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SONOCAN ABD Review > Biliary Review > Flashcards

Biliary Review Flashcards

1
Q

Cholangiocarcinoma is located at the junction of the right and left hepatic ducts is termed:

  1. Biloma
  2. Phlegmon
  3. Caroli disease
  4. Klatskin tumor
A
  1. Klatskin tumor
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2
Q

What is a biloma?

A

Extrahepatic collection of extravasated bile

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3
Q

What is a phlegmon?

A

Extension of pancreatic inflammation into the peripancreatic tissues

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4
Q

What does Caroli’s disease look like on U/S?

A

Saccular or beaded appearance to the intrahepatic biliary tree

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5
Q

Which of the following patient positions may aid in visualization of the cystic duct?

  1. Supine
  2. Prone
  3. Left posterior oblique
  4. Trendelenburg
A
  1. Trendelenburg

RLD works as well

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6
Q

A small septation located between the neck and body of the GB best describes?

  1. A junctional fold
  2. A phrygian cap
  3. Hartmann pouch
  4. Diverticulosis of the GB
A
  1. Junctional fold
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7
Q

A hypoechoic focus with marked posterior acoustic shadowing is demonstrated in the anterior wall of the GB. This is most consistent with which of the following pathologies?

  1. Emphysematous cholecystitis
  2. Porcelain GB
  3. Cholelithiasis
  4. Mirizzi syndrome
A
  1. Porcelain GB
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8
Q

Emphysematous cholecystitis appears on U/S how?

A

An echogenic focus in the GB wall or lumen with ill defined posterior acoustic shadowing

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9
Q

What is Mirizzi syndrome?

A

Condition caused by a lodge stone in the neck of the GB or cystic duct

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10
Q

Non shadowing, low amplitude echoes located in the dependent portion of the GB best describes:

  1. Cholecystitis
  2. Cholelithiasis
  3. Biliary sludge
  4. Adenomyomatosis
A
  1. Biliary sludge
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11
Q

Which of the following is associated with cholesterolosis?

  1. Increase in serum cholesterol levels
  2. Intolerance to fatty foods
  3. Decrease in serum cholesterol levels
  4. Local disturbance in cholesterol metabolism
A
  1. Local disturbance in cholesterol metabolism
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12
Q

The spiral valves of heister are located in which of the following structures?

  1. Cystic ducts
  2. Duct of wirsung
  3. CBD
  4. CHD
A
  1. Cystic duct
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13
Q

A patient presents with sudden onset of abdominal pain and extreme tenderness over the GB fossa. Located GB wall thickening is visualized on U/S. The most likely represents:

  1. Cholelithiasis
  2. Acute Cholecystitis
  3. Adenomyomatosis
  4. Gallbladder carcinoma
A
  1. Acute cholecystitis
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14
Q

Which of the following findings is identified in this sonogram?

  1. Cholangitis
  2. Cholecystitis
  3. Cholangiocarcinoma
  4. Choledocholithiasis
A
  1. Choledocholithiasis
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15
Q

Complications with this abnormality would most likely include:

  1. Biliary obstruction
  2. Cholecystitis
  3. Lymphadenopathy
  4. Portal hypertension
A
  1. Biliary Obstruction
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16
Q

A sagittal sonogram in a neonate demonstrates a small contracted GB (arrow) and a large anechoic nonvascular tubular structure in the region of the porta hepatis. The anechoic structure is most suspicious for:

  1. Hepatic cyst
  2. Hepatic artery aneurysm
  3. A choledochal cyst
  4. GB duplication
A

A choledochal cyst

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17
Q

The GB in this sonogram is demonstrating

  1. A phrygian cap
  2. Hartmann pouch
  3. Junctional fold
  4. GB diverticulum
A

A. Phrygian cap

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18
Q

Which type of sonographic artifact is demonstrated adjacent to this structure?

  1. A grating lobe
  2. Refraction
  3. Reverberation
  4. Slice thickness
A
  1. Refraction
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19
Q

The biliary system has three main functions. Which of the following describes one of these functions?

  1. Produces bile
  2. Stores enzymes
  3. Stores fats
  4. Stores Biles
A
  1. Stores bile
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20
Q

Which of the following conditions is most likely to occur with an episode of prolonged fasting?

  1. Cholangitis
  2. Biliary sludge
  3. Cholelithiasis
  4. GB carcinoma
A
  1. Biliary sludge
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21
Q

The GB wall is composed of which of the following layers?

  1. Serosal, subserosal, muscular, and epithelial
  2. Serosal, endothelial, muscular, and epithelial
  3. Serosal, subserosal, Muscular, and endothelial
  4. Serosal, subserosal, endothelial, and epithelial
A
  1. Serosal, sub serosal, muscular, and epithelial
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22
Q

The distal portion of the CBD terminates in which of the following structures?

  1. Pylorus
  2. Pancreas
  3. Duodenum
  4. Hepatic hilum
A

c. Duodenum

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23
Q

In the portal hepatis, the common hepatic duct is located:

  1. Posterior to the MPV
  2. Lateral to the Proper hepatic artery
  3. Medial to the proper hepatic artery
  4. Anterior to the common hepatic artery
A
  1. Lateral to the proper hepatic artery
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24
Q

Which of the following is an indication for GB ultrasound?

  1. Elevated creatinine
  2. LUQ pain
  3. Positive Mcburney’s sign
  4. Intolerance to fatty foods
A

d. Intolerance to fatty foods

25
Q

Which of the following hormones stimulates GB contraction and the secretion of pancreatic enzymes?

  1. Amylase
  2. Gastrin
  3. Bilirubin
  4. Cholecystokinin
A
  1. Cholecystokinin
26
Q

The inner diameter of normal fasting adult GB should not exceed?

  1. 2 cm
  2. 4 cm
  3. 6 cm
  4. 10 cm
A
  1. 4cm
27
Q

The findings demonstrated in this sonogram most likely represent

  1. An abscess
  2. Empyema
  3. Biliary sludge
  4. GB carcinoma
A
  1. Biliary sludge
28
Q

The hyperechoic linear structure identified by the arrow is the

  1. Ligamentum venosum
  2. Intrasegmental fissure
  3. MLF
  4. Falciform ligament
A
  1. MLF
29
Q

This hyperechoic structure is routinely used as a sonographic landmark to located which of the following structures?

  1. Caudate lobe
  2. GB
  3. Left lobe of the liver
  4. CHD
A
  1. GB
30
Q

This sonogram of the GB shows which of the following pathologies?

  1. Cholelithiasis
  2. Adenomyomatosis
  3. Acute cholecystitis
  4. Tumefactive sludge
A
  1. Cholelithiasis
31
Q

Which of the following technical factors would aid in the diagnosis of the pathology?

  1. Deep inspiration
  2. Drinking 12 oz of water
  3. An intercostal approach
  4. Patient position change
A
  1. Patient position change
32
Q

Gravity dependent low level echoes within the bile ducts describe:

  1. Hemobilia
  2. Cholangitis
  3. Pneumobilia
  4. Klatskin tumor
A
  1. Hemobilia
33
Q

Which of the following enzymes is produced primarily by the liver, bone, and placenta?

  1. ALT
  2. Alkaline phosphatase
  3. AST
  4. Prothrombin
A
  1. Alkaline phosphatase
34
Q

A decrease in diameter of the CBD after ingestion of a fatty meal is associated with?

  1. Normal findings
  2. Cholecystitis
  3. Distal pathology
  4. Obstructive jaundice
A
  1. Normal findings
35
Q

Thickness of the GB wall in a normal fasting patient should not exceed:

  1. 3mm
  2. 6mm
  3. 8mm
  4. 10mm
A
  1. 3mm
36
Q

Dilation of the intrahepatic ducts with normal extrahepatic ducts is characteristic of

  1. Cholangitis
  2. Klatskin tumor
  3. Choledocholithiasis
  4. Pancreatic neoplasm
A
  1. Klatskin tumor
37
Q

Which of the following complications associated with acute cholecystitis is more prevalent in older diabetic patients?

  1. Hepatic abscess
  2. Ascending cholangitis
  3. Gangrenous cholecystitis
  4. Emphysematous cholecystitis
A
  1. Gangrenous cholecystitis
38
Q

As dilation of the intraheptic biliary tree progresses, the portal system becomes

  1. Rounded
  2. Fusiform
  3. Beaded
  4. Flattened
A
  1. flattened
39
Q

The sonogram is most likely demonstrating:

  1. Acute cholecystitis
  2. GB hydrops
  3. Chronic cholecystitis
  4. ectopic GB
A
  1. GB hydrops
40
Q

The TRV diameter of the Normal GB should not exceeed how much?

A

4cm

41
Q

What happens if the TRV GB exceeds 4cm?

A

Hydrops

42
Q

The GB in this sonogram is demonstrating:
1. WES sign
2. Target sign
3. Murphy sign
4. Comet- tail artifact

A
  1. WES sign
43
Q

The sonographic findings are most consistent with:

  1. Adenomyomatosis
  2. Tumefactive sludge
  3. Multiple adenomas
  4. Metastatic leisons
A
  1. Multiple adenomas
44
Q

An asymptomatic patient with history of cholecystectomy of 3 years earlier presents for an abdominal U/S. Based on the clinical history, the abnormality documented in this sonogram most likely represents:

  1. Surgical clips
  2. Pneumobilia
  3. Arterial calcificaitons
  4. Choledocholithiasis
A
  1. Pneumobilia
45
Q

The sonographic findings are most consistent with:

  1. Cholelithiasis
  2. Acute cholecystitis
  3. Chronic cholecystitis
  4. Adenomyomatosis
A

Adenomyomatosis

46
Q

Which of the following acoustic artifacts is associated with this finding?

  1. Comet tail artifact
  2. Edge artifact
  3. Mirror image
  4. Posterior acoustic shadowing
A
  1. Comet tail artifact
47
Q

A small protrusion near the neck of the GB describes:

  1. A junctional fold
  2. Hartmanns pouch
  3. A choledochal cyst
  4. Morisons pouch
A
  1. Hartmanns pouch
48
Q

In biliary obstruction, identifying multiple anechoic tubular structures in the left lobe of the liver is termed:

  1. Parallel channeling
  2. Stare effect
  3. Murphey’s sign
  4. Twinkle sign
A
  1. Parallel channeling
49
Q

Which of the following liver function tests is produced form the breakdown of hemoglobin

  1. Bilirubin
  2. AFP
  3. Alpha phosphatase
  4. Alanine aminotransferase
A
  1. Bilirubin
50
Q

Which of the following are predisposing factors linked to the development of cholelithiasis

  1. Family history, pregnancy, obesity, and pancreatitis
  2. Female gender, Family history, Progesterone replacement therapy, and hepatitis
  3. Diabetes mellitus, fair complexion, male gender, and cirrhosis
  4. Obesity, fair complexion, pregnancy, diabetes mellitus
A
  1. Obesity, fair complexion, pregnancy, diabetes mellitus
51
Q

Which of the following technical factors would most likely aid in demonstrating shadowing posterior to small-caliber gallstones?

  1. Decreased image depth
  2. Decreased overall gain
  3. Increased transducer frequency
  4. Fewer focal zones
A
  1. Increased transducer frequency
52
Q

Which of the following is the most likely cause of ascariasis?

  1. Bile stasis
  2. Surgical procedure
  3. Ingestion of contaminated water
  4. Hyperplasia of the GB wall
A
  1. Ingestion of contaminated water
53
Q

All of the following are potential differential considerations in cases of pneumobilia except

  1. Stent
  2. Surgical clip
  3. Biliary calculus
  4. Cavernous hemangioma
A
  1. Cavernous hemangioma
54
Q

Pneumobilia usually demonstrates which U/S characteristics?

A

Hyperechoic focus with posteriro acoustic shadowing.

55
Q

Differential considerations for the findings in this u/s may include all the following except:

  1. Adenoma
  2. Tumefactive sludge
  3. GB carcinoma
  4. Metastatic GB Disease
A
  1. Tumefactive sludge
56
Q

Additional clinical history of pancreatic carcinoma is documented in the patients chart. Multiple target shaped lesions are demonstrated within the liver. Given this additional information, the echogenic mass is most suspicious for

  1. Adenoma
  2. Tumefactive sludge
  3. GB carcinoma
  4. Metastatic GB disease
A
  1. Metastatic GB disease
57
Q

Which of the following congenital GB anomalies is most likely demonstrated in this sonogram of the GB?

  1. Phrygian cap
  2. GB duplicaiton
  3. Multiseptated GB
  4. Strawberry GB
A
  1. GB duplicaiton
58
Q

A patient presents with an acute onset of RUQ pain. Based on this clinical history, the sonogram is most suspicious for?

  1. WES
  2. Acute cholecystitis
  3. Cholangiocarcinoma
  4. GB carcinoma
A
  1. Acute cholecystitis

SONOCAN ABD Review (22 decks)

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