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
A low albumin/globulin ratio usually indicates:
cirrhosis
impacted stone at the GB neck
partial obstruction of the ampulla of Vater
pancreatitis
cirrhosis
While scanning the liver, you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. The CBD measures 5mm in diameter and the GB appears normal. The liver demonstrates mild fatty infiltration and the pancreas and kidneys appear within normal limits. Which of the following correctly describes the lab findings that correlate with these findings?
increased LFTs, normal direct bilirubin
increased LFTs, increased bilirubin
increased direct bilirubin, normal LFTs
increased indirect bilirubin, increased LFTs
increased LFTs, normal direct bilirubin
All of the following are reasons for a patient to be NPO prior to an abdominal ultrasound EXCEPT:
allow GB to fill with bile for better visualization
decrease peristalsis in GI tract
decrease blood sugar for better pancreas visualization
decrease gas in GI tract
decrease blood sugar for better pancreas visualization
Which of the following is a contraindication for a liver transplant in a patient with HCC?
more than 1 HCC tumor
a single primary tumor >5cm
more than 2 HCC tumors
the presence of a tumor in the caudate lobe
contraindications include:
a single primary tumor >5cm
more than 3 HCC tumors
metastatic disease
Which of the following describes a technique that can be used to locate a collapsed GB in a patient with chronic cholecystitis?
locate the RPV and the MLF, trace the fissure to the GB neck
have the patient perform the valsalva maneuver to force bile into the GB for improved visualization
locate the umbilical vein and trace it to the Lig Teres to locate the GB neck just medial to the prox ligamentum
use color Doppler to identify the associated hypervascularity seen with wall inflammation
locate the RPV and the MLF, trace the fissure to the GB neck
Several simple cysts are identified in the liver of a 38 year old male patient. What structures in the abdomen should also be evaluated for related findings?
kidneys and thyroid
abdominal AO and renal arteries
kidneys and pancreas
kidneys, pancreas, and ovaries
kidneys and pancreas
Which of the following ultrasound exams requires the patient to be NPO for accurate results?
RUQ ultrasound for possible hematoma
abdominal ultrasound for possible rectus sheath hematoma
RUQ ultrasound for possible cholecystitis
abdominal ultrasound for possible Crohn disease
RUQ ultrasound for possible cholecystitis
Acetic acid injection, ethanol injection, and radiofrequency ablation are techniques used to treat?
varicosities
polycystic liver disease
HCC
PHTN
HCC
All of the following correctly describe AFP, EXCEPT:
liver metastasis causes the most significant increase in AFP levels
normally only trace amounts are identified in adults
increased levels are associated with liver cancer in adults and children
it is substance produced by the fetal liver and yolk sac
the most significant increase in AFP levels is seen with HCC NOT LIVER METASTASIS
A 60 year old male presents for an abdominal ultrasound for recurrent epigastric pain. The patient tells you this is the 4th time he has been hospitalized for pancreatitis and the medications are just not working. What is the expected appearance of his pancreas on ultrasound?
increased size with decreased echogenicity
enlarged and edematous with a hyperechoic appearance
atrophied with calcifications in the parenchyma
atrophied with multiple cysts and calcifications consuming the parenchyma
atrophied with calcifications in the parenchyma
All of the following signs/symptoms are associated with the pathology demonstrated, EXCEPT
Murphy sign
increased WBC
Homan sign
fever
Homan sign - when the foot is quickly dorsiflexed and causes calf pain
What is an absolute contraindication for ethanol ablation of a liver nodule?
nodule location in the central liver
patient allergic to injectate
nodule location in the periphery of the liver
diabetes mellitus
patient allergic to injectate
Which of the following will cause a moderate increased in AFP values in an adult?
adenoma
glycogen storage disease
HCC
hepatoblastoma
HCC
Which probe position is used to demonstrate all three HVs entering the IVC?
oblique subcostal approach angled superior toward the right shoulder
sagittal subcostal position just to the left of midline
oblique intercostal approach superior toward the left shoulder
sagittal subcostal position just to the right of midline
oblique subcostal approach angled superior toward the right shoulder
In case of acute pancreatitis, which enzyme level increases first?
trypsin
amylase
ALP
lipase
amylase
The primary indication for a liver transplant in an adult is ___ and in children ___ is the most common indication.
cirrhosis, Hep C
cirrhosis, biliary atresia
Hep C, cirrhosis
biliary atresia, Hep C
cirrhosis, biliary atresia
ALP is normally produced by all of the following, EXCEPT:
placenta
liver tissue
growing bones
pancreas tissue
pancreas tissue
ALP is found in the liver, bones, and placenta
Which of the following can be found on urinalysis of a patient with choledocholithiasis?
AFP
ALP
unconjugated bilirubin
conjugated bilirubin
conjugated bilirubin
Alcoholic fatty liver disease demonstrates what difference in lab values from nonalcoholic causes?
alcoholic fatty liver disease demonstrates a much greater increase in LFT levels with an AST/ALT ratio >2
alcoholic fatty liver disease demonstrates a much smaller increase in LFT levels with an AST/ALT ratio < 1
alcoholic fatty liver disease has no effect on the AST level, but the ALT level is markedly increased
alcoholic fatty liver disease demonstrates much greater increase in AFP levels
alcoholic fatty liver disease demonstrates a much greater increase in LFT levels with an AST/ALT ratio >2
Elevated GGTP and ALP indicates ___.
Elevated GGTP and ALT indicates ___.
hepatocellular disease, biliary obstruction
hepatic carcinoma, hepatic adenoma
biliary obstruction, hepatocellular disease
cirrhosis, hepatitis
GGTP + ALP = biliary obstruction
GGTP + ALT = hepatocellular disease
Which of the following lab values will increase with mucinous cystadenocarcinoma of the pancreas?
alanine aminotransferase
hematocrit
carcinoembryonic antigen
AFP
carcinoembryonic antigen
Which of the following is the most likely cause for an increase in AFP levels in a 7 month old boy?
hepatoblastoma
neuroblastoma
pheochromocytoma
nephroblastoma
hepatoblastoma
A 56 year old male presents with a 4 year history of cirrhosis. When performing the ultrasound exam on this patient, the size of which the following structures should be assessed to evaluate the effects of cirrhosis?
PV, HV, and HA
caudate lobe and HA
left lobe and caudate lobe
right lobe, PV, and caudate lobe
right lobe, PV, and caudate lobe
A patient presents for an abdominal ultrasound due to abdominal pain and bloating. The script for their exam read “ R/O cholangiocarcinoma.” What structure should you closely evaluate to answer the question?
gallbladder
biliary tree
spleen
adrenals
biliary tree
A patient presents for an abdominal sonogram due to a history of esophageal varices. What structure(s) should be closely evaluated for related findings?
pylorus
splenic artery
renal arteries
portal system
portal system
What lab values would be elevated in this patient?
albumin and AFP
ALP and PT
unconjugated bilirubin and PT
GGTP and creatinine
ALP and PT
ALP, GGTP, PT and conjugated bilirubin and increased with extrahepatic ductal obstruction
A patient presents for an abdominal ultrasound with an order that states “R/O pancreatic endocrine tumor.” Which of the following pancreatic tumors can be described as an endocrine tumor?
cystadenocarcinoma
oncocytoma
pseudocyst
gastrinoma
gastrinoma
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 mass marked with #3?
right anterior superior segment
right posterior superior segment
caudate lobe
left medial superior segment
left medial superior segment
Which of the following blood tests will aid in diagnosis of a hydatid cyst in the liver?
albumin/protein ratio and aldosterone assay
ratio of conjugated bilirubin to unconjugated bilirubin
indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA)
serum lipase and amylase
indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA)
Casoni test (similar to PPD test) can also be administered to assess for hydatid disease
Which of the following will typically demonstrate normal values on liver function tests?
adenoma
fatty liver
HCC
hepatoblastoma
adenoma
A patient’s chart indicates they have a history of cavernous transformation. Where does this abnormality form?
pancreatic tail
porta hepatis
Morrison pouch
gallbladder fossa
porta hepatis
Which of the following is not an expected clinical symptom of an abscess?
leukocytosis
fever
pain
anemia
anemia
A patient presents with mildly increased levels of ALT and significantly increased levels of AST. Which of the following is an expected finding on the ultrasound exam?
cirrhosis
Mirizzi syndrome
acute viral hepatitis
choledocholithiasis
cirrhosis
Which of the following pancreatic abnormalities are associated with an increase in amylase and lipase levels in the blood?
chronic pancreatitis and pseudocyst
pseudocyst and adenoma
pseudocyst, acute and chronic pancreatitis
acute pancreatitis and pseudocyst
acute pancreatitis and pseudocyst
Which of the following statements correctly describes the findings on the image?
the calipers are improperly placed inside the vessel walls and should be repositioned to measure the distance from outer wall to outer wall for an accurate measurement
the PV is measured at the incorrect location along the course of the vessel, which causes the false appearance of enlargement
the PV is measured correctly and demonstrates normal portal venous anatomy
the PV is measured correctly and demonstrates possible PHTN
the PV is measured correctly and demonstrates possible PHTN
What lab value increases with gallbladder cancer, cholecystitis or prolonged biliary obstruction?
AFP
CA-125
LDH
PT
PT
What type of hepatic abscess causes a fever and leukopenia?
fungal
amebic
pyogenic
echinococcal
fungal
Which line indicates the correct AP measurement of the liver cyst?
green
purple
orange
blue
orange
Increased serum level of __ usually provide the first indication of an extrahepatic biliary obstruction.
indirect bilirubin
ALP
aldosterone
direct bilirubin
ALP
A patient presents for an abdominal US exam with a history of a recent single episode of significant indigestion. The lab results demonstrate increased levels of AST and normal levels or ALT, ALP and bilirubin. These clinical findings are most consistent with:
chronic Hep C
myocardial infarction
schistosomiasis
biliary stasis with a partial ductal obstruction due to Klatskin tumor
myocardial infarction
( increase AST with normal ALT )
Which of the following will cause an increase in AFP values in pediatric patients?
FNH
glycogen storage disease
polycystic liver disease
hepatoblastoma
hepatoblastoma
Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in patient with a liver transplant?
S/D ratio
PSV
pulsatility index
resistive index
resistive index
Which line indicates the correct length measurement of the liver cyst?
orange
green
blue
purple
blue
What lab test is used to evaluate the exocrine function of a pancreas transplant?
hematocrit levels
glomerular filtration rate
amylase levels
glucose levels
amylase levels
ALT levels are:
decreased with hepatitis, cirrhosis, liver tumors, biliary obstruction and Reye syndrome
the most sensitive indicator for alcoholism
used to evaluate the degree of jaundice and monitor hepatitis and cirrhosis
the primary indicator for HCC
used to evaluate the degree of jaundice and monitor hepatitis and cirrhosis
Which of the following will lead to increased levels of indirect bilirubin in the blood?
pancreatic adenocarcinoma
fatty liver
cirrhosis
cholangitis
cirrhosis
serum amylase will be increased with all of the following, EXCEPT:
parathyroid adenoma
tumor of the submandibular gland
acute pancreatitis
use of oral contraceptives
parathyroid adenoma
Sulfur colloid imaging is:
used to evaluate autosomal polycystic liver disease
used to evaluate suspected FNH
a type of contrast used in MR imaging
a type of contrast used in CT imaging
used to evaluate suspected FNH
A 28 year old male presents for an abdominal ultrasound exam. The chart states he has elevated urine copper levels and Kayser-Fleischer rings noted on physical exam. What organ should be closely evaluated for findings related to the clinical findings?
kidneys
liver
gallbladder
bladder
liver
What lab values will be monitored in patients undergoing treatment for primary liver cancer?
ALT
ALP
AFP
bilirubin
AFP
Which of the following lab values would be elevated with biliary obstruction due to a HCC, but not with a biliary obstruction due to choledocholithiasis?
GGTP
conjugated bilirubin
AFP
ALP
AFP
Before performing a liver transplant evaluation, the Sonographer must review the surgical history to determine:
if the transplant was full or partial
the location of all sites of vascular anastomosis
if the transplant has a piggyback or interposition anastomosis
more than one of the above
more than one of the above
Dark urine and pale stool are indications of:
RCC
hyperbilirubinemia
diverticulitis
ulcerative colitis
hyperbilirubinemia
A patient presents for a RUQ ultrasound due to a positive Casoni skin test. What are you looking for on the exam?
cirrhosis
schistosomiasis
metastasis in the liver
hydatid cyst
hydatid cyst
Which of the following liver disorders will result in increased levels of iron stored in the liver?
glycogen storage disease
hemochromatosis
Wilson disease
amyloid disease
hemochromatosis
This image is the first sagittal image of an abdominal US exam you are performing. What should you be sure to do during the rest of the exam for this patient?
evaluate the abdomen for fluid collections and/or active bleeding
evaluate the organs for parasitic infection
evaluate the organs for carcinoma
evaluate the AO for thrombus accumulation and source of embolus
evaluate the organs for carcinoma
portal lymphadenopathy is present
Which of the following correctly describes the method used to measure the wall thickness of the gallbladder?
with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the posterior wall
with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the anterior wall
with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall
with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the posterior wall
with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall
Steatorrhea is a clinical finding with:
hyperparathyroidism or parathyroid adenoma
aortic or splenic aneurysms
splenic or hepatic hemartomas
pancreatitis or celiac disease
steatorrhea ( excess fecal fat ) is seen with pancreatitis or celiac disease
What lab test is used to evaluate the endocrine function of a pancreas transplant?
amylase
hematocrit
glucose
anodal trypsinogen
glucose
A 55 year old male presents with a history of Budd-Chiari syndrome. What vessels should be evaluated with Doppler on this exam?
HVs
HAs
AO
RVs
HVs
___ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood.
acute hepatitis
Budd Chiari
Kaposi sarcoma
anemia
anemia
A patient is referred for an abdominal ultrasound due to an abnormal CT scan. The report is not available yet but the study is in the PACS system. Based on this single CT image, where will you scan to evaluate an abnormality identified on the CT exam?
anterolateral left kidney
right renal hilum
anterolateral right kidney
right lower quadrant
anterolateral right kidney
The liver measurement normally used to assess liver size is:
measured from the TRV view at the midclavicular plane
the medial to lateral dimension
the superior inferior dimension
overall volume 9 L x W x H x 0.5 )
the superior inferior dimension
