Clinical Rotation II: Self Study

The liver is suspended from the diaphragm and anterior abdominal wall by the:

falciform ligament

Fatty infiltration may be seen in all patients except those with:

hepatoportal fistula

Sonographic findings of acute hepatitis include:

accentuated brightness, more extensive demonstration of portal veins radicles, and overall decreased echogenicity of liver

Budd-Chiari syndrome is a rare disorder caused by the obstruction of the:

hepatic vein

Echinococcal cysts have the highest incidence in countries in which:

sheep grazing is common

The most common benign tumor of the liver is:

cavernous hemangioma

What benign liver tumor has been found in patients with Type 1 Glycogen storage disease?

adenoma

Patients who have hepatocellular carcinoma are likely to have had:

cirrhosis

The most common form of neoplastic involvement of the liver is:

metastases

The fossae of the right portal vein (RPV) and gallbladder are found in the:

main lobar fissure

In severe hepatocellular destruction, the AST and ALT are:

high

Elevation of alkaline phosphate is associated with:

biliary obstruction

Diminished vascular structures within the liver parenchyma most likely represent:

cirrhosis

The falciform ligament extends from the umbilicus to the diaphragm in a parasagittal plane containing the:

ligamentum teres

Elevation of serum bilirubin results in:

jaundice

Which of the following should be done to image the near field of the liver?

change from a sector to a curved array transducer

Typical symptoms a patient may have with an abscess formation include all of the following except:

decreased white blood count

Jim MacDonald, a sheep farmer, arrives at the hospital with right upper quadrant pain, fever, and elevated white blood cell count. He states that 3 months ago he was kicked in the ribs. An irregular mass showing low-level echoes is found on the sonogram. What is your differential diagnosis?

echinococcal cyst

The vascular tumor composed of blood vessel cells with nonspecific sonographic findings is:

hemangioma

Dilated intrahepatic bile ducts may be seen with all of the following except:

gallstones in the fundus of the gallbladder

Hepatocellular disease can be defined as a process that affects the:

hepatocytes and interferes with liver function

In glycogen storage disease, Type 1 in the most common. This is also known as:

von Gierke’s disease

Normal average measurement of the portal vein is:

1.3 cm

Which of the following is noted in Type 1 glycogen storage disease?

echogenic large liver, hepatic adenomas

All of the following are true about the features most often observed in an extrahepatic mass except:

posterior shift of IVC

All of the following are true about the features most often observed in an intrahepatic mass except:

anterior displacement of the right kidney

The most common site for Echinococcal virus growth is the:

liver

The amebic abscess may reach the liver through the:

portal vein

What benign liver tumor is located near the free edge of the liver, is solitary, well circumscribed, and in a nonencapsulated multinodular mass?

focal nodular hyperplasia

In the pediatric population the most common malignancies include all of the following except:

hepatoblastoma

If a patient has chronic choledocholithiasis, all of the following structures are dilated except the:

pancreatic duct

The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the:

common hepatic duct

The diameter of the common hepatic duct is:

4 mm

The hepatic duct is joined by the ___ to form the ___.

cystic duct; common bile duct

In a 60-year-old adult, the normal common bile duct should not measure than:

6 mm

The distal duct lies ___ with the anterior wall of the inferior vena cava (IVC).

parallel

The cystic duct connects the ___ of the gallbladder with the common hepatic duct to form the ___.

neck; CBD

A phrygian cap of the gallbladder is:

folding of the fundus

The function of the gallbladder is:

reservoir of bile

Hartmann’s pouch is formed:

when the gallbladder folds back on itself at the neck

The bright linear echo within the liver connecting the gallbladder and the right or main portal vein is the:

main lobar fissure

An extrahepatic mass compressing the common bile duct can produce an enlarged gallbladder. This sign is known as

Courvoisier’s sign

The ___ branch of the hepatic artery can be seen between the common duct and the portal vein as a small circular structure.

right

Classic symptoms of gallbladder disease include all of the followinf except:

hematuria

Thickening of the gallbladder wall may be caused by all of the following except:

pancreatitis

The most common sign for carcinoma of the gallbladder is:

irregular fungating mass tat contains low-intensity echoes within the gallbladder

The common bile duct is joined by the main pancreatic duct. Together the open through the ___ into the duodenal wall.

ampulla of Vater

A fusiform dilation of the common bile duct that causes obstruction is known as:

choledochal cyst

Inflammation of the gallbladder is:

cholecystitis

A condition causing RUQ pain in which small polypoid masses arise from the gallbladder wall is:

adenomyomatosis

Gallstone appearance on ultrasound examination is:

dependent, mobile, echogenic

Cholelithiasis is characterized on ultrasound as:

clean shadow with distinct margins

In the case of a porcelain gallbladder, all of the following facts are true except:

dense wall without shadowing

Nonshadowing, low-amplitude echoes in a dependent gallbladder is most characteristic of:

sludge

Gallbladder perforation may appear in patients with any of the following diseases except:

negative Murphy’s sign

The ultrasound appearance of a gallbladder neoplasm is:

wall thickening, wall mass

The physiologic effect of a fatty meal includes all of the following except:

decrease of bile flow to the liver

The most common level of obstruction is:

cystic duct

Ultrasound findings in a primary neoplasm include all of the following except:

a normal duct

The most frequent cause of metastatic disease to the biliary system is:

melanoma

The pancreas is a ___ gland.

retroperitoneal

The pancreas is found behind the ___ omental sac

lesser

Which of the following statements is false?

The head of the pancreas is superior to the caudate lobe.

The head of the pancreas lies in the:

lap of the duodenum

The head of the pancreas is inferior to the:

caudate lobe if liver

The ___ passes through a groove posterior to the pancreatic head.

common bile duct

The ___is the anterolateral border of the pancreas.

gastroduodenal artery

The tail of the pancreas is found:

anterior to the left kidney, near the splenic hilum

The primary pancreatic duct is the:

duct of Wirsung

The duct receives tributaries from lobules at right angles and enters the medial second part of the duodenum with the common bile duct at the:

ampulla of vater

What vessel passes anterior to the third part of the duodenum and posterior to the neck of the pancreas?

superior mesenteric vein

The head of the pancreas, the duodenum, and parts of the stomach are supplied by the:

gastroduodenal artery

The duct of Santorini is a/an:

accessory duct to the pancreas

The normal dimension of the pancreatic head is usually less than:

2 cm

The normal size of the pancreatic duct is less than:

3 mm

The enzyme is the most sensitive over time in laboratory tests for the diagnosis of acute pancreatitis is:

lipase

What is the microscopic collection of cells numbering 1 to 2 million embedded within tissue throughout the gland?

islets of Langerhans

The splenic vein is considered to be the:

medial posterior border of the pancreas

If the celiac axis is well visualized, the sonographer should move the transducer in which direction to image the pancreas?

inferior

The splenic artery is considered to be the:

superior border of the pancreas

The main pancreatic duct joins the ___ before entering the second part of the duodenum.

common bile duct

Clinical signs and symptoms in acute pancreatitis include all of the following except:

severe abdominal pain radiating to the right shoulder

A common cause of acute pancreatitis is:

alcohol intake

The pancreatic is reflective in its sonographic appearance because of the multiple:

fat between the lobules

What vessel runs posterior to the lower neck of the pancreas and anterior to the uncinate process?

superior mesenteric vein

The persistence of the dorsal and ventral pancreas with the head encircling the duodenum is called:

annular pancreas

A condition that causes increased secretion of abnormal mucus by the exocrine gland is:

cystic fibrosis

Gallstones are present in 40% to 60% of patients with:

acute pancreatitis

A common course of enzyme destruction via the pancreas is accumulation in the:

lesser sac

On ultrasound, acute pancreatitis may appear:

hypoechoic

An elderly man with a history of alcoholism recently was diagnosed with acute pancreatitis. He now presents with decreased hematocrit and hypotension. Your differential includes:

pancreatic hemorrhage

The spreading process of diffuse inflammatory edema of soft tissues that may proceed to necrosis and suppuration is:

phlegmon

The most common cause of acute pancreatitis in children is:

trauma

A patient who presents with jaundice, weight loos, and a palpable right upper quadrant (RUQ) mass should be elevated for:

adenocarcinoma of the pancreas

A congenital obstruction found in utero as well as infants is:

uteropelvic junction obstruction (UPJ)

Parapelvic cysts are located in the:

renal hilum

The most common solid renal mass found in childhood is:

Wilm’s tumor

A cause of non obstructive hydronephrosis is:

overhydration

A sign of transplant rejection is:

resistive index (RI) greater than 0.7

Fusion of the lower pole of the kidneys is called a:

horseshoe kidney