Ultrasound Examination for Appendicitis (2020).
NEW QUESTION # 32
Which technique would best eliminate the spectral Doppler artifact in this image?
Answer: A
Explanation:
The spectral Doppler image demonstrates excessive noise along the baseline, including a "fuzzy" or filled-in spectral window. This artifact is known as spectral broadening or "blossoming," and it typically results from excessive Doppler gain.
When Doppler gain is set too high, it amplifies not only the true Doppler signal but also the background noise.
This results in a falsely broadened waveform that can obscure diagnostic information such as peak velocities or flow turbulence. The best way to correct this artifact is to reduce the Doppler gain (Option A).
Key points regarding gain-related artifact:
* Excessive gain exaggerates spectral display by amplifying weak signals and noise.
* Reducing gain restores the clarity of the spectral window and accurate envelope definition.
* The goal is to optimize gain just enough to see the real flow signals without cluttering the display.
Differentiation from other options:
* B. Adjust baseline: Useful in avoiding aliasing but does not affect gain-related noise.
* C. Increase wall filter: Removes low-frequency signals from vessel wall motion but not background spectral noise.
* D. Increase pulse repetition frequency (PRF): Used to reduce aliasing in high-velocity flow, not to address gain-related spectral clutter.
References:
Kremkau FW. Sonography: Principles and Instruments. 9th Edition. Elsevier, 2015. Chapter: Doppler Principles, pp. 189-193.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Doppler Artifacts, pp. 65-67.
American Institute of Ultrasound in Medicine (AIUM) Doppler Ultrasound Practice Guidelines, 2020.
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NEW QUESTION # 33
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