UTC Treatment Planning & Management 2 — Questions and Answers
Question 1: When performing a pre-procedure ultrasound for a liver biopsy, which finding would most likely prompt the sonographer to alert the physician before proceeding?
- Mild hepatomegaly
- Ascites surrounding the liver (Correct answer)
- Increased hepatic echogenicity
- Portal vein diameter of 12 mm
Correct answer: Ascites surrounding the liver
Ascites increases the risk of bleeding and complicates needle trajectory, requiring physician assessment before biopsy.
Question 2: A patient is scheduled for ultrasound-guided fine-needle aspiration (FNA) of a thyroid nodule. Which patient preparation step is most critical?
- NPO status for 8 hours
- Discontinuation of anticoagulants per physician order (Correct answer)
- Removal of all neck jewelry
- Hyperextension of the neck for 10 minutes prior
Correct answer: Discontinuation of anticoagulants per physician order
Anticoagulants increase bleeding risk during FNA, and their discontinuation must be ordered by the physician prior to the procedure.
Question 3: During follow-up imaging of a patient with a treated renal cell carcinoma, ultrasound shows a new hypoechoic lesion in the contralateral kidney. What is the most appropriate next action?
- Document findings and schedule routine annual follow-up
- Report findings immediately to the referring physician (Correct answer)
- Perform color Doppler and recommend MRI correlation
- Reassure the patient as contralateral involvement is rare
Correct answer: Report findings immediately to the referring physician
A new suspicious lesion in a patient with known malignancy must be communicated immediately to the referring physician for urgent clinical decision-making.
Question 4: Which measurement is most critical to document when performing serial ultrasounds to monitor response to chemotherapy for a hepatic mass?
- Mass echogenicity pattern
- Maximum diameter in at least two planes (Correct answer)
- Distance from the liver capsule
- Presence or absence of acoustic shadowing
Correct answer: Maximum diameter in at least two planes
RECIST criteria require maximum diameter measurements in standardized planes to objectively assess tumor response to therapy.
Question 5: A patient with ovarian cancer is undergoing ultrasound to assess for ascites prior to paracentesis. Which finding best indicates a sufficient fluid pocket for safe drainage?
- A pocket depth of at least 2 cm free of bowel loops (Correct answer)
- Echogenic fluid with internal septations
- Fluid confined to the right lower quadrant
- Fluid detected only in the rectouterine pouch
Correct answer: A pocket depth of at least 2 cm free of bowel loops
A minimum pocket depth of 2 cm free of intervening bowel loops is required to safely guide paracentesis needle placement.
Question 6: When scanning a patient post-radiofrequency ablation (RFA) of a hepatic tumor, which ultrasound appearance is expected at the ablation zone in the immediate post-procedure period?
- Hyperechoic region with posterior acoustic enhancement
- Anechoic cystic cavity with thin walls
- Hyperechoic area with posterior shadowing or heterogeneous texture (Correct answer)
- Isoechoic region indistinguishable from normal parenchyma
Correct answer: Hyperechoic area with posterior shadowing or heterogeneous texture
Immediately after RFA, the ablation zone typically appears hyperechoic due to microbubble formation and tissue coagulation, often with shadowing.
Question 7: A sonographer notices the patient's heart rate on the monitor is 140 bpm and irregular during a routine abdominal scan. What is the most appropriate response?
- Continue scanning and note the finding in the report
- Immediately stop scanning and call a code blue
- Pause the exam and notify the supervising clinician or nurse (Correct answer)
- Ask the patient if they feel this heart rate is normal for them
Correct answer: Pause the exam and notify the supervising clinician or nurse
An unexpected arrhythmia requires prompt notification of clinical staff who can assess the patient and determine appropriate intervention.
UTC Treatment Planning & Management 2
When performing a pre-procedure ultrasound for a liver biopsy, which finding would most likely prompt the sonographer to alert the physician before proceeding?