AB-Abdomen Exam Dumps and Practice Questions

The ultrasound image shows a hypoechoic, round structure with internal microcalcifications --- hallmarks of recurrent papillary thyroid carcinoma (PTC) metastasis in a lymph node.

Key sonographic features supporting recurrent papillary thyroid cancer:

Hypoechoic round lymph node (loss of normal oval shape and hilum)

Microcalcifications (punctate echogenic foci) -- highly suggestive of metastatic PTC

Abnormal morphology (loss of fatty hilum, rounded shape, increased vascularity if Doppler used)

Seen in the thyroid bed or lateral neck post-thyroidectomy

Why the other options are incorrect:

B . Normal postsurgical lymph node -- Would be oval with echogenic hilum and no microcalcifications

C . Residual glandular tissue -- Would have a more homogeneous echotexture similar to thyroid tissue and be located at the thyroid bed, not necessarily nodal

D . Reactive lymph node -- May be enlarged but retain a normal hilum and vascular pattern, and lack microcalcifications

ACR TI-RADS Guidelines for Thyroid Nodule Assessment

Radiopaedia: 'Lymph node metastases from papillary thyroid carcinoma'

Ahuja A, Ying M. 'Sonographic Evaluation of Cervical Lymph Nodes.' AJR, 2005

Direct inguinal hernias protrude through Hesselbach's triangle, which lies medial to the inferior epigastric artery. In contrast, indirect inguinal hernias pass lateral to the inferior epigastric artery via the deep inguinal ring.

According to Moore's Clinically Oriented Anatomy:

''Direct inguinal hernias occur medial to the inferior epigastric vessels, within Hesselbach's triangle.''

Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.

Gray's Anatomy for Students, 4th ed., Elsevier, 2019.

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The CT and ultrasound images show a lenticular-shaped, hypoechoic fluid collection compressing the renal parenchyma from the periphery. The location---between the renal capsule and the renal parenchyma---strongly suggests a subcapsular hematoma.

Subcapsular hematomas in transplant kidneys are uncommon but important postoperative complications, often resulting from trauma, biopsy, or surgical manipulation. They typically present as a crescent-shaped, low-attenuation collection beneath the renal capsule and may cause mass effect on the underlying renal parenchyma. This can impair renal perfusion and function---a phenomenon known as ''Page kidney.''

Ultrasound findings:

Anechoic to hypoechoic, crescent-shaped collection surrounding or compressing the transplant kidney.

Deformation or flattening of the renal contour due to the compressive effect of the hematoma.

CT findings:

Hyperdense collection (if acute) or hypodense (if subacute/chronic) located subcapsularly.

May be seen distorting the renal capsule and compressing renal tissue.

Differentiation from other options:

Urinoma: Typically appears as a perinephric fluid collection and may result from urine leak. Not usually subcapsular.

Lymphocele: Develops in the post-transplant period due to lymphatic disruption. Appears as a well-defined perinephric fluid collection and tends to be medial to the kidney or between the bladder and the kidney.

Renal cell carcinoma: Would appear as a solid mass with variable enhancement and not a simple fluid collection. RCC is rare in transplant kidneys and usually detected much later post-transplant.

Radiopaedia.org. Subcapsular renal hematoma. https://radiopaedia.org/articles/subcapsular-renal-haematoma

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018. Chapter: Kidney Transplant Imaging, pp. 524--530.

American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum. 2020.

The ultrasound images show two views of the same groin region --- one without compression (left image labeled ''W/O COMPRESSION'') and one with graded probe compression (right image labeled ''W/ COMPRESSION'').

In the non-compression image, a hypoechoic mass-like structure is visible protruding through the abdominal wall, consistent with a hernia sac. On the compression image, the herniated content is no longer visible, indicating that the contents have been pushed back into the abdominal cavity. This is the hallmark feature of a reducible hernia.

Key characteristics of a reducible hernia on ultrasound:

Herniated contents are visible without pressure.

Contents disappear or reduce back into the abdomen with graded probe compression or Valsalva release.

Typically includes omental fat or bowel, but reduction confirms lack of incarceration or strangulation.

Comparison of answer choices:

Fat only refers to the hernia content type, not the behavior or reducibility shown here.

Reducible --- Correct. The change in hernia appearance between images demonstrates successful reduction with compression.

Incarcerated hernia would remain visible and not compressible or reducible.

Strangulated hernia would show signs of ischemia (bowel wall thickening, absent perfusion, hyperechoic mesentery), and would also not reduce with compression.

Radswiki. Ultrasound evaluation of hernia. Radiopaedia.org

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination for Hernia (2021)

The superior mesenteric artery (SMA) is typically visualized surrounded by an echogenic fat pad in the mesentery, producing a characteristic 'echogenic ring' appearance on ultrasound. This is a helpful landmark for identifying the SMA in the transverse abdominal aortic plane.

According to Rumack's Diagnostic Ultrasound:

''The superior mesenteric artery is often seen as a round anechoic structure surrounded by echogenic fat at its origin from the anterior aorta.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.