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Pancreas Flashcards

1
Q

what results in a shortened main pancreatic duct that works to drain only the pancreatic head and not the entire pancreas?

pancreatic divisum
annular pancreas
acute pancreatitis
zollinger-ellison syndrome

A

pancreatic divisum

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2
Q

all of the following are part of the exocrine function of the pancreas except for the production of:

lipase
glucagon
amylase
sodium bicarbonate

A

glucagon

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3
Q

what is another name for the accessory duct of the pancreas?

duct of santorini
duct of langerhans
duct of oddi
duct of wirsung

A

duct of santorini

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4
Q

which of the following results from the maldevelopment of the two embryologic events of the pancreas and consequent obstruction of the duodenum?

pancreatic divisum
annular pancreas
whipple syndrome
zollinger-ellison syndrome

A

annular pancreas

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5
Q

which is associated with development of cysts within the pancreas?

ARPKD
von hippel-lindau disease
zollinger-ellison syndrome
ERCP

A

von hippel-lindau disease

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6
Q

the most common form of malignancy of the pancreas is:

cystadenocarcinoma
islet cell tumors
cystadenoma
adenocarcinoma

A

adenocarcinoma

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7
Q

the Whipple procedure is performed on patients who have:

chronic pancreatitis
acute pancreatitis
pancreatic carcinoma
pancreatic transplants

A

pancreatic carcinoma

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8
Q

which is the enzyme released by the pancreas that neutralized stomach acid?

insulin
somatostatin
glycogen
sodium bicarbonate

A

sodium bicarbonate

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9
Q

the most common location of adenocarcinoma of the pancreas is within the:

head of the pancreas
neck of the pancreas
body of the pancreas
tail of the pancreas

A

head of the pancreas

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10
Q

which is a peripancreatic fluid collection that results from the inflammation of the pancreas?

pus
trypsin
phlegmon
chyme

A

phlegmon

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11
Q

the most common location of focal pancreatitis is within the:

head of the pancreas
neck of the pancreas
body of the pancreas
tail of the pancreas

A

head of the pancreas

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12
Q

all of the following are sonographic features of chronic pancreatitis EXCEPT:

dilated pancreatic duct
calcifications within the pancreas
pancreatic pseudocyst
diffusely hypoechoic pancreas

A

diffusely hypoechoic pancreas

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13
Q

which would be the least likely complication of a pancreatic transplant?

hematoma
biloma
ascites
urinoma

A

biloma

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14
Q

all of the following are classic clinical features of acute pancreatitis EXCEPT:

leukocytosis
back pain
weight gain
fever

A

weight gain

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15
Q

which lab value appears to be more specific for acute pancreatitis?

amylase
lipase
AST
serum glutamic oxaloacetic transaminase

A

lipase

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16
Q

which type of pancreatic transplantation is more common?

exocrine enteric drainage
exocrine bladder drainage
endocrine bladder drainage
endocrine enteric drainage

A

exocrine enteric drainage

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17
Q

one of the most common locations for a pancreatic pseudocyst is within the:

paracolic gutters
groin
spleen
lesser sac

A

lesser sac

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18
Q

which would be the least likely cause of acute pancreatitis?

alcohol abuse
hepatitis
trauma
gallstones

A

hepatitis

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19
Q

which is the most common islet cell tumor?

granulomas
garstrinoma
insulinoma
cystadenoma

A

insulinoma

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20
Q

which lab finding elevates first in the presence of acute pancreatitis?

amylase
ALP
ALT
lipase

A

amylase

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21
Q

courvoisier GB is found in the presence of:

hepatitis
cholecystitis and chronic pancreatitis
adenocarcinoma in the head of the pancreas
islet cell tumor in the tail of the pancreas

A

adenocarcinoma in the head of the pancreas

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22
Q

a gastrinoma of the pancreas can produce:

ARPKD
von hippel-lindau disease
zollinger-ellison syndrome
hyperinsulinoma

A

zollinger-ellison syndrome

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23
Q

the muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:

sphincter of vater
sphincter of oddi
ampulla of vater
ampulla of oddi

A

sphincter of oddi

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24
Q

what is the name of the main pancreatic duct?

duct of santorini
duct of langerhans
duct of oddi
duct of wirsung

A

duct of wirsung

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25
Q

all of the following are clinical findings associated with pancreatic adenocarcinoma EXCEPT:

epigastric pain
weight loss
jaundice
decrease amylase and lipase

A

decrease amylase and lipase

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26
Q

the portion of bowel that encompasses the head of the pancreas is the:

duodenum
jejunum
ileum
cecum

A

duodenum

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27
Q

which cells perform the exocrine function of the pancreas?

whipple cells
islets of langerhans
delta cells
acinar cells

A

acinar cells

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28
Q

the most common echogenicity of an acutely inflamed pancreas is

anechoic
hyperechoic
hypoechoic
calcified

A

hypoechoic

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29
Q

which would be the most likely vascular complication of acute pancreatitis?

thrombosis of the splenic vein
pseudoaneurysm of the SMA
thrombosis of the MPV
stenosis of the SMA

A

thrombosis of the splenic vein

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30
Q

the arterial blood supply to the head of the pancreas is via the:

SMA
splenic artery
gastroduodenal artery
hepatic artery

A

gastroduodenal artery

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31
Q

one clinical sign of insulinoma is the presence of:

hypoglycemia
elevated AFP
hepatitis
zollinger-ellison syndrome

A

hypoglycemia

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32
Q

what is the early sonographic appearance of acute pancreatitis?

calcifications within the gland
pancreatic pseudocyst
normal
hyperechoic glandular echotexture

A

normal

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33
Q

Within which part of the pancreas are mucinous cystadenocarcinomas most often located?

uncinate process and neck
head and neck
body and tail
fundus of neck

A

body and tail

34
Q

coexisting obstruction of the CBD and pancreatic duct may be referred to as the:

double barrel shotgun sign
courvoisier sign
mirizzi sign
double duct sign

A

double duct sign

35
Q

the pancreas is an:

intraperitoneal organ
retroperitoneal organ

A

retroperitonal organ

36
Q

which part of the pancreas is located right lateral to the SMV, anterior to IVC, and inferior to PV?

head
neck
body
tail

37
Q

what vascular structure outlines the pancreatic tail posteriorly?

SMA
IMV
portal confluence
splenic vein

A

splenic vein

38
Q

Which part of the pancreas is located anterior to the portal confluence?

uncinate process
pancreatic body
pancreatic neck
pancreatic tail

A

pancreatic neck

39
Q

which hormone is released by the pancreas that encourages the body’s use of glucagon?

insulin
somatosatin
glycogen
sodium bicarbonate

40
Q

what letter represents the uncinate process?

A
B
C
D
E

41
Q

which letter represents the pancreatic tail?

A
B
C
D
E

42
Q

which letter represents the pancreatic body?

A
B
C
D
E

43
Q

how should you align the probe on the body to obtain a long-axis view of the head and body of the pancreas?

obtain a midline oblique scan plane with the left side of the probe slightly cephalad compared to the right side of the probe

obtain a midline transverse scan plane with the left side of the probe slightly caudad compared to the right side of the probe

obtain an oblique scan plane to the right of midline, with the left side of the probe slightly cephalad compared to the right side of the probe

obtain a midline sagittal scan plane with the probe angled toward the patient’s right side

obtain a sagittal scan plane with the left side of the probe slightly cephalad compared to the right side of the probe

A

obtain a midline transverse scan plane with the left side of the probe slightly caudad compared to the right side of the probe

44
Q

what is the anatomic relationship of the CBD to the pancreas?

CBD is posterior to the head of the pancreas

CBD is anterior to the head of the pancreas

CBD is medial to the head of the pancreas

CBD is superior to the head of the pancreas

CBD is lateral to the tail of the pancreas

A

CBD is posterior to the head of the pancreas

45
Q

what structure can you use to identify the anterior aspect of the head of the pancreas?

CBD
CHD
gastroduodenal artery
splenic vein
LRV

A

gastroduodenal artery

46
Q

what structure can you use to identify the posterior aspect of the head of the pancreas?

CBD
CHD
gastroduodenal artery
splenic vein
LRV

47
Q

what structure can be seen coursing transversely at the level of the upper pancreatic head?

CBD
CHD
gastroduodenal artery
splenic vein
LRV

A

gastroduodenal artery

48
Q

A thin patient has been referred for ultrasound evaluation of the pancreas. Which transducer would be best for this exam?

2.25 MHz phased linear array
3.5 MHz curved linear array
5.0 MHz curved linear array
7.5 MHz small phased array
12 MHz linear array

A

5.0 MHz curved linear array

49
Q

You are performing an ultrasound exam on a patient with a history of repeated bouts of pancreatitis. What would you most likely use color doppler for in this study?

evaluate for increased flow in the pancreatic parenchyma

improve detectability of possible pseudoaneurysms

look for flow direction in the SMA

assess the quality of flow in the abdominal aorta

rule out thrombus in the IVC

A

improve detectability of possible pseudoaneurysms

50
Q

During insonation of the pancreas, you notice a prominent vessel just posterior to the pancreatic neck. What vessel are you imaging?

porta-splenic confluence
IMV
LRV
SMA
gastroduodenal artery

A

porta-splenic confluence

51
Q

which part of the pancreas is least commonly visualized by ultrasound?

head
neck
body
tail

52
Q

what frequency transducer would most commonly be used for endoscopic ultrasound of the pancreas?

2.25 MHz
3.5 MHz
5.0 MHz
10 MHz
25 MHz

53
Q

which of the following is a risk factor for the development of pancreatic cancer?

smoking
high fat diet
diabetes
chronic pancreatitis
all of the above

A

all of the above

54
Q

You are scanning a 52-year-old male with a history of alcohol abuse. Ultrasound findings include a hyperechoic mass in the head of the pancreas, dilatation of the pancreatic and common bile duct, and diffuse calcification within the pancreas. Which of the following conditions is most likely present?

acute pancreatitis
chronic pancreatitis
adenocarcinoma
cystadenocarcinoma
islet cell tumor

A

chronic pancreatitis

it can be difficult to differentiate between chronic pancreatitis and adenocarcinoma when chronic pancreatitis presents as a focal mass or a pseudocyst accompanies adenocarcinoma. the presence of calcification within the pancreas implicates chronic pancreatitis.

55
Q

which is the most accurate in staging pancreatic adenocarcinoma?

ABD ultrasound
endoscopic ultrasound
CT
MRI
plain film x-ray

56
Q

A patient has been referred to ultrasound to rule out the presence of pancreatic cancer. The cancer is most likely to be located in which part of the pancreas?

head
neck
uncinate process
body
tail

57
Q

what is the most common ultrasound appearance of pancreatic adenocarcinoma?

hyperechoic mass
hypoechoic mass
cystic mass
calcified mass
complex mass with both cystic and solid components

A

hypoechoic mass

58
Q

You are requested to perform an ultrasound on a patient to evaluate for complications of pancreatitis. What should you look for?

pseudoaneurysm
pseudocyst
phlegmon
abscess
all of the above

A

all of the above

59
Q

You have just discovered a pancreatic mass suspicious for adenocarcinoma in a patient with weight loss and abdominal pain. What associated findings should you look for?

A. lymphadenopathy
B. liver metastasis
C PV aneurysm
D. aortic aneurysm
A and B

60
Q

You are scanning a patient with increased pancreatic enzymes and WBC count. Which condition is most commonly associated with these lab findings?

acute pancreatitis
chronic pancreatitis
adenocarcinoma of the pancreas
islet cell tumor
metastasis to the pancreas

A

acute pancreatitis

61
Q

You are scanning a patient with a history of alcohol abuse and liver cirrhosis. The pancreatic tissue is heterogenous. Calcifications and dilation of the pancreatic duct is present. Which condition is most likely considering this history and findings?

acute pancreatitis
chronic pancreatitis
adenocarcinoma of the pancreas
islet cell tumor
metastasis to the pancreas

A

chronic pancreatitis

62
Q

You have been asked to perform an ultrasound study on a patient with a pancreatic transplant. What chronic condition does this patient probably have?

crohn’s disease
chronic pancreatitis
lymphoma
type I diabetes mellitus
lupus

A

type I diabetes mellitus

63
Q

where should you look for a pancreas on a patient with a pancreatic transplant?

pouch of douglas
morison’s pouch
LUQ
iliac fossa
epigatrium

A

iliac fossa

64
Q

Which would be an indicator of pancreatic transplant rejection?

A. high resistance doppler signals
B. low resistance doppler signals
C. heterogenous parenchyma
A and C
B and C

65
Q

a noncapsulated collection of necrotic and edematous peripancreatic tissues is termed:

phlegmon
pseudocyst
pseudoaneurysm
ascites
cystadenoma

66
Q

what is the most common cause of acute pancreatitis?

obstruction of the pancreatic duct by biliary calculi

pancreatic divisum

alcohol abuse

trauma

crohn’s disease

A

obstruction of the pancreatic duct by biliary calculi

67
Q

Surgery has requested ultrasound guidance to expose an insulinoma. What transducer would be best for this application?

2.25 MHz curved array
3.5 MHz curved array
5.0 MHz curved array
7.0 MHz curved array
10 MHz linear array

A

10 MHz linear array

68
Q

You have documented the presence of a pseudocyst adjacent to the pancreatic head in a 56 year old male. Pseudocysts may be associated with which of the following?

acute pancreatitis
chronic pancreatitis
pancreatic cancer
A and B only
all of the above

A

all of the above

69
Q

what is the relationship of the SMA to the pancreas?

posterior to the tail
posterior to the neck
superior to the body
cephalad to the head
lateral to the tail

A

posterior to the neck

70
Q

what is the ultrasound appearance of a pancreatic pseudocyst?

cyst without internal echoes
cyst with low level echoes
cyst with internal separations
well defined wall
all of the above

A

all of the above

71
Q

You are performing an ultrasound on an obese patient and notice a small, hypoechoic tumor located in the tail of the pancreas. This most likely represents:

adenocarcinoma
cystadenocarcinoma
insulinoma
klatskin tumor
pancreatoblastoma

A

insulinoma

72
Q

which vessel is located at the superior border of the pancreas?

SMA
celiac trunk
LRV
RRA
IMA

A

celiac trunk

73
Q

when imaging the pancreas, which vessel do you routinely image that courses anterior to the uncinate process?

IMV
SMV
gastroduodenal artery
LRV
splenic artery

74
Q

when imaging the pancreas, which vessel do you routinely visualize at the posterior border of the pancreatic head?

abdominal AO
RRA
SMA
SMV
IVC

75
Q

You have obtained a SAG image of the pancreatic head and detect a small, tubular structure coursing cephalocaudad anterior to the pancreas. What is this structure?

CBD
SMA
CHA
gastroduodenal artery
left gastric artery

A

gastroduodenal artery

76
Q

what structure is labeled E?

SMA
gastroduodenal artery
CBD
CHD
left gastric artery

77
Q

what part of the pancreas is anterior to the vessel labeled E?

head
uncinate process
neck
body
tail

78
Q

what vessel is seen posterior to the vessel labeled D?

IVC
abdominal AO
RRA
IMV
splenic vein

A

abdominal AO

79
Q

what part of the pancreas is NOT demonstrated in this image?

head
neck
body
tail
A and B

80
Q

which part of the pancreas generally has the largest dimensions?

head
neck
body
tail
uncinate process

81
Q

what is the normal echogenicity of the normal pancreas?

either isoechoic or hyperechoic compared to the liver

always hypoechoic compared to the liver

always hyperechoic compared to the liver

always isoechoic compared to the liver

pancreatic echogenicity should never be compared to the liver

A

either isoechoic or hyperechoic compared to the liver

82
Q

the tail of the pancreas is in contact with which of the following structures?

A. left kidney
B. splenic flexure of the colon
C. spleen
A and C only
all of the above

A

all of the above

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