Examination Review for Ultrasound: Abdomen and Obstetrics & Gynecology

414 Pages·2010·12.15 MB·English

by  Steven M. Penny

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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
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Copyright © 2011 Lippincott Williams & Wilkins
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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
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necessary arrangements at the first opportunity.
To purchase additional copies of this book, call our customer service department at
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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
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P R E F A C E
Recognizing the educator within the sonography profes- all the key terms mentioned throughout the book for
sion is straightforward; we are all educators. Whether easy reference. The combination of basic tables, easy-
our interaction with students is in the classroom or to-read narrative, and high-quality images offers the
clinical setting, we have all actively been involved with reader the opportunity to evaluate notable, uncompli-
educating individuals who may someday perform a cated details of each topic discussed. Basic review
sonographic examination on us. Therefore, as well- questions are provided at the end of each chapter to
trained healthcare professionals, we must appreciate help the reader determine if additional studying is
the significance of obtaining and maintaining national needed before progressing further. An answer key for all
certification. the review questions is provided in the back of the
book.
In general, the book is divided into three sections:
OBJECTIVE Section 1, Abdominal Sonography Review; Section 2,
Gynecologic Sonography Review; and Section 3, Obstet-
Our responsibility in advancing the diagnostic signifi- ric Sonography Review. The overall configuration of
cance of sonography is obvious, but more importantly, each section and enclosed chapters are unlike compet-
we must be capable of providing consistent high-quality ing texts in several ways.
patient care. Standardized testing through credential In the abdominal section, the initial information of
granting organizations such as the American Registry each chapter focuses on normal anatomic and sono-
for Diagnostic Medical Sonography and American Reg- graphic anatomy. Only the most imperative anatomic
istry of Radiologic Technologist affords our profession a facts of each structure are offered, with the intention of
means of necessitating competency, a competency that not overwhelming the reviewer with an immense
all patients not only expect but deserve. Accordingly, amount of information. Next, abdominal pathology is
the objective of Examination Review for Ultrasound: presented in a logical manner, again providing only the
Abdomen & Obstetrics and Gynecology is to provide a most crucial information. After the narrative summary,
comprehensive review in sonography of the abdomen, a concise synopsis of clinical findings and sonographic
nongravid female pelvis, and obstetric patient, and the findings is listed. Furthermore, the reader will find that
foundation for its content is based on the examinations the abdominal section contains broader chapters on
offered by the above-mentioned organizations. major abdominal organs, such as the liver and kidneys,
while supplementary, smaller, and yet thorough chap-
ters on the bile ducts (Chapter 4) and the adrenal
ORGANIZATION glands (Chapter 8) are also included.
Section 2, the gynecologic section, contains a de-
The challenge of constructing a universally functional tailed review of the female pelvis and pathology that can
certification review book lies not only in the presenting be either revealed or further evaluated with the use of
of vital information in a comprehensible and yet basic sonography. The format is much like the abdominal sec-
format, but also in providing the user with a tool for tion, with both clinical and sonographic findings
knowledge assessment as he or she prepares for the offered. Unique chapters to this text include an entire
examinations. Each chapter of this book offers opportu- chapter (Chapter 19) dedicated to understanding the
nity for individual evaluation. menstrual cycle, an essential element of physiology
A list of key terms is provided at the beginning of thatmust be appreciated in order to do well on the
each chapter, which should allow for a rapid assess- examinations, and chapters solely dedicated to under-
ment of one’s familiarity with the associated material. In standing the significance of postmenopausal sonography
the back of the book the student will find a glossary of (Chapter 20) and female infertility (Chapter 21).
iv
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PREFACE v
Throughout the pages of the obstetric section,
FINAL NOTE
Section 3, the reader will find accommodating narrative
as well. The focus of the obstetric section is placed The material contained is deliberately not exhaustive so
more on the visual sonographic findings of fetal abnor- that the review isn’t hindered by an overwhelming
malities. Since the clinical manifestations of many fetal amount of statistics and superfluous information.
disorders are not always obvious, vital sonographic Therefore, there are several uses for this book that are
images and diagrams are offered. Distinctive topics can inherent in its arrangement. It is certainly suitable for
be found within the obstetric chapters as well. For ex- implementation in the classroom environment. Instruc-
ample, in Chapter 24, the significance of understanding tors offering registry review classes would significantly
and recognizing neural tube defects and the brain is benefit by adopting this text. The structure will provide
discussed. Also, under “Fetal Spine Abnormalities” in the educator with the opportunity to assign a review of
Chapter 26, a description of the relationship between one topic at a time, while affording the recognition and
spina bifida, alpha-fetoprotein, and folic acid supplements correction of subject matter weaknesses. It should also
can be found. be helpful to individuals who have completed a formal
educational program and who need a realistic gauge of
material mastery before attempting the examinations.
ADDITIONAL RESOURCES Lastly, in the clinical setting, this text could be em-
ployed as a tool for sonographers, whose complicated
The registry review does not end with the conclusion daily tasks include correlating clinical presentations
ofthis book. Because computer-based testing has be- with sonographic findings quickly.
come the principal device for administering certification The expectation of this book is for it to assist those
examinations, we have supplied the student with an op- of you who plan on attempting these difficult examina-
portunity to take a computer-based mock exam: registry tions that often are used to define our proficiency as
review examinations in all three subjects are provided sonographers. Whether you use its information to re-
online to those who purchase this book. By accessing fresh or reinforce your understanding of this material,
at thepoint.lww.com/Penny_AbObGyn1e, the may the knowledge that you acquire from its pages not
reader will have the opportunity to take computer-based only be maintained through the examination period but
examinations with more intense “registry-like” questions. may it also be exploited in your daily practice as a regis-
Other instructor and student resources and review tered sonographer.
materials also can be found online: the faculty resource
center includes an image bank, chapter outlines, Power- Steven M. Penny
Point presentations, and the mock exams. The student
resource center includes the mock exams and an image
bank.
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R E V I E W E R S
RENATO AGUSTIN, MD JOANN LAMB, RDMS, RVT, RT
Program Director DMS
Diagnostic Medical Sonography Department Cuyahoga Community College
Sanford-Brown Institute Parma, OH
Middleburg Heights, OH
JOANN MCGIVERN, RDMS, RVT
SHARLETTE ANDERSON, BS, RDMS, RVT, RDCS Program Director
Program Director Diagnostic Medical Sonography
Sonography Department Sonography Department
American Institute of Medical Technology Carl Sandburg College
Tulsa, OK Galesburg, IL
PATTY BRAGA, BSRT, RDMS, RVT, RDC NANDKUMAR RAWOOL, MD, RDMS
Program Director Associate Professor, Program Director
Sonography Department Radiologic Sciences Department
Palm Beach Community College Thomas Jefferson University
Palm Beach Gardens, FL Philadelphia, PA
MARCIA COOPER CATHERINE E. RIENZO, MS, RT(R), RDMS
Associate Professor Assistant Professor, Program Director
Imaging Science Department Sonography Department
Morehead State University Northampton Community College
Morehead, KY Bethlehem, PA
MICHELLE M. GAGNON, RDCS, RVT CHERYL ZELINSKY, MM, RT(R), CRT (R,F), RDMS
Associate Professor/Program Director Associate Professor & Diagnostic Medical Sonography
Medical Imaging Program Program Director
Bunker Hill Community College Medical Imaging Department
Boston, MA Oregon Institute of Technology
Klamath Falls, OR
DWIGHT GUNTER, BS, RDMS
Program Chair
Ultrasound Department
Sanford-Brown Institute
Atlanta, GA
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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
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C O N T E N T S
Dedication iii
Preface iv
Reviewers vi
Acknowledgments vii
Contents viii
SECTION 1 Abdominal Sonography Review 01
CHAPTER1 Abdominal Sonography Overview 01
CHAPTER2 The Liver 09
CHAPTER3 The Gallbladder 28
CHAPTER4 The Bile Ducts 38
CHAPTER5 The Pancreas 46
CHAPTER6 The Spleen 56
CHAPTER7 The Urinary Tract 63
CHAPTER8 The Adrenal Glands 90
CHAPTER9 Abdominal Vasculature 97
CHAPTER10 The Gastrointestinal Tract 109
CHAPTER11 Noncardiac Chest and Retroperitoneum 119
CHAPTER12 The Neck 124
CHAPTER13 The Male Pelvis 132
CHAPTER14 Musculoskeletal Imaging and Superficial Structure 147
SECTION 2 Gynecologic Sonography Review 153
CHAPTER15 Gynecologic Sonography Overview 153
CHAPTER16 Anatomy of the Female Pelvis 162
CHAPTER17 The Uterus and Vagina 170
CHAPTER18 The Ovaries and Fallopian Tubes 183
CHAPTER19 The Menstrual Cycle 200
CHAPTER20 Postmenopausal Sonography and Sonohysterography 208
CHAPTER21 Pelvic Inflammatory Disease and Infertility 216
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