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Chapter 9 Vascular > Test ch 11 Gallbladder and Biliary System > Flashcards

Test ch 11 Gallbladder and Biliary System Flashcards

1
Q
  1. In cases of choledocholithiasis, stones tend to lodge in the:
    a. Pancreatic duct
    b. Common bile duct
    c. Ampulla of Vater
    d. Common hepatic duct
A

ANS: C

In cases of choledocholithiasis, stones tend to lodge in the ampulla of Vater and may project into the duodenum.

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2
Q

The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the:

a. Common hepatic duct
b. Cystic duct
c. Common bile duct

A

ANS: A

The right and left hepatic ducts unite to form the common hepatic duct, which then passes caudally and medially.

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3
Q

The diameter of the common hepatic duct is approximately ________ millimeters (mm).

a. 2
b. 3
c. 4
d. 5

A

ANS: C

The common hepatic duct is approximately 4 mm in diameter and descends within the edge of the omentum.

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4
Q

The hepatic duct is joined by the ___________ to form the ___________ .

a. Pancreatic duct; cystic duct
b. Cystic duct; common bile duct
c. Common bile duct; cystic duct
d. Right hepatic duct; common bile duct

A

ANS: C

The common hepatic duct is joined by the cystic duct to form the common bile duct.

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5
Q

In a 60-year-old adult, the normal common bile duct should not measure more than _____ mm.

a. 5
b. 6
c. 8
d. 10

A

ANS: B

The normal common bile duct has a diameter of up to 6 mm

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6
Q

The distal duct lies ___________ with the anterior wall of the inferior vena cava (IVC).

a. Parallel
b. Perpendicular
c. Lateral
d. Horizontal

A

ANS: A

The distal common bile duct lies parallel with the anterior wall of the IVC

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7
Q

The cystic duct connects the ___________ of the gallbladder with the common hepatic duct to form the ___________.

a. Fundus; common hepatic duct (CHD)
b. Fundus; common bile duct (CBD)
c. Neck; CBD
d. Body; CHD

A

ANS: C

The cystic duct is about 4 cm long and connects the neck of the gallbladder with the CHD to form the CBD.

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8
Q

A Phrygian cap of the gallbladder is:

a. Partial septation
b. Calcification of the gallbladder wall
c. Septations within the organ
d. Folding of the fundus

A

ANS: D

The folding of the gallbladder fundus is termed a Phrygian cap.

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9
Q

Which one of the following is a function of the gallbladder?

a. Storage for extra cholesterol
b. Storage for enzymes
c. Reservoir for bile
d. Reservoir for biliary salts

A

C

The gallbladder serves as a reservoir for bile, which is drained from the hepatic ducts in the liver.

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10
Q

. A gallbladder that folds near the area of the neck is called:

a. Murphy pouch
b. Phyrgian cap
c. Hartmann pouch
d. Murphy sign

A

ANS: C

The gallbladder may fold on itself at the neck, forming a Hartmann pouch

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11
Q

The bright linear echo within the liver connecting the gallbladder and the right or main portal vein is called the:

a. Right lobar fissure
b. Main lobar fissure
c. Ligamentum teres
d. Left lobar fissure

A

ANS: B
The main lobar fissure is a sonographic landmark leading to the gallbladder fossa. It is a bright linear echo connecting the right portal vein to the neck of the gallbladder.

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12
Q

Gas-forming bacteria in the gallbladder appear on ultrasound as:

a. Dilated round shape
b. Nonshadowing echogenic mass
c. Localized dilation
d. Bright echo with a comet tail artifact

A

ANS: D
Emphysematous cholecystitis is gas-forming bacteria in the gallbladder, which appear on ultrasound as a bright echo in the area of the gallbladder with a ring down or comet tail artifact.

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13
Q

A positive Murphy sign is a clinical finding associated with:

a. Cholelithiasis
b. Cholecystitis
c. Porcelain gallbladder
d. Adenomyomatosis

A

ANS: B
A presenting sign of cholecystitis is acute right-upper quadrant pain upon palpation of the gallbladder (positive Murphy sign).

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14
Q

. Classic symptoms of gallbladder disease include all of the following except:

a. Hematuria
b. Right upper quadrant pain
c. Right shoulder pain
d. Nausea and vomiting

A

ANS: A
The most common symptom of gallbladder disease is right upper quadrant pain, usually after ingesting a fatty meal. Other symptoms include nausea and vomiting, right shoulder blade pain, and epigastric pain.

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15
Q

Thickening of the gallbladder wall may be caused by all of the following except:

a. Hepatitis
b. Pancreatitis
c. Adenomyomatosis
d. Cholecystitis

A

ANS: B
A thickening of the gallbladder wall may be caused by cholecystitis, acquired immunodeficiency syndrome, cholangiopathy, sclerosing cholangitis, ascites, right heart failure, renal failure, severe hypoalbuminemia states, and nonfasting state

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16
Q

Which one of the following describes the most common sonographic appearance of gallbladder carcinoma?

a. “Comet tail” shadowing posterior to a hypoechoic focus
b. Irregular echogenic mass projecting from the gallbladder wall
c. Shadowing posterior to mobile echogenic mass
d. Comet tail shadowing posterior to a hyperechoic focus

A

B
The sonographic appearance of gallbladder carcinoma is described as a heterogeneous, solid, immobile mass projecting into the gallbladder from a thickened gallbladder wall.

17
Q

The common bile duct is joined by the main pancreatic duct. Together they open through the _____ into the duodenal wall.

a. Ampulla of Oddi
b. Ampulla of Water
c. Ampulla of Vater
d. Ampulla of Santorini

A

ANS: C
The pancreatic duct (Wirsung duct) and the common bile duct join and enter through the ampulla of Vater into the duodenum.

18
Q

A fusiform dilation of the common bile duct that causes obstruction is known as:

a. Choledochal cyst
b. Adenomyomatosis
c. Cholangitis
d. Phrygian cap

A

ANS: A
Choledochal cysts are classified as one of the following: (1) localized cystic dilation of the common bile duct; (2) diverticulum from the common bile duct; (3) dilation of the entire common bile duct and common hepatic duct. ; and (4) invagination of common bile duct into the duodenum.

19
Q

. Inflammation of the gallbladder is:

a. Cholecystitis
b. Choledocholithiasis
c. Cholesterosis
d. Adenomyomatosis

A

ANS: A
Cholecystitis is the inflammation of the gallbladder that may have several forms—acute or chronic, acalculous, emphysematous, or gangrenous.

20
Q

. A condition causing RUQ pain in which small polypoid masses arise from the gallbladder wall is:

a. Choledocholithiasis
b. Cholesterosis
c. Adenomyomatosis
d. Pruritus

A

ANS: C
An immobile echogenic focus (i) protruding from the gallbladder wall demonstrating a “comet tail” posterior shadow describes adenomyomatosis

21
Q

The sonographic appearance of cholelithiasis is best described as:

a. Nonshadowing mobile hyperechoic focus
b. Mobile, hyperechoic focus demonstrating posterior shadowing
c. Immobile, echogenic focus demonstrating a comet tail artifact
d. Mobile, hypoechoic focus demonstrating posterior shadowing.

A

ANS: B
A gallstone generally appears as mobile hyperechoic intraluminal focus (i) demonstrating posterior acoustic shadowing. Gallstones are typically mobile.

22
Q

The most common cause of biliary ductal obstruction is the presence of a ductal:

a. Cyst
b. Tumor
c. Stone
d. Stricture

A

ANS: B

The most common cause of biliary ductal obstruction is the presence of a ductal tumor or thrombus in the ductal system

23
Q

A thick calcified gallbladder wall describes which one of the following conditions?

a. Wall-echo-shadow (WES) sign
b. Gangrenous gallbladder
c. Porcelain gallbladder
d. Emphysematous gallbladder

A

ANS: C
A porcelain gallbladder is associated with gallstones and demonstrates a thick hyperechoic (calcified) gallbladder wall with posterior acoustic shadowing. WES sign demonstrates a gallbladder wall and then a hyperechoic focus with posterior shadowing.

24
Q

Which one of the following is most characteristic of nonshadowing, low-amplitude echoes in a dependent gallbladder?

a. Cholelithiasis
b. Porcelain gallbladder
c. Cholecystitis
d. Sludge

A

ANS: D

Sludge is described as low-level internal echoes that are gravity dependent.

25
Q

The valves of Heister are tiny valves found with the:

a. Cystic duct
b. Common bile duct
c. Pancreatic duct
d. Common hepatic duct

A

ANS: A

The valves of Heister are tiny valves located within the cystic duct.

26
Q

. All of the following sonographic appearances are found in cases of gallbladder carcinoma except:

a. Sludge
b. Wall thickening
c. Cholelithiasis
d. Intraluminal wall mass

A

ANS: A
Sonographic findings in cases of gallbladder carcinoma generally demonstrate a thickening of the gallbladder wall with a global-shaped heterogeneous mass projecting into the lumen of the gallbladder. Between 80% and 90% of patients have associated gallstones

27
Q

The physiologic effect of a fatty meal includes all of the following except:

a. Stimulation of cholecystokinin (CCK)
b. Contraction of the gallbladder
c. Decrease bile flow to the liver
d. Relaxation of the sphincter of Oddi

A

ANS: C
After a fatty meal, CCK stimulation causes the contraction of the gallbladder; the sphincter of Oddi relaxes with the outpouring of bile into the duodenum.

28
Q

Patients positive for the AIDS are at risk for developing:

a. Hepatitis
b. Cholangitis
c. Pancreatitis
d. Nephritis

A

ANS: B

AIDS patients are at risk for developing cholangitis.

29
Q

Air within the biliary tree, secondary to common bile duct stents, is called:

a. Pneumobilia
b. Hemobilia
c. Pneumothorax
d. Cholangitis

A

ANS: A
Pneumobilia is air within the biliary tree, secondary to biliary intervention, biliary-enteric anastamoses, or common bile duct stents

30
Q

The most common tumor sites that can spread carcinoma to the biliary tree include all of the following except the:

a. Colon
b. Breast
c. Melanoma
d. Kidney

A

ANS: D

Metastatic carcinoma in the gallbladder occurs secondary to melanoma, colon, or breast carcinoma

Chapter 9 Vascular (16 decks)

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