Examination Review for Ultrasound: Abdomen and Obstetrics & Gynecology PDF
Preview Examination Review for Ultrasound: Abdomen and Obstetrics & Gynecology
79784_fm.qxd 11/28/09 12:14 PM Page x 79784_fm.qxd 11/28/09 12:14 PM Page i EXAMINATION REVIEW FOR ULTRASOUND ABDOMEN & OBSTETRICS AND GYNECOLOGY Steven M. Penny, B.S., RT(R), RDMS Johnston Community College Smithfield, North Carolina 79784_fm.qxd 11/28/09 12:14 PM Page ii Acquisitions Editor:Peter Sabatini Product Director:Eric Branger Managing Editor:Karen Ruppert Marketing Manager:Allison Noplock Compositor: MPS Limited, A Macmillan Company Printed in China Copyright © 2011 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, Maryland 21201-2436 USA 227 East Washington Square Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. 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 The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800)638-3030or fax orders to (301) 824-7390. International customers should call (301) 714-2324. 79784_fm.qxd 11/28/09 12:14 PM Page iii 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 79784_fm.qxd 11/28/09 12:14 PM Page iv 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 79784_fm.qxd 11/28/09 12:14 PM Page v 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. 79784_fm.qxd 11/28/09 12:14 PM Page vi 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 vi 79784_fm.qxd 11/28/09 12:14 PM Page vii 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 vii 79784_fm.qxd 11/28/09 12:14 PM Page viii 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 vviiiiii
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