Anatomy test #3

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Approximately 1/__ women will develop Breast cancer

...6 or 9

The breast is sonographically divided into three
layers. Which one of the following is incorrect?
a. Skin, nipple, subareolar
b. Pectoralis major
c. Subcutaneous region
d. Parenchyma

B: Sonographically, the breast is divided into the subcutaneous, mammary, and retromammary layers.

The functional portion of the breast consists of _________ lobes.

15 to 20

Which one of the following form(s) a fibrous
"skeleton" that is responsible for maintaining the shape of the breast?
a. Acini
b. Cooper's ligaments
c. Pectoralis major muscle
d. Glandular layer of the breast

B:Cooper's ligaments are the connective tissue septa in the breast that form a fibrous "skeleton" that is responsible for maintaining the shape and structure of the breast.

As a woman ages, the glandular breast tissue is
replaced with?

Fat

Cooper's ligaments are best characterized as
which one of the following?
a. Low reflectivity in the retromammary layer
b. High reflectivity in the retromammary layer
c. Echogenic line interfaces in the subcutaneous layer
d. Homogeneous reflections in the parenchyma

C: Cooper's ligaments appear echogenic and are dispersed in a linear pattern.

The retromammary layer is sonographically
imaged as which one of the following?
a. Hyperechoic
b. Dense
c. Hypoechoic
d. High reflectivity

C: The retromammary layer appears hypoechoic, similar to the subcutaneous layer.

The most important signs to look for in determining a cystic lesion of the breast include all of the following except:
a. Well-defined borders
b. Good through transmission
c. Anechoic
d. Disruption of architecture

D: A simple cyst should demonstrate no internal echoes (anechoic) or smooth borders and demonstrate posterior acoustic enhancement.

Clinical findings of lumpy, painful, tender breasts
that vary with monthly cycles usually represent which one of the following?
a. Carcinoma
b. Fibrocystic disease
c. Cysts
d. Adenomas

B: Symptoms of fibrocystic disease include breast lumps and pain that fluctuates with every monthly cycle.

The characteristic findings of a papilloma of the
breast include all of the following except:
a. Well-circumscribed solid mass with microcalcifications
b. Sonolucent cystic lesions with a medium-level encapsulated component
c. Single or multiple
d. No disruption of architecture

D: Small proliferations of duct epithelium project outward into a dilated duct.

The most common solid benign tumor of the
breast is which one of the following?
a. Fibrocystic disease
b. Fibroadenoma
c. Papilloma
d. Lipoma

B: The fibroadenoma is the most common solid benign tumor of the breast. It occurs primarily in young women.

The most sonographic characteristic of a fibroadenoma is which one of the following?
a. Poorly defined border
b. Uniform, low-level homogeneous echoes
c. Increased through transmission
d. Disruption of architecture

B: Sonographic characteristics of a fibroadenoma include smooth, rounded margins and low-level homogeneous echoes. In addition, sonography may demonstrate immediate posterior acoustic enhancement.

Lymphatic drainage from all parts of the breast generally flows to the _____ lymph nodes.
a. interpectoral
b. axillary
c. supraclavicular
d. internal mammary

B: Lymphatic drainage from all parts of the breast generally flows to the axillary lymph nodes.

The most common malignant neoplasm of the breast is which one of the following?
a. Lobular carcinoma in situ
b. Invasive ductal carcinoma (IDC)
c. Invasive lobular carcinoma
d. Ductal carcinoma in situ

B

Characteristic findings of breast carcinoma include all of the following except:
a. Attenuation of sound
b. Irregular margins
c. Strong posterior margin
d. Inhomogeneous low-level internal echo pattern with calcifications

C: Characteristics of breast cancer include irregular margins; a taller-than-wide mass; and strongly attenuating, rigid, noncompressible, and disrupted architecture.

Skin dimpling may be caused by which one of the
following?
a. Old age
b. Retraction of tissue secondary to tumor infiltration
c. Enlarged ducts
d. Thrombosis of arterial vessels

B: As malignant masses enlarge, they may cause retracting of the nipple or a dimpling of the skin as the spiculations pull on the Cooper's ligaments.

The most common clinical sign of breast
carcinoma is which one of the following?
a. Skin dimpling
b. Skin discoloration
c. Palpable lump
d. Pain

C: A palpable lump is the most common clinical symptom of breast cancer.

The primary purpose of breast screening examinations is to:
a. Evaluate the retromammary region.
b. Provide a baseline study for fibrocystic disease.
c. Provide for early detection of breast carcinoma.
d. Evaluate dense breast parenchyma.

C: The primary purpose of breast screening examinations is the detection and diagnosis of breast cancer at its earliest and most curable stage.

The midportion of the right medial and left lateral
breast would be annotated as which one of the following?
a. 3:00
b. 6:00
c. 9:00
d. 12:00

A: The midportion of the right medial and left lateral breast would be annotated as 3:00.

A normal extension of breast tissue into the \axillary region is called ______________.
a. Lobar neoplasm
b. Tail of Spence
c. Peau d'orange
d. Terminal ductal lobular unit

B
A normal extension of breast tissue into the axillary region is called the tail of Spence.

According to the American Cancer Society, all women should begin annual screening mammography and screening breast ultrasound at the age of _____ years.
a. 20
b. 30
c. 40
d. 50

C
Screening mammograms should be performed annually starting at 40 years of age.

Which one of the following arteries is responsible
for supplying blood to more than one half of the breast?
a. Intercostal
b. Thoracodorsal
c. Internal mammary
d. Lateral thoracic

C
More than one half of the breastâ€"mainly the central and medial portionsâ€"is supplied by the anterior perforating branches of the internal mammary artery.

A condition of the male breast in which the ducta
l elements hypertrophy is called ______________.
a. Mastitis
b. Galactocele
c. Gynecomastia
d. Paget's disease

C
Gynecomastia is a condition in which the ductal elements hypertrophy

Signs of possible breast cancer include all the
following except:
a. Irregular or spiculated mammographic mass, solid on ultrasound
b. Clustered pleomorphic microcalcifications on mammogram, with or without any abnormality on ultrasound
c. Focal distortion on mammogram, and a correlating area of distortion on breast ultrasound
d. A smooth low-density mass, solid lesion that has not changed in over 3 years on ultrasound

D
A smooth, low-density mass on mammography and a sonographic finding of a solid lesion that does not change or grow are characteristic of benign lesions. Microcalcifications, focal distortion and irregular (speculated), high-density masses are signs of breast cancer on mammography. Microcalcifications and focal distortion are often difficult to visualize with ultrasound.

Ultrasound is often of benefit in guiding breast
procedures for all of the following except:
a. Cyst aspiration
b. Fine-needle aspiration cytology (FNAC)
c. Drainage procedures
d. Large-core needle biopsy of microcalcifications

ANS: D

Which one of the following statements is false?

a. Breast ultrasound is the imaging tool of choice to evaluate a breast mass in a teenage girl.
b. Ultrasound of the breast is the primary imaging tool of choice in evaluating a breast mass in a pregnant woman.
c. Breast ultrasound is the primary imaging tool of choice in screening a 45-year-old woman for any evidence of possible breast cancer.
d. In the case of a benign fibroadenoma, the sonographic features of a smooth, sharply circumscribed hypoechoic mass with homogeneous echogenicity and a mild posterior acoustic enhancement will usually be seen.

ANS: C

Ultrasound of the breast is often performed as an
adjunctive imaging tool in all of the following situations except:
a. To assess a smooth mammographic mass as cystic or solid
b. To further evaluate a palpable breast lump in a patient with very dense breast tissue and a negative mammogram
c. To further evaluate a palpable breast lump in a patient with breast implants
d. To further evaluate an asymptomatic patient with large fatty replaced breasts and a negative mammogram

ANS: D
Ultrasound is used to further evaluate symptomatic patients with a negative mammogram.

In the case of a cancerous mammographic mass,
the correlating sonographic mass will likely show which one of the following features?
a. Irregular margin and taller than wide
b. Anechoic
c. Irregular margin and wider than tall
d. Posterior acoustic enhancement

ANS: A
Sonographic characteristics of a malignant mass include indistinct walls, taller-than-wide, hypoechoic, rigid, and strongly attenuating structure.

In the case of a smooth mammographic mass that
is cystic, the correlating sonographic mass will likely show which one of the following features?
a. Irregular margin
b. Anechoic and posterior acoustic enhancement
c. Taller than wide
d. Echogenic and posterior acoustic enhancement

ANS: B

The advantages of breast ultrasound over
mammography in evaluating the breast include all of the following except:
a. Limited radiation exposure to the patient
b. Differentiation of cystic versus solid smooth masses
c. More comfortable examination for the patient
d. Better visualization of juxtathoracic deep tissues

ANS: A
The patient is exposed to no radiation with ultrasound.

The advantages of breast ultrasound over
mammography in evaluating the breast include which one of the following?
a. Can better visualize those often-obscure signs of breast cancer such as microcalcifications.
b. Can better visualize microcystic adenosis with layering milk of calcium and sclerosing adenosis, as well as variants of benign fibrocystic conditions that contain small calcifications as the principle mammographic finding that can be easily overlooked on routine mammographic images.
c. Can better discriminate Cooper's ligaments within lumen of the small ducts of the terminal ductal lobular units (TDLUs).
d. Can better evaluate those hard-to-reach places, such as parasternal tissues and axilla, not well seen on mammography.

ANS: D
Ultrasound can evaluate the parasternal tissues, axilla, and juxtathoracic deep tissues better than mammography

____ gland produces and secretes milk during lactation?

Mammary

Milk Production is controlled by hormones produced by the ____, ___ ___ and _____ ____. While progesterone levels stimilate glandular tissure During PG

Hypothalamus, anterior pituitary and posterior pituitarty.

This gland stores milk?

Montgomerys Gland

This is how the milk is transported to the nipple.

Lactiferous ducts/tubules

Divisions of the Breast anatomy are the ____ ___ which is lobes, lobules ducts and acini and the ___ ____ which is connective tissue and fat.

Parenchymal element; Stromal element

What are the 3 breast layers?

1. Subcutaneous -fat and skin
2. Mammary-glandular tissues, ducts and connective tissues.
3. Retromammary- retromammary fat, muscle and deep conective tissue.

What can yo find in the subcutaneous layer of the breast?

Fatty tissue and cooper ligaments.

This is the functional zone of the breast?

Mammary layer

What structures are found within the mammary layer?

15-20 lobes that are separated by adipose tissue.
Lobules contain glandular tissue(alveoli)
Lactiferous ducts
cooper ligaments
terminal ductal lobar unit.

Vasculature of the breast is : supplied by the ___ ___ ___ and the ___ ___ ____ a branch off of the subclavian artery.

Internal thoracic artery and the internal mammary artery

Venous drainage of the breast happens mainly through the _____ veins.

Superficial

Lymph orginate originates in the connective tissue and majority drains through _____ -__ ___.

Auxillary lymph nodes

What are the scanning planes for the breast>

Sagital (transverse) and Radial/anti radial

Lesion annotation methods?(4)

1. Clock position
2. quadrant
3. distance from the nipple
4. 1,2,3....or A, B, C

In this scanning plane a mass will be the longest axis of a mass as it runs along the ductal system.

Radial

In a younger womens breasts they will have more ___ tissue and older women will have more ___.

Glandular, FAt

The nipple appears as a ____ , with shadowing may be seen due to attenuation.

Homogenous

breast fat is ____ echogenic than surrounding glandular tissue.

Less

Fibroglandular tissue is _____ echogenic, can vary in echo pattern depending on fat dispersed through out.

homogeneous

This is a suspensory ligament that supports connective tissue. curved echogenic striation surrounding hypoechoic fat lobules

Coopers ligaments

When shadowing is seen behind coopers ligaments and glandular tissue this can help rid of it.

Decrease transducer pressure

Ducts vary in size are are larger in nursing moms; what is the normal size range?

1-8mm

THis is a linear structure with medium echogenicity , parallel to chest wall and SHOULD be identified to make sure breast tissue is adequately visualized

Pectoralis major

These appear as a highly echogenic round to oval structure with posterior shadowing

Ribs

Oval hypoechoic structures seen near the axillary region.

Lymph nodes.

Seen posterior to glandular tissue and appears hypoechoic to surrounding parenchymal

Retromammary fat

This is a mommographic image that is read lateral to medial in determining a mass location is?

CC-Craniocaudal mammogram

This is a mammographic image that is read superior and inferior to determine mass location. Film is placed at an oblique angel. Radiograph beam is angled mediolaterally.

MLO- mediolateral oblique

Lab values looked at for breast cancer are _____ ____ which is secreated by the liver and can be elevated with cancer reoccurrence and ____ ____ which is used to evaluate tumor metastasis.

Carcinoembryonic Antigen(CEA) and Alkaline PHosphatase.

A breast screening exam that can be performed at home monthly starting at age 20 .

BSE-breast self-examination

A clinical breats examination should be done between __ to __ and every __ years. for ages ___ and older annually.

20-39; 40+

Mammograms should be started annually at age.

40

Name the risks associated with Stroke?

Age, hypertension, cardiac diseases, elevated choloesterol, smoking, and diabetes

Classic warning signs of a stroke?

Sudden numbness ore weakness in facem arm or legm expecially on one side of the body.
Sudden confusion, trouble speaking m or understanding
Sudden trouble seeing in one or both eyes.
Sudden trouble walking or expiriencing dizzinessm loss or balance or corrdination
sudden headache with no known cause

Normal flow of the vertebral arteries are?

Antegrade flow-toward the head

This is when CA is blocked and the vertebral Artery will be the route and blood will back up in the subclavian artery.

Subclavian steele

The Internal carotid artery feeds the?

Brain..to the middle.

The three layers or walls of the carotid artery? Outer? Middle? Inner

outer= tunica externa
middle=tunica media
inner= tunica interna

The thickest layer of an artery?

Tunica Media

The thickest layer of a vein?

The external-aventicia

In spectral doppler this is the highest peak -resembaling.

The Peak systolic frequency/velocity

When the "mountain " peak is on its way down from peak systole this outer edge is called?

The envelope

The inside of the mountain in spectral doppler>

The window

The first bumb up after the mountains on its up...the foot hills.

Dicrotic Arch

The very end of the wave form in spectral prior to the next peak>

the end diastolic frequency.

In a stenotic carotid at the stenosis the pressure will be _____ and the velocity will be _____

Pressure =decreased at narrowing
Velocity = increased at the narrowing.

After the point of narrowing in carotid stenosis pressure will ____ and velocity will_____.

Pressure=increased
Velocity = decreased

Spectrap transcranial exam uses a ___ MHz sector transducer. What are some indications in which this exam should be performed?

2Mhz sector-
Vasospasm( subarachnoid hemorrhage and migraine)
Intracrainial stenosis
evaluation of hemodynamic effects of extracranial occlusive disease.
Detection of arteriovenous malformation
Carotid endarterectomy

Scanning position of a transcrainial exam?

Supine
-Scan the circle of wilis around the temporal region.

What are the indications leading to a CCA scan?

-Vertigo
-Dizzy
_ Vision Problems
-stroke
- Family HX
- Numbness
-weakness
-bruit(noise)
-Speech problems

Normal carotid wall thickness is less than?

.9mm

The location of the ICA is ___ and ____ and had no branched coming off of. THe waveform is ___ and will a temp tap work to identify this vessel?

Posterior/lateral-waveform low, temp tap will not work and is typically bigger than the ECA

THe location of the ECA is __ and ___ and the first branch of the ECA is_____ a the wave form is ___ resistance and a temporal tap will work to prove this vessel.

Anterior and medial; 1st branch is th e STA; waveform is high resistance and smaller than ICA a temp tap assists in identifying this vessel.

The subclavian artery is low or high resistance>

High

What are the reasons in which we would evaluate the venous system?

Look for deep vein thrombosis
follow-up on DVT
Superficial vein Thromb
Evaluate saphenous veins for potentioa lgraft material
incompenance of valves

Symptoms of DVT?

Evtremity swelling
extremity discoloration
varicose veins
pain
shortness of breath

3 Factors asscociated with thrombus formation

1. Hypercoagulable state
2. venous stasis
3. Vein wall injury

Risk factors for DVT

>40, Malignancy, previous DVT or PE, immobilization, Fracture of pelvis, hipm or long bones., Myocardial infarction, stroke

What transducers are used to evaluate the extremity veins?

5-7 MHx linear array
3-5 MHz curved
3-5 MHz sector transducer

Name the Superficial veins in the upper extremity?

Cephalic, Medial Cubital, Basalic

THe deep veins of the upper extremities?

Radial, ulnar, brachial, axillary, subclavian(all paried but subcl.)

In an upper extremity protocol what veins are imaged?

Subclavian, axillary, brachialn cephalic and lasilic in lng and trans planes; use cdop, spec dop and compression

Patients position with an upper extremity scan?

Supine, semi-fowlers position, arem up with bent elbow when scanning upper arem and lateral chest, distal arm-pt arm downa nd straight with palm up.

What are some doppler characteristics of the upper extremity veins?

Phasic with respiration
inspiration decreses the intrathoracic pressure(which venous return is encouraged)
A signal from the proximal veins is normally pulsitile with cardiac activity.

During Inspiration _____ decreses, ______ pressure increases, outflow of the peripheral veins decrease , and blood flow moves from the abdomen to the chest.

Intrathoracic pressure decreases, intrabdominal pressure increases...opposite happens during expiration.

5 factors that determine the rate of blood returned to the heart.

1. Calf muscle pump
2. Cardiac factors
3. Venous pressure
4. Venous valves
5. Respiratory related pressures in the thorax

What veins drain the gastrocnemuis muscle and soleal muscle.

Deep veins

______ veins are paried with an artery.

Gastronecmius

____ sinuses do not have arteries and drain into the PTV and PER veins.

Soleal

Venous sinuses act as a _____ for venous blood and are important part of the calf muscle pump.

Resercoir

What are perforator veins?

Communicating veins that connect the deep and superficial ceins, mostly found in medial calf, normal hard to find, insufficient can be identified in the upright position.

THis is a common fluid collection seen in the popliteal fossa?

Bakers cyst

what is a bakers cysts' contents?

Synovial fluid. usually found in those with arthritis or injuty, -be carful as can mimic DVT

Where should you look if you find an aneurysm in the popliteal fossa?

In the AO--high % happen together.

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