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Fall 2014 study > abd 3 > Flashcards

abd 3 Flashcards

1
Q

name the portal triad vessels

A

Main portal vein
proper hepatic artery (rt)
Common hepatic duct (lt)

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2
Q

what is the direction of the fetal circulation

A

Umbilical vein → lt portal vein → ductus venosus → ivc

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3
Q

Name the spectral analysis presentation

A

Flow toward transducer = above baseline

Flow away from transducer = below baseline

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4
Q

located in the right intersegmental fissure and divides the anterior and posterior segments of the right lobe

A

RHV

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5
Q

located in the main lobar fissure and separates the right and left lobes

A

MHV

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6
Q

located in the left intersegmental fissure and divides the lateral and medial segments of the left lobe

A

LHV

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7
Q

Intrasegmental in anterior segment of the right lobe and courses centrally in anterior segment of the right lobe

A

RPV ( anterior branch)

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8
Q

intrasegmental in posterior segment of the right lobe: courses centrally in posterior segment of the right lobe

A

RPV ( posterior branch)

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9
Q

anterior to the caudate lobe, it separates the caudate lobe from medial segment of the left lobe

A

LPV (horizontal segment)

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10
Q

Located in the left intersegmental fissure, in divides medial and lateral segments of the left lobe

A

LPV ( ascending segment)

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11
Q

located in the main lobar fissure, it separates right and left lobes

A

GB fossa

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12
Q

located in the left intersegmental fissure it divides the caudal aspect of the left lobe into medial and lateral segments

A

ligamentum teres

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13
Q

located in the left anterior margin of the caudate lobe, it separates the caudate from the left lobe of the liver

A

ligamentum venosum

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14
Q

what are the three major forms of liver abscesses

A

Pyogenic
amebic
fungal

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15
Q

most often polymicrobial, accounts for 80% of hepatic abscess cases in the united states

A

pyogenic hepatic abscess

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16
Q

due to entamoeba histolytica (10% of cases)

A

amebic abscess

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17
Q

due to candida species (

A

fungal abscess

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18
Q

the differentiation of a pyogenic abscess from an amebic abscess is difficult how do you decide

A

if the patient has traveled out of the united states than amebic abscess may be the correct diagnosis

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19
Q

although ___________ infections are not common in the united states, it is estimated that 400,000 infected persons have migrated to the country

A

schistisomiasis

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20
Q

what are the four types of portal hypertension

A

extrahepatic presinusoidal—— portal vein thrombosis
intrahepatic presimusoidal——-schistosomiasis
intrahepatic—————————-cirrhosis (most common)
intrahepatic postsinusoidal——hepatic vein thrombosis

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21
Q

a patient presents with acute right upper quadrant pain and decreasing hematocrit what is the possible diagnosis?

A

hemorrhagic cyst

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22
Q

list of hyperechoic liver masses

A

hepatic lipoma
hemangioma
echogenic metastases
focal fatty infiltration

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23
Q

______ ,_______ and ________ are monitured prior to and invasive procedure to ensure proper clotting

A

PT(INR), PTT, and platelets

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24
Q

what causes gas in the biliary tree

A 
ERCP
spincter of Oddi papiliotomy
choledochojejunostomy
GB (biliary) fistula
emphysematous cholecystitis
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25
Q

what structures are in contact with the pancreatic head

A 
IVC
CBD
AMPULLA OF VATER (terminal end of CBD)
GDA
Duodenal C loop (2nd portion)
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26
Q

a spreading inflammatory reaction to an infection which forms a suppurative lesion

A

Phlegmon

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27
Q

Although not characteristic of insulinomas and gastrinomas, many pancreatic islet cell tumors are commonly located in the

A

body and tail

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28
Q

what are the most common sites of involvement for Multiple Endocrine Neoplasio (MEN)

A 
parathyroids (hyperparathyroidism)
Pancreatic islet tumors- insulinoma, gastrinoma
pituitary glands- prolactinomas
adrenal glands- pheochromocytomas
thyroid- medullary thyroid carcinoma
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29
Q

How many types of MEN are there

A
  1. wermer syndrome

2. sipples syndrome

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30
Q

the head of the pancreas is

A

anterior to IVC

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31
Q

the head of the pancreas is medial

A

to the 2nd part of the duodenum

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32
Q

the head of the pancreas is anterior and lateral

A

to CBD

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33
Q

the head of the pancreas is posterior and lateral

A

to GDA

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34
Q

the CBD is posterior and lateral to

A

the head of the pancreas

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35
Q

the GDA is anterior and lateral to

A

the head of the pancrea

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36
Q

the SMV is to the right of the

A

SMA

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37
Q

the SMV and SMA are posterior to the

A

neck of the pancreas

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38
Q

the SMV and SMA are anterior to the

A

3rd portion of the duodenum

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39
Q

the SMV and SMA are anterior to the

A

uncinate process

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40
Q

the uncinate process is posterior to the

A

SMV and SMA

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41
Q

the aorta is posterior to the

A

body of the pancreas

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42
Q

the celiac axis is superior to the

A

pancreas

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43
Q

the splenic vein is posterior/ inferior to

A

pancreas

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44
Q

the stomach is anterior and medial to the

A

splenic hilum

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45
Q

the stomach is anterior to the

A

pancreatic body and tail

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46
Q

the tail of the pancreas is posterior to the

A

stomach

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47
Q

the tail of the pancreas is anterior to the

A

upper pole of the left kidney

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48
Q

the splenic artery is superior/ anterior to the

A

pancreas

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49
Q

name the renal vascular flow

A

main renal artery → segmental →interlobar →arcuate →interlobular

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50
Q

name the types of renal cysts

A

pylogenic
parapelvic
peripelvic

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51
Q

calyceal diverticula that sonographically appear as simple cyst

A

Pylogenic cysts

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52
Q

cortical cysts that buldge into the central sinus of the kidney

A

parapelvic cyst

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53
Q

lymphatic cysts in the central sinus

A

peripelvic cysts

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54
Q

what are the locations of renal cysts

A

cortical or parenchymal- periphery of kidney

peripelvic- located in the center ( renal sinus)

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55
Q

refers to the typical physical appearance of a neonate as a direct result of oligohydramnios and compression while in utero

A

Potter syndrome

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56
Q

what are some of the causes of potter syndrome

A 
bilateral renal agenesis
ARPKD
ADPKD
Multicystic renal Dysplasia
Obstructive uropathy (posterior urethral valve defect)
Early rupture of membranes
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57
Q

Pediatric cancer incidence

A 
Leukemia              35.0%
CNS tumors           16.6
Lymphoma             15.0
Neuroblastoma      7.8
Soft tissue sarcoma 7.4
Wilms                         6.3
Bone                          6.0
Hepatic tumors         1.1
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58
Q

name the hyperechoic renal masses

A 
Mycetoma
Angiomyolipoma
Blood clots
Pyogenic debris
Sloughed papilla
Renal stones
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59
Q

What is the most common cause of intrarenal (intrinsic) acute kidney injury?

A

Acute tubular necrosis

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60
Q

what is the normal bladder wall thickness

A

5mm in nondistended bladder

3mm in a distended bladder

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61
Q

Renal artery stenosis is determined by

A

Renal artery/ aorta ratio (RAR) > 3.5

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62
Q

Tardus parvus is defined as a

A

small slow pulse

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63
Q

What are the stages of chronic kidney disease

A

1 GFR >90mL/ min/1.73m2 NORMAL
2 GFR 60.-89 mL/ min/1.73m2 MILD
3 GFR 30-59 mL/ min/1.73m2 MODERATE
4 GFR 15-29 mL/ min/1.73m2 SEVERE
5 GFR

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64
Q

What is the most common neonatal abdominal mass?

A

Multicystic Dysplastic kidney

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65
Q

What is the most common neonatal adrenal mass?

A

Adrenal hemorrhage

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66
Q

What is the most common childhood adrenal mass?

A

Neuroblastoma

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67
Q

what is the most common childhood renal mass?

A

Nephroblastoma

68
Q

what is the order of the testicles

A 
Seminiferous tubules
           ↓
Tubuli Recti
           ↓
Efferent tubules
           ↓
Ductus epidydimis
           ↓
Vas deferens
69
Q

what is within the spermatic cord

A 
Vas deferens 
Cremastic, deferential and testicular artery
Pampiniform plexus of veins
Lymphatics
Nerves
70
Q

The most common correctible cause of male feritility, 90% are on the left

A

Varicoceles

71
Q

The prostate is located in the retroperitoneum bordered anteriorly by

A

the pubic bone

72
Q

The prostate is located in the retroperitoneum bordered posteriorly by the

A

Rectum

73
Q

The prostate is located in the retroperitoneum bordered superiorly by the

A

Bladder

74
Q

The prostate is located in the retroperitoneum bordered inferiorly by the

A

Urogenital diaphragm

75
Q

name the prostate glandular zones

A

peripheral
Central
Transitional
Fibromuscular stroma

76
Q

Posteriorly located portion of prostate

contains 70% of the prostatic glandural tissue this is the location of most prostate tumors

A

Peripheral zone

77
Q

Superiorly located
Contains 25% of the prostate glandular tissue.
Ejaculatory ducts pass through this zone from the seminal vesicles to the urethra

A

Central zone

78
Q

contains 5% of the prostatic glandular tissue.

site of origin of benign prostatic hyperplasia

A

Transitional zone

79
Q

anteriorly located nonglandular portion of the prostate, not affected by cancer prostatitis or hyperplasia

A

Fibromuscular zone

80
Q

What are the retroperitoneal structures?

A 
Kidneys and ureters
adrenal glands
ascending and descending colon
2,3,& 4th parts of the duodenum
pancreas
aorta
IVC
Renal vessels
superior messenteric vessels
gonadal vessels
Lymphatics
Prostate
Rectum
esophagus
81
Q

what is the abd sandwich

A

anterior Transvesalis fascia
Anterior parietal peritoneum
Peritoneal space
Posterior perietal peritoneum
Anterior Pararenal space
anterior renal fascia
Perirenal space
Posterior renal fascia
Posterior pararenal space
Posterior transversalis Fascia

82
Q

the Azygous vein is located on the

A

right

83
Q

the Hemiazygous vein is located on the

A

left

84
Q

the crus of the diaphragm is located anterior to

A

the aorta

85
Q

the crus of the diaphragm is located supertior to

A

the celica axis

86
Q

the crus of the diaphragm is located posterior to the

A

IVC

87
Q

Excessive cortisol secretion is associated with

A

Cushing syndrome

88
Q

Excessive aldosterone is associated with

A

Conn syndrome

89
Q

Excessive androgen

A

Hirsutism

90
Q

What is the most likely diagnosis in a newborn with an abdominal mass and decreasing hematocrit?

A

Adrenal hemorrhage

91
Q

In what direction will the IVC be displaced with a right liver mass?

A

Posterior

92
Q

In what direction will the IVC be displaced with a right renal artery aneurysm?

A

anterior

93
Q

In what direction will the IVC be displaced with a tortous aorta?

A

to the right

94
Q

In what direction will the IVC be displaced with a right adrenal mass

A

medial/ anterior

95
Q

In what direction will the IVC be displaced with a right renal mass

A

medial/ left

96
Q

Lymphadenopathy typically surrounds vessels, but commonly displaces the IVC and SMA

A

Anteriorly

97
Q

In what direction will the splenic vein be displaced by a left adrenal gland mass?

A

Anteriorly

98
Q

In what direction will the bladder be displaced by a hematoma in the pouch of douglas?

A

Anterior

99
Q

With gastric outlet obstruction and dilatation of the stomach, in what direction will wht pancreatic tail be displaced?

A

Posterior

100
Q

In what direction will a mass in the uncinate process displace the smv?

A

anteriorly

101
Q

In what direction will a mass in the left lobe of the liver displace the gastroesophageal junction?

A

posterior

102
Q

the normal intestinal wall is ____________ thick?

A

3-5mm

103
Q

name the layers of the gut wall

A

mucusa
submucusa
Muscularis externa
Adventitia (serosa)

104
Q

what is the typical location of appendicitis

A

Posterior to the terminal ileum

anterior to iliac vessels

105
Q

what are the sono characteristics of appendicitis

A

Non compressible appy
>6mm diameter
appendicolith
(hyperemia)

106
Q

what are the characteristics of Hypertrophic Pyloric Stenosis

A

Neonatal 3-8 wks
Vomiting (nonbloody, nonbilious) projectile
palpable “olive” shaped pylorus
visible peristalsis

107
Q

what are the pylorus size criteria?

A

Muscle thickness >3mm (3-4mm)
Channel length >17mm ( 14-24mm)
cross section diameter 15mm

108
Q

what is the criteria for intussusception?

A 
6m-3 yrs
intermittent abd pain
right sided mass
vomiting
lethargy and irritability ( may be only symptom)
109
Q

Intussusception in the long view looks like

A

Pseudokidney

110
Q

Intussussception in the trans view looks like ?

A

a target sign

111
Q

the strap muscles are ______ to the thyroid

A

anterior

112
Q

the sternocleidomastoid are ______ to the thyroid

A

anterolateral

113
Q

the CCA and IJV are ______ to the thyroid

A

lateral

114
Q

the minor neurovascular bundle is ______ to the thyroid

A

postetior

115
Q

the longus colli muscle is ______ to the thyroid

A

posterior

116
Q

the parathyroid glands are ______ to the thyroid

A

posterior

117
Q

what are the glands that regulate the thyroid hormones

A

Thyroid (T4, T3)
Pituitary (TSH)
Hypothalamus (thyrotropin releasing hormone) TRH

118
Q

with a normal funtioning pituitary and hypothalamus __________goes up and _________ go down, this is considered hypothyroidism

A

TSH ↑

T3, T4↓

119
Q

with a normal funtioning pituitary and hypothalamus __________ goes down and ___________ goes up this is considered Hyperthyroidism

A

TSH↓

T3,T4 ↑

120
Q

Spreads to the lymphatics to nearby lymphoceles

A

Papillary carcinoma

121
Q

spreads via the bloodstream

A

Follicular carcinoma

122
Q

Secretes calcitonin and is associated with multiple endocrine Neoplasia syndrome

A

Medullary carcinoma

123
Q

what are the features associated with thyroid cancer

A 
microcalcification
solid hypoechogenicity
Irregular margins
Absence of halo
Intranodule central vascularity
taller than wider
124
Q

Primary Hyperparathyroidsm (parathyroid adenoma) increases __________ and ___________

A

↑serum parathyroid hormone (parathyroid hyperplasia)

↑ serum calcium

125
Q

Secondary hyperparathyroidism ( parathyroid hyperplasia) had increased ____________ and decreased ___________

A

↑serun Phosphates

serum calcium

126
Q

Cystic hygromas are associated with?

A

Turner syndrome
Trisomy 21,18,13
Klinefelter syndrome (xxy)

127
Q

name the vessels of the aortic arch?

A

innominate artery (brachiocephalic)(rt carotid & rt subclavian)
Left common carotid artery
left subclavian artery

128
Q

There is only ____ innominate ( rt) artery and _____ innominate veins

A

one and two

129
Q

in the abscence of gas within a collection , differentiation of and abscess from a hematoma is by

A

percutaneous aspiration

130
Q

what are the risk factors for hip dysplasia

A 
Female
First born
Frank breech presentation
Family history of DDH
Oligohydramnios
131
Q

a stress maneuver where dislocation of the hip by adducting and pushing the leg posteriorly

A

Barlow

132
Q

Stress maneuver where relocation of the dislocated hip by abducting the legs, a palpable “clunk” is noted as the femoral head slips back into the socket

A

Ortolani

133
Q

Beta angle is

A
134
Q

Alpha angle is

A

> 60 degrees

135
Q

lymphoma is noted to displace the IVC and SMA

A

anteriorly

136
Q

a result of bleeding from the superior and inferior epigastric vessels (superior and inferior to umbilicus) or from a tear of the rectus muscle a recognized complication of anticoagulation therapy

A

Rectus sheath hematoma

137
Q

labs found in hepatitis

A

↑ALT(SGPT)
↑AST(SGOT)
↑CONJUGATED BILIRUBIN
↑UNCONJUGATED BILIRUBIN

138
Q

labs found in Amebic abscess

A

↑LFT’S

139
Q

labs found in Cirrhosis:

A 
↑ALT(SGPT)
↑AST(SGOT)
↑CONJUGATED BILIRUBIN
↑GGT
↑LDH
140
Q

labs found in Hepatocellular carcinoma (HCC)

A

↑ALT(SGPT)
↑AST(SGOT)
↑ALPHA FETOPROTEIN

141
Q

labs found in hepatoblastoma

A

↑ALPHA FETOPROTEIN

142
Q

↑GGT + ↑ALP=

A

biliary obstruction

143
Q

↑GGT + ↑ALT=

A

hepatocellular disease

144
Q

labs with biliary obstruction and Choledocholithiasis

A

↑GGT
↑ALP
↑CONJUGATED BILIRUBIN

145
Q

Labs with cholangitis

A 
↑CONJUGATED BILIRUBIN
↑ALP
↑GGT 
↑AMYLASE
↑LIPASE
↑WBC
146
Q

labs with Primary sclerosing Cholangitis

A 
↑ALT(SGPT)
↑AST(SGOT)
↑CONJUGATED BILIRUBIN
↑GGT
↑ALP (dominates profile)
147
Q

labs in Primary BIliary Cirrhosis

A 
↑ALT(SGPT)
↑AST(SGOT)
↑ALP 
↑GGT
↑ANTIMICROBIAL ANTIBODIES (AMA'S) hallmark
148
Q

labs in acute attacks of pancratitis

A

serum amylase

serum lipase

149
Q

labs in pancreatic carcinoma

A 
↑CONJUGATED BILIRUBIN
↑ALP 
↑GGT
↑serum amylase
↑serum lipase
150
Q

what raises later and lasts longer

A

Lipase

151
Q

Labs for a seminoma

A

↑Beta hCG

↑LDH

152
Q

labs for a neuroblastoma

A

↑epinephrine
↑Norepinephrine
↑dopamine

153
Q

Lab analysis for a paracentesis or a thoracentesis should include

A 
Total protein
LDH
Cell count and differantial
Gram stain
Aerobic and Anaerobic bacterial cultures
cytology
154
Q

the left lateral is segments

A

II and III

155
Q

the left medial is segments

A

IVa and IVb

156
Q

the right anterior is segments

A

V and VIII

157
Q

the right posterior is segments

A

VI and Vii

158
Q

the right hepatic lobe is supplies by the

A

right portal vein

159
Q

the left hepatic lobe is supplied by the

A

left portal vein

160
Q

the caudate lobe is supplied by

A

both right and left portal veins

161
Q

the caudate lobe is posterior to the

A

ligamentum venosum and porta hepatis

162
Q

the caudate lobe is anterior and medial to

A

the IVC

163
Q

the caudate lobe is lateral to

A

the lesser sac

164
Q

in the event of caudate enlargement the IVC may be

A

compressed

165
Q

Which lab value is most sensitive to hepatocellular disease?

A

ALT

166
Q

An increase in AST without ALT is seen with

A

Myocardial infarction

167
Q

Which lab value is specific for obstructive jaundice?

A

Conjugated(direct)

Fall 2014 study (9 decks)

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