Clinical #1 Flashcards
When evaluating the venous outflow of a liver transplant patient, it is most important to check the surgical history to find ___ before scanning.
what segment of the PV was attached to the HV
what segment of the PV was attached to the IVC
the patient’s current LFT levels and PT
the type of surgical anastomosis
the type of surgical anastomosis
( anastomosis sites are common sites of obstruction )
Which of the following is associated with hypoglycemia?
oncocytoma
diabetes mellitus
mucinous cystadenoma
islet cell tumor
islet cell tumor
You are scanning the GB and you obtain images of several echogenic foci within the lumen. What should you do next to better evaluate the findings?
have the patient drink water and rescan
change the patient position and rescan
ask the patient to perform the valsalva maneuver
apply color Doppler and obtain a PW sample
change the patient position and rescan
Which of the following is an appropriate indication for a liver transplant?
extrahepatic malignancy
Hep C
cholangiocarcinoma
current alcohol abuse
Hep C
Hypersplenism and anemia are common findings in cases of:
cirrhosis
asplenia
sickle cell disease
celiac disease
cirrhosis
Which of the following describes the best technique to differentiate a polyp in the GB wall from a stone within the lumen?
apply color Doppler
ask the patient to perform the valsalva maneuver
roll the patient into the LLD position
have the patient drink water and rescan the GB
roll the patient into the LLD position
Which probe position is used to demonstrate a longitudinal view of the MPV entering the liver?
SAG subcostal position just to the right of midline
oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch
SAG subcostal position just to the left of midline
oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more inferiorly than the side of the probe without the notch side
oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch
The best way to differentiate hepatic jaundice from obstructive jaundice is:
evaluate the diameter of the biliary duct
measure serum levels of AFP
measure levels of total bilirubin in the blood
evaluate the liver for tumor formation
evaluate the diameter of the biliary duct
( if bile ducts are normal size, the cause of the jaundice is not obstructive )
A patient with multiple gastrinomas will usually present with what other GI tract issue?
esophageal and gastric varices
mesenteric ischemia
peptic ulcer formation
intussusception
peptic ulcer formation
A patient is referred for an abdominal ultrasound due to an abnormal CT scan. The yellow arrow indicates the GB. Based on the single CT image, which of the following is an expected finding on the ultrasound evaluation?
extrahepatic ductal obstruction
klatskin tumor
hydropic GB
GB wall thickness >3mm
GB wall thickness > 3mm
Decreased serum albumin levels are associated with the development of ___.
ascites
kidney stones
thyroid adenomas
epididymitis
ascites
Which of the following ultrasound exams requires the patient to be NPO for accurate results?
abdominal ultrasound for possible Crohn disease
RUQ ultrasound for possible hepatoma
RUQ ultrasound for possible cholecystitis
ABD ultrasound for possible rectus sheath hematoma
RUQ ultrasound for possible cholecystitis
A patient presents for an abdominal ultrasound due to elevated LDH and a low grade fever. Which of the following is the most likely finding on the exam?
Wilson disease
steatosis
hepatitis
choledocholithiasis
hepatitis
Which of the following lab values is usually unaffected by an isolated biliary duct obstruction?
total bilirubin
GGTP
AST
ALP
AST
Budd Chiari syndrome, portal thrombosis, and splenomegaly are complications of:
anemia
steatosis
polycythemia vera
increased PT
polycythemia vera
While scanning in the TRV plane of the abdomen, you notice a round anechoic structure just anterior to pancreatic head. Which of the following should be the next step in evaluating this finding?
apply color Doppler
evaluate the kidneys for cysts
have the patient drink water
scan the patient in the decubitus position
apply color Doppler
A patient is referred for an abdominal ultrasound due to an abnormal CT scan. Refer to the image to determine where will you find the largest liver mass?
caudate lobe
right anterior superior segment
right posterior superior segment
left medial superior segment
right anterior superior segmet
You are trying to scan the liver from a midline window but there is excessive gas in the GI tract. All of the following techniques can aid in better visualization of the liver, EXCEPT:
ask the patient to take a deep breath and hold it
use graded compression to displace bowel gas
give the patient cholecystokinin
give the patient water and rescan
give the patient cholecystokinin
Which of the following pancreatic abnormalities will cause an increase in insulin levels in the blood?
acute pancreatitis
pseudocyst
chronic pancreatitis
islet cell tumor
islet cell tumor
A patient presents for a pre-surgical evaluation of a known pancreatic mass. What is the most important information you need to document for the surgeon?
the number and location of abnormal lymph nodes in and around the porta hepatis
the volume of normal pancreatic tissue present
the volume of the pancreatic mass
if any vessels around the pancreas demonstrate tumor invasion
if any vessels around the pancreas demonstrate tumor invasion
Which of the following will cause an increase in alpha-fetoprotein values?
HCC
glycogen storage disease
adenoma
FNH
HCC
Anemia is a complication of cirrhosis due to associated abnormality of which of the following?
pancreas
kidney
aorta
esophagus
esophagus
Which of the following liver abnormalities can be related to the use of oral contraceptives?
hepatic adenoma and Budd Chiari
FNH and hepatic adenoma
hydatid disease and schistosomiasis
Budd Chiari and hydatid disease
hepatic adenoma and Budd Chiari
Applying compression using curvilinear transducer with a large footprint is the key method used to best evaluate:
neonatal hips
the body of the pancreas
a suspected thyroglossal duct cyst
the scrotal wall thickness
the body of the pancreas
What is the proper patient position and respiration for assessing the PV diameter?
LLD position with deep inspiration
RLD position with deep inspiration
supine with quiet respiration
supine with inspiration and Valsalva
supine with quiet respiration
Which liver function level is the most sensitive indicator for alcoholism?
GGTP
ALT
AFP
AST
GGTP
The most important structure to evaluate with a liver transplant is:
biliary anastomosis
HV
HA
PV
HA
What lab value would be at a normal level in this patient?
conjugated bilirubin
PT
ALP
unconjugated bilirubin
unconjugated bilirubin
What liver mass is associated with glycogen storage disease?
hamartoma
hepatoma
adenoma
lipoma
adenoma
Charcot triad is used to describe the classic clinical presentation of:
Hashimoto thyroiditis
acute cholangitis
pyloric stenosis
abdominal aortic aneurysm
acute cholangitis
AFP values will be increased with:
biliary obstruction
glycogen storage disease and Wilson disease
viral and alcoholic hepatitis
malignancy and pregnancy
malignancy and pregnancy
A female patient presents with 8 days of abdominal pain, fever, and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, ALP, and WBCs. These clinical findings are most suggestive of:
cholangitis
Klatskin tumor
primary GB carcinoma
pneumobilia
cholangitis
Jaundice is not a clinical symptom of:
fatty infiltration
ductal obstruction
hepatocellular disease
RBC destruction
fatty infiltration
Which of the following is required when performing liver elastography?
patient should perform a neutral breath hold for a few seconds when recording measurements
the region of interest box should be placed on the liver tissue within 2cm of the skin surface
patient should perform the Valsalva maneuver for a few seconds when recording measurements
the region of interest box should be placed on the liver tissue within 2cm of the diaphragm
patient should perform a neutral breath hold for a few seconds when recording measurements
A patient presents for an abdominal ultrasound due to loss of appetite, weight loss and epigastric pain. A hypoechoic mass is identified in the anterior aspect of the head of the pancreas. Which of the following best describes the next step in evaluating this patient?
review the patient chart to view the pancreatic enzyme levels related to acute pancreatitis
apply color Doppler to the area to determine if the hypoechoic area is a possible portal thrombosis
evaluate the surrounding areas for lymphadenopathy
evaluate the GB for stones
evaluate the surrounding areas for lymphadenopathy
A patient presents for an abdominal US to verify findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that do not communicate with the biliary tree or the vascular system. Which of the following best describes the expected US findings?
Caroli disease
Budd Chiari
choledochal cysts
polycystic disease
polycystic disease
What is the proper caliper placement for assessing the PV diameter?
outer wall to outer wall at the junction of the splenic vein and PV
inner wall to inner wall at the point the PV crosses the IVC
outer wall to outer wall at the point the PV crosses the IVC
inner wall to inner wall at the junction of the splenic vein and PV
inner wall to inner wall at the point the PV crosses the IVC
When scanning the pancreas, which of the following techniques will not assist in reducing the gas artifact around the pancreas?
NPO 8-12hrs prior to exam
water ingestion
deep inspiration
ask patient to perform the Valsalva maneuver
ask patient to perform the Valsalva maneuver
Which of the following is associated with hyperglycemia?
diabetes mellitus
islet cell tumor
hyperinsulinism
adenoma
diabetes mellitus
Which of the following serum levels would be unaffected by a benign obstruction of the biliary tree?
ALP
AFP
GGTP
conjugated bilirubin
AFP
Which of the following will help to differentiate HCC invasion of the PV from portal thrombosis on ultrasound examination?
measure the PV diameter on inspiration and expiration
measure the PV diameter on before and after a fatty meal
cannot differentiate thrombus from tumor in the PV by ultrasound, requires CT exam
apply power doppler to the PV
apply power doppler to the PV
Which of the following organs should be evaluated when looking for a tumor of the endocrine system?
pancreas and kidneys
salivary glands and adrenal glands
liver, spleen, and pancreas
pancreas and adrenal glands
pancreas and adrenal glands