ESP-Abdominal Sonography Flashcards
All of the following are associated with echinococcal cysts except:
a. cyst within a cyst presentation
b. Casoni skin test
c. ascites
d. anaphylactic shock
e. water lily sign
C
Humans also become infected by ingesting tapeworm eggs passed from an infected carnivore. This occurs when individuals handle infected carnivores (dogs) or ingest food contaminated with fecal matter containing tapeworm eggs. Sonographic appearance of “cyst within a cyst” or “water-lily sign”. Lab test = casoni skin test. Rupture or aspiration is associated with anaphylactic shock
Which fetal circulation pathway connects the left portal vein to the IVC?
a. ductus arteriosus
b. ligamentum teres
c. umbilical vein
d. ductus venosus
e. ligamentum venosum
D
Direction of fetal circulation = umbilical vein > left portal vein > ductus venosus (ligamentum teres) > IVC.
The ligamentum venosum is a remnant of the ductus venosus. It runs from the left portal vein to the inferior vena cava separating the left lobe from the caudate lobe of the liver.
The ligamentum venosum is all of the following except:
a. a remnant of the umbilical vein
b. a remnant of the ductus venosus
c. a remnant of the fetal circulation which shunts blood from the left portal vein to the IVC bypassing the liver
d. divides caudate lobe from left lobe of liver
A
The ligamentum venosum is a remnant of the ductus venosus. It runs from the left portal vein to the inferior vena cava separating the left lobe from the caudate lobe of the liver.
The caudate lobe is located on the:
a. anteroinferior surface of the liver
b. anterosuperior surface of the liver
c. posteroinferior surface of the liver
d. posterosuperior surface of the liver
D
What used to be referred to as the quadrate lobe is a misnomer and is the medial aspect of the left lobe of the liver. The caudate lobe lies on the posterior-superior surface of the liver between the IVC and the medial left lobe of the liver.
The ligamentum teres:
a. resides in the left intersegmental fissure
b. is a remnant of the umbilical vein
c. recannalizes in severe cirrhosis
d. is an echogenic spot on transverse liver images
e. all of the above
E
The ligamentum teres is a remnant of the umbilical vein which runs from the umbilicus to the left portal vein. Shortly after birth, the umbilical vein contracts down forming the ligamentum teres. With portal hypertension, the ligamentum teres recanalizes to form a portosystemic venous collateral.
Cystic lesions within the liver include all except:
a. congenital cysts
b. polycystic liver disease
c. Caroli’s disease
d. hemangiomas
D
A liver cyst is defined as a fluid-filled space lined by biliary epithelium. Liver cysts usually refer to nonparasitic simple cysts. Caroli’s disease: a congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts. Hemangiomas = most common benign liver tumor.
Which is in decreasing order of echogenicity?
a. pancreas > renal sinus > liver > renal parenchyma
b. renal sinus > pancreas > liver > renal parenchyma
c. renal sinus > renal parenchyma > pancreas > liver
d. pancreas > renal sinus > renal parenchyma > liver
B
Which part of the liver is least affected by Budd Chiari?
a. right anterior
b. right posterior
c. left medial
d. left lateral
e. caudate
E
A disorder characterized by hepatic vein obstruction. The caudate lobe is often spared because the emissary veins drain directly into the IVC. Thus, the caudate lobe enlarges with atrophy of the right and left lobes. IVC may be compressed by enlarging caudate lobe.
All of the following mass lesions are benign except:
a. hematoma
b. hamartoma
c. hepatic adenoma
d. hepatoma
e. hemangioma
D
Hematoma: liver hemorrhage, initially appears echogenic but over time as it resolves it will appear more cystic or complex.
Hamartoma: benign tumor
Hepatic adenoma: asymptomatic, rare benign liver tumor; often associated with use of oral contraceptives. Usually removed d/t propensity to turn cancerous. Variable appearance.
Hepatoma: mass associated with HCC.
Hemangioma: most common benign liver tumor; more common in women; asymptomatic; usually in right lobe and appear small and hyperechoic < 3cm.
A parasitic disease of the liver causing portal hypertension and occlusion of the portal veins is:
a. hydatid cyst
b. echinoccocal cyst
c. schistosomiasis
d. hepatic candidiasis
C
Schistosomiasis is one of the most common parasitic infections in humans. Major cause of portal hypertension worldwide. Usually found in tropical zones around the world. Eggs reach the liver through the portal vein, inciting a granulomatous reaction resulting in periportal fibrosis. The intrahepatic portal veins become occluded resulting in portal hypertension.
If on sonographic examination, one finds a patient with intrahepatic dilated ducts and a small gallbladder, this may indicate that the level of obstruction is:
a. at the proximal common bile duct
b. above the cystic duct
c. at the Ampulla of Vater
d. at the head of the pancreas
B
Obstruction at the junction of the right and left hepatic ducts. At this location only the intrahepatic ducts dilate. the gallbladder will be contracted.
Dilatation of the intrahepatic biliary tree without dilatation of the extrahepatic duct includes all of the following except:
a. Klatskin tumor
b. enlarged portal lymph nodes
c. cholangiocarcinoma
d. pancreatic carcinoma
D
Klatskin tumor: is a cholangiocarcinoma located at the hepatic hilum (junction of the right and left hepatic duct) resulting in intrahepatic but not extrahepatic biliary dilation.
Enlarged periportal lymph nodes: malignant infiltration and enlargement of periportal nodes occur in patients with cancers of the liver, gallbladder, biliary tree, and pancreas and lymphoma.
cholangiocarcinoma: typically originate within the extrahepatic bile ducts (CHD or CBD).
Pancreatic carcinoma: Courvoisier’s gallbladder, bile duct dilatation, dilated pancreatic duct, liver metastases, ascites, lymphadenopathy, pseudocyst formation.
A 48 year old female presents postcholecystectomy with RUQ pain, an elevated serum bilirubin (mainly conjugated), and bilirubin in her urine. It is true that:
a. she probably has hepatitis
b. she probably has a stone, tumor, or stricture obstructing the bile duct
c. the common duct will probably be less than 5 mm in diameter
d. alkaline phosphatase will be normal
B
Increased levels of alkaline phosphatase are expected with:
a. biliary obstruction
b. children
c. hepatocellular disease
d. pregnancy
e. all of the above
E
A Phrygian cap is:
a. an enlarged gallbladder
b. a fold at the gallbladder fundus
c. a fold in the gallbladder neck
d. a diverticula at the gallbladder neck
B
The causes of a large gallbladder include all of the following except:
a. adenomyomatosis
b. cystic duct obstruction
c. pancreatic carcinoma
d. diabetes mellitus
e. a fasting patient
f. common duct obstruction
A
Which of the following is associated with Caroli disease?
a. dilated intrahepatic bile ducts
b. dilated extrahepatic bile ducts
c. courvoisier gallbladder
d. diffuse thickening of the common duct
A
Thickening of the gallbladder wall is a common feature in:
a. hypoalbuminemia
b. cholecystitis
c. adenomyomatosis
d. carcinoma of the gallbladder
e. all of the above
E
Gallbladder wall thickening may be due to all of the following except:
a. ascites
b. hypoproteinemia
c. right-sided congestive cardiac failure
d. fatty liver
e. acute cholecystitis
D
Courvoisier’s sign is associated with all of the following except:
a. pancreatic carcinoma
b. dilated gallbladder
c. hepatocellular carcinoma
d. biliary duct dilatation
e. painless jaundice
C
Throughout its course, the splenic vein is located on the:
a. anterior surface of the pancreatic body and tail
b. anterior surface of the uncinate process
c. posterior surface of the pancreatic body and tail
d. superior surface of the pancreatic body and tail
C
The most common primary neoplasm of the pancreas is adenocarcinoma. This:
a. is usually found in the head of the pancreas
b. is accompanied by weight loss and painless jaundice
c. is accompanied by a dilated gallbladder
d. causes dilatation of the common bile duct
e. all of the above
E
The portion of the pancreas that lies posterior to the superior mesenteric artery and vein is the
a. head
b. uncinate process
c. body
d. tail
B
The pancreas is located in the:
a. lesser sac
b. greater sac
c. perirenal space
d. peritoneum
e. retroperitoneum
E
Occasionally, a pseudocyst may have internal echoes and be confused with an abscess. To distinguish the two, one should look for
a. calcifications
b. fluid in the lesser sac
c. gas
d. septations
C
Chronic pancreatitis may be associated with which of the following sonographic patterns?
a. increased echogenicity
b. decrease in pancreas size
c. calcifications
d. dilated pancreatic duct
e. all of the above
E
Islet cell tumors of the pancreas are most likely to be located:
a. in the head, never in the body or tail
b. frequently in the head, rarely in the body or tail
c. never in the head, frequently in the body or tail
d. rarely in the head, frequently in the body or tail
D
The gastroduodenal artery:
a. is the first branch of the common hepatic artery
b. proceeds caudally along the anterolateral margin of the pancreatic head
c. is seen in the transverse views directly anterior to the common bile duct
d. is the point where the common hepatic artery becomes the hepatic artery proper
e. all of the above
E
The common bile duct is joined with the pancreatic duct before entering the:
a. transverse portion of the duodenum
b. first portion of the duodenum
c. third portion of the duodenum
d. second portion of the duodenum
D
Which of the following is correct?
a. the lesser sac is located anterior and superior to the pancreas
b. the greater sac is within the retroperitoneum
c. the perirenal space is within the peritoneum
d. the lesser sac contains bowel
e. the lesser sac is within the retroperitoneum
A
Which of the following will displace the superior mesenteric artery anteriorly?
a. common bile duct stone
b. pancreatic head mass
c. left renal vein thrombosis
d. rectus sheath hematoma
C
What is the correct path of a red blood cell returning to the heart?
a. splenic vein, hepatic vein, sinusoids, portal vein, IVC, right atrium
b. superior mesenteric vein, portal vein, hepatic vein, sinusoids, IVC, right atrium
c. inferior mesenteric vein, portal vein, sinusoids, hepatic veins, IVC, right atrium
d. splenic vein, portal vein, right portal vein, emissary veins, IVC, right atrium
D
Which of the following are associated with splenomegaly?
a. polycythemia
b. lymphoma
c. portal vein thrombosis
d. schistosomiasis
e. all of the above
E
Which of the following diseases would result in splenic atrophy (autosplenectomy):
a. infectious mononucleosis
b. typhoid fever
c. splenitis
d. sickle-cell anemia
e. HIV
D
The congenital absence of the spleen is associated with:
a. biliary atresia
b. visceral heterotaxy
c. Turner’s syndrome
d. polysplenia
B
The most common cause of splenomegaly is:
a. congestive heart failure
b. lymphoma
c. sickle-cell anemia
d. portal hypertension
D
A wedge-shaped lesion within the spleen is associated with:
a. sickle-cell disease
b. lymphoma
c. splenic infarct
d. splenic artery aneurysm
e. leukemia
C
Which of the following is not associated with splenic trauma?
a. decreasing hematocrit
b. perisplenic fluid collection
c. subcapsular fluid collection
d. pelvic fluid collection
e. perinephric fluid collection
E
Which of the following is not a cause of splenomegaly?
a. lymphoma
b. portal hypertension
c. pancreatitis
d. mononucleosis
e. cirrhosis
C
What is the most common newborn abdominal mass associated with a decrease in hematocrit?
a. Wilm’s tumor
b. adrenal neuroblastoma
c. hepatoblastoma
d. ARPKD
e. adrenal hemorrhage
E
While performing an ultrasound examination, the sonographer finds that both kidneys measure 5 cm in length. They are very echogenic. All of the following are possible except:
a. chronic glomerulonephritis
b. chronic pyelonephritis
c. bilateral renal artery disease
d. renal vein thrombosis
D
A 3 year old boy presents with hematuria and a palpable left flank mass. Sonography depicts a solid renal mass. This finding would most likely represent:
a. hypernephroma
b. Wilm’s tumor
c. neuroblastoma
d. Infantile polycystic kidney disease
B
Which statement about the kidney is false?
a. the kidneys are mobile within the retroperitoneum
b. the kidneys consist of an internal medulla and external cortex
c. the kidneys rest on he psoas laterally and quadratus lumborum medially
d. renal pyramids are found within the medullary region
C
Anechoic masses that occur around a renal transplant include all of the following except:
a. urinoma
b. lymphocele
c. hematoma
d. corpus luteal cyst
e. Baker’s cyst
E
Which of the following represents the most commonly reported cause of a palpable abdominal mass in the newborn?
a. neuroblastoma
b. hydronephrosis
c. multicystic dysplastic kidney
d. Wilm’s tumor
e. hepatoblastoma
C
Ectopic ureterocele is associated with which complication?
a. upper pole hydronephrosis
b. stone formation
c. renal cell carcinoma
d. lower pole hydronephrosis
e. transitional cell carcinoma
A
Which organ is most likely to be affected in adult polycystic kidney disease?
a. ovary
b. pancreas
c. spleen
d. adrenal gland
e. liver
E
Bilateral echogenic kidneys in newborns most likely represent?
a. multicystic dysplastic kidneys
b. Wilm’s tumor
c. autosomal recessive polycystic kidney disease
d. autosomal dominant polycystic kidney disease
C
The most common cause of acute renal failure is:
a. renal vein thrombosis
b. renal artery thrombosis
c. acute tubular necrosis
d. acute glomerulonephritis
C
A hypernephroma is a solid renal mass. It is known as all of the following except:
a. von Grawitz tumor
b. renal cell carcinoma
c. adenocarcinoma of the kidney
d. transitional cell carcinoma
D
All of the following laboratory values may be elevated in renal failure except:
a. protein
b. creatinine
c. alkaline phosphatase
d. BUN
C
Elevated serum amylase may be secondary to all of the following except:
a. pancreatic duct obstruction
b. acute pancreatitis
c. liver disease
d. obstruction of the ampulla of vater
C
Which laboratory value is associated with prostate carcinoma?
a. alkaline phosphatase
b. PCK
c. acid phosphatase
d. BUN
C
Which one of the following laboratory values is elevated with liver metastases?
a. alkaline phosphatase
b. BUN
c. PSA
d. alpha-fetoprotein
D
Which laboratory value is the most sensitive indicator of hepatocellular disease?
a. conjugated bilirubin
b. lactic dehydrogenase
c. alanine aminotransferase (ALT)
d. aspartate aminotransferase (AST)
C
Which laboratory value is specific for obstructive jaundice?
a. direct bilirubin
b. SGOT
c. SGPT
d. indirect bilirubin
A
All of the following increase with hepatocellular disease except:
a. AST
b. SGOT
c. SGPT
d. PSA
e. ALT
D
Alkaline phosphatase increased without elevation of ALT may be seen in all of the following except:
a. Mirizzi syndrome
b. pancreatic carcinoma
c. acute hepatitis
d. choledocholithiasis
C
Choledocholithiasis may result in:
a. an increase in indirect bilirubin
b. an increase in direct bilirubin and a slight increase in indirect bilirubin
c. bilirubin is not elevated in choledocholithiasis
d. an increase in creatinine
B
Hemolytic disorders may result in:
a. a predominant increase in direct bilirubin
b. a predominant increase in indirect bilirubin
c. a normal total bilirubin
d. increased hemoglobin level
B
A patient presents with hypertension, urinary epinephrine and norepinephrine and an adrenal mass. Name the adrenal mass?
a. adenoma
b. Wilm’s tumor
c. myelolipoma
d. pheochromocytoma
D
What is the most common neonatal adrenal mass?
a. adenoma
b. neuroblastoma
c. pheochromocytoma
d. adrenal hemorrhage
e. myelolipoma
D
What is the most common childhood adrenal mass?
a. pheochromocytoma
b. Wilm’s tumor
c. neuroblastoma
d. adrenal hemorrhage
e. myelolipoma
C
What is the most common primary carcinoma associated with adrenal metastases?
a. colon
b. bone
c. ovarian
d. melanoma
e. lung
E