Which of the following must be sterile for a percutaneous procedure?
Answer(s): D
In percutaneous procedures such as biopsies or drainages, maintaining a sterile field is critical to avoid introducing infection. While the transducer is covered by a sterile cover, the gel placed inside this cover (between the probe and the cover) must also be sterile, as it contacts the sterile field. The transducer itself and machine controls are not sterile but are handled appropriately to avoid field contamination.According to the AIUM Guidelines:"Sterile coupling gel must be used inside the sterile probe cover during all invasive or percutaneous procedures." (AIUM Guidelines for Cleaning and Preparing Ultrasound Transducers, 2021).
AIUM Guidelines for Cleaning and Preparing Ultrasound Transducers and Equipment for Reuse, 2021.ACR Practice Parameter for Performing Ultrasound-Guided Procedures, 2020.
Which probe frequency is most appropriate for imaging of the salivary glands?
Salivary glands are superficial structures, and high-frequency transducers (1015 MHz) are optimal to obtain high spatial resolution. Lower frequencies are inappropriate as they lack sufficient resolution for superficial structures. A 12 MHz transducer provides excellent detail necessary for detecting small lesions, duct abnormalities, and vascular structures.According to Rumack et al., Diagnostic Ultrasound:"High-frequency linear transducers (1015 MHz) are recommended for evaluating superficial structures such as salivary glands." (Rumack CM et al., Diagnostic Ultrasound, 5th ed.).
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier; 2017.AIUM Practice Parameter for the Performance of a Head and Neck Ultrasound Examination, 2020.
A patient with hepatocellular carcinoma presents for a paracentesis. Which lab value is the most pertinent to the procedure?
Answer(s): A
Before performing a paracentesis, assessment of the patient's coagulation status is crucial to minimize bleeding risk. The International Normalized Ratio (INR) is the standard lab value used to assess coagulation. Elevated INR may increase the risk of bleeding complications during the procedure. ALT, AFP, and bilirubin levels evaluate liver function or cancer progression but are not directly relevant to bleeding risk for this procedure.As per AASLD and SIR guidelines:"An INR and platelet count should be evaluated before paracentesis to assess bleeding risk. Minor elevations in INR (<1.5) may not contraindicate the procedure." (AASLD Practice Guidance, 2021; SIR Consensus Guidelines, 2019).
American Association for the Study of Liver Diseases (AASLD), Management of Ascites, 2021.Society of Interventional Radiology (SIR) Consensus Guidelines for Coagulation Parameters in Image- Guided Procedures, 2019.
Which cause of transudative pleural effusion is most common?
Transudative pleural effusions result from imbalances in hydrostatic and oncotic pressures, most commonly caused by congestive heart failure (CHF). In CHF, elevated hydrostatic pressure in the pulmonary capillaries leads to fluid leakage into the pleural space without significant protein or cellular content (hence, transudate). Exudative effusions (associated with infections, malignancy, and inflammation) are more often seen with pulmonary emboli, lymphoma, or empyema.According to Light's criteria (which differentiates transudates from exudates):"Congestive heart failure remains the leading cause of transudative pleural effusions." (Light RW.Pleural Diseases, 6th ed.).
Light RW. Pleural Diseases. 6th ed. Lippincott Williams & Wilkins, 2013.American Thoracic Society Guidelines for Diagnosis and Management of Pleural Effusion, 2019.
Which sonographic appearance of the normal epididymis is the most common?
Answer(s): C
The normal epididymis typically appears as a homogeneous structure that is either isoechoic or slightly hypoechoic compared to the testis. The most accurate description is "homogeneous compared to the testis," meaning the texture is uniform. It is not anechoic, nor does it typically show irregular borders unless pathology is present.According to Rumack's Diagnostic Ultrasound:"The normal epididymis appears homogeneous and is isoechoic or slightly hypoechoic relative to the testis." (Rumack CM et al., Diagnostic Ultrasound, 5th ed.)
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier; 2017.AIUM Practice Parameter for Scrotal Ultrasound, 2020.
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